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Boldrini L, D'Aviero A, De Felice F, Desideri I, Grassi R, Greco C, Iorio GC, Nardone V, Piras A, Salvestrini V. Artificial intelligence applied to image-guided radiation therapy (IGRT): a systematic review by the Young Group of the Italian Association of Radiotherapy and Clinical Oncology (yAIRO). LA RADIOLOGIA MEDICA 2024; 129:133-151. [PMID: 37740838 DOI: 10.1007/s11547-023-01708-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/16/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION The advent of image-guided radiation therapy (IGRT) has recently changed the workflow of radiation treatments by ensuring highly collimated treatments. Artificial intelligence (AI) and radiomics are tools that have shown promising results for diagnosis, treatment optimization and outcome prediction. This review aims to assess the impact of AI and radiomics on modern IGRT modalities in RT. METHODS A PubMed/MEDLINE and Embase systematic review was conducted to investigate the impact of radiomics and AI to modern IGRT modalities. The search strategy was "Radiomics" AND "Cone Beam Computed Tomography"; "Radiomics" AND "Magnetic Resonance guided Radiotherapy"; "Radiomics" AND "on board Magnetic Resonance Radiotherapy"; "Artificial Intelligence" AND "Cone Beam Computed Tomography"; "Artificial Intelligence" AND "Magnetic Resonance guided Radiotherapy"; "Artificial Intelligence" AND "on board Magnetic Resonance Radiotherapy" and only original articles up to 01.11.2022 were considered. RESULTS A total of 402 studies were obtained using the previously mentioned search strategy on PubMed and Embase. The analysis was performed on a total of 84 papers obtained following the complete selection process. Radiomics application to IGRT was analyzed in 23 papers, while a total 61 papers were focused on the impact of AI on IGRT techniques. DISCUSSION AI and radiomics seem to significantly impact IGRT in all the phases of RT workflow, even if the evidence in the literature is based on retrospective data. Further studies are needed to confirm these tools' potential and provide a stronger correlation with clinical outcomes and gold-standard treatment strategies.
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Affiliation(s)
- Luca Boldrini
- UOC Radioterapia Oncologica, Fondazione Policlinico Universitario IRCCS "A. Gemelli", Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andrea D'Aviero
- Radiation Oncology, Mater Olbia Hospital, Olbia, Sassari, Italy
| | - Francesca De Felice
- Radiation Oncology, Department of Radiological, Policlinico Umberto I, Rome, Italy
- Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Carlo Greco
- Department of Radiation Oncology, Università Campus Bio-Medico di Roma, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Valerio Nardone
- Department of Precision Medicine, University of Campania "L. Vanvitelli", Naples, Italy
| | - Antonio Piras
- UO Radioterapia Oncologica, Villa Santa Teresa, Bagheria, Palermo, Italy.
| | - Viola Salvestrini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
- Cyberknife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), 50139, Florence, Italy
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Murr M, Brock KK, Fusella M, Hardcastle N, Hussein M, Jameson MG, Wahlstedt I, Yuen J, McClelland JR, Vasquez Osorio E. Applicability and usage of dose mapping/accumulation in radiotherapy. Radiother Oncol 2023; 182:109527. [PMID: 36773825 DOI: 10.1016/j.radonc.2023.109527] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
Dose mapping/accumulation (DMA) is a topic in radiotherapy (RT) for years, but has not yet found its widespread way into clinical RT routine. During the ESTRO Physics workshop 2021 on "commissioning and quality assurance of deformable image registration (DIR) for current and future RT applications", we built a working group on DMA from which we present the results of our discussions in this article. Our aim in this manuscript is to shed light on the current situation of DMA in RT and to highlight the issues that hinder consciously integrating it into clinical RT routine. As a first outcome of our discussions, we present a scheme where representative RT use cases are positioned, considering expected anatomical variations and the impact of dose mapping uncertainties on patient safety, which we have named the DMA landscape (DMAL). This tool is useful for future reference when DMA applications get closer to clinical day-to-day use. Secondly, we discussed current challenges, lightly touching on first-order effects (related to the impact of DIR uncertainties in dose mapping), and focusing in detail on second-order effects often dismissed in the current literature (as resampling and interpolation, quality assurance considerations, and radiobiological issues). Finally, we developed recommendations, and guidelines for vendors and users. Our main point include: Strive for context-driven DIR (by considering their impact on clinical decisions/judgements) rather than perfect DIR; be conscious of the limitations of the implemented DIR algorithm; and consider when dose mapping (with properly quantified uncertainties) is a better alternative than no mapping.
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Affiliation(s)
- Martina Murr
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Germany.
| | - Kristy K Brock
- Department of Imaging Physics and Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, USA
| | - Marco Fusella
- Department of Radiation Oncology, Abano Terme Hospital, Italy
| | - Nicholas Hardcastle
- Physical Sciences, Peter MacCallum Cancer Centre & Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Mohammad Hussein
- Metrology for Medical Physics Centre, National Physical Laboratory, Teddington, United Kingdom
| | - Michael G Jameson
- GenesisCare New South Wales, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Australia
| | - Isak Wahlstedt
- Department of Health Technology, Technical University of Denmark, Anker Engelunds Vej 1, Bygning 101A, 2800 Kongens Lyngby, Denmark; Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte (HGH), Borgmester Ib Juuls Vej 7, 2730 Herlev, Denmark
| | - Johnson Yuen
- St George Hospital Cancer Care Centre, Kogarah, NSW 2217, Australia; South Western Clinical School, University of New South Wales, Sydney, Australia; Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Jamie R McClelland
- Centre for Medical Image Computing and Wellcome/EPSRC Centre for Interventional and Surgical Sciences, Dept of Medical Physics and Biomedical Engineering, UCL, United Kingdom
| | - Eliana Vasquez Osorio
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M20 4BX Manchester, United Kingdom
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Costin IC, Marcu LG. Factors impacting on patient setup analysis and error management during breast cancer radiotherapy. Crit Rev Oncol Hematol 2022; 178:103798. [PMID: 36031175 DOI: 10.1016/j.critrevonc.2022.103798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/28/2022] [Accepted: 08/21/2022] [Indexed: 12/24/2022] Open
Abstract
Radiotherapy is required to deliver an accurate dose to the tumor while protecting surrounding normal tissues. Breast cancer radiotherapy involves a number of factors that can influence patient setup and error management, including the immobilization device used, the verification system and the patient's treatment position. The aim of this review is to compile and discuss the setup errors that occur due to the above-mentioned factors. In view of this, a systematic search of the scientific literature in the Medline/PubMed databases was performed over the 1990-2021 time period, with 93 articles found to be relevant for the study. To be accessible to all, this study not only aims to identify factors impacting on patient setup analysis, but also seeks to evaluate the role of each verification device, board immobilization and position in influencing these errors.
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Affiliation(s)
- Ioana-Claudia Costin
- West University of Timisoara, Faculty of Physics, Timisoara, Romania; "Dr. Gavril Curteanu" County Hospital, Oradea 410469, Romania
| | - Loredana G Marcu
- West University of Timisoara, Faculty of Physics, Timisoara, Romania; Faculty of Informatics & Science, University of Oradea, Oradea 410087, Romania; Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia.
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McCallum S, Maresse S, Fearns P. Evaluating 3D-printed Bolus Compared to Conventional Bolus Types Used in External Beam Radiation Therapy. Curr Med Imaging 2021; 17:820-831. [PMID: 33530912 DOI: 10.2174/1573405617666210202114336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND When treating superficial tumors with external beam radiation therapy, bolus is often used. Bolus increases surface dose, reduces dose to underlying tissue, and improves dose homogeneity. INTRODUCTION The conventional bolus types used clinically in practice have some disadvantages. The use of Three-Dimensional (3D) printing has the potential to create more effective boluses. CT data is used for dosimetric calculations for these treatments and often to manufacture the customized 3D-printed bolus. PURPOSE The aim of this review is to evaluate the published studies that have compared 3D-printed bolus against conventional bolus types. METHODS AND RESULTS A systematic search of several databases and a further appraisal for relevance and eligibility resulted in the 14 articles used in this review. The 14 articles were analyzed based on their comparison of 3D-printed bolus and at least one conventional bolus type. CONCLUSION The findings of this review indicated that 3D-printed bolus has a number of advantages. Compared to conventional bolus types, 3D-printed bolus was found to have equivalent or improved dosimetric measures, positional accuracy, fit, and uniformity. 3D-printed bolus was also found to benefit workflow efficiency through both time and cost effectiveness. However, factors such as patient comfort and staff perspectives need to be further explored to support the use of 3Dprinted bolus in routine practice.
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Affiliation(s)
- Stephanie McCallum
- Medical Radiation Science, Faculty of Science and Engineering, Curtin University, Perth, Australia
| | - Sharon Maresse
- Medical Radiation Science, Faculty of Science and Engineering, Curtin University, Perth, Australia
| | - Peter Fearns
- Medical Radiation Science, Faculty of Science and Engineering, Curtin University, Perth, Australia
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Luo J, Yin Z, Zhang Z, Guo X, Yu X, Wang J. Does the protocol-required uniform margin around the CTV adequately account for setup inaccuracies in whole breast irradiation? Radiat Oncol 2021; 16:143. [PMID: 34344403 PMCID: PMC8336062 DOI: 10.1186/s13014-021-01863-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 07/19/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To use cone-beam computed tomography (CBCT) imaging to determine the impacts of patient characteristics on the magnitude of geometric setup errors and obtain patient-specific planning target volume (PTV) margins from the correlated patient characteristics in whole breast irradiation (WBI). Methods Between January 2019 and December 2019, a total of 97 patients who underwent breast-conserving surgery, followed by intensity-modulated radiation therapy in WBI, were scanned with pre-treatment CBCT for the first three treatment fractions and weekly for the subsequent fractions. Setup errors in the left–right (LR), superior–inferior (SI) and anterior–posterior (AP) directions were recorded and analyzed with patient characteristics—including age, tumor location, body mass index (BMI), chest circumference (CC) and breast volume (BV)—to examine the predictors for setup errors and obtain specific PTV margins. Results A total of 679 CBCT images from 97 patients were acquired for analysis. The mean setup errors for the whole group were 2.32 ± 1.21 mm, 3.71 ± 2.21 mm and 2.75 ± 1.56 mm in the LR, SI and AP directions, respectively. Patients’ BMI, CC and BV were moderately associated with setup errors, especially in the SI directions (R = 0.40, 0.43 and 0.22, respectively). Setup errors in the SI directions for patients with BMI > 23.8 kg/m2, CC > 89 cm and BV > 657 cm3 were 4.56 ± 2.59 mm, 4.77 ± 2.42 mm and 4.30 ± 2.43 mm, respectively, which were significantly greater than those of patients with BMI ≤ 23.8 kg/m2, CC ≤ 89 cm and BV ≤ 657 cm3 (P < 0.05). Correspondingly, the calculated PTV margins in patients with BMI > 23.8 kg/m2, CC > 89 cm and BV > 657 cm3 were 4.25/7.95/4.93 mm, 4.37/7.66/5.24 mm and 4.22/7.54/5.29 mm in the LR/SI/AP directions, respectively, compared with 3.64/4.64/5.09 mm, 3.31/4.50/4.82 mm and 3.29/5.74/4.73 mm for BMI ≤ 23.8 kg/m2, CC ≤ 89 cm and BV ≤ 657 cm3, respectively. Conclusions The magnitude of geometric setup errors was moderately correlated with BMI, CC and BV. It was recommended to set patient-specific PTV margins according to patient characteristics in the absence of daily image-guided treatment setup.
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Affiliation(s)
- Jurui Luo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhihai Yin
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Juanqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Cone-beam CT image quality improvement using Cycle-Deblur consistent adversarial networks (Cycle-Deblur GAN) for chest CT imaging in breast cancer patients. Sci Rep 2021; 11:1133. [PMID: 33441936 PMCID: PMC7807016 DOI: 10.1038/s41598-020-80803-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 12/23/2020] [Indexed: 01/26/2023] Open
Abstract
Cone-beam computed tomography (CBCT) integrated with a linear accelerator is widely used to increase the accuracy of radiotherapy and plays an important role in image-guided radiotherapy (IGRT). For comparison with fan-beam computed tomography (FBCT), the image quality of CBCT is indistinct due to X-ray scattering, noise, and artefacts. We proposed a deep learning model, “Cycle-Deblur GAN”, combined with CycleGAN and Deblur-GAN models to improve the image quality of chest CBCT images. The 8706 CBCT and FBCT image pairs were used for training, and 1150 image pairs were used for testing in deep learning. The generated CBCT images from the Cycle-Deblur GAN model demonstrated closer CT values to FBCT in the lung, breast, mediastinum, and sternum compared to the CycleGAN and RED-CNN models. The quantitative evaluations of MAE, PSNR, and SSIM for CBCT generated from the Cycle-Deblur GAN model demonstrated better results than the CycleGAN and RED-CNN models. The Cycle-Deblur GAN model improved image quality and CT-value accuracy and preserved structural details for chest CBCT images.
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Shen K, Xiong J, Wang Z, Wang W, Li W, Zhou J, Deng Z, Li B, Zhong R. Design of a new breast vacuum bag to reduce the global and local setup errors and to reduce PTV margin in post-mastectomy radiation therapy. JOURNAL OF RADIATION RESEARCH 2020; 61:985-992. [PMID: 32823282 PMCID: PMC7674700 DOI: 10.1093/jrr/rraa066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/09/2020] [Indexed: 02/05/2023]
Abstract
To design a new breast vacuum bag to reduce global and local setup errors in post-mastectomy radiation therapy (PMRT). A total of 24 PMRT patients were immobilized with an old vacuum bag and 26 PMRT patients were immobilized with a new vacuum bag. The registration results were analysed using four regions of interest (ROI): the global ROI [including the whole region of the planning target volume (PTV), GROI], the supraclavicular area (SROI), the ipsilateral chest wall region (CROI) and the ipsilateral arm region (AROI). The global and local setup errors of the two groups were compared. The global setup errors of the new vacuum group were significantly smaller than those in the old vacuum group with the exception of yaw axes (P < 0.05). The systematic error (Σ) and random error (σ) ranged from 1.21 to 2.13 mm. In the new vacuum group, the local setup errors in the medial-lateral (ML) direction and roll axes for CROI (the Σ and σ ranged from 0.65 to 1.35 mm), and the local setup errors in ML and superior-inferior (SI) directions for SROI were significantly smaller than those in the old vacuum group. The total required PTV margins for the chest wall in ML, SI, and anterior-posterior (AP) were 4.40, 3.12 and 3.77 mm respectively. The new vacuum bag can significantly reduce the global setup errors and local setup errors in PMRT. The respiratory motion of the chest wall was negligible, and the 5 mm PTV margin could cover the local setup errors in PMRT using the new vacuum bag with cone beam CT (CBCT) correction.
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Affiliation(s)
- Konglong Shen
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Jie Xiong
- Radiology Department, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Zhiguo Wang
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Weifeng Wang
- Jingzhou Central Hospital, the Second Clinical Medical College, Yangtze University, Jinzhou 121001, P.R. China
| | - Wan Li
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Jidan Zhou
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Zhonghua Deng
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Bin Li
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Renming Zhong
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
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Chang S, Liu G, Zhao L, Dilworth JT, Zheng W, Jawad S, Yan D, Chen P, Stevens C, Kabolizadeh P, Li X, Ding X. Feasibility study: spot-scanning proton arc therapy (SPArc) for left-sided whole breast radiotherapy. Radiat Oncol 2020; 15:232. [PMID: 33028378 PMCID: PMC7542109 DOI: 10.1186/s13014-020-01676-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study investigated the feasibility and potential clinical benefit of utilizing a new proton treatment technique: Spot-scanning proton arc (SPArc) therapy for left-sided whole breast radiotherapy (WBRT) to further reduce radiation dose to healthy tissue and mitigate the probability of normal tissue complications compared to conventional intensity modulated proton therapy (IMPT). METHODS Eight patients diagnosed with left-sided breast cancer and treated with breast-preserving surgery followed by whole breast irradiation without regional nodal irradiation were included in this retrospective planning. Two proton treatment plans were generated for each patient: vertical intensity-modulated proton therapy used for clinical treatment (vIMPT, gantry angle 10°-30°) and SPArc for comparison purpose. Both SPArc and vIMPT plans were optimized using the robust optimization of ± 3.5% range and 5 mm setup uncertainties. Root-mean-square deviation dose (RMSD) volume histograms were used for plan robustness evaluation. All dosimetric results were evaluated based on dose-volume histograms (DVH), and the interplay effect was evaluated based on the accumulation of single-fraction 4D dynamic dose on CT50. The treatment beam delivery time was simulated based on a gantry rotation with energy-layer-switching-time (ELST) from 0.2 to 5 s. RESULTS The average D1 to the heart and LAD were reduced to 53.63 cGy and 82.25 cGy compared with vIMPT 110.38 cGy (p = 0.001) and 170.38 cGy (p = 0.001), respectively. The average V5Gy and V20Gy of ipsilateral lung was reduced to 16.77% and 3.07% compared to vIMPT 25.56% (p = 0.001) and 4.68% (p = 0.003). Skin3mm mean and maximum dose were reduced to 3999.38 cGy and 4395.63 cGy compared to vIMPT 4104.25 cGy (p = 0.039) and 4411.63 cGy (p = 0.043), respectively. A significant relative risk reduction (RNTCP = NTCPSPArc/NTCPvIMPT) for organs at risk (OARs) was obtained with SPArc ranging from 0.61 to 0.86 depending on the clinical endpoint. The RMSD volume histogram (RVH) analysis shows SPArc provided better plan robustness in OARs sparing, including the heart, LAD, ipsilateral lung, and skin. The average estimated treatment beam delivery times were comparable to vIMPT plans when the ELST is about 0.5 s. CONCLUSION SPArc technique can further reduce dose delivered to OARs and the probability of normal tissue complications in patients treated for left-sided WBRT.
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Affiliation(s)
- Sheng Chang
- Department of Radiation Oncology, Renmin Hospital, Wuhan University, Wuhan, 430060, Hubei Province, China.,Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Gang Liu
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA.,Cancer Center, Union Hospital, Tongji Medical College, Huazhong, University of Science and Technology, Wuhan, 430023, China.,School of Physics and Technology, Wuhan University, Wuhan, 430072, Hubei, China
| | - Lewei Zhao
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Joshua T Dilworth
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Weili Zheng
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Saada Jawad
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Di Yan
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Peter Chen
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Peyman Kabolizadeh
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Xiaoqiang Li
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA
| | - Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, 48074, USA.
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Prehabilitation for patient positioning: pelvic exercises assist in minimizing inter-fraction sacral slope variability during radiation therapy. Med Oncol 2019; 37:3. [PMID: 31713056 DOI: 10.1007/s12032-019-1322-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
Reproducible patient positioning is essential for precision in radiation therapy (RT) delivery. We tested the hypothesis that a structured daily pre-treatment stretching regimen is both feasible and effective for minimizing variability in positioning, as measured by sacral slope angles (SSA). Eight female subjects undergoing pelvic radiotherapy performed a structured daily hip exercise regimen (extension and external rotation) immediately prior to both simulation imaging and daily treatment, throughout their RT course. This exercising cohort was compared to a retrospective review of 20 subjects (17 women and 3 men) undergoing RT, who had usual care. SSA measurements from daily pre-treatment imaging were compared to SSA measurements from the simulation CT. The average variation in SSA among the intervention subjects was 0.91° (± 0.58°), with a range among subjects of 0.57°-1.27°. The average variation for the control subjects was 2.27° (± 1.43°), ranging 1.22°-5.09°. The difference between the two groups was statistically significant (p = 0.0001). There was a statistically significant SSA variation between groups at each week of treatment. There was no significant variation among the intervention subjects between week 1 and later weeks, whereas subjects in the control group demonstrated significant SSA variation between week 1 and later weeks. We demonstrated a significant decrease in the variability of SSA by implementing a simple pre-treatment exercise program, while control subjects exhibited increasing variation in SSA over the course of treatment. We conclude that there is a potential benefit of prehabilitation during pelvic RT; however, a larger randomized control trial is required to confirm the findings.Clinical Trial: This research project was approved by the University of Massachusetts Medical School IRB (IRB ID H00012353) on January 21, 2017. The study is listed on ClinicalTrials.gov, provided by the U.S. National Library of Medicine, found with identifier NCT03242538.
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