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Court L, Aggarwal A, Burger H, Cardenas C, Chung C, Douglas R, du Toit M, Jaffray D, Jhingran A, Mejia M, Mumme R, Muya S, Naidoo K, Ndumbalo J, Nealon K, Netherton T, Nguyen C, Olanrewaju N, Parkes J, Shaw W, Trauernicht C, Xu M, Yang J, Zhang L, Simonds H, Beadle BM. Addressing the Global Expertise Gap in Radiation Oncology: The Radiation Planning Assistant. JCO Glob Oncol 2023; 9:e2200431. [PMID: 37471671 PMCID: PMC10581646 DOI: 10.1200/go.22.00431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/08/2023] [Accepted: 04/24/2023] [Indexed: 07/22/2023] Open
Abstract
PURPOSE Automation, including the use of artificial intelligence, has been identified as a possible opportunity to help reduce the gap in access and quality for radiotherapy and other aspects of cancer care. The Radiation Planning Assistant (RPA) project was conceived in 2015 (and funded in 2016) to use automated contouring and treatment planning algorithms to support the efforts of oncologists in low- and middle-income countries, allowing them to scale their efforts and treat more patients safely and efficiently (to increase access). DESIGN In this review, we discuss the development of the RPA, with a particular focus on clinical acceptability and safety/risk across jurisdictions as these are important indicators for the successful future deployment of the RPA to increase radiotherapy availability and ameliorate global disparities in access to radiation oncology. RESULTS RPA tools will be offered through a webpage, where users can upload computed tomography data sets and download automatically generated contours and treatment plans. All interfaces have been designed to maximize ease of use and minimize risk. The current version of the RPA includes automated contouring and planning for head and neck cancer, cervical cancer, breast cancer, and metastases to the brain. CONCLUSION The RPA has been designed to bring high-quality treatment planning to more patients across the world, and it may encourage greater investment in treatment devices and other aspects of cancer treatment.
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Affiliation(s)
- Laurence Court
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ajay Aggarwal
- Guy's and St Thomas' Hospital, London, United Kingdom
| | - Hester Burger
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Christine Chung
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Raphael Douglas
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Monique du Toit
- Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | - David Jaffray
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anuja Jhingran
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Mejia
- Benavides Cancer Institute, University of Santo Tomas, Manila, Philippines
| | - Raymond Mumme
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Komeela Naidoo
- Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
| | | | - Kelly Nealon
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Niki Olanrewaju
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeannette Parkes
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Willie Shaw
- University of the Free State, Bloemfontein, South Africa
| | | | - Melody Xu
- University of California San Francisco, San Francisco, CA
| | - Jinzhong Yang
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lifei Zhang
- The University of Texas MD Anderson Cancer Center, Houston, TX
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Sengupta B, Oh K, Sponseller P, Zaki P, Eastman B, Dinh TKT, Cardenas CE, Court LE, Parvathaneni U, Ford E. Cobalt compensator-based IMRT device: A treatment planning study of head and neck cases. Phys Med 2023; 106:102526. [PMID: 36621080 PMCID: PMC10468209 DOI: 10.1016/j.ejmp.2023.102526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 12/28/2022] [Accepted: 01/02/2023] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Our goal is to develop a novel cobalt-compensator-based IMRT device for low- and middle-income countries that is reliable and cost-effective while delivering treatment plans of equal quality to those from linac-MLC devices. The present study examines the quality of treatment plans using this device. METHODS A commercial treatment planning system (TPS; RayStation v.8B) was commissioned for this device using Monte Carlo simulations from the Geant4 toolkit. Patient-specific compensators were created as regions-of-interest. Thirty clinical head & neck cases were planned and compared to clinical plans with a 6MV linac using IMRT. The mock head and neck plan from TG-119 was used for further validation. RESULTS PTV objectives were achieved in all 30 plans with PTV V95% >95 %. OAR sparing was similar to clinical plans. There were 14 cases where OAR dose limits exceeded the recommended QUANTEC limits in the clinical plan in order to achieve target coverage. OAR sparing was better in the cobalt compensator plan in 8 cases and worse in 3 cases, in the latter cases exceeding the clinical plan doses by an average of 8.22 % (0.0 %-13.5 %). Average field-by-field gamma pass-rate were 93.7 % (2 %/2mm). Estimated treatment times using the Co-60 compensator device were 1 min 27 s vs 1 min 2 s for the clinical system. CONCLUSION This system is the first of its kind to allow for IMRT with a Co-60 device. Data here suggests that the delivery meets plan quality criteria while maintaining short treatment times which may offer a sustainable and cost-low option for IMRT on the global scale.
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Affiliation(s)
| | - Kyuhak Oh
- Department of Radiation Oncology, University of Washington, Seattle, USA; M.D. Anderson Cancer Center, Houston, USA
| | | | - Peter Zaki
- Department of Radiation Oncology, University of Washington, Seattle, USA
| | - Boryana Eastman
- Department of Radiation Oncology, University of Washington, Seattle, USA
| | - Tru-Khang T Dinh
- Department of Radiation Oncology, University of Washington, Seattle, USA
| | - Carlos E Cardenas
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Eric Ford
- Department of Radiation Oncology, University of Washington, Seattle, USA.
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Kawahara D, Nakano H, Saito A, Ozawa S, Nagata Y. Dose compensation based on biological effectiveness due to interruption time for photon radiation therapy. Br J Radiol 2020; 93:20200125. [PMID: 32356450 DOI: 10.1259/bjr.20200125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To evaluate the biological effectiveness of dose associated with interruption time; and propose the dose compensation method based on biological effectiveness when an interruption occurs during photon radiation therapy. METHODS The lineal energy distribution for human salivary gland tumor was calculated by Monte Carlo simulation using a photon beam. The biological dose (Dbio) was estimated using the microdosimetric kinetic model. The dose compensating factor with the physical dose for the difference of the Dbio with and without interruption (Δ) was derived. The interruption time (τ) was varied to 0.1, 0.2, 0.3, 0.4, 0.5, 1, 2, 3, 4, 5, 10, 20, 30, 40, 50, 75, and 120 min. The dose per fraction and dose rate varied from 2 to 8 Gy and 0.1 to 24 Gy/min, respectively. RESULTS The maximum Δ with 1 Gy/min occurred when the interruption occurred at half the dose. The Δ with 1 Gy/min at half of the dose was over 3% for τ >= 20 min for 2 Gy, τ = 10 min for 5 Gy, and τ = 10 min for 8 Gy. The maximum difference of the Δ due to the dose rate was within 3% for 2 and 5 Gy, and achieving values of 4.0% for 8 Gy. The dose compensating factor was larger with a high dose per fraction and high-dose rate beams. CONCLUSION A loss of biological effectiveness occurs due to interruption. Our proposal method could correct for the unexpected decrease of the biological effectiveness caused by interruption time. ADVANCES IN KNOWLEDGE For photon radiotherapy, the interruption causes the sublethal damage repair. The current study proposed the dose compensation method for the decrease of the biological effect by the interruption.
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Affiliation(s)
- Daisuke Kawahara
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima 734-8551, Japan
| | - Hisashi Nakano
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata, Niigata, 951-8122, Japan
| | - Akito Saito
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima 734-8551, Japan
| | - Shuichi Ozawa
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima 734-8551, Japan.,Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, 732-0057, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Hiroshima 734-8551, Japan.,Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Yamaguchi, 755-0046, Japan
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Yang J, Zhang Y, Zhang Z, Zhang L, Balter P, Court L. Technical Note: Density correction to improve CT number mapping in thoracic deformable image registration. Med Phys 2019; 46:2330-2336. [PMID: 30896047 DOI: 10.1002/mp.13502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 03/11/2019] [Accepted: 03/11/2019] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To improve the accuracy of computed tomography (CT) number mapping inside the lung in deformable image registration with large differences in lung volume for applications in vertical CT imaging and adaptive radiotherapy. METHODS The deep inspiration breath hold (DIBH) CT image and the end of exhalation (EE) phase image in four-dimensional CT of 14 thoracic cancer patients were used in this study. Lung volumes were manually delineated. A Demons-based deformable registration was first applied to register the EE CT to the DIBH CT for each patient, and the resulting deformation vector field deformed the EE CT image to the DIBH CT space. Given that the mass of the lung remains the same during respiration, we created a mass-preserving model to correlate lung density variations with volumetric changes, which were characterized by the Jacobian derived from the deformation field. The Jacobian determinant was used to correct the lung CT numbers transferred from the EE CT image. The absolute intensity differences created by subtracting the deformed EE CT from the DIBH CT with and without density correction were compared. RESULTS The ratio of DIBH CT to EE CT lung volumes was 1.6 on average. The deformable registration registered the lung shape well, but the appearance of voxel intensities inside the lung was different, demonstrating the need for density correction. Without density correction, the mean and standard deviation of the absolute intensity difference between the deformed EE CT and the DIBH CT inside the lung were 54.5 ± 45.5 for all cases. After density correction, these numbers decreased to 18.1 ± 34.9, demonstrating greater accuracy. The cumulative histogram of the intensity difference also showed that density correction improved CT number mapping greatly. CONCLUSION Density correction improves CT number mapping inside the lung in deformable image registration for difficult cases with large lung volume differences.
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Affiliation(s)
- Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yongbin Zhang
- Proton Therapy Center, University of Cincinnati Medical Center, Liberty Township, OH, USA
| | - Zijian Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Central South University Xiangya Hospital, Changsha, Hunan, China
| | - Lifei Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Peter Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laurence Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Fang R, Yang J, Du W, Court L. Automatic detection of graticule isocenter and scale from kV and MV images. J Appl Clin Med Phys 2019; 20:18-28. [PMID: 30843335 PMCID: PMC6448171 DOI: 10.1002/acm2.12558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To automate the detection of isocenter and scale of the mechanical graticule on kilo-voltage (kV) or mega-voltage (MV) films or electronic portal imaging device (EPID) images. METHODS We developed a robust image processing approach to automatically detect isocenter and scale of mechanical graticule from digitized kV or MV films and EPID images. After a series of preprocessing steps applied to the digital images, a combination of Hough transform and Radon transform was performed to detect the graticule axes and isocenter. The magnification of the graticule was automatically detected by solving an optimization problem using golden section search and parabolic interpolation algorithm. Tick marks of the graticule were then determined by extending from isocenter along the graticule axes with multiples of the magnification value. This approach was validated using 23 kV films, 26 MV films, and 91 EPID images in different anatomical sites (head-and-neck, thorax, and pelvis). Accuracy was measured by comparing computer detected results with manually selected results. RESULTS The proposed approach was robust for kV and MV films of varying image quality. The isocenter was detected within 1 mm for 98% of the images. The exceptions were three kV films where the graticule was not actually visible. Of all images with correct isocenter detection, 99% had a magnification detection error less than 1% and tick mark detection error less than 1 mm, with the exception of 1 kV film (magnification error: 3.17%; tick mark error: 1.29 mm) and 1 MV film (magnification error: 0.45%; tick mark error: 1.11 mm). CONCLUSION We developed an approach to robustly and automatically detect graticule isocenter and scale from two-dimensionla (2D) kV and MV films. This is a first step toward automated treatment planning based on 2D x-ray images.
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Affiliation(s)
- Raymond Fang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Deparmtent of Physics and Astronomy, Rice University, Houston, TX, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Weiliang Du
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Laurence Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Van Schelt J, Smith DL, Fong N, Toomeh D, Sponseller PA, Brown DW, Macomber MW, Mayr NA, Patel S, Shulman A, Subrahmanyam GV, Govindarajan KN, Ford EC. A ring-based compensator IMRT system optimized for low- and middle-income countries: Design and treatment planning study. Med Phys 2018; 45:3275-3286. [PMID: 29777595 DOI: 10.1002/mp.12985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 12/26/2022] Open
Abstract
PURPOSE We propose a novel compensator-based IMRT system designed to provide a simple, reliable, and cost-effective adjunct technology, with the goal of expanding global access to advanced radiotherapy techniques. The system would employ easily reusable tungsten bead compensators that operate independent of a gantry (e.g., mounted in a ring around the patient). Thereby the system can be retrofitted to existing linac and cobalt teletherapy units. This study explores the quality of treatment plans from the proposed system and the dependence on associated design parameters. METHODS We considered 60 Co-based plans as the most challenging scenario for dosimetry and benchmarked them against clinical MLC-based plans delivered on a linac. Treatment planning was performed in the Pinnacle treatment planning system with commissioning based on Monte Carlo simulations of compensated beams. 60 Co-compensator IMRT plans were generated for five patients with head-and-neck cancer and five with gynecological cancer and compared to respective IMRT plans using a 6 MV linac beam with an MLC. The dependence of dosimetric endpoints on compensator resolution, thickness, position, and number of beams was assessed. Dosimetric accuracy was validated by Monte Carlo simulations of dose distribution in a water phantom from beams with the IMRT plan compensators. RESULTS The 60 Co-compensator plans had on average equivalent PTV coverage and somewhat inferior OAR sparing compared to the 6 MV-MLC plans, but the differences in dosimetric endpoints were clinically acceptable. Calculated treatment times for head-and-neck plans were 7.6 ± 2.0 min vs 3.9 ± 0.8 min (6 MV-MLC vs 60 Co-compensator) and for gynecological plans were 8.7 ± 3.1 min vs 4.3 ± 0.4 min. Plan quality was insensitive to most design parameters over much of the ranges studied, with no degradation found when the compensator resolution was finer than 6 mm, maximum thickness at least 2 tenth-value-layers, and more than five beams were used. Source-to-compensator distances of 53 and 63 cm resulted in very similar plan quality. Monte Carlo simulations suggest no increase in surface dose for the geometries considered here. Simulated dosimetric validation tests had median gamma pass rates of 97.6% for criteria of 3% (global)/3 mm with a 10% threshold. CONCLUSIONS The novel ring-compensator IMRT system can produce plans of comparable quality to standard 6 MV-MLC systems. Even when 60 Co beams are used the plan quality is acceptable and treatment times are substantially reduced. 60 Co-compensator IMRT plans are adequately modeled in an existing commercial treatment planning system. These results motivate further development of this low-cost adaptable technology with translation through clinical trials and deployment to expand the reach of IMRT in low- and middle-income countries.
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Affiliation(s)
- Jonathon Van Schelt
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Daniel L Smith
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, 98195, USA
| | - Nicholas Fong
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, 98195, USA
| | - Dolla Toomeh
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, 98195, USA
| | - Patricia A Sponseller
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, 98195, USA
| | - Derek W Brown
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, CA, 92093, USA
| | - Meghan W Macomber
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, 98195, USA
| | - Nina A Mayr
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, 98195, USA
| | | | | | - G V Subrahmanyam
- Panacea Medical Technologies Pvt. Ltd, Bangalore, Karnataka, 560 066, India
| | | | - Eric C Ford
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, WA, 98195, USA
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Netherton T, Li Y, Nitsch P, Shaitelman S, Balter P, Gao S, Klopp A, Muruganandham M, Court L. Interplay effect on a 6-MV flattening-filter-free linear accelerator with high dose rate and fast multi-leaf collimator motion treating breast and lung phantoms. Med Phys 2018; 45:2369-2376. [DOI: 10.1002/mp.12899] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 03/15/2018] [Accepted: 03/16/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Tucker Netherton
- The University of Texas Graduate School of Biomedical Sciences at Houston; Houston TX USA
- Department of Radiation Physics; Division of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Yuting Li
- The University of Texas Graduate School of Biomedical Sciences at Houston; Houston TX USA
- Department of Radiation Oncology; Ohio State University Medical Center; Columbus OH USA
| | - Paige Nitsch
- Department of Radiation Physics; Division of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Simona Shaitelman
- Department of Radiation Physics; Division of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Peter Balter
- Department of Radiation Physics; Division of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Song Gao
- Department of Radiation Physics; Division of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Ann Klopp
- Department of Radiation Physics; Division of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Manickam Muruganandham
- Department of Radiation Physics; Division of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Laurence Court
- Department of Radiation Physics; Division of Radiation Oncology; The University of Texas MD Anderson Cancer Center; Houston TX USA
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