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Lee JY, Bhandare RR, Boddu SHS, Shaik AB, Saktivel LP, Gupta G, Negi P, Barakat M, Singh SK, Dua K, Chellappan DK. Molecular mechanisms underlying the regulation of tumour suppressor genes in lung cancer. Biomed Pharmacother 2024; 173:116275. [PMID: 38394846 DOI: 10.1016/j.biopha.2024.116275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/30/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Tumour suppressor genes play a cardinal role in the development of a large array of human cancers, including lung cancer, which is one of the most frequently diagnosed cancers worldwide. Therefore, extensive studies have been committed to deciphering the underlying mechanisms of alterations of tumour suppressor genes in governing tumourigenesis, as well as resistance to cancer therapies. In spite of the encouraging clinical outcomes demonstrated by lung cancer patients on initial treatment, the subsequent unresponsiveness to first-line treatments manifested by virtually all the patients is inherently a contentious issue. In light of the aforementioned concerns, this review compiles the current knowledge on the molecular mechanisms of some of the tumour suppressor genes implicated in lung cancer that are either frequently mutated and/or are located on the chromosomal arms having high LOH rates (1p, 3p, 9p, 10q, 13q, and 17p). Our study identifies specific genomic loci prone to LOH, revealing a recurrent pattern in lung cancer cases. These loci, including 3p14.2 (FHIT), 9p21.3 (p16INK4a), 10q23 (PTEN), 17p13 (TP53), exhibit a higher susceptibility to LOH due to environmental factors such as exposure to DNA-damaging agents (carcinogens in cigarette smoke) and genetic factors such as chromosomal instability, genetic mutations, DNA replication errors, and genetic predisposition. Furthermore, this review summarizes the current treatment landscape and advancements for lung cancers, including the challenges and endeavours to overcome it. This review envisages inspired researchers to embark on a journey of discovery to add to the list of what was known in hopes of prompting the development of effective therapeutic strategies for lung cancer.
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Affiliation(s)
- Jia Yee Lee
- School of Health Sciences, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia
| | - Richie R Bhandare
- Department of Pharmaceutical Sciences, College of Pharmacy & Health Sciences, Ajman University, Al-Jurf, P.O. Box 346, Ajman, United Arab Emirates; Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Al-Jurf, P.O. Box 346, Ajman, United Arab Emirates.
| | - Sai H S Boddu
- Department of Pharmaceutical Sciences, College of Pharmacy & Health Sciences, Ajman University, Al-Jurf, P.O. Box 346, Ajman, United Arab Emirates; Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Al-Jurf, P.O. Box 346, Ajman, United Arab Emirates
| | - Afzal B Shaik
- St. Mary's College of Pharmacy, St. Mary's Group of Institutions Guntur, Affiliated to Jawaharlal Nehru Technological University Kakinada, Chebrolu, Guntur, Andhra Pradesh 522212, India; Center for Global Health Research, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, India
| | - Lakshmana Prabu Saktivel
- Department of Pharmaceutical Technology, University College of Engineering (BIT Campus), Anna University, Tiruchirappalli 620024, India
| | - Gaurav Gupta
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Al-Jurf, P.O. Box 346, Ajman, United Arab Emirates; School of Pharmacy, Suresh Gyan Vihar University, Jaipur, Rajasthan 302017, India
| | - Poonam Negi
- School of Pharmaceutical Sciences, Shoolini University, PO Box 9, Solan, Himachal Pradesh 173229, India
| | - Muna Barakat
- Department of Clinical Pharmacy & Therapeutics, Applied Science Private University, Amman-11937, Jordan
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Jalandhar-Delhi G.T Road, Phagwara 144411, India; Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia
| | - Kamal Dua
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney 2007, Australia; Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney 2007, Australia
| | - Dinesh Kumar Chellappan
- Department of Life Sciences, School of Pharmacy, International Medical University, Bukit Jalil, Kuala Lumpur 57000, Malaysia.
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Dong Z, Yu S, Szmul A, Wang J, Qi J, Wu H, Li J, Lu Z, Zhang Y. Simulation of a new respiratory phase sorting method for 4D-imaging using optical surface information towards precision radiotherapy. Comput Biol Med 2023; 162:107073. [PMID: 37290392 PMCID: PMC10311359 DOI: 10.1016/j.compbiomed.2023.107073] [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] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/09/2023] [Accepted: 05/27/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Respiratory signal detection is critical for 4-dimensional (4D) imaging. This study proposes and evaluates a novel phase sorting method using optical surface imaging (OSI), aiming to improve the precision of radiotherapy. METHOD Based on 4D Extended Cardiac-Torso (XCAT) digital phantom, OSI in point cloud format was generated from the body segmentation, and image projections were simulated using the geometries of Varian 4D kV cone-beam-CT (CBCT). Respiratory signals were extracted respectively from the segmented diaphragm image (reference method) and OSI respectively, where Gaussian Mixture Model and Principal Component Analysis (PCA) were used for image registration and dimension reduction respectively. Breathing frequencies were compared using Fast-Fourier-Transform. Consistency of 4DCBCT images reconstructed using Maximum Likelihood Expectation Maximization algorithm was also evaluated quantitatively, where high consistency can be suggested by lower Root-Mean-Square-Error (RMSE), Structural-Similarity-Index (SSIM) value closer to 1, and larger Peak-Signal-To-Noise-Ratio (PSNR) respectively. RESULTS High consistency of breathing frequencies was observed between the diaphragm-based (0.232 Hz) and OSI-based (0.251 Hz) signals, with a slight discrepancy of 0.019Hz. Using end of expiration (EOE) and end of inspiration (EOI) phases as examples, the mean±1SD values of the 80 transverse, 100 coronal and 120 sagittal planes were 0.967, 0,972, 0.974 (SSIM); 1.657 ± 0.368, 1.464 ± 0.104, 1.479 ± 0.297 (RMSE); and 40.501 ± 1.737, 41.532 ± 1.464, 41.553 ± 1.910 (PSNR) for the EOE; and 0.969, 0.973, 0.973 (SSIM); 1.686 ± 0.278, 1.422 ± 0.089, 1.489 ± 0.238 (RMSE); and 40.535 ± 1.539, 41.605 ± 0.534, 41.401 ± 1.496 (PSNR) for EOI respectively. CONCLUSIONS This work proposed and evaluated a novel respiratory phase sorting approach for 4D imaging using optical surface signals, which can potentially be applied to precision radiotherapy. Its potential advantages were non-ionizing, non-invasive, non-contact, and more compatible with various anatomic regions and treatment/imaging systems.
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Affiliation(s)
- Zhengkun Dong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China; Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
| | - Shutong Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China; Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
| | - Adam Szmul
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Jingyuan Wang
- Department of Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Junfeng Qi
- Department of Engineering Physics, Tsinghua University, Beijing, 100084, China
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Junyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Zihong Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Yibao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
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El Naqa I, Pogue BW, Zhang R, Oraiqat I, Parodi K. Image guidance for FLASH radiotherapy. Med Phys 2022; 49:4109-4122. [PMID: 35396707 PMCID: PMC9844128 DOI: 10.1002/mp.15662] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/10/2022] [Accepted: 03/30/2022] [Indexed: 01/19/2023] Open
Abstract
FLASH radiotherapy (FLASH-RT) is an emerging ultra-high dose (>40 Gy/s) delivery that promises to improve the therapeutic potential by limiting toxicities compared to conventional RT while maintaining similar tumor eradication efficacy. Image guidance is an essential component of modern RT that should be harnessed to meet the special emerging needs of FLASH-RT and its associated high risks in planning and delivering of such ultra-high doses in short period of times. Hence, this contribution will elaborate on the imaging requirements and possible solutions in the entire chain of FLASH-RT treatment, from the planning, through the setup and delivery with online in vivo imaging and dosimetry, up to the assessment of biological mechanisms and treatment response. In patient setup and delivery, higher temporal sampling than in conventional RT should ensure that the short treatment is delivered precisely to the targeted region. Additionally, conventional imaging tools such as cone-beam computed tomography will continue to play an important role in improving patient setup prior to delivery, while techniques based on magnetic resonance imaging or positron emission tomography may be extremely valuable for either linear accelerator (Linac) or particle FLASH therapy, to monitor and track anatomical changes during delivery. In either planning or assessing outcomes, quantitative functional imaging could supplement conventional imaging for more accurate utilization of the biological window of the FLASH effect, selecting for or verifying things such as tissue oxygen and existing or transient hypoxia on the relevant timescales of FLASH-RT delivery. Perhaps most importantly at this time, these tools might help improve the understanding of the biological mechanisms of FLASH-RT response in tumor and normal tissues. The high dose deposition of FLASH provides an opportunity to utilize pulse-to-pulse imaging tools such as Cherenkov or radiation acoustic emission imaging. These could provide individual pulse mapping or assessing the 3D dose delivery superficially or at tissue depth, respectively. In summary, the most promising components of modern RT should be used for safer application of FLASH-RT, and new promising developments could be advanced to cope with its novel demands but also exploit new opportunities in connection with the unique nature of pulsed delivery at unprecedented dose rates, opening a new era of biological image guidance and ultrafast, pulse-based in vivo dosimetry.
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Affiliation(s)
- Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL 33612, USA,Corresponding Author:
| | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA,Department of Medical Physics, University of Wisconsin-Madison, WI 53705, USA
| | - Rongxiao Zhang
- Giesel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Ibrahim Oraiqat
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Katia Parodi
- Department of Medical Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, Garching 85748, Germany
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Kim J, Keum KC, Lee H, Hong CS, Park K, Kim JS. Image quality of 4D in-treatment CBCT acquired during lung SBRT using FFF beam: a phantom study. Radiat Oncol 2020; 15:224. [PMID: 32977808 PMCID: PMC7519557 DOI: 10.1186/s13014-020-01668-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/14/2020] [Indexed: 12/25/2022] Open
Abstract
Background Rotational beam delivery enables concurrent acquisition of cone-beam CT (CBCT), thereby facilitating further geometric verification of patient setup during radiation treatment. However, it is challenging to acquire CBCT during stereotactic body radiation therapy (SBRT) using flattening-filter free X-ray beams, in which a high radiation dose is delivered. This study presents quantitative evaluation results of the image quality in four-dimensional (4D) in-treatment CBCT acquired during SBRT delivery. Methods The impact of megavoltage (MV) scatter and acquisition parameters on the image quality was evaluated using Catphan 503 and XSight lung tracking phantoms. The in-treatment CBCT images of the phantoms were acquired while delivering 16 SBRT plans. The uniformity, contrast, and contrast-to-noise ratio (CNR) of the in-treatment CBCT images were calculated and compared to those of CBCT images acquired without SBRT delivery. Furthermore, the localizing accuracy of the moving target in the XSight lung phantom was evaluated for 10 respiratory phases. Results The CNR of the 3D-reconstucted Catphan CBCT images was reduced from 6.3 to 2.6 due to the effect of MV treatment scatter. Both for the Catphan and XSight phantoms, the CBCT image quality was affected by the tube current and monitor units (MUs) of the treatment plan. The lung target in the XSight tracking phantom was most visible for extreme phases; the mean CNRs of the lung target in the in-treatment CBCT images (with 40 mA tube current) across the SBRT plans were 3.2 for the end-of-exhalation phase and 3.0 for the end-of-inhalation phase. The lung target was localized with sub-millimeter accuracy for the extreme respiratory phases. Conclusions Full-arc acquisition with an increased tube current (e.g. 40 mA) is recommended to compensate for degradation in the CBCT image quality due to unflattened MV beam scatter. Acquiring in-treatment CBCT with a high-MU treatment beam is also suggested to improve the resulting CBCT image quality.
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Affiliation(s)
- Jihun Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Ki Chang Keum
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Ho Lee
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Chae-Seon Hong
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Kwangwoo Park
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, South Korea.
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Vergalasova I, Cai J. A modern review of the uncertainties in volumetric imaging of respiratory-induced target motion in lung radiotherapy. Med Phys 2020; 47:e988-e1008. [PMID: 32506452 DOI: 10.1002/mp.14312] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/15/2020] [Accepted: 05/26/2020] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy has become a critical component for the treatment of all stages and types of lung cancer, often times being the primary gateway to a cure. However, given that radiation can cause harmful side effects depending on how much surrounding healthy tissue is exposed, treatment of the lung can be particularly challenging due to the presence of moving targets. Careful implementation of every step in the radiotherapy process is absolutely integral for attaining optimal clinical outcomes. With the advent and now widespread use of stereotactic body radiation therapy (SBRT), where extremely large doses are delivered, accurate, and precise dose targeting is especially vital to achieve an optimal risk to benefit ratio. This has largely become possible due to the rapid development of image-guided technology. Although imaging is critical to the success of radiotherapy, it can often be plagued with uncertainties due to respiratory-induced target motion. There has and continues to be an immense research effort aimed at acknowledging and addressing these uncertainties to further our abilities to more precisely target radiation treatment. Thus, the goal of this article is to provide a detailed review of the prevailing uncertainties that remain to be investigated across the different imaging modalities, as well as to highlight the more modern solutions to imaging motion and their role in addressing the current challenges.
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Affiliation(s)
- Irina Vergalasova
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ, USA
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Shimohigashi Y, Doi Y, Kouno Y, Yotsuji Y, Maruyama M, Kai Y, Toya R. Image quality evaluation of in-treatment four-dimensional cone-beam computed tomography in volumetric-modulated arc therapy for stereotactic body radiation therapy. Phys Med 2019; 68:10-16. [PMID: 31726265 DOI: 10.1016/j.ejmp.2019.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/18/2019] [Accepted: 11/01/2019] [Indexed: 11/27/2022] Open
Abstract
In this study, the image quality of in-treatment four-dimensional cone-beam computed tomography (In-4D-CBCT) obtained with various prescription doses (PDs) were quantitatively evaluated in volumetric-modulated arc therapy (VMAT) for stereotactic body radiation therapy (SBRT) of the lungs and liver. To assess image quality, we used a dynamic thorax phantom and three-dimensional (3D) abdominal phantom; In-4D-CBCT images were acquired with various PDs (from 5 to 12 Gy). The In-4D-CBCT with various PDs were compared with the reference images (pre-4D-CBCT). The image quality was evaluated using the signal-to-noise ratio (SNR), the contrast-to-noise ratio (CNR), and the Dice similarity coefficient (DSC). The fiducial marker positions with various PDs were compared with those of the reference images. For the dynamic thorax phantom, the difference between pre- and In-4D-CBCT in terms of SNR and CNR decreased, as the PD increased from 6 to 12 Gy. The median DSC ranged from 0.7 to 0.74, and showed good similarity. For the 3D abdominal phantom, the difference between pre- and In-4D-CBCT in terms of SNR and CNR decreased as the PD increased from 5 to 6 Gy; conversely, it increased as the PD increased from 7 to 8 Gy. The fiducial marker positions were within 1.0 mm for all PDs. We concluded that the image quality of In-4D-CBCT degraded compared with the reference image; however, it was sufficiently accurate for assessing the intra-fractional tumor position in VMAT for SBRT of the lungs and liver both in terms of the target volume similarity and accuracy of the fiducial marker position.
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Affiliation(s)
| | - Yasuhiro Doi
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yumiko Kouno
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yohei Yotsuji
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Masato Maruyama
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yudai Kai
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
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Mao W, Liu C, Gardner SJ, Siddiqui F, Snyder KC, Kumarasiri A, Zhao B, Kim J, Wen NW, Movsas B, Chetty IJ. Evaluation and Clinical Application of a Commercially Available Iterative Reconstruction Algorithm for CBCT-Based IGRT. Technol Cancer Res Treat 2019; 18:1533033818823054. [PMID: 30803367 PMCID: PMC6373994 DOI: 10.1177/1533033818823054] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose: We have quantitatively evaluated the image quality of a new commercially available iterative cone-beam computed tomography reconstruction algorithm over standard cone-beam computed tomography image reconstruction results. Methods: This iterative cone-beam computed tomography reconstruction pipeline uses a finite element solver (AcurosCTS)-based scatter correction and a statistical (iterative) reconstruction in addition to a standard kernel-based correction followed by filtered back-projection-based Feldkamp-Davis-Kress cone-beam computed tomography reconstruction. Standard full-fan half-rotation Head, half-fan full-rotation Head, and standard Pelvis cone-beam computed tomography protocols have been investigated to scan a quality assurance phantom via the following image quality metrics: uniformity, HU constancy, spatial resolution, low contrast detection, noise level, and contrast-to-noise ratio. An anthropomorphic head phantom was scanned for verification of noise reduction. Clinical patient image data sets for 5 head/neck patients and 5 prostate patients were qualitatively evaluated. Results: Quality assurance phantom study results showed that relative to filtered back-projection-based cone-beam computed tomography, noise was reduced from 28.8 ± 0.3 HU to a range between 18.3 ± 0.2 and 5.9 ± 0.2 HU for Full-Fan Head scans, from 14.4 ± 0.2 HU to a range between 12.8 ± 0.3 and 5.2 ± 0.3 HU for Half-Fan Head scans, and from 6.2 ± 0.1 HU to a range between 3.8 ± 0.1 and 2.0 ± 0.2 HU for Pelvis scans, with the iterative cone-beam computed tomography algorithm. Spatial resolution was marginally improved while results for uniformity and HU constancy were similar. For the head phantom study, noise was reduced from 43.6 HU to a range between 24.8 and 13.0 HU for a Full-Fan Head and from 35.1 HU to a range between 22.9 and 14.0 HU for a Half-Fan Head scan. The patient data study showed that artifacts due to photon starvation and streak artifacts were all reduced, and image noise in specified target regions were reduced to 62% ± 15% for 10 patients. Conclusion: Noise and contrast-to-noise ratio image quality characteristics were significantly improved using the iterative cone-beam computed tomography reconstruction algorithm relative to the filtered back-projection-based cone-beam computed tomography method. These improvements will enhance the accuracy of cone-beam computed tomography-based image-guided applications.
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Affiliation(s)
- Weihua Mao
- 1 Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Chang Liu
- 1 Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Stephen J Gardner
- 1 Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Farzan Siddiqui
- 1 Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Karen C Snyder
- 1 Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Akila Kumarasiri
- 1 Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Bo Zhao
- 1 Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Joshua Kim
- 1 Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Ning Winston Wen
- 1 Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Benjamin Movsas
- 1 Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
| | - Indrin J Chetty
- 1 Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, USA
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Quantitative evaluation of 4D Cone beam CT scans with reduced scan time in lung cancer patients. Radiother Oncol 2019; 136:64-70. [PMID: 31015131 PMCID: PMC6598855 DOI: 10.1016/j.radonc.2019.03.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 11/21/2022]
Abstract
Fast (2 min) 4D CBCT can be simulated accurately from long (4 min) scans. Registration was accurate for 96.6% of simulated 2 min scans. Acquired 2 min scan registration was accurate in 6/8 patients. 2 min 4D CBCT produces sufficient image quality for IGRT in lung cancer patients.
Purpose Image guided radiotherapy (IGRT) based on respiration correlated cone-beam CT (4D-CBCT) provides accurate tumour localisation in lung cancer patients by taking into account respiratory motion when deriving setup correction. However, 4D-CBCT scan times are typically longer than for acquisition of 3D-CBCT scans, e.g. 4 min. This work aims to quantitatively evaluate the effect of reduced scan times on 4D-CBCT image quality and registration accuracy in lung cancer patients. Methods and materials Scan times down to 1 min were simulated by retaining only projection images corresponding to every second, third or fourth respiratory cycle in forty-four 4D-CBCTs from 15 lung cancer patients. In addition twenty 2-minute scans were acquired for 12 lung cancer patients. Image quality was quantified by assessing registration accuracy in the shorter scan times, comparing to the 4-minute scan registration result where available as reference. Results Use of 2-minute scans had little impact on registration accuracy or ability to detect tumour motion: automatic registration accuracy was within 2 mm in 6/8 scans analysed with 2-minute acquisitions, and 96.6% of registration discrepancies were within 2 mm for the simulated scans. When the scan time simulated was below 2 min, automatic registration results still agreed within 2 mm for 84.7% of scans, however visual image quality was considerably degraded. Conclusion A 4D-CBCT acquisition time of 2 min produces scans of sufficient image quality for IGRT in most lung cancer patients, as demonstrated quantitatively by assessing the impact on automatic registration accuracy in simulated and real acquisitions.
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Doi Y, Shimohigashi Y, Yotsuji Y, Maruyama M, Kai Y, Toya R. Target volume and motion position evaluation of four-dimensional cone-beam CT: comparison with 4D-CT using dynamic thorax phantom. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab1054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mao W, Gardner SJ, Snyder KC, Wen NW, Zhong H, Li H, Jackson P, Shah M, Chetty IJ. On the improvement of CBCT image quality for soft tissue-based SRS localization. J Appl Clin Med Phys 2018; 19:177-184. [PMID: 30294838 PMCID: PMC6236842 DOI: 10.1002/acm2.12470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/10/2018] [Accepted: 09/11/2018] [Indexed: 12/02/2022] Open
Abstract
Purpose We explore the optimal cone‐beam CT (CBCT) acquisition parameters to improve CBCT image quality to enhance intracranial stereotactic radiosurgery (SRS) localization and also assess the imaging dose levels associated with each imaging protocol. Methods Twenty‐six CBCT acquisition protocols were generated on an Edge® linear accelerator (Varian Medical Systems, Palo Alto, CA) with different x‐ray tube current and potential settings, gantry rotation trajectories, and gantry rotation speeds. To assess image quality, images of the Catphan 504 phantom were analyzed to evaluate the following image quality metrics: uniformity, HU constancy, spatial resolution, low contrast detection, noise level, and contrast‐to‐noise ratio (CNR). To evaluate the imaging dose for each protocol, the cone‐beam dose index (CBDI) was measured. To validate the phantom results, further analysis was performed with an anthropomorphic head phantom as well as image data acquired for a clinical SRS patient. Results The Catphan data indicates that adjusting acquisition parameters had direct effects on the image noise level, low contrast detection, and CNR, but had minimal effects on uniformity, HU constancy, and spatial resolution. The noise level was reduced from 34.5 ± 0.3 to 18.5 ± 0.2 HU with a four‐fold reduction in gantry speed, and to 18.7 ± 0.2 HU with a four‐fold increase in tube current. Overall, the noise level was found to be proportional to inverse square root of imaging dose, and imaging dose was proportional to the product of total tube current‐time product and the cube of the x‐ray potential. Analysis of the anthropomorphic head phantom data and clinical SRS imaging data also indicates that noise is reduced with imaging dose increase. Conclusions Our results indicate that optimization of the imaging protocol, and thereby an increase in the imaging dose, is warranted for improved soft‐tissue visualization for intracranial SRS.
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Affiliation(s)
- Weihua Mao
- Henry Ford Health System, Detroit, MI, USA
| | | | | | | | | | - Haisen Li
- Henry Ford Health System, Detroit, MI, USA
| | | | - Mira Shah
- Henry Ford Health System, Detroit, MI, USA
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Shimohigashi Y, Araki F, Maruyama M, Yonemura K, Nakaguchi Y, Kai Y, Toya R. Image quality of four-dimensional cone-beam computed tomography obtained at various gantry rotation speeds for liver stereotactic body radiation therapy with fiducial markers. Phys Med 2017; 45:19-24. [PMID: 29472086 DOI: 10.1016/j.ejmp.2017.11.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/24/2017] [Accepted: 11/26/2017] [Indexed: 11/25/2022] Open
Abstract
In this study, qualities of 4D cone-beam CT (CBCT) images obtained using various gantry rotation speeds (GRSs) for liver stereotactic body radiation therapy (SBRT) with fiducial markers were quantitatively evaluated. Abdominal phantom containing a fiducial marker was moved along a sinusoidal waveform, and 4D-CBCT images were acquired with GRSs of 50-200° min-1. We obtained the 4D-CBCT projection data from six patients who underwent liver SBRT and generated 4D-CBCT images at GRSs of 67-200° min-1, by varying the number of projection data points. The image quality was evaluated based on the signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and structural similarity index (SSIM). The fiducial marker positions with different GRSs were compared with the setup values and a reference position in the phantom and clinical studies, respectively. The root mean square errors (RMSEs) were calculated relative to the reference positions. In the phantom study, the mean SNR, CNR, and SSIM decreased from 37.6 to 10.1, from 39.8 to 10.1, and from 0.9 to 0.7, respectively, as the GRS increased from 50 to 200° min-1. The fiducial marker positions were within 2.0 mm at all GRSs. Similarly, in the clinical study, the mean SNR, CNR, and SSIM decreased from 50.4 to 13.7, from 24.2 to 6.0, and from 0.92 to 0.73, respectively. The mean RMSEs were 2.0, 2.1, and 3.6 mm for the GRSs of 67, 100, and 200° min-1, respectively. We conclude that GRSs of 67 and 85° min-1 yield images of acceptable quality for 4D-CBCT in liver SBRT with fiducial markers.
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Affiliation(s)
- Yoshinobu Shimohigashi
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan; Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan.
| | - Fujio Araki
- Department of Health Sciences, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Masato Maruyama
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Keisuke Yonemura
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yuji Nakaguchi
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Yudai Kai
- Department of Radiological Technology, Kumamoto University Hospital, Kumamoto, Japan
| | - Ryo Toya
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
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Yoganathan SA, Maria Das KJ, Agarwal A, Kumar S. Magnitude, Impact, and Management of Respiration-induced Target Motion in Radiotherapy Treatment: A Comprehensive Review. J Med Phys 2017; 42:101-115. [PMID: 28974854 PMCID: PMC5618455 DOI: 10.4103/jmp.jmp_22_17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/31/2017] [Accepted: 07/11/2017] [Indexed: 12/11/2022] Open
Abstract
Tumors in thoracic and upper abdomen regions such as lungs, liver, pancreas, esophagus, and breast move due to respiration. Respiration-induced motion introduces uncertainties in radiotherapy treatments of these sites and is regarded as a significant bottleneck in achieving highly conformal dose distributions. Recent developments in radiation therapy have resulted in (i) motion-encompassing, (ii) respiratory gating, and (iii) tracking methods for adapting the radiation beam aperture to account for the respiration-induced target motion. The purpose of this review is to discuss the magnitude, impact, and management of respiration-induced tumor motion.
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Affiliation(s)
- S. A. Yoganathan
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - K. J. Maria Das
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Arpita Agarwal
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shaleen Kumar
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Santoso AP, Song KH, Qin Y, Gardner SJ, Liu C, Chetty IJ, Movsas B, Ajlouni M, Wen N. Evaluation of gantry speed on image quality and imaging dose for 4D cone-beam CT acquisition. Radiat Oncol 2016; 11:98. [PMID: 27473367 PMCID: PMC4966562 DOI: 10.1186/s13014-016-0677-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background This study investigates the effect of gantry speed on 4DCBCT image quality and dose for the Varian On-Board Imager®. Methods A thoracic 4DCBCT protocol was designed using a 125 kVp spectrum. Image quality parameters were evaluated for 4DCBCT acquisition using Catphan® phantom with real-time position management™ system for gantry speeds varying between 1.0 to 6.0°/s. Superior-inferior motion of the phantom was executed using a sinusoidal waveform with five second period. Scans were retrospectively sorted into 4 phases (CBCT-4 ph) and 10 phases (CBCT-10 ph); average 4DCBCT (CBCT-ave), using all image data from the 4DCBCT acquisitions was also evaluated. The 4DCBCT images were evaluated using the following image quality metrics: spatial resolution, contrast-to-noise ratio (CNR), and uniformity index (UI). Additionally, Hounsfield unit (HU) sensitivity compared to a baseline CBCT and percent differences and RMS errors (RMSE) of excursion were also determined. Imaging dose was evaluated using an IBA CC13 ion chamber placed within CIRS Thorax phantom using the same sinusoidal motion and image acquisition settings as mentioned above. Results Spatial resolution decreased linearly from 5.93 to 3.82 lp/cm as gantry speed increased from 1.0 to 6.0°/s. CNR decreased linearly from 4.80 to 1.82 with gantry speed increasing from 1.0 to 6.0°/s, respectively. No noteworthy variations in UI, HU sensitivity, or excursion metrics were observed with changes in gantry speed. Ion chamber dose rates measured ranged from 2.30 (lung) to 5.18 (bone) E-3 cGy/mAs. Conclusions A quantitative analysis of the Varian OBI’s 4DCBCT capabilities was explored. Changing gantry speed changes the number of projections used for reconstruction, affecting both image quality and imaging dose if x-ray tube current is held constant. From the results of this study, a gantry speed between 2 and 3°/s was optimal when considering image quality, dose, and reconstruction time. The future of 4DCBCT clinical utility relies on further investigation of image acquisition and reconstruction optimization.
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Affiliation(s)
- Andrew P Santoso
- Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Kwang H Song
- Texas Oncology, Fort Worth, TX, 76104, USA.,Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Yujiao Qin
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Stephen J Gardner
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Chang Liu
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Munther Ajlouni
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA.
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