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Kang CL, Lee TF, Chan SH, Liu SC, Wang JC, Tsai CH, Liao KC, Fang FM, Chang L, Huang CC. Comparison of Intrafractional Motion in Head and Neck Cancer Between Two Immobilization Methods During Stereotactic Ablative Radiation Therapy by CyberKnife. Cancer Manag Res 2021; 12:13599-13606. [PMID: 33447079 PMCID: PMC7802594 DOI: 10.2147/cmar.s283746] [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: 09/28/2020] [Accepted: 11/28/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Maintaining immobilization to minimize spine motion is very important during salvage stereotactic ablative radiation therapy (SABR) for recurrent head and neck cancer. This study aimed to compare the intrafractional motion between two immobilization methods. Patients and Methods With a spine tracking system for image guiding, 9094 records from 41 patients receiving SABR by CyberKnife were obtained for retrospective comparison. Twenty-one patients were immobilized with a thermoplastic mask and headrest (Group A), and another 20 patients used a thermoplastic mask and headrest together with a vacuum bag to support the head and neck area (Group B). The intrafractional motion in the X (superior-inferior), Y (right-left), Z (anterior-posterior) axes, 3D (three-dimensional) vector, Roll, Pitch and Yaw in the two groups was compared. The margins of the planning target volume (PTV) to cover 95% intrafractional motion were evaluated. Results The translational movements in the X-axis, Y-axis, and 3D vector in Group A were significantly smaller than in Group B. The rotational errors in the Roll and Yaw in Group A were also significantly smaller than those in Group B; conversely, those in the Pitch in Group A were larger. To cover 95% intrafractional motion, margins of 0.96, 1.55, and 1.51 mm in the X, Y and Z axes, respectively were needed in Group A, and 1.06, 2.86, and 1.34 mm, respectively were required in Group B. Conclusion The immobilization method of thermoplastic mask and head rest with vacuum bag did not provide better immobilization than that without vacuum bag in most axes. The clinical use of 2 mm as a margin of PTV to cover 95% intrafractional motion was adequate in Group A but not in Group B.
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Affiliation(s)
- Chen-Lin Kang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan.,Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Tsair-Fwu Lee
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan.,Biomedical Engineering, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shan-Ho Chan
- Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Shyh-Chang Liu
- Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Jui-Chu Wang
- Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsiang Tsai
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuan-Cho Liao
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Fu-Min Fang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Liyun Chang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Chieh Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Jeon SH, Kim JH. Positional uncertainties of cervical and upper thoracic spine in stereotactic body radiotherapy with thermoplastic mask immobilization. Radiat Oncol J 2018; 36:122-128. [PMID: 29983032 PMCID: PMC6074070 DOI: 10.3857/roj.2017.00591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/07/2018] [Indexed: 01/19/2023] Open
Abstract
Purpose To investigate positional uncertainty and its correlation with clinical parameters in spine stereotactic body radiotherapy (SBRT) using thermoplastic mask (TM) immobilization. Materials and Methods A total of 21 patients who underwent spine SBRT for cervical or upper thoracic spinal lesions were retrospectively analyzed. All patients were treated with image guidance using cone beam computed tomography (CBCT) and 4 degrees-of-freedom (DoF) positional correction. Initial, pre-treatment, and post-treatment CBCTs were analyzed. Setup error (SE), pre-treatment residual error (preRE), post-treatment residual error (postRE), intrafraction motion before treatment (IM1), and intrafraction motion during treatment (IM2) were determined from 6 DoF manual rigid registration. Results The three-dimensional (3D) magnitudes of translational uncertainties (mean ± 2 standard deviation) were 3.7±3.5 mm (SE), 0.9±0.9 mm (preRE), 1.2±1.5 mm (postRE), 1.4±2.4 mm (IM1), and 0.9±1.0 mm (IM2), and average angular differences were 1.1°±1.2° (SE), 0.9°±1.1° (preRE), 0.9°±1.1° (postRE), 0.6°±0.9° (IM1), and 0.5°±0.5° (IM2). The 3D magnitude of SE, preRE, postRE, IM1, and IM2 exceeded 2 mm in 18, 0, 3, 3, and 1 patients, respectively. No association were found between all positional uncertainties and body mass index, pain score, and treatment location (p > 0.05, Mann-Whitney test). There was a tendency of intrafraction motion to increase with overall treatment time; however, the correlation was not statistically significant (p > 0.05, Spearman rank correlation test). Conclusion In spine SBRT using TM immobilization, CBCT and 4 DoF alignment correction, a minimum residual translational uncertainty was 2 mm. Shortening overall treatment time and 6 DoF positional correction may further reduce positional uncertainties.
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Affiliation(s)
- Seung Hyuck Jeon
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
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Leitzen C, Wilhelm-Buchstab T, Müdder T, Heimann M, Koch D, Schmeel C, Simon B, Stumpf S, Vornholt S, Garbe S, Röhner F, Schoroth F, Schild HH, Schüller H. Patient positioning in head and neck cancer : Setup variations and safety margins in helical tomotherapy. Strahlenther Onkol 2018; 194:386-391. [PMID: 29372290 DOI: 10.1007/s00066-018-1265-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/05/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the interfractional variations of patient positioning during intensity-modulated radiotherapy (IMRT) with helical tomotherapy in head and neck cancer and to calculate the required safety margins (sm) for bony landmarks resulting from the necessary table adjustments. MATERIALS AND METHODS In all, 15 patients with head and neck cancer were irradiated using the Hi-Art II tomotherapy system between April and September 2016. Before therapy sessions, patient position was frequently checked by megavolt computed tomography (MV-CT). Necessary table adjustments (ta) in the right-left (rl), superior-inferior (si) and anterior-posterior (ap) directions were recorded for four anatomical points: second, fourth and sixth cervical vertebral body (CVB), anterior nasal spine (ANS). Based upon these data sm were calculated for non-image-guided radiotherapy, image-guided radiotherapy (IGRT) and image guidance limited to a shortened area (CVB 2). RESULTS Based upon planning CT the actual treatment required ta from -0.05 ± 1.31 mm for CVB 2 (ap) up to 2.63 ± 2.39 mm for ANS (rl). Considering the performed ta resulting from image control (MV-CT) we detected remaining ta from -0.10 ± 1.09 mm for CVB 4 (rl) up to 1.97 ± 1.64 mm for ANS (si). After theoretical adjustment of patients position to CVB 2 the resulting ta ranged from -0.11 ± 2.44 mm for CVB6 (ap) to 2.37 ± 2.17 mm for ANS (si). These data imply safety margins: uncorrected patient position: 3.63-9.95 mm, corrected positioning based upon the whole target volume (IGRT): 1.85-6.63 mm, corrected positioning based upon CVB 2 (IGRT): 3.13-6.66 mm. CONCLUSIONS The calculated safety margins differ between anatomic regions. Repetitive and frequent image control of patient positioning is necessary that, however, possibly may be focussed on a limited region.
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Affiliation(s)
- Christina Leitzen
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany.
| | - Timo Wilhelm-Buchstab
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Thomas Müdder
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Martina Heimann
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - David Koch
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Christopher Schmeel
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Birgit Simon
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Sabina Stumpf
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Susanne Vornholt
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Stephan Garbe
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Fred Röhner
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Felix Schoroth
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Hans Heinz Schild
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
| | - Heinrich Schüller
- Radiologische Klinik, FE Strahlentherapie, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany
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Park ET, Park SK. Setup uncertainties for inter-fractional head and neck cancer in radiotherapy. Oncotarget 2016; 7:46662-46667. [PMID: 27259242 PMCID: PMC5216827 DOI: 10.18632/oncotarget.9748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 04/27/2016] [Indexed: 12/25/2022] Open
Abstract
Purpose The aim of this study is to determine the inter-fractional motion of cervical spine in radiotherapy (RT). Materials and Methods Eleven localized head and neck cancer patients who were treated from April 2014 to September 2015 were evaluated. Every patient underwent 3 times of computed tomography (CT) simulation with equivalent setting. Left-right (LR, x) and antero-posterior (AP, z) directional shift of cervical spine were evaluated using 33 number of CT image. In regard to random error, geometric changes were evaluated by 22 data set (compared the first obtained CT to second or third CT) by one-sample T test. Systemic error was evaluated by each patients’ data set (11 pairs) by paired T test. Results The mean random error of LR and AP translational shift of cervical spine were −0.39 ± 3.24 mm and −0.57 ± 0.99 mm respectively. The mean random error of translational change of AP direction showed statistical significance (p = 0.014). The mean random error of x and z rotational shift were −0.07 ± 0.29° and −0.05 ± 0.35°, respectively. The mean systemic error of translational shift of LR and AP direction were −0.64 ± 2.57 mm and −0.33 ± 1.22 mm, respectively. The mean systemic error of rotational shift of x and z were 0.01 ± 0.18° and −0.27 ± 0.33°, respectively. The mean systemic error of rotational changes of z direction showed statistical difference (p = 0.022). Conclusions We have to be aware of the inter-fractional motion of cervical spine in head and neck RT and give enough margins in RT planning.
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Affiliation(s)
- Eun-Tae Park
- Department of Radiation Oncology, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea
| | - Sung Kwang Park
- Department of Radiation Oncology, Busan Paik Hospital, Inje University School of Medicine, Busan, Korea
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Sharp G, Fritscher KD, Pekar V, Peroni M, Shusharina N, Veeraraghavan H, Yang J. Vision 20/20: perspectives on automated image segmentation for radiotherapy. Med Phys 2014; 41:050902. [PMID: 24784366 PMCID: PMC4000389 DOI: 10.1118/1.4871620] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/01/2014] [Accepted: 04/03/2014] [Indexed: 12/25/2022] Open
Abstract
Due to rapid advances in radiation therapy (RT), especially image guidance and treatment adaptation, a fast and accurate segmentation of medical images is a very important part of the treatment. Manual delineation of target volumes and organs at risk is still the standard routine for most clinics, even though it is time consuming and prone to intra- and interobserver variations. Automated segmentation methods seek to reduce delineation workload and unify the organ boundary definition. In this paper, the authors review the current autosegmentation methods particularly relevant for applications in RT. The authors outline the methods' strengths and limitations and propose strategies that could lead to wider acceptance of autosegmentation in routine clinical practice. The authors conclude that currently, autosegmentation technology in RT planning is an efficient tool for the clinicians to provide them with a good starting point for review and adjustment. Modern hardware platforms including GPUs allow most of the autosegmentation tasks to be done in a range of a few minutes. In the nearest future, improvements in CT-based autosegmentation tools will be achieved through standardization of imaging and contouring protocols. In the longer term, the authors expect a wider use of multimodality approaches and better understanding of correlation of imaging with biology and pathology.
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Affiliation(s)
- Gregory Sharp
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Karl D Fritscher
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114
| | | | - Marta Peroni
- Center for Proton Therapy, Paul Scherrer Institut, 5232 Villigen-PSI, Switzerland
| | - Nadya Shusharina
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114
| | - Harini Veeraraghavan
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065
| | - Jinzhong Yang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, Texas 77030
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Auto-segmentation of low-risk clinical target volume for head and neck radiation therapy. Pract Radiat Oncol 2014; 4:e31-7. [DOI: 10.1016/j.prro.2013.03.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/01/2013] [Accepted: 03/04/2013] [Indexed: 12/25/2022]
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