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Guberina M, Santiago A, Pöttgen C, Indenkämpen F, Lübcke W, Qamhiyeh S, Gauler T, Hoffmann C, Guberina N, Stuschke M. Respiration-controlled radiotherapy in lung cancer: Systematic evaluation of the optimal application practice. Clin Transl Radiat Oncol 2023; 40:100628. [PMID: 37138702 PMCID: PMC10149340 DOI: 10.1016/j.ctro.2023.100628] [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: 09/15/2022] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 05/05/2023] Open
Abstract
Background and purpose Definitive radiochemotherapy (RCT) for non-small cell lung cancer (NSCLC) in UICC/TNM I-IVA (singular, oligometastatic) is one of the treatment methods with a potentially curative concept. However, tumour respiratory motion during RT requires exact pre-planning. There are various techniques of motion management like creating internal target volume (ITV), gating, inspiration breath-hold and tracking. The primary goal is to cover the PTV with the prescribed dose while at the same time maximizing dose reduction of surrounding normal tissues (organs at risk, OAR). In this study, two standardized online breath-controlled application techniques used alternately in our department are compared with respect to lung and heart dose. Materials and methods Twenty-four patients who were indicated for thoracic RT received planning CTs in voluntary deep inspiration breath-hold (DIBH) and in free shallow breathing, prospectively gated in expiration (FB-EH). A respiratory gating system by Varian (Real-time Position Management, RPM) was used for monitoring. OAR, GTV, CTV and PTV were contoured on both planning CTs. The PTV margin to the CTV was 5 mm in the axial and 6-8 mm in the cranio-caudal direction. The consistency of the contours was checked by elastic deformation (Varian Eclipse Version 15.5). RT plans were generated and compared in both breathing positions using the same technique, IMRT over fixed irradiation directions or VMAT. The patients were treated in a prospective registry study with the approval of the local ethics committee. Results The PTV in expiration (FB-EH) was on average significantly smaller than the PTV in inspiration (DIBH): for tumours in the lower lobe (LL) 431.5 vs. 477.6 ml (Wilcoxon test for connected samples; p = 0.004), in the upper lobe (UL) 659.5 vs. 686.8 ml (p = 0.005). The intra-patient comparison of plans in DIBH and FB-EH showed superiority of DIBH for UL-tumours and equality of DIBH and FB-EH for LL-tumours. The dose for OAR in UL-tumours was lower in DIBH than in FB-EH (mean lung dose p = 0.011; lungV20, p = 0.002; mean heart dose p = 0.016). The plans for LL-tumours in FB-EH showed no difference in OAR compared to DIBH (mean lung dose p = 0.683; V20Gy p = 0.33; mean heart dose p = 0.929). The RT setting was controlled online for each fraction and was robustly reproducible in FB-EH. Conclusion RT plans for treating lung tumours implemented depend on the reproducibility of the DIBH and advantages of the respiratory situation with respect to OAR. The primary tumour localization in UL correlates with advantages of RT in DIBH, compared to FB-EH. For LL-tumours there is no difference between RT in FB-EH and RT in DIBH with respect to heart or lung exposure and therefore, reproducibility is the dominant criterion. FB-EH is recommended as a very robust and efficient technique for LL-tumours.
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Affiliation(s)
- M. Guberina
- Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Consortium for Translational Cancer Research, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site University Hospital Essen, Deutsche Krebsforschungszentrum (DKFZ), Essen, Germany
- Corresponding author at: Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Hufealndstr. 55, Essen 45147, Germany.
| | - A. Santiago
- Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
- Medical Physics, Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - C. Pöttgen
- Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - F. Indenkämpen
- Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
- Medical Physics, Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - W. Lübcke
- Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
- Medical Physics, Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - S. Qamhiyeh
- Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
- Medical Physics, Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - T. Gauler
- Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - C. Hoffmann
- Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - N. Guberina
- Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
| | - M. Stuschke
- Department for Radiotherapy, University Hospital Essen, West German Cancer Center, University Duisburg-Essen, Essen, Germany
- German Consortium for Translational Cancer Research, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site University Hospital Essen, Deutsche Krebsforschungszentrum (DKFZ), Essen, Germany
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Ohashi A, Nishio T, Saito A, Hashimoto D, Maekawa H, Murakami Y, Ozawa S, Suitani M, Tsuneda M, Watanabe H, Ikenaga K, Nagata Y. Baseline drift vector of multiple points on body surface using a near-infrared camera. Phys Eng Sci Med 2022; 45:143-155. [PMID: 34982403 DOI: 10.1007/s13246-021-01097-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to extract the three-dimensional (3D) vector of the baseline drift baseline drift vector (BDV) of the specific points on the body surface and to demonstrate the importance of the 3D tracking of the body surface. Our system consisted of a near-infrared camera (NIC: Kinect V2) and software that recognized and tracked blue stickers as markers. We acquired 3D coordinates of 30 markers stuck on the body surface for 30 min for eight healthy volunteers and developed a simple technique to extract the BDV. The BDV on the sternum, rib, and abdomen was extracted from the measured data. BDV per min. was analyzed to estimate the frequency to exceed a given tolerance. Also, the correlation among BDVs for multiple body sites was analyzed. The longitudinal baseline drift was observed in the BDV of healthy volunteers. Among the eight volunteers, the maximum probability that the BDV per min. exceeded the tolerance of 1 mm and 2 mm was 30% and 15%, respectively. The correlation among BDVs of multiple body sites suggested a potential feasibility to distinguish the translational movement of the whole area and the respiratory movement. In conclusion, we constructed the 3D tracking system of multiple points on the body surface using a noninvasive NIC at a low cost and established the method to extract the BDV. The existence of the longitudinal baseline drift showed the importance of the 3D tracking in the body surface.
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Affiliation(s)
- Atsuyuki Ohashi
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, Hiroshima, 734-8551, Japan. .,Ashiya Radiotherapy Clinic Nozomi, 3-84 Yokocho, Ashiya, Hyogo, 659-0034, Japan. .,Insightec Japan K.K., Hachioji First Square 7F 3-20-6, Myojin-cho, Hachioji-shi, Tokyo, 192-0046, Japan.
| | - Teiji Nishio
- Department of Medical Physics, Graduate School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan
| | - Akito Saito
- Department of Radiation Oncology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami, Hiroshima, Hiroshima, 734-8551, Japan
| | - Daiki Hashimoto
- Information and Communication Research Division, Mizuho Information & Research Institute, Inc., 2-3 Kanda-Nishikicho, Chiyoda-ku, Tokyo, 101-8443, Japan
| | - Hidemasa Maekawa
- Information and Communication Research Division, Mizuho Information & Research Institute, Inc., 2-3 Kanda-Nishikicho, Chiyoda-ku, Tokyo, 101-8443, Japan
| | - Yuji Murakami
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, Hiroshima, 734-8551, Japan
| | - Shuichi Ozawa
- Hiroshima High-Precision Radiotherapy Cancer Center, 3-2-2 Futabanosato, Higashi Ward, Hiroshima, Hiroshima, 732-0057, Japan
| | - Makiko Suitani
- Information and Communication Research Division, Mizuho Information & Research Institute, Inc., 2-3 Kanda-Nishikicho, Chiyoda-ku, Tokyo, 101-8443, Japan
| | - Masato Tsuneda
- Department of Radiation Oncology, Graduate School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku, Tokyo, 162-8666, Japan
| | - Hiroshi Watanabe
- Ashiya Radiotherapy Clinic Nozomi, 3-84 Yokocho, Ashiya, Hyogo, 659-0034, Japan
| | - Koji Ikenaga
- Ashiya Radiotherapy Clinic Nozomi, 3-84 Yokocho, Ashiya, Hyogo, 659-0034, Japan
| | - Yasushi Nagata
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, Hiroshima, 734-8551, Japan
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Erdoğan T, Fidan U, Özyiğit G. Patient-specific tumor and respiratory monitoring phantom design for quality controls of stereotactic ablative body radiotherapy in lung cancer cases. Phys Med 2021; 90:40-49. [PMID: 34536726 DOI: 10.1016/j.ejmp.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 11/16/2022] Open
Abstract
The design, production and adaptability to clinical routine of a patient-specific tumor and respiratory monitoring phantom (TRMP) was investigated using 3D printer technology. TRMP and GTV modelling were done using 4D-CT images of the inhalation phase. The model was converted to STL (Stereolithography) format and printed with STH (Strong Herbal) biopolymer with HU (Hounsfield Unit) suitable for imaging purposes. The assembly of TRMP motorized parts and mechanical equipment has been completed and made suitable for clinical use. In the first part of the study, the deviations of radio-opaque markers attached to the TRMP sternum to perform mechanical quality control tests and T1-7 costal vertebrae in CC, AP, and LAT directions were evaluated. In the second part of the study, in order to evaluate the usability of the TRMP in quality assurance (QA), point dose measurements with BeO OSL dosimetry and EBT3 gafchromic film measurements were taken in Trilogy® radiotherapy accelerator and CyberKnife® robotic radiosurgery accelerator. In this study, we present a highly flexible TMRP capable of performing independent internal and external motions. TRMP was successfully tested in different treatment accelerators, both mechanically and dosimetrically.
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Affiliation(s)
- Taha Erdoğan
- Department of Radiation Oncology, Afyonkarahisar Health Sciences University Faculty of Medicine, 03030 Afyonkarahisar, Turkey.
| | - Uğur Fidan
- Department of Biomedical Engineering, Afyonkocatepe University Faculty of Engineering, 03030 Afyonkarahisar, Turkey
| | - Gökhan Özyiğit
- Department of Radiation Oncology, Cancer Institute, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey
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Shiinoki T, Fujii F, Yuasa Y, Nonomura T, Fujimoto K, Sera T, Tanaka H. Analysis of dosimetric impact of intrafraction translation and rotation during respiratory‐gated stereotactic body radiotherapy with real‐time tumor monitoring of the lung using a novel six degrees‐of‐freedom robotic moving phantom. Med Phys 2020; 47:3870-3881. [DOI: 10.1002/mp.14369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/02/2020] [Accepted: 06/23/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Takehiro Shiinoki
- Department of Radiation Oncology Graduate School of Medicine Yamaguchi University 1‐1‐1 Minamikogushi Ube Yamaguchi755‐8505Japan
| | - Fumitake Fujii
- Department of Mechanical Engineering Graduate School of Science and Technology for Innovation Yamaguchi University 2‐16‐1 Tokiwadai Ube Yamaguchi755‐8611Japan
| | - Yuki Yuasa
- Department of Radiation Oncology Graduate School of Medicine Yamaguchi University 1‐1‐1 Minamikogushi Ube Yamaguchi755‐8505Japan
| | - Tatsuki Nonomura
- Department of Mechanical Engineering Graduate School of Science and Technology for Innovation Yamaguchi University 2‐16‐1 Tokiwadai Ube Yamaguchi755‐8611Japan
| | - Koya Fujimoto
- Department of Radiation Oncology Graduate School of Medicine Yamaguchi University 1‐1‐1 Minamikogushi Ube Yamaguchi755‐8505Japan
| | - Tatsuhiro Sera
- Department of Radiological Technology Yamaguchi University Hospital 1‐1‐1 Minamikogushi Ube Yamaguchi755‐8505Japan
| | - Hidekazu Tanaka
- Department of Radiation Oncology Graduate School of Medicine Yamaguchi University 1‐1‐1 Minamikogushi Ube Yamaguchi755‐8505Japan
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Shiinoki T, Fujii F, Fujimoto K, Yuasa Y, Sera T. A novel dynamic robotic moving phantom system for patient-specific quality assurance in real-time tumor-tracking radiotherapy. J Appl Clin Med Phys 2020; 21:16-28. [PMID: 32281265 PMCID: PMC7386190 DOI: 10.1002/acm2.12876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 12/29/2020] [Accepted: 03/10/2020] [Indexed: 12/25/2022] Open
Abstract
In this study, we assess a developed novel dynamic moving phantom system that can reproduce patient three-dimensional (3D) tumor motion and patient anatomy, and perform patient-specific quality assurance (QA) of respiratory-gated radiotherapy using SyncTraX. Three patients with lung cancer were enrolled in a study. 3D printing technology was adopted to obtain individualized lung phantoms using CT images. A water-equivalent phantom (WEP) with the 3D-printed plate lung phantom was set at the tip of the robotic arm. The log file that recorded the 3D positions of the lung tumor was used as the input to the dynamic robotic moving phantom. The WEP was driven to track 3D respiratory motion. Respiratory-gated radiotherapy was performed for driving the WEP. The tracking accuracy was calculated as the differences between the actual and measured positions. For the absolute dose and dose distribution, the differences between the planned and measured doses were calculated. The differences between the planned and measured absolute doses were <1.0% at the isocenter and <4.0% for the lung region. The gamma pass ratios of γ3 mm/3% and γ2 mm/2% under the conditions of gating and no-gating were 99.9 ± 0.1% and 90.1 ± 8.5%, and 97.5 ± 0.9% and 68.6 ± 17.8%, respectively, for all the patients. Furthermore, for all the patients, the mean ± SD of the root mean square values of the positional error were 0.11 ± 0.04 mm, 0.33 ± 0.04 mm, and 0.20 ± 0.04 mm in the LR, AP, and SI directions, respectively. Finally, we showed that patient-specific QA of respiratory-gated radiotherapy using SyncTraX can be performed under realistic conditions using the moving phantom.
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Affiliation(s)
- Takehiro Shiinoki
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Fumitake Fujii
- Department of Mechanical Engineering, Graduate School of Science and Technology for innovation, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Koya Fujimoto
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Yuki Yuasa
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, Ube, Yamaguchi, Japan
| | - Tatsuhiro Sera
- Department of Radiological Technology, Yamaguchi University Hospital, Ube, Yamaguchi, Japan
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Zhang K, Dai J, Hu Z, Niu C. Dosimetric impact of hysteresis on lung cancer tomotherapy: A moving phantom study. Phys Med 2018; 49:40-46. [DOI: 10.1016/j.ejmp.2018.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/15/2018] [Accepted: 04/04/2018] [Indexed: 12/25/2022] Open
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Dose Verification for Tumor Motion with Different Treatment Planning Systems: A Dynamic Thorax Phantom Study. J Med Biol Eng 2018. [DOI: 10.1007/s40846-017-0367-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Goo HW, Allmendinger T. Combined Electrocardiography- and Respiratory-Triggered CT of the Lung to Reduce Respiratory Misregistration Artifacts between Imaging Slabs in Free-Breathing Children: Initial Experience. Korean J Radiol 2017; 18:860-866. [PMID: 28860904 PMCID: PMC5552470 DOI: 10.3348/kjr.2017.18.5.860] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/12/2017] [Indexed: 11/16/2022] Open
Abstract
Objective Cardiac and respiratory motion artifacts degrade the image quality of lung CT in free-breathing children. The aim of this study was to evaluate the effect of combined electrocardiography (ECG) and respiratory triggering on respiratory misregistration artifacts on lung CT in free-breathing children. Materials and Methods In total, 15 children (median age 19 months, range 6 months–8 years; 7 boys), who underwent free-breathing ECG-triggered lung CT with and without respiratory-triggering were included. A pressure-sensing belt of a respiratory gating system was used to obtain the respiratory signal. The degree of respiratory misregistration artifacts between imaging slabs was graded on a 4-point scale (1, excellent image quality) on coronal and sagittal images and compared between ECG-triggered lung CT studies with and without respiratory triggering. A p value < 0.05 was considered significant. Results Lung CT with combined ECG and respiratory triggering showed significantly less respiratory misregistration artifacts than lung CT with ECG triggering only (1.1 ± 0.4 vs. 2.2 ± 1.0, p = 0.003). Conclusion Additional respiratory-triggering reduces respiratory misregistration artifacts on ECG-triggered lung CT in free-breathing children.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 05505, Korea
| | - Thomas Allmendinger
- Siemens Healthcare, GmbH, Computed Tomography Division, Forchheim 91301, Germany
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