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Thomsen SN, Møller DS, Knap MM, Khalil AA, Shcytte T, Hoffmann L. Daily CBCT-based dose calculations for enhancing the safety of dose-escalation in lung cancer radiotherapy. Radiother Oncol 2024; 200:110506. [PMID: 39197502 DOI: 10.1016/j.radonc.2024.110506] [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: 07/01/2024] [Accepted: 08/19/2024] [Indexed: 09/01/2024]
Abstract
PURPOSE Dose-escalation in lung cancer comes with a high risk of severe toxicity. This study aimed to calculate the delivered dose in a Scandinavian phase-III dose-escalation trial. METHODS The delivered dose was evaluated for 21 locally-advanced non-small cell lung cancer (LA-NSCLC) patients treated as part of the NARLAL2 dose-escalation trial. The patients were randomized between standard and escalated heterogeneous dose-delivery. Both treatment plans were created and approved before randomization. Daily cone-beam CT (CBCT) for patient positioning, and adaptive radiotherapy were mandatory. Standard and escalated plans, including adaptive re-plans, were recalculated on each daily CBCT and accumulated on the planning CT for each patient. Dose to the clinical target volume (CTV), organs at risk (OAR), and the effects of plan adaptions were evaluated for the accumulated dose and on each treated fraction scaled to full treatment. RESULTS For the standard treatment, plan adaptations reduced the number of patients with CTV-T underdosage from six to one, and the total number of fractions with CTV-T underdosage from 161 to 56; while for the escalated treatment, the number of patients was reduced from five to zero and number of fractions from 81 to 11. For dose-escalation, three patients had fractions exceeding trial constraints for heart, bronchi, or esophagus, and one had an accumulated heart dose above the constraints. CONCLUSION Dose-escalation for LA-NSCLC patients, using daily image guidance and adaptive radiotherapy, is dosimetrically safe for the majority of patients. Dose calculation on daily CBCTs is an efficient tool to monitor target coverage and OAR doses.
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Affiliation(s)
- S N Thomsen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - D S Møller
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - M M Knap
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - A A Khalil
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - T Shcytte
- Department of Oncology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - L Hoffmann
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Jassim H, Nedaei HA, Geraily G, Banaee N, Kazemian A. The geometric and dosimetric accuracy of kilovoltage cone beam computed tomography images for adaptive treatment: a systematic review. BJR Open 2023; 5:20220062. [PMID: 37389008 PMCID: PMC10301728 DOI: 10.1259/bjro.20220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/24/2023] [Indexed: 07/01/2023] Open
Abstract
Objectives To provide an overview and meta-analysis of different techniques adopted to accomplish kVCBCT for dose calculation and automated segmentation. Methods A systematic review and meta-analysis were performed on eligible studies demonstrating kVCBCT-based dose calculation and automated contouring of different tumor features. Meta-analysis of the performance was accomplished on the reported γ analysis and dice similarity coefficient (DSC) score of both collected results as three subgroups (head and neck, chest, and abdomen). Results After the literature scrutinization (n = 1008), 52 papers were recognized for the systematic review. Nine studies of dosimtric studies and eleven studies of geometric analysis were suitable for inclusion in meta-analysis. Using kVCBCT for treatment replanning depends on a method used. Deformable Image Registration (DIR) methods yielded small dosimetric error (≤2%), γ pass rate (≥90%) and DSC (≥0.8). Hounsfield Unit (HU) override and calibration curve-based methods also achieved satisfactory yielded small dosimetric error (≤2%) and γ pass rate ((≥90%), but they are prone to error due to their sensitivity to a vendor-specific variation in kVCBCT image quality. Conclusions Large cohorts of patients ought to be undertaken to validate methods achieving low levels of dosimetric and geometric errors. Quality guidelines should be established when reporting on kVCBCT, which include agreed metrics for reporting on the quality of corrected kVCBCT and defines protocols of new site-specific standardized imaging used when obtaining kVCBCT images for adaptive radiotherapy. Advances in knowledge This review gives useful knowledge about methods making kVCBCT feasible for kVCBCT-based adaptive radiotherapy, simplifying patient pathway and reducing concomitant imaging dose to the patient.
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Affiliation(s)
| | | | | | - Nooshin Banaee
- Medical Radiation Research Center, Islamic Azad University, Tehran, Iran
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Prasath SS, Babu PR. Dosimetric Comparison between Acuros XB (AXB) and Anisotropic Analytical Algorithm (AAA) in Volumetric Modulated Arc Therapy. Asian Pac J Cancer Prev 2023; 24:1677-1685. [PMID: 37247288 PMCID: PMC10495917 DOI: 10.31557/apjcp.2023.24.5.1677] [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: 12/17/2022] [Accepted: 05/22/2023] [Indexed: 05/31/2023] Open
Abstract
AIM Dose calculation accuracy between Anisotropic Analytical Algorithm (AAA) and Acuros XB (AXB) for various megavoltage (MV) photon beams for both flattening filter (FF) and flattening filter free (FFF) beams and to validate the accuracy of these dose calculations using inhomogeneous phantom in volumetric modulated arc therapy (VMAT). MATERIAL AND METHODS A Cheese Phantom having 20 holes that can be filled with all virtual water plugs or set of density calibration plugs was used for VMAT planning using two different algorithms using either single or double arc. Further phantom was used irradiate plan in linear accelerator and the point doses measured using a 0.053 cc A1SL ionization chamber along electrometer . Different plans, cylindrical shape, C-shaped and donut targets were planned 6MV, 10MV, 6FFF MV and 10FFF MV beam energy. RESULT The minimum average mean dose difference was 1.2% for PTV structures between AAA and AXB (p=0.02). Apart from these structures, the following density plugs have a more than 2% difference in maximum dose with statistical significance. (i) Solid water (MD=6.1%, p=0.016), (ii) Bone 200 (2.3%, p=0.029), (iii) CB_30% (MD=2.4%, p=0.050) and (iv) Cortical bone (MD=4.3%, p=0.018). In 6MV FFF and 10 MV FFF plans, the difference between AAA and AXB was not statistically significant (Fig 3). The Conformity index for the AAA less than that of AXB, in all energies and for all the PTVs. The CI was better in AXB than AAA, but the CI was not having much variation due to changes in beam energies, particularly for Cylinder shaped PTV. CONCLUSION All combinations of beam energy AAA showed higher values in the maximum dose than the Acuros XB, except for the lung insert. Nonetheless, AAA showed a higher mean dose than the Acuros XB. Differences between these two algorithms for most of the beam energies are minimal.
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Affiliation(s)
- S. Sriram Prasath
- Division of Medical Physics, Department of Radiation Oncology, Tata Medical Center, Newtown, Rajarhat, Kolkata, West Bengal, India.
- Department of Physics, SAS, Vellore Institute of Technology, Vellore, Tamil Nadu, India.
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Holm AIS, Nyeng TB, S. Møller D, Assenholt MS, Hansen R, Nyvang L, Ravkilde T, Thomsen MS, Hoffmann L. Density calibrated cone beam CT as a tool for adaptive radiotherapy. Acta Oncol 2021; 60:1275-1282. [PMID: 34224288 DOI: 10.1080/0284186x.2021.1945678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Visual inspections of anatomical changes observed on daily cone-beam CT (CBCT) images are often used as triggers for radiotherapy plan adaptation to avoid unacceptable dose levels to the target or OARs. Direct CBCT dose calculations would improve the ability to adapt only those plans where dosimetric changes are observed. This study investigates the accuracy of dose calculations on CBCTs. MATERIALS AND METHODS Calibration curves were obtained for CBCT imagers at nine identical accelerators. CBCT scans of a phantom with different density inserts were recorded for two scan modes (Head-Neck and Pelvis) and mean calibration curves were calculated. Subsequently, CBCT scans of the phantom with six different density inserts were recorded, the dose distributions on the CBCTs were calculated and compared to dose on the planning CT (pCT). The uncertainty was quantified by the dosimetric difference between the pCT and the CBCT. The two mean calibration curves were used to calculate the daily delivered CBCT dose for ten Head-Neck-, eleven Lung-, and ten pelvic patients. Additional patient calculations were performed using low-HU empirically corrected calibration curves. Patient doses were compared on target coverage and mean dose, and D1cc for OARs. RESULTS The dose differences between pCT and CBCT for phantom data were small for all DVH parameters, with mean deviations below ±0.6% for both CBCT modes. For patient data, it was found that low-HU corrected calibration curves performed the best. The mean deviations for the mean dose and coverage of the target were 0.2%±0.7% and 0.1%±0.6%, across all patient groups. CONCLUSION Dose calculation on CBCT images results in target coverage and mean dose with an accuracy of the order of 1%, which makes this acceptable for clinical use. The CBCT mode specific calibration curves can be used at all identical imaging devices and for all patient groups.
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Affiliation(s)
- Anne I. S. Holm
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Tine B. Nyeng
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte S. Møller
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne S. Assenholt
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Rune Hansen
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Nyvang
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Ravkilde
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Mette S. Thomsen
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Hoffmann
- Department of Oncology, Section for Medical Physics, Aarhus University Hospital, Aarhus, Denmark
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Martin TW, Boss MK, LaRue SM, Leary D. 3D-printed bolus improves dose distribution for veterinary patients treated with photon beam radiation therapy. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2020; 61:638-644. [PMID: 32675816 PMCID: PMC7238465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Commercial bolus is frequently used to increase dose at the patient's surface for superficial radiotherapy; however, uneven surfaces can create air gaps and discrepancies between prescribed and delivered dose. The purpose of this study was to determine if a customizable, 3D-printed bolus would improve dosimetry compared with a commercial bolus. For each patient, a planned bolus was generated within planning software, then created with 3D-printing. The treatment plan was recalculated with each bolus in situ. When evaluating tumor volumes at prescription, the 3D-printed bolus was closer to prescription compared to the commercial bolus. There was a significant difference in air gaps in patients receiving radiotherapy to the head (P < 0.001) but the difference was not significant for air gaps in caudal body sites (P = 0.05). Overall, the 3D-printed bolus resulted in reduced air gaps, dosimetry closer to prescription, and should be considered for superficial treatment areas of high irregularity.
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Affiliation(s)
- Tiffany Wormhoudt Martin
- Colorado State University Veterinary Teaching Hospital, Flint Animal Cancer Center, Department of Environmental & Radiological Health Sciences, 300 W. Drake Rd., Fort Collins, Colorado 80523, USA
| | - Mary-Keara Boss
- Colorado State University Veterinary Teaching Hospital, Flint Animal Cancer Center, Department of Environmental & Radiological Health Sciences, 300 W. Drake Rd., Fort Collins, Colorado 80523, USA
| | - Susan M LaRue
- Colorado State University Veterinary Teaching Hospital, Flint Animal Cancer Center, Department of Environmental & Radiological Health Sciences, 300 W. Drake Rd., Fort Collins, Colorado 80523, USA
| | - Del Leary
- Colorado State University Veterinary Teaching Hospital, Flint Animal Cancer Center, Department of Environmental & Radiological Health Sciences, 300 W. Drake Rd., Fort Collins, Colorado 80523, USA
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