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Muecke J, Reitz D, Huang L, da Silva Mendes V, Landry G, Reiner M, Belka C, Freislederer P, Corradini S, Niyazi M. Intrafractional motion detection for spine SBRT via X-ray imaging using ExacTrac Dynamic. Clin Transl Radiat Oncol 2024; 46:100765. [PMID: 38560512 PMCID: PMC10979138 DOI: 10.1016/j.ctro.2024.100765] [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: 07/21/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Due to its close vicinity to critical structures, especially the spinal cord, standards for safety for spine stereotactic body radiotherapy (SBRT) should be high. This study was conducted, to evaluate intrafractional motion during spine SBRT for patients without individualized immobilization (e.g., vacuum cushions) using high accuracy patient monitoring via orthogonal X-ray imaging. Methods Intrafractional X-ray data were collected from 29 patients receiving 79 fractions of spine SBRT. No individualized immobilization devices were used during the treatment. Intrafractional motion was monitored using the ExacTrac Dynamic (ETD) System (Brainlab AG, Munich, Germany). Deviations were detected in six degrees of freedom (6 DOF). Tolerances for repositioning were 0.7 mm for translational and 0.5° for rotational deviations. Patients were repositioned when the tolerance levels were exceeded. Results Out of the 925 pairs of stereoscopic X-ray images examined, 138 (15 %) showed at least one deviation exceeding the predefined tolerance values. In all 6 DOF together, a total of 191 deviations out of tolerance were recorded. The frequency of deviations exceeding the tolerance levels varied among patients but occurred in all but one patient. Deviations out of tolerance could be seen in all 6 DOF. Maximum translational deviations were 2.6 mm, 2.3 mm and 2.8 mm in the lateral, longitudinal and vertical direction. Maximum rotational deviations were 1.8°, 2.6° and 1.6° for pitch, roll and yaw, respectively. Translational deviations were more frequent than rotational ones, and frequency and magnitude of deviations showed an inverse correlation. Conclusion Intrafractional motion detection and patient repositioning during spine SBRT using X-ray imaging via the ETD System can lead to improved safety during the application of high BED in critical locations. When using intrafractional imaging with low thresholds for re-positioning individualized immobilization devices (e.g. vacuum cushions) may be omitted.
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Affiliation(s)
- Johannes Muecke
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Reitz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- Strahlentherapie Nymphenburg/Fürstenfeldbruck, Munich, Germany
| | - Lili Huang
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | | | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | | | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
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Iramina H, Nakamura M, Nakamura K, Fujimoto T, Mizowaki T. Quantification of six-degree-of-freedom motion during beam delivery in spine stereotactic body radiotherapy using intra-irradiation cone-beam computed tomography imaging technique. Phys Med 2023; 110:102605. [PMID: 37167776 DOI: 10.1016/j.ejmp.2023.102605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/22/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023] Open
Abstract
PURPOSE Quantifying intra-fractional six-degree-of-freedom (6DoF) residual errors or motion from approved patient setups is necessary for accurate beam delivery in spine stereotactic body radiotherapy. However, previously reported errors were not acquired during beam delivery. Therefore, we aimed to quantify the 6DoF residual errors and motions during arc beam delivery using a concurrent cone-beam computed tomography (CBCT) imaging technique, intra-irradiation CBCT. METHODS Consecutive 15 patients, 19 plans for various treatment sites, and 199 CBCT images were analyzed. Pre-irradiation CBCT was performed to verify shifts from the initial patient setup using the ExacTrac system. During beam delivery by two or three co-planar full-arc rotations, CBCT imaging was performed concurrently. Subsequently, an intra-irradiation CBCT image was reconstructed. Pre- and intra-irradiation CBCT images were rigidly registered to a planning CT image based on the bone to quantify 6DoF residual errors. RESULTS 6DoF residual errors quantified using pre- and intra-irradiation CBCTs were within 2.0 mm/2.0°, except for one measurement. The mean elapsed time (mean ± standard deviation [min:sec]) after pre-irradiation CBCT to the end of the last arc beam delivery was 6:08 ± 1:25 and 7:54 ± 2:14 for the 2- and 3-arc plans, respectively. Root mean squares of residual errors for several directions showed significant differences; however, they were within 1.0 mm/1.0°. Time-dependent analysis revealed that the residual errors tended to increase with elapsed time. CONCLUSION The errors represent the optimal intra-fractional error compared with those acquired using the pre-, inter-beam, and post-6DoF image guidance and can be acquired within a standard treatment timeslot.
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Affiliation(s)
- Hiraku Iramina
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Mitsuhiro Nakamura
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Kiyonao Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takahiro Fujimoto
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
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Mizonobe K, Akasaka H, Uehara K, Oki Y, Nakayama M, Tamura S, Munetomo Y, Kubo K, Kawaguchi H, Harada A, Mayahara H. Respiratory motion tracking of spine stereotactic radiotherapy in prone position. J Appl Clin Med Phys 2023; 24:e13910. [PMID: 36650923 PMCID: PMC10161010 DOI: 10.1002/acm2.13910] [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: 07/11/2022] [Revised: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The CyberKnife system is a specialized device for non-coplanar irradiation; however, it possesses the geometric restriction that the beam cannot be irradiated from under the treatment couch. Prone positioning is expected to reduce the dose to normal lung tissue in spinal stereotactic body radiotherapy (SBRT) owing to the efficiency of beam arrangement; however, respiratory motion occurs. Therefore, the Xsight spine prone tracking (XSPT) system is used to reduce the effects of respiratory motion. The purpose of this study was to evaluate the motion-tracking error of the spine in the prone position. MATERIALS AND METHODS Data from all 25 patients who underwent spinal SBRT at our institution between April 2020 and February 2022 using CyberKnife (VSI, version 11.1.0) with the XSPT tracking system were retrospectively analyzed using log files. The tumor motion, correlation, and prediction errors for each patient were examined. Furthermore, to assess the potential relationships between the parameters, the relationships between the tumor-motion amplitudes and correlation or prediction errors were investigated using linear regression. RESULTS The tumor-motion amplitudes in each direction were as follows: superior-inferior (SI), 0.51 ± 0.39 mm; left-right (LR), 0.37 ± 0.29 mm; and anterior-posterior (AP), 3.43 ± 1.63 mm. The overall mean correlation and prediction errors were 0.66 ± 0.48 mm and 0.06 ± 0.07 mm, respectively. The prediction errors were strongly correlated with the tumor-motion amplitudes, whereas the correlation errors were not. CONCLUSIONS This study demonstrated that the correlation error of spinal SBRT in the prone position is sufficiently small to be independent of the tumor-motion amplitude. Furthermore, the prediction error is small, contributing only slightly to the tracking error. These findings will improve the understanding of how to compensate for respiratory-motion uncertainty in the prone position.
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Affiliation(s)
- Kazufusa Mizonobe
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroaki Akasaka
- Department of Chemical Engineering, The University of Melbourne, The University of Melbourne Grattan Street, Parkville, Victoria, Australia.,Division of Radiation Oncology, Kobe University Graduate School of Medicine, Chuou-ku, Kobe, Hyogo, Japan
| | - Kazuyuki Uehara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Yuya Oki
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Masao Nakayama
- Division of Radiation Oncology, Kobe University Graduate School of Medicine, Chuou-ku, Kobe, Hyogo, Japan.,Division of Radiation Therapy, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Shuhei Tamura
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Yoshiki Munetomo
- Division of Radiological Technology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Katsumaro Kubo
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroki Kawaguchi
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Aya Harada
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroshi Mayahara
- Division of Radiation Oncology, Kobe Minimally Invasive Cancer Center, Chuo-ku, Kobe, Hyogo, Japan
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Implementation of triggered kilovoltage imaging for stereotactic radiotherapy of the spine for patients with spinal fixation hardware. Phys Imaging Radiat Oncol 2023; 25:100422. [PMID: 36875327 PMCID: PMC9978845 DOI: 10.1016/j.phro.2023.100422] [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: 08/06/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Background and purpose Mitigation of intrafraction motion (IM) is valuable in stereotactic radiotherapy (SRT) radiotherapy where submillimeter accuracy is desired. The purpose of this study was to investigate the application of triggered kilovoltage (kV) imaging for spine SRT patients with hardware by correlating kV imaging with patient motion and summarizing implications of tolerance for IM based on calculated dose. Materials and methods Ten plans (33 fractions) were studied, correlating kV imaging during treatment with pre- and post-treatment cone beam computed tomography (CBCT). Images were taken at 20-degree gantry angle intervals during the arc-based treatment. The contour of the hardware with a 1 mm expansion was displayed at the treatment console to manually pause treatment delivery if the hardware was visually detected outside the contour. The treatment CBCTs were compared using retrospective image registration to assess the validity of contour-based method for pausing treatment. Finally, plans were generated to estimate dose volume objective differences in case of 1 mm deviation. Results When kV imaging during treatment was used with the 1 mm contour, 100 % of the post-treatment CBCTs reported consistent results. One patient in the cohort exhibited motion greater than 1 mm during treatment which allowed intervention and re-setup during treatment. The average translational motion was 0.35 mm. Treatment plan comparison at 1 mm deviation showed little differences in calculated dose for the target and cord. Conclusions Utilizing kV imaging during treatment is an effective method of assessing IM for SRT spine patients with hardware without increasing treatment time.
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Quan E, Krafft SP, Briere TM, Vaccarelli MJ, Ghia AJ, Bishop AJ, Yeboa DN, Swanson TA, Han EY. Comparison of setup accuracy and efficiency between the Klarity system and BodyFIX system for spine stereotactic body radiation therapy. J Appl Clin Med Phys 2022; 23:e13804. [DOI: 10.1002/acm2.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/03/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Enzhuo Quan
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Shane P. Krafft
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Tina M. Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Marissa J. Vaccarelli
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Amol J. Ghia
- Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Andrew J. Bishop
- Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Debra N. Yeboa
- Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Todd A. Swanson
- Radiation Oncology The University of Texas MD Anderson Cancer Center Houston Texas USA
| | - Eun Young Han
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center Houston Texas USA
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Billiet C, Vingerhoed W, Van Laere S, Joye I, Mercier C, Dirix P, Nevens D, Vermeulen P, Meijnders P, Verellen D. Precision of image-guided spinal stereotactic ablative radiotherapy and impact of positioning variables. Phys Imaging Radiat Oncol 2022; 22:73-76. [PMID: 35686020 PMCID: PMC9172170 DOI: 10.1016/j.phro.2022.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background and purpose Spinal stereotactic ablative body radiotherapy (SABR) requires high precision. We evaluate the intrafraction motion during cone-beam computed tomography (CBCT) guided SABR with different immobilization techniques. Material and methods Fifty-seven consecutive patients were treated for 62 spinal lesions with SABR with positioning corrected in six degrees of freedom. A surface monitoring system was used for patient set up and to ensure patient immobilization in 65% of patients. Intrafractional motion was defined as the difference between the last CBCT before the start of treatment and the first CT afterwards. Results For all 194 fractions, the mean intrafractional motion was 0.1 cm (0-1.1 cm) in vertical direction, 0.1 cm (0-1.1 cm) in longitudinal direction and 0.1 cm (0-0.5 cm) in lateral direction. A mean pitch of 0.6° (0-4.3°), a roll of 0.5° (0-3.4°) and a rotational motion of 0.4° (0-3.9°) was observed. 95.5% of the translational errors and 95.4% of the rotational errors were within safety range. There was a significantly higher rotational motion for patients with arms along the body (p = 0.01) and without the use of the body mask (p = 0.05). For cervical locations a higher rotational motion was seen, although not significant (p = 0.1). The acquisition of an extra CBCT was correlated with a higher rotational (pitch) motion (p = 0 < 0.01). Conclusion Very high precision in CBCT guided and surface-guided spinal SABR was observed in this cohort. The lowest intrafraction motion was seen in patients treated with arms above their head and a body mask. The use of IGRT with surface monitoring is an added value for patient monitoring leading to treatment interruption if necessary.
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Affiliation(s)
- Charlotte Billiet
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, Antwerp, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Belgium
| | - Wim Vingerhoed
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, Antwerp, Belgium
| | - Steven Van Laere
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Belgium
| | - Ines Joye
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, Antwerp, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Belgium
| | - Carole Mercier
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, Antwerp, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Belgium
| | - Piet Dirix
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, Antwerp, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Belgium
| | - Daan Nevens
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, Antwerp, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Belgium
| | - Peter Vermeulen
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Belgium
| | - Paul Meijnders
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, Antwerp, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Belgium
| | - Dirk Verellen
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk, Antwerp, Belgium
- Center for Oncological Research (CORE), Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Belgium
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He X, Cai W, Li F, Fan Q, Zhang P, Cuaron JJ, Cerviño LI, Li X, Li T. Decompose kV projection using neural network for improved motion tracking in paraspinal SBRT. Med Phys 2021; 48:7590-7601. [PMID: 34655442 DOI: 10.1002/mp.15295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 01/03/2023] Open
Abstract
PURPOSE On-treatment kV images have been used in tracking patient motion. One challenge of markerless motion tracking in paraspinal SBRT is the reduced contrast when the X-ray beam needs to pass through a large portion of the patient's body, for example, from the lateral direction. Besides, due to the spine's overlapping with the surrounding moving organs in the X-ray images, auto-registration could lead to potential errors. This work aims to automatically extract the spine component from the conventional 2D X-ray images, to achieve more robust and more accurate motion management. METHODS A ResNet generative adversarial network (ResNetGAN) consisting of one generator and one discriminator was developed to learn the mapping between 2D kV image and the reference spine digitally reconstructed radiograph (DRR). A tailored multi-channel multi-domain loss function was used to improve the quality of the decomposed spine image. The trained model took a 2D kV image as input and learned to generate the spine component of the X-ray image. The training dataset included 1347 2D kV thoracic and lumbar region X-ray images from 20 randomly selected patients, and the corresponding matched reference spine DRR. Another 226 2D kV images from the remaining four patients were used for evaluation. The resulted decomposed spine images and the original X-ray images were registered to the reference spine DRRs, to compare the spine tracking accuracy. RESULTS The decomposed spine image had the mean peak signal-to-noise ratio (PSNR) and structural similarity index measure (SSIM) of 60.08 and 0.99, respectively, indicating the model retained and enhanced the spine structure information in the original 2D X-ray image. The decomposed spine image matching with the reference spine DRR had submillimeter accuracy (in mm) with a mean error of 0.13, 0.12, and a maximum of 0.58, 0.49 in the x - and y -directions (in the imager coordinates), respectively. The accuracy improvement is robust in all lateral and anteroposterior X-ray beam angles. CONCLUSION We developed a deep learning-based approach to remove soft tissues in the kV image, leading to more accurate spine tracking in paraspinal SBRT.
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Affiliation(s)
- Xiuxiu He
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Weixing Cai
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Feifei Li
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Qiyong Fan
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Pengpeng Zhang
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - John J Cuaron
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Laura I Cerviño
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Xiang Li
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Tianfang Li
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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Rossi E, Fiorino C, Fodor A, Deantoni C, Mangili P, Di Muzio NG, Del Vecchio A, Broggi S. Residual intra-fraction error in robotic spinal stereotactic body radiotherapy without immobilization devices. Phys Imaging Radiat Oncol 2020; 16:20-25. [PMID: 33458339 PMCID: PMC7807594 DOI: 10.1016/j.phro.2020.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/11/2020] [Accepted: 09/23/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND PURPOSE Spinal stereotactic body radiotherapy (SBRT) involves large dose gradients and high geometrical accuracy is therefore required. The aim of this work was to assess residual intra-fraction error with a tracking robotic system for non-immobilized patients. Shifts from the first alignment (i.e. mimicking the unavailability of tracking) were also quantified. MATERIALS AND METHODS Forty-two patients treated for spinal metastasis (128 fractions, 4220 images) were analyzed. Residual error was quantified as the difference between translations/rotations referring to consecutive x-ray images during delivery (tracking) and to the initial set-up (no-tracking). The error distribution for each fraction/patient and the entire population was assessed for each axis/rotation angle. The impact of lesion sites, fractionation and patient's pain (VAS score) were investigated. Finally, the dosimetric impact of residual motion was quantified in the four most affected fractions. RESULTS Mean overall errors (OE) were near 0 (SD < 0.1 mm). Residual translations/rotations >1 mm/1° were found in less than 1.5%/1% of measurements. Lesion site and fractionation showed no impact. The dosimetric impact in the most affected fractions was negligible. For "no-tracking", mean OE was <1 mm/0.5°; less than 2% of displacements were >2 mm/1° within 10 min from the start of treatment with an increasing probability of shifts >2 mm over time. A significantly higher fraction of OE ≥ 2 mm was found for patients with pain in case of no-tracking. CONCLUSIONS Spine tracking with a latest-generation robotic system is highly efficient for non-immobilized patients: residual error is time independent and close to 0. For delivery times >7-8 min, tracking should be considered as mandatory for non-immobilized patients.
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Affiliation(s)
- Eleonora Rossi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Andrei Fodor
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Chiara Deantoni
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | - Paola Mangili
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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Rijken J, Crowe S, Trapp J, Kairn T. A review of stereotactic body radiotherapy for the spine. Phys Eng Sci Med 2020; 43:799-824. [DOI: 10.1007/s13246-020-00889-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
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10
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Wu J, Wu J, Ballangrud Å, Mechalakos J, Yamada J, Lovelock DM. Frequency of Large Intrafractional Target Motions During Spine Stereotactic Body Radiation Therapy. Pract Radiat Oncol 2019; 10:e45-e49. [PMID: 31446148 DOI: 10.1016/j.prro.2019.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/23/2019] [Accepted: 08/15/2019] [Indexed: 11/25/2022]
Abstract
Spine stereotactic body radiation therapy frequently involves the delivery of high doses to targets in proximity to the spinal cord; thus, the radiation must be delivered with great spatial accuracy. Monitoring for large shifts in target and cord position that might occur during dose delivery is a challenge for clinics equipped with a conventional C-arm Linac. Treatment must be halted, then imaging and registration must be done to determine whether a significant shift has occurred. In this retrospective study of 1019 spine SBRT treatments, we investigated the number of target shifts >2 mm in any direction that occurred in carefully immobilized patients. Orthogonal kV images were acquired 3 to 5 times during each session using in an in-room imaging system. Although the likelihood of large intrafractional shifts was found to be very low, they did occur in 6 treatment sessions. Intrafractional monitoring was found to be an important safety component of treatment delivery.
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Affiliation(s)
| | | | - Åse Ballangrud
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jim Mechalakos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Josh Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - D Michael Lovelock
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York.
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Lincoln JD, Parsons D, Clarke SE, Cwajna S, Robar JL. Technical Note: Evaluation of kV CBCT enhancement using a liver-specific contrast agent for stereotactic body radiation therapy image guidance. Med Phys 2019; 46:1175-1181. [PMID: 30624784 DOI: 10.1002/mp.13384] [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: 08/24/2018] [Revised: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate possible use for cone-beam computed tomography (CBCT) guidance, this phantom study evaluated the contrast enhancement provided by Gadoxetate Disodium (Primovist® CAN/EU, or Eovist® USA, Bayer Healthcare, Leverkusen, Germany), a contrast agent that is taken up selectively by liver cells and is retained for up to an hour. Image quality from CBCT was benchmarked against helical fan-beam computed tomography for two phantom geometries. METHODS AND MATERIALS Concentrations were diluted to 0.0125-0.1 mmol per kilogram of body weight (mmol/kg) corresponding to expected physiological concentrations in the liver. Kilovoltage CBCT imaging parameters of x-ray tube potential, current, and filtration were investigated using clinically available options on a TrueBeam STx linear accelerator CBCT platform. Two phantoms were created, a cylindrical idealized imaging geometry and an ellipsoidal more realistic abdominal geometry. All parameters were optimized according to the contrast-to-noise ratio (CNR) image quality metric, as a function of concentration, following the Rose criterion for CNR. RESULTS Acceptable CNR was defined as greater than or equal to three, in accordance with the Rose criterion for CNR. These were found in a range of expected liver concentrations of 0.025-0.1 mmol/kg for a tube potential of 100 kVp, half-fan bowtie filtration and tube currents giving exposures between 2025 and 5085 mAs. Linear correlations were found for all CNR as a function of concentration, in agreement with the literature. CONCLUSION Based on this phantom study, with appropriate selection of imaging protocol, Gadoxetate Disodium may provide useful liver CBCT enhancement at physiologically achievable liver concentrations.
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Affiliation(s)
- John D Lincoln
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, B3H 4R2, Canada
| | - David Parsons
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Sharon E Clarke
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, B3H 4R2, Canada.,Department of Diagnostic Radiology, Dalhousie University, Halifax, B3H 4R2, Canada.,Nova Scotia Health Authority, Halifax, B3H 1V8, Canada
| | - Slawa Cwajna
- Department of Radiation Oncology, Dalhousie University, Halifax, B3H 4R2, Canada.,Nova Scotia Health Authority, Halifax, B3H 1V8, Canada
| | - James L Robar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, B3H 4R2, Canada.,Department of Radiation Oncology, Dalhousie University, Halifax, B3H 4R2, Canada.,Nova Scotia Health Authority, Halifax, B3H 1V8, Canada
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Cawley DT, Butler JS, Benton A, Altaf F, Rezajooi K, Kyriakou C, Selvadurai S, Molloy S. Managing the cervical spine in multiple myeloma patients. Hematol Oncol 2018; 37:129-135. [PMID: 30334279 DOI: 10.1002/hon.2564] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/15/2018] [Indexed: 12/12/2022]
Abstract
Discuss the relevant literature on surgical and nonsurgical treatments for multiple myeloma (MM) and their complementary effects on overall treatment. Existing surgical algorithms designed for neoplasia of the spine may not suit the management of spinal myeloma. Less than a fifth of metastatic, including myelomatous lesions, occur in the cervical spine but have a poorer prognosis and surgery in this area carries a higher morbidity. With the advances of chemotherapy, early access to radiotherapy, early orthosis management, and high definition imaging, including CT and MRI, surgical indications in MM have changed. Medical decompression (or oncolysis), including in the presence of neurological deficit and orthotic stabilization, are proving viable nonsurgical options to manage MM. A key to decision making is the assessment and monitoring of biomechanical spinal stability as part of a multidisciplinary approach.
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Affiliation(s)
- Derek T Cawley
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Joseph S Butler
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Adam Benton
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Farhaan Altaf
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Kia Rezajooi
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Charalampia Kyriakou
- Department of Haematology, University College London & London North West Healthcare NHS Trust, London, UK
| | - Susanne Selvadurai
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
| | - Sean Molloy
- Myeloma Spine Service, Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, Middlesex, UK
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Wang X, Ghia AJ, Zhao Z, Yang J, Luo D, Briere TM, Pino R, Li J, McAleer MF, Weksberg DC, Chang EL, Brown PD, Yang JN. Prospective evaluation of target and spinal cord motion and dosimetric changes with respiration in spinal stereotactic body radiation therapy utilizing 4-D CT. JOURNAL OF RADIOSURGERY AND SBRT 2016; 4:191-201. [PMID: 29296444 PMCID: PMC5658802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 08/09/2016] [Indexed: 06/07/2023]
Abstract
PURPOSE To assess the dosimetric effects of respiratory motion on the target and spinal cord in spinal stereotactic body radiation therapy (SBRT). METHODS AND MATERIALS Thirty patients with 33 lesions were enrolled on a prospective clinical protocol and simulated with both free-breathing and four-dimensional (4-D) computed tomography (CT). We studied the target motion using 4-D data (10 phases) by registering a secondary image dataset (phase 1 to 9) to a primary image dataset (phase 0) and analyzing the displacement in both translational and rotational directions. The study of dosimetric impacts from respiration includes both the effect of potential target and spinal cord motion and anatomic changes in the beam path. A clinical step-and-shoot IMRT plan generated on the free-breathing CT was copied to the 4-D datasets to evaluate the difference in the dose-volume histogram of target and normal tissues in each phase of a breathing cycle. RESULTS Twenty three lesions had no motion in a breathing cycle; four lesions had anterior-posterior motion ≤ 0.2 mm; two lesions had lateral motion ≤ 0.2 mm; and eight lesions had superior-inferior motion, most ≤ 0.2 mm with the worst at 0.6 mm. The difference of maximum dose to 0.01 cm3 of spinal cord in different phases of a breathing cycle was within 20 cGy in worst case. Target volumes that received the prescription dose (V100) varied little, with deviations of V100 of each phase from the average CT < 1% in most cases. Only when lesions were close to the diaphragm (e.g., at T11) did the V100 deviate by about 7% in the worst case scenario. However, this was caused by a small dose difference of 20 cGy to part of the target volume. CONCLUSIONS Breathing induced target and spinal cord motion is negligible compared with other setup uncertainties. Dose calculation using averaged or free-breathing CT is reliable when posterior beams are used.
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Affiliation(s)
- Xin Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amol J. Ghia
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhongxiang Zhao
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dershan Luo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tina M. Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ramiro Pino
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary F. McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David C. Weksberg
- Department of Radiation Oncology, PinnacleHealth Cancer Institute, Harrisburg, PA, USA
| | - Eric L. Chang
- Department of Radiation Oncology, University of Southern California Keck School of Medicine, Norris Cancer Hospital, Los Angeles, CA, USA
| | - Paul D. Brown
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - James N. Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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