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Wang L, Ding Y, Bruno TL, Stafford RJ, Lin E, Bathala TK, Sanders JW, Ning MS, Ma J, Klopp AH, Venkatesan A, Wang J, Martirosyan KS, Frank SJ. A Novel Positive-Contrast Magnetic Resonance Imaging Line Marker for High-Dose-Rate (HDR) MRI-Assisted Radiosurgery (MARS). Cancers (Basel) 2024; 16:1922. [PMID: 38792000 PMCID: PMC11119838 DOI: 10.3390/cancers16101922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/26/2024] Open
Abstract
Magnetic resonance imaging (MRI) can facilitate accurate organ delineation and optimal dose distributions in high-dose-rate (HDR) MRI-Assisted Radiosurgery (MARS). Its use for this purpose has been limited by the lack of positive-contrast MRI markers that can clearly delineate the lumen of the HDR applicator and precisely show the path of the HDR source on T1- and T2-weighted MRI sequences. We investigated a novel MRI positive-contrast HDR brachytherapy or interventional radiotherapy line marker, C4:S, consisting of C4 (visible on T1-weighted images) complexed with saline. Longitudinal relaxation time (T1) and transverse relaxation time (T2) for C4:S were measured on a 1.5 T MRI scanner. High-density polyethylene (HDPE) tubing filled with C4:S as an HDR brachytherapy line marker was tested for visibility on T1- and T2-weighted MRI sequences in a tissue-equivalent female ultrasound training pelvis phantom. Relaxivity measurements indicated that C4:S solution had good T1-weighted contrast (relative to oil [fat] signal intensity) and good T2-weighted contrast (relative to water signal intensity) at both room temperature (relaxivity ratio > 1; r2/r1 = 1.43) and body temperature (relaxivity ratio > 1; r2/r1 = 1.38). These measurements were verified by the positive visualization of the C4:S (C4/saline 50:50) HDPE tube HDR brachytherapy line marker on both T1- and T2-weighted MRI sequences. Orientation did not affect the relaxivity of the C4:S contrast solution. C4:S encapsulated in HDPE tubing can be visualized as a positive line marker on both T1- and T2-weighted MRI sequences. MRI-guided HDR planning may be possible with these novel line markers for HDR MARS for several types of cancer.
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Affiliation(s)
- Li Wang
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (L.W.); (E.L.)
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.D.); (J.W.)
| | - Teresa L. Bruno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.L.B.); (M.S.N.); (A.H.K.)
| | - R. Jason Stafford
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.J.S.); (J.M.)
| | - Eric Lin
- Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (L.W.); (E.L.)
| | - Tharakeswara K. Bathala
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.K.B.); (A.V.)
| | | | - Matthew S. Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.L.B.); (M.S.N.); (A.H.K.)
| | - Jingfei Ma
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.J.S.); (J.M.)
| | - Ann H. Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.L.B.); (M.S.N.); (A.H.K.)
| | - Aradhana Venkatesan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.K.B.); (A.V.)
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (Y.D.); (J.W.)
| | - Karen S. Martirosyan
- Department of Physics, The University of Texas Rio Grande Valley, Brownsville, TX 78500, USA;
| | - Steven J. Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (T.L.B.); (M.S.N.); (A.H.K.)
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Lee SW, Kim A, Lee SJ, Kim SH, Lee JH. Intensity-Modulated Radiation Therapy for Uterine Cervical Cancer to Reduce Toxicity and Enhance Efficacy - an Option or a Must?: A Narrative Review. Cancer Res Treat 2024; 56:1-17. [PMID: 37654111 PMCID: PMC10789959 DOI: 10.4143/crt.2023.562] [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: 04/10/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023] Open
Abstract
Radiotherapy (RT) is a fundamental modality in treatment of cervical cancer. With advancement of technology, conventional RT used for external beam radiotherapy (EBRT) for over half a century has been rapidly replaced with intensity-modulated radiation therapy (IMRT) especially during the last decade. This newer technique is able to differentiate the intensity of radiation within the same field, thus reduces the inevitable exposure of radiation to normal organs and enables better dose delivery to tumors. Recently, the American Society for Radiation Oncology has released a guideline for RT in cervical cancer. Although a section of the guideline recommends IMRT for the purpose of toxicity reduction, a thorough review of the literature is necessary to understand the current status of IMRT in cervical cancer. This narrative review updates the recent high-level evidences regarding the efficacy and toxicity of IMRT and provides a better understanding of the most innovative techniques currently available for EBRT enabled by IMRT.
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Affiliation(s)
- Sea-Won Lee
- Department of Radiation Oncology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Aeran Kim
- Department of Biomedicine & Health Sciences, The Catholic University of Korea, Seoul, Korea
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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Deng L, Zhang M, Wang J, Huang S, Yang X. Improving cone-beam CT quality using a cycle-residual connection with a dilated convolution-consistent generative adversarial network. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac7b0a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/21/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective.Cone-Beam CT (CBCT) often results in severe image artifacts and inaccurate HU values, meaning poor quality CBCT images cannot be directly applied to dose calculation in radiotherapy. To overcome this, we propose a cycle-residual connection with a dilated convolution-consistent generative adversarial network (Cycle-RCDC-GAN). Approach. The cycle-consistent generative adversarial network (Cycle-GAN) was modified using a dilated convolution with different expansion rates to extract richer semantic features from input images. Thirty pelvic patients were used to investigate the effect of synthetic CT (sCT) from CBCT, and 55 head and neck patients were used to explore the generalizability of the model. Three generalizability experiments were performed and compared: the pelvis trained model was applied to the head and neck; the head and neck trained model was applied to the pelvis, and the two datasets were trained together. Main results. The mean absolute error (MAE), the root mean square error (RMSE), peak signal to noise ratio (PSNR), the structural similarity index (SSIM), and spatial nonuniformity (SNU) assessed the quality of the sCT generated from CBCT. Compared with CBCT images, the MAE improved from 28.81 to 18.48, RMSE from 85.66 to 69.50, SNU from 0.34 to 0.30, and PSNR from 31.61 to 33.07, while SSIM improved from 0.981 to 0.989. The sCT objective indicators of Cycle-RCDC-GAN were better than Cycle-GAN’s. The objective metrics for generalizability were also better than Cycle-GAN’s. Significance. Cycle-RCDC-GAN enhances CBCT image quality and has better generalizability than Cycle-GAN, which further promotes the application of CBCT in radiotherapy.
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Aggarwal L, Mourya A, Choudhary S, Sharma N, Shahi U, Singh G, Pradhan S. A mathematical model to predict the different isodose volumes using TRAK value in HDR intracavitary brachytherapy for revised Manchester and ICRU-89 based Point A plans using computer tomography images. J Cancer Res Ther 2022; 18:1105-1113. [DOI: 10.4103/jcrt.jcrt_47_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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Gao L, Xie K, Wu X, Lu Z, Li C, Sun J, Lin T, Sui J, Ni X. Generating synthetic CT from low-dose cone-beam CT by using generative adversarial networks for adaptive radiotherapy. Radiat Oncol 2021; 16:202. [PMID: 34649572 PMCID: PMC8515667 DOI: 10.1186/s13014-021-01928-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/17/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To develop high-quality synthetic CT (sCT) generation method from low-dose cone-beam CT (CBCT) images by using attention-guided generative adversarial networks (AGGAN) and apply these images to dose calculations in radiotherapy. METHODS The CBCT/planning CT images of 170 patients undergoing thoracic radiotherapy were used for training and testing. The CBCT images were scanned under a fast protocol with 50% less clinical projection frames compared with standard chest M20 protocol. Training with aligned paired images was performed using conditional adversarial networks (so-called pix2pix), and training with unpaired images was carried out with cycle-consistent adversarial networks (cycleGAN) and AGGAN, through which sCT images were generated. The image quality and Hounsfield unit (HU) value of the sCT images generated by the three neural networks were compared. The treatment plan was designed on CT and copied to sCT images to calculated dose distribution. RESULTS The image quality of sCT images by all the three methods are significantly improved compared with original CBCT images. The AGGAN achieves the best image quality in the testing patients with the smallest mean absolute error (MAE, 43.5 ± 6.69), largest structural similarity (SSIM, 93.7 ± 3.88) and peak signal-to-noise ratio (PSNR, 29.5 ± 2.36). The sCT images generated by all the three methods showed superior dose calculation accuracy with higher gamma passing rates compared with original CBCT image. The AGGAN offered the highest gamma passing rates (91.4 ± 3.26) under the strictest criteria of 1 mm/1% compared with other methods. In the phantom study, the sCT images generated by AGGAN demonstrated the best image quality and the highest dose calculation accuracy. CONCLUSIONS High-quality sCT images were generated from low-dose thoracic CBCT images by using the proposed AGGAN through unpaired CBCT and CT images. The dose distribution could be calculated accurately based on sCT images in radiotherapy.
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Affiliation(s)
- Liugang Gao
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, China.,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
| | - Kai Xie
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, China.,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
| | - Xiaojin Wu
- Oncology Department, Xuzhou No.1 People's Hospital, Xuzhou, 221000, China
| | - Zhengda Lu
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, China.,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China.,School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, 213000, China
| | - Chunying Li
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, China.,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
| | - Jiawei Sun
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, China.,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
| | - Tao Lin
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, China.,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
| | - Jianfeng Sui
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, China.,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China
| | - Xinye Ni
- Radiotherapy Department, Second People's Hospital of Changzhou, Nanjing Medical University, Changzhou, 213003, China. .,Center for Medical Physics, Nanjing Medical University, Changzhou, 213003, China.
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Wang X, Wang P, Tang B, Kang S, Hou Q, Wu Z, Gou C, Li L, Orlandini L, Lang J, Li J. An Inverse Dose Optimization Algorithm for Three-Dimensional Brachytherapy. Front Oncol 2020; 10:564580. [PMID: 33194640 PMCID: PMC7606999 DOI: 10.3389/fonc.2020.564580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/30/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To investigate an implementation method and the results of an inverse dose optimization algorithm, Gradient Based Planning Optimization (GBPO), for three-dimensional brachytherapy. METHODS The GBPO used a quadratic objective function, and a dwell time modulation item was added to the objective function to restrict the dwell time variance. We retrospectively studied 4 cervical cancer patients using different applicators and 15 cervical cancer patients using the Fletcher applicator. We assessed the plan quality of GBPO by isodose lines for the patients using different applicators. For the 15 patients using the Fletcher applicator, we utilized dose-volume histogram (DVH) parameters of HR-CTV (D100%, V150%) and organs at risk (OARs) (D0.1cc, D1cc, D2cc) to evaluate the difference between the GBPO plans and the IPSA (Inverse Planning Simulated Annealing) plans, as well as the GBPO plans and the Graphic plans. RESULTS For the 4 patients using different applicators, the dose distributions are conformable. For the 15 patients using the Fletcher applicator, when the dwell time modulation factor (DTMF) is less than 20, the dwell time deviation reduces quickly; however, after the DTMF increased to 100, the dwell time deviation has no remarkable change. The difference in dosimetric parameters between the GBPO plans and the IPSA plans is not statistically significant (P>0.05). The GBPO plans have a higher D100% (3.57 ± 0.36, 3.38 ± 0.34; P<0.01) and a lower V150% (55.73 ± 4.06, 57.75 ± 3.79; P<0.01) than those of the Graphic plans. The differences in other DVH parameters are negligible between the GBPO plans and the Graphic plans. CONCLUSIONS The GBPO plans have a comparable quality as the IPSA plans and the Graphic plans for the studied cervical cancer cases. The GBPO algorithm could be integrated into a three-dimensional brachytherapy treatment planning system after studying more sites.
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Affiliation(s)
- Xianliang Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Pei Wang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Bin Tang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Shengwei Kang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Qing Hou
- Key Laboratory of Radiation Physics and Technology, Institute of Nuclear Science and Technology, Sichuan University, Chengdu, China
| | - Zhangwen Wu
- Key Laboratory of Radiation Physics and Technology, Institute of Nuclear Science and Technology, Sichuan University, Chengdu, China
| | - Chengjun Gou
- Key Laboratory of Radiation Physics and Technology, Institute of Nuclear Science and Technology, Sichuan University, Chengdu, China
| | - Lintao Li
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Lucia Orlandini
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Jinyi Lang
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
| | - Jie Li
- Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology Key Laboratory Of Sichuan Province, Chengdu, China
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Kida S, Kaji S, Nawa K, Imae T, Nakamoto T, Ozaki S, Ohta T, Nozawa Y, Nakagawa K. Visual enhancement of Cone-beam CT by use of CycleGAN. Med Phys 2020; 47:998-1010. [PMID: 31840269 DOI: 10.1002/mp.13963] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Cone-beam computed tomography (CBCT) offers advantages over conventional fan-beam CT in that it requires a shorter time and less exposure to obtain images. However, CBCT images suffer from low soft-tissue contrast, noise, and artifacts compared to conventional fan-beam CT images. Therefore, it is essential to improve the image quality of CBCT. METHODS In this paper, we propose a synthetic approach to translate CBCT images with deep neural networks. Our method requires only unpaired and unaligned CBCT images and planning fan-beam CT (PlanCT) images for training. The CBCT images and PlanCT images may be obtained from other patients as long as they are acquired with the same scanner settings. Once trained, three-dimensionally reconstructed CBCT images can be directly translated into high-quality PlanCT-like images. RESULTS We demonstrate the effectiveness of our method with images obtained from 20 prostate patients, and provide a statistical and visual comparison. The image quality of the translated images shows substantial improvement in voxel values, spatial uniformity, and artifact suppression compared to those of the original CBCT. The anatomical structures of the original CBCT images were also well preserved in the translated images. CONCLUSIONS Our method produces visually PlanCT-like images from CBCT images while preserving anatomical structures.
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Affiliation(s)
- Satoshi Kida
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Shizuo Kaji
- Institute of Mathematics for Industry, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan.,JST PRESTO, Kawaguchi, Japan
| | - Kanabu Nawa
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Toshikazu Imae
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Takahiro Nakamoto
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Sho Ozaki
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Takeshi Ohta
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Yuki Nozawa
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
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Dosimetric comparison of graphical optimization and inverse planning simulated annealing for brachytherapy of cervical cancer. J Contemp Brachytherapy 2019; 11:379-383. [PMID: 31523240 PMCID: PMC6737576 DOI: 10.5114/jcb.2019.87145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 06/25/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose Graphical optimization (GO) and inverse planning simulated annealing (IPSA) are the main treatment planning optimization techniques used in patients undergoing 3D brachytherapy treatment. This study aims to compare the dosimetric difference of plans optimized by GO and IPSA in cervical cancer brachytherapy. Material and methods 21 cervical cancer patients data sets consisted of computed tomography (CT) and magnetic resonance imaging (MRI), acquired with the Fletcher applicator in situ were transferred to the Oncentra brachytherapy planning system. For each patient, the treatment plan was initially optimized with GO to reach a maximal D90 tumor dose (6 Gy/fraction, 5 fractions), while keeping the dose to organs at risk (OARs) as low as possible. A second plan was then optimized with IPSA on the same CT images and data set (i.e., contours, catheters, and location of dwell points). Targets and OARs dose volume histograms and irradiation time were compared; data were analyzed with paired t-test; p value < 0.05 was considered statistically significant. Results The plans with both optimizations meet the clinical requirements. The mean D90 of the clinical target volume was comparable for GO and IPSA. Similar values (p > 0.05) of target V100, V150, V200, HI, and CI were registered for GO and IPSA optimizations. Bladder and rectum D1cc and D2cc obtained by GO resulted in larger values than those obtained by IPSA (p = 0.002). V75 for bladder and rectum were slightly higher for IPSA, but without statistical difference (p > 0.05). The irradiation time was comparable (p > 0.05). Conclusions In 3D brachytherapy of cervical cancer, GO and IPSA optimizations do not present a significant difference in target dose coverage; nevertheless, IPSA may reduce the maximum dose to normal tissue when compared with GO.
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Kumar M, Thangaraj R, Alva RC, Koushik K, Ponni A, Achar JM. Impact of different dose prescription schedules on EQD 2 in high-dose-rate intracavitary brachytherapy of carcinoma cervix. J Contemp Brachytherapy 2019; 11:189-193. [PMID: 31139229 PMCID: PMC6536140 DOI: 10.5114/jcb.2019.84586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/26/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To observe the effect of different high-dose-rate (HDR) intracavitary brachytherapy dose schedules on equieffective dose in 2 Gy per fraction (EQD2). MATERIAL AND METHODS It is a retrospective study involving 50 cervical cancer patients, who received external radiotherapy of 45 Gy in 25 fractions and underwent intracavitary brachytherapy (ICBT). Computed tomography (CT) simulation was done after insertion of the applicators. High-risk clinical target volume (CTVHR) and organs at risk (OARs) such as bladder, rectum, and sigmoid were contoured. Four different plans were generated for each patient, with dose prescriptions of 5.5 Gy × 5 fractions (plan A), 6.5 Gy × 4 fractions (plan B), 7 Gy × 4 fractions (plan C), and 9 Gy × 2 fractions (plan D), delivered to CTVHR. The total EQD2 for 0.1 cm3 and 2 cm3 of bladder, rectum, and sigmoid as well as dose received by 90% of the CTVHR (D90) and point A were calculated. The values were analyzed and compared with available literature. RESULTS The mean CTVHR volume was 47.12 ±13.8 cm3. All plans delivered similar EQD2 for 0.1 cm3 and 2 cm3 of sigmoid. Plan D delivered lesser EQD2 compared to other plans for bladder, rectum, D90 CTVHR, and point A (p = 0.0001). Plan C delivered higher EQD2 to OARs compared to other plans (p = 0.001). Plan A, B, and plan C delivered similar EQD2 for D90 CTVHR and point A. CONCLUSIONS EQD2 of bladder, rectum, sigmoid, D90 CTVHR, and point A were similar with 5.5 Gy × 5 fractions, 6.5 Gy × 4 fractions, and 7 Gy × 4 fractions, whereas EQD2 of 9 Gy × 2 fractions was significantly unfavorable compared to other schedules. Further clinical studies are recommended to observe clinical outcomes.
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Affiliation(s)
| | | | | | | | - Arul Ponni
- Ramaiah Medical College Bengaluru, India
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MRI-guided adaptive brachytherapy for locally advanced cervix cancer: Treatment outcomes from a single institution in Hong Kong. Brachytherapy 2019; 18:171-179. [DOI: 10.1016/j.brachy.2018.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/26/2018] [Accepted: 11/27/2018] [Indexed: 12/12/2022]
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Chakrabarti B, Pal SK, Sepai HM, Roy SB, Kar SK, Lahiri A, Das S, Bala A. Clinical and dosimetric consequences of imperfect applicator insertion in cervical cancer brachytherapy. J Contemp Brachytherapy 2018; 10:321-336. [PMID: 30237816 PMCID: PMC6142650 DOI: 10.5114/jcb.2018.77954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 07/31/2018] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study analyzes clinical consequences and dosimetric variations after imperfect brachytherapy insertions. It examines treatment decisions after such insertions in patients having difficult anatomy, which leads to good subsequent insertions with acceptable dose volume parameters. MATERIAL AND METHODS We reviewed images of all insertions performed during last one year and sorted faulty ones out. Clinical outcome was assessed, analyzing original treatment records. Repeat three-dimensional planning using identical dose-optimization-technique compared their dosimetry. Statistical analysis using SPSS®-Statistics-software included Fisher's-exact-test to analyze predisposing factors for faulty insertions and predictive factors for subsequent satisfactory insertion. Friedman test was used to compare dose-volume-effects of normalization. RESULTS Eighteen of 292 brachytherapy plans revealed imperfect insertions, including thirteen perforations (4.5%). Lack of pre-planning, obstructing mass, narrow vagina, acute anteversion of uterus, and multi-parity were significant (p ≤ 0.05) predisposing factors for atypical insertions. Satisfactory optimization was possible after correcting acute anteflexion or positioning tandem in retroverted direction in uncorrectable retroverted uterus. Dose normalization at point A shifted optimized dose from contoured volume to point of normalization, often undesirably. This difference, however, was statistically not significant (p = 0.121). In patients having obstructing mass, subsequent insertions were perfect, and dose volume parameters were acceptable only when full prescribed dose was delivered to at least 60% volume of the mass after a faulty insertion (p < 0.001). CONCLUSIONS Pre-planning by imaging is suggested in all cases of brachytherapy. Insertion of adequate length of tandem aligned to uterine axis is warranted for adequate tumor coverage. Whenever detected, acute anteflexion and mobile retroversion should be corrected. Tandem inserted in retroverted direction in uncorrectable retroverted uterus generates acceptable dose volume parameters. In cases with obstructive cervical mass, good subsequent insertion is possible with acceptable dose volume parameters, if planned dose can be delivered to its 60% volume.
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Affiliation(s)
- Bikramjit Chakrabarti
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Suparna Kanti Pal
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Harris Mahammad Sepai
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Somapriya Basu Roy
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Sanjay Kr Kar
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Annesha Lahiri
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Sounik Das
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
| | - Amit Bala
- Department of Radiotherapy, Institute of Post-Graduate Medical Education and Research and Seth Sukhlal Kernani Memorial Hospital, Kolkata, India
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Oyama A, Kumagai S, Arai N, Takata T, Saikawa Y, Shiraishi K, Kobayashi T, Kotoku J. Image quality improvement in cone-beam CT using the super-resolution technique. JOURNAL OF RADIATION RESEARCH 2018; 59:501-510. [PMID: 29659997 PMCID: PMC6054223 DOI: 10.1093/jrr/rry019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/28/2017] [Indexed: 06/08/2023]
Abstract
This study was conducted to improve cone-beam computed tomography (CBCT) image quality using the super-resolution technique, a method of inferring a high-resolution image from a low-resolution image. This technique is used with two matrices, so-called dictionaries, constructed respectively from high-resolution and low-resolution image bases. For this study, a CBCT image, as a low-resolution image, is represented as a linear combination of atoms, the image bases in the low-resolution dictionary. The corresponding super-resolution image was inferred by multiplying the coefficients and the high-resolution dictionary atoms extracted from planning CT images. To evaluate the proposed method, we computed the root mean square error (RMSE) and structural similarity (SSIM). The resulting RMSE and SSIM between the super-resolution images and the planning CT images were, respectively, as much as 0.81 and 1.29 times better than those obtained without using the super-resolution technique. We used super-resolution technique to improve the CBCT image quality.
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Affiliation(s)
- Asuka Oyama
- Graduate School of Medical Care and Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Shinobu Kumagai
- Central Radiology Division, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Norikazu Arai
- Central Radiology Division, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Takeshi Takata
- Graduate School of Medical Care and Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Yusuke Saikawa
- Graduate School of Medical Care and Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Kenshiro Shiraishi
- Department of Radiology, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Takenori Kobayashi
- Graduate School of Medical Care and Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Jun’ichi Kotoku
- Graduate School of Medical Care and Technology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
- Central Radiology Division, Teikyo University Hospital, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
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Impact of brachytherapy technique (2D versus 3D) on outcome following radiotherapy of cervical cancer. J Contemp Brachytherapy 2018; 10:17-25. [PMID: 29619052 PMCID: PMC5881591 DOI: 10.5114/jcb.2018.73955] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/11/2018] [Indexed: 01/20/2023] Open
Abstract
Purpose The purpose of this study was to analyze the effect of 2D conventional brachytherapy (CBT) compared to 3D MRI-guided brachytherapy (IGBT) with and without the use of interstitial needles on local control, overall survival, and toxicity in patients treated for cervical cancer with radiation or chemoradiation. Material and methods A retrospective analysis was performed of biopsy-proven FIGO IB-IVA cervical cancer patients, treated with primary radiation or chemoradiation, followed by brachytherapy (BT) between January 1997 and July 2016. Endpoints were local control, overall survival, and toxicity. Results Of 126 patients included, 35 have been treated with CBT, 31 with IGBT without needles (IC), and 60 with IGBT with needles (ICIS). External beam radiotherapy (EBRT) had mostly been delivered concurrently with chemotherapy (weekly cisplatin). Overall local control was 93% after 1 year, and 88% after 3 years. Overall 3-year survival was 75%, and 5-year survival was 66%. The 3D technique (IGBT cohorts) showed a trend for an improved local control and overall survival (p = 0.05) compared to the 2D technique (CBT cohort). A decrease in toxicity was observed from 17% (2D cohort) to 12% (3D cohort). The use of interstitial needles was associated with a higher high-risk clinical target volume (HR-CTV) dose (11.3 Gy vs. 9.9 Gy) and a lower D2cc bladder dose (10.9 Gy vs. 14.7 Gy, both p < 0.01). Conclusions In cervical cancer treatment, the use of a 3D brachytherapy technique (MRI-guided with or without interstitial needles) showed a trend towards an increased local control and improved overall survival with reduced toxicity, compared to the conventional 2D brachytherapy technique. The use of interstitial needles allowed dose sculpting, resulting in delivery of higher doses to the HR-CTV, while reducing radiation doses to organs at risk, such as the bladder.
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Jaberi R, Siavashpour Z, Aghamiri MR, Kirisits C, Ghaderi R. Artificial neural network based gynaecological image-guided adaptive brachytherapy treatment planning correction of intra-fractional organs at risk dose variation. J Contemp Brachytherapy 2017; 9:508-518. [PMID: 29441094 PMCID: PMC5807998 DOI: 10.5114/jcb.2017.72567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 12/20/2017] [Indexed: 12/04/2022] Open
Abstract
PURPOSE Intra-fractional organs at risk (OARs) deformations can lead to dose variation during image-guided adaptive brachytherapy (IGABT). The aim of this study was to modify the final accepted brachytherapy treatment plan to dosimetrically compensate for these intra-fractional organs-applicators position variations and, at the same time, fulfilling the dosimetric criteria. MATERIAL AND METHODS Thirty patients with locally advanced cervical cancer, after external beam radiotherapy (EBRT) of 45-50 Gy over five to six weeks with concomitant weekly chemotherapy, and qualified for intracavitary high-dose-rate (HDR) brachytherapy with tandem-ovoid applicators were selected for this study. Second computed tomography scan was done for each patient after finishing brachytherapy treatment with applicators in situ. Artificial neural networks (ANNs) based models were used to predict intra-fractional OARs dose-volume histogram parameters variations and propose a new final plan. RESULTS A model was developed to estimate the intra-fractional organs dose variations during gynaecological intracavitary brachytherapy. Also, ANNs were used to modify the final brachytherapy treatment plan to compensate dosimetrically for changes in 'organs-applicators', while maintaining target dose at the original level. CONCLUSIONS There are semi-automatic and fast responding models that can be used in the routine clinical workflow to reduce individually IGABT uncertainties. These models can be more validated by more patients' plans to be able to serve as a clinical tool.
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Affiliation(s)
- Ramin Jaberi
- Department of Radiotherapy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Siavashpour
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran
| | - Mahmoud Reza Aghamiri
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran
| | - Christian Kirisits
- Department of Radiotherapy and Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Reza Ghaderi
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran
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Dumane VA, Yuan Y, Sheu RD, Gupta V. Computed tomography-based treatment planning for high-dose-rate brachytherapy using the tandem and ring applicator: influence of applicator choice on organ dose and inter-fraction adaptive planning. J Contemp Brachytherapy 2017; 9:279-286. [PMID: 28725253 PMCID: PMC5509987 DOI: 10.5114/jcb.2017.68519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 06/13/2017] [Indexed: 11/30/2022] Open
Abstract
Three dimensional planning for high-dose-rate (HDR) brachytherapy in cervical cancer has been highly recommended by consensus guidelines such as the American Brachytherapy Society (ABS) and the Groupe Européen de Curiethérapie - European Society for Radiotherapy and Oncology (GEC-ESTRO). In this document, we describe our experience with computed tomography (CT)-based planning using the tandem/ring applicator. We discuss the influence of applicator geometry on doses to organs at risk (OARs), namely the bladder, rectum, and sigmoid. Through example cases with dose prescribed to point A, we demonstrate how adaptive planning can help achieve constraints to the OARs as per guidelines.
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Affiliation(s)
- Vishruta A Dumane
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yading Yuan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ren-Dih Sheu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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The usefulness of fleet rectal enemas on high-dose-rate intracavitary cervical cancer brachytherapy. A prospective trial. J Contemp Brachytherapy 2017; 9:224-229. [PMID: 28725245 PMCID: PMC5509980 DOI: 10.5114/jcb.2017.68135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 04/29/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the effects of rectal enemas on rectal doses during radical high-dose-rate (HDR) intracavitary cervical brachytherapy (BT). Material and methods Twenty patients suffering from cervical cancer and treated with external beam radiotherapy and HDR-BT were included in a prospective trial. The first brachytherapy fraction was considered the basal status, and patients were instructed to self-administer two rectal cleansing enemas before the second fraction. Dose-volume histogram (DVH) values were generated for the rectum and correlated with rectal volume variation. Brachytherapy was carried out with a Fletcher or Utrecht applicator. Results No significant rectal volume differences were observed between fractions with or without rectal enemas (without, 52.64 ± 15.92 cc; with, 53.16 ± 19.28 cc). There was a significant correlation between both rectal volumes (r = 0.722, p = 0.001). No significant differences were observed in analyzed DVH parameters (median values: ΔD0.1cc, 4.17 vs. 3.61 Gy; ΔD1cc, 3.23 vs. 2.87 Gy; ΔD2cc, 2.9 vs. 2.54 Gy; ΔD5cc, 2.35 vs. 2.05 Gy, for no enema and enema fraction, respectively). No significant rectal volume differences nor DVH parameter differences were observed according the applicator type. Conclusions Our rectal enemas protocol prior to HDR-BT was ineffective in significantly modifying rectal DVH parameters. No differences were observed according to the type of applicator used.
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Commissioning of applicator-guided stereotactic body radiation therapy boost with high-dose-rate brachytherapy for advanced cervical cancer using radiochromic film dosimetry. Brachytherapy 2017; 16:893-902. [PMID: 28457741 DOI: 10.1016/j.brachy.2017.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/21/2017] [Accepted: 03/21/2017] [Indexed: 11/21/2022]
Abstract
PURPOSE To describe an EBT3 GAFCHROMIC film-based dosimetry method to be used in commissioning of a combined HDR brachytherapy (HDRB) and stereotactic body radiation therapy (SBRT) boost for treatment of advanced cervical cancer involving extensive residual disease after external beam treatment. METHODS AND MATERIALS A cube phantom was designed to firmly fit an intrauterine tandem applicator and EBT3 radiochromic film pieces. A high-risk clinical target volume (CTVHR, Total) was contoured with an extended arm at one side. The HDRB treatment was planned to cover the proximal CTVHR, Total with 7 Gy and the distal volume, referred to as CTVHR, Distal, was planned by SBRT for dose augmentation. After HDRB treatment delivery, SBRT treatment was delivered within 1 hour by image guidance using the applicator geometry. Intentional 1D and 2D misalignments were introduced to evaluate the effect on target volumes. In addition, effect of film reirradiation at different time gaps and dose levels was evaluated. RESULTS Film dosimetric accuracy, with up to 2 hours gap between irradiations, was shown to be unaffected. A 2%/2 mm gamma analysis between measured and planned doses showed agreement of >99%. Misalignments of more than 2 mm between applicator and SBRT isocenter resulted in suboptimal dose-volume histogram affecting mostly D98% and D90% of CTVHR, Distal. CONCLUSIONS Visualizing how target dose-volume metrics are affected by minor misalignments between SBRT and HDRB dose gradients, in light of achievable phantom-based experimental quality assurance level, encourages the clinical applicability of this technique. Radiochromic film was shown to be a valuable tool to commission procedures combining two different treatment planning systems and modalities with varying dose rates and energy ranges.
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