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Tan IZ, Mitchell A, McNair H, Dunlop A, Herbert T, Nartey J, Lawes R, O'Connell N, De-Colle C, Han K, Hahn E, Nelms B, Russell N, Kirby A. A Multicenter Study of Clinical to Planning Target Volume Margins for Adjuvant Partial Breast Irradiation Delivered on the 1.5T MR-Linear Accelerator. Int J Radiat Oncol Biol Phys 2023; 117:e725. [PMID: 37786112 DOI: 10.1016/j.ijrobp.2023.06.2237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Adjuvant partial breast irradiation (APBI) for early-stage breast cancer patients delivered on a conventional Linac commonly uses a clinical to planning target volume (CTV-PTV) margin of 10 mm. Published data suggest this margin could be reduced using an MR-guided workflow. This study quantifies the CTV to PTV margin for APBI delivered on the 1.5T MR-Linac (MRL) using an Adapt to Position (ATP) workflow. MATERIALS/METHODS All target contouring was done as per the IMPORT LOW trial and MRL Consortium guidelines. The CTV is the tumor bed defined by surgical clips including postsurgical changes. A single center cohort of ten patients was used to assess delineation error on ProKnow DS v1.28.0 by measuring CTV contour displacements on the CT planning scans (pCT) delineated by five breast radiation oncologists. All other error components were measured on treatment planning software on another single center cohort of ten patients. Target deformation error was measured as surgical clip displacements between the pCT and daily pre-treatment (pre-Tx) MRI scans. Intrafraction motion was determined by the CTV displacement between pre- and post-treatment MRIs (post-Tx) in available paired images from five patients. Matching error was estimated as the interobserver variation of three MRL radiographers registering the pCT with daily pre-Tx MRI. Technical delivery accuracy was estimated using the results from routine quality assurance measurements. Beam penumbral width (p) was estimated from the clinical treatment plans. The systematic (Σ) and random errors (σ) for each component were calculated in the left/right (X), superior/inferior (Y) and anterior/posterior (Z) directions. The contribution of these errors to the PTV margin, M was calculated using van Herk's formula with α and β being 2.50 and 1.64 respectively. RESULTS For APBI using an MRL ATP workflow, a CTV-PTV margin of 5.7 to 7.6 mm is required to achieve a 90% confidence of CTV coverage by the 95% isodose. Individual error components are in. Table 1 delineation error remains the largest component of error. CONCLUSION A minimum CTV-PTV margin of 6-8 mm is required for APBI using an MRL ATP workflow. Although smaller than margins used in conventional Linacs, the clinical benefits (in terms of fibrosis risk) of treating APBI patients on an MRL are likely to be modest. Further margin reductions may be possible using an "Adapt to Shape" workflow with daily online recontouring.
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Affiliation(s)
- I Z Tan
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - A Mitchell
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - H McNair
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - A Dunlop
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - T Herbert
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - J Nartey
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - R Lawes
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | - C De-Colle
- Tübingen University Hospital, Tübingen, Germany
| | - K Han
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - E Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - B Nelms
- Canis Lupus LLC, Merrimac, WI
| | - N Russell
- Dutch Cancer Institute, Amsterdam, The Netherlands
| | - A Kirby
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
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Lin D, Wahid K, Nelms B, He R, Naser M, Duke S, Sherer M, Cislo M, Murphy J, Gillespie E, Fuller C. Interobserver Agreement among Multiple Generalists is Comparable to that of Recognized Experts: Prospective Acceptability Benchmarks from the C3RO Crowdsourced Initiative. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Hardcastle N, Nelms B, O’Connor L, Shakeshaft J, Haworth A, Cook O, Harris M, Phillips C. OC-0521 SRS plan quality with variation in modality: Results of an international planning competition. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30941-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gintz D, Ahmed S, Feygelman V, Caudell J, Zhang G, Moros E, Nelms B. A Novel Method for a Priori Estimation of "Best Possible Sparing" DVH for Organs at Risk: Validation for Head and Neck VMAT Planning. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nelms B, Jarry G, Chan M, Hampton C, Watanabe Y, Feygelman V. Real-world examples of sensitivity failures of the 3%/3mm pass rate metric and published action levels when used in IMRT/VMAT system commissioning. ACTA ACUST UNITED AC 2013. [DOI: 10.1088/1742-6596/444/1/012086] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Kothera L, Nelms B, Savage HM, Reisen WK. Complexity of the Culex pipiens complex in California. Proc Pap Annu Conf Mosq Vector Control Assoc Calif 2012; 80:1-3. [PMID: 28701905 PMCID: PMC5502828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In California, the Culex pipiens complex consists of Culex pipiens, Cx. quinquefasciatus, their hybrids and Culex pipiens form molestus. Using 15 microsatellite markers and a variety of statistical analyses of within- and among-population variation, there is widespread introgression throughout the Central Valley with mostly quinquefasciatus genotypes in the south and pipiens in the north. Those specimens in the Sacramento County area consisted primarily of pipiens-quinquefasciatus and pipiens-molestus hybrids. Populations in Coachella Valley and Los Angeles, CA and Benton, WA were Cx. quinquefasciatus and Cx. pipiens, respectively. Studies are underway to relate these genotypes to phenotypes of autogeny, diapause and vector competence for West Nile Virus.
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Affiliation(s)
- L Kothera
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO
| | - B Nelms
- Center for Vectorborne Diseases, School of Veterinary Medicine, University of California, Davis, CA
| | - H M Savage
- Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO
| | - W K Reisen
- Center for Vectorborne Diseases, School of Veterinary Medicine, University of California, Davis, CA
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Opp D, Robinson J, Nelms B, Zhang G, Feygelman V. SU-E-T-348: Measurement-Guided 4D VMAT Dose Reconstruction on an Arbitrary Homogeneous Dataset. Med Phys 2012. [DOI: 10.1118/1.4735435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Bailey D, Nelms B, Kumaraswamy L, Attwood K, Podgorsak M. SU-E-T-16: Statistical Variability and Confidence Intervals for Planar Dose QA Pass Rates. Med Phys 2012; 39:3705-3706. [DOI: 10.1118/1.4735070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Kozelka J, Robinson J, Zhang G, Nelms B, Feygelman V. SU-E-T-154: Evaluation and Improvement of the ArcCHECK 3D Dosimeter. Med Phys 2011. [DOI: 10.1118/1.3612104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Zhen H, Nelms B, Tome W. SU-GG-T-195: On the Correlation of Conventional IMRT QA Metrics to Clinical Impact in Per-Patient Dose QA. Med Phys 2010. [DOI: 10.1118/1.3468584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nelms B, Robinson G, Magliari J, Roeske J. MO-EE-A2-01: On the Dosimetric/DVH Impact of Variation in Organ Delineation: A Multi-Institutional Study and Proposed Quality System. Med Phys 2010. [DOI: 10.1118/1.3469085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nelms B, Feygelman V. SU-DD-A1-02: The X's and O's of 3D Dosimetry Phantoms. Med Phys 2010. [DOI: 10.1118/1.3467983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nelms B. SU-GG-T-364: Designing Custom Radiation Therapy Phantoms Using Contoured Regions-Of-Interest. Med Phys 2010. [DOI: 10.1118/1.3468761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Feygelman V, Zhang G, Stevens C, Nelms B. SU-DD-A1-03: On Rotational Measurements with the ArcCHECK 3D Diode Array. Med Phys 2010. [DOI: 10.1118/1.3467984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nelms B, Zhen H, Savitskij D, Hardee R, Tome W. SU-GG-T-184: Per-Patient Dose QA Based on Clinically Relevant Metrics: Validation of the Planned Dose Perturbation Method to Estimate Patient Dose/DVH Using Conventional QA Data. Med Phys 2010. [DOI: 10.1118/1.3468574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Savitskij D, Nelms B, Gluckman G. SU-FF-T-132: Clinical Validation of Solid IMRT with the Pinnacle3 Radiation Treatment Planning System. Med Phys 2006. [DOI: 10.1118/1.2241057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Roeske J, Cao J, Aydogan B, Nelms B, Mundt A. SU-FF-T-144: Comparison of MLC and Solid Modulation in Pediatric Patients Receiving IMRT. Med Phys 2006. [DOI: 10.1118/1.2241068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Ehler E, Kim Y, Arvidson N, Nelms B, Tome W. TH-E-ValA-01: On the Dose Delivered to a Moving Target When Employing Different IMRT Delivery Mechanisms. Med Phys 2006. [DOI: 10.1118/1.2241970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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