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Håkansson K, Josipovic M, Ottosson W, Behrens CP, Vogelius IR, Persson G. Evaluating the dosimetric effect of intra-fractional variations in deep inspiration breath-hold radiotherapy - a proof-of-concept study. Acta Oncol 2023; 62:1246-1250. [PMID: 37738385 DOI: 10.1080/0284186x.2023.2259084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Affiliation(s)
- K Håkansson
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - M Josipovic
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - W Ottosson
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - C P Behrens
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Roskilde, Denmark
| | - I R Vogelius
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - G Persson
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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Åström LM, Sibolt P, Mouritsen LS, Serup-Hansen E, Fredberg Persson G, Smedgaard Storm K, Behrens CP. Target Re-Delineation in Daily Online Adaptive Radiotherapy of Bladder Cancer: AI vs. Adapters. Int J Radiat Oncol Biol Phys 2023; 117:e639-e640. [PMID: 37785905 DOI: 10.1016/j.ijrobp.2023.06.2047] [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) The purpose was to assess the quality of artificial intelligence (AI) generated targets in cone-beam CT (CBCT) guided online adaptive radiotherapy (oART) of bladder cancer and compare it to corresponding contours edited by adapters (radiotherapy technicians performing oART routinely). Furthermore, to assess the inter-observer delineation variation in daily target re-delineation in oART of bladder cancer. MATERIALS/METHODS Ten consecutive patients treated with oART for muscle-invasive bladder cancer from Feb 2020 to Feb 2021 were retrospectively included. One CBCT randomly selected from each of the 10 clinical treatment courses was exported to an emulator, where delineations and oART simulations were carried out. The bladder was automatically segmented (clinical target volume (CTV)) using AI. Seven adapters independently reviewed and, if necessary, manually edited the AI-generated structure. A ground truth structure was first delineated blindly by a senior oncologist, then reviewed by an oART experienced medical physicist, and finally edited to a consensus structure. Planning CT and MR images with reference delineations were available during all simulations and delineations. The AI-generated and adapter-edited CTVs were compared to ground truth using dice similarity coefficient (DSC) and volume difference. The inter-observer variation in adapter-edited CTVs was assessed using coefficient of variation (CV) and the generalized conformity index (CIgen). Cigen was calculated as the ratio of the sum of all overlapping volumes between pairs of observers and the sum of all overlapping and non-overlapping volumes between the same pairs. RESULTS Nine CTVs (7 adapter-edited, 1 AI-generated, 1 ground truth) were generated per patient. Patient cases included three male and seven females; three had catheter. The ground truth volume ranged from 51.5 to 221.6 cc. The median volume difference compared to ground truth was -4.5 (range, -17.8 - 42.4) cc and -15.5 (range, -54.2 - 4.3) cc for adapter-edited and AI-generated structures, respectively. Corresponding DSC values were 0.87 (range, 0.71 - 0.95) and 0.84 (range, 0.64 - 0.95). The AI-generated CTV was smaller than ground truth for all patients except one and smaller than all adapter-edited CTVs. The largest differences among adapter-edited CTVs were observed in cranial, caudal and posterior directions. The median CV was 0.08 (range, 0.05-0.11) and Cigen was 0.78 (range, 0.71-0.88). CONCLUSION Target re-delineations in daily CBCT-based oART of bladder cancer demonstrated small inter-observer variation. Manual adjustment of AI-generated structures resulted in improved accuracy in target delineation compared to ground truth. Efforts to reduce the inter-observer variation, e.g., physician support during the initial fractions and review by a second adapter, have been implemented clinically.
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Affiliation(s)
- L M Åström
- Dept of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Dept of Health Technology, Technical University of Denmark, Roskilde, Denmark
| | - P Sibolt
- Dept of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - L S Mouritsen
- Dept of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - E Serup-Hansen
- Dept of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - G Fredberg Persson
- Dept of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - K Smedgaard Storm
- Dept of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - C P Behrens
- Dept of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Dept of Health Technology, Technical University of Denmark, Roskilde, Denmark
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Korreman SS, Behrens CP, Hansen VN, Thygesen J, Andersen TL. New technologies from bench to bedside - report from the Nordic association for clinical physics 2023 symposium. Acta Oncol 2023; 62:1157-1160. [PMID: 37916999 DOI: 10.1080/0284186x.2023.2262111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Stine Sofia Korreman
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Claus Preibisch Behrens
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Lyngby, Denmark
| | - Vibeke Nordmark Hansen
- Department of Oncology, Copenhagen University Hospital, - Rigshospitalet, Copenhagen, Denmark
| | - Jesper Thygesen
- Department of Clinical Engineering and Procurement, Central Denmark Region, Aarhus Denmark
| | - Thomas Lund Andersen
- Department of Clinical Physiology & Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark
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Klavsen MF, Ankjærgaard C, Boye K, Behrens CP, Vogelius IR, Ehrbar S, Baumgartl M, Rippke C, Buchele C, Renkamp CK, Santurio GV, Andersen CE. Accumulated dose implications from systematic dose-rate transients in gated treatments with Viewray MRIdian accelerators. Biomed Phys Eng Express 2023; 9:065001. [PMID: 37591227 DOI: 10.1088/2057-1976/acf138] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/17/2023] [Indexed: 08/19/2023]
Abstract
The combination of magnetic resonance (MR) imaging and linear accelerators (linacs) into MR-Linacs enables continuous MR imaging and advanced gated treatments of patients. Previously, a dose-rate transient (∼8% reduced dose rate during the initial 0.5 s of each beam) was identified for a Viewray MRIdian MR-Linac (Klavsenet al2022Radiation Measurement106759). Here, the dose-rate transient is studied in more detail at four linacs of the same type at different hospitals. The implications of dose-rate transients were examined for gated treatments. The dose-rate transients were investigated using dose-per pulse measurements with organic plastic scintillators in three experiments: (i) A gated treatment with the scintillator placed in a moving target in a dynamic phantom, (ii) a gated treatment with the same dynamic conditions but with the scintillator placed in a stationary target, and (iii) measurements in a water-equivalent material to examine beam quality deviations at a dose-per-pulse basis. Gated treatments (i) compared with non-gated treatments with a static target in the same setup showed a broadening of accumulated dose profiles due to motion (dose smearing). The linac with the largest dose-rate transient had a reduced accumulated dose of up to (3.1 ± 0.65) % in the center of the PTV due to the combined dose smearing and dose-rate transient effect. Dose-rate transients were found to vary between different machines. Two MR-Linacs showed initial dose-rate transients that could not be identified from conventional linearity tests. The source of the transients includes an initial change in photon fluence rate and an initial change in x-ray beam quality. For gated treatments, this caused a reduction of more than 1% dose delivered at the central part of the beam for the studied, cyclic-motion treatment plan. Quality assurance of this effect should be considered when gated treatment with the Viewray MRIdian is implemented clinically.
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Affiliation(s)
- M F Klavsen
- DTU Health Tech, Technical University of Denmark, Roskilde, Denmark
| | - C Ankjærgaard
- DTU Health Tech, Technical University of Denmark, Roskilde, Denmark
| | - K Boye
- Dept. of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - C P Behrens
- DTU Health Tech, Technical University of Denmark, Roskilde, Denmark
- Dept. of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - I R Vogelius
- Dept. of Oncology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen- Copenhagen, Denmark
| | - S Ehrbar
- Dept. of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - M Baumgartl
- Dept. of Radiation Oncology, University Hospital Zürich and University of Zürich, Zürich, Switzerland
| | - C Rippke
- Dept. of Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - C Buchele
- Dept. of Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - C K Renkamp
- Dept. of Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - G V Santurio
- Dept. of Oncology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
| | - C E Andersen
- DTU Health Tech, Technical University of Denmark, Roskilde, Denmark
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Wahlstedt I, George Smith A, Andersen CE, Behrens CP, Nørring Bekke S, Boye K, van Overeem Felter M, Josipovic M, Petersen J, Risumlund SL, Tascón-Vidarte JD, van Timmeren JE, Vogelius IR. Interfractional dose accumulation for MR-guided liver SBRT: Variation among algorithms is highly patient- and fraction-dependent. Radiother Oncol 2022; 182:109448. [PMID: 36566988 DOI: 10.1016/j.radonc.2022.109448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/22/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Daily plan adaptations could take the dose delivered in previous fractions into account. Due to high dose delivered per fraction, low number of fractions, steep dose gradients, and large interfractional organ deformations, this might be particularly important for liver SBRT. This study investigates inter-algorithm variation of interfractional dose accumulation for MR-guided liver SBRT. MATERIALS AND METHODS We assessed 27 consecutive MR-guided liver SBRT treatments of 67.5 Gy in three (n = 15) or 50 Gy in five fractions (n = 12), both prescribed to the GTV. We calculated fraction doses on daily patient anatomy, warped these doses to the simulation MRI using seven different algorithms, and accumulated the warped doses. Thus, we obtained differences in planned doses and warped or accumulated doses for each algorithm. This enabled us to calculate the inter-algorithm variations in warped doses per fraction and in accumulated doses per treatment course. RESULTS The four intensity-based algorithms were more consistent with planned PTV dose than affine or contour-based algorithms. The mean (range) variation of the dose difference for PTV D95% due to dose warping by these intensity-based algorithms was 10.4 percentage points (0.3 to 43.7) between fractions and 8.6 (0.3 to 24.9) between accumulated treatment doses. As seen by these ranges, the variation was very dependent on the patient and the fraction being analyzed. Nevertheless, no correlations between patient or plan characteristics on the one hand and inter-algorithm dose warping variation on the other hand was found. CONCLUSION Inter-algorithm dose accumulation variation is highly patient- and fraction-dependent for MR-guided liver SBRT. We advise against trusting a single algorithm for dose accumulation in liver SBRT.
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Affiliation(s)
- Isak Wahlstedt
- Department of Health Technology, Technical University of Denmark, Anker Engelunds Vej 1, Bygning 101A, 2800 Kongens Lyngby, Denmark; Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte (HGH), Borgmester Ib Juuls Vej 7, 2730 Herlev, Denmark.
| | - Abraham George Smith
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Computer Science, University of Copenhagen, Universitetsparken 1, 2100 Copenhagen, Denmark
| | - Claus Erik Andersen
- Department of Health Technology, Technical University of Denmark, Anker Engelunds Vej 1, Bygning 101A, 2800 Kongens Lyngby, Denmark
| | - Claus Preibisch Behrens
- Department of Health Technology, Technical University of Denmark, Anker Engelunds Vej 1, Bygning 101A, 2800 Kongens Lyngby, Denmark; Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte (HGH), Borgmester Ib Juuls Vej 7, 2730 Herlev, Denmark
| | - Susanne Nørring Bekke
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte (HGH), Borgmester Ib Juuls Vej 7, 2730 Herlev, Denmark
| | - Kristian Boye
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mette van Overeem Felter
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte (HGH), Borgmester Ib Juuls Vej 7, 2730 Herlev, Denmark
| | - Mirjana Josipovic
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Jens Petersen
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Computer Science, University of Copenhagen, Universitetsparken 1, 2100 Copenhagen, Denmark
| | - Signe Lenora Risumlund
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - José David Tascón-Vidarte
- Department of Computer Science, University of Copenhagen, Universitetsparken 1, 2100 Copenhagen, Denmark
| | | | - Ivan Richter Vogelius
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
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Korreman SS, Vogelius IR, Abdi AJ, Hansen SB, Behrens CP. Novel technologies in radiotherapy in the Nordic countries - report from the NACP2020/21 conference. Acta Oncol 2021; 60:1383-1385. [PMID: 34612766 DOI: 10.1080/0284186x.2021.1979250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stine Sofia Korreman
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ivan Richter Vogelius
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Ahmed Jibril Abdi
- Region of Southern Denmark, Clinical Engineering Department, Area of Diagnostic Radiology, Odense, Denmark
- Research and Innovation Unit, University of Southern Denmark, Odense, Denmark
| | - Søren Baarsgaard Hansen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Nuclear Medicine and PET Center, Aarhus University Hospital Aarhus, Denmark
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