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Zwan BJ, Caillet V, Booth JT, Colvill E, Fuangrod T, O'Brien R, Briggs A, O'Connor DJ, Keall PJ, Greer PB. Toward real-time verification for MLC tracking treatments using time-resolved EPID imaging. Med Phys 2021; 48:953-964. [PMID: 33354787 DOI: 10.1002/mp.14675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/16/2020] [Revised: 11/29/2020] [Accepted: 12/03/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE In multileaf collimator (MLC) tracking, the MLC positions from the original treatment plan are continuously modified to account for intrafraction tumor motion. As the treatment is adapted in real time, there is additional risk of delivery errors which cannot be detected using traditional pretreatment dose verification. The purpose of this work is to develop a system for real-time geometric verification of MLC tracking treatments using an electronic portal imaging device (EPID). METHODS MLC tracking was utilized during volumetric modulated arc therapy (VMAT). During these deliveries, treatment beam images were taken at 9.57 frames per second using an EPID and frame grabber computer. MLC positions were extracted from each image frame and used to assess delivery accuracy using three geometric measures: the location, size, and shape of the radiation field. The EPID-measured field location was compared to the tumor motion measured by implanted electromagnetic markers. The size and shape of the beam were compared to the size and shape from the original treatment plan, respectively. This technique was validated by simulating errors in phantom test deliveries and by comparison between EPID measurements and treatment log files. The method was applied offline to images acquired during the LIGHT Stereotactic Ablative Body Radiotherapy (SABR) clinical trial, where MLC tracking was performed for 17 lung cancer patients. The EPID-based verification results were subsequently compared to post-treatment dose reconstruction. RESULTS Simulated field location errors were detected during phantom validation tests with an uncertainty of 0.28 mm (parallel to MLC motion) and 0.38 mm (perpendicular), expressed as a root-mean-square error (RMSError ). For simulated field size errors, the RMSError was 0.47 cm2 and field shape changes were detected for random errors with standard deviation ≥ 2.5 mm. For clinical lung SABR deliveries, field location errors of 1.6 mm (parallel MLC motion) and 4.9 mm (perpendicular) were measured (expressed as a full-width-half-maximum). The mean and standard deviation of the errors in field size and shape were 0.0 ± 0.3 cm2 and 0.3 ± 0.1 (expressed as a translation-invariant normalized RMS). No correlation was observed between geometric errors during each treatment fraction and dosimetric errors in the reconstructed dose to the target volume for this cohort of patients. CONCLUSION A system for real-time delivery verification has been developed for MLC tracking using time-resolved EPID imaging. The technique has been tested offline in phantom-based deliveries and clinical patient deliveries and was used to independently verify the geometric accuracy of the MLC during MLC tracking radiotherapy.
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Affiliation(s)
- Benjamin J Zwan
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia.,Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Vincent Caillet
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,ACRF Image X Institute, School of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Jeremy T Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia
| | - Emma Colvill
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.,ACRF Image X Institute, School of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Todsaporn Fuangrod
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia.,Faculty of Medicine and Public Health HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Ricky O'Brien
- ACRF Image X Institute, School of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Adam Briggs
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Daryl J O'Connor
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia
| | - Paul J Keall
- ACRF Image X Institute, School of Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Peter B Greer
- School of Mathematical and Physical Sciences, University of Newcastle, Newcastle, NSW, Australia.,Department of Radiation Oncology, Calvary Mater Hospital, Newcastle, NSW, Australia
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Colvill E, Safai S, Bieri O, Kozerke S, Weber D, Lomax A, Fattori G. PO-1687: Regional lung motion amplitude and variability assessment from a 4DMRI dataset. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01705-9] [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: 11/27/2022]
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Fattori G, Hrbacek J, Regele H, Bula C, Mayor A, Danuser S, Oxley DC, Rechsteiner U, Grossmann M, Via R, Böhlen TT, Bolsi A, Walser M, Togno M, Colvill E, Lempen D, Weber DC, Lomax AJ, Safai S. Commissioning and quality assurance of a novel solution for respiratory-gated PBS proton therapy based on optical tracking of surface markers. Z Med Phys 2020; 32:52-62. [PMID: 32830006 PMCID: PMC9948868 DOI: 10.1016/j.zemedi.2020.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/01/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022]
Abstract
We present the commissioning and quality assurance of our clinical protocol for respiratory gating in pencil beam scanning proton therapy for cancer patients with moving targets. In a novel approach, optical tracking has been integrated in the therapy workflow and used to monitor respiratory motion from multiple surrogates, applied on the patients' chest. The gating system was tested under a variety of experimental conditions, specific to proton therapy, to evaluate reaction time and reproducibility of dose delivery control. The system proved to be precise in the application of beam gating and allowed the mitigation of dose distortions even for large (1.4cm) motion amplitudes, provided that adequate treatment windows were selected. The total delivered dose was not affected by the use of gating, with measured integral error within 0.15cGy. Analysing high-resolution images of proton transmission, we observed negligible discrepancies in the geometric location of the dose as a function of the treatment window, with gamma pass rate greater than 95% (2%/2mm) compared to stationary conditions. Similarly, pass rate for the latter metric at the 3%/3mm level was observed above 97% for clinical treatment fields, limiting residual movement to 3mm at end-exhale. These results were confirmed in realistic clinical conditions using an anthropomorphic breathing phantom, reporting a similarly high 3%/3mm pass rate, above 98% and 94%, for regular and irregular breathing, respectively. Finally, early results from periodic QA tests of the optical tracker have shown a reliable system, with small variance observed in static and dynamic measurements.
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Affiliation(s)
- Giovanni Fattori
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland.
| | - Jan Hrbacek
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Harald Regele
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Christian Bula
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Alexandre Mayor
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Stefan Danuser
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - David C. Oxley
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Urs Rechsteiner
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Martin Grossmann
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Riccardo Via
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Till T. Böhlen
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Michele Togno
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Emma Colvill
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Daniel Lempen
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland,Department of Radiation Oncology, University Hospital Zurich, 8091 Zurich, Switzerland,Department of Radiation Oncology, University Hospital Bern, 3000 Bern, Switzerland
| | - Antony J. Lomax
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland,Department of Physics, ETH Zurich, 8092 Zurich, Switzerland
| | - Sairos Safai
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
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Colvill E, Krieger M, Bosshard P, Steinacher P, Rohrer Schnidrig BA, Parkel T, Stergiou I, Zhang Y, Peroni M, Safai S, Weber DC, Lomax A, Fattori G. Anthropomorphic phantom for deformable lung and liver CT and MR imaging for radiotherapy. Phys Med Biol 2020; 65:07NT02. [PMID: 32045898 DOI: 10.1088/1361-6560/ab7508] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this study, a functioning and ventilated anthropomorphic phantom was further enhanced for the purpose of CT and MR imaging of the lung and liver. A deformable lung, including respiratory tract was 3D printed. Within the lung's inner structures is a solid region shaped from a patient's lung tumour and six nitro-glycerine capsules as reference landmarks. The full internal mesh was coated, and the tumour filled, with polyorganosiloxane based gel. A moulded liver was created with an external casing of silicon filled with polyorganosiloxane gel and flexible plastic internal structures. The liver, fitted to the inferior portion of the right lung, moves along with the lung's ventilation. In the contralateral side, a cavity is designed to host a dosimeter, whose motion is correlated to the lung pressure. A 4DCT of the phantom was performed along with static and 4D T1 weighted MR images. The CT Hounsfield units (HU) for the flexible 3D printed material were -600-100 HU (lung and liver structures), for the polyorganosiloxane gel 30-120 HU (lung coating and liver filling) and for the silicon 650-800 HU (liver casing). The MR image intensity units were 0-40, 210-280 and 80-130, respectively. The maximum range of motion in the 4D imaging for the superior lung was 1-3.5 mm and 3.5-8 mm in the inferior portion. The liver motion was 5.5-8.0 mm at the tip and 5.7-10.0 mm at the dome. No measurable drift in motion was observed over a 2 h session and motion was reproducible over three different sessions for sin2(t), sin4(t) and a patient-like breathing curve with the interquartile range of amplitudes for all breathing cycles within 0.5 mm. The addition of features within the lung and of a deformable liver will allow the phantom to be used for imaging studies such as validation of 4DMRI and pseudo CT methods.
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Affiliation(s)
- Emma Colvill
- Paul Scherrer Institute, Center for Proton Therapy, Villigen, Switzerland. Author to whom any correspondence should be addressed
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Colvill E, Krieger M, Zhang Y, Safai S, Weber D, Lomax A, Fattori G. PO-0895 Anthropomorphic breathing phantom with lung and liver components for testing MR-guided radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31315-5] [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: 10/26/2022]
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Caillet V, O'Brien R, Moore D, Poulsen P, Pommer T, Colvill E, Sawant A, Booth J, Keall P. Technical Note: In silico and experimental evaluation of two leaf-fitting algorithms for MLC tracking based on exposure error and plan complexity. Med Phys 2019; 46:1814-1820. [PMID: 30719723 DOI: 10.1002/mp.13425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/02/2018] [Revised: 01/13/2019] [Accepted: 01/14/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Multileaf collimator (MLC) tracking is being clinically pioneered to continuously compensate for thoracic and pelvic motion during radiotherapy. The purpose of this work was to characterize the performance of two MLC leaf-fitting algorithms, direct optimization and piecewise optimization, for real-time motion compensation with different plan complexity and tumor trajectories. METHODS To test the algorithms, both in silico and phantom experiments were performed. The phantom experiments were performed on a Trilogy Varian linac and a HexaMotion programmable motion platform. High and low modulation VMAT plans for lung and prostate cancer cases were used along with eight patient-measured organ-specific trajectories. For both MLC leaf-fitting algorithms, the plans were run with their corresponding patient trajectories. To compare algorithms, the average exposure errors, i.e., the difference in shape between ideal and fitted MLC leaves by the algorithm, plan complexity and system latency of each experiment were calculated. RESULTS Comparison of exposure errors for the in silico and phantom experiments showed minor differences between the two algorithms. The average exposure errors for in silico experiments with low/high plan complexity were 0.66/0.88 cm2 for direct optimization and 0.66/0.88 cm2 for piecewise optimization, respectively. The average exposure errors for the phantom experiments with low/high plan complexity were 0.73/1.02 cm2 for direct and 0.73/1.02 cm2 for piecewise optimization, respectively. The measured latency for the direct optimization was 226 ± 10 ms and for the piecewise algorithm was 228 ± 10 ms. In silico and phantom exposure errors quantified for each treatment plan demonstrated that the exposure errors from the high plan complexity (0.96 cm2 mean, 2.88 cm2 95% percentile) were all significantly different from the low plan complexity (0.70 cm2 mean, 2.18 cm2 95% percentile) (P < 0.001, two-tailed, Mann-Whitney statistical test). CONCLUSIONS The comparison between the two leaf-fitting algorithms demonstrated no significant differences in exposure errors, neither in silico nor with phantom experiments. This study revealed that plan complexity impacts the overall exposure errors significantly more than the difference between the algorithms.
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Affiliation(s)
- Vincent Caillet
- Northern Sydney Cancer Centre, Sydney, NSW, Australia.,ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Ricky O'Brien
- ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Douglas Moore
- Beyond Center for Fundamental Concepts in Science, Arizona State University, Tempe, AZ, USA
| | | | - Tobias Pommer
- Unit of Radiotherapy Physics and Engineering, Karolinska University Hospital, Solna, Sweden
| | - Emma Colvill
- Northern Sydney Cancer Centre, Sydney, NSW, Australia.,ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Sydney, NSW, Australia.,ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Paul Keall
- ACRF Image X Institute, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Colvill E, Petersen JBB, Hansen R, Worm E, Skouboe S, Høyer M, Poulsen PR. Validation of fast motion-including dose reconstruction for proton scanning therapy in the liver. Phys Med Biol 2018; 63:225021. [PMID: 30457119 DOI: 10.1088/1361-6560/aaeae9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study validates a method of fast motion-including dose reconstruction for proton pencil beam scanning in the liver. The method utilizes a commercial treatment planning system (TPS) and calculates the delivered dose for any translational 3D target motion. Data from ten liver patients previously treated with photon radiotherapy with intrafraction tumour motion monitoring were used. The dose reconstruction method utilises an in-house developed program to incorporate beam's-eye-view tumour motion by shifting each spot in the opposite direction of the tumour and in-depth motion as beam energy changes for each spot. The doses are then calculated on a single CT phase in the TPS. Two aspects of the dose reconstruction were assessed: (1) The accuracy of reconstruction, by comparing dose reconstructions created using 4DCT motion with ground truth doses obtained by calculating phase specific doses in all 4DCT phases and summing up these partial doses. (2) The error caused by assuming 4DCT motion, by comparing reconstructions with 4DCT motion and actual tumour motion. The CTV homogeneity index (HI) and the root-mean-square (rms) dose error for all dose points receiving >70%, >80% and >90% of the prescribed dose were calculated. The dose reconstruction resulted in mean (range) absolute CTV HI errors of 1.0% (0.0-3.0)% and rms dose errors of 2.5% (1.0%-5.3%), 2.1% (0.9%-4.5%), and 1.8% (0.7%-3.7%) for >70%, >80% and >90% doses, respectively, when compared with the ground truth. The assumption of 4DCT motion resulted in mean (range) absolute CTV HI errors of 5.9% (0.0-15.0)% and rms dose errors of 6.3% (3.9%-12.6%), 5.9% (3.4%-12.5%), and 5.4% (2.6%-12.1%) for >70%, >80% and >90% doses, respectively. The investigated method allows tumour dose reconstruction with the actual tumour motion and results in significantly smaller dose errors than those caused by assuming that motion at treatment is identical to the 4DCT motion.
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Affiliation(s)
- Emma Colvill
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark. Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland. Author to whom any correspondence should be addressed
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Caillet V, Keall PJ, Colvill E, Hardcastle N, O'Brien R, Szymura K, Booth JT. MLC tracking for lung SABR reduces planning target volumes and dose to organs at risk. Radiother Oncol 2017; 124:18-24. [DOI: 10.1016/j.radonc.2017.06.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 11/26/2022]
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Colvill E, Petersen J, Høyer M, Worm E, Hansen R, Poulsen P. PV-0137: Validation of fast motion-including dose reconstruction for proton scanning therapy in the liver. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30580-7] [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: 11/12/2022]
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Colvill E. SP-0214: Online tumour tracking - technology and quality assurance. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30657-6] [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: 10/19/2022]
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Colvill E, Booth J, Nill S, Fast M, Bedford J, Oelfke U, Nakamura M, Poulsen P, Hansen R, Worm E, Ravkilde T, Rydhoeg JS, Pommer T, Munck Af Rosenschoeld P, Lang S, Guckenberger M, Groh C, Herrmann C, Verellen D, Poels K, Wang L, Hadsell M, Blanck O, Sothmann T, Keall P. TH-AB-303-01: Benchmarking Real-Time Adaptive Radiotherapy Systems: A Multi- Platform Multi-Institutional Study. Med Phys 2016. [DOI: 10.1118/1.4926156] [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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Caillet V, Colvill E, Szymura K, Stevens M, Booth J, Keall P. SU-G-JeP1-05: Clinical Impact of MLC Tracking for Lung SABR. Med Phys 2016. [DOI: 10.1118/1.4956980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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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J Zwan B, Colvill E, Booth J, J O'Connor D, Keall P, B Greer P. TH-AB-202-02: Real-Time Verification and Error Detection for MLC Tracking Deliveries Using An Electronic Portal Imaging Device. Med Phys 2016. [DOI: 10.1118/1.4958066] [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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Caillet V, O'Brien R, Colvill E, Poulsen P, Moore D, Booth J, Sawant A, Keall P. SU-G-JeP1-12: Head-To-Head Performance Characterization of Two Multileaf Collimator Tracking Algorithms for Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4956987] [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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Colvill E, Booth J, Nill S, Fast M, Bedford J, Oelfke U, Nakamura M, Poulsen P, Worm E, Hansen R, Ravkilde T, Scherman Rydhög J, Pommer T, Munck Af Rosenschold P, Lang S, Guckenberger M, Groh C, Herrmann C, Verellen D, Poels K, Wang L, Hadsell M, Sothmann T, Blanck O, Keall P. A dosimetric comparison of real-time adaptive and non-adaptive radiotherapy: A multi-institutional study encompassing robotic, gimbaled, multileaf collimator and couch tracking. Radiother Oncol 2016; 119:159-65. [PMID: 27016171 PMCID: PMC4854175 DOI: 10.1016/j.radonc.2016.03.006] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 03/02/2016] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE A study of real-time adaptive radiotherapy systems was performed to test the hypothesis that, across delivery systems and institutions, the dosimetric accuracy is improved with adaptive treatments over non-adaptive radiotherapy in the presence of patient-measured tumor motion. METHODS AND MATERIALS Ten institutions with robotic(2), gimbaled(2), MLC(4) or couch tracking(2) used common materials including CT and structure sets, motion traces and planning protocols to create a lung and a prostate plan. For each motion trace, the plan was delivered twice to a moving dosimeter; with and without real-time adaptation. Each measurement was compared to a static measurement and the percentage of failed points for γ-tests recorded. RESULTS For all lung traces all measurement sets show improved dose accuracy with a mean 2%/2mm γ-fail rate of 1.6% with adaptation and 15.2% without adaptation (p<0.001). For all prostate the mean 2%/2mm γ-fail rate was 1.4% with adaptation and 17.3% without adaptation (p<0.001). The difference between the four systems was small with an average 2%/2mm γ-fail rate of <3% for all systems with adaptation for lung and prostate. CONCLUSIONS The investigated systems all accounted for realistic tumor motion accurately and performed to a similar high standard, with real-time adaptation significantly outperforming non-adaptive delivery methods.
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Affiliation(s)
- Emma Colvill
- Radiation Physics Laboratory, University of Sydney, Australia; Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia
| | - Jeremy Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Australia; School of Physics, University of Sydney, Australia
| | - Simeon Nill
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Martin Fast
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - James Bedford
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Uwe Oelfke
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-Applied Therapy, Kyoto University, Japan
| | | | | | | | | | - Jonas Scherman Rydhög
- Radiation Medicine Research Center, Rigshospitalet, Copenhagen, Denmark; Niels Bohr Institute, University of Copenhagen, Denmark
| | - Tobias Pommer
- Radiation Medicine Research Center, Rigshospitalet, Copenhagen, Denmark; Section of Radiotherapy Physics and Engineering, Medical Physics Department, Karolinska University Hospital, Stockholm, Sweden
| | - Per Munck Af Rosenschold
- Radiation Medicine Research Center, Rigshospitalet, Copenhagen, Denmark; Niels Bohr Institute, University of Copenhagen, Denmark
| | - Stephanie Lang
- Department of Radiation Oncology, University Hospital Zurich, Switzerland
| | | | - Christian Groh
- Department of Radiation Oncology, University Hospital of Würzburg, Germany
| | | | - Dirk Verellen
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Kenneth Poels
- Department of Radiotherapy, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Lei Wang
- Radiation Oncology Department, Stanford University, Palo Alto, United States
| | - Michael Hadsell
- Radiation Oncology Department, Stanford University, Palo Alto, United States
| | - Thilo Sothmann
- Department for Radiation Oncology, University Clinic Eppendorf, Hamburg, Germany
| | - Oliver Blanck
- Department for Radiation Oncology, University Clinic Schleswig-Holstein, Kiel, Germany; Saphir Radiosurgery Center, Güstrow and Frankfurt am Main, Germany
| | - Paul Keall
- Radiation Physics Laboratory, University of Sydney, Australia.
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Keall PJ, Ng JA, Juneja P, O'Brien RT, Huang CY, Colvill E, Caillet V, Simpson E, Poulsen PR, Kneebone A, Eade T, Booth JT. Real-Time 3D Image Guidance Using a Standard LINAC: Measured Motion, Accuracy, and Precision of the First Prospective Clinical Trial of Kilovoltage Intrafraction Monitoring–Guided Gating for Prostate Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 94:1015-21. [DOI: 10.1016/j.ijrobp.2015.10.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 09/14/2015] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
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Keall P, Ng J, Caillet V, Huang C, Colvill E, Simpson E, Poulsen P, Kneebone A, Eade T, Booth J. Sub-mm Accuracy Results Measured From the First Prospective Clinical Trial of a Novel Real-Time IGRT System, Kilovoltage Intrafraction Monitoring (KIM). Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.461] [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: 11/25/2022]
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Juneja P, Kneebone A, Booth JT, Thwaites DI, Kaur R, Colvill E, Ng JA, Keall PJ, Eade T. Prostate motion during radiotherapy of prostate cancer patients with and without application of a hydrogel spacer: a comparative study. Radiat Oncol 2015; 10:215. [PMID: 26499473 PMCID: PMC4619294 DOI: 10.1186/s13014-015-0526-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/19/2015] [Indexed: 12/16/2022] Open
Abstract
Background and purpose The use of a tissue expander (hydrogel) for sparing of the rectum from increased irradiation during prostate radiotherapy is becoming popular. The goal of this study is to investigate the effect of a tissue expander (hydrogel) on the intrafraction prostate motion during radiotherapy. Methods and material Real time prostate motion was analysed for 26 patients and 742 fractions; 12 patients with and 14 patients without hydrogel (SpaceOAR™). The intra-fraction motion was quantified and compared between the two groups. Results The average (±standard deviation) of the mean motion during the treatment for patients with and without hydrogel was 1.5 (±0.8 mm) and 1.1 (±0.9 mm) respectively (p < 0.05). The average time of motion >3 mm for patients with and without hydrogel was 7.7 % (±1.1 %) and 4.5 % (±0.9 %) respectively (p > 0.05). The hydrogel age, fraction number and treatment time were found to have no effect (R2 < 0.05) on the prostate motion. Conclusions Differences in intrafraction motion in patients with hydrogel and without hydrogel were within measurement uncertainty (<1 mm). This result confirms that the addition of a spacer does not negate the need for intrafraction motion management if clinically indicated.
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Affiliation(s)
- Prabhjot Juneja
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia. .,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.
| | - Jeremy T Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia. .,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, 2006, Australia.
| | - David I Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Ramandeep Kaur
- , 5/161A Willoughby Road, Naremburn, NSW, 2065, Australia.
| | - Emma Colvill
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia. .,Radiation Physics Laboratory, School of Medicine, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Jin A Ng
- Radiation Physics Laboratory, School of Medicine, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Paul J Keall
- Radiation Physics Laboratory, School of Medicine, University of Sydney, Sydney, NSW, 2006, Australia.
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.
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Ng JA, Booth JT, O'Brien RT, Colvill E, Huang CY, Poulsen PR, Keall PJ. Quality assurance for the clinical implementation of kilovoltage intrafraction monitoring for prostate cancer VMAT. Med Phys 2015; 41:111712. [PMID: 25370626 DOI: 10.1118/1.4898119] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Kilovoltage intrafraction monitoring (KIM) is a real-time 3D tumor monitoring system for cancer radiotherapy. KIM uses the commonly available gantry-mounted x-ray imager as input, making this method potentially more widely available than dedicated real-time 3D tumor monitoring systems. KIM is being piloted in a clinical trial for prostate cancer patients treated with VMAT (NCT01742403). The purpose of this work was to develop clinical process and quality assurance (QA) practices for the clinical implementation of KIM. METHODS Informed by and adapting existing guideline documents from other real-time monitoring systems, KIM-specific QA practices were developed. The following five KIM-specific QA tests were included: (1) static localization accuracy, (2) dynamic localization accuracy, (3) treatment interruption accuracy, (4) latency measurement, and (5) clinical conditions accuracy. Tests (1)-(4) were performed using KIM to measure static and representative patient-derived prostate motion trajectories using a 3D programmable motion stage supporting an anthropomorphic phantom with implanted gold markers to represent the clinical treatment scenario. The threshold for system tolerable latency is <1 s. The tolerances for all other tests are that both the mean and standard deviation of the difference between the programmed trajectory and the measured data are <1 mm. The (5) clinical conditions accuracy test compared the KIM measured positions with those measured by kV/megavoltage (MV) triangulation from five treatment fractions acquired in a previous pilot study. RESULTS For the (1) static localization, (2) dynamic localization, and (3) treatment interruption accuracy tests, the mean and standard deviation of the difference are <1.0 mm. (4) The measured latency is 350 ms. (5) For the tests with previously acquired patient data, the mean and standard deviation of the difference between KIM and kV/MV triangulation are <1.0 mm. CONCLUSIONS Clinical process and QA practices for the safe clinical implementation of KIM, a novel real-time monitoring system using commonly available equipment, have been developed and implemented for prostate cancer VMAT.
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Affiliation(s)
- J A Ng
- School of Medicine, University of Sydney, NSW 2006, Australia and School of Physics, University of Sydney, NSW 2006, Australia
| | - J T Booth
- School of Physics, University of Sydney, NSW 2006, Australia and Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW 2065, Australia
| | - R T O'Brien
- School of Medicine, University of Sydney, NSW 2006, Australia
| | - E Colvill
- School of Medicine, University of Sydney, NSW 2006, Australia and Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW 2065, Australia
| | - C-Y Huang
- School of Medicine, University of Sydney, NSW 2006, Australia
| | - P R Poulsen
- Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, Aarhus C 8000, Denmark
| | - P J Keall
- School of Medicine, University of Sydney, NSW 2006, Australia
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Ge Y, Booth J, Colvill E, O'Brien R, Keall P. SU-E-J-57: First Development of Adapting to Intrafraction Relative Motion Between Prostate and Pelvic Lymph Nodes Targets. Med Phys 2015. [DOI: 10.1118/1.4924144] [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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Petasecca M, Newall MK, Booth JT, Duncan M, Aldosari AH, Fuduli I, Espinoza AA, Porumb CS, Guatelli S, Metcalfe P, Colvill E, Cammarano D, Carolan M, Oborn B, Lerch MLF, Perevertaylo V, Keall PJ, Rosenfeld AB. MagicPlate-512: A 2D silicon detector array for quality assurance of stereotactic motion adaptive radiotherapy. Med Phys 2015; 42:2992-3004. [DOI: 10.1118/1.4921126] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [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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Keall PJ, Aun Ng J, O'Brien R, Colvill E, Huang CY, Rugaard Poulsen P, Fledelius W, Juneja P, Simpson E, Bell L, Alfieri F, Eade T, Kneebone A, Booth JT. The first clinical treatment with kilovoltage intrafraction monitoring (KIM): A real-time image guidance method. Med Phys 2014; 42:354-8. [DOI: 10.1118/1.4904023] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [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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Booth J, Colvill E, Eade T, Kneebone A, O'Brien R, Keall P. First Clinical Implementation of Electromagnetic Transponder-Guided MLC Tracking. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.119] [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: 11/25/2022]
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Colvill E, Booth J, O'Brien R, Eade T, Kneebone A, Poulsen P, Keall P. First Clinical Implementation of MLC Tracking for Prostate VMAT: MLC Tracking Improves the Agreement Between the Planned and Delivered Doses. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.604] [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: 10/24/2022]
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Colvill E, Poulsen PR, Booth JT, O'Brien RT, Ng JA, Keall PJ. DMLC tracking and gating can improve dose coverage for prostate VMAT. Med Phys 2014; 41:091705. [DOI: 10.1118/1.4892605] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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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Keall PJ, Colvill E, O'Brien R, Ng JA, Poulsen PR, Eade T, Kneebone A, Booth JT. The first clinical implementation of electromagnetic transponder-guided MLC tracking. Med Phys 2014; 41:020702. [PMID: 24506591 PMCID: PMC3977852 DOI: 10.1118/1.4862509] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 12/29/2013] [Accepted: 01/02/2014] [Indexed: 11/07/2022] Open
Abstract
PURPOSE We report on the clinical process, quality assurance, and geometric and dosimetric results of the first clinical implementation of electromagnetic transponder-guided MLC tracking which occurred on 28 November 2013 at the Northern Sydney Cancer Centre. METHODS An electromagnetic transponder-based positioning system (Calypso) was modified to send the target position output to in-house-developed MLC tracking code, which adjusts the leaf positions to optimally align the treatment beam with the real-time target position. Clinical process and quality assurance procedures were developed and performed. The first clinical implementation of electromagnetic transponder-guided MLC tracking was for a prostate cancer patient being treated with dual-arc VMAT (RapidArc). For the first fraction of the first patient treatment of electromagnetic transponder-guided MLC tracking we recorded the in-room time and transponder positions, and performed dose reconstruction to estimate the delivered dose and also the dose received had MLC tracking not been used. RESULTS The total in-room time was 21 min with 2 min of beam delivery. No additional time was needed for MLC tracking and there were no beam holds. The average prostate position from the initial setup was 1.2 mm, mostly an anterior shift. Dose reconstruction analysis of the delivered dose with MLC tracking showed similar isodose and target dose volume histograms to the planned treatment and a 4.6% increase in the fractional rectal V60. Dose reconstruction without motion compensation showed a 30% increase in the fractional rectal V60 from that planned, even for the small motion. CONCLUSIONS The real-time beam-target correction method, electromagnetic transponder-guided MLC tracking, has been translated to the clinic. This achievement represents a milestone in improving geometric and dosimetric accuracy, and by inference treatment outcomes, in cancer radiotherapy.
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Affiliation(s)
- Paul J Keall
- Radiation Physics Laboratory, Sydney Medical School, University of Sydney, NSW 2006, Australia
| | - Emma Colvill
- Radiation Physics Laboratory, Sydney Medical School, University of Sydney, NSW 2006, Australia and Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Ricky O'Brien
- Radiation Physics Laboratory, Sydney Medical School, University of Sydney, NSW 2006, Australia
| | - Jin Aun Ng
- Radiation Physics Laboratory, Sydney Medical School, University of Sydney, NSW 2006, Australia
| | - Per Rugaard Poulsen
- Department of Oncology, Aarhus University Hospital, Aarhus 8000, Denmark and Institute of Clinical Medicine, Aarhus University, Aarhus 8000, Denmark
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia
| | - Jeremy T Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW 2065, Australia
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Colvill E, Ng J, O' Brien R, Poulsen P, Booth J, Keall P. TU-E-141-04: Dose Reconstruction for DMLC Tracking and Gating in Adaptive Prostate Radiotherapy. Med Phys 2013. [DOI: 10.1118/1.4815432] [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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