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Hughes N, Salzillo TC, Vedam S, Lim TY, Wang X, Wang H, Mohammedsaid M, Fuller CD, Wang J, Yang J. A look-up-table development to facilitate CT simulation of MR-Linac treatment. Phys Imaging Radiat Oncol 2024; 29:100524. [PMID: 38192414 PMCID: PMC10772372 DOI: 10.1016/j.phro.2023.100524] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/10/2024] Open
Abstract
While current MR-Linac (MRL) treatment workflows utilize a large table overlay during CT simulation to convert indexing between the two machines, we developed a look-up-table (LUT) as an alternative approach. After populating the LUT, index conversion factors were verified at three separate table locations. The resultant root-mean-square isocenter shifts on the MRL were 0.04/0.08 cm, 0.08/0.07 cm, and 0.09/0.08 cm with/without using the table overlay during simulation in the lateral, longitudinal, and vertical directions, respectively, which is within registration tolerance. Clinical implementation of the LUT has resulted in a more efficient MRL treatment workflow while maintaining accurate patient setup.
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Affiliation(s)
- Neil Hughes
- Radiation Therapy Program, MD Anderson Cancer Center School of Health Professions, Houston, TX, United States
| | - Travis C. Salzillo
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, United States
| | - Sastry Vedam
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, United States
| | - Tze Yee Lim
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, United States
| | - Xin Wang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, United States
| | - He Wang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, United States
| | - Mustefa Mohammedsaid
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, United States
| | - Clifton D. Fuller
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, United States
| | - Jihong Wang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, United States
| | - Jinzhong Yang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX, United States
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Jacobsen MC, Rigaud B, Simiele SJ, Rauch GM, Ning MS, Vedam S, Klopp AH, Stafford RJ, Brock KK, Venkatesan AM. Feasibility of quantitative diffusion-weighted imaging during intra-procedural MRI-guided brachytherapy of locally advanced cervical and vaginal cancers. Brachytherapy 2023; 22:736-745. [PMID: 37612174 DOI: 10.1016/j.brachy.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/11/2023] [Revised: 05/30/2023] [Accepted: 06/15/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE To determine the feasibility of quantitative apparent diffusion coefficient (ADC) acquisition during magnetic resonance imaging-guided brachytherapy (MRgBT) using reduced field-of-view (rFOV) diffusion-weighted imaging (DWI). METHODS AND MATERIALS T2-weighted (T2w) MR and full-FOV single-shot echo planar (ssEPI) DWI were acquired in 7 patients with cervical or vaginal malignancy at baseline and prior to brachytherapy, while rFOV-DWI was acquired during MRgBT following brachytherapy applicator placement. The gross target volume (GTV) was contoured on the T2w images and registered to the ADC map. Voxels at the GTV's maximum Maurer distance comprised a central sub-volume (GTVcenter). Contour ADC mean and standard deviation were compared between timepoints using repeated measures ANOVA. RESULTS ssEPI-DWI mean ADC increased between baseline and prebrachytherapy from 1.03 ± 0.18 10-3 mm2/s to 1.34 ± 0.28 10-3 mm2/s for the GTV (p = 0.06) and from 0.84 ± 0.13 10-3 mm2/s to 1.26 ± 0.25 10-3 mm2/s at the level of the GTVcenter (p = 0.03), consistent with early treatment response. rFOV-DWI during MRgBT demonstrated mean ADC values of 1.28 ± 0.14 10-3 mm2/s and 1.28 ± 0.19 10-3 mm2/s for the GTV and GTVcenter, respectively (p = 0.02 and p = 0.03 relative to baseline). No significant differences were observed between ssEPI-DWI and rFOV-DWI ADC measurements. CONCLUSIONS Quantitative ADC measurement in the setting of MRI guided brachytherapy implant placement for cervical and vaginal cancers is feasible using rFOV-DWI, with comparable mean ADC comparable to prebrachytherapy ssEPI-DWI, and may enable MRI-guided radiotherapy targeting of low ADC, radiation resistant sub-volumes of tumor.
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Affiliation(s)
- Megan C Jacobsen
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Bastien Rigaud
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Samantha J Simiele
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gaiane M Rauch
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthew S Ning
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sastry Vedam
- University of Maryland, Department of Radiation Oncology, Baltimore, MD
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - R Jason Stafford
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kristy K Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Aradhana M Venkatesan
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Yao W, Zhang B, Han D, Polf J, Vedam S, Lasio G, Yi B. Use of CBCT plus plan robustness for reducing QACT frequency in intensity-modulated proton therapy: Head-and-neck cases. Med Phys 2022; 49:6794-6801. [PMID: 35933322 DOI: 10.1002/mp.15915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/04/2022] [Revised: 06/20/2022] [Accepted: 08/01/2022] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Anatomic variation has a significant dosimetric impact in intensity-modulated proton therapy. Weekly or biweekly computed tomography (CT) scans, called quality assurance CTs (QACTs), are used to monitor anatomic and resultant dose changes to determine whether adaptive plans are needed. Frequent CT scans result in unwanted QACT dose and increased clinical workloads. This study proposed utilizing patient setup cone-beam CTs (CBCTs) and treatment plan robustness to reduce the frequency of QACTs. METHODS We retrospectively analyzed data from 27 patients with head-and-neck cancer, including 594 CBCTs, 136 QACTs, and 19 adaptive plans. For each CBCT, water-equivalent thickness (WET) along the pencil-beam path was calculated. For each treatment plan, the WET of the first-day CBCT was used as the reference, and the mean WET changes (ΔWET) in each following CBCT was used as the surrogate of proton range change. Using CBCTs acquired prior to a QACT, we predicted the ΔWET on the QACT day by a linear regression model. The impact of range change on target dose was calculated as the predicted ΔWET weighted by the monitor units of each field. In addition, plan robustness was estimated from the robust dose-volume histograms (DVHs) and combined with ΔWET to reduce QACT frequency. Robustness was estimated from the distance between the DVH curves of the nominal and worst scenarios. RESULTS When the estimated mean ΔWET was <6.5 mm (or <7.5 mm if the robustness was >95%), the QACT could be skipped without missing any adaptive planning; otherwise a QACT was required. Overall, 41% of QACTs could be eliminated when ΔWET was <6.5 mm and 56% when ΔWET was <7.5 mm, and robustness was >95%. At least one QACT could have been omitted in 25 of the 27 cases under skipping thresholds at ΔWETs <7.5 mm and R > 95%. CONCLUSION This study suggests that the number of QACTs can be greatly reduced by calculating range change in patient setup CBCTs and can be further reduced by combining this information with analyses of plan robustness.
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Affiliation(s)
- Weiguang Yao
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Baoshe Zhang
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Dong Han
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jerimy Polf
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sastry Vedam
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Giovanni Lasio
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Byongyong Yi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Guerrero M, Yao W, Lin M, Becker S, Molitoris J, Vedam S, Yi B. Validation of a commercial software dose calculation for Y-90 microspheres. Brachytherapy 2022; 21:561-566. [DOI: 10.1016/j.brachy.2022.03.007] [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] [Received: 11/13/2021] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 11/26/2022]
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Lakomy DS, Yang J, Vedam S, Wang J, Lee B, Sobremonte A, Castillo P, Hughes N, Mohammadsaid M, Jhingran A, Klopp AH, Choi S, Fuller CD, Lin LL. Clinical implementation and initial experience with a 1.5 Tesla MR-linac for MR-guided radiotherapy for gynecologic cancer: An R-IDEAL stage 1/2a first in humans/feasibility study of new technology implementation. Pract Radiat Oncol 2022; 12:e296-e305. [PMID: 35278717 DOI: 10.1016/j.prro.2022.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/15/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Magnetic resonance imaging-guided linear accelerator systems (MR-linacs) can facilitate the daily adaptation of radiotherapy plans. Here, we report our early clinical experience using an MR-linac for adaptive radiotherapy of gynecologic malignancies. METHODS AND MATERIALS Treatments were planned with an Elekta Monaco v5.4.01 and delivered by a 1.5 Tesla Elekta Unity MR-linac. The system offers a choice of daily adaptation based on either position (ATP) or shape (ATS) of the tumor and surrounding normal structures. The ATS approach has the option of manually editing the contours of tumors and surrounding normal structures before the plan is adapted. Here we documented the duration of each treatment fraction; set-up variability (assessed by isocenter shifts in each plan) between fractions; and, for quality assurance, calculated the percentage of plans meeting the γ-criterion of 3%/3-mm distance to agreement. Deformable accumulated dose calculations were used to compare accumulated versus planned dose for patient treated with exclusively ATP fractions. RESULTS Of the 10 patients treated with 90 fractions on the MR-linac, most received boost doses to recurrence in nodes or isolated tumors. Each treatment fraction lasted a median 32 minutes; fractions were shorter with ATP than with ATS (30 min vs 42 min, P<0.0001). The γ criterion for all fraction plans exceeded >90% (median 99.9%, range 92.4%-100%), i.e., all plans passed quality assurance testing. The average extent of isocenter shift was <0.5 cm in each axis. The accumulated dose to the gross tumor volume was within 5% of the reference plan for all ATP cases. Accumulated doses for lesions in the pelvic periphery were within <1% of the reference plan as opposed to -1.6% to -4.4% for central pelvic tumors. CONCLUSIONS The MR-linac is a reliable and clinically feasible tool for treating patients with gynecologic cancer.
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Affiliation(s)
- David S Lakomy
- Departments of Radiation Oncology; Dartmouth Geisel School of Medicine, Hanover, NH, USA
| | - Jinzhong Yang
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sastry Vedam
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jihong Wang
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Belinda Lee
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Angela Sobremonte
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pamela Castillo
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neil Hughes
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mustefa Mohammadsaid
- Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Peters LL, van der Pijl MSG, Vedam S, Barkema WS, van Lohuizen MT, Jansen DEMC, Feijen-de Jong EI. Assessing Dutch women's experiences of labour and birth: adaptations and psychometric evaluations of the measures Mothers on Autonomy in Decision Making Scale, Mothers on Respect Index, and Childbirth Experience Questionnaire 2.0. BMC Pregnancy Childbirth 2022; 22:134. [PMID: 35180852 PMCID: PMC8857821 DOI: 10.1186/s12884-022-04445-0] [Citation(s) in RCA: 5] [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: 09/02/2021] [Accepted: 01/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background The Mothers Autonomy in Decision Making Scale (MADM) assesses women’s autonomy and role in decision making. The Mothers on Respect Index (MORi) asseses women’s experiences of respect when interacting with their healthcare providers. The Childbirth Experience Questionnaire 2.0 assesses the overall experience of childbirth (CEQ2.0). There are no validated Dutch measures of the quality of women’s experiences in the intrapartum period. Therefore, the aim of this study was to evaluate the psychometric properties of these measures in their Dutch translations. Methods The available Dutch versions of the MADM and MORi were adapted to assess experiences in the intrapartum period. The CEQ2.0 was translated by using forward-backward procedures. The three measures were included in an online survey including items on individual characteristics (i.e. maternal, birth, birth interventions). Reliability was assessed by calculating Cronbach’s alphas. Mann-Whitney, Kruskal Wallis or Student T-tests were applied where appropriate, to assess discrimination between women who differed on individual characteristics (known group validity). We hypothesized that women who experienced pregnancy complications and birth interventions would have statistically lower scores on the MADM, MORi and CEQ2.0, compared with women who had healthy pregnancies and physiological births. Convergent validity was assessed using Spearman Rank correlations between the MADM, MORi and/or CEQ2.0. We hypothesized moderate to strong correlations between these measures. Women’s uptake of and feedback on the measures were tracked to assess acceptability and clarity. Results In total 621 women were included in the cross sectional study. The calculated Cronbach’s alphas for the MADM, MORi and CEQ, were ≥ 0.77. Knowngroup validity was confirmed through significant differences on all relevant individual characteristics, except for vaginal laceration repair. Spearman Rank correlations ranged from 0.46-0.80. In total 98% of the included women out of the eligible population completed the MADM and MORi for each healthcare professional they encountered during childbirth. The proportions of MADM and MORi-items which were difficult to complete ranged from 0.0-10.8%, 0.6-2.7%, respectively. Conclusions The results of our study showed that the Dutch version of the MADM, MORi and CEQ2.0 in Dutch are valid instruments that can be used to assess women’s experiences in the intrapartum period. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04445-0.
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Affiliation(s)
- L L Peters
- Department of General Practice & Elderly Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. .,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands. .,AVAG (Midwifery Academy Amsterdam Groningen), Groningen, The Netherlands.
| | - M S G van der Pijl
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Vedam
- Birth Place Laboratory, Division of Midwifery, University of British Columbia, Vancouver, BC, Canada
| | - W S Barkema
- Department of General Practice & Elderly Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,AVAG (Midwifery Academy Amsterdam Groningen), Groningen, The Netherlands
| | - M T van Lohuizen
- AVAG (Midwifery Academy Amsterdam Groningen), Groningen, The Netherlands
| | - D E M C Jansen
- Department of General Practice & Elderly Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - E I Feijen-de Jong
- Department of General Practice & Elderly Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Midwifery Science AVAG, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,AVAG (Midwifery Academy Amsterdam Groningen), Groningen, The Netherlands
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Li H, Dong L, Bert C, Chang J, Flampouri S, Jee KW, Lin L, Moyers M, Mori S, Rottmann J, Tryggestad E, Vedam S. Report of AAPM Task Group 290: Respiratory motion management for particle therapy. Med Phys 2022; 49:e50-e81. [PMID: 35066871 PMCID: PMC9306777 DOI: 10.1002/mp.15470] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 05/29/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Dose uncertainty induced by respiratory motion remains a major concern for treating thoracic and abdominal lesions using particle beams. This Task Group report reviews the impact of tumor motion and dosimetric considerations in particle radiotherapy, current motion‐management techniques, and limitations for different particle‐beam delivery modes (i.e., passive scattering, uniform scanning, and pencil‐beam scanning). Furthermore, the report provides guidance and risk analysis for quality assurance of the motion‐management procedures to ensure consistency and accuracy, and discusses future development and emerging motion‐management strategies. This report supplements previously published AAPM report TG76, and considers aspects of motion management that are crucial to the accurate and safe delivery of particle‐beam therapy. To that end, this report produces general recommendations for commissioning and facility‐specific dosimetric characterization, motion assessment, treatment planning, active and passive motion‐management techniques, image guidance and related decision‐making, monitoring throughout therapy, and recommendations for vendors. Key among these recommendations are that: (1) facilities should perform thorough planning studies (using retrospective data) and develop standard operating procedures that address all aspects of therapy for any treatment site involving respiratory motion; (2) a risk‐based methodology should be adopted for quality management and ongoing process improvement.
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Affiliation(s)
- Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christoph Bert
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Joe Chang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stella Flampouri
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Kyung-Wook Jee
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Liyong Lin
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Michael Moyers
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Shinichiro Mori
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Joerg Rottmann
- Center for Proton Therapy, Proton Therapy Singapore, Proton Therapy Pte Ltd, Singapore
| | - Erik Tryggestad
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sastry Vedam
- Department of Radiation Oncology, University of Maryland, Baltimore, USA
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Wang J, Salzillo T, Jiang Y, Mackeyev Y, David Fuller C, Chung C, Choi S, Hughes N, Ding Y, Yang J, Vedam S, Krishnan S. Stability of MRI contrast agents in high-energy radiation of a 1.5T MR-Linac. Radiother Oncol 2021; 161:55-64. [PMID: 34089753 PMCID: PMC8324543 DOI: 10.1016/j.radonc.2021.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 12/10/2020] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gadolinium-based contrast is often used when acquiring MR images for radiation therapy planning for better target delineation. In some situations, patients may still have residual MRI contrast agents in their tissue while being treated with high-energy radiation. This is especially true when MRI contrast agents are administered during adaptive treatment replanning for patients treated on MR-Linac systems. PURPOSE The purpose of this study was to analyze the molecular stability of MRI contrast agents when exposed to high energy photons and the associated secondary electrons in a 1.5T MR-Linac system. This was the first step in assessing the safety of administering MRI contrast agents throughout the course of treatment. MATERIALS AND METHODS Two common MRI contrast agents were irradiated with 7 MV photons to clinical dose levels. The irradiated samples were analyzed using liquid chromatography-high resolution mass spectrometry to detect degradation products or conformational alterations created by irradiation with high energy photons and associated secondary electrons. RESULTS No significant change in chemical composition or displacement of gadolinium ions from their chelates was discovered in samples irradiated with 7 MV photons at relevant clinical doses in a 1.5T MR-Linac. Additionally, no significant correlation between concentrations of irradiated MRI contrast agents and radiation dose was observed. CONCLUSION The chemical composition stability of the irradiated contrast agents is promising for future use throughout the course of patient treatment. However, in vivo studies are needed to confirm that unexpected metabolites are not created in biological milieus.
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Affiliation(s)
- Jihong Wang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, United States.
| | - Travis Salzillo
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Yongying Jiang
- The Institute for Applied Cancer Science, MD Anderson Cancer Center, Houston, United States
| | - Yuri Mackeyev
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, United States
| | - Clifton David Fuller
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Seungtaek Choi
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Neil Hughes
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Yao Ding
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, United States
| | - Jinzhong Yang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, United States
| | - Sastry Vedam
- Department of Radiation Oncology, University of Maryland, Baltimore, United States
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, United States
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Roberts DA, Sandin C, Vesanen PT, Lee H, Hanson IM, Nill S, Perik T, Lim SB, Vedam S, Yang J, Woodings SW, Wolthaus JWH, Keller B, Budgell G, Chen X, Li XA. Machine QA for the Elekta Unity system: A Report from the Elekta MR-linac consortium. Med Phys 2021; 48:e67-e85. [PMID: 33577091 PMCID: PMC8251771 DOI: 10.1002/mp.14764] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [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: 05/11/2020] [Revised: 01/21/2021] [Accepted: 02/03/2021] [Indexed: 12/31/2022] Open
Abstract
Over the last few years, magnetic resonance image‐guided radiotherapy systems have been introduced into the clinic, allowing for daily online plan adaption. While quality assurance (QA) is similar to conventional radiotherapy systems, there is a need to introduce or modify measurement techniques. As yet, there is no consensus guidance on the QA equipment and test requirements for such systems. Therefore, this report provides an overview of QA equipment and techniques for mechanical, dosimetric, and imaging performance of such systems and recommendation of the QA procedures, particularly for a 1.5T MR‐linac device. An overview of the system design and considerations for QA measurements, particularly the effect of the machine geometry and magnetic field on the radiation beam measurements is given. The effect of the magnetic field on measurement equipment and methods is reviewed to provide a foundation for interpreting measurement results and devising appropriate methods. And lastly, a consensus overview of recommended QA, appropriate methods, and tolerances is provided based on conventional QA protocols. The aim of this consensus work was to provide a foundation for QA protocols, comparative studies of system performance, and for future development of QA protocols and measurement methods.
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Affiliation(s)
- David A Roberts
- Elekta Limited, Cornerstone, London Road, Crawley, RH10 9BL, United Kingdom
| | - Carlos Sandin
- Elekta Limited, Cornerstone, London Road, Crawley, RH10 9BL, United Kingdom
| | | | - Hannah Lee
- Allegheny Health Network Cancer Institute, Pennsylvania, USA
| | - Ian M Hanson
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, UK
| | - Simeon Nill
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, UK
| | - Thijs Perik
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Seng Boh Lim
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - Sastry Vedam
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Texas, USA
| | - Simon W Woodings
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jochem W H Wolthaus
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Brian Keller
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Geoff Budgell
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, United Kingdom
| | - Xinfeng Chen
- Department of Radiation Oncology, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, USA
| | - X Allen Li
- Department of Radiation Oncology, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, USA
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McDonald BA, Vedam S, Yang J, Wang J, Castillo P, Lee B, Sobremonte A, Ahmed S, Ding Y, Mohamed ASR, Balter P, Hughes N, Thorwarth D, Nachbar M, Philippens MEP, Terhaard CHJ, Zips D, Böke S, Awan MJ, Christodouleas J, Fuller CD. Initial Feasibility and Clinical Implementation of Daily MR-Guided Adaptive Head and Neck Cancer Radiation Therapy on a 1.5T MR-Linac System: Prospective R-IDEAL 2a/2b Systematic Clinical Evaluation of Technical Innovation. Int J Radiat Oncol Biol Phys 2021; 109:1606-1618. [PMID: 33340604 PMCID: PMC7965360 DOI: 10.1016/j.ijrobp.2020.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/04/2020] [Accepted: 12/11/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE This prospective study is, to our knowledge, the first report of daily adaptive radiation therapy (ART) for head and neck cancer (HNC) using a 1.5T magnetic resonance imaging-linear accelerator (MR-linac) with particular focus on safety and feasibility and dosimetric results of an online rigid registration-based adapt to position (ATP) workflow. METHODS AND MATERIALS Ten patients with HNC received daily ART on a 1.5T/7MV MR-linac, 6 using ATP only and 4 using ATP with 1 offline adapt-to-shape replan. Setup variability with custom immobilization masks was assessed by calculating the mean systematic error (M), standard deviation of the systematic error (Σ), and standard deviation of the random error (σ) of the isocenter shifts. Quality assurance was performed with a cylindrical diode array using 3%/3 mm γ criteria. Adaptive treatment plans were summed for each patient to compare the delivered dose with the planned dose from the reference plan. The impact of dosimetric variability between adaptive fractions on the summation plan doses was assessed by tracking the number of optimization constraint violations at each individual fraction. RESULTS The random errors (mm) for the x, y, and z isocenter shifts, respectively, were M = -0.3, 0.7, 0.1; Σ = 3.3, 2.6, 1.4; and σ = 1.7, 2.9, 1.0. The median (range) γ pass rate was 99.9% (90.9%-100%). The differences between the reference and summation plan doses were -0.61% to 1.78% for the clinical target volume and -11.74% to 8.11% for organs at risk (OARs), although an increase greater than 2% in OAR dose only occurred in 3 cases, each for a single OAR. All cases had at least 2 fractions with 1 or more constraint violations. However, in nearly all instances, constraints were still met in the summation plan despite multiple single-fraction violations. CONCLUSIONS Daily ART on a 1.5T MR-linac using an online ATP workflow is safe and clinically feasible for HNC and results in delivered doses consistent with planned doses.
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Affiliation(s)
- Brigid A McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Houston, Texas
| | - Sastry Vedam
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela Castillo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Belinda Lee
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Angela Sobremonte
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sara Ahmed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; The University of Texas MD Anderson Cancer Center, UTHealth Graduate School of Biomedical Sciences, Houston, Texas
| | - Peter Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Neil Hughes
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Marcel Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | | | - Chris H J Terhaard
- Department of Radiotherapy, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Daniel Zips
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Simon Böke
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Musaddiq J Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Wauwatosa, Wisconsin
| | - John Christodouleas
- Elekta, Inc., Stockholm, Sweden; Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Yang J, Vedam S, Lee B, Castillo P, Sobremonte A, Hughes N, Mohammedsaid M, Wang J, Choi S. Online adaptive planning for prostate stereotactic body radiotherapy using a 1.5 Tesla magnetic resonance imaging-guided linear accelerator. Phys Imaging Radiat Oncol 2020; 17:20-24. [PMID: 33898773 PMCID: PMC8057955 DOI: 10.1016/j.phro.2020.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/19/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023]
Abstract
Recent advances in integrating 1.5 Tesla magnetic resonance (MR) imaging with a linear accelerator (MR-Linac) allow MR-guided stereotactic body radiotherapy (SBRT) for prostate cancer. Choosing an optimal strategy for daily online plan adaptation is particularly important for MR-guided radiotherapy. We analyzed deformable dose accumulation on scans from four patients and found that daily anatomy changes had little impact on the delivered dose, with the dose to the prostate within 0.5% and dose to the rectum/bladder mostly less than 0.5 Gy. These findings could help in the choice of an optimal strategy for online plan adaptation for MR-guided prostate SBRT.
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Affiliation(s)
- Jinzhong Yang
- Department of Radiation Physics, the University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Sastry Vedam
- Department of Radiation Physics, the University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Belinda Lee
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Pamela Castillo
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Angela Sobremonte
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Neil Hughes
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Mustefa Mohammedsaid
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Jihong Wang
- Department of Radiation Physics, the University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Seungtaek Choi
- Department of Radiation Oncology, the University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
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12
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Lakomy D, Vedam S, Yang J, Wang J, Lee B, Sobremonte A, Castillo P, Hughes N, Mohammedsaid M, Jhingran A, Klopp A, Fuller C, Choi S, Lin L. Single-institution Experience Utilizing MR-Linac for Gynecologic Malignancies. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Brock K, Ohrt A, Cazoulat G, McCulloch M, Balter P, Ohrt J, Svensson S, Nilsson R, Andersson S, Mohamed A, Bahig H, Ding Y, Wang J, McDonald B, Yang J, Vedam S, Elgohari B, Sen A, Fuller C. PO-1642: CBCT Padding for Full Field of View Daily Dose Accumulation and Head and Neck Adaptive Radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01660-1] [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: 10/22/2022]
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14
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Rhee DJ, Jhingran A, Rigaud B, Netherton T, Cardenas CE, Zhang L, Vedam S, Kry S, Brock KK, Shaw W, O’Reilly F, Parkes J, Burger H, Fakie N, Trauernicht C, Simonds H, Court LE. Automatic contouring system for cervical cancer using convolutional neural networks. Med Phys 2020; 47:5648-5658. [PMID: 32964477 PMCID: PMC7756586 DOI: 10.1002/mp.14467] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 07/29/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To develop a tool for the automatic contouring of clinical treatment volumes (CTVs) and normal tissues for radiotherapy treatment planning in cervical cancer patients. METHODS An auto-contouring tool based on convolutional neural networks (CNN) was developed to delineate three cervical CTVs and 11 normal structures (seven OARs, four bony structures) in cervical cancer treatment for use with the Radiation Planning Assistant, a web-based automatic plan generation system. A total of 2254 retrospective clinical computed tomography (CT) scans from a single cancer center and 210 CT scans from a segmentation challenge were used to train and validate the CNN-based auto-contouring tool. The accuracy of the tool was evaluated by calculating the Sørensen-dice similarity coefficient (DSC) and mean surface and Hausdorff distances between the automatically generated contours and physician-drawn contours on 140 internal CT scans. A radiation oncologist scored the automatically generated contours on 30 external CT scans from three South African hospitals. RESULTS The average DSC, mean surface distance, and Hausdorff distance of our CNN-based tool were 0.86/0.19 cm/2.02 cm for the primary CTV, 0.81/0.21 cm/2.09 cm for the nodal CTV, 0.76/0.27 cm/2.00 cm for the PAN CTV, 0.89/0.11 cm/1.07 cm for the bladder, 0.81/0.18 cm/1.66 cm for the rectum, 0.90/0.06 cm/0.65 cm for the spinal cord, 0.94/0.06 cm/0.60 cm for the left femur, 0.93/0.07 cm/0.66 cm for the right femur, 0.94/0.08 cm/0.76 cm for the left kidney, 0.95/0.07 cm/0.84 cm for the right kidney, 0.93/0.05 cm/1.06 cm for the pelvic bone, 0.91/0.07 cm/1.25 cm for the sacrum, 0.91/0.07 cm/0.53 cm for the L4 vertebral body, and 0.90/0.08 cm/0.68 cm for the L5 vertebral bodies. On average, 80% of the CTVs, 97% of the organ at risk, and 98% of the bony structure contours in the external test dataset were clinically acceptable based on physician review. CONCLUSIONS Our CNN-based auto-contouring tool performed well on both internal and external datasets and had a high rate of clinical acceptability.
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Affiliation(s)
- Dong Joo Rhee
- MD Anderson UTHealth Graduate SchoolHoustonTXUSA
- Department of Radiation PhysicsDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Anuja Jhingran
- Department of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Bastien Rigaud
- Department of Imaging PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Tucker Netherton
- MD Anderson UTHealth Graduate SchoolHoustonTXUSA
- Department of Radiation PhysicsDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Carlos E. Cardenas
- Department of Radiation PhysicsDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Lifei Zhang
- Department of Radiation PhysicsDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Sastry Vedam
- Department of Radiation PhysicsDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Stephen Kry
- Department of Radiation PhysicsDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - Kristy K. Brock
- Department of Imaging PhysicsThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
| | - William Shaw
- Department of Medical Physics (G68)University of the Free StateBloemfonteinSouth Africa
| | - Frederika O’Reilly
- Department of Medical Physics (G68)University of the Free StateBloemfonteinSouth Africa
| | - Jeannette Parkes
- Division of Radiation Oncology and Medical PhysicsUniversity of Cape Town and Groote Schuur HospitalCape TownSouth Africa
| | - Hester Burger
- Division of Radiation Oncology and Medical PhysicsUniversity of Cape Town and Groote Schuur HospitalCape TownSouth Africa
| | - Nazia Fakie
- Division of Radiation Oncology and Medical PhysicsUniversity of Cape Town and Groote Schuur HospitalCape TownSouth Africa
| | - Chris Trauernicht
- Division of Medical PhysicsStellenbosch UniversityTygerberg Academic HospitalCape TownSouth Africa
| | - Hannah Simonds
- Division of Radiation OncologyStellenbosch UniversityTygerberg Academic HospitalCape TownSouth Africa
| | - Laurence E. Court
- Department of Radiation PhysicsDivision of Radiation OncologyThe University of Texas MD Anderson Cancer CenterHoustonTXUSA
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15
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Feijen-de Jong E, van der Pijl M, Vedam S, Jansen D, Peters L. Measuring respect and autonomy in Dutch maternity care: Applicability of two measures. Women Birth 2020; 33:e447-e454. [DOI: 10.1016/j.wombi.2019.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/24/2022]
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16
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Ning MS, Venkatesan AM, Stafford RJ, Bui TP, Carlson R, Bailard NS, Vedam S, Davis R, Olivieri ND, Guzman AB, Incalcaterra JR, McKelvey FA, Thaker NG, Rauch GM, Tang C, Frank SJ, Joyner MM, Lin LL, Jhingran A, Eifel PJ, Klopp AH. Developing an intraoperative 3T MRI-guided brachytherapy program within a diagnostic imaging suite: Methods, process workflow, and value-based analysis. Brachytherapy 2020; 19:427-437. [DOI: 10.1016/j.brachy.2019.09.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/11/2019] [Accepted: 09/21/2019] [Indexed: 12/22/2022]
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17
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Rigaud B, Cazoulat G, Vedam S, Venkatesan AM, Peterson CB, Taku N, Klopp AH, Brock KK. Modeling Complex Deformations of the Sigmoid Colon Between External Beam Radiation Therapy and Brachytherapy Images of Cervical Cancer. Int J Radiat Oncol Biol Phys 2020; 106:1084-1094. [PMID: 32029345 DOI: 10.1016/j.ijrobp.2019.12.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/13/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE In this study, we investigated registration methods for estimating the large interfractional sigmoid deformations that occur between external beam radiation therapy (EBRT) and brachytherapy (BT) for cervical cancer. METHODS AND MATERIALS Sixty-three patients were retrospectively analyzed. The sigmoid colon was delineated on 2 computed tomography images acquired during EBRT (without applicator) and BT (with applicator) for each patient. Five registration approaches were compared to propagate the contour of the sigmoid from BT to EBRT anatomies: rigid registration, commercial hybrid (ANAtomically CONstrained Deformation Algorithm), controlling ROI surface projection of RayStation, and the classical and constrained symmetrical thin-plate spline robust point matching (sTPS-RPM) methods. Deformation of the sigmoid due to insertion of the BT applicator was reported. Registration performance was compared by using the Dice similarity coefficient (DSC), distance to agreement, and Hausdorff distance. The 2 sTPS-RPM methods were compared by using surface triangle quality criteria between deformed surfaces. Using the deformable approaches, the BT dose of the sigmoid was deformed toward the EBRT anatomy. The displacement and discrepancy between the deformable methods to propagate the planned D1cm3 and D2cm3 of the sigmoid from BT to EBRT anatomies were reported for 55 patients. RESULTS Large and complex deformations of the sigmoid were observed for each patient. Rigid registration resulted in poor sigmoid alignment with a mean DSC of 0.26. Using the contour to drive the deformation, ANAtomically CONstrained Deformation Algorithm was able to slightly improve the alignment of the sigmoid with a mean DSC of 0.57. Using only the sigmoid surface as controlling ROI, the mean DSC was improved to 0.79. The classical and constrained sTPS-RPM methods provided mean DSCs of 0.95 and 0.96, respectively, with an average inverse consistency error <1 mm. The constrained sTPS-RPM provided more realistic deformations and better surface topology of the deformed sigmoids. The planned mean (range) D1cm3 and D2cm3 of the sigmoid were 13.4 Gy (1-24.1) and 12.2 Gy (1-21.5) on the BT anatomy, respectively. Using the constrained sTPS-RPM to deform the sigmoid from BT to EBRT anatomies, these hotspots had a mean (range) displacement of 27.1 mm (6.8-81). CONCLUSIONS Large deformations of the sigmoid were observed between the EBRT and BT anatomies, suggesting that the D1cm3 and D2cm3 of the sigmoid would unlikely to be at the same position throughout treatment. The proposed constrained sTPS-RPM seems to be the preferred approach to manage the large deformation due to BT applicator insertion. Such an approach could be used to map the EBRT dose to the BT anatomy for personalized BT planning optimization.
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Affiliation(s)
- Bastien Rigaud
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Guillaume Cazoulat
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sastry Vedam
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aradhana M Venkatesan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christine B Peterson
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nicolette Taku
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristy K Brock
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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18
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Han EY, Aima M, Hughes N, Briere TM, Yeboa DN, Castillo P, Wang J, Yang J, Vedam S. Feasibility of spinal stereotactic body radiotherapy in Elekta Unity ® MR-Linac. J Radiosurg SBRT 2020; 7:127-134. [PMID: 33282466 PMCID: PMC7717094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/02/2020] [Indexed: 06/12/2023]
Abstract
The Elekta Unity MR-Linac (MRL) is expected to benefit spine stereotactic body radiotherapy (SBRT) due to the improved soft tissue contrast available with onboard MR imaging. However, the irradiation geometry and beam configuration of the MRL deviates from the conventional linear accelerator (Linac). The purpose of the study was to investigate the feasibility of spine SBRT on the MRL. Treatment plans were generated for lumbar and thoracic spines. Target and spinal cord doses were measured with two cylindrical ion chambers inserted into an anthropomorphic spine phantom. Our study indicated that the Monaco treatment planning system (TPS) could generate clinical treatment plans for the MRL that were of comparable quality to the RayStation TPS with a conventional Linac. For both Linacs the planned dose within the gross tumor volume agreed with measurements within ±3%. For the spinal cord, while the measured doses from the TrueBeam were 1.8% higher for the lumbar spine plan and 6.9% higher for thoracic spine plan, the measured doses from MRL were 0.6% lower for the lumbar spine plan and 3.9% higher for the thoracic spine plan. In conclusion, the feasibility of spine SBRT in Elekta Unity MRL has been demonstrated, however, more effort is needed for such as optimizing the online plan adaptation method.
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Affiliation(s)
- Eun Young Han
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Manik Aima
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Neil Hughes
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tina M. Briere
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Debra N. Yeboa
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Pam Castillo
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jihong Wang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jinzhong Yang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Sastry Vedam
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Ning MS, Klopp AH, Jhingran A, Lin LL, Eifel PJ, Vedam S, Lawyer AA, Olivieri ND, Guzman AB, Incalcaterra JR, Mesko SM, Pezzi TA, Boyce-Fappiano DR, Shaitelman SF, Frank SJ, Thaker NG. Quantifying institutional resource utilization of adjuvant brachytherapy and intensity-modulated radiation therapy for endometrial cancer via time-driven activity-based costing. Brachytherapy 2019; 18:445-452. [DOI: 10.1016/j.brachy.2019.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Rigaud B, Klopp A, Vedam S, Venkatesan A, Taku N, Simon A, Haigron P, de Crevoisier R, Brock KK, Cazoulat G. Deformable image registration for dose mapping between external beam radiotherapy and brachytherapy images of cervical cancer. Phys Med Biol 2019; 64:115023. [PMID: 30913542 DOI: 10.1088/1361-6560/ab1378] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
For locally advanced cervical cancer (LACC), anatomy correspondence with and without BT applicator needs to be quantified to merge the delivered doses of external beam radiation therapy (EBRT) and brachytherapy (BT). This study proposed and evaluated different deformable image registration (DIR) methods for this application. Twenty patients who underwent EBRT and BT for LACC were retrospectively analyzed. Each patient had a pre-BT CT at EBRT boost (without applicator) and a CT and MRI at BT (with applicator). The evaluated DIR methods were the diffeomorphic Demons, commercial intensity and hybrid methods, and three different biomechanical models. The biomechanical models considered different boundary conditions (BCs). The impact of the BT devices insertion on the anatomy was quantified. DIR method performances were quantified using geometric criteria between the original and deformed contours. The BT dose was deformed toward the pre-CT BT by each DIR method. The impact of boundary conditions to drive the biomechanical model was evaluated based on the deformation vector field and dose differences. The GEC-ESTRO guideline dose indices were reported. Large organ displacements, deformations, and volume variations were observed between the pre-BT and BT anatomies. Rigid registration and intensity-based DIR resulted in poor geometric accuracy with mean Dice similarity coefficient (DSC) inferior to 0.57, 0.63, 0.42, 0.32, and 0.43 for the rectum, bladder, vagina, cervix and uterus, respectively. Biomechanical models provided a mean DSC of 0.96 for all the organs. By considering the cervix-uterus as one single structure, biomechanical models provided a mean DSC of 0.88 and 0.94 for the cervix and uterus, respectively. The deformed doses were represented for each DIR method. Caution should be used when performing DIR for this application as standard techniques may have unacceptable results. The biomechanical model with the cervix-uterus as one structure provided the most realistic deformations to propagate the BT dose toward the EBRT boost anatomy.
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Affiliation(s)
- B Rigaud
- Univ Rennes, CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, F-35000 Rennes, France. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America. Author to whom any correspondence should be addressed
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Vorbeck CS, Jhingran A, Iyer RB, Loft A, Klopp A, Mirza MR, Sobremonte A, Vedam S, Vogelius IR. Patterns of treatment failure in patients undergoing adjuvant or definitive radiotherapy for vulvar cancer. Int J Gynecol Cancer 2019; 29:ijgc-2019-000223. [PMID: 31126968 DOI: 10.1136/ijgc-2019-000223] [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: 01/11/2019] [Revised: 03/08/2019] [Accepted: 03/26/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Knowledge of the detailed pattern of failure can be useful background knowledge in clinical decision making and potentially drive the development of new treatment strategies by increasing radiotherapy dose prescription to high-risk sub-regions of the target. Here, we analyze patterns of recurrence in patients with vulvar cancer treated with radiotherapy according to original planning target volumes and radiation dose delivered. METHODS We analyzed dose-planning and post-treatment recurrence scans from patients with vulvar cancer treated at two institutions from January 2009 through October 2014. We delineated the recurrences and merged the dose-planning and recurrence scans for each patient by using deformable co-registration. We estimated the center of each recurrence on the merged scans with the goal of relating them to the original dose plan. RESULTS We evaluated 157 patients who received radiotherapy for vulvar cancer. Median age was 68 years (range 29-91). Patients with International Federation of Gynecology and Obstetrics (FIGO) stage IA-IVB were included. Twenty-nine patients had recurrent disease; 156 patients had squamous cell carcinoma and one patient had adenosquamous carcinoma of the vulva. Among the 157 patients, 37 patients with recurrent disease had recurrence scans available for review, for a total of 80 recurrence sites; 53% of the recurrences were located in the region to which the highest dose (60-70 Gy) had been prescribed. Patients who received definitive radiotherapy developed failure primarily in the high-dose region (80.5%), whereas patients who received adjuvant radiotherapy had a more scattered failure pattern (p<0.0001). Among the latter group, 29.5% failed in the high-dose region. CONCLUSIONS Patients who received definitive versus adjuvant radiotherapy had different failure patterns, indicating that separate approaches are needed to improve both adjuvant and definitive radiotherapy for vulvar cancer.
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Affiliation(s)
| | - Anuja Jhingran
- Division of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Revathy B Iyer
- Department of Diagnostic Radiology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ann Klopp
- Division of Radiation Oncology, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Mansoor Raza Mirza
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Angela Sobremonte
- Department of Radiation Oncology Medical Dosimetry, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Sastry Vedam
- Department of Radiation Physics, University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - Ivan Richter Vogelius
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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22
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Swanick CW, Castle KO, Vedam S, Munsell MF, Turner LM, Rauch GM, Jhingran A, Eifel PJ, Klopp AH. Comparison of Computed Tomography- and Magnetic Resonance Imaging-based Clinical Target Volume Contours at Brachytherapy for Cervical Cancer. Int J Radiat Oncol Biol Phys 2016; 96:793-800. [PMID: 27788952 DOI: 10.1016/j.ijrobp.2016.07.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 07/15/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE We prospectively compared computed tomography (CT)- and magnetic resonance imaging (MRI)-based high-risk clinical target volume (HR-CTV) contours at the time of brachytherapy for cervical cancer in an effort to identify patients who might benefit most from MRI-based planning. METHODS AND MATERIALS Thirty-seven patients who had undergone a pretreatment diagnostic MRI scan were included in the analysis. We delineated the HR-CTV on the brachytherapy CT and brachytherapy MRI scans independently for each patient. We then calculated the absolute volumes for each HR-CTV and the Dice coefficient of similarity (DC, a measure of spatial agreement) for the HR-CTV contours. We identified the clinical and tumor factors associated with (1) a discrepancy in volume between the CT HR-CTV and MRI HR-CTV contours; and (2) DC. The mean values were compared using 1-way analysis of variance or paired or unpaired t tests, as appropriate. Simple and multivariable linear regression analyses were used to model the effects of covariates on the outcomes. RESULTS Patients with International Federation of Gynecology and Obstetrics stage IB to IVA cervical cancer were treated with intracavitary brachytherapy using tandem and ovoid (n=33) or tandem and cylinder (n=4) applicators. The mean CT HR-CTV volume (44.1 cm3) was larger than the mean MRI HR-CTV volume (35.1 cm3; P<.0001, paired t test). On multivariable analysis, a higher body mass index (BMI) and tumor size ≥5 cm with parametrial invasion on the MRI scan at diagnosis were associated with an increased discrepancy in volume between the HR-CTV contours (P<.02 for both). In addition, the spatial agreement (as measured by DC) between the HR-CTV contours decreased with an increasing BMI (P=.013). CONCLUSIONS We recommend MRI-based brachytherapy planning for patients with tumors >5 cm and parametrial invasion on MRI at diagnosis and for those with a high BMI.
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Affiliation(s)
- Cameron W Swanick
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Sastry Vedam
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lehendrick M Turner
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gaiane M Rauch
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patricia J Eifel
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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23
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Vedam S, Stoll K, Jolicouer G, Martin K, Korchinski M, Velasquez R. O-OBS-RM-112 Patient-led Decision Making: Measuring Autonomy and Respect in Canadian Maternity Care. Journal of Obstetrics and Gynaecology Canada 2016. [DOI: 10.1016/j.jogc.2016.04.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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24
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Swanick C, Castle K, Vedam S, Turner L, Yang J, Rauch G, Jhingran A, Eifel P, Klopp A. Comparison of CT and MRI-Based Clinical Target Volume Contours at the Time of Brachytherapy for Cervical Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1259] [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: 11/16/2022]
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25
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Abstract
PURPOSE To create a patient respiratory management system and patient self-practice tool using the Wii remote, a widely available consumer hardware product. METHODS The Wii remote (Wiimote) (Nintendo, Redmond, WA) contains an infrared (IR) camera that can track up to four spots whose coordinates are reported to a host computer via Bluetooth. The Wiimote is capable of tracking a fiducial box currently used by a commercial monitoring system [Real-time Position Management(TM) (RPM) system, Varian Associates, Palo Alto, CA], if the correct IR source is used. The authors validated the Wiimote tracking by comparing the amplitude and frequency of signals among those reported by Wiimote with known movements from an inhouse servo-driven respiratory simulator, as well as with those measured using the RPM. The simulator comparison was done using standard sinusoid signals with amplitude of 2.0 cm as well as recorded patient respiratory traces. The RPM comparisons were done by simultaneously recording the RPM reflective box position with the Wiimote and the RPM. Timing was compared between these two systems by using the digital beam-on signal from the CT scanner, for the 4DCT to synchronize these acquisitions. RESULTS The data acquisition rate from the Wiimote was 100.0 ± 0.4 Hz with a version 2.1 Bluetooth adaptor. The standard deviation of the height of the motion extrema was 0.06 and 1.1 mm when comparing those measured by the Wiimote and the servomotor encoder for standard sinusoid signal and prerecorded patient respiratory signal, respectively. The standard deviation of the amplitude of motion extrema between the Wiimote and RPM was 0.9 mm and the timing difference was 253 ms. CONCLUSION The performance of Wiimote shows promise for respiratory monitoring for its faster sampling rate as well as the potential optical and GPU abilities. If used with care it can deliver reasonable spatial and temporal accuracy.
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Affiliation(s)
- Y Peng
- Department of Radiation Oncology, Indiana University School of Medicine, 535 Barnhill Drive, RT 041, Indianapolis, Indiana 46202-5116, USA.
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26
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Benedict S, Vedam S, Cai J, Wijesooriya K, Murphy M. TU-C-500-01: Evaluating Benefits and Challenges of Multi-Modality Co-Registration. Med Phys 2013. [DOI: 10.1118/1.4815362] [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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27
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Matney J, Bluett J, Vedam S, Dong L, Mohan R. TH-E-218-06: Dosimetric Effects of Respiratory Motion in Proton Vs. Photon Therapy for Stage II-III NSCLC. Med Phys 2012. [DOI: 10.1118/1.4736392] [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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28
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Peng Y, Vedam S, Balter P. SU-E-T-518: Application of Wii Remote in Patinet Respiratory Monitoring and Possible as a Patient Self Pratice Tool. Med Phys 2011. [DOI: 10.1118/1.3612471] [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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29
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Peng Y, Vedam S, Chang JY, Gao S, Sadagopan R, Bues M, Balter P. Implementation of feedback-guided voluntary breath-hold gating for cone beam CT-based stereotactic body radiotherapy. Int J Radiat Oncol Biol Phys 2011; 80:909-17. [PMID: 21470784 DOI: 10.1016/j.ijrobp.2010.08.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 07/28/2010] [Accepted: 08/07/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE To analyze tumor position reproducibility of feedback-guided voluntary deep inspiration breath-hold (FGBH) gating for cone beam computed tomography (CBCT)-based stereotactic body radiotherapy (SBRT). METHODS AND MATERIALS Thirteen early-stage lung cancer patients eligible for SBRT with tumor motion of >1cm were evaluated for FGBH-gated treatment. Multiple FGBH CTs were acquired at simulation, and single FGBH CBCTs were also acquired prior to each treatment. Simulation CTs and treatment CBCTs were analyzed to quantify reproducibility of tumor positions during FGBH. Benefits of FGBH gating compared to treatment during free breathing, as well treatment with gating at exhalation, were examined for lung sparing, motion margins, and reproducibility of gross tumor volume (GTV) position relative to nonmoving anatomy. RESULTS FGBH increased total lung volumes by 1.5 times compared to free breathing, resulting in a proportional drop in total lung volume receiving 10 Gy or more. Intra- and inter-FGBH reproducibility of GTV centroid positions at simulation were 1.0 ± 0.5 mm, 1.3 ± 1.0 mm, and 0.6 ± 0.4 mm in the anterior-posterior (AP), superior-inferior (SI), and left-right lateral (LR) directions, respectively, compared to more than 1 cm of tumor motion at free breathing. During treatment, inter-FGBH reproducibility of the GTV centroid with respect to bony anatomy was 1.2 ± 0.7 mm, 1.5 ± 0.8 mm, and 1.0 ± 0.4 mm in the AP, SI, and LR directions. In addition, the quality of CBCTs was improved due to elimination of motion artifacts, making this technique attractive for poorly visualized tumors, even with small motion. CONCLUSIONS The extent of tumor motion at normal respiration does not influence the reproducibility of the tumor position under breath hold conditions. FGBH-gated SBRT with CBCT can improve the reproducibility of GTV centroids, reduce required margins, and minimize dose to normal tissues in the treatment of mobile tumors.
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Affiliation(s)
- Yong Peng
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA
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30
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Turner LM, Howard JA, Dehghanpour P, Barrett RD, Rebueno N, Palmer M, Vedam S, Klopp A, Komaki R, Welsh JW. Exploring the feasibility of dose escalation positron emission tomography-positive disease with intensity-modulated radiation therapy and the effects on normal tissue structures for thoracic malignancies. Med Dosim 2010; 36:383-8. [PMID: 21144734 DOI: 10.1016/j.meddos.2010.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 05/21/2010] [Accepted: 09/21/2010] [Indexed: 02/03/2023]
Abstract
The pattern of failure is one of the major causes of mortality among thoracic patients. Studies have shown a correlation between local control and dose. Intensity-modulated radiation therapy (IMRT) has resulted in conformal dose distributions while limiting dose to normal tissue. However, thoracic malignancies treated with IMRT to highly conformal doses up to 70 Gy still have been found to fail. Thus, the need for dose escalation through simultaneous integrated boost (SIB) may prove effective in minimizing reoccurrences. For our study, 28 thoracic IMRT plans were reoptimized via dose escalation to the gross tumor volume (GTV) and planning target volume (PTV) of 79.2 Gy and 68.4 Gy, respectively. Reoccurrences in surrounding regions of microscopic disease are rare therefore, dose-escalating regional nodes (outside GTV) were not included. Hence, the need to edit GTV margins was acceptable for our retrospective study. A median dose escalation of approximately 15 Gy (64.8-79.2 Gy) via IMRT using SIB was deemed achievable with minimal percent differences received by critical structures compared with the original treatment plan. The target's mean doses were significantly increased based on p-value analysis, while the normal tissue structures were not significantly changed.
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Affiliation(s)
- Lehendrick M Turner
- The University of Texas M D Anderson Cancer Center School of Health Professions, Medical Dosimetry Program, Houston, TX, USA.
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Tsunashima Y, Vedam S, Dong L, Umezawa M, Balter P, Mohan R. The precision of respiratory-gated delivery of synchrotron-based pulsed beam proton therapy. Phys Med Biol 2010; 55:7633-47. [PMID: 21113089 DOI: 10.1088/0031-9155/55/24/016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A synchrotron-based proton therapy system operates in a low repetition rate pulsed beam delivery mode. Unlike cyclotron-based beam delivery, there is no guarantee that a synchrotron beam can be delivered effectively or precisely under the respiratory-gated mode. To evaluate the performance of gated synchrotron treatment, we simulated proton beam delivery in the synchrotron-based respiratory-gated mode using realistic patient breathing signals. Parameters used in the simulation were respiratory motion traces (70 traces from 24 patients), respiratory gate levels (10%, 20% and 30% duty cycles at the exhalation phase) and synchrotron magnet excitation cycles (T(cyc)) (fixed T(cyc) mode: 2.7, 3.0-6.0 s and each patient breathing cycle, and variable T(cyc) mode). The simulations were computed according to the breathing trace in which the proton beams were delivered. In the shorter fixed T(cyc) (<4 s), most of the proton beams were delivered uniformly to the target during the entire expiration phase of the respiratory cycle. In the longer fixed T(cyc) (>4 s) and the variable T(cyc) mode, the proton beams were not consistently delivered during the end-expiration phase of the respiratory cycle. However we found that the longer and variable T(cyc) operation modes delivered proton beams more precisely during irregular breathing.
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Affiliation(s)
- Yoshikazu Tsunashima
- Department of Radiation Physics, Unit 94, The University of Texas M D Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
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Tsunashima Y, Vedam S, Dong L, Zhang X, Umezawa M, Balter P, Mohan R. MO-FF-A3-02: What Is the Maximum Number of Beam Spots Deliverable within One Gating Window for Synchrotron Based Scanning Proton Beam Therapy of Lung Cancer? Med Phys 2010. [DOI: 10.1118/1.3469150] [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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33
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Nelson C, Balter P, Morice RC, Bucci K, Dong L, Tucker S, Vedam S, Chang JY, Starkschall G. Evaluation of tumor position and PTV margins using image guidance and respiratory gating. Int J Radiat Oncol Biol Phys 2010; 76:1578-85. [PMID: 20137865 DOI: 10.1016/j.ijrobp.2009.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Revised: 08/03/2009] [Accepted: 08/04/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate the margins currently used to generate the planning target volume for lung tumors and to determine whether image-guided patient setup or respiratory gating is more effective in reducing uncertainties in tumor position. METHODS AND MATERIALS Lung tumors in 7 patients were contoured on serial four-dimensional computed tomography (4DCT) data sets (4-8 4DCTs/patient; 50 total) obtained throughout the course of treatment. Simulations were performed to determine the tumor position when the patient was aligned using skin marks, image-guided setup based on vertebral bodies, fiducials implanted near the tumor, and the actual tumor volume under various scenarios of respiratory gating. RESULTS Because of the presence of setup uncertainties, the reduction in overall margin needed to completely encompass the tumor was observed to be larger for imaged-guided patient setup than for a simple respiratory-gated treatment. Without respiratory gating and image-guided patient setup, margins ranged from 0.9 cm to 3.1 cm to completely encompass the tumor. These were reduced to 0.7-1.7 cm when image-guided patient setup was simulated and further reduced with respiratory gating. CONCLUSIONS Our results indicate that if respiratory motion management is used, it should be used in conjunction with image-guided patient setup in order to reduce the overall treatment margin effectively.
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Affiliation(s)
- Christopher Nelson
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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34
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Palmer M, Vedam S, Komaki R, Welsh J. Intensity Modulated Radiation Therapy (IMRT) Benchmarks for Thoracic Malignancies. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1087] [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: 11/30/2022]
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35
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Vedam S, Tucker S, Zhuang Y, Mohan R, Komaki R, Liao Z, Martel M. Does the Choice of a 4D CT Reference Dataset for Treatment Planning Affect Normal Tissue Dose Response Model Parameters for Non Small Cell Lung Cancer Patients? Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1398] [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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36
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Peng Y, Balter P, Mirkovic D, Vedam S. SU-FF-J-117: Real-Time Characterization of Respiratory Motion Regularity During Radiation Therapy. Med Phys 2009. [DOI: 10.1118/1.3181409] [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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37
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Vedam S. TH-B-211A-02: Clinical Implementation of Respiration Motion Correlated Imaging, Treatment Planning and Delivery. Med Phys 2009. [DOI: 10.1118/1.3182596] [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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38
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Matney J, Vedam S, Dong L, Amos R, Zhu X, Balter P, Mohan R. MO-FF-A2-03: Is Average CT a Good Estimate of Mid-Ventilation Position of Surrounding Normal Structures for Proton Therapy Treatment Planning of Lung Tumors? Med Phys 2009. [DOI: 10.1118/1.3182285] [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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39
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Peng Y, Vedam S, Gao S, Polf J, Sadagopan R, Balter P. SU-FF-T-565: Implementation of Feedback Guided Voluntary Breath Hold Gating for CBCT Based Stereotactic Body Radiotherapy. Med Phys 2009. [DOI: 10.1118/1.3182063] [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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40
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Tsunashima Y, Vedam S, Dong L, Umezawa M, Sakae T, Smith A, Balter P, Mohan R. WE-E-BRB-03: Precision of Respiratory-Gated Delivery of Synchrotron-Based Proton Therapy. Med Phys 2009. [DOI: 10.1118/1.3182563] [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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41
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Tsunashima Y, Vedam S, Dong L, Zhang X, Umezawa M, Smith A, Balter P, Mohan R. SU-FF-T-132: Efficiency of Respiratory-Gated Synchrotron Based Scanning Beam Delivery of Proton Therapy for Lung. Med Phys 2009. [DOI: 10.1118/1.3181606] [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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42
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Ezhil M, Vedam S, Balter P, Choi B, Mirkovic D, Starkschall G, Chang JY. Determination of patient-specific internal gross tumor volumes for lung cancer using four-dimensional computed tomography. Radiat Oncol 2009; 4:4. [PMID: 19173738 PMCID: PMC2645420 DOI: 10.1186/1748-717x-4-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [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: 10/23/2008] [Accepted: 01/27/2009] [Indexed: 12/25/2022] Open
Abstract
Background To determine the optimal approach to delineating patient-specific internal gross target volumes (IGTV) from four-dimensional (4-D) computed tomography (CT) image data sets used in the planning of radiation treatment for lung cancers. Methods We analyzed 4D-CT image data sets of 27 consecutive patients with non-small-cell lung cancer (stage I: 17, stage III: 10). The IGTV, defined to be the envelope of respiratory motion of the gross tumor volume in each 4D-CT data set was delineated manually using four techniques: (1) combining the gross tumor volume (GTV) contours from ten respiratory phases (IGTVAllPhases); (2) combining the GTV contours from two extreme respiratory phases (0% and 50%) (IGTV2Phases); (3) defining the GTV contour using the maximum intensity projection (MIP) (IGTVMIP); and (4) defining the GTV contour using the MIP with modification based on visual verification of contours in individual respiratory phase (IGTVMIP-Modified). Using the IGTVAllPhases as the optimum IGTV, we compared volumes, matching indices, and extent of target missing using the IGTVs based on the other three approaches. Results The IGTVMIP and IGTV2Phases were significantly smaller than the IGTVAllPhases (p < 0.006 for stage I and p < 0.002 for stage III). However, the values of the IGTVMIP-Modified were close to those determined from IGTVAllPhases (p = 0.08). IGTVMIP-Modified also matched the best with IGTVAllPhases. Conclusion IGTVMIP and IGTV2Phases underestimate IGTVs. IGTVMIP-Modified is recommended to improve IGTV delineation in lung cancer.
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Affiliation(s)
- Muthuveni Ezhil
- Department of Radiation Oncology, The University of Texas M, D, Anderson Cancer Center, Houston, USA.
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Nelson C, Balter P, Morice RC, Choi B, Kudchadker RJ, Bucci K, Chang JY, Dong L, Tucker S, Vedam S, Briere T, Starkschall G. A technique for reducing patient setup uncertainties by aligning and verifying daily positioning of a moving tumor using implanted fiducials. J Appl Clin Med Phys 2008; 9:110-122. [PMID: 19020478 PMCID: PMC5722352 DOI: 10.1120/jacmp.v9i4.2766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [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: 09/28/2007] [Revised: 01/16/2008] [Accepted: 04/22/2008] [Indexed: 12/03/2022] Open
Abstract
This study aimed to validate and implement a methodology in which fiducials implanted in the periphery of lung tumors can be used to reduce uncertainties in tumor location. Alignment software that matches marker positions on two‐dimensional (2D) kilovoltage portal images to positions on three‐dimensional (3D) computed tomography data sets was validated using static and moving phantoms. This software also was used to reduce uncertainties in tumor location in a patient with fiducials implanted in the periphery of a lung tumor. Alignment of fiducial locations in orthogonal projection images with corresponding fiducial locations in 3D data sets can position both static and moving phantoms with an accuracy of 1 mm. In a patient, alignment based on fiducial locations reduced systematic errors in the left–right direction by 3 mm and random errors by 2 mm, and random errors in the superior–inferior direction by 3 mm as measured by anterior–posterior cine images. Software that matches fiducial markers on 2D and 3D images is effective for aligning both static and moving fiducials before treatment and can be implemented to reduce patient setup uncertainties. PACS number: 81.40.Wx
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Affiliation(s)
- Christopher Nelson
- Departments of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
| | - Peter Balter
- Departments of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
| | - Rodolfo C Morice
- Pulmonary Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
| | - Bum Choi
- Departments of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
| | - Rajat J Kudchadker
- Departments of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
| | - Kara Bucci
- Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
| | - Joe Y Chang
- Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
| | - Lei Dong
- Departments of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
| | - Susan Tucker
- Bioinformatics and Computational Biology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
| | - Sastry Vedam
- Departments of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
| | - Tina Briere
- Departments of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
| | - George Starkschall
- Departments of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A
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Wang H, Vedam S, Balter P, Starkschall G, Zhang L, Cox J, Mohan R, Dong L. Phase-by-phase Reproducibility of Thoracic Anatomy Based on 4D-CT Imaging and Effects on Resultant Internal Target Volumes (ITV). Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.253] [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: 11/30/2022]
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45
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Mirkovic D, Vedam S, Chang J. SU-GG-T-475: Volumetric Analysis of Moving Structures in Radiation Treatment Planning. Med Phys 2008. [DOI: 10.1118/1.2962224] [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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Vedam S. MO-A-AUD C-02: Clinical Implementation of Respiration Motion Correlated Imaging, Treatment Planning and Delivery. Med Phys 2008. [DOI: 10.1118/1.2962323] [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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Yu Z, Liu H, Balter P, Vedam S, Hunjan S, Ikushima H, Zhang L, Mohan R, Dong L. SU-GG-J-132: Motion Characterization for Early Stage Non-Small Cell Lung Cancer. Med Phys 2008. [DOI: 10.1118/1.2961681] [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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Tsunashima Y, Vedam S, Sakae T, Dong L, Mohan R. SU-GG-T-197: Measurement of Dosimetric Impact of Fiducial Makers On Proton Dose Distribution. Med Phys 2008. [DOI: 10.1118/1.2961949] [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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Ezhil M, Choi B, Starkschall G, Bucci MK, Vedam S, Balter P. Comparison of Rigid and Adaptive Methods of Propagating Gross Tumor Volume Through Respiratory Phases of Four-Dimensional Computed Tomography Image Data Set. Int J Radiat Oncol Biol Phys 2008; 71:290-6. [DOI: 10.1016/j.ijrobp.2008.01.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Revised: 12/27/2007] [Accepted: 01/15/2008] [Indexed: 10/22/2022]
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Soofi W, Starkschall G, Britton K, Vedam S. Determination of an optimal organ set to implement deformations to support four-dimensional dose calculations in radiation therapy planning. J Appl Clin Med Phys 2008; 9:69-82. [PMID: 18714284 PMCID: PMC5721707 DOI: 10.1120/jacmp.v9i2.2794] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 11/20/2007] [Revised: 01/14/2008] [Accepted: 01/21/2008] [Indexed: 11/23/2022] Open
Abstract
Surface‐based deformable image registration to generate a four‐dimensional (4D) dose calculation in radiation treatment planning requires the selection of a set of organ contours representing a basis set from which to generate anatomic deformation. The purpose of the present work was to determine the optimal set of organs needed to generate a basis set for deformation in treatment planning for thoracic tumors, such that the required computations are minimized, but that dose accuracy is high. Using retrospectively reviewed records and a deformable model algorithm in a research version of a commercial radiation treatment planning system, we calculated 4D dose distributions based on treatment plans for 10 patients with thoracic tumors. Various combinations of organs (total lungs, heart, spinal cord, external body surface) were used to generate the basis set used in the calculations for deformations. The external surface contour did not have a noticeable effect on the dose calculation. Total lung, heart, and spinal cord together provided an adequate set of deformation organs to generate accurate dose deformations. The magnitude of the calculated dose differences had no obvious relationship to tumor parameters, including site, histologic type, disease stage, extent of motion, or degree of centralization. PACS numbers: 87.55.D‐, 87.55.dk, 87.55.kh
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Affiliation(s)
- Wafa Soofi
- Department of Bioengineering, Rice University, Houston.,Departments of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - George Starkschall
- Departments of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Keith Britton
- Departments of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas.,Departments of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
| | - Sastry Vedam
- Departments of Radiation Physics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas
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