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Roohani S, Ehret F, Beck M, Veltsista DP, Nadobny J, Zschaeck S, Abdel-Rahman S, Eckert F, Flörcken A, Issels RD, Klöck S, Krempien R, Lindner LH, Notter M, Ott OJ, Pink D, Potkrajcic V, Reichardt P, Riesterer O, Spałek MJ, Stutz E, Wessalowski R, Zilli T, Zips D, Ghadjar P, Kaul D. Regional hyperthermia for soft tissue sarcoma - a survey on current practice, controversies and consensus among 12 European centers. Int J Hyperthermia 2024; 41:2342348. [PMID: 38653548 DOI: 10.1080/02656736.2024.2342348] [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: 02/12/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE To analyze the current practice of regional hyperthermia (RHT) for soft tissue sarcoma (STS) at 12 European centers to provide an overview, find consensuses and identify controversies necessary for future guidelines and clinical trials. METHODS In this cross-sectional survey study, a 27-item questionnaire assessing clinical subjects and procedural details on RHT for STS was distributed to 12 European cancer centers for RHT. RESULTS We have identified seven controversies and five consensus points. Of 12 centers, 6 offer both, RHT with chemotherapy (CTX) or with radiotherapy (RT). Two centers only offer RHT with CTX and four centers only offer RHT with RT. All 12 centers apply RHT for localized, high-risk STS of the extremities, trunk wall and retroperitoneum. However, eight centers also use RHT in metastatic STS, five in palliative STS, eight for superficial STS and six for low-grade STS. Pretherapeutic imaging for RHT treatment planning is used by 10 centers, 9 centers set 40-43 °C as the intratumoral target temperature, and all centers use skin detectors or probes in body orifices for thermometry. DISCUSSION There is disagreement regarding the integration of RHT in contemporary interdisciplinary care of STS patients. Many clinical controversies exist that require a standardized consensus guideline and innovative study ideas. At the same time, our data has shown that existing guidelines and decades of experience with the technique of RHT have mostly standardized procedural aspects. CONCLUSIONS The provided results may serve as a basis for future guidelines and inform future clinical trials for RHT in STS patients.
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Affiliation(s)
- Siyer Roohani
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Felix Ehret
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marcus Beck
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Danai P Veltsista
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jacek Nadobny
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sebastian Zschaeck
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité, Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité (Junior) Clinician Scientist Program, Berlin, Germany
| | - Sultan Abdel-Rahman
- Department of Medicine III, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Franziska Eckert
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- Department of Radiation Oncology, AKH, Comprehensive Cancer Center Vienna, Medical University Vienna, Vienna, Austria
| | - Anne Flörcken
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department of Hematology, Oncology and Tumor Immunology, Charité - Universitätsmedizin Berlin, corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Rolf D Issels
- Department of Medicine III, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stephan Klöck
- Department of Radiation Oncology, Lindenhofspital Bern, Bern, Switzerland
| | - Robert Krempien
- Clinic for Radiotherapy, HELIOS Klinikum Berlin-Buch, Berlin, Germany
- MSB Medical School Berlin, Fakultät für Medizin, Berlin, Germany
| | - Lars H Lindner
- Department of Medicine III, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Markus Notter
- Department of Radiation Oncology, Lindenhofspital Bern, Bern, Switzerland
| | - Oliver J Ott
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Daniel Pink
- Department of Medical Oncology, Helios Klinikum Bad Saarow, Bad Saarow, Germany
- Cinic for Internal Medicine C - Haematology and Oncology, Stem Cell Transplantation and Palliative Care, University Medicine Greifswald, Greifswald, Germany
| | - Vlatko Potkrajcic
- Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Peter Reichardt
- Department of Medical Oncology, Helios Klinikum Berlin-Buch, and Medical School Berlin, Berlin, Germany
| | - Oliver Riesterer
- Center for Radiation Oncology KSA-KSB, Kantonsspital Aarau, Aarau, Switzerland
| | - Mateusz Jacek Spałek
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Department of Radiotherapy I, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Emanuel Stutz
- Department of Radiation Oncology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rüdiger Wessalowski
- Department of Paediatric Haematology and Oncology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Thomas Zilli
- Department of Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), EOC, Bellinzona, Switzerland
- Facoltà di Scienze Biomediche, Università Della Svizzera Italiana (USI), Lugano, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel Zips
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Charité - Universitätsmedizin Berlin, Berlin, Germany
- German Cancer Consortium (DKTK), Partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany
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van Asten W, Markidou ES, Gromoll C, Gourzoulidis GA, Maguire S, Guidi G, Pace E, Spruijt H, Martinez-Ortega J, Klöck S. EFOMP policy statement 17: The role and competences of medical physicists and medical physics experts in the different stages of a medical device life cycle. Phys Med 2023; 108:102557. [PMID: 36905774 DOI: 10.1016/j.ejmp.2023.102557] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
MPPs are trained in the branches of physics associated with the practice of medicine. Possessing a solid scientific background and technical skills, MPPs are well suited to play a leading role within each stage of a medical device life cycle. The various stages of the life cycle of a medical device include establishment of requirements with use-case assessment, investment planning, procurement of medical devices, acceptance testing especially regarding safety and performance, quality management, effective and safe use and maintenance, user training, interfacing with IT systems, and safe decommissioning and removal of the medical devices. Acting as an expert within the clinical staff of a healthcare organisation, the MPP can play an important role to achieve a balanced life cycle management of medical devices. Given that the functioning of medical devices and their clinical application in routine clinical practice and research is heavily physics and engineering based, the MPP is strongly associated with the hard science aspects and advanced clinical applications of medical devices and associated physical agents. Indeed, this is reflected in the mission statement of MPP professionals [1]. PURPOSE: The life cycle management of medical devices is described as well as the procedures involved. These procedures are performed by multi-disciplinary teams within a healthcare environment. The task of this workgroup was focused on clarifying and elaborating the role of the Medical Physicist and Medical Physics Expert - here collectively referred to as the Medical Physics Professional (MPP) - within these multi-disciplinary teams. This policy statement describes the role and competences of MPPs in every stage of a medical device life cycle. If MPPs are an integral part of these multi-disciplinary teams, the effective use, safety, and sustainability of the investment is likely to improve as well as the overall service quality delivered by the medical device during its life cycle. It leads to better health care quality and reduced costs. Furthermore, it gives MPPs a stronger position in health care organisations throughout Europe.
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Van Asten W, Markidou ES, Gromoll C, Gourzoulidis G, Maguire S, Guidi G, Pace E, Spruijt H, Martinez-Ortega J, Klöck S. EFOMP POLICY STATEMENT 17: THE ROLE AND COMPETENCES OF MEDICAL PHYSICISTS AND MEDICAL PHYSICS EXPERTS IN THE DIFFERENT STAGES OF A MEDICAL DEVICE LIFE CYCLE. Phys Med 2022. [DOI: 10.1016/s1120-1797(22)02155-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Jöhl A, Ehrbar S, Guckenberger M, Klöck S, Mack A, Meboldt M, Zeilinger M, Tanadini-Lang S, Schmid Daners M. The ideal couch tracking system-Requirements and evaluation of current systems. J Appl Clin Med Phys 2019; 20:152-159. [PMID: 31535782 PMCID: PMC6806475 DOI: 10.1002/acm2.12731] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 06/21/2019] [Accepted: 09/03/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Intrafractional motion can cause substantial uncertainty in precision radiotherapy. Traditionally, the target volume is defined to be sufficiently large to cover the tumor in every position. With the robotic treatment couch, a real-time motion compensation can improve tumor coverage and organ at risk sparing. However, this approach poses additional requirements, which are systematically developed and which allow the ideal robotic couch to be specified. METHODS AND MATERIALS Data of intrafractional tumor motion were collected and analyzed regarding motion range, frequency, speed, and acceleration. Using this data, ideal couch requirements were formulated. The four robotic couches Protura, Perfect Pitch, RoboCouch, and RPSbase were tested with respect to these requirements. RESULTS The data collected resulted in maximum speed requirements of 60 mm/s in all directions and maximum accelerations of 80 mm/s2 in the longitudinal, 60 mm/s2 in the lateral, and 30 mm/s2 in the vertical direction. While the two robotic couches RoboCouch and RPSbase completely met the requirements, even these two showed a substantial residual motion (40% of input amplitude), arguably due to their time delays. CONCLUSION The requirements for the motion compensation by an ideal couch are formulated and found to be feasible for currently available robotic couches. However, the performance these couches can be improved further regarding the position control if the demanded speed and acceleration are taken into account as well.
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Affiliation(s)
- Alexander Jöhl
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland.,Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Stephan Klöck
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Andreas Mack
- Institute for radiotherapy, Klinik Hirslanden Zurich, Zurich, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Melanie Zeilinger
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
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Ehrbar S, Jöhl A, Kühni M, Meboldt M, Ozkan Elsen E, Tanner C, Goksel O, Klöck S, Unkelbach J, Guckenberger M, Tanadini-Lang S. ELPHA: Dynamically deformable liver phantom for real-time motion-adaptive radiotherapy treatments. Med Phys 2019; 46:839-850. [PMID: 30588635 DOI: 10.1002/mp.13359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 01/30/2018] [Revised: 12/03/2018] [Accepted: 12/14/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Real-time motion-adaptive radiotherapy of intrahepatic tumors needs to account for motion and deformations of the liver and the target location within. Phantoms representative of anatomical deformations are required to investigate and improve dynamic treatments. A deformable phantom capable of testing motion detection and motion mitigation techniques is presented here. METHODS The dynamically dEformable Liver PHAntom (ELPHA) was designed to fulfill three main constraints: First, a reproducibly deformable anatomy is required. Second, the phantom should provide multimodality imaging contrast for motion detection. Third, a time-resolved dosimetry system to measure temporal effects should be provided. An artificial liver with vasculature was casted from soft silicone mixtures. The silicones allow for deformation and radiographic image contrast, while added cellulose provides ultrasonic contrast. An actuator was used for compressing the liver in the inferior direction according to a prescribed respiratory motion trace. Electromagnetic (EM) transponders integrated in ELPHA help provide ground truth motion traces. They were used to quantify the motion reproducibility of the phantom and to validate motion detection based on ultrasound imaging. A two-dimensional ultrasound probe was used to follow the position of the vessels with a template-matching algorithm. This detected vessel motion was compared to the EM transponder signal by calculating the root-mean-square error (RMSE). ELPHA was then used to investigate the dose deposition of dynamic treatment deliveries. Two dosimetry systems, radio-chromic film and plastic scintillation dosimeters (PSD), were integrated in ELPHA. The PSD allow for time-resolved measurement of the delivered dose, which was compared to a time-resolved dose of the treatment planning system. Film and PSD were used to investigate dose delivery to the deforming phantom without motion compensation and with treatment-couch tracking for motion compensation. RESULTS ELPHA showed densities of 66 and 45 HU in the liver and the surrounding tissues. A high motion reproducibility with a submillimeter RMSE (<0.32 mm) was measured. The motion of the vasculature detected with ultrasound agreed well with the EM transponder position (RMSE < 1 mm). A time-resolved dosimetry system with a 1 Hz time resolution was achieved with the PSD. The agreement of the planned and measured dose to the PSD decreased with increasing motion amplitude: A dosimetric RMSE of 1.2, 2.1, and 2.7 cGy/s was measured for motion amplitudes of 8, 16, and 24 mm, respectively. With couch tracking as motion compensation, these values decreased to 1.1, 1.4, and 1.4 cGy/s. This is closer to the static situation with 0.7 cGy/s. Film measurements showed that couch tracking was able to compensate for motion with a mean target dose within 5% of the static situation (-5% to +1%), which was higher than in the uncompensated cases (-41% to -1%). CONCLUSIONS ELPHA is a deformable liver phantom with high motion reproducibility. It was demonstrated to be suitable for the verification of motion detection and motion mitigation modalities. Based on the multimodality image contrast, a high accuracy of ultrasound based motion detection was shown. With the time-resolved dosimetry system, ELPHA is suitable for performance assessment of real-time motion-adaptive radiotherapy, as was shown exemplary with couch tracking.
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Affiliation(s)
- Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich and, University of Zurich, 8091, Zurich, Switzerland
| | - Alexander Jöhl
- Department of Radiation Oncology, University Hospital Zurich and, University of Zurich, 8091, Zurich, Switzerland.,Department of Mechanical and Process Engineering, Product Development Group Zurich, ETH Zurich, 8001, Zurich, Switzerland
| | - Michael Kühni
- Department of Mechanical and Process Engineering, Product Development Group Zurich, ETH Zurich, 8001, Zurich, Switzerland
| | - Mirko Meboldt
- Department of Mechanical and Process Engineering, Product Development Group Zurich, ETH Zurich, 8001, Zurich, Switzerland
| | - Ece Ozkan Elsen
- Department of Information Technology and Electrical Engineering, Computer-assisted Applications in Medicine, ETH Zurich, 8001, Zürich, Switzerland
| | - Christine Tanner
- Department of Information Technology and Electrical Engineering, Computer-assisted Applications in Medicine, ETH Zurich, 8001, Zürich, Switzerland
| | - Orcun Goksel
- Department of Information Technology and Electrical Engineering, Computer-assisted Applications in Medicine, ETH Zurich, 8001, Zürich, Switzerland
| | - Stephan Klöck
- Department of Radiation Oncology, University Hospital Zurich and, University of Zurich, 8091, Zurich, Switzerland
| | - Jan Unkelbach
- Department of Radiation Oncology, University Hospital Zurich and, University of Zurich, 8091, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich and, University of Zurich, 8091, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich and, University of Zurich, 8091, Zurich, Switzerland
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Jöhl A, Bogowicz M, Ehrbar S, Guckenberger M, Klöck S, Meboldt M, Riesterer O, Zeilinger M, Schmid Daners M, Tanadini-Lang S. Body motion during dynamic couch tracking with healthy volunteers. Phys Med Biol 2018; 64:015001. [PMID: 30523943 DOI: 10.1088/1361-6560/aaf361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In precision radiotherapy, the intrafractional motion can cause a considerable uncertainty of the location of the tumor to be treated. An established approach is the expansion of the target volume to account for the motion. An alternative approach is couch-tracking, in which the patient is continually moved to compensate the intrafractional motion. However, couch-tracking itself might induce uncertainty of the patient's body position, because the body is non-rigid. One hundred healthy volunteers were positioned supine on a robotic couch. Optical markers were placed on the torso of the volunteers as well as on the couch, and their positions were tracked with an optical surface measurement system. Using these markers, the uncertainty of the body position relative to the couch position was estimated while the couch was static or moving. Over the included 83 healthy volunteers, the median of the uncertainty increased by 0.8 mm (SI), 0.4 mm (LR) and 0.4 mm (AP) when the couch moved. Couch motion was found to increase the uncertainty of the body position relative to the couch. However, this uncertainty is one order of magnitude smaller than the intrafractional tumor motion amplitudes to be compensated. Therefore, even with body motion present, the couch-tracking approach is a viable option. The study was registered at ClinicalTrials.gov (NCT02820532) and the Swiss national clinical trials portal (SNCTP000001878).
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Affiliation(s)
- Alexander Jöhl
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich 8092, Switzerland. Department of Radiation Oncology, University Hospital Zurich, Zurich 8091, Switzerland
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Stieb S, Malla M, Graydon S, Riesterer O, Klöck S, Studer G, Tanadini-Lang S. Dosimetric influence of pitch in patient positioning for radiotherapy of long treatment volumes; the usefulness of six degree of freedom couch. Br J Radiol 2018; 91:20170704. [PMID: 30004794 DOI: 10.1259/bjr.20170704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: Pitch, the rotation around the transversal axis of the patient during radiotherapy has little impact on the dose distribution of small spherical treatment volumes; however it might affect treatment of long volumes requiring a correction with a six degree of freedom couch. METHODS: We included 10 patients each with nasopharyngeal carcinoma (NPC) and esophageal cancer, treated with volumetric modulated arc therapy. Pitch was simulated by tilting the planning CT in ventral and dorsal direction by ± 1.5° and ± 3°. Verification plans were calculated on the tilted datasets and were compared to the original plan and the dose constraints of the organs at risk (OAR). RESULTS: The deviation in dose to the planning target volume is increasing with the degree of pitch with mean changes of up to 2% for NPC and 1% for esophageal cancer. The most affected OAR in NPC patients are brainstem (max. dose +6.0%) and spinal cord (max. dose +10.0%) when tilted by 3° dorsally and lenses (max. dose +3.3%), oral mucosa (mean dose +2.6%) and parotid glands (mean dose +4.3%) when tilted by 3° ventrally. For esophageal cancer patients, there was no significant change in dose to any OAR. Whereas for esophageal cancer, all tilted treatment plans were still clinically acceptable regarding OAR, 5 NPC plans would no longer be acceptable with a pitch of 1.5° ventral (N = 1), 3° ventral (N = 2) and 3° dorsal (N = 2). CONCLUSION: Planning target volume coverage in both tumor entities was only slightly affected, but pitch errors could be relevant for OAR in NPC patients. ADVANCES IN KNOWLEDGE: A correction with a six degree of freedom couch is recommended for NPC patients with a pitch mismatch of more than 1.5° to avoid exceeded doses to the OAR.
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Affiliation(s)
- Sonja Stieb
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland.,2 Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland
| | - Michelle Malla
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland
| | - Shaun Graydon
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland
| | - Oliver Riesterer
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland
| | - Stephan Klöck
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland
| | - Gabriela Studer
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland.,3 Institute for Radiation Oncology, Cantonal Hospital Lucerne , Lucerne , Switzerland
| | - Stephanie Tanadini-Lang
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland
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Chamberlain M, Klöck S, Linsenmeier C, Di Martino M, Guckenberger M, Tanadini-Lang S. OC-0617: A new technique for robust VMAT treatment planning of total craniospinal irradiation. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30927-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ehrbar S, Schmid S, Jöhl A, Klöck S, Guckenberger M, Riesterer O, Tanadini-Lang S. Comparison of multi-leaf collimator tracking and treatment-couch tracking during stereotactic body radiation therapy of prostate cancer. Radiother Oncol 2017; 125:445-452. [DOI: 10.1016/j.radonc.2017.08.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/18/2017] [Accepted: 08/29/2017] [Indexed: 11/28/2022]
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Jöhl A, Bogowicz M, Ehrbar S, Guckenberger M, Klöck S, Meboldt M, Riesterer O, Zeilinger M, Schmid Daners M, Tanadini-Lang S. Unconscious physiological response of healthy volunteers to dynamic respiration-synchronized couch motion. Radiat Oncol 2017; 12:189. [PMID: 29183337 PMCID: PMC5706399 DOI: 10.1186/s13014-017-0925-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/28/2017] [Accepted: 11/14/2017] [Indexed: 12/25/2022] Open
Abstract
Background Intrafractional motion can be a substantial uncertainty in precision radiotherapy. Conventionally, the target volume is expanded to account for the motion. Couch-tracking is an alternative, where the patient is moved to compensate for the tumor motion. However, the couch motion may influence the patient’s stress and respiration behavior decreasing the couch-tracking effectiveness. Methods In total, 100 volunteers were positioned supine on a robotic couch, which moved dynamically and respiration synchronized. During the measurement, the skin conductivity, the heartrate, and the gaze location were measured indicating the volunteer’s stress. Volunteers rated the subjective motion sickness using a questionnaire. The measurement alternated between static and tracking segments (three cycles), each 1 min long. Results The respiration amplitude showed no significant difference between tracking and static segments, but decreased significantly from the first to the last tracking segment (p < 0.0001). The respiration frequency differed significantly between tracking and static segments (p < 0.0001), but not between the first and the last tracking segment. The physiological parameters and the questionnaire showed mild signals of stress and motion sickness. Conclusion Generally, people tolerated the couch motions. The interaction between couch motion and the patient’s breathing pattern should be considered for a clinical implementation. Trial registration The study was registered at ClinicalTrials.gov (NCT02820532) and the Swiss national clinical trials portal (SNCTP000001878) on June 20, 2016. Electronic supplementary material The online version of this article (10.1186/s13014-017-0925-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alexander Jöhl
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zürich, Switzerland. .,Department of Radiation Oncology, University Hospital Zurich, Zürich, Switzerland.
| | - Marta Bogowicz
- Department of Radiation Oncology, University Hospital Zurich, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
| | - Stephan Klöck
- Department of Radiation Oncology, University Hospital Zurich, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zürich, Switzerland
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
| | - Melanie Zeilinger
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Zürich, Switzerland
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zürich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, Zürich, Switzerland.,University of Zurich, Zürich, Switzerland
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Karava K, Ehrbar S, Riesterer O, Roesch J, Glatz S, Klöck S, Guckenberger M, Tanadini-Lang S. Potential dosimetric benefits of adaptive tumor tracking over the internal target volume concept for stereotactic body radiation therapy of pancreatic cancer. Radiat Oncol 2017; 12:175. [PMID: 29121945 PMCID: PMC5680781 DOI: 10.1186/s13014-017-0906-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 07/21/2017] [Accepted: 10/30/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Radiotherapy for pancreatic cancer has two major challenges: (I) the tumor is adjacent to several critical organs and, (II) the mobility of both, the tumor and its surrounding organs at risk (OARs). A treatment planning study simulating stereotactic body radiation therapy (SBRT) for pancreatic tumors with both the internal target volume (ITV) concept and the tumor tracking approach was performed. The two respiratory motion-management techniques were compared in terms of doses to the target volume and organs at risk. METHODS AND MATERIALS Two volumetric-modulated arc therapy (VMAT) treatment plans (5 × 5 Gy) were created for each of the 12 previously treated pancreatic cancer patients, one using the ITV concept and one the tumor tracking approach. To better evaluate the overall dose delivered to the moving tumor volume, 4D dose calculations were performed on four-dimensional computed tomography (4DCT) scans. The resulting planning target volume (PTV) size for each technique was analyzed. Target and OAR dose parameters were reported and analyzed for both 3D and 4D dose calculation. RESULTS Tumor motion ranged from 1.3 to 11.2 mm. Tracking led to a reduction of PTV size (max. 39.2%) accompanied with significant better tumor coverage (p<0.05, paired Wilcoxon signed rank test) both in 3D and 4D dose calculations and improved organ at risk sparing. Especially for duodenum, stomach and liver, the mean dose was significantly reduced (p<0.05) with tracking for 3D and 4D dose calculations. CONCLUSIONS By using an adaptive tumor tracking approach for respiratory-induced pancreatic motion management, a significant reduction in PTV size can be achieved, which subsequently facilitates treatment planning, and improves organ dose sparing. The dosimetric benefit of tumor tracking is organ and patient-specific.
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Affiliation(s)
- Konstantina Karava
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland. .,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland.
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Johannes Roesch
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Stefan Glatz
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Stephan Klöck
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
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Jöhl A, Berdou Y, Guckenberger M, Klöck S, Meboldt M, Zeilinger M, Tanadini-Lang S, Daners MS. Performance behavior of prediction filters for respiratory motion compensation in radiotherapy. Current Directions in Biomedical Engineering 2017. [DOI: 10.1515/cdbme-2017-0090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractIntroduction: In radiotherapy, tumors may move due to the patient’s respiration, which decreases treatment accuracy. Some motion mitigation methods require measuring the tumor position during treatment. Current available sensors often suffer from time delays, which degrade the motion mitigation performance. However, the tumor motion is often periodic and continuous, which allows predicting the motion ahead. Method and Materials: A couch tracking system was simulated in MATLAB and five prediction filters selected from literature were implemented and tested on 51 respiration signals (median length: 103 s). The five filters were the linear filter (LF), the local regression (LOESS), the neural network (NN), the support vector regression (SVR), and the wavelet least mean squares (wLMS). The time delay to compensate was 320 ms. The normalized root mean square error (nRMSE) was calculated for all prediction filters and respiration signals. The correlation coefficients between the nRMSE of the prediction filters were computed. Results: The prediction filters were grouped into a low and a high nRMSE group. The low nRMSE group consisted of the LF, the NN, and the wLMS with a median nRMSE of 0.14, 0.15, and 0.14, respectively. The high nRMSE group consisted of the LOESS and the SVR with both a median nRMSE of 0.34. The correlations between the low nRMSE filters were above 0.87 and between the high nRMSE filters it was 0.64. Conclusion: The low nRMSE prediction filters not only have similar median nRMSEs but also similar nRMSEs for the same respiration signals as the high correlation shows. Therefore, good prediction filters perform similarly for identical respiration patterns, which might indicate a minimally achievable nRMSE for a given respiration pattern.
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Affiliation(s)
- Alexander Jöhl
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, CLA G19.2 Tannenstrasse 3 8092 Zurich, Switzerland
| | - Yannick Berdou
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Stephan Klöck
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Mirko Meboldt
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Switzerland
| | - Melanie Zeilinger
- Institute for Dynamic Systems and Control, Department of Mechanical and Process Engineering, ETH Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Switzerland
| | - Marianne Schmid Daners
- Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Switzerland
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13
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Ehrbar S, Jöhl A, Tartas A, Stark LS, Riesterer O, Klöck S, Guckenberger M, Tanadini-Lang S. ITV, mid-ventilation, gating or couch tracking - A comparison of respiratory motion-management techniques based on 4D dose calculations. Radiother Oncol 2017; 124:80-88. [PMID: 28587761 DOI: 10.1016/j.radonc.2017.05.016] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [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: 11/11/2016] [Revised: 04/19/2017] [Accepted: 05/20/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE Respiratory motion-management techniques (MMT) aim to ensure tumor dose coverage while sparing lung tissue. Dynamic treatment-couch tracking of the moving tumor is a promising new MMT and was compared to the internal-target-volume (ITV) concept, the mid-ventilation (MidV) principle and the gating approach in a planning study based on 4D dose calculations. METHODS For twenty patients with lung lesions, planning target volumes (PTV) were adapted to the MMT and stereotactic body radiotherapy treatments were prepared with the 65%-isodose enclosing the PTV. For tracking, three concepts for target volume definition were considered: Including the gross tumor volume of one phase (single-phase tracking), including deformations between phases (multi-phase tracking) and additionally including tracking latencies of a couch tracking system (reliable couch tracking). The accumulated tumor and lung doses were estimated with 4D dose calculations based on 4D-CT datasets and deformable image registration. RESULTS Single-phase tracking showed the lowest ipsilateral lung Dmean (median: 3.3Gy), followed by multi-phase tracking, gating, reliable couch tracking, MidV and ITV concepts (3.6, 3.8, 4.1, 4.3 and 4.8Gy). The 4D dose calculations showed the MidV and single-phase tracking overestimated the target mean dose (-2.3% and -1.3%), while it was slightly underestimated by the other MMT (<+1%). CONCLUSION The ITV concept ensures tumor coverage, but exposes the lung tissue to a higher dose. The MidV, gating and tracking concepts were shown to reduce the lung dose. Neglecting non-translational changes of the tumor in the target volume definition for tracking results in a slightly reduced target coverage. The slightly inferior dose coverage for MidV should be considered when applying this technique clinically.
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Affiliation(s)
- Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland.
| | - Alexander Jöhl
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Switzerland
| | - Adrianna Tartas
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Warsaw, Faculty of Physics, Poland
| | - Luisa Sabrina Stark
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
| | - Stephan Klöck
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
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Ehrbar S, Schmid S, Klöck S, Guckenberger M, Riesterer O, Tanadini-Lang S. OC-0305: Validation of Dynamic Treatment-Couch Tracking for Prostate SBRT. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30747-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ehrbar S, Schmid S, Jöhl A, Klöck S, Guckenberger M, Riesterer O, Tanadini-Lang S. Validation of dynamic treatment-couch tracking for prostate SBRT. Med Phys 2017; 44:2466-2477. [PMID: 28339109 DOI: 10.1002/mp.12236] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 11/11/2016] [Revised: 02/20/2017] [Accepted: 03/13/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In stereotactic body radiation therapy (SBRT) of prostatic cancer, a high dose per fraction is applied to the target with steep dose gradients. Intrafractional prostate motion can occur unpredictably during the treatment and lead to target miss. This work investigated the dosimetric benefit of motion compensation with dynamic treatment-couch tracking for prostate SBRT treatments in the presence of prostatic motion. METHODS Ten SBRT treatment plans for prostate cancer patients with integrated boosts to their index lesion were prepared. The treatment plans were applied with a TrueBeam linear accelerator to a phantom in (a) static reference position, (b) moved with five prostate motion trajectories without any motion compensation, and (c) with real-time compensation using transponder-guided couch tracking. The geometrical position of the electromagnetic transponder was evaluated in the tracked and untracked situation. The dosimetric performance of couch tracking was evaluated, using Gamma agreement indices (GAI) and other dose parameters. These were evaluated within the phantoms biplanar diode array, as well as target- and organ-specific. RESULTS The root-mean-square error of the motion traces (range: 0.8-4.4 mm) was drastically reduced with couch tracking (0.2-0.4 mm). Residual motion was mainly observed at abrupt direction changes with steep motion gradients. The phantom measurements showed significantly better GAI1%/1mm with tracked (range: 83.4%-100.0%) than with untracked motion (28.9%-99.7%). Also GAI2%/2mm was significantly superior for the tracked (98.4%-100.0%) than the untracked motion (52.3%-100.0%). The organ-specific evaluation showed significantly better target coverage with tracking. The dose to the rectum and bladder showed a dependency on the anterior-posterior motion direction. CONCLUSIONS Couch tracking clearly improved the dosimetric accuracy of prostate SBRT treatments. The treatment couch was able to compensate the prostatic motion with only some minor residual motion. Therefore, couch tracking combined with electromagnetic position monitoring for prostate SBRT is feasible and improves the accuracy in treatment delivery when prostate motion is present.
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Affiliation(s)
- Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Simon Schmid
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Alexander Jöhl
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Product Development Group Zurich, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Stephan Klöck
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Ehrbar S, Perrin R, Peroni M, Bernatowicz K, Parkel T, Pytko I, Klöck S, Guckenberger M, Tanadini-Lang S, Weber DC, Lomax A. Respiratory motion-management in stereotactic body radiation therapy for lung cancer - A dosimetric comparison in an anthropomorphic lung phantom (LuCa). Radiother Oncol 2016; 121:328-334. [PMID: 27817945 DOI: 10.1016/j.radonc.2016.10.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 09/19/2016] [Accepted: 10/06/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE The objective of this study was to compare the latest respiratory motion-management strategies, namely the internal-target-volume (ITV) concept, the mid-ventilation (MidV) principle, respiratory gating and dynamic couch tracking. MATERIALS AND METHODS An anthropomorphic, deformable and dynamic lung phantom was used for the dosimetric validation of these techniques. Stereotactic treatments were adapted to match the techniques and five distinct respiration patterns, and delivered to the phantom while radiographic film measurements were taken inside the tumor. To report on tumor coverage, these dose distributions were used to calculate mean doses (Dmean), changes in homogeneity indices (ΔH2-98), gamma agreement, and areas covered by the planned minimum dose (A>Dmin). RESULTS All techniques achieved good tumor coverage (A>Dmin>99.0%) and minor changes in Dmean (±3.2%). Gating and tracking strategies showed superior results in gamma agreement and ΔH2-98 compared to ITV and MidV concepts, which seem to be more influenced by the interplay and the gradient effect. For lung, heart and spinal cord, significant dose differences between the four techniques were found (p<0.05), with lowest doses for gating and tracking strategies. CONCLUSION Active motion-management techniques, such as gating or tracking, showed superior tumor dose coverage and better organ dose sparing than the passive techniques based on tumor margins.
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Affiliation(s)
- Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland.
| | - Rosalind Perrin
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Switzerland
| | - Marta Peroni
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Switzerland
| | - Kinga Bernatowicz
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Switzerland
| | - Thomas Parkel
- Innovative Design, Centre Suisse d'Electronique et de Microtechnique (CSEM) S. A., Switzerland
| | - Izabela Pytko
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
| | - Stephan Klöck
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich (USZ), Switzerland; University of Zurich, Switzerland
| | - Damien Charles Weber
- University of Zurich, Switzerland; Center for Proton Therapy, Paul Scherrer Institute (PSI), Switzerland
| | - Antony Lomax
- Center for Proton Therapy, Paul Scherrer Institute (PSI), Switzerland; Swiss Federal Institute of Technology in Zurich (ETHZ), Switzerland
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Ehrbar S, Lang S, Stieb S, Riesterer O, Stark LS, Guckenberger M, Klöck S. Three-dimensional versus four-dimensional dose calculation for volumetric modulated arc therapy of hypofractionated treatments. Z Med Phys 2016; 26:45-53. [DOI: 10.1016/j.zemedi.2015.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/29/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
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Jöhl A, Lang S, Ehrbar S, Guckenberger M, Klöck S, Meboldt M, Schmid Daners M. Modeling and performance evaluation of a robotic treatment couch for tumor tracking. ACTA ACUST UNITED AC 2016; 61:557-566. [DOI: 10.1515/bmt-2015-0187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/20/2016] [Indexed: 12/25/2022]
Abstract
AbstractTumor motion during radiation therapy increases the irradiation of healthy tissue. However, this problem may be mitigated by moving the patient via the treatment couch such that the tumor motion relative to the beam is minimized. The treatment couch poses limitations to the potential mitigation, thus the performance of the Protura (CIVCO) treatment couch was characterized and numerically modeled. The unknown parameters were identified using chirp signals and verified with one-dimensional tumor tracking. The Protura tracked chirp signals well up to 0.2 Hz in both longitudinal and vertical directions. If only the vertical or only the longitudinal direction was tracked, the Protura tracked well up to 0.3 Hz. However, there was unintentional yet substantial lateral motion in the former case. And during vertical motion, the extension caused rotation of the Protura around the lateral axis. The numerical model matched the Protura up to 0.3 Hz. Even though the Protura was designed for static positioning, it was able to reduce the tumor motion by 69% (median). The correlation coefficient between the tumor motion reductions of the Protura and the model was 0.99. Therefore, the model allows tumor-tracking results of the Protura to be predicted.
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Stieb S, Malla M, Graydon S, Riesterer O, Klöck S, Studer G, Lang S. PO-0783: Dosimetric influence of pitch for radiotherapy of long treatment volumes. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40775-3] [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: 10/23/2022]
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Zamburlini M, Krayenbühl J, Najafi Y, Verlaan S, Graydon S, Streller T, Klöck S. EP-1441: Evaluation of Eclipse Rapidplan for semi-automatic treatment planning of prostate radiation treatment. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41433-1] [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: 10/23/2022]
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Pytko I, Stüssi A, Lang S, Klöck S, Guckenberger M. EP-1486: Feasibility study of using a radiofrequency tracking system for intra-fractional monitoring during radiosurgery. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41478-1] [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: 10/23/2022]
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Ehrbar S, Jöhl A, Stieb S, Riesterer O, Stark L, Guckenberger M, Klöck S, Lang S. PO-0926: Dosimetric comparison of different motion management techniques. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40918-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jöhl A, Schmid Daners M, Ehrbar S, Guckenberger M, Klöck S, Lang S. PO-0925: Respiratory motion prediction filters for real time tumor tracking during radiation treatment. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40917-x] [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: 10/23/2022]
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Stüssi A, Zamburlini M, Andratschke N, Lang S, Klöck S. PD-0447: Clinical evaluation of a dose calculation algorithm based on the linear Boltzmann transport equation. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40443-8] [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: 11/28/2022]
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Hauri P, Verlaan S, Graydon S, Ahnen L, Klöck S, Lang S. Clinical evaluation of an anatomy-based patient specific quality assurance system. J Appl Clin Med Phys 2014; 15:4647. [PMID: 24710453 PMCID: PMC5875461 DOI: 10.1120/jacmp.v15i2.4647] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 12/03/2013] [Accepted: 11/27/2013] [Indexed: 11/23/2022] Open
Abstract
The Delta(4DVH) Anatomy 3D quality assurance (QA) system (ScandiDos), which converts the measured detector dose into the dose distribution in the patient geometry was evaluated. It allows a direct comparison of the calculated 3D dose with the measured back-projected dose. In total, 16 static and 16 volumetric-modulated arc therapy (VMAT) fields were planned using four different energies. Isocenter dose was measured with a pinpoint chamber in homogeneous phantoms to investigate the dose prediction by the Delta(4DVH) Anatomy algorithm for static fields. Dose distributions of VMAT fields were measured using GAFCHROMIC film. Gravitational gantry errors up to 10° were introduced into all VMAT plans to study the potential of detecting errors. Additionally, 20 clinical treatment plans were verified. For static fields, the Delta(4DVH) Anatomy predicted the isocenter dose accurately, with a deviation to the measured phantom dose of 1.1% ± 0.6%. For VMAT fields the predicted Delta(4DVH) Anatomy dose in the isocenter plane corresponded to the measured dose in the phantom, with an average gamma agreement index (GAI) (3 mm/3%) of 96.9± 0.4%. The Delta(4DVH) Anatomy detected the induced systematic gantry error of 10° with a relative GAI (3 mm/3%) change of 5.8% ± 1.6%. The conventional Delta(4PT) QA system detected a GAI change of 4.2%± 2.0%. The conventional Delta(4PT) GAI (3 mm/3%) was 99.8% ± 0.4% for the clinical treatment plans. The mean body and PTV-GAI (3 mm/5%) for the Delta(4DVH) Anatomy were 96.4% ± 2.0% and 97.7%± 1.8%; however, this dropped to 90.8%± 3.4% and 87.1% ± 4.1% for passing criteria of 3 mm/3%. The anatomy-based patient specific quality assurance system predicts the dose distribution correctly for a homogeneous case. The limiting factor for the error detection is the large variability in the error-free plans. The dose calculation algorithm is inferior to that used in the TPS (Eclipse).
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Hrbacek J, Lang S, Graydon SN, Klöck S, Riesterer O. Dosimetric comparison of flattened and unflattened beams for stereotactic ablative radiotherapy of stage I non-small cell lung cancer. Med Phys 2014; 41:031709. [DOI: 10.1118/1.4866231] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Lang S, Zeimetz J, Ochsner G, Schmid Daners M, Riesterer O, Klöck S. Development and evaluation of a prototype tracking system using the treatment couch. Med Phys 2014; 41:021720. [DOI: 10.1118/1.4862077] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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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Lang S, Zeimetz J, Ochsner G, Schmid-Daners M, Klöck S, Riesterer O. EP-1661: Effect of couch tracking upon volunteers. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31779-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Graydon S, Verlaan S, Lang S, Matzen T, Klöck S. EP-1501: Evaluation of a prototype in vivo dosimetry device. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31619-4] [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: 11/25/2022]
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Lindl BL, Müller RG, Lang S, Herraiz Lablanca MD, Klöck S. TOPOS: A new topometric patient positioning and tracking system for radiation therapy based on structured white light. Med Phys 2013; 40:042701. [DOI: 10.1118/1.4794927] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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31
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Buchegger N, Zamburlini M, Klöck S, Zwahlen D. PO-0982: Additional value of T2-weighted MR imaging for post-planning dosimetry after I-125 prostate brachytherapy. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33288-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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32
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Krayenbuehl J, Loewenich K, Norton I, Zamburlini M, Riesterer O, Klöck S. PO-0885: Implementation and validation of Pinnacle for stereotactic body radiotherapy with a flattening filter free linac. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33191-1] [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: 10/23/2022]
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33
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Lang S, Zamburlini M, Stüssi A, Hrbacek J, Klöck S. EP-1298: Evaluation of dosimetric and geometric stability of a new digital linear accelerator over a period of 3 years. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33604-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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34
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Lang S, Shrestha B, Graydon S, Cavelaars F, Linsenmeier C, Hrbacek J, Klöck S, Studer G, Riesterer O. Clinical application of flattening filter free beams for extracranial stereotactic radiotherapy. Radiother Oncol 2013; 106:255-9. [DOI: 10.1016/j.radonc.2012.12.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Revised: 11/15/2012] [Accepted: 12/19/2012] [Indexed: 11/16/2022]
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35
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Lang S, Hrbacek J, Leong A, Klöck S. Ion-recombination correction for different ionization chambers in high dose rate flattening-filter-free photon beams. Phys Med Biol 2012; 57:2819-27. [DOI: 10.1088/0031-9155/57/9/2819] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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36
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Lang S, Reggiori G, Puxeu Vaqué J, Calle C, Hrbacek J, Klöck S, Scorsetti M, Cozzi L, Mancosu P. Pretreatment quality assurance of flattening filter free beams on 224 patients for intensity modulated plans: A multicentric study. Med Phys 2012; 39:1351-6. [DOI: 10.1118/1.3685461] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [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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Mancosu P, Lang S, Reggiori G, Hrbacek J, Scorsetti M, Klöck S. Multicentric Pre-Treatment Quality Assurance Study on first 166 Patients Treated with Truebeam using Flattering Filter Free Beams. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1592] [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: 10/16/2022]
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38
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Hrbacek J, Lang S, Graydon S, Klöck S, Riesterer O. 405 poster CONTRIBUTION OF FLATTENING FILTER FREE BEAMS TO EXTRACRANIAL STEREOTACTIC VMAT TREATMENT OF NSCLC PATIENTS. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70527-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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39
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Hrbacek J, Lang S, Dossenbach T, Bocanek J, Klöck S. TU-A-BRA-02: Flattening Filter Free RapidArc Treatment with Trilogy MX Linear Accelerator. Med Phys 2010. [DOI: 10.1118/1.3469163] [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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