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Madesta F, Sentker T, Gauer T, Werner R. Deep learning-based conditional inpainting for restoration of artifact-affected 4D CT images. Med Phys 2023. [PMID: 38055336 DOI: 10.1002/mp.16851] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND 4D CT imaging is an essential component of radiotherapy of thoracic and abdominal tumors. 4D CT images are, however, often affected by artifacts that compromise treatment planning quality and image information reliability. PURPOSE In this work, deep learning (DL)-based conditional inpainting is proposed to restore anatomically correct image information of artifact-affected areas. METHODS The restoration approach consists of a two-stage process: DL-based detection of common interpolation (INT) and double structure (DS) artifacts, followed by conditional inpainting applied to the artifact areas. In this context, conditional refers to a guidance of the inpainting process by patient-specific image data to ensure anatomically reliable results. The study is based on 65 in-house 4D CT images of lung cancer patients (48 with only slight artifacts, 17 with pronounced artifacts) and two publicly available 4D CT data sets that serve as independent external test sets. RESULTS Automated artifact detection revealed a ROC-AUC of 0.99 for INT and of 0.97 for DS artifacts (in-house data). The proposed inpainting method decreased the average root mean squared error (RMSE) by 52 % (INT) and 59 % (DS) for the in-house data. For the external test data sets, the RMSE improvement is similar (50 % and 59 %, respectively). Applied to 4D CT data with pronounced artifacts (not part of the training set), 72 % of the detectable artifacts were removed. CONCLUSIONS The results highlight the potential of DL-based inpainting for restoration of artifact-affected 4D CT data. Compared to recent 4D CT inpainting and restoration approaches, the proposed methodology illustrates the advantages of exploiting patient-specific prior image information.
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Affiliation(s)
- Frederic Madesta
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Biomedical Artificial Intelligence (bAIome), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thilo Sentker
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Biomedical Artificial Intelligence (bAIome), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Gauer
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - René Werner
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Biomedical Artificial Intelligence (bAIome), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Schwarz A, Werner R, Wimmert L, Vornehm M, Gauer T, Hofmann C. Dose reduction in sequence scanning 4D CT imaging through respiratory signal-guided tube current modulation: A feasibility study. Med Phys 2023; 50:7539-7547. [PMID: 37831550 DOI: 10.1002/mp.16785] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 06/28/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Respiratory signal-guided 4D CT sequence scanning such as the recently introduced Intelligent 4D CT (i4DCT) approach reduces image artifacts compared to conventional 4D CT, especially for irregular breathing. i4DCT selects beam-on periods during scanning such that data sufficiency conditions are fulfilled for each couch position. However, covering entire breathing cycles during beam-on periods leads to redundant projection data and unnecessary dose to the patient during long exhalation phases. PURPOSE We propose and evaluate the feasibility of respiratory signal-guided dose modulation (i.e., temporary reduction of the CT tube current) to reduce the i4DCT imaging dose while maintaining high projection data coverage for image reconstruction. METHODS The study is designed as an in-silico feasibility study. Dose down- and up-regulation criteria were defined based on the patients' breathing signals and their representative breathing cycle learned before and during scanning. The evaluation (including an analysis of the impact of the dose modulation criteria parameters) was based on 510 clinical 4D CT breathing curves. Dose reduction was determined as the fraction of the downregulated dose delivery time to the overall beam-on time. Furthermore, under the assumption of a 10-phase 4D CT and amplitude-based reconstruction, beam-on periods were considered negatively affected by dose modulation if the downregulation period covered an entire phase-specific amplitude range for a specific breathing phase (i.e., no appropriate reconstruction of the phase image possible for this specific beam-on period). Corresponding phase-specific amplitude bins are subsequently denoted as compromised bins. RESULTS Dose modulation resulted in a median dose reduction of 10.4% (lower quartile: 7.4%, upper quartile: 13.8%, maximum: 28.6%; all values corresponding to a default parameterization of the dose modulation criteria). Compromised bins were observed in 1.0% of the beam-on periods (72 / 7370 periods) and affected 10.6% of the curves (54/510 curves). The extent of possible dose modulation depends strongly on the individual breathing patterns and is weakly correlated with the median breathing cycle length (Spearman correlation coefficient 0.22, p < 0.001). Moreover, the fraction of beam-on periods with compromised bins is weakly anti-correlated with the patient's median breathing cycle length (Spearman correlation coefficient -0.24; p < 0.001). Among the curves with the 17% longest average breathing cycles, no negatively affected beam-on periods were observed. CONCLUSION Respiratory signal-guided dose modulation for i4DCT imaging is feasible and promises to significantly reduce the imaging dose with little impact on projection data coverage. However, the impact on image quality remains to be investigated in a follow-up study.
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Affiliation(s)
- Annette Schwarz
- Pattern Recognition Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Siemens Healthcare GmbH, Forchheim, Germany
| | - René Werner
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Wimmert
- Institute of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Applied Medical Informatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Vornehm
- Siemens Healthcare GmbH, Forchheim, Germany
- Computational Imaging Lab, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Tobias Gauer
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Heitkamp A, Madesta F, Amberg S, Wahaj S, Schröder T, Bechstein M, Meyer L, Broocks G, Hanning U, Gauer T, Werner R, Fiehler J, Gellißen S, Kniep HC. Discordant and Converting Receptor Expressions in Brain Metastases from Breast Cancer: MRI-Based Non-Invasive Receptor Status Tracking. Cancers (Basel) 2023; 15:cancers15112880. [PMID: 37296843 DOI: 10.3390/cancers15112880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023] Open
Abstract
Discordance and conversion of receptor expressions in metastatic lesions and primary tumors is often observed in patients with brain metastases from breast cancer. Therefore, personalized therapy requires continuous monitoring of receptor expressions and dynamic adaptation of applied targeted treatment options. Radiological in vivo techniques may allow receptor status tracking at high frequencies at low risk and cost. The present study aims to investigate the potential of receptor status prediction through machine-learning-based analysis of radiomic MR image features. The analysis is based on 412 brain metastases samples from 106 patients acquired between 09/2007 and 09/2021. Inclusion criteria were as follows: diagnosed cerebral metastases from breast cancer; histopathology reports on progesterone (PR), estrogen (ER), and human epidermal growth factor 2 (HER2) receptor status; and availability of MR imaging data. In total, 3367 quantitative features of T1 contrast-enhanced, T1 non-enhanced, and FLAIR images and corresponding patient age were evaluated utilizing random forest algorithms. Feature importance was assessed using Gini impurity measures. Predictive performance was tested using 10 permuted 5-fold cross-validation sets employing the 30 most important features of each training set. Receiver operating characteristic areas under the curves of the validation sets were 0.82 (95% confidence interval [0.78; 0.85]) for ER+, 0.73 [0.69; 0.77] for PR+, and 0.74 [0.70; 0.78] for HER2+. Observations indicate that MR image features employed in a machine learning classifier could provide high discriminatory accuracy in predicting the receptor status of brain metastases from breast cancer.
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Affiliation(s)
- Alexander Heitkamp
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Frederic Madesta
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Sophia Amberg
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Schohla Wahaj
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Tanja Schröder
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Matthias Bechstein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Gabriel Broocks
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Tobias Gauer
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - René Werner
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
- Center for Biomedical Artificial Intelligence (bAIome), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Susanne Gellißen
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Helge C Kniep
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
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Baehr A, Hummel D, Gauer T, Oertel M, Kittel C, Löser A, Todorovic M, Petersen C, Krüll A, Buchgeister M. Risk management patterns in radiation oncology-results of a national survey within the framework of the Patient Safety in German Radiation Oncology (PaSaGeRO) project. Strahlenther Onkol 2023; 199:350-359. [PMID: 35931889 PMCID: PMC10033570 DOI: 10.1007/s00066-022-01984-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/20/2022] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Risk management (RM) is a key component of patient safety in radiation oncology (RO). We investigated current approaches on RM in German RO within the framework of the Patient Safety in German Radiation Oncology (PaSaGeRO) project. Aim was not only to evaluate a status quo of RM purposes but furthermore to discover challenges for sustainable RM that should be addressed in future research and recommendations. METHODS An online survey was conducted from June to August 2021, consisting of 18 items on prospective and reactive RM, protagonists of RM, and self-assessment concerning RM. The survey was designed using LimeSurvey and invitations were sent by e‑mail. Answers were requested once per institution. RESULTS In all, 48 completed questionnaires from university hospitals, general and non-academic hospitals, and private practices were received and considered for evaluation. Prospective and reactive RM was commonly conducted within interprofessional teams; 88% of all institutions performed prospective risk analyses. Most institutions (71%) reported incidents or near-events using multiple reporting systems. Results were presented to the team in 71% for prospective analyses and 85% for analyses of incidents. Risk conferences take place in 46% of institutions. 42% nominated a manager/committee for RM. Knowledge concerning RM was mostly rated "satisfying" (44%). However, 65% of all institutions require more information about RM by professional societies. CONCLUSION Our results revealed heterogeneous patterns of RM in RO departments, although most departments adhered to common recommendations. Identified mismatches between recommendations and implementation of RM provide baseline data for future research and support definition of teaching content.
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Affiliation(s)
- Andrea Baehr
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany.
| | - Daniel Hummel
- Department of Radiotherapy and Genetics, Outpatient Center Stuttgart, University Hospital Tübingen, Stuttgart, Germany
| | - Tobias Gauer
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Oertel
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
| | - Christopher Kittel
- Department of Radiation Oncology, University Hospital Münster, Münster, Germany
| | - Anastassia Löser
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
| | - Manuel Todorovic
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cordula Petersen
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Krüll
- Outpatient Center of the UKE GmbH, Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Germany
- Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Buchgeister
- Faculty of Mathematics-Physics-Chemistry (II), Berliner Hochschule für Technik, Berlin, Germany
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Werner R, Szkitsak J, Madesta F, Büttgen L, Wimmert L, Sentker T, Fietkau R, Haderlein M, Bert C, Gauer T, Hofmann C. Clinical application of breathing-adapted 4D CT: image quality comparison to conventional 4D CT. Strahlenther Onkol 2023:10.1007/s00066-023-02062-0. [PMID: 37000223 DOI: 10.1007/s00066-023-02062-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/17/2023] [Indexed: 04/01/2023]
Abstract
PURPOSE 4D CT imaging is an integral part of 4D radiotherapy workflows. However, 4D CT data often contain motion artifacts that mitigate treatment planning. Recently, breathing-adapted 4D CT (i4DCT) was introduced into clinical practice, promising artifact reduction in in-silico and phantom studies. Here, we present an image quality comparison study, pooling clinical patient data from two centers: a new i4DCT and a conventional spiral 4D CT patient cohort. METHODS The i4DCT cohort comprises 129 and the conventional spiral 4D CT cohort 417 4D CT data sets of lung and liver tumor patients. All data were acquired for treatment planning. The study consists of three parts: illustration of image quality in selected patients of the two cohorts with similar breathing patterns; an image quality expert rater study; and automated analysis of the artifact frequency. RESULTS Image data of the patients with similar breathing patterns underline artifact reduction by i4DCT compared to conventional spiral 4D CT. Based on a subgroup of 50 patients with irregular breathing patterns, the rater study reveals a fraction of almost artifact-free scans of 89% for i4DCT and only 25% for conventional 4D CT; the quantitative analysis indicated a reduction of artifact frequency by 31% for i4DCT. CONCLUSION The results demonstrate 4D CT image quality improvement for patients with irregular breathing patterns by breathing-adapted 4D CT in this first corresponding clinical data image quality comparison study.
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Affiliation(s)
- René Werner
- University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Juliane Szkitsak
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054, Erlangen, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Frederic Madesta
- University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Laura Büttgen
- University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Lukas Wimmert
- University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Thilo Sentker
- University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054, Erlangen, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Marlen Haderlein
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054, Erlangen, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, 91054, Erlangen, Germany
- Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany
| | - Tobias Gauer
- University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
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Krug D, Hecht M, Ebert N, Mäurer M, Fleischmann DF, Fokas E, Straube C, Nicolay NH, Hörner-Rieber J, Schmitt D, von Neubeck C, Zamboglou C, Sperk E, Kaul D, Hess J, Corradini S, Seidel C, Gani C, Baues C, Frey B, Blanck O, Gauer T, Niyazi M. Correction to: Innovative radiation oncology Together-Precise, Personalized, Human. Strahlenther Onkol 2021; 197:1049-1050. [PMID: 34731288 PMCID: PMC8604837 DOI: 10.1007/s00066-021-01869-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus Hecht
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadja Ebert
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Matthias Mäurer
- Department of Radiotherapy and Radiation Oncology, University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Daniel F Fleischmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany
| | - Christoph Straube
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.,RadioLog, Hof, Germany
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniela Schmitt
- Department of Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Cläre von Neubeck
- Department of Particle Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Hess
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Clemens Seidel
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Cihan Gani
- Department of Radiation Oncology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Christian Baues
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Tobias Gauer
- Department of Radiotherapy and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
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Krug D, Hecht M, Ebert N, Mäurer M, Fleischmann DF, Fokas E, Straube C, Nicolay NH, Hörner-Rieber J, Schmitt D, von Neubeck C, Zamboglou C, Sperk E, Kaul D, Hess J, Corradini S, Seidel C, Gani C, Baues C, Frey B, Blanck O, Gauer T, Niyazi M. Innovative radiation oncology Together - Precise, Personalized, Human : Vision 2030 for radiotherapy & radiation oncology in Germany. Strahlenther Onkol 2021; 197:1043-1048. [PMID: 34515820 PMCID: PMC8604860 DOI: 10.1007/s00066-021-01843-9] [Citation(s) in RCA: 1] [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: 06/04/2021] [Accepted: 08/09/2021] [Indexed: 11/01/2022]
Abstract
PURPOSE Scientific and clinical achievements in radiation, medical, and surgical oncology are changing the landscape of interdisciplinary oncology. The German Society for Radiation Oncology (DEGRO) working group of young clinicians and scientists (yDEGRO) and the DEGRO representation of associate and full professors (AKRO) are aware of the essential role of radiation oncology in multidisciplinary treatment approaches. Together, yDEGRO and AKRO endorsed developing a German radiotherapy & radiation oncology vision 2030 to address future challenges in patient care, research, and education. The vision 2030 aims to identify priorities and goals for the next decade in the field of radiation oncology. METHODS The vision development comprised three phases. During the first phase, areas of interest, objectives, and the process of vision development were defined jointly by the yDEGRO, AKRO, and the DEGRO board. In the second phase, a one-day strategy retreat was held to develop AKRO and yDEGRO representatives' final vision from medicine, biology, and physics. The third phase was dedicated to vision interpretation and program development by yDEGRO representatives. RESULTS The strategy retreat's development process resulted in conception of the final vision "Innovative radiation oncology Together - Precise, Personalized, Human." The first term "Innovative radiation oncology" comprises the promotion of preclinical research and clinical trials and highlights the development of a national committee for strategic development in radiation oncology research. The term "together" underpins collaborations within radiation oncology departments as well as with other partners in the clinical and scientific setting. "Precise" mainly covers technological precision in radiotherapy as well as targeted oncologic therapeutics. "Personalized" emphasizes biology-directed individualization of radiation treatment. Finally, "Human" underlines the patient-centered approach and points towards the need for individual longer-term career curricula for clinicians and researchers in the field. CONCLUSION The vision 2030 balances the ambition of physical, technological, and biological innovation as well as a comprehensive, patient-centered, and collaborative approach towards radiotherapy & radiation oncology in Germany.
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Affiliation(s)
- David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Markus Hecht
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Nadja Ebert
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany
| | - Matthias Mäurer
- Department of Radiotherapy and Radiation Oncology, University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Daniel F Fleischmann
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, University Hospital, Goethe University, Frankfurt, Germany
| | - Christoph Straube
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, School of Medicine, Munich, Germany.,RadioLog, Hof, Germany
| | - Nils Henrik Nicolay
- Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Daniela Schmitt
- Department of Radiation Oncology, University Medical Center Göttingen, Göttingen, Germany
| | - Cläre von Neubeck
- Department of Particle Therapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - David Kaul
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Hess
- Research Unit Radiation Cytogenetics, Helmholtz Zentrum München, German Research Center for Environmental Health GmbH, Neuherberg, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Clemens Seidel
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Cihan Gani
- Department of Radiation Oncology, Eberhard Karls Universität Tübingen, Tübingen, Germany
| | - Christian Baues
- Department of Radiation Oncology and Cyberknife Center, University Hospital of Cologne, Cologne, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Tobias Gauer
- Department of Radiotherapy and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
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Gauer T, Sentker T, Schmidt V, Wimmert L, Ozga A, Petersen C, Madesta F, Hofmann C, Werner R. OC-0560 Impact of 4D-CT imaging protocol on local control in SBRT of lung and liver metastases. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06967-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: 11/30/2022]
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Büttner M, Cordes N, Gauer T, Habermehl D, Klautke G, Micke O, Mäurer M, Sokoll J, Troost EGC, Christiansen H, Niyazi M. Current status and developments of German curriculum-based residency training programmes in radiation oncology. Radiat Oncol 2021; 16:55. [PMID: 33743750 PMCID: PMC7981823 DOI: 10.1186/s13014-021-01785-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/10/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose The current status of German residency training in the field of radiation oncology is provided and compared to programmes in other countries. In particular, we present the DEGRO-Academy within the international context. Methods Certified courses from 2018 and 2019 were systematically assigned to the DEGRO-Curriculum, retrospectively for 2018 and prospectively for 2019. In addition, questionnaires of course evaluations were provided, answered by course participants and collected centrally. Results Our data reveal a clear increase in curriculum coverage by certified courses from 57.6% in 2018 to 77.5% in 2019. The analyses enable potential improvements in German curriculum-based education. Specific topics of the DEGRO-Curriculum are still underrepresented, while others decreased in representation between 2018 and 2019. It was found that several topics in the DEGRO-Curriculum require more attention because of a low DEGRO-curriculum coverage. Evaluation results of certified courses improved significantly with a median grade of 1.62 in 2018 to 1.47 in 2019 (p = 0.0319). Conclusion The increase of curriculum coverage and the simultaneous improvement of course evaluations are promising with respect to educational standards in Germany. Additionally, the early integration of radiation oncology into medical education is a prerequisite for resident training because of rising demands on quality control and increasing patient numbers. This intensified focus is a requirement for continued high standards and quality of curriculum-based education in radiation oncology both in Germany and other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01785-7.
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Affiliation(s)
- Marcel Büttner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Nils Cordes
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany.,Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
| | - Tobias Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Gunther Klautke
- Clinic for Radiation Oncology, Chemnitz Medical Center, Chemnitz, Germany
| | - Oliver Micke
- Department of Radiotherapy and Radiation Oncology, Franziskus Hospital Bielefeld, Kiskerstrasse 26, 33615, Bielefeld, Germany
| | - Matthias Mäurer
- Department of Radiation Oncology, University Medical Center Jena, Jena, Germany
| | - Jan Sokoll
- PRO RadioOncology GmbH, Poststraße 10-12, 27404, Zeven, Germany
| | - Esther Gera Cornelia Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,Helmholtz Association/Helmholtz-Zentrum Dresden - Rossendorf (HZDR), Dresden, Germany.,Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
| | - Hans Christiansen
- Department of Radiation Oncology, Hannover Medical School, 30625, Hannover, Germany.
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
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10
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Ostheimer C, Mäurer M, Ebert N, Schmitt D, Krug D, Baumann R, Henkenberens C, Giordano FA, Sautter L, López G, Fleischmann DF, Niyazi M, Käsmann L, Kaul D, Thieme AH, Billiet C, Dobiasch S, Arnold CR, Oertel M, Haussmann J, Gauer T, Goy Y, Suess C, Ziegler S, Panje CM, Baues C, Trommer M, Skripcak T, Medenwald D. Correction to: Prognostic impact of gross tumor volume during radical radiochemotherapy of locally advanced non-small cell lung cancer-results from the NCT03055715 multicenter cohort study of the Young DEGRO Trial Group. Strahlenther Onkol 2021; 197:560-561. [PMID: 33674905 PMCID: PMC8154766 DOI: 10.1007/s00066-021-01750-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C Ostheimer
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany.
| | - M Mäurer
- Department of Radiation Oncology, University Medical Center Jena, Jena, Germany
| | - N Ebert
- Department of Radiation Oncology, University Medical Center Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Dresden, Germany
| | - D Schmitt
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - D Krug
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - R Baumann
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - C Henkenberens
- Department of Radiation and Special Oncology, Hannover Medical School, Hannover, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - L Sautter
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - Guerra López
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - D F Fleischmann
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Niyazi
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany
| | - L Käsmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - D Kaul
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany.,Campus Virchow-Klinikum, University Hospital, Berlin, Germany
| | - A H Thieme
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany
| | - C Billiet
- Department of Radiation Oncology, Iridium Kankernetwerk, Antwerp, Belgium
| | - S Dobiasch
- Department of Radiation Oncology, Technische Universität München, Munich, Germany
| | - C R Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Oertel
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - J Haussmann
- Department of Radiation Oncology, University Medical Center Düsseldorf, Dusseldorf, Germany
| | - T Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y Goy
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Suess
- Department of Radiation Oncology, University Medical Center Regensburg, Regensburg, Germany
| | - S Ziegler
- Department of Radiation Oncology, University Medical Center Erlangen, Erlangen, Germany
| | - C M Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - M Trommer
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - T Skripcak
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Dresden, Germany
| | - D Medenwald
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany
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11
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Werner R, Szkitsak J, Sentker T, Madesta F, Schwarz A, Fernolendt S, Vornehm M, Gauer T, Bert C, Hofmann C. Comparison of intelligent 4D CT sequence scanning and conventional spiral 4D CT: a first comprehensive phantom study. Phys Med Biol 2021; 66. [PMID: 33171441 DOI: 10.1088/1361-6560/abc93a] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/10/2020] [Indexed: 11/11/2022]
Abstract
4D CT imaging is a cornerstone of 4D radiotherapy treatment. Clinical 4D CT data are, however, often affected by severe artifacts. The artifacts are mainly caused by breathing irregularity and retrospective correlation of breathing phase information and acquired projection data, which leads to insufficient projection data coverage to allow for proper reconstruction of 4D CT phase images. The recently introduced 4D CT approach i4DCT (intelligent 4D CT sequence scanning) aims to overcome this problem by breathing signal-driven tube control. The present motion phantom study describes the first in-depth evaluation of i4DCT in a real-world scenario. Twenty-eight 4D CT breathing curves of lung and liver tumor patients with pronounced breathing irregularity were selected to program the motion phantom. For every motion pattern, 4D CT imaging was performed with i4DCT and a conventional spiral 4D CT mode. For qualitative evaluation, the reconstructed 4D CT images were presented to clinical experts, who scored image quality. Further quantitative evaluation was based on established image intensity-based artifact metrics to measure (dis)similarity of neighboring image slices. In addition, beam-on and scan times of the scan modes were analyzed. The expert rating revealed a significantly higher image quality for the i4DCT data. The quantitative evaluation further supported the qualitative: While 20% of the slices of the conventional spiral 4D CT images were found to be artifact-affected, the corresponding fraction was only 4% for i4DCT. The beam-on time (surrogate of imaging dose) did not significantly differ between i4DCT and spiral 4D CT. Overall i4DCT scan times (time between first beam-on and last beam-on event, including scan breaks to compensate for breathing irregularity) were, on average, 53% longer compared to spiral CT. Thus, the results underline that i4DCT significantly improves 4D CT image quality compared to standard spiral CT scanning in the case of breathing irregularity during scanning.
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Affiliation(s)
- René Werner
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Juliane Szkitsak
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friederich-Alexander-Universität Erlangen-Nürnberg, 91504 Erlangen, Germany
| | - Thilo Sentker
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Frederic Madesta
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Annette Schwarz
- Friederich-Alexander-Universität Erlangen-Nürnberg, 91504 Erlangen, Germany.,Siemens Healthcare GmbH, Siemensstr. 3, 91301 Forchheim, Germany
| | - Susanne Fernolendt
- Friederich-Alexander-Universität Erlangen-Nürnberg, 91504 Erlangen, Germany.,Siemens Healthcare GmbH, Siemensstr. 3, 91301 Forchheim, Germany
| | - Marc Vornehm
- Friederich-Alexander-Universität Erlangen-Nürnberg, 91504 Erlangen, Germany.,Siemens Healthcare GmbH, Siemensstr. 3, 91301 Forchheim, Germany
| | - Tobias Gauer
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friederich-Alexander-Universität Erlangen-Nürnberg, 91504 Erlangen, Germany
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12
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Ostheimer C, Mäurer M, Ebert N, Schmitt D, Krug D, Baumann R, Henkenberens C, Giordano FA, Sautter L, López G, Fleischmann DF, Niyazi M, Käsmann L, Kaul D, Thieme AH, Billiet C, Dobiasch S, Arnold CR, Oertel M, Haussmann J, Gauer T, Goy Y, Suess C, Ziegler S, Panje CM, Baues C, Trommer M, Skripcak T, Medenwald D. Prognostic impact of gross tumor volume during radical radiochemotherapy of locally advanced non-small cell lung cancer-results from the NCT03055715 multicenter cohort study of the Young DEGRO Trial Group. Strahlenther Onkol 2021; 197:385-395. [PMID: 33410959 PMCID: PMC8062351 DOI: 10.1007/s00066-020-01727-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/17/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In radical radiochemotherapy (RCT) of inoperable non-small-cell lung cancer (NSCLC) typical prognostic factors include T- and N-stage, while there are still conflicting data on the prognostic relevance of gross tumor volume (GTV) and particularly its changes during RCT. The NCT03055715 study of the Young DEGRO working group of the German Society of Radiation Oncology (DEGRO) evaluated the prognostic impact of GTV and its changes during RCT. METHODS A total of 21 university centers for radiation oncology from five different European countries (Germany, Switzerland, Spain, Belgium, and Austria) participated in the study which evaluated n = 347 patients with confirmed (biopsy) inoperable NSCLC in UICC stage III A/B who received radical curative-intent RCT between 2010 and 2013. Patient and disease data were collected anonymously via electronic case report forms and entered into the multi-institutional RadPlanBio platform for central data analysis. GTV before RCT (initial planning CT, GTV1) and at 40-50 Gy (re-planning CT for radiation boost, GTV2) was delineated. Absolute GTV before/during RCT and relative GTV changes were correlated with overall survival as the primary endpoint. Hazard ratios (HR) of survival analysis were estimated by means of adjusted Cox regression models. RESULTS GTV1 was found to have a mean of 154.4 ml (95%CI: 1.5-877) and GTV2 of 106.2 ml (95% CI: 0.5-589.5), resulting in an estimated reduction of 48.2 ml (p < 0.001). Median overall survival (OS) was 18.8 months with a median of 22.1, 20.9, and 12.6 months for patients with high, intermediate, and low GTV before RT. Considering all patients, in one survival model of overall mortality, GTV2 (2.75 (1.12-6.75, p = 0.03) was found to be a stronger survival predictor than GTV1 (1.34 (0.9-2, p > 0.05). In patients with available data on both GTV1 and GTV2, absolute GTV1 before RT was not significantly associated with survival (HR 0-69, 0.32-1.49, p > 0.05) but GTV2 significantly predicted OS in a model adjusted for age, T stage, and chemotherapy, with an HR of 3.7 (1.01-13.53, p = 0.04) per 300 ml. The absolute decrease from GTV1 to GTV2 was correlated to survival, where every decrease by 50 ml reduced the HR by 0.8 (CI 0.64-0.99, p = 0.04). There was no evidence for a survival effect of the relative change between GTV1 and GTV2. CONCLUSION Our results indicate that independently of T stage, the re-planning GTV during RCT is a significant and superior survival predictor compared to baseline GTV before RT. Patients with a high absolute (rather than relative) change in GTV during RT show a superior survival outcome after RCT.
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Affiliation(s)
- C Ostheimer
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany.
| | - M Mäurer
- Department of Radiation Oncology, University Medical Center Jena, Jena, Germany
| | - N Ebert
- Department of Radiation Oncology, University Medical Center Dresden, Dresden, Germany.,OncoRay-National Center for Radiation Research in Oncology, Dresden, Germany
| | - D Schmitt
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.,Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - D Krug
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - R Baumann
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - C Henkenberens
- Department of Radiation and Special Oncology, Hannover Medical School, Hannover, Germany
| | - F A Giordano
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - L Sautter
- Department of Radiation Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - Guerra López
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - D F Fleischmann
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M Niyazi
- Department of Radiation Oncology, LMU Munich, Munich, Germany.,partner site Munich, German Cancer Consortium (DKTK), Munich, Germany
| | - L Käsmann
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - D Kaul
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany.,Campus Virchow-Klinikum, University Hospital, Berlin, Germany
| | - A H Thieme
- Department of Radiation Oncology, Charité School of Medicine, Berlin, Germany
| | - C Billiet
- Department of Radiation Oncology, Iridium Kankernetwerk, Antwerp, Belgium
| | - S Dobiasch
- Department of Radiation Oncology, Technische Universität München, Munich, Germany
| | - C R Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Oertel
- Department of Radiation Oncology, University Medical Center Muenster, Muenster, Germany
| | - J Haussmann
- Department of Radiation Oncology, University Medical Center Düsseldorf, Dusseldorf, Germany
| | - T Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Y Goy
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Suess
- Department of Radiation Oncology, University Medical Center Regensburg, Regensburg, Germany
| | - S Ziegler
- Department of Radiation Oncology, University Medical Center Erlangen, Erlangen, Germany
| | - C M Panje
- Department of Radiation Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - C Baues
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - M Trommer
- Department of Radiation Oncology and Cyberknife Center, University of Cologne, Cologne, Germany
| | - T Skripcak
- German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Dresden, Germany
| | - D Medenwald
- Department of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06110, Halle (Saale), Germany
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13
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Käsmann L, Schröder A, Frey B, Fleischmann DF, Gauer T, Ebert N, Hecht M, Krug D, Niyazi M, Mäurer M. Peer review analysis in the field of radiation oncology: results from a web-based survey of the Young DEGRO working group. Strahlenther Onkol 2020; 197:667-673. [PMID: 33337507 PMCID: PMC8292256 DOI: 10.1007/s00066-020-01729-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/03/2020] [Accepted: 11/30/2020] [Indexed: 11/25/2022]
Abstract
Purpose To evaluate the reviewing behaviour in the German-speaking countries in order to provide recommendations to increase the attractiveness of reviewing activity in the field of radiation oncology. Methods In November 2019, a survey was conducted by the Young DEGRO working group (jDEGRO) using the online platform “eSurveyCreator”. The questionnaire consisted of 29 items examining a broad range of factors that influence reviewing motivation and performance. Results A total of 281 responses were received. Of these, 154 (55%) were completed and included in the evaluation. The most important factors for journal selection criteria and peer review performance in the field of radiation oncology are the scientific background of the manuscript (85%), reputation of the journal (59%) and a high impact factor (IF; 40%). Reasons for declining an invitation to review include the scientific background of the article (60%), assumed effort (55%) and a low IF (27%). A double-blind review process is preferred by 70% of respondents to a single-blind (16%) or an open review process (14%). If compensation was offered, 59% of participants would review articles more often. Only 12% of the participants have received compensation for their reviewing activities so far. As compensation for the effort of reviewing, 55% of the respondents would prefer free access to the journal’s articles, 45% a discount for their own manuscripts, 40% reduced congress fees and 39% compensation for expenses. Conclusion The scientific content of the manuscript, reputation of the journal and a high IF determine the attractiveness for peer reviewing in the field of radiation oncology. The majority of participants prefer a double-blind peer review process and would conduct more reviews if compensation was available. Free access to journal articles, discounts for publication costs or congress fees, or an expense allowance were identified to increase attractiveness of the review process. Supplementary Information The online version of this article (10.1007/s00066-020-01729-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lukas Käsmann
- Department of Radiation Oncology, LMU University Hospital, Marchioninistraße 15, 81377, Munich, Germany.
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany.
| | - Annemarie Schröder
- Department of Radiation Oncology, University Hospital Rostock, Rostock, Germany
| | - Benjamin Frey
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Daniel F Fleischmann
- Department of Radiation Oncology, LMU University Hospital, Marchioninistraße 15, 81377, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tobias Gauer
- Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nadja Ebert
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- OncoRay-National Center for Radiation Research in Oncology, Medical Faculty and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Markus Hecht
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein campus Kiel, Kiel, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, LMU University Hospital, Marchioninistraße 15, 81377, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Matthias Mäurer
- Department of Radiation Oncology, University Hospital Jena, Jena, Germany
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14
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Werner R, Sentker T, Madesta F, Gauer T, Hofmann C. PO-1724: Intelligent 4D CT sequence scanning (i4DCT): First prototype measurements. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01742-4] [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: 11/29/2022]
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15
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Madesta F, Sentker T, Gauer T, Werner R. Self‐contained deep learning‐based boosting of 4D cone‐beam CT reconstruction. Med Phys 2020; 47:5619-5631. [DOI: 10.1002/mp.14441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/02/2020] [Accepted: 07/16/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Frederic Madesta
- Department of Computational Neuroscience University Medical Center Hamburg‐Eppendorf Hamburg20246 Germany
| | - Thilo Sentker
- Department of Computational Neuroscience University Medical Center Hamburg‐Eppendorf Hamburg20246 Germany
- Department of Radiotherapy and Radio‐Oncology University Medical Center Hamburg‐Eppendorf Hamburg20246 Germany
| | - Tobias Gauer
- Department of Radiotherapy and Radio‐Oncology University Medical Center Hamburg‐Eppendorf Hamburg20246 Germany
| | - René Werner
- Department of Computational Neuroscience University Medical Center Hamburg‐Eppendorf Hamburg20246 Germany
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16
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Schmitt D, Blanck O, Gauer T, Fix MK, Brunner TB, Fleckenstein J, Loutfi-Krauss B, Manser P, Werner R, Wilhelm ML, Baus WW, Moustakis C. Technological quality requirements for stereotactic radiotherapy : Expert review group consensus from the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. Strahlenther Onkol 2020; 196:421-443. [PMID: 32211939 PMCID: PMC7182540 DOI: 10.1007/s00066-020-01583-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 12/25/2022]
Abstract
This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as a basis for the future assignments of the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The review was group peer-reviewed, and consensus was obtained through multiple working group meetings.
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Affiliation(s)
- Daniela Schmitt
- Klinik für Radioonkologie und Strahlentherapie, National Center for Radiation Research in Oncology (NCRO), Heidelberger Institut für Radioonkologie (HIRO), Universitätsklinikum Heidelberg, Heidelberg, Germany.
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Tobias Gauer
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Michael K Fix
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Thomas B Brunner
- Universitätsklinik für Strahlentherapie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Jens Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Britta Loutfi-Krauss
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Peter Manser
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Rene Werner
- Institut für Computational Neuroscience, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maria-Lisa Wilhelm
- Klinik für Strahlentherapie, Universitätsmedizin Rostock, Rostock, Germany
| | - Wolfgang W Baus
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Universitätsklinikum Köln, Cologne, Germany
| | - Christos Moustakis
- Klinik für Strahlentherapie-Radioonkologie, Universitätsklinikum Münster, Münster, Germany
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Guckenberger M, Baus WW, Blanck O, Combs SE, Debus J, Engenhart-Cabillic R, Gauer T, Grosu AL, Schmitt D, Tanadini-Lang S, Moustakis C. Definition and quality requirements for stereotactic radiotherapy: consensus statement from the DEGRO/DGMP Working Group Stereotactic Radiotherapy and Radiosurgery. Strahlenther Onkol 2020; 196:417-420. [PMID: 32211940 PMCID: PMC7182610 DOI: 10.1007/s00066-020-01603-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Stereotactic radiotherapy with its forms of intracranial stereotactic radiosurgery (SRS), intracranial fractionated stereotactic radiotherapy (FSRT) and stereotactic body radiotherapy (SBRT) is today a guideline-recommended treatment for malignant or benign tumors as well as neurological or vascular functional disorders. The working groups for radiosurgery and stereotactic radiotherapy of the German Society for Radiation Oncology (DEGRO) and for physics and technology in stereotactic radiotherapy of the German Society for Medical Physics (DGMP) have established a consensus statement about the definition and minimal quality requirements for stereotactic radiotherapy to achieve best clinical outcome and treatment quality in the implementation into routine clinical practice.
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Affiliation(s)
- Matthias Guckenberger
- Universität Zürich, Klinik für Radio-Onkologie, Universitätsspital Zürich, Zurich, Switzerland
| | - Wolfgang W Baus
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Köln, Cologne, Germany
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Stephanie E Combs
- Klinikum rechts der Isar, Klinik für RadioOnkologie und Strahlentherapie, Technische Universität München, Munich, Germany
| | - Jürgen Debus
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Rita Engenhart-Cabillic
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Gießen Marburg, Marburg, Germany
| | - Tobias Gauer
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Anca L Grosu
- Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Robert-Koch-Str. 3, 79106, Freiburg, Germany.
| | - Daniela Schmitt
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Stephanie Tanadini-Lang
- Universität Zürich, Klinik für Radio-Onkologie, Universitätsspital Zürich, Zurich, Switzerland
| | - Christos Moustakis
- Klinik für Strahlentherapie, Universitätsklinikum Münster, Munster, Germany
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Werner R, Sentker T, Madesta F, Schwarz A, Vornehm M, Gauer T, Hofmann C. Intelligent 4D CT sequence scanning (i4DCT): First scanner prototype implementation and phantom measurements of automated breathing signal-guided 4D CT. Med Phys 2020; 47:2408-2412. [PMID: 32115724 DOI: 10.1002/mp.14106] [Citation(s) in RCA: 11] [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: 12/09/2019] [Revised: 02/05/2020] [Accepted: 02/20/2020] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Four-dimensional (4D) computed tomography (CT) imaging is an essential part of current 4D radiotherapy treatment planning workflows, but clinical 4D CT images are often affected by artifacts. The artifacts are mainly caused by breathing irregularity during data acquisition, which leads to projection data coverage issues for currently available commercial 4D CT protocols. It was proposed to improve projection data coverage by online respiratory signal analysis and signal-guided CT tube control, but related work was always theoretical and presented as pure in silico studies. The present work demonstrates a first CT prototype implementation along with respective phantom measurements for the recently introduced intelligent 4D CT (i4DCT) sequence scanning concept (https://doi.org/10.1002/mp.13632). METHODS Intelligent 4D CT was implemented on the Siemens SOMATOM go platform. Four-dimensional CT measurements were performed using the CIRS motion phantom. Motion curves were programmed to systematically vary from regular to very irregular, covering typical irregular patterns that are known to result in image artifacts using standard 4D CT imaging protocols. Corresponding measurements were performed using i4DCT and routine spiral 4D CT with similar imaging parameters (e.g., mAs setting and gantry rotation time, retrospective ten-phase reconstruction) to allow for a direct comparison of the image data. RESULTS Following technological implementation of i4DCT on the clinical CT scanner platform, 4D CT motion artifacts were significantly reduced for all investigated levels of breathing irregularity when compared to routine spiral 4D CT scanning. CONCLUSIONS The present study confirms feasibility of fully automated respiratory signal-guided 4D CT scanning by means of a first implementation of i4DCT on a CT scanner. The measurements thereby support the conclusions of respective in silico studies and demonstrate that respiratory signal-guided 4D CT (here: i4DCT) is ready for integration into clinical CT scanners.
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Affiliation(s)
- René Werner
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.,Center for Biomedical Artificial Intelligence (bAIome), University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Thilo Sentker
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.,Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Frederic Madesta
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Annette Schwarz
- Friedrich-Alexander-Universität Erlangen, 91504, Erlangen, Germany.,Siemens Healthcare GmbH, 91301, Forchheim, Germany
| | - Marc Vornehm
- Friedrich-Alexander-Universität Erlangen, 91504, Erlangen, Germany.,Siemens Healthcare GmbH, 91301, Forchheim, Germany
| | - Tobias Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
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Werner R, Henningsen M, Schmitz R, Guse AH, Augustin M, Gauer T. Digital Health meets Hamburg integrated medical degree program iMED: concept and introduction of the new interdisciplinary 2 nd track Digital Health. GMS J Med Educ 2020; 37:Doc61. [PMID: 33225053 PMCID: PMC7672380 DOI: 10.3205/zma001354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/27/2020] [Accepted: 05/11/2020] [Indexed: 05/10/2023]
Abstract
Digitalization in medicine is transforming the everyday work and the environment of current and future physicians - and thereby brings new competencies required by the medical profession. The necessity for a curricular integration of related digital medicine and, in more general, digital health topics is mostly undisputed; however, few specific concepts and experience reports are available. Therefore, the present article reports on the aims, the implementation, and the initial experiences of the integration of the topic Digital Health as a longitudinal elective course (2nd track) into the integrated medical degree program iMED in Hamburg.
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Affiliation(s)
- René Werner
- University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Center for Biomedical Artificial Intelligence (bAIome), Hamburg, Germany
- *To whom correspondence should be addressed: René Werner, University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Martinistr. 52, D-20246 Hamburg, Germany, E-mail:
| | - Maike Henningsen
- University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Hamburg, Germany
| | - Rüdiger Schmitz
- University Medical Center Hamburg-Eppendorf, Department of Computational Neuroscience, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Center for Biomedical Artificial Intelligence (bAIome), Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Department for Interdisciplinary Endoscopy, Hamburg, Germany
| | - Andreas H. Guse
- University Medical Center Hamburg-Eppendorf, Faculty of Medicine, Deanery, Hamburg, Germany
- University Medical Center Hamburg-Eppendorf, Department of Biochemistry and Molecular Cell Biology, Hamburg, Germany
| | - Matthias Augustin
- University Medical Center Hamburg-Eppendorf, Institute for Health Services Research in Dermatology and Nursing, Hamburg, Germany
| | - Tobias Gauer
- University Medical Center Hamburg-Eppendorf, Department of Radiotherapy and Radiation Oncology, Hamburg, Germany
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Hagen M, Kretschmer M, Würschmidt F, Gauer T, Giro C, Karsten E, Lorenzen J. Clinical relevance of metal artefact reduction in computed tomography (iMAR) in the pelvic and head and neck region: Multi-institutional contouring study of gross tumour volumes and organs at risk on clinical cases. J Med Imaging Radiat Oncol 2019; 63:842-851. [PMID: 31265214 DOI: 10.1111/1754-9485.12924] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 11/21/2018] [Accepted: 06/03/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Artefacts caused by dental implants and hip replacements may impede target volume definition and dose calculation accuracy. The iterative metal artefact reduction (iMAR) algorithm can provide a solution for this problem. The present study compares delineation of gross tumour volumes (GTVs) and organs at risk (OARs) in the pelvic and the head and neck (H & N) regions using computed tomography (CT) with and without iMAR, and thus the practical applicability of iMAR for routine clinical use. METHODS The native planning CT and CT-iMAR data of two typical clinical cases with image-distorting artefacts were used for multi-institutional contouring and analysis using the Dice similarity coefficient (DSC). GTV/OAR contours were compared with an intraobserver approach and compared to predefined reference structures. RESULTS Mean volume for GTVprostate in the intraobserver approach decreased from 87 ± 44 cm3 (native CT) to 75 ± 22 cm3 (CT-iMAR) (P = 0.168). Compared to the reference, DSC values for GTVP rostate increased from 0.68 ± 0.15 to 0.78 ± 0.07 (CT vs. iMAR) (P < 0.05). In the H & N region, the reference for GTVT ongue (34 cm3 ) was underestimated on both data sets. No significant improvement in DSC values (0.83 ± 0.06 (native CT) versus 0.86 ± 0.06 (CT-iMAR)) was observed. CONCLUSION The use of iMAR improves the anatomical delineation at the transition of prostate and bladder in cases of bilateral hip replacement. In the H & N region, anatomical residual structures and experience were apparently sufficient for precise contouring.
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Affiliation(s)
| | | | | | - Tobias Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Elias Karsten
- Department of Radiotherapy, University Medical Center Schleswig-Holstein, Kiel, Germany
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Werner R, Sentker T, Madesta F, Gauer T, Hofmann C. Intelligent 4D CT sequence scanning (i4DCT): Concept and performance evaluation. Med Phys 2019; 46:3462-3474. [DOI: 10.1002/mp.13632] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/30/2019] [Accepted: 05/22/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- René Werner
- Department of Computational Neuroscience University Medical Center Hamburg‐Eppendorf 20246Hamburg Germany
| | - Thilo Sentker
- Department of Computational Neuroscience University Medical Center Hamburg‐Eppendorf 20246Hamburg Germany
- Department of Radiotherapy and Radio‐Oncology University Medical Center Hamburg‐Eppendorf 20246Hamburg Germany
| | - Frederic Madesta
- Department of Computational Neuroscience University Medical Center Hamburg‐Eppendorf 20246Hamburg Germany
| | - Tobias Gauer
- Department of Radiotherapy and Radio‐Oncology University Medical Center Hamburg‐Eppendorf 20246Hamburg Germany
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Kniep HC, Madesta F, Schneider T, Hanning U, Schönfeld MH, Schön G, Fiehler J, Gauer T, Werner R, Gellissen S. Radiomics of Brain MRI: Utility in Prediction of Metastatic Tumor Type. Radiology 2018; 290:479-487. [PMID: 30526358 DOI: 10.1148/radiol.2018180946] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose To investigate the feasibility of tumor type prediction with MRI radiomic image features of different brain metastases in a multiclass machine learning approach for patients with unknown primary lesion at the time of diagnosis. Materials and methods This single-center retrospective analysis included radiomic features of 658 brain metastases from T1-weighted contrast material-enhanced, T1-weighted nonenhanced, and fluid-attenuated inversion recovery (FLAIR) images in 189 patients (101 women, 88 men; mean age, 61 years; age range, 32-85 years). Images were acquired over a 9-year period (from September 2007 through December 2016) with different MRI units, reflecting heterogeneous image data. Included metastases originated from breast cancer (n = 143), small cell lung cancer (n = 151), non-small cell lung cancer (n = 225), gastrointestinal cancer (n = 50), and melanoma (n = 89). A total of 1423 quantitative image features and basic clinical data were evaluated by using random forest machine learning algorithms. Validation was performed with model-external fivefold cross validation. Comparative analysis of 10 randomly drawn cross-validation sets verified the stability of the results. The classifier performance was compared with predictions from a respective conventional reading by two radiologists. Results Areas under the receiver operating characteristic curve of the five-class problem ranged between 0.64 (for non-small cell lung cancer) and 0.82 (for melanoma); all P values were less than .01. Prediction performance of the classifier was superior to the radiologists' readings. Highest differences were observed for melanoma, with a 17-percentage-point gain in sensitivity compared with the sensitivity of both readers; P values were less than .02. Conclusion Quantitative features of routine brain MR images used in a machine learning classifier provided high discriminatory accuracy in predicting the tumor type of brain metastases. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Helge C Kniep
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Frederic Madesta
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Tanja Schneider
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Uta Hanning
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Michael H Schönfeld
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Gerhard Schön
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Jens Fiehler
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Tobias Gauer
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - René Werner
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Susanne Gellissen
- From the Department of Diagnostic and Interventional Neuroradiology (H.C.K., T.S., U.H., M.H.S., J.F., S.G.), Department of Radiotherapy and Radiation Oncology (F.M., T.G.), Institute of Medical Biometry and Epidemiology (G.S.), and Institute of Computational Neuroscience (F.M., R.W.); University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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Werner R, Sentker T, Madesta F, Gauer T, Hofmann C. Intelligent 4D CT Sequence Scanning (i4DCT). Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.108] [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: 10/28/2022]
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Rendenbach C, Schoellchen M, Bueschel J, Gauer T, Sedlacik J, Kutzner D, Vallittu PK, Heiland M, Smeets R, Fiehler J, Siemonsen S. Evaluation and reduction of magnetic resonance imaging artefacts induced by distinct plates for osseous fixation: an in vitro study @ 3 T. Dentomaxillofac Radiol 2018; 47:20170361. [PMID: 29718688 DOI: 10.1259/dmfr.20170361] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES: To analyze MRI artefacts induced at 3 T by bioresorbable, titanium (TI) and glass fibre reinforced composite (GFRC) plates for osseous reconstruction. METHODS: Fixation plates including bioresorbable polymers (Inion CPS, Inion Oy, Tampere, Finland; Rapidsorb, DePuy Synthes, Umkirch, Germany; Resorb X, Gebrueder KLS Martin GmbH, Tuttlingen, Germany), GFRC (Skulle Implants Oy, Turku, Finland) and TI plates of varying thickness and design (DePuy Synthes, Umkirch, Germany) were embedded in agarose gel and a 3 T MRI was performed using a standard protocol for head and neck imaging including T1W and T2W sequences. Additionally, different artefact reduction techniques (slice encoding for metal artefact reduction & ultrashort echo time) were used and their impact on the extent of artefacts evaluated for each material. RESULTS: All TI plates induced significantly more artefacts than resorbable plates in T1W and T2W sequences. GFRCs induced the least artefacts in both sequences. The total extent of artefacts increased with plate thickness and height. Plate thickness had no influence on the percentage of overestimation in all three dimensions. TI-induced artefacts were significantly reduced by both artefact reduction techniques. CONCLUSIONS: Polylactide, GFRC and magnesium plates produce less susceptibility artefacts in MRI compared to TI, while the dimensions of TI plates directly influence artefact extension. Slice encoding for metal artefact reduction and ultrashort echo time significantly reduce metal artefacts at the expense of scan time or image resolution.
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Affiliation(s)
- Carsten Rendenbach
- 1 Department of Oral and Maxillofacial Surgery, Charité - Universitaetsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,2 Berlin Institute of Health (BIH) , Berlin , Germany
| | - Max Schoellchen
- 3 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Julie Bueschel
- 3 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Tobias Gauer
- 4 Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Jan Sedlacik
- 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Daniel Kutzner
- 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Pekka K Vallittu
- 6 Department of Biomaterials Science, Institute of Dentistry, University of Turku, and City of Turku, Welfare Division , Turku , Finland
| | - Max Heiland
- 1 Department of Oral and Maxillofacial Surgery, Charité - Universitaetsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Ralf Smeets
- 3 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Jens Fiehler
- 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Susanne Siemonsen
- 5 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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Ostheimer C, Baues C, Baumann R, Billiet C, Dobiasch S, Ebert N, Fleischmann D, Gauer T, Goy Y, Haussmann J, Henkenberens C, Kaessmann L, López guerra J, Kaul D, Krug D, Maeurer M, Niyazi M, Oertel M, Panje C, Sautter L, Schmitt D, Suess C, Trommer-Nestler M, Ziegler S, Medenwald D. OC-0329: Predictive value of GTV in radiotherapy of NSCLC - early results of the NCT03055715 trial. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30639-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: 10/14/2022]
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Dietzel C, Jablonska K, Niyazi M, Gauer T, Ebert N, Ostheimer C, Krug D. EP-1692: Quality of Radiation Oncology Training in Germany: Results from the 2017 survey of the young DEGRO. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32001-2] [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: 10/14/2022]
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Mogadas N, Sothmann T, Knopp T, Gauer T, Petersen C, Werner R. Influence of deformable image registration on 4D dose simulation for extracranial SBRT: A multi-registration framework study. Radiother Oncol 2018; 127:225-232. [PMID: 29606523 DOI: 10.1016/j.radonc.2018.03.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 10/20/2017] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE To evaluate the influence of deformable image registration approaches on correspondence model-based 4D dose simulation in extracranial SBRT by means of open source deformable image registration (DIR) frameworks. MATERIAL AND METHODS Established DIR algorithms of six different open source DIR frameworks were considered and registration accuracy evaluated using freely available 4D image data. Furthermore, correspondence models (regression-based correlation of external breathing signal measurements and internal structure motion field) were built and model accuracy evaluated. Finally, the DIR algorithms were applied for motion field estimation in radiotherapy planning 4D CT data of five lung and five liver lesion patients, correspondence model formation, and model-based 4D dose simulation. Deviations between the original, statically planned and the 4D-simulated VMAT dose distributions were analyzed and correlated to DIR accuracy differences. RESULTS Registration errors varied among the DIR approaches, with lower DIR accuracy translating into lower correspondence modeling accuracy. Yet, for lung metastases, indices of 4D-simulated dose distributions widely agreed, irrespective of DIR accuracy differences. In contrast, liver metastases 4D dose simulation results strongly vary for the different DIR approaches. CONCLUSIONS Especially in treatment areas with low image contrast (e.g. the liver), DIR-based 4D dose simulation results strongly depend on the applied DIR algorithm, drawing resulting dose simulations and indices questionable.
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Affiliation(s)
- Nik Mogadas
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Germany
| | - Thilo Sothmann
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Germany; Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Germany.
| | - Tobias Knopp
- Section for Biomedical Imaging, University Medical Center Hamburg-Eppendorf, Germany
| | - Tobias Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | - Cordula Petersen
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Germany
| | - René Werner
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Germany
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Sothmann T, Gauer T, Wilms M, Werner R. Correspondence model-based 4D VMAT dose simulation for analysis of local metastasis recurrence after extracranial SBRT. ACTA ACUST UNITED AC 2017; 62:9001-9017. [DOI: 10.1088/1361-6560/aa955b] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
Background Respiration-correlated CT (4D CT) is the basis of radiotherapy treatment planning of thoracic and abdominal tumors. Current clinical 4D CT images suffer, however, from artifacts due to unfulfilled assumptions concerning breathing pattern regularity. We propose and evaluate modifications to existing low-pitch spiral 4D CT reconstruction protocols to counteract respective artifacts. Methods The proposed advanced reconstruction (AR) approach consists of two steps that build on each other: (1) statistical analysis of the breathing signal recorded during CT data acquisition and extraction of a patient-specific reference breathing cycle for projection binning; (2) incorporation of an artifact measure into the reconstruction. 4D CT data of 30 patients were reconstructed by standard phase- and local amplitude-based reconstruction (PB, LAB) and compared with images obtained by AR. The number of artifacts was evaluated and artifact statistics correlated to breathing curve characteristics. Results AR reduced the number of 4D CT artifacts by 31% and 27% compared to PB and LAB; the reduction was most pronounced for irregular breathing curves. Conclusions We described a two-step optimization of low-pitch spiral 4D CT reconstruction to reduce artifacts in the presence of breathing irregularity and illustrated that the modifications to existing reconstruction solutions are effective in terms of artifact reduction. Electronic supplementary material The online version of this article (doi:10.1186/s13014-017-0835-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- René Werner
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany.
| | | | - Eike Mücke
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany
| | - Tobias Gauer
- University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany
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Abstract
Radiotherapy of lung and liver lesions has changed from normofractioned 3D-CRT to stereotactic treatment in a single or few fractions, often employing volumetric arc therapy (VMAT)-based techniques. Potential unintended interference of respiratory target motion and dynamically changing beam parameters during VMAT dose delivery motivates establishing 4D quality assurance (4D QA) procedures to assess appropriateness of generated VMAT treatment plans when taking into account patient-specific motion characteristics. Current approaches are motion phantom-based 4D QA and image-based 4D VMAT dose simulation. Whereas phantom-based 4D QA is usually restricted to a small number of measurements, the computational approaches allow simulating many motion scenarios. However, 4D VMAT dose simulation depends on various input parameters, influencing estimated doses along with mitigating simulation reliability. Thus, aiming at routine use of simulation-based 4D VMAT QA, the impact of such parameters as well as the overall accuracy of the 4D VMAT dose simulation has to be studied in detail–which is the topic of the present work. In detail, we introduce the principles of 4D VMAT dose simulation, identify influencing parameters and assess their impact on 4D dose simulation accuracy by comparison of simulated motion-affected dose distributions to corresponding dosimetric motion phantom measurements. Exploiting an ITV-based treatment planning approach, VMAT treatment plans were generated for a motion phantom and different motion scenarios (sinusoidal motion of different period/direction; regular/irregular motion). 4D VMAT dose simulation results and dose measurements were compared by local 3% / 3 mm γ-evaluation, with the measured dose distributions serving as ground truth. Overall γ-passing rates of simulations and dynamic measurements ranged from 97% to 100% (mean across all motion scenarios: 98% ± 1%); corresponding values for comparison of different day repeat measurements were between 98% and 100%. Parameters of major influence on 4D VMAT dose simulation accuracy were the degree of temporal discretization of the dose delivery process (the higher, the better) and correct alignment of the assumed breathing phases at the beginning of the dose measurements and simulations. Given the high γ-passing rates between simulated motion-affected doses and dynamic measurements, we consider the simulations to provide a reliable basis for assessment of VMAT motion effects that–in the sense of 4D QA of VMAT treatment plans–allows to verify target coverage in hypofractioned VMAT-based radiotherapy of moving targets. Remaining differences between measurements and simulations motivate, however, further detailed studies.
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Affiliation(s)
- Thilo Sothmann
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
- * E-mail:
| | - Tobias Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - René Werner
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
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Smeets R, Schöllchen M, Gauer T, Aarabi G, Assaf AT, Rendenbach C, Beck-Broichsitter B, Semmusch J, Sedlacik J, Heiland M, Fiehler J, Siemonsen S. Artefacts in multimodal imaging of titanium, zirconium and binary titanium-zirconium alloy dental implants: an in vitro study. Dentomaxillofac Radiol 2016; 46:20160267. [PMID: 27910719 DOI: 10.1259/dmfr.20160267] [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] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To analyze and evaluate imaging artefacts induced by zirconium, titanium and titanium-zirconium alloy dental implants. METHODS Zirconium, titanium and titanium-zirconium alloy implants were embedded in gelatin and MRI, CT and CBCT were performed. Standard protocols were used for each modality. For MRI, line-distance profiles were plotted to quantify the accuracy of size determination. For CT and CBCT, six shells surrounding the implant were defined every 0.5 cm from the implant surface and histogram parameters were determined for each shell. RESULTS While titanium and titanium-zirconium alloy induced extensive signal voids in MRI owing to strong susceptibility, zirconium implants were clearly definable with only minor distortion artefacts. For titanium and titanium-zirconium alloy, the MR signal was attenuated up to 14.1 mm from the implant. In CT, titanium and titanium-zirconium alloy resulted in less streak artefacts in comparison with zirconium. In CBCT, titanium-zirconium alloy induced more severe artefacts than zirconium and titanium. CONCLUSIONS MRI allows for an excellent image contrast and limited artefacts in patients with zirconium implants. CT and CBCT examinations are less affected by artefacts from titanium and titanium-zirconium alloy implants compared with MRI. The knowledge about differences of artefacts through different implant materials and image modalities might help support clinical decisions for the choice of implant material or imaging device in the clinical setting.
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Affiliation(s)
- Ralf Smeets
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schöllchen
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Gauer
- 2 Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ghazal Aarabi
- 3 Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandre T Assaf
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Rendenbach
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benedicta Beck-Broichsitter
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Semmusch
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Sedlacik
- 4 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Max Heiland
- 1 Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jens Fiehler
- 4 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Siemonsen
- 4 Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Krug D, Baumann R, Rieckmann T, Fokas E, Gauer T, Niyazi M. Situation of young radiation oncologists, medical physicists and radiation biologists in German-speaking countries : Results from a web-based survey of the Young DEGRO working group. Strahlenther Onkol 2016; 192:507-15. [PMID: 27343188 DOI: 10.1007/s00066-016-1003-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/09/2015] [Accepted: 05/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The working group "Young DEGRO" (yDEGRO) was established in 2014 by the German Society of Radiation Oncology (DEGRO). We aimed to assess the current situation of young radiation oncologists, medical physicists and radiation biologists. METHODS An online survey that included 52 questions or statements was designed to evaluate topics related to training, clinical duties and research opportunities. Using the electronic mailing list of the DEGRO and contact persons at university hospitals in Germany as well as at four hospitals in Switzerland and Austria, young professionals employed in the field of radiation oncology were invited to participate in the survey. RESULTS A total of 260 responses were eligible for analysis. Of the respondents 69 % had a professional background in medicine, 23 % in medical physics and 9 % in radiation biology. Median age was 33 years. There was a strong interest in research among the participants; however a clear separation between research, teaching and routine clinical duties was rarely present for radiation oncologists and medical physicists. Likewise, allocated time for research and teaching during regular working hours was often not available. For radiation biologists, a lack of training in clinical and translational research was stated. CONCLUSION This survey details the current state of education and research opportunities in young radiation oncologists, medical physicists and radiation biologists. These results will form the basis for the future working program of the yDEGRO.
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Affiliation(s)
- David Krug
- Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany. .,National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany.
| | - Rene Baumann
- Department of Radiation Oncology, University of Schleswig-Holstein, Kiel, Germany
| | - Thorsten Rieckmann
- Laboratory for Radiobiology and Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Emmanouil Fokas
- Department of Radiotherapy and Oncology, Goethe University of Frankfurt, Frankfurt, Germany.,Department of Oncology, CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - Tobias Gauer
- Department for Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University of Munich, Munich, Germany
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Gauer T, Sothmann T, Werner R. EP-1763: Experimental analysis of interplay effects in flattening filter free VMAT treatment techniques. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33014-6] [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: 10/21/2022]
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Sothmann T, Blanck O, Poels K, Werner R, Gauer T. Real time tracking in liver SBRT: comparison of CyberKnife and Vero by planning structure-based γ-evaluation and dose-area-histograms. Phys Med Biol 2016; 61:1677-91. [PMID: 26836488 DOI: 10.1088/0031-9155/61/4/1677] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to evaluate and compare two clinical tracking systems for radiosurgery with regard to their dosimetric and geometrical accuracy in liver SBRT: the robot-based CyberKnife and the gimbal-based Vero. Both systems perform real-time tumour tracking by correlating internal tumour and external surrogate motion. CyberKnife treatment plans were delivered to a high resolution 2D detector array mounted on a 4D motion platform, with the platform simulating (a) tumour motion trajectories extracted from the corresponding CyberKnife predictor log files and (b) the tumour motion trajectories with superimposed baseline-drift. Static reference and tracked dose measurements were compared and dosimetric as well as geometrical uncertainties analyzed by a planning structure-based evaluation. For (a), γ-passing rates inside the CTV (γ-criteria of 1% / 1 mm) ranged from 95% to 100% (CyberKnife) and 98% to 100% (Vero). However, dosimetric accuracy decreases in the presence of the baseline-drift. γ-passing rates for (b) ranged from 26% to 92% and 94% to 99%, respectively; i.e. the effect was more pronounced for CyberKnife. In contrast, the Vero system led to maximum dose deviations in the OAR between +1.5 Gy to +6.0 Gy (CyberKnife: +0.5 Gy to +3.5 Gy). Potential dose shifts were interpreted as motion-induced geometrical tracking errors. Maximum observed shift ranges were -1.0 mm to +0.7 mm (lateral) /-0.6 mm to +0.1 mm (superior-inferior) for CyberKnife and -0.8 mm to +0.2 mm /-0.8 mm to +0.4 mm for Vero. These values illustrate that CyberKnife and Vero provide high precision tracking of regular breathing patterns. Even for the modified motion trajectory, the obtained dose distributions appear to be clinical acceptable with regard to literature QA γ-criteria of 3% / 3 mm.
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Affiliation(s)
- T Sothmann
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany. Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Ortmüller J, Gauer T, Wilms M, Handels H, Werner R. Respiratory surface motion measurement by Microsoft Kinect. Current Directions in Biomedical Engineering 2015. [DOI: 10.1515/cdbme-2015-0067] [Citation(s) in RCA: 6] [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] [Indexed: 11/15/2022] Open
Abstract
Abstract
In radiotherapy of abdominal and thoracic tumors, respiratory motion is a problem for an accurate treatment. Most current motion compensation techniques rely on externally acquired breathing signals of the patient. The systems in clinical use usually work with 1D surface motion signals to describe internal structure respiratory motion patterns. As a 1D signal is not able to describe complex motion patterns and breathing variations, in this work the Microsoft Kinect, which can record multidimensional respiratory surface motion signals, is proposed to be used instead. For the Kinect, a clinically acceptable measurement setup is designed and Kinect measurements are compared to the Varian RPM system (clinical standard). The results show that the signals are well aligned. An additional comparison of Kinect signals from different regions of interest on the chest further reveals variations between them. This illustrates that the use of a system that provides multidimensional signals is worthwhile; the knowledge about breathing variations could be applied for optimization of current clinical workflows.
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Affiliation(s)
- J. Ortmüller
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Institute of Medical Informatics, University of Lübeck
| | - T. Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf
| | - M. Wilms
- Institute of Medical Informatics, University of Lübeck
| | - H. Handels
- Institute of Medical Informatics, University of Lübeck
| | - R. Werner
- Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf
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Gauer T, Sothmann T, Werner R. PO-0891: Experimental verification of 4DCT-based dose accumulation for IMRT and VMAT beam techniques in lung and liver SBRT. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40883-7] [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: 10/23/2022]
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Gauer T. SP-0349: Overview of EU funding options. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30454-0] [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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Weichel M, Werner R, Petersen C, Gauer T. EP-1646: Breathing irregularity of free-breathing lung and liver tumor patients over the course of SBRT. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31764-3] [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: 11/24/2022]
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Wulfhekel E, Grohmann C, Gauer T, Werner R. EP-1743: Compilation of a database for illustration and automated detection of 4DCT motion artifacts. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31861-2] [Citation(s) in RCA: 3] [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: 11/16/2022]
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Gargioni E, Petersen C, Wernecke J, Henze L, Cremers F, Gauer T. PO-0889: Clinical use of an add electron MLC in radiotherapy of skin and breast cancer. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Gauer T, Kiesel A, Engel K, Gargioni E, Petersen C. EP-1508 VALIDATION OF A LEAF SEQUENCING MODEL FOR ELECTRON IMRT PROVIDING EFFICIENT AND ROBUST DOSE DELIVERY IN BREAST CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71841-8] [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: 11/17/2022]
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Gargioni E, Cremers F, Gauer T, Engel K, Goy Y, Petersen C. 317 oral DOSIMETRIC COMPARISON OF IMRT USING HELICAL PHOTON BEAMS VERSUS RANGE-MODULATED ELECTRON BEAMS IN RADIOTHERAPY OF BREAST AND CHEST WALL CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70439-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: 10/18/2022]
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Gauer T, Engel K, Kiesel A, Albers D, Rades D. Comparison of electron IMRT to helical photon IMRT and conventional photon irradiation for treatment of breast and chest wall tumours. Radiother Oncol 2010; 94:313-8. [PMID: 20116121 DOI: 10.1016/j.radonc.2009.12.037] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2009] [Revised: 12/30/2009] [Accepted: 12/30/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Conventional irradiation of breast and chest wall tumours may cause high doses in underlying organs. Intensity-modulated radiation therapy (IMRT) with photons achieves high conformity between treated and tumour volume but is associated with considerable low-dose effects which may induce secondary malignancies. We compare treatment plans of electron IMRT to helical photon IMRT and conventional irradiation. MATERIAL AND METHODS Treatment planning for three patients (breast, chest wall plus lymph nodes, sarcoma of medial chest wall/sternum) was performed using XiO 4.3.3 (CMS) for conventional photon irradiation, Hi-Art 2.2.2.05 (TomoTherapy) for helical photon IMRT, and a self-designed programme for electron IMRT. RESULTS The techniques resulted in similar mean and maximum target doses. Target coverage by the 95%-isodose was best with tomotherapy. Mean ipsilateral lung doses were similar with all techniques. Electron IMRT achieved best sparing of heart, and contralateral breast. Compared with photon IMRT, electron IMRT allowed better sparing of contralateral lung and total healthy tissue. CONCLUSIONS Electron IMRT is superior to conventional irradiation, as it allows satisfying target coverage and avoids high doses in underlying organs. Its advantage over photon IMRT is better sparing of most organs at risk (low-dose effects) which reduces the risk of radiation-induced malignancies.
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Affiliation(s)
- Tobias Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Germany.
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Gauer T, Sokoll J, Cremers F, Harmansa R, Luzzara M, Schmidt R. Characterization of an add-on multileaf collimator for electron beam therapy. Phys Med Biol 2008; 53:1071-85. [PMID: 18263959 DOI: 10.1088/0031-9155/53/4/017] [Citation(s) in RCA: 24] [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] [Indexed: 12/20/2022]
Abstract
An add-on multileaf collimator for electrons (eMLC) has been developed that provides computer-controlled beam collimation and isocentric dose delivery. The design parameters result from the design study by Gauer et al (2006 Phys. Med. Biol. 51 5987-6003) and were configured such that a compact and light-weight eMLC with motorized leaves can be industrially manufactured and stably mounted on a conventional linear accelerator. In the present study, the efficiency of an initial computer-controlled prototype was examined according to the design goals and the performance of energy- and intensity-modulated treatment techniques. This study concentrates on the attachment and gantry stability as well as the dosimetric characteristics of central-axis and off-axis dose, field size dependence, collimator scatter, field abutment, radiation leakage and the setting of the accelerator jaws. To provide isocentric irradiation, the eMLC can be placed either 16 or 28 cm above the isocentre through interchangeable holders. The mechanical implementation of this feature results in a maximum field displacement of less than 0.6 mm at 90 degrees and 270 degrees gantry angles. Compared to a 10 x 10 cm applicator at 6-14 MeV, the beam penumbra of the eMLC at a 16 cm collimator-to-isocentre distance is 0.8-0.4 cm greater and the depth-dose curves show a larger build-up effect. Due to the loss in energy dependence of the therapeutic range and the much lower dose output at small beam sizes, a minimum beam size of 3 x 3 cm is necessary to avoid suboptimal dose delivery. Dose output and beam symmetry are not affected by collimator scatter when the central axis is blocked. As a consequence of the broader beam penumbra, uniform dose distributions were measured in the junction region of adjacent beams at perpendicular and oblique beam incidence. However, adjacent beams with a high difference in a beam energy of 6 to 14 MeV generate cold and hot spots of approximately 15% in the abutting region. In order to improve uniformity, the energy of adjacent beams must be limited to 6 to 10 MeV and 10 to 14 MeV respectively. At the maximum available beam energy of 14 MeV, radiation leakage results mainly from the intraleaf leakage of approximately 2.5% relative dose which could be effectively eliminated at off-axis distances remote from the field edge by adjusting the jaw field size to the respective opening of the eMLC. Additionally, the interleaf and leaf-end leakage could be reduced by using a tongue-and-groove leaf shape and adjoining the leaf-ends off-axis respectively.
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Affiliation(s)
- T Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Gauer T, Albers D, Harmansa R, Luzzara M, Schmidt R. SU-FF-T-153: Development of An Electron Multileaf Collimator Performing Computer-Controlled Beam Collimation and Isocentric Dose Delivery with Electrons. Med Phys 2007. [DOI: 10.1118/1.2760812] [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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Gauer T, Albers D, Cremers F, Harmansa R, Pellegrini R, Schmidt R. Design of a computer-controlled multileaf collimator for advanced electron radiotherapy. Phys Med Biol 2006; 51:5987-6003. [PMID: 17110765 DOI: 10.1088/0031-9155/51/23/003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A multileaf collimator for electrons (eMLC) has been designed that fulfils the technical requirements for providing advanced irradiation techniques with electrons. In the present work, the basic design parameters of leaf material, leaf height, leaf width and number of leaves as well as leaf overtravel and leaf shape were determined such that an eMLC with motorized leaves can be manufactured by a company specialized in MLC technology. For this purpose, a manually driven eMLC with variable source-to-collimator distance (SCD) was used to evaluate the chosen leaf specification and investigate the impact of the SCD on the off-axis dose distribution. In order to select the final SCD of the eMLC, a compromise had to be found between maximum field size, minimum beam penumbra and necessary distance between eMLC and isocentre to eliminate patient realignments during gantry rotation. As a result, the eMLC is placed according to the target position at 72 and 84 cm SCD, respectively. This feature will be achieved by interchangeable distance holders. At these SCDs, the corresponding maximum field sizes at 100 cm source-to-isocentre distance are 20 x 20 cm and 17 x 17 cm, respectively. Finally, the off-axis dose distribution at the maximum opening of the eMLC was improved by fine-tuning the settings of the accelerator jaws and introducing trimmer bars above the eMLC. Following this optimization, a prototype eMLC consisting of 2 x 24 computer-controlled brass leaves is manufactured by 3D Line Medical Systems.
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Affiliation(s)
- T Gauer
- Department of Radiotherapy and Radio-Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Gauer T, Cremers F, Thom E, Schoenborn T, Schmidt R. 153 Electron beam collimation with an electron multileaf collimator (eMLC). Radiother Oncol 2005. [DOI: 10.1016/s0167-8140(05)81129-6] [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: 11/27/2022]
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