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Haisraely O, Weiss I, Jaffe M, Appel S, Person-Kaidar O, Symon Z, Ben-Ayun M, Dubinski S, Lawrence Y. Total dose, fraction dose and respiratory motion management impact adrenal SBRT outcome. Clin Transl Radiat Oncol 2024; 47:100788. [PMID: 38745963 PMCID: PMC11090868 DOI: 10.1016/j.ctro.2024.100788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/10/2024] [Accepted: 04/27/2024] [Indexed: 05/16/2024] Open
Abstract
Purpose/Objectives Stereotactic body radiotherapy (SBRT) is an effective treatment for oligometastatic disease in multiple sites. However, the optimal radiation dose for long-term local control of adrenal metastases has yet to be determined. The aim of this study is to evaluate outcomes of adrenal SBRT and to evaluate factors that correlate with local control. Materials/Methods After IRB approval, a retrospective data review of patients treated with SBRT for adrenal metastases at a medical center in Israel between 2015 and 2021 was conducted. A biological effective dose was calculated using an alpha beta ratio of 10. Kaplan Meier and Cox regression were calculated using SPSS software to describe the hazard ratio for local control and survival. Results 83 cases of adrenal SBRT were identified. The average age was 67 (range 42-92 years old). Non-small cell lung cancer was the primary site in 44 % of patients. A total of 70 % of the patients had oligometastatic disease (less than five lesions), and the rest were polymetastatic, responding to systemic therapy with oligo progression in the adrenal. The average gross tumor volume (GTV) was 42 ml. Respiratory control was applied in 88 % of cases; 49.3 % used 4-D/ITV, and 38.5 % used breath-hold or continuous positive airway pressure (CPAP) with free breathing. On multivariable analysis, Dose above 75 Gy (biological effective Dose) (HR = 0.41, p = 0.031), Dose above 8 Gy per fraction (HR = 0.53p = 0.038), and breath-holds or CPAP (HR = 0.65, p = 0.047) were significant for local control. From multivariable analysis, we computed a predicted nomogram curve using seven clinical parameters to evaluate local control odds. Conclusion In this single institution series reported to date, we found unilateral adrenal SBRT safe, yet bilateral treatment harbors a risk of adrenal insufficiency. Biological effective Dose > 75 Gy (BED), motion management with breath-hold or CPAP, and Dose per fraction > 8 Gy were the enhanced local controls. We propose a nomogram to help in decision-making regarding total Dose and Dose per fraction when treating adrenal SBRT.
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Affiliation(s)
- Ory Haisraely
- Sheba Medical Center, Radiation Oncology Unit, Israel
| | - Ilana Weiss
- Sheba Medical Center, Radiation Oncology Unit, Israel
| | - Marcia Jaffe
- University of Nicosia (UNIC) Medical School, Cyprus
| | - Sarit Appel
- Sheba Medical Center, Radiation Oncology Unit, Israel
| | | | - Zvi Symon
- Sheba Medical Center, Radiation Oncology Unit, Israel
| | - Maoz Ben-Ayun
- Sheba Medical Center, Radiation Oncology Unit, Israel
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Burton A, Gaudreault M, Hardcastle N, Lye J, Beveridge S, Kry SF, Franich R. Optimized scoring of end-to-end dosimetry audits for passive motion management - A simulation study using the IROC thorax phantom. Phys Med 2024; 121:103363. [PMID: 38653119 DOI: 10.1016/j.ejmp.2024.103363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/24/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024] Open
Abstract
Dosimetry audits for passive motion management require dynamically-acquired measurements in a moving phantom to be compared to statically calculated planned doses. This study aimed to characterise the relationship between planning and delivery errors, and the measured dose in the Imaging and Radiation Oncology Core (IROC) thorax phantom, to assess different audit scoring approaches. Treatment plans were created using a 4DCT scan of the IROC phantom, equipped with film and thermoluminescent dosimeters (TLDs). Plans were created on the average intensity projection from all bins. Three levels of aperture complexity were explored: dynamic conformal arcs (DCAT), low-, and high-complexity volumetric modulated arcs (VMATLo, VMATHi). Simulated-measured doses were generated by modelling motion using isocenter shifts. Various errors were introduced including incorrect setup position and target delineation. Simulated-measured film doses were scored using gamma analysis and compared within specific regions of interest (ROIs) as well as the entire film plane. Positional offsets were estimated based on isodoses on the film planes, and point doses within TLD contours were compared. Motion-induced differences between planned and simulated-measured doses were evident even without introduced errors Gamma passing rates within target-centred ROIs correlated well with error-induced dose differences, while whole film passing rates did not. Isodose-based setup position measurements demonstrated high sensitivity to errors. Simulated point doses at TLD locations yielded erratic responses to introduced errors. ROI gamma analysis demonstrated enhanced sensitivity to simulated errors compared to whole film analysis. Gamma results may be further contextualized by other metrics such as setup position or maximum gamma.
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Affiliation(s)
- Alex Burton
- Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), Yallambie, Victoria 3085, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Victoria 3000, Australia; School of Science, RMIT University, Melbourne, Victoria 3000, Australia.
| | - Mathieu Gaudreault
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Victoria 3000, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum Department of Oncology, the University of Melbourne, Victoria 3000, Australia; Centre for Medical Radiation Physics, University of Wollongong, New South Wales 2522, Australia
| | - Jessica Lye
- Olivia Newton John Cancer Research and Wellness Centre, Heidelberg 3084, Australia
| | - Sabeena Beveridge
- Australian Radiation Protection and Nuclear Safety Agency (ARPANSA), Yallambie, Victoria 3085, Australia
| | - Stephen F Kry
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; Imaging and Radiation Oncology Core, Houston, TX 77054, USA
| | - Rick Franich
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia; School of Science, RMIT University, Melbourne, Victoria 3000, Australia
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van den Dobbelsteen M, Hackett SL, van Asselen B, Oolbekkink S, Raaymakers BW, de Boer JC. Treatment planning evaluation and experimental validation of the magnetic resonance-based intrafraction drift correction. Phys Imaging Radiat Oncol 2024; 30:100580. [PMID: 38707627 PMCID: PMC11068926 DOI: 10.1016/j.phro.2024.100580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
Background and purpose MRI-guided online adaptive treatments can account for interfractional variations, however intrafraction motion reduces treatment accuracy. Intrafraction plan adaptation methods, such as the Intrafraction Drift Correction (IDC) or sub-fractionation, are needed. IDC uses real-time automatic monitoring of the tumor position to initiate plan adaptations by repositioning segments. IDC is a fast adaptation method that occurs only when necessary and this method could enable margin reduction. This research provides a treatment planning evaluation and experimental validation of the IDC. Materials and methods An in silico treatment planning evaluation was performed for 13 prostate patients mid-treatment without and with intrafraction plan adaptation (IDC and sub-fractionation). The adaptation methods were evaluated using dose volume histogram (DVH) metrics. To experimentally verify IDC a treatment was mimicked whereby a motion phantom containing an EBT3 film moved mid-treatment, followed by repositioning of segments. In addition, the delivered treatment was irradiated on a diode array phantom for plan quality assurance purposes. Results The planning study showed benefits for using intrafraction adaptation methods relative to no adaptation, where the IDC and sub-fractionation showed consistently improved target coverage with median target coverages of 100.0%. The experimental results verified the IDC with high minimum gamma passing rates of 99.1% and small mean dose deviations of maximum 0.3%. Conclusion The straightforward and fast IDC technique showed DVH metrics consistent with the sub-fractionation method using segment weight re-optimization for prostate patients. The dosimetric and geometric accuracy was shown for a full IDC workflow using film and diode array dosimetry.
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Affiliation(s)
- Madelon van den Dobbelsteen
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Sara L. Hackett
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Bram van Asselen
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Stijn Oolbekkink
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Bas W. Raaymakers
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Johannes C.J. de Boer
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Buschmann M, Kauer-Dorner D, Konrad S, Georg D, Widder J, Knäusl B. Stereoscopic X-ray image and thermo-optical surface guidance for breast cancer radiotherapy in deep inspiration breath-hold. Strahlenther Onkol 2024; 200:306-313. [PMID: 37796341 DOI: 10.1007/s00066-023-02153-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE To investigate the feasibility of a thermo-optical surface imaging (SGRT) system combined with room-based stereoscopic X‑ray image guidance (IGRT) in a dedicated breast deep inspiration breath-hold (DIBH) irradiation workflow. In this context, benchmarking of portal imaging (EPID) and cone-beam CT (CBCT) against stereoscopic X‑rays was performed. METHODS SGRT + IGRT data of 30 left-sided DIBH breast patients (1 patient with bilateral cancer) treated in 351 fractions using thermo-optical surface imaging and X-ray IGRT were retrospectively analysed. Patients were prepositioned based on a free-breathing surface reference derived from a CT scan. Once the DIBH was reached using visual feedback, two stereoscopic X‑ray images were acquired and registered to the digitally reconstructed radiographs derived from the DIBH CT. Based on this registration, a couch correction was performed. Positioning and monitoring by surface and X-ray imaging were verified by protocol-based EPID or CBCT imaging at selected fractions and the calculation of residual geometric deviations. RESULTS The median X‑ray-derived couch correction vector was 4.9 (interquartile range [IQR] 3.3-7.1) mm long. Verification imaging was performed for 134 fractions (216 RT field verifications) with EPID and for 37 fractions with CBCT, respectively. The median 2D/3D deviation vector length over all verification images was 2.5 (IQR 1.6-3.9) mm/3.4 (IQR 2.2-4.8) mm for EPID/CBCT, both being well within the planning target volume (PTV) margins (7 mm). A moderate correlation (0.49-0.65) was observed between the surface signal and X-ray position in DIBH. CONCLUSION DIBH treatments using thermo-optical SGRT and X-ray IGRT were feasible for breast cancer patients. Stereoscopic X‑ray positioning was successfully verified by standard IGRT techniques.
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Affiliation(s)
- Martin Buschmann
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Daniela Kauer-Dorner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Stefan Konrad
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Dietmar Georg
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Joachim Widder
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, Vienna, 1090, Austria
| | - Barbara Knäusl
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna/AKH Wien, Währinger Gürtel 18-20, Vienna, 1090, Austria.
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Fujimoto D, Takatsu J, Hara N, Oshima M, Tomihara J, Segawa E, Inoue T, Shikama N. Dosimetric comparison of four-dimensional computed tomography based internal target volume against variations in respiratory motion during treatment between volumetric modulated arc therapy and three-dimensional conformal radiotherapy in lung stereotactic body radiotherapy. Radiol Phys Technol 2024; 17:143-152. [PMID: 37930563 DOI: 10.1007/s12194-023-00757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
This study focused on the dosimetric impact of variations in respiratory motion during lung stereotactic body radiotherapy (SBRT). Dosimetric comparisons between volumetric modulated arc therapy (VMAT) and three-dimensional conformal radiotherapy (3DCRT) were performed using four-dimensional computed tomography (4DCT)-based internal target volumes (ITV). We created retrospective plans for ten patients with lung cancer who underwent SBRT using 3DCRT and VMAT techniques. A Delta4 Phantom + (ScandiDos, Uppsala, Sweden) was used to evaluate the dosimetric robustness of 4DCT-based ITV against variations in respiratory motion during treatment. We analyzed respiratory motion during treatment. Dose-volume histogram parameters were evaluated for the 95% dose (D95%) to the planning target volume (PTV) contoured on CT images obtained under free breathing. The correlations between patient respiratory parameters and dosimetric errors were also evaluated. In the phantom study, the average PTV D95% dose differences for all fractions were - 2.9 ± 4.4% (- 16.0 - 1.2%) and - 2.0 ± 2.8% (- 11.2 - 0.7%) for 3DCRT and VMAT, respectively. The average dose difference was < 3% for both 3DCRT and VMAT; however, in 5 out of 42 fractions in 3DCRT, the difference in PTV D95% was > 10%. Dosimetric errors were correlated with respiratory amplitude and velocity, and differences in respiratory amplitude between 4DCT and treatment days were the main factors causing dosimetric errors. The overall average dose error of the PTV D95% was small; however, both 3DCRT and VMAT cases exceeding 10% error were observed. Larger errors occurred with amplitude variation or baseline drift, indicating limited robustness of 4DCT-based ITV.
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Affiliation(s)
- Daimu Fujimoto
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Jun Takatsu
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Naoya Hara
- Department of Radiology, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Masaki Oshima
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Jun Tomihara
- Department of Radiology, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Eisuke Segawa
- Department of Radiology, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Tatsuya Inoue
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Department of Radiology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu-shi, Chiba, 279-0021, Japan
| | - Naoto Shikama
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Chen X, Liu L, Wang Y, Huang X, Cai W, Rong X, Lin L, Liu J, Jiang X. Surface guided radiation therapy with an innovative open-face mask and mouth bite: patient motion management in brain stereotactic radiotherapy. Clin Transl Oncol 2024; 26:424-433. [PMID: 37395988 DOI: 10.1007/s12094-023-03260-z] [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: 03/30/2023] [Accepted: 06/18/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION To guarantee treatment reproducibility and stability, immobilization devices are essential. Additionally, surface-guided radiation therapy (SGRT) serves as an accurate complement to frameless stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT) by aiding patient positioning and real-time monitoring, especially when non-coplanar fields are in use. At our institute, we have developed a surface-guided SRS (SG-SRS) workflow that incorporates our innovative open-face mask (OM) and mouth bite (MB) to guarantee a precise and accurate dose delivery. METHODS This study included 40 patients, and all patients were divided into closed mask (CM) and open-face mask (OM) groups according to different positioning flow. Cone beam computed tomography (CBCT) scans were performed, and the registration results were recorded before and after the treatment. Then Bland-Altman method was used to analyze the consistency of AlignRT-guided positioning errors and CBCT scanning results in the OM group. The error changes between 31 fractions in one patient were recorded to evaluate the feasibility of monitoring during treatment. RESULTS The median of translation error between stages of the AlignRT positioning process was (0.03-0.07) cm, and the median of rotation error was (0.20-0.40)°, which were significantly better than those of the Fraxion positioning process (0.09-0.11) cm and (0.60-0.75)°. The mean bias values between the AlignRT guided positioning errors and CBCT were 0.01 cm, - 0.07 cm, 0.03 cm, - 0.30°, - 0.08° and 0.00°. The 31 inter-fractional errors of a single patient monitored by SGRT were within 0.10 cm and 0.50°. CONCLUSIONS The application of the SGRT with an innovative open-face mask and mouth bite device could achieve precision positioning accuracy and stability, and the accuracy of the AlignRT system exhibits excellent constancy with the CBCT gold standard. The non-coplanar radiation field monitoring can provide reliable support for motion management in fractional treatment.
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Affiliation(s)
- Xuemei Chen
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lu Liu
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yajuan Wang
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaotong Huang
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Weixun Cai
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaodong Rong
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Liuwen Lin
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jindi Liu
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
| | - Xiaobo Jiang
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China.
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Knäusl B, Belotti G, Bertholet J, Daartz J, Flampouri S, Hoogeman M, Knopf AC, Lin H, Moerman A, Paganelli C, Rucinski A, Schulte R, Shimizu S, Stützer K, Zhang X, Zhang Y, Czerska K. A review of the clinical introduction of 4D particle therapy research concepts. Phys Imaging Radiat Oncol 2024; 29:100535. [PMID: 38298885 PMCID: PMC10828898 DOI: 10.1016/j.phro.2024.100535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024] Open
Abstract
Background and purpose Many 4D particle therapy research concepts have been recently translated into clinics, however, remaining substantial differences depend on the indication and institute-related aspects. This work aims to summarise current state-of-the-art 4D particle therapy technology and outline a roadmap for future research and developments. Material and methods This review focused on the clinical implementation of 4D approaches for imaging, treatment planning, delivery and evaluation based on the 2021 and 2022 4D Treatment Workshops for Particle Therapy as well as a review of the most recent surveys, guidelines and scientific papers dedicated to this topic. Results Available technological capabilities for motion surveillance and compensation determined the course of each 4D particle treatment. 4D motion management, delivery techniques and strategies including imaging were diverse and depended on many factors. These included aspects of motion amplitude, tumour location, as well as accelerator technology driving the necessity of centre-specific dosimetric validation. Novel methodologies for X-ray based image processing and MRI for real-time tumour tracking and motion management were shown to have a large potential for online and offline adaptation schemes compensating for potential anatomical changes over the treatment course. The latest research developments were dominated by particle imaging, artificial intelligence methods and FLASH adding another level of complexity but also opportunities in the context of 4D treatments. Conclusion This review showed that the rapid technological advances in radiation oncology together with the available intrafractional motion management and adaptive strategies paved the way towards clinical implementation.
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Affiliation(s)
- Barbara Knäusl
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Gabriele Belotti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Juliane Daartz
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Mischa Hoogeman
- Department of Medical Physics & Informatics, HollandPTC, Delft, The Netherlands
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Antje C Knopf
- Institut für Medizintechnik und Medizininformatik Hochschule für Life Sciences FHNW, Muttenz, Switzerland
| | - Haibo Lin
- New York Proton Center, New York, NY, USA
| | - Astrid Moerman
- Department of Medical Physics & Informatics, HollandPTC, Delft, The Netherlands
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Antoni Rucinski
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland
| | - Reinhard Schulte
- Division of Biomedical Engineering Sciences, School of Medicine, Loma Linda University
| | - Shing Shimizu
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kristin Stützer
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden – Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
| | - Xiaodong Zhang
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
| | - Katarzyna Czerska
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
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Xiao H, Han X, Zhi S, Wong YL, Liu C, Li W, Liu W, Wang W, Zhang Y, Wu H, Lee HFV, Cheung LYA, Chang HC, Liao YP, Deng J, Li T, Cai J. Ultra-fast multi-parametric 4D-MRI image reconstruction for real-time applications using a downsampling-invariant deformable registration (D2R) model. Radiother Oncol 2023; 189:109948. [PMID: 37832790 DOI: 10.1016/j.radonc.2023.109948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/12/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND AND PURPOSE Motion estimation from severely downsampled 4D-MRI is essential for real-time imaging and tumor tracking. This simulation study developed a novel deep learning model for simultaneous MR image reconstruction and motion estimation, named the Downsampling-Invariant Deformable Registration (D2R) model. MATERIALS AND METHODS Forty-three patients undergoing radiotherapy for liver tumors were recruited for model training and internal validation. Five prospective patients from another center were recruited for external validation. Patients received 4D-MRI scans and 3D MRI scans. The 4D-MRI was retrospectively down-sampled to simulate real-time acquisition. Motion estimation was performed using the proposed D2R model. The accuracy and robustness of the proposed D2R model and baseline methods, including Demons, Elastix, the parametric total variation (pTV) algorithm, and VoxelMorph, were compared. High-quality (HQ) 4D-MR images were also constructed using the D2R model for real-time imaging feasibility verification. The image quality and motion accuracy of the constructed HQ 4D-MRI were evaluated. RESULTS The D2R model showed significantly superior and robust registration performance than all the baseline methods at downsampling factors up to 500. HQ T1-weighted and T2-weighted 4D-MR images were also successfully constructed with significantly improved image quality, sub-voxel level motion error, and real-time efficiency. External validation demonstrated the robustness and generalizability of the technique. CONCLUSION In this study, we developed a novel D2R model for deformation estimation of downsampled 4D-MR images. HQ 4D-MR images were successfully constructed using the D2R model. This model may expand the clinical implementation of 4D-MRI for real-time motion management during liver cancer treatment.
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Affiliation(s)
- Haonan Xiao
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China 999077; Department of Radiation Oncology and Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, China.
| | - Xinyang Han
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China 999077
| | - Shaohua Zhi
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China 999077
| | - Yat-Lam Wong
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China 999077
| | - Chenyang Liu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China 999077
| | - Wen Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China 999077
| | - Weiwei Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing 100000, China
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing 100000, China
| | - Yibao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing 100000, China
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Beijing Cancer Hospital & Institute, Peking University Cancer Hospital & Institute, Beijing 100000, China
| | - Ho-Fun Victor Lee
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China 999077
| | - Lai-Yin Andy Cheung
- Department of Clinical Oncology, The University of Hong Kong, Hong Kong, China 999077
| | - Hing-Chiu Chang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, China 999077
| | - Yen-Peng Liao
- Department of Radiation Oncology's Division of Medical Physics & Engineering, University of Texas Southwestern Medical Center, Texas 75390, USA
| | - Jie Deng
- Department of Radiation Oncology's Division of Medical Physics & Engineering, University of Texas Southwestern Medical Center, Texas 75390, USA
| | - Tian Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China 999077.
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China 999077.
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Hui MCM, Chiu G, Wong S, Lien SL. An analysis of the impact of different levels of inspiratory volume using active breathing control on the intrafraction motion and dose coverage of target volumes in patients undergoing thoracic radiotherapy. J Med Imaging Radiat Sci 2023; 54:653-661. [PMID: 37620180 DOI: 10.1016/j.jmir.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE To determine whether the level of inspiratory volume affect the extent to which active breathing control (ABC) reduces intrafraction motion and the dose coverage of target volumes in patients receiving external beam radiation therapy (EBRT) to the thoracic region MATERIALS/METHODS: 20 patients undergoing thoracic radiotherapy enrolled in a prospective study using ABC for respiratory motion management and volumetric-modulated arc therapy (VMAT) as the treatment technique. They were randomized to one of two groups, the control group of 80% inspiratory volume and the other test group of 70%. At least one set of repeated CBCTs was done weekly. All images including CBCTs and Planning CTs were sent to MIM softwareTM for analysis of intrafraction motion using Dice Similarity Coefficient (DSC). The target dose conformality was assessed using conformation number (CN). Intention-to-treat analysis was employed for statistical purpose. RESULTS The DSC for the 70% and 80% inspiratory volume group were 0.93 and 0.92, respectively. For the 70% group, there was a significant negative correlation (p < 0.05) between DSC and time between two CBCTs, but not for the 80% group. The average percentage change in CN for the 70% and 80% group was 10.91% and 8.14%, respectively, and their difference was significant (p < 0.05). Furthermore, the actual change in volume had a significant positive correlation (p < 0.05) with the percentage change in CN for the 70% inspiratory volume group but not the 80% group. CONCLUSION More evidence suggests that the target volumes from the 80% inspiratory volume group have less intrafraction motion compared to the 70% group. The findings from the percentage change in CN suggest that there could potentially be less tumor motion for higher levels of inspiratory volume and this could possibly contribute to why intrafraction motion is less for the 80% inspiratory volume group.
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Affiliation(s)
- Michael Chun Man Hui
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, G/F, Li Shu Pui Block, 2 Village Road, Happy Valley, Hong Kong.
| | - George Chiu
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, G/F, Li Shu Pui Block, 2 Village Road, Happy Valley, Hong Kong
| | - Szeming Wong
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, G/F, Li Shu Pui Block, 2 Village Road, Happy Valley, Hong Kong
| | - Shao Lung Lien
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, G/F, Li Shu Pui Block, 2 Village Road, Happy Valley, Hong Kong
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10
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Mannerberg A, Nilsson MP, Edvardsson A, Karlsson K, Ceberg S. Abdominal compression as motion management for stereotactic radiotherapy of ventricular tachycardia. Phys Imaging Radiat Oncol 2023; 28:100499. [PMID: 37869475 PMCID: PMC10585386 DOI: 10.1016/j.phro.2023.100499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/24/2023] Open
Abstract
Background and purpose Stereotactic body radiotherapy (SBRT) has emerged as a promising treatment for patients with ventricular tachycardia (VT) who do not respond to standard treatments. However, the management of respiratory motion during treatment remains a challenge. This study aimed to investigate the effect of abdominal compression (AC) on respiratory induced motion in the heart. Materials and methods A patient cohort of 18 lung cancer patients was utilized, where two four-dimensional computed tomography (4DCT) scans were performed for each patient, one with and one without AC. The patient setup consisted of an AC plate together with a stereotactic body frame. The left coronary artery, the left anterior descending artery, the lateral wall of the left ventricle, the heart apex, the carina, and the right and left diaphragm were delineated in max expiration and max inspiration phases in both 4DCT scans. The center of mass shift from expiration to inspiration phase was determined to assess the AC's impact on respiratory motion. Results A significant reduction in motion in the superior-inferior direction was found for all heart structures when AC was used. The median respiratory motion of the heart structures decreased by approximately 1-3 mm with AC in the superior-inferior direction, and approximately 60% of the patients had a motion reduction ≥3 mm in the left ventricle wall. Conclusion These findings suggest that AC has the potential to improve the motion management of SBRT for VT patients, by reducing the respiratory induced motion in the heart.
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Affiliation(s)
- Annika Mannerberg
- Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Martin P. Nilsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anneli Edvardsson
- Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Kristin Karlsson
- Karolinska University Hospital, Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Stockholm, Sweden
- Karolinska Institutet, Department of Oncology-Pathology, Stockholm, Sweden
| | - Sofie Ceberg
- Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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11
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Aznar MC, Carrasco de Fez P, Corradini S, Mast M, McNair H, Meattini I, Persson G, van Haaren P. ESTRO-ACROP guideline: Recommendations on implementation of breath-hold techniques in radiotherapy. Radiother Oncol 2023; 185:109734. [PMID: 37301263 DOI: 10.1016/j.radonc.2023.109734] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
The use of breath-hold techniques in radiotherapy, such as deep-inspiration breath hold, is increasing although guidelines for clinical implementation are lacking. In these recommendations, we aim to provide an overview of available technical solutions and guidance for best practice in the implementation phase. We will discuss specific challenges in different tumour sites including factors such as staff training and patient coaching, accuracy, and reproducibility. In addition, we aim to highlight the need for further research in specific patient groups. This report also reviews considerations for equipment, staff training and patient coaching, as well as image guidance for breath-hold treatments. Dedicated sections for specific indications, namely breast cancer, thoracic and abdominal tumours are also included.
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Affiliation(s)
- Marianne Camille Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom.
| | - Pablo Carrasco de Fez
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Mirjam Mast
- Department of Radiotherapy, Haaglanden Medical Center, Leidschendam, The Netherlands
| | - Helen McNair
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, UK
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Department of Clinical and Experimental Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Gitte Persson
- Department of Oncology, Herlev-Gentofte Hospital, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Denmark
| | - Paul van Haaren
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
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12
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Belikhin M, Pryanichnikov A, Balakin V, Shemyakov A, Zhogolev P, Chernyaev A. High-speed low-noise optical respiratory monitoring for spot scanning proton therapy. Phys Med 2023; 112:102612. [PMID: 37329740 DOI: 10.1016/j.ejmp.2023.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/24/2023] [Accepted: 05/30/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE To investigate a novel optical markerless respiratory sensor for surface guided spot scanning proton therapy and to measure its main technical characteristics. METHODS The main characteristics of the respiratory sensor including sensitivity, linearity, noise, signal-to-noise, and time delay were measured using a dynamic phantom and electrical measuring equipment on a laboratory stand. The respiratory signals of free breathing and deep-inspiration breath-hold patterns were acquired for various distances with a volunteer. A comparative analysis of this sensor with existing commercially available and experimental respiratory monitoring systems was carried out based on several criteria including principle of operation, patient contact, application to proton therapy, distance range, accuracy (noise, signal-to-noise ratio), and time delay (sampling rate). RESULTS The sensor provides optical respiratory monitoring of the chest surface over a distance range of 0.4-1.2 m with the RMS noise of 0.03-0.60 mm, SNR of 40-15 dB (for motion with peak-to-peak of 10 mm), and time delay of 1.2 ± 0.2 ms. CONCLUSIONS The investigated optical respiratory sensor was found to be appropriate to use in surface guided spot scanning proton therapy. This sensor combined with a fast respiratory signal processing algorithm may provide accurate beam control and a fast response in patients' irregular breathing movements. A careful study of correlation between the respiratory signal and 4DCT data of tumor position will be required before clinical implementation.
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Affiliation(s)
- Mikhail Belikhin
- JSC Protom., Protvino 142281, Russian Federation; Lomonosov Moscow State University, Moscow 119992, Russian Federation.
| | - Alexander Pryanichnikov
- Division of Biomedical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany.
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Dong Z, Yu S, Szmul A, Wang J, Qi J, Wu H, Li J, Lu Z, Zhang Y. Simulation of a new respiratory phase sorting method for 4D-imaging using optical surface information towards precision radiotherapy. Comput Biol Med 2023; 162:107073. [PMID: 37290392 PMCID: PMC10311359 DOI: 10.1016/j.compbiomed.2023.107073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/09/2023] [Accepted: 05/27/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Respiratory signal detection is critical for 4-dimensional (4D) imaging. This study proposes and evaluates a novel phase sorting method using optical surface imaging (OSI), aiming to improve the precision of radiotherapy. METHOD Based on 4D Extended Cardiac-Torso (XCAT) digital phantom, OSI in point cloud format was generated from the body segmentation, and image projections were simulated using the geometries of Varian 4D kV cone-beam-CT (CBCT). Respiratory signals were extracted respectively from the segmented diaphragm image (reference method) and OSI respectively, where Gaussian Mixture Model and Principal Component Analysis (PCA) were used for image registration and dimension reduction respectively. Breathing frequencies were compared using Fast-Fourier-Transform. Consistency of 4DCBCT images reconstructed using Maximum Likelihood Expectation Maximization algorithm was also evaluated quantitatively, where high consistency can be suggested by lower Root-Mean-Square-Error (RMSE), Structural-Similarity-Index (SSIM) value closer to 1, and larger Peak-Signal-To-Noise-Ratio (PSNR) respectively. RESULTS High consistency of breathing frequencies was observed between the diaphragm-based (0.232 Hz) and OSI-based (0.251 Hz) signals, with a slight discrepancy of 0.019Hz. Using end of expiration (EOE) and end of inspiration (EOI) phases as examples, the mean±1SD values of the 80 transverse, 100 coronal and 120 sagittal planes were 0.967, 0,972, 0.974 (SSIM); 1.657 ± 0.368, 1.464 ± 0.104, 1.479 ± 0.297 (RMSE); and 40.501 ± 1.737, 41.532 ± 1.464, 41.553 ± 1.910 (PSNR) for the EOE; and 0.969, 0.973, 0.973 (SSIM); 1.686 ± 0.278, 1.422 ± 0.089, 1.489 ± 0.238 (RMSE); and 40.535 ± 1.539, 41.605 ± 0.534, 41.401 ± 1.496 (PSNR) for EOI respectively. CONCLUSIONS This work proposed and evaluated a novel respiratory phase sorting approach for 4D imaging using optical surface signals, which can potentially be applied to precision radiotherapy. Its potential advantages were non-ionizing, non-invasive, non-contact, and more compatible with various anatomic regions and treatment/imaging systems.
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Affiliation(s)
- Zhengkun Dong
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China; Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
| | - Shutong Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China; Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, China
| | - Adam Szmul
- Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London, London, United Kingdom
| | - Jingyuan Wang
- Department of Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Junfeng Qi
- Department of Engineering Physics, Tsinghua University, Beijing, 100084, China
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Junyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Zihong Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Yibao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, China.
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Hardcastle N, Gaudreault M, Yeo AU, Ungureanu E, Markham C, Barnes R, Chander S, Chu J. Selection of motion management in liver stereotactic body radiotherapy and its impact on treatment time. Phys Imaging Radiat Oncol 2023; 25:100407. [PMID: 36655214 PMCID: PMC9841271 DOI: 10.1016/j.phro.2022.12.004] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/30/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
Abstract
Background and purpose Reduction of respiratory tumour motion is important in liver stereotactic body radiation therapy (SBRT) to reduce side effects and improve tumour control probability. We have assessed the distribution of use of voluntary exhale breath hold (EBH), abdominal compression (AC), free breathing gating (gating) and free breathing (FB), and the impact of these on treatment time. Materials and Methods We assessed all patients treated in a single institution with liver SBRT between September 2017 and September 2021. Data from pre-simulation motion management assessment using fluoroscopic assessment of liver dome position in repeat breath holds, and motion with and without AC, was reviewed to determine liver dome position consistency in EBH and the impact of AC on motion. Treatment time was assessed for all fractions as time from first image acquisition to last treatment beam off. Results Of 136 patients treated with 145 courses of liver SBRT, 68 % were treated in EBH, 20 % with AC, 7 % in gating and 5 % in FB. AC resulted in motion reduction < 1 mm in 9/26 patients assessed. Median treatment time was higher using EBH (39 min) or gating (42 min) compared with AC (30 min) or FB (24 min) treatments. Conclusions Motion management in liver SBRT needs to be assessed per-patient to ensure appropriate techniques are applied. Motion management significantly impacts treatment time therefore patient comfort must also be taken into account when selecting the technique for each patient.
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Key Words
- AC, Abdominal Compression
- Abdominal compression
- BED, Biologically Effective Dose
- CBCT, Cone Beam Computed Tomography
- EBH, Exhale Breath Hold
- FB, Free Breathing
- FFF, Flattening Filter Free
- GTV, Gross Tumor Volume
- IMRT, Intensity Modulated Radiation Therapy
- ITV, Internal Target Volume
- Liver
- Motion management
- PTV, Planning Target Volume
- SBRT, Stereotactic body radiation thearpy
- Stereotactic body radiation therapy
- VMAT, Volumetric Modulated Arc Therapy
- exhale breath hold. Stereotactic ablative body radiotherapy
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Affiliation(s)
- Nicholas Hardcastle
- Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
- Corresponding author.
| | - Mathieu Gaudreault
- Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Adam U. Yeo
- Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Elena Ungureanu
- Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Cathy Markham
- Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rebecca Barnes
- Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sarat Chander
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Julie Chu
- Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Morton N, Keall P, O'Brien R, Reynolds T. CArdiac and REspiratory adaptive Computed Tomography (CARE-CT): a proof-of-concept digital phantom study. Phys Eng Sci Med 2022. [PMID: 36434201 DOI: 10.1007/s13246-022-01193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 10/20/2022] [Indexed: 11/27/2022]
Abstract
Current respiratory 4DCT imaging for high-dose rate thoracic radiotherapy treatments are negatively affected by the complex interaction of cardiac and respiratory motion. We propose an imaging method to reduce artifacts caused by thoracic motion, CArdiac and REspiratory adaptive CT (CARE-CT), that monitors respiratory motion and ECG signals in real-time, triggering CT acquisition during combined cardiac and respiratory bins. Using a digital phantom, conventional 4DCT and CARE-CT acquisitions for nineteen patient-measured physiological traces were simulated. Ten respiratory bins were acquired for conventional 4DCT scans and ten respiratory bins during cardiac diastole were acquired for CARE-CT scans. Image artifacts were quantified for 10 common thoracic organs at risk (OAR) substructures using the differential normalized cross correlation between axial slices (ΔNCC), mean squared error (MSE) and sensitivity. For all images, on average, CARE-CT improved the ΔNCC for 18/19 and the MSE and sensitivity for all patient traces. The ΔNCC was reduced for all cardiac OARs (mean reduction 21%). The MSE was reduced for all OARs (mean reduction 36%). In the digital phantom study, the average scan time was increased from 1.8 ± 0.4 min to 7.5 ± 2.2 min with a reduction in average beam on time from 98 ± 28 s to 45 s using CARE-CT compared to conventional 4DCT. The proof-of-concept study indicates the potential for CARE-CT to image the thorax in real-time during the cardiac and respiratory cycle simultaneously, to reduce image artifacts for common thoracic OARs.
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Nie X, Li G. Real-Time 2D MR Cine From Beam Eye's View With Tumor-Volume Projection to Ensure Beam-to-Tumor Conformality for MR-Guided Radiotherapy of Lung Cancer. Front Oncol 2022; 12:898771. [PMID: 35847879 PMCID: PMC9277147 DOI: 10.3389/fonc.2022.898771] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/20/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To minimize computation latency using a predictive strategy to retrieve and project tumor volume onto 2D MR beam eye’s view (BEV) cine from time-resolved four-dimensional magnetic resonance imaging (TR-4DMRI) libraries (inhalation/exhalation) for personalized MR-guided intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT). Methods Two time-series forecasting algorithms, autoregressive (AR) modeling and deep-learning-based long short-term memory (LSTM), were applied to predict the diaphragm position in the next 2D BEV cine to identify a motion-matched and hysteresis-accounted image to retrieve the tumor volume from the inhalation/exhalation TR-4DMRI libraries. Three 40-s TR-4DMRI (2 Hz, 3 × 80 images) per patient of eight lung cancer patients were used to create patient-specific inhalation/exhalation 4DMRI libraries, extract diaphragmatic waveforms, and interpolate them to f = 4 and 8 Hz to match 2D cine frame rates. Along a (40•f)-timepoint waveform, 30•f training timepoints were moved forward to produce 3×(10•f-1) predictions. The accuracy of position prediction was assessed against the waveform ground truth. The accuracy of tumor volume projections was evaluated using the center-of-mass difference (∆COM) and Dice similarity index against the TR-4DMRI ground truth for both IMRT (six beam angles, 30° interval) and VMAT (240/480 beam angles, 1.5°/0.75° interval, at 4/8 Hz, respectively). Results The accuracy of the first-timepoint prediction is 0.36 ± 0.10 mm (AR) and 0.62 ± 0.21 mm (LSTM) at 4 Hz and 0.06 ± 0.02 mm (AR) and 0.18 ± 0.06 mm (LSTM) at 8 Hz. A 10%–20% random error in prediction-library matching increases the overall uncertainty slightly. For both IMRT and VMAT, the accuracy of projected tumor volume contours on 2D BEV cine is ∆COM = 0.39 ± 0.13 mm and DICE = 0.97 ± 0.02 at 4 Hz and ∆COM = 0.10 ± 0.04 mm and DICE = 1.00 ± 0.00 at 8Hz. Conclusion This study demonstrates the feasibility of accurately predicting respiratory motion during 2D BEV cine imaging, identifying a motion-matched and hysteresis-accounted tumor volume, and projecting tumor volume contour on 2D BEV cine for real-time assessment of beam-to-tumor conformality, promising for optimal personalized MR-guided radiotherapy.
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Affiliation(s)
- Xingyu Nie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Department of Radiology, University of Kentucky, Lexington, KY, United States
| | - Guang Li
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Lydiard S, Pontré B, Lowe BS, Keall P. Atrial fibrillation cardiac radioablation target visibility on magnetic resonance imaging. Phys Eng Sci Med 2022; 45:757-767. [PMID: 35687311 PMCID: PMC9448688 DOI: 10.1007/s13246-022-01141-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/16/2022] [Indexed: 11/27/2022]
Abstract
Magnetic resonance imaging (MRI) guided cardiac radioablation (CR) for atrial fibrillation (AF) is a promising treatment concept. However, the visibility of AF CR targets on MRI acquisitions requires further exploration and MRI sequence and parameter optimization has not yet been performed for this application. This pilot study explores the feasibility of MRI-guided tracking of AF CR targets by evaluating AF CR target visualization on human participants using a selection of 3D and 2D MRI sequences.MRI datasets were acquired in healthy and AF participants using a range of MRI sequences and parameters. MRI acquisition categories included 3D free-breathing acquisitions (3Dacq), 2D breath-hold ECG-gated acquisitions (2DECG-gated), stacks of 2D breath-hold ECG-gated acquisitions which were retrospectively interpolated to 3D datasets (3Dinterp), and 2D breath-hold ungated acquisitions (2Dreal-time). The ease of target delineation and the presence of artifacts were qualitatively analyzed. Image quality was quantitatively analyzed using signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR) and non-uniformity. Confident 3D target delineation was achievable on all 3Dinterp datasets but was not possible on any of the 3Dacq datasets. Fewer artifacts and significantly better SNR, CNR and non-uniformity metrics were observed with 3Dinterp compared to 3Dacq. 2Dreal-time datasets had slightly lower SNR and CNR than 2DECG-gated and 3Dinterp n datasets. AF CR target visualization on MRI was qualitatively and quantitatively evaluated. The study findings indicate that AF CR target visualization is achievable despite the imaging challenges associated with these targets, warranting further investigation into MRI-guided AF CR treatments.
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Affiliation(s)
- Suzanne Lydiard
- ACRF Image X Institute, University of Sydney, 1 Central Avenue, Eveleigh, NSW, Australia. .,Kathleen Kilgour Centre, 18 Twentieth Avenue, Tauranga South, Tauranga, New Zealand.
| | - Beau Pontré
- Department of Anatomy and Medical Imaging, University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Boris S Lowe
- Green Lane Cardiovascular Service, Auckland City Hospital, 2 Park Road, Grafton, Auckland, New Zealand
| | - Paul Keall
- ACRF Image X Institute, University of Sydney, 1 Central Avenue, Eveleigh, NSW, Australia
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Thomas HR, Miao X, Ferguson D, Calvin C, Bhaskar Krishnamurthy U, Anwar M, Feng M, Scholey J. Contrast-enhanced 4D-MRI for internal target volume generation in treatment planning for liver tumors. Radiother Oncol 2022:S0167-8140(22)04143-3. [PMID: 35667575 DOI: 10.1016/j.radonc.2022.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Liver tumors are often invisible on four-dimensional commuted tomography (4D-CT). Imperfect imaging surrogates are used to estimate the tumor motion. Here, we assessed multiple 4D magnetic resonance (MR) binning algorithms for directly visualizing liver tumor motion for radiotherapy planning. METHODS Patients were simulated using a 3 Tesla MR and CT scanner. Three prototype binning algorithms (phase, amplitude, and two-directional) were applied to the 4D-MRIs, and the image quality was assessed using a qualitative clarity score and quantitative sharpness score. Radiation plans were generated for internal target volumes (ITVs) derived using 4D-MRI and 4D-CT, and the dosimetry of targets were compared. Paired t-tests were used to compare sharpness scores and dosimetric data. RESULTS Twelve patients with 17 liver tumors were scanned between May and November 2021. Compared to phase binning, two-directional demonstrated equal or better clarity and sharpness scores (end-expiration: 0.33 vs. 0.38, p=0.018, end-inspiration: 0.28 vs. 0.31, p=0.010). Compared to amplitude binning, two-directional binning captured hysteresis of ≥3 mm in 35% of patients. Evaluation of dosimetry CT-optimized plans revealed that PTV coverage of MR-derived targets were significantly lower than CT-derived targets (PTV receiving 90% of prescription: 75.56% vs. 89.38%, p=0.002). CONCLUSION Using contrast-enhanced 4D-MRI is feasible for directly delineating liver tumors throughout the respiratory cycle. The current standard of using radiation plans optimized for 4D-CT-derived targets achieved lower coverage of directly visualized MRI targets, suggesting that adopting MRI for motion management may improve radiation treatment of liver lesions and reduce the risk of marginal misses.
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Batista V, Gober M, Moura F, Webster A, Oellers M, Ramtohul M, Kügele M, Freislederer P, Buschmann M, Anastasi G, Steiner E, Al-Hallaq H, Lehmann J. Surface guided radiation therapy: An international survey on current clinical practice. Tech Innov Patient Support Radiat Oncol 2022; 22:1-8. [PMID: 35402740 PMCID: PMC8984757 DOI: 10.1016/j.tipsro.2022.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022] Open
Abstract
Introduction Surface Guided Radiation Therapy (SGRT) is being increasingly implemented into clinical practice across a number of techniques and irradiation-sites. This technology, which is provided by different vendors, can be used with most simulation- and delivery-systems. However, limited guidelines and the complexity of clinical settings have led to diverse patterns of operation. With the aim to understand current clinical practice a survey was designed focusing on specifics of the clinical implementation and usage. Materials and methods A 32-question survey covered: type and number of systems, quality assurance (QA), clinical workflows, and identification of strengths/limitations. Respondents from different professional groups and countries were invited to participate. The survey was distributed internationally via ESTRO-membership, social media and vendors. Results Of the 278 institutions responding, 172 had at least one SGRT-system and 136 use SGRT clinically. Implementation and QA were primarily based on the vendors' recommendations and phantoms. SGRT was mainly implemented in breast RT (116/136), with strong but diverse representation of other sites. Many (58/135) reported at least partial elimination of skin-marks and a third (43/126) used open-masks. The most common imaging protocol reported included the combination of radiographic imaging with SGRT. Patient positioning (115/136), motion management (104/136) and DIBH (99/136) were the main applications.Main barriers to broader application were cost, system integration issues and lack of demonstrated clinical value. A lack of guidelines in terms of QA of the system was highlighted. Conclusions This overview of the SGRT status has the potential to support users, vendors and organisations in the development of practices, products and guidelines.
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Affiliation(s)
- V Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg, Germany
| | - M Gober
- Department of Radiation Oncology, Medical University of Vienna, Austria.,Institute for Radiation Oncology and Radiotherapy, Landesklinikum Wiener Neustadt, Austria
| | - F Moura
- Hospital CUF Descobertas, Department of Radiation Oncology, Lisbon, Portugal
| | - A Webster
- Radiotherapy and Proton Beam Therapy, University College Hospital, London, United Kingdom
| | - M Oellers
- MAASTRO Clinic, Department of Medical Physics, Maastricht, the Netherlands
| | - M Ramtohul
- Department of Medical Physics, Queen Elizabeth Hospital, University Hospitals Birmingham
| | - M Kügele
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Medical Radiation Physics, Lund University, Lund, Sweden
| | - P Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M Buschmann
- Department of Radiation Oncology, Medical University of Vienna, Austria
| | - G Anastasi
- St. Luke's Cancer Centre, Royal Surrey Foundation Trust, Radiotherapy Physics, United Kingdom
| | - E Steiner
- Institute for Radiation Oncology and Radiotherapy, Landesklinikum Wiener Neustadt, Austria
| | - H Al-Hallaq
- Department of Radiation and Cellular Oncology, University of Chicago, USA
| | - J Lehmann
- Radiation Oncology Department, Calvary Mater Newcastle, Australia.,School of Information and Physical Sciences, University of Newcastle, Callaghan, Australia.,Institute of Medical Physics, University of Sydney, Australia
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Grimbergen G, Eijkelenkamp H, Heerkens HD, Raaymakers BW, Intven MPW, Meijer GJ. Intrafraction pancreatic tumor motion patterns during ungated magnetic resonance guided radiotherapy with an abdominal corset. Phys Imaging Radiat Oncol 2022; 21:1-5. [PMID: 35005257 PMCID: PMC8715205 DOI: 10.1016/j.phro.2021.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 12/25/2022] Open
Abstract
Background Stereotactic body radiotherapy (SBRT) has been shown to be a promising therapy for unresectable pancreatic tumors. However, intrafraction motion, caused by respiratory motion and organ drift, is one of the main concerns for efficient dose delivery in ungated upper abdominal radiotherapy. The aim of this study was to analyze the intrafraction gross tumor volume (GTV) motion in a clinical cohort. Materials and methods We included 13 patients that underwent online adaptive magnetic resonance (MR)-guided SBRT for malignancies in the pancreatic region (5 × 8 Gy). An abdominal corset was fitted in order to reduce the abdominal respiratory motion. Coronal and sagittal cine magnetic resonance images of the tumor region were made at 2 Hz during the entire beam-on time of each fraction. We used deformable image registration to obtain GTV motion profiles in all three directions, which were subsequently high-pass and low-pass filtered to isolate the motion caused by respiratory motion and baseline drift, respectively. Results The mean (SD) respiratory amplitudes were 4.2 (1.9) mm cranio-caudal (CC), 2.3 (1.1) mm ventral-dorsal (AP) and 1.4 (0.6) mm left–right (LR), with low variability within patients. The mean (SD) maximum baseline drifts were 1.2 (1.1) mm CC, 0.5 (0.4) mm AP and 0.5 (0.3) mm LR. The mean (SD) minimum baseline drifts were −0.7 (0.5) mm CC, −0.6 (0.5) mm AP and −0.5 (0.4) mm LR. Conclusion Overall tumor motion during treatment was small and interfractionally stable. These findings show that high-precision ungated MR-guided SBRT is feasible with an abdominal corset.
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Affiliation(s)
- Guus Grimbergen
- Department of Radiation Oncology, University Medical Center Utrecht, the Netherlands
| | - Hidde Eijkelenkamp
- Department of Radiation Oncology, University Medical Center Utrecht, the Netherlands
| | - Hanne D Heerkens
- Department of Radiation Oncology, University Medical Center Utrecht, the Netherlands
| | - Bas W Raaymakers
- Department of Radiation Oncology, University Medical Center Utrecht, the Netherlands
| | - Martijn P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, the Netherlands
| | - Gert J Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, the Netherlands
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21
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Sharma M, Nano TF, Akkati M, Milano MT, Morin O, Feng M. A systematic review and meta-analysis of liver tumor position variability during SBRT using various motion management and IGRT strategies. Radiother Oncol 2021; 166:195-202. [PMID: 34843841 DOI: 10.1016/j.radonc.2021.11.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE To suggest PTV margins for liver SBRT with different motion management strategies based on a systematic review and meta-analysis. METHODS In accordance with Preferred-Reporting-Items-for-Systematic-Reviews-and-Meta-Analyses (PRISMA), a systematic review in PubMed, Embase and Medline databases was performed for liver tumor position variability. From an initial 533 studies published before October 2020, 36 studies were categorized as 18 free-breathing (FB; npatients = 401), 9 abdominal compression (AC; npatients = 145) and 9 breath-hold (BH; npatients = 126). A meta-analysis was performed on inter- and intra-fraction position variability to report weighted-mean with 95% confidence interval (CI95) in superior-inferior (SI), left-right (LR) and anterior-posterior (AP) directions. Furthermore, weighted-mean ITV margins were computed for FB (nstudies = 15, npatients = 373) and AC (nstudies = 6, npatients = 97) and PTV margins were computed for FB (nstudies = 6, npatients = 95), AC (nstudies = 7, npatients = 106) and BH (nstudies = 8, npatients = 133). RESULTS The FB weighted-mean intra-fraction variability, ITV margins and weighted-standard-deviation in mm were SI-9.7, CI95 = 9.3-10.1, 13.5 ± 4.9; LR-5.4, CI95 = 5.3-5.6, 7.3 ± 7.9; and AP-4.2, CI95 = 4.0-4.4, 6.3 ± 7.6. The inter-fraction-based results were SI-4.7, CI95 = 4.3-5.1, 5.7 ± 1.7; LR-1.4, CI95 = 1.1-1.6, 3.6 ± 2.7; and AP-2.8, CI95 = 2.5-3.1, 4.8 ± 2.1. For AC intra-fraction results in mm were SI-1.8, CI95 = 1.6-2.0, 2.6 ± 1.2; LR-0.7, CI95 = 0.6-0.8, 1.7 ± 1.5; and AP-0.9, CI95 = 0.8-1.0, 1.9 ± 1.7. The inter-fraction results were SI-2.6, CI95 = 2.3-3.0, 5.2 ± 2.9; LR-1.9, CI95 = 1.7-2.1, 4.0 ± 2.2; and AP-2.9, CI95 = 2.5-3.2, 5.8 ± 2.7. For BH the inter-fraction variability, and the weighted-mean PTV margins and weighted-standard-deviation in mm were SI-2.4, CI95 = 2.1-2.7, 5.6 ± 2.9; LR-1.8, CI95 = 1.3-2.2, 5.5 ± 1.7; and AP-1.4; CI95 = 1.2-1.7, 6.1 ± 2.1. CONCLUSION Our meta-analysis suggests a symmetric weighted-mean PTV margin of 6 mm might be appropriate for BH. For AC and FB, asymmetric PTV margins (weighted-mean margin of 4 mm (AP), 6 mm (SI/LR)) might be appropriate. For FB, if larger (>ITV margin) intra-fraction variability observed, the additional intra- and inter-fraction variability should be accounted in the PTV margin.
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Affiliation(s)
- Manju Sharma
- University of California, San Francisco, United States.
| | - Tomi F Nano
- University of California, San Francisco, United States
| | | | | | - Olivier Morin
- University of California, San Francisco, United States
| | - Mary Feng
- University of California, San Francisco, United States
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Rodriguez LL, Kotecha R, Tom MC, Chuong MD, Contreras JA, Romaguera T, Alvarez D, McCulloch J, Herrera R, Hernandez RJ, Mercado J, Mehta MP, Gutierrez AN, Mittauer KE. CT-guided versus MR-guided radiotherapy: Impact on gastrointestinal sparing in adrenal stereotactic body radiotherapy. Radiother Oncol 2021; 166:101-9. [PMID: 34843842 DOI: 10.1016/j.radonc.2021.11.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE To quantify the indication for adaptive, gated breath-hold (BH) MR-guided radiotherapy (MRgRTBH) versus BH or free-breathing (FB) CT-based image-guided radiotherapy (CT-IGRT) for the ablative treatment of adrenal malignancies. MATERIALS AND METHODS Twenty adrenal patients underwent adaptive IMRT MRgRTBH to a median dose of 50 Gy/5 fractions. Each patient was replanned for VMAT CT-IGRTBH and CT-IGRTFB on a c-arm linac. Only CT-IGRTFB used an ITV, summed from GTVs of all phases of the 4DCT respiratory evaluation. All used the same 5 mm GTV/ITV to PTV expansion. Metrics evaluated included: target volume and coverage, conformality, mean ipsilateral kidney and 0.5 cc gastrointestinal organ-at-risk (OAR) doses (D0.5cc). Adaptive dose for MRgRTBH and predicted dose (i.e., initial plan re-calculated on anatomy of the day) was performed for CT-IGRTBH and MRgRTBH to assess frequency of OAR violations and coverage reductions for each fraction. RESULTS The more common VMAT CT-IGRTFB, with its significantly larger target volumes, proved inferior to MRgRTBH in mean PTV and ITV/GTV coverage, as well as small bowel D0.5cc. Conversely, VMAT CT-IGRTBH delivered a dosimetrically superior initial plan in terms of statistically significant (p ≤ 0.02) improvements in target coverage, conformality and D0.5cc to the large bowel, duodenum and mean ipsilateral kidney compared to IMRT MRgRTBH. However, non-adaptive CT-IGRTBH had a 71.8% frequency of predicted indications for adaptation and was 2.8 times more likely to experience a coverage reduction in PTV D95% than predicted for MRgRTBH. CONCLUSION Breath-hold VMAT radiotherapy provides superior target coverage and conformality over MRgRTBH, but the ability of MRgRTBH to safely provide ablative doses to adrenal lesions near mobile luminal OAR through adaptation and direct, real-time motion tracking is unmatched.
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23
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Gaudreault M, Siva S, Kron T, Hardcastle N. Reducing the impact on renal function of kidney SABR through management of respiratory motion. Phys Med 2021; 89:72-79. [PMID: 34352678 DOI: 10.1016/j.ejmp.2021.07.020] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Stereotactic ablative body radiotherapy (SABR) is as a viable treatment option to treat kidney cancer. This study quantifies dose reduction to non-tumour ipsilateral kidney and estimated renal function gain from elimination of respiratory motion. METHODS We reviewed 62 previously treated kidney SABR patients. The gross tumour volume (GTV) was segmented in each phase of a four-dimensional CT (4DCT). Tumour motion amplitude (TMA) was obtained from the GTV centroid on each phase. Low modulation, motion managed (MM) plans were generated on the exhale phase image. Internal target volume (ITV)-based plans were generated on the 4DCT average intensity projection. To estimate delivered kidney dose, the ITV-based plan was copied ten times to the exhale phase image, with isocentre located at the GTV centroid position in each phase. The dose was calculated and averaged to result in non-motion managed plans. Difference in ipsilateral kidney volume receiving 50% of the prescription dose (V50%) and estimated glomerular filtration rate (GFR) change were compared between ITV and MM plans. RESULTS The mean ± st.dev. TMA was 0.79 ± 0.49 cm. Removing respiratory motion reduced ipsilateral kidney V50% (slope of the difference = 12 cc/cm of TMA, Pearson-r = 0.69, p-value <10-9), and estimated GFR was improved (slope = 4.4 %/cm of TMA, Pearson-r = 0.85, p-value < 10-10). CONCLUSIONS We have quantified the improvement in healthy kidney dose when removing respiratory motion from kidney SABR plans, and demonstrated an expected gain in GFR of 4.4 %/cm of motion removed.
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Affiliation(s)
- Mathieu Gaudreault
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia.
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia; Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia; Centre for Medical Radiation Physics, University of Wollongong, NSW 2522, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria 3000, Australia; Centre for Medical Radiation Physics, University of Wollongong, NSW 2522, Australia
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Mu Z, Wang Q, Guo C, Feng Y, Gu H, Zhai Z, Wu J, He X. The first internal electromagnetic motion monitoring implementation for stereotactic liver radiotherapy in China: procedures and preliminary results. J Cancer Res Clin Oncol 2021. [PMID: 34226975 DOI: 10.1007/s00432-021-03726-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Respiratory motion may compromise the dose delivery accuracy in liver stereotactic body radiation therapy (SBRT). Motion management can improve treatment delivery. However, external surrogate signal may be unstable and inaccurate. This study reports the first case of liver SBRT based on internal electromagnetic motion monitoring (Calypso, Varian Medical Systems, USA) in China. MATERIALS AND METHODS The patient with a primary liver cancer was treated with respiratory-gated SBRT guided by three implanted electromagnetic transponders. The treatment was carried out in breath-hold end-exhale with beam-on when the centroid of the three transponders drifted within 5 mm (left-right (LR), anterior-posterior (AP) and cranio-caudal (CC) directions) from the planned position. The motion monitoring treatments were delivered in breath-hold end-exhale mode with the energy of 6 MV in FFF mode with 1200 monitor units (MU) per minute. For each fraction, QA results, intertransponder distances, geometric checks as well as tumor motion logs were explicitly recorded. RESULTS Comparing with the plan data, distance variances between each two transponders were - 0.56 ± 0.32 mm, 0.17 ± 0.33 mm and - 0.82 ± 0.68 mm. Geometric residual, the pitch, roll and yaw angles were 0.48 ± 0.21 mm (threshold 2.0 mm), 2.17° ± 1.85° (threshold 10°), - 2.42° ± 1.51° (threshold 10°) and 1.67° ± 1.07° (threshold 10°), respectively. The delivery time of the five fields were 13.8 s, 13.1 s, 11.2 s, 11.6 s, and 11.6 s with the average value of 12.3 ± 1.1 s. Treatment duration of each fraction ranged from 6.2 to 21.4 min, with the average value of 11.3 ± 5.0 min. CONCLUSIONS The first case of liver SBRT patient of China based on internal electromagnetic motion monitoring was performed. The system had a high tracking accuracy, and it did not delay the treatment time. In addition, the patient did not show any severe side effects except for grade I myelotoxicity. The internal electromagnetic motion monitoring system provides a real-time and direct way to track liver tumor targets.
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Bednarz BP, Jupitz S, Lee W, Mills D, Chan H, Fiorillo T, Sabitini J, Shoudy D, Patel A, Mitra J, Sarcar S, Wang B, Shepard A, Matrosic C, Holmes J, Culberson W, Bassetti M, Hill P, McMillan A, Zagzebski J, Smith LS, Foo TK. First-in-human imaging using a MR-compatible e4D ultrasound probe for motion management of radiotherapy. Phys Med 2021; 88:104-110. [PMID: 34218199 DOI: 10.1016/j.ejmp.2021.06.017] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 06/08/2021] [Accepted: 06/21/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Respiration-induced tumor or organ positional changes can impact the accuracy of external beam radiotherapy. Motion management strategies are used to account for these changes during treatment. The authors report on the development, testing, and first-in-human evaluation of an electronic 4D (e4D) MR-compatible ultrasound probe that was designed for hands-free operation in a MR and linear accelerator (LINAC) environment. METHODS Ultrasound components were evaluated for MR compatibility. Electromagnetic interference (EMI) shielding was used to enclose the entire probe and a factory-fabricated cable shielded with copper braids was integrated into the probe. A series of simultaneous ultrasound and MR scans were acquired and analyzed in five healthy volunteers. RESULTS The ultrasound probe led to minor susceptibility artifacts in the MR images immediately proximal to the ultrasound probe at a depth of <10 mm. Ultrasound and MR-based motion traces that were derived by tracking the salient motion of endogenous target structures in the superior-inferior (SI) direction demonstrated good concordance (Pearson correlation coefficients of 0.95-0.98) between the ultrasound and MRI datasets. CONCLUSION We have demonstrated that our hands-free, e4D probe can acquire ultrasound images during a MR acquisition at frame rates of approximately 4 frames per second (fps) without impacting either the MR or ultrasound image quality. This use of this technology for interventional procedures (e.g. biopsies and drug delivery) and motion compensation during imaging are also being explored.
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Affiliation(s)
- Bryan P Bednarz
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States.
| | - Sydney Jupitz
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Warren Lee
- GE Global Research, Niskayuna, NY 12309, United States
| | - David Mills
- GE Global Research, Niskayuna, NY 12309, United States
| | - Heather Chan
- GE Global Research, Niskayuna, NY 12309, United States
| | | | | | - David Shoudy
- GE Global Research, Niskayuna, NY 12309, United States
| | - Aqsa Patel
- GE Global Research, Niskayuna, NY 12309, United States
| | - Jhimli Mitra
- GE Global Research, Niskayuna, NY 12309, United States
| | | | - Bo Wang
- GE Global Research, Niskayuna, NY 12309, United States
| | - Andrew Shepard
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States; Department of Radiation Oncology, University of Iowa, Iowa City, IA 52242, United States
| | - Charles Matrosic
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States; Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, United States
| | - James Holmes
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Wesley Culberson
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Michael Bassetti
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Patrick Hill
- Department of Human Oncology, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Alan McMillan
- Department of Radiology, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - James Zagzebski
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - L Scott Smith
- GE Global Research, Niskayuna, NY 12309, United States
| | - Thomas K Foo
- GE Global Research, Niskayuna, NY 12309, United States
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Matrosic CK, Culberson W, Shepard A, Jupitz S, Bednarz B. 3D dosimetric validation of ultrasound-guided radiotherapy with a dynamically deformable abdominal phantom. Phys Med 2021; 84:159-167. [PMID: 33901860 DOI: 10.1016/j.ejmp.2021.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The purpose of this study was to dosimetrically benchmark gel dosimetry measurements in a dynamically deformable abdominal phantom for intrafraction image guidance through a multi-dosimeter comparison. Once benchmarked, the study aimed to perform a proof-of-principle study for validation measurements of an ultrasound image-guided radiotherapy delivery system. METHODS The phantom was dosimetrically benchmarked by delivering a liver VMAT plan and measuring the 3D dose distribution with DEFGEL dosimeters. Measured doses were compared to the treatment planning system and measurements acquired with radiochromic film and an ion chamber. The ultrasound image guidance validation was performed for a hands-free ultrasound transducer for the tracking of liver motion during treatment. RESULTS Gel dosimeters were compared to the TPS and film measurements, showing good qualitative dose distribution matches, low γ values through most of the high dose region, and average 3%/5 mm γ-analysis pass rates of 99.2%(0.8%) and 90.1%(0.8%), respectively. Gel dosimeter measurements matched ion chamber measurements within 3%. The image guidance validation study showed the measurement of the treatment delivery improvements due to the inclusion of the ultrasound image guidance system. Good qualitative matching of dose distributions and improvements of the γ-analysis results were observed for the ultrasound-gated dosimeter compared to the ungated dosimeter. CONCLUSIONS DEFGEL dosimeters in phantom showed good agreement with the planned dose and other dosimeters for dosimetric benchmarking. Ultrasound image guidance validation measurements showed good proof-of-principle of the utility of the phantom system as a method of validating ultrasound-based image guidance systems and potentially other image guidance methods.
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Affiliation(s)
- Charles K Matrosic
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States.
| | - Wesley Culberson
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Andrew Shepard
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Sydney Jupitz
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
| | - Bryan Bednarz
- School of Medicine and Public Health, Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, United States
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González-Sanchis A, Brualla-González L, Fuster-Diana C, Gordo-Partearroyo JC, Piñeiro-Vidal T, García-Hernandez T, López-Torrecilla JL. Surface-guided radiation therapy for breast cancer: more precise positioning. Clin Transl Oncol 2021; 23:2120-2126. [PMID: 33840013 DOI: 10.1007/s12094-021-02617-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hypofractionated radiation therapy for breast cancer requires highly precise delivery through the use of image-guided radiotherapy (IGRT). Surface-guided radiation therapy (SGRT) is being increasingly used for patient positioning in breast radiotherapy. We aimed to assess the role of SGRT for verification of breast radiotherapy and the tumour bed. MATERIALS AND METHODS Prospective study of 252 patients with early stage breast cancer. A total of 1170 determinations of daily positioning were performed. Breast surface positioning was determined with SGRT (AlignRT) and correlated with the surgical clips in the tumour bed, verified by IGRT (ExacTrac). RESULTS SGRT improved surface matching by a mean of 5.3 points compared to conventional skin markers (98.0 vs. 92.7), a statistically significant difference (p < 0.01, Wilcoxon Test). For surface matching values > 95%, ≥ 3 clips coincided in 99.7% of the determinations and all markers coincided in 92.5%. For surface matching rates > 90%, the location of ≥ 3 clips coincided in 99.55% of determinations. CONCLUSIONS SGRT improves patient positioning accuracy compared to skin markers. Optimal breast SGRT can accurately verify the localisation of the tumour bed, ensuring matching with ≥ 3 surgical clips. SGRT can eliminate unwanted radiation from IGRT verification systems.
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Affiliation(s)
- A González-Sanchis
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia (CHGUV), Avenida Tres Cruces, No. 2, 46014, Valencia, Spain.
| | - L Brualla-González
- Department of Radiophysics, ERESA, Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - C Fuster-Diana
- Department of Surgery, Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - J C Gordo-Partearroyo
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia (CHGUV), Avenida Tres Cruces, No. 2, 46014, Valencia, Spain
| | - T Piñeiro-Vidal
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia (CHGUV), Avenida Tres Cruces, No. 2, 46014, Valencia, Spain
| | - T García-Hernandez
- Department of Radiophysics, ERESA, Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - J L López-Torrecilla
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia (CHGUV), Avenida Tres Cruces, No. 2, 46014, Valencia, Spain
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Hill CS, Han-Oh S, Cheng Z, Wang KKH, Meyer JJ, Herman JM, Narang AK. Fiducial-based image-guided SBRT for pancreatic adenocarcinoma: Does inter-and intra-fraction treatment variation warrant adaptive therapy? Radiat Oncol 2021; 16:53. [PMID: 33741015 PMCID: PMC7980583 DOI: 10.1186/s13014-021-01782-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/10/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Variation in target positioning represents a challenge to set-up reproducibility and reliability of dose delivery with stereotactic body radiation therapy (SBRT) for pancreatic adenocarcinoma (PDAC). While on-board imaging for fiducial matching allows for daily shifts to optimize target positioning, the magnitude of the shift as a result of inter- and intra-fraction variation may directly impact target coverage and dose to organs-at-risk. Herein, we characterize the variation patterns for PDAC patients treated at a high-volume institution with SBRT. Methods We reviewed 30 consecutive patients who received SBRT using active breathing coordination (ABC). Patients were aligned to bone and then subsequently shifted to fiducials. Inter-fraction and intra-fraction scans were reviewed to quantify the mean and maximum shift along each axis, and the shift magnitude. A linear regression model was conducted to investigate the relationship between the inter- and intra-fraction shifts. Results The mean inter-fraction shift in the LR, AP, and SI axes was 3.1 ± 1.8 mm, 2.9 ± 1.7 mm, and 3.5 ± 2.2 mm, respectively, and the mean vector shift was 6.4 ± 2.3 mm. The mean intra-fraction shift in the LR, AP, and SI directions were 2.0 ± 0.9 mm, 2.0 ± 1.3 mm, and 2.3 ± 1.4 mm, respectively, and the mean vector shift was 4.3 ± 1.8 mm. A linear regression model showed a significant relationship between the inter- and intra-fraction shift in the AP and SI axis and the shift magnitude. Conclusions Clinically significant inter- and intra-fraction variation occurs during treatment of PDAC with SBRT even with a comprehensive motion management strategy that utilizes ABC. Future studies to investigate how these variations could lead to variation in the dose to the target and OAR should be investigated. Strategies to mitigate the dosimetric impact, including real time imaging and adaptive therapy, in select cases should be considered. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01782-w.
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Affiliation(s)
- Colin S Hill
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231, USA.
| | - Sarah Han-Oh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231, USA
| | - Zhi Cheng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231, USA
| | - Ken Kang-Hsin Wang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231, USA
| | - Jeffrey J Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231, USA
| | - Joseph M Herman
- Radiation Medicine, Zucker School of Medicine At Hofstra/Northwell, Lake Success, USA
| | - Amol K Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231, USA
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Dechambre D, Vander Veken L, Delor A, Sterpin E, Vanneste F, Geets X. Feasibility of a TPS-integrated method to incorporate tumor motion in the margin recipe. Med Dosim 2021; 46:253-258. [PMID: 33685768 DOI: 10.1016/j.meddos.2021.02.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/14/2021] [Accepted: 02/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE There are several alternatives to the widespread ITV strategy in order to account for breathing-induced motion in PTV margins. The most sophisticated one includes the generation of a motion-compensated CT scan with the CTV placed in its average position - the mid-position approach (MidP). In such configuration, PTV margins integrate breathing as another random error. Despite overall irradiated volume reduction, such approach is barely used in clinical practice because of its dependence to deformable registration and its unavailability in commercial treatment planning systems. As an alternative, the mid-ventilation approach (MidV) selects the phase in the 4D-CT scan that is the closest to the MidP, with a residual error accounted for in the PTV margin. We propose a treatment planning system-integrated strategy, aiming at better approximating the MidP approach without its drawbacks: Hybrid MidV-MidP approach, i.e., the delineation on the MidV-CT and translation at the mid-position coordinates using treatment planning system built-in capabilities. MATERIAL AND METHODS Forty-five lung lesions treated with stereotactic radiotherapy were selected. PTV was defined using MidP, MidV, Hybrid MidV-MidP and ITV strategies. Margin definitions were adapted and resulting PTVs were compared. RESULTS Hybrid MidV-MidP showed similar target volume and location than the MidP and confirmed that margin-incorporated tumor motion strategies lead to significantly smaller PTVs than the ITV with mean reduction of 26 ± 7%. CONCLUSION We report on the successful implementation of a pseudo-MidP solution without its inherent drawbacks. It answers the need for TPS-embedded tumor motion range identification and related margin's component calculation.
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Affiliation(s)
- David Dechambre
- Cliniques Universitaires Saint-Luc, Radiotherapy Department, Brussels, Belgium.
| | - Loïc Vander Veken
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium
| | - Antoine Delor
- Cliniques Universitaires Saint-Luc, Radiotherapy Department, Brussels, Belgium
| | - Edmond Sterpin
- Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; KU Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | - Françoise Vanneste
- Cliniques Universitaires Saint-Luc, Radiotherapy Department, Brussels, Belgium
| | - Xavier Geets
- Cliniques Universitaires Saint-Luc, Radiotherapy Department, Brussels, Belgium
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Siregar H, Bäumer C, Blanck O, Chan M, Engwall E, Plaude S, Spaan B, Timmermann B, Wulff J. Mitigation of motion effects in pencil-beam scanning - Impact of repainting on 4D robustly optimized proton treatment plans for hepatocellular carcinoma. Z Med Phys 2022; 32:63-73. [PMID: 33131995 DOI: 10.1016/j.zemedi.2020.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/29/2020] [Accepted: 08/14/2020] [Indexed: 12/27/2022]
Abstract
Proton fields delivered by the active scanning technique can be interfered with the intrafractional motion. This in-silico study seeks to mitigate the dosimetric impacts of motion artifacts, especially its interplay with the time-modulated dose delivery. Here four-dimensional (4d) robust optimization and dose repainting, which is the multiple application of the same field with reduced fluence, were combined. Two types of repainting were considered: layered and volumetric repainting. The time-resolved dose calculation, which is necessary to quantify the interplay effect, was integrated into the treatment planning system and validated. Nine clinical cases of hepatocellular carcinoma (HCC) showing motion in the range of 0.4-1.5cm were studied. It was found that the repainted delivery of 4D robustly optimized plans reduced the impact of interplay effect as quantified by the homogeneity index within the clinical target volume (CTV) to a tolerable level. Similarly, the fractional over- and underdosage was reduced sufficiently for some HCC cases to achieve the purpose of motion management. This holds true for both investigated types of repainting with small dosimetric advantages of volume repainting over layered repainting. Volume repainting, however, cannot be applied clinically in proton centers with slow energy changes. Thus, it served as a reference in the in-silico evaluation. It is recommended to perform the dynamic dose calculation for individual cases to judge if robust optimization in conjunction with repainting is sufficient to keep the interplay effect within bounds.
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Dhont J, Verellen D, Mollaert I, Vanreusel V, Vandemeulebroucke J. RealDRR - Rendering of realistic digitally reconstructed radiographs using locally trained image-to-image translation. Radiother Oncol 2020; 153:213-219. [PMID: 33039426 DOI: 10.1016/j.radonc.2020.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Digitally reconstructed radiographs (DRRs) represent valuable patient-specific pre-treatment training data for tumor tracking algorithms. However, using current rendering methods, the similarity of the DRRs to real X-ray images is limited, requires time-consuming measurements and/or are computationally expensive. In this study we present RealDRR, a novel framework for highly realistic and computationally efficient DRR rendering. MATERIALS AND METHODS RealDRR consists of two components applied sequentially to render a DRR. First, a raytracer is applied for forward projection from 3D CT data to a 2D image. Second, a conditional Generative Adverserial Network (cGAN) is applied to translate the 2D forward projection to a realistic 2D DRR. The planning CT and CBCT projections from a CIRS thorax phantom and 6 radiotherapy patients (3 prostate, 3 brain) were split in training and test sets for evaluating the intra-patient, inter-patient and inter-anatomical region generalization performance of the trained framework. Several image similarity metrics, as well as a verification based on template matching, were used between the rendered DRRs and respective CBCT projections in the test sets, and results were compared to those of a current state-of-the-art DRR rendering method. RESULTS When trained on 800 CBCT projection images from two patients and tested on a third unseen patient from either anatomical region, RealDRR outperformed the current state-of-the-art with statistical significance on all metrics (two-sample t-test, p < 0.05). Once trained, the framework is able to render 100 highly realistic DRRs in under two minutes. CONCLUSION A novel framework for realistic and efficient DRR rendering was proposed. As the framework requires a reasonable amount of computational resources, the internal parameters can be tailored to imaging systems and protocols through on-site training on retrospective imaging data.
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Affiliation(s)
- Jennifer Dhont
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium; Imec, Leuven, Belgium; Faculty of Medicine and Pharmaceutical Sciences, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Dirk Verellen
- Iridium Kankernetwerk, Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | | | | | - Jef Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel, Brussels, Belgium; Imec, Leuven, Belgium
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Elangovan A, Husain S, McGeahy P, Roumeliotis M, Wu CHD, Wolfe N, Meyer T, Watt E, Martell K, Thind K. Implementation of high-dose-rate brachytherapy for prostatic carcinoma in an unshielded operating room facility. Brachytherapy 2020; 20:58-65. [PMID: 33008763 DOI: 10.1016/j.brachy.2020.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/26/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of the study was to describe our approach towards safe delivery of single-fraction high-dose-rate (HDR) brachytherapy (BT) boost in patients with prostate cancer in the setting of an unshielded operating room (OR). METHODS AND MATERIALS A total of 95 patients received 15 Gy HDR BT boost. The procedure involved transrectal ultrasound-based catheter insertion and planning in the OR, after which the patient was moved to a shielded treatment room for radiation. This required three vital components: (1) an OR table capable of transporting the patient in lithotomy position, (2) robust motion management checks to ensure reproducibility of prostate and catheter positions in the treatment room before radiation delivery, (3) remote monitoring of patient vitals while under anesthesia, during the radiation. Initial viability of this approach was confirmed by assessing acute toxicities using the Common Terminology Criteria for Adverse Events v4.0 and American Urologic Association symptom scores. RESULTS We found good stability in prostate and catheter position, with less than 1 mm shifts in each direction due to patient transfer. The median baseline American Urologic Association score was 7 (3-11), which increased to 12 (7-17) at 4 weeks and 9 (5-14) at 3 months (p = 0.003). Common Terminology Criteria for Adverse Events ≥ grade 2 genitourinary and gastrointestinal toxicities were experienced by 7% and 0% patients, respectively, at 3 months posttreatment completion. CONCLUSIONS Single-fraction HDR prostate BT can be delivered safely in an unshielded OR facility with a distant shielded treatment room using rigorous motion management checks and supplementary procedural equipment.
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Affiliation(s)
- Arun Elangovan
- Department of Oncology, Radiation Oncology, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada.
| | - Siraj Husain
- Department of Oncology, Radiation Oncology, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada
| | - Philip McGeahy
- Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Calgary, AB, Canada
| | - Michael Roumeliotis
- Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Calgary, AB, Canada
| | - Che Hsuan David Wu
- Department of Oncology, Radiation Oncology, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada
| | | | - Tyler Meyer
- Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Calgary, AB, Canada
| | - Elizabeth Watt
- Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Calgary, AB, Canada
| | - Kevin Martell
- Department of Oncology, Radiation Oncology, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada
| | - Kundan Thind
- Tom Baker Cancer Centre, Calgary, AB, Canada; University of Calgary, Calgary, AB, Canada; Department of Medical Physics, Calgary, AB, Canada
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Freislederer P, Kügele M, Öllers M, Swinnen A, Sauer TO, Bert C, Giantsoudi D, Corradini S, Batista V. Recent advanced in Surface Guided Radiation Therapy. Radiat Oncol 2020; 15:187. [PMID: 32736570 PMCID: PMC7393906 DOI: 10.1186/s13014-020-01629-w] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 01/27/2023] Open
Abstract
The growing acceptance and recognition of Surface Guided Radiation Therapy (SGRT) as a promising imaging technique has supported its recent spread in a large number of radiation oncology facilities. Although this technology is not new, many aspects of it have only recently been exploited. This review focuses on the latest SGRT developments, both in the field of general clinical applications and special techniques.SGRT has a wide range of applications, including patient positioning with real-time feedback, patient monitoring throughout the treatment fraction, and motion management (as beam-gating in free-breathing or deep-inspiration breath-hold). Special radiotherapy modalities such as accelerated partial breast irradiation, particle radiotherapy, and pediatrics are the most recent SGRT developments.The fact that SGRT is nowadays used at various body sites has resulted in the need to adapt SGRT workflows to each body site. Current SGRT applications range from traditional breast irradiation, to thoracic, abdominal, or pelvic tumor sites, and include intracranial localizations.Following the latest SGRT applications and their specifications/requirements, a stricter quality assurance program needs to be ensured. Recent publications highlight the need to adapt quality assurance to the radiotherapy equipment type, SGRT technology, anatomic treatment sites, and clinical workflows, which results in a complex and extensive set of tests.Moreover, this review gives an outlook on the leading research trends. In particular, the potential to use deformable surfaces as motion surrogates, to use SGRT to detect anatomical variations along the treatment course, and to help in the establishment of personalized patient treatment (optimized margins and motion management strategies) are increasingly important research topics. SGRT is also emerging in the field of patient safety and integrates measures to reduce common radiotherapeutic risk events (e.g. facial and treatment accessories recognition).This review covers the latest clinical practices of SGRT and provides an outlook on potential applications of this imaging technique. It is intended to provide guidance for new users during the implementation, while triggering experienced users to further explore SGRT applications.
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Affiliation(s)
- P. Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M. Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - M. Öllers
- Maastricht Radiation Oncology (MAASTRO), Maastricht, the Netherlands
| | - A. Swinnen
- Maastricht Radiation Oncology (MAASTRO), Maastricht, the Netherlands
| | - T.-O. Sauer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C. Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - D. Giantsoudi
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - S. Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - V. Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
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Huang C, Shiue K, Bartlett G, Agrawal N, Arbab M, Maxim P, DesRosiers C, Mereniuk T, Ellsworth S, Rhome R, Holmes J, Langer M, Zellars R, Lautenschlaeger T. Exploiting tumor position differences between deep inspiration and expiration in lung stereotactic body radiation therapy planning. Med Dosim 2020; 45:293-297. [PMID: 32249105 DOI: 10.1016/j.meddos.2020.02.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 02/13/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE We demonstrate proof of principle that normal tissue doses can be greatly reduced in lung stereotactic body radiation therapy (SBRT) for mobile tumors, if the delivered dose is split between opposite respiratory states. METHODS Patients that underwent 5 fraction lung SBRT at our institution and had deep inspiration breath hold (DIBH) and free breathing 4D computed tomography scans were included. Volumetric modulated arc therapy plans were generated on both respiratory phases and a third composite plan was generated delivering half the dose using the DIBH plan and the other half using the expiratory phase plan for each fraction. Computed tomography scans for the composite plan were fused based on ribs adjacent to the tumor to evaluate the dose volume histogram of critical structures. RESULTS Four patients with 4 total tumors had requisite planning scans available. Tumor size was between 0.7 to 2.9 cm and tumor movement 1.4 to 2.9 cm. Median reduction in the chest wall (CW) V30Gy for the composite plan was 74.6% (range 33.7 to 100%), 76.9% (range 32.9 to 100%), and 89.3% (range 69.5 to 100%) compared to the DIBH, expiration phase, and free breathing plans, respectively. Median reduction in CW maximum dose for the composite plan was 23.3% (range 0.27% to 46.4%), 23.5% (range 3.2 to 48.2%), and 23.4% (range 0.27% to 48.4%) compared to the DIBH, expiration phase, and free breathing plans, respectively. Greater reduction in CW maximum dose was observed when patients had no overlap in planning target volumes between DIBH and expiration phases (median reduction 43.9% for no overlap vs 2.7% with overlap). Between all plans, lung V20Gy absolute differences were within 1.3%. For 2 of 4 patients, the composite plan met constraints for 3 fraction SBRT, while standard plans did not. CONCLUSIONS We conclude that composite DIBH-expiration SBRT planning has the potential to improve organ at risk sparing.
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Affiliation(s)
- Christina Huang
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Kevin Shiue
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Greg Bartlett
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Namita Agrawal
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Mona Arbab
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Peter Maxim
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Colleen DesRosiers
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Todd Mereniuk
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Susannah Ellsworth
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Ryan Rhome
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Jordan Holmes
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Mark Langer
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Richard Zellars
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN
| | - Tim Lautenschlaeger
- Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
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Magallon-Baro A, Granton PV, Milder MTW, Loi M, Zolnay AG, Nuyttens JJ, Hoogeman MS. A model-based patient selection tool to identify who may be at risk of exceeding dose tolerances during pancreatic SBRT. Radiother Oncol 2019; 141:116-122. [PMID: 31606227 DOI: 10.1016/j.radonc.2019.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/25/2019] [Revised: 09/04/2019] [Accepted: 09/19/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Locally advanced pancreatic cancer (LAPC) patients are prone to experience daily anatomical variations, which can lead to additional doses in organs-at-risk (OAR) during SBRT. A patient selection tool was developed to identify who may be at risk of exceeding dose tolerances, by quantifying the dosimetric impact of daily variations using an OAR motion model. MATERIALS AND METHODS The study included 133 CT scans from 35 LAPC patients. By following a leave-one-out approach, an OAR motion model trained with the remaining 34 subjects variations was used to simulate organ deformations on the left-out patient planning CT anatomy. Dose-volume histograms obtained from planned doses sampled on simulated organs resulted in the probability of exceeding OAR dose-constraints due to anatomical variations. Simulated probabilities were clustered with a threshold per organ according to clinical observations. If the prediction of at least one OAR was above the established thresholds, the patient was classified as being at risk. RESULTS Clinically, in 20/35 patients at least one OAR exceeded dose-constraints in the daily CTs. The model-based prediction had an accuracy of 89%, 71%, 91% in estimating the risk of exceeding dose tolerances for the duodenum, stomach and bowel, respectively. By combining the three predictions, our approach resulted in a correct patient classification for 29/35 patients (83%) when compared with clinical observations. CONCLUSIONS Our model-based patient selection tool is able to predict who might be at risk of exceeding dose-constraints during SBRT. It is a promising tool to tailor LAPC treatments, e.g. by employing online adaptive SBRT; and hence, to minimize toxicity of patients being at risk.
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Affiliation(s)
- Alba Magallon-Baro
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, The Netherlands.
| | - Patrick V Granton
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, The Netherlands
| | - Maaike T W Milder
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, The Netherlands
| | - Mauro Loi
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, The Netherlands
| | - Andras G Zolnay
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, The Netherlands
| | - Joost J Nuyttens
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, The Netherlands
| | - Mischa S Hoogeman
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, The Netherlands
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Abstract
Motion management in radiation oncology is an important aspect of modern treatment planning and delivery. Special attention has been paid to control respiratory motion in recent years. However, other medical procedures related to both diagnosis and treatment are likely to benefit from the explicit control of breathing motion. Quantitative imaging - including increasingly important tools in radiology and nuclear medicine - is among the fields where a rapid development of motion control is most likely, due to the need for quantification accuracy. Emerging treatment modalities like focussed-ultrasound tumor ablation are also likely to benefit from a significant evolution of motion control in the near future. In the present article an overview of available respiratory motion systems along with ongoing research in this area is provided. Furthermore, an attempt is made to envision some of the most expected developments in this field in the near future.
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Skouboe S, Ravkilde T, Bertholet J, Hansen R, Worm ES, Muurholm CG, Weber B, Høyer M, Poulsen PR. First clinical real-time motion-including tumor dose reconstruction during radiotherapy delivery. Radiother Oncol 2019; 139:66-71. [PMID: 31431367 DOI: 10.1016/j.radonc.2019.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 02/21/2019] [Revised: 06/25/2019] [Accepted: 07/04/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To clinically implement and characterize real-time motion-including tumor dose reconstruction during radiotherapy delivery. METHODS Seven patients with 2-3 fiducial markers implanted near liver tumors received stereotactic body radiotherapy on a conventional linear accelerator. The 3D marker motion during a setup CBCT scan was determined online from the CBCT projections and used to generate a correlation model between tumor and external marker block motion. During treatment, the correlation model was updated by kV imaging every three seconds and used for real-time tumor localization. Using streamed accelerator parameters and tumor positions, in-house developed software, DoseTracker, calculated the dose to the moving tumor in real-time assuming water density in the patient. Post-treatment, the real-time tumor localization was validated by comparison with independent marker segmentations and 3D motion estimations. Dose reconstruction was validated by comparison with treatment planning system (TPS) calculations that modeled motion as isocenter shifts and used both actual CT densities and water densities. RESULTS The real-time estimated tumor position had a mean 3D root-mean-square error of 1.7 mm (range: 0.9-2.6 mm). The motion-induced reduction in the minimum dose to 95% of the clinical target volume (CTV D95) per fraction was up to 12.3%-points. It was estimated in real-time by DoseTracker during patient treatment with a root-mean-square difference relative to the TPS of 1.3%-points (TPS CT) and 1.0%-points (TPS water). CONCLUSIONS The world's first clinical real-time motion-including tumor dose reconstruction during radiotherapy was demonstrated. This marks an important milestone for real-time in-treatment quality assurance and paves the way for real-time dose-guided treatment adaptation.
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Affiliation(s)
- Simon Skouboe
- Department of Oncology, Aarhus University Hospital, Denmark.
| | - Thomas Ravkilde
- Department of Medical Physics, Aarhus University Hospital, Denmark
| | - Jenny Bertholet
- Joint Department of Physics, The Institute of Cancer Research and the Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Rune Hansen
- Department of Medical Physics, Aarhus University Hospital, Denmark
| | | | | | - Britta Weber
- Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - Morten Høyer
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - Per Rugaard Poulsen
- Department of Oncology, Aarhus University Hospital, Denmark; Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
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Zhao W, Han B, Yang Y, Buyyounouski M, Hancock SL, Bagshaw H, Xing L. Incorporating imaging information from deep neural network layers into image guided radiation therapy (IGRT). Radiother Oncol 2019; 140:167-174. [PMID: 31302347 DOI: 10.1016/j.radonc.2019.06.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 12/07/2018] [Revised: 05/06/2019] [Accepted: 06/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE To investigate a novel markerless prostate localization strategy using a pre-trained deep learning model to interpret routine projection kilovoltage (kV) X-ray images in image-guided radiation therapy (IGRT). MATERIALS AND METHODS We developed a personalized region-based convolutional neural network to localize the prostate treatment target without implanted fiducials. To train the deep neural network (DNN), we used the patient's planning computed tomography (pCT) images with pre-delineated prostate target to generate a large amount of synthetic kV projection X-ray images in the geometry of onboard imager (OBI) system. The DNN model was evaluated by retrospectively studying 10 patients who underwent prostate IGRT. Three out of the ten patients who had implanted fiducials and the fiducials' positions in the OBI images acquired for treatment setup were examined to show the potential of the proposed method for prostate IGRT. Statistical analysis using Lin's concordance correlation coefficient was calculated to assess the results along with the difference between the digitally reconstructed radiographs (DRR) derived and DNN predicted locations of the prostate. RESULTS Differences between the predicted target positions using DNN and their actual positions are (mean ± standard deviation) 1.58 ± 0.43 mm, 1.64 ± 0.43 mm, and 1.67 ± 0.36 mm in anterior-posterior, lateral, and oblique directions, respectively. Prostate position identified on the OBI kV images is also found to be consistent with that derived from the implanted fiducials. CONCLUSIONS Highly accurate, markerless prostate localization based on deep learning is achievable. The proposed method is useful for daily patient positioning and real-time target tracking during prostate radiotherapy.
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Affiliation(s)
- Wei Zhao
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Bin Han
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Yong Yang
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Mark Buyyounouski
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Steven L Hancock
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Hilary Bagshaw
- Stanford University, Department of Radiation Oncology, Stanford, USA.
| | - Lei Xing
- Stanford University, Department of Radiation Oncology, Stanford, USA.
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Gargett M, Haddad C, Kneebone A, Booth JT, Hardcastle N. Clinical impact of removing respiratory motion during liver SABR. Radiat Oncol 2019; 14:93. [PMID: 31159840 PMCID: PMC6547575 DOI: 10.1186/s13014-019-1300-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 04/09/2019] [Accepted: 05/16/2019] [Indexed: 12/26/2022] Open
Abstract
Background Liver tumors are subject to motion with respiration, which is typically accounted for by increasing the target volume. The prescription dose is often reduced to keep the mean liver dose under a threshold level to limit the probability of radiation induced liver toxicity. A retrospective planning study was performed to determine the potential clinical gains of removal of respiratory motion from liver SABR treatment volumes, which may be achieved with gating or tumor tracking. Methods Twenty consecutive liver SABR patients were analysed. The treated PTV included the GTV in all phases of respiration (ITV) with a 5 mm margin. The goal prescription was 50Gy/5# (BED 100 Gy10) but was reduced by 2.5 Gy increments to meet liver dose constraints. Elimination of motion was modelled by contouring the GTV in the expiration phase only, with a 5 mm PTV margin. All patients were replanned using the no-motion PTV and tumor dose was escalated to higher prescription levels where feasible given organ-at-risk constraints. For the cohort of patients with metastatic disease, BED gains were correlated to increases in tumour control probability (TCP). The effect of the gradient of the TCP curve on the magnitude of TCP increase was evaluated by repeating the study for an additional prescription structure, 54Gy/3# (BED 151 Gy10). Results Correlation between PTV size and prescribed dose exists; PTVs encompassing < 10% of the liver could receive the highest prescription level. A monotonically increasing correlation (Spearman’s rho 0.771, p = 0.002) between the degree of PTV size reduction and motion vector magnitude was observed for GTV sizes <100cm3. For 11/13 patients initially planned to a decreased prescription, tumor dose escalation was possible (5.4Gy10–21.4Gy10 BED) using the no-motion PTV. Dose escalation in excess of 20 Gy10 increased the associated TCP by 5% or more. A comparison of TCP gains between the two fractionation schedules showed that, for the same patient geometry, the absolute increase in BED was the overarching factor rather than the gradient of the TCP curve. Conclusions In liver SABR treatments unable to be prescribed optimal dose due to exceeding mean liver thresholds, eliminating respiratory motion allowed dose escalation in the majority of patients studied and substantially increased TCP.
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Affiliation(s)
- M Gargett
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - C Haddad
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - A Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - J T Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia.,Institute of Medical Physics, University of Sydney, Sydney, NSW, Australia
| | - N Hardcastle
- Institute of Medical Physics, University of Sydney, Sydney, NSW, Australia.,Department of Physical Sciences, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
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Van Ooteghem G, Dasnoy-Sumell D, Lambrecht M, Reychler G, Liistro G, Sterpin E, Geets X. Mechanically-assisted non-invasive ventilation: A step forward to modulate and to improve the reproducibility of breathing-related motion in radiation therapy. Radiother Oncol 2019; 133:132-139. [PMID: 30935569 DOI: 10.1016/j.radonc.2018.12.026] [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: 06/29/2018] [Revised: 12/27/2018] [Accepted: 12/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE When using highly conformal radiotherapy techniques, a stabilized breathing pattern could greatly benefit the treatment of mobile tumours. Therefore, we assessed the feasibility of Mechanically-assisted non-invasive ventilation (MANIV) on unsedated volunteers, and its ability to stabilize and modulate the breathing pattern over time. MATERIALS AND METHODS Twelve healthy volunteers underwent 2 sessions of dynamic MRI under 4 ventilation modes: spontaneous breathing (SP), volume-controlled mode (VC) that imposes regular breathing in physiologic conditions, shallow-controlled mode (SH) that intends to lower amplitudes while increasing the breathing rate, and slow-controlled mode (SL) that mimics end-inspiratory breath-holds. The last 3 modes were achieved under respirator without sedation. The motion of the diaphragm was tracked along the breathing cycles on MRI images and expressed in position, breathing amplitude, and breathing period for intra- and inter-session analyses. In addition, end-inspiratory breath-hold duration and position stability were analysed during the SL mode. RESULTS MANIV was well-tolerated by all volunteers, without adverse event. The MRI environment led to more discomfort than MANIV itself. Compared to SP, VC and SH modes improved the inter-session reproducibility of the amplitude (by 43% and 47% respectively) and significantly stabilized the intra- and inter-session breathing rate (p < 0.001). Compared to VC, SH mode significantly reduced the intra-session mean amplitude (36%) (p < 0.002), its variability (42%) (p < 0.001), and the intra-session baseline shift (26%) (p < 0.001). The SL mode achieved end-inspiratory plateaus lasting more than 10 s. CONCLUSION MANIV offers exciting perspectives for motion management. It improves its intra- and inter-session reproducibility and should facilitate respiratory tracking, gating or margin techniques for both photon and proton treatments.
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Affiliation(s)
- Geneviève Van Ooteghem
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Cliniques Universitaires Saint Luc, Department of Radiation Oncology, Brussels, Belgium.
| | - Damien Dasnoy-Sumell
- Université Catholique de Louvain, ImagX-R, Institute of Information and Communication Technologies, Electronics and Applied Mathematics, Louvain-La-Neuve, Belgium.
| | - Maarten Lambrecht
- University Hospitals Leuven Gasthuisberg, Department of Radiation Oncology, Leuven, Belgium; Katholieke Universiteit Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium.
| | - Grégory Reychler
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ENT & Dermatologie, Brussels, Belgium.
| | - Giuseppe Liistro
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ENT & Dermatologie, Brussels, Belgium.
| | - Edmond Sterpin
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Katholieke Universiteit Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium.
| | - Xavier Geets
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Molecular Imaging, Radiotherapy and Oncology (MIRO), Brussels, Belgium; Cliniques Universitaires Saint Luc, Department of Radiation Oncology, Brussels, Belgium.
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Yock AD. Generating amorphous target margins in radiation therapy to promote maximal target coverage with minimal target size. Comput Methods Programs Biomed 2018; 166:1-8. [PMID: 30415709 DOI: 10.1016/j.cmpb.2018.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 08/09/2018] [Accepted: 09/04/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND AND SIGNIFICANCE This work provides proof-of-principle for two versions of a heuristic approach that automatically creates amorphous radiation therapy planning target volume (PTV) margins considering local effects of tumor shape and motion to ensure adequate voxel coverage with while striving to minimize PTV size. The resulting target thereby promotes disease control while minimizing the risk of normal tissue toxicity. METHODS This work describes the mixed-PDF algorithm and the independent-PDF algorithm which generate amorphous margins around a radiation therapy target by incorporating user-defined models of target motion. Both algorithms were applied to example targets - one circular and one "cashew-shaped." Target motion was modeled by four probability density functions applied to the target quadrants. The spatially variant motion model illustrates the application of the algorithms even with tissue deformation. Performance of the margins was evaluated in silico with respect to voxelized target coverage and PTV size, and was compared to conventional techniques: a threshold-based probabilistic technique and an (an)isotropic expansion technique. To demonstrate the algorithm's clinical utility, a lung cancer patient was analyzed retrospectively. For this case, 4D CT measurements were combined with setup uncertainty to compare the PTV from the mixed-PDF algorithm with a PTV equivalent to the one used clinically. RESULTS For both targets, the mixed-PDF algorithm performed best, followed by the independent-PDF algorithm, the threshold algorithm, and lastly, the (an)isotropic algorithm. Superior coverage was always achieved by the amorphous margin algorithms for a given PTV size. Alternatively, the margin required for a particular level of coverage was always smaller (8-15%) when created with the amorphous algorithms. For the lung cancer patient, the mixed-PDF algorithm resulted in a PTV that was 13% smaller than the clinical PTV while still achieving ≥99.9% coverage. CONCLUSIONS The amorphous margin algorithms are better suited for the local effects of target shape and positional uncertainties than conventional margins. As a result, they provide superior target coverage with smaller PTVs, ensuring dose delivered to the target while decreasing the risk of normal tissue toxicity.
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Affiliation(s)
- Adam D Yock
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Oar A, Liney G, Rai R, Deshpande S, Pan L, Johnston M, Jameson M, Kumar S, Lee M. Comparison of four dimensional computed tomography and magnetic resonance imaging in abdominal radiotherapy planning. Phys Imaging Radiat Oncol 2018; 7:70-5. [PMID: 33458408 DOI: 10.1016/j.phro.2018.09.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 12/25/2022]
Abstract
Background and Purpose Four-dimensional (4D) computed tomography (CT) is widely used in radiotherapy (RT) planning and remains the current standard for motion evaluation. We assess a 4D magnetic resonance imaging (MRI) sequence in terms of motion and image quality in a phantom, healthy volunteers and patients undergoing RT. Materials and Methods The 4D-MRI sequence is a prototype T1-weighted 3D gradient echo with radial acquisition with self-gating. The accuracy of the 4D-MRI respiratory sorting based method was assessed using a MRI-CT compatible respiratory simulation phantom. In volunteers, abdominal viscera were evaluated for artefact, noise, structure delineation and overall image quality using a previously published four-point scoring system. In patients undergoing abdominal RT, the tumour (or a surrogate) was utilized to assess the range of motion on both 4D-CT and 4D-MRI. Furthermore, imaging quality was evaluated for both 4D-CT and 4D-MRI. Results In phantom studies 4D-MRI demonstrated amplitude of motion error of less than 0.2 mm for five, seven and ten bins. 4D-MRI provided excellent image quality for liver, kidney and pancreas. In patients, the median amplitude of motion seen on 4D-CT and 4D-MRI was 11.2 mm (range 2.8–20.3 mm) and 10.1 mm (range 0.7–20.7 mm) respectively. The median difference in amplitude between 4D-CT and 4D-MRI was −0.6 mm (range −3.4–5.2 mm). 4D-MRI demonstrated superior edge detection (median score 3 versus 1) and overall image quality (median score 2 versus 1) compared to 4D-CT. Conclusions The prototype 4D-MRI sequence demonstrated promising results and may be used in abdominal targeting, motion gating, and towards implementing MRI-based adaptive RT.
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Dunn L, Kenny J. A software platform for statistical evaluation of patient respiratory patterns in radiation therapy. Phys Med 2017; 42:135-40. [PMID: 29173907 DOI: 10.1016/j.ejmp.2017.09.128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/25/2017] [Accepted: 09/17/2017] [Indexed: 12/25/2022] Open
Abstract
AIM The aim of this work was to design and evaluate a software tool for analysis of a patient's respiration, with the goal of optimizing the effectiveness of motion management techniques during radiotherapy imaging and treatment. MATERIALS AND METHODS A software tool which analyses patient respiratory data files (.vxp files) created by the Varian Real-Time Position Management System (RPM) was developed to analyse patient respiratory data. The software, called RespAnalysis, was created in MATLAB and provides four modules, one each for determining respiration characteristics, providing breathing coaching (biofeedback training), comparing pre and post-training characteristics and performing a fraction-by-fraction assessment. The modules analyse respiratory traces to determine signal characteristics and specifically use a Sample Entropy algorithm as the key means to quantify breathing irregularity. Simulated respiratory signals, as well as 91 patient RPM traces were analysed with RespAnalysis to test the viability of using the Sample Entropy for predicting breathing regularity. RESULTS Retrospective assessment of patient data demonstrated that the Sample Entropy metric was a predictor of periodic irregularity in respiration data, however, it was found to be insensitive to amplitude variation. Additional waveform statistics assessing the distribution of signal amplitudes over time coupled with Sample Entropy method were found to be useful in assessing breathing regularity. CONCLUSIONS The RespAnalysis software tool presented in this work uses the Sample Entropy method to analyse patient respiratory data recorded for motion management purposes in radiation therapy. This is applicable during treatment simulation and during subsequent treatment fractions, providing a way to quantify breathing irregularity, as well as assess the need for breathing coaching. It was demonstrated that the Sample Entropy metric was correlated to the irregularity of the patient's respiratory motion in terms of periodicity, whilst other metrics, such as percentage deviation of inhale/exhale peak positions provided insight into respiratory amplitude regularity.
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Karava K, Ehrbar S, Riesterer O, Roesch J, Glatz S, Klöck S, Guckenberger M, Tanadini-Lang S. Potential dosimetric benefits of adaptive tumor tracking over the internal target volume concept for stereotactic body radiation therapy of pancreatic cancer. Radiat Oncol 2017; 12:175. [PMID: 29121945 PMCID: PMC5680781 DOI: 10.1186/s13014-017-0906-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/30/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Radiotherapy for pancreatic cancer has two major challenges: (I) the tumor is adjacent to several critical organs and, (II) the mobility of both, the tumor and its surrounding organs at risk (OARs). A treatment planning study simulating stereotactic body radiation therapy (SBRT) for pancreatic tumors with both the internal target volume (ITV) concept and the tumor tracking approach was performed. The two respiratory motion-management techniques were compared in terms of doses to the target volume and organs at risk. METHODS AND MATERIALS Two volumetric-modulated arc therapy (VMAT) treatment plans (5 × 5 Gy) were created for each of the 12 previously treated pancreatic cancer patients, one using the ITV concept and one the tumor tracking approach. To better evaluate the overall dose delivered to the moving tumor volume, 4D dose calculations were performed on four-dimensional computed tomography (4DCT) scans. The resulting planning target volume (PTV) size for each technique was analyzed. Target and OAR dose parameters were reported and analyzed for both 3D and 4D dose calculation. RESULTS Tumor motion ranged from 1.3 to 11.2 mm. Tracking led to a reduction of PTV size (max. 39.2%) accompanied with significant better tumor coverage (p<0.05, paired Wilcoxon signed rank test) both in 3D and 4D dose calculations and improved organ at risk sparing. Especially for duodenum, stomach and liver, the mean dose was significantly reduced (p<0.05) with tracking for 3D and 4D dose calculations. CONCLUSIONS By using an adaptive tumor tracking approach for respiratory-induced pancreatic motion management, a significant reduction in PTV size can be achieved, which subsequently facilitates treatment planning, and improves organ dose sparing. The dosimetric benefit of tumor tracking is organ and patient-specific.
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Affiliation(s)
- Konstantina Karava
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland. .,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland.
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Johannes Roesch
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Stefan Glatz
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Stephan Klöck
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich (USZ), Rämistrasse 100, Zurich, 8091, Switzerland.,University of Zurich, Rämistrasse 71, Zurich, 8006, Switzerland
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Schmitt D, Nill S, Roeder F, Gompelmann D, Herth F, Oelfke U. Motion monitoring during a course of lung radiotherapy with anchored electromagnetic transponders : Quantification of inter- and intrafraction motion and variability of relative transponder positions. Strahlenther Onkol 2017; 193:840-7. [PMID: 28733724 DOI: 10.1007/s00066-017-1183-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 06/30/2017] [Indexed: 11/14/2022]
Abstract
Purpose Anchored electromagnetic transponders for tumor motion monitoring during lung radiotherapy were clinically evaluated. First, intrafractional motion patterns were analyzed as well as their interfractional variations. Second, intra- and interfractional changes of the geometric transponder positions were investigated. Materials and methods Intrafractional motion data from 7 patients with an upper or middle lobe tumor and three implanted transponders each was used to calculate breathing amplitudes, overall motion amount and motion midlines in three mutual perpendicular directions and three-dimensionally (3D) for 162 fractions. For 6 patients intra- and interfractional variations in transponder distances and in the size of the triangle defined by the transponder locations over the treatment course were determined. Results Mean 3D values of all fractions were up to 4.0, 4.6 and 3.4 mm per patient for amplitude, overall motion amount and midline deviation, respectively. Intrafractional transponder distances varied with standard deviations up to 3.2 mm, while a maximal triangle shrinkage of 36.5% over 39 days was observed. Conclusions Electromagnetic real-time motion monitoring was feasible for all patients. Detected respiratory motion was on average modest in this small cohort without lower lobe tumors, but changes in motion midline were of the same size as the amplitudes and greater midline motion can be observed in some fractions. Intra- and interfractional variations of the geometric transponder positions can be large, so for reliable motion management correlation between transponder and tumor motion needs to be evaluated per patient. Electronic supplementary material The online version of this article (doi: 10.1007/s00066-017-1183-0) contains supplementary material, which is available to authorized users.
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Abstract
Patient motion can cause misalignment of the tumour and toxicities to the healthy lung tissue during lung stereotactic body radiation therapy (SBRT). Any deviations from the reference setup can miss the target and have acute toxic effects on the patient with consequences onto its quality of life and survival outcomes. Correction for motion, either immediately prior to treatment or intra-treatment, can be realized with image-guided radiation therapy (IGRT) and motion management devices. The use of these techniques has demonstrated the feasibility of integrating complex technology with clinical linear accelerator to provide a higher standard of care for the patients and increase their quality of life.
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Affiliation(s)
- Vincent Caillet
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; School of Physics, University of Sydney, Sydney, Australia.
| | - Jeremy T Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, Australia; School of Physics, University of Sydney, Sydney, Australia
| | - Paul Keall
- School of Medicine, University of Sydney, Sydney, Australia
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Campbell WG, Jones BL, Schefter T, Goodman KA, Miften M. An evaluation of motion mitigation techniques for pancreatic SBRT. Radiother Oncol 2017; 124:168-173. [PMID: 28571887 DOI: 10.1016/j.radonc.2017.05.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/20/2017] [Accepted: 05/15/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Ablative radiation therapy can be beneficial for pancreatic cancer, and motion mitigation helps to reduce dose to nearby organs-at-risk. Here, we compared two competing methods of motion mitigation-abdominal compression and respiratory gating. MATERIALS AND METHODS CBCT scans of 19 pancreatic cancer patients receiving stereotactic body radiation therapy were acquired with and without abdominal compression, and 3D target motion was reconstructed from CBCT projection images. Daily target motion without mitigation was compared against motion with compression and with simulated respiratory gating. Gating was free-breathing and based on an external surrogate. Target coverage was also evaluated for each scenario by simulating reduced target margins. RESULTS Without mitigation, average daily target motion in LR/AP/SI directions was 5.3, 7.3, and 13.9mm, respectively. With abdominal compression, these values were 5.2, 5.3, and 8.5mm, and with respiratory gating they were 3.2, 3.9, and 5.5mm, respectively. Reductions with compression were significant in AP/SI directions, while reductions with gating were significant in all directions. Respiratory gating also demonstrated better coverage in the reduced margins scenario. CONCLUSION Respiratory gating is the most effective strategy for reducing motion in pancreatic SBRT, and may allow for dose escalation through a reduction in target margin.
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Affiliation(s)
- Warren G Campbell
- Department of Radiation Oncology, University of Colorado School of Medicine, USA.
| | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, USA
| | - Tracey Schefter
- Department of Radiation Oncology, University of Colorado School of Medicine, USA
| | - Karyn A Goodman
- Department of Radiation Oncology, University of Colorado School of Medicine, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, USA
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Riou O, Llacer Moscardo C, Fenoglietto P, Deshayes E, Tetreau R, Molinier J, Lenglet A, Assenat E, Ychou M, Guiu B, Aillères N, Bedos L, Azria D. SBRT planning for liver metastases: A focus on immobilization, motion management and planning imaging techniques. Rep Pract Oncol Radiother 2017; 22:103-110. [PMID: 28490980 DOI: 10.1016/j.rpor.2017.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 03/15/2016] [Revised: 01/05/2017] [Accepted: 02/25/2017] [Indexed: 02/08/2023] Open
Abstract
AIM To evaluate the different techniques used for liver metastases Stereotactic Body Radiation Therapy (SBRT) planning. We especially focused on immobilization devices, motion management and imaging used for contouring. BACKGROUND Although some guidelines exist, there is no consensus regarding the minimal requirements for liver SBRT treatments. MATERIALS AND METHODS We reviewed the main liver metastases SBRT publications and guidelines; and compared the techniques used for immobilization, motion management, margins and imaging. RESULTS There is a wide variety of techniques used for immobilization, motion management and planning imaging. CONCLUSIONS We provide a subjective critical analysis of minimal requirements and ideal technique for liver SBRT planning.
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Affiliation(s)
- Olivier Riou
- Institut Régional du Cancer de Montpellier, ICM-Val d'Aurelle, Rue de la Croix Verte, Montpellier, France
| | - Carmen Llacer Moscardo
- Institut Régional du Cancer de Montpellier, ICM-Val d'Aurelle, Rue de la Croix Verte, Montpellier, France
| | - Pascal Fenoglietto
- Institut Régional du Cancer de Montpellier, ICM-Val d'Aurelle, Rue de la Croix Verte, Montpellier, France
| | - Emmanuel Deshayes
- Institut Régional du Cancer de Montpellier, ICM-Val d'Aurelle, Rue de la Croix Verte, Montpellier, France
| | - Raphaël Tetreau
- Institut Régional du Cancer de Montpellier, ICM-Val d'Aurelle, Rue de la Croix Verte, Montpellier, France
| | - Jessica Molinier
- Institut Régional du Cancer de Montpellier, ICM-Val d'Aurelle, Rue de la Croix Verte, Montpellier, France
| | - Alexis Lenglet
- Institut Régional du Cancer de Montpellier, ICM-Val d'Aurelle, Rue de la Croix Verte, Montpellier, France
| | - Eric Assenat
- Institut Régional du Cancer de Montpellier, ICM-Val d'Aurelle, Rue de la Croix Verte, Montpellier, France.,CHU Saint Eloi, 80 Avenue Augustin Fliche, 34090 Montpellier, France
| | - Marc Ychou
- Institut Régional du Cancer de Montpellier, ICM-Val d'Aurelle, Rue de la Croix Verte, Montpellier, France.,CHU Saint Eloi, 80 Avenue Augustin Fliche, 34090 Montpellier, France
| | - Boris Guiu
- CHU Saint Eloi, 80 Avenue Augustin Fliche, 34090 Montpellier, France
| | - Norbert Aillères
- Institut Régional du Cancer de Montpellier, ICM-Val d'Aurelle, Rue de la Croix Verte, Montpellier, France
| | - Ludovic Bedos
- Institut Régional du Cancer de Montpellier, ICM-Val d'Aurelle, Rue de la Croix Verte, Montpellier, France
| | - David Azria
- Institut Régional du Cancer de Montpellier, ICM-Val d'Aurelle, Rue de la Croix Verte, Montpellier, France
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Sonier M, Chu W, Lalani N, Erler D, Cheung P, Korol R. Implementation of a volumetric modulated arc therapy treatment planning solution for kidney and adrenal stereotactic body radiation therapy. Med Dosim 2016; 41:323-328. [PMID: 27745995 DOI: 10.1016/j.meddos.2016.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 07/05/2016] [Accepted: 09/07/2016] [Indexed: 12/31/2022]
Abstract
To develop a volumetric modulated arc therapy (VMAT) treatment planning solution in the treatment of primary renal cell carcinoma and oligometastatic adrenal lesions with stereotactic body radiation therapy. Single-arc VMAT plans (n = 5) were compared with clinically delivered step-and-shoot intensity-modulated radiotherapy (IMRT) with planning target volume coverage normalized between techniques. Target volume conformity, organ-at-risk (OAR) dose, treatment time, and monitor units were compared. A VMAT planning solution, created from a combination of arc settings and optimization constraints, auto-generated treatment plans in a single optimization. The treatment planning solution was evaluated on 15 consecutive patients receiving kidney and adrenal stereotactic body radiation therapy. Treatment time was reduced from 13.0 ± 2.6 to 4.0 ± 0.9 minutes for IMRT and VMAT, respectively. The VMAT planning solution generated treatment plans with increased target homogeneity, improved 95% conformity index, and a reduced maximum point dose to nearby OARs but with increased intermediate dose to distant OARs. The conformity of the 95% isodose improved from 1.32 ± 0.39 to 1.12 ± 0.05 for IMRT and VMAT treatment plans, respectively. Evaluation of the planning solution showed clinically acceptable dose distributions for 13 of 15 cases with tight conformity of the prescription isodose to the planning target volume of 1.07 ± 0.04, delivering minimal dose to OARs. The introduction of a stereotactic body radiation therapy VMAT treatment planning solution improves the efficiency of planning and delivery time, producing treatment plans of comparable or superior quality to IMRT in the case of primary renal cell carcinoma and oligometastatic adrenal lesions.
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Affiliation(s)
- Marcus Sonier
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - William Chu
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Nafisha Lalani
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Darby Erler
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Patrick Cheung
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Renee Korol
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Santoso AP, Song KH, Qin Y, Gardner SJ, Liu C, Chetty IJ, Movsas B, Ajlouni M, Wen N. Evaluation of gantry speed on image quality and imaging dose for 4D cone-beam CT acquisition. Radiat Oncol 2016; 11:98. [PMID: 27473367 PMCID: PMC4966562 DOI: 10.1186/s13014-016-0677-8] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background This study investigates the effect of gantry speed on 4DCBCT image quality and dose for the Varian On-Board Imager®. Methods A thoracic 4DCBCT protocol was designed using a 125 kVp spectrum. Image quality parameters were evaluated for 4DCBCT acquisition using Catphan® phantom with real-time position management™ system for gantry speeds varying between 1.0 to 6.0°/s. Superior-inferior motion of the phantom was executed using a sinusoidal waveform with five second period. Scans were retrospectively sorted into 4 phases (CBCT-4 ph) and 10 phases (CBCT-10 ph); average 4DCBCT (CBCT-ave), using all image data from the 4DCBCT acquisitions was also evaluated. The 4DCBCT images were evaluated using the following image quality metrics: spatial resolution, contrast-to-noise ratio (CNR), and uniformity index (UI). Additionally, Hounsfield unit (HU) sensitivity compared to a baseline CBCT and percent differences and RMS errors (RMSE) of excursion were also determined. Imaging dose was evaluated using an IBA CC13 ion chamber placed within CIRS Thorax phantom using the same sinusoidal motion and image acquisition settings as mentioned above. Results Spatial resolution decreased linearly from 5.93 to 3.82 lp/cm as gantry speed increased from 1.0 to 6.0°/s. CNR decreased linearly from 4.80 to 1.82 with gantry speed increasing from 1.0 to 6.0°/s, respectively. No noteworthy variations in UI, HU sensitivity, or excursion metrics were observed with changes in gantry speed. Ion chamber dose rates measured ranged from 2.30 (lung) to 5.18 (bone) E-3 cGy/mAs. Conclusions A quantitative analysis of the Varian OBI’s 4DCBCT capabilities was explored. Changing gantry speed changes the number of projections used for reconstruction, affecting both image quality and imaging dose if x-ray tube current is held constant. From the results of this study, a gantry speed between 2 and 3°/s was optimal when considering image quality, dose, and reconstruction time. The future of 4DCBCT clinical utility relies on further investigation of image acquisition and reconstruction optimization.
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Affiliation(s)
- Andrew P Santoso
- Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Kwang H Song
- Texas Oncology, Fort Worth, TX, 76104, USA.,Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Yujiao Qin
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Stephen J Gardner
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Chang Liu
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Munther Ajlouni
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA.
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