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Siiskonen T, Alenius S, Seppälä T, Tikkanen J, Nadhum M, Ojala J. Cone beam CT doses in radiotherapy patient positioning in Finland-prostate treatments. RADIATION PROTECTION DOSIMETRY 2024; 200:842-847. [PMID: 38828501 DOI: 10.1093/rpd/ncae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/22/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
Imaging parameters, frequencies and resulting patient organ doses in treatments of prostate cancer were assessed in Finnish radiotherapy centres. Based on a questionnaire to the clinics, Monte Carlo method was used to estimate organ doses in International Commission on Radiological Protection standard phantom for prostate, bladder, rectum and femoral head. The results show that doses from cone beam computed tomography imaging have reduced compared to earlier studies and are between 3.6 and 34.5 mGy per image for the above-mentioned organs and for normal sized patients. There still is room for further optimization of the patient exposure, as many centres use the default imaging parameters, and the length of the imaged region may not be optimal for the purpose.
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Affiliation(s)
- Teemu Siiskonen
- Department of Physics, University of Helsinki, P.O. Box 64 (Gustaf Hällströmin katu 2), FI-00014 Helsinki, Finland
- STUK-Radiation and Nuclear Safety Authority, Measurements and Environmental Surveillance, Jokiniemenkuja 1, FI-01370 Vantaa, Finland
| | - Saara Alenius
- Department of Physics, University of Helsinki, P.O. Box 64 (Gustaf Hällströmin katu 2), FI-00014 Helsinki, Finland
| | - Tiina Seppälä
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, PL180, 00290 Helsinki, Finland
| | - Joonas Tikkanen
- STUK-Radiation and Nuclear Safety Authority, Measurements and Environmental Surveillance, Jokiniemenkuja 1, FI-01370 Vantaa, Finland
| | - Miia Nadhum
- Department of Medical Physics, Tampere University Hospital, FI-33521 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, FI-33720 Tampere, Finland
| | - Jarkko Ojala
- Department of Medical Physics, Tampere University Hospital, FI-33521 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, FI-33720 Tampere, Finland
- Department of Oncology, Tampere University Hospital, FI-33521 Tampere, Finland
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2
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Nakayama R, Matsubara K. [The Study for Standardization of Dose Evaluation Method in Cone-beam CT]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2024; 80:374-384. [PMID: 38417899 DOI: 10.6009/jjrt.2024-1435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
PURPOSE This study aimed to compare the dose evaluation methods by constructing simulation models using the Monte Carlo calculation code and propose an evaluation method for cone beam CT (CBCT) that ensures accuracy and practicality. METHODS The Particle and Heavy Ion Transport code System (PHITS) ver. 3.26 was used as the Monte Carlo calculation code. CBCT doses were measured by CB dose index (CBDI) and American Association of Physicists in Medicine task group 111 (TG111) methods. The CBDI was compared with the equilibrium doses obtained by the TG111 method. RESULTS Although CBDI was lower than equilibrium doses obtained by the TG111 method, its practicality was ensured because it can be measured using the dosimeter and phantom that are commonly used. In contrast, the TG111 method guarantees accuracy, but it is difficult to prepare a long phantom to obtain the equilibrium dose. The TG111 method with a phantom length of 15 cm underestimated the equilibrium dose by 20% compared to that with a phantom length of 45 cm that satisfies the dose equilibrium. Therefore, the equilibrium dose obtained by the TG111 method with a phantom length of 15 cm is multiplied by 1.20 to obtain the equilibrium dose equivalent to that with a phantom length of 45 cm. CONCLUSION This study has proposed the dose evaluation method that combines guarantees accuracy and practicality in CBCT.
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Affiliation(s)
- Ryo Nakayama
- Technology Room of Radiologic, Shizuoka General Hospital
| | - Kosuke Matsubara
- Department of Quantum Medical Technology, Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University
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3
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Gazdag-Hegyesi S, Gáldi Á, Major T, Pesznyák C. Dose indices of kilovoltage cone beam computed tomography for various image guided radiotherapy protocols. RADIATION PROTECTION DOSIMETRY 2023; 199:983-988. [PMID: 37225198 DOI: 10.1093/rpd/ncad101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Varian Halcyon (HA) linear accelerators (LINAC) require kilovoltage cone-beam computed tomography (CT) acquisition for all patients before all treatment fractions. The aim of this study is to compare dose indices of various available protocols with different calculation and measurement methods. CT dose index (CTDI) in mGy is a measure of the radiation dose output of a CT scanner. A pencil ionisation chamber was used to measure dose index free air and in a standard CTDI phantom for different imaging protocols of HA and TrueBeam LINACs. For the point measurements, we found large deviations between displayed and calculated low CTDI values: 26.6 and 27.1% at Head low dose and Breast protocol, respectively. The calculated values were always larger than the displayed ones for all protocols and measurement setups. For the point measurements similar results were found as in the international literature, where the displayed values the measured CTDIs.
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Affiliation(s)
- Szilvia Gazdag-Hegyesi
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Institute of Nuclear Techniques, Budapest University of Technology and Economics, Budapest, Hungary
| | - Ádám Gáldi
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Tibor Major
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Department of Oncology, Semmelweis University, Budapest, Hungary
| | - Csilla Pesznyák
- Center of Radiotherapy, National Institute of Oncology, Budapest, Hungary
- Institute of Nuclear Techniques, Budapest University of Technology and Economics, Budapest, Hungary
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Sakai Y, Monzen H, Takei Y, Kosaka H, Nakamura K, Yanagi Y, Wakabayashi K, Hosono M, Nishimura Y. Evaluation of In-room Volumetric Imaging Doses for Image-guided Radiotherapy: A Multi-institutional Study. J Med Phys 2023; 48:189-194. [PMID: 37576099 PMCID: PMC10419753 DOI: 10.4103/jmp.jmp_109_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 08/15/2023] Open
Abstract
Aims We investigated imaging dose and noise under clinical scan conditions at multiple institutions using a simple and unified method, and demonstrated the need for diagnostic reference levels in image-guided radiotherapy (IGRT). Materials and Methods Nine cone-beam and helical computed tomography (CT) scanners (Varian, Elekta, Accuray Inc., and BrainLAB) from seven institutions were investigated in this study. The weighted cone-beam dose index (CBDIw) was calculated for head and pelvic protocols using a 100 mm pencil chamber under the conditions used in actual clinical practice at each institution. Cone-beam CT image noise was evaluated using polymethylmethacrylate head and body phantoms with diameters of 16 and 32 cm, respectively. Results For head and pelvic protocols, CBDIw values ranged from 0.94-6.59 and 1.47-20.9 mGy, respectively. Similarly, standard deviation (SD) values ranged from 9.3-34.0 and 26.9-97.4 HU, respectively. The SD values tended to increase with decreasing imaging dose (r = -0.33 and -0.61 for the head and pelvic protocols, respectively). Conclusions Among the nine machines, the imaging dose for high imaging dose institutions was approximately 20 mGy to the pelvic phantom, and there was a 14-fold difference in dose compared with the other institutions. These results suggest the need to establish DRLs for IGRT to guide clinical decision-making.
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Affiliation(s)
- Yusuke Sakai
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Hyogo, Japan
- Department of Radiotherapy, Takarazuka City Hospital, Takarazuka, Hyogo, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Hyogo, Japan
| | - Yoshiki Takei
- Department of Radiology, Kindai University Nara Hospital, Ikoma, Nara, Japan
| | - Hiroyuki Kosaka
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Hyogo, Japan
| | - Kenji Nakamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Hyogo, Japan
| | - Yuya Yanagi
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Hyogo, Japan
| | - Kazuki Wakabayashi
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, Hyogo, Japan
| | - Makoto Hosono
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osakasayama, Osaka, Japan
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Ueno H, Matsubara K, Bou S, Hizume M. Accuracy of patient dose estimation in cone beam computed tomography in breast irradiation by size-specific dose estimates with position correction. J Appl Clin Med Phys 2022; 23:e13851. [PMID: 36448537 PMCID: PMC9797173 DOI: 10.1002/acm2.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 08/09/2022] [Accepted: 11/02/2022] [Indexed: 12/03/2022] Open
Abstract
This study aims to investigate the effects of the position correction of size-specific dose estimates (SSDE) on patient dose estimation in cone beam computed tomography (CBCT). The relationship between the phantom position and absorbed dose in the right breast was studied using optically stimulated luminescence dosimeters and a simulated human body phantom. The effect of position correction for CT dose index (CTDI) on SSDE was investigated in 51 patients who underwent right breast irradiation by comparing the SSDE with position correction and SSDE without position correction. The absorbed dose in the right breast tended to decrease by 10.2% as the phantom was placed away from the center of CBCT. The mean and standard deviation of SSDE were 2.54 ± 0.29 and 2.92 ± 0.30 mGy with and without position correction, respectively. The SSDE with position correction was 13.1% lower than that without position correction (p < 0.05). SSDE was different when the patient's torso center was located at the isocenter of CBCT, and when it was not. The same tendency was seen in the case of the breast. Therefore, if the center of the patient is not at the acquisition center of the CT scanner, position correction is required when estimating SSDE.
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Affiliation(s)
- Hiroyuki Ueno
- Division of Health SciencesGraduate School of Medical SciencesKanazawa UniversityKanazawaJapan,Department of RadiologyTakaoka City HospitalTakaokaJapan
| | - Kosuke Matsubara
- Division of Health SciencesGraduate School of Medical SciencesKanazawa UniversityKanazawaJapan
| | - Sayuri Bou
- Department of RadiotherapyTakaoka City HospitalTakaokaJapan,Department of RadiologyGraduate School of Medical SciencesKanazawa UniversityKanazawaJapan
| | - Masato Hizume
- Department of RadiologyTakaoka City HospitalTakaokaJapan
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6
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Al-Kabkabi A, Ramachandran P, Aamry A, Tamam N, Abuhadi NH, Johary Y, Aamri H, Sulieman A, Trapp J. Assessment of cone beam computed tomography image quality and dose for commonly used pre-sets in external beam radiotherapy. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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7
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Karius A, Szkitsak J, Boronikolas V, Fietkau R, Bert C. Quality assurance and long-term stability of a novel 3-in-1 X-ray system for brachytherapy. J Appl Clin Med Phys 2022; 23:e13727. [PMID: 35848090 PMCID: PMC9512339 DOI: 10.1002/acm2.13727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/20/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose A novel, mobile 3‐in‐1 X‐ray system featuring radiography, fluoroscopy, and cone‐beam computed tomography (CBCT) has been launched for brachytherapy recently. Currently, there is no quality assurance (QA) procedure explicitly applicable to this system equipped with innovative technologies such as dynamic jaws and motorized lasers. We developed a dedicated QA procedure and, based on its performance for a duration of 6 months, provide an assessment of the device's stability over time. Methods With the developed QA procedure, we assessed the system's planar and CBCT‐imaging performance by investigating geometric accuracy, CT‐number stability, contrast‐noise‐ratio, uniformity, spatial resolution, low‐contrast detectability, dynamic range, and X‐ray exposure using dedicated phantoms. Furthermore, we evaluated geometric stability by using the flexmap‐approach and investigated the device's laser‐ and jaw‐positioning accuracy with an in‐house test phantom. CBCT‐ and planar‐imaging protocols for pelvis, breast, and abdomen imaging were examined. Results Planar‐ and CBCT‐imaging performances were widely stable with a geometric accuracy ≤1 mm, CT‐number stability of up to 46 HU, and uniformity variations of up to 48 HU over time. For planar imaging, low‐contrast detectability and dynamic range exceeded current recommendations. Although geometric stability was considered tolerable, partly substantial positioning inaccuracies of up to more than 120 mm and −13 mm were obtained for lasers and jaws, respectively. X‐ray exposure showed small variations of ≤0.56 μGy and ≤0.76 mGy for planar‐ and CBCT‐imaging, respectively. The conductance of the QA procedure allowed a smooth evaluation of the system's overall performance. Conclusion We developed a QA workflow for a novel 3‐in‐1 X‐ray system allowing to assess the device's imaging and hardware performance. The system showed in general a reasonable imaging performance and stability over time, whereas improvements regarding laser and jaw accuracy are strictly required.
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Affiliation(s)
- Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Juliane Szkitsak
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Vasilios Boronikolas
- Abteilung für medizinische Physik, Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Freiburg im Breisgau, Deutschland.,Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau, Deutschland.,Partnerstandort Freiburg, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Freiburg im Breisgau, Deutschland.,Partnerstandort Freiburg, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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Less time is less motion: Analysis of practical efficiencies gained with a modified workflow integrating planar kV mid-imaging with CBCT for spine stereotactic body radiation therapy. Adv Radiat Oncol 2022; 7:100961. [PMID: 35847546 PMCID: PMC9280020 DOI: 10.1016/j.adro.2022.100961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 03/29/2022] [Indexed: 11/22/2022] Open
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9
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Karius A, Bert C. QAMaster: A new software framework for phantom-based computed tomography quality assurance. J Appl Clin Med Phys 2022; 23:e13588. [PMID: 35297569 PMCID: PMC8992959 DOI: 10.1002/acm2.13588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/04/2021] [Accepted: 02/28/2022] [Indexed: 11/06/2022] Open
Abstract
The regular evaluation of imaging performance of computed tomography (CT) scanners is essential for CT quality assurance. For automation of this process, the software QAMaster was developed at the Universitätsklinikum Erlangen, which provides based on CT scans of the CatPhan® 504 (The Phantom Laboratory, Salem, USA) automated image quality analysis and documentation by evaluating CT number accuracy, spatial linearity, uniformity, contrast-noise-ratio, spatial resolution, noise, and slice thickness. Dose assessment is supported by calculations of the weighted computed tomography dose index (CTDIw ) and weighted cone beam dose index (CBDIw ). QAMaster was tested with CatPhan® 504 scans and compared to manual evaluations of these scans, whereby high consistency of the respective results was observed. The CT numbers, spatial linearity, uniformity, contrast-noise-ratio, noise, and slice thickness deviated by only (0.13 ± 0.25) HU, (0.02 ± 0.05) mm, (-0.01 ± 0.03)%, 0.8 ± 1.8, (0.131 ± 0.05) HU, and (0.004 ± 0.005) mm between both evaluations, respectively. The QAMaster results for spatial resolution did not differ significantly (p = 0.34) from the CatPhan® 504 based manual resolution assessment. Dose computations were fully consistent between QAMaster and manual calculations. Thus, QAMaster proved to be a comprehensive and functional software for performing an automated CT quality assurance routine. QAMaster will be open-source after its release.
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Affiliation(s)
- Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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Karius A, Strnad V, Lotter M, Kreppner S, Bert C. First clinical experience with a novel, mobile cone-beam CT system for treatment quality assurance in brachytherapy. Strahlenther Onkol 2022; 198:573-581. [PMID: 35278094 PMCID: PMC9165284 DOI: 10.1007/s00066-022-01912-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/16/2022] [Indexed: 11/04/2022]
Abstract
Background and purpose On-site cone-beam computed tomography (CBCT) has gained in importance in adaptive brachytherapy during recent years. Besides treatment planning, there is increased need particularly for image-guidance during interventional procedures and for image-guided treatment quality assurance (QA). For this purpose, an innovative CBCT device was rolled out at our hospital as the first site worldwide. We present the first clinical images and experiences. Materials and methods The novel CBCT system is constructed of a 121 cm diameter ring gantry, and features a 43.2 × 43.2 cm2 flat-panel detector, wireless remote-control via tablet-PC, and battery-powered maneuverability. Within the first months of clinical operation, we performed CBCT-based treatment QA for a total of 26 patients (8 with breast, 16 with cervix, and 2 with vaginal cancer). CBCT scans were analyzed regarding potential movements of implanted applicators in-situ during the brachytherapy course. Results With the presented device, treatment QA was feasible for the majority of patients. The CBCT scans of breast patients showed sufficient contrast between implanted catheters and tissue. For gynecologic patients, a distinct visualization of applicators was achieved in general. However, reasonable differentiations of organic soft tissues were not feasible. Conclusion The CBCT system allowed basic treatment QA measures for breast and gynecologic patients. For image-guidance during interventional brachytherapy procedures, the current image quality is not adequate. Substantial performance enhancements are required for intraoperative image-guidance.
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Affiliation(s)
- Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Germany. .,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Michael Lotter
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Stephan Kreppner
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstr. 27, 91054, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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Gilling L, Ali O. Organ dose from Varian XI and Varian OBI systems are clinically comparable for pelvic CBCT imaging. Phys Eng Sci Med 2022; 45:279-285. [PMID: 35143026 DOI: 10.1007/s13246-021-01090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 12/07/2021] [Indexed: 11/27/2022]
Abstract
Pelvic cone-beam computed tomography (CBCT) occurs daily in many radiotherapy clinics as a part of image-guided verification before treatment. These images are acquired by the use of ionizing radiation. The dose received by CBCT imaging is often not quantified in a patient's radiation therapy prescription. The purpose of this work was to quantify the dose from a TrueBeam XI pelvic CBCT imaging system. The dose to organs from this imaging protocol was then compared with published dose data for OBI v1.4 pelvic CBCT imaging. A model of the Varian XI imager was constructed using GATE Monte Carlo scripting language. The model was calibrated by correlation with experimental measurements. An IBA 3D water tank was used to perform relative dose measurements in water. An adult anthropomorphic Alderson phantom with embedded thermolumeniscent dosimeters was used to evaluate dose from prostate CBCT imaging. Following the calibration, the GATE model was used to simulate the dose from the XI pelvic CBCT protocol to the ICRP computational anthropomorphic phantom. The Monte Carlo model constructed in GATE was validated for use in dose estimates for the XI pelvic imaging protocol. The D50 and D10 values tabulated the pelvic CBCT protocol show that doses to organs in the pelvic region are comparable for both systems. For a clinician who intends to evaluate the dose to organs as a result of CBCT imaging of the pelvis from the TrueBeam XI system, for the purposes of treatment planning, the doses reported for OBI v1.4 given in AAPM TG-180 provide a valid estimate.
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Affiliation(s)
- Luke Gilling
- Medical Physics Department, Waikato District Health Board, Hamilton, New Zealand.
| | - Omer Ali
- Medical Physics Department, Waikato District Health Board, Hamilton, New Zealand
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12
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Dose assessment for daily cone-beam CT in lung radiotherapy patients and its combination with treatment planning. Phys Eng Sci Med 2022; 45:231-237. [PMID: 35076869 DOI: 10.1007/s13246-022-01105-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
Abstract
With the increased use of X-ray imaging for patient alignment in external beam radiation therapy, particularly with cone-beam computed tomography (CBCT), the additional dose received by patients has become of greater consideration. In this study, we analysed the radiation dose from CBCT for clinical lung radiotherapy and assessed its relative contribution when combined with radiation treatment planning for a variety of lung radiotherapy techniques. The Monte Carlo simulation program ImpactMC was used to calculate the 3D dose delivered by a Varian TrueBeam linear accelerator to patients undergoing thorax CBCT imaging. The concomitant dose was calculated by simulating the daily CBCT irradiation of ten lung cancer patients. Each case was planned with a total dose of 50-60 Gy to the target lesion in 25-30 fractions using the 3DCRT or IMRT plan and retrospectively planned using VMAT. For each clinical case, the calculated CBCT dose was summed with the planned dose, and the dose to lungs, heart, and spinal cord were analysed according to conventional dose conformity metrics. Our results indicate greater variations in dose to the heart, lungs, and spinal cord based on planning technique, (3DCRT, IMRT, VMAT) than from the inclusion of daily cone-beam imaging doses over 25-30 fractions. The average doses from CBCT imaging per fraction to the lungs, heart and spinal cord were 0.52 ± 0.10, 0.49 ± 0.15 and 0.39 ± 0.08 cGy, respectively. Lung dose variations were related to the patient's size and body composition. Over a treatment course, this may result in an additional mean absorbed dose of 0.15-0.2 Gy. For lung V5, the imaging dose resulted in an average increase of ~ 0.6% of the total volume receiving 5 Gy. The increase in V20 was more dependent on the planning technique, with 3DCRT increasing by 0.11 ± 0.09% with imaging and IMRT and VMAT increasing by 0.17 ± 0.05% and 0.2 ± 0.06%, respectively. In this study, we assessed the concomitant dose for daily CBCT lung cancer patients undergoing radiotherapy. The additional radiation dose to the normal lungs from daily CBCT was found to range from 0.15 to 0.2 Gy when the patient was treated with 25-30 fractions. Consideration of potential variation in relative biological effectiveness between kilovoltage imaging and megavoltage treatment dose was outside the scope of this study. Regardless of this, our results show that the assessment of imaging dose can be incorporated into the treatment planning process and the relative effect on overall dose distribution was small compared to the difference among planning techniques.
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Karius A, Karolczak M, Strnad V, Bert C. Technical evaluation of the cone-beam computed tomography imaging performance of a novel, mobile, gantry-based X-ray system for brachytherapy. J Appl Clin Med Phys 2021; 23:e13501. [PMID: 34905285 PMCID: PMC8833290 DOI: 10.1002/acm2.13501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 10/21/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022] Open
Abstract
Purpose A novel, mobile cone‐beam computed tomography (CBCT) system for image‐guided adaptive brachytherapy was recently deployed at our hospital as worldwide first site. Prior to the device's clinical operation, a profound characterization of its imaging performance was conducted. This was essential to optimize both the imaging workflow and image quality for achieving the best possible clinical outcomes. We present the results of our investigations. Methods The novel CBCT‐system features a ring gantry with 121 cm clearance as well as a 43.2 × 43.2 cm2 flat‐panel detector, and is controlled via a tablet‐personal computer (PC). For evaluating its imaging performance, the geometric reproducibility as well as imaging fidelity, computed tomography (CT)‐number accuracy, uniformity, contrast‐noise‐ratio (CNR), noise characteristics, and spatial resolution as fundamental image quality parameters were assessed. As dose metric the weighted cone‐beam dose index (CBDIw) was measured. Image quality was evaluated using standard quality assurance (QA) as well as anthropomorphic upper torso and breast phantoms. Both in‐house and manufacturer protocols for abdomen, pelvis, and breast imaging were examined. Results Using the in‐house protocols, the QA phantom scans showed altogether a high image quality, with high CT‐number accuracy (R2 > 0.97) and uniformity (<12 Hounsfield Unit (HU) cupping), reasonable noise and imaging fidelity, and good CNR at bone–tissue transitions of up to 28:1. Spatial resolution was strongly limited by geometric instabilities of the device. The breast phantom scans fulfilled clinical requirements, whereas the abdomen and pelvis scans showed severe artifacts, particularly at air/bone–tissue transitions. Conclusion With the novel CBCT‐system, achieving a high image quality appears possible in principle. However, adaptations of the standard protocols, performance enhancements in image reconstruction referring to artifact reductions, as well as the extinction of geometric instabilities are imperative.
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Affiliation(s)
- Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstraße 27, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Marek Karolczak
- Institute of Medical Physics, Friedrich-Alexander-University Erlangen-Nuremberg, Henkestraße 91, Erlangen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstraße 27, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Universitätsstraße 27, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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CT-on-Rails Versus In-Room CBCT for Online Daily Adaptive Proton Therapy of Head-and-Neck Cancers. Cancers (Basel) 2021; 13:cancers13235991. [PMID: 34885100 PMCID: PMC8656713 DOI: 10.3390/cancers13235991] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To compare the efficacy of CT-on-rails versus in-room CBCT for daily adaptive proton therapy. METHODS We analyzed a cohort of ten head-and-neck patients with daily CBCT and corresponding virtual CT images. The necessity of moving the patient after a CT scan is the most significant difference in the adaptation workflow, leading to an increased treatment execution uncertainty σ. It is a combination of the isocenter-matching σi and random patient movements induced by the couch motion σm. The former is assumed to never exceed 1 mm. For the latter, we studied three different scenarios with σm = 1, 2, and 3 mm. Accordingly, to mimic the adaptation workflow with CT-on-rails, we introduced random offsets after Monte-Carlo-based adaptation but before delivery of the adapted plan. RESULTS There were no significant differences in accumulated dose-volume histograms and dose distributions for σm = 1 and 2 mm. Offsets with σm = 3 mm resulted in underdosage to CTV and hot spots of considerable volume. CONCLUSION Since σm typically does not exceed 2 mm for in-room CT, there is no clinically significant dosimetric difference between the two modalities for online adaptive therapy of head-and-neck patients. Therefore, in-room CT-on-rails can be considered a good alternative to CBCT for adaptive proton therapy.
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15
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Nasser NJ, Klein J, Fenig E, Agbarya A. Automatic localization of the prostatic urethra for image guided radiation therapy. Tech Innov Patient Support Radiat Oncol 2021; 19:1-6. [PMID: 34189284 PMCID: PMC8215297 DOI: 10.1016/j.tipsro.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/27/2021] [Accepted: 05/27/2021] [Indexed: 11/28/2022] Open
Abstract
Prostatic urethra can be used for image guided radiation for prostate cancer. Computer “finds” the urethra by digital subtraction of scans with / without contrast. Urethra segmentation used to setup the patient and position prostate as in simulation. A catheter with continuous aerated gel flow is used to detect the urethra under US.
Treatment of prostate cancer with radiation therapy (RT) requires image guided RT (IGRT) to focus the radiation on the target volumes while minimizing doses to organs at risk. Here we describe a urinary catheter that allows imaging of the prostatic urethra and uses it for automatic localization of the prostate for IGRT. The catheter has a contrast lumen that can be empty or full with contrast. Computerized tomography is performed twice, with contrast lumen empty and full, allowing urethral autosegmentation using digital subtraction. Under ultrasound, continuous urethral visualization is possible by pumping aerated gel in- and out of the contrast lumen.
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Affiliation(s)
- Nicola J Nasser
- Department of Radiation Oncology, University of Maryland School of Medicine, Maryland Proton Treatment Center, Baltimore, MD, USA
| | - Jonathan Klein
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA
| | - Eyal Fenig
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Abed Agbarya
- Institute of Oncology, Bnai Zion Medical Center, Haifa, Israel
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16
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Alcorn SR, Zhou XC, Bojechko C, Rubo RA, Chen MJ, Dieckmann K, Ermoian RP, Ford EC, Kobyzeva D, MacDonald SM, McNutt TR, Nechesnyuk A, Nilsson K, Sjostrand H, Smith KS, Stock M, Tryggestad EJ, Villar RC, Winey BA, Terezakis SA. Low-Dose Image-Guided Pediatric CNS Radiation Therapy: Final Analysis From a Prospective Low-Dose Cone-Beam CT Protocol From a Multinational Pediatrics Consortium. Technol Cancer Res Treat 2020; 19:1533033820920650. [PMID: 32329413 PMCID: PMC7225835 DOI: 10.1177/1533033820920650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Lower-dose cone-beam computed tomography protocols for image-guided radiotherapy may permit target localization while minimizing radiation exposure. We prospectively evaluated a lower-dose cone-beam protocol for central nervous system image-guided radiotherapy across a multinational pediatrics consortium. Methods: Seven institutions prospectively employed a lower-dose cone-beam computed tomography central nervous system protocol (weighted average dose 0.7 mGy) for patients ≤21 years. Treatment table shifts between setup with surface lasers versus cone-beam computed tomography were used to approximate setup accuracy, and vector magnitudes for these shifts were calculated. Setup group mean, interpatient, interinstitution, and random error were estimated, and clinical factors were compared by mixed linear modeling. Results: Among 96 patients, with 2179 pretreatment cone-beam computed tomography acquisitions, median age was 9 years (1-20). Setup parameters were 3.13, 3.02, 1.64, and 1.48 mm for vector magnitude group mean, interpatient, interinstitution, and random error, respectively. On multivariable analysis, there were no significant differences in mean vector magnitude by age, gender, performance status, target location, extent of resection, chemotherapy, or steroid or anesthesia use. Providers rated >99% of images as adequate or better for target localization. Conclusions: A lower-dose cone-beam computed tomography protocol demonstrated table shift vector magnitude that approximate clinical target volume/planning target volume expansions used in central nervous system radiotherapy. There were no significant clinical predictors of setup accuracy identified, supporting use of this lower-dose cone-beam computed tomography protocol across a diverse pediatric population with brain tumors.
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Affiliation(s)
| | - Xian Chiong Zhou
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Michael J Chen
- Grupo de Apoio ao Adolescente e à Criança com Câncer, São Paulo, Brazil
| | - Karin Dieckmann
- Universität Klinik Für Strahlentherapie und Strahlenbiologie, Vienna, Austria
| | | | | | - Daria Kobyzeva
- Federal Scientific Clinical Center of Children's Hematology, Oncology and Immunology, Moscow, Russia
| | | | | | - Alexey Nechesnyuk
- Federal Scientific Clinical Center of Children's Hematology, Oncology and Immunology, Moscow, Russia
| | | | | | | | - Markus Stock
- Universität Klinik Für Strahlentherapie und Strahlenbiologie, Vienna, Austria
| | | | | | | | - Stephanie A Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, University of Minnesota, Minneapolis, MN, USA
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17
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Koutsouvelis N, Rouzaud M, Dubouloz A, Nouet P, Jaccard M, Garibotto V, Tournier BB, Zilli T, Dipasquale G. 3D printing for dosimetric optimization and quality assurance in small animal irradiations using megavoltage X-rays. Z Med Phys 2020; 30:227-235. [DOI: 10.1016/j.zemedi.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/17/2020] [Accepted: 03/30/2020] [Indexed: 11/29/2022]
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18
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Mancosu P, Navarria P, Muren LP, Castagna L, Reggiori G, Clerici E, Sarina B, Bramanti S, De Philippis C, Tomatis S, Santoro A, Scorsetti M. Development of an Immobilization Device for Total Marrow Irradiation. Pract Radiat Oncol 2020; 11:e98-e105. [PMID: 32160952 DOI: 10.1016/j.prro.2020.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/24/2020] [Accepted: 02/15/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE A body frame dedicated to total marrow (lymph node) irradiation (TMI/TMLI) could minimize patient motion during the potentially extended beam-on time with this technique. We present the development of a dedicated immobilization system for TMI/TMLI using volumetric modulated arc therapy. METHODS AND MATERIALS Since 2010, 59 adult patients were treated with TMI/TMLI using a multi-isocenter volumetric modulated arc therapy technique. Two computed tomographies (CTs) were required (1 head-first supine and 1 feet-first supine) to cover the whole volume. For the first 10 patients, 2 standard commercial frames with personalized masks (with/without personalized vacuum cushion for the lower extremities) were used without specific interfixation (frame A). For the next 49 patients a homemade 3-frame immobilization system was adopted (frame B), where each frame was interlocked with the next one and thermoplastic masks used to fix the patient. The effectiveness of the 2 immobilization systems was assessed by offline/online matching between daily cone beam CT of each isocenter and the simulation CTs. RESULTS Mean offline shifts for frame A were 3 to 12 mm in anterior-posterior, 2 to 5 mm in cranilal-caudal, and 2 to 6 mm in left-right directions. Larger shifts were found for feet-first supine series (shifts up to 23 mm). In frame B, mean offline shifts were 1 to 4 mm in anterior-posterior, 1 to 4 mm in cranial-caudal, and 1 to 4 mm in left-right directions. Mean online adjustments were -1 ± 4 mm in anterior-posterior, 0 ± 2 mm in cranial-caudal, and 0 ± 4 mm in left-right directions. CONCLUSIONS The patient positioning shifts for TMI/TMLI irradiation were mitigated by a homemade immobilization system and the use of individualized masks.
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Affiliation(s)
- Pietro Mancosu
- Medical Physics Service, Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy.
| | - Pierina Navarria
- Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy
| | | | - Luca Castagna
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Giacomo Reggiori
- Medical Physics Service, Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy
| | - Elena Clerici
- Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy
| | - Barbara Sarina
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Stefania Bramanti
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Chiara De Philippis
- Bone Marrow Transplantation Unit, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Stefano Tomatis
- Medical Physics Service, Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy
| | - Armando Santoro
- Medical Oncology Department, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy
| | - Marta Scorsetti
- Radiation Oncology Department, Humanitas Clinical and Research Hospital, Rozzano-Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Rozzano, Italy
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Siewerdsen JH, Uneri A, Hernandez AM, Burkett GW, Boone JM. Cone‐beam CT dose and imaging performance evaluation with a modular, multipurpose phantom. Med Phys 2019; 47:467-479. [DOI: 10.1002/mp.13952] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- J. H. Siewerdsen
- Department of Biomedical Engineering Johns Hopkins University Baltimore MD 21205USA
| | - A. Uneri
- Department of Biomedical Engineering Johns Hopkins University Baltimore MD 21205USA
| | - A. M. Hernandez
- Department of Radiology University of California – Davis Sacramento CA 95817USA
| | - G. W. Burkett
- Department of Radiology University of California – Davis Sacramento CA 95817USA
| | - J. M. Boone
- Department of Radiology University of California – Davis Sacramento CA 95817USA
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20
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Nenoff L, Matter M, Hedlund Lindmar J, Weber DC, Lomax AJ, Albertini F. Daily adaptive proton therapy - the key to innovative planning approaches for paranasal cancer treatments. Acta Oncol 2019; 58:1423-1428. [PMID: 31364904 DOI: 10.1080/0284186x.2019.1641217] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: For proton therapy of paranasal tumors, field directions avoiding volumes that might change during therapy are typically used. If the plan is optimized on the daily anatomy using daily adapted proton therapy (DAPT) however, field directions crossing the nasal cavities might be feasible. In this study, we investigated the effectiveness of DAPT for enabling narrow-field treatment approaches. Material and methods: For five paranasal tumor patients, representing a wide patient spectrum, anatomically robust 4-field-star and narrow-field plans were calculated and their robustness to anatomical and setup uncertainties was compared with and without DAPT. Based on the nominal planning CTs, per patient up to 125 simulated CTs (simCTs) with different nasal cavity fillings were created and random translations and rotations due to patient setup uncertainties were further simulated. Plans were recalculated or re-optimized on all error scenarios, representing non-adapted and DAPT fractions, respectively. From these, 100 possible treatments (60 GyRBE, 30 fx) were simulated and changes in integral dose, target and organs at risk (OARs) doses evaluated. Results: In comparison to the 4-field-star approach, the use of narrow-fields reduced integral dose between 29% and 56%. If OARs did not overlap with the target, OAR doses were also reduced. Finally, the significantly reduced target coverage in non-adapted treatments (mean V95 reductions of up to 34%) could be almost fully restored with DAPT in all cases (differences <1%). Conclusions: DAPT was found to be not only an effective way to increase plan robustness to anatomical and positional uncertainties, but also opened the possibility to use improved and more conformal field arrangements.
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Affiliation(s)
- Lena Nenoff
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Physics, ETH Zurich, Zurich, Switzerland
| | - Michael Matter
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Physics, ETH Zurich, Zurich, Switzerland
| | - Johanna Hedlund Lindmar
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Physics, ETH Zurich, Zurich, Switzerland
| | - Damien Charles Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
- Department of Radiation Oncology, University Hospital Bern, Bern, Switzerland
| | - Antony John Lomax
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
- Department of Physics, ETH Zurich, Zurich, Switzerland
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Ren XC, Liu YE, Li J, Lin Q. Progress in image-guided radiotherapy for the treatment of non-small cell lung cancer. World J Radiol 2019; 11:46-54. [PMID: 30949299 PMCID: PMC6441935 DOI: 10.4329/wjr.v11.i3.46] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 01/27/2019] [Accepted: 02/28/2019] [Indexed: 02/06/2023] Open
Abstract
Lung cancer is one of the most common malignant tumors. It has the highest incidence and mortality rate of all cancers worldwide. Late diagnosis of non-small cell lung cancer (NSCLC) is very common in clinical practice, and most patients miss the chance for radical surgery. Thus, radiotherapy plays an indispensable role in the treatment of NSCLC. Radiotherapy technology has evolved from the classic two-dimensional approach to three-dimensional conformal and intensity-modulated radiotherapy. However, how to ensure delivery of an accurate dose to the tumor while minimizing the irradiation of normal tissues remains a huge challenge for radiation oncologists, especially due to the positioning error between fractions and the autonomous movement of organs. In recent years, image-guided radiotherapy (IGRT) has greatly increased the accuracy of tumor irradiation while reducing the irradiation dose delivered to healthy tissues and organs. This paper presents a brief review of the definition of IGRT and the various technologies and applications of IGRT. IGRT can help ensure accurate dosing of the target area and reduce radiation damage to the surrounding normal tissue. IGRT may increase the local control rate of tumors and reduce the incidence of radio-therapeutic complications.
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Affiliation(s)
- Xiao-Cang Ren
- Department of Oncology, North China Petroleum Bureau General Hospital, Hebei Medical University, Renqiu 062552, Hebei Province, China
| | - Yue-E Liu
- Department of Oncology, North China Petroleum Bureau General Hospital, Hebei Medical University, Renqiu 062552, Hebei Province, China
| | - Jing Li
- Department of Oncology, North China Petroleum Bureau General Hospital, Hebei Medical University, Renqiu 062552, Hebei Province, China
| | - Qiang Lin
- Department of Oncology, North China Petroleum Bureau General Hospital, Hebei Medical University, Renqiu 062552, Hebei Province, China
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