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Remmerts de Vries IF, Verbakel WFAR, Adema M, Slotman BJ, Dahele M. Spine Stereotactic Body Radiation Therapy Without Immobilization: Detailed Analysis of Intrafraction Motion Using High-Frequency kV Imaging During Irradiation. Int J Radiat Oncol Biol Phys 2024; 118:525-532. [PMID: 37652305 DOI: 10.1016/j.ijrobp.2023.08.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Spine stereotactic body radiation therapy (SBRT) requires high positioning accuracy and a stable patient to maximize target coverage and reduce excessive irradiation to organs at risk. Positional verification during spine SBRT delivery helps to ensure accurate positioning for all patients. We report our experience with noninvasive 3-dimensional target position monitoring during volumetric modulated arc therapy of spine metastases in nonimmobilized patients positioned using only a thin mattress and simple arm and knee supports. METHODS AND MATERIALS Fluoroscopic planar kV images were acquired at 7 frames/s using the on-board imaging system during volumetric modulated arc therapy spine SBRT. Template matching and triangulation were used to track the target in vertical, longitudinal, and lateral directions. If the tracking trace deviated >1 mm from the planned position in ≥1 direction, treatment was manually interrupted and 6-dimensional cone beam computed tomography (CBCT)-based couch correction was performed. Tracking data were used to retrospectively analyze the target position. Positional data, agreement with CBCT, correlation between position of the couch and direction of any positional correction, and treatment times were analyzed. RESULTS In total, 175 fractions were analyzed. Delivery was interrupted 83 times in 66 fractions for a deviation >1 mm. In 97% of cases the difference between tracking data and subsequent clinical shift performed after the CBCT match was ≤0.5 mm. Lateral/longitudinal shift performed after intervention correlated with the couch roll/pitch at the start of treatment (correlation coefficient, -0.63/0.53). Mean (SD; range) time between start of first imaging and end of the last arc was 15.2 minutes (5.1; 7.6-36.3). CONCLUSIONS Spine tracking during irradiation can be used to prompt an intervention CBCT scan and repositioning so that a spine SBRT target deviates by ≤1 mm from the planned position, even in nonimmobilized patients. kV tracking and CBCT are in good agreement. The data support verification CBCT after all 6 degrees-of-freedom positional corrections in nonimmobilized spine SBRT patients.
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Affiliation(s)
- Isabel F Remmerts de Vries
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands.
| | - Wilko F A R Verbakel
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Marrit Adema
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
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Schindhelm R, Razinskas G, Ringholz J, Kraft J, Sauer OA, Wegener S. Evaluation of a head rest prototype for rotational corrections in three degrees of freedom. J Appl Clin Med Phys 2024; 25:e14172. [PMID: 37793069 PMCID: PMC10860431 DOI: 10.1002/acm2.14172] [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: 06/20/2023] [Revised: 08/22/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
Cranial stereotactic irradiations require accurate reproduction of the planning CT patient position at the time of treatment, including removal of rotational offsets. A device prototype was evaluated for potential clinical use to correct rotational positional offsets in image-guided radiotherapy workflow. Analysis was carried out with a prototype device "RPS head" by gKteso GmbH, rotatable up to 4° in three dimensions by hand wheels. A software tool accounts for the nonrectangular rotation axes and also indicates translational motions to be performed with the standard couch to correct the initial offset and translational shifts introduced by the rotational motion. The accuracy of angular corrections and positioning of an Alderson RANDO head phantom using the prototype device was evaluated for nine treatment plans for cranial targets. Corrections were obtained from cone beam computed tomography (CBCT) imaging. The phantom position was adjusted and the final position was then verified by another CBCT. The long-term stability of the prototype device was evaluated. Attenuation by the device along its three main axes was assessed. A planning study was performed to evaluate if regions of high-density material can be avoided during plan generation. The device enabled the accurate correction of rotational offsets in a clinical setup with a mean residual angular difference of (0.0 ± 0.1)° and a maximum deviation of 0.2°. Translational offsets were less than 1 mm. The device was stable over a period of 20 min, not changing the head support plate position by more than (0.7 ± 0.6) mm. The device contains high-density material in the adjustment mechanism and slightly higher density in the support structures. These can be avoided during planning generation maintaining comparable plan quality. The head positioning device can be used to correct rotational offsets in a clinical setting.
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Affiliation(s)
| | - Gary Razinskas
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Jonas Ringholz
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Johannes Kraft
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Otto A. Sauer
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Sonja Wegener
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
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Heikkilä A, Boman E, Rossi M, Vanhanen A, Mankinen M, Postema M, Koivumäki T. Dosimetric effect of rotational setup errors in volumetric modulated arc therapy and field-in-field treatment of left-sided breast cancer. Phys Med 2024; 117:103203. [PMID: 38171219 DOI: 10.1016/j.ejmp.2023.103203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/06/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
Setup errors are an important factor in the dosimetric accuracy of radiotherapy delivery. In this study, we investigated how rotational setup errors influence the dose distribution in volumetric modulated arc therapy (VMAT) and tangential field-in-field (FiF) treatment of left-sided breast cancer with supraclavicular lymph node involvement in deep inspiration breath hold. Treatment planning computed tomography images and radiotherapy plans of 20 patients were collected retrospectively for the study. Rotational setup errors up to 3° were simulated by rotating the planning images, and the resulting dosimetric changes were calculated. With rotational setup errors up to 3°, the median decrease of V95% to clinical target volume was less than 0.8 percentage point in both VMAT and FiF plans. The dose distribution of the heart and left anterior descending artery was more stable with respect to rotations in VMAT plans compared to FiF plans. Correction of ≥1° setup errors is recommended due to increased doses to the heart and left anterior descending artery after 1° setup errors.
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Affiliation(s)
- Annele Heikkilä
- BioMediTech, Faculty of Medicine and Health Technology, Tampere University, Korkeakoulunkatu 3, 33720 Tampere, Finland; Department of Medical Physics, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland.
| | - Eeva Boman
- Department of Medical Physics, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland; Department of Oncology, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland
| | - Maija Rossi
- Department of Medical Physics, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland; Department of Oncology, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland
| | - Antti Vanhanen
- Department of Medical Physics, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland; Department of Oncology, Tampere University Hospital, P.O. Box 2000, 33521 Tampere, Finland
| | - Mikko Mankinen
- Department of Medical Physics, Central Finland Health Care District, Hoitajantie 3, 40620, Jyväskylä, Finland
| | - Michiel Postema
- BioMediTech, Faculty of Medicine and Health Technology, Tampere University, Korkeakoulunkatu 3, 33720 Tampere, Finland; School of Electrical and Information Engineering, University of the Witwatersrand, Johannesburg, 1 Jan Smutslaan, 2050 Braamfontein, South Africa
| | - Tuomas Koivumäki
- Department of Medical Physics, Central Finland Health Care District, Hoitajantie 3, 40620, Jyväskylä, Finland
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Evaluation of the accuracy of a six-degree-of-freedom robotic couch using optical surface and cone beam CT images of an SRS QA phantom. JOURNAL OF RADIOTHERAPY IN PRACTICE 2023. [DOI: 10.1017/s1460396922000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract
Purpose:
To assess the accuracy of the Varian PerfectPitch six-degree-of-freedom (6DOF) robotic couch by using a Varian SRS QA phantom.
Methods:
The stereotactic radiosurgery (SRS) phantom has five tungsten carbide BBs each with 7·5 mm in diameter arranged with the known geometry. Optical surface images and cone beam CT (CBCT) images of the phantom were taken at different pitch, roll and rotation angles. The pitch, roll, and rotation angles were varied from −3 to 3 degrees by inputs from the linac console. A total of 39 Vision RT images with different rotation angle combinations were collected, and the Vision RT software was used to determine the rotation angles and translational shifts from those images. Eight CBCT images at most allowed rotational angles were analysed by in-house software. The software took the coordinates of the voxel of the maximum CT number inside a 7·5-mm sphere surrounding one BB to be the measured position of this BB. Expected BB positions at different rotation angles were determined by multiplying measured BB positions at zero pitch and roll values by a rotation matrix. Applying the rotation matrix to 5 BB positions yielded 15 equations. A linear least square method was used for regression analysis to approximate the solutions of those equations.
Results:
Of the eight calculations from CBCT images, the maximum rotation angle differences (degree) were 0·10 for pitch, 0·15 for roll and 0·09 for yaw. The maximum translation differences were 0·3 mm in the left–right direction, 0·5 mm in the anterior–posterior direction and 0·4 mm in the superior–inferior direction.
Conclusions:
The uncertainties of the 6-DOF couch were examined with the methods of optical surface imaging and CBCT imaging of the SRS QA phantom. The rotational errors were less than 0·2 degree, and the isocentre shifts were less than 0·8 mm.
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Descriptive Time Series Analysis for Downtime Prediction Using the Maintenance Data of a Medical Linear Accelerator. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12115431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A medical linear accelerator (LINAC) delivers high-energy X-rays or electrons to the patient’s tumor. In this study, we categorized failures and predicted downtime leading to discontinuous radiation treatment using a descriptive time series analysis of a 20-year maintenance dataset of a medical LINAC. A LINAC dataset of failure records for 359 instances was collected from 2001 to 2021. Next, we performed institution-specific seasonal autoregressive integrated moving average (ARIMA) modeling to analyze the causes of the failure categories and predict the downtime. Furthermore, we evaluated the performance of the predictive model using standard error metrics and statistical methods. Our results show that the downtime will increase by 95 h/year after 2022 and 100 h/year after 2023. The accumulated downtime in 2029 is predicted to be a maximum of 2820 h. The modeled seasonal ARIMA showed statistical significance (p < 0.001) with a residual error of σ2 (328.33 ± 9.4). In addition, the forecasting performance of the model was assessed using the mean absolute percentage error (MAPE). The failure parts where the major downtime occurred were the multileaf collimator (25.2%), gantry and couch motion part (15.4%), dosimetric part (11.7%), and computer console (10.0%). Using the development of the ARIMA model specific to our institution, the downtime is predicted to reach up to 2820 h.
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Sarkar B, Manikandan A, Munshi A, Krishnankutty S, Ganesh T, Mohanti B, Manikandan S, Anirudh P, Chandrasekharan S. Calculation of set-up margin in frameless stereotactic radiotherapy accounting for translational and rotational patient positing error. J Cancer Res Ther 2022. [DOI: 10.4103/jcrt.jcrt_359_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Sarkar B, Ganesh T, Munshi A, Manikandan A, Choudhari S, Jassal K, Mohanti BK, Pradhan A. Compatibility assessment of Varian and Elekta robotic couch‐assisted six‐dimensional patient positioning correction systems with external independent imaging modalities. PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Biplab Sarkar
- Department of Radiation Oncology, Apollo Multispeciality Hospitals Kolkata West Bengal India
- GLA University Mathura Uttar Pradesh India
| | | | - Anusheel Munshi
- Department of Radiation Oncology, Manipal Hospitals New Delhi India
| | | | | | - Kanan Jassal
- Department of Radiation Oncology, Fortis Memorial Research Institute Gurugram Haryana India
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Chalkia M, Kouloulias V, Tousoulis D, Deftereos S, Tsiachris D, Vrachatis D, Platoni K. Stereotactic Arrhythmia Radioablation as a Novel Treatment Approach for Cardiac Arrhythmias: Facts and Limitations. Biomedicines 2021; 9:biomedicines9101461. [PMID: 34680578 PMCID: PMC8533522 DOI: 10.3390/biomedicines9101461] [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: 09/05/2021] [Revised: 09/29/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Stereotactic ablative radiotherapy (SABR) is highly focused radiation therapy that targets well-demarcated, limited-volume malignant or benign tumors with high accuracy and precision using image guidance. Stereotactic arrhythmia radioablation (STAR) applies SABR to treat cardiac arrhythmias, including ventricular tachycardia (VT) and atrial fibrillation (AF), and has recently been a focus in research. Clinical studies have demonstrated electrophysiologic conduction blockade and histologic fibrosis after STAR, which provides a proof of principle for its potential for treating arrhythmias. This review will present the basic STAR principles, available clinical study outcomes, and how the technique has evolved since the first pre-clinical study. In addition to the clinical workflow, focus will be given on the process for stereotactic radiotherapy Quality Assurance (QA) tests, as well as the need for establishing a standardized QA protocol. Future implications and potential courses of research will also be discussed.
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Affiliation(s)
- Marina Chalkia
- Radiotherapy Unit, Second Department of Radiology, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (V.K.); (K.P.)
- Correspondence: ; Tel.: +30-2105326418
| | - Vassilis Kouloulias
- Radiotherapy Unit, Second Department of Radiology, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (V.K.); (K.P.)
| | - Dimitris Tousoulis
- First Department of Cardiology, ‘Hippokration’ General Hospital, Vasilissis Sofias 114, 115 27 Athens, Greece;
| | - Spyridon Deftereos
- Second Department of Cardiology, “Attikon” University Hospital, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (S.D.); (D.V.)
| | | | - Dimitrios Vrachatis
- Second Department of Cardiology, “Attikon” University Hospital, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (S.D.); (D.V.)
| | - Kalliopi Platoni
- Radiotherapy Unit, Second Department of Radiology, School of Medicine, Rimini 1, National and Kapodistrian University of Athens, 124 62 Athens, Greece; (V.K.); (K.P.)
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Visser S, den Otter LA, Ribeiro CO, Korevaar EW, Both S, Langendijk JA, Muijs CT, Sijtsema NM, Knopf A. Diaphragm-Based Position Verification to Improve Daily Target Dose Coverage in Proton and Photon Radiation Therapy Treatment of Distal Esophageal Cancer. Int J Radiat Oncol Biol Phys 2021; 112:463-474. [PMID: 34530091 DOI: 10.1016/j.ijrobp.2021.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 08/21/2021] [Accepted: 09/06/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE In modern conformal radiation therapy of distal esophageal cancer, target coverage can be affected by variations in the diaphragm position. We investigated if daily position verification (PV) extended by a diaphragm position correction would optimize target dose coverage for esophageal cancer treatment. METHODS AND MATERIALS For 15 esophageal cancer patients, intensity modulated proton therapy (IMPT) and volumetric modulated arc therapy (VMAT) plans were computed. Displacements of the target volume were correlated with diaphragm displacements using repeated 4-dimensional computed tomography images to determine the correction needed to account for diaphragm variations. Afterwards, target coverage was evaluated for 3 PV approaches based on: (1) bony anatomy (PV_B), (2) bony anatomy corrected for the diaphragm position (PV_BD) and (3) target volume (PV_T). RESULTS The cranial-caudal mean target displacement was congruent with almost half of the diaphragm displacement (y = 0.459x), which was used for the diaphragm correction in PV_BD. Target dose coverage using PV_B was adequate for most patients with diaphragm displacements up till 10 mm (≥94% of the dose in 98% of the volume [D98%]). For larger displacements, the target coverage was better maintained by PV_T and PV_BD. Overall, PV_BD accounted best for target displacements, especially in combination with tissue density variations (D98%: IMPT 94% ± 5%, VMAT 96% ± 5%). Diaphragm displacements of more than 10 mm were observed in 22% of the cases. CONCLUSIONS PV_B was sufficient to achieve adequate target dose coverage in case of small deviations in diaphragm position. However, large deviations of the diaphragm were best mitigated by PV_BD. To detect the cases where target dose coverage could be compromised due to diaphragm position variations, we recommend monitoring of the diaphragm position before treatment through online imaging.
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Affiliation(s)
- Sabine Visser
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Lydia A den Otter
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Cássia O Ribeiro
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik W Korevaar
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antje Knopf
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Rotational positional error-corrected linear set-up margin calculation technique for lung stereotactic body radiotherapy in a dual imaging environment of 4-D cone beam CT and ExacTrac stereoscopic imaging. Radiol Med 2021; 126:979-988. [PMID: 33900527 DOI: 10.1007/s11547-021-01355-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/08/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Accurate calculation of set-up margin is a prerequisite to arrive at the most optimal clinical to planning target volume margin. The aim of this study was to evaluate the compatibility of different on-board and in-room stereoscopic imaging modalities by calculating the set-up margins (SM) in stereotactic body radiotherapy technique accounting and unaccounting for rotational positional errors (PE). Further, we calculated separate SMs one based on residual positional errors and another based on residual + intrafraction positional errors from the imaging data obtained in a dual imaging environment. MATERIALS AND METHODS A total of 22 lung cancer patients were included in this study. For primary image guidance, four-dimensional cone beam computed tomography (4-D CBCT) was used and stereoscopic ExacTrac was used as the auxiliary imaging. Following table position correction (TPC) based on the initial 4-D CBCT, another 4-D CBCT (post-TPC) and a pair of stereoscopic ExacTrac images were obtained. Further, during the treatment delivery, a series of ExacTrac images were acquired to identify the intrafraction PE. If a, b and c were the observed translational shifts in lateral (x-axis), longitudinal (y-axis) and vertical direction (z-axis) and α, β and γ were the rotational shifts in radians about the same axes, respectively, then the resultant translational vectors (A, B and C) were calculated on the basis of translational and rotational values. Set-up margins were calculated using residual errors post-TPC only and also using intrafraction positional errors in addition to the residual errors. RESULTS Residual and residual + intrafraction SM were calculated from a dataset of 82 CBCTs and 189 ExacTrac imaging sessions. CBCT-based mean ± SD shifts in translational and rotational directions were 0.3 ± 1.8 mm, 0.1 ± 1.8 mm, - 0.4 ± 1.6 mm, 0.1 ± 0.4°, 0.0 ± 1.0° and 0.3 ± 0.7°, respectively, and for ExacTrac - 0.1 ± 1.8 mm, 0.2 ± 2.4 mm, - 0.6 ± 1.8 mm, 0.1 ± 1.2°, - 0.2 ± 1.3° and - 0.1 ± 0.6°, respectively. Residual SM without considering the rotational correction in x, y and z directions were 5.0 mm, 4.5 mm and 4.4 mm; rotation-corrected SM were 4.4 mm, 4.0 mm and 5.5 mm, respectively. Residual plus intrafraction SM were 5.5 mm, 6.6 mm and 6.2 mm without considering the rotational corrections, whereas they were 5.0 mm, 6.3 mm and 6.2 mm with rotational errors accounted for. CONCLUSION Accurate calculation of set-up margin is required to find the clinical to planning target volume margin. Primary and auxiliary imaging margins fall in the range of 4.0 to 5.5 mm and 5.0 to 7.0 mm, respectively, indicating a higher SM for X-ray-based planar imaging techniques over three-dimensional cone beam images. This study established the degree of mutual compatibility between two different kinds of widely used set-up imaging modalities, on-board CBCT and in-room stereoscopic imaging ExacTrac. It also describes the technique to calculate the residual and residual plus intrafraction SM and its variation in a dual imaging environment accounting for rotational PE in stereotactic body radiotherapy of lung.
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Utena Y, Takatsu J, Sugimoto S, Sasai K. Trajectory log analysis and cone-beam CT-based daily dose calculation to investigate the dosimetric accuracy of intensity-modulated radiotherapy for gynecologic cancer. J Appl Clin Med Phys 2021; 22:108-117. [PMID: 33426810 PMCID: PMC7882102 DOI: 10.1002/acm2.13163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 11/13/2020] [Accepted: 12/15/2020] [Indexed: 11/21/2022] Open
Abstract
This study evaluated unexpected dosimetric errors caused by machine control accuracy, patient setup errors, and patient weight changes/internal organ deformations. Trajectory log files for 13 gynecologic plans with seven‐ or nine‐beam dynamic multileaf collimator (MLC) intensity‐modulated radiation therapy (IMRT), and differences between expected and actual MLC positions and MUs were evaluated. Effects of patient setup errors on dosimetry were estimated by in‐house software. To simulate residual patient setup errors after image‐guided patient repositioning, planned dose distributions were recalculated (blurred dose) after the positions were randomly moved in three dimensions 0–2 mm (translation) and 0°–2° (rotation) 28 times per patient. Differences between planned and blurred doses in the clinical target volume (CTV) D98% and D2% were evaluated. Daily delivered doses were calculated from cone‐beam computed tomography by the Hounsfield unit‐to‐density conversion method. Fractional and accumulated dose differences between original plans and actual delivery were evaluated by CTV D98% and D2%. The significance of accumulated doses was tested by the paired t test. Trajectory log file analysis showed that MLC positional errors were −0.01 ± 0.02 mm and MU delivery errors were 0.10 ± 0.10 MU. Differences in CTV D98% and D2% were <0.5% for simulated patient setup errors. Differences in CTV D98% and D2% were 2.4% or less between the fractional planned and delivered doses, but were 1.7% or less for the accumulated dose. Dosimetric errors were primarily caused by patient weight changes and internal organ deformation in gynecologic radiation therapy.
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Affiliation(s)
- Yohei Utena
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.,Department of Radiology, Toranomon Hospital, Tokyo, Japan
| | - Jun Takatsu
- Department of Radiation Oncology, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Satoru Sugimoto
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Keisuke Sasai
- Department of Radiation Oncology, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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Wang L, Ke Q, Huang Q, Shao L, Chen J, Wu J. Stereotactic body radiotherapy versus radiofrequency ablation for hepatocellular carcinoma: a systematic review and meta-analysis. Int J Hyperthermia 2020; 37:1313-1321. [PMID: 33243024 DOI: 10.1080/02656736.2020.1843719] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Lei Wang
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, PR China
| | - Qiao Ke
- Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, PR China
| | - Qizhen Huang
- Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, PR China
| | - Lingdong Shao
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, PR China
| | - Juhui Chen
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, PR China
| | - Junxin Wu
- Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, PR China
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Arbab M, Ai H, Bartlett G, Dawson B, Langer M. The effect of designing a rotational planning target volume on sparing pharyngeal constrictor muscles in patients with oropharyngeal cancer. J Appl Clin Med Phys 2020; 21:172-178. [PMID: 33078521 PMCID: PMC7700916 DOI: 10.1002/acm2.13052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/02/2020] [Accepted: 09/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Planning target volume (PTV) has been used to account for variations in tissue, patient and beam position. In oropharyngeal cancers, an isotropic expanded PTV has been used. AIM The aim of this study was to design a new margin formula that would cover the space occupied by an oropharyngeal clinical target volume (CTV) with ±5-degree rotation around the spine in order to reduce the pharyngeal constrictors overlap with PTV compared to an isotropic expanded PTV. METHODS We retrospectively evaluated 20 volumetric-modulated arc therapy (VMAT) plans. In order to perform an off-axis rotation, a hypothetical point was placed through the center of the cervical spinal canal and the image was then rotated around the longitudinal axis ±5 degrees. This created a new set of CTVs that were combined to form the new rotational PTV. The overlap between the pharyngeal constrictor muscles (PCMs) and both PTVs was then evaluated. RESULTS The new rotational PTV causes reduction in the superior PCM overlap in the base of tongue (BOT) lesions compared to tonsillar lesion, 57.8% vs 25.8%, P = 0.01, as well as middle PCM overlap, 73% vs 49%, P = 0.04. Average percent change for PTV volume and overlap with the superior, middle, and inferior PCMs are as followed: -19%, -37%, -59.4%, and -45.2. The smallest isotropic expansion that covers the new rotational PTV was between 3 and 5mm with the average tumor center shift of 0.49 cm. CONCLUSION This new rotational PTV causes significant reduction of the overlap volume between PCMs and PTVs in order to spare the PCMs compared to isotropic expanded PTV.
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Affiliation(s)
- Mona Arbab
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Huisi Ai
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gregory Bartlett
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin Dawson
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mark Langer
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
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14
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Tamihardja J, Schortmann M, Lawrenz I, Weick S, Bratengeier K, Flentje M, Guckenberger M, Polat B. Moderately hypofractionated radiotherapy for localized prostate cancer: updated long-term outcome and toxicity analysis. Strahlenther Onkol 2020; 197:124-132. [PMID: 32833036 PMCID: PMC7840645 DOI: 10.1007/s00066-020-01678-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Evaluation of long-term outcome and toxicity of moderately hypofractionated radiotherapy using intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost treatment planning and cone beam CT-based image guidance for localized prostate cancer. METHODS Between 2005 and 2015, 346 consecutive patients with localized prostate cancer received primary radiotherapy using cone beam CT-based image-guided intensity-modulated radiotherapy (IG-IMRT) and volumetric modulated arc therapy (IG-VMAT) with a simultaneous integrated boost (SIB). Total doses of 73.9 Gy (n = 44) and 76.2 Gy (n = 302) to the high-dose PTV were delivered in 32 and 33 fractions, respectively. The low-dose PTV received a dose (D95) of 60.06 Gy in single doses of 1.82 Gy. The pelvic lymph nodes were treated in 91 high-risk patients to 45.5 Gy (D95). RESULTS Median follow-up was 61.8 months. The 5‑year biochemical relapse-free survival (bRFS) was 85.4% for all patients and 93.3, 87.4, and 79.4% for low-, intermediate-, and high-risk disease, respectively. The 5‑year prostate cancer-specific survival (PSS) was 94.8% for all patients and 98.7, 98.9, 89.3% for low-, intermediate-, and high-risk disease, respectively. The 5‑year and 10-year overall survival rates were 83.8 and 66.3% and the 5‑year and 10-year freedom from distant metastasis rates were 92.2 and 88.0%, respectively. Cumulative 5‑year late GU toxicity and late GI toxicity grade ≥2 was observed in 26.3 and 12.1% of the patients, respectively. Cumulative 5‑year late grade 3 GU/GI toxicity occurred in 4.0/1.2%. CONCLUSION Moderately hypofractionated radiotherapy using SIB treatment planning and cone beam CT image guidance resulted in high biochemical control and survival with low rates of late toxicity.
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Affiliation(s)
- Jörg Tamihardja
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany.
| | - Max Schortmann
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Ingulf Lawrenz
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Stefan Weick
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Klaus Bratengeier
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
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15
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Swinnen ACC, Öllers MC, Loon Ong C, Verhaegen F. The potential of an optical surface tracking system in non-coplanar single isocenter treatments of multiple brain metastases. J Appl Clin Med Phys 2020; 21:63-72. [PMID: 32237274 PMCID: PMC7324699 DOI: 10.1002/acm2.12866] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/23/2020] [Accepted: 02/24/2020] [Indexed: 12/25/2022] Open
Abstract
To evaluate the accuracy of a commercial optical surface tracking (OST) system and to demonstrate how it can be implemented to monitor patient positioning during non‐coplanar single isocenter stereotactic treatments of brain metastases. A 3‐camera OST system was used (Catalyst HD™, C‐RAD) on a TruebeamSTx with a 6DoF couch. The setup accuracy and agreement between the OST system, and CBCT and kV‐MV imaging at couch angles 0° and 270°, respectively, were examined. Film measurements at 3 depths in the Rando‐Alderson phantom were performed using a single isocenter non‐coplanar VMAT plan containing 4 brain lesions. Setup of the phantom was performed with CBCT at couch 0° and subsequently monitored by OST at other couch angles. Setup data for 7 volunteers were collected to evaluate the accuracy and reproducibility of the OST system at couch angles 0°, 45°, 90°, 315°, and 270°. These results were also correlated to the couch rotation offsets obtained by a Winston‐Lutz (WL) test. The Rando‐Alderson phantom, as well as volunteers, were fixated using open face masks (Orfit). For repeated tests with the Rando‐Alderson phantom, deviations between rotational and translational isocenter corrections for CBCT and OST systems are always within 0.2° (pitch, roll, yaw), and 0.1mm and 0.5mm (longitudinal, lateral, vertical) for couch positions 0° and 270°, respectively. Dose deviations between the film and TPS doses in the center of the 4 lesions were −1.2%, −0.1%, −0.0%, and −1.9%. Local gamma evaluation criteria of 2%/2 mm and 3%/1 mm yielded pass rates of 99.2%, 99.2%, 98.6%, 89.9% and 98.8%, 97.5%, 81.7%, 78.1% for the 4 lesions. Regarding the volunteers, the mean translational and rotational isocenter shift values were (0.24 ± 0.09) mm and (0.15 ± 0.07) degrees. Largest isocenter shifts were found for couch angles 45˚ and 90˚, confirmed by WL couch rotation offsets. Patient monitoring during non‐coplanar VMAT treatments of brain metastases is feasible with submillimeter accuracy.
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Affiliation(s)
| | | | - Chin Loon Ong
- Department of Radiation Oncology, HagaZiekenhuis, Den Haag, the Netherlands
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16
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Hartgerink D, Swinnen A, Roberge D, Nichol A, Zygmanski P, Yin FF, Deblois F, Hurkmans C, Ong CL, Bruynzeel A, Aizer A, Fiveash J, Kirckpatrick J, Guckenberger M, Andratschke N, de Ruysscher D, Popple R, Zindler J. LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation. Acta Oncol 2019; 58:1275-1282. [PMID: 31257960 DOI: 10.1080/0284186x.2019.1633016] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Stereotactic radiosurgery (SRS) is a promising treatment option for patients with multiple brain metastases (BM). Recent technical advances have made LINAC based SRS a patient friendly technique, allowing for accurate patient positioning and a short treatment time. Since SRS is increasingly being used for patients with multiple BM, it remains essential that SRS be performed with the highest achievable quality in order to prevent unnecessary complications such as radionecrosis. The purpose of this article is to provide guidance for high-quality LINAC based SRS for patients with BM, with a focus on single isocenter non-coplanar volumetric modulated arc therapy (VMAT). Methods: The article is based on a consensus statement by the study coordinators and medical physicists of four trials which investigated whether patients with multiple BM are better palliated with SRS instead of whole brain radiotherapy (WBRT): A European trial (NCT02353000), two American trials and a Canadian CCTG lead intergroup trial (CE.7). This manuscript summarizes the quality assurance measures concerning imaging, planning and delivery. Results: To optimize the treatment, the interval between the planning-MRI (gadolinium contrast-enhanced, maximum slice thickness of 1.5 mm) and treatment should be kept as short as possible (< two weeks). The BM are contoured based on the planning-MRI, fused with the planning-CT. GTV-PTV margins are minimized or even avoided when possible. To maximize efficiency, the preferable technique is single isocenter (non-)coplanar VMAT, which delivers high doses to the target with maximal sparing of the organs at risk. The use of flattening filter free photon beams ensures a lower peripheral dose and shortens the treatment time. To bench mark SRS treatment plan quality, it is advisable to compare treatment plans between hospitals. Conclusion: This paper provides guidance for quality assurance and optimization of treatment delivery for LINAC-based radiosurgery for patients with multiple BM.
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Affiliation(s)
- Dianne Hartgerink
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ans Swinnen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - David Roberge
- Department of Radiation Oncology, CHUM, Montreal, QC, Canada
| | - Alan Nichol
- Department of Radiation Oncology, CHUM, Montreal, QC, Canada
| | - Piotr Zygmanski
- Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Chin Loon Ong
- Department of Radiation Oncology, HagaZiekenhuis, Den Haag, The Netherlands
| | - Anna Bruynzeel
- Department of Radiotherapy, Cancer Center Amsterdam, VU University medical center, Amsterdam, The Netherlands
| | - Ayal Aizer
- Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John Kirckpatrick
- Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Dirk de Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Richard Popple
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jaap Zindler
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Radiation Oncology, Erasmus MC, Rotterdam, The Netherlands
- Holland Proton Therapy Center, Delft, The Netherlands
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17
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Rodrigues MF, Veen S, van Egmond J, van Hameren M, van Oorschot T, de Vet S, van Santvoort JPC, Wiggenraad RGJ, Mast ME. The influence of a six degrees of freedom couch and an individual head support in patient positioning in radiotherapy of head and neck cancer. Phys Imaging Radiat Oncol 2019; 11:30-33. [PMID: 33458274 PMCID: PMC7807734 DOI: 10.1016/j.phro.2019.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/30/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022] Open
Abstract
Reproducible patient positioning is important in radiotherapy (RT) of head-and-neck cancer. We therefore compared set-up errors in head-and-neck RT resulting from three different patient positioning systems. Patients were either treated with a standard head support (SHS) and conventional treatment couch (SHS-3, n = 10), a SHS and rotational couch (SHS-6, n = 10), or an individual head support (IHS) and rotational couch (IHS-6, n = 10). Interfraction mean translation vector lenghts were significantly lower for IHS-6 compared to SHS-3 (0.8 ± 0.3 mm vs. 1.4 ± 0.7 mm, P = 0.001). Intrafraction displacement was comparable among cohorts. This study showed that the use of a six degrees of freedom couch combined with an IHS in head-and-neck RT resulted in better interfraction reproducibility.
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Affiliation(s)
- Myra F Rodrigues
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands.,Department of Radiation Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Sten Veen
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Jaap van Egmond
- Department of Medical Physics, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Mark van Hameren
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Theodorus van Oorschot
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Steven de Vet
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Jan P C van Santvoort
- Department of Medical Physics, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Ruud G J Wiggenraad
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Mirjam E Mast
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
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18
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Cao X, Liu M, Zhai F, Li N, Bao C, Liu Y, Chen G. Comparison of different registration methods and landmarks for image-guided radiation therapy of pulmonary tumors. BMC Med Imaging 2019; 19:46. [PMID: 31151424 PMCID: PMC6544943 DOI: 10.1186/s12880-019-0343-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 05/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the accuracy, advantages and disadvantages of automatic registration methods at different anatomical-sites for thoracic image-guided radiation therapy (IGRT). METHODS The Varian-IX IGRT system was used to perform a manual registration of the images collected on the first fraction of 60 patients with lung cancer (42 cases central location and 18 cases of peripheral). The registered images were used as reference images. Offline registration was performed for computed tomography-CBCT images using four methods: whole image registration, ipsilateral registration, soft tissue tumor registration, and vertebral body registration. Time taken to complete and deviation value were analyzed between the different methods. RESULTS There were significant differences in absolute deviation value of all the three directions (P < 0.001) and the time consumption (P < 0.001) between 4 methods. The Z direction had significant differences in deviation value of 4 methods (0.023 ± 0.128 mm, - 0.030 ± 0.175 mm, - 0.010 ± 0.238 mm, - 0.075 ± 0.137 mm, P = 0.011). The difference was significant in the X direction of the ipsilateral registration method between central and peripheral lung cancer (0.033 ± 0.053 mm vs. 0.067 ± 0.067 mm, P = 0.045). CONCLUSIONS The whole lung or affected side registration methods could be recommended to be used in the automatic registration function of the Varian-IX's On-Board Imaging (OBI) system.
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Affiliation(s)
- Xiaohui Cao
- Department of Radiotherapy and Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Ming Liu
- Department of Radiotherapy and Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Fushan Zhai
- Department of Radiotherapy and Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Nan Li
- Department of Radiotherapy and Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Chaoen Bao
- Department of Radiotherapy and Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Yinliang Liu
- Department of Radiotherapy and Oncology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Gang Chen
- Department of Respiratory Medicine, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, China.
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19
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Yao Z, Feng H, Song Y, Li S, Yang Y, Liu L, Liu C. A supervised network for fast image-guided radiotherapy (IGRT) registration. J Med Syst 2019; 43:194. [PMID: 31114956 DOI: 10.1007/s10916-019-1256-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/27/2019] [Indexed: 11/30/2022]
Abstract
3D/3D image registration in IGRT, which aligns planning Computed Tomography (CT) image set with on board Cone Beam CT (CBCT) image set in a short time with high accuracy, is still a challenge due to its high computational cost and complex anatomical structure of medical image. In order to overcome these difficulties, a new method is proposed which contains a coarse registration and a fine registration. For the coarse registration, a supervised regression convolutional neural networks (CNNs) is used to optimize the spatial variation by minimizing the loss when combine the CT images with the CBCT images. For the fine registration, intensity-based image registration is used to calculate the accurate spatial difference of the input image pairs. A coarse registration can get a rough result with a wide capture range in less than 0.5 s. Sequentially a fine registration can get accurate results in a reasonable short time. RSD-111 T chest phantom was used to test our new method. The set-up error was calculated in less than 10s in time scale, and was reduced to sub-millimeter level in spatial scale. The average residual errors in translation and rotation are within ±0.5 mm and ± 0.2°.
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Affiliation(s)
- Zhixin Yao
- Institute of Plasma Physics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, China.,University of Science and Technology of China, Hefei, 230026, China
| | - Hansheng Feng
- Institute of Plasma Physics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, China. .,University of Science and Technology of China, Hefei, 230026, China.
| | - Yuntao Song
- Institute of Plasma Physics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, China.,University of Science and Technology of China, Hefei, 230026, China
| | - Shi Li
- Institute of Plasma Physics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, China.,University of Science and Technology of China, Hefei, 230026, China
| | - Yang Yang
- Institute of Plasma Physics, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, China
| | - Lingling Liu
- Cancer Hospital, Chinese Academy of Science, Hefei, 230031, China.,Anhui Province Key Laboratory of Medical Physics and Technology, Center of Medical Physics and Technology, Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei, 230031, China
| | - Chunbo Liu
- University of Science and Technology of China, Hefei, 230026, China
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20
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Local control rates in stereotactic body radiotherapy (SBRT) of lung metastases associated with the biologically effective dose. Rep Pract Oncol Radiother 2019; 24:142-150. [PMID: 30723385 DOI: 10.1016/j.rpor.2019.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 01/02/2019] [Indexed: 12/20/2022] Open
Abstract
Aim To evaluate dose differences in lung metastases treated with stereotactic body radiotherapy (SBRT), and the correlation with local control, regarding the dose algorithm, target volume and tissue density. Background Several studies showed excellent local control rates in SBRT for lung metastases, with different fractionation schemes depending on the tumour location or size. These results depend on the dose distributions received by the lesions in terms of the tissue heterogeneity corrections performed by the dose algorithms. Materials and methods Forty-seven lung metastases treated with SBRT, using intrafraction control and respiratory gating with internal fiducial markers as surrogates (ExacTrac, BrainLAB AG), were calculated using Pencil Beam (PB) and Monte Carlo (MC) (iPlan, BrainLAB AG).Dose differences between both algorithms were obtained for the dose received by 99% (D 99%) and 50% (D 50%) of the planning treatment volume (PTV). The biologically effective dose delivered to 99% (BED99%) and 50% (BED50%) of the PTV were estimated from the MC results. Local control was evaluated after 24 months of median follow-up (range: 3-52 months). Results The greatest variations (40.0% in ΔD 99% and 38.4% in ΔD 50%) were found for the lower volume and density cases. The BED99% and BED50% were strongly correlated with observed local control rates: 100% and 61.5% for BED99% > 85 Gy and <85 Gy (p < 0.0001), respectively, and 100% and 58.3% for BED50% > 100 Gy and <100 Gy (p < 0.0001), respectively. Conclusions Lung metastases treated with SBRT, with delivered BED99% > 85 Gy and BED50% > 100 Gy, present better local control rates than those treated with lower BED values (p = 0.001).
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21
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Chan MF, Lim SB, Li X, Tang X, Zhang P, Shi C. Commissioning and Evaluation of a Third-Party 6 Degrees-of-Freedom Couch Used in Radiotherapy. Technol Cancer Res Treat 2019; 18:1533033819870778. [PMID: 31434547 PMCID: PMC6704415 DOI: 10.1177/1533033819870778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purposes: The newly released Protura 6 degrees-of-freedom couch (CIVCO) has limited quality assurance protocols and pertinent publications. Herein, we report our experiences of the Protura system acceptance, commissioning, and quality assurance. Methods: The Protura system integration was tested with peripheral equipment on the following items: couch movement range limit, 6 degrees-of-freedom movement accuracy, weight test and couch sagging, system connection with Linac, isocentricity of couch and rotation alignment, kV and cone-beam computed tomography imaging of HexaCHECK with MIMI phantom (Standard Imaging), and an in-house custom 6 degrees-of-freedom quality assurance phantom. A couch transmission measurement was also performed. Results: The vertical, longitudinal, and lateral ranges of the 6 degrees-of-freedom couch pedestal are 43.9 to 0.0 cm, 24.6 to 149.5 cm, −20.6 to 20.7 cm, respectively. The couch movement accuracy was within 1 mm in all directions. The couch sagging with a 200 lbs (∼91 kg) evenly distributed object is 1.0 cm and 0.4° pitch in the distal end of the couch. The isocentricity of the couch was about 0.5 mm in diameter of all crosshair projections on the couch isocenter level, and the largest couch rotation alignment observed was (0.3°) at the couch angle of 90°. The deviation from the reference position (zero position) of the HexaCHECK phantom, measured by matching the cone-beam computed tomography with the reference planning computed tomography, was found to be below 0.2 mm in the anterior–posterior and right–left dimensions, 0.4 mm in superior–inferior dimension, and 0.1° in roll, pitch, and yaw directions. Conclusions: A 6 degrees-of-freedom quality assurance phantom is helpful for the commissioning and routine quality assurance tests. Due to the third-party integration with Linac, the system is prone to “double-correction” errors. A rigorous quality assurance program is the key to a successful clinical implementation of the Protura system.
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Affiliation(s)
- Maria F Chan
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Seng-Boh Lim
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiang Li
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiaoli Tang
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peng Zhang
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chengyu Shi
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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22
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Kurz C, Süss P, Arnsmeyer C, Haehnle J, Teichert K, Landry G, Hofmaier J, Exner F, Hille L, Kamp F, Thieke C, Ganswindt U, Valentini C, Hölscher T, Troost E, Krause M, Belka C, Küfer KH, Parodi K, Richter C. Dose-guided patient positioning in proton radiotherapy using multicriteria-optimization. Z Med Phys 2018; 29:216-228. [PMID: 30409729 DOI: 10.1016/j.zemedi.2018.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 10/01/2018] [Accepted: 10/15/2018] [Indexed: 12/25/2022]
Abstract
Proton radiotherapy (PT) requires accurate target alignment before each treatment fraction, ideally utilizing 3D in-room X-ray computed tomography (CT) imaging. Typically, the optimal patient position is determined based on anatomical landmarks or implanted markers. In the presence of non-rigid anatomical changes, however, the planning scenario cannot be exactly reproduced and positioning should rather aim at finding the optimal position in terms of the actually applied dose. In this work, dose-guided patient alignment, implemented as multicriterial optimization (MCO) problem, was investigated in the scope of intensity-modulated and double-scattered PT (IMPT and DSPT) for the first time. A method for automatically determining the optimal patient position with respect to pre-defined clinical goals was implemented. Linear dose interpolation was used to access a continuous space of potential patient shifts. Fourteen head and neck (H&N) and eight prostate cancer patients with up to five repeated CTs were included. Dose interpolation accuracy was evaluated and the potential dosimetric advantages of dose-guided over bony-anatomy-based patient alignment investigated by comparison of clinically relevant target and organ-at-risk (OAR) dose-volume histogram (DVH) parameters. Dose interpolation was found sufficiently accurate with average pass-rates of 90% and 99% for an exemplary H&N and prostate patient, respectively, using a 2% dose-difference criterion. Compared to bony-anatomy-based alignment, the main impact of automated MCO-based dose-guided positioning was a reduced dose to the serial OARs (spinal cord and brain stem) for the H&N cohort. For the prostate cohort, under-dosage of the target structures could be efficiently diminished. Limitations of dose-guided positioning were mainly found in reducing target over-dosage due to weight loss for H&N patients, which might require adaptation of the treatment plan. Since labor-intense online quality-assurance is not required for dose-guided patient positioning, it might, nevertheless, be considered an interesting alternative to full online re-planning for initially mitigating the effects of anatomical changes.
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Affiliation(s)
- Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany; Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, 85748 Garching bei München, Germany.
| | - Philipp Süss
- Fraunhofer Institute for Industrial Mathematics (ITWM), Fraunhofer-Platz 1, 67663 Kaiserslautern, Germany
| | - Carolin Arnsmeyer
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, PF 41, 01307 Dresden, Germany
| | - Jonas Haehnle
- Fraunhofer Institute for Industrial Mathematics (ITWM), Fraunhofer-Platz 1, 67663 Kaiserslautern, Germany
| | - Katrin Teichert
- Fraunhofer Institute for Industrial Mathematics (ITWM), Fraunhofer-Platz 1, 67663 Kaiserslautern, Germany
| | - Guillaume Landry
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, 85748 Garching bei München, Germany
| | - Jan Hofmaier
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Florian Exner
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, PF 41, 01307 Dresden, Germany
| | - Lucas Hille
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, 85748 Garching bei München, Germany
| | - Florian Kamp
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Christian Thieke
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Ute Ganswindt
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany
| | - Chiara Valentini
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Tobias Hölscher
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - Esther Troost
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, PF 41, 01307 Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; German Cancer Consortium (DKTK) partner site Dresden, Germany and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Bautzner Landstr. 400, 01328 Dresden, Germany; National Center for Tumor Diseases (NCT), partner site Dresden, Germany
| | - Mechthild Krause
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, PF 41, 01307 Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; German Cancer Consortium (DKTK) partner site Dresden, Germany and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Bautzner Landstr. 400, 01328 Dresden, Germany; National Center for Tumor Diseases (NCT), partner site Dresden, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 München, Germany; German Cancer Consortium (DKTK) partner site Munich, Germany and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Karl-Heinz Küfer
- Fraunhofer Institute for Industrial Mathematics (ITWM), Fraunhofer-Platz 1, 67663 Kaiserslautern, Germany
| | - Katia Parodi
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, 85748 Garching bei München, Germany
| | - Christian Richter
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Fetscherstr. 74, PF 41, 01307 Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 01307 Dresden, Germany; German Cancer Consortium (DKTK) partner site Dresden, Germany and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Bautzner Landstr. 400, 01328 Dresden, Germany
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Sarkar B, Ray J, Ganesh T, Manikandan A, Munshi A, Rathinamuthu S, Kaur H, Anbazhagan S, Giri UK, Roy S, Jassal K, Mohanti BK. Methodology to reduce 6D patient positional shifts into a 3D linear shift and its verification in frameless stereotactic radiotherapy. ACTA ACUST UNITED AC 2018; 63:075004. [DOI: 10.1088/1361-6560/aab231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Ono T, Miyabe Y, Akimoto M, Mukumoto N, Ishihara Y, Nakamura M, Mizowaki T. Development of a portable quality control application using a tablet-type electronic device. Med Phys 2018; 45:1029-1035. [DOI: 10.1002/mp.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 12/28/2017] [Accepted: 01/08/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Tomohiro Ono
- Department of Radiation Oncology and Image-Applied Therapy; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
| | - Yuki Miyabe
- Department of Radiation Oncology and Image-Applied Therapy; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
| | - Mami Akimoto
- Department of Radiation Oncology; Kurashiki Central Hospital; Okayama 710-8602 Japan
| | - Nobutaka Mukumoto
- Department of Radiation Oncology and Image-Applied Therapy; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
| | - Yoshitomo Ishihara
- Division of Radiation Oncology; Wakayama Red Cross Hospital; Wakayama 640-8558 Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-Applied Therapy; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
- Division of Medical Physics; Department of Information Technology and Medical Engineering; Human Health Sciences; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy; Graduate School of Medicine; Kyoto University; Kyoto 606-8507 Japan
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Kung JS, Tran WT, Poon I, Atenafu EG, Courneyea L, Higgins K, Enepekides D, Sahgal A, Chin L, Karam I. Evaluation of the Efficacy of Rotational Corrections for Standard-Fractionation Head and Neck Image-Guided Radiotherapy. Technol Cancer Res Treat 2018; 18:1533033819853824. [PMID: 31122178 PMCID: PMC6535727 DOI: 10.1177/1533033819853824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/23/2019] [Accepted: 04/24/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Modern linear accelerators are equipped with cone beam computed tomography and robotic couches that can correct for errors in the translational (X, Y, Z) and rotational (α, β, γ) axes prior to treatment delivery. Here, we compared the positional accuracy of 2 cone beam registration approaches: (1) employing translational shifts only in 3 degrees of freedom (X, Y, Z), versus; (2) using translational-rotational shifts in 6 degrees of freedom (X, Y, Z, α, β, γ). METHODS This retrospective study examined 140 interfraction cone beam images from 20 patients with head and neck cancer treated with standard intensity-modulated radiation therapy. The cone beam images were matched to planning simulation scans in 3, then in 6 degrees of freedom, using the mandible, clivus, and C2 and C7 vertebrae as surrogate volumes. Statistical analyses included a generalized mixed model and was used to assess whether there were significant differences in acceptable registrations between the 2 correction methods. RESULTS The rates of improvement with corrections in 6 degrees of freedom for the mandible with a 5-mm expansion margin were 54.55% ( P = .793), for the clivus 85.71% ( P = .222), and for C7 87.50% ( P = .015). There was a 100% increase in acceptability for the C2 vertebra within the 5-mm margin ( P < .001). For the 3-mm expansion margin, the rates of improvement for the mandible, clivus, C2, and C7 were 63.16% ( P = .070), 91.30% ( P = .011), 84.21% ( P = .027), and 76.92% ( P < .001), respectively. CONCLUSIONS Significant registration improvements with the use of rotational corrections with a 5-mm expansion margin are only seen in the C7 vertebra. At the 3-mm margin, significant improvements are found for the C2, C7, and clivus registrations, suggesting that intensity-modulated radiotherapy treatments for head and neck cancers with 3-mm planning target volume margins may benefit from corrections in 6 degrees of freedom.
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Affiliation(s)
- Joseph S. Kung
- Division of Radiation Therapy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - William T. Tran
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eshetu G. Atenafu
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Lorraine Courneyea
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology/Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology/Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lee Chin
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Woods K, Ayan AS, Woollard J, Gupta N. Quality assurance for a six degrees-of-freedom table using a 3D printed phantom. J Appl Clin Med Phys 2017; 19:115-124. [PMID: 29159920 PMCID: PMC5768004 DOI: 10.1002/acm2.12227] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 09/07/2017] [Accepted: 10/17/2017] [Indexed: 12/31/2022] Open
Abstract
Purpose To establish a streamlined end‐to‐end test of a 6 degrees‐of‐freedom (6DoF) robotic table using a 3D printed phantom for periodic quality assurance. Methods A 3D printed phantom was fabricated with translational and rotational offsets and an imbedded central ball‐bearing (BB). The phantom underwent each step of the radiation therapy process: CT simulation in a straight orientation, plan generation using the treatment planning software, setup to offset marks at the linac, registration and corrected 6DoF table adjustments via hidden target test, delivery of a Winston‐Lutz test to the BB, and verification of table positioning via field and laser lights. The registration values, maximum total displacement of the combined Winston‐Lutz fields, and a pass or fail criterion of the laser and field lights were recorded. The quality assurance process for each of the three linacs were performed for the first 30 days. Results Within a 95% confidence interval, the overall uncertainty values for both translation and rotation were below 1.0 mm and 0.5° for each linac respectively. When combining the registration values and other uncertainties for all three linacs, the average deviations were within 2.0 mm and 1.0° of the designed translation and rotation offsets of the 3D print respectively. For all three linacs, the maximum total deviation for the Winston‐Lutz test did not exceed 1.0 mm. Laser and light field verification was within tolerance every day for all three linacs given the latest guidance documentation for table repositioning. Conclusion The 3D printer is capable of accurately fabricating a quality assurance phantom for 6DoF positioning verification. The end‐to‐end workflow allows for a more efficient test of the 6DoF mechanics while including other important tests needed for routine quality assurance.
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Affiliation(s)
- Kyle Woods
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Ahmet S Ayan
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Jeffrey Woollard
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
| | - Nilendu Gupta
- Department of Radiation Oncology, Ohio State University, Columbus, OH, USA
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An infrared interactive patient position guidance and acquisition control system for use during radiotherapy treatment. JOURNAL OF RADIOTHERAPY IN PRACTICE 2017. [DOI: 10.1017/s1460396917000140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundThe control of patient position, posture and respiratory movements during radiotherapy is important for effective and specific treatment of malignancy. We have developed an infrared (IR) interactive patient position guidance and acquisition control system for clinical use, comprising IR cameras, IR markers and dedicated software.Materials and methodsWe evaluated the system with ten healthy volunteers and ten experienced operators. IR markers were placed on the body surface. Their positions were calculated using vectors of three translational and three rotational parameters, and the intrafractional error for each marker was acquired with and without respiratory motion. The inclusion of multiple positioning markers allowed for real-time visualisation of the patient posture, with feedback on misalignment and required postural adjustments.ResultsThe positioning time was 73 seconds (with a minimum period of 39 seconds), which was significantly shorter than for conventional line alignment. A comparison of positioning reproducibility between conventional line alignment and this system was <3·5 mm and was not patient dependent or operator dependent. An intrafractional error of displacement of up to 10·0 mm was found in the right iliac crest.ConclusionsThis IR interactive system was shown to be high utility and suitable for monitoring patient position, posture and respiratory movements during radiotherapy.
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Dhillon A, Erler D, Poon I, Lee J, Enepekides D, Higgins K, Chin L, Karam I. The Impact of Correcting for Translational and Rotational Errors Using the HexaPOD in Head and Neck Stereotactic Body Radiation Therapy Patients. J Med Imaging Radiat Sci 2017; 48:276-281. [DOI: 10.1016/j.jmir.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 11/17/2022]
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Zhang Q, Driewer J, Wang S, Li S, Zhu X, Zheng D, Cao Y, Zhang J, Jamshidi A, Cox BW, Knisely JPS, Potters L, Klein EE. Accuracy evaluation of a six-degree-of-freedom couch using cone beam CT and IsoCal phantom with an in-house algorithm. Med Phys 2017; 44:3888-3898. [PMID: 28500790 DOI: 10.1002/mp.12342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/24/2017] [Accepted: 05/03/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The accuracy of a six degree of freedom (6DoF) couch was evaluated using a novel method. METHODS Cone beam CT (CBCT) images of a 3D phantom (IsoCal) were acquired with different, known combinations of couch pitch and roll angles. Pitch and roll angles between the maximum allowable values of 357 and 3 degrees were tested in one degree increments. A total of 49 combinations were tested at 0 degrees of yaw (couch rotation angle). The 3D positions of 16 tungsten carbide ball bearings (BBs), each 4 mm in diameter and arranged in a known geometry within the IsoCal phantom, were determined in the 49 image sets with in-house software. The BB positions at different rotation angles were determined using a rotation matrix from the original BB positions at zero pitch and roll angles. A linear least squares fit method estimated the rotation angles and differences between detected and nominal rotation angles were calculated. This study was conducted for the case with and without extra weight on the couch. Couch walk shifts for the system were investigated using eight combinations of rotation, roll and pitch. RESULTS A total of 49 CBCT images with voxel sizes 0.5 × 0.5 × 1.0 mm3 were taken for the case without extra weight on the couch. The 16 BBs were determined to evaluate the isocenter translation and rotation differences between the calculated and nominal couch values. Among all 49 calculations, the maximum rotation angle differences were 0.10 degrees for pitch, 0.15 degrees for roll and 0.09 degrees for yaw. The corresponding mean and standard deviation values were 0.028 ± 0.032, -0.043 ± 0.058, and -0.009 ± 0.033 degrees. The maximum translation differences were 0.3 mm in the left-right direction, 0.5 mm in the anterior-posterior direction and 0.4 mm in the superior-inferior direction. The mean values and corresponding standard deviations were 0.07 ± 0.12, -0.05 ± 0.25, and -0.12±0.14 mm for the planes described above. With an 80 kg phantom on the couch, the maximum translation shift was 0.69 mm. The couch walk translation shifts were less than 0.1 mm and rotation shifts were less than 0.1 degree. CONCLUSIONS Errors of a new 6DoF couch were tested using CBCT images of a 3D phantom. The rotation errors were less than 0.3 degree and the translation errors were less than or equal to 0.8 mm in each direction. This level of accuracy is warranted for clinical radiotherapy utilization including stereotactic radiosurgery.
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Affiliation(s)
- Qinghui Zhang
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Joseph Driewer
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Shuo Wang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Sicong Li
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Xiaofeng Zhu
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Dandan Zheng
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yijian Cao
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Jiaju Zhang
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Abolghassem Jamshidi
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Brett W Cox
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Jonathan P S Knisely
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Eric E Klein
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
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Haehnle J, Süss P, Landry G, Teichert K, Hille L, Hofmaier J, Nowak D, Kamp F, Reiner M, Thieke C, Ganswindt U, Belka C, Parodi K, Küfer KH, Kurz C. A novel method for interactive multi-objective dose-guided patient positioning. Phys Med Biol 2016; 62:165-185. [DOI: 10.1088/1361-6560/62/1/165] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Richter A, Polat B, Lawrenz I, Weick S, Sauer O, Flentje M, Mantel F. Initial results for patient setup verification using transperineal ultrasound and cone beam CT in external beam radiation therapy of prostate cancer. Radiat Oncol 2016; 11:147. [PMID: 27825386 PMCID: PMC5101794 DOI: 10.1186/s13014-016-0722-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evaluation of set up error detection by a transperineal ultrasound in comparison with a cone beam CT (CBCT) based system in external beam radiation therapy (EBRT) of prostate cancer. METHODS Setup verification was performed with transperineal ultrasound (TPUS) and CBCT for 10 patients treated with EBRT for prostate cancer. In total, 150 ultrasound and CBCT scans were acquired in rapid succession and analyzed for setup errors. The deviation between setup errors of the two modalities was evaluated separately for each dimension. RESULTS A moderate correlation in lateral, vertical and longitudinal direction was observed comparing the setup errors. Mean differences between TPUS and CBCT were (-2.7 ± 2.3) mm, (3.0 ± 2.4) mm and (3.2 ± 2.7) mm in lateral, vertical and longitudinal direction, respectively. The mean Euclidean difference between TPUS and CBCT was (6.0 ± 3.1) mm. Differences up to 19.2 mm were observed between the two imaging modalities. Discrepancies between TPUS and CBCT of at least 5 mm occurred in 58 % of monitored treatment sessions. CONCLUSION Setup differences between TPUS and CBCT are 6 mm on average. Although the correlation of the setup errors determined by the two different image modalities is rather week, the combination of setup verification by CBCT and intrafraction motion monitoring by TPUS imaging can use the benefits of both imaging modalities.
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Affiliation(s)
- Anne Richter
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany.
| | - Bülent Polat
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Ingulf Lawrenz
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Stefan Weick
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Otto Sauer
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
| | - Frederick Mantel
- Department of Radiation Oncology, University of Wuerzburg, Josef-Schneider-Str. 11, 97080, Wuerzburg, Germany
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Xu H, Brown S, Chetty IJ, Wen N. A Systematic Analysis of Errors in Target Localization and Treatment Delivery for Stereotactic Radiosurgery Using 2D/3D Image Registration. Technol Cancer Res Treat 2016; 16:321-331. [PMID: 27582369 DOI: 10.1177/1533034616664425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To determine the localization uncertainties associated with 2-dimensional/3-dimensional image registration in comparison to 3-dimensional/3-dimensional image registration in 6 dimensions on a Varian Edge Linac under various imaging conditions. METHODS The systematic errors in 6 dimensions were assessed by comparing automatic 2-dimensional/3-dimensional (kV/MV vs computed tomography) with 3-dimensional/3-dimensional (cone beam computed tomography vs computed tomography) image registrations under various conditions encountered in clinical applications. The 2-dimensional/3-dimensional image registration uncertainties for 88 patients with different treatment sites including intracranial and extracranial were evaluated by statistically analyzing 2-dimensional/3-dimensional pretreatment verification shifts of 192 fractions in stereotactic radiosurgery and stereotactic body radiotherapy. RESULTS The systematic errors of 2-dimensional/3-dimensional image registration using kV-kV, MV-kV, and MV-MV image pairs were within 0.3 mm and 0.3° for the translational and rotational directions within a 95% confidence interval. No significant difference ( P > .05) in target localization was observed with various computed tomography slice thicknesses (0.8, 1, 2, and 3 mm). Two-dimensional/3-dimensional registration had the best accuracy when pattern intensity and content filter were used. For intracranial sites, means ± standard deviations of translational errors were -0.20 ± 0.70 mm, 0.04 ± 0.50 mm, and 0.10 ± 0.40 mm for the longitudinal, lateral, and vertical directions, respectively. For extracranial sites, means ± standard deviations of translational errors were -0.04 ± 1.00 mm, 0.2 ± 1.0 mm, and 0.1 ± 1.0 mm for the longitudinal, lateral, and vertical directions, respectively. Two-dimensional/3-dimensional image registration for intracranial and extracranial sites had comparable systematic errors that were approximately 0.2 mm in the translational direction and 0.08° in the rotational direction. CONCLUSION The standard 2-dimensional/3-dimensional image registration tool available on the Varian Edge radiosurgery device, a state-of-the-art system, is helpful for robust and accurate target positioning for image-guided stereotactic radiosurgery.
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Affiliation(s)
- Hao Xu
- 1 Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Stephen Brown
- 2 Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
| | - Indrin J Chetty
- 2 Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
| | - Ning Wen
- 2 Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
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Yang CC, Chen FL, Lo YC. Improving Image Quality of On-Board Cone-Beam CT in Radiation Therapy Using Image Information Provided by Planning Multi-Detector CT: A Phantom Study. PLoS One 2016; 11:e0157072. [PMID: 27280593 PMCID: PMC4900643 DOI: 10.1371/journal.pone.0157072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 05/24/2016] [Indexed: 11/22/2022] Open
Abstract
Purpose The aim of this study was to improve the image quality of cone-beam computed tomography (CBCT) mounted on the gantry of a linear accelerator used in radiation therapy based on the image information provided by planning multi-detector CT (MDCT). Methods MDCT-based shading correction for CBCT and virtual monochromatic CT (VMCT) synthesized using the dual-energy method were performed. In VMCT, the high-energy data were obtained from CBCT, while the low-energy data were obtained from MDCT. An electron density phantom was used to investigate the efficacy of shading correction and VMCT on improving the target detectability, Hounsfield unit (HU) accuracy and variation, which were quantified by calculating the contrast-to-noise ratio (CNR), the percent difference (%Diff) and the standard deviation of the CT numbers for tissue equivalent background material, respectively. Treatment plan studies for a chest phantom were conducted to investigate the effects of image quality improvement on dose planning. Results For the electron density phantom, the mean value of CNR was 17.84, 26.78 and 34.31 in CBCT, shading-corrected CBCT and VMCT, respectively. The mean value of %Diff was 152.67%, 11.93% and 7.66% in CBCT, shading-corrected CBCT and VMCT, respectively. The standard deviation within a uniform background of CBCT, shading-corrected CBCT and VMCT was 85, 23 and 15 HU, respectively. With regards to the chest phantom, the monitor unit (MU) difference between the treatment plan calculated using MDCT and those based on CBCT, shading corrected CBCT and VMCT was 6.32%, 1.05% and 0.94%, respectively. Conclusions Enhancement of image quality in on-board CBCT can contribute to daily patient setup and adaptive dose delivery, thus enabling higher confidence in patient treatment accuracy in radiation therapy. Based on our results, VMCT has the highest image quality, followed by the shading corrected CBCT and the original CBCT. The research results presented in this study should be able to provide a route to reach a high level of image quality for CBCT imaging in radiation oncology.
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Affiliation(s)
- Ching-Ching Yang
- Department of Medical Imaging and Radiological Sciences, Tzu-Chi University of Science and Technology, Hualien, Taiwan
- * E-mail:
| | - Fong-Lin Chen
- Department of Medical Physics, Koo Foundation Sun Yat-Sen Cancer Center, Taipei City, Taiwan
| | - Yeh-Chi Lo
- Department of Radiation Oncology, Mount Sinai Medical School, New York, New York, United States of America
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Garibaldi C, Piperno G, Ferrari A, Surgo A, Muto M, Ronchi S, Bazani A, Pansini F, Cremonesi M, Jereczek-Fossa BA, Orecchia R. Translational and rotational localization errors in cone-beam CT based image-guided lung stereotactic radiotherapy. Phys Med 2016; 32:859-65. [PMID: 27289354 DOI: 10.1016/j.ejmp.2016.05.055] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Accurate localization is crucial in delivering safe and effective stereotactic body radiation therapy (SBRT). The aim of this study was to analyse the accuracy of image-guidance using the cone-beam computed tomography (CBCT) of the VERO system in 57 patients treated for lung SBRT and to calculate the treatment margins. MATERIALS AND METHODS The internal target volume (ITV) was obtained by contouring the tumor on maximum and mean intensity projection CT images reconstructed from a respiration correlated 4D-CT. Translational and rotational tumor localization errors were identified by comparing the manual registration of the ITV to the motion-blurred tumor on the CBCT and they were corrected by means of the robotic couch and the ring rotation. A verification CBCT was acquired after correction in order to evaluate residual errors. RESULTS The mean 3D vector at initial set-up was 6.6±2.3mm, which was significantly reduced to 1.6±0.8mm after 6D automatic correction. 94% of the rotational errors were within 3°. The PTV margins used to compensate for residual tumor localization errors were 3.1, 3.5 and 3.3mm in the LR, SI and AP directions, respectively. CONCLUSIONS On-line image guidance with the ITV-CBCT matching technique and automatic 6D correction of the VERO system allowed a very accurate tumor localization in lung SBRT.
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Affiliation(s)
- Cristina Garibaldi
- Unit of Radiation Research, European Institute of Oncology, Milano, Italy.
| | - Gaia Piperno
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Annamaria Ferrari
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Alessia Surgo
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Matteo Muto
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Sara Ronchi
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Alessia Bazani
- Unit of Medical Physics, European Institute of Oncology, Milano, Italy
| | - Floriana Pansini
- Unit of Medical Physics, European Institute of Oncology, Milano, Italy
| | - Marta Cremonesi
- Unit of Radiation Research, European Institute of Oncology, Milano, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy; Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Roberto Orecchia
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy; Scientific Director, European Institute of Oncology, Milano, Italy
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Simeonova-Chergou A, Jahnke A, Siebenlist K, Stieler F, Mai S, Boda-Heggemann J, Wenz F, Lohr F, Jahnke L. Automatically gated image-guided breath-hold IMRT is a fast, precise, and dosimetrically robust treatment for lung cancer patients. Strahlenther Onkol 2016; 192:166-73. [PMID: 26780654 DOI: 10.1007/s00066-015-0934-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND High-dose radiotherapy of lung cancer is challenging. Tumors may move by up to 2 cm in craniocaudal and anteroposterior directions as a function of breathing cycle. Tumor displacement increases with treatment time, which consequentially increases the treatment uncertainty. OBJECTIVE This study analyzed whether automatically gated cone-beam-CT (CBCT)-controlled intensity modulated fast deep inspiration breath hold (DIBH) stereotactic body radiation therapy (SBRT) in flattening filter free (FFF) technique and normofractionated lung DIBH intensity-modulated radiotherapy (IMRT)/volumetric-modulated arc therapy (VMAT) treatments delivered with a flattening filter can be applied with sufficient accuracy within a clinically acceptable timeslot. MATERIALS AND METHODS Plans of 34 patients with lung tumors were analyzed. Of these patients, 17 received computer-controlled fast DIBH SBRT with a dose of 60 Gy (5 fractions of 12 Gy or 12 fractions of 5 Gy) in an FFF VMAT technique (FFF-SBRT) every other day and 17 received conventional VMAT with a flattening filter (conv-VMAT) and 2-Gy daily fractional doses (cumulative dose 50-70 Gy). RESULTS FFF-SBRT plans required more monitor units (MU) than conv-VMAT plans (2956.6 ± 885.3 MU for 12 Gy/fraction and 1148.7 ± 289.2 MU for 5 Gy/fraction vs. 608.4 ± 157.5 MU for 2 Gy/fraction). Total treatment and net beam-on times were shorter for FFF-SBRT plans than conv-VMAT plans (268.0 ± 74.4 s vs. 330.2 ± 93.6 s and 85.8 ± 25.3 s vs. 117.2 ± 29.6 s, respectively). Total slot time was 13.0 min for FFF-SBRT and 14.0 min for conv-VMAT. All modalities could be delivered accurately despite multiple beam-on/-off cycles and were robust against multiple interruptions. CONCLUSION Automatically gated CBCT-controlled fast DIBH SBRT in VMAT FFF technique and normofractionated lung DIBH VMAT can be applied with a low number of breath-holds in a short timeslot, with excellent dosimetric accuracy. In clinical routine, these approaches combine optimally reduced lung tissue irradiation with maximal delivery precision for patients with small and larger lung tumors.
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Affiliation(s)
- Anna Simeonova-Chergou
- Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Anika Jahnke
- Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Kerstin Siebenlist
- Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Florian Stieler
- Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Sabine Mai
- Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Judit Boda-Heggemann
- Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frank Lohr
- Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Lennart Jahnke
- Department of Radiotherapy and Oncology, University Medical Center Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Deep Inspiration Breath Hold-Based Radiation Therapy: A Clinical Review. Int J Radiat Oncol Biol Phys 2015; 94:478-92. [PMID: 26867877 DOI: 10.1016/j.ijrobp.2015.11.049] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/03/2015] [Accepted: 11/29/2015] [Indexed: 01/06/2023]
Abstract
Several recent developments in linear accelerator-based radiation therapy (RT) such as fast multileaf collimators, accelerated intensity modulation paradigms like volumeric modulated arc therapy and flattening filter-free (FFF) high-dose-rate therapy have dramatically shortened the duration of treatment fractions. Deliverable photon dose distributions have approached physical complexity limits as a consequence of precise dose calculation algorithms and online 3-dimensional image guided patient positioning (image guided RT). Simultaneously, beam quality and treatment speed have continuously been improved in particle beam therapy, especially for scanned particle beams. Applying complex treatment plans with steep dose gradients requires strategies to mitigate and compensate for motion effects in general, particularly breathing motion. Intrafractional breathing-related motion results in uncertainties in dose delivery and thus in target coverage. As a consequence, generous margins have been used, which, in turn, increases exposure to organs at risk. Particle therapy, particularly with scanned beams, poses additional problems such as interplay effects and range uncertainties. Among advanced strategies to compensate breathing motion such as beam gating and tracking, deep inspiration breath hold (DIBH) gating is particularly advantageous in several respects, not only for hypofractionated, high single-dose stereotactic body RT of lung, liver, and upper abdominal lesions but also for normofractionated treatment of thoracic tumors such as lung cancer, mediastinal lymphomas, and breast cancer. This review provides an in-depth discussion of the rationale and technical implementation of DIBH gating for hypofractionated and normofractionated RT of intrathoracic and upper abdominal tumors in photon and proton RT.
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Lee J, Kim JI, Ye SJ, Kim HJ, Carlson J, Park JM. Dosimetric effects of roll rotational setup errors on lung stereotactic ablative radiotherapy using volumetric modulated arc therapy. Br J Radiol 2015; 88:20140862. [PMID: 26369834 DOI: 10.1259/bjr.20140862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To evaluate the dosimetric effects of roll-rotational setup errors of stereotactic ablative radiotherapy (SABR) for lung cancer using volumetric modulated arc therapy (VMAT). METHODS A total of 23 lung SABR cases were evaluated retrospectively. Each of the planning CT images was intentionally rotated by ±1°, ±2° and ±3°. After that, to simulate the translational couch correction, rotated CT images were moved along the x, y and z axis to match the centroid of the target volume in the rotated CT images with that in the original CT images. The differences in D95% and V100% of the target volume, D0.35cc of spinal cord, D0.35cc and D5cc of oesophagus and V20Gy of lung between the original and the rotated CT images were calculated. RESULTS The average differences in D95% and V100% of target volume, D0.35cc of spinal cord, D0.35cc and D5cc of oesophagus and V20Gy of lung were -0.3% ± 0.4% and -0.7% ± 2.4%, 1.6 ± 27.9 cGy, -1.6 ± 37.6 cGy, 15.9 ± 25.3 cGy and 0.0% ± 0.1%, respectively. The dosimetric changes in organs at risk (OARs) near the target volume were sometimes considerable due to roll-rotational setup errors, despite the translational correction, and those were patient specific. CONCLUSION In the case of coplanar VMAT for lung SABR, dosimetric changes to the target volume due to roll-rotational setup errors could be compensated by translational correction, whereas those to the OARs could not in some cases. ADVANCES IN KNOWLEDGE Roll-rotational setup errors would increase the dose to OARs despite the translational correction.
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Affiliation(s)
- Jaegi Lee
- 1 Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Seoul, Korea.,2 Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-In Kim
- 2 Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea.,3 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,4 Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,5 Center for Convergence Research on Robotics, Advanced Institutes of Convergence Technology, Suwon, Korea
| | - Sung-Joon Ye
- 1 Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Seoul, Korea.,3 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
| | - Hak Jae Kim
- 3 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,4 Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,6 Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Joel Carlson
- 1 Program in Biomedical Radiation Sciences, Department of Transdisciplinary Studies, Seoul National University Graduate School of Convergence Science and Technology, Seoul, Korea.,2 Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Min Park
- 2 Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea.,3 Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea.,4 Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.,5 Center for Convergence Research on Robotics, Advanced Institutes of Convergence Technology, Suwon, Korea
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Gardner SJ, Gulam M, Song K, Li H, Huang Y, Zhao B, Qin Y, Snyder K, Kim J, Gordon J, Chetty IJ, Wen N. Generation and verification of QFix kVue Calypso-compatible couch top model for a dedicated stereotactic linear accelerator with FFF beams. J Appl Clin Med Phys 2015. [PMID: 26219010 PMCID: PMC5690015 DOI: 10.1120/jacmp.v16i4.5441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study details the generation, verification, and implementation of a treatment planning system (TPS) couch top model for patient support system used in conjunction with a dedicated stereotactic linear accelerator. Couch top model was created within the TPS using CT simulation images of the kVue Calpyso-compatible couchtop (with rails). Verification measurements were compared to TPS dose prediction for different energies (6 MV FFF and 10 MV FFF) and rail configurations (rails in and rails out) using: 1) central axis point-dose measurements with pinpoint chamber in water-equivalent phantom at 42 gantry angles for various field sizes (2 × 2 cm², 4 × 4 cm², 10 × 10 cm²); and 2) Gafchromic EBT3 film parallel to beam in acrylic slab to assess changes in surface and percent depth doses in PA geometry. To assess sensitivity of delivered dose to variations in patient lateral position, measurements at central axis using the pinpoint chamber geometry were taken at lateral couch displacements of 2, 5, and 10 mm for 6 MV FFF. The maximum percent difference for point-dose measurements was 3.24% (6 MV FFF) and 2.30% (10 MV FFF). The average percent difference for point-dose measurements was less than 1.10% for all beam energies and rail geometries. The maximum percent difference between calculated and measured dose can be as large as 13.0% if no couch model is used for dose calculation. The presence of the couch structures also impacts surface dose and PDD, which was evaluated with Gafchromic film measurements. The upstream shift in the depth of dose maximum (dmax) was found to be 10.5 mm for 6 MV FFF and 5.5 mm for 10 MV FFF for 'Rails In' configuration. Transmission of the treatment beam through the couch results in an increase in surface dose (absolute percentage) of approximately 50% for both photon energies (6 MV FFF and 10MV FFF). The largest sensitivity to lateral shifts occurred at the lateral boundary of the rail structures. The mean magnitude (standard deviation) of the deviation between shifted and centered measurements over all field sizes tested was 0.61% (0.61%) for 2 mm shifts, 0.46% (0.67%) for 5 mm shifts, and 0.86% (1.46%) for 10 mm shifts.
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Liu X, Belcher AH, Grelewicz Z, Wiersma RD. Robotic real-time translational and rotational head motion correction during frameless stereotactic radiosurgery. Med Phys 2015; 42:2757-63. [PMID: 26127028 DOI: 10.1118/1.4919279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To develop a control system to correct both translational and rotational head motion deviations in real-time during frameless stereotactic radiosurgery (SRS). METHODS A novel feedback control with a feed-forward algorithm was utilized to correct for the coupling of translation and rotation present in serial kinematic robotic systems. Input parameters for the algorithm include the real-time 6DOF target position, the frame pitch pivot point to target distance constant, and the translational and angular Linac beam off (gating) tolerance constants for patient safety. Testing of the algorithm was done using a 4D (XY Z + pitch) robotic stage, an infrared head position sensing unit and a control computer. The measured head position signal was processed and a resulting command was sent to the interface of a four-axis motor controller, through which four stepper motors were driven to perform motion compensation. RESULTS The control of the translation of a brain target was decoupled with the control of the rotation. For a phantom study, the corrected position was within a translational displacement of 0.35 mm and a pitch displacement of 0.15° 100% of the time. For a volunteer study, the corrected position was within displacements of 0.4 mm and 0.2° over 98.5% of the time, while it was 10.7% without correction. CONCLUSIONS The authors report a control design approach for both translational and rotational head motion correction. The experiments demonstrated that control performance of the 4D robotic stage meets the submillimeter and subdegree accuracy required by SRS.
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Affiliation(s)
- Xinmin Liu
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637
| | - Andrew H Belcher
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637
| | - Zachary Grelewicz
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637
| | - Rodney D Wiersma
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637
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Matsuo Y, Verellen D, Poels K, Mukumoto N, Depuydt T, Akimoto M, Nakamura M, Ueki N, Engels B, Collen C, Kokubo M, Hiraoka M, de Ridder M. A multi-centre analysis of treatment procedures and error components in dynamic tumour tracking radiotherapy. Radiother Oncol 2015; 115:412-8. [DOI: 10.1016/j.radonc.2015.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 03/31/2015] [Accepted: 05/03/2015] [Indexed: 12/25/2022]
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Simeonova AO, Fleckenstein K, Wertz H, Frauenfeld A, Boda-Heggemann J, Lohr F, Wenz F. Are three doses of stereotactic ablative radiotherapy (SABR) more effective than 30 doses of conventional radiotherapy? Transl Lung Cancer Res 2015; 1:45-53. [PMID: 25806154 DOI: 10.3978/j.issn.2218-6751.10.01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 10/24/2011] [Indexed: 12/29/2022]
Abstract
In early stage non-small cell lung cancer (NSCLC) definitive radiation therapy is an appropriate alternative to surgery. Recent studies show, that in such patients hypofractionation schedules (for example 3 times 18 Gy or 5 times 12 Gy), can be safely applied, without causing severe toxicities and achieving high local control rates of up to 90% and more. In the last couple of years a lot of knowledge about the cancer biology, technical aspects, clinical outcomes and toxicities has been accumulated from different clinical trials. The purpose of this review is to summarize recent outcomes and developments in stereotactic radiation therapy for patients with early stage NSCLC.
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Affiliation(s)
- Anna O Simeonova
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Katharina Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hansjörg Wertz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Anian Frauenfeld
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frank Lohr
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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Comparing morbidity and cancer control after 3D-conformal (70/74 Gy) and intensity modulated radiotherapy (78/82 Gy) for prostate cancer. Strahlenther Onkol 2015; 191:338-46. [DOI: 10.1007/s00066-014-0806-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 12/18/2014] [Indexed: 10/24/2022]
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Dose-dependent changes in renal (1)H-/(23)Na MRI after adjuvant radiochemotherapy for gastric cancer. Strahlenther Onkol 2014; 191:356-64. [PMID: 25445156 DOI: 10.1007/s00066-014-0787-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Combined radiochemotherapy (RCT) for gastric cancer with three-dimensional conformal radiotherapy (3D-CRT) results in ablative doses to the upper left kidney, while image-guided intensity-modulated radiotherapy (IG-IMRT) allows kidney sparing despite improved target coverage. Renal function in long-term gastric cancer survivors was evaluated with 3T functional magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) and (23)Na imaging. PATIENTS AND METHODS Five healthy volunteers and 13 patients after radiotherapy were included: 11×IG-IMRT; 1×3D-CRT; 1× "positive control" with stereotactic body radiotherapy (SBRT) of a metastasis between the spleen/left kidney. Radiation doses were documented for the upper/middle/lower kidney subvolumes. Late toxicity was evaluated based on CTC criteria, questionnaire, and creatinine values. Morphological sequences, DWI images, and (23)Na images were acquired using a (1)H/(23)Na-tuned body-coil before/after intravenous water load (WL). Statistics for [(23)Na] (concentration) and apparent diffusion coefficient (ADC) values were calculated for upper/middle/lower renal subvolumes. Corticomedullary [(23)Na] gradients and [(23)Na] differences after WL were determined. RESULTS No major morphological alteration was detected in any patient. Minor scars were observed in the cranial subvolume of the left kidney of the 3D-CRT and the whole kidney of the control SBRT patient. All participants presented a corticomedullary [(23)Na] gradient. After WL, a significant physiological [(23)Na] gradient decrease (p < 0.001) was observed in all HV and IG-IMRT patients. In the cranial left kidney of the 3D-CRT patient and the positive control SBRT patient, the decrease was nonsignificant (p = 0.01, p = 0.02). ADC values were altered nonsignificantly in all renal subvolumes (all participants). Renal subvolumes with doses ≥ 35 Gy showed a reduced change of the [(23)Na] gradient after WL (p = 0.043). No participants showed clinical renal impairment. CONCLUSIONS Functional parameters of renal (23)Na MRI after gastric IG-IMRT are identical to those of healthy volunteers, in contrast to renal subvolumes after ablative doses in the control and 3D-CRT patient. While kidney doses to the cortex below 20-25 Gy in fractional doses of ~ 1 Gy in IG-IMRT (combined with intensified chemotherapy) do not seem to cause significant MRI morphological or functional alterations, doses of > 35 Gy in 1.5-2 Gy fractions clearly result in impairment.
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Roll and pitch set-up errors during volumetric modulated arc delivery. Strahlenther Onkol 2014; 191:272-80. [DOI: 10.1007/s00066-014-0766-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/30/2014] [Indexed: 10/24/2022]
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Naoi Y, Kunishima N, Yamamoto K, Yoda K. A planning target volume margin formula for hypofractionated intracranial stereotactic radiotherapy under cone beam CT image guidance with a six-degrees-of-freedom robotic couch and a mouthpiece-assisted mask system: a preliminary study. Br J Radiol 2014; 87:20140240. [PMID: 25029296 DOI: 10.1259/bjr.20140240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE A planning target volume (PTV) margin formula for hypofractionated intracranial stereotactic radiotherapy (SRT) has been proposed under cone beam CT (CBCT) image guidance with a six-degrees-of-freedom (6-DOF) robotic couch. METHODS CBCT-based registration using a 6-DOF couch reportedly led to negligibly small systematic positioning errors, suggesting that each in-treatment positioning error during the treatment courses for the patients employing this combination was predominantly caused by a random gaussian process. Under this assumption, an anisotropic PTV margin for each axis was formulated based on a gaussian distribution model. 19 patients with intracranial lesions who underwent additional post-treatment CBCT were consecutively selected, to whom stereotactic hypofractionated radiotherapy was delivered by a linear accelerator equipped with a CBCT imager, a 6-DOF couch and a mouthpiece-assisted mask system. Time-averaged patient-positioning errors during treatment were estimated by comparing the post-treatment CBCT with the reference planning CT images. RESULTS It was suggested that each histogram of the in-treatment positioning error in each axis would approach each single gaussian distribution with a mean of zero. The calculated PTV margins in the x, y and z directions were 0.97, 1.30 and 0.88 mm, respectively. CONCLUSION The empirical isotropic PTV margin of 2 mm used in our facility for intracranial SRT was consistent with the margin calculated by the proposed gaussian model. ADVANCES IN KNOWLEDGE We have proposed a PTV margin formula for hypofractionated intracranial SRT under CBCT image guidance with a 6-DOF robotic couch.
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Affiliation(s)
- Y Naoi
- 1 Department of Radiology, Self Defense Forces Central Hospital, Tokyo, Japan
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Srinivasan K, Mohammadi M, Shepherd J. Applications of linac-mounted kilovoltage Cone-beam Computed Tomography in modern radiation therapy: A review. Pol J Radiol 2014; 79:181-93. [PMID: 25006356 PMCID: PMC4085117 DOI: 10.12659/pjr.890745] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 03/27/2014] [Indexed: 11/23/2022] Open
Abstract
The use of Cone-beam Computed Tomography (CBCT) in radiotherapy is increasing due to the widespread implementation of kilovoltage systems on the currently available linear accelerators. Cone beam CT acts as an effective Image-Guided Radiotherapy (IGRT) tool for the verification of patient position. It also opens up the possibility of real-time re-optimization of treatment plans for Adaptive Radiotherapy (ART). This paper reviews the most prominent applications of CBCT (linac-mounted) in radiation therapy, focusing on CBCT-based planning and dose calculation studies. This is followed by a concise review of the main issues associated with CBCT, such as imaging artifacts, dose and image quality. It explores how medical physicists and oncologists can best apply CBCT for therapeutic applications.
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Affiliation(s)
- Kavitha Srinivasan
- School of Chemistry and Physics, University of Adelaide, Adelaide, Australia
| | - Mohammad Mohammadi
- School of Chemistry and Physics, University of Adelaide, Adelaide, Australia ; Department of Medical Physics, Royal Adelaide Hospital, Adelaide, Australia
| | - Justin Shepherd
- Department of Medical Physics, Royal Adelaide Hospital, Adelaide, Australia
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Oh YK, Baek JG, Kim OB, Kim JH. Assessment of setup uncertainties for various tumor sites when using daily CBCT for more than 2200 VMAT treatments. J Appl Clin Med Phys 2014; 15:4418. [PMID: 24710431 PMCID: PMC5875470 DOI: 10.1120/jacmp.v15i2.4418] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 11/07/2013] [Accepted: 10/25/2013] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was assess the patient setup errors for various tumor sites based on clinical data from a sufficient number of treatments with volumetric-modulated arc therapy (VMAT) using daily pretreatment CBCT imaging guidance. In addition, we calculated and compared the planning target volume (PTV) margins for all disease sites based on an analysis of specific systematic and random errors in our institution. All patients underwent pretreatment kV-CBCT imaging. The various tumor sites were divided into four categories; 21 brain (438 fractions), 35 head-and-neck tumors (H&N, 933 fractions), 19 thorax and abdomen tumors (T&A, 313 fractions), and 17 prostate cancer tumors (546 fractions). Overall distributions of setup corrections in all directions, frequencies of 3D vector lengths, institution-specific setup error, and PTV margins were analyzed. The longitudinal distribution for the T&A site represented an asymmetric offset in the negative direction. Rotational distributions were comparable for all treatment sites, and the prostate site had the narrowest distribution of ≤ ± 2°. The cumulative frequencies of 3D vector length of ≥ 7 mm were rare for brain lesions and H&N, but more common for T&A and prostate lesions at 25.6% and 12.1%, respectively. The overall mean error for all treatment sites were within ± 1 mm and ± 0.1°, with the exception of the T&A site, which had overall mean error of 2 mm in the negative longitudinal direction. The largest magnitude of systematic error and random error for the brain lesions and H&N was 1.4 mm in the translational directions, and 3.3 mm for T&A and prostate lesions. The PTV margins required in this analysis are ≤ 4 mm for the brain lesions and H&N in all translational directions, but ranged from 4 to 10 mm for T&A and prostate lesions. Analysis of each institution's specific setup errors using daily CBCT is essential for determining PTV margins and reducing setup uncertainties, because setup errors vary according to each immobilization system and patient.
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Greene TC, Rong XJ. Evaluation of techniques for slice sensitivity profile measurement and analysis. J Appl Clin Med Phys 2014; 15:4042. [PMID: 24710429 PMCID: PMC5875475 DOI: 10.1120/jacmp.v15i2.4042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 12/10/2013] [Accepted: 11/22/2013] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to compare the resulting full width at half maximum of slice sensitivity profiles (SSP) generated by several commercially available point response phantoms, and determine an appropriate imaging technique and analysis method. Four CT phantoms containing point response objects designed to produce a delta impulse signal used in this study: a Fluke CT-SSP phantom, a Gammex 464, a CatPhan 600, and a Kagaku Micro Disc phantom. Each phantom was imaged using 120 kVp, 325 mAs, head scan field of view, 32 × 0.625 mm helical scan with a 20 mm beam width and a pitch of 0.969. The acquired images were then reconstructed into all available slice thicknesses (0.625 mm - 5.0 mm). A computer program was developed to analyze the images of each dataset for generating a SSP from which the full width at half maximum (FWHM) was determined. Two methods for generating SSPs were evaluated and compared by choosing the mean vs. maximum value in the ROI, along with two methods for evaluating the FWHM of the SSP, linear interpolation and Gaussian curve fitting. FWHMs were compared with the manufacturer's specifications using percent error and z-test with a significance value of p < 0.05. The FWHMs from each phantom were not significantly different (p ≥ 0.089) with an average error of 3.5%. The FWHMs from SSPs generated from the mean value were statistically different (p ≤ 3.99 × 10¹³). The FWHMs from the different FWHM methods were not statistically different (p ≤ 0.499). Evaluation of the SSP is dependent on the ROI value used. The maximum value from the ROI should be used to generate the SSP whenever possible. SSP measurement is independent of the phantoms used in this study.
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Liang J, Li M, Zhang T, Han W, Chen D, Hui Z, Lv J, Zhang Z, Zhang Y, Zhang L, Zheng R, Dai J, Wang L. The effect of image-guided radiation therapy on the margin between the clinical target volume and planning target volume in lung cancer. J Med Radiat Sci 2014; 61:30-7. [PMID: 26229633 PMCID: PMC4175824 DOI: 10.1002/jmrs.42] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/13/2013] [Accepted: 01/14/2014] [Indexed: 12/25/2022] Open
Abstract
IntroductionThis study aimed to evaluate the effect of image-guided radiation therapy (IGRT) on the margin between the clinical target volume (CTV) and planning target volume (PTV) in lung cancer. MethodsThe CTV and PTV margin were determined in three dimensions by four radiation oncologists using a standard method in 10 lung cancer patients, and compared to consensus values. Transfer error was measured using a rigid phantom containing gold markers. Systematic error () and random error () set up errors were calculated in three dimensions from pre-treatment and post-treatment cone beam CT scans. Finally, the margin between the CTV and PTV was corrected for set up error and calculated. ResultsThe margins between the CTV and PTV with IGRT (and without IGRT) were 0.88 cm (0.96 cm), 0.99 cm (1.08 cm) and 1.28 cm (1.82 cm) in the anterior and posterior (AP), left and right (LR) and superior and inferior (SI) directions, respectively. Images from two other patients verified the validity of the corrected margin. The target delineation errors of the radiation oncologists are considered to be the largest compared with the set up errors. The application of IGRT reduced the set up errors and the margins between CTV and PTV. ConclusionsThe delineation errors of radiation oncologists are the most important factor to consider for the margin between CTV and PTV for lung cancer. IGRT can reduce the margins by reducing the set up errors, especially in the SI direction. Further research is required to assess whether the reduction in the margin is solely based on set up errors.
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Affiliation(s)
- Jun Liang
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
| | - Minghui Li
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
| | - Tao Zhang
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
| | - Wei Han
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
| | - Dongfu Chen
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
| | - Zhouguang Hui
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
| | - Jima Lv
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
| | - Zhong Zhang
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
| | - Yin Zhang
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
| | - Liansheng Zhang
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
| | - Rong Zheng
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
| | - Jianrong Dai
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
| | - Luhua Wang
- Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences Beijing, China
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Moderately hypofractionated radiotherapy for localized prostate cancer: long-term outcome using IMRT and volumetric IGRT. Strahlenther Onkol 2013; 190:48-53. [PMID: 24196279 DOI: 10.1007/s00066-013-0443-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/31/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate long-term outcome after dose-escalated, moderately hypofractionated radiotherapy for prostate cancer. METHODS Since 2005, 150 consecutive patients were treated with primary radiotherapy for localized prostate cancer. Intensity modulated radiotherapy (IMRT) using the simultaneous integrated boost (SIB) technique was practiced in all patients and doses of 73.9 Gy (n = 41) and 76.2 Gy (n = 109) were delivered in 32 and 33 fractions, respectively. The pelvic lymph nodes were treated in 41 high-risk patients. Treatment was delivered using cone-beam CT based image-guided radiotherapy (IGRT). Toxicity was assessed prospectively using CTCAE 3.0; biochemical failure was defined according to the Phoenix definition of nadir + 2 ng/ml. RESULTS Median follow-up of living patients was 50 months. Gastrointestinal (GI) toxicity was mild with > 80% of the patients free from any GI toxicity during follow-up and no time trend to increased rates or to higher grade of GI toxicity. Two patients suffered from late grade 3 GI toxicity. Acute genitourinary (GU) toxicity grade 1-2 was observed in 85% of the patients; most patients recovered quickly within 6 weeks after treatment. The rate of GU toxicity grade ≥ 2 was <10% at 6-12 month but increased continuously to 22.4% at 60 months; grade 3 GU toxicity remained below 5% during follow-up. The 5-year freedom from biochemical failure (FFBF) was 82% for all patients and 88, 80, and 78% for low-, intermediate-, and high-risk disease. CONCLUSION Favorable FFBF with simultaneously low rates of toxicity was observed after moderately hypofractionated radiotherapy with 2 Gy-equivalent doses ≥ 80 Gy. Conformal IMRT planning and accurate IGRT treatment delivery may have contributed to these results.
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