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Aouadi S, Torfeh T, Bouhali O, Yoganathan SA, Paloor S, Chandramouli S, Hammoud R, Al-Hammadi N. Prediction of cervix cancer stage and grade from diffusion weighted imaging using EfficientNet. Biomed Phys Eng Express 2024; 10:045042. [PMID: 38815562 DOI: 10.1088/2057-1976/ad5207] [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: 01/15/2024] [Accepted: 05/30/2024] [Indexed: 06/01/2024]
Abstract
Purpose. This study aims to introduce an innovative noninvasive method that leverages a single image for both grading and staging prediction. The grade and the stage of cervix cancer (CC) are determined from diffusion-weighted imaging (DWI) in particular apparent diffusion coefficient (ADC) maps using deep convolutional neural networks (DCNN).Methods. datasets composed of 85 patients having annotated tumor stage (I, II, III, and IV), out of this, 66 were with grade (II and III) and the remaining patients with no reported grade were retrospectively collected. The study was IRB approved. For each patient, sagittal and axial slices containing the gross tumor volume (GTV) were extracted from ADC maps. These were computed using the mono exponential model from diffusion weighted images (b-values = 0, 100, 1000) that were acquired prior to radiotherapy treatment. Balanced training sets were created using the Synthetic Minority Oversampling Technique (SMOTE) and fed to the DCNN. EfficientNetB0 and EfficientNetB3 were transferred from the ImageNet application to binary and four-class classification tasks. Five-fold stratified cross validation was performed for the assessment of the networks. Multiple evaluation metrics were computed including the area under the receiver operating characteristic curve (AUC). Comparisons with Resnet50, Xception, and radiomic analysis were performed.Results. for grade prediction, EfficientNetB3 gave the best performance with AUC = 0.924. For stage prediction, EfficientNetB0 was the best with AUC = 0.931. The difference between both models was, however, small and not statistically significant EfficientNetB0-B3 outperformed ResNet50 (AUC = 0.71) and Xception (AUC = 0.89) in stage prediction, and demonstrated comparable results in grade classification, where AUCs of 0.89 and 0.90 were achieved by ResNet50 and Xception, respectively. DCNN outperformed radiomic analysis that gave AUC = 0.67 (grade) and AUC = 0.66 (stage).Conclusion.the prediction of CC grade and stage from ADC maps is feasible by adapting EfficientNet approaches to the medical context.
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Affiliation(s)
- Souha Aouadi
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Tarraf Torfeh
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Othmane Bouhali
- Department of Science, Texas A&M University at Qatar, PO Box 23874, Education City, Doha, Qatar
| | - S A Yoganathan
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Satheesh Paloor
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Suparna Chandramouli
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Rabih Hammoud
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Noora Al-Hammadi
- Department of Radiation Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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Nuyts S, Bollen H, Eisbruch A, Strojan P, Mendenhall WM, Ng SP, Ferlito A. Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view. Cancer Med 2024; 13:e7192. [PMID: 38650546 PMCID: PMC11036082 DOI: 10.1002/cam4.7192] [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: 01/11/2024] [Revised: 03/19/2024] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patients with head and neck cancer (HNC) may experience substantial anatomical changes during the course of radiotherapy treatment. The implementation of adaptive radiotherapy (ART) proves effective in managing the consequent impact on the planned dose distribution. METHODS This narrative literature review comprehensively discusses the diverse strategies of ART in HNC and the documented dosimetric and clinical advantages associated with these approaches, while also addressing the current challenges for integration of ART into clinical practice. RESULTS AND CONCLUSION Although based on mainly non-randomized and retrospective trials, there is accumulating evidence that ART has the potential to reduce toxicity and improve quality of life and tumor control in HNC patients treated with RT. However, several questions remain regarding accurate patient selection, the ideal frequency and timing of replanning, and the appropriate way for image registration and dose calculation. Well-designed randomized prospective trials, with a predetermined protocol for both image registration and dose summation, are urgently needed to further investigate the dosimetric and clinical benefits of ART.
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Affiliation(s)
- Sandra Nuyts
- Laboratory of Experimental Radiotherapy, Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyLeuven Cancer Institute, University Hospitals LeuvenLeuvenBelgium
| | - Heleen Bollen
- Laboratory of Experimental Radiotherapy, Department of OncologyKU LeuvenLeuvenBelgium
- Department of Radiation OncologyLeuven Cancer Institute, University Hospitals LeuvenLeuvenBelgium
| | - Avrahram Eisbruch
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
| | - Primoz Strojan
- Department of Radiation Oncology Institute of OncologyUniversity of LjubljanaLjubljanaSlovenia
| | - William M. Mendenhall
- Department of Radiation OncologyUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Sweet Ping Ng
- Department of Radiation OncologyOlivia Newton‐John Cancer and Wellness Centre, Austin HealthMelbourneAustralia
| | - Alfio Ferlito
- Coordinator International Head and Neck Scientific GroupUdineItaly
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Rabe M, Dietrich O, Forbrig R, Niyazi M, Belka C, Corradini S, Landry G, Kurz C. Repeatability quantification of brain diffusion-weighted imaging for future clinical implementation at a low-field MR-linac. Radiat Oncol 2024; 19:31. [PMID: 38448888 PMCID: PMC10916154 DOI: 10.1186/s13014-024-02424-7] [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: 01/31/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Longitudinal assessments of apparent diffusion coefficients (ADCs) derived from diffusion-weighted imaging (DWI) during intracranial radiotherapy at magnetic resonance imaging-guided linear accelerators (MR-linacs) could enable early response assessment by tracking tumor diffusivity changes. However, DWI pulse sequences are currently unavailable in clinical practice at low-field MR-linacs. Quantifying the in vivo repeatability of ADC measurements is a crucial step towards clinical implementation of DWI sequences but has not yet been reported on for low-field MR-linacs. This study assessed ADC measurement repeatability in a phantom and in vivo at a 0.35 T MR-linac. METHODS Eleven volunteers and a diffusion phantom were imaged on a 0.35 T MR-linac. Two echo-planar imaging DWI sequence variants, emphasizing high spatial resolution ("highRes") and signal-to-noise ratio ("highSNR"), were investigated. A test-retest study with an intermediate outside-scanner-break was performed to assess repeatability in the phantom and volunteers' brains. Mean ADCs within phantom vials, cerebrospinal fluid (CSF), and four brain tissue regions were compared to literature values. Absolute relative differences of mean ADCs in pre- and post-break scans were calculated for the diffusion phantom, and repeatability coefficients (RC) and relative RC (relRC) with 95% confidence intervals were determined for each region-of-interest (ROI) in volunteers. RESULTS Both DWI sequence variants demonstrated high repeatability, with absolute relative deviations below 1% for water, dimethyl sulfoxide, and polyethylene glycol in the diffusion phantom. RelRCs were 7% [5%, 12%] (CSF; highRes), 12% [9%, 22%] (CSF; highSNR), 9% [8%, 12%] (brain tissue ROIs; highRes), and 6% [5%, 7%] (brain tissue ROIs; highSNR), respectively. ADCs measured with the highSNR variant were consistent with literature values for volunteers, while smaller mean values were measured for the diffusion phantom. Conversely, the highRes variant underestimated ADCs compared to literature values, indicating systematic deviations. CONCLUSIONS High repeatability of ADC measurements in a diffusion phantom and volunteers' brains were measured at a low-field MR-linac. The highSNR variant outperformed the highRes variant in accuracy and repeatability, at the expense of an approximately doubled voxel volume. The observed high in vivo repeatability confirms the potential utility of DWI at low-field MR-linacs for early treatment response assessment.
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Affiliation(s)
- Moritz Rabe
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany.
| | - Olaf Dietrich
- Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Robert Forbrig
- Institute of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, a Partnership Between DKFZ and LMU University Hospital Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site Munich, a Partnership Between DKFZ and LMU University Hospital Munich, Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
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Elliott A, Villemoes E, Farhat M, Klingberg E, Langshaw H, Svensson S, Chung C. Development and benchmarking diffusion magnetic resonance imaging analysis for integration into radiation treatment planning. Med Phys 2024; 51:2108-2118. [PMID: 37633837 DOI: 10.1002/mp.16670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 02/20/2023] [Accepted: 04/28/2023] [Indexed: 08/28/2023] Open
Abstract
PURPOSE The rising promise in the utility of advanced multi-parametric magnetic resonance (MR) imaging in radiotherapy (RT) treatment planning creates a necessity for testing and enhancing the accuracy of quantitative imaging analysis. Standardizing the analysis of diffusion weighted imaging (DWI) and diffusion tensor imaging (DTI) to generate meaningful and reproducible apparent diffusion coefficient (ADC) and fractional anisotropy (FA) lays the requisite needed for clinical integration. The aim of the demonstrated work is to benchmark the generation of the ADC and FA parametric map analyses using integrated tools in a commercial treatment planning system against the currently used ones. METHODS Three software packages were used for generating ADC and FA maps in this study; one tool was developed within a commercial treatment planning system, another by the Functional Magnetic Resonance Imaging of the Brain (FMRIB) Software Library FSL (Analysis Group, FMRIB, Oxford, United Kingdom), and an in-house tool developed at the M.D. Anderson Cancer Center. The ADC and FA maps generated by all three packages for 35 subjects were subtracted from one another, and the standard deviation of the images' differences was used to compare the reproducibility. The reproducibility of the ADC maps was compared with the Quantitative Imaging Biomarkers Alliance (QIBA) protocol, while that of the FA maps was compared to data in published literature. RESULTS Results show that the discrepancies between the ADC maps calculated for each patient using the three different software algorithms are less than 2% which meets the 3.6% recommended QIBA requirement. Except for a small number of isolated points, the majority of differences in FA maps for each patient produced by the three methods did not exceed 0.02 which is 10 times lower than the differences seen in healthy gray and white matter. The results were also compared to the maps generated by existing MR Imaging consoles and showed that the robustness of console generated ADC and FA maps is largely dependent on the correct application of scaling factors, that only if correctly placed; the differences between the three tested methods and the console generated values were within the recommended QIBA guidelines. CONCLUSIONS Cross-comparison difference maps demonstrated that quantitative reproducibility of ADC and FA metrics generated using our tested commercial treatment planning system were comparable to in-house and established tools as benchmarks. This integrated approach facilitates the clinical utility of diffusion imaging in radiation treatment planning workflow.
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Affiliation(s)
- Andrew Elliott
- Department Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Maguy Farhat
- Department Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Holly Langshaw
- Department Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | | | - Caroline Chung
- Department Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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García-Figueiras R, Baleato-González S, Luna A, Padhani AR, Vilanova JC, Carballo-Castro AM, Oleaga-Zufiria L, Vallejo-Casas JA, Marhuenda A, Gómez-Caamaño A. How Imaging Advances Are Defining the Future of Precision Radiation Therapy. Radiographics 2024; 44:e230152. [PMID: 38206833 DOI: 10.1148/rg.230152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Radiation therapy is fundamental in the treatment of cancer. Imaging has always played a central role in radiation oncology. Integrating imaging technology into irradiation devices has increased the precision and accuracy of dose delivery and decreased the toxic effects of the treatment. Although CT has become the standard imaging modality in radiation therapy, the development of recently introduced next-generation imaging techniques has improved diagnostic and therapeutic decision making in radiation oncology. Functional and molecular imaging techniques, as well as other advanced imaging modalities such as SPECT, yield information about the anatomic and biologic characteristics of tumors for the radiation therapy workflow. In clinical practice, they can be useful for characterizing tumor phenotypes, delineating volumes, planning treatment, determining patients' prognoses, predicting toxic effects, assessing responses to therapy, and detecting tumor relapse. Next-generation imaging can enable personalization of radiation therapy based on a greater understanding of tumor biologic factors. It can be used to map tumor characteristics, such as metabolic pathways, vascularity, cellular proliferation, and hypoxia, that are known to define tumor phenotype. It can also be used to consider tumor heterogeneity by highlighting areas at risk for radiation resistance for focused biologic dose escalation, which can impact the radiation planning process and patient outcomes. The authors review the possible contributions of next-generation imaging to the treatment of patients undergoing radiation therapy. In addition, the possible roles of radio(geno)mics in radiation therapy, the limitations of these techniques, and hurdles in introducing them into clinical practice are discussed. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Roberto García-Figueiras
- From the Department of Radiology, Division of Oncologic Imaging (R.G.F., S.B.G.), and Department of Radiation Oncology (A.M.C.C., A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Department of Advanced Medical Imaging, Grupo Health Time, Sercosa (Servicio Radiologia Computerizada, Clínica Las Nieves, Jaén, Spain (A.L.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Department of Radiology, Clínica Girona and Hospital Santa Caterina, Girona, Spain (J.C.V.); Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (L.O.Z.); Unidad de Gestión Clínica de Medicina Nuclear, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Córdoba, Spain (J.A.V.C.); and Department of Radiology, Instituto Valenciano de Oncología, Valencia, Spain (A.M.)
| | - Sandra Baleato-González
- From the Department of Radiology, Division of Oncologic Imaging (R.G.F., S.B.G.), and Department of Radiation Oncology (A.M.C.C., A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Department of Advanced Medical Imaging, Grupo Health Time, Sercosa (Servicio Radiologia Computerizada, Clínica Las Nieves, Jaén, Spain (A.L.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Department of Radiology, Clínica Girona and Hospital Santa Caterina, Girona, Spain (J.C.V.); Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (L.O.Z.); Unidad de Gestión Clínica de Medicina Nuclear, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Córdoba, Spain (J.A.V.C.); and Department of Radiology, Instituto Valenciano de Oncología, Valencia, Spain (A.M.)
| | - Antonio Luna
- From the Department of Radiology, Division of Oncologic Imaging (R.G.F., S.B.G.), and Department of Radiation Oncology (A.M.C.C., A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Department of Advanced Medical Imaging, Grupo Health Time, Sercosa (Servicio Radiologia Computerizada, Clínica Las Nieves, Jaén, Spain (A.L.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Department of Radiology, Clínica Girona and Hospital Santa Caterina, Girona, Spain (J.C.V.); Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (L.O.Z.); Unidad de Gestión Clínica de Medicina Nuclear, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Córdoba, Spain (J.A.V.C.); and Department of Radiology, Instituto Valenciano de Oncología, Valencia, Spain (A.M.)
| | - Anwar R Padhani
- From the Department of Radiology, Division of Oncologic Imaging (R.G.F., S.B.G.), and Department of Radiation Oncology (A.M.C.C., A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Department of Advanced Medical Imaging, Grupo Health Time, Sercosa (Servicio Radiologia Computerizada, Clínica Las Nieves, Jaén, Spain (A.L.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Department of Radiology, Clínica Girona and Hospital Santa Caterina, Girona, Spain (J.C.V.); Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (L.O.Z.); Unidad de Gestión Clínica de Medicina Nuclear, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Córdoba, Spain (J.A.V.C.); and Department of Radiology, Instituto Valenciano de Oncología, Valencia, Spain (A.M.)
| | - Joan C Vilanova
- From the Department of Radiology, Division of Oncologic Imaging (R.G.F., S.B.G.), and Department of Radiation Oncology (A.M.C.C., A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Department of Advanced Medical Imaging, Grupo Health Time, Sercosa (Servicio Radiologia Computerizada, Clínica Las Nieves, Jaén, Spain (A.L.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Department of Radiology, Clínica Girona and Hospital Santa Caterina, Girona, Spain (J.C.V.); Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (L.O.Z.); Unidad de Gestión Clínica de Medicina Nuclear, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Córdoba, Spain (J.A.V.C.); and Department of Radiology, Instituto Valenciano de Oncología, Valencia, Spain (A.M.)
| | - Ana M Carballo-Castro
- From the Department of Radiology, Division of Oncologic Imaging (R.G.F., S.B.G.), and Department of Radiation Oncology (A.M.C.C., A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Department of Advanced Medical Imaging, Grupo Health Time, Sercosa (Servicio Radiologia Computerizada, Clínica Las Nieves, Jaén, Spain (A.L.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Department of Radiology, Clínica Girona and Hospital Santa Caterina, Girona, Spain (J.C.V.); Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (L.O.Z.); Unidad de Gestión Clínica de Medicina Nuclear, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Córdoba, Spain (J.A.V.C.); and Department of Radiology, Instituto Valenciano de Oncología, Valencia, Spain (A.M.)
| | - Laura Oleaga-Zufiria
- From the Department of Radiology, Division of Oncologic Imaging (R.G.F., S.B.G.), and Department of Radiation Oncology (A.M.C.C., A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Department of Advanced Medical Imaging, Grupo Health Time, Sercosa (Servicio Radiologia Computerizada, Clínica Las Nieves, Jaén, Spain (A.L.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Department of Radiology, Clínica Girona and Hospital Santa Caterina, Girona, Spain (J.C.V.); Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (L.O.Z.); Unidad de Gestión Clínica de Medicina Nuclear, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Córdoba, Spain (J.A.V.C.); and Department of Radiology, Instituto Valenciano de Oncología, Valencia, Spain (A.M.)
| | - Juan Antonio Vallejo-Casas
- From the Department of Radiology, Division of Oncologic Imaging (R.G.F., S.B.G.), and Department of Radiation Oncology (A.M.C.C., A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Department of Advanced Medical Imaging, Grupo Health Time, Sercosa (Servicio Radiologia Computerizada, Clínica Las Nieves, Jaén, Spain (A.L.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Department of Radiology, Clínica Girona and Hospital Santa Caterina, Girona, Spain (J.C.V.); Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (L.O.Z.); Unidad de Gestión Clínica de Medicina Nuclear, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Córdoba, Spain (J.A.V.C.); and Department of Radiology, Instituto Valenciano de Oncología, Valencia, Spain (A.M.)
| | - Ana Marhuenda
- From the Department of Radiology, Division of Oncologic Imaging (R.G.F., S.B.G.), and Department of Radiation Oncology (A.M.C.C., A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Department of Advanced Medical Imaging, Grupo Health Time, Sercosa (Servicio Radiologia Computerizada, Clínica Las Nieves, Jaén, Spain (A.L.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Department of Radiology, Clínica Girona and Hospital Santa Caterina, Girona, Spain (J.C.V.); Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (L.O.Z.); Unidad de Gestión Clínica de Medicina Nuclear, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Córdoba, Spain (J.A.V.C.); and Department of Radiology, Instituto Valenciano de Oncología, Valencia, Spain (A.M.)
| | - Antonio Gómez-Caamaño
- From the Department of Radiology, Division of Oncologic Imaging (R.G.F., S.B.G.), and Department of Radiation Oncology (A.M.C.C., A.G.C.), Hospital Clínico Universitario de Santiago de Compostela, Choupana s/n, 15706 Santiago de Compostela, Spain; Department of Advanced Medical Imaging, Grupo Health Time, Sercosa (Servicio Radiologia Computerizada, Clínica Las Nieves, Jaén, Spain (A.L.); Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, England (A.R.P.); Department of Radiology, Clínica Girona and Hospital Santa Caterina, Girona, Spain (J.C.V.); Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain (L.O.Z.); Unidad de Gestión Clínica de Medicina Nuclear, Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Córdoba, Spain (J.A.V.C.); and Department of Radiology, Instituto Valenciano de Oncología, Valencia, Spain (A.M.)
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Arslan M, Haider A, Khurshid M, Abu Bakar SSU, Jani R, Masood F, Tahir T, Mitchell K, Panchagnula S, Mandair S. From Pixels to Pathology: Employing Computer Vision to Decode Chest Diseases in Medical Images. Cureus 2023; 15:e45587. [PMID: 37868395 PMCID: PMC10587792 DOI: 10.7759/cureus.45587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Radiology has been a pioneer in the healthcare industry's digital transformation, incorporating digital imaging systems like picture archiving and communication system (PACS) and teleradiology over the past thirty years. This shift has reshaped radiology services, positioning the field at a crucial junction for potential evolution into an integrated diagnostic service through artificial intelligence and machine learning. These technologies offer advanced tools for radiology's transformation. The radiology community has advanced computer-aided diagnosis (CAD) tools using machine learning techniques, notably deep learning convolutional neural networks (CNNs), for medical image pattern recognition. However, the integration of CAD tools into clinical practice has been hindered by challenges in workflow integration, unclear business models, and limited clinical benefits, despite development dating back to the 1990s. This comprehensive review focuses on detecting chest-related diseases through techniques like chest X-rays (CXRs), magnetic resonance imaging (MRI), nuclear medicine, and computed tomography (CT) scans. It examines the utilization of computer-aided programs by researchers for disease detection, addressing key areas: the role of computer-aided programs in disease detection advancement, recent developments in MRI, CXR, radioactive tracers, and CT scans for chest disease identification, research gaps for more effective development, and the incorporation of machine learning programs into diagnostic tools.
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Affiliation(s)
- Muhammad Arslan
- Department of Emergency Medicine, Royal Infirmary of Edinburgh, National Health Service (NHS) Lothian, Edinburgh, GBR
| | - Ali Haider
- Department of Allied Health Sciences, The University of Lahore, Gujrat Campus, Gujrat, PAK
| | - Mohsin Khurshid
- Department of Microbiology, Government College University Faisalabad, Faisalabad, PAK
| | | | - Rutva Jani
- Department of Internal Medicine, C. U. Shah Medical College and Hospital, Gujarat, IND
| | - Fatima Masood
- Department of Internal Medicine, Gulf Medical University, Ajman, ARE
| | - Tuba Tahir
- Department of Business Administration, Iqra University, Karachi, PAK
| | - Kyle Mitchell
- Department of Internal Medicine, University of Science, Arts and Technology, Olveston, MSR
| | - Smruthi Panchagnula
- Department of Internal Medicine, Ganni Subbalakshmi Lakshmi (GSL) Medical College, Hyderabad, IND
| | - Satpreet Mandair
- Department of Internal Medicine, Medical University of the Americas, Charlestown, KNA
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Longitudinal diffusion and volumetric kinetics of head and neck cancer magnetic resonance on a 1.5 T MR-linear accelerator hybrid system: A prospective R-IDEAL stage 2a imaging biomarker characterization/pre-qualification study. Clin Transl Radiat Oncol 2023; 42:100666. [PMID: 37583808 PMCID: PMC10424120 DOI: 10.1016/j.ctro.2023.100666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/18/2023] [Accepted: 07/22/2023] [Indexed: 08/17/2023] Open
Abstract
Objectives We aim to characterize the serial quantitative apparent diffusion coefficient (ADC) changes of the target disease volume using diffusion-weighted imaging (DWI) acquired weekly during radiation therapy (RT) on a 1.5 T MR-Linac and correlate these changes with tumor response and oncologic outcomes for head and neck squamous cell carcinoma (HNSCC) patients as part of a programmatic R-IDEAL biomarker characterization effort. Methods Thirty patients with HNSCC who received curative-intent RT at MD Anderson Cancer Center, were included. Baseline and weekly MRI were obtained, and various ADC parameters were extracted from the regions of interest (ROIs). Baseline and weekly ADC parameters were correlated with response during and after RT, and the recurrence using the Mann-Whitney U test. The Wilcoxon signed-rank test was used to compare the weekly ADC versus baseline values. Weekly volumetric changes (Δvolume) for each ROI were correlated with ΔADC using Spearman's Rho test. Recursive partitioning analysis (RPA) identified the optimal ΔADC threshold associated with different oncologic outcomes. Results There was a significant rise in all ADC parameters at different time points of RT compared to baseline for both gross primary disease (GTV-P) and gross nodal disease volumes (GTV-N). The increased ADC values for GTV-P were statistically significant only for primary tumors achieving complete remission (CR) during RT. RPA identified GTV-P ΔADC 5th percentile > 13% at the mid-RT as the most significant parameter associated with primary tumors' CR during RT (p < 0.001). There was a significant decrease in residual volume of both GTV-P & GTV-N throughout the course of RT. A significant negative correlation between mean ΔADC and Δvolume for GTV-P at the 3rd and 4th week of RT was detected (r = -0.39, p = 0.044 & r = -0.45, p = 0.019, respectively). Conclusion Assessment of ADC kinetics at regular intervals throughout RT seems to be correlated with RT response. Further studies with larger cohorts and multi-institutional data are needed for validation of ΔADC as a model for prediction of response to RT.
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8
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Li T, Wang J, Yang Y, Glide-Hurst CK, Wen N, Cai J. Multi-parametric MRI for radiotherapy simulation. Med Phys 2023; 50:5273-5293. [PMID: 36710376 PMCID: PMC10382603 DOI: 10.1002/mp.16256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 09/10/2022] [Accepted: 12/06/2022] [Indexed: 01/31/2023] Open
Abstract
Magnetic resonance imaging (MRI) has become an important imaging modality in the field of radiotherapy (RT) in the past decade, especially with the development of various novel MRI and image-guidance techniques. In this review article, we will describe recent developments and discuss the applications of multi-parametric MRI (mpMRI) in RT simulation. In this review, mpMRI refers to a general and loose definition which includes various multi-contrast MRI techniques. Specifically, we will focus on the implementation, challenges, and future directions of mpMRI techniques for RT simulation.
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Affiliation(s)
- Tian Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jihong Wang
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yingli Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong Univeristy School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Carri K Glide-Hurst
- Department of Radiation Oncology, University of Wisconsin, Madison, Wisconsin, USA
| | - Ning Wen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong Univeristy School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- The Global Institute of Future Technology, Shanghai Jiaotong University, Shanghai, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
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9
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El-Habashy DM, Wahid KA, He R, McDonald B, Rigert J, Mulder SJ, Lim TY, Wang X, Yang J, Ding Y, Naser MA, Ng SP, Bahig H, Salzillo TC, Preston KE, Abobakr M, Shehata MA, Elkhouly EA, Alagizy HA, Hegazy AH, Mohammadseid M, Terhaard C, Philippens M, Rosenthal DI, Wang J, Lai SY, Dresner A, Christodouleas JC, Mohamed ASR, Fuller CD. Longitudinal diffusion and volumetric kinetics of head and neck cancer magnetic resonance on a 1.5T MR-Linear accelerator hybrid system: A prospective R-IDEAL Stage 2a imaging biomarker characterization/ pre-qualification study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.04.23289527. [PMID: 37205359 PMCID: PMC10187456 DOI: 10.1101/2023.05.04.23289527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Objectives We aim to characterize the serial quantitative apparent diffusion coefficient (ADC) changes of the target disease volume using diffusion-weighted imaging (DWI) acquired weekly during radiation therapy (RT) on a 1.5T MR-Linac and correlate these changes with tumor response and oncologic outcomes for head and neck squamous cell carcinoma (HNSCC) patients as part of a programmatic R-IDEAL biomarker characterization effort. Methods Thirty patients with pathologically confirmed HNSCC who received curative-intent RT at the University of Texas MD Anderson Cancer Center, were included in this prospective study. Baseline and weekly Magnetic resonance imaging (MRI) (weeks 1-6) were obtained, and various ADC parameters (mean, 5 th , 10 th , 20 th , 30 th , 40 th , 50 th , 60 th , 70 th , 80 th , 90 th and 95 th percentile) were extracted from the target regions of interest (ROIs). Baseline and weekly ADC parameters were correlated with response during RT, loco-regional control, and the development of recurrence using the Mann-Whitney U test. The Wilcoxon signed-rank test was used to compare the weekly ADC versus baseline values. Weekly volumetric changes (Δvolume) for each ROI were correlated with ΔADC using Spearman's Rho test. Recursive partitioning analysis (RPA) was performed to identify the optimal ΔADC threshold associated with different oncologic outcomes. Results There was an overall significant rise in all ADC parameters during different time points of RT compared to baseline values for both gross primary disease volume (GTV-P) and gross nodal disease volumes (GTV-N). The increased ADC values for GTV-P were statistically significant only for primary tumors achieving complete remission (CR) during RT. RPA identified GTV-P ΔADC 5 th percentile >13% at the 3 rd week of RT as the most significant parameter associated with CR for primary tumor during RT (p <0.001). Baseline ADC parameters for GTV-P and GTV-N didn't significantly correlate with response to RT or other oncologic outcomes. There was a significant decrease in residual volume of both GTV-P & GTV-N throughout the course of RT. Additionally, a significant negative correlation between mean ΔADC and Δvolume for GTV-P at the 3 rd and 4 th week of RT was detected (r = -0.39, p = 0.044 & r = -0.45, p = 0.019, respectively). Conclusion Assessment of ADC kinetics at regular intervals throughout RT seems to be correlated with RT response. Further studies with larger cohorts and multi-institutional data are needed for validation of ΔADC as a model for prediction of response to RT.
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Affiliation(s)
- Dina M El-Habashy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Kareem A Wahid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Renjie He
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Brigid McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jillian Rigert
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Samuel J. Mulder
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Tze Yee Lim
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xin Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohamed A Naser
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, Austin Health Melbourne, Australia
| | - Houda Bahig
- Department of radiology, radiation oncology and nuclear medicine, Université de Montréal, Canada
| | - Travis C Salzillo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Kathryn E Preston
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- University of Houston College of Pharmacy, Houston, Texas, USA
| | - Moamen Abobakr
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohamed A Shehata
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Enas A Elkhouly
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Hagar A Alagizy
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Amira H Hegazy
- Department of Clinical Oncology and Nuclear Medicine, Menoufia University, Shebin Elkom, Egypt
| | - Mustefa Mohammadseid
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Chris Terhaard
- Department of Radiation Therapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle Philippens
- Department of Radiation Therapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David I. Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Stephen Y. Lai
- Department of Head and Neck Surgery, Division of Surgery,The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alex Dresner
- Philips Healthcare MR Oncology, Cleveland, Ohio, USA
| | | | | | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Fritz V, Martirosian P, Machann J, Thorwarth D, Schick F. Soy lecithin: A beneficial substance for adjusting the ADC in aqueous solutions to the values of biological tissues. Magn Reson Med 2023; 89:1674-1683. [PMID: 36458695 DOI: 10.1002/mrm.29543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/31/2022] [Accepted: 11/11/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE To test soy lecithin as a substance added to water for the construction of MRI phantoms with tissue-like diffusion coefficients. The performance of soy lecithin was assessed for the useable range of adjustable ADC values, the degree of non-Gaussian diffusion, simultaneous effects on relaxation times, and spectral signal properties. METHODS Aqueous soy lecithin solutions of different concentrations (0%, 0.5%, 1%, 2%, 3% …, 10%) and soy lecithin-agar gels were prepared and examined on a 3 Tesla clinical scanner at 18.5° ± 0.5°C. Echoplanar sequences (b values: 0-1000/3000 s/mm2 ) were applied for ADC measurements. Quantitative relaxometry and MRS were performed for assessment of T1 , T2 , and detectable spectral components. RESULTS The presence of soy lecithin significantly restricts the diffusion of water molecules and mimics the nearly Gaussian nature of diffusion observed in tissue (for b values <1000 s/mm2 ). ADC values ranged from 2.02 × 10-3 mm2 /s to 0.48 × 10-3 mm2 /s and cover the entire physiological range reported on biological tissue. Measured T1 /T2 values of pure lecithin solutions varied from 2685/2013 to 668/133 ms with increasing concentration. No characteristic signals of soy lecithin were observed in the MR spectrum. The addition of agar to the soy lecithin solutions allowed T2 values to be well adjusted to typical values found in parenchymal tissue without affecting the soy lecithin-controlled ADC value. CONCLUSION Soy lecithin is a promising substance for the construction of diffusion phantoms with tissue-like ADC values. It provides several advantages over previously proposed substances, in particular a wide range of adjustable ADC values, the lack of additional 1 H-signals, and the possibility to adjust ADC and T2 values (by adding agar) almost independently of each other.
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Affiliation(s)
- Victor Fritz
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Petros Martirosian
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Jürgen Machann
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany.,Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Centre Munich at the University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Fritz Schick
- Section on Experimental Radiology, Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany.,Cluster of Excellence iFIT (EXC 2180) "Image Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
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11
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Uder L, Nachbar M, Butzer S, Boldt J, Baumeister S, Bitzer M, Königsrainer A, Seufferlein T, Hoffmann R, Gatidis S, Nikolaou K, Zips D, Thorwarth D, Gani C, Boeke S. Local control and patient reported outcomes after online MR guided stereotactic body radiotherapy of liver metastases. Front Oncol 2023; 12:1095633. [PMID: 36727060 PMCID: PMC9885175 DOI: 10.3389/fonc.2022.1095633] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction Stereotactic body radiotherapy (SBRT) is used to treat liver metastases with the intention of ablation. High local control rates were shown. Magnetic resonance imaging guided radiotherapy (MRgRT) provides the opportunity of a marker-less liver SBRT treatment due to the high soft tissue contrast. We report herein on one of the largest cohorts of patients treated with online MRgRT of liver metastases focusing on oncological outcome, toxicity, patient reported outcome measures (PROMs), quality of life. Material and methods Patients treated for liver metastases with online MR-guided SBRT at a 1,5 T MR-Linac (Unity, Elekta, Crawley, UK) between March 2019 and December 2021 were included in this prospective study. UK SABR guidelines were used for organs at risk constraints. Oncological endpoints such as survival parameters (overall survival, progression-free survival) and local control as well as patient reported acceptance and quality of life data (EORTC QLQ-C30 questionnaire) were assessed. For toxicity scoring the Common Toxicity Criteria Version 5 were used. Results A total of 51 patients with 74 metastases were treated with a median of five fractions. The median applied BED GTV D98 was 84,1 Gy. Median follow-up was 15 months. Local control of the irradiated liver metastasis after 12 months was 89,6%, local control of the liver was 40,3%. Overall survival (OS) after 12 months was 85.1%. Progression free survival (PFS) after 12 months was 22,4%. Local control of the irradiated liver lesion was 100% after three years when a BED ≥100 Gy was reached. The number of treated lesions did not impact local control neither of the treated or of the hepatic control. Patient acceptance of online MRgSBRT was high. There were no acute grade ≥ 3 toxicities. Quality of life data showed no significant difference comparing baseline and follow-up data. Conclusion Online MR guided radiotherapy is a noninvasive, well-tolerated and effective treatment for liver metastases. Further prospective trials with the goal to define patients who actually benefit most from an online adaptive workflow are currently ongoing.
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Affiliation(s)
- Laura Uder
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany,*Correspondence: Laura Uder,
| | - Marcel Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Sarah Butzer
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Jessica Boldt
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Sabrina Baumeister
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Michael Bitzer
- Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Alfred Königsrainer
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Thomas Seufferlein
- Department of Internal Medicine I, Ulm University Hospital Medical Center, Ulm, Germany
| | - Rüdiger Hoffmann
- Department of Diagnostic and Interventional Radiology , University of Tübingen, Tübingen, Germany
| | - Sergios Gatidis
- Department of Diagnostic and Interventional Radiology , University of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology , University of Tübingen, Tübingen, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany,German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany,Department of Radiation Oncology, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany,German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Cihan Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany,German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Simon Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany,German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
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12
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Morelli L, Palombo M, Buizza G, Riva G, Pella A, Fontana G, Imparato S, Iannalfi A, Orlandi E, Paganelli C, Baroni G. Microstructural parameters from DW-MRI for tumour characterization and local recurrence prediction in particle therapy of skull-base chordoma. Med Phys 2023; 50:2900-2913. [PMID: 36602230 DOI: 10.1002/mp.16202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 11/21/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Quantitative imaging such as Diffusion-Weighted MRI (DW-MRI) can be exploited to non-invasively derive patient-specific tumor microstructure information for tumor characterization and local recurrence risk prediction in radiotherapy. PURPOSE To characterize tumor microstructure according to proliferative capacity and predict local recurrence through microstructural markers derived from pre-treatment conventional DW-MRI, in skull-base chordoma (SBC) patients treated with proton (PT) and carbon ion (CIRT) radiotherapy. METHODS Forty-eight patients affected by SBC, who underwent conventional DW-MRI before treatment and were enrolled for CIRT (n = 25) or PT (n = 23), were retrospectively selected. Clinically verified local recurrence information (LR) and histological information (Ki-67, proliferation index) were collected. Apparent diffusion coefficient (ADC) maps were calculated from pre-treatment DW-MRI and, from these, a set of microstructural parameters (cellular radius R, volume fraction vf, diffusion D) were derived by applying a fine-tuning procedure to a framework employing Monte Carlo simulations on synthetic cell substrates. In addition, apparent cellularity (ρapp ) was estimated from vf and R for an easier clinical interpretation. Histogram-based metrics (mean, median, variance, entropy) from estimated parameters were considered to investigate differences (Mann-Whitney U-test, α = 0.05) in estimated tumor microstructure in SBCs characterized by low or high cell proliferation (Ki-67). Recurrence-free survival analyses were also performed to assess the ability of the microstructural parameters to stratify patients according to the risk of local recurrence (Kaplan-Meier curves, log-rank test α = 0.05). RESULTS Refined microstructural markers revealed optimal capabilities in discriminating patients according to cell proliferation, achieving best results with mean values (p-values were 0.0383, 0.0284, 0.0284, 0.0468, and 0.0088 for ADC, R, vf, D, and ρapp, respectively). Recurrence-free survival analyses showed significant differences between populations at high and low risk of local recurrence as stratified by entropy values of estimated microstructural parameters (p = 0.0110). CONCLUSION Patient-specific microstructural information was non-invasively derived providing potentially useful tools for SBC treatment personalization and optimization in particle therapy.
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Affiliation(s)
- Letizia Morelli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Marco Palombo
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, UK
- School of Computer Science and Informatics, Cardiff University, Cardiff, UK
| | - Giulia Buizza
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Giulia Riva
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Andrea Pella
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giulia Fontana
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Imparato
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alberto Iannalfi
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Ester Orlandi
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milan, Italy
- National Center of Oncological Hadrontherapy (CNAO), Pavia, Italy
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13
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Morelli L, Parrella G, Molinelli S, Magro G, Annunziata S, Mairani A, Chalaszczyk A, Fiore MR, Ciocca M, Paganelli C, Orlandi E, Baroni G. A Dosiomics Analysis Based on Linear Energy Transfer and Biological Dose Maps to Predict Local Recurrence in Sacral Chordomas after Carbon-Ion Radiotherapy. Cancers (Basel) 2022; 15:cancers15010033. [PMID: 36612029 PMCID: PMC9817801 DOI: 10.3390/cancers15010033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Carbon Ion Radiotherapy (CIRT) is one of the most promising therapeutic options to reduce Local Recurrence (LR) in Sacral Chordomas (SC). The aim of this work is to compare the performances of survival models fed with dosiomics features and conventional DVH metrics extracted from relative biological effectiveness (RBE)-weighted dose (DRBE) and dose-averaged Linear Energy Transfer (LETd) maps, towards the identification of possible prognostic factors for LR in SC patients treated with CIRT. This retrospective study included 50 patients affected by SC with a focus on patients that presented a relapse in a high-dose region. Survival models were built to predict both LR and High-Dose Local Recurrencies (HD-LR). The models were evaluated through Harrell Concordance Index (C-index) and patients were stratified into high/low-risk groups. Local Recurrence-free Kaplan-Meier curves were estimated and evaluated through log-rank tests. The model with highest performance (median(interquartile-range) C-index of 0.86 (0.22)) was built on features extracted from LETd maps, with DRBE models showing promising but weaker results (C-index of 0.83 (0.21), 0.80 (0.21)). Although the study should be extended to a wider patient population, LETd maps show potential as a prognostic factor for SC HD-LR in CIRT, and dosiomics appears to be the most promising approach against more conventional methods (e.g., DVH-based).
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Affiliation(s)
- Letizia Morelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
- Correspondence: (L.M.); (G.P.); Tel.: +39-02-2399-9022 (G.P.)
| | - Giovanni Parrella
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
- Correspondence: (L.M.); (G.P.); Tel.: +39-02-2399-9022 (G.P.)
| | - Silvia Molinelli
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
| | - Giuseppe Magro
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
| | - Simone Annunziata
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Andrea Mairani
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
- Heidelberg Ion Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg, Germany
| | - Agnieszka Chalaszczyk
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
| | - Maria Rosaria Fiore
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
| | - Mario Ciocca
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Ester Orlandi
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
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14
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Shahbazi-Gahrouei D, Aminolroayaei F, Nematollahi H, Ghaderian M, Gahrouei SS. Advanced Magnetic Resonance Imaging Modalities for Breast Cancer Diagnosis: An Overview of Recent Findings and Perspectives. Diagnostics (Basel) 2022; 12:2741. [PMID: 36359584 PMCID: PMC9689118 DOI: 10.3390/diagnostics12112741] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/26/2022] [Accepted: 11/07/2022] [Indexed: 08/28/2023] Open
Abstract
Breast cancer is the most prevalent cancer among women and the leading cause of death. Diffusion-weighted imaging (DWI) and diffusion tensor imaging (DTI) are advanced magnetic resonance imaging (MRI) procedures that are widely used in the diagnostic and treatment evaluation of breast cancer. This review article describes the characteristics of new MRI methods and reviews recent findings on breast cancer diagnosis. This review study was performed on the literature sourced from scientific citation websites such as Google Scholar, PubMed, and Web of Science until July 2021. All relevant works published on the mentioned scientific citation websites were investigated. Because of the propensity of malignancies to limit diffusion, DWI can improve MRI diagnostic specificity. Diffusion tensor imaging gives additional information about diffusion directionality and anisotropy over traditional DWI. Recent findings showed that DWI and DTI and their characteristics may facilitate earlier and more accurate diagnosis, followed by better treatment. Overall, with the development of instruments and novel MRI modalities, it may be possible to diagnose breast cancer more effectively in the early stages.
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Affiliation(s)
- Daryoush Shahbazi-Gahrouei
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Fahimeh Aminolroayaei
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Hamide Nematollahi
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Mohammad Ghaderian
- Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran
| | - Sogand Shahbazi Gahrouei
- Department of Management, School of Humanities, Najafabad Branch, Islamic Azad University, Najafabad 8514143131, Iran
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15
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Zhou S, Meng Y, Sun X, Jin Z, Feng W, Yang H. The critical components for effective adaptive radiotherapy in patients with unresectable non-small-cell lung cancer: who, when and how. Future Oncol 2022; 18:3551-3562. [PMID: 36189758 DOI: 10.2217/fon-2022-0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Adaptive radiotherapy (ART) is a new radiotherapy technology based on image-guided radiation therapy technology, used to avoid radiation overexposure to residual tumors and the surrounding normal tissues. Tumors undergoing the same radiation doses and modes can occur unequal shrinkage due to the variation of response times to radiation doses in different patients. To perform ART effectively, eligible patients with a high probability of benefits from ART need to be identified. Confirming the precise timetable for ART in every patient is another urgent problem to be resolved. Moreover, the outcomes of ART are different depending on the various image guidance used. This review discusses 'who, when and how' as the three key factors involved in the most effective implementation for the management of ART.
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Affiliation(s)
- Suna Zhou
- Key Laboratory of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China.,Department of Radiation Oncology, Xi'an No.3 Hospital, the Affiliated Hospital of Northwest University, Xi'an, Shanxi, 710018, PR China
| | - Yinnan Meng
- Key Laboratory of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China.,Department of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China
| | - Xuefeng Sun
- Key Laboratory of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China.,Department of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China
| | - Zhicheng Jin
- Key Laboratory of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China.,Department of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China
| | - Wei Feng
- Department of Radiation Oncology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou, 310022, PR China
| | - Haihua Yang
- Key Laboratory of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China.,Department of Radiation Oncology, The Affiliated Taizhou Hospital, Wenzhou Medical University, Taizhou, 317000, Zhejiang, PR China
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16
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Barlas BA, Bahadir CD, Kafali SG, Yilmaz U, Saritas EU. Sheared two-dimensional radiofrequency excitation for off-resonance robustness and fat suppression in reduced field-of-view imaging. Magn Reson Med 2022; 88:2504-2519. [PMID: 36000548 DOI: 10.1002/mrm.29416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/16/2022] [Accepted: 07/27/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Two-dimensional (2D) echo-planar radiofrequency (RF) pulses are widely used for reduced field-of-view (FOV) imaging in applications such as diffusion-weighted imaging. However, long pulse durations render the 2D RF pulses sensitive to off-resonance effects, causing local signal losses in reduced-FOV images. This work aims to achieve off-resonance robustness for 2D RF pulses via a sheared trajectory design. THEORY AND METHODS A sheared 2D RF pulse design is proposed to reduce pulse durations while covering identical excitation k-space extent as a standard 2D RF pulse. For a given shear angle, the number of sheared trajectory lines is minimized to obtain the shortest pulse duration, such that the excitation replicas are repositioned outside the slice stack to guarantee unlimited slice coverage. A target fat/water signal ratio of 5% is chosen to achieve robust fat suppression. RESULTS Simulations, imaging experiments on a custom head and neck phantom, and in vivo imaging experiments in the spinal cord at 3 T demonstrate that the sheared 2D RF design provides significant improvement in image quality while preserving profile sharpnesses. In regions with high off-resonance effects, the sheared 2D RF pulse improves the signal by more than 50% when compared to the standard 2D RF pulse. CONCLUSION The proposed sheared 2D RF design successfully reduces pulse durations, exhibiting significantly improved through-plane off-resonance robustness, while providing unlimited slice coverage and high fidelity fat suppression. This method will be especially beneficial in regions suffering from a variety of off-resonance effects, such as spinal cord and breast.
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Affiliation(s)
- Bahadir Alp Barlas
- Department of Electrical and Electronics Engineering, Bilkent University, Ankara, Turkey.,National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey
| | - Cagla Deniz Bahadir
- Department of Electrical and Electronics Engineering, Bilkent University, Ankara, Turkey.,National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey.,Department of Biomedical Engineering, Cornell University, Ithaca, New York, USA
| | - Sevgi Gokce Kafali
- Department of Electrical and Electronics Engineering, Bilkent University, Ankara, Turkey.,National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey.,Department of Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| | - Ugur Yilmaz
- National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey
| | - Emine Ulku Saritas
- Department of Electrical and Electronics Engineering, Bilkent University, Ankara, Turkey.,National Magnetic Resonance Research Center (UMRAM), Bilkent University, Ankara, Turkey.,Neuroscience Graduate Program, Bilkent University, Ankara, Turkey
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17
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Fontana G, Barcellini A, Boccuzzi D, Pecorilla M, Loap P, Cobianchi L, Vitolo V, Fiore MR, Vai A, Baroni G, Preda L, Imparato S, Orlandi E. Role of diffusion-weighted MRI in recurrent rectal cancer treated with carbon ion radiotherapy. Future Oncol 2022; 18:2403-2412. [PMID: 35712914 DOI: 10.2217/fon-2021-1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate the association between pretreatment diffusion-weighted MRI (DW-MRI) and 12-month radiological response in locally recurrent rectal cancer treated with carbon ion radiotherapy. Methods: Histogram analysis was performed on pretreatment DW-MRI for patients re-irradiated with carbon ion radiotherapy for local recurrence of rectal cancer. Results: A total of 17 patients were enrolled in the study. Pretreatment DW-MRI b-value of 1000 s/mm2 (b1000) and apparent diffusion coefficient (ADC) lesion median values for 1-year nonresponders (six patients) and responders (11 patients) demonstrated a median (interquartile of median values) of 62.5 (23.9) and 34.0 (13.0) and 953.0 (277.0) and 942.5 (339.0) μm2/s, respectively. All b1000 histogram features (h-features) and ADC h-kurtosis showed statistically significant differences, whereas only b1000 h-median, b1000 h-interquartile range and ADC h-kurtosis demonstrated remarkable diagnostic accuracy. Conclusion: DW-MRI showed promising results in predicting carbon ion radiotherapy outcome in local recurrence of rectal cancer, particularly with regard to b1000 h-median, b1000 h-interquartile range and ADC h-kurtosis.
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Affiliation(s)
- Giulia Fontana
- Clinical Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Dario Boccuzzi
- Department of Radiology, Diagnostic Radiology Residency School, University of Pavia, Pavia, 27100, Italy.,Department of Radiology, Valduce Hospital, Como, 22100, Italy
| | - Mattia Pecorilla
- Radiology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Pierre Loap
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy.,Department of Radiation Oncology, Institut Curie, Paris, 75005, France
| | - Lorenzo Cobianchi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, 27100, Italy.,Department of General Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Viviana Vitolo
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Maria Rosaria Fiore
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Alessandro Vai
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Guido Baroni
- Clinical Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, 20133, Italy
| | - Lorenzo Preda
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, 27100, Italy.,Department of Radiology, Fondazione IRCCS Policlinico San Matteo, Pavia, 27100, Italy
| | - Sara Imparato
- Radiology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy, Pavia, 27100, Italy
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18
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Gough J, Hall W, Good J, Nash A, Aitken K. Technical Radiotherapy Advances – The Role of Magnetic Resonance Imaging-Guided Radiation in the Delivery of Hypofractionation. Clin Oncol (R Coll Radiol) 2022; 34:301-312. [DOI: 10.1016/j.clon.2022.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/07/2022] [Accepted: 02/23/2022] [Indexed: 12/30/2022]
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19
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Lindemann ME, Gratz M, Blumhagen JO, Jakoby B, Quick HH. MR-based truncation correction using an advanced HUGE method to improve attenuation correction in PET/MR imaging of obese patients. Med Phys 2022; 49:865-877. [PMID: 35014697 DOI: 10.1002/mp.15446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 12/08/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE Truncation artifacts in the periphery of the magnetic resonance (MR) field-of-view (FOV) and thus, in the MR-based attenuation correction (AC) map, may hamper accurate positron emission tomography (PET) quantification in whole-body PET/MR, which is especially problematic in patients with obesity with overall large body dimensions. Therefore, an advanced truncation correction (TC) method to extend the conventional MR FOV is needed. METHODS The extent of MR-based AC-map truncations in obese patients was determined in a data set including n = 10 patients that underwent whole-body PET/MR exams. Patient inclusion criteria were defined as BMI > 30 kg/m2 and body weight > 100 kg. Truncations in PET/MR patients with obesity were quantified comparing the MR-based AC-map volume to segmented non-AC PET data, serving as the reference body volume without truncations to demonstrate the need of improved TC. The new method implemented in this study, termed "advanced HUGE", was modified and extended from the original HUGE method by Blumhagen et al. in order to provide improved TC across the entire axial MR FOV and to unlock new clinical applications of PET/MR. Advanced HUGE was then systematically tested in PET/MR NEMA phantom measurements. Relative differences between computed tomography (CT) AC PET data of the phantom setup (reference) and MR-based Dixon AC, respectively Dixon + advanced HUGE AC, were calculated. The applicability of the method for advanced TC was then demonstrated in first MR-based measurements in healthy volunteers. RESULTS It was found that the MR-based AC maps of obese patients often reveal truncations in anterior-posterior direction. Especially the abdominal region could benefit from improved TC, where maximal relative differences in the AC-map volume up to -17 % were calculated. Applying advanced HUGE to improve the MR-based AC in PET/MR, PET quantification errors in the large-volume phantom setup could be considerably reduced from average -18.6 % (Dixon AC) to 4.6 % compared to the CT AC reference. Volunteer measurements demonstrate that formerly missing AC-map volume in the Dixon-VIBE AC-map could be added due to advanced HUGE in anterior-posterior direction and thus, potentially improves AC in PET/MR. CONCLUSIONS The advanced HUGE method for truncation correction considerably reduces truncations in anterior-posterior direction demonstrated in phantom measurements and healthy volunteers and thus, further improves MR-based AC in PET/MR imaging. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Maike E Lindemann
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Marcel Gratz
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
| | | | | | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, Essen, Germany.,Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, Essen, Germany
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20
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van der Hoogt KJJ, Schipper RJ, Winter-Warnars GA, Ter Beek LC, Loo CE, Mann RM, Beets-Tan RGH. Factors affecting the value of diffusion-weighted imaging for identifying breast cancer patients with pathological complete response on neoadjuvant systemic therapy: a systematic review. Insights Imaging 2021; 12:187. [PMID: 34921645 PMCID: PMC8684570 DOI: 10.1186/s13244-021-01123-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/06/2021] [Indexed: 12/18/2022] Open
Abstract
This review aims to identify factors causing heterogeneity in breast DWI-MRI and their impact on its value for identifying breast cancer patients with pathological complete response (pCR) on neoadjuvant systemic therapy (NST). A search was performed on PubMed until April 2020 for studies analyzing DWI for identifying breast cancer patients with pCR on NST. Technical and clinical study aspects were extracted and assessed for variability. Twenty studies representing 1455 patients/lesions were included. The studies differed with respect to study population, treatment type, DWI acquisition technique, post-processing (e.g., mono-exponential/intravoxel incoherent motion/stretched exponential modeling), and timing of follow-up studies. For the acquisition and generation of ADC-maps, various b-value combinations were used. Approaches for drawing regions of interest on longitudinal MRIs were highly variable. Biological variability due to various molecular subtypes was usually not taken into account. Moreover, definitions of pCR varied. The individual areas under the curve for the studies range from 0.50 to 0.92. However, overlapping ranges of mean/median ADC-values at pre- and/or during and/or post-NST were found for the pCR and non-pCR groups between studies. The technical, clinical, and epidemiological heterogeneity may be causal for the observed variability in the ability of DWI to predict pCR accurately. This makes implementation of DWI for pCR prediction and evaluation based on one absolute ADC threshold for all breast cancer types undesirable. Multidisciplinary consensus and appropriate clinical study design, taking biological and therapeutic variation into account, is required for obtaining standardized, reliable, and reproducible DWI measurements for pCR/non-pCR identification.
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Affiliation(s)
- Kay J J van der Hoogt
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Robert J Schipper
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Gonneke A Winter-Warnars
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Leon C Ter Beek
- Department of Medical Physics, The Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Claudette E Loo
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ritse M Mann
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Regina G H Beets-Tan
- Department of Radiology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,GROW School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.,Danish Colorectal Cancer Unit South, Institute of Regional Health Research, Vejle University Hospital, University of Southern Denmark, Odense, Denmark
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21
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Morelli L, Buizza G, Palombo M, Riva G, Fontana G, Imparato S, Iannalfi A, Orlandi E, Paganelli C, Baroni G. Analysis of tumour microstructure estimation from conventional diffusion MRI and application to skull-base chordoma . ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:3761-3764. [PMID: 34892054 DOI: 10.1109/embc46164.2021.9630129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Skull-base chordoma (SBC) is a rare tumour whose molecular and radiological characteristics are still being investigated. In neuro-oncology microstructural imaging techniques, like diffusion-weighted MRI (DW-MRI), have been widely investigated, with the apparent diffusion coefficient (ADC) being one of the most used DW-MRI parameters due to its ease of acquisition and computation. ADC is a potential biomarker without a clear link to microstructure. The aim of this work was to derive microstructural information from conventional ADC, showing its potential for the characterisation of skull-base chordomas. Sixteen patients affected by SBC, who underwent conventional DW-MRI were retrospectively selected. From mono-exponential fits of DW-MRI, ADC maps were estimated using different sets of b-values. DW-MRI signals were simulated from synthetic substrates , which mimic the cellular packing of a tumour tissue with well-defined microstructural features. Starting from a published method, an error-driven procedure was evaluated to improve the estimates of microstructural parameters obtained through the simulated signals. A quantitative description of the tumour microstructure was then obtained from the DW-MRI images. This allowed successfully differentiating patients according to histologically-verified cell proliferation information.Clinical Relevance - The impact on cancer management derives from the expected improvement of radiation treatment quality tailored to a patient-specific non-invasive description of tumour microstructure.
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22
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Hernando D, Zhang Y, Pirasteh A. Quantitative diffusion MRI of the abdomen and pelvis. Med Phys 2021; 49:2774-2793. [PMID: 34554579 DOI: 10.1002/mp.15246] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 12/14/2022] Open
Abstract
Diffusion MRI has enormous potential and utility in the evaluation of various abdominal and pelvic disease processes including cancer and noncancer imaging of the liver, prostate, and other organs. Quantitative diffusion MRI is based on acquisitions with multiple diffusion encodings followed by quantitative mapping of diffusion parameters that are sensitive to tissue microstructure. Compared to qualitative diffusion-weighted MRI, quantitative diffusion MRI can improve standardization of tissue characterization as needed for disease detection, staging, and treatment monitoring. However, similar to many other quantitative MRI methods, diffusion MRI faces multiple challenges including acquisition artifacts, signal modeling limitations, and biological variability. In abdominal and pelvic diffusion MRI, technical acquisition challenges include physiologic motion (respiratory, peristaltic, and pulsatile), image distortions, and low signal-to-noise ratio. If unaddressed, these challenges lead to poor technical performance (bias and precision) and clinical outcomes of quantitative diffusion MRI. Emerging and novel technical developments seek to address these challenges and may enable reliable quantitative diffusion MRI of the abdomen and pelvis. Through systematic validation in phantoms, volunteers, and patients, including multicenter studies to assess reproducibility, these emerging techniques may finally demonstrate the potential of quantitative diffusion MRI for abdominal and pelvic imaging applications.
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Affiliation(s)
- Diego Hernando
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yuxin Zhang
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ali Pirasteh
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, Wisconsin, USA
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23
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Riva G, Imparato S, Savietto G, Pecorilla M, Iannalfi A, Barcellini A, Ronchi S, Fiore MR, Paganelli C, Buizza G, Ciocca M, Baroni G, Preda L, Orlandi E. Potential role of functional imaging in predicting outcome for patients treated with carbon ion therapy: a review. Br J Radiol 2021; 94:20210524. [PMID: 34520670 DOI: 10.1259/bjr.20210524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Carbon ion radiation therapy (CIRT) is an emerging radiation technique with advantageous physical and radiobiologic properties compared to conventional radiotherapy (RT) providing better response in case of radioresistant and hypoxic tumors. Our aim is to critically review if functional imaging techniques could play a role in predicting outcome of CIRT-treated tumors, as already proven for conventional RT. METHODS 14 studies, concerning Magnetic resonance imaging (MRI) and Positron Emission Tomography (PET), were selected after a comprehensive search on multiple electronic databases from January 2000 to March 2020. RESULTS MRI studies (n = 5) focused on diffusion-weighted MRI and, even though quantitative parameters were the same in all studies (apparent diffusion coefficient, ADC), results were not univocal, probably due to different imaging acquisition protocols and tumoral histology. For PET studies (n = 9), different tracers were used such as [18F]FDG and other uncommon tracers ([11C]MET, [18F]FLT), with a relevant heterogeneity regarding parameters used for outcome assessment. CONCLUSION No conclusion can be drawn on the predictive value of functional imaging in CIRT-treated tumors. A standardization of image acquisition, multi-institutional large trials and external validations are needed in order to establish the prognostic value of functional imaging in CIRT and to guide clinical practice. ADVANCES IN KNOWLEDGE Emerging studies focused on functional imaging's role in predicting CIRT outcome. Due to the heterogeneity of images acquisition and studies, results are conflicting and prospective large studies with imaging standardized protocol are needed.
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Affiliation(s)
- Giulia Riva
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Imparato
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giovanni Savietto
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Mattia Pecorilla
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Alberto Iannalfi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Amelia Barcellini
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Sara Ronchi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Maria Rosaria Fiore
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Giulia Buizza
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Mario Ciocca
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Lorenzo Preda
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy.,Department of Radiology, I.R.C.C.S. Policlinico San Matteo Foundation, Pavia, Italy
| | - Ester Orlandi
- Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
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24
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Madamesila J, Ploquin N, Faruqi S, Tchistiakova E. Investigating diffusion patterns of brain metastases pre- and post-stereotactic radiosurgery: a feasibility study. Biomed Phys Eng Express 2021; 7. [PMID: 34388735 DOI: 10.1088/2057-1976/ac1d89] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/13/2021] [Indexed: 11/12/2022]
Abstract
Purpose.Metastatic complications are responsible for 90% of cancer-associated mortality. Magnetic resonance imaging (MRI) can be used to observe the brain's microstructure and potentially correlate changes with metastasis occurrence. Diffusion weighted imaging (DWI) is an MRI technique that utilizes the kinetics of water molecules within the body. The aim of this study is to use DWI to characterize diffusion changes within brain metastases in cancer patients pre- and post-stereotactic radiosurgery (SRS).Methods.We retrospectively analyzed 113 metastases from 13 patients who underwent SRS for brain metastasis recurrence. Longitudinal apparent diffusion coefficient (ADC) maps were registered to Gd-T1 images and CT, and clinical metastasis ROIs from all SRS treatments were retrospectively transferred onto these ADC maps for analysis. Metastases were characterized based on pre-SRS diffusion pattern, primary cancer site, and post-SRS outcome. ADC values were calculated pre- and post-SRS.Results.ADC values were significantly elevated (980.2 × 10-6mm2s-1and 1040.3 × 10-6mm2s-1pre- and post-SRS, respectively) when compared to healthy brain tissue (826.8 × 10-6mm2s-1) for all metastases. Three identified pre-SRS patterns were significantly different before SRS and within 6 months post-SRS. No significant differences were observed between different primaries pre-SRS. Post-SRS, Lung metastases ADC decreased by 86.2 × 10-6mm2s-1, breast metastases increased by 116.7 × 10-6mm2s-1, and genitourinary metastases showed no significant ADC change. SRS outcomes showed ADC variability pre-treatment but no significant differences pre- and post-SRS, except at 6-9 months post-SRS where progressing metastases were elevated when compared to other response groups.Conclusion. This study provided a unique opportunity to characterize diffusion changes in brain metastases before their manifestation on standard Gd-T1 images and post-SRS. Identified patterns may improve early detection of brain metastases as well as predict their response to treatment.
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Affiliation(s)
| | - Nicolas Ploquin
- Department of Physics and Astronomy, University of Calgary, Canada.,Department of Oncology, Division of Medical Physics, University of Calgary, Canada
| | - Salman Faruqi
- Department of Oncology, Division of Radiation Oncology, University of Calgary, Canada
| | - Ekaterina Tchistiakova
- Department of Physics and Astronomy, University of Calgary, Canada.,Department of Oncology, Division of Medical Physics, University of Calgary, Canada
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Wang C, Padgett KR, Su MY, Mellon EA, Maziero D, Chang Z. Multi-parametric MRI (mpMRI) for treatment response assessment of radiation therapy. Med Phys 2021; 49:2794-2819. [PMID: 34374098 DOI: 10.1002/mp.15130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 11/11/2022] Open
Abstract
Magnetic resonance imaging (MRI) plays an important role in the modern radiation therapy (RT) workflow. In comparison with computed tomography (CT) imaging, which is the dominant imaging modality in RT, MRI possesses excellent soft-tissue contrast for radiographic evaluation. Based on quantitative models, MRI can be used to assess tissue functional and physiological information. With the developments of scanner design, acquisition strategy, advanced data analysis, and modeling, multiparametric MRI (mpMRI), a combination of morphologic and functional imaging modalities, has been increasingly adopted for disease detection, localization, and characterization. Integration of mpMRI techniques into RT enriches the opportunities to individualize RT. In particular, RT response assessment using mpMRI allows for accurate characterization of both tissue anatomical and biochemical changes to support decision-making in monotherapy of radiation treatment and/or systematic cancer management. In recent years, accumulating evidence have, indeed, demonstrated the potentials of mpMRI in RT response assessment regarding patient stratification, trial benchmarking, early treatment intervention, and outcome modeling. Clinical application of mpMRI for treatment response assessment in routine radiation oncology workflow, however, is more complex than implementing an additional imaging protocol; mpMRI requires additional focus on optimal study design, practice standardization, and unified statistical reporting strategy to realize its full potential in the context of RT. In this article, the mpMRI theories, including image mechanism, protocol design, and data analysis, will be reviewed with a focus on the radiation oncology field. Representative works will be discussed to demonstrate how mpMRI can be used for RT response assessment. Additionally, issues and limits of current works, as well as challenges and potential future research directions, will also be discussed.
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Affiliation(s)
- Chunhao Wang
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
| | - Kyle R Padgett
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA.,Department of Radiology, University of Miami, Miami, Florida, USA
| | - Min-Ying Su
- Department of Radiological Sciences, University of California, Irvine, California, USA.,Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Eric A Mellon
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA
| | - Danilo Maziero
- Department of Radiation Oncology, University of Miami, Miami, Florida, USA
| | - Zheng Chang
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
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van Houdt PJ, Saeed H, Thorwarth D, Fuller CD, Hall WA, McDonald BA, Shukla-Dave A, Kooreman ES, Philippens MEP, van Lier ALHMW, Keesman R, Mahmood F, Coolens C, Stanescu T, Wang J, Tyagi N, Wetscherek A, van der Heide UA. Integration of quantitative imaging biomarkers in clinical trials for MR-guided radiotherapy: Conceptual guidance for multicentre studies from the MR-Linac Consortium Imaging Biomarker Working Group. Eur J Cancer 2021; 153:64-71. [PMID: 34144436 PMCID: PMC8340311 DOI: 10.1016/j.ejca.2021.04.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 12/14/2022]
Abstract
Quantitative imaging biomarkers (QIBs) derived from MRI techniques have the potential to be used for the personalised treatment of cancer patients. However, large-scale data are missing to validate their added value in clinical practice. Integrated MRI-guided radiotherapy (MRIgRT) systems, such as hybrid MRI-linear accelerators, have the unique advantage that MR images can be acquired during every treatment session. This means that high-frequency imaging of QIBs becomes feasible with reduced patient burden, logistical challenges, and costs compared to extra scan sessions. A wealth of valuable data will be collected before and during treatment, creating new opportunities to advance QIB research at large. The aim of this paper is to present a roadmap towards the clinical use of QIBs on MRIgRT systems. The most important need is to gather and understand how the QIBs collected during MRIgRT correlate with clinical outcomes. As the integrated MRI scanner differs from traditional MRI scanners, technical validation is an important aspect of this roadmap. We propose to integrate technical validation with clinical trials by the addition of a quality assurance procedure at the start of a trial, the acquisition of in vivo test-retest data to assess the repeatability, as well as a comparison between QIBs from MRIgRT systems and diagnostic MRI systems to assess the reproducibility. These data can be collected with limited extra time for the patient. With integration of technical validation in clinical trials, the results of these trials derived on MRIgRT systems will also be applicable for measurements on other MRI systems.
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Affiliation(s)
- Petra J van Houdt
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 102, Amsterdam, 1066CX, the Netherlands.
| | - Hina Saeed
- Department of Radiation Oncology, Medical College of Wisconsin, 9200 W Wisconsin Av, Milwaukee, WI, 53226, USA.
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Hoppe-Seyler-Str. 3, Tübingen, 72076, Germany.
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0097, Houston, TX, 77030, USA.
| | - William A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, 9200 W Wisconsin Av, Milwaukee, WI, 53226, USA.
| | - Brigid A McDonald
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0097, Houston, TX, 77030, USA.
| | - Amita Shukla-Dave
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Ernst S Kooreman
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 102, Amsterdam, 1066CX, the Netherlands.
| | - Marielle E P Philippens
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Astrid L H M W van Lier
- Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Rick Keesman
- Department of Radiation Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 32, Nijmegen, 6525GA, the Netherlands.
| | - Faisal Mahmood
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Kløvervænget 19, Odense C, 5000, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19.3, Odense C, 5000, Denmark.
| | - Catherine Coolens
- Department of Medical Physics, Princess Margaret Cancer Centre and University Health Network, 700 University Avenue, Toronto, Ontario, M5M 1G7, Canada.
| | - Teodor Stanescu
- Department of Medical Physics, Princess Margaret Cancer Centre and University Health Network, 700 University Avenue, Toronto, Ontario, M5M 1G7, Canada; Department of Radiation Oncology, University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada.
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 0097, Houston, TX, 77030, USA.
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
| | - Andreas Wetscherek
- Joint Department of Physics, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, 15 Cotswold Road, London, SM2 5NG, United Kingdom.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 102, Amsterdam, 1066CX, the Netherlands.
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Wegener D, Zips D, Gani C, Boeke S, Nikolaou K, Othman AE, Almansour H, Paulsen F, Müller AC. [Primary treatment of prostate cancer using 1.5 T MR-linear accelerator]. Radiologe 2021; 61:839-845. [PMID: 34297139 PMCID: PMC8410708 DOI: 10.1007/s00117-021-00882-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
Hintergrund Der potenzielle Nutzen des verbesserten Weichteilkontrastes von MR-Sequenzen gegenüber der Computertomographie (CT) für die Radiotherapie des Prostatakarzinoms ist bekannt und führt zu konsistenteren und kleineren Zielvolumina sowie verbesserter Risikoorganschonung. Hybridgeräte aus Magnetresonanztomographie (MRT) und Linearbeschleuniger (MR-Linac) stellen eine neue vielversprechende Erweiterung der radioonkologischen Therapieoptionen dar. Material und Methoden Dieser Artikel gibt eine Übersicht über bisherige Erfahrungen, Indikationen, Vorteile und Herausforderungen für die Radiotherapie des primären Prostatakarzinoms mit dem 1,5-T-MR-Linac. Ergebnisse Alle strahlentherapeutischen Therapieindikationen für das primäre Prostatakarzinom können mit dem 1,5-T-MR-Linac abgedeckt werden. Die potenziellen Vorteile umfassen die tägliche MR-basierte Lagekontrolle in Bestrahlungsposition und die Möglichkeit der täglichen Echtzeitanpassung des Bestrahlungsplans an die aktuelle Anatomie der Beckenorgane (adaptive Strahlentherapie). Zusätzlich werden am 1,5-T-MR-Linac funktionelle MRT-Sequenzen für individuelles Response-Assessment für die Therapieanpassung untersucht. Dadurch soll das therapeutische Fenster weiter optimiert werden. Herausforderungen stellen u. a. die technische Komplexität und die Dauer der Behandlungssitzung dar. Schlussfolgerung Der 1,5-T-MR-Linac erweitert das radioonkologische Spektrum in der Therapie des Prostatakarzinoms und bietet Vorteile durch tagesaktuelle MRT-basierte Zielvolumendefinition und Planadaptation. Weitere klinische Untersuchungen sind notwendig, um die Patienten zu identifizieren, die von der Behandlung am MR-Linac gegenüber anderen strahlentherapeutischen Methoden besonders profitieren.
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Affiliation(s)
- Daniel Wegener
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
| | - Daniel Zips
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Cihan Gani
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Simon Boeke
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - Konstantin Nikolaou
- Universitätsklinik für Radiologie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Ahmed E Othman
- Universitätsklinik für Radiologie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
- Universitätsklink für Neuroradiologie, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Haidara Almansour
- Universitätsklinik für Radiologie, Eberhard Karls Universität Tübingen, Tübingen, Deutschland
| | - Frank Paulsen
- Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
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Seravalli E, Kroon PS, Buatti JM, Hall MD, Mandeville HC, Marcus KJ, Onal C, Ozyar E, Paulino AC, Paulsen F, Saunders D, Tsang DS, Wolden SL, Janssens GO. The potential role of MR-guided adaptive radiotherapy in pediatric oncology: Results from a SIOPE-COG survey. Clin Transl Radiat Oncol 2021; 29:71-78. [PMID: 34159265 PMCID: PMC8202186 DOI: 10.1016/j.ctro.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Magnetic resonance guided radiotherapy (MRgRT) has been successfully implemented for several routine clinical applications in adult patients. The purpose of this study is to map the potential benefit of MRgRT on toxicity reduction and outcome in pediatric patients treated with curative intent for primary and metastatic sites. MATERIALS AND METHODS Between May and August 2020, a survey was distributed among SIOPE- and COG-affiliated radiotherapy departments, treating at least 25 pediatrics patients annually and being (candidate) users of a MRgRT system. The survey consisted of a table with 45 rows (clinical scenarios for primary (n = 28) and metastatic (n = 17) tumors) and 7 columns (toxicity reduction, outcome improvement, PTV margin reduction, target volume daily adaptation, online re-planning, intrafraction motion compensation and on-board functional imaging) and the option to answer by 'yes/no' . Afterwards, the Dutch national radiotherapy cohort was used to estimate the percentage of pediatric treatments that may benefit from MRgRT. RESULTS The survey was completed by 12/17 (71% response rate) institutions meeting the survey inclusion criteria. Responders indicated an 'expected benefit' from MRgRT for toxicity/outcome in 7% (for thoracic lymphomas and abdominal rhabdomyosarcomas)/0% and 18% (for mediastinal lymph nodes, lymph nodes located in the liver/splenic hilum, and liver metastases)/0% of the considered scenarios for the primary and metastatic tumor sites, respectively, and a 'possible benefit' was estimated in 64%/46% and 47%/59% of the scenarios. When translating the survey outcome into a clinical perspective a toxicity/outcome benefit, either expected or possible, was anticipated for 55%/24% of primary sites and 62%/38% of the metastatic sites. CONCLUSION Although the benefit of MRgRT in pediatric radiation oncology is estimated to be modest, the potential role for reducing toxicity and improving clinical outcomes warrants further investigation. This fits best within the context of prospective studies or registration trials.
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Affiliation(s)
- Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra S. Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - John M. Buatti
- Departments of Radiation Oncology, University of Iowa, Iowa City, USA
| | - Matthew D. Hall
- Department of Radiation Oncology, Miami Cancer Institute, Miami, FL, USA
| | - Henry C. Mandeville
- Department of Radiotherapy, The Royal Marsden Hospital and Institute of Cancer Research, Sutton, United Kingdom
| | - Karen J. Marcus
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA, USA
| | - Cem Onal
- Department of Radiation Oncology, Baskent University, Ankara, Turkey
| | - Enis Ozyar
- Department of Radiation Oncology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Arnold C. Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, USA
| | - Frank Paulsen
- Department of Radiation Oncology, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Derek S. Tsang
- Radiation Medicine Program, University Health Network – Princess Margaret Cancer Centre, Toronto, Canada
| | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Geert O. Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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Lee SL, Bassetti M, Meijer GJ, Mook S. Review of MR-Guided Radiotherapy for Esophageal Cancer. Front Oncol 2021; 11:628009. [PMID: 33828980 PMCID: PMC8019940 DOI: 10.3389/fonc.2021.628009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/02/2021] [Indexed: 12/24/2022] Open
Abstract
In this review, we outline the potential benefits and the future role of MRI and MR-guided radiotherapy (MRgRT) in the management of esophageal cancer. Although not currently used in most clinical practice settings, MRI is a useful non-invasive imaging modality that provides excellent soft tissue contrast and the ability to visualize cancer physiology. Chemoradiation therapy with or without surgery is essential for the management of locally advanced esophageal cancer. MRI can help stage esophageal cancer, delineate the gross tumor volume (GTV), and assess the response to chemoradiotherapy. Integrated MRgRT systems can help overcome the challenge of esophageal motion due to respiratory motion by using real-time imaging and tumor tracking with respiratory gating. With daily on-table MRI, shifts in tumor position and tumor regression can be taken into account for online-adaptation. The combination of accurate GTV visualization, respiratory gating, and online adaptive planning, allows for tighter treatment volumes and improved sparing of the surrounding normal organs. This could lead to a reduction in radiotherapy induced cardiac toxicity, pneumonitis and post-operative complications. Tumor physiology as seen on diffusion weighted imaging or dynamic contrast enhancement can help individualize treatments based on the response to chemoradiotherapy. Patients with a complete response on MRI can be considered for organ preservation while patients with no response can be offered an earlier resection. In patients with a partial response to chemoradiotherapy, areas of residual cancer can be targeted for dose escalation. The tighter and more accurate targeting enabled with MRgRT may enable hypofractionated treatment schedules.
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Affiliation(s)
- Sangjune Laurence Lee
- Department of Oncology, Division of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, AB, Canada
| | - Michael Bassetti
- Department of Human Oncology, University of Wisconsin Hospital and Clinics, Madison, WI, United States
| | - Gert J. Meijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Stella Mook
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Boeke S, Mönnich D, van Timmeren JE, Balermpas P. MR-Guided Radiotherapy for Head and Neck Cancer: Current Developments, Perspectives, and Challenges. Front Oncol 2021; 11:616156. [PMID: 33816247 PMCID: PMC8017313 DOI: 10.3389/fonc.2021.616156] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/01/2021] [Indexed: 02/06/2023] Open
Abstract
Based on the development of new hybrid machines consisting of an MRI and a linear accelerator, magnetic resonance image guided radiotherapy (MRgRT) has revolutionized the field of adaptive treatment in recent years. Although an increasing number of studies have been published, investigating technical and clinical aspects of this technique for various indications, utilizations of MRgRT for adaptive treatment of head and neck cancer (HNC) remains in its infancy. Yet, the possible benefits of this novel technology for HNC patients, allowing for better soft-tissue delineation, intra- and interfractional treatment monitoring and more frequent plan adaptations appear more than obvious. At the same time, new technical, clinical, and logistic challenges emerge. The purpose of this article is to summarize and discuss the rationale, recent developments, and future perspectives of this promising radiotherapy modality for treating HNC.
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Affiliation(s)
- Simon Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - David Mönnich
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | | | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
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Thorwarth D, Low DA. Technical Challenges of Real-Time Adaptive MR-Guided Radiotherapy. Front Oncol 2021; 11:634507. [PMID: 33763369 PMCID: PMC7982516 DOI: 10.3389/fonc.2021.634507] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/26/2021] [Indexed: 12/18/2022] Open
Abstract
In the past few years, radiotherapy (RT) has experienced a major technological innovation with the development of hybrid machines combining magnetic resonance (MR) imaging and linear accelerators. This new technology for MR-guided cancer treatment has the potential to revolutionize the field of adaptive RT due to the opportunity to provide high-resolution, real-time MR imaging before and during treatment application. However, from a technical point of view, several challenges remain which need to be tackled to ensure safe and robust real-time adaptive MR-guided RT delivery. In this manuscript, several technical challenges to MR-guided RT are discussed. Starting with magnetic field strength tradeoffs, the potential and limitations for purely MR-based RT workflows are discussed. Furthermore, the current status of real-time 3D MR imaging and its potential for real-time RT are summarized. Finally, the potential of quantitative MR imaging for future biological RT adaptation is highlighted.
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Affiliation(s)
- Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Daniel A Low
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, United States
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Koerber SA, Beuthien-Baumann B. [Modern radiation therapy planning and image-guided radiotherapy using the example of prostate cancer]. Radiologe 2021; 61:28-35. [PMID: 33057736 DOI: 10.1007/s00117-020-00763-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
CLINICAL/METHODICAL ISSUE Optimizing radiotherapy demands precise delineation of the target structure, not only before but also during the course of radiotherapy. STANDARD RADIOLOGICAL METHODS For many years, planning of external radiation treatment planning has been based on computer tomography data. METHODOLOGICAL INNOVATIONS With the advent of image-guided radiotherapy (IGRT), magnetic resonance imaging (MRI) and functional hybrid imaging are increasingly being integrated into radiation treatment planning. The development of the MR-linac can be seen as an innovation. PERFORMANCE The integration of MRI and hybrid imaging (positron emission tomography [PET]/CT, PET/MRI) in the treatment planning process enables more precise treatment planning due to the better morphological and functional information. The integration of MRI data on the MR-linac in daily position control enables adaptation of the irradiation plan to the current conditions. ACHIEVEMENTS Technical innovation such as the MR-linac as well as increasing use of hybrid imaging contribute to the objective of further individualization within (radio)oncology. PRACTICAL RECOMMENDATIONS Using the example of prostate cancer, the application of prostate-specific membrane antigen (PSMA) ligands and hybrid imaging offers great potential for individualized strategic treatment decisions. The MR-linac appears to be particularly suitable for radiation therapy of prostate cancer. Special attention must be paid to the technical aspects of positioning and data acquisition for the purpose of radiation treatment planning.
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Affiliation(s)
- Stefan A Koerber
- Klinik für Radioonkologie und Strahlentherapie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland. .,Nationales Centrum für Tumorerkrankungen (NCT), Heidelberg, Deutschland. .,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Deutschland.
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Gani C, Boeke S, McNair H, Ehlers J, Nachbar M, Mönnich D, Stolte A, Boldt J, Marks C, Winter J, Künzel LA, Gatidis S, Bitzer M, Thorwarth D, Zips D. Marker-less online MR-guided stereotactic body radiotherapy of liver metastases at a 1.5 T MR-Linac - Feasibility, workflow data and patient acceptance. Clin Transl Radiat Oncol 2021; 26:55-61. [PMID: 33319073 PMCID: PMC7723999 DOI: 10.1016/j.ctro.2020.11.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/24/2020] [Accepted: 11/24/2020] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Stereotactic body radiotherapy (SBRT) is an established ablative treatment for liver tumors with excellent local control rates. Magnetic resonance imaging guided radiotherapy (MRgRT) provides superior soft tissue contrast and may therefore facilitate a marker-less liver SBRT workflow. The goal of the present study was to investigate feasibility, workflow parameters, toxicity and patient acceptance of MRgSBRT on a 1.5 T MR-Linac. METHODS Ten consecutive patients with liver metastases treated on a 1.5 T MR-Linac were included in this prospective trial. Tumor delineation was performed on four-dimensional computed tomography scans and both exhale triggered and free-breathing T2 MRI scans from the MR-Linac. An internal target volume based approach was applied. Organ at risk constraints were based on the UKSABR guidelines (Version 6.1). Patient acceptance regarding device specific aspects was assessed and toxicity was scored according to the common toxicity criteria of adverse events, version 5. RESULTS Nine of ten tumors were clearly visible on the 1.5 T MR-Linac. No patient had fiducial markers placed for treatment. All patients were treated with three or five fractions. Median dose to 98% of the gross tumor volume was 38.5 Gy. The median time from "patient identity check" until "beam-off" was 31 min. Median beam on time was 9.6 min. Online MRgRT was well accepted in general and no treatment had to be interrupted on patient request. No event of symptomatic radiation induced liver disease was observed after a median follow-up of ten month (range 3-17 months). CONCLUSION Our early experience suggests that online 1.5 T MRgSBRT of liver metastases represents a promising new non-invasive marker-free treatment modality based on high image quality, clinically reasonable in-room times and high patient acceptance. Further studies are necessary to assess clinical outcome, to validate advanced motion management and to explore the benefit of online response adaptive liver SBRT.
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Affiliation(s)
- Cihan Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - S. Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - H. McNair
- Department of Radiotherapy, The Royal Marsden Hospital NHS Foundation Trust, United Kingdom
| | - J. Ehlers
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - M. Nachbar
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - D. Mönnich
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - A. Stolte
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - J. Boldt
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - C. Marks
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - J. Winter
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - Luise A. Künzel
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - S. Gatidis
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Eberhard Karls University, Tübingen, Germany
| | - M. Bitzer
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology and Infectious Diseases, Eberhard Karls University, Tübingen, Germany
| | - D. Thorwarth
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Section for Biomedical Physics. Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
| | - D. Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Thorwarth D, Ege M, Nachbar M, Mönnich D, Gani C, Zips D, Boeke S. Quantitative magnetic resonance imaging on hybrid magnetic resonance linear accelerators: Perspective on technical and clinical validation. Phys Imaging Radiat Oncol 2020; 16:69-73. [PMID: 33458346 PMCID: PMC7807787 DOI: 10.1016/j.phro.2020.09.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022] Open
Abstract
Many preclinical and clinical observations support that functional magnetic resonance imaging (MRI), such as diffusion weighted (DW) and dynamic contrast enhanced (DCE) MRI, might have a predictive value for radiotherapy. The aim of this review was to assess the current status of quantitative MRI on hybrid MR-Linacs. In a literature research, four publications were identified, investigating technical feasibility, accuracy, repeatability and reproducibility of DW and DCE-MRI in phantoms and first patients. Accuracy and short term repeatability was < 5% for DW-MRI in current MR-Linac systems. Consequently, quantitative imaging providing accurate and reproducible functional information seems possible in MR-Linacs.
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Affiliation(s)
- Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Ege
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Marcel Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - David Mönnich
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Cihan Gani
- Department for Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Daniel Zips
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department for Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - Simon Boeke
- German Cancer Consortium (DKTK), Partner Site Tübingen, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Department for Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
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Sim AJ, Kaza E, Singer L, Rosenberg SA. A review of the role of MRI in diagnosis and treatment of early stage lung cancer. Clin Transl Radiat Oncol 2020; 24:16-22. [PMID: 32596518 PMCID: PMC7306507 DOI: 10.1016/j.ctro.2020.06.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022] Open
Abstract
Despite magnetic resonance imaging (MRI) being a mainstay in the oncologic care for many disease sites, it has not routinely been used in early lung cancer diagnosis, staging, and treatment. While MRI provides improved soft tissue contrast compared to computed tomography (CT), an advantage in multiple organs, the physical properties of the lungs and mediastinum create unique challenges for lung MRI. Although multi-detector CT remains the gold standard for lung imaging, advances in MRI technology have led to its increased clinical relevance in evaluating early stage lung cancer. Even though positron emission tomography is used more frequently in this context, functional MR imaging, including diffusion-weighted MRI and dynamic contrast-enhanced MRI, are emerging as useful modalities for both diagnosis and evaluation of treatment response for lung cancer. In parallel with these advances, the development of combined MRI and linear accelerator devices (MR-linacs), has spurred the integration of MRI into radiation treatment delivery in the form of MR-guided radiotherapy (MRgRT). Despite challenges for MRgRT in early stage lung cancer radiotherapy, early data utilizing MR-linacs shows potential for the treatment of early lung cancer. In both diagnosis and treatment, MRI is a promising modality for imaging early lung cancer.
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Affiliation(s)
- Austin J. Sim
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr., Tampa, FL, USA
| | - Evangelia Kaza
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham & Women’s Hospital & Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Lisa Singer
- Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham & Women’s Hospital & Harvard Medical School, 75 Francis St., Boston, MA, USA
| | - Stephen A. Rosenberg
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr., Tampa, FL, USA
- University of South Florida Morsani College of Medicine, 12901 Bruce B. Downs Blvd., Tampa, FL, USA
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Sijtsema ND, Petit SF, Poot DHJ, Verduijn GM, van der Lugt A, Hoogeman MS, Hernandez-Tamames JA. An optimal acquisition and post-processing pipeline for hybrid IVIM-DKI in head and neck. Magn Reson Med 2020; 85:777-789. [PMID: 32869353 PMCID: PMC7693044 DOI: 10.1002/mrm.28461] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 12/30/2022]
Abstract
Purpose To optimize the diffusion‐weighting b values and postprocessing pipeline for hybrid intravoxel incoherent motion diffusion kurtosis imaging in the head and neck region. Methods Optimized diffusion‐weighting b value sets ranging between 5 and 30 b values were constructed by optimizing the Cramér‐Rao lower bound of the hybrid intravoxel incoherent motion diffusion kurtosis imaging model. With this model, the perfusion fraction, pseudodiffusion coefficient, diffusion coefficient, and kurtosis were estimated. Sixteen volunteers were scanned with a reference b value set and 3 repeats of the optimized sets, of which 1 with volunteers swallowing on purpose. The effects of (1) b value optimization and number of b values, (2) registration type (none vs. intervolume vs. intra‐ and intervolume registration), and (3) manual swallowing artifact rejection on the parameter precision were assessed. Results The SD was higher in the reference set for perfusion fraction, diffusion coefficient, and kurtosis by a factor of 1.7, 1.5, and 2.3 compared to the optimized set, respectively. A smaller SD (factor 0.7) was seen in pseudodiffusion coefficient. The sets containing 15, 20, and 30 b values had comparable repeatability in all parameters, except pseudodiffusion coefficient, for which set size 30 was worse. Equal repeatability for the registration approaches was seen in all parameters of interest. Swallowing artifact rejection removed the bias when present. Conclusion To achieve optimal hybrid intravoxel incoherent motion diffusion kurtosis imaging in the head and neck region, b value optimization and swallowing artifact image rejection are beneficial. The optimized set of 15 b values yielded the optimal protocol efficiency, with a precision comparable to larger b value sets and a 50% reduction in scan time.
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Affiliation(s)
- Nienke D Sijtsema
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Steven F Petit
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Dirk H J Poot
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Informatics, Erasmus MC, Rotterdam, The Netherlands
| | - Gerda M Verduijn
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Aad van der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Mischa S Hoogeman
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.,Department of Medical Physics & Informatics, HollandPTC, Delft, The Netherlands
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Thureau S, Briens A, Decazes P, Castelli J, Barateau A, Garcia R, Thariat J, de Crevoisier R. PET and MRI guided adaptive radiotherapy: Rational, feasibility and benefit. Cancer Radiother 2020; 24:635-644. [PMID: 32859466 DOI: 10.1016/j.canrad.2020.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023]
Abstract
Adaptive radiotherapy (ART) corresponds to various replanning strategies aiming to correct for anatomical variations occurring during the course of radiotherapy. The goal of the article was to report the rational, feasibility and benefit of using PET and/or MRI to guide this ART strategy in various tumor localizations. The anatomical modifications defined by scanner taking into account tumour mobility and volume variation are not always sufficient to optimise treatment. The contribution of functional imaging by PET or the precision of soft tissue by MRI makes it possible to consider optimized ART. Today, the most important data for both PET and MRI are for lung, head and neck, cervical and prostate cancers. PET and MRI guided ART appears feasible and safe, however in a very limited clinical experience. Phase I/II studies should be therefore performed, before proposing cost-effectiveness comparisons in randomized trials and before using the approach in routine practice.
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Affiliation(s)
- S Thureau
- Département de radiothérapie et de physique médicale, centre Henri-Becquerel, QuantIF EA 4108, université de Rouen, 76000 Rouen, France.
| | - A Briens
- Département de radiothérapie, centre Eugène-Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France
| | - P Decazes
- Département de médecine nucléaire, center Henri-Becquerel, QuantIF EA 4108, université de Rouen, Rouen, France
| | - J Castelli
- Département de radiothérapie, centre Eugène Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
| | - A Barateau
- Département de radiothérapie, centre Eugène Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
| | - R Garcia
- Service de physique médicale, institut Sainte-Catherine, 84918 Avignon, France
| | - J Thariat
- Department of radiation oncology, centre François-Baclesse, 14000 Caen, France; Laboratoire de physique corpusculaire IN2P3/ENSICAEN-UMR6534-Unicaen-Normandie université, 14000 Caen, France; ARCHADE Research Community, 14000 Caen, France
| | - R de Crevoisier
- Département de radiothérapie, centre Eugène-Marquis, rue de la Bataille-Flandres-Dunkerque, CS 44229, 35042 Rennes cedex, France; CLCC Eugène Marquis, Inserm, LTSI-UMR 1099, université de Rennes, 35000 Rennes, France
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Gao Y, Zhou Z, Han F, Zhong X, Yang Y, Hu P. 3D isotropic resolution diffusion‐prepared magnitude‐stabilized bSSFP imaging with high geometric fidelity at 1.5 Tesla. Med Phys 2020; 47:3511-3519. [DOI: 10.1002/mp.14195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/18/2020] [Accepted: 04/14/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Yu Gao
- Department of Radiological Sciences University of California Los Angeles CA USA
- Physics and Biology in Medicine IDP University of California Los Angeles CA USA
| | - Ziwu Zhou
- Department of Radiological Sciences University of California Los Angeles CA USA
| | - Fei Han
- Department of Radiological Sciences University of California Los Angeles CA USA
| | - Xiaodong Zhong
- MR R&D Collaborations Siemens Healthcare Los Angeles CA USA
| | - Yingli Yang
- Physics and Biology in Medicine IDP University of California Los Angeles CA USA
- Department of Radiation Oncology University of California Los Angeles CA USA
| | - Peng Hu
- Department of Radiological Sciences University of California Los Angeles CA USA
- Physics and Biology in Medicine IDP University of California Los Angeles CA USA
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Groot Koerkamp ML, Vasmel JE, Russell NS, Shaitelman SF, Anandadas CN, Currey A, Vesprini D, Keller BM, De-Colle C, Han K, Braunstein LZ, Mahmood F, Lorenzen EL, Philippens MEP, Verkooijen HM, Lagendijk JJW, Houweling AC, van den Bongard HJGD, Kirby AM. Optimizing MR-Guided Radiotherapy for Breast Cancer Patients. Front Oncol 2020; 10:1107. [PMID: 32850318 PMCID: PMC7399349 DOI: 10.3389/fonc.2020.01107] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/03/2020] [Indexed: 01/01/2023] Open
Abstract
Current research in radiotherapy (RT) for breast cancer is evaluating neoadjuvant as opposed to adjuvant partial breast irradiation (PBI) with the aim of reducing the volume of breast tissue irradiated and therefore the risk of late treatment-related toxicity. The development of magnetic resonance (MR)-guided RT, including dedicated MR-guided RT systems [hybrid machines combining an MR scanner with a linear accelerator (MR-linac) or 60Co sources], could potentially reduce the irradiated volume even further by improving tumour visibility before and during each RT treatment. In this position paper, we discuss MR guidance in relation to each step of the breast RT planning and treatment pathway, focusing on the application of MR-guided RT to neoadjuvant PBI.
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Affiliation(s)
| | - Jeanine E. Vasmel
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nicola S. Russell
- Department of Radiotherapy, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Simona F. Shaitelman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Carmel N. Anandadas
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Adam Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Danny Vesprini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian M. Keller
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Chiara De-Colle
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Kathy Han
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Lior Z. Braunstein
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Faisal Mahmood
- Department of Oncology, Odense University Hospital, Odense, Denmark
- Research Unit for Oncology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ebbe L. Lorenzen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | | | - Jan J. W. Lagendijk
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Antonetta C. Houweling
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Anna M. Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
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Bitencourt FBCSN, Bitencourt AGV, Chojniak MMM, Souza JO, Castro DG, Pellizzon ACA, Chojniak R. Response Evaluation of Choroidal Melanoma After Brachytherapy Using Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI): Preliminary Findings. Front Oncol 2020; 10:825. [PMID: 32509587 PMCID: PMC7248391 DOI: 10.3389/fonc.2020.00825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/28/2020] [Indexed: 02/03/2023] Open
Abstract
Purpose: To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the assessment of therapeutic response in patients with choroidal melanoma treated with brachytherapy. Materials and Methods: We performed a prospective, unicentric study which included patients with choroidal melanoma and indication for brachytherapy. Three DW-MRI examinations were proposed for each patient, one before and two after treatment. The apparent diffusion coefficient (ADC) value was calculated on DW-MRI and compared with local tumor control assessed by ophthalmologic follow-up. Results: From 07/2018 to 06/2019, 19 patients were recruited, 13 of whom underwent follow-up examinations. Patients' ages ranged from 24 to 78 years and 52.9% were male. At the ocular ultrasound, the mean tumor thickness and diameter were 6.3 and 11.5 mm, respectively. Two patients (15.4%) showed signs of tumor progression during follow-up (7 and 9 months after treatment). There was no statistically significant difference in tumor size between MR before and after treatment, however, there was a significant reduction in mean ADC in patients with progression (p = 0.02). Conclusion: DW-MRI is a promising method for monitoring patients with choroidal melanoma; reduction in the mean ADC values between pre-treatment MRI and the first post-treatment MRI may be related to the lack of response to brachytherapy and increased risk of disease progression.
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Affiliation(s)
| | | | | | - Juliana O Souza
- Imaging Department, A.C.Camargo Cancer Center, São Paulo, Brazil
| | - Douglas G Castro
- Radiation Oncology Department, A.C.Camargo Cancer Center, São Paulo, Brazil
| | | | - Rubens Chojniak
- Imaging Department, A.C.Camargo Cancer Center, São Paulo, Brazil
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Kurz C, Buizza G, Landry G, Kamp F, Rabe M, Paganelli C, Baroni G, Reiner M, Keall PJ, van den Berg CAT, Riboldi M. Medical physics challenges in clinical MR-guided radiotherapy. Radiat Oncol 2020; 15:93. [PMID: 32370788 PMCID: PMC7201982 DOI: 10.1186/s13014-020-01524-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 03/24/2020] [Indexed: 12/18/2022] Open
Abstract
The integration of magnetic resonance imaging (MRI) for guidance in external beam radiotherapy has faced significant research and development efforts in recent years. The current availability of linear accelerators with an embedded MRI unit, providing volumetric imaging at excellent soft tissue contrast, is expected to provide novel possibilities in the implementation of image-guided adaptive radiotherapy (IGART) protocols. This study reviews open medical physics issues in MR-guided radiotherapy (MRgRT) implementation, with a focus on current approaches and on the potential for innovation in IGART.Daily imaging in MRgRT provides the ability to visualize the static anatomy, to capture internal tumor motion and to extract quantitative image features for treatment verification and monitoring. Those capabilities enable the use of treatment adaptation, with potential benefits in terms of personalized medicine. The use of online MRI requires dedicated efforts to perform accurate dose measurements and calculations, due to the presence of magnetic fields. Likewise, MRgRT requires dedicated quality assurance (QA) protocols for safe clinical implementation.Reaction to anatomical changes in MRgRT, as visualized on daily images, demands for treatment adaptation concepts, with stringent requirements in terms of fast and accurate validation before the treatment fraction can be delivered. This entails specific challenges in terms of treatment workflow optimization, QA, and verification of the expected delivered dose while the patient is in treatment position. Those challenges require specialized medical physics developments towards the aim of fully exploiting MRI capabilities. Conversely, the use of MRgRT allows for higher confidence in tumor targeting and organs-at-risk (OAR) sparing.The systematic use of MRgRT brings the possibility of leveraging IGART methods for the optimization of tumor targeting and quantitative treatment verification. Although several challenges exist, the intrinsic benefits of MRgRT will provide a deeper understanding of dose delivery effects on an individual basis, with the potential for further treatment personalization.
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Affiliation(s)
- Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- Department of Medical Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, 85748, Garching, Germany
| | - Giulia Buizza
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, P.za Leonardo da Vinci 32, 20133, Milano, Italy
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- Department of Medical Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, 85748, Garching, Germany
- German Cancer Consortium (DKTK), 81377, Munich, Germany
| | - Florian Kamp
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Moritz Rabe
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, P.za Leonardo da Vinci 32, 20133, Milano, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, P.za Leonardo da Vinci 32, 20133, Milano, Italy
- Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Privata Campeggi 53, 27100, Pavia, Italy
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Paul J Keall
- ACRF Image X Institute, University of Sydney, Sydney, NSW, 2006, Australia
| | - Cornelis A T van den Berg
- Department of Radiotherapy, University Medical Centre Utrecht, PO box 85500, 3508 GA, Utrecht, The Netherlands
| | - Marco Riboldi
- Department of Medical Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, 85748, Garching, Germany.
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Gurney-Champion OJ, Mahmood F, van Schie M, Julian R, George B, Philippens MEP, van der Heide UA, Thorwarth D, Redalen KR. Quantitative imaging for radiotherapy purposes. Radiother Oncol 2020; 146:66-75. [PMID: 32114268 PMCID: PMC7294225 DOI: 10.1016/j.radonc.2020.01.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/22/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023]
Abstract
Quantitative imaging biomarkers show great potential for use in radiotherapy. Quantitative images based on microscopic tissue properties and tissue function can be used to improve contouring of the radiotherapy targets. Furthermore, quantitative imaging biomarkers might be used to predict treatment response for several treatment regimens and hence be used as a tool for treatment stratification, either to determine which treatment modality is most promising or to determine patient-specific radiation dose. Finally, patient-specific radiation doses can be further tailored to a tissue/voxel specific radiation dose when quantitative imaging is used for dose painting. In this review, published standards, guidelines and recommendations on quantitative imaging assessment using CT, PET and MRI are discussed. Furthermore, critical issues regarding the use of quantitative imaging for radiation oncology purposes and resultant pending research topics are identified.
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Affiliation(s)
- Oliver J Gurney-Champion
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Faisal Mahmood
- Department of Oncology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marcel van Schie
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Robert Julian
- Department of Radiotherapy Physics, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
| | - Ben George
- Radiation Therapy Medical Physics Group, CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, United Kingdom
| | | | - Uulke A van der Heide
- Department of Radiation Oncology, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniela Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, Eberhard Karls University of Tübingen, Germany
| | - Kathrine R Redalen
- Department of Physics, Norwegian University of Science and Technology, Trondheim, Norway
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PET/MRI and genetic intrapatient heterogeneity in head and neck cancers. Strahlenther Onkol 2020; 196:542-551. [PMID: 32211941 DOI: 10.1007/s00066-020-01606-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/09/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE The relation between functional imaging and intrapatient genetic heterogeneity remains poorly understood. The aim of our study was to investigate spatial sampling and functional imaging by FDG-PET/MRI to describe intrapatient tumour heterogeneity. METHODS Six patients with oropharyngeal cancer were included in this pilot study. Two tumour samples per patient were taken and sequenced by next-generation sequencing covering 327 genes relevant in head and neck cancer. Corresponding regions were delineated on pretherapeutic FDG-PET/MRI images to extract apparent diffusion coefficients and standardized uptake values. RESULTS Samples were collected within the primary tumour (n = 3), within the primary tumour and the involved lymph node (n = 2) as well as within two independent primary tumours (n = 1). Genetic heterogeneity of the primary tumours was limited and most driver gene mutations were found ubiquitously. Slightly increasing heterogeneity was found between primary tumours and lymph node metastases. One private predicted driver mutation within a primary tumour and one in a lymph node were found. However, the two independent primary tumours did not show any shared mutations in spite of a clinically suspected field cancerosis. No conclusive correlation between genetic heterogeneity and heterogeneity of PET/MRI-derived parameters was observed. CONCLUSION Our limited data suggest that single sampling might be sufficient in some patients with oropharyngeal cancer. However, few driver mutations might be missed and, if feasible, spatial sampling should be considered. In two independent primary tumours, both lesions should be sequenced. Our data with a limited number of patients do not support the concept that multiparametric PET/MRI features are useful to guide biopsies for genetic tumour characterization.
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Chin S, Eccles CL, McWilliam A, Chuter R, Walker E, Whitehurst P, Berresford J, Van Herk M, Hoskin PJ, Choudhury A. Magnetic resonance-guided radiation therapy: A review. J Med Imaging Radiat Oncol 2020; 64:163-177. [PMID: 31646742 DOI: 10.1111/1754-9485.12968] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022]
Abstract
Magnetic resonance-guided radiation therapy (MRgRT) is a promising approach to improving clinical outcomes for patients treated with radiation therapy. The roles of image guidance, adaptive planning and magnetic resonance imaging in radiation therapy have been increasing over the last two decades. Technical advances have led to the feasible combination of magnetic resonance imaging and radiation therapy technologies, leading to improved soft-tissue visualisation, assessment of inter- and intrafraction motion, motion management, online adaptive radiation therapy and the incorporation of functional information into treatment. MRgRT can potentially transform radiation oncology by improving tumour control and quality of life after radiation therapy and increasing convenience of treatment by shortening treatment courses for patients. Multiple groups have developed clinical implementations of MRgRT predominantly in the abdomen and pelvis, with patients having been treated since 2014. While studies of MRgRT have primarily been dosimetric so far, an increasing number of trials are underway examining the potential clinical benefits of MRgRT, with coordinated efforts to rigorously evaluate the benefits of the promising technology. This review discusses the current implementations, studies, potential benefits and challenges of MRgRT.
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Affiliation(s)
- Stephen Chin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Cynthia L Eccles
- Department of Radiotherapy, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Alan McWilliam
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Robert Chuter
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Emma Walker
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Philip Whitehurst
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Joseph Berresford
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Marcel Van Herk
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Peter J Hoskin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
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45
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Zhang H, Zhou Y, Li J, Zhang P, Li Z, Guo J. The value of DWI in predicting the response to synchronous radiochemotherapy for advanced cervical carcinoma: comparison among three mathematical models. Cancer Imaging 2020; 20:8. [PMID: 31937371 PMCID: PMC6961298 DOI: 10.1186/s40644-019-0285-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022] Open
Abstract
Background Diffusion weighted imaging(DWI) mode mainly includes intravoxel incoherent motion (IVIM), stretched exponential model (SEM) and Gaussian diffusion model, but it is still unclear which mode is the most valuable in predicting the response to radiochemotherapy for cervical cancer. This study aims to compare the values of three mathematical models in predicting the response to synchronous radiochemotherapy for cervical cancer. Methods Eighty-four patients with cervical cancer were enrolled into this study. They underwent DWI examination by using 12 b-values prior to treatment. The imaging parameters were calculated on the basis of IVIM, SEM and Gaussian diffusion models respectively. The imaging parameters derived from three mathematical modes were compared between responders and non-responders groups. The repeatability of each imaging parameter was assessed. Results The ADC, D or DDC value was lower in responders than in non-responders groups (P = 0.03, 0.02, 0.01). The α value was higher in responders group than in non-responders group (P = 0.03). DDC had the largest area under curves (AUC) (=0.948) in predicting the response to treatment. The imaging parameters derived from SEM had better repeatability (CCC for DDC and α were 0.969 and 0.924 respectively) than that derived from other exponential models. Conclusion Three exponential modes of DWI are useful for predicting the response to radiochemotherapy for cervical cancer, and SEM may be used as a potential optimal model for predicting treatment effect.
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Affiliation(s)
- Hui Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Avenue, Zhengzhou, 450014, Henan Province, China
| | - Yuyang Zhou
- Department of Cardiac Surgery, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, Henan Province, China
| | - Jie Li
- Department of Radiology, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Avenue, Zhengzhou, 450014, Henan Province, China
| | - Pengjuan Zhang
- Department of Radiology, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Avenue, Zhengzhou, 450014, Henan Province, China
| | - Zhenzhen Li
- Department of Radiology, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Avenue, Zhengzhou, 450014, Henan Province, China
| | - Junwu Guo
- Department of Radiology, The Second Affiliated Hospital of Zhengzhou University, No. 2 Jingba Avenue, Zhengzhou, 450014, Henan Province, China.
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MRI basics for radiation oncologists. Clin Transl Radiat Oncol 2019; 18:74-79. [PMID: 31341980 PMCID: PMC6630156 DOI: 10.1016/j.ctro.2019.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 02/01/2023] Open
Abstract
Issues of MRI that are relevant for radiation oncologists are addressed. Radiation oncology requires dedicated scan protocols. Use of diagnostic protocols is not recommended for radiotherapy. MR images must be made in treatment position with the standard positioning devices. Safety screening prior to entering the MRI room is crucial.
MRI is increasingly used in radiation oncology to facilitate tumor and organ-at-risk delineation and image guidance. In this review, we address issues of MRI that are relevant for radiation oncologists when interpreting MR images offered for radiotherapy. Whether MRI is used in combination with CT or in an MRI-only workflow, it is generally necessary to ensure that MR images are acquired in treatment position, using the positioning and fixation devices that are commonly applied in radiotherapy. For target delineation, often a series of separate image sets are used with distinct image contrasts, acquired within a single exam. MR images can suffer from image distortions. While this can be avoided with dedicated scan protocols, in a diagnostic setting geometrical fidelity is less relevant and is therefore less accounted for. Since geometrical fidelity is of utmost importance in radiation oncology, it requires dedicated scan protocols. The strong magnetic field of an MRI scanner and the use of radiofrequency radiation can cause safety hazards if not properly addressed. Safety screening is crucial for every patient and every operator prior to entering the MRI room.
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