1
|
Bolin MC, Falk M, Hedman M, Gagliardi G, Onjukka E. Surface-guided radiotherapy improves rotational accuracy in gynecological cancer patients. Rep Pract Oncol Radiother 2024; 28:764-771. [PMID: 38515814 PMCID: PMC10954265 DOI: 10.5603/rpor.98733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/20/2023] [Indexed: 03/23/2024] Open
Abstract
Background The aim of this study was to determine if rotational uncertainties in gynecological cancer patients can be reduced using surface imaging (SI) compared to aligning three markers on the patient's skin with in-room lasers (marker-laser). Materials and methods Fifty gynecological cancer patients treated with external-beam radiotherapy were retrospectively analyzed; 25 patients were positioned with marker-laser and 25 patients were positioned with SI. The values of rotational (pitch and roll) deviations of the patient positions between the treatment-planning computed tomography (CT) and online cone-beam computed tomography (CBCT) were collected for both subcohorts and all treatment fractions after performing automatic registration between the two image sets. Statistical analysis of the difference between the two set-up methods was performed using the Mann-Whitney U-test. Results The median pitch deviation were 1.5° [interquartile range (IQR): 0.6°-2.6°] and 1.1° (IQR: 0.5°-1.9°) for the marker-laser and SI methods, respectively (p < 0.01). The median roll deviation was 0.5° (IQR: 0.2°-0.9°), and 0.7° (IQR: 0.3°-1.2°) for the marker-laser and SI methods, respectively (p < 0.01). Given the shape of the target, pitch deviations had a greater impact on the uncertainty at the periphery of the target and were considered more relevant. Conclusion By introducing SI as a set-up method in gynecological cancer patients, higher positioning accuracy could be achieved compared with the marker-laser set-up method. This was demonstrated based on residual deviations rather than deviations corrected for by image-guided radiotherapy (IGRT).
Collapse
Affiliation(s)
- Mimmi-Caroline Bolin
- Section of Radiotherapy and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marianne Falk
- Section of Radiotherapy and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mattias Hedman
- Department of Radiation Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Giovanna Gagliardi
- Section of Radiotherapy and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Eva Onjukka
- Section of Radiotherapy and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
2
|
Schindhelm R, Razinskas G, Ringholz J, Kraft J, Sauer OA, Wegener S. Evaluation of a head rest prototype for rotational corrections in three degrees of freedom. J Appl Clin Med Phys 2024; 25:e14172. [PMID: 37793069 PMCID: PMC10860431 DOI: 10.1002/acm2.14172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/22/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
Cranial stereotactic irradiations require accurate reproduction of the planning CT patient position at the time of treatment, including removal of rotational offsets. A device prototype was evaluated for potential clinical use to correct rotational positional offsets in image-guided radiotherapy workflow. Analysis was carried out with a prototype device "RPS head" by gKteso GmbH, rotatable up to 4° in three dimensions by hand wheels. A software tool accounts for the nonrectangular rotation axes and also indicates translational motions to be performed with the standard couch to correct the initial offset and translational shifts introduced by the rotational motion. The accuracy of angular corrections and positioning of an Alderson RANDO head phantom using the prototype device was evaluated for nine treatment plans for cranial targets. Corrections were obtained from cone beam computed tomography (CBCT) imaging. The phantom position was adjusted and the final position was then verified by another CBCT. The long-term stability of the prototype device was evaluated. Attenuation by the device along its three main axes was assessed. A planning study was performed to evaluate if regions of high-density material can be avoided during plan generation. The device enabled the accurate correction of rotational offsets in a clinical setup with a mean residual angular difference of (0.0 ± 0.1)° and a maximum deviation of 0.2°. Translational offsets were less than 1 mm. The device was stable over a period of 20 min, not changing the head support plate position by more than (0.7 ± 0.6) mm. The device contains high-density material in the adjustment mechanism and slightly higher density in the support structures. These can be avoided during planning generation maintaining comparable plan quality. The head positioning device can be used to correct rotational offsets in a clinical setting.
Collapse
Affiliation(s)
| | - Gary Razinskas
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Jonas Ringholz
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Johannes Kraft
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Otto A. Sauer
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Sonja Wegener
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| |
Collapse
|
3
|
Nakayama S, Hirose M, Kaneshige S, Nakamura K, Matsuo Y, Monzen H. Development and evaluation of a novel water-based pigment marker for radiation therapy skin marking. Radiol Phys Technol 2023; 16:543-551. [PMID: 37839000 DOI: 10.1007/s12194-023-00743-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 10/17/2023]
Abstract
Skin marks are widely used in external radiation therapy to ensure the accuracy of the irradiation position. However, conventional skin markers contain harmful substance, so we developed an alternative skin marker. The purpose of this study was to investigate the feasibility of using a novel water-based pigment marker comprising safe materials commonly used in cosmetics for clinical radiation therapy. We investigated various properties of the marker, namely marker longevity, color variety, line visibility, ink bleeding, and line durability, and improved the marker in response to the feel when drawing or being drawn on. The durability of the ink was evaluated by simultaneously applying the new marker and oil-based pen and comparing the period until the marks faded and became invisible. In clinical trial, we applied marks on the skin of 56 patients over three months to observe symptoms and visible changes in the skin. There were no complications of discomfort or pain, owing to the improvements in the marker tip. The marks drawn on the arms of volunteers with the new marker and the oil-based pen remained visible for a mean of 7.2 days and 3.6 days, respectively (P value < 0.001). The percentages of participants with no symptoms and no visible changes were 100%, respectively. We developed an alternative skin marker that complies with current regulatory standards by excluding crystal violet. The newly developed marker has features suitable for clinical use, such as resistance to smudging and water, marker tip shape and texture, and color variations.
Collapse
Affiliation(s)
- Shinichi Nakayama
- Division of Clinical Radiology Service, Okayama Central Hospital, 6-3, Ishimakitamachi, Kitaku, Okayama, 700-0017, Japan
| | - Miduki Hirose
- Department of Radiation Oncology, Okayama Central Hospital, 6-3, Ishimakitamachi, Kitaku, Okayama, 700-0017, Japan
| | - Soichiro Kaneshige
- Department of Radiation Oncology, Okayama Central Hospital, 6-3, Ishimakitamachi, Kitaku, Okayama, 700-0017, Japan
| | - Kenji Nakamura
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan
| | - Hajime Monzen
- Division of Clinical Radiology Service, Okayama Central Hospital, 6-3, Ishimakitamachi, Kitaku, Okayama, 700-0017, Japan.
- Department of Medical Physics, Graduate School of Medical Sciences, Kindai University, 377-2, Onohigashi, Osakasayama, Osaka, 589-8511, Japan.
| |
Collapse
|
4
|
Shinde P, Jadhav A, Shankar V, Dhoble SJ. Assessment of dosimetric impact of interfractional 6D setup error in tongue cancer treated with IMRT and VMAT using daily kV-CBCT. Rep Pract Oncol Radiother 2023; 28:224-240. [PMID: 37456705 PMCID: PMC10348325 DOI: 10.5603/rpor.a2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/29/2023] [Indexed: 07/18/2023] Open
Abstract
Background This study aimed to evaluate the dosimetric influence of 6-dimensional (6D) interfractional setup error in tongue cancer treated with intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) using daily kilovoltage cone-beam computed tomography (kV-CBCT). Materials and methods This retrospective study included 20 tongue cancer patients treated with IMRT (10), VMAT (10), and daily kV-CBCT image guidance. Interfraction 6D setup errors along the lateral, longitudinal, vertical, pitch, roll, and yaw axes were evaluated for 600 CBCTs. Structures in the planning CT were deformed to the CBCT using deformable registration. For each fraction, a reference CBCT structure set with no rotation error was created. The treatment plan was recalculated on the CBCTs with the rotation error (RError), translation error (TError), and translation plus rotation error (T+RError). For targets and organs at risk (OARs), the dosimetric impacts of RError, TError, and T+RError were evaluated without and with moderate correction of setup errors. Results The maximum dose variation ΔD (%) for D98% in clinical target volumes (CTV): CTV-60, CTV-54, planning target volumes (PTV): PTV-60, and PTV-54 was -1.2%, -1.9%, -12.0%, and -12.3%, respectively, in the T+RError without setup error correction. The maximum ΔD (%) for D98% in CTV-60, CTV-54, PTV-60, and PTV-54 was -1.0%, -1.7%, -9.2%, and -9.5%, respectively, in the T+RError with moderate setup error correction. The dosimetric impact of interfractional 6D setup errors was statistically significant (p < 0.05) for D98% in CTV-60, CTV-54, PTV-60, and PTV-54. Conclusions The uncorrected interfractional 6D setup errors could significantly impact the delivered dose to targets and OARs in tongue cancer. That emphasized the importance of daily 6D setup error correction in IMRT and VMAT.
Collapse
Affiliation(s)
- Prashantkumar Shinde
- Department of Physics, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur, India
| | - Anand Jadhav
- Department of Radiation Oncology, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - V. Shankar
- Department of Radiation Oncology, Apollo Cancer Center, Chennai, India
| | - Sanjay J. Dhoble
- Department of Physics, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur, India
| |
Collapse
|
5
|
Mayinger M, Kotecha R, Sahgal A, Kim MS, Lo SS, Louie AV, Scorsetti M, Slotman B, Guckenberger M. Stereotactic Body Radiotherapy for Lung Oligo-metastases: Systematic Review and International Stereotactic Radiosurgery Society Practice Guidelines. Lung Cancer 2023; 182:107284. [PMID: 37390723 DOI: 10.1016/j.lungcan.2023.107284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE A systematic review of treatment characteristics, outcomes, and treatment-related toxicities of stereotactic body radiation therapy (SBRT) for pulmonary oligometastases served as the basis for development of this International Stereotactic Radiosurgery Society (ISRS) practice guideline. METHODS In accordance with PRISMA guidelines, a systematic review was performed of retrospective series with ≥50 patients/lung metastases, prospective trials with ≥25 patients/lung metastases, analyses of specific high-risk situations, and all randomized trials published between 2012 and July 2022 in the MEDLINE or Embase database using the key words "lung oligometastases", "lung metastases", "pulmonary metastases", "pulmonary oligometastases", "stereotactic body radiation therapy (SBRT)" and "stereotactic ablative body radiotherapy (SBRT)". Weighted random effects models were used to calculate pooled outcomes estimates. RESULTS Of the 1884 articles screened, 35 analyses (27 retrospective-, 5 prospective, and 3 randomized trials) reporting on treatment of >3600 patients and >4650 metastases were included. The median local control was 90 % (Range: 57-100 %) at 1 year and 79 % (R: 70-96 %) at 5 years. Acute toxicity ≥3 was reported for 0.5 % and late toxicity ≥3 for 1.8 % of patients. A total of 21 practice recommendations covering the areas of staging & patient selection (n = 10), SBRT treatment (n = 10), and follow-up (n = 1) were developed, with agreements rates of 100 %, except for recommendation 13 (83 %). CONCLUSION SBRT represents an effective definitive local treatment modality combining high local control rates with low risk of radiation-induced toxicities.
Collapse
Affiliation(s)
- Michael Mayinger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Nowon-gu, Seoul, South Korea
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano 20089, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Ben Slotman
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
6
|
Saito M, Sano N, Suzuki H, Komiyama T, Marino K, Ueda K, Nemoto H, Onishi H. Long-term experience in quality assurance of on-rail computed tomography systems for image-guided radiotherapy using in-house multifunctional phantoms. Radiol Phys Technol 2023; 16:292-298. [PMID: 37079253 DOI: 10.1007/s12194-023-00718-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 04/21/2023]
Abstract
To report the long-term quality assurance (QA) experience of an on-rail computed tomography (CT) system for image-guided radiotherapy using an in-house phantom. An on-rail CT system combining the Elekta Synergy and Canon Aquilion LB was used. The treatment couch was shared by the linear accelerators and CT, and the couch was rotated by 180° when using the on-rail-CT system to ensure that the CT direction was toward the head. All QA analyses were performed by radiation technologists on CBCT or on-rail CT images of the in-house phantom. The CBCT center accuracy from the linac laser, couch rotational accuracy (CBCT center vs. on-rail CT center), horizontal accuracy by CT gantry shift, and remote couch shift accuracy were evaluated. This study reported the QA status of the system during the period 2014-2021. The absolute mean accuracy of couch rotation was 0.4 ± 0.28 mm, 0.44 ± 0.36 mm, and 0.37 ± 0.27 mm in the SI, RL, and AP directions, respectively. Horizontal and remote movement accuracies of the treatment couch were also within 0.5 mm of the absolute mean value. A decrease in the accuracy of couch rotation was also observed due to aging deterioration of related parts caused by the frequent use of couch rotation. The three-dimensional accuracy of on-rail CT systems derived mainly from treatment couches can be maintained within 0.5 mm with appropriate accuracy assurance for at least > 8 years.
Collapse
Affiliation(s)
- Masahide Saito
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-City, Yamanashi, 409-3898, Japan.
| | - Naoki Sano
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-City, Yamanashi, 409-3898, Japan
| | - Hidekazu Suzuki
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-City, Yamanashi, 409-3898, Japan
| | - Takafumi Komiyama
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-City, Yamanashi, 409-3898, Japan
| | - Kan Marino
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-City, Yamanashi, 409-3898, Japan
| | - Koji Ueda
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-City, Yamanashi, 409-3898, Japan
| | - Hikaru Nemoto
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-City, Yamanashi, 409-3898, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-City, Yamanashi, 409-3898, Japan
| |
Collapse
|
7
|
Hwang C. Impact of dose distribution on rotational setup errors in radiotherapy for prostate cancer. Med Dosim 2023:S0958-3947(23)00028-6. [PMID: 37085402 DOI: 10.1016/j.meddos.2023.03.007] [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: 08/29/2022] [Revised: 02/10/2023] [Accepted: 03/18/2023] [Indexed: 04/23/2023]
Abstract
This study aimed to assess the impact of rotational setup errors on the target volume's dose distribution during radiotherapy for prostate cancer. A 6D robotic couch was used to describe the rotational setup error, and the dosage change in the target volume was analyzed using the planning evaluation factors. Treatment plans for three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and volumetric modulated arc radiotherapy (VMAT) were established after contouring the target volume and surrounding normal tissues on tomography obtained from the humanoid phantom. A 6D robotic couch was employed in the radiation room to describe the rotational setup errors of ±1° to ±5° in roll, yaw, and pitch, and cone beam computed tomography (CBCT) images were obtained. Furthermore, the dose distribution was extracted from the 3DCRT, IMRT, and VMAT treatment plans, dose mapping was performed on CBCT that depicts the rotational setup error. Target coverage(TC) decreased by 0.39% to 2.17% in roll, 0.43% to 2.59% in yaw, and 0.70% to 4.12% in pitch, respectively. In the comparison using the Radiation Therapy Oncology Group (RTOG) protocol criteria, when the rotational setup error of VMAT pitch was -2° or more, more than +1°, a target coverage of 95% or lower was shown, indicating the greatest effect among rotational setup errors. Furthermore, in 3DCRT, IMRT, and VMAT, the rotational setup error showed the greatest effect in pitch, and the dose change was larger in VMAT than in 3DCRT and IMRT. Therefore, specific rotational error due to pitch during radiotherapy for prostate cancer requires special consideration. Moreover, the more sophisticated and complex algorithms, such as VMAT, applied, the greater the dose change of target coverage due to rotational error; therefore, caution is required.
Collapse
Affiliation(s)
- Chulhwan Hwang
- Department of Radiology, Masan University, Changwon-si, Gyeongsangnam-do, 51217, Republic of Korea.
| |
Collapse
|
8
|
van Reenen CJ, Trauernicht CJ, Bojechko C. The application of gradient dose segmented analysis of in-vivo EPID images for patients undergoing VMAT in a resource-constrained environment. J Appl Clin Med Phys 2023:e13985. [PMID: 37051765 PMCID: PMC10402667 DOI: 10.1002/acm2.13985] [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: 11/09/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
The gamma analysis metric is a commonly used metric for VMAT plan evaluation. The major drawback of this is the lack of correlation between gamma passing rates and DVH values. The novel GDSAmean metric was developed by Steers et al. to quantify changes in the PTV mean dose (Dmean ) for VMAT patients. The aim of this work is to apply the GDSA retrospectively on head-and-neck cancer patients treated on the newly acquired Varian Halcyon, to assess changes in GDSAmean , and to evaluate the cause of day-to-day changes in the time-plot series. In-vivo EPID transmission images of head-and-neck cancer patients treated between August 2019 and July 2020 were analyzed retrospectively. The GDSAmean was determined for all patients treated. The changes in patient anatomy and rotational errors were quantified using the daily CBCT images and added to a time-plot with the daily change in GDSAmean . Over 97% of the delivered treatment fractions had a GDSAmean < 3%. Thirteen of the patients received at least one treatment fraction where the GDSAmean > 3%. Most of these deviations occurred for the later fractions of radiotherapy treatment. Additionally, 92% of these patients were treated for malignancies involving the larynx and oropharynx. Notable deviations in the effective separation diameters were observed for 62% of the patients where the change in GDSAmean > 3%. For the other five cases with GDSAmean < 3%, the mean pitch, roll, and yaw rotational errors were 0.90°, 0.45°, and 0.43°, respectively. A GDSAmean > 3% was more likely due to a change in separation, whereas a GDSAmean < 3% was likely caused by rotational errors. Pitch errors were shown to be the most dominant. The GDSAmean is easily implementable and can aid in scheduling new CT scans for patients before significant deviations in dose delivery occur.
Collapse
Affiliation(s)
- Christoffel Jacobus van Reenen
- Department of Medical Imaging and Radiation Oncology, Medical Physics Division, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Christoph Jan Trauernicht
- Department of Medical Imaging and Radiation Oncology, Medical Physics Division, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Casey Bojechko
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, San Diego, California, USA
| |
Collapse
|
9
|
Xu H, Zhang Z, Tian B, Li X, Bian Y, Liang X, Bo C. Evaluation of corrective effect of 6 degree of freedom couch on setup errors in intensity modulated radiotherapy for postoperative rectal cancer patients. Front Oncol 2023; 13:1030599. [PMID: 36816975 PMCID: PMC9929531 DOI: 10.3389/fonc.2023.1030599] [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: 10/05/2022] [Accepted: 01/11/2023] [Indexed: 02/04/2023] Open
Abstract
Objective To explore the corrective effect of 6 degree of freedom couch on rotation errors in intensity modulated radiotherapy (IMRT) for postoperative rectal cancer patients, further to probe into the clinical application value of 6 degree of freedom couch in radiotherapy. Methods From January 1, 2020 to December 1, 2020, 30 patients with rectal cancer receiving postoperative intensity modulated radiotherapy in The First Hospital of Hebei Medical University were included in this retrospective study. The setup error values in all direction of patients before and after 6 degree of freedom correction were collected during each radiotherapy session. Results In this study, a total of 382 data before and after the correction of 6 degree of freedom couch were collected. It was found that the setup errors in the Y direction gradually increased, was maximal in the third week, and then became smaller, and the setup errors in the other directions increased with the extension of radiotherapy time and reached the maximum at the 5th week. In the translation direction, the setup errors value in Z direction occurred more frequently than that in X and Y directions between the range of 0.21-0.80 cm. In the rotation direction, the setup errors value in rotation X direction occurred more frequently than that in rotation Y and Z directions between the range of 0.21°-2.99°. In addition, after the correction of the 6 degree of freedom couch in real time, the setup errors in patients were significantly reduced in all directions (P < 0.05). Conclusion In summary, it was recommended to clinically use 6 degree of freedom couch combined with IMRT for real-time correction of placement errors in patients with rectal cancer undergoing radiotherapy. At the same time, it was necessary to observe the tumor size and body weight changes of patients on the 5th week. If necessary, radiotherapy positioning and planning should be performed in time.
Collapse
|
10
|
Fu M, Cui Y, Qiu W, Cui Z, Zhang Y, Wang D, Yan S, Zhao Z, Wang Y, Zhu J. In Silico Studies of the Impact of Rotational Errors on Translation Shifts and Dose Distribution in Image-Guided Radiotherapy. Technol Cancer Res Treat 2023; 22:15330338231168763. [PMID: 37050884 PMCID: PMC10102941 DOI: 10.1177/15330338231168763] [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: 04/14/2023] Open
Abstract
Objective: To compare the 6-dimensional errors of different immobilization devices and body regions based on 3-dimensional cone beam computed tomography for image-guided radiotherapy and to further quantitatively evaluate the impact of rotational corrections on translational shifts and dose distribution based on anthropomorphic phantoms. Materials and Methods: Two hundred ninety patients with cone beam computed tomographies from 3835 fractions were retrospectively analyzed for brain, head & neck, chest, abdomen, pelvis, and breast cases. A phantom experiment was conducted to investigate the impact of rotational errors on translational shifts using cone beam computed tomography and the registration system. For the dosimetry study, pitch rotations were simulated by adjusting the breast bracket by ±2.5°. Roll and yaw rotations were simulated by rotating the gantry and couch in the planning system by ±3.0°, respectively. The original plan for the breast region was designed in the computed tomography image space without rotation. With the same planning parameters, the original plan was transplanted into the image space with different rotations for dose recalculation. The effect of these errors on the breast target and organs at risk was assessed by dose-volume histograms. Results: Most of the mean rotational errors in the breast region were >1°. A single uncorrected yaw of 3° caused a change of 2.9 mm in longitudinal translation. A phantom study for the breast region demonstrated that when the pitch rotations were -2.5° and 2.5° and roll and yaw were both 3°, the reductions in the planning target volumes-V50 Gy were 20.07% and 29.58% of the original values, respectively. When the pitch rotation was +2.5°, the left lung V5 Gy and heart Dmean were 7.49% and 165.76 Gy larger, respectively, than the original values. Conclusions: Uncorrected rotations may cause changes in the values and directions of translational shifts. Rotational corrections may improve the patient setup and dose distribution accuracy.
Collapse
Affiliation(s)
- Min Fu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Yanhua Cui
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Wenlong Qiu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Zhen Cui
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Yan Zhang
- Department of Radiation Oncology Physics and Technology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research and Nanjing Medical University Affiliated Cancer Hospital, Nanjing, People's Republic of China
| | - Dandan Wang
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Shaojie Yan
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Zengjing Zhao
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Yungang Wang
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| | - Jian Zhu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, People's Republic of China
| |
Collapse
|
11
|
Comprehensive Analysis of Set-Up Gain of 6-Dimensional Cone-Beam CT Correction Method in Radiotherapy for Head and Neck and Brain Tumors. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2964023. [PMID: 36311255 PMCID: PMC9613383 DOI: 10.1155/2022/2964023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/01/2022] [Indexed: 11/18/2022]
Abstract
This study quantitatively analyzed the gain of the six-dimensional (6D) cone-beam CT (CBCT) correction method compared with the conventional set-up method in 60 patients who underwent radiation treatment of head and neck and brain tumors. The correction gain of CBCT was calculated for the translational and rotational motion components separately and in combination to evaluate the individual and overall effects of these motion components. Using a statistical simulation mimicking the actual set-up correction process, the effective gain of periodic CBCT correction during the entire treatment fraction was analyzed by target size and CBCT correction period under two different correction scenarios: translation alone and full 6D corrections. From the analyses performed in this study, the gain of CBCT correction was quantitatively determined for each situation, and the appropriate CBCT correction strategy was suggested based on treatment purpose and target size.
Collapse
|
12
|
Zhang G, Liu X, Wang L, Zhu J, Yu J. Development and feasibility evaluation of an AR-assisted radiotherapy positioning system. Front Oncol 2022; 12:921607. [PMID: 36267969 PMCID: PMC9577500 DOI: 10.3389/fonc.2022.921607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose The aim of this study is to develop an augmented reality (AR)–assisted radiotherapy positioning system based on HoloLens 2 and to evaluate the feasibility and accuracy of this method in the clinical environment. Methods The obtained simulated computed tomography (CT) images of an “ISO cube”, a cube phantom, and an anthropomorphic phantom were reconstructed into three-dimensional models and imported into the HoloLens 2. On the basis of the Vuforia marker attached to the “ISO cube” placed at the isocentric position of the linear accelerator, the correlation between the virtual and real space was established. First, the optimal conditions to minimize the deviation between virtual and real objects were explored under different conditions with a cube phantom. Then, the anthropomorphic phantom–based positioning was tested under the optimal conditions, and the positioning errors were evaluated with cone-beam CT. Results Under the normal light intensity, the registration and tracking angles are 0°, the distance is 40 cm, and the deviation reached a minimum of 1.4 ± 0.3 mm. The program would not run without light. The hologram drift caused by the light change, camera occlusion, and head movement were 0.9 ± 0.7 mm, 1.0 ± 0.6 mm, and 1.5 ± 0.9 mm, respectively. The anthropomorphic phantom–based positioning errors were 3.1 ± 1.9 mm, 2.4 ± 2.5 mm, and 4.6 ± 2.8 mm in the X (lateral), Y (vertical), and Z (longitudinal) axes, respectively, and the angle deviation of Rtn was 0.26 ± 0.14°. Conclusion The AR-assisted radiotherapy positioning based on HoloLens 2 is a feasible method with certain advantages, such as intuitive visual guidance, radiation-free position verification, and intelligent interaction. Hardware and software upgrades are expected to further improve accuracy and meet clinicalbrendaannmae requirements.
Collapse
Affiliation(s)
- Gongsen Zhang
- 1Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xinchao Liu
- Cancer Center, Shandong University, Jinan, China
| | - Linlin Wang
- 1Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- Cancer Center, Shandong University, Jinan, China
- *Correspondence: Linlin Wang, ; Jinming Yu,
| | - Jian Zhu
- 1Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinming Yu
- 1Department of Radiology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Linlin Wang, ; Jinming Yu,
| |
Collapse
|
13
|
Shinde P, Jadhav A, Gupta KK, Dhoble S. QUANTIFICATION OF 6D INTER-FRACTION TUMOUR LOCALISATION ERRORS IN TONGUE AND PROSTATE CANCER USING DAILY KV-CBCT FOR 1000 IMRT AND VMAT TREATMENT FRACTIONS. RADIATION PROTECTION DOSIMETRY 2022; 198:1265-1281. [PMID: 35870445 DOI: 10.1093/rpd/ncac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/08/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to evaluate the 6D inter-fraction tumour localisation errors in 20 tongue and 20 prostate cancer patients treated with intensity-modulated radiation therapy and volumetric-modulated arc therapy. The patient tumour localisation errors in lateral, longitudinal and vertical translation axes and pitch, roll and yaw rotational axes were analysed by automatic image registration of daily pretreatment kilovoltage cone-beam computed tomography (kV-CBCT) with planning CT in 1000 fractions. The overall mean error (M), systematic error (Σ), random error (σ) and planning target volume (PTV) margins were evaluated. The frequency distributions of setup errors were normally distributed about the mean except for pitch in the tongue and prostate. The overall 3D vector length ≥ 5 mm was 14.2 and 49.8% in the ca-tongue and ca-prostate, respectively. The frequency of rotational errors ≥1 degree was a maximum of 37 and 59.5%, respectively, in ca-tongue and ca-prostate. The M, Σ and σ for all translational and rotational axes decreased with increasing frequency of verification correction in ca-tongue and ca-prostate patients. Similarly, the PTV margin was reduced with no correction to alternate day correction from a maximum of 4.7 to 2.5 mm in ca-tongue and from a maximum of 8.6 to 4.7 mm in ca-prostate. The results emphasised the vital role of the higher frequency of kV-CBCT based setup correction in reducing M, Σ, σ and PTV margins in ca-tongue and ca-prostate patients.
Collapse
Affiliation(s)
- Prashantkumar Shinde
- Department of Physics, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440033, India
| | - Anand Jadhav
- Department of Radiation Oncology, Sir H N Reliance Foundation Hospital & Research Centre, Mumbai 400004, India
| | - Karan Kumar Gupta
- Department of Chemical Engineering, National Taiwan University, Taipei, Taiwan 10617, ROC
| | - Sanjay Dhoble
- Department of Physics, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440033, India
| |
Collapse
|
14
|
Generation and Evaluation of Synthetic Computed Tomography (CT) from Cone-Beam CT (CBCT) by Incorporating Feature-Driven Loss into Intensity-Based Loss Functions in Deep Convolutional Neural Network. Cancers (Basel) 2022; 14:cancers14184534. [PMID: 36139692 PMCID: PMC9497126 DOI: 10.3390/cancers14184534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/08/2022] [Accepted: 09/15/2022] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Despite numerous benefits of cone-beam computed tomography (CBCT), its applications to radiotherapy were limited mainly due to degraded image quality. Recently, enhancing the CBCT image quality by generating synthetic CT image by deep convolutional neural network (CNN) has become frequent. Most of the previous works, however, generated synthetic CT with simple, classical intensity-driven loss in network training, while not specifying a full-package of verifications. This work trained the network by combining feature- and intensity-driven losses and attempted to demonstrate clinical relevance of the synthetic CT images by assessing both image similarity and dose calculating accuracy throughout a commercial Monte-Carlo. Abstract Deep convolutional neural network (CNN) helped enhance image quality of cone-beam computed tomography (CBCT) by generating synthetic CT. Most of the previous works, however, trained network by intensity-based loss functions, possibly undermining to promote image feature similarity. The verifications were not sufficient to demonstrate clinical applicability, either. This work investigated the effect of variable loss functions combining feature- and intensity-driven losses in synthetic CT generation, followed by strengthening the verification of generated images in both image similarity and dosimetry accuracy. The proposed strategy highlighted the feature-driven quantification in (1) training the network by perceptual loss, besides L1 and structural similarity (SSIM) losses regarding anatomical similarity, and (2) evaluating image similarity by feature mapping ratio (FMR), besides conventional metrics. In addition, the synthetic CT images were assessed in terms of dose calculating accuracy by a commercial Monte-Carlo algorithm. The network was trained with 50 paired CBCT-CT scans acquired at the same CT simulator and treatment unit to constrain environmental factors any other than loss functions. For 10 independent cases, incorporating perceptual loss into L1 and SSIM losses outperformed the other combinations, which enhanced FMR of image similarity by 10%, and the dose calculating accuracy by 1–2% of gamma passing rate in 1%/1mm criterion.
Collapse
|
15
|
Arbab M, Bartlett G, Dawson B, Ge J, Langer M. The Dosimetric Outcome of a Rotational Planning Target Volume in Patients With Oropharyngeal Cancers. Dysphagia 2022; 37:848-855. [PMID: 34283289 PMCID: PMC11079995 DOI: 10.1007/s00455-021-10341-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 07/08/2021] [Indexed: 11/26/2022]
Abstract
An isotropic expanded Planning Target Volume (PTV) neglects patient's off-axis rotation. This study designs a rotational PTV that is used instead of the standard 3-mm Clinical Target Volume (CTV) expanded PTV in oropharyngeal cancers with the goal to reduce pharyngeal constrictor muscle (PCM) mean dose. 10 patients were retrospectively evaluated. For off-axis rotation, the image was rotated around the longitudinal axis (cervical spinal canal) ± 5 degrees. These new CTVs were combined to form the rotational PTV. The standard and rotational treatment plans were designed with the goal to keep the superior and middle PCM-CTV70 mean dose to less than 50 Gy. There were a 355 cGy reduction in the superior PCM mean dose (form 5332 to 4977 cGy) and a 506 cGy reduction in middle PCM mean dose (from 4185 to 3679 cGy). 60% of patients may have at least a 20% reduction in dysphagia probability based on a Normal Tissue Complication Probability (NTCP) formula. The superior and middle PCM mean dose were reduced to less than 50 Gy in 40 and 20% of cases. There was an association between superior PCM mean dose and overlap volume of PTV70 and superior PCM in both standard (r = 0.92, p = 0.001) and rotational (r = 0.84, p = 0.002) plans. This association was present for middle PCM and PTV70 (r = 0.52, p = 0.02 and r = 0.62, p = 0.006). Rotational PTV can lower the mean dose to superior and middle PCMs, ultimately leading to lower dysphagia rates.
Collapse
Affiliation(s)
- Mona Arbab
- Department of Radiation Oncology, Indiana University, 535 Barnhill Drive, RT041, Indianapolis, IN, 46202, USA.
| | - Gregory Bartlett
- Department of Radiation Oncology, Indiana University, 535 Barnhill Drive, RT041, Indianapolis, IN, 46202, USA
| | - Benjamin Dawson
- Department of Radiation Oncology, Indiana University, 535 Barnhill Drive, RT041, Indianapolis, IN, 46202, USA
| | - Jeffrey Ge
- Department of Mechanical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Mark Langer
- Department of Radiation Oncology, Indiana University, 535 Barnhill Drive, RT041, Indianapolis, IN, 46202, USA
| |
Collapse
|
16
|
Seah V, Dundas K, Hudson F, Surjan Y, Bartlett R, Ko R, Smith S, Arumugam S, Johnston M, Wong K, Lee M. Correcting rotational error in rectal cancer radiation therapy: Can planning target volume margins be safely reduced? J Med Radiat Sci 2022; 69:473-483. [PMID: 35715996 DOI: 10.1002/jmrs.602] [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: 08/25/2021] [Accepted: 05/17/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The magnitude and impact of rotational error is unclear in rectal cancer radiation therapy. This study evaluates rotational errors in rectal cancer patients, and investigates the feasibility of planning target volume (PTV) margin reduction to decrease organs at risk (OAR) irradiation. METHODS In this study, 10 patients with rectal cancer were retrospectively selected. Rotational errors were assessed through image registration of daily cone beam computed tomography (CBCT) and planning CT scans. Two reference treatment plans (TPR ) with PTV margins of 5 mm and 10 mm were generated for each patient. Pre-determined rotational errors (±1°, ±3°, ±5°) were simulated to produce six manipulated treatment plans (TPM ) from each TPR . Differences in evaluated dose-volume metrics between TPR and TPM of each rotation were compared using Wilcoxon Signed-Rank Test. Clinical compliance was investigated for statistically significant dose-volume metrics. RESULTS Mean rotational errors in pitch, roll and yaw were -0.72 ± 1.81°, -0.04 ± 1.36° and 0.38 ± 0.96° respectively. Pitch resulted in the largest potential circumferential displacement of clinical target volume (CTV) at 1.42 ± 1.06 mm. Pre-determined rotational errors resulted in statistically significant differences in CTV, small bowel, femoral heads and iliac crests (P < 0.05). Only small bowel and iliac crests failed clinical compliance, with majority in the PTV 10 mm margin group. CONCLUSION Rotational errors affected clinical compliance for OAR dose but exerted minimal impact on CTV coverage even with reduced PTV margins. Both PTV margin reduction and rotational correction decreased irradiated volume of OAR. PTV margin reduction to 5 mm is feasible, and rotational corrections are recommended in rectal patients to further minimise OAR irradiation.
Collapse
Affiliation(s)
- Vivian Seah
- Medical Radiation Science (Radiation Therapy), School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia.,Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Kylie Dundas
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Felicity Hudson
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Yolanda Surjan
- Medical Radiation Science (Radiation Therapy), School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rebecca Bartlett
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia
| | - Rebecca Ko
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia
| | - Sandie Smith
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia
| | - Sankar Arumugam
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool Hospital, Sydney, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Meredith Johnston
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Wong
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Lee
- Liverpool and Macarthur Cancer Therapy Centres, Liverpool, New South Wales, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
17
|
Li F, Park J, Lalonde R, Jang SY, diMayorca MS, Flickinger JC, Keller A, Huq MS. Is Halcyon feasible for single thoracic or lumbar vertebral segment SBRT? J Appl Clin Med Phys 2021; 23:e13458. [PMID: 34845817 PMCID: PMC8803290 DOI: 10.1002/acm2.13458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/27/2021] [Accepted: 10/08/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose Halcyon linear accelerators employ intensity‐modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) techniques. The Halcyon offers translational, but not rotational, couch correction, which only allows a 3 degrees of freedom (3‐DOF) correction. In contrast, the TrueBeam (TB) linear accelerator offers full 6‐DOF corrections. This study aims to evaluate the difference in treatment plan quality for single thoracic or lumbar vertebral segment SBRT between the Halcyon and TB linear accelerators. In addition, this study will also investigate the effect of patient rotational setup errors on the final plan quality. Methods We analyzed 20 patients with a single‐level spine metastasis located between the T7 and L5 vertebrae near the spinal canal. The median planning target volume was 52.0 cm3 (17.9–138.7 cm3). The median tumor diameter in the axial plane was 4.6 cm (range 1.7–6.8 cm), in the sagittal plane was 3.3 cm (range 2–5 cm). The prescription doses were either 12–16 Gy in 1 fraction or 18–24 Gy in 3 fractions. All patients were treated on the TB linear accelerator with a 2.5 mm Multi‐Leaf Collimator (MLC) leaf width. Treatment plans were retrospectively created for the Halcyon, which has a 5 mm effective MLC leaf width. The 20 patients had a total of 50 treatments. Analysis of the 50 cone beam computed tomography (CBCT) scans showed average rotational setup errors of 0.6°, 1.2°, and 0.8° in pitch, yaw, and roll, respectively. Rotational error in roll was not considered in this study, as the original TB plans used a coplanar volumetric modulated arc therapy (VMAT) technique, and each 1° of roll will contribute an error of 1/360. If a plan has 3 arcs, the contribution from errors in roll will be < 0.1%. To simulate different patient setup errors, for each patient, 12 CT image datasets were generated in Velocity AI with different rotational combinations at a pitch and yaw of 1°, 2°, and 3°, respectively. We recalculated both the TB and Halcyon plans on these rotated images. The dosimetric plan quality was evaluated based on the percent tumor coverage, the Conformity Index (CI), Gradient Index (GI), Homogeneity index (HI), the maximum dose to the cord/cauda, and the volume of the cord/cauda receiving 8, 10, and 12 Gy (V8Gy, V10Gy and V12Gy). Paired t‐tests were performed between the original and rotated plans with a significance level of 0.05. Results The Eclipse based VMAT plans on Halcyon achieved a similar target coverage (92.3 ± 3.0% vs. 92.4 ± 3.3%, p = 0.82) and CI (1.0 ± 0.1 vs. 1.1 ± 0.2, p = 0.12) compared to the TB plans. The Gradient index of Halcyon is higher (3.96 ±0.8) than TB (3.85 ±0.7), but not statistically significant. The maximum dose to the spinal cord/cauda was comparable (11.1 ± 2.8 Gy vs. 11.4 ± 3.6 Gy, p = 0.39), as were the V8Gy, V10Gy and V12Gy to the cord/cauda. The dosimetric influence of patient rotational setup error was statistically insignificant for rotations of up to 1° pitch/yaw (with similar target coverage, CI, max cord/cauda dose and V8Gy, V10Gy, V12Gy for cord/cauda). The total number of monitor units (MUs) for Halcyon (4998 ± 1688) was comparable to that of TB (5463 ± 2155) (p = 0.09). Conclusions The Halcyon VMAT plans for a single thoracic or lumbar spine metastasis were dosimetrically comparable to the TB plans. Patient rotation within 1° in the pitch and yaw directions, if corrected by translation, resulted in insignificant dosimetric effects. The Halcyon linear accelerator is an acceptable alternative to TB for the treatment of single thoracic or lumbar spinal level metastasis, but users need to be cautious about the patient rotational setup error. It is advisable to select patients appropriately, including only those with the thoracic or lumbar spine involvement and keeping at least 2 mm separation between the target and the cord/cauda. More margin is needed if the distance between the isocenter and cord/cauda is larger. It is advisable to place the planning isocenter close to the spinal canal to further mitigate the rotational error. Summary We simulated various scenarios of patient setup errors with different rotational combinations of pitch and yaw with 1°, 2°, and 3°, respectively. Rotation was corrected with translation only to mimic the Halcyon treatment scenario. Using the Halcyon for treating a tumor in a single thoracic or lumbar vertebral segment is feasible, but caution should be noted in patients requiring rotational corrections of > 1° in the absence of 6‐DOF correction capabilities.
Collapse
Affiliation(s)
- Fang Li
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Jeonghoon Park
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, Basking Ridge, New Jersey, USA
| | - Ron Lalonde
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Si Young Jang
- Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts, USA
| | | | - John C Flickinger
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Andrew Keller
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Mohammed Saiful Huq
- Department of Radiation Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
18
|
Tsujii K, Ueda Y, Isono M, Miyazaki M, Teshima T, Koizumi M. Dosimetric impact of rotational setup errors in volumetric modulated arc therapy for postoperative cervical cancer. JOURNAL OF RADIATION RESEARCH 2021; 62:688-698. [PMID: 34056648 PMCID: PMC8273806 DOI: 10.1093/jrr/rrab044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/19/2021] [Indexed: 06/12/2023]
Abstract
We aimed to evaluate the impact of rotational setup errors on the doses received during postoperative volumetric-modulated arc therapy (VMAT) for cervical cancer. Overall, 121 cone-beam computed tomography (CBCT) sets from 20 patients were rigidly registered to reference computed tomography (CT) sets based on bony landmarks. The rotational setup errors (pitch, yaw and roll) were calculated. Then, 121 CT sets involving rotational setup errors were created, and the dose distribution in these CT sets were recalculated. The recalculated dosimetric parameters for the clinical target volume (CTV) and organs at risk (OAR) were compared to the reference values, and the correlation coefficients between the dosimetric parameter differences and rotational setup errors were calculated. Only the pitch setup error was moderately correlated with CTV coverage (r ≥ 0.40) and strongly correlated with V45 for the bladder (r ≥ 0.91) and V40 for the rectum, small bowel and bone marrow (r ≥ 0.91). The maximum dosimetric difference in a single fraction and overall fractions was -1.59% and -0.69% in D98 for the CTV, 11.72% and 5.17% in V45 for the bladder and -8.03% and -4.68% in V40 for the rectum, respectively. In conclusion, rotational setup errors only slightly impact dose coverage during postoperative cervical cancer VMAT. However, the pitch setup error occasionally affected the doses received by the bladder or the rectum in the overall fraction when the error was systematic. Thus, rotational setup errors should be corrected by adjusting six-degree-of-freedom (DOF) couches to reduce dosimetric differences in the OARs.
Collapse
Affiliation(s)
- Katsutomo Tsujii
- Department of Medical Physics & Engineering, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
- Varian Medical Systems, Chuo-ku, Tokyo 103-0026, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Masaru Isono
- Department of Radiation Oncology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Masayoshi Miyazaki
- Department of Radiation Oncology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, Chuo-ku, Osaka 541-8567, Japan
| | - Masahiko Koizumi
- Corresponding author: Department of Medical Physics & Engineering, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan. Phone number: +81-6-6879-2570, Fax: +81-6-6879-2564, E-mail address:
| |
Collapse
|
19
|
Abubakar A, Zamri NAM, Shaukat SI, Mohd Zin H. Automated algorithm for calculation of setup corrections and planning target volume margins for offline image-guided radiotherapy protocols. J Appl Clin Med Phys 2021; 22:137-146. [PMID: 34109736 PMCID: PMC8292705 DOI: 10.1002/acm2.13291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Each radiotherapy center should have a site‐specific planning target volume (PTV) margins and image‐guided (IG) radiotherapy (IGRT) correction protocols to compensate for the geometric errors that can occur during treatment. This study developed an automated algorithm for the calculation and evaluation of these parameters from cone beam computed tomography (CBCT)‐based IG‐intensity modulated radiotherapy (IG‐IMRT) treatment. Methods and materials A MATLAB algorithm was developed to extract the setup errors in three translational directions (x, y, and z) from the data logged by the CBCT system during treatment delivery. The algorithm also calculates the resulted population setup error and PTV margin based on the van Herk margin recipe and subsequently estimates their respective values for no action level (NAL) and extended no action level (eNAL) offline correction protocols. The algorithm was tested on 25 head and neck cancer (HNC) patients treated using IG‐IMRT. Results The algorithms calculated that the HNC patients require a PTV margin of 3.1, 2.7, and 3.2 mm in the x‐, y‐, and z‐direction, respectively, without IGRT. The margin can be reduced to 2.0, 2.2, and 3.0 mm in the x‐, y‐, and z‐direction, respectively, with NAL and 1.6, 1.7, and 2.2 mm in the x‐, y‐, and z‐direction, respectively, with eNAL protocol. The results obtained were verified to be the same with the margins calculated using an Excel spreadsheet. The algorithm calculates the weekly offline setup error correction values automatically and reduces the risk of input data error observed in the spreadsheet. Conclusions In conclusion, the algorithm provides an automated method for optimization and reduction of PTV margin using logged setup errors from CBCT‐based IGRT.
Collapse
Affiliation(s)
- Auwal Abubakar
- Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia, Kepala Batas 13200, Malaysia.,Department of Medical Radiography, Faculty of Allied Health Sciences, College of Medical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Nada Alia M Zamri
- Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia, Kepala Batas 13200, Malaysia
| | - Shazril Imran Shaukat
- Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia, Kepala Batas 13200, Malaysia
| | - Hafiz Mohd Zin
- Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia, Kepala Batas 13200, Malaysia
| |
Collapse
|
20
|
Rotational positional error-corrected linear set-up margin calculation technique for lung stereotactic body radiotherapy in a dual imaging environment of 4-D cone beam CT and ExacTrac stereoscopic imaging. Radiol Med 2021; 126:979-988. [PMID: 33900527 DOI: 10.1007/s11547-021-01355-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/08/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Accurate calculation of set-up margin is a prerequisite to arrive at the most optimal clinical to planning target volume margin. The aim of this study was to evaluate the compatibility of different on-board and in-room stereoscopic imaging modalities by calculating the set-up margins (SM) in stereotactic body radiotherapy technique accounting and unaccounting for rotational positional errors (PE). Further, we calculated separate SMs one based on residual positional errors and another based on residual + intrafraction positional errors from the imaging data obtained in a dual imaging environment. MATERIALS AND METHODS A total of 22 lung cancer patients were included in this study. For primary image guidance, four-dimensional cone beam computed tomography (4-D CBCT) was used and stereoscopic ExacTrac was used as the auxiliary imaging. Following table position correction (TPC) based on the initial 4-D CBCT, another 4-D CBCT (post-TPC) and a pair of stereoscopic ExacTrac images were obtained. Further, during the treatment delivery, a series of ExacTrac images were acquired to identify the intrafraction PE. If a, b and c were the observed translational shifts in lateral (x-axis), longitudinal (y-axis) and vertical direction (z-axis) and α, β and γ were the rotational shifts in radians about the same axes, respectively, then the resultant translational vectors (A, B and C) were calculated on the basis of translational and rotational values. Set-up margins were calculated using residual errors post-TPC only and also using intrafraction positional errors in addition to the residual errors. RESULTS Residual and residual + intrafraction SM were calculated from a dataset of 82 CBCTs and 189 ExacTrac imaging sessions. CBCT-based mean ± SD shifts in translational and rotational directions were 0.3 ± 1.8 mm, 0.1 ± 1.8 mm, - 0.4 ± 1.6 mm, 0.1 ± 0.4°, 0.0 ± 1.0° and 0.3 ± 0.7°, respectively, and for ExacTrac - 0.1 ± 1.8 mm, 0.2 ± 2.4 mm, - 0.6 ± 1.8 mm, 0.1 ± 1.2°, - 0.2 ± 1.3° and - 0.1 ± 0.6°, respectively. Residual SM without considering the rotational correction in x, y and z directions were 5.0 mm, 4.5 mm and 4.4 mm; rotation-corrected SM were 4.4 mm, 4.0 mm and 5.5 mm, respectively. Residual plus intrafraction SM were 5.5 mm, 6.6 mm and 6.2 mm without considering the rotational corrections, whereas they were 5.0 mm, 6.3 mm and 6.2 mm with rotational errors accounted for. CONCLUSION Accurate calculation of set-up margin is required to find the clinical to planning target volume margin. Primary and auxiliary imaging margins fall in the range of 4.0 to 5.5 mm and 5.0 to 7.0 mm, respectively, indicating a higher SM for X-ray-based planar imaging techniques over three-dimensional cone beam images. This study established the degree of mutual compatibility between two different kinds of widely used set-up imaging modalities, on-board CBCT and in-room stereoscopic imaging ExacTrac. It also describes the technique to calculate the residual and residual plus intrafraction SM and its variation in a dual imaging environment accounting for rotational PE in stereotactic body radiotherapy of lung.
Collapse
|
21
|
Mohandass P, Khanna D, Nishaanth B, Saravanan C, Bhalla N, Puri A, Mohandass B. IMPACT OF THREE DIFFERENT MATCHING METHODS ON PATIENT SET-UP ERROR IN X-RAY VOLUMETRIC IMAGING FOR HEAD AND NECK CANCER. Rep Pract Oncol Radiother 2020; 25:906-912. [PMID: 33029107 PMCID: PMC7528047 DOI: 10.1016/j.rpor.2020.09.001] [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: 04/23/2020] [Revised: 06/30/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
Impact of three different matching methods for delivery of Volumetric Modulated Arc Therapy (VMAT) in Cone-beam computed tomography (CBCT) on patient set-up error. As per institutional imaging protocol, 300 CBCT scans of 20 VMAT head and neck cancer patients treated with 60 Gy/30 fractions were chosen for the present study. Approved CT images of the plan were registered as a reference with the CBCT images on board. Grey-scale matching (GM), manual matching (MM), and bone matching (BM) between on-board CBCT and reference CT images were used to assess patient translation errors. Patient positioning verification was evaluated using the Clip-box registration in all three matching methods. Using the GM approach as a reference point, two additional matchings were rendered in offline mode using BM and MM. For analysis, random error (σ), systematic error (∑), maximum error (E) mean set-up error (M), mean displacement vector (R), matching time (Mt), and multiple comparisons using Post hoc Tukey's HSD test were performed. In MM, less random and systematic errors were found than in GM and BM with an insignificant difference (p > 0.05) Compared to BM and GM, the maximum error, mean set-up error, and displacement vector were marginally less in MM (p > 0.05). In MM, an increased Mt relative to BM and GM was observed (p > 0.05). Furthermore, an insignificant difference in set-up error was revealed in a multiple comparison test (p > 0.05). Any of the three matching methods can be used during CBCT to check patient translation errors for the delivery of the VMAT head and neck patients.
Collapse
Affiliation(s)
- P. Mohandass
- Department of Physics, School of Sciences, Arts, Media and Management, Karunya Institute of Technology and Sciences, Coimbatore, Tamilnadu, India
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Sector-62, Phase8, SAS Nagar, Mohali 160062, Punjab, India
| | - D. Khanna
- Department of Physics, School of Sciences, Arts, Media and Management, Karunya Institute of Technology and Sciences, Coimbatore, Tamilnadu, India
| | - B. Nishaanth
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Sector-62, Phase8, SAS Nagar, Mohali 160062, Punjab, India
| | - C. Saravanan
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Sector-62, Phase8, SAS Nagar, Mohali 160062, Punjab, India
| | - Narendra Bhalla
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Sector-62, Phase8, SAS Nagar, Mohali 160062, Punjab, India
| | - Abhishek Puri
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Sector-62, Phase8, SAS Nagar, Mohali 160062, Punjab, India
| | - Blessy Mohandass
- Chitkara School of Health Sciences, Chitkara University, Punjab, India
| |
Collapse
|
22
|
Tamihardja J, Schortmann M, Lawrenz I, Weick S, Bratengeier K, Flentje M, Guckenberger M, Polat B. Moderately hypofractionated radiotherapy for localized prostate cancer: updated long-term outcome and toxicity analysis. Strahlenther Onkol 2020; 197:124-132. [PMID: 32833036 PMCID: PMC7840645 DOI: 10.1007/s00066-020-01678-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Evaluation of long-term outcome and toxicity of moderately hypofractionated radiotherapy using intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost treatment planning and cone beam CT-based image guidance for localized prostate cancer. METHODS Between 2005 and 2015, 346 consecutive patients with localized prostate cancer received primary radiotherapy using cone beam CT-based image-guided intensity-modulated radiotherapy (IG-IMRT) and volumetric modulated arc therapy (IG-VMAT) with a simultaneous integrated boost (SIB). Total doses of 73.9 Gy (n = 44) and 76.2 Gy (n = 302) to the high-dose PTV were delivered in 32 and 33 fractions, respectively. The low-dose PTV received a dose (D95) of 60.06 Gy in single doses of 1.82 Gy. The pelvic lymph nodes were treated in 91 high-risk patients to 45.5 Gy (D95). RESULTS Median follow-up was 61.8 months. The 5‑year biochemical relapse-free survival (bRFS) was 85.4% for all patients and 93.3, 87.4, and 79.4% for low-, intermediate-, and high-risk disease, respectively. The 5‑year prostate cancer-specific survival (PSS) was 94.8% for all patients and 98.7, 98.9, 89.3% for low-, intermediate-, and high-risk disease, respectively. The 5‑year and 10-year overall survival rates were 83.8 and 66.3% and the 5‑year and 10-year freedom from distant metastasis rates were 92.2 and 88.0%, respectively. Cumulative 5‑year late GU toxicity and late GI toxicity grade ≥2 was observed in 26.3 and 12.1% of the patients, respectively. Cumulative 5‑year late grade 3 GU/GI toxicity occurred in 4.0/1.2%. CONCLUSION Moderately hypofractionated radiotherapy using SIB treatment planning and cone beam CT image guidance resulted in high biochemical control and survival with low rates of late toxicity.
Collapse
Affiliation(s)
- Jörg Tamihardja
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany.
| | - Max Schortmann
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Ingulf Lawrenz
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Stefan Weick
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Klaus Bratengeier
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bülent Polat
- Department of Radiation Oncology, University Hospital Wuerzburg, University of Wuerzburg, Wuerzburg, Germany
| |
Collapse
|
23
|
Haraldsson A, Ceberg S, Ceberg C, Bäck S, Engelholm S, Engström PE. Surface-guided tomotherapy improves positioning and reduces treatment time: A retrospective analysis of 16 835 treatment fractions. J Appl Clin Med Phys 2020; 21:139-148. [PMID: 32592288 PMCID: PMC7484821 DOI: 10.1002/acm2.12936] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/20/2020] [Accepted: 05/07/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE In this study, we have quantified the setup deviation and time gain when using fast surface scanning for daily setup/positioning with weekly megavoltage computed tomography (MVCT) and compared it to daily MVCT. METHODS A total of 16 835 treatment fractions were analyzed, treated, and positioned using our TomoTherapy HD (Accuray Inc., Madison, USA) installed with a Sentinel optical surface scanning system (C-RAD Positioning AB, Uppsala, Sweden). Patients were positioned using in-room lasers, surface scanning and MVCT for the first three fractions. For the remaining fractions, in-room laser was used for setup followed by daily surface scanning with MVCT once weekly. The three-dimensional (3D) setup correction for surface scanning was evaluated from the registration between MVCT and the planning CT. The setup correction vector for the in-room lasers was assessed from the surface scanning and the MVCT to planning CT registration. The imaging time was evaluated as the time from imaging start to beam-on. RESULTS We analyzed 894 TomoTherapy treatment plans from 2012 to 2018. Of all the treatment fractions performed with surface scanning, 90 % of the residual errors were within 2.3 mm for CNS (N = 284), 2.9 mm for H&N (N = 254), 8.7 mm for thorax (N = 144) and 10.9 for abdomen (N = 134) patients. The difference in residual error between surface scanning and positioning with in-room lasers was significant (P < 0.005) for all sites. The imaging time was assessed as total imaging time per treatment plan, modality, and treatment site and found that surface scanning significantly reduced patient on-couch time compared to MVCT for all treatment sites (P < 0.005). CONCLUSIONS The results indicate that daily surface scanning with weekly MVCT can be used with the current target margins for H&N, CNS, and thorax, with reduced imaging time.
Collapse
Affiliation(s)
- André Haraldsson
- Department Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sofie Ceberg
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Crister Ceberg
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sven Bäck
- Department Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Silke Engelholm
- Department Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Per E Engström
- Department Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
24
|
Comparing Setup Errors Using Portal Imaging in Patients With Gynecologic Cancers by Two Methods of Alignment. J Med Imaging Radiat Sci 2020; 51:394-403. [PMID: 32444331 DOI: 10.1016/j.jmir.2020.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/29/2020] [Accepted: 04/02/2020] [Indexed: 12/25/2022]
Abstract
AIMS Alignment tattoos on a lax abdomen contribute to misalignment of patients undergoing abdomino-pelvic radiotherapy (RT). The present study was undertaken to assess setup reproducibility in gynecologic cancer patients positioned identically but aligned for treatment to machine isocenter by two different ways. MATERIALS AND METHODS A prospective study in 35 women treated with radical RT for gynecologic malignancy was undertaken. A RT planning contrast-enhanced computed tomography scan in the supine position using an foot and ankle positioning device was done, and three reference points tattooed on the reference plane, anteriorly at the mons pubis and one on each side laterally at a fixed table top-to-vertical height of 10 cm, whereas a fourth point was tattooed at the xiphoid in the anterior midline. Patients were aligned using either a field center, that is, conventional method (Arm I, n = 18) or by a new setup isocenter (Arm II, n = 17) defined by a cranial offset of 4 cm to the reference plane for daily treatment. Anterior and right lateral digitally reconstructed radiograph setup fields were created at the treatment isocenters and compared with orthogonal megavoltage portal images (PI) taken during initial 3 days of RT and subsequently twice weekly. Setup deviations-rotations and translations were analysed in mediolateral (ML), craniocaudal, and anteroposterior direction. No online and offline corrections were performed. Population systematic error and random error were calculated and planning target volume margins required were estimated using van Herk's formula. RESULTS Arm I had 209 PI while Arm II had 188 PI. Patients in arm II had a lesser systematic error in the ML direction. Patients with large pelvic girth (>95 cm) were susceptible for greater movements during treatment, more so in Arm I, major shifts (>5 mm) with respect to Arm II in the ML direction (37% vs. 22%, P = .001). A larger planning target volume expansion was required in Arm I (1.6 cm) compared with Arm II (0.9 cm). The margin expansion required from clinical target volume in anteroposterior direction was about 0.6 cm and about a cm in the craniocaudal direction in both the arm. CONCLUSIONS Alignment of patient with anterior tattoo at the relatively immobile portion of lower abdomen (mons pubis) Arm II (setup) is superior to a more cranial location over the flabby abdomen during radiation treatment.
Collapse
|
25
|
Kida S, Kaji S, Nawa K, Imae T, Nakamoto T, Ozaki S, Ohta T, Nozawa Y, Nakagawa K. Visual enhancement of Cone-beam CT by use of CycleGAN. Med Phys 2020; 47:998-1010. [PMID: 31840269 DOI: 10.1002/mp.13963] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 11/27/2019] [Accepted: 11/27/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Cone-beam computed tomography (CBCT) offers advantages over conventional fan-beam CT in that it requires a shorter time and less exposure to obtain images. However, CBCT images suffer from low soft-tissue contrast, noise, and artifacts compared to conventional fan-beam CT images. Therefore, it is essential to improve the image quality of CBCT. METHODS In this paper, we propose a synthetic approach to translate CBCT images with deep neural networks. Our method requires only unpaired and unaligned CBCT images and planning fan-beam CT (PlanCT) images for training. The CBCT images and PlanCT images may be obtained from other patients as long as they are acquired with the same scanner settings. Once trained, three-dimensionally reconstructed CBCT images can be directly translated into high-quality PlanCT-like images. RESULTS We demonstrate the effectiveness of our method with images obtained from 20 prostate patients, and provide a statistical and visual comparison. The image quality of the translated images shows substantial improvement in voxel values, spatial uniformity, and artifact suppression compared to those of the original CBCT. The anatomical structures of the original CBCT images were also well preserved in the translated images. CONCLUSIONS Our method produces visually PlanCT-like images from CBCT images while preserving anatomical structures.
Collapse
Affiliation(s)
- Satoshi Kida
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Shizuo Kaji
- Institute of Mathematics for Industry, Kyushu University, 744 Motooka, Nishi-ku, Fukuoka, 819-0395, Japan.,JST PRESTO, Kawaguchi, Japan
| | - Kanabu Nawa
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Toshikazu Imae
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Takahiro Nakamoto
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Sho Ozaki
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Takeshi Ohta
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Yuki Nozawa
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, Tokyo, 113-8655, Japan
| |
Collapse
|
26
|
Kügele M, Mannerberg A, Nørring Bekke S, Alkner S, Berg L, Mahmood F, Thornberg C, Edvardsson A, Bäck SÅJ, Behrens CF, Ceberg S. Surface guided radiotherapy (SGRT) improves breast cancer patient setup accuracy. J Appl Clin Med Phys 2019; 20:61-68. [PMID: 31478615 PMCID: PMC6753725 DOI: 10.1002/acm2.12700] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/13/2019] [Accepted: 07/26/2019] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The purpose of the study was to investigate if surface guided radiotherapy (SGRT) can decrease setup deviations for tangential and locoregional breast cancer patients compared to conventional laser-based setup (LBS). MATERIALS AND METHODS Both tangential (63 patients) and locoregional (76 patients) breast cancer patients were enrolled in this study. For LBS, the patients were positioned by aligning skin markers to the room lasers. For the surface based setup (SBS), an optical surface scanning system was used for daily setup using both single and three camera systems. To compare the two setup methods, the patient position was evaluated using verification imaging (field images or orthogonal images). RESULTS For both tangential and locoregional treatments, SBS decreased the setup deviation significantly compared to LBS (P < 0.01). For patients receiving tangential treatment, 95% of the treatment sessions were within the clinical tolerance of ≤ 4 mm in any direction (lateral, longitudinal or vertical) using SBS, compared to 84% for LBS. Corresponding values for patients receiving locoregional treatment were 70% and 54% for SBS and LBS, respectively. No significant difference was observed comparing the setup result using a single camera system or a three camera system. CONCLUSIONS Conventional laser-based setup can with advantage be replaced by surface based setup. Daily SGRT improves patient setup without additional imaging dose to breast cancer patients regardless if a single or three camera system was used.
Collapse
Affiliation(s)
- Malin Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Annika Mannerberg
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Susanne Nørring Bekke
- Radiotherapy Research Unit, Department of Oncology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sara Alkner
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Lovisa Berg
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Faisal Mahmood
- Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Charlotte Thornberg
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Anneli Edvardsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sven Å J Bäck
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Claus F Behrens
- Radiotherapy Research Unit, Department of Oncology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Ceberg
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| |
Collapse
|
27
|
Hartgerink D, Swinnen A, Roberge D, Nichol A, Zygmanski P, Yin FF, Deblois F, Hurkmans C, Ong CL, Bruynzeel A, Aizer A, Fiveash J, Kirckpatrick J, Guckenberger M, Andratschke N, de Ruysscher D, Popple R, Zindler J. LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation. Acta Oncol 2019; 58:1275-1282. [PMID: 31257960 DOI: 10.1080/0284186x.2019.1633016] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Stereotactic radiosurgery (SRS) is a promising treatment option for patients with multiple brain metastases (BM). Recent technical advances have made LINAC based SRS a patient friendly technique, allowing for accurate patient positioning and a short treatment time. Since SRS is increasingly being used for patients with multiple BM, it remains essential that SRS be performed with the highest achievable quality in order to prevent unnecessary complications such as radionecrosis. The purpose of this article is to provide guidance for high-quality LINAC based SRS for patients with BM, with a focus on single isocenter non-coplanar volumetric modulated arc therapy (VMAT). Methods: The article is based on a consensus statement by the study coordinators and medical physicists of four trials which investigated whether patients with multiple BM are better palliated with SRS instead of whole brain radiotherapy (WBRT): A European trial (NCT02353000), two American trials and a Canadian CCTG lead intergroup trial (CE.7). This manuscript summarizes the quality assurance measures concerning imaging, planning and delivery. Results: To optimize the treatment, the interval between the planning-MRI (gadolinium contrast-enhanced, maximum slice thickness of 1.5 mm) and treatment should be kept as short as possible (< two weeks). The BM are contoured based on the planning-MRI, fused with the planning-CT. GTV-PTV margins are minimized or even avoided when possible. To maximize efficiency, the preferable technique is single isocenter (non-)coplanar VMAT, which delivers high doses to the target with maximal sparing of the organs at risk. The use of flattening filter free photon beams ensures a lower peripheral dose and shortens the treatment time. To bench mark SRS treatment plan quality, it is advisable to compare treatment plans between hospitals. Conclusion: This paper provides guidance for quality assurance and optimization of treatment delivery for LINAC-based radiosurgery for patients with multiple BM.
Collapse
Affiliation(s)
- Dianne Hartgerink
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ans Swinnen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - David Roberge
- Department of Radiation Oncology, CHUM, Montreal, QC, Canada
| | - Alan Nichol
- Department of Radiation Oncology, CHUM, Montreal, QC, Canada
| | - Piotr Zygmanski
- Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Chin Loon Ong
- Department of Radiation Oncology, HagaZiekenhuis, Den Haag, The Netherlands
| | - Anna Bruynzeel
- Department of Radiotherapy, Cancer Center Amsterdam, VU University medical center, Amsterdam, The Netherlands
| | - Ayal Aizer
- Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John Kirckpatrick
- Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Dirk de Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Richard Popple
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jaap Zindler
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Radiation Oncology, Erasmus MC, Rotterdam, The Netherlands
- Holland Proton Therapy Center, Delft, The Netherlands
| |
Collapse
|
28
|
Selvan KT, Padma G, Revathy MK, Nambi Raj NA, Senthilnathan K, Babu PR. Dosimetric Effect of Rotational Setup Errors in Single-Isocenter Volumetric-Modulated Arc Therapy of Multiple Brain Metastases. J Med Phys 2019; 44:84-90. [PMID: 31359925 PMCID: PMC6580820 DOI: 10.4103/jmp.jmp_103_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 03/12/2019] [Accepted: 03/17/2019] [Indexed: 11/08/2022] Open
Abstract
AIM The aim of this study is to investigate the dosimetric effects of rotational uncertainties in patient positioning on target coverage in stereotactic radiosurgery (SRS) of multiple brain metastases using single isocenter volumetric modulated arc therapy (VMAT). MATERIALS AND METHODS Ten SRS cases with multiple brain metastases (2-8) planned with single isocenter non-coplanar VMAT technique were investigated in this study. Pitch, yaw and roll displacements of 1, 3 and 5° were simulated about isocenter along each axes and nine plans were obtained for each case. Gross tumor volume (GTV) coverage obtained on simulated plans were compared with the original plan on four metrics of mean dose (Dmean), minimum dose to GTV (Dmin), dose to 95% of GTV (D95) and the volume covered by the 95% of the prescribed dose (V95). RESULTS At 1° rotation about 4% of the PTV had V95 and D95 values <95%. The minimum dose obtained across all PTV was 85.1% and there was not much change in the mean dose values obtained. The PTV volume which had V95 and D95 values <95% were in the range of 0.05 - 0.07cc and at a radial distance of 6.2 cm - 7.2 cm. At 3° rotation almost 50% of the PTV had V95 and D95 values <95%. The minimum dose obtained across all PTV was 48.3% and the mean dose reduced to as low as 78.8%. At 5° rotation almost 74% of the PTV had V95 and D95 values <95%. The minimum dose obtained across all PTV was 21.2% and the mean dose reduced to as low as 49.2%. CONCLUSION Our results indicate that correcting rotational uncertainties is critical in single-isocenter, multi-target SRS. For rotational deviations, radial distance of the target from isocenter along the respective axis has a strong influence on target coverage. For rotational setup deviation at a given radial distance larger targets tend to have lesser geometric miss compared to smaller targets. Mathematical model for spherical targets can be used to estimate V95 for given rotational errors.
Collapse
Affiliation(s)
- Kasirajan Tamil Selvan
- Department of Oncology, Apollo Cancer Hospital, Hyderabad, Telangana, India
- Department of Physics, School of Advanced Sciences, Vellore Institute of Technology University, Vellore, Tamil Nadu, India
| | - Ganesan Padma
- Department of Oncology, Apollo Cancer Hospital, Hyderabad, Telangana, India
| | | | - N. Arunai Nambi Raj
- Centre for Biomaterials, Cellular and Molecular Theranostics, Vellore Institute of Technology University, Vellore, Tamil Nadu, India
| | - K. Senthilnathan
- Department of Physics, School of Advanced Sciences, Vellore Institute of Technology University, Vellore, Tamil Nadu, India
| | - P. Ramesh Babu
- Department of Physics, School of Advanced Sciences, Vellore Institute of Technology University, Vellore, Tamil Nadu, India
| |
Collapse
|
29
|
Njeh CF, Snyder KC, Cai J. The use of six degrees of freedom couch is only clinically beneficial in stereotactic radio surgery. Med Phys 2019; 46:415-418. [DOI: 10.1002/mp.13380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/02/2019] [Accepted: 01/05/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Christopher F. Njeh
- Department of Radiation Oncology Franciscan Health Indianapolis & Mooresville Indianapolis IN 46237 USA
| | - Karen C. Snyder
- Department of Radiation Oncology Henry Ford Hospital System Detroit MI 48067 USA
| | | |
Collapse
|
30
|
Chan MF, Lim SB, Li X, Tang X, Zhang P, Shi C. Commissioning and Evaluation of a Third-Party 6 Degrees-of-Freedom Couch Used in Radiotherapy. Technol Cancer Res Treat 2019; 18:1533033819870778. [PMID: 31434547 PMCID: PMC6704415 DOI: 10.1177/1533033819870778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purposes: The newly released Protura 6 degrees-of-freedom couch (CIVCO) has limited quality assurance protocols and pertinent publications. Herein, we report our experiences of the Protura system acceptance, commissioning, and quality assurance. Methods: The Protura system integration was tested with peripheral equipment on the following items: couch movement range limit, 6 degrees-of-freedom movement accuracy, weight test and couch sagging, system connection with Linac, isocentricity of couch and rotation alignment, kV and cone-beam computed tomography imaging of HexaCHECK with MIMI phantom (Standard Imaging), and an in-house custom 6 degrees-of-freedom quality assurance phantom. A couch transmission measurement was also performed. Results: The vertical, longitudinal, and lateral ranges of the 6 degrees-of-freedom couch pedestal are 43.9 to 0.0 cm, 24.6 to 149.5 cm, −20.6 to 20.7 cm, respectively. The couch movement accuracy was within 1 mm in all directions. The couch sagging with a 200 lbs (∼91 kg) evenly distributed object is 1.0 cm and 0.4° pitch in the distal end of the couch. The isocentricity of the couch was about 0.5 mm in diameter of all crosshair projections on the couch isocenter level, and the largest couch rotation alignment observed was (0.3°) at the couch angle of 90°. The deviation from the reference position (zero position) of the HexaCHECK phantom, measured by matching the cone-beam computed tomography with the reference planning computed tomography, was found to be below 0.2 mm in the anterior–posterior and right–left dimensions, 0.4 mm in superior–inferior dimension, and 0.1° in roll, pitch, and yaw directions. Conclusions: A 6 degrees-of-freedom quality assurance phantom is helpful for the commissioning and routine quality assurance tests. Due to the third-party integration with Linac, the system is prone to “double-correction” errors. A rigorous quality assurance program is the key to a successful clinical implementation of the Protura system.
Collapse
Affiliation(s)
- Maria F Chan
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Seng-Boh Lim
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiang Li
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiaoli Tang
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peng Zhang
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chengyu Shi
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
31
|
A study for the dosimetric evaluation of rotational setup error for
lung stereotactic body radiation therapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396918000250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractPurposeTo investigate the necessity of rotational shifts by considering dosimetric
impact of rotational errors on stereotactic body radiation therapy
(SBRT).Materials and methods20 lung patients with the lesion size <5 cm treated with SBRT have
been selected for dosimetric analysis. Three-dimensional dose has been
rotationally shifted (±1°, ±3°,
±5° for pitch, roll and yaw) and overlaid to the original
computed tomography images. The dose–volume histograms of
18-rotational plans of each patient were compared to those of the original
plan.ResultsNo significant dosimetric differences were observed in target coverage. For
all of the cases up to 5° in any couch angle dose differences of
D99 and D95 were
<3%. Variations of conformity index were observed to be less
than 0·05. None of the organ at risk doses exceeded the dose limit.
The V20 differences of the ipsilateral and the
total lungs were less than 0·4%.ConclusionIt has been found to be unnecessary to perform rotational shifts up to
5° for lung SBRT treatments; the translational shift is sufficient
for the cases used in this study. This method may be applied and tested
after planning and before treatment initiation to rule out exceptionally
extreme cases.
Collapse
|
32
|
Kidar HS, Azizi H. Assessing the impact of choosing different deformable registration algorithms on cone-beam CT enhancement by histogram matching. Radiat Oncol 2018; 13:217. [PMID: 30404657 PMCID: PMC6223042 DOI: 10.1186/s13014-018-1162-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this work is to assess the impact of using different deformable registration (DR) algorithms on the quality of cone-beam CT (CBCT) correction with histogram matching (HM). Methods and materials Data sets containing planning CT (pCT) and CBCT images for ten patients with prostate cancer were used. Each pCT image was registered to its corresponding CBCT image using one rigid registration algorithm with mutual information similarity metric (RR-MI) and three DR algorithms with normalized correlation coefficient, mutual information and normalized mutual information (DR-NCC, DR-MI and DR-NMI, respectively). Then, the HM was performed between deformed pCT and CBCT in order to correct the distribution of the Hounsfield Units (HU) in CBCT images. Results The visual assessment showed that the absolute difference between corrected CBCT and deformed pCT was reduced after correction with HM except for soft tissue-air and soft-tissue-bone interfaces due to the improper registration. Furthermore, volumes comparison in terms of average HU error showed that using DR-NCC algorithm with HM yielded the lowest error values of about 55.95 ± 10.43 HU compared to DR-MI and DR-NMI for which the errors were 58.60 ± 10.35 and 56.58 ± 10.51 HU, respectively. Tissue class’s comparison by the mean absolute error (MAE) plots confirmed the performance of DR-NCC algorithm to produce corrected CBCT images with lowest values of MAE even in regions where the misalignment is more pronounced. It was also found that the used method had successfully improved the spatial uniformity in the CBCT images by reducing the root mean squared difference (RMSD) between the pCT and CBCT in fat and muscle from 57 and 25 HU to 8HU, respectively. Conclusion The choice of an accurate DR algorithm before performing the HM leads to an accurate correction of CBCT images. The results suggest that applying DR process based on NCC similarity metric reduces significantly the uncertainties in CBCT images and generates images in good agreement with pCT.
Collapse
Affiliation(s)
- Halima Saadia Kidar
- Department of Physics, Ferhat Abbas Setif University, El Bez Compus, 19000, Setif, Algeria.
| | - Hacene Azizi
- Department of Physics, Ferhat Abbas Setif University, El Bez Compus, 19000, Setif, Algeria
| |
Collapse
|
33
|
Stieb S, Malla M, Graydon S, Riesterer O, Klöck S, Studer G, Tanadini-Lang S. Dosimetric influence of pitch in patient positioning for radiotherapy of long treatment volumes; the usefulness of six degree of freedom couch. Br J Radiol 2018; 91:20170704. [PMID: 30004794 DOI: 10.1259/bjr.20170704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: Pitch, the rotation around the transversal axis of the patient during radiotherapy has little impact on the dose distribution of small spherical treatment volumes; however it might affect treatment of long volumes requiring a correction with a six degree of freedom couch. METHODS: We included 10 patients each with nasopharyngeal carcinoma (NPC) and esophageal cancer, treated with volumetric modulated arc therapy. Pitch was simulated by tilting the planning CT in ventral and dorsal direction by ± 1.5° and ± 3°. Verification plans were calculated on the tilted datasets and were compared to the original plan and the dose constraints of the organs at risk (OAR). RESULTS: The deviation in dose to the planning target volume is increasing with the degree of pitch with mean changes of up to 2% for NPC and 1% for esophageal cancer. The most affected OAR in NPC patients are brainstem (max. dose +6.0%) and spinal cord (max. dose +10.0%) when tilted by 3° dorsally and lenses (max. dose +3.3%), oral mucosa (mean dose +2.6%) and parotid glands (mean dose +4.3%) when tilted by 3° ventrally. For esophageal cancer patients, there was no significant change in dose to any OAR. Whereas for esophageal cancer, all tilted treatment plans were still clinically acceptable regarding OAR, 5 NPC plans would no longer be acceptable with a pitch of 1.5° ventral (N = 1), 3° ventral (N = 2) and 3° dorsal (N = 2). CONCLUSION: Planning target volume coverage in both tumor entities was only slightly affected, but pitch errors could be relevant for OAR in NPC patients. ADVANCES IN KNOWLEDGE: A correction with a six degree of freedom couch is recommended for NPC patients with a pitch mismatch of more than 1.5° to avoid exceeded doses to the OAR.
Collapse
Affiliation(s)
- Sonja Stieb
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland.,2 Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland
| | - Michelle Malla
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland
| | - Shaun Graydon
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland
| | - Oliver Riesterer
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland
| | - Stephan Klöck
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland
| | - Gabriela Studer
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland.,3 Institute for Radiation Oncology, Cantonal Hospital Lucerne , Lucerne , Switzerland
| | - Stephanie Tanadini-Lang
- 1 Department of Radiation Oncology, University Hospital Zurich and University of Zurich , Zurich, , Switzerland
| |
Collapse
|
34
|
Wei M, Ye Q, Wang X, Wang M, Hu Y, Yang Y, Yang J, Cai J. Early tumor shrinkage served as a prognostic factor for patients with stage III non-small cell lung cancer treated with concurrent chemoradiotherapy. Medicine (Baltimore) 2018; 97:e0632. [PMID: 29742701 PMCID: PMC5959434 DOI: 10.1097/md.0000000000010632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Lung cancer is the most common cause of cancer death. About 80% of patients are diagnosed at stage III in the non-small cell lung cancer (NSCLC). It is extremely important to understand the progression of this disease which has low survival times despite the advancing treatment modalities. We aimed to investigate the relationship between early tumor shrinkage (ETS) after initial concurrent chemoradiotherapy (C-CRT) and survival outcome in patients with stage III (NSCLC). METHODS A retrospective review of 103 patients with stage III NSCLC who had received C-CRT from January 2006 to October 2011 was performed. Patients were treated with systemic chemotherapy regimen of Cisplatin/Vp-16 and concurrent thoracic radiotherapy at a median dose of 66 Gy (range 60-70 Gy). All patients received a computed tomography (CT) examination before treatment. Also subsequently, chest CT scans were performed with the same imaging parameters at approximately 5 weeks after the initiation of treatment. ETS is here stratified by a decrease in tumor size ≥30% and <30% in the longest dimension of the target lesion within 5 weeks. RESULTS Of the 103 patients, 59 ones showed a 30% decrease in tumor size, and the rest displayed a decrease of <30%. ETS showed no significant correlation with age, T classification, N classification, histological classification, smoking status, G classification, EGFR status, or acute pulmonary toxicity. In the current retrospective clinical study, Kaplan-Meier curves showed that patients with ETS ≥ 30% had a better progression-free survival and overall survival. The univariate and multivariate Cox regression analyses indicated that ETS < 30% was associated with a significantly increased risk of cancer-related death (P < .05) in stage IIINSCLC. CONCLUSIONS ETS may be served as a useful prognostic factor to predict the outcome of stage III NSCLC patients treated with CCRT.
Collapse
Affiliation(s)
| | - Qingqing Ye
- Department of Surgical Oncology, First Affiliated Hospital of Yangtze University, Jingzhou, Hubei, China
| | | | | | | | | | | | | |
Collapse
|
35
|
Gurney-Champion OJ, McQuaid D, Dunlop A, Wong KH, Welsh LC, Riddell AM, Koh DM, Oelfke U, Leach MO, Nutting CM, Bhide SA, Harrington KJ, Panek R, Newbold KL. MRI-based Assessment of 3D Intrafractional Motion of Head and Neck Cancer for Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 100:306-316. [PMID: 29229323 PMCID: PMC5777665 DOI: 10.1016/j.ijrobp.2017.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/14/2017] [Accepted: 10/03/2017] [Indexed: 01/25/2023]
Abstract
PURPOSE To determine the 3-dimensional (3D) intrafractional motion of head and neck squamous cell carcinoma (HNSCC). METHODS AND MATERIALS Dynamic contrast-enhanced magnetic resonance images from 56 patients with HNSCC in the treatment position were analyzed. Dynamic contrast-enhanced magnetic resonance imaging consisted of 3D images acquired every 2.9 seconds for 4 minutes 50 seconds. Intrafractional tumor motion was studied in the 3 minutes 43 seconds of images obtained after initial contrast enhancement. To assess tumor motion, rigid registration (translations only) was performed using a region of interest (ROI) mask around the tumor. The results were compared with bulk body motion from registration to all voxels. Motion was split into systematic motion and random motion. Correlations between the tumor site and random motion were tested. The within-subject coefficient of variation was determined from 8 patients with repeated baseline measures. Random motion was also assessed at the end of the first week (38 patients) and second week (25 patients) of radiation therapy to investigate trends of motion. RESULTS Tumors showed irregular occasional rapid motion (eg, swallowing or coughing), periodic intermediate motion (respiration), and slower systematic drifts throughout treatment. For 95% of the patients, displacements due to systematic and random motion were <1.4 mm and <2.1 mm, respectively, 95% of the time. The motion without an ROI mask was significantly (P<.0001, Wilcoxon signed rank test) less than the motion with an ROI mask, indicating that tumors can move independently from the bony anatomy. Tumor motion was significantly (P=.005, Mann-Whitney U test) larger in the hypopharynx and larynx than in the oropharynx. The within-subject coefficient of variation for random motion was 0.33. The average random tumor motion did not increase notably during the first 2 weeks of treatment. CONCLUSIONS The 3D intrafractional tumor motion of HNSCC is small, with systematic motion <1.4 mm and random motion <2.1 mm 95% of the time.
Collapse
Affiliation(s)
- Oliver J Gurney-Champion
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
| | - Dualta McQuaid
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Alex Dunlop
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Kee H Wong
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Liam C Welsh
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Angela M Riddell
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Uwe Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Martin O Leach
- CR UK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Christopher M Nutting
- Joint Department of Radiotherapy, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Shreerang A Bhide
- Joint Department of Radiotherapy, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Kevin J Harrington
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Rafal Panek
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kate L Newbold
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| |
Collapse
|
36
|
Kung JS, Tran WT, Poon I, Atenafu EG, Courneyea L, Higgins K, Enepekides D, Sahgal A, Chin L, Karam I. Evaluation of the Efficacy of Rotational Corrections for Standard-Fractionation Head and Neck Image-Guided Radiotherapy. Technol Cancer Res Treat 2018; 18:1533033819853824. [PMID: 31122178 PMCID: PMC6535727 DOI: 10.1177/1533033819853824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 03/23/2019] [Accepted: 04/24/2019] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Modern linear accelerators are equipped with cone beam computed tomography and robotic couches that can correct for errors in the translational (X, Y, Z) and rotational (α, β, γ) axes prior to treatment delivery. Here, we compared the positional accuracy of 2 cone beam registration approaches: (1) employing translational shifts only in 3 degrees of freedom (X, Y, Z), versus; (2) using translational-rotational shifts in 6 degrees of freedom (X, Y, Z, α, β, γ). METHODS This retrospective study examined 140 interfraction cone beam images from 20 patients with head and neck cancer treated with standard intensity-modulated radiation therapy. The cone beam images were matched to planning simulation scans in 3, then in 6 degrees of freedom, using the mandible, clivus, and C2 and C7 vertebrae as surrogate volumes. Statistical analyses included a generalized mixed model and was used to assess whether there were significant differences in acceptable registrations between the 2 correction methods. RESULTS The rates of improvement with corrections in 6 degrees of freedom for the mandible with a 5-mm expansion margin were 54.55% ( P = .793), for the clivus 85.71% ( P = .222), and for C7 87.50% ( P = .015). There was a 100% increase in acceptability for the C2 vertebra within the 5-mm margin ( P < .001). For the 3-mm expansion margin, the rates of improvement for the mandible, clivus, C2, and C7 were 63.16% ( P = .070), 91.30% ( P = .011), 84.21% ( P = .027), and 76.92% ( P < .001), respectively. CONCLUSIONS Significant registration improvements with the use of rotational corrections with a 5-mm expansion margin are only seen in the C7 vertebra. At the 3-mm margin, significant improvements are found for the C2, C7, and clivus registrations, suggesting that intensity-modulated radiotherapy treatments for head and neck cancers with 3-mm planning target volume margins may benefit from corrections in 6 degrees of freedom.
Collapse
Affiliation(s)
- Joseph S. Kung
- Division of Radiation Therapy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - William T. Tran
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Eshetu G. Atenafu
- Department of Biostatistics, University Health Network, Toronto, Ontario, Canada
| | - Lorraine Courneyea
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology/Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology/Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lee Chin
- Department of Medical Physics, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| |
Collapse
|
37
|
Fangzheng W, Quanquan S, Chuner J, Zhimin Y, Shuangyan Y, Huanhuan Y, Jianfang S, Sakamoto M, Weifeng Q, Zhenfu F, Yangming J, Yuezhen W. Optimization of the margin expanded from the clinical to the planned target volume during intensity-modulated radiotherapy for nasopharyngeal carcinoma. Oncotarget 2017; 8:110201-110208. [PMID: 29299141 PMCID: PMC5746376 DOI: 10.18632/oncotarget.22518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/03/2017] [Indexed: 12/25/2022] Open
Abstract
During the radiotherapy process, the emergence of set-up errors is nearly inevitable. Because set-up errors were not detected and corrected daily, planned target volumes were formed by expanding the clinical target volume according to each unit's experience. We optimized the margins of clinical and planned target volumes during administration of intensity-modulated radiotherapy for nasopharyngeal carcinoma. A total of 72 patients newly diagnosed with non-metastatic nasopharyngeal carcinoma and treated with Tomotherapy were prospectively enrolled in the study. For each patient, one megavoltage computed tomography scan was obtained after conventional positioning, online correction, and daily tomotherapy delivery. The interfraction set-up errors were determined using a planning CT based on the registered scan. The mean interfraction errors were -2.437±2.0529 mm, 0.0652±2.3844 mm, 0.318±1.8314 mm, and 0.197±1.8721° for the medial-lateral, superior-inferior, and anterior-posterior directions, and the direction of rotation, respectively. The total MPTV in the three directions was 7.53 mm, 1.83 mm, and 2.08 mm, respectively. The 3-mm margins in the superior-inferior and anterior-posterior directions uniformly expanded from the clinical target volume should be sufficient, and the marging in the medial-lateral direction was up to 7.5 mm. These results suggest that personalized MPTV may be adopted for intensity-modulated radiotherapy planning.
Collapse
Affiliation(s)
- Wang Fangzheng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Radiobiology Research Unit Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, China
| | - Sun Quanquan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Radiobiology Research Unit Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, China
| | - Jiang Chuner
- Department of Breast Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Ye Zhimin
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Radiobiology Research Unit Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, China
| | - Yang Shuangyan
- Department of Physics, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Yu Huanhuan
- Department of Physics, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Shi Jianfang
- Department of Physics, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - Masoto Sakamoto
- Department of Radiology, Fukui Red Cross Hospital, Fukui 918-8501, Japan
| | - Qin Weifeng
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Radiobiology Research Unit Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, China
| | - Fu Zhenfu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Radiobiology Research Unit Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, China
| | - Jiang Yangming
- Department of Digital Earth, Institute of Remote Sensing and Digital Earth, CAS, Beijing 100101, China
| | - Wang Yuezhen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.,Radiobiology Research Unit Key Laboratory of Radiation Oncology of Zhejiang Province, Hangzhou 310022, China
| |
Collapse
|
38
|
Sasaki M, Nakamura M, Mukumoto N, Nakata M, Hiraoka M. Dosimetric impact of translational and rotational setup errors for spine stereotactic body radiotherapy: A phantom study. Med Dosim 2017; 43:320-326. [PMID: 29217331 DOI: 10.1016/j.meddos.2017.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 09/26/2017] [Accepted: 10/31/2017] [Indexed: 11/19/2022]
Abstract
This study aimed to investigate experimentally the effect of translational and rotational setup errors on 3-dimensional dose distributions by using the gamma index and dose volumetric indices for spine stereotactic body radiotherapy. Treatment plans were designed in accordance with the Radiation Therapy Oncology Group (RTOG) 0631 protocol. Measurements were taken using a Delta4 phantom (ScandiDos, Uppsala, Sweden). Setup errors were generated using the HexaMotion 6D moving platform (ScandiDos). Dose distributions in the presence of setup errors were evaluated, according to the γ passing rate with the 3% and 2 mm criteria (γ3%/2 mm) and dose volumetric indices (D90 for the target volume and D2 for the spinal cord), using the Delta4 device (ScandiDos). The sensitivity coefficient, which represented the correlation between the γ3%/2 mm passing rate and dose volumetric indices, was determined to assess robustness against setup errors. Rotational setup errors of 2° were equivalent to translational setup errors of 2 mm for the γ3%/2 mm passing rate, D90 for the target, and D2 for the spinal cord. D90 for the target had low robustness against a translational setup error in the vertical direction and a rotational setup error in the pitch direction. D2 for the spinal cord was sensitive to a translational setup error in the lateral direction and a rotational setup error in the roll direction. The positioning accuracy of the rotational setup error, corresponding to the tolerance level of image-guided radiotherapy in the RTOG 0631 protocol, was required to be ≤ 2°.
Collapse
Affiliation(s)
- Makoto Sasaki
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Nobutaka Mukumoto
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Manabu Nakata
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, Kyoto, Japan
| |
Collapse
|
39
|
Chuter RW, Whitehurst P, Choudhury A, van Herk M, McWilliam A. Technical Note: Investigating the impact of field size on patient selection for the 1.5T MR-Linac. Med Phys 2017; 44:5667-5671. [PMID: 28869651 DOI: 10.1002/mp.12557] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The 1.5 T Elekta MR-Linac, due to the construction of the system will have a maximum radiation field size in the superior-inferior patient direction of 22 cm at isocentre. The field size may impact on the patient groups which can be treated on the system. This technical note aims to address the question of which treatment sites will be affected by field size limitations on the MR-Linac. METHODS Using historical data for 11 595 cases over 2 yr treated at the authors' institution, the proportion of plans that would fit the MR-Linac's field size was determined for eleven patient groups. In addition, cervix plans were analyzed to determine the length of the two Clinical Target Volumes (CTVs) and any overlap between them. RESULTS With a 1 cm margin to allow for online plan adaption, 80% of all plans would be suitable for the MR-Linac due to the field size. This percentage increases to 100% for smaller tumor volumes such as prostate and brain. However, for cervix and three dose-level head and neck plans the percentage becomes 61% and 66%, respectively. CONCLUSION The maximum radiation field size of the MR-Linac in the superior-inferior patient direction is 22 cm. With a 1 cm margin approximately 80% of all plans would be suitable for the MR-Linac with the available field size, decreasing to 61% for larger tumor volumes. For cervix patients this may motivate investigations into treating each CTV with a separate isocentre, allowing for careful control of matching fields.
Collapse
Affiliation(s)
- Robert W Chuter
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
- Division of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, M13 9PL, UK
| | - Philip Whitehurst
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, M13 9PL, UK
- Clinical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
| | - Marcel van Herk
- Division of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, M13 9PL, UK
| | - Alan McWilliam
- Christie Medical Physics and Engineering (CMPE), The Christie NHS Foundation Trust, Wilmslow Road, Manchester, M20 4BX, UK
- Division of Cancer Sciences, Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, M13 9PL, UK
| |
Collapse
|
40
|
Dhillon A, Erler D, Poon I, Lee J, Enepekides D, Higgins K, Chin L, Karam I. The Impact of Correcting for Translational and Rotational Errors Using the HexaPOD in Head and Neck Stereotactic Body Radiation Therapy Patients. J Med Imaging Radiat Sci 2017; 48:276-281. [DOI: 10.1016/j.jmir.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 11/17/2022]
|
41
|
Anjanappa M, Rafi M, Bhasi S, Kumar R, Thommachan KC, Bhattacharya T, Ramadas K. Setup uncertainties and PTV margins at different anatomical levels in intensity modulated radiotherapy for nasopharyngeal cancer. Rep Pract Oncol Radiother 2017; 22:396-401. [PMID: 28831279 PMCID: PMC5552104 DOI: 10.1016/j.rpor.2017.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/17/2017] [Accepted: 07/18/2017] [Indexed: 12/25/2022] Open
Abstract
AIM To determine the systematic error (∑), random error (σ) and derive PTV margin at different levels of the target volumes in Nasopharyngeal Cancer (NPC). MATERIALS AND METHODS A retrospective offline review was done for patients who underwent IMRT for NPC from June 2015 to May 2016 at our institution. Alternate day kV images were matched with digitally reconstructed radiographs to know the setup errors. All radiographs were matched at three levels - the clivus, third cervical (C3) and sixth cervical (C6) vertebra. The shifts in positions along the vertical, longitudinal and lateral axes were noted and the ∑ and σ at three levels were calculated. PTV margins were derived using van Herk's formula. RESULTS Twenty patients and 300 pairs of orthogonal portal films were reviewed. The ∑ for the clivus, C3 and C6 along vertical, longitudinal and lateral directions were 1.6 vs. 1.8 vs. 2 mm; 1.2 vs. 1.4 vs. 1.4 mm and 0.9 vs. 1.6 and 2.3 mm, respectively. Similarly, the random errors were 1.1 vs. 1.4 vs. 1.8 mm; 1.1 vs. 1.2 vs. 1.2 mm and 1.2 vs. 1.3 vs. 1.6 mm. The PTV margin at the clivus was 4.4 mm along the vertical, 4 mm along the longitudinal direction and 3.2 m in the lateral direction. At the C3 level, it was 5.5 mm in the vertical, 5 mm in the lateral direction and 4.4 mm in the longitudinal direction. At the C6 level, it was 6.4 mm in the vertical, 6.9 mm in the lateral direction and 4.4 mm in the longitudinal direction. CONCLUSION A differential margin along different levels of target may be necessary to adequately cover the target.
Collapse
Affiliation(s)
- Milan Anjanappa
- Division of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Malu Rafi
- Division of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Saju Bhasi
- Division of Radiation Physics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Rejnish Kumar
- Division of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | | | - Tapesh Bhattacharya
- Division of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Kunnambath Ramadas
- Division of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| |
Collapse
|
42
|
Sonier M, Chu W, Lalani N, Erler D, Cheung P, Korol R. Evaluation of kidney motion and target localization in abdominal SBRT patients. J Appl Clin Med Phys 2016; 17:429-433. [PMID: 27929514 PMCID: PMC5690515 DOI: 10.1120/jacmp.v17i6.6406] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/05/2016] [Accepted: 06/29/2016] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to evaluate bilateral kidney and target translational/rotational intrafraction motion during stereotactic body radiation therapy treatment delivery of primary renal cell carcinoma and oligometastatic adrenal lesions for patients immobilized in the Elekta BodyFIX system. Bilateral kidney motion was assessed at midplane for 30 patients immobilized in a full‐body dual‐vacuum‐cushion system with two patients immobilized via abdominal compression. Intrafraction motion was assessed for 15 patients using kilovoltage cone‐beam computed tomography (kV‐CBCT) datasets (n=151) correlated to the planning CT. Patient positioning was corrected for translational and rotational misalignments using a robotic couch in six degrees of freedom if setup errors exceeded 1 mm and 1°. Absolute bilateral kidney motion between inhale and exhale 4D CT imaging phases for left–right (LR), superior–inferior (SI), and anterior–posterior (AP) directions was 1.51±1.00mm,8.10±4.33mm, and 3.08±2.11mm, respectively. Residual setup error determined across CBCT type (pretreatment, intrafraction, and post‐treatment) for x (LR), y (SI), and z (AP) translations was 0.63±0.74mm,1.08±1.38mm, and 0.70±1.00mm; while for x (pitch), y (roll), and z (yaw) rotations was 0.24±0.39°,0.19±0.34°, and 0.26±0.43°, respectively. Targets were localized to within 2.1 mm and 0.8° 95% of the time. The frequency of misalignments in the y direction was significant (p<0.05) when compared to the x and z directions with no significant difference in translations between IMRT and VMAT. This technique is robust using BodyFIX for patient immobilization and reproducible localization of kidney and adrenal targets and daily CBCT image guidance for correction of positional errors to maintain treatment accuracy. PACS number(s): 87.55.‐x, 87.56.‐v, 87.56.Da
Collapse
|
43
|
Garibaldi C, Piperno G, Ferrari A, Surgo A, Muto M, Ronchi S, Bazani A, Pansini F, Cremonesi M, Jereczek-Fossa BA, Orecchia R. Translational and rotational localization errors in cone-beam CT based image-guided lung stereotactic radiotherapy. Phys Med 2016; 32:859-65. [PMID: 27289354 DOI: 10.1016/j.ejmp.2016.05.055] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 05/16/2016] [Accepted: 05/18/2016] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Accurate localization is crucial in delivering safe and effective stereotactic body radiation therapy (SBRT). The aim of this study was to analyse the accuracy of image-guidance using the cone-beam computed tomography (CBCT) of the VERO system in 57 patients treated for lung SBRT and to calculate the treatment margins. MATERIALS AND METHODS The internal target volume (ITV) was obtained by contouring the tumor on maximum and mean intensity projection CT images reconstructed from a respiration correlated 4D-CT. Translational and rotational tumor localization errors were identified by comparing the manual registration of the ITV to the motion-blurred tumor on the CBCT and they were corrected by means of the robotic couch and the ring rotation. A verification CBCT was acquired after correction in order to evaluate residual errors. RESULTS The mean 3D vector at initial set-up was 6.6±2.3mm, which was significantly reduced to 1.6±0.8mm after 6D automatic correction. 94% of the rotational errors were within 3°. The PTV margins used to compensate for residual tumor localization errors were 3.1, 3.5 and 3.3mm in the LR, SI and AP directions, respectively. CONCLUSIONS On-line image guidance with the ITV-CBCT matching technique and automatic 6D correction of the VERO system allowed a very accurate tumor localization in lung SBRT.
Collapse
Affiliation(s)
- Cristina Garibaldi
- Unit of Radiation Research, European Institute of Oncology, Milano, Italy.
| | - Gaia Piperno
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Annamaria Ferrari
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Alessia Surgo
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Matteo Muto
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Sara Ronchi
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy
| | - Alessia Bazani
- Unit of Medical Physics, European Institute of Oncology, Milano, Italy
| | - Floriana Pansini
- Unit of Medical Physics, European Institute of Oncology, Milano, Italy
| | - Marta Cremonesi
- Unit of Radiation Research, European Institute of Oncology, Milano, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milano, Italy; Department of Health Sciences, Università degli Studi di Milano, Milano, Italy
| | - Roberto Orecchia
- Department of Health Sciences, Università degli Studi di Milano, Milano, Italy; Scientific Director, European Institute of Oncology, Milano, Italy
| |
Collapse
|
44
|
Kaur I, Rawat S, Ahlawat P, Kakria A, Gupta G, Saxena U, Mishra MB. Dosimetric impact of setup errors in head and neck cancer patients treated by image-guided radiotherapy. J Med Phys 2016; 41:144-8. [PMID: 27217627 PMCID: PMC4871004 DOI: 10.4103/0971-6203.181640] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
To assess and analyze the impact of setup uncertainties on target volume coverage and doses to organs at risk (OAR) in head and neck cancer (HNC) patients treated by image-guided radiotherapy (IGRT). Translational setup errors in 25 HNC patients were observed by kilovoltage cone beam computed tomography (kV CBCT). Two plans were generated. Plan one – the original plan which was the initially optimized and approved plan of the patient. All patients were treated according to their respective approved plans at a defined isocenter. Plan two – the plan sum which was the sum of all plans recalculated at a different isocenter according to setup errors in x, y, and z-direction. Plan sum was created to evaluate doses that would have been received by planning target volume (PTV) and OARs if setup errors were not corrected. These 2 plans were analyzed and compared in terms of target volume coverage and doses to OARs. A total 503 kV CBCT images were acquired for evaluation of setup errors in 25 HNC patients. The systematic (mean) and random errors (standard deviation) combined for 25 patients in x, y, and z directions were 0.15 cm, 0.21 cm, and 0.19 cm and 0.09 cm, 0.12 cm, and 0.09 cm, respectively. The study showed that there was a significant difference in PTV coverage between 2 plans. The doses to various OARs showed a nonsignificant increase in the plan sum. The correction of translational setup errors is essential for IGRT treatment in terms of delivery of planned optimal doses to target volume.
Collapse
Affiliation(s)
- Inderjit Kaur
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Sheh Rawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Parveen Ahlawat
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anjali Kakria
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Gourav Gupta
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Upasna Saxena
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Manindra Bhushan Mishra
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| |
Collapse
|
45
|
Wang H, Wang C, Tung S, Dimmitt AW, Wong PF, Edson MA, Garden AS, Rosenthal DI, Fuller CD, Gunn GB, Takiar V, Wang XA, Luo D, Yang JN, Wong J, Phan J. Improved setup and positioning accuracy using a three-point customized cushion/mask/bite-block immobilization system for stereotactic reirradiation of head and neck cancer. J Appl Clin Med Phys 2016; 17:180-189. [PMID: 27167275 PMCID: PMC5690911 DOI: 10.1120/jacmp.v17i3.6038] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 01/19/2016] [Accepted: 01/11/2016] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to investigate the setup and positioning uncertainty of a custom cushion/mask/bite‐block (CMB) immobilization system and determine PTV margin for image‐guided head and neck stereotactic ablative radiotherapy (HN‐SABR). We analyzed 105 treatment sessions among 21 patients treated with HN‐SABR for recurrent head and neck cancers using a custom CMB immobilization system. Initial patient setup was performed using the ExacTrac infrared (IR) tracking system and initial setup errors were based on comparison of ExacTrac IR tracking system to corrected online ExacTrac X‐rays images registered to treatment plans. Residual setup errors were determined using repeat verification X‐ray. The online ExacTrac corrections were compared to cone‐beam CT (CBCT) before treatment to assess agreement. Intrafractional positioning errors were determined using prebeam X‐rays. The systematic and random errors were analyzed. The initial translational setup errors were −0.8±1.3 mm, −0.8±1.6 mm, and 0.3±1.9 mm in AP, CC, and LR directions, respectively, with a three‐dimensional (3D) vector of 2.7±1.4 mm. The initial rotational errors were up to 2.4° if 6D couch is not available. CBCT agreed with ExacTrac X‐ray images to within 2 mm and 2.5°. The intrafractional uncertainties were 0.1±0.6 mm, 0.1±0.6 mm, and 0.2±0.5 mm in AP, CC, and LR directions, respectively, and 0.0∘±0.5°, 0.0∘±0.6°, and −0.1∘±0.4∘ in yaw, roll, and pitch direction, respectively. The translational vector was 0.9±0.6 mm. The calculated PTV margins mPTV(90,95) were within 1.6 mm when using image guidance for online setup correction. The use of image guidance for online setup correction, in combination with our customized CMB device, highly restricted target motion during treatments and provided robust immobilization to ensure minimum dose of 95% to target volume with 2.0 mm PTV margin for HN‐SABR. PACS number(s): 87.55.ne
Collapse
Affiliation(s)
- He Wang
- The University of Texas MD Anderson Cancer Center.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Li J, Tang XB, Zhang XZ, Zhang XW, Ge Y, Chen D, Chai L. Analysis of the setup errors of medical image registration-based cone-beam CT for lung cancer. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2016; 24:521-530. [PMID: 27061797 DOI: 10.3233/xst-160568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE This study aimed to investigate the feasibility of efficiently using a rigid image registration (RIR) algorithm or a deformable image registration (DIR) algorithm to match medical images and evaluate the impact of setup errors on intensity modulated radiation therapy of lung cancer patients. METHODS Ten lung cancer patients were chosen randomly each day and were subjected to image-guided radiotherapy. The clinical registration between cone-beam computed tomography (CBCT) images and treatment planning system CT images was performed by applying both RIR and DIR; the clinical registration was evaluated on the basis of the contour index, including dice similarity coefficient, sensitivity, and positive predictive value; the optimal scheme of image registration was selected to ensure that the actual irradiation isocenter was consistent with the treatment planning isocenter. In each patient, the translational errors in the right-left (x), superior-inferior (y), and anterior-posterior (z) directions and the rotational errors in the u, υ, and w directions formed by the x, y, and z directions were calculated and analyzed daily in the whole course of treatment; margins were calculated according to this equation: M = 2.5∑+ 0.7δ. RESULTS The tumors and the surrounding soft tissues of the patients are shown more clearly in the CBCT images than in the CT images. DIR can be applied more efficiently than RIR to determine the morphological and positional changes in the organs shown in the images with the same or different modalities in the different period. The setup errors in translation in the x, y and z axes were 0.05±0.16, 0.09±0.32 and -0.02±0.13 cm, respectively; by contrast, the setup errors in rotation in u, υ and w directions were (0.41±0.64)°, (-0.08±0.57)° and (-0.03±0.62)°, respectively. The setup errors in the x, y and z axes of the patients indicated that the margins expansions were 0.82, 1.15 and 0.72 cm, respectively. CONCLUSION CBCT with DIR can measure and correct the setup errors online; as a result, setup errors in lung cancer treatments can be significantly reduced and the accuracy of radiotherapy can be enhanced.
Collapse
Affiliation(s)
- Jun Li
- Department of Nuclear Science & Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, P. R. China
- Radiotherapy Center, Subei People's Hospital of Jiangsu province, Yangzhou, P. R. China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, P. R. China
| | - Xiao-Bin Tang
- Department of Nuclear Science & Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, P. R. China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, P. R. China
| | - Xi-Zhi Zhang
- Radiotherapy Center, Subei People's Hospital of Jiangsu province, Yangzhou, P. R. China
| | - Xian-Wen Zhang
- Radiotherapy Center, Subei People's Hospital of Jiangsu province, Yangzhou, P. R. China
| | - Yun Ge
- School of Electronic Science and Engineering, Nanjing University, Nanjing, P. R. China
| | - Da Chen
- Department of Nuclear Science & Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, P. R. China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, P. R. China
| | - Lei Chai
- Department of Nuclear Science & Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, P. R. China
- Collaborative Innovation Center of Radiation Medicine of Jiangsu Higher Education Institutions, P. R. China
| |
Collapse
|
47
|
Arthurs M, Gillham C, O'Shea E, McCrickard E, Leech M. Dosimetric comparison of 3-dimensional conformal radiation therapy and intensity modulated radiation therapy and impact of setup errors in lower limb sarcoma radiation therapy. Pract Radiat Oncol 2016; 6:119-25. [PMID: 26932232 DOI: 10.1016/j.prro.2015.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/19/2015] [Accepted: 03/30/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE This study compared dosimetric data between 3-dimensional conformal radiation therapy (3DCRT) and intensity modulated radiation therapy (IMRT) plans in a population of patients with lower limb sarcoma immobilized with an in-house device and quantified the impact of systematic and random errors on these techniques. The dosimetric effects of displacements on target coverage and organs at risk (OARs) were considered. METHODS AND MATERIALS Plans were created for 11 postoperative patients using both 3DCRT and IMRT. The techniques were compared dosimetrically. Population-based systematic and random errors were applied and the results compared with the initial plans. RESULTS Higher target D95, D2, D98, and D50 and the best homogeneity index resulted with IMRT compared with 3DCRT. Systematic errors increased target D2 in IMRT. Random errors decreased target homogeneity in IMRT. Maximum bone dose was higher in IMRT than in 3DCRT. Neither error type increased OAR dose for either technique. CONCLUSIONS IMRT could become the favored lower limb sarcoma radiation therapy technique because of superior target coverage and homogeneity. Offline imaging can adequately correct for systematic errors in these patients when an in-house immobilization device is used.
Collapse
Affiliation(s)
- Meadhbh Arthurs
- Applied Radiation Therapy Trinity Research Group, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland
| | | | - Evelyn O'Shea
- St. Luke's Radiation Oncology Network, Dublin, Ireland
| | | | - Michelle Leech
- Applied Radiation Therapy Trinity Research Group, Discipline of Radiation Therapy, School of Medicine, Trinity College Dublin, Ireland.
| |
Collapse
|
48
|
Zhang X, Shan GP, Liu JP, Wang BB. Margin evaluation of translational and rotational set-up errors in intensity modulated radiotherapy for cervical cancer. SPRINGERPLUS 2016; 5:153. [PMID: 27026850 PMCID: PMC4766143 DOI: 10.1186/s40064-016-1796-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/12/2016] [Indexed: 12/04/2022]
Abstract
A clinical target volume (CTV) to planning target volume (PTV) margin recipes was routinely used to ensure dose was actually delivered to target for all (most) patients. Currently used margin recipes were associated with only translational set-up errors in radiotherapy. However, when set-up errors extended to six-degree (6D) scope (three translational and three rotational set-up errors), margin recipe should be re-evaluated. The purpose of this study was to investigate dosimetric changes of targets (both CTV and PTV) coverage when 6D set-up errors were introduced and testify the practicability of currently used margin recipe in radiotherapy. A total number of 105 cone beam computer tomography scans for ten patients with cervical cancer were derived prior to treatment delivery and 6D set-up errors were acquired with image registration tools. Target coverage was evaluated retrospectively for 6D set-up errors introduced plan with 6 mm CTV to PTV margin. Target coverage of PTV showed significant decreases (3.3 %) in set-up errors introduced plans compared with original plans. But CTV coverage was not susceptible to these set-up errors. A tendency of coverage decrease for PTV along with distance away from treatment was testified, from −0.2 to −6.2 %. However, CTV seems changed less, from −0.2 to −0.8 %. The result indicate that a CTV to PTV margin of 6 mm was sufficient to take into account 6D set-up errors for most patients with cervical cancer. Future research suggests a smaller margin to further improve both tumor coverage and organs at risk sparing.
Collapse
Affiliation(s)
- Xiang Zhang
- Department of Gynecologic Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, 310022 China ; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310022 China
| | - Guo-Ping Shan
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou, 310022 China ; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310022 China
| | - Ji-Ping Liu
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou, 310022 China ; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310022 China
| | - Bin-Bing Wang
- Department of Radiation Physics, Zhejiang Cancer Hospital, Hangzhou, 310022 China ; Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, 310022 China
| |
Collapse
|
49
|
Katayama H, Ookubo M, Tsuzuki M, Sasakawa Y, Takahashi S, Shibata T. [Impact of Pelvic Rotational Setup Error on Lymph Nodal Dose in Whole Pelvic IMRT Using Fiducial Markers]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:1152-1160. [PMID: 27867176 DOI: 10.6009/jjrt.2016_jsrt_72.11.1152] [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: 06/06/2023]
Abstract
PURPOSE The aim of this study was to investigate the impact of pelvic rotational setup error on lymph nodal dose in the whole pelvic intensity-modulated radiation therapy using the fiducial marker. METHODS The dose differences of clinical target volume for pelvic lymph node (CTVLN) due to isocenter (IC) shift and pelvic rotation were evaluated using the radiation treatment planning system. The rotated computed tomography (CT) images were created for the simulation of the pelvic rotation. The original CT images were rotated around the IC of the original plan in the pitch and roll directions up to±3.0 deg. at 1.0 deg. intervals. As simulated plans, IC positions were shifted in the anterior-posterior and superior-inferior directions up to±10 mm at 2 mm intervals in the original and rotated CT images, and the dose distributions were calculated. The dose calculation was performed for each CT image while keeping the movement of multi leaf collimator and the monitor unit of the original plan. The differences between D98% of CTVLN in the original plan and simulated plans were calculated. RESULTS In the posterior direction shifts of 4, 6, 8, and 10 mm, the dose reduction of 0.7, 2.1, 6.1, and 11.9% from the original plan were found for D98% of CTVLN, respectively. The dose reductions due to the rotation of pitch direction were greater than the rotation of roll direction. In the posterior direction shifts of 4, 6, 8, and 10 mm with 3.0 deg. rotation of pitch direction, the dose reduction of 2.2, 6.8, 12.8, and 19.0% from the original plan were found, respectively. CONCLUSION The dose reduction of CTVLN might be occurred due to the rotational setup error of pitch direction.
Collapse
Affiliation(s)
- Hiroki Katayama
- Department of Clinical Radiology, Kagawa University Hospital
| | | | | | | | | | | |
Collapse
|
50
|
CBCT image guidance in head and neck irradiation: the impact of daily and weekly imaging protocols. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractPurposeThis study evaluated the impact of a daily and weekly image-guided radiotherapy protocols in reducing setup errors and setting of appropriate margins in head and neck cancer patients.Materials and methodsInterfraction and systematic shifts for the hypothetical day 1–3 plus weekly imaging were extrapolated from daily imaging data from 31 patients (964 cone beam computed tomography (CBCT) scans). In addition, residual setup errors were calculated by taking the average shifts in each direction for each patient based on the first three shifts and were presumed to represent systematic setup error. The clinical target volume (CTV) to planning target volume (PTV) margins were calculated using van Herk formula and analysed for each protocol.ResultsThe mean interfraction shifts for daily imaging were 0·8, 0·3 and 0·5 mm in the S-I (superior-inferior), L-R (left-right) and A-P (anterior-posterior) direction, respectively. On the other hand the mean shifts for day 1–3 plus weekly imaging were 0·9, 1·8 and 0·5 mm in the S-I, L-R and A-P direction, respectively. The mean day 1–3 residual shifts were 1·5, 2·1 and 0·7 mm in the S-I, L-R and A-P direction, respectively. No significant difference was found in the mean setup error for the daily and hypothetical day 1–3 plus weekly protocol. However, the calculated CTV to PTV margins for the daily interfraction imaging data were 1·6, 3·8 and 1·4 mm in the S-I, L-R and A-P directions, respectively. Hypothetical day 1–3 plus weekly resulted in CTV–PTV margins of 5, 4·2 and 5 mm in the S-I, L-R and A-P direction.ConclusionsThe results of this study show that a daily CBCT protocol reduces setup errors and allows setup margin reduction in head and neck radiotherapy compared to a weekly imaging protocol.
Collapse
|