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Sarkar B, Pradhan A. Setup time analysis for stereotactic body radiotherapy in O-ring linear accelerator without rotational correction. Radiol Phys Technol 2024; 17:527-535. [PMID: 38526690 DOI: 10.1007/s12194-024-00791-0] [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: 10/17/2023] [Revised: 02/10/2024] [Accepted: 02/14/2024] [Indexed: 03/27/2024]
Abstract
This study analyse setup time (ST) and frequency of on-board imaging for stereotactic abdomen (liver, stomach), lung, and spine radiotherapy in the absence of automatic rotational correction. Total 53 stereotactic body radiotherapy (SBRT) patients, 28 of abdomen, 19 lung, and 6 spine treated for 230 sessions in O-ring gantry accelerator were evaluated for ST analysis. The mean setup time for all patients, abdomen, lung, and spine cases were 7.7 ± 7.4 min, 9.2 ± 9.2 min, 6.3 ± 4.1 min, and 5.5 ± 3.3 min, respectively. Median number CBCT was 2. 96% of cases had a CBCT between 1 and 3, and 9 (4%) had ≥ 4 CBCTs. Overall, 38.1%, 35.5%, 22.1%, 2.2%, and 2.2% of setup time fall into window of 0-5 min, 5-10 min, 10-20 min, 20-30 min, and > 30 min. Most difficult challenge is to negotiate with unknown rotational errors. It will be easy to dealt with them without automatic rotational correction if values are known.
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Affiliation(s)
- Biplab Sarkar
- Department of Radiation Oncology, Apollo Multispeciality Hospitals, Kolkata, India.
- Department of Physics, GLA University, Mathura, Uttar Pradesh, 281406, India.
| | - Anirudh Pradhan
- Centre for Cosmology, Astrophysics and Space Science (CCASS), GLA University, Mathura, Uttar Pradesh, 281406, India
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2
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Schindhelm R, Razinskas G, Ringholz J, Kraft J, Sauer OA, Wegener S. Evaluation of a head rest prototype for rotational corrections in three degrees of freedom. J Appl Clin Med Phys 2024; 25:e14172. [PMID: 37793069 PMCID: PMC10860431 DOI: 10.1002/acm2.14172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/22/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
Cranial stereotactic irradiations require accurate reproduction of the planning CT patient position at the time of treatment, including removal of rotational offsets. A device prototype was evaluated for potential clinical use to correct rotational positional offsets in image-guided radiotherapy workflow. Analysis was carried out with a prototype device "RPS head" by gKteso GmbH, rotatable up to 4° in three dimensions by hand wheels. A software tool accounts for the nonrectangular rotation axes and also indicates translational motions to be performed with the standard couch to correct the initial offset and translational shifts introduced by the rotational motion. The accuracy of angular corrections and positioning of an Alderson RANDO head phantom using the prototype device was evaluated for nine treatment plans for cranial targets. Corrections were obtained from cone beam computed tomography (CBCT) imaging. The phantom position was adjusted and the final position was then verified by another CBCT. The long-term stability of the prototype device was evaluated. Attenuation by the device along its three main axes was assessed. A planning study was performed to evaluate if regions of high-density material can be avoided during plan generation. The device enabled the accurate correction of rotational offsets in a clinical setup with a mean residual angular difference of (0.0 ± 0.1)° and a maximum deviation of 0.2°. Translational offsets were less than 1 mm. The device was stable over a period of 20 min, not changing the head support plate position by more than (0.7 ± 0.6) mm. The device contains high-density material in the adjustment mechanism and slightly higher density in the support structures. These can be avoided during planning generation maintaining comparable plan quality. The head positioning device can be used to correct rotational offsets in a clinical setting.
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Affiliation(s)
| | - Gary Razinskas
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Jonas Ringholz
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Johannes Kraft
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Otto A. Sauer
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
| | - Sonja Wegener
- Radiation OncologyUniversity Hospital WurzburgWurzburgGermany
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3
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Faccenda V, Panizza D, Pisoni V, Trivellato S, Daniotti MC, Bianchi SP, De Ponti E, Arcangeli S. Single-Isocenter Linac-Based Radiosurgery for Brain Metastases with Coplanar Arcs: A Dosimetric and Clinical Analysis. Cancers (Basel) 2023; 15:4496. [PMID: 37760466 PMCID: PMC10526167 DOI: 10.3390/cancers15184496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The efficacy of linac-based SRS/fSRS treatments using the single-isocenter coplanar FFF-VMAT technique for both single and multiple BM was investigated. Seventy patients (129 BM) treated with 15-21 Gy in 1 (n = 59) or 27 Gy in 3 (n = 11) fractions were analyzed. For each fraction, plans involving the intra-fractional errors measured by post-treatment CBCT were recalculated. The relationships of BM size, distance-to-isocenter, and barycenter shift with the difference in target coverage were evaluated. Clinical outcomes were assessed using logistic regression and Kaplan-Meier analysis. The median delivery time was 3.78 min (range, 1.83-9.25). The median post-treatment 3D error was 0.5 mm (range, 0.1-2.7) and the maximum rotational error was 0.3° (range, 0.0-1.3). In single BM patients, the GTV D95% was never reduced by >5%, whereas PTV D95% reductions >1% occurred in only 11 cases (29%). In multiple BM patients, dose deficits >5% and >1% occurred in 2 GTV (2%) and 34 PTV (37%), respectively. The differences in target coverage showed a moderate-to-strong correlation only with barycenter shift. Local failure of at least one treated BM occurred in 13 (21%) patients and the 1-year and 2-year local control rates for all lesions were 94% and 90%, respectively. The implemented workflow ensured that the degradation of target and brain dose metrics in delivered treatments was negligible. Along with encouraging clinical outcomes, these findings warrant a reduction in the PTV margins at our institution.
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Affiliation(s)
- Valeria Faccenda
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
| | - Denis Panizza
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
| | - Valerio Pisoni
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
| | - Sara Trivellato
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
| | - Martina Camilla Daniotti
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
| | - Sofia Paola Bianchi
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
| | - Elena De Ponti
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (V.F.); (D.P.); (S.T.); (M.C.D.); (E.D.P.)
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
| | - Stefano Arcangeli
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy;
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy;
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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.
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Comparative analysis of setup margin calculation in cone beam CT, by van Herk formula, using two different image registration methods. JOURNAL OF RADIOTHERAPY IN PRACTICE 2023. [DOI: 10.1017/s1460396923000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
ABSTRACT
Introduction:
This study aimed to quantify the difference in setup margin in cone beam computed tomography (CBCT) setup imaging, utilising the van Herk formula for two different image registration methods. Two alternative techniques of registration, bony landmark (BL) matching and soft tissue matching (ST) for head and neck cancer patients, were investigated.
Methods:
This study included 30 head and neck cancer patients who received a simultaneous integrated boost of 54–60–66 Gy in 30 fractions, using volumetric modulated arc treatment. A total of 867 CBCT images were acquired during patient setup and further analysed for setup margin calculation. A region of interest was described using a clip box between the reference and CBCT image to calculate the patient’s positional inaccuracy in three translational directions, X, Y and Z, where X was mediolateral, Y was the cranial-caudal, and Z was the anterior-posterior direction in the patient-based coordinate system, respectively. The shifts were captured by altering the BL and ST matching, and the setup margin was calculated using the van Herk formula (=2·5Σ + 0·7σ where Σ was the systematic and σ was the random error).
Results:
The difference between bony and ST matching in most cases was observed to be 1·4 mm in all translational directions at a 95% confidence interval and <1° in all rotational directions. The rotational error was found to be below the action level (±3°); hence, no corrections related to rotational error were made. The translational setup margin for bone and ST-based registration was X (BL) = 4·6 mm, X (ST) = 4·4 mm, Y (BL) = 6·3 mm, Y (ST) = 4·7 mm, Z (BL) = 3·0 mm, Z (ST) = 3·6mm.
Conclusion:
Two distinct registration approaches for head-neck patient setup did not yield any significant difference in the setup margin calculation. A suitable approach for CBCT and reference CT registration technique was required for the setup margin calculation. Confusion in selecting the correct image registration procedure can result in incorrect treatment execution. The compatibility of the two registration approaches was established in this study. Image fusion was neutralised before the second match (ST) to avoid hysteresis. For setup verification using CBCT for the head and neck region, both bone and ST registration were compatible for setup verification.
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Evaluation of the accuracy of a six-degree-of-freedom robotic couch using optical surface and cone beam CT images of an SRS QA phantom. JOURNAL OF RADIOTHERAPY IN PRACTICE 2023. [DOI: 10.1017/s1460396922000395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Abstract
Purpose:
To assess the accuracy of the Varian PerfectPitch six-degree-of-freedom (6DOF) robotic couch by using a Varian SRS QA phantom.
Methods:
The stereotactic radiosurgery (SRS) phantom has five tungsten carbide BBs each with 7·5 mm in diameter arranged with the known geometry. Optical surface images and cone beam CT (CBCT) images of the phantom were taken at different pitch, roll and rotation angles. The pitch, roll, and rotation angles were varied from −3 to 3 degrees by inputs from the linac console. A total of 39 Vision RT images with different rotation angle combinations were collected, and the Vision RT software was used to determine the rotation angles and translational shifts from those images. Eight CBCT images at most allowed rotational angles were analysed by in-house software. The software took the coordinates of the voxel of the maximum CT number inside a 7·5-mm sphere surrounding one BB to be the measured position of this BB. Expected BB positions at different rotation angles were determined by multiplying measured BB positions at zero pitch and roll values by a rotation matrix. Applying the rotation matrix to 5 BB positions yielded 15 equations. A linear least square method was used for regression analysis to approximate the solutions of those equations.
Results:
Of the eight calculations from CBCT images, the maximum rotation angle differences (degree) were 0·10 for pitch, 0·15 for roll and 0·09 for yaw. The maximum translation differences were 0·3 mm in the left–right direction, 0·5 mm in the anterior–posterior direction and 0·4 mm in the superior–inferior direction.
Conclusions:
The uncertainties of the 6-DOF couch were examined with the methods of optical surface imaging and CBCT imaging of the SRS QA phantom. The rotational errors were less than 0·2 degree, and the isocentre shifts were less than 0·8 mm.
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Saito M, Ueda K, Suzuki H, Komiyama T, Marino K, Aoki S, Sano N, Onishi H. Evaluation of the detection accuracy of set-up for various treatment sites using surface-guided radiotherapy system, VOXELAN: a phantom study. JOURNAL OF RADIATION RESEARCH 2022; 63:435-442. [PMID: 35467750 PMCID: PMC9124621 DOI: 10.1093/jrr/rrac015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/31/2022] [Indexed: 06/01/2023]
Abstract
The purpose of this study is to evaluate the detection accuracy of a 3-dimensional (3D) body scanner, VOXELAN, in surface-guided radiotherapy (SGRT) of each part of the human body using a whole-body human phantom. We used A Resusci Anne was used as the whole-body phantom. The detection accuracy of VOXELAN in a radiotherapy treatment room with a linear accelerator (LINAC) was evaluated for two reference images: reconstruction of the planning computed tomography (CT) image (CT reference) and scanning by VOXELAN before the treatment (scan reference). The accuracy of the translational and rotational directions was verified for four treatment sites (open face shell, breast, abdomen, and arm), using the magnitude of the 6D robotic couch movement as the true value. Our results showed that the detection accuracy improved as the displacement from the reference position decreased for all the sites. Using the scan reference, the average accuracy of the translational and rotational axes was within 1.44 mm and 0.41°, respectively, for all sites except the arms. Similarly, using the CT reference, the average accuracy was within 2.45 mm and 1.35°, respectively. Additionally, it was difficult for both reference images to recognize misalignment of the arms. In conclusion we discovered that VOXELAN achieved a high detection accuracy for the head with an open face shell, chest, and abdomen, indicating that the system is useful in a clinical setting. However, it is necessary to pay attention to location matching for areas with few features, such as surface irregularities and potential errors, when the reference image is created from CT.
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Affiliation(s)
- Masahide Saito
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Koji Ueda
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hidekazu Suzuki
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Takafumi Komiyama
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Kan Marino
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Shinichi Aoki
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Naoki Sano
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi 409-3898, Japan
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NAOI YUTAKA. Historical Review of Stereotactic Radiosurgery in Juntendo University. JUNTENDO MEDICAL JOURNAL 2022. [DOI: 10.14789/jmj.jmj22-0029-r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- YUTAKA NAOI
- Department of Radiation Oncology Juntendo University Nerima Hospital
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9
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Sarkar B, Manikandan A, Munshi A, Krishnankutty S, Ganesh T, Mohanti B, Manikandan S, Anirudh P, Chandrasekharan S. Calculation of set-up margin in frameless stereotactic radiotherapy accounting for translational and rotational patient positing error. J Cancer Res Ther 2022. [DOI: 10.4103/jcrt.jcrt_359_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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10
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Tsui SSW, Wu VWC, Cheung JSC. Comparison of dosimetric impact of intra-fractional setup discrepancy between multiple- and single-isocenter approaches in linac-based stereotactic radiotherapy of multiple brain metastases. J Appl Clin Med Phys 2021; 23:e13484. [PMID: 34931447 PMCID: PMC8833285 DOI: 10.1002/acm2.13484] [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: 12/12/2021] [Revised: 04/23/2021] [Accepted: 11/09/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction Treatment of multiple brain metastases by linac‐based stereotactic radiotherapy (SRT) can employ either a multiple‐isocenter (MI) or single‐isocenter (SI) approach. The purposes of this study were to evaluate the dosimetric results of MI and SI approaches and compare the impacts of intra‐fractional setup discrepancies on the robustness of respective approaches using isocenter shifts, whether the same magnitude of translational and rotational effects could lead to a significant difference between the two approaches. Methods Twenty‐two patients with multiple brain metastases treated by linac‐based SRT were recruited. Treatment plans were computed with both the MI and SI approaches. For the MI approach, the isocenter was located at the geometric center of each planning target volumes (PTVs), whereas the isocenter of the SI approach was located midway between the PTV centroids. To simulate the intra‐fractional errors, isocenter displacements including translational and rotational shifts were hypothetically applied. Apart from the dosimetric outcomes of the two approaches, the impact of the isocenter shifts on PTVs and organs at risk (OARs) were recorded in terms of the differences (δ) in dose parameters relative to the reference plan and was then compared between the MI and SI approaches. Results Both MI and SI plans met the plan acceptance criteria. The mean Paddick conformity index (Paddick CI) and Dmax of most OARs between MI and SI plans did not show a significant difference, except that higher doses to the left optic nerve and optic chiasm were found in SI plans (p = 0.03). After the application of the isocenter shifts, δCI increased with an increase in the magnitude of the isocenter shift. When comparing between MI and SI plans, the δCIs were similar (p > 0.05) for all extents of translational shifts, but δCIs were significantly higher in SI plans after application of all rotations particularly ±1.5° and ±2.0° shifts. Despite the result that the majority of δDMax of OARs were higher in the SI plans, only the differences in the left optic nerve and chiasm showed generally consistent significance after both translational ≥±1 mm and rotational shifts of ≥±1∘. Conclusion Both MI and SI approaches could produce clinically acceptable plans. However, isocenter shifts brought dosimetric impacts to both MI and SI approaches and the effects increased with the increase of the shift magnitude. Although similar impacts were shown in plans of both approaches after translational isocenter shift, SI plans were relatively more vulnerable than MI plans to rotational shifts.
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Affiliation(s)
- Sylvia S W Tsui
- Department of Clinical Oncology, Prince of Wales Hospital, Shatin, Hong Kong
| | - Vincent W C Wu
- Department of Health Technology & Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Jerry S C Cheung
- Department of Clinical Oncology, Queen Mary Hospital, Pok Fu Lam, Hong Kong
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Sarkar B, Ganesh T, Munshi A, Manikandan A, Choudhari S, Jassal K, Mohanti BK, Pradhan A. Compatibility assessment of Varian and Elekta robotic couch‐assisted six‐dimensional patient positioning correction systems with external independent imaging modalities. PRECISION RADIATION ONCOLOGY 2021. [DOI: 10.1002/pro6.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Biplab Sarkar
- Department of Radiation Oncology, Apollo Multispeciality Hospitals Kolkata West Bengal India
- GLA University Mathura Uttar Pradesh India
| | | | - Anusheel Munshi
- Department of Radiation Oncology, Manipal Hospitals New Delhi India
| | | | | | - Kanan Jassal
- Department of Radiation Oncology, Fortis Memorial Research Institute Gurugram Haryana India
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12
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Sun J, Kong L, Chen Z, You D, Mao J, Guan X, Wu X, Sheng Y. Clinical Implementation of a 6D Treatment Chair for Fixed Ion Beam Lines. Front Oncol 2021; 11:694749. [PMID: 34249751 PMCID: PMC8260974 DOI: 10.3389/fonc.2021.694749] [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: 04/13/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To verify the practicality and safety of a treatment chair with six degrees of freedom (6DTC) through demonstrating the efficacy of the workflow in clinical settings and analyzing the obtained technical data, including intra-fraction patient movement during the use of the 6DTC. Materials and Methods A clinical study was designed and conducted to test the clinical treatment workflow and the safety of the 6DTC. Based on the demonstrated dosimetric advantages, fifteen patients with head and neck tumors were selected and treated with the 6DTC. The positional error at the first beam position (PE-B1) and the second beam position (PE-B2) were analyzed and compared with the results from daily quality assurance (QA) procedures of the 6DTC and imaging system performed each day before clinical treatment. The intra-fraction patient movement was derived from the total patient alignment positional error and the QA data based on a Gaussian distribution formulism. Results The QA results showed sub-millimeter mechanical accuracy of the 6DTC over the course of the clinical study. For 150 patient treatment fractions, the mean deviations between PE-B1 and PE-B2 were 0.13mm (SD 0.88mm), 0.25mm (SD 1.17mm), -0.57mm (SD 0.85mm), 0.02° (SD 0.35°), 0.00° (SD 0.37°), and -0.02° (SD 0.37°) in the x, y, z (translational), and u, v, w (rotational) directions, respectively. The calculated intra-fraction patient movement was -0.08mm (SD 0.56mm), 0.71mm (SD 1.12mm), -0.52mm (SD 0.84mm), 0.10° (SD 0.32°), 0.09° (SD 0.36°), and -0.04° (SD 0.36°) in the x, y, z, u, v, w directions, respectively. Conclusions The performance stability of the 6DTC was satisfactory. The position accuracy and intra-fraction patient movement in an upright posture with the 6DTC were verified and found adequate for clinical implementation.
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Affiliation(s)
- Jiayao Sun
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Lin Kong
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Zhi Chen
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Dan You
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Jingfang Mao
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Xiyin Guan
- Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Xiaodong Wu
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Yinxiangzi Sheng
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Key Laboratory of Radiation Oncology (20dz2261000), Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
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Heilbroner SP, Xanthopoulos EP, Buono D, Carrier D, Durkee BY, Corradetti M, Wang TJC, Neugut AI, Hershman DL, Cheng SK. Efficacy and cost of high-frequency IGRT in elderly stage III non-small-cell lung cancer patients. PLoS One 2021; 16:e0252053. [PMID: 34043677 PMCID: PMC8158910 DOI: 10.1371/journal.pone.0252053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 05/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background High-frequency image-guided radiotherapy (hfIGRT) is ubiquitous but its benefits are unproven. We examined the cost effectiveness of hfIGRT in stage III non-small-cell lung cancer (NSCLC). Methods We selected stage III NSCLC patients ≥66 years old who received definitive radiation therapy from the Surveillance, Epidemiology, and End-Results-Medicare database. Patients were stratified by use of hfIGRT using Medicare claims. Predictors for hfIGRT were calculated using a logistic model. The impact of hfIGRT on lung toxicity free survival (LTFS), esophageal toxicity free survival (ETFS), cancer-specific survival (CSS), overall survival (OS), and cost of treatment was calculated using Cox regressions, propensity score matching, and bootstrap methods. Results Of the 4,430 patients in our cohort, 963 (22%) received hfIGRT and 3,468 (78%) did not. By 2011, 49% of patients were receiving hfIGRT. Predictors of hfIGRT use included treatment with intensity-modulated radiotherapy (IMRT) (OR = 7.5, p < 0.01), recent diagnosis (OR = 51 in 2011 versus 2006, p < 0.01), and residence in regions where the Medicare intermediary allowed IMRT (OR = 1.50, p < 0.01). hfIGRT had no impact on LTFS (HR 0.97; 95% CI 0.86–1.09), ETFS (HR 1.05; 95% CI 0.93–1.18), CSS (HR 0.94; 95% CI 0.84–1.04), or OS (HR 0.95; 95% CI 0.87–1.04). Mean radiotherapy and total medical costs six months after diagnosis were $17,330 versus $15,024 (p < 0.01) and $71,569 versus $69,693 (p = 0.49), respectively. Conclusion hfIGRT did not affect clinical outcomes in elderly patients with stage III NSCLC but did increase radiation cost. hfIGRT deserves further scrutiny through a randomized controlled trial.
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Affiliation(s)
- Samuel P. Heilbroner
- Department of Radiation Oncology, New York Presbyterian Hospital, New York, New York, United States of America
| | - Eric P. Xanthopoulos
- University of Wisconsin - Beloit Health Cancer Center, Beloit, Wisconsin, United States of America
| | - Donna Buono
- Herbert Irving Comprehensive Cancer Center, New York, New York, United States of America
| | - Daniel Carrier
- Department of Radiation Oncology, New York Presbyterian Hospital, New York, New York, United States of America
| | - Ben Y. Durkee
- Department of Radiation Oncology, University of Wisconsin–Madison, Madison, Wisconsin, United States of America
| | | | - Tony J. C. Wang
- Department of Radiation Oncology, New York Presbyterian Hospital, New York, New York, United States of America
| | - Alfred I. Neugut
- Herbert Irving Comprehensive Cancer Center, New York, New York, United States of America
| | - Dawn L. Hershman
- Herbert Irving Comprehensive Cancer Center, New York, New York, United States of America
| | - Simon K. Cheng
- Department of Radiation Oncology, New York Presbyterian Hospital, New York, New York, United States of America
- * E-mail:
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14
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Kojima H, Takemura A, Kurokawa S, Ueda S, Noto K, Yokoyama H, Takamatsu S. Evaluation of technical performance of optical surface imaging system using conventional and novel stereotactic radiosurgery algorithms. J Appl Clin Med Phys 2020; 22:58-68. [PMID: 33369014 PMCID: PMC7882109 DOI: 10.1002/acm2.13152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/20/2020] [Accepted: 12/08/2020] [Indexed: 01/18/2023] Open
Abstract
The Catalyst HD (C-RAD Positioning AB, Uppsala, Sweden) optical surface imaging (OSI) system is able to manage interfractional patient positioning, intrafractional motion monitoring, and non-contact respiratory gating without x-ray exposure for radiation therapy. In recent years, a novel high-precision surface registration algorithm for stereotactic radiosurgery (SRS algorithm) has been released. This study aimed to evaluate the technical performance of the OSI system using rigid phantoms, by comparing the conventional and SRS algorithms. To determine the system's technical performance, isocenter displacements were calculated by surface image registration via the OSI system using head, thorax, and pelvis rigid phantoms. The reproducibility of positioning was evaluated by the mean value calculated by repeating the registration 10 times, without moving each phantom. The accuracy of positioning was evaluated by the mean value of the residual error, where the 10 offset values given to each phantom were subtracted from the isocenter displacement values. The stability of motion monitoring was evaluated by measuring isocenter drift during 20 min and averaging it over 10 measurements. For the head phantom, all tests were compared with the mask types and algorithms. As a result, for all sites and both algorithms, the reproducibility, accuracy, and stability for translation and rotation were <0.1 mm and <0.1°, <1.0 mm and <1.0°, and <0.1 mm and <0.1°, respectively. In particular, the SRS algorithm had a small absolute error and standard deviation of calculated isocenter displacement, and a significantly higher reproducibility and accuracy than the conventional algorithm (P < 0.01). There was no difference in the stability between the algorithms (P = 0.0280). The SRS algorithm was found to be suitable for the treatment of rigid body sites with less deformation and small area, such as the head and face.
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Affiliation(s)
- Hironori Kojima
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Akihiro Takemura
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shogo Kurokawa
- Department of Radiation Technology, Shizuoka General Hospital, Shizuoka, Shizuoka, Japan
| | - Shinichi Ueda
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Kimiya Noto
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
| | - Haruna Yokoyama
- Department of Radiology, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, Japan
| | - Shigeyuki Takamatsu
- Department of Radiation Therapy, Kanazawa University Hospital, Kanazawa, Ishikawa, Japan
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15
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Combs SE, Baumert BG, Bendszus M, Bozzao A, Brada M, Fariselli L, Fiorentino A, Ganswindt U, Grosu AL, Lagerwaard FL, Niyazi M, Nyholm T, Paddick I, Weber DC, Belka C, Minniti G. ESTRO ACROP guideline for target volume delineation of skull base tumors. Radiother Oncol 2020; 156:80-94. [PMID: 33309848 DOI: 10.1016/j.radonc.2020.11.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE For skull base tumors, target definition is the key to safe high-dose treatments because surrounding normal tissues are very sensitive to radiation. In the present work we established a joint ESTRO ACROP guideline for the target volume definition of skull base tumors. MATERIAL AND METHODS A comprehensive literature search was conducted in PubMed using various combinations of the following medical subjects headings (MeSH) and free-text words: "radiation therapy" or "stereotactic radiosurgery" or "proton therapy" or "particle beam therapy" and "skull base neoplasms" "pituitary neoplasms", "meningioma", "craniopharyngioma", "chordoma", "chondrosarcoma", "acoustic neuroma/vestibular schwannoma", "organs at risk", "gross tumor volume", "clinical tumor volume", "planning tumor volume", "target volume", "target delineation", "dose constraints". The ACROP committee identified sixteen European experts in close interaction with the ESTRO clinical committee who analyzed and discussed the body of evidence concerning target delineation. RESULTS All experts agree that magnetic resonance (MR) images with high three-dimensional spatial accuracy and tissue-contrast definition, both T2-weighted and volumetric T1-weighted sequences, are required to improve target delineation. In detail, several key issues were identified and discussed: i) radiation techniques and immobilization, ii) imaging techniques and target delineation, and iii) technical aspects of radiation treatments including planning techniques and dose-fractionation schedules. Specific target delineation issues with regard to different skull base tumors, including pituitary adenomas, meningiomas, craniopharyngiomas, acoustic neuromas, chordomas and chondrosarcomas are presented. CONCLUSIONS This ESTRO ACROP guideline achieved detailed recommendations on target volume definition for skull base tumors, as well as comprehensive advice about imaging modalities and radiation techniques.
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Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich, Munich, Germany; Institute of Radiation Medicine, Department of Radiation Sciences, Helmholtz Zentrum München, Munich, Germany; German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany
| | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Martin Bendszus
- Department of Neuroradiology, University Hospital Heidelberg, Germany
| | - Alessandro Bozzao
- Dipartimento NESMOS, Università Sapienza Roma, Azienda Ospedaliera Sant'Andrea, Rome, Italy
| | - Michael Brada
- Department of Radiation Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Bebington, United Kingdom
| | - Laura Fariselli
- Radiotherapy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva delle fonti, Italy
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anca L Grosu
- Department of Radiation Oncology, Medical Faculty, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK) Partner Site Freiburg, Germany
| | - Frank L Lagerwaard
- Department of Radiation Oncology, Amsterdam University Medical Centers, Location VUmc, The Netherlands
| | - Maximilian Niyazi
- German Cancer Consortium (DKTK) Partner Site (DKTK), Munich, Germany; Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Tufve Nyholm
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Ian Paddick
- Queen Square Radiosurgery Centre, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | | | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy; IRCCS Neuromed, Pozzilli, Italy.
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16
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Batista V, Meyer J, Kügele M, Al-Hallaq H. Clinical paradigms and challenges in surface guided radiation therapy: Where do we go from here? Radiother Oncol 2020; 153:34-42. [PMID: 32987044 DOI: 10.1016/j.radonc.2020.09.041] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/26/2022]
Abstract
Surface guided radiotherapy (SGRT) is becoming a routine tool for patient positioning for specific clinical sites in many clinics. However, it has not yet gained its full potential in terms of widespread adoption. This vision paper first examines some of the difficulties in transitioning to SGRT before exploring the current and future role of SGRT alongside and in concert with other imaging techniques. Finally, future horizons and innovative ideas that may shape and impact the direction of SGRT going forward are reviewed.
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Affiliation(s)
- Vania Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Germany; National Center for Tumor Diseases (NCT), Heidelberg, Germany.
| | - Juergen Meyer
- Seattle Cancer Care Alliance, University of Washington, Department of Radiation Oncology, United States.
| | - Malin Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; Medical Radiation Physics, Department of Clinical Sciences, Lund University, Sweden.
| | - Hania Al-Hallaq
- The University of Chicago, Department of Radiation and Cellular Oncology, United States.
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17
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Rijken J, Crowe S, Trapp J, Kairn T. A review of stereotactic body radiotherapy for the spine. Phys Eng Sci Med 2020; 43:799-824. [DOI: 10.1007/s13246-020-00889-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 06/11/2020] [Indexed: 12/11/2022]
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18
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Swinnen ACC, Öllers MC, Loon Ong C, Verhaegen F. The potential of an optical surface tracking system in non-coplanar single isocenter treatments of multiple brain metastases. J Appl Clin Med Phys 2020; 21:63-72. [PMID: 32237274 PMCID: PMC7324699 DOI: 10.1002/acm2.12866] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/23/2020] [Accepted: 02/24/2020] [Indexed: 12/25/2022] Open
Abstract
To evaluate the accuracy of a commercial optical surface tracking (OST) system and to demonstrate how it can be implemented to monitor patient positioning during non‐coplanar single isocenter stereotactic treatments of brain metastases. A 3‐camera OST system was used (Catalyst HD™, C‐RAD) on a TruebeamSTx with a 6DoF couch. The setup accuracy and agreement between the OST system, and CBCT and kV‐MV imaging at couch angles 0° and 270°, respectively, were examined. Film measurements at 3 depths in the Rando‐Alderson phantom were performed using a single isocenter non‐coplanar VMAT plan containing 4 brain lesions. Setup of the phantom was performed with CBCT at couch 0° and subsequently monitored by OST at other couch angles. Setup data for 7 volunteers were collected to evaluate the accuracy and reproducibility of the OST system at couch angles 0°, 45°, 90°, 315°, and 270°. These results were also correlated to the couch rotation offsets obtained by a Winston‐Lutz (WL) test. The Rando‐Alderson phantom, as well as volunteers, were fixated using open face masks (Orfit). For repeated tests with the Rando‐Alderson phantom, deviations between rotational and translational isocenter corrections for CBCT and OST systems are always within 0.2° (pitch, roll, yaw), and 0.1mm and 0.5mm (longitudinal, lateral, vertical) for couch positions 0° and 270°, respectively. Dose deviations between the film and TPS doses in the center of the 4 lesions were −1.2%, −0.1%, −0.0%, and −1.9%. Local gamma evaluation criteria of 2%/2 mm and 3%/1 mm yielded pass rates of 99.2%, 99.2%, 98.6%, 89.9% and 98.8%, 97.5%, 81.7%, 78.1% for the 4 lesions. Regarding the volunteers, the mean translational and rotational isocenter shift values were (0.24 ± 0.09) mm and (0.15 ± 0.07) degrees. Largest isocenter shifts were found for couch angles 45˚ and 90˚, confirmed by WL couch rotation offsets. Patient monitoring during non‐coplanar VMAT treatments of brain metastases is feasible with submillimeter accuracy.
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Affiliation(s)
| | | | - Chin Loon Ong
- Department of Radiation Oncology, HagaZiekenhuis, Den Haag, the Netherlands
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19
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Wack LJ, Exner F, Wegener S, Sauer OA. The impact of isocentric shifts on delivery accuracy during the irradiation of small cerebral targets-Quantification and possible corrections. J Appl Clin Med Phys 2020; 21:56-64. [PMID: 32196950 PMCID: PMC7286018 DOI: 10.1002/acm2.12854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/26/2020] [Accepted: 02/07/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose To assess the impact of isocenter shifts due to linac gantry and table rotation during cranial stereotactic radiosurgery on D98, target volume coverage (TVC), conformity (CI), and gradient index (GI). Methods Winston‐Lutz (WL) checks were performed on two Elekta Synergy linacs. A stereotactic quality assurance (QA) plan was applied to the ArcCHECK phantom to assess the impact of isocenter shift corrections on Gamma pass rates. These corrections included gantry sag, distance of collimator and couch axes to the gantry axis, and distance between cone‐beam computed tomography (CBCT) isocenter and treatment beam (MV) isocenter. We applied the shifts via script to the treatment plan in Pinnacle 16.2. In a planning study, isocenter and mechanical rotation axis shifts of 0.25 to 2 mm were applied to stereotactic plans of spherical planning target volumes (PTVs) of various volumes. The shifts determined via WL measurements were applied to 16 patient plans with PTV sizes between 0.22 and 10.4 cm3. Results ArcCHECK measurements of a stereotactic treatment showed significant increases in Gamma pass rate for all three measurements (up to 3.8 percentage points) after correction of measured isocenter deviations. For spherical targets of 1 cm3, CI was most severely affected by increasing the distance of the CBCT isocenter (1.22 to 1.62). Gradient index increased with an isocenter‐collimator axis distance of 1.5 mm (3.84 vs 4.62). D98 (normalized to reference) dropped to 0.85 (CBCT), 0.92 (table axis), 0.95 (collimator axis), and 0.98 (gantry sag), with similar but smaller changes for larger targets. Applying measured shifts to patient plans lead to relevant drops in D98 and TVC (7%) for targets below 2 cm3 treated on linac 1. Conclusion Mechanical deviations during gantry, collimator, and table rotation may adversely affect the treatment of small stereotactic lesions. Adjustments of beam isocenters in the treatment planning system (TPS) can be used to both quantify their impact and for prospective correction of treatment plans.
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Affiliation(s)
- Linda J Wack
- Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - Florian Exner
- Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - Sonja Wegener
- Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - Otto A Sauer
- Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
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20
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Sheng Y, Sun J, Wang W, Stuart B, Kong L, Gao J, You D, Wu X. Performance of a 6D Treatment Chair for Patient Positioning in an Upright Posture for Fixed Ion Beam Lines. Front Oncol 2020; 10:122. [PMID: 32117769 PMCID: PMC7026365 DOI: 10.3389/fonc.2020.00122] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 01/23/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the mechanical accuracy and the robustness of position alignment under x-ray-based image guidance of a treatment chair with six degrees of freedom (6DTC) which was developed for patient treatment in an upright posture at fixed horizontal beam lines in particle (proton, carbon ion, or others) radiotherapy facilities. Method and Material: The positional accuracy including translational and axial rotational accuracy of the 6DTC was evaluated by using a Vicon Motion Capture System (VMCS). Stability of the chair rotation isocenter was determined by a CCD camera with an in-house developed software. The tests were carried out to examine two key motion components of the 6DTC: a floor/rail-mount 360°-rotating platform and a 6-degree-of-freedom (6DOF) platform. The measurement results were compared to that of a commercial clinical robot couch. The accuracy of position alignment, simulating the actual clinical protocol, through an Image-guided Radiation Therapy (IGRT) system was studied at the pre-treatment position and beam specific treatment position. Results: The translational accuracy was 0.12 mm (SD 0.07 mm) for the 6DOF platform. The rotational accuracy was 0.04° (SD 0.03°) and 0.02° (SD 0.02°) for the 6DOF platform and the 360° -rotating platform, respectively. The displacement between the chair rotation center and the room isocenter center was no more than 0.18 mm in all three rotational axes. Combined with an x-ray-based IGRT system, the treatment alignment test with a rigid phantom yielded a total positional accuracy of 0.23 mm (SD 0.17 mm) and 0.14° (SD 0.14°) at treatment position. Conclusions: On the basis of the rigid phantom study, the 6DTC showed comparable accuracy to the robot treatment couch. Combining with the IGRT, the 6DTC can provide position alignment with submillimeter accuracy for rigid phantom in upright posture.
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Affiliation(s)
- Yinxiangzi Sheng
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Jiayao Sun
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Weiwei Wang
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
| | - Brian Stuart
- Executive Medical Physics Associates, Miami, FL, United States
| | - Lin Kong
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Jing Gao
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - Dan You
- Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China.,Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Xiaodong Wu
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China.,Shanghai Engineering Research Center of Proton and Heavy Ion Radiation Therapy, Shanghai, China
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21
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Meyer J, Smith W, Geneser S, Koger B, Kalet AM, Young LA, Cao N, Price RG, Norris C, Horton T, Womeldorf J, Alexandrian AN, Wootton LS. Characterizing a deformable registration algorithm for surface-guided breast radiotherapy. Med Phys 2019; 47:352-362. [PMID: 31724177 DOI: 10.1002/mp.13921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Surface-guided radiation therapy (SGRT) is a nonionizing imaging approach for patient setup guidance, intra-fraction monitoring, and automated breath-hold gating of radiation treatments. SGRT employs the premise that the external patient surface correlates to the internal anatomy, to infer the treatment isocenter position at time of treatment delivery. Deformations and posture variations are known to impact the correlation between external and internal anatomy. However, the degree, magnitude, and algorithm dependence of this impact are not intuitive and currently no methods exist to assess this relationship. The primary aim of this work was to develop a framework to investigate and understand how a commercial optical surface imaging system (C-RAD, Uppsala, Sweden), which uses a nonrigid registration algorithm, handles rotations and surface deformations. METHODS A workflow consisting of a female torso phantom and software-introduced transformations to the corresponding digital reference surface was developed. To benchmark and validate the approach, known rigid translations and rotations were first applied. Relevant breast radiotherapy deformations related to breast size, hunching/arching back, distended/deflated abdomen, and an irregular surface to mimic a cover sheet over the lower part of the torso were investigated. The difference between rigid and deformed surfaces was evaluated as a function of isocenter location. RESULTS For all introduced rigid body transformations, C-RAD computed isocenter shifts were determined within 1 mm and 1˚. Additional translational shifts to correct for rotations as a function of isocenter location were determined with the same accuracy. For yaw setup errors, the difference in shift corrections between a plan with an isocenter placed in the center of the breast (BrstIso) and one located 12 cm superiorly (SCFIso) was 2.3 mm/1˚ in lateral direction. Pitch setup errors resulted in a difference of 2.1 mm/1˚ in vertical direction. For some of the deformation scenarios, much larger differences up to 16 mm and 7˚ in the calculated shifts between BrstIso and SCFIso were observed that could lead to large unintended gaps or overlap between adjacent matched fields if uncorrected. CONCLUSIONS The methodology developed lends itself well for quality assurance (QA) of SGRT systems. The deformable C-RAD algorithm determined accurate shifts for rigid transformations, and this was independent of isocenter location. For surface deformations, the position of the isocenter had considerable impact on the registration result. It is recommended to avoid off-axis isocenters during treatment planning to optimally utilize the capabilities of the deformable image registration algorithm, especially when multiple isocenters are used with fields that share a field edge.
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Affiliation(s)
- Juergen Meyer
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Wade Smith
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Northwest Hospital, 1560 N 115th St, Seattle, WA, 98125, USA
| | - Sarah Geneser
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA
| | - Brandon Koger
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA
| | - Alan M Kalet
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Lori A Young
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Ning Cao
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Ryan G Price
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Northwest Hospital, 1560 N 115th St, Seattle, WA, 98125, USA
| | - Chris Norris
- Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Tony Horton
- Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Jeff Womeldorf
- Department of Radiation Oncology, Northwest Hospital, 1560 N 115th St, Seattle, WA, 98125, USA
| | - Ara N Alexandrian
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA
| | - Landon S Wootton
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
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22
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Sarkar B, Munshi A, Ganesh T, Manikandan A, Krishnankutty S, Chitral L, Pradhan A, Kalyan Mohanti B. Technical Note: Rotational positional error corrected intrafraction set-up margins in stereotactic radiotherapy: A spatial assessment for coplanar and noncoplanar geometry. Med Phys 2019; 46:4749-4754. [PMID: 31495931 DOI: 10.1002/mp.13810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of this study is to calculate setup margin based on six-dimensional (6D) corrected residual positional errors from kV cone beam computed tomography (CBCT) and from intrafraction projection kV imaging in coplanar and in noncoplanar couch positions in stereotactic radiotherapy. METHODS Six dimensional positional corrections were carried out before patient treatments, using a robotic couch and CBCT matching. A CBCT and stereoscopic ExacTrac image were acquired post-table position correction. Further, a series of intrafraction ExacTrac images were obtained for the variable couch position. Translational and rotational errors were identified as lateral (X), longitudinal (Y), vertical (Z); roll (Ɵ°), pitch (Φ°) and yaw (Ψ°). A total of 699 intrafraction image sets (361 coplanar and 338 noncoplanar) for 51 SRS/SRT patients were analysed. Rotational errors were corrected in terms of translational coordinates. Residual set-up margins were calculated from CBCT shifts. ExacTrac shifts give residual + intrafraction setup margins as a function of coplanar and noncoplanar couch positions. RESULTS The average residual positional error obtained from CBCT in X, Y, Z, Ɵ, Φ, Ψ were 0.1 ± 0.4 mm, 0.0 ± 0.6 mm, 0.0 ± 0.5 mm, 0.2 ± 0.8°, 0.1 ± 0.6° and -0.1 ± 0.7° respectively. For ExacTrac, the shits were -0.5 ± 0.9 mm, -0.0 ± 1mm, -0.6 ± 1.0mm, 0.4 ± 0.9°, -0.2 ± 0.6°, and -0.0 ± 0.8°. CBCT calculated linear setup margins in X, Y, Z direction were 0.5, 1.2, and 1 mm respectively. ExacTrac yielded coplanar and noncoplanar linear setup margins were 1.2, 1.3, 1.5, 1.4, 1.5, and 2.1 mm respectively. CONCLUSION CBCT-based gross residual set-up margin is equal to 1 mm. ExacTrac calculated residual plus intrafraction setup margin falls within a 2 mm range; attributed to intrafraction patient movement, table position inaccuracies, and poor image fusion in noncoplanar geometry. There could be variations in the required additional margin between centers and between machines, which require further studies.
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Affiliation(s)
- Biplab Sarkar
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| | - Anusheel Munshi
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| | - Tharmarnadar Ganesh
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| | - Arjunan Manikandan
- Department of Medical Physics, Apollo Proton Cancer Centre, Chennai, 600096, Tamil Nadu, India
| | - Saneg Krishnankutty
- Department of Radiation Oncology, Fortis Memorial Research Institute, Gurgaon, 122002, Haryana, India
| | - Latika Chitral
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
| | - Anirudh Pradhan
- Department of Mathematics, Institute of Applied Sciences & Humanities, GLA University, Mathura, 281406, Uttar Pradesh, India
| | - Bidhu Kalyan Mohanti
- Department of Radiation Oncology, Manipal Hospitals, Dwarka, New Delhi, 110070, India
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Hartgerink D, Swinnen A, Roberge D, Nichol A, Zygmanski P, Yin FF, Deblois F, Hurkmans C, Ong CL, Bruynzeel A, Aizer A, Fiveash J, Kirckpatrick J, Guckenberger M, Andratschke N, de Ruysscher D, Popple R, Zindler J. LINAC based stereotactic radiosurgery for multiple brain metastases: guidance for clinical implementation. Acta Oncol 2019; 58:1275-1282. [PMID: 31257960 DOI: 10.1080/0284186x.2019.1633016] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Stereotactic radiosurgery (SRS) is a promising treatment option for patients with multiple brain metastases (BM). Recent technical advances have made LINAC based SRS a patient friendly technique, allowing for accurate patient positioning and a short treatment time. Since SRS is increasingly being used for patients with multiple BM, it remains essential that SRS be performed with the highest achievable quality in order to prevent unnecessary complications such as radionecrosis. The purpose of this article is to provide guidance for high-quality LINAC based SRS for patients with BM, with a focus on single isocenter non-coplanar volumetric modulated arc therapy (VMAT). Methods: The article is based on a consensus statement by the study coordinators and medical physicists of four trials which investigated whether patients with multiple BM are better palliated with SRS instead of whole brain radiotherapy (WBRT): A European trial (NCT02353000), two American trials and a Canadian CCTG lead intergroup trial (CE.7). This manuscript summarizes the quality assurance measures concerning imaging, planning and delivery. Results: To optimize the treatment, the interval between the planning-MRI (gadolinium contrast-enhanced, maximum slice thickness of 1.5 mm) and treatment should be kept as short as possible (< two weeks). The BM are contoured based on the planning-MRI, fused with the planning-CT. GTV-PTV margins are minimized or even avoided when possible. To maximize efficiency, the preferable technique is single isocenter (non-)coplanar VMAT, which delivers high doses to the target with maximal sparing of the organs at risk. The use of flattening filter free photon beams ensures a lower peripheral dose and shortens the treatment time. To bench mark SRS treatment plan quality, it is advisable to compare treatment plans between hospitals. Conclusion: This paper provides guidance for quality assurance and optimization of treatment delivery for LINAC-based radiosurgery for patients with multiple BM.
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Affiliation(s)
- Dianne Hartgerink
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ans Swinnen
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - David Roberge
- Department of Radiation Oncology, CHUM, Montreal, QC, Canada
| | - Alan Nichol
- Department of Radiation Oncology, CHUM, Montreal, QC, Canada
| | - Piotr Zygmanski
- Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Fang-Fang Yin
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | | | - Coen Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Chin Loon Ong
- Department of Radiation Oncology, HagaZiekenhuis, Den Haag, The Netherlands
| | - Anna Bruynzeel
- Department of Radiotherapy, Cancer Center Amsterdam, VU University medical center, Amsterdam, The Netherlands
| | - Ayal Aizer
- Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - John Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John Kirckpatrick
- Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Dirk de Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Richard Popple
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jaap Zindler
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Radiation Oncology, Erasmus MC, Rotterdam, The Netherlands
- Holland Proton Therapy Center, Delft, The Netherlands
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Rodrigues MF, Veen S, van Egmond J, van Hameren M, van Oorschot T, de Vet S, van Santvoort JPC, Wiggenraad RGJ, Mast ME. The influence of a six degrees of freedom couch and an individual head support in patient positioning in radiotherapy of head and neck cancer. Phys Imaging Radiat Oncol 2019; 11:30-33. [PMID: 33458274 PMCID: PMC7807734 DOI: 10.1016/j.phro.2019.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/30/2019] [Accepted: 07/03/2019] [Indexed: 11/25/2022] Open
Abstract
Reproducible patient positioning is important in radiotherapy (RT) of head-and-neck cancer. We therefore compared set-up errors in head-and-neck RT resulting from three different patient positioning systems. Patients were either treated with a standard head support (SHS) and conventional treatment couch (SHS-3, n = 10), a SHS and rotational couch (SHS-6, n = 10), or an individual head support (IHS) and rotational couch (IHS-6, n = 10). Interfraction mean translation vector lenghts were significantly lower for IHS-6 compared to SHS-3 (0.8 ± 0.3 mm vs. 1.4 ± 0.7 mm, P = 0.001). Intrafraction displacement was comparable among cohorts. This study showed that the use of a six degrees of freedom couch combined with an IHS in head-and-neck RT resulted in better interfraction reproducibility.
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Affiliation(s)
- Myra F Rodrigues
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands.,Department of Radiation Oncology, Erasmus MC Cancer Institute, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands
| | - Sten Veen
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Jaap van Egmond
- Department of Medical Physics, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Mark van Hameren
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Theodorus van Oorschot
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Steven de Vet
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Jan P C van Santvoort
- Department of Medical Physics, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Ruud G J Wiggenraad
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
| | - Mirjam E Mast
- Department of Radiation Oncology, Haaglanden Medical Center, Burgemeester Banninglaan 1, 2262 BA Leidschendam, The Netherlands
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Shimizu H, Sasaki K, Aoyama T, Matsushima S, Isomura T, Fukuma H, Tachibana H, Kodaira T. Development of twist‐correction system for radiotherapy of head and neck cancer patients. J Appl Clin Med Phys 2019; 20:128-134. [PMID: 31222881 PMCID: PMC6612693 DOI: 10.1002/acm2.12667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 04/04/2019] [Accepted: 05/05/2019] [Indexed: 11/09/2022] Open
Abstract
To propose a concept for correcting the twist between the head and neck and the body frequently occurring in radiotherapy patients and to develop a prototype device for achieving this. Furthermore, the operational accuracy of this device under no load was evaluated. We devised a concept for correcting the twist of patients by adjustment of the three rotation (pitch, roll, and yaw) angles in two independent plates connected by a joint (fulcrum). The two plates (head and neck plate and body plate) rotate around the fulcrum by adjusting screws under each of them. A prototype device was created to materialize this concept. First, after all adjusting screws were set to the zero position, the rotation angle of each plate was measured by a digital goniometer. Repeatability was evaluated by performing 20 repeated measurements. Next, to confirm the rotational accuracy of each plate of the prototype device, the calculated rotation angles for 20 combinations of patterns of traveled distances of the adjusting screws were compared with those measured by the digital goniometer and cone‐beam computed tomography (CT). The repeatability (standard deviation: SD) of the pitch, roll, and yaw angles of the head and neck plate was 0.04°, 0.05°, and 0.03°, and the repeatability (SD) of the body plate was 0.05°, 0.04°, and 0.04°, respectively. The mean differences ± SD between the calculated and measured pitch, roll, and yaw angles for the head and neck plate with the digital goniometer were 0.00 ± 0.06°, −0.01 ± 0.06°, and −0.04 ± 0.04°, respectively. The differences for the body plate were −0.03 ± 0.04°, 0.03 ± 0.05°, and 0.02 ± 0.05°, respectively. Results of the cone‐beam CT were similar to those of the digital goniometer. The prototype device exhibited good performance regarding the rotational accuracy and repeatability under no load. The clinical implementation of this concept is expected to reduce the residual error of the patient position due to the twist.
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Affiliation(s)
- Hidetoshi Shimizu
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
- Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences Gunma Japan
| | - Koji Sasaki
- Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences Gunma Japan
| | - Takahiro Aoyama
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
| | - Shigeru Matsushima
- Department of Diagnostic and Interventional Radiology Aichi Cancer Center Hospital Aichi Japan
| | - Taiki Isomura
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
| | - Hiroshi Fukuma
- Department of Radiology Nagoya City University Hospital Aichi Japan
| | - Hiroyuki Tachibana
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan
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Otake S, Goto T. Stereotactic Radiotherapy for Oligometastasis. Cancers (Basel) 2019; 11:cancers11020133. [PMID: 30678111 PMCID: PMC6407034 DOI: 10.3390/cancers11020133] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/17/2019] [Accepted: 01/21/2019] [Indexed: 12/22/2022] Open
Abstract
Oligometastatic disease is defined as “a condition with a few metastases arising from tumors that have not acquired a potential for widespread metastases.” Its behavior suggests a transitional malignant state somewhere between localized and metastatic cancer. Treatment of oligometastatic disease is expected to achieve long-term local control and to improve survival. Historically, patients with oligometastases have often undergone surgical resection since it was anecdotally believed that surgical resection could result in progression-free or overall survival benefits. To date, no prospective randomized trials have demonstrated surgery-related survival benefits. Short courses of highly focused, extremely high-dose radiotherapies (e.g., stereotactic radiosurgery and stereotactic ablative body radiotherapy (SABR)) have frequently been used as alternatives to surgery for treatment of oligometastasis. A randomized study has demonstrated the overall survival benefits of stereotactic radiosurgery for solitary brain metastasis. Following the success of stereotactic radiosurgery, SABR has been widely accepted for treating extracranial metastases, considering its efficacy and minimum invasiveness. In this review, we discuss the history of and rationale for the local treatment of oligometastases and probe into the implementation of SABR for oligometastatic disease.
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Affiliation(s)
- Sotaro Otake
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Kofu 400-8506, Japan.
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Kofu 400-8506, Japan.
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Chan MF, Lim SB, Li X, Tang X, Zhang P, Shi C. Commissioning and Evaluation of a Third-Party 6 Degrees-of-Freedom Couch Used in Radiotherapy. Technol Cancer Res Treat 2019; 18:1533033819870778. [PMID: 31434547 PMCID: PMC6704415 DOI: 10.1177/1533033819870778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purposes: The newly released Protura 6 degrees-of-freedom couch (CIVCO) has limited quality assurance protocols and pertinent publications. Herein, we report our experiences of the Protura system acceptance, commissioning, and quality assurance. Methods: The Protura system integration was tested with peripheral equipment on the following items: couch movement range limit, 6 degrees-of-freedom movement accuracy, weight test and couch sagging, system connection with Linac, isocentricity of couch and rotation alignment, kV and cone-beam computed tomography imaging of HexaCHECK with MIMI phantom (Standard Imaging), and an in-house custom 6 degrees-of-freedom quality assurance phantom. A couch transmission measurement was also performed. Results: The vertical, longitudinal, and lateral ranges of the 6 degrees-of-freedom couch pedestal are 43.9 to 0.0 cm, 24.6 to 149.5 cm, −20.6 to 20.7 cm, respectively. The couch movement accuracy was within 1 mm in all directions. The couch sagging with a 200 lbs (∼91 kg) evenly distributed object is 1.0 cm and 0.4° pitch in the distal end of the couch. The isocentricity of the couch was about 0.5 mm in diameter of all crosshair projections on the couch isocenter level, and the largest couch rotation alignment observed was (0.3°) at the couch angle of 90°. The deviation from the reference position (zero position) of the HexaCHECK phantom, measured by matching the cone-beam computed tomography with the reference planning computed tomography, was found to be below 0.2 mm in the anterior–posterior and right–left dimensions, 0.4 mm in superior–inferior dimension, and 0.1° in roll, pitch, and yaw directions. Conclusions: A 6 degrees-of-freedom quality assurance phantom is helpful for the commissioning and routine quality assurance tests. Due to the third-party integration with Linac, the system is prone to “double-correction” errors. A rigorous quality assurance program is the key to a successful clinical implementation of the Protura system.
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Affiliation(s)
- Maria F Chan
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Seng-Boh Lim
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiang Li
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Xiaoli Tang
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peng Zhang
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Chengyu Shi
- 1 Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Mohandass P, Khanna D, Kumar TM, Thiyagaraj T, Saravanan C, Bhalla NK, Puri A. Study to Compare the Effect of Different Registration Methods on Patient Setup Uncertainties in Cone-beam Computed Tomography during Volumetric Modulated Arc Therapy for Breast Cancer Patients. J Med Phys 2018; 43:207-213. [PMID: 30636845 PMCID: PMC6299751 DOI: 10.4103/jmp.jmp_67_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/02/2018] [Accepted: 10/12/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study compared three different methods used in registering cone-beam computed tomography (CBCT) image set with planning CT image set for determining patient setup uncertainties during volumetric modulated arc therapy (VMAT) for breast cancer patients. MATERIALS AND METHODS Seven breast cancer patients treated with 50 Gy in 25 fractions using VMAT technique were chosen for this study. A total of 105 CBCT scans were acquired by image guidance protocol for patient setup verification. Approved plans' CT images were used as the reference image sets for registration with their corresponding CBCT image sets. Setup errors in mediolateral, craniocaudal, and anteroposterior direction were determined using gray-scale matching between the reference CT images and onboard CBCT images. Patient setup verification was performed using clip-box registration (CBR) method during online imaging. Considering the CBR method as the reference, two more registrations were performed using mask registration (MR) method and dual registration (DR) (CBR + MR) method in the offline mode. For comparison, systematic error (∑), random error (σ), mean displacement vector (R), mean setup error (M), and registration time (R t) were analyzed. Post hoc Tukey's honest significant difference test was performed for multiple comparisons. RESULTS Systematic and random errors were less in CBR as compared to MR and DR (P > 0.05). The mean displacement error and mean setup errors were less in CBR as compared to MR and DR (P > 0.05). Increased R t was observed in DR as compared to CBR and MR (P < 0.05). In addition, multiple comparisons did not show any significant difference in patient setup error (P > 0.05). CONCLUSION For breast VMAT plan delivery, all three registration methods show insignificant variation in patient setup error. One can use any of the three registration methods for patient setup verification.
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Affiliation(s)
- P. Mohandass
- Department of Physics, Karunya Institute of Technology and Sciences, Coimbatore, Tamil Nadu, India
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - D. Khanna
- Department of Physics, Karunya Institute of Technology and Sciences, Coimbatore, Tamil Nadu, India
| | - T. Manoj Kumar
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - T. Thiyagaraj
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - C. Saravanan
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - Narendra Kumar Bhalla
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - Abhishek Puri
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
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Sarkar B, Ray J, Ganesh T, Manikandan A, Munshi A, Rathinamuthu S, Kaur H, Anbazhagan S, Giri UK, Roy S, Jassal K, Mohanti BK. Methodology to reduce 6D patient positional shifts into a 3D linear shift and its verification in frameless stereotactic radiotherapy. ACTA ACUST UNITED AC 2018; 63:075004. [DOI: 10.1088/1361-6560/aab231] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Babic S, Lee Y, Ruschin M, Lochray F, Lightstone A, Atenafu E, Phan N, Mainprize T, Tsao M, Soliman H, Sahgal A. To frame or not to frame? Cone-beam CT-based analysis of head immobilization devices specific to linac-based stereotactic radiosurgery and radiotherapy. J Appl Clin Med Phys 2018; 19:111-120. [PMID: 29363282 PMCID: PMC5849846 DOI: 10.1002/acm2.12251] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 11/27/2017] [Accepted: 12/08/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose Noninvasive frameless systems are increasingly being utilized for head immobilization in stereotactic radiosurgery (SRS). Knowing the head positioning reproducibility of frameless systems and their respective ability to limit intrafractional head motion is important in order to safely perform SRS. The purpose of this study was to evaluate and compare the intrafractional head motion of an invasive frame and a series of frameless systems for single fraction SRS and fractionated/hypofractionated stereotactic radiotherapy (FSRT/HF‐SRT). Methods The noninvasive PinPoint system was used on 15 HF‐SRT and 21 SRS patients. Intrafractional motion for these patients was compared to 15 SRS patients immobilized with Cosman‐Roberts‐Wells (CRW) frame, and a FSRT population that respectively included 23, 32, and 15 patients immobilized using Gill‐Thomas‐Cosman (GTC) frame, Uniframe, and Orfit. All HF‐SRT and FSRT patients were treated using intensity‐modulated radiation therapy on a linear accelerator equipped with cone‐beam CT (CBCT) and a robotic couch. SRS patients were treated using gantry‐mounted stereotactic cones. The CBCT image‐guidance protocol included initial setup, pretreatment and post‐treatment verification images. The residual error determined from the post‐treatment CBCT was used as a surrogate for intrafractional head motion during treatment. Results The mean intrafractional motion over all fractions with PinPoint was 0.62 ± 0.33 mm and 0.45 ± 0.33 mm, respectively, for the HF‐SRT and SRS cohort of patients (P‐value = 0.266). For CRW, GTC, Orfit, and Uniframe, the mean intrafractional motions were 0.30 ± 0.21 mm, 0.54 ± 0.76 mm, 0.73 ± 0.49 mm, and 0.76 ± 0.51 mm, respectively. For CRW, PinPoint, GTC, Orfit, and Uniframe, intrafractional motion exceeded 1.5 mm in 0%, 0%, 5%, 6%, and 8% of all fractions treated, respectively. Conclusions The noninvasive PinPoint system and the invasive CRW frame stringently limit cranial intrafractional motion, while the latter provides superior immobilization. Based on the results of this study, our clinical practice for malignant tumors has evolved to apply an invasive CRW frame only for metastases in eloquent locations to minimize normal tissue exposure.
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Affiliation(s)
- Steven Babic
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Young Lee
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Mark Ruschin
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Fiona Lochray
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Alex Lightstone
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Eshetu Atenafu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Nic Phan
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Todd Mainprize
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - May Tsao
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
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Li D, Yang Z, Chen T, Guan C, Wang F, Matz EL, Zhang Y, Ji P. 3D cone beam computed tomography reconstruction images in diagnosis of ameloblastomas of lower jaw: A case report and mini review. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2018; 26:133-140. [PMID: 29480235 DOI: 10.3233/xst-17344] [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: 06/08/2023]
Abstract
Cone beam computed tomography (CBCT) has obvious advantages over regular radiography in diagnosis of complex diseases. Objective of this study is to report a case of a mandibular jaw ameloblastoma recurring cyst, which represents a benign tumor of odontogenic epithelium, using CBCT imaging technology. CBCT examination of the patient suffering with recurrent lower jaw cyst (relapsing four years after surgery) showed a decrease in irregular bone density and appearance of a honeycomb pattern (3.5 cm×2.5 cm×1.8 cm) in the right lower jaw. This suggests that the lesion is more likely to be an ameloblastoma. Preoperative tissue biopsy and pathological examination of surgical sample confirmed the diagnosis. Surgical resection of the diseased tissue and autogenous bone grafting in the mandible was performed. Postoperative CBCT examination showed that the bone defect healed well, without recurrence of the tumor 22 months postoperatively. In conclusion, the rotated 3D CBCT images clearly displays the exact size, location, borders and internal changes of the tumor in the jaw cyst itself and the adjacent tissues. Thus, the dental CBCT allows clinicians to better evaluate lesions, leading to better treatment outcomes.
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Affiliation(s)
- Dize Li
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Zhiqiang Yang
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Tao Chen
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Chao Guan
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Feilong Wang
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Ethan L Matz
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA
| | - Yuanyuan Zhang
- Wake Forest Institute for Regenerative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, USA
| | - Ping Ji
- College of Stomatology, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory for Oral Diseases and Biomedical Sciences, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
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Hammi A, Placidi L, Weber DC, Lomax AJ. Positioning of head and neck patients for proton therapy using proton range probes: a proof of concept study. ACTA ACUST UNITED AC 2017; 63:015025. [DOI: 10.1088/1361-6560/aa9cff] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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An infrared interactive patient position guidance and acquisition control system for use during radiotherapy treatment. JOURNAL OF RADIOTHERAPY IN PRACTICE 2017. [DOI: 10.1017/s1460396917000140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundThe control of patient position, posture and respiratory movements during radiotherapy is important for effective and specific treatment of malignancy. We have developed an infrared (IR) interactive patient position guidance and acquisition control system for clinical use, comprising IR cameras, IR markers and dedicated software.Materials and methodsWe evaluated the system with ten healthy volunteers and ten experienced operators. IR markers were placed on the body surface. Their positions were calculated using vectors of three translational and three rotational parameters, and the intrafractional error for each marker was acquired with and without respiratory motion. The inclusion of multiple positioning markers allowed for real-time visualisation of the patient posture, with feedback on misalignment and required postural adjustments.ResultsThe positioning time was 73 seconds (with a minimum period of 39 seconds), which was significantly shorter than for conventional line alignment. A comparison of positioning reproducibility between conventional line alignment and this system was <3·5 mm and was not patient dependent or operator dependent. An intrafractional error of displacement of up to 10·0 mm was found in the right iliac crest.ConclusionsThis IR interactive system was shown to be high utility and suitable for monitoring patient position, posture and respiratory movements during radiotherapy.
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Dhillon A, Erler D, Poon I, Lee J, Enepekides D, Higgins K, Chin L, Karam I. The Impact of Correcting for Translational and Rotational Errors Using the HexaPOD in Head and Neck Stereotactic Body Radiation Therapy Patients. J Med Imaging Radiat Sci 2017; 48:276-281. [DOI: 10.1016/j.jmir.2017.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 11/17/2022]
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Zhang Q, Driewer J, Wang S, Li S, Zhu X, Zheng D, Cao Y, Zhang J, Jamshidi A, Cox BW, Knisely JPS, Potters L, Klein EE. Accuracy evaluation of a six-degree-of-freedom couch using cone beam CT and IsoCal phantom with an in-house algorithm. Med Phys 2017; 44:3888-3898. [PMID: 28500790 DOI: 10.1002/mp.12342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 04/24/2017] [Accepted: 05/03/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The accuracy of a six degree of freedom (6DoF) couch was evaluated using a novel method. METHODS Cone beam CT (CBCT) images of a 3D phantom (IsoCal) were acquired with different, known combinations of couch pitch and roll angles. Pitch and roll angles between the maximum allowable values of 357 and 3 degrees were tested in one degree increments. A total of 49 combinations were tested at 0 degrees of yaw (couch rotation angle). The 3D positions of 16 tungsten carbide ball bearings (BBs), each 4 mm in diameter and arranged in a known geometry within the IsoCal phantom, were determined in the 49 image sets with in-house software. The BB positions at different rotation angles were determined using a rotation matrix from the original BB positions at zero pitch and roll angles. A linear least squares fit method estimated the rotation angles and differences between detected and nominal rotation angles were calculated. This study was conducted for the case with and without extra weight on the couch. Couch walk shifts for the system were investigated using eight combinations of rotation, roll and pitch. RESULTS A total of 49 CBCT images with voxel sizes 0.5 × 0.5 × 1.0 mm3 were taken for the case without extra weight on the couch. The 16 BBs were determined to evaluate the isocenter translation and rotation differences between the calculated and nominal couch values. Among all 49 calculations, the maximum rotation angle differences were 0.10 degrees for pitch, 0.15 degrees for roll and 0.09 degrees for yaw. The corresponding mean and standard deviation values were 0.028 ± 0.032, -0.043 ± 0.058, and -0.009 ± 0.033 degrees. The maximum translation differences were 0.3 mm in the left-right direction, 0.5 mm in the anterior-posterior direction and 0.4 mm in the superior-inferior direction. The mean values and corresponding standard deviations were 0.07 ± 0.12, -0.05 ± 0.25, and -0.12±0.14 mm for the planes described above. With an 80 kg phantom on the couch, the maximum translation shift was 0.69 mm. The couch walk translation shifts were less than 0.1 mm and rotation shifts were less than 0.1 degree. CONCLUSIONS Errors of a new 6DoF couch were tested using CBCT images of a 3D phantom. The rotation errors were less than 0.3 degree and the translation errors were less than or equal to 0.8 mm in each direction. This level of accuracy is warranted for clinical radiotherapy utilization including stereotactic radiosurgery.
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Affiliation(s)
- Qinghui Zhang
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Joseph Driewer
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Shuo Wang
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Sicong Li
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Xiaofeng Zhu
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Dandan Zheng
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yijian Cao
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Jiaju Zhang
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Abolghassem Jamshidi
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Brett W Cox
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Jonathan P S Knisely
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Louis Potters
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
| | - Eric E Klein
- Department of Radiation Medicine, Northwell Health and Hofstra Northwell School of Medicine, New York, NY, 11042, USA
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Tuntipumiamorn L, Iampongpaiboon P, Damrongkijudom N, Krongyuth K, Polwatsatian V, Jaikreng S. Technical report. Accuracy of intensity-modulated radiation therapy dose calculations: verification based on-board conebeam CT imaging. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0504.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Patient’s conebeam computer tomography (CBCT) images have suggested a possibility for adaptive radiotherapy although the dose delivery is of structural complexity. It is of practical importance to verify and test the intensity-modulated radiation (IMRT) planning system for radiation therapy.
Objective: Verify accuracy of dose calculations based on CBCT imaging.
Materials and methods: Electron density calibration curve was generated for planning CT and CBCT data set using two CT phantoms (Gammex RMI® and Catphan® 600). Anthropomorphic head and neck phantom images were acquired from planning CT and CBCT. The routine IMRT technique was generated on the planning CT, which was applied to the CBCT. Dose distributions were computed. All LiF TLD-100 dosimeters were calibrated with gamma-ray. Forty-eight TLD measuring points were chosen in five different slices of the phantom. Measurements were repeated four times, and the average dose was compared to the reading doses on both CT and CBCT plans. Dose volume histograms (DVH) of various structures were generated, and dose statistics were analyzed.
Results: Hounsfield unit obtained from Catphan phantom was similar between planning CT and CBCT. IMRT dose calculations based on the planning CT and CBCT agreed well with reading doses at 48 points. Statistical point doses by DVH calculation on CBCT were about 3% lower than those by the conventional CT. Dose ratios calculated over measured ones ranged from 0.82 to 1.09.
Conclusion: Point doses and DVH calculations based on the planning CT and on-board CBCT were in acceptable agreement. CT phantom specifically designed for CBCT is recommended to improve accuracy of IMRT dose calculation on CBCT images.
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Affiliation(s)
- Lalida Tuntipumiamorn
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital; Bangkok 10700, Thailand
| | - Porntip Iampongpaiboon
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital; Bangkok 10700, Thailand
| | - Nuanpen Damrongkijudom
- Department of Radiological Technology, Faculty of Medical Technology, Mahidol University, Bangkok 10700, Thailand
| | - Khummook Krongyuth
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital; Bangkok 10700, Thailand
| | - Vinai Polwatsatian
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital; Bangkok 10700, Thailand
| | - Satja Jaikreng
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Siriraj Hospital; Bangkok 10700, Thailand
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Taniguchi T, Hara T, Shimozato T, Shiraki K, Ohono K, Maejima R. [Influence of Acquisition Mode of Cone-beam Computed Tomography on Accuracy of Image Registration for Image-guided Radiotherapy]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2017; 73:646-653. [PMID: 28824088 DOI: 10.6009/jjrt.2017_jsrt_73.8.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Half scan can acquire images at the 200° rotation in image-guided radiation treatment using cone-beam CT and is useful to evaluate the influence of the half-scan-imaging start angle and imaging direction on image registration accuracy. The half-scan-imaging start angle is changed from 180° to 340° in the clockwise direction and from 180° to 20° in the counter clockwise direction to calculate the registration error. As a result, registration errors between -0.37 mm and 0.27 mm in the left and right directions occur because of the difference in the imaging start angle and approximately 0.3° in the gantry rotation direction because of the difference in the imaging direction. Because half scan does not have data for 360° rotation, depending on the subject structure, inconsistency of opposing data can lower reconstruction accuracy and cause a verification error. In addition, in image acquisition during rotation, the slower the shutter speed is, the more the actual gantry angle and angle information of the image are apart, which is considered the cause of rotation errors. Although these errors are very minute, it is thought that there is no influence on the treatment effect, but these errors are considered an evaluation item indispensable for ensuring the accuracy of high-precision radiation treatment. In addition, these errors need to be considered for ensuring the quality of high-precision radiation treatment.
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Affiliation(s)
- Takuya Taniguchi
- Radiology Department, Murakami Memorial Hospital, Asahi University
| | - Takanori Hara
- Department of Medical Technology, Nakatsugawa Municipal General Hospital
| | | | | | - Kousei Ohono
- Radiology Department, Murakami Memorial Hospital, Asahi University
| | - Ryousyuu Maejima
- Radiology Department, Murakami Memorial Hospital, Asahi University
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Xu H, Brown S, Chetty IJ, Wen N. A Systematic Analysis of Errors in Target Localization and Treatment Delivery for Stereotactic Radiosurgery Using 2D/3D Image Registration. Technol Cancer Res Treat 2016; 16:321-331. [PMID: 27582369 DOI: 10.1177/1533034616664425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To determine the localization uncertainties associated with 2-dimensional/3-dimensional image registration in comparison to 3-dimensional/3-dimensional image registration in 6 dimensions on a Varian Edge Linac under various imaging conditions. METHODS The systematic errors in 6 dimensions were assessed by comparing automatic 2-dimensional/3-dimensional (kV/MV vs computed tomography) with 3-dimensional/3-dimensional (cone beam computed tomography vs computed tomography) image registrations under various conditions encountered in clinical applications. The 2-dimensional/3-dimensional image registration uncertainties for 88 patients with different treatment sites including intracranial and extracranial were evaluated by statistically analyzing 2-dimensional/3-dimensional pretreatment verification shifts of 192 fractions in stereotactic radiosurgery and stereotactic body radiotherapy. RESULTS The systematic errors of 2-dimensional/3-dimensional image registration using kV-kV, MV-kV, and MV-MV image pairs were within 0.3 mm and 0.3° for the translational and rotational directions within a 95% confidence interval. No significant difference ( P > .05) in target localization was observed with various computed tomography slice thicknesses (0.8, 1, 2, and 3 mm). Two-dimensional/3-dimensional registration had the best accuracy when pattern intensity and content filter were used. For intracranial sites, means ± standard deviations of translational errors were -0.20 ± 0.70 mm, 0.04 ± 0.50 mm, and 0.10 ± 0.40 mm for the longitudinal, lateral, and vertical directions, respectively. For extracranial sites, means ± standard deviations of translational errors were -0.04 ± 1.00 mm, 0.2 ± 1.0 mm, and 0.1 ± 1.0 mm for the longitudinal, lateral, and vertical directions, respectively. Two-dimensional/3-dimensional image registration for intracranial and extracranial sites had comparable systematic errors that were approximately 0.2 mm in the translational direction and 0.08° in the rotational direction. CONCLUSION The standard 2-dimensional/3-dimensional image registration tool available on the Varian Edge radiosurgery device, a state-of-the-art system, is helpful for robust and accurate target positioning for image-guided stereotactic radiosurgery.
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Affiliation(s)
- Hao Xu
- 1 Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Stephen Brown
- 2 Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
| | - Indrin J Chetty
- 2 Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
| | - Ning Wen
- 2 Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, USA
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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
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Affiliation(s)
- He Wang
- The University of Texas MD Anderson Cancer Center.
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Sresty NVNM, Alluri K, Thogata R. A study of X-ray volume imaging system in image guided radiotherapy with variable gantry rotations. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2016. [DOI: 10.14319/ijcto.41.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Arns A, Blessing M, Fleckenstein J, Stsepankou D, Boda-Heggemann J, Simeonova-Chergou A, Hesser J, Lohr F, Wenz F, Wertz H. Towards clinical implementation of ultrafast combined kV-MV CBCT for IGRT of lung cancer : Evaluation of registration accuracy based on phantom study. Strahlenther Onkol 2016; 192:312-21. [PMID: 26864049 DOI: 10.1007/s00066-016-0947-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/14/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE Combined kV-MV cone-beam CT (CBCT) is a promising approach to accelerate imaging for patients with lung tumors treated with deep inspiration breath-hold. During a single breath-hold (15 s), a 3D kV-MV CBCT can be acquired, thus minimizing motion artifacts and increasing patient comfort. Prior to clinical implementation, positioning accuracy was evaluated and compared to clinically established imaging techniques. METHODS AND MATERIALS An inhomogeneous thorax phantom with four tumor-mimicking inlays was imaged in 10 predefined positions and registered to a planning CT. Novel kV-MV CBCT imaging (90° arc) was compared to clinically established kV-chest CBCT (360°) as well as nonclinical kV-CBCT and low-dose MV-CBCT (each 180°). Manual registration, automatic registration provided by the manufacturer and an additional in-house developed manufacturer-independent framework based on the MATLAB registration toolkit were applied. RESULTS Systematic setup error was reduced to 0.05 mm by high-precision phantom positioning with optical tracking. Stochastic mean displacement errors were 0.5 ± 0.3 mm in right-left, 0.4 ± 0.4 mm in anteroposterior and 0.0 ± 0.4 mm in craniocaudal directions for kV-MV CBCT with manual registration (maximum errors of no more than 1.4 mm). Clinical kV-chest CBCT resulted in mean errors of 0.2 mm (other modalities: 0.4-0.8 mm). Similar results were achieved with both automatic registration methods. CONCLUSION The comparison study of repositioning accuracy between novel kV-MV CBCT and clinically established volume imaging demonstrated that registration accuracy is maintained below 1 mm. Since imaging time is reduced to one breath-hold, kV-MV CBCT is ideal for image guidance, e.g., in lung stereotactic ablative radiotherapy.
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Affiliation(s)
- Anna Arns
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Haus 4, Ebene 0, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Manuel Blessing
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Haus 4, Ebene 0, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jens Fleckenstein
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Haus 4, Ebene 0, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Dzmitry Stsepankou
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Haus 4, Ebene 0, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Haus 4, Ebene 0, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Anna Simeonova-Chergou
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Haus 4, Ebene 0, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jürgen Hesser
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Haus 4, Ebene 0, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frank Lohr
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Haus 4, Ebene 0, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Haus 4, Ebene 0, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Hansjörg Wertz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Haus 4, Ebene 0, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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Martens D, Luesink M, Huizenga H, Pasma KL. eNAL++: a new and effective off-line correction protocol for rotational setup errors when using a robotic couch. J Appl Clin Med Phys 2015; 16:177-185. [PMID: 26699569 PMCID: PMC5690996 DOI: 10.1120/jacmp.v16i6.5583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 08/26/2015] [Accepted: 07/22/2015] [Indexed: 12/25/2022] Open
Abstract
Cone‐beam CTs (CBCTs) installed on a linear accelerator can be used to provide fast and accurate automatic six degrees of freedom (6DoF) vector displacement information of the patient position just prior to radiotherapy. These displacement corrections can be made with 6DoF couches, which are primarily used for patient setup correction during stereotactic treatments. When position corrections are performed daily prior to treatment, the correction is deemed "online". However, the interface between the first generation 6DoF couches and the imaging software is suboptimal. The system requires the user to select manually the patient and type the match result by hand. The introduction of 6DoF setup correction for treatments, other than stereotactic radiotherapy, is hindered by both the high workload associated with the online protocol and the interface issues. For these reasons, we developed software that fully integrates the 6DoF couch with the linear accelerator. To further reduce both the workload and imaging dose, three off‐line 6DoF correction protocols were analyzed. While the protocols require significantly less imaging, the analysis assessed their ability to reduce the systematic rotation setup correction. CBCT scans were acquired for 19 patients with intracranial meningioma. The total number of CBCT scans was 856, acquired before and after radiotherapy treatment fractions. The patient positions were corrected online using a 6DoF robotic couch. The effects on the residual rotational setup error for three off‐line protocols were simulated. The three protocols used were two known off‐line protocols, the no action level (NAL) and the extended no action level (eNAL), and one new off‐line protocol (eNAL++). The residual setup errors were compared using the systematic and random components of the total setup error. The reduction of the rotational setup error of these protocols was optimized with respect to the required workload (i.e., number of CBCTs required). Rotational errors up to 3.2° were found after initial patient setup. The eNAL++ protocol achieved a reduction of the systematic rotational setup error similar to that of the online protocol (pitch from 0.8° to 0.3°), while requiring 70% fewer CBCTs. With a 6DoF robotic couch, translation, and rotation patient position corrections can be performed off‐line to reduce the systematic setup error, workload, and patient scan dose. PACS numbers: 87.56.Fc, 87.56.Da, 87.57.‐s
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Sresty N, Ramanjappa T. Optimal usage of cone beam computed tomography system with different field of views in image guided radiotherapy (IGRT). INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.33.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Chiesa S, Placidi L, Azario L, Mattiucci GC, Greco F, Damiani A, Mantini G, Frascino V, Piermattei A, Valentini V, Balducci M. Adaptive optimization by 6 DOF robotic couch in prostate volumetric IMRT treatment: rototranslational shift and dosimetric consequences. J Appl Clin Med Phys 2015; 16:35-45. [PMID: 26699314 PMCID: PMC5690171 DOI: 10.1120/jacmp.v16i5.5525] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 06/02/2015] [Accepted: 05/21/2015] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to investigate the magnitude and dosimetric relevance of translational and rotational shifts on IGRT prostate volumetric‐modulated arc therapy (VMAT) using Protura six degrees of freedom (DOF) Robotic Patient Positioning System. Patients with cT3aN0M0 prostate cancer, treated with VMAT simultaneous integrated boost (VMAT‐SIB), were enrolled. PTV2 was obtained adding 0.7 cm margin to seminal vesicles base (CTV2), while PTV1 adding to prostate (CTV1) 0.7 cm margin in all directions, except 1.2 cm, as caudal margin. A daily CBCT was acquired before dose delivery. The translational and rotational displacements were corrected through Protura Robotic Couch, collected and applied to the simulation CT to obtain a translated CT (tCT) and a rototranslated CT (rtCT) on which we recalculated the initial treatment plan (TP). We analyzed the correlation between dosimetric coverage, organs at risk (OAR) sparing, and translational or rotational displacements. The dosimetric impact of a rototranslational correction was calculated. From October 2012 to September 2013, a total of 263 CBCT scans from 12 patients were collected. Translational shifts were <5mm in 81% of patients and the rotational shifts were <2∘ in 93% of patient scans. The dosimetric analysis was performed on 172 CBCT scans and calculating 344 VMAT‐TP. Two significant linear correlations were observed between yaw and the V20 femoral heads and between pitch rotation and V50 rectum (p<0.001); rototranslational correction seems to impact more on PTV2 than on PTV1, especially when margins are reduced. Rotational errors are of dosimetric significance in sparing OAR and in target coverage. This is relevant for femoral heads and rectum because of major distance from isocenter, and for seminal vesicles because of irregular shape. No correlation was observed between translational and rotational errors. A study considering the intrafractional error and the deformable registration is ongoing. PACS number: 87.55.de
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Finnigan R, Lamprecht B, Barry T, Jones K, Boyd J, Pullar A, Burmeister B, Foote M. Inter- and intra-fraction motion in stereotactic body radiotherapy for spinal and paraspinal tumours using cone-beam CT and positional correction in six degrees of freedom. J Med Imaging Radiat Oncol 2015; 60:112-8. [PMID: 26813044 DOI: 10.1111/1754-9485.12353] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 07/24/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Stereotactic body radiotherapy (SBRT) for spinal tumours delivers high doses per fraction to targets in close proximity to neural tissue. With steep dose gradients, small changes in position can confer significant dosimetric impact on adjacent structures. We analysed positioning error in consecutively treated patients on a strict image-guidance protocol with online correction in 6 degrees of freedom (6-DOF). METHODS Set-up error, residual error post-correction and intra-fraction motion for 30 courses of spinal SBRT in 27 patients were assessed using cone-beam CT. Positional error was corrected in x, y and z translational planes and rotational axes using a robotic couch, applying 2 mm and 2° action levels. Linear mixed-effects model assessed whether positional error was influenced by factors such as vertebral level, immobilisation device and treatment duration. RESULTS Sixty-two fractions were delivered with 225 image registrations. Median treatment duration was significantly longer for patients treated with static-field intensity-modulated radiotherapy compared with volumetric-modulated arc treatment--40 min versus 28 min, respectively (P = 0.01). Across all fractions, the median residual positional error after initial correction was greatest in the x translational plane (0.5 mm; 95% confidence interval (CI) 0.3-0.6) and y rotational axis (0.25°; 95% CI 0.1-0.3). Median intra-fraction error was also greatest in the x-plane (0.7 mm; 95% CI 0.5-1.0) and y-axis (0.4°; 95% CI 0.2-0.5). CONCLUSION With strict immobilisation, image-guidance and 6-DOF correction, our current practice of applying 3-mm planning margins for target volumes and critical structures appears safe. Lower image-guidance action thresholds plus verification with end-to-end testing would be recommended before further reducing margins.
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Affiliation(s)
- Renee Finnigan
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Brock Lamprecht
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Tamara Barry
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Kimberley Jones
- Centre for Experimental Haematology, University of Queensland School of Medicine, Translational Research Institute, Brisbane, Queensland, Australia
| | - Joshua Boyd
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrew Pullar
- University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Bryan Burmeister
- University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Matthew Foote
- University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Seravalli E, van Haaren PMA, van der Toorn PP, Hurkmans CW. A comprehensive evaluation of treatment accuracy, including end-to-end tests and clinical data, applied to intracranial stereotactic radiotherapy. Radiother Oncol 2015; 116:131-8. [PMID: 26094075 DOI: 10.1016/j.radonc.2015.06.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 04/30/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE A methodology is presented to quantify the uncertainty associated with linear accelerator-based frameless intracranial stereotactic radiotherapy (SRT) combining end-to-end phantom tests and clinical data. METHODS AND MATERIALS The following steps of the SRT chain were analysed: planning computed tomography (CT) and magnetic resonance (MR) scans registration, target volume delineation, CT and cone beam CT (CBCT) registration and intrafraction-patient displacement. The overall accuracy was established with an end-to-end test. The measured uncertainties were combined, deriving the total systematic (ΣT) and random (σT) error components, to estimate the GTV-PTV margin. RESULTS The uncertainty in the MR-CT registration was on average 0.40mm (averaged over AP, CC and LR directions). Rotational variations were smaller than 0.5° in all directions. Interobser variation in GTV delineation was on average 0.29mm. The uncertainty in the CBCT-CT registration was on average 0.15mm. Again, rotational variations were smaller than 0.5° in all directions. The systematic and random intrafraction displacement errors were on average 0.55mm and 0.45mm, respectively. The systematic and random positional errors from the end-to-end test were on average 0.49mm and 0.53mm, respectively. Combining these uncertainties resulted in an average ΣT=0.9mm and σT=0.7mm and an average GTV-PTV margin of 2.8mm. CONCLUSION This comprehensive methodology including end-to-end tests enabled a GTV-PTV margin calculation considering all sources of uncertainties. This generic method can also be used for other treatment sites.
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Affiliation(s)
- E Seravalli
- Department of Radiation Oncology (MAASTRO), University Medical Centre Maastricht, The Netherlands.
| | - P M A van Haaren
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - P P van der Toorn
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - C W Hurkmans
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, The Netherlands
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Yao L, Zhu L, Wang J, Liu L, Zhou S, Jiang S, Cao Q, Qu A, Tian S. Positioning accuracy during VMAT of gynecologic malignancies and the resulting dosimetric impact by a 6-degree-of-freedom couch in combination with daily kilovoltage cone beam computed tomography. Radiat Oncol 2015; 10:104. [PMID: 25927659 PMCID: PMC4443556 DOI: 10.1186/s13014-015-0412-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Accepted: 04/20/2015] [Indexed: 12/25/2022] Open
Abstract
Background To improve the delivery of radiotherapy in gynecologic malignancies and to minimize the irradiation of unaffected tissues by using daily kilovoltage cone beam computed tomography (kV-CBCT) to reduce setup errors. Methods Thirteen patients with gynecologic cancers were treated with postoperative volumetric-modulated arc therapy (VMAT). All patients had a planning CT scan and daily CBCT during treatment. Automatic bone anatomy matching was used to determine initial inter-fraction positioning error. Positional correction on a six-degrees-of-freedom (6DoF) couch was followed by a second scan to calculate the residual inter-fraction error, and a post-treatment scan assessed intra-fraction motion. The margins of the planning target volume (MPTV) were calculated from these setup variations and the effect of margin size on normal tissue sparing was evaluated. Results In total, 573 CBCT scans were acquired. Mean absolute pre-/post-correction errors were obtained in all six planes. With 6DoF couch correction, the MPTV accounting for intra-fraction errors was reduced by 3.8–5.6 mm. This permitted a reduction in the maximum dose to the small intestine, bladder and femoral head (P = 0.001, 0.035 and 0.032, respectively), the average dose to the rectum, small intestine, bladder and pelvic marrow (P = 0.003, 0.000, 0.001 and 0.000, respectively) and markedly reduced irradiated normal tissue volumes. Conclusions A 6DoF couch in combination with daily kV-CBCT can considerably improve positioning accuracy during VMAT treatment in gynecologic malignancies, reducing the MPTV. The reduced margin size permits improved normal tissue sparing and a smaller total irradiated volume.
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Affiliation(s)
- Lihong Yao
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Lihong Zhu
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Lu Liu
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Shun Zhou
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - ShuKun Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Qianqian Cao
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Ang Qu
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
| | - Suqing Tian
- Department of Radiation Oncology, Peking University Third Hospital, Hua-yuan North Road No.49, Haidian District, Beijing, 100191, P. R. China.
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Ali ESM, Webb R, Nyiri BJ. Rotational artifacts in on-board cone beam computed tomography. Phys Med Biol 2015; 60:1461-76. [PMID: 25611205 DOI: 10.1088/0031-9155/60/4/1461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Rotational artifacts in image guidance systems lead to registration errors that affect non-isocentric treatments and dose to off-axis organs-at-risk. This study investigates a rotational artifact in the images acquired with the on-board cone beam computed tomography system XVI (Elekta, Stockholm, Sweden). The goals of the study are to identify the cause of the artifact, to characterize its dependence on other quantities, and to investigate possible solutions. A 30 cm diameter cylindrical phantom is used to acquire clockwise and counterclockwise scans at five speeds (120 to 360 deg min(-1)) on six Elekta linear accelerators from three generations (MLCi, MLCi2 and Agility). Additional scans are acquired with different pulse widths and focal spot sizes for the same mAs. Image quality is evaluated using a common phantom with an in-house three dimensional contrast transfer function attachment. A robust, operator-independent analysis is developed which quantifies rotational artifacts with 0.02° accuracy and imaging system delays with 3 ms accuracy. Results show that the artifact is caused by mislabelling of the projections with a lagging angle due to various imaging system delays. For the most clinically used scan speed (360 deg min(-1)), the artifact is ∼0.5°, which corresponds to ∼0.25° error per scan direction with the standard Elekta procedure for angle calibration. This leads to a 0.5 mm registration error at 11 cm off-center. The artifact increases linearly with scan speed, indicating that the system delay is independent of scan speed. For the most commonly used pulse width of 40 ms, this delay is 34 ± 1 ms, part of which is half the pulse width. Results are consistent among the three linac generations. A software solution that corrects the angles of individual projections is shown to eliminate the rotational error for all scan speeds and directions. Until such a solution is available from the manufacturer, three clinical solutions are presented, which reduce the rotational error without compromising image quality.
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Affiliation(s)
- E S M Ali
- Department of Medical Physics, The Ottawa Hospital Cancer Centre, Ottawa, Canada
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Naoi Y, Kunishima N, Yamamoto K, Yoda K. A planning target volume margin formula for hypofractionated intracranial stereotactic radiotherapy under cone beam CT image guidance with a six-degrees-of-freedom robotic couch and a mouthpiece-assisted mask system: a preliminary study. Br J Radiol 2014; 87:20140240. [PMID: 25029296 DOI: 10.1259/bjr.20140240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE A planning target volume (PTV) margin formula for hypofractionated intracranial stereotactic radiotherapy (SRT) has been proposed under cone beam CT (CBCT) image guidance with a six-degrees-of-freedom (6-DOF) robotic couch. METHODS CBCT-based registration using a 6-DOF couch reportedly led to negligibly small systematic positioning errors, suggesting that each in-treatment positioning error during the treatment courses for the patients employing this combination was predominantly caused by a random gaussian process. Under this assumption, an anisotropic PTV margin for each axis was formulated based on a gaussian distribution model. 19 patients with intracranial lesions who underwent additional post-treatment CBCT were consecutively selected, to whom stereotactic hypofractionated radiotherapy was delivered by a linear accelerator equipped with a CBCT imager, a 6-DOF couch and a mouthpiece-assisted mask system. Time-averaged patient-positioning errors during treatment were estimated by comparing the post-treatment CBCT with the reference planning CT images. RESULTS It was suggested that each histogram of the in-treatment positioning error in each axis would approach each single gaussian distribution with a mean of zero. The calculated PTV margins in the x, y and z directions were 0.97, 1.30 and 0.88 mm, respectively. CONCLUSION The empirical isotropic PTV margin of 2 mm used in our facility for intracranial SRT was consistent with the margin calculated by the proposed gaussian model. ADVANCES IN KNOWLEDGE We have proposed a PTV margin formula for hypofractionated intracranial SRT under CBCT image guidance with a 6-DOF robotic couch.
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Affiliation(s)
- Y Naoi
- 1 Department of Radiology, Self Defense Forces Central Hospital, Tokyo, Japan
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Li Q, Mu J, Gu W, Chen Y, Ning Z, Jin J, Pei H. Frameless stereotactic body radiation therapy for multiple lung metastases. J Appl Clin Med Phys 2014; 15:4737. [PMID: 25207400 PMCID: PMC5875519 DOI: 10.1120/jacmp.v15i4.4737] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 04/15/2014] [Accepted: 04/05/2014] [Indexed: 12/02/2022] Open
Abstract
Two patients with multiple lung metastases (≥ 5) were treated using frameless stereotactic body radiation therapy (SBRT) on an Elekta Axesse linear accelerator equipped with an interdigitation‐capable multileaf collimator and four‐dimensional cone‐beam CT (4D CBCT). The technique and the early clinical outcomes were evaluated. Patient A with five lung metastases and Patient B with seven lung metastases underwent SBRT (48 Gy/8 fractions for Patient A, 42 Gy/7 fractions for Patient B). The treatments were administered using a 6 MV photon beam. The nominal dose rate was 660 MUs/min. Patients were positioned and immobilized using thermoplastic masks and image guidance was done using 4D CBCT. The targets were delineated on the images of the 4D CT, and the positron emission tomography‐computed tomography (PET‐CT) images were taken as references. A two‐step, volumetric‐modulated arc therapy (VMAT) plan was designed for each patient. Step 1: the lesions in one lung were irradiated by a 210° arc field; Step 2: the rest of the lesions in the other lung were irradiated by a 120° arc field. Plans were evaluated using conformity index (CI) and homogeneity index (HI). Patients were followed up and adverse events were graded according to the Common Terminology Criteria for Adverse Events v4.0 (CTCAE v4.0). The beam‐on time of each treatment was less than 10 min. The CI and HI for the two plans were 0.562, 0.0709 and 0.513, 0.0794, respectively. Pulmonary function deteriorated slightly in both patients, and the patient with seven lung lesions was confirmed to have Grade 1 radiation pneumonitis. The technique was fast, accurate, and well tolerated by patients, and the two‐step plan is a helpful design in reducing the dose to the lungs. PACS numbers: 87.55‐x, 87.56.J‐, 87.56.‐v, 87.56.nk, 87.57.qp
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Affiliation(s)
- Qilin Li
- The First People's Hospital of Changzhou City.
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