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Fu W, Zhang Y, Mehta K, Chen A, Musunuru HB, Pucci P, Kubis J, Huq MS. Evaluating intra-fractional tumor motion in lung stereotactic radiotherapy with deep inspiration breath-hold. J Appl Clin Med Phys 2024:e14414. [PMID: 38803045 DOI: 10.1002/acm2.14414] [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: 02/27/2024] [Revised: 04/19/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE To evaluate the intra-fractional tumor motion in lung stereotactic body radiotherapy (SBRT) with deep inspiration breath-hold (DIBH), and to investigate the adequacy of the current planning target volume (PTV) margins. METHODS Twenty-eight lung SBRT patients with DIBH were selected in this study. Among the lesions, twenty-three were at right or left lower lobe, two at right middle lobe, and three at right or left upper lobe. Post-treatment gated cone-beam computed tomography (CBCT) was acquired to quantify the intra-fractional tumor shift at each treatment. These obtained shifts were then used to calculate the required PTV margin, which was compared with the current applied margin of 5 mm margin in anterior-posterior (AP) and right-left (RL) directions and 8 mm in superior-inferior (SI) direction. The beam delivery time was prolonged with DIBH. The actual beam delivery time with DIBH (Tbeam_DIBH) was compared with the beam delivery time without DIBH (Tbeam_wo_DIBH) for the corresponding SBRT plan. RESULTS A total of 113 treatments were analyzed. At six treatments (5.3%), the shifts exceeded the tolerance defined by the current PTV margin. The average shifts were 0.0 ± 1.9 mm, 0.1±1.5 mm, and -0.5 ± 3.7 mm in AP, RL, and SI directions, respectively. The required PTV margins were determined to be 4.5, 3.9, and 7.4 mm in AP, RL, and SI directions, respectively. The average Tbeam_wo_DIBH and Tbeam_DIBH were 2.4 ± 0.4 min and 3.6 ± 1.5 min, respectively. The average treatment slot for lung SBRT with DIBH was 25.3 ± 7.9 min. CONCLUSION Intra-fractional tumor motion is the predominant source of treatment uncertainties in CBCT-guided lung SBRT with DIBH. The required PTV margin should be determined based on data specific to each institute, considering different techniques and populations. Our data indicate that our current applied PTV margin is adequate, and it is possible to reduce further in the RL direction. The time increase of Tbeam_DIBH, relative to the treatment slot, is not clinically significant.
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Affiliation(s)
- Weihua Fu
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Yongqian Zhang
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Kiran Mehta
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Alex Chen
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Hima Bindu Musunuru
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Pietro Pucci
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Jason Kubis
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - M Saiful Huq
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
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Aznar MC, Carrasco de Fez P, Corradini S, Mast M, McNair H, Meattini I, Persson G, van Haaren P. ESTRO-ACROP guideline: Recommendations on implementation of breath-hold techniques in radiotherapy. Radiother Oncol 2023; 185:109734. [PMID: 37301263 DOI: 10.1016/j.radonc.2023.109734] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
The use of breath-hold techniques in radiotherapy, such as deep-inspiration breath hold, is increasing although guidelines for clinical implementation are lacking. In these recommendations, we aim to provide an overview of available technical solutions and guidance for best practice in the implementation phase. We will discuss specific challenges in different tumour sites including factors such as staff training and patient coaching, accuracy, and reproducibility. In addition, we aim to highlight the need for further research in specific patient groups. This report also reviews considerations for equipment, staff training and patient coaching, as well as image guidance for breath-hold treatments. Dedicated sections for specific indications, namely breast cancer, thoracic and abdominal tumours are also included.
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Affiliation(s)
- Marianne Camille Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom.
| | - Pablo Carrasco de Fez
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Mirjam Mast
- Department of Radiotherapy, Haaglanden Medical Center, Leidschendam, The Netherlands
| | - Helen McNair
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, UK
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Department of Clinical and Experimental Biomedical Sciences "M. Serio", University of Florence, Florence, Italy
| | - Gitte Persson
- Department of Oncology, Herlev-Gentofte Hospital, University of Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Denmark
| | - Paul van Haaren
- Department of Radiotherapy, Catharina Hospital, Eindhoven, The Netherlands
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Appel S, Lawrence YR, Bar J, Jacobson G, Marom EM, Katzman T, Ben-Ayun M, Dubinski S, Haisraely O, Weizman N, Davidson T, Weiss I, Mansano A, Goldstein JD, Symon Z. Deep inspiratory breath hold assisted by continuous positive airway pressure ventilation for lung stereotactic body radiotherapy. Cancer Radiother 2023; 27:23-30. [PMID: 36057519 DOI: 10.1016/j.canrad.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 05/14/2022] [Accepted: 05/24/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Continuous positive airway pressure (CPAP) ventilation hyperinflates the lungs and reduces diaphragmatic motion. We hypothesized that CPAP could be safely combined with deep inspiratory breath hold (CPAP-DIBH) during lung stereotactic radiotherapy (SBRT). MATERIAL AND METHODS Patients with stage-1 lung cancer or lung metastasis treated with CPAP-DIBH SBRT between 3/2017-5/2021 were analyzed retrospectively. Patient characteristics, treatment parameters, duration of breath holds in all sessions and tolerance to CPAP-DIBH were recorded. Local control (LC) was assessed from CT or PET-CT imaging. The distances between the tumor and mediastinal organs at risk (OAR) in centrally located tumors using either free breathing (FB) or CPAP-DIBH were compared. Toxicity was graded retrospectively. RESULTS Forty-five patients with 71 lesions were treated with CPAP-DIBH SBRT. Indications for CPAP-DIBH were prior radiation (35/71, 65%), lower lobe location (34/71, 48%), multiple lesions (26/71, 36.6%) and proximity to mediastinal OAR (7/71, 10%). Patient characteristics were: F:M 43%: 57%; mean gross tumor volume 4.5cm3 (SD 7.9), mean planning target volume 20cm3 (SD 27), primary: metastatic lesions (7%:93%). Mean radiation dose was 52.5 Gray (SD3.5). Mean lung volume was 5292cm3 (SD 1106). Mean duration of CPAP-DIBH was 41.3s (IQR 31-46.8). LC at 2 years was 89.5% (95% CI 76-95.5). In patients with central lesions, the distance between the tumor and mediastinal OAR increased from 0.84cm (SD 0.65) with FB to 1.23cm (SD 0.8) with CPAP-DIBH (p=0.002). Most patients tolerated CPAP well and completed all treatments after starting therapy. Three patients did not receive treatment: 2 were unable to tolerate CPAP and 1 had syncope (pre-existing). Toxicity was grade 2 in 4/65 (6%) and grade 3 in 1/65 (1.5%). There was no grade 2 or higher esophageal or tracheal toxicities. CONCLUSION CPAP-DIBH assisted lung SBRT was tolerated well and was associated with minimal toxicity and favorable LC. This technique may be considered when treating multiple lung lesions, lesions located in the lower lobes or adjacent to mediastinal OAR.
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Affiliation(s)
- Sarit Appel
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yaacov Richard Lawrence
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jair Bar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - Galia Jacobson
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Edith M Marom
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Radiology, Sheba Medical Center, Tel Hashomer, Israel
| | - Tamar Katzman
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Maoz Ben-Ayun
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sergei Dubinski
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ory Haisraely
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noam Weizman
- Department of Radiation Oncology, Hadassah Medical Center, Jerusalem, Israel
| | - Tima Davidson
- Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel
| | - Ilana Weiss
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Mansano
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Zvi Symon
- Department of Radiation Oncology, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Prado A, Zucca D, De la Casa MÁ, Martí J, Alonso L, de Acilu PG, García J, Hernando O, Fernández-Letón P, Rubio C. Intrafraction target shift comparison using two breath-hold systems in lung stereotactic body radiotherapy. Phys Imaging Radiat Oncol 2022; 22:57-62. [PMID: 35514526 PMCID: PMC9065403 DOI: 10.1016/j.phro.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 12/25/2022] Open
Abstract
Background and purpose In lung Stereotactic Body Radiotherapy (SBRT) respiratory management is used to reduce target motion due to respiration. This study aimed (1) to estimate intrafraction shifts through a Cone Beam Computed Tomography (CBCT) acquired during the first treatment arc when deep inspiration breath-hold (DIBH) was performed using spirometry-based (SB) or surface-guidance (SG) systems and (2) to analyze the obtained results depending on lesion localization. Material and methods A sample of 157 patients with 243 lesions was analyzed. A total of 860 and 410 fractions were treated using SB and SG. Averaged intrafraction shifts were estimated by the offsets obtained when registering a CBCT acquired during the first treatment arc with the planning CT. Offsets were recorded in superior-inferior (SI), left-right (LR) and anterior-posterior (AP). Significance tests were applied to account for differences in average offsets and variances between DIBH systems. Systematic and random errors were computed. Results Average offset moduli were 2.4 ± 2.2 mm and 3.5 ± 2.6 mm for SB and SG treatments (p < 0.001). When comparing SB and SG offset distributions in each direction no differences were found in average values (p > 0.3). However, variances were statistically smaller for SB than for SG (p < 0.001). The number of vector moduli offsets greater than 5 mm was 2.1 times higher for SG. Compared to other locations, lower lobe lesions moduli were at least 2.3 times higher. Conclusions Both systems were accuracy-equivalent but not precision-equivalent systems. Furthermore, the SB system was more precise than the SG one. Despite DIBH, patients with lower lobe lesions had larger offsets than superior lobe ones, mainly in SI.
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Affiliation(s)
- Alejandro Prado
- Medical Physics and Radiation Protection Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
| | - Daniel Zucca
- Medical Physics and Radiation Protection Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
| | - Miguel Ángel De la Casa
- Medical Physics and Radiation Protection Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
| | - Jaime Martí
- Medical Physics and Radiation Protection Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
| | - Leyre Alonso
- Medical Physics and Radiation Protection Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
| | - Paz García de Acilu
- Medical Physics and Radiation Protection Department, HU HM Puerta del Sur, HM Hospitales, Av. Carlos V n° 70, 28938 Móstoles, Madrid, Spain
| | - Juan García
- Medical Physics and Radiation Protection Department, HU HM Puerta del Sur, HM Hospitales, Av. Carlos V n° 70, 28938 Móstoles, Madrid, Spain
| | - Ovidio Hernando
- Radiation Oncology Department, HU HM Puerta del Sur, HM Hospitales, Av. Carlos V n° 70, 28938 Móstoles, Madrid, Spain
| | - Pedro Fernández-Letón
- Medical Physics and Radiation Protection Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
- Medical Physics and Radiation Protection Department, HU HM Puerta del Sur, HM Hospitales, Av. Carlos V n° 70, 28938 Móstoles, Madrid, Spain
| | - Carmen Rubio
- Radiation Oncology Department, HU HM Sanchinarro, HM Hospitales, c\ Oña n°10, 28050 Madrid, Spain
- Radiation Oncology Department, HU HM Puerta del Sur, HM Hospitales, Av. Carlos V n° 70, 28938 Móstoles, Madrid, Spain
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Takahashi S, Nishide T, Tsuzuki M, Katayama H, Anada M, Kinoshita T, Kozai S, Shibata T. Target coverage of daily cone-beam computed tomography in breath-hold image-guided radiotherapy for gastric lymphoma. BJR Open 2021; 2:20200062. [PMID: 34381938 PMCID: PMC8320113 DOI: 10.1259/bjro.20200062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives We evaluated retrospectively the daily target coverage using cone-beam computed tomography (CBCT) in breath-hold image-guided radiotherapy (BH-IGRT) for gastric lymphoma. Methods BH-IGRT was performed using a prescribed dose of 30.6 Gy in 17 fractions for the whole stomach. We assessed the target coverage of the whole stomach on daily CBCT images [daily clinical target volume (CTV)], which was delineated individually by two observers. We evaluated V95% (percentage of volume receiving ≥95% of the prescribed dose) of daily CTV. Results In total, 102 fractions from 6 patients were assessed. The mean V95% of daily CTV was 97.2%, which was over 95%. In two of six patients, the V95% of daily CTV was over 95% for either observer in all fractions. One patient had significant interobserver variation (p = 0.013). In 95 fractions (93%), the V95% of daily CTV was over 95% for either observer. Conclusion Daily target coverage for CTV in BH-IGRT for gastric lymphoma seems to be favorable, even when using CBCT. Advances in knowledge A previous study ascertained good daily target coverage in BH-IGRT for gastric lymphoma using in-room CT. Even when using CBCT in our study, daily target coverage for CTV in BH-IGRT for gastric lymphoma seems to be favorable.
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Affiliation(s)
- Shigeo Takahashi
- Department of Radiation Oncology, Kagawa University Hospital, Kagawa, Japan
| | - Takamasa Nishide
- Department of Radiation Oncology, Kagawa University Hospital, Kagawa, Japan
| | - Masato Tsuzuki
- Department of Clinical Radiology, Kagawa University Hospital, Kagawa, Japan
| | - Hiroki Katayama
- Department of Clinical Radiology, Kagawa University Hospital, Kagawa, Japan
| | - Masahide Anada
- Department of Radiation Oncology, Kagawa University Hospital, Kagawa, Japan
| | | | - Shohei Kozai
- Department of Radiation Oncology, Kagawa University Hospital, Kagawa, Japan
| | - Toru Shibata
- Department of Radiation Oncology, Kagawa University Hospital, Kagawa, Japan
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Han-Oh S, Hill C, Kang-Hsin Wang K, Ding K, Wright JL, Alcorn S, Meyer J, Herman J, Narang A. Geometric Reproducibility of Fiducial Markers and Efficacy of a Patient-Specific Margin Design Using Deep Inspiration Breath Hold for Stereotactic Body Radiation Therapy for Pancreatic Cancer. Adv Radiat Oncol 2021; 6:100655. [PMID: 33732963 PMCID: PMC7940819 DOI: 10.1016/j.adro.2021.100655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/20/2020] [Accepted: 12/30/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose In patients undergoing stereotactic body radiation therapy (SBRT) for pancreatic adenocarcinoma, the reproducibility of tumor positioning between deep-inspiration breath holds is unclear. We characterized this variation with fiducials at simulation and treatment and investigated whether a patient-specific breath-hold (PSBH) margin would help account for intrafraction variation at treatment. Methods and Materials We analyzed 20 consecutive patients with pancreatic cancer who underwent SBRT with deep-inspiration breath holds. At simulation, 3 additional breath-hold scans were acquired immediately after the contrast-enhanced planning computed tomography (CT) scan and used to quantify the mean and maximum variations in the simulation fiducial position (Sim_Varavg and Sim_Varmax), as well as to design the internal target volume (ITV) incorporating a PSBH margin. Results At treatment, a mean of 5 breath-hold cone beam CT (CBCT) scans were acquired per fraction for each patient to quantify the mean and maximum variations in the treatment fiducial position (Tx_Varavg and Tx_Varmax). Various planning target volume (PTV) margins on the gross tumor volume (GTV) versus ITV were evaluated using CBCT scans, with the goal of >95% of fiducials being covered at treatment. The Sim_Varavg and Sim_Varmax were 0.9 ± 0.5 mm and 1.5 ± 0.8 mm in the left-right (LR) direction, 0.9 ± 0.4 mm and 1.4 ± 0.4 mm in the anteroposterior (AP) direction, and 1.5 ± 0.9 mm and 2.1 ± 1.0 mm in the superoinferior (SI) direction, respectively. The Tx_Varavg and Tx_Varmax were 1.2 ± 0.4 mm and 2.0 ± 0.7 mm in the LR direction, 1.1 ± 0.4 mm and 1.8 ± 0.6 mm in the AP direction, and 1.9 ± 1.0 mm and 3.1 ± 1.4 mm in the SI direction, respectively. The ITV was increased by 21.0% ± 8.6% compared with the GTV alone. The PTV margin necessary to encompass >95% of the fiducial locations was 2 mm versus 4 mm in both LR and AP and 4 mm versus 6 mm in SI for the ITV and the GTV, respectively. Conclusions The interbreath-hold variation is not insignificant, especially in the SI direction. Acquiring multiple breath-hold CT scans at simulation can help quantify the reproducibility of the interbreath hold and design a PSBH margin for treatment.
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Affiliation(s)
- Sarah Han-Oh
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland
| | - Colin Hill
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland
| | - Ken Kang-Hsin Wang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland
| | - Kai Ding
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland
| | - Jean L Wright
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland
| | - Sara Alcorn
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland
| | - Jeffrey Meyer
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland
| | - Joseph Herman
- Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York
| | - Amol Narang
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University of School of Medicine, Baltimore, Maryland
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Xu H, Gong G, Yin Y, Liu T. A preliminary investigation of re-evaluating the irradiation dose in hepatocellular carcinoma radiotherapy applying 4D CT and deformable registration. J Appl Clin Med Phys 2021; 22:13-20. [PMID: 33452706 PMCID: PMC7882094 DOI: 10.1002/acm2.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/26/2020] [Accepted: 11/11/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To investigate the effect of breathing motion on dose distribution for hepatocellular carcinoma (HCC) patients using four‐dimensional (4D) CT and deformable registration. Methods Fifty HCC patients who were going to receive radiotherapy were enrolled in this study. All patients had been treated with transarterial chemoembolization beforehand. Three‐dimensional (3D) and 4D CT scans in free breathing were acquired sequentially. Volumetric modulated arc therapy (VMAT) was planned on the 3D CT images and maximum intensity projection (MIP) images. Thus, the 3D dose (Dose‐3D) and MIP dose (Dose‐MIP) were obtained, respectively. Then, the Dose‐3D and Dose‐MIP were recalculated on 10 phases of 4D CT images, respectively, in which the end‐inhale and end‐exhale phase doses were defined as Dose‐3D‐EI, Dose‐3D‐EE, Dose‐MIP‐EI, and Dose‐MIP‐EE. The 4D dose (Dose‐4D‐3D and Dose‐4D‐MIP) were obtained by deforming 10 phase doses to the end‐exhale CT to accumulate. The dosimetric difference in Dose‐3D, Dose‐EI3D, Dose‐EE3D, Dose‐4D‐3D, Dose‐MIP, Dose‐EIMIP, Dose‐EEMIP, and Dose‐4D‐MIP were compared to evaluate the motion effect on dose delivery to the planning target volume (PTV) and normal liver. Results Compared with Dose‐3D, PTV D99 in Dose‐EI3D, Dose‐EE3D and Dose‐4D‐3D decreased by an average of 6.02%, 1.32%, 2.43%, respectively (P < 0.05); while PTV D95 decreased by an average of 3.34%, 1.51%, 1.93%, respectively (P < 0.05). However, CI and HI of the PTV in Dose‐3D was superior to the other three distributions (P < 0.05). There was no significant differences for the PTV between Dose‐EI and Dose‐EE, and between the two extreme phase doses and Dose‐4D (P> 0.05). Negligible difference was observed for normal liver in all dose distributions (P> 0.05). Conclusions Four‐dimensional dose calculations potentially ensure target volume coverage when breathing motion may affect the dose distribution. Dose escalation can be considered to improve the local control of HCC on the basis of accurately predicting the probability of radiation‐induced liver disease.
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Affiliation(s)
- Hua Xu
- The Second People's Hospital of Liaocheng, The Second Hospital of Liaocheng Affiliated to Shandong First Medical University, Shandong, China
| | - Guanzhong Gong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Yong Yin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
| | - Tonghai Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Shandong, China
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Capaldi DPI, Nano TF, Zhang H, Skinner LB, Xing L. Technical Note: Evaluation of audiovisual biofeedback smartphone application for respiratory monitoring in radiation oncology. Med Phys 2020; 47:5496-5504. [PMID: 32969075 PMCID: PMC7722016 DOI: 10.1002/mp.14484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/26/2020] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Radiation dose delivered to targets located near the upper abdomen or thorax are significantly affected by respiratory motion, necessitating large margins, limiting dose escalation. Surrogate motion management devices, such as the Real-time Position Management (RPM™) system (Varian Medical Systems, Palo Alto, CA), are commonly used to improve normal tissue sparing. Alternative to current solutions, we have developed and evaluated the feasibility of a real-time position management system that leverages the motion data from the onboard hardware of Apple iOS devices to provide patients with visual coaching with the potential to improve the reproducibility of breathing as well as improve patient compliance and reduce treatment delivery time. METHODS AND MATERIALS The iOS application, coined the Instant Respiratory Feedback (IRF) system, was developed in Swift (Apple Inc., Cupertino, CA) using the Core-Motion library and implemented on an Apple iPhone® devices. Operation requires an iPhone®, a three-dimensional printed arm, and a radiolucent projector screen system for feedback. Direct comparison between IRF, which leverages sensor fusion data from the iPhone®, and RPM™, an optical-based system, was performed on multiple respiratory motion phantoms and volunteers. The IRF system and RPM™ camera tracking marker were placed on the same location allowing for simultaneous data acquisition. The IRF surrogate measurement of displacement was compared to the signal trace acquired using RPM™ with univariate linear regressions and Bland-Altman analysis. RESULTS Periodic motion shows excellent agreement between both systems, and subject motion shows good agreement during regular and irregular breathing motion. Comparison of IRF and RPM™ show very similar signal traces that were significantly related across all phantoms, including those motion with different amplitude and frequency, and subjects' waveforms (all r > 0.9, P < 0.0001). We demonstrate the feasibility of performing four-dimensional cone beam computed tomography using IRF which provided similar image quality as RPM™ when reconstructing dynamic motion phantom images. CONCLUSIONS Feasibility of an iOS application to provide real-time respiratory motion is demonstrated. This system generated comparable signal traces to a commercially available system and offers an alternative method to monitor respiratory motion.
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Affiliation(s)
- Dante P I Capaldi
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Tomi F Nano
- San Francisco (UCSF) Comprehensive Cancer Centre, University of California, San Francisco, CA, USA
| | - Hao Zhang
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Lawrie B Skinner
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Lei Xing
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
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Naumann P, Batista V, Farnia B, Fischer J, Liermann J, Tonndorf-Martini E, Rhein B, Debus J. Feasibility of Optical Surface-Guidance for Position Verification and Monitoring of Stereotactic Body Radiotherapy in Deep-Inspiration Breath-Hold. Front Oncol 2020; 10:573279. [PMID: 33102232 PMCID: PMC7546313 DOI: 10.3389/fonc.2020.573279] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/08/2020] [Indexed: 12/25/2022] Open
Abstract
Background Reductions in tumor movement allow for more precise and accurate radiotherapy with decreased dose delivery to adjacent normal tissue that is crucial in stereotactic body radiotherapy (SBRT). Deep inspiration breath-hold (DIBH) is an established approach to mitigate respiratory motion during radiotherapy. We assessed the feasibility of combining modern optical surface-guided radiotherapy (SGRT) and image-guided radiotherapy (IGRT) to ensure and monitor reproducibility of DIBH and to ensure accurate tumor localization for SBRT as an imaging-guided precision medicine. Methods We defined a new workflow for delivering SBRT in DIBH for lung and liver tumors incorporating SGRT and IGRT with cone beam computed tomography (CBCT) twice per treatment fraction. Daily position corrections were analyzed and for every patient two points retrospectively characterized: an anatomically stable landmark (predominately Schmorl's nodes or spinal enostosis) and a respiratory-dependent landmark (predominately surgical clips or branching vessel). The spatial distance of these points was compared for each CBCT and used as surrogate for intra- and interfractional variability. Differences between the lung and liver targets were assessed using the Welch t-test. Finally, the planning target volumes were compared to those of free-breathing plans, prepared as a precautionary measure in case of technical or patient-related problems with DIBH. Results Ten patients were treated with SBRT according this workflow (7 liver, 3 lung). Planning target volumes could be reduced significantly from an average of 148 ml in free breathing to 110 ml utilizing DIBH (p < 0.001, paired t-test). After SGRT-based patient set-up, subsequent IGRT in DIBH yielded significantly higher mean corrections for liver targets compared to lung targets (9 mm vs. 5 mm, p = 0.017). Analysis of spatial distance between the fixed and moveable landmarks confirmed higher interfractional variability (interquartile range (IQR) 6.8 mm) than intrafractional variability (IQR 2.8 mm). In contrast, lung target variability was low, indicating a better correlation of patients' surface to lung targets (intrafractional IQR 2.5 mm and interfractional IQR 1.7 mm). Conclusion SBRT in DIBH utilizing SGRT and IGRT is feasible and results in significantly lower irradiated volumes. Nevertheless, IGRT is of paramount importance given that interfractional variability was high, particularly for liver tumors.
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Affiliation(s)
- Patrick Naumann
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Vania Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Benjamin Farnia
- Department of Radiation Oncology, University of Miami, Miami, FL, United States
| | - Jann Fischer
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Jakob Liermann
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Eric Tonndorf-Martini
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany
| | - Bernhard Rhein
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.,National Center for Tumor diseases (NCT), Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Schmitt D, Blanck O, Gauer T, Fix MK, Brunner TB, Fleckenstein J, Loutfi-Krauss B, Manser P, Werner R, Wilhelm ML, Baus WW, Moustakis C. Technological quality requirements for stereotactic radiotherapy : Expert review group consensus from the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. Strahlenther Onkol 2020; 196:421-443. [PMID: 32211939 PMCID: PMC7182540 DOI: 10.1007/s00066-020-01583-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 01/13/2020] [Indexed: 12/25/2022]
Abstract
This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as a basis for the future assignments of the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The review was group peer-reviewed, and consensus was obtained through multiple working group meetings.
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Affiliation(s)
- Daniela Schmitt
- Klinik für Radioonkologie und Strahlentherapie, National Center for Radiation Research in Oncology (NCRO), Heidelberger Institut für Radioonkologie (HIRO), Universitätsklinikum Heidelberg, Heidelberg, Germany.
| | - Oliver Blanck
- Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Tobias Gauer
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Michael K Fix
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Thomas B Brunner
- Universitätsklinik für Strahlentherapie, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Jens Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Britta Loutfi-Krauss
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Peter Manser
- Abteilung für Medizinische Strahlenphysik und Universitätsklinik für Radio-Onkologie, Inselspital-Universitätsspital Bern, Universität Bern, Bern, Switzerland
| | - Rene Werner
- Institut für Computational Neuroscience, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maria-Lisa Wilhelm
- Klinik für Strahlentherapie, Universitätsmedizin Rostock, Rostock, Germany
| | - Wolfgang W Baus
- Klinik für Radioonkologie, CyberKnife- und Strahlentherapie, Universitätsklinikum Köln, Cologne, Germany
| | - Christos Moustakis
- Klinik für Strahlentherapie-Radioonkologie, Universitätsklinikum Münster, Münster, Germany
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Miura H, Ozawa S, Nakao M, Doi Y, Kubo K, Kenjo M, Nagata Y. Evaluation of interbreath-hold lung tumor position reproducibility with vector volume histogram using the breath-hold technique. Med Dosim 2020; 45:252-255. [PMID: 32063423 DOI: 10.1016/j.meddos.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/10/2020] [Indexed: 12/25/2022]
Abstract
Tumor geometric reproducibility for lung stereotactic body radiotherapy (SBRT) is an important issue in the breath-hold (BH) technique. We investigated the inter-BH reproducibility of the tumor position in expiratory BH using our proposed vector volume histogram (VVH) method. Subjects comprising 14 patients with lung cancer who were treated with lung SBRT under expiratory BH conditions were monitored by the Abches system. Multiple computed tomography (CT) scans were performed to evaluate the inter-BH reproducibility of the tumor position at the expiratory BH in the simulation session. Gross tumor volume was delineated by a physician. Deformable image registration was used to deform the images from the 3 expiratory BH-CTs to the treatment planning expiratory BH-CT. To evaluate the inter-BH reproducibility of the tumor positions, we measured the largest motion extent within the organ of 3 dimensions (left-right, LR; anterior-posterior, AP; cranio-caudal, CC) and a 3D vector using the VVH method. The average and standard deviations of the inter-BH reproducibility of the tumor position in the LR, AP, and CC directions, and the 3D vector were 1.7 ± 0.5, 2.0 ± 0.7, 2.1 ± 0.7, and 2.7 ± 0.7 mm, respectively. Ten patients exhibited inter-BH displacements of the lung tumor >3 mm in the 3D vector. No displacement >5 mm was observed in any direction for all patients. Our study indicated that the inter-BH variation of the tumor position was small for lung cancer patients, using the Abches system and the VVH method.
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Affiliation(s)
- Hideharu Miura
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan; Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Higashihiroshima, Japan.
| | - Shuichi Ozawa
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan; Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Minoru Nakao
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan; Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Yoshiko Doi
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan; Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Katsumaro Kubo
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan
| | - Masahiko Kenjo
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan; Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Higashihiroshima, Japan
| | - Yasushi Nagata
- Hiroshima High-Precision Radiotherapy Cancer Center, Hiroshima, Japan; Department of Radiation Oncology, Institute of Biomedical & Health Sciences, Hiroshima University, Higashihiroshima, Japan
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Wang P, Tang S, Leach K, Mangona V, Simone CB, Langen K, Chang C. Proton pencil beam scanning treatment with feedback based voluntary moderate breath hold. Med Dosim 2019; 45:e10-e15. [PMID: 31870600 DOI: 10.1016/j.meddos.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 10/18/2019] [Accepted: 11/18/2019] [Indexed: 11/27/2022]
Abstract
Introduction The aim of this article is to introduce a novel protocol for proton pencil beam scanning treatment with moderate deep inspiration breath hold (mDIBH) and report on our clinical implementation results. Methods Three computed tomography (CT) scannings to build the patient's anatomy model were performed during the patient's voluntary mDIBH. All 3 CT scans were used in the optimization during the treatment planning process. Both orthogonal kV imaging and cone-beam computed tomography (CBCT) were implemented for patient alignment with BH prior to the treatment. The BH CBCT images were analyzed for BH reproducibility and the virtual total dose (VTD) retrospectively. To find the VTD, a series of deformable image registrations (DIR) were performed between CBCT and pCT. The effect of the variation of lung density on the dose distribution was also analyzed in the study. Results The values of the mean, standard deviation, maximum, and minimum of the tumor location difference between the CBCT and pCT were 1.9, 1.6, 4.7, and 0.0 mm, respectively. The percentage difference in D99% of CTVs between VTD and the nominal plan was within 1.5%. Conclusions The feedback-based voluntary moderate BH proton PBS treatment was successfully performed in our clinic. This study shows that there is a potential to implement the BH treatment widely in proton centers.
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Affiliation(s)
- Peng Wang
- Department of Radiation Oncology, Inova Health System, Falls Church, VA, USA.
| | - Shikui Tang
- Texas Center for Proton Therapy, Irving, TX, USA
| | - Karla Leach
- Texas Center for Proton Therapy, Irving, TX, USA
| | | | | | | | - Chang Chang
- California Protons Ca Therapy Center, San Diego, CA, USA
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Lee D, Kim S, Palta J, Lewis B, Keall P, Kim T. A retrospective 4D-MRI based on 2D diaphragm profiles for lung cancer patients. J Med Imaging Radiat Oncol 2019; 63:360-369. [PMID: 30932353 DOI: 10.1111/1754-9485.12877] [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: 06/12/2018] [Accepted: 02/22/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION 4D-MRI, compared to 4D-CT, provides better soft-tissue contrast for target delineation. However, motion artefacts are often observed due to residual breathing variations. This study is to present a retrospective 4D-MRI reconstruction method based on 2D diaphragm profiles to improve the quality of 4D-MR images in the presence of significant breathing variations. METHODS The proposed 4D-MRI reconstruction method utilized diaphragm profiles (2D cine images on a single sagittal plan at the peak diaphragm) in conjunction with 4D-MR scans (2D-cine images on multiple pre-determined coronal planes along the anterior-posterior direction over a volume of interest). The diaphragm profile images were exploited to sort the 4D-MR scans by matching respiratory amplitude of diaphragm on the 4D-MR scans to the diaphragm profiles. To evaluate reconstructed 4D-MR images (ten 3D-MR images), sagittal images on ten 3D-MR images under free breathing (FB) and respiratory guidance (GB) were compared with diaphragm profile images (reference) from 13 healthy volunteers. RESULTS Forty-four 4D-MR scan datasets were successfully reconstructed without distinct respiratory-related motion artefacts even with the presence of breathing variation. The differences in diaphragm profiles between the reference and corresponding reconstructed images in the mean of root mean square were similar between FB (3.5 mm) and GB (3.0 mm), confirming that the 4D-MRI reconstruction method was effective even with significant breathing variation. CONCLUSIONS The diaphragm profiles were utilized to reconstruct 4D-MR images with spatial reliability and a fixed scan time under FB and GB. Our method can provide reliable 4D information of thoracic and abdominal regions for MRI-guided radiotherapy.
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Affiliation(s)
- Danny Lee
- School of Mathematical and Physical Science, University of Newcastle, Newcastle, New South Wales, Australia
| | - Siyong Kim
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Jatinder Palta
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Benjamin Lewis
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paul Keall
- Radiation Physics Laboratory, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Taeho Kim
- Radiation Oncology, School of Medicine, Washington University, St. Louis, Missouri, USA
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Effect of setup and inter-fraction anatomical changes on the accumulated dose in CT-guided breath-hold intensity modulated proton therapy of liver malignancies. Radiother Oncol 2019; 134:101-109. [PMID: 31005203 DOI: 10.1016/j.radonc.2019.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/04/2018] [Accepted: 01/22/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate the effect of setup uncertainties including uncertainties between different breath holds (BH) and inter-fractional anatomical changes under CT-guided BH with intensity-modulated proton therapy (IMPT) in patients with liver cancer. METHODS AND MATERIALS This retrospective study considered 17 patients with liver tumors who underwent feedback-guided BH (FGBH) IMRT treatment with daily CT-on-rail imaging. Planning CT images were acquired at simulation using FGBH, and FGBH CT-on-rail images were also acquired prior to each treatment. Selective robust IMPT plans were generated using planning CT and re-calculated on each daily CT-on-rail image. Subsequently, the fractional doses were deformed and accumulated onto the planning CT according to the deformable image registration between daily and planning CTs. The doses to the target and organs at risk (OARs) were compared between IMRT, planned IMPT, and accumulated IMPT doses. RESULTS For IMPT plans, the mean of D98% of CTV for all 17 patients was slightly reduced from the planned dose of 68.90 ± 1.61 Gy to 66.48 ± 1.67 Gy for the accumulated dose. The target coverage could be further improved by adjusting planning techniques. The dose-volume histograms of both planned and accumulated IMPT doses showed better sparing of OARs than that of the IMRT. CONCLUSIONS IMPT with FGBH and CT-on-rail guidance is a robust treatment approach for liver tumor cases.
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Josipovic M, Persson GF, Rydhög JS, Smulders B, Thomsen JB, Aznar MC. Advanced dose calculation algorithms in lung cancer radiotherapy: Implications for SBRT and locally advanced disease in deep inspiration breath hold. Phys Med 2018; 56:50-57. [PMID: 30527089 DOI: 10.1016/j.ejmp.2018.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 11/01/2018] [Accepted: 11/18/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Evaluating performance of modern dose calculation algorithms in SBRT and locally advanced lung cancer radiotherapy in free breathing (FB) and deep inspiration breath hold (DIBH). METHODS For 17 patients with early stage and 17 with locally advanced lung cancer, a plan in FB and in DIBH were generated with Anisotropic Analytical Algorithm (AAA). Plans for early stage were 3D-conformal SBRT, 45 Gy in 3 fractions, prescribed to 95% isodose covering 95% of PTV and aiming for 140% dose centrally in the tumour. Locally advanced plans were volumetric modulated arc therapy, 66 Gy in 33 fractions, prescribed to mean PTV dose. Calculation grid size was 1 mm for SBRT and 2.5 mm for locally advanced plans. All plans were recalculated with AcurosXB with same MU as in AAA, for comparison on target coverage and dose to risk organs. RESULTS Lung volume increased in DIBH, resulting in decreased lung density (6% for early and 13% for locally-advanced group). In SBRT, AAA overestimated mean and near-minimum PTV dose (p-values < 0.01) compared to AcurosXB, with largest impact in DIBH (differences of up to 11 Gy). These clinically relevant differences may be a combination of small targets and large dose gradients within the PTV. In locally advanced group, AAA overestimated mean GTV, CTV and PTV doses by median less than 0.8 Gy and near-minimum doses by median 0.4-2.7 Gy. No clinically meaningful difference was observed for lung and heart dose metrics between the algorithms, for both FB and DIBH. CONCLUSIONS AAA overestimated target coverage compared to AcurosXB, especially in DIBH for SBRT.
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Affiliation(s)
- Mirjana Josipovic
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Blegdamsvej17, 2100 Copenhagen, Denmark.
| | - Gitte Fredberg Persson
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jonas Scherman Rydhög
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Blegdamsvej17, 2100 Copenhagen, Denmark; Department of Radiation Physics, Skåne University Hospital, Lund University, 221 85 Lund, Sweden.
| | - Bob Smulders
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jakob Borup Thomsen
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Marianne Camille Aznar
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Faculty of Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark; Manchester Cancer Research Centre, Division of Cancer Science, University of Manchester, Wilmslow Road, Manchester M20 4BX, UK; Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
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17
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Evaluation of a reproducible breath hold technique for the SABR treatment of lower lobe lung tumours. JOURNAL OF RADIOTHERAPY IN PRACTICE 2017. [DOI: 10.1017/s1460396917000097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractAimDeep inspiration breath hold (DIBH) is a method of motion management used in stereotactic ablative body radiotherapy (SABR) for lung tumours. An external gating block marker can be used as a tumour motion surrogate, however, inter-fraction gross target volume (GTV) displacement within DIBH occurs. This study measured this displacement during a reproducible breath hold regime. In addition, factors such as position of the gating block marker were analysed.Methods and materialsA total of 121 cone beam computed tomography scans (CBCTs) from 22 patients who received DIBH SABR were retrospectively evaluated and the magnitude of inter-fraction GTV displacement was calculated for each fraction. This data was analysed to assess if any correlation existed between tumour displacement and variation in the gating block marker position on the patient, the amplitude of breath hold (BH) at computed tomography (CT), the amplitude of BH at treatment and the tumour location.The measured tumour displacement was applied to the original planning CT to evaluate the dosimetric effect on surrounding organs at risk (OARs) using cumulative dose volume histograms (DVHs).ResultsBH amplitude was reproducible within 0·13±0·1 cm (mean±standard deviation). The magnitude of tumour displacement within BH ranged from 0 to 1·52 cm (0·41±0·28 cm). Displacement in the superior-inferior, anterior-posterior and left-right planes were 0·31±0·26 cm, 0·16±0·18 cm and 0·07±0·12 cm, respectively. No statistically significant correlation was detected between tumour displacement within DIBH and the factors investigated. The range of variation in OAR dose was −7·0 to +3·6 Gy with one statistically significant increase in OAR dose observed (oesophagus mean dose increasing by 0·16 Gy).FindingsReproducible BH was achievable across a range of patients. Inter-fraction GTV displacement measured 0·41±0·28 cm. Due to this low level of motion, the correction of soft tissue moves did not adversely affect OAR dose.
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Holliday EB, Tao R, Brownlee Z, Das P, Krishnan S, Taniguchi C, Minsky BD, Herman JM, Kaseb A, Raghav K, Conrad C, Vauthey JN, Aloia TA, Chun YS, Crane CH, Koay EJ. Definitive radiation therapy for hepatocellular carcinoma with portal vein tumor thrombus. Clin Transl Radiat Oncol 2017; 4:39-45. [PMID: 29594206 PMCID: PMC5833919 DOI: 10.1016/j.ctro.2017.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/12/2017] [Accepted: 04/20/2017] [Indexed: 02/08/2023] Open
Abstract
Prognosis for patients with HCC and PVTT is historically poor. Definitive RT may improve OS by prolonging the time to hepatic failure. Our data suggest dose escalation may further improve OS. Patients who received a BED >75 Gy had significantly better OS. RT was well tolerated with no confirmed cases of radiation-induced liver disease.
Background The purpose of this study is to review the results of radiation therapy (RT) for hepatocellular carcinoma (HCC) with portal venous tumor thrombus (PVTT) in a Western patient population. Methods Thirty-four patients with HCC PVTT treated from 2007 to 2014 with RT were identified. Biologically effective dose (BED) was calculated for each patient, and greater than the median dose delivered (75 Gray (Gy)) was evaluated as a potential prognostic factor. Survival was compared and independent prognostic variables were evaluated by a Cox proportional hazards regression model. Results Twenty-six patients (76.5%) exhibited a radiographic response to RT, and 10 patients (29.4%) ultimately developed local failure. Local control, liver control, distant control and OS at one year were 57.1%, 36.4%, 55.2% and 57.4%, respectively. Patients who received a BED >75 Gy had a significantly better local control at 1 year (93.3% vs 45.6%; Log Rank p = 0.0184). Patients who received a BED >75 Gy also had significantly better median survival (24.7mo vs 6.1mo) and 1-year overall survival (76.5% vs 30.0%) when compared with BED ≤75 Gy (Log-Rank p = 0.002). Conclusion Our data suggest that RT should be considered for well-selected patients with HCC and PVTT for the purpose of improving local control and potentially prolonging the time to worsening venous obstruction and liver failure. When feasible, dose-escalation should be considered with a target BED of >75 Gy if normal organ dose constraints can be safely met.
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Affiliation(s)
- Emma B Holliday
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, TX, United States
| | - Randa Tao
- The University of Utah Department of Radiation Oncology, Salt Lake City, UT, United States
| | - Zachary Brownlee
- Baylor College of Medicine Department of Medicine, Houston, TX, United States
| | - Prajnan Das
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, TX, United States
| | - Sunil Krishnan
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, TX, United States
| | - Cullen Taniguchi
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, TX, United States
| | - Bruce D Minsky
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, TX, United States
| | - Joseph M Herman
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, TX, United States
| | - Ahmed Kaseb
- The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, Houston, TX, United States
| | - Kanwal Raghav
- The University of Texas MD Anderson Cancer Center Department of Gastrointestinal Medical Oncology, Houston, TX, United States
| | - Claudius Conrad
- The University of Texas MD Anderson Cancer Center Department of Surgical Oncology, Houston, TX, United States
| | - Jean-Nicholas Vauthey
- The University of Texas MD Anderson Cancer Center Department of Surgical Oncology, Houston, TX, United States
| | - Thomas A Aloia
- The University of Texas MD Anderson Cancer Center Department of Surgical Oncology, Houston, TX, United States
| | - Yun Shin Chun
- The University of Texas MD Anderson Cancer Center Department of Surgical Oncology, Houston, TX, United States
| | - Christopher H Crane
- Memorial Sloan Kettering Cancer Center Department of Radiation Oncology, New York, NY, United States
| | - Eugene J Koay
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, TX, United States
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Schwarz M, Cattaneo GM, Marrazzo L. Geometrical and dosimetrical uncertainties in hypofractionated radiotherapy of the lung: A review. Phys Med 2017; 36:126-139. [DOI: 10.1016/j.ejmp.2017.02.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/23/2016] [Accepted: 02/14/2017] [Indexed: 12/25/2022] Open
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Audiovisual biofeedback guided breath-hold improves lung tumor position reproducibility and volume consistency. Adv Radiat Oncol 2017; 2:354-362. [PMID: 29114603 PMCID: PMC5605281 DOI: 10.1016/j.adro.2017.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/05/2016] [Accepted: 03/02/2017] [Indexed: 12/25/2022] Open
Abstract
Purpose Respiratory variation can increase the variability of tumor position and volume, accounting for larger treatment margins and longer treatment times. Audiovisual biofeedback as a breath-hold technique could be used to improve the reproducibility of lung tumor positions at inhalation and exhalation for the radiation therapy of mobile lung tumors. This study aimed to assess the impact of audiovisual biofeedback breath-hold (AVBH) on interfraction lung tumor position reproducibility and volume consistency for respiratory-gated lung cancer radiation therapy. Methods Lung tumor position and volume were investigated in 9 patients with lung cancer who underwent a breath-hold training session with AVBH before 2 magnetic resonance imaging (MRI) sessions. During the first MRI session (before treatment), inhalation and exhalation breath-hold 3-dimensional MRI scans with conventional breath-hold (CBH) using audio instructions alone and AVBH were acquired. The second MRI session (midtreatment) was repeated within 6 weeks after the first session. Gross tumor volumes (GTVs) were contoured on each dataset. CBH and AVBH were compared in terms of tumor position reproducibility as assessed by GTV centroid position and position range (defined as the distance of GTV centroid position between inhalation and exhalation) and tumor volume consistency as assessed by GTV between inhalation and exhalation. Results Compared with CBH, AVBH improved the reproducibility of interfraction GTV centroid position by 46% (P = .009) from 8.8 mm to 4.8 mm and GTV position range by 69% (P = .052) from 7.4 mm to 2.3 mm. Compared with CBH, AVBH also improved the consistency of intrafraction GTVs by 70% (P = .023) from 7.8 cm3 to 2.5 cm3. Conclusions This study demonstrated that audiovisual biofeedback can be used to improve the reproducibility and consistency of breath-hold lung tumor position and volume, respectively. These results may provide a pathway to achieve more accurate lung cancer radiation treatment in addition to improving various medical imaging and treatments by using breath-hold procedures.
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Josipovic M, Persson GF, Bangsgaard JP, Specht L, Aznar MC. Deep inspiration breath-hold radiotherapy for lung cancer: impact on image quality and registration uncertainty in cone beam CT image guidance. Br J Radiol 2016; 89:20160544. [PMID: 27706950 PMCID: PMC5604920 DOI: 10.1259/bjr.20160544] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/20/2016] [Accepted: 10/03/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We investigated the impact of deep inspiration breath-hold (DIBH) and tumour baseline shifts on image quality and registration uncertainty in image-guided DIBH radiotherapy (RT) for locally advanced lung cancer. METHODS Patients treated with daily cone beam CT (CBCT)-guided free-breathing (FB) RT had an additional CBCT in DIBH at three fractions. These CBCT scans were offline rigidly registered (on tumour) to FB and DIBH CT scans acquired at planning. All registrations were repeated to evaluate the intraobserver uncertainty. CBCT scans were scored on degree of streak artefacts and visualization of tumour and anatomical structures. We examined the impact of tumour baseline shift between consecutive DIBHs on CBCT image quality. RESULTS CBCT scans from 15 patients were analysed. Intraobserver image registration uncertainty was approximately 2 mm in both FB and DIBH, except for the craniocaudal direction in FB, where it was >3 mm. On the 31st fraction, the intraobserver uncertainty increased compared with the second fraction. This increase was more pronounced in FB. Image quality scores improved in DIBH compared with FB for all parameters in all patients. Simulated tumour baseline shifts ≤2 mm did not affect the CBCT image quality considerably. CONCLUSION DIBH CBCT improved image quality and reduced registration uncertainty in the craniocaudal direction in image-guided RT of locally advanced lung cancer. Baseline shifts ≤2 mm in DIBH during CBCT acquisition did not affect image quality. Advances in knowledge: DIBH RT has dosimetric advantages over FB; this work demonstrates an additional benefit of DIBH in terms of registration accuracy because of improved image quality.
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Affiliation(s)
- Mirjana Josipovic
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Gitte F Persson
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Jens P Bangsgaard
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Lena Specht
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marianne C Aznar
- Section of Radiotherapy, Department of Oncology, Rigshospitalet, Copenhagen, Denmark
- Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
- Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Chance WW, Nguyen QN, Mehran R, Welsh JW, Gomez DR, Balter P, Komaki R, Liao Z, Chang JY. Stereotactic ablative radiotherapy for adrenal gland metastases: Factors influencing outcomes, patterns of failure, and dosimetric thresholds for toxicity. Pract Radiat Oncol 2016; 7:e195-e203. [PMID: 27743801 DOI: 10.1016/j.prro.2016.09.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 09/04/2016] [Accepted: 09/08/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE We report our single-institution experience with stereotactic ablative radiotherapy (SABR) for adrenal metastasis and identify factors influencing outcomes, patterns of failure, and dosimetric thresholds for toxicity. METHODS AND MATERIALS We identified patients with adrenal metastases treated with SABR from 2009 to 2015. Toxicity was evaluated with Common Terminology Criteria for Adverse Events v4.0. Local failures were categorized as in-field, marginal, or out-of-field. New or progressive disease outside the treated adrenal gland was considered distant failure. Survival and time to local and distant failure were estimated by the Kaplan-Meier method. Prognostic factors were evaluated with a Cox proportional hazards model. Fisher's exact tests were used to compare toxicity between dosimetric thresholds. RESULTS Forty-three patients with 49 adrenal metastases (84% from lung) were treated with SABR to a median prescribed dose of 60 Gy in 10 fractions. Median overall survival time was 19 months, and 1- and 2-year rates were 65% and 42%, respectively. Bilateral adrenal metastases were associated with worse overall survival (P = .01). Median progression-free survival (PFS) time was 6 months, with most progressions being distant failure (most often to brain or bone). PFS was better in patients with a solitary adrenal metastasis (P = .03). Median time to local failure was not reached; the 1-year freedom from local failure rate was 74%. Nine failures were in field and 1 was marginal; no local failures occurred in lesions treated with biologically equivalent doses of >100 Gy. No patient experienced grade 3-5 toxicity. Low-grade gastrointestinal toxicity was common, but grade 2 toxicity was avoided in patients with a maximum stomach-bowel point dose of ≤50 Gy (P = .03). Low-grade adrenal insufficiency was common with bilateral treatment. CONCLUSION SABR was well tolerated and resulted in good 1-year local control; PFS was promising for patients with solitary metastases. Low-grade toxicity was common, but can be minimized with strict dosimetric constraints.
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Affiliation(s)
- William W Chance
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza Mehran
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James W Welsh
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel R Gomez
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter Balter
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zhongxing Liao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Santoso AP, Song KH, Qin Y, Gardner SJ, Liu C, Chetty IJ, Movsas B, Ajlouni M, Wen N. Evaluation of gantry speed on image quality and imaging dose for 4D cone-beam CT acquisition. Radiat Oncol 2016; 11:98. [PMID: 27473367 PMCID: PMC4966562 DOI: 10.1186/s13014-016-0677-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
Background This study investigates the effect of gantry speed on 4DCBCT image quality and dose for the Varian On-Board Imager®. Methods A thoracic 4DCBCT protocol was designed using a 125 kVp spectrum. Image quality parameters were evaluated for 4DCBCT acquisition using Catphan® phantom with real-time position management™ system for gantry speeds varying between 1.0 to 6.0°/s. Superior-inferior motion of the phantom was executed using a sinusoidal waveform with five second period. Scans were retrospectively sorted into 4 phases (CBCT-4 ph) and 10 phases (CBCT-10 ph); average 4DCBCT (CBCT-ave), using all image data from the 4DCBCT acquisitions was also evaluated. The 4DCBCT images were evaluated using the following image quality metrics: spatial resolution, contrast-to-noise ratio (CNR), and uniformity index (UI). Additionally, Hounsfield unit (HU) sensitivity compared to a baseline CBCT and percent differences and RMS errors (RMSE) of excursion were also determined. Imaging dose was evaluated using an IBA CC13 ion chamber placed within CIRS Thorax phantom using the same sinusoidal motion and image acquisition settings as mentioned above. Results Spatial resolution decreased linearly from 5.93 to 3.82 lp/cm as gantry speed increased from 1.0 to 6.0°/s. CNR decreased linearly from 4.80 to 1.82 with gantry speed increasing from 1.0 to 6.0°/s, respectively. No noteworthy variations in UI, HU sensitivity, or excursion metrics were observed with changes in gantry speed. Ion chamber dose rates measured ranged from 2.30 (lung) to 5.18 (bone) E-3 cGy/mAs. Conclusions A quantitative analysis of the Varian OBI’s 4DCBCT capabilities was explored. Changing gantry speed changes the number of projections used for reconstruction, affecting both image quality and imaging dose if x-ray tube current is held constant. From the results of this study, a gantry speed between 2 and 3°/s was optimal when considering image quality, dose, and reconstruction time. The future of 4DCBCT clinical utility relies on further investigation of image acquisition and reconstruction optimization.
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Affiliation(s)
- Andrew P Santoso
- Department of Radiation Oncology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Kwang H Song
- Texas Oncology, Fort Worth, TX, 76104, USA.,Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Yujiao Qin
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Stephen J Gardner
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Chang Liu
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Indrin J Chetty
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Munther Ajlouni
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA
| | - Ning Wen
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI, 48202, USA.
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The advantage of deep-inspiration breath-hold and cone-beam CT based soft-tissue registration for locally advanced lung cancer radiotherapy. Radiother Oncol 2016; 119:432-7. [DOI: 10.1016/j.radonc.2016.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 11/18/2022]
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Josipovic M, Persson GF, Dueck J, Bangsgaard JP, Westman G, Specht L, Aznar MC. Geometric uncertainties in voluntary deep inspiration breath hold radiotherapy for locally advanced lung cancer. Radiother Oncol 2016; 118:510-4. [PMID: 26631647 DOI: 10.1016/j.radonc.2015.11.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 11/03/2015] [Accepted: 11/08/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Deep inspiration breath hold (DIBH) increases lung volume and can potentially reduce treatment-related toxicity in locally advanced lung cancer. We estimated geometric uncertainties in visually guided voluntary DIBH and derived the appropriate treatment margins for different image-guidance strategies. MATERIAL AND METHODS Seventeen patients were included prospectively. An optical marker-based respiratory monitoring with visual guidance enabled comfortable DIBHs, adjusted to each patient's performance. All patients had three consecutive DIBH CTs at each of the treatment fractions 2, 16 and 31. DIBH reproducibility was evaluated as inter- and intra-fractional variations in lung volume, tumour position and differential motion between primary tumour and mediastinal lymph nodes. RESULTS Lung volume increased by median 60% in DIBH. Inter- and intra-fractional lung volume variations were median 2.1% and 1.1%, respectively. Inter- and intra-fractional uncertainties in 3D tumour position were 4.8 ± 2.8 mm and 1.7 ± 1.4 mm (mean ± SD). Inter- and intra-fractional differential motion was 4.8 ± 3.3 mm and 0.0 ± 1.1 mm. CONCLUSIONS For single targets, visually guided voluntary DIBH radiotherapy is highly reproducible provided an image-guidance strategy with tumour registration is performed. If the primary tumour is separated from the mediastinal lymph nodes, inter-fractional differential motion remains a challenge and margins must be adapted to reflect the image registration strategy.
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Affiliation(s)
- Mirjana Josipovic
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Denmark.
| | - Gitte F Persson
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
| | - Jenny Dueck
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Denmark; Paul Scherrer Institute, 5232 Villigen PSI, Switzerland
| | - Jens Peter Bangsgaard
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Westman
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
| | - Lena Specht
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Faculty of Medical Sciences, University of Copenhagen, Denmark
| | - Marianne C Aznar
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Denmark; Faculty of Medical Sciences, University of Copenhagen, Denmark
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Nguyen VNV, Ellerbusch DC, Cetnar AJ, James JA, Wang B. Implementation of an in-house visual feedback system for motion management during radiation therapy. J Appl Clin Med Phys 2016; 17:421-427. [PMID: 26894353 PMCID: PMC5690230 DOI: 10.1120/jacmp.v17i1.5817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 08/04/2015] [Accepted: 08/18/2015] [Indexed: 12/25/2022] Open
Abstract
In this Technical Note, we describe an in‐house video goggles feedback system assembled using several commercially available products. This goggle video feedback system is currently being used at University of Louisville and Mayo Clinic for both CT simulation and linac treatment delivery. The setup details, including specific recommendations, are provided, along with an alternative option for using the video goggles system. PACS number: 07.07Hj
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Deep Inspiration Breath Hold-Based Radiation Therapy: A Clinical Review. Int J Radiat Oncol Biol Phys 2015; 94:478-92. [PMID: 26867877 DOI: 10.1016/j.ijrobp.2015.11.049] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/03/2015] [Accepted: 11/29/2015] [Indexed: 01/06/2023]
Abstract
Several recent developments in linear accelerator-based radiation therapy (RT) such as fast multileaf collimators, accelerated intensity modulation paradigms like volumeric modulated arc therapy and flattening filter-free (FFF) high-dose-rate therapy have dramatically shortened the duration of treatment fractions. Deliverable photon dose distributions have approached physical complexity limits as a consequence of precise dose calculation algorithms and online 3-dimensional image guided patient positioning (image guided RT). Simultaneously, beam quality and treatment speed have continuously been improved in particle beam therapy, especially for scanned particle beams. Applying complex treatment plans with steep dose gradients requires strategies to mitigate and compensate for motion effects in general, particularly breathing motion. Intrafractional breathing-related motion results in uncertainties in dose delivery and thus in target coverage. As a consequence, generous margins have been used, which, in turn, increases exposure to organs at risk. Particle therapy, particularly with scanned beams, poses additional problems such as interplay effects and range uncertainties. Among advanced strategies to compensate breathing motion such as beam gating and tracking, deep inspiration breath hold (DIBH) gating is particularly advantageous in several respects, not only for hypofractionated, high single-dose stereotactic body RT of lung, liver, and upper abdominal lesions but also for normofractionated treatment of thoracic tumors such as lung cancer, mediastinal lymphomas, and breast cancer. This review provides an in-depth discussion of the rationale and technical implementation of DIBH gating for hypofractionated and normofractionated RT of intrathoracic and upper abdominal tumors in photon and proton RT.
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Yu AS, von Eyben R, Yamamoto T, Diehn M, Shultz DB, Loo BW, Maxim PG. Anatomic optimization of lung tumor stereotactic ablative radiation therapy. Pract Radiat Oncol 2015; 5:e607-13. [DOI: 10.1016/j.prro.2015.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/20/2015] [Accepted: 05/27/2015] [Indexed: 11/25/2022]
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Tao R, Krishnan S, Bhosale PR, Javle MM, Aloia TA, Shroff RT, Kaseb AO, Bishop AJ, Swanick CW, Koay EJ, Thames HD, Hong TS, Das P, Crane CH. Ablative Radiotherapy Doses Lead to a Substantial Prolongation of Survival in Patients With Inoperable Intrahepatic Cholangiocarcinoma: A Retrospective Dose Response Analysis. J Clin Oncol 2015; 34:219-26. [PMID: 26503201 DOI: 10.1200/jco.2015.61.3778] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Standard therapies for localized inoperable intrahepatic cholangiocarcinoma (IHCC) are ineffective. Advances in radiotherapy (RT) techniques and image guidance have enabled ablative doses to be delivered to large liver tumors. This study evaluated the effects of RT dose escalation in the treatment of IHCC. PATIENTS AND METHODS Seventy-nine consecutive patients with inoperable IHCC were identified and treated with definitive RT from 2002 to 2014. At diagnosis, the median tumor size was 7.9 cm (range, 2.2 to 17 cm). Seventy patients (89%) received systemic chemotherapy before RT. RT doses were 35 to 100 Gy (median, 58.05 Gy) in three to 30 fractions for a median biologic equivalent dose (BED) of 80.5 Gy (range, 43.75 to 180 Gy). RESULTS Median follow-up time for patients alive at time of analysis was 33 months (range, 11 to 93 months). Median overall survival (OS) time after diagnosis was 30 months; 3-year OS rate was 44%. Radiation dose was the single most important prognostic factor; higher doses correlated with an improved local control (LC) rate and OS. The 3-year OS rate for patients receiving BED greater than 80.5 Gy was 73% versus 38% for those receiving lower doses (P = .017); 3-year LC rate was significantly higher (78%) after a BED greater than 80.5 Gy than after lower doses (45%, P = .04). BED as a continuous variable significantly affected LC (P = .009) and OS (P = .004). There were no significant treatment-related toxicities. CONCLUSION Delivery of higher doses of RT improves LC and OS in inoperable IHCC. A BED greater than 80.5 Gy seems to be an ablative dose of RT for large IHCCs, with long-term survival rates that compare favorably with resection.
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Affiliation(s)
- Randa Tao
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Sunil Krishnan
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Priya R Bhosale
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Milind M Javle
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Thomas A Aloia
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Rachna T Shroff
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Ahmed O Kaseb
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Andrew J Bishop
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Cameron W Swanick
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Eugene J Koay
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Howard D Thames
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Theodore S Hong
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Prajnan Das
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA
| | - Christopher H Crane
- Randa Tao, Sunil Krishnan, Priya R. Bhosale, Milind M. Javle, Thomas A. Aloia, Rachna T. Shroff, Ahmed O. Kaseb, Andrew J. Bishop, Cameron W. Swanick, Eugene J. Koay, Howard D. Thames, Prajnan Das, and Christopher H. Crane, The University of Texas MD Anderson Cancer Center, Houston, TX; and Theodore S. Hong, Harvard Medical School, Boston, MA.
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Nakamura M, Akimoto M, Ono T, Nakamura A, Yano S, Nakata M, Itasaka S, Mizowaki T, Shibuya K, Hiraoka M. Interfraction positional variation in pancreatic tumors using daily breath-hold cone-beam computed tomography with visual feedback. J Appl Clin Med Phys 2015; 16:5123. [PMID: 26103180 PMCID: PMC5690071 DOI: 10.1120/jacmp.v16i2.5123] [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: 06/05/2014] [Revised: 12/10/2014] [Accepted: 12/08/2014] [Indexed: 12/11/2022] Open
Abstract
We assessed interfraction positional variation in pancreatic tumors using daily breath‐hold cone‐beam computed tomography at end‐exhalation (EE) with visual feedback (BH‐CBCT). Eleven consecutive patients with pancreatic cancer who underwent BH intensity‐modulated radiation therapy with visual feedback were enrolled. All participating patients stopped oral intake, with the exception of drugs and water, for >3 hr before treatment planning and daily treatment. Each patient was fixed in the supine position on an individualized vacuum pillow. An isotropic margin of 5 mm was added to the clinical target volume to create the planning target volume (PTV). The prescription dose was 42 to 51 Gy in 15 fractions. After correcting initial setup errors based on bony anatomy, the first BH‐CBCT scans were performed before beam delivery in every fraction. BH‐CBCT acquisition was obtained in three or four times breath holds by interrupting the acquisition two or three times, depending on the patient's BH ability. The image acquisition time for a 360° gantry rotation was approximately 90 s, including the interruption time due to BH. The initial setup errors were corrected based on bony structure, and the residual errors in the target position were then recorded. The magnitude of the interruptions variation in target position was assessed for 165 fractions. The systematic and random errors were 1.2 and 1.8 mm, 1.1 and 1.8 mm, and 1.7 and 2.9 mm in the left–right (LR), anterior–posterior (AP), and superior–inferior (SI) directions, respectively. Absolute interfraction variations of >5 mm were observed in 18 fractions (11.0%) from seven patients because of EE‐BH failure. In conclusion, target matching is required to correct interfraction variation even with visual feedback, especially to ensure safe delivery of escalated doses to patients with pancreatic cancer. PACS number: 87.57.Q‐, 87.57.‐s, 87.55.Qr
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Hu W, Li G, Ye J, Wang J, Peng J, Gong M, Yu X, Studentski MT, Xiao Y, Zhang Z. Passive breath gating equipment for cone beam CT-guided RapidArc gastric cancer treatments. Radiother Oncol 2015; 114:104-8. [DOI: 10.1016/j.radonc.2014.11.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 11/18/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
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Jensen NKG, Stewart E, Lock M, Fisher B, Kozak R, Chen J, Lee TY, Wong E. Assessment of contrast enhanced respiration managed cone-beam CT for image guided radiotherapy of intrahepatic tumors. Med Phys 2014; 41:051905. [PMID: 24784384 DOI: 10.1118/1.4870385] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Contrast enhancement and respiration management are widely used during image acquisition for radiotherapy treatment planning of liver tumors along with respiration management at the treatment unit. However, neither respiration management nor intravenous contrast is commonly used during cone-beam CT (CBCT) image acquisition for alignment prior to radiotherapy. In this study, the authors investigate the potential gains of injecting an iodinated contrast agent in combination with respiration management during CBCT acquisition for liver tumor radiotherapy. METHODS Five rabbits with implanted liver tumors were subjected to CBCT with and without motion management and contrast injection. The acquired CBCT images were registered to the planning CT to determine alignment accuracy and dosimetric impact. The authors developed a simulation tool for simulating contrast-enhanced CBCT images from dynamic contrast enhanced CT imaging (DCE-CT) to determine optimal contrast injection protocols. The tool was validated against contrast-enhanced CBCT of the rabbit subjects and was used for five human patients diagnosed with hepatocellular carcinoma. RESULTS In the rabbit experiment, when neither motion management nor contrast was used, tumor centroid misalignment between planning image and CBCT was 9.2 mm. This was reduced to 2.8 mm when both techniques were employed. Tumors were not visualized in clinical CBCT images of human subjects. Simulated contrast-enhanced CBCT was found to improve tumor contrast in all subjects. Different patients were found to require different contrast injections to maximize tumor contrast. CONCLUSIONS Based on the authors' animal study, respiration managed contrast enhanced CBCT improves IGRT significantly. Contrast enhanced CBCT benefits from patient specific tracer kinetics determined from DCE-CT.
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Affiliation(s)
- Nikolaj K G Jensen
- Physics and Engineering, London Regional Cancer Program, London, Ontario N6A3K7, Canada
| | - Errol Stewart
- Radiology, St. Joseph's Health Care, London, Ontario N6A 4V2, Canada; Imaging Research Lab, Robarts Research Institute, London, Ontario N6A 5B7, Canada; and Imaging Program, Lawson Health Research Institute, London, Ontario N6C 2R5, Canada
| | - Michael Lock
- Radiation Oncology, London Regional Cancer Program, London, Ontario N6A3K7, Canada and Department of Oncology, University of Western Ontario, London, Ontario N6A 4L6, Canada
| | - Barbara Fisher
- Radiation Oncology, London Regional Cancer Program, London, Ontario N6A3K7, Canada and Department of Oncology, University of Western Ontario, London, Ontario N6A 4L6, Canada
| | - Roman Kozak
- Radiology, St. Joseph's Health Care, London, Ontario N6A 4V2, Canada
| | - Jeff Chen
- Physics and Engineering, London Regional Cancer Program, London, Ontario N6A3K7, Canada; Department of Oncology, University of Western Ontario, London, Ontario N6A 4L6, Canada; and Department of Medical Biophysics, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Ting-Yim Lee
- Radiology, St. Joseph's Health Care, London, Ontario N6A 4V2, Canada; Imaging Research Lab, Robarts Research Institute, London, Ontario N6A 5B7, Canada; Imaging Program, Lawson Health Research Institute, London, Ontario N6C 2R5, Canada; Department of Oncology, University of Western Ontario, London, Ontario N6A 4L6, Canada; and Department of Medical Biophysics, University of Western Ontario, London, Ontario N6A 5C1, Canada
| | - Eugene Wong
- Physics and Engineering, London Regional Cancer Program, London, Ontario N6A3K7, Canada; Department of Oncology, University of Western Ontario, London, Ontario N6A 4L6, Canada; Department of Medical Biophysics, University of Western Ontario, London, Ontario N6A 5C1, Canada; and Department of Physics and Astronomy, University of Western Ontario, London, Ontario N6A 3K7, Canada
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Interfractional variations of tumor centroid position and tumor regression during stereotactic body radiotherapy for lung tumor. BIOMED RESEARCH INTERNATIONAL 2014; 2014:372738. [PMID: 25548770 PMCID: PMC4274869 DOI: 10.1155/2014/372738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/11/2014] [Accepted: 10/02/2014] [Indexed: 12/25/2022]
Abstract
Purpose. To determine interfractional changes of lung tumor centroid position and tumor regression during stereotactic body radiation therapy (SBRT). Methods and Materials. 34 patients were treated by SBRT in 4-5 fractions to a median dose of 50 Gy. The CT scans acquired for verification were registered with simulation CT scans. The gross target volume (GTV) was contoured on all verification CT scans and compared to the initial GTV in treatment plan system. Results. The mean (±standard deviation, SD) three-dimension vector shift was 5.2 ± 3.1 mm. The mean (±SD) interfractional variations of tumor centroid position were −0.7 ± 4.5 mm in anterior-posterior (AP) direction, 0.2 ± 3.1 mm in superior-inferior (SI) direction, and 0.4 ± 2.4 mm in right-left (RL) direction. Large interfractional variations (≥5 mm) were observed in 5 fractions (3.3%) in RL direction, 16 fractions (10.5%) in SI direction, and 36 fractions (23.5%) in AP direction. Tumor volume did not decrease significantly during lung SBRT. Conclusions. Small but insignificant tumor volume regression was observed during lung SBRT. While the mean interfractional variations of tumor centroid position were minimal in three directions, variations more than 5 mm account for approximately a third of all, indicating additional margin for PTV, especially in AP direction.
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Wiant D, Vanderstraeten C, Maurer J, Pursley J, Terrell J, Sintay BJ. On the validity of density overrides for VMAT lung SBRT planning. Med Phys 2014; 41:081707. [DOI: 10.1118/1.4887778] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Zhong R, Wang J, Zhou L, Xu F, Liu L, Zhou J, Jiang X, Chen N, Bai S, Lu Y. Implementation of single-breath-hold cone beam CT guided hypofraction radiotherapy for lung cancer. Radiat Oncol 2014; 9:77. [PMID: 24646067 PMCID: PMC3994492 DOI: 10.1186/1748-717x-9-77] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/16/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To analyze the feasibility of active breath control (ABC), the lung tumor reproducibility and the rationale for single-breath-hold cone beam CT (CBCT)-guided hypofraction radiotherapy. METHODS Single-breath-hold CBCT images were acquired using ABC in a cohort of 83 lung cancer patients (95 tumors) treated with hypofraction radiotherapy. For all alignments between the reference CT and CBCT images (including the pre-correction, post-correction and post-treatment CBCT images), the tumor reproducibility was evaluated via online manual alignment of the tumors, and the vertebral bone uncertainties were evaluated via offline manual alignment of the vertebral bones. The difference between the tumor reproducibility and the vertebral bone uncertainty represents the change in the tumor position relative to the vertebral bone. The relative tumor positions along the coronal, sagittal and transverse axes were measured based on the reference CT image. The correlations between the vertebral bone uncertainty, the relative tumor position, the total treatment time and the tumor reproducibility were evaluated using the Pearson correlations. RESULTS Pre-correction, the systematic/random errors of tumor reproducibility were 4.5/2.6 (medial-lateral, ML), 5.1/4.8 (cranial-caudal, CC) and 4.0/3.6 mm (anterior-posterior, AP). These errors were significantly decreased to within 3 mm, both post-correction and post-treatment. The corresponding PTV margins were 4.7 (ML), 7.4 (CC) and 5.4 (AP) mm. The changes in the tumor position relative to the vertebral bone displayed systematic/random errors of 2.2/2.0 (ML), 4.1/4.4 (CC) and 3.1/3.3 (AP) mm. The uncertainty of the vertebral bone significantly correlated to the reproducibility of the tumor position (P<0.05), except in the CC direction post-treatment. However, no significant correlation was detected between the relative tumor position, the total treatment time and the tumor reproducibility (P>0.05). CONCLUSIONS Using ABC for single-breath-hold CBCT guidance is an effective method to reduce the PTV margin of hypofraction radiotherapy for lung cancer. Using ABC, the tumor position was significantly altered relative to the vertebral position. The reproducibility of the tumor position was affected by the vertebral bone but not by the relative tumor position or the total treatment time.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sen Bai
- Department of Radiation Oncology, Cancer Center, West China School of Medicine/West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, People's Republic of China.
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Cole A, Hanna G, Jain S, O'Sullivan J. Motion Management for Radical Radiotherapy in Non-small Cell Lung Cancer. Clin Oncol (R Coll Radiol) 2014; 26:67-80. [DOI: 10.1016/j.clon.2013.11.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/23/2013] [Accepted: 09/24/2013] [Indexed: 11/28/2022]
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Parkhurst JM, Price GJ, Sharrock PJ, Jackson ASN, Stratford J, Moore CJ. Self-management of patient body position, pose, and motion using wide-field, real-time optical measurement feedback: results of a volunteer study. Int J Radiat Oncol Biol Phys 2013; 87:904-10. [PMID: 24125700 DOI: 10.1016/j.ijrobp.2013.08.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 08/16/2013] [Accepted: 08/27/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE We present the results of a clinical feasibility study, performed in 10 healthy volunteers undergoing a simulated treatment over 3 sessions, to investigate the use of a wide-field visual feedback technique intended to help patients control their pose while reducing motion during radiation therapy treatment. METHODS AND MATERIALS An optical surface sensor is used to capture wide-area measurements of a subject's body surface with visualizations of these data displayed back to them in real time. In this study we hypothesize that this active feedback mechanism will enable patients to control their motion and help them maintain their setup pose and position. A capability hierarchy of 3 different level-of-detail abstractions of the measured surface data is systematically compared. RESULTS Use of the device enabled volunteers to increase their conformance to a reference surface, as measured by decreased variability across their body surfaces. The use of visual feedback also enabled volunteers to reduce their respiratory motion amplitude to 1.7 ± 0.6 mm compared with 2.7 ± 1.4 mm without visual feedback. CONCLUSIONS The use of live feedback of their optically measured body surfaces enabled a set of volunteers to better manage their pose and motion when compared with free breathing. The method is suitable to be taken forward to patient studies.
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Affiliation(s)
- James M Parkhurst
- Developing Technologies, Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
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Parkhurst J, Price G, Sharrock P, Moore C. A visual patient feedback device using optical surface measurement for the cooperative management of setup and body dynamics during radiotherapy. Biomed Signal Process Control 2013. [DOI: 10.1016/j.bspc.2013.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yang J, Chu D, Dong L, Court LE. Advantages of simulating thoracic cancer patients in an upright position. Pract Radiat Oncol 2013; 4:e53-8. [PMID: 24621432 DOI: 10.1016/j.prro.2013.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/24/2013] [Accepted: 04/26/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE To compare lung volume and respiratory motion in supine and upright positions to assess the potential advantages of treating thoracic cancer patients in an upright position. METHODS AND MATERIALS A multi-position MRI scanner (FONAR, Melville, NY) was used to take MRI images of 5 healthy volunteers in both supine and upright setup positions. In each case, a series of sagittal cine MR scans were acquired during normal respiration, followed by a volumetric scan taken during breath-hold at end of normal expiration. The trajectory of points inside the lung was automatically detected and tracked in the cine images and then analyzed using a deformable image registration technique together with a principal component analysis model. The exhale volume images were imported into a treatment planning system and lung volumes were delineated and compared for different setup positions. RESULTS The amplitude of motion for a set of landmark points in the lung volume ranged from 2 mm (distant from the diaphragm) to 29 mm (close to the diaphragm) in the superior-inferior direction. A linear regression to the amplitude of respiratory motion versus distance from the diaphragm for each volunteer showed that the motion was 3 mm less on average in the upright position than in the supine position, although there was variability among individuals. The average exhale lung volume was 27% (751 cm(3)) larger (range: 9%-53%, 250-1390 cm(3)) when volunteers were in the upright position compared with the supine position. CONCLUSIONS The magnitude of motion inside the lung was smaller and the absolute lung volumes were much larger in the upright position than in the supine position, which suggests that treating thoracic patients in the upright position may allow for a reduction in the mean lung dose.
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Affiliation(s)
- Jinzhong Yang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Chu
- Fonar Corporation, Melville, New York
| | - Lei Dong
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas; Scripps Proton Therapy Center, San Diego, California
| | - Laurence E Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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Stam MK, van Vulpen M, Barendrecht MM, Zonnenberg BA, Intven M, Crijns SPM, Lagendijk JJW, Raaymakers BW. Kidney motion during free breathing and breath hold for MR-guided radiotherapy. Phys Med Biol 2013; 58:2235-45. [DOI: 10.1088/0031-9155/58/7/2235] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Yan H, Li H, Liu Z, Nath R, Liu W. Hybrid MV-kV 3D respiratory motion tracking during radiation therapy with low imaging dose. Phys Med Biol 2012. [PMID: 23202376 DOI: 10.1088/0031-9155/57/24/8455] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A novel real-time adaptive MV-kV imaging framework for image-guided radiation therapy is developed to reduce the thoracic and abdominal tumor targeting uncertainty caused by respiration-induced intrafraction motion with ultra-low patient imaging dose. In our method, continuous stereoscopic MV-kV imaging is used at the beginning of a radiation therapy delivery for several seconds to measure the implanted marker positions. After this stereoscopic imaging period, the kV imager is switched off except for the times when no fiducial marker is detected in the cine-MV images. The 3D time-varying marker positions are estimated by combining the MV 2D projection data and the motion correlations between directional components of marker motion established from the stereoscopic imaging period and updated afterwards; in particular, the most likely position is assumed to be the position on the projection line that has the shortest distance to the first principal component line segment constructed from previous trajectory points. An adaptive windowed auto-regressive prediction is utilized to predict the marker position a short time later (310 ms and 460 ms in this study) to allow for tracking system latency. To demonstrate the feasibility and evaluate the accuracy of the proposed method, computer simulations were performed for both arc and fixed-gantry deliveries using 66 h of retrospective tumor motion data from 42 patients treated for thoracic or abdominal cancers. The simulations reveal that using our hybrid approach, a smaller than 1.2 mm or 1.5 mm root-mean-square tracking error can be achieved at a system latency of 310 ms or 460 ms, respectively. Because the kV imaging is only used for a short period of time in our method, extra patient imaging dose can be reduced by an order of magnitude compared to continuous MV-kV imaging, while the clinical tumor targeting accuracy for thoracic or abdominal cancers is maintained. Furthermore, no additional hardware is required with the proposed method.
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Affiliation(s)
- Huagang Yan
- School of Biomedical Engineering, Capital Medical University, Beijing, People's Republic of China
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Impact of Computed Tomography Image Quality on Image-Guided Radiation Therapy Based on Soft Tissue Registration. Int J Radiat Oncol Biol Phys 2012; 82:e733-8. [DOI: 10.1016/j.ijrobp.2011.11.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 11/10/2011] [Accepted: 11/13/2011] [Indexed: 11/30/2022]
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