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McGee KP, Cao M, Das IJ, Yu V, Witte RJ, Kishan AU, Valle LF, Wiesinger F, De-Colle C, Cao Y, Breen WG, Traughber BJ. The Use of Magnetic Resonance Imaging in Radiation Therapy Treatment Simulation and Planning. J Magn Reson Imaging 2024. [PMID: 38265188 DOI: 10.1002/jmri.29246] [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: 09/05/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
Ever since its introduction as a diagnostic imaging tool the potential of magnetic resonance imaging (MRI) in radiation therapy (RT) treatment simulation and planning has been recognized. Recent technical advances have addressed many of the impediments to use of this technology and as a result have resulted in rapid and growing adoption of MRI in RT. The purpose of this article is to provide a broad review of the multiple uses of MR in the RT treatment simulation and planning process, identify several of the most used clinical scenarios in which MR is integral to the simulation and planning process, highlight existing limitations and provide multiple unmet needs thereby highlighting opportunities for the diagnostic MR imaging community to contribute and collaborate with our oncology colleagues. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Kiaran P McGee
- Department of Radiology, Mayo Clinic & Foundation, Rochester, Minnesota, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Indra J Das
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Victoria Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert J Witte
- Department of Radiology, Mayo Clinic & Foundation, Rochester, Minnesota, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Luca F Valle
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | | | - Chiara De-Colle
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Yue Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - William G Breen
- Department of Radiation Oncology, Mayo Clinic & Foundation, Rochester, Minnesota, USA
| | - Bryan J Traughber
- Department of Radiation Oncology, Mayo Clinic & Foundation, Rochester, Minnesota, USA
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Iachecen F, Dallagassa MR, Portela Santos EA, Carvalho DR, Ioshii SO. Is it possible to automate the discovery of process maps for the time-driven activity-based costing method? A systematic review. BMC Health Serv Res 2023; 23:1408. [PMID: 38093275 PMCID: PMC10720189 DOI: 10.1186/s12913-023-10411-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES The main objective of this manuscript was to identify the methods used to create process maps for care pathways that utilized the time-driven activity-based costing method. METHODS This is a systematic mapping review. Searches were performed in the Embase, PubMed, CINAHL, Scopus, and Web of Science electronic literature databases from 2004 to September 25, 2022. The included studies reported practical cases from healthcare institutions in all medical fields as long as the time-driven activity-based costing method was employed. We used the time-driven activity-based costing method and analyzed the created process maps and a qualitative approach to identify the main fields. RESULTS A total of 412 studies were retrieved, and 70 articles were included. Most of the articles are related to the fields of orthopedics and childbirth-related to hospital surgical procedures. We also identified various studies in the field of oncology and telemedicine services. The main methods for creating the process maps were direct observational practices, complemented by the involvement of multidisciplinary teams through surveys and interviews. Only 33% of the studies used hospital documents or healthcare data records to integrate with the process maps, and in 67% of the studies, the created maps were not validated by specialists. CONCLUSIONS The application of process mining techniques effectively automates models generated through clinical pathways. They are applied to the time-driven activity-based costing method, making the process more agile and contributing to the visualization of high degrees of variations encountered in processes, thereby making it possible to enhance and achieve continual improvements in processes.
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Affiliation(s)
- Franciele Iachecen
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil.
| | - Marcelo Rosano Dallagassa
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil
| | | | - Deborah Ribeiro Carvalho
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil
| | - Sérgio Ossamu Ioshii
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil
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Carr ME, Jelen U, Picton M, Batumalai V, Crawford D, Peng V, Twentyman T, de Leon J, Jameson MG. Towards simulation-free MR-linac treatment: utilizing male pelvis PSMA-PET/CT and population-based electron density assignments. Phys Med Biol 2023; 68:195012. [PMID: 37652043 DOI: 10.1088/1361-6560/acf5c6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/31/2023] [Indexed: 09/02/2023]
Abstract
Objective. This study aimed to investigate the dosimetric impact of using population-based relative electron density (RED) overrides in lieu of simulation computerized tomography (CT) in a magnetic resonance linear accelerator (MRL) workflow for male pelvis patients. Additionally, the feasibility of using prostate specific membrane antigen positron emission tomography/CT (PSMA-PET/CT) scans to assess patients' eligibility for this proposed workflow was examined.Approach. In this study, 74 male pelvis patients treated on an Elekta Unity 1.5 T MRL were retrospectively selected. The patients' individual RED values for 8 organs of interest were extracted from their simulation-CT images to establish population-based RED values. These values were used to generate individual (IndD) and population-based (PopD) RED dose plans, representing current and proposed MRL workflows, respectively. Lastly, this study compared RED values obtained from CT and PET-CT scanners in a phantom and a subset of patients.Results. Population-based RED values were mostly within two standard deviations of ICRU Report 46 values. PopD plans were comparable to IndD plans, with the average %difference magnitudes of 0.5%, 0.6%, and 0.6% for mean dose (all organs), D0.1cm3(non-target organs) and D95%/D98% (target organs), respectively. Both phantom and patient PET-CT derived RED values had high agreement with corresponding CT-derived values, with correlation coefficients ≥ 0.9.Significance. Population-based RED values were considered suitable in a simulation-free MRL treatment workflow. Utilizing these RED values resulted in similar dosimetric uncertainties as per the current workflow. Initial findings also suggested that PET-CT scans may be used to assess prospective patients' eligibility for the proposed workflow. Future investigations will evaluate the clinical feasibility of implementing this workflow for prospective patients in the clinical setting. This is aimed to reduce patient burden during radiotherapy and increase department efficiencies.
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Affiliation(s)
- Madeline E Carr
- GenesisCare, New South Wales, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | | | | | - Vikneswary Batumalai
- GenesisCare, New South Wales, Australia
- School of Clinical Medicine, Medicine and Health, University of New South Wales, Australia
| | | | | | | | | | - Michael G Jameson
- GenesisCare, New South Wales, Australia
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
- School of Clinical Medicine, Medicine and Health, University of New South Wales, Australia
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Ranta I, Wright P, Suilamo S, Kemppainen R, Schubert G, Kapanen M, Keyriläinen J. Clinical feasibility of a commercially available MRI-only method for radiotherapy treatment planning of the brain. J Appl Clin Med Phys 2023; 24:e14044. [PMID: 37345212 PMCID: PMC10476982 DOI: 10.1002/acm2.14044] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/19/2023] [Accepted: 04/25/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Advancements in deep-learning based synthetic computed tomography (sCT) image conversion methods have enabled the development of magnetic resonance imaging (MRI)-only based radiotherapy treatment planning (RTP) of the brain. PURPOSE This study evaluates the clinical feasibility of a commercial, deep-learning based MRI-only RTP method with respect to dose calculation and patient positioning verification performance in RTP of the brain. METHODS Clinical validation of dose calculation accuracy was performed by a retrospective evaluation for 25 glioma and 25 brain metastasis patients. Dosimetric and image quality of the studied MRI-only RTP method was evaluated by a direct comparison of the sCT-based and computed tomography (CT)-based external beam radiation therapy (EBRT) images and treatment plans. Patient positioning verification accuracy of sCT images was evaluated retrospectively for 10 glioma and 10 brain metastasis patients based on clinical cone-beam computed tomography (CBCT) imaging. RESULTS An average mean dose difference of Dmean = 0.1% for planning target volume (PTV) and 0.6% for normal tissue (NT) structures were obtained for glioma patients. Respective results for brain metastasis patients were Dmean = 0.5% for PTVs and Dmean =1.0% for NTs. Global three-dimensional (3D) gamma pass rates using 2%/2 mm dose difference and distance-to-agreement (DTA) criterion were 98.0% for the glioma subgroup, and 95.2% for the brain metastasis subgroup using 1%/1 mm criterion. Mean distance differences of <1.0 mm were observed in all Cartesian directions between CT-based and sCT-based CBCT patient positioning in both subgroups. CONCLUSIONS In terms of dose calculation and patient positioning accuracy, the studied MRI-only method demonstrated its clinical feasibility for RTP of the brain. The results encourage the use of the studied method as part of a routine clinical workflow.
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Affiliation(s)
- Iiro Ranta
- Department of Physics and AstronomyUniversity of TurkuTurkuFinland
- Department of Medical PhysicsTurku University HospitalTurkuFinland
- Department of Oncology and RadiotherapyTurku University HospitalTurkuFinland
| | - Pauliina Wright
- Department of Medical PhysicsTurku University HospitalTurkuFinland
- Department of Oncology and RadiotherapyTurku University HospitalTurkuFinland
| | - Sami Suilamo
- Department of Medical PhysicsTurku University HospitalTurkuFinland
- Department of Oncology and RadiotherapyTurku University HospitalTurkuFinland
| | - Reko Kemppainen
- HUS Diagnostic CenterUniversity of Helsinki and Helsinki University HospitalHelsinkiFinland
| | | | - Mika Kapanen
- Department of Medical PhysicsMedical Imaging CenterTampere University HospitalTampereFinland
- Department of OncologyUnit of RadiotherapyTampere University HospitalTampereFinland
| | - Jani Keyriläinen
- Department of Physics and AstronomyUniversity of TurkuTurkuFinland
- Department of Medical PhysicsTurku University HospitalTurkuFinland
- Department of Oncology and RadiotherapyTurku University HospitalTurkuFinland
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Koivula L, Seppälä T, Collan J, Visapää H, Tenhunen M, Korhonen A. Synthetic computed tomography based dose calculation in prostate cancer patients with hip prostheses for magnetic resonance imaging-only radiotherapy. Phys Imaging Radiat Oncol 2023; 27:100469. [PMID: 37520639 PMCID: PMC10371839 DOI: 10.1016/j.phro.2023.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/01/2023] Open
Abstract
Background and purpose Metallic hip prostheses cause substantial artefacts in both computed tomography (CT) and magnetic resonance (MR) images used in radiotherapy treatment planning (RTP) for prostate cancer patients. The aim of this study was to evaluate the dose calculation accuracy of a synthetic CT (sCT) generation workflow and the improvement in implant visibility using metal artefact reduction sequences. Materials and methods The study included 23 patients with prostate cancer who had hip prostheses, of which 10 patients had bilateral hip implants. An in-house protocol was applied to create sCT images for dose calculation comparison. The study compared prostheses volumes and resulting avoidance sectors against planning target volume (PTV) dose uniformity and organs at risk (OAR) sparing. Results Median PTV dose difference between sCT and CT-based dose calculation among all patients was 0.1 % (-0.4 to 0.4%) (median(range)). Bladder and rectum differences (V50Gy) were 0.2 % (-0.3 to 1.1%) and 0.1 % (-0.9 to 0.5%). The median 3D local gamma pass rate for partial arc cases using a Dixon MR sequence was Γ20%2mm/2% = 99.9%. For the bilateral full arc cases, using a metal artefact reconstruction sequence, the pass rate was Γ20%2mm/2% = 99.0%. Conclusions An in-house protocol for generating sCT images for dose calculation provided clinically feasible dose calculation accuracy for prostate cancer patients with hip implants. PTV median dose difference for uni- and bilateral patients with avoidance sectors remained <0.4%. The Outphase images enhanced implant visibility resulting in smaller avoidance sectors, better OAR sparing, and improved PTV uniformity.
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Affiliation(s)
- Lauri Koivula
- Department of Physics, MATRENA-doctoral programme, University of Helsinki, Gustaf Hällströmin katu 2, 00560 Helsinki, Finland
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4 Building 2, 00290 Helsinki, Finland
| | - Tiina Seppälä
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4 Building 2, 00290 Helsinki, Finland
| | - Juhani Collan
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4 Building 2, 00290 Helsinki, Finland
| | - Harri Visapää
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4 Building 2, 00290 Helsinki, Finland
| | - Mikko Tenhunen
- Comprehensive Cancer Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4 Building 2, 00290 Helsinki, Finland
| | - Arthur Korhonen
- Department of Medical Physics, Kymenlaakso Central Hospital, Kymenlaakso Social and Health Services (KymenHVA), Kotkantie 41, 48210 Kotka, Finland
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Persson E, Svanberg N, Scherman J, Jamtheim Gustafsson C, Fridhammar A, Hjalte F, Bäck S, Nilsson P, Gunnlaugsson A, Olsson LE. MRI-only radiotherapy from an economic perspective: Can new techniques in prostate cancer treatment be cost saving? Clin Transl Radiat Oncol 2022; 38:183-187. [DOI: 10.1016/j.ctro.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 10/16/2022] [Accepted: 11/19/2022] [Indexed: 11/23/2022] Open
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