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Haraldsson A, Ceberg S, Ceberg C, Bäck S, Engelholm S, Engström PE. Surface-guided tomotherapy improves positioning and reduces treatment time: A retrospective analysis of 16 835 treatment fractions. J Appl Clin Med Phys 2020; 21:139-148. [PMID: 32592288 PMCID: PMC7484821 DOI: 10.1002/acm2.12936] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/20/2020] [Accepted: 05/07/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE In this study, we have quantified the setup deviation and time gain when using fast surface scanning for daily setup/positioning with weekly megavoltage computed tomography (MVCT) and compared it to daily MVCT. METHODS A total of 16 835 treatment fractions were analyzed, treated, and positioned using our TomoTherapy HD (Accuray Inc., Madison, USA) installed with a Sentinel optical surface scanning system (C-RAD Positioning AB, Uppsala, Sweden). Patients were positioned using in-room lasers, surface scanning and MVCT for the first three fractions. For the remaining fractions, in-room laser was used for setup followed by daily surface scanning with MVCT once weekly. The three-dimensional (3D) setup correction for surface scanning was evaluated from the registration between MVCT and the planning CT. The setup correction vector for the in-room lasers was assessed from the surface scanning and the MVCT to planning CT registration. The imaging time was evaluated as the time from imaging start to beam-on. RESULTS We analyzed 894 TomoTherapy treatment plans from 2012 to 2018. Of all the treatment fractions performed with surface scanning, 90 % of the residual errors were within 2.3 mm for CNS (N = 284), 2.9 mm for H&N (N = 254), 8.7 mm for thorax (N = 144) and 10.9 for abdomen (N = 134) patients. The difference in residual error between surface scanning and positioning with in-room lasers was significant (P < 0.005) for all sites. The imaging time was assessed as total imaging time per treatment plan, modality, and treatment site and found that surface scanning significantly reduced patient on-couch time compared to MVCT for all treatment sites (P < 0.005). CONCLUSIONS The results indicate that daily surface scanning with weekly MVCT can be used with the current target margins for H&N, CNS, and thorax, with reduced imaging time.
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Affiliation(s)
- André Haraldsson
- Department Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sofie Ceberg
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Crister Ceberg
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sven Bäck
- Department Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Silke Engelholm
- Department Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Per E Engström
- Department Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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Zani M, Marrazzo L, Calusi S, Talamonti C, Scoccianti S, Greto D, Desideri I, Fusi F, Pallotta S. TomoTherapy treatments of multiple brain lesions: an in-phantom accuracy evaluation. Phys Med Biol 2019; 64:025020. [PMID: 30561374 DOI: 10.1088/1361-6560/aaf977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Aim of the present study was to evaluate the accuracy which can be obtained with helical TomoTherapy® (HT, Accuray) systems in the case of multiple intracranial targets treatments. Set-up accuracy was measured, for different registration options and MegaVoltage CT (MVCT) slice thickness, by applying known misalignments to an ad-hoc developed phantom. End-to-end (E2E) tests were performed to assess the delivery accuracy in phantoms containing multiple targets by using radiochromic films: measured dose distribution centroids were compared with physical and calculated target positions on axial and coronal planes. A Gamma index analysis was carried out on planned and measured planar dose maps. The bone and tissue algorithm with the fine MVCT reconstruction grid gave the best results among the automatic options. The most accurate registration modality resulted to be the manual one with a sub-voxel accuracy shifts and a capability in the detection of rotations within 0.3°. For the E2E along the coronal plane (six targets), a mean deviation between measured dose distribution centroids and physical barycenters of 0.6 mm (range 0.1 mm-1.3 mm) was observed. Along the axial plane (five targets), a mean deviation of 1.2 mm (range 0.7 mm-2.1 mm) was found for the centroids shifts. Gamma index (5%, 1 mm, local) passing rates higher than 87.5% between planned and delivered dose distributions were measured. These results demonstrate that multiple brain lesion HT treatments are feasible with an accuracy at least comparable to frameless linac-based delivery, when a set-up capable to assure angular corrections and a reliable patient immobilization is employed.
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Affiliation(s)
- M Zani
- Department of Biomedical, Experimental and Clinical Sciences 'Mario Serio', Viale Morgagni, 50, 50134 Firenze. Author to whom any correspondence should be addressed
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Zhao B, Maquilan G, Jiang S, Schwartz DL. Minimal mask immobilization with optical surface guidance for head and neck radiotherapy. J Appl Clin Med Phys 2018; 19:17-24. [PMID: 29119677 PMCID: PMC5768028 DOI: 10.1002/acm2.12211] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Full face and neck thermoplastic masks provide standard-of-care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable and increase skin dose. The purpose of this pilot trial was to investigate the feasibility and setup accuracy of minimal face and neck mask immobilization with optical surface guidance. METHODS Twenty patients enrolled onto this IRB-approved protocol. Patients were immobilized with masks securing only forehead and chin. Shoulder movement was restricted by either moldable cushion or hand held strap retractors. Positional information, including isocenter location and CT skin contours, were imported to a commercial surface image guidance system. Patients typically received standard-of-care IMRT to 60-70 Gy in 30-33 fractions. Patients were first set up to surface markings with optical image guidance referenced to regions of interest (ROIs) on simulation CT images. Positioning was confirmed by in-room CBCT. Following six-dimensional robotic couch correction, a new optical real-time surface image was acquired to track intrafraction motion and to serve as a reference surface for setup at the next treatment fraction. Therapists manually recorded total treatment time as well as couch shifts based on kV imaging. Intrafractional ROI motion tracking was automatically recorded by the optical image guidance system. Patient comfort was assessed by self-administered surveys. RESULTS Setup error was measured as six-dimensional shifts (vertical/longitudinal/lateral/rotation/pitch/roll). Mean error values were -0.51 ± 2.42 mm, -0.49 ± 3.30 mm, 0.23 ± 2.58 mm, -0.15 ± 1.01o , -0.02 ± 1.19o , and 0.06 ± 1.08o , respectively. Average treatment time was 21.6 ± 8.4 mins). Subjective comfort during surface-guided treatment was confirmed on patient surveys. CONCLUSION These pilot results confirm feasibility of minimal mask immobilization combined with commercially available optical image guidance. Patient acceptance of minimal mask immobilization has been encouraging. Follow-up validation, with direct comparison to standard mask immobilization, appears warranted.
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Affiliation(s)
- Bo Zhao
- Department of Radiation OncologyThe University of Texas Southwestern Medical CenterDallasTXUSA
| | - Genevieve Maquilan
- Department of Radiation OncologyThe University of Texas Southwestern Medical CenterDallasTXUSA
| | - Steve Jiang
- Department of Radiation OncologyThe University of Texas Southwestern Medical CenterDallasTXUSA
| | - David L. Schwartz
- Department of Radiation OncologyThe University of Texas Southwestern Medical CenterDallasTXUSA
- Department of Radiation OncologyUniversity of Tennessee Health Science Center‐West Cancer CenterMemphisTNUSA
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Tong Y, Gong G, Chen J, Lu J, Liu T, Cheng P, Yin Y. The heterogeneous CTV-PTV margins should be given for different parts of tumors during tomotherapy. Oncotarget 2017; 8:89086-89094. [PMID: 29179501 PMCID: PMC5687671 DOI: 10.18632/oncotarget.21631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/07/2017] [Indexed: 11/25/2022] Open
Abstract
Objective The purpose of this study was to evaluate CTV-PTV margins of tumors for tomotherapy. Methods Setup errors were analyzed for 151 patients receiving helical tomotherapy treatment. 53 patients had head and neck tumors, 45 had thoracic tumors, 20 had abdominal tumors, and 33 had pelvic tumors. The setup errors were calculated in six directions, i.e. +X (left), -X (right), +Y (head), -Y (foot), +Z (ventral), and -Z (dorsal), after Megavoltage CT (MVCT) images were registered to simulation CT images. And then the CTV-PTV margins were calculated. Results The setup errors along the +Z direction were significantly higher than that along the –Z direction (p<0.05). The CTV-PTV margins on +X, -X, +Y, -Y, +Z, and -Z directions were asymmetric for all tumors, and the heterogeneity were more remarkable on the +Z and –Z directions. The CTV-PTV margins on +Z and –Z were 4.1 mm, 4.6 mm, 5.2 mm, and 8.4 mm; and 3.9 mm, 7.7 mm, 3.3 mm, and 7.7 mm for head and neck tumors, thoracic tumors, abdominal tumors, and pelvic tumors, respectively. Conclusions The CTV-PTV margins for patients with different types of tumors were heterogeneous during tomotherapy. The individual margins of six directions should be given for those patients who accept tomotherapy.
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Affiliation(s)
- Ying Tong
- School of Nuclear Science and Technology, University of South China, Hengyang, China
| | - Guanzhong Gong
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Jinhu Chen
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Jie Lu
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Tonghai Liu
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Pinjing Cheng
- School of Nuclear Science and Technology, University of South China, Hengyang, China
| | - Yong Yin
- Radiation Physics Department of Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
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Differding S, Sterpin E, Hermand N, Vanstraelen B, Nuyts S, de Patoul N, Denis JM, Lee JA, Grégoire V. Radiation dose escalation based on FDG-PET driven dose painting by numbers in oropharyngeal squamous cell carcinoma: a dosimetric comparison between TomoTherapy-HA and RapidArc. Radiat Oncol 2017; 12:59. [PMID: 28335778 PMCID: PMC5364636 DOI: 10.1186/s13014-017-0793-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 03/01/2017] [Indexed: 12/31/2022] Open
Abstract
Purpose Validation of dose escalation through FDG-PET dose painting (DP) for oropharyngeal squamous cell carcinoma (SCC) requires randomized clinical trials with large sample size, potentially involving different treatment planning and delivery systems. As a first step of a joint clinical study of DP, a planning comparison was performed between Tomotherapy HiArt® (HT) and Varian RapidArc® (RA). Methods The planning study was conducted on five patients with oropharyngeal SCC. Elective and therapeutic CTVs were delineated based on anatomic information, and the respective PTVs (CTVs + 4 mm) were prescribed a dose of 56 (PTV56) and 70 Gy (PTV70). A gradient-based method was used to delineate automatically the external contours of the FDG-PET volume (GTVPET). Variation of the FDG uptake within the GTVPET was linearly converted into a prescription between 70 and 86 Gy. A dilation of the voxel-by-voxel prescription of 2.5 mm was applied to account for geometric errors in dose delivery (PTVPET). The study was divided in two planning phases aiming at maximizing target coverage (phase I) and lowering doses to OAR (phase II). A Quality-Volume Histogram (QVH) assessed conformity with the DP prescription inside the PTVPET. Results In phase I, for both HT and RA, all plans achieved comparable target coverage for PTV56 and PTV70, respecting the planning objectives. A median value of 99.9 and 97.2% of all voxels in the PTVPET received at least 95% of the prescribed dose for RA and HT, respectively. A median value of 0.0% and 3.7% of the voxels in the PTVPET received 105% or more of prescribed dose for RA and HT, respectively. In phase II, no significant differences were found in OAR sparing. Median treatment times were 13.7 min for HT and 5 min for RA. Conclusions Both HT and RA can generate similar dose distributions for FDG-PET based dose escalation and dose painting in oropharyngeal SCC patients. Electronic supplementary material The online version of this article (doi:10.1186/s13014-017-0793-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Differding
- Department of Radiation Oncology, and Center for Molecular Imaging, Oncology and Radiotherapy (MIRO), Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium
| | - Edmond Sterpin
- Department of Radiation Oncology, and Center for Molecular Imaging, Oncology and Radiotherapy (MIRO), Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium
| | - Nicolas Hermand
- Department of Oncology, Experimental Radiation Oncology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Bianca Vanstraelen
- Department of Oncology, Experimental Radiation Oncology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Sandra Nuyts
- Department of Oncology, Experimental Radiation Oncology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Radiation Oncology, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | - Nathalie de Patoul
- Department of Radiation Oncology, St-Luc University Hospital, Avenue Hippocrate 10, B-1200, Bruxelles, Belgium
| | - Jean-Marc Denis
- Department of Radiation Oncology, St-Luc University Hospital, Avenue Hippocrate 10, B-1200, Bruxelles, Belgium
| | - John Aldo Lee
- Department of Radiation Oncology, and Center for Molecular Imaging, Oncology and Radiotherapy (MIRO), Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium
| | - Vincent Grégoire
- Department of Radiation Oncology, and Center for Molecular Imaging, Oncology and Radiotherapy (MIRO), Université catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium. .,Department of Radiation Oncology, St-Luc University Hospital, Avenue Hippocrate 10, B-1200, Bruxelles, Belgium.
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Saha A, Mallick I, Das P, Shrimali R, Achari R, Chatterjee S. Evaluating the Need for Daily Image Guidance in Head and Neck Cancers Treated with Helical Tomotherapy: A Retrospective Analysis of a Large Number of Daily Imaging-based Corrections. Clin Oncol (R Coll Radiol) 2016; 28:178-84. [DOI: 10.1016/j.clon.2015.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/25/2015] [Accepted: 10/26/2015] [Indexed: 10/22/2022]
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Wiant D, Squire S, Liu H, Maurer J, Lane Hayes T, Sintay B. A prospective evaluation of open face masks for head and neck radiation therapy. Pract Radiat Oncol 2016; 6:e259-e267. [PMID: 27025164 DOI: 10.1016/j.prro.2016.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/03/2016] [Accepted: 02/10/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Head and neck (HN) radiation therapy patients are typically immobilized with closed thermoplastic masks that cover the face and may cause discomfort. In this work, we examine the use of open masks for HN radiation therapy. METHODS AND MATERIALS Fifty HN patients were prospectively randomized into 2 groups (25 closed masks, 25 open masks). The open-mask group was monitored with surface imaging to evaluate intrafraction motion. Both groups underwent daily volumetric imaging. All daily images were rigidly registered to their respective planning images to evaluate spinal canal and mandible position as a check for interfraction posture change. Posture changes were determined by the amount the spinal canal and mandible contours from the planning images had to be expanded to cover the structures on each daily image set. The vector length (VL) of the intrafraction linear translations, spine, and mandible positions for each open-mask patient were checked for correlation with fraction number using the Pearson r value. All patients were given a weekly survey ranking anxiety and claustrophobia from 0 to 10 (0 = no issue, 10 = extreme issue). RESULTS The mean VL for all open-mask patients was 0.9 ± 0.5 mm (1 standard deviation). Only 1 patient showed significant correlation between VL and fraction number. The mean contour expansions to cover the spine and mandible were 1.5 ± 0.9 mm and 1.8 ± 1.3 mm for the closed-mask group, and 1.6 ± 0.8 mm and 1.8 ± 1.1 mm for the open-mask group. Both groups showed similar behavior relative to fraction number. The mean anxiety and claustrophobia scores were 1.63 and 1.44 for the closed-mask group, and 0.81 and 0.63 for the open-mask group. The groups were not significantly different. CONCLUSIONS Open masks provide comparable immobilization and posture preservation to closed masks for HN radiation therapy.
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Affiliation(s)
- David Wiant
- Cone Health Cancer Center, Greensboro, North Carolina.
| | - Sarah Squire
- Cone Health Cancer Center, Greensboro, North Carolina
| | - Han Liu
- Cone Health Cancer Center, Greensboro, North Carolina
| | | | - T Lane Hayes
- Cone Health Cancer Center, Greensboro, North Carolina
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Thondykandy BA, Swamidas JV, Agarwal J, Gupta T, Laskar SG, Mahantshetty U, Iyer SS, Mukherjee IU, Shrivastava SK, Deshpande DD. Setup error analysis in helical tomotherapy based image-guided radiation therapy treatments. J Med Phys 2016; 40:233-9. [PMID: 26865760 PMCID: PMC4728895 DOI: 10.4103/0971-6203.170796] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The adequacy of setup margins for various sites in patients treated with helical tomotherapy was investigated. A total of 102 patients were investigated. The breakdown of the patients were as follows: Twenty-five patients each in brain, head and neck (H and N), and pelvis, while 12 patients in lung and 15 in craniospinal irradiation (CSI). Patients were immobilized on the institutional protocol. Altogether 2686 megavoltage computed tomography images were analyzed with 672, 747, 622, 333, and 312 fractions, respectively, from brain, H and N, pelvis, lung, and CSI. Overall systematic and random errors were calculated in three translational and three rotational directions. Setup margins were evaluated using van Herk formula. The calculated margins were compared with the margins in the clinical use for various directions and sites. We found that the clinical isotropic margin of 3 mm was adequate for brain patients. However, in the longitudinal direction it was found to be out of margin by 0.7 mm. In H and N, the calculated margins were well within the isotropic margin of 5 mm which is in clinical use. In pelvis, the calculated margin was within the limits, 8.3 mm versus 10 mm only in longitudinal direction, however, in vertical and lateral directions the calculated margins were out of clinical margins 11 mm versus 10 mm, and 8.7 mm versus 7.0, mm respectively. In lung, all the calculated margins were well within the margins used clinically. In CSI, the variation was found in the middle spine in the longitudinal direction. The clinical margins used in our hospital are adequate enough for sites H and N, lung, and brain, however, for CSI and pelvis the margins were found to be out of clinical margins.
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Affiliation(s)
| | - Jamema V Swamidas
- Department of Medical Physics, Advanced Center for Treatment, Research, and Education in Cancer, Navi Mumbai, Maharashtra, India
| | - Jayprakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sarbani G Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shrinivasan S Iyer
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Indrani U Mukherjee
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Shyam K Shrivastava
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Deepak D Deshpande
- Department of Medical Physics, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Blanco Kiely JP, White BM, Low DA, Qi SX. Geometric validation of MV topograms for patient localization on TomoTherapy. Phys Med Biol 2016; 61:728-39. [PMID: 26717197 DOI: 10.1088/0031-9155/61/2/728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Our goal was to geometrically validate the use of mega-voltage orthogonal scout images (MV topograms) as a fast and low-dose alternative to mega-voltage computed tomography (MVCT) for daily patient localization on the TomoTherapy system. To achieve this, anthropomorphic head and pelvis phantoms were imaged on a 16-slice kilo-voltage computed tomography (kVCT) scanner to synthesize kilo-voltage digitally reconstructed topograms (kV-DRT) in the Tomotherapy detector geometry. MV topograms were generated for couch speeds of 1-4 cm s(-1) in 1 cm s(-1) increments with static gantry angles in the anterior-posterior and left-lateral directions. Phantoms were rigidly translated in the anterior-posterior (AP), superior-inferior (SI), and lateral (LAT) directions to simulate potential setup errors. Image quality improvement was demonstrated by estimating the noise level in the unenhanced and enhanced MV topograms using a principle component analysis-based noise level estimation algorithm. Average noise levels for the head phantom were reduced by 2.53 HU (AP) and 0.18 HU (LAT). The pelvis phantom exhibited average noise level reduction of 1.98 HU (AP) and 0.48 HU (LAT). Mattes Mutual Information rigid registration was used to register enhanced MV topograms with corresponding kV-DRT. Registration results were compared to the known rigid displacements, which assessed the MV topogram localization's sensitivity to daily positioning errors. Reduced noise levels in the MV topograms enhanced the registration results so that registration errors were <1 mm. The unenhanced head MV topograms had discrepancies < 2.1 mm and the pelvis topograms had discrepancies < 2.7 mm. Result were found to be consistent regardless of couch speed. In total, 64.7% of the head phantom MV topograms and 60.0% of the pelvis phantom MV topograms exactly measured the phantom offsets. These consistencies demonstrated the potential for daily patient positioning using MV topogram pairs in the context bony-anatomy based procedures such as total marrow irradiation, total body irradiation, and cranial spinal irradiation.
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Affiliation(s)
- Janid P Blanco Kiely
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA
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Ciardo D, Alterio D, Jereczek-Fossa BA, Riboldi M, Zerini D, Santoro L, Preve E, Rondi E, Comi S, Serafini F, Laudati A, Ansarin M, Preda L, Baroni G, Orecchia R. Set-up errors in head and neck cancer patients treated with intensity modulated radiation therapy: Quantitative comparison between three-dimensional cone-beam CT and two-dimensional kilovoltage images. Phys Med 2015; 31:1015-1021. [PMID: 26459318 DOI: 10.1016/j.ejmp.2015.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/13/2015] [Accepted: 08/01/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To compare the patient set-up error detection capabilities of three-dimensional cone beam computed tomography (3D-CBCT) and two-dimensional orthogonal kilovoltage (2D-kV) techniques. METHODS 3D-CBCT and 2D-kV projections were acquired on 29 head-and-neck (H&N) patients undergoing Intensity Modulated Radiotherapy (IMRT) on the first day of treatment (time 0) and after the delivery of 40 Gy and 50 Gy. Set-up correction vectors were analyzed after fully automatic image registration as well as after revision by radiation oncologists. The dosimetric effects of the different sensitivities of the two image guidance techniques were assessed. RESULTS A statistically significant correlation among detected set-up deviations by the two techniques was found along anatomical axes (0.60 < ρ < 0.72, p < 0.0001); no correlation was found for table rotation (p = 0.41). No evidence of statistically significant differences between the indications provided along the course of the treatment was found; this was also the case when full automatic versus manually refined correction vectors were compared. The dosimetric effects analysis revealed slight statistically significant differences in the median values of the maximum relative dose to mandible, spinal cord and its 5 mm Planning Organ at Risk Volume (0.95%, 0.6% and 2.45%, respectively), with higher values (p < 0.01) observed when 2D-kV corrections were applied. CONCLUSION A similar sensitivity to linear set-up errors was observed for 2D-kV and 3D-CBCT image guidance techniques in our H&N patient cohort. Higher rotational deviations around the table vertical axis were detected by the 3D-CBCT with respect to the 2D-kV method, leading to a consistent better sparing of organs at risk.
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Affiliation(s)
- Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy.
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy; Department of Health Sciences, University of Milan, via Festa del Perdono 7, Milano 20122, Italy
| | - Marco Riboldi
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano, Italy; Centro Nazionale di Adroterapia Oncologica (CNAO), Strada Campeggi 53, Pavia 27100, Italy
| | - Dario Zerini
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Luigi Santoro
- Division of Epidemiology and Biostatistics, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Eleonora Preve
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Elena Rondi
- Unit of Medical Physics, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Flavia Serafini
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Antonio Laudati
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Mohssen Ansarin
- Division of Head and Neck Surgery, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Lorenzo Preda
- Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Guido Baroni
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano, Italy; Centro Nazionale di Adroterapia Oncologica (CNAO), Strada Campeggi 53, Pavia 27100, Italy
| | - Roberto Orecchia
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy; Department of Health Sciences, University of Milan, via Festa del Perdono 7, Milano 20122, Italy
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Differding S, Sterpin E, Janssens G, Hanin FX, Lee JA, Grégoire V. Methodology for adaptive and robust FDG-PET escalated dose painting by numbers in head and neck tumors. Acta Oncol 2015; 55:217-25. [PMID: 26079436 DOI: 10.3109/0284186x.2015.1046997] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To develop a methodology for using FDG PET/CT in adaptive dose painting by numbers (DPBN) in head and neck squamous cell carcinoma (HNSCC) patients. Issues related to noise in PET and treatment robustness against geometric errors are addressed. METHODS Five patients with locally advanced HNSCC scheduled for chemo-radiotherapy were imaged with FDG-PET/CT at baseline and 2-3 times during radiotherapy (RT). The GTVPET was segmented with a gradient-based method. A double median filter reduces the impact of noise in the PET uptake-to-dose conversion. Filtered FDG uptake values were linearly converted into a voxel-by-voxel prescription from 70 (median uptake) to 86 Gy (highest uptake). A PTVPET was obtained by applying a dilation of 2.5 mm to the entire prescription. Seven iso-uptake thresholds led to seven sub-levels compatible with the Tomotherapy HiArt(®) Treatment Planning System. Planning aimed to deliver a median dose of 56 Gy and 70 Gy in 35 fractions on the elective and therapeutic PTVs, respectively. Plan quality was assessed with quality volume histogram (QVH). At each time point, plans were generated with a total of 3-4 plans for each patient. Deformable image registration was used for automatic contour propagation and dose summation of the 3 or 4 treatment plans (MIMvista(®)). RESULTS GTVPET segmentations were performed successfully until week 2 of RT but failed in two patients at week 3. QVH analysis showed high conformity for all plans (mean VQ = 0.95 93%; mean VQ = 1.05 3.9%; mean QF 2.2%). Good OAR sparing was achieved while keeping high plan quality. CONCLUSION Our results show that adaptive FDG-PET-based escalated dose painting in patients with locally advanced HNSCC is feasible while respecting strict dose constraints to organs at risk. Clinical studies must be conducted to evaluate toxicities and tumor response of such a strategy.
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Affiliation(s)
- Sarah Differding
- a Department of Radiation Oncology , and Center for Molecular Imaging, Oncology and Radiotherapy (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain , Brussels , Belgium
| | - Edmond Sterpin
- a Department of Radiation Oncology , and Center for Molecular Imaging, Oncology and Radiotherapy (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain , Brussels , Belgium
| | - Guillaume Janssens
- a Department of Radiation Oncology , and Center for Molecular Imaging, Oncology and Radiotherapy (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain , Brussels , Belgium
| | - François-Xavier Hanin
- b Department of Nuclear Medicine , and Center for Molecular Imaging, Radiotherapy and Oncology (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Universite catholique de Louvain, St-Luc University Hospital , Brussels , Belgium
| | - John Aldo Lee
- a Department of Radiation Oncology , and Center for Molecular Imaging, Oncology and Radiotherapy (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain , Brussels , Belgium
| | - Vincent Grégoire
- a Department of Radiation Oncology , and Center for Molecular Imaging, Oncology and Radiotherapy (MIRO), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain , Brussels , Belgium
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Sánchez-Rubio P, Rodríguez-Romero R, Castro-Tejero P. A retrospective tomotherapy image-guidance study: analysis of more than 9,000 MVCT scans for ten different tumor sites. J Appl Clin Med Phys 2014; 15:4663. [PMID: 25493505 PMCID: PMC5711128 DOI: 10.1120/jacmp.v15i6.4663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 06/24/2014] [Accepted: 06/18/2014] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to quantify the systematic and random errors for various disease sites when daily MVCT scans are acquired, and to analyze alterna- tive off-line verification protocols (OVP) with respect to the patient setup accuracy achieved. Alignment data from 389 patients (9,418 fractions) treated at ten differ- ent anatomic sites with daily image-guidance (IG) on a helical tomotherapy unit were analyzed. Moreover, six OVP were retrospectively evaluated. For each OVP, the frequency of the residual setup errors and additional margins required were calculated for the treatment sessions without image guidance. The magnitude of the three-dimensional vector displacement and its frequency were evaluated for all OVP. From daily IG, the main global systematic error was in the vertical direction (4.4-9.4 mm), and all rotations were negligible (less than 0.5°) for all anatomic sites. The lowest systematic and random errors were found for H&N and brain patients. All OVP were effective in reducing the mean systematic error to less than 1 mm and 0.2° in all directions and roll corrections for almost all treatment sites. The treatment margins needed to adapt the residual errors should be increased by 2-5 mm for brain and H&N, around 8 mm in the vertical direction for the other anatomic sites, and up to 19 mm in the longitudinal direction for abdomen patients. Almost 70% of the sessions presented a setup error of 3 mm for OVPs with an imaging frequency above 50%. Only for brain patients it would be feasible to apply an OVP because the residual setup error could be compensated for with a slight margin increase. However, daily imaging should be used for anatomic sites of difficult immobilization and/or large interfraction movement.
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Nagai A, Shibamoto Y, Yoshida M, Wakamatsu K, Kikuchi Y. Treatment of single or multiple brain metastases by hypofractionated stereotactic radiotherapy using helical tomotherapy. Int J Mol Sci 2014; 15:6910-24. [PMID: 24758932 PMCID: PMC4013669 DOI: 10.3390/ijms15046910] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/10/2014] [Accepted: 04/11/2014] [Indexed: 12/13/2022] Open
Abstract
This study investigated the clinical outcomes of a 4-fraction stereotactic radiotherapy (SRT) study using helical tomotherapy for brain metastases. Between August 2009 and June 2013, 54 patients with a total of 128 brain metastases underwent SRT using tomotherapy. A total dose of 28 or 28.8 Gy at 80% isodose was administered in 4 fractions for all tumors. The mean gross tumor volume (GTV) was 1.9 cc. Local control (LC) rates at 6, 12, and 18 months were 96%, 91%, and 88%, respectively. The 12-month LC rates for tumors with GTV ≤0.25, >0.25 and ≤1, and >1 cc were 98%, 82%, and 93%, respectively; the rates were 92% for tumors >3 cc and 100% for >10 cc. The 6-month rates for freedom from distant brain failure were 57%, 71%, and 55% for patients with 1, 2, and >3 brain metastases, respectively. No differences were significant. No major complications were observed. The 4-fraction SRT protocol provided excellent tumor control with minimal toxicity. Distant brain failure was not so frequent, even in patients with multiple tumors. The results of the current study warrant a prospective randomized study comparing single-fraction stereotactic radiosurgery (SRS) with SRT in this patient population.
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Affiliation(s)
- Aiko Nagai
- Radiation Therapy Center, Fukui Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
| | - Masanori Yoshida
- Radiation Therapy Center, Fukui Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
| | - Koichi Wakamatsu
- Department of Neurosurgery, Fukui Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
| | - Yuzo Kikuchi
- Radiation Therapy Center, Fukui Saiseikai Hospital, 7-1, Funabashi, Wadanaka-cho, Fukui 918-8503, Japan.
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Chen AM, Yu Y, Daly ME, Farwell DG, Benedict SH, Purdy JA. Long-term experience with reduced planning target volume margins and intensity-modulated radiotherapy with daily image-guidance for head and neck cancer. Head Neck 2014; 36:1766-72. [PMID: 24174221 DOI: 10.1002/hed.23532] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to compare outcomes among patients treated by intensity-modulated radiotherapy (IMRT) with daily image-guided radiotherapy (IGRT) for head and neck cancer according to the margins used to expand the clinical target volume (CTV) to create a planning target volume (PTV). METHODS Three hundred sixty-seven consecutive patients were treated with IMRT for squamous cell carcinoma of the head and neck. The first 103 patients were treated with 5-mm CTV-to-PTV margins. The subsequent 264 patients were treated using reduced (3 mm) margins. RESULTS The 3-year locoregional control for patients treated using 5-mm and 3-mm CTV-to-PTV margins, respectively, was 78% and 80% (p = .75). The incidence of gastrostomy-tube dependence at 1 year was 10% and 3%, respectively (p = .001). The incidence of posttreatment esophageal stricture was 14% and 7%, respectively (p = .01). CONCLUSION The use of reduced (3 mm) CTV-to-PTV margins was associated with reduced late toxicity while maintaining locoregional control.
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Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, California
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15
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Yu Y, Michaud AL, Sreeraman R, Liu T, Purdy JA, Chen AM. Comparison of daily versus nondaily image-guided radiotherapy protocols for patients treated with intensity-modulated radiotherapy for head and neck cancer. Head Neck 2013; 36:992-7. [DOI: 10.1002/hed.23401] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Revised: 03/20/2013] [Accepted: 06/03/2013] [Indexed: 11/06/2022] Open
Affiliation(s)
- Yao Yu
- Department of Radiation Oncology; University of California, Davis, Comprehensive Cancer Center; Sacramento California
| | - Anthony L. Michaud
- Department of Radiation Oncology; University of California, Davis, Comprehensive Cancer Center; Sacramento California
| | - Radhika Sreeraman
- Department of Radiation Oncology; University of California, Davis, Comprehensive Cancer Center; Sacramento California
| | - Tianxiao Liu
- Department of Radiation Oncology; University of California, Davis, Comprehensive Cancer Center; Sacramento California
| | - James A. Purdy
- Department of Radiation Oncology; University of California, Davis, Comprehensive Cancer Center; Sacramento California
| | - Allen M. Chen
- Department of Radiation Oncology; University of California, Davis, Comprehensive Cancer Center; Sacramento California
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Optimizing image guidance frequency and implications on margins for gynecologic malignancies. Radiat Oncol 2013; 8:110. [PMID: 23638800 PMCID: PMC3671193 DOI: 10.1186/1748-717x-8-110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 04/19/2013] [Indexed: 12/25/2022] Open
Abstract
Background To analyze setup deviations using daily megavoltage computed tomography (MVCT) and to evaluate three MVCT frequency reducing protocols for gynecologic cancer patients treated with helical tomotherapy. Methods We recorded the setup errors of 56 patients with gynecological cancer observed throughout their whole course by matching their daily MVCT with the planning CT. Systematic and random errors were calculated on a patient and population basis. We defined three different protocols corresponding to MVCTs from the first five fractions (FFF), the first ten fractions (FTF) or from the first and third weeks (505). We compared theoretical. setup errors calculated using these 5 or 10 early MVCT scans with the actual errors found with the remaining fractions to to analyze the residual deviations. Results The total systematic (random) deviations had means of −2.0 (3.8)mm, 0.5 (3.4)mm, 0.5 (6.1)mm and −0.5° (0.9°) in vertical (V), longitudinal (LO), lateral (LA), and roll (R) directions, respectively. The proposed three MVCT protocols resulted in minor residual deviations. In all three protocols, 95% of all calculated residual deviations were less than or equal to 5 mm in all 3 directions. When examining the additional minimal CTV-PTV setup margins that were calculated based on these residual deviations, the 505 protocol would have allowed smaller margins than the FFF and FTF protocol, particularly in the V direction. Conclusions For patients with gynecologic cancer, the 505-protocol led to the lowest residual deviations and therefore might offer the best approach in reducing the frequency of pre-treatment MVCTs.
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Daily setup uncertainty analysis for craniospinal irradiation using helical tomotherapy. Pract Radiat Oncol 2012; 3:349-55. [PMID: 24674409 DOI: 10.1016/j.prro.2012.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 06/28/2012] [Accepted: 07/16/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE Setup deviations of a craniospinal irradiation (CSI) patient cohort previously treated with helical tomotherapy were used to derive the optimal planning target volume (PTV) margin for CSI patients treated in the supine position. METHODS AND MATERIALS The daily setup shifts of 27 CSI tomotherapy patients as determined using pretreatment megavoltage computed tomography verification for a total of 454 fractions were evaluated. Translational displacements in the mediolateral (ML), craniocaudal (CC), and anteroposterior (AP) directions were used to assess the systematic and random setup errors, and to derive the PTV margin required when daily image guidance is unavailable. RESULTS The individual patient mean shifts and the corresponding standard deviations in the ML, CC, and AP directions were -0.5 ± 2.1 mm, 1.0 ± 2.7 mm, and 0.7 ± 1.1 mm, respectively. The random errors in the corresponding directions were 1.9 mm, 1.9 mm, and 2.2 mm. The PTV margins required in the absence of daily imaging were 3.7 mm to the right, 4.7 mm to the left, 4.4 mm inferior, 6.4 mm superior, 1.6 mm posterior, and 3.0 mm anterior. CONCLUSIONS The current PTV margin of 3.0 mm is sufficient to ensure clinical target volume coverage for CSI tomotherapy patients treated with daily megavoltage computed tomography imaging. When pretreatment verification imaging is not used to lower the setup uncertainty, a larger PTV margin of up to 6.4 mm in the CC direction will be needed.
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Piotrowski T, Ryczkowski A, Kazmierska J. B-Spline Registration Based on New Concept of an Intelligent Masking Procedure and GPU Computations for the Head and Neck Adaptive Tomotherapy. Technol Cancer Res Treat 2012; 11:257-66. [DOI: 10.7785/tcrt.2012.500294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The deformable image registration (DIR) procedure has been optimized for helical tomotherapy. The data on registration shifts obtained on matching planning image with pre-treatment megavoltage CT are used in our software for acceleration of the first step (rigid registration) of the DIR procedure and for implementation of the B-Spline algorithm with intelligent masking. Priorities of the masks were automatically calculated based on disagreement detected during rigid registration. Evaluation tasks included: (a) comparison of accuracy and rate for schemes of pre-registered and non-registered images; (b) qualification of the effectiveness of the intelligent masking process, and (c) determination of acceleration of achievable with GPU computing. A specially designed head and neck phantom used for evaluation included structures with controlled changes of position, volume, density, and shape. Re-contouring procedures were performed with an Adaptive Planning software (Tomotherapy Inc.). No statistical difference was observed in accuracy of DIR based on structure position match on the tomotherapy unit and non pre-registered images (p > 0.7). Using pre-registered data reduces the total time required for execution of the elastic registration procedure by 5%. These data are also necessary for intelligent masking procedure during B-Spine registration. Intelligent masking procedure increases accuracy of the registration for a masked structure (p < 0.04) without decreasing the accuracy in non-masked tissues and additionally reduces the total time by 13%. GPU computations speed up procedure 30 times. GPU computing of the DIR in current status of our investigation could be realized in a relatively short time after pre-treatment imaging. The proposed approach can be used in the routine assessment of anatomic changes occurring in healthy tissue during the course of radiotherapy. Further developments will be concentrated on the full integration of DIR computations in the imaging and treatment process of helical tomotherapy.
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Affiliation(s)
- T. Piotrowski
- Department of Medical Physics, Greater Poland Cancer Center, Garbary 15 st, 61-866, Poznan, Poland
- Department of Electroradiology, University of Medical Sciences, Poznan, Garbary 15 st, 61-866, Poznan, Poland
| | - A. Ryczkowski
- Department of Medical Physics, Greater Poland Cancer Center, Garbary 15 st, 61-866, Poznan, Poland
| | - J. Kazmierska
- II Radiotherapy Department, Greater Poland Cancer Center, Garbary 15 st, 61-866, Poznan, Poland
- Department of Electroradiology, University of Medical Sciences, Poznan, Garbary 15 st, 61-866, Poznan, Poland
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Chen AM, Farwell DG, Luu Q, Donald PJ, Perks J, Purdy JA. Evaluation of the Planning Target Volume in the Treatment of Head and Neck Cancer With Intensity-Modulated Radiotherapy: What Is the Appropriate Expansion Margin in the Setting of Daily Image Guidance? Int J Radiat Oncol Biol Phys 2011; 81:943-9. [PMID: 20932680 DOI: 10.1016/j.ijrobp.2010.07.017] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Revised: 07/01/2010] [Accepted: 07/02/2010] [Indexed: 11/18/2022]
Affiliation(s)
- Allen M Chen
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California 95817, USA.
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Ren G, Du L, Ma L, Feng LC, Zhou GX, Qu BL, Xu SP, Xie CB, Ou GM, Li F, Zhang XX, Yang J. Clinical observation of 73 nasopharyngeal carcinoma patients treated by helical tomotherapy: the China experience. Technol Cancer Res Treat 2011; 10:259-66. [PMID: 21517132 DOI: 10.7785/tcrt.2012.500201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The preliminary short-term clinical outcome of 73 nasopharyngeal carcinoma (NPC) patients treated with helical tomotherapy at our cancer institute has been evaluated. Between September 2007 and September 2009, 73 newly diagnosed NPC patients were treated with helical tomotherapy. The distributions of clinical stages according to the UICC 2002 Staging System were: 6, 27, 24, and 16 for Stage I, IIa-b, III, and IVa-b, respectively. The prescription dose was 70-74 Gy/33F to planning gross tumor volume containing the primary tumor and positive lymph nodes, with 60-62.7 Gy/33F to high risk planning target volume, while delivering 52-56 Gy/33F to low risk planning target volume. Twenty-four patients were treated with radiation therapy as single modality, 25 with concurrent cisplatin-based chemotherapy with or without anti-EGFR monoclonal antibody therapy, and 24 with concurrent anti-EGFR monoclonal antibody therapy. Setup errors were analyzed. Side-effects were evaluated with the established RTOG/EORTC criteria. Average beam-on-time was 468.8 sec/F (396.7-696.1 sec). The setup errors in the lateral, longitudinal and vertical directions were 0.00 ± 1.79 mm, -0.55± 2.17 mm and 0.38 ± 1.43 mm, corresponding to 3.80 mm, 4.20 mm, and 2.46 mm as the CTV-PTV margin in these directions. The grade 0, 1, 2 and 3 acute skin toxicity was 2.7%, 76.7%, 13.8% and 6.8%; the grade 0, 1, 2 and 3 acute mucositis was 1.4%, 32.9%, 60.2% and 5.5%; and the grade 0, 1, 2 and 3 acute xerostomia was 4.0%, 45.3%, 50.7% and 0, respectively. Only 5 patients suffered from grade 3 or 4 leucopenia. Xerostomia resolved with passing of time and no grade 2 or more xerostomia was noted one year after radiation therapy. Concurrent chemotherapy significantly increased incidence of severe acute toxicities. One month after radiation therapy the remission rates of primary tumor and positive lymph nodes were 91.8% and 98.1%, respectively. The median follow-up was 14.8 months. The one-year relapse-free survival, distant metastasis-free survival and overall survival was 95.6%, 97.2% and 94.8%, respectively. In conclusion, the incidence of severe acute toxicities and late xerostomia was relatively infrequent for NPC patients treated with helical tomotherapy. The long-term clinical outcome for these patients is under investigation.
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Affiliation(s)
- G Ren
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing 100853, China.
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Schiappacasse L, Cendales R, Sallabanda K, Schnitman F, Samblas J. Preliminary results of helical tomotherapy in patients with complex-shaped meningiomas close to the optic pathway. Med Dosim 2011; 36:416-22. [PMID: 21397487 DOI: 10.1016/j.meddos.2010.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 10/17/2010] [Accepted: 10/21/2010] [Indexed: 10/18/2022]
Abstract
Meningiomas are the most common benign intracranial tumor. Meningiomas close to the optic pathway represent a treatment challenge both for surgery and radiotherapy. The aim of this article is to describe early results of helical tomotherapy treatment in complex-shaped meningiomas close to the optic pathway. Twenty-eight patients were consecutively treated. All patients were immobilized with a thermoplastic head mask and planned with the aid of a magnetic resonance imaging-computed tomography fusion. All treatments included daily image guidance. Pretreatment symptoms and acute toxicity were recorded. Median age was 57.5 years, and 92.8% patients had Eastern Cooperative Oncology Group performance status scale ≤1. The most common localizations were the sella turcica, followed by the cavernous sinus and the sphenoid. The most common symptoms were derived from cranial nerve deficits. Tomotherapy was administered as primary treatment in 35.7% of patients, as an adjuvant treatment in 32.4%, and as a rescue treatment after postsurgical progression in 32.1% patients. Most patients were either inoperable or Simpson IV. Total dose varied between 5000 and 5400 cGy; fractionation varied between 180 and 200 cGy. Median dose to the planning target volume was 51.7 Gy (range, 50.2-55.9 Gy). Median coverage index was 0.89 (range, 0.18-0.97). Median homogeneity index was 1.05 (range, 1-1.12). Acute transient toxicity was grade 1 and included headache in 35.7% patients, ocular pain/dryness in 28.5%, and radiation dermatitis in 25%. Thus far, with a maximal follow-up of 3 years, no late effects have been seen and all patients have a radiological stabilization of the disease. Helical tomotherapy offered a safe and effective therapeutic alternative for patients with inoperable or subtotally resected complex-shaped meningiomas close to the optic pathway. Acceptable coverage and homogeneity indexes were achieved with appropriate values for maximal doses delivered to the eyes, lenses, and chiasm, despite the proximity of the tumor to these structures.
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Affiliation(s)
- Luis Schiappacasse
- Tomotherapy Department, Clinica La Milagrosa, IMO Group (Instituto Madrileno de Oncologia), Madrid, Spain.
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