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Garibaldi C, Beddar S, Bizzocchi N, Tobias Böhlen T, Iliaskou C, Moeckli R, Psoroulas S, Subiel A, Taylor PA, Van den Heuvel F, Vanreusel V, Verellen D. Minimum and optimal requirements for a safe clinical implementation of ultra-high dose rate radiotherapy: A focus on patient's safety and radiation protection. Radiother Oncol 2024; 196:110291. [PMID: 38648991 DOI: 10.1016/j.radonc.2024.110291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/28/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Cristina Garibaldi
- IEO, Unit of Radiation Research, European Institute of Oncology IRCCS, 20141 Milan, Italy.
| | - Sam Beddar
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nicola Bizzocchi
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - Till Tobias Böhlen
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Charoula Iliaskou
- Division of Medical Physics, Department of Radiation Oncology, University Medical Center Freiburg, 79106, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center (DKFZ), Heidelberg 69120, Germany
| | - Raphaël Moeckli
- Institute of Radiation Physics, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Serena Psoroulas
- Center for Proton Therapy, Paul Scherrer Institut, Villigen, Switzerland
| | - Anna Subiel
- National Physical Laboratory, Medical Radiation Science, Teddington, UK
| | - Paige A Taylor
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Frank Van den Heuvel
- Zuidwest Radiotherapeutisch Institute, Vlissingen, the Netherlands; Dept of Oncology, University of Oxford, Oxford, UK
| | - Verdi Vanreusel
- Iridium Netwerk, Antwerp University (Centre for Oncological Research, CORE), Antwerpen, Belgium; SCK CEN (Research in Dosimetric Applications), Mol, Belgium
| | - Dirk Verellen
- Iridium Netwerk, Antwerp University (Centre for Oncological Research, CORE), Antwerpen, Belgium
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Lee J, Shin NY, Lee SJ, Cho YJ, Jung IH, Sung JW, Kim SJ, Kim JW. Development of Magnetic Resonance-Compatible Head Immobilization Device and Initial Experience of Magnetic Resonance-Guided Radiation Therapy for Central Nervous System Tumors. Pract Radiat Oncol 2024:S1879-8500(24)00093-6. [PMID: 38697347 DOI: 10.1016/j.prro.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/04/2024]
Abstract
PURPOSE We aimed to develop and investigate positional reproducibility using a fixation device (Unity Brain tumor Immobilization Device [UBID]) in patients with brain tumor undergoing magnetic resonance (MR)-guided radiation therapy (RT) with a 1.5 Tesla (T) MR-linear accelerator (MR-LINAC) to evaluate its feasibility in clinical practice and report representative cases of patients with central nervous system (CNS) tumor. MATERIALS AND METHODS Quantitative analysis was performed by comparing images obtained by placing only the MR phantom on the couch with those obtained by placing UBID next to the MR phantom. Twenty patients who underwent RT for CNS tumors using 1.5T MR-LINAC between June and October 2022 were retrospectively analyzed. Among them, 5 did not use UBID, whereas 15 used UBID. The positional reproducibility of UBID was evaluated using the median interfractional and intrafractional errors in the first 10 fractions. RESULTS Each MR quality factor of the MR phantom with UBID satisfied the criteria presented by Elekta. Median values of median shifts in the mediolateral, anteroposterior, and craniocaudal axes for interfractional errors were 2.98, 2.35, and 1.40 mm, respectively. For intrafractional errors, the median values were 0.05, 0.03, and 0.06 mm, respectively. The median values of the median rotations in pitch, roll, and yaw for both interfractional and intrafractional rotations were 0.00°. One patient diagnosed with an optic nerve sheath meningioma received RT with motion monitoring during irradiation. In 2 patients, changes in the tumor cavity and residual lesions were observed in the MRI obtained using 1.5T MR-LINAC on the day of the first treatment and immediately before the 21st fraction, respectively; therefore, offline/online adaptation was performed. CONCLUSIONS The reproducible and immobile UBID is clinically feasible in patients with CNS tumors receiving RT with 1.5T MR-LINAC. Based on our initial experience, we developed a workflow for 1.5T MR-LINAC treatment of CNS tumors.
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Affiliation(s)
- Joongyo Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea; Department of Radiation Oncology, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Na Young Shin
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Seo Jin Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoon Jin Cho
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - In Ho Jung
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Ji Won Sung
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Sei Joon Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
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Budrukkar A, Murthy V, Kashid S, Swain M, Rangarajan V, Laskar SG, Kannan S, Kale S, Upreti R, Pai P, Pantvaidya G, Gupta T, Agarwal JP. Intensity-Modulated Radiation Therapy Alone Versus Intensity-Modulated Radiation Therapy and Brachytherapy for Early-Stage Oropharyngeal Cancers: Results From a Randomized Controlled Trial. Int J Radiat Oncol Biol Phys 2024; 118:1541-1551. [PMID: 37660737 DOI: 10.1016/j.ijrobp.2023.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The objective of this study was to compare clinical outcomes of intensity-modulated radiation therapy (IMRT) alone versus IMRT + brachytherapy (BT) in patients with T1-T2N0M0 oropharyngeal squamous cell cancers (OPSCC). METHODS AND MATERIALS This open-label randomized controlled trial was conducted at Tata Memorial Hospital, Mumbai, India. Patients with stage I and II OPSCC were considered for IMRT to a dose of 50 Gy/25 fractions/5 weeks in phase I followed by randomization (1:1) to further treatment with IMRT (20 Gy/10 fractions/2 weeks) or BT (192Ir high dose rate, 21 Gy/7 fractions/2 fractions per day). The primary endpoint of the trial was the reduction in xerostomia at 6 months evaluated using 99mTc salivary scintigraphy. Severe salivary toxicity (xerostomia) was defined as posttreatment salivary excretion fraction ratio <45%. Secondary endpoints were local control, disease-free survival, and overall survival. RESULTS Between November 2010 and February 2020, 90 patients were randomized to IMRT (n = 46) alone or IMRT + BT (n = 44). Eleven patients (8 residual/recurrent disease, 2 lost to follow-up, 1 second primary) in the IMRT arm and 9 patients (8 residual/recurrence, 1 lost to follow-up) in the BT arm were not evaluable at 6 months for the primary endpoint. At 6 months, xerostomia rates using salivary scintigraphy were 14% (5/35: 95% CI, 5%-30%) in the BT arm while it was seen in 44% (14/32: 95% CI, 26%-62%) in the IMRT arm (P = .008). Physician-rated Radiation Therapy Oncology Group grade ≥2 xerostomia at any time point was observed in 30% of patients (9/30) in the IMRT arm and 6.7% (2/30) in the BT arm (P = .02). At a median follow-up of 42.5 months, the 3-year local control in the IMRT arm was 56.4% (95% CI, 43%-73%) while it was 66.2% (95% CI, 53%-82%) in the BT arm (P = .24). CONCLUSIONS The addition of BT to IMRT for T1-T2N0M0 OPSCC results in a significant reduction in xerostomia. This strongly supports the addition of BT to IMRT in suitable cases.
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Affiliation(s)
- Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.
| | - Vedang Murthy
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer/Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sheetal Kashid
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Sadhana Kannan
- Clinical Research Secretariat, Advanced Centre for Treatment, Research and Education in Cancer/Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shrikant Kale
- Department of Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rituraj Upreti
- Department of Medical Physics, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Prathamesh Pai
- Department of Head Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Gouri Pantvaidya
- Department of Head Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Advanced Centre for Treatment, Research and Education in Cancer/Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Liu M, Tang B, Orlandini LC, Li J, Wang X, Peng Q, Thwaites D. Potential dosimetric error in the adaptive workflow of a 1.5 T MR-Linac from patient movement relative to immobilisation systems. Phys Eng Sci Med 2024; 47:351-359. [PMID: 38227140 DOI: 10.1007/s13246-023-01369-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/10/2023] [Indexed: 01/17/2024]
Abstract
In magnetic resonance- (MR-) based adaptive workflows for an MR-linac, the treatment plan is optimized and recalculated online using the daily MR images. The Unity MR-linac is supplied with a patient positioning device (ppd) using pelvic and abdomen thermoplastic masks attached to a board with high-density components. This study highlights the dosimetric effect of using this in such workflows when there are relative patient-ppd displacements, as these are not visualized on MR imaging and the treatment planning system assumes the patient is fixed relative to the ppd. The online adapted plans of two example rectum cancer patients treated at a Unity MR-linac were perturbed by introducing relative patient-ppd displacements, and the effect was evaluated on plan dosimetry. Forty-eight perturbed clinical adapted plans were recalculated, based on online MR-based synthetic computed tomography, and compared with the original plans, using dose-volume histogram parameters and gamma analysis. The target volume covered by the prescribed dose ( D pre ) and by at least 107% of D pre varied up to - 1.87% and + 3.67%, respectively for 0.5 cm displacements, and to - 3.18% and + 4.96% for 2 cm displacements; whilst 2%-2 mm gamma analysis showed a median value of 92.9%. The use of a patient positioning system with high-density components in a Unity MR-based online adaptive treatment workflow can introduce unrecognized errors in plan dosimetry and it is recommended not to use such a device for such treatments, without modifying the device and the workflow, followed by careful clinical evaluation, or alternatively to use other immobilization methods.
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Affiliation(s)
- Min Liu
- Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China
- Institute of Nuclear Technology and Automation Engineering, Chengdu University of Technology, Chengdu, China
| | - Bin Tang
- Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China
| | - Lucia Clara Orlandini
- Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China
| | - Jie Li
- Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China.
- Radiotherapy Research Group, Leeds Institute of Medical Research, St James's Hospital and University of Leeds, Leeds, UK.
| | - Xianliang Wang
- Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China.
- Radiotherapy Research Group, Leeds Institute of Medical Research, St James's Hospital and University of Leeds, Leeds, UK.
| | - Qian Peng
- Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China
| | - David Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
- Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, NSW, Australia
- Radiotherapy Research Group, Leeds Institute of Medical Research, St James's Hospital and University of Leeds, Leeds, UK
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Aoyama T, Shimizu H, Kitagawa T, Ishiguro Y, Kodaira T. Development of a device that remotely removes a mask in the head and neck immobilization system: a prototype and demonstration experiment. Radiol Phys Technol 2022; 15:249-254. [PMID: 35790662 DOI: 10.1007/s12194-022-00663-5] [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: 04/15/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022]
Abstract
In this study, a prototype device was developed to quickly remove the mask used to immobilize the head and neck by remotely releasing the quick fasteners. As a first step in investigating the usefulness of this prototype, we performed repeated removal tests and examined the accuracy of dose calculation. The results showed that the quick-release fasteners of a Type-S system (CIVCO Medical Solutions, Iowa, USA) could be removed remotely and accurately (success rate: 100%). Additionally, the dose errors in treatment planning were negligible (< 1.0%), and the gamma pass rate was equivalent (99.9%). Therefore, this prototype device with a remote system would help manage patient safety in emergencies, such as a disaster or a sudden change in the patient's condition. However, age-related deterioration with long-term clinical use or its ability to link with beam-off still requires further exploration.
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Affiliation(s)
- Takahiro Aoyama
- Department of Radiation Oncology, Aichi Cancer Centre, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi, 464-8681, Japan.
- Graduate School of Medicine, Aichi Medical University, 1-1 Yazako-karimata, Nagakute, Aichi, 480-1195, Japan.
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Centre, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi, 464-8681, Japan
| | - Tomoki Kitagawa
- Department of Radiation Oncology, Aichi Cancer Centre, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi, 464-8681, Japan
| | - Yasunori Ishiguro
- Department of Radiation Oncology, Aichi Cancer Centre, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi, 464-8681, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Centre, 1-1 Kanokoden, Chikusa-Ku, Nagoya, Aichi, 464-8681, Japan
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Park JW, Yea JW, Park J, Oh SA. Setup uncertainties and appropriate setup margins in the head-tilted supine position of whole-brain radiotherapy (WBRT). PLoS One 2022; 17:e0271077. [PMID: 35925916 PMCID: PMC9352041 DOI: 10.1371/journal.pone.0271077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/22/2022] [Indexed: 11/18/2022] Open
Abstract
Various applications of head-tilting techniques in whole-brain radiotherapy (WBRT) have been introduced. However, a study on the setup uncertainties and margins in head-tilting techniques has not been reported. This study evaluated the setup uncertainties and determined the appropriate planning target volume (PTV) margins for patients treated in the head-tilted supine (ht-SP) and conventional supine position (c-SP) in WBRT. Thirty patients who received WBRT at our institution between October 2020 and May 2021 in the c-SP and ht-SP were investigated. The DUON head mask (60124, Orfit Industries, Wijnegem, Belgium) was used in the c-SP, and a thermoplastic U-Frame Mask (R420U, Klarity Medical & Equipment Co. Ltd., Lan Yu, China) was used in the ht-SP. Daily setup verification using planning computed tomography (CT) and cone-beam CT was corrected for translational (lateral, longitudinal, and vertical) and rotational (yaw) errors. In the c-SP, the means of systematic errors were -0.80, 0.79, and 0.37 mm and random errors were 0.27, 0.54, and 0.39 mm in the lateral, longitudinal, and vertical translational dimensions, respectively. Whereas, for the ht-SP, the means of systematic errors were -0.07, 0.73, and -0.63 mm, and random errors were 0.75, 1.39, 1.02 mm in the lateral, longitudinal, and vertical translational dimensions, respectively. The PTV margins were calculated using Stroom et al.’s [2Σ+0.7σ] and van Herk et al.’s recipe [2.5Σ+0.7σ]. Appropriate PTV margins with van Herk et al.’s recipe in WBRT were <2 mm and 1.5° in the c-SP and <3 mm and 2° in the ht-SP in the translational and rotational directions, respectively. Although the head tilt in the supine position requires more margin, it can be applied as a sufficiently stable and effective position in radiotherapy.
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Affiliation(s)
- Jae Won Park
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ji Woon Yea
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jaehyeon Park
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Se An Oh
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
- * E-mail:
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Kim TH, Cho MS, Shin DS, Shin DH, Kim S. Development of a Real-Time Thermoplastic Mask Compression Force Monitoring System Using Capacitive Force Sensor. Front Robot AI 2022; 9:778594. [PMID: 35875702 PMCID: PMC9298856 DOI: 10.3389/frobt.2022.778594] [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: 09/20/2021] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose: Thermoplastic masks keep patients in an appropriate position to ensure accurate radiation delivery. For a thermoplastic mask to maintain clinical efficacy, the mask should wrap the patient's surface properly and provide uniform pressure to all areas. However, to our best knowledge, no explicit method for achieving such a goal currently exists. Therefore, in this study, we intended to develop a real-time thermoplastic mask compression force (TMCF) monitoring system to measure compression force quantitatively. A prototype system was fabricated, and the feasibility of the proposed method was evaluated. Methods: The real-time TMCF monitoring system basically consists of four force sensor units, a microcontroller board (Arduino Bluno Mega 2560), a control PC, and an in-house software program. To evaluate the reproducibility of the TMCF monitoring system, both a reproducibility test using a micrometer and a setup reproducibility test using a head phantom were performed. Additionally, the reproducibility tests of mask setup and motion detection tests were carried out with a cohort of six volunteers. Results: The system provided stable pressure readings in all 10 trials during the sensor unit reproducibility test. The largest standard deviation (SD) among trials was about 36 gf/cm2 (∼2.4% of the full-scale range). For five repeated mask setups on the phantom, the compression force variation of the mask was less than 39 gf/cm2 (2.6% of the full-scale range). We were successful in making masks together with the monitoring system connected and demonstrated feasible utilization of the system. Compression force variations were observed among the volunteers and according to the location of the sensor (among forehead, both cheekbones, and chin). The TMCF monitoring system provided the information in real time on whether the mask was properly pressing the human subject as an immobilization tool. Conclusion: With the developed system, it is possible to monitor the effectiveness of the mask in real time by continuously measuring the compression force between the mask and patient during the treatment. The graphical user interface (GUI) of the monitoring system developed provides a warning signal when the compression force of the mask is insufficient. Although the number of volunteers participated in the study was small, the obtained preliminary results suggest that the system could ostensibly improve the setup accuracy of a thermoplastic mask.
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Affiliation(s)
- Tae-Ho Kim
- Proton Therapy Center, National Cancer Center, Goyang, South Korea
| | - Min-Seok Cho
- Department of Radiation Oncology, Yongin Severance Hospital, Yongin, South Korea
| | - Dong-Seok Shin
- Proton Therapy Center, National Cancer Center, Goyang, South Korea
| | - Dong Ho Shin
- Proton Therapy Center, National Cancer Center, Goyang, South Korea
| | - Siyong Kim
- Department of Radiation Oncology, Virginia Commonwealth University, Virginia, VA, United States
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Kato R, Hirose K, Kato T, Motoyanagi T, Arai K, Harada T, Takeuchi A, Yamazaki Y, Narita Y, Komori S, Sato M, Takai Y. Dosimetric effects of the ipsilateral shoulder position variations in the sitting-positioned boron neutron capture therapy for lower neck tumor. Appl Radiat Isot 2022; 188:110397. [DOI: 10.1016/j.apradiso.2022.110397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/07/2022] [Accepted: 07/27/2022] [Indexed: 11/02/2022]
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Cumur C, Fujibuchi T, Hamada K. Dose estimation for cone-beam computed tomography in image-guided radiation therapy using mesh-type reference computational phantoms and assuming head and neck cancer. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:021533. [PMID: 35705020 DOI: 10.1088/1361-6498/ac7914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to estimate the additional dose the cone-beam computed tomography (CBCT) system integrated into the Varian TrueBeam linear accelerator delivers to a patient with head and neck cancer using mesh-type International Commission on Radiological Protection reference computational phantoms. In the first part, for use as a benchmark for the accuracy of the Monte Carlo geometry of CBCT, Particle and Heavy Ion Transport code System (PHITS) calculations were confirmed against measured lateral and depth dose profiles using a computed tomography dose profiler. After obtaining good agreement, organ dose calculations were performed by PHITS using mesh-type reference computational phantom (MRCP) and irradiating the neck region; the effective dose was calculated utilising absorbed organ doses and tissue weighting factors for male and female MRCP. Substantially, it has been found that the effective doses for male and female MRCP are 0.81 and 1.06 mSv, respectively. As this study aimed to assess the imaging dose from the CBCT system used in image-guided radiation therapy, it is required to take into account this dose in terms of both the target organ and surrounding tissues. Although the absorbed organ dose values and effective dose values obtained for both MRCP males and females were small, attention should be paid to the additional dose resulting from CBCT. This study can create awareness on the importance of doses arising from imaging techniques, especially CBCT.
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Affiliation(s)
- Ceyda Cumur
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka City 812-8582, Japan
| | - Toshioh Fujibuchi
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka City 812-8582, Japan
| | - Keisuke Hamada
- Department of Radiological Technology, National Hospital Organisation Kyushu Cancer Center, 3-1-1, Notame Minami-ku, Fukuoka City 811-1395, Japan
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Miron VM, Etzelstorfer T, Kleiser R, Raffelsberger T, Major Z, Geinitz H. Evaluation of novel 3D-printed and conventional thermoplastic stereotactic high-precision patient fixation masks for radiotherapy. Strahlenther Onkol 2022; 198:1032-1041. [PMID: 35697775 PMCID: PMC9581856 DOI: 10.1007/s00066-022-01963-w] [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: 02/24/2022] [Accepted: 05/15/2022] [Indexed: 11/30/2022]
Abstract
Purpose For stereotactic radiation therapy of intracranial malignancies, a patient’s head needs to be immobilized with high accuracy. Fixation devices such as invasive stereotactic head frames or non-invasive thermoplastic mask systems are often used. However, especially stereotactic high-precision masks often cause discomfort for patients due to a long manufacturing time during which the patient is required to lie still and because the face is covered, including the mouth, nose, eyes, and ears. To avoid these issues, the target was to develop a non-invasive 3D-printable mask system with at least the accuracy of the high-precision masks, for producing masks which can be manufactured in the absence of patients and which allow the eyes, mouth, and nose to be uncovered during therapy. Methods For four volunteers, a personalized 3D-printed mask based on magnetic resonance imaging (MRI) data was designed and manufactured using fused filament fabrication (FFF). Additionally, for each of the volunteers, a conventional thermoplastic stereotactic high-precision mask from Brainlab AG (Munich, Germany) was fabricated. The intra-fractional fixation accuracy for each mask and volunteer was evaluated using the motion-correction algorithm of functional MRI measurements with and without guided motion. Results The average values for the translations and rotations of the volunteers’ heads lie in the range between ±1 mm and ±1° for both masks. Interestingly, the standard deviations and the relative and absolute 3D displacements are lower for the 3D-printed masks compared to the Brainlab masks. Conclusion It could be shown that the intra-fractional fixation accuracy of the 3D-printed masks was higher than for the conventional stereotactic high-precision masks.
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Affiliation(s)
- Veronika M Miron
- Institute of Polymer Product Engineering, Johannes Kepler University, Altenberger Str. 69, 4040, Linz, Austria.
| | - Tanja Etzelstorfer
- Abteilung für Radioonkologie, Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria
| | - Raimund Kleiser
- Department of Neuroradiology, Johannes Kepler University Clinic, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Tobias Raffelsberger
- Department of Neuroradiology, Johannes Kepler University Clinic, Wagner-Jauregg-Weg 15, 4020, Linz, Austria
| | - Zoltan Major
- Institute of Polymer Product Engineering, Johannes Kepler University, Altenberger Str. 69, 4040, Linz, Austria
| | - Hans Geinitz
- Abteilung für Radioonkologie, Ordensklinikum Linz Barmherzige Schwestern, Seilerstätte 4, 4010, Linz, Austria
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11
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Miura H. [5. Robust Techniques for Radiotherapy Treatment Plan]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:882-888. [PMID: 35989258 DOI: 10.6009/jjrt.2022-2072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
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12
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Konnerth D, Eze C, Nierer L, Thum P, Braun J, Niyazi M, Belka C, Corradini S. Novel modified patient immobilisation device with an integrated coil support system for MR-guided online adaptive radiotherapy in the management of brain and head-and-neck tumours. Tech Innov Patient Support Radiat Oncol 2021; 20:35-40. [PMID: 34841095 PMCID: PMC8605429 DOI: 10.1016/j.tipsro.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/15/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
Magnetic resonance imaging (MR)-guided online adaptive radiotherapy is a promising technique in the field of radiation oncology providing excellent visualisation of soft-tissues, and allowing for online plan adaptation and tumour tracking. In order to facilitate the accurate dose delivery to the target volume while sparing healthy surrounding normal tissue in the brain or head-and-neck (H&N) region, precise patient immobilisation with good image quality is pertinent. Herein, we present a customised thermoplastic mask holder with an integrated anterior MR receiver coil support system for MR-guided online adaptive radiotherapy in the brain and head-and-neck region. The approved medical product was developed by Innovative Technologie Voelp (IT-V), Innsbruck, Austria. MR image uniformity measurements demonstrated improved image uniformity at the expense of decreased signal-to-noise ratio due to a more defined and larger distance between the anterior receiver coil and the phantom or patient. This integrated coil support system represents a practical solution facilitating stable and reproducible anterior coil placement while maintaining the thermoplastic mask holder functionality, a widely established immobilisation technique.
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Affiliation(s)
- Dinah Konnerth
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- Corresponding author at: Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377 Munich, Germany.
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Lukas Nierer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Patrick Thum
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Juliane Braun
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), Partner Site, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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13
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Cleland S, Chan P, Chua B, Crowe SB, Dawes J, Kenny L, Lin C, Obereigner E, Peet SC, Trapp JV, Poroa T, Kairn T. Dosimetric evaluation of a patient-specific 3D-printed oral positioning stent for head-and-neck radiotherapy. Phys Eng Sci Med 2021; 44:887-899. [PMID: 34110611 DOI: 10.1007/s13246-021-01025-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/03/2021] [Indexed: 12/21/2022]
Abstract
As head-and-neck radiotherapy treatments become more complex and sophisticated, and the need to control and stabilise the positioning of intra-oral anatomy becomes more important, leading the increasing use of oral positioning stents during head-and-neck radiotherapy simulation and delivery. As an alternative to the established practice of creating oral positioning stents using wax, this study investigated the use of a 3D printing technique. An Ender 5 3D printer (Creality 3D, Shenzhen, China) was used, with PLA+ "food-safe" polylactic acid filament (3D Fillies, Dandenong South, Australia), to produce a low-density 3D printed duplicate of a conventional wax stent. The physical and dosimetric effects of the two stents were evaluated using radiochromic film in a solid head phantom that was modified to include flexible parts. The Varian Eclipse treatment planning system (Varian Medical Systems, Palo Alto, USA) was used to calculate the dose from two different head-and-neck treatment plans for the phantom with each of the two stents. Examination of the resulting four dose distributions showed that both stents effectively pushed sensitive oral tissues away from the treatment targets, even though most of the phantom was solid. Film measurements confirmed the accuracy of the dose calculations from the treatment planning system, despite the steep density gradients in the treated volume, and demonstrated that the 3D print could be a suitable replacement for the wax stent. This study demonstrated a useful method for dosimetrically testing novel oral positioning stents. We recommend the development of flexible phantoms for future studies.
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Affiliation(s)
- Susannah Cleland
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Queensland University of Technology, Brisbane, QLD, 4001, Australia.,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia.,Radiation Oncology Princess Alexandra Hospital Raymond Terrace, South Brisbane, QLD, 4101, Australia
| | - Philip Chan
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Benjamin Chua
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Scott B Crowe
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Queensland University of Technology, Brisbane, QLD, 4001, Australia.,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Jodi Dawes
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Lizbeth Kenny
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Charles Lin
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,University of Queensland, Brisbane, QLD, 4072, Australia
| | - Elise Obereigner
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia
| | - Samuel C Peet
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Queensland University of Technology, Brisbane, QLD, 4001, Australia
| | - Jamie V Trapp
- Queensland University of Technology, Brisbane, QLD, 4001, Australia
| | - Tania Poroa
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia.,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia
| | - Tanya Kairn
- Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia. .,Queensland University of Technology, Brisbane, QLD, 4001, Australia. .,Herston Bifabrication Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia. .,University of Queensland, Brisbane, QLD, 4072, Australia.
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14
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Individual 3D-printed fixation masks for radiotherapy: first clinical experiences. Int J Comput Assist Radiol Surg 2021; 16:1043-1049. [PMID: 34021859 PMCID: PMC8166668 DOI: 10.1007/s11548-021-02393-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 04/27/2021] [Indexed: 11/13/2022]
Abstract
Purpose To show the feasibility of 3D-printed fixation masks for whole brain radiation therapy in a clinical setting and perform a first comparison to an established thermoplastic mask system. Methods Six patients were irradiated with whole brain radiotherapy using individually 3D-printed masks. Daily image guidance and position correction were performed prior to each irradiation fraction. The vectors of the daily position correction were compared to two collectives of patients, who were irradiated using the standard thermoplastic mask system (one cohort with head masks; one cohort with head and neck masks). Results The mean systematic errors in the experimental cohort ranged between 0.59 and 2.10 mm which is in a comparable range to the control groups (0.18 mm–0.68 mm and 0.34 mm–2.96 mm, respectively). The 3D-printed masks seem to be an alternative to the established thermoplastic mask systems. Nevertheless, further investigation will need to be performed. Conclusion The prevailing study showed a reliable and reproducible interfractional positioning accuracy using individually 3D-printed masks for whole brain irradiation in a clinical routine. Further investigations, especially concerning smaller target volumes or other areas of the body, need to be performed before using the system on a larger basis.
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15
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Sakai Y, Tanooka M, Okada W, Sano K, Nakamura K, Shibata M, Ueda Y, Mizuno H, Tanaka M. Characteristics of a bolus created using thermoplastic sheets for postmastectomy radiation therapy. Radiol Phys Technol 2021; 14:179-185. [PMID: 33837911 DOI: 10.1007/s12194-021-00618-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/19/2021] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
This study applied a "shell bolus," an immobilizing thermoplastic shell locally thickened with extra layers over the radiation target, during postmastectomy radiation therapy (PMRT). We performed ion chamber and film measurements for a solid water phantom for thermoplastic sheets and a gel bolus for dosimetric characterization using a 6-MV X-ray flattening-filter-free (FFF) beam. The air gaps between the body surface for the gel and shell bolus were measured using computed tomography (CT) images in patients who underwent PMRT. This included seven and 13 patients treated with the gel and shell boluses, respectively. A comparison of the dose differences between a 10-mm gel bolus and a 9.6-mm-thick thermoplastic sheet at the surface and 5 cm below the surface showed a 4.2% higher surface dose and 0.5% lower dose at 5-cm depth for the thermoplastic sheet compared to those for the gel bolus. The mean (p = 0.029) and maximum (p < 0.001) air gaps of the shell bolus were significantly thinner than those of the gel bolus. Thus, the shell bolus provided a close fit and robust bolus effect. In addition, the shell bolus reduced respiratory motion and eliminated the need for skin marking. Therefore, this system can be effectively used as a bolus for PMRT.
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Affiliation(s)
- Yusuke Sakai
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan.
| | - Masao Tanooka
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Wataru Okada
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Keisuke Sano
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Kenji Nakamura
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Mayuri Shibata
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
| | - Yoshihiro Ueda
- Department of Radiation Oncology, Osaka International Cancer Institute, 3-1-69 Otemae, Chuo-ku, Osaka, 537-8567, Japan
| | - Hirokazu Mizuno
- Division of Central Radiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masahiro Tanaka
- Radiation Therapy Center, Takarazuka City Hospital, 4-5-1 Kohama, Takarazuka, Hyogo, 665-0827, Japan
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16
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Evaluation of PTV margins in IMRT for head and neck cancer and prostate cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396919000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPurpose:The aim of this study was to evaluate planning target volume (PTV) margins for two different locations using an electronic portal imaging device (EPID) to ensure that the correct radiation dose is delivered to the tumour when using intensity-modulated radiation therapy (IMRT).Materials and methods:Setup data were collected from 40 patients treated with IMRT for head and neck cancer (HN) (20 patients) and prostate cancer (20 patients). Setup errors from 720 registration images were analysed to evaluate systematic and random errors. Thereafter, optimal PTV margins were calculated based on International Commission on Radiation Units and Measurements 62 (ICRU), Stroom and Parker formulas compared with the Van Herk’s recipe.Results:To calculate the margins around the PTV, several different formulas have been used. Setup margins ranged between 2–4·3, 2·2–4·6 and 2·1–4·7 mm in X, Y and Z directions, respectively, for HN cases. Similarly, for the prostate site, setup margins ranged between 3·7–8·3, 3·2–6·8 and 3·3–8·2 mm in X, Y and Z directions.Conclusion:To ensure better coverage of target volume, we adopted a PTV margin of 5 mm for HN PTVs and 10 mm for prostate PTVs in our department.
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17
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Impact of brachial plexus movement during radical radiotherapy for head and neck cancers: the case for a larger planning organ at risk volume margin. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AbstractIntroduction:Treatment volumes for radical radiotherapy to head and neck cancers commonly extend into the lower neck, the territory of the brachial plexus (BP). There is a risk of radiation-induced brachial plexopathy, a non-reversible late toxicity experienced by a small number of patients. The BP was anatomically divided into superior and inferior divisions and analysed to establish if segmental inter-fractional BP movement should be considered when planning radiotherapy in this high-dose region.Methods:A retrospective single-centre analysis of 15 patients with head and neck cancers treated with radical bilateral neck irradiation was conducted. The extent of BP movement relative to the planning scan was assessed using weekly cone beam computed tomography (CBCT) scans. The BP was contoured on the planning scan and the subsequent six weekly CBCTs; this was used to calculate the Jaccard Conformity Index (JCI) for the left, right, superior and inferior divisions of the BP.Results:The mean (±SD) JCI for right and left superior BP was 44·4±15·5%, whereas the mean (±SD) JCI for right and left inferior BP was 38·3±15·5%. There was a statistically significant difference between superior and inferior JCI, p=0·0002, 95% CI (−9·26 to −2·88). Bilateral superior BP JCI was higher, with better conformity than the corresponding inferior divisions.Conclusions:Inter-fractional BP movement occurs; the greatest movement is seen at the inferior division. This data suggest the need for re-evaluation of current BP margins and consideration of a larger inferior BP planning at risk volume (PRV) margin.
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18
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Evaluation of set-up errors and determination of set-up margin in pelvic radiotherapy by electronic portal imaging device (EPID). JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction and purpose:The error in set-up of patients is an inherent part of treatment processes. The positioning errors can be used to determine the margins of the planning target volume (PTV) to cover the target volume, while minimising the radiation dose delivered to normal tissues. This study aimed to evaluate random and systematic errors occurring in inter-fraction set-ups of pelvic radiotherapy measured by electronic portal imaging device (EPID) and then to propose the optimum clinical target volume (CTV) to PTV margin in pelvic cancer patients.Materials and methods:This study examined 22 patients treated with pelvic radiotherapy. A total of 182 portal images were evaluated. Population random (σ) and systematic (Σ) errors were determined based on the portal images in three directions (X, Y and Z). The set-up margin for CTV to PTV was calculated by published margin formulae of International Commission on Radiation Units and measurements (ICRU) report No. 62 recommendation and formulas presented by Stroom and Heijmen and Van Herk et al.Results:Systematic set-up errors for radiotherapy to patients ranged between 2·36 and 4·99 mm, and random errors ranged between 1·51 and 2·74 mm. The margin required to cover the target volume retrospectively was calculated based on ICRU 62 and formulas presented by Stroom and Heijmen and Van Herk et al. were used to calculate the range 2·8–5·7 mm, 5·7–11·9 mm and 6·9–14·4 mm, respectively.Conclusion:According to our findings, it can be concluded that by extending the CTV margin by 6·9–14·4 mm, we can ensure that 90% of the pelvic cancer patients will receive ≥ 95% of the prescribed dose in the CTV area.
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19
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Fukao M, Okamura K, Sabu S, Akino Y, Arimura T, Inoue S, Kado R, Seo Y. Repositioning accuracy of a novel thermoplastic mask for head and neck cancer radiotherapy. Phys Med 2020; 74:92-99. [PMID: 32450542 DOI: 10.1016/j.ejmp.2020.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 03/05/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The aim of this study was to assess the reproducibility of patient shoulder position immobilized with a novel and innovative prototype mask (E-Frame, Engineering System). METHODS The E-frame mask fixes both shoulders and bisaxillary regions compared with that of a commercial mask (Type-S, CIVCO). Thirteen and twelve patients were immobilized with the Type-S and E-Frame mask systems, respectively. For each treatment fraction, cone-beam CT (CBCT) images of the patient were acquired and retrospectively analyzed. The CBCT images were registered to the planning CT based on the cervical spine, and then the displacements of the acromial extremity of the clavicle were measured. RESULTS The systematic and random errors between the two mask systems were evaluated. The differences of the systematic errors between the two mask systems were not statistically significant. The mean random errors in the three directions (AP, SI and LR) were 2.7 mm, 3.1 mm and 1.5 mm, respectively for the Type-S mask, and 2.8 mm 2.5 mm and 1.4 mm, respectively for the E-Frame mask. The random error of the E-Frame masks in the SI direction was significantly smaller than that of the Type-S. The number of cases showing displacements exceeding 10 mm in the SI direction for at least one fraction was eight (61% of 13 cases) and three (25% of 12 cases) for Type-S and E-Frame masks, respectively. CONCLUSIONS The E-Frame masks reduced the random displacements of patient's shoulders in the SI direction, effectively preventing large shoulder shifts that occurred frequently with Type-S masks.
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Affiliation(s)
- Mari Fukao
- Department of Medical Technology, Osaka University Hospital, 2-15, Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Keita Okamura
- Department of Medical Technology, Osaka University Hospital, 2-15, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shotaro Sabu
- Department of Medical Technology, Osaka University Hospital, 2-15, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yuichi Akino
- Oncology Center, Osaka University Hospital, 2-2 (D10), Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Takehiro Arimura
- Department of Medical Technology, Osaka University Hospital, 2-15, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shinichi Inoue
- Department of Medical Technology, Osaka University Hospital, 2-15, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Ryoko Kado
- Department of Nursing, Osaka University Hospital, 2-15, Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yuji Seo
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10), Yamadaoka, Suita, Osaka 565-0871, Japan
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20
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A comparative study between open-face and closed-face masks for head and neck cancer (HNC) in radiation therapy. Rep Pract Oncol Radiother 2020; 25:382-388. [PMID: 32322177 DOI: 10.1016/j.rpor.2020.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/09/2019] [Accepted: 03/12/2020] [Indexed: 11/20/2022] Open
Abstract
Aim To determine the setup reproducibility in the radiation treatment of Head and Neck (HN) patients using open face head and shoulder masks (OHSM) with customized headrest (CHR) versus standard closed head and shoulder masks (CHSM) and to determine the patient's level of comfort and satisfaction for both masks. Methods Forty patients were prospectively randomized into two groups using simple random sampling. Group 1 was assigned with CHSMs, immobilized with a standard HR (SHR) while Group 2 was assigned with OHSMs, and immobilized with CHR. Cone beam computed tomography (CBCT) was taken the first 3 days, followed by weekly CBCT (prior treatment) with results registered to the planning CT to determine translational and rotational inter-fraction shifts and to verify accuracy. Mean (M) and standard deviation (SD) of the systematic and random setup errors of the 2 arms in the translational and rotational directions were analyzed, using Independent t-test and Mann-Whitney U test. Patient comfort was measured using a Likert questionnaire. Results The vertical, lateral, longitudinal and Z/roll rotational shifts were not significantly different between the two masks. X/yaw and Y/pitch rotational shifts were significantly greater in Group 2 versus Group 1, for both systematic (p = 0.009 and 0.046, respectively) and random settings (p = 0.016 and 0.020) but still within three degrees. Patients reported higher neck and shoulder comfort (p = 0.020) and overall satisfaction (p = 0.026) using the OHSM with the CHR versus the CHSM with the SHR during CT simulation. Conclusion Open masks provide comparable yet comfortable immobilization to closed masks for HN radiotherapy.
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21
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Jiang P, Zhang X, Wei S, Zhao T, Wang J. Set-up error and dosimetric analysis of HexaPOD evo RT 6D couch combined with cone beam CT image-guided intensity-modulated radiotherapy for primary malignant tumor of the cervical spine. J Appl Clin Med Phys 2020; 21:22-30. [PMID: 32170991 PMCID: PMC7170283 DOI: 10.1002/acm2.12840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/28/2019] [Accepted: 01/28/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the set‐up error and consequent dosimetric change in HexaPOD evo RT 6D couch under image‐guided intensity‐modulated radiotherapy (IG‐IMRT) for primary malignant tumor of the cervical spine. Methods Ten cases with primary malignant tumor of the cervical spine were treated with intensity‐modulated radiotherapy (IMRT) in our hospital from August 2013 to November 2014. The X‐ray volumetric images (XVI) were scanned and obtained by cone‐beam CT (CBCT). The six directions (6D) of set‐up errors of translation and rotation were obtained by planned CT image registration. HexaPOD evo RT 6D couch made online correction of the set‐up error, and then the CBCT was conducted to obtain the residual error. Results We performed set‐up error and dosimetric analysis. First, for the set‐up error analysis, the average error in three translation directions of 6D set‐up error of the primary tumor of the cervical spine was <2 mm, whereas the single maximum error (absolute value) is 7.0 mm. Among average errors of rotation direction, Rotation X (RX) direction 0.67° ± 0.04°, Rotation Y (RY) direction 1.06° ± 0.06°, Rotation Z (RZ) direction 0.78° ± 0.05°; and the single maximum error in three rotation directions were 2.8°, 3.8°, and 2.9°, respectively. On three directions (X, Y, Z axis), the extended distance from clinical target volume (CTV) to planning target volume (PTV) was 3.45, 3.17, and 3.90 mm by calculating, respectively. Then, for the dosimetric analysis, the parameters, including plan sum PTV D98 and D95, planning gross tumor volume D98 and D95, V100% of the plan sum were significantly lower than the treatment plan. Moreover, Dmax of the spinal cord was significantly higher than the treatment plan. Conclusion 6D set‐up error correction system should be used for accurate position calibration of precise radiotherapy for patients with malignant tumor of the cervical spine.
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Affiliation(s)
- Ping Jiang
- Department of Radiation OncologyPeking University 3rd HospitalBeijing100191China
| | - Xile Zhang
- Department of Radiation OncologyPeking University 3rd HospitalBeijing100191China
| | - Shuhua Wei
- Department of Radiation OncologyPeking University 3rd HospitalBeijing100191China
| | - Tiandi Zhao
- Department of Radiation OncologyPeking University 3rd HospitalBeijing100191China
| | - Junjie Wang
- Department of Radiation OncologyPeking University 3rd HospitalBeijing100191China
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22
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Ricotti R, Pella A, Tagaste B, Elisei G, Fontana G, Bonora M, Ciocca M, Valvo F, Orecchia R, Baroni G. Long-time clinical experience in patient setup for several particle therapy clinical indications: management of patient positioning and evaluation of setup reproducibility and stability. Br J Radiol 2019; 93:20190595. [PMID: 31687833 DOI: 10.1259/bjr.20190595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Accurate patient positioning is crucial in particle therapy due to the geometrical selectivity of particles. We report and discuss the National Center for Oncological Hadrontherapy (CNAO) experience in positioning accuracy and stability achieved with solid thermoplastic masks fixed on index base plates and assessed by daily orthogonal X-ray imaging. METHODS Positioning data were retrospectively collected (between 2012 and 2018) and grouped according to the treated anatomical site. 19696 fractions of 1325 patients were evaluated.The study was designed to assess:(i) the number of fractions in which a single correction vector was applied(SCV);(ii) the number of fractions in which further setup verification was performed (SV);(iii) the number of fractions in which SV lead to an additional correction within (MCV<5min) or after (MCV>5min) 5 minutes from the first setup correction;(iv) the systematic (Σ) and random (σ) error components of the correction vectors applied. RESULTS A SCV was applied in 71.5% of fractions, otherwise SV was required. In 30.6% of fractions with SV, patient position was not further revised. In the remaining fractions, MCV<5min and MCV>5min were applied mainly in extracranial and cranial sites respectively.Interfraction Σ was ≤ 1.7 mm/0.7° and σ was ≤ 1.2 mm/0.6° in cranial sites while in extracranial sites Σ was ≤ 5.5 mm/0.9° and σ was ≤4.4 mm/0.9°. Setup residuals were submillimetric in all sites. In cranial patients, maximum intrafractional Σ was 0.8 mm/0.4°. CONCLUSION This report extensively quantifies inter- and intrafraction setup accuracy on an institutional basis and confirms the need of image guidance to fully benefit from the geometrical selectivity of particles. ADVANCES IN KNOWLEDGE The reported analysis provides a board institutional data set on the evaluation of patient immobilization and bony anatomy alignment for several particle therapy clinical indications.
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Affiliation(s)
- Rosalinda Ricotti
- Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Andrea Pella
- Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Barbara Tagaste
- Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Giovanni Elisei
- Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Giulia Fontana
- Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Maria Bonora
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Mario Ciocca
- Medical Physics Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Francesca Valvo
- Radiotherapy Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Roberto Orecchia
- CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.,European Institute of Oncology, Milan, Italy
| | - Guido Baroni
- Bioengineering Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano University, Milan, Italy
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Tanabe Y, Ishida T. Optimizing multiple acquisition planning CT for prostate cancer IMRT. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab0dc7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Tanabe Y, Ishida T, Eto H, Sera T, Emoto Y. Evaluation of the correlation between prostatic displacement and rectal deformation using the Dice similarity coefficient of the rectum. Med Dosim 2019; 44:e39-e43. [PMID: 30642696 DOI: 10.1016/j.meddos.2018.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/07/2018] [Accepted: 12/26/2018] [Indexed: 11/28/2022]
Abstract
To estimate the relationship between the three-dimensional (3D) displacement error of the prostate and rectal deformation for reduction of deviation between the planned and treatment dose, using multiple acquisition planning CT (MPCT) and the Dice similarity coefficient (DSC) for rectal deformation for treatment of patients with prostate cancer. The 3D displacement error between the pelvic bone and a matching fiducial marker was calculated using MPCT in 24 patients who underwent prostate volumetric-modulated arc therapy for prostate cancer. We calculated the 3D displacement error between the pelvic bone and a matching fiducial marker on MPCT. The correlation of the 3D displacement error with the DSC of the rectum, calculated from MPCT images, was evaluated based on deformable image registration. The 3D displacement error of the prostate showed a slight correlation between MPCT and cone-beam computed tomography (adjusted r2 = 0.241). The 3D displacement error, based on the pelvic bone and a fiducial marker on MPCT images, showed a moderate correlation with the DSC of the rectum (adjusted r2 = 0.645) and was improved by a mean of 3.94 mm, based on MPCT, during the treatment period. The 3D displacement error on MPCT correlates with the 3D displacement error of daily cone-beam computed tomography; optimal selection of MPCT can potentially facilitate on-board setup of prostate patients to enable more accurate radiotherapy. The advance information of the 3D displacement error and rectal deformation is useful for optimal planning CT that can minimize the deviation between the planned dose and the treatment dose in patients receiving treatment for prostate cancer.
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Affiliation(s)
- Yoshinori Tanabe
- Department of Radiology, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan; Division of Health Sciences, Graduate School of Medicine, Osaka University, Yamadaoka, Suita 565-0871, Japan
| | - Takayuki Ishida
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Yamadaoka, Suita 565-0871, Japan.
| | - Hidetoshi Eto
- Department of Radiology, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Tatsuhiro Sera
- Department of Radiology, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
| | - Yuki Emoto
- Department of Radiology, Yamaguchi University Hospital, Ube, Yamaguchi 755-8505, Japan
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Zhou Y, Yuan J, Wong OL, Fung WWK, Cheng KF, Cheung KY, Yu SK. Assessment of positional reproducibility in the head and neck on a 1.5-T MR simulator for an offline MR-guided radiotherapy solution. Quant Imaging Med Surg 2018; 8:925-935. [PMID: 30505721 DOI: 10.21037/qims.2018.10.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Recently, a shuttle-based offline magnetic resonance-guided radiotherapy (MRgRT) approach was proposed. This study aims to evaluate the positional reproducibility in the immobilized head and neck using a 1.5-T MR-simulator (MR-sim) on healthy volunteers. Methods A total of 159 scans of 14 healthy volunteers were conducted on a 1.5-T MR-sim with thermoplastic mask immobilization. MR images with isotropic 1.053 mm3 voxel size were rigidly registered to the first scan based on fiducial, anatomical and gross positions. Mean and standard deviation of positional displacements in translation and rotation were assessed. Systematic error and random errors of positioning in the head and neck on the MR-sim were determined in the translation of, and in the rotation of roll, pitch and yaw. Results The systematic error (Σ) of translation in left-right (LR), anterior-posterior (AP) and superior-inferior (SI) direction was 0.57, 0.22 and 0.26 mm for fiducial displacement, 0.28, 0.10 and 0.52 mm for anatomical displacement, and 0.53, 0.22 and 0.49 mm for gross displacement, respectively. The random error (σ) in corresponding translation direction was 2.07, 0.54 and 1.32 mm for fiducial displacement, 1.34, 0.73 and 2.04 mm for anatomical displacement, and 2.24, 0.86 and 2.61 mm for gross displacement. The systematic error and random error of rotation were generally smaller than 1°. Conclusions Our results suggested that high gross positional reproducibility (<1 mm translational and <1° rotational systematic error) could be achieved on an MR-sim for the proposed offline MRgRT.
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Affiliation(s)
- Yihang Zhou
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Jing Yuan
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Oi Lei Wong
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Winky Wing Ki Fung
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Ka Fai Cheng
- Department of Radiotherapy, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Kin Yin Cheung
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
| | - Siu Ki Yu
- Medical Physics and Research Department, Hong Kong Sanatorium & Hospital, Hong Kong, China
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Carminucci A, Nie K, Weiner J, Hargreaves E, Danish SF. Assessment of motion error for frame-based and noninvasive mask-based fixation using the Leksell Gamma Knife Icon radiosurgery system. J Neurosurg 2018; 129:133-139. [DOI: 10.3171/2018.7.gks181516] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe Leksell Gamma Knife Icon (GK Icon) radiosurgery system can utilize cone-beam computed tomography (CBCT) to evaluate motion error. This study compares the accuracy of frame-based and frameless mask-based fixation using the Icon system.METHODSA retrospective cohort study was conducted to evaluate patients who had undergone radiosurgery with the GK Icon system between June and December 2017. Patients were immobilized in either a stereotactic head frame or a noninvasive thermoplastic mask with stereotactic infrared (IR) camera monitoring. Setup error was defined as displacement of the skull in the stereotactic space upon setup as noted on pretreatment CBCT compared to its position in the stereotactic space defined by planning MRI for frame patients and defined as skull displacement on planning CBCT compared to its position on pretreatment CBCT for mask patients. For frame patients, the intrafractionation motion was measured by comparing pretreatment and posttreatment CBCT. For mask patients, the intrafractionation motion was evaluated by comparing pretreatment CBCT and additional CBCT obtained during the treatment. The translational and rotational errors were recorded.RESULTSData were collected from 77 patients undergoing SRS with the GK Icon. Sixty-four patients underwent frame fixation, with pre- and posttreatment CBCT studies obtained. Thirteen patients were treated using mask fixation to deliver a total of 33 treatment fractions. Mean setup and intrafraction translational and rotation errors were small for both fixation systems, within 1 mm and 1° in all axes. Yet mask fixation demonstrated significantly larger intrafraction errors than frame fixation. Also, there was greater variability in both setup and intrafraction errors for mask fixation than for frame fixation in all translational and rotational directions. Whether the GK treatment was for metastasis or nonmetastasis did not influence motion uncertainties between the two fixation types. Additionally, monitoring IR-based intrafraction motion for mask fixation—i.e., the number of treatment stoppages due to reaching the IR displacement threshold—correlated with increasing treatment time.CONCLUSIONSCompared to frame-based fixation, mask-based fixation demonstrated larger motion variations. The variability in motion error associated with mask fixation must be taken into account when planning for small lesions or lesions near critical structures.
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Affiliation(s)
| | - Ke Nie
- 2Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Joseph Weiner
- 2Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Eric Hargreaves
- 1Department of Neurological Surgery, Rutgers University; and
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Impact of shoulder deformation on volumetric modulated arc therapy doses for head and neck cancer. Phys Med 2018; 53:118-128. [PMID: 30241746 DOI: 10.1016/j.ejmp.2018.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 07/13/2018] [Accepted: 08/13/2018] [Indexed: 11/20/2022] Open
Abstract
PURPOSE When using volumetric modulated arc therapy (VMAT) for head and neck cancer, setup errors regarding the shoulders can create loss of target coverage or increased organ-at-risk doses. This study created variations of realistic shoulder deformations to understand the associated VMAT dosimetric effects and investigated water-equivalent thickness (WET) differences using in-house software. METHODS Ten patients with head and neck cancer with lower neck involvement were retrospectively and randomly enrolled. Their retrospective analysis comprised treatment planning using RayStation 5.0 (RaySearch Laboratories, Stockholm, Sweden), shoulder deformation of 5-15 mm in three-dimensional axes using the ImSimQA package (Oncology Systems Limited, Shrewsbury, Shropshire, UK), and evaluation of the clinical impact of the dose distribution after recalculating the dose distribution using computed tomography images of deformed shoulders and deforming the dose distribution. Additionally, our in-house software program was used to measure WET differences for shoulder deformation. RESULTS WET differences were greater in the superoinferior (SI) direction than in the other directions (the WET difference was >20 mm for 15-mm SI deformation). D99%, D98%, and D95% for all clinical target volumes were within 3%. Local dose differences of more than ±10% were found for normal tissues at the level of the shoulder for 15-mm movement in the SI direction. CONCLUSIONS Shoulder deformation of >6 mm could cause large dose variations delivered to the targeted tissue at the level of the shoulder. Thus, to ensure delivery of appropriate treatment coverage to the targeted tissue, shoulder deformation should be taken into consideration during the planning stage.
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Divneet M, Quoc-Anh H, Betsy W, Gia J, Denise R, Christopher W, Yi SK. Comparison of two thermoplastic immobilization mask systems in daily volumetric image guided radiation therapy for head and neck cancers. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aad574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Udayashankar AH, Noorjahan S, Srikantia N, Babu KR, Muzumder S. Immobilization versus no immobilization for pelvic external beam radiotherapy. Rep Pract Oncol Radiother 2018; 23:233-241. [PMID: 29991927 DOI: 10.1016/j.rpor.2018.04.007] [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: 09/07/2017] [Revised: 12/23/2017] [Accepted: 04/12/2018] [Indexed: 10/16/2022] Open
Abstract
Aim To identify the most reproducible technique of patient positioning and immobilization during pelvic radiotherapy. Background Radiotherapy plays an important role in the treatment of pelvic malignancies. Errors in positioning of patient are an integral component of treatment. The present study compares two methods of immobilization with no immobilization with an aim of identifying the most reproducible method. Materials and methods 65 consecutive patients receiving pelvic external beam radiotherapy were retrospectively analyzed. 30, 21 and 14 patients were treated with no-immobilization with a leg separator, whole body vacuum bag cushion (VBC) and six point aquaplast immobilization system, respectively. The systematic error, random error and the planning target volume (PTV) margins were calculated for all the three techniques and statistically analyzed. Results The systematic errors were the highest in the VBC and random errors were the highest in the aquaplast group. Both systematic and random errors were the lowest in patients treated with no-immobilization. 3D Systematic error (mm, mean ± 1SD) was 4.31 ± 3.84, 3.39 ± 1.71 and 2.42 ± 0.97 for VBC, aquaplast and no-immobilization, respectively. 3D random error (mm, 1SD) was 2.96, 3.59 and 1.39 for VBC, aquaplast and no-immobilization, respectively. The differences were statistically significant between all the three groups. The calculated PTV margins were the smallest for the no-immobilization technique with 4.56, 4.69 and 4.59 mm, respectively, in x, y and z axes, respectively. Conclusions Among the three techniques, no-immobilization technique with leg separator was the most reproducible technique with the smallest PTV margins. For obvious reasons, this technique is the least time consuming and most economically viable in developing countries.
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Affiliation(s)
- Avinash H Udayashankar
- Department of Radiation Oncology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Sarjapur Road, Bangalore 560034, India
| | - Shibina Noorjahan
- Department of Radiation Oncology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Sarjapur Road, Bangalore 560034, India
| | - Nirmala Srikantia
- Department of Radiation Oncology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Sarjapur Road, Bangalore 560034, India
| | - K Ravindra Babu
- Department of Radiation Oncology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Sarjapur Road, Bangalore 560034, India
| | - Sandeep Muzumder
- Department of Radiation Oncology, St John's Medical College Hospital, St John's National Academy of Health Sciences, Sarjapur Road, Bangalore 560034, India
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Lewis BC, Snyder WJ, Kim S, Kim T. Monitoring frequency of intra-fraction patient motion using the ExacTrac system for LINAC-based SRS treatments. J Appl Clin Med Phys 2018; 19:58-63. [PMID: 29577592 PMCID: PMC5978384 DOI: 10.1002/acm2.12279] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/23/2017] [Accepted: 01/02/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose The aim of this study was to investigate the intra‐fractional patient motion using the ExacTrac system in LINAC‐based stereotactic radiosurgery (SRS). Method A retrospective analysis of 104 SRS patients with kilovoltage image‐guided setup (Brainlab ExacTrac) data was performed. Each patient was imaged pre‐treatment, and at two time points during treatment (1st and 2nd mid‐treatment), and bony anatomy of the skull was used to establish setup error at each time point. The datasets included the translational and rotational setup error, as well as the time period between image acquisitions. After each image acquisition, the patient was repositioned using the calculated shift to correct the setup error. Only translational errors were corrected due to the absence of a 6D treatment table. Setup time and directional shift values were analyzed to determine correlation between shift magnitudes as well as time between acquisitions. Results The average magnitude translation was 0.64 ± 0.59 mm, 0.79 ± 0.45 mm, and 0.65 ± 0.35 mm for the pre‐treatment, 1st mid‐treatment, and 2nd mid‐treatment imaging time points. The average time from pre‐treatment image acquisition to 1st mid‐treatment image acquisition was 7.98 ± 0.45 min, from 1st to 2nd mid‐treatment image was 4.87 ± 1.96 min. The greatest translation was 3.64 mm, occurring in the pre‐treatment image. No patient had a 1st or 2nd mid‐treatment image with greater than 2 mm magnitude shifts. Conclusion There was no correlation between patient motion over time, in direction or magnitude, and duration of treatment. The imaging frequency could be reduced to decrease imaging dose and treatment time without significant changes in patient position.
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Affiliation(s)
- Benjamin C Lewis
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - William J Snyder
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Siyong Kim
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Taeho Kim
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
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Gurney-Champion OJ, McQuaid D, Dunlop A, Wong KH, Welsh LC, Riddell AM, Koh DM, Oelfke U, Leach MO, Nutting CM, Bhide SA, Harrington KJ, Panek R, Newbold KL. MRI-based Assessment of 3D Intrafractional Motion of Head and Neck Cancer for Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 100:306-316. [PMID: 29229323 PMCID: PMC5777665 DOI: 10.1016/j.ijrobp.2017.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/14/2017] [Accepted: 10/03/2017] [Indexed: 01/25/2023]
Abstract
PURPOSE To determine the 3-dimensional (3D) intrafractional motion of head and neck squamous cell carcinoma (HNSCC). METHODS AND MATERIALS Dynamic contrast-enhanced magnetic resonance images from 56 patients with HNSCC in the treatment position were analyzed. Dynamic contrast-enhanced magnetic resonance imaging consisted of 3D images acquired every 2.9 seconds for 4 minutes 50 seconds. Intrafractional tumor motion was studied in the 3 minutes 43 seconds of images obtained after initial contrast enhancement. To assess tumor motion, rigid registration (translations only) was performed using a region of interest (ROI) mask around the tumor. The results were compared with bulk body motion from registration to all voxels. Motion was split into systematic motion and random motion. Correlations between the tumor site and random motion were tested. The within-subject coefficient of variation was determined from 8 patients with repeated baseline measures. Random motion was also assessed at the end of the first week (38 patients) and second week (25 patients) of radiation therapy to investigate trends of motion. RESULTS Tumors showed irregular occasional rapid motion (eg, swallowing or coughing), periodic intermediate motion (respiration), and slower systematic drifts throughout treatment. For 95% of the patients, displacements due to systematic and random motion were <1.4 mm and <2.1 mm, respectively, 95% of the time. The motion without an ROI mask was significantly (P<.0001, Wilcoxon signed rank test) less than the motion with an ROI mask, indicating that tumors can move independently from the bony anatomy. Tumor motion was significantly (P=.005, Mann-Whitney U test) larger in the hypopharynx and larynx than in the oropharynx. The within-subject coefficient of variation for random motion was 0.33. The average random tumor motion did not increase notably during the first 2 weeks of treatment. CONCLUSIONS The 3D intrafractional tumor motion of HNSCC is small, with systematic motion <1.4 mm and random motion <2.1 mm 95% of the time.
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Affiliation(s)
- Oliver J Gurney-Champion
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
| | - Dualta McQuaid
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Alex Dunlop
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Kee H Wong
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Liam C Welsh
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Angela M Riddell
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Dow-Mu Koh
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Uwe Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Martin O Leach
- CR UK Cancer Imaging Centre, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Christopher M Nutting
- Joint Department of Radiotherapy, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Shreerang A Bhide
- Joint Department of Radiotherapy, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Kevin J Harrington
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Rafal Panek
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kate L Newbold
- Department of Clinical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
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Dincoglan F, Beyzadeoglu M, Sager O, Oysul K, Sirin S, Surenkok S, Gamsiz H, Uysal B, Demiral S, Dirican B. Image-Guided Positioning in Intracranial Non-Invasive Stereotactic Radiosurgery for the Treatment of Brain Metastasis. TUMORI JOURNAL 2018; 98:630-5. [DOI: 10.1177/030089161209800514] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aims and background The aim of the study was to examine the feasibility of non-invasive image-guided radiosurgery to improve patient comfort and quality of life in stereotactic radiosurgery planning and treatment of patients with brain metastasis. Precise immobilization is a rule of thumb for stereotactic radiosurgery. Non-invasive immobilization techniques have the potential of improved quality of life compared with invasive procedures. Methods and study design A total of 92 lesions from 42 patients with brain metastasis were included in the study. After immobilization with a thermoplastic mask and a bite-block unlike the invasive frame-based procedure, planning computed tomography images were acquired and fused with magnetic resonance images. After contouring, intensity-modulated stereotactic radiosurgery (IM-SRS) planning was done, and the patients were re-immobilized on the treatment couch for the therapy procedures. While patients were on the treatment couch, kilovoltage-cone beam computed tomography images were acquired to determine setup errors and achieve on-line correction and then repeated after on-line correction to confirm precise tumor localization. The patients then underwent single-fraction definitive treatment. Results For the 92 lesions treated, mean ± SD values of translational setup corrections in X (lateral), Y (longitudinal), and Z (vertical) dimensions were 0.7 ± 0.7 mm, 0.8 ± 0.7 mm, and 0.6 ± 0.5 mm, and rotational set-up corrections were 0.5 ± 1.1°, 0.06 ± 1.1°, and -0.1 ± 1.1° in X (pitch), Y (roll), and Z (yaw), respectively. The mean three-dimensional correction vector was 1.2 ± 1.1 mm. Conclusions Non-invasive image-guided radiosurgery for brain metastasis is feasible, and the non-invasive treatment approach can be routinely used in clinical practice to improve patientís quality of life.
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Affiliation(s)
- Ferrat Dincoglan
- Radiation Oncology Department, Gulhane Military Faculty of Medicine, Ankara, Turkey
| | - Murat Beyzadeoglu
- Radiation Oncology Department, Gulhane Military Faculty of Medicine, Ankara, Turkey
| | - Omer Sager
- Radiation Oncology Department, Gulhane Military Faculty of Medicine, Ankara, Turkey
| | - Kaan Oysul
- Radiation Oncology Department, Gulhane Military Faculty of Medicine, Ankara, Turkey
| | - Sait Sirin
- Neurosurgery Department, Gulhane Military Faculty of Medicine, Ankara, Turkey
| | - Serdar Surenkok
- Radiation Oncology Department, Gulhane Military Faculty of Medicine, Ankara, Turkey
| | - Hakan Gamsiz
- Radiation Oncology Department, Gulhane Military Faculty of Medicine, Ankara, Turkey
| | - Bora Uysal
- Radiation Oncology Department, Gulhane Military Faculty of Medicine, Ankara, Turkey
| | - Selcuk Demiral
- Radiation Oncology Department, Gulhane Military Faculty of Medicine, Ankara, Turkey
| | - Bahar Dirican
- Radiation Oncology Department, Gulhane Military Faculty of Medicine, Ankara, Turkey
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Zhang J, Chen Y, Chen Y, Wang C, Cai J, Chu K, Jin J, Ge Y, Huang X, Guan Y, Li W. A Noninvasive Body Setup Method for Radiotherapy by Using a Multimodal Image Fusion Technique. Technol Cancer Res Treat 2018; 16:1187-1193. [PMID: 29333959 PMCID: PMC5762088 DOI: 10.1177/1533034617740302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose: To minimize the mismatch error between patient surface and immobilization system for tumor location by a noninvasive patient setup method. Materials and Methods: The method, based on a point set registration, proposes a shift for patient positioning by integrating information of the computed tomography scans and that of optical surface landmarks. An evaluation of the method included 3 areas: (1) a validation on a phantom by estimating 100 known mismatch errors between patient surface and immobilization system. (2) Five patients with pelvic tumors were considered. The tumor location errors of the method were measured using the difference between the proposal shift of cone-beam computed tomography and that of our method. (3) The collected setup data from the evaluation of patients were compared with the published performance data of other 2 similar systems. Results: The phantom verification results showed that the method was capable of estimating mismatch error between patient surface and immobilization system in a precision of <0.22 mm. For the pelvic tumor, the method had an average tumor location error of 1.303, 2.602, and 1.684 mm in left–right, anterior–posterior, and superior–inferior directions, respectively. The performance comparison with other 2 similar systems suggested that the method had a better positioning accuracy for pelvic tumor location. Conclusion: By effectively decreasing an interfraction uncertainty source (mismatch error between patient surface and immobilization system) in radiotherapy, the method can improve patient positioning precision for pelvic tumor.
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Affiliation(s)
- Jie Zhang
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Ying Chen
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Yunxia Chen
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Chenchen Wang
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Jing Cai
- 2 Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Kaiyue Chu
- 2 Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Jianhua Jin
- 2 Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Yun Ge
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Xiaolin Huang
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Yue Guan
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Weifeng Li
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
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Haefner MF, Giesel FL, Mattke M, Rath D, Wade M, Kuypers J, Preuss A, Kauczor HU, Schenk JP, Debus J, Sterzing F, Unterhinninghofen R. 3D-Printed masks as a new approach for immobilization in radiotherapy - a study of positioning accuracy. Oncotarget 2018; 9:6490-6498. [PMID: 29464087 PMCID: PMC5814227 DOI: 10.18632/oncotarget.24032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 01/02/2018] [Indexed: 11/25/2022] Open
Abstract
We developed a new approach to produce individual immobilization devices for the head based on MRI data and 3D printing technologies. The purpose of this study was to determine positioning accuracy with healthy volunteers. 3D MRI data of the head were acquired for 8 volunteers. In-house developed software processed the image data to generate a surface mesh model of the immobilization mask. After adding an interface for the couch, the fixation setup was materialized using a 3D printer with acrylonitrile butadiene styrene (ABS). Repeated MRI datasets (n=10) were acquired for all volunteers wearing their masks thus simulating a setup for multiple fractions. Using automatic image-to-image registration, displacements of the head were calculated relative to the first dataset (6 degrees of freedom). The production process has been described in detail. The absolute lateral (x), vertical (y) and longitudinal (z) translations ranged between −0.7 and 0.5 mm, −1.8 and 1.4 mm, and −1.6 and 2.4 mm, respectively. The absolute rotations for pitch (x), yaw (y) and roll (z) ranged between −0.9 and 0.8°, −0.5 and 1.1°, and −0.6 and 0.8°, respectively. The mean 3D displacement was 0.9 mm with a standard deviation (SD) of the systematic and random error of 0.2 mm and 0.5 mm, respectively. In conclusion, an almost entirely automated production process of 3D printed immobilization masks for the head derived from MRI data was established. A high level of setup accuracy was demonstrated in a volunteer cohort. Future research will have to focus on workflow optimization and clinical evaluation.
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Affiliation(s)
- Matthias Felix Haefner
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Frederik Lars Giesel
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Matthias Mattke
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Daniel Rath
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Moritz Wade
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany.,Institute of Antropomatics and Robotics, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany
| | - Jacob Kuypers
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany.,Institute of Antropomatics and Robotics, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany
| | - Alan Preuss
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany.,Institute of Antropomatics and Robotics, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Jens-Peter Schenk
- Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Juergen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany.,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany
| | - Florian Sterzing
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), 69120 Heidelberg, Germany.,Department of Radiation Oncology Kempten, 87439 Kempten, Germany
| | - Roland Unterhinninghofen
- Institute of Antropomatics and Robotics, Karlsruhe Institute of Technology (KIT), 76131 Karlsruhe, Germany.,Institute of Robotics and Mechatronics, German Aerospace Center, 82234 Oberpfaffenhofen-Weßling, Germany
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Lee AW, Ng WT, Pan JJ, Poh SS, Ahn YC, AlHussain H, Corry J, Grau C, Grégoire V, Harrington KJ, Hu CS, Kwong DL, Langendijk JA, Le QT, Lee NY, Lin JC, Lu TX, Mendenhall WM, O'Sullivan B, Ozyar E, Peters LJ, Rosenthal DI, Soong YL, Tao Y, Yom SS, Wee JT. International guideline for the delineation of the clinical target volumes (CTV) for nasopharyngeal carcinoma. Radiother Oncol 2018; 126:25-36. [DOI: 10.1016/j.radonc.2017.10.032] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 10/25/2017] [Accepted: 10/25/2017] [Indexed: 12/09/2022]
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Goldsworthy S, Leslie-Dakers M, Higgins S, Barnes T, Jankowska P, Dogramadzi S, Latour JM. A Pilot Study Evaluating the Effectiveness of Dual-Registration Image-Guided Radiotherapy in Patients with Oropharyngeal Cancer. J Med Imaging Radiat Sci 2017; 48:377-384. [PMID: 31047473 DOI: 10.1016/j.jmir.2017.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the article was to determine the impact of Dual Registration (DR) image-guided radiotherapy (IGRT) on clinical judgement and treatment delivery for patients with oropharyngeal cancer before implementation. METHODS Ninety cone beam computed tomography images from 10 retrospective patients were matched using standard clipbox registration (SCR) and DR. Three IGRT specialist radiographers performed all registrations and evaluated by intraclass correlation to determine inter-rater agreement, Bland-Altman with 95% limits of agreement to determine differences between SCR and DR procedures, changes in clinical judgment, time taken to perform registrations, and radiographer satisfaction. RESULTS Inter-rater agreement between radiographers using both SCR and DR was high (0.867 and 0.917, P ≤ .0001). The 95% limits of agreement between SCR and DR procedures in the mediolateral, cranial-caudal, and ventrodorsal translational directions were -6.40 to +4.91, -7.49 to +6.05, and -7.00 to +5.44 mm, respectively. The mediolateral direction demonstrated significant proportional bias (P ≤ .001) suggesting non-agreement between SCR and DR. Eighty percent of DR matches resulted in a change in clinical judgement to ensure maximum target coverage. Mean registration times for SCR and DR were 94 and 115 seconds, respectively, and radiographers found DR feasible and satisfactory. CONCLUSION The standard method using SCR in patients with oropharyngeal cancer underestimates the deviation in the lower neck. In these patients, DR is an effective IGRT tool to ensure target coverage of the inferior neck nodes and has demonstrated acceptability to radiotherapy clinical practice.
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Affiliation(s)
- Simon Goldsworthy
- Radiotherapy, Beacon Centre, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
| | - Marcus Leslie-Dakers
- Radiotherapy, Beacon Centre, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Steven Higgins
- Radiotherapy, Beacon Centre, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Terri Barnes
- Radiotherapy, Beacon Centre, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Petra Jankowska
- Radiotherapy, Beacon Centre, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Sanja Dogramadzi
- Bristol Robotics laboratory, University of the West of England, Bristol, UK
| | - Jos M Latour
- Clinical School, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK; School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
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Denton TR, Shields LB, Howe JN, Shanks TS, Spalding AC. Practical considerations of linear accelerator-based frameless extracranial radiosurgery for treatment of occipital neuralgia for nonsurgical candidates. J Appl Clin Med Phys 2017; 18:123-132. [PMID: 28517492 PMCID: PMC5874950 DOI: 10.1002/acm2.12105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/02/2017] [Accepted: 04/10/2017] [Indexed: 12/31/2022] Open
Abstract
Occipital neuralgia generally responds to medical or invasive procedures. Repeated invasive procedures generate increasing complications and are often contraindicated. Stereotactic radiosurgery (SRS) has not been reported as a treatment option largely due to the extracranial nature of the target as opposed to the similar, more established trigeminal neuralgia. A dedicated phantom study was conducted to determine the optimum imaging studies, fusion matrices, and treatment planning parameters to target the C2 dorsal root ganglion which forms the occipital nerve. The conditions created from the phantom were applied to a patient with medically and surgically refractory occipital neuralgia. A dose of 80 Gy in one fraction was prescribed to the C2 occipital dorsal root ganglion. The phantom study resulted in a treatment achieved with an average translational magnitude of correction of 1.35 mm with an acceptable tolerance of 0.5 mm and an average rotational magnitude of correction of 0.4° with an acceptable tolerance of 1.0°. For the patient, the spinal cord was 12.0 mm at its closest distance to the isocenter and received a maximum dose of 3.36 Gy, a dose to 0.35 cc of 1.84 Gy, and a dose to 1.2 cc of 0.79 Gy. The brain maximum dose was 2.20 Gy. Treatment time was 59 min for 18, 323 MUs. Imaging was performed prior to each arc delivery resulting in 21 imaging sessions. The average deviation magnitude requiring a positional or rotational correction was 0.96 ± 0.25 mm, 0.8 ± 0.41°, whereas the average deviation magnitude deemed within tolerance was 0.41 ± 0.12 mm, 0.57 ± 0.28°. Dedicated quality assurance of the treatment planning and delivery is necessary for safe and accurate SRS to the cervical spine dorsal root ganglion. With additional prospective study, linear accelerator-based frameless radiosurgery can provide an accurate, noninvasive alternative for treating occipital neuralgia where an invasive procedure is contraindicated.
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Affiliation(s)
- Travis R. Denton
- The Norton Cancer Institute Radiation CenterNorton HealthcareLouisvilleKYUSA
- Associates in Medical PhysicsLLCGreenbeltMDUSA
| | - Lisa B.E. Shields
- The Norton Cancer Institute Radiation CenterNorton HealthcareLouisvilleKYUSA
- Norton Neuroscience InstituteLouisvilleKYUSA
- The Brain Tumor CenterNorton HealthcareLouisvilleKYUSA
| | - Jonathan N. Howe
- The Norton Cancer Institute Radiation CenterNorton HealthcareLouisvilleKYUSA
- Associates in Medical PhysicsLLCGreenbeltMDUSA
| | - Todd S. Shanks
- The Norton Cancer Institute Radiation CenterNorton HealthcareLouisvilleKYUSA
- Norton Neuroscience InstituteLouisvilleKYUSA
- The Brain Tumor CenterNorton HealthcareLouisvilleKYUSA
| | - Aaron C. Spalding
- The Norton Cancer Institute Radiation CenterNorton HealthcareLouisvilleKYUSA
- Norton Neuroscience InstituteLouisvilleKYUSA
- The Brain Tumor CenterNorton HealthcareLouisvilleKYUSA
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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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Lin CG, Xu SK, Yao WY, Wu YQ, Fang JL, Wu VWC. Comparison of set up accuracy among three common immobilisation systems for intensity modulated radiotherapy of nasopharyngeal carcinoma patients. J Med Radiat Sci 2016; 64:106-113. [PMID: 27741377 PMCID: PMC5454330 DOI: 10.1002/jmrs.189] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 07/20/2016] [Accepted: 07/22/2016] [Indexed: 12/25/2022] Open
Abstract
Introduction In intensity modulated radiotherapy (IMRT) of nasopharyngeal carcinoma (NPC) patients, an effective immobilisation system is important to minimise set up deviation. This study evaluated the effectiveness of three immobilisation systems by assessing their set up deviations. Methods Patients were randomly assigned to one of the three immobilisation systems: (1) supine on head rest and base plate (HB); (2) supine with alpha cradle supporting the head and shoulder (AC); (3) supine with vacuum bag supporting the head and shoulder (VB). CBCT was conducted weekly for each patient on the linear accelerator. Image registration was conducted at the nasopharynx (NP) and cervical regions. The translational displacements (latero‐medial, antero‐posterior and cranio‐caudal), rotational displacements (pitch, yaw and roll) and 3D vectors obtained at the NP and cervical regions were recorded and compared among the three systems. Results The mean translational and rotational deviations were within 3 mm and 2°, respectively, and the range of 3D vector was 1.53–3.47 mm. At the NP region, the AC system demonstrated the smallest translational and rotational deviations and 3D vector. The differences were significant except for the latero‐medial, yaw and roll directions. Similarly, at the cervical region, the AC system showed smaller translational and rotational deviations and 3D vector, with only the cranio‐caudal and yaw deviations that did not reach statistical significance. Conclusions Set up deviation was greater in the neck than the NP region. The set up accuracy of the AC system was better than the other two systems, and it is recommended for IMRT of NPC patients in our institution.
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Affiliation(s)
- Cheng-Guang Lin
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Sen-Kui Xu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Wen-Yan Yao
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yu-Qi Wu
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jian-Lan Fang
- State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Vincent W C Wu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Lapeyre M, Biau J, Racadot S, Moreira J, Berger L, Peiffert D. Radiothérapie des cancers de la cavité buccale. Cancer Radiother 2016; 20 Suppl:S116-25. [DOI: 10.1016/j.canrad.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Oh SA, Yea JW, Kang MK, Park JW, Kim SK. Analysis of the Setup Uncertainty and Margin of the Daily ExacTrac 6D Image Guide System for Patients with Brain Tumors. PLoS One 2016; 11:e0151709. [PMID: 27019082 PMCID: PMC4809593 DOI: 10.1371/journal.pone.0151709] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/02/2016] [Indexed: 12/25/2022] Open
Abstract
This study evaluated the setup uncertainties for brain sites when using BrainLAB's ExacTrac X-ray 6D system for daily pretreatment to determine the optimal planning target volume (PTV) margin. Between August 2012 and April 2015, 28 patients with brain tumors were treated by daily image-guided radiotherapy using the BrainLAB ExacTrac 6D image guidance system of the Novalis-Tx linear accelerator. DUONTM (Orfit Industries, Wijnegem, Belgium) masks were used to fix the head. The radiotherapy was fractionated into 27-33 treatments. In total, 844 image verifications were performed for 28 patients and used for the analysis. The setup corrections along with the systematic and random errors were analyzed for six degrees of freedom in the translational (lateral, longitudinal, and vertical) and rotational (pitch, roll, and yaw) dimensions. Optimal PTV margins were calculated based on van Herk et al.'s [margin recipe = 2.5∑ + 0.7σ - 3 mm] and Stroom et al.'s [margin recipe = 2∑ + 0.7σ] formulas. The systematic errors (∑) were 0.72, 1.57, and 0.97 mm in the lateral, longitudinal, and vertical translational dimensions, respectively, and 0.72°, 0.87°, and 0.83° in the pitch, roll, and yaw rotational dimensions, respectively. The random errors (σ) were 0.31, 0.46, and 0.54 mm in the lateral, longitudinal, and vertical rotational dimensions, respectively, and 0.28°, 0.24°, and 0.31° in the pitch, roll, and yaw rotational dimensions, respectively. According to van Herk et al.'s and Stroom et al.'s recipes, the recommended lateral PTV margins were 0.97 and 1.66 mm, respectively; the longitudinal margins were 1.26 and 3.47 mm, respectively; and the vertical margins were 0.21 and 2.31 mm, respectively. Therefore, daily setup verifications using the BrainLAB ExacTrac 6D image guide system are very useful for evaluating the setup uncertainties and determining the setup margin.
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Affiliation(s)
- Se An Oh
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
| | - Ji Woon Yea
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Min Kyu Kang
- Department of Radiation Oncology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae Won Park
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
| | - Sung Kyu Kim
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
- * E-mail:
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Henriques de Figueiredo B, Petit A, Sargos P, Kantor G, Pouypoudat C, Saut O, Zacharatou C, Antoine M. Radiothérapie adaptative en routine : point de vue de l’oncologue radiothérapeute. Cancer Radiother 2015; 19:446-9. [DOI: 10.1016/j.canrad.2015.06.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 10/23/2022]
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MRI integration into treatment planning of head and neck tumors: Can patient immobilization be avoided? Radiother Oncol 2015; 115:191-4. [DOI: 10.1016/j.radonc.2015.03.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 03/03/2015] [Accepted: 03/17/2015] [Indexed: 11/22/2022]
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Hansen KS, Théon AP, Dieterich S, Kent MS. VALIDATION OF AN INDEXED RADIOTHERAPY HEAD POSITIONING DEVICE FOR USE IN DOGS AND CATS. Vet Radiol Ultrasound 2015; 56:448-55. [DOI: 10.1111/vru.12257] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 01/15/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Katherine S. Hansen
- Department of Surgical and Radiological Sciences; VM: Surgery Radiology, University of California; Davis CA USA 95616
| | - Alain P. Théon
- Department of Surgical and Radiological Sciences; VM: Surgery Radiology, University of California; Davis CA USA 95616
| | - Sonja Dieterich
- UC Davis Comprehensive Cancer Center; Radiation Oncology; Sacramento CA USA
| | - Michael S. Kent
- Department of Surgical and Radiological Sciences; VM: Surgery Radiology, University of California; Davis CA USA 95616
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de Kruijf WJM, Martens RJW. Reducing patient posture variability using the predicted couch position. Med Dosim 2015; 40:218-21. [PMID: 25619554 DOI: 10.1016/j.meddos.2014.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/23/2014] [Accepted: 12/07/2014] [Indexed: 11/28/2022]
Abstract
A method is presented in which the couch position is predicted before the treatment instead of obtaining a reference position at the first treatment fraction. This prevents systematic differences in patient posture between preparation and treatment. In literature, only limited data are available on couch positioning. We position our patients at the planned couch position, allowing a small difference between skin marks and lasers, followed by online imaging. For a 3-month period, our standard deviations (mm) in couch position in the vertical, longitudinal, and lateral directions were head and neck-1.6, 2.8, and 2.5; thorax-2.9, 5.5, and 4.5; breast-3.0, 4.1, and 4.0; and pelvis-3.5, 4.0, and 4.7, respectively. We have improved the reproducibility of patient posture in our institute by using the predicted couch position. Our data may serve as a reference for other institutes because the couch position variation is less than that published in literature.
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Towards the production of radiotherapy treatment shells on 3D printers using data derived from DICOM CT and MRI: preclinical feasibility studies. JOURNAL OF RADIOTHERAPY IN PRACTICE 2014. [DOI: 10.1017/s1460396914000326] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:Immobilisation for patients undergoing brain or head and neck radiotherapy is achieved using perspex or thermoplastic devices that require direct moulding to patient anatomy. The mould room visit can be distressing for patients and the shells do not always fit perfectly. In addition the mould room process can be time consuming. With recent developments in three-dimensional (3D) printing technologies comes the potential to generate a treatment shell directly from a computer model of a patient. Typically, a patient requiring radiotherapy treatment will have had a computed tomography (CT) scan and if a computer model of a shell could be obtained directly from the CT data it would reduce patient distress, reduce visits, obtain a close fitting shell and possibly enable the patient to start their radiotherapy treatment more quickly.Purpose:This paper focuses on the first stage of generating the front part of the shell and investigates the dosimetric properties of the materials to show the feasibility of 3D printer materials for the production of a radiotherapy treatment shell.Materials and methods:Computer algorithms are used to segment the surface of the patient’s head from CT and MRI datasets. After segmentation approaches are used to construct a 3D model suitable for printing on a 3D printer. To ensure that 3D printing is feasible the properties of a set of 3D printing materials are tested.Conclusions:The majority of the possible candidate 3D printing materials tested result in very similar attenuation of a therapeutic radiotherapy beam as the Orfit soft-drape masks currently in use in many UK radiotherapy centres. The costs involved in 3D printing are reducing and the applications to medicine are becoming more widely adopted. In this paper we show that 3D printing of bespoke radiotherapy masks is feasible and warrants further investigation.
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Cacicedo J, Perez JF, Ortiz de Zarate R, del Hoyo O, Casquero F, Gómez-Iturriaga A, Lasso A, Boveda E, Bilbao P. A prospective analysis of inter- and intrafractional errors to calculate CTV to PTV margins in head and neck patients. Clin Transl Oncol 2014; 17:113-20. [PMID: 25037850 DOI: 10.1007/s12094-014-1200-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 06/23/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate an institute-specific CTV-PTV margin for head and neck (HN) patients according to a 3-mm action level protocol. METHODS/PATIENTS Twenty-three HN patients were prospectively analysed. Patients were immobilized with a thermoplastic mask. Inter- and intrafractional set-up errors (in the three dimensions) were assessed from portal images (PI) registration. Digitally reconstructed radiographs (DRRs) were compared with two orthogonal PI by matching bone anatomy landmarks. The isocenter was verified during the first five consecutive days of treatment: if the mean error detected was greater than 2 mm the isocenter position was corrected for the rest of the treatment. Isocenter was checked weekly thereafter. Set-up images were obtained before and after treatment administration on 10, 20 and 30 fractions to quantify the intrafractional displacement. For the set-up errors, systematic (Σ), random (σ), overall standard deviations, and the overall mean displacement (M), were determined. CTV to PTV margin was calculated considering both inter- and intrafractional errors. RESULTS A total of 396 portal images was analysed in 23 patients. Systematic interfractional (Σ(inter)) set-up errors ranged between 0.77 and 1.42 mm in the three directions, whereas the random (σ (inter)) errors were around 1-1.31 mm. Systematic intrafractional (Σ(intra)) errors ranged between 0.65 and 1.11 mm, whereas the random (σ (intra)) errors were around 1.13-1.16 mm. CONCLUSIONS A verification protocol (3-mm action level) provided by EPIDs improves the set-up accuracy. Intrafractional error is not negligible and contributes to create a larger CTV-PTV margin. The appropriate CTV-PTV margin for our institute is between 3 and 4.5 mm considering both inter- and intrafractional errors.
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Affiliation(s)
- J Cacicedo
- Radiation Oncology Department, Cruces University Hospital, c/Plaza de Cruces s/n, 48903, Barakaldo, Vizcaya, Spain,
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Robb D, Plank A, Middleton M. Assessing the Efficiency and Consistency of Daily Image-guided Radiation Therapy in a Modern Radiotherapy Centre. J Med Imaging Radiat Sci 2014; 45:72-78. [PMID: 31051954 DOI: 10.1016/j.jmir.2013.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 10/15/2013] [Accepted: 10/16/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients at Radiation Oncology Queensland Toowoomba are treated using the assistance of daily image-guided radiation therapy (IGRT). Each patient's daily setup is exposed to a number of variables. This study investigates the effect that these variables have on the total time taken to analyse field placement and the total time taken for treatment, as well accessing setup error across a variety of treatment types. METHODS This is a retrospective study of 80 patients across a variety of treatment sites where daily IGRT was undertaken using kilovoltage and megavoltage orthogonal images. Variables investigated include the treatment type, the imaging modality used, and the setup error of each session. Statistical analysis was then performed on the data. RESULTS Patients being treated in the thoracic region had the greatest random setup error. The mean matching times were also longer for chest patients (197 seconds), whereas there were minimal differences in times regarding modality. Treatment times were longest for head and neck variables (399-405 seconds). CONCLUSIONS Pretreatment daily IGRT is beneficial to all patients and can be performed efficiently. Pelvic variables were the strongest performer, with fiducial markers providing the most consistent and rapid match times. Chest variables were the worst performer specifically regarding random setup error and match times indicating future work required on chest stabilization.
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Affiliation(s)
- Dean Robb
- Radiation Oncology Queensland, Toowoomba, Cairns, Australia.
| | - Ashley Plank
- Oncology Research Australia, Toowoomba, Cairns, Australia
| | - Mark Middleton
- Radiation Oncology Queensland, Toowoomba, Cairns, Australia
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Alcorn SR, Chen MJ, Claude L, Dieckmann K, Ermoian RP, Ford EC, Malet C, MacDonald SM, Nechesnyuk AV, Nilsson K, Villar RC, Winey BA, Tryggestad EJ, Terezakis SA. Practice patterns of photon and proton pediatric image guided radiation treatment: results from an International Pediatric Research consortium. Pract Radiat Oncol 2014; 4:336-341. [PMID: 25194103 DOI: 10.1016/j.prro.2014.03.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 03/28/2014] [Accepted: 03/31/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Image guided radiation therapy (IGRT) has become common practice for both photon and proton radiation therapy, but there is little consensus regarding its application in the pediatric population. We evaluated clinical patterns of pediatric IGRT practice through an international pediatrics consortium comprised of institutions using either photon or proton radiation therapy. METHODS AND MATERIALS Seven international institutions with dedicated pediatric expertise completed a 53-item survey evaluating patterns of IGRT use in definitive radiation therapy for patients ≤21 years old. Two institutions use proton therapy for children and all others use IG photon therapy. Descriptive statistics including frequencies of IGRT use and means and standard deviations for planning target volume (PTV) margins by institution and treatment site were calculated. RESULTS Approximately 750 pediatric patients were treated annually across the 7 institutions. IGRT was used in tumors of the central nervous system (98%), abdomen or pelvis (73%), head and neck (100%), lung (83%), and liver (69%). Photon institutions used kV cone beam computed tomography and kV- and MV-based planar imaging for IGRT, and all proton institutions used kV-based planar imaging; 57% of photon institutions used a specialized pediatric protocol for IGRT that delivers lower dose than standard adult protocols. Immobilization techniques varied by treatment site and institution. IGRT was utilized daily in 45% and weekly in 35% of cases. The PTV margin with use of IGRT ranged from 2 cm to 1 cm across treatment sites and institution. CONCLUSIONS Use of IGRT in children was prevalent at all consortium institutions. There was treatment site-specific variability in IGRT use and technique across institutions, although practices varied less at proton facilities. Despite use of IGRT, there was no consensus of optimum PTV margin by treatment site. Given the desire to restrict any additional radiation exposure in children to instances where the exposure is associated with measureable benefit, prospective studies are warranted to optimize IGRT protocols by modality and treatment site.
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Affiliation(s)
- Sara R Alcorn
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Michael J Chen
- Department of Radiation, Grupo de Apoio ao Adolescente e à Criança com Câncer, São Paulo, Brazil
| | - Line Claude
- Département de Radiothérapie, Centre de Lutte Contre Le Cancer Léon Bérard, Lyon, France
| | - Karin Dieckmann
- Department of Radiation Oncology, Universität Klinik Für Strahlentherapie und Strahlenbiologie, Vienna, Austria
| | - Ralph P Ermoian
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Eric C Ford
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Claude Malet
- Département de Radiothérapie, Centre de Lutte Contre Le Cancer Léon Bérard, Lyon, France
| | - Shannon M MacDonald
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexey V Nechesnyuk
- Department of Radiotherapy, Federal Scientific Clinical Center of Children's Hematology, Oncology and Immunology, Moscow, Russia
| | - Kristina Nilsson
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Rosangela C Villar
- Department of Radiation Oncology Centro Infantil Boldrini, São Paulo e Região, Brazil
| | - Brian A Winey
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Erik J Tryggestad
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Stephanie A Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland.
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Hansen CR, Christiansen RL, Nielsen TB, Bertelsen AS, Johansen J, Brink C. Comparison of three immobilisation systems for radiation therapy in head and neck cancer. Acta Oncol 2014; 53:423-7. [PMID: 24063295 DOI: 10.3109/0284186x.2013.813966] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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