1
|
Penoncello GP, Voss MM, Gao Y, Sensoy L, Cao M, Pepin MD, Herchko SM, Benedict SH, DeWees TA, Rong Y. Multicenter Multivendor Evaluation of Dose Volume Histogram Creation Consistencies for 8 Commercial Radiation Therapy Dosimetric Systems. Pract Radiat Oncol 2024; 14:e236-e248. [PMID: 37914082 DOI: 10.1016/j.prro.2023.09.009] [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: 07/13/2023] [Revised: 09/11/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE To evaluate dose volume histogram (DVH) construction differences across 8 major commercial treatment planning systems (TPS) and dose reporting systems for clinically treated plans of various anatomic sites and target sizes. METHODS AND MATERIALS Dose files from 10 selected clinically treated plans with a hypofractionation, stereotactic radiation therapy prescription or sharp dose gradients such as head and neck plans ranging from prescription doses of 18 Gy in 1 fraction to 70 Gy in 35 fractions, each calculated at 0.25 and 0.125 cm grid size, were created and anonymized in Eclipse TPS, and exported to 7 other major TPS (Pinnacle, RayStation, and Elements) and dose reporting systems (MIM, Mobius, ProKnow, and Velocity) systems for comparison. Dose-volume constraint points of clinical importance for each plan were collected from each evaluated system (D0.03 cc [Gy], volume, and the mean dose were used for structures without specified constraints). Each reported constraint type and structure volume was normalized to the value from Eclipse for a pairwise comparison. A Wilcoxon rank-sum test was used for statistical significance and a multivariable regression model was evaluated adjusting for plan, grid size, and distance to target center. RESULTS For all DVH points relative to Eclipse, all systems reported median values within 1.0% difference of each other; however, they were all different from Eclipse. Considering mean values, Pinnacle, RayStation, and Elements averaged at 1.038, 1.046, and 1.024, respectively, while MIM, Mobius, ProKnow, and Velocity reported 1.026, 1.050, 1.033, and 1.022, respectively relative to Eclipse. Smaller dose grid size improved agreement between the systems marginally without statistical significance. For structure volumes relative to Eclipse, larger differences are seen across all systems with a range in median values up to 3.0% difference and mean up to 10.1% difference. CONCLUSIONS Large variations were observed between all systems. Eclipse generally reported, at statistically significant levels, lower values than all other evaluated systems. The nonsignificant change resulting from lowering the dose grid resolution indicates that this resolution may be less important than other aspects of calculating DVH curves, such as the 3-dimensional modeling of the structure.
Collapse
Affiliation(s)
- Gregory P Penoncello
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona; Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - Molly M Voss
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, Arizona
| | - Yu Gao
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Levent Sensoy
- Department of Radiation Oncology, University of Miami, Miami, Florida
| | - Minsong Cao
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California
| | - Mark D Pepin
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Steven M Herchko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida
| | - Stanley H Benedict
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - Todd A DeWees
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, California; Department of Radiation Oncology, City of Hope, Duarte, California.
| | - Yi Rong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.
| |
Collapse
|
2
|
Meffe G, Votta C, Turco G, Chillè E, Nardini M, Romano A, Chiloiro G, Panza G, Galetto M, Capotosti A, Moretti R, Gambacorta MA, Boldrini L, Indovina L, Placidi L. Impact of data transfer between treatment planning systems on dosimetric parameters. Phys Med 2024; 121:103369. [PMID: 38669811 DOI: 10.1016/j.ejmp.2024.103369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/27/2024] [Accepted: 04/21/2024] [Indexed: 04/28/2024] Open
Abstract
PURPOSE In radiotherapy it is often necessary to transfer a patient's DICOM (Digital Imaging and COmmunications in Medicine) dataset from one system to another for re-treatment, plan-summation or registration purposes. The aim of the study is to evaluate effects of dataset transfer between treatment planning systems. MATERIALS AND METHODS Twenty-five patients treated in a 0.35T MR-Linac (MRidian, ViewRay) for locally-advanced pancreatic cancer were enrolled. For each patient, a nominal dose distribution was optimized on the planning MRI. Each plan was daily re-optimized if needed to match the anatomy and exported from MRIdian-TPS (ViewRay Inc.) to Eclipse-TPS (Siemens-Varian). A comparison between the two TPSs was performed considering the PTV and OARs volumes (cc), as well as dose coverages and clinical constraints. RESULTS From the twenty-five enrolled patients, 139 plans were included in the data comparison. The median values of percentage PTV volume variation are 10.8 % for each fraction, while percentage differences of PTV coverage have a mean value of -1.4 %. The median values of the percentage OARs volume variation are 16.0 %, 7.0 %, 10.4 % and 8.5 % for duodenum, stomach, small and large bowel, respectively. The percentage variations of the dose constraints are 41.0 %, 52.7 % and 49.8 % for duodenum, stomach and small bowel, respectively. CONCLUSIONS This study has demonstrated a non-negligible variation in size and dosimetric parameters when datasets are transferred between TPSs. Such variations should be clinically considered. Investigations are focused on DICOM structure algorithm employed by the TPSs during the transfer to understand the cause of such variations.
Collapse
Affiliation(s)
- Guenda Meffe
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Claudio Votta
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriele Turco
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Elena Chillè
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Matteo Nardini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Angela Romano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giuditta Chiloiro
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giulia Panza
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Amedeo Capotosti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Moretti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Antonietta Gambacorta
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Roma, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Indovina
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lorenzo Placidi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| |
Collapse
|
3
|
Ravari ME, Nasseri S, Mohammadi M, Behmadi M, Ghiasi-Shirazi SK, Momennezhad M. Deep-learning Method for the Prediction of Three-Dimensional Dose Distribution for Left Breast Cancer Conformal Radiation Therapy. Clin Oncol (R Coll Radiol) 2023; 35:e666-e675. [PMID: 37741713 DOI: 10.1016/j.clon.2023.09.002] [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: 04/04/2023] [Revised: 07/25/2023] [Accepted: 09/08/2023] [Indexed: 09/25/2023]
Abstract
AIMS An increase in the demand of a new generation of radiotherapy planning systems based on learning approaches has been reported. At this stage, the new approach is able to improve the planning speed while saving a reasonable level of plan quality, compared with available planning systems. We believe that new achievements, such as deep-learning models, will be able to review the issue from a different point of view. MATERIALS AND METHODS The data of 120 breast cancer patients were used to train and test the three-dimensional U-Res-Net model. The network input was computed tomography images and patients' contouring, while the patients' dose distribution was addressed as the output of the model proposed. The predicted dose distributions, created by the model for 10 test patients, were then compared with corresponding dose distributions calculated by a reliable treatment planning system. In particular, the dice similarity coefficients for different isodose volumes, dose difference and mean absolute errors (MAE) for all voxels inside the body, Dmean, D98%, D50%, D2%, V95% for planning target volume and organs at risk were calculated and were statistically analysed with the paired-samples t-test. RESULTS The average dose difference for all patients and voxels in body was 0.60 ± 2.81%. The MAE varied from 3.85 ± 6.65% to 8.06 ± 10.00%. The average MAE for test cases was 5.71 ± 1.19%. The average dice similarity coefficients for isodose volumes was 0.91 ± 0.03. The three-dimensional gamma passing rates with 3 mm/3% criteria varied from 78.99% to 97.58% for planning target volume and organs at risk, respectively. CONCLUSIONS The investigation showed that a deep-learning model can be applied to predict the three-dimensional dose distribution with optimal accuracy and precision for patients with left breast cancer. As further study, the model can be extended to predict dose distribution in other cancers.
Collapse
Affiliation(s)
- M E Ravari
- Medical Physics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sh Nasseri
- Medical Physics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - M Mohammadi
- Department of Medical Physics, Royal Adelaide Hospital, Adelaide, Australia
| | - M Behmadi
- Cancer Research Center, Semnan University of Medical Sciences, Semnan, Iran; Medical Physics Department, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - S K Ghiasi-Shirazi
- Department of Computer Engineering, Ferdowsi University of Mashhad, Mashhad, Iran
| | - M Momennezhad
- Medical Physics Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
4
|
Addo DA, Kaufmann EE, Tagoe SN, Kyere AK. Characterization of GafChromic EBT2 film dose measurements using a tissue-equivalent water phantom for a Theratron® Equinox Cobalt-60 teletherapy machine. PLoS One 2022; 17:e0271000. [PMID: 35984784 PMCID: PMC9390906 DOI: 10.1371/journal.pone.0271000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/21/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose
In vivo dosimetry is a quality assurance tool that provides post-treatment measurement of the absorbed dose as delivered to the patient. This dosimetry compares the prescribed and measured dose delivered to the target volume. In this study, a tissue-equivalent water phantom provided the simulation of the human environment. The skin and entrance doses were measured using GafChromic EBT2 film for a Theratron® Equinox Cobalt-60 teletherapy machine.
Methods
We examined the behaviors of unencapsulated films and custom-made film encapsulation. Films were cut to 1 cm × 1 cm, calibrated, and used to assess skin dose depositions and entrance dose. We examined the response of the film for variations in field size, source to skin distance (SSD), gantry angle and wedge angle.
Results
The estimated uncertainty in EBT2 film for absorbed dose measurement in phantom was ±1.72%. Comparison of the measurements of the two film configurations for the various irradiation parameters were field size (p = 0.0193, α = 0.05, n = 11), gantry angle (p = 0.0018, α = 0.05, n = 24), SSD (p = 0.1802, α = 0.05, n = 11) and wedge angle (p = 0.6834, α = 0.05, n = 4). For a prescribed dose of 200 cGy and at reference conditions (open field 10 cm x 10 cm, SSD = 100 cm, and gantry angle = 0º), the measured skin dose using the encapsulation material was 70% while that measured with the unencapsulated film was 24%. At reference irradiation conditions, the measured skin dose using the unencapsulated film was higher for open field configurations (24%) than wedged field configurations (19%). Estimation of the entrance dose using the unencapsulated film was within 3% of the prescribed dose.
Conclusions
GafChromic EBT2 film measurements were significantly affected at larger field sizes and gantry angles. Furthermore, we determined a high accuracy in entrance dose estimations using the film.
Collapse
Affiliation(s)
- Daniel Akwei Addo
- Department of Computer Engineering, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- * E-mail:
| | - Elsie Effah Kaufmann
- Department of Biomedical Engineering, School of Engineering Sciences, University of Ghana, Legon, Accra, Ghana
| | - Samuel Nii Tagoe
- National Radiotherapy Oncology and Nuclear Medicine Centre, Korle-Bu, Accra, Ghana
- School of Biomedical and Allied health Sciences, University of Ghana, Accra, Ghana
| | - Augustine Kwame Kyere
- Medical Physics Department, Graduate School of Nuclear and Allied Sciences, University of Ghana, Atomic, Accra, Ghana
| |
Collapse
|
5
|
Simiele E, Capaldi D, Breitkreutz D, Han B, Yeung T, White J, Zaks D, Owens M, Maganti S, Xing L, Surucu M, Kovalchuk N. Treatment planning system commissioning of the first clinical biology‐guided radiotherapy machine. J Appl Clin Med Phys 2022; 23:e13638. [PMID: 35644039 PMCID: PMC9359035 DOI: 10.1002/acm2.13638] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/18/2022] [Accepted: 04/22/2022] [Indexed: 11/09/2022] Open
Abstract
Purpose Methods Results Conclusions
Collapse
Affiliation(s)
- Eric Simiele
- Department of Radiation Oncology Stanford University Stanford California USA
| | - Dante Capaldi
- Department of Radiation Oncology Stanford University Stanford California USA
| | - Dylan Breitkreutz
- Department of Radiation Oncology Stanford University Stanford California USA
| | - Bin Han
- Department of Radiation Oncology Stanford University Stanford California USA
| | | | - John White
- RefleXion Medical, Inc. Hayward California USA
| | - Daniel Zaks
- RefleXion Medical, Inc. Hayward California USA
| | | | | | - Lei Xing
- Department of Radiation Oncology Stanford University Stanford California USA
| | - Murat Surucu
- Department of Radiation Oncology Stanford University Stanford California USA
| | - Nataliya Kovalchuk
- Department of Radiation Oncology Stanford University Stanford California USA
| |
Collapse
|
6
|
Bismack B, Dolan J, Laugeman E, Gopal A, Wen N, Chetty I. Model refinement increases confidence levels and clinical agreement when commissioning a three-dimensional secondary dose calculation system. J Appl Clin Med Phys 2022; 23:e13590. [PMID: 35389554 PMCID: PMC9194992 DOI: 10.1002/acm2.13590] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/13/2022] [Accepted: 02/22/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose Evaluate custom beam models for a second check dose calculation system using statistically verifiable passing criteria for film analysis, DVH, and 3D gamma metrics. Methods Custom beam models for nine linear accelerators for the Sun Nuclear Dose Calculator algorithm (SDC, Sun Nuclear) were evaluated using the AAPM‐TG119 test suite (5 Intensity Modulated Radiation Therapy (IMRT) and 5 Volumetric Modulated Arc Therapy (VMAT) plans) and a set of clinical plans. Where deemed necessary, adjustments to Multileaf Collimator (MLC) parameters were made to improve results. Comparisons to the Analytic Anisotropic Algorithm (AAA), and gafchromic film measurements were performed. Confidence intervals were set to 95% per TG‐119. Film gamma criteria were 3%/3 mm (conventional beams) or 3%/1 mm (Stereotactic Radiosurgery [SRS] beams). Dose distributions in solid water phantom were evaluated based on DVH metrics (e.g., D95, V20) and 3D gamma criteria (3%/3 mm or 3%/1 mm). Film passing rates, 3D gamma passing rates, and DVH metrics were reported for HD MLC machines and Millennium MLC Machines. Results For HD MLC machines, SDC gamma film agreement was 98.76% ± 2.30% (5.74% CL) for 6FFF/6srs (3%/1 mm), and 99.80% ± 0.32% (0.83% CL) for 6x (3%/3 mm). For Millennium MLC machines, film passing rates were 98.20% ± 3.14% (7.96% CL), 99.52% ± 1.14% (2.71% CL), and 99.69% ± 0.82% (1.91% CL) for 6FFF, 6x, and 10x, respectively. For SDC to AAA comparisons: HD MLC Linear Accelerators (LINACs); DVH point agreement was 0.97% ± 1.64% (4.18% CL) and 1.05% ± 2.12% (5.20% CL); 3D gamma agreement was 99.97% ± 0.14% (0.30% CL) and 100.00% ± 0.02% (0.05% CL), for 6FFF/6srs and 6x, respectively; Millennium MLC LINACs: DVH point agreement was 0.77% ± 2.40% (5.47% CL), 0.80% ± 3.40% (7.47% CL), and 0.07% ± 2.15% (4.30% CL); 3D gamma agreement was 99.97% ± 0.13% (0.29% CL), 99.97% ± 0.17% (0.36% CL), and 99.99% ± 0.06% (0.12% CL) for 6FFF, 6x, and 10x, respectively. Conclusion SDC shows agreement well within TG119 CLs for film and redundant dose calculation comparisons with AAA. In some models (SRS), this was achieved using stricter criteria. TG119 plans can be used to help guide model adjustments and to establish clinical baselines for DVH and 3D gamma criteria.
Collapse
Affiliation(s)
| | | | | | - Anant Gopal
- Henry Ford Health System, Detroit, Michigan, USA
| | - Ning Wen
- Henry Ford Health System, Detroit, Michigan, USA
| | | |
Collapse
|
7
|
Della Gala G, Bardiès M, Tipping J, Strigari L. Overview of commercial treatment planning systems for targeted radionuclide therapy. Phys Med 2021; 92:52-61. [PMID: 34864422 DOI: 10.1016/j.ejmp.2021.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/23/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Targeted Radionuclide Therapy (TRT) is a branch of cancer medicine dealing with the therapeutic use of radioisotopes associated with biological vectors accumulating in the tumors/targets, indicated as Molecular Radiotherapy (MRT), or directly injected into the arteries that supply blood to liver tumour vasculature, indicated as Selective RT (SRT). The aim of this work is to offer a panoramic view on the increasing number of commercially-available TRT treatment planning systems (TPSs). MATERIALS AND METHODS A questionnaire was sent to manufacturers' representatives. Academic software were not considered. Questions were grouped as follows: general information, clinical workflow, calibration procedure, image processing/reconstruction, image registration and segmentation tools, time-activity curve (TAC) fitting and absorbed dose calculation. RESULTS All software reported have CE-marking. TPSs were divided between SRT-dedicated software [4] and MRT [5] dosimetry software. In SRT, since no kinetic process is involved, absorbed dose calculation does not require TAC fitting, and image registration is not fully developed in all TPS. All software requires a radionuclide-specific calibration. In SRT, a relative image calibration can be obtained by scaling the counts to a known activity. Automated VOI contouring and rigid/deformable propagation between different acquisitions time-points is implemented in most TPSs, although DICOM export is rare. Different TAC fits are available depending on the number of time-points. Voxel S-value and Local deposition methods are the most frequent dosimetric approaches; dose-voxel kernel convolution and semi-Monte Carlo method are also available. CONCLUSIONS Available TPSs allows performing personalized dosimetry in clinical practice. Individual variations in methodology/algorithms must be considered in the standardisation/harmonization processes.
Collapse
Affiliation(s)
- Giuseppe Della Gala
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Manuel Bardiès
- Département de Médecine Nucléaire, Institut Régional du Cancer de Montpellier (ICM), Montpellier F-34298, France; IRCM, UMR 1194 INSERM, Université de Montpellier and Institut Régional du Cancer de Montpellier (ICM), Montpellier F-34298, France
| | - Jill Tipping
- The Christie NHS Foundation Trust, Manchester, UK
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| |
Collapse
|
8
|
Anetai Y, Koike Y, Takegawa H, Nakamura S, Tanigawa N. Evaluation approach for whole dose distribution in clinical cases using spherical projection and spherical harmonics expansion: spherical coefficient tensor and score method. JOURNAL OF RADIATION RESEARCH 2021:rrab081. [PMID: 34590126 DOI: 10.1093/jrr/rrab081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/26/2021] [Indexed: 06/13/2023]
Abstract
Whole dose distribution results from well-conceived treatment plans including patient-specific (location, size and shape of tumor, etc.) and facility-specific (clinical policy and goal, equipment, etc.) information. To evaluate the whole dose distribution efficiently and effectively, we propose a method to apply spherical projection and real spherical harmonics (SH) expansion, thus leading to the expanded coefficients as a rank-2 tensor, SH coefficient tensor, for every patient-specific dose distribution. To verify the feature of this tensor, we introduce Isomap from the manifold learning method and multi-dimensional scaling (MDS). Subsequently, we obtained the MDS distance representing similarity, η, and the SH score, ζ, which is a Frobenius norm of the SH coefficient tensor. These were then validated in the intensity-modulated radiation therapy (IMRT) data sets of: (i) 375 mixing treated regions, (ii) 135 head and neck (HN), and (iii) 132 prostate cases, respectively. The MDS map indicated that the SH coefficient tensor enabled a quantitative feature extraction of whole dose distributions. In particular, the SH score systematically detected irregular cases as the deviation higher than +1.5 standard deviations (SD) from the average case, which matched up with clinically irregular case that required very complicated dose distributions. In summary, the proposed SH coefficient tensor is a useful representation of the whole dose distribution. The SH score from the SH coefficient tensor is a convenient and simple criterion used to characterize the entire dose distributions, which is not dependent on the data set.
Collapse
Affiliation(s)
- Yusuke Anetai
- Department of Radiology, Kansai Medical University, Shin-machi 2-5-1, Hirakata-shi, Osaka 573-0101, Japan
| | - Yuhei Koike
- Department of Radiology, Kansai Medical University, Shin-machi 2-5-1, Hirakata-shi, Osaka 573-0101, Japan
| | - Hideki Takegawa
- Department of Radiology, Kansai Medical University, Shin-machi 2-5-1, Hirakata-shi, Osaka 573-0101, Japan
| | - Satoaki Nakamura
- Department of Radiology, Kansai Medical University, Shin-machi 2-5-1, Hirakata-shi, Osaka 573-0101, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, Shin-machi 2-5-1, Hirakata-shi, Osaka 573-0101, Japan
| |
Collapse
|
9
|
Ebert MA, Gulliford S, Acosta O, de Crevoisier R, McNutt T, Heemsbergen WD, Witte M, Palma G, Rancati T, Fiorino C. Spatial descriptions of radiotherapy dose: normal tissue complication models and statistical associations. Phys Med Biol 2021; 66:12TR01. [PMID: 34049304 DOI: 10.1088/1361-6560/ac0681] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/28/2021] [Indexed: 12/20/2022]
Abstract
For decades, dose-volume information for segmented anatomy has provided the essential data for correlating radiotherapy dosimetry with treatment-induced complications. Dose-volume information has formed the basis for modelling those associations via normal tissue complication probability (NTCP) models and for driving treatment planning. Limitations to this approach have been identified. Many studies have emerged demonstrating that the incorporation of information describing the spatial nature of the dose distribution, and potentially its correlation with anatomy, can provide more robust associations with toxicity and seed more general NTCP models. Such approaches are culminating in the application of computationally intensive processes such as machine learning and the application of neural networks. The opportunities these approaches have for individualising treatment, predicting toxicity and expanding the solution space for radiation therapy are substantial and have clearly widespread and disruptive potential. Impediments to reaching that potential include issues associated with data collection, model generalisation and validation. This review examines the role of spatial models of complication and summarises relevant published studies. Sources of data for these studies, appropriate statistical methodology frameworks for processing spatial dose information and extracting relevant features are described. Spatial complication modelling is consolidated as a pathway to guiding future developments towards effective, complication-free radiotherapy treatment.
Collapse
Affiliation(s)
- Martin A Ebert
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- 5D Clinics, Claremont, Western Australia, Australia
| | - Sarah Gulliford
- Department of Radiotherapy Physics, University College Hospitals London, United Kingdom
- Department of Medical Physics and Bioengineering, University College London, United Kingdom
| | - Oscar Acosta
- Univ Rennes, CLCC Eugène Marquis, INSERM, LTSI-UMR 1099, F-35000 Rennes, France
| | | | - Todd McNutt
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Marnix Witte
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Giuseppe Palma
- Institute of Biostructures and Bioimaging, National Research Council, Napoli, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| |
Collapse
|
10
|
Ruiz Boiset G, V S Batista D, Coutinho Cardoso S. Clinical verification of treatment planning dose calculation in lung SBRT with GATE Monte Carlo simulation code. Phys Med 2021; 87:1-10. [PMID: 34091196 DOI: 10.1016/j.ejmp.2021.05.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/04/2021] [Accepted: 05/21/2021] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study aims to use GATE/Geant4 simulation code to evaluate the performance of dose calculations with Anisotropic Analytical Algorithm (AAA) in the context of lung SBRT for complex treatments considering images of patients. METHODS Four cases of non-small cell lung cancer treated with SBRT were selected for this study. Irradiation plans were created with AAA and recalculated end to end using Monte Carlo (MC) method maintaining field configurations identical to the original plans. Each treatment plan was evaluated in terms of PTV and organs at risk (OARs) using dose-volume histograms (DVH). Dosimetric parameters obtained from DVHs were used to compare AAA and MC. RESULTS The comparison between the AAA and MC DVH using gamma analysis with the passing criteria of 3%/3% showed an average passing rate of more than 90% for the PTV structure and 97% for the OARs. Tightening the criteria to 2%/2% showed a reduction in the average passing rate of the PTV to 86%. The agreement between the AAA and MC dose calculations for PTV dosimetric parameters (V100; V90; Homogeneity index; maximum, minimum and mean dose; CIPaddick and D2cm) was within 18.4%. For OARs, the biggest differences were observed in the spinal cord and the great vessels. CONCLUSIONS In general, we did not find significant differences between AAA and MC. The results indicate that AAA could be used in complex SBRT cases that involve a larger number of small treatment fields in the presence of tissue heterogeneities.
Collapse
Affiliation(s)
- Gisell Ruiz Boiset
- Instituto de Fı́sica, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Delano V S Batista
- Instituto de Radioproteção e Dosimetria, IRD/CNEN, Rio de Janeiro, Brazil; Oncologia D'Or São Cristóvão, Rede D'Or São Luiz, Rio de Janeiro, Brazil
| | | |
Collapse
|
11
|
Velten C, Kabarriti R, Garg M, Tomé WA. Single isocenter treatment planning techniques for stereotactic radiosurgery of multiple cranial metastases. Phys Imaging Radiat Oncol 2021; 17:47-52. [PMID: 33898778 PMCID: PMC8058031 DOI: 10.1016/j.phro.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 11/05/2022] Open
Abstract
DCA in most cases is superior to VMAT for multi metastases single isocenter SRS. Normal brain V12Gy was significantly reduced with DCA, predicting for lower S-NEC. Maximum doses to critical organs-at-risk were significantly lower with DCA. Conformity was comparable between VMAT and DCA.
Background and purpose Whole brain radiation therapy use has decreased in favor of stereotactic radiosurgery (SRS) for the treatment of multiple brain metastases due to reduced neurotoxicity. Here we compare two single isocenter radiosurgery planning techniques, volumetric modulated arc therapy (VMAT) and dynamic conformal arcs (DCA) in terms of their dosimetric and delivery performance. Materials and methods Sixteen patients with 2– 18 brain metastases (total 103; median 4) previously treated with single fraction SRS were replanned for multiple lesion single isocenter treatments using VMAT and DCA using different treatment planning systems for each and three different plan geometries for DCA. Plans were evaluated using the Paddick conformity index, normal tissue V12Gy, the probability for symptomatic brain necrosis (S-NEC), maximum organ-at-risk (OAR) point doses, and total number of monitor units (MU). Results Conformity was not significantly different between VMAT and DCA plans. VMAT plans showed a trend towards higher MU with a median difference between 18% and 24% (p ≤ 0.09). Median V12Gy differences were 7.0 cm3–8.6 cm3 favoring DCA plans (p < 0.01). VMAT plans had median excess absolute and relative S-NEC risks compared to DCA plans of 8%–10% and 25%–31%, respectively (p < 0.01). Moreover for VMAT compared to DCA, maximum OAR doses were significantly higher for the brainstem (1.9 Gy; p < 0.01), chiasm (0.5 Gy; p ≤ 0.02), and optic nerves (0.5 Gy; p ≤ 0.04). Conclusions In most cases DCA plans were found to be dosimetrically superior to VMAT plans with reduced V12Gy and associated risk for S-NEC. Maximum doses to important OARs showed significant improvement, increasing the ability for subsequent salvage treatments involving radiation.
Collapse
Affiliation(s)
- Christian Velten
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10467, USA
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10467, USA.,Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Madhur Garg
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10467, USA.,Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Wolfgang A Tomé
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY 10467, USA.,Albert Einstein College of Medicine, Bronx, NY 10461, USA
| |
Collapse
|
12
|
Stanley DN, Covington EL, Liu H, Alexandrian AN, Cardan RA, Bridges DS, Thomas EM, Fiveash JB, Popple RA. Accuracy of dose-volume metric calculation for small-volume radiosurgery targets. Med Phys 2021; 48:1461-1468. [PMID: 33294990 PMCID: PMC8248418 DOI: 10.1002/mp.14645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/18/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE For stereotactic radiosurgery (SRS), accurate evaluation of dose-volume metrics for small structures is necessary. The purpose of this study was to compare the DVH metric capabilities of five commercially available SRS DVH analysis tools (Eclipse, Elements, Raystation, MIM, and Velocity). METHODS DICOM RTdose and RTstructure set files created using MATLAB were imported and evaluated in each of the tools. Each structure set consisted of 50 randomly placed spherical targets. The dose distributions were created on a 1-mm grid using an analytic model such that the dose-volume metrics of the spheres were known. Structure sets were created for 3, 5, 7, 10, 15, and 20 mm diameter spheres. The reported structure volume, V100% [cc], and V50% [cc], and the RTOG conformity index and Paddick Gradient Index, were compared with the analytical values. RESULTS The average difference and range across all evaluated target sizes for the reported structure volume was - 4.73%[-33.2,0.2], 0.11%[-10.9, 9.5], -0.39%[-12.1, 7.0], -2.24%[-21.0, 1.3], and 1.15%[-15.1,0.8], for TPS-A through TPS-E, respectively. The average difference and range for the V100%[cc] (V20Gy[cc]) was - 0.4[-24.5,9.8], -2.73[-23.6, 1.1], -3.01[-23.6, 0.6], -3.79[-27.3, 1.3], and 0.26[-6.1,2.6] for TPS-A through TPS-E, respectively. For V50%[cc](V10Gy[cc]) in TPS-A through TPS-E the average and ranger were - 0.05[-0.8,0.4], -0.18[-1.2, 0.5], -0.44[-1.4, 0.3], -0.26[-1.8, 2.6], and 0.09[-1.4,2.7]. CONCLUSION This study expanded on the previously published literature to quantitatively compare the DVH analysis capabilities of software commonly used for SRS plan evaluation and provides freely available and downloadable analytically derived set of ground truth DICOM dose and structure files for the use of radiotherapy clinics. The differences between systems highlight the need for standardization and/or transparency between systems, especially when evaluating plan quality for multi-institutional clinical trials.
Collapse
Affiliation(s)
- Dennis N Stanley
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth L Covington
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Haisong Liu
- Department of Radiation Oncology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ara N Alexandrian
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Radiation Oncology, University of Washington, Seattle, WA, USA
| | - Rex A Cardan
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Daniel S Bridges
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Evan M Thomas
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John B Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard A Popple
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
13
|
Using fuzzy logics to determine optimal oversampling factor for voxelizing 3D surfaces in radiation therapy. Soft comput 2020. [DOI: 10.1007/s00500-020-05126-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
14
|
Goodall SK, Ebert MA. Recommended dose voxel size and statistical uncertainty parameters for precision of Monte Carlo dose calculation in stereotactic radiotherapy. J Appl Clin Med Phys 2020; 21:120-130. [PMID: 33124741 PMCID: PMC7769395 DOI: 10.1002/acm2.13077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/31/2022] Open
Abstract
Monte Carlo (MC)‐based treatment planning requires a choice of dose voxel size (DVS) and statistical uncertainty (SU). These parameters effect both the precision of displayed dose distribution and time taken to complete a calculation. For efficient, accurate, and precise treatment planning in a clinical setting, optimal values should be selected. In this investigation, 30 volumetric modulated arc therapy (VMAT) stereotactic radiotherapy (SRT) treatment plans, 10 brain, 10 lung, and 10 spine were calculated in the Monaco 5.11.02 treatment planning system (TPS). Each plan was calculated with a DVS of 0.1 and 0.2 cm using SU values of 0.50%, 0.75%, 1.00%, 1.50%, and 2.00%, along with a ground truth calculation using a DVS of 0.1 cm and SU of 0.15%. The variance at each relative dose level was calculated for all SU settings to assess their relationship. The variation from the ground truth calculation for each DVS and SU combination was determined for a range of DVH metrics and plan quality indices along with the time taken to complete the calculations. Finally, the effect of defining the maximum dose using a volume of 0.035 cc was compared to 0.100 cc when considering DVS and SU settings. Changes in the DVS produced greater variations from the ground truth calculation than changes in SU across the values tested. Plan quality metrics and mean dose values showed less sensitivity to changes in SU than DVH metrics. From this study, it was concluded that while maintaining an average calculation time of <10 min, 75% of plans could be calculated with variations of <2.0% from their ground truth values when using an SU setting of 1.50% and a DVS of 0.1 cm in the case of brain or spine plans, and a 0.2 cm DVS in the case of lung plans.
Collapse
Affiliation(s)
- Simon K Goodall
- School of Physics, Mathematics, and Computing, Faculty of Engineering and Mathematical Sciences, University of Western Australia, Crawley, WA, Australia.,GenesisCare, Wembley, WA, Australia
| | - Martin A Ebert
- School of Physics, Mathematics, and Computing, Faculty of Engineering and Mathematical Sciences, University of Western Australia, Crawley, WA, Australia.,Department of Radiation Oncology, Sir Charles Gardiner Hospital, Nedlands, WA, Australia.,5D Clinics, Perth, WA, Australia
| |
Collapse
|
15
|
Hansen CR, Crijns W, Hussein M, Rossi L, Gallego P, Verbakel W, Unkelbach J, Thwaites D, Heijmen B. Radiotherapy Treatment plannINg study Guidelines (RATING): A framework for setting up and reporting on scientific treatment planning studies. Radiother Oncol 2020; 153:67-78. [PMID: 32976873 DOI: 10.1016/j.radonc.2020.09.033] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/04/2020] [Accepted: 09/11/2020] [Indexed: 12/26/2022]
Abstract
Radiotherapy treatment planning studies contribute significantly to advances and improvements in radiation treatment of cancer patients. They are a pivotal step to support and facilitate the introduction of novel techniques into clinical practice, or as a first step before clinical trials can be carried out. There have been numerous examples published in the literature that demonstrated the feasibility of such techniques as IMRT, VMAT, IMPT, or that compared different treatment methods (e.g. non-coplanar vs coplanar treatment), or investigated planning approaches (e.g. automated planning). However, for a planning study to generate trustworthy new knowledge and give confidence in applying its findings, then its design, execution and reporting all need to meet high scientific standards. This paper provides a 'quality framework' of recommendations and guidelines that can contribute to the quality of planning studies and resulting publications. Throughout the text, questions are posed and, if applicable to a specific study and if met, they can be answered positively in the provided 'RATING' score sheet. A normalised weighted-sum score can then be calculated from the answers as a quality indicator. The score sheet can also be used to suggest how the quality might be improved, e.g. by focussing on questions with high weight, or by encouraging consideration of aspects given insufficient attention. Whilst the overall aim of this framework and scoring system is to improve the scientific quality of treatment planning studies and papers, it might also be used by reviewers and journal editors to help to evaluate scientific manuscripts reporting planning studies.
Collapse
Affiliation(s)
- Christian Rønn Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Odense, Denmark; Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia; Danish Centre for Particle Therapy, Aarhus University Hospital, Denmark.
| | - Wouter Crijns
- Department Oncology - Laboratory of Experimental Radiotherapy, KU Leuven, Belgium; Radiation Oncology, UZ Leuven, Belgium
| | - Mohammad Hussein
- Metrology for Medical Physics Centre, National Physical Laboratory, Teddington, UK
| | - Linda Rossi
- Erasmus MC Cancer Institute, Radiation Oncology, Rotterdam, The Netherlands
| | - Pedro Gallego
- Servei de Radiofísica I Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jan Unkelbach
- Radiation Oncology Department, University Hospital Zurich, Switzerland
| | - David Thwaites
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, Australia
| | - Ben Heijmen
- Erasmus MC Cancer Institute, Radiation Oncology, Rotterdam, The Netherlands
| |
Collapse
|
16
|
Liu H, Thomas EM, Li J, Yu Y, Andrews D, Markert JM, Fiveash JB, Shi W, Popple RA. Interinstitutional Plan Quality Assessment of 2 Linac-Based, Single-Isocenter, Multiple Metastasis Radiosurgery Techniques. Adv Radiat Oncol 2019; 5:1051-1060. [PMID: 33089021 PMCID: PMC7560574 DOI: 10.1016/j.adro.2019.10.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/28/2019] [Indexed: 12/05/2022] Open
Abstract
Purpose Interest and application of stereotactic radiosurgery for multiple brain metastases continue to increase. Various planning systems are available for linear accelerator (linac)–based single-isocenter multiple metastasis radiosurgery. Two of the most advanced systems are BrainLAB Multiple Metastases Elements (MME), a dynamic conformal arc (DCA) approach, and Varian RapidArc (RA), a volumetric modulated arc therapy (VMAT) approach. In this work, we systematically compared plan quality between the 2 techniques. Methods and Materials Thirty patients with 4 to 10 metastases (217 total; median 7.5; Vmin = 0.014 cm3; Vmax = 17.73 cm3) were planned with both Varian RA and MME at 2 different institutions with extensive experience in each respective technique. All plans had a single isocenter and used Varian linac equipped with high-definition multileaf collimator. RA plans used 2 to 4 noncoplanar VMAT arcs with 10 MV flattening filter-free beam. MME plans used 4 to 9 noncoplanar DCAs and 6 MV flattening filter-free beam, (minimum planning target volume [PTVmin] = 0.49 cm3; PTVmax = 27.32 cm3; PTVmedian = 7.05 cm3). Prescriptions were 14 to 24 Gy in a single fraction. Target coverage goal was 99% of volume receiving prescription dose (D99% ≥ 100%). Plans were evaluated by Radiation Therapy Oncology Group/Paddick conformity index (CI) score, 12 Gy volume (V12Gy), V8Gy, V5Gy, mean brain dose (Dmean), and beam-on time. Results Conformity was favorable among RA plans (median: MME CIRTOG = 1.38; RA CIRTOG = 1.21; P < .0001). V12Gy and V8Gy were lower for RA plans (median: MME V12 = 23.7 cm3; RA V12 = 19.2 cm3; P = .0001; median: MME V8Gy = 53.6 cm3; RA V8Gy = 44.1 cm3; P = .024). V5Gy was lower for MME plans (median: MME V5Gy = 141.4 cm3; RA V5Gy = 142.8 cm3; P = .009). Mean brain was lower for MME plans (median: MME Dmean = 2.57 Gy; RA Dmean = 2.76 Gy; P < .0001). Conclusions For linac-based multiple metastasis stereotactic radiosurgery, RapidArc VMAT facilitates favorable conformity and V12Gy/V8Gy volume compared with the MME DCA plan. MME planning facilitates reduced dose spill at levels ≤V5Gy.
Collapse
Affiliation(s)
- Haisong Liu
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Evan M Thomas
- Department of Radiation Oncology, University of Alabama at Birmingham, Comprehensive Cancer Center, Birmingham, Alabama
| | - Jun Li
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Yan Yu
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David Andrews
- Department of Neurosurgery, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - James M Markert
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - John B Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Comprehensive Cancer Center, Birmingham, Alabama
| | - Wenyin Shi
- Department of Radiation Oncology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Richard A Popple
- Department of Radiation Oncology, University of Alabama at Birmingham, Comprehensive Cancer Center, Birmingham, Alabama
| |
Collapse
|
17
|
Wang X, Li G, Zhao J, Song Y, Xiao J, Bai S. Verification of eye lens dose in IMRT by MOSFET measurement. Med Dosim 2019; 44:107-110. [DOI: 10.1016/j.meddos.2018.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/23/2018] [Accepted: 02/26/2018] [Indexed: 11/17/2022]
|
18
|
Wang Z, van Dijk IWEM, Wiersma J, Ronckers CM, Oldenburger F, Balgobind BV, Bosman PAN, Bel A, Alderliesten T. Are age and gender suitable matching criteria in organ dose reconstruction using surrogate childhood cancer patients' CT scans? Med Phys 2018; 45:2628-2638. [PMID: 29637577 DOI: 10.1002/mp.12908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE The purpose of this work was to assess the feasibility of using surrogate CT scans of matched patients for organ dose reconstructions for childhood cancer (CC) survivors, treated in the past with only 2D imaging data available instead of 3D CT data, and in particular using the current literature standard of matching patients based on similarity in age and gender. METHODS Thirty-one recently treated CC patients with abdominal CT scans were divided into six age- and gender-matched groups. From each group, two radiotherapy plans for Wilms' tumor were selected as reference plans and applied to the age- and gender-matched patients' CTs in the respective group. Two reconstruction strategies were investigated: S1) without field adjustments; S2) with manual field adjustments according to anatomical information, using a visual check in digitally reconstructed radiographs. To assess the level of agreement between the reconstructed and the reference dose distributions, we computed (using a collapsed cone algorithm) and compared the absolute deviation in mean and maximum dose normalized by the prescribed dose (i.e., normalized errors |NEmean | and |NE2cc |) in eight organs at risk (OARs): heart, lungs, liver, spleen, kidneys, and spinal cord. Furthermore, we assessed the quality of a reconstruction case by varying acceptance thresholds for |NEmean | and |NE2cc |. A reconstruction case was accepted (i.e., considered to pass) if the errors in all OARs are smaller than the threshold. The pass fraction for a given threshold was then defined as the percentage of reconstruction cases that were classified as a pass. Furthermore, we consider the impact of allowing to use a different CT scan for each OAR. RESULTS Slightly smaller reconstruction errors were achieved with S2 in multiple OARs than with S1 (P < 0.05). Among OARs, the best reconstruction was found for the spinal cord (average |NEmean | and |NE2cc | ≤ 4%). The largest average |NEmean | was found in the spleen (18%). The largest average |NE2cc | was found in the left lung (26%). Less than 30% of the reconstruction cases (i.e., pass fraction) meet the criteria that |NEmean | < 20% and |NE2cc | < 20% in all OARs when using age and gender matching and a single CT to do reconstructions. Allowing other matchings and combining reconstructions for OARs from multiple patients, the pass fraction increases substantially to more than 60%. CONCLUSIONS To conclude, reconstructions with small deviations can be obtained by using CC patients' CT scans, making the general approach promising. However, using age and gender as the only matching criteria to select a CT scan for the reconstruction is not sufficient to guarantee sufficiently low reconstruction errors. It is therefore suggested to include more features (e.g., height, features extracted from 2D radiographs) than only age and gender for dose reconstruction for CC survivors treated in the pre-3D radiotherapy planning era and to consider ways to combine multiple reconstructions focused on different OARs.
Collapse
Affiliation(s)
- Ziyuan Wang
- Department of Radiation Oncology, Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Irma W E M van Dijk
- Department of Radiation Oncology, Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jan Wiersma
- Department of Radiation Oncology, Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Cécile M Ronckers
- Department of Pediatric Oncology, Emma Children's Hospital/AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Foppe Oldenburger
- Department of Radiation Oncology, Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Brian V Balgobind
- Department of Radiation Oncology, Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Peter A N Bosman
- Centrum Wiskunde & Informatica (CWI), Science Park 123, 1098 XG, Amsterdam, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tanja Alderliesten
- Department of Radiation Oncology, Academic Medical Center (AMC), Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
19
|
Kron T, Chesson B, Hardcastle N, Crain M, Clements N, Burns M, Ball D. Credentialing of radiotherapy centres in Australasia for TROG 09.02 (Chisel), a Phase III clinical trial on stereotactic ablative body radiotherapy of early stage lung cancer. Br J Radiol 2018; 91:20170737. [PMID: 29446317 DOI: 10.1259/bjr.20170737] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE A randomised clinical trial comparing stereotactic ablative body radiotherapy (SABR) with conventional radiotherapy for early stage lung cancer has been conducted in Australia and New Zealand under the auspices of the TransTasman Radiation Oncology Group (NCT01014130). We report on the technical credentialing program as prerequisite for centres joining the trial. METHODS Participating centres were asked to develop treatment plans for two test cases to assess their ability to create plans according to protocol. Dose delivery in the presence of inhomogeneity and motion was assessed during a site visit using a phantom with moving inserts. RESULTS Site visits for the trial were conducted in 16 Australian and 3 New Zealand radiotherapy facilities. The tests with low density inhomogeneities confirmed shortcomings of the AAA algorithm for dose calculation. Dose was assessed for a typical treatment delivery including at least one non-coplanar beam in a stationary and moving phantom. This end-to-end test confirmed that all participating centres were able to deliver stereotactic ablative body radiotherapy with the required accuracy while the planning study demonstrated that they were able to produce acceptable plans for both test cases. CONCLUSION The credentialing process documented that participating centres were able to deliver dose as required in the trial protocol. It also gave an opportunity to provide education about the trial and discuss technical issues such as four-dimensional CT, small field dosimetry and patient immobilisation with staff in participating centres. Advances in knowledge: Credentialing is an important quality assurance tool for radiotherapy trials using advanced technology. In addition to confirming technical competence, it provides an opportunity for education and discussion about the trial.
Collapse
Affiliation(s)
- Tomas Kron
- 1 Department of Physical Sciences, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia.,2 Sir Peter MacCallum Department of Oncology, University of Melbourne , Parkville, VIC , Australia
| | - Brent Chesson
- 3 Department of Radiation Therapy Services, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia
| | - Nicholas Hardcastle
- 1 Department of Physical Sciences, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia
| | - Melissa Crain
- 4 Trans Tasman Radiation Oncology Group (TROG) , Newcastle, NSW , Australia
| | | | - Mark Burns
- 3 Department of Radiation Therapy Services, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia
| | - David Ball
- 2 Sir Peter MacCallum Department of Oncology, University of Melbourne , Parkville, VIC , Australia.,6 Department of Radiation Oncology, Peter MacCallum Cancer Centre , Melbourne, VIC , Australia
| |
Collapse
|
20
|
Jin F, Zhou J, Luo HL, Wang Y. In Regard to Briere et al. Int J Radiat Oncol Biol Phys 2017; 96:481. [PMID: 27598814 DOI: 10.1016/j.ijrobp.2016.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Fu Jin
- Division of Physics, Chongqing Cancer Institute, Chongqing, People's Republic of China; Department of Radiation Oncology, Chongqing Cancer Institute, Chongqing, People's Republic of China
| | - Juan Zhou
- Forensic Identification Center, College of Criminal Investigation, Southwest University of Political Science and Law, Chongqing, People's Republic of China
| | - Huan-Li Luo
- Division of Physics, Chongqing Cancer Institute, Chongqing, People's Republic of China
| | - Ying Wang
- Department of Radiation Oncology, Chongqing Cancer Institute, Chongqing, People's Republic of China
| |
Collapse
|
21
|
Eaton DJ, Alty K. Dependence of volume calculation and margin growth accuracy on treatment planning systems for stereotactic radiosurgery. Br J Radiol 2017; 90:20170633. [PMID: 29022748 DOI: 10.1259/bjr.20170633] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Uncertainties in radiotherapy target structures are partly dependent on differences between volume calculation and margin growing methods in treatment planning systems (TPS). These uncertainties are exacerbated with very small structures such as those common in stereotactic radiosurgery. METHODS Data from a national commissioning programme for SRS was used to assess variation in reported volumes for six benchmark cases, including malignant and benign indications. Reported volumes were compared both with and without any margins added according to local practice. RESULTS 137 plans were submitted, with a total of 311 structures and covering seven TPS. For volumes < 1 cm3 agreement was within 0.05 cm3, and for volumes > 1 cm3 agreement was within 5%. Systematic differences were seen between TPS, partly because of different methods for calculating the end slice volume. About one third of structures had a margin added, of 1-2 mm. Most TPS over-grew the volumes, compared to the approximation of a perfect sphere, especially Pinnacle and Eclipse. CONCLUSION Differences between volume calculation methods may lead to 5-10% variation in reported volumes from different TPS. This should be taken into account when comparing multicentre studies, and it is recommended that a minimum volume of 0.05 cm3 be used for any near-point doses to allow more consistent comparisons. When margins are added to small structures, there may be up to 40% difference to nominal margin size. Such differences are still small compared to interobserver variation in delineation. Advances in knowledge: This study quantifies the potential uncertainties in clinical volume calculation and margin growth with small radiosurgical targets.
Collapse
Affiliation(s)
- David J Eaton
- 1 National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Hospital , Northwood , UK
| | - Kevin Alty
- 2 Radiotherapy Physics, Leeds Cancer Centre , Leeds , UK
| |
Collapse
|
22
|
Isobio software: biological dose distribution and biological dose volume histogram from physical dose conversion using linear-quadratic-linear model. J Contemp Brachytherapy 2017; 9:44-51. [PMID: 28344603 PMCID: PMC5346611 DOI: 10.5114/jcb.2017.66082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/20/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To develop an in-house software program that is able to calculate and generate the biological dose distribution and biological dose volume histogram by physical dose conversion using the linear-quadratic-linear (LQL) model. MATERIAL AND METHODS The Isobio software was developed using MATLAB version 2014b to calculate and generate the biological dose distribution and biological dose volume histograms. The physical dose from each voxel in treatment planning was extracted through Computational Environment for Radiotherapy Research (CERR), and the accuracy was verified by the differentiation between the dose volume histogram from CERR and the treatment planning system. An equivalent dose in 2 Gy fraction (EQD2) was calculated using biological effective dose (BED) based on the LQL model. The software calculation and the manual calculation were compared for EQD2 verification with pair t-test statistical analysis using IBM SPSS Statistics version 22 (64-bit). RESULTS Two and three-dimensional biological dose distribution and biological dose volume histogram were displayed correctly by the Isobio software. Different physical doses were found between CERR and treatment planning system (TPS) in Oncentra, with 3.33% in high-risk clinical target volume (HR-CTV) determined by D90%, 0.56% in the bladder, 1.74% in the rectum when determined by D2cc, and less than 1% in Pinnacle. The difference in the EQD2 between the software calculation and the manual calculation was not significantly different with 0.00% at p-values 0.820, 0.095, and 0.593 for external beam radiation therapy (EBRT) and 0.240, 0.320, and 0.849 for brachytherapy (BT) in HR-CTV, bladder, and rectum, respectively. CONCLUSIONS The Isobio software is a feasible tool to generate the biological dose distribution and biological dose volume histogram for treatment plan evaluation in both EBRT and BT.
Collapse
|
23
|
Guimas V, Thariat J, Graff-Cailleau P, Boisselier P, Pointreau Y, Pommier P, Montbarbon X, Laude C, Racadot S. Radiothérapie conformationnelle avec modulation d’intensité des cancers des voies aérodigestives supérieures, dose de tolérance des tissus sains : appareil cochléovestibulaire et tronc cérébral. Cancer Radiother 2016; 20:475-83. [DOI: 10.1016/j.canrad.2016.07.077] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 12/25/2022]
|
24
|
Hardcastle N, Oborn BM, Haworth A. On the use of a convolution-superposition algorithm for plan checking in lung stereotactic body radiation therapy. J Appl Clin Med Phys 2016; 17:99-110. [PMID: 27685114 PMCID: PMC5874108 DOI: 10.1120/jacmp.v17i5.6186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 05/09/2016] [Accepted: 04/18/2016] [Indexed: 12/31/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) aims to deliver a highly conformal ablative dose to a small target. Dosimetric verification of SBRT for lung tumors presents a challenge due to heterogeneities, moving targets, and small fields. Recent software (M3D) designed for dosimetric verification of lung SBRT treatment plans using an advanced convolution–superposition algorithm was evaluated. Ten lung SBRT patients covering a range of tumor volumes were selected. 3D CRT plans were created using the XiO treatment planning system (TPS) with the superposition algorithm. Dose was recalculated in the Eclipse TPS using the AAA algorithm, M3D verification software using the collapsed‐cone‐convolution algorithm, and in‐house Monte Carlo (MC). Target point doses were calculated with RadCalc software. Near‐maximum, median, and near‐minimum target doses, conformity indices, and lung doses were compared with MC as the reference calculation. M3D 3D gamma passing rates were compared with the XiO and Eclipse. Wilcoxon signed‐rank test was used to compare each calculation method with XiO with a threshold of significance of p<0.05. M3D and RadCalc point dose calculations were greater than MC by up to 7.7% and 13.1%, respectively, with M3D being statistically significant (s.s.). AAA and XiO calculated point doses were less than MC by 11.3% and 5.2%, respectively (AAA s.s.). Median and near‐minimum and near‐maximum target doses were less than MC when calculated with AAA and XiO (all s.s.). Near‐maximum and median target doses were higher with M3D compared with MC (s.s.), but there was no difference in near‐minimum M3D doses compared with MC. M3D‐calculated ipsilateral lung V20 Gy and V5 Gy were greater than that calculated with MC (s.s.); AAA‐ and XiO‐calculated V20 Gy was lower than that calculated with MC, but not statistically different to MC for V5 Gy. Nine of the 10 plans achieved M3D gamma passing rates greater than 95% and 80%for 5%/1 mm and 3%/1 mm criteria, respectively. M3D typically calculated a higher target and lung dose than MC for lung SBRT plans. The results show a range of calculated doses with different algorithms and suggest that M3D is in closer agreement with Monte Carlo, thus discrepancies between the TPS and M3D software will be observed for lung SBRT plans. M3D provides a useful supplement to verification of lung SBRT plans by direct measurement, which typically excludes patient specific heterogeneities. PACS number(s): 87.55.D‐, 87.55.Qr, 87.55.K‐
Collapse
|
25
|
Evaluating the utility of “3D Slicer” as a fast and independent tool to assess intrafractional organ dose variations in gynecological brachytherapy. Brachytherapy 2016; 15:514-523. [DOI: 10.1016/j.brachy.2016.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/15/2016] [Accepted: 03/21/2016] [Indexed: 11/17/2022]
|
26
|
Nelms B, Stambaugh C, Hunt D, Tonner B, Zhang G, Feygelman V. Methods, software and datasets to verify DVH calculations against analytical values: Twenty years late(r). Med Phys 2016; 42:4435-48. [PMID: 26233174 DOI: 10.1118/1.4923175] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The authors designed data, methods, and metrics that can serve as a standard, independent of any software package, to evaluate dose-volume histogram (DVH) calculation accuracy and detect limitations. The authors use simple geometrical objects at different orientations combined with dose grids of varying spatial resolution with linear 1D dose gradients; when combined, ground truth DVH curves can be calculated analytically in closed form to serve as the absolute standards. METHODS dicom RT structure sets containing a small sphere, cylinder, and cone were created programmatically with axial plane spacing varying from 0.2 to 3 mm. Cylinders and cones were modeled in two different orientations with respect to the IEC 1217 Y axis. The contours were designed to stringently but methodically test voxelation methods required for DVH. Synthetic RT dose files were generated with 1D linear dose gradient and with grid resolution varying from 0.4 to 3 mm. Two commercial DVH algorithms-pinnacle (Philips Radiation Oncology Systems) and PlanIQ (Sun Nuclear Corp.)-were tested against analytical values using custom, noncommercial analysis software. In Test 1, axial contour spacing was constant at 0.2 mm while dose grid resolution varied. In Tests 2 and 3, the dose grid resolution was matched to varying subsampled axial contours with spacing of 1, 2, and 3 mm, and difference analysis and metrics were employed: (1) histograms of the accuracy of various DVH parameters (total volume, Dmax, Dmin, and doses to % volume: D99, D95, D5, D1, D0.03 cm(3)) and (2) volume errors extracted along the DVH curves were generated and summarized in tabular and graphical forms. RESULTS In Test 1, pinnacle produced 52 deviations (15%) while PlanIQ produced 5 (1.5%). In Test 2, pinnacle and PlanIQ differed from analytical by >3% in 93 (36%) and 18 (7%) times, respectively. Excluding Dmin and Dmax as least clinically relevant would result in 32 (15%) vs 5 (2%) scored deviations for pinnacle vs PlanIQ in Test 1, while Test 2 would yield 53 (25%) vs 17 (8%). In Test 3, statistical analyses of volume errors extracted continuously along the curves show pinnacle to have more errors and higher variability (relative to PlanIQ), primarily due to pinnacle's lack of sufficient 3D grid supersampling. Another major driver for pinnacle errors is an inconsistency in implementation of the "end-capping"; the additional volume resulting from expanding superior and inferior contours halfway to the next slice is included in the total volume calculation, but dose voxels in this expanded volume are excluded from the DVH. PlanIQ had fewer deviations, and most were associated with a rotated cylinder modeled by rectangular axial contours; for coarser axial spacing, the limited number of cross-sectional rectangles hinders the ability to render the true structure volume. CONCLUSIONS The method is applicable to any DVH-calculating software capable of importing dicom RT structure set and dose objects (the authors' examples are available for download). It includes a collection of tests that probe the design of the DVH algorithm, measure its accuracy, and identify failure modes. Merits and applicability of each test are discussed.
Collapse
Affiliation(s)
| | | | - Dylan Hunt
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida 33612
| | - Brian Tonner
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida 33612
| | - Geoffrey Zhang
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida 33612
| | - Vladimir Feygelman
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida 33612
| |
Collapse
|
27
|
Nyholm T, Olsson C, Agrup M, Björk P, Björk-Eriksson T, Gagliardi G, Grinaker H, Gunnlaugsson A, Gustafsson A, Gustafsson M, Johansson B, Johnsson S, Karlsson M, Kristensen I, Nilsson P, Nyström L, Onjukka E, Reizenstein J, Skönevik J, Söderström K, Valdman A, Zackrisson B, Montelius A. A national approach for automated collection of standardized and population-based radiation therapy data in Sweden. Radiother Oncol 2016; 119:344-50. [DOI: 10.1016/j.radonc.2016.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 10/21/2022]
|
28
|
Pogson EM, Begg J, Jameson MG, Dempsey C, Latty D, Batumalai V, Lim A, Kandasamy K, Metcalfe PE, Holloway LC. A phantom assessment of achievable contouring concordance across multiple treatment planning systems. Radiother Oncol 2015; 117:438-41. [DOI: 10.1016/j.radonc.2015.09.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 09/01/2015] [Accepted: 09/18/2015] [Indexed: 11/26/2022]
|
29
|
Yahya N, Ebert MA, Bulsara M, House MJ, Kennedy A, Joseph DJ, Denham JW. Urinary symptoms following external beam radiotherapy of the prostate: Dose-symptom correlates with multiple-event and event-count models. Radiother Oncol 2015; 117:277-82. [PMID: 26476560 DOI: 10.1016/j.radonc.2015.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 09/30/2015] [Accepted: 10/03/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE This study aimed to compare urinary dose-symptom correlates after external beam radiotherapy of the prostate using commonly utilised peak-symptom models to multiple-event and event-count models which account for repeated events. MATERIALS AND METHODS Urinary symptoms (dysuria, haematuria, incontinence and frequency) from 754 participants from TROG 03.04-RADAR trial were analysed. Relative (R1-R75 Gy) and absolute (A60-A75Gy) bladder dose-surface area receiving more than a threshold dose and equivalent uniform dose using exponent a (range: a ∈[1 … 100]) were derived. The dose-symptom correlates were analysed using; peak-symptom (logistic), multiple-event (generalised estimating equation) and event-count (negative binomial regression) models. RESULTS Stronger dose-symptom correlates were found for incontinence and frequency using multiple-event and/or event-count models. For dysuria and haematuria, similar or better relationships were found using peak-symptom models. Dysuria, haematuria and high grade (⩾ 2) incontinence were associated to high dose (R61-R71 Gy). Frequency and low grade (⩾ 1) incontinence were associated to low and intermediate dose-surface parameters (R13-R41Gy). Frequency showed a parallel behaviour (a=1) while dysuria, haematuria and incontinence showed a more serial behaviour (a=4 to a ⩾ 100). Relative dose-surface showed stronger dose-symptom associations. CONCLUSIONS For certain endpoints, the multiple-event and event-count models provide stronger correlates over peak-symptom models. Accounting for multiple events may be advantageous for a more complete understanding of urinary dose-symptom relationships.
Collapse
Affiliation(s)
- Noorazrul Yahya
- School of Physics, University of Western Australia, Australia; School of Health Sciences, National University of Malaysia, Malaysia.
| | - Martin A Ebert
- School of Physics, University of Western Australia, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, Australia
| | - Michael J House
- School of Physics, University of Western Australia, Australia
| | - Angel Kennedy
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Australia
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Australia; School of Surgery, University of Western Australia, Australia
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, Australia
| |
Collapse
|
30
|
Duchesne GM, Haworth A, Bone E, Carter H, Ebert MA, Gagliardi F, Gibbs A, Hornby C, Martin A, Sidhom M, Wood M, Jackson M. Testing the Assessment of New Radiation Oncology Technology and Treatments framework using the evaluation of post-prostatectomy radiotherapy techniques. J Med Imaging Radiat Oncol 2015; 60:129-37. [PMID: 26439588 DOI: 10.1111/1754-9485.12390] [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: 05/07/2015] [Accepted: 08/16/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION We tested the ability of the Assessment of New Radiation Oncology Technology and Treatments framework to determine the clinical efficacy and safety of intensity-modulated radiation therapy (IMRT) compared with 3-dimensional radiation therapy (3DCRT) for post-prostatectomy radiation therapy (PPRT) to support its timely health economic evaluation. METHODS Treatment plans produced using FROGG guidelines provided dosimetry parameters for both techniques at 64 Gy and 70 Gy and were also used to model early and late outcome probabilities. Clinical parameters were derived from early toxicity and quality of life patient data, systematic literature review and expert opinion. Dosimetry parameters were correlated with the measures of clinical efficacy and safety. RESULTS Data from two patient cohorts (29 and 27 respectively) were collected within the project timeframe, providing evidence for acute toxicity and quality of life, and dosimetric comparisons. Relative rates of tumour control probability (TCP) and normal tissue control probability (NTCP) modelling were readily derived from the planning exercise and demonstrated advantages in uncomplicated TCP for IMRT over 3DCRT, predominantly due to normal tissue sparing. The safety of IMRT delivery was demonstrated with TCP uncompromised by IMRT protocol violations, which achieved rectal sparing only by reducing minimum target dose and coverage. CONCLUSION Sources of desk-top and patient-based evidence were successfully used to demonstrate potential improved clinical efficacy and safety of applying dose escalation using IMRT instead of 3DCRT in PPRT.
Collapse
Affiliation(s)
- Gillian M Duchesne
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Annette Haworth
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Eric Bone
- TROG, Consumer Representative, Newcastle, New South Wales, Australia
| | - Hannah Carter
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Martin A Ebert
- Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Physics, University of Western Australia, Perth, Western Australia, Australia
| | - Frank Gagliardi
- William Buckland Radiotherapy Centre, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Adrian Gibbs
- Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Colin Hornby
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Sidhom
- Liverpool Cancer Therapy Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Maree Wood
- Coffs Harbour Health Campus, North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Michael Jackson
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
31
|
CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol 2015; 117:83-90. [PMID: 26277855 DOI: 10.1016/j.radonc.2015.07.041] [Citation(s) in RCA: 381] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 12/25/2022]
|
32
|
Srivastava SP, Cheng CW, Das IJ. The effect of slice thickness on target and organs at risk volumes, dosimetric coverage and radiobiological impact in IMRT planning. Clin Transl Oncol 2015; 18:469-79. [DOI: 10.1007/s12094-015-1390-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 08/17/2015] [Indexed: 12/31/2022]
|
33
|
Yahya N, Ebert MA, Bulsara M, Haworth A, Kennedy A, Joseph DJ, Denham JW. Dosimetry, clinical factors and medication intake influencing urinary symptoms after prostate radiotherapy: An analysis of data from the RADAR prostate radiotherapy trial. Radiother Oncol 2015; 116:112-8. [PMID: 26163088 DOI: 10.1016/j.radonc.2015.06.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 05/31/2015] [Accepted: 06/08/2015] [Indexed: 01/09/2023]
Abstract
PURPOSE/OBJECTIVE To identify dosimetry, clinical factors and medication intake impacting urinary symptoms after prostate radiotherapy. MATERIAL AND METHODS Data describing clinical factors and bladder dosimetry (reduced with principal component (PC) analysis) for 754 patients treated with external beam radiotherapy accrued by TROG 03.04 RADAR prostate radiotherapy trial were available for analysis. Urinary symptoms (frequency, incontinence, dysuria and haematuria) were prospectively assessed using LENT-SOMA to a median of 72months. The endpoints assessed were prevalence (grade ⩾1) at the end of radiotherapy (representing acute symptoms), at 18-, 36- and 54-month follow-ups (representing late symptoms) and peak late incidence including only grade ⩾2. Impact of factors was assessed using multivariate logistic regression models with correction for over-optimism. RESULTS Baseline symptoms, non-insulin dependent diabetes mellitus, age and PC1 (correlated to the mean dose) impact symptoms at >1 timepoints. Associations at a single timepoint were found for cerebrovascular condition, ECOG status and non-steroidal anti-inflammatory drug intake. Peak incidence analysis shows the impact of baseline, bowel and cerebrovascular condition and smoking status. CONCLUSIONS The prevalence and incidence analysis provide a complementary view for urinary symptom prediction. Sustained impacts across time points were found for several factors while some associations were not repeated at different time points suggesting poorer or transient impact.
Collapse
Affiliation(s)
- Noorazrul Yahya
- School of Physics, University of Western Australia, Australia; Faculty of Health Sciences, National University of Malaysia, Bangi, Malaysia.
| | - Martin A Ebert
- School of Physics, University of Western Australia, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Australia
| | - Max Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, Australia
| | - Annette Haworth
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Angel Kennedy
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Australia
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Australia; School of Surgery, University of Western Australia, Australia
| | - Jim W Denham
- School of Medicine and Public Health, University of Newcastle, Australia
| |
Collapse
|
34
|
Brown E, Cray A, Haworth A, Chander S, Lin R, Subramanian B, Ng M. Dose planning objectives in anal canal cancer IMRT: the TROG ANROTAT experience. J Med Radiat Sci 2015; 62:99-107. [PMID: 26229674 PMCID: PMC4462981 DOI: 10.1002/jmrs.99] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 01/09/2015] [Accepted: 01/20/2015] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Intensity modulated radiotherapy (IMRT) is ideal for anal canal cancer (ACC), delivering high doses to irregular tumour volumes whilst minimising dose to surrounding normal tissues. Establishing achievable dose objectives is a challenge. The purpose of this paper was to utilise data collected in the Assessment of New Radiation Oncology Treatments and Technologies (ANROTAT) project to evaluate the feasibility of ACC IMRT dose planning objectives employed in the Australian situation. METHODS Ten Australian centres were randomly allocated three data sets from 15 non-identifiable computed tomography data sets representing a range of disease stages and gender. Each data set was planned by two different centres, producing 30 plans. All tumour and organ at risk (OAR) contours, prescription and dose constraint details were provided. Dose-volume histograms (DVHs) for each plan were analysed to evaluate the feasibility of dose planning objectives provided. RESULTS All dose planning objectives for the bone marrow (BM) and femoral heads were achieved. Median planned doses exceeded one or more objectives for bowel, external genitalia and bladder. This reached statistical significance for bowel V30 (P = 0.04), V45 (P < 0.001), V50 (P < 0.001), external genitalia V20 (P < 0.001) and bladder V35 (P < 0.001), V40 (P = 0.01). Gender was found to be the only significant factor in the likelihood of achieving the bowel V50 (P = 0.03) and BM V30 constraints (P = 0.04). CONCLUSION The dose planning objectives used in the ANROTAT project provide a good starting point for ACC IMRT planning. To facilitate clinical implementation, it is important to prioritise OAR objectives and recognise factors that affect the achievability of these objectives.
Collapse
Affiliation(s)
| | - Alison Cray
- Peter MacCallum Cancer Cancer Centre Box Hill, Victoria, Australia
| | - Annette Haworth
- Peter MacCallum Cancer Cancer Centre Box Hill, Victoria, Australia ; University of Melbourne Melbourne, Victoria, Australia
| | - Sarat Chander
- Peter MacCallum Cancer Cancer Centre Box Hill, Victoria, Australia
| | - Robert Lin
- Medica Oncology Hurstville, New South Wales, Australia
| | | | - Michael Ng
- Radiation Oncology Victoria Melbourne, Victoria, Australia
| |
Collapse
|
35
|
Rosewall T, Kong V, Heaton R, Currie G, Milosevic M, Wheat J. The Effect of Dose Grid Resolution on Dose Volume Histograms for Slender Organs at Risk during Pelvic Intensity-modulated Radiotherapy. J Med Imaging Radiat Sci 2014; 45:204-209. [DOI: 10.1016/j.jmir.2014.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
|
36
|
Olsson C, Thor M, Liu M, Moissenko V, Petersen SE, Høyer M, Apte A, Deasy JO. Influence of image slice thickness on rectal dose-response relationships following radiotherapy of prostate cancer. Phys Med Biol 2014; 59:3749-59. [PMID: 24936956 DOI: 10.1088/0031-9155/59/14/3749] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
When pooling retrospective data from different cohorts, slice thicknesses of acquired computed tomography (CT) images used for treatment planning may vary between cohorts. It is, however, not known if varying slice thickness influences derived dose-response relationships. We investigated this for rectal bleeding using dose-volume histograms (DVHs) of the rectum and rectal wall for dose distributions superimposed on images with varying CT slice thicknesses. We used dose and endpoint data from two prostate cancer cohorts treated with three-dimensional conformal radiotherapy to either 74 Gy (N = 159) or 78 Gy (N = 159) at 2 Gy per fraction. The rectum was defined as the whole organ with content, and the morbidity cut-off was Grade ≥2 late rectal bleeding. Rectal walls were defined as 3 mm inner margins added to the rectum. DVHs for simulated slice thicknesses from 3 to 13 mm were compared to DVHs for the originally acquired slice thicknesses at 3 and 5 mm. Volumes, mean, and maximum doses were assessed from the DVHs, and generalized equivalent uniform dose (gEUD) values were calculated. For each organ and each of the simulated slice thicknesses, we performed predictive modeling of late rectal bleeding using the Lyman-Kutcher-Burman (LKB) model. For the most coarse slice thickness, rectal volumes increased (≤18%), whereas maximum and mean doses decreased (≤0.8 and ≤4.2 Gy, respectively). For all a values, the gEUD for the simulated DVHs were ≤1.9 Gy different than the gEUD for the original DVHs. The best-fitting LKB model parameter values with 95% CIs were consistent between all DVHs. In conclusion, we found that the investigated slice thickness variations had minimal impact on rectal dose-response estimations. From the perspective of predictive modeling, our results suggest that variations within 10 mm in slice thickness between cohorts are unlikely to be a limiting factor when pooling multi-institutional rectal dose data that include slice thickness variations within this range.
Collapse
Affiliation(s)
- C Olsson
- Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Sweden
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Westberg J, Krogh S, Brink C, Vogelius IR. A DICOM based radiotherapy plan database for research collaboration and reporting. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/1742-6596/489/1/012100] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
38
|
Das IJ, Glatstein E. The music of V20: a symphony or cacophony? Int J Radiat Oncol Biol Phys 2014; 88:973-4. [PMID: 24606859 DOI: 10.1016/j.ijrobp.2013.12.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 11/26/2013] [Accepted: 12/15/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Indra J Das
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Eli Glatstein
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
39
|
van Nieuwenhuysen J, Waterhouse D, Bydder S, Joseph D, Ebert M, Caswell N. Survey of high-dose-rate prostate brachytherapy practice in Australia and New Zealand, 2010-2011. J Med Imaging Radiat Oncol 2013; 58:101-8. [PMID: 24529063 DOI: 10.1111/1754-9485.12101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 06/19/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION A survey was designed to establish a baseline data set for the current routine practice of high-dose-rate prostate brachytherapy (HDR-PB) in Australia and New Zealand. Existing treatment protocols and clinical implementations are not generally known. METHODS The survey, for the 2010 and 2011 calendar years, collected data including number of patients treated; equipment used; imaging modalities; applicator verification and correction methods; dose prescriptions and normal tissue dose constraints. The number of HDR-PB patients treated was compared with the most recently published prostate cancer incidence data in Australia and in New Zealand. Total biologically equivalent doses in 2.0 Gy fractions (EQD2) were calculated for each prescription regime reported. RESULTS There were reductions, of 25-60%, in patients treated with HDR-PB from 2010 to 2011 in four departments. Prostate cancer patients are two to six times more likely to be prescribed HDR-PB in Western Australia than elsewhere in the region. There were 12 different treatment prescriptions, with EQD2 doses ranging from 73.5 to 97.6 Gy, among the 18 reported by survey respondents. Normal tissue definition methodology and dose constraints varied, and 13 of 15 departments reported that no particular published external guidelines were followed in full. CONCLUSION The high survey response rate, 15 of 17 departments, has provided a representative baseline data set of contemporary HDR-PB practice in Australia and New Zealand that may assist government and professional bodies, such as the Australasian Brachytherapy Group, in formulating recommendations, setting standards and future planning.
Collapse
Affiliation(s)
- Jane van Nieuwenhuysen
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | | | | | | | | | | |
Collapse
|
40
|
Wang J, Chen W, Studenski M, Cui Y, Lee AJ, Xiao Y. A semi-automated tool for treatment plan-quality evaluation and clinical trial quality assurance. Phys Med Biol 2013; 58:N181-7. [PMID: 23756538 DOI: 10.1088/0031-9155/58/13/n181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The goal of this work is to develop a plan-quality evaluation program for clinical routine and multi-institutional clinical trials so that the overall evaluation efficiency is improved. In multi-institutional clinical trials evaluating the plan quality is a time-consuming and labor-intensive process. In this note, we present a semi-automated plan-quality evaluation program which combines MIMVista, Java/MATLAB, and extensible markup language (XML). More specifically, MIMVista is used for data visualization; Java and its powerful function library are implemented for calculating dosimetry parameters; and to improve the clarity of the index definitions, XML is applied. The accuracy and the efficiency of the program were evaluated by comparing the results of the program with the manually recorded results in two RTOG trials. A slight difference of about 0.2% in volume or 0.6 Gy in dose between the semi-automated program and manual recording was observed. According to the criteria of indices, there are minimal differences between the two methods. The evaluation time is reduced from 10-20 min to 2 min by applying the semi-automated plan-quality evaluation program.
Collapse
Affiliation(s)
- Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | | | | | | | | | | |
Collapse
|
41
|
Zhang L, Hub M, Mang S, Thieke C, Nix O, Karger CP, Floca RO. Software for quantitative analysis of radiotherapy: overview, requirement analysis and design solutions. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2013; 110:528-537. [PMID: 23523366 DOI: 10.1016/j.cmpb.2013.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 01/26/2013] [Accepted: 03/04/2013] [Indexed: 06/02/2023]
Abstract
Radiotherapy is a fast-developing discipline which plays a major role in cancer care. Quantitative analysis of radiotherapy data can improve the success of the treatment and support the prediction of outcome. In this paper, we first identify functional, conceptional and general requirements on a software system for quantitative analysis of radiotherapy. Further we present an overview of existing radiotherapy analysis software tools and check them against the stated requirements. As none of them could meet all of the demands presented herein, we analyzed possible conceptional problems and present software design solutions and recommendations to meet the stated requirements (e.g. algorithmic decoupling via dose iterator pattern; analysis database design). As a proof of concept we developed a software library "RTToolbox" following the presented design principles. The RTToolbox is available as open source library and has already been tested in a larger-scale software system for different use cases. These examples demonstrate the benefit of the presented design principles.
Collapse
Affiliation(s)
- Lanlan Zhang
- Software Development for Integrated Diagnostics and Therapy, German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | | | | | | | | | | | | |
Collapse
|
42
|
Young T, Som S, Sathiakumar C, Holloway L. An investigation into positron emission tomography contouring methods across two treatment planning systems. Med Dosim 2013; 38:60-5. [DOI: 10.1016/j.meddos.2012.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 04/18/2012] [Accepted: 07/09/2012] [Indexed: 11/26/2022]
|
43
|
Kearvell R, Haworth A, Ebert MA, Murray J, Hooton B, Richardson S, Joseph DJ, Lamb D, Spry NA, Duchesne G, Denham JW. Quality improvements in prostate radiotherapy: Outcomes and impact of comprehensive quality assurance during the TROG 03.04 ‘RADAR’ trial. J Med Imaging Radiat Oncol 2013; 57:247-57. [DOI: 10.1111/1754-9485.12025] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 10/01/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Rachel Kearvell
- Department of Radiation Oncology; Sir Charles Gairdner Hospital; Nedlands; Western Australia; Australia
| | | | | | - Judy Murray
- Department of Pathology and Molecular Medicine; University of Otago; Wellington; New Zealand
| | - Ben Hooton
- Department of Radiation Oncology; Sir Charles Gairdner Hospital; Nedlands; Western Australia; Australia
| | - Sharon Richardson
- Department of Radiation Oncology; Sir Charles Gairdner Hospital; Nedlands; Western Australia; Australia
| | | | - David Lamb
- Department of Pathology and Molecular Medicine; University of Otago; Wellington; New Zealand
| | | | | | - James W Denham
- School of Medicine and Public Health; University of Newcastle; Callaghan; New South Wales; Australia
| |
Collapse
|
44
|
Pinter C, Lasso A, Wang A, Jaffray D, Fichtinger G. SlicerRT: radiation therapy research toolkit for 3D Slicer. Med Phys 2012; 39:6332-8. [PMID: 23039669 DOI: 10.1118/1.4754659] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Interest in adaptive radiation therapy research is constantly growing, but software tools available for researchers are mostly either expensive, closed proprietary applications, or free open-source packages with limited scope, extensibility, reliability, or user support. To address these limitations, we propose SlicerRT, a customizable, free, and open-source radiation therapy research toolkit. SlicerRT aspires to be an open-source toolkit for RT research, providing fast computations, convenient workflows for researchers, and a general image-guided therapy infrastructure to assist clinical translation of experimental therapeutic approaches. It is a medium into which RT researchers can integrate their methods and algorithms, and conduct comparative testing. METHODS SlicerRT was implemented as an extension for the widely used 3D Slicer medical image visualization and analysis application platform. SlicerRT provides functionality specifically designed for radiation therapy research, in addition to the powerful tools that 3D Slicer offers for visualization, registration, segmentation, and data management. The feature set of SlicerRT was defined through consensus discussions with a large pool of RT researchers, including both radiation oncologists and medical physicists. The development processes used were similar to those of 3D Slicer to ensure software quality. Standardized mechanisms of 3D Slicer were applied for documentation, distribution, and user support. The testing and validation environment was configured to automatically launch a regression test upon each software change and to perform comparison with ground truth results provided by other RT applications. RESULTS Modules have been created for importing and loading DICOM-RT data, computing and displaying dose volume histograms, creating accumulated dose volumes, comparing dose volumes, and visualizing isodose lines and surfaces. The effectiveness of using 3D Slicer with the proposed SlicerRT extension for radiation therapy research was demonstrated on multiple use cases. CONCLUSIONS A new open-source software toolkit has been developed for radiation therapy research. SlicerRT can import treatment plans from various sources into 3D Slicer for visualization, analysis, comparison, and processing. The provided algorithms are extensively tested and they are accessible through a convenient graphical user interface as well as a flexible application programming interface.
Collapse
Affiliation(s)
- Csaba Pinter
- School of Computing, Queen's University, Kingston, Ontario, Canada.
| | | | | | | | | |
Collapse
|
45
|
Denham JW, Wilcox C, Lamb DS, Spry NA, Duchesne G, Atkinson C, Matthews J, Turner S, Kenny L, Tai KH, Gogna NK, Ebert M, Delahunt B, McElduff P, Joseph D. Rectal and urinary dysfunction in the TROG 03.04 RADAR trial for locally advanced prostate cancer. Radiother Oncol 2012; 105:184-92. [DOI: 10.1016/j.radonc.2012.09.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 09/20/2012] [Accepted: 09/29/2012] [Indexed: 01/03/2023]
|