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Milewski A, Li G. Stability and Reliability of Enhanced External-Internal Motion Correlation via Dynamic Phase-Shift Corrections Over 30-min Timeframe for Respiratory-Gated Radiotherapy. Technol Cancer Res Treat 2022; 21:15330338221111592. [PMID: 35880289 PMCID: PMC9340341 DOI: 10.1177/15330338221111592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To assess the stability of patient-specific phase shifts between external- and
internal-respiratory motion waveforms, the reliability of enhanced
external–internal correlation with phase-shift correction, and the feasibility
of guiding respiratory-gated radiotherapy (RGRT) over 30 min. In this clinical
feasibility investigation, external bellows and internal-navigator waveforms
were simultaneously and prospectively acquired along with two four-dimensional
magnetic resonance imaging (4DMRI) scans (6–15 m each) with 15–20 m intervals in
10 volunteers. A bellows was placed 5 cm inferior to the xiphoid to monitor
abdominal motion, and an MR navigator was used to track the diaphragmatic
motion. The mean phase-domain (MPD) method was applied, which combines three
individual phase-calculating methods: phase-space oval fitting, principal
component analysis, and analytic signal analysis, weighted by the reciprocal of
their residual errors (RE) excluding outliers (RE >2σ). The time-domain
cross-correlation (TCC) analysis was applied for comparison. Dynamic phase-shift
correction was performed based on the phase shift detected on the fly within two
10 s moving datasets. Simulating bellows-triggered gating, the median and 95%
confidence interval for the navigator's position at beam-on/beam-off and %harm
(percentage of beam-on time outside the safety margin) were calculated. Averaged
across all subjects, the mean phase shifts are found indistinguishable
(p > .05) between scan 1 (55˚ ± 9˚) and scan 2
(59˚ ± 11˚). Using the MPD method the averaged correlation increases from
0.56 ± 0.22 to 0.85 ± 0.11 for scan 1 and from 0.47 ± 0.30 to 0.84 ± 0.08 for
scan 2. The TCC correction results in similar results. After phase-shift
correction, the number of cases that were suitable for amplitude gating (with
<10%harm) increased from 2 to 17 out of 20 cases. A patient-specific, stable
phase-shift between the external and internal motions was observed and corrected
using the MPD and TCC methods, producing long-lasting enhanced motion
correlation over 30m. Phase-shift correction offers a feasible strategy for
improving the accuracy of tumor-motion prediction during RGRT.
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Affiliation(s)
- Andrew Milewski
- Department of Medical Physics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guang Li
- Department of Medical Physics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Fattori G, Hrbacek J, Regele H, Bula C, Mayor A, Danuser S, Oxley DC, Rechsteiner U, Grossmann M, Via R, Böhlen TT, Bolsi A, Walser M, Togno M, Colvill E, Lempen D, Weber DC, Lomax AJ, Safai S. Commissioning and quality assurance of a novel solution for respiratory-gated PBS proton therapy based on optical tracking of surface markers. Z Med Phys 2020; 32:52-62. [PMID: 32830006 PMCID: PMC9948868 DOI: 10.1016/j.zemedi.2020.07.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 06/01/2020] [Accepted: 07/10/2020] [Indexed: 12/15/2022]
Abstract
We present the commissioning and quality assurance of our clinical protocol for respiratory gating in pencil beam scanning proton therapy for cancer patients with moving targets. In a novel approach, optical tracking has been integrated in the therapy workflow and used to monitor respiratory motion from multiple surrogates, applied on the patients' chest. The gating system was tested under a variety of experimental conditions, specific to proton therapy, to evaluate reaction time and reproducibility of dose delivery control. The system proved to be precise in the application of beam gating and allowed the mitigation of dose distortions even for large (1.4cm) motion amplitudes, provided that adequate treatment windows were selected. The total delivered dose was not affected by the use of gating, with measured integral error within 0.15cGy. Analysing high-resolution images of proton transmission, we observed negligible discrepancies in the geometric location of the dose as a function of the treatment window, with gamma pass rate greater than 95% (2%/2mm) compared to stationary conditions. Similarly, pass rate for the latter metric at the 3%/3mm level was observed above 97% for clinical treatment fields, limiting residual movement to 3mm at end-exhale. These results were confirmed in realistic clinical conditions using an anthropomorphic breathing phantom, reporting a similarly high 3%/3mm pass rate, above 98% and 94%, for regular and irregular breathing, respectively. Finally, early results from periodic QA tests of the optical tracker have shown a reliable system, with small variance observed in static and dynamic measurements.
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Affiliation(s)
- Giovanni Fattori
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland.
| | - Jan Hrbacek
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Harald Regele
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Christian Bula
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Alexandre Mayor
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Stefan Danuser
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - David C. Oxley
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Urs Rechsteiner
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Martin Grossmann
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Riccardo Via
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Till T. Böhlen
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Alessandra Bolsi
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Marc Walser
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Michele Togno
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Emma Colvill
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Daniel Lempen
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
| | - Damien C. Weber
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland,Department of Radiation Oncology, University Hospital Zurich, 8091 Zurich, Switzerland,Department of Radiation Oncology, University Hospital Bern, 3000 Bern, Switzerland
| | - Antony J. Lomax
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland,Department of Physics, ETH Zurich, 8092 Zurich, Switzerland
| | - Sairos Safai
- Center for Proton Therapy, Paul Scherrer Institute, 5232 Villigen, Switzerland
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A modular dose delivery system for treating moving targets with scanned ion beams: Performance and safety characteristics, and preliminary tests. Phys Med 2020; 76:307-316. [PMID: 32739784 DOI: 10.1016/j.ejmp.2020.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 07/01/2020] [Accepted: 07/21/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The purpose of this study was to develop a modular dose-delivery system (DDS) for scanned-ion radiotherapy that mitigates against organ motion artifacts by synchronizing the motion of the beam with that of the moving anatomy. METHODS We integrated a new motion synchronization system and an existing DDS into two centers. The modular approach to integration utilized an adaptive layer of software and hardware interfaces. The method of synchronization comprised three major tasks, namely, the creation of 3D treatment plans (each representing one phase of respiratory motion and together comprising a 4D plan), monitoring anatomic motion during treatment, and synchronization of the beam to anatomic motion. The synchronization was accomplished in real time by repeatedly selecting and delivering a 3D plan, i.e., the one that most closely corresponded to the current anatomic state, until all plans were delivered. The performance characteristics of the motion mitigation system were tested by delivering 4D treatment plans to a moving phantom and comparing planned and measured dose distributions. Dosimetric performance was considered acceptable when the gamma-index pass rate was >90%, homogeneity-index value was >95%, and conformity-index value was >60%. Selected safety characteristics were tested by introducing errors during treatment and testing DDS response. RESULTS Acceptable dosimetric performance and safety characteristics were observed for all treatment plans. CONCLUSIONS We demonstrated, for the first time, that a modular prototype system, synchronizing scanned ion beams with moving targets can deliver conformal, motion-compensated dose distributions. The prototype system was implemented and characterized at GSI and CNAO.
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Milewski AR, Olek D, Deasy JO, Rimner A, Li G. Enhancement of Long-Term External-Internal Correlation by Phase-Shift Detection and Correction Based on Concurrent External Bellows and Internal Navigator Signals. Adv Radiat Oncol 2019; 4:377-389. [PMID: 31011684 PMCID: PMC6460238 DOI: 10.1016/j.adro.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 12/26/2018] [Accepted: 02/10/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose The purpose of this study was to enhance the correlation between external and internal respiratory motions by dynamically determining and correcting the patient-specific phase shift between external and internal respiratory waveforms acquired concurrently during respiratory-correlated 4-dimensional magnetic resonance imaging scans. Methods and Materials Internal-navigator and external-bellows waveforms were acquired simultaneously during 6- to 15-minute respiratory-correlated 4-dimensional magnetic resonance imaging scans in 10 healthy participants under an institutional review board–approved protocol. The navigator was placed at the right lung–diaphragm interface, and the bellows were placed ∼5 cm inferior to the sternum. Three segments of each respiratory waveform, at the beginning, middle, and end of a scan, were analyzed. Three phase-domain methods were employed to estimate the phase shift, including analytical signal analysis, phase-space oval fitting, and principal component analysis. A robust strategy for estimating the phase shift was realized by combining these methods in a weighted average and by eliminating outliers (>2 σ) caused by breathing irregularities. Whether phase-shift correction affects the external-internal correlation was evaluated. The cross-correlation between the 2 waveforms in the time domain provided an independent check of the correlation enhancement. Results Phase-shift correction significantly enhanced the external-internal correlation in all participants across the entire 6- to 15-minute scans. On average, the correlation increased from 0.45 ± 0.28 to 0.85 ± 0.15 for the combined method. The combined method exhibited a 99.5% success rate and revealed that the phase of the external waveform leads that of the internal waveform in all 10 participants by 57 o ± 17o (1.6 ± 0.5 bins) on average. Seven participants exhibited highly reproducible phase shifts over time, evidenced by standard deviations (σ) < 4o, whereas 8o < σ < 12o in the remaining 3 participants. Regardless, phase-shift correction significantly improved the correlation in all participants. Conclusions Correcting the phase shift estimated by the phase-domain methods provides a new approach for enhancing the correlation between external and internal respiratory motions. This strategy holds promise for improving the accuracy of respiratory-gated radiation therapy.
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Affiliation(s)
- Andrew R. Milewski
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Devin Olek
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Joseph O. Deasy
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Guang Li
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
- Correspondence author. Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065.
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Pötter R, Balosso J, Baumann M, Bert C, Davies J, Enghardt W, Fossati P, Harris S, Jones B, Krämer M, Mayer R, Mock U, Pullia M, Schreiner T, Dosanjh M, Debus J, Orecchia R, Georg D. Union of light ion therapy centers in Europe (ULICE EC FP7) – Objectives and achievements of joint research activities. Radiother Oncol 2018; 128:83-100. [DOI: 10.1016/j.radonc.2018.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 04/21/2018] [Indexed: 12/25/2022]
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6
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Evaluation of residual abdominal tumour motion in carbon ion gated treatments through respiratory motion modelling. Phys Med 2017; 34:28-37. [DOI: 10.1016/j.ejmp.2017.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/22/2016] [Accepted: 01/11/2017] [Indexed: 11/21/2022] Open
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Kubiak T. Particle therapy of moving targets-the strategies for tumour motion monitoring and moving targets irradiation. Br J Radiol 2016; 89:20150275. [PMID: 27376637 DOI: 10.1259/bjr.20150275] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Particle therapy of moving targets is still a great challenge. The motion of organs situated in the thorax and abdomen strongly affects the precision of proton and carbon ion radiotherapy. The motion is responsible for not only the dislocation of the tumour but also the alterations in the internal density along the beam path, which influence the range of particle beams. Furthermore, in case of pencil beam scanning, there is an interference between the target movement and dynamic beam delivery. This review presents the strategies for tumour motion monitoring and moving target irradiation in the context of hadron therapy. Methods enabling the direct determination of tumour position (fluoroscopic imaging of implanted radio-opaque fiducial markers, electromagnetic detection of inserted transponders and ultrasonic tumour localization systems) are presented. Attention is also drawn to the techniques which use external surrogate motion for an indirect estimation of target displacement during irradiation. The role of respiratory-correlated CT [four-dimensional CT (4DCT)] in the determination of motion pattern prior to the particle treatment is also considered. An essential part of the article is the review of the main approaches to moving target irradiation in hadron therapy: gating, rescanning (repainting), gated rescanning and tumour tracking. The advantages, drawbacks and development trends of these methods are discussed. The new accelerators, called "cyclinacs", are presented, because their application to particle therapy will allow making a breakthrough in the 4D spot scanning treatment of moving organs.
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Affiliation(s)
- Tomasz Kubiak
- Medical Physics Division, Faculty of Physics, Adam Mickiewicz University, Poznań, Poland
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Baumann M, Krause M, Overgaard J, Debus J, Bentzen SM, Daartz J, Richter C, Zips D, Bortfeld T. Radiation oncology in the era of precision medicine. Nat Rev Cancer 2016; 16:234-49. [PMID: 27009394 DOI: 10.1038/nrc.2016.18] [Citation(s) in RCA: 496] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Technological advances and clinical research over the past few decades have given radiation oncologists the capability to personalize treatments for accurate delivery of radiation dose based on clinical parameters and anatomical information. Eradication of gross and microscopic tumours with preservation of health-related quality of life can be achieved in many patients. Two major strategies, acting synergistically, will enable further widening of the therapeutic window of radiation oncology in the era of precision medicine: technology-driven improvement of treatment conformity, including advanced image guidance and particle therapy, and novel biological concepts for personalized treatment, including biomarker-guided prescription, combined treatment modalities and adaptation of treatment during its course.
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Affiliation(s)
- Michael Baumann
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden
- OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, 01307 Dresden
- National Center for Tumor Diseases (NCT), Fetscherstrasse 74, 01307 Dresden
- German Cancer Consortium (DKTK) Dresden, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Oncology, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Mechthild Krause
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden
- OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, 01307 Dresden
- National Center for Tumor Diseases (NCT), Fetscherstrasse 74, 01307 Dresden
- German Cancer Consortium (DKTK) Dresden, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiation Oncology, Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
| | - Jürgen Debus
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), University of Heidelberg Medical School and German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg
- Heidelberg Ion Therapy Center (HIT), Department of Radiation Oncology, University of Heidelberg Medical School, Im Neuenheimer Feld 400, 69120 Heidelberg
- German Cancer Consortium (DKTK) Heidelberg, Germany
| | - Søren M Bentzen
- Department of Epidemiology and Public Health and Greenebaum Cancer Center, University of Maryland School of Medicine, 22 S Greene Street S9a03, Baltimore, Maryland 21201, USA
| | - Juliane Daartz
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital and Harvard Medical School, 1000 Blossom Street Cox 362, Boston, Massachusetts 02114, USA
| | - Christian Richter
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden
- OncoRay - National Center for Radiation Research in Oncology (NCRO), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, and Helmholtz-Zentrum Dresden-Rossendorf, Fetscherstrasse 74, 01307 Dresden
- National Center for Tumor Diseases (NCT), Fetscherstrasse 74, 01307 Dresden
- German Cancer Consortium (DKTK) Dresden, Germany
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Daniel Zips
- German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
- German Cancer Consortium Tübingen, Postfach 2669, 72016 Tübingen
- Department of Radiation Oncology, Faculty of Medicine and University Hospital Tübingen, Eberhard Karls Universität Tübingen, Hoppe-Seyler-Strasse 3, 72016 Tübingen, Germany
| | - Thomas Bortfeld
- Department of Radiation Oncology, Physics Division, Massachusetts General Hospital and Harvard Medical School, 1000 Blossom Street Cox 362, Boston, Massachusetts 02114, USA
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Morel P, Wu X, Blin G, Vialette S, Flynn R, Hyer D, Wang D. Spot Weight Adaptation for Moving Target in Spot Scanning Proton Therapy. Front Oncol 2015; 5:119. [PMID: 26075184 PMCID: PMC4447005 DOI: 10.3389/fonc.2015.00119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 05/13/2015] [Indexed: 12/25/2022] Open
Abstract
Purpose This study describes a real-time spot weight adaptation method in spot-scanning proton therapy for moving target or moving patient, so that the resultant dose distribution closely matches the planned dose distribution. Materials and methods The method proposed in this study adapts the weight (MU) of the delivering pencil beam to that of the target spot; it will actually hit during patient/target motion. The target spot that a certain delivering pencil beam may hit relies on patient monitoring and/or motion modeling using four-dimensional (4D) CT. After the adapted delivery, the required total weight [Monitor Unit (MU)] for this target spot is then subtracted from the planned value. With continuous patient motion and continuous spot scanning, the planned doses to all target spots will eventually be all fulfilled. In a proof-of-principle test, a lung case was presented with realistic temporal and motion parameters; the resultant dose distribution using spot weight adaptation was compared to that without using this method. The impact of the real-time patient/target position tracking or prediction was also investigated. Results For moderate motion (i.e., mean amplitude 0.5 cm), D95% to the planning target volume (PTV) was only 81.5% of the prescription (RX) dose; with spot weight adaptation PTV D95% achieves 97.7% RX. For large motion amplitude (i.e., 1.5 cm), without spot weight adaptation PTV D95% is only 42.9% of RX; with spot weight adaptation, PTV D95% achieves 97.7% RX. Larger errors in patient/target position tracking or prediction led to worse final target coverage; an error of 3 mm or smaller in patient/target position tracking is preferred. Conclusion The proposed spot weight adaptation method was able to deliver the planned dose distribution and maintain target coverage when patient motion was involved. The successful implementation of this method would rely on accurate monitoring or prediction of patient/target motion.
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Affiliation(s)
- Paul Morel
- Laboratoire Informatique Gaspard Monge (LIGM), UMR CNRS 8049, Université Paris-Est , Paris , France
| | - Xiaodong Wu
- Department of Radiation Oncology, The University of Iowa , Iowa City, IA , USA ; Department of Electrical and Computer Engineering, The University of Iowa , Iowa City, IA , USA
| | - Guillaume Blin
- Laboratoire Informatique Gaspard Monge (LIGM), UMR CNRS 8049, Université Paris-Est , Paris , France ; UMR 5800, Laboratoire Bordelais de Recherche en Informatique (LaBRI), Université de Bordeaux , Talence , France
| | - Stéphane Vialette
- Laboratoire Informatique Gaspard Monge (LIGM), UMR CNRS 8049, Université Paris-Est , Paris , France
| | - Ryan Flynn
- Department of Radiation Oncology, The University of Iowa , Iowa City, IA , USA
| | - Daniel Hyer
- Department of Radiation Oncology, The University of Iowa , Iowa City, IA , USA
| | - Dongxu Wang
- Department of Radiation Oncology, The University of Iowa , Iowa City, IA , USA
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Rossi S. The National Centre for Oncological Hadrontherapy (CNAO): Status and perspectives. Phys Med 2015; 31:333-51. [DOI: 10.1016/j.ejmp.2015.03.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/05/2015] [Accepted: 03/04/2015] [Indexed: 11/27/2022] Open
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Giordanengo S, Garella MA, Marchetto F, Bourhaleb F, Ciocca M, Mirandola A, Monaco V, Hosseini MA, Peroni C, Sacchi R, Cirio R, Donetti M. The CNAO dose delivery system for modulated scanning ion beam radiotherapy. Med Phys 2014; 42:263-75. [DOI: 10.1118/1.4903276] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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12
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Bert C, Graeff C, Riboldi M, Nill S, Baroni G, Knopf AC. Advances in 4D treatment planning for scanned particle beam therapy - report of dedicated workshops. Technol Cancer Res Treat 2014; 13:485-95. [PMID: 24354749 PMCID: PMC4527425 DOI: 10.7785/tcrtexpress.2013.600274] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 09/27/2013] [Accepted: 10/01/2013] [Indexed: 11/25/2022] Open
Abstract
We report on recent progress in the field of mobile tumor treatment with scanned particle beams, as discussed in the latest editions of the 4D treatment planning workshop. The workshop series started in 2009, with about 20 people from 4 research institutes involved, all actively working on particle therapy delivery and development. The first workshop resulted in a summary of recommendations for the treatment of mobile targets, along with a list of requirements to apply these guidelines clinically. The increased interest in the treatment of mobile tumors led to a continuously growing number of attendees: the 2012 edition counted more than 60 participants from 20 institutions and commercial vendors. The focus of research discussions among workshop participants progressively moved from 4D treatment planning to complete 4D treatments, aiming at effective and safe treatment delivery. Current research perspectives on 4D treatments include all critical aspects of time resolved delivery, such as in-room imaging, motion detection, beam application, and quality assurance techniques. This was motivated by the start of first clinical treatments of hepato cellular tumors with a scanned particle beam, relying on gating or abdominal compression for motion mitigation. Up to date research activities emphasize significant efforts in investigating advanced motion mitigation techniques, with a specific interest in the development of dedicated tools for experimental validation. Potential improvements will be made possible in the near future through 4D optimized treatment plans that require upgrades of the currently established therapy control systems for time resolved delivery. But since also these novel optimization techniques rely on the validity of the 4DCT, research focusing on alternative 4D imaging technique, such as MRI based 4DCT generation will continue.
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Affiliation(s)
- Christoph Bert
- University Clinic Erlangen, Radiation Oncology, Universitatsstrasse 27, 91054 Erlangen, Germany.
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Zhang Y, Knopf A, Tanner C, Lomax AJ. Online image guided tumour tracking with scanned proton beams: a comprehensive simulation study. Phys Med Biol 2014; 59:7793-817. [DOI: 10.1088/0031-9155/59/24/7793] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Graeff C, Constantinescu A, Lüchtenborg R, Durante M, Bert C. Multigating, a 4D optimized beam tracking in scanned ion beam therapy. Technol Cancer Res Treat 2013; 13:497-504. [PMID: 24354752 PMCID: PMC4527435 DOI: 10.7785/tcrtexpress.2013.600277] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The treatment of moving tumors with a scanned ion beam is challenging due to interplay effects and changing beam range. We propose multigating, as a method for 4D-treatment optimization and delivery. In 3D beam tracking, tracking vectors are added during delivery to beam spot positions based on the detected motion phase. This has the disadvantage of dose errors in case of complex motion patterns and an uncertain out-of-target dose distribution. In multigating, the motion phase for each beam spot is predefined, which allows to add the tracking vector prior to beam weight optimization on all motion phases. The synchronization of delivery and target motion is assured by fast gating. The feasibility of the delivery was shown in a film experiment and required only minor software modification to the treatment planning system. In a treatment planning study in 4 lung cancer patients, target coverage could be restored to the level of a static reference plan by multigating (V95 > 99%) but not by standard beam tracking (V95 < 95%). The conformity of the multigating plans was only slightly lower than those of the static plan, with a conformity number of 72.0% (median, range 64.6–76.6%) compared to 75.8% (70.8–81.5%) in spite of target motion of up to 22 mm. In conclusion, we showed the technical feasibility of multigating, a 4D-optimization and delivery method using scanned beams that allows for conformal and homogeneous dose delivery to moving targets also in case of complex motion.
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Affiliation(s)
- Christian Graeff
- GSI Helmholtzzentrum fur Schwerionenforschung GmbH, Darmstadt, Germany.
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Fattori G, Saito N, Seregni M, Kaderka R, Pella A, Constantinescu A, Riboldi M, Steidl P, Cerveri P, Bert C, Durante M, Baroni G. Commissioning of an integrated platform for time-resolved treatment delivery in scanned ion beam therapy by means of optical motion monitoring. Technol Cancer Res Treat 2013; 13:517-28. [PMID: 24354750 PMCID: PMC4527457 DOI: 10.7785/tcrtexpress.2013.600275] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The integrated use of optical technologies for patient monitoring is addressed in the framework of time-resolved treatment delivery for scanned ion beam therapy. A software application has been designed to provide the therapy control system (TCS) with a continuous geometrical feedback by processing the external surrogates tridimensional data, detected in real-time via optical tracking. Conventional procedures for phase-based respiratory phase detection were implemented, as well as the interface to patient specific correlation models, in order to estimate internal tumor motion from surface markers. In this paper, particular attention is dedicated to the quantification of time delays resulting from system integration and its compensation by means of polynomial interpolation in the time domain. Dedicated tests to assess the separate delay contributions due to optical signal processing, digital data transfer to the TCS and passive beam energy modulation actuation have been performed. We report the system technological commissioning activities reporting dose distribution errors in a phantom study, where the treatment of a lung lesion was simulated, with both lateral and range beam position compensation. The zero-delay systems integration with a specific active scanning delivery machine was achieved by tuning the amount of time prediction applied to lateral (14.61 ± 0.98 ms) and depth (34.1 ± 6.29 ms) beam position correction signals, featuring sub-millimeter accuracy in forward estimation. Direct optical target observation and motion phase (MPh) based tumor motion discretization strategies were tested, resulting in −0.3(2.3)% and −1.2(9.3)% median (IQR) percentual relative dose difference with respect to static irradiation, respectively. Results confirm the technical feasibility of the implemented strategy towards 4D treatment delivery, with negligible percentual dose deviations with respect to static irradiation.
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Affiliation(s)
- G Fattori
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, P.zza Leonardo da Vinci 32, 20133 Milano, Italy.
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