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Liu Y, Chen M, Fang J, Xiao L, Liu S, Li Q, Qiu B, Huang R, Zhang J, Peng Y. A novel evaluation model of image registration for cone-beam computed tomography guided lung cancer radiotherapy. Thorac Cancer 2024; 15:1333-1342. [PMID: 38686543 PMCID: PMC11168913 DOI: 10.1111/1759-7714.15320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The aim of the study was to establish a weighted comprehensive evaluation model (WCEM) of image registration for cone-beam computed tomography (CBCT) guided lung cancer radiotherapy that considers the geometric accuracy of gross target volume (GTV) and organs at risk (OARs), and assess the registration accuracy of different image registration methods to provide clinical references. METHODS The planning CT and CBCT images of 20 lung cancer patients were registered using diverse algorithms (bony and grayscale) and regions of interest (target, ipsilateral, and body). We compared the coverage ratio (CR) of the planning target volume (PTVCT) to GTVCBCT, as well as the dice similarity coefficient (DSC) of the GTV and OARs, considering the treatment position across various registration methods. Furthermore, we developed a mathematical model to assess registration results comprehensively. This model was evaluated and validated using CRFs across four automatic registration methods. RESULTS The grayscale registration method, coupled with the registration of the ipsilateral structure, exhibited the highest level of automatic registration accuracy, the DSC were 0.87 ± 0.09 (GTV), 0.71 ± 0.09 (esophagus), 0.74 ± 0.09 (spinal cord), and 0.91 ± 0.05 (heart), respectively. Our proposed WCEM proved to be both practical and effective. The results clearly indicated that the grayscale registration method, when applied to the ipsilateral structure, achieved the highest CRF score. The average CRF scores, excellent rates, good rate and qualification rates were 58 ± 26, 40%, 75%, and 85%, respectively. CONCLUSIONS This study successfully developed a clinically relevant weighted evaluation model for CBCT-guided lung cancer radiotherapy. Validation confirmed the grayscale method's optimal performance in ipsilateral structure registration.
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Affiliation(s)
- Yimei Liu
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Radiation Oncology, Guangdong Provincial Clinical Research Center for CancerSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Meining Chen
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Radiation Oncology, Guangdong Provincial Clinical Research Center for CancerSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Jianlan Fang
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Radiation Oncology, Guangdong Provincial Clinical Research Center for CancerSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Liangjie Xiao
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Radiation Oncology, Guangdong Provincial Clinical Research Center for CancerSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Songran Liu
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Radiation Oncology, Guangdong Provincial Clinical Research Center for CancerSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Qiwen Li
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Radiation Oncology, Guangdong Provincial Clinical Research Center for CancerSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Bo Qiu
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Radiation Oncology, Guangdong Provincial Clinical Research Center for CancerSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Runda Huang
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Radiation Oncology, Guangdong Provincial Clinical Research Center for CancerSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Jun Zhang
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Radiation Oncology, Guangdong Provincial Clinical Research Center for CancerSun Yat‐sen University Cancer CenterGuangzhouChina
| | - Yinglin Peng
- State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Department of Radiation Oncology, Guangdong Provincial Clinical Research Center for CancerSun Yat‐sen University Cancer CenterGuangzhouChina
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Clark S, Pollard N, Brown E. An evaluation of isocentre shift magnitude and treatment site on image-guided radiation therapy online decision analysis times. J Med Radiat Sci 2023; 70:301-309. [PMID: 37000972 PMCID: PMC10500104 DOI: 10.1002/jmrs.671] [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: 06/28/2022] [Accepted: 03/03/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION The ability to capture more anatomical detail in cone-beam computed tomography (CBCT) imaging compared to kilovoltage (kV) and megavoltage (MV) imaging, has seen a documented shift towards CBCT image verification and staff adopting more extensive image analysis processes. The timeframe associated with assessing online CBCT images, termed the online decision analysis time, if drawn out, can affect treatment efficiency and accuracy. This study aimed to determine the current CBCT online decision analysis time at Radiation Oncology Princess Alexandra Ipswich Road (ROPAIR) and investigate the influence of isocentre shift magnitude and treatment site considerations on this timeframe. METHODS This retrospective clinical audit collected treatment parameters from 202 CBCT images over 2 treatment days. The online decision analysis time was calculated by subtracting the image acquisition timestamp from the image verification shift application timestamp. The quantitative data were analysed using mean, standard deviation, and range in the following categories: all CBCTs, CBCTs grouped by isocentre shift magnitude and CBCTs grouped by treatment site. Content analysis was performed on staff comments made during image analysis. RESULTS The average online decision analysis time was 2:37 ± 1:28 min. On average approximately, head and neck, spine and extremity treatment sites measured 1 min, pelvis, breast, and chest measured 2-3 min with abdomen measuring 4 min. Common categories reported in staff comments included anatomical changes, repositioning, and organs at risk size. CONCLUSION The results provide baseline online decision analysis times. Further refinement is required to determine if the image match method, treatment site considerations, and rotational discrepancies influence this timeframe.
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Affiliation(s)
- Sarah Clark
- Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Natalie Pollard
- Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Elizabeth Brown
- Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
- Radiation Oncology Princess Alexandra HospitalBrisbaneQueenslandAustralia
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Comparative analysis of setup margin calculation in cone beam CT, by van Herk formula, using two different image registration methods. JOURNAL OF RADIOTHERAPY IN PRACTICE 2023. [DOI: 10.1017/s1460396923000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
ABSTRACT
Introduction:
This study aimed to quantify the difference in setup margin in cone beam computed tomography (CBCT) setup imaging, utilising the van Herk formula for two different image registration methods. Two alternative techniques of registration, bony landmark (BL) matching and soft tissue matching (ST) for head and neck cancer patients, were investigated.
Methods:
This study included 30 head and neck cancer patients who received a simultaneous integrated boost of 54–60–66 Gy in 30 fractions, using volumetric modulated arc treatment. A total of 867 CBCT images were acquired during patient setup and further analysed for setup margin calculation. A region of interest was described using a clip box between the reference and CBCT image to calculate the patient’s positional inaccuracy in three translational directions, X, Y and Z, where X was mediolateral, Y was the cranial-caudal, and Z was the anterior-posterior direction in the patient-based coordinate system, respectively. The shifts were captured by altering the BL and ST matching, and the setup margin was calculated using the van Herk formula (=2·5Σ + 0·7σ where Σ was the systematic and σ was the random error).
Results:
The difference between bony and ST matching in most cases was observed to be 1·4 mm in all translational directions at a 95% confidence interval and <1° in all rotational directions. The rotational error was found to be below the action level (±3°); hence, no corrections related to rotational error were made. The translational setup margin for bone and ST-based registration was X (BL) = 4·6 mm, X (ST) = 4·4 mm, Y (BL) = 6·3 mm, Y (ST) = 4·7 mm, Z (BL) = 3·0 mm, Z (ST) = 3·6mm.
Conclusion:
Two distinct registration approaches for head-neck patient setup did not yield any significant difference in the setup margin calculation. A suitable approach for CBCT and reference CT registration technique was required for the setup margin calculation. Confusion in selecting the correct image registration procedure can result in incorrect treatment execution. The compatibility of the two registration approaches was established in this study. Image fusion was neutralised before the second match (ST) to avoid hysteresis. For setup verification using CBCT for the head and neck region, both bone and ST registration were compatible for setup verification.
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Low dose cone beam CT for paediatric image-guided radiotherapy: Image quality and practical recommendations. Radiother Oncol 2021; 163:68-75. [PMID: 34343544 DOI: 10.1016/j.radonc.2021.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Cone beam CT (CBCT) is used in paediatric image-guided radiotherapy (IGRT) for patient setup and internal anatomy assessment. Adult CBCT protocols lead to excessive doses in children, increasing the risk of radiation-induced malignancies. Reducing imaging dose increases quantum noise, degrading image quality. Patient CBCTs also include 'anatomical noise' (e.g. motion artefacts), further degrading quality. We determine noise contributions in paediatric CBCT, recommending practical imaging protocols and thresholds above which increasing dose yields no improvement in image quality. METHODS AND MATERIALS Sixty CBCTs including the thorax or abdomen/pelvis from 7 paediatric patients (aged 6-13 years) were acquired at a range of doses and used to simulate lower dose scans, totalling 192 scans (0.5-12.8 mGy). Noise measured in corresponding regions of each patient and a 10-year-old phantom were compared, modelling total (including anatomical) noise, and quantum noise contributions as a function of dose. Contrast-to-noise ratio (CNR) was measured between fat/muscle. Soft tissue registration was performed on the kidneys, comparing accuracy to the highest dose scans. RESULTS Quantum noise contributed <20% to total noise in all cases, suggesting anatomical noise is the largest determinant of image quality in the abdominal/pelvic region. CNR exceeded 3 in over 90% of cases ≥ 1 mGy, and 57% of cases at 0.5 mGy. Soft tissue registration was accurate for doses > 1 mGy. CONCLUSION Anatomical noise dominates quantum noise in paediatric CBCT. Appropriate soft tissue contrast and registration accuracy can be achieved for doses as low as 1 mGy. Increasing dose above 1 mGy holds no benefit in improving image quality or registration accuracy due to the presence of anatomical noise.
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Sousa F, Jourani Y, Van den Begin R, Otte FX, Ridai S, Desle M, Ferreira A, Ahmimed R, van Klink - de Goeij MC, Van Gestel D. Evaluation of the XVI dual registration tool for image-guided radiotherapy in prostate cancer. Tech Innov Patient Support Radiat Oncol 2021; 18:22-28. [PMID: 33997323 PMCID: PMC8093993 DOI: 10.1016/j.tipsro.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/22/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare the reliability and the required time for two cone-beam CT (CBCT) registration methods for prostate irradiation (PI) and prostate bed irradiation (PBI). Material and methods Two-hundred treatment fractions (in 10 PI and 10 PBI patients) were reanalyzed, using two CBCT registration methods: (1) a combination of an automated chamfer matching (CM) with manual matching (MM), and (2) the automated XVI dual registration tool (DRT). Bland-Altman 95% Limits of Agreement (LoA) were used to assess agreement with manual registration by Radiation Oncologists. Results All 95% LoA for CM + MM were ≤ 0.33 cm. For DRT, several 95% LoA were notably larger than the predefined clinical threshold of 0.3 cm: -0.47 to +0.25 cm (PI) and -0.36 to +0.23 cm (PBI) for the superior-inferior direction and -0.52 to +0.24 cm (PI) and -0.38 to +0.31 cm (PBI) for the anterior-posterior direction.For PI, the average time required was 33 s with CM + MM versus only 18 s with DRT (p = 0.002). For PBI, this was 13 versus 19 s, respectively (p = 0.16). Conclusion For PI, DRT was significantly faster than CM + MM, but the accuracy is insufficient to use without manual verification. Therefore, manual verification is still warranted, but could offset the time benefit. For PBI, the CM + MM method was faster and more accurate.
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Affiliation(s)
- Filipa Sousa
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
- Inholland University of Applied Sciences, School of Health, Haarlem, The Netherlands
- Corresponding author
| | - Younes Jourani
- Medical Physics Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Robbe Van den Begin
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - François-Xavier Otte
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Sara Ridai
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Maxime Desle
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Angela Ferreira
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Radia Ahmimed
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Dirk Van Gestel
- Radiation Oncology Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Mohandass P, Khanna D, Nishaanth B, Saravanan C, Bhalla N, Puri A, Mohandass B. IMPACT OF THREE DIFFERENT MATCHING METHODS ON PATIENT SET-UP ERROR IN X-RAY VOLUMETRIC IMAGING FOR HEAD AND NECK CANCER. Rep Pract Oncol Radiother 2020; 25:906-912. [PMID: 33029107 PMCID: PMC7528047 DOI: 10.1016/j.rpor.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/30/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022] Open
Abstract
Impact of three different matching methods for delivery of Volumetric Modulated Arc Therapy (VMAT) in Cone-beam computed tomography (CBCT) on patient set-up error. As per institutional imaging protocol, 300 CBCT scans of 20 VMAT head and neck cancer patients treated with 60 Gy/30 fractions were chosen for the present study. Approved CT images of the plan were registered as a reference with the CBCT images on board. Grey-scale matching (GM), manual matching (MM), and bone matching (BM) between on-board CBCT and reference CT images were used to assess patient translation errors. Patient positioning verification was evaluated using the Clip-box registration in all three matching methods. Using the GM approach as a reference point, two additional matchings were rendered in offline mode using BM and MM. For analysis, random error (σ), systematic error (∑), maximum error (E) mean set-up error (M), mean displacement vector (R), matching time (Mt), and multiple comparisons using Post hoc Tukey's HSD test were performed. In MM, less random and systematic errors were found than in GM and BM with an insignificant difference (p > 0.05) Compared to BM and GM, the maximum error, mean set-up error, and displacement vector were marginally less in MM (p > 0.05). In MM, an increased Mt relative to BM and GM was observed (p > 0.05). Furthermore, an insignificant difference in set-up error was revealed in a multiple comparison test (p > 0.05). Any of the three matching methods can be used during CBCT to check patient translation errors for the delivery of the VMAT head and neck patients.
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Affiliation(s)
- P. Mohandass
- Department of Physics, School of Sciences, Arts, Media and Management, Karunya Institute of Technology and Sciences, Coimbatore, Tamilnadu, India
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Sector-62, Phase8, SAS Nagar, Mohali 160062, Punjab, India
| | - D. Khanna
- Department of Physics, School of Sciences, Arts, Media and Management, Karunya Institute of Technology and Sciences, Coimbatore, Tamilnadu, India
| | - B. Nishaanth
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Sector-62, Phase8, SAS Nagar, Mohali 160062, Punjab, India
| | - C. Saravanan
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Sector-62, Phase8, SAS Nagar, Mohali 160062, Punjab, India
| | - Narendra Bhalla
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Sector-62, Phase8, SAS Nagar, Mohali 160062, Punjab, India
| | - Abhishek Puri
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Sector-62, Phase8, SAS Nagar, Mohali 160062, Punjab, India
| | - Blessy Mohandass
- Chitkara School of Health Sciences, Chitkara University, Punjab, India
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Bell LJ, Eade T, Hruby G, Bromley R, Kneebone A. Implementing daily soft tissue image guidance with reduced margins for post-prostatectomy radiotherapy: research-based changes to clinical practice. J Med Radiat Sci 2019; 66:259-268. [PMID: 31680490 PMCID: PMC6920694 DOI: 10.1002/jmrs.362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 08/15/2019] [Accepted: 09/29/2019] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION We have previously demonstrated that daily soft tissue matching with reduced anisotropic margins provides an ideal balance between prostate bed coverage and meeting organ at risk constraints. The aim of this study was to evaluate the implementation of this approach in clinical practice. METHODS Thirty-eight radiation therapists (RTs) completed offline IGRT training involving six patients. After training was completed, this approach was implemented clinically. The first 24 patients were evaluated with a central review of match displacements and geographic miss (GM). An assessment of treatment times and planning parameters was also performed. RESULTS During offline training, the anterior-posterior (AP) match discrepancy had the largest mean variation ranging from -0.46 to 0.06 cm and undetected geographic miss occurred in 17% of alignments. The mean time taken to treat the first 24 patients ranged from 12.2 to 20.6 min. The smaller anisotropic margin resulted in similar target coverage but achieved reduced doses to the bladder (V65Gy from 36% to 27%, V40Gy from 54% to 51%) and rectum (V65Gy from 20% to 19%, V60Gy from 27% to 24%, V40Gy from 42% to 38%). The matches of 806 CBCT images in 24 patients were reviewed. The mean match ranged from -0.12 to 0.17 cm AP, -0.14 to 0.14 cm superior-inferior (SI) and -0.04 to 0.04 cm left-right (LR). An undetected geographic miss was found in the prostate bed in 17 (2.1%) images and lymph nodes in 2 (0.2%) images. CONCLUSIONS Daily soft tissue IGRT with reduced anisotropic margins for post-prostatectomy radiotherapy has been successfully implemented. RTs performed better with real-time online matching than they did in offline training, perhaps influenced by having several RTs perform online matching. Daily soft tissue IGRT did not prolong treatment time.
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Affiliation(s)
- Linda J. Bell
- Northern Sydney Cancer CentreRadiation Oncology DepartmentRoyal North Shore HospitalSt LeonardsNSWAustralia
| | - Thomas Eade
- Northern Sydney Cancer CentreRadiation Oncology DepartmentRoyal North Shore HospitalSt LeonardsNSWAustralia
- Northern Clinical SchoolUniversity of SydneySt LeonardsNSWAustralia
| | - George Hruby
- Northern Sydney Cancer CentreRadiation Oncology DepartmentRoyal North Shore HospitalSt LeonardsNSWAustralia
- Northern Clinical SchoolUniversity of SydneySt LeonardsNSWAustralia
| | - Regina Bromley
- Northern Sydney Cancer CentreRadiation Oncology DepartmentRoyal North Shore HospitalSt LeonardsNSWAustralia
| | - Andrew Kneebone
- Northern Sydney Cancer CentreRadiation Oncology DepartmentRoyal North Shore HospitalSt LeonardsNSWAustralia
- Northern Clinical SchoolUniversity of SydneySt LeonardsNSWAustralia
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Mohandass P, Khanna D, Kumar TM, Thiyagaraj T, Saravanan C, Bhalla NK, Puri A. Study to Compare the Effect of Different Registration Methods on Patient Setup Uncertainties in Cone-beam Computed Tomography during Volumetric Modulated Arc Therapy for Breast Cancer Patients. J Med Phys 2018; 43:207-213. [PMID: 30636845 PMCID: PMC6299751 DOI: 10.4103/jmp.jmp_67_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/02/2018] [Accepted: 10/12/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study compared three different methods used in registering cone-beam computed tomography (CBCT) image set with planning CT image set for determining patient setup uncertainties during volumetric modulated arc therapy (VMAT) for breast cancer patients. MATERIALS AND METHODS Seven breast cancer patients treated with 50 Gy in 25 fractions using VMAT technique were chosen for this study. A total of 105 CBCT scans were acquired by image guidance protocol for patient setup verification. Approved plans' CT images were used as the reference image sets for registration with their corresponding CBCT image sets. Setup errors in mediolateral, craniocaudal, and anteroposterior direction were determined using gray-scale matching between the reference CT images and onboard CBCT images. Patient setup verification was performed using clip-box registration (CBR) method during online imaging. Considering the CBR method as the reference, two more registrations were performed using mask registration (MR) method and dual registration (DR) (CBR + MR) method in the offline mode. For comparison, systematic error (∑), random error (σ), mean displacement vector (R), mean setup error (M), and registration time (R t) were analyzed. Post hoc Tukey's honest significant difference test was performed for multiple comparisons. RESULTS Systematic and random errors were less in CBR as compared to MR and DR (P > 0.05). The mean displacement error and mean setup errors were less in CBR as compared to MR and DR (P > 0.05). Increased R t was observed in DR as compared to CBR and MR (P < 0.05). In addition, multiple comparisons did not show any significant difference in patient setup error (P > 0.05). CONCLUSION For breast VMAT plan delivery, all three registration methods show insignificant variation in patient setup error. One can use any of the three registration methods for patient setup verification.
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Affiliation(s)
- P. Mohandass
- Department of Physics, Karunya Institute of Technology and Sciences, Coimbatore, Tamil Nadu, India
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - D. Khanna
- Department of Physics, Karunya Institute of Technology and Sciences, Coimbatore, Tamil Nadu, India
| | - T. Manoj Kumar
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - T. Thiyagaraj
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - C. Saravanan
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - Narendra Kumar Bhalla
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - Abhishek Puri
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
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Goldsworthy S, Leslie-Dakers M, Higgins S, Barnes T, Jankowska P, Dogramadzi S, Latour JM. A Pilot Study Evaluating the Effectiveness of Dual-Registration Image-Guided Radiotherapy in Patients with Oropharyngeal Cancer. J Med Imaging Radiat Sci 2017; 48:377-384. [PMID: 31047473 DOI: 10.1016/j.jmir.2017.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of the article was to determine the impact of Dual Registration (DR) image-guided radiotherapy (IGRT) on clinical judgement and treatment delivery for patients with oropharyngeal cancer before implementation. METHODS Ninety cone beam computed tomography images from 10 retrospective patients were matched using standard clipbox registration (SCR) and DR. Three IGRT specialist radiographers performed all registrations and evaluated by intraclass correlation to determine inter-rater agreement, Bland-Altman with 95% limits of agreement to determine differences between SCR and DR procedures, changes in clinical judgment, time taken to perform registrations, and radiographer satisfaction. RESULTS Inter-rater agreement between radiographers using both SCR and DR was high (0.867 and 0.917, P ≤ .0001). The 95% limits of agreement between SCR and DR procedures in the mediolateral, cranial-caudal, and ventrodorsal translational directions were -6.40 to +4.91, -7.49 to +6.05, and -7.00 to +5.44 mm, respectively. The mediolateral direction demonstrated significant proportional bias (P ≤ .001) suggesting non-agreement between SCR and DR. Eighty percent of DR matches resulted in a change in clinical judgement to ensure maximum target coverage. Mean registration times for SCR and DR were 94 and 115 seconds, respectively, and radiographers found DR feasible and satisfactory. CONCLUSION The standard method using SCR in patients with oropharyngeal cancer underestimates the deviation in the lower neck. In these patients, DR is an effective IGRT tool to ensure target coverage of the inferior neck nodes and has demonstrated acceptability to radiotherapy clinical practice.
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Affiliation(s)
- Simon Goldsworthy
- Radiotherapy, Beacon Centre, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK; Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK.
| | - Marcus Leslie-Dakers
- Radiotherapy, Beacon Centre, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Steven Higgins
- Radiotherapy, Beacon Centre, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Terri Barnes
- Radiotherapy, Beacon Centre, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Petra Jankowska
- Radiotherapy, Beacon Centre, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Sanja Dogramadzi
- Bristol Robotics laboratory, University of the West of England, Bristol, UK
| | - Jos M Latour
- Clinical School, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK; School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
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10
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Rosewall T, Yan J, Alasti H, Cerase C, Bayley A. 'Compromise position' image alignment to accommodate independent motion of multiple clinical target volumes during radiotherapy: A high risk prostate cancer example. J Med Imaging Radiat Oncol 2016; 61:271-278. [PMID: 27709834 DOI: 10.1111/1754-9485.12543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 09/04/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Inclusion of multiple independently moving clinical target volumes (CTVs) in the irradiated volume causes an image guidance conundrum. The purpose of this research was to use high risk prostate cancer as a clinical example to evaluate a 'compromise' image alignment strategy. METHODS The daily pre-treatment orthogonal EPI for 14 consecutive patients were included in this analysis. Image matching was performed by aligning to the prostate only, the bony pelvis only and using the 'compromise' strategy. Residual CTV surrogate displacements were quantified for each of the alignment strategies. RESULTS Analysis of the 388 daily fractions indicated surrogate displacements were well-correlated in all directions (r2 = 0.95 (LR), 0.67 (AP) and 0.59 (SI). Differences between the surrogates displacements (95% range) were -0.4 to 1.8 mm (LR), -1.2 to 5.2 mm (SI) and -1.2 to 5.2 mm (AP). The distribution of the residual displacements was significantly smaller using the 'compromise' strategy, compared to the other strategies (p 0.005). The 'compromise' strategy ensured the CTV was encompassed by the PTV in all fractions, compared to 47 PTV violations when aligned to prostate only. CONCLUSIONS This study demonstrated the feasibility of a compromise position image guidance strategy to accommodate simultaneous displacements of two independently moving CTVs. Application of this strategy was facilitated by correlation between the CTV displacements and resulted in no geometric excursions of the CTVs beyond standard sized PTVs. This simple image guidance strategy may also be applicable to other disease sites that concurrently irradiate multiple CTVs, such as head and neck, lung and cervix cancer.
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Affiliation(s)
- Tara Rosewall
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Jing Yan
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Hamideh Alasti
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Carla Cerase
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Andrew Bayley
- Radiation Medicine Program, Princess Margaret Hospital, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
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