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Ma P, Li M, Chen X, Tian Y, Niu C, Feng Q, Dai J. Ultrasound-guided intraoperative electron beam radiation therapy: A phantom study. Phys Med 2020; 78:1-7. [DOI: 10.1016/j.ejmp.2020.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 01/03/2023] Open
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Mori S, Knopf A, Umegaki K. Motion management in particle therapy. Med Phys 2018; 45:e994-e1010. [DOI: 10.1002/mp.12679] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/24/2017] [Accepted: 11/07/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Shinichiro Mori
- Research Center for Charged Particle Therapy National Institute of Radiological Sciences Chiba 263‐8555Japan
| | - Antje‐Christin Knopf
- Department of Radiation Oncology University of Groningen University Medical Center Groningen Groningen 9713 GZ The Netherlands
| | - Kikuo Umegaki
- Faculty of Engineering Division of Quantum Science and Engineering Hokkaido University Sapporo 060‐8628 Japan
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O'Shea T, Bamber J, Fontanarosa D, van der Meer S, Verhaegen F, Harris E. Review of ultrasound image guidance in external beam radiotherapy part II: intra-fraction motion management and novel applications. Phys Med Biol 2016; 61:R90-137. [PMID: 27002558 DOI: 10.1088/0031-9155/61/8/r90] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Imaging has become an essential tool in modern radiotherapy (RT), being used to plan dose delivery prior to treatment and verify target position before and during treatment. Ultrasound (US) imaging is cost-effective in providing excellent contrast at high resolution for depicting soft tissue targets apart from those shielded by the lungs or cranium. As a result, it is increasingly used in RT setup verification for the measurement of inter-fraction motion, the subject of Part I of this review (Fontanarosa et al 2015 Phys. Med. Biol. 60 R77-114). The combination of rapid imaging and zero ionising radiation dose makes US highly suitable for estimating intra-fraction motion. The current paper (Part II of the review) covers this topic. The basic technology for US motion estimation, and its current clinical application to the prostate, is described here, along with recent developments in robust motion-estimation algorithms, and three dimensional (3D) imaging. Together, these are likely to drive an increase in the number of future clinical studies and the range of cancer sites in which US motion management is applied. Also reviewed are selections of existing and proposed novel applications of US imaging to RT. These are driven by exciting developments in structural, functional and molecular US imaging and analytical techniques such as backscatter tissue analysis, elastography, photoacoustography, contrast-specific imaging, dynamic contrast analysis, microvascular and super-resolution imaging, and targeted microbubbles. Such techniques show promise for predicting and measuring the outcome of RT, quantifying normal tissue toxicity, improving tumour definition and defining a biological target volume that describes radiation sensitive regions of the tumour. US offers easy, low cost and efficient integration of these techniques into the RT workflow. US contrast technology also has potential to be used actively to assist RT by manipulating the tumour cell environment and by improving the delivery of radiosensitising agents. Finally, US imaging offers various ways to measure dose in 3D. If technical problems can be overcome, these hold potential for wide-dissemination of cost-effective pre-treatment dose verification and in vivo dose monitoring methods. It is concluded that US imaging could eventually contribute to all aspects of the RT workflow.
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Affiliation(s)
- Tuathan O'Shea
- Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, London SM2 5NG, UK
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Deep Inspiration Breath Hold-Based Radiation Therapy: A Clinical Review. Int J Radiat Oncol Biol Phys 2015; 94:478-92. [PMID: 26867877 DOI: 10.1016/j.ijrobp.2015.11.049] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 11/03/2015] [Accepted: 11/29/2015] [Indexed: 01/06/2023]
Abstract
Several recent developments in linear accelerator-based radiation therapy (RT) such as fast multileaf collimators, accelerated intensity modulation paradigms like volumeric modulated arc therapy and flattening filter-free (FFF) high-dose-rate therapy have dramatically shortened the duration of treatment fractions. Deliverable photon dose distributions have approached physical complexity limits as a consequence of precise dose calculation algorithms and online 3-dimensional image guided patient positioning (image guided RT). Simultaneously, beam quality and treatment speed have continuously been improved in particle beam therapy, especially for scanned particle beams. Applying complex treatment plans with steep dose gradients requires strategies to mitigate and compensate for motion effects in general, particularly breathing motion. Intrafractional breathing-related motion results in uncertainties in dose delivery and thus in target coverage. As a consequence, generous margins have been used, which, in turn, increases exposure to organs at risk. Particle therapy, particularly with scanned beams, poses additional problems such as interplay effects and range uncertainties. Among advanced strategies to compensate breathing motion such as beam gating and tracking, deep inspiration breath hold (DIBH) gating is particularly advantageous in several respects, not only for hypofractionated, high single-dose stereotactic body RT of lung, liver, and upper abdominal lesions but also for normofractionated treatment of thoracic tumors such as lung cancer, mediastinal lymphomas, and breast cancer. This review provides an in-depth discussion of the rationale and technical implementation of DIBH gating for hypofractionated and normofractionated RT of intrathoracic and upper abdominal tumors in photon and proton RT.
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Stereotactic Body Radiation Therapy for Liver Cancer: A Review of the Technology. J Med Imaging Radiat Sci 2015; 46:343-350. [PMID: 31052142 DOI: 10.1016/j.jmir.2015.06.005] [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: 12/23/2014] [Revised: 05/25/2015] [Accepted: 06/17/2015] [Indexed: 12/25/2022]
Abstract
Stereotactic body radiation therapy has been adopted in the treatment of liver cancer because of its highly conformal dose distribution when compared with other conventional approaches, and many studies have been published to report the positive clinical outcome associated with this technique. To achieve the precision needed to maintain or to improve the therapeutic ratio, various strategies are applied in different components in the stereotactic body radiation therapy process. Immobilization devices are used in minimizing geometric uncertainty induced by treatment positioning and internal organ motion. Along with a better definition of target by the integration of multimodality imaging, planning target volume margin to compensate for the uncertainty can be reduced to minimize inclusion of normal tissue in the treatment volume. In addition, sparing of normal tissue from irradiation is improved by the use of high precision treatment delivery technologies such as intensity-modulated radiotherapy or volumetric modulated arc therapy. Target localization before treatment delivery with image guidance enables reproduction of the patient's geometry for delivering the planned dose. The application of these advanced technologies contributes to the evolution of the role of radiation therapy in the treatment of liver cancer, making it an important radical or palliative treatment modality.
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Kubota Y, Matsumura A, Fukahori M, Minohara SI, Yasuda S, Nagahashi H. A new method for tracking organ motion on diagnostic ultrasound images. Med Phys 2014; 41:092901. [PMID: 25186417 DOI: 10.1118/1.4892065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Respiratory-gated irradiation is effective in reducing the margins of a target in the case of abdominal organs, such as the liver, that change their position as a result of respiratory motion. However, existing technologies are incapable of directly measuring organ motion in real-time during radiation beam delivery. Hence, the authors proposed a novel quantitative organ motion tracking method involving the use of diagnostic ultrasound images; it is noninvasive and does not entail radiation exposure. In the present study, the authors have prospectively evaluated this proposed method. METHODS The method involved real-time processing of clinical ultrasound imaging data rather than organ monitoring; it comprised a three-dimensional ultrasound device, a respiratory sensing system, and two PCs for data storage and analysis. The study was designed to evaluate the effectiveness of the proposed method by tracking the gallbladder in one subject and a liver vein in another subject. To track a moving target organ, the method involved the control of a region of interest (ROI) that delineated the target. A tracking algorithm was used to control the ROI, and a large number of feature points and an error correction algorithm were used to achieve long-term tracking of the target. Tracking accuracy was assessed in terms of how well the ROI matched the center of the target. RESULTS The effectiveness of using a large number of feature points and the error correction algorithm in the proposed method was verified by comparing it with two simple tracking methods. The ROI could capture the center of the target for about 5 min in a cross-sectional image with changing position. Indeed, using the proposed method, it was possible to accurately track a target with a center deviation of 1.54±0.9 mm. The computing time for one frame image using our proposed method was 8 ms. It is expected that it would be possible to track any soft-tissue organ or tumor with large deformations and changing cross-sectional position using this method. CONCLUSIONS The proposed method achieved real-time processing and continuous tracking of the target organ for about 5 min. It is expected that our method will enable more accurate radiation treatment than is the case using indirect observational methods, such as the respiratory sensor method, because of direct visualization of the tumor. Results show that this tracking system facilitates safe treatment in clinical practice.
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Affiliation(s)
- Yoshiki Kubota
- Heavy Ion Medical Center, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Akihiko Matsumura
- Heavy Ion Medical Center, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Mai Fukahori
- Research Center of Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Shin-ichi Minohara
- Medical Physics Section, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-ku, Yokohama 241-8515, Japan
| | - Shigeo Yasuda
- Research Center Hospital of Charged Particle Therapy, National Institute of Radiological Sciences, 4-9-1 Anagawa, Inage-ku, Chiba 263-8555, Japan
| | - Hiroshi Nagahashi
- Imaging Science and Engineering Laboratory, Tokyo Institute of Technology, 4259 Nagatsuda-cho, Midori-ku, Yokohama 226-8503, Japan
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Zhong Y, Stephans K, Qi P, Yu N, Wong J, Xia P. Assessing Feasibility of Real-Time Ultrasound Monitoring in Stereotactic Body Radiotherapy of Liver Tumors. Technol Cancer Res Treat 2013; 12:243-50. [DOI: 10.7785/tcrt.2012.500323] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To monitor tumor motion during stereotactic body radiotherapy (SBRT) for patients with liver cancer, an integrated ultrasound and kilo-voltage cone-beam computed tomography (KV-CBCT) system has been proposed. The presence of an ultrasound probe may interfere with the radiation beams. The purpose of this study is to minimize this interference by altering orientations of the ultrasound probe and directions of radiation beams while not compromising the quality of SBRT plans. Ten patients, who received SBRT of liver cancer, were randomly selected for this study. To simulate the presence of an ultrasound probe, a virtual probe was oriented either parallel or vertical to the longitudinal axis of the patient's body and was added on the surface of the patient's body at the nearest location to the tumor. For both the parallel and vertical probe orientations, 2 new SBRT (Probe-Para and Probe-Vert) plans that minimize the interference between the probe and radiation beams were created for each patient. These SBRT plans were compared to the original clinically accepted SBRT plans, with a treatment goal of 37.5 Gy to the planning target volume (PTV) in 3 fractions. Specific dosimetric endpoints were evaluated, including doses to 95% (D95), of the PTV plan conformal index (CI), homogeneity index (HI), and relevant endpoint doses to organs at risk. For 2 patients with superficially located tumors, no clinically acceptable SBRT plans could be produced without the interference between the probe and radiation beams. For the remaining 8 patients, the Probe-Para plans allowed 7 patients to be treated with coplanar radiation beams (without moving the treatment couch during treatment) and 1 patient to be treated with non-coplanar beams (by moving the treatment couch during treatment). The Probe-Vert plans allowed 2 patients to be treated with coplanar beams and 6 patients to be treated with non-coplanar beams. The average D95 of the PTV were 38.63 Gy ± 0.14 ( p = 0.65) for Probe-Para plans, 38.48 Gy ± 0.31 ( p = 0.33) for Probe-Vert plans, and 38.72 Gy ± 0.14 for clinical SBRT plans. There were no significant differences ( p > 0.05) in CI and HI of all SBRT plans. The endpoint doses to the liver, heart, esophagus, right kidney, and stomach also had no significant differences ( p > 0.05). Except for superficial lesions, real-time ultrasound monitoring during liver SBRT is clinically feasible. Placing the ultrasound probe parallel to the longitudinal axis of the patient allows a greater probability of utilizing preferred coplanar beams.
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Affiliation(s)
- Yahua Zhong
- Department of Radiation Oncology, Cleveland Clinical, Cleveland, OH 44195, USA
- Cancer Clinical Study Center, Department of Radiochemotherapy, Zhongnan Hospital, Wuhan University, Hubei Province, China
| | - Kevin Stephans
- Department of Radiation Oncology, Cleveland Clinical, Cleveland, OH 44195, USA
| | - Peng Qi
- Department of Radiation Oncology, Cleveland Clinical, Cleveland, OH 44195, USA
| | - Naichang Yu
- Department of Radiation Oncology, Cleveland Clinical, Cleveland, OH 44195, USA
| | - John Wong
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Ping Xia
- Department of Radiation Oncology, Cleveland Clinical, Cleveland, OH 44195, USA
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Online Image-based Monitoring of Soft-tissue Displacements for Radiation Therapy of the Prostate. Int J Radiat Oncol Biol Phys 2012; 83:1633-40. [DOI: 10.1016/j.ijrobp.2011.10.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 10/07/2011] [Accepted: 10/24/2011] [Indexed: 11/24/2022]
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Rubin JM, Feng M, Hadley SW, Fowlkes JB, Hamilton JD. Potential use of ultrasound speckle tracking for motion management during radiotherapy: preliminary report. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:469-481. [PMID: 22368138 DOI: 10.7863/jum.2012.31.3.469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We prospectively evaluated real-time ultrasound speckle tracking for monitoring soft tissue motion for image-guided radiotherapy. Two human volunteers and 1 patient with a proven hepatocellular carcinoma, who was being prepared for radiation therapy treatment, were scanned using a clinical ultrasound scanner modified to acquire and store radiofrequency signals. Scans were performed of the liver in the volunteers and the patient. In the patient, the speckle-tracking results were compared to those measured on a treatment-planning 4-dimensional computed tomogram with tumors contoured manually in each phase and with estimates made by hand on gray scale ultrasound images. The surface of the right lung and the prostate were scanned in a volunteer. The liver and lung surface were scanned during respiration. To simulate prostate motion, the ultrasound probe was rocked in an anterior-posterior direction. The correlation coefficients of all motion measurements were significantly correlated at all sites (P < .00001 for all sites) with 0 time delays. Ultrasound speckle-tracking motion estimates of tumor motion were within 2 mm of estimates made by hand tracking on gray scale ultrasound images and the 4-dimensional computed tomogram. The total tumor motion was greater than 20 mm. The angular displacement of the prostate was within 0.02 radians (1.1°) with displacements measured by hand. Speckle tracking could be used to monitor organ motion during radiotherapy.
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Affiliation(s)
- Jonathan M Rubin
- Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA.
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Schlosser J, Salisbury K, Hristov D. Telerobotic system concept for real‐time soft‐tissue imaging during radiotherapy beam delivery. Med Phys 2010; 37:6357-67. [DOI: 10.1118/1.3515457] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Jeffrey Schlosser
- Department of Mechanical Engineering, Stanford University, Stanford, California 94305
| | - Kenneth Salisbury
- Department of Computer Science and Department of Surgery, Stanford University, Stanford, California 94305
| | - Dimitre Hristov
- Department of Radiation Oncology, Stanford University, Stanford, California 94305
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Harris EJ, Miller NR, Bamber JC, Symonds-Tayler JRN, Evans PM. Speckle tracking in a phantom and feature-based tracking in liver in the presence of respiratory motion using 4D ultrasound. Phys Med Biol 2010; 55:3363-80. [DOI: 10.1088/0031-9155/55/12/007] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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