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Han C, Amini A, Wong JYC, Liang J, Qing K, Watkins WT, Zhang S, Williams TM, Liu A. Comparison of intrafractional motion with two frameless immobilization systems in surface-guided intracranial stereotactic radiosurgery. J Appl Clin Med Phys 2022; 23:e13613. [PMID: 35441441 PMCID: PMC9195026 DOI: 10.1002/acm2.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/12/2022] [Accepted: 04/21/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose/objectives The aim of this study is to compare intrafractional motion using two commercial non‐invasive immobilization systems for linac‐based intracranial stereotactic radiosurgery (SRS) under guidance with a surface‐guided radiotherapy (SGRT) system. Materials/methods Twenty‐one patients who received intracranial SRS were retrospectively selected. Ten patients were immobilized with a vacuum fixation biteplate system, while 11 patients were immobilized with an open‐face mask system. A setup margin of 1 mm was used in treatment planning. Real‐time surface motion data in 37 treatment fractions using the vacuum fixation system and 44 fractions using the open‐face mask were recorded by an SGRT system. Variances of intrafractional motion along three translational directions and three rotational directions were compared between the two immobilization techniques with Levene's tests. Intrafractional motion variation over time during treatments was also evaluated. Results Using the vacuum fixation system, the average and standard deviations of the shifts were 0.01 ± 0.18 mm, ‐0.06 ± 0.30 mm, and 0.02 ± 0.26 mm in the anterior–posterior (AP), superior–inferior (SI), and left–right (LR) directions, and ‐0.02 ± 0.19°, ‐0.01 ± 0.13°, and 0.01 ± 0.13° for rotations in yaw, roll, and pitch, respectively; using the open‐face mask system, the average and standard deviations of the shifts were ‐0.06 ± 0.20 mm, ‐0.02 ± 0.35 mm, and 0.01 ± 0.40 mm in the AP, SI, and LR directions, and were 0.05 ± 0.23°, 0.02 ± 0.21°, and 0.00 ± 0.16° for rotations in yaw, roll, and pitch, respectively. There was a significant increase in intrafractional motion variance over time during treatments. Conclusion Patients with the vacuum fixation system had significantly smaller intrafractional motion variation compared to those with the open‐face mask system. Using intrafractional motion techniques such as surface imaging system is recommended to minimize dose deviation due to intrafractional motion. The increase in intrafractional motion over time indicates clinical benefits with shorter treatment time.
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Affiliation(s)
- Chunhui Han
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Jeffrey Y C Wong
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Jieming Liang
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Kun Qing
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - W Tyler Watkins
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Sean Zhang
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - Terence M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
| | - An Liu
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California, USA
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Lee S, Lovelock DM, Kowalski A, Chapman K, Foley R, Gil M, Pastrana G, Higginson DS, Yamada Y, Zhang L, Mechalakos J, Yorke E. Failure mode and effect analysis for linear accelerator-based paraspinal stereotactic body radiotherapy. J Appl Clin Med Phys 2021; 22:87-96. [PMID: 34708910 PMCID: PMC8664134 DOI: 10.1002/acm2.13455] [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: 04/07/2021] [Revised: 09/21/2021] [Accepted: 10/06/2021] [Indexed: 12/31/2022] Open
Abstract
Introduction Paraspinal stereotactic body radiotherapy (SBRT) involves risks of severe complications. We evaluated the safety of the paraspinal SBRT program in a large academic hospital by applying failure modes and effects analysis. Methods The analysis was conducted by a multidisciplinary committee (two therapists, one dosimetrist, four physicists, and two radiation oncologists). The paraspinal SBRT workflow was segmented into four phases (simulation, treatment planning, delivery, and machine quality assurance (QA)). Each phase was further divided into a sequence of sub‐processes. Potential failure modes (PFM) were identified from each subprocess and scored in terms of the frequency of occurrence, severity and detectability, and a risk priority number (RPN). High‐risk PFMs were identified based on RPN and were studied for root causes using fault tree analysis. Results Our paraspinal SBRT process was characterized by eight simulations, 11 treatment planning, nine delivery, and two machine QA sub‐processes. There were 18, 29, 19, and eight PFMs identified from simulation, planning, treatment, and machine QA, respectively. The median RPN of the PFMs was 62.9 for simulation, 68.3 for planning, 52.9 for delivery, and 22.0 for machine QA. The three PFMs with the highest RPN were: previous radiotherapy outside the institution is not accurately evaluated (RPN: 293.3), incorrect registration between diagnostic magnetic resonance imaging and simulation computed tomography causing incorrect contours (273.0), and undetected patient movement before ExacTrac baseline (217.8). Remedies to the high RPN failures were implemented, including staff education, standardized magnetic resonance imaging acquisition parameters, and an image fusion process, and additional QA on beam steering. Conclusions A paraspinal SBRT workflow in a large clinic was evaluated using a multidisciplinary and systematic risk analysis, which led to feasible solutions to key root causes. Treatment planning was a major source of PFMs that systematically affect the safety and quality of treatments. Accurate evaluation of external treatment records remains a challenge.
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Affiliation(s)
- Sangkyu Lee
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dale Michael Lovelock
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alex Kowalski
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kate Chapman
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert Foley
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mary Gil
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Gerri Pastrana
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Daniel S Higginson
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lei Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - James Mechalakos
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Barnes M, Yeo A, Thompson K, Phillips C, Kron T, Hardcastle N. A retrospective analysis of setup and intrafraction positional variation in stereotactic radiotherapy treatments. J Appl Clin Med Phys 2020; 21:109-119. [PMID: 33140915 PMCID: PMC7769413 DOI: 10.1002/acm2.13076] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 09/10/2020] [Accepted: 09/25/2020] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The aim of this study was to provide a comprehensive assessment of patient intrafraction motion in linac-based frameless stereotactic radiosurgery (SRS) and radiotherapy (SRT). METHODS A retrospective review was performed on 101 intracranial SRS/SRT patients immobilized with the Klarity stereotactic thermoplastic mask (compatible with the Brainlab frameless stereotactic system) and aligned on a 6 Degree of Freedom (DoF) couch with the Brainlab ExacTrac image guidance system. Both pretreatment and intrafraction correction data are provided as observed by the ExacTrac system. The effects of couch angle and treatment duration on positioning outcomes are also explored. RESULTS Initial setup data for patients is shown to vary by up to ±4.18 mm, ±2.97°, but when corrected with a single x-ray image set with ExacTrac, patient positions are corrected to within ±2.11 mm, ±2.27°. Intrafraction patient motion is shown to be uniformly random and independent of both time and couch angle. Patient motion was also limited to within approximately 3 mm, 3° by the thermoplastic mask. CONCLUSIONS Our results indicate that since patient intrafraction motion is unrelated to couch rotation and treatment duration, intrafraction patient monitoring in 6 DoF is required to minimize intracranial SRS/SRT margins.
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Affiliation(s)
- Micah Barnes
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Imaging and Medical Beamline, Australian Nuclear Science and Technology Organisation - Australian Synchrotron, Clayton, VIC, Australia
| | - Adam Yeo
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,School of Science, RMIT University, Melbourne, VIC, Australia
| | - Kenton Thompson
- Department of Radiation Therapy Services, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Claire Phillips
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
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Shiinoki T, Fujii F, Yuasa Y, Nonomura T, Fujimoto K, Sera T, Tanaka H. Analysis of dosimetric impact of intrafraction translation and rotation during respiratory‐gated stereotactic body radiotherapy with real‐time tumor monitoring of the lung using a novel six degrees‐of‐freedom robotic moving phantom. Med Phys 2020; 47:3870-3881. [DOI: 10.1002/mp.14369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/02/2020] [Accepted: 06/23/2020] [Indexed: 12/26/2022] Open
Affiliation(s)
- Takehiro Shiinoki
- Department of Radiation Oncology Graduate School of Medicine Yamaguchi University 1‐1‐1 Minamikogushi Ube Yamaguchi755‐8505Japan
| | - Fumitake Fujii
- Department of Mechanical Engineering Graduate School of Science and Technology for Innovation Yamaguchi University 2‐16‐1 Tokiwadai Ube Yamaguchi755‐8611Japan
| | - Yuki Yuasa
- Department of Radiation Oncology Graduate School of Medicine Yamaguchi University 1‐1‐1 Minamikogushi Ube Yamaguchi755‐8505Japan
| | - Tatsuki Nonomura
- Department of Mechanical Engineering Graduate School of Science and Technology for Innovation Yamaguchi University 2‐16‐1 Tokiwadai Ube Yamaguchi755‐8611Japan
| | - Koya Fujimoto
- Department of Radiation Oncology Graduate School of Medicine Yamaguchi University 1‐1‐1 Minamikogushi Ube Yamaguchi755‐8505Japan
| | - Tatsuhiro Sera
- Department of Radiological Technology Yamaguchi University Hospital 1‐1‐1 Minamikogushi Ube Yamaguchi755‐8505Japan
| | - Hidekazu Tanaka
- Department of Radiation Oncology Graduate School of Medicine Yamaguchi University 1‐1‐1 Minamikogushi Ube Yamaguchi755‐8505Japan
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Zaffino P, Moccia S, De Momi E, Spadea MF. A Review on Advances in Intra-operative Imaging for Surgery and Therapy: Imagining the Operating Room of the Future. Ann Biomed Eng 2020; 48:2171-2191. [PMID: 32601951 DOI: 10.1007/s10439-020-02553-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/17/2020] [Indexed: 12/19/2022]
Abstract
With the advent of Minimally Invasive Surgery (MIS), intra-operative imaging has become crucial for surgery and therapy guidance, allowing to partially compensate for the lack of information typical of MIS. This paper reviews the advancements in both classical (i.e. ultrasounds, X-ray, optical coherence tomography and magnetic resonance imaging) and more recent (i.e. multispectral, photoacoustic and Raman imaging) intra-operative imaging modalities. Each imaging modality was analyzed, focusing on benefits and disadvantages in terms of compatibility with the operating room, costs, acquisition time and image characteristics. Tables are included to summarize this information. New generation of hybrid surgical room and algorithms for real time/in room image processing were also investigated. Each imaging modality has its own (site- and procedure-specific) peculiarities in terms of spatial and temporal resolution, field of view and contrasted tissues. Besides the benefits that each technique offers for guidance, considerations about operators and patient risk, costs, and extra time required for surgical procedures have to be considered. The current trend is to equip surgical rooms with multimodal imaging systems, so as to integrate multiple information for real-time data extraction and computer-assisted processing. The future of surgery is to enhance surgeons eye to minimize intra- and after-surgery adverse events and provide surgeons with all possible support to objectify and optimize the care-delivery process.
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Affiliation(s)
- Paolo Zaffino
- Department of Experimental and Clinical Medicine, Universitá della Magna Graecia, Catanzaro, Italy
| | - Sara Moccia
- Department of Information Engineering (DII), Universitá Politecnica delle Marche, via Brecce Bianche, 12, 60131, Ancona, AN, Italy.
| | - Elena De Momi
- Department of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milano, MI, Italy
| | - Maria Francesca Spadea
- Department of Experimental and Clinical Medicine, Universitá della Magna Graecia, Catanzaro, Italy
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Mangesius J, Seppi T, Weigel R, Arnold CR, Vasiljevic D, Goebel G, Lukas P, Ganswindt U, Nevinny-Stickel M. Intrafractional 6D head movement increases with time of mask fixation during stereotactic intracranial RT-sessions. Radiat Oncol 2019; 14:231. [PMID: 31852497 PMCID: PMC6921566 DOI: 10.1186/s13014-019-1425-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/22/2019] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The present study investigates the intrafractional accuracy of a frameless thermoplastic mask used for head immobilization during stereotactic radiotherapy. Non-invasive masks cannot completely prohibit head movements. Previous studies attempted to estimate the magnitude of intrafractional inaccuracy by means of pre- and postfractional measurements only. However, this might not be sufficient to accurately map also intrafractional head movements. MATERIALS AND METHODS Intrafractional deviation of mask-fixed head positions was measured in five patients during a total of 94 fractions by means of close-meshed repeated ExacTrac measurements (every 1.4 min) conducted during the entire treatment session. A median of six (range: 4 to 11) measurements were recorded per fraction, delivering a dataset of 453 measurements. RESULTS Random errors (SD) for the x, y and z axes were 0.27 mm, 0.29 mm and 0.29 mm, respectively. Median 3D deviation was 0.29 mm. Of all 3D intrafractional motions, 5.5 and 0.4% exceeded 1 mm and 2 mm, respectively. A moderate correlation between treatment duration and mean 3D displacement was determined (rs = 0.45). Mean 3D deviation increased from 0.21 mm (SD = 0.26 mm) in the first 2 min to a maximum of 0.53 mm (SD = 0.31 mm) after 10 min of treatment time. CONCLUSION Pre- and post-treatment measurement is not sufficient to adequately determine the range of intrafractional head motion. Thermoplastic masks provide both reliable interfractional and intrafractional immobilization for image-guided stereotactic hypofractionated radiotherapy. Greater positioning accuracy may be obtained by reducing treatment duration (< 6 min) and applying intrafractional correction. TRIAL REGISTRATION Clinicaltrials.gov, NCT03896555, Registered 01 April 2019 - retrospectively registered.
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Affiliation(s)
- Julian Mangesius
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Thomas Seppi
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Rocco Weigel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Christoph Reinhold Arnold
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Danijela Vasiljevic
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Georg Goebel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - Peter Lukas
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Ute Ganswindt
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
| | - Meinhard Nevinny-Stickel
- Department of Therapeutic Radiology and Oncology, Medical University of Innsbruck, Anichstraße 35, A-6020 Innsbruck, Austria
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7
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Gallagher KJ, Wong J, Zhang J. Photon caliper to achieve submillimeter positioning accuracy. Phys Med Biol 2017; 62:N404-N416. [DOI: 10.1088/1361-6560/aa8493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Oh SA, Park JW, Yea JW, Kim SK. Evaluations of the setup discrepancy between BrainLAB 6D ExacTrac and cone-beam computed tomography used with the imaging guidance system Novalis-Tx for intracranial stereotactic radiosurgery. PLoS One 2017; 12:e0177798. [PMID: 28542254 PMCID: PMC5438169 DOI: 10.1371/journal.pone.0177798] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 05/03/2017] [Indexed: 12/31/2022] Open
Abstract
The objective of this study was to evaluate the setup discrepancy between BrainLAB 6 degree-of-freedom (6D) ExacTrac and cone-beam computed tomography (CBCT) used with the imaging guidance system Novalis Tx for intracranial stereotactic radiosurgery. We included 107 consecutive patients for whom white stereotactic head frame masks (R408; Clarity Medical Products, Newark, OH) were used to fix the head during intracranial stereotactic radiosurgery, between August 2012 and July 2016. The patients were immobilized in the same state for both the verification image using 6D ExacTrac and online 3D CBCT. In addition, after radiation treatment, registration between the computed tomography simulation images and the CBCT images was performed with offline 6D fusion in an offline review. The root-mean-square of the difference in the translational dimensions between the ExacTrac system and CBCT was <1.01 mm for online matching and <1.10 mm for offline matching. Furthermore, the root-mean-square of the difference in the rotational dimensions between the ExacTrac system and the CBCT were <0.82° for online matching and <0.95° for offline matching. It was concluded that while the discrepancies in residual setup errors between the ExacTrac 6D X-ray and the CBCT were minor, they should not be ignored.
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Affiliation(s)
- Se An Oh
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
| | - Jae Won Park
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Ji Woon Yea
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
| | - Sung Kyu Kim
- Department of Radiation Oncology, Yeungnam University Medical Center, Daegu, Korea
- Department of Radiation Oncology, Yeungnam University College of Medicine, Daegu, Korea
- * E-mail:
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9
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Belcher AH, Liu X, Grelewicz Z, Wiersma RD. Spatial and rotational quality assurance of 6DOF patient tracking systems. Med Phys 2017; 43:2785-2793. [PMID: 27277026 DOI: 10.1118/1.4948506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE External tracking systems used for patient positioning and motion monitoring during radiotherapy are now capable of detecting both translations and rotations. In this work, the authors develop a novel technique to evaluate the 6 degree of freedom 6(DOF) (translations and rotations) performance of external motion tracking systems. The authors apply this methodology to an infrared marker tracking system and two 3D optical surface mapping systems in a common tumor 6DOF workspace. METHODS An in-house designed and built 6DOF parallel kinematics robotic motion phantom was used to perform motions with sub-millimeter and subdegree accuracy in a 6DOF workspace. An infrared marker tracking system was first used to validate a calibration algorithm which associates the motion phantom coordinate frame to the camera frame. The 6DOF positions of the mobile robotic system in this space were then tracked and recorded independently by an optical surface tracking system after a cranial phantom was rigidly fixed to the moveable platform of the robotic stage. The calibration methodology was first employed, followed by a comprehensive 6DOF trajectory evaluation, which spanned a full range of positions and orientations in a 20 × 20 × 16 mm and 5° × 5° × 5° workspace. The intended input motions were compared to the calibrated 6DOF measured points. RESULTS The technique found the accuracy of the infrared (IR) marker tracking system to have maximal root-mean square error (RMSE) values of 0.18, 0.25, 0.07 mm, 0.05°, 0.05°, and 0.09° in left-right (LR), superior-inferior (SI), anterior-posterior (AP), pitch, roll, and yaw, respectively, comparing the intended 6DOF position and the measured position by the IR camera. Similarly, the 6DOF RSME discrepancy for the HD optical surface tracker yielded maximal values of 0.46, 0.60, 0.54 mm, 0.06°, 0.11°, and 0.08° in LR, SI, AP, pitch, roll, and yaw, respectively, over the same 6DOF evaluative workspace. An earlier generation 3D optical surface tracking unit was observed to have worse tracking capabilities than both the IR camera unit and the newer 3D surface tracking system with maximal RMSE of 0.69, 0.74, 0.47 mm, 0.28°, 0.19°, and 0.18°, in LR, SI, AP, pitch, roll, and yaw, respectively, in the same 6DOF evaluation space. CONCLUSIONS The proposed technique was found to be effective at evaluating the performance of 6DOF patient tracking systems. All observed optical tracking systems were found to exhibit tracking capabilities at the sub-millimeter and subdegree level within a 6DOF workspace.
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Affiliation(s)
- Andrew H Belcher
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637-1470
| | - Xinmin Liu
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637-1470
| | - Zachary Grelewicz
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637-1470
| | - Rodney D Wiersma
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637-1470
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Tarnavski N, Engelholm SA, af Rosenschold PM. Fast intra-fractional image-guidance with 6D positioning correction reduces delivery uncertainty for stereotactic radiosurgery and radiotherapy. JOURNAL OF RADIOSURGERY AND SBRT 2016; 4:15-20. [PMID: 29296422 PMCID: PMC5658830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/18/2015] [Indexed: 06/07/2023]
Abstract
The purpose of this study is to analyze intra-fractional positioning uncertainty for stereotactic radiotherapy and radiosurgery of cranial tumors. Specifically, we wish to determine the use of intra-fractional image guided patient positioning verification is necessary during delivery of "frameless" stereotactic radiotherapy and radiosurgery (SRT/SRS) and non-coplanar radiation beams, and if positioning uncertainty is associated with overall treatment time. Orthogonal radiographic treatment verification data was extracted for 288 patients and 1344 fractions, and were analyzed with respect to 3D translational and angular corrections once during treatment delivery of SRT/SRS. We find that positioning corrections greater than 2 mm are required for approximately 6% of beams, and that the magnitude of the translational corrections was significantly associated with the delay time between beams (p=0.003). Further, we find that the maximum angular and translational deviations were associated (p<0.001). We conclude that a subgroup of SRT/SRS patients may have considerable positioning error unless this is monitored and corrected during treatment, and that keeping the imaging and delivery times below approximately 5 min is beneficial towards clinically relevant geographical errors. In case longer time-delays than 5 min occurs, the treatment staff should consider acquiring a new set of radiographs in order to verify the patient's position, assuming this technically feasible to be performed quickly.
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Affiliation(s)
- Nikolai Tarnavski
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Svend Aage Engelholm
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Per Munck af Rosenschold
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
- Niels Bohr Institute, University of Copenhagen, Denmark
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Belcher AH, Liu X, Grelewicz Z, Pearson E, Wiersma RD. Development of a 6DOF robotic motion phantom for radiation therapy. Med Phys 2015; 41:121704. [PMID: 25471951 DOI: 10.1118/1.4900828] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The use of medical technology capable of tracking patient motion or positioning patients along 6 degree-of-freedom (6DOF) has steadily increased in the field of radiation therapy. However, due to the complex nature of tracking and performing 6DOF motion, it is critical that such technology is properly verified to be operating within specifications in order to ensure patient safety. In this study, a robotic motion phantom is presented that can be programmed to perform highly accurate motion along any X (left-right), Y (superior-inferior), Z (anterior-posterior), pitch (around X), roll (around Y), and yaw (around Z) axes. In addition, highly synchronized motion along all axes can be performed in order to simulate the dynamic motion of a tumor in 6D. The accuracy and reproducibility of this 6D motion were characterized. METHODS An in-house designed and built 6D robotic motion phantom was constructed following the Stewart-Gough parallel kinematics platform archetype. The device was controlled using an inverse kinematics formulation, and precise movements in all 6 degrees-of-freedom (X, Y, Z, pitch, roll, and yaw) were performed, both simultaneously and separately for each degree-of-freedom. Additionally, previously recorded 6D cranial and prostate motions were effectively executed. The robotic phantom movements were verified using a 15 fps 6D infrared marker tracking system and the measured trajectories were compared quantitatively to the intended input trajectories. The workspace, maximum 6D velocity, backlash, and weight load capabilities of the system were also established. RESULTS Evaluation of the 6D platform demonstrated translational root mean square error (RMSE) values of 0.14, 0.22, and 0.08 mm over 20 mm in X and Y and 10 mm in Z, respectively, and rotational RMSE values of 0.16°, 0.06°, and 0.08° over 10° of pitch, roll, and yaw, respectively. The robotic stage also effectively performed controlled 6D motions, as well as reproduced cranial trajectories over 15 min, with a maximal RMSE of 0.04 mm translationally and 0.04° rotationally, and a prostate trajectory over 2 min, with a maximal RMSE of 0.06 mm translationally and 0.04° rotationally. CONCLUSIONS This 6D robotic phantom has proven to be accurate under clinical standards and capable of reproducing tumor motion in 6D. Such functionality makes the robotic phantom usable for either quality assurance or research purposes.
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Affiliation(s)
- Andrew H Belcher
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637-1470
| | - Xinmin Liu
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637-1470
| | - Zachary Grelewicz
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637-1470
| | - Erik Pearson
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637-1470
| | - Rodney D Wiersma
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois 60637-1470
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Burnet N, Jena R, Burton K, Tudor G, Scaife J, Harris F, Jefferies S. Clinical and Practical Considerations for the Use of Intensity-modulated Radiotherapy and Image Guidance in Neuro-oncology. Clin Oncol (R Coll Radiol) 2014; 26:395-406. [DOI: 10.1016/j.clon.2014.04.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/04/2014] [Indexed: 12/26/2022]
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Kim DD, Eng C. The current state of targeted agents in rectal cancer. Int J Surg Oncol 2012; 2012:406830. [PMID: 22675625 PMCID: PMC3362864 DOI: 10.1155/2012/406830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 03/16/2012] [Indexed: 12/19/2022] Open
Abstract
Targeted biologic agents have an established role in treating metastatic colorectal cancer (CRC), and the integration of targeted therapies into the treatment of CRC has resulted in significant improvements in outcomes. Rapidly growing insight into the molecular biology of CRC, as well as recent developments in gene sequencing and molecular diagnostics, has led to high expectations for the identification of molecular markers to be used in personalized treatment regimens. The mechanisms of action and toxicities of targeted therapies differ from those of traditional cytotoxic chemotherapy. Targeted therapy has raised new insight about the possibility of tailoring treatment to an individual's disease, the assessment of drug effectiveness and toxicity, and the economics of cancer care. This paper covers the last decade of clinical trials that have explored the toxicity and efficacy of targeted agents in locally advanced and metastatic CRC and how their role may benefit patients with rectal cancer. Future efforts should include prospective studies of these agents in biomarker-defined subpopulations, as well as studies of novel agents that target angiogenesis, tumor-stromal interaction, and the cell signaling pathways implicated in rectal cancer.
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Affiliation(s)
- Dae Dong Kim
- Department of Surgery, Catholic University of Daegu, 3056-6 Daemyung-4 Dong, Nam-Gu, Daegu 705-718, Republic of Korea
| | - Cathy Eng
- Department of Gastrointestinal Medical Oncology, MD Anderson Cancer Center, The University of Texas, 1515 Holcombe Boulevard, Box 0426, Houston, TX 77030, USA
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Shi C, Tazi A, Fang DX, Iannuzzi C. Study of ExacTrac X-ray 6D IGRT setup uncertainty for marker-based prostate IMRT treatment. J Appl Clin Med Phys 2012; 13:3757. [PMID: 22584176 PMCID: PMC5716561 DOI: 10.1120/jacmp.v13i3.3757] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/02/2012] [Accepted: 01/05/2012] [Indexed: 11/23/2022] Open
Abstract
Novalis Tx ExacTrac X-ray system has the 6D adjustment ability for patient setup. Limited studies exist about the setup uncertainty with ExacTrac X-ray system for IMRT prostate treatment with fiducial markers implanted. The purpose of this study is to investigate the marker-based prostate IMRT treatment setup uncertainty using ExacTrac 6D IGRT ability for patient setup. Forty-three patients with prostate cancers and markers implanted have been treated on the Novalis Tx machine. The ExacTrac X-ray system has been used for the patient pretreatment setup and intratreatment verification. In total, the shifts data for 1261 fractions and 3504 correction times (the numbers of X-ray images were taken from tube 1 and tube 2) have been analyzed. The setup uncertainty has been separated into uncertainties in 6D. Marker matching uncertainty was also analyzed. Correction frequency probability density function was plotted, and the radiation dose for imaging was calculated. The minimum, average, and maximum translation shifts were: -5.12 ± 3.89 mm, 0.20 ± 2.21 mm, and 6.07 ± 4.44 mm, respectively, in the lateral direction; -6.80 ± 3.21 mm, -1.09 ± 2.21 mm, and 3.12 ± 2.62 mm, respectively, in the longitudinal direction; and -7.33 ± 3.46 mm, -0.93 ± 2.70 mm, and 5.93 ± 4.85mm, respectively, in the vertical direction. The minimum, average, and maximum rotation shifts were: -1.23° ± 1.95°, 0.25° ± 1.30°, and 2.38° ± 2.91°, respectively, along lateral direction; -0.67° ± 0.91°, 0.10° ± 0.61°, and 1.51° ± 2.04°, respectively, along longitudinal direction; and -0.75° ± 1.01°, 0.02° ± 0.50°, and 0.82° ± 1.13°, respectively, along vertical direction. On average, each patient had three correction times during one fraction treatment. The radiation dose is about 3 mSv per fraction. With the ExacTrac 6D X-ray system, the prostate IMRT treatment with marker implanted can achieve less than 2 mm setup uncertainty in translations, and less than 0.25° in rotations as overall interfraction mean error. The imaging dose is less than kV (CBCT) for setup verification.
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Affiliation(s)
- Chengyu Shi
- Department of Oncology, St. Vincent’s Medical Center, Bridgeport, CT, USA.
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