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Clough A, Chuter R, Hales RB, Parker J, McMahon J, Whiteside L, McHugh L, Davies L, Sanders J, Benson R, Nelder C, McDaid L, Choudhury A, Eccles CL. Impact of a contouring atlas on radiographer inter-observer variation in male pelvis radiotherapy. J Med Imaging Radiat Sci 2024; 55:281-288. [PMID: 38609834 DOI: 10.1016/j.jmir.2024.03.004] [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: 01/11/2024] [Revised: 02/26/2024] [Accepted: 03/19/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE/OBJECTIVE To determine the impact of a MR-based contouring atlas for male pelvis radiotherapy delineation on inter-observer variation to support radiographer led real-time magnetic resonance image guided adaptive radiotherapy (MRgART). MATERIAL/METHODS Eight RTTs contoured 25 MR images in the Monaco treatment planning system (Monaco 5.40.01), from 5 patients. The prostate, seminal vesicles, bladder, and rectum were delineated before and after the introduction of an atlas developed through multi-disciplinary consensus. Inter-observer contour variations (volume), time to contour and observer contouring confidence were determined at both time-points using a 5-point Likert scale. Descriptive statistics were used to analyse both continuous and categorical variables. Dice similarity coefficient (DSC), Dice-Jaccard coefficient (DJC) and Hausdorff distance were used to calculate similarity between observers. RESULTS Although variation in volume definition decreased for all structures among all observers post intervention, the change was not statistically significant. DSC and DJC measurements remained consistent following the introduction of the atlas for all observers. The highest similarity was found in the bladder and prostate whilst the lowest was the seminal vesicles. The mean contouring time for all observers was reduced by 50% following the introduction of the atlas (53 to 27 minutes, p=0.01). For all structures across all observers, the mean contouring confidence increased significantly from 2.3 to 3.5 out of 5 (p=0.02). CONCLUSION Although no significant improvements were observed in contour variation amongst observers, the introduction of the consensus-based contouring atlas improved contouring confidence and speed; key factors for a real-time RTT-led MRgART.
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Affiliation(s)
- Abigael Clough
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Robert Chuter
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Rosie B Hales
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jacqui Parker
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - John McMahon
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lee Whiteside
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Louise McHugh
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lucy Davies
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Rebecca Benson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Claire Nelder
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Lisa McDaid
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Cynthia L Eccles
- The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
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Hizam DA, Tan LK, Saad M, Muaadz A, Ung NM. Comparison of commercial atlas-based automatic segmentation software for prostate radiotherapy treatment planning. Phys Eng Sci Med 2024:10.1007/s13246-024-01411-2. [PMID: 38647633 DOI: 10.1007/s13246-024-01411-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/20/2024] [Indexed: 04/25/2024]
Abstract
This study aims to assess the accuracy of automatic atlas-based contours for various key anatomical structures in prostate radiotherapy treatment planning. The evaluated structures include the bladder, rectum, prostate, seminal vesicles, femoral heads and penile bulb. CT images from 20 patients who underwent intensity-modulated radiotherapy were randomly chosen to create an atlas library. Atlas contours of the seven anatomical structures were generated using four software packages: ABAS, Eclipse, MIM, and RayStation. These contours were then compared to manual delineations performed by oncologists, which served as the ground truth. Evaluation metrics such as dice similarity coefficient (DSC), mean distance to agreement (MDA), and volume ratio (VR) were calculated to assess the accuracy of the contours. Additionally, the time taken by each software to generate the atlas contour was recorded. The mean DSC values for the bladder exhibited strong agreement (>0.8) with manual delineations for all software except for Eclipse and RayStation. Similarly, the femoral heads showed significant similarity between the atlas contours and ground truth across all software, with mean DSC values exceeding 0.9 and MDA values close to zero. On the other hand, the penile bulb displayed only moderate agreement with the ground truth, with mean DSC values ranging from 0.5 to 0.7 for all software. A similar trend was observed in the prostate atlas contours, except for MIM, which achieved a mean DSC of over 0.8. For the rectum, both ABAS and MIM atlases demonstrated strong agreement with the ground truth, resulting in mean DSC values of more than 0.8. Overall, MIM and ABAS outperformed Eclipse and RayStation in both DSC and MDA. These results indicate that the atlas-based segmentation employed in this study produces acceptable contours for the anatomical structures of interest in prostate radiotherapy treatment planning.
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Affiliation(s)
- Diyana Afrina Hizam
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Li Kuo Tan
- Department of Biomedical Imaging, Universiti Malaya, Kuala Lumpur, Malaysia.
| | - Marniza Saad
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Asyraf Muaadz
- Department of Clinical Oncology, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Ngie Min Ung
- Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
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3
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Sritharan K, Akhiat H, Cahill D, Choi S, Choudhury A, Chung P, Diaz J, Dysager L, Hall W, Huddart R, Kerkmeijer LGW, Lawton C, Mohajer J, Murray J, Nyborg CJ, Pos FJ, Rigo M, Schytte T, Sidhom M, Sohaib A, Tan A, van der Voort van Zyp J, Vesprini D, Zelefsky MJ, Tree AC. Development of Prostate Bed Delineation Consensus Guidelines for Magnetic Resonance Image-Guided Radiotherapy and Assessment of Its Effect on Interobserver Variability. Int J Radiat Oncol Biol Phys 2024; 118:378-389. [PMID: 37633499 DOI: 10.1016/j.ijrobp.2023.08.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE The use of magnetic resonance imaging (MRI) in radiotherapy planning is becoming more widespread, particularly with the emergence of MRI-guided radiotherapy systems. Existing guidelines for defining the prostate bed clinical target volume (CTV) show considerable heterogeneity. This study aimed to establish baseline interobserver variability (IOV) for prostate bed CTV contouring on MRI, develop international consensus guidelines, and evaluate its effect on IOV. METHODS AND MATERIALS Participants delineated the CTV on 3 MRI scans, obtained from the Elekta Unity MR-Linac, as per their normal practice. Radiation oncologist contours were visually examined for discrepancies, and interobserver comparisons were evaluated against simultaneous truth and performance level estimation (STAPLE) contours using overlap metrics (Dice similarity coefficient and Cohen's kappa), distance metrics (mean distance to agreement and Hausdorff distance), and volume measurements. A literature review of postradical prostatectomy local recurrence patterns was performed and presented alongside IOV results to the participants. Consensus guidelines were collectively constructed, and IOV assessment was repeated using these guidelines. RESULTS Sixteen radiation oncologists' contours were included in the final analysis. Visual evaluation demonstrated significant differences in the superior, inferior, and anterior borders. Baseline IOV assessment indicated moderate agreement for the overlap metrics while volume and distance metrics demonstrated greater variability. Consensus for optimal prostate bed CTV boundaries was established during a virtual meeting. After guideline development, a decrease in IOV was observed. The maximum volume ratio decreased from 4.7 to 3.1 and volume coefficient of variation reduced from 40% to 34%. The mean Dice similarity coefficient rose from 0.72 to 0.75 and the mean distance to agreement decreased from 3.63 to 2.95 mm. CONCLUSIONS Interobserver variability in prostate bed contouring exists among international genitourinary experts, although this is lower than previously reported. Consensus guidelines for MRI-based prostate bed contouring have been developed, and this has resulted in an improvement in contouring concordance. However, IOV persists and strategies such as an education program, development of a contouring atlas, and further refinement of the guidelines may lead to additional improvements.
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Affiliation(s)
- Kobika Sritharan
- Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom.
| | | | - Declan Cahill
- Department of Urology, Royal Marsden Hospital NHS Trust, London, United Kingdom
| | - Seungtaek Choi
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Ananya Choudhury
- Christie National Health Service Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Lars Dysager
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - William Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert Huddart
- Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Colleen Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Julia Murray
- Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom
| | | | - Floris J Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Italy
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mark Sidhom
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Aslam Sohaib
- Department of Radiology, Royal Marsden Hospital NHS Trust, Sutton, United Kingdom
| | - Alex Tan
- Sunshine Coast Hospital and Health Service, Queensland, Australia; James Cook University, Townsville, Queensland, Australia
| | | | - Danny Vesprini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison C Tree
- Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom
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Mikalsen SG, Skjøtskift T, Flote VG, Hämäläinen NP, Heydari M, Rydén-Eilertsen K. Extensive clinical testing of Deep Learning Segmentation models for thorax and breast cancer radiotherapy planning. Acta Oncol 2023; 62:1184-1193. [PMID: 37883678 DOI: 10.1080/0284186x.2023.2270152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The performance of deep learning segmentation (DLS) models for automatic organ extraction from CT images in the thorax and breast regions was investigated. Furthermore, the readiness and feasibility of integrating DLS into clinical practice were addressed by measuring the potential time savings and dosimetric impact. MATERIAL AND METHODS Thirty patients referred to radiotherapy for breast cancer were prospectively included. A total of 23 clinically relevant left- and right-sided organs were contoured manually on CT images according to ESTRO guidelines. Next, auto-segmentation was executed, and the geometric agreement between the auto-segmented and manually contoured organs was qualitatively assessed applying a scale in the range [0-not acceptable, 3-no corrections]. A quantitative validation was carried out by calculating Dice coefficients (DSC) and the 95% percentile of Hausdorff distances (HD95). The dosimetric impact of optimizing the treatment plans on the uncorrected DLS contours, was investigated from a dose coverage analysis using DVH values of the manually delineated contours as references. RESULTS The qualitative analysis showed that 93% of the DLS generated OAR contours did not need corrections, except for the heart where 67% of the contours needed corrections. The majority of DLS generated CTVs needed corrections, whereas a minority were deemed not acceptable. Still, using the DLS-model for CTV and heart delineation is on average 14 minutes faster. An average DSC=0.91 and H95=9.8 mm were found for the left and right breasts, respectively. Likewise, and average DSC in the range [0.66, 0.76]mm and HD95 in the range [7.04, 12.05]mm were found for the lymph nodes. CONCLUSION The validation showed that the DLS generated OAR contours can be used clinically. Corrections were required to most of the DLS generated CTVs, and therefore warrants more attention before possibly implementing the DLS models clinically.
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Affiliation(s)
| | | | | | | | - Mojgan Heydari
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
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5
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Qi X, Hu J, Zhang L, Bai S, Yi Z. Automated Segmentation of the Clinical Target Volume in the Planning CT for Breast Cancer Using Deep Neural Networks. IEEE TRANSACTIONS ON CYBERNETICS 2022; 52:3446-3456. [PMID: 32833659 DOI: 10.1109/tcyb.2020.3012186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
3-D radiotherapy is an effective treatment modality for breast cancer. In 3-D radiotherapy, delineation of the clinical target volume (CTV) is an essential step in the establishment of treatment plans. However, manual delineation is subjective and time consuming. In this study, we propose an automated segmentation model based on deep neural networks for the breast cancer CTV in planning computed tomography (CT). Our model is composed of three stages that work in a cascade manner, making it applicable to real-world scenarios. The first stage determines which slices contain CTVs, as not all CT slices include breast lesions. The second stage detects the region of the human body in an entire CT slice, eliminating boundary areas, which may have side effects for the segmentation of the CTV. The third stage delineates the CTV. To permit the network to focus on the breast mass in the slice, a novel dynamically strided convolution operation, which shows better performance than standard convolution, is proposed. To train and evaluate the model, a large dataset containing 455 cases and 50 425 CT slices is constructed. The proposed model achieves an average dice similarity coefficient (DSC) of 0.802 and 0.801 for right-0 and left-sided breast, respectively. Our method shows superior performance to that of previous state-of-the-art approaches.
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Casati M, Piffer S, Calusi S, Marrazzo L, Simontacchi G, Di Cataldo V, Greto D, Desideri I, Vernaleone M, Francolini G, Livi L, Pallotta S. Clinical validation of an automatic atlas‐based segmentation tool for male pelvis CT images. J Appl Clin Med Phys 2022; 23:e13507. [PMID: 35064746 PMCID: PMC8906199 DOI: 10.1002/acm2.13507] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose This retrospective work aims to evaluate the possible impact on intra‐ and inter‐observer variability, contouring time, and contour accuracy of introducing a pelvis computed tomography (CT) auto‐segmentation tool in radiotherapy planning workflow. Methods Tests were carried out on five structures (bladder, rectum, pelvic lymph‐nodes, and femoral heads) of six previously treated subjects, enrolling five radiation oncologists (ROs) to manually re‐contour and edit auto‐contours generated with a male pelvis CT atlas created with the commercial software MIM MAESTRO. The ROs first delineated manual contours (M). Then they modified the auto‐contours, producing automatic‐modified (AM) contours. The procedure was repeated to evaluate intra‐observer variability, producing M1, M2, AM1, and AM2 contour sets (each comprising 5 structures × 6 test patients × 5 ROs = 150 contours), for a total of 600 contours. Potential time savings was evaluated by comparing contouring and editing times. Structure contours were compared to a reference standard by means of Dice similarity coefficient (DSC) and mean distance to agreement (MDA), to assess intra‐ and inter‐observer variability. To exclude any automation bias, ROs evaluated both M and AM sets as “clinically acceptable” or “to be corrected” in a blind test. Results Comparing AM to M sets, a significant reduction of both inter‐observer variability (p < 0.001) and contouring time (‐45% whole pelvis, p < 0.001) was obtained. Intra‐observer variability reduction was significant only for bladder and femoral heads (p < 0.001). The statistical test showed no significant bias. Conclusion Our atlas‐based workflow proved to be effective for clinical practice as it can improve contour reproducibility and generate time savings. Based on these findings, institutions are encouraged to implement their auto‐segmentation method.
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Affiliation(s)
- Marta Casati
- Medical Physics Unit Careggi University Hospital Florence Italy
| | - Stefano Piffer
- Department of Experimental and Clinical Biomedical Sciences University of Florence Florence Italy
- National Institute of Nuclear Physics (INFN) Florence Italy
| | - Silvia Calusi
- Department of Experimental and Clinical Biomedical Sciences University of Florence Florence Italy
- National Institute of Nuclear Physics (INFN) Florence Italy
| | - Livia Marrazzo
- Medical Physics Unit Careggi University Hospital Florence Italy
| | | | | | - Daniela Greto
- Radiation Oncology Unit Careggi University Hospital Florence Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences University of Florence Florence Italy
| | - Marco Vernaleone
- Radiation Oncology Unit Careggi University Hospital Florence Italy
| | | | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences University of Florence Florence Italy
- Radiation Oncology Unit Careggi University Hospital Florence Italy
| | - Stefania Pallotta
- Medical Physics Unit Careggi University Hospital Florence Italy
- Department of Experimental and Clinical Biomedical Sciences University of Florence Florence Italy
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Leonardi MC, Pepa M, Luraschi R, Vigorito S, Dicuonzo S, Isaksson LJ, La Porta MR, Marino L, Ippolito E, Huscher A, Argenone A, De Rose F, Cucciarelli F, De Santis MC, Rossi F, Prisco A, Guarnaccia R, de Fatis PT, Palumbo I, Colangione SP, Mormile M, Ravo V, Fozza A, Aristei C, Orecchia R, Cattani F, Jereczek-Fossa BA. The dosimetric impact of axillary nodes contouring variability in breast cancer radiotherapy: an AIRO multi-institutional study. Radiother Oncol 2022; 168:113-120. [PMID: 35033602 DOI: 10.1016/j.radonc.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 12/01/2022]
Abstract
AIM To quantify the dosimetric impact of contouring variability of axillary lymph nodes (L2, L3, L4) in breast cancer (BC) locoregional radiotherapy (RT). MATERIALS AND METHODS 18 RT centres were asked to plan a locoregional treatment on their own planning target volume (single centre, SC-PTV) which was created by applying their institutional margins to the clinical target volume of the axillary nodes of three BC patients (P1, P2, P3) previously delineated (SC-CTV). The gold standard CTVs (GS-CTVs) of P1, P2 and P3 were developed by BC experts' consensus and validated with STAPLE algorithm. For each participating centre, the GS-PTV of each patient was created by applying the same margins as those used for the SC-CTV to SC-PTV expansion and replaced the SC-PTV in the treatment plan. Datasets were imported into MIM v6.1.7 [MIM Software Inc.], where dose-volume histograms (DVHs) were extracted and differences were analysed. RESULTS 17/18 centres used intensity-modulated RT (IMRT). The CTV to PTV margins ranged from 0 to 10 mm (median 5 mm). No correlation was observed between GS-CTV coverage by 95% isodose and GS-PTV margins width. Doses delivered to 98% (D98) and 95% (D95) of GS-CTVs were significantly lower than those delivered to the SC-CTVs. No significant difference between SC-CTV and GS-CTV was observed in maximum dose (D2), always under 110%. Mean dose ≥ 99% of the SC-CTVs and GS-CTVs was satisfied in 84% and 50%, respectively. In less than one half of plans, GS-CTV V95% was above 90%. Breaking down the GS-CTV into the three nodal levels (L2, L3 and L4), L4 had the lowest probability to be covered by the 95% isodose. CONCLUSIONS Overall, GS-CTV resulted worse coverage, especially for L4. IMRT was largely used and CTV-to-PTV margins did not compensate for contouring issues. The results highlighted the need for delineation training and standardization.
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Affiliation(s)
| | - Matteo Pepa
- Division of Radiation Oncology, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Rosa Luraschi
- Unit of Medical Physics, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Sabrina Vigorito
- Unit of Medical Physics, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Samantha Dicuonzo
- Division of Radiation Oncology, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy.
| | - Lars Johannes Isaksson
- Division of Radiation Oncology, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | | | - Lorenza Marino
- Radiotherapy Unit, REM Radioterapia, Viagrande, (CT), Italy
| | - Edy Ippolito
- Department of Radiotherapy, Campus Bio-Medico University, Roma, Italy
| | | | - Angela Argenone
- Division of Radiation Oncology, Azienda Ospedaliera di Rilievo Nazionale San Pio, Benevento, Italy
| | - Fiorenza De Rose
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Centre IRCCS, Milano, Italy
| | - Francesca Cucciarelli
- Department of Internal Medicine, Radiotherapy Institute, Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy
| | - Maria Carmen De Santis
- Radiotherapy Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori (INT), Milano, Italy
| | - Francesca Rossi
- Radiotherapy Unit, Usl Toscana Centro, Ospedale Santa Maria Annunziata, Firenze, Italy
| | - Agnese Prisco
- Department of Radiotherapy, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Roberta Guarnaccia
- Radiotherapy Unit, Ospedale Fatebenefratelli Isola Tiberina, Roma, Italy
| | | | - Isabella Palumbo
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Sarah Pia Colangione
- Radiotherapy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Maria Mormile
- Unit of Medical Physics, ASL Napoli 1 Centro - Ospedale del Mare, Napoli, Italy
| | - Vincenzo Ravo
- Unit of Radiotherapy, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy
| | - Alessandra Fozza
- Division of Radiation Oncology, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Roberto Orecchia
- Scientific Direction, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Federica Cattani
- Unit of Medical Physics, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
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- Division of Radiation Oncology, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milano, Italy
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Chen W, Wang C, Zhan W, Jia Y, Ruan F, Qiu L, Yang S, Li Y. A comparative study of auto-contouring softwares in delineation of organs at risk in lung cancer and rectal cancer. Sci Rep 2021; 11:23002. [PMID: 34836989 PMCID: PMC8626498 DOI: 10.1038/s41598-021-02330-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022] Open
Abstract
Radiotherapy requires the target area and the organs at risk to be contoured on the CT image of the patient. During the process of organs-at-Risk (OAR) of the chest and abdomen, the doctor needs to contour at each CT image. The delineations of large and varied shapes are time-consuming and laborious. This study aims to evaluate the results of two automatic contouring softwares on OARs definition of CT images of lung cancer and rectal cancer patients. The CT images of 15 patients with rectal cancer and 15 patients with lung cancer were selected separately, and the organs at risk were manually contoured by experienced physicians as reference structures. And then the same datasets were automatically contoured based on AiContour (version 3.1.8.0, Manufactured by Linking MED, Beijing, China) and Raystation (version 4.7.5.4, Manufactured by Raysearch, Stockholm, Sweden) respectively. Deep learning auto-segmentations and Atlas were respectively performed with AiContour and Raystation. Overlap index (OI), Dice similarity index (DSC) and Volume difference (Dv) were evaluated based on the auto-contours, and independent-sample t-test analysis is applied to the results. The results of deep learning auto-segmentations on OI and DSC were better than that of Atlas with statistical difference. There was no significant difference in Dv between the results of two software. With deep learning auto-segmentations, auto-contouring results of most organs in the chest and abdomen are good, and with slight modification, it can meet the clinical requirements for planning. With Atlas, auto-contouring results in most OAR is not as good as deep learning auto-segmentations, and only the auto-contouring results of some organs can be used clinically after modification.
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Affiliation(s)
- Weijun Chen
- Department of Radiation Therapy, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Cheng Wang
- Department of Nuclear Science and Technology, University of South China, Hengyang, 421001, Hunan, People's Republic of China
| | - Wenming Zhan
- Department of Radiation Therapy, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Yongshi Jia
- Department of Radiation Therapy, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Fangfang Ruan
- Department of Radiation Therapy, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Lingyun Qiu
- Department of Radiation Therapy, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China
| | - Shuangyan Yang
- Department of Radiation Therapy, Shanghai Pulmonary Hospital, Shanghai, 200433, People's Republic of China
| | - Yucheng Li
- Department of Radiation Therapy, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, 310014, Zhejiang, People's Republic of China.
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Ying Y, Wang H, Chen H, Cheng J, Gu H, Shao Y, Duan Y, Feng A, Feng W, Fu X, Quan H, Xu Z. A novel specific grading standard study of auto-segmentation of organs at risk in thorax: subjective-objective-combined grading standard. Biomed Eng Online 2021; 20:54. [PMID: 34082755 PMCID: PMC8173789 DOI: 10.1186/s12938-021-00890-8] [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: 10/31/2020] [Accepted: 05/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To develop a novel subjective-objective-combined (SOC) grading standard for auto-segmentation for each organ at risk (OAR) in the thorax. METHODS A radiation oncologist manually delineated 13 thoracic OARs from computed tomography (CT) images of 40 patients. OAR auto-segmentation accuracy was graded by five geometric objective indexes, including the Dice similarity coefficient (DSC), the difference of the Euclidean distance between centers of mass (ΔCMD), the difference of volume (ΔV), maximum Hausdorff distance (MHD), and average Hausdorff distance (AHD). The grading results were compared with those of the corresponding geometric indexes obtained by geometric objective methods in the other two centers. OAR auto-segmentation accuracy was also graded by our subjective evaluation standard. These grading results were compared with those of DSC. Based on the subjective evaluation standard and the five geometric indexes, the correspondence between the subjective evaluation level and the geometric index range was established for each OAR. RESULTS For ΔCMD, ΔV, and MHD, the grading results of the geometric objective evaluation methods at our center and the other two centers were inconsistent. For DSC and AHD, the grading results of three centers were consistent. Seven OARs' grading results in the subjective evaluation standard were inconsistent with those of DSC. Six OARs' grading results in the subjective evaluation standard were consistent with those of DSC. Finally, we proposed a new evaluation method that combined the subjective evaluation level of those OARs with the range of corresponding DSC to determine the grading standard. If the DSC ranges between the adjacent levels did not overlap, the DSC range was used as the grading standard. Otherwise, the mean value of DSC was used as the grading standard. CONCLUSIONS A novel OAR-specific SOC grading standard in thorax was developed. The SOC grading standard provides a possible alternative for evaluation of the auto-segmentation accuracy for thoracic OARs.
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Affiliation(s)
- Yanchen Ying
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China.,Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education and Center for Electronic Microscopy and Department of Physics, Wuhan University, Wuhan, 430070, China
| | - Hao Wang
- Institute of Modern Physics, Fudan University, Shanghai, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Jianfan Cheng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Hengle Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Yanhua Duan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Aihui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Wen Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Xiaolong Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Hong Quan
- Key Laboratory of Artificial Micro- and Nano-Structures of Ministry of Education and Center for Electronic Microscopy and Department of Physics, Wuhan University, Wuhan, 430070, China
| | - Zhiyong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, 200030, China.
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10
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Yoshimura T, Nishioka K, Hashimoto T, Fujiwara T, Ishizaka K, Sugimori H, Kogame S, Seki K, Tamura H, Tanaka S, Matsuo Y, Dekura Y, Kato F, Aoyama H, Shimizu S. Visualizing the urethra by magnetic resonance imaging without usage of a catheter for radiotherapy of prostate cancer. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2021; 18:1-4. [PMID: 34258400 PMCID: PMC8254197 DOI: 10.1016/j.phro.2021.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023]
Abstract
Post urination MRI is useful for urethra-sparing radiotherapy treatment planning. This prospective clinical trial included 11 prostate cancer patients. Post urination MRI is the identification method of prostatic urinary tract in non-invasive manner.
The urethra position may shift due to the presence/absence of the catheter. Our proposed post-urination-magnetic resonance imaging (PU-MRI) technique is possible to identify the urethra without catheter. We aimed to verify the inter-operator difference in contouring the urethra by PU-MRI. The mean values of the evaluation indices of dice similarity coefficient, mean slice-wise Hausdorff distance, and center coordinates were 0.93, 0.17 mm, and 0.36 mm for computed tomography, and 0.75, 0.44 mm, and 1.00 mm for PU-MRI. Therefore, PU-MRI might be useful for identifying the prostatic urinary tract without using a urethral catheter. Clinical trial registration: Hokkaido University Hospital for Clinical Research (018-0221).
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Affiliation(s)
- Takaaki Yoshimura
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan.,Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Kentaro Nishioka
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takayuki Hashimoto
- Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Taro Fujiwara
- Department of Radiation Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Kinya Ishizaka
- Department of Radiation Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroyuki Sugimori
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Shoki Kogame
- Division of Radiological Science and Technology, Department of Health Sciences, School of Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuya Seki
- Division of Radiological Science and Technology, Department of Health Sciences, School of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroshi Tamura
- Department of Radiation Technology, Hokkaido University Hospital, Sapporo, Japan
| | - Sodai Tanaka
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Yuto Matsuo
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Yasuhiro Dekura
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Hidefumi Aoyama
- Department of Radiation Oncology, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Shinichi Shimizu
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan.,Department of Radiation Medical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan.,Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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11
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Casati M, Piffer S, Calusi S, Marrazzo L, Simontacchi G, Di Cataldo V, Greto D, Desideri I, Vernaleone M, Francolini G, Livi L, Pallotta S. Methodological approach to create an atlas using a commercial auto-contouring software. J Appl Clin Med Phys 2020; 21:219-230. [PMID: 33236827 PMCID: PMC7769405 DOI: 10.1002/acm2.13093] [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: 07/01/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The aim of this work was to establish a methodological approach for creation and optimization of an atlas for auto-contouring, using the commercial software MIM MAESTRO (MIM Software Inc. Cleveland OH). METHODS A computed tomography (CT) male pelvis atlas was created and optimized to evaluate how different tools and options impact on the accuracy of automatic segmentation. Pelvic lymph nodes (PLN), rectum, bladder, and femurs of 55 subjects were reviewed for consistency by a senior consultant radiation oncologist with 15 yr of experience. Several atlas and workflow options were tuned to optimize the accuracy of auto-contours. The deformable image registration (DIR), the finalization method, the k number of atlas best matching subjects, and several post-processing options were studied. To test our atlas performances, automatic and reference manual contours of 20 test subjects were statistically compared based on dice similarity coefficient (DSC) and mean distance to agreement (MDA) indices. The effect of field of view (FOV) reduction on auto-contouring time was also investigated. RESULTS With the optimized atlas and workflow, DSC and MDA median values of bladder, rectum, PLN, and femurs were 0.91 and 1.6 mm, 0.85 and 1.6 mm, 0.85 and 1.8 mm, and 0.96 and 0.5 mm, respectively. Auto-contouring time was more than halved by strictly cropping the FOV of the subject to be contoured to the pelvic region. CONCLUSION A statistically significant improvement of auto-contours accuracy was obtained using our atlas and optimized workflow instead of the MIM Software pelvic atlas.
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Affiliation(s)
- Marta Casati
- Department of Medical Physics, Careggi University Hospital, Florence, Italy
| | - Stefano Piffer
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.,National Institute of Nuclear Physics (INFN), Florence, Italy
| | - Silvia Calusi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Livia Marrazzo
- Department of Medical Physics, Careggi University Hospital, Florence, Italy
| | | | | | - Daniela Greto
- Department of Radiation Oncology, Careggi University Hospital, Florence, Italy
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Marco Vernaleone
- Department of Radiation Oncology, Careggi University Hospital, Florence, Italy
| | - Giulio Francolini
- Department of Radiation Oncology, Careggi University Hospital, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
| | - Stefania Pallotta
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy
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12
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Vasmel JE, Groot Koerkamp ML, Kirby AM, Russell NS, Shaitelman SF, Vesprini D, Anandadas CN, Currey A, Keller BM, Braunstein LZ, Han K, Kotte ANTJ, de Waard SN, Philippens MEP, Houweling AC, Verkooijen HM, van den Bongard HJGD. Consensus on Contouring Primary Breast Tumors on MRI in the Setting of Neoadjuvant Partial Breast Irradiation in Trials. Pract Radiat Oncol 2020; 10:e466-e474. [PMID: 32315784 DOI: 10.1016/j.prro.2020.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Our purpose was to present and evaluate expert consensus on contouring primary breast tumors on magnetic resonance imaging (MRI) in the setting of neoadjuvant partial breast irradiation in trials. METHODS AND MATERIALS Expert consensus on contouring guidelines for target definition of primary breast tumors on contrast-enhanced MRI in trials was developed by an international team of experienced breast radiation oncologists and a dedicated breast radiologist during 3 meetings. At the first meeting, draft guidelines were developed through discussing and contouring 2 cases. At the second meeting 6 breast radiation oncologists delineated gross tumor volume (GTV) in 10 patients with early-stage breast cancer (cT1N0) according to draft guidelines. GTV was expanded isotropically (20 mm) to generate clinical target volume (CTV), excluding skin and chest wall. Delineations were reviewed for disagreement and guidelines were clarified accordingly. At the third meeting 5 radiation oncologists redelineated 6 cases using consensus-based guidelines. Interobserver variation of GTV and CTV was assessed using generalized conformity index (CI). CI was calculated as the sum of volumes each pair of observers agreed upon, divided by the sum of encompassing volumes for each pair of observers. RESULTS For the 2 delineation sessions combined, mean GTV ranged between 0.19 and 2.44 cm3, CI for GTV ranged between 0.28 and 0.77, and CI for CTV between 0.77 and 0.94. The largest interobserver variation in GTV delineations was observed in cases with extended tumor spiculae, blood vessels near or markers within the tumor, or with increased enhancement of glandular breast tissue. Consensus-based guidelines stated to delineate all visible tumors on contrast enhanced-MRI scan 1 to 2 minutes after contrast injection and if a marker was inserted in the tumor to include this. CONCLUSIONS Expert-based consensus on contouring primary breast tumors on MRI in trials has been reached. This resulted in low interobserver variation for CTV in the context of a uniform 20 mm GTV to CTV expansion margin.
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Affiliation(s)
- Jeanine E Vasmel
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | | | - Anna M Kirby
- Royal Marsden NHS Foundation Trust/The Institute of Cancer Research, Sutton, England, United Kingdom
| | - Nicola S Russell
- Department of Radiation Oncology, AVL/NKI, Amsterdam, the Netherlands
| | - Simona F Shaitelman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Danny Vesprini
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Adam Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Wauwatosa, Wisconsin
| | - Brian M Keller
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Kathy Han
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Alexis N T J Kotte
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Stephanie N de Waard
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marielle E P Philippens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Antonetta C Houweling
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Helena M Verkooijen
- Imaging Division, University Medical Center Utrecht, Utrecht, the Netherlands; Utrecht University, Utrecht, The Netherlands
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13
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Atif M, Devanesan S, AlSalhi MS, Masilamani V, Saleem MNA, AlShebly M, Farhat K, Hussain I, Alimgeer KS. An experimental and algorithm-based study of the spectral features of breast cancer patients by a photodiagnosis approach. Photodiagnosis Photodyn Ther 2020; 31:101851. [PMID: 32497774 DOI: 10.1016/j.pdpdt.2020.101851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/26/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
Abstract
In the present study, the spectral diagnosis of blood plasma samples of breast cancer patients and an equal number of normal controls was investigated. A set of ratio parameters was acquired by employing SXS and FES. The samples were also analyzed statistically by employing Welch two-sample t-tests, and the effects of three ratio parameters, R1, R2, and R3, were also studied by plotting them against the subject numbers. A linear discriminant was also applied to verify the exact classification of normal control and breast cancer patients. It was observed that the levels of biofluorophores such as porphyrin, NADH, tryptophan and flavins were elevated 2- to 3-fold for breast cancer patients compared to normal controls, with an accuracy of approximately 100 %. We have also confirmed the validity of the obtained experimental results by using an advanced robust diagnostic algorithm. The experimental results of the current study may have a vital and substantial impact on the detection and screening protocols used for future breast cancer patients. The spectral analysis of body fluid could be of great value to add to and enhance the current procedures with an accuracy of approximately 100 % with limited number of samples. The results and objectives of this preliminary study were encouraging and useful for the discrimination of the features of breast cancer patients compared to those of normal controls.
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Affiliation(s)
- M Atif
- Department of Physics and Astronomy, College of Science, King Saud University, P.O. Box-2455, Riyadh 11451, Saudi Arabia
| | - S Devanesan
- Department of Physics and Astronomy, College of Science, King Saud University, P.O. Box-2455, Riyadh 11451, Saudi Arabia.
| | - M S AlSalhi
- Department of Physics and Astronomy, College of Science, King Saud University, P.O. Box-2455, Riyadh 11451, Saudi Arabia.
| | - V Masilamani
- Department of Physics and Astronomy, College of Science, King Saud University, P.O. Box-2455, Riyadh 11451, Saudi Arabia
| | | | - Mashael AlShebly
- Department of Obstetrics and Gynecology, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, 11451, Saudi Arabia
| | - K Farhat
- Department of Urology, Cancer Research Chair, College of Medicine, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Ijaz Hussain
- Department of Statistics, Quaid-i-Azam University, Islamabad, Pakistan
| | - K S Alimgeer
- Electrical and Computer Engineering Department, COMSATS University Islambad, Islamabad Campus, Park Road, Chak Shahzad, Islamabad, 45550, Pakistan
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14
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Kim N, Chang JS, Kim YB, Kim JS. Atlas-based auto-segmentation for postoperative radiotherapy planning in endometrial and cervical cancers. Radiat Oncol 2020; 15:106. [PMID: 32404123 PMCID: PMC7218589 DOI: 10.1186/s13014-020-01562-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/05/2020] [Indexed: 12/22/2022] Open
Abstract
Background Since intensity-modulated radiation therapy (IMRT) has become popular for the treatment of gynecologic cancers, the contouring process has become more critical. This study evaluated the feasibility of atlas-based auto-segmentation (ABAS) for contouring in patients with endometrial and cervical cancers. Methods A total of 75 sets of planning CT images from 75 patients were collected. Contours for the pelvic nodal clinical target volume (CTV), femur, and bladder were carefully generated by two skilled radiation oncologists. Of 75 patients, 60 were randomly registered in three different atlas libraries for ABAS in groups of 20, 40, or 60. ABAS was conducted in 15 patients, followed by manual correction (ABASc). The time required to generate all contours was recorded, and the accuracy of segmentation was assessed using Dice’s coefficient (DC) and the Hausdorff distance (HD) and compared to those of manually delineated contours. Results For ABAS-CTV, the best results were achieved with groups of 60 patients (DC, 0.79; HD, 19.7 mm) and the worst results with groups of 20 patients (DC, 0.75; p = 0.012; HD, 21.3 mm; p = 0.002). ABASc-CTV performed better than ABAS-CTV in terms of both HD and DC (ABASc [n = 60]; DC, 0.84; HD, 15.6 mm; all p < 0.017). ABAS required an average of 45.1 s, whereas ABASc required 191.1 s; both methods required less time than the manual methods (p < 0.001). Both ABAS-Femur and simultaneous ABAS-Bilateral-femurs showed satisfactory performance, regardless of the atlas library used (DC > 0.9 and HD ≤10.0 mm), with significant time reduction compared to that needed for manual delineation (p < 0.001). However, ABAS-Bladder did not prove to be feasible, with inferior results regardless of library size (DC < 0.6 and HD > 40 mm). Furthermore, ABASc-Bladder required a longer processing time than manual contouring to achieve the same accuracy. Conclusions ABAS could help physicians to delineate the CTV and organs-at-risk (e.g., femurs) in IMRT planning considering its consistency, efficacy, and accuracy.
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Affiliation(s)
- Nalee Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.,Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Yong Bae Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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15
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Martell K, Law C, Hasan Y, Taggar A, Barnes E, Ravi A, Leung E. Using infrared depth-sensing technology to improve the brachytherapy operating room experience. Brachytherapy 2020; 19:323-327. [PMID: 32220519 DOI: 10.1016/j.brachy.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/31/2020] [Accepted: 02/06/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to discuss the merits of using depth-sensing infrared camera technology in the brachytherapy operating room during interstitial brachytherapy for gynecologic malignancies. MATERIALS AND METHODS The infrared depth-sensing camera from a Microsoft Kinect that had been adapted for surgical use was introduced into a high-volume interstitial brachytherapy operating room. Brachytherapists then used the touchless, gestural interface to review preoperative MRI in real time to guide needle insertion. RESULTS The interface was used for 10 consecutive procedures by 4 separate brachytherapists. The initial training and adjustment to the technology was variable among brachytherapists. All brachytherapists found the controls intuitive and were able to successfully navigate MRI on the system after 1, 30, 30, and 45 min. Qualitatively, brachytherapists found the system helpful for interpretation of intraoperative ultrasound imaging. Furthermore, it ensured adequate needle positioning and deposition was maintained for large tumors. Surgeons involved in its use agreed on potential for considerable benefit when performing interstitial brachytherapy. CONCLUSIONS Adapting this technology for use in the brachytherapy suite provided a higher level of comfort with interstitial catheter placement. This novel tool or similar technology might be considered within other brachytherapy suites.
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Affiliation(s)
- Kevin Martell
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario; Sunnybrook Health Sciences Centre, Toronto, Ontario; Department of Oncology, University of Calgary, Calgary, Alberta; Tom Baker Cancer Centre, Calgary, Alberta
| | - Calvin Law
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario; Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Yaser Hasan
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario; Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Amandeep Taggar
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario; Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Elizabeth Barnes
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario; Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Ananth Ravi
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario; Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Eric Leung
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario; Sunnybrook Health Sciences Centre, Toronto, Ontario.
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16
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Guo B, Shah C, Xia P. Automated planning of whole breast irradiation using hybrid IMRT improves efficiency and quality. J Appl Clin Med Phys 2019; 20:87-96. [PMID: 31743598 PMCID: PMC6909113 DOI: 10.1002/acm2.12767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/05/2019] [Accepted: 10/14/2019] [Indexed: 11/25/2022] Open
Abstract
Purpose To develop an automated workflow for whole breast irradiation treatment planning using hybrid intensity modulated radiation therapy (IMRT) approach and to demonstrate that this workflow can improve planning quality and efficiency when compared to manual planning. Methods The auto planning framework was built based on scripting with MIM and Pinnacle systems. MIM workflows were developed to automatically segment normal structures and targets, identify landmarks for beam placement, select beam energies, and set beam configurations. Pinnacle scripts were generated from the MIM workflow to create hybrid IMRT plans automatically. Each hybrid IMRT plan included two prescriptions: a three‐dimensional (3D) prescription consisted of two open tangent beams, and an IMRT prescription consisted of two step‐and‐shoot IMRT beams. The 3D prescription delivered a full prescription dose to the maximum dose point, and the IMRT prescription was optimized to deliver a uniform dose to the entire breast while sparing dose to the normal structures. For 30 patients, the auto plans were compared with clinically accepted manual plans using the paired sample t‐test. Results The auto planning process took approximately 8 min to complete. The mean dice coefficients between auto‐segmentation and manual contours were 0.98, 0.94 and 0.88 for the lungs, heart, and PTVeval_Breast, respectively. The MUs of the auto plans was on average 13% higher than that of the manual plans. Auto planning improved plan quality significantly: percentage volume receiving 95% of the prescription dose (V95%) of the PTVeval_Breast increased from 91.5% to 93.2% (P = 0.001), V105% of the PTVeval_Breast decreased from 7.2% to 1.2% (P = 0.013), V20Gy of the ipsilateral lung decreased from 13.1% to 10.4% (P = 0.001) and mean heart dose for left‐sided breast patients decreased from 1.2 Gy to 0.9 Gy (P < 0.001). Conclusion An automated treatment planning process can make the planning process efficient with improved plan quality.
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Affiliation(s)
- Bingqi Guo
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ping Xia
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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17
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Wu X, Udupa JK, Tong Y, Odhner D, Pednekar GV, Simone CB, McLaughlin D, Apinorasethkul C, Apinorasethkul O, Lukens J, Mihailidis D, Shammo G, James P, Tiwari A, Wojtowicz L, Camaratta J, Torigian DA. AAR-RT - A system for auto-contouring organs at risk on CT images for radiation therapy planning: Principles, design, and large-scale evaluation on head-and-neck and thoracic cancer cases. Med Image Anal 2019; 54:45-62. [PMID: 30831357 PMCID: PMC6499546 DOI: 10.1016/j.media.2019.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/04/2018] [Accepted: 01/26/2019] [Indexed: 12/25/2022]
Abstract
Contouring (segmentation) of Organs at Risk (OARs) in medical images is required for accurate radiation therapy (RT) planning. In current clinical practice, OAR contouring is performed with low levels of automation. Although several approaches have been proposed in the literature for improving automation, it is difficult to gain an understanding of how well these methods would perform in a realistic clinical setting. This is chiefly due to three key factors - small number of patient studies used for evaluation, lack of performance evaluation as a function of input image quality, and lack of precise anatomic definitions of OARs. In this paper, extending our previous body-wide Automatic Anatomy Recognition (AAR) framework to RT planning of OARs in the head and neck (H&N) and thoracic body regions, we present a methodology called AAR-RT to overcome some of these hurdles. AAR-RT follows AAR's 3-stage paradigm of model-building, object-recognition, and object-delineation. Model-building: Three key advances were made over AAR. (i) AAR-RT (like AAR) starts off with a computationally precise definition of the two body regions and all of their OARs. Ground truth delineations of OARs are then generated following these definitions strictly. We retrospectively gathered patient data sets and the associated contour data sets that have been created previously in routine clinical RT planning from our Radiation Oncology department and mended the contours to conform to these definitions. We then derived an Object Quality Score (OQS) for each OAR sample and an Image Quality Score (IQS) for each study, both on a 1-to-10 scale, based on quality grades assigned to each OAR sample following 9 key quality criteria. Only studies with high IQS and high OQS for all of their OARs were selected for model building. IQS and OQS were employed for evaluating AAR-RT's performance as a function of image/object quality. (ii) In place of the previous hand-crafted hierarchy for organizing OARs in AAR, we devised a method to find an optimal hierarchy for each body region. Optimality was based on minimizing object recognition error. (iii) In addition to the parent-to-child relationship encoded in the hierarchy in previous AAR, we developed a directed probability graph technique to further improve recognition accuracy by learning and encoding in the model "steady" relationships that may exist among OAR boundaries in the three orthogonal planes. Object-recognition: The two key improvements over the previous approach are (i) use of the optimal hierarchy for actual recognition of OARs in a given image, and (ii) refined recognition by making use of the trained probability graph. Object-delineation: We use a kNN classifier confined to the fuzzy object mask localized by the recognition step and then fit optimally the fuzzy mask to the kNN-derived voxel cluster to bring back shape constraint on the object. We evaluated AAR-RT on 205 thoracic and 298 H&N (total 503) studies, involving both planning and re-planning scans and a total of 21 organs (9 - thorax, 12 - H&N). The studies were gathered from two patient age groups for each gender - 40-59 years and 60-79 years. The number of 3D OAR samples analyzed from the two body regions was 4301. IQS and OQS tended to cluster at the two ends of the score scale. Accordingly, we considered two quality groups for each gender - good and poor. Good quality data sets typically had OQS ≥ 6 and had distortions, artifacts, pathology etc. in not more than 3 slices through the object. The number of model-worthy data sets used for training were 38 for thorax and 36 for H&N, and the remaining 479 studies were used for testing AAR-RT. Accordingly, we created 4 anatomy models, one each for: Thorax male (20 model-worthy data sets), Thorax female (18 model-worthy data sets), H&N male (20 model-worthy data sets), and H&N female (16 model-worthy data sets). On "good" cases, AAR-RT's recognition accuracy was within 2 voxels and delineation boundary distance was within ∼1 voxel. This was similar to the variability observed between two dosimetrists in manually contouring 5-6 OARs in each of 169 studies. On "poor" cases, AAR-RT's errors hovered around 5 voxels for recognition and 2 voxels for boundary distance. The performance was similar on planning and replanning cases, and there was no gender difference in performance. AAR-RT's recognition operation is much more robust than delineation. Understanding object and image quality and how they influence performance is crucial for devising effective object recognition and delineation algorithms. OQS seems to be more important than IQS in determining accuracy. Streak artifacts arising from dental implants and fillings and beam hardening from bone pose the greatest challenge to auto-contouring methods.
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Affiliation(s)
- Xingyu Wu
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 602 Goddard building, 3710 Hamilton Walk, 6th Floor, Rm 602W, Philadelphia, PA 19104, United States
| | - Jayaram K Udupa
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 602 Goddard building, 3710 Hamilton Walk, 6th Floor, Rm 602W, Philadelphia, PA 19104, United States.
| | - Yubing Tong
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 602 Goddard building, 3710 Hamilton Walk, 6th Floor, Rm 602W, Philadelphia, PA 19104, United States
| | - Dewey Odhner
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 602 Goddard building, 3710 Hamilton Walk, 6th Floor, Rm 602W, Philadelphia, PA 19104, United States
| | - Gargi V Pednekar
- Quantitative Radiology Solutions, 3624 Market Street, Suite 5E, Philadelphia, PA 19104, United States
| | - Charles B Simone
- Department of Radiation Oncology, Maryland Proton Treatment Center, School of Medicine, University of Maryland 850W, Baltimore, MD 21201, United States
| | - David McLaughlin
- Quantitative Radiology Solutions, 3624 Market Street, Suite 5E, Philadelphia, PA 19104, United States
| | - Chavanon Apinorasethkul
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Ontida Apinorasethkul
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - John Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Dimitris Mihailidis
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Geraldine Shammo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Paul James
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Akhil Tiwari
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Lisa Wojtowicz
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - Joseph Camaratta
- Quantitative Radiology Solutions, 3624 Market Street, Suite 5E, Philadelphia, PA 19104, United States
| | - Drew A Torigian
- Medical Image Processing Group, Department of Radiology, University of Pennsylvania, 602 Goddard building, 3710 Hamilton Walk, 6th Floor, Rm 602W, Philadelphia, PA 19104, United States
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Djukelic M, Waterhouse D, Toh R, Tan H, Rowshanfarzad P, Joseph D, Ebert MA. Evaluation of a mobile C-arm cone-beam CT in interstitial high-dose-rate prostate brachytherapy treatment planning. J Med Radiat Sci 2019; 66:112-121. [PMID: 30945476 PMCID: PMC6545480 DOI: 10.1002/jmrs.331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/25/2019] [Accepted: 02/28/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction The aim of this study was to evaluate the suitability of using cone‐beam computed tomography (CBCT) obtained with a mobile C‐arm X‐ray fluoroscopy unit as a single modality for planning of high‐dose‐rate (HDR) prostate brachytherapy treatments. Methods The feasibility of using CBCT images obtained using a Siemens Arcadis Orbic 3D mobile C‐arm was evaluated. A retrospective clinical study was undertaken of six participants undergoing HDR prostate brachytherapy. Plans generated using images from a Toshiba Aquilion One LB CT were compared with those generated using CBCT images. After rigid spatial registration, the plans were compared based on various parameters such as dose‐volume histograms, overlap quantities and metrics, and dose constraints. Results Provided they were within the limited field of view, the brachytherapy catheters and fiducial markers were clearly visible in the CBCT images and thus, localisable and identifiable in the treatment planning process. The Siemens CBCT underestimated CT numbers leading to poorer tissue contrast which exacerbated the difficulties in delineation of the target tumour and the surrounding organs at risk. Between CT‐ and CBCT‐based plans, the mean difference of CTV‐D90 was 1.58 Gy, CTV‐V100 was 12.13%, rectum‐V80 was 0.06% and urethra‐V120 was −0.70%. Conclusion It was not feasible to solely utilise the Siemens Arcadis Orbic 3D for HDR prostate brachytherapy treatment planning due to suboptimal organ delineation. However, the methods in this study could be used to evaluate other mobile CBCT imaging devices for feasibility in HDR brachytherapy treatment planning since the results indicated that it may not be necessary to have standard quality CT images for treatment planning.
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Affiliation(s)
- Mario Djukelic
- Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,Department of Physics, The University of Western Australia, Crawley, WA, Australia
| | - David Waterhouse
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Ryan Toh
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Hendrick Tan
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Pejman Rowshanfarzad
- Department of Physics, The University of Western Australia, Crawley, WA, Australia
| | - David Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Martin A Ebert
- Department of Physics, The University of Western Australia, Crawley, WA, Australia.,Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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19
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Men K, Zhang T, Chen X, Chen B, Tang Y, Wang S, Li Y, Dai J. Fully automatic and robust segmentation of the clinical target volume for radiotherapy of breast cancer using big data and deep learning. Phys Med 2018; 50:13-19. [PMID: 29891089 DOI: 10.1016/j.ejmp.2018.05.006] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 05/03/2018] [Accepted: 05/04/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To train and evaluate a very deep dilated residual network (DD-ResNet) for fast and consistent auto-segmentation of the clinical target volume (CTV) for breast cancer (BC) radiotherapy with big data. METHODS DD-ResNet was an end-to-end model enabling fast training and testing. We used big data comprising 800 patients who underwent breast-conserving therapy for evaluation. The CTV were validated by experienced radiation oncologists. We performed a fivefold cross-validation to test the performance of the model. The segmentation accuracy was quantified by the Dice similarity coefficient (DSC) and the Hausdorff distance (HD). The performance of the proposed model was evaluated against two different deep learning models: deep dilated convolutional neural network (DDCNN) and deep deconvolutional neural network (DDNN). RESULTS Mean DSC values of DD-ResNet (0.91 and 0.91) were higher than the other two networks (DDCNN: 0.85 and 0.85; DDNN: 0.88 and 0.87) for both right-sided and left-sided BC. It also has smaller mean HD values of 10.5 mm and 10.7 mm compared with DDCNN (15.1 mm and 15.6 mm) and DDNN (13.5 mm and 14.1 mm). Mean segmentation time was 4 s, 21 s and 15 s per patient with DDCNN, DDNN and DD-ResNet, respectively. The DD-ResNet was also superior with regard to results in the literature. CONCLUSIONS The proposed method could segment the CTV accurately with acceptable time consumption. It was invariant to the body size and shape of patients and could improve the consistency of target delineation and streamline radiotherapy workflows.
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Affiliation(s)
- Kuo Men
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Tao Zhang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xinyuan Chen
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bo Chen
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu Tang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shulian Wang
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yexiong Li
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
| | - Jianrong Dai
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
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20
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Delouya G, Carrier JF, Xavier-Larouche R, Hervieux Y, Béliveau-Nadeau D, Donath D, Taussky D. Fusion of Intraoperative Transrectal Ultrasound Images with Post-implant Computed Tomography and Magnetic Resonance Imaging. Cureus 2018; 10:e2394. [PMID: 29850389 PMCID: PMC5973483 DOI: 10.7759/cureus.2394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Purpose To compare the impact of the fusion of intraoperative transrectal ultrasound (TRUS) images with day 30 computed tomography (CT) and magnetic resonance imaging (MRI) on prostate volume and dosimetry. Methods and materials Seventy-five consecutive patients with CT and MRI obtained on day 30 with a Fast Spin Echo T2-weighted magnetic resonance (MR) sequence were analyzed. A rigid manual registration was performed between the intraoperative TRUS and day-30 CT based on the prostate volume. A second manual rigid registration was performed between the intraoperative TRUS and the day-30 MRI. The prostate contours were manually modified on CT and MRI. The difference in prostate volume and dosimetry between CT and MRI were compared. Results Prostate volume was on average 8% (standard deviation (SD) ± 16%) larger on intraoperative TRUS than on CT and 6% (18%) larger than on MRI. In 48% of the cases, the difference in volume on CT was > 10% compared to MRI. The difference in prostate volume between CT and MRI was inversely correlated to the difference in D90 (minimum dose that covers 90% of the prostate volume) between CT and MRI (r = -0.58, P < .001). A D90 < 90% was found in 5% (n = 4) on MRI and in 10% (n = 7) on CT (Fisher exact test one-sided P = .59), but in no patient was the D90 < 90% on both MRI and CT. Conclusions When fusing TRUS images with CT and MRI, the differences in prostate volume between those modalities remain clinically important in nearly half of the patients, and this has a direct influence on how implant quality is evaluated.
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Affiliation(s)
- Guila Delouya
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)
| | - Jean-Francois Carrier
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)
| | - Renée Xavier-Larouche
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)
| | - Yannick Hervieux
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)
| | | | - David Donath
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)
| | - Daniel Taussky
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal (CHUM)
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Pathmanathan AU, van As NJ, Kerkmeijer LGW, Christodouleas J, Lawton CAF, Vesprini D, van der Heide UA, Frank SJ, Nill S, Oelfke U, van Herk M, Li XA, Mittauer K, Ritter M, Choudhury A, Tree AC. Magnetic Resonance Imaging-Guided Adaptive Radiation Therapy: A "Game Changer" for Prostate Treatment? Int J Radiat Oncol Biol Phys 2018; 100:361-373. [PMID: 29353654 DOI: 10.1016/j.ijrobp.2017.10.020] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 01/25/2023]
Abstract
Radiation therapy to the prostate involves increasingly sophisticated delivery techniques and changing fractionation schedules. With a low estimated α/β ratio, a larger dose per fraction would be beneficial, with moderate fractionation schedules rapidly becoming a standard of care. The integration of a magnetic resonance imaging (MRI) scanner and linear accelerator allows for accurate soft tissue tracking with the capacity to replan for the anatomy of the day. Extreme hypofractionation schedules become a possibility using the potentially automated steps of autosegmentation, MRI-only workflow, and real-time adaptive planning. The present report reviews the steps involved in hypofractionated adaptive MRI-guided prostate radiation therapy and addresses the challenges for implementation.
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Affiliation(s)
- Angela U Pathmanathan
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Nicholas J van As
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | | | | | | | - Danny Vesprini
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Steven J Frank
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Simeon Nill
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Uwe Oelfke
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
| | - Marcel van Herk
- Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Science Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; National Institute of Health Research, Manchester Biomedical Research Centre, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - X Allen Li
- Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathryn Mittauer
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Mark Ritter
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ananya Choudhury
- Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Science Centre, The Christie National Health Service Foundation Trust, Manchester, United Kingdom; National Institute of Health Research, Manchester Biomedical Research Centre, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
| | - Alison C Tree
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden National Health Service Foundation Trust, London, United Kingdom
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Ciardo D, Argenone A, Boboc GI, Cucciarelli F, De Rose F, De Santis MC, Huscher A, Ippolito E, La Porta MR, Marino L, Meaglia I, Palumbo I, Rossi F, Alpi P, Bignardi M, Bonanni A, Cante D, Ceschia T, Fabbietti L, Lupattelli M, Mantero ED, Monaco A, Porcu P, Ravo V, Silipigni S, Tozzi A, Umina V, Zerini D, Bordonaro L, Capezzali G, Clerici E, Colangione SP, Dispinzieri M, Dognini J, Donadoni L, Falivene S, Fozza A, Grilli B, Guarnaccia R, Iannacone E, Lancellotta V, Prisco A, Ricotti R, Orecchia R, Jereczek-Fossa BA, Leonardi MC. Variability in axillary lymph node delineation for breast cancer radiotherapy in presence of guidelines on a multi-institutional platform. Acta Oncol 2017; 56:1081-1088. [PMID: 28534430 DOI: 10.1080/0284186x.2017.1325004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To quantify the variability between radiation oncologists (ROs) when outlining axillary nodes in breast cancer. MATERIAL AND METHODS For each participating center, three ROs with different levels of expertise, i.e., junior (J), senior (S) and expert (E), contoured axillary nodal levels (L1, L2, L3 and L4) on the CT images of three different patients (P) of an increasing degree of anatomical complexity (from P1 to P2 to P3), according to contouring guidelines. Consensus contours were generated using the simultaneous truth and performance level estimation (STAPLE) method. RESULTS Fifteen centers and 42 ROs participated. Overall, the median Dice similarity coefficient was 0.66. Statistically significant differences were observed according to the level of expertise (better agreement for J and E, worse for S); the axillary level (better agreement for L1 and L4, worse for L3); the patient (better agreement for P1, worse for P3). Statistically significant differences in contouring were found in 18% of the inter-center comparison. Less than a half of the centers could claim to have a good agreement between the internal ROs. CONCLUSIONS The overall intra-institute and inter-institute agreement was moderate. Central lymph-node levels were the most critical and variability increased as the complexity of the patient's anatomy increased. These findings might have an effect on the interpretation of results from multicenter and even mono-institute studies.
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Affiliation(s)
- Delia Ciardo
- Division of Radiation Oncology, Istituto Europeo di Oncologia, Milano, Italy
| | - Angela Argenone
- Division of Radiotherapy, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale IRCCS, Napoli, Italy
| | | | - Francesca Cucciarelli
- Department of Internal Medicine, Radiotherapy Institute, Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy
| | - Fiorenza De Rose
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Centre and Research Hospital, Milano, Italy
| | | | | | - Edy Ippolito
- Department of Radiotherapy, Campus Bio-Medico University, Roma, Italy
| | - Maria Rosa La Porta
- Radiotherapy Department, Ivrea Community Hospital, Ivrea, Italy; Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale ‘U. Parini’, AUSL Valle d'Aosta, Aosta, Italy
| | - Lorenza Marino
- REM Radioterapia, Istituto Oncologico del Mediterraneo (IOM), Catania, Italy
| | - Ilaria Meaglia
- Department of Radiation Oncology, Fondazione Salvatore Maugeri, Pavia, Italy
| | - Isabella Palumbo
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | | | - Paolo Alpi
- Radiotherapy Unit, Azienda Sanitaria 10, Firenze, Italy
| | - Mario Bignardi
- Radiotherapy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Alessio Bonanni
- Radiotherapy Unit, Ospedale Fatebenefratelli Isola Tiberina, Roma, Italy
| | - Domenico Cante
- Radiotherapy Department, Ivrea Community Hospital, Ivrea, Italy; Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale ‘U. Parini’, AUSL Valle d'Aosta, Aosta, Italy
| | - Tino Ceschia
- Department of Radiotherapy, Azienda Sanitaria Universitaria Integrata Santa Maria della Misericordia, Udine, Italy
| | - Letizia Fabbietti
- Department of Internal Medicine, Radiotherapy Institute, Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy
| | - Marco Lupattelli
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | | | - Alessia Monaco
- Department of Radiation Oncology, S. Camillo-Forlanini Hospital, Roma, Italy
| | - Patrizia Porcu
- Department of Radiation Oncology, Fondazione Salvatore Maugeri, Pavia, Italy
| | - Vincenzo Ravo
- Division of Radiotherapy, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale IRCCS, Napoli, Italy
| | - Sonia Silipigni
- Department of Radiotherapy, Campus Bio-Medico University, Roma, Italy
| | - Angelo Tozzi
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Centre and Research Hospital, Milano, Italy
| | - Vincenza Umina
- REM Radioterapia, Istituto Oncologico del Mediterraneo (IOM), Catania, Italy
| | - Dario Zerini
- Division of Radiation Oncology, Istituto Europeo di Oncologia, Milano, Italy
| | - Luigi Bordonaro
- REM Radioterapia, Istituto Oncologico del Mediterraneo (IOM), Catania, Italy
| | - Giorgia Capezzali
- Department of Internal Medicine, Radiotherapy Institute, Ospedali Riuniti Umberto I, G.M. Lancisi, G. Salesi, Ancona, Italy
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, Humanitas Cancer Centre and Research Hospital, Milano, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | | | - Michela Dispinzieri
- Radiotherapy Unit 1, National Cancer Institute of Milan, Milano, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | - Jessica Dognini
- Department of Radiation Oncology, S. Camillo-Forlanini Hospital, Roma, Italy
| | - Laura Donadoni
- Radiotherapy Unit, Fondazione Poliambulanza, Brescia, Italy
| | - Sara Falivene
- Division of Radiotherapy, Istituto Nazionale per lo Studio e la Cura dei Tumori, Fondazione G. Pascale IRCCS, Napoli, Italy
| | - Alessandra Fozza
- Radiotherapy Department, Ivrea Community Hospital, Ivrea, Italy; Radiation Oncology Department, Tomotherapy Unit, Ospedale Regionale ‘U. Parini’, AUSL Valle d'Aosta, Aosta, Italy
| | | | - Roberta Guarnaccia
- Radiotherapy Unit, Ospedale Fatebenefratelli Isola Tiberina, Roma, Italy
| | - Eva Iannacone
- Department of Radiotherapy, Campus Bio-Medico University, Roma, Italy
| | - Valentina Lancellotta
- Radiation Oncology Section, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Agnese Prisco
- Department of Radiotherapy, Azienda Sanitaria Universitaria Integrata Santa Maria della Misericordia, Udine, Italy
| | - Rosalinda Ricotti
- Division of Radiation Oncology, Istituto Europeo di Oncologia, Milano, Italy
| | - Roberto Orecchia
- Scientific Directorate, European Institute of Oncology, Milano, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, Istituto Europeo di Oncologia, Milano, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milano, Italy
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Ciardo D, Gerardi MA, Vigorito S, Morra A, Dell'acqua V, Diaz FJ, Cattani F, Zaffino P, Ricotti R, Spadea MF, Riboldi M, Orecchia R, Baroni G, Leonardi MC, Jereczek-Fossa BA. Atlas-based segmentation in breast cancer radiotherapy: Evaluation of specific and generic-purpose atlases. Breast 2017; 32:44-52. [DOI: 10.1016/j.breast.2016.12.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/21/2016] [Accepted: 12/18/2016] [Indexed: 12/22/2022] Open
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Internal and external validation of an ESTRO delineation guideline – dependent automated segmentation tool for loco-regional radiation therapy of early breast cancer. Radiother Oncol 2016; 121:424-430. [DOI: 10.1016/j.radonc.2016.09.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 09/18/2016] [Accepted: 09/18/2016] [Indexed: 12/25/2022]
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Nyholm T, Olsson C, Agrup M, Björk P, Björk-Eriksson T, Gagliardi G, Grinaker H, Gunnlaugsson A, Gustafsson A, Gustafsson M, Johansson B, Johnsson S, Karlsson M, Kristensen I, Nilsson P, Nyström L, Onjukka E, Reizenstein J, Skönevik J, Söderström K, Valdman A, Zackrisson B, Montelius A. A national approach for automated collection of standardized and population-based radiation therapy data in Sweden. Radiother Oncol 2016; 119:344-50. [DOI: 10.1016/j.radonc.2016.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 03/30/2016] [Accepted: 04/02/2016] [Indexed: 10/21/2022]
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Barkati M, Simard D, Taussky D, Delouya G. Magnetic resonance imaging for prostate bed radiotherapy planning: An inter- and intra-observer variability study. J Med Imaging Radiat Oncol 2015; 60:255-9. [DOI: 10.1111/1754-9485.12416] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 10/10/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Maroie Barkati
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame; Montreal Québec Canada
| | - Dany Simard
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame; Montreal Québec Canada
| | - Daniel Taussky
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame; Montreal Québec Canada
| | - Guila Delouya
- Department of Radiation Oncology; Centre hospitalier de l'Université de Montréal (CHUM), Hôpital Notre-Dame; Montreal Québec Canada
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Falcinelli L, Palumbo I, Radicchia V, Arcidiacono F, Lancellotta V, Montesi G, Matrone F, Zucchetti C, Marcantonini M, Bini V, Aristei C. Prostate cancer: contouring target and organs at risk by kilovoltage and megavoltage CT and MRI in patients with and without hip prostheses. Br J Radiol 2015; 88:20150509. [PMID: 26462970 DOI: 10.1259/bjr.20150509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE In radiotherapy treatment, planning target volume and organs at risk are contoured on kilovoltage CT (kVCT) images. Unlike MR images, kVCT does not provide precise information on target volume extension. Since neither kVCT nor MRI may be suitable for contouring in patients with ferrous hip prostheses, this study evaluated whether megavoltage CT (MVCT) reduced interobserver variability. METHODS Two patients without hip prostheses and one patient (Patient 3) with hip prostheses were enrolled. Six radiation oncologists contoured prostate, rectum and bladder on kVCT (Patients 1 and 3), MRI (Patient 2) and MVCT images (Patient 3). MVCT was acquired with fine, normal and coarse modalities. Interobserver variability for each organ was analysed using conformity index (CI) and coefficient of variation (CV). RESULTS In patients without hip prostheses, CIs were higher in prostate contouring with MRI than with kVCT, indicating lower interobserver variability with MRI. Very slight variations were seen in rectum and bladder contouring. In the patient with hip prostheses (Patient 3), contouring on kVCT lowered CI and increased CV in the prostate, bladder and rectum. The differences were more marked in the prostate. Only fine modality MVCT reduced interobserver variability and only for the prostate. CONCLUSION Even though greater noise and less soft-tissue contrast increase contouring variability with MVCT than with kVCT, lack of artefacts on MVCT could provide better image definition by this modality in hip prosthesis patients in whom MRI is precluded. ADVANCES IN KNOWLEDGE We recommend the fine modality MVCT for contouring hip prostheses patients.
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Affiliation(s)
- Lorenzo Falcinelli
- 1 Department of Onco-Haematological and Gastroenterological Science, Radiation Oncology Division, Perugia General Hospital, Perugia, Italy
| | - Isabella Palumbo
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Valentina Radicchia
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Fabio Arcidiacono
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Valentina Lancellotta
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Giampaolo Montesi
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Fabio Matrone
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Claudio Zucchetti
- 3 Department of Imaging and Laboratory Diagnosis, Medical Physics Unit, Perugia General Hospital, Perugia, Italy
| | - Marta Marcantonini
- 3 Department of Imaging and Laboratory Diagnosis, Medical Physics Unit, Perugia General Hospital, Perugia, Italy
| | - Vittorio Bini
- 4 Internal Medicine, Endocrine and Metabolic Sciences Section, Perugia General Hospital, Perugia, Italy
| | - Cynthia Aristei
- 2 Radiation Oncology Section, Department of Surgical and Biomedical Sciences, University of Perugia and Perugia General Hospital, Perugia, Italy
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Tanguturi SK, Lyatskaya Y, Chen Y, Catalano PJ, Chen MH, Yeo WP, Marques A, Truong L, Yeh M, Orlina L, Wong JS, Punglia RS, Bellon JR. Prospective assessment of deep inspiration breath-hold using 3-dimensional surface tracking for irradiation of left-sided breast cancer. Pract Radiat Oncol 2015; 5:358-65. [PMID: 26231594 DOI: 10.1016/j.prro.2015.06.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/30/2015] [Accepted: 06/02/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE Deep inspiration breath hold (DIBH) is used to decrease cardiac irradiation during radiation therapy (RT) for breast cancer. The patients most likely to benefit and the impact on treatment time remain largely unknown. We sought to identify predictors for the use of DIBH and to quantify differences in dosimetry and treatment time using a prospective registry. METHODS AND MATERIALS A total of 150 patients with left breast cancer were enrolled. All patients were simulated with both free breathing (FB) and DIBH. RT was delivered by either modality. Alternate scans were planned with use of deformable registration to include identical RT volumes. DIBH patients were monitored by a real-time surface tracking system, AlignRT (Vision RT, Ltd, London, United Kingdom). Baseline characteristics and treatment times were compared by Fisher exact test and Wilcoxon rank sum test. Dosimetric endpoints were analyzed by Wilcoxon signed rank test, and linear regression identified predictors for change in mean heart dose (∆MHD). RESULTS We treated 38 patients with FB and 110 with DIBH. FB patients were older, more likely to have heart and lung disease, and less likely to receive chemotherapy or immediate reconstruction (all P < .05). Treatment times were not significantly different, but DIBH patients had greater variability in times (P = .0002). Of 146 evaluable patients, DIBH resulted in >20 cGy improvement in MHD in 107 patients but a >20 cGy increase in MHD in 14. Both MHD and lung V20 were significantly lower in DIBH than in paired FB plans. On multivariate analysis, younger age (4.18 cGy per year; P < .0001), higher body mass index (6.06 cGy/kg/m(2); P = .0018), and greater change in lung volumes (130 cGy/L; P = .003) were associated with greater ∆MHD. CONCLUSIONS DIBH improves cardiac dosimetry without significantly impacting treatment time in most patients. Greater inspiratory lung volumes augment this benefit. Because the improvement with DIBH was not uniform, patients should be scanned with both FB and DIBH.
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Affiliation(s)
| | - Yulia Lyatskaya
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
| | - Yuhui Chen
- Department of Biostatistics and Computational Biology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Paul J Catalano
- Department of Biostatistics and Computational Biology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Ming Hui Chen
- Department of Cardiology, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Wee-Pin Yeo
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Alex Marques
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Linh Truong
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Mary Yeh
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Lawrence Orlina
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Julia S Wong
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Rinaa S Punglia
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Jennifer R Bellon
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
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QuickStart radiotherapy: an inter-professional approach to expedite radiotherapy treatment in early breast cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2015. [DOI: 10.1017/s1460396915000205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground and purposeThis study aims to develop an expedited radiotherapy (RT) process and evaluate its time savings in women requiring whole breast RT.Material and methodsAn inter-professional RT team streamlined the computed tomography (CT) simulation and treatment pathway for a ‘QuickStart’ process. Target delineation was performed by an advanced practice radiation therapist and approved by the radiation oncologist (RO) for planning. Automated breast planning software was used for treatment planning and standard quality checks were performed. To assess time savings, the initial 25 QuickStart patients were matched with women who underwent whole breast simulation on the same day (±3 days), treated using the conventional process.ResultsA total of 73 post-lumpectomy women were treated through the QuickStart process; the median consent-to-RT was 2 days (range: 0–13) and the mean CT simulation-to-RT treatment was 2 hours and 42 minutes (SD 0:30). In the subgroup analysis, QuickStart patients saved an average of 11 days from CT simulation-to-RT and had shorter median wait-times for both surgery/chemotherapy-to-RT (60 versus 38 days;p=0·002) and consultation-to-RT (7 versus 20 days;p<0·001).ConclusionsThrough inter-professional team efforts and the application of automated planning software, we have achieved a process that significantly decreases patient wait-times while maintaining the quality of whole breast RT.
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