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O'Connor LM, Quinn A, Denley S, Leigh L, Martin J, Dowling JA, Skehan K, Warren-Forward H, Greer PB. Cone beam computed tomography image guidance within a magnetic resonance imaging-only planning workflow. Phys Imaging Radiat Oncol 2023; 27:100472. [PMID: 37720461 PMCID: PMC10500022 DOI: 10.1016/j.phro.2023.100472] [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: 05/15/2023] [Revised: 07/06/2023] [Accepted: 07/06/2023] [Indexed: 09/19/2023] Open
Abstract
Background and purpose Magnetic Resonance Imaging (MRI)-only planning workflows offer many advantages but raises challenges regarding image guidance. The study aimed to assess the viability of MRI to Cone Beam Computed Tomography (CBCT) based image guidance for MRI-only planning treatment workflows. Materials and methods An MRI matching training package was developed. Ten radiation therapists, with a range of clinical image guidance experience and experience with MRI, completed the training package prior to matching assessment. The matching assessment was performed on four match regions: prostate gold seed, prostate soft tissue, rectum/anal canal and gynaecological. Each match region consisted of five patients, with three CBCTs per patient, resulting in fifteen CBCTs for each match region. The ten radiation therapists performed the CBCT image matching to CT and to MRI for all regions and recorded the match values. Results The median inter-observer variation for MRI-CBCT matching and CT-CBCT matching for all regions were within 2 mm and 1 degree. There was no statistically significant association in the inter-observer variation in mean match values and radiation therapist image guidance experience levels. There was no statistically significant association in inter-observer variation in mean match values for MRI experience levels for prostate soft tissue and gynaecological match regions, while there was a statistically significant difference for prostate gold seed and rectum match regions. Conclusion The results of this study support the concept that with focussed training, an MRI to CBCT image guidance approach can be successfully implemented in a clinical planning workflow.
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Affiliation(s)
- Laura M O'Connor
- Department of Radiation Oncology, Calvary Mater Hospital, Edith Street, Waratah, Newcastle, NSW 2298, Australia
- School of Health Sciences, University of Newcastle, University Drive, Newcastle, NSW 2308, Australia
| | - Alesha Quinn
- Department of Radiation Oncology, Calvary Mater Hospital, Edith Street, Waratah, Newcastle, NSW 2298, Australia
| | - Samuel Denley
- Department of Radiation Oncology, Calvary Mater Hospital, Edith Street, Waratah, Newcastle, NSW 2298, Australia
| | - Lucy Leigh
- Hunter Medical Research Institute, Lot 1 Kookaburra Ct, New Lambton Heights, NSW 2305, Australia
| | - Jarad Martin
- Department of Radiation Oncology, Calvary Mater Hospital, Edith Street, Waratah, Newcastle, NSW 2298, Australia
| | - Jason A Dowling
- Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Bowen Bridge Rd, Herston, QLD 4029, Australia
| | - Kate Skehan
- Department of Radiation Oncology, Calvary Mater Hospital, Edith Street, Waratah, Newcastle, NSW 2298, Australia
| | - Helen Warren-Forward
- School of Health Sciences, University of Newcastle, University Drive, Newcastle, NSW 2308, Australia
| | - Peter B Greer
- Department of Radiation Oncology, Calvary Mater Hospital, Edith Street, Waratah, Newcastle, NSW 2298, Australia
- School of Information and Physical Sciences, University of Newcastle, University Drive, Newcastle, NSW 2308, Australia
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Wyatt JJ, Pearson RA, Frew J, Walker C, Richmond N, Wilkinson M, Wilkes K, Driver S, West S, Karen P, Brooks-Pearson RL, Ainslie D, Wilkins E, McCallum HM. The first patients treated with MR-CBCT soft-tissue matching in a MR-only prostate radiotherapy pathway. Radiography (Lond) 2023; 29:347-354. [PMID: 36736147 DOI: 10.1016/j.radi.2023.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Magnetic Resonance (MR)-only radiotherapy for prostate cancer has previously been reported using fiducial markers for on-treatment verification. MR-Cone Beam Computed Tomography (CBCT) soft-tissue matching does not require invasive fiducial markers and enables MR-only treatments to other pelvic cancers. This study evaluated the first clinical implementation of MR-only prostate radiotherapy using MR-CBCT soft-tissue matching. METHODS Twenty prostate patients were treated with MR-only radiotherapy using a synthetic (s)CT-optimised plan with MR-CBCT soft-tissue matching. Two MR sequences were acquired: small Field Of View (FOV) for target delineation and large FOV for organs at risk delineation, sCT generation and on-treatment verification. Patients also received a CT for validation. The prostate was independently contoured on the small FOV MR, copied to the registered CT and modified if there were MR-CT soft-tissue alignment differences (MR-CT volume). This was compared to the MR-only volume with a paired t-test. The treatment plan was recalculated on CT and the doses compared. Independent offline CT-CBCT matches for 5/20 fractions were performed by three therapeutic radiographers using the MR-only contours and compared to the online MR-CBCT matches using two one-sided paired t-tests for equivalence within ±1 mm. RESULTS The MR-only volumes were significantly smaller than MR-CT (p = 0.003), with a volume ratio 0.92 ± 0.02 (mean ± standard error). The sCT isocentre dose difference to CT was 0.2 ± 0.1%. MR-CBCT soft-tissue matching was equivalent to CT-CBCT (p < 0.001), with differences of 0.1 ± 0.2 mm (vertical), -0.1 ± 0.2 mm (longitudinal) and 0.0 ± 0.1 mm (lateral). CONCLUSIONS MR-only radiotherapy with soft-tissue matching has been successfully clinically implemented. It produced significantly smaller target volumes with high dosimetric and on-treatment matching accuracy. IMPLICATIONS FOR PRACTICE MR-only prostate radiotherapy can be safely delivered without using invasive fiducial markers. This enables MR-only radiotherapy to be extended to other pelvic cancers where fiducial markers cannot be used.
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Affiliation(s)
- J J Wyatt
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK.
| | - R A Pearson
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - J Frew
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - C Walker
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - N Richmond
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - M Wilkinson
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - K Wilkes
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - S Driver
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - S West
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - P Karen
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - R L Brooks-Pearson
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - D Ainslie
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - E Wilkins
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - H M McCallum
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
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Joyce E, Jackson M, Skok J, Peet B, McNair HA. Images and images: Current roles of therapeutic radiographers. Radiography (Lond) 2022; 28:1093-1100. [PMID: 36054937 DOI: 10.1016/j.radi.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/26/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Therapeutic radiography is a small profession and has adapted in response to advanced techniques. An increase in on-line adaptive MRI-guided radiotherapy (MRIgRT) will require role extension for therapeutic radiographers (TRs). This study will investigate the current role description for TRs and the activities they currently undertake with regards to MRIgRT. METHOD A training needs analysis was used to ask TRs about their current roles and responsibilities and essential skills required for MRIgRT. For the purposes of this paper, the authors present the results from the demographics of the individual, their current job title with roles and responsibilities, and experience with decision making and image assessment. Descriptive statistics was used to analyse the data. RESULTS 261 responses were received (n = 261). Only 28% of job titles listed contained the protected title of 'therapeutic radiographer'. Advanced clinical practice roles were expressed by participants indicating that if a service need is presented, emerging roles will be created. Variation existed across the standardised roles of TRs and this discrepancy could present challenges when training for MRIgRT. TRs are pivotal in image verification and recognition on a standard linac, and skills developed there can be transferred to MRIgRT. Decision making is crucial for adaptive techniques and there are many skills within their current scope of practice that are indispensable for the MRIgRT. CONCLUSION It has been demonstrated that TRs have a range of roles that cover vast areas of the oncology pathway and so it is important that TRs are recognised so the pivotal role they play is understood by all. TRs have extensive soft-tissue IGRT knowledge and experience, aiding the evolution of decision-making skills and application of off-protocol judgments, the basis of MRIgRT. IMPLICATIONS FOR PRACTICE Role development and changes in education for therapeutic radiographers.
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Affiliation(s)
- E Joyce
- Royal Marsden NHS Foundation Trust, UK
| | - M Jackson
- St George's University of London, UK
| | - J Skok
- St George's University of London, UK
| | - B Peet
- Royal Marsden NHS Foundation Trust, UK
| | - H A McNair
- Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, UK.
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