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Hobson MA, Hu Y, Caldwell B, Cohen GN, Glide-Hurst C, Huang L, Jackson PD, Jang S, Langner U, Lee HJ, Levesque IR, Narayanan S, Park JC, Steffen J, Wu QJ, Zhou Y. AAPM Task Group 334: A guidance document to using radiotherapy immobilization devices and accessories in an MR environment. Med Phys 2024; 51:3822-3849. [PMID: 38648857 DOI: 10.1002/mp.17061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/13/2023] [Accepted: 03/28/2024] [Indexed: 04/25/2024] Open
Abstract
Use of magnetic resonance (MR) imaging in radiation therapy has increased substantially in recent years as more radiotherapy centers are having MR simulators installed, requesting more time on clinical diagnostic MR systems, or even treating with combination MR linear accelerator (MR-linac) systems. With this increased use, to ensure the most accurate integration of images into radiotherapy (RT), RT immobilization devices and accessories must be able to be used safely in the MR environment and produce minimal perturbations. The determination of the safety profile and considerations often falls to the medical physicist or other support staff members who at a minimum should be a Level 2 personnel as per the ACR. The purpose of this guidance document will be to help guide the user in making determinations on MR Safety labeling (i.e., MR Safe, Conditional, or Unsafe) including standard testing, and verification of image quality, when using RT immobilization devices and accessories in an MR environment.
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Affiliation(s)
- Maritza A Hobson
- Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Yanle Hu
- Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Barrett Caldwell
- School of Industrial Engineering, Purdue University, West Lafayette, Indiana, USA
- School of Aeronautics and Astronautics, Purdue University, West Lafayette, Indiana, USA
| | - Gil'ad N Cohen
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Carri Glide-Hurst
- Department of Human Oncology, University of Wisconsin--Madison, Madison, Wisconsin, USA
- Department of Medical Physics, University of Wisconsin--Madison, Madison, Wisconsin, USA
| | - Long Huang
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Paul D Jackson
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan, USA
| | - Sunyoung Jang
- Department of Radiation Oncology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ulrich Langner
- Department of Radiation Oncology, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Hannah J Lee
- Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Ives R Levesque
- Gerald Bronfman Department of Oncology and Medical Physics Unit, McGill University, Montreal, QC, Canada
- Department of Medical Physics, McGill University Health Centre, Cedars Cancer Centre, Montreal, QC, Canada
| | - Sreeram Narayanan
- Department of Radiation Oncology, Virginia Mason Cancer Institute, Seattle, Washington, USA
| | - Justin C Park
- Division of Medical Physics, Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Q Jackie Wu
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina, USA
| | - Yong Zhou
- Department of Radiology Services, Corewell Health, Grand Rapids, Michigan, USA
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2
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Mao Q, Gu M, Hong C, Wang H, Ruan X, Liu Z, Yuan B, Xu M, Dong C, Mou L, Gao X, Tang G, Chen T, Wu A, Pan Y. A Contrast-Enhanced Tri-Modal MRI Technique for High-Performance Hypoxia Imaging of Breast Cancer. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024:e2308850. [PMID: 38366271 DOI: 10.1002/smll.202308850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/19/2024] [Indexed: 02/18/2024]
Abstract
Personalized radiotherapy strategies enabled by the construction of hypoxia-guided biological target volumes (BTVs) can overcome hypoxia-induced radioresistance by delivering high-dose radiotherapy to targeted hypoxic areas of the tumor. However, the construction of hypoxia-guided BTVs is difficult owing to lack of precise visualization of hypoxic areas. This study synthesizes a hypoxia-responsive T1 , T2 , T2 mapping tri-modal MRI molecular nanoprobe (SPION@ND) and provides precise imaging of hypoxic tumor areas by utilizing the advantageous features of tri-modal magnetic resonance imaging (MRI). SPION@ND exhibits hypoxia-triggered dispersion-aggregation structural transformation. Dispersed SPION@ND can be used for routine clinical BTV construction using T1 -contrast MRI. Conversely, aggregated SPION@ND can be used for tumor hypoxia imaging assessment using T2 -contrast MRI. Moreover, by introducing T2 mapping, this work designs a novel method (adjustable threshold-based hypoxia assessment) for the precise assessment of tumor hypoxia confidence area and hypoxia level. Eventually this work successfully obtains hypoxia tumor target and accurates hypoxia tumor target, and achieves a one-stop hypoxia-guided BTV construction. Compared to the positron emission tomography-based hypoxia assessment, SPION@ND provides a new method that allows safe and convenient imaging of hypoxic tumor areas in clinical settings.
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Affiliation(s)
- Quanliang Mao
- Department of Radiology, First Affiliated Hospital of Ningbo University, 59 Liuting Street, Ningbo, 315010, P. R. China
| | - Mengyin Gu
- Department of Radiology, First Affiliated Hospital of Ningbo University, 59 Liuting Street, Ningbo, 315010, P. R. China
| | - Chengyuan Hong
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Huiying Wang
- Department of Radiology, First Affiliated Hospital of Ningbo University, 59 Liuting Street, Ningbo, 315010, P. R. China
| | - Xinzhong Ruan
- Department of Radiology, First Affiliated Hospital of Ningbo University, 59 Liuting Street, Ningbo, 315010, P. R. China
| | - Zhusheng Liu
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Bo Yuan
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Mengting Xu
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Chen Dong
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Lei Mou
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Xiang Gao
- Department of Neurosurgery, First Affiliated Hospital of Ningbo University, Ningbo, 315010, P. R. China
| | - Guangyu Tang
- Department of Radiology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, 200072, P. R. China
| | - Tianxiang Chen
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
- Ningbo Clinical Research Center for Medical Imaging, Ningbo, 315010, P. R. China
| | - Aiguo Wu
- Cixi Institute of Biomedical Engineering, International Cooperation Base of Biomedical Materials Technology and Application, CAS Key Laboratory of Magnetic Materials and Devices and Zhejiang Engineering Research Center for Biomedical Materials, Ningbo Institute of Materials Technology and Engineering, Chinese Academy of Sciences (CAS), Ningbo Key Laboratory of Biomedical Imaging Probe Materials and Technology, Ningbo, Zhejiang Province, 315201, P. R. China
| | - Yuning Pan
- Department of Radiology, First Affiliated Hospital of Ningbo University, 59 Liuting Street, Ningbo, 315010, P. R. China
- Department of Radiology, Shanghai Tenth People's Hospital of Tongji University, Shanghai, 200072, P. R. China
- Ningbo Clinical Research Center for Medical Imaging, Ningbo, 315010, P. R. China
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McGee KP, Cao M, Das IJ, Yu V, Witte RJ, Kishan AU, Valle LF, Wiesinger F, De-Colle C, Cao Y, Breen WG, Traughber BJ. The Use of Magnetic Resonance Imaging in Radiation Therapy Treatment Simulation and Planning. J Magn Reson Imaging 2024. [PMID: 38265188 DOI: 10.1002/jmri.29246] [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: 09/05/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/25/2024] Open
Abstract
Ever since its introduction as a diagnostic imaging tool the potential of magnetic resonance imaging (MRI) in radiation therapy (RT) treatment simulation and planning has been recognized. Recent technical advances have addressed many of the impediments to use of this technology and as a result have resulted in rapid and growing adoption of MRI in RT. The purpose of this article is to provide a broad review of the multiple uses of MR in the RT treatment simulation and planning process, identify several of the most used clinical scenarios in which MR is integral to the simulation and planning process, highlight existing limitations and provide multiple unmet needs thereby highlighting opportunities for the diagnostic MR imaging community to contribute and collaborate with our oncology colleagues. EVIDENCE LEVEL: 5 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Kiaran P McGee
- Department of Radiology, Mayo Clinic & Foundation, Rochester, Minnesota, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Indra J Das
- Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Victoria Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Robert J Witte
- Department of Radiology, Mayo Clinic & Foundation, Rochester, Minnesota, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Luca F Valle
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | | | - Chiara De-Colle
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Yue Cao
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA
| | - William G Breen
- Department of Radiation Oncology, Mayo Clinic & Foundation, Rochester, Minnesota, USA
| | - Bryan J Traughber
- Department of Radiation Oncology, Mayo Clinic & Foundation, Rochester, Minnesota, USA
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Dumane V, Ohri N, Choi JI, Chhabra A, Lin H. Editorial: Advances in treatment planning, optimization and delivery for radiotherapy of breast cancer. Front Oncol 2024; 13:1354731. [PMID: 38260841 PMCID: PMC10800783 DOI: 10.3389/fonc.2023.1354731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Affiliation(s)
- Vishruta Dumane
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Nisha Ohri
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Jehee Isabelle Choi
- Department of Radiation Oncology, New York Proton Center, New York, NY, United States
| | - Arpit Chhabra
- Department of Radiation Oncology, New York Proton Center, New York, NY, United States
| | - Haibo Lin
- Department of Radiation Oncology, New York Proton Center, New York, NY, United States
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Obermann M, Nohava L, Frass-Kriegl R, Soanca O, Ginefri JC, Felblinger J, Clauser P, Baltzer PA, Laistler E. Panoramic Magnetic Resonance Imaging of the Breast With a Wearable Coil Vest. Invest Radiol 2023; 58:799-810. [PMID: 37227137 PMCID: PMC10581436 DOI: 10.1097/rli.0000000000000991] [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: 02/17/2023] [Accepted: 04/21/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Breast cancer, the most common malignant cancer in women worldwide, is typically diagnosed by x-ray mammography, which is an unpleasant procedure, has low sensitivity in women with dense breasts, and involves ionizing radiation. Breast magnetic resonance imaging (MRI) is the most sensitive imaging modality and works without ionizing radiation, but is currently constrained to the prone imaging position due to suboptimal hardware, therefore hampering the clinical workflow. OBJECTIVES The aim of this work is to improve image quality in breast MRI, to simplify the clinical workflow, shorten measurement time, and achieve consistency in breast shape with other procedures such as ultrasound, surgery, and radiation therapy. MATERIALS AND METHODS To this end, we propose "panoramic breast MRI"-an approach combining a wearable radiofrequency coil for 3 T breast MRI (the "BraCoil"), acquisition in the supine position, and a panoramic visualization of the images. We demonstrate the potential of panoramic breast MRI in a pilot study on 12 healthy volunteers and 1 patient, and compare it to the state of the art. RESULTS With the BraCoil, we demonstrate up to 3-fold signal-to-noise ratio compared with clinical standard coils and acceleration factors up to 6 × 4. Panoramic visualization of supine breast images reduces the number of slices to be viewed by a factor of 2-4. CONCLUSIONS Panoramic breast MRI allows for high-quality diagnostic imaging and facilitated correlation to other diagnostic and interventional procedures. The developed wearable radiofrequency coil in combination with dedicated image processing has the potential to improve patient comfort while enabling more time-efficient breast MRI compared with clinical coils.
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Li T, Wang J, Yang Y, Glide-Hurst CK, Wen N, Cai J. Multi-parametric MRI for radiotherapy simulation. Med Phys 2023; 50:5273-5293. [PMID: 36710376 PMCID: PMC10382603 DOI: 10.1002/mp.16256] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 09/10/2022] [Accepted: 12/06/2022] [Indexed: 01/31/2023] Open
Abstract
Magnetic resonance imaging (MRI) has become an important imaging modality in the field of radiotherapy (RT) in the past decade, especially with the development of various novel MRI and image-guidance techniques. In this review article, we will describe recent developments and discuss the applications of multi-parametric MRI (mpMRI) in RT simulation. In this review, mpMRI refers to a general and loose definition which includes various multi-contrast MRI techniques. Specifically, we will focus on the implementation, challenges, and future directions of mpMRI techniques for RT simulation.
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Affiliation(s)
- Tian Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jihong Wang
- Department of Radiation Physics, Division of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Yingli Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong Univeristy School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Carri K Glide-Hurst
- Department of Radiation Oncology, University of Wisconsin, Madison, Wisconsin, USA
| | - Ning Wen
- Department of Radiology, Ruijin Hospital, Shanghai Jiaotong Univeristy School of Medicine, Shanghai, China
- SJTU-Ruijing-UIH Institute for Medical Imaging Technology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- The Global Institute of Future Technology, Shanghai Jiaotong University, Shanghai, China
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, China
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Lee HH, Wang CY, Chen ST, Lu TY, Chiang CH, Huang MY, Huang CJ. Electron stream effect in 0.35 Tesla magnetic resonance image guided radiotherapy for breast cancer. Front Oncol 2023; 13:1147775. [PMID: 37519814 PMCID: PMC10373926 DOI: 10.3389/fonc.2023.1147775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose This research aimed to analyze electron stream effect (ESE) during magnetic resonance image guided radiotherapy (MRgRT) for breast cancer patients on a MR-Linac (0.35 Tesla, 6MV), with a focus on the prevention of redundant radiation exposure. Materials and methods RANDO phantom was used with and without the breast attachment in order to represent the patients after breast conserving surgery (BCS) and those received modified radical mastectomy (MRM). The prescription dose is 40.05 Gy in fifteen fractions for whole breast irradiation (WBI) or 20 Gy single shot for partial breast irradiation (PBI). Thirteen different portals of intensity-modulated radiation therapy were created. And then we evaluated dose distribution in five areas (on the skin of the tip of the nose, the chin, the neck, the abdomen and the thyroid.) outside of the irradiated field with and without 0.35 Tesla. In addition, we added a piece of bolus with the thickness of 1cm on the skin in order to compare the ESE difference with and without a bolus. Lastly, we loaded two patients' images for PBI comparison. Results We found that 0.35 Tesla caused redundant doses to the skin of the chin and the neck as high as 9.79% and 5.59% of the prescription dose in the BCS RANDO model, respectively. For RANDO phantom without the breast accessory (simulating MRM), the maximal dose increase were 8.71% and 4.67% of the prescription dose to the skin of the chin and the neck, respectively. Furthermore, the bolus we added efficiently decrease the unnecessary dose caused by ESE up to 59.8%. Conclusion We report the first physical investigation on successful avoidance of superfluous doses on a 0.35T MR-Linac for breast cancer patients. Future studies of MRgRT on the individual body shape and its association with ESE influence is warranted.
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Affiliation(s)
- Hsin-Hua Lee
- Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Radiation Oncology, Faculty of Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Yen Wang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shan-Tzu Chen
- Department of Medical Imaging, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan
| | - Tzu-Ying Lu
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Cheng-Han Chiang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yii Huang
- Ph.D. Program in Environmental and Occupational Medicine, Kaohsiung Medical University and National Health Research Institutes, Kaohsiung, Taiwan
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Radiation Oncology, Faculty of Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chih-Jen Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Radiation Oncology, Faculty of Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Center for Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan
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Chick J, Alexander S, Herbert T, Huddart R, Ingle M, Mitchell A, Nill S, Oelfke U, Dunlop A, Hafeez S. Evaluation of non-vendor magnetic resonance imaging sequences for use in bladder cancer magnetic resonance image guided radiotherapy. Phys Imaging Radiat Oncol 2023; 27:100481. [PMID: 37655122 PMCID: PMC10465927 DOI: 10.1016/j.phro.2023.100481] [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: 03/16/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023] Open
Abstract
Hybrid systems that combine Magnetic Resonance Imaging (MRI) and linear accelerators are available clinically to guide and adapt radiotherapy. Vendor-approved MRI sequences are provided, however alternative sequences may offer advantages. The aim of this study was to develop a systematic approach for non-vendor sequence evaluation, to determine safety, accuracy and overall clinical application of two potential sequences for bladder cancer MRI guided radiotherapy. Non-vendor sequences underwent and passed clinical image qualitative review, phantom quality assurance, and radiotherapy planning assessments. Volunteer workflow tests showed the potential for one sequence to reduce workflow time by 27% compared to the standard vendor sequence.
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Affiliation(s)
- Joan Chick
- The Joint Department of Physics at The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Sophie Alexander
- The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Trina Herbert
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Robert Huddart
- The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Manasi Ingle
- The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Adam Mitchell
- The Joint Department of Physics at The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Simeon Nill
- The Joint Department of Physics at The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Uwe Oelfke
- The Joint Department of Physics at The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Alex Dunlop
- The Joint Department of Physics at The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
| | - Shaista Hafeez
- The Institute of Cancer Research & The Royal Marsden NHS Foundation Trust, Downs Road, Sutton SM2 5PT, UK
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9
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Liu X, Li Z, Yin Y. Clinical application of MR-Linac in tumor radiotherapy: a systematic review. Radiat Oncol 2023; 18:52. [PMID: 36918884 PMCID: PMC10015924 DOI: 10.1186/s13014-023-02221-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/01/2023] [Indexed: 03/15/2023] Open
Abstract
Recent years have seen both a fresh knowledge of cancer and impressive advancements in its treatment. However, the clinical treatment paradigm of cancer is still difficult to implement in the twenty-first century due to the rise in its prevalence. Radiotherapy (RT) is a crucial component of cancer treatment that is helpful for almost all cancer types. The accuracy of RT dosage delivery is increasing as a result of the quick development of computer and imaging technology. The use of image-guided radiation (IGRT) has improved cancer outcomes and decreased toxicity. Online adaptive radiotherapy will be made possible by magnetic resonance imaging-guided radiotherapy (MRgRT) using a magnetic resonance linear accelerator (MR-Linac), which will enhance the visibility of malignancies. This review's objectives are to examine the benefits of MR-Linac as a treatment approach from the perspective of various cancer patients' prognoses and to suggest prospective development areas for additional study.
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Affiliation(s)
- Xin Liu
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.,Department of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China
| | - Zhenjiang Li
- Department of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China.
| | - Yong Yin
- Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China. .,Department of Radiation Physics, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, 250117, China.
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10
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De-Colle C, Kirby A, Russell N, Shaitelman S, Currey A, Donovan E, Hahn E, Han K, Anandadas C, Mahmood F, Lorenzen E, van den Bongard D, Groot Koerkamp M, Houweling A, Nachbar M, Thorwarth D, Zips D. Adaptive radiotherapy for breast cancer. Clin Transl Radiat Oncol 2023; 39:100564. [PMID: 36632056 PMCID: PMC9826896 DOI: 10.1016/j.ctro.2022.100564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Research in the field of local and locoregional breast cancer radiotherapy aims to maintain excellent oncological outcomes while reducing treatment-related toxicity. Adaptive radiotherapy (ART) considers variations in target and organs at risk (OARs) anatomy occurring during the treatment course and integrates these in re-optimized treatment plans. Exploiting ART routinely in clinic may result in smaller target volumes and better OAR sparing, which may lead to reduction of acute as well as late toxicities. In this review MR-guided and CT-guided ART for breast cancer patients according to different clinical scenarios (neoadjuvant and adjuvant partial breast irradiation, whole breast, chest wall and regional nodal irradiation) are reviewed and their advantages as well as challenging aspects discussed.
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Affiliation(s)
- C. De-Colle
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - A. Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - N. Russell
- Department of Radiotherapy, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - S.F. Shaitelman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - A. Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - E. Donovan
- Department of Radiation Oncology, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Canada
| | - E. Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - K. Han
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - C.N. Anandadas
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - F. Mahmood
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - E.L. Lorenzen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - M.L. Groot Koerkamp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - A.C. Houweling
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - M. Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology. University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - D. Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology. University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D. Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
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11
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Moore-Palhares D, Ho L, Lu L, Chugh B, Vesprini D, Karam I, Soliman H, Symons S, Leung E, Loblaw A, Myrehaug S, Stanisz G, Sahgal A, Czarnota GJ. Clinical implementation of magnetic resonance imaging simulation for radiation oncology planning: 5 year experience. Radiat Oncol 2023; 18:27. [PMID: 36750891 PMCID: PMC9903411 DOI: 10.1186/s13014-023-02209-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023] Open
Abstract
PURPOSE Integrating magnetic resonance (MR) into radiotherapy planning has several advantages. This report details the clinical implementation of an MR simulation (MR-planning) program for external beam radiotherapy (EBRT) in one of North America's largest radiotherapy programs. METHODS AND MATERIALS An MR radiotherapy planning program was developed and implemented at Sunnybrook Health Sciences Center in 2016 with two dedicated wide-bore MR platforms (1.5 and 3.0 Tesla). Planning MR was sequentially implemented every 3 months for separate treatment sites, including the central nervous system (CNS), gynecologic (GYN), head and neck (HN), genitourinary (GU), gastrointestinal (GI), breast, and brachial plexus. Essential protocols and processes were detailed in this report, including clinical workflow, optimized MR-image acquisition protocols, MR-adapted patient setup, strategies to overcome risks and challenges, and an MR-planning quality assurance program. This study retrospectively reviewed simulation site data for all MR-planning sessions performed for EBRT over the past 5 years. RESULTS From July 2016 to December 2021, 8798 MR-planning sessions were carried out, which corresponds to 25% of all computer tomography (CT) simulations (CT-planning) performed during the same period at our institution. There was a progressive rise from 80 MR-planning sessions in 2016 to 1126 in 2017, 1492 in 2018, 1824 in 2019, 2040 in 2020, and 2236 in 2021. As a result, the relative number of planning MR/CT increased from 3% of all planning sessions in 2016 to 36% in 2021. The most common site of MR-planning was CNS (49%), HN (13%), GYN (12%), GU (12%), and others (8%). CONCLUSION Detailed clinical processes and protocols of our MR-planning program were presented, which have been improved over more than 5 years of robust experience. Strategies to overcome risks and challenges in the implementation process are highlighted. Our work provides details that can be used by institutions interested in implementing an MR-planning program.
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Affiliation(s)
- Daniel Moore-Palhares
- grid.413104.30000 0000 9743 1587Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2, Toronto, ON M4N3M5 Canada ,grid.17063.330000 0001 2157 2938Department of Radiation Oncology, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Ling Ho
- grid.413104.30000 0000 9743 1587Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2, Toronto, ON M4N3M5 Canada
| | - Lin Lu
- grid.413104.30000 0000 9743 1587Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2, Toronto, ON M4N3M5 Canada
| | - Brige Chugh
- grid.413104.30000 0000 9743 1587Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2, Toronto, ON M4N3M5 Canada ,grid.17063.330000 0001 2157 2938Department of Radiation Oncology, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Danny Vesprini
- grid.413104.30000 0000 9743 1587Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2, Toronto, ON M4N3M5 Canada ,grid.17063.330000 0001 2157 2938Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Irene Karam
- grid.413104.30000 0000 9743 1587Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2, Toronto, ON M4N3M5 Canada ,grid.17063.330000 0001 2157 2938Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Hany Soliman
- grid.413104.30000 0000 9743 1587Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2, Toronto, ON M4N3M5 Canada ,grid.17063.330000 0001 2157 2938Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Sean Symons
- grid.17063.330000 0001 2157 2938Physical Sciences, Sunnybrook Research Institute, Toronto, Canada ,grid.413104.30000 0000 9743 1587Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Eric Leung
- grid.413104.30000 0000 9743 1587Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2, Toronto, ON M4N3M5 Canada ,grid.17063.330000 0001 2157 2938Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Andrew Loblaw
- grid.413104.30000 0000 9743 1587Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2, Toronto, ON M4N3M5 Canada ,grid.17063.330000 0001 2157 2938Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Sten Myrehaug
- grid.413104.30000 0000 9743 1587Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2, Toronto, ON M4N3M5 Canada ,grid.17063.330000 0001 2157 2938Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Greg Stanisz
- grid.17063.330000 0001 2157 2938Physical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Arjun Sahgal
- grid.413104.30000 0000 9743 1587Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2, Toronto, ON M4N3M5 Canada ,grid.17063.330000 0001 2157 2938Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Gregory J. Czarnota
- grid.413104.30000 0000 9743 1587Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, T2, Toronto, ON M4N3M5 Canada ,grid.17063.330000 0001 2157 2938Department of Radiation Oncology, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Physical Sciences, Sunnybrook Research Institute, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Medical Biophysics, University of Toronto, Toronto, Canada
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12
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Schiff JP, Maraghechi B, Chin RI, Price A, Laugeman E, Rudra S, Hatscher C, Spraker MB, Badiyan SN, Henke LE, Green O, Kim H. A pilot study of same-day MRI-only simulation and treatment with MR-guided adaptive palliative radiotherapy (MAP-RT). Clin Transl Radiat Oncol 2022; 39:100561. [PMID: 36594078 PMCID: PMC9803918 DOI: 10.1016/j.ctro.2022.100561] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/02/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
We conducted a prospective pilot study evaluating the feasibility of same day MRI-only simulation and treatment with MRI-guided adaptive palliative radiotherapy (MAP-RT) for urgent palliative indications (NCT#03824366). All (16/16) patients were able to complete 99% of their first on-table attempted fractions, and no grades 3-5 toxicities occurred.
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Affiliation(s)
- Joshua P. Schiff
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Borna Maraghechi
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Re-I. Chin
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Alex Price
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Eric Laugeman
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Souman Rudra
- Emory University School of Medicine, Department of Radiation Oncology, Atlanta, GA, USA
| | - Casey Hatscher
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Matthew B. Spraker
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Shahed N. Badiyan
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Lauren E. Henke
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA
| | - Olga Green
- Varian Medical Systems, Palo Alto, CA, USA
| | - Hyun Kim
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO, USA,Corresponding author at: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA.
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13
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Takanen S, Pinnarò P, Farina I, Sperati F, Botti C, Vici P, Soriani A, Marucci L, Sanguineti G. Stereotactic partial breast irradiation in primary breast cancer: A comprehensive review of the current status and future directions. Front Oncol 2022; 12:953810. [PMID: 36313648 PMCID: PMC9606691 DOI: 10.3389/fonc.2022.953810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
In selected low-risk breast cancer patients, accelerated partial breast irradiation (APBI) may represent an alternative option to the whole breast irradiation to reduce the volume of irradiated breast and total treatment duration. In the last few years, preliminary data from clinical trials showed that stereotactic partial breast radiotherapy may have the advantage to be less invasive compared to other APBI techniques, with preliminary good results in terms of local toxicity and cosmesis: the use of magnetic resonance, fiducial markers in the tumor bed, and new breast devices support both a precise definition of the target and radiation planning.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021257856, identifier CRD42021257856.
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Affiliation(s)
- Silvia Takanen
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Silvia Takanen, ; Ilaria Farina,
| | - Paola Pinnarò
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Ilaria Farina
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
- *Correspondence: Silvia Takanen, ; Ilaria Farina,
| | - Francesca Sperati
- Biostatistics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Surgery, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Phase IV Studies, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Antonella Soriani
- Physics, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Laura Marucci
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Sanguineti
- Radiation Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Regina Elena National Cancer Institute, Rome, Italy
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14
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Emergence of MR-Linac in Radiation Oncology: Successes and Challenges of Riding on the MRgRT Bandwagon. J Clin Med 2022; 11:jcm11175136. [PMID: 36079065 PMCID: PMC9456673 DOI: 10.3390/jcm11175136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 12/05/2022] Open
Abstract
The special issue of JCM on “Advances of MRI in Radiation Oncology” provides a unique forum for scientific literature related to MR imaging in radiation oncology. This issue covered many aspects, such as MR technology, motion management, economics, soft-tissue–air interface issues, and disease sites such as the pancreas, spine, sarcoma, prostate, head and neck, and rectum from both camps—the Unity and MRIdian systems. This paper provides additional information on the success and challenges of the two systems. A challenging aspect of this technology is low throughput and the monumental task of education and training that hinders its use for the majority of therapy centers. Additionally, the cost of this technology is too high for most institutions, and hence widespread use is still limited. This article highlights some of the difficulties and how to resolve them.
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15
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MRI-guided Radiotherapy (MRgRT) for treatment of Oligometastases: Review of clinical applications and challenges. Int J Radiat Oncol Biol Phys 2022; 114:950-967. [PMID: 35901978 DOI: 10.1016/j.ijrobp.2022.07.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Early clinical results on the application of magnetic resonance imaging (MRI) coupled with a linear accelerator to deliver MR-guided radiation therapy (MRgRT) have demonstrated feasibility for safe delivery of stereotactic body radiotherapy (SBRT) in treatment of oligometastatic disease. Here we set out to review the clinical evidence and challenges associated with MRgRT in this setting. METHODS AND MATERIALS We performed a systematic review of the literature pertaining to clinical experiences and trials on the use of MRgRT primarily for the treatment of oligometastatic cancers. We reviewed the opportunities and challenges associated with the use of MRgRT. RESULTS Benefits of MRgRT pertaining to superior soft-tissue contrast, real-time imaging and gating, and online adaptive radiotherapy facilitate safe and effective dose escalation to oligometastatic tumors while simultaneously sparing surrounding healthy tissues. Challenges concerning further need for clinical evidence and technical considerations related to planning, delivery, quality assurance (QA) of hypofractionated doses, and safety in the MRI environment must be considered. CONCLUSIONS The promising early indications of safety and effectiveness of MRgRT for SBRT-based treatment of oligometastatic disease in multiple treatment locations should lead to further clinical evidence to demonstrate the benefit of this technology.
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16
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Sakellis CG, Jacene HA. Imaging for Radiation Planning in Breast Cancer. Semin Nucl Med 2022; 52:542-550. [PMID: 35523601 DOI: 10.1053/j.semnuclmed.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/27/2022] [Indexed: 01/31/2023]
Abstract
Radiation therapy is an integral component of the treatment of breast cancer. The indications and type of radiation therapy vary depending on disease invasiveness and stage. Imaging is the cornerstone for radiation therapy planning. While conventional imaging with CT remains the primary modality for radiation treatment planning locally in the breast, molecular imaging with [18F]FDG-PET/CT identifies additional occult disease that may help alter the local radiation therapy plan or treat oligometastatic disease. The ultimate effects on long-term outcomes remain to be determined. This article reviews the role of imaging in radiation planning for breast cancer.
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Affiliation(s)
- Christopher G Sakellis
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Heather A Jacene
- Department of Imaging, Dana-Farber Cancer Institute, Boston, MA; Department of Radiology, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
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17
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Habatsch M, Schneider M, Requardt M, Doussin S. Movement assessment of breast and organ-at-risks using free-breathing, self-gating 4D magnetic resonance imaging workflow for breast cancer radiation therapy. Phys Imaging Radiat Oncol 2022; 22:111-114. [PMID: 35619641 PMCID: PMC9127201 DOI: 10.1016/j.phro.2022.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022] Open
Abstract
Motion management is essential in treatment planning of radiotherapy for breast cancer. This study assessed the movement of organs-at-risk and the breast using 4D magnetic resonance imaging (MRI). A self-gating respiration-resolved radial 3D gradient echo sequence was used. Five healthy volunteers were imaged at 1.5 T during free-breathing in supine position making use of a breast board. Median distances between heart and chest wall in axial views were 2.4 cm (range: 1.5 cm) and 3.0 cm (range: 1.7 cm) for end-of-exhale and end-of-inhale. 4D-MRI allowed organ delineation and might be a promising addition to novel RT planning for breast cancer patients.
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18
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Mireştean CC, Iancu RI, Iancu DPT. Hypofractionated Whole-Breast Irradiation Focus on Coronary Arteries and Cardiac Toxicity-A Narrative Review. Front Oncol 2022; 12:862819. [PMID: 35463375 PMCID: PMC9021451 DOI: 10.3389/fonc.2022.862819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Breast cancer is the most common cancer among women worldwide, which is often treated with radiotherapy. Whole breast irradiation (WBI) is one of the most common types of irradiation. Hypo-fractionated WBI (HF-WBI) reduces the treatment time from 5 to 3 weeks. Recent radiobiological and clinical evidence recommended the use of HF-WBI regardless of the age or stage of disease, and it is proven that hypo-fractionation is non-inferior to conventional fractionation regimen irradiation. However, some studies report an increased incidence of heart-related deaths in the case of breast irradiation by hypo-fractionation, especially in patients with pre-existing cardiac risk factors at the time of treatment. Due to the new technical possibilities of radiotherapy techniques, HF-WBI can reduce the risk of cardiac toxicity by controlling the doses received both by the heart and by the anatomical structures of the heart. The radiobiological “double trouble”, in particular “treble trouble”, for hypo-fractionated regimen scan be avoided by improving the methods of heart sparing based on image-guided irradiation (IGRT) and by using respiration control techniques so that late cardiac toxicity is expected to be limited. However, long-term follow-up of patients treated with HF-WBI with modern radiotherapy techniques is necessary considering the progress of systemic therapy, which is associated with long-term survival, and also the cardiac toxicity of new oncological treatments. The still unknown effects of small doses spread in large volumes on lung tissue may increase the risk of second malignancy, but they can also be indirectly involved in the later development of a heart disease. It is also necessary to develop multivariable radiobiological models that include histological, molecular, clinical, and therapeutic parameters to identify risk groups and dosimetric tolerance in order to limit the incidence of late cardiac events. MR-LINAC will be able to offer a new standard for reducing cardiac toxicity in the future, especially in neoadjuvant settings for small tumors.
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Affiliation(s)
- Camil Ciprian Mireştean
- Department of Medical Oncology and Radiotherapy, University of Medicine and Pharmacy Craiova, Craiova, Romania.,Department of Surgery, Railways Clinical Hospital, Iasi, Romania
| | - Roxana Irina Iancu
- Oral Pathology Department, Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Clinical Laboratory, St. Spiridon Emergency Hospital, Iaşi, Romania
| | - Dragoş Petru Teodor Iancu
- Department of Medical Oncology and Radiotherapy Grigore T. Popa University of Medicine and Pharmacy, Iasi, Romania.,Department of Radiation Oncology, Regional Institute of Oncology, Iasi, Romania
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19
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Compact bunker shielding assessment for 1.5 T MR-Linac. Sci Rep 2022; 12:6712. [PMID: 35468983 PMCID: PMC9038779 DOI: 10.1038/s41598-022-10498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/06/2022] [Indexed: 11/12/2022] Open
Abstract
This study evaluated the effect of the 1.5 T magnetic field of the magnetic resonance-guided linear accelerator (MR-Linac) on the radiation leakage doses penetrating the bunker radiation shielding wall. The evaluated 1.5 T MR-Linac Unity system has a bunker of the minimum recommended size. Unlike a conventional Linac, both primary beam transmission and secondary beam leakage were considered independently in the design and defined at the machine boundary away from the isocenter. Moreover, additional shielding was designed considering the numerous ducts between the treatment room and other rooms. The Linac shielding was evaluated by measuring the leakage doses at several locations. The intrinsic vibration and magnetic field were inspected at the proposed isocenter of the system. For verification, leakage doses were measured before and after applying the magnetic field. The intrinsic vibration and magnetic field readings were below the permitted limit. The leakage dose (0.05–12.2 µSv/week) also complied with internationally stipulated limits. The special shielding achieved a five-fold reduction in leakage dose. Applying the magnetic field increased the leakage dose by 0.12 to 4.56 µSv/week in several measurement points, although these values fall within experimental uncertainty. Thus, the effect of the magnetic field on the leakage dose could not be ascertained.
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20
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De-Colle C, Dohm O, Mönnich D, Nachbar M, Weidner N, Heinrich V, Boeke S, Gani C, Zips D, Thorwarth D. Estimation of secondary cancer projected risk after partial breast irradiation at the 1.5 T MR-linac. Strahlenther Onkol 2022; 198:622-629. [PMID: 35412045 PMCID: PMC9217770 DOI: 10.1007/s00066-022-01930-5] [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: 10/11/2021] [Accepted: 03/10/2022] [Indexed: 10/26/2022]
Abstract
PURPOSE For patients treated with partial breast irradiation (PBI), potential long-term treatment-related toxicities are important. The 1.5 T magnetic resonance guided linear accelerator (MRL) offers excellent tumor bed visualization and a daily treatment plan adaption possibility, but MRL-specific electron stream and return effects may cause increased dose deposition at air-tissue interfaces. In this study, we aimed to investigate the projected risk of radiation-induced secondary malignancies (RISM) in patients treated with PBI at the 1.5 T MRL. METHODS Projected excess absolute risk values (EARs) for the contralateral breast, lungs, thyroid and esophagus were estimated for 11 patients treated with PBI at the MRL and compared to 11 patients treated with PBI and 11 patients treated with whole breast irradiation (WBI) at the conventional linac (CTL). All patients received 40.05 Gy in 15 fractions. For patients treated at the CTL, additional dose due to daily cone beam computed tomography (CBCT) was simulated. The t‑test with Bonferroni correction was used for comparison. RESULTS The highest projected risk for a radiation-induced secondary cancer was found for the ipsilateral lung, without significant differences between the groups. A lower contralateral breast EAR was found for MRL-PBI (EAR = 0.89) compared to CTL-PBI (EAR = 1.41, p = 0.01), whereas a lower thyroid EAR for CTL-PBI (EAR = 0.17) compared to MRL-PBI (EAR = 0.33, p = 0.03) and CTL-WBI (EAR = 0.46, p = 0.002) was observed. Nevertheless, when adding the CBCT dose no difference between thyroid EAR for CTL-PBI compared to MRL-PBI was detected. CONCLUSION Better breast tissue visualization and the possibility for daily plan adaption make PBI at the 1.5 T MRL particularly attractive. Our simulations suggest that this treatment can be performed without additional projected risk of RISM.
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Affiliation(s)
- C De-Colle
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - O Dohm
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - D Mönnich
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - M Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - N Weidner
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - V Heinrich
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - S Boeke
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,partner site Tübingen, and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - C Gani
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - D Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,partner site Tübingen, and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - D Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany.,partner site Tübingen, and German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
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21
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Hall WA, Paulson E, Li XA, Erickson B, Schultz C, Tree A, Awan M, Low DA, McDonald BA, Salzillo T, Glide-Hurst CK, Kishan AU, Fuller CD. Magnetic resonance linear accelerator technology and adaptive radiation therapy: An overview for clinicians. CA Cancer J Clin 2022; 72:34-56. [PMID: 34792808 PMCID: PMC8985054 DOI: 10.3322/caac.21707] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/01/2021] [Accepted: 09/22/2021] [Indexed: 12/25/2022] Open
Abstract
Radiation therapy (RT) continues to play an important role in the treatment of cancer. Adaptive RT (ART) is a novel method through which RT treatments are evolving. With the ART approach, computed tomography or magnetic resonance (MR) images are obtained as part of the treatment delivery process. This enables the adaptation of the irradiated volume to account for changes in organ and/or tumor position, movement, size, or shape that may occur over the course of treatment. The advantages and challenges of ART maybe somewhat abstract to oncologists and clinicians outside of the specialty of radiation oncology. ART is positioned to affect many different types of cancer. There is a wide spectrum of hypothesized benefits, from small toxicity improvements to meaningful gains in overall survival. The use and application of this novel technology should be understood by the oncologic community at large, such that it can be appropriately contextualized within the landscape of cancer therapies. Likewise, the need to test these advances is pressing. MR-guided ART (MRgART) is an emerging, extended modality of ART that expands upon and further advances the capabilities of ART. MRgART presents unique opportunities to iteratively improve adaptive image guidance. However, although the MRgART adaptive process advances ART to previously unattained levels, it can be more expensive, time-consuming, and complex. In this review, the authors present an overview for clinicians describing the process of ART and specifically MRgART.
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MESH Headings
- History, 20th Century
- History, 21st Century
- Humans
- Magnetic Resonance Imaging, Interventional/history
- Magnetic Resonance Imaging, Interventional/instrumentation
- Magnetic Resonance Imaging, Interventional/methods
- Magnetic Resonance Imaging, Interventional/trends
- Neoplasms/diagnostic imaging
- Neoplasms/radiotherapy
- Particle Accelerators
- Radiation Oncology/history
- Radiation Oncology/instrumentation
- Radiation Oncology/methods
- Radiation Oncology/trends
- Radiotherapy Planning, Computer-Assisted/history
- Radiotherapy Planning, Computer-Assisted/instrumentation
- Radiotherapy Planning, Computer-Assisted/methods
- Radiotherapy Planning, Computer-Assisted/trends
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Affiliation(s)
- William A. Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Eric Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - X. Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Beth Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Christopher Schultz
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Alison Tree
- The Royal Marsden National Health Service Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Musaddiq Awan
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Daniel A. Low
- Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, California
| | - Brigid A. McDonald
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Travis Salzillo
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Carri K. Glide-Hurst
- Department of Radiation Oncology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Amar U. Kishan
- Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, California
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, Texas
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22
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Groot Koerkamp ML, van der Leij F, van 't Westeinde T, Bol GH, Scholten V, Bouwmans R, Mandija S, Philippens MEP, van den Bongard HJGD, Houweling AC. Prone vs. supine accelerated partial breast irradiation on an MR-Linac: A planning study. Radiother Oncol 2021; 165:193-199. [PMID: 34774649 DOI: 10.1016/j.radonc.2021.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Accelerated partial breast irradiation (APBI) may benefit from the MR-Linac for target definition, patient setup, and motion monitoring. In this planning study, we investigated whether prone or supine position is dosimetrically beneficial for APBI on an MR-Linac and we evaluated patient comfort. MATERIALS AND METHODS Twenty-patients (9 postoperative, 11 preoperative) with a DCIS or breast tumor <3 cm underwent 1.5 T MRI in prone and supine position. The tumor or tumor bed was delineated as GTV and a 2 cm CTV-margin and 0.5 cm PTV-margin were added. 1.5 T MR-Linac treatment plans (5 × 5.2 Gy) with 11 beams were created for both positions in each patient. We evaluated the number of plans that achieved the planning constraints and performed a dosimetric comparison between prone and supine position using the Wilcoxon signed-rank test (p-value <0.01 for significance). Patient experience during scanning was evaluated with a questionnaire. RESULTS All 40 plans met the target coverage and OAR constraints, regardless of position. Heart Dmean was not significantly different (1.07 vs. 0.79 Gy, p-value: 0.027). V5Gy to the ipsilateral lung (4.4% vs. 9.8% median, p-value 0.009) and estimated delivery time (362 vs. 392 s, p-value: 0.003) were significantly lower for prone position. PTV coverage and dose to other OAR were comparable between positions. The majority of patients (13/20) preferred supine position. CONCLUSION APBI on the MR-Linac is dosimetrically feasible in prone and supine position. Mean heart dose was similar in both positions. Ipsilateral lung V5Gy was lower in prone position.
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Affiliation(s)
| | | | | | - Gijsbert H Bol
- Department of Radiotherapy, UMC Utrecht, The Netherlands
| | | | - Roel Bouwmans
- Department of Radiotherapy, UMC Utrecht, The Netherlands
| | - Stefano Mandija
- Department of Radiotherapy, UMC Utrecht, The Netherlands; Computational Imaging Group for MR Diagnostics & Therapy, Center for Image Sciences, UMC Utrecht, The Netherlands
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23
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Kim N, Tringale KR, Crane C, Tyagi N, Otazo R. MR SIGnature MAtching (MRSIGMA) with retrospective self-evaluation for real-time volumetric motion imaging. Phys Med Biol 2021; 66. [PMID: 34619666 DOI: 10.1088/1361-6560/ac2dd2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/07/2021] [Indexed: 11/11/2022]
Abstract
Objective. MR SIGnature MAtching (MRSIGMA) is a real-time volumetric MRI technique to image tumor and organs at risk motion in real-time for radiotherapy applications, where a dictionary of high-resolution 3D motion states and associated motion signatures are computed first during offline training and real-time 3D imaging is performed afterwards using fast signature-only acquisition and signature matching. However, the lack of a reference image with similar spatial resolution and temporal resolution introduces significant challenges forin vivovalidation.Approach. This work proposes a retrospective self-validation for MRSIGMA, where the same data used for real-time imaging are used to create a non-real-time reference for comparison. MRSIGMA with self-validation is tested in patients with liver tumors using quantitative metrics defined on the tumor and nearby organs-at-risk structures. The dice coefficient between contours defined on the real-time MRSIGMA and non-real-time reference was used to assess motion imaging performance.Main Results. Total latency (including signature acquisition and signature matching) was between 250 and 314 ms, which is sufficient for organs affected by respiratory motion. Mean ± standard deviation dice coefficient over time was 0.74 ± 0.03 for patients imaged without contrast agent and 0.87 ± 0.03 for patients imaged with contrast agent, which demonstrated high-performance real-time motion imaging.Signficance. MRSIGMA with self-evaluation provides a means to perform real-time volumetric MRI for organ motion tracking with quantitative performance measures.
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Affiliation(s)
- Nathanael Kim
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Kathryn R Tringale
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Christopher Crane
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Neelam Tyagi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Ricardo Otazo
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America.,Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
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24
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Target motion management in breast cancer radiation therapy. Radiol Oncol 2021; 55:393-408. [PMID: 34626533 PMCID: PMC8647788 DOI: 10.2478/raon-2021-0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/04/2021] [Indexed: 12/25/2022] Open
Abstract
Background Over the last two decades, breast cancer remains the main cause of cancer deaths in women. To treat this type of cancer, radiation therapy (RT) has proved to be efficient. RT for breast cancer is, however, challenged by intrafractional motion caused by respiration. The problem is more severe for the left-sided breast cancer due to the proximity to the heart as an organ-at-risk. While particle therapy results in superior dose characteristics than conventional RT, due to the physics of particle interactions in the body, particle therapy is more sensitive to target motion. Conclusions This review highlights current and emerging strategies for the management of intrafractional target motion in breast cancer treatment with an emphasis on particle therapy, as a modern RT technique. There are major challenges associated with transferring real-time motion monitoring technologies from photon to particles beams. Surface imaging would be the dominant imaging modality for real-time intrafractional motion monitoring for breast cancer. The magnetic resonance imaging (MRI) guidance and ultra high dose rate (FLASH)-RT seem to be state-of-the-art approaches to deal with 4D RT for breast cancer.
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25
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Cuccia F, Alongi F, Belka C, Boldrini L, Hörner-Rieber J, McNair H, Rigo M, Schoenmakers M, Niyazi M, Slagter J, Votta C, Corradini S. Patient positioning and immobilization procedures for hybrid MR-Linac systems. Radiat Oncol 2021; 16:183. [PMID: 34544481 PMCID: PMC8454038 DOI: 10.1186/s13014-021-01910-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023] Open
Abstract
Hybrid magnetic resonance (MR)-guided linear accelerators represent a new horizon in the field of radiation oncology. By harnessing the favorable combination of on-board MR-imaging with the possibility to daily recalculate the treatment plan based on real-time anatomy, the accuracy in target and organs-at-risk identification is expected to be improved, with the aim to provide the best tailored treatment. To date, two main MR-linac hybrid machines are available, Elekta Unity and Viewray MRIdian. Of note, compared to conventional linacs, these devices raise practical issues due to the positioning phase for the need to include the coil in the immobilization procedure and in order to perform the best reproducible positioning, also in light of the potentially longer treatment time. Given the relative novelty of this technology, there are few literature data regarding the procedures and the workflows for patient positioning and immobilization for MR-guided daily adaptive radiotherapy. In the present narrative review, we resume the currently available literature and provide an overview of the positioning and setup procedures for all the anatomical districts for hybrid MR-linac systems.
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Affiliation(s)
- Francesco Cuccia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy.
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy
- University of Brescia, Brescia, Italy
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Luca Boldrini
- Radiology, Radiation Oncology and Hematology Department, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, University Hospital of Heidelberg, National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg, Germany
| | - Helen McNair
- The Royal Marsden NHS Foundation Trust, and Institute of Cancer Research Sutton, Surrey, UK
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, VR, Italy
| | - Maartje Schoenmakers
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Judith Slagter
- Department of Radiation Oncology - Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Claudio Votta
- Radiology, Radiation Oncology and Hematology Department, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italy
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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26
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Berlangieri A, Elliott S, Wasiak J, Chao M, Foroudi F. Use of magnetic resonance image-guided radiotherapy for breast cancer: a scoping review. J Med Radiat Sci 2021; 69:122-133. [PMID: 34523823 PMCID: PMC8892442 DOI: 10.1002/jmrs.545] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 12/28/2022] Open
Abstract
In recent years, we have seen the integration of magnetic resonance imaging (MRI) simulators into radiotherapy centres and the emergence MR linear accelerators (MR-linac). Currently, there are limited studies to demonstrate the clinical effectiveness of MRI guided radiotherapy (MRIgRT) treatment for breast cancer patients. The objective of this scoping review was to identify and map the existing evidence surrounding the clinical implementation of MRIgRT for breast cancer patients. We also identified the challenges and knowledge gaps in the literature. The scoping review was reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension for Scoping Reviews reporting guidelines. Titles and abstracts were screened by two independent reviewers. Quantitative and qualitative data were extracted and summarised using thematically organised tables. Results identify that accelerated partial breast irradiation (APBI) is the most common form of treatment for MRIgRT. The presence of the magnet does not affect target coverage or violate organ at risk (OAR) constraints compared to standard radiotherapy methods. Consideration is advised for skin and chest wall (CW) due to the electron return effect (ERE) and areas such as armpit and chin due to the electron stream effect (ESE). Clinically, bolus has been used to protect and prevent unwanted dose in these areas. Overall treatment for APBI on the MR-linac is feasible.
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Affiliation(s)
- Alexandra Berlangieri
- Olivia Newton John Cancer Wellness and Research Centre (ONCWRC), Austin Health, Heidelberg, Victoria, Australia
| | - Sarah Elliott
- Olivia Newton John Cancer Wellness and Research Centre (ONCWRC), Austin Health, Heidelberg, Victoria, Australia
| | - Jason Wasiak
- Olivia Newton John Cancer Wellness and Research Centre (ONCWRC), Austin Health, Heidelberg, Victoria, Australia
| | - Michael Chao
- Olivia Newton John Cancer Wellness and Research Centre (ONCWRC), Austin Health, Heidelberg, Victoria, Australia
| | - Farshad Foroudi
- Olivia Newton John Cancer Wellness and Research Centre (ONCWRC), Austin Health, Heidelberg, Victoria, Australia
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27
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Li M, Zhang Q, Yang K. Role of MRI-Based Functional Imaging in Improving the Therapeutic Index of Radiotherapy in Cancer Treatment. Front Oncol 2021; 11:645177. [PMID: 34513659 PMCID: PMC8429950 DOI: 10.3389/fonc.2021.645177] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/30/2021] [Indexed: 02/05/2023] Open
Abstract
Advances in radiation technology, such as intensity-modulated radiation therapy (IMRT), have largely enabled a biological dose escalation of the target volume (TV) and reduce the dose to adjacent tissues or organs at risk (OARs). However, the risk of radiation-induced injury increases as more radiation dose utilized during radiation therapy (RT), which predominantly limits further increases in TV dose distribution and reduces the local control rate. Thus, the accurate target delineation is crucial. Recently, technological improvements for precise target delineation have obtained more attention in the field of RT. The addition of functional imaging to RT can provide a more accurate anatomy of the tumor and normal tissues (such as location and size), along with biological information that aids to optimize the therapeutic index (TI) of RT. In this review, we discuss the application of some common MRI-based functional imaging techniques in clinical practice. In addition, we summarize the main challenges and prospects of these imaging technologies, expecting more inspiring developments and more productive research paths in the near future.
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Affiliation(s)
- Mei Li
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Zhang
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Kaixuan Yang
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
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28
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Wang J, Salzillo T, Jiang Y, Mackeyev Y, David Fuller C, Chung C, Choi S, Hughes N, Ding Y, Yang J, Vedam S, Krishnan S. Stability of MRI contrast agents in high-energy radiation of a 1.5T MR-Linac. Radiother Oncol 2021; 161:55-64. [PMID: 34089753 PMCID: PMC8324543 DOI: 10.1016/j.radonc.2021.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gadolinium-based contrast is often used when acquiring MR images for radiation therapy planning for better target delineation. In some situations, patients may still have residual MRI contrast agents in their tissue while being treated with high-energy radiation. This is especially true when MRI contrast agents are administered during adaptive treatment replanning for patients treated on MR-Linac systems. PURPOSE The purpose of this study was to analyze the molecular stability of MRI contrast agents when exposed to high energy photons and the associated secondary electrons in a 1.5T MR-Linac system. This was the first step in assessing the safety of administering MRI contrast agents throughout the course of treatment. MATERIALS AND METHODS Two common MRI contrast agents were irradiated with 7 MV photons to clinical dose levels. The irradiated samples were analyzed using liquid chromatography-high resolution mass spectrometry to detect degradation products or conformational alterations created by irradiation with high energy photons and associated secondary electrons. RESULTS No significant change in chemical composition or displacement of gadolinium ions from their chelates was discovered in samples irradiated with 7 MV photons at relevant clinical doses in a 1.5T MR-Linac. Additionally, no significant correlation between concentrations of irradiated MRI contrast agents and radiation dose was observed. CONCLUSION The chemical composition stability of the irradiated contrast agents is promising for future use throughout the course of patient treatment. However, in vivo studies are needed to confirm that unexpected metabolites are not created in biological milieus.
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Affiliation(s)
- Jihong Wang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, United States.
| | - Travis Salzillo
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Yongying Jiang
- The Institute for Applied Cancer Science, MD Anderson Cancer Center, Houston, United States
| | - Yuri Mackeyev
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, United States
| | - Clifton David Fuller
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Seungtaek Choi
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Neil Hughes
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Yao Ding
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, United States
| | - Jinzhong Yang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, United States
| | - Sastry Vedam
- Department of Radiation Oncology, University of Maryland, Baltimore, United States
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, United States
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29
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Groot Koerkamp ML, de Hond YJM, Maspero M, Kontaxis C, Mandija S, Vasmel JE, Charaghvandi RK, Philippens MEP, van Asselen B, van den Bongard HJGD, Hackett SS, Houweling AC. Synthetic CT for single-fraction neoadjuvant partial breast irradiation on an MRI-linac. Phys Med Biol 2021; 66. [PMID: 33761491 DOI: 10.1088/1361-6560/abf1ba] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/24/2021] [Indexed: 01/08/2023]
Abstract
A synthetic computed tomography (sCT) is required for daily plan optimization on an MRI-linac. Yet, only limited information is available on the accuracy of dose calculations on sCT for breast radiotherapy. This work aimed to (1) evaluate dosimetric accuracy of treatment plans for single-fraction neoadjuvant partial breast irradiation (PBI) on a 1.5 T MRI-linac calculated on a) bulk-density sCT mimicking the current MRI-linac workflow and b) deep learning-generated sCT, and (2) investigate the number of bulk-density levels required. For ten breast cancer patients we created three bulk-density sCTs of increasing complexity from the planning-CT, using bulk-density for: (1) body, lungs, and GTV (sCTBD1); (2) volumes for sCTBD1plus chest wall and ipsilateral breast (sCTBD2); (3) volumes for sCTBD2plus ribs (sCTBD3); and a deep learning-generated sCT (sCTDL) from a 1.5 T MRI in supine position. Single-fraction neoadjuvant PBI treatment plans for a 1.5 T MRI-linac were optimized on each sCT and recalculated on the planning-CT. Image evaluation was performed by assessing mean absolute error (MAE) and mean error (ME) in Hounsfield Units (HU) between the sCTs and the planning-CT. Dosimetric evaluation was performed by assessing dose differences, gamma pass rates, and dose-volume histogram (DVH) differences. The following results were obtained (median across patients for sCTBD1/sCTBD2/sCTBD3/sCTDLrespectively): MAE inside the body contour was 106/104/104/75 HU and ME was 8/9/6/28 HU, mean dose difference in the PTVGTVwas 0.15/0.00/0.00/-0.07 Gy, median gamma pass rate (2%/2 mm, 10% dose threshold) was 98.9/98.9/98.7/99.4%, and differences in DVH parameters were well below 2% for all structures except for the skin in the sCTDL. Accurate dose calculations for single-fraction neoadjuvant PBI on an MRI-linac could be performed on both bulk-density and deep learning sCT, facilitating further implementation of MRI-guided radiotherapy for breast cancer. Balancing simplicity and accuracy, sCTBD2showed the optimal number of bulk-density levels for a bulk-density approach.
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Affiliation(s)
- M L Groot Koerkamp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y J M de Hond
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - M Maspero
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Computational Imaging Group for MR diagnostics & therapy, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C Kontaxis
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Mandija
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.,Computational Imaging Group for MR diagnostics & therapy, Center for Image Sciences, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J E Vasmel
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R K Charaghvandi
- Department of Radiation Oncology, Radboudumc, Nijmegen, The Netherlands
| | - M E P Philippens
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B van Asselen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - S S Hackett
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A C Houweling
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
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30
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Analysis of the electron-stream effect in patients treated with partial breast irradiation using the 1.5 T MR-linear accelerator. Clin Transl Radiat Oncol 2021; 27:103-108. [PMID: 33553697 PMCID: PMC7856390 DOI: 10.1016/j.ctro.2020.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/21/2020] [Accepted: 12/28/2020] [Indexed: 12/25/2022] Open
Abstract
The electron-stream effect is responsible of an out-of-field dose when performing partial breast irradiation at the MR-linac. The electron-stream effect is located to the patient́s chin and, for lateral targets, to the arm. The electron-stream effect is effectively minimized by a bolus. Novel concepts and clinical trials for breast cancer at the 1.5 T MR-linac can be tested.
Introduction The hybrid magnetic resonance linear accelerator (MRL) has the potential to test novel concepts in breast cancer patients such as daily MR-guided real-time plan adaptation. Before starting clinical trials, preparatory studies for example of the MR-dependent electron stream effect (ESE) are necessary. Material and Methods To prospectively investigate the ESE, data from 11 patients treated with partial breast irradiation (PBI) at the 1.5 T MRL were evaluated. A bolus was placed on the chin and in vivo dosimetry results were compared with the dose simulated by the treatment planning system (TPS). The same measurements were carried out for three patients treated at a conventional linac. Toxicity and cosmesis were evaluated. Results Median doses measured and simulated on top/ underneath the bolus were 1.91 / 0.62 Gy and 2.82 / 0.63 Gy, respectively. Median differences between calculations and measurements were 0.8 Gy and 0.1 Gy. At the conventional linac, median measured doses on top/ underneath the bolus were 0.98 and 1.37 Gy. No acute toxicity exceeding grade 2 was recorded. Cosmesis was good or excellent and patient reported outcome measures were mostly scored as none or mild. Conclusion The dose due to the ESE is low, correctly predicted by the TPS and effectively minimized by a bolus.
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31
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Liu H, Ding S, Wang B, Li Y, Sun Y, Huang X. In-Air Electron Streaming Effect for Esophageal Cancer Radiotherapy With a 1.5 T Perpendicular Magnetic Field: A Treatment Planning Study. Front Oncol 2020; 10:607061. [PMID: 33335861 PMCID: PMC7736404 DOI: 10.3389/fonc.2020.607061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose To investigate the in-air out-of-field electron streaming effect (ESE) for esophageal cancer radiotherapy in the presence of 1.5 T perpendicular magnetic field. Methods Ten esophageal cancer patients treated with conventional Linac were retrospectively enrolled into a cohort of this study, with the prescription of 4,400 cGy/20 fx. All cases received IMRT replanning using Elekta Unity MR-Linac specified Monaco system, denoted as primary plan. To visualize the in-air dose outside the body in Monaco system, an auxiliary structure was created by extending the external structure. For each case, another comparable plan with no magnetic field was created using the same planning parameters. The plan was also recalculated by placing a bolus upon the neck and chin area to investigate its shielding effect for ESE. Dosimetric evaluations of the out-of-field neck and chin skin area and statistical analysis for these plans were then performed. Results Out-of-field ESE was also observed in esophageal cancer treatment planning under 1.5 T magnetic field, while totally absent for plans with no magnetic field. On average, the maximum dose to the neck and chin skin area of the primary plan (657.92 ± 69.07 cGy) was higher than that of plan with no magnetic field (281.78 ± 36.59 cGy, p = 0.005) and plan with bolus (398.43 ± 69.19 cGy, p = 0.007). DVH metrics D1cc (the minimum dose to 1 cc volume) of the neck and chin skin for primary plan was 382.06 ± 44.14 cGy, which can be reduced to 212.42 ± 23.65 cGy by using the 1 cm bolus (with p = 0.005), even lower than the plan without magnetic field (214.45 ± 23.82, p = 0.005). No statistically significant difference of the neck and chin skin dose between the plan with bolus and plan with no magnetic field was observed (all with p > 0.05). Conclusion For MRI guided esophageal cancer radiotherapy, a relatively high out-of-field neck and chin skin doses will be introduced by ESE in the presence of magnetic field. It is therefore recommended to take this into account during the planning phase. Adding bolus could effectively reduce the ESE dose contributions, achieve the shielding effect almost equivalent to the scenario with no magnetic field. Further explorations of measurement verifications for the ESE dose distributions are required.
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Affiliation(s)
- Hongdong Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Shouliang Ding
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bin Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yongbao Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ying Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaoyan Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
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