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Wulff J, Koska B, Ahmad Khalil D, Richter R, Maximilian Bäcker C, Bäumer C, Foerster A, Bechrakis NE, Timmermann B. Uncertainties in ocular proton planning and their impact on required margins. Phys Med 2024; 121:103358. [PMID: 38643558 DOI: 10.1016/j.ejmp.2024.103358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 03/11/2024] [Accepted: 04/16/2024] [Indexed: 04/23/2024] Open
Abstract
PURPOSE To review required margins in ocular proton therapy (OPT) based on an uncertainty estimation and to compare them with widely used values. Further, uncertainties when using registered funduscopy images in the 3D model is investigated. METHODS An uncertainty budget in planning and delivery was defined to determine required aperture and range margins. Setup uncertainties were considered for a cohort of treated patients and tested in a worst-case estimation. Other uncertainties were based on a best-guess and knowledge of institutional specifics, e.g. range reproducibility. Margins for funduscopy registration were defined resulting from scaling, rotation and translation of the image. Image formation for a wide-field fundus camera was reviewed and compared to the projection employed in treatment planning systems. RESULTS Values for aperture and range with margins of 2.5 mm as reported in literature could be determined. Aperture margins appear appropriate for setup uncertainties below 0.5 mm, but depend on lateral penumbra. Range margins depend on depth and associated density uncertainty in tissue. Registration of funduscopy images may require margins of >2 mm, increasing towards the equator. Difference in the projection may lead to discrepancies of several mm. CONCLUSIONS The commonly used 2.5 mm aperture margin was validated as an appropriate choice, while range margins could be reduced for lower ranges. Margins may however not include uncertainties in contouring and possible microscopic spread. If a target base is contoured on registered funduscopy images care must be taken as they are subject to larger uncertainties. Multimodal imaging approach in OPT remains advisable.
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Affiliation(s)
- Jörg Wulff
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany.
| | - Benjamin Koska
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany
| | - Dalia Ahmad Khalil
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; Department of Particle Therapy, Essen, Germany
| | - Ronald Richter
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; Department of Particle Therapy, Essen, Germany
| | - Claus Maximilian Bäcker
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany
| | - Christian Bäumer
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; German Cancer Consortium (DKTK), Essen, Germany; Department of Physics, TU Dortmund University, Dortmund, Germany
| | - Andreas Foerster
- University Hospital Essen, Essen, Germany; Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Nikolaos E Bechrakis
- University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; Department of Ophthalmology, University Hospital Essen, Essen, Germany
| | - Beate Timmermann
- West German Proton Therapy Centre Essen (WPE), Essen, Germany; University Hospital Essen, Essen, Germany; West German Cancer Centre (WTZ), Essen, Germany; Department of Particle Therapy, Essen, Germany; German Cancer Consortium (DKTK), Essen, Germany
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Pors LJ, Haasjes C, van Vught L, Hoes NP, Luyten GPM, van Rijn GA, Vu THK, Rasch CRN, Horeweg N, Beenakker JWM. Correction Method for Optical Scaling of Fundoscopy Images: Development, Validation, and First Implementation. Invest Ophthalmol Vis Sci 2024; 65:43. [PMID: 38271188 PMCID: PMC10829800 DOI: 10.1167/iovs.65.1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Purpose Although fundus photography is extensively used in ophthalmology, refraction prevents accurate distance measurement on fundus images, as the resulting scaling differs between subjects due to varying ocular anatomy. We propose a PARaxial Optical fundus Scaling (PAROS) method to correct for this variation using commonly available clinical data. Methods The complete optics of the eye and fundus camera were modeled using ray transfer matrix formalism to obtain fundus image magnification. The subject's ocular geometry was personalized using biometry, spherical equivalent of refraction (RSE), keratometry, and/or corneal topography data. The PAROS method was validated using 41 different eye phantoms and subsequently evaluated in 44 healthy phakic subjects (of whom 11 had phakic intraocular lenses [pIOLs]), 29 pseudophakic subjects, and 21 patients with uveal melanoma. Results Validation of the PAROS method showed small differences between model and actual image magnification (maximum 3.3%). Relative to the average eye, large differences in fundus magnification were observed, ranging from 0.79 to 1.48. Magnification was strongly inversely related to RSE (R2 = 0.67). In phakic subjects, magnification was directly proportional to axial length (R2 = 0.34). The inverse relation was seen in pIOL (R2 = 0.79) and pseudophakic (R2 = 0.12) subjects. RSE was a strong contributor to magnification differences (1%-83%). As this effect is not considered in the commonly used Bennett-Littmann method, statistically significant differences up to 40% (mean absolute 9%) were observed compared to the PAROS method (P < 0.001). Conclusions The significant differences in fundus image scaling observed among subjects can be accurately accounted for with the PAROS method, enabling more accurate quantitative assessment of fundus photography.
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Affiliation(s)
- Lennart J. Pors
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Corné Haasjes
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Luc van Vught
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Noor P. Hoes
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Gwyneth A. van Rijn
- Department of Ophthalmology, Amsterdam University Medical Center, Amsterdam, the Netherlands
- Department of Ophthalmology, Northwest Clinics, Alkmaar, the Netherlands
| | - T. H. Khanh Vu
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Coen R. N. Rasch
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nanda Horeweg
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan-Willem M. Beenakker
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Chou HD, Yap WK, Wang CC, Chao AN. Clinical outcomes of fiducial-free proton beam therapy in Asian patients with uveal melanoma. Clin Exp Ophthalmol 2023; 51:875-878. [PMID: 37743703 DOI: 10.1111/ceo.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Hung-Da Chou
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wing-Keen Yap
- Department of Radiation Oncology and Proton Therapy Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Chun-Chieh Wang
- Department of Radiation Oncology and Proton Therapy Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - An-Ning Chao
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Jarczak J, Karska-Basta I, Romanowska-Dixon B. Deterioration of Visual Acuity after Brachytherapy and Proton Therapy of Uveal Melanoma, and Methods of Counteracting This Complication Based on Recent Publications. Medicina (Kaunas) 2023; 59:1131. [PMID: 37374335 DOI: 10.3390/medicina59061131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023]
Abstract
Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. The eyeball is the most common extracutaneous location of melanoma. UM is a huge threat to a patient's life. It metastasizes distantly via blood vessels, but it can also spread locally and infiltrate extraocular structures. The treatment uses surgical methods, which include, among others, enucleation and conservative methods, such as brachytherapy (BT), proton therapy (PT), stereotactic radiotherapy (SRT), stereotactic radiosurgery (SRS), transpupillary thermotherapy (TTT) and photodynamic therapy. The key advantage of radiotherapy, which is currently used in most patients, is the preservation of the eyeball with the risk of metastasis and mortality comparable to that of enucleation. Unfortunately, radiotherapy very often leads to a significant deterioration in visual acuity (VA) as a result of radiation complications. This article is a review of the latest research on ruthenium-106 (Ru-106) brachytherapy, iodine-125 (I-125) brachytherapy and proton therapy of uveal melanoma that took into account the deterioration of eye function after therapy, and also the latest studies presenting the new concepts of modifications to the applied treatments in order to reduce radiation complications and maintain better visual acuity in treated patients.
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Affiliation(s)
- Jakub Jarczak
- Department of Ophthalmology, Division of Ophthalmology and Ocular Oncology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland
- Jagiellonian University Medical College, Doctoral School of Medical and Health Sciences, 31-530 Krakow, Poland
| | - Izabella Karska-Basta
- Department of Ophthalmology, Division of Ophthalmology and Ocular Oncology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland
| | - Bożena Romanowska-Dixon
- Department of Ophthalmology, Division of Ophthalmology and Ocular Oncology, Faculty of Medicine, Jagiellonian University Medical College, 31-501 Krakow, Poland
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Jaarsma-Coes MG, Klaassen L, Marinkovic M, Luyten GPM, Vu THK, Ferreira TA, Beenakker JWM. Magnetic Resonance Imaging in the Clinical Care for Uveal Melanoma Patients-A Systematic Review from an Ophthalmic Perspective. Cancers (Basel) 2023; 15:cancers15112995. [PMID: 37296958 DOI: 10.3390/cancers15112995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
Conversely to most tumour types, magnetic resonance imaging (MRI) was rarely used for eye tumours. As recent technical advances have increased ocular MRI's diagnostic value, various clinical applications have been proposed. This systematic review provides an overview of the current status of MRI in the clinical care of uveal melanoma (UM) patients, the most common eye tumour in adults. In total, 158 articles were included. Two- and three-dimensional anatomical scans and functional scans, which assess the tumour micro-biology, can be obtained in routine clinical setting. The radiological characteristics of the most common intra-ocular masses have been described extensively, enabling MRI to contribute to diagnoses. Additionally, MRI's ability to non-invasively probe the tissue's biological properties enables early detection of therapy response and potentially differentiates between high- and low-risk UM. MRI-based tumour dimensions are generally in agreement with conventional ultrasound (median absolute difference 0.5 mm), but MRI is considered more accurate in a subgroup of anteriorly located tumours. Although multiple studies propose that MRI's 3D tumour visualisation can improve therapy planning, an evaluation of its clinical benefit is lacking. In conclusion, MRI is a complementary imaging modality for UM of which the clinical benefit has been shown by multiple studies.
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Affiliation(s)
- Myriam G Jaarsma-Coes
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Lisa Klaassen
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Marina Marinkovic
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Gregorius P M Luyten
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - T H Khanh Vu
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Teresa A Ferreira
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jan-Willem M Beenakker
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Radiation Oncology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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Via R, Fattori G, Pica A, Paganelli C, Lomax A, Schalenbourg A, Weber DC, Baroni G, Hrbacek J. Response to "Letter to the Editor of Radiotherapy and Oncology regarding the paper titled "MRI and FUNDUS image fusion for improved ocular biometry in Ocular Proton Therapy" by Via et al.". Radiother Oncol 2022; 176:252. [PMID: 35988774 DOI: 10.1016/j.radonc.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Riccardo Via
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland.
| | - Giovanni Fattori
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Alessia Pica
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Chiara Paganelli
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Antony Lomax
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
| | - Ann Schalenbourg
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, FAA, Lausanne, Switzerland
| | - Damien Charles Weber
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland; Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; Department of Radiation Oncology, University Hospital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Guido Baroni
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milano 20133, Italy
| | - Jan Hrbacek
- Paul Scherrer Institut (PSI), Center for Proton Therapy, 5232 Villigen PSI, Switzerland
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Klaassen L, Jaarsma-Coes MG, Verbist BM, Vu TK, Marinkovic M, Rasch CR, Luyten GP, Beenakker JWM. Automatic Three-Dimensional Magnetic Resonance-based measurements of tumour prominence and basal diameter for treatment planning of uveal melanoma. Phys Imaging Radiat Oncol 2022; 24:102-110. [PMID: 36386446 PMCID: PMC9649381 DOI: 10.1016/j.phro.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
Abstract
Background and Purpose Three-dimensional (3D) Magnetic Resonance Imaging (MRI) is increasingly used to complement conventional two-dimensional ultrasound in the assessment of tumour dimension measurement of uveal melanoma. However, the lack of definitions of the 3D measurements of these tumour dimensions hinders further adaptation of MRI in ocular radiotherapy planning. In this study, we composed 3D MR-based definitions of tumour prominence and basal diameter and compared them to conventional ultrasound. Materials and methods Tumours were delineated on 3DT2 and contrast-enhanced 3DT1 (T1gd) MRI for 25 patients. 3D definitions of tumour prominence and diameter were composed and evaluated automatically on the T1gd and T2 contours. Automatic T1gd measurements were compared to manual MRI measurements, to automatic T2 measurements and to manual ultrasound measurements. Results Prominence measurements were similar for all modalities (median absolute difference 0.3 mm). Automatic T1gd diameter measurements were generally larger than manual MRI, automatic T2 and manual ultrasound measurements (median absolute differences of 0.5, 1.6 and 1.1 mm respectively), mainly due to difficulty defining the axis of the largest diameter. Largest differences between ultrasound and MRI for both prominence and diameter were found in anteriorly located tumours (up to 1.6 and 4.5 mm respectively), for which the tumour extent could not entirely be visualized with ultrasound. Conclusions The proposed 3D definitions for tumour prominence and diameter agreed well with ultrasound measurements for tumours for which the extent was visible on ultrasound. 3D MRI measurements generally provided larger diameter measurements than ultrasound. In anteriorly located tumours, the MRI measurements were considered more accurate than conventional ultrasound.
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Affiliation(s)
- Lisa Klaassen
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiation Oncology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Myriam G. Jaarsma-Coes
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Berit M. Verbist
- Leiden University Medical Center, Department of Radiology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Holland Particle Therapy Center, PO Box 110, 2600 AC Delft, the Netherlands
| | - T.H. Khanh Vu
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Marina Marinkovic
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Coen R.N. Rasch
- Leiden University Medical Center, Department of Radiation Oncology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Holland Particle Therapy Center, PO Box 110, 2600 AC Delft, the Netherlands
| | - Gregorius P.M. Luyten
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Jan-Willem M. Beenakker
- Leiden University Medical Center, Department of Ophthalmology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiology, PO Box 9600, 2300 RC Leiden, the Netherlands
- Leiden University Medical Center, Department of Radiation Oncology, PO Box 9600, 2300 RC Leiden, the Netherlands
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