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Knäusl B, Belotti G, Bertholet J, Daartz J, Flampouri S, Hoogeman M, Knopf AC, Lin H, Moerman A, Paganelli C, Rucinski A, Schulte R, Shimizu S, Stützer K, Zhang X, Zhang Y, Czerska K. A review of the clinical introduction of 4D particle therapy research concepts. Phys Imaging Radiat Oncol 2024; 29:100535. [PMID: 38298885 PMCID: PMC10828898 DOI: 10.1016/j.phro.2024.100535] [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: 10/11/2023] [Revised: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 02/02/2024] Open
Abstract
Background and purpose Many 4D particle therapy research concepts have been recently translated into clinics, however, remaining substantial differences depend on the indication and institute-related aspects. This work aims to summarise current state-of-the-art 4D particle therapy technology and outline a roadmap for future research and developments. Material and methods This review focused on the clinical implementation of 4D approaches for imaging, treatment planning, delivery and evaluation based on the 2021 and 2022 4D Treatment Workshops for Particle Therapy as well as a review of the most recent surveys, guidelines and scientific papers dedicated to this topic. Results Available technological capabilities for motion surveillance and compensation determined the course of each 4D particle treatment. 4D motion management, delivery techniques and strategies including imaging were diverse and depended on many factors. These included aspects of motion amplitude, tumour location, as well as accelerator technology driving the necessity of centre-specific dosimetric validation. Novel methodologies for X-ray based image processing and MRI for real-time tumour tracking and motion management were shown to have a large potential for online and offline adaptation schemes compensating for potential anatomical changes over the treatment course. The latest research developments were dominated by particle imaging, artificial intelligence methods and FLASH adding another level of complexity but also opportunities in the context of 4D treatments. Conclusion This review showed that the rapid technological advances in radiation oncology together with the available intrafractional motion management and adaptive strategies paved the way towards clinical implementation.
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Affiliation(s)
- Barbara Knäusl
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
| | - Gabriele Belotti
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Jenny Bertholet
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Juliane Daartz
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Mischa Hoogeman
- Department of Medical Physics & Informatics, HollandPTC, Delft, The Netherlands
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Radiotherapy, Rotterdam, The Netherlands
| | - Antje C Knopf
- Institut für Medizintechnik und Medizininformatik Hochschule für Life Sciences FHNW, Muttenz, Switzerland
| | - Haibo Lin
- New York Proton Center, New York, NY, USA
| | - Astrid Moerman
- Department of Medical Physics & Informatics, HollandPTC, Delft, The Netherlands
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - Antoni Rucinski
- Institute of Nuclear Physics Polish Academy of Sciences, PL-31342 Krakow, Poland
| | - Reinhard Schulte
- Division of Biomedical Engineering Sciences, School of Medicine, Loma Linda University
| | - Shing Shimizu
- Department of Carbon Ion Radiotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kristin Stützer
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- Helmholtz-Zentrum Dresden – Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
| | - Xiaodong Zhang
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
| | - Katarzyna Czerska
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
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Parrella G, Vai A, Nakas A, Garau N, Meschini G, Camagni F, Molinelli S, Barcellini A, Pella A, Ciocca M, Vitolo V, Orlandi E, Paganelli C, Baroni G. Synthetic CT in Carbon Ion Radiotherapy of the Abdominal Site. Bioengineering (Basel) 2023; 10:bioengineering10020250. [PMID: 36829745 PMCID: PMC9951997 DOI: 10.3390/bioengineering10020250] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
The generation of synthetic CT for carbon ion radiotherapy (CIRT) applications is challenging, since high accuracy is required in treatment planning and delivery, especially in an anatomical site as complex as the abdomen. Thirty-nine abdominal MRI-CT volume pairs were collected and a three-channel cGAN (accounting for air, bones, soft tissues) was used to generate sCTs. The network was tested on five held-out MRI volumes for two scenarios: (i) a CT-based segmentation of the MRI channels, to assess the quality of sCTs and (ii) an MRI manual segmentation, to simulate an MRI-only treatment scenario. The sCTs were evaluated by means of similarity metrics (e.g., mean absolute error, MAE) and geometrical criteria (e.g., dice coefficient). Recalculated CIRT plans were evaluated through dose volume histogram, gamma analysis and range shift analysis. The CT-based test set presented optimal MAE on bones (86.03 ± 10.76 HU), soft tissues (55.39 ± 3.41 HU) and air (54.42 ± 11.48 HU). Higher values were obtained from the MRI-only test set (MAEBONE = 154.87 ± 22.90 HU). The global gamma pass rate reached 94.88 ± 4.9% with 3%/3 mm, while the range shift reached a median (IQR) of 0.98 (3.64) mm. The three-channel cGAN can generate acceptable abdominal sCTs and allow for CIRT dose recalculations comparable to the clinical plans.
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Affiliation(s)
- Giovanni Parrella
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
- Correspondence: ; Tel.: +39-02-2399-18-9022
| | - Alessandro Vai
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
| | - Anestis Nakas
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Noemi Garau
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Giorgia Meschini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Francesca Camagni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Silvia Molinelli
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
| | - Amelia Barcellini
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
- Department of Internal Medicine and Medical Therapy, University of Pavia, 27100 Pavia, Italy
| | - Andrea Pella
- Bioengineering Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
| | - Mario Ciocca
- Medical Physics Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
| | - Viviana Vitolo
- Radiotherapy Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
| | - Ester Orlandi
- Clinical Unit, National Center of Oncological Hadrontherapy (CNAO), Strada Campeggi, 53, 27100 Pavia, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
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Meschini G, Vai A, Barcellini A, Fontana G, Molinelli S, Mastella E, Pella A, Vitolo V, Imparato S, Orlandi E, Ciocca M, Baroni G, Paganelli C. Time-resolved MRI for off-line treatment robustness evaluation in carbon-ion radiotherapy of pancreatic cancer. Med Phys 2022; 49:2386-2395. [PMID: 35124811 PMCID: PMC9306947 DOI: 10.1002/mp.15510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/28/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
PURPOSE In this study, we investigate the use of magnetic resonance imaging (MRI) for the clinical evaluation of gating treatment robustness in carbon-ion radiotherapy (CIRT) of pancreatic cancer. Indeed, MRI allows radiation-free repeated scans and fast dynamic sequences for time-resolved (TR) imaging (cine-MRI), providing information on inter- and intra-fraction cycle-to-cycle variations of respiratory motion. MRI can therefore support treatment planning and verification, overcoming the limitations of the current clinical standard, that is, four-dimensional computed tomography (4DCT), which describes an "average" breathing cycle neglecting breathing motion variability. METHODS We integrated a technique to generate a virtual CT (vCT) from 3D MRI with a method for 3D reconstruction from 2D cine-MRI, to produce TR vCTs for dose recalculations. For eight patients, the method allowed evaluating inter-fraction variations at end-exhale and intra-fraction cycle-to-cycle variability within the gating window in terms of tumor displacement and dose to the target and organs at risk. RESULTS The median inter-fraction tumor motion was in the range 3.33-12.16 mm, but the target coverage was robust (-0.4% median D95% variation). Concerning cycle-to-cycle variations, the gating technique was effective in limiting tumor displacement (1.35 mm median gating motion) and corresponding dose variations (-3.9% median D95% variation). The larger exposure of organs at risk (duodenum and stomach) was caused by inter-fraction motion, whereas intra-fraction cycle-to-cycle dose variations were limited. CONCLUSIONS This study proposed a method for the generation of TR vCTs from MRI, which enabled an off-line evaluation of gating treatment robustness and suggested its feasibility to support treatment planning of pancreatic tumors in CIRT.
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Affiliation(s)
- Giorgia Meschini
- Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
| | - Alessandro Vai
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Amelia Barcellini
- Clinical DepartmentNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Giulia Fontana
- Clinical Bioengineering UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Silvia Molinelli
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Edoardo Mastella
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Andrea Pella
- Clinical Bioengineering UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Viviana Vitolo
- Clinical DepartmentNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Sara Imparato
- Radiology UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Ester Orlandi
- Clinical DepartmentNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Mario Ciocca
- Medical Physics UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Guido Baroni
- Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
- Clinical Bioengineering UnitNational Center for Oncological Hadrontherapy (Fondazione CNAO)PaviaItaly
| | - Chiara Paganelli
- Department of Electronics, Information and BioengineeringPolitecnico di MilanoMilanItaly
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Ricotti R, Pella A, Mirandola A, Fiore MR, Chalaszczyk A, Paganelli C, Antonioli L, Vai A, Tagaste B, Belotti G, Rossi M, Ciocca M, Orlandi E, Baroni G. Dosimetric effect of variable rectum and sigmoid colon filling during carbon ion radiotherapy to sacral chordoma. Phys Med 2021; 90:123-133. [PMID: 34628271 DOI: 10.1016/j.ejmp.2021.09.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/13/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Carbon ion radiotherapy (CIRT) is sensitive to anatomical density variations. We examined the dosimetric effect of variable intestinal filling condition during CIRT to ten sacral chordoma patients. METHODS For each patient, eight virtual computed tomography scans (vCTs) were generated by varying the density distribution within the rectum and the sigmoid in the planning computed tomography (pCT) with a density override approach mimicking a heterogeneous combination of gas and feces. Totally full and empty intestinal preparations were modelled. In addition, five different intestinal filling conditions were modelled by a mixed density pattern derived from two combined and weighted Gaussian distributions simulating gas and feces respectively. Finally, a patient-specific mixing proportion was estimated by evaluating the daily amount of gas detected in the cone beam computed tomography (CBCT). Dose distribution was recalculated on each vCT and dose volume histograms (DVHs) were examined. RESULTS No target coverage degradation was observed at different vCTs. Rectum and sigma dose degradation ranged respectively between: [-6.7; 21.6]GyE and [-0.7; 15.4]GyE for D50%; [-377.4; 1197.9] and [-95.2; 1027.5] for AUC; [-1.2; 10.7]GyE and [-2.6; 21.5]GyE for D1%. CONCLUSIONS Variation of intestinal density can greatly influence the penetration depth of charged particle and might compromise dose distribution. In particular cases, with large clinical target volume in very close proximity to rectum and sigmoid colon, it is appropriate to evaluate the amount of gas present in the daily CBCT images even if it is totally included in the reference planning structures.
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Affiliation(s)
- R Ricotti
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy.
| | - A Pella
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - A Mirandola
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - M R Fiore
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - A Chalaszczyk
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - C Paganelli
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - L Antonioli
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - A Vai
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - B Tagaste
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - G Belotti
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - M Rossi
- Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
| | - M Ciocca
- Medical Physics Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - E Orlandi
- Radiation Oncology Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - G Baroni
- Bioengineering Unit, Clinical Department, National Center for Oncological Hadrontherapy (CNAO), Pavia, Italy; Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy
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Meschini G, Paganelli C, Vai A, Fontana G, Molinelli S, Pella A, Vitolo V, Barcellini A, Orlandi E, Ciocca M, Riboldi M, Baroni G. An MRI framework for respiratory motion modelling validation. J Med Imaging Radiat Oncol 2021; 65:337-344. [PMID: 33773081 PMCID: PMC8251859 DOI: 10.1111/1754-9485.13175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/27/2021] [Accepted: 03/07/2021] [Indexed: 12/20/2022]
Abstract
Introduction Respiratory motion models establish a correspondence between respiratory‐correlated (RC) 4‐dimensional (4D) imaging and respiratory surrogates, to estimate time‐resolved (TR) 3D breathing motion. To evaluate the performance of motion models on real patient data, a validation framework based on magnetic resonance imaging (MRI) is proposed, entailing the use of RC 4DMRI to build the model, and on both (i) TR 2D cine‐MRI and (ii) additional 4DMRI data for testing intra‐/inter‐fraction breathing motion variability. Methods Repeated MRI data were acquired in 7 patients with abdominal lesions. The considered model relied on deformable image registration (DIR) for building the model and compensating for inter‐fraction baseline variations. Both 2D and 3D validation were performed, by comparing model estimations with the ground truth 2D cine‐MRI and 4DMRI respiratory phases, respectively. Results The median DIR error was comparable to the voxel size (1.33 × 1.33 × 5 mm3), with higher values in the presence of large inter‐fraction motion (median value: 2.97 mm). In the 2D validation, the median estimation error on anatomical landmarks’ position resulted below 4 mm in every scenario, whereas in the 3D validation it was 1.33 mm and 4.21 mm when testing intra‐ and inter‐fraction motion, respectively. The range of motion described in the cine‐MRI was comparable to the motion of the building 4DMRI, being always above the estimation error. Overall, the model performance was dependent on DIR error, presenting reduced accuracy when inter‐fraction baseline variations occurred. Conclusions Results suggest the potential of the proposed framework in evaluating global motion models for organ motion management in MRI‐guided radiotherapy.
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Affiliation(s)
- Giorgia Meschini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Chiara Paganelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Alessandro Vai
- National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Giulia Fontana
- National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Silvia Molinelli
- National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Andrea Pella
- National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Viviana Vitolo
- National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | | | - Ester Orlandi
- National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Mario Ciocca
- National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy
| | - Marco Riboldi
- Department of Medical Physics, Ludwig-Maximilians-Universität (LMU), Garching bei München, Germany
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,National Centre for Oncological Hadrontherapy (CNAO), Pavia, Italy
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