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Ali A, Morris JM, Decker SJ, Huang YH, Wake N, Rybicki FJ, Ballard DH. Clinical situations for which 3D printing is considered an appropriate representation or extension of data contained in a medical imaging examination: neurosurgical and otolaryngologic conditions. 3D Print Med 2023; 9:33. [PMID: 38008795 PMCID: PMC10680204 DOI: 10.1186/s41205-023-00192-w] [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: 09/11/2023] [Accepted: 10/03/2023] [Indexed: 11/28/2023] Open
Abstract
BACKGROUND Medical three dimensional (3D) printing is performed for neurosurgical and otolaryngologic conditions, but without evidence-based guidance on clinical appropriateness. A writing group composed of the Radiological Society of North America (RSNA) Special Interest Group on 3D Printing (SIG) provides appropriateness recommendations for neurologic 3D printing conditions. METHODS A structured literature search was conducted to identify all relevant articles using 3D printing technology associated with neurologic and otolaryngologic conditions. Each study was vetted by the authors and strength of evidence was assessed according to published guidelines. RESULTS Evidence-based recommendations for when 3D printing is appropriate are provided for diseases of the calvaria and skull base, brain tumors and cerebrovascular disease. Recommendations are provided in accordance with strength of evidence of publications corresponding to each neurologic condition combined with expert opinion from members of the 3D printing SIG. CONCLUSIONS This consensus guidance document, created by the members of the 3D printing SIG, provides a reference for clinical standards of 3D printing for neurologic conditions.
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Affiliation(s)
- Arafat Ali
- Department of Radiology, Henry Ford Health, Detroit, MI, USA
| | | | - Summer J Decker
- Division of Imaging Research and Applied Anatomy, Department of Radiology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Yu-Hui Huang
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Nicole Wake
- Department of Research and Scientific Affairs, GE HealthCare, New York, NY, USA
- Center for Advanced Imaging Innovation and Research, Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Frank J Rybicki
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, MO, USA.
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Antoniou A, Nikolaou A, Georgiou A, Evripidou N, Damianou C. Development of an US, MRI, and CT imaging compatible realistic mouse phantom for thermal ablation and focused ultrasound evaluation. Ultrasonics 2023; 131:106955. [PMID: 36854247 DOI: 10.1016/j.ultras.2023.106955] [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] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/09/2022] [Accepted: 02/10/2023] [Indexed: 06/18/2023]
Abstract
Tissue mimicking phantoms (TMPs) play an essential role in modern biomedical research as cost-effective quality assurance and training tools, simultaneously contributing to the reduction of animal use. Herein, we present the development and evaluation of an anatomically accurate mouse phantom intended for image-guided thermal ablation and Focused Ultrasound (FUS) applications. The proposed mouse model consists of skeletal and soft tissue mimics, whose design was based on the Computed tomography (CT) scans data of a live mouse. Advantageously, it is compatible with US, CT, and Magnetic Resonance Imaging (MRI). The compatibility assessment was focused on the radiological behavior of the phantom due to the lack of relevant literature. The X-ray linear attenuation coefficient of candidate materials was estimated to assess the one that matches best the radiological behavior of living tissues. The bone part was manufactured by Fused Deposition Modeling (FDM) printing using Acrylonitrile styrene acrylate (ASA) material. For the soft-tissue mimic, a special mold was 3D printed having a cavity with the unique shape of the mouse body and filled with an agar-based silica-doped gel. The mouse phantom accurately matched the size and reproduced the body surface of the imaged mouse. Tissue-equivalency in terms of X-ray attenuation was demonstrated for the agar-based soft-tissue mimic. The phantom demonstrated excellent MRI visibility of the skeletal and soft-tissue mimics. Good radiological contrast between the skeletal and soft-tissue models was also observed in the CT scans. The model was also able to reproduce realistic behavior during trans-skull sonication as proved by thermocouple measurements. Overall, the proposed phantom is inexpensive, ergonomic, and realistic. It could constitute a powerful tool for image-guided thermal ablation and FUS studies in terms of testing and optimizing the performance of relevant equipment and protocols. It also possess great potential for use in transcranial FUS applications, including the emerging topic of FUS-mediated blood brain barrier (BBB) disruption.
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Affiliation(s)
- Anastasia Antoniou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
| | - Anastasia Nikolaou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
| | - Andreas Georgiou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
| | - Nikolas Evripidou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
| | - Christakis Damianou
- Department of Electrical Engineering, Computer Engineering, and Informatics, Cyprus University of Technology, Limassol, Cyprus.
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Park CK. 3D-Printed Disease Models for Neurosurgical Planning, Simulation, and Training. J Korean Neurosurg Soc 2022; 65:489-498. [PMID: 35762226 PMCID: PMC9271812 DOI: 10.3340/jkns.2021.0235] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/17/2021] [Indexed: 11/27/2022] Open
Abstract
Spatial insight into intracranial pathology and structure is important for neurosurgeons to perform safe and successful surgeries. Three-dimensional (3D) printing technology in the medical field has made it possible to produce intuitive models that can help with spatial perception. Recent advances in 3D-printed disease models have removed barriers to entering the clinical field and medical market, such as precision and texture reality, speed of production, and cost. The 3D-printed disease model is now ready to be actively applied to daily clinical practice in neurosurgical planning, simulation, and training. In this review, the development of 3D-printed neurosurgical disease models and their application are summarized and discussed.
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Affiliation(s)
- Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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Sato K, Yamashiro A, Koyama T. [Material Investigation for the Development of Non-rigid Phantoms for CT-MRI Image Registration]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2022; 78:615-624. [PMID: 35569958 DOI: 10.6009/jjrt.2022-1241] [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] [Indexed: 11/11/2022]
Abstract
PURPOSE In radiotherapy, deformable image registration (DIR) has been frequently used in different imaging examinations in recent years. However, no phantom has been established for quality assurance for DIR. In order to develop a non-rigid phantom for accuracy control between CT and MRI images, we investigated the suitability of 3D printing materials and gel materials in this study. METHODS We measured CT values, T1 values, T2 values, and the proton densities of 31 3D printer materials-purchased from three manufacturers-and one gel material. The dice coefficient after DIR was calculated for the CT-MRI images using a prototype phantom made of a gel material compatible with CT-MRI. RESULTS The CT number of the 3D printing materials ranged from -6.8 to 146.4 HU. On MRI, T1 values were not measurable in most cases, whereas T2 values were not measurable in all cases; proton density (PD) ranged from 2.51% to 4.9%. The gel material had a CT number of 111.16 HU, T1 value of 813.65 ms, and T2 value of 27.19 ms. The prototype phantom was flexible, and the usefulness of DIR with CT and MRI images was demonstrated using this phantom. CONCLUSION The CT number and T1 and T2 values of the gel material are close to those of the human body and may therefore be developed as a DIR verification phantom between CT and MRI. These findings may contribute to the development of non-rigid phantoms for DIR in the future.
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Affiliation(s)
- Kazuki Sato
- Department of Radiology, Nagano Red Cross Hospital
| | - Akihiro Yamashiro
- Department of Radiology, Nagano Red Cross Hospital.,Division of Health Sciences, Graduate School of Medical Sciences, Kanazawa University
| | - Tomio Koyama
- Department of Radiation Oncology, Nagano Red Cross Hospital
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Bry V, Saenz D, Pappas E, Kalaitzakis G, Papanikolaou N, Rasmussen K. End to end comparison of surface-guided imaging versus stereoscopic X-rays for the SRS treatment of multiple metastases with a single isocenter using 3D anthropomorphic gel phantoms. J Appl Clin Med Phys 2022; 23:e13576. [PMID: 35322526 PMCID: PMC9121024 DOI: 10.1002/acm2.13576] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/10/2022] [Accepted: 02/12/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Two end-to-end tests evaluate the accuracy of a surface-guided radiation therapy (SGRT) system (CRAD Catalyst HD) for position verification in comparison to a stereoscopic x-ray imaging system (Brainlab Exactrac ) for single-isocenter, multiple metastases stereotactic radiosurgery (SRS) using 3D polymer gel inserts. MATERIALS AND METHODS A 3D-printed phantom (Prime phantom, RTsafe PC, Athens, Greece) with two separate cylindrical polymer gel inserts were immobilized in open-face masks and treated with a single isocentric, multitarget SRS plan. Planning was done in Brainlab (Elements) to treat five metastatic lesions in one fraction, and initial setup was done using cone beam computed tomography. Positional verification was done using orthogonal X-ray imaging (Brainlab Exactrac) and/or a surface imaging system (CRAD Catalyst HD, Uppsala, Sweden), and shift discrepancies were recorded for each couch angle. Forty-two hours after irradiation, the gel phantom was scanned in a 1.5 Tesla MRI, and images were fused with the patient computed tomography data/structure set for further analysis of spatial dose distribution. RESULTS Discrepancies between the CRAD Catalyst HD system and Brainlab Exactrac were <1 mm in the translational direction and <0.5° in the angular direction at noncoplanar couch angles. Dose parameters (DMean% , D95% ) and 3D gamma index passing rates were evaluated for both setup modalities for each planned target volume (PTV) at a variety of thresholds: 3%/2 mm (Exactrac≥93.1% and CRAD ≥87.2%), 5%/2 mm (Exactrac≥95.6% and CRAD ≥94.6%), and 5%/1 mm (Exactrac≥81.8% and CRAD ≥83.7%). CONCLUSION Dose metrics for a setup with surface imaging was found to be consistent with setup using x-ray imaging, demonstrating high accuracy and reproducibility for treatment delivery. Results indicate the feasibility of using surface imaging for position verification at noncoplanar couch angles for single-isocenter, multiple-target SRS using end-to-end quality assurance (QA) testing with 3D polymer gel dosimetry.
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Affiliation(s)
- Victoria Bry
- Department of Radiation OncologyThe University of Texas Health at San AntonioSan AntonioTexasUSA
| | - Daniel Saenz
- Department of Radiation OncologyThe University of Texas Health at San AntonioSan AntonioTexasUSA
| | - Evangelos Pappas
- Department of Biomedical SciencesRadiology and Radiotherapy SectorUniversity of West AtticaAthensGreece
| | | | - Nikos Papanikolaou
- Department of Radiation OncologyThe University of Texas Health at San AntonioSan AntonioTexasUSA
| | - Karl Rasmussen
- Department of Radiation OncologyThe University of Texas Health at San AntonioSan AntonioTexasUSA
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Nierer L, Kamp F, Reiner M, Corradini S, Rabe M, Dietrich O, Parodi K, Belka C, Kurz C, Landry G. Evaluation of an anthropomorphic ion chamber and 3D gel dosimetry head phantom at a 0.35 T MR-linac using separate 1.5 T MR-scanners for gel readout. Z Med Phys 2022; 32:312-325. [PMID: 35305857 PMCID: PMC9948847 DOI: 10.1016/j.zemedi.2022.01.006] [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: 09/10/2021] [Revised: 01/27/2022] [Accepted: 01/31/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE To date, no universally accepted technique for the evaluation of the overall dosimetric performance of hybrid integrated magnetic resonance imaging (MR) - linear accelerators (linacs) is available. We report on the suitability and reliability of a novel phantom with modular inserts for combined polymer gel (PG) and ionisation chamber (IC) measurements at a 0.35 T MR-linac. METHODS Three 3D-printed, modular head phantoms, based on real patient anatomy, were used for repeated (2 times) PG irradiations of cranial treatment plans on a 0.35 T MR-linac. The PG readout was performed on two 1.5 T diagnostic MR-scanners to reduce scanning time. The PG dose volumes were normalised to the IC dose (normalised dose N1) and to the median planning target volume dose (normalised dose N2). Linearity of the PG dose response was validated and dose profiles, centres of mass (COM) of the 95% isodoses and dose volume histograms (DVH) were compared between planned and measured dose distributions and a 3D gamma analysis was performed. RESULTS Dose linearity of the PG was good (R2> 0.99 for all linear fit functions). High agreement was found between planned and measured dose volumes in the dose profiles and DVHs. The largest dose deviation was found in the intermediate dose region (mean dose deviation 0.2Gy; 5.6%). A mean COM offset of 1.2mm indicated high spatial accuracy. Mean 3D gamma passing rates (2%, 2mm) of 83.3% for N1 and 91.6% for N2 dose distributions were determined. When comparing repeated PG measurements to each other, a mean gamma passing rate of 95.7% was found. CONCLUSION The new modular phantom was found practical for use at a 0.35 T MR-linac. In contrast to the high dose region, larger mean deviations were found in the mid dose range. The PG measurements showed high reproducibility. The MR-linac performed well in a non-adaptive setting in terms of spatial and dosimetric accuracy.
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Affiliation(s)
- Lukas Nierer
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany.
| | - Florian Kamp
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; Department of Radiation Oncology, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Moritz Rabe
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Olaf Dietrich
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Katia Parodi
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München, 85748 Garching, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany; German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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Pappas EP, Seimenis I, Kouris P, Theocharis S, Lampropoulos KI, Kollias G, Karaiskos P. Target localization accuracy in frame‐based stereotactic radiosurgery: Comparison between MR‐only and MR/CT co‐registration approaches. J Appl Clin Med Phys 2022; 23:e13580. [PMID: 35285583 PMCID: PMC9121047 DOI: 10.1002/acm2.13580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose In frame‐based Gamma Knife (GK) stereotactic radiosurgery two treatment planning workflows are commonly employed; one based solely on magnetic resonance (MR) images and the other based on magnetic resonance/computed tomography (MR/CT) co‐registered images. In both workflows, target localization accuracy (TLA) can be deteriorated due to MR‐related geometric distortions and/or MR/CT co‐registration uncertainties. In this study, the overall TLA following both clinical workflows is evaluated for cases of multiple brain metastases. Methods A polymer gel‐filled head phantom, having the Leksell stereotactic headframe attached, was CT‐imaged and irradiated by a GK Perfexion unit. A total of 26 4‐mm shots were delivered at 26 locations directly defined in the Leksell stereotactic space (LSS), inducing adequate contrast in corresponding T2‐weighted (T2w) MR images. Prescribed shot coordinates served as reference locations. An additional MR scan was acquired to implement the “mean image” distortion correction technique. The TLA for each workflow was assessed by comparing the radiation‐induced target locations, identified in MR images, with corresponding reference locations. Using T1w MR and CT images of 15 patients (totaling 81 lesions), TLA in clinical cases was similarly assessed, considering MR‐corrected data as reference. For the MR/CT workflow, both global and region of interest (ROI)‐based MR/CT registration approaches were studied. Results In phantom measurements, the MR‐corrected workflow demonstrated unsurpassed TLA (median offset of 0.2 mm) which deteriorated for MR‐only and MR/CT workflows (median offsets of 0.8 and 0.6 mm, respectively). In real‐patient cases, the MR‐only workflow resulted in offsets that exhibit a significant positive correlation with the distance from the MR isocenter, reaching 1.1 mm (median 0.6 mm). Comparable results were obtained for the MR/CT‐global workflow, although a maximum offset of 1.4 mm was detected. TLA was improved with the MR/CT‐ROI workflow resulting in median/maximum offsets of 0.4 mm/1.1 mm. Conclusions Subpixel TLA is achievable in all workflows. For the MR/CT workflow, a ROI‐based MR/CT co‐registration approach could considerably increase TLA and should be preferred instead of a global registration.
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Affiliation(s)
- Eleftherios P. Pappas
- Medical Physics Laboratory Medical School National and Kapodistrian University of Athens Athens Greece
| | - Ioannis Seimenis
- Medical Physics Laboratory Medical School National and Kapodistrian University of Athens Athens Greece
| | - Panagiotis Kouris
- Medical Physics Laboratory Medical School National and Kapodistrian University of Athens Athens Greece
| | - Stefanos Theocharis
- Medical Physics Laboratory Medical School National and Kapodistrian University of Athens Athens Greece
| | | | - Georgios Kollias
- Medical Physics and Gamma Knife Department Hygeia Hospital Marousi Greece
| | - Pantelis Karaiskos
- Medical Physics Laboratory Medical School National and Kapodistrian University of Athens Athens Greece
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Neppl S, Kurz C, Köpl D, Yohannes I, Schneider M, Bondesson D, Rabe M, Belka C, Dietrich O, Landry G, Parodi K, Kamp F. Measurement-based range evaluation for quality assurance of CBCT-based dose calculations in adaptive proton therapy. Med Phys 2021; 48:4148-4159. [PMID: 34032301 DOI: 10.1002/mp.14995] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/17/2020] [Revised: 04/08/2021] [Accepted: 05/10/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The implementation of volumetric in-room imaging for online adaptive radiotherapy makes extensive testing of this image data for treatment planning necessary. Especially for proton beams the higher sensitivity to stopping power properties of the tissue results in more stringent requirements. Current approaches mainly focus on recalculation of the plans on the new image data, lacking experimental verification, and ignoring the impact on the plan re-optimization process. The aim of this study was to use gel and film dosimetry coupled with a three-dimensional (3D) printed head phantom (based on the planning CT of the patient) for 3D range verification of intensity-corrected cone beam computed tomography (CBCT) image data for adaptive proton therapy. METHODS Single field uniform dose pencil beam scanning proton plans were optimized for three different patients on the patients' planning CT (planCT) and the patients' intensity-corrected CBCT (scCBCT) for the same target volume using the same optimization constraints. The CBCTs were corrected on projection level using the planCT as a prior. The dose optimized on planCT and recalculated on scCBCT was compared in terms of proton range differences (80% distal fall-off, recalculation). Moreover, the dose distribution resulting from recalculation of the scCBCT-optimized plan on the planCT and the original planCT dose distribution were compared (simulation). Finally, the two plans of each patient were irradiated on the corresponding patient-specific 3D printed head phantom using gel dosimetry inserts for one patient and film dosimetry for all three patients. Range differences were extracted from the measured dose distributions. The measured and the simulated range differences were corrected for range differences originating from the initial plans and evaluated. RESULTS The simulation approach showed high agreement with the standard recalculation approach. The median values of the range differences of these two methods agreed within 0.1 mm and the interquartile ranges (IQRs) within 0.3 mm for all three patients. The range differences of the film measurement were accurately matching with the simulation approach in the film plane. The median values of these range differences deviated less than 0.1 mm and the IQRs less than 0.4 mm. For the full 3D evaluation of the gel range differences, the median value and IQR matched those of the simulation approach within 0.7 and 0.5 mm, respectively. scCBCT- and planCT-based dose distributions were found to have a range agreement better than 3 mm (median and IQR) for all considered scenarios (recalculation, simulation, and measurement). CONCLUSIONS The results of this initial study indicate that an online adaptive proton workflow based on scatter-corrected CBCT image data for head irradiations is feasible. The novel presented measurement- and simulation-based method was shown to be equivalent to the standard literature recalculation approach. Additionally, it has the capability to catch effects of image differences on the treatment plan optimization. This makes the measurement-based approach particularly interesting for quality assurance of CBCT-based online adaptive proton therapy. The observed uncertainties could be kept within those of the registration and positioning. The proposed validation could also be applied for other alternative in-room images, e.g. for MR-based pseudoCTs.
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Affiliation(s)
- Sebastian Neppl
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.,Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München (LMU Munich), 85748, Garching bei München, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.,Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München (LMU Munich), 85748, Garching bei München, Germany
| | - Daniel Köpl
- Rinecker Proton Therapy Center, 81371, Munich, Germany
| | | | - Moritz Schneider
- Department of Radiology, University Hospital, LMU Munich, 81377, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), 81377, Munich, Germany
| | - David Bondesson
- Department of Radiology, University Hospital, LMU Munich, 81377, Munich, Germany.,Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), 81377, Munich, Germany
| | - Moritz Rabe
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.,Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München (LMU Munich), 85748, Garching bei München, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.,German Cancer Consortium (DKTK), Partner site Munich, 81377, Munich, Germany
| | - Olaf Dietrich
- Department of Radiology, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany.,Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München (LMU Munich), 85748, Garching bei München, Germany
| | - Katia Parodi
- Department of Medical Physics, Faculty of Physics, Ludwig-Maximilians-Universität München (LMU Munich), 85748, Garching bei München, Germany
| | - Florian Kamp
- Department of Radiation Oncology, University Hospital, LMU Munich, 81377, Munich, Germany
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Decabooter E, Swinnen AC, Öllers MC, Göpfert F, Verhaegen F. Operation and calibration of the novel PTW 1600SRS detector for the verification of single isocenter stereotactic radiosurgery treatments of multiple small brain metastases. Br J Radiol 2021; 94:20210473. [PMID: 34111967 PMCID: PMC8248213 DOI: 10.1259/bjr.20210473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objectives: The aim of this work was to evaluate the operation of the 1600SRS detector and to develop a calibration procedure for verifying the dose delivered by a single isocenter stereotactic radiosurgery (SRS) treatment of small multiple brain metastases (BM). Methods: 14 clinical treatment cases were selected with the number of BM ranging from 2 to 11. The dosimetric agreement was investigated between the calculated and the measured dose by an OCTAVIUS 1600SRS array detector in an OCTAVIUS 4D phantom equipped with dedicated SRS top. The cross-calibration procedure deviated from the manufacturer’s as it applied field sizes and dose rates corresponding to the volumetric modulated arc therapy segments in each plan. Results: Measurements with a plan specific cross-calibration showed mean ± standard deviation (SD) agreement scores for cut-off values 50%, 80%, 95%, of 98.6 ± 1.7%, 96.5 ± 4.6%, 97.3 ± 4.4% for the 6 MV plans respectively, and 98.6 ± 1.5%, 96.6 ± 4.0% 96.4 ± 6.3%, for the 6 MV flattening filter free (FFF) plans respectively. Using the default calibration procedure instead of the plan specific calibration could lead to a combined systematic dose offset of 4.1% for our treatment plans. Conclusion: The 1600SRS detector array with the 4D phantom offers an accurate solution to perform routine quality assurance measurements of single isocenter SRS treatments of multiple BM. This work points out the necessity of an adapted cross-calibration procedure. Advances in knowledge: A dedicated calibration procedure enables accurate dosimetry with the 1600SRS detector for small field single isocenter SRS treatment of multiple brain metastases for a large amount of BM.
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Affiliation(s)
- Esther Decabooter
- Department of Radiation Oncology (Maastro clinic), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ans Cc Swinnen
- Department of Radiation Oncology (Maastro clinic), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Michel C Öllers
- Department of Radiation Oncology (Maastro clinic), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Frank Verhaegen
- Department of Radiation Oncology (Maastro clinic), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Saenz D, Papanikolaou N, Zoros E, Pappas E, Reiner M, Chew LT, Lim HY, Hancock S, Nebelsky A, Njeh C, Anagnostopoulos G. Robustness of single-isocenter multiple-metastasis stereotactic radiosurgery end-to-end testing across institutions. J Radiosurg SBRT 2021; 7:223-232. [PMID: 33898086 PMCID: PMC8055241] [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] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/31/2020] [Indexed: 06/12/2023]
Abstract
The accuracy of stereotactic radiosurgery (SRS) to multiple metastases with a single-isocenter using high definition dynamic radiosurgery (HDRS) was evaluated across institutions. An SRS plan was delivered at six HDRS-capable institutions to an anthropomorphic phantom consisting of point, film, and 3D-gel dosimeters. Direct dose comparison and gamma analysis were used to evaluate the accuracy. Point measurements averaged across institutions were within 1.2±0.5%. The average gamma passing rate in the film was 96.6±2.2% (3%/2 mm). For targets within 4 cm of the isocenter, the 3D dosimetric gel gamma passing rate averaged across institutions was >90% (3%/2 mm). The targeting accuracy of high definition dynamic radiosurgery assessed by geometrical offset of the center of dose distributions across multiple institutions in this study was within 1 mm for targets within 4 cm of isocenter. Across variations in clinical practice, comparable dosimetry and localization is possible with this treatment planning and delivery technique.
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Affiliation(s)
- Daniel Saenz
- University of Texas Health Science Center, San Antonio, TX, USA
| | | | - Emmanouil Zoros
- National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | | | | | | | - Sam Hancock
- Southeast Health, Cape Girardeau, Missouri, USA
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Dellios D, Pappas EP, Seimenis I, Paraskevopoulou C, Lampropoulos KI, Lymperopoulou G, Karaiskos P. Evaluation of patient-specific MR distortion correction schemes for improved target localization accuracy in SRS. Med Phys 2020; 48:1661-1672. [PMID: 33230923 DOI: 10.1002/mp.14615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 07/26/2020] [Revised: 10/16/2020] [Accepted: 11/16/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This work aims at promoting target localization accuracy in cranial stereotactic radiosurgery (SRS) applications by focusing on the correction of sequence-dependent (also patient induced) magnetic resonance (MR) distortions at the lesion locations. A phantom-based quality assurance (QA) methodology was developed and implemented for the evaluation of three distortion correction techniques. The same approach was also adapted to cranial MR images used for SRS treatment planning purposes in single or multiple brain metastases cases. METHODS A three-dimensional (3D)-printed head phantom was filled with a 3D polymer gel dosimeter. Following treatment planning and dose delivery, volumes of radiation-induced polymerization served as hypothetical lesions, offering adequate MR contrast with respect to the surrounding unirradiated areas. T1-weighted (T1w) MR imaging was performed at 1.5 T using the clinical scanning protocol for SRS. Additional images were acquired to implement three distortion correction methods; the field mapping (FM), mean image (MI) and signal integration (SI) techniques. Reference lesion locations were calculated as the averaged centroid positions of each target identified in the forward and reverse read gradient polarity MRI scans. The same techniques and workflows were implemented for the correction of contrast-enhanced T1w MR images of 10 patients with a total of 27 brain metastases. RESULTS All methods employed in the phantom study diminished spatial distortion. Median and maximum distortion magnitude decreased from 0.7 mm (2.10 ppm) and 0.8 mm (2.36 ppm), respectively, to <0.2 mm (0.61 ppm) at all target locations, using any of the three techniques. Image quality of the corrected images was acceptable, while contrast-to-noise ratio slightly increased. Results of the patient study were in accordance with the findings of the phantom study. Residual distortion in corrected patient images was found to be <0.3 mm in the vast majority of targets. Overall, the MI approach appears to be the most efficient correction method from the three investigated. CONCLUSIONS In cranial SRS applications, patient-specific distortion correction at the target location(s) is feasible and effective, despite the expense of longer imaging time since additional MRI scan(s) need to be performed. A phantom-based QA methodology was developed and presented to reassure efficient implementation of correction techniques for sequence-dependent spatial distortion.
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Affiliation(s)
- Dimitrios Dellios
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, 115 27, Greece
| | - Eleftherios P Pappas
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, 115 27, Greece
| | - Ioannis Seimenis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, 115 27, Greece
| | | | - Kostas I Lampropoulos
- Medical Physics and Gamma Knife Department, Hygeia Hospital, Marousi, 151 23, Greece
| | - Georgia Lymperopoulou
- 1st Department of Radiology, Medical School, National and Kapodistrian University of Athens, Athens, 115 28, Greece
| | - Pantelis Karaiskos
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, 115 27, Greece.,Medical Physics and Gamma Knife Department, Hygeia Hospital, Marousi, 151 23, Greece
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Delombaerde L, Petillion S, Weltens C, De Roover R, Reynders T, Depuydt T. Technical Note: Development of 3D‐printed breast phantoms for end‐to‐end testing of whole breast volumetric arc radiotherapy. J Appl Clin Med Phys 2020. [PMCID: PMC7484846 DOI: 10.1002/acm2.12976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
End‐to‐end testing of a new breast radiotherapy technique preferably requires realistic phantom geometries, which is challenging to achieve using currently commercially available solutions. We have developed a series of three‐dimensional (3D)‐printed breast phantoms, with ionization chamber and radiochromic film inserts, which can be attached to a commercial anthropomorphic thorax phantom. A contoured left breast from a patient’s planning CT was mapped onto a CT of the CIRS E2E thorax phantom (CIRS Inc.) and cropped to fit the surface. Four versions of the breast were 3D printed, containing a cavity for an ionization chamber and slits for radiochromic film insertion in the three cardinal planes, respectively. The phantoms were fully compatible with surface scanning technology used for setup. The phantoms were validated using a whole‐breast volumetric modulated arc therapy protocol with a simultaneous integrated boost to the tumor bed (VMAT‐SIB). Six patient plans and one original plan on the breast phantom were verified with planar portal imaging, point dose, and film measurements in the MultiCube phantom and planar γ‐analysis using ArcCHECK diode array. Six patient plans were recalculated on the breast phantom (hybrid plans) and delivered with point dose and film measurements with 3% (local)/2 mm γ‐analysis. One complete end‐to‐end test on the breast phantom was performed. All plan quality verifications had point dose differences below 2.4% from the calculated dose and γ‐agreement scores (γAS) > 87.3% for film measurements in the MultiCube, portal dosimetry, and ArcCHECK. Point dose differences in the 3D‐printed phantoms were below 2.6% (median −1.4%, range −2.6%; 0.3%). Median γAS was 96.4% (range 80.1%–99.7%) for all film inserts. The proposed 3D‐printed attachable breast dosimetry phantoms have been shown to be a valuable tool for end‐to‐end testing of a new radiotherapy protocol. The workflow described in this report can aid users to create their own phantom‐specific breast 3D‐printed phantoms.
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Affiliation(s)
| | - Saskia Petillion
- Department of Radiation Oncology University Hospitals Leuven Leuven Belgium
| | - Caroline Weltens
- Department of Oncology KU Leuven Leuven Belgium
- Department of Radiation Oncology University Hospitals Leuven Leuven Belgium
| | | | - Truus Reynders
- Department of Radiation Oncology University Hospitals Leuven Leuven Belgium
| | - Tom Depuydt
- Department of Oncology KU Leuven Leuven Belgium
- Department of Radiation Oncology University Hospitals Leuven Leuven Belgium
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Han EY, Diagaradjane P, Luo D, Ding Y, Kalaitzakis G, Zoros E, Zourari K, Boursianis T, Pappas E, Wen Z, Wang J, Briere TM. Validation of PTV margin for Gamma Knife Icon frameless treatment using a PseudoPatient® Prime anthropomorphic phantom. J Appl Clin Med Phys 2020; 21:278-285. [PMID: 32786141 PMCID: PMC7497928 DOI: 10.1002/acm2.12997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 03/02/2020] [Revised: 04/28/2020] [Accepted: 06/23/2020] [Indexed: 11/09/2022] Open
Abstract
The Gamma Knife Icon allows the treatment of brain tumors mask-based single-fraction or fractionated treatment schemes. In clinic, uniform axial expansion of 1 mm around the gross tumor volume (GTV) and a 1.5 mm expansion in the superior and inferior directions are used to generate the planning target volume (PTV). The purpose of the study was to validate this margin scheme with two clinical scenarios: (a) the patient's head remaining right below the high-definition motion management (HDMM) threshold, and (b) frequent treatment interruptions followed by plan adaptation induced by large pitch head motion. A remote-controlled head assembly was used to control the motion of a PseudoPatient® Prime head phantom; for dosimetric evaluations, an ionization chamber, EBT3 films, and polymer gels were used. These measurements were compared with those from the Gamma Knife plan. For the absolute dose measurements using an ionization chamber, the percentage differences for both targets were less than 3.0% for all scenarios, which was within the expected tolerance. For the film measurements, the two-dimensional (2D) gamma index with a 2%/2 mm criterion showed the passing rates of ≥87% in all scenarios except the scenario 1. The results of Gel measurements showed that GTV (D100 ) was covered by the prescription dose and PTV (D95 ) was well above the planned dose by up to 5.6% and the largest geometric PTV offset was 0.8 mm for all scenarios. In conclusion, the current margin scheme with HDMM setting is adequate for a typical patient's intrafractional motion.
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Affiliation(s)
- Eun Young Han
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Parmeswaran Diagaradjane
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dershan Luo
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yao Ding
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Emmanouil Zoros
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyveli Zourari
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelos Pappas
- Department of Biomedical Sciences, Radiology & Radiotherapy Sector, University of West Attica, Athens, Greece
| | - Zhifei Wen
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jihong Wang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tina Marie Briere
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Pappas E, Kalaitzakis G, Boursianis T, Zoros E, Zourari K, Pappas EP, Makris D, Seimenis I, Efstathopoulos E, Maris TG. Dosimetric performance of the Elekta Unity MR-linac system: 2D and 3D dosimetry in anthropomorphic inhomogeneous geometry. ACTA ACUST UNITED AC 2019; 64:225009. [DOI: 10.1088/1361-6560/ab52ce] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Clifton W, Nottmeier E, Edwards S, Damon A, Dove C, Refaey K, Pichelmann M. Development of a Novel 3D Printed Phantom for Teaching Neurosurgical Trainees the Freehand Technique of C2 Laminar Screw Placement. World Neurosurg 2019; 129:e812-e820. [DOI: 10.1016/j.wneu.2019.06.038] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 12/13/2022]
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