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Vitzthum LK, Surucu M, Gensheimer MF, Kovalchuk N, Han B, Pham D, Chang D, Shirvani SM, Aksoy D, Maniyedath A, Narayanan M, Da Silva AJ, Mazin S, Feghali KAA, Iyengar P, Dan T, Pompos A, Timmerman R, Öz O, Cai B, Garant A. BIOGUIDE-X: A First-in-Human Study of the Performance of Positron Emission Tomography-Guided Radiation Therapy. Int J Radiat Oncol Biol Phys 2024; 118:1172-1180. [PMID: 38147912 DOI: 10.1016/j.ijrobp.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 12/28/2023]
Abstract
PURPOSE Positron emission tomography (PET)-guided radiation therapy is a novel tracked dose delivery modality that uses real-time PET to guide radiation therapy beamlets. The BIOGUIDE-X study was performed with sequential cohorts of participants to (1) identify the fluorodeoxyglucose (FDG) dose for PET-guided therapy and (2) confirm that the emulated dose distribution was consistent with a physician-approved radiation therapy plan. METHODS AND MATERIALS This prospective study included participants with at least 1 FDG-avid targetable primary or metastatic tumor (2-5 cm) in the lung or bone. For cohort I, a modified 3 + 3 design was used to determine the FDG dose that would result in adequate signal for PET-guided therapy. For cohort II, PET imaging data were collected on the X1 system before the first and last fractions among patients undergoing conventional stereotactic body radiation therapy. PET-guided therapy dose distributions were modeled on the patient's computed tomography anatomy using the collected PET data at each fraction as input to an "emulated delivery" and compared with the physician-approved plan. RESULTS Cohort I demonstrated adequate FDG activity in 6 of 6 evaluable participants (100.0%) with the first injected dose level of 15 mCi FDG. In cohort II, 4 patients with lung tumors and 5 with bone tumors were enrolled, and evaluable emulated delivery data points were collected for 17 treatment fractions. Sixteen of the 17 emulated deliveries resulted in dose distributions that were accurate with respect to the approved PET-guided therapy plan. The 17th data point was just below the 95% threshold for accuracy (dose-volume histogram score = 94.6%). All emulated fluences were physically deliverable. No toxicities were attributed to multiple FDG administrations. CONCLUSIONS PET-guided therapy is a novel radiation therapy modality in which a radiolabeled tumor can act as its own fiducial for radiation therapy targeting. Emulated therapy dose distributions calculated from continuously acquired real-time PET data were accurate and machine-deliverable in tumors that were 2 to 5 cm in size with adequate FDG signal characteristics.
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Affiliation(s)
- Lucas K Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California.
| | - Murat Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Michael F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Nataliya Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Bin Han
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Daniel Pham
- Department of Radiation Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Daniel Chang
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | | | | | | | | | | | | | - Puneeth Iyengar
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Tu Dan
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Arnold Pompos
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Robert Timmerman
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Orhan Öz
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Bin Cai
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Aurelie Garant
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
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Zhuang T, Parsons D, Desai N, Gibbard G, Keilty D, Lin MH, Cai B, Nguyen D, Chiu T, Godley A, Pompos A, Jiang S. Simulation and pre-planning omitted radiotherapy (SPORT): a feasibility study for prostate cancer. Biomed Phys Eng Express 2024; 10:025019. [PMID: 38241733 DOI: 10.1088/2057-1976/ad20aa] [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: 08/27/2023] [Accepted: 01/19/2024] [Indexed: 01/21/2024]
Abstract
This study explored the feasibility of on-couch intensity modulated radiotherapy (IMRT) planning for prostate cancer (PCa) on a cone-beam CT (CBCT)-based online adaptive RT platform without an individualized pre-treatment plan and contours. Ten patients with PCa previously treated with image-guided IMRT (60 Gy/20 fractions) were selected. In contrast to the routine online adaptive RT workflow, a novel approach was employed in which the same preplan that was optimized on one reference patient was adapted to generate individual on-couch/initial plans for the other nine test patients using Ethos emulator. Simulation CTs of the test patients were used as simulated online CBCT (sCBCT) for emulation. Quality assessments were conducted on synthetic CTs (sCT). Dosimetric comparisons were performed between on-couch plans, on-couch plans recomputed on the sCBCT and individually optimized plans for test patients. The median value of mean absolute difference between sCT and sCBCT was 74.7 HU (range 69.5-91.5 HU). The average CTV/PTV coverage by prescription dose was 100.0%/94.7%, and normal tissue constraints were met for the nine test patients in on-couch plans on sCT. Recalculating on-couch plans on the sCBCT showed about 0.7% reduction of PTV coverage and a 0.6% increasing of hotspot, and the dose difference of the OARs was negligible (<0.5 Gy). Hence, initial IMRT plans for new patients can be generated by adapting a reference patient's preplan with online contours, which had similar qualities to the conventional approach of individually optimized plan on the simulation CT. Further study is needed to identify selection criteria for patient anatomy most amenable to this workflow.
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Affiliation(s)
- Tingliang Zhuang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America
| | - David Parsons
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America
| | - Neil Desai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America
| | - Grant Gibbard
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America
| | - Dana Keilty
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America
| | - Mu-Han Lin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America
| | - Bin Cai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America
| | - Dan Nguyen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America
| | - Tsuicheng Chiu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America
| | - Andrew Godley
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America
| | - Arnold Pompos
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America
| | - Steve Jiang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States of America
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Lin J, Chen M, Lai Y, Trivedi Z, Wu J, Foo T, Gonzalez Y, Reynolds R, Park C, Yan Y, Godley A, Jiang S, Jia X, Lin MH, Pompos A, Lu W. ART2Dose: A comprehensive dose verification platform for online adaptive radiotherapy. Med Phys 2024; 51:18-30. [PMID: 37856190 DOI: 10.1002/mp.16806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/09/2023] [Accepted: 10/07/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Online adaptive radiotherapy (ART) involves the development of adaptable treatment plans that consider patient anatomical data obtained right prior to treatment administration, facilitated by cone-beam computed tomography guided adaptive radiotherapy (CTgART) and magnetic resonance image-guided adaptive radiotherapy (MRgART). To ensure accuracy of these adaptive plans, it is crucial to conduct calculation-based checks and independent verification of volumetric dose distribution, as measurement-based checks are not practical within online workflows. However, the absence of comprehensive, efficient, and highly integrated commercial software for secondary dose verification can impede the time-sensitive nature of online ART procedures. PURPOSE The main aim of this study is to introduce an efficient online quality assurance (QA) platform for online ART, and subsequently evaluate it on Ethos and Unity treatment delivery systems in our clinic. METHODS To enhance efficiency and ensure compliance with safety standards in online ART, ART2Dose, a secondary dose verification software, has been developed and integrated into our online QA workflow. This implementation spans all online ART treatments at our institution. The ART2Dose infrastructure comprises four key components: an SQLite database, a dose calculation server, a report generator, and a web portal. Through this infrastructure, file transfer, dose calculation, report generation, and report approval/archival are seamlessly managed, minimizing the need for user input when exporting RT DICOM files and approving the generated QA report. ART2Dose was compared with Mobius3D in pre-clinical evaluations on secondary dose verification for 40 adaptive plans. Additionally, a retrospective investigation was conducted utilizing 1302 CTgART fractions from ten treatment sites and 1278 MRgART fractions from seven treatment sites to evaluate the practical accuracy and efficiency of ART2Dose in routine clinical use. RESULTS With dedicated infrastructure and an integrated workflow, ART2Dose achieved gamma passing rates that were comparable to or higher than those of Mobius3D. Additionally, it significantly reduced the time required to complete pre-treatment checks by 3-4 min for each plan. In the retrospective analysis of clinical CTgART and MRgART fractions, ART2Dose demonstrated average gamma passing rates of 99.61 ± 0.83% and 97.75 ± 2.54%, respectively, using the 3%/2 mm criteria for region greater than 10% of prescription dose. The average calculation times for CTgART and MRgART were approximately 1 and 2 min, respectively. CONCLUSION Overall, the streamlined implementation of ART2Dose notably enhances the online ART workflow, offering reliable and efficient online QA while reducing time pressure in the clinic and minimizing labor-intensive work.
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Affiliation(s)
- Jingying Lin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mingli Chen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Youfang Lai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Zipalkumar Trivedi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Junjie Wu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Tim Foo
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yesenia Gonzalez
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Robert Reynolds
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Chunjoo Park
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Yulong Yan
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andrew Godley
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Steve Jiang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Xun Jia
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mu-Han Lin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Arnold Pompos
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Weiguo Lu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Montalvo SK, Arbab M, Gonzalez Y, Lin MH, Parsons DDM, Zhuang T, Cai B, Pompos A, Hannan R, Westover KD, Zhang Y, Timmerman RD, Iyengar P. Predictive Factors for Response to Adaptive Therapy in Thoracic Stereotactic Ablative Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e43. [PMID: 37785405 DOI: 10.1016/j.ijrobp.2023.06.742] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Online adaptive radiotherapy (ART) has been increasingly adopted for clinical use. However, ART for thoracic malignancies has lagged beyond its implementation for other primary cancers. Efforts are needed to identify optimal patients for ART by finding trends for changes in tumor position, shape, or proximity to OARs are needed. We hypothesized tumor size, histology, pre-RT SUV value, and intrathoracic location could influence how tumors change during cone beam computed tomography (CBCT)-based ART Stereotactic Ablative Radiotherapy (SAbR) for thoracic disease. MATERIALS/METHODS Data was collected from a prospective registry of patients who received CBCT-ART and SAbR for primary and secondary lung tumors. Dosimetry data was obtained from the simulation planning and the daily adaptive workflow. Central lung tumors were defined as those located within 2 cm of the bronchial tree. Plans were either delivered as per simulation or through the online adaptive workflow delivery (AD). Change in planning tumor volumes (PTV) were calculated between initial and final fractions (ΔPTV). RESULTS A total of 42 patients with a median age of 67 (range 17-90) and median 8.3 months follow up, treated between June 2021 and December 2022 were included. Most patients had NSCLC or presumed NSCLC (73.85%, 31/42), and most lesions were peripheral (61.9%, 26/42) versus central (31%, 13/42) or apical (7.1%, 3/42). Mean dose and median fractions were 52.5 Gy (SD 8.07) and 5 (range 3-5) while median initial (i) PTV was 31.75 cm3 (IQR 42.3 cm3). On average, ΔPTV decreased by 4.9% (SD 21) and volume shrunk by 5 cm3 (SD 14.5). AD improved per fraction PTV coverage and conformality while esophageal, cardiac, and spinal cord dose were significantly decreased (all p < 0.05), and most fractions were delivered with AD (73.4%, 138/188). AD was aborted most often for small iPTVs. ΔPTV grew >10% for two lesions though their iPTV were < 10 cm3. 12/42 ΔPTV were >10% smaller by the end of RT and corresponded to larger iPTVs. Age, lung primary, metastatic disease, smoking status, and tumor location were not predictive for >10% decrease in ΔPTV. Among 24 biopsy-proven NSCLC ΔPTV was >10% smaller in 6/12 patients (50%) with adenocarcinoma and only in 2/12 (16.7%) with SCC, although this was not significant on χ2 testing (p = 0.08). There were no differences in local, regional, distant failure or death comparing those with a ΔPTV of >10% vs <10% (all p > 0.1). Comparing pre-treatment PET SUV and tumor response, lower SUVs appear to be associated with more PTV shrinkage, with no significant PTV change plateauing at SUV 20. However, this analysis was limited by the number of patients with high SUV values. CONCLUSION CBCT-ART SAbR is associated with improved PTV coverage, target conformality, and reduced OAR dose. Large iPTV and adenocarcinomas were more likely to decrease >10%. High metabolic activity appeared predictive for a lack of significant ΔPTV. Further clinical and radiographic features should be explored to predict response to ART.
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Affiliation(s)
- S K Montalvo
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - M Arbab
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - Y Gonzalez
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - M H Lin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - D D M Parsons
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - T Zhuang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - B Cai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A Pompos
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - R Hannan
- University of Texas Southwestern Medical Center, Dallas, TX
| | - K D Westover
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Y Zhang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - R D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - P Iyengar
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
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5
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Surucu M, Vitzthum L, Chang DT, Gensheimer MF, Kovalchuk N, Han B, Iagaru AH, Da Silva A, Narayanan M, Aksoy D, Feghali K, Shirvani SM, Maniyedath A, Cai B, Pompos A, Dan T, Öz OK, Iyengar P, Timmerman RD, Garant A. Analysis of the Measured FDG Uptake from the First-in-Human Clinical Trial of Biology-Guided Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e61-e62. [PMID: 37785835 DOI: 10.1016/j.ijrobp.2023.06.782] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The RefleXion X1 system is a novel linear accelerator equipped with dual 90° PET arcs incorporated into its architecture to capture emissions from tumors and designed to respond by directing the radiation beam towards target. This study reports on the measured FDG uptake from the first in human multi-institutional clinical trial (BIOGUIDE-X) evaluating the performance and safety of the RefleXion X1 PET-LINAC. MATERIALS/METHODS A total of nine patients treated with stereotactic body radiotherapy (SBRT) for lung (5) and bone (4) tumors were enrolled in the Cohort II of this study after screening their pre-study diagnostic PET/CT, acquired up to 60 days prior to enrollment, to ensure their tumor size between 2 to 5 cm and SUVmax >6. After CT simulation, the tumor and OARs were delineated, and patients had a 4-pass Imaging-only (BgRT Modeling) PET/CT acquisition on the X1 system to generate biology-guided radiotherapy (BgRT) plans. Before the patients' first and last SBRT fractions, they were injected with FDG, and short PET pre-scan (1-pass) was performed on the X1 followed by a long-PET acquisition (4-pass) to emulate the expected BgRT dose distribution without firing beam. Patients were also imaged on a third-party diagnostic PET/CT scanner after the last-fraction X1 scan. This study compares the SUVmax from the screening PET/CT, X1 Imaging-only scan, X1 PET pre-scan and long scan before the first and last-fractions, and final diagnostic PET/CT. RESULTS The median time from injection to PET imaging was 84 ± 15.4 mins for X1 Imaging-only (used for generating BgRT plans), 77 ± 21.6 mins for X1 pre-scan (safety check before treatment start), 108+/- 22 mins for X1 long-PET (used to emulate treatment delivery), and 161 ± 23 mins for final diagnostic PET. For a nominal 10 mCi injection, the mean SUVmax for screening imaging performed on the diagnostic PET/CT was 10.8 ± 4.3. For a 15 mCi nominal injection, the mean SUVmax calculated on the X1 was 5.3 ± 2.6, 5.4 ± 2.0, 5.5 ± 2.6, 5.2 ± 1.8 and 5.4 ± 2.2 for the Imaging-only, first-fraction PET pre-scan, first-fraction long PET scan, last-fraction PET pre-scan, and last-fraction long PET scan, respectively. The overall median SUVmax for all patients across all timepoints and scans with X1 was calculated to be 4.8 with a range of 2.4 to 9.8. The median SUVmax for the diagnostic PET/CT scan after the last fraction X1 scan was 15.8 with a range of 8.5 to 27.7. CONCLUSION The dual PET arcs and limited axial extent of the X1 PET subsystem results in lower system sensitivity in comparison to diagnostic PET scanners equipped with full ring and larger axial extent, as expected. With the same FDG injection, the RefleXion X1 produced SUVmax values that were 30.4 % of the diagnostic PET/CT scanners' values. Nevertheless, the X1 collected sufficient emission data to enable successful completion of emulated BgRT deliveries that met dose accuracy criteria in a clinical setting.
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Affiliation(s)
- M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA; Department of Radiation Oncology, Michigan Medicine, Ann Arbor, MI
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - A H Iagaru
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA
| | | | | | - D Aksoy
- RefleXion Medical, Inc., Hayward, CA
| | - K Feghali
- RefleXion Medical, Inc., Hayward, CA
| | | | | | - B Cai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A Pompos
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - T Dan
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - O K Öz
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - P Iyengar
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - R D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A Garant
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
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6
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Garant T, Iyengar P, Dan T, Pompos A, Timmerman RD, Öz OK, Cai B, Shirvani SM, Aksoy D, Al Feghali KA, Maniyedath A, Narayanan M, Da Silva A, Surucu M, Gensheimer MF, Kovalchuk N, Han B, Pham D, Chang DT, Vitzthum L. Imaging Performance of the PET Scan on a Novel Ring Gantry-Based PET/CT Linear Accelerator System in the First-in-Human Study of Biology-Guided Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e665. [PMID: 37785968 DOI: 10.1016/j.ijrobp.2023.06.2105] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Biology-guided radiotherapy (BgRT) is a novel tracked dose delivery modality using real-time positron emission tomography (PET) to guide radiotherapy beamlets. The present study was performed with sequential cohorts of participants to evaluate the performance and safety of BgRT. Primary endpoints were previously reported. We hereby report on one of the secondary endpoints assessing a novel treatment planning machine with integrated dual kVCT/PET imaging ("novel device") performance in comparison to a third-party diagnostic PET/CT scan. MATERIALS/METHODS This single-arm, open-label, prospective study included participants with at least 1 FDG-avid targetable primary or metastatic tumor (≥2cm and ≤5cm) in the lung or bone. PET imaging data were collected on the novel device and on a third-party diagnostic PET/CT performed in sequence once at the planning timepoint in Cohort I, and immediately before the last fraction among patients undergoing stereotactic radiotherapy in Cohort II. Three central read radiation oncologists (CRRO) provided an interpretation of the novel device PET scans which were compared to an agreement standard based on 3 central radiologists' review of the paired diagnostic PET/CT scan. Positive percent agreement for localization of the target tumor within the biology-tracking zone (BTZ) was the key metric because it reflects whether advancing patients to subsequent steps in the BgRT workflow based on the novel device's imaging was ultimately appropriate. RESULTS In Cohort 1, 6 image comparisons were performed. The positive (%) agreement for the aggregate radiation oncologist review was 100% (5/5), reflecting that in all 5 cases where the aggregate radiation oncologists deemed the tumor to fall within the BTZ based upon the novel device PET images, the central radiologists came to the same conclusion upon review of the paired diagnostic PET/CT images. The overall (%) agreement for the aggregate radiation oncologist review was 83.3% (5/6): localization was not established on the novel device in 1 case, even though it was established on the diagnostic PET/CT. This would not pose risk in real world practice as BgRT candidacy would be aborted for tumors not visible on the novel device. In Cohort II, among the 7 image comparisons, there was 100% positive percent agreement between the aggregate CRRO and the agreement standard as the localization criteria was met in both scans for all 7 patients. This was concordant with a 100% overall percent agreement. CONCLUSION This investigation demonstrated a 100% positive percent agreement between central review of this novel device images by radiation oncologists and central review of the accompanying third-party PET/CT images by radiologists. There were no cases where a positive localization by the aggregate CRRO was not confirmed by the third-party PET/CT standard, providing evidence against the likelihood of falsely positive localizations on the novel device that would inappropriately advance patients in the workflow.
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Affiliation(s)
- T Garant
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - P Iyengar
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - T Dan
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - A Pompos
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - R D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - O K Öz
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - B Cai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - D Aksoy
- RefleXion Medical, Inc., Hayward, CA
| | | | | | | | | | - M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D Pham
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
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7
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Gonzalez Y, Chen L, Lee H, Kim N, Arbab M, Alluri PG, Zhang Y, Chiu TD, Iqbal Z, Zhuang T, Cai B, Kim H, Pompos A, Jiang SB, Godley AR, Timmerman RD, Lin MH, Rahimi AS, Parsons DDM. Dosimetric Comparison of Adaptive Radiotherapy Modalities for Stereotactic Partial Breast Irradiation. Int J Radiat Oncol Biol Phys 2023; 117:S163-S164. [PMID: 37784408 DOI: 10.1016/j.ijrobp.2023.06.260] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) An increase in the availability of adaptive radiotherapy (ART) platforms have proven to be effective in the treatment of a variety of sites. In this study, we aim to evaluate the effectiveness of non-adaptive RT and 3 different ART platforms: (1) CBCT-based, (2) CT-based, and (3) MRI-based for stereotactic partial breast irradiation (SPBI). MATERIALS/METHODS Data were collected from 32 patients (16 left and 16 right breast) treated at a single institution. 16 patients (8 left and 8 right) treated using the non-ART platform were re-planned onto two different ART platforms, CBCT- and MRI-based. The remaining 16 patients treated using CT-based adaptive platform were not re-planned due to the prone patient treatment position (others systems supine). All cases were planned to 30 Gy in 5 fractions. Plan quality was evaluated based on pre-defined planning goals to the OARS: ipsilateral and contralateral lungs (Dmean, Dmax, V20 Gy, V9 Gy), ipsilateral (V15 Gy, V30 Gy) and contralateral breasts (Dmax), heart (Dmean, Dmax, V3 Gy, V1.5 Gy), skin (Dmax, V36.5 Gy), and rib (Dmax, V30 Gy). Target goals were defined by Dmax, Dmin, gradient index, and paddock conformality index. Re-planned cases were compared within the cohort using a paired t-test and a 2-sided t-test was used comparing to the CT-based platform. RESULTS Comparing the left and right breast cohort across all platforms, the CT-based ART system showed a signification dose reduction in Dmean (p<0.001 for all platforms), Dmax (p<0.001 for left breast, p<0.03 for right breast) and V9 Gy (p<0.004 for left breast, p<0.001 for right breast) to the ipsilateral lung, V15 Gy (p<0.004 for left breast cohort) to the ipsilateral breast, and Dmax to the contralateral breast (p<0.001) and ribs (p = 0.01, p<0.001, p = 0.01 for CBCT-ART, MRI-ART, and non-ART for left breast cohort only). On average, the MR-Linac platform showed the least degree of OAR sparing across nearly all dosimetric parameters evaluated when compared to all modalities, especially for contralateral lung Dmean and Dmax (p<0.05 for all dosimetric parameters for all platforms) and contralateral breast Dmax (p<0.003 for all platforms). The CBCT-based platform showed superior dose reduction in contralateral lung mean (p<0.03 for all platforms) and heart Dmean (p = 0.065, p<0.001, p = 0.045 for non-adaptive, MRI-ART, and CT-ART for left breast and p<0.008 for right breast). PTV coverage was comparable across all platforms, averaging at approximately 95%. The CT-based ART platform showed a significantly reduced gradient index relative to the CBCT- and MRI-based platforms (p<0.001). CONCLUSION For SPBI treatments, the CT-based ART platforms displayed a higher degree of OAR sparing for many of the dosimetric parameters recorded relative to the other ART and non-ART platforms presented. The MRI-based system typically showed less reduced OAR sparing; however, the advantage of the system is shown if soft tissue contrast is needed. PTV coverage remained comparable across all platforms.
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Affiliation(s)
- Y Gonzalez
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - L Chen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - H Lee
- Washington University School of Medicine in St. Louis, St. Louis, MO
| | - N Kim
- Vanderbilt University Department of Radiation Oncology, Nashville, TN
| | - M Arbab
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - P G Alluri
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - Y Zhang
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - T D Chiu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Z Iqbal
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - T Zhuang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - B Cai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - H Kim
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A Pompos
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - S B Jiang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A R Godley
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - R D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - M H Lin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A S Rahimi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - D D M Parsons
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
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Surucu M, Vitzthum L, Chang DT, Gensheimer MF, Kovalchuk N, Han B, Pham D, Da Silva A, Narayanan M, Aksoy D, Feghali K, Shirvani SM, Maniyedath A, Cai B, Pompos A, Dan T, Öz OK, Iyengar P, Timmerman RD, Garant A. Workflow Considerations for Biology-Guided Radiotherapy (BgRT) Implementation. Int J Radiat Oncol Biol Phys 2023; 117:e441. [PMID: 37785431 DOI: 10.1016/j.ijrobp.2023.06.1618] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Biology-guided radiotherapy (BgRT) is a novel platform that combines real-time PET imaging with a 6MV Linac to target tumors. The performance and safety of BgRT was assessed in the BIOGUIDE-X clinical trial. This study aims to report on the BgRT workflow steps and assess the time required for each step of the BgRT process during this trial. MATERIALS/METHODS A total of nine patients were enrolled in the second Cohort of the BIOGUIDE-X study which included patients treated with stereotactic body radiotherapy (SBRT) for lung tumors (5) and bone tumors (4). The pre-treatment BgRT workflow includes CT simulation, contouring, imaging-only (BgRT Modeling) PET acquisition, BgRT planning, patient specific QA and plan approval. The imaging-only PET acquisition on the X1 collects a representative PET volumetric 3D image and is an input to develop the BgRT treatment plan. The steps during the BgRT delivery session are kVCT localization, PET pre-scan, PET evaluation and BgRT delivery. The PET PreScan is a 1-pass short-duration PET acquisition that is used to confirm that the PET biodistribution on the day of treatment is consistent with that of the imaging-only PET. During BIOGUIDE-X, the BgRT delivery step was replaced by a 4-pass long-PET acquisition that was used to emulate the expected BgRT dose distribution without turning the beam on. To assess BgRT workflow, times from 18F-FDG injection to image-only PET acquisition, 18F-FDG injection to PET pre-scan, Pre-scan to PET evaluation, and PET evaluation to BgRT delivery (long PET acquisition) were recorded. RESULTS Time between the 18F-FDG injection and the X1 imaging-only PET scan was 84 ± 19 minutes which includes time for 18F-FDG update. Average time to perform imaging-only PET scan was 26 ± 4 minutes. During the BgRT 'delivery' session, the mean time between the kVCT acquisition and PET pre-scan acquisition was 7 ± 3 minutes. The mean time to acquire a 1-pass PET pre-scan was 6 ± 1 then followed by 6 ± 1 minutes for the PET pre-scan dose calculation to estimate the BgRT doses that it would have delivered for this fraction. On average, the PET reconstruction, the PET signal localization verification and the evaluation of safety metrics took 11 ± 4 minutes. The mean time for BgRT 'delivery' was 27 ± 5 minutes based on the 4-pass long PET acquisition. Time from the start of the BgRT session to the end of the BgRT 'delivery' with this version of the investigative product release was 65 ± 9 minutes. CONCLUSION The new processes introduced by the BgRT technology were evaluated and found clinically feasible. Improvements are being undertaken to shorten the time required for each step and to increase patient comfort ahead of BgRT clinical implementation.
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Affiliation(s)
- M Surucu
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - L Vitzthum
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA; Department of Radiation Oncology, Michigan Medicine, Ann Arbor, MI
| | - M F Gensheimer
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - N Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - B Han
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - D Pham
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | | | | | - D Aksoy
- RefleXion Medical, Inc., Hayward, CA
| | - K Feghali
- RefleXion Medical, Inc., Hayward, CA
| | | | | | - B Cai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A Pompos
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - T Dan
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - O K Öz
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - P Iyengar
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
| | - R D Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX
| | - A Garant
- University of Texas Southwestern Department of Radiation Oncology, Dallas, TX
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Zhuang T, Gibbard G, Duan X, Tan J, Park Y, Lin MH, Sun Z, Oderinde OM, Lu W, Reynolds R, Godley A, Pompos A, Dan T, Garant A, Iyengar P, Timmerman R, Jiang S, Cai B. Evaluation of fan-beam kilovoltage computed tomography image quality on a novel biological-guided radiotherapy platform. Phys Imaging Radiat Oncol 2023; 26:100438. [PMID: 37342208 PMCID: PMC10277913 DOI: 10.1016/j.phro.2023.100438] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/29/2023] [Accepted: 04/05/2023] [Indexed: 06/22/2023] Open
Abstract
Background and Purpose A recently developed biology-guided radiotherapy platform, equipped with positron emission tomography (PET) and computed tomography (CT), provides both anatomical and functional image guidance for radiotherapy. This study aimed to characterize performance of the kilovoltage CT (kVCT) system on this platform using standard quality metrics measured on phantom and patient images, using CT simulator images as reference. Materials and Methods Image quality metrics, including spatial resolution/modular transfer function (MTF), slice sensitivity profile (SSP), noise performance and image uniformity, contrast-noise ratio (CNR) and low-contrast resolution, geometric accuracy, and CT number (HU) accuracy, were evaluated on phantom images. Patient images were evaluated mainly qualitatively. Results On phantom images the MTF10% is about 0.68 lp/mm for kVCT in PET/CT Linac. The SSP agreed with nominal slice thickness within 0.7 mm. The diameter of the smallest visible target (1% contrast) is about 5 mm using medium dose mode. The image uniformity is within 2.0 HU. The geometric accuracy tests passed within 0.5 mm. Relative to CT simulator images, the noise is generally higher and the CNR is lower in PET/CT Linac kVCT images. The CT number accuracy is comparable between the two systems with maximum deviation from the phantom manufacturer range within 25 HU. On patient images, higher spatial resolution and image noise are observed on PET/CT Linac kVCT images. Conclusions Major image quality metrics of the PET/CT Linac kVCT were within vendor-recommended tolerances. Better spatial resolution but higher noise and better/comparable low contrast visibility were observed as compared to a CT simulator when images were acquired with clinical protocols.
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Affiliation(s)
- Tingliang Zhuang
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Grant Gibbard
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Xinhui Duan
- Department of Radiology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Jun Tan
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Yang Park
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Mu-Han Lin
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Zhihui Sun
- RefleXion Medical, Inc, Hayward, CA, USA
| | | | - Weiguo Lu
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Robert Reynolds
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Andrew Godley
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Arnold Pompos
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Tu Dan
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Aurelie Garant
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Puneeth Iyengar
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Steve Jiang
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
| | - Bin Cai
- Department of Radiation Oncology, University of Texas- Southwestern Medical Center, Dallas, USA
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10
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Lin J, Chen M, Lai Y, Trivedi Z, Wu J, Foo T, Gonzalez Y, Lin M, Reynolds R, Park J, Yan Y, Godley A, Pompos A, Jiang S, Jia X, Lu W. Improving Online Adaptive Radiotherapy Quality Assurance with Streamlined Clinical Workflow through In-House Development. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.2260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Pompos A, Foote RL, Koong AC, Le QT, Mohan R, Paganetti H, Choy H. National Effort to Re-Establish Heavy Ion Cancer Therapy in the United States. Front Oncol 2022; 12:880712. [PMID: 35774126 PMCID: PMC9238353 DOI: 10.3389/fonc.2022.880712] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
In this review, we attempt to make a case for the establishment of a limited number of heavy ion cancer research and treatment facilities in the United States. Based on the basic physics and biology research, conducted largely in Japan and Germany, and early phase clinical trials involving a relatively small number of patients, we believe that heavy ions have a considerably greater potential to enhance the therapeutic ratio for many cancer types compared to conventional X-ray and proton radiotherapy. Moreover, with ongoing technological developments and with research in physical, biological, immunological, and clinical aspects, it is quite plausible that cost effectiveness of radiotherapy with heavier ions can be substantially improved.
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Affiliation(s)
- Arnold Pompos
- Department of Radiation Oncology, University of Texas (UT) Southwestern Medical Center, Dallas, TX, United States
| | - Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Robert L. Foote,
| | - Albert C. Koong
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Quynh Thu Le
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United States
| | - Radhe Mohan
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Harald Paganetti
- Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States
| | - Hak Choy
- Department of Radiation Oncology, University of Texas (UT) Southwestern Medical Center, Dallas, TX, United States
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12
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Ding L, Sishc BJ, Polsdofer E, Yordy JS, Facoetti A, Ciocca M, Saha D, Pompos A, Davis AJ, Story MD. Evaluation of the Response of HNSCC Cell Lines to γ-Rays and 12C Ions: Can Radioresistant Tumors Be Identified and Selected for 12C Ion Radiotherapy? Front Oncol 2022; 12:812961. [PMID: 35280731 PMCID: PMC8914432 DOI: 10.3389/fonc.2022.812961] [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: 11/10/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy worldwide. Thirty percent of patients will experience locoregional recurrence for which median survival is less than 1 year. Factors contributing to treatment failure include inherent resistance to X-rays and chemotherapy, hypoxia, epithelial to mesenchymal transition, and immune suppression. The unique properties of 12C radiotherapy including enhanced cell killing, a decreased oxygen enhancement ratio, generation of complex DNA damage, and the potential to overcome immune suppression make its application well suited to the treatment of HNSCC. We examined the 12C radioresponse of five HNSCC cell lines, whose surviving fraction at 3.5 Gy ranged from average to resistant when compared with a larger panel of 38 cell lines to determine if 12C irradiation can overcome X-ray radioresistance and to identify biomarkers predictive of 12C radioresponse. Cells were irradiated with 12C using a SOBP with an average LET of 80 keV/μm (CNAO: Pavia, Italy). RBE values varied depending upon endpoint used. A 37 gene signature was able to place cells in their respective radiosensitivity cohort with an accuracy of 86%. Radioresistant cells were characterized by an enrichment of genes associated with radioresistance and survival mechanisms including but not limited to G2/M Checkpoint MTORC1, HIF1α, and PI3K/AKT/MTOR signaling. These data were used in conjunction with an in silico-based modeling approach to evaluate tumor control probability after 12C irradiation that compared clinically used treatment schedules with fixed RBE values vs. the RBEs determined for each cell line. Based on the above analysis, we present the framework of a strategy to utilize biological markers to predict which HNSCC patients would benefit the most from 12C radiotherapy.
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Affiliation(s)
- Lianghao Ding
- Univeristy of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX, United States
| | - Brock J Sishc
- Univeristy of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX, United States
| | - Elizabeth Polsdofer
- Univeristy of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX, United States
| | - John S Yordy
- Univeristy of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX, United States
| | - Angelica Facoetti
- Medical Physics Unit & Research Department, Foundazione Centro Nazionale di Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Mario Ciocca
- Medical Physics Unit & Research Department, Foundazione Centro Nazionale di Adroterapia Oncologica (CNAO), Pavia, Italy
| | - Debabrata Saha
- Univeristy of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX, United States
| | - Arnold Pompos
- Univeristy of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX, United States
| | - Anthony J Davis
- Univeristy of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX, United States
| | - Michael D Story
- Univeristy of Texas Southwestern Medical Center, Department of Radiation Oncology, Dallas, TX, United States
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13
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Gonzalez Y, Yang M, Hrycushko B, Medin P, Pompos A, Albuquerque K, Jia X. Time Management Analysis of Physicist Planning for Image Guided Adaptive Brachytherapy (IGABT) for Cervical Cancer. Brachytherapy 2019. [DOI: 10.1016/j.brachy.2019.04.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Durante M, Paganetti H, Pompos A, Kry SF, Wu X, Grosshans DR. Report of a National Cancer Institute special panel: Characterization of the physical parameters of particle beams for biological research. Med Phys 2018; 46:e37-e52. [PMID: 30506898 DOI: 10.1002/mp.13324] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 10/06/2017] [Revised: 10/28/2018] [Accepted: 11/05/2018] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To define the physical parameters needed to characterize a particle beam in order to allow intercomparison of different experiments performed using different ions at the same facility and using the same ion at different facilities. METHODS At the request of the National Cancer Institute (NCI), a special panel was convened to review the current status of the field and to provide suggested metrics for reporting the physical parameters of particle beams to be used for biological research. A set of physical parameters and measurements that should be performed by facilities and understood and reported by researchers supported by NCI to perform pre-clinical radiobiology and medical physics of heavy ions were generated. RESULTS Standard measures such as radiation delivery technique, beam modifiers used, nominal energy, field size, physical dose and dose rate should all be reported. However, more advanced physical measurements, including detailed characterization of beam quality by microdosimetric spectrum and fragmentation spectra, should also be established and reported. Details regarding how such data should be incorporated into Monte Carlo simulations and the proper reporting of simulation details are also discussed. CONCLUSIONS In order to allow for a clear relation of physical parameters to biological effects, facilities and researchers should establish and report detailed physical characteristics of the irradiation beams utilized including both standard and advanced measures. Biological researchers are encouraged to actively engage facility staff and physicists in the design and conduct of experiments. Modeling individual experimental setups will allow for the reporting of the uncertainties in the measurement or calculation of physical parameters which should be routinely reported.
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Affiliation(s)
- Marco Durante
- Biophysics Department, GSI Helmholtzzentrum für Schwerionenforschung and Technische Universität Darmstadt, Institute of Condensed Matter Physics, Planckstraße 1, 64291, Darmstadt, Germany
| | - Harald Paganetti
- Department of Radiation Oncology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, 02114, USA
| | - Arnold Pompos
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Stephen F Kry
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Xiaodong Wu
- Department of Medical Physics, Shanghai Proton and Heavy Ion Center, Shanghai, China
| | - David R Grosshans
- Departments of Radiation and Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77054, USA
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15
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Tan J, Folkert M, Trivedi Z, Pompos A, Wardak Z, Jiang S, Yan Y. A Web-Based Application That Makes Radiation Therapy Plans and Treatment Details Readily Accessible to Multidisciplinary Care Teams. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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16
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Shrestha D, Qin N, Zhang Y, Kalantari F, Niu S, Jia X, Pompos A, Jiang S, Wang J. Iterative reconstruction with boundary detection for carbon ion computed tomography. Phys Med Biol 2018; 63:055002. [PMID: 29384493 DOI: 10.1088/1361-6560/aaac0f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In heavy ion radiation therapy, improving the accuracy in range prediction of the ions inside the patient's body has become essential. Accurate localization of the Bragg peak provides greater conformity of the tumor while sparing healthy tissues. We investigated the use of carbon ions directly for computed tomography (carbon CT) to create the relative stopping power map of a patient's body. The Geant4 toolkit was used to perform a Monte Carlo simulation of the carbon ion trajectories, to study their lateral and angular deflections and the most likely paths, using a water phantom. Geant4 was used to create carbonCT projections of a contrast and spatial resolution phantom, with a cone beam of 430 MeV/u carbon ions. The contrast phantom consisted of cranial bone, lung material, and PMMA inserts while the spatial resolution phantom contained bone and lung material inserts with line pair (lp) densities ranging from 1.67 lp cm-1 through 5 lp cm-1. First, the positions of each carbon ion on the rear and front trackers were used for an approximate reconstruction of the phantom. The phantom boundary was extracted from this approximate reconstruction, by using the position as well as angle information from the four tracking detectors, resulting in the entry and exit locations of the individual ions on the phantom surface. Subsequent reconstruction was performed by the iterative algebraic reconstruction technique coupled with total variation minimization (ART-TV) assuming straight line trajectories for the ions inside the phantom. The influence of number of projections was studied with reconstruction from five different sets of projections: 15, 30, 45, 60 and 90. Additionally, the effect of number of ions on the image quality was investigated by reducing the number of ions/projection while keeping the total number of projections at 60. An estimation of carbon ion range using the carbonCT image resulted in improved range prediction compared to the range calculated using a calibration curve.
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Affiliation(s)
- Deepak Shrestha
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75235, United States of America
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Qin N, Shen C, Tsai MY, Pinto M, Tian Z, Dedes G, Pompos A, Jiang SB, Parodi K, Jia X. Full Monte Carlo-Based Biologic Treatment Plan Optimization System for Intensity Modulated Carbon Ion Therapy on Graphics Processing Unit. Int J Radiat Oncol Biol Phys 2018; 100:235-243. [PMID: 29079118 DOI: 10.1016/j.ijrobp.2017.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/29/2017] [Accepted: 09/01/2017] [Indexed: 01/29/2023]
Abstract
PURPOSE One of the major benefits of carbon ion therapy is enhanced biological effectiveness at the Bragg peak region. For intensity modulated carbon ion therapy (IMCT), it is desirable to use Monte Carlo (MC) methods to compute the properties of each pencil beam spot for treatment planning, because of their accuracy in modeling physics processes and estimating biological effects. We previously developed goCMC, a graphics processing unit (GPU)-oriented MC engine for carbon ion therapy. The purpose of the present study was to build a biological treatment plan optimization system using goCMC. METHODS AND MATERIALS The repair-misrepair-fixation model was implemented to compute the spatial distribution of linear-quadratic model parameters for each spot. A treatment plan optimization module was developed to minimize the difference between the prescribed and actual biological effect. We used a gradient-based algorithm to solve the optimization problem. The system was embedded in the Varian Eclipse treatment planning system under a client-server architecture to achieve a user-friendly planning environment. We tested the system with a 1-dimensional homogeneous water case and 3 3-dimensional patient cases. RESULTS Our system generated treatment plans with biological spread-out Bragg peaks covering the targeted regions and sparing critical structures. Using 4 NVidia GTX 1080 GPUs, the total computation time, including spot simulation, optimization, and final dose calculation, was 0.6 hour for the prostate case (8282 spots), 0.2 hour for the pancreas case (3795 spots), and 0.3 hour for the brain case (6724 spots). The computation time was dominated by MC spot simulation. CONCLUSIONS We built a biological treatment plan optimization system for IMCT that performs simulations using a fast MC engine, goCMC. To the best of our knowledge, this is the first time that full MC-based IMCT inverse planning has been achieved in a clinically viable time frame.
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Affiliation(s)
- Nan Qin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Chenyang Shen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Min-Yu Tsai
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Marco Pinto
- Department of Experimental Physics-Medical Physics, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Zhen Tian
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Georgios Dedes
- Department of Experimental Physics-Medical Physics, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Arnold Pompos
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Steve B Jiang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katia Parodi
- Department of Experimental Physics-Medical Physics, Ludwig-Maximilian University of Munich, Munich, Germany
| | - Xun Jia
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas.
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18
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Qin N, Pinto M, Tian Z, Dedes G, Pompos A, Jiang SB, Parodi K, Jia X. Initial development of goCMC: a GPU-oriented fast cross-platform Monte Carlo engine for carbon ion therapy. Phys Med Biol 2017; 62:3682-3699. [PMID: 28140352 PMCID: PMC5730973 DOI: 10.1088/1361-6560/aa5d43] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Monte Carlo (MC) simulation is considered as the most accurate method for calculation of absorbed dose and fundamental physics quantities related to biological effects in carbon ion therapy. To improve its computational efficiency, we have developed a GPU-oriented fast MC package named goCMC, for carbon therapy. goCMC simulates particle transport in voxelized geometry with kinetic energy up to 450 MeV u-1. Class II condensed history simulation scheme with a continuous slowing down approximation was employed. Energy straggling and multiple scattering were modeled. δ-electrons were terminated with their energy locally deposited. Four types of nuclear interactions were implemented in goCMC, i.e. carbon-hydrogen, carbon-carbon, carbon-oxygen and carbon-calcium inelastic collisions. Total cross section data from Geant4 were used. Secondary particles produced in these interactions were sampled according to particle yield with energy and directional distribution data derived from Geant4 simulation results. Secondary charged particles were transported following the condensed history scheme, whereas secondary neutral particles were ignored. goCMC was developed under OpenCL framework and is executable on different platforms, e.g. GPU and multi-core CPU. We have validated goCMC with Geant4 in cases with different beam energy and phantoms including four homogeneous phantoms, one heterogeneous half-slab phantom, and one patient case. For each case [Formula: see text] carbon ions were simulated, such that in the region with dose greater than 10% of maximum dose, the mean relative statistical uncertainty was less than 1%. Good agreements for dose distributions and range estimations between goCMC and Geant4 were observed. 3D gamma passing rates with 1%/1 mm criterion were over 90% within 10% isodose line except in two extreme cases, and those with 2%/1 mm criterion were all over 96%. Efficiency and code portability were tested with different GPUs and CPUs. Depending on the beam energy and voxel size, the computation time to simulate [Formula: see text] carbons was 9.9-125 s, 2.5-50 s and 60-612 s on an AMD Radeon GPU card, an NVidia GeForce GTX 1080 GPU card and an Intel Xeon E5-2640 CPU, respectively. The combined accuracy, efficiency and portability make goCMC attractive for research and clinical applications in carbon ion therapy.
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Affiliation(s)
- Nan Qin
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75390, United States of America
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19
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Zhou Y, Klages P, Tan J, Chi Y, Stojadinovic S, Yang M, Hrycushko B, Medin P, Pompos A, Jiang S, Albuquerque K, Jia X. Automated high-dose rate brachytherapy treatment planning for a single-channel vaginal cylinder applicator. Phys Med Biol 2017; 62:4361-4374. [DOI: 10.1088/1361-6560/aa637e] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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20
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Affiliation(s)
- Arnold Pompos
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
| | - Marco Durante
- Trento Institute for Fundamental Physics and Applications, National Institute of Nuclear Physics, Department of Physics, University of Trento, Trento, Italy
| | - Hak Choy
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas
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21
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Affiliation(s)
- Michael Story
- University of Texas, Southwestern Medical Center, Dallas
| | - Arnold Pompos
- University of Texas, Southwestern Medical Center, Dallas
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22
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Zhen H, Ouyang L, Bao Q, Qin N, Stojadinovic S, Pompos A. The step-and-shoot IMRT overshooting phenomenon: a novel method to mitigate patient overdosage. J Appl Clin Med Phys 2016; 17:214-222. [PMID: 27455482 PMCID: PMC5690057 DOI: 10.1120/jacmp.v17i4.6101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/05/2015] [Revised: 03/31/2016] [Accepted: 03/02/2016] [Indexed: 11/24/2022] Open
Abstract
The goal of this work is to evaluate the dosimetric impact of an overshooting phenomenon in step‐and‐shoot IMRT delivery, and to demonstrate a novel method to mitigate the issue. Five pelvis IMRT patients treated on Varian 2100C EX linacs with larger than +4.5% phantom ion chamber point‐dose difference relative to planned dose were investigated. For each patient plan, 5 fractions were delivered. DynaLog files were recorded and centi‐MU pulses from dose integrator board for every control point (CP) were counted using a commercial pulse counter. The counter recorded CP MU agrees with DynaLog records, both showing an ~0.6 MU overshoot of the first segment of every beam. The 3D patient dose was recalculated from the counter records and compared to the planned dose, showing that the overshoot resulted in on average 2.05% of PTV D95 error, and 2.49%, 2.61% and 2.45% of D1cc error for rectum, bladder, and bowel, respectively. The initial plans were then modified by inserting a specially designed MLC segment to the start of every beam. The modified plans were also delivered five times. The dose from the modified delivery was calculated using counter recorded CP MU. The corresponding Dx parameters were all within 0.31% from the original plan. IMRT QA results also show a 2.2% improvement in ion chamber point‐dose agreement. The results demonstrate that the proposed plan modification method effectively eliminates the overdosage from the overshooting phenomenon. PACS number(s): 87.55.Qr, 87.55.km
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23
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Le A, Jiang S, Timmerman R, Choy H, Pompos A. SU-G-JeP3-07: Real-Time Image Guided Radiation Therapy for Heterotopic Ossification in Patients After Hip Replacement. Med Phys 2016. [DOI: 10.1118/1.4957072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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24
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Qin N, Pinto M, Tian Z, Dedes G, Pompos A, Jiang S, Parodi K, Jia X. SU-C-BRC-06: OpenCL-Based Cross-Platform Monte Carlo Simulation Package for Carbon Ion Therapy. Med Phys 2016. [DOI: 10.1118/1.4955553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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25
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Tan J, Pompos A, Jiang S, Yan Y. SU-F-T-96: A New Paradigm of Weekly Chart Checking for Radiation Therapy Clinics. Med Phys 2016. [DOI: 10.1118/1.4956232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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26
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Lin M, Pompos A, Gu X, Yan Y, Abdulrahman R, Timmerman R, Jiang S. SU-F-T-598: Robotic Radiosurgery System Versus Pencil Beam Scanning Proton Therapy for Definitive Intracranial Treatments. Med Phys 2016. [DOI: 10.1118/1.4956783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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27
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Pompos A, Le A, Timmerman R, Jiang S, Choy H. EP-1458: CBCT-Based On-site Simulation, Planning, and Delivery (OSPD) for whole brain radiotherapy. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32708-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Laine A, Pompos A, Story M, Jiang S, Timmerman R, Choy H. International Symposium on Ion Therapy: Planning the First Hospital-Based Heavy Ion Therapy Center in the United States. Int J Part Ther 2016; 2:468-471. [PMID: 27110586 DOI: 10.14338/ijpt-15-00028.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/21/2022] Open
Abstract
Investigation into the use of heavy ions for therapeutic purposes was initially pioneered at Lawrence Berkeley National Laboratory in the 1970s [1, 2]. More recently, however, significant advances in determining the safety and efficacy of using heavy ions in the hospital setting have been reported in Japan and Germany [3, 4]. These promising results have helped to resurrect interest in the establishment of hospital-based heavy ion therapy in the United States. In line with these efforts, world experts in the field of heavy ion therapy were invited to attend the first annual International Symposium on Ion Therapy, which was held at the University of Texas Southwestern Medical Center, Dallas, Texas, from November 12 to 14, 2014. A brief overview of the results and discussions that took place during the symposium are presented in this article.
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Affiliation(s)
- Aaron Laine
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Arnold Pompos
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael Story
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Steve Jiang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hak Choy
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Laine AM, Pompos A, Timmerman R, Jiang S, Story MD, Pistenmaa D, Choy H. The Role of Hypofractionated Radiation Therapy with Photons, Protons, and Heavy Ions for Treating Extracranial Lesions. Front Oncol 2016; 5:302. [PMID: 26793619 PMCID: PMC4707221 DOI: 10.3389/fonc.2015.00302] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/14/2015] [Indexed: 12/14/2022] Open
Abstract
Traditionally, the ability to deliver large doses of ionizing radiation to a tumor has been limited by radiation-induced toxicity to normal surrounding tissues. This was the initial impetus for the development of conventionally fractionated radiation therapy, where large volumes of healthy tissue received radiation and were allowed the time to repair the radiation damage. However, advances in radiation delivery techniques and image guidance have allowed for more ablative doses of radiation to be delivered in a very accurate, conformal, and safe manner with shortened fractionation schemes. Hypofractionated regimens with photons have already transformed how certain tumor types are treated with radiation therapy. Additionally, hypofractionation is able to deliver a complete course of ablative radiation therapy over a shorter period of time compared to conventional fractionation regimens making treatment more convenient to the patient and potentially more cost-effective. Recently, there has been an increased interest in proton therapy because of the potential further improvement in dose distributions achievable due to their unique physical characteristics. Furthermore, with heavier ions the dose conformality is increased and, in addition, there is potentially a higher biological effectiveness compared to protons and photons. Due to the properties mentioned above, charged particle therapy has already become an attractive modality to further investigate the role of hypofractionation in the treatment of various tumors. This review will discuss the rationale and evolution of hypofractionated radiation therapy, the reported clinical success with initially photon and then charged particle modalities, and further potential implementation into treatment regimens going forward.
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Affiliation(s)
- Aaron Michael Laine
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Arnold Pompos
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Steve Jiang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Michael D Story
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - David Pistenmaa
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
| | - Hak Choy
- Department of Radiation Oncology, University of Texas Southwestern Medical Center , Dallas, TX , USA
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30
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Qin N, Pinto M, Tian Z, Dedes G, Pompos A, Jiang S, Parodi K, Jia X. SU-E-T-499: Initial Developments of An OpenCL-Based Cross-Platform Monte Carlo Dose Engine for Carbon Ion Therapy. Med Phys 2015. [DOI: 10.1118/1.4924861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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31
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Le A, Choe K, Jiang S, Timmerman R, Choy H, Pompos A. TU-AB-303-03: CBCT-Based On-Site Simulation, Planning, and Delivery (OSPD) for Whole Brain Radiotherapy. Med Phys 2015. [DOI: 10.1118/1.4925520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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32
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Pompos A, Choy H, Jia X, Jiang S, Timmerman R. SU-E-T-539: Maximum Energy of Helium and Carbon Ions Clinically Needed for Spine, Lung, Prostate and Pancreas Cancer. Med Phys 2015. [DOI: 10.1118/1.4924901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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33
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Qin N, Giantsoudi D, Tian Z, Schuemann J, Pompos A, Paganetti H, Jiang S, Jia X. SU-E-T-673: Recent Developments and Comprehensive Validations of a GPU-Based Proton Monte Carlo Simulation Package, GPMC. Med Phys 2015. [DOI: 10.1118/1.4925036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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34
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Medin P, Pompos A, Britton L, Foster R. SU-E-P-01: Adaptation of Commercial, Web-Based, Medical Residency Management Software (MedHub, Inc.) for a Medium-Sized Medical Physics Residency Program. Med Phys 2015. [DOI: 10.1118/1.4923937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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35
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Tan J, Shi F, Hrycushko B, Medin P, Stojadinovic S, Pompos A, Yang M, Albuquerque K, Jia X. TU-AB-201-02: An Automated Treatment Plan Quality Assurance Program for Tandem and Ovoid High Dose-Rate Brachytherapy. Med Phys 2015. [DOI: 10.1118/1.4925540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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36
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37
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Tan J, Yan Y, Hager F, Gu X, Jia X, Pompos A, Foster R, Stojadinovic S, Yang M, Hrycushko B, Folkerts M, Zhao B, Medin P, Ding C, Jiang S. SU-D-BRD-02: Auto Weekly - An Automated Online Weekly Chart Check System for Medical Physics. Med Phys 2015. [DOI: 10.1118/1.4923868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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38
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Shi F, Hrycushko B, Tan J, Medin P, Stojadinovic S, Pompos A, Yang M, Albuquerque K, Jia X. An Automated Treatment Plan Quality Assurance Program for Tandem and Ovoid High Dose-Rate Brachytherapy. Brachytherapy 2015. [DOI: 10.1016/j.brachy.2015.02.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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39
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Xu Y, Bai T, Yan H, Ouyang L, Pompos A, Wang J, Zhou L, Jiang SB, Jia X. A practical cone-beam CT scatter correction method with optimized Monte Carlo simulations for image-guided radiation therapy. Phys Med Biol 2015; 60:3567-87. [PMID: 25860299 DOI: 10.1088/0031-9155/60/9/3567] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cone-beam CT (CBCT) has become the standard image guidance tool for patient setup in image-guided radiation therapy. However, due to its large illumination field, scattered photons severely degrade its image quality. While kernel-based scatter correction methods have been used routinely in the clinic, it is still desirable to develop Monte Carlo (MC) simulation-based methods due to their accuracy. However, the high computational burden of the MC method has prevented routine clinical application. This paper reports our recent development of a practical method of MC-based scatter estimation and removal for CBCT. In contrast with conventional MC approaches that estimate scatter signals using a scatter-contaminated CBCT image, our method used a planning CT image for MC simulation, which has the advantages of accurate image intensity and absence of image truncation. In our method, the planning CT was first rigidly registered with the CBCT. Scatter signals were then estimated via MC simulation. After scatter signals were removed from the raw CBCT projections, a corrected CBCT image was reconstructed. The entire workflow was implemented on a GPU platform for high computational efficiency. Strategies such as projection denoising, CT image downsampling, and interpolation along the angular direction were employed to further enhance the calculation speed. We studied the impact of key parameters in the workflow on the resulting accuracy and efficiency, based on which the optimal parameter values were determined. Our method was evaluated in numerical simulation, phantom, and real patient cases. In the simulation cases, our method reduced mean HU errors from 44 to 3 HU and from 78 to 9 HU in the full-fan and the half-fan cases, respectively. In both the phantom and the patient cases, image artifacts caused by scatter, such as ring artifacts around the bowtie area, were reduced. With all the techniques employed, we achieved computation time of less than 30 s including the time for both the scatter estimation and CBCT reconstruction steps. The efficacy of our method and its high computational efficiency make our method attractive for clinical use.
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Affiliation(s)
- Yuan Xu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX 75235, USA. Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong 510515, People's Republic of China
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40
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Reynolds R, Pompos A, Gu X, Jiang S, Stojadinovic S. Initial Experience With VMAT Plan and Delivery Verification Using a DICOM-RT Framework and Linac Delivery Log Files. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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41
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Xu Y, Bai T, Yan H, Ouyang L, Wang J, Pompos A, Zhou L, Jiang S, Jia X. TH-A-18C-04: Ultrafast Cone-Beam CT Scatter Correction with GPU-Based Monte Carlo Simulation. Med Phys 2014. [DOI: 10.1118/1.4889563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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42
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Reynolds R, Pompos A, Gu X, Jiang S, Stojadinovic S. SU-E-T-213: Initial Experience with VMAT Plan and Delivery Verification Using a DICOM-RT Framework and Linac Delivery Log Files. Med Phys 2014. [DOI: 10.1118/1.4888543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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43
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Chen H, Zhen X, Zhong Z, Pompos A, Yan H, Zhou L, Jiang S, Gu X. SU-F-BRF-09: A Non-Rigid Point Matching Method for Accurate Bladder Dose Summation in Cervical Cancer HDR Brachytherapy. Med Phys 2014. [DOI: 10.1118/1.4889079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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44
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Xu Y, Bai T, Yan H, Ouyang L, Wang J, Pompos A, Zhou L, Jiang S, Jia X. Ultrafast cone-beam CT scatter correction with GPU-based Monte Carlo simulation. Int J Cancer Ther Oncol 2014. [DOI: 10.14319/ijcto.0202.45] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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45
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Reynolds R, Stojadinovic S, Pompos A, Gu X, Foster R, Solberg T. SU-E-T-575: Independent Verification of VMAT Treatment Plans Using a DICOM-RT Framework. Med Phys 2013. [DOI: 10.1118/1.4815003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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46
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Gu X, Pompos A, Zhong Z, Wang J, Guo X, Jia X, Dong B, Jiang S, Solberg T. SU-E-J-81: A Contour-Guided Deformable Image Registration Scheme for Organ Surface Deformation. Med Phys 2013. [DOI: 10.1118/1.4814293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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47
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Pompos A, Zhen H, Ouyang L, Bao Q, Stojadinovic S. SU-E-T-381: The Step-And-Shoot IMRT Overshooting Phenomena: A Novel Method to Mitigate Patient Overdosage. Med Phys 2013. [DOI: 10.1118/1.4814815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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48
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Zhen H, Hrycushko B, Pompos A, Foster R, Yan Y, Stojadinovic S, Solberg T, Gu X. SU-E-T-556: Verification and Evaluation of Acuros XB Dose Calculations for Stereotactic Ablative Radiotherapy of the Thoracic Spine. Med Phys 2013. [DOI: 10.1118/1.4814985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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49
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Tumati V, Dubas J, Pompos A, Abdulrahman R, Timmerman R, Albuquerque K. Stereotactic Body Radiation Therapy (SBRT) Can Be Dosimetrically Equivalent to High-dose Brachytherapy as a Boost for Locally Advanced Cervical Cancer— A New Clinical Trial Concept. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.1134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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50
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Stojadinovic S, Ouyang L, Bao Q, Pompos A, Gu X, Solberg T. Gamma Analysis of Normalized and Un-normalized Dose Distributions. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.2157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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