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Cao H, Zheng T, Jin Z. Validation for the effect of intra-exposure patient motion on the assessment of radiostereometric implant migration in a tibial component phantom study. Orthop Traumatol Surg Res 2024; 110:103776. [PMID: 38016580 DOI: 10.1016/j.otsr.2023.103776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND An increasing number of radiostereometry (RSA) research studies have long-term follow-up implant migration outcomes, which show ascending curves of implant migration with occasionally decreasing migration. After scrutinizing images and RSA scenes related to the alternating curves, we suppose that intra-exposure patient motion may contribute to that. The main purposes of this in vitro study were 1) to identify whether the patient motion in different directions could result in the inaccurate assessment of implant migration, and 2) to figure out which direction(s) accounted for the alternating curves. HYPOTHESIS It was hypothesized that the assessments of implant migration would be less precise and accurate than they could be when patient motion occurred, and such motion would contribute to the alternating curves of radiostereometric implant migration. MATERIALS AND METHODS A customized phantom, assembled with a tibial component, was designed for simulating intra-exposure patient motion during follow-up RSA examinations. Two different Roentgen tubes were used as the current standard of radiology departments. Radiographs were acquired in a uniplanar technical arrangement. Two defined protocols were conducted: one is to simulate implant migration outcomes at post-op, the early stage (6months), and the later stage (2 to 10years) ; during the later stage, the other is to mimic patient motion by phantom motion in the medial-lateral (x), distal-proximal (y), and anterior-posterior (z) axes. RESULTS Phantom motion could result in the inaccurate assessment of implant migration, and translations along the medial-lateral (x) axis were the most influenced by patient motion. Motion along the medial-lateral (x) axis could account for the curves with decreasing migration. DISCUSSION Our assessments of implant migration may be less precise and accurate than they could be when intra-exposure patient motion occurs. We probably neglect the importance of 100% simultaneous exposures, and the influence of patient motion on RSA accuracy and data reliability, due to the difficulty in detecting patient (micro)motion. Electronically synchronized exposures of two paired Roentgen tubes are 100% simultaneous for image acquisition, and they are thus highly recommended for the assessment of implant migration in RSA. TYPE OF STUDY AND LEVEL OF PROOF not applicable.
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Affiliation(s)
- Han Cao
- Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany; Department of Orthopaedic Surgery, Taizhou Second People's Hospital, 225599 Taizhou, PR China.
| | - Tiansheng Zheng
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Gannan Medical University, 341000 Ganzhou, PR China
| | - Zhengshuai Jin
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanjing Medical University, 210029 Nanjing, PR China; Department of Orthopaedic Surgery, Jiangsu Shengze Hospital, 215228 Suzhou, PR China
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van Prooijen M, Chau L, Tsui G, Kelly V, Holwell M, Tadic T, Tsang DS, Krema H, Laperriere N. Simple and effective immobilization for radiation treatment of choroidal melanoma. Med Dosim 2023:S0958-3947(23)00023-7. [PMID: 37120386 DOI: 10.1016/j.meddos.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/03/2023] [Accepted: 03/11/2023] [Indexed: 05/01/2023]
Abstract
At our institution, patients diagnosed with choroidal melanoma requiring external beam radiation therapy are treated with two 6 MV volumetric-modulated arcs delivering 50 Gy over 5 daily fractions. The patient is immobilized using an Orfit head and neck mask and is directed to look at a light emitting diode (LED) during CT simulation and treatment to minimize eye movement. Patient positioning is checked with cone beam computed tomography (CBCT) daily. Translational and rotational displacements greater than 1 mm or 1° off the planned isocenter position are corrected using a Hexapod couch. The aim of this study is to verify that the mask system provides adequate immobilization and to verify our 2-mm planning target volume (PTV) margins are sufficient. Residual displacements provided by pretreatment verification and post-treatment CBCT data sets were used to assess the impact of patient mobility during treatment on the reconstructed delivered dose to the target and organs at risk. The PTV margin calculated using van Herk's method1 was used to assess patient motion plus other factors that affect treatment position, such as kV-MV isocenter coincidence. Patient position variations were small and were shown to not cause significant dose variations between the planned and reconstructed dose to the target and organs at risk. The PTV margin analysis showed patient translational motion alone required a PTV margin of 1 mm. Given other factors that affect treatment delivery accuracy, a 2-mm PTV margin was shown to be sufficient for treatment of 95% of our patients with 100% of dose delivered to the GTV. The mask immobilization with LED focus is robust and we showed a 2-mm PTV margin is adequate with this technique.
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Affiliation(s)
- Monique van Prooijen
- Department of Medical Physics, Princess Margaret Cancer Centre, Toronto, ON, M5G 1Z5, Canada.
| | - Lily Chau
- Department of Radiation Therapy, Princess Margaret Cancer Centre, Toronto, ON, M5G 2M9, Canada
| | - Grace Tsui
- Department of Radiation Therapy, Princess Margaret Cancer Centre, Toronto, ON, M5G 2M9, Canada
| | - Valerie Kelly
- Department of Radiation Therapy, Princess Margaret Cancer Centre, Toronto, ON, M5G 2M9, Canada
| | - Michael Holwell
- Department of Radiation Therapy, Princess Margaret Cancer Centre, Toronto, ON, M5G 2M9, Canada
| | - Tony Tadic
- Department of Medical Physics, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, M5G 1Z5, Canada; Department of Radiation Oncology, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, M5G 1Z5, Canada
| | - Derek S Tsang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, M5G 1Z5, Canada
| | - Hatem Krema
- Department of Ocular Oncology, Princess Margaret Cancer Centre/ UHN, University of Toronto, Toronto, ON, M5G 2M9, Canada
| | - Normand Laperriere
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, M5G 1Z5, Canada
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Lyra V, Kallergi M, Rizos E, Lamprakopoulos G, Chatziioannou SN. The effect of patient anxiety and depression on motion during myocardial perfusion SPECT imaging. BMC Med Imaging 2016; 16:49. [PMID: 27550022 PMCID: PMC4994279 DOI: 10.1186/s12880-016-0153-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 02/01/2016] [Accepted: 08/09/2016] [Indexed: 11/19/2022] Open
Abstract
Background Patient motion during myocardial perfusion SPECT imaging (MPI) may be triggered by a patient’s physical and/or psychological discomfort. The aim of this study was to investigate the impact of state anxiety (patient’s reaction to exam-related stress), trait anxiety (patient’s personality characteristic) and depression on patient motion during MPI. Methods All patients that underwent MPI in our department in a six-month period were prospectively enrolled. One hundred eighty-three patients (45 females; 138 males) filled in the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI), along with a short questionnaire regarding their age, height and weight, level of education in years, occupation, and marital status. Cardiovascular and other co-morbidity factors were also evaluated. Through inspection of raw data on cinematic display, the presence or absence of patient motion was registered and classified into mild, moderate and severe, for both phases involved in image acquisition. Results The correlation of patient motion in the stress and delay phases of MPI and each of the other variables was investigated and the corresponding Pearson’s coefficients of association were calculated. The anxiety-motion (r = 0.43, P < 0.0001) and depression-motion (r = 0.32, P < 0.0001) correlation results were moderately strong and statistically significant for the female but not the male patients. All the other variables did not demonstrate any association with motion in MPI, except a weak correlation between age and motion in females (r = 0.23, P < 0.001). Conclusions The relationship between anxiety-motion and depression-motion identified in female patients represents the first supporting evidence of psychological discomfort as predisposing factor for patient motion during MPI.
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Affiliation(s)
- Vassiliki Lyra
- 2nd Department of Radiology, Nuclear Medicine Section, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini St., Athens, 12462, Greece.
| | - Maria Kallergi
- Department of Medical Instruments Technology, Technological Educational Institution of Athens, TEI, 28 Ag. Spiridona St., Athens, 12210, Greece
| | - Emmanouil Rizos
- 2nd Department of Psychiatry, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini St., Athens, 12462, Greece
| | - Georgios Lamprakopoulos
- 2nd Department of Radiology, Nuclear Medicine Section, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini St., Athens, 12462, Greece
| | - Sofia N Chatziioannou
- 2nd Department of Radiology, Nuclear Medicine Section, National and Kapodistrian University of Athens, Attikon Hospital, 1 Rimini St., Athens, 12462, Greece.,Nuclear Medicine Section, Biomedical Research Foundation Academy of Athens, BRFAA, 4 Soranou Efesiou St., Athens, 11527, Greece
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Mansor S, Boellaard R, Huisman MC, van Berckel BNM, Schuit RC, Windhorst AD, Lammertsma AA, van Velden FHP. Impact of New Scatter Correction Strategies on High-Resolution Research Tomograph Brain PET Studies. Mol Imaging Biol 2016; 18:627-35. [PMID: 26728160 PMCID: PMC4927607 DOI: 10.1007/s11307-015-0921-x] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study is to evaluate the impact of different scatter correction strategies on quantification of high-resolution research tomograph (HRRT) data for three tracers covering a wide range in kinetic profiles. PROCEDURES Healthy subjects received dynamic HRRT scans using either (R)-[(11)C]verapamil (n = 5), [(11)C]raclopride (n = 5) or [(11)C]flumazenil (n = 5). To reduce the effects of patient motion on scatter scaling factors, a margin in the attenuation correction factor (ACF) sinogram was applied prior to 2D or 3D single scatter simulation (SSS). RESULTS Some (R)-[(11)C]verapamil studies showed prominent artefacts that disappeared with an ACF-margin of 10 mm or more. Use of 3D SSS for (R)-[(11)C]verapamil showed a statistically significant increase in volume of distribution compared with 2D SSS (p < 0.05), but not for [(11)C]raclopride and [(11)C]flumazenil studies (p > 0.05). CONCLUSIONS When there is a patient motion-induced mismatch between transmission and emission scans, applying an ACF-margin resulted in more reliable scatter scaling factors but did not change (and/or deteriorate) quantification.
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Affiliation(s)
- Syahir Mansor
- Department of Radiology and Nuclear Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
- Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, Groningen, The Netherlands.
| | - Marc C Huisman
- Department of Radiology and Nuclear Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Robert C Schuit
- Department of Radiology and Nuclear Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Albert D Windhorst
- Department of Radiology and Nuclear Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Floris H P van Velden
- Department of Radiology and Nuclear Medicine, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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