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Kim T, Laugeman E, Kiser K, Schiff J, Marasini S, Price A, Gach HM, Knutson N, Samson P, Robinson C, Hatscher C, Henke L. Feasibility of surface-guidance combined with CBCT for intra-fractional breath-hold motion management during Ethos RT. J Appl Clin Med Phys 2024; 25:e14242. [PMID: 38178622 PMCID: PMC11005966 DOI: 10.1002/acm2.14242] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/08/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE High-quality CBCT and AI-enhanced adaptive planning techniques allow CBCT-guided stereotactic adaptive radiotherapy (CT-STAR) to account for inter-fractional anatomic changes. Studies of intra-fractional respiratory motion management with a surface imaging solution for CT-STAR have not been fully conducted. We investigated intra-fractional motion management in breath-hold Ethos-based CT-STAR and CT-SBRT (stereotactic body non-adaptive radiotherapy) using optical surface imaging combined with onboard CBCTs. METHODS Ten cancer patients with mobile lower lung or upper abdominal malignancies participated in an IRB-approved clinical trial (Phase I) of optical surface image-guided Ethos CT-STAR/SBRT. In the clinical trial, a pre-configured gating window (± 2 mm in AP direction) on optical surface imaging was used for manually triggering intra-fractional CBCT acquisition and treatment beam irradiation during breath-hold (seven patients for the end of exhalation and three patients for the end of inhalation). Two inter-fractional CBCTs at the ends of exhalation and inhalation in each fraction were acquired to verify the primary direction and range of the tumor/imaging-surrogate (donut-shaped fiducial) motion. Intra-fractional CBCTs were used to quantify the residual motion of the tumor/imaging-surrogate within the pre-configured breath-hold window in the AP direction. Fifty fractions of Ethos RT were delivered under surface image-guidance: Thirty-two fractions with CT-STAR (adaptive RT) and 18 fractions with CT-SBRT (non-adaptive RT). The residual motion of the tumor was quantified by determining variations in the tumor centroid position. The dosimetric impact on target coverage was calculated based on the residual motion. RESULTS We used 46 fractions for the analysis of intra-fractional residual motion and 43 fractions for the inter-fractional motion analysis due to study constraints. Using the image registration method, 43 pairs of inter-fractional CBCTs and 100 intra-fractional CBCTs attached to dose maps were analyzed. In the motion range study (image registration) from the inter-fractional CBCTs, the primary motion (mean ± std) was 16.6 ± 9.2 mm in the SI direction (magnitude: 26.4 ± 11.3 mm) for the tumors and 15.5 ± 7.3 mm in the AP direction (magnitude: 20.4 ± 7.0 mm) for the imaging-surrogate, respectively. The residual motion of the tumor (image registration) from intra-fractional breath-hold CBCTs was 2.2 ± 2.0 mm for SI, 1.4 ± 1.4 mm for RL, and 1.3 ± 1.3 mm for AP directions (magnitude: 3.5 ± 2.1 mm). The ratio of the actual dose coverage to 99%, 90%, and 50% of the target volume decreased by 0.95 ± 0.11, 0.96 ± 0.10, 0.99 ± 0.05, respectively. The mean percentage of the target volume covered by the prescribed dose decreased by 2.8 ± 4.4%. CONCLUSION We demonstrated the intra-fractional motion-managed treatment strategy in breath-hold Ethos CT-STAR/SBRT using optical surface imaging and CBCT. While the controlled residual tumor motion measured at 3.5 mm exceeded the predetermined setup value of 2 mm, it is important to note that this motion still fell within the clinically acceptable range defined by the PTV margin of 5 mm. Nonetheless, additional caution is needed with intra-fractional motion management in breath-hold Ethos CT-STAR/SBRT using optical surface imaging and CBCT.
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Affiliation(s)
- Taeho Kim
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Eric Laugeman
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Kendall Kiser
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Joshua Schiff
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Shanti Marasini
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Alex Price
- Radiation OncologyWashington University School of MedicineWashingtonUSA
- Radiation OncologyUniversity HospitalsCase Western Reserve University
| | - H Michael Gach
- Radiation OncologyWashington University School of MedicineWashingtonUSA
- Radiology and Biomedical EngineeringWashington University School of MedicineWashingtonUSA
| | - Nels Knutson
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Pamela Samson
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Clifford Robinson
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Casey Hatscher
- Radiation OncologyWashington University School of MedicineWashingtonUSA
| | - Lauren Henke
- Radiation OncologyWashington University School of MedicineWashingtonUSA
- Radiation OncologyUniversity HospitalsCase Western Reserve University
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Chen S, Eldeniz C, Fraum TJ, Ludwig DR, Gan W, Liu J, Kamilov US, Yang D, Gach HM, An H. Respiratory motion management using a single rapid MRI scan for a 0.35 T MRI-Linac system. Med Phys 2023; 50:6163-6176. [PMID: 37184305 DOI: 10.1002/mp.16469] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND MRI has a rapidly growing role in radiation therapy (RT) for treatment planning, real-time image guidance, and beam gating (e.g., MRI-Linac). Free-breathing 4D-MRI is desirable in respiratory motion management for therapy. Moreover, high-quality 3D-MRIs without motion artifacts are needed to delineate lesions. Existing MRI methods require multiple scans with lengthy acquisition times or are limited by low spatial resolution, contrast, and signal-to-noise ratio. PURPOSE We developed a novel method to obtain motion-resolved 4D-MRIs and motion-integrated 3D-MRI reconstruction using a single rapid (35-45 s scan on a 0.35 T MRI-Linac. METHODS Golden-angle radial stack-of-stars MRI scans were acquired from a respiratory motion phantom and 12 healthy volunteers (n = 12) on a 0.35 T MRI-Linac. A self-navigated method was employed to detect respiratory motion using 2000 (acquisition time = 5-7 min) and the first 200 spokes (acquisition time = 35-45 s). Multi-coil non-uniform fast Fourier transform (MCNUFFT), compressed sensing (CS), and deep-learning Phase2Phase (P2P) methods were employed to reconstruct motion-resolved 4D-MRI using 2000 spokes (MCNUFFT2000) and 200 spokes (CS200 and P2P200). Deformable motion vector fields (MVFs) were computed from the 4D-MRIs and used to reconstruct motion-corrected 3D-MRIs with the MOtion Transformation Integrated forward-Fourier (MOTIF) method. Image quality was evaluated quantitatively using the structural similarity index measure (SSIM) and the root mean square error (RMSE), and qualitatively in a blinded radiological review. RESULTS Evaluation using the respiratory motion phantom experiment showed that the proposed method reversed the effects of motion blurring and restored edge sharpness. In the human study, P2P200 had smaller inaccuracy in MVFs estimation than CS200. P2P200 had significantly greater SSIMs (p < 0.0001) and smaller RMSEs (p < 0.001) than CS200 in motion-resolved 4D-MRI and motion-corrected 3D-MRI. The radiological review found that MOTIF 3D-MRIs using MCNUFFT2000 exhibited the highest image quality (scoring > 8 out of 10), followed by P2P200 (scoring > 5 out of 10), and then motion-uncorrected (scoring < 3 out of 10) in sharpness, contrast, and artifact-freeness. CONCLUSIONS We have successfully demonstrated a method for respiratory motion management for MRI-guided RT. The method integrated self-navigated respiratory motion detection, deep-learning P2P 4D-MRI reconstruction, and a motion integrated reconstruction (MOTIF) for 3D-MRI using a single rapid MRI scan (35-45 s) on a 0.35 T MRI-Linac system.
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Affiliation(s)
- Sihao Chen
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Cihat Eldeniz
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Weijie Gan
- Department of Computer Science & Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jiaming Liu
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ulugbek S Kamilov
- Department of Computer Science & Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Deshan Yang
- Department of Radiation Oncology, Duke University, Durham, North Carolina, USA
| | - H Michael Gach
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Hongyu An
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Electrical & Systems Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, USA
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Zhou D, Nakamura M, Mukumoto N, Matsuo Y, Mizowaki T. Feasibility study of deep learning-based markerless real-time lung tumor tracking with orthogonal X-ray projection images. J Appl Clin Med Phys 2022; 24:e13894. [PMID: 36576920 PMCID: PMC10113683 DOI: 10.1002/acm2.13894] [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: 07/30/2022] [Revised: 10/02/2022] [Accepted: 12/20/2022] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The feasibility of a deep learning-based markerless real-time tumor tracking (RTTT) method was retrospectively studied with orthogonal kV X-ray images and clinical tracking records acquired during lung cancer treatment. METHODS Ten patients with lung cancer treated with marker-implanted RTTT were included. The prescription dose was 50 Gy in four fractions, using seven- to nine-port non-coplanar static beams. This corresponds to 14-18 X-ray tube angles for an orthogonal X-ray imaging system rotating with the gantry. All patients underwent 10 respiratory phases four-dimensional computed tomography. After a data augmentation approach, for each X-ray tube angle of a patient, 2250 digitally reconstructed radiograph (DRR) images with gross tumor volume (GTV) contour labeled were obtained. These images were adopted to train the patient and X-ray tube angle-specific GTV contour prediction model. During the testing, the model trained with DRR images predicted GTV contour on X-ray projection images acquired during treatment. The predicted three-dimensional (3D) positions of the GTV were calculated based on the centroids of the contours in the orthogonal images. The 3D positions of GTV determined by the marker-implanted RTTT during the treatment were considered as the ground truth. The 3D deviations between the prediction and the ground truth were calculated to evaluate the performance of the model. RESULTS The median GTV volume and motion range were 7.42 (range, 1.18-25.74) cm3 and 22 (range, 11-28) mm, respectively. In total, 8993 3D position comparisons were included. The mean calculation time was 85 ms per image. The overall median value of the 3D deviation was 2.27 (interquartile range: 1.66-2.95) mm. The probability of the 3D deviation smaller than 5 mm was 93.6%. CONCLUSIONS The evaluation results and calculation efficiency show the proposed deep learning-based markerless RTTT method may be feasible for patients with lung cancer.
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Affiliation(s)
- Dejun Zhou
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Mitsuhiro Nakamura
- Department of Advanced Medical Physics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nobutaka Mukumoto
- Department of Radiation Oncology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Ball HJ, Santanam L, Senan S, Tanyi JA, van Herk M, Keall PJ. Results from the AAPM Task Group 324 respiratory motion management in radiation oncology survey. J Appl Clin Med Phys 2022; 23:e13810. [PMID: 36316761 PMCID: PMC9680579 DOI: 10.1002/acm2.13810] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 08/12/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To quantify the clinical practice of respiratory motion management in radiation oncology. METHODS A respiratory motion management survey was designed and conducted based on clinician survey guidelines. The survey was administered to American Association of Physicists in Medicine (AAPM) members on 17 August 2020 and closed on 13 September 2020. RESULTS A total of 527 respondents completed the entire survey and 651 respondents completed part of the survey, with the partially completed surveys included in the analysis. Overall, 84% of survey respondents used deep inspiration breath hold for left-sided breast cancer. Overall, 83% of respondents perceived respiratory motion management for thoracic and abdominal cancer radiotherapy patients to be either very important or required. Overall, 95% of respondents used respiratory motion management for thoracic and abdominal sites, with 36% of respondents using respiratory motion management for at least 90% of thoracic and abdominal patients. The majority (60%) of respondents used the internal target volume method to treat thoracic and abdominal cancer patients, with 25% using breath hold or abdominal compression and 13% using gating or tracking. CONCLUSIONS A respiratory motion management survey has been completed by AAPM members. Respiratory motion management is generally considered very important or required and is widely used for breast, thoracic, and abdominal cancer treatments.
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Affiliation(s)
- Helen J. Ball
- ACRF Image X InstituteFaculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Lakshmi Santanam
- Medical Physics DepartmentMemorial Sloan‐Kettering Cancer CenterNew YorkNew YorkUSA
| | - Suresh Senan
- Amsterdam University Medical Centers – VUmc LocationAmsterdamThe Netherlands
| | - James A. Tanyi
- Department of Radiation OncologyGeisinger Cancer InstituteDanvillePennsylvaniaUSA
| | - Marcel van Herk
- Department of Radiotherapy Related Research, Division of Cancer Sciences, Faculty of MedicineBiology and HealthSchool of Medical SciencesThe University of ManchesterManchesterUK
| | - Paul J. Keall
- ACRF Image X InstituteFaculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
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Kim T, Ji Z, Lewis B, Laugeman E, Price A, Hao Y, Hugo G, Knutson N, Cai B, Kim H, Henke L. Visually guided respiratory motion management for Ethos adaptive radiotherapy. J Appl Clin Med Phys 2021; 23:e13441. [PMID: 34697865 PMCID: PMC8803298 DOI: 10.1002/acm2.13441] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/22/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose Ethos adaptive radiotherapy (ART) is emerging with AI‐enhanced adaptive planning and high‐quality cone‐beam computed tomography (CBCT). Although a respiratory motion management solution is critical for reducing motion artifacts on abdominothoracic CBCT and improving tumor motion control during beam delivery, our institutional Ethos system has not incorporated a commercial solution. Here we developed an institutional visually guided respiratory motion management system to coach patients in regular breathing or breath hold during intrafractional CBCT scans and beam delivery with Ethos ART. Methods The institutional visual‐guidance respiratory motion management system has three components: (1) a respiratory motion detection system, (2) an in‐room display system, and (3) a respiratory motion trace management software. Each component has been developed and implemented in the clinical Ethos ART workflow. The applicability of the solution was demonstrated in installation, routine QA, and clinical workflow. Results An air pressure sensor has been utilized to detect patient respiratory motion in real time. Either a commercial or in‐house software handled respiratory motion trace display, collection and visualization for operators, and visual guidance for patients. An extended screen and a projector on an adjustable stand were installed as the in‐room visual guidance solution for the closed‐bore ring gantry medical linear accelerator utilized by Ethos. Consistent respiratory motion traces and organ positions on intrafractional CBCTs demonstrated the clinical suitability of the proposed solution in Ethos ART. Conclusion The study demonstrated the utilization of an institutional visually guided respiratory motion management system for Ethos ART. The proposed solution can be easily applied for Ethos ART and adapted for use with any closed bore‐type system, such as computed tomography and magnetic resonance imaging, through incorporation with appropriate respiratory motion sensors.
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Affiliation(s)
- Taeho Kim
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Zhen Ji
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Benjamin Lewis
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Eric Laugeman
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Alex Price
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Yao Hao
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Geoffrey Hugo
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Nels Knutson
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Bin Cai
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA.,Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Hyun Kim
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Lauren Henke
- Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri, USA
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Koiwai K, Endo Y, Mizuhata K, Ina H, Fukazawa A, Ozawa T, Fujinaga Y. Ten-Year Experience of Stereotactic Body Radiotherapy at a Single Institution: Impact of Technological Development on the Outcome of Patients With Early Lung Cancer. Technol Cancer Res Treat 2020; 19:1533033820979163. [PMID: 33267715 PMCID: PMC7720300 DOI: 10.1177/1533033820979163] [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] [Indexed: 11/17/2022] Open
Abstract
Purpose: Advanced radiotherapeutic techniques and apparatus have been developed and widely applied in stereotactic body radiation therapy for early-stage non-small cell lung cancer, but their clinical benefits have not necessarily been confirmed. This study was performed to review our 10-year experience with therapy for the disease and to evaluate whether the advanced radiotherapeutic system implemented in our hospital 5 years after we began the therapy improved the clinical outcomes of patients. Materials and Methods: Patients who underwent the therapy at our hospital between April 2008 and March 2018 were retrospectively reviewed. They were divided into 2 groups treated with the conventional system or the advanced system, and the characteristics and clinical outcomes were compared between the groups. The same analyses were also performed in propensity-matched patients from the 2 groups. Results: Among the 73 patients eligible for this study, 42 were treated with the conventional system and 31 with the advanced system. All were treated as planned, and severe adverse events were rare. The local progression-free survival rate in the advanced system group was significantly higher than in the conventional system group (P = 0.025). In the propensity-matched patients, both the local progression-free survival rate and the overall survival rate were significantly higher compared in the advanced system group than the conventional system group (P = 0.089 and 0.080, respectively). Conclusion: The advanced system improved the outcomes of patients with the disease, suggesting that technological development has had a strong impact on clinical outcomes.
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Affiliation(s)
- Keiichiro Koiwai
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Yuuki Endo
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Kai Mizuhata
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Hironobu Ina
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Ayumu Fukazawa
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Takesumi Ozawa
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Yasunari Fujinaga
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
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Mihai AM, Rock L, Milano MT. Technical challenges of linac-based stereotactic ablative body radiotherapy: short review for non-radiation oncologists. Ann Palliat Med 2020; 10:5931-5943. [PMID: 33040563 DOI: 10.21037/apm-20-950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/27/2020] [Indexed: 11/06/2022]
Abstract
Stereotactic ablative radiotherapy (SABR) is a radiation technique delivering high doses of radiation in a small number of treatments, to extracranial targets. It is standard of care in patients with inoperable early stage non-small cell lung cancer, and it is increasingly used in patients with oligometastatic disease. The main advantage of SABR is a steep dose gradient, allowing delivery of high biologically effective doses to the target, while minimizing irradiation exposure of the neighboring normal tissues. This results in high rates of local control of the treated target and minimal toxicity risks, and minimal impact on the quality of life of the patients. However, it requires high precision, accuracy and reproducibility during the entire process, from simulation to treatment planning and treatment delivery. This article will focus on general principles of SABR treatment planning and delivery, with emphasis on the strategies to reduce errors related to immobilization, respiratory management and treatment verification.
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Affiliation(s)
- Alina M Mihai
- Department of Radiotherapy, Beacon Hospital, Dublin, Ireland
| | - Luke Rock
- Department of Radiotherapy, Beacon Hospital, Dublin, Ireland
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester Medical Centre, NY, USA
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8
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Yamauchi R, Mizuno N, Itazawa T, Saitoh H, Kawamori J. Dosimetric evaluation of deep inspiration breath hold for left-sided breast cancer: analysis of patient-specific parameters related to heart dose reduction. J Radiat Res 2020; 61:447-456. [PMID: 32100831 PMCID: PMC7299269 DOI: 10.1093/jrr/rraa006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/18/2019] [Accepted: 02/06/2020] [Indexed: 06/10/2023]
Abstract
Deep inspiration breath hold (DIBH) is a common method used worldwide for reducing the radiation dose to the heart. However, few studies have reported on the relationship between dose reduction and patient-specific parameters. The aim of this study was to compare the reductions of heart dose and volume using DIBH with the dose/volume of free breathing (FB) for patients with left-sided breast cancer and to analyse patient-specific dose reduction parameters. A total of 85 Asian patients who underwent whole-breast radiotherapy after breast-conserving surgery were recruited. Treatment plans for FB and DIBH were retrospectively generated by using an automated breast planning tool with a two-field tangential intensity-modulated radiation therapy technique. The prescribed dose was 50 Gy in 25 fractions. The dosimetric parameters (e.g., mean dose and maximum dose) in heart and lung were extracted from the dose-volume histogram. The relationships between dose-volume data and patient-specific parameters, such as age, body mass index (BMI), and inspiratory volume, were analyzed. The mean heart doses for the FB and DIBH plans were 1.56 Gy and 0.75 Gy, respectively, a relative reduction of 47%. There were significant differences in all heart dosimetric parameters (p < 0.001). For patients with a high heart dose in the FB plan, a relative reduction of the mean heart dose correlated with inspiratory volume (r = 0.646). There was correlation between the relative reduction of mean heart dose and BMI (r = -0.248). We recommend considering the possible feasibility of DIBH in low BMI patients because the degree of benefit from DIBH varied with BMI.
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Affiliation(s)
- Ryohei Yamauchi
- Department of Radiation Oncology, St Luke’s International Hospital, Tokyo, Japan
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Norifumi Mizuno
- Department of Radiation Oncology, St Luke’s International Hospital, Tokyo, Japan
| | - Tomoko Itazawa
- Department of Radiation Oncology, St Luke’s International Hospital, Tokyo, Japan
| | - Hidetoshi Saitoh
- Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Jiro Kawamori
- Department of Radiation Oncology, St Luke’s International Hospital, Tokyo, Japan
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Johnson JE, Herman MG, Kruse JJ. Optimization of motion management parameters in a synchrotron-based spot scanning system. J Appl Clin Med Phys 2019; 20:69-77. [PMID: 31538720 PMCID: PMC6753740 DOI: 10.1002/acm2.12702] [Citation(s) in RCA: 2] [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: 01/07/2019] [Revised: 04/12/2019] [Accepted: 07/08/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To quantify the effects of combining layer-based repainting and respiratory gating as a strategy to mitigate the dosimetric degradation caused by the interplay effect between a moving target and dynamic spot-scanning proton delivery. METHODS An analytic routine modeled three-dimensional dose distributions of pencil-beam proton plans delivered to a moving target. Spot positions and weights were established for a single field to deliver 100 cGy to a static, 15-cm deep, 3-cm radius spherical clinical target volume with a 1-cm isotropic internal target volume expansion. The interplay effect was studied by modeling proton delivery from a clinical synchrotron-based spot scanning system and respiratory target motion, patterned from surrogate patient breathing traces. Motion both parallel and orthogonal to the beam scanning direction was investigated. Repainting was modeled using a layer-based technique. For each of 13 patient breathing traces, the dose from 20 distinct delivery schemes (combinations of four gate window amplitudes and five repainting techniques) was computed. Delivery strategies were inter-compared based on target coverage, dose homogeneity, high dose spillage, and delivery time. RESULTS Notable degradation and variability in plan quality were observed for ungated delivery. Decreasing the gate window reduced this variability and improved plan quality at the expense of longer delivery times. Dose deviations were substantially greater for motion orthogonal to the scan direction when compared with parallel motion. Repainting coupled with gating was effective at partially restoring dosimetric coverage at only a fraction of the delivery time increase associated with very small gate windows alone. Trends for orthogonal motion were similar, but more complicated, due to the increased severity of the interplay. CONCLUSIONS Layer-based repainting helps suppress the interplay effect from intra-gate motion, with only a modest penalty in delivery time. The magnitude of the improvement in target coverage is strongly influenced by individual patient breathing patterns and the tumor motion trajectory.
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Affiliation(s)
- Jedediah E Johnson
- Department of Radiation Oncology, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - Michael G Herman
- Department of Radiation Oncology, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
| | - Jon J Kruse
- Department of Radiation Oncology, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN, 55905, USA
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Ranjbar M, Sabouri P, Repetto C, Sawant A. A novel deformable lung phantom with programably variable external and internal correlation. Med Phys 2019; 46:1995-2005. [PMID: 30919974 DOI: 10.1002/mp.13507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 03/06/2019] [Accepted: 03/06/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Lung motion phantoms used to validate radiotherapy motion management strategies have fairly simplistic designs that do not adequately capture complex phenomena observed in human respiration such as external and internal deformation, variable hysteresis and variable correlation between different parts of the thoracic anatomy. These limitations make reliable evaluation of sophisticated motion management techniques quite challenging. In this work, we present the design and implementation of a programmable, externally and internally deformable lung motion phantom that allows for a reproducible change in external-internal and internal-internal correlation of embedded markers. METHODS An in-house-designed lung module, made from natural latex foam was inserted inside the outer shell of a commercially available lung phantom (RSD, Long Beach, CA, USA). Radiopaque markers were placed on the external surface and embedded into the lung module. Two independently programmable high-precision linear motion actuators were used to generate primarily anterior-posterior (AP) and primarily superior-inferior (SI) motion in a reproducible fashion in order to enable (a) variable correlation between the displacement of interior volume and the exterior surface, (b) independent changes in the amplitude of the AP and SI motions, and (c) variable hysteresis. The ability of the phantom to produce complex and variable motion accurately and reproducibly was evaluated by programming the two actuators with mathematical and patient-recorded lung tumor motion traces, and recording the trajectories of various markers using kV fluoroscopy. As an example application, the phantom was used to evaluate the performance of lung motion models constructed from kV fluoroscopy and 4DCT images. RESULTS The phantom exhibited a high degree of reproducibility and marker motion ranges were reproducible to within 0.5 mm. Variable correlation was observed between the displacements of internal-internal and internal-external markers. The SI and AP components of motion of a specific marker had a correlation parameter that varied from -11 to 17. Monitoring a region of interest on the phantom's surface to estimate internal marker motion led to considerably lower uncertainties than when a single point was monitored. CONCLUSIONS We successfully designed and implemented a programmable, externally and internally deformable lung motion phantom that allows for a reproducible change in external-internal and internal-internal correlation of embedded markers.
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Affiliation(s)
- Maida Ranjbar
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Pouya Sabouri
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Carlo Repetto
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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11
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Talapatra K, Majumder D, Chadha P, Shaju P, Goyle S, Smruti BK, Mistry R. Stereotactic body radiotherapy for lung tumors: Dosimetric analysis and clinical outcome. Indian J Cancer 2019; 55:170-175. [PMID: 30604731 DOI: 10.4103/ijc.ijc_555_17] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Stereotactic body radiotherapy (SBRT) has emerged as an important modality in malignant lung tumor treatment both in early localized primary and oligometastatic setting. This study aims to present the results of lung SBRT both in terms of dosimetry and clinical outcome. MATERIALS AND METHODS Twenty-seven patients were assessed from 2012 to 2016. Both the primary and oligometastatic lung tumors were evaluated. Respiratory motion management was done employing ANZAI (Siemens, Germany) based four-dimensional computed tomography (CT). Commonly used fractionations were 60 Gy/5 fractions for peripheral tumors and 48 Gy/6 fractions for central tumors. Radiation Therapy Oncology Group toxicity criteria were used for toxicity and whole-body positron emission tomography-CT scan was done at follow-up for response evaluation. RESULTS Twenty-seven patients were evaluated, 18 (66.7%) patients had a primary, and 9 (33.3%) patients had metastatic lung tumors. The male-to-female ratio for the entire cohort was 2:1. The median age at diagnosis was 65.8 years. Mean planning target volume (PTV) D2cc was 54.9 ± 9.04 Gy and mean internal target volume diameter was 3.0 ± 1.07 cm. Mean V20 Gy, V10 Gy, and V5 Gy of (lungs total-PTV) and (Lung ipsilateral - PTV) were 5.4 ± 4% and 10.9 ± 7.9%, 11.7 ± 5.8% and 24.2 ± 14.0%, and 22.05 ± 12.4% and 33.2 ± 15.3%, respectively. In total 21 (84%) patients and 4 patients (16%) showed a complete and partial response, respectively. One (3%) patient developed Gr 3 radiation pneumonitis. One year local control was in 18 (81%) patients whereas 4 (14%) patients progressed and three patients did not report. A higher prescribed dose significantly correlated with 1 year tumor control (P = 0.036). CONCLUSION This study infers the feasibility and a favorable outcome for lung cancer amenable to SBRT in addition to being one of the largest clinical experiences for lung stereotactic treatment in our country.
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Affiliation(s)
- Kaustav Talapatra
- Department of Radiation Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Dipanjan Majumder
- Department of Radiation Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Pranav Chadha
- Department of Radiation Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - P Shaju
- Department of Radiation Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Sandeep Goyle
- Department of Medical Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - B K Smruti
- Department of Medical Oncology, Bombay Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Rajesh Mistry
- Department of Surgical Oncology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
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12
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Takanaka T, Taima Y, Horichi Y, Kawamori Y, Nobata K, Kitagawa K, Norishima A, Koshikawa K, Mito T, Yoshida S, Kawanaka T, Matsutani K, Kawahara M. Multiple Breath-hold Volumetric Modulated Arc Therapy Under Fluoroscopic Image Guidance with an Implanted Fiducial Marker: An Advanced Technique. Cureus 2018; 10:e2499. [PMID: 29951345 PMCID: PMC6019328 DOI: 10.7759/cureus.2499] [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: 03/19/2018] [Accepted: 04/17/2018] [Indexed: 11/05/2022] Open
Abstract
An advanced technique for multiple breath-hold volumetric modulated arc therapy (VMAT) has been proposed under fluoroscopic image guidance with a fiducial marker implanted close to a tumor. The marker coordinates on a digitally reconstructed radiography image at a gantry start angle, under a planned breath-hold condition, were transferred to the fluoroscopic image window. Then, a reference lateral line passing through the planned breath-hold marker position was drawn on the fluoroscopic image. Additional lateral lines were further added on both sides of the reference line with a distance of 3 mm as a tolerance limit for the breath-hold beam delivery. Subsequently, the patient was asked to breathe in slowly under fluoroscopy. Immediately after the marker position on the fluoroscopic image moved inside the tolerance range, the patient was asked to hold the breath and the VMAT beam was delivered. During the beam delivery, the breath-hold status was continuously monitored by checking if the deviation of the marker position exceeded the tolerance limit. As long as the marker stayed within the tolerance range, a segmented VMAT delivery continued for a preset period of 15 to 30 seconds depending on the breath-hold capability of each patient. As soon as each segmented delivery was completed, the beam interrupt button was pushed; subsequently, the patient was asked for free breathing. This procedure was repeated until all the segmented VMAT beams were delivered. A lung tumor case is reported here as an initial study. The proposed technique may be clinically advantageous for treating respiratory moving tumors including lung tumor, liver cancer, and other abdominal cancers.
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Affiliation(s)
| | - Yoko Taima
- Department of Radiation Oncology, Kanazawa University Hospital
| | | | | | - Koji Nobata
- Department of Radiology, Kouseiren Takaoka Hospital
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13
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Liu Y, Yin FF, Czito BG, Bashir MR, Palta M, Cai J. Retrospective four-dimensional magnetic resonance imaging with image-based respiratory surrogate: a sagittal-coronal-diaphragm point of intersection motion tracking method. J Med Imaging (Bellingham) 2017; 4:024007. [PMID: 28653014 DOI: 10.1117/1.jmi.4.2.024007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 01/27/2017] [Accepted: 06/01/2017] [Indexed: 11/14/2022] Open
Abstract
A four-dimensional magnetic resonance imaging (4-D-MRI) technique with Sagittal-Coronal-Diaphragm Point-of-Intersection (SCD-PoI) as a respiratory surrogate is proposed. To develop an image-based respiratory surrogate, the SCD-PoI motion tracking method is used for retrospective 4-D-MRI reconstruction. Single-slice sagittal MR cine was acquired at a location near the center of the diaphragmatic dome. Multiple-slice coronal MR cines were acquired for 4-D-MRI reconstruction. As a motion surrogate, the diaphragm motion was measured from the PoI among the sagittal MRI cine plane, coronal MRI cine planes, and the diaphragm surface. These points were defined as the SCD-PoI. This point is used as a one-dimensional diaphragmatic navigator in our study. The 4-D-MRI technique was evaluated on a 4-D digital extended cardiac-torso (XCAT) human phantom, a motion phantom, and seven human subjects (five healthy volunteers and two cancer patients). Motion trajectories of a selected region of interest were measured on 4-D-MRI and compared with the known XCAT motion that served as references. The mean absolute amplitude difference ([Formula: see text]) and the cross-correlation coefficient (CC) of the comparisons were determined. 4-D-MRI of the XCAT phantom demonstrated highly accurate motion information ([Formula: see text], [Formula: see text]). Motion trajectories of the motion phantom measured on 4-D-MRI matched well with the references ([Formula: see text], [Formula: see text]). 4-D-MRI of human subjects showed minimal artifacts and clearly revealed the respiratory motion of organs and tumor (mean [Formula: see text]; mean [Formula: see text]). A 4-D-MRI technique with image-based respiratory surrogate has been developed and tested on phantoms and human subjects.
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Affiliation(s)
- Yilin Liu
- Duke University, Medical Physics Graduate Program, Durham, North Carolina, United States.,Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
| | - Fang-Fang Yin
- Duke University, Medical Physics Graduate Program, Durham, North Carolina, United States.,Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
| | - Brian G Czito
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
| | - Mustafa R Bashir
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States.,Duke University Medical Center, Center for Advanced Magnetic Resonance Development, Durham, North Carolina, United States
| | - Manisha Palta
- Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
| | - Jing Cai
- Duke University, Medical Physics Graduate Program, Durham, North Carolina, United States.,Duke University Medical Center, Department of Radiation Oncology, Durham, North Carolina, United States
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14
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Han F, Zhou Z, Cao M, Yang Y, Sheng K, Hu P. Respiratory motion-resolved, self-gated 4D-MRI using rotating cartesian k-space (ROCK). Med Phys 2017; 44:1359-1368. [PMID: 28133752 DOI: 10.1002/mp.12139] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [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: 10/02/2016] [Revised: 12/20/2016] [Accepted: 01/23/2017] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To propose and validate a respiratory motion resolved, self-gated (SG) 4D-MRI technique to assess patient-specific breathing motion of abdominal organs for radiation treatment planning. METHODS The proposed 4D-MRI technique was based on the balanced steady-state free-precession (bSSFP) technique and 3D k-space encoding. A novel rotating cartesian k-space (ROCK) reordering method was designed which incorporates repeatedly sampled k-space centerline as the SG motion surrogate and allows for retrospective k-space data binning into different respiratory positions based on the amplitude of the surrogate. The multiple respiratory-resolved 3D k-space data were subsequently reconstructed using a joint parallel imaging and compressed sensing method with spatial and temporal regularization. The proposed 4D-MRI technique was validated using a custom-made dynamic motion phantom and was tested in six healthy volunteers, in whom quantitative diaphragm and kidney motion measurements based on 4D-MRI images were compared with those based on 2D-CINE images. RESULTS The 5-minute 4D-MRI scan offers high-quality volumetric images in 1.2 × 1.2 × 1.6 mm3 and eight respiratory positions, with good soft-tissue contrast. In phantom experiments with triangular motion waveform, the motion amplitude measurements based on 4D-MRI were 11.89% smaller than the ground truth, whereas a -12.5% difference was expected due to data binning effects. In healthy volunteers, the difference between the measurements based on 4D-MRI and the ones based on 2D-CINE were 6.2 ± 4.5% for the diaphragm, 8.2 ± 4.9% and 8.9 ± 5.1% for the right and left kidney. CONCLUSION The proposed 4D-MRI technique could provide high-resolution, high-quality, respiratory motion-resolved 4D images with good soft-tissue contrast and are free of the "stitching" artifacts usually seen on 4D-CT and 4D-MRI based on resorting 2D-CINE. It could be used to visualize and quantify abdominal organ motion for MRI-based radiation treatment planning.
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Affiliation(s)
- Fei Han
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza Suite B119, Los Angeles, CA 90095, USA
| | - Ziwu Zhou
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza Suite B119, Los Angeles, CA 90095, USA.,Department of Bioengineering, University of California, 300 UCLA Medical Plaza Suite B119, Los Angeles, CA 90095, USA
| | - Minsong Cao
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, 200 UCLA Medical Plaza Suite B265, Los Angeles, CA 90095, USA.,Physics and Biology in Medicine Graduate Program, David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza Suite B119, Los Angeles, CA 90095, USA
| | - Yingli Yang
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, 200 UCLA Medical Plaza Suite B265, Los Angeles, CA 90095, USA.,Physics and Biology in Medicine Graduate Program, David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza Suite B119, Los Angeles, CA 90095, USA
| | - Ke Sheng
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, 200 UCLA Medical Plaza Suite B265, Los Angeles, CA 90095, USA.,Physics and Biology in Medicine Graduate Program, David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza Suite B119, Los Angeles, CA 90095, USA
| | - Peng Hu
- Department of Radiological Sciences, David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza Suite B119, Los Angeles, CA 90095, USA.,Physics and Biology in Medicine Graduate Program, David Geffen School of Medicine, University of California, 300 UCLA Medical Plaza Suite B119, Los Angeles, CA 90095, USA
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15
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Nakajima Y, Kadoya N, Kanai T, Ito K, Sato K, Dobashi S, Yamamoto T, Ishikawa Y, Matsushita H, Takeda K, Jingu K. Comparison of visual biofeedback system with a guiding waveform and abdomen-chest motion self-control system for respiratory motion management. J Radiat Res 2016; 57:387-392. [PMID: 26922090 PMCID: PMC4973639 DOI: 10.1093/jrr/rrv106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 11/17/2015] [Accepted: 12/22/2015] [Indexed: 06/05/2023]
Abstract
Irregular breathing can influence the outcome of 4D computed tomography imaging and cause artifacts. Visual biofeedback systems associated with a patient-specific guiding waveform are known to reduce respiratory irregularities. In Japan, abdomen and chest motion self-control devices (Abches) (representing simpler visual coaching techniques without a guiding waveform) are used instead; however, no studies have compared these two systems to date. Here, we evaluate the effectiveness of respiratory coaching in reducing respiratory irregularities by comparing two respiratory management systems. We collected data from 11 healthy volunteers. Bar and wave models were used as visual biofeedback systems. Abches consisted of a respiratory indicator indicating the end of each expiration and inspiration motion. Respiratory variations were quantified as root mean squared error (RMSE) of displacement and period of breathing cycles. All coaching techniques improved respiratory variation, compared with free-breathing. Displacement RMSEs were 1.43 ± 0.84, 1.22 ± 1.13, 1.21 ± 0.86 and 0.98 ± 0.47 mm for free-breathing, Abches, bar model and wave model, respectively. Period RMSEs were 0.48 ± 0.42, 0.33 ± 0.31, 0.23 ± 0.18 and 0.17 ± 0.05 s for free-breathing, Abches, bar model and wave model, respectively. The average reduction in displacement and period RMSE compared with the wave model were 27% and 47%, respectively. For variation in both displacement and period, wave model was superior to the other techniques. Our results showed that visual biofeedback combined with a wave model could potentially provide clinical benefits in respiratory management, although all techniques were able to reduce respiratory irregularities.
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Affiliation(s)
- Yujiro Nakajima
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takayuki Kanai
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kiyokazu Sato
- Department of Radiology, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Suguru Dobashi
- Department of Radiological Technology, Health Sciences, Tohoku University, Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Ken Takeda
- Department of Radiological Technology, Health Sciences, Tohoku University, Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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16
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Matsuo Y, Onishi H, Nakagawa K, Nakamura M, Ariji T, Kumazaki Y, Shimbo M, Tohyama N, Nishio T, Okumura M, Shirato H, Hiraoka M. Guidelines for respiratory motion management in radiation therapy. J Radiat Res 2013; 54:561-8. [PMID: 23239175 PMCID: PMC3650747 DOI: 10.1093/jrr/rrs122] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 11/21/2012] [Indexed: 05/19/2023]
Abstract
Respiratory motion management (RMM) systems in external and stereotactic radiotherapies have been developed in the past two decades. Japanese medical service fee regulations introduced reimbursement for RMM from April 2012. Based on thorough discussions among the four academic societies concerned, these Guidelines have been developed to enable staff (radiation oncologists, radiological technologists, medical physicists, radiotherapy quality managers, radiation oncology nurses, and others) to apply RMM to radiation therapy for tumors subject to respiratory motion, safely and appropriately.
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Affiliation(s)
- Yukinori Matsuo
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto-shi, Kyoto 606-8507, Japan
| | - Hiroshi Onishi
- Department of Radiology, School of Medicine, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan
| | - Keiichi Nakagawa
- Department of Radiology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Mitsuhiro Nakamura
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto-shi, Kyoto 606-8507, Japan
- Corresponding author. Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto-shi, Kyoto 606-8507, Japan. Tel: +81-75-751-3762; Fax: +81-75-771-9749;
| | - Takaki Ariji
- Department of Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba 277–8577, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397–1 Yamane, Hidaka-shi, Saitama 350-1298, Japan
| | - Munefumi Shimbo
- Department of Radiology, Saitama Medical Center, 1981 Kamoda, Kawagoe-shi, Saitama 350–8550, Japan
| | - Naoki Tohyama
- Division of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba 260-8717, Japan
| | - Teiji Nishio
- Particle Therapy Division, Research Center for Innovative Oncology, National Cancer Center, 6-5-1 Kashiwanoha, Kashiwa-shi, Chiba 277-8577, Japan
| | - Masahiko Okumura
- Department of Central Radiological Service, Kinki University School of Medicine, 377-2 Ohno-higashi, Osakasayama-shi, Osaka, 589-8511, Japan
| | - Hiroki Shirato
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-5, Kita-ku, Sapporo-shi, Hokkaido 060-8638, Japan
| | - Masahiro Hiraoka
- Department of Radiation Oncology and Image-applied Therapy, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawaharacho, Sakyo-ku, Kyoto-shi, Kyoto 606-8507, Japan
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