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Keilig L, Fittgen A, Schneider H, Sifa R, Schwarze J, Bourauel C, Konermann A. Accuracy of Digital Orthodontic Treatment Planning: Assessing Aligner-Directed Tooth Movements and Exploring Inherent Intramaxillary Side Effects. J Clin Med 2024; 13:2298. [PMID: 38673571 PMCID: PMC11051260 DOI: 10.3390/jcm13082298] [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: 03/18/2024] [Revised: 04/03/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The attainment of precise posterior occlusion alignment necessitates a deeper understanding of the clinical efficacy of aligner therapy. This study aims to determine whether the treatment goals defined in the virtual planning of aligner therapy are effectively implemented in clinical practice, with a particular focus on the influence of distalization distances on potential vertical side effects. Methods: In this retrospective, non-interventional investigation, a cohort of 20 individuals undergoing Invisalign® treatment was examined. Pre- and post-treatment maxillary clinical and ClinCheck® casts were superimposed utilizing a surface-surface matching algorithm on palatal folds, median palatine raphe, and unmoved teeth as the stable references. The effectivity of planned versus clinical movements was evaluated. Groupings were based on distalization distances, planned vertical movements, and Class II elastic prescription. Statistics were performed with a two-sample t-test and p-value < 0.05. Results: Clinically achieved distalization was significantly lower than virtually planned distalization, regardless of additional vertical movements, where a lack of implementation was contingent upon the extent of distalization, with no mitigating effects observed with the application of Class II elastics. Intriguingly, no adverse vertical side effects were noted; however, the intended intrusions or extrusions, as per the therapeutic plans, remained unattainable regardless of the magnitude of distalization. Conclusions: These findings underscore the imperative for future investigations to delve deeper into the intricacies surrounding translational mesio-distal and vertical movements, thereby enhancing predictability within orthodontic practice. To facilitate successful clinical implementation of vertical and translational movements via aligners, the incorporation of sliders emerges as a promising strategy for bolstering anchorage reinforcement.
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Affiliation(s)
- Ludger Keilig
- Oral Technology, University Hospital Bonn, 53111 Bonn, Germany
- Department of Prosthodontics, University Hospital Bonn, 53111 Bonn, Germany
| | - Anna Fittgen
- Department of Orthodontics, University Hospital Bonn, 53111 Bonn, Germany
| | - Helen Schneider
- Fraunhofer-Institute for Intelligent Analysis- and Informationsystems IAIS, 53757 Sankt Augustin, Germany
| | - Rafet Sifa
- Bonn-Aachen International Center for Information Technology (B-IT), LAMARR Institute for Machine Learning and Artificial Intelligence, University of Bonn, 53115 Bonn, Germany
| | | | | | - Anna Konermann
- Department of Orthodontics, University Hospital Bonn, 53111 Bonn, Germany
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Arumugam S, Young T, Do V, Chlap P, Tawfik C, Udovitch M, Wong K, Sidhom M. Assessment of intrafraction motion and its dosimetric impact on prostate radiotherapy using an in-house developed position monitoring system. Front Oncol 2023; 13:1082391. [PMID: 37519787 PMCID: PMC10375704 DOI: 10.3389/fonc.2023.1082391] [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: 10/28/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose To implement an in-house developed position monitoring software, SeedTracker, for conventional fractionation prostate radiotherapy, and study the effect on dosimetric impact and intrafraction motion. Methods Thirty definitive prostate radiotherapy patients with implanted fiducial markers were included in the study. All patients were treated with VMAT technique and plans were generated using the Pinnacle planning system using the 6MV beam model for Elekta linear accelerator. The target dose of 60 Gy in 20 fractions was prescribed for 29 of 30 patients, and one patient was treated with the target dose of 78 Gy in 39 fractions. The SeedTracker position monitoring system, which uses the x-ray images acquired during treatment delivery in the Elekta linear accelerator and associated XVI system, was used for online prostate position monitoring. The position tolerance for online verification was progressively reduced from 5 mm, 4 mm, and to 3 mm in 10 patient cohorts to effectively manage the treatment interruptions resulting from intrafraction motion in routine clinical practice. The delivered dose to target volumes and organs at risk in each of the treatment fractions was assessed by incorporating the observed target positions into the original treatment plan. Results In 27 of 30 patients, at least one gating event was observed, with a total of 177 occurrences of position deviation detected in 146 of 619 treatment fractions. In 5 mm, 4 mm, and 3 mm position tolerance cohorts, the position deviations were observed in 13%, 24%, and 33% of treatment fractions, respectively. Overall, the mean (range) deviation of -0.4 (-7.2 to 5.3) mm, -0.9 (-6.1 to 15.6) mm, and -1.7 (-7.0 to 6.1) mm was observed in Left-Right, Anterior-Posterior, and Superior-Inferior directions, respectively. The prostate CTV D99 would have been reduced by a maximum value of 1.3 Gy compared to the planned dose if position deviations were uncorrected, but with corrections, it was 0.3 Gy. Similarly, PTV D98 would have been reduced by a maximum value of 7.6 Gy uncorrected, with this difference reduced to 2.2 Gy with correction. The V60 to the rectum increased by a maximum of 1.0% uncorrected, which was reduced to 0.5%. Conclusion Online target position monitoring for conventional fractionation prostate radiotherapy was successfully implemented on a standard Linear accelerator using an in-house developed position monitoring software, with an improvement in resultant dose to prostate target volume.
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Affiliation(s)
- Sankar Arumugam
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Tony Young
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia
| | - Viet Do
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Phillip Chlap
- Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Sydney, NSW, Australia
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Christine Tawfik
- Department of Radiation Therapy, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Mark Udovitch
- Department of Radiation Therapy, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Karen Wong
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
| | - Mark Sidhom
- South Western Clinical School, University of New South Wales, Sydney, NSW, Australia
- Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Sydney, NSW, Australia
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D’Antò V, Bucci R, De Simone V, Huanca Ghislanzoni L, Michelotti A, Rongo R. Evaluation of Tooth Movement Accuracy with Aligners: A Prospective Study. Materials (Basel) 2022; 15:ma15072646. [PMID: 35407978 PMCID: PMC9000684 DOI: 10.3390/ma15072646] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 01/05/2023]
Abstract
Background. Clear aligners treatment (CAT) is a common solution in orthodontics to treat both simple and complex malocclusions. This study aimed to evaluate the predictability of CAT, comparing the virtually planned and the achieved tooth movement at the end of stage 15, which is often the time of first refinement. Methods. Seventeen patients (mean age: 28.3 years) were enrolled in the study. Torque, tip and rotation were analyzed in 238 maxillary teeth on digital models at Pre-treatment (T0), at the end of stage 15 (T15) and at virtually planned stage 15 (T15i). Prescription, Achieved movement and performance values were calculated to compare the virtually planned and the clinical tooth position. Data were analyzed by means of Student’s t test with a level of significance set at p < 0.05. Results. The largest iper-performance was the torque correction of the second molars (+2.3° ± 3.1°), the greatest under-performance was the tip correction of the first molars (−2.3° ± 3.3°), while rotation corrections of all the teeth showed more accurate performance. No significant differences were found between mean Prescription and mean Achieved movement for all the assessed movements (p < 0.05). Conclusions. An accurate evaluation of CAT after the 15th aligner is fundamental in order to individuate the movements that are not matching the digital set-up.
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Affiliation(s)
- Vincenzo D’Antò
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, 80138 Naples, Italy; (R.B.); (V.D.S.); (A.M.); (R.R.)
- Correspondence:
| | - Rosaria Bucci
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, 80138 Naples, Italy; (R.B.); (V.D.S.); (A.M.); (R.R.)
| | - Vincenzo De Simone
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, 80138 Naples, Italy; (R.B.); (V.D.S.); (A.M.); (R.R.)
| | | | - Ambrosina Michelotti
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, 80138 Naples, Italy; (R.B.); (V.D.S.); (A.M.); (R.R.)
| | - Roberto Rongo
- Department of Neuroscience, Reproductive Sciences and Oral Sciences, University of Naples “Federico II”, 80138 Naples, Italy; (R.B.); (V.D.S.); (A.M.); (R.R.)
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Christiansen RL, Johansen J, Zukauskaite R, Hansen CR, Bertelsen AS, Hansen O, Mahmood F, Brink C, Bernchou U. Accuracy of automatic structure propagation for daily magnetic resonance image-guided head and neck radiotherapy. Acta Oncol 2021; 60:589-597. [PMID: 33688793 DOI: 10.1080/0284186x.2021.1891282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND PURPOSE Deformable image registration (DIR) and contour propagation are used in daily online adaptation for hybrid MRI linac (MRL) treatments. The accuracy of the propagated contours may vary depending on the chosen workflow (WF), affecting the amount of required manual corrections. This study investigated the impact of three different WFs of contour propagations produced by a clinical treatment planning system for a high-field MRL on head and neck cancer patients. METHODS Seventeen patients referred for curative radiotherapy for oropharyngeal cancer underwent standard CT-based dose planning and MR scans in the treatment position for planning (pMR), and at the 10th (MR10), 20th (MR20) and 30th (MR30) fraction (±2). The primary tumour, a metastatic lymph node and 8 organs at risk were manually delineated on each set of T2 weighted images. Delineations were repeated one month later on the pMR by the same observer to determine the intra-observer variation (IOV). Three WFs were used to deform images in the treatment planning system for the high-field MRL: In WF1, only the planning image and contours were used as a reference for DIR and propagation to MR10,20,30. The most recently acquired image set prior to the daily images was deformed and uncorrected (WF2) versus manually corrected (WF3) structures propagated to the session image. Dice similarity coefficient (DSC), mean surface distance (MSD) and Hausdorff distance (HD) were calculated for each structure in each model. RESULTS Population median DSC, MSD and HD for WF1 and WF3 were similar and slightly better than for WF2. WF3 provided higher accuracy than WF1 for structures that are likely to shrink. All DIR workflows were less accurate than the IOV. CONCLUSIONS WF1 and WF3 provide higher accuracy in structure propagation than WF2. Manual revision and correction of propagated structures are required for all evaluated workflows.
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Affiliation(s)
- Rasmus L. Christiansen
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Ruta Zukauskaite
- Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Christian R. Hansen
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Anders S. Bertelsen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Olfred Hansen
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
- Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Faisal Mahmood
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Carsten Brink
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Uffe Bernchou
- Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, Odense C, Denmark
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