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Wei Z, Huang X, Sun A, Peng L, Lou Z, Hu Z, Wang H, Xing L, Yu J, Qian J. A model that predicts a real-time tumour surface using intra-treatment skin surface and end-of-expiration and end-of-inhalation planning CT images. Br J Radiol 2024; 97:980-992. [PMID: 38547402 DOI: 10.1093/bjr/tqae067] [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: 08/09/2023] [Revised: 11/06/2023] [Accepted: 03/25/2024] [Indexed: 05/09/2024] Open
Abstract
OBJECTIVES To develop a mapping model between skin surface motion and internal tumour motion and deformation using end-of-exhalation (EOE) and end-of-inhalation (EOI) 3D CT images for tracking lung tumours during respiration. METHODS Before treatment, skin and tumour surfaces were segmented and reconstructed from the EOE and the EOI 3D CT images. A non-rigid registration algorithm was used to register the EOE skin and tumour surfaces to the EOI, resulting in a displacement vector field that was then used to construct a mapping model. During treatment, the EOE skin surface was registered to the real-time, yielding a real-time skin surface displacement vector field. Using the mapping model generated, the input of a real-time skin surface can be used to calculate the real-time tumour surface. The proposed method was validated with and without simulated noise on 4D CT images from 15 patients at Léon Bérard Cancer Center and the 4D-lung dataset. RESULTS The average centre position error, dice similarity coefficient (DSC), 95%-Hausdorff distance and mean distance to agreement of the tumour surfaces were 1.29 mm, 0.924, 2.76 mm, and 1.13 mm without simulated noise, respectively. With simulated noise, these values were 1.33 mm, 0.920, 2.79 mm, and 1.15 mm, respectively. CONCLUSIONS A patient-specific model was proposed and validated that was constructed using only EOE and EOI 3D CT images and real-time skin surface images to predict internal tumour motion and deformation during respiratory motion. ADVANCES IN KNOWLEDGE The proposed method achieves comparable accuracy to state-of-the-art methods with fewer pre-treatment planning CT images, which holds potential for application in precise image-guided radiation therapy.
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Affiliation(s)
- Ziwen Wei
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230031, P.R. China
- Science Island Branch of the Graduate School, University of Science and Technology of China, Hefei 230026, Anhui, P.R. China
| | - Xiang Huang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230031, P.R. China
| | - Aiming Sun
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230031, P.R. China
| | - Leilei Peng
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230031, P.R. China
| | - Zhixia Lou
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230031, P.R. China
| | - Zongtao Hu
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230031, P.R. China
| | - Hongzhi Wang
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230031, P.R. China
| | - Ligang Xing
- Department of Radiation Oncology, School of Medicine, Shandong University, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong, P.R. China
| | - Jinming Yu
- Department of Radiation Oncology, School of Medicine, Shandong University, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong, P.R. China
| | - Junchao Qian
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical Science, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei 230031, P.R. China
- Science Island Branch of the Graduate School, University of Science and Technology of China, Hefei 230026, Anhui, P.R. China
- Department of Radiation Oncology, School of Medicine, Shandong University, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, Shandong, P.R. China
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Saito M, Ueda K, Nemoto H, Onishi Y, Suzuki H, Suzuki T, Sano N, Komiyama T, Marino K, Onishi H. Development of a phantom for assessing the precision of setup in skin mark-less surface-guided radiotherapy. J Appl Clin Med Phys 2024:e14381. [PMID: 38696715 DOI: 10.1002/acm2.14381] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/19/2024] [Accepted: 04/10/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Surface-guided radiotherapy (SGRT) is adopted by several institutions; however, reports on the phantoms used to assess the precision of the SGRT setup are limited. PURPOSE The purpose of this study was to develop a phantom to verify the accuracy of the irradiation position during skin mark-less SGRT. METHODS An acrylonitrile butadiene styrene (ABS) plastic cube phantom with a diameter of 150 mm on each side containing a dummy target of 15 mm and two types of body surface-shaped phantoms (breast/face shape) that could be attached to the cube phantom were fabricated. Films can be inserted on four sides of the cubic phantom (left, right, anterior and posterior), and the center of radiation can be calculated by irradiating the dummy target with orthogonal MV beams. Three types of SGRT using a VOXELAN-HEV600M (Electronics Research&Development Corporation, Okayama, Japan) were evaluated using this phantom: (i) SGRTCT-a SGRT set-up based solely on a computed tomography (CT)-reference image. (ii) SGRTCT + CBCT-a method where cone beam computed tomography (CBCT) matching was performed after SGRTCT. (iii) SGRTScan-a resetup technique using a scan reference image obtained after completing the (ii) step. RESULTS Both the breast and face phantoms were recognized in the SGRT system without problems. SGRTScan ensure precision within 1 mm/1° for breast and face verification, respectively. All SGRT methods showed comparable rotational accuracies with no significant disparities. CONCLUSIONS The developed phantom was useful for verifying the accuracy of skin mark-less SGRT position matching. The SGRTScan demonstrated the feasibility of achieving skin-mark less SGRT with high accuracy, with deviations of less than 1 mm. Additional research is necessary to evaluate the suitability of the developed phantoms for use in various facilities and systems. This phantom could be used for postal surveys in the future.
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Affiliation(s)
- Masahide Saito
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Koji Ueda
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Hikaru Nemoto
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Yoshiko Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Hidekazu Suzuki
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | | | - Naoki Sano
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | | | - Kan Marino
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
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Lastrucci A, Serventi E, Francolini G, Marciello L, Fedeli L, Meucci F, Marzano S, Esposito M, Ricci R. A retrospective comparison of setup accuracy from CBCT and SGRT data in breast cancer patients. J Med Imaging Radiat Sci 2024; 55:29-36. [PMID: 38016852 DOI: 10.1016/j.jmir.2023.10.005] [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: 07/19/2023] [Revised: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Both cone-beam computed tomography (CBCT) and surface-guided radiotherapy (SGRT) are used for breast patient positioning verification before treatment delivery. SGRT may reduce treatment time and imaging dose by potentially reduce the number of CBCT needed. The aim of this study was to compare the displacements resulting in positioning from the Image Guided Radiation Therapy (IGRT) 3D and SGRT methods and to design a clinical workflow for SGRT implementation in breast radiotherapy to establish an imaging strategy based on the data obtained. METHODS For this study 128 breast cancer patients treated with 42.5 Gy in 16 fractions using 3D conformal radiotherapy with free breathing technique were enroled. A total of 366 CBCT images were evaluated for patient setup verification and compared with SGRT. Image registrations between planning CT images and CBCT images were performed in mutual agreement and in online mode by three health professionals. Student's paired t-test was used to compare the absolute difference in vector shift, measured in mm, for each orthogonal axis (x, y, z) between SGRT and CBCT methods. The multidisciplinary team evaluated a review of the original clinical workflow for SGRT implementation and data about patients treated with the updated workflow were reported. RESULTS Comparison of the shifts obtained with IGRT and SGRT for each orthogonal axis (for the x-axes the average displacement was 0.9 ± 0.7 mm, y = 1.1 ± 0.8 mm and z = 1.0 ± 0.7 mm) revealed no significant statistical differences (p > 0.05). Using the updated workflow the difference between SGRT and IGRT displacements was <3 mm in 91.4 % of patients with a reduction in total treatment time of approximately 20 %, due to the reduce frequency of the CBCT images acquisition and matching. CONCLUSIONS This study has shown that IGRT and SGRT agree in positioning patients with breast cancer within a millimetre tolerance. SGRT can be used for patient positioning, with the advantages of reducing radiation exposure and shorter overall treatment time.
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Affiliation(s)
- Andrea Lastrucci
- Radiation Oncology Unit, Santo Stefano Hospital, Department of Allied Health Professions, Azienda USL Toscana Centro, Prato 59100, Italy.
| | - Eva Serventi
- Radiation Oncology Unit, Santo Stefano Hospital, Department of Allied Health Professions, Azienda USL Toscana Centro, Prato 59100, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Luisa Marciello
- Radiation Oncology Unit, Santo Stefano Hospital, Department of Oncology, Azienda USL Toscana Centro, Prato 59100, Italy
| | - Luca Fedeli
- Medical Physics Unit, Santo Stefano Hospital, Azienda USL Toscana Centro, Prato-Pistoia 59100, Italy
| | - Francesco Meucci
- Medical Physics Unit, Santo Stefano Hospital, Azienda USL Toscana Centro, Prato-Pistoia 59100, Italy
| | - Salvino Marzano
- Radiation Oncology Unit, Santo Stefano Hospital, Department of Oncology, Azienda USL Toscana Centro, Prato 59100, Italy
| | - Marco Esposito
- Medical Physics, The Abdus Salam International Centre for Theoretical Physics, Trieste 34151, Italy
| | - Renzo Ricci
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
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Bolin MC, Falk M, Hedman M, Gagliardi G, Onjukka E. Surface-guided radiotherapy improves rotational accuracy in gynecological cancer patients. Rep Pract Oncol Radiother 2024; 28:764-771. [PMID: 38515814 PMCID: PMC10954265 DOI: 10.5603/rpor.98733] [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: 05/04/2023] [Accepted: 12/20/2023] [Indexed: 03/23/2024] Open
Abstract
Background The aim of this study was to determine if rotational uncertainties in gynecological cancer patients can be reduced using surface imaging (SI) compared to aligning three markers on the patient's skin with in-room lasers (marker-laser). Materials and methods Fifty gynecological cancer patients treated with external-beam radiotherapy were retrospectively analyzed; 25 patients were positioned with marker-laser and 25 patients were positioned with SI. The values of rotational (pitch and roll) deviations of the patient positions between the treatment-planning computed tomography (CT) and online cone-beam computed tomography (CBCT) were collected for both subcohorts and all treatment fractions after performing automatic registration between the two image sets. Statistical analysis of the difference between the two set-up methods was performed using the Mann-Whitney U-test. Results The median pitch deviation were 1.5° [interquartile range (IQR): 0.6°-2.6°] and 1.1° (IQR: 0.5°-1.9°) for the marker-laser and SI methods, respectively (p < 0.01). The median roll deviation was 0.5° (IQR: 0.2°-0.9°), and 0.7° (IQR: 0.3°-1.2°) for the marker-laser and SI methods, respectively (p < 0.01). Given the shape of the target, pitch deviations had a greater impact on the uncertainty at the periphery of the target and were considered more relevant. Conclusion By introducing SI as a set-up method in gynecological cancer patients, higher positioning accuracy could be achieved compared with the marker-laser set-up method. This was demonstrated based on residual deviations rather than deviations corrected for by image-guided radiotherapy (IGRT).
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Affiliation(s)
- Mimmi-Caroline Bolin
- Section of Radiotherapy and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Marianne Falk
- Section of Radiotherapy and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mattias Hedman
- Department of Radiation Oncology, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Giovanna Gagliardi
- Section of Radiotherapy and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Eva Onjukka
- Section of Radiotherapy and Engineering, Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
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Zhao H, Sarkar V, St James S, Paxton A, Su FF, Price RG, Dial C, Poppe M, Gaffney D, Salter B. Verification of surface-guided radiation therapy ( SGRT) alignment for proton breast and chest wall patients by comparison to CT-on-rails and kV-2D alignment. J Appl Clin Med Phys 2024; 25:e14263. [PMID: 38268200 PMCID: PMC10860439 DOI: 10.1002/acm2.14263] [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: 03/27/2023] [Revised: 12/10/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Surface-guided radiation therapy (SGRT) systems have been widely installed and utilized on linear accelerators. However, the use of SGRT with proton therapy is still a newly developing field, and published reports are currently very limited. PURPOSE To assess the clinical application and alignment agreement of SGRT with CT-on-rails (CTOR) and kV-2D image-guided radiation therapy (IGRT) for breast treatment using proton therapy. METHODS Four patients receiving breast or chest wall treatment with proton therapy were the subjects of this study. Patient #1's IGRT modalities were a combination of kV-2D and CTOR. CTOR was the only imaging modality for patients #2 and #3, and kV-2D was the only imaging modality for patient #4. The patients' respiratory motions were assessed using a 2-min surface position recorded by the SGRT system during treatment. SGRT offsets reported after IGRT shifts were recorded for each fraction of treatment. The agreement between SGRT and either kV-2D or CTOR was evaluated. RESULTS The respiratory motion amplitude was <4 mm in translation and <2.0° in rotation for all patients. The mean and maximum amplitude of SGRT offsets after application of IGRT shifts were ≤(2.6 mm, 1.6° ) and (6.8 mm, 4.5° ) relative to kV-2D-based IGRT; ≤(3.0 mm, 2.6° ) and (5.0 mm, 4.7° ) relative to CTOR-based IGRT without breast tissue inflammation. For patient #3, breast inflammation was observed for the last three fractions of treatment, and the maximum SGRT offsets post CTOR shifts were up to (14.0 mm, 5.2° ). CONCLUSIONS Due to the overall agreement between SGRT and IGRT within reasonable tolerance, SGRT has the potential to serve as a valuable auxiliary IGRT tool for proton breast treatment and may improve the efficiency of proton breast treatment.
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Affiliation(s)
- Hui Zhao
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Vikren Sarkar
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Sara St James
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Adam Paxton
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | | | - Ryan G. Price
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Christian Dial
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Matthew Poppe
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - David Gaffney
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
| | - Bill Salter
- Radiation Oncology DepartmentUniversity of UtahSalt Lake CityUtahUSA
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Rudat V, Shi Y, Zhao R, Yu W. Setup margins based on the inter- and intrafractional setup error of left-sided breast cancer radiotherapy using deep inspiration breath-hold technique (DIBH) and surface guided radiotherapy ( SGRT). J Appl Clin Med Phys 2024:e14271. [PMID: 38273673 DOI: 10.1002/acm2.14271] [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: 08/23/2023] [Revised: 10/27/2023] [Accepted: 12/29/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE The use of volumetric modulated arc therapy (VMAT), simultaneous integrated boost (SIB), and hypofractionated regimen requires adequate patient setup accuracy to achieve an optimal outcome. The purpose of this study was to assess the setup accuracy of patients receiving left-sided breast cancer radiotherapy using deep inspiration breath-hold technique (DIBH) and surface guided radiotherapy (SGRT) and to calculate the corresponding setup margins. METHODS The patient setup accuracy between and within radiotherapy fractions was measured by comparing the 6DOF shifts made by the SGRT system AlignRT with the shifts made by kV-CBCT. Three hundred and three radiotherapy fractions of 23 left-sided breast cancer patients using DIBH and SGRT were used for the analysis. All patients received pre-treatment DIBH training and visual feedback during DIBH. An analysis of variance (ANOVA) was used to test patient setup differences for statistical significance. The corresponding setup margins were calculated using the van Herk's formula. RESULTS The intrafractional patient setup accuracy was significantly better than the interfractional setup accuracy (p < 0.001). The setup margin for the combined inter- and intrafractional setup error was 4, 6, and 4 mm in the lateral, longitudinal, and vertical directions if based on SGRT alone. The intrafractional error contributed ≤1 mm to the calculated setup margins. CONCLUSION With SGRT, excellent intrafractional and acceptable interfractional patient setup accuracy can be achieved for the radiotherapy of left-sided breast cancer using DIBH and modern radiation techniques. This allows for reducing the frequency of kV-CBCTs, thereby saving treatment time and radiation exposure.
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Affiliation(s)
- Volker Rudat
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China
| | - Yanyan Shi
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China
| | - Ruping Zhao
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China
| | - Wei Yu
- Department of Radiation Oncology, Jiahui International Cancer Center Shanghai, Jiahui Health, Shanghai, China
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Stanley DN, Covington E, Harms J, Pogue J, Cardenas CE, Popple RA. Evaluation and correlation of patient movement during online adaptive radiotherapy with CBCT and a surface imaging system. J Appl Clin Med Phys 2023; 24:e14133. [PMID: 37643456 PMCID: PMC10691620 DOI: 10.1002/acm2.14133] [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: 05/23/2023] [Revised: 07/10/2023] [Accepted: 08/06/2023] [Indexed: 08/31/2023] Open
Abstract
PURPOSE With the clinical implementation of kV-CBCT-based daily online-adaptive radiotherapy, the ability to monitor, quantify, and correct patient movement during adaptive sessions is paramount. With sessions lasting between 20-45 min, the ability to detect and correct for small movements without restarting the entire session is critical to the adaptive workflow and dosimetric outcome. The purpose of this study was to quantify and evaluate the correlation of observed patient movement with machine logs and a surface imaging (SI) system during adaptive radiation therapy. METHODS Treatment machine logs and SGRT registration data log files for 1972 individual sessions were exported and analyzed. For each session, the calculated shifts from a pre-delivery position verification CBCT were extracted from the machine logs and compared to the SGRT registration data log files captured during motion monitoring. The SGRT calculated shifts were compared to the reported shifts of the machine logs for comparison for all patients and eight disease site categories. RESULTS The average (±STD) net displacement of the SGRT shifts were 2.6 ± 3.4 mm, 2.6 ± 3.5 mm, and 3.0 ± 3.2 in the lateral, longitudinal, and vertical directions, respectively. For the treatment machine logs, the average net displacements in the lateral, longitudinal, and vertical directions were 2.7 ± 3.7 mm, 2.6 ± 3.7 mm, and 3.2 ± 3.6 mm. The average difference (Machine-SGRT) was -0.1 ± 1.8 mm, 0.2 ± 2.1 mm, and -0.5 ± 2.5 mm for the lateral, longitudinal, and vertical directions. On average, a movement of 5.8 ± 5.6 mm and 5.3 ± 4.9 mm was calculated prior to delivery for the CBCT and SGRT systems, respectively. The Pearson correlation coefficient between CBCT and SGRT shifts was r = 0.88. The mean and median difference between the treatment machine logs and SGRT log files was less than 1 mm for all sites. CONCLUSION Surface imaging should be used to monitor and quantify patient movement during adaptive radiotherapy.
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Affiliation(s)
- Dennis N. Stanley
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Elizabeth Covington
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of Radiation OncologyMichigan MedicineAnn ArborMichiganUSA
| | - Joseph Harms
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Joel Pogue
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Carlos E. Cardenas
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Richard A. Popple
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Covington EL, Stanley DN, Sullivan RJ, Riley KO, Fiveash JB, Popple RA. Commissioning and clinical evaluation of the IDENTIFY TM surface imaging system for frameless stereotactic radiosurgery. J Appl Clin Med Phys 2023; 24:e14058. [PMID: 37289550 PMCID: PMC10562042 DOI: 10.1002/acm2.14058] [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: 02/25/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE To commission and assess the clinical performance of a new commercial surface imaging (SI) system by analyzing intra-fraction motion from the initial cohort of patients treated with frameless stereotactic radiosurgery (fSRS). METHODS The IDENTIFYTM SI system was commissioned for clinical use on an Edge (Varian Medical Systems, Palo Alto, CA) linear accelerator. All patients who received intracranial radiotherapy with HyperArcTM (Varian Medical Systems, Palo Alto, CA) were immobilized with the EncompassTM (Qfix, Avondale, PA) thermoplastic mask and monitored for intra-fraction motion with SI. IDENTIFYTM log files were correlated with trajectory log files to correlate treatment parameters with SI-reported offsets. IDENTIFYTM reported offsets were correlated with gantry and couch angles to assess system performance for obstructed and clear camera field of view. Data were stratified by race to evaluate performance differences due to skin tone. RESULTS All commissioning data were found to meet recommended tolerances. IDENTIFYTM was used to monitor intra-fraction motion on 1164 fractions from 386 patients. The median magnitude of translational SI reported offsets at the end of treatment was 0.27 mm. SI reported offsets were shown to increase when camera pods are blocked by the gantry with larger increases seen at non-zero couch angles. With camera obstruction, the median magnitude of the SI reported offset was 0.50 and 0.80 mm for White and Black patients, respectively. CONCLUSIONS IDENTIFYTM performance during fSRS is comparable to other commercially available SI systems where offsets are shown to increase at non-zero couch angles and during camera pod blockage.
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Affiliation(s)
- Elizabeth L. Covington
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Department of Radiation OncologyUniversity of MichiganAnn ArborMichiganUSA
| | - Dennis N. Stanley
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rodney J. Sullivan
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Kristen O. Riley
- Department of NeurosurgeryUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - John B. Fiveash
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Richard A. Popple
- Department of Radiation OncologyUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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Darréon J, Massabeau C, Geffroy C, Maroun P, Simon L. Surface-guided radiotherapy overview: Technical aspects and clinical applications. Cancer Radiother 2023; 27:504-510. [PMID: 37558608 DOI: 10.1016/j.canrad.2023.07.003] [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: 06/29/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 08/11/2023]
Abstract
In radiotherapy, patient positioning has long been ensured by ionizing imaging (kV or MV). Over the past ten years, surface-guided radiotherapy has appeared in radiotherapy departments. It is a continuous three-dimensional acquisition of the surface of the patient, based on the use of several optical cameras. The acquired surface is compared to an expected surface (usually taken from the planning scanner). Operators can constantly appreciate poor position, anatomical deformity or patient shift. Thus, the system allows an aid to the positioning of the patient, possibly without tattooing, but also a follow-up of the patient during the duration of the session. The most obvious contribution of the system concerns the treatment of the breast. In fact, for this location, the bone registration is not ideal and the target is visible in surface-guided radiotherapy. These systems also make it possible to treat in deep inspiration breath hold. But several other locations can benefit from it (pelvis, thorax, etc.).
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Affiliation(s)
- J Darréon
- Medical Physics Department, institut Paoli-Calmettes, Marseille, France.
| | - C Massabeau
- Département de radiothérapie, Oncopole Claudius-Regaud (OCR), institut universitaire du cancer de Toulouse Oncopole (IUCT O), Toulouse, France
| | - C Geffroy
- Centre Eugène-Marquis, Rennes, France
| | - P Maroun
- Institut radiothérapie Sud de l'Oise, Creil, France
| | - L Simon
- Département de radiothérapie, Oncopole Claudius-Regaud (OCR), institut universitaire du cancer de Toulouse Oncopole (IUCT O), Toulouse, France; Inserm, équipe Radopt, CNRS, centre de recherches en cancérologie de Toulouse (CRCT), université Paul-Sabatier Toulouse III, Toulouse, France
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Lai J, Luo Z, Hu H, Jiang L, Wu J, Lei L, Qu L, Wu Z. SGRT-based DIBH radiotherapy practice for right-sided breast cancer combined with RNI: A retrospective study on dosimetry and setup accuracy. J Appl Clin Med Phys 2023:e13998. [PMID: 37087557 PMCID: PMC10402663 DOI: 10.1002/acm2.13998] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/29/2023] [Accepted: 04/07/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND We retrospectively studied the dosimetry and setup accuracy of deep inspiration breath-hold (DIBH) radiotherapy in right-sided breast cancer patients with regional nodal irradiation (RNI) who had completed treatment based on surface-guided radiotherapy (SGRT) technology by Sentinel/Catalyst system, aiming to clarify the clinical application value and related issues. METHODS Dosimetric indicators of four organs at risk (OARs), namely the heart, right coronary artery (RCA), right lung, and liver, were compared on the premise that the planning target volume met dose-volume prescription requirements. Meanwhile, the patients were divided into the edge of the xiphoid process (EXP), sternum middle (SM), and left breast wall (LBW) groups according to different positions of respiratory gating primary points. The CBCT setup error data of the three groups were contrasted for the treatment accuracy study, and the effects of different gating window heights on the right lung volume increases were compared among the three groups. RESULTS Compared with free breath (FB), DIBH reduced the maximum dose of heart and RCA by 739.3 ± 571.2 cGy and 509.8 ± 403.8 cGy, respectively (p < 0.05). The liver changed the most in terms of the mean dose (916.9 ± 318.9 cGy to 281.2 ± 150.3 cGy, p < 0.05). The setup error of the EXP group in the anterior-posterior (AP) direction was 3.6 ± 4.5 mm, which is the highest among the three groups. The right lung volume increases in the EXP, SM, and LBW groups were 72.3%, 69.9%, and 67.2%, respectively (p = 0.08), and the corresponding breath-holding heights were 13.5 ± 3.7 mm, 10.3 ± 2.4 mm, and 9.6 ± 2.8 mm, respectively (p < 0.05). CONCLUSIONS SGRT-based DIBH radiotherapy can better protect the four OARs of right-sided breast cancer patients with RNI. Different respiratory gating primary points have different setup accuracy and breath-hold height.
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Affiliation(s)
- Jianjun Lai
- Instiute of Intelligent Control and Robotics, Hangzhou Dianzi University, Hangzhou, China
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Zhizeng Luo
- Instiute of Intelligent Control and Robotics, Hangzhou Dianzi University, Hangzhou, China
| | - Haili Hu
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Lu Jiang
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Jing Wu
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Lan Lei
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Li Qu
- Department of Breast Surgery, Affiliated Hangzhou First Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhibing Wu
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
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11
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Kang S, Jin H, Chang JH, Jang BS, Shin KH, Choi CH, Kim JI. Evaluation of initial patient setup methods for breast cancer between surface-guided radiation therapy and laser alignment based on skin marking in the Halcyon system. Radiat Oncol 2023; 18:60. [PMID: 37016351 PMCID: PMC10071653 DOI: 10.1186/s13014-023-02250-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/27/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND This study was conducted to evaluate the efficiency and accuracy of the daily patient setup for breast cancer patients by applying surface-guided radiation therapy (SGRT) using the Halcyon system instead of conventional laser alignment based on the skin marking method. METHODS AND MATERIALS We retrospectively investigated 228 treatment fractions using two different initial patient setup methods. The accuracy of the residual rotational error of the SGRT system was evaluated by using an in-house breast phantom. The residual translational error was analyzed using the couch position difference in the vertical, longitudinal, and lateral directions between the reference computed tomography and daily kilo-voltage cone beam computed tomography acquired from the record and verification system. The residual rotational error (pitch, yaw, and roll) was also calculated using an auto rigid registration between the two images based on Velocity. The total setup time, which combined the initial setup time and imaging time, was analyzed to evaluate the efficiency of the daily patient setup for SGRT. RESULTS The average residual rotational errors using the in-house fabricated breast phantom for pitch, roll, and yaw were 0.14°, 0.13°, and 0.29°, respectively. The average differences in the couch positions for laser alignment based on the skin marking method were 2.7 ± 1.6 mm, 2.0 ± 1.2 mm, and 2.1 ± 1.0 mm for the vertical, longitudinal, and lateral directions, respectively. For SGRT, the average differences in the couch positions were 1.9 ± 1.2 mm, 2.9 ± 2.1 mm, and 1.9 ± 0.7 mm for the vertical, longitudinal, and lateral directions, respectively. The rotational errors for pitch, yaw, and roll without the surface-guided radiation therapy approach were 0.32 ± 0.30°, 0.51 ± 0.24°, and 0.29 ± 0.22°, respectively. For SGRT, the rotational errors were 0.30 ± 0.22°, 0.51 ± 0.26°, and 0.19 ± 0.13°, respectively. The average total setup times considering both the initial setup time and imaging time were 314 s and 331 s, respectively, with and without SGRT. CONCLUSION We demonstrated that using SGRT improves the accuracy and efficiency of initial patient setups in breast cancer patients using the Halcyon system, which has limitations in correcting the rotational offset.
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Affiliation(s)
- Seonghee Kang
- Department of Radiation Oncology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Hyeongmin Jin
- Department of Radiation Oncology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Ji Hyun Chang
- Department of Radiation Oncology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bum-Sup Jang
- Department of Radiation Oncology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Hwan Shin
- Department of Radiation Oncology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.
| | - Jung-In Kim
- Department of Radiation Oncology, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.
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12
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Cilla S, Romano C, Craus M, Viola P, Macchia G, Boccardi M, De Vivo LP, Buwenge M, Morganti AG, Deodato F. Reproducibility and stability of spirometer-guided deep inspiration breath-hold in left-breast treatments using an optical surface monitoring system. J Appl Clin Med Phys 2023:e13922. [PMID: 36852489 DOI: 10.1002/acm2.13922] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 03/01/2023] Open
Abstract
The aim of this study was to evaluate the reproducibility and stability of left breast positioning during spirometer-guided deep-inspiration breath-hold (DIBH) radiotherapy using an optical surface imaging system (AlignRT). The AlignRT optical tracking system was used to monitor five left-sided breast cancer patients treated using the Active Breathing Coordinator spirometer with DIBH technique. Treatment plans were created using an automated hybrid-VMAT technique on DIBH CTs. A prescribed dose of 60 Gy to the tumor bed and 50 Gy to the breast in 25 fractions was planned. During each treatment session, the antero-posterior (VRT), superior-inferior (LNG), and lateral (LAT) motion of patients was continuously recorded by AlignRT. The intra-breath-hold stability and the intra- and inter-fraction reproducibility were analyzed for all breath-holds and treatment fractions. The dosimetric impact of the residual motion during DIBH was evaluated from the isocenter shifts amplitudes obtained from the 50%, 90%, and 100% cumulative distribution functions of intra-fractional reproducibility. The positional variations of 590 breath-holds as measured by AlignRT were evaluated. The mean intra-breath-hold stability during DIBH was 1.0 ± 0.4 mm, 2.1 ± 1.9 mm, and 0.7 ± 0.5 mm in the VRT, LNG, and LAT directions, with a maximal value of 8.8 mm in LNG direction. Similarly, the mean intra-breath-hold reproducibility was 1.4 ± 0.8 mm, 1.7 ± 1.0 mm, and 0.8 ± 0.5 mm in the VRT, LNG, and LAT directions, with a maximal value of 4.1 mm in LNG direction. Inter-fractional reproducibility showed better reliability, with difference in breathing levels in all fractions of 0.3 mm on average. Based on tolerance limits corresponding to the 90% cumulative distribution level, gating window widths of 1 mm, 2 mm, and 5 mm in the LAT, VRT, and LNG directions were considered an appropriate choice. In conclusion, despite the use of a dedicated spirometer at constant tidal volume, a non-negligible variability of the breast surface position has been reported during breath-holds. The real-time monitoring of breast surface using surface-guided optical technology is strongly recommended.
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Affiliation(s)
- Savino Cilla
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Carmela Romano
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Maurizio Craus
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Pietro Viola
- Medical Physics Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Gabriella Macchia
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Mariangela Boccardi
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Livia P De Vivo
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
| | - Milly Buwenge
- Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy
| | - Alessio G Morganti
- Radiation Oncology Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,DIMES, Alma Mater Studiorum, Bologna University, Bologna, Italy
| | - Francesco Deodato
- Radiation Oncology Unit, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, Campobasso, Italy
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13
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Parsons D, Joo M, Iqbal Z, Godley A, Kim N, Spangler A, Albuquerque K, Sawant A, Zhao B, Gu X, Rahimi A. Stability and reproducibility comparisons between deep inspiration breath-hold techniques for left-sided breast cancer patients: A prospective study. J Appl Clin Med Phys 2023; 24:e13906. [PMID: 36691339 PMCID: PMC10161105 DOI: 10.1002/acm2.13906] [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: 08/30/2022] [Revised: 12/06/2022] [Accepted: 12/23/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Deep inspiration breath-hold (DIBH) is crucial in reducing the lung and cardiac dose for treatment of left-sided breast cancer. We compared the stability and reproducibility of two DIBH techniques: Active Breathing Coordinator (ABC) and VisionRT (VRT). MATERIALS AND METHODS We examined intra- and inter-fraction positional variation of the left lung. Eight left-sided breast cancer patients were monitored with electronic portal imaging during breath-hold (BH) at every fraction. For each patient, half of the fractions were treated using ABC and the other half with VRT, with an equal amount starting with either ABC or VRT. The lung in each portal image was delineated, and the variation of its area was evaluated. Intrafraction stability was evaluated as the mean coefficient of variation (CV) of the lung area for the supraclavicular (SCV) and left lateral (LLat) field over the course of treatment. Reproducibility was the CV for the first image of each fraction. Daily session time and total imaging monitor units (MU) used in patient positioning were recorded. RESULTS The mean intrafraction stability across all patients for the LLat field was 1.3 ± 0.7% and 1.5 ± 0.9% for VRT and ABC, respectively. Similarly, this was 1.5 ± 0.7% and 1.6 ± 0.8% for VRT and ABC, respectively, for the SCV field. The mean interfraction reproducibility for the LLat field was 11.0 ± 3.4% and 14.9 ± 6.0% for VRT and ABC, respectively. Similarly, this was 13.0 ± 2.5% and 14.8 ± 9% for VRT and ABC, respectively, for the SCV. No difference was observed in the number of verification images required for either technique. CONCLUSIONS The stability and reproducibility were found to be comparable between ABC and VRT. ABC can have larger interfractional variation with less feedback to the treating therapist compared to VRT as shown in the increase in geometric misses at the matchline.
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Affiliation(s)
- David Parsons
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Mindy Joo
- Department of Radiation Oncology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Zohaib Iqbal
- 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
| | - Nathan Kim
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ann Spangler
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kevin Albuquerque
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amit Sawant
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bo Zhao
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Xuejun Gu
- Department of Radiation Oncology, Stanford University, Palo Alto, California, USA
| | - Asal Rahimi
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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14
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Da Silva Mendes V, Reiner M, Huang L, Reitz D, Straub K, Corradini S, Niyazi M, Belka C, Kurz C, Landry G, Freislederer P. ExacTrac Dynamic workflow evaluation: Combined surface optical/thermal imaging and X-ray positioning. J Appl Clin Med Phys 2022; 23:e13754. [PMID: 36001389 DOI: 10.1002/acm2.13754] [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: 11/18/2021] [Revised: 07/07/2022] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
Abstract
In modern radiotherapy (RT), especially for stereotactic radiotherapy or stereotactic radiosurgery treatments, image guidance is essential. Recently, the ExacTrac Dynamic (EXTD) system, a new combined surface-guided RT and image-guided RT (IGRT) system for patient positioning, monitoring, and tumor targeting, was introduced in clinical practice. The purpose of this study was to provide more information about the geometric accuracy of EXTD and its workflow in a clinical environment. The surface optical/thermal- and the stereoscopic X-ray imaging positioning systems of EXTD was evaluated and compared to cone-beam computed tomography (CBCT). Additionally, the congruence with the radiation isocenter was tested. A Winston Lutz test was executed several times over 1 year, and repeated end-to-end positioning tests were performed. The magnitude of the displacements between all systems, CBCT, stereoscopic X-ray, optical-surface imaging, and MV portal imaging was within the submillimeter range, suggesting that the image guidance provided by EXTD is accurate at any couch angle. Additionally, results from the evaluation of 14 patients with intracranial tumors treated with open-face masks are reported, and limited differences with a maximum of 0.02 mm between optical/thermal- and stereoscopic X-ray imaging were found. As the optical/thermal positioning system showed a comparable accuracy to other IGRT systems, and due to its constant monitoring capability, it can be an efficient tool for detecting intra-fractional motion and for real-time tracking of the surface position during RT.
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Affiliation(s)
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Lili Huang
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Reitz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Katrin Straub
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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15
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Ates O, Zhao L, Sobczak D, Pirlepesov F, Hua CH, Waghorn B, Merchant TE. Design of a novel 5-camera surface guidance system with multiple imaging isocenters. J Appl Clin Med Phys 2022; 23:e13750. [PMID: 35946854 PMCID: PMC9588261 DOI: 10.1002/acm2.13750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/27/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose/objective(s) Surface‐guided radiation therapy (SGRT) can track the patient surface noninvasively to complement radiographic image‐guided radiation therapy with a standard 3‐camera system and a single radiation/image isocenter. Here we report the commissioning of a novel SGRT system that monitors three imaging isocenters locations in a proton half‐gantry room with a unique 5‐camera configuration. Materials/methods The proton half‐gantry room has three image isocenters, designated ISO‐0, ISO‐1, and ISO‐2, to cover various anatomical sites via a robotic ceiling‐mounted cone‐beam CT. Although ISO‐0 and ISO‐1 are used to image the cranium, head and neck, and thoracic regions, ISO‐2 is often used to image body and extremity sites and contiguous craniospinal target volumes. The five‐camera system was calibrated to the radiographic isocenter by using a stereotactic radiosurgery cube phantom for each image isocenter. Results The performance of this 5‐camera system was evaluated for 6 degrees of freedom in three categories: (1) absolute setup accuracy relative to the radiographic kV image isocenter based on the DICOM reference; (2) relative shift accuracy based on a reference surface capture; and (3) isocenter tracking accuracy from one isocenter to another based on a reference surface capture. The evaluation revealed maximum deviations of 0.8, 0.2, and 0.6 mm in translation and 0.2°, 0.1°, and 0.1° in rotation for the first, second, and third categories, respectively. Comparing the dosimetry and latency with static and gated irradiation revealed a 0.1% dose difference and positional differences of 0.8 mm in X and 0.9 mm in Y with less than 50 ms temporal accuracy. Conclusion The unique 5‐camera system configuration provides SGRT at the treatment isocenter (ISO‐0) and also imaging isocenter locations (ISO‐0, ISO‐1, and ISO‐2) to ensure correct patient positioning before and after radiographic imaging, especially during transitions from the offset imaging isocenters to the treatment isocenter.
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Affiliation(s)
- Ozgur Ates
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Li Zhao
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - David Sobczak
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Fakhriddin Pirlepesov
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Chia-Ho Hua
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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16
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Zhou S, Li J, Zhu X, Du Y, Yu S, Wang M, Yao K, Wu H, Yue H. Initial clinical experience of surface guided stereotactic radiation therapy with open-face mask immobilization for improving setup accuracy: a retrospective study. Radiat Oncol 2022; 17:104. [PMID: 35659685 PMCID: PMC9167505 DOI: 10.1186/s13014-022-02077-4] [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: 03/15/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
Purpose To propose a specific surface guided stereotactic radiotherapy (SRT) treatment procedure with open-face mask immobilization and evaluate the initial clinical experience in improving setup accuracy. Methods and materials The treatment records of 48 SRT patients with head lesions were retrospectively analyzed. For each patient, head immobilization was achieved with a double-shell open-face mask. The anterior shell was left open to expose the forehead, nose, eyes and cheekbones. The exposed facial area was used as region-of-interest for surface tracking by AlignRT (VisionRT Inc, UK). The posterior shell provided a sturdy and personalized headrest. Patient initial setup was guided by 6DoF real-time deltas (RTD) using the reference surface obtained from the skin contour delineated on the planning CT images. The endpoint of initial setup was 1 mm in translational RTD and 1 degree in rotational RTD. CBCT guidance was performed to derive the initial setup errors, and couch shifts for setup correction were applied prior to treatment delivery. CBCT couch shifts, AlignRT RTD values, repositioning rate and setup time were analyzed. Results The absolute values of median (maximal) CBCT couch shifts were 0.4 (1.3) mm in VRT, 0.1 (2.5) mm in LNG, 0.2 (1.6) mm in LAT, 0.1(1.2) degree in YAW, 0.2 (1.4) degree in PITCH and 0.1(1.3) degree in ROLL. The couch shifts and AlignRT RTD values exhibited highly agreement except in VRT and PITCH (p value < 0.01), of which the differences were as small as negligible. We did not find any case of patient repositioning that was due to out-of-tolerance setup errors, i.e., 3 mm and 2 degree. The surface guided setup time ranged from 52 to 174 s, and the mean and median time was 97.72 s and 94 s respectively. Conclusions The proposed surface guided SRT procedure with open-face mask immobilization is a step forward in improving patient comfort and positioning accuracy in the same process. Minimized initial setup errors and repositioning rate had been achieved with reasonably efficiency for routine clinical practice.
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Affiliation(s)
- Shun Zhou
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China
| | - Junyu Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China
| | - Xianggao Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China
| | - Yi Du
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China. .,Institute of Medical Technology, Peking University Health Science Center, 38 Huayuan Road, Beijing, 100191, China.
| | - Songmao Yu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China
| | - Meijiao Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China
| | - Kaining Yao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China
| | - Hao Wu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China.,Institute of Medical Technology, Peking University Health Science Center, 38 Huayuan Road, Beijing, 100191, China
| | - Haizhen Yue
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, 52 Fucheng Road, Beijing, 100142, China.
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17
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Batista V, Gober M, Moura F, Webster A, Oellers M, Ramtohul M, Kügele M, Freislederer P, Buschmann M, Anastasi G, Steiner E, Al-Hallaq H, Lehmann J. Surface guided radiation therapy: An international survey on current clinical practice. Tech Innov Patient Support Radiat Oncol 2022; 22:1-8. [PMID: 35402740 PMCID: PMC8984757 DOI: 10.1016/j.tipsro.2022.03.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/25/2022] [Accepted: 03/21/2022] [Indexed: 12/17/2022] Open
Abstract
Introduction Surface Guided Radiation Therapy (SGRT) is being increasingly implemented into clinical practice across a number of techniques and irradiation-sites. This technology, which is provided by different vendors, can be used with most simulation- and delivery-systems. However, limited guidelines and the complexity of clinical settings have led to diverse patterns of operation. With the aim to understand current clinical practice a survey was designed focusing on specifics of the clinical implementation and usage. Materials and methods A 32-question survey covered: type and number of systems, quality assurance (QA), clinical workflows, and identification of strengths/limitations. Respondents from different professional groups and countries were invited to participate. The survey was distributed internationally via ESTRO-membership, social media and vendors. Results Of the 278 institutions responding, 172 had at least one SGRT-system and 136 use SGRT clinically. Implementation and QA were primarily based on the vendors' recommendations and phantoms. SGRT was mainly implemented in breast RT (116/136), with strong but diverse representation of other sites. Many (58/135) reported at least partial elimination of skin-marks and a third (43/126) used open-masks. The most common imaging protocol reported included the combination of radiographic imaging with SGRT. Patient positioning (115/136), motion management (104/136) and DIBH (99/136) were the main applications.Main barriers to broader application were cost, system integration issues and lack of demonstrated clinical value. A lack of guidelines in terms of QA of the system was highlighted. Conclusions This overview of the SGRT status has the potential to support users, vendors and organisations in the development of practices, products and guidelines.
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Affiliation(s)
- V Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Oncology (NCRO), Heidelberg, Germany
| | - M Gober
- Department of Radiation Oncology, Medical University of Vienna, Austria.,Institute for Radiation Oncology and Radiotherapy, Landesklinikum Wiener Neustadt, Austria
| | - F Moura
- Hospital CUF Descobertas, Department of Radiation Oncology, Lisbon, Portugal
| | - A Webster
- Radiotherapy and Proton Beam Therapy, University College Hospital, London, United Kingdom
| | - M Oellers
- MAASTRO Clinic, Department of Medical Physics, Maastricht, the Netherlands
| | - M Ramtohul
- Department of Medical Physics, Queen Elizabeth Hospital, University Hospitals Birmingham
| | - M Kügele
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Medical Radiation Physics, Lund University, Lund, Sweden
| | - P Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M Buschmann
- Department of Radiation Oncology, Medical University of Vienna, Austria
| | - G Anastasi
- St. Luke's Cancer Centre, Royal Surrey Foundation Trust, Radiotherapy Physics, United Kingdom
| | - E Steiner
- Institute for Radiation Oncology and Radiotherapy, Landesklinikum Wiener Neustadt, Austria
| | - H Al-Hallaq
- Department of Radiation and Cellular Oncology, University of Chicago, USA
| | - J Lehmann
- Radiation Oncology Department, Calvary Mater Newcastle, Australia.,School of Information and Physical Sciences, University of Newcastle, Callaghan, Australia.,Institute of Medical Physics, University of Sydney, Australia
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Freislederer P, Batista V, Öllers M, Buschmann M, Steiner E, Kügele M, Fracchiolla F, Corradini S, de Smet M, Moura F, Perryck S, Dionisi F, Nguyen D, Bert C, Lehmann J. ESTRO-ACROP guideline on surface guided radiation therapy. Radiother Oncol 2022; 173:188-196. [PMID: 35661677 DOI: 10.1016/j.radonc.2022.05.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
Abstract
Surface guidance systems enable patient positioning and motion monitoring without using ionising radiation. Surface Guided Radiation Therapy (SGRT) has therefore been widely adopted in radiation therapy in recent years, but guidelines on workflows and specific quality assurance (QA) are lacking. This ESTRO-ACROP guideline aims to give recommendations concerning SGRT roles and responsibilities and highlights common challenges and potential errors. Comprehensive guidelines for procurement, acceptance, commissioning, and QA of SGRT systems installed on computed tomography (CT) simulators, C-arm linacs, closed-bore linacs, and particle therapy treatment systems are presented that will help move to a consensus among SGRT users and facilitate a safe and efficient implementation and clinical application of SGRT.
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Affiliation(s)
- P Freislederer
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.
| | - V Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - M Öllers
- Department of Radiotherapy, MAASTRO, Maastricht, The Netherlands
| | - M Buschmann
- Department of Radiation Oncology, Medical University of Vienna/AKH Wien, Austria
| | - E Steiner
- Institute for Radiation Oncology and Radiotherapy, Landesklinikum Wiener Neustadt, Austria
| | - M Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - F Fracchiolla
- Azienda Provinciale per i Servizi Sanitari (APSS) Protontherapy Department, Trento, Italy
| | - S Corradini
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany
| | - M de Smet
- Department of Medical Physics & Instrumentation, Institute Verbeeten, Tilburg, The Netherlands
| | - F Moura
- Hospital CUF Descobertas, Department of Radiation Oncology, Lisbon, Portugal
| | - S Perryck
- Department of Radiation Oncology, University Hospital Zürich, Switzerland
| | - F Dionisi
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - D Nguyen
- Centre de Radiothérapie de Mâcon, France
| | - C Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - J Lehmann
- Radiation Oncology Department, Calvary Mater Newcastle, Australia; School of Information and Physical Sciences, University of Newcastle, Australia; Institute of Medical Physics, University of Sydney, Australia
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Bry V, Saenz D, Pappas E, Kalaitzakis G, Papanikolaou N, Rasmussen K. End to end comparison of surface-guided imaging versus stereoscopic X-rays for the SRS treatment of multiple metastases with a single isocenter using 3D anthropomorphic gel phantoms. J Appl Clin Med Phys 2022; 23:e13576. [PMID: 35322526 PMCID: PMC9121024 DOI: 10.1002/acm2.13576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 01/10/2022] [Accepted: 02/12/2022] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Two end-to-end tests evaluate the accuracy of a surface-guided radiation therapy (SGRT) system (CRAD Catalyst HD) for position verification in comparison to a stereoscopic x-ray imaging system (Brainlab Exactrac ) for single-isocenter, multiple metastases stereotactic radiosurgery (SRS) using 3D polymer gel inserts. MATERIALS AND METHODS A 3D-printed phantom (Prime phantom, RTsafe PC, Athens, Greece) with two separate cylindrical polymer gel inserts were immobilized in open-face masks and treated with a single isocentric, multitarget SRS plan. Planning was done in Brainlab (Elements) to treat five metastatic lesions in one fraction, and initial setup was done using cone beam computed tomography. Positional verification was done using orthogonal X-ray imaging (Brainlab Exactrac) and/or a surface imaging system (CRAD Catalyst HD, Uppsala, Sweden), and shift discrepancies were recorded for each couch angle. Forty-two hours after irradiation, the gel phantom was scanned in a 1.5 Tesla MRI, and images were fused with the patient computed tomography data/structure set for further analysis of spatial dose distribution. RESULTS Discrepancies between the CRAD Catalyst HD system and Brainlab Exactrac were <1 mm in the translational direction and <0.5° in the angular direction at noncoplanar couch angles. Dose parameters (DMean% , D95% ) and 3D gamma index passing rates were evaluated for both setup modalities for each planned target volume (PTV) at a variety of thresholds: 3%/2 mm (Exactrac≥93.1% and CRAD ≥87.2%), 5%/2 mm (Exactrac≥95.6% and CRAD ≥94.6%), and 5%/1 mm (Exactrac≥81.8% and CRAD ≥83.7%). CONCLUSION Dose metrics for a setup with surface imaging was found to be consistent with setup using x-ray imaging, demonstrating high accuracy and reproducibility for treatment delivery. Results indicate the feasibility of using surface imaging for position verification at noncoplanar couch angles for single-isocenter, multiple-target SRS using end-to-end quality assurance (QA) testing with 3D polymer gel dosimetry.
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Affiliation(s)
- Victoria Bry
- Department of Radiation OncologyThe University of Texas Health at San AntonioSan AntonioTexasUSA
| | - Daniel Saenz
- Department of Radiation OncologyThe University of Texas Health at San AntonioSan AntonioTexasUSA
| | - Evangelos Pappas
- Department of Biomedical SciencesRadiology and Radiotherapy SectorUniversity of West AtticaAthensGreece
| | | | - Nikos Papanikolaou
- Department of Radiation OncologyThe University of Texas Health at San AntonioSan AntonioTexasUSA
| | - Karl Rasmussen
- Department of Radiation OncologyThe University of Texas Health at San AntonioSan AntonioTexasUSA
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Lehmann J, Standen TS, Kaur G, Wolf J, Wilfert A, Simpson J. Methodology of thermal drift measurements for surface guided radiation therapy systems and clinical impact assessment illustrated on the C-Rad Catalyst + HD system. Tech Innov Patient Support Radiat Oncol 2022; 21:58-63. [PMID: 35243046 DOI: 10.1016/j.tipsro.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 02/09/2022] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Thermal drift of optical systems employed for surface guided radiation therapy (SGRT) adds uncertainty to patient setup and monitoring. This work describes methods to measure the drift of individual camera pods as well as the drift of the combined clinical signal. It presents results for four clinical C-Rad Catalyst+ HD systems. Based on the measured clinical drift, recipes are provided on how to calculate relevant uncertainties in patient setup and patient position monitoring with SGRT. Strategies to reduce the impact of drift are explained. While the results are specific to the systems investigated, the methodology is transferable and the clinical recipes are universally applicable.
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21
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Bright M, Foster RD, Hampton CJ, Ruiz J, Moeller B. Failure modes and effects analysis for surface-guided DIBH breast radiotherapy. J Appl Clin Med Phys 2022; 23:e13541. [PMID: 35112445 PMCID: PMC8992938 DOI: 10.1002/acm2.13541] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 11/19/2021] [Accepted: 01/03/2022] [Indexed: 12/04/2022] Open
Abstract
Despite breast cancer prevalence and widespread adoption of deep inspiration breath‐hold (DIBH) radiation techniques, few data exist on the error risks related to using surface‐guided (SG) DIBH during breast radiation therapy (RT). Due to the increasingly technical nature of these methods and being a paradigm shift from traditional breast setups/treatments, the associated risk for error is high. Failure modes and effects analysis (FMEA) has been used in identifying risky RT processes yet is time‐consuming to perform. A subset of RT staff and a hospital patient‐safety representative performed FMEA to study SG‐DIBH RT processes. After this group (cohort 1) analyzed these processes, additional scoring data were acquired from RT staff uninvolved in the original FMEA (cohort 2). Cohort 2 received abbreviated FMEA training while using the same process maps that cohort 1 had created, which was done with the goal of validating our results and exploring the feasibility of expedited FMEA training and efficient implementation elsewhere. An extensive review of the SG‐DIBH RT process revealed 57 failure modes in 16 distinct steps. Risks deemed to have the highest priority, large risk priority number (RPN), and severity were addressed with policy changes, checklists, and standardization; of these, most were linked with operator error via manual inputs and verification. Reproducibility results showed that 5% of the average RPN between cohorts 1 and 2 was statistically different. Unexpected associations were noted between RPN and RT staff role; 12% of the physicist and therapist average scores were statistically different. Different levels of FMEA training yielded similar scoring within one RT department, suggesting a time‐savings can be achieved with abbreviated training. Scores between professions, however, yielded significant differences suggesting the importance of involving staff across disciplines.
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Affiliation(s)
- Megan Bright
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health Cabarrus, Concord, North Carolina, USA
| | - Ryan D Foster
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health Cabarrus, Concord, North Carolina, USA
| | - Carnell J Hampton
- Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Justin Ruiz
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health Cabarrus, Concord, North Carolina, USA
| | - Benjamin Moeller
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health Cabarrus, Concord, North Carolina, USA
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22
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Blake N, Pereira L, Eaton DJ, Dobson D. Surface-guided radiotherapy for lung cancer can reduce the number of close patient contacts without compromising initial setup accuracy. Tech Innov Patient Support Radiat Oncol 2021; 20:61-63. [PMID: 34988300 PMCID: PMC8710980 DOI: 10.1016/j.tipsro.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 01/21/2023] Open
Abstract
Surface-guided radiotherapy (SGRT) can assist with patient setup by providing a real-time feedback mechanism over the whole patient treatment surface. It also has the potential to reduce the number of close contacts between staff and the patient, which is advocated for infection control during the COVID-19 pandemic. Residual translations and rotations (post-CBCT) were acquired following a conventional setup protocol (using permanent marks and lasers) and an SGRT setup protocol. The SGRT protocol resulted in one of the two therapeutic radiographers not having any close contact (<2m) with a patient during setup. Data from 702 imaging sessions showed similar setup accuracy with either protocol, fewer large translations and fewer repeat setup occurrences using the SGRT protocol. The potential of SGRT for infection control should be recognised alongside other benefits.
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Affiliation(s)
- Nicola Blake
- Department of Radiotherapy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK,Corresponding author at: Guy’s Cancer Centre, London SE1 9RT, UK.
| | - Luciano Pereira
- Department of Radiotherapy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - David J Eaton
- Department of Medical Physics, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Deirdre Dobson
- Department of Radiotherapy, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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23
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Paolani G, Strolin S, Santoro M, Della Gala G, Tolento G, Guido A, Siepe G, Morganti AG, Strigari L. A novel tool for assessing the correlation of internal/external markers during SGRT guided stereotactic ablative radiotherapy treatments. Phys Med 2021; 92:40-51. [PMID: 34856464 DOI: 10.1016/j.ejmp.2021.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION An in-house developed tool was implemented and validated to investigate the skin surface, hepatic dome, and target displacement for stereotactic ablative radiotherapy (SABR) of thoracic/abdominal lesions using a Surface Guided Radiation Therapy (SGRT) system combined with 4D- images. MATERIALS AND METHODS Fourteen consecutive patients with tumors near the hepatic dome undergoing SABR treatments were analyzed. For each patient, a planning 4D-CT and five 4D-CBCT images were acquired. The C-RAD technology was also used to register/monitor the position of the skin reference point (SRP) as an external marker representative of patient breathing. The 4D images were imported in the developed tool, and the absolute maximum height (Pmax,dome) of the hepatic dome on the ten respiratory phases was semi-automatically detected. Similarly, the contour of the skin surface was extracted in correspondence with the SRP position. The tool has been validated using an ad hoc modified moving phantom with pre-selected amplitudes and numbers of cycles. The Pearson correlation coefficients and Bland-Altman plots were calculated. RESULTS There was a strong correlation between the skin motion amplitude based on 4D-CBCT and the C-RAD in all the patients (0.90 ± 0.08). Similarly, the mean ± SD of Pearson correlation coefficients of skin and Pmax,dome movements registered by 4D-CT and 4D-CBCT were 0.90 ± 0.05 and 0.94 ± 0.05, respectively. The mean ± SD of Pearson correlation coefficients comparing the skin and Pmax,dome displacements within each imaging modality were 0.88 ± 0.05 and 0.90 ± 0.05 for 4D-CT and 4D-CBCT, respectively. The SRP displacement during the set-up imaging and the treatment delivery were similar in all the investigated patients. Similar results were obtained for the ad hoc modified phantom in the preliminary validation phase. CONCLUSION The strong correlation between the tumor/ hepatic dome and skin displacements confirms that the SGRT approach can be considered appropriate for intra- and inter-fraction motion management in SABR therapy.
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Affiliation(s)
- Giulia Paolani
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Silvia Strolin
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Miriam Santoro
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giuseppe Della Gala
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giorgio Tolento
- Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessandra Guido
- Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Giambattista Siepe
- Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Alessio G Morganti
- Department of Radiation Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum, Bologna University, 40138 Bologna, Italy
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.
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Johnson PB, Jackson A, Saki M, Feldman E, Bradley J. Patient posture correction and alignment using mixed reality visualization and the HoloLens 2. Med Phys 2021; 49:15-22. [PMID: 34780068 DOI: 10.1002/mp.15349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/08/2021] [Accepted: 11/02/2021] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The purpose of this study was to develop and preliminarily test a radiotherapy system for patient posture correction and alignment using mixed reality (MixR) visualization. The write-up of this work also provides an opportunity to introduce the concepts and technology of MixR for a medical physics audience who may be unfamiliar with the topic. METHODS A MixR application was developed for on optical-see-through head-mounted display (HoloLens 2) allowing a user to simultaneously and directly view a patient and a reference hologram derived from their simulation CT scan. The hologram provides a visual reference for the exact posture needed during treatment and is initialized in relation to the origin of a radiotherapy device using marker-based tracking. The system further provides marker-less tracking that allows the user tofreely navigate the room as they view and align the patient from various angles. The system was preliminarily tested using both a rigid (pelvis) and nonrigid (female mannequin) anthropomorphic phantom. Each phantom was aligned via hologram and accuracy quantified using CBCT and CT. RESULTS A fully realized system was developed. Rigid registration accuracy was on the order of 3.0 ± 1.5 mm based on the performance of three users repeating alignment five times each. The lateral direction showed the most variability among users and was associated with the largest off-sets (approximately 2.0 mm). For nonrigid alignment, the MixR setup outperformed a setup based on three-point alignment and setup photos, the latter of which showed a difference in arm position of 2 cm and a torso roll of 6-7°. CONCLUSIONS MixR visualization is a rapidly emerging domain that has the potential to significantly impact the field of medicine. The current application is an illustration of this and highlights the advantages of MixR for patient setup in radiation oncology. The key feature of the system is the way in which it transforms nonrigid registration into rigid registration by providing an efficient, portable, and cost-effective mechanism for reproducing patient posture without the use of ionizing radiation. Preliminary estimates of registration accuracy indicate clinical viability and form the foundation for further development and clinical testing.
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Affiliation(s)
- Perry B Johnson
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.,University of Florida Health Proton Therapy Institute, Jacksonville, Florida, USA
| | - Amanda Jackson
- Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mohammad Saki
- University of Florida Health Proton Therapy Institute, Jacksonville, Florida, USA
| | - Emily Feldman
- University of Florida Health Proton Therapy Institute, Jacksonville, Florida, USA
| | - Julie Bradley
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, Florida, USA.,University of Florida Health Proton Therapy Institute, Jacksonville, Florida, USA
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Sarudis S, Karlsson A, Bäck A. Surface guided frameless positioning for lung stereotactic body radiation therapy. J Appl Clin Med Phys 2021; 22:215-226. [PMID: 34406710 PMCID: PMC8425933 DOI: 10.1002/acm2.13370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/10/2021] [Accepted: 07/05/2021] [Indexed: 12/25/2022] Open
Abstract
Background and purpose When treating lung tumors with stereotactic body radiation therapy (SBRT), patient immobilization is of outmost importance. In this study, the intra‐fractional shifts of the patient (based on bony anatomy) and the tumor (based on the visible target volume) are quantified, and the associated impact on the delivered dose is estimated for a frameless immobilization approach in combination with surface guided radiation therapy (SGRT) monitoring. Methods Cone beam computed tomographies (CBCT) were collected in free breathing prior and after each treatment for 25 patients with lung tumors, in total 137 fractions. The CBCT collected after each treatment was registered to the CBCT collected before each treatment with focus on bony anatomy to determine the shift of the patient, and with focus on the visible target volume to determine the shift of the tumor. Rigid registrations with 6 degrees of freedom were used. The patients were positioned in frameless immobilizations with their position and respiration continuously monitored by a commercial SGRT system. The patients were breathing freely within a preset gating window during treatment delivery. The beam was automatically interrupted if isocenter shifts >4 mm or breathing amplitudes outside the gating window were detected by the SGRT system. The time between the acquisition of the CBCTs was registered for each fraction to examine correlations between treatment time and patient shift. The impact of the observed shifts on the dose to organs at risk (OAR) and the gross tumor volume (GTV) was assessed. Results The shift of the patient in the CBCTs was ≤2 mm for 132/137 fractions in the vertical (vrt) and lateral (lat) directions, and 134/137 fractions in the longitudinal (lng) direction and ≤4 mm in 134/137 (vrt) and 137/137 (lat, lng) of the fractions. The shift of the tumor was ≤2 mm in 116/137 (vrt), 123/137 (lat) and 115/137 (lng) fractions and ≤4 mm in 136/137 (vrt), 137/137 (lat), and 135/137 (lng) fractions. The maximal observed shift in the evaluated CBCT data was 4.6 mm for the patient and 7.2 mm for the tumor. Rotations were ≤3.3ᵒ for all fractions and the mean/standard deviation were 0.2/1.0ᵒ (roll), 0.1/0.8ᵒ (yaw), and 0.3/1.0ᵒ (pitch). The SGRT system interrupted the beam due to intra‐fractional isocenter shifts >4 mm for 21% of the fractions, but the patients always returned within tolerance without the need of repositioning. The maximal observed isocenter shift by the SGRT system during the beam holds was 8 mm. For the respiration monitoring, the beam was interrupted at least one time for 54% of the fractions. The visual tumor was within the planned internal target volume (ITV) for 136/137 fractions in the evaluated CBCT data collected at the end of each fraction. For the fraction where the tumor was outside the ITV, the D98% for the GTV decreased with 0.4 Gy. For the OARs, the difference between planned and estimated dose from the CBCT data (D2% or Dmean) was ≤2.6% of the prescribed PTV dose. No correlation was found between treatment time and the magnitude of the patient shift. Conclusions Using SGRT for motion management and respiration monitoring in combination with a frameless immobilization is a feasible approach for lung SBRT.
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Affiliation(s)
- Sebastian Sarudis
- Department of Radiation Physics, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Medical Physics, County Hospital Ryhov, Jönköping, Sweden
| | - Anna Karlsson
- Department of Radiation Physics, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Anna Bäck
- Department of Radiation Physics, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Göteborg, Sweden
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Poeta S, Jourani Y, De Caluwé A, Van den Begin R, Van Gestel D, Reynaert N. Split-VMAT technique to control the deep inspiration breath hold time for breast cancer radiotherapy. Radiat Oncol 2021; 16:77. [PMID: 33879209 PMCID: PMC8056647 DOI: 10.1186/s13014-021-01800-x] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To improve split-VMAT technique by optimizing treatment delivery time for deep-inspiration breath hold (DIBH) radiotherapy in left-sided breast cancer patients, when automatic beam-interruption devices are not available. METHODS Ten consecutive patients were treated with an eight partial arcs (8paVMAT) plan, standard of care in our center. A four partial arcs (4paVMAT) plan was also created and actual LINAC outputs were measured, to evaluate whether there was a dosimetric difference between both techniques and potential impact on the delivered dose. Subsequently, ten other patients were consecutively treated with a 4paVMAT plan to compare the actual treatment delivery time between both techniques. The prescribed dose was 40.05 Gy/15 fractions on the PTV breast (breast or thoracic wall), lymph nodes (LN) and intramammary lymph node chain (IMN). Treatment delivery time, PTVs coverage, conformity index (CI), organs at risk (OAR) dose, monitor units (MU), and gamma index were compared. RESULTS Both split-VMAT techniques resulted in similar dose coverage for the PTV Breast and LN, and similar CI. For PTV IMN we observed a 5% increased coverage for the volume receiving ≥ 36 Gy with 4paVMAT, with an identical volume receiving ≥ 32 Gy. There was no difference for the OAR sparing, with the exception of the contralateral organs: there was a 0.6 Gy decrease for contralateral breast mean (p ≤ 0.01) and 1% decrease for the volume of right lung receiving ≥ 5 Gy (p = 0.024). Overall, these results indicate a modest clinical benefit of using 4paVMAT in comparison to 8paVMAT. An increase in the number of MU per arc was observed for the 4paVMAT technique, as expected, while the total number of MU remained comparable for both techniques. All the plans were measured with the Delta4 phantom and passed the gamma index criteria with no significant differences. Finally, the main difference was seen for the treatment delivery time: there was a significant decrease from 8.9 to 5.4 min for the 4paVMAT plans (p < .05). CONCLUSIONS This study is mainly of interest for centers who are implementing the DIBH technique without automatic beam-holding devices and who therefore may require to manually switch the beam on and off during breast DIBH treatment. Split-VMAT technique with 4 partial arcs significantly reduces the treatment delivery time compared to 8 partial arcs, without compromising the target coverage and the OAR sparing. The technique decreases the number of breath holds per fraction, resulting in a shorter treatment session.
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Affiliation(s)
- Sara Poeta
- Medical Physics Department, Institut Jules Bordet – Université Libre de Bruxelles, Brussels, Belgium
| | - Younes Jourani
- Medical Physics Department, Institut Jules Bordet – Université Libre de Bruxelles, Brussels, Belgium
| | - Alex De Caluwé
- Radiation Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | - Robbe Van den Begin
- Radiation Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | - Dirk Van Gestel
- Radiation Oncology Department, Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | - Nick Reynaert
- Medical Physics Department, Institut Jules Bordet – Université Libre de Bruxelles, Brussels, Belgium
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Bry V, Licon AL, McCulloch J, Kirby N, Myers P, Saenz D, Stathakis S, Papanikolaou N, Rasmussen K. Quantifying false positional corrections due to facial motion using SGRT with open-face Masks. J Appl Clin Med Phys 2021; 22:172-183. [PMID: 33739569 PMCID: PMC8035563 DOI: 10.1002/acm2.13170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 08/10/2020] [Revised: 12/09/2020] [Accepted: 12/25/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose Studies have evaluated the viability of using open‐face masks as an immobilization technique to treat intracranial and head and neck cancers. This method offers less stress to the patient with comparable accuracy to closed‐face masks. Open‐face masks permit implementation of surface guided radiation therapy (SGRT) to assist in positioning and motion management. Research suggests that changes in patient facial expressions may influence the SGRT system to generate false positional corrections. This study aims to quantify these errors produced by the SGRT system due to face motion. Methods Ten human subjects were immobilized using open‐face masks. Four discrete SGRT regions of interest (ROIs) were analyzed based on anatomical features to simulate different mask openings. The largest ROI was lateral to the cheeks, superior to the eyebrows, and inferior to the mouth. The smallest ROI included only the eyes and bridge of the nose. Subjects were asked to open and close their eyes and simulate fear and annoyance and peak isocenter shifts were recorded. This was performed in both standard and SRS specific resolutions with the C‐RAD Catalyst HD system. Results All four ROIs analyzed in SRS and Standard resolutions demonstrated an average deviation of 0.3 ± 0.3 mm for eyes closed and 0.4 ± 0.4 mm shift for eyes open, and 0.3 ± 0.3 mm for eyes closed and 0.8 ± 0.9 mm shift for eyes open. The average deviation observed due to changing facial expressions was 1.4 ± 0.9 mm for SRS specific and 1.6 ± 1.6 mm for standard resolution. Conclusion The SGRT system can generate false positional corrections for face motion and this is amplified at lower resolutions and smaller ROIs. These errors should be considered in the overall tolerances and treatment plan when using open‐face masks with SGRT and may warrant additional radiographic imaging.
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Affiliation(s)
- Victoria Bry
- Department of Radiation Oncology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Anna Laura Licon
- Department of Radiation Oncology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - James McCulloch
- Department of Radiation Oncology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Neil Kirby
- Department of Radiation Oncology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Pamela Myers
- Department of Radiation Oncology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Daniel Saenz
- Department of Radiation Oncology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Sotirios Stathakis
- Department of Radiation Oncology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Niko Papanikolaou
- Department of Radiation Oncology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
| | - Karl Rasmussen
- Department of Radiation Oncology, School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, 78229, USA
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Covington EL, Stanley DN, Fiveash JB, Thomas EM, Marcrom SR, Bredel M, Willey CD, Riley KO, Popple RA. Surface guided imaging during stereotactic radiosurgery with automated delivery. J Appl Clin Med Phys 2020; 21:90-95. [PMID: 33095971 PMCID: PMC7769383 DOI: 10.1002/acm2.13066] [Citation(s) in RCA: 8] [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: 06/19/2020] [Revised: 07/29/2020] [Accepted: 09/22/2020] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To report on the use of surface guided imaging during frameless intracranial stereotactic radiotherapy with automated delivery via HyperArcTM (Varian Medical Systems, Palo Alto, CA). METHODS All patients received intracranial radiotherapy with HyperArcTM and were monitored for intrafraction motion by the AlignRT® (VisionRT, London, UK) surface imaging (SI) system. Immobilization was with the EncompassTM (Qfix, Avondale, PA) aquaplast mask device. AlignRT® log files were correlated with trajectory log files to correlate treatment parameters with SI reported offsets. SI reported offsets were correlated with gantry angle and analyzed for performance issues at non-zero couch angles and during camera-pod blockage during gantry motion. Demographics in the treatment management system were used to identify race and determine if differences in SI reported offsets are due to skin tone settings. RESULTS A total of 981 fractions were monitored over 14 months and 819 were analyzed. The median AlignRT® reported motion from beginning to the end of treatment was 0.24 mm. The median offset before beam on at non-zero couch angles was 0.55 mm. During gantry motion when camera pods are blocked, the median magnitude was below 1 mm. Median magnitude of offsets at non-zero couch angles was not found to be significantly different for patients stratified by race. CONCLUSIONS Surface image guidance is a viable alternative to scheduled mid-treatment imaging for monitoring intrafraction motion during stereotactic radiosurgery with automated delivery.
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Affiliation(s)
- Elizabeth L Covington
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Dennis N Stanley
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - John B Fiveash
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Evan M Thomas
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Samuel R Marcrom
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Marcus Bredel
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Christopher D Willey
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Kristen O Riley
- Department of Neurosurgery, University of Alabama - Birmingham, Birmingham, AL, USA
| | - Richard A Popple
- Department of Radiation Oncology, University of Alabama - Birmingham, Birmingham, AL, USA
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Freislederer P, Kügele M, Öllers M, Swinnen A, Sauer TO, Bert C, Giantsoudi D, Corradini S, Batista V. Recent advanced in Surface Guided Radiation Therapy. Radiat Oncol 2020; 15:187. [PMID: 32736570 PMCID: PMC7393906 DOI: 10.1186/s13014-020-01629-w] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 01/27/2023] Open
Abstract
The growing acceptance and recognition of Surface Guided Radiation Therapy (SGRT) as a promising imaging technique has supported its recent spread in a large number of radiation oncology facilities. Although this technology is not new, many aspects of it have only recently been exploited. This review focuses on the latest SGRT developments, both in the field of general clinical applications and special techniques.SGRT has a wide range of applications, including patient positioning with real-time feedback, patient monitoring throughout the treatment fraction, and motion management (as beam-gating in free-breathing or deep-inspiration breath-hold). Special radiotherapy modalities such as accelerated partial breast irradiation, particle radiotherapy, and pediatrics are the most recent SGRT developments.The fact that SGRT is nowadays used at various body sites has resulted in the need to adapt SGRT workflows to each body site. Current SGRT applications range from traditional breast irradiation, to thoracic, abdominal, or pelvic tumor sites, and include intracranial localizations.Following the latest SGRT applications and their specifications/requirements, a stricter quality assurance program needs to be ensured. Recent publications highlight the need to adapt quality assurance to the radiotherapy equipment type, SGRT technology, anatomic treatment sites, and clinical workflows, which results in a complex and extensive set of tests.Moreover, this review gives an outlook on the leading research trends. In particular, the potential to use deformable surfaces as motion surrogates, to use SGRT to detect anatomical variations along the treatment course, and to help in the establishment of personalized patient treatment (optimized margins and motion management strategies) are increasingly important research topics. SGRT is also emerging in the field of patient safety and integrates measures to reduce common radiotherapeutic risk events (e.g. facial and treatment accessories recognition).This review covers the latest clinical practices of SGRT and provides an outlook on potential applications of this imaging technique. It is intended to provide guidance for new users during the implementation, while triggering experienced users to further explore SGRT applications.
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Affiliation(s)
- P. Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M. Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - M. Öllers
- Maastricht Radiation Oncology (MAASTRO), Maastricht, the Netherlands
| | - A. Swinnen
- Maastricht Radiation Oncology (MAASTRO), Maastricht, the Netherlands
| | - T.-O. Sauer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C. Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - D. Giantsoudi
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - S. Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - V. Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
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Haraldsson A, Ceberg S, Ceberg C, Bäck S, Engelholm S, Engström PE. Surface-guided tomotherapy improves positioning and reduces treatment time: A retrospective analysis of 16 835 treatment fractions. J Appl Clin Med Phys 2020; 21:139-148. [PMID: 32592288 PMCID: PMC7484821 DOI: 10.1002/acm2.12936] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/20/2020] [Accepted: 05/07/2020] [Indexed: 01/16/2023] Open
Abstract
PURPOSE In this study, we have quantified the setup deviation and time gain when using fast surface scanning for daily setup/positioning with weekly megavoltage computed tomography (MVCT) and compared it to daily MVCT. METHODS A total of 16 835 treatment fractions were analyzed, treated, and positioned using our TomoTherapy HD (Accuray Inc., Madison, USA) installed with a Sentinel optical surface scanning system (C-RAD Positioning AB, Uppsala, Sweden). Patients were positioned using in-room lasers, surface scanning and MVCT for the first three fractions. For the remaining fractions, in-room laser was used for setup followed by daily surface scanning with MVCT once weekly. The three-dimensional (3D) setup correction for surface scanning was evaluated from the registration between MVCT and the planning CT. The setup correction vector for the in-room lasers was assessed from the surface scanning and the MVCT to planning CT registration. The imaging time was evaluated as the time from imaging start to beam-on. RESULTS We analyzed 894 TomoTherapy treatment plans from 2012 to 2018. Of all the treatment fractions performed with surface scanning, 90 % of the residual errors were within 2.3 mm for CNS (N = 284), 2.9 mm for H&N (N = 254), 8.7 mm for thorax (N = 144) and 10.9 for abdomen (N = 134) patients. The difference in residual error between surface scanning and positioning with in-room lasers was significant (P < 0.005) for all sites. The imaging time was assessed as total imaging time per treatment plan, modality, and treatment site and found that surface scanning significantly reduced patient on-couch time compared to MVCT for all treatment sites (P < 0.005). CONCLUSIONS The results indicate that daily surface scanning with weekly MVCT can be used with the current target margins for H&N, CNS, and thorax, with reduced imaging time.
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Affiliation(s)
- André Haraldsson
- Department Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sofie Ceberg
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Crister Ceberg
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sven Bäck
- Department Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Silke Engelholm
- Department Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Per E Engström
- Department Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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Leong B, Padilla L. Impact of use of optical surface imaging on initial patient setup for stereotactic body radiotherapy treatments. J Appl Clin Med Phys 2020; 20:149-158. [PMID: 31833639 PMCID: PMC6909112 DOI: 10.1002/acm2.12779] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 12/31/2022] Open
Abstract
Purpose To evaluate the effectiveness of surface image guidance (SG) for pre‐imaging setup of stereotactic body radiotherapy (SBRT) patients, and to investigate the impact of SG reference surface selection on this process. Methods and materials 284 SBRT fractions (SG‐SBRT = 113, non‐SG‐SBRT = 171) were retrospectively evaluated. Differences between initial (pre‐imaging) and treatment couch positions were extracted from the record‐and‐verify system and compared for the two groups. Rotational setup discrepancies were also computed. The utility of orthogonal kVs in reducing CBCT shifts in the SG‐SBRT/non‐SG‐SBRT groups was also calculated. Additionally, the number of CBCTs acquired for setup was recorded and the average for each cohort was compared. These data served to evaluate the effectiveness of surface imaging in pre‐imaging patient positioning and its potential impact on the necessity of including orthogonal kVs for setup. Since reference surface selection can affect SG setup, daily surface reproducibility was estimated by comparing camera‐acquired surface references (VRT surface) at each fraction to the external surface of the planning CT (DICOM surface) and to the VRT surface from the previous fraction. Results The reduction in all initial‐to‐treatment translation/rotation differences when using SG‐SBRT was statistically significant (Rank‐Sum test, α = 0.05). Orthogonal kV imaging kept CBCT shifts below reimaging thresholds in 19%/51% of fractions for SG‐SBRT/non‐SG‐SBRT cohorts. Differences in average number of CBCTs acquired were not statistically significant. The reference surface study found no statistically significant differences between the use of DICOM or VRT surfaces. Conclusions SG‐SBRT improved pre‐imaging treatment setup compared to in‐room laser localization alone. It decreased the necessity of orthogonal kV imaging prior to CBCT but did not affect the average number of CBCTs acquired for setup. The selection of reference surface did not have a significant impact on initial patient positioning.
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Affiliation(s)
- Brian Leong
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Laura Padilla
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
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Rigley J, Robertson P, Scattergood L. Radiotherapy without tattoos: Could this work? Radiography (Lond) 2020; 26:288-293. [PMID: 32245712 DOI: 10.1016/j.radi.2020.02.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION An evaluation to compare the traditional tattoo based set up procedure with a surface guided method to assess the possibility of eliminating permanent tattoos in breast cancer patents who are undergoing radiotherapy to the breast/chest wall. METHODS Forty-three patients that were having radiotherapy to the breast or chest wall were included in this evaluation. The patients were divided into two groups and further divided into 2 sub-groups. The first group received standard dark ink tattoos and were positioned by aligning these tattoos with lasers. The second group had no tattoo's and were positioned using the Surface-Guided technology (SGRT). Within each group the patients were split into 2 sub-group; right and left sided treatment areas. The right side were treated using a Free-Breathing (FB) technique and the left sided were treated using a Deep-Inspiration Breath-Hold (DIBH) technique. RESULTS For the patients having right sided breast radiotherapy, the mean shift using the standard tattoos and laser set up was 0.52 cm, compared with using the SGRT method where the mean shift was 0.47 cm. (p-value 0.04) For patients having left sided breast radiotherapy with DIBH the mean shift using the standard tattoo's and laser set up was 0.76 cm, compared with a mean shift of 0.45 cm using SGRT alone (p-value < 0.001). CONCLUSION The elimination of tattoos together with SGRT offers a comparable set-up for right sided breast treatments against the traditional tattoo method. A significant set-up improvement was observed for the left sided breast DIBH treatments. IMPLICATIONS FOR PRACTICE To set up patients having breast Radiotherapy, with no tattoo's.
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Affiliation(s)
- J Rigley
- GenesisCare Nottingham, The Park Centre of Oncology, Sherwood Lodge Drive, Nottingham, NG5 8RX, UK.
| | - P Robertson
- GenesisCare Guildford, 46 Harvey Road, Guildford, GU1 3XL, UK
| | - L Scattergood
- GenesisCare Nottingham, The Park centre of oncology, Sherwood Lodge Drive, Nottingham, NG5 8RX, UK
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Heinzerling JH, Hampton CJ, Robinson M, Bright M, Moeller BJ, Ruiz J, Prabhu R, Burri SH, Foster RD. Use of surface-guided radiation therapy in combination with IGRT for setup and intrafraction motion monitoring during stereotactic body radiation therapy treatments of the lung and abdomen. J Appl Clin Med Phys 2020; 21:48-55. [PMID: 32196944 PMCID: PMC7286017 DOI: 10.1002/acm2.12852] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/08/2020] [Accepted: 02/16/2020] [Indexed: 12/24/2022] Open
Abstract
Background and purpose Multiple techniques can be used to assist with more accurate patient setup and monitoring during Stereotactic body radiation therapy (SBRT) treatment. This study analyzes the accuracy of 3D surface mapping with Surface‐guided radiation therapy (SGRT) in detecting interfraction setup error and intrafraction motion during SBRT treatments of the lung and abdomen. Materials and Methods Seventy‐one patients with 85 malignant thoracic or abdominal tumors treated with SBRT were analyzed. For initial patient setup, an alternating scheme of kV/kV imaging or SGRT was followed by cone beam computed tomography (CBCT) for more accurate tumor volumetric localization. The CBCT six degree shifts after initial setup with each method were recorded to assess interfraction setup error. Patients were then monitored continuously with SGRT during treatment. If an intrafractional shift in any direction >2 mm for longer than 2 sec was detected by SGRT, then CBCT was repeated and the recorded deltas were compared to those detected by SGRT. Results Interfractional shifts after SGRT setup and CBCT were small in all directions with mean values of <5 mm and < 0.5 degrees in all directions. Additionally, 25 patients had detected intrafraction motion by SGRT during a total of 34 fractions. This resulted in 25 (73.5%) additional shifts of at least 2 mm on subsequent CBCT. When comparing the average vector detected shift by SGRT to the resulting vector shift on subsequent CBCT, no significant difference was found between the two. Conclusions Surface‐guided radiation therapy provides initial setup within 5 mm for patients treated with SBRT and can be used in place of skin marks or planar kV imaging prior to CBCT. In addition, continuous monitoring with SGRT during treatment was valuable in detecting potentially clinically meaningful intrafraction motion and was comparable in magnitude to shifts from additional CBCT scans. PTV margin reduction may be feasible for SBRT in the lung and abdomen when using SGRT for continuous patient monitoring during treatment.
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Affiliation(s)
- John H Heinzerling
- Levine Cancer Institute, Southeast Radiation Oncology Group, Atrium Health, Charlotte, NC, USA
| | - Carnell J Hampton
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health, Charlotte, NC, USA
| | - Myra Robinson
- Levine Cancer Institute, Department of Biostatistics, Atrium Health, Charlotte, NC, USA
| | - Megan Bright
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health, Charlotte, NC, USA
| | - Benjamin J Moeller
- Levine Cancer Institute, Southeast Radiation Oncology Group, Atrium Health, Charlotte, NC, USA
| | - Justin Ruiz
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health, Charlotte, NC, USA
| | - Roshan Prabhu
- Levine Cancer Institute, Southeast Radiation Oncology Group, Atrium Health, Charlotte, NC, USA
| | - Stuart H Burri
- Levine Cancer Institute, Southeast Radiation Oncology Group, Atrium Health, Charlotte, NC, USA
| | - Ryan D Foster
- Levine Cancer Institute, Department of Radiation Oncology, Atrium Health, Charlotte, NC, USA
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Flores-Martinez E, Cerviño LI, Pawlicki T, Kim GY. Assessment of the use of different imaging and delivery techniques for cranial treatments on the Halcyon linac. J Appl Clin Med Phys 2019; 21:53-61. [PMID: 31738473 PMCID: PMC6964767 DOI: 10.1002/acm2.12772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/27/2019] [Revised: 08/01/2019] [Accepted: 10/14/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose In this work, we investigated the effect on the workflow and setup accuracy of using surface guided radiation therapy (SGRT) for patient setup, megavoltage cone beam CT (MVCBCT) or kilovoltage cone beam CT (kVCBCT) for imaging and fixed IMRT or volumetric‐modulated arc therapy (VMAT) for treatment delivery with the Halcyon linac. Methods We performed a retrospective investigation of 272 treatment fractions, using three different workflows. The first and second workflows used MVCBCT and fixed IMRT for imaging and treatment delivery, and the second one also used SGRT for patient setup. The third workflow used SGRT for setup, kVCBCT for imaging and VMAT for delivery. Workflows were evaluated by comparing the number of fractions requiring repeated imaging acquisitions and the time required for setup, imaging and treatment delivery. Setup position accuracy was assessed by comparing the daily kV‐ or MV‐ CBCT with the planning CT and measuring the residual rotational errors for pitch, yaw and roll angles. Results Without the use of SGRT, the imaging fields were delivered more than once on 11.1% of the fractions, while re‐imaging was necessary in 5.5% of the fractions using SGRT. The total treatment time, including setup, imaging, and delivery, for the three workflows was 531 ± 157 s, 503 ± 130 s and 457 ± 91 s, respectively. A statistically significant difference was observed when comparing the third workflow with the first two. The total residual rotational errors were 1.96 ± 1.29°, 1.28 ± 0.67° and 1.22 ± 0.76° and statistically significant differences were observed when comparing workflows with and without SGRT. Conclusions The use of SGRT allowed for a reduction of re‐imaging during patient setup and improved patient position accuracy by reducing residual rotational errors. A reduction in treatment time using kVCBCT with SGRT was observed. The most efficient workflow was the one including kVCBCT and SGRT for setup and VMAT for delivery.
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Affiliation(s)
- Everardo Flores-Martinez
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Laura I Cerviño
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Todd Pawlicki
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
| | - Gwe-Ya Kim
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA, USA
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Zhao H, Williams N, Poppe M, Sarkar V, Wang B, Rassiah-Szegedi P, Huang YJ, Kokeny K, Gaffney D, Salter B. Comparison of surface guidance and target matching for image-guided accelerated partial breast irradiation (APBI). Med Phys 2019; 46:4717-4724. [PMID: 31509632 DOI: 10.1002/mp.13816] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/15/2019] [Accepted: 08/15/2019] [Indexed: 11/06/2022] Open
Abstract
PURPOSE We investigate the feasibility of surface guided radiation therapy (SGRT) for accelerated partial breast irradiation (APBI) by comparing it with in-room, fan beam kV computed tomography on rails (CTOR) imaging of the targeted region. The uniqueness of our study is that all patients have multiple daily CTOR scans to compare corresponding SGRT AlignRT (VisionRT, United Kingdom) images to. METHODS/MATERIALS Twelve patients receiving APBI were enrolled in this study. Before each treatment fraction, after patients were setup on tattoos, SGRT was performed using AlignRT, and then target matching was performance using CTOR. The average and maximum difference in shifts between SGRT and CTOR were calculated and analyzed for each patient, so as the correlation between surgical cavity size and shift difference. RESULTS Our study showed that SGRT agreed well with CTOR for patients with small surgical cavity volume changes (<10%). There were nine patients who had a ≥5 mm maximum shift difference between SGRT and CTOR along any direction, and in two patients the difference was more than 10 mm (one patient with surgical cavity change 44.3% and one patient with 27 cc cavity volume decrease). All patients, except one, had a mean shift difference < 5 mm along any direction. CONCLUSION For the patients studied here, SGRT appears to be a reasonable and potentially valuable image guidance approach for APBI for patients who experience small changes in surgical cavity volume (<10%) between CT simulation and treatment. However, there is potential for larger alignment errors (up to 11 mm) when using SGRT for patients who experience larger surgical cavity changes.
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Affiliation(s)
- Hui Zhao
- University of Utah, Salt Lake City, UT, 84112, USA
| | - Ned Williams
- San Antonio Military Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX, 78234, USA
| | | | | | - Brian Wang
- University of Louisville, 2301 S 3rd St, Louisville, KY, 40292, USA
| | | | | | | | | | - Bill Salter
- University of Utah, Salt Lake City, UT, 84112, USA
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Delombaerde L, Petillion S, Michiels S, Weltens C, Depuydt T. Development and accuracy evaluation of a single-camera intra-bore surface scanning system for radiotherapy in an O-ring linac. Phys Imaging Radiat Oncol 2019; 11:21-6. [PMID: 33458272 DOI: 10.1016/j.phro.2019.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/28/2019] [Accepted: 07/03/2019] [Indexed: 11/22/2022] Open
Abstract
Background and purpose Current commercial surface scanning systems are not able to monitor patients during radiotherapy fractions in closed-bore linacs during adaptive workflows. In this work a surface scanning system for monitoring in an O-ring linac is proposed. Methods and materials A depth camera was mounted at the backend of the bore. The acquired surface point cloud was transformed to the linac coordinate system after a cube detection calibration step. The real-time surface was registered using an Iterative Closest Point algorithm to a reference region-of-interest of the body contour from the planning CT and of a depth camera surface acquisition from the first fraction. The positioning accuracy was investigated using anthropomorphic 3D-printed phantoms with embedded markers: a head, hand and breast. To simulate clinically observed positioning errors, each phantom was placed 24 times with 0-10 mm and 0-8° offsets from the planned position. At every position a cone-beam CT (CBCT) was acquired and a surface registration performed. The surface registration error was determined as the difference between the surface registration and the CBCT-to-CT fiducial marker registration. Results The registration errors were (mean ± SD): lat: 0.4 ± 0.8 mm, vert: -0.2 ± 0.2 mm, long: 0.3 ± 0.5 mm and Yaw: -0.2 ± 0.6°, Pitch: 0.4 ± 0.2°, Roll: 0.5 ± 0.8° for the body contour reference, and lat: -0.7 ± 0.7 mm, vert: 0.3 ± 0.2 mm, long: 0.2 ± 0.5 mm and Yaw: -0.5 ± 0.5°, Pitch: 0.1 ± 0.3°, Roll: -0.7 ± 0.7° for the captured surface reference. Conclusion The proposed single camera intra-bore surface system was capable of accurately detecting phantom displacements and allows intrafraction motion monitoring for surface guided radiotherapy inside the bore of O-ring gantries.
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Stanley DN, McConnell KA, Kirby N, Gutiérrez AN, Papanikolaou N, Rasmussen K. Comparison of initial patient setup accuracy between surface imaging and three point localization: A retrospective analysis. J Appl Clin Med Phys 2017; 18:58-61. [PMID: 28901684 PMCID: PMC5689923 DOI: 10.1002/acm2.12183] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [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: 06/05/2017] [Revised: 07/20/2017] [Accepted: 07/27/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose Historically, the process of positioning a patient prior to imaging verification used a set of permanent patient marks, or tattoos, placed subcutaneously. After aligning to these tattoos, plan specific shifts are applied and the position is verified with imaging, such as cone‐beam computed tomography (CBCT). Due to a variety of factors, these marks may deviate from the desired position or it may be hard to align the patient to these marks. Surface‐based imaging systems are an alternative method of verifying initial positioning with the entire skin surface instead of tattoos. The aim of this study was to retrospectively compare the CBCT‐based 3D corrections of patients initially positioned with tattoos against those positioned with the C‐RAD CatalystHD surface imager system. Methods A total of 6000 individual fractions (600–900 per site per method) were randomly selected and the post‐CBCT 3D corrections were calculated and recorded. For both positioning methods, four common treatment site combinations were evaluated: pelvis/lower extremities, abdomen, chest/upper extremities, and breast. Statistical differences were evaluated using a paired sample Wilcoxon signed‐rank test with significance level of <0.01. Results The average magnitudes of the 3D shift vectors for tattoos were 0.9 ± 0.4 cm, 1.0 ± 0.5 cm, 0.9 ± 0.6 cm and 1.4 ± 0.7 cm for the pelvis/lower extremities, abdomen, chest/upper extremities and breast, respectively. For the CatalystHD, the average magnitude of the 3D shifts for the pelvis/lower extremities, abdomen, chest/upper extremities and breast were 0.6 ± 0.3 cm, 0.5 ± 0.3 cm, 0.5 ± 0.3 cm and 0.6 ± 0.2 cm, respectively. Statistically significant differences (P < 0.01) in the 3D shift vectors were found for all four sites. Conclusion This study shows that the overall 3D shift corrections for patients initially aligned with the C‐RAD CatalystHD were significantly smaller than those aligned with subcutaneous tattoos. Surface imaging systems can be considered a viable option for initial patient setup and may be preferable to permanent marks for specific clinics and patients.
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Affiliation(s)
- Dennis N Stanley
- Radiation Oncology - Medical Physics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Kristen A McConnell
- Radiation Oncology - Medical Physics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Neil Kirby
- Radiation Oncology - Medical Physics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Alonso N Gutiérrez
- Radiation Oncology - Medical Physics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.,Miami Cancer Institute, Baptist Hospital, Miami, FL, USA
| | - Nikos Papanikolaou
- Radiation Oncology - Medical Physics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Karl Rasmussen
- Radiation Oncology - Medical Physics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA
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