1
|
Faccenda V, Panizza D, Daniotti MC, Pellegrini R, Trivellato S, Caricato P, Lucchini R, De Ponti E, Arcangeli S. Dosimetric Impact of Intrafraction Prostate Motion and Interfraction Anatomical Changes in Dose-Escalated Linac-Based SBRT. Cancers (Basel) 2023; 15:cancers15041153. [PMID: 36831496 PMCID: PMC9954235 DOI: 10.3390/cancers15041153] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/23/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
The dosimetric impact of intrafraction prostate motion and interfraction anatomical changes and the effect of beam gating and motion correction were investigated in dose-escalated linac-based SBRT. Fifty-six gated fractions were delivered using a novel electromagnetic tracking device with a 2 mm threshold. Real-time prostate motion data were incorporated into the patient's original plan with an isocenter shift method. Delivered dose distributions were obtained by recalculating these motion-encoded plans on deformed CTs reflecting the patient's CBCT daily anatomy. Non-gated treatments were simulated using the prostate motion data assuming that no treatment interruptions have occurred. The mean relative dose differences between delivered and planned treatments were -3.0% [-18.5-2.8] for CTV D99% and -2.6% [-17.8-1.0] for PTV D95%. The median cumulative CTV coverage with 93% of the prescribed dose was satisfactory. Urethra sparing was slightly degraded, with the maximum dose increased by only 1.0% on average, and a mean reduction in the rectum and bladder doses was seen in almost all dose metrics. Intrafraction prostate motion marginally contributed in gated treatments, while in non-gated treatments, further deteriorations in the minimum target coverage and bladder dose metrics would have occurred on average. The implemented motion management strategy and the strict patient preparation regimen, along with other treatment optimization strategies, ensured no significant degradations of dose metrics in delivered treatments.
Collapse
Affiliation(s)
- Valeria Faccenda
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Denis Panizza
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
| | - Martina Camilla Daniotti
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Department of Physics, University of Milan, 20133 Milan, Italy
| | | | - Sara Trivellato
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Paolo Caricato
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Raffaella Lucchini
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
| | - Elena De Ponti
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
| | - Stefano Arcangeli
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- Correspondence:
| |
Collapse
|
2
|
Muurholm CG, Ravkilde T, De Roover R, Skouboe S, Hansen R, Crijns W, Depuydt T, Poulsen PR. Experimental investigation of dynamic real-time rotation-including dose reconstruction during prostate tracking radiotherapy. Med Phys 2022; 49:3574-3584. [PMID: 35395104 PMCID: PMC9322296 DOI: 10.1002/mp.15660] [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: 11/07/2021] [Revised: 02/12/2022] [Accepted: 03/30/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hypofractionation in prostate radiotherapy is of increasing interest. Steep dose gradients and a large weight on each individual fraction emphasize the need for motion management. Real-time motion management techniques such as multi-leaf collimator (MLC) tracking or couch tracking typically adjust for translational motion while rotations remain uncompensated with unknown dosimetric impact. PURPOSE The purpose of this study is to demonstrate and validate dynamic real-time rotation-including dose reconstruction during radiotherapy experiments with and without MLC and couch tracking. METHODS Real-time dose reconstruction was performed using the in-house developed software DoseTracker. DoseTracker receives streamed target positions and accelerator parameters during treatment delivery and uses a pencil beam algorithm with water density assumption to reconstruct the dose in a moving target. DoseTracker's ability to reconstruct motion-induced dose errors in a dynamically rotating and translating target was investigated during three different scenarios: (1) no motion compensation and translational motion correction with (2) MLC tracking and (3) couch tracking. In each scenario, dose reconstruction was performed online and in real-time during delivery of two dual-arc volumetric modulated arc therapy (VMAT) prostate plans with a prescribed fraction dose of 7 Gy to the prostate and simultaneous intraprostatic lesion boosts with doses of at least 8 Gy, but up to 10 Gy as long as the organs-at-risk dose constraints were fulfilled. The plans were delivered to a pelvis phantom that replicated three patient-measured motion traces using a rotational insert with 21 layers of EBT3 film spaced 2.5 mm apart. DoseTracker repeatedly calculated the actual motion-including dose increment and the planned static dose increment since the last calculation in 84500 points in the film stack. The experiments were performed with a TrueBeam accelerator with MLC and couch tracking based on electromagnetic transponders embedded in the film stack. The motion-induced dose error was quantified as the difference between the final cumulative dose with motion and without motion using the 2D 2%/2mm γ-failure rate and the difference in dose to 95% of the clinical target volume (CTV ΔD95% ) and the gross target volume (GTV ΔD95% ) as well as the difference in dose to 0.1 cm3 of the urethra, bladder, and rectum (ΔD0.1CC ). The motion-induced errors were compared between dose reconstructions and film measurements. RESULTS The dose was reconstructed in all calculation points at a mean frequency of 4.7 Hz. The root-mean-square difference between real-time reconstructed and film measured motion-induced errors was 3.1%-points (γ-failure rate), 0.13 Gy (CTV ΔD95% ), 0.23 Gy (GTV ΔD95% ), 0.19 Gy (urethra ΔD0.1CC ), 0.09 Gy (bladder ΔD0.1CC ), and 0.07 Gy (rectum ΔD0.1CC ). CONCLUSIONS In a series of phantom experiments, online real-time rotation-including dose reconstruction was performed for the first time. The calculated motion-induced errors agreed well with film measurements. The dose reconstruction provides a valuable tool for monitoring dose delivery and investigating the efficacy of advanced motion-compensation techniques in the presence of translational and rotational motion. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
| | - Thomas Ravkilde
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Robin De Roover
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Simon Skouboe
- Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Rune Hansen
- Department of Medical Physics, Aarhus University Hospital, Aarhus, Denmark
| | - Wouter Crijns
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Tom Depuydt
- Department of Oncology, KU Leuven, Leuven, Belgium.,Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Per R Poulsen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.,Danish Center for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
3
|
Lessard R, Tremblay NM, Plourde MÉ, Guillot M. An open-source software for monitoring intrafraction motion during external beam radiation therapy based on superimposition of contours of projected ROIs on cine-MV images. J Appl Clin Med Phys 2020; 21:173-182. [PMID: 32506590 PMCID: PMC7484890 DOI: 10.1002/acm2.12940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/05/2020] [Accepted: 05/07/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose To present an open‐source software (https://github.com/CHUSRadOncPhys/FluoMV) for monitoring intrafraction motion that is based on the visualization of superimposed contours of projected region‐of‐interests from DICOM RTSTRUCT files on cine‐MV images acquired and displayed in real‐time during radiation therapy delivery. Clinical use with prostate gold fiducial markers is presented. Methods Projections of regions of interest (ROI) in the reference frame of the electronic portal imaging device are computed offline for different gantry angles before the first treatment fraction. During treatment delivery, the contrast of portal images is automatically adjusted using a histogram equalization algorithm. The projections associated with the current gantry angle are then superimposed on the images in real time. This allows the therapist to evaluate if the imaged structures of interest remain within their respective contours during treatment delivery and to potentially interrupt the treatment if deemed necessary. The spatial accuracy of the method was evaluated by imaging a ball bearing phantom in a set‐up where the position of the projected ROI is highly sensitive to gantry angle errors. The visibility of fiducial markers during one fraction of seven different volumetric modulated arc therapy (VMAT) prostate treatments is characterized. Results The geometric validation showed a negligible systematic error μ < 0.1 mm for the position of the projections. The random errors associated with the time accuracy of the gantry angle readout were characterized by standard deviations σ ≤ 0.6 mm. The VMAT clinical treatments showed that the fiducial markers were frequently visible, allowing for a meaningful clinical use. Conclusions The results demonstrate that the method presented is sufficiently accurate to be used for intrafraction monitoring of patients. The fact that this method could be implemented on many modern linacs at little to no cost and with no additional dose delivered to the patients makes this solution very attractive for improving patient care and safety in radiation therapy.
Collapse
Affiliation(s)
- Rémi Lessard
- Département de radio-oncologie, Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, J1H 5N4, Canada
| | - Nicolas M Tremblay
- Département de radio-oncologie, Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, J1H 5N4, Canada
| | - Marc-Émile Plourde
- Département de radio-oncologie, Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, J1H 5N4, Canada.,Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, J1H 5N4, Canada
| | - Mathieu Guillot
- Département de radio-oncologie, Centre hospitalier universitaire de Sherbrooke (CHUS), Sherbrooke, Québec, J1H 5N4, Canada.,Département de médecine nucléaire et radiobiologie, Université de Sherbrooke, Sherbrooke, Québec, J1H 5N4, Canada
| |
Collapse
|
4
|
Korpics MC, Rokni M, Degnan M, Aydogan B, Liauw SL, Redler G. Utilizing the TrueBeam Advanced Imaging Package to monitor intrafraction motion with periodic kV imaging and automatic marker detection during VMAT prostate treatments. J Appl Clin Med Phys 2020; 21:184-191. [PMID: 31981305 PMCID: PMC7075383 DOI: 10.1002/acm2.12822] [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: 08/18/2019] [Revised: 12/18/2019] [Accepted: 12/27/2019] [Indexed: 02/01/2023] Open
Abstract
Background Fiducial markers are frequently used before treatment for image‐guided patient setup in radiation therapy (RT), but can also be used during treatment for image‐guided intrafraction motion detection. This report describes our implementation of automatic marker detection with periodic kV imaging (TrueBeam v2.5) to monitor and correct intrafraction motion during prostate RT. Methods We evaluated the reproducibility and accuracy of software fiducial detection using a phantom with 3 implanted fiducial markers. Clinical implementation for patients with intraprostatic fiducials receiving volumetric modulated arc therapy (VMAT) utilized periodic on‐board kV imaging with 10 s intervals during treatment delivery. For each image, the software automatically identified fiducial locations and determined whether their distance relative to planned locations were within a 3 mm tolerance. Motion was corrected if either ≥2 fiducials in a single image or ≥1 fiducial in sequential images were out of tolerance. Results Phantom studies demonstrated poorer performance of linear fiducials compared to collapsible fiducials, and wide variability to accurately detect fiducials across eight software settings. For any given setting, results were relatively reproducible and precise to ~0.5 mm. Across 17 patients treated with a median of 20 fractions, the software recommended a shift in 44% of fractions, and a shift was actually implemented after visual confirmation of movement greater than the 3 mm threshold in 20% of fractions. Adjustment of our approach led to improved accuracy for the latter (n = 7) patient subset. On average, table repositioning added 3.0 ± 0.3 min to patient time on table. Periodic kV imaging increased skin dose by an estimated 1 cGy per treatment arc. Conclusions Periodic kV imaging with automatic detection of motion during VMAT prostate treatments is commercially available, and can be successfully implemented to mitigate effects of intrafraction motion with careful attention to software settings.
Collapse
Affiliation(s)
- Mark C Korpics
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Michelle Rokni
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Michael Degnan
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Bulent Aydogan
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL, USA
| | - Gage Redler
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL, USA
| |
Collapse
|
5
|
Ma X, Yan H, Nath R, Chen Z, Li H, Liu W. Adaptive Imaging Versus Periodic Surveillance for Intrafraction Motion Management During Prostate Cancer Radiotherapy. Technol Cancer Res Treat 2019; 18:1533033819844489. [PMID: 31177934 PMCID: PMC6558533 DOI: 10.1177/1533033819844489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: To evaluate the benefits of adaptive imaging with automatic correction compared to
periodic surveillance strategies with either manual or automatic correction. Methods: Using Calypso trajectories from 54 patients with prostate cancer at 2 institutions, we
simulated 5-field intensity-modulated radiation therapy and dual-arc
volumetric-modulated arc therapy with periodic imaging at various frequencies and with
continuous adaptive imaging, respectively. With manual/automatic correction, we assumed
there was a 30/1 second delay after imaging to determine and apply couch shift. For
adaptive imaging, real-time “dose-free” cine-MV images during beam delivery are used in
conjunction with online-updated motion pattern information to estimate 3D displacement.
Simultaneous MV-kV imaging is only used to confirm the estimated overthreshold motion
and calculate couch shift, hence very low additional patient dose from kV imaging. Results: Without intrafraction intervention, the prostates could on average have moved out of a
3-mm margin for ∼20% of the beam-on time after setup imaging in current clinical
situation. If the time interval from the setup imaging to beam-on can be reduced to only
30 seconds, the mean over-3 mm percentage can be reduced to ∼7%. For intensity-modulated
radiation therapy simulation, with manual correction, 110 and 70 seconds imaging periods
both reduced the mean over-3 mm time to ∼4%. Automatic correction could give another 1%
to 2% improvement. However, with either manual or automatic correction, the maximum
patient-specific over-3 mm time was still relatively high (from 6.4% to 12.6%) and those
patients are actually clinically most important. In contrast, adaptive imaging with
automatic intervention significantly reduced the mean percentage to 0.6% and the maximum
to 2.7% and averagely only ∼1 kV image and ∼1 couch shift were needed per fraction. The
results of volumetric-modulated arc therapy simulation show a similar trend to that of
intensity-modulated radiation therapy. Conclusions: Adaptive continuous monitoring with automatic motion compensation is more beneficial
than periodic imaging surveillance at similar or even less imaging dose.
Collapse
Affiliation(s)
- Xiangyu Ma
- 1 School of Biomedical Engineering, Capital Medical University, Beijing, China.,2 Department of Therapeutic Radiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA.,3 Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Huagang Yan
- 1 School of Biomedical Engineering, Capital Medical University, Beijing, China.,2 Department of Therapeutic Radiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA
| | - Ravinder Nath
- 2 Department of Therapeutic Radiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA
| | - Zhe Chen
- 2 Department of Therapeutic Radiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA
| | - Haiyun Li
- 1 School of Biomedical Engineering, Capital Medical University, Beijing, China.,3 Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Wu Liu
- 2 Department of Therapeutic Radiology, Yale University School of Medicine and Yale-New Haven Hospital, New Haven, CT, USA
| |
Collapse
|
6
|
Zhang P, Hunt M, Telles AB, Pham H, Lovelock M, Yorke E, Li G, Happersett L, Rimner A, Mageras G. Design and validation of a MV/kV imaging-based markerless tracking system for assessing real-time lung tumor motion. Med Phys 2018; 45:5555-5563. [PMID: 30362124 DOI: 10.1002/mp.13259] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/17/2018] [Accepted: 10/18/2018] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Localizing lung tumors during treatment delivery is critical for managing respiratory motion, ensuring tumor coverage, and reducing toxicities. The purpose of this project is to develop a real-time system that performs markerless tracking of lung tumors using simultaneously acquired MV and kV images during radiotherapy of lung cancer with volumetric modulated arc therapy. METHOD Continuous MV/kV images were simultaneously acquired during dose delivery. In the subsequent analysis, a gantry angle-specific region of interest was defined according to the treatment aperture. After removing imaging artifacts, processed MV/kV images were directly registered to the corresponding daily setup cone-beam CT (CBCT) projections that served as reference images. The registration objective function consisted of a sum of normalized cross-correlation, weighted by the contrast-to-noise ratio of each MV and kV image. The calculated 3D shifts of the tumor were corrected by the displacements between the CBCT projections and the planning respiratory correlated CT (RCCT) to generate motion traces referred to a specific respiratory phase. The accuracy of the algorithm was evaluated on both anthropomorphic phantom and patient studies. The phantom consisted of localizing a 3D printed tumor, embedded in a thorax phantom, in an arc delivery. In an IRB-approved study, data were obtained from VMAT treatments of two lung cancer patients with three electromagnetic (Calypso) beacon transponders implanted in airways near the lung tumor. RESULT In the phantom study, the root mean square error (RMSE) between the registered and actual (programmed couch movement) target position was 1.2 mm measured by the MV/kV imaging system, which was smaller compared to the MV or kV alone, of 4.1 and 1.3 mm, respectively. In the patient study, the mean and standard deviation discrepancy between electromagnetic-based tumor position and the MV/KV-markerless approach was -0.2 ± 0.6 mm, 0.2 ± 1.0 mm, and -1.2 ± 1.5 mm along the superior-inferior, anterior-posterior, and left-right directions, respectively; resulting in a 3D displacement discrepancy of 2.0 ± 1.1 mm. Poor contrast around the tumor was the main contribution to registration uncertainties. CONCLUSION The combined MV/kV imaging system can provide real-time 3D localization of lung tumor, with comparable accuracy to the electromagnetic-based system when features of tumors are detectable. Careful design of a registration algorithm and a VMAT plan that maximizes the tumor visibility are key elements for a successful MV/KV localization strategy.
Collapse
Affiliation(s)
- Pengpeng Zhang
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Margie Hunt
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | | | - Hai Pham
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Michael Lovelock
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Guang Li
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Laura Happersett
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Gig Mageras
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| |
Collapse
|