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Hurkmans C, Bibault JE, Clementel E, Dhont J, van Elmpt W, Kantidakis G, Andratschke N. Assessment of bias in scoring of AI-based radiotherapy segmentation and planning studies using modified TRIPOD and PROBAST guidelines as an example. Radiother Oncol 2024; 194:110196. [PMID: 38432311 DOI: 10.1016/j.radonc.2024.110196] [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: 11/27/2023] [Revised: 01/29/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND PURPOSE Studies investigating the application of Artificial Intelligence (AI) in the field of radiotherapy exhibit substantial variations in terms of quality. The goal of this study was to assess the amount of transparency and bias in scoring articles with a specific focus on AI based segmentation and treatment planning, using modified PROBAST and TRIPOD checklists, in order to provide recommendations for future guideline developers and reviewers. MATERIALS AND METHODS The TRIPOD and PROBAST checklist items were discussed and modified using a Delphi process. After consensus was reached, 2 groups of 3 co-authors scored 2 articles to evaluate usability and further optimize the adapted checklists. Finally, 10 articles were scored by all co-authors. Fleiss' kappa was calculated to assess the reliability of agreement between observers. RESULTS Three of the 37 TRIPOD items and 5 of the 32 PROBAST items were deemed irrelevant. General terminology in the items (e.g., multivariable prediction model, predictors) was modified to align with AI-specific terms. After the first scoring round, further improvements of the items were formulated, e.g., by preventing the use of sub-questions or subjective words and adding clarifications on how to score an item. Using the final consensus list to score the 10 articles, only 2 out of the 61 items resulted in a statistically significant kappa of 0.4 or more demonstrating substantial agreement. For 41 items no statistically significant kappa was obtained indicating that the level of agreement among multiple observers is due to chance alone. CONCLUSION Our study showed low reliability scores with the adapted TRIPOD and PROBAST checklists. Although such checklists have shown great value during development and reporting, this raises concerns about the applicability of such checklists to objectively score scientific articles for AI applications. When developing or revising guidelines, it is essential to consider their applicability to score articles without introducing bias.
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Affiliation(s)
- Coen Hurkmans
- Dept. of Radiation Oncology, Catharina Hospital Eindhoven, the Netherlands; Dept. of Electrical Engineering, Technical University Eindhoven, the Netherlands.
| | - Jean-Emmanuel Bibault
- Dept. of Radiation Oncology, Hôpital Européen Georges Pompidou, Université Paris Cité, Paris, France
| | - Enrico Clementel
- European Organisation for the Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Jennifer Dhont
- Université libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (H.U.B), Institut Jules Bordet, Department of Medical Physics, Brussels, Belgium; Université Libre De Bruxelles (ULB), Radiophysics and MRI Physics Laboratory, Brussels, Belgium
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Georgios Kantidakis
- European Organisation for the Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Nicolaus Andratschke
- Dept. of Radiation Oncology, University Hospital of Zurich, The University of Zurich, Zurich, Switzerland
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Gogineni E, Schaefer D, Ewing A, Andraos T, DiCostanzo D, Weldon M, Christ D, Baliga S, Jhawar S, Mitchell D, Grecula J, Konieczkowski DJ, Palmer J, Jahraus T, Dibs K, Chakravarti A, Martin D, Gamez ME, Blakaj D. Systematic Implementation of Effective Quality Assurance Processes for the Assessment of Radiation Target Volumes in Head and Neck Cancer. Pract Radiat Oncol 2024; 14:e205-e213. [PMID: 38237893 DOI: 10.1016/j.prro.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/17/2023] [Accepted: 12/01/2023] [Indexed: 02/26/2024]
Abstract
PURPOSE Significant heterogeneity exists in clinical quality assurance (QA) practices within radiation oncology departments, with most chart rounds lacking prospective peer-reviewed contour evaluation. This has the potential to significantly affect patient outcomes, particularly for head and neck cancers (HNC) given the large variance in target volume delineation. With this understanding, we incorporated a prospective systematic peer contour-review process into our workflow for all patients with HNC. This study aims to assess the effectiveness of implementing prospective peer review into practice for our National Cancer Institute Designated Cancer Center and to report factors associated with contour modifications. METHODS AND MATERIALS Starting in November 2020, our department adopted a systematic QA process with real-time metrics, in which contours for all patients with HNC treated with radiation therapy were prospectively peer reviewed and graded. Contours were graded with green (unnecessary), yellow (minor), or red (major) colors based on the degree of peer-recommended modifications. Contours from November 2020 through September 2021 were included for analysis. RESULTS Three hundred sixty contours were included. Contour grades were made up of 89.7% green, 8.9% yellow, and 1.4% red grades. Physicians with >12 months of clinical experience were less likely to have contour changes requested than those with <12 months (8.3% vs 40.9%; P < .001). Contour grades were significantly associated with physician case load, with physicians presenting more than the median number of 50 cases having significantly less modifications requested than those presenting <50 (6.7% vs 13.3%; P = .013). Physicians working with a resident or fellow were less likely to have contour changes requested than those without a trainee (5.2% vs 12.6%; P = .039). Frequency of major modification requests significantly decreased over time after adoption of prospective peer contour review, with no red grades occurring >6 months after adoption. CONCLUSIONS This study highlights the importance of prospective peer contour-review implementation into systematic clinical QA processes for HNC. Physician experience proved to be the highest predictor of approved contours. A growth curve was demonstrated, with major modifications declining after prospective contour review implementation. Even within a high-volume academic practice with subspecialist attendings, >10% of patients had contour changes made as a direct result of prospective peer review.
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Affiliation(s)
- E Gogineni
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D Schaefer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - A Ewing
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - T Andraos
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D DiCostanzo
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - M Weldon
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D Christ
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - S Baliga
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - S Jhawar
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D Mitchell
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - J Grecula
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D J Konieczkowski
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - J Palmer
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - T Jahraus
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - K Dibs
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - A Chakravarti
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - D Martin
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - M E Gamez
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - D Blakaj
- Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
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3
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Muthu S, Mudhana G. Dosimetric Systems in Pre-Treatment QA for Stereotactic Treatments: Correlation Agreements and Target Volume Dependency. Asian Pac J Cancer Prev 2024; 25:1425-1432. [PMID: 38680004 DOI: 10.31557/apjcp.2024.25.4.1425] [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: 12/27/2023] [Indexed: 05/01/2024] Open
Abstract
AIM This study comprehensively investigated pre-treatment quality assurance (QA) for 100 cancer patients undergoing stereotactic treatments (SRS/SRT) using various detectors. METHODS The study conducted QA for SRS/SRT treatments planned with a 6MV SRS beam at a dose rate of 1,000 MU/min, utilizing Eclipse v13.6 Treatment Planning System (TPS). Point dose measurements employed 0.01cm3 and 0.13cm3 cylindrical ionization chambers, while planar dose verification utilized Gafchromic EBT-XD Film and Portal Imager (aS1000). Plans were categorized by target volume, and a thorough analysis compared point dose agreements, planar dose gamma pass rates, and their correlations with chamber volume mean dose, detector type, and point dose agreement. Additionally, the consistency between different ionization chambers was assessed. RESULTS Point dose agreement generally improved with increasing target volume, except for volumes over 10cm3 with 0.01cm3 chambers, showing a contrary trend. Significant differences (p<0.05) were observed between TPS and measured doses for both chambers. Gamma pass rate improved with increasing target volume in EBT XD and aS1000 analyses, except for the >10cm3 group in EBT XD. EBT XD demonstrated better agreement with TPS for target volumes up to 10cm3 compared to aS1000, with a statistically significant difference (p<0.05) between the detectors. Strong correlations were found between chamber point dose and chamber volume mean dose agreement, as well as between the two gamma criteria analyses of the same detector type in the planar dose correlation analysis. However, weak correlations were discovered for other analyses. CONCLUSION This study found weak correlation between different detector types in pre-treatment QA for point dose and planar dose evaluation. However, within a specific detector type, strong correlation was observed for different point dose evaluation methods and gamma criteria. This highlights the importance of cautious interpretation of QA results, particularly for SRS QA, due to the lack of correlation between detector types.
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Affiliation(s)
- Sivakumar Muthu
- Department of Physics, School of Advanced Sciences, Vellore Institute of Technology, Chennai - 600 127, India
- Department of Radiotherapy, Sri Shankara Cancer Hospital & Research Centre, Bangalore - 560 004, India
| | - Gopinath Mudhana
- Department of Physics, School of Advanced Sciences, Vellore Institute of Technology, Chennai - 600 127, India
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Lee JH, Eom KY, Phi JH, Park CK, Kim SK, Cho BK, Kim TM, Heo DS, Hong KT, Choi JY, Kang HJ, Shin HY, Choi SH, Lee ST, Park SH, Wang KC, Kim IH. Long-Term Outcomes and Sequelae Analysis of Intracranial Germinoma: Need to Reduce the Extended-Field Radiotherapy Volume and Dose to Minimize Late Sequelae. Cancer Res Treat 2021; 53:983-990. [PMID: 33494128 PMCID: PMC8524020 DOI: 10.4143/crt.2020.1052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/08/2021] [Indexed: 12/18/2022] Open
Abstract
PURPOSE We aimed to refine the radiotherapy (RT) volume and dose for intracranial germinoma considering recurrences and long-term toxicities. MATERIALS AND METHODS Total 189 patients with intracranial germinoma were treated with RT alone (n=50) and RT with upfront chemotherapy (CRT) (n=139). All cases were confirmed histologically. RT fields comprised the extended-field and involved-field only for primary site. The extended-field, including craniospinal, whole brain (WB), and whole ventricle (WV) for cranial field, is followed by involved-field boost. The median follow-up duration was 115 months. RESULTS The relapses developed in 13 patients (6.9%). For the extended-field, cranial RT dose down to 18 Gy exhibited no cranial recurrence in 34 patients. In CRT, 74 patients (56.5%) showed complete response to chemotherapy and no involved-field recurrence with low-dose RT of 30 Gy. WV RT with chemotherapy for the basal ganglia or thalamus germinoma showed no recurrence. Secondary malignancy developed in 10 patients (5.3%) with a latency of 20 years (range, 4 to 26 years) and caused mortalities in six. WB or craniospinal field rather than WV or involved-field significantly increased the rate of hormone deficiencies, and secondary malignancy. RT dose for extended-field correlated significantly with the rate of hormone deficiencies, secondary malignancy, and neurocognitive dysfunction. CONCLUSION De-intensifying extended-field rather than involved-field or total scheme of RT will be critical to decrease the late toxicities. Upfront chemotherapy could be beneficial for the patients with complete response to minimize the RT dose down to 30 Gy. Prospective trials focused on de-intensification of the extended-field RT are warranted.
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Affiliation(s)
- Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul,
Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Ji Hoon Phi
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Seung Ki Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Byung-Kyu Cho
- Department of Neurosurgery, The Armed Forces Capital Hospital, Seongnam,
Korea
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Dae Seog Heo
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Kyung Taek Hong
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Jung Yoon Choi
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Hyoung Jin Kang
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Hee Young Shin
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Seung Hong Choi
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Soon Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Sung Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Kyu-Chang Wang
- Department of Neurosurgery, National Cancer Center, Goyang,
Korea
| | - Il Han Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
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FitzGerald TJ, Followill D, Laurie F, Boterberg T, Hanusik R, Kessel S, Karolczuk K, Iandoli M, Ulin K, Morano K, Bishop-Jodoin M, Kry S, Lowenstein J, Molineu A, Moni J, Cicchetti MG, Prior F, Saltz J, Sharma A, Mandeville HC, Bernier-Chastagner V, Janssens G. Quality assurance in radiation oncology. Pediatr Blood Cancer 2021; 68 Suppl 2:e28609. [PMID: 33818891 PMCID: PMC10578132 DOI: 10.1002/pbc.28609] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 07/06/2020] [Accepted: 07/08/2020] [Indexed: 11/08/2022]
Abstract
The Children's Oncology Group (COG) has a strong quality assurance (QA) program managed by the Imaging and Radiation Oncology Core (IROC). This program consists of credentialing centers and providing real-time management of each case for protocol compliant target definition and radiation delivery. In the International Society of Pediatric Oncology (SIOP), the lack of an available, reliable online data platform has been a challenge and the European Society for Paediatric Oncology (SIOPE) quality and excellence in radiotherapy and imaging for children and adolescents with cancer across Europe in clinical trials (QUARTET) program currently provides QA review for prospective clinical trials. The COG and SIOP are fully committed to a QA program that ensures uniform execution of protocol treatments and provides validity of the clinical data used for analysis.
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Affiliation(s)
| | | | - Fran Laurie
- Imaging and Radiation Oncology Core Rhode Island, Lincoln, Rhode Island
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University, Ghent, Belgium
| | - Richard Hanusik
- Imaging and Radiation Oncology Core Rhode Island, Lincoln, Rhode Island
| | - Sandra Kessel
- Imaging and Radiation Oncology Core Rhode Island, Lincoln, Rhode Island
| | - Kathryn Karolczuk
- Imaging and Radiation Oncology Core Rhode Island, Lincoln, Rhode Island
| | - Matthew Iandoli
- Imaging and Radiation Oncology Core Rhode Island, Lincoln, Rhode Island
| | - Kenneth Ulin
- Imaging and Radiation Oncology Core Rhode Island, Lincoln, Rhode Island
| | - Karen Morano
- Imaging and Radiation Oncology Core Rhode Island, Lincoln, Rhode Island
| | | | - Stephen Kry
- Imaging and Radiation Oncology Core Houston, Houston, Texas
| | | | - Andrea Molineu
- Imaging and Radiation Oncology Core Houston, Houston, Texas
| | - Janaki Moni
- Imaging and Radiation Oncology Core Rhode Island, Lincoln, Rhode Island
| | | | - Fred Prior
- Department of Biomedical Informatics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Joel Saltz
- Department of Biomedical Informatics, Stony Brook University, Stony Brook, New York
| | - Ashish Sharma
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia
| | - Henry C Mandeville
- Children's and Young Person's Unit and Haemato-oncology Unit, The Royal Marsden NHS Foundation Trust, Surrey, UK
| | | | - Geert Janssens
- Radiation Therapy, Prinses Maxima - Center for Pediatric Oncology, Utrecht, The Netherlands
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Su TS, Liu QH, Zhu XF, Liang P, Liang SX, Lai L, Zhou Y, Huang Y, Cheng T, Li LQ. Optimal stereotactic body radiotherapy dosage for hepatocellular carcinoma: a multicenter study. Radiat Oncol 2021; 16:79. [PMID: 33882972 PMCID: PMC8058965 DOI: 10.1186/s13014-021-01778-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The optimal dose and fractionation scheme of stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC) remains unclear due to different tolerated liver volumes and degrees of cirrhosis. In this study, we aimed to verify the dose-survival relationship to optimize dose selection for treatment of HCC. METHODS This multicenter retrospective study included 602 patients with HCC, treated with SBRT between January 2011 and March 2017. The SBRT dosage was classified into high dose, moderate dose, and low dose levels: SaRT (BED10 ≥ 100 Gy), SbRT (EQD2 > 74 Gy to BED10 < 100 Gy), and ScRT (EQD2 < 74 Gy). Overall survival (OS), progression-free survival (PFS), local control (LC), and intrahepatic control (IC) were evaluated in univariable and multivariable analyses. RESULTS The median tumor size was 5.6 cm (interquartile range [IQR] 1.1-21.0 cm). The median follow-up time was 50.0 months (IQR 6-100 months). High radiotherapy dose correlated with better outcomes. After classifying into the SaRT, SbRT, and ScRT groups, three notably different curves were obtained for long-term post-SBRT survival and intrahepatic control. On multivariate analysis, higher radiation dose was associated with improved OS, PFS, and intrahepatic control. CONCLUSIONS If tolerated by normal tissue, we recommend SaRT (BED10 ≥ 100 Gy) as a first-line ablative dose or SbRT (EQD2 ≥ 74 Gy) as a second-line radical dose. Otherwise, ScRT (EQD2 < 74 Gy) is recommended as palliative irradiation.
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Affiliation(s)
- Ting-Shi Su
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530001 Guangxi Zhuang Autonomous Region China
- Department of Radiation Oncology, Rui Kang Hospital, Guangxi Traditional Chinese Medical University, Nanning, 530001 Guangxi Zhuang Autonomous Region China
| | - Qiu-Hua Liu
- Department of Radiation Oncology, Rui Kang Hospital, Guangxi Traditional Chinese Medical University, Nanning, 530001 Guangxi Zhuang Autonomous Region China
| | - Xiao-Fei Zhu
- Department of Radiation Oncology, Changhai Hospital Affiliated To Navy Medical University, Shanghai, China
| | - Ping Liang
- Department of Radiation Oncology, Rui Kang Hospital, Guangxi Traditional Chinese Medical University, Nanning, 530001 Guangxi Zhuang Autonomous Region China
| | - Shi-Xiong Liang
- Department of Radiation Oncology, Guangxi Medical University Cancer Hospital, Nanning, 530001 Guangxi Zhuang Autonomous Region China
| | - Lin Lai
- Department of Radiation Oncology, Rui Kang Hospital, Guangxi Traditional Chinese Medical University, Nanning, 530001 Guangxi Zhuang Autonomous Region China
| | - Ying Zhou
- Department of Radiation Oncology, Rui Kang Hospital, Guangxi Traditional Chinese Medical University, Nanning, 530001 Guangxi Zhuang Autonomous Region China
| | - Yong Huang
- Department of Radiation Oncology, Rui Kang Hospital, Guangxi Traditional Chinese Medical University, Nanning, 530001 Guangxi Zhuang Autonomous Region China
| | - Tao Cheng
- Department of Radiation Oncology, Rui Kang Hospital, Guangxi Traditional Chinese Medical University, Nanning, 530001 Guangxi Zhuang Autonomous Region China
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning, 530021 Guangxi Zhuang Autonomous Region China
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Nishio T, Nakamura M, Okamoto H, Kito S, Minemura T, Ozawa S, Kumazaki Y, Ishikawa M, Tohyama N, Kurooka M, Nakashima T, Shimizu H, Suzuki R, Ishikura S, Nishimura Y. An overview of the medical-physics-related verification system for radiotherapy multicenter clinical trials by the Medical Physics Working Group in the Japan Clinical Oncology Group-Radiation Therapy Study Group. J Radiat Res 2020; 61:999-1008. [PMID: 32989445 PMCID: PMC7674673 DOI: 10.1093/jrr/rraa089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/25/2020] [Indexed: 05/14/2023]
Abstract
The Japan Clinical Oncology Group-Radiation Therapy Study Group (JCOG-RTSG) has initiated several multicenter clinical trials for high-precision radiotherapy, which are presently ongoing. When conducting multi-center clinical trials, a large difference in physical quantities, such as the absolute doses to the target and the organ at risk, as well as the irradiation localization accuracy, affects the treatment outcome. Therefore, the differences in the various physical quantities used in different institutions must be within an acceptable range for conducting multicenter clinical trials, and this must be verified with medical physics consideration. In 2011, Japan's first Medical Physics Working Group (MPWG) in the JCOG-RTSG was established to perform this medical-physics-related verification for multicenter clinical trials. We have developed an auditing method to verify the accuracy of the absolute dose and the irradiation localization. Subsequently, we credentialed the participating institutions in the JCOG multicenter clinical trials that were using stereotactic body radiotherapy (SBRT) for lungs, intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) for several disease sites, and proton beam therapy (PT) for the liver. From the verification results, accuracies of the absolute dose and the irradiation localization among the participating institutions of the multicenter clinical trial were assured, and the JCOG clinical trials could be initiated.
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Affiliation(s)
- Teiji Nishio
- Corresponding author. Department of Medical Physics, Graduate School of Medicine, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Tel: +81-3-3353-8111; Fax: +81-3-5269-7040;
| | - Mitsuhiro Nakamura
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human He Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
- Medical Physics Working Group (MPWG) in Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Hiroyuki Okamoto
- Department of Medical Physics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
- Medical Physics Working Group (MPWG) in Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Satoshi Kito
- Department of Radiology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan
- Department of Radiation Oncology, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human He Sciences, Graduate School of Medicine, Kyoto University, 53 Shogoin-Kawaharacho, Sakyo-ku, Kyoto 606-8507, Japan
- Medical Physics Working Group (MPWG) in Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Toshiyuki Minemura
- Division of Medical Support and Partnership, Center for Cancer Control and Information Services, National Cancer Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan
- Medical Physics Working Group (MPWG) in Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Shuichi Ozawa
- Department of Radiation Oncology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
- Hiroshima High-Precision Radiotherapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan
- Medical Physics Working Group (MPWG) in Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Yu Kumazaki
- Department of Radiation Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
- Medical Physics Working Group (MPWG) in Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Masayori Ishikawa
- Faculty of Health Sciences, Hokkaido University, N-12 W-5 Kita-ku, Sapporo, 060-0812, Japan
- Medical Physics Working Group (MPWG) in Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Naoki Tohyama
- Division of Medical Physics, Tokyo Bay Advanced Imaging & Radiation Oncology Makuhari Clinic, 1-17 Toyosuna, Mihama-ku, Chiba, 261-0024, Japan
- Medical Physics Working Group (MPWG) in Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Masahiko Kurooka
- Department of Radiation Therapy, Tokyo Medical University Hospital, 6-7-1, Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
- Medical Physics Working Group (MPWG) in Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Takeo Nakashima
- Radiation Therapy Section, Department of Clinical Support, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan
- Medical Physics Working Group (MPWG) in Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Hidetoshi Shimizu
- Department of Radiation Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi 464-8681, Japan
- Medical Physics Working Group (MPWG) in Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Ryusuke Suzuki
- Department of Medical Physics, Hokkaido University Hospital, North-14, West-5, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan
- Medical Physics Working Group (MPWG) in Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Satoshi Ishikura
- Department of Radiology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
- Radiotherapy Committee (RC) in Japan Clinical Oncology Group, Tokyo, Japan
- Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
- Japan Clinical Oncology Group - Radiation Therapy Study Group (JCOG-RTSG), Tokyo, Japan
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van Timmeren JE, Chamberlain M, Krayenbuehl J, Wilke L, Ehrbar S, Bogowicz M, Hartley C, Zamburlini M, Andratschke N, Garcia Schüler H, Pavic M, Balermpas P, Ryu C, Guckenberger M, Tanadini-Lang S. Treatment plan quality during online adaptive re-planning. Radiat Oncol 2020; 15:203. [PMID: 32825848 PMCID: PMC7441614 DOI: 10.1186/s13014-020-01641-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [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: 05/04/2020] [Accepted: 08/12/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Online adaptive radiotherapy is intended to prevent plan degradation caused by inter-fractional tumor volume and shape changes, but time limitations make online re-planning challenging. The aim of this study was to compare the quality of online-adapted plans to their respective reference treatment plans. METHODS Fifty-two patients treated on a ViewRay MRIdian Linac were included in this retrospective study. In total 238 online-adapted plans were analyzed, which were optimized with either changing of the segment weights (n = 85) or full re-optimization (n = 153). Five different treatment sites were evaluated: prostate, abdomen, liver, lung and pelvis. Dosimetric parameters of gross tumor volume (GTV), planning target volume (PTV), 2 cm ring around the PTV and organs at risk (OARs) were considered. The Wilcoxon signed-rank test was used to assess differences between online-adapted and reference treatment plans, p < 0.05 was considered significant. RESULTS The average duration of the online adaptation, consisting of contour editing, plan optimization and quality assurance (QA), was 24 ± 6 min. The GTV was slightly larger (average ± SD: 1.9% ± 9.0%) in the adapted plans than in the reference plans (p < 0.001). GTV-D95% exhibited no significant changes when considering all plans, but GTV-D2% increased by 0.40% ± 1.5% on average (p < 0.001). There was a very small yet significant decrease in GTV-coverage for the abdomen plans. The ring Dmean increased on average by 1.0% ± 3.6% considering all plans (p < 0.001). There was a significant reduction of the dose to the rectum of 4.7% ± 16% on average (p < 0.001) for prostate plans. CONCLUSIONS Dosimetric quality of online-adapted plans was comparable to reference treatment plans and OAR dose was either comparable or decreased, depending on treatment site. However, dose spillage was slightly increased.
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Affiliation(s)
- Janita E van Timmeren
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
| | - Madalyne Chamberlain
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Jérôme Krayenbuehl
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Lotte Wilke
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Marta Bogowicz
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Callum Hartley
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Mariangela Zamburlini
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Helena Garcia Schüler
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Matea Pavic
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Chaehee Ryu
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zürich and University of Zürich, Rämistrasse 100, 8091, Zürich, Switzerland
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9
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van den Ende RPJ, Peters FP, Harderwijk E, Rütten H, Bouwmans L, Berbee M, Canters RAM, Stoian G, Compagner K, Rozema T, de Smet M, Intven MPW, Tijssen RHN, Theuws J, van Haaren P, van Triest B, Eekhout D, Marijnen CAM, van der Heide UA, Kerkhof EM. Radiotherapy quality assurance for mesorectum treatment planning within the multi-center phase II STAR-TReC trial: Dutch results. Radiat Oncol 2020; 15:41. [PMID: 32070386 PMCID: PMC7027245 DOI: 10.1186/s13014-020-01487-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/09/2019] [Accepted: 02/10/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The STAR-TReC trial is an international multi-center, randomized, phase II study assessing the feasibility of short-course radiotherapy or long-course chemoradiotherapy as an alternative to total mesorectal excision surgery. A new target volume is used for both (chemo)radiotherapy arms which includes only the mesorectum. The treatment planning QA revealed substantial variation in dose to organs at risk (OAR) between centers. Therefore, the aim of this study was to determine the treatment plan variability in terms of dose to OAR and assess the effect of a national study group meeting on the quality and variability of treatment plans for mesorectum-only planning for rectal cancer. METHODS Eight centers produced 25 × 2 Gy treatment plans for five cases. The OAR were the bowel cavity, bladder and femoral heads. A study group meeting for the participating centers was organized to discuss the planning results. At the meeting, the values of the treatment plan DVH parameters were distributed among centers so that results could be compared. Subsequently, the centers were invited to perform replanning if they considered this to be necessary. RESULTS All treatment plans, both initial planning and replanning, fulfilled the target constraints. Dose to OAR varied considerably for the initial planning, especially for dose levels below 20 Gy, indicating that there was room for trade-offs between the defined OAR. Five centers performed replanning for all cases. One center did not perform replanning at all and two centers performed replanning on two and three cases, respectively. On average, replanning reduced the bowel cavity V20Gy by 12.6%, bowel cavity V10Gy by 22.0%, bladder V35Gy by 14.7% and bladder V10Gy by 10.8%. In 26/30 replanned cases the V10Gy of both the bowel cavity and bladder was lower, indicating an overall lower dose to these OAR instead of a different trade-off. In addition, the bowel cavity V10Gy and V20Gy showed more similarity between centers. CONCLUSIONS Dose to OAR varied considerably between centers, especially for dose levels below 20 Gy. The study group meeting and the distribution of the initial planning results among centers resulted in lower dose to the defined OAR and reduced variability between centers after replanning. TRIAL REGISTRATION The STAR-TReC trial, ClinicalTrials.gov Identifier: NCT02945566. Registered 26 October 2016, https://clinicaltrials.gov/ct2/show/NCT02945566).
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Affiliation(s)
- Roy P. J. van den Ende
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
| | - Femke P. Peters
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ernst Harderwijk
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
| | - Heidi Rütten
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Liza Bouwmans
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maaike Berbee
- Department of Radiation Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Richard A. M. Canters
- Department of Radiation Oncology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Georgiana Stoian
- Department of Radiation Oncology, Isala Clinics, Zwolle, the Netherlands
| | - Kim Compagner
- Department of Radiation Oncology, Isala Clinics, Zwolle, the Netherlands
| | - Tom Rozema
- Department of Radiation Oncology, Verbeeten Institute, Tilburg, the Netherlands
| | - Mariska de Smet
- Department of Radiation Oncology, Verbeeten Institute, Tilburg, the Netherlands
| | - Martijn P. W. Intven
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob H. N. Tijssen
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jacqueline Theuws
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Paul van Haaren
- Department of Radiation Oncology, Catharina Hospital, Eindhoven, the Netherlands
| | - Baukelien van Triest
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Dave Eekhout
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Corrie A. M. Marijnen
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Uulke A. van der Heide
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ellen M. Kerkhof
- Department of Radiation Oncology, Leiden University Medical Center, P.O. Box 9600 2300, RC, Leiden, the Netherlands
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de Jong EEC, Guckenberger M, Andratschke N, Dieckmann K, Hoogeman MS, Milder M, Møller DS, Nyeng TB, Tanadini-Lang S, Lartigau E, Lacornerie T, Senan S, Verbakel W, Verellen D, De Kerf G, Hurkmans C. Variation in current prescription practice of stereotactic body radiotherapy for peripherally located early stage non-small cell lung cancer: Recommendations for prescribing and recording according to the ACROP guideline and ICRU report 91. Radiother Oncol 2020; 142:217-223. [PMID: 31767472 DOI: 10.1016/j.radonc.2019.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 05/13/2019] [Revised: 10/30/2019] [Accepted: 11/02/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE In 2017 the ACROP guideline on SBRT for peripherally located early stage NSCLC was published. Later that year ICRU-91 about prescribing, recording and reporting was published. The purpose of this study is to quantify the current variation in prescription practice in the institutions that contributed to the ACROP guideline and to establish the link between the ACROP and ICRU-91 recommendations. MATERIAL AND METHODS From each of the eight participating centres, 15 SBRT plans for stage I NSCLC were analyzed. Plans were generated following the institutional protocol, centres prescribed 3 × 13.5 Gy, 3 × 15 Gy, 3 × 17 Gy or 3 × 18 Gy. Dose parameters of the target volumes were reported as recommended by ICRU-91 and also converted to BED10Gy. RESULTS The intra-institutional variance in D98%, Dmean and D2% of the PTV and GTV/ITV is substantially smaller than the inter-institutional spread, indicating well protocollised planning procedures are followed. The median values per centre ranged from 56.1 Gy to 73.1 Gy (D2%), 50.4 Gy to 63.3 Gy (Dmean) and 40.5 Gy to 53.6 Gy (D98%) for the PTV and from 57.1 Gy to 73.6 Gy (D2%), 53.7 Gy to 68.7 Gy (Dmean) and 48.5 Gy to 62.3 Gy (D98%) for the GTV/ITV. Comparing the variance in PTV D98% with the variance in GTV Dmean per centre, using an F-test, shows that four centres have a larger variance in GTV Dmean, while one centre has a larger variance in PTV D98% (p values <0.01). This shows some centres focus on achieving a constant PTV coverage while others aim at a constant GTV coverage. CONCLUSION More detailed recommendations for dose planning and reporting of lung SBRT in line with ICRU-91 were formulated, including a minimum PTV D98% of 100 Gy BED10Gy and minimum GTV/ITV mean dose of 150 Gy BED10Gy and a D2% in the range of 60-70 Gy.
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Affiliation(s)
| | | | | | | | | | - Maaike Milder
- Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | | | | | | | | | | | - Suresh Senan
- Amsterdam University Medical Center, the Netherlands.
| | | | - Dirk Verellen
- Iridium Kankernetwerk, Antwerp University, Antwerp, Belgium.
| | - Geert De Kerf
- Iridium Kankernetwerk, Antwerp University, Antwerp, Belgium.
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11
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Kapuciánová M, Ekendahl D. POSTAL TLD AUDIT OF HETEROGENEITY CORRECTIONS IN RADIOTHERAPY IN THE CZECH REPUBLIC. Radiat Prot Dosimetry 2019; 186:373-376. [PMID: 31834932 DOI: 10.1093/rpd/ncz234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 06/10/2023]
Abstract
In the Czech Republic, a more advanced version of postal audit in radiotherapy (RT) is available. It covers dose measurements with thermoluminescent dosemeters (TLD) in more complex conditions of irradiation, when dose distribution is affected by heterogeneities in the irradiated volume. Relative deviation between doses measured with TLDs and doses stated by RT centre should not exceed 3%. During 2015-2017, all Czech RT centres equipped with modern linear accelerators were subjected to this more advanced TLD audit. A total of 70% of participants complied with the limit of 3% in the first round of this audit.
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Affiliation(s)
- Michaela Kapuciánová
- National Radiation Protection Institute, Bartoskova 1450/28, 14000 Prague 4, Czech Republic
| | - Daniela Ekendahl
- National Radiation Protection Institute, Bartoskova 1450/28, 14000 Prague 4, Czech Republic
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12
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Koniarová I, Kotík L. DETERMINATION OF TOLERANCE LEVELS IN RADIOTHERAPY DOSIMETRY BASED ON STATISTICAL INTERFERENCE. Radiat Prot Dosimetry 2019; 186:367-372. [PMID: 31712816 DOI: 10.1093/rpd/ncz233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The most important dosimetry quantity that is determined at radiotherapy centers is the absorbed dose to water for external beams. Fixed tolerances for absorbed doses measured under reference conditions with an ionization chamber for high-energy photon and electron beams are usually 2 and 3%, respectively, regardless of uncertainties of the input variables and other conditions during evaluation. In reality, this agreement should be evaluated considering the uncertainties of the input variables because they affect the size of the random deviations of the measurements from their true values. The aim of this work was to develop a new approach to evaluate the agreement between measured and reported values based on statistical interference rather than to use fixed tolerance levels. The proposed method considers different scenarios that can occur during the evaluation of agreement. Because the method is described in general, it can be used in all similar situations when partial uncertainties can be established.
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Affiliation(s)
- Irena Koniarová
- National Radiation Protection Institute, Bartoškova 28, 14000 Prague, Czech Republic
| | - Lukáš Kotík
- National Radiation Protection Institute, Bartoškova 28, 14000 Prague, Czech Republic
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13
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Becker SJ, Niu Y, Mutaf Y, Chen S, Poirier Y, Nichols EM, Yi B. Development and validation of a comprehensive patient-specific quality assurance program for a novel stereotactic radiation delivery system for breast lesions. J Appl Clin Med Phys 2019; 20:138-148. [PMID: 31833640 PMCID: PMC6909122 DOI: 10.1002/acm2.12778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The GammaPod is a dedicated prone breast stereotactic radiosurgery (SRS) machine composed of 25 cobalt-60 sources which rotate around the breast to create highly conformal dose distributions for boosts, partial-breast irradiation, or neo-adjuvant SRS. We describe the development and validation of a patient-specific quality assurance (PSQA) system for the GammaPod. METHODS We present two PSQA methods: measurement based and calculation based PSQA. The measurements are performed with a combination of absolute and relative dose measurements. Absolute dosimetry is performed in a single point using a 0.053-cc pinpoint ionization chamber in the center of a polymethylmethacrylate (PMMA) breast phantom and a water-filled breast cup. Relative dose distributions are verified with EBT3 film in the PMMA phantom. The calculation-based method verifies point doses with a novel semi-empirical independent-calculation software. RESULTS The average (± standard deviation) breast and target sizes were 1263 ± 335.3 cc and 66.9 ± 29.9 cc, respectively. All ion chamber measurements performed in water and the PMMA phantom agreed with the treatment planning system (TPS) within 2.7%, with average (max) difference of -1.3% (-1.9%) and -1.3% (-2.7%), respectively. Relative dose distributions measured by film showed an average gamma pass rate of 97.0 ± 3.2 when using a 3%/1 mm criteria. The lowest gamma analysis pass rate was 90.0%. The independent calculation software had average agreements (max) with the patient and QA plan calculation of 0.2% (2.2%) and -0.1% (2.0%), respectively. CONCLUSION We successfully implemented the first GammaPod PSQA program. These results show that the GammaPod can be used to calculate and deliver the predicted dose precisely and accurately. For routine PSQA performed prior to treatments, the independent calculation is recommended as it verifies the accuracy of the planned dose without increasing the risk of losing vacuum due to prolonged waiting times.
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Affiliation(s)
- Stewart J. Becker
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Ying Niu
- MedStar Georgetown University HospitalWashingtonDCUSA
| | - Yildirim Mutaf
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Shifeng Chen
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Yannick Poirier
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - Elizabeth M. Nichols
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
| | - ByongYong Yi
- Department of Radiation OncologyUniversity of Maryland School of MedicineBaltimoreMDUSA
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Abstract
In radiation therapy, the accurate delineation of gross tumor volume (GTV) is crucial for treatment planning. However, it is challenging for head and neck cancer (HNC) due to the morphology complexity of various organs in the head, low targets to background contrast and potential artifacts on conventional planning CT images. Thus, manual delineation of GTV on anatomical images is extremely time consuming and suffers from inter-observer variability that leads to planning uncertainty. With the wide use of PET/CT imaging in oncology, complementary functional and anatomical information can be utilized for tumor contouring and bring a significant advantage for radiation therapy planning. In this study, by taking advantage of multi-modality PET and CT images, we propose an automatic GTV segmentation framework based on deep learning for HNC. The backbone of this segmentation framework is based on 3D convolution with dense connections which enables a better information propagation and takes full advantage of the features extracted from multi-modality input images. We evaluate our proposed framework on a dataset including 250 HNC patients. Each patient receives both planning CT and PET/CT imaging before radiation therapy (RT). Manually delineated GTV contours by radiation oncologists are used as ground truth in this study. To further investigate the advantage of our proposed Dense-Net framework, we also compared with the framework using 3D U-Net which is the state-of-the-art in segmentation tasks. Meanwhile, for each frame, the performance comparison between single modality input (PET or CT image) and multi-modality input (both PET/CT) is conducted. Dice coefficient, mean surface distance (MSD), 95th-percentile Hausdorff distance (HD95) and displacement of mass centroid (DMC) are calculated for quantitative evaluation. The dataset is split into train (140 patients), validation (35 patients) and test (75 patients) groups to optimize the network. Based on the results on independent test group, our proposed multi-modality Dense-Net (Dice 0.73) shows better performance than the compared network (Dice 0.71). Furthermore, the proposed Dense-Net structure has less trainable parameters than the 3D U-Net, which reduces the prediction variability. In conclusion, our proposed multi-modality Dense-Net can enable satisfied GTV segmentation for HNC using multi-modality images and yield superior performance than conventional methods. Our proposed method provides an automatic, fast and consistent solution for GTV segmentation and shows potentials to be generally applied for radiation therapy planning of a variety of cancer (e.g. lung, sarcoma, liver and so on).
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Affiliation(s)
- Zhe Guo
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China 100081
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA 02114
| | - Ning Guo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA 02114
| | - Kuang Gong
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA 02114
| | - Shun’an Zhong
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China 100081
| | - Quanzheng Li
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA 02114
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15
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Chiavassa S, Bessieres I, Edouard M, Mathot M, Moignier A. Complexity metrics for IMRT and VMAT plans: a review of current literature and applications. Br J Radiol 2019; 92:20190270. [PMID: 31295002 PMCID: PMC6774599 DOI: 10.1259/bjr.20190270] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 12/21/2022] Open
Abstract
Modulated radiotherapy with multileaf collimators is widely used to improve target conformity and normal tissue sparing. This introduced an additional degree of complexity, studied by multiple teams through different properties. Three categories of complexity metrics were considered in this review: fluence, deliverability and accuracy metrics. The first part of this review is dedicated to the inventory of these complexity metrics. Different applications of these metrics emerged. Influencing the optimizer by integrating complexity metrics into the cost function has been little explored and requires more investigations. In modern treatment planning system, it remains confined to MUs or treatment time limitation. A large majority of studies calculated metrics only for analysis, without plan modification. The main application was to streamline the patient specific quality assurance workload, investigating the capability of complexity metrics to predict patient specific quality assurance results. Additionally complexity metrics were used to analyze behaviour of TPS optimizer, compare TPS, operators and plan properties, and perform multicentre audit. Their potential was also explored in the context of adaptive radiotherapy and automation planning. The second part of the review gives an overview of these studies based on the complexity metrics.
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Affiliation(s)
- Sophie Chiavassa
- Department of Medical Physics, Institut de Cancérologie de l’Ouest Centre René Gauducheau, 44805 Saint-Herblain, France
| | - Igor Bessieres
- Departement of Medical Physics, Centre Georges-François Leclerc, 1 rue Professeur Marion, 21000 Dijon, France
| | - Magali Edouard
- Department of Radiation Oncology, Gustave Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif, France
| | - Michel Mathot
- Liege University Hospital, Domaine du Sart Tilman - B.35 - B-4000 LIEGE1, Belgium
| | - Alexandra Moignier
- Department of Medical Physics, Institut de Cancérologie de l’Ouest Centre René Gauducheau, 44805 Saint-Herblain, France
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16
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Liu S, Bush KK, Bertini J, Fu Y, Lewis JM, Pham DJ, Yang Y, Niedermayr TR, Skinner L, Xing L, Beadle BM, Hsu A, Kovalchuk N. Optimizing efficiency and safety in external beam radiotherapy using automated plan check (APC) tool and six sigma methodology. J Appl Clin Med Phys 2019; 20:56-64. [PMID: 31423729 PMCID: PMC6698761 DOI: 10.1002/acm2.12678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 03/20/2019] [Revised: 05/20/2019] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To develop and implement an automated plan check (APC) tool using a Six Sigma methodology with the aim of improving safety and efficiency in external beam radiotherapy. METHODS The Six Sigma define-measure-analyze-improve-control (DMAIC) framework was used by measuring defects stemming from treatment planning that were reported to the departmental incidence learning system (ILS). The common error pathways observed in the reported data were combined with our departmental physics plan check list, and AAPM TG-275 identified items. Prioritized by risk priority number (RPN) and severity values, the check items were added to the APC tool developed using Varian Eclipse Scripting Application Programming Interface (ESAPI). At 9 months post-APC implementation, the tool encompassed 89 check items, and its effectiveness was evaluated by comparing RPN values and rates of reported errors. To test the efficiency gains, physics plan check time and reported error rate were prospectively compared for 20 treatment plans. RESULTS The APC tool was successfully implemented for external beam plan checking. FMEA RPN ranking re-evaluation at 9 months post-APC demonstrated a statistically significant average decrease in RPN values from 129.2 to 83.7 (P < .05). After the introduction of APC, the average frequency of reported treatment-planning errors was reduced from 16.1% to 4.1%. For high-severity errors, the reduction was 82.7% for prescription/plan mismatches and 84.4% for incorrect shift note. The process shifted from 4σ to 5σ quality for isocenter-shift errors. The efficiency study showed a statistically significant decrease in plan check time (10.1 ± 7.3 min, P = .005) and decrease in errors propagating to physics plan check (80%). CONCLUSIONS Incorporation of APC tool has significantly reduced the error rate. The DMAIC framework can provide an iterative and robust workflow to improve the efficiency and quality of treatment planning procedure enabling a safer radiotherapy process.
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Affiliation(s)
- Shi Liu
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | - Karl K. Bush
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | | | - Yabo Fu
- Department of Radiation OncologyWashington University School of MedicineSt. LouisMOUSA
| | | | - Daniel J. Pham
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | - Yong Yang
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | | | - Lawrie Skinner
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | - Lei Xing
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | - Beth M. Beadle
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
| | - Annie Hsu
- Department of Radiation OncologyStanford UniversityStanfordCAUSA
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Kaidar-Person O, Vrou Offersen B, Hol S, Arenas M, Aristei C, Bourgier C, Cardoso MJ, Chua B, Coles CE, Engberg Damsgaard T, Gabrys D, Jagsi R, Jimenez R, Kirby AM, Kirkove C, Kirova Y, Kouloulias V, Marinko T, Meattini I, Mjaaland I, Nader Marta G, Witt Nystrom P, Senkus E, Skyttä T, Tvedskov TF, Verhoeven K, Poortmans P. ESTRO ACROP consensus guideline for target volume delineation in the setting of postmastectomy radiation therapy after implant-based immediate reconstruction for early stage breast cancer. Radiother Oncol 2019; 137:159-166. [PMID: 31108277 DOI: 10.1016/j.radonc.2019.04.010] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [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: 03/26/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
Immediate breast reconstruction (IBR) rates after mastectomy are increasing. Postmastectomy radiation therapy (PMRT) contouring guidelines for target volumes in the setting of IBR are lacking. Therefore, many patients who have had IBR receive PMRT to target volumes similar to conventional simulator-based whole breast irradiation. The aim of this paper is to describe delineation guidelines for PMRT after implant-based IBR based on a thorough understanding of the surgical procedures, disease stage, patterns of recurrence and radiation techniques. They are based on a consensus endorsed by a global multidisciplinary group of breast cancer experts.
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Affiliation(s)
- Orit Kaidar-Person
- Oncology Institute, Radiation Oncology Unit, Rambam Medical Center, Haifa, Israel.
| | - Birgitte Vrou Offersen
- Department of Experimental Clinical Oncology, Danish Center for Particle Therapy, Department of Oncology, Aarhus University Hospital, Denmark
| | - Sandra Hol
- Department of Radiation Oncology, Institute Verbeeten, Tilburg, the Netherlands
| | - Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, University Rovira i Virgili, Spain
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Italy
| | - Celine Bourgier
- Department of Radiation Oncology, ICM - Val d'Aurelle, INSERM U1194, IRCM; Montpellier University, Montpellier, France
| | - Maria Joao Cardoso
- Breast Unit, Champalimaud Foundation, and Nova Medical School, Lisbon, Portugal
| | - Boon Chua
- Faculty of Medicine, The University of New South Wales, UNSW Sydney, NSW, Australia
| | | | | | - Dorota Gabrys
- Department of Radiation Oncology, Maria Sklodowska Curie Memorial Cancer Centre, Gliwice, Poland
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, USA
| | - Rachel Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, USA
| | - Anna M Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, UK
| | - Carine Kirkove
- Department of Radiation Oncology, University Hospital St-Luc, Brussels, Belgium
| | - Youlia Kirova
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - Vassilis Kouloulias
- National and Kapodistrian University of Athens, Medical School, 2nd Dpt of Radiology, Radiotherapy Unit, Athens, Greece
| | - Tanja Marinko
- Department of Radiation Oncology, Institute of Oncology Ljubljana, Slovenia
| | - Icro Meattini
- Department of Biomedical, Experimental, and Clinical Sciences, University of Florence, Italy, Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ingvil Mjaaland
- Department of Oncology & Radiotherapy, Stavanger University Hospital, Norway
| | - Gustavo Nader Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Department of Radiology and Oncology, Division of Radiation Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Petra Witt Nystrom
- The Skandion Clinic, Uppsala, Sweden and Danish Center for Particle Therapy, Aarhus, Denmark
| | - Elzbieta Senkus
- Department of Oncology & Radiotherapy, Medical University of Gdańsk, Poland
| | - Tanja Skyttä
- Department of Oncology, Tampere University Hospital, Finland
| | - Tove F Tvedskov
- Dept. of Breast Surgery, Herlev Hospital, Copenhagen, Denmark
| | - Karolien Verhoeven
- GROW School for Oncology and Developmental Biology, Department of Radiation Oncology, Maastricht University Medical Centre, Netherlands
| | - Philip Poortmans
- Department of Radiation Oncology, Institut Curie, and Paris Sciences & Lettres University, Paris, France
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18
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Okamoto H, Murakami N, Isohashi F, Kasamatsu T, Hasumi Y, Iijima K, Nishioka S, Nakamura S, Nakamura M, Nishio T, Igaki H, Nakayama Y, Itami J, Ishikura S, Nishimura Y, Toita T. Dummy-run for standardizing plan quality of intensity-modulated radiotherapy for postoperative uterine cervical cancer: Japan Clinical Oncology Group study (JCOG1402). Radiat Oncol 2019; 14:133. [PMID: 31358026 PMCID: PMC6664568 DOI: 10.1186/s13014-019-1340-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/18/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to assess compliance with treatment planning in a dummy-run for a multicenter clinical trial involving patients with high-risk postoperative uterine cervical cancer using intensity-modulated radiation therapy (IMRT) (JCOG1402 trial). METHODS For the dummy-run, we prepared a computed tomography dataset comprising two anonymized cases of post-hysterectomy cervical cancer. These were sent to the 47 participating institutions to assess institutional plan quality such as delineations and dose distributions. RESULTS Central review showed 3 and 4 deviations per treatment plan on average. The deviations related to the nodal and vaginal cuff clinical target volume (CTV) delineation, which accounted for approximately 50% of the total deviations. The CTV vaginal cuff showed considerable differences in delineation compared with the nodal CTV. For the Dice similarity coefficient, case 1 showed a mean ± 1σ of 0.81 ± 0.03 and 0.60 ± 0.09 for the nodal and the CTV vaginal cuff, respectively, while these were 0.81 ± 0.04 and 0.54 ± 0.14, respectively, for case two. Of the 47 institutions, 10 were required to resubmit their treatment plan because the delineations, planning target volume margin, and required dose distributions were not in accordance with the JCOG1402 protocol. CONCLUSIONS The dummy-run test in postoperative uterine cervical cancer demonstrated substantial deviations in the delineations, particularly for the CTV vaginal cuff. The analysis data could provide helpful information on delineation and planning, allowing standardization of IMRT planning for postoperative uterine cervical cancer. TRIAL REGISTRATION Japanese Clinical Trial Registry #: UMIN000027017 at https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000030672;language=J.
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Affiliation(s)
- Hiroyuki Okamoto
- Department of Medical Physics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Naoya Murakami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, 104-0045 Japan
| | - Fumiaki Isohashi
- Department of Radiation Oncology, Graduate School of Medicine, Osaka University, Osaka, 565-0871 Japan
| | - Takahiro Kasamatsu
- Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, 130-8575 Japan
| | - Yoko Hasumi
- Department of Obstetrics and Gynaecology, Mitsui Memorial Hospital, Tokyo, 101-8643 Japan
| | - Kotaro Iijima
- Department of Medical Physics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Shie Nishioka
- Department of Medical Physics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Satoshi Nakamura
- Department of Medical Physics, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Mitsuhiro Nakamura
- Department of Information Technology and Medical Engineering, Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507 Japan
| | - Teiji Nishio
- Department of Medical Physics, Graduate School of Medicine, Tokyo Women’s Medical University, Tokyo, 162-8666 Japan
| | - Hiroshi Igaki
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, 104-0045 Japan
| | - Yuko Nakayama
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, 104-0045 Japan
| | - Jun Itami
- Department of Radiation Oncology, National Cancer Center Hospital, Tokyo, 104-0045 Japan
| | - Satoshi Ishikura
- Department of Radiology, Graduate School of Medical Sciences, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601 Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511 Japan
| | - Takafumi Toita
- Radiation Therapy Center, Okinawa Chubu Hospital, Okinawa, 904-2293 Japan
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19
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Choi CH, Kim JH, Kim JI, Park JM. Comparison of treatment plan quality among MRI-based IMRT with a linac, MRI-based IMRT with tri-Co-60 sources, and VMAT for spine SABR. PLoS One 2019; 14:e0220039. [PMID: 31329641 PMCID: PMC6645671 DOI: 10.1371/journal.pone.0220039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/08/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study compares the plan quality of magnetic-resonance image (MRI)-based intensity modulated radiation therapy (IMRT) using a linac (MR-linac-IMRT), MRI-based IMRT using tri-Co-60 sources (MR-Co-60-IMRT), and volumetric modulated arc therapy (VMAT) for spine stereotactic ablative radiotherapy (SABR). METHODS Twenty patients with thoracic spine metastasis were retrospectively selected for this study. For each patient, the MR-linac-IMRT, MR-Co-60-IMRT, and VMAT plans were generated using an identical CT image set and structures, except for the spinal cord and spinal cord planning organ-at-risk volume (PRV). Those two structures were contoured based on CT image sets for VMAT planning while those were contoured based on MR image sets for MR-linac-IMRT and MR-Co-60-IMRT planning. The initial prescription doses were 18 Gy in a single fraction for every plan in this study. If the tolerance level of the spinal cord was not met, the prescription doses were reduced to meet the tolerance level of the spinal cord. Dose-volumetric parameters of each plan were analyzed. RESULTS The average spinal cord volumes contoured based on the CT and MR images were 3.8±1.6 cm3 and 1.1±1.0 cm3, respectively (p<0.001). For four patients, the prescription doses of VMAT plans were reduced to 16 Gy to satisfy the spinal cord tolerance level. For thirteen patients, the prescription doses of MR-Co-60-IMRT plans were reduced to be less than 16 Gy to meet the spinal cord tolerance level. However, for every MR-linac-IMRT plan, the initial prescription doses of 18 Gy could be delivered to the target volume while satisfying the spinal cord tolerance. The average values of D10%, V10Gy, and V14Gy of the spinal cord PRV consistently indicated that the doses to the spinal cord PRV in the MR-linac-IMRT plans were the lowest among three types of plans in this study (all with p≤0.003). CONCLUSION MR-linac-IMRT appears promising for spine SABR.
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Affiliation(s)
- Chang Heon Choi
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Department of Radiation Oncology, Sheikh Khalifa Specialty Hospital, Ras Al Khaimah, United Arab Emirates
| | - Jin Ho Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jung-in Kim
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- * E-mail: (JMP); (JK)
| | - Jong Min Park
- Department of Radiation Oncology, Seoul National University Hospital, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Robotics Research Laboratory for Extreme Environments, Advanced Institute of Convergence Technology, Suwon, Korea
- * E-mail: (JMP); (JK)
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20
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Amaloo C, Hayes L, Manning M, Liu H, Wiant D. Can automated treatment plans gain traction in the clinic? J Appl Clin Med Phys 2019; 20:29-35. [PMID: 31313508 PMCID: PMC6698763 DOI: 10.1002/acm2.12674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/20/2019] [Accepted: 05/29/2019] [Indexed: 01/09/2023] Open
Abstract
Recently, there has been an increased interest in the feasibility and impact of automation within the field of medical dosimetry. While there have been many commercialized solutions for automatic treatment planning, the use of an application programming interface to achieve complete plan generation for specific treatment sites is a process only recently available for certain commercial vendors. Automatic plan generation for 20 prostate patients was achieved via a stand‐alone automated planning script that accessed a knowledge‐based planning solution. Differences between the auto plans and clinically treated, baseline plans were analyzed and compared. The planning script successfully initialized a treatment plan, accessed the knowledge‐based planning model, optimized the plan, assessed for constraint compliance, and normalized the treatment plan for maximal coverage while meeting constraints. Compared to baseline plans, the auto‐generated plans showed significantly improved rectal sparing with similar coverage for targets and comparable doses to the remaining organs‐at‐risk. Utilization of a script, with its associated time saving and integrated process management, can quickly and automatically generate an acceptable clinical treatment plan for prostate cancer with either improved or similar results compared to a manually created plan.
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Affiliation(s)
- Christopher Amaloo
- Department of Radiation OncologyCone Health Cancer CenterGreensboroNCUSA
| | - Lane Hayes
- Department of Radiation OncologyCone Health Cancer CenterGreensboroNCUSA
| | - Matthew Manning
- Department of Radiation OncologyCone Health Cancer CenterGreensboroNCUSA
| | - Han Liu
- Department of Radiation OncologyCone Health Cancer CenterGreensboroNCUSA
| | - David Wiant
- Department of Radiation OncologyCone Health Cancer CenterGreensboroNCUSA
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21
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Carrier F, Liao Y, Mendenhall N, Guerrieri P, Todor D, Ahmad A, Dominello M, Joiner MC, Burmeister J. Three Discipline Collaborative Radiation Therapy (3DCRT) Special Debate: I would treat prostate cancer with proton therapy. J Appl Clin Med Phys 2019; 20:7-14. [PMID: 31166085 PMCID: PMC6612688 DOI: 10.1002/acm2.12621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- France Carrier
- Department of Radiation OncologyUniversity of MarylandBaltimoreMDUSA
| | - Yixiang Liao
- Department of Radiation OncologyRush University Medical CenterChicagoILUSA
| | | | | | - Dorin Todor
- Department of Radiation OncologyVirginia Commonwealth UniversityRichmondVAUSA
| | - Anis Ahmad
- Department of Radiation OncologyUniversity of Miami, Sylvester Comprehensive Cancer Center, Miller School of MedicineMiamiFLUSA
| | - Michael Dominello
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
| | - Michael C. Joiner
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
| | - Jay Burmeister
- Department of OncologyWayne State University School of MedicineDetroitMIUSA
- Gershenson Radiation Oncology CenterBarbara Ann Karmanos Cancer InstituteDetroitMIUSA
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22
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Rezaee M, Letourneau D. Assessment of Image Quality and Dosimetric Performance of CT Simulators. J Med Imaging Radiat Sci 2019; 50:297-307. [PMID: 31176438 DOI: 10.1016/j.jmir.2019.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/09/2019] [Accepted: 01/17/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND CT simulator for radiation therapy aims to produce high-quality images for dose calculation and delineation of target and organs at risk in the process of treatment planning. Selection of CT imaging protocols that achieve a desired image quality while minimizing patient dose depends on technical CT parameters and their relationship with image quality and radiation dose. For similar imaging protocols using comparable technical CT parameters, there are also variations in image quality metrics between different CT simulator models. Understanding the relationship and variation is important for selecting appropriate imaging protocol and standardizing QC process. Here, we proposed an automated method to determine the relationship between image quality and radiation dose for various CT technical parameters. MATERIAL AND METHOD The impact of scan parameters on various aspects of image quality and volumetric CT dose index for a Philips Brilliance Big Bore and a Toshiba Aquilion One CT scanners were determined by using commercial phantom and automated image quality analysis software and cylindrical radiation dose phantom. RESULTS AND DISCUSSION Both scanners had very similar and satisfactory performance based on the diagnostic acceptance criteria recommended by ACR, International Atomic Energy Agency, and American Association of Physicists in Medicine. However, our results showed a compromise between different image quality components such as low-contrast and spatial resolution with the change of scanning parameters and revealed variations between the two scanners on their image quality performance. Measurement using a generic phantom and analysis by automated software was unbiased and efficient. CONCLUSION This method provides information that can be used as a baseline for CT scanner image quality and dosimetric QC for different CT scanner models in a given institution or across sites.
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Affiliation(s)
- Mohammad Rezaee
- Department of Medical Physics, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
| | - Daniel Letourneau
- Department of Medical Physics, Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Department of Radiation Oncology, Faculty of Medicine, University of Toronto, Toronto, Canada
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23
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Smyth G, Evans PM, Bamber JC, Mandeville HC, Rollo Moore A, Welsh LC, Saran FH, Bedford JL. Dosimetric accuracy of dynamic couch rotation during volumetric modulated arc therapy (DCR-VMAT) for primary brain tumours. Phys Med Biol 2019; 64:08NT01. [PMID: 30808011 PMCID: PMC6877349 DOI: 10.1088/1361-6560/ab0a8e] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 11/12/2022]
Abstract
Radiotherapy treatment plans using dynamic couch rotation during volumetric modulated arc therapy (DCR-VMAT) reduce the dose to organs at risk (OARs) compared to coplanar VMAT, while maintaining the dose to the planning target volume (PTV). This paper seeks to validate this finding with measurements. DCR-VMAT treatment plans were produced for five patients with primary brain tumours and delivered using a commercial linear accelerator (linac). Dosimetric accuracy was assessed using point dose and radiochromic film measurements. Linac-recorded mechanical errors were assessed by extracting deviations from log files for multi-leaf collimator (MLC), couch, and gantry positions every 20 ms. Dose distributions, reconstructed from every fifth log file sample, were calculated and used to determine deviations from the treatment plans. Median (range) treatment delivery times were 125 s (123-133 s) for DCR-VMAT, compared to 78 s (64-130 s) for coplanar VMAT. Absolute point doses were 0.8% (0.6%-1.7%) higher than prediction. For coronal and sagittal films, respectively, 99.2% (96.7%-100%) and 98.1% (92.9%-99.0%) of pixels above a 20% low dose threshold reported gamma <1 for 3% and 3 mm criteria. Log file analysis showed similar gantry rotation root-mean-square error (RMSE) for VMAT and DCR-VMAT. Couch rotation RMSE for DCR-VMAT was 0.091° (0.086-0.102°). For delivered dose reconstructions, 100% of pixels above a 5% low dose threshold reported gamma <1 for 2% and 2 mm criteria in all cases. DCR-VMAT, for the primary brain tumour cases studied, can be delivered accurately using a commercial linac.
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Affiliation(s)
- Gregory Smyth
- Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom. Author to whom any correspondence should be addressed
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24
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Alshaikhi J, Doolan PJ, D'Souza D, Holloway SM, Amos RA, Royle G. Impact of varying planning parameters on proton pencil beam scanning dose distributions in four commercial treatment planning systems. Med Phys 2019; 46:1150-1162. [PMID: 30632173 DOI: 10.1002/mp.13382] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 07/22/2018] [Revised: 11/27/2018] [Accepted: 12/23/2018] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In pencil beam scanning proton therapy, target coverage is achieved by scanning the pencil beam laterally in the x- and y-directions and delivering spots of dose to positions at a given radiological depth (layer). Dose is delivered to the spots on different layers by pencil beams of different energy until the entire volume has been irradiated. The aim of this study is to investigate the implementation of proton planning parameters (spot spacing, layer spacing and margins) in four commercial proton treatment planning systems (TPSs): Eclipse, Pinnacle3 , RayStation and XiO. MATERIALS AND METHODS Using identical beam data in each TPS, plans were created on uniform material synthetic phantoms with cubic targets. The following parameters were systematically varied in each TPS to observe their different implementations: spot spacing, layer spacing and margin. Additionally, plans were created in Eclipse to investigate the impact of these parameters on plan delivery and optimal values are suggested. RESULTS It was found that all systems except Eclipse use a variable layer spacing per beam, based on the Bragg peak width of each energy layer. It is recommended that if this cannot be used, then a constant value of 5 mm will ensure good dose homogeneity. Only RayStation varies the spot spacing according to the variable spot size with depth. If a constant spot spacing is to be used, a value of 5 mm is recommended as a good compromise between dose homogeneity, plan robustness and planning time. It was found that both Pinnacle3 and RayStation position spots outside of the defined volume (target plus margin). CONCLUSIONS All four systems are capable of delivering uniform dose distributions to simple targets, but their implementation of the various planning parameters is different. In this paper comparisons are made between the four systems and recommendations are made as to the values that will provide the best compromise in dose homogeneity and planning time.
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Affiliation(s)
- Jailan Alshaikhi
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
- Saudi Particle Therapy Center, Riyadh, Saudi Arabia
| | - Paul J Doolan
- Department of Medical Physics, German Oncology Center, Limassol, Cyprus
| | - Derek D'Souza
- Department of Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stacey McGowan Holloway
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Richard A Amos
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Gary Royle
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
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25
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Gwynne S, Higgins E, Poon King A, Radhakrishna G, Wills L, Mukherjee S, Hawkins M, Jones G, Staffurth J, Crosby T. Driving developments in UK oesophageal radiotherapy through the SCOPE trials. Radiat Oncol 2019; 14:26. [PMID: 30717810 PMCID: PMC6360789 DOI: 10.1186/s13014-019-1225-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The SCOPE trials (SCOPE 1, NeoSCOPE and SCOPE 2) have been the backbone of oesophageal RT trials in the UK. Many changes in oesophageal RT techniques have taken place in this time. The SCOPE trials have, in addition to adopting these new techniques, been influential in aiding centres with their implementation. We discuss the progress made through the SCOPE trials and include details of a questionnaire sent to participating centres. to establish the role that trial participation played in RT changes in their centre. METHODS Questionnaires were sent to 47 centres, 27 were returned. RESULTS 100% of centres stated their departmental protocol for TVD was based on the relevant SCOPE trial protocol. 4DCT use has increased from 42 to 71%. Type B planning algorithms, mandated in the NeoSCOPE trial, were used in 79.9% pre NeoSCOPE and now in 83.3%. 12.5% of centres were using a stomach filling protocol pre NeoSCOPE, now risen to 50%. CBCT was mandated for IGRT in the NeoSCOPE trial. 66.7% used this routinely pre NeoSCOPE/SCOPE 2 which has risen to 87.5% in the survey. CONCLUSION The results of the questionnaires show how participation in national oesophageal RT trials has led to the adoption of newer RT techniques in UK centres, leading to better patient care.
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Affiliation(s)
- S. Gwynne
- South West Wales Cancer Centre, Swansea, UK
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - E. Higgins
- South West Wales Cancer Centre, Swansea, UK
| | | | | | - L. Wills
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - S. Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - Maria Hawkins
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - G. Jones
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - J. Staffurth
- NIHR Cardiff RTTQA Group, Cardiff, UK
- Cardiff University, Cardiff, UK
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26
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Najafzadeh M, Hoseini-Ghafarokhi M, Bolagh RSM, Haghparast M, Zarifi S, Nickfarjam A, Farhood B, Chow JCL. Benchmarking of Monte Carlo model of Siemens Oncor® linear accelerator for 18MV photon beam: Determination of initial electron beam parameters. J Xray Sci Technol 2019; 27:1047-1070. [PMID: 31498147 DOI: 10.3233/xst-190568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study aims to benchmark a Monte Carlo (MC) model of the 18 MV photon beam produced by the Siemens Oncor® linac using the BEAMnrc and DOSXYZnrc codes. METHODS By matching the percentage depth doses and beam profiles calculated by MC simulations with measurements, the initial electron beam parameters including electron energy, full width at half maximum (spatial FWHM), and mean angular spread were derived for the 10×10 cm2 and 20×20 cm2 field sizes. The MC model of the 18 MV photon beam was then validated against the measurements for different field sizes (5×5, 30×30 and 40×40 cm2) by gamma index analysis. RESULTS The optimum values for electron energy, spatial FWHM and mean angular spread were 14.2 MeV, 0.08 cm and 0.8 degree, respectively. The MC simulations yielded the comparable measurement results of these optimum parameters. The gamma passing rates (with acceptance criteria of 1% /1 mm) for percentage depth doses were found to be 100% for all field sizes. For cross-line profiles, the gamma passing rates were 100%, 97%, 95%, 96% and 95% for 5×5, 10×10, 20×20, 30×30 and 40×40 cm2 field sizes, respectively. CONCLUSIONS By validation of the MC model of Siemens Oncor® linac using various field sizes, it was found that both dose profiles of small and large field sizes were very sensitive to the changes in spatial FWHM and mean angular spread of the primary electron beam from the bending magnet. Hence, it is recommended that both small and large field sizes of the 18 MV photon beams should be considered in the Monte Carlo linac modeling.
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Affiliation(s)
- Milad Najafzadeh
- Department of Radiology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandare-Abbas, Iran
| | - Mojtaba Hoseini-Ghafarokhi
- Department of Radiology and Nuclear Medicine, School of Para Medical Science, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Mohammad Haghparast
- Department of Radiology, Faculty of Para-Medicine, Hormozgan University of Medical Sciences, Bandare-Abbas, Iran
| | - Shiva Zarifi
- Department of Medical Physics, Faculty of Medicine, Semnan University of Medical Sciences, Semnan, Iran
| | - Abolfazl Nickfarjam
- Department of Medical Physics, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Bagher Farhood
- Department of Medical Physics and Radiology, Faculty of Paramedical Sciences, Kashan University of Medical Sciences, Kashan, Iran
| | - James C L Chow
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
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Han C, Yu W, Zheng X, Zhou Y, Gong C, Xie C, Jin X. Composite QA for intensity-modulated radiation therapy using individual volume-based 3D gamma indices. J Radiat Res 2018; 59:669-676. [PMID: 30085157 PMCID: PMC6151639 DOI: 10.1093/jrr/rry061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/19/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study was to investigate the feasibility and sensitivity of using individual volume-based 3D gamma indices for composite dose-volume histogram (DVH)-based intensity-modulated radiation therapy (IMRT) quality assurance (QA). Composite IMRT QA for 15 cervical cancer patients was performed with ArcCHECK. The percentage dosimetric errors (%DEs) of DVH metrics when comparing treatment planning system and QA-reconstructed dose distribution, percentage gamma passing rates (%GPs) with different criteria for individual volumes and global gamma indices were evaluated, as well as their correlations. Receiver operating characteristic (ROC) curves were applied in order to study the sensitivities of the global and individual volume gamma indices. Most %DEs of the DVH metrics were within 3%. The γPTV and γrectum were <80% at 2%/2 mm; apart from these two individual volume indices, all other individual volume gamma indices and global indices had acceptable %GPs. For the criteria of 2%/2 mm, 3%/3 mm and 4%/4 mm, individual volume-based %GPs and global %GPs were correlated in 11, 1 and 12 out of 24 %DE metrics, and in 5, 4 and 5 out of 24 %DE metrics, respectively. Individual volume-based %GPs had a higher percentage of correlation with DVH metrics (%DEs) compared with global %GPs in composite IMRT QA. The areas under the curve (AUCs) of individual volume %GPs were higher than those of global %GPs. In conclusion, individual volume-based %GPs had a higher correlation with %DEs of metrics and a higher sensitivity presented by ROC analysis compared with global %GPs for composite IMRT QA. Thus, use of individual volume-based 3D gamma indices was found to be feasible and sensitive for composite IMRT QA.
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Affiliation(s)
- Ce Han
- Department of Radiation and Medical Oncology, the 1st Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, China
| | - Wenliang Yu
- Department of Radiation Oncology, Quzhou People’s Hospital, No.2 Zhongloudi Road, Quzhou, China
| | - Xiaomin Zheng
- Department of Radiation and Medical Oncology, the 1st Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, China
| | - Yongqiang Zhou
- Department of Radiation and Medical Oncology, the 1st Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, China
| | - Changfei Gong
- Department of Radiation and Medical Oncology, the 1st Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, China
| | - Congying Xie
- Department of Radiation and Medical Oncology, the 1st Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, China
| | - Xiance Jin
- Department of Radiation and Medical Oncology, the 1st Affiliated Hospital of Wenzhou Medical University, No. 2 Fuxue Lane, Wenzhou, China
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Ho F, Tey J, Chia D, Soon YY, Tan CW, Bahiah S, Cheo T, Tham IWK. Implementation of temporal lobe contouring protocol in head and neck cancer radiotherapy planning: A quality improvement project. Medicine (Baltimore) 2018; 97:e12381. [PMID: 30235702 PMCID: PMC6160234 DOI: 10.1097/md.0000000000012381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Temporal lobe necrosis as result of radiation for nasopharyngeal cancer (NPC) occurs up to 28% of NPC patients. The only effective mitigation is by strict adherence to temporal lobe dose tolerances during radiotherapy planning, which in turn hinges on accurate temporal lobe delineation. We aim to improve the accuracy and to standardize temporal lobe contouring for patients receiving head and neck radiotherapy for NPC in a tertiary teaching hospital in Singapore.The baseline data were obtained from 10 patients in the diagnostic phase and the effect of interventions were measured in 37 patients who underwent head and neck radiotherapy over a 6-month period.We conducted the project based on the Clinical Practice Improvement Program methodology. The baseline pooled mean percentage variation in temporal lobe contouring was 39.9% (0.8%-60.2%). There was a low level of temporal lobe contouring concordance and this provided the impetus for implementation of strategies to improve the accuracy and reproducibility of temporal lobe contouring. The interventions included supervision and training of radiation therapists and residents in temporal lobe contouring, and standardization of temporal lobe contouring with a protocol and contouring atlas.Thirty-seven patients were treated during the study period from June to November 2014. Following implementation of the first set of interventions, the pooled mean percentage variation in temporal lobe contouring decreased but was not sustained. The implementation of the second set of interventions resulted in a decrease from 39.9% (January to September 2014) to 17.3% (October to November 2014) where P = .004 using t test. Weekly variation was seen throughout the study period but the decrease was sustained after standardizing and providing a contouring atlas for temporal lobe contouring.Temporal lobe contouring can be standardized through effective implementation of a temporal lobe contouring protocol and atlas.
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Liang X, Zheng D, Mamalui-Hunter M, Flampouri S, Hoppe BS, Mendenhall N, Li Z. ITV-Based Robust Optimization for VMAT Planning of Stereotactic Body Radiation Therapy of Lung Cancer. Pract Radiat Oncol 2018; 9:38-48. [PMID: 30138747 DOI: 10.1016/j.prro.2018.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/09/2018] [Accepted: 08/09/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE Using planning target volume (PTV) to account for setup uncertainties in stereotactic body radiation therapy (SBRT) of lung cancer has been questioned because a significant portion of the PTV contains low-density lung tissue. The purpose of this study is to (1) investigate the feasibility of using robust optimization to account for setup uncertainties in volumetric modulated arc therapy plan for lung SBRT and (2) evaluate the potential normal tissue-sparing benefit of a robust optimized plan compared with a conventional PTV-based optimized plan. METHODS AND MATERIALS The study was conducted with both phantom and patient cases. For each patient or phantom, 2 SBRT lung volumetric modulated arc therapy plans were generated, including an optimized plan based on the PTV (PTV-based plan) with a 5-mm internal target volume (ITV)-to-PTV margin and a second plan based on robust optimization of ITV (ITV-based plan) with ±5-mm setup uncertainties. The target coverage was evaluated on ITV D99 in 15 scenarios that simulated a 5-mm setup error. Dose-volume information on normal lung tissue, intermediate-to-high dose spillage, and integral dose was evaluated. RESULTS Compared with PTV-based plans, ITV-based robust optimized plans resulted in lower normal lung tissue dose, lower intermediate-to-high dose spillage to the body, and lower integral dose, while preserving the dose coverage under setup error scenarios for both phantom and patient cases. CONCLUSIONS Using ITV-based robust optimization, we have shown that accounting for setup uncertainty in SBRT planning is feasible. Further clinical studies are warranted to confirm the clinical effectiveness of this novel approach.
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Affiliation(s)
- Xiaoying Liang
- Department of Radiation Oncology, University of Florida, Gainesville, Florida.
| | - Dandan Zheng
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Stella Flampouri
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Bradford S Hoppe
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Nancy Mendenhall
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
| | - Zuofeng Li
- Department of Radiation Oncology, University of Florida, Gainesville, Florida
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Hansen H, Nielsen BK, Boejen A, Vestergaard A. Teaching Cancer Patients the Value of Correct Positioning During Radiotherapy Using Visual Aids and Practical Exercises. J Cancer Educ 2018; 33:680-685. [PMID: 27726108 DOI: 10.1007/s13187-016-1122-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to investigate if teaching patients about positioning before radiotherapy treatment would (a) reduce the residual rotational set-up errors, (b) reduce the number of repositionings and (c) improve patients' sense of control by increasing self-efficacy and reducing distress. Patients were randomized to either standard care (control group) or standard care and a teaching session combining visual aids and practical exercises (intervention group). Daily images from the treatment sessions were evaluated off-line. Both groups filled in a questionnaire before and at the end of the treatment course on various aspects of cooperation with the staff regarding positioning. Comparisons of residual rotational set-up errors showed an improvement in the intervention group compared to the control group. No significant differences were found in number of repositionings, self-efficacy or distress. Results show that it is possible to teach patients about positioning and thereby improve precision in positioning. Teaching patients about positioning did not seem to affect self-efficacy or distress scores at baseline and at the end of the treatment course.
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Affiliation(s)
- Helle Hansen
- Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark.
| | - Berit Kjærside Nielsen
- Department of Psychology and Behavioural Sciences, Aarhus University and Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
- Department of Clinical Medicine, Aarhus University, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - Annette Boejen
- Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
| | - Anne Vestergaard
- Department of Medical Physics, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus C, Denmark
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Pang H, Sun X, Yang B, Wu J. A quality control method for intensity-modulated radiation therapy planning based on generalized equivalent uniform dose. J Appl Clin Med Phys 2018; 19:276-282. [PMID: 29696777 PMCID: PMC5978717 DOI: 10.1002/acm2.12331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 07/16/2017] [Revised: 01/22/2018] [Accepted: 03/18/2018] [Indexed: 12/25/2022] Open
Abstract
To ensure good quality intensity-modulated radiation therapy (IMRT) planning, we proposed the use of a quality control method based on generalized equivalent uniform dose (gEUD) that predicts absorbed radiation doses in organs at risk (OAR). We conducted a retrospective analysis of patients who underwent IMRT for the treatment of cervical carcinoma, nasopharyngeal carcinoma (NPC), or non-small cell lung cancer (NSCLC). IMRT plans were randomly divided into data acquisition and data verification groups. OAR in the data acquisition group for cervical carcinoma and NPC were further classified as sub-organs at risk (sOAR). The normalized volume of sOAR and normalized gEUD (a = 1) were analyzed using multiple linear regression to establish a fitting formula. For NSCLC, the normalized intersection volume of the planning target volume (PTV) and lung, the maximum diameter of the PTV (left-right, anterior-posterior, and superior-inferior), and the normalized gEUD (a = 1) were analyzed using multiple linear regression to establish a fitting formula for the lung gEUD (a = 1). The r-squared and P values indicated that the fitting formula was a good fit. In the data verification group, IMRT plans verified the accuracy of the fitting formula, and compared the gEUD (a = 1) for each OAR between the subjective method and the gEUD-based method. In conclusion, the gEUD-based method can be used effectively for quality control and can reduce the influence of subjective factors on IMRT planning optimization.
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Affiliation(s)
- Haowen Pang
- Department of OncologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Xiaoyang Sun
- Department of OncologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Bo Yang
- Department of OncologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
| | - Jingbo Wu
- Department of OncologyThe Affiliated Hospital of Southwest Medical UniversityLuzhouChina
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Nestle U, De Ruysscher D, Ricardi U, Geets X, Belderbos J, Pöttgen C, Dziadiuszko R, Peeters S, Lievens Y, Hurkmans C, Slotman B, Ramella S, Faivre-Finn C, McDonald F, Manapov F, Putora PM, LePéchoux C, Van Houtte P. ESTRO ACROP guidelines for target volume definition in the treatment of locally advanced non-small cell lung cancer. Radiother Oncol 2018; 127:1-5. [PMID: 29605476 DOI: 10.1016/j.radonc.2018.02.023] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [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: 02/16/2018] [Revised: 02/22/2018] [Accepted: 02/22/2018] [Indexed: 12/18/2022]
Abstract
Radiotherapy (RT) plays a major role in the curative treatment of locally advanced non-small cell lung cancer (NSCLC). Therefore, the ACROP committee was asked by the ESTRO to provide recommendations on target volume delineation for standard clinical scenarios in definitive (chemo)radiotherapy (RT) and adjuvant RT for locally advanced NSCLC. The guidelines given here are a result of the evaluation of a structured questionnaire followed by a consensus discussion, voting and writing procedure within the committee. Hence, we provide advice for methods and time-points of diagnostics and imaging before the start of treatment planning and for the mandatory and optional imaging to be used for planning itself. Concerning target volumes, recommendations are given for GTV delineation of primary tumour and lymph nodes followed by issues related to the delineation of CTVs for definitive and adjuvant radiotherapy. In the context of PTV delineation, recommendations about the management of geometric uncertainties and target motion are given. We further provide our opinions on normal tissue delineation and organisational and responsibility questions in the process of target volume delineation. This guideline intends to contribute to the standardisation and optimisation of the process of RT treatment planning for clinical practice and prospective studies.
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Affiliation(s)
- Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany; Department of Radiation Oncology, University Hospital Freiburg, Germany.
| | - Dirk De Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro clinic), GROW School for Oncology and Developmental Biology, The Netherlands; KU Leuven, Radiation Oncology, Belgium
| | | | - Xavier Geets
- Department of Radiation Oncology, Cliniques universitaires Saint-Luc, MIRO - IREC Lab, UCL, Belgium
| | - Jose Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Christoph Pöttgen
- Department of Radiation Oncology, West German Tumor Centre, University of Duisburg-Essen Medical School, Germany
| | - Rafal Dziadiuszko
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Poland
| | - Stephanie Peeters
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro clinic), GROW School for Oncology and Developmental Biology, The Netherlands
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Belgium
| | - Coen Hurkmans
- Catharina Hospital, Department of Radiation Oncology, Eindhoven, The Netherlands
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Sara Ramella
- Department of Radiation Oncology, Campus Bio-Medico University, Rome, Italy
| | - Corinne Faivre-Finn
- University of Manchester & The Christie NHS Foundation Trust, Manchester, UK
| | - Fiona McDonald
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital, LMU Munich, Germany
| | - Paul Martin Putora
- Department of Radiation Oncology, Kantonsspital St. Gallen, Switzerland; Medical Faculty, University of Bern, Switzerland
| | - Cécile LePéchoux
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Paul Van Houtte
- Department Radiation Oncology, Institut Bordet, Université Libre Bruxelles, Belgium
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Kubo K, Monzen H, Tamura M, Hirata M, Ishii K, Okada W, Nakahara R, Kishimoto S, Kawamorita R, Nishimura Y. Minimizing dose variation from the interplay effect in stereotactic radiation therapy using volumetric modulated arc therapy for lung cancer. J Appl Clin Med Phys 2018; 19:121-127. [PMID: 29368420 PMCID: PMC5849850 DOI: 10.1002/acm2.12264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 08/09/2017] [Revised: 12/04/2017] [Accepted: 12/15/2017] [Indexed: 11/06/2022] Open
Abstract
It is important to improve the magnitude of dose variation that is caused by the interplay effect. The aim of this study was to investigate the impact of the number of breaths (NBs) to the dose variation for VMAT-SBRT to lung cancer. Data on respiratory motion and multileaf collimator (MLC) sequence were collected from the cases of 30 patients who underwent radiotherapy with VMAT-SBRT for lung cancer. The NBs in the total irradiation time with VMAT and the maximum craniocaudal amplitude of the target were calculated. The MLC sequence complexity was evaluated using the modulation complexity score for VMAT (MCSv). Static and dynamic measurements were performed using a cylindrical respiratory motion phantom and a micro ionization chamber. The 1 standard deviation which were obtained from 10 dynamic measurements for each patient were defined as dose variation caused by the interplay effect. The dose distributions were also verified with radiochromic film to detect undesired hot and cold dose spot. Dose measurements were also performed with different NBs in the same plan for 16 patients in 30 patients. The correlations between dose variations and parameters assessed for each treatment plan including NBs, MCSv, the MCSv/amplitude quotient (TMMCSv), and the MCSv/amplitude quotient × NBs product (IVS) were evaluated. Dose variation was decreased with increasing NBs, and NBs of >40 times maintained the dose variation within 3% in 15 cases. The correlation between dose variation and IVS which were considered NBs was shown stronger (R2 = 0.43, P < 0.05) than TMMCSv (R2 = 0.32, P < 0.05). The NBs is an important factor to reduce the dose variation. The patient who breathes >40 times during irradiation of two partial arcs VMAT (i.e., NBs = 16 breaths per minute) may be suitable for VMAT-SBRT for lung cancer.
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Affiliation(s)
- Kazuki Kubo
- Graduate School of Medical SciencesDepartment of Medical PhysicsKindai UniversityOsakaJapan
- Department of Radiation OncologyTane General HospitalOsakaJapan
| | - Hajime Monzen
- Graduate School of Medical SciencesDepartment of Medical PhysicsKindai UniversityOsakaJapan
| | - Mikoto Tamura
- Graduate School of Medical SciencesDepartment of Medical PhysicsKindai UniversityOsakaJapan
| | - Makoto Hirata
- Graduate School of Medical SciencesDepartment of Medical PhysicsKindai UniversityOsakaJapan
| | - Kentaro Ishii
- Department of Radiation OncologyTane General HospitalOsakaJapan
| | - Wataru Okada
- Department of Radiation OncologyTane General HospitalOsakaJapan
| | - Ryuta Nakahara
- Department of Radiation OncologyTane General HospitalOsakaJapan
| | - Shun Kishimoto
- Department of Radiation OncologyTane General HospitalOsakaJapan
| | - Ryu Kawamorita
- Department of Radiation OncologyTane General HospitalOsakaJapan
| | - Yasumasa Nishimura
- Faculty of MedicineDepartment of Radiation OncologyKindai UniversityOsakaJapan
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Straube C, Oechsner M, Kampfer S, Scharl S, Schmidt-Graf F, Wilkens JJ, Combs SE. Dosimetric impact of tumor treating field (TTField) transducer arrays onto treatment plans for glioblastomas - a planning study. Radiat Oncol 2018; 13:31. [PMID: 29471879 PMCID: PMC5824562 DOI: 10.1186/s13014-018-0976-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 02/15/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Tumor-Treating Fields (TTFields) are a novel treatment strategy for glioblastoma (GBM) that is approved for the use concomitantly to adjuvant chemotherapy. Preclinical data suggest a synergistic interaction of TTFields and radiotherapy (RT). However, the dosimetric uncertainties caused by the highly dense arrays have led to caution of applying the TTF setup during RT. METHODS In a RW3 slab phantom we compared the MV- and kV-CT based planned dose with the measured dose. VMAT-plans were optimized on MV-CTs of an Alderson head phantom without TTF arrays and then re-calculated on the same phantom equipped with TTF arrays. Dose at organs at risk (OAR) and target volumes (PTVs) were compared. RESULTS Measurements at a depth of 2, 3 and 4 cm of a RW 3 slab phantom show an attenuation due to TTField arrays of 3.4, 3.7 and 2.7% respectively. This was in-line with calculated attenuations based on MV-CT (1.2, 2.5 and 2.5%) but not with the attenuation expected from kV-CT based calculations (7.1, 8.2 and 8.6%). Consecutive MV-CT based VMAT planning and re-calculation reveals, that the conformity and homogeneity are not affected by the presence of TTField arrays. The dose at organs at risk (OAR) can show increases or decreases by < 0.5 Gy, which should be considered especially in cases next to the scull base. CONCLUSION MV-CT based dose calculation results in reliable dose distributions also in the presence of TTField arrays. There is a small but clinically not relevant interaction between the TTField arrays and VMAT dose application. Thus, daily replacement of TTField arrays is not necessary in regard to deeply located OARs. RT is feasible, when a VMAT treatment plan is optimized to an array free planning CT. As the biologic effect of a concomitant treatment especially on OARs is currently unknown, a concomitant treatment should be performed only within clinical trials.
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Affiliation(s)
- Christoph Straube
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Severin Kampfer
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Sophia Scharl
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany
| | - Friederike Schmidt-Graf
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany
| | - Jan J. Wilkens
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany
- Department of Radiation Sciences (DRS), Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Munich, Germany
| | - Stephanie E. Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich (TUM), 81675 Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
- Department of Radiation Sciences (DRS), Institute for Innovative Radiotherapy (iRT), Helmholtz Zentrum München, Munich, Germany
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Chan M, Wong M, Leung R, Cheung S, Blanck O. Optimizing the prescription isodose level in stereotactic volumetric-modulated arc radiotherapy of lung lesions as a potential for dose de-escalation. Radiat Oncol 2018; 13:24. [PMID: 29426358 PMCID: PMC5807823 DOI: 10.1186/s13014-018-0965-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 01/29/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To derive and exploit the optimal prescription isodose level (PIL) in inverse optimization of volumetric modulated arc radiotherapy (VMAT) as a potential approach to dose de-escalation in stereotactic body radiotherapy for non-small cell lung carcinomas (NSCLC). METHODS For ten patients, inverse Monte Carlo dose optimization was performed to cover 95% PTV by varying prescription isodose lines (PIL) at 60 to 80% and reference 85%. Subsequently, these were re-normalized to the median gross tumor volume dose (GTV-based prescription) to assess the impacts of PTV and normal tissue dose reduction. RESULTS With PTV-based prescription, GTV mean dose was much higher with the optimized PIL at 60% with significant reduction of normal lung receiving 30 to 10 Gy (V 30-10Gy ), and observable but insignificant dose reduction to spinal cord, esophagus, ribs, and others compared with 85% PIL. Mean doses to the normal lung between PTV and GTV was higher with 60-70% PIL than 85%. The dose gradient index was 5.0 ± 1.1 and 6.1 ± 1.4 for 60 and 85% PIL (p < 0.05), respectively. Compared with the reference 85% PIL plan using PTV-base prescription, significant decreases of all normal tissue doses were observed with 60% and 70% PIL by GTV-based prescription. Yet, the resulting biological effective (BED) mean doses of PTV remain sufficiently high, ranging 104.2 to 116.9 Gy α/β = 10. CONCLUSIONS Optimizing the PIL with VMAT has notable advantage of improving the dosimetric quality of lung SBRT and offers the potential of dose de-escalation for surrounding tissues while increasing the GTV dose simultaneously. The clinical implication of re-normalizing plans from PTV-prescription at 60-70% to the GTV median dose requires further investigations.
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Affiliation(s)
- Mark Chan
- University Medical Center Schleswig–Holstein, Campus Kiel, Department for Radiation Oncology, Arnold–Heller–Straße 3, Haus 50, Karl–Lennert–Krebscentrum Nord, 24105 Kiel, Germany
- Imperial College London Healthcare NHS Trust, Department of Radiation Physics, London, UK
| | - Matthew Wong
- Tuen Mun Hospital, Department of Clinical Oncology, Special Administrative Region of China, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Ronnie Leung
- Tuen Mun Hospital, Department of Clinical Oncology, Special Administrative Region of China, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Steven Cheung
- Tuen Mun Hospital, Department of Clinical Oncology, Special Administrative Region of China, Hong Kong, Hong Kong, Special Administrative Region of China
| | - Oliver Blanck
- University Medical Center Schleswig–Holstein, Campus Kiel, Department for Radiation Oncology, Arnold–Heller–Straße 3, Haus 50, Karl–Lennert–Krebscentrum Nord, 24105 Kiel, Germany
- Saphir Radiosurgery Center Northern Germany, Güstrow, Germany
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Hatanaka S, Shimbo M, Hariu M, Nakajima G, Todoroki K, Hosaka K, Watanabe T, Washizu K, Utsumi N, Yamano T, Nishimura K, Takahashi T. Simple index for validity of the evaluation point for dosimetric verification results of intensity-modulated radiation therapy using a Farmer-type ionization chamber. J Xray Sci Technol 2018; 26:473-480. [PMID: 29562582 DOI: 10.3233/xst-17339] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Based on a retrospective analysis, this study aims to develop a simple index for validity of the evaluation point for the dosimetric verification of intensity-modulated radiation therapy (IMRT). METHODS The results for the dosimetric verifications of a total of 69 IMRT plans were analyzed in this study. A Farmer-type ion chamber was used as a dose detector, and a solid water-equivalent phantom was used. Index values were obtained by dividing the difference between the maximum and minimum dosages by the mean dosage of the 69 plans, and the values were classified into five groups with index value <4, 4-8, 8-12, 12-16, and >16. A t-test was used to assess the statistical significance of the mean differences of the absolute values of the relative errors among these groups. RESULTS We found that there was no significant difference between the groups with index value <4 and 4-8 (p = 0.152); however, there were significant differences between the other groups (p < 0.01). In addition, when the index values were smaller than 8, the pass ratio of 3% tolerance was 96.2% and the pass ratio of 5% tolerance was 99.9%. We observed that the smaller the index value, the smaller the uncertainty of the dose measurement. CONCLUSIONS The results obtained in this study may prove to be useful for accurate dosimetric verifications of IMRTs when ion chambers are used.
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Affiliation(s)
- Shogo Hatanaka
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe City, Saitama, Japan
| | - Munefumi Shimbo
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe City, Saitama, Japan
| | - Masatsugu Hariu
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe City, Saitama, Japan
| | - Go Nakajima
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe City, Saitama, Japan
| | - Keisuke Todoroki
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe City, Saitama, Japan
| | - Katsuhito Hosaka
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe City, Saitama, Japan
| | - Tetsuya Watanabe
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe City, Saitama, Japan
| | - Kana Washizu
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe City, Saitama, Japan
| | - Nobuko Utsumi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe City, Saitama, Japan
- Department of Radiology, JCHO Tokyo Shinjuku Medical Center, Tsukudocho, Shinjuku-Ku, Tokyo, Japan
| | - Takafumi Yamano
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe City, Saitama, Japan
| | - Keiichiro Nishimura
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe City, Saitama, Japan
| | - Takeo Takahashi
- Department of Radiation Oncology, Saitama Medical Center, Saitama Medical University, Kamoda, Kawagoe City, Saitama, Japan
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Eaton DJ, Lee J, Paddick I. Stereotactic radiosurgery for multiple brain metastases: Results of multicenter benchmark planning studies. Pract Radiat Oncol 2017; 8:e212-e220. [PMID: 29452865 DOI: 10.1016/j.prro.2017.12.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/08/2017] [Accepted: 12/20/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE Stereotactic radiosurgery is indicated for treatment of multiple brain metastases. Various treatment platforms are available, but most comparisons are limited to single-center studies. As part of a national commissioning program, benchmark planning cases were completed by 21 clinical centers, providing a unique dataset of current practice across a large number of providers and equipment platforms. METHODS AND MATERIALS Two brain metastases cases were provided, with images and structures predrawn, involving 3 and 7 lesions. Centers produced plans according to their local practice, which were reviewed centrally using metrics for target coverage, selectivity, gradient fall-off, and normal tissue sparing. RESULTS Fifty plans were submitted, using 24 treatment platforms. Eleven plans were revised following feedback, including 2 centers that acquired a new platform; 1 other center accepted a restriction of service. All centers prioritized coverage, with the prescription isodose covering ≥95% of 233 of 235 target volumes. Selectivity was much more variable, especially for smaller lesions, and when combined with poor gradient indices resulted in large volumes of normal tissue being irradiated. Tomotherapy submissions were outliers for either selectivity or gradient index, but other platforms could produce plans with relatively low gradient indices for larger lesion volumes. There was more variation among Varian and Elekta LINAC plans than for Gamma Knife and CyberKnife, and larger differences for smaller targets, both inter- and intratreatment platform. Doses to normal brain and brainstem were highest when margins were applied, but improvements were possible by replanning alone. CONCLUSIONS Multicenter benchmarking exercises have highlighted some variation in clinical practice and priorities, with a few outliers. Most platforms are able to achieve comparable plans, except for the smallest volumes and when larger planning margins are used. The data will be used to advance standardization and quality improvement of national services and can provide useful guidance for centers worldwide.
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Affiliation(s)
- David J Eaton
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, Northwood, United Kingdom.
| | - Jonathan Lee
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, Northwood, United Kingdom
| | - Ian Paddick
- Medical Physics Ltd, Reading, United Kingdom; Cromwell Hospital, London, United Kingdom
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Squires M, Hu Y, Byrne M, Archibald‐Heeren B, Cheers S, Bosco B, Teh A, Fong A. Static beam tomotherapy as an optimisation method in whole-breast radiation therapy (WBRT). J Med Radiat Sci 2017; 64:281-289. [PMID: 28580762 PMCID: PMC5715293 DOI: 10.1002/jmrs.232] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 09/13/2016] [Revised: 04/10/2017] [Accepted: 04/21/2017] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION TomoTherapy (Accuray, Sunnyvale, CA) has recently introduced a static form of tomotherapy: TomoDirect™ (TD). This study aimed to evaluate TD against a contemporary intensity modulated radiation therapy (IMRT) alternative through comparison of target and organ at risk (OAR) doses in breast cancer cases. A secondary objective was to evaluate planning efficiency by measuring optimisation times. METHODS Treatment plans of 27 whole-breast radiation therapy (WBRT) patients optimised with a tangential hybrid IMRT technique were replanned using TD. Parameters included a dynamic field width of 2.5 cm, a pitch of 0.251 and a modulation factor of 2.000; 50 Gy in 25 fractions was prescribed and planning time recorded. The planning metrics used in analysis were ICRU based, with the mean PTV minimum (D99 ) used as the point of comparison. RESULTS Both modalities met ICRU50 target heterogeneity objectives (TD D99 = 48.0 Gy vs. IMRT = 48.1 Gy, P = 0.26; TD D1 = 53.5 Gy vs. IMRT = 53.0 Gy, P = 0.02; Homogeneity index TD = 0.11 vs. IMRT = 0.10, P = 0.03), with TD plans generating higher median doses (TD D50 = 51.1 Gy vs. IMRT = 50.9 Gy, P = 0.03). No significant difference was found in prescription dose coverage (TD V50 = 85.5% vs. IMRT = 82.0%, P = 0.09). TD plans produced a statistically significant reduction in V5 ipsilateral lung doses (TD V5 = 23.2% vs. IMRT = 27.2%, P = 0.04), while other queried OARs remained comparable (TD ipsilateral lung V20 = 13.2% vs. IMRT = 14.6%, P = 0.30; TD heart V5 = 2.7% vs. IMRT = 2.8%, P = 0.47; TD heart V10 = 1.7% vs. IMRT = 1.8%, P = 0.44). TD reduced planning time considerably (TD = 9.8 m vs. IMRT = 27.6 m, P < 0.01), saving an average planning time of 17.8 min per patient. CONCLUSIONS TD represents a suitable WBRT treatment approach both in terms of plan quality metrics and planning efficiency.
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Affiliation(s)
| | - Yunfei Hu
- Radiation Oncology CentresGosfordNew South WalesAustralia
| | - Mikel Byrne
- Radiation Oncology CentresWahroongaNew South WalesAustralia
| | | | - Sonja Cheers
- Radiation Oncology CentresGosfordNew South WalesAustralia
| | - Bruno Bosco
- Precision Cancer CareAustralia
- Radiation Oncology CentresGosfordNew South WalesAustralia
| | - Amy Teh
- Radiation Oncology CentresGosfordNew South WalesAustralia
- Radiation Oncology CentresWahroongaNew South WalesAustralia
| | - Andrew Fong
- Radiation Oncology CentresWahroongaNew South WalesAustralia
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Cubillos-Mesías M, Baumann M, Troost EGC, Lohaus F, Löck S, Richter C, Stützer K. Impact of robust treatment planning on single- and multi-field optimized plans for proton beam therapy of unilateral head and neck target volumes. Radiat Oncol 2017; 12:190. [PMID: 29183377 PMCID: PMC5706329 DOI: 10.1186/s13014-017-0931-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 06/01/2017] [Accepted: 11/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Proton beam therapy is promising for the treatment of head and neck cancer (HNC), but it is sensitive to uncertainties in patient positioning and particle range. Studies have shown that the planning target volume (PTV) concept may not be sufficient to ensure robustness of the target coverage. A few planning studies have considered irradiation of unilateral HNC targets with protons, but they have only taken into account the dose on the nominal plan, without considering anatomy changes occurring during the treatment course. METHODS Four pencil beam scanning (PBS) proton therapy plans were calculated for 8 HNC patients with unilateral target volumes: single-field (SFO) and multi-field optimized (MFO) plans, either using the PTV concept or clinical target volume (CTV)-based robust optimization. The dose was recalculated on computed tomography (CT) scans acquired during the treatment course. Doses to target volumes and organs at risk (OARs) were compared for the nominal plans, cumulative doses considering anatomical changes, and additional setup and range errors in each fraction. If required, the treatment plan was adapted, and the dose was compared with the non-adapted plan. RESULTS All nominal plans fulfilled the clinical specifications for target coverage, but significantly higher doses on the ipsilateral parotid gland were found for both SFO approaches. MFO PTV-based plans had the lowest robustness against range and setup errors. During the treatment course, the influence of the anatomical variation on the dose has shown to be patient specific, mostly independent of the chosen planning approach. Nine plans in four patients required adaptation, which led to a significant improvement of the target coverage and a slight reduction in the OAR dose in comparison to the cumulative dose without adaptation. CONCLUSIONS The use of robust MFO optimization is recommended for ensuring plan robustness and reduced doses in the ipsilateral parotid gland. Anatomical changes occurring during the treatment course might degrade the target coverage and increase the dose in the OARs, independent of the chosen planning approach. For some patients, a plan adaptation may be required.
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Affiliation(s)
- Macarena Cubillos-Mesías
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden – Rossendorf, Dresden, Germany
| | - Michael Baumann
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden – Rossendorf, Dresden, Germany
| | - Esther G. C. Troost
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden – Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
- National Center for Tumor Diseases (NCT), partner site Dresden, Dresden, Germany
| | - Fabian Lohaus
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden – Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Steffen Löck
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden – Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christian Richter
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden – Rossendorf, Dresden, Germany
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- German Cancer Consortium (DKTK), partner site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
| | - Kristin Stützer
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden – Rossendorf, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology – OncoRay, Dresden, Germany
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Wills L, Maggs R, Lewis G, Jones G, Nixon L, Staffurth J, Crosby T. Quality assurance of the SCOPE 1 trial in oesophageal radiotherapy. Radiat Oncol 2017; 12:179. [PMID: 29141663 PMCID: PMC5688711 DOI: 10.1186/s13014-017-0916-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/10/2017] [Accepted: 11/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND SCOPE 1 was the first UK based multi-centre trial involving radiotherapy of the oesophagus. A comprehensive radiotherapy trials quality assurance programme was launched with two main aims: 1. To assist centres, where needed, to adapt their radiotherapy techniques in order to achieve protocol compliance and thereby enable their participation in the trial. 2. To support the trial's clinical outcomes by ensuring the consistent planning and delivery of radiotherapy across all participating centres. METHODS A detailed information package was provided and centres were required to complete a benchmark case in which the delineated target volumes and organs at risk, dose distribution and completion of a plan assessment form were assessed prior to recruiting patients into the trial. Upon recruiting, the quality assurance (QA) programme continued to monitor the outlining and planning of radiotherapy treatments. Completion of a questionnaire was requested in order to gather information about each centre's equipment and techniques relating to their trial participation and to assess the impact of the trial nationally on standard practice for radiotherapy of the oesophagus. During the trial, advice was available for individual planning issues, and was circulated amongst the SCOPE 1 community in response to common areas of concern using bulletins. RESULTS 36 centres were supported through QA processes to enable their participation in SCOPE1. We discuss the issues which have arisen throughout this process and present details of the benchmark case solutions, centre questionnaires and on-trial protocol compliance. The range of submitted benchmark case GTV volumes was 29.8-67.8cm3; and PTV volumes 221.9-513.3 cm3. For the dose distributions associated with these volumes, the percentage volume of the lungs receiving 20Gy (V20Gy) ranged from 20.4 to 33.5%. Similarly, heart V40Gy ranged from 16.1 to 33.0%. Incidence of incorrect outlining of OAR volumes increased from 50% of centres at benchmark case, to 64% on trial. Sixty-five percent of centres, who returned the trial questionnaire, stated that their standard practice had changed as a result of their participation in the SCOPE1 trial. CONCLUSIONS The SCOPE 1 QA programme outcomes lend support to the trial's clinical conclusions. The range of patient planning outcomes for the benchmark case indicated, at the outset of the trial, the significant degree of variation present in UK oesophageal radiotherapy planning outcomes, despite the presence of a protocol. This supports the case for increasingly detailed definition of practice by means of consensus protocols, training and peer review. The incidence of minor inconsistencies of technique highlights the potential for improved QA systems and the need for sufficient resource for this to be addressed within future trials. As indicated in questionnaire responses, the QA exercise as a whole has contributed to greater consistency of oesophageal radiotherapy in the UK via the adoption into standard practice of elements of the protocol. TRIAL REGISTRATION The SCOPE1 trial is an International Standard Randomized Controlled Trial, ISRCTN47718479 .
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Affiliation(s)
- Lucy Wills
- Department of Medical Physics, Velindre Cancer Centre, Cardiff, CF14 2TL UK
- National Radiotherapy Trials QA (RTTQA) Group, Velindre Cancer Centre, Cardiff, CF14 2TL UK
| | - Rhydian Maggs
- Department of Medical Physics, Velindre Cancer Centre, Cardiff, CF14 2TL UK
- National Radiotherapy Trials QA (RTTQA) Group, Velindre Cancer Centre, Cardiff, CF14 2TL UK
| | - Geraint Lewis
- Department of Medical Physics, Velindre Cancer Centre, Cardiff, CF14 2TL UK
- National Radiotherapy Trials QA (RTTQA) Group, Velindre Cancer Centre, Cardiff, CF14 2TL UK
| | - Gareth Jones
- Department of Medical Physics, Velindre Cancer Centre, Cardiff, CF14 2TL UK
- National Radiotherapy Trials QA (RTTQA) Group, Velindre Cancer Centre, Cardiff, CF14 2TL UK
| | - Lisette Nixon
- Wales Cancer Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, CF14 1YS UK
| | - John Staffurth
- School of Medicine, Cardiff University, University Hospital Wales, Cardiff, CF14 4XN UK
- National Radiotherapy Trials QA (RTTQA) Group, Velindre Cancer Centre, Cardiff, CF14 2TL UK
| | - Tom Crosby
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, CF14 2TL UK
| | - on behalf of the SCOPE 1 trial management group and collaborators
- Department of Medical Physics, Velindre Cancer Centre, Cardiff, CF14 2TL UK
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, CF14 2TL UK
- Wales Cancer Trials Unit, Centre for Trials Research, Cardiff University, Cardiff, CF14 1YS UK
- School of Medicine, Cardiff University, University Hospital Wales, Cardiff, CF14 4XN UK
- National Radiotherapy Trials QA (RTTQA) Group, Velindre Cancer Centre, Cardiff, CF14 2TL UK
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Kim SW, Shin HJ, Hwang JH, Shin JS, Park SK, Kim JY, Kim KJ, Kay CS, Kang YN. Image similarity evaluation of the bulk-density-assigned synthetic CT derived from MRI of intracranial regions for radiation treatment. PLoS One 2017; 12:e0185082. [PMID: 28926610 PMCID: PMC5605009 DOI: 10.1371/journal.pone.0185082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 09/06/2017] [Indexed: 11/30/2022] Open
Abstract
Objective Various methods for radiation-dose calculation have been investigated over previous decades, focusing on the use of magnetic resonance imaging (MRI) only. The bulk-density-assignment method based on manual segmentation has exhibited promising results compared to dose-calculation with computed tomography (CT). However, this method cannot be easily implemented in clinical practice due to its time-consuming nature. Therefore, we investigated an automatic anatomy segmentation method with the intention of providing the proper methodology to evaluate synthetic CT images for a radiation-dose calculation based on MR images. Methods CT images of 20 brain cancer patients were selected, and their MR images including T1-weighted, T2-weighted, and PETRA were retrospectively collected. Eight anatomies of the patients, such as the body, air, eyeball, lens, cavity, ventricle, brainstem, and bone, were segmented for bulk-density-assigned CT image (BCT) generation. In addition, water-equivalent CT images (WCT) with only two anatomies—body and air—were generated for a comparison with BCT. Histogram comparison and gamma analysis were performed by comparison with the original CT images, after the evaluation of automatic segmentation performance with the dice similarity coefficient (DSC), false negative dice (FND) coefficient, and false positive dice (FPD) coefficient. Results The highest DSC value was 99.34 for air segmentation, and the lowest DSC value was 73.50 for bone segmentation. For lens segmentation, relatively high FND and FPD values were measured. The cavity and bone were measured as over-segmented anatomies having higher FPD values than FND. The measured histogram comparison results of BCT were better than those of WCT in all cases. In gamma analysis, the averaged improvement of BCT compared to WCT was measured. All the measured results of BCT were better than those of WCT. Therefore, the results of this study show that the introduced methods, such as histogram comparison and gamma analysis, are valid for the evaluation of the synthetic CT generation from MR images. Conclusions The image similarity results showed that BCT has superior results compared to WCT for all measurements performed in this study. Consequently, more accurate radiation treatment for the intracranial regions can be expected when the proper image similarity evaluation introduced in this study is performed.
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Affiliation(s)
- Shin-Wook Kim
- Department of Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hun-Joo Shin
- Department of Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Ho Hwang
- Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Sol Shin
- Department of Biomedical Engineering, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung-Kwang Park
- Department of Radiation Oncology, Busan Paik Hospital, Inje University, Busan, Korea
| | - Jin-Young Kim
- Department of Radiation Oncology, Haeundae Paik Hospital, Inje University, Busan, Korea
| | - Ki-Jun Kim
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul-Seung Kay
- Department of Radiation Oncology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young-Nam Kang
- Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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De Ruysscher D, Faivre-Finn C, Moeller D, Nestle U, Hurkmans CW, Le Péchoux C, Belderbos J, Guckenberger M, Senan S. European Organization for Research and Treatment of Cancer (EORTC) recommendations for planning and delivery of high-dose, high precision radiotherapy for lung cancer. Radiother Oncol 2017; 124:1-10. [PMID: 28666551 DOI: 10.1016/j.radonc.2017.06.003] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [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: 03/26/2017] [Revised: 04/25/2017] [Accepted: 06/05/2017] [Indexed: 12/23/2022]
Abstract
PURPOSE To update literature-based recommendations for techniques used in high-precision thoracic radiotherapy for lung cancer, in both routine practice and clinical trials. METHODS A literature search was performed to identify published articles that were considered clinically relevant and practical to use. Recommendations were categorised under the following headings: patient positioning and immobilisation, Tumour and nodal changes, CT and FDG-PET imaging, target volumes definition, radiotherapy treatment planning and treatment delivery. An adapted grading of evidence from the Infectious Disease Society of America, and for models the TRIPOD criteria, were used. RESULTS Recommendations were identified for each of the above categories. CONCLUSION Recommendations for the clinical implementation of high-precision conformal radiotherapy and stereotactic body radiotherapy for lung tumours were identified from the literature. Techniques that were considered investigational at present are highlighted.
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Affiliation(s)
- Dirk De Ruysscher
- Maastricht University Medical Center+, Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, The Netherlands; KU Leuven, Radiation Oncology, Belgium.
| | - Corinne Faivre-Finn
- Division of Cancer Sciences University of Manchester, Christie NHS Foundation Trust, UK
| | - Ditte Moeller
- Aarhus University Hospital, Department of Oncology, Denmark
| | - Ursula Nestle
- Freiburg University Medical Center (DKTK partner site), Department of Radiation Oncology, Germany; Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany
| | - Coen W Hurkmans
- Catharina Hospital, Department of Radiation Oncology, Eindhoven, The Netherlands
| | | | - José Belderbos
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | | | - Suresh Senan
- VU University Medical Center, Department of Radiation Oncology, Amsterdam, The Netherlands
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Moustakis C, Blanck O, Ebrahimi Tazehmahalleh F, Ka Heng Chan M, Ernst I, Krieger T, Duma MN, Oechsner M, Ganswindt U, Heinz C, Alheit H, Blank H, Nestle U, Wiehle R, Kornhuber C, Ostheimer C, Petersen C, Pollul G, Baus W, Altenstein G, Beckers E, Jurianz K, Sterzing F, Kretschmer M, Seegenschmiedt H, Maass T, Droege S, Wolf U, Schoeffler J, Haverkamp U, Eich HT, Guckenberger M. Planning benchmark study for SBRT of early stage NSCLC : Results of the DEGRO Working Group Stereotactic Radiotherapy. Strahlenther Onkol 2017; 193:780-790. [PMID: 28567503 DOI: 10.1007/s00066-017-1151-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [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: 10/08/2016] [Accepted: 05/10/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The aim was to evaluate stereotactic body radiation therapy (SBRT) treatment planning variability for early stage nonsmall cell lung cancer (NSCLC) with respect to the published guidelines of the Stereotactic Radiotherapy Working Group of the German Society for Radiation Oncology (DEGRO). MATERIALS AND METHODS Planning computed tomography (CT) scan and the structure sets (planning target volume, PTV; organs at risk, OARs) of 3 patients with early stage NSCLC were sent to 22 radiotherapy departments with SBRT experience: each department was asked to prepare a treatment plan according to the DEGRO guidelines. The prescription dose was 3 fractions of 15 Gy to the 65% isodose. RESULTS In all, 87 plans were generated: 36 used intensity-modulated arc therapy (IMAT), 21 used three-dimensional conformal radiation therapy (3DCRT), 6 used static field intensity-modulated radiation therapy (SF-IMRT), 9 used helical radiotherapy and 15 used robotic radiosurgery. PTV dose coverage and simultaneously kept OARs doses were within the clinical limits published in the DEGRO guidelines. However, mean PTV dose (mean 58.0 Gy, range 52.8-66.4 Gy) and dose conformity indices (mean 0.75, range 0.60-1.00) varied between institutions and techniques (p ≤ 0.02). OARs doses varied substantially between institutions, but appeared to be technique independent (p = 0.21). CONCLUSION All studied treatment techniques are well suited for SBRT of early stage NSCLC according to the DEGRO guidelines. Homogenization of SBRT practice in Germany is possible through the guidelines; however, detailed treatment plan characteristics varied between techniques and institutions and further homogenization is warranted in future studies and recommendations. Optimized treatment planning should always follow the ALARA (as low as reasonably achievable) principle.
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Affiliation(s)
- Christos Moustakis
- Department of Radiation Oncology, University Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany.
- German CyberKnife Center, Soest, Germany.
| | - Oliver Blanck
- Department of Radiation Oncology, UKSH Universitätsklinikum Schleswig Holstein, Kiel, Germany
- Güstrow and Frankfurt, Saphir Radiosurgery Center, Frankfurt, Germany
| | - Fatemeh Ebrahimi Tazehmahalleh
- Department of Radiation Oncology, University Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
- City Hospital Dessau, Dessau, Germany
| | - Mark Ka Heng Chan
- Department of Radiation Oncology, UKSH Universitätsklinikum Schleswig Holstein, Kiel, Germany
| | - Iris Ernst
- Department of Radiation Oncology, University Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
- German CyberKnife Center, Soest, Germany
| | - Thomas Krieger
- Department of Radiation Oncology, University of Wuerzburg, Wuerzburg, Germany
| | - Marciana-Nona Duma
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ute Ganswindt
- Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany
| | - Christian Heinz
- Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany
| | | | | | - Ursula Nestle
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
| | - Rolf Wiehle
- Department of Radiation Oncology, University Medical Center Freiburg, Freiburg, Germany
| | | | | | | | - Gerhard Pollul
- Department of Radiation Oncology, University Mainz, Mainz, Germany
| | | | | | | | | | | | | | | | - Torsten Maass
- Radiationtherapy and Cyberknife Center Hamburg, Hamburg, Germany
| | | | - Ulrich Wolf
- Department of Radiation Oncology, University Leipzig, Leipzig, Germany
| | | | - Uwe Haverkamp
- Department of Radiation Oncology, University Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
- German CyberKnife Center, Soest, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Muenster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Germany
- German CyberKnife Center, Soest, Germany
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44
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Powis R, Bird A, Brennan M, Hinks S, Newman H, Reed K, Sage J, Webster G. Clinical implementation of a knowledge based planning tool for prostate VMAT. Radiat Oncol 2017; 12:81. [PMID: 28482845 PMCID: PMC5423022 DOI: 10.1186/s13014-017-0814-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 01/07/2017] [Accepted: 04/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A knowledge based planning tool has been developed and implemented for prostate VMAT radiotherapy plans providing a target average rectum dose value based on previously achievable values for similar rectum/PTV overlap. The purpose of this planning tool is to highlight sub-optimal clinical plans and to improve plan quality and consistency. METHODS A historical cohort of 97 VMAT prostate plans was interrogated using a RayStation script and used to develop a local model for predicting optimum average rectum dose based on individual anatomy. A preliminary validation study was performed whereby historical plans identified as "optimal" and "sub-optimal" by the local model were replanned in a blinded study by four experienced planners and compared to the original clinical plan to assess whether any improvement in rectum dose was observed. The predictive model was then incorporated into a RayStation script and used as part of the clinical planning process. Planners were asked to use the script during planning to provide a patient specific prediction for optimum average rectum dose and to optimise the plan accordingly. RESULTS Plans identified as "sub-optimal" in the validation study observed a statistically significant improvement in average rectum dose compared to the clinical plan when replanned whereas plans that were identified as "optimal" observed no improvement when replanned. This provided confidence that the local model can identify plans that were suboptimal in terms of rectal sparing. Clinical implementation of the knowledge based planning tool reduced the population-averaged mean rectum dose by 5.6Gy. There was a small but statistically significant increase in total MU and femoral head dose and a reduction in conformity index. These did not affect the clinical acceptability of the plans and no significant changes to other plan quality metrics were observed. CONCLUSIONS The knowledge-based planning tool has enabled substantial reductions in population-averaged mean rectum dose for prostate VMAT patients. This suggests plans are improved when planners receive quantitative feedback on plan quality against historical data.
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Affiliation(s)
- Richard Powis
- Worcestershire Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Andrew Bird
- Worcestershire Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Matthew Brennan
- Worcestershire Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Susan Hinks
- Worcestershire Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Hannah Newman
- Worcestershire Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Katie Reed
- Worcestershire Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - John Sage
- Worcestershire Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
- Centre for Technology Enabled Health Care, Coventry University, Coventry, UK
| | - Gareth Webster
- Worcestershire Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
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45
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Eaton DJ, Tyler J, Backshall A, Bernstein D, Carver A, Gasnier A, Henderson J, Lee J, Patel R, Tsang Y, Yang H, Zotova R, Wells E. An external dosimetry audit programme to credential static and rotational IMRT delivery for clinical trials quality assurance. Phys Med 2017; 35:25-30. [PMID: 28236559 DOI: 10.1016/j.ejmp.2017.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/23/2017] [Accepted: 02/14/2017] [Indexed: 11/19/2022] Open
Affiliation(s)
- David J Eaton
- Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, UK.
| | - Justine Tyler
- RTTQA, Royal Marsden Hospital, Fulham Road, London, UK
| | | | | | | | - Anne Gasnier
- RTTQA, Royal Marsden Hospital, Fulham Road, London, UK
| | | | - Jonathan Lee
- Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, UK
| | - Rushil Patel
- Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, UK
| | - Yatman Tsang
- Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, UK
| | - Huiqi Yang
- Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, UK
| | - Rada Zotova
- Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, UK
| | - Emma Wells
- RTTQA, Royal Marsden Hospital, Fulham Road, London, UK
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46
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Fokas E, Spezi E, Patel N, Hurt C, Nixon L, Chu KY, Staffurth J, Abrams R, Mukherjee S. Comparison of investigator-delineated gross tumour volumes and quality assurance in pancreatic cancer: Analysis of the on-trial cases for the SCALOP trial. Radiother Oncol 2016; 120:212-6. [PMID: 27497804 PMCID: PMC5013754 DOI: 10.1016/j.radonc.2016.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 05/27/2016] [Revised: 07/01/2016] [Accepted: 07/03/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE We performed a retrospective central review of tumour outlines in patients undergoing radiotherapy in the SCALOP trial. MATERIALS AND METHODS The planning CT scans were reviewed retrospectively by a central review team, and the accuracy of investigators' GTV (iGTV) and PTV (iPTV) was compared to the trials team-defined gold standard (gsGTV and gsPTV) using the Jaccard Conformity Index (JCI) and Geographical Miss Index (GMI). The prognostic value of JCI and GMI was also assessed. The RT plans were also reviewed against protocol-defined constraints. RESULTS 60 patients with diagnostic-quality planning scans were included. The median whole volume JCI for GTV was 0.64 (IQR: 0.43-0.82), and the median GMI was 0.11 (IQR: 0.05-0.22). For PTVs, the median JCI and GMI were 0.80 (IQR: 0.71-0.88) and 0.04 (IQR: 0.02-0.12) respectively. Tumour was completely missed in 1 patient, and⩾50% of the tumour was missed in 3. Patients with JCI for GTV⩾0.7 had 7.12 (95% CIs: 1.83-27.67, p=0.005) higher odds of progressing by 9months in multivariate analysis. Major deviations in RT planning were noted in 4.5% of cases. CONCLUSIONS Radiotherapy workshops and real-time central review of contours are required in RT trials of pancreatic cancer.
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Affiliation(s)
- Emmanouil Fokas
- Department of Oncology, CRUK/MRC Institute for Radiation Oncology, University of Oxford, UK
| | | | - Neel Patel
- Oxford University Hospital NHS Foundation Trust, UK
| | - Chris Hurt
- Wales Cancer Trials Unit, Centre for Trials Research, Cardiff University, UK
| | - Lisette Nixon
- Wales Cancer Trials Unit, Centre for Trials Research, Cardiff University, UK
| | - Kwun-Ye Chu
- Department of Oncology, CRUK/MRC Institute for Radiation Oncology, University of Oxford, UK; Oxford University Hospital NHS Foundation Trust, UK
| | - John Staffurth
- Institute of Cancer and Genetics, Cardiff University, UK; Cardiff NCRI RTTQA Centre, Velindre NHS Trust, UK
| | - Ross Abrams
- Department of Radiation Oncology, Rush University Medical Center, Chicago, USA
| | - Somnath Mukherjee
- Department of Oncology, CRUK/MRC Institute for Radiation Oncology, University of Oxford, UK; Oxford University Hospital NHS Foundation Trust, UK.
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47
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Bedford JL, Smyth G, Hanson IM, Tree AC, Dearnaley DP, Hansen VN. Quality of treatment plans and accuracy of in vivo portal dosimetry in hybrid intensity-modulated radiation therapy and volumetric modulated arc therapy for prostate cancer. Radiother Oncol 2016; 120:320-6. [PMID: 27470308 DOI: 10.1016/j.radonc.2016.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 12/08/2015] [Revised: 06/27/2016] [Accepted: 07/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Delivering selected parts of volumetric modulated arc therapy (VMAT) plans using step-and-shoot intensity modulated radiotherapy (IMRT) beams has the potential to increase plan quality by allowing specific aperture positioning. This study investigates the quality of treatment plans and the accuracy of in vivo portal dosimetry in such a hybrid approach for the case of prostate radiotherapy. MATERIAL AND METHODS Conformal and limited-modulation VMAT plans were produced, together with five hybrid IMRT/VMAT plans, in which 0%, 25%, 50%, 75% or 100% of the segments were sequenced for IMRT, while the remainder were sequenced for VMAT. Integrated portal images were predicted for the plans. The plans were then delivered as a single hybrid beam using an Elekta Synergy accelerator with Agility head to a water-equivalent phantom and treatment time, isocentric dose and portal images were measured. RESULTS Increasing the IMRT percentage improves dose uniformity to the planning target volume (p<0.01 for 50% IMRT or more), substantially reduces the volume of rectum irradiated to 65Gy (p=0.02 for 25% IMRT) and increases the monitor units (p<0.001). Delivery time also increases substantially. All plans show accurate delivery of dose and reliable prediction of portal images. CONCLUSIONS Hybrid IMRT/VMAT can be efficiently planned and delivered as a single beam sequence. Beyond 25% IMRT, the delivery time becomes unacceptably long, with increased risk of intrafraction motion, but 25% IMRT is an attractive compromise. Integrated portal images can be used to perform in vivo dosimetry for this technique.
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Affiliation(s)
- James L Bedford
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK.
| | - Gregory Smyth
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Ian M Hanson
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Alison C Tree
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - David P Dearnaley
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - Vibeke N Hansen
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
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48
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Ph Kamerling C, Ziegenhein P, Sterzing F, Oelfke U. Interactive dose shaping part 2: proof of concept study for six prostate patients. Phys Med Biol 2016; 61:2471-84. [PMID: 26948274 PMCID: PMC5390954 DOI: 10.1088/0031-9155/61/6/2471] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 06/17/2015] [Accepted: 02/09/2016] [Indexed: 11/11/2022]
Abstract
Recently we introduced interactive dose shaping (IDS) as a new IMRT planning strategy. This planning concept is based on a hierarchical sequence of local dose modification and recovery operations. The purpose of this work is to provide a feasibility study for the IDS planning strategy based on a small set of six prostate patients. The IDS planning paradigm aims to perform interactive local dose adaptations of an IMRT plan without compromising already established valuable dose features in real-time. Various IDS tools were developed in our in-house treatment planning software Dynaplan and were utilized to create IMRT treatment plans for six patients with an adeno-carcinoma of the prostate. The sequenced IDS treatment plans were compared to conventionally optimized clinically approved plans (9 beams, co-planar). For each patient, several IDS plans were created, with different trade-offs between organ sparing and target coverage. The reference dose distributions were imported into Dynaplan. For each patient, the IDS treatment plan with a similar or better trade-off between target coverage and OAR sparing was selected for plan evaluation, guided by a physician. For this initial study we were able to generate treatment plans for prostate geometries in 15-45 min. Individual local dose adaptations could be performed in less than one second. The average differences compared to the reference plans were for the mean dose: 0.0 Gy (boost) and 1.2 Gy (PTV), for D98% : -1.1 Gy and for D2% : 1.1 Gy (both target volumes). The dose-volume quality indicators were well below the Quantec constraints. However, we also observed limitations of our currently implemented approach. Most prominent was an increase of the non-tumor integral dose by 16.4% on average, demonstrating that further developments of our planning strategy are required.
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Affiliation(s)
- Cornelis Ph Kamerling
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, SM2 5NG, UK
| | - Peter Ziegenhein
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, SM2 5NG, UK
| | - Florian Sterzing
- Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
| | - Uwe Oelfke
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, SM2 5NG, UK
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49
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AAPM Medical Physics Practice Guideline 5.a.: Commissioning and QA of Treatment Planning Dose Calculations - Megavoltage Photon and Electron Beams. J Appl Clin Med Phys 2016; 17:457. [PMID: 26894369 DOI: 10.1120/jacmp.v17i1.6166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022] Open
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50
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Liu XJ, Lin XT, Yin Y, Chen JH, Xing LG, Yu JM. Determining the Optimal Dose Prescription for the Planning Target Volume with Stereotactic Body Radiotherapy for Non- Small Cell Lung Cancer Patients. Asian Pac J Cancer Prev 2016; 17:2573-2577. [PMID: 27268632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine a method of dose prescription that minimizes normal tissue irradiation outside the planning target volume (PTV) during stereotactic body radiotherapy (SBRT) for patients with non-small cell lung cancer. METHODS Previous research and patients with typical T1 lung tumors with peripheral lesions in the lung were selected for analysis. A PTV and several organs at risk (OARs) were constructed for the dose calculated; six treatment plans employing intensity modulated radiotherapy (IMRT) were produced, in which the dose was prescribed to encompass the PTV, with the prescription isodose level (PIL) set at 50, 60, 70, 80, 90 or 95% of the isocenter dose. Additionally, four OARs around the PTV were constructed to evaluate the dose received in adjacent tissues. RESULTS The use of higher PILs for SBRT resulted in improved sparing of OARs, with the exception of the volume of lung treated with a lower dose. CONCLUSIONS The use of lower PILs is likely to create significant inhomogeneity of the dose delivered to the target, which may be beneficial for the control of tumors with poor conformity indices.
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Affiliation(s)
- Xi-Jun Liu
- Departments of Radiation Oncology, Shandong University School of Medicine, Shandong Cancer Hospital and Institute, Jinan, Shandong, China E-mail :
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