|
1
|
Abeywardhana R, Sattarivand M. The effect of kV imaging dose on PTV and OAR planning constraints in lung SBRT using stereoscopic/monoscopic real-time tumor-monitoring system. J Appl Clin Med Phys 2025; 26:e70019. [PMID: 39985128 PMCID: PMC12059302 DOI: 10.1002/acm2.70019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 10/01/2024] [Accepted: 12/15/2024] [Indexed: 02/24/2025] Open
Abstract
PURPOSE Quantify the impact of additional imaging doses on clinical dose constraints during lung stereotactic body radiotherapy (SBRT) treatment utilizing stereoscopic/monoscopic real-time tumor monitoring. MATERIALS AND METHODS Thirty lung SBRT patients treated with the volumetric arc therapy technique were randomly selected from the institutional clinical database. Contours of patients' and computed tomography data were extracted from the Eclipse treatment planning system, along with information regarding the treatment dose. Subsequently, patient-specific three-dimensional real-time imaging dose distributions were computed using a validated Monte Carlo simulation of the ExacTrac imaging. The 3D imaging dose was added to the treatment dose, and the influence of the imaging dose on clinical dose constraints was analyzed for planning target volume (PTV) and various organs at risk (OARs). RESULTS Among the 30 patients, 14 patients exhibited one or more failed OAR constraints based solely on the treatment dose, resulting in a total of 24 constraint failures. The addition of the real-time imaging dose altered the pass/fail criteria for one OAR constraint and two PTV constraints. The change in constraint due to additional imaging dose relative to the prescription dose was less than 1% for all patients, except for one case, where it reached 1.9%, which had remained below the threshold of 5% recommended by AAPM TG-180 guidelines. Furthermore, the additional imaging dose relative to the treatment dose resulted in an increase in OAR constraints ranging from 0 to 27% (mean of 0.8%), with nine cases exceeding 5%. CONCLUSION The current study represents the first attempt to investigate the impact of additional imaging doses on clinical planning constraints in real-time tumor monitoring during lung SBRT utilizing ExacTrac imaging system. The addition of an imaging dose will likely have minimal clinical impact.
Collapse
Affiliation(s)
- Ruwan Abeywardhana
- Department of Medical PhysicsNova Scotia Health AuthorityHalifaxNova ScotiaCanada
- Faculty of Computer ScienceDalhousie UniversityHalifaxNova ScotiaCanada
| | - Mike Sattarivand
- Department of Medical PhysicsNova Scotia Health AuthorityHalifaxNova ScotiaCanada
- Department of Physics & Atmospheric ScienceDalhousie UniversityHalifaxNova ScotiaCanada
- Department of Radiation OncologyDalhousie UniversityHalifaxNova ScotiaCanada
| |
Collapse
|
|
2
|
Walter YA, Wang CJ, Speir DB, Burrell WE, Palomeque CD, Henry JC, Rodrigues MM, Jacobs TD, Broekhoven BL, Dugas JP, Hubbard AN, Durham PF, Wu HT. Patient Positional Uncertainty and Margin Reduction in Lung Stereotactic Ablative Radiation Therapy Using Pneumatic Abdominal Compression. Pract Radiat Oncol 2025; 15:253-261. [PMID: 39733967 DOI: 10.1016/j.prro.2024.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 11/24/2024] [Accepted: 12/09/2024] [Indexed: 12/31/2024]
Abstract
PURPOSE Motion management presents a significant challenge in thoracic stereotactic ablative radiation therapy (SABR). Currently, a 5.0-mm standard planning target volume (PTV) margin is widely used to ensure adequate dose to the tumor. Considering recent advancements in tumor localization and motion management, there is merit to reassessing the necessary PTV margins for modern techniques. This work presents a large-scale analysis of intrafraction repositioning for lung SABR under forced shallow breathing to determine the margin requirements for modern delivery techniques. METHODS AND MATERIALS Treatment data for 124 lung SABR patients treated in 607 fractions on a linear accelerator were retrospectively collected for analysis. All patients were treated using pneumatic abdominal compression and intrafraction 4-dimensional (4D) cone beam computed tomography (4D CBCT)-guided repositioning halfway through treatment. Executed repositioning shifts were collected and used to calculate margin requirements using the 2-SD method and an analytical model which accounts for systematic and random errors in treatment. RESULTS A total of 85.7% of treated fractions had 3-dimensional repositioning shifts under 5.0 mm. Fifty-three fractions (8.7%) had shifts ≥ 5.0 mm in at least 1 direction. Margins in the right-left, inferior-superior, and posterior-anterior directions were 3.62 mm, 4.34 mm, and 3.50 mm, respectively, calculated using the 2-SD method. The analytical approach estimated that 4.01 mm, 4.37 mm, and 3.95 mm margins were appropriate for our workflow. Executing intrafraction repositioning reduced margin requirements by 0.73 ± 0.07 mm. CONCLUSIONS Clinical data suggest that the uniform 5.0-mm margin is conservative for our workflow. Using modern techniques such as 4D CT, 4D CBCT, and effective motion management can significantly reduce required margins, and therefore necessary healthy tissue dose. However, the limitations of margin calculation models must be considered, and margin reduction must be approached with caution. Users should conduct a formal risk assessment prior to adopting new standard PTV margins.
Collapse
Affiliation(s)
- Yohan A Walter
- Department of Clinical Research, University of Jamestown, Fargo, North Dakota; Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana.
| | - Chiachien J Wang
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - Daniel B Speir
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - William E Burrell
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - Carlos D Palomeque
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - James C Henry
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - Megan M Rodrigues
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - Troy D Jacobs
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - Bethany L Broekhoven
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - Joseph P Dugas
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - Anne N Hubbard
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - Philip F Durham
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| | - Hsinshun T Wu
- Department of Radiation Oncology, Willis Knighton Cancer Center, Shreveport, Louisiana
| |
Collapse
|
|
3
|
Salvestrini V, Lastrucci A, Banini M, Loi M, Carnevale MG, Olmetto E, Garlatti P, Simontacchi G, Francolini G, Bonomo P, Wandael Y, Desideri I, Ricci R, Giansanti D, Scotti V, Livi L. Recent Advances and Current Challenges in Stereotactic Body Radiotherapy for Ultra-Central Lung Tumors. Cancers (Basel) 2024; 16:4135. [PMID: 39766035 PMCID: PMC11674056 DOI: 10.3390/cancers16244135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2024] [Revised: 12/03/2024] [Accepted: 12/09/2024] [Indexed: 01/11/2025] Open
Abstract
Stereotactic body radiotherapy has been established as a viable treatment option for inoperable early-stage non-small cell lung cancer or secondary lesions mainly in oligoprogressive/oligometastatic scenarios. Treating lesions in the so-called "no flight zone" has always been challenging and conflicting data never cleared how to safely treat these lesions. This is truer considering ultra-central lesions, i.e., directly abutting or whose PTV is overlapping critical mediastinal organs. While historical retrospective data are abundant but mostly heterogenous in terms of the definition of ultra-central lesions, dosing regimens and outcomes, prospective data remain scarce, even though recently published studies have given new encouraging results for such delicate treatment scenarios. For this reason, we aimed to review and summarize current knowledge on stereotactic radiation treatment for ultra-central thoracic lesions, highlighting the most recent advances and the messages that can be taken from them. Lastly, we propose a workflow of the necessary steps to identify and treat such patients, therefore helping in elucidating the advantages and caveats of such treatment options.
Collapse
Affiliation(s)
- Viola Salvestrini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (V.S.); (A.L.); (M.L.); (E.O.); (P.G.); (G.S.); (G.F.); (P.B.); (V.S.); (L.L.)
| | - Andrea Lastrucci
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (V.S.); (A.L.); (M.L.); (E.O.); (P.G.); (G.S.); (G.F.); (P.B.); (V.S.); (L.L.)
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (Y.W.); (R.R.)
| | - Marco Banini
- Department of Experimental and Clinical Biomedical Sciences “M Serio”, University of Florence, 50134 Florence, Italy; (M.G.C.); (I.D.)
| | - Mauro Loi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (V.S.); (A.L.); (M.L.); (E.O.); (P.G.); (G.S.); (G.F.); (P.B.); (V.S.); (L.L.)
| | - Maria Grazia Carnevale
- Department of Experimental and Clinical Biomedical Sciences “M Serio”, University of Florence, 50134 Florence, Italy; (M.G.C.); (I.D.)
| | - Emanuela Olmetto
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (V.S.); (A.L.); (M.L.); (E.O.); (P.G.); (G.S.); (G.F.); (P.B.); (V.S.); (L.L.)
| | - Pietro Garlatti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (V.S.); (A.L.); (M.L.); (E.O.); (P.G.); (G.S.); (G.F.); (P.B.); (V.S.); (L.L.)
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (V.S.); (A.L.); (M.L.); (E.O.); (P.G.); (G.S.); (G.F.); (P.B.); (V.S.); (L.L.)
| | - Giulio Francolini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (V.S.); (A.L.); (M.L.); (E.O.); (P.G.); (G.S.); (G.F.); (P.B.); (V.S.); (L.L.)
| | - Pierluigi Bonomo
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (V.S.); (A.L.); (M.L.); (E.O.); (P.G.); (G.S.); (G.F.); (P.B.); (V.S.); (L.L.)
| | - Yannick Wandael
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (Y.W.); (R.R.)
| | - Isacco Desideri
- Department of Experimental and Clinical Biomedical Sciences “M Serio”, University of Florence, 50134 Florence, Italy; (M.G.C.); (I.D.)
| | - Renzo Ricci
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (Y.W.); (R.R.)
| | | | - Vieri Scotti
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (V.S.); (A.L.); (M.L.); (E.O.); (P.G.); (G.S.); (G.F.); (P.B.); (V.S.); (L.L.)
| | - Lorenzo Livi
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy; (V.S.); (A.L.); (M.L.); (E.O.); (P.G.); (G.S.); (G.F.); (P.B.); (V.S.); (L.L.)
- Department of Experimental and Clinical Biomedical Sciences “M Serio”, University of Florence, 50134 Florence, Italy; (M.G.C.); (I.D.)
| |
Collapse
|
|
4
|
Zhu H, Dong T, Pang T, Guan Q, Yang J, Zhao F, Yang B, Qiu J. Characterization of kilovoltage x-ray image guidance system with a novel post-processing algorithm on a new slip ring-mounted radiotherapy system. J Appl Clin Med Phys 2024; 25:e14524. [PMID: 39259864 PMCID: PMC11633797 DOI: 10.1002/acm2.14524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/15/2024] [Accepted: 08/14/2024] [Indexed: 09/13/2024] Open
Abstract
PURPOSE This study evaluates the performance of a kilovoltage x-ray image-guidance system equipped with a novel post-processing optimization algorithm on the newly introduced TAICHI linear accelerator (Linac). METHODS A comparative study involving image quality tests and radiation dose measurements was conducted across six scanning protocols of the kV-cone beam computed tomography (CBCT) system on the TAICHI Linac. The performance assessment utilized the conventional Feldkamp-Davis-Kress (FDK) algorithm and a novel Non-Local Means denoising and adaptive scattering correction (NLM-ASC) algorithm. Image quality metrics, including spatial resolution, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR), were evaluated using a Catphan 604 phantom. Radiation doses for low-dose and standard protocols were measured using a computed tomography dose index (CTDI) phantom, with comparative measurements from the Halcyon Linac's iterative CBCT (iCBCT). RESULTS The NLM-ASC algorithm significantly improved image quality, achieving a 300%-1000% increase in CNR and SNR over the FDK-only images and it also showed a 100%-200% improvement over the iCBCT images from Halcyon's head protocol. The optimized low-dose protocols yielded higher image quality than the standard FDK protocols, indicating potential for reduced radiation exposure. Clinical implementation confirmed the TAICHI system's utility for precise and adaptive radiotherapy. CONCLUSION The kV-IGRT system on the TAICHI Linac, with its novel post-processing algorithm, demonstrated superior image quality suitable for routine clinical use, effectively reducing image noise without compromising other quality metrics.
Collapse
Affiliation(s)
- Heling Zhu
- Department of Radiation Oncology, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Tingting Dong
- Department of Radiation Oncology, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Tingtian Pang
- Department of Radiation Oncology, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qiu Guan
- Department of Radiation Oncology, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jingru Yang
- Department of Radiation Oncology, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Feini Zhao
- Our United CorporationXi'anShanxi ProvinceChina
| | - Bo Yang
- Department of Radiation Oncology, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jie Qiu
- Department of Radiation Oncology, Peking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| |
Collapse
|
|
5
|
Olovsson N, Wikström K, Flejmer A, Ahnesjö A, Dasu A. Impact of setup and geometric uncertainties on the robustness of free-breathing photon radiotherapy of small lung tumors. Phys Med 2024; 123:103396. [PMID: 38943799 DOI: 10.1016/j.ejmp.2024.103396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/19/2024] [Accepted: 06/01/2024] [Indexed: 07/01/2024] Open
Abstract
PURPOSE Respiratory motion and patient setup error both contribute to the dosimetric uncertainty in radiotherapy of lung tumors. Managing these uncertainties for free-breathing treatments is usually done by margin-based approaches or robust optimization. However, breathing motion can be irregular and concerns have been raised for the robustness of the treatment plans. We have previously reported the dosimetric effects of the respiratory motion, without setup uncertainties, in lung tumor photon radiotherapy using free-breathing images. In this study, we include setup uncertainty. METHODS Tumor positions from cine-CT images acquired in free-breathing were combined with per-fraction patient shifts to simulate treatment scenarios. A total of 14 patients with 300 tumor positions were used to evaluate treatment plans based on 4DCT. Four planning methods aiming at delivering 54 Gy as median tumor dose in three fractions were compared. The planning methods were denoted robust 4D (RB4), isodose to the PTV with a central higher dose (ISD), the ISD method normalized to the intended median tumor dose (IRN) and homogeneous fluence to the PTV (FLU). RESULTS For all planning methods 95% of the intended dose was achieved with at least 90% probability with RB4 and FLU having equal CTV D50% values at this probability. FLU gave the most consistent results in terms of CTV D50% spread and dose homogeneity. CONCLUSIONS Despite the simulated patient shifts and tumor motions being larger than observed in the 4DCTs the dosimetric impact was suggested to be small. RB4 or FLU are recommended for the planning of free-breathing treatments.
Collapse
Affiliation(s)
- Nils Olovsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; The Skandion Clinic, Uppsala, Sweden.
| | - Kenneth Wikström
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; Department of Medical Physics, Uppsala University Hospital, Uppsala, Sweden
| | - Anna Flejmer
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; The Skandion Clinic, Uppsala, Sweden; Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Anders Ahnesjö
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Alexandru Dasu
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; The Skandion Clinic, Uppsala, Sweden
| |
Collapse
|
|
6
|
Mochizuki Z, Saito M, Suzuki T, Mochizuki K, Hasegawa J, Nemoto H, Satani K, Takahashi H, Onishi H. Cycle-generative adversarial network-based bone suppression imaging for highly accurate markerless motion tracking of lung tumors for cyberknife irradiation therapy. J Appl Clin Med Phys 2024; 25:e14212. [PMID: 37985163 PMCID: PMC10795441 DOI: 10.1002/acm2.14212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 10/01/2023] [Accepted: 11/04/2023] [Indexed: 11/22/2023] Open
Abstract
PURPOSE Lung tumor tracking during stereotactic radiotherapy with the CyberKnife can misrecognize tumor location under conditions where similar patterns exist in the search area. This study aimed to develop a technique for bone signal suppression during kV-x-ray imaging. METHODS Paired CT images were created with or without bony structures using a 4D extended cardiac-torso phantom (XCAT phantom) in 56 cases. Subsequently, 3020 2D x-ray images were generated. Images with bone were input into cycle-consistent adversarial network (CycleGAN) and the bone suppressed images on the XCAT phantom (BSIphantom ) were created. They were then compared to images without bone using the structural similarity index measure (SSIM) and peak signal-to-noise ratio (PSNR). Next, 1000 non-simulated treatment images from real cases were input into the training model, and bone-suppressed images of the patient (BSIpatient ) were created. Zero means normalized cross correlation (ZNCC) by template matching between each of the actual treatment images and BSIpatient were calculated. RESULTS BSIphantom values were compared to their paired images without bone of the XCAT phantom test data; SSIM and PSNR were 0.90 ± 0.06 and 24.54 ± 4.48, respectively. It was visually confirmed that only bone was selectively suppressed without significantly affecting tumor visualization. The ZNCC values of the actual treatment images and BSIpatient were 0.763 ± 0.136 and 0.773 ± 0.143, respectively. The BSIpatient showed improved recognition accuracy over the actual treatment images. CONCLUSIONS The proposed bone suppression imaging technique based on CycleGAN improves image recognition, making it possible to achieve highly accurate motion tracking irradiation.
Collapse
Affiliation(s)
- Zennosuke Mochizuki
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Masahide Saito
- Department of RadiologyUniversity of YamanashiChuo‐cityYamanashiJapan
| | - Toshihiro Suzuki
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
- Department of RadiologyUniversity of YamanashiChuo‐cityYamanashiJapan
| | - Koji Mochizuki
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Junichi Hasegawa
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Hikaru Nemoto
- Department of RadiologyUniversity of YamanashiChuo‐cityYamanashiJapan
| | - Kenichiro Satani
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Hiroshi Takahashi
- Department of RadiologyKasugai‐CyberKnife Rehabilitation HospitalFuefuki‐cityYamanashiJapan
| | - Hiroshi Onishi
- Department of RadiologyUniversity of YamanashiChuo‐cityYamanashiJapan
| |
Collapse
|
|
7
|
Wang T, Liu X, Dai J, Zhang C, He W, Liu L, Chan Y, He Y, Zhao H, Xie Y, Liang X. An unsupervised dual contrastive learning framework for scatter correction in cone-beam CT image. Comput Biol Med 2023; 165:107377. [PMID: 37651766 DOI: 10.1016/j.compbiomed.2023.107377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE Cone-beam computed tomography (CBCT) is widely utilized in modern radiotherapy; however, CBCT images exhibit increased scatter artifacts compared to planning CT (pCT), compromising image quality and limiting further applications. Scatter correction is thus crucial for improving CBCT image quality. METHODS In this study, we proposed an unsupervised contrastive learning method for CBCT scatter correction. Initially, we transformed low-quality CBCT into high-quality synthetic pCT (spCT) and generated forward projections of CBCT and spCT. By computing the difference between these projections, we obtained a residual image containing image details and scatter artifacts. Image details primarily comprise high-frequency signals, while scatter artifacts consist mainly of low-frequency signals. We extracted the scatter projection signal by applying a low-pass filter to remove image details. The corrected CBCT (cCBCT) projection signal was obtained by subtracting the scatter artifacts projection signal from the original CBCT projection. Finally, we employed the FDK reconstruction algorithm to generate the cCBCT image. RESULTS To evaluate cCBCT image quality, we aligned the CBCT and pCT of six patients. In comparison to CBCT, cCBCT maintains anatomical consistency and significantly enhances CT number, spatial homogeneity, and artifact suppression. The mean absolute error (MAE) of the test data decreased from 88.0623 ± 26.6700 HU to 17.5086 ± 3.1785 HU. The MAE of fat regions of interest (ROIs) declined from 370.2980 ± 64.9730 HU to 8.5149 ± 1.8265 HU, and the error between their maximum and minimum CT numbers decreased from 572.7528 HU to 132.4648 HU. The MAE of muscle ROIs reduced from 354.7689 ± 25.0139 HU to 16.4475 ± 3.6812 HU. We also compared our proposed method with several conventional unsupervised synthetic image generation techniques, demonstrating superior performance. CONCLUSIONS Our approach effectively enhances CBCT image quality and shows promising potential for future clinical adoption.
Collapse
Affiliation(s)
- Tangsheng Wang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China; University of Chinese Academy of Sciences, Beijing 101408, China.
| | - Xuan Liu
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China.
| | - Jingjing Dai
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China.
| | - Chulong Zhang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China.
| | - Wenfeng He
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China.
| | - Lin Liu
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China; University of Chinese Academy of Sciences, Beijing 101408, China.
| | - Yinping Chan
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China.
| | - Yutong He
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China.
| | - Hanqing Zhao
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China; University of Chinese Academy of Sciences, Beijing 101408, China.
| | - Yaoqin Xie
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China.
| | - Xiaokun Liang
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong 518055, China.
| |
Collapse
|
|
8
|
Shields B, Ramachandran P. Generating missing patient anatomy from partially acquired cone-beam computed tomography images using deep learning: a proof of concept. Phys Eng Sci Med 2023; 46:1321-1330. [PMID: 37462889 PMCID: PMC10480263 DOI: 10.1007/s13246-023-01302-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/05/2023] [Indexed: 09/07/2023]
Abstract
The patient setup technique currently in practice in most radiotherapy departments utilises on-couch cone-beam computed tomography (CBCT) imaging. Patients are positioned on the treatment couch using visual markers, followed by fine adjustments to the treatment couch position depending on the shift observed between the computed tomography (CT) image acquired for treatment planning and the CBCT image acquired immediately before commencing treatment. The field of view of CBCT images is limited to the size of the kV imager which leads to the acquisition of partial CBCT scans for lateralised tumors. The cone-beam geometry results in high amounts of streaking artifacts and in conjunction with limited anatomical information reduces the registration accuracy between planning CT and the CBCT image. This study proposes a methodology that can improve radiotherapy patient setup CBCT images by removing streaking artifacts and generating the missing patient anatomy with patient-specific precision. This research was split into two separate studies. In Study A, synthetic CBCT (sCBCT) data was created and used to train two machine learning models, one for removing streaking artifacts and the other for generating the missing patient anatomy. In Study B, planning CT and on-couch CBCT data from several patients was used to train a base model, from which a transfer of learning was performed using imagery from a single patient, producing a patient-specific model. The models developed for Study A performed well at removing streaking artifacts and generating the missing anatomy. The outputs yielded in Study B show that the model understands the individual patient and can generate the missing anatomy from partial CBCT datasets. The outputs generated demonstrate that there is utility in the proposed methodology which could improve the patient setup and ultimately lead to improving overall treatment quality.
Collapse
Affiliation(s)
- Benjamin Shields
- Biomedical Technology Services, Townsville University Hospital, Townsville, Australia.
- School of Chemistry and Physics, Queensland University of Technology, Brisbane, Australia.
| | - Prabhakar Ramachandran
- School of Chemistry and Physics, Queensland University of Technology, Brisbane, Australia
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
|
9
|
Umbarkar P, Kannan V, Anand VJ, Deshpande S, Hinduja R, Babu V, Naidu S, Jadhav O, Jejurkar A. A comparative study of rectal volume variation in patients with prostate cancer: A tertiary care center study. Radiography (Lond) 2023; 29:845-850. [PMID: 37399732 DOI: 10.1016/j.radi.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Every day variations in rectal filling in prostate cancer radiotherapy can significantly alter the delivered dose distribution from what was intended. The goal of this study was to see if the time of treatment delivery affected the rectal filling. METHODS This is a retrospective study which included 50 patients with localized prostate cancer treated with volumetric modulated arc therapy (VMAT) to the primary and regional lymph nodes. Cone Beam Computed Tomography (CBCT) image-sets were done for all patient's daily setup verification. The radiation therapist contoured the rectum on all CBCT image sets. The rectal volumes delineated on CBCT and the planning CT image sets were compared. The change in rectal volumes between morning and afternoon treatments were calculated and compared. RESULTS A total of 1000 CBCT image sets were obtained on 50 patients in the morning and afternoon. The percentage variation of the CBCT rectal volumes over the planning CT scan was 16.57% in the AM group and 24.35% in the PM group. CONCLUSION The percentage change in rectal volume was significantly lesser in AM group compared to PM group and therefore morning treatments may result in dose distribution that is close to the intended dose distribution. IMPLICATIONS FOR PRACTICE In prostate cancer radiotherapy our study suggests that a simple technique of changing the time of treatment from afternoon to morning can help to reduce the rectal volume.
Collapse
Affiliation(s)
- P Umbarkar
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - V Kannan
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - V J Anand
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - S Deshpande
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - R Hinduja
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - V Babu
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - S Naidu
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - O Jadhav
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| | - A Jejurkar
- Radiotherapy Section, Dept. of Medicine., PD Hinduja National Hospital and Medical Research Centre, Mumbai, 400016, India.
| |
Collapse
|
|
10
|
Deng L, Ji Y, Huang S, Yang X, Wang J. Synthetic CT generation from CBCT using double-chain-CycleGAN. Comput Biol Med 2023; 161:106889. [DOI: 10.1016/j.compbiomed.2023.106889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/16/2023] [Accepted: 04/01/2023] [Indexed: 04/05/2023]
|
|
11
|
Goldsworthy S, Latour JM, Palmer S, McNair HA, Cramp M. Patient and therapeutic radiographer experiences of comfort during the radiotherapy pathway: A qualitative study. Radiography (Lond) 2023; 29 Suppl 1:S24-S31. [PMID: 36841685 DOI: 10.1016/j.radi.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 02/27/2023]
Abstract
INTRODUCTION There is little research regarding the experiences of patient comfort and how it is best managed in radiotherapy. The aim of this study was to explore the experiences of patient and therapeutic radiographer views of comfort during radiotherapy. METHODS This qualitative study involved semi-structured interviews, with cancer patients (n = 25) and therapeutic radiographers (n = 25), conducted between January-July 2019. Patients were recruited from one radiotherapy clinic and therapeutic radiographers were recruited from across the United Kingdom via specialist interest groups and social media. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data separately between both groups and shared themes were identified. RESULTS Four themes were identified of which two themes were shared among both the patients and therapeutic radiographer. Emotional Health was a shared theme highlighting experiences such as stress, vulnerability and privacy. The second shared theme, Positioning and Immobilisation Experiences, concerned how patients' experience being physically positioned and using immobilisation for accurate radiotherapy. The theme Information and Communication Experience was derived from patients highlighting concerns over sharing and provision of information and ways of communication. The last theme, Environmental Experience, emerged from the patient interviews and related to the first impressions of the radiotherapy environment such as reception or treatment rooms and how this effects the overall feelings of comfort. CONCLUSION This qualitative study has provided the shared voice of patients and therapeutic radiographers and their experiences of comfort during radiotherapy. These shared experiences emphasise the importance of considering comfort holistically and not just from a physical context. This information can be used by therapeutic radiographers to better understand their patients experiences and needs to provide better comfort during radiotherapy to improve patients' outcomes. IMPLICATIONS FOR PRACTICE The clinical implications of our study can encourage Therapeutic Radiographers to provide holistic care for their patients throughout the pathway and specifically to comfort patients while they are having treatment. In the short term this could be via simple adaptions to practice while in the long term, research is needed to develop comfort interventions for patients receiving radiotherapy.
Collapse
Affiliation(s)
- Simon Goldsworthy
- Beacon Radiotherapy, Musgrove Park Hospital, Somerset NHS Foundation Trust, Taunton, United Kingdom; Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom.
| | - Jos M Latour
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom; School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Shea Palmer
- Centre for Care Excellence, Coventry University and University Hospitals Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Helen A McNair
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - Mary Cramp
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| |
Collapse
|
|
12
|
Kensen CM, Janssen TM, Betgen A, Wiersema L, Peters FP, Remeijer P, Marijnen CAM, van der Heide UA. Effect of intrafraction adaptation on PTV margins for MRI guided online adaptive radiotherapy for rectal cancer. Radiat Oncol 2022; 17:110. [PMID: 35729587 PMCID: PMC9215022 DOI: 10.1186/s13014-022-02079-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To determine PTV margins for intrafraction motion in MRI-guided online adaptive radiotherapy for rectal cancer and the potential benefit of performing a 2nd adaptation prior to irradiation. Methods Thirty patients with rectal cancer received radiotherapy on a 1.5 T MR-Linac. On T2-weighted images for adaptation (MRIadapt), verification prior to (MRIver) and after irradiation (MRIpost) of 5 treatment fractions per patient, the primary tumor GTV (GTVprim) and mesorectum CTV (CTVmeso) were delineated. The structures on MRIadapt were expanded to corresponding PTVs. We determined the required expansion margins such that on average over 5 fractions, 98% of CTVmeso and 95% of GTVprim on MRIpost was covered in 90% of the patients. Furthermore, we studied the benefit of an additional adaptation, just prior to irradiation, by evaluating the coverage between the structures on MRIver and MRIpost. A threshold to assess the need for a secondary adaptation was determined by considering the overlap between MRIadapt and MRIver. Results PTV margins for intrafraction motion without 2nd adaptation were 6.4 mm in the anterior direction and 4.0 mm in all other directions for CTVmeso and 5.0 mm isotropically for GTVprim. A 2nd adaptation, applied for all fractions where the motion between MRIadapt and MRIver exceeded 1 mm (36% of the fractions) would result in a reduction of the PTVmeso margin to 3.2 mm/2.0 mm. For PTVprim a margin reduction to 3.5 mm is feasible when a 2nd adaptation is performed in fractions where the motion exceeded 4 mm (17% of the fractions). Conclusion We studied the potential benefit of intrafraction motion monitoring and a 2nd adaptation to reduce PTV margins in online adaptive MRIgRT in rectal cancer. Performing 2nd adaptations immediately after online replanning when motion exceeded 1 mm and 4 mm for CTVmeso and GTVprim respectively, could result in a 30–50% margin reduction with limited reduction of dose to the bowel.
Collapse
Affiliation(s)
- Chavelli M Kensen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Tomas M Janssen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Anja Betgen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Lisa Wiersema
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Femke P Peters
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Peter Remeijer
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Corrie A M Marijnen
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| |
Collapse
|
|
13
|
Velten C, Goddard L, Jeong K, Garg MK, Tomé WA. Clinical Assessment of a Novel Ring Gantry Linear Accelerator-Mounted Helical Fan-Beam kVCT System. Adv Radiat Oncol 2022; 7:100862. [PMID: 35036634 PMCID: PMC8749200 DOI: 10.1016/j.adro.2021.100862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/23/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose To assess clinically relevant image quality metrics (IQMs) of helical fan beam kilovoltage (kV) fan beam computed tomography (CT). Methods and Materials kVCT IQMs were evaluated on an Accuray Radixact unit equipped with helical fan beam kVCT to assess the capabilities of this newly available modality. kVCT IQMs were evaluated and compared to a kVCT simulator and linear accelerator-based cone beam CTs (CBCT) using a commercial CBCT image quality phantom. kVCTs were acquired on the Accuray Radixact for all combinations of kVp and mAs in fine mode using a 440-mm field of view (FOV). Evaluated IQMs were spatial resolution, overall uniformity, subject contrast, contrast-to-noise ratio (CNR), and effective slice thickness. Imaging dose was assessed for planar kV imaging. Results On this kVCT system spatial resolution and contrast were consistent across all settings with 0.28 ± 0.03 lp/mm and 9.8% ± 0.7% (both 95% confidence interval). CNR strongly depended on selected mode (views per rotation) and body size (mA per view) and ranged between 7.9 and 34.9. Overall uniformity was greater than 97% for all settings. Large FOV was not found to substantially affect the IQMs whereas small FOV affected IQMs due to its effect on pitch. Technique-matched CT simulator scans were comparable for uniformity and contrast, while spatial resolution was higher (0.43 ± 0.06 lp/mm), and CNR was between 4% (140 kVp) and 51% (100 kVp) lower. For kV-CBCT, spatial resolutions ranging from 0.37 to 0.44 lp/mm were achieved with comparable contrast, CNR, and uniformity to kVCT. All kVCT scans exhibit imaging artifacts due to helical acquisition. Clinical acquisitions of megavoltage (MV) CT, kV-CBCT, and kVCT on the same patient showed improved and comparable image quality of kVCT compared to MVCT and kV-CBCT, respectively. Conclusions Helical fan beam kVCT allows for daily image guidance for localization and setup verification with comparable performance to existing kV-CBCT systems. Scan parameters must be selected carefully to maximize image quality for the desired tasks. Due to the large effective slice thicknesses for all parameter combinations, kVCT scans should not be used for simulation or planning of stereotactic procedures. Finally, improved image quality over MVCT has the potential to greatly improve manual and automated adaptive monitoring and planning.
Collapse
Affiliation(s)
- Christian Velten
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York.,Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, New York
| | - Lee Goddard
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York.,Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, New York
| | - Kyoungkeun Jeong
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York.,Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, New York
| | - Madhur K Garg
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York.,Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, New York
| | - Wolfgang A Tomé
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, New York.,Institute for Onco-Physics, Albert Einstein College of Medicine, Bronx, New York
| |
Collapse
|
|
14
|
Jasper K, Liu B, Olson R, Matthews Q. Evidence-Based Planning Target Volume Margin Reduction for Modern Lung Stereotactic Ablative Radiation Therapy Using Deformable Registration. Adv Radiat Oncol 2021; 6:100750. [PMID: 34401609 PMCID: PMC8349747 DOI: 10.1016/j.adro.2021.100750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 05/20/2021] [Accepted: 06/25/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Standard planning target volume (PTV) margins for lung stereotactic ablative radiation therapy (SABR) are 5 mm. High-dose-rate volumetric modulated arc therapy delivered using flattening filter-free (FFF) beams with modern immobilization systems may allow for PTV margin reduction. This study assesses whether PTV margins can be reduced from 5 to 3 mm. METHODS Target intrafractional motions derived from pretreatment and posttreatment cone beam computed tomography (CBCT) scans for 33 patients receiving lung SABR treated with 10XFFF energy and 5-mm PTV margins from 2016 to 2019 were used to calculate the required PTV margin. Deformable registration of the planning CT scan and internal gross tumor volume (IGTV) contour to posttreatment CBCT scans for 36 consecutive patients with 4 fraction schedules was completed to capture volume changes and intrafractional movement. Plans were replanned with 3-mm margins and recalculated on each deformed CT scan to assess deformed IGTV (d-IGTV) coverage and organ-at-risk doses. RESULTS Margin analysis showed PTV margins may be reduced to 3 mm. The mean d-IGTV coverage (percentage of the d-IGTV receiving ≥100% of the prescription dose [V100%] and the minimum dose covering 99.9% of the d-IGTV volume [D99.9%]) over 4 fractions for each patient was >95% with both margins. With 5-mm PTV margins, all 144 fractions had a d-IGTV V100% of >95% and a D99.9% >95%. With 3-mm PTV margins, the d-IGTV V100% was >95% in 99.3% of fractions (143 of 144) and the D99.9% was >95% in 98.6% of fractions (142 of 144). With 3-mm PTV margins, significant reductions in body V50%, body V80%, the volume of the lung receiving ≥20 Gy, and the mean lung dose and chest wall dose to 0.035 cm3 and 30 cm3 were observed (all P < .001). Using theoretical models, the normal tissue complication probability for radiation pneumonitis decreased by a mean of 0.8% (range, 0.1%-2.7%), and the mean 2-year tumor control probability was 96.1% and 95.2% with 5-mm and 3-mm PTV margins, respectively. CONCLUSION With modern treatment and immobilization techniques in lung SABR, 3-mm PTV margins maintain acceptable IGTV coverage, modestly reduce toxicity to organs at risk, and maintain a calculated 2-year local control rate of >95%.
Collapse
Affiliation(s)
- Katie Jasper
- BC Cancer–Vancouver, Vancouver, British Columbia, Canada
- Division of Radiation Oncology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Baochang Liu
- BC Cancer–Prince George, Prince George, British Columbia, Canada
- Radiation Medicine Program, Walker Family Cancer Centre, St. Catharines, Ontario, Canada
| | - Robert Olson
- Division of Radiation Oncology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- BC Cancer–Prince George, Prince George, British Columbia, Canada
| | - Quinn Matthews
- BC Cancer–Prince George, Prince George, British Columbia, Canada
| |
Collapse
|
|
15
|
Baran G, Dominello MM, Bossenberger T, Paximadis P, Burmeister JW. MVCT versus kV-CBCT for targets subject to respiratory motion: A phantom study. J Appl Clin Med Phys 2021; 22:143-152. [PMID: 34272819 PMCID: PMC8425904 DOI: 10.1002/acm2.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/20/2020] [Accepted: 06/06/2021] [Indexed: 11/06/2022] Open
Abstract
The use of kilovoltage cone-beam computed tomography (kV-CBCT) or megavoltage computed tomography (MVCT) for image guidance prior to lung stereotactic body radiation therapy (SBRT) is common clinical practice. We demonstrate that under equivalent respiratory conditions, image guidance using both kV-CBCT and MVCT may result in the inadequate estimation of the range of target motion under free-breathing (FB) conditions when standard low-density window and levels are used. Two spherical targets within a respiratory motion phantom were imaged using both long-exhale (LE) and sinusoidal respiratory traces. MVCT and kV-CBCT images were acquired and evaluated for peak-to-peak amplitudes of 10 or 20 mm in the cranial-caudal direction, and with 2, 4 or 5 s periods. All images were visually inspected for artifacts and conformity to the ITV for each amplitude, period, trace-type, and target size. All LE respiratory traces required a lower threshold HU window for MVCT and kV-CBCT compared to sinusoidal traces to obtain 100% volume conformity compared with the theoretical ITV (ITVT ). Excess volume was less than 2% for all kV-CBCT contours regardless of trace-type, breathing period, or amplitude, while the maximum excess volume for MVCT was 48%. Adjusting window and level to maximize conformity with the ITVT is necessary to reduce registration uncertainty to less than 5 mm. To fully capture target motion with either MVCT or kV-CBCT, substantial changes in HU levels up to -600 HU are required which may not be feasible clinically depending on the target's location and surrounding tissue contrast. This registration method, utilizing a substantially decreased window and level compared to standard low-density settings, was retrospectively compared to the automated registration algorithm for five lung SBRT patients exposed to pre-treatment kV-CBCT image guidance. Differences in registrations in the super-inferior (SI) direction greater than the commonly used ITV to PTV margin of 5 mm were encountered for several cases. In conclusion, pre-treatment image guidance for lung SBRT targets using MVCT or kV-CBCT is unlikely to capture the full extent of target motion as defined by the ITVT and additional caution is warranted to avoid registration errors for small targets and patients with LE respiratory traces.
Collapse
Affiliation(s)
- Geoffrey Baran
- Department of Radiation OncologyKarmanos Cancer InstituteDetroitMIUSA
| | - Michael M. Dominello
- Department of Radiation OncologyKarmanos Cancer Institute and Wayne State UniversityDetroitMIUSA
| | - Todd Bossenberger
- Department of Radiation OncologyKarmanos Cancer InstituteDetroitMIUSA
| | - Peter Paximadis
- Department of Radiation OncologyLakeland Medical CenterSaint JosephMIUSA
| | - Jay W. Burmeister
- Department of Radiation OncologyKarmanos Cancer Institute and Wayne State UniversityDetroitMIUSA
| |
Collapse
|
|
16
|
Gutiérrez E, Sánchez I, Díaz O, Valles A, Balderrama R, Fuentes J, Lara B, Olimón C, Ruiz V, Rodríguez J, Bayardo LH, Chan M, Villafuerte CJ, Padayachee J, Sun A. Current Evidence for Stereotactic Body Radiotherapy in Lung Metastases. ACTA ACUST UNITED AC 2021; 28:2560-2578. [PMID: 34287274 PMCID: PMC8293144 DOI: 10.3390/curroncol28040233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/25/2022]
Abstract
Lung metastases are the second most common malignant neoplasms of the lung. It is estimated that 20–54% of cancer patients have lung metastases at some point during their disease course, and at least 50% of cancer-related deaths occur at this stage. Lung metastases are widely accepted to be oligometastatic when five lesions or less occur separately in up to three organs. Stereotactic body radiation therapy (SBRT) is a noninvasive, safe, and effective treatment for metastatic lung disease in carefully selected patients. There is no current consensus on the ideal dose and fractionation for SBRT in lung metastases, and it is the subject of study in ongoing clinical trials, which examines different locations in the lung (central and peripheral). This review discusses current indications, fractionations, challenges, and technical requirements for lung SBRT.
Collapse
Affiliation(s)
- Enrique Gutiérrez
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Irving Sánchez
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Omar Díaz
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Adrián Valles
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Ricardo Balderrama
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Jesús Fuentes
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Brenda Lara
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Cipatli Olimón
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Víctor Ruiz
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - José Rodríguez
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Luis H. Bayardo
- Western National Medical Center, Department of Radiation Oncology, Mexican Institute of Social Security (IMSS), Belisario Domínguez 1000, Guadalajara 44340, Jalisco, Mexico; (I.S.); (O.D.); (A.V.); (R.B.); (J.F.); (B.L.); (C.O.); (V.R.); (J.R.); (L.H.B.)
| | - Matthew Chan
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Conrad J. Villafuerte
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Jerusha Padayachee
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
| | - Alexander Sun
- Princess Margaret Cancer Centre, Radiation Medicine Program, University Health Network, Toronto, ON M5G2M9, Canada; (E.G.); (M.C.); (C.J.V.); (J.P.)
- Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
- Correspondence: ; Tel.: +1-41-6946-2853
| |
Collapse
|
|
17
|
Abella M, Martinez C, Garcia I, Moreno P, De Molina C, Desco M. Tolerance to geometrical inaccuracies in CBCT systems: A comprehensive study. Med Phys 2021; 48:6007-6019. [PMID: 34213782 DOI: 10.1002/mp.15065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The last decades have seen the consolidation of the cone-beam CT (CBCT) technology, which is nowadays widely used for different applications such as micro-CT for small animals, mammography, dentistry, or surgical procedures. Some CBCT systems may suffer mechanical strains due to the heavy load of the x-ray tube. This fact, together with tolerances in the manufacturing process, lead to different types of undesirable effects in the reconstructed image unless they are properly accounted for during the reconstruction. To obtain good quality images, it is necessary to have a complete characterization of the system geometry including the angular position of the gantry, the source-object and detector-object distances, and the position and pose of the detector. These parameters can be obtained through a calibration process done periodically, depending on the stability of the system geometry. To the best of our knowledge, there are no comprehensive works studying the effect of inaccuracies in the geometrical calibration of CBCT systems in a systematic and quantitative way. In this work, we describe the effects of detector misalignments (linear shifts, rotation, and inclinations) on the image and define their tolerance as the maximum error that keeps the image free from artifacts. METHODS We used simulations of four phantoms including systematic and random misalignments. Reconstructions of these data with and without errors were compared to identify the artifacts introduced in the reconstructed image and the tolerance to miscalibration deemed to provide acceptable image quality. RESULTS Visual assessment provided an easy guideline to identify the sources of error by visual inspection of the artifactual images. Systematic errors result in blurring, shape distortion and/or reduction of the axial field of view while random errors produce streaks and blurring in all cases, with a tolerance which is more than twice that of systematic errors. The tolerance corresponding to errors in position of the detector along the tangential direction, that is, skew (<0.2°) and horizontal shift (<0.4 mm), is tighter than the tolerance to those errors affecting the position along the longitudinal direction or the magnification, that is, vertical shift (<2 mm), roll (<1.5°), tilt (<2°), and SDD (<3 mm). CONCLUSION We present a comprehensive study, based on realistic simulations, of the effects on the reconstructed image quality of errors in the geometrical characterization of a CBCT system and define their tolerance. These results could be used to guide the design of new systems, establishing the mechanical precision that must be achieved, and to help in the definition of an optimal geometrical calibration process. Also, the thorough visual assessment may be valuable to identify the most predominant sources of error based on the effects shown in the reconstructed image.
Collapse
Affiliation(s)
- Monica Abella
- Dept. Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Cristobal Martinez
- Dept. Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ines Garcia
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Patricia Moreno
- Dept. Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Claudia De Molina
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Manuel Desco
- Dept. Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| |
Collapse
|
|
18
|
To analyse target volume variations during SIB-IMRT of squamous cell carcinoma of uterine cervix. JOURNAL OF RADIOTHERAPY IN PRACTICE 2021. [DOI: 10.1017/s1460396920000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractPurpose:To assess volume variations in target site due to changes in bladder filling and rectal content including air bubbles during simultaneous-integrated boost intensity-modulated radiotherapy (SIB-IMRT) of patients suffering from squamous cell carcinoma of uterine cervix.Materials and methods:A total of ten patients of squamous cell carcinoma of uterine cervix were enrolled in this analysis. All patients were planned to undergo SIB-IMRT using 10 MV beam. Planning target volume of the tumour (PTVtumour) and PTVnodal were prescribed with 5,040 and 4,500 cGy doses, respectively. During planning, PTVtumour V95%, PTVnodal V95% and organs at risk (OARs) (bladder, rectum, femoral heads and small bowel) volumes were measured from initial CT planning scans taken with full bladder. CT scans were acquired once in a week over a treatment period of 5·5 weeks. Intra-treatment scans with full bladder were then fused with the planning scans to determine variations in the target volume and the OAR volume. Changes in radiation dose to the PTVtumour and the PTVnodal were also assessed by comparing intra-treatment scans with the planning (first) scans.Results:All patients showed intra-treatment bladder volume larger than the planning bladder volume. Difference between planning bladder and intra-treatment bladder volumes ranged from 4·5 to 49%. Rectal volume varied from 17 to 60 cc. A wide variation between planning and intra-treatment air volumes was found in most of the patients. When comparing initial and inter-fraction air volumes, the maximum difference was 366·67%. Due to bladder and rectal volume variations, PTVtumour V95% and PTVnodal V95% doses did not remain constant throughout the treatment. The maximum discrepancy between intra-treatment PTVtumour dose and planning PTVtumour dose was 12·15%. The maximum difference between planning and inter-fraction PTV V95% was 48·28%. PTVnodal dose observed from scan taken in last week of treatment was 12·87% less than planning PTVnodal dose analysed from planning CT scan. Maximum difference in planning and inter-fraction PTVnodal V95% was 57·78%.Conclusion:Inconsistent bladder and rectal volumes had a significant impact on target volume and dosage during an entire course of SIB-IMRT. For radiotherapy of gynaecological malignancies, data on variations in PTV should be acquired on daily basis to target radiation dose to the tumour site with accuracy.
Collapse
|
|
19
|
Liu G, Zhao L, Qin A, Grills I, Deraniyagala R, Stevens C, Zhang S, Yan D, Li X, Ding X. Lung Stereotactic Body Radiotherapy (SBRT) Using Spot-Scanning Proton Arc (SPArc) Therapy: A Feasibility Study. Front Oncol 2021; 11:664455. [PMID: 33968770 PMCID: PMC8100671 DOI: 10.3389/fonc.2021.664455] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/26/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose We developed a 4D interplay effect model to quantitatively evaluate breathing-induced interplay effects and assess the feasibility of utilizing spot-scanning proton arc (SPArc) therapy for hypo-fractionated lung stereotactic body radiotherapy (SBRT). The model was then validated by retrospective application to clinical cases. Materials and Methods A digital lung 4DCT phantoms was used to mimic targets in diameter of 3cm with breathing motion amplitudes: 5, 10, 15, and 20 mm, respectively. Two planning groups based on robust optimization were generated: (1) Two-field Intensity Modulated Proton Therapy (IMPT) plans and (2) SPArc plans via a partial arc. 5,000 cGy relative biological effectiveness (RBE) was prescribed to the internal target volume (ITV) in five fractions. To quantitatively assess the breathing induced interplay effect, the 4D dynamic dose was calculated by synchronizing the breathing pattern with the simulated proton machine delivery sequence, including IMPT, Volumetric repainting (IMPTvolumetric), iso-layered repainting (IMPTlayer) and SPArc. Ten lung patients’ 4DCT previously treated with VMAT SBRT, were used to validate the digital lung tumor model. Normal tissue complicated probability (NTCP) of chestwall toxicity was calculated. Result Target dose were degraded as the tumor motion amplitude increased. The 4D interplay effect phantom model indicated that motion mitigation effectiveness using SPArc was about five times of IMPTvolumetric or IMPTlayer using maximum MU/spot as 0.5 MU at 20 mm motion amplitude. The retrospective study showed that SPArc has an advantage in normal tissue sparing. The probability of chestwall’s toxicity were significantly improved from 40.2 ± 29.0% (VMAT) (p = 0.01) and 16.3 ± 12.0% (IMPT) (p = 0.01) to 10.1 ± 5.4% (SPArc). SPArc could play a significant role in the interplay effect mitigation with breathing-induced motion more than 20 mm, where the target D99 of 4D dynamic dose for patient #10 was improved from 4,514 ± 138 cGy [RBE] (IMPT) vs. 4,755 ± 129 cGy [RBE] (SPArc) (p = 0.01). Conclusion SPArc effectively mitigated the interplay effect for proton lung SBRT compared to IMPT with repainting and was associated with normal tissue sparing. This technology may make delivery of proton SBRT more technically feasible and less complex with fewer concerns over underdosing the target compared to other proton therapy techniques.
Collapse
Affiliation(s)
- Gang Liu
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Lewei Zhao
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - An Qin
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Inga Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Rohan Deraniyagala
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Craig Stevens
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Sheng Zhang
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Di Yan
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Xiaoqiang Li
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| | - Xuanfeng Ding
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, United States
| |
Collapse
|
|
20
|
Bjaanæs MM, Sande EPS, Loe Ø, Ramberg C, Næss TM, Ottestad A, Rogg LV, Svestad JG, Haakensen VD. Improved adaptive radiotherapy to adjust for anatomical alterations during curative treatment for locally advanced lung cancer. Phys Imaging Radiat Oncol 2021; 18:51-54. [PMID: 34258408 PMCID: PMC8254190 DOI: 10.1016/j.phro.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/09/2021] [Accepted: 04/23/2021] [Indexed: 12/24/2022] Open
Abstract
Anatomical changes during chemoradiation for lung cancer may decrease dose to the target or increase dose to organs at risk. To assess our ability to identify clinically significant anatomical alterations, we followed 67 lung cancer patients by daily cone-beam CT scans to ensure correct patient positioning and observe anatomical alterations. We also re-calculated the original dose distribution on a planned control CT scan obtained halfway during the treatment course to identify anatomical changes that potentially affected doses to the target or organs at risk. Of 66 patients who completed the treatment, 12 patients needed adaptation, two patients were adapted twice. We conclude that daily cone-beam CT and routines at the treatment machine discover relevant anatomical changes during curative radiotherapy for patients with lung cancer without additional imaging.
Collapse
Affiliation(s)
| | | | - Øyvind Loe
- Dept of Oncology, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Lotte V. Rogg
- Dept of Oncology, Oslo University Hospital, Oslo, Norway
| | | | - Vilde Drageset Haakensen
- Dept of Oncology, Oslo University Hospital, Oslo, Norway
- Dept of Cancer Genetics, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
|
21
|
Botticella A, Levy A, Auzac G, Chabert I, Berthold C, Le Pechoux C. Tumour motion management in lung cancer: a narrative review. Transl Lung Cancer Res 2021; 10:2011-2017. [PMID: 34012810 PMCID: PMC8107759 DOI: 10.21037/tlcr-20-856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Respiratory motion is one of the geometrical uncertainties that may affect the accuracy of thoracic radiotherapy in the treatment of lung cancer. Accounting for tumour motion may allow reducing treatment volumes, irradiated healthy tissue and possibly toxicity, and finally enabling dose escalation. Historically, large population-based margins were used to encompass tumour motion. A paradigmatic change happened in the last decades led to the development of modern imaging techniques during the simulation and the delivery, such as the 4-dimensional (4D) computed tomography (CT) or the 4D-cone beam CT scan, has contributed to a better understanding of lung tumour motion and to the widespread use of individualised margins (with either an internal tumour volume approach or a mid-position/ventilation approach). Moreover, recent technological advances in the delivery of radiotherapy treatments (with a variety of commercial solution allowing tumour tracking, gating or treatments in deep-inspiration breath-hold) conjugate the necessity of minimising treatment volumes while maximizing the patient comfort with less invasive techniques. In this narrative review, we provided an introduction on the intra-fraction tumour motion (in both lung tumours and mediastinal lymph-nodes), and summarized the principal motion management strategies (in both the imaging and the treatment delivery) in thoracic radiotherapy for lung cancer, with an eye on the clinical outcomes.
Collapse
Affiliation(s)
- Angela Botticella
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, F-94805, Villejuif, France
| | - Antonin Levy
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, F-94805, Villejuif, France.,Univ Paris Sud, Université Paris-Saclay, F-94270, Le Kremlin-Bicêtre, France.,INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, F-94805, Villejuif, France
| | - Guillaume Auzac
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, F-94805, Villejuif, France
| | - Isabelle Chabert
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, F-94805, Villejuif, France
| | - Céline Berthold
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, F-94805, Villejuif, France
| | - Cécile Le Pechoux
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, F-94805, Villejuif, France
| |
Collapse
|
|
22
|
Conibear J. Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer. Br J Cancer 2020; 123:10-17. [PMID: 33293671 PMCID: PMC7735212 DOI: 10.1038/s41416-020-01070-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
When treating patients with unresectable stage III non-small-cell lung cancer (NSCLC), those with a good performance status and disease measured within a radical treatment volume should be considered for definitive concurrent chemoradiotherapy (cCRT). This guidance is based on key scientific rationale from two large Phase 3 randomised studies and meta-analyses demonstrating the superiority of cCRT over sequential (sCRT). However, the efficacy of cCRT comes at the cost of increased acute toxicity versus sequential treatment. Currently, there are several documented approaches that are addressing this drawback, which this paper outlines. At the point of diagnosis, a multidisciplinary team (MDT) approach can enable accurate assessment of patients, to determine the optimal treatment strategy to minimise risks. In addition, reviewing the Advisory Committee on Radiation Oncology Practice (ACROP) guidelines can provide clinical oncologists with additional recommendations for outlining target volume and organ-at-risk delineation for standard clinical scenarios in definitive cCRT (and adjuvant radiotherapy). Furthermore, modern advances in radiotherapy treatment planning software and treatment delivery mean that radiation oncologists can safely treat substantially larger lung tumours with higher radiotherapy doses, with greater accuracy, whilst minimising the radiotherapy dose to the surrounding healthy tissues. The combination of these advances in cCRT may assist in creating comprehensive strategies to allow patients to receive potentially curative benefits from treatments such as immunotherapy, as well as minimising treatment-related risks.
Collapse
Affiliation(s)
- John Conibear
- Department of Clinical Oncology, St. Bartholomew's Hospital, London, UK.
| |
Collapse
|
|
23
|
Anthropomorphic lung phantom based validation of in-room proton therapy 4D-CBCT image correction for dose calculation. Z Med Phys 2020; 32:74-84. [PMID: 33248812 PMCID: PMC9948846 DOI: 10.1016/j.zemedi.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/18/2020] [Accepted: 09/23/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Ventilation-induced tumour motion remains a challenge for the accuracy of proton therapy treatments in lung patients. We investigated the feasibility of using a 4D virtual CT (4D-vCT) approach based on deformable image registration (DIR) and motion-aware 4D CBCT reconstruction (MA-ROOSTER) to enable accurate daily proton dose calculation using a gantry-mounted CBCT scanner tailored to proton therapy. METHODS Ventilation correlated data of 10 breathing phases were acquired from a porcine ex-vivo functional lung phantom using CT and CBCT. 4D-vCTs were generated by (1) DIR of the mid-position 4D-CT to the mid-position 4D-CBCT (reconstructed with the MA-ROOSTER) using a diffeomorphic Morphons algorithm and (2) subsequent propagation of the obtained mid-position vCT to the individual 4D-CBCT phases. Proton therapy treatment planning was performed to evaluate dose calculation accuracy of the 4D-vCTs. A robust treatment plan delivering a nominal dose of 60Gy was generated on the average intensity image of the 4D-CT for an approximated internal target volume (ITV). Dose distributions were then recalculated on individual phases of the 4D-CT and the 4D-vCT based on the optimized plan. Dose accumulation was performed for 4D-vCT and 4D-CT using DIR of each phase to the mid position, which was chosen as reference. Dose based on the 4D-vCT was then evaluated against the dose calculated on 4D-CT both, phase-by-phase as well as accumulated, by comparing dose volume histogram (DVH) values (Dmean, D2%, D98%, D95%) for the ITV, and by a 3D-gamma index analysis (global, 3%/3mm, 5Gy, 20Gy and 30Gy dose thresholds). RESULTS Good agreement was found between the 4D-CT and 4D-vCT-based ITV-DVH curves. The relative differences ((CT-vCT)/CT) between accumulated values of ITV Dmean, D2%, D95% and D98% for the 4D-CT and 4D-vCT-based dose distributions were -0.2%, 0.0%, -0.1% and -0.1%, respectively. Phase specific values varied between -0.5% and 0.2%, -0.2% and 0.5%, -3.5% and 1.5%, and -5.7% and 2.3%. The relative difference of accumulated Dmean over the lungs was 2.3% and Dmean for the phases varied between -5.4% and 5.8%. The gamma pass-rates with 5Gy, 20Gy and 30Gy thresholds for the accumulated doses were 96.7%, 99.6% and 99.9%, respectively. Phase-by-phase comparison yielded pass-rates between 86% and 97%, 88% and 98%, and 94% and 100%. CONCLUSIONS Feasibility of the suggested 4D-vCT workflow using proton therapy specific imaging equipment was shown. Results indicate the potential of the method to be applied for daily 4D proton dose estimation.
Collapse
|
|
24
|
Gandhidasan S, Woody NM, Stephans KL, Videtic GMM. Does Motion Management Technique for Lung SBRT Influence Local Control? A Single Institutional Experience Comparing Abdominal Compression to Breath-Hold Technique. Pract Radiat Oncol 2020; 11:e180-e185. [PMID: 33130317 DOI: 10.1016/j.prro.2020.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Abdominal compression (COMP) and breath-hold with an active breathing coordinator (ABC) device are 2 different respiratory motion management techniques used in lung stereotactic body radiation therapy (SBRT) practice. We compared local failure (LF) results for COMP versus ABC. METHODS AND MATERIALS We surveyed our institutional review board-approved prospective registry for patients who were treated with SBRT for either a primary lung cancer (PRIME) or an oligometastatic (OLIGO) diagnosis with a minimum of 6 months' follow-up to determine their rates of local failure by motion management modality. RESULTS From October 2003 to July 2014, 873 patients with 931 lesions were treated. Patient characteristics included: 455 (52.1%) female; median age of 73 years (range, 37-97); median Karnofsky performance status (KPS) of 80 (range, 40-100); and median BMI of 26.2 (range, 12.1-56.3). Tumor characteristics included: median tumor size of 2.2 cm (range, 0.7-10.0); median maximum standardized uptake value from positron emission tomography PET SUVmax of 7.5 (range, 0.8-59); 234 (25.4%) were central lesions; 830 (89.2%) lesions were PRIME; and 101 (10.8%) were OLIGO. Median follow-up and SBRT dose were 16.4 months and 50 G in 5 fractions, respectively. Overall crude rate of LF was 9.9%. Use of ABC was not associated with increased LF compared with COMP: hazard ratio (HR) = 1.043 (95% CI 0.48-2.29; P = .92). Three-year actuarial rates of LF for ABC versus COMP were 13.8% and 16.5%, respectively. After stratifying by OLIGO/PRIME, neither ABC nor COMP was significantly associated with LF. Central location may be associated with LF with ABC (HR = 2.087, P = .066). On univariate analysis, BMI, tumor size, PET SUV max and central location were associated with failure, with size the most significant. CONCLUSIONS LF rates after lung SBRT were not influenced by form of motion control overall or when stratified by tumor type. Further study on LF rates for central tumors where ABC is used is warranted.
Collapse
Affiliation(s)
| | - Neil M Woody
- Department of Radiation Oncology, Taussig Cancer Centre, Cleveland Clinic, Cleveland, Ohio
| | - Kevin L Stephans
- Department of Radiation Oncology, Taussig Cancer Centre, Cleveland Clinic, Cleveland, Ohio
| | - Gregory M M Videtic
- Department of Radiation Oncology, Taussig Cancer Centre, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
|
25
|
Madesta F, Sentker T, Gauer T, Werner R. Self‐contained deep learning‐based boosting of 4D cone‐beam CT reconstruction. Med Phys 2020; 47:5619-5631. [DOI: 10.1002/mp.14441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/02/2020] [Accepted: 07/16/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Frederic Madesta
- Department of Computational Neuroscience University Medical Center Hamburg‐Eppendorf Hamburg20246 Germany
| | - Thilo Sentker
- Department of Computational Neuroscience University Medical Center Hamburg‐Eppendorf Hamburg20246 Germany
- Department of Radiotherapy and Radio‐Oncology University Medical Center Hamburg‐Eppendorf Hamburg20246 Germany
| | - Tobias Gauer
- Department of Radiotherapy and Radio‐Oncology University Medical Center Hamburg‐Eppendorf Hamburg20246 Germany
| | - René Werner
- Department of Computational Neuroscience University Medical Center Hamburg‐Eppendorf Hamburg20246 Germany
| |
Collapse
|
|
26
|
Image-guided Radiotherapy to Manage Respiratory Motion: Lung and Liver. Clin Oncol (R Coll Radiol) 2020; 32:792-804. [PMID: 33036840 DOI: 10.1016/j.clon.2020.09.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/26/2020] [Accepted: 09/18/2020] [Indexed: 12/25/2022]
Abstract
Organ motion as a result of respiratory and cardiac motion poses significant challenges for the accurate delivery of radiotherapy to both the thorax and the upper abdomen. Modern imaging techniques during radiotherapy simulation and delivery now permit better quantification of organ motion, which in turn reduces tumour and organ at risk position uncertainty. These imaging advances, coupled with respiratory correlated radiotherapy delivery techniques, have led to the development of a range of approaches to manage respiratory motion. This review summarises the key strategies of image-guided respiratory motion management with a focus on lung and liver radiotherapy.
Collapse
|
|
27
|
Tumor volume is more reliable to predict nodal metastasis in non-small cell lung cancer of 3.0 cm or less in the greatest tumor diameter. World J Surg Oncol 2020; 18:168. [PMID: 32669129 PMCID: PMC7364500 DOI: 10.1186/s12957-020-01946-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/03/2020] [Indexed: 01/08/2023] Open
Abstract
Background In this study, we sought to evaluate the correlation between TV, GTD, and lymph node metastases in NSCLC patients with tumors of GTD ≤ 3.0 cm. Methods We retrospectively analyzed the characteristics of clinicopathologic variables for lymph node involvement in 285 NSCLC patients with tumors of GTD ≤ 3.0 cm who accepted curative surgical resection. The TVs were semi-automatically measured by a software, and optimal cutoff points were obtained using the X-tile software. The relationship between GTD and TV were described using non-linear regression. The correlation between GTD, TV, and N stages was analyzed using the Pearson correlation coefficient. The one-way ANOVA was used to compare the GTD and TV of different lymph node stage groups. Results The relationship between GTD and TV accorded with the exponential growth model: y = 0.113e1.455x (y = TV, x = GTD). TV for patients with node metastases (4.78 cm3) was significantly greater than those without metastases (3.57 cm3) (P < 0.001). However, there were no obvious GTD differences in cases with or without lymph node metastases (P = 0.054). We divided all cases into three TV groups using the two cutoff values (0.9 cm3 and 3.9 cm3), and there was an obvious difference in the lymphatic involvement rate between the groups (P < 0.001). The tendency to metastasize was greater with higher TV especially when the TV was > 0.9–14.2 cm3 (P = 0.010). Conclusions For NSCLC tumors with GTD ≤ 3.0 cm, TV is a more sensitive marker than GTD in predicting the positive lymph node metastases. The likelihood for metastasis increases with an increasing TV especially when GTD is > 2.0–3.0 cm.
Collapse
|
|
28
|
Watkins WT, Nourzadeh H, Siebers JV. Dose escalation in the definite target volume. Med Phys 2020; 47:3174-3183. [PMID: 32267535 PMCID: PMC8259326 DOI: 10.1002/mp.14164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To introduce the definite target volume (DTV) and evaluate dosimetric consequences of boosting dose to this region of high clinical target volume (CTV)- and low organs at risk (OAR)-probability. METHODS This work defines the DTV via occupancy probability and via contraction of the CTV by margin M less any planning risk volume (PRV) volumes. The equivalence to within varying occupancy probability of the two methods is established for spherical target volumes. We estimate a margin for four radiation treatment sites based on modern images guided radiation therapy-literature utilizing repeat volumetric imaging. Based on margins and patient-specific DTV targets, the ability to dose escalate the DTV including the effects of spatial uncertainty was evaluated. We simulate delivery assuming violation of the underlying spatial uncertainty of 130%. RESULTS Contracting the planning target volume (PTV) by M and excluding PRV volumes, the DTV ranged from 7.3 to 93.6 cc. In a brain treatment, DTV-Dmax increased to 66.8 Gy (145% of prescription isodose); in advanced lung DTV-Dmax increased to 122.2 Gy (204% of prescription isodose), in a pancreatic case DTV-Dmax was boosted up to 87.3 Gy (173% or prescription isodose), and in retroperitoneal sarcoma to 74.6 Gy (249% of prescription isodose). The high point doses were not associated with increased dose to OARs, even when considering the effects of spatial uncertainty. Simulated delivery at 130% of assumed spatial uncertainties revealed DTV-based planning can result in minor increases in OAR Dmean/Dmax of 2.7 ± 2.1 Gy/1.8 ± 2.2 Gy with duodenum Dmax > 110% of prescription isodose in the pancreatic case. These dose increases were consistent with simulation of clinical, homogenous PTV-dose distributions. CONCLUSION We have proposed and tested a method to deliver extremely high doses to subvolumes of target volumes in multiple treatment sites by defining a new target volume, the DTV. Based on simulated delivery, the method does not result in significant increases in dose to OARs if spatial uncertainty can be estimated.
Collapse
Affiliation(s)
- W. Tyler Watkins
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA 22908, USA
| | - Hamidreza Nourzadeh
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA 22908, USA
| | - Jeffrey V. Siebers
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA 22908, USA
| |
Collapse
|
|
29
|
Leong B, Padilla L. Impact of use of optical surface imaging on initial patient setup for stereotactic body radiotherapy treatments. J Appl Clin Med Phys 2020; 20:149-158. [PMID: 31833639 PMCID: PMC6909112 DOI: 10.1002/acm2.12779] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 12/31/2022] Open
Abstract
Purpose To evaluate the effectiveness of surface image guidance (SG) for pre‐imaging setup of stereotactic body radiotherapy (SBRT) patients, and to investigate the impact of SG reference surface selection on this process. Methods and materials 284 SBRT fractions (SG‐SBRT = 113, non‐SG‐SBRT = 171) were retrospectively evaluated. Differences between initial (pre‐imaging) and treatment couch positions were extracted from the record‐and‐verify system and compared for the two groups. Rotational setup discrepancies were also computed. The utility of orthogonal kVs in reducing CBCT shifts in the SG‐SBRT/non‐SG‐SBRT groups was also calculated. Additionally, the number of CBCTs acquired for setup was recorded and the average for each cohort was compared. These data served to evaluate the effectiveness of surface imaging in pre‐imaging patient positioning and its potential impact on the necessity of including orthogonal kVs for setup. Since reference surface selection can affect SG setup, daily surface reproducibility was estimated by comparing camera‐acquired surface references (VRT surface) at each fraction to the external surface of the planning CT (DICOM surface) and to the VRT surface from the previous fraction. Results The reduction in all initial‐to‐treatment translation/rotation differences when using SG‐SBRT was statistically significant (Rank‐Sum test, α = 0.05). Orthogonal kV imaging kept CBCT shifts below reimaging thresholds in 19%/51% of fractions for SG‐SBRT/non‐SG‐SBRT cohorts. Differences in average number of CBCTs acquired were not statistically significant. The reference surface study found no statistically significant differences between the use of DICOM or VRT surfaces. Conclusions SG‐SBRT improved pre‐imaging treatment setup compared to in‐room laser localization alone. It decreased the necessity of orthogonal kV imaging prior to CBCT but did not affect the average number of CBCTs acquired for setup. The selection of reference surface did not have a significant impact on initial patient positioning.
Collapse
Affiliation(s)
- Brian Leong
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Laura Padilla
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
|
30
|
Zhang Y, Huang X, Wang J. Advanced 4-dimensional cone-beam computed tomography reconstruction by combining motion estimation, motion-compensated reconstruction, biomechanical modeling and deep learning. Vis Comput Ind Biomed Art 2019; 2:23. [PMID: 32190409 PMCID: PMC7055574 DOI: 10.1186/s42492-019-0033-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/13/2019] [Indexed: 12/25/2022] Open
Abstract
4-Dimensional cone-beam computed tomography (4D-CBCT) offers several key advantages over conventional 3D-CBCT in moving target localization/delineation, structure de-blurring, target motion tracking, treatment dose accumulation and adaptive radiation therapy. However, the use of the 4D-CBCT in current radiation therapy practices has been limited, mostly due to its sub-optimal image quality from limited angular sampling of cone-beam projections. In this study, we summarized the recent developments of 4D-CBCT reconstruction techniques for image quality improvement, and introduced our developments of a new 4D-CBCT reconstruction technique which features simultaneous motion estimation and image reconstruction (SMEIR). Based on the original SMEIR scheme, biomechanical modeling-guided SMEIR (SMEIR-Bio) was introduced to further improve the reconstruction accuracy of fine details in lung 4D-CBCTs. To improve the efficiency of reconstruction, we recently developed a U-net-based deformation-vector-field (DVF) optimization technique to leverage a population-based deep learning scheme to improve the accuracy of intra-lung DVFs (SMEIR-Unet), without explicit biomechanical modeling. Details of each of the SMEIR, SMEIR-Bio and SMEIR-Unet techniques were included in this study, along with the corresponding results comparing the reconstruction accuracy in terms of CBCT images and the DVFs. We also discussed the application prospects of the SMEIR-type techniques in image-guided radiation therapy and adaptive radiation therapy, and presented potential schemes on future developments to achieve faster and more accurate 4D-CBCT imaging.
Collapse
Affiliation(s)
- You Zhang
- Division of Medical Physics and Engineering, Department of Radiation Oncology, UT Southwestern Medical Center, 2280 Inwood Road, Dallas, TX 75390 USA
| | - Xiaokun Huang
- Division of Medical Physics and Engineering, Department of Radiation Oncology, UT Southwestern Medical Center, 2280 Inwood Road, Dallas, TX 75390 USA
| | - Jing Wang
- Division of Medical Physics and Engineering, Department of Radiation Oncology, UT Southwestern Medical Center, 2280 Inwood Road, Dallas, TX 75390 USA
| |
Collapse
|
|
31
|
Yuasa Y, Shiinoki T, Onizuka R, Fujimoto K. Estimation of effective imaging dose and excess absolute risk of secondary cancer incidence for four-dimensional cone-beam computed tomography acquisition. J Appl Clin Med Phys 2019; 20:57-68. [PMID: 31593377 PMCID: PMC6839364 DOI: 10.1002/acm2.12741] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 09/02/2019] [Accepted: 09/15/2019] [Indexed: 12/25/2022] Open
Abstract
This study was conducted to estimate the organ equivalent dose and effective imaging dose for four-dimensional cone-beam computed tomography (4D-CBCT) using a Monte Carlo simulation, and to evaluate the excess absolute risk (EAR) of secondary cancer incidence. The EGSnrc/BEAMnrc were used to simulate the on-board imager (OBI) from the TrueBeam linear accelerator. Specifically, the OBI was modeled based on the percent depth dose and the off-center ratio was measured using a three-dimensional (3D) water phantom. For clinical cases, 15 lung and liver cancer patients were simulated using the EGSnrc/DOSXYZnrc. The mean absorbed doses to the lung, stomach, bone marrow, esophagus, liver, thyroid, bone surface, skin, adrenal glands, gallbladder, heart, intestine, kidney, pancreas and spleen, were quantified using a treatment planning system, and the equivalent doses to each organ were calculated. Subsequently, the effective dose was calculated as the weighted sum of the equivalent dose, and the EAR of the secondary cancer incidence was determined for each organ with the use of the biologic effects of ionizing radiation (BEIR) VII model. The effective doses were 3.9 ± 0.5, 15.7 ± 2.0, and 7.3 ± 0.9 mSv, for the lung, and 4.2 ± 0.6, 16.7 ± 2.4, and 7.8 ± 1.1 mSv, for the liver in the respective cases of the 3D-CBCT (thorax, pelvis) and 4D-CBCT modes. The lung EARs for males and females were 7.3 and 10.7 cases per million person-years, whereas the liver EARs were 9.9 and 4.5 cases per million person-years. The EAR increased with increasing time since radiation exposure. In clinical studies, we should use 4D-CBCT based on consideration of the effective dose and EAR of secondary cancer incidence.
Collapse
Affiliation(s)
- Yuki Yuasa
- Department of Radiation OncologyGraduate School of MedicineYamaguchi UniversityUbeYamaguchiJapan
| | - Takehiro Shiinoki
- Department of Radiation OncologyGraduate School of MedicineYamaguchi UniversityUbeYamaguchiJapan
| | - Ryota Onizuka
- Department of Radiological TechnologyYamaguchi University HospitalUbeYamaguchiJapan
| | - Koya Fujimoto
- Department of Radiation OncologyGraduate School of MedicineYamaguchi UniversityUbeYamaguchiJapan
| |
Collapse
|
|
32
|
Gensanne D, Hadj Henni A, Lauzin Y, Clarisse P, Thureau S. [Inter- and intrafraction imaging during stereotactic body radiation therapy: Which solutions for which tumours?]. Cancer Radiother 2019; 23:891-895. [PMID: 31615729 DOI: 10.1016/j.canrad.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/29/2019] [Accepted: 09/02/2019] [Indexed: 10/25/2022]
Abstract
Due to high dose gradients, stereotactic body radiation therapy requires high precision in the location of the tumour. Uncertainties in the positioning can introduce serious damage on organs at risk and consequently can reduce tumour local control. A better tumour location can be achieved by controlling its position with an efficient inter and intrafraction imaging procedure. The various imaging techniques available on treatment systems are presented and performances are discussed. Finally, propositions are given in terms of imaging system according to the location treated by stereotactic body radiation therapy.
Collapse
Affiliation(s)
- D Gensanne
- Centre Henri-Becquerel, département de radiothérapie et de physique médicale, rue d'Amiens, CS 11516, 76038 Rouen cedex 1, France.
| | - A Hadj Henni
- Centre Henri-Becquerel, département de radiothérapie et de physique médicale, rue d'Amiens, CS 11516, 76038 Rouen cedex 1, France
| | - Y Lauzin
- Centre Henri-Becquerel, département de radiothérapie et de physique médicale, rue d'Amiens, CS 11516, 76038 Rouen cedex 1, France
| | - P Clarisse
- Centre Henri-Becquerel, département de radiothérapie et de physique médicale, rue d'Amiens, CS 11516, 76038 Rouen cedex 1, France
| | - S Thureau
- Centre Henri-Becquerel, département de radiothérapie et de physique médicale, rue d'Amiens, CS 11516, 76038 Rouen cedex 1, France; Quantif-Litis EA 4108, université de Rouen, 76000 Rouen, France
| |
Collapse
|
|
33
|
Technical note: improved positioning protocol for patient setup accuracy in conventional radiotherapy for lung cancer. Radiol Phys Technol 2019; 12:426-432. [PMID: 31549292 DOI: 10.1007/s12194-019-00537-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 12/31/2022]
Abstract
This study aimed to investigate an improved setup protocol for maintaining patient setup accuracy, with minimal or no use of image-guided radiation therapy in conventional radiotherapy for lung cancer. A coordinate value for the treatment couch in the anterior-posterior (AP) direction was obtained from the first fraction using bony anatomy image guidance. The coordinate value was invariably used for patient positioning in the second and subsequent treatment fractions. The errors of 2410 setup image sets (anterior and lateral) from 105 patients with lung cancer were analyzed. The systematic and random patient positioning errors in the AP direction were 0.6 ± 1.0 mm. Such errors accounted for 97% of all fractions within ± 2 mm. The protocol resulted in minimal patient setup errors in the AP direction using only one image for guidance; therefore, it may be applied to conventional radiotherapy for lung cancer in case of insufficient image guidance.
Collapse
|
|
34
|
Wang X, Zamdborg L, Ye H, Grills IS, Yan D. A matched-pair analysis of stereotactic body radiotherapy (SBRT) for oligometastatic lung tumors from colorectal cancer versus early stage non-small cell lung cancer. BMC Cancer 2018; 18:962. [PMID: 30305131 PMCID: PMC6180414 DOI: 10.1186/s12885-018-4865-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 09/26/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The use of stereotactic body radiotherapy (SBRT) for early-stage primary non-small cell lung cancer (NSCLC) reported excellent local control rates. But the optimal SBRT dose for oligometastatic lung tumors (OLTs) from colorectal cancer (CRC) has not yet been determined. This study aimed to evaluate whether SBRT to a dose of 48-60 Gy in 4-5 fractions could result in similar local outcomes for OLTs from CRC as compared to early-stage NSCLC, and to examine potential dose-response relationships for OLTs from CRC. METHODS OLTs from CRC and primary NSCLCs treated with SBRT to 48-60 Gy in 4-5 fractions at a single institution were evaluated, and a matched-pair analysis was performed. Local recurrence-free survival (LRFS) was estimated by the Kaplan-Meier method. Univariate Cox regression was performed to identify significant predictors. RESULTS There were 72 lung lesions in 61 patients (24 OLTs from CRC in 15 patients and 48 NSCLCs in 46 patients) were analyzed with a median follow-up of 30 months. LRFS for OLTs from CRC was significantly worse than that of NSCLC when treated with 48-60 Gy/4-5 fx (p = 0.006). The 1, 3 and 5-year LRFS of OLTs from CRC vs NSCLC were 80.6% vs. 100%, 68.6% vs. 97.2%, and 68.6% vs. 81.0%, respectively. On univariate analysis, OLTs from CRC treated with higher dose (BED10 = 132 Gy) exhibited significantly better local recurrence-free survival than those treated to lower doses (BED10 ≤ 105.6 Gy) (p = 0.0022). The 1 and 3-year LRFS rates for OLTs treated to a higher dose (BED10 = 132 Gy) were 88.9% and 81.5%, vs 33.3%, and not achieved for lower doses (BED10 ≤ 105.6 Gy). CONCLUSION The LRFS of OLTs from CRC after SBRT of 48-60 Gy/4-5 fx was significantly worse than that of primary NSCLC. Lower dose SBRT appeared to have inferior control for OLTs of CRC in this cohort. Further studies with larger sample sizes are needed.
Collapse
Affiliation(s)
- Xin Wang
- Department of Abdominal Oncology, Cancer Center, West China Hospital, Sichuan University, No. 37 of Wainan Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan Province, China. .,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Leonid Zamdborg
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Hong Ye
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Inga S Grills
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA.,Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Di Yan
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan, USA.,Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| |
Collapse
|
|
35
|
Wierzbicki M, Mathew L, Swaminath A. A method for optimizing planning target volume margins for patients receiving lung stereotactic body radiotherapy. Phys Med Biol 2018; 63:195015. [PMID: 30183684 DOI: 10.1088/1361-6560/aadf26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Lung stereotactic-body radiotherapy (SBRT) places additional requirements on targeting accuracy over standard approaches. In treatment planning, a tumour volume is geometrically expanded and the resulting planning target volume (PTV) is covered with the prescribed dose. This ensures full dose delivery despite various uncertainties encountered during treatment. We developed a retrospective technique for optimizing the PTV expansion for a patient population. The method relies on deformable image registration (DIR) of the planning CT to a treatment cone-beam CT (CBCT). The resulting transformation is used to map the planned target onto the treatment geometry, allowing the computation of the achieved target/PTV overlap. Basic validation of the method was performed using an anthropomorphic respiratory motion phantom. A self-validation technique was also implemented to allow estimation of the DIR error for the data being analyzed. Our workflow was used to retrospectively optimize PTV margin for 25 patients treated over 93 fractions. Targets for these patients were contoured on 4D CT images. SBRT delivery followed CBCT acquisition and a couch correction. A post-treatment CBCT was also acquired in some cases. Our basic validation demonstrated that the DIR-based technique is capable of transforming target volumes from planning CTs to treatment CBCTs with sub-mm accuracy. Our clinical analysis showed that the minimum percentages of target volumes covered for 3, 4, and 5 mm PTV margins were 92.1, 97.6, and 99.2, respectively. Analyzing data acquired before and just after treatment demonstrated that margins exceeding 5 mm did not significantly improve coverage. Finally, a 5 mm PTV margin achieved ⩾95% target volume coverage with ⩾95% probability. Our technique is accurate, automated, self-validating, and incorporates complex ITV shapes/deformations to allow PTV margin optimization. The analysis of clinical data indicates a 5 mm PTV margin is optimal for our process. This approach is generalizable to other disease sites and treatment strategies.
Collapse
Affiliation(s)
- Marcin Wierzbicki
- Juravinski Cancer Centre, 699 Concession St., Hamilton, ON L8V 4X2, Canada. School of Interdisciplinary Science, McMaster University, 1280 Main St. W., Hamilton, ON L8S 4K1, Canada. Author to whom any correspondence should be addressed
| | | | | |
Collapse
|
|
36
|
Shen C, Li B, Lou Y, Yang M, Zhou L, Jia X. Multienergy element-resolved cone beam CT (MEER-CBCT) realized on a conventional CBCT platform. Med Phys 2018; 45:4461-4470. [PMID: 30179261 DOI: 10.1002/mp.13169] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 07/29/2018] [Accepted: 08/20/2018] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Cone beam CT (CBCT) has been widely used in radiation therapy. However, its main application is still to acquire anatomical information for patient positioning. This study proposes a multienergy element-resolved (MEER) CBCT framework that employs energy-resolved data acquisition on a conventional CBCT platform and then simultaneously reconstructs images of x-ray attenuation coefficients, electron density relative to water (rED), and elemental composition (EC) to support advanced applications. METHODS The MEER-CBCT framework is realized on a Varian TrueBeam CBCT platform using a kVp-switching scanning scheme. A simultaneous image reconstruction and elemental decomposition model is formulated as an optimization problem. The objective function uses a least square term to enforce fidelity between x-ray attenuation coefficients and projection measurements. Spatial regularization is introduced via sparsity under a tight wavelet-frame transform. Consistency is imposed among rED, EC, and attenuation coefficients and inherently serves as a regularization term along the energy direction. The EC is further constrained by a sparse combination of ECs in a dictionary containing tissues commonly existing in humans. The optimization problem is solved by a novel alternating-direction minimization scheme. The MEER-CBCT framework was tested in a simulation study using an NCAT phantom and an experimental study using a Gammex phantom. RESULTS MEER-CBCT framework was successfully realized on a clinical Varian TrueBeam onboard CBCT platform with three energy channels of 80, 100, and 120 kVp. In the simulation study, the attenuation coefficient image achieved a structural similarity index of 0.98, compared to 0.61 for the image reconstructed by the conventional conjugate gradient least square (CGLS) algorithm, primarily because of reduction in artifacts. In the experimental study, the attenuation image obtained a contrast-to-noise ratio ≥60, much higher than that of CGLS results (~16) because of noise reduction. The median errors in rED and EC were 0.5% and 1.4% in the simulation study and 1.4% and 2.3% in the experimental study. CONCLUSION We proposed a novel MEER-CBCT framework realized on a clinical CBCT platform. Simulation and experimental studies demonstrated its capability to simultaneously reconstruct x-ray attenuation coefficient, rED, and EC images accurately.
Collapse
Affiliation(s)
- Chenyang Shen
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Bin Li
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, 510060, China
| | - Yifei Lou
- Department of Mathematical Science, University of Texas at Dallas, Dallas, TX, 75080, USA
| | - Ming Yang
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Linghong Zhou
- Department of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Xun Jia
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| |
Collapse
|
|
37
|
Yegya-Raman N, Reyhan M, Kim S, Deek MP, Yue N, Zou W, Malhotra J, Aisner J, Jabbour SK. Association of Target Volume Margins With Locoregional Control and Acute Toxicities for Non-small cell lung cancer Treated With Concurrent Chemoradiation Therapy. Pract Radiat Oncol 2018; 9:e74-e82. [PMID: 30144583 DOI: 10.1016/j.prro.2018.08.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/23/2018] [Accepted: 08/09/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE This study aimed to investigate the association between target volume margins and clinical outcomes for patients with inoperable non-small cell lung cancer (NSCLC) treated with concurrent chemoradiation therapy. METHODS AND MATERIALS We reviewed the records of 82 patients with inoperable NSCLC treated between 2009 and 2016 with concurrent chemoradiation. All patients received positron emission tomography-based treatment planning, 4-dimensional computed tomography simulation to define an internal target volume, and daily cone beam computed tomography. We quantified variations in target volume margins with a margin deviation index (MDI), calculated as the percentage change in equivalent uniform dose between the original planning target volume (PTV) and a standard reference PTV 10 mm beyond the original gross tumor volume, consistent with the minimum margins mandated by recent NSCLC trials. Greater MDIs equated to smaller effective target volume margins. We dichotomized patients by the upper tercile MDI value (5.8%). Endpoints included time to locoregional progression and time to grade ≥ 3 radiation esophagitis (RE3) or radiation pneumonitis (RP3), modelled with the Fine-Gray method. RESULTS Median follow-up was 37.8 months (range, 5.9-58.1 months). Larger MDIs correlated with smaller clinical target volume (CTV) + PTV margins, larger gross tumor volumes, later treatment year, and intensity modulated radiation therapy use. The risk of locoregional progression did not differ for MDI ≥5.8% versus <5.8% (adjusted hazard ratio: 0.88; P = .76), but the risk of RE3 or RP3 was decreased for MDI ≥5.8% (adjusted hazard ratio: 0.27; P = .027). Patients with MDI ≥5.8% were treated with smaller CTV + PTV margins (median, 5.6 vs 8 mm; P < .0001) and a marginally lower volume of esophagus receiving ≥50 Gy (median, 31.1% vs 35.3%; P = .069). CONCLUSIONS Smaller margins were used for larger tumors but were not associated with an increase in locoregional failures. Additional studies could clarify whether smaller margins, when used alongside modern radiation therapy techniques, decrease treatment-related toxicity for inoperable NSCLC.
Collapse
MESH Headings
- Adenocarcinoma/diagnostic imaging
- Adenocarcinoma/pathology
- Adenocarcinoma/therapy
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/therapy
- Chemoradiotherapy/adverse effects
- Cone-Beam Computed Tomography
- Esophagitis/diagnosis
- Esophagitis/etiology
- Female
- Follow-Up Studies
- Four-Dimensional Computed Tomography
- Humans
- Image Processing, Computer-Assisted/methods
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/pathology
- Lung Neoplasms/therapy
- Male
- Margins of Excision
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/etiology
- Positron-Emission Tomography
- Prognosis
- Radiation Pneumonitis/diagnosis
- Radiation Pneumonitis/etiology
- Radiotherapy Dosage
- Radiotherapy Planning, Computer-Assisted/methods
- Radiotherapy, Intensity-Modulated/methods
- Retrospective Studies
Collapse
Affiliation(s)
- Nikhil Yegya-Raman
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Meral Reyhan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Sinae Kim
- Department of Biostatistics, School of Public Health, Rutgers University, Piscataway, New Jersey; Biometrics Division, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Matthew P Deek
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey; Department of Radiation Oncology & Molecular Radiation Sciences, the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ning Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jyoti Malhotra
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Joseph Aisner
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.
| |
Collapse
|
|
38
|
Aboudaram A, Khalifa J, Massabeau C, Simon L, Hadj Henni A, Thureau S. [Image-guided radiotherapy in lung cancer]. Cancer Radiother 2018; 22:602-607. [PMID: 30104150 DOI: 10.1016/j.canrad.2018.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/29/2018] [Indexed: 12/20/2022]
Abstract
Image-guided radiotherapy takes place at every step of the treatment in lung cancer, from treatment planning, with fusion imaging, to daily in-room repositioning. Managing tumoral and surrounding thoracic structures motion has been allowed since the routine use of 4D computed tomography (4DCT). The integration of respiratory motion has been made with "passive" techniques based on reconstruction images from 4DCT planning, or "active" techniques adapted to the patient's breathing. Daily repositioning is based on regular images, weekly or daily, low (kV) or high (MV) energy. MRI and functional imaging also play an important part in lung cancer radiation and open the way for adaptative radiotherapy.
Collapse
Affiliation(s)
- A Aboudaram
- Département de radiothérapie, institut universitaire du cancer de Toulouse-oncopôle, 1, avenue Irène-Joliot Curie, 31037 Toulouse, France.
| | - J Khalifa
- Département de radiothérapie, institut universitaire du cancer de Toulouse-oncopôle, 1, avenue Irène-Joliot Curie, 31037 Toulouse, France
| | - C Massabeau
- Département de radiothérapie, institut universitaire du cancer de Toulouse-oncopôle, 1, avenue Irène-Joliot Curie, 31037 Toulouse, France
| | - L Simon
- Département de radiothérapie, institut universitaire du cancer de Toulouse-oncopôle, 1, avenue Irène-Joliot Curie, 31037 Toulouse, France; CRCT UMR 1037 Inserm/UPS, 2, avenue Hubert-Curien, 31037 Toulouse, France
| | - A Hadj Henni
- Département de physique médicale, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| | - S Thureau
- Département de radiothérapie, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France; Laboratoire QuantIF, EA4108-Litis, FR CNRS 3638, 1, rue d'Amiens, 76000 Rouen, France; Département de médecine nucléaire, centre Henri-Becquerel, 1, rue d'Amiens, 76000 Rouen, France
| |
Collapse
|
|
39
|
Yegya-Raman N, Kim S, Deek MP, Li D, Gupta A, Bond L, Dwivedi A, Braver JK, Reyhan M, Mittal A, Gui B, Malhotra J, Aisner J, Jabbour SK. Daily Image Guidance With Cone Beam Computed Tomography May Reduce Radiation Pneumonitis in Unresectable Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2018; 101:1104-1112. [PMID: 29730063 PMCID: PMC11167533 DOI: 10.1016/j.ijrobp.2018.03.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/02/2018] [Accepted: 03/22/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE To investigate the impact of daily image-guided radiation therapy technique on clinical outcomes in patients with inoperable non-small cell lung cancer treated with definitive chemoradiation therapy. METHODS AND MATERIALS We compared patients with inoperable non-small cell lung cancer receiving daily cone beam computed tomography (CBCT) after an initial 4-dimensional computed tomography (4DCT) simulation (n = 76) with those receiving daily 2-dimensional orthogonal kilovoltage (kV) imaging (n = 48). The primary endpoint was time to grade ≥2 radiation pneumonitis (RP2), estimated with the cumulative incidence method, compared with Gray's test, and modeled with the Fine-Gray method. RESULTS Median follow-up was 40.6 months (range, 5.9-58.1 months) for the CBCT group and 75.8 months (range, 9.9-107.8 months) for the orthogonal kV group. Four-dimensional computed tomography simulation was used in 100% (n = 76) of the CBCT group and 56% (n = 27) of the orthogonal kV group (P < .0001). The 1-year cumulative incidence of RP2 was lower in the CBCT group than in the orthogonal kV group (24% vs 44%, P = .020). On multivariate analysis, daily imaging with CBCT after an initial 4DCT simulation was associated with a decreased risk of RP2 (adjusted hazard ratio 0.43, 95% confidence interval 0.22-0.82, P = .011), a finding that persisted among only patients who received 4DCT simulation (adjusted hazard ratio 0.48, 95% confidence interval 0.23-0.98, P = .045). There was no difference in locoregional progression, distant metastasis, any progression, or overall survival between groups. CONCLUSIONS Daily image guided radiation therapy with CBCT compared with 2-dimensional orthogonal kV imaging was associated with a decreased risk of RP2. Clinicians could consider the implications of localization methods during curative intent radiation therapy.
Collapse
Affiliation(s)
- Nikhil Yegya-Raman
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Sinae Kim
- Department of Biostatistics, School of Public Health, Rutgers University, Piscataway, New Jersey; Biometrics Division, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Matthew P Deek
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Diana Li
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Apar Gupta
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Laura Bond
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Abhishek Dwivedi
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Joel K Braver
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Meral Reyhan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Akaash Mittal
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Bin Gui
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Jyoti Malhotra
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Joseph Aisner
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.
| |
Collapse
|
|
40
|
Yegya-Raman N, Zou W, Nie K, Malhotra J, Jabbour SK. Advanced radiation techniques for locally advanced non-small cell lung cancer: intensity-modulated radiation therapy and proton therapy. J Thorac Dis 2018; 10:S2474-S2491. [PMID: 30206493 DOI: 10.21037/jtd.2018.07.29] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Radiation therapy (RT) represents an integral part of a multimodality treatment plan in the definitive, preoperative and postoperative management of non-small cell lung cancer (NSCLC). Technological advances in RT have enabled a shift from two-dimensional radiotherapy to more conformal techniques. Three-dimensional conformal radiotherapy (3DCRT), the current minimum technological standard for treating NSCLC, allows for more accurate delineation of tumor burden by using computed tomography-based treatment planning instead of two-dimensional radiographs. Intensity-modulated RT (IMRT) and proton therapy represent advancements over 3DCRT that aim to improve the conformity of RT and provide the possibility for dose escalation to the tumor by minimizing radiation dose to organs at risk. Both techniques likely confer benefits to certain anatomic subgroups of NSCLC requiring RT. This article reviews pertinent studies evaluating the use of IMRT and proton therapy in locally advanced NSCLC, and outlines challenges, indications for use, and areas for future research.
Collapse
Affiliation(s)
- Nikhil Yegya-Raman
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ke Nie
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Jyoti Malhotra
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| |
Collapse
|
|
41
|
Vloet A, Li W, Giuliani M, Seco P, Silver L, Sun A, Bissonnette JP. Comparison of residual geometric errors obtained for lung SBRT under static beams and VMAT techniques: Implications for PTV margins. Phys Med 2018; 52:129-132. [PMID: 30139601 DOI: 10.1016/j.ejmp.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 07/09/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Anita Vloet
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Winnie Li
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Meredith Giuliani
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Petula Seco
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Lauren Silver
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada
| | - Alexander Sun
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; Department of Radiation Oncology, University of Toronto, Canada
| | - Jean-Pierre Bissonnette
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON M5G 2M9, Canada; Department of Radiation Oncology, University of Toronto, Canada.
| |
Collapse
|
|
42
|
Li H, Chang JY. Accounting for, Mitigating, and Choice of Margins for Moving Tumors. Semin Radiat Oncol 2018; 28:194-200. [DOI: 10.1016/j.semradonc.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
|
43
|
|
|
44
|
Calikusu Z, Altinok P. Treatment of locally advanced, unresectable or medically inoperable stage III non-small-cell lung cancer; the past, present and future of chemoradiotherapy. JOURNAL OF ONCOLOGICAL SCIENCES 2018. [DOI: 10.1016/j.jons.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
|
|
45
|
Aznar MC, Warren S, Hoogeman M, Josipovic M. The impact of technology on the changing practice of lung SBRT. Phys Med 2018; 47:129-138. [PMID: 29331227 PMCID: PMC5883320 DOI: 10.1016/j.ejmp.2017.12.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 11/20/2017] [Accepted: 12/23/2017] [Indexed: 02/09/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT) for lung tumours has been gaining wide acceptance in lung cancer. Here, we review the technological evolution of SBRT delivery in lung cancer, from the first treatments using the stereotactic body frame in the 1990's to modern developments in image guidance and motion management. Finally, we discuss the impact of current technological approaches on the requirements for quality assurance as well as future technological developments.
Collapse
Affiliation(s)
- Marianne Camille Aznar
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK; Institute for Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.
| | - Samantha Warren
- Hall Edwards Radiotherapy Group, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mischa Hoogeman
- MC-Daniel den Hoed Cancer Center, Erasmus University, Rotterdam, Netherlands
| | - Mirjana Josipovic
- Niels Bohr Institute, Faculty of Science, University of Copenhagen, Copenhagen, Denmark; Department of Oncology, Section for Radiotherapy, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
|
46
|
Molitoris JK, Diwanji T, Snider JW, Mossahebi S, Samanta S, Onyeuku N, Mohindra P, Choi JI, Simone CB. Optimizing immobilization, margins, and imaging for lung stereotactic body radiation therapy. Transl Lung Cancer Res 2018; 8:24-31. [PMID: 30788232 DOI: 10.21037/tlcr.2018.09.25] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The simultaneous advancement of technologies for the delivery of precisely targeted radiation therapy and the paradigm shift to substantial hypofractionation have led to significant improvements in the treatment of early stage non-small cell lung cancer (ES-NSCLC). Stereotactic body radiation therapy (SBRT) has become a well-established option for the treatment of ES-NSCLC and is now becoming widely available within the radiation oncology community. Implementation of this technique, however, requires highly accurate target delineation, thorough evaluation of tumor motion, and improved on-board imaging at the time of treatment for patient alignment, each of which is critical for successful tumor control and mitigation of risks to normal tissues. In this article, we review updates and issues related to immobilization and image guidance for SBRT in the treatment of ES-NSCLC.
Collapse
Affiliation(s)
- Jason K Molitoris
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tejan Diwanji
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - James W Snider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Sina Mossahebi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Santanu Samanta
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Nasarachi Onyeuku
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - J Isabelle Choi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
|
47
|
Zhang J, Chen Y, Chen Y, Wang C, Cai J, Chu K, Jin J, Ge Y, Huang X, Guan Y, Li W. A Noninvasive Body Setup Method for Radiotherapy by Using a Multimodal Image Fusion Technique. Technol Cancer Res Treat 2018; 16:1187-1193. [PMID: 29333959 PMCID: PMC5762088 DOI: 10.1177/1533034617740302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose: To minimize the mismatch error between patient surface and immobilization system for tumor location by a noninvasive patient setup method. Materials and Methods: The method, based on a point set registration, proposes a shift for patient positioning by integrating information of the computed tomography scans and that of optical surface landmarks. An evaluation of the method included 3 areas: (1) a validation on a phantom by estimating 100 known mismatch errors between patient surface and immobilization system. (2) Five patients with pelvic tumors were considered. The tumor location errors of the method were measured using the difference between the proposal shift of cone-beam computed tomography and that of our method. (3) The collected setup data from the evaluation of patients were compared with the published performance data of other 2 similar systems. Results: The phantom verification results showed that the method was capable of estimating mismatch error between patient surface and immobilization system in a precision of <0.22 mm. For the pelvic tumor, the method had an average tumor location error of 1.303, 2.602, and 1.684 mm in left–right, anterior–posterior, and superior–inferior directions, respectively. The performance comparison with other 2 similar systems suggested that the method had a better positioning accuracy for pelvic tumor location. Conclusion: By effectively decreasing an interfraction uncertainty source (mismatch error between patient surface and immobilization system) in radiotherapy, the method can improve patient positioning precision for pelvic tumor.
Collapse
Affiliation(s)
- Jie Zhang
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Ying Chen
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Yunxia Chen
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Chenchen Wang
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Jing Cai
- 2 Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Kaiyue Chu
- 2 Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Jianhua Jin
- 2 Department of Radiotherapy, Nantong Tumor Hospital, Nantong, China
| | - Yun Ge
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Xiaolin Huang
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Yue Guan
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| | - Weifeng Li
- 1 Department of Biomedical Engineering, School of Electronic Science and Engineering, Nanjing University, Nanjing, China
| |
Collapse
|
|
48
|
Yuasa Y, Shiinoki T, Fujimoto K, Hanazawa H, Uehara T, Koike M, Shibuya K. Effect of gantry speed on accuracy of extracted target motion trajectories and image quality in 4D-CBCT: phantom study. Biomed Phys Eng Express 2017. [DOI: 10.1088/2057-1976/aa8ade] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
|
49
|
Martin R, Ahmad M, Hugo G, Pan T. Iterative volume of interest based 4D cone-beam CT. Med Phys 2017; 44:6515-6528. [PMID: 28898423 DOI: 10.1002/mp.12575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/15/2017] [Accepted: 08/18/2017] [Indexed: 01/09/2023] Open
Abstract
PURPOSE 4D cone-beam CT (CBCT) has potential applications in soft tissue alignment and tumor motion verification at the time of radiation treatment. However, prominent streak artifacts with conventional image reconstructions have limited its clinical use and alternative reconstructions are generally too computationally expensive for the time available. We propose an iterative volume of interest based (I4D VOI) reconstruction technique, where 4D reconstruction is only performed within a VOI, to limit streak artifacts with limited added computation time. METHODS The I4D VOI technique is compared to standard cone-beam filtered back projection (FDK), an FDK VOI technique, and unconstrained total variation (TV) minimization by comparing tumor motion quantification errors and image quality. 14 long CBCT scans (6.5 to 12 min) of patients receiving radiation treatment for lung cancer were used for the comparison. Rigid registration between phase images of FDK reconstructions using all projections were used to quantify the gold standard motion. Projections were removed to simulate 2 minute scans and these new projection sets were used for each of the test reconstructions. RESULTS Excluding two patients where registration failed, the average root mean square (RMS) error for each method was as follows: 1.5 ± 0.2 mm for FDK, 1.4 ± 0.2 mm for FDK VOI, 1.3 ± 0.2 mm for I4D VOI, 1.7 ± 0.4 mm for low regularization TV minimization, and 1.1 ± 0.2 mm for high regularization TV minimization. No significant difference was observed between RMS error for I4D VOI and the other methods, except for unsmoothed FDK VOI (P = 0.02). An increase in RMS error difference between I4D VOI and smoothed FDK VOI was observed going from 2 min to 1 min scans (0.1 mm to 0.3 mm, P = 0.20 to P = 0.09). CONCLUSIONS I4D VOI and FDK VOI reconstruction measured tumor trajectories with equivalent accuracy as TV minimization with improved bony anatomy image quality and computation time (I4D VOI was approximately 15 and 95 times faster than low and high regularization TV minimization, respectively). Within the VOI, streak artifact reduction compared to FDK VOI may be beneficial for tumor visualization and motion measurement, but requires further study.
Collapse
Affiliation(s)
- Rachael Martin
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Moiz Ahmad
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Geoffrey Hugo
- Department of Radiation Oncology Physics, Washington University School of Medicine, St. Louis, MO, USA
| | - Tinsu Pan
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
|
50
|
Xie H, Tang X. Optimization of data acquisition in axial CT under the framework of sampling on lattice for suppression of aliasing artifacts with algorithmic detector interlacing. Med Phys 2017; 44:6239-6250. [PMID: 28986917 DOI: 10.1002/mp.12618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 08/29/2017] [Accepted: 09/26/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We present the methodology for analyzing and optimizing the sampling structure of projection data acquisition in axial multidetector CT (MDCT) and cone beam CT (CBCT) under the framework of sampling on lattice. Specifically, we propose and evaluate the scheme of interlaced detector cell binning for suppression of longitudinal aliasing artifacts. In addition, we investigate the proposed scheme's capability of mitigating shift variation in spatial resolution and possibility of improving CB image reconstruction accuracy. METHODS Under the framework of sampling on lattice, the proposed scheme is evaluated using an axial MDCT with its architecture similar to that of state-of-the-art CT scanners for diagnostic imaging in the clinic. The widely used FDK algorithm is adopted for image reconstruction, in which either horizontal/latitudinal or vertical/longitudinal interpolation is used for lining-up of projection data between interlaced detector cells. Using a spiral clock phantom, the capability of suppressing aliasing artifacts and possibility of improving reconstruction accuracy is quantitatively investigated. The in-plane spatial resolution, as assessed by the modulation transfer function (MTF), and its shift-variant property are quantitatively assessed using wire phantoms, while the through-plane spatial resolution and its shift-variant behavior are assessed by the slice sensitivity profile (SSP) using thin foil phantoms. RESULTS The preliminary results show that the interlaced detector cell binning can suppress longitudinal aliasing artifacts effectively, while the shift variation in spatial resolution and reconstruction inaccuracy can be mitigated moderately. In addition, the direction, along which the interpolation is carried out to line up projection data between the interlaced detector cells for image reconstruction, plays a significant role in determining the in-plane and through-plane spatial resolution. CONCLUSIONS The scheme of interlaced detector cell binning with longitudinal interpolation for data lining-up is an effective solution for suppression of longitudinal aliasing artifacts in axial MDCT and CBCT.
Collapse
Affiliation(s)
- Huiqiao Xie
- Imaging and Medical Physics, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1701 Uppergate Dr., C-5018, Atlanta, GA, 30322, USA
| | - Xiangyang Tang
- Imaging and Medical Physics, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1701 Uppergate Dr., C-5018, Atlanta, GA, 30322, USA
| |
Collapse
|