Abdominal organ motion measured using 4D CT Brandner, Edward D; Wu, Andrew; Chen, Hungcheng ...
International journal of radiation oncology, biology, physics,
06/2006, Volume:
65, Issue:
2
Journal Article
Peer reviewed
To measure respiration-induced abdominal organ motion using four-dimensional computed tomography (4D CT) scanning and to examine the organ paths.
During 4D CT scanning, consecutive CT images are ...acquired of the patient at each couch position. Simultaneously, the patient's respiratory pattern is recorded using an external marker block taped to the patient's abdomen. This pattern is used to retrospectively organize the CT images into multiple three-dimensional images, each representing one breathing phase. These images are analyzed to measure organ motion between each phase. The displacement from end expiration is compared to a displacement limit that represents acceptable dosimetric results (5 mm).
The organs measured in 13 patients were the liver, spleen, and left and right kidneys. Their average superior to inferior absolute displacements were 1.3 cm for the liver, 1.3 cm for the spleen, 1.1 cm for the left kidney, and 1.3 cm for the right kidney. Although the organ paths varied among patients, 5 mm of superior to inferior displacement from end expiration resulted in less than 5 mm of displacement in the other directions for 41 of 43 organs measured.
Four-dimensional CT scanning can accurately measure abdominal organ motion throughout respiration. This information may result in greater organ sparing and planning target volume coverage.
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GEOZS, IJS, NUK, OILJ, UL, UM, UPUK
Abstract Background and purpose To assess the impact of a standardized delineation protocol and training interventions on PET/CT-based target volume delineation (TVD) in NSCLC in a multicenter ...setting. Material and methods Over a one-year period, 11 pairs, comprised each of a radiation oncologist and nuclear medicine physician with limited experience in PET/CT-based TVD for NSCLC from nine different countries took part in a training program through an International Atomic Energy Agency (IAEA) study (NCT02247713). Teams delineated gross tumor volume of the primary tumor, during and after training interventions, according to a provided delineation protocol. In-house developed software recorded the performed delineations, to allow visual inspection of strategies and to assess delineation accuracy. Results Following the first training, overall concordance indices for 3 repetitive cases increased from 0.57 ± 0.07 to 0.66 ± 0.07. The overall mean surface distance between observer and expert contours decreased from −0.40 ± 0.03 cm to −0.01 ± 0.33 cm. After further training overall concordance indices for another 3 repetitive cases further increased from 0.64 ± 0.06 to 0.80 ± 0.05 ( p = 0.01). Mean surface distances decreased from −0.34 ± 0.16 cm to −0.05 ± 0.20 cm ( p = 0.01). Conclusion Multiple training interventions improve PET/CT-based TVD delineation accuracy in NSCLC and reduce interobserver variation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The modeling of respiratory motion is important for a more accurate understanding and accounting of its effect on dose to cancers in the thorax and abdomen by radiotherapy. We have developed a model ...of respiration-induced organ motion in the thorax without the commonly adopted assumption of repeatable breath cycles. The model describes the motion of a volume of interest within the patient based on a reference three-dimensional (3D) image (at end expiration) and the diaphragm positions at different time points. The input data are respiration-correlated CT (RCCT) images of patients treated for non-small- cell lung cancer, consisting of 3D images, including the diaphragm positions, at ten phases of the respiratory cycle. A deformable image registration algorithm calculates the deformation field that maps each 3D image to the reference 3D image. A principal component analysis is performed to parameterize the 3D deformation field in terms of the diaphragm motion. We show that the first two principal components are adequate to accurately and completely describe the organ motion in the data of four patients. Artifacts in the RCCT images that commonly occur at the mid-respiration states are reduced in the model-generated images. Further validation of the model is demonstrated in the successful application of the parameterized 3D deformation field to RCCT data of the same patient but acquired several days later. We have developed a method for predicting respiration-induced organ motion in patients that has potential for improving the accuracy of dose calculation in radiotherapy. Possible limitations of the model are cases where the correlation between lung tumor and diaphragm position is less reliable such as superiorly situated tumors and interfraction changes in tumor-diaphragm correlation. The limited number of clinical cases examined suggests, but does not confirm, the model’s applicability to a wide range of patients.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract
Deviceless four-dimensional (4D) computed tomography (CT) allows the acquisition of respiratory signals from six features without requiring an external device for cine CT processing. This ...method has been recently introduced in radiation treatment planning of lung tumors. To validate deviceless 4D CT, it must be compared with conventional 4D CT, which requires an external monitoring device. We compared the two methods using a multicell 4D phantom that simulates patient’s movement during respiration regarding the target volume (TV), target position (TP), and internal TV for lung tumor radiation therapy. We retrospectively obtained images of 10 patients who underwent radiation treatment planning of lung tumors and compared the two methods, as in the phantom study. For the phantom study, the mean TV, root mean square errors of the TP, and mean internal TV differences between the two methods ranged from −4.5% to 1.2%, 0.7 to 2.6 mm, and −1.1% to 3.4%, respectively. The corresponding results of the clinical study ranged from −1.5% to 14.9%, 0.1 to 5.9 mm, and −9.7% to 10.1%, respectively. The results of deviceless 4D CT for the clinical study were consistent with those of conventional 4D CT, except for target movements with high excursions. Therefore, deviceless 4D CT can be an alternative to conventional 4D CT for radiation treatment planning of lung tumors.
Summary
A linear accelerator with the flattening‐filter removed generates a non‐uniform dose profile beam. We aimed to analyse and compare plan quality and treatment time between flattened beam (FB) ...and flattening‐filter‐free (FFF) beam to assess the efficacy of FFF beam for stereotactic body radiation therapy (SBRT). The search strategy was based around 3 concepts; radiation therapy, flattening‐filter‐free and treatment delivery. The years searched were restricted from 2010 to date of review (October 2015). All plan quality comparisons were between FFF and FB plans from the same data sets. We identified 210 potential studies based on the three searched concepts. All articles were screened by two authors for title and and by three authors for full text. Ten studies met the eligibility criteria. Plan quality was evaluated using conformity index (CI), heterogeneity index (HI) and gradient index (GI). Dose to organs‐at‐risk (OAR) and healthy tissues were compared. Differences between beam‐on‐time (BOT) and treatment time (T × T) were also analysed. Normalized percentage ratios of CI and HI demonstrated no clinical differences among the studied articles. GI displayed small variations between the articles favouring FFF beam. The BOT with FFF is substantially reduced, and appears to impact the frequency of intra‐fraction imaging which, in turn, affects total treatment time. Based on planning tumour volume (PTV) coverage, dose to OAR and healthy tissue sparing, FFF beam is clinically effective for the treatment of cancer patients using SBRT. We recommend the use of FFF beam for SBRT based on these factors and the reported overall treatment time reduction.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
Purpose
For lung and liver tumors requiring radiotherapy, motion artifacts are common in 4D‐CT images due to the small axial field‐of‐view (aFOV) of conventional CT scanners. This may negatively ...impact contouring and dose calculation accuracy and could lead to a geographic miss during treatment. Recent advancements in volumetric CT (vCT) enable an aFOV up to 160 mm in a single rotation, which may reduce motion artifacts. However, the impact of large aFOV on CT number required for dose calculation needs to be evaluated before clinical implementation. The objective of this study was to determine the utility of a 256‐slice vCT scanner for 4D‐CT simulation by evaluating image quality and generating relative electron density (RED) curves.
Methods
Images were acquired on a 256‐slice GE Revolution CT scanner with 40 mm, 80 mm, 120 mm, 140 mm, and 160 mm aFOV. Image quality was assessed by evaluating CT number linearity, uniformity, noise, and low‐contrast resolution. The relationship between each quality metric and aFOV was assessed.
Results
CT number linearity, uniformity, noise, and low‐contrast resolution were within the expected range for each image set, except CT number in Teflon and Delrin, which were underestimated. Spearman correlation coefficient (ρ) showed that the CT number for Teflon (ρ = 1.0, p = 0.02), Delrin (ρ = 1.0, p = 0.02), and air (ρ = 1.0, p = 0.02) was significantly related to aFOV, while all other measurements were not. The measured deviations from expected values were not clinically significant.
Conclusion
These results suggest that vCT can be used for CT simulation for radiation treatment planning.
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
In carbon-ion radiotherapy, single-beam delivery each day in alternate directions has been common practice for efficient operation, taking advantage of the Bragg peak and the relative biological ...effectiveness (RBE) for uniform dose conformation to a tumor. Treatments are usually fractionated and treatment plans are evaluated with the total RBE-weighted dose; however, this is of limited relevance to the biological effect. In this study, we reformulate the biologically effective dose (BED) to normalize the dose-fractionation and cell-repopulation effects as well as the RBE of treating radiation, based on inactivation of a reference cell line by a reference carbon-ion radiation. The BED distribution virtually represents the biological effect of a treatment regardless of radiation modality or fractionation scheme. We applied the BED formulation to simplistic model treatments and to a preclinical survey for hypofractionation based on an actual prostate cancer treatment with carbon ions. The proposed formulation was demonstrated to be practical and to give theoretical implications. For a prostate cancer treatment in 12 fractions, the distributions of BED and of RBE-weighted dose were very similar. With hypofractionation, while the RBE-weighted dose distribution varied significantly, the BED distribution was nearly invariant, implying that carbon-ion radiotherapy would be effectively insensitive to fractionation. However, treatment evaluation with such a simplistic biological dose is intrinsically limited and must be complemented in practice by clinical experience and biological experiments.
In the recent past, robust optimization methods have been developed and successfully applied to a variety of single-stage problems. More recently, some of these approaches have been extended to ...multi-stage settings with fixed uncertainties. However, in many real-world applications, uncertainties evolve over time, rendering the robust solutions suboptimal. This issue is particularly prevalent in medical decision making, where a patient's condition can change during the course of the treatment. In the context of radiation therapy, changes in cell oxygenation directly affect the response to radiation. To address such uncertain changes, we provide a general robust optimization framework that incorporates time-dependent uncertainty sets in a tractable fashion. Temporal changes reside within a cone, whose projection at each step yields the current uncertainty set. We develop conic robust two-stage linear problems and provide their robust counterparts for uncertain constraint parameters, covering the range of radiation therapy problems. For a clinical prostate cancer case, the time-dependent robust approach improves the tumor control throughout the treatment, as opposed to current methods that lose efficacy at some stage. We show that this advantage does not bear additional risks compared to current clinical methods. For intermediate diagnostics, we provide the optimal observation timing that maximizes the value of information. While these findings are relevant to clinical settings, they are also general and can be applied to a broad range of applications; e.g., in maintenance scheduling.
Multi-leaf collimator (MLC) parameters, which are registered with radiation treatment planning systems, are very important for intensity modulated radiation therapy (IMRT). In this study, we ...investigated MLC parameters of respective institutions for efficient commissioning of IMRT. Data of linac models, MLC types, nominal energy, irradiation technique, calculation algorithm, dosimetric leaf gap (DLG) values, and MLC transmission values were collected from each institution in which Varian linac and Eclipse were owned, and analyzed. The numbers of responses from institutions to questionnaire were 15, and the total number of linac was 22. In most institutions, volumetric modulated arc therapy (VMAT) technique was used, and the most used nominal energy was 10 MV. The higher nominal energy was, the higher values of MLC parameters (DLG and MLC transmission) were. In addition, values of MLC parameters of flattening filter free (FFF) beams were smaller than those of flattening filter (FF) beams, even when nominal energy was same. Values of DLG of VMAT tended to be greater than those of multi-field IMRT. These results are expected to be useful for institutions, in which IMRT is implemented.
In neuro-oncology, high spatial accuracy is needed for clinically acceptable high-precision radiation treatment planning (RTP). In this study, the clinical applicability of anatomically optimised ...7-Tesla (7T) MR images for reliable RTP is assessed with respect to standard clinical imaging modalities.
System- and phantom-related geometrical distortion (GD) were quantified on clinically-relevant MR sequences at 7T and 3T, and on CT images using a dedicated anthropomorphic head phantom incorporating a 3D grid-structure, creating 436 points-of-interest. Global GD was assessed by mean absolute deviation (MADGlobal). Local GD relative to the magnetic isocentre was assessed by MADLocal. Using 3D displacement vectors of individual points-of-interest, GD maps were created. For clinically acceptable radiotherapy, 7T images need to meet the criteria for accurate dose delivery (GD < 1 mm) and present comparable GD as tolerated in clinically standard 3T MR/CT-based RTP.
MADGlobal in 7T and 3T images ranged from 0.3 to 2.2 mm and 0.2–0.8 mm, respectively. MADLocal increased with increasing distance from the isocentre, showed an anisotropic distribution, and was significantly larger in 7T MR sequences (MADLocal = 0.2–1.2 mm) than in 3T (MADLocal = 0.1–0.7 mm) (p < 0.05). Significant differences in GD were detected between 7T images (p < 0.001). However, maximum MADLocal remained ≤1 mm within 68.7 mm diameter spherical volume. No significant differences in GD were found between 7T and 3T protocols near the isocentre.
System- and phantom-related GD remained ≤1 mm in central brain regions, suggesting that 7T MR images could be implemented in radiotherapy with clinically acceptable spatial accuracy and equally tolerated GD as in 3T MR/CT-based RTP. For peripheral regions, GD should be incorporated in safety margins for treatment uncertainties. Moreover, the effects of sequence-related factors on GD needs further investigation to obtain RTP-specific MR protocols.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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