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Thummerer A, Schmidt L, Hofmaier J, Corradini S, Belka C, Landry G, Kurz C. Deep learning based super-resolution for CBCT dose reduction in radiotherapy. Med Phys 2025; 52:1629-1642. [PMID: 39625126 PMCID: PMC11880651 DOI: 10.1002/mp.17557] [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: 06/25/2024] [Revised: 10/19/2024] [Accepted: 11/14/2024] [Indexed: 03/06/2025] Open
Abstract
BACKGROUND Cone-beam computed tomography (CBCT) is a crucial daily imaging modality in image-guided and adaptive radiotherapy. However, the use of ionizing radiation in CBCT imaging increases the risk of secondary cancers, which is particularly concerning for pediatric patients. Deep learning super-resolution has shown promising results in enhancing the resolution of photographic and medical images but has not yet been explored in the context of CBCT dose reduction. PURPOSE To facilitate CBCT imaging dose reduction, we propose using an enhanced super-resolution generative adversarial network (ESRGAN) in both the projection and image domains to restore the image quality of low-dose CBCT. METHODS An extensive projection database, containing 2997 CBCT scans from head and neck cancer patients, was used to train two different ESRGAN models to generate super-resolution CBCTs. One model operated in the projection domain, using pairs of simulated low-resolution (low-dose) and original high-resolution (high-dose) projections and yielded CBCTSRpro. The other model operated in the image domain, using pairs of axial slices from reconstructed low-resolution and high-resolution CBCTs (CBCTLR and CBCTHR) and resulted in CBCTSRimg. Super-resolution CBCTs were evaluated in terms of image similarity (MAE, ME, PSNR, and SSIM), noise characteristics, spatial resolution, and registration accuracy, using the original CBCT as a reference. To test the perceptual difference between the original and super-resolution CBCT, we performed a visual Turing test. RESULTS Visually, both super-resolution approaches in the projection and image domains improved the image quality of low-dose CBCTs. This was confirmed by the visual Turing test, that showed low accuracy, sensitivity, and specificity, indicating almost no perceptual difference between CBCTHR and the super-resolution CBCTs. CBCTSRimg (accuracy: 0.55, sensitivity: 0.59, specificity: 0.50) performed slightly better than CBCTSRpro (accuracy: 0.59, sensitivity: 0.61, specificity: 0.57). Image similarity metrics were affected by varying noise levels and did not reflect the visual improvements, with MAE/ME/PSNR/SSIM values of 110.4 HU/2.9 HU/40.4 dB/0.82 for CBCTLR, 136.6 HU/-0.4 HU/38.6 dB/0.77 for CBCTSRpro, and 128.2 HU/1.9 HU/39.0 dB/0.80 for CBCTSRimg. In terms of spatial resolution, quantified by calculating 10% levels of the task transfer function, both CBCTSRpro and CBCTSRimg outperformed CBCTLR and nearly matched the reference CBCTHR (CBCTLR: 0.66 lp/mm, CBCTSRpro: 0.88 lp/mm, CBCTSRimg: 0.95 lp/mm, CBCTHR: 1.01 lp/mm). Noise characteristics of CBCTSRimg and CBCTSRpro were comparable to the reference CBCTHR. Registration parameters showed negligible differences for all CBCTs (CBCTLR, CBCTSRpro, CBCTSRimg), with average absolute differences in registration parameters being below 0.4° for rotations and below 0.06 mm for translations (CBCTHR as reference). CONCLUSIONS This study demonstrates that deep learning can be a valuable tool for CBCT dose reduction in CBCT-guided radiotherapy by acquiring low-dose CBCTs and restoring the image quality using deep learning super-resolution. The results suggest that higher quality images can be generated when super-resolution is performed in the image domain compared to the projection domain.
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Affiliation(s)
- Adrian Thummerer
- Department of Radiation OncologyLMU University Hospital, LMU MunichMunichGermany
| | - Lukas Schmidt
- Department of Radiation OncologyLMU University Hospital, LMU MunichMunichGermany
| | - Jan Hofmaier
- Department of Radiation OncologyLMU University Hospital, LMU MunichMunichGermany
| | - Stefanie Corradini
- Department of Radiation OncologyLMU University Hospital, LMU MunichMunichGermany
| | - Claus Belka
- Department of Radiation OncologyLMU University Hospital, LMU MunichMunichGermany
- German Cancer Consortium (DKTK), Partner Site MunichA Partnership Between DKFZ and LMU University Hospital Munich GermanyMunichGermany
- Bavarian Cancer Research Center (BZKF)MunichGermany
| | - Guillaume Landry
- Department of Radiation OncologyLMU University Hospital, LMU MunichMunichGermany
| | - Christopher Kurz
- Department of Radiation OncologyLMU University Hospital, LMU MunichMunichGermany
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Carlton H, Salimi M, Arepally N, Bentolila G, Sharma A, Bibic A, Newgren M, Goodwill P, Attaluri A, Korangath P, Bulte JW, Ivkov R. Ranking Magnetic Colloid Performance for Magnetic Particle Imaging and Magnetic Particle Hyperthermia. ADVANCED FUNCTIONAL MATERIALS 2025; 35:2412321. [PMID: 39882193 PMCID: PMC11774450 DOI: 10.1002/adfm.202412321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 09/05/2024] [Indexed: 01/31/2025]
Abstract
Magnetic particle imaging (MPI) is an emerging modality that can address longstanding technological challenges encountered with magnetic particle hyperthermia (MPH) cancer therapy. MPI is a tracer technology compatible with MPH for which magnetic nanoparticles (MNPs) provide signal for MPI and heat for MPH. Identifying whether a specific MNP formulation is suitable for both modalities is essential for clinical implementation. Current models predict that functional requirements of each modality impose conflicting demands on nanoparticle magnetic properties. This objective here is to develop a measurement and ranking scheme based on end-use performance to streamline evaluation of candidate MNP formulations. The measured MPI point-spread function (PSF) and specific loss power (SLP) is combined to generate a single numerical value for comparison on a relative ranking scale, or figure of merit (FoM). 12 aqueous iron-containing formulations are evaluated, including FDA-approved (parenteral) iron-containing colloids. MNPs with high (Synomag-D70: 123.4), medium (Synomag-D50: 63.2), and low (NanoXact: 0.147) FoM values are selected for in vivo validation of the selection scheme in subcutaneous 4T1 tumors. Results demonstrate that the proposed ranking accurately assessed the relative performance of MNPs for MPI and MPH. Data demonstrated that image quality and tumor temperature rise increased with FoM ranking, validating predictions. It isshown that the MPI signal correlated with MNP concentration in tissue. Computational heat transfer models anchored on tumor MPI data harmonized with experimental results to within an average of 2 °C when MNP content estimated from MPI data is included. Computational studies emphasized the importance of post-injection MNP quantitation and MPI spatial resolution.
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Affiliation(s)
- Hayden Carlton
- Department of Radiation Oncology and Molecular Radiation Sciencesthe Johns Hopkins University School of MedicineBaltimoreMD21231USA
| | - Marzieh Salimi
- Russell H. Morgan Department of Radiology and Radiological ScienceDivision of MR Researchthe Johns Hopkins University School of MedicineBaltimoreMD21205USA
- Cellular Imaging Section and Vascular Biology ProgramInstitute for Cell Engineeringthe Johns Hopkins University School of MedicineBaltimoreMD21205USA
| | - Nageshwar Arepally
- Department of Mechanical EngineeringSchool of ScienceEngineeringand TechnologyThe Pennsylvania State University – HarrisburgHarrisburgPA17057USA
| | - Gabriela Bentolila
- Department of Radiation Oncology and Molecular Radiation Sciencesthe Johns Hopkins University School of MedicineBaltimoreMD21231USA
| | - Anirudh Sharma
- Department of Radiation Oncology and Molecular Radiation Sciencesthe Johns Hopkins University School of MedicineBaltimoreMD21231USA
| | - Adnan Bibic
- Russell H. Morgan Department of Radiology and Radiological ScienceDivision of MR Researchthe Johns Hopkins University School of MedicineBaltimoreMD21205USA
- F.M. Kirby Research Center for Functional Brain ImagingKennedy Krieger Inc.BaltimoreMD21205USA
| | | | | | - Anilchandra Attaluri
- Department of Mechanical EngineeringSchool of ScienceEngineeringand TechnologyThe Pennsylvania State University – HarrisburgHarrisburgPA17057USA
| | - Preethi Korangath
- Department of Radiation Oncology and Molecular Radiation Sciencesthe Johns Hopkins University School of MedicineBaltimoreMD21231USA
| | - Jeff W.M. Bulte
- Russell H. Morgan Department of Radiology and Radiological ScienceDivision of MR Researchthe Johns Hopkins University School of MedicineBaltimoreMD21205USA
- Cellular Imaging Section and Vascular Biology ProgramInstitute for Cell Engineeringthe Johns Hopkins University School of MedicineBaltimoreMD21205USA
- F.M. Kirby Research Center for Functional Brain ImagingKennedy Krieger Inc.BaltimoreMD21205USA
- Department of Biomedical Engineeringthe Johns Hopkins University School of MedicineBaltimoreMD21205USA
- Department of Chemical & Biomolecular EngineeringWhiting School of EngineeringJohns Hopkins UniversityBaltimoreMD21218USA
- Department of OncologySydney Kimmel Comprehensive Cancer CenterJohns Hopkins University School of MedicineBaltimoreMD21287USA
| | - Robert Ivkov
- Department of Radiation Oncology and Molecular Radiation Sciencesthe Johns Hopkins University School of MedicineBaltimoreMD21231USA
- Department of OncologySydney Kimmel Comprehensive Cancer CenterJohns Hopkins University School of MedicineBaltimoreMD21287USA
- Department of Mechanical EngineeringWhiting School of EngineeringJohns Hopkins UniversityBaltimoreMD21218USA
- Department of Materials Science and EngineeringWhiting School of EngineeringJohns Hopkins UniversityBaltimoreMD21218USA
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Kavousi N, Nazari M, Toossi MTB, Azimian H, Alibolandi M. Smart bismuth-based platform: A focus on radiotherapy and multimodal systems. J Drug Deliv Sci Technol 2024; 101:106136. [DOI: 10.1016/j.jddst.2024.106136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Ghazy SG, Abdel-Maksoud MA, Saleh IA, El-Tayeb MA, Elsaid AA, Kotb MA, Al-Sherif DA, Ramadan HS, Elwahsh A, Hussein AM, Kodous AS. Comparative Analysis of Dosimetry: IMRT versus 3DCRT in Left-Sided Breast Cancer Patients with Considering Some Organs in Out - of - Field Borders. BREAST CANCER (DOVE MEDICAL PRESS) 2024; 16:567-582. [PMID: 39253547 PMCID: PMC11382807 DOI: 10.2147/bctt.s463024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 09/11/2024]
Abstract
Purpose The local management approach for node-positive breast cancer has undergone substantial evolution. Consequently, there exists a pressing need to enhance our treatment strategies by placing greater emphasis on planning and dosimetric factors, given the availability of more conformal techniques and delineation criteria, achieving optimal goals of radiotherapy treatment. The primary aim of this article is to discuss how the extent of regional nodal coverage influences the choice between IMRT and 3D radiation therapy for patients. Patients and Methods A total of 15 patients diagnosed with left breast cancer with disease involved lymph nodes were included in this study. Delivering the recommended dose required the use of a linear accelerator (LINAC) with photon beams energy of 6 mega voltage (6MV). Each patient had full breast radiation using two planning procedures: intensity-modulated radiotherapy (IMRT) and three-dimensional radiotherapy (3D conformal). Following the guidelines set forth by the Radiation Therapy Oncology Group (RTOG), the planned treatment coverage was carefully designed to fall between 95% and 107% of the recommended dose. Additionally, Dose Volume Histograms (DVHs) were generated the dose distribution within these anatomical contours. Results and Conclusion The DVH parameters were subjected to a comparative analysis, focusing on the doses absorbed by both Organs at Risk (OARs) and the Planning Target Volume (PTV). The findings suggest that low doses in IMRT plan might raise the risk of adverse oncological outcomes or potentially result in an increased incidence of subsequent malignancies. Consequently, the adoption of inverse IMRT remains limited, and the decision to opt for this therapy should be reserved for situations where it is genuinely necessary to uphold a satisfactory quality of life. Additionally, this approach helps in reducing the likelihood of developing thyroid problems and mitigates the risk of injuries to the supraclavicular area and the proximal head of the humerus bone.
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Affiliation(s)
- Shaimaa G Ghazy
- Radiation Therapy Department, Armed Forces Medical Complex, Alexandria, Egypt
| | - Mostafa A Abdel-Maksoud
- Botany and Microbiology Department- College of Science- King Saud University, Riyadh, Saudi Arabia
| | | | - Mohamed A El-Tayeb
- Botany and Microbiology Department- College of Science- King Saud University, Riyadh, Saudi Arabia
| | - Amr A Elsaid
- Oncology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Metwally A Kotb
- Medical Biophysics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Diana A Al-Sherif
- Applied Medical Science Faculty, Sixth October University, Sixth October, Giza, Egypt
| | - Heba S Ramadan
- Medical Biophysics Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Ahmed Elwahsh
- Central Radiology Institute, Kepler University Hospital GmbH, Linz, Austria
- Department of Molecular and Translational Medicine, Division of Biology and Genetics, University of Brescia, Brescia, Italy
| | - Ahmed M Hussein
- Department of Pharmaceutical Sciences, Division of Pharmacology and Toxicology, University of Vienna, Vienna, 1090, Austria
- Zoology Department, Faculty of Science, Al Azhar University, Assiut, Egypt
| | - Ahmad S Kodous
- Pharmacology Department, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College & Hospitals, Chennai, TN, India
- Radiation Biology Department, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
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Fedrigo R, Coope R, Rahmim A, Bénard F, Uribe CF. Development of the quantitative PET prostate phantom (Q3P) for improved quality assurance of 18F-PSMA PET imaging in metastatic prostate cancer. Med Phys 2024; 51:4311-4323. [PMID: 38348927 DOI: 10.1002/mp.16977] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Phantoms are commonly used to evaluate and compare the performance of imaging systems given the known ground truth. Positron emission tomography (PET) scanners are routinely validated using the NEMA image quality phantom, in which lesions are modeled using 10 to 37 mm fillable spheres. The NEMA phantom neglects, however, to model focal (3-10-mm), high-uptake lesions that are increasingly observed in prostate-specific membrane antigen (PSMA) PET images. PSMA-targeting radiopharmaceuticals allow for enhanced detection of metastatic prostate cancers. As such, there is significant need to develop an updated phantom which considers both the quantitative and lesion detectability of this new paradigm in oncological PET imaging. PURPOSE In this work, we present the Quantitative PET Prostate Phantom (Q3P); a portable and modular phantom that can be used to improve and harmonize imaging protocols for 18F-PSMA PET scans. METHODS A one-piece cylindrical phantom was designed effectively in two halves, which we call modules. Module 1 was designed to mimic lesions in the presence of background, and Module 2 mimicked very high contrast conditions (i.e., very low background) that can be observed in 18F-PSMA PET scans. Shell-less radioactive spheres (3-16-mm) were cast using epoxy resin mixed with sodium-22 (22Na), a long half-life positron emitter with positron range similar to 18F. To establish realistic lesion contrast, the 22Na spheres were mounted in a cylindrical chamber that can be filled with an 18F background (module 1). Thirteen exchangeable spherical cavity inserts (3-37-mm) were machined in two parts and solvent welded together, and filled with 18F (50 kBq/mL) to model lesions with very high contrast (module 2). Five 2.5-min PET scans were acquired on a 5-ring GE Discovery MI PET/CT scanner (General Electric, USA). Lesions were segmented using 41% of SUVmax fixed thresholding (41% FT) and recovery coefficients (RCs) were computed from 5 noise realizations. RESULTS The manufactured phantom is portable (5.7 kg) and scan preparation takes less than 40 min. The total 22Na activity is 250 kBq, allowing it to be shipped as an exempt package under International Atomic Energy Agency (IAEA) regulations. Recovery coefficients, computed using PSF modeling and no post-reconstruction smoothing, were 130.3% (16 mm), 147.1% (10 mm), 87.2% (6 mm), and 7.0% (3 mm) for RCmax, which decreased to 91.1% (16 mm), 90.6% (10 mm), 53.2% (6 mm), and 3.6% (3 mm) for RCmean in the 22Na spheres. Comparatively, 18F sphere recovery was 110.7% (17 mm), 123.6% (10 mm), 106.5% (7 mm), and 23.3% (3 mm) for RCmax, which was reduced to 76.7% (17 mm), 77.7% (10 mm), 66.8% (7 mm), and 13.5% (3 mm), for RCmean. CONCLUSIONS A standardized imaging phantom was developed for lesion quantification assessment in 18F-PSMA PET images. The phantom is configurable, providing users with the opportunity to modify background activity levels or sphere sizes according to clinical demands. Distributed to the community, the Q3P phantom has the potential to enable better assessment of lesion quantification and harmonization of 18F-PSMA PET imaging, which may lead to more robust predictive metrics and better outcome prediction in metastatic prostate cancer.
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Affiliation(s)
- Roberto Fedrigo
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Department of Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robin Coope
- Canada's Michael Smith Genome Science Centre, BC Cancer, Vancouver, British Columbia, Canada
| | - Arman Rahmim
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Department of Physics & Astronomy, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Functional Imaging, BC Cancer, Vancouver, British Columbia, Canada
| | - François Bénard
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Functional Imaging, BC Cancer, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Carlos F Uribe
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Functional Imaging, BC Cancer, Vancouver, British Columbia, Canada
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Cumming J, Thompson K, Woodford K, Panettieri V, Sapkaroski D. The impact of a prophylactic skin dressing on surface-guided patient positioning in chest wall Radiation Therapy. J Med Radiat Sci 2024; 71:177-185. [PMID: 38525921 PMCID: PMC11177042 DOI: 10.1002/jmrs.781] [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: 07/02/2023] [Accepted: 03/01/2024] [Indexed: 03/26/2024] Open
Abstract
INTRODUCTION Surface-guided radiation therapy (SGRT) has emerged as a powerful tool to improve patient setup accuracy in radiation therapy (RT). Combined with the goal of increasing RT accuracy is an ongoing effort to decrease RT side effects. The application of a prophylactic skin dressing to the treatment site is a well-documented method of reducing skin-related side effects from RT. This paper aims to investigate whether the application of Mepitel, a prophylactic skin dressing, has an impact on the accuracy of surface-guided patient setups in chest wall RT. METHODS A retrospective analysis of daily image-guided Online Corrections (OLCs) from patients undergoing chest wall irradiation with SGRT was performed. Translational (superior-inferior, lateral, and anterior-posterior) OLC magnitude and direction were compared between patients treated with Mepitel applied and those treated without. Systematic and random errors were calculated and compared between groups. RESULTS OLCs from 275 fractions were analysed. Mean OLCs were larger for patients with Mepitel applied in the superior_inferior axis (0.34 vs. 0.22 cm, P = 0.049) and for the combined translational vector (0.54 vs. 0.43 cm, P = 0.043). Combined translational systematic error was slightly larger for patients with Mepitel applied (0.15 vs. 0.09 cm). CONCLUSION Mepitel can impact the accuracy of SGRT patient-positioning in chest wall RT. The variation however is small and unlikely to have any clinical impact if SGRT is coupled with image guidance and appropriate PTV margins. Further investigation is required to assess the effect of Mepitel on SGRT accuracy in other treatment sites, as well as any potential dosimetric impacts.
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MESH Headings
- Retrospective Studies
- Patient Positioning/methods
- Patient Positioning/statistics & numerical data
- Radiotherapy, Image-Guided/adverse effects
- Radiotherapy, Image-Guided/methods
- Radiotherapy, Image-Guided/statistics & numerical data
- Occlusive Dressings/adverse effects
- Occlusive Dressings/statistics & numerical data
- Silicones/adverse effects
- Radiodermatitis/etiology
- Radiodermatitis/prevention & control
- Thoracic Wall/diagnostic imaging
- Thoracic Wall/radiation effects
- Radiotherapy Planning, Computer-Assisted/methods
- Tomography, X-Ray Computed
- Skin/radiation effects
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Radiotherapy, Adjuvant/adverse effects
- Radiotherapy, Adjuvant/methods
- Mastectomy
- Humans
- Female
- Male
- Adult
- Middle Aged
- Aged
- Aged, 80 and over
- Breast Neoplasms, Male/radiotherapy
- Breast Neoplasms, Male/surgery
- Radiometry/statistics & numerical data
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Affiliation(s)
- James Cumming
- Department of Radiation Therapy ServicesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Kenton Thompson
- Department of Radiation Therapy ServicesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
| | - Katrina Woodford
- Department of Radiation Therapy ServicesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonVictoriaAustralia
| | - Vanessa Panettieri
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonVictoriaAustralia
- Department of Physical SciencesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Daniel Sapkaroski
- Department of Radiation Therapy ServicesPeter MacCallum Cancer CentreMelbourneVictoriaAustralia
- Department of Medical Imaging and Radiation SciencesMonash UniversityClaytonVictoriaAustralia
- Department of Health and Biomedical SciencesRoyal Melbourne Institute of TechnologyBundooraVictoriaAustralia
- The Sir Peter MacCallum Department of OncologyThe University of MelbourneMelbourneVictoriaAustralia
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Morani DO, Patil PO. Review on Multifunctional Nanotherapeutics for Drug Delivery, Tumor
Imaging, and Selective Tumor Targeting by Hyaluronic Acid Coupled
Graphene Quantum Dots. CURRENT NANOSCIENCE 2024; 20:89-108. [DOI: 10.2174/1573413719666230210122445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/11/2022] [Accepted: 11/23/2022] [Indexed: 01/06/2025]
Abstract
Abstract:
Cancer is one of the most widespread life-threatening diseases, and among different
types of cancers, breast cancer is the major disease affecting many women worldwide.
Background:
Conventional chemotherapy using anticancer drugs has many drawbacks, like
poor water solubility, poor bioavailability, rapid relapse, non-specific selectivity, effect on normal
tissues, and rapid drug resistance. Thus, over the last few years, immense efforts have been
made to fabricate nanotherapeutics that will release drugs in response to stimuli.
Objective:
Nanotherapeutics based on graphene quantum dots have been acknowledged with
much gratitude in the bioscience field and investigation applications because of their distinguishing
chemical and physical properties, such as medicine delivery, biosensors, and bioimaging for
the advancement invention of disease.
Conclusion:
This paper analyzes the potential applications of graphene quantum dots for the
modified and desired release of antitumor drugs. Also, it shows graphene quantum dots' capability
to functionalize in the companionship of hyaluronic acid that operates regarding cancer cell
directing matrix in bioimaging and multimodal therapy.
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Affiliation(s)
- Dilip O. Morani
- Department of Pharmaceutics , Shri D. D. Vispute College of Pharmacy & Research Center, Devad - Vichumbe,
Panvel, Navi Mumbai-410206, India
| | - Pravin O. Patil
- Department of Pharmaceutical Chemistry, H. R. Patel Institute of Pharmaceutical
Education and Research, Shirpur, Dist. Dhule. 425405, India
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Zhang M, Shao Y, Gu W. The Mechanism of Ubiquitination or Deubiquitination Modifications in Regulating Solid Tumor Radiosensitivity. Biomedicines 2023; 11:3240. [PMID: 38137461 PMCID: PMC10741492 DOI: 10.3390/biomedicines11123240] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/29/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
Radiotherapy, a treatment method employing radiation to eradicate tumor cells and subsequently reduce or eliminate tumor masses, is widely applied in the management of numerous patients with tumors. However, its therapeutic effectiveness is somewhat constrained by various drug-resistant factors. Recent studies have highlighted the ubiquitination/deubiquitination system, a reversible molecular modification pathway, for its dual role in influencing tumor behaviors. It can either promote or inhibit tumor progression, impacting tumor proliferation, migration, invasion, and associated therapeutic resistance. Consequently, delving into the potential mechanisms through which ubiquitination and deubiquitination systems modulate the response to radiotherapy in malignant tumors holds paramount significance in augmenting its efficacy. In this paper, we comprehensively examine the strides made in research and the pertinent mechanisms of ubiquitination and deubiquitination systems in governing radiotherapy resistance in tumors. This underscores the potential for developing diverse radiosensitizers targeting distinct mechanisms, with the aim of enhancing the effectiveness of radiotherapy.
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Affiliation(s)
| | - Yingjie Shao
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China;
| | - Wendong Gu
- Department of Radiation Oncology, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China;
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Kim BJ, Ahn HY, Song C, Ryu D, Goh TS, Lee JS, Lee C. A novel computer modeling and simulation technique for bronchi motion tracking in human lungs under respiration. Phys Eng Sci Med 2023; 46:1741-1753. [PMID: 37787839 DOI: 10.1007/s13246-023-01336-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/10/2023] [Indexed: 10/04/2023]
Abstract
In this work, we proposed a novel computer modeling and simulation technique for motion tracking of lung bronchi (or tumors) under respiration using 9 cases of computed tomography (CT)-based patient-specific finite element (FE) models and Ogden's hyperelastic model. In the fabrication of patient-specific FE models for the respiratory system, various organs such as the mediastinum, diaphragm, and thorax that could affect the lung motions during breathing were considered. To describe the nonlinear material behavior of lung parenchyma, the comparative simulation for biaxial tension-compression of lung parenchyma was carried out using several hyperelastic models in ABAQUS, and then, Ogden's model was adopted as an optimal model. Based on the aforementioned FE models and Ogden's material model, the 9 cases of respiration simulation were carried out from exhalation to inhalation, and the motion of lung bronchi (or tumors) was tracked. In addition, the changes in lung volume, lung cross-sectional area on the axial plane during breathing were calculated. Finally, the simulation results were quantitatively compared to the inhalation/exhalation CT images of 9 subjects to validate the proposed technique. Through the simulation, it was confirmed that the average relative errors of simulation to clinical data regarding to the displacement of 258 landmarks in the lung bronchi branches of total subjects were 1.10%~2.67%. In addition, the average relative errors of those with respect to the lung cross-sectional area changes and the volume changes in the superior-inferior direction were 0.20%~5.00% and 1.29 ~ 9.23%, respectively. Hence, it was considered that the simulation results were coincided well with the clinical data. The novelty of the present study is as follows: (1) The framework from fabrication of the human respiratory system to validation of the bronchi motion tracking is provided step by step. (2) The comparative simulation study for nonlinear material behavior of lung parenchyma was carried out to describe the realistic lung motion. (3) Various organs surrounding the lung parenchyma and restricting its motion were considered in respiration simulation. (4) The simulation results such as landmark displacement, lung cross-sectional area/volume changes were quantitatively compared to the clinical data of 9 subjects.
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Affiliation(s)
- Byeong-Jun Kim
- Department of Biomedical Engineering, Graduate School, and University Research Park, Pusan National University, Busan, 49241, Republic of Korea
| | - Hyo Yeong Ahn
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Biomedical Research Institute, Pusan National University, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Chanhee Song
- Medical Research Institute, Pusan National University, Busan, 49241, Republic of Korea
| | - Dongman Ryu
- Medical Research Institute, Pusan National University, Busan, 49241, Republic of Korea
| | - Tae Sik Goh
- Department of Orthopaedic Surgery, School of Medicine, Biomedical Research Institute, Pusan National University, Pusan National University Hospital, Busan, 49241, Republic of Korea
| | - Jung Sub Lee
- Department of Orthopaedic Surgery, School of Medicine, Biomedical Research Institute, Pusan National University, Pusan National University Hospital, Busan, 49241, Republic of Korea.
| | - Chiseung Lee
- Department of Biomedical Engineering, School of Medicine, Pusan National University, Busan, Republic of Korea.
- Biomedical Research Institute, Pusan National University Hospital, Busan, 49241, Republic of Korea.
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10
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Gan G, Gong W, Jia L, Zhang W, Wang S, Zhou J, Jiang H. Study of peripheral dose from low-dose CT to adaptive radiotherapy of postoperative prostate cancer. Front Oncol 2023; 13:1227946. [PMID: 38023166 PMCID: PMC10646313 DOI: 10.3389/fonc.2023.1227946] [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: 05/24/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objectives The increasing use of computed tomography (CT) for adaptive radiotherapy (ART) has raised concerns about the peripheral radiation dose. This study investigates the feasibility of low-dose CT (LDCT) for postoperative prostate cancer ART to reduce the peripheral radiation dose, and evaluates the peripheral radiation dose of different imaging techniques and propose an image enhancement method based on deep learning for LDCT. Materials and methods A linear accelerator integrated with a 16-slice fan-beam CT from UIH (United Imaging Healthcare, China) was utilized for prostate cancer ART. To reduce the tube current of CT for ART, LDCT was acquired. Peripheral doses of normal-dose CT (NDCT), LDCT, and mega-voltage computed tomography (MV-CT) were measured using a cylindrical Virtual Water™ phantom and an ion chamber. A deep learning model of LDCT for abdominal and pelvic-based cycle-consistent generative adversarial network was employed to enhance the image quality of LDCT. Six postoperative prostate cancer patients were selected to evaluate the feasibility of low-dose CT network restoration images (RCT) by the deep learning model for ART. The three aspects among NDCT, LDCT, and RCT were compared: the Hounsfield Unit (HU) of the tissue, the Dice Similarity Coefficient (DSC) criterion of target and organ, and dose calculation differences. Results In terms of peripheral dose, the LDCT had a surface measurement point dose of approximately 1.85 mGy at the scanning field, while the doses of NDCT and MV-CT were higher at 22.85 mGy and 29.97 mGy, respectively. However, the image quality of LDCT was worse than NDCT. When compared to LDCT, the tissue HU value of RCT showed a significant improvement and was closer to that of NDCT. The DSC results for target CTV between RCT and NDCT were also impressive, reaching up to 94% for bladder and femoral heads, 98% for rectum, and 94% for the target organ. Additionally, the dose calculation differences for the ART plan based on LDCT and NDCT were all within 1%. Overall, these findings suggest that RCT can provide an effective alternative to NDCT and MV-CT with similar or better outcomes in HU values of tissue and organ damage. More testing is required before clinical application.
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Affiliation(s)
- Guanghui Gan
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wei Gong
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Lecheng Jia
- Real-time Lab, Shenzhen United Imaging Research Institute of Innovative Medical Equipment, Shenzhen, China
- Zhejiang Engineering Research Center for Innovation and Application of Intelligent Radiotherapy Technology, Wenzhou, China
| | - Wei Zhang
- Radiotherapy Business Unit, Shanghai United Imaging Healthcare Co., Ltd., Shanghai, China
| | - Shimei Wang
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Juying Zhou
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hua Jiang
- Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, China
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11
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Harris TC, Jacobson M, Myronakis M, Lehmann M, Huber P, Morf D, Ozoemelam I, Hu YH, Ferguson D, Fueglistaller R, Corral Arroyo P, Berbeco RI. Impact of a novel multilayer imager on metal artifacts in MV-CBCT. Phys Med Biol 2023; 68:10.1088/1361-6560/ace09a. [PMID: 37343590 PMCID: PMC10382207 DOI: 10.1088/1361-6560/ace09a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 06/21/2023] [Indexed: 06/23/2023]
Abstract
Objective. Megavoltage cone-beam computed tomography (MV-CBCT) imaging offers several advantages including reduced metal artifacts and accurate electron density mapping for adaptive or emergent situations. However, MV-CBCT imaging is limited by the poor efficiency of current detectors. Here we examine a new MV imager and compare CBCT reconstructions under clinically relevant scenarios.Approach. A multilayer imager (MLI), consisting of four vertically stacked standard flat-panel imagers, was mounted to a clinical linear accelerator. A custom anthropomorphic pelvis phantom with replaceable femoral heads was imaged using MV-CBCT and kilovoltage CBCT (kV-CBCT). Bone, aluminum, and titanium were used as femoral head inserts. 8 MU 2.5 MV scans were acquired for all four layers and (as reference) the top layer. Prostate and bladder were contoured on a reference CT and transferred to the other scans after rigid registration, from which the structural similarity index measure (SSIM) was calculated. Prostate and bladder were also contoured on CBCT scans without guidance, and Dice coefficients were compared to CT contours.Main results. kV-CBCT demonstrated the highest SSIMs with bone inserts (prostate: 0.86, bladder: 0.94) and lowest with titanium inserts (0.32, 0.37). Four-layer MV-CBCT SSIMs were preserved with bone (0.75, 0.80) as compared to titanium (0.67, 0.74), outperforming kV-CBCT when metal is present. One-layer MV-CBCT consistently underperformed four-layer results across all phantom configurations. Unilateral titanium inserts and bilateral aluminum insert results fell between the bone and bilateral titanium results. Dice coefficients trended similarly, with four-layer MV-CBCT reducing metal artifact impact relative to KV-CBCT to provide better soft-tissue identification.Significance. MV-CBCT with a four-layer MLI showed improvement over single-layer MV scans, approaching kV-CBCT quality for soft-tissue contrast. In the presence of artifact-producing metal implants, four-layer MV-CBCT scans outperformed kV-CBCT by eliminating artifacts and single-layer MV-CBCT by reducing noise. MV-CBCT with a novel multi-layer imager may be a valuable alternative to kV-CBCT, particularly in the presence of metal.
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Affiliation(s)
- T C Harris
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, United States of America
| | - M Jacobson
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, United States of America
| | - M Myronakis
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, United States of America
| | - M Lehmann
- Varian Medical Systems, Baden-Dattwil, Switzerland
| | - P Huber
- Varian Medical Systems, Baden-Dattwil, Switzerland
| | - D Morf
- Varian Medical Systems, Baden-Dattwil, Switzerland
| | - I Ozoemelam
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, United States of America
| | - Y H Hu
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, United States of America
| | - D Ferguson
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, United States of America
| | | | | | - R I Berbeco
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, United States of America
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12
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Roeder F, Jensen AD, Lindel K, Mattke M, Wolf F, Gerum S. Geriatric Radiation Oncology: What We Know and What Can We Do Better? Clin Interv Aging 2023; 18:689-711. [PMID: 37168037 PMCID: PMC10166100 DOI: 10.2147/cia.s365495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/22/2023] [Indexed: 05/13/2023] Open
Abstract
Elderly patients represent a growing subgroup of cancer patients for whom the role of radiation therapy is poorly defined. Older patients are still clearly underrepresented in clinical trials, resulting in very limited high-level evidence. Moreover, elderly patients are less likely to receive radiation therapy in similar clinical scenarios compared to younger patients. However, there is no clear evidence for a generally reduced radiation tolerance with increasing age. Modern radiation techniques have clearly reduced acute and late side effects, thus extending the boundaries of the possible regarding treatment intensity in elderly or frail patients. Hypofractionated regimens have further decreased the socioeconomic burden of radiation treatments by reducing the overall treatment time. The current review aims at summarizing the existing data for the use of radiation therapy or chemoradiation in elderly patients focusing on the main cancer types. It provides an overview of treatment tolerability and outcomes with current standard radiation therapy regimens, including possible predictive factors in the elderly population. Strategies for patient selection for standard or tailored radiation therapy approaches based on age, performance score or comorbidity, including the use of prediction tests or geriatric assessments, are discussed. Current and future possibilities for improvements of routine care and creation of high-level evidence in elderly patients receiving radiation therapy are highlighted.
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Affiliation(s)
- Falk Roeder
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Alexandra D Jensen
- Department of Radiation Oncology, University Hospital Marburg-Giessen, Giessen, Germany
| | - Katja Lindel
- Department of Radiation Oncology, Städtisches Klinikum, Karlsruhe, Germany
| | - Matthias Mattke
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Frank Wolf
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
| | - Sabine Gerum
- Department of Radiation Therapy and Radiation Oncology, Paracelsus Medical University Hospital, Salzburg, Austria
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13
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Doses delivered to small and large breasts and adjacent organs in left breast cancer patients utilizing 3D and IM radiotherapy. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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14
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Qin P, Lin G, Li X, Piao Z, Huang S, Wu W, Qi M, Ma J, Zhou L, Xu Y. A correlated sampling-based Monte Carlo simulation for fast CBCT iterative scatter correction. Med Phys 2023; 50:1466-1480. [PMID: 36323626 DOI: 10.1002/mp.16073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/03/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND In recent years, cone-beam computed tomography (CBCT) has played an important role in medical imaging. However, the applications of CBCT are limited due to the severe scatter contamination. Conventional Monte Carlo (MC) simulation can provide accurate scatter estimation for scatter correction, but the expensive computational cost has always been the bottleneck of MC method in clinical application. PURPOSE In this work, an MC simulation method combined with a variance reduction technique called correlated sampling is proposed for fast iterative scatter correction. METHODS Correlated sampling exploits correlation between similar simulation systems to reduce the variance of interest quantities. Specifically, conventional MC simulation is first performed on the scatter-contaminated CBCT to generate the initial scatter signal. In the subsequent correction iterations, scatter estimation is then updated by applying correlated MC sampling to the latest corrected CBCT images by reusing the random number sequences of the task-related photons in conventional MC. Afterward, the corrected projections obtained by subtracting the scatter estimation from raw projections are utilized for FDK reconstruction. These steps are repeated until an adequate scatter correction is obtained. The performance of the proposed framework is evaluated by the accuracy of the scatter estimation, the quality of corrected CBCT images and efficiency. RESULTS Overall, the difference in mean absolute percentage error between scatter estimation with and without correlated sampling is 0.25% for full-fan case and 0.34% for half-fan case, respectively. In simulation studies, scatter artifacts are substantially eliminated, where the mean absolute error value is reduced from 15 to 2 HU in full-fan case and from 53 to 13 HU in half-fan case. Scatter-to-primary ratio is reduced to 0.02 for full-fan and 0.04 for half-fan, respectively. In phantom study, the contrast-to-noise ratio (CNR) is increased by a factor of 1.63, and the contrast is increased by a factor of 1.77. As for clinical studies, the CNR is improved by 11% and 14% for half-fan and full-fan, respectively. The contrast after correction is increased by 19% for half-fan and 44% for full-fan. Furthermore, root mean square error is also effectively reduced, especially from 78 to 4 HU for full-fan. Experimental results demonstrate that the figure of merit is improved between 23 and 43 folds when using correlated sampling. The proposed method takes less than 25 s for the whole iterative scatter correction process. CONCLUSIONS The proposed correlated sampling-based MC simulation method can achieve fast and accurate scatter correction for CBCT, making it suitable for real-time clinical use.
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Affiliation(s)
- Peishan Qin
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Guoqin Lin
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Xu Li
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Zun Piao
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Shuang Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - WangJiang Wu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Mengke Qi
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianhui Ma
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Linghong Zhou
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
| | - Yuan Xu
- School of Biomedical Engineering, Southern Medical University, Guangzhou, Guangdong, China
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15
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Taşcı B. Attention Deep Feature Extraction from Brain MRIs in Explainable Mode: DGXAINet. Diagnostics (Basel) 2023; 13:859. [PMID: 36900004 PMCID: PMC10000758 DOI: 10.3390/diagnostics13050859] [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: 01/24/2023] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023] Open
Abstract
Artificial intelligence models do not provide information about exactly how the predictions are reached. This lack of transparency is a major drawback. Particularly in medical applications, interest in explainable artificial intelligence (XAI), which helps to develop methods of visualizing, explaining, and analyzing deep learning models, has increased recently. With explainable artificial intelligence, it is possible to understand whether the solutions offered by deep learning techniques are safe. This paper aims to diagnose a fatal disease such as a brain tumor faster and more accurately using XAI methods. In this study, we preferred datasets that are widely used in the literature, such as the four-class kaggle brain tumor dataset (Dataset I) and the three-class figshare brain tumor dataset (Dataset II). To extract features, a pre-trained deep learning model is chosen. DenseNet201 is used as the feature extractor in this case. The proposed automated brain tumor detection model includes five stages. First, training of brain MR images with DenseNet201, the tumor area was segmented with GradCAM. The features were extracted from DenseNet201 trained using the exemplar method. Extracted features were selected with iterative neighborhood component (INCA) feature selector. Finally, the selected features were classified using support vector machine (SVM) with 10-fold cross-validation. An accuracy of 98.65% and 99.97%, were obtained for Datasets I and II, respectively. The proposed model obtained higher performance than the state-of-the-art methods and can be used to aid radiologists in their diagnosis.
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Affiliation(s)
- Burak Taşcı
- Vocational School of Technical Sciences, Firat University, Elazig 23119, Turkey
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16
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Yuan JH, Li QS, Shen Y. Visual analysis of image-guided radiation therapy based on bibliometrics: A review. Medicine (Baltimore) 2023; 102:e32989. [PMID: 36827068 PMCID: PMC11309653 DOI: 10.1097/md.0000000000032989] [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: 01/11/2023] [Accepted: 01/25/2023] [Indexed: 02/25/2023] Open
Abstract
Radiation therapy plays an important role in tumor treatment. The development of image-guided radiation therapy (IGRT) technology provides a strong guarantee for precise radiation therapy of tumors. However, bibliometric studies on IGRT research have rarely been reported. This study uses literature collected from the Web of Science during 1987 to 2021 as a sample and uses the bibliometric method to reveal the current research status, hotspots, and development trends in IGRT. Based on 6407 papers published from the Web of Science during 1987 to 2021, we utilized Microsoft Excel 2007 and cite space software to perform statistical analysis and visualization of IGRT. A total of 6407 articles were included, this area of IGRT has gone through 4 stages: budding period, growth period, outbreak period, and stationary period. The research category is mainly distributed in Radiology Nuclear Medicine Medical Imaging, which intersects with the research categories of Materials, Physics, and Mathematics. Yin FF, Tanderup K, and Sonke JJ are highly productive scholars who are active in IGRT research, while Jaffray DA, van Herk M and Guckenberger M are authors with high impact in this field. The team of scholars has close cooperation within the team and weak cooperation among teams. The League of European Research Universities, University of Texas System, University of Toronto, and Princess Margaret Cancer are the main research institutions in this field. The United States has the most research literature, followed by China and Germany. Six thousand four hundred seven articles are distributed in 712 journals, and the top 3 journals are Med Phys, Int J Radiat Oncol, and Radiather Oncol. Precise registration, intelligence, magnetic resonance guidance, and deep learning are current research hotspots. These results demonstrate that the research in this field is relatively mature and fruitful in the past 35 years, providing a solid theoretical basis and practical experience for precision radiotherapy.
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Affiliation(s)
- Jin-Hui Yuan
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing-Song Li
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan Shen
- Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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17
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Ng J, Gregucci F, Pennell RT, Nagar H, Golden EB, Knisely JPS, Sanfilippo NJ, Formenti SC. MRI-LINAC: A transformative technology in radiation oncology. Front Oncol 2023; 13:1117874. [PMID: 36776309 PMCID: PMC9911688 DOI: 10.3389/fonc.2023.1117874] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
Advances in radiotherapy technologies have enabled more precise target guidance, improved treatment verification, and greater control and versatility in radiation delivery. Amongst the recent novel technologies, Magnetic Resonance Imaging (MRI) guided radiotherapy (MRgRT) may hold the greatest potential to improve the therapeutic gains of image-guided delivery of radiation dose. The ability of the MRI linear accelerator (LINAC) to image tumors and organs with on-table MRI, to manage organ motion and dose delivery in real-time, and to adapt the radiotherapy plan on the day of treatment while the patient is on the table are major advances relative to current conventional radiation treatments. These advanced techniques demand efficient coordination and communication between members of the treatment team. MRgRT could fundamentally transform the radiotherapy delivery process within radiation oncology centers through the reorganization of the patient and treatment team workflow process. However, the MRgRT technology currently is limited by accessibility due to the cost of capital investment and the time and personnel allocation needed for each fractional treatment and the unclear clinical benefit compared to conventional radiotherapy platforms. As the technology evolves and becomes more widely available, we present the case that MRgRT has the potential to become a widely utilized treatment platform and transform the radiation oncology treatment process just as earlier disruptive radiation therapy technologies have done.
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Affiliation(s)
- John Ng
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States,*Correspondence: John Ng,
| | - Fabiana Gregucci
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States,Department of Radiation Oncology, Miulli General Regional Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Ryan T. Pennell
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
| | - Himanshu Nagar
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
| | - Encouse B. Golden
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
| | | | | | - Silvia C. Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, United States
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18
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Wong YM, Koh CWY, Lew KS, Chua CGA, Nei W, Tan HQ, Lee JCL, Mazonakis M, Damilakis J. A review on fetal dose in Radiotherapy: A historical to contemporary perspective. Phys Med 2023; 105:102513. [PMID: 36565555 DOI: 10.1016/j.ejmp.2022.102513] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/09/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
This paper aims to review on fetal dose in radiotherapy and extends and updates on a previous work1 to include proton therapy. Out-of-field doses, which are the doses received by regions outside of the treatment field, are unavoidable regardless of the treatment modalities used during radiotherapy. In the case of pregnant patients, fetal dose is a major concern as it has long been recognized that fetuses exposed to radiation have a higher probability of suffering from adverse effects such as anatomical malformations and even fetal death, especially when the 0.1Gy threshold is exceeded. In spite of the low occurrence of cancer during pregnancy, the radiotherapy team should be equipped with the necessary knowledge to deal with fetal dose. This is crucial so as to ensure that the fetus is adequately protected while not compromising the patient treatment outcomes. In this review paper, various aspects of fetal dose will be discussed ranging from biological, clinical to the physics aspects. Other than fetal dose resulting from conventional photon therapy, this paper will also extend the discussion to modern treatment modalities and techniques, namely proton therapy and image-guided radiotherapy, all of which have seen a significant increase in use in current radiotherapy. This review is expected to provide readers with a comprehensive understanding of fetal dose in radiotherapy, and to be fully aware of the steps to be taken in providing radiotherapy for pregnant patients.
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Affiliation(s)
- Yun Ming Wong
- Division of Physics and Applied Physics, Nanyang Technological University, Singapore
| | | | - Kah Seng Lew
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | | | - Wenlong Nei
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Hong Qi Tan
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore.
| | - James Cheow Lei Lee
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore; Division of Physics and Applied Physics, Nanyang Technological University, Singapore
| | - Michael Mazonakis
- Department of Medical Physics, School of Medicine, University of Crete, Greece
| | - John Damilakis
- Department of Medical Physics, School of Medicine, University of Crete, Greece
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Wheatley M, De Deene Y. A novel anthropomorphic breathing phantom with a pneumatic MR-safe actuator for tissue deformation studies during MRI and radiotherapy. Phys Med 2022; 104:43-55. [PMID: 36368090 DOI: 10.1016/j.ejmp.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/01/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022] Open
Abstract
A novel MR-safe anthropomorphic torso phantom with an MR-conditional pneumatic respiration system and inflatable lungs for tissue deformation studies is proposed. The phantom consists of a pair of lungs made from sponges encased in flexible polyurethane. The lung phantom also contains a set of silicone tubes of various diameters to mimic the larger vasculature and airways of the lungs. The lungs are surrounded by a plastic ribcage and immersed in a gelatine hydrogel within a flexible polyurethane skin. A plastic pneumatic pump system was constructed to inflate and deflate the lungs. A fibre optic rotary encoder was constructed to determine the volume of displaced air in the lungs. The pneumatic pump and rotary encoder were constructed of plastic materials to allow placement within the bore of the MR scanner with minimal interaction with the magnetic field. Breath-gated scans and rapid imaging scans (2.5 s per image) were taken of the phantom in the stationary state and during inflation/deflation, and with Cartesian and BLADE k-space sampling. It was found that BLADE shows the least motion artifacts during breathing. This phantom and respiration system shows potential for quality assurance of MRI incorporating breathing corrections and for radiotherapy applications in tracking a moving target.
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Affiliation(s)
- Morgan Wheatley
- Faculty of Science and Engineering, Macquarie University, Sydney, Australia.
| | - Yves De Deene
- Faculty of Science and Engineering, Macquarie University, Sydney, Australia; Faculty of Science, Western Sydney University, Sydney, Australia
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Morris L, O'Donovan A, Hashmi A, Agar M. Older adults and the unique role of the radiation therapist: Future directions for improving geriatric oncology training and education. Tech Innov Patient Support Radiat Oncol 2022; 23:21-26. [PMID: 36059564 PMCID: PMC9434163 DOI: 10.1016/j.tipsro.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Abstract
This article reviews the status quo of the available evidence and guidance for geriatric oncology clinical practice, training and education for radiation therapists worldwide. We explore the unique clinical role that radiation therapists play in the management of older adults undergoing radiation therapy. We define multiple clinical care points in which the radiation therapists role could potentially expand or specialise into geriatric screening, assessment and intervention to optimise the care of older adults. Current GO educational offerings and future directions to improve RTT knowledge and skills around caring for older adults are outlined. There is widespread recognition that the provision of high quality, appropriate and equitable care to older adults with cancer is a growing challenge in oncology practice. Radiation therapy (RT) is an effective and localised treatment that represents an attractive curative or palliative option for many older adults, and radiation therapists (RTT) play an important role in the delivery, support and quality of care for people during RT. The need to develop an evidence-based, global approach to improving all radiation oncology (RO) professionals’ knowledge and clinical practice in geriatric oncology (GO) has been previously identified. This article specifically focusses on the status quo of GO clinical practice and education for RTT worldwide. We explore the unique clinical role that RTT play in the management of older adults with cancer and define multiple clinical care points in which RTT could potentially participate in geriatric screening, geriatric assessment and intervention to optimise the care of older adults, with a focus on dementia. Directions for future efforts to improve the knowledge and clinical skills of RTT in caring for older adults are discussed.
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Affiliation(s)
- Lucinda Morris
- University of Technology Sydney (UTS), Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, Australia
- St George Cancer Care Centre, St George Hospital, Sydney, NSW, Australia
- Corresponding author at: University of Technology Sydney (UTS), Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, Australia.
| | - Anita O'Donovan
- Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James’s Cancer Institute, Trinity College, Dublin, Ireland
| | - Amira Hashmi
- Radiotherapy Department, The Christie NHS Foundation Trust, Manchester, UK
| | - Meera Agar
- University of Technology Sydney (UTS), Faculty of Health, Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Ultimo, NSW, Australia
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21
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Han P, Chen J, Xiao J, Han F, Hu Z, Yang W, Cao M, Ling DC, Li D, Christodoulou AG, Fan Z. Single projection driven real-time multi-contrast (SPIDERM) MR imaging using pre-learned spatial subspace and linear transformation. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac783e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/13/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Objective. To develop and test the feasibility of a novel Single ProjectIon DrivEn Real-time Multi-contrast (SPIDERM) MR imaging technique that can generate real-time 3D images on-the-fly with flexible contrast weightings and a low latency. Approach. In SPIDERM, a ‘prep’ scan is first performed, with sparse k-space sampling periodically interleaved with the central k-space line (navigator data), to learn a subject-specific model, incorporating a spatial subspace and a linear transformation between navigator data and subspace coordinates. A ‘live’ scan is then performed by repeatedly acquiring the central k-space line only to dynamically determine subspace coordinates. With the ‘prep’-learned subspace and ‘live’ coordinates, real-time 3D images are generated on-the-fly with computationally efficient matrix multiplication. When implemented based on a multi-contrast pulse sequence, SPIDERM further allows for data-driven image contrast regeneration to convert real-time contrast-varying images into contrast-frozen images at user’s discretion while maintaining motion states. Both digital phantom and in-vivo experiments were performed to evaluate the technical feasibility of SPIDERM. Main results. The elapsed time from the input of the central k-space line to the generation of real-time contrast-frozen 3D images was approximately 45 ms, permitting a latency of 55 ms or less. Motion displacement measured from SPIDERM and reference images showed excellent correlation (
R
2
≥
0.983
). Geometric variation from the ground truth in the digital phantom was acceptable as demonstrated by pancreas contour analysis (Dice ≥ 0.84, mean surface distance ≤ 0.95 mm). Quantitative image quality metrics showed good consistency between reference images and contrast-varying SPIDREM images in in-vivo studies (mean
NMRSE
=
0.141
,
PSNR
=
3
0.12
,
SSIM
=
0.88
). Significance. SPIDERM is capable of generating real-time multi-contrast 3D images with a low latency. An imaging framework based on SPIDERM has the potential to serve as a standalone package for MR-guided radiation therapy by offering adaptive simulation through a ‘prep’ scan and real-time image guidance through a ‘live’ scan.
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22
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The role of medical physicists in clinical trials across Europe. Phys Med 2022; 100:31-38. [PMID: 35717777 DOI: 10.1016/j.ejmp.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 06/11/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The roles and responsibilities of medical physicists (MPs) are growing together with the evolving science and technology. The complexity of today's clinical trials requires the skills and knowledge of MPs for their safe and efficient implementation. However, it is unclear to what extent the skillsets offered by MPs are being exploited in clinical trials across Europe. METHODS The EFOMP Working Group on the role of Medical Physics Experts in Clinical Trials has designed a survey that targeted all 36 current National Member Organisations, receiving a response from 31 countries. The survey included both quantitative and qualitative queries regarding the involvement of MPs in trial design, setup, and coordination, either as trial team members or principal investigators. RESULTS The extent of MPs involvement in clinical trials greatly varies across European countries. The results showed disparities between the roles played by MPs in trial design, conduct or data processing. Similarly, differences among the 31 European countries that responded to the survey were found regarding the existence of national bodies responsible for trials or the available training offered to MPs. The role of principal investigator or co-investigator was reported by 12 countries (39%), a sign of efficient collaboration with medical doctors in designing and implementing clinical studies. CONCLUSION Organisation of specific training courses and guideline development for clinical trial design and conduct would encourage the involvement of a larger number of MPs in all stages of trials across Europe, leading to a better standardisation of clinical practice.
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23
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Cao X, Lai SWT, Chen S, Wang S, Feng M. Targeting tumor-associated macrophages for cancer immunotherapy. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2022; 368:61-108. [PMID: 35636930 DOI: 10.1016/bs.ircmb.2022.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Tumor-associated macrophages (TAMs) are one of the most abundant immune components in the tumor microenvironment and play a plethora of roles in regulating tumorigenesis. Therefore, the therapeutic targeting of TAMs has emerged as a new paradigm for immunotherapy of cancer. Herein, the review summarizes the origin, polarization, and function of TAMs in the progression of malignant diseases. The understanding of such knowledge leads to several distinct therapeutic strategies to manipulate TAMs to battle cancer, which include those to reduce TAM abundance, such as depleting TAMs or inhibiting their recruitment and differentiation, and those to harness or boost the anti-tumor activities of TAMs such as blocking phagocytosis checkpoints, inducing antibody-dependent cellular phagocytosis, and reprogramming TAM polarization. In addition, modulation of TAMs may reshape the tumor microenvironment and therefore synergize with other cancer therapeutics. Therefore, the rational combination of TAM-targeting therapeutics with conventional therapies including radiotherapy, chemotherapy, and other immunotherapies is also reviewed. Overall, targeting TAMs presents itself as a promising strategy to add to the growing repertoire of treatment approaches in the fight against cancer, and it is hopeful that these approaches currently being pioneered will serve to vastly improve patient outcomes and quality of life.
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Affiliation(s)
- Xu Cao
- Department of Immuno-Oncology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, United States.
| | - Seigmund W T Lai
- Department of Immuno-Oncology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Siqi Chen
- Department of Immuno-Oncology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Sadira Wang
- Department of Immuno-Oncology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, United States
| | - Mingye Feng
- Department of Immuno-Oncology, Beckman Research Institute, City of Hope Comprehensive Cancer Center, Duarte, CA, United States.
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24
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El Naqa I, Pogue BW, Zhang R, Oraiqat I, Parodi K. Image guidance for FLASH radiotherapy. Med Phys 2022; 49:4109-4122. [PMID: 35396707 PMCID: PMC9844128 DOI: 10.1002/mp.15662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/10/2022] [Accepted: 03/30/2022] [Indexed: 01/19/2023] Open
Abstract
FLASH radiotherapy (FLASH-RT) is an emerging ultra-high dose (>40 Gy/s) delivery that promises to improve the therapeutic potential by limiting toxicities compared to conventional RT while maintaining similar tumor eradication efficacy. Image guidance is an essential component of modern RT that should be harnessed to meet the special emerging needs of FLASH-RT and its associated high risks in planning and delivering of such ultra-high doses in short period of times. Hence, this contribution will elaborate on the imaging requirements and possible solutions in the entire chain of FLASH-RT treatment, from the planning, through the setup and delivery with online in vivo imaging and dosimetry, up to the assessment of biological mechanisms and treatment response. In patient setup and delivery, higher temporal sampling than in conventional RT should ensure that the short treatment is delivered precisely to the targeted region. Additionally, conventional imaging tools such as cone-beam computed tomography will continue to play an important role in improving patient setup prior to delivery, while techniques based on magnetic resonance imaging or positron emission tomography may be extremely valuable for either linear accelerator (Linac) or particle FLASH therapy, to monitor and track anatomical changes during delivery. In either planning or assessing outcomes, quantitative functional imaging could supplement conventional imaging for more accurate utilization of the biological window of the FLASH effect, selecting for or verifying things such as tissue oxygen and existing or transient hypoxia on the relevant timescales of FLASH-RT delivery. Perhaps most importantly at this time, these tools might help improve the understanding of the biological mechanisms of FLASH-RT response in tumor and normal tissues. The high dose deposition of FLASH provides an opportunity to utilize pulse-to-pulse imaging tools such as Cherenkov or radiation acoustic emission imaging. These could provide individual pulse mapping or assessing the 3D dose delivery superficially or at tissue depth, respectively. In summary, the most promising components of modern RT should be used for safer application of FLASH-RT, and new promising developments could be advanced to cope with its novel demands but also exploit new opportunities in connection with the unique nature of pulsed delivery at unprecedented dose rates, opening a new era of biological image guidance and ultrafast, pulse-based in vivo dosimetry.
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Affiliation(s)
- Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Brian W. Pogue
- Thayer School of Engineering, Dartmouth College, Hanover, NH 03755, USA
- Department of Medical Physics, University of Wisconsin-Madison, WI 53705, USA
| | - Rongxiao Zhang
- Giesel School of Medicine, Dartmouth College, Hanover, NH 03755, USA
| | - Ibrahim Oraiqat
- Department of Machine Learning, Moffitt Cancer Center, Tampa, FL 33612, USA
| | - Katia Parodi
- Department of Medical Physics, Ludwig-Maximilians-Universität München, Am Coulombwall 1, Garching 85748, Germany
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25
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Eliminating tattoos for short course palliative radiation therapy: Set-up error, satisfaction and cost. J Med Imaging Radiat Sci 2022; 53:S56-S62. [PMID: 35523652 DOI: 10.1016/j.jmir.2022.04.004] [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: 11/05/2021] [Revised: 01/10/2022] [Accepted: 04/05/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Palliative patients are living longer thanks to advancements in systemic therapies and radiotherapy technologies. Prior to image guided radiotherapy, permanent ink tattoos were used to ensure set up accuracy. Permanent marks can cause psychological damage, physical pain and can reduce a patient's quality of life. In recent years, image guided radiation therapy (IGRT) has become standard practice and may eliminate the need for permanent tattoos in this patient population. METHODS Twenty-five patients were consecutively chosen from the Palliative Radiation Oncology Program (PROP). Each received 5 fractions of radiotherapy commencing within 72 hours of CT simulation. In place of permanent tattoos, patients were marked with permanent marker and an adherent transparent film dressing (Tegaderm TM ) was placed over the mark. Patients were educated on maintaining the marks and dressing. Daily cone beam CT (CBCT) isocentre mismatch values were compared with 25 patients who received tattoos for radiotherapy to similar body regions. Radiation therapist concerns, cost, variations in isocentre shift values and additional imaging requirements were obtained. RESULTS Isocentre shift values were similar (p<0.05) for Tegaderm TM vs. tattoo patients in the anterior-posterior (AP) and right-left (RL) directions. The mean shift value in the superior-inferior (SI) direction was larger for Tegaderm TM than for tattoos (p=0.01), however the magnitude was only 2 mm, which is clinically insignificant as these shifts were prior to IGRT guided correction. No patient required a repeat CBCT or a resimulation. The cost of the Tegaderm TM dressing was substantially less than the tattoo group. Radiation Therapists' satifaction with Tegaderm TM was overall high, however some expressed concerns with their durability and longevity. CONCLUSIONS We found that the use of Tegaderm TM dressing did not result in increased set-up time, mismatch error or additional imaging procedures (CBCT or CTsimulation) and moreover cost substantially less than permanent ink tattoos.
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26
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Amini A, Morris L, Ludmir EB, Movsas B, Jagsi R, VanderWalde NA. Radiation Therapy in Older Adults With Cancer: A Critical Modality in Geriatric Oncology. J Clin Oncol 2022; 40:1806-1811. [PMID: 35417248 DOI: 10.1200/jco.21.02656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Radiation therapy (RT) is a commonly used modality in the treatment of older adults with cancer, and RT represents an attractive oncologic treatment option, providing a noninvasive local therapy with limited systemic side effects. The Journal of Clinical Oncology (JCO) recently published a special series on Geriatric Oncology providing a comprehensive overview of multiple treatment modalities available to older adults with cancer. The purpose of this short review is to highlight the importance of RT in the treatment of older adults and encourage multidisciplinary participation in their care.
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Affiliation(s)
- Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - Lucinda Morris
- Department of Radiation Oncology, St George Cancer Care Centre, Kogarah, New South Wales, Australia
| | - Ethan B Ludmir
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Noam A VanderWalde
- Department of Radiation Oncology, West Cancer Center and Research Institute, Memphis, TN
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27
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Improving the Education of Radiation Oncology Professionals in Geriatric Oncology: Where Are We and Where Should We Be? Semin Radiat Oncol 2022; 32:109-114. [DOI: 10.1016/j.semradonc.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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28
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Tang EM, El-Haddad MT, Patel SN, Tao YK. Automated instrument-tracking for 4D video-rate imaging of ophthalmic surgical maneuvers. BIOMEDICAL OPTICS EXPRESS 2022; 13:1471-1484. [PMID: 35414968 PMCID: PMC8973184 DOI: 10.1364/boe.450814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 05/11/2023]
Abstract
Intraoperative image-guidance provides enhanced feedback that facilitates surgical decision-making in a wide variety of medical fields and is especially useful when haptic feedback is limited. In these cases, automated instrument-tracking and localization are essential to guide surgical maneuvers and prevent damage to underlying tissue. However, instrument-tracking is challenging and often confounded by variations in the surgical environment, resulting in a trade-off between accuracy and speed. Ophthalmic microsurgery presents additional challenges due to the nonrigid relationship between instrument motion and instrument deformation inside the eye, image field distortion, image artifacts, and bulk motion due to patient movement and physiological tremor. We present an automated instrument-tracking method by leveraging multimodal imaging and deep-learning to dynamically detect surgical instrument positions and re-center imaging fields for 4D video-rate visualization of ophthalmic surgical maneuvers. We are able to achieve resolution-limited tracking accuracy at varying instrument orientations as well as at extreme instrument speeds and image defocus beyond typical use cases. As proof-of-concept, we perform automated instrument-tracking and 4D imaging of a mock surgical task. Here, we apply our methods for specific applications in ophthalmic microsurgery, but the proposed technologies are broadly applicable for intraoperative image-guidance with high speed and accuracy.
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Affiliation(s)
- Eric M. Tang
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37232, USA
| | - Mohamed T. El-Haddad
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37232, USA
| | - Shriji N. Patel
- Vanderbilt Eye Institute, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Yuankai K. Tao
- Vanderbilt University, Department of Biomedical Engineering, Nashville, TN 37232, USA
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29
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Heidarloo N, Mahmoud Reza Aghamiri S, Saghamanesh S, Azma Z, Alaei P. A novel analytical method for computing dose from kilovoltage beams used in Image-Guided radiation therapy. Phys Med 2022; 96:54-61. [PMID: 35219962 DOI: 10.1016/j.ejmp.2022.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/12/2022] [Accepted: 02/20/2022] [Indexed: 10/19/2022] Open
Abstract
PURPOSE A modified convolution/superposition algorithm is proposed to compute dose from the kilovoltage beams used in IGRT. The algorithm uses material-specific energy deposition kernels instead of water-energy deposition kernels. METHODS Monte Carlo simulation was used to model the Elekta XVI unit and determine dose deposition characteristics of its kilovoltage beams. The dosimetric results were compared with ion chamber measurements. The dose from the kilovoltage beams was then computed using convolution/superposition along with material-specific energy deposition kernels and compared with Monte Carlo and measurements. The material-specific energy deposition kernels were previously generated using Monte Carlo. RESULTS The obtained gamma indices (using 2%/2mm criteria for 95% of points) were lower than 1 in almost all instances which indicates good agreement between simulated and measured depth doses and profiles. The comparisons of the algorithm with measurements in a homogeneous solid water slab phantom, and that with Monte Carlo in a head and neck CT dataset produced acceptable results. The calculated point doses were within 4.2% of measurements in the homogeneous phantom. Gamma analysis of the calculated vs. Monte Carlo simulations in the head and neck phantom resulted in 94% of points passing with a 2%/2mm criteria. CONCLUSIONS The proposed method offers sufficient accuracy in kilovoltage beams dose calculations and has the potential to supplement the conventional megavoltage convolution/superposition algorithms for dose calculations in low energy range.
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Affiliation(s)
- Nematollah Heidarloo
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran
| | | | - Somayeh Saghamanesh
- Center for X-ray Analytics, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, Switzerland
| | - Zohreh Azma
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran; Erfan Radiation Oncology Center, Erfan-Niyayesh hospital, Iran University of Medical Science, Tehran, Iran
| | - Parham Alaei
- Department of Radiation Oncology, University of Minnesota, Minneapolis, MN, USA
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30
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Li B, Spronk D, Luo Y, Puett C, Inscoe CR, Tyndall DA, Lee YZ, Lu J, Zhou O. Feasibility of dual-energy CBCT by spectral filtration of a dual-focus CNT x-ray source. PLoS One 2022; 17:e0262713. [PMID: 35113908 PMCID: PMC8812859 DOI: 10.1371/journal.pone.0262713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/01/2022] [Indexed: 11/19/2022] Open
Abstract
Cone beam computed tomography (CBCT) is now widely used in dentistry and growing areas of medical imaging. The presence of strong metal artifacts is however a major concern of using CBCT especially in dentistry due to the presence of highly attenuating dental restorations, fixed appliances, and implants. Virtual monoenergetic images (VMIs) synthesized from dual energy CT (DECT) datasets are known to reduce metal artifacts. Although several techniques exist for DECT imaging, they in general come with significantly increased equipment cost and not available in dental clinics. The objectives of this study were to investigate the feasibility of developing a low-cost dual energy CBCT (DE-CBCT) by retrofitting a regular CBCT scanner with a carbon nanotube (CNT) x-ray source with dual focal spots and corresponding low-energy (LE) and high-energy (HE) spectral filters. A testbed with a CNT field emission x-ray source (NuRay Technology, Chang Zhou, China), a flat panel detector (Teledyne, Waterloo, Canada), and a rotating object stage was used for this feasibility study. Two distinct polychromatic x-ray spectra with the mean photon energies of 66.7keV and 86.3keV were produced at a fixed 120kVp x-ray tube voltage by using Al+Au and Al+Sn foils as the respective LE and HE filters attached to the exist window of the x-ray source. The HE filter attenuated the x-ray photons more than the LE filter. The calculated post-object air kerma rate of the HE beam was 31.7% of the LE beam. An anthropomorphic head phantom (RANDO, Nuclear Associates, Hicksville, NY) with metal beads was imaged using the testbed and the images were reconstructed using an iterative volumetric CT reconstruction algorithm. The VMIs were synthesized using an image-domain basis materials decomposition method with energy ranging from 30 to 150keV. The results were compared to the reconstructed images from a single energy clinical dental CBCT scanner (CS9300, Carestream Dental, Atlanta, GA). A significant reduction of the metal artifacts was observed in the VMI images synthesized at high energies compared to those from the same object imaged by the clinical dental CBCT scanner. The ability of the CNT x-ray source to generate the output needed to compensate the reduction of photon flux due to attenuation from the spectral filters and to maintain the CT imaging time was evaluated. The results demonstrated the feasibility of DE-CBCT imaging using the proposed approach. Metal artifact reduction was achieved in VMIs synthesized. The x-ray output needed for the proposed DE-CBCT can be generated by a fixed-anode CNT x-ray source.
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Affiliation(s)
- Boyuan Li
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Derrek Spronk
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Yueting Luo
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Connor Puett
- Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Christina R. Inscoe
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Donald A. Tyndall
- Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Yueh Z. Lee
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jianping Lu
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Otto Zhou
- Department of Physics and Astronomy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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31
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Liu C, Li M, Xiao H, Li T, Li W, Zhang J, Teng X, Cai J. Advances in MRI‐guided precision radiotherapy. PRECISION RADIATION ONCOLOGY 2022. [DOI: 10.1002/pro6.1143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Chenyang Liu
- Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong SAR China
| | - Mao Li
- Department of Radiation Oncology Philips Healthcare Chengdu China
| | - Haonan Xiao
- Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong SAR China
| | - Tian Li
- Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong SAR China
| | - Wen Li
- Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong SAR China
| | - Jiang Zhang
- Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong SAR China
| | - Xinzhi Teng
- Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong SAR China
| | - Jing Cai
- Department of Health Technology and Informatics The Hong Kong Polytechnic University Hong Kong SAR China
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32
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Górecka Ż, Grzelecki D, Paskal W, Choińska E, Gilewicz J, Wrzesień R, Macherzyński W, Tracz M, Budzińska-Wrzesień E, Bedyńska M, Kopka M, Jackowska-Tracz A, Świątek-Najwer E, Włodarski PK, Jaworowski J, Święszkowski W. Biodegradable Fiducial Markers for Bimodal Near-Infrared Fluorescence- and X-ray-Based Imaging. ACS Biomater Sci Eng 2022; 8:859-870. [PMID: 35020357 DOI: 10.1021/acsbiomaterials.1c01259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This study aimed to evaluate, for the first time, implantable, biodegradable fiducial markers (FMs), which were designed for bimodal, near-infrared fluorescence-based (NIRF) and X-ray-based imaging. The developed FMs had poly(l-lactide-co-caprolactone)-based core-shell structures made of radiopaque (core) and fluorescent (shell) composites with a poly(l-lactide-co-caprolactone) matrix. The approved for human use contrast agents were utilized as fillers. Indocyanine green was applied to the shell material, whereas in the core materials, iohexol and barium sulfate were compared. Moreover, the possibility of tailoring the stability of the properties of the core materials by the addition of hydroxyapatite (HAp) was examined. The performed in situ (porcine tissue) and in vivo experiment (rat model) confirmed that the developed FMs possessed pronounced contrasting properties in NIRF and X-ray imaging. The presence of HAp improved the radiopacity of FMs at the initial state. It was also proved that, in iohexol-containing FMs, the presence of HAp slightly decreased the stability of contrasting properties, while in BaSO4-containing ones, changes were less pronounced. A comprehensive material analysis explaining the differences in the stability of the contrasting properties was also presented. The tissue response around the FMs with composite cores was comparable to that of the FMs with a pristine polymeric core. The developed composite FMs did not cause serious adverse effects on the surrounding tissues even when irradiated in vivo. The developed FMs ensured good visibility for NIRF image-supported tumor surgery and the following X-ray image-guided radiotherapy. Moreover, this study replenishes a scanty report regarding similar biodegradable composite materials with a high potential for application.
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Affiliation(s)
- Żaneta Górecka
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland.,Centre for Advanced Materials and Technologies CEZAMAT, Warsaw University of Technology, 02-822 Warsaw, Poland
| | - Dariusz Grzelecki
- Department of Applied Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland.,Department of Orthopedics and Rheumoorthopedics, Professor Adam Gruca Teaching Hospital, Centre of Postgraduate Medical Education, 05-400 Otwock, Poland
| | - Wiktor Paskal
- Centre for Preclinical Research, The Department of Methodology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Emilia Choińska
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland
| | - Joanna Gilewicz
- Department of Applied Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Robert Wrzesień
- Central Laboratory of Experimental Animal, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Wojciech Macherzyński
- Faculty of Microsystem Electronics and Photonics, Wroclaw University of Science and Technology, 50-372 Wroclaw, Poland
| | - Michał Tracz
- Institute of Veterinary Medicine, Department of Food Hygiene and Public Health Protection, Warsaw University of Life Sciences, 02-776 Warsaw, Poland
| | | | - Maria Bedyńska
- Department of Applied Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Michał Kopka
- Centre for Preclinical Research, The Department of Methodology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Agnieszka Jackowska-Tracz
- Institute of Veterinary Medicine, Department of Food Hygiene and Public Health Protection, Warsaw University of Life Sciences, 02-776 Warsaw, Poland
| | - Ewelina Świątek-Najwer
- Faculty of Mechanical Engineering, Wroclaw University of Science and Technology, 50-371 Wroclaw, Poland
| | - Paweł K Włodarski
- Centre for Preclinical Research, The Department of Methodology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Janusz Jaworowski
- Department of Applied Pharmacy, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Wojciech Święszkowski
- Division of Materials Design, Faculty of Materials Science and Engineering, Warsaw University of Technology, 141 Woloska Str., 02-507 Warsaw, Poland
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Liu J, Yan H, Cheng H, Liu J, Sun P, Wang B, Mao R, Du C, Luo S. CBCT-based synthetic CT generation using generative adversarial networks with disentangled representation. Quant Imaging Med Surg 2021; 11:4820-4834. [PMID: 34888192 DOI: 10.21037/qims-20-1056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 06/02/2021] [Indexed: 11/06/2022]
Abstract
Background Cone-beam computed tomography (CBCT) plays a key role in image-guided radiotherapy (IGRT), however its poor image quality limited its clinical application. In this study, we developed a deep-learning based approach to translate CBCT image to synthetic CT (sCT) image that preserves both CT image quality and CBCT anatomical structures. Methods A novel synthetic CT generative adversarial network (sCTGAN) was proposed for CBCT-to-CT translation via disentangled representation. The approach of disentangled representation was employed to extract the anatomical information shared by CBCT and CT image domains. Both on-board CBCT and planning CT of 40 patients were used for network learning and those of another 12 patients were used for testing. Accuracy of our network was quantitatively evaluated using a series of statistical metrics, including the peak signal-to-noise ratio (PSNR), mean structural similarity index (SSIM), mean absolute error (MAE), and root-mean-square error (RMSE). Effectiveness of our network was compared against three state-of-the-art CycleGAN-based methods. Results The PSNR, SSIM, MAE, and RMSE between sCT generated by sCTGAN and deformed planning CT (dpCT) were 34.12 dB, 0.86, 32.70 HU, and 60.53 HU, while the corresponding values between original CBCT and dpCT were 28.67 dB, 0.64, 70.56 HU, and 112.13 HU. The RMSE (60.53±14.38 HU) of sCT generated by sCTGAN was less than that of sCT generated by all the three comparing methods (72.40±16.03 HU by CycleGAN, 71.60±15.09 HU by CycleGAN-Unet512, 64.93±14.33 HU by CycleGAN-AG). Conclusions The sCT generated by our sCTGAN network was closer to the ground truth (dpCT), in comparison to all the three comparing CycleGAN-based methods. It provides an effective way to generate high-quality sCT which has a wide application in IGRT and adaptive radiotherapy.
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Affiliation(s)
- Jiwei Liu
- School of Automation and Electrical Engineering, University of Science and Technology Beijing, Beijing, China
| | - Hui Yan
- Department of Radiation Oncology, National Clinical Research Center for Cancer, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanlin Cheng
- School of Automation and Electrical Engineering, University of Science and Technology Beijing, Beijing, China
| | - Jianfei Liu
- School of Electrical Engineering and Automation, Anhui University, Hefei, China
| | - Pengjian Sun
- School of Automation and Electrical Engineering, University of Science and Technology Beijing, Beijing, China
| | - Boyi Wang
- School of Automation and Electrical Engineering, University of Science and Technology Beijing, Beijing, China
| | - Ronghu Mao
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Chi Du
- Cancer Center, The Second Peoples Hospital of Neijiang, Neijiang, China
| | - Shengquan Luo
- School of Automation and Electrical Engineering, University of Science and Technology Beijing, Beijing, China
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Thind K, Roumeliotis M, Mann T, Van Dyke L, Martell K, Smith W, Barbera L, Quirk S. Increasing Demand on Human Capital and Resource Utilization in Radiation Therapy: The Past Decade. Int J Radiat Oncol Biol Phys 2021; 112:457-462. [PMID: 34543682 DOI: 10.1016/j.ijrobp.2021.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/23/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To quantify the change resource utilization in radiation therapy in the context of advancing technologies and techniques over the last decade. METHODS AND MATERIALS Prospectively, the time to complete radiation therapy workflow tasks was captured between January 1, 2020, and December 31, 2020. The institutional task workflows are specific to each technique and broadly organized into 4 categories: 3-dimenstional conformal radiation therapy, intensity modulated radiation therapy, volumetric modulated arc therapy simple, and volumetric modulated arc therapy complex. These discipline-specific task times were used to quantify a resource utilization factor, which is the median time taken to complete all tasks for each category divided by the median time for 3-dimensional conformal radiation therapy treatments. Retrospectively, all plans treated between January 1, 2012, and December 31, 2019, were quantified and categorized. The resource factor was applied to determine resource utilization. For context, institutional staffing levels were captured across the same decade for medical dosimetrists, medical physicists, and radiation oncologists. RESULTS This analysis includes 30,229 patient plans in the retrospective data set and 4747 patient plans in the prospective data set. This analysis demonstrates that over this period, patient numbers increased by approximately 45%, whereas time-based human resources increased by almost 150%. The resource allocation factors for 3-dimenstional conformal radiation therapy, intensity modulated radiation therapy, volumetric modulated arc therapy simple, and volumetric arc therapy complex were 1.0, 2.4, 2.9, and 4.3, respectively. Across the 3 disciplines, staffing levels increased from 15 to 17 (13%) for medical dosimetrists, from 10 to 13 (30%) for medical physicists, and from 16 to 23 (44%) for radiation oncologists. CONCLUSIONS This work demonstrates the increase in resource utilization due to the introduction of advanced technologies and changes in radiation therapy techniques over the past decade. Human resource utilization is the predominant factor and should be considered with increasing patient volume for operational planning.
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Affiliation(s)
- Kundan Thind
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Department of Physics & Astronomy, University of Calgary, Calgary, Alberta; Tom Baker Cancer Centre, Calgary Alberta, Canada.
| | - Michael Roumeliotis
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Department of Physics & Astronomy, University of Calgary, Calgary, Alberta; Tom Baker Cancer Centre, Calgary Alberta, Canada
| | - Thomas Mann
- Department of Physics & Astronomy, University of Calgary, Calgary, Alberta; Tom Baker Cancer Centre, Calgary Alberta, Canada
| | | | - Kevin Martell
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary Alberta, Canada
| | - Wendy Smith
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Department of Physics & Astronomy, University of Calgary, Calgary, Alberta; Tom Baker Cancer Centre, Calgary Alberta, Canada
| | - Lisa Barbera
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Tom Baker Cancer Centre, Calgary Alberta, Canada
| | - Sarah Quirk
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada; Department of Physics & Astronomy, University of Calgary, Calgary, Alberta; Tom Baker Cancer Centre, Calgary Alberta, Canada
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Zhang Y, Yan S, Cui Z, Wang Y, Li Z, Yin Y, Li B, Quan H, Zhu J. Out-of-field dose assessment for a 1.5 T MR-Linac with optically stimulated luminescence dosimeters. Med Phys 2021; 48:4027-4037. [PMID: 33714229 PMCID: PMC8360091 DOI: 10.1002/mp.14839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/04/2021] [Accepted: 03/04/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE To assess the out-of-field surface and internal dose of the 1.5 T MR-Linac compared to the conventional external beam linac using optically stimulated luminescence dosimeters (OSLDs), and evaluate the out-of-field dose calculation accuracy of the Monaco treatment planning system (TPS) of the 1.5T MR-Linac. METHODS A cubic solid water phantom, with OSLDs on the surface, was vertically irradiated by MR-Linac square fields with different sizes. In addition, OSLDs were arranged out of the beam edges in four directions. An anthropomorphic adult phantom, with 125 cm3 simulated volume, was irradiated in four orthogonal directions by both MR-Linac and conventional linac at the head, thoracic, and pelvic sites. Out-of-field doses were measured by OSLDs on both the surface and internal emulational organs at risk (OARs). The results were compared to the simulated dose from Monaco TPS. RESULTS At different field sizes (5 × 5 to 20 × 20 cm2 ) and distances (1 to 10 cm) to beam edge, the out-of-field surface dose measured on MR-Linac varied from 0.16 % (10 cm to 5 × 5 cm2 edge) to 7.02 % (1 cm to 20 × 20 cm2 edge) of the maximum dose laterally and from 0.14 % (10 cm to 5 × 5 cm2 edge) to 8.56 % (1 cm to 20 × 20 cm2 edge) of the maximum dose longitudinally. Compared to the OSLDs measured data, the Monaco TPS presented an overestimate of the out-of-field dose of OARs at 0-2 % isodose area on both surface and internal check points, and the overestimation gets greater as the distance increases. The underestimation was found to be 0-35% at 2-5% isodose area on both surface and internal check points. Compared to the conventional linac, MR-Linac delivered higher average values of out-of-field dose on surface check points (20%, 19%, 21%) and internal simulated OARs (42%, 37%, 9%) of the anthropomorphic phantom at head, thoracic, and pelvic irradiations, respectively. CONCLUSIONS Compared to the conventional linac, MR-Linac has the same out-of-field dose distribution. However, considering the absolute dose values, MR-Linac delivered relatively higher out-of-field doses on both surface and internal OARs. Additional radiation shielding to patients undergoing MR-Linac may provide protection from out-of-field exposure.
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Affiliation(s)
- Yan Zhang
- School of Physics and Technology, Wuhan University, Wuhan, P.R. China.,Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Shaojie Yan
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China.,School of Nuclear Science and Technology, University of South China, Hengyang, P.R. China
| | - Zhen Cui
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Yungang Wang
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Zhenjiang Li
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Yong Yin
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Hong Quan
- School of Physics and Technology, Wuhan University, Wuhan, P.R. China
| | - Jian Zhu
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China.,Shandong Medical Imaging and Radiotherapy Engineering Center, Jinan, P.R. China.,Shandong Key Laboratory of Digital Medicine and Computer Assisted Surgery, The Affiliated Hospital of Qingdao University, Qingdao, P.R. China
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Shahid W, Mukhtar R, Rizvi SFA, Shahid S, Iqbal MA. Evaluation and validation of tungsten fiducial marker-based image-guided radiotherapy. Biomed Phys Eng Express 2021; 7. [PMID: 33862602 DOI: 10.1088/2057-1976/abf90b] [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: 12/19/2020] [Accepted: 04/16/2021] [Indexed: 11/11/2022]
Abstract
In this research work, a simple homemade cubic phantom was designed to validate the Image-Guided Radiotherapy (IGRT) set up and verified with the help of tungsten fiducial markers (size 2-3 mm) inserted into the cubic phantom. Phantom made up of Styrofoam, was scanned with the help of 16 slice Toshiba CT scanner where each slice was of 1 mm thickness and HU level set to -1000. A radio-opaque contrast medium was rubbed on the phantom to visualize the scanner images. Once the iso-center had been marked on a phantom with the help of in-room positioning laser and the fields (RT-LAT and AP) were applied on the contoured body of the phantom in Varian's ARIA-11 Eclipse dosimeter software, the same position of the phantom was reproduced on Varian's Linear Accelerator DHX. Known shifts of 3.0 to 30.0 mm from the marked iso-center were applied on the phantom by moving the couch in all six directions one by one. On each applied couch shift, an x-ray image of the phantom was acquired with the help of an MV portal imager of Linac in AP and RT-LAT direction. This image was superimposed with a reference image of phantom and shift accuracy calculated by ARIA-11 software was noted down. It turned out that irrespective of the position of the phantom on the couch, the calculated corrected shift and deviation from reference position was always between ± 1-2 mm which is the required accuracy for IGRT according to International Atomic Energy Agency (IAEA). This process was repeated 40 times and each time, the corrected shift came out to be ± 1-2 mm. We can conclude that our system is safe and accurate enough to perfectly position the actual patient for IGRT.
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Affiliation(s)
- Wajeehah Shahid
- Department of Physics, The University of Lahore, Lahore-54000, Punjab, Pakistan
| | - Raheel Mukhtar
- Department of Physics, The University of Lahore, Lahore-54000, Punjab, Pakistan
| | - Syed Faheem Askari Rizvi
- College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou-730000, Gansu, People's Republic of China
| | - Samiah Shahid
- Institute of Molecular Biology and Biotechnology, The University of Lahore, Lahore-54000, Punjab, Pakistan
| | - Muhammad Aamir Iqbal
- School of Material Science and Engineering, Zhejiang University, People's Republic of China
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Marta GN, Coles C, Kaidar-Person O, Meattini I, Hijal T, Zissiadis Y, Pignol JP, Ramiah D, Ho AY, Cheng SHC, Sancho G, Offersen BV, Poortmans P. The use of moderately hypofractionated post-operative radiation therapy for breast cancer in clinical practice: A critical review. Crit Rev Oncol Hematol 2020; 156:103090. [PMID: 33091800 PMCID: PMC7448956 DOI: 10.1016/j.critrevonc.2020.103090] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/14/2022] Open
Abstract
Post-operative radiation therapy (RT) reduces loco-regional recurrence rates and mortality in most patients with non-metastatic breast cancer. The aim of this critical review is to provide an overview of the applicability of moderately hypofractionated RT for breast cancer patients, focusing on factors influencing clinical decision-making. An international group of radiation oncologists agreed to assess, integrate, and interpret the existing evidence into a practical report to guide clinicians in their daily management of breast cancer patients. We conclude that moderately hypofractionated RT to the breast, chest wall (with/without breast reconstruction), and regional lymph nodes is at least as safe and effective as conventionally fractionated regimens and could be considered as the treatment option for the vast majority of the patients.For those who are still concerned about its generalised application, we recommend participating in ongoing trials comparing moderately hypofractionated RT to conventionally fractionated RT for breast cancer patients in some clinical circumstances.
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Affiliation(s)
- Gustavo Nader Marta
- Department of Radiation Oncology - Hospital Sírio-Libanês, São Paulo, Brazil; Department of Radiology and Oncology - Division of Radiation Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Charlotte Coles
- Department of Oncology, University of Cambridge, Cambridge, UK.
| | - Orit Kaidar-Person
- Breast Cancer Radiation Unit, Radiation Oncology Institute, Sheba Medical Center, Ramat Gan, Israel.
| | - Icro Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy.
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montréal, Quebec, Canada.
| | - Yvonne Zissiadis
- Department of Radiation Oncology, Genesis Cancer Care, Wembley, Western Australia, Australia.
| | | | - Duvern Ramiah
- Department of Radiation Oncology, Donald Gordon Medical Centre, Johannesburg, South Africa.
| | - Alice Y Ho
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA.
| | - Skye Hung-Chun Cheng
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
| | - Gemma Sancho
- Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Birgitte Vrou Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark.
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium.
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Alcorn SR, Zhou XC, Bojechko C, Rubo RA, Chen MJ, Dieckmann K, Ermoian RP, Ford EC, Kobyzeva D, MacDonald SM, McNutt TR, Nechesnyuk A, Nilsson K, Sjostrand H, Smith KS, Stock M, Tryggestad EJ, Villar RC, Winey BA, Terezakis SA. Low-Dose Image-Guided Pediatric CNS Radiation Therapy: Final Analysis From a Prospective Low-Dose Cone-Beam CT Protocol From a Multinational Pediatrics Consortium. Technol Cancer Res Treat 2020; 19:1533033820920650. [PMID: 32329413 PMCID: PMC7225835 DOI: 10.1177/1533033820920650] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Lower-dose cone-beam computed tomography protocols for image-guided radiotherapy may permit target localization while minimizing radiation exposure. We prospectively evaluated a lower-dose cone-beam protocol for central nervous system image-guided radiotherapy across a multinational pediatrics consortium. Methods: Seven institutions prospectively employed a lower-dose cone-beam computed tomography central nervous system protocol (weighted average dose 0.7 mGy) for patients ≤21 years. Treatment table shifts between setup with surface lasers versus cone-beam computed tomography were used to approximate setup accuracy, and vector magnitudes for these shifts were calculated. Setup group mean, interpatient, interinstitution, and random error were estimated, and clinical factors were compared by mixed linear modeling. Results: Among 96 patients, with 2179 pretreatment cone-beam computed tomography acquisitions, median age was 9 years (1-20). Setup parameters were 3.13, 3.02, 1.64, and 1.48 mm for vector magnitude group mean, interpatient, interinstitution, and random error, respectively. On multivariable analysis, there were no significant differences in mean vector magnitude by age, gender, performance status, target location, extent of resection, chemotherapy, or steroid or anesthesia use. Providers rated >99% of images as adequate or better for target localization. Conclusions: A lower-dose cone-beam computed tomography protocol demonstrated table shift vector magnitude that approximate clinical target volume/planning target volume expansions used in central nervous system radiotherapy. There were no significant clinical predictors of setup accuracy identified, supporting use of this lower-dose cone-beam computed tomography protocol across a diverse pediatric population with brain tumors.
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Affiliation(s)
| | - Xian Chiong Zhou
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | - Michael J Chen
- Grupo de Apoio ao Adolescente e à Criança com Câncer, São Paulo, Brazil
| | - Karin Dieckmann
- Universität Klinik Für Strahlentherapie und Strahlenbiologie, Vienna, Austria
| | | | | | - Daria Kobyzeva
- Federal Scientific Clinical Center of Children's Hematology, Oncology and Immunology, Moscow, Russia
| | | | | | - Alexey Nechesnyuk
- Federal Scientific Clinical Center of Children's Hematology, Oncology and Immunology, Moscow, Russia
| | | | | | | | - Markus Stock
- Universität Klinik Für Strahlentherapie und Strahlenbiologie, Vienna, Austria
| | | | | | | | - Stephanie A Terezakis
- Department of Radiation Oncology and Molecular Radiation Sciences, University of Minnesota, Minneapolis, MN, USA
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Dos Reis RB, Muglia VF, Rodrigues AA, Viani G. Editorial Comment: Endoclips as novel fiducial markers in trimodality bladder preserving therapy of muscle-invasive bladder carcinoma: feasibility and patient out-comes. Int Braz J Urol 2020; 47:100-102. [PMID: 33047915 PMCID: PMC7712691 DOI: 10.1590/s1677-5538.ibju.2019.0713.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Rodolfo Borges Dos Reis
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Valdair Francisco Muglia
- Departamento de Imagens Médicas, Radioterapia e Oncohematologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
| | - Antônio Antunes Rodrigues
- Departamento de Cirurgia e Anatomia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Gustavo Viani
- Departamento de Imagens Médicas, Radioterapia e Oncohematologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
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Hua CH, Vern-Gross TZ, Hess CB, Olch AJ, Alaei P, Sathiaseelan V, Deng J, Ulin K, Laurie F, Gopalakrishnan M, Esiashvili N, Wolden SL, Krasin MJ, Merchant TE, Donaldson SS, FitzGerald TJ, Constine LS, Hodgson DC, Haas-Kogan DA, Mahajan A, Laack N, Marcus KJ, Taylor PA, Ahern VA, Followill DS, Buchsbaum JC, Breneman JC, Kalapurakal JA. Practice patterns and recommendations for pediatric image-guided radiotherapy: A Children's Oncology Group report. Pediatr Blood Cancer 2020; 67:e28629. [PMID: 32776500 PMCID: PMC7774502 DOI: 10.1002/pbc.28629] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 06/16/2020] [Accepted: 07/19/2020] [Indexed: 12/18/2022]
Abstract
This report by the Radiation Oncology Discipline of Children's Oncology Group (COG) describes the practice patterns of pediatric image-guided radiotherapy (IGRT) based on a member survey and provides practice recommendations accordingly. The survey comprised of 11 vignettes asking clinicians about their recommended treatment modalities, IGRT preferences, and frequency of in-room verification. Technical questions asked physicists about imaging protocols, dose reduction, setup correction, and adaptive therapy. In this report, the COG Radiation Oncology Discipline provides an IGRT modality/frequency decision tree and the expert guidelines for the practice of ionizing image guidance in pediatric radiotherapy patients.
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Affiliation(s)
- Chia-ho Hua
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | | | - Clayton B. Hess
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Arthur J. Olch
- Department of Radiation Oncology, University of Southern California and Children’s Hospital of Los Angeles, Los Angeles, California
| | - Parham Alaei
- Department of Radiation Oncology, University of Minnesota, Minneapolis, Minnesota
| | | | - Jun Deng
- Department of Therapeutic Radiology, Yale University, New Haven, Connecticut
| | - Kenneth Ulin
- Department of Radiation Oncology, University of Massachusetts, Worcester, Massachusetts
| | - Fran Laurie
- Department of Radiation Oncology, University of Massachusetts, Worcester, Massachusetts
| | | | - Natia Esiashvili
- Department of Radiation Oncology, Emory University, Atlanta, Georgia
| | - Suzanne L. Wolden
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Matthew J. Krasin
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Thomas E Merchant
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Sarah S. Donaldson
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Thomas J. FitzGerald
- Department of Radiation Oncology, University of Massachusetts, Worcester, Massachusetts
| | - Louis S. Constine
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - David C. Hodgson
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Daphne A. Haas-Kogan
- Department of Radiation Oncology, Dana Farber Cancer Institute/Boston Children’s Hospital, Boston, Massachusetts
| | - Anita Mahajan
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Nadia Laack
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Karen J. Marcus
- Department of Radiation Oncology, Dana Farber Cancer Institute/Boston Children’s Hospital, Boston, Massachusetts
| | - Paige A Taylor
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Verity A Ahern
- Department of Radiation Oncology, Children’s Hospital at Westmead, Sydney, Australia
| | - David S. Followill
- Department of Radiation Physics, Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey C. Buchsbaum
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - John C. Breneman
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio
| | - John A. Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
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Liu J, Zhang Y, Li Q, Feng Z, Huang P, Wang W, Liu J. Development of injectable thermosensitive polypeptide hydrogel as facile radioisotope and radiosensitizer hotspot for synergistic brachytherapy. Acta Biomater 2020; 114:133-145. [PMID: 32688087 DOI: 10.1016/j.actbio.2020.07.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 01/02/2023]
Abstract
Brachytherapy is considered to be an unparalleled form of conformal radiation therapy, which involves the delivery of radiation directly to tumor lesions or the postoperative cavity. With the development of specific applicators, the exploitation of in situ drug-delivery platform introduces opportunities for the synchronous administration of radiosensitizers. In this study, an iodine-131 (I131)-labeled injectable thermosensitive methoxy poly(ethylene glycol)-b-poly(tyrosine) hydrogel (denoted as PETyr-I131) was developed via a facile method. The radioactive source of I131 was immobilized at the subcutaneous injection site and monitored via single-photon emission computed tomography in real time, and hematological and histopathological analyses revealed no obvious side effects. Additionally, the SmacN7 peptide conjugated with cell membrane-permeable oligosarginine (denoted as SmacN7-R9) was used to enhance the radiosensitivity of cancer cells, as confirmed by the results of reactive oxygen species detection, DNA damage assay, cell apoptosis assay, and clonogenic evaluation. Importantly, a synergistic brachytherapy treatment effect on tumor-bearing nude mice was achieved. The proposed thermosensitive supramolecular hydrogel platform, which conformally immobilizes radionuclides and delivers radiosensitizers by virtue of its proximity to the site of the primary tumor or the postoperative cavity, has great potential for achieving synergistic treatment outcomes with reduced radiation-related side effects. STATEMENT OF SIGNIFICANCE: In this work, a kind of radioiodinated thermosensitive supramolecular hydrogel was developed, which was facilely used as the radioactive source for brachytherapy. Meanwhile, SmacN7-R9 peptide was combined as a model radiosensitizer to facilitate the activation of tumor cell apoptosis pathways and promotion of radiation-induced cytotoxicity. Synergistic brachytherapy outcomes were achieved from the in vitro and in vivo evaluations. Therefore, from the practical standpoint, this thermosensitive supramolecular hydrogel platform holds great potential for the 3D-conformally immobilizing radionuclide and delivering radiosensitizer by virtue of its proximity to the site of primary tumor lesions or postoperative cavity, resulting in synergetic treatment outcomes with reduced radiation associated side effects.
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Yoo GS, Yu JI, Park HC, Hyun D, Jeong WK, Lim HY, Choi MS, Ha SY. Do Biliary Complications after Proton Beam Therapy for Perihilar Hepatocellular Carcinoma Matter? Cancers (Basel) 2020; 12:cancers12092395. [PMID: 32847035 PMCID: PMC7565009 DOI: 10.3390/cancers12092395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/21/2022] Open
Abstract
We aimed to evaluate the biliary complications and efficacy of proton beam therapy (PBT) for hepatocellular carcinoma (HCC). We retrospectively analyzed 167 patients who received PBT with ≥ 75 GyRBE of biological effective dose with 𝛼/β = 10 for primary HCC. The perihilar region was defined as a 1-cm area extending from the right, left, and common hepatic ducts, including the gallbladder and cystic duct. PBT-related biliary complications were defined as follows: significant elevation in bilirubin level to > 3.0 mg/dL; elevation to more than twice of the baseline level after the completion of PBT; or newly developed radiological biliary abnormalities, which were not caused by HCC progression, comorbidities, or other treatments. Eighty (47.9%) had perihilar HCC. PBT-related events occurred in seven (4.2%), three of whom had perihilar HCC. Radiologic biliary abnormalities developed in 12 patients (7.2%); however, no events were PBT-related. All patients who experienced PBT-related biliary complications had underlying liver cirrhosis. The albumin-bilirubin grade was identified as an independent factor associated with PBT-related biliary complications. PBT at the current dose showed a low rate of PBT-related biliary complications even for patients with perihilar HCC. PBT for HCC patients with risk factors requires attention to reduce PBT-related biliary complications.
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Affiliation(s)
- Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (G.S.Y.); (J.I.Y.)
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (G.S.Y.); (J.I.Y.)
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (G.S.Y.); (J.I.Y.)
- Correspondence: ; Tel.: +82-2-3410-2612; Fax: +82-2-3410-2619
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (D.H.); (W.K.J.)
| | - Woo Kyoung Jeong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (D.H.); (W.K.J.)
| | - Ho Yeong Lim
- Department of Internal Medicine (Division of Hematology-Oncology), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Moon Seok Choi
- Department of Internal Medicine (Division of Gastroenterology), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Sang Yun Ha
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
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Li M, Shan S, Chandra SS, Liu F, Crozier S. Fast geometric distortion correction using a deep neural network: Implementation for the 1 Tesla MRI‐Linac system. Med Phys 2020; 47:4303-4315. [DOI: 10.1002/mp.14382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/18/2020] [Accepted: 07/04/2020] [Indexed: 11/08/2022] Open
Affiliation(s)
- Mao Li
- School of Information Technology and Electrical Engineering University of Queensland Brisbane QLD 4067 Australia
| | - Shanshan Shan
- School of Information Technology and Electrical Engineering University of Queensland Brisbane QLD 4067 Australia
| | - Shekhar S. Chandra
- School of Information Technology and Electrical Engineering University of Queensland Brisbane QLD 4067 Australia
| | - Feng Liu
- School of Information Technology and Electrical Engineering University of Queensland Brisbane QLD 4067 Australia
| | - Stuart Crozier
- School of Information Technology and Electrical Engineering University of Queensland Brisbane QLD 4067 Australia
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Farahani S, Riyahi Alam N, Haghgoo S, Shirazi A, Geraily G, Gorji E, Kavousi N. The effect of bismuth nanoparticles in kilovoltage and megavoltage radiation therapy using magnetic resonance imaging polymer gel dosimetry. Radiat Phys Chem Oxf Engl 1993 2020. [DOI: 10.1016/j.radphyschem.2019.108573] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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SKIN-COBRA (Consortium for Brachytherapy data Analysis) ontology: The first step towards interdisciplinary standardized data collection for personalized oncology in skin cancer. J Contemp Brachytherapy 2020; 12:105-110. [PMID: 32395133 PMCID: PMC7207239 DOI: 10.5114/jcb.2020.94579] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 02/17/2020] [Indexed: 01/21/2023] Open
Abstract
Purpose The primary objective of the SKIN-COBRA (Consortium for Brachytherapy data Analysis) ontology is to define a specific terminological system to standardize data collection for non-melanoma skin cancer patients treated with brachytherapy (BT, interventional radiotherapy). Through ontological characterization of information, it is possible to find, isolate, organize, and integrate its meaning. Material and methods SKIN-COBRA is a standardized data collection consortium for non-melanoma skin patients treated with BT, including 8 cancer centers. Its ontology was firstly defined by a multicentric and multidisciplinary working group and evaluated by the consortium, followed by a multi-professional technical commission involving a mathematician, an engineer, a physician with experience in data storage, a programmer, and a software expert. Results Two hundred and ninety variables were defined in 10 input forms. There are 3 levels, with each offering a specific type of analysis: 1. Registry level (epidemiology analysis); 2. Procedures level (standard oncology analysis); 3. Research level (radiomics analysis). The ontology was approved by the technical commission and consortium, and an ad-hoc software system was defined to be implemented in the SKIN-COBRA consortium. Conclusions Large databases are natural extension of traditional statistical approaches, a valuable and increasingly necessary tool for modern healthcare system. Future analysis of the collected multinational and multicenter data will show whether the use of the system can produce high-quality evidence to support multidisciplinary management of non-melanoma skin cancer and utilizing this information for personalized treatment decisions.
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Tomita T, Isobe T, Furuyama Y, Takei H, Kobayashi D, Mori Y, Terunuma T, Sato E, Yokota H, Sakae T. Evaluation of Dose Distribution and Normal Tissue Complication Probability of a Combined Dose of Cone-Beam Computed Tomography Imaging with Treatment in Prostate Intensity-Modulated Radiation Therapy. J Med Phys 2020; 45:78-87. [PMID: 32831490 PMCID: PMC7416863 DOI: 10.4103/jmp.jmp_4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/02/2020] [Accepted: 03/31/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose: The purpose of this study is to evaluate the effects of cone-beam computed tomography (CBCT) on dose distribution and normal tissue complication probability (NTCP) by constructing a comprehensive dose evaluation system for prostate intensity-modulated radiation therapy (IMRT). Methods: A system that could combine CBCT and treatment doses with MATLAB was constructed. Twenty patients treated with prostate IMRT were studied. A mean dose of 78 Gy was prescribed to the prostate region, excluding the rectal volume from the target volume, with margins of 4 mm to the dorsal side of the prostate and 7 mm to the entire circumference. CBCT and treatment doses were combined, and the dose distribution and the NTCP of the rectum and bladder were evaluated. Results: The radiation dose delivered to 2% and 98% of the target volume increased by 0.90 and 0.74 Gy on average, respectively, in the half-fan mode and on average 0.76 and 0.72 Gy, respectively, in the full-fan mode. The homogeneity index remained constant. The percent volume of the rectum and bladder irradiated at each dose increased slightly, with a maximum increase of <1%. The rectal NTCP increased by approximately 0.07% from 0.46% to 0.53% with the addition of a CBCT dose, while the maximum NTCP in the bladder was approximately 0.02%. Conclusions: This study demonstrated a method to evaluate a combined dose of CBCT and a treatment dose using the constructed system. The combined dose distribution revealed increases of <1% volume in the rectal and bladder doses and approximately 0.07% in the rectal NTCP.
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Affiliation(s)
- Tetsuya Tomita
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Department of Radiology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Tomonori Isobe
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Hideyuki Takei
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Daisuke Kobayashi
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Ibaraki, Japan.,Department of Radiology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Yutaro Mori
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | | | - Eisuke Sato
- Faculty of Health Sciences, Juntendo University, Tokyo, Japan
| | - Hiroshi Yokota
- Department of Radiology, University of Tsukuba Hospital, Ibaraki, Japan
| | - Takeji Sakae
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Wang C, Hunt M, Zhang L, Rimner A, Yorke E, Lovelock M, Li X, Li T, Mageras G, Zhang P. Technical Note: 3D localization of lung tumors on cone beam CT projections via a convolutional recurrent neural network. Med Phys 2020; 47:1161-1166. [PMID: 31899807 DOI: 10.1002/mp.14007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/16/2019] [Accepted: 12/28/2019] [Indexed: 11/07/2022] Open
Abstract
PURPOSE To design a convolutional recurrent neural network (CRNN) that calculates three-dimensional (3D) positions of lung tumors from continuously acquired cone beam computed tomography (CBCT) projections, and facilitates the sorting and reconstruction of 4D-CBCT images. METHOD Under an IRB-approved clinical lung protocol, kilovoltage (kV) projections of the setup CBCT were collected in free-breathing. Concurrently, an electromagnetic signal-guided system recorded motion traces of three transponders implanted in or near the tumor. Convolutional recurrent neural network was designed to utilize a convolutional neural network (CNN) for extracting relevant features of the kV projections around the tumor, followed by a recurrent neural network for analyzing the temporal patterns of the moving features. Convolutional recurrent neural network was trained on the simultaneously collected kV projections and motion traces, subsequently utilized to calculate motion traces solely based on the continuous feed of kV projections. To enhance performance, CRNN was also facilitated by frequent calibrations (e.g., at 10° gantry rotation intervals) derived from cross-correlation-based registrations between kV projections and templates created from the planning 4DCT. Convolutional recurrent neural network was validated on a leave-one-out strategy using data from 11 lung patients, including 5500 kV images. The root-mean-square error between the CRNN and motion traces was calculated to evaluate the localization accuracy. RESULT Three-dimensional displacement around the simulation position shown in the Calypso traces was 3.4 ± 1.7 mm. Using motion traces as ground truth, the 3D localization error of CRNN with calibrations was 1.3 ± 1.4 mm. CRNN had a success rate of 86 ± 8% in determining whether the motion was within a 3D displacement window of 2 mm. The latency was 20 ms when CRNN ran on a high-performance computer cluster. CONCLUSIONS CRNN is able to provide accurate localization of lung tumors with aid from frequent recalibrations using the conventional cross-correlation-based registration approach, and has the potential to remove reliance on the implanted fiducials.
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Affiliation(s)
- Chuang Wang
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Margie Hunt
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Lei Zhang
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Michael Lovelock
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Xiang Li
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Tianfang Li
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Gig Mageras
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
| | - Pengpeng Zhang
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY, 10065, USA
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Kh. Saleh K, Dalkiliç S, Kadioğlu Dalkiliç L, R. Hamarashid B, Kirbağ S. Targeting cancer cells: from historic methods to modern chimeric antigen receptor (CAR) T-Cell strategies. AIMS ALLERGY AND IMMUNOLOGY 2020. [DOI: 10.3934/allergy.2020004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Kamperis E, Kodona C, Hatziioannou K, Giannouzakos V. Complexity in Radiation Therapy: It's Complicated. Int J Radiat Oncol Biol Phys 2020; 106:182-184. [DOI: 10.1016/j.ijrobp.2019.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 12/11/2022]
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Alexander S, Hopkins N, Lalondrelle S, Taylor A, Titmarsh K, McNair H. RTT-led IGRT for cervix cancer; training, implementation and validation. Tech Innov Patient Support Radiat Oncol 2019; 12:41-49. [PMID: 32095554 PMCID: PMC7033802 DOI: 10.1016/j.tipsro.2019.10.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/18/2019] [Accepted: 10/31/2019] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION IGRT in cervical cancer treatment delivery is complex due to significant target and organs at risk (OAR) motion. Implementing image assessment of soft-tissue target and OAR position to improve accuracy is recommended. We report the development and refinement of a training and competency programme (TCP), leading to on-line Radiation Therapist (RTT) led soft-tissue assessment, evaluated by a prospective audit. METHODS AND MATERIALS The TCP comprised didactic lectures and practical sessions, supported by a comprehensive workbook. The content was decided by a team comprised of Clinical Oncologists, RTTs, and Physicists. On completion of training, RTT soft-tissue review proficiency (after bony anatomy registration) was assessed against a clinician gold-standard from a database of 20 cervical cancer CBCT images. Reviews were graded pass or fail based on PTV coverage assessment and decision taken in concordance with the gold-standard. Parity was set at ≥80% agreement.The initial TCP (stage one) focussed on offline verification and decision making. Sixteen RTTs completed this stage, four achieved ≥80%. This was not sufficient to support clinical implementation.The TCP was redesigned, more stringent review guidelines and greater anatomy teaching was added. TCP stage two focussed on online verification and decision making supported by a decision flowchart. Twenty-one RTTs completed this TCP, all achieved ≥80%. This supported clinical implementation of RTT-led soft-tissue review under prospective audit conditions.The prospective audit was conducted between March 2017 and August 2017. Daily online review was performed by two trained RTTs. Online review and decision making proficiency was evaluated by a clinician. RESULTS Thirteen patients were included in the audit. Daily online RTT-led IGRT was achieved for all 343 fractions. Two-hundred CBCT images were reviewed offline by the clinician; the mean number of reviews per patient was 15. 192/200 (96%) RTT image reviews were in agreement with clinician review, presenting excellent concordance. DISCUSSION AND CONCLUSION Multidisciplinary involvement in training development, redesign of the TCP and inclusion of summative competency assessment were important factors to support RTT skill development. Consequently, RTT-led cervical cancer soft-tissue IGRT was clinically implemented in the hospital.
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Affiliation(s)
| | - N. Hopkins
- The Royal Marsden NHS Foundation Trust, United Kingdom
| | - S. Lalondrelle
- The Royal Marsden NHS Foundation Trust, United Kingdom
- The Institute of Cancer Research, United Kingdom
| | - A. Taylor
- The Royal Marsden NHS Foundation Trust, United Kingdom
- The Institute of Cancer Research, United Kingdom
| | - K. Titmarsh
- Formerly Kingston and St Georges University of London, United Kingdom
| | - H.A. McNair
- The Royal Marsden NHS Foundation Trust, United Kingdom
- The Institute of Cancer Research, United Kingdom
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