A study on the dosimetric accuracy of treatment planning for stereotactic body radiation therapy of lung cancer using average and maximum intensity projection images

Huang, Long; Park, Kwangyoul; Boike, Thomas; Lee, Pam; Papież, Lech; Solberg, Timothy D.; Ding, Chuxiong; Timmerman, Robert

doi:10.1016/j.radonc.2010.04.003

Cited by 58 publications

(52 citation statements)

References 20 publications

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“…The analysis of organ motion via positional extremes, as shown in this work, is integral to margin determination 10, 18. A MidP strategy, which uses the mean position of an organ throughout the respiratory cycle as the planning volume, margin has been studied in lung volumes and has been found to result in smaller volumes and less therapeutic radiation dose 19.…”

Section: Discussionmentioning

confidence: 99%

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Organ motion in pediatric high‐risk neuroblastoma patients using four‐dimensional computed tomography

Kannan

Teo

Solberg

et al. 2016

J Applied Clin Med Phys

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Purpose/objective(s)High‐risk neuroblastoma (HR‐NBL) requires multimodality treatment, including external beam radiation of the primary tumor site following resection. Radiotherapy planning must take into account motion of the target and adjacent normal anatomy, both of which are poorly understood in the pediatric population, and which may differ significantly from those in adults.Methods/materialsWe examined 4DCT scans of 15 consecutive pediatric patients treated for HR‐NBL, most with tumors in the abdominal cavity. The diaphragm and organs at risk were contoured at full inhale, full exhale, and on free‐breathing scans. Maximum displacement of organs between full inhale and full exhale was measured in the anterior, posterior, superior, inferior, left, and right directions, as was displacement of centroids in the A/P, S/I, and L/R axes. Contours on free‐breathing scans were compared to those on 4D scans.ResultsMaximum displacement was along the S/I axis, with the superior aspects of organs moving more than the inferior, implying organ compression with respiration. Liver and spleen exhibited the largest motion, which correlated strongly with the S/I motion of the diaphragm. The maximum organ motion observed in the abdomen and thorax were 4.5 mm and 7.4 mm, respectively, while maximum diaphragm displacement was 5.7 mm. Overall findings mirrored observations in adults, but with smaller magnitudes, as expected. No consistent margins could be added to the free‐breathing scans to encompass the motion determined using 4DCT.ConclusionsOrgan motion within the pediatric abdomen and pelvis is similar to that observed in adults, but with smaller magnitude. Precise margins to accommodate motion are patient‐specific, underscoring the need for 4DCT scanning when possible.

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Section: Discussionmentioning

confidence: 99%

“…Conversely, the use of maximum intensity projection (MIP) images can induce inaccuracies in motion assessment, particularly for irregular breathing patterns 10, 11. Organs in every other breathing phase were assessed to ensure that the union structure fully encompassed each organ's extreme positions in all breathing phases.…”

Section: Methodsmentioning

confidence: 99%

Organ motion in pediatric high‐risk neuroblastoma patients using four‐dimensional computed tomography

Kannan

Teo

Solberg

et al. 2016

J Applied Clin Med Phys

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“…13 Cork plates (density 0.26 g/cm 3 ) were inserted into the frame in order to model the aerated lung tissue as shown in Figure 1B. One acrylic cylindrical target size 25 mm × 10mm is embedded in the middle of the cork plates.…”

Section: Lung Phantommentioning

confidence: 99%

Extended distance non-isocentric treatment in stereotactic body radiation therapy (SBRT) for lung cancer

Huang

Papież

Papiez

et al. 2014

Int J Cancer Ther Oncol

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Purpose: To obtain the maximum differential non-coplanar beams angle for a faster dose dropping outside Plan Target Volume (PTV) for lung cancer treated by Stereotactic body radiation therapy (SBRT), an extended distance non-isocentric (EDNI) treatment method was explored and developed. Methods: The EDNI requires delivering of the treatment beam at 120 cm or farther for sauce axial distance (SAD) instead of standard 100 cm. This change provides a more compact dose distribution around PTV and the lower toxicity to organs at risk (OAR) due to benefit of 120 cm SAD and more choice of beam and couch angle. A hand calculation formula for the translation between 100 SAD and EDNI was used to verify the treatment plan results. A phantom for end to end study based on this EDNI technique was used to compare with standard 100 SAD deliveries for SBRT. Three patients who underwent SBRT treatment were randomly chosen to demonstrate the benefits of EDNI technique. These treatment re-plans were applied to EDNI and evaluated for conformal index (CI) of PTV, R50% of PTV, 2 cm distance (D2cm) of PTV and Maximum dose (Dmax) of OARs to compare with original clinical plans. Results: All of the cases delivered by the EDNI technique satisfied dose requirements of RTOG 0263 and showed a faster dose dropping outside of PTV than standard SAD deliveries. The distance from PTV after 1.5 cm for the EDNI technique had a smaller maximum dose and much lower standard deviation for dose distribution. The EDNI applied plans for patients showed less R50% and D2cm of PTV (P≤ 0.05), also similar results for Dmax of esophagus, trachea and spinal cord. Conclusion: The EDNI method enhances the capabilities of linear accelerators as far as the increased gradient of dose drop-off outside of PTV is concerned. More angular separation between beams leads to more compact dose distributions, which allow decreasing volume of high dose exposure in SBRT treatments and better dose distribution on sensitive organs to minimize the treatment toxicity.

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“…The proposed methodology for irregular breathing classification can impact the dose calculation for patient treatments [9], [10]. The highly irregularly breathing patient may be expected to have a much bigger internal target volume (ITV) than a regular one, where ITV contains the macroscopic cancer and an internal margin to take into account the variations due to organ motions [9].…”

mentioning

confidence: 99%

“…The highly irregularly breathing patient may be expected to have a much bigger internal target volume (ITV) than a regular one, where ITV contains the macroscopic cancer and an internal margin to take into account the variations due to organ motions [9]. Thus, the detection of irregular breathing motion before and during the external beam radiotherapy is desired for minimizing the safety margin [10].…”

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confidence: 99%

Irregular Breathing Classification From Multiple Patient Datasets Using Neural Networks

Lee

Motai

Weiss

et al. 2012

IEEE Trans. Inform. Technol. Biomed.

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Complicated breathing behaviors including uncertain and irregular patterns can affect the accuracy of predicting respiratory motion for precise radiation dose delivery [3-6, 25, 36]. So far investigations on irregular breathing patterns have been limited to respiratory monitoring of only extreme inspiration and expiration [37]. Using breathing traces acquired on a Cyberknife treatment facility, we retrospectively categorized breathing data into several classes based on the extracted feature metrics derived from breathing data of multiple patients. The novelty of this paper is that the classifier using neural networks can provide clinical merit for the statistical quantitative modeling of irregular breathing motion based on a regular ratio representing how many regular/irregular patterns exist within an observation period. We propose a new approach to detect irregular breathing patterns using neural networks, where the reconstruction error can be used to build the distribution model for each breathing class. The proposed irregular breathing classification used a regular ratio to decide whether or not the current breathing patterns were regular. The sensitivity, specificity, and receiver operating characteristic (ROC) curve of the proposed irregular breathing pattern detector was analyzed. The experimental results of 448 patients breathing patterns validated the proposed irregular breathing classifier.

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A study on the dosimetric accuracy of treatment planning for stereotactic body radiation therapy of lung cancer using average and maximum intensity projection images

Cited by 58 publications

References 20 publications

Organ motion in pediatric high‐risk neuroblastoma patients using four‐dimensional computed tomography

Organ motion in pediatric high‐risk neuroblastoma patients using four‐dimensional computed tomography

Extended distance non-isocentric treatment in stereotactic body radiation therapy (SBRT) for lung cancer

Irregular Breathing Classification From Multiple Patient Datasets Using Neural Networks

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