Adaptive Dose Painting by Numbers for Head-and-Neck Cancer

Duprez, Frédéric; Neve, Wilfried De; Gersem, Werner De; Coghe, M.; Madani, Indira

doi:10.1016/j.ijrobp.2010.03.028

Cited by 161 publications

(112 citation statements)

References 26 publications

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“…Deformable image registration is used to map daily dose distributions to a common coordinate system, typically the original treatment plan, to create a cumulative dose distribution. The approach can be used to estimate the difference between the planned and delivered doses (36) or to study the need for re‐planning 37 , 38 …”

Section: Resultsmentioning

confidence: 99%

A measure to evaluate deformable registration fields in clinical settings

Schreibmann

Pantalone

Waller

et al. 2012

J Applied Clin Med Phys

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Deformable registration has migrated from a research topic to a widely used clinical tool that can improve radiotherapeutic treatment accuracy by tracking anatomical changes. Although various mathematical formulations have been reported in the literature and implemented in commercial software, we lack a straightforward method to verify a given solution in routine clinical use. We propose a metric using concepts derived from vector analysis that complements the standard evaluation tools to identify unrealistic wrappings in a displacement field. At the heart of the proposed procedure is identification of vortexes in the displacement field that do not correspond to underlying anatomical changes. Vortexes are detected and their intensity quantified using the CURL operator and presented as a vortex map overlaid on the original anatomy for rapid identification of problematic regions. We show application of the proposed metric on clinical scenarios of adaptive radiotherapy and treatment response assessment, where the CURL operator quantitatively detected errors in the displacement field and identified problematic regions that were invisible to classical voxel‐based evaluation methods. Unrealistic warping not visible to standard voxel‐based solution assessment can produce erroneous results when the deformable solution is applied on a secondary dataset, such as dose matrix in adaptive therapy or PET data for treatment response assessment. The proposed metric for evaluating deformable registration provides increased usability and accuracy of detecting unrealistic deformable registration solutions when compared to standard intensity‐based approaches. It is computationally efficient and provides a valuable platform for the clinical acceptance of image‐guided radiotherapy.PACS numbers: 87.57.nj; 87.55.Qr; 87.57.cp

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Section: Resultsmentioning

confidence: 99%

A measure to evaluate deformable registration fields in clinical settings

Schreibmann

Pantalone

Waller

et al. 2012

J Applied Clin Med Phys

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“…Although 18 F-FDG PET/CT is the molecular imaging technique with the highest clinical acceptance and availability (68,135), treatment adaption based on 18 F-FDG PET/CT is hampered by the inflammatory signal after radiotherapy. The potential use of 18 F-FDG PET/CT for adaptive tumor dose escalation or normaltissue sparing has been investigated in patients with NSCLC (135) and even coupled with dose painting in patients with head and neck cancer (68).…”

Section: Adaptationmentioning

confidence: 99%

“…The potential use of 18 F-FDG PET/CT for adaptive tumor dose escalation or normaltissue sparing has been investigated in patients with NSCLC (135) and even coupled with dose painting in patients with head and neck cancer (68). Both studies found significant changes in target (138) SPECT (138) MRI (138) volumes based on mid-therapy 18 F-FDG PET/CT images, warranting replanning of the treatment target.…”

Section: Adaptationmentioning

confidence: 99%

Molecular Imaging to Plan Radiotherapy and Evaluate Its Efficacy

2015

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Learning Objectives: On successful completion of this activity, participants should be able to describe (1) how to acquire high-quality molecular images for use in radiation therapy; (2) how molecular imaging can be used to plan radiotherapy and evaluate treatment efficacy; and (3) the limitations and challenges to widespread use of molecular imaging in radiation oncology.Financial Disclosure: The authors of this article have indicated no relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA Category 1 Credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through November 2018.Molecular imaging plays a central role in the management of radiation oncology patients. Specific uses of imaging, particularly to plan radiotherapy and assess its efficacy, require an additional level of reproducibility and image quality beyond what is required for diagnostic imaging. Specific requirements include proper patient preparation, adequate technologist training, careful imaging protocol design, reliable scanner technology, reproducible software algorithms, and reliable data analysis methods. As uncertainty in target definition is arguably the greatest challenge facing radiation oncology, the greatest impact that molecular imaging can have may be in the reduction of interobserver variability in target volume delineation and in providing greater conformity between target volume boundaries and true tumor boundaries. Several automatic and semiautomatic contouring methods based on molecular imaging are available but still need sufficient validation to be widely adopted. Biologically conformal radiotherapy (dose painting) based on molecular imaging-assessed tumor heterogeneity is being investigated, but many challenges remain to fully exploring its potential. Molecular imaging also plays increasingly important roles in both early (during treatment) and late (after treatment) response assessment as both a predictive and a prognostic tool. Because of potentially confounding effects of radiation-induced inflammation, treatment response assessment requires careful interpretation. Although molecular imaging is already strongly embedded in radiotherapy, the path to widespread and all-inclusive use is still long. The lack of solid clinical evidence is the main impediment to broader use. Recommendations for practicing physicians are still rather scarce. 18 F-FDG PET/CT remains the main molecular imaging modality in radiation oncology applications. Although other molecular imaging options (e.g., proliferation imaging) are becoming more common, their widespread use is limited ...

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“…32 Following Phase I, studies demonstrated the feasibility of adaptive 18 F-FDG-PET-voxel intensity-based intensity modulated radiotherapy (IMRT) using dose painting by numbers in patients with head and neck cancer as well the feasibility of using deformable image co-registration of a three-phase adaptive 18 F-FDG-PET-guided dose painting by numbers tool. 74,75 In a recent Phase I clinical trial, a dose escalation in 18 F-FDG regions and dose painting by numbers approach (i.e. dose prescription to voxels as a function of signal intensity of the corresponding voxel in a biological image) was used for adaptation of radiation treatment volumes based on 18 F-FDG-PET/CT-detected biological and anatomical changes at the end of the second week of treatment.…”

Section: Functional Bioimage-tailored Radiotherapy For Head and Neck mentioning

confidence: 99%

Validation of functional imaging as a biomarker for radiation treatment response

Jentsch¹,

Beuthien‐Baumann²,

Troost³

et al. 2015

BJR

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Major advances in radiotherapy techniques, increasing knowledge of tumour biology and the ability to translate these advances into new therapeutic approaches are important goals towards more individualized cancer treatment. With the development of non-invasive functional and molecular imaging techniques such as positron emission tomography (PET)-CT scanning and MRI, there is now a need to evaluate potential new biomarkers for tumour response prediction, for treatment individualization is not only based on morphological criteria but also on biological tumour characteristics. The goal of individualization of radiotherapy is to improve treatment outcome and potentially reduce chronic treatment toxicity. This review gives an overview of the molecular and functional imaging modalities of tumour hypoxia and tumour cell metabolism, proliferation and perfusion as predictive biomarkers for radiation treatment response in head and neck tumours and in lung tumours. The current status of knowledge on integration of PET/CT/MRI into treatment management and bioimage-guided adaptive radiotherapy are discussed.

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Adaptive Dose Painting by Numbers for Head-and-Neck Cancer

Cited by 161 publications

References 26 publications

A measure to evaluate deformable registration fields in clinical settings

A measure to evaluate deformable registration fields in clinical settings

Molecular Imaging to Plan Radiotherapy and Evaluate Its Efficacy

Validation of functional imaging as a biomarker for radiation treatment response

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