An online x‐ray based position validation system for prostate hypofractionated radiotherapy

Arumugam, Sankar; Sidhom, Mark; Xing, Aitang; Holloway, Lois

doi:10.1118/1.4940351

Cited by 19 publications

(17 citation statements)

References 29 publications

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“…To compare EPI and CBCT-B, the CBCT-B setup errors in the superior-inferior (SI) and anterior-posterior (AP) directions were first transformed into the V and U coordinate system of the EPI plane 13 so that a direct comparison could be performed in 2D. The 3D isocentre position shift as determined from the CBCT-B was transformed to a 2D shift in the EPI plane (V and U coordinate system) as described by Arumugam et al 26 Setup errors were acquired in three dimensions for CBCT-B and CBCT-S for direct comparison. Two experienced radiation therapists were involved in all image analysis and measurements to reduce inter-observer variability.…”

Section: Discussionmentioning

confidence: 99%

“…The 3D isocentre position shift as determined from the CBCT‐B was transformed to a 2D shift in the EPI plane (V and U coordinate system) as described by Arumugam et al26 Setup errors were acquired in three dimensions for CBCT‐B and CBCT‐S for direct comparison. Two experienced radiation therapists were involved in all image analysis and measurements to reduce inter‐observer variability.…”

Section: Methodsmentioning

confidence: 99%

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Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy

et al. 2016

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IntroductionTo compare the differences in setup errors measured with electronic portal image (EPI) and cone‐beam computed tomography (CBCT) in patients undergoing tangential breast radiotherapy (RT). Relationship between setup errors, body mass index (BMI) and breast size was assessed.MethodsTwenty‐five patients undergoing postoperative RT to the breast were consented for this study. Weekly CBCT scans were acquired and retrospectively registered to the planning CT in three dimensions, first using bony anatomy for bony registration (CBCT‐B) and again using breast tissue outline for soft tissue registration (CBCT‐S). Digitally reconstructed radiographs (DRR) generated from CBCT to simulate EPI were compared to the planning DRR using bony anatomy in the V (parallel to the cranio‐caudal axis) and U (perpendicular to V) planes. The systematic (Σ) and random (σ) errors were calculated and correlated with BMI and breast size.ResultsThe systematic and random errors for EPI (Σ V = 3.7 mm, Σ U = 2.8 mm and σ V = 2.9 mm, σ U = 2.5) and CBCT‐B (Σ V = 3.5 mm, Σ U = 3.4 mm and σ V = 2.8 mm, σ U = 2.8) were of similar magnitude in the V and U planes. Similarly, the differences in setup errors for CBCT‐B and CBCT‐S in three dimensions were less than 1 mm. Only CBCT‐S setup error correlated with BMI and breast size.Conclusions CBCT and EPI show insignificant variation in their ability to detect setup error. These findings suggest no significant differences that would make one modality considered superior over the other and EPI should remain the standard of care for most patients. However, there is a correlation with breast size, BMI and setup error as detected by CBCT‐S, justifying the use of CBCT‐S for larger patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy

et al. 2016

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“…Image guidance comprised an initial fiducial marker match and verification of soft tissue anatomy with cone beam computed tomography (CBCT). Intra-fraction image guidance was achieved using ExacTrac ® (Brainlab AG, Germany), triggered kV imaging (Varian medical systems, Palo Alto, USA), mid-treatment CBCT or an in-house real-time continuous kilovoltage fiducial marker tracking software (SeedTracker) (12).…”

Section: Methodsmentioning

confidence: 99%

Phase 2 Multicenter Study of Gantry-Based Stereotactic Radiotherapy Boost for Intermediate and High Risk Prostate Cancer (PROMETHEUS)

et al. 2019

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Objectives: To report feasibility, early toxicity, and PSA kinetics following gantry-based, stereotactic radiotherapy (SBRT) boost within a prospective, phase 2, multicenter study (PROMETHEUS: ACTRN12615000223538). Methods: Patients were treated with gantry-based SBRT, 19–20 Gy in two fractions delivered 1 week apart, followed by conventionally fractionated IMRT (46 Gy in 23 fractions). The study mandated MRI fusion for RT planning, rectal displacement, and intrafraction image guidance. Toxicity was prospectively graded using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v4). Results: Between March 2014 and July 2018, 135 patients (76% intermediate, 24% high-risk) with a median age of 70 years (range 53–81) were treated across five centers. Short course (≤6 months) androgen deprivation therapy (ADT) was used in 36% and long course in 18%. Rectal displacement method was SpaceOAR in 59% and Rectafix in 41%. Forty-two and ninety-three patients were treated at the 19 Gy and 20 Gy dose levels, respectively. Median follow-up was 24 months. Acute grade 2 gastrointestinal (GI) and urinary toxicity occurred in 4.4 and 26.6% with no acute grade 3 toxicity. At 6, 12, 18, 24, and 36 months post-treatment the prevalence of late grade ≥2 gastrointestinal toxicity was 1.6, 3.7, 2.2, 0, and 0%, respectively, and the prevalence of late grade ≥2 urinary toxicity was 0.8, 11, 12, 7.1, and 6.3%, respectively. Three patients experienced grade 3 late toxicity at 12 to 18 months which subsequently resolved to grade 2 or less. For patients not receiving ADT the median PSA value pre-treatment was 7.6 ug/L (1.1–20) and at 12, 24, and 36 months post-treatment was 0.86, 0.36, and 0.20 ug/L. Conclusions: Delivery of a gantry-based SBRT boost is feasible in a multicenter setting, is well-tolerated with low rates of early toxicity and is associated with promising PSA responses. A second transient peak in urinary toxicity was observed at 18 months which subsequently resolved. Follow-up is ongoing to document late toxicity, long-term patient reported outcomes, and tumor control with this approach.

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“…This is particularly true in the field of radiation oncology, where the implementation of increasingly sophisticated technologies requires increasingly complex processes to maintain the improving standard of care. To help address this challenge, software tools that improve the quality, safety and efficiency of clinical tasks are increasingly being developed in-house (Arumugam et al, 2016;Bakhtiari et al, 2011;Bhagroo et al, 2019;Chan et al, 2015;Edvardsson et al, 2018;Huang et al, 2021;Inaniwa & Kanematsu, 2018;Keall et al, 2014;Kimura et al, 2021;Kuo et al, 2020;Latala et al, 2020;Li et al, 2010;Maughan et al, 2019;Skouboe et al, 2019). Commercial options are often prohibitively expensive or insufficiently tailored to an individual clinic's needs.…”

Section: Statement Of Needmentioning

confidence: 99%

PyMedPhys: A community effort to develop an open, Python-based standard library for medical physics applications

Biggs¹,

Jennings²,

Swerdloff³

et al. 2022

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PyMedPhys is an open-source medical physics library built for Python by a diverse community that values and prioritizes code sharing, review, continuous improvement, and peer development. PyMedPhys aims to simplify and enhance both research and clinical work related to medical physics. It is inspired by the Astropy Project (Astropy Collaboration, 2013); a highly successful collaborative work of our physics peers in astronomy.

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An online x‐ray based position validation system for prostate hypofractionated radiotherapy

Cited by 19 publications

References 29 publications

Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy

Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy

Phase 2 Multicenter Study of Gantry-Based Stereotactic Radiotherapy Boost for Intermediate and High Risk Prostate Cancer (PROMETHEUS)

PyMedPhys: A community effort to develop an open, Python-based standard library for medical physics applications

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