Daily online localization using implanted fiducial markers and its impact on planning target volume for carcinoma prostate

Khosa, Robin; Nangia, Sapna; Chufal, Kundan Singh; Ghosh, D.; Kaul, Rakesh; Sharma, Lalit Mohan

doi:10.4103/0973-1482.65244

Cited by 12 publications

(10 citation statements)

References 16 publications

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“…5. A smaller displacement in the AP direction was also reported by Khosa et al but using the supine position and immobilization with a thermoplastic shell [20]. As indicated before, rectal gas in the supine position without fixation devices can greatly affect the prostate position in the AP direction (Fig.…”

Section: Discussionsupporting

confidence: 64%

“…of PatientsMethodNo. of dataMargin (mm)APSILRSupine−Bylund et al [19]24MVCT without M9727.04.03.1Tanyi et al [24]14CBCT with M54610.28.91.6Nederveen et al [21]23EPID with M6757.511.93.1Osei et al [23]20EPID with M6426.67.44.4Alonso-Arrizabalaga et al [18]30ExacTrac with M133010.512.04.1O'Daniel et al [22]10kV CT without M24310.48.62.8Stroom et al [30]15kV CT without M2408.38.24.0+Khosa et al [20]10EPID with M1804.77.33.6Prone−Stroom et al [30]15kV CT without M240…”

Section: Discussionmentioning

confidence: 99%

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Assessment of interfractional prostate motion in patients immobilized in the prone position using a thermoplastic shell

Ikeda

Mizowaki

Sawada

et al. 2013

Journal of Radiation Research

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The aim of this study was to evaluate the interfractional prostate motion of patients immobilized in the prone position using a thermoplastic shell. A total of 24 patients with prostate calcifications detectable using a kilo-voltage X-ray image-guidance system (ExacTrac X-ray system) were examined. Daily displacements of the calcification within the prostate relative to pelvic bony structures were calculated by the ExacTrac X-ray system. The average displacement and standard deviation (SD) in each of the left–right (LR), anterior–posterior (AP), and superior–inferior (SI) directions were calculated for each patient. Based on the results of interfractional prostate motion, we also calculated planning target volume (PTV) margins using the van Herk formula and examined the validity of the PTV margin of our institute (a 9-mm margin everywhere except posteriorly, where a 6-mm margin was applied). In total, 899 data measurements from 24 patients were obtained. The average prostate displacements ± SD relative to bony structures were 2.8 ± 3.3, −2.0 ± 2.0 and 0.2 ± 0.4 mm, in the SI, AP and LR directions, respectively. The required PTV margins were 9.7, 6.1 and 1.4 mm in the SI, AP and LR directions, respectively. The clinical target volumes of 21 patients (87.5%) were located within the PTV for 90% or more of all treatment sessions. Interfractional prostate motion in the prone position with a thermoplastic shell was equivalent to that reported for the supine position. The PTV margin of our institute is considered appropriate for alignment, based on bony structures.

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

Assessment of interfractional prostate motion in patients immobilized in the prone position using a thermoplastic shell

Ikeda

Mizowaki

Sawada

et al. 2013

Journal of Radiation Research

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“…Different IGRT techniques include, but are not limited to ultrasound, 5,10 linear accelerator (Linac)-based kilovoltage (kV)/megavoltage (MV) x-rays, 3–6,11,12 in-room CT on rail, and kV or MV cone-beam CT (CBCT). 6,13 Ultrasound IGRT is typically based on soft tissue anatomy, not directly involving fiducial markers for guidance.…”

Section: Introductionmentioning

confidence: 99%

Qualitative Evaluation of Fiducial Markers for Radiotherapy Imaging

Chan

Cohen

Deasy

2014

Technol Cancer Res Treat

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Purpose To evaluate visibility, artifacts, and distortions of various commercial markers in magnetic resonance imaging (MRI), computer tomography (CT), and ultrasound imaging used for radiotherapy planning and treatment guidance. Methods We compare 2 solid gold markers, 4 gold coils, and 1 polymer marker from 3 vendors. Imaging modalities used were 3-T and 1.5-T GE MRIs, Siemens Sequoia 512 Ultrasound, Phillips Big Bore CT, Varian Trilogy linear accelerator (cone-beam CT [CBCT], on-board imager kilovoltage [OBI-kV], electronic portal imaging device megavoltage [EPID-MV]), and Medtronic O-ARM CBCT. Markers were imaged in a 30 × 30 × 10 cm3 custom bolus phantom. In one experiment, Surgilube was used around the markers to reduce air gaps. Images were saved in Digital Imaging and Communications in Medicine (DICOM) format and analyzed using an in-house software. Profiles across the markers were used for objective comparison of the markers’ signals. The visibility and artifacts/distortions produced by each marker were assessed qualitatively and quantitatively. Results All markers are visible in CT, CBCT, OBI-kV, and ultrasound. Gold markers below 0.75 mm in diameter are not visible in EPID-MV images. The larger the markers, the more CT and CBCT image artifacts there are, yet the degree of the artifact depends on scan parameters and the scanner itself. Visibility of gold coils of 0.75 mm diameter or larger is comparable across all imaging modalities studied. The polymer marker causes minimal artifacts in CT and CBCT but has poor visibility in EPID-MV. Gold coils of 0.5 mm exhibit poor visibility in MRI and EPID-MV due to their small size. Gold markers are more visible in 3-T T1 gradient-recalled echo than in 1.5-T T1 fast spin-echo, depending on the scan sequence. In this study, all markers are clearly visible on ultrasound. Conclusion All gold markers are visible in CT, CBCT, kV, and ultrasound; however, only the large diameter markers are visible in MV. When MR and EPID-MV imagers are used, the selection of fiducial markers is not straightforward. For hybrid kV/MV image-guided radiotherapy imaging, larger diameter markers are suggested. If using kV imaging alone, smaller sized markers may be used in smaller sized patients in order to reduce artifacts. Only larger diameter gold markers are visible across all imaging modalities.

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“…Full synthetic procedure including chemical characterization ( 1 H NMR, 13 C NMR, HRMS, and FTIR) is available in the Supporting Information.…”

Section: Methodsmentioning

confidence: 99%

“…[9][10][11] Such markers can improve treatment through optimized planning, tumor positioning accuracy, and tumor tracking resulting in more precise dose delivery and enable treatment of cancers, which are presently not eligible for radiotherapy. [ 12,13 ] Tissue markers currently used in the clinic are metal-based solid implants with large physical dimensions, which require complicated insertion procedures and therefore the risk of complications. Lung tumor insertion is especially problematic, with pneumothorax (reported in 33%-68% of patients) as well as bleeding being reported as primary complications.…”

Section: Introductionmentioning

confidence: 99%

Injectable Colloidal Gold for Use in Intrafractional 2D Image‐Guided Radiation Therapy

Jølck

Rydhög

Christensen

et al. 2015

Adv Healthcare Materials

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In the western world, approximately 50% of all cancer patients receive radiotherapy alone or in combination with surgery or chemotherapy. Image-guided radiotherapy (IGRT) has in recent years been introduced to enhance precision of the delivery of radiation dose to tumor tissue. Fiducial markers are often inserted inside the tumor to improve IGRT precision and to enable monitoring of the tumor position during radiation therapy. In the present article, a liquid fi ducial tissue marker is presented, which can be injected into tumor tissue using thin and fl exible needles. The liquid fi ducial has high radioopacity, which allows for marker-based image guidance in 2D and 3D X-ray imaging during radiation therapy. This is achieved by surface-engineering gold nanoparticles to be highly compatible with a carbohydrate-based gelation matrix. The new fi ducial marker is investigated in mice where they are highly biocompatible and stable after implantation. To investigate the clinical potential, a study is conducted in a canine cancer patient with spontaneous developed solid tumor in which the marker is successfully injected and used to align and image-guide radiation treatment of the canine patient. It is concluded that the new fi ducial marker has highly interesting properties that warrant investigations in cancer patients.

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Daily online localization using implanted fiducial markers and its impact on planning target volume for carcinoma prostate

Abstract: Daily alignment using gold fiducial markers is an effective method of localizing prostate displacement. It provides the option of reducing margins, thus limiting normal tissue toxicity and allowing the possibility of dose escalation for better long-term control.

Cited by 12 publications

References 16 publications

Assessment of interfractional prostate motion in patients immobilized in the prone position using a thermoplastic shell

Assessment of interfractional prostate motion in patients immobilized in the prone position using a thermoplastic shell

Qualitative Evaluation of Fiducial Markers for Radiotherapy Imaging

Injectable Colloidal Gold for Use in Intrafractional 2D Image‐Guided Radiation Therapy

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