Frequency of Large Intrafractional Target Motions During Spine Stereotactic Body Radiation Therapy

Wu, Jia-Rung; Wu, J.; Ballangrud, Åse M.; Mechalakos, J; Yamada, Josh; Lovelock, D. Michael

doi:10.1016/j.prro.2019.08.006

Cited by 8 publications

(9 citation statements)

References 17 publications

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“…This result is quite consistent with those of Hoogeeman et al [31], where 95% of the observed displacements were within 3 mm for an interval of 15 min. Similar conclusions were also recently reported in a paper by Wu et al [36], where treatment was stopped due to intra-fractional observed motion >2 mm in 6/1019 treatment sessions (median treatment time ~ 29 min).…”

Section: Discussionsupporting

confidence: 90%

“…The quantification of residual error for SBRT treatments to spinal metastasis has been the focus of several published works [19,[29][30][31][32][33][34][35][36][37], most referring to immobilized patients. The availability of tracking data for the current investigation provided information on the patients' movements throughout the entire treatment.…”

Section: Discussionmentioning

confidence: 99%

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Residual intra-fraction error in robotic spinal stereotactic body radiotherapy without immobilization devices

Rossi

Fiorino

Fodor

et al. 2020

Physics and Imaging in Radiation Oncology

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Background and purpose: Spinal stereotactic body radiotherapy (SBRT) involves large dose gradients and high geometrical accuracy is therefore required. The aim of this work was to assess residual intra-fraction error with a tracking robotic system for non-immobilized patients. Shifts from the first alignment (i.e. mimicking the unavailability of tracking) were also quantified. Materials and methods: Forty-two patients treated for spinal metastasis (128 fractions, 4220 images) were analyzed. Residual error was quantified as the difference between translations/rotations referring to consecutive x-ray images during delivery (tracking) and to the initial setup (no-tracking). The error distribution for each fraction/patient and the entire population was assessed for each axis/rotation angle. The impact of lesion sites, fractionation and patient's pain (VAS score) were investigated. Finally, the dosimetric impact of residual motion was quantified in the four most affected fractions. Results: Mean overall errors (OE) were near 0 (SD < 0.1 mm). Residual translations/rotations >1 mm/1 • were found in less than 1.5%/1% of measurements. Lesion site and fractionation showed no impact. The dosimetric impact in the most affected fractions was negligible. For "no-tracking", mean OE was <1 mm/0.5 • ; less than 2% of displacements were >2 mm/1 • within 10 min from the start of treatment with an increasing probability of shifts >2 mm over time. A significantly higher fraction of OE ≥ 2 mm was found for patients with pain in case of no-tracking. Conclusions: Spine tracking with a latest-generation robotic system is highly efficient for non-immobilized patients: residual error is time independent and close to 0. For delivery times >7-8 min, tracking should be considered as mandatory for non-immobilized patients.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Residual intra-fraction error in robotic spinal stereotactic body radiotherapy without immobilization devices

Rossi

Fiorino

Fodor

et al. 2020

Physics and Imaging in Radiation Oncology

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“…[7][8][9][10][11] Despite the use of immobilization devices, many studies have shown multi-millimeter motions during spinal/paraspinal SRS/SBRT. [10][11][12][13][14] Therefore, intrafraction motion management has been a critical element in such treatments. For instance, a hardware-focused method on platforms including CyberKnife (Accuray, Inc., Sunnyvale, CA, USA) and ExacTrac (BrainLAB AG, Feldkirchen, Germany) use the on-treatment orthogonal Xray images acquired with a pair of fix-mounted kV imaging systems.…”

Section: Introduction and Purposementioning

confidence: 99%

“…Stereotactic radiosurgery (SRS) or stereotactic body radiotherapy (SBRT) with intense dose 1,2 delivered in one to three fractions has been demonstrated highly effective in the management of metastatic or primary spinal malignancy 3–6 . However, due to the proximity of the spinal cord, the ablative dose, and the steep dose gradient, slight geometric inaccuracy of radiation delivery 7 could lead to significant risks of reduced local control or myelopathy 7–11 . Despite the use of immobilization devices, many studies have shown multi‐millimeter motions during spinal/paraspinal SRS/SBRT 10–14 .…”

Section: Introduction and Purposementioning

confidence: 99%

“…[3][4][5][6] However, due to the proximity of the spinal cord, the ablative dose, and the steep dose gradient, slight geometric inaccuracy of radiation delivery 7 could lead to significant risks of reduced local control or myelopathy. [7][8][9][10][11] Despite the use of immobilization devices, many studies have shown multi-millimeter motions during spinal/paraspinal SRS/SBRT. [10][11][12][13][14] Therefore, intrafraction motion management has been a critical element in such treatments.…”

Section: Introduction and Purposementioning

confidence: 99%

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Decompose kV projection using neural network for improved motion tracking in paraspinal SBRT

Cai

et al. 2021

Medical Physics

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Purpose On‐treatment kV images have been used in tracking patient motion. One challenge of markerless motion tracking in paraspinal SBRT is the reduced contrast when the X‐ray beam needs to pass through a large portion of the patient's body, for example, from the lateral direction. Besides, due to the spine's overlapping with the surrounding moving organs in the X‐ray images, auto‐registration could lead to potential errors. This work aims to automatically extract the spine component from the conventional 2D X‐ray images, to achieve more robust and more accurate motion management. Methods A ResNet generative adversarial network (ResNetGAN) consisting of one generator and one discriminator was developed to learn the mapping between 2D kV image and the reference spine digitally reconstructed radiograph (DRR). A tailored multi‐channel multi‐domain loss function was used to improve the quality of the decomposed spine image. The trained model took a 2D kV image as input and learned to generate the spine component of the X‐ray image. The training dataset included 1347 2D kV thoracic and lumbar region X‐ray images from 20 randomly selected patients, and the corresponding matched reference spine DRR. Another 226 2D kV images from the remaining four patients were used for evaluation. The resulted decomposed spine images and the original X‐ray images were registered to the reference spine DRRs, to compare the spine tracking accuracy. Results The decomposed spine image had the mean peak signal‐to‐noise ratio (PSNR) and structural similarity index measure (SSIM) of 60.08 and 0.99, respectively, indicating the model retained and enhanced the spine structure information in the original 2D X‐ray image. The decomposed spine image matching with the reference spine DRR had submillimeter accuracy (in mm) with a mean error of 0.13, 0.12, and a maximum of 0.58, 0.49 in the x‐ and y‐directions (in the imager coordinates), respectively. The accuracy improvement is robust in all lateral and anteroposterior X‐ray beam angles. Conclusion We developed a deep learning‐based approach to remove soft tissues in the kV image, leading to more accurate spine tracking in paraspinal SBRT.

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Stereotactic body radiation therapy for spine and non-spine bone metastases. GETUG (french society of urological radiation oncologists) recommendations using a national two-round modified Delphi survey

Vilotte

Pasquier

Blanchard

et al. 2022

Clinical and Translational Radiation Oncology

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Frequency of Large Intrafractional Target Motions During Spine Stereotactic Body Radiation Therapy

Cited by 8 publications

References 17 publications

Residual intra-fraction error in robotic spinal stereotactic body radiotherapy without immobilization devices

Residual intra-fraction error in robotic spinal stereotactic body radiotherapy without immobilization devices

Decompose kV projection using neural network for improved motion tracking in paraspinal SBRT

Stereotactic body radiation therapy for spine and non-spine bone metastases. GETUG (french society of urological radiation oncologists) recommendations using a national two-round modified Delphi survey

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