Dataset Information

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer.

ABSTRACT:

Background and purpose

Organ motion is a challenge during high-precision external beam radiotherapy in cervical cancer, and improved strategies for treatment adaptation and monitoring of target dose coverage are needed. This study evaluates a cone beam computed tomography (CBCT)-based approach.

Materials and methods

In twenty-three patients, individualized internal target volumes (ITVs) were generated from pre-treatment MRI and CT scans with full and empty bladders. The target volumes encompassed high-risk clinical target volume (CTV-T HR) (gross tumor volume?+?remaining cervix) and low risk (LR) CTV-T (CTV-T HR?+?uterus?+?parametriae?+?upper vagina). Volumetric Modulated Arc Therapy (VMAT) was used to deliver a dose of 45?Gy in 25 fractions. CBCTs were used for setup and for radiation therapists (RTTs) to evaluate the target coverage (inside/outside the planning target volume). CBCTs were reviewed offline. Estimates of the dose delivered with minimum (point) doses across all fractions to CTV-T HR (aim 42.75?Gy) and CTV-T LR (aim 40?Gy) were assessed. In patients with insufficient dose coverage, re-plans were generated based on previous imaging.

Results

Median (range) of the ITV-margins (mean of anterior-posterior margins) related to uterus and cervix was 1.2 (0.5-2.2 and 1.0-2.1) cm. RTTs were able to assess the target coverage in 90% of all CBCTs (505/563). With re-planning, one patient had considerable benefit (12.7?Gy increase of minimum dose) to CTV-T LR_vagina, four patients had improved dose to the CTV-T LR_uterus (1.2-1.8?Gy), and 3 patients did not benefit from re-planning.

Conclusions

Daily CBCT-based monitoring of target coverage by the RTTs has proven safe with limited workload. It allows for reduction in the treated volumes without compromising the target dose coverage.

SUBMITTER: Jensen NBK

PROVIDER: S-EPMC7807672 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer.

Jensen Nina Boje Kibsgaard NBK Assenholt Marianne Sanggaard MS Fokdal Lars Ulrik LU Vestergaard Anne A Schouboe Annette A Kjaersgaard Eva Bruun EB Boejen Annette A Nyvang Lars L Lindegaard Jacob Christian JC Tanderup Kari K

Physics and imaging in radiation oncology 20181220

<h4>Background and purpose</h4>Organ motion is a challenge during high-precision external beam radiotherapy in cervical cancer, and improved strategies for treatment adaptation and monitoring of target dose coverage are needed. This study evaluates a cone beam computed tomography (CBCT)-based approach.<h4>Materials and methods</h4>In twenty-three patients, individualized internal target volumes (ITVs) were generated from pre-treatment MRI and CT scans with full and empty bladders. The target vol ...[more]

PMID: 33458421

Similar Datasets

Project description:Background To evaluate the effects of dose to tumors and organs at risk (OARs) on inter-fractional anatomic changes. Methods We evaluated nine patients with cervical cancer treated with intensity-modulated radiotherapy (IMRT) (45 Gy in 25 fractions) using kV cone-beam computed tomography (CBCT) image guidance once or twice a week before treatment. For each patient, the original plan on the computed tomography (CT) image was copied to merged images, and then the fractional doses were calculated. Subsequently, deformable accumulated doses were obtained by summing the fractional absolute doses into a single dose in MIM Maestro software. The volume changes in the target and OARs were compared between the original CT and merged CBCT images, and the differences in the fractional and accumulated doses were also evaluated. Results Sixty-nine merged CBCT images were obtained and analyzed in this study. For the target areas, the volume changes in the clinical target volume (CTV) and planning target volume (PTV) reached −18.05% and −24.11% at most, respectively. The fractional D2% of the CTV and PTV was generally higher than the original plans, and the accumulated deviations were 2.27%±0.82% (P<0.01) and 2.42%±1.28% (P<0.01), respectively. The fractional D98% of the PTV was underdosed up to 18.28% for 78% of patients, and the accumulated deviations were −2.06% to −17.29% (P<0.05). For the OARs, the bladder volume changes were the most dramatic, reducing up to 93.60%. The fractional Dmean and D2cc of the bladder were generally higher than the original plans, and there were significant differences in their accumulated values (P<0.05). There was no obvious trend of rectal volume change with −69.65% to 74.20%. The rectum Dmean and D2cc of the accumulated were not significantly different from the planned dose (P>0.05). Conclusions For patients with cervical cancer, the changes in bladder and rectal volume were greater than in the target volume. Although the volume changes in the bladder and rectum had no significant effect on D98% of the CTV and PTV, they had a significant effect on their own D2cc and the D2% of the CTV and PTV. More attention should be paid to the volume changes in the bladder and rectum in clinical work.

Project description:BackgroundMotion-compensated (MoCo) reconstruction shows great promise in improving four-dimensional cone-beam computed tomography (4D-CBCT) image quality. MoCo reconstruction for a 4D-CBCT could be more accurate using motion information at the CBCT imaging time than that obtained from previous 4D-CT scans. However, such data-driven approaches are hampered by the quality of initial 4D-CBCT images used for motion modeling.PurposeThis study aims to develop a deep-learning method to generate high-quality motion models for MoCo reconstruction to improve the quality of final 4D-CBCT images.MethodsA 3D artifact-reduction convolutional neural network (CNN) was proposed to improve conventional phase-correlated Feldkamp-Davis-Kress (PCF) reconstructions by reducing undersampling-induced streaking artifacts while maintaining motion information. The CNN-generated artifact-mitigated 4D-CBCT images (CNN enhanced) were then used to build a motion model which was used by MoCo reconstruction (CNN+MoCo). The proposed procedure was evaluated using in-vivo patient datasets, an extended cardiac-torso (XCAT) phantom, and the public SPARE challenge datasets. The quality of reconstructed images for XCAT phantom and SPARE datasets was quantitatively assessed using root-mean-square-error (RMSE) and normalized cross-correlation (NCC).ResultsThe trained CNN effectively reduced the streaking artifacts of PCF CBCT images for all datasets. More detailed structures can be recovered using the proposed CNN+MoCo reconstruction procedure. XCAT phantom experiments showed that the accuracy of estimated motion model using CNN enhanced images was greatly improved over PCF. CNN+MoCo showed lower RMSE and higher NCC compared to PCF, CNN enhanced and conventional MoCo. For the SPARE datasets, the average (± standard deviation) RMSE in mm-1 for body region of PCF, CNN enhanced, conventional MoCo and CNN+MoCo were 0.0040 ± 0.0009, 0.0029 ± 0.0002, 0.0024 ± 0.0003 and 0.0021 ± 0.0003. Corresponding NCC were 0.84 ± 0.05, 0.91 ± 0.05, 0.91 ± 0.05 and 0.93 ± 0.04.ConclusionsCNN-based artifact reduction can substantially reduce the artifacts in the initial 4D-CBCT images. The improved images could be used to enhance the motion modeling and ultimately improve the quality of the final 4D-CBCT images reconstructed using MoCo.

Project description:PurposeTo demonstrate the feasibility of a dedicated breast computed tomography (bCT) platform to deliver rotational kilovoltage (kV) external beam radiotherapy (RT) for partial breast irradiation, whole breast irradiation, and dose painting.Methods and materialsRotational kV-external beam RT using the geometry of a prototype bCT platform was evaluated using a Monte Carlo simulator. A point source emitting 178 keV photons (approximating a 320-kVp spectrum with 4-mm copper filtration) was rotated around a 14-cm voxelized polyethylene disk (0.1 cm tall) or cylinder (9 cm tall) to simulate primary and primary plus scattered photon interactions, respectively. Simulations were also performed using voxelized bCT patient images. Beam collimation was varied in the x-y plane (1-14 cm) and in the z-direction (0.1-10 cm). Dose painting for multiple foci, line, and ring distributions was demonstrated using multiple rotations with varying beam collimation. Simulations using the scanner's native hardware (120 kVp filtered by 0.2-mm copper) were validated experimentally.ResultsAs the x-y collimator was narrowed, the two-dimensional dose profiles shifted from a cupped profile with a high edge dose to an increasingly peaked central dose distribution with a sharp dose falloff. Using a 1-cm beam, the cylinder edge dose was <7% of the dose deposition at the cylinder center. Simulations using 120-kVp X-rays showed distributions similar to the experimental measurements. A homogeneous dose distribution (<2.5% dose fluctuation) with a 20% decrease in dose deposition at the cylinder edge (i.e., skin sparing) was demonstrated by weighted summation of four dose profiles using different collimation widths. Simulations using patient bCT images demonstrated the potential for treatment planning and image-guided RT.ConclusionsRotational kV-external beam RT for partial breast irradiation, dose painting, and whole breast irradiation with skin sparing is feasible on a bCT platform with the potential for high-resolution image-guided RT.

Dataset Information

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer.

Background and purpose

Materials and methods

Results

Conclusions

Publications

Cone beam computed tomography-based monitoring and management of target and organ motion during external beam radiotherapy in cervical cancer.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets