1887
banner image
No data available.
Please log in to see this content.
You have no subscription access to this content.
No metrics data to plot.
The attempt to load metrics for this article has failed.
The attempt to plot a graph for these metrics has failed.
oa
A study of respiration-correlated cone-beam CT scans to correct target positioning errors in radiotherapy of thoracic cancer
Rent:
Rent this article for
Access full text Article
/content/aapm/journal/medphys/39/10/10.1118/1.4748503
1.
1.RTOG0617, “A randomized phase III comparison of standard-dose (60 Gy) versus high-dose (74 Gy) conformal radiotherapy with concurrent and consolidation carboplatin paclitaxel +/− cetuximab in patients with stage IIIA/IIIB non-small cell lung cancer” (2011) (available URL: http://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=0617). Last accessed April 30, 2012.
2.
2.RTOG1106, “Randomized phase II trial of individualized adaptive radiotherapy using during-treatment FDG-PET/CT and modern technology in locally advanced non-small cell lung cancer (NSCLC)” (2011) (available URL: http://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=1106). Last accessed April 30, 2012.
3.
3.J. P. Bissonnette, K. N. Franks, T. G. Purdie, D. J. Moseley, J. J. Sonke, D. A. Jaffray, L. A. Dawson, and A. Bezjak, “Quantifying interfraction and intrafraction tumor motion in lung stereotactic body radiotherapy using respiration-correlated cone beam computed tomography,” Int. J. Radiat. Oncol. Biol. Phys. 75, 688695 (2009).
http://dx.doi.org/10.1016/j.ijrobp.2008.11.066
4.
4.T. G. Purdie, D. J. Moseley, J. P. Bissonnette, M. B. Sharpe, K. Franks, A. Bezjak, and D. A. Jaffray, “Respiration correlated cone-beam computed tomography and 4DCT for evaluating target motion in Stereotactic Lung Radiation Therapy,” Acta Oncol. 45, 915922 (2006).
http://dx.doi.org/10.1080/02841860600907345
5.
5.I. S. Grills, G. Hugo, L. L. Kestin, A. P. Galerani, K. K. Chao, J. Wloch, and D. Yan, “Image-guided radiotherapy via daily online cone-beam CT substantially reduces margin requirements for stereotactic lung radiotherapy,” Int. J. Radiat. Oncol. Biol. Phys. 70, 10451056 (2008).
http://dx.doi.org/10.1016/j.ijrobp.2007.07.2352
6.
6.Z. Wang, J. W. Nelson, S. Yoo, Q. J. Wu, J. P. Kirkpatrick, L. B. Marks, and F. F. Yin, “Refinement of treatment setup and target localization accuracy using three-dimensional cone-beam computed tomography for stereotactic body radiotherapy,” Int. J. Radiat. Oncol. Biol. Phys. 73, 571577 (2009).
http://dx.doi.org/10.1016/j.ijrobp.2008.09.040
7.
7.J. J. Sonke, M. Rossi, J. Wolthaus, M. van Herk, E. Damen, and J. Belderbos, “Frameless stereotactic body radiotherapy for lung cancer using four-dimensional cone beam CT guidance,” Int. J. Radiat. Oncol. Biol. Phys. 74, 567574 (2009).
http://dx.doi.org/10.1016/j.ijrobp.2008.08.004
8.
8.K. Matsugi, Y. Narita, A. Sawada, M. Nakamura, Y. Miyabe, Y. Matsuo, M. Narabayashi, Y. Norihisa, T. Mizowaki, and M. Hiraoka, “Measurement of interfraction variations in position and size of target volumes in stereotactic body radiotherapy for lung cancer,” Int. J. Radiat. Oncol. Biol. Phys. 75, 543548 (2009).
http://dx.doi.org/10.1016/j.ijrobp.2008.12.091
9.
9.A. R. Yeung, J. G. Li, W. Y. Shi, H. E. Newlin, A. Chvetsov, C. R. Liu, J. R. Palta, and K. Olivier, “Tumor localization using cone-beam CT reduces setup margins in conventionally fractionated radiotherapy for lung tumors,” Int. J. Radiat. Oncol. Biol. Phys. 74, 11001107 (2009).
http://dx.doi.org/10.1016/j.ijrobp.2008.09.048
10.
10.J. P. Bissonnette, T. G. Purdie, J. A. Higgins, W. Li, and A. Bezjak, “Cone-beam computed tomographic image guidance for lung cancer radiation therapy,” Int. J. Radiat. Oncol. Biol. Phys. 73, 927934 (2009).
http://dx.doi.org/10.1016/j.ijrobp.2008.08.059
11.
11.X. Wang, R. Zhong, S. Bai, Q. Xu, Y. Zhao, J. Wang, X. Jiang, Y. Shen, F. Xu, and Y. Wei, “Lung tumor reproducibility with active breath control (ABC) in image-guided radiotherapy based on cone-beam computed tomography with two registration methods,” Radiother. Oncol. 99, 148154 (2011).
http://dx.doi.org/10.1016/j.radonc.2011.05.020
12.
12.G. X. Ding and C. W. Coffey, “Radiation dose from kilovoltage cone beam computed tomography in an image-guided radiotherapy procedure,” Int. J. Radiat. Oncol. Biol. Phys. 73, 610617 (2009).
http://dx.doi.org/10.1016/j.ijrobp.2008.10.006
13.
13.J. Chang, G. S. Mageras, E. Yorke, F. De Arruda, J. Sillanpaa, K. E. Rosenzweig, A. Hertanto, H. Pham, E. Seppi, A. Pevsner, C. C. Ling, and H. Amols, “Observation of interfractional variations in lung tumor position using respiratory gated and ungated megavoltage cone-beam computed tomography,” Int. J. Radiat. Oncol. Biol. Phys. 67, 15481558 (2007).
http://dx.doi.org/10.1016/j.ijrobp.2006.11.055
14.
14.E. C. Ford, G. S. Mageras, E. Yorke, and C. C. Ling, “Respiration-correlated spiral CT: A method of measuring respiratory-induced anatomic motion for radiation treatment planning,” Med. Phys. 30, 8897 (2003).
http://dx.doi.org/10.1118/1.1531177
15.
15.D. A. Low, M. Nystrom, E. Kalinin, P. Parikh, J. F. Dempsey, J. D. Bradley, S. Mutic, S. H. Wahab, T. Islam, G. Christensen, D. G. Politte, and B. R. Whiting, “A method for the reconstruction of four-dimensional synchronized CT scans acquired during free breathing,” Med. Phys. 30, 12541263 (2003).
http://dx.doi.org/10.1118/1.1576230
16.
16.T. Pan, T. Y. Lee, E. Rietzel, and G. T. Chen, “4D-CT imaging of a volume influenced by respiratory motion on multi-slice CT,” Med. Phys. 31, 333340 (2004).
http://dx.doi.org/10.1118/1.1639993
17.
17.S. S. Vedam, P. J. Keall, V. R. Kini, H. Mostafavi, H. P. Shukla, and R. Mohan, “Acquiring a four-dimensional computed tomography dataset using an external respiratory signal,” Phys. Med. Biol. 48, 4562 (2003).
http://dx.doi.org/10.1088/0031-9155/48/1/304
18.
18.T. F. Li, L. Xing, P. Munro, C. McGuinness, M. Chao, Y. Yang, B. Loo, and A. Koong, “Four-dimensional cone-beam computed tomography using an on-board imager,” Med. Phys. 33, 38253833 (2006).
http://dx.doi.org/10.1118/1.2349692
19.
19.J. Lu, T. M. Guerrero, P. Munro, A. Jeung, P. C. M. Chi, P. Balter, X. R. Zhu, R. Mohan, and T. Pan, “Four-dimensional cone beam CT with adaptive gantry rotation and adaptive data sampling,” Med. Phys. 34, 35203529 (2007).
http://dx.doi.org/10.1118/1.2767145
20.
20.J. J. Sonke, L. Zijp, P. Remeijer, and M. van Herk, “Respiratory correlated cone beam CT,” Med. Phys. 32, 11761186 (2005).
http://dx.doi.org/10.1118/1.1869074
21.
21.S. A. Kriminski, D. M. Lovelock, V. E. Seshan, I. Ali, P. Munro, H. I. Amols, Z. Fuks, M. Bilsky, and Y. Yamada, “Comparison of kilovoltage cone-beam computed tomography with megavoltage projection pairs for paraspinal radiosurgery patient alignment and position verification,” Int. J. Radiat. Oncol. Biol. Phys. 71, 15721580 (2008).
http://dx.doi.org/10.1016/j.ijrobp.2008.04.029
22.
22.T. Juhler-Nottrup, S. S. Korreman, A. N. Pedersen, G. F. Persson, L. R. Aarup, H. Nystrom, M. Olsen, N. Tarnavski, and L. Specht, “Interfractional changes in tumour volume and position during entire radiotherapy courses for lung cancer with respiratory gating and image guidance,” Acta Oncol. 47, 14061413 (2008).
http://dx.doi.org/10.1080/02841860802258778
23.
23.A. Harsolia, G. D. Hugo, L. L. Kestin, I. S. Grills, and D. Yan, “Dosimetric advantages of four-dimensional adaptive image-guided radiotherapy for lung tumors using online cone-beam computed tomography,” Int. J. Radiat. Oncol. Biol. Phys. 70, 582589 (2008).
http://dx.doi.org/10.1016/j.ijrobp.2007.08.078
24.
24.R. J. Ginsberg, E. E. Vokes, and K. Rosenzweig, “Non-small cell lung cancer,” in Cancer Principles and Practice of Oncology, edited by V. T. Devita, S. Hellman, and S. A. Rosenberg (Lippincott, Philadelphia, 2001), pp. 925983.
25.
25.J. Higgins, A. Bezjak, A. Hope, T. Panzarella, W. Li, J. B. C. Cho, T. Craig, A. Brade, A. Sun, and J. P. Bissonnette, “Effect of image-guidance frequency on geometric accuracy and setup margins in radiotherapy for locally advanced lung cancer,” Int. J. Radiat. Oncol. Biol. Phys. 80, 13301337 (2011).
http://dx.doi.org/10.1016/j.ijrobp.2010.04.006
26.
26.G. D. Hugo, J. A. Liang, J. Campbell, and D. Yan, “On-line target position localization in the presence of respiration: A comparison of two methods,” Int. J. Radiat. Oncol. Biol. Phys. 69, 16341641 (2007).
http://dx.doi.org/10.1016/j.ijrobp.2007.08.023
http://aip.metastore.ingenta.com/content/aapm/journal/medphys/39/10/10.1118/1.4748503
Loading
View: Figures

Figures

Image of FIG. 1.

Click to view

FIG. 1.

Coronal section from six phase-binned images of a respiration-correlated cone-beam CT (RC-CBCT) scan of Patient 4. Tumor is shown at cross hairs in each phase.

Image of FIG. 2.

Click to view

FIG. 2.

Example tumor trajectories in the anterior-posterior (A/P) and superior-inferior (S/I) directions, obtained from the respiration-correlated CT (RCCT) and one of the respiration-correlated cone-beam CT (RC-CBCT) image sets of Patient 11. Each point indicates displacement relative to the 50% phase reference point (approximately end expiration, EE) in the RCCT. Star symbol indicates the respiration average position in both image sets.

Image of FIG. 3.

Click to view

FIG. 3.

Graphical representation of procedure used to determine the displacement of the respiration-averaged gross tumor volume (GTV) position (“Resp avg position”) in the respiration-correlated cone-beam CT (RC-CBCT) relative to that in the respiration-correlated CT (RCCT). Circle and diamond symbols denote the GTV trajectory along anterior-posterior (AP) and superior-inferior (SI) directions in the RCCT and RC-CBCT image sets, respectively. Displacement of the respiration-averaged GTV (solid arrow) is derived from the sum of three vectors (dashed arrows): the displacement of the respiration-averaged GTV from the end-expiration (“Ref EE”) in the reference RCCT image; the corresponding displacement in the RC-CBCT; and displacement of the GTV at EE in the RC-CBCT relative to its EE position in the RCCT.

Image of FIG. 4.

Click to view

FIG. 4.

Flow chart of the clinical RC-CBCT guided (Type 1) correction process.

Image of FIG. 5.

Click to view

FIG. 5.

Example (Patient 1) of 3D deviations in GTV position on treatment fractions in which an RC-CBCT scan was acquired. Data labeled “GTV systematic” are the actual measurements resulting from the RC-CBCT guided (Type 1) correction shown in Fig. 4, whereas data for the other correction methods are retrospectively simulated as described in the text.

Image of FIG. 6.

Click to view

FIG. 6.

Mean 3D residual GTV position errors of GTV-based systematic (Type 1) correction, bony-based systematic (Type 2) correction, bony-based daily (Type 3) correction, and bony-based weekly (Type 4) correction versus patient. Error bars indicate 1-standard-deviation residual error.

Image of FIG. 7.

Click to view

FIG. 7.

Difference in mean GTV residual error between GTV-based systematic (Type 1) and bony-based systematic (Type 2) corrections, vs GTV motion extent in RCCT.

Image of FIG. 8.

Click to view

FIG. 8.

Difference in GTV superior-inferior displacement D S/I between respiration-correlated (RCCT-to-RC-CBCT) and respiration-averaged (AVE-IP-to-CBCT using all projections) image registration (circle symbols). Square symbols indicate maximum S/I displacement of the GTV from its end-expiration position in the RCCT scan.

Image of FIG. 9.

Click to view

FIG. 9.

Coronal section of Patient 1 in (a) the end-expiration respiration-correlated CT (RCCT) at simulation; (b) the end-expiration respiration-correlated cone-beam CT (RC-CBCT) at treatment 19 days later. Contours indicate the outline of the GTV drawn on the RCCT. Arrows in (b) indicate regions where the GTV in the cone-beam CT has grown outside the RCCT-defined GTV.

Image of FIG. 10.

Click to view

FIG. 10.

Overlay of coronal sections from the respiration-correlated CT (RCCT, blue enhanced) and respiration-correlated cone-beam CT (CBCT, red) of Patient 7. The images are aligned to the vertebral column. Yellow curve indicates outline of the GTV drawn on the RCCT; blue curve indicates location in the cone-beam CT of the GTV, which has shifted 14 mm posteriorly relative to the RCCT (arrow).

Loading

Article metrics loading...

/content/aapm/journal/medphys/39/10/10.1118/1.4748503
2012-09-11
2014-04-17

Abstract

Purpose:

There is increasingly widespread usage of cone-beam CT(CBCT) for guiding radiation treatment in advanced-stage lungtumors, but difficulties associated with daily CBCT in conventionally fractionated treatments include imaging dose to the patient, increased workload and longer treatment times. Respiration-correlated cone-beam CT (RC-CBCT) can improve localization accuracy in mobile lungtumors, but further increases the time and workload for conventionally fractionated treatments. This study investigates whether RC-CBCT-guided correction of systematic tumor deviations in standard fractionated lungtumorradiation treatments is more effective than 2D image-based correction of skeletal deviations alone. A second study goal compares respiration-correlated vs respiration-averaged images for determining tumor deviations.

Methods:

Eleven stage II–IV nonsmall cell lungcancer patients are enrolled in an IRB-approved prospective off-line protocol using RC-CBCT guidance to correct for systematic errors in GTV position. Patients receive a respiration-correlated planning CT (RCCT) at simulation, daily kilovoltage RC-CBCT scans during the first week of treatment and weekly scans thereafter. Four types of correction methods are compared: (1) systematic error in gross tumor volume (GTV) position, (2) systematic error in skeletal anatomy, (3) daily skeletal corrections, and (4) weekly skeletal corrections. The comparison is in terms of weighted average of the residual GTV deviations measured from the RC-CBCT scans and representing the estimated residual deviation over the treatment course. In the second study goal, GTV deviations computed from matching RCCT and RC-CBCT are compared to deviations computed from matching respiration-averaged images consisting of a CBCTreconstructed using all projections and an average-intensity-projection CT computed from the RCCT.

Results:

Of the eleven patients in the GTV-based systematic correction protocol, two required no correction, seven required a single correction, one required two corrections, and one required three corrections. Mean residual GTV deviation (3D distance) following GTV-based systematic correction (mean ± 1 standard deviation 4.8 ± 1.5 mm) is significantly lower than for systematic skeletal-based (6.5 ± 2.9 mm,p = 0.015), and weekly skeletal-based correction (7.2 ± 3.0 mm, p = 0.001), but is not significantly lower than daily skeletal-based correction (5.4 ± 2.6 mm, p = 0.34). In two cases, first-day CBCTimages reveal tumor changes—one showing tumor growth, the other showing large tumor displacement—that are not readily observed in radiographs. Differences in computed GTV deviations between respiration-correlated and respiration-averaged images are 0.2 ± 1.8 mm in the superior-inferior direction and are of similar magnitude in the other directions.

Conclusions:

An off-line protocol to correct GTV-based systematic error in locally advanced lungtumor cases can be effective at reducing tumor deviations, although the findings need confirmation with larger patient statistics. In some cases, a single cone-beam CT can be useful for assessing tumor changes early in treatment, if more than a few days elapse between simulation and the start of treatment.Tumor deviations measured with respiration-averaged CT and CBCTimages are consistent with those measured with respiration-correlated images; the respiration-averaged method is more easily implemented in the clinic.

Loading

Full text loading...

/deliver/fulltext/aapm/journal/medphys/39/10/1.4748503.html;jsessionid=12g9lqcr40tfd.x-aip-live-03?itemId=/content/aapm/journal/medphys/39/10/10.1118/1.4748503&mimeType=html&fmt=ahah&containerItemId=content/aapm/journal/medphys
true
true
This is a required field
Please enter a valid email address
752b84549af89a08dbdd7fdb8b9568b5 journal.articlezxybnytfddd
Scitation: A study of respiration-correlated cone-beam CT scans to correct target positioning errors in radiotherapy of thoracic cancer
http://aip.metastore.ingenta.com/content/aapm/journal/medphys/39/10/10.1118/1.4748503
10.1118/1.4748503
SEARCH_EXPAND_ITEM