Document Type : Original Research
Authors
- Hussam Hameed Jassim 1, 2, 3
- Hassan A Nedaei 1, 2
- Nooshin Banaee 4
- Ghazale Geraily 1, 2
- Ali Kazemian 2
1 Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
2 Radiation Oncology Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Radiotherapy Physics, General Al-Najaf Al-Ashraf Hospital, Najaf, Iraq
4 Medical Radiation Research Center, Central Tehran Branch, Islamic Azad University, Tehran, Iran
Abstract
Background: Kilovoltage Cone Beam Computed Tomography (kVCBCT) is used for patient setup, monitoring the delivered dose, and adapting the treatment to changes in the patient’s condition. Radiation therapy has recently shifted from image guidance to dose guidance, resulting in accurately calculating the daily dose, calculated by re-simulating CT-based treatment planning, to increase the precision of the actual treatment dosage. The use of kVCBCT instead of re-simulated CT can simplify the patient pathway and reduce potential therapeutic errors by eliminating the need for additional simulation.
Objective: The present study aimed to assess the dosimetric effects of anatomical changes on prostate tumors using Deformation Image Registration (DIR) and kVCBCT.
Material and Methods: In this experimental study, eight patients with primary prostate cancer were treated with Volumetric Modulated Arc Therapy (VMAT), and kVCBCT images were obtained for each patient during the first treatment fraction. Both the planning CT (pCT) and kVCBCT images were imported into DIR software. The pCT was then deformed to the kVCBCT image and imported into a Treatment Planning System (TPS). A new contour was created on the deformed Computed Tomography (dCT) using Atlas-based Auto-segmentation (ABAS). Daily dCT plans were individually created based on the same planning principles using the new contours and also denoted dCTp1 through dCTp8. The outcomes of dose calculations were compared using Dose Volume Histograms (DVH), including mean Planning Target Volume (PTV) doses at the prescribed dose and dose volume limitations for the bladder and rectal wall.
Results: The mean doses to the PTV in the eight dCT-based plans were the same as those in the pCT-based plans. However, the mean doses to organs at risk in the dCT plans were different from those in the pCT plans. The mean doses to the bladder were on average 4% lower than those in the pCT plans, while the mean doses to the rectum were on average 8% higher than those in the pCT plans.
Conclusion: The use of VMAT based on kilovoltage kVCBCT and Deformtion Image Registration (DIR) can lead to re-decreasing the dose to the bladder while increasing that to the rectum, with the same PTV dose coverage.
Highlights
Hussam Hameed Jassim (PubMed)
Keywords
- Marin Anaya V, Fairfoul J. Assessing the feasibility of adaptive planning for prostate radiotherapy using Smartadapt deformable image registration. Med Eng Phys. 2019;64:65-73. doi: 10.1016/j.medengphy.2019.01.001. PubMed PMID: 30679023.
- Rigaud B, Simon A, Castelli J, Lafond C, Acosta O, Haigron P, et al. Deformable image registration for radiation therapy: principle, methods, applications and evaluation. Acta Oncol. 2019;58(9):1225-37. doi: 10.1080/0284186X.2019.1620331. PubMed PMID: 31155990.
- Yan D, Vicini F, Wong J, Martinez A. Adaptive radiation therapy. Phys Med Biol. 1997;42(1):123-32. doi: 10.1088/0031-9155/42/1/008. PubMed PMID: 9015813.
- Oh S, Kim S. Deformable image registration in radiation therapy. Radiat Oncol J. 2017;35(2):101-11. doi: 10.3857/roj.2017.00325. PubMed PMID: 28712282. PubMed PMCID: PMC5518453.
- Yang D, Chaudhari SR, Goddu SM, Pratt D, Khullar D, Deasy JO, El Naqa I. Deformable registration of abdominal kilovoltage treatment planning CT and tomotherapy daily megavoltage CT for treatment adaptation. Med Phys. 2009;36(2):329-38. doi: 10.1118/1.3049594. PubMed PMID: 19291972. PubMed PMCID: PMC5148039.
- Qin A, Sun Y, Liang J, Yan D. Evaluation of online/offline image guidance/adaptation approaches for prostate cancer radiation therapy. Int J Radiat Oncol Biol Phys. 2015;91(5):1026-33. doi: 10.1016/j.ijrobp.2014.12.043. PubMed PMID: 25832693.
- Giacometti V, Hounsell AR, McGarry CK. A review of dose calculation approaches with cone beam CT in photon and proton therapy. Phys Med. 2020;76:243-76. doi: 10.1016/j.ejmp.2020.06.017. PubMed PMID: 32736286.
- Jassim H, Nedaei HA, Geraily G, Banaee N, Kazemian A. The geometric and dosimetric accuracy of kilovoltage cone beam computed tomography images for adaptive treatment: a systematic review. BJR Open. 2023;5(1):20220062. doi: 10.1259/bjro.20220062. PubMed PMID: 37389008. PubMed PMCID: PMC10301728.
- Yang D, Brame S, El Naqa I, Aditya A, Wu Y, Goddu SM, et al. Technical note: DIRART--A software suite for deformable image registration and adaptive radiotherapy research. Med Phys. 2011;38(1):67-77. doi: 10.1118/1.3521468. PubMed PMID: 21361176. PubMed PMCID: PMC3017581.
- Brock KK, Mutic S, McNutt TR, Li H, Kessler ML. Use of image registration and fusion algorithms and techniques in radiotherapy: Report of the AAPM Radiation Therapy Committee Task Group No. 132. Medical Physics. 2017;44(7):e43-76. doi: 10.1002/mp.12256.
- Deasy JO, Blanco AI, Clark VH. CERR: a computational environment for radiotherapy research. Med Phys. 2003;30(5):979-85. doi: 10.1118/1.1568978. PubMed PMID: 12773007.
- Dice LR. Measures of the amount of ecologic association between species. 1945;26(3):297-302. doi: 10.2307/1932409.
- Giacometti V, King RB, Agnew CE, Irvine DM, Jain S, Hounsell AR, McGarry CK. An evaluation of techniques for dose calculation on cone beam computed tomography. Br J Radiol. 2019;92(1096):20180383. doi: 10.1259/bjr.20180383. PubMed PMID: 30433821. PubMed PMCID: PMC6540850.
- Yang Y, Schreibmann E, Li T, Wang C, Xing L. Evaluation of on-board kV cone beam CT (CBCT)-based dose calculation. Phys Med Biol. 2007;52(3):685-705. doi: 10.1088/0031-9155/52/3/011. PubMed PMID: 17228114.
- Ding GX, Duggan DM, Coffey CW, Deeley M, Hallahan DE, Cmelak A, Malcolm A. A study on adaptive IMRT treatment planning using kV cone-beam CT. Radiother Oncol. 2007;85(1):116-25. doi: 10.1016/j.radonc.2007.06.015. PubMed PMID: 17707938.
- Shinde P, Jadhav A, Shankar V, Dhoble SJ. Evaluation of the dosimetric influence of interfractional 6D setup error in hypofractionated prostate cancer treated with IMRT and VMAT using daily kV-CBCT. J Med Imaging Radiat Sci. 2022;53(4):693-703. doi: 10.1016/j.jmir.2022.09.026. PubMed PMID: 36289030.
- Laughlin BS, Lo S, Vargas CE, DeWees TA, Van Der Walt C, Tinnon K, et al. Clinical Practice Evolvement for Post-Operative Prostate Cancer Radiotherapy-Part 1: Consistent Organs at Risk Management with Advanced Image Guidance. Cancers (Basel). 2022;15(1):16. doi: 10.3390/cancers15010016. PMID: 36612013. PMCID: PMC9817677.
)