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Title: Feasibility of Image Registration and Intensity-Modulated Radiotherapy Planning With Hyperpolarized Helium-3 Magnetic Resonance Imaging for Non-Small-Cell Lung Cancer

Abstract

Purpose: To demonstrate the feasibility of registering hyperpolarized helium-3 magnetic resonance images ({sup 3}He-MRI) to X-ray computed tomography (CT) for functionally weighted intensity-modulated radiotherapy (IMRT) planning. Methods and Materials: Six patients with non-small-cell lung cancer underwent {sup 3}He ventilation MRI, which was fused with radiotherapy planning CT using rigid registration. Registration accuracy was assessed using an overlap coefficient, calculated as the proportion of the segmented {sup 3}He-MR volume (V{sub MRI} ) that intersects the segmented CT lung volume expressed as a percentage of V{sub MRI} . For each patient, an IMRT plan that minimized the volume of total lung receiving a dose {>=}20 Gy (V{sub 20} ) was compared with a plan that minimized the V{sub 20} to well-ventilated lung defined by the registered {sup 3}He-MRI. Results: The {sup 3}He-MRI and CT were registered with sufficient accuracy to enable functionally guided IMRT planning (median overlap, 89%; range, 72-97%). In comparison with the total lung IMRT plans, IMRT constrained with {sup 3}He-MRI reduced the V{sub 20} not only for the well-ventilated lung (median reduction, 3.1%; range, 0.4-5.1%; p = 0.028) but also for the total lung volume (median reduction, 1.6%; range, 0.2-3.7%; p 0.028). Conclusions: Statistically significant improvements to IMRT plansmore » are possible using functional information provided by {sup 3}He-MRI that has been registered to radiotherapy planning CT.« less

Authors:
 [1];  [2];  [3];  [4];  [3];  [5];  [5];  [5];  [6];  [5];  [7]
  1. Academic Unit of Radiology, University of Sheffield, Sheffield (United Kingdom) and Department of Radiotherapy Physics, Weston Park Hospital, Sheffield (United Kingdom). E-mail: r.ireland@sheffield.ac.uk
  2. Academic Unit of Medical Physics, University of Sheffield, Sheffield (United Kingdom)
  3. (United Kingdom)
  4. Department of Radiotherapy Physics, Weston Park Hospital, Sheffield (United Kingdom)
  5. Academic Unit of Radiology, University of Sheffield, Sheffield (United Kingdom)
  6. (United States)
  7. Academic Unit of Clinical Oncology, University of Sheffield, Sheffield (United Kingdom)
Publication Date:
OSTI Identifier:
20951643
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 68; Journal Issue: 1; Other Information: DOI: 10.1016/j.ijrobp.2006.12.068; PII: S0360-3016(07)00094-6; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ACCURACY; CARCINOMAS; COMPUTERIZED TOMOGRAPHY; HELIUM 3; IMAGES; LUNGS; NMR IMAGING; PATIENTS; PLANNING; RADIATION DOSES; RADIOTHERAPY; X RADIATION

Citation Formats

Ireland, Rob H., Bragg, Chris M., Department of Radiotherapy Physics, Weston Park Hospital, Sheffield, McJury, Mark, Department of Medical Physics, Belfast City Hospital Trust, Belfast, Northern Ireland, Woodhouse, Neil, Fichele, Stan, Beek, Edwin J.R. van, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, Wild, Jim M., and Hatton, Matthew Q. Feasibility of Image Registration and Intensity-Modulated Radiotherapy Planning With Hyperpolarized Helium-3 Magnetic Resonance Imaging for Non-Small-Cell Lung Cancer. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.12.068.
Ireland, Rob H., Bragg, Chris M., Department of Radiotherapy Physics, Weston Park Hospital, Sheffield, McJury, Mark, Department of Medical Physics, Belfast City Hospital Trust, Belfast, Northern Ireland, Woodhouse, Neil, Fichele, Stan, Beek, Edwin J.R. van, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, Wild, Jim M., & Hatton, Matthew Q. Feasibility of Image Registration and Intensity-Modulated Radiotherapy Planning With Hyperpolarized Helium-3 Magnetic Resonance Imaging for Non-Small-Cell Lung Cancer. United States. doi:10.1016/j.ijrobp.2006.12.068.
Ireland, Rob H., Bragg, Chris M., Department of Radiotherapy Physics, Weston Park Hospital, Sheffield, McJury, Mark, Department of Medical Physics, Belfast City Hospital Trust, Belfast, Northern Ireland, Woodhouse, Neil, Fichele, Stan, Beek, Edwin J.R. van, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, Wild, Jim M., and Hatton, Matthew Q. Tue . "Feasibility of Image Registration and Intensity-Modulated Radiotherapy Planning With Hyperpolarized Helium-3 Magnetic Resonance Imaging for Non-Small-Cell Lung Cancer". United States. doi:10.1016/j.ijrobp.2006.12.068.
@article{osti_20951643,
title = {Feasibility of Image Registration and Intensity-Modulated Radiotherapy Planning With Hyperpolarized Helium-3 Magnetic Resonance Imaging for Non-Small-Cell Lung Cancer},
author = {Ireland, Rob H. and Bragg, Chris M. and Department of Radiotherapy Physics, Weston Park Hospital, Sheffield and McJury, Mark and Department of Medical Physics, Belfast City Hospital Trust, Belfast, Northern Ireland and Woodhouse, Neil and Fichele, Stan and Beek, Edwin J.R. van and Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA and Wild, Jim M. and Hatton, Matthew Q.},
abstractNote = {Purpose: To demonstrate the feasibility of registering hyperpolarized helium-3 magnetic resonance images ({sup 3}He-MRI) to X-ray computed tomography (CT) for functionally weighted intensity-modulated radiotherapy (IMRT) planning. Methods and Materials: Six patients with non-small-cell lung cancer underwent {sup 3}He ventilation MRI, which was fused with radiotherapy planning CT using rigid registration. Registration accuracy was assessed using an overlap coefficient, calculated as the proportion of the segmented {sup 3}He-MR volume (V{sub MRI} ) that intersects the segmented CT lung volume expressed as a percentage of V{sub MRI} . For each patient, an IMRT plan that minimized the volume of total lung receiving a dose {>=}20 Gy (V{sub 20} ) was compared with a plan that minimized the V{sub 20} to well-ventilated lung defined by the registered {sup 3}He-MRI. Results: The {sup 3}He-MRI and CT were registered with sufficient accuracy to enable functionally guided IMRT planning (median overlap, 89%; range, 72-97%). In comparison with the total lung IMRT plans, IMRT constrained with {sup 3}He-MRI reduced the V{sub 20} not only for the well-ventilated lung (median reduction, 3.1%; range, 0.4-5.1%; p = 0.028) but also for the total lung volume (median reduction, 1.6%; range, 0.2-3.7%; p 0.028). Conclusions: Statistically significant improvements to IMRT plans are possible using functional information provided by {sup 3}He-MRI that has been registered to radiotherapy planning CT.},
doi = {10.1016/j.ijrobp.2006.12.068},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 68,
place = {United States},
year = {Tue May 01 00:00:00 EDT 2007},
month = {Tue May 01 00:00:00 EDT 2007}
}
  • Purpose: To compare and analyze the characteristics of intensity-modulated arc therapy(IMAT) versus fixed-gantry intensity-modulated radiotherapy(IMRT) in treatment of non-small-cell lung cancer. Methods: Twelve patients treated in our radiotherapy center were selected for this study. The patient subsequently underwent 4D-CT simulation.Margins of 5mm and 10mm were added to the ITV to generate the CTV and PTV respectively. Three treatment plans (IMRT,one single arc (RA1),double arcs (RA2))were generated with Eclipse ver.8.6 planning systems. Using a dose level of 75Gy in 15fractions to the ITV,60Gy in 15fractions to the CTV and 45Gy in 15fractions to the PTV respectively. The target and normol tissuemore » volumes were compared,as were the dosimetry parameters. Results: There were no significant differences in CI of ITV,PTV,HI of ITV,CTV and PTV, V5,V10,V15,V20,V25,V30,V45,V50 of total-lung and mean lung dose (all p>0.05). However, the differences were significant in terms of CI of CTV,V5 of B-P (all p<0.05). On the MU, IMRT=1540MU,RA1=1006 MU and RA2=1096 MU. (F=12.00,P=0.000).On the treatment time, IMRT= 13.5min,RA1= 1.5min,and RA2=2.5 min (F= 30.11,P=0.000 ). Conclusion: IMAT is equal to IMRT in dosimetril evaluation. Due to much less Mu and delivery time,IMAT is an ideal technique in treating patients by reduceing the uncomfortable influnce which could effect the treatment.« less
  • Purpose: To evaluate the potential for dose escalation with intensity-modulated radiotherapy (IMRT) in positron emission tomography-based radiotherapy planning for locally advanced non-small-cell lung cancer (LA-NSCLC). Methods and Materials: For 35 LA-NSCLC patients, three-dimensional conformal radiotherapy and IMRT plans were made to a prescription dose (PD) of 66 Gy in 2-Gy fractions. Dose escalation was performed toward the maximal PD using secondary endpoint constraints for the lung, spinal cord, and heart, with de-escalation according to defined esophageal tolerance. Dose calculation was performed using the Eclipse pencil beam algorithm, and all plans were recalculated using a collapsed cone algorithm. The normal tissuemore » complication probabilities were calculated for the lung (Grade 2 pneumonitis) and esophagus (acute toxicity, grade 2 or greater, and late toxicity). Results: IMRT resulted in statistically significant decreases in the mean lung (p <.0001) and maximal spinal cord (p = .002 and 0005) doses, allowing an average increase in the PD of 8.6-14.2 Gy (p {<=}.0001). This advantage was lost after de-escalation within the defined esophageal dose limits. The lung normal tissue complication probabilities were significantly lower for IMRT (p <.0001), even after dose escalation. For esophageal toxicity, IMRT significantly decreased the acute NTCP values at the low dose levels (p = .0009 and p <.0001). After maximal dose escalation, late esophageal tolerance became critical (p <.0001), especially when using IMRT, owing to the parallel increases in the esophageal dose and PD. Conclusion: In LA-NSCLC, IMRT offers the potential to significantly escalate the PD, dependent on the lung and spinal cord tolerance. However, parallel increases in the esophageal dose abolished the advantage, even when using collapsed cone algorithms. This is important to consider in the context of concomitant chemoradiotherapy schedules using IMRT.« less
  • Purpose: To evaluate the implications of differences between contours drawn manually and contours generated automatically by deformable image registration for four-dimensional (4D) treatment planning. Methods and Materials: In 12 lung cancer patients intensity-modulated radiotherapy (IMRT) planning was performed for both manual contours and automatically generated ('auto') contours in mid and peak expiration of 4D computed tomography scans, with the manual contours in peak inspiration serving as the reference for the displacement vector fields. Manual and auto plans were analyzed with respect to their coverage of the manual contours, which were assumed to represent the anatomically correct volumes. Results: Auto contoursmore » were on average larger than manual contours by up to 9%. Objective scores, D{sub 2%} and D{sub 98%} of the planning target volume, homogeneity and conformity indices, and coverage of normal tissue structures (lungs, heart, esophagus, spinal cord) at defined dose levels were not significantly different between plans (p = 0.22-0.94). Differences were statistically insignificant for the generalized equivalent uniform dose of the planning target volume (p = 0.19-0.94) and normal tissue complication probabilities for lung and esophagus (p = 0.13-0.47). Dosimetric differences >2% or >1 Gy were more frequent in patients with auto/manual volume differences {>=}10% (p = 0.04). Conclusions: The applied deformable image registration algorithm produces clinically plausible auto contours in the majority of structures. At this stage clinical supervision of the auto contouring process is required, and manual interventions may become necessary. Before routine use, further investigations are required, particularly to reduce imaging artifacts.« less
  • Purpose: Adaptive radiotherapy allows treatment plan modification based on data obtained during treatment. Assessing volume changes during treatment is now possible with intratreatment imaging capabilities on radiotherapy devices. This study assesses non-small-cell lung cancer (NSCLC) volume changes during treatment with conformal intensity-modulated radiotherapy by evaluating serial megavoltage computed tomography (MVCT) scans, with a specific emphasis on the frequency, reliability, and meaningfulness of these changes. Methods and Materials: Megavoltage CTs were retrospectively reviewed for 25 patients treated with the TomoTherapy Hi-Art system at University of Wisconsin. Twenty-one patients received definitive radiotherapy, 4 with extracranial stereotactic radioablation (60 Gy in five fractions)more » and 17 on a dose-per-fraction escalation protocol (57-80.5 Gy in 25 fractions). Four patients were treated palliatively (22-30 Gy in 8 to 10 fractions). Gross tumor volumes were contoured on serial MVCTs at weekly intervals. Each patient had 4 to 25 scans, including at least one at the beginning, midway, and one at the end of treatment. Results: At completion of treatment, no patient demonstrated a complete response. Partial response occurred in 3 (12%) and marginal response was noted in 5 (20%). The remaining 17 patients (68%) showed stable disease. The minimum 'scorable threshold' for volume discrepancy between scans to account for interscan assessment variability was set at >25% volume change; 10 patients (40%) had >25% tumor regression. None of the patients treated ablatively or palliatively showed tumor regression during treatment. Conclusions: Although gross tumor regression during treatment may be objectively measured using MVCTs, substantial volumetric decrease occurs only in a minority. The clinical significance of this regression is questionable, because there is no way to document histologic tumor clearance, and therefore field reductions during radiotherapy cannot be recommended.« less
  • Purpose: To compare dose volume histograms of intensity-modulated proton therapy (IMPT) with those of intensity-modulated radiation therapy (IMRT) and passive scattering proton therapy (PSPT) for the treatment of stage IIIB non-small-cell lung cancer (NSCLC) and to explore the possibility of individualized radical radiotherapy. Methods and Materials: Dose volume histograms designed to deliver IMRT at 60 to 63 Gy, PSPT at 74 Gy, and IMPT at the same doses were compared and the use of individualized radical radiotherapy was assessed in patients with extensive stage IIIB NSCLC (n = 10 patients for each approach). These patients were selected based on theirmore » extensive disease and were considered to have no or borderline tolerance to IMRT at 60 to 63 Gy, based on the dose to normal tissue volume constraints (lung volume receiving 20 Gy [V20] of <35%, total mean lung dose <20 Gy; spinal cord dose, <45 Gy). The possibility of increasing the total tumor dose with IMPT for each patient without exceeding the dose volume constraints (maximum tolerated dose [MTD]) was also investigated. Results: Compared with IMRT, IMPT spared more lung, heart, spinal cord, and esophagus, even with dose escalation from 63 Gy to 83.5 Gy, with a mean MTD of 74 Gy. Compared with PSPT, IMPT allowed further dose escalation from 74 Gy to a mean MTD of 84.4 Gy (range, 79.4-88.4 Gy) while all parameters of normal tissue sparing were kept at lower or similar levels. In addition, IMPT prevented lower-dose target coverage in patients with complicated tumor anatomies. Conclusions: IMPT reduces the dose to normal tissue and allows individualized radical radiotherapy for extensive stage IIIB NSCLC.« less