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Title: SU-F-J-217: Accurate Dose Volume Parameters Calculation for Revealing Rectum Dose-Toxicity Effect Using Deformable Registration in Cervical Cancer Brachytherapy: A Pilot Study

Abstract

Purpose: To study the feasibility of employing deformable registration methods for accurate rectum dose volume parameters calculation and their potentials in revealing rectum dose-toxicity between complication and non-complication cervical cancer patients with brachytherapy treatment. Method and Materials: Data from 60 patients treated with BT including planning images, treatment plans, and follow-up clinical exam were retrospectively collected. Among them, 12 patients complained about hematochezia were further examined with colonoscopy and scored as Grade 1–3 complication (CP). Meanwhile, another 12 non-complication (NCP) patients were selected as a reference group. To seek for potential gains in rectum toxicity prediction when fractional anatomical deformations are account for, the rectum dose volume parameters D0.1/1/2cc of the selected patients were retrospectively computed by three different approaches: the simple “worstcase scenario” (WS) addition method, an intensity-based deformable image registration (DIR) algorithm-Demons, and a more accurate, recent developed local topology preserved non-rigid point matching algorithm (TOP). Statistical significance of the differences between rectum doses of the CP group and the NCP group were tested by a two-tailed t-test and results were considered to be statistically significant if p < 0.05. Results: For the D0.1cc, no statistical differences are found between the CP and NCP group in all threemore » methods. For the D1cc, dose difference is not detected by the WS method, however, statistical differences between the two groups are observed by both Demons and TOP, and more evident in TOP. For the D2cc, the CP and NCP cases are statistically significance of the difference for all three methods but more pronounced with TOP. Conclusion: In this study, we calculated the rectum D0.1/1/2cc by simple WS addition and two DIR methods and seek for gains in rectum toxicity prediction. The results favor the claim that accurate dose deformation and summation tend to be more sensitive in unveiling the dose-toxicity relationship. This work is supported in part by grant from VARIAN MEDICAL SYSTEMS INC, the National Natural Science Foundation of China (no 81428019 and no 81301940), the Guangdong Natural Science Foundation (2015A030313302)and the 2015 Pearl River S&T Nova Program of Guangzhou (201506010096).« less

Authors:
; ; ;  [1]; ; ;  [2]
  1. Southern Medical University, Guangzhou, Guangdong (China)
  2. UT Southwestern Medical Center, Dallas, TX (United States)
Publication Date:
OSTI Identifier:
22642244
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; ALGORITHMS; BRACHYTHERAPY; IMAGES; NEOPLASMS; PATIENTS; RADIATION DOSES; RECTUM; TOPOLOGY; TOXICITY

Citation Formats

Zhen, X, Chen, H, Liao, Y, Zhou, L, Hrycushko, B, Albuquerque, K, and Gu, X. SU-F-J-217: Accurate Dose Volume Parameters Calculation for Revealing Rectum Dose-Toxicity Effect Using Deformable Registration in Cervical Cancer Brachytherapy: A Pilot Study. United States: N. p., 2016. Web. doi:10.1118/1.4956125.
Zhen, X, Chen, H, Liao, Y, Zhou, L, Hrycushko, B, Albuquerque, K, & Gu, X. SU-F-J-217: Accurate Dose Volume Parameters Calculation for Revealing Rectum Dose-Toxicity Effect Using Deformable Registration in Cervical Cancer Brachytherapy: A Pilot Study. United States. doi:10.1118/1.4956125.
Zhen, X, Chen, H, Liao, Y, Zhou, L, Hrycushko, B, Albuquerque, K, and Gu, X. 2016. "SU-F-J-217: Accurate Dose Volume Parameters Calculation for Revealing Rectum Dose-Toxicity Effect Using Deformable Registration in Cervical Cancer Brachytherapy: A Pilot Study". United States. doi:10.1118/1.4956125.
@article{osti_22642244,
title = {SU-F-J-217: Accurate Dose Volume Parameters Calculation for Revealing Rectum Dose-Toxicity Effect Using Deformable Registration in Cervical Cancer Brachytherapy: A Pilot Study},
author = {Zhen, X and Chen, H and Liao, Y and Zhou, L and Hrycushko, B and Albuquerque, K and Gu, X},
abstractNote = {Purpose: To study the feasibility of employing deformable registration methods for accurate rectum dose volume parameters calculation and their potentials in revealing rectum dose-toxicity between complication and non-complication cervical cancer patients with brachytherapy treatment. Method and Materials: Data from 60 patients treated with BT including planning images, treatment plans, and follow-up clinical exam were retrospectively collected. Among them, 12 patients complained about hematochezia were further examined with colonoscopy and scored as Grade 1–3 complication (CP). Meanwhile, another 12 non-complication (NCP) patients were selected as a reference group. To seek for potential gains in rectum toxicity prediction when fractional anatomical deformations are account for, the rectum dose volume parameters D0.1/1/2cc of the selected patients were retrospectively computed by three different approaches: the simple “worstcase scenario” (WS) addition method, an intensity-based deformable image registration (DIR) algorithm-Demons, and a more accurate, recent developed local topology preserved non-rigid point matching algorithm (TOP). Statistical significance of the differences between rectum doses of the CP group and the NCP group were tested by a two-tailed t-test and results were considered to be statistically significant if p < 0.05. Results: For the D0.1cc, no statistical differences are found between the CP and NCP group in all three methods. For the D1cc, dose difference is not detected by the WS method, however, statistical differences between the two groups are observed by both Demons and TOP, and more evident in TOP. For the D2cc, the CP and NCP cases are statistically significance of the difference for all three methods but more pronounced with TOP. Conclusion: In this study, we calculated the rectum D0.1/1/2cc by simple WS addition and two DIR methods and seek for gains in rectum toxicity prediction. The results favor the claim that accurate dose deformation and summation tend to be more sensitive in unveiling the dose-toxicity relationship. This work is supported in part by grant from VARIAN MEDICAL SYSTEMS INC, the National Natural Science Foundation of China (no 81428019 and no 81301940), the Guangdong Natural Science Foundation (2015A030313302)and the 2015 Pearl River S&T Nova Program of Guangzhou (201506010096).},
doi = {10.1118/1.4956125},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: Accurate deformable image registration (DIR) between external beam radiotherapy (EBRT) and HDR brachytherapy (BT) CT images in cervical cancer is challenging. DSC has been evaluated only on the basis of the consistency of the structure, and its use does not guarantee an anatomically reasonable deformation. We evaluate the DIR accuracy for cervical cancer with DSC and anatomical landmarks using a 3D-printed pelvis phantom. Methods: A 3D-printed, deformable female pelvis phantom was created on the basis of the patient’s CT image. Urethane and silicon were used as materials for creating the uterus and bladder, respectively, in the phantom. We performedmore » DIR in two cases: case-A with a full bladder (170 ml) in both the EBRT and BT images and case-B with a full bladder in the BT image and a half bladder (100 ml) in the EBRT image. DIR was evaluated using DSCs and 70 uterus and bladder landmarks. A Hybrid intensity and structure DIR algorithm with two settings (RayStation) was used. Results: In the case-A, DSCs of the intensity-based DIR were 0.93 and 0.85 for the bladder and uterus, respectively, whereas those of hybrid-DIR were 0.98 and 0.96, respectively. The mean landmark error values of intensity-based DIR were 0.73±0.29 and 1.70±0.19 cm for the bladder and uterus, respectively, whereas those of Hybrid-DIR were 0.43±0.33 and 1.23±0.25 cm, respectively. In both cases, the Hybrid-DIR accuracy was better than the intensity-based DIR accuracy for both evaluation methods. However, for several bladder landmarks, the Hybrid-DIR landmark errors were larger than the corresponding intensity-based DIR errors (e.g., 2.26 vs 1.25 cm). Conclusion: Our results demonstrate that Hybrid-DIR can perform with a better accuracy than the intensity-based DIR for both DSC and landmark errors; however, Hybrid-DIR shows a larger landmark error for some landmarks because the technique focuses on both the structure and intensity.« less
  • Purpose: To compare the performance of two deformable image registration (DIR) algorithms for contour propagation and to evaluate the accuracy of DIR for use with high dose rate (HDR) brachytherapy planning for cervical cancer. Methods: Five patients undergoing HDR ring and tandem brachytherapy were included in this retrospective study. All patients underwent CT simulation and replanning prior to each fraction (3–5 fractions total). CT-to-CT DIR was performed using two commercially available software platforms: SmartAdapt, Varian Medical Systems (Demons) and Velocity AI, Velocity Medical Solutions (B-spline). Fraction 1 contours were deformed and propagated to each subsequent image set and compared tomore » contours manually drawn by an expert clinician. Dice similarity coefficients (DSC), defined as, DSC(A,B)=2(AandB)/(A+B) were calculated to quantify spatial overlap between manual (A) and deformed (B) contours. Additionally, clinician-assigned visual scores were used to describe and compare the performance of each DIR method and ultimately evaluate which was more clinically acceptable. Scoring was based on a 1–5 scale—with 1 meaning, “clinically acceptable with no contour changes” and 5 meaning, “clinically unacceptable”. Results: Statistically significant differences were not observed between the two DIR algorithms. The average DSC for the bladder, rectum and rectosigmoid were 0.82±0.08, 0.67±0.13 and 0.48±0.18, respectively. The poorest contour agreement was observed for the rectosigmoid due to limited soft tissue contrast and drastic anatomical changes, i.e., organ shape/filling. Two clinicians gave nearly equivalent average scores of 2.75±0.91 for SmartAdapt and 2.75±0.94 for Velocity AI—indicating that for a majority of the cases, more than one of the three contours evaluated required major modifications. Conclusion: Limitations of both DIR algorithms resulted in inaccuracies in contour propagation in the pelvic region, thus hampering the clinical utility of this technology. Further work is required to optimize these algorithms and take advantage of the potential of DIR for HDR brachytherapy planning.« less
  • Purpose: We introduce a new method combined with the deformable image registration (DIR) and regions-of-interest mapping (ROIM) technique to accurately calculate dose on daily CBCT for esophageal cancer. Methods: Patients suffered from esophageal cancer were enrolled in the study. Prescription was set to 66 Gy/30 F and 54 Gy/30 F to the primary tumor (PTV66) and subclinical disease (PTV54) . Planning CT (pCT) were segmented into 8 substructures in terms of their differences in physical density, such as gross target volume (GTV), venae cava superior (SVC), aorta, heart, spinal cord, lung, muscle and bones. The pCT and its substructures weremore » transferred to the MIM software to readout their mean HU values. Afterwards, a deformable planning CT to daily KV-CBCT image registration method was then utilized to acquire a new structure set on CBCT. The newly generated structures on CBCT were then transferred back to the treatment planning system (TPS) and its HU information were overridden manually with mean HU values obtained from pCT. Finally, the treatment plan was projected onto the CBCT images with the same beam arrangements and monitor units (MUs) to accomplish dose calculation. Planning target volume (PTV) and organs at risk (OARs) from both of the pCT and CBCT were compared to evaluate the dose calculation accuracy. Results: It was found that the dose distribution in the CBCT showed little differences compared to the pCT, regardless of whether PTV or OARs were concerned. Specifically, dose variation in GTV, PTV54, PTV66, SVC, lung and heart were within 0.1%. The maximum dose variation was presented in the spinal cord, which was up to 2.7% dose difference. Conclusion: The proposed method combined with DIR and ROIM technique to accurately calculate dose distribution on CBCT for esophageal cancer is feasible.« less
  • Purpose: To evaluate the severity of genitourinary (GU) toxicity in high-dose-rate (HDR) brachytherapy combined with hypofractionated external beam radiotherapy (EBRT) for prostate cancer and to explore factors that might affect the severity of GU toxicity. Methods and Materials: A total of 100 Japanese men with prostate cancer underwent {sup 192}Ir HDR brachytherapy combined with hypofractionated EBRT. Mean (SD) dose to 90% of the planning target volume was 6.3 (0.7) Gy per fraction of HDR. After 5 fractions of HDR treatment, EBRT with 10 fractions of 3 Gy was administrated. The urethral volume receiving 1-15 Gy per fraction in HDR brachytherapymore » (V1-V15) and the dose to at least 5-100% of urethral volume in HDR brachytherapy (D5-D100) were compared between patients with Grade 3 toxicity and those with Grade 0-2 toxicity. Prostate volume, patient age, and International Prostate Symptom Score were also compared between the two groups. Results: Of the 100 patients, 6 displayed Grade 3 acute GU toxicity, and 12 displayed Grade 3 late GU toxicity. Regarding acute GU toxicity, values of V1, V2, V3, and V4 were significantly higher in patients with Grade 3 toxicity than in those with Grade 0-2 toxicity. Regarding late GU toxicity, values of D70, D80, V12, and V13 were significantly higher in patients with Grade 3 toxicity than in those with Grade 0-2 toxicity. Conclusions: The severity of GU toxicity in HDR brachytherapy combined with hypofractionated EBRT for prostate cancer was relatively high. The volume of prostatic urethra was associated with grade of acute GU toxicity, and urethral dose was associated with grade of late GU toxicity.« less
  • Purpose: To compare the dose-volume histogram (DVH) parameters obtained by three-dimensional gynecologic brachytherapy planning with the rectosigmoid mucosal changes observed by flexible sigmoidoscopy. Methods and Materials: Between January 2004 and July 2005, 71 patients with International Federation of Gynecology and Obstetrics Stage IB-IIIB uterine cervical cancer underwent computed tomography-based high-dose-rate intracavitary brachytherapy. The total dose (external beam radiotherapy [RT] plus intracavitary brachytherapy) to the International Commission of Radiation Units and Measurements rectal point (ICRU{sub RP}) and DVH parameters for rectosigmoid colon were calculated using the equivalent dose in 2-Gy fractions ({alpha}/{beta} = 3 Gy). Sigmoidoscopy was performed every 6 monthsmore » after RT, with the 6-scale scoring system used to determine mucosal changes. Results: The mean values of the DVH parameters and ICRU{sub RP} were significantly greater in patients with a score of {>=}2 than in those with a score <2 at 12 months after RT (ICRU{sub RP}, 71 Gy{sub {alpha}}{sub /{beta}}{sub 3} vs. 66 Gy{sub {alpha}}{sub /{beta}}{sub 3}, p = 0.02; D{sub 0.1cc}, 93 Gy{sub {alpha}}{sub /{beta}}{sub 3} vs. 85 Gy{sub {alpha}}{sub /{beta}}{sub 3}, p = 0.04; D{sub 1cc}, 80 Gy{sub {alpha}}{sub /{beta}}{sub 3} vs. 73 Gy{sub {alpha}}{sub /{beta}}{sub 3}, p = 0.02; D{sub 2cc}, 75 Gy{sub {alpha}}{sub /{beta}}{sub 3} vs. 69 Gy{sub {alpha}}{sub /{beta}}{sub 3}, p = 0.02). The probability of a score of {>=}2 showed a significant relationship with the DVH parameters and ICRU{sub RP} (ICRU{sub RP}, p = 0.03; D{sub 0.1cc}, p = 0.05; D{sub 1cc}, p = 0.02; D{sub 2cc}, p = 0.02). Conclusion: Our preliminary data have shown that DVH values of the rectosigmoid colon obtained by computed tomography-based three-dimensional brachytherapy planning are reliable and predictive of score {>=}2 rectosigmoid mucosal changes.« less