首页期刊导航|Medical Physics
期刊信息/Journal information
Medical Physics
Published for the American Association of Physicists in Medicine by the American Institute of Physics
Medical Physics

Published for the American Association of Physicists in Medicine by the American Institute of Physics

0094-2405

Medical Physics/Journal Medical PhysicsSCIISTPEI
正式出版
收录年代

    Adaptive confidence regions for indirect tracking of moving tumors in radiotherapy

    Charlotte RemyHugo Bouchard
    11页
    查看更多>>摘要:Abstract Background Target motion in the course of radiotherapy is one of the largest factors affecting the treatment quality of highly dynamic sites such as lung. A critical component of real‐time motion management is not only the prediction of tumor location at a future point in time but assessment of positional uncertainty for the purposes of margin adjustment and optimization of validation?schemes. Purpose In this study, we propose to investigate the ability of a confidence estimator to accurately reflect the reliability of individual target position predictions and prospectively detect large prediction errors by relying exclusively on a surrogate?signal. Methods This work uses a Bayesian framework for indirect tracking. While constant covariance estimates are commonly used to express the uncertainty of the models involved, in this study new adaptive estimates are derived from the surrogate behavior to reflect increasing uncertainty when the breathing conditions differ from the reference conditions observed during the training step. The accuracy of the resulting 95% predicted confidence regions (CRs) is evaluated on nine breathing sequences involving changes of respiratory types (free, thoracic, abdominal, deep). The breathing motions are collected simultaneously from a lung target and two different surrogate signals (an external marker and an anatomical location within the liver). Receiver operating characteristic (ROC) analysis is performed to evaluate the ability of the predicted uncertainty to prospectively detect large prediction?errors. Results Higher CR accuracy is obtained when using the proposed adaptive estimates over using constant estimations: on average over the cohort, the proportion of actual target positions lying within the 95% CR is increased by 40 and 35 p.p. with the internal and external surrogates. The time‐dependent inflation of the CR width tends to match the magnitude variation of the prediction errors: the adaptive CR effectively enlarges when the target position cannot be predicted reliably, which corresponds to potentially high prediction errors. More precisely, the ROC analysis indicates that the proposed uncertainty estimate can detect if prediction errors are greater than 5 mm with on average high sensitivity (90%) and modest specificity (54% and 47% from internal and external surrogates, respectively). Conclusions While relying exclusively on the surrogate motion characteristics being continuously monitored, the Bayesian framework coupled to adaptive uncertainty estimations can provide reliable CR able to detect large prediction errors. The findings of this study could be further used to automatically trigger risk management mechanisms prospectively.

    A system‐based operational assessment of external beam radiotherapy

    Lawrence M. WongTodd Pawlicki
    9页
    查看更多>>摘要:Abstract Purpose Advanced technologies have led to improvements in modern radiotherapy over the years. However, adoption of advanced technologies can present challenges to existing clinical operations and negatively impact safety. The purpose of this work is to perform an assessment of modern radiotherapy for the operational objectives of safety, efficiency, and financial viability. Methods This work focuses on external beam radiotherapy (EBRT). The operational assessment included department management, treatment planning, treatment delivery, and associated workflows for three equipment configurations of Ethos, Halcyon, and TrueBeam with the ARIA information system, Eclipse treatment planning, and IDENTIFY surface guidance. Systems‐theoretic process analysis (STPA) was used to analyze the related workflows. Control actions, unsafe contexts of those control actions, and associated causal scenarios that can lead to unsafe radiation and non‐radiation physical injury (safety objective), reduced treatment capacity (efficiency objective), and costs that exceed budget (financial viability objective) were identified. Results The number of control actions (and causal scenarios) were 18 (254), 18 (267), and 20 (267) for the equipment configurations of Halcyon, TrueBeam, and Ethos, respectively. The extent that safety, efficiency, and financial viability were impacted is similar across the different equipment configurations, but there were some noteworthy differences related to information transfer and workflow bottlenecks potentially impacting access to care. Seventy‐five percent of the scenarios across all three configurations were related to safety. Overall, 29% of the scenarios impacted more than one operational objective and 48% were related to human decisions during the process of care. Planned or unplanned process changes were responsible for 8% of the causal scenarios. Conclusions Broad‐based clinical improvements may be realized by addressing causal scenarios that impact multiple objectives. Redesigning the roles and responsibilities of the clinical team and some aspects of the radiotherapy workflow may be helpful to fully realize the benefits of advanced technologies. Radiotherapy may benefit from additional tools to improve the consistency between decisions and actions when system or process changes occur.

    Toward automatic beam angle selection for pencil‐beam scanning proton liver treatments: A deep learning–based approach

    Robert KaderkaKeng‐Chi LiuLawrence LiuReynald VanderStraeten...
    12页
    查看更多>>摘要:Abstract Background Dose deposition characteristics of proton radiation can be advantageous over photons. Proton treatment planning, however, poses additional challenges for the planners. Proton therapy is usually delivered with only a small number of beam angles, and the quality of a proton treatment plan is largely determined by the beam angles employed. Finding the optimal beam angles for a proton treatment plan requires time and experience, motivating the investigation of automatic beam angle selection methods. Purpose A deep learning–based approach to automatic beam angle selection is proposed for the proton pencil‐beam scanning treatment planning of liver lesions. Methods We cast beam‐angle selection as a multi‐label classification problem. To account for angular boundary discontinuity, the underlying convolution neural network is trained with the proposed Circular Earth Mover's Distance–based regularization and multi‐label circular–smooth label technique. Furthermore, an analytical algorithm emulating proton treatment planners’ clinical practice is employed in post‐processing to improve the output of the model. Forty‐nine patients that received proton liver treatments between 2017 and 2020 were randomly divided into training (n?=?31), validation (n?=?7), and test sets (n?=?11). AI‐selected beam angles were compared with those angles selected by human planners, and the dosimetric outcome was investigated by creating plans using knowledge‐based treatment planning. Results For 7 of the 11 cases in the test set, AI‐selected beam angles agreed with those chosen by human planners to within 20° (median angle difference?=?10°; mean?=?18.6°). Moreover, out of the total 22 beam angles predicted by the model, 15 (68%) were within 10° of the human‐selected angles. The high correlation in beam angles resulted in comparable dosimetric statistics between proton treatment plans generated using AI‐ and human‐selected angles. For the cases with beam angle differences exceeding 20°, the dosimetric analysis showed similar plan quality although with different emphases on organ‐at‐risk sparing. Conclusions This pilot study demonstrated the feasibility of a novel deep learning–based beam angle selection technique. Testing on liver cancer patients showed that the resulting plans were clinically viable with comparable dosimetric quality to those using human‐selected beam angles. In tandem with auto‐contouring and knowledge‐based treatment planning tools, the proposed model could represent a pathway for nearly fully automated treatment planning in proton therapy.

    Intra‐arc binary collimation with dynamic axes trajectory optimization for the SRS treatment of multiple metastases with multiple prescriptions

    Eva LeeR. Lee MacDonaldChristopher G. ThomasAlasdair Syme...
    17页
    查看更多>>摘要:Abstract Purpose This work generates multi‐metastases cranial stereotactic radiosurgery/radiotherapy (SRS/SRT) plans using a novel treatment planning technique in which dynamic couch, collimator, and gantry trajectories are used with periodic binary target collimation. The performance of this planning technique is evaluated against conventional volumetric arc therapy (VMAT) planning in terms of various dose and plan quality metrics. Methods A 3D cost space (referred to herein as the combined optimization of dynamic axes or CODA cube) was calculated based on an overlap between targets and organs‐at‐risk (OARs) and uncollimated areas between targets (island blocking) for all combinations of couch, gantry, and collimator angles. Gradient descent through the cube was applied to determine dynamic trajectories. At each control point (CP), each target can either be conformally treated or blocked by the multi‐leaf collimator (referred to as intra‐arc binary collimation, iABC). Simulated annealing was used to optimize the collimation patterns throughout the arcs as well as the monitor units (MUs) delivered at each CP. Seven previously treated VMAT plans were selected for comparison against the CODA–iABC planning technique. Two CODA–iABC plans were developed: a single gantry arc plan and a plan with one gantry arc and two couch arcs. Plan quality comparison metrics included maximum and mean dose to OARs (brainstem, chiasm, optic nerves, eyes, and lenses), the volume of normal brain receiving 12?Gy (V12Gy), total MUs, target conformity, and dose‐gradient index. Results Treatment plans generated with 1‐arc CODA–iABC plans delivered an average of 21% and 30% higher maximum and mean doses to brainstem, respectively, when compared to VMAT plans. Treatment plans generated with 3‐arc CODA–iABC used an average of 24% fewer MUs and resulted in an average reduction of 48% maximum dose and 50% mean dose to the OARs, when compared to VMAT. Target conformity values were worse in both CODA–iABC plans than VMAT by an average of 35% and 15%, respectively. There are no significant differences in V12Gy for all three planning techniques; however, 3‐arc CODA–iABC is more effective at reducing dose to normal brain in the low‐dose region (<12?Gy). Conclusion CODA–iABC is a novel planning technique that has been developed to automatically generate patient‐specific multi‐axis trajectories for multiple metastases cranial SRS/SRT. This work has demonstrated the feasibility of planning with this novel method. The 1‐arc CODA–iABC planning technique is slightly dosimetric inferior to VMAT. With an increased sampling of a three‐dimensional CODA cube by using a 3‐arc CODA–iABC technique, there was improved total dose sparing to all the OARs and increased MU efficiency, but with a cost in target conformity, when compared to VMAT.

    Implementation of TG‐218 for patient‐specific quality assurance tolerance and action limits determination: Gamma passing rate evaluation using 3DVH software

    Despoina StasinouGeorge PatatoukasNikos KollarosStefanos Diamantopoulos...
    13页
    查看更多>>摘要:Abstract Purpose To determine the tolerance limit (TL) and action limit (AL) of gamma passing rates (%GP) for volumetric‐modulated arc therapy (VMAT) patient‐specific quality assurance (PSQA) according to the American Association of Physicists in Medicine (AAPM) Task Group (TG)‐218 recommendations, and to comparatively evaluate the clinical relevance of 2D %GP and 3D %GP. Methods PSQA was performed for 100 head and neck (H&N) and 73 prostate cancer VMAT treatment plans. Measurements were acquired using a cylindrical water equivalent phantom, hollow in the center, allowing measurements with homogeneous or heterogeneous inserts. The LINAC‐delivered dose distributions were compared to those calculated from the treatment planning system through the gamma index. TL and AL were determined through the computation of two‐dimensional (2D) %GP using the recommended acceptance criteria. Dose–volume histograms were reconstructed from the measurements using a commercially available software to detect the dosimetric errors (%DE) between the compared dose distributions. Utilizing the estimated dose on the patient anatomy, structure‐specific %GP (3D %GP) were calculated. The 3D %GP were compared to the 2D %GP ones based on their correlation with the %DE. Each metric's sensitivity was determined through receiver operator characteristic analysis. Results TL and AL were in concordance with the universal ones, regarding the prostate cancer cases, but were lower for the H&N cases. Evaluation of %DE did not deem the plans unacceptable. The 2D %GP and the 3D %GP did not differ significantly regarding their correlation with %DE. For prostate plans, %GP sensitivity was higher than for H&N cases. Conclusions Determination of institutional‐specific TL and AL allows the monitoring of the PSQA procedure, yet for plans close to the limits, clinically relevant metrics should be used before they are deemed unacceptable for the process to be of higher sensitivity and efficiency.

    A practical algorithm for VMAT optimization using column generation techniques

    Yuanbo WangHongcheng LiuYu YangBo Lu...
    18页
    查看更多>>摘要:Abstract Purpose As a challenging but important optimization problem, the inverse planning for volumetric modulated arc therapy (VMAT) has attracted much research attention. The column generation (CG) type method is so far one of the most effective solution schemes. However, it often relies on simplifications leading to significant gaps between the output and the actual feasible plan. This paper presents a novel column generation (NCG) approach to push the planning results substantially closer to?practice. Methods The proposed NCG algorithm is equipped with multiple new quality‐enhancing and computation‐facilitating modules as below: (1) Flexible constraints are enabled on both dose rates and treatment time to adapt to machine capabilities as well as planner's preferences, respectively; (2) a cross‐control‐point intermediate aperture simulation is incorporated to better conform to the underlying physics; (3) new pricing and pruning subroutines are adopted to achieve better optimization outputs. To evaluate the effectiveness of this NCG, five VMAT plans, that is, three prostate cases and two head‐and‐neck cases, were computed using proposed NCG. The planning results were compared with those yielded by a historical benchmark planning?scheme. Results The NCG generated plans of significantly better quality than the benchmark planning algorithm. For prostate cases, NCG plans satisfied all planning target volume (PTV) criteria whereas CG plans failed on D10% criteria of PTVs for over 9 Gy or more on all cases. For head‐and‐neck cases, again, NCG plans satisfied all PTVs criteria while CG plans failed on D10% criteria of PTVs for over 3 Gy or more on all cases as well as the max dose criteria of both cord and brain stem for over 13 Gy on one case. Moreover, the pruning scheme was found to be effective in enhancing the optimization?quality. Conclusions The proposed NCG inherits the computational advantages of the traditional CG, while capturing a more realistic characterization of the machine capability and underlying physics. The output solutions of the NCG are substantially closer to practical?implementation.

    A deep learning method for translating 3DCT to SPECT ventilation imaging: First comparison with 81mKr‐gas SPECT ventilation imaging

    Tomohiro KajikawaNoriyuki KadoyaYosuke MaeharaHiroshi Miura...
    12页
    查看更多>>摘要:Abstract Purpose This study aimed to evaluate the accuracy of deep learning (DL)‐based computed tomography (CT) ventilation imaging (CTVI). Methods A total of 71 cases that underwent single‐photon emission CT 81mKr‐gas ventilation (SPECT V) and CT imaging were included. Sixty cases were assigned to the training and validation sets, and the remaining 11 cases were assigned to the test set. To directly transform three‐dimensional (3D) CT (free‐breathing CT) images to SPECT V images, a DL‐based model was implemented based on the U‐Net architecture. The input and output data were 3DCT‐ and SPECT V‐masked, respectively, except for whole‐lung volumes. These data were rearranged in voxel size, registered rigidly, cropped, and normalized in preprocessing. In addition to a standard estimation method (i.e., without dropout during the estimation process), a Monte Carlo dropout (MCD) method (i.e., with dropout during the estimation process) was used to calculate prediction uncertainty. To evaluate the two models’ (CTVIMCD U‐Net, CTVIU‐Net) performance, we used fivefold cross‐validation for the training and validation sets. To test the final model performances for both approaches, we applied the test set to each trained model and averaged the test prediction results from the five trained models to acquire the mean test result (bagging) for each approach. For the MCD method, the models were predicted repeatedly (sample size?=?200), and the average and standard deviation (SD) maps were calculated in each voxel from the predicted results: The average maps were defined as test prediction results in each fold. As an evaluation index, the voxel‐wise Spearman rank correlation coefficient (Spearman rs) and Dice similarity coefficient (DSC) were calculated. The DSC was calculated for three functional regions (high, moderate, and low) separated by an almost equal volume. The coefficient of variation was defined as prediction uncertainty, and these average values were calculated within three functional regions. The Wilcoxon signed‐rank test was used to test for a significant difference between the two DL‐based approaches. Results The average indexes with one SD (1SD) between CTVIMCD U‐Net and SPECT V were 0.76 ± 0.06, 0.69 ± 0.07, 0.51 ± 0.06, and 0.75 ± 0.04 for Spearman rs, DSChigh, DSCmoderate, and DSClow, respectively. The average indexes with 1SD between CTVIU‐Net and SPECT V were 0.72 ± 0.05, 0.66 ± 0.04, 0.48 ± 0.04, and 0.74 ± 0.06 for Spearman rs, DSChigh, DSCmoderate, and DSClow, respectively. These indexes between CTVIMCD U‐Net and CTVIU‐Net showed no significance difference (Spearman rs, p?=?0.175; DSChigh, p?=?0.123; DSCmoderate, p?=?0.278; DSClow, p?=?0.520). The average coefficient of variations with 1SD were 0.27 ± 0.00, 0.27 ± 0.01, and 0.36 ± 0.03 for the high‐, moderate‐, and low‐functional regions, respectively, and the low‐functional region showed a tendency to exhibit larger uncertainties than the others. Conclusion We evaluated DL‐based framework for estimating lung‐functional ventilation images only from CT images. The results indicated that the DL‐based approach could potentially be used for lung‐ventilation estimation.

    Technical note: Low‐cost MR‐compatible pneumatic respiratory organ motion simulator for the development of MR‐guided thermal therapy

    Kisoo KimPeter JonesChris DiederichEugene Ozhinsky...
    7页
    查看更多>>摘要:Abstract Background In magnetic resonance (MR)‐guided thermal therapy, respiratory motion can cause a significant temperature error in MR thermometry and reduce the efficiency of the treatment. A respiratory motion simulator is necessary for the development of new MR imaging (MRI) and motion compensation techniques. Purpose The purpose of this study is to develop a low‐cost and simple MR‐compatible respiratory motion simulator to support proof‐of‐concept studies of MR monitoring approaches with respiratory‐induced abdominal organ motion. Methods The phantom motion system integrates pneumatic control via an actuator subsystem located outside the MRI and coupled via plastic tubing to a compressible bag for distention and retraction within the MRI safe motion subsystem and phantom positioned within the MRI scanner. Performance of the respiratory motion simulator was evaluated with a real‐time gradient echo MRI pulse sequence. Results The motion simulator can produce respiratory rates in the range of 8–16 breaths/min. Our experiments showed the consistent periodic motion of the phantom during MRI acquisition in the range of 3.7–9?mm with 16 breaths/min. The operation of the simulator did not cause interference with MRI acquisition. Conclusions In this study, we have demonstrated the ability of the motion simulator to generate controlled respiratory motion of a phantom. The low‐cost MR‐compatible respiratory motion simulator can be easily constructed from off‐the‐shelf and 3D‐printed parts based on open‐source 3D models and instructions. This could lower the barriers to the development of new MRI techniques with motion compensation.

    Nuclear‐medicine probes: Where we are and where we are going

    Andrea Gonzalez‐MontoroCesar David Vera‐DonosoGeorgios KonstantinouJose Maria Benlloch...
    19页
    查看更多>>摘要:Abstract Nuclear medicine probes turned into the key for the identification and precise location of sentinel lymph nodes and other occult lesions (i.e., tumors) by using the systemic administration of radiotracers. Intraoperative nuclear probes are key in the surgical management of some malignancies as well as in the determination of positive surgical margins, thus reducing the extent and potential surgery morbidity. Depending on their application, nuclear probes are classified into two main categories, namely, counting and imaging. Although counting probes present a simple design, are handheld (to be moved rapidly), and provide only acoustic signals when detecting radiation, imaging probes, also known as cameras, are more hardware‐complex and also able to provide images but at the cost of an increased intervention time as displacing the camera has to be done slowly. This review article begins with an introductory section to highlight the relevance of nuclear‐based probes and their components as well as the main differences between ionization‐ (semiconductor) and scintillation‐based probes. Then, the most significant performance parameters of the probe are reviewed (i.e., sensitivity, contrast, count rate capabilities, shielding, energy, and spatial resolution), as well as the different types of probes based on the target radiation nature, namely: gamma (γ), beta (β) (positron and electron), and Cherenkov. Various available intraoperative nuclear probes are finally compared in terms of performance to discuss the state‐of‐the‐art of nuclear medicine probes. The manuscript concludes by discussing the ideal probe design and the aspects to be considered when selecting nuclear‐medicine probes.

    Patient‐specific radiation risk‐based tube current modulation for diagnostic CT

    Laura KleinChang LiuJ?rg SteidelLucia Enzmann...
    13页
    查看更多>>摘要:Abstract Purpose Modern CT scanners use automatic exposure control (AEC) techniques, such as tube current modulation (TCM), to reduce dose delivered to patients while maintaining image quality. In contrast to conventional approaches that minimize the tube current time product of the CT scan, referred to as mAsTCM in the following, we herein propose a new method referred to as riskTCM, which aims at reducing the radiation risk to the patient by taking into account the specific radiation risk of every dose‐sensitive?organ. Methods For current mAsTCM implementations, the mAs product is used as a surrogate for the patient dose. Thus, they do not take into account the varying dose sensitivity of different organs. Our riskTCM framework assumes that a coarse CT reconstruction, an organ segmentation, and an estimation of the dose distribution can be provided in real time, for example, by applying machine learning techniques. Using this information, riskTCM determines a tube current curve that minimizes a patient risk measure, for example, the effective dose, while keeping the image quality constant. We retrospectively applied riskTCM to 20 patients covering all relevant anatomical regions and tube voltages from 70 to 150 kV. The potential reduction of effective dose at same image noise is evaluated as a figure?of merit and compared to mAsTCM and to a situation with a constant tube current referred to as?noTCM. Results Anatomical regions like the neck, thorax, abdomen, and the pelvis benefit from the proposed riskTCM. On average, a reduction of effective dose of about 23% for the thorax, 31% for the abdomen, 24% for the pelvis, and 27% for the neck has been evaluated compared to today's state‐of‐the‐art mAsTCM. For the head, the resulting reduction of effective dose is lower, about 13% on average compared to?mAsTCM. Conclusions With a risk‐minimizing TCM, significant higher reduction of effective dose compared to mAs‐minimizing TCM is?possible.