Pub Date : 2024-10-28DOI: 10.1088/1361-6560/ad8859
Mark Ka Heng Chan, Ying Zhang
Objective.This study proposes a robust optimization (RO) strategy utilizing virtual CTs (vCTs) predicted by an anatomical model in intensity-modulated proton therapy (IMPT) for nasopharyngeal cancer (NPC).Methods and Materials.For ten NPC patients, vCTs capturing anatomical changes at different treatment weeks were generated using a population average anatomy model. Two RO strategies of a 6 beams IMPT with 3 mm setup uncertainty (SU) and 3% range uncertainty (RU) were compared: conventional robust optimization (cRO) based on a single planning CT (pCT), and anatomical RO incorporating 2 and 3 predicted anatomies (aRO2 and aRO3). The robustness of these plans was assessed by recalculating them on weekly CTs (week 2-7) and extracting the voxel wise-minimum and maximum doses with 1 mm SU and 3% RU (voxminvoxmax1mm3%).Results.The aRO plans demonstrated improved robustness in high-risk CTV1 and low-risk CTV 2 coverage compared to cRO plans. The weekly evaluation showed a lower plan adaptation rate for aRO3 (40%) vs. cRO (70%). The weekly nominal and voxmax1mm3%doses to OARs, especially spinal cord, are better controlled relative to their baseline doses at week 1 with aRO plans. The accumulated dose analysis showed that CTV1&2 had adequate coverage and serial organs (spinal cord and brainstem) were within their dose tolerances in the voxminvoxmax1mm3%, respectively.Conclusion.Incorporating predicted weekly CTs from a population based average anatomy model in RO improves week-to-week target dose coverage and reduces false plan adaptations without increasing normal tissue doses. This approach enhances IMPT plan robustness, potentially facilitating reduced SU and further lowering OAR doses.
{"title":"Robust optimization incorporating weekly predicted anatomical CTs in IMPT of nasopharyngeal cancer.","authors":"Mark Ka Heng Chan, Ying Zhang","doi":"10.1088/1361-6560/ad8859","DOIUrl":"10.1088/1361-6560/ad8859","url":null,"abstract":"<p><p><i>Objective.</i>This study proposes a robust optimization (RO) strategy utilizing virtual CTs (vCTs) predicted by an anatomical model in intensity-modulated proton therapy (IMPT) for nasopharyngeal cancer (NPC).<i>Methods and Materials.</i>For ten NPC patients, vCTs capturing anatomical changes at different treatment weeks were generated using a population average anatomy model. Two RO strategies of a 6 beams IMPT with 3 mm setup uncertainty (SU) and 3% range uncertainty (RU) were compared: conventional robust optimization (cRO) based on a single planning CT (pCT), and anatomical RO incorporating 2 and 3 predicted anatomies (aRO2 and aRO3). The robustness of these plans was assessed by recalculating them on weekly CTs (week 2-7) and extracting the voxel wise-minimum and maximum doses with 1 mm SU and 3% RU (voxminvoxmax<sub>1mm3%</sub>).<i>Results.</i>The aRO plans demonstrated improved robustness in high-risk CTV1 and low-risk CTV 2 coverage compared to cRO plans. The weekly evaluation showed a lower plan adaptation rate for aRO3 (40%) vs. cRO (70%). The weekly nominal and voxmax<sub>1mm3%</sub>doses to OARs, especially spinal cord, are better controlled relative to their baseline doses at week 1 with aRO plans. The accumulated dose analysis showed that CTV1&2 had adequate coverage and serial organs (spinal cord and brainstem) were within their dose tolerances in the voxminvoxmax<sub>1mm3%</sub>, respectively.<i>Conclusion.</i>Incorporating predicted weekly CTs from a population based average anatomy model in RO improves week-to-week target dose coverage and reduces false plan adaptations without increasing normal tissue doses. This approach enhances IMPT plan robustness, potentially facilitating reduced SU and further lowering OAR doses.</p>","PeriodicalId":20185,"journal":{"name":"Physics in medicine and biology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1088/1361-6560/ad8858
Xin Zhang, Jixiong Xie, Ting Su, Jiongtao Zhu, Dongmei Xia, Hairong Zheng, Dong Liang, Yongshuai Ge
Objective.The aim of this study was to investigate the impact of the bowtie filter on the image quality of the photon-counting detector (PCD) based CT imaging.Approach.Numerical simulations were conducted to investigate the impact of bowtie filters on image uniformity using two water phantoms, with tube potentials ranging from 60 to 140 kVp with a step of 5 kVp. Subsequently, benchtop PCD-CT imaging experiments were performed to verify the observations from the numerical simulations. Additionally, various correction methods were validated through these experiments.Main results.It was found that the use of a bowtie filter significantly alters the uniformity of PCD-CT images, depending on the size of the object and the x-ray spectrum. Two notable effects were observed: the capping effect and the flattening effect. Furthermore, it was demonstrated that the conventional beam hardening correction method could effectively mitigate such non-uniformity in PCD-CT images, provided that dedicated calibration parameters were used.Significance.It was demonstrated that the incorporation of a bowtie filter results in varied image artifacts in PCD-CT imaging under different conditions. Certain image correction methods can effectively mitigate and reduce these artifacts, thereby enhancing the overall quality of PCD-CT images.
{"title":"Study on the impact of bowtie filter on photon-counting CT imaging.","authors":"Xin Zhang, Jixiong Xie, Ting Su, Jiongtao Zhu, Dongmei Xia, Hairong Zheng, Dong Liang, Yongshuai Ge","doi":"10.1088/1361-6560/ad8858","DOIUrl":"10.1088/1361-6560/ad8858","url":null,"abstract":"<p><p><i>Objective.</i>The aim of this study was to investigate the impact of the bowtie filter on the image quality of the photon-counting detector (PCD) based CT imaging.<i>Approach.</i>Numerical simulations were conducted to investigate the impact of bowtie filters on image uniformity using two water phantoms, with tube potentials ranging from 60 to 140 kVp with a step of 5 kVp. Subsequently, benchtop PCD-CT imaging experiments were performed to verify the observations from the numerical simulations. Additionally, various correction methods were validated through these experiments.<i>Main results.</i>It was found that the use of a bowtie filter significantly alters the uniformity of PCD-CT images, depending on the size of the object and the x-ray spectrum. Two notable effects were observed: the capping effect and the flattening effect. Furthermore, it was demonstrated that the conventional beam hardening correction method could effectively mitigate such non-uniformity in PCD-CT images, provided that dedicated calibration parameters were used.<i>Significance.</i>It was demonstrated that the incorporation of a bowtie filter results in varied image artifacts in PCD-CT imaging under different conditions. Certain image correction methods can effectively mitigate and reduce these artifacts, thereby enhancing the overall quality of PCD-CT images.</p>","PeriodicalId":20185,"journal":{"name":"Physics in medicine and biology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1088/1361-6560/ad8c1f
Pierre Gebhardt, Begona Lavin, Alkystis Phinikaridou, Jane E Mackewn, Markus Henningsson, David Schug, Andre Salomon, Paul K Marsden, Volkmar Schulz, René Botnar
Objective: In preclinical research, in vivo imaging of mice and rats is more
common than any other animal species, since their physiopathology is very well-
known and many genetically altered disease models exist. Animal studies based on
small rodents are usually performed using dedicated preclinical imaging systems
with high spatial resolution. For studies that require animal models such as mini-
pigs or New-Zealand White (NZW) rabbits, imaging systems with larger bore
sizes are required. In case of hybrid imaging using Positron Emission Tomography
(PET) and Magnetic Resonance Imaging (MRI), clinical systems have to be used,
as these animal models do not typically fi t in preclinical simultaneous PET-MRI
scanners.
Approach. In this paper, we present initial imaging results obtained with the
Hyperion IID PET insert which can accommodate NZW rabbits when combined
with a large volume MRI RF coil. First, we developed a rabbit-sized image
quality phantom of comparable size to a NZW rabbit in order to evaluate the
PET imaging performance of the insert under high count rates. For this phantom,
radioactive spheres with inner diameters between 3.95 and 7.86 mm were visible
in a warm background with a tracer activity ratio of 4.1 to 1 and with a total
18-F activity in the phantom of 58MBq at measurement start. Second, we performed
simultaneous PET-MR imaging of atherosclerotic plaques in a rabbit in vivo using
a single injection containing 18-F-FDG for detection of infl ammatory activity,
and Gd-ESMA for visualization of the aortic vessel wall and plaques with MRI.
Main results. The fused PET-MR images reveal 18-F-FDG uptake within an
active plaques with plaque thicknesses in the sub-millimeter range. Histology
showed colocalization of 18-F-FDG uptake with macrophages in the aortic vessel wall lesions.
Significance. Our initial results demonstrate that this PET insert
is a promising system for simultaneous high-resolution PET-MR atherosclerotic
plaque imaging studies in NZW rabbits.
{"title":"Initial results of the Hyperion II<sup>D</sup>PET insert for simultaneous PET-MRI applied to atherosclerotic plaque imaging in New-Zealand white rabbits.","authors":"Pierre Gebhardt, Begona Lavin, Alkystis Phinikaridou, Jane E Mackewn, Markus Henningsson, David Schug, Andre Salomon, Paul K Marsden, Volkmar Schulz, René Botnar","doi":"10.1088/1361-6560/ad8c1f","DOIUrl":"https://doi.org/10.1088/1361-6560/ad8c1f","url":null,"abstract":"<p><strong>Objective: </strong>In preclinical research, in vivo imaging of mice and rats is more
common than any other animal species, since their physiopathology is very well-
known and many genetically altered disease models exist. Animal studies based on
small rodents are usually performed using dedicated preclinical imaging systems
with high spatial resolution. For studies that require animal models such as mini-
pigs or New-Zealand White (NZW) rabbits, imaging systems with larger bore
sizes are required. In case of hybrid imaging using Positron Emission Tomography
(PET) and Magnetic Resonance Imaging (MRI), clinical systems have to be used,
as these animal models do not typically fi t in preclinical simultaneous PET-MRI
scanners.
Approach. In this paper, we present initial imaging results obtained with the
Hyperion IID PET insert which can accommodate NZW rabbits when combined
with a large volume MRI RF coil. First, we developed a rabbit-sized image
quality phantom of comparable size to a NZW rabbit in order to evaluate the
PET imaging performance of the insert under high count rates. For this phantom,
radioactive spheres with inner diameters between 3.95 and 7.86 mm were visible
in a warm background with a tracer activity ratio of 4.1 to 1 and with a total
18-F activity in the phantom of 58MBq at measurement start. Second, we performed
simultaneous PET-MR imaging of atherosclerotic plaques in a rabbit in vivo using
a single injection containing 18-F-FDG for detection of infl ammatory activity,
and Gd-ESMA for visualization of the aortic vessel wall and plaques with MRI.
Main results. The fused PET-MR images reveal 18-F-FDG uptake within an
active plaques with plaque thicknesses in the sub-millimeter range. Histology
showed colocalization of 18-F-FDG uptake with macrophages in the aortic vessel wall lesions. 
Significance. Our initial results demonstrate that this PET insert
is a promising system for simultaneous high-resolution PET-MR atherosclerotic
plaque imaging studies in NZW rabbits.</p>","PeriodicalId":20185,"journal":{"name":"Physics in medicine and biology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1088/1361-6560/ad8830
Meshal Alzahrani, David A Broadbent, Irvin Teh, Bashar Al-Qaisieh, Richard Speight
Objective:This study aims to identify and evaluate suitable and stable materials for developing a head and neck anthropomorphic multimodality phantom for radiotherapy purposes. These materials must mimic human head and neck tissues in both computed tomography (CT) and magnetic resonance imaging (MRI) and maintain stable imaging properties over time and after radiation exposure, including the high levels associated with linear accelerator (linac) use.Approach:Various materials were assessed by measuring their CT numbers and T1 and T2 relaxation times. These measurements were compared to literature values to determine how closely the properties of the candidate materials resemble those of human tissues in the head and neck region. The stability of these properties was evaluated monthly over a year and after radiation exposure to doses up to 1000 Gy. Statistical analyzes were conducted to identify any significant changes over time and after radiation exposure.Main results:10% and 12.6% Polyvinyl alcohol cryogel (PVA-c) both exhibited T1 and T2 relaxation times and CT numbers within the range appropriate for brain grey matter. 14.3% PVA-c and some plastic-based materials matched the MRI properties of brain white matter, with CT numbers close to the clinical range. Additionally, some plastic-based materials showed T1 and T2 relaxation times consistent with MRI properties of fat, although their CT numbers were not suitable. Over time and after irradiation, 10% PVA-c maintained consistent properties for brain grey matter. 12.6% PVA-c's T1 relaxation time decreased beyond the range after the first month.Significance:This study identified 10% PVA-c as a substitute for brain grey matter, demonstrating stable imaging properties over a year and after radiation exposure up to 1000 Gy. However, the results highlight a need for further research to find additional materials to accurately simulate a wider range of human tissues.
{"title":"Assessing suitability and stability of materials for a head and neck anthropomorphic multimodality (MRI/CT) phantoms for radiotherapy.","authors":"Meshal Alzahrani, David A Broadbent, Irvin Teh, Bashar Al-Qaisieh, Richard Speight","doi":"10.1088/1361-6560/ad8830","DOIUrl":"10.1088/1361-6560/ad8830","url":null,"abstract":"<p><p><i>Objective:</i>This study aims to identify and evaluate suitable and stable materials for developing a head and neck anthropomorphic multimodality phantom for radiotherapy purposes. These materials must mimic human head and neck tissues in both computed tomography (CT) and magnetic resonance imaging (MRI) and maintain stable imaging properties over time and after radiation exposure, including the high levels associated with linear accelerator (linac) use.<i>Approach:</i>Various materials were assessed by measuring their CT numbers and T1 and T2 relaxation times. These measurements were compared to literature values to determine how closely the properties of the candidate materials resemble those of human tissues in the head and neck region. The stability of these properties was evaluated monthly over a year and after radiation exposure to doses up to 1000 Gy. Statistical analyzes were conducted to identify any significant changes over time and after radiation exposure.<i>Main results:</i>10% and 12.6% Polyvinyl alcohol cryogel (PVA-c) both exhibited T1 and T2 relaxation times and CT numbers within the range appropriate for brain grey matter. 14.3% PVA-c and some plastic-based materials matched the MRI properties of brain white matter, with CT numbers close to the clinical range. Additionally, some plastic-based materials showed T1 and T2 relaxation times consistent with MRI properties of fat, although their CT numbers were not suitable. Over time and after irradiation, 10% PVA-c maintained consistent properties for brain grey matter. 12.6% PVA-c's T1 relaxation time decreased beyond the range after the first month.<i>Significance:</i>This study identified 10% PVA-c as a substitute for brain grey matter, demonstrating stable imaging properties over a year and after radiation exposure up to 1000 Gy. However, the results highlight a need for further research to find additional materials to accurately simulate a wider range of human tissues.</p>","PeriodicalId":20185,"journal":{"name":"Physics in medicine and biology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1088/1361-6560/ad88d2
Meshal Alzahrani, Christopher O'Hara, David Bird, Jack P C Baldwin, Mitchell Naisbit, Irvin Teh, David A Broadbent, Bashar Al-Qaisieh, Emily Johnstone, Richard Speight
Objective.This study aimed to optimise Cone Beam Computed Tomography (CBCT) protocols for head and neck (H&N) radiotherapy treatments using a 3D printed anthropomorphic phantom. It focused on precise patient positioning in conventional treatment and adaptive radiotherapy (ART).Approach.Ten CBCT protocols were evaluated with the 3D-printed H&N anthropomorphic phantom, including one baseline protocol currently used at our centre and nine new protocols. Adjustments were made to milliamperage and exposure time to explore their impact on radiation dose and image quality. Additionally, the effect on image quality of varying the scatter correction parameter for each of the protocols was assessed. Each protocol was compared against a reference CT scan. Usability was assessed by three Clinical Scientists using a Likert scale, and statistical validation was performed on the findings.Main results. The work revealed variability in the effectiveness of protocols. Protocols optimised for lower radiation exposure maintained sufficient image quality for patient setup in a conventional radiotherapy pathway, suggesting the potential for reducing patient radiation dose by over 50% without compromising efficacy. Optimising ART protocols involves balancing accuracy across brain, bone, and soft tissue, as no single protocol or scatter correction parameter achieves optimal results for all simultaneously.Significance.This study underscores the importance of optimising CBCT protocols in H&N radiotherapy. Our findings highlight the potential to maintain the usability of CBCT for bony registration in patient setup while significantly reducing the radiation dose, emphasizing the significance of optimising imaging protocols for the task in hand (registering to soft tissue or bone) and aligning with the as low as reasonably achievable principle. More studies are needed to assess these protocols for ART, including CBCT dose measurements and CT comparisons. Furthermore, the novel 3D printed anthropomorphic phantom demonstrated to be a useful tool when optimising CBCT protocols.
目的:
本研究旨在使用 3D 打印的拟人化模型优化头颈部 (H&N) 放射治疗的锥形束计算机断层扫描 (CBCT) 方案。方法:
使用 3D 打印的 H&N 拟人模型评估了十种 CBCT 方案,包括我们中心目前使用的一种基准方案和九种新方案。对毫安培数和曝光时间进行了调整,以探讨它们对辐射剂量和图像质量的影响。此外,还评估了改变每个方案的散射校正参数对图像质量的影响。每个方案都与参考 CT 扫描进行了比较。由三位临床科学家使用李克特量表对可用性进行评估,并对评估结果进行统计验证。为降低辐射量而优化的方案在传统放疗路径中保持了足够的图像质量,这表明在不影响疗效的情况下,有可能将患者的辐射剂量减少 50%以上。优化 ART 方案需要平衡脑、骨和软组织的精确度,因为没有一种方案或散射校正参数能同时达到所有方案的最佳效果。我们的研究结果突显了在患者设置中保持 CBCT 用于骨骼登记的可用性,同时大幅降低辐射剂量的潜力,强调了针对手头任务(登记到软组织或骨骼)优化成像方案的重要性,并符合 "尽可能低"(ALARA)的原则。需要进行更多的研究来评估这些 ART 方案,包括 CBCT 剂量测量和 CT 对比。此外,在优化 CBCT 方案时,新颖的 3D 打印拟人模型被证明是一种有用的工具。
{"title":"Optimisation of cone beam CT radiotherapy imaging protocols using a novel 3D printed head and neck anthropomorphic phantom.","authors":"Meshal Alzahrani, Christopher O'Hara, David Bird, Jack P C Baldwin, Mitchell Naisbit, Irvin Teh, David A Broadbent, Bashar Al-Qaisieh, Emily Johnstone, Richard Speight","doi":"10.1088/1361-6560/ad88d2","DOIUrl":"10.1088/1361-6560/ad88d2","url":null,"abstract":"<p><p><i>Objective.</i>This study aimed to optimise Cone Beam Computed Tomography (CBCT) protocols for head and neck (H&N) radiotherapy treatments using a 3D printed anthropomorphic phantom. It focused on precise patient positioning in conventional treatment and adaptive radiotherapy (ART).<i>Approach.</i>Ten CBCT protocols were evaluated with the 3D-printed H&N anthropomorphic phantom, including one baseline protocol currently used at our centre and nine new protocols. Adjustments were made to milliamperage and exposure time to explore their impact on radiation dose and image quality. Additionally, the effect on image quality of varying the scatter correction parameter for each of the protocols was assessed. Each protocol was compared against a reference CT scan. Usability was assessed by three Clinical Scientists using a Likert scale, and statistical validation was performed on the findings.<i>Main results</i>. The work revealed variability in the effectiveness of protocols. Protocols optimised for lower radiation exposure maintained sufficient image quality for patient setup in a conventional radiotherapy pathway, suggesting the potential for reducing patient radiation dose by over 50% without compromising efficacy. Optimising ART protocols involves balancing accuracy across brain, bone, and soft tissue, as no single protocol or scatter correction parameter achieves optimal results for all simultaneously.<i>Significance.</i>This study underscores the importance of optimising CBCT protocols in H&N radiotherapy. Our findings highlight the potential to maintain the usability of CBCT for bony registration in patient setup while significantly reducing the radiation dose, emphasizing the significance of optimising imaging protocols for the task in hand (registering to soft tissue or bone) and aligning with the as low as reasonably achievable principle. More studies are needed to assess these protocols for ART, including CBCT dose measurements and CT comparisons. Furthermore, the novel 3D printed anthropomorphic phantom demonstrated to be a useful tool when optimising CBCT protocols.</p>","PeriodicalId":20185,"journal":{"name":"Physics in medicine and biology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1088/1361-6560/ad87a6
Mohammad Zarenia, Ying Zhang, Christina Sarosiek, Renae Conlin, Asma Amjad, Eric Paulson
Objective.Deep-learning auto-segmentation (DLAS) aims to streamline contouring in clinical settings. Nevertheless, achieving clinical acceptance of DLAS remains a hurdle in abdominal MRI, hindering the implementation of efficient clinical workflows for MR-guided online adaptive radiotherapy (MRgOART). Integrating automated contour quality assurance (ACQA) with automatic contour correction (ACC) techniques could optimize the performance of ACC by concentrating on inaccurate contours. Furthermore, ACQA can facilitate the contour selection process from various DLAS tools and/or deformable contour propagation from a prior treatment session. Here, we present the performance of novel DL-based 3D ACQA models for evaluating DLAS contours acquired during MRgOART.Approach.The ACQA model, based on a 3D convolutional neural network (CNN), was trained using pancreas and duodenum contours obtained from a research DLAS tool on abdominal MRIs acquired from a 1.5 T MR-Linac. The training dataset contained abdominal MR images, DL contours, and their corresponding quality ratings, from 103 datasets. The quality of DLAS contours was determined using an in-house contour classification tool, which categorizes contours as acceptable or edit-required based on the expected editing effort. The performance of the 3D ACQA model was evaluated using an independent dataset of 34 abdominal MRIs, utilizing confusion matrices for true and predicted classes.Main results.The ACQA predicted 'acceptable' and 'edit-required' contours at 72.2% (91/126) and 83.6% (726/868) accuracy for pancreas, and at 71.2% (79/111) and 89.6% (772/862) for duodenum contours, respectively. The model successfully identified false positive (extra) and false negative (missing) DLAS contours at 93.75% (15/16) and %99.7 (438/439) accuracy for pancreas, and at 95% (57/60) and 98.9% (91/99) for duodenum, respectively.Significance.We developed 3D-ACQA models capable of quickly evaluating the quality of DLAS pancreas and duodenum contours on abdominal MRI. These models can be integrated into clinical workflow, facilitating efficient and consistent contour evaluation process in MRgOART for abdominal malignancies.
{"title":"Deep learning-based automatic contour quality assurance for auto-segmented abdominal MR-Linac contours.","authors":"Mohammad Zarenia, Ying Zhang, Christina Sarosiek, Renae Conlin, Asma Amjad, Eric Paulson","doi":"10.1088/1361-6560/ad87a6","DOIUrl":"10.1088/1361-6560/ad87a6","url":null,"abstract":"<p><p><i>Objective.</i>Deep-learning auto-segmentation (DLAS) aims to streamline contouring in clinical settings. Nevertheless, achieving clinical acceptance of DLAS remains a hurdle in abdominal MRI, hindering the implementation of efficient clinical workflows for MR-guided online adaptive radiotherapy (MRgOART). Integrating automated contour quality assurance (ACQA) with automatic contour correction (ACC) techniques could optimize the performance of ACC by concentrating on inaccurate contours. Furthermore, ACQA can facilitate the contour selection process from various DLAS tools and/or deformable contour propagation from a prior treatment session. Here, we present the performance of novel DL-based 3D ACQA models for evaluating DLAS contours acquired during MRgOART.<i>Approach.</i>The ACQA model, based on a 3D convolutional neural network (CNN), was trained using pancreas and duodenum contours obtained from a research DLAS tool on abdominal MRIs acquired from a 1.5 T MR-Linac. The training dataset contained abdominal MR images, DL contours, and their corresponding quality ratings, from 103 datasets. The quality of DLAS contours was determined using an in-house contour classification tool, which categorizes contours as acceptable or edit-required based on the expected editing effort. The performance of the 3D ACQA model was evaluated using an independent dataset of 34 abdominal MRIs, utilizing confusion matrices for true and predicted classes.<i>Main results.</i>The ACQA predicted 'acceptable' and 'edit-required' contours at 72.2% (91/126) and 83.6% (726/868) accuracy for pancreas, and at 71.2% (79/111) and 89.6% (772/862) for duodenum contours, respectively. The model successfully identified false positive (extra) and false negative (missing) DLAS contours at 93.75% (15/16) and %99.7 (438/439) accuracy for pancreas, and at 95% (57/60) and 98.9% (91/99) for duodenum, respectively.<i>Significance.</i>We developed 3D-ACQA models capable of quickly evaluating the quality of DLAS pancreas and duodenum contours on abdominal MRI. These models can be integrated into clinical workflow, facilitating efficient and consistent contour evaluation process in MRgOART for abdominal malignancies.</p>","PeriodicalId":20185,"journal":{"name":"Physics in medicine and biology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1088/1361-6560/ad84b3
M Granado-González, T Price, L Gonella, K Moustakas, T Hirono, T Hemperek, L De Marzi, A Patriarca
Objective.Proton radiotherapy's efficacy relies on an accurate relative stopping power (RSP) map of the patient to optimise the treatment plan and minimize uncertainties. Currently, a conversion of a Hounsfield Units map obtained by a common x-ray computed tomography (CT) is used to compute the RSP. This conversion is one of the main limiting factors for proton radiotherapy. To bypass this conversion a direct RSP map could be obtained by performing a proton CT (pCT). The focal point of this article is to present a proof of concept of the potential of fast pixel technologies for proton tracking at clinical facilities.Approach.A two-layer tracker based on the TJ-Monopix1, a depleted monolithic active pixel sensor (DMAPS) chip initially designed for the ATLAS, was tested at the proton minibeam radiotherapy beamline at the Curie Institute. The chips were subjected to 100 MeV protons passing through the single slit collimator (0.4×20mm2) with fluxes up to1.3×107p s-1 cm-2. The performance of the proton tracker was evaluated with GEANT4 simulations.Main results.The beam profile and dispersion in air were characterized by an opening of 0.031 mm cm-1, and aσx=0.172mm at the position of the slit. The results of the proton tracking show how the TJ-Monopix1 chip can effectively track protons in a clinical environment, achieving a tracking purity close to 70%, and a position resolution below 0.5 mm; confirming the chip's ability to handle high proton fluxes with a competitive performance.Significance.This work suggests that DMAPS technologies can be a cost-effective alternative for proton imaging. Additionally, the study identifies areas where further optimization of chip design is required to fully leverage these technologies for clinical ion imaging applications.
{"title":"First test beam of the DMAPS-based proton tracker at the pMBRT facility at the Curie Institute.","authors":"M Granado-González, T Price, L Gonella, K Moustakas, T Hirono, T Hemperek, L De Marzi, A Patriarca","doi":"10.1088/1361-6560/ad84b3","DOIUrl":"10.1088/1361-6560/ad84b3","url":null,"abstract":"<p><p><i>Objective.</i>Proton radiotherapy's efficacy relies on an accurate relative stopping power (RSP) map of the patient to optimise the treatment plan and minimize uncertainties. Currently, a conversion of a Hounsfield Units map obtained by a common x-ray computed tomography (CT) is used to compute the RSP. This conversion is one of the main limiting factors for proton radiotherapy. To bypass this conversion a direct RSP map could be obtained by performing a proton CT (pCT). The focal point of this article is to present a proof of concept of the potential of fast pixel technologies for proton tracking at clinical facilities.<i>Approach.</i>A two-layer tracker based on the TJ-Monopix1, a depleted monolithic active pixel sensor (DMAPS) chip initially designed for the ATLAS, was tested at the proton minibeam radiotherapy beamline at the Curie Institute. The chips were subjected to 100 MeV protons passing through the single slit collimator (0.4×20mm<sup>2</sup>) with fluxes up to1.3×107p s<sup>-1</sup> cm<sup>-2</sup>. The performance of the proton tracker was evaluated with GEANT4 simulations.<i>Main results.</i>The beam profile and dispersion in air were characterized by an opening of 0.031 mm cm<sup>-1</sup>, and aσx=0.172mm at the position of the slit. The results of the proton tracking show how the TJ-Monopix1 chip can effectively track protons in a clinical environment, achieving a tracking purity close to 70%, and a position resolution below 0.5 mm; confirming the chip's ability to handle high proton fluxes with a competitive performance.<i>Significance.</i>This work suggests that DMAPS technologies can be a cost-effective alternative for proton imaging. Additionally, the study identifies areas where further optimization of chip design is required to fully leverage these technologies for clinical ion imaging applications.</p>","PeriodicalId":20185,"journal":{"name":"Physics in medicine and biology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1088/1361-6560/ad8855
Ya-Nan Zhu, Weijie Zhang, Jufri Setianegara, Yuting Lin, Erik Traneus, Yong Long, Xiaoqun Zhang, Rajeev Badkul, David Akhavan, Fen Wang, Ronald C Chen, Hao Gao
<p><p><i>Objective.</i>LATTICE, a spatially fractionated radiation therapy (SFRT) modality, is a 3D generalization of GRID and delivers highly modulated peak-valley spatial dose distribution to tumor targets, characterized by peak-to-valley dose ratio (PVDR). Proton LATTICE is highly desirable, because of the potential synergy of the benefit from protons compared to photons, and the benefit from LATTICE compared to GRID. Proton LATTICE using standard proton RT via intensity modulated proton therapy (IMPT) (with a few beam angles) can be problematic with poor target dose coverage and high dose spill to organs-at-risk (OAR). This work will develop novel proton LATTICE method via proton ARC (with many beam angles) to overcome these challenges in target coverage and OAR sparing, with optimized delivery efficiency via energy layer optimization and optimized biological dose distribution via linear energy transfer (LET) optimization, to enable the clinical use of proton LATTICE.<i>Approach.</i>ARC based proton LATTICE is formulated and solved with energy layer optimization, during which plan quality and delivery efficiency are jointly optimized. In particular, the number of energy jumps (NEJ) is explicitly modelled and minimized during plan optimization for improving delivery efficiency, while target dose conformality and OAR dose objectives are optimized. The plan deliverability is ensured by considering the minimum-monitor-unit (MMU) constraint, and the plan robustness is accounted for using robust optimization. The biological dose is optimized via LET optimization. The optimization solution algorithm utilizes iterative convex relaxation method to handle the dose-volume constraint and the MMU constraint, with spot-weight optimization subproblems solved by proximal descent method.<i>Main results.</i>ARC based proton LATTCE substantially improved plan quality from IMPT based proton LATTICE, such as (1) improved conformity index (CI) from 0.47 to 0.81 for the valley target dose and from 0.62 to 0.97 for the peak target dose, (2) reduced esophagus dose from 0.68 Gy to 0.44 Gy (a 12% reduction with respect to 2 Gy valley prescription dose) and (3) improved PVDR from 4.15 to 4.28 in the lung case. Moreover, energy layer optimization improved plan delivery efficiency for ARC based proton LATTICE, such as (1) reduced NEJ from 71 to 56 and (2) reduction of energy layer switching time by 65% and plan delivery time by 52% in the lung case. The biological target and OAR dose distributions were further enhanced via LET optimization. On the other hand, proton ARC LATTCE also substantially improved plan quality from VMAT LATTICE, such as (1) improved CI from 0.45 to 0.81 for the valley target dose and from 0.63 to 0.97 for the peak target dose, (2) reduced esophagus dose from 0.59 Gy to 0.38 Gy (a 10.5% reduction with respect to 2 Gy valley prescription dose) and (3) improved PVDR from 3.88 to 4.28 in the lung case.<i>Significance.</i>The feasibility of high-plan-qu
{"title":"Proton ARC based LATTICE radiation therapy: feasibility study, energy layer optimization and LET optimization.","authors":"Ya-Nan Zhu, Weijie Zhang, Jufri Setianegara, Yuting Lin, Erik Traneus, Yong Long, Xiaoqun Zhang, Rajeev Badkul, David Akhavan, Fen Wang, Ronald C Chen, Hao Gao","doi":"10.1088/1361-6560/ad8855","DOIUrl":"10.1088/1361-6560/ad8855","url":null,"abstract":"<p><p><i>Objective.</i>LATTICE, a spatially fractionated radiation therapy (SFRT) modality, is a 3D generalization of GRID and delivers highly modulated peak-valley spatial dose distribution to tumor targets, characterized by peak-to-valley dose ratio (PVDR). Proton LATTICE is highly desirable, because of the potential synergy of the benefit from protons compared to photons, and the benefit from LATTICE compared to GRID. Proton LATTICE using standard proton RT via intensity modulated proton therapy (IMPT) (with a few beam angles) can be problematic with poor target dose coverage and high dose spill to organs-at-risk (OAR). This work will develop novel proton LATTICE method via proton ARC (with many beam angles) to overcome these challenges in target coverage and OAR sparing, with optimized delivery efficiency via energy layer optimization and optimized biological dose distribution via linear energy transfer (LET) optimization, to enable the clinical use of proton LATTICE.<i>Approach.</i>ARC based proton LATTICE is formulated and solved with energy layer optimization, during which plan quality and delivery efficiency are jointly optimized. In particular, the number of energy jumps (NEJ) is explicitly modelled and minimized during plan optimization for improving delivery efficiency, while target dose conformality and OAR dose objectives are optimized. The plan deliverability is ensured by considering the minimum-monitor-unit (MMU) constraint, and the plan robustness is accounted for using robust optimization. The biological dose is optimized via LET optimization. The optimization solution algorithm utilizes iterative convex relaxation method to handle the dose-volume constraint and the MMU constraint, with spot-weight optimization subproblems solved by proximal descent method.<i>Main results.</i>ARC based proton LATTCE substantially improved plan quality from IMPT based proton LATTICE, such as (1) improved conformity index (CI) from 0.47 to 0.81 for the valley target dose and from 0.62 to 0.97 for the peak target dose, (2) reduced esophagus dose from 0.68 Gy to 0.44 Gy (a 12% reduction with respect to 2 Gy valley prescription dose) and (3) improved PVDR from 4.15 to 4.28 in the lung case. Moreover, energy layer optimization improved plan delivery efficiency for ARC based proton LATTICE, such as (1) reduced NEJ from 71 to 56 and (2) reduction of energy layer switching time by 65% and plan delivery time by 52% in the lung case. The biological target and OAR dose distributions were further enhanced via LET optimization. On the other hand, proton ARC LATTCE also substantially improved plan quality from VMAT LATTICE, such as (1) improved CI from 0.45 to 0.81 for the valley target dose and from 0.63 to 0.97 for the peak target dose, (2) reduced esophagus dose from 0.59 Gy to 0.38 Gy (a 10.5% reduction with respect to 2 Gy valley prescription dose) and (3) improved PVDR from 3.88 to 4.28 in the lung case.<i>Significance.</i>The feasibility of high-plan-qu","PeriodicalId":20185,"journal":{"name":"Physics in medicine and biology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1088/1361-6560/ad87a7
Naoki D-Kondo, Thongchai A M Masilela, Wook-Geun Shin, Bruce Faddegon, Jay LaVerne, Jan Schuemann, Jose Ramos-Mendez
Objective.To present and validate a method to simulate from first principles the effect of oxygen on radiation-induced double-strand breaks (DSBs) using the Monte Carlo Track-structure code TOPAS-nBio.Approach.Two chemical models based on the oxygen fixation hypothesis (OFH) were developed in TOPAS-nBio by considering an oxygen adduct state of DNA and creating a competition kinetic mechanism between oxygen and the radioprotective molecule WR-1065. We named these models 'simple' and 'detailed' due to the way they handle the hydrogen abstraction pathways. We used the simple model to obtain additional information for the •OH-DNA hydrogen abstraction pathway probability for the detailed model. These models were calibrated and compared with published experimental data of linear and supercoiling fractions obtained with R6K plasmids, suspended in dioxane as a hydroxyl scavenger, and irradiated with137Cs gamma-rays. The reaction rates for WR-1065 and O2with DNA were taken from experimental works. Single-Strand Breaks (SSBs) and DSBs as a function of the dose for a range of oxygen concentrations [O2] (0.021%-21%) were obtained. Finally, the hypoxia reduction factor (HRF) was obtained from DSBs.Main Results.Validation results followed the trend of the experimental within 12% for the supercoiled and linear plasmid fractions for both models. The HRF agreed with measurements obtained with137Cs and 200-280 kVp x-ray within experimental uncertainties. However, the HRF at an oxygen concentration of 2.1% overestimated experimental results by a factor of 1.7 ± 0.1. Increasing the concentration of WR-1065 from 1 mM to 10-100 mM resulted in a HRF difference of 0.01, within the 8% statistical uncertainty between TOPAS-nBio and experimental data. This highlights the possibility of using these chemical models to recreate experimental HRF results.Significance.Results support the OFH as a leading cause of oxygen radio-sensitization effects given a competition between oxygen and chemical DNA repair molecules like WR-1065.
{"title":"Modeling the oxygen effect in DNA strand break induced by gamma-rays with TOPAS-nBio.","authors":"Naoki D-Kondo, Thongchai A M Masilela, Wook-Geun Shin, Bruce Faddegon, Jay LaVerne, Jan Schuemann, Jose Ramos-Mendez","doi":"10.1088/1361-6560/ad87a7","DOIUrl":"10.1088/1361-6560/ad87a7","url":null,"abstract":"<p><p><i>Objective.</i>To present and validate a method to simulate from first principles the effect of oxygen on radiation-induced double-strand breaks (DSBs) using the Monte Carlo Track-structure code TOPAS-nBio.<i>Approach.</i>Two chemical models based on the oxygen fixation hypothesis (OFH) were developed in TOPAS-nBio by considering an oxygen adduct state of DNA and creating a competition kinetic mechanism between oxygen and the radioprotective molecule WR-1065. We named these models 'simple' and 'detailed' due to the way they handle the hydrogen abstraction pathways. We used the simple model to obtain additional information for the •OH-DNA hydrogen abstraction pathway probability for the detailed model. These models were calibrated and compared with published experimental data of linear and supercoiling fractions obtained with R6K plasmids, suspended in dioxane as a hydroxyl scavenger, and irradiated with<sup>137</sup>Cs gamma-rays. The reaction rates for WR-1065 and O<sub>2</sub>with DNA were taken from experimental works. Single-Strand Breaks (SSBs) and DSBs as a function of the dose for a range of oxygen concentrations [O<sub>2</sub>] (0.021%-21%) were obtained. Finally, the hypoxia reduction factor (HRF) was obtained from DSBs.<i>Main Results.</i>Validation results followed the trend of the experimental within 12% for the supercoiled and linear plasmid fractions for both models. The HRF agreed with measurements obtained with<sup>137</sup>Cs and 200-280 kVp x-ray within experimental uncertainties. However, the HRF at an oxygen concentration of 2.1% overestimated experimental results by a factor of 1.7 ± 0.1. Increasing the concentration of WR-1065 from 1 mM to 10-100 mM resulted in a HRF difference of 0.01, within the 8% statistical uncertainty between TOPAS-nBio and experimental data. This highlights the possibility of using these chemical models to recreate experimental HRF results.<i>Significance.</i>Results support the OFH as a leading cause of oxygen radio-sensitization effects given a competition between oxygen and chemical DNA repair molecules like WR-1065.</p>","PeriodicalId":20185,"journal":{"name":"Physics in medicine and biology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.1088/1361-6560/ad8b08
Robin Straathof, Sharline M van Vliet-Pérez, Inger-Karine K Kolkman-Deurloo, Linda S G L Wauben, Remi A Nout, Ben J M Heijmen, Linda Rossi, Jenny Dankelman, Nick J van de Berg
Purpose
Patient-tailored intracavitary/interstitial (IC/IS) brachytherapy (BT) applicators may increase dose conformity in cervical cancer patients. Current configuration planning methods in these custom applicators rely on manual specification or a small set of (straight) needles. This work introduces and validates a two-stage approach for establishing channel configurations in the 3D printed patient-tailored ARCHITECT applicator.
Methods
For each patient, the patient-tailored applicator shape was based on the first BT application with a commercial applicator and integrated connectors to a commercial (Geneva) intrauterine tube and two lunar ring channels. First, a large candidate set was generated of channels that steer the needle to desired poses in the target region and are contained in the applicator. The channels' centrelines were represented by Bézier curves. Channels running between straight target segments and entry points were optimised and refined to ensure (dynamic) feasibility. Second, channel configurations were selected using geometric coverage optimisation. This workflow was applied to establish patient-tailored geometries for twenty-two patients previously treated using the Venezia applicator. Treatment plans were automatically generated using the in-house developed algorithm BiCycle. Plans for the clinically used configuration, TPclin, and patient-tailored configuration, TParch, were compared.
Results
Channel configurations could be generated in clinically feasible time (median: 2651s, range 1826-3812s). All TParchand TPclinplans were acceptable, but planning aims were more frequently attained with patient-tailored configurations (115/132 versus 100/132 instances). Median CTVIRD98and bladderD2cm3doses significantly improved (p< 0.001 andp< 0.01 respectively) in TParchplans in comparison with TPclinplans, and in approximately half of the patients dosimetric indices improved.
Conclusion
Automated patient-tailored BT channel configuration planning for 3D printed applicators is clinically feasible. A treatment planning study showed that all plans met planning limits for the patient-tailored configurations, and in selected cases improved the plan quality in comparison with commercial applicator configurations.
.
{"title":"Automated planning of curved needle channels in 3D printed patient-tailored applicators for cervical cancer brachytherapy.","authors":"Robin Straathof, Sharline M van Vliet-Pérez, Inger-Karine K Kolkman-Deurloo, Linda S G L Wauben, Remi A Nout, Ben J M Heijmen, Linda Rossi, Jenny Dankelman, Nick J van de Berg","doi":"10.1088/1361-6560/ad8b08","DOIUrl":"https://doi.org/10.1088/1361-6560/ad8b08","url":null,"abstract":"<p><p><b>Purpose</b>
Patient-tailored intracavitary/interstitial (IC/IS) brachytherapy (BT) applicators may increase dose conformity in cervical cancer patients. Current configuration planning methods in these custom applicators rely on manual specification or a small set of (straight) needles. This work introduces and validates a two-stage approach for establishing channel configurations in the 3D printed patient-tailored ARCHITECT applicator. 

<b>Methods</b>
For each patient, the patient-tailored applicator shape was based on the first BT application with a commercial applicator and integrated connectors to a commercial (Geneva) intrauterine tube and two lunar ring channels. First, a large candidate set was generated of channels that steer the needle to desired poses in the target region and are contained in the applicator. The channels' centrelines were represented by Bézier curves. Channels running between straight target segments and entry points were optimised and refined to ensure (dynamic) feasibility. Second, channel configurations were selected using geometric coverage optimisation. This workflow was applied to establish patient-tailored geometries for twenty-two patients previously treated using the Venezia applicator. Treatment plans were automatically generated using the in-house developed algorithm BiCycle. Plans for the clinically used configuration, TP<sub>clin</sub>, and patient-tailored configuration, TP<sub>arch</sub>, were compared.

<b>Results</b>
Channel configurations could be generated in clinically feasible time (median: 2651s, range 1826-3812s). All TP<sub>arch</sub>and TP<sub>clin</sub>plans were acceptable, but planning aims were more frequently attained with patient-tailored configurations (115/132 versus 100/132 instances). Median CTV<sub>IR</sub><i>D</i><sub>98</sub>and bladder<i>D</i><sub>2cm<sup>3</sup></sub>doses significantly improved (<i>p</i>< 0.001 and<i>p</i>< 0.01 respectively) in TP<sub>arch</sub>plans in comparison with TP<sub>clin</sub>plans, and in approximately half of the patients dosimetric indices improved. 

<b>Conclusion</b>
Automated patient-tailored BT channel configuration planning for 3D printed applicators is clinically feasible. A treatment planning study showed that all plans met planning limits for the patient-tailored configurations, and in selected cases improved the plan quality in comparison with commercial applicator configurations.
.</p>","PeriodicalId":20185,"journal":{"name":"Physics in medicine and biology","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}