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Development of a PTV margin for preclinical irradiation of orthotopic pancreatic tumors derived from a well-known recipe for humans. 开发一种PTV切缘,用于临床前放射治疗原位胰腺肿瘤,源自一种众所周知的人类处方。
IF 2 4区 医学 Q1 Medicine Pub Date : 2023-05-22 DOI: 10.1016/j.zemedi.2023.03.005
Severin Kampfer, Sophie Dobiasch, Stephanie E Combs, Jan J Wilkens

In human radiotherapy a safety margin (PTV margin) is essential for successful irradiation and is usually part of clinical treatment planning. In preclinical radiotherapy research with small animals, most uncertainties and inaccuracies are present as well, but according to the literature a margin is used only scarcely. In addition, there is only little experience about the appropriate size of the margin, which should carefully be investigated and considered, since sparing of organs at risk or normal tissue is affected. Here we estimate the needed margin for preclinical irradiation by adapting a well-known human margin recipe from van Herck et al. to the dimensions and requirements of the specimen on a small animal radiation research platform (SARRP). We adjusted the factors of the described formula to the specific challenges in an orthotopic pancreatic tumor mouse model to establish an appropriate margin concept. The SARRP was used with its image-guidance irradiation possibility for arc irradiation with a field size of 10 × 10 mm2 for 5 fractions. Our goal was to irradiate the clinical target volume (CTV) of at least 90% of our mice with at least 95% of the prescribed dose. By carefully analyzing all relevant factors we gain a CTV to planning target volume (PTV) margin of 1.5 mm for our preclinical setup. The stated safety margin is strongly dependent on the exact setting of the experiment and has to be adjusted for other experimental settings. The few stated values in literature correspond well to our result. Even if using margins in the preclinical setting might be an additional challenge, we think it is crucial to use them to produce reliable results and improve the efficacy of radiotherapy.

在人体放射治疗中,安全裕度(PTV裕度)对于放射治疗的成功至关重要,通常是临床治疗计划的一部分。在小动物的临床前放疗研究中,大多数不确定性和不准确性也存在,但根据文献,边际仅很少使用。此外,关于切缘的适当大小只有很少的经验,应该仔细调查和考虑,因为保留有危险的器官或正常组织受到影响。在这里,我们通过将van Herck等人的著名人类边缘配方改编为小动物辐射研究平台(SARRP)上标本的尺寸和要求来估计临床前辐射所需的边缘。我们根据原位胰腺肿瘤小鼠模型的具体挑战调整了所述公式的因素,以建立适当的切缘概念。SARRP具有图像引导照射的可能性,对5个分数进行视场尺寸为10 × 10 mm2的弧照射。我们的目标是用至少95%的规定剂量照射至少90%的小鼠的临床靶体积(CTV)。通过仔细分析所有相关因素,我们获得了临床前设置的CTV到计划目标体积(PTV)的1.5 mm的裕度。所述的安全裕度在很大程度上取决于实验的确切设置,并且必须根据其他实验设置进行调整。文献中所陈述的几个值与我们的结果很吻合。即使在临床前使用切缘可能是一个额外的挑战,我们认为使用它们来产生可靠的结果和提高放射治疗的疗效是至关重要的。
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引用次数: 0
Quality assurance and temporal stability of a 1.5 T MRI scanner for MR-guided Photon and Particle Therapy. 用于核磁共振引导光子和粒子治疗的1.5 T MRI扫描仪的质量保证和时间稳定性。
IF 2 4区 医学 Q1 Medicine Pub Date : 2023-05-05 DOI: 10.1016/j.zemedi.2023.04.004
Stefan Dorsch, Katharina Paul, Cedric Beyer, Christian P Karger, Oliver Jäkel, Jürgen Debus, Sebastian Klüter

Purpose: To describe performance measurements, adaptations and time stability over 20 months of a diagnostic MR scanner for integration into MR-guided photon and particle radiotherapy.

Material and methods: For realization of MR-guided photon and particle therapy (MRgRT/MRgPT), a 1.5 T MR scanner was installed at the Heidelberg Ion Beam Therapy Center. To integrate MRI into the treatment process, a flat tabletop and dedicated coil holders for flex coils were used, which prevent deformation of the patient external contour and allow for the use of immobilization tools for reproducible positioning. The signal-to-noise ratio (SNR) was compared for the diagnostic and therapy-specific setup using the flat couch top and flexible coils for the a) head & neck and b) abdominal region as well as for different bandwidths and clinical pulse sequences. Additionally, a quality assurance (QA) protocol with monthly measurements of the ACR phantom and measurement of geometric distortions for a large field-of-view (FOV) was implemented to assess the imaging quality parameters of the device over the course of 20 months.

Results: The SNR measurements showed a decreased SNR for the RT-specific as compared to the diagnostic setup of (a) 26% to 34% and (b) 11% to 33%. No significant bandwidth dependency for this ratio was found. The longitudinal assessment of the image quality parameters with the ACR and distortion phantom confirmed the long-term stability of the MRI device.

Conclusion: A diagnostic MRI was commissioned for use in MR-guided particle therapy. Using a radiotherapy specific setup, a high geometric accuracy and signal homogeneity was obtained after some adaptions and the measured parameters were shown to be stable over a period of 20 months.

目的:描述诊断性磁共振扫描仪集成到磁共振引导光子和粒子放射治疗的性能测量,适应性和时间稳定性超过20个月。材料和方法:为了实现核磁共振引导光子和粒子治疗(MRgRT/MRgPT),在海德堡离子束治疗中心安装了一台1.5 T核磁共振扫描仪。为了将MRI整合到治疗过程中,使用了一个扁平的桌面和专用的弯曲线圈支架,以防止患者外部轮廓变形,并允许使用固定工具进行可重复定位。在诊断和治疗的特定设置中,对a)头颈部和b)腹部区域使用平面沙发顶和柔性线圈以及不同带宽和临床脉冲序列的信噪比(SNR)进行比较。此外,实施了质量保证(QA)方案,每月测量ACR模体和测量大视场(FOV)的几何畸变,以评估设备在20个月内的成像质量参数。结果:信噪比测量显示,与(a) 26%至34%和(b) 11%至33%的诊断设置相比,rt特异性的信噪比降低了。该比率没有发现明显的带宽依赖关系。利用ACR和畸变模体对图像质量参数进行纵向评估,证实了该MRI装置的长期稳定性。结论:一种诊断性MRI被委托用于MRI引导的粒子治疗。使用放射治疗专用装置,经过一些调整后获得了高几何精度和信号均匀性,并且测量参数在20个月的时间内显示稳定。
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引用次数: 0
Post-mastectomy radiotherapy: Impact of bolus thickness and irradiation technique on skin dose. 乳腺切除术后放疗:丸厚及照射技术对皮肤剂量的影响。
IF 2 4区 医学 Q1 Medicine Pub Date : 2023-05-05 DOI: 10.1016/j.zemedi.2023.03.004
Frédéric A Miéville, Nicolas Pitteloud, Vérane Achard, Giorgio Lamanna, Olivier Pisaturo, Pierre-Alain Tercier, Abdelkarim S Allal

Purpose: To determine 10 MV IMRT and VMAT based protocols with a daily bolus targeting a skin dose of 45 Gy in order to replace the 6 MV tangential fields with a 5 mm thick bolus on alternate days method for post-mastectomy radiotherapy.

Method: We measured the mean surface dose along the chest wall PTV as a function of different bolus thicknesses for sliding window IMRT and VMAT plans. We analyzed surface dose profiles and dose homogeneities and compared them to our standard 6 MV strategy. All measurements were performed on a thorax phantom with Gafchromic films while dosimetric plans were computed using the Acuros XB algorithm (Varian).

Results: We obtained the best compromise between measured surface dose (mean dose and homogeneity) and skin toxicity threshold obtained from the literature using a daily 3 mm thick bolus. Mean surface doses were 91.4 ± 2.8% [85.7% - 95.4%] and 92.2 ± 2.3% [85.6% - 95.2%] of the prescribed dose with IMRT and VMAT techniques, respectively. Our standard 6 MV alternate days 5 mm thick bolus leads to 89.0 ± 3.7% [83.6% - 95.5%]. Mean dose differences between measured and TPS results were < 3.2% for depths as low as 2 mm depth.

Conclusion: 10 MV IMRT-based protocols with a daily 3 mm thick bolus produce a surface dose comparable to the standard 6 MV 5 mm thick bolus on alternate days method but with an improved surface dose homogeneity. This allows for a better control of skin toxicity and target volume coverage.

目的:确定基于10 MV IMRT和VMAT的方案,每日丸剂靶向45 Gy的皮肤剂量,以隔天5 mm厚丸剂替代6 MV切向场,用于乳房切除术后放疗。方法:我们测量了滑动窗IMRT和VMAT方案的胸壁PTV平均表面剂量随不同剂量厚度的变化。我们分析了表面剂量分布和剂量均匀性,并将它们与我们的标准6 MV策略进行了比较。使用Gafchromic薄膜在胸腔假体上进行所有测量,同时使用acros XB算法(Varian)计算剂量计划。结果:我们获得了测量表面剂量(平均剂量和均匀性)和皮肤毒性阈值之间的最佳折衷,使用每日3 mm厚的丸。IMRT和VMAT技术的平均表面剂量分别为处方剂量的91.4 ± 2.8%[85.7% - 95.4%]和92.2 ± 2.3%[85.6% - 95.2%]。我们的标准6 MV隔天5 mm厚的丸剂导致89.0 ± 3.7%[83.6% - 95.5%]。对于低至2 mm的深度,测量结果与TPS结果之间的平均剂量差异< 3.2%。结论:基于10 毫伏imrt的方案,每天3 毫米厚的丸剂产生的表面剂量与标准的6 毫伏5 毫米厚隔日丸剂方法相当,但表面剂量均匀性有所改善。这允许更好地控制皮肤毒性和目标体积覆盖。
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引用次数: 1
Editorial Board + Consulting Editorial Board 编委会+咨询编委会
IF 2 4区 医学 Q1 Medicine Pub Date : 2023-05-01 DOI: 10.1016/S0939-3889(23)00063-6
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引用次数: 0
Additively manufactured test phantoms for mimicking soft tissue radiation attenuation in CBCT using Polyjet technology 利用Polyjet技术增材制造模拟CBCT软组织辐射衰减的测试模型
IF 2 4区 医学 Q1 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.zemedi.2022.05.002
Sepideh Hatamikia , Gunpreet Oberoi , Anna Zacher , Gernot Kronreif , Wolfgang Birkfellner , Joachim Kettenbach , Stefanie Ponti , Andrea Lorenz , Martin Buschmann , Laszlo Jaksa , Nikolaus Irnstorfer , Ewald Unger

Objectives

To develop and validate a simple approach for building cost-effective imaging phantoms for Cone Beam Computed Tomography (CBCT) using a modified Polyjet additive manufacturing technology where a single material can mimic a range of human soft-tissue radiation attenuation.

Materials and Methods

Single material test phantoms using a cubic lattice were designed in 3-Matic 15.0 software . Keeping the individual cubic lattice volume constant, eight different percentage ratio (R) of air: material from 0% to 70% with a 10% increment were assigned to each sample. The phantoms were printed in three materials, namely Vero PureWhite, VeroClear and TangoPlus using Polyjet technology. The CT value analysis, non-contact profile measurement and microCT-based volumetric analysis was performed for all the samples.

Results

The printed test phantoms produced a grey value spectrum equivalent to the radiation attenuation of human soft tissues in the range of −757 to +286 HU on CT. The results from dimensional comparison analysis of the printed phantoms with the digital test phantoms using non-contact profile measurement showed a mean accuracy of 99.07 % and that of micro-CT volumetric analysis showed mean volumetric accuracy of 84.80–94.91%. The material and printing costs of developing 24 test phantoms was 83.00 Euro.

Conclusions

The study shows that additive manufacturing-guided macrostructure manipulation modifies successfully the radiographic visibility of a material in CBCT imaging with 1 mm3 resolution, helping customization of imaging phantoms.

目的开发和验证一种简单的方法,使用改进的Polyjet增材制造技术,为锥形束计算机断层扫描(CBCT)构建具有成本效益的成像模型,其中单一材料可以模拟一系列人类软组织辐射衰减。材料和方法在3-Matic 15.0软件中设计了使用立方体晶格的单材料测试体模。在保持单个立方晶格体积不变的情况下,为每个样品分配了从0%到70%的八种不同的空气:材料百分比比(R),增量为10%。使用Polyjet技术将模型打印在三种材料中,即Vero PureWhite、VeroClear和TangoPlus。对所有样本进行了CT值分析、非接触式轮廓测量和基于microCT的体积分析。结果打印的测试体模在CT上产生的灰度值谱相当于人体软组织的辐射衰减,范围为−757至+286 HU。使用非接触轮廓测量对印刷体模和数字测试体模进行尺寸比较分析的结果显示平均准确度为99.07%,而微型CT体积分析的结果则显示平均体积准确度为84.80–94.91%。开发24个测试体模的材料和打印成本为83.00欧元。结论该研究表明,增材制造引导的宏观结构操作成功地改变了CBCT成像中材料的射线可视性,分辨率为1mm3,有助于定制成像模型。
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引用次数: 2
A new digitised screen test for strabismus measurement 一种用于斜视测量的新型数字化屏幕测试
IF 2 4区 医学 Q1 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.zemedi.2022.07.001
Theo Oltrup, Marvin Bende, Celine Henseling, Thomas Bende, Martin A Leitritz, Karl Ulrich Bartz-Schmidt

Purpose

Our study presents a digitised tangent screen test for ocular motility analysis according to the Harms and Hess tests (measurement of the squint angle in all fields of vision). This test uses an image beamer to display the tangent screen, a position sensor to measure the patient’s head orientation, and a distance sensor to measure the fixation distance. Digital measurement of head orientation allows for a test procedure that eliminates the conventional requirement for a light pointer in the patient’s hand. Thus, the digital screen test is presented, and the uncertainty of the measurement system is evaluated.

Methods

A mathematical relationship was given between the measured squint angles, as well as the angle of diagnostic gaze direction, and the influence quantities on their measurement uncertainty. The individual uncertainties resulted from deviations in the measured values by the position and distance sensors, the calibration of the projection image of the beamer in length units, and the finite image resolution of the beamer. The individual standard uncertainties of the influence quantities were determined. The combined standard measurement uncertainties of the squint and gaze direction angles were given based on the model equation of the error propagation law at the tangent table according to Harms at a test distance of 2.5 m. The patient’s uncertainty contribution to the mobility analysis was not considered.

Results

The combined standard uncertainty of the measurement system (coverage factor k = 2 for 95% confidence level) for the squint angle is ≤ 0.43° for the angle of diagnostic gaze direction ≤ 3.13° at the test distance of 2.5 m. The individual standard uncertainties of the influence quantities on the angles are (k = 1): 1.55°/1.01° (horizontal/vertical angle of the position sensor), 0.19° (distance sensor), 0.06° (calibration of the projection image of the beamer), and 0.02° (image resolution of the beamer). The maximum valid test distance of the digital screen test is 3.8 m.

Conclusion

The digital screen test is compact and can be used at different locations. Compared to the traditional test, the time required for examination via the digitised test is less; additionally, its documentation is simplified. The measurement uncertainty of the diagnostic gaze direction angle is dominated by the sensor drift of the position sensor in the horizontal direction (yaw angle) and is due to the sensor technology. However, this drift error does not affect the squint angle measurement result nor its measurement uncertainty because the measurement principle used here is based on the congruence between the position cross and the fixation object and the confusion principle and compensates for the drift error. The measurement uncertainties of the determined measurement system are the lower limits of the uncertainties in the clinical use of the digital scree

目的我们的研究根据Harms和Hess测试(测量所有视野中的斜视角),提出了一种用于眼运动分析的数字化切屏测试。该测试使用图像波束仪显示切线屏幕,使用位置传感器测量患者的头部方向,使用距离传感器测量固定距离。头部方位的数字测量允许一种测试程序,该程序消除了对患者手中指针的传统要求。因此,提出了数字屏幕测试,并对测量系统的不确定度进行了评估。方法给出测量斜视角度、诊断凝视方向角度及其对测量不确定度的影响量之间的数学关系。单个不确定性是由位置和距离传感器测量值的偏差、以长度为单位的波束仪投影图像的校准以及波束仪的有限图像分辨率引起的。确定了影响量的单个标准不确定度。在测试距离为2.5的情况下,根据Harms在正切表上的误差传播定律模型方程,给出了斜视和凝视方向角的组合标准测量不确定度 m.未考虑患者对移动性分析的不确定性贡献。结果测量系统的组合标准不确定度(覆盖因子k = 2表示95%置信水平)在2.5的测试距离下,斜视角度≤0.43°,诊断凝视方向角度≤3.13° m.角度影响量的单个标准不确定度为(k = 1) :1.55°/1.01°(位置传感器的水平/垂直角度)、0.19°(距离传感器)、0.06°(波束仪投影图像的校准)和0.02°(波束机的图像分辨率)。数字屏幕测试的最大有效测试距离为3.8 m。结论数字屏幕测试结构紧凑,可在不同位置使用。与传统考试相比,通过数字化考试进行考试所需的时间更少;此外,它的文档也得到了简化。诊断凝视方向角的测量不确定性主要由位置传感器在水平方向上的传感器漂移(偏航角)决定,并且是由于传感器技术造成的。然而,这种漂移误差既不影响斜视角测量结果,也不影响其测量不确定度,因为这里使用的测量原理是基于位置十字和固定物体之间的一致性和混淆原理,并补偿漂移误差。所确定的测量系统的测量不确定度是数字屏幕测试临床使用中不确定度的下限,如果由于患者的重大偏差而没有影响。
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引用次数: 0
Free-breathing half-radial dual-echo balanced steady-state free precession thoracic imaging with wobbling Archimedean spiral pole trajectories 自由呼吸半径向双回波平衡稳态自由进动胸椎成像与摆动阿基米德螺旋极轨迹
IF 2 4区 医学 Q1 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.zemedi.2022.01.003
Oliver Bieri , Orso Pusterla , Grzegorz Bauman

Purpose

To demonstrate free-breathing thoracic MRI with a minimal-TR balanced steady-state free precession (bSSFP) technique using wobbling Archimedean spiral pole (WASP) trajectories.

Methods

Phantom and free-breathing in vivo chest imaging in healthy volunteers was performed at 1.5T with a half-radial, dual-echo, bSSFP sequence, termed bSTAR. For maximum sampling efficiency, a single analog-to-digital converter window along the full bipolar readout was used. To ensure a homogeneous coverage of the k-space over multiple breathing cycles, radial k-space sampling followed short-duration Archimedean spiral interleaves that were randomly titled by a small polar angle and rotated by a golden angle about the polar axis; depticting a wobbling Archimedean spiral pole (WASP) trajectory. In phantom and in vivo experiments, WASP trajectories were compared to spiral phyllotaxis sampling in terms of eddy currents and were used to generate in vivo thorax images at different respiratory phases.

Results

WASP trajectories provided artifact-free bSTAR imaging in both phantom and in vivo and respiratory self-gated reconstruction was successfully performed in all subjects. The amount of the acquired data allowed the reconstruction of 10 volumes at different respiratory levels with isotropic resolution of 1.77 mm from a scan of 5.5 minutes (using a TR of 1.32ms), and one high-resolution 1.16 mm end-expiratory volume from a scan of 4.7 minutes (using a TR of 1.42ms). The very short TR of bSTAR mitigated off-resonance artifacts despite the large field-of-view.

Conclusion

We have demonstrated the feasibility of high-resolution free-breathing thoracic imaging with bSTAR using the wobbling Archimedean spiral pole in healthy subjects at 1.5T.

目的利用摆动阿基米德螺旋极(WASP)轨迹,用最小TR平衡稳态自由进动(bSFP)技术演示自由呼吸胸部MRI。方法健康志愿者的体模和自由呼吸胸部成像在1.5T下进行,采用半径向双回波bSFP序列,称为bSTART。为了获得最大的采样效率,使用了沿全双极读出的单个模数转换器窗口。为了确保在多个呼吸周期内均匀覆盖k空间,径向k空间采样遵循短持续时间的阿基米德螺旋交织,这些交织以小的极角随机命名,并绕极轴旋转金角;深入到摆动的阿基米德螺旋极点(WASP)轨迹。在体模和体内实验中,将WASP轨迹与涡流方面的螺旋叶序采样进行比较,并用于生成不同呼吸阶段的体内胸部图像。结果WASP轨迹在体模和体内都提供了无伪影的bSTART成像,所有受试者都成功地进行了呼吸自门控重建。所获取的数据量允许从5.5分钟的扫描(使用1.32ms的TR)以1.77mm的各向同性分辨率重建不同呼吸水平下的10个体积,在4.7分钟的扫描中(使用1.42ms的TR)获得一个高分辨率的1.16mm呼气末容积。尽管视野很大,但bSTART的极短TR减轻了非共振伪影。结论我们已经证明了在1.5T的健康受试者中使用摆动的阿基米德螺旋杆使用bSTART进行高分辨率自由呼吸胸部成像的可行性。
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引用次数: 3
Nanoparticle-based radiotherapy: Is dose all that matters? 纳米粒子放射治疗:剂量是否重要?
IF 2 4区 医学 Q1 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.zemedi.2023.04.002
Piotr Zygmanski, Erno Sajo, Davide Brivio
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引用次数: 0
Automated Parameter Selection for Accelerated MRI Reconstruction via Low-Rank Modeling of Local k-Space Neighborhoods 基于局部k空间邻域低秩建模的加速MRI重建自动参数选择
IF 2 4区 医学 Q1 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.zemedi.2022.02.002
Efe Ilicak , Emine Ulku Saritas , Tolga Çukur

Purpose

Image quality in accelerated MRI rests on careful selection of various reconstruction parameters. A common yet tedious and error-prone practice is to hand-tune each parameter to attain visually appealing reconstructions. Here, we propose a parameter tuning strategy to automate hybrid parallel imaging (PI) – compressed sensing (CS) reconstructions via low-rank modeling of local k-space neighborhoods (LORAKS) supplemented with sparsity regularization in wavelet and total variation (TV) domains.

Methods

For low-rank regularization, we leverage a soft-thresholding operation based on singular values for matrix rank selection in LORAKS. For sparsity regularization, we employ Stein's unbiased risk estimate criterion to select the wavelet regularization parameter and local standard deviation of reconstructions to select the TV regularization parameter. Comprehensive demonstrations are presented on a numerical brain phantom and in vivo brain and knee acquisitions. Quantitative assessments are performed via PSNR, SSIM and NMSE metrics.

Results

The proposed hybrid PI-CS method improves reconstruction quality compared to PI-only techniques, and it achieves on par image quality to reconstructions with brute-force optimization of reconstruction parameters. These results are prominent across several different datasets and the range of examined acceleration rates.

Conclusion

A data-driven parameter tuning strategy to automate hybrid PI-CS reconstructions is presented. The proposed method achieves reliable reconstructions of accelerated multi-coil MRI datasets without the need for exhaustive hand-tuning of reconstruction parameters.

目的加速MRI的图像质量取决于各种重建参数的选择。一种常见但乏味且容易出错的做法是手动调整每个参数以获得视觉上吸引人的重建。在此,我们提出了一种参数调整策略,通过局部k空间邻域(LORAKS)的低秩建模,辅以小波和总变分域(TV)的稀疏正则化,实现混合并行成像(PI) -压缩感知(CS)重建的自动化。对于低秩正则化,我们在LORAKS中利用基于奇异值的软阈值操作进行矩阵秩选择。对于稀疏性正则化,采用Stein无偏风险估计准则选择小波正则化参数,采用重构局部标准差选择TV正则化参数。全面的演示提出了一个数字脑幻影和在体内的脑和膝盖的收购。通过PSNR、SSIM和NMSE指标进行定量评估。结果所提出的PI-CS混合方法与单纯PI-CS方法相比,提高了重建质量,并且在对重建参数进行暴力优化的情况下,重建的图像质量达到了同等水平。这些结果在几个不同的数据集和检测的加速度范围内都很突出。结论提出了一种数据驱动的参数调优策略,实现了PI-CS混合重建的自动化。该方法实现了对加速多线圈MRI数据集的可靠重建,而无需对重建参数进行详尽的手动调整。
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引用次数: 3
Possibilities and challenges when using synthetic computed tomography in an adaptive carbon-ion treatment workflow 在自适应碳离子处理工作流程中使用合成计算机断层扫描的可能性和挑战
IF 2 4区 医学 Q1 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.zemedi.2022.05.003
Barbara Knäusl , Peter Kuess , Markus Stock , Dietmar Georg , Piero Fossati , Petra Georg , Lukas Zimmermann

Background and purpose

Anatomical surveillance during ion-beam therapy is the basis for an effective tumor treatment and optimal organ at risk (OAR) sparing. Synthetic computed tomography (sCT) based on magnetic resonance imaging (MRI) can replace the X-ray based planning CT (X-rayCT) in photon radiotherapy and improve the workflow efficiency without additional imaging dose. The extension to carbon-ion radiotherapy is highly challenging; complex patient positioning, unique anatomical situations, distinct horizontal and vertical beam incidence directions, and limited training data are only few problems. This study gives insight into the possibilities and challenges of using sCTs in carbon-ion therapy.

Materials and methods

For head and neck patients immobilised with thermoplastic masks 30 clinically applied actively scanned carbon-ion treatment plans on 15 CTs comprising 60 beams were analyzed. Those treatment plans were re-calculated on MRI based sCTs which were created employing a 3D U-Net. Dose differences and carbon-ion spot displacements between sCT and X-rayCT were evaluated on a patient specific basis.

Results

Spot displacement analysis showed a peak displacement by 0.2 cm caused by the immobilisation mask not measurable with the MRI. 95.7% of all spot displacements were located within 1 cm. For the clinical target volume (CTV) the median D50% agreed within −0.2% (−1.3 to 1.4%), while the median D0.01cc differed up to 4.2% (−1.3 to 25.3%) comparing the dose distribution on the X-rayCT and the sCT. OAR deviations depended strongly on the position and the dose gradient. For three patients no deterioration of the OAR parameters was observed. Other patients showed large deteriorations, e.g. for one patient D2% of the chiasm differed by 28.1%.

Conclusion

The usage of sCTs opens several new questions, concluding that we are not ready yet for an MR-only workflow in carbon-ion therapy, as envisaged in photon therapy. Although omitting the X-rayCT seems unfavourable in the case of carbon-ion therapy, an sCT could be advantageous for monitoring, re-planning, and adaptation.

背景和目的离子束治疗过程中的解剖监测是有效治疗肿瘤和保留最佳危险器官(OAR)的基础。基于磁共振成像(MRI)的合成计算机断层扫描(sCT)可以取代光子放射治疗中基于X射线的计划CT(X-rayCT),并在不增加成像剂量的情况下提高工作流程效率。扩展到碳离子放射治疗是极具挑战性的;复杂的患者定位、独特的解剖情况、不同的水平和垂直波束入射方向以及有限的训练数据只是少数问题。这项研究深入了解了在碳离子治疗中使用sCTs的可能性和挑战。材料和方法对于用热塑性口罩固定的头颈部患者,分析了临床应用的15个CT上的30个主动扫描碳离子治疗计划,包括60个波束。这些治疗计划是在使用3D U-Net创建的基于MRI的sCT上重新计算的。sCT和X射线CT之间的剂量差异和碳离子点位移在患者特定的基础上进行评估。结果点位移分析显示,位移峰值为0.2 cm,这是由不能用MRI测量的固定掩模引起的。95.7%的点位移位于1 对于临床目标体积(CTV),与X射线CT和sCT上的剂量分布相比,中值D50%在-0.2%(-1.3-1.4%)内一致,而中值D0.01cc差异高达4.2%(-1.3-25.3%)。OAR偏差很大程度上取决于位置和剂量梯度。对于三名患者,未观察到OAR参数的恶化。其他患者表现出严重的恶化,例如,对于一名患者,D2%的交叉差异为28.1%。结论sCTs的使用打开了几个新的问题,得出的结论是,我们还没有准备好在碳离子治疗中采用仅MR的工作流程,如光子治疗中所设想的那样。尽管在碳离子治疗的情况下,省略X射线CT似乎是不利的,但sCT可能有利于监测、重新规划和适应。
{"title":"Possibilities and challenges when using synthetic computed tomography in an adaptive carbon-ion treatment workflow","authors":"Barbara Knäusl ,&nbsp;Peter Kuess ,&nbsp;Markus Stock ,&nbsp;Dietmar Georg ,&nbsp;Piero Fossati ,&nbsp;Petra Georg ,&nbsp;Lukas Zimmermann","doi":"10.1016/j.zemedi.2022.05.003","DOIUrl":"10.1016/j.zemedi.2022.05.003","url":null,"abstract":"<div><h3>Background and purpose</h3><p>Anatomical surveillance during ion-beam therapy is the basis for an effective tumor treatment and optimal organ at risk (OAR) sparing. Synthetic computed tomography (sCT) based on magnetic resonance imaging (MRI) can replace the X-ray based planning CT (X-rayCT) in photon radiotherapy and improve the workflow efficiency without additional imaging dose. The extension to carbon-ion radiotherapy is highly challenging; complex patient positioning, unique anatomical situations, distinct horizontal and vertical beam incidence directions, and limited training data are only few problems. This study gives insight into the possibilities and challenges of using sCTs in carbon-ion therapy.</p></div><div><h3>Materials and methods</h3><p>For head and neck patients immobilised with thermoplastic masks 30 clinically applied actively scanned carbon-ion treatment plans on 15 CTs comprising 60 beams were analyzed. Those treatment plans were re-calculated on MRI based sCTs which were created employing a 3D U-Net. Dose differences and carbon-ion spot displacements between sCT and X-rayCT were evaluated on a patient specific basis.</p></div><div><h3>Results</h3><p>Spot displacement analysis showed a peak displacement by 0.2 cm caused by the immobilisation mask not measurable with the MRI. 95.7% of all spot displacements were located within 1 cm. For the clinical target volume (CTV) the median <span><math><mrow><msub><mrow><mi>D</mi></mrow><mrow><mn>50</mn><mo>%</mo></mrow></msub></mrow></math></span> agreed within −0.2% (−1.3 to 1.4%), while the median <span><math><mrow><msub><mrow><mi>D</mi></mrow><mrow><mn>0.01</mn><mspace></mspace><mi>cc</mi></mrow></msub></mrow></math></span> differed up to 4.2% (−1.3 to 25.3%) comparing the dose distribution on the X-rayCT and the sCT. OAR deviations depended strongly on the position and the dose gradient. For three patients no deterioration of the OAR parameters was observed. Other patients showed large deteriorations, <em>e.g.</em> for one patient <span><math><mrow><msub><mrow><mi>D</mi></mrow><mrow><mn>2</mn><mo>%</mo></mrow></msub></mrow></math></span> of the chiasm differed by 28.1%.</p></div><div><h3>Conclusion</h3><p>The usage of sCTs opens several new questions, concluding that we are not ready yet for an MR-only workflow in carbon-ion therapy, as envisaged in photon therapy. Although omitting the X-rayCT seems unfavourable in the case of carbon-ion therapy, an sCT could be advantageous for monitoring, re-planning, and adaptation.</p></div>","PeriodicalId":54397,"journal":{"name":"Zeitschrift fur Medizinische Physik","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8c/51/main.PMC10311249.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9744002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
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Zeitschrift fur Medizinische Physik
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