Analysis of dose using CBCT and synthetic CT during head and neck radiotherapy: A single centre feasibility study

Hay, Lisa; Paterson, C.; McLoone, Philip; Miguel-Chumacero, Eliane; Valentine, R.; Currie, S.; Grose, Derek; Schipani, Stefano; Wilson, Christina; Nixon, Ioanna; James, Allan; Duffton, A.

doi:10.1016/j.tipsro.2020.02.004

Cited by 19 publications

(21 citation statements)

References 32 publications

(63 reference statements)

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“…This survey data agrees with the Japanese data in 2018 15 which found single modality DIR (CT‐CT) as the most common DIR image modality pair. Lower DIR usage of CT‐CBCT usage could correspond to additional complexities such as image noise and streaking 32,33 for contour propagation, or image truncation 32,34 for synthetic CT generation 35 which may creep into the implementation of adaptive radiotherapy 24,36,37 …”

Section: Discussionmentioning

confidence: 99%

“…8 In scenarios where DIR is challenging (e.g., tissue appearance or disappearance 6,31 or large deformations 6 ), accurate use requires appropriate management of uncertainties. 4 Data on the use of RIR with multi-modality imaging show the rel- noise and streaking 32,33 for contour propagation, or image truncation 32,34 for synthetic CT generation 35 which may creep into the implementation of adaptive radiotherapy. 24,36,37 Data indicate that more centers have independent DIR software Three different approaches of evaluating IR processes (process satisfaction, staff involvement, key challenges) found that key concerns were registration accuracy classification (satisfactory or not) with appropriate follow-up use.…”

Section: Dir Software Type Dir Software Websitementioning

confidence: 99%

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An international survey on the clinical use of rigid and deformable image registration in radiotherapy

Yuen

Barber

Ralston

et al. 2020

J Applied Clin Med Phys

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Objectives: Rigid image registration (RIR) and deformable image registration (DIR) are widely used in radiotherapy. This project aims to capture current international approaches to image registration. Methods: A survey was designed to identify variations in use, resources, implementation, and decision-making criteria for clinical image registration. This was distributed to radiotherapy centers internationally in 2018. Results: There were 57 responses internationally, from the Americas (46%), Australia/New Zealand (32%), Europe (12%), and Asia (10%). Rigid image registration and DIR were used clinically for computed tomography (CT)-CT registration (96% and 51%, respectively), followed by CT-PET (81% and 47%), CT-CBCT (84% and 19%), CT-MR (93% and 19%), MR-MR (49% and 5%), and CT-US (9% and 0%). Respondent centers performed DIR using dedicated software (75%) and treatment planning systems (29%), with 84% having some form of DIR software. Centers have clinically implemented DIR for atlas-based segmentation (47%), multi-modality treatment planning (65%), and dose deformation (63%). The clinical use of DIR for multimodality treatment planning and accounting for retreatments was considered to have the highest benefit-to-risk ratio (69% and 67%, respectively). Conclusions: This survey data provides useful insights on where, when, and how image registration has been implemented in radiotherapy centers around the world. DIR is mainly in clinical use for CT-CT (51%) and CT-PET (47%) for the head and neck (43-57% over all use cases) region. The highest benefit-risk ratio for clinical use of DIR was for multi-modality treatment planning and accounting for retreatments, which also had higher clinical use than for adaptive radiotherapy and atlasbased segmentation.

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Section: Discussionmentioning

confidence: 99%

Section: Dir Software Type Dir Software Websitementioning

confidence: 99%

An international survey on the clinical use of rigid and deformable image registration in radiotherapy

Yuen

Barber

Ralston

et al. 2020

J Applied Clin Med Phys

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“…The RR and the LCR have published in peer reviewed journals as first author [16] , [17] , [18] . The RR has published as senior author [19] , [20] , [21] . Each RTT has contributed to publications as co-author.…”

Section: Resultsmentioning

confidence: 99%

Diversity in radiation therapist/therapeutic radiographer (RTT) advanced practice (AP) roles delivering on the four domains

Duffton

Moore

Williamson

2021

Technical Innovations & Patient Support in Radiation Oncolo

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Introduction: Advanced practice roles are well documented, and continue to respond to the changing landscape in radiotherapy and oncology. In the UK the highest level of AP for the therapeutic radiographer/radiation therapist (RTT) is the consultant radiographer. These posts should meet the four domains of practice, as set out in national guidance. Here we aim to describe well established roles that meet this criteria, and provide subgroups of examples. Methodology: Three AP post holders with over 10 years AP experience completed a questionnaire adapted from the consultant radiographer toolkit. These were completed in conjunction with guidance and framework documents. The examples were to demonstrate how they achieve a high level of practice in clinical and expert practice; professional leadership and consultancy; education, training and development; and practice and service development, research and evaluation. Participants then categorised results to add subgroups to each domain. Results: The questionnaire was completed by three RTTs specialising as a lung consultant radiographer (LCR), a neuro-oncology consultant radiographer (NCR) and a lead research radiographer (RR). Each post holder described how they meet the criteria by discussing the benefit they make to their profession, department and patients. All posts had examples for all criteria, achieving consultant practice. Clinical and expert practice was the dominant domain for the clinical specialist posts, and professional leadership and research evaluation was the strongest domains for the RR. Conclusion: All three consultant RTTs have demonstrated expert practice with clear and transparent examples of their professional practice which evidence the four domains of consultant practice. Following two decades of AP practice for RTTs there is a need to be strategic in the development of future posts with a prospective view on succession planning that safeguards their longevity.

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“…A previous retrospective study used a similar workflow to assess the ability of deforming Halcyon CBCT scans to assess margins for prostate treatments 3 . Other retrospective studies have assessed the feasibility of using deformable registration to a CBCT to replan head‐and‐neck plans and found limitations in the field of view and soft tissue contrast 2,4 . Previously, the limited field of view of CBCT has made the images unusable for treatment planning due to missing patient anatomy, 5 and deforming the target volumes has been discouraged due to the lack of soft tissue contrast and target visibility.…”

Section: Discussionmentioning

confidence: 99%

“…The initial planning CT was registered to the CBCT and then used for replanning, removing the need to repeat patient CT simulation. Previous studies have used a similar approach; due to the limited longitudinal range of CBCT scans, the primary planning CT is required in regions outside of CBCT the field of view 2 . Due to the large field of view of the Halcyon, CBCT large head‐and‐neck tumours can be included in the field of view.…”

Section: Introductionmentioning

confidence: 99%

Adaptive replanning using cone beam CT for deformation of original CT simulation

Bojechko

Hua

Sumner

et al. 2021

J of Medical Radiation Sci

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Background During a course of radiation therapy, anatomical changes such as a decrease in tumour size or weight loss can trigger the need for repeating a computed tomography (CT) simulation scan in order to generate a new treatment plan. This adaptive approach requires a separate appointment for an additional CT scan which generates additional burden, cost, and radiation exposure for patients. Case Presentation Here, we present a case of a head and neck cancer patient who required palliative radiation for a large neck mass. During treatment, he had a remarkable response which required a replan due to rapid tumour downsizing. In this case, we used a novel technique to avoid repeating the planning CT simulation by using a mid‐treatment high‐quality cone beam CT (CBCT) to deform the secondary image (plan CT) of the original planning CT and generate a new adapted treatment plan. Conclusion This is the first report to our knowledge using a Halcyon CBCT to deform the original planning CT in order to generate a new radiation treatment plan, and this novel technique represents a new potential method of adaptive replanning for select patients.

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Analysis of dose using CBCT and synthetic CT during head and neck radiotherapy: A single centre feasibility study

Cited by 19 publications

References 32 publications

An international survey on the clinical use of rigid and deformable image registration in radiotherapy

An international survey on the clinical use of rigid and deformable image registration in radiotherapy

Diversity in radiation therapist/therapeutic radiographer (RTT) advanced practice (AP) roles delivering on the four domains

Adaptive replanning using cone beam CT for deformation of original CT simulation

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