Applying physical science techniques and CERN technology to an unsolved problem in radiation treatment for cancer: the multidisciplinary ‘VoxTox’ research programme

Burnet, N.G.; Scaife, J.E.; Romanchikova, Marina; Thomas, Simon; Bates, A.; Wong, Eric T.T.; Noble, D.; Shelley, Leila E.A.; Bond, Simon; Forman, Julia; Hoole, A.; Barnett, Gillian C.; Brochu, F. M.; Simmons, M P D; Jena, R.; Harrison, K.; Yeap, Ping Lin; Drew, Amelia; Silvester, Emma; Elwood, Patrick; Pullen, H.; Sultana, Andrew; Seah, Shannon Y.K.; Wilson, Megan Z; Russell, Simon; Benson, Richard; Rimmer, Y.; Jefferies, Sarah; Taku, Nicolette; Gurnell, Mark; Powlson, Andrew S; Schönlieb, Carola‐Bibiane; Cai, Xiaohao; Sutcliffe, M.P.F.; Parker, M. A.

doi:10.23726/cij.2017.457

Cited by 11 publications

(7 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Data for this study were collected as part of the VoxTox study (UKCRN:13716) [31] , [32] , which received approval from the National Research Ethics Service Committee East of England (13/EE/0008) in 2013. All patients in the cohort were treated using TomoTherapy HiArt machines (Accuray, Sunnyvale, CA, USA) [31] , [33] that deliver helical intensity modulated radiotherapy at each fraction after the acquisition of daily mega-voltage CT image-guidance (MVCT) scans.…”

Section: Methodsmentioning

confidence: 99%

“…All patients in the cohort were treated using TomoTherapy HiArt machines (Accuray, Sunnyvale, CA, USA) [31] , [33] that deliver helical intensity modulated radiotherapy at each fraction after the acquisition of daily mega-voltage CT image-guidance (MVCT) scans. In the VoxTox study, these daily MVCT images were extracted from vendor archive, converted to dicom format, anonymised, and curated for analysis [31] , [32] .…”

Section: Methodsmentioning

confidence: 99%

“…Their demographic and treatment characteristics are listed in Table 1 . Toxicity data collected as part of the VoxTox was used for this study, with Common Terminology Criteria for Adverse Events (CTCAEv4.03) assessments [32] , [33] at months 6, 12 and 24 after completion of therapy.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Predicting radiotherapy-induced xerostomia in head and neck cancer patients using day-to-day kinetics of radiomics features

Berger

Noble

Shelley

et al. 2022

Physics and Imaging in Radiation Oncology

View full text Add to dashboard Cite

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Predicting radiotherapy-induced xerostomia in head and neck cancer patients using day-to-day kinetics of radiomics features

Berger

Noble

Shelley

et al. 2022

Physics and Imaging in Radiation Oncology

View full text Add to dashboard Cite

“…The VoxTox research programme is an observational study investigating the link between delivered radiation dose and toxicity (Burnet et al 2017). All patients were treated with TomoTherapy® (Accuray, Sunnyvale CA), with daily MVCT image guidance scans acquired immediately prior to treatment for the purposes of online positional verification.…”

Section: Clinical Imaging Detailsmentioning

confidence: 99%

“…Full details are provided, including the use of prior knowledge, rigid registration for setup correction, image windowing, and identification of poor contours. The algorithm was developed on training data, and validated on test scans, before integration into the VoxTox research programme (Burnet et al 2017). We demonstrate that IG scans have further use than routine positional verification by extracting quantitative information in the form of anatomical contours from these images.…”

Section: Introductionmentioning

confidence: 99%

Autosegmentation of the rectum on megavoltage image guidance scans

Shelley

Sutcliffe

Harrison

et al. 2019

Biomed. Phys. Eng. Express

View full text Add to dashboard Cite

Autosegmentation of image guidance (IG) scans is crucial for streamlining and optimising delivered dose calculation in radiotherapy. By accounting for interfraction motion, daily delivered dose can be accumulated and incorporated into automated systems for adaptive radiotherapy. Autosegmentation of IG scans is challenging due to poorer image quality than typical planning kilovoltage computed tomography (kVCT) systems, and the resulting reduction of soft tissue contrast in regions such as the pelvis makes organ boundaries less distinguishable. Current autosegmentation solutions generally involve propagation of planning contours to the IG scan by deformable image registration (DIR). Here, we present a novel approach for primary autosegmentation of the rectum on megavoltage IG scans acquired during prostate radiotherapy, based on the Chan-Vese algorithm. Pre-processing steps such as Hounsfield unit/intensity scaling, identifying search regions, dealing with air, and handling the prostate, are detailed. Post-processing features include identification of implausible contours (nominally those affected by muscle or air), 3D self-checking, smoothing, and interpolation. In cases where the algorithm struggles, the best estimate on a given slice may revert to the propagated kVCT rectal contour. Algorithm parameters were optimised systematically for a training cohort of 26 scans, and tested on a validation cohort of 30 scans, from 10 patients. Manual intervention was not required. Comparing Chan-Vese autocontours with contours manually segmented by an experienced clinical oncologist achieved a mean Dice Similarity Coefficient of 0.78 (SE < 0.011). This was comparable with DIR methods for kVCT and CBCT published in the literature. The autosegmentation system was developed within the VoxTox Research Programme for accumulation of delivered dose to the rectum in prostate radiotherapy, but may have applicability to further anatomical sites and imaging modalities.

show abstract

Associations between voxel-level accumulated dose and rectal toxicity in prostate radiotherapy

Shelley

Sutcliffe

Thomas

et al. 2020

Physics and Imaging in Radiation Oncology

Self Cite

View full text Add to dashboard Cite

Background and Purpose: Associations between dose and rectal toxicity in prostate radiotherapy are generally poorly understood. Evaluating spatial dose distributions to the rectal wall (RW) may lead to improvements in dose-toxicity modelling by incorporating geometric information, masked by dose-volume histograms. Furthermore, predictive power may be strengthened by incorporating the effects of interfraction motion into delivered dose calculations.Here we interrogate 3D dose distributions for patients with and without toxicity to identify rectal subregions at risk (SRR), and compare the discriminatory ability of planned and delivered dose. Material and Methods: Daily delivered dose to the rectum was calculated using image guidance scans, and accumulated at the voxel level using biomechanical finite element modelling. SRRs were statistically determined for rectal bleeding, proctitis, faecal incontinence and stool frequency from a training set (n = 139), and tested on a validation set (n = 47). Results: SRR patterns differed per endpoint. Analysing dose to SRRs improved discriminative ability with respect to the full RW for three of four endpoints. Training set AUC and OR analysis produced stronger toxicity associations from accumulated dose than planned dose. For rectal bleeding in particular, accumulated dose to the SRR (AUC 0.76) improved upon dose-toxicity associations derived from planned dose to the RW (AUC 0.63). However, validation results could not be considered significant. Conclusions: Voxel-level analysis of dose to the RW revealed SRRs associated with rectal toxicity, suggesting nonhomogeneous intra-organ radiosensitivity. Incorporating spatial features of accumulated delivered dose improved dose-toxicity associations. This may be an important tool for adaptive radiotherapy in the future.

show abstract

Applying physical science techniques and CERN technology to an unsolved problem in radiation treatment for cancer: the multidisciplinary ‘VoxTox’ research programme

Cited by 11 publications

References 28 publications

Predicting radiotherapy-induced xerostomia in head and neck cancer patients using day-to-day kinetics of radiomics features

Predicting radiotherapy-induced xerostomia in head and neck cancer patients using day-to-day kinetics of radiomics features

Autosegmentation of the rectum on megavoltage image guidance scans

Associations between voxel-level accumulated dose and rectal toxicity in prostate radiotherapy

Contact Info

Product

Resources

About