Feasibility and accuracy of UF/NCI phantoms and Monte Carlo retrospective dosimetry in children treated on National Wilms Tumor Study protocols

Kalapurakal, John A.; Gopalakrishnan, Mahesh; Mille, Marie-Laure; Helenowski, Irene; Peterson, Susan; Rigsby, Cynthia K.; Laurie, Fran; Jung, Jae Won; Fitzgerald, Thomas J.; Lee, Choonsik

doi:10.1002/pbc.27395

Cited by 9 publications

(7 citation statements)

References 34 publications

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“…Their utilization for potentially refining indications for RT in certain risk groups remains to be studied. Detailed studies of late toxicities specifically by analyzing the effects of RT doses to target organs is critical to improve our understanding of the relationship between RT and a variety of toxicities such as infertility, hypogonadism, congestive heart failure and secondary malignancies [60]. International collaborations like the Pediatric Normal Tissue Effects in the Clinic (PENTEC), are systematically analyzing the association between RT doses and volumes and organ toxicities by reviewing published reports of late toxicities following RT in children.…”

Section: Discussionmentioning

confidence: 99%

“…Another approach, as used by the CCSS, is to perform retrospective dosimetry using patient age and sex-matched phantoms to recreate multiorgan dosimetry from past treatments for correlation with late toxicities [61]. A similar approach using patientmatched 3D University of Florida/National Cancer Institute (UF/NCI) phantoms is currently being completed by the NWTS Late Effects Study [60]. A better understanding of the RT dose thresholds for these toxicities will help promote the adoption of interventions for their prevention and mitigation.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Toxicities among Wilms Tumor Survivors

Patel¹,

Lo²,

Pater³

et al. 2023

Radiation Therapy

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Successive trials conducted by the National Wilms Tumor Study have resulted in very high cure rates for children with Wilms tumor (WT). These trials have also significantly reduced the indications for doxorubicin and higher doses of RT in WT. Late toxicities after multimodality treatment especially RT, continues to be a major problem among WT survivors. Higher doses of RT is the most important factor responsible for the many late effects including congestive heart failure, secondary malignant neoplasms, hypogonadism, infertility and pregnancy complications, pulmonary disease, musculoskeletal effects, renal failure and diabetes mellitus. The potential for novel RT techniques like IMRT and proton therapy to reduce the incidence of these toxicities is discussed. The surveillance recommendations for WT survivors are mainly derived from the COG long-term follow-up guidelines. The future directions in late effects research include novel research to improve current knowledge of association between RT doses to target organs and late effects, discovery of novel biomarkers, and identification of predictive genetic biomarkers. Despite all these advances, there are significant challenges facing the global health care community that need to be overcome before the benefits of these innovations in late effects research can be translated to individual cancer survivors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-Term Toxicities among Wilms Tumor Survivors

Patel¹,

Lo²,

Pater³

et al. 2023

Radiation Therapy

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“…After processing the phantoms in the DICOM-RT Generator, the resulting DICOM-RT files were imported into the Philips Pinnacle TPS at Northwestern University, where patientspecific RT fields were then reconstructed (including photon energy, field-type, and prescribed dose) based on scanned paper medical records available from the NWTS database (Kalapurakal et al 2018). These radiotherapy plans were created by a practicing radiation oncologist and senior medical physicist who carefully reviewed the available medical records and portal films.…”

Section: National Wilms Tumor Study (Nwts) Application-using the Dicom-rtmentioning

confidence: 99%

Conversion of computational human phantoms into DICOM-RT for normal tissue dose assessment in radiotherapy patients

et al. 2019

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Radiotherapy treatment planning systems are designed for the fast calculation of dose to the tumor bed and nearby organs at risk using x-ray computed tomography (CT) images. However, CT images for a patient are typically available for only a small portion of the body, and in some cases, such as for retrospective epidemiological studies, no images may be available at all. When dose to organs that lie out-of-scan must be estimated, a convenient alternative for the unknown patient anatomy is to use a matching whole-body computational phantom as a surrogate. The purpose of the current work is to connect such computational phantoms to commercial radiotherapy treatment planning systems for retrospective organ dose estimation. A custom software with graphical user interface, called the DICOM-RT Generator, was developed in MATLAB to convert voxel computational phantoms into the Digital Imaging and Communications in Medicine radiotherapy (DICOM-RT) format, compatible with commercial treatment planning systems. DICOM CT image sets for the phantoms are created via a density-to-Hounsfield unit conversion curve. Accompanying structure sets containing the organ contours are automatically generated by tracing binary masks of user-specified organs on each phantom CT slice. The software was tested on a library of body size-dependent phantoms, the International Commission on Radiological Protection reference phantoms, and a canine voxel phantom, taking only a few minutes per conversion. The resulting DICOM-RT files were tested on several commercial treatment planning systems. As an example application, a library of converted phantoms was used to estimate organ doses for members of the National Wilms Tumor Study cohort. The converted phantom library, in DICOM format, and a standalone MATLAB-compiled executable of the DICOM-RT Generator are available for others to use for research purposes (http://ncidose.cancer.gov).

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“…8,[12][13][14][15] These methods provide 3-D dose estimations by emulating the historical treatment on a 3-D patient-resembling surrogate anatomy, e.g., physical phantoms, 12 computational phantoms, 8,12,15 or surrogate CTs. 12,14,16 For a dose reconstruction approach, the discrepancy between the surrogate anatomy and the true anatomy of the patient for whom the plan was originally designed is one of the main sources of uncertainties, making it an important topic to research. 7,8,17 As variations in anatomy exist in the population, it has been found that an approach that uses a representative surrogate patient's anatomy to reconstruct RT dose for an individual patient can introduce large dose uncertainties.…”

Section: Introductionmentioning

confidence: 99%

“…The last step, i.e., the dose calculation, can be automated, by scripting the dose calculation algorithms in a commercial treatment planning system (TPS), or using other standalone analytical or Monte-Carlo dose calculation algorithms. 15,16,28 The bottleneck that prevents performing dose reconstruction on a large scale is the intermediate step of RT plan emulation (step 2).…”

Section: Introductionmentioning

confidence: 99%

Automatic generation of three-dimensional dose reconstruction data for two-dimensional radiotherapy plans for historically treated patients

et al. 2020

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Performing large-scale three-dimensional radiation dose reconstruction for patients requires a large amount of manual work. We present an image processing-based pipeline to automatically reconstruct radiation dose. The pipeline was designed for childhood cancer survivors that received abdominal radiotherapy with anterior-to-posterior and posterior-to-anterior field set-up. First, anatomical landmarks are automatically identified on two-dimensional radiographs. Second, these landmarks are used to derive parameters to emulate the geometry of the plan on a surrogate computed tomography. Finally, the plan is emulated and used as input for dose calculation. For qualitative evaluation, 100 cases of automatic and manual plan emulations were assessed by two experienced radiation dosimetrists in a blinded comparison. The two radiation dosimetrists approved 100%/100% and 92%/91% of the automatic/manual plan emulations, respectively. Similar approval rates of 100% and 94% hold when the automatic pipeline is applied on another 50 cases. Further, quantitative comparisons resulted in on average <5 mm difference in plan isocenter/borders, and <0.9 Gy in organ mean dose (prescribed dose: 14.4 Gy) calculated from the automatic and manual plan emulations. No statistically significant difference in terms of dose reconstruction accuracy was found for most organs at risk. Ultimately, our automatic pipeline results are of sufficient quality to enable effortless scaling of dose reconstruction data generation.

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Feasibility and accuracy of UF/NCI phantoms and Monte Carlo retrospective dosimetry in children treated on National Wilms Tumor Study protocols

Abstract: This pilot study has demonstrated that the patient-matched UF/NCI phantoms together with MC dosimetry is an accurate model for performing retrospective 3D dosimetry in large-scale epidemiology studies such as the NWTS.

Cited by 9 publications

References 34 publications

Long-Term Toxicities among Wilms Tumor Survivors

Long-Term Toxicities among Wilms Tumor Survivors

Conversion of computational human phantoms into DICOM-RT for normal tissue dose assessment in radiotherapy patients

Automatic generation of three-dimensional dose reconstruction data for two-dimensional radiotherapy plans for historically treated patients

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