Intra- and inter-fraction uncertainties during IGRT for Wilms’ tumor

Guerreiro, Filipa; Seravalli, Enrica; Janssens, Geert O.; Ven, Cornelis P. van de; Heuvel‐Eibrink, Marry M. van den; Raaymakers, B W

doi:10.1080/0284186x.2018.1438655

Cited by 22 publications

(55 citation statements)

References 25 publications

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“…Patient positioning was corrected online using the automated treatment table movement. For every other fraction, post-treatment CBCT scans were acquired for each patient as standard of care [24]. All pre-and post-treatment CBCT scans were registered to the planning-CT using the automated rigid registration algorithm available clinically on the XVI software [25].…”

Section: Patients and Imaging Characteristicsmentioning

confidence: 99%

“…The clinical target volume (CTV) was created by expanding the GTV by 10 mm [11]. To account for the uncertainty introduced by patient breathing, an individual and direction-specific internal target volume (ITV) was defined by measuring the surgical clips center of mass (CoM) displacements between the maximum expiration and inspiration phases of the 4D-CT scans [24]. OARs were contoured using the planning-CT.…”

Section: Target Volumes and Oars Definitionmentioning

confidence: 99%

“…A flowchart with all the steps of the uncertainty analysis is represented in Figure 1. For more details on the methodology we refer to [24]. A mean PTV (PTV mean ) expansion defined around the clinical ITV was calculated per workflow.…”

Section: Ptv Mean Determinationmentioning

confidence: 99%

“…Inter-fraction motion uncertainties were related to the TB motion between treatment fractions. For the VMAT CBCT workflow, the inter-fraction uncertainty was assessed by measuring the clips CoM displacements between the pre-treatment CBCT scans and the planning-CT [24].…”

Section: Motion Uncertaintiesmentioning

confidence: 99%

“…For the VMAT CBCT workflow, the intra-and inter-fraction uncertainties were calculated by measuring the clinical registration off-sets between the post-treatment and the pretreatment CBCT scans (Table 1) and the planning-CT [24], respectively.…”

Section: Patient Set-up Uncertaintiesmentioning

confidence: 99%

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Potential benefit of MRI-guided IMRT for flank irradiation in pediatric patients with Wilms’ tumor

et al. 2018

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Purpose/Objective: Flank irradiation for Wilms' tumor (WT) is currently performed at our institute using a cone-beam computed tomography-guided volumetric modulated arc (VMAT CBCT) workflow. By adding real-time magnetic resonance imaging (MRI) guidance to the treatment, safety margins could be reduced. The study purpose was to quantify the potential reduction of the planning target volume (PTV) margin and its dosimetric impact when using an MRI-guided intensity modulated radiation therapy (IMRT MRI) workflow compared to the VMAT CBCT workflow. Material/Methods: 4D-CT, MRI and CBCT scans acquired during preparation and treatment of 15 patients, were used to estimate both geometric, motion and patient setup systematic (P) and random (r) errors for VMAT CBCT and IMRT MRI workflows. The mean PTV (PTV mean) expansion was calculated using the van Herk formula. Treatment plans were generated using five margin scenarios (PTV mean ± 0, 1 and 2 mm). Furthermore, the IMRT MRI plans were optimized with a 1.5T transverse magnetic field turned-on to realistically model an MRI-guided treatment. Plans were evaluated using dose-volume statistics (p<.01, Wilcoxon). Results: Analysis of P and r errors resulted in a PTV mean of 5 mm for the VMAT CBCT and 3 mm for the IMRT MRI workflows in each orthogonal direction. Target coverage was unaffected by the margin decrease with a mean V 95% ¼100% for all margin scenarios. For the PTV mean , an average reduction of the mean dose to the organs at risk (OARs) was achieved with IMRT MRI compared to VMAT CBCT : 3.4 ± 2.4% (p<.01) for the kidney, 3.4 ± 2.1% (p<.01) for the liver, 2.8 ± 3.0% (p<.01) for the spleen and 4.9 ± 3.8% (p<.01) for the pancreas, respectively. Conclusions: Imaging data in children with WT demonstrated that the PTV margin could be reduced isotropically down to 2 mm when using the IMRT MRI compared to the VMAT CBCT workflow. The former results in a dose reduction to the OARs while maintaining target coverage.

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Section: Patients and Imaging Characteristicsmentioning

confidence: 99%

Section: Target Volumes and Oars Definitionmentioning

confidence: 99%

Section: Ptv Mean Determinationmentioning

confidence: 99%

Section: Motion Uncertaintiesmentioning

confidence: 99%

Section: Patient Set-up Uncertaintiesmentioning

confidence: 99%

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Potential benefit of MRI-guided IMRT for flank irradiation in pediatric patients with Wilms’ tumor

et al. 2018

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Advances in radiotherapy technology for pediatric cancer patients and roles of medical physicists: COG and SIOP Europe perspectives

Hua

Mascia

Seravalli

et al. 2021

Pediatric Blood & Cancer

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Over the last two decades, rapid technological advances have dramatically changed radiation delivery to children with cancer, enabling improved normal‐tissue sparing. This article describes recent advances in photon and proton therapy technologies, image‐guided patient positioning, motion management, and adaptive therapy that are relevant to pediatric cancer patients. For medical physicists who are at the forefront of realizing the promise of technology, challenges remain with respect to ensuring patient safety as new technologies are implemented with increasing treatment complexity. The contributions of medical physicists to meeting these challenges in daily practice, in the conduct of clinical trials, and in pediatric oncology cooperative groups are highlighted. Representing the perspective of the physics committees of the Children's Oncology Group (COG) and the European Society for Paediatric Oncology (SIOP Europe), this paper provides recommendations regarding the safe delivery of pediatric radiotherapy. Emerging innovations are highlighted to encourage pediatric applications with a view to maximizing the therapeutic ratio.

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Pencil Beam Scanning Proton Therapy for Paediatric Neuroblastoma with Motion Mitigation Strategy for Moving Target Volumes

et al. 2020

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Intra- and inter-fraction uncertainties during IGRT for Wilms’ tumor

Cited by 22 publications

References 25 publications

Potential benefit of MRI-guided IMRT for flank irradiation in pediatric patients with Wilms’ tumor

Potential benefit of MRI-guided IMRT for flank irradiation in pediatric patients with Wilms’ tumor

Advances in radiotherapy technology for pediatric cancer patients and roles of medical physicists: COG and SIOP Europe perspectives

Pencil Beam Scanning Proton Therapy for Paediatric Neuroblastoma with Motion Mitigation Strategy for Moving Target Volumes

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