Motion management strategies and technical issues associated with stereotactic body radiotherapy of thoracic and upper abdominal tumors: A review from NRG oncology

Brandner, E; Chetty, Indrin J.; Giaddui, T; Xiao, Ying; Huq, M. Saiful

doi:10.1002/mp.12227

Cited by 129 publications

(141 citation statements)

References 170 publications

(494 reference statements)

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“…Efforts are under way to update that report with guidance needed today for clinic care and clinical trials. In 2017, several members of the Medical Physics Committee of NRG Oncology reviewed guidance in the context of stereotactic body radiation therapy for thoracic and upper abdominal tumors and made recommendations in the context of clinical trials 20. They describe considerations regarding both motion assessment and motion management 20.…”

Section: Motion Assessment and Managementmentioning

confidence: 99%

“…For trials when target motion may be ≥5 mm and delivery of a high daily dose (e.g. SBRT), institutions should be required to document the assessment and follow formal guidance such as that provided by AAPM TG 7619 or other organizations such as NRG20 to ensure motion assessment and management information is accurately captured for patients enrolled on the trial.For protocols involving monitoring of intra‐fraction motion, provide information regarding the acceptable technologies for monitoring and the thresholds for evaluation. Information should be provided as to whether intra‐fraction monitoring is required and the acceptable methods.…”

Section: Appendix a Recommendations For Clinical Trial Designersmentioning

confidence: 99%

Section: Appendix a Recommendations For Clinical Trial Designersmentioning

confidence: 99%

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Executive summary of AAPM Report Task Group 113: Guidance for the physics aspects of clinical trials

Moran

Molineu

Kruse

et al. 2018

J Applied Clin Med Phys

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The charge of AAPM Task Group 113 is to provide guidance for the physics aspects of clinical trials to minimize variability in planning and dose delivery for external beam trials involving photons and electrons. Several studies have demonstrated the importance of protocol compliance on patient outcome. Minimizing variability for treatments at different centers improves the quality and efficiency of clinical trials. Attention is focused on areas where variability can be minimized through standardization of protocols and processes through all aspects of clinical trials. Recommendations are presented for clinical trial designers, physicists supporting clinical trials at their individual clinics, quality assurance centers, and manufacturers.

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Section: Motion Assessment and Managementmentioning

confidence: 99%

Section: Appendix a Recommendations For Clinical Trial Designersmentioning

confidence: 99%

Section: Appendix a Recommendations For Clinical Trial Designersmentioning

confidence: 99%

See 1 more Smart Citation

Executive summary of AAPM Report Task Group 113: Guidance for the physics aspects of clinical trials

Moran

Molineu

Kruse

et al. 2018

J Applied Clin Med Phys

View full text Add to dashboard Cite

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“…4D CT is a standard imaging method for treatment planning in stereotactic body radiation therapy (SBRT) and in the modern era of 3D conformal RT or IMRT, as it can provide personalized margins accounting for target motion (46,47 Radiotherapy treatment planning of locally advanced NSCLC in a curative setting is based on TV delineation of all discernible tumor sites, usually consisting of the primary tumor and all involved lymph nodes. The restriction of TVs to the FDG-positive areas is supported by data from the 3D-CRT-era (53).…”

Section: Imaging For Tv Delineation For Radiotherapymentioning

confidence: 99%

Anatomic, functional and molecular imaging in lung cancer precision radiation therapy: treatment response assessment and radiation therapy personalization

MacManus

Everitt

Schimek-Jasch

et al. 2017

Transl. Lung Cancer Res.

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This article reviews key imaging modalities for lung cancer patients treated with radiation therapy (RT) and considers their actual or potential contributions to critical decision-making. An international group of researchers with expertise in imaging in lung cancer patients treated with RT considered the relevant literature on modalities, including computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET). These perspectives were coordinated to summarize the current status of imaging in lung cancer and flag developments with future implications.Although there are no useful randomized trials of different imaging modalities in lung cancer, multiple prospective studies indicate that management decisions are frequently impacted by the use of complementary imaging modalities, leading both to more appropriate treatments and better outcomes. This is especially true of 18 F-fluoro-deoxyglucose (FDG)-PET/CT which is widely accepted to be the standard imaging modality for staging of lung cancer patients, for selection for potentially curative RT and for treatment planning. PET is also more accurate than CT for predicting survival after RT. PET imaging during RT is also correlated with survival and makes response-adapted therapies possible. PET tracers other than FDG have potential for imaging important biological process in tumors, including hypoxia and proliferation. MRI has superior accuracy in soft tissue imaging and the MRI Linac is a rapidly developing technology with great potential for online monitoring and modification of treatment. The role of imaging in RT-treated lung cancer patients is evolving rapidly and will allow increasing personalization of therapy according to the biology of both the tumor and dose limiting normal tissues.

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“…The respiratory motion of the diaphragm and liver has been reported in the range of millimeters to several centimeters . The dynamic change of the tumor and healthy tissue arrangement can be handled with several motion mitigation approaches . Motion‐encompassing treatment approaches ensure tumor coverage by increasing the treatment volumes according to the motion.…”

Section: Introductionmentioning

confidence: 99%

ELPHA: Dynamically deformable liver phantom for real‐time motion‐adaptive radiotherapy treatments

et al. 2019

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Purpose Real‐time motion‐adaptive radiotherapy of intrahepatic tumors needs to account for motion and deformations of the liver and the target location within. Phantoms representative of anatomical deformations are required to investigate and improve dynamic treatments. A deformable phantom capable of testing motion detection and motion mitigation techniques is presented here. Methods The dynamically dEformable Liver PHAntom (ELPHA) was designed to fulfill three main constraints: First, a reproducibly deformable anatomy is required. Second, the phantom should provide multimodality imaging contrast for motion detection. Third, a time‐resolved dosimetry system to measure temporal effects should be provided. An artificial liver with vasculature was casted from soft silicone mixtures. The silicones allow for deformation and radiographic image contrast, while added cellulose provides ultrasonic contrast. An actuator was used for compressing the liver in the inferior direction according to a prescribed respiratory motion trace. Electromagnetic (EM) transponders integrated in ELPHA help provide ground truth motion traces. They were used to quantify the motion reproducibility of the phantom and to validate motion detection based on ultrasound imaging. A two‐dimensional ultrasound probe was used to follow the position of the vessels with a template‐matching algorithm. This detected vessel motion was compared to the EM transponder signal by calculating the root‐mean‐square error (RMSE). ELPHA was then used to investigate the dose deposition of dynamic treatment deliveries. Two dosimetry systems, radio‐chromic film and plastic scintillation dosimeters (PSD), were integrated in ELPHA. The PSD allow for time‐resolved measurement of the delivered dose, which was compared to a time‐resolved dose of the treatment planning system. Film and PSD were used to investigate dose delivery to the deforming phantom without motion compensation and with treatment‐couch tracking for motion compensation. Results ELPHA showed densities of 66 and 45 HU in the liver and the surrounding tissues. A high motion reproducibility with a submillimeter RMSE (<0.32 mm) was measured. The motion of the vasculature detected with ultrasound agreed well with the EM transponder position (RMSE < 1 mm). A time‐resolved dosimetry system with a 1 Hz time resolution was achieved with the PSD. The agreement of the planned and measured dose to the PSD decreased with increasing motion amplitude: A dosimetric RMSE of 1.2, 2.1, and 2.7 cGy/s was measured for motion amplitudes of 8, 16, and 24 mm, respectively. With couch tracking as motion compensation, these values decreased to 1.1, 1.4, and 1.4 cGy/s. This is closer to the static situation with 0.7 cGy/s. Film measurements showed that couch tracking was able to compensate for motion with a mean target dose within 5% of the static situation (−5% to +1%), which was higher than in the uncompensated cases (−41% to −1%). Conclusions ELPHA is a deformable liver phantom with high motion reproducibility. It was demonstrated t...

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Motion management strategies and technical issues associated with stereotactic body radiotherapy of thoracic and upper abdominal tumors: A review from NRG oncology

Cited by 129 publications

References 170 publications

Executive summary of AAPM Report Task Group 113: Guidance for the physics aspects of clinical trials

Executive summary of AAPM Report Task Group 113: Guidance for the physics aspects of clinical trials

Anatomic, functional and molecular imaging in lung cancer precision radiation therapy: treatment response assessment and radiation therapy personalization

ELPHA: Dynamically deformable liver phantom for real‐time motion‐adaptive radiotherapy treatments

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