The role of image guidance in respiratory gated radiotherapy

Korreman, S.; Juhler-Nøttrup, Trine; Persson, Gitte Fredberg; Pedersen, Anders N.; Enmark, Marika; Nyström, Håkan; Specht, Lena

doi:10.1080/02841860802282786

Cited by 40 publications

(28 citation statements)

References 40 publications

(53 reference statements)

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“…This assumption fails in anatomical sites such as the thoracic cavity and the abdomen, owing predominantly to respiratory motions. [2][3][4][5][6] In the lungs, for example, respiration related deformation 13 can be as much as 4 cm. As a result, although higher radiation doses have shown better local tumor control, less aggressive treatment strategies with various degrees of dose margin have been adopted to accommodate for potential targeting errors.…”

Section: Introductionmentioning

confidence: 99%

“…In space, the different lung lobes have varying ranges of deformation. 3,6,7 In time, the respiratory cycle can be unstable and patient dependent. 25,26 To predict the lung motion, one must take into account of nonlinear elasticity of lung tissue, 27,28 pleural sliding, 29,30 regional differences in lung response, and the motion of adjacent structures such as the heart.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10][11][12] The current radiation treatment paradigm, for the most part, is still based on an assumption that both the tumor location and shape are known and remain unchanged during the course of radiation delivery. This assumption fails in anatomical sites such as the thoracic cavity and the abdomen, owing predominantly to respiratory motions.…”

Section: Introductionmentioning

confidence: 99%

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Predictive modeling of lung motion over the entire respiratory cycle using measured pressure‐volume data, 4DCT images, and finite‐element analysis

Eom

et al. 2010

Medical Physics

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Purpose: Predicting complex patterns of respiration can benefit the management of the respiratory motion for radiation therapy of lung cancer. The purpose of the present work was to develop a patient-specific, physiologically relevant respiratory motion model which is capable of predicting lung tumor motion over a complete normal breathing cycle. Methods: Currently employed techniques for generating the lung geometry from four-dimensional computed tomography data tend to lose details of mesh topology due to excessive surface smoothening. Some of the existing models apply displacement boundary conditions instead of the intrapleural pressure as the actual motive force for respiration, while others ignore the nonlinearity of lung tissues or the mechanics of pleural sliding. An intermediate nonuniform rational basis spline surface representation is used to avoid multiple geometric smoothing procedures used in the computational mesh preparation. Measured chest pressure-volume relationships are used to simulate pressure loading on the surface of the model for a given lung volume, as in actual breathing. A hyperelastic model, developed from experimental observations, has been used to model the lung tissue material. Pleural sliding on the inside of the ribcage has also been considered. Results:The finite-element model has been validated using landmarks from four patient CT data sets over 34 breathing phases. The average differences of end-inspiration in position between the landmarks and those predicted by the model are observed to be 0.450Ϯ 0.330 cm for Patient P1, 0.387Ϯ 0.169 cm for Patient P2, 0.319Ϯ 0.186 cm for Patient P3, and 0.204Ϯ 0.102 cm for Patient P4 in the magnitude of error vector, respectively. The average errors of prediction at landmarks over multiple breathing phases in superior-inferior direction are less than 3 mm. Conclusions:The prediction capability of pressure-volume curve driven nonlinear finite-element model is consistent over the entire breathing cycle. The biomechanical parameters in the model are physiologically measurable, so that the results can be extended to other patients and additional neighboring organs affected by respiratory motion.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictive modeling of lung motion over the entire respiratory cycle using measured pressure‐volume data, 4DCT images, and finite‐element analysis

Eom

et al. 2010

Medical Physics

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“…For gating-based radiation procedures, often exploited in for example lung cancer patients, 2D X-ray visualization is required for intrafractional real-time imaging of moving tumors. [ 6,[18][19][20] Additionally, fi ducial marker visualization using 2D X-ray techniques lowers the X-ray exposure level to the patients and may reduce treatment time compared to 3D X-ray-based procedures. [ 2 ] Furthermore, with the increasing focus on stereotactic radiation procedures and the clinical introduction of proton therapy, visualization of tumor position and motion becomes crucial to optimize irradiation of cancerous tissue.…”

Section: Introductionmentioning

confidence: 99%

Injectable Colloidal Gold for Use in Intrafractional 2D Image‐Guided Radiation Therapy

Jølck

Rydhög

Christensen

et al. 2015

Adv Healthcare Materials

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In the western world, approximately 50% of all cancer patients receive radiotherapy alone or in combination with surgery or chemotherapy. Image-guided radiotherapy (IGRT) has in recent years been introduced to enhance precision of the delivery of radiation dose to tumor tissue. Fiducial markers are often inserted inside the tumor to improve IGRT precision and to enable monitoring of the tumor position during radiation therapy. In the present article, a liquid fi ducial tissue marker is presented, which can be injected into tumor tissue using thin and fl exible needles. The liquid fi ducial has high radioopacity, which allows for marker-based image guidance in 2D and 3D X-ray imaging during radiation therapy. This is achieved by surface-engineering gold nanoparticles to be highly compatible with a carbohydrate-based gelation matrix. The new fi ducial marker is investigated in mice where they are highly biocompatible and stable after implantation. To investigate the clinical potential, a study is conducted in a canine cancer patient with spontaneous developed solid tumor in which the marker is successfully injected and used to align and image-guide radiation treatment of the canine patient. It is concluded that the new fi ducial marker has highly interesting properties that warrant investigations in cancer patients.

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“…In human patients, the advent of respiratory gated image-guided radiotherapy has facilitated complex treatment planning to precisely deliver high doses to intrathoracic and intraabdominal tumors while minimizing the dose the surrounding normal tissue, especially critical organs (21). In contrast, in the preclinical radiobiology setting, the concept of respiratory gating to enable precise and less toxic irradiation of orthotopic and transgenic tumor mouse models remains largely unexplored due to the lack of availability of such systems and the technical challenges posed in working with small animals.…”

Section: Respiratory-gated Small Animal Irradiationsmentioning

confidence: 99%

The Development of Technology for Effective Respiratory-Gated Irradiation Using an Image-Guided Small Animal Irradiator

et al. 2017

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The role of image guidance in respiratory gated radiotherapy

Cited by 40 publications

References 40 publications

Predictive modeling of lung motion over the entire respiratory cycle using measured pressure‐volume data, 4DCT images, and finite‐element analysis

Predictive modeling of lung motion over the entire respiratory cycle using measured pressure‐volume data, 4DCT images, and finite‐element analysis

Injectable Colloidal Gold for Use in Intrafractional 2D Image‐Guided Radiation Therapy

The Development of Technology for Effective Respiratory-Gated Irradiation Using an Image-Guided Small Animal Irradiator

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