Using corrected Cone-Beam CT image for accelerated partial breast irradiation treatment dose verification: the preliminary experience

Radiation Oncology

Jiayi Chen¹  Xiaomao Guo¹  Ziqiang Pan¹  Jiayuan Peng¹  Gang Cai¹  Weigang Hu¹  Jiazhou Wang¹ 

[1] Department of Oncology, Shanghai Medical College, Fudan University, 270 DongAn Road, Shanghai 200032, China

关键词: Image correction;    APBI;    CBCT;   

Others  :  1152984
DOI  :  10.1186/1748-717X-8-214

 received in 2013-02-18, accepted in 2013-09-03,  发布年份 2013

【 摘 要 】

Background

Accurate target localization is mandatory in the accelerated partial breast irradiation (APBI) delivery. Dosimetric verification for positional error will further guarantee the accuracy of treatment delivery. The purpose of this study is to evaluate the clinical feasibility of a cone beam computer tomographic (CBCT) image correction method in APBI.

Methods

A CBCT image correction method was developed. First, rigid image registration was proceeded for CTs and CBCTs; second, these images were separated into four parts; then, ratio images for each of the four parts of planning CTs/CBCTs were calculated and filtered to reduce the high spatial frequency; finally, the enhanced CBCT images were generated combing the four parts. An anthropomorphic thorax rando phantom was used to evaluate the feasibility and accuracy of the CBCT correction method. The CBCT images of consecutive 10 patients receiving APBI were corrected using the above method and dosimetric variations were evaluated. Each set of CBCT is composed of three images: one acquired after skin-marker setup, one after online setup correction and one after treatment delivery.

Results

The phantom study showed the improved accuracy of dose calculation with corrected CBCT. The Dose Volume Histogram (DVH) difference between the planning CT and corrected CBCT is less than the difference between the planning CT and original CBCT. The maximum dose difference between the corrected CBCT and planning CT is 0.8% in PTV_EVAL V₁₀₀, which is 3.8% between original CBCT and planning. In the patient study, 67.4% of fractions benefit from CBCT setup corrections in PTV_EVAL D95, while in 47.4% of the fractions, reduced dose coverage was found on the post-treatment CBCT. Overall, the CBCT based initial setup correction guaranteed target dose coverage in 9 patients.

Conclusions

A generic CBCT image correction algorithm was created and proved to be easily implemented in clinic. Compared to the original CBCT, the corrected CBCT has more accuracy in dose calculation. The CBCT guided APBI based on initial skin setup is not sufficient to guarantee the accurate dose delivery throughout each fraction. The long treatment delivery time may compromise the target coverage benefits in some patients.

【 授权许可】

   
2013 Wang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]Darby S, McGale P, Correa C, Taylor C, Arriagada R, Clarke M, Cutter D, Davies C, Ewertz M, Early Breast Cancer Trialists’ Collaborative G, et al.: Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011, 378:1707-1716.
• [2]Smith BD, Arthur DW, Buchholz TA, Haffty BG, Hahn CA, Hardenbergh PH, Julian TB, Marks LB, Todor DA, Vicini FA, et al.: Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). J Am Coll Surg 2009, 209:269-277.
• [3]White EA, Cho J, Vallis KA, Sharpe MB, Lee G, Blackburn H, Nageeti T, McGibney C, Jaffray DA: Cone beam computed tomography guidance for setup of patients receiving accelerated partial breast irradiation. Int J Radiat Oncol Biol Phys 2007, 68:547-554.
• [4]van Mourik A, van Kranen S, den Hollander S, Sonke JJ, van Herk M, van Vliet-Vroegindeweij C: Effects of setup errors and shape changes on breast radiotherapy. Int J Radiat Oncol Biol Phys 2011, 79:1557-1564.
• [5]Hu W, Ye J, Wang J, Ma X, Zhang Z: Use of kilovoltage X-ray volume imaging in patient dose calculation for head-and-neck and partial brain radiation therapy. Radiat Oncol 2010, 5:29. BioMed Central Full Text
• [6]Richter A, Hu Q, Steglich D, Baier K, Wilbert J, Guckenberger M, Flentje M: Investigation of the usability of conebeam CT data sets for dose calculation. Radiat Oncol 2008, 3:42. BioMed Central Full Text
• [7]Fotina I, Hopfgartner J, Stock M, Steininger T, Lutgendorf-Caucig C, Georg D: Feasibility of CBCT-based dose calculation: comparative analysis of HU adjustment techniques. Radiother Oncol 2012, 104:249-256.
• [8]van Zijtveld M, Dirkx M, Heijmen B: Correction of conebeam CT values using a planning CT for derivation of the “dose of the day”. Radiother Oncol 2007, 85:195-200.
• [9]Ruhrnschopf EP, Klingenbeck K: A general framework and review of scatter correction methods in x-ray cone-beam computerized tomography. Part 1: scatter compensation approaches. Med Phys 2011, 38:4296-4311.
• [10]Niu T, Sun M, Star-Lack J, Gao H, Fan Q, Zhu L: Shading correction for on-board cone-beam CT in radiation therapy using planning MDCT images. Med Phys 2010, 37:5395-5406.
• [11]Niu T, Al-Basheer A, Zhu L: Quantitative cone-beam CT imaging in radiation therapy using planning CT as a prior: first patient studies. Med Phys 2012, 39:1991-2000.
• [12]Yang Y, Schreibmann E, Li T, Wang C, Xing L: Evaluation of on-board kV cone beam CT (CBCT)-based dose calculation. Phys Med Biol 2007, 52:685-705.
• [13]Rong Y, Smilowitz J, Tewatia D, Tome WA, Paliwal B: Dose calculation on kV cone beam CT images: an investigation of the Hu-density conversion stability and dose accuracy using the site-specific calibration. Med Dosim 2010, 35:195-207.
• [14]Guan H, Dong H: Dose calculation accuracy using cone-beam CT (CBCT) for pelvic adaptive radiotherapy. Phys Med Biol 2009, 54:6239-6250.
• [15]Yoo S, Yin FF: Dosimetric feasibility of cone-beam CT-based treatment planning compared to CT-based treatment planning. Int J Radiat Oncol Biol Phys 2006, 66:1553-1561.
• [16]Cai G, Hu WG, Chen JY, Yu XL, Pan ZQ, Yang ZZ, Guo XM, Shao ZM, Jiang GL: Impact of residual and intrafractional errors on strategy of correction for image-guided accelerated partial breast irradiation. Radiat Oncol 2010, 5:96. BioMed Central Full Text
• [17]Baglan KL, Sharpe MB, Jaffray D, Frazier RC, Fayad J, Kestin LL, Remouchamps V, Martinez AA, Wong J, Vicini FA: Accelerated partial breast irradiation using 3D conformal radiation therapy (3D-CRT). Int J Radiat Oncol Biol Phys 2003, 55:302-311.
• [18]NSABP B-39: A randomized phase III study of conventional whole breast irradiation versus partial breast irradiation for women with stage 0, I, or II breast cancer. Clin Adv Hematol Oncol 2006, 4:719-721.
• [19]Poludniowski GG, Evans PM, Webb S: Cone beam computed tomography number errors and consequences for radiotherapy planning: an investigation of correction methods. Int J Radiat Oncol Biol Phys 2012, 84:e109-e114.
• [20]Pouliot J: Megavoltage imaging, megavoltage cone beam CT and dose-guided radiation therapy. Front Radiat Ther Oncol 2007, 40:132-142.
• [21]Marchant TE, Moore CJ, Rowbottom CG, MacKay RI, Williams PC: Shading correction algorithm for improvement of cone-beam CT images in radiotherapy. Phys Med Biol 2008, 53:5719-5733.