ESTRO-ACROP guideline on surface guided radiation therapy

Surface guidance systems enable patient positioning and motion monitoring without using ionising radiation. Surface Guided Radiation Therapy (SGRT) has therefore been widely adopted in radiation therapy in recent years, but guidelines on workflows and specific quality assurance (QA) are lacking. This ESTRO-ACROP guideline aims to give recommendations concerning SGRT roles and responsibilities and highlights common challenges and potential errors. Comprehensive guidelines for procurement, acceptance, commissioning, and QA of SGRT systems installed on computed tomography (CT) simulators, C-arm linacs, closed-bore linacs, and particle therapy treatment systems are presented that will help move to a consensus among SGRT users and facilitate a safe and efficient implementation and clinical application of SGRT. Keywords: ACROP; ESTRO; Guideline; SGRT; Surface guided radiation therapy

PET imaging of hypoxia using [F-18]HX4: a phase I trial

 Download the images using these instructions and this DOI : 10.1007/s00259-010-1437-x Background and purposeNon-invasive PET imaging of tumour hypoxia could help in the selection of those patients who could benefit from chemotherapy or radiation with specific antihypoxic treatments such as bioreductive drugs or hypoxic radiosensitizers. In this phase I trial, we aimed to determine the toxicity of [18F]HX4, a member of the 2-nitroimidazole family, at different dose levels. The secondary aim was to analyse image quality related to the HX4 dose and the timing of imaging.MethodsPatients with a..

Automatic selection of lung cancer patients for adaptive radiotherapy using cone-beam CT imaging

Background and purpose: Anatomical changes in non-small cell lung cancer (NSCLC) patients may lead to unacceptable treatment results, requiring adaptive radiotherapy (ART). The method proposed in this study describes the proof-of-principle to automatically select patients eligible for ART. Materials and methods: A method was developed flagging patients potentially requiring replanning using changes in density information between the planning CT and cone-beam CT (CBCT) scan. Potential candidates were defined based on anatomical changes in the primary tumour, mediastinum and a region including the lungs. In total, CBCTs of 70 NSCLC patients were retrospectively scored by two independent experts for the need of replanning using the clinical guidelines. Expert evaluation was used as benchmark for the automatic method and accuracy was quantified using a leave-one-out cross-validation strategy. Results: The automatic method correctly selected 79%, 71%, and 89% of the pre-defined candidates based on anatomical change in the tumour, mediastinum and lungs, respectively. The false positive rate was 27%, 9%, and 19% for these regions, respectively. If a single criterion (‘flag’) per patient is sufficient for replanning, the overall sensitivity was 89% with a false positive rate of 34%. Most common reasons for false positives were changes in breathing pattern or anatomical shifts outside the evaluated region. Excluding these reasons, the false positive rate dropped to 21% and the accuracy was almost similar to expert evaluation: overall sensitivity of approx. 95% with a false positive rate below 19%. Conclusion: Our method based on daily CBCT allows automatic selection of patients that should be investigated for treatment adaptation. Keywords: Non-small cell lung cancer, Adaptive radiotherapy, Replanning, Automatic selection method, Cone-beam C

A study of the leakage of the Antarctic polar vortex in late austral winter and spring using isentropic and 3-D trajectories

The permeability of the Antarctic polar vortex is investigated in late austral winter and spring by comparing isentropic and three-dimensional (3-D) trajectories. Trajectory computations were performed with the help of the Royal Dutch Meteorological Institute (KNMI) trajectory model, using data from the European Centre for Medium-Range Weather Forecasts (ECMWF) from August to November 1998. Large numbers of air parcels were initially released inside and outside the polar vortex on the 350, 450, and 550 K isentropic surfaces. They were integrated 4 months forward in time in an isentropic mode, as well as in a 3-D mode that uses all three wind components from the ECMWF and takes into account diabatic heating and cooling effects. For the isentropic trajectory calculations, very little transport (0.37%/week) was found for August and September, while October and November gave somewhat higher transport rates (1.95%/week). The 3-D trajectory calculations for October gave much more exchange between the vortex and midlatitudes than the isentropic ones owing to a significant number of parcels that descended inside the vortex. Descent rates were calculated for 350 K (October), 450 K (August–October) and 550 K (October). Overall, the results show that 3-D trajectories will provide more accurate leakage rates than the isentropic ones. Also, despite the large-scale mixing in the polar vortex or in midlatitudes, little ozone-depleted air leaks from the ozone hole into the midlatitude stratosphere

A traffic light protocol workflow for image-guided adaptive radiotherapy in lung cancer patients

BACKGROUND AND PURPOSE: Image-guided radiotherapy using cone beam-CT (CBCT) images is used to evaluate patient anatomy and positioning before radiotherapy. In this study we analyzed and optimized a traffic light protocol (TLP) used in lung cancer patients to identify patients requiring treatment adaptation. MATERIALS AND METHODS: First, CBCT review requests of 243 lung cancer patients were retrospectively analyzed and divided into 6 pre-defined categories. Frequencies and follow-up actions were scored. Based on these results, the TLP was optimized and evaluated in the same way on 230 patients treated in 2018. RESULTS: In the retrospective study, a total of 543 CBCT review requests were created during treatment in 193/243 patients due to changed anatomy of lung (24%), change of tumor volume (24%), review of match (18%), shift of the mediastinum (15%), shift of tumor (15%) and other (4%). The majority of requests (474, 87%) did not require further action. In 6% an adjustment of the match criteria sufficed; in 7% treatment plan adaptation was required. Plan adaptation was frequently seen in the categories changed anatomy of lung, change of tumor volume and shift of tumor outside the PTV. Shift of mediastinum outside PRV and shift of GTV outside CTV (but inside PTV) never required plan adaptation and were omitted to optimize the TLP, which reduced the CBCT review requests by 23%. CONCLUSIONS: The original TLP selected patients that required a treatment adaptation, but with a high false positive rate. The optimized TLP reduced the amount of CBCT review requests, while still correctly identifying patients requiring adaptation

A study of the leakage of the Antarctic polar vortex in late austral winter and spring using isentropic and 3-D trajectories

The permeability of the Antarctic polar vortex is investigated in late austral winter and spring by comparing isentropic and three-dimensional (3-D) trajectories. Trajectory computations were performed with the help of the Royal Dutch Meteorological Institute (KNMI) trajectory model, using data from the European Centre for Medium-Range Weather Forecasts (ECMWF) from August to November 1998. Large numbers of air parcels were initially released inside and outside the polar vortex on the 350, 450, and 550 K isentropic surfaces. They were integrated 4 months forward in time in an isentropic mode, as well as in a 3-D mode that uses all three wind components from the ECMWF and takes into account diabatic heating and cooling effects. For the isentropic trajectory calculations, very little transport (0.37%/week) was found for August and September, while October and November gave somewhat higher transport rates (1.95%/week). The 3-D trajectory calculations for October gave much more exchange between the vortex and midlatitudes than the isentropic ones owing to a significant number of parcels that descended inside the vortex. Descent rates were calculated for 350 K (October), 450 K (August–October) and 550 K (October). Overall, the results show that 3-D trajectories will provide more accurate leakage rates than the isentropic ones. Also, despite the large-scale mixing in the polar vortex or in midlatitudes, little ozone-depleted air leaks from the ozone hole into the midlatitude stratosphere

A traffic light protocol workflow for image-guided adaptive radiotherapy in lung cancer patients

BACKGROUND AND PURPOSE: Image-guided radiotherapy using cone beam-CT (CBCT) images is used to evaluate patient anatomy and positioning before radiotherapy. In this study we analyzed and optimized a traffic light protocol (TLP) used in lung cancer patients to identify patients requiring treatment adaptation. MATERIALS AND METHODS: First, CBCT review requests of 243 lung cancer patients were retrospectively analyzed and divided into 6 pre-defined categories. Frequencies and follow-up actions were scored. Based on these results, the TLP was optimized and evaluated in the same way on 230 patients treated in 2018. RESULTS: In the retrospective study, a total of 543 CBCT review requests were created during treatment in 193/243 patients due to changed anatomy of lung (24%), change of tumor volume (24%), review of match (18%), shift of the mediastinum (15%), shift of tumor (15%) and other (4%). The majority of requests (474, 87%) did not require further action. In 6% an adjustment of the match criteria sufficed; in 7% treatment plan adaptation was required. Plan adaptation was frequently seen in the categories changed anatomy of lung, change of tumor volume and shift of tumor outside the PTV. Shift of mediastinum outside PRV and shift of GTV outside CTV (but inside PTV) never required plan adaptation and were omitted to optimize the TLP, which reduced the CBCT review requests by 23%. CONCLUSIONS: The original TLP selected patients that required a treatment adaptation, but with a high false positive rate. The optimized TLP reduced the amount of CBCT review requests, while still correctly identifying patients requiring adaptation