Quantifying inter-fraction cardiac substructure displacement during radiotherapy via magnetic resonance imaging guidance.
Quantifying inter-fraction cardiac substructure displacement during radiotherapy via magnetic resonance imaging guidance.
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DOI：
10.1016/j.phro.2021.03.005
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发表时间：
2021-04
影响因子：
--
通讯作者：
Glide-Hurst CK
中科院分区：
文献类型：
--
作者：
Morris ED;Ghanem AI;Zhu S;Dong M;Pantelic MV;Glide-Hurst CK
新出现的证据表明，心脏亚结构在癌症治疗的放射治疗过程中具有高度的放射敏感性。然而，肿瘤定位后亚结构位置的变化还没有得到很好的表征。本研究通过利用磁共振成像（MRI）出色的软组织对比度来量化子结构的级间位移和计划危险器官体积（PRV）。回顾性评价的18例患者使用0.35 T MRI引导的直线加速器接受了胸内肿瘤放疗。在17-25 s屏气下采集成像（分辨率1.5 × 1.5 × 3 mm 3）。每例患者（n = 71）每天3 - 4次MRI严格配准到基于肿瘤匹配的计划MRI模拟。深度学习或基于图谱的分割传播了13个子结构（例如，心腔、冠状动脉、大血管）进行每日MRI检查，并由两名放射肿瘤学家进行验证。对MRI模拟的每日质心位移进行量化，并计算PRV。在各亚结构中，14%左右、18%前后和21%上下的片段间位移> 5 mm。由于缺乏屏气顺应性，约4%的所有结构在任何轴上移位> 10 mm。对于心腔，左-右、前-后和上-下轴的中位位移分别为1.8、1.9和2.2 mm。大血管在上下轴（43%的移位）显示出较大的移位（> 3 mm），而在其他位置仅为25%（左右）和29%（前后）。3至5 mm的PRV被确定为各向异性的亚结构特异性边缘。这项探索性工作得出了亚结构特异性安全裕度，以确保高效的心脏保护。研究结果需要在更大的队列中进行验证，以获得可靠的边缘推导和前瞻性临床试验中的应用。
Emerging evidence suggests cardiac substructures are highly radiosensitive during radiation therapy for cancer treatment. However, variability in substructure position after tumor localization has not been well characterized. This study quantifies inter-fraction displacement and planning organ at risk volumes (PRVs) of substructures by leveraging the excellent soft tissue contrast of magnetic resonance imaging (MRI). Eighteen retrospectively evaluated patients underwent radiotherapy for intrathoracic tumors with a 0.35 T MRI-guided linear accelerator. Imaging was acquired at a 17–25 s breath-hold (resolution 1.5 × 1.5 × 3 mm3). Three to four daily MRIs per patient (n = 71) were rigidly registered to the planning MRI-simulation based on tumor matching. Deep learning or atlas-based segmentation propagated 13 substructures (e.g., chambers, coronary arteries, great vessels) to daily MRIs and were verified by two radiation oncologists. Daily centroid displacements from MRI-simulation were quantified and PRVs were calculated. Across substructures, inter-fraction displacements for 14% in the left–right, 18% in the anterior-posterior, and 21% of fractions in the superior-inferior were > 5 mm. Due to lack of breath-hold compliance, ~4% of all structures shifted > 10 mm in any axis. For the chambers, median displacements were 1.8, 1.9, and 2.2 mm in the left–right, anterior-posterior, and superior-inferior axis, respectively. Great vessels demonstrated larger displacements (> 3 mm) in the superior-inferior axis (43% of shifts) and were only 25% (left–right) and 29% (anterior-posterior) elsewhere. PRVs from 3 to 5 mm were determined as anisotropic substructure-specific margins. This exploratory work derived substructure-specific safety margins to ensure highly effective cardiac sparing. Findings require validation in a larger cohort for robust margin derivation and for applications in prospective clinical trials.
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影响因子：
51.1
作者：
Bradley, Jeffrey D.;Paulus, Rebecca;Komaki, Ritsuko;Masters, Gregory;Blumenschein, George;Schild, Steven;Bogart, Jeffrey;Hu, Chen;Forster, Kenneth;Magliocco, Anthony;Kavadi, Vivek;Garces, Yolanda I.;Narayan, Samir;Iyengar, Puneeth;Robinson, Cliff;Wynn, Raymond B.;Koprowski, Christopher;Meng, Joanne;Beitler, Jonathan;Gaur, Rakesh;Curran, Walter, Jr.;Choy, Hak
通讯作者：
Choy, Hak
影响因子：
5.7
作者：
McKenzie, A;van Herk, M;Mijnheer, B
通讯作者：
Mijnheer, B
影响因子：
158.5
作者：
Darby, Sarah C.;Ewertz, Marianne;Hall, Per
通讯作者：
Hall, Per
DOI：
10.1016/j.ejmp.2018.05.008
发表时间：
2018-05-01
影响因子：
3.4
作者：
Li, Qian;Tong, Ying;Gong, Guanzhong
通讯作者：
Gong, Guanzhong
影响因子：
2.1
作者：
Attili, Anil K.;Schuster, Andreas;Nagel, Eike;Reiber, Johan H. C.;van der Geest, Rob J.
通讯作者：
van der Geest, Rob J.