A novel comprehensive metric balancing imaging dose and setup accuracy in image-guided radiotherapy: concept proposal and clinical validation
PurposeTo propose and validate a comprehensive novel metric balancing the registration accuracy and imaging dose for image-guided-radiotherapy based on real patient data.Materials and methodsWith written informed consent and ethical approval, 56 patients were scanned using 6MV CBCT, 140 kV CBCT, and...
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| Format: | Article |
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Frontiers Media S.A.
2024-11-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2024.1463219/full |
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| author | Jiang Liu Xinhui Fu Xinhui Fu Zhiyao Luo Chuou Yin Qiao Li Xigang Fan Tian Li Chen Lin Shouping Xu Yibao Zhang Yibao Zhang |
| author_facet | Jiang Liu Xinhui Fu Xinhui Fu Zhiyao Luo Chuou Yin Qiao Li Xigang Fan Tian Li Chen Lin Shouping Xu Yibao Zhang Yibao Zhang |
| author_sort | Jiang Liu |
| collection | DOAJ |
| description | PurposeTo propose and validate a comprehensive novel metric balancing the registration accuracy and imaging dose for image-guided-radiotherapy based on real patient data.Materials and methodsWith written informed consent and ethical approval, 56 patients were scanned using 6MV CBCT, 140 kV CBCT, and 100 kV CBCT on Halcyon system for three consecutive treatment fractions. Online registration was performed by various on-duty therapists under routine clinical pressure and time limitation. Offline registration was carried out by an experienced physicist without pressure. The consistency between the online and offline results was used as a surrogate of the missing ground-truth of registration accuracy, which was usually developed by introducing ‘known’ setup errors and rescan the phantoms, yet is ethnically not applicable to real patients. The registration differences (ΔD) between various imaging methods and observers were analyzed. The weighted CT dose index (CTDIw) for kV and MV CBCT was acquired using the PTW CTDI head phantom. The weighted-Dose-Accuracy-Product (DAPw) index was defined as DAPw =ΔD(mm) w1* CTDIw(mGy) w2, where w1 and w2 are the weighting factors of accuracy and dose respectively (w1+w2 = 1).ResultsThe mean and interquartile range (IQR) of ΔD decreased monotonically for MV CBCT, 100 kV CBCT, and 140 kV CBCT, supporting the registration consistency as a surrogate metric of image quality. Significant differences of ΔD were observed between the online and offline registration across three imaging methods (P<0.05). The 140 kV CBCT provides superior positioning accuracy, less dependency on observer subjectivity and time pressure of clinical workflow. Using w1=w2 = 0.5 as an example, the smallest mean, standard deviation, and IQR of DAPw were observed on the 100 kV CBCT, indicating optimal balance between dose and accuracy than the other two methods. Analysis of variance (ANOVA) showed statistically significant differences in DAPw among the different imaging methods (P<0.01, F=50.57).ConclusionUsing registration consistency as a surrogate indicator of image quality, this study proposed and validated a novel “DAPw” parameter based on real patient data, providing a purpose-specific tool for balancing setup accuracy and radiation dose in clinic. |
| format | Article |
| id | doaj-art-63fab08bf4cb421a93cd014456bb763d |
| institution | OA Journals |
| issn | 2234-943X |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj-art-63fab08bf4cb421a93cd014456bb763d2025-08-20T02:23:44ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2024-11-011410.3389/fonc.2024.14632191463219A novel comprehensive metric balancing imaging dose and setup accuracy in image-guided radiotherapy: concept proposal and clinical validationJiang Liu0Xinhui Fu1Xinhui Fu2Zhiyao Luo3Chuou Yin4Qiao Li5Xigang Fan6Tian Li7Chen Lin8Shouping Xu9Yibao Zhang10Yibao Zhang11Department of Oncology, People’s Hospital of Deyang City, Deyang, ChinaLaboratory Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, ChinaInstitute of Medical Technology, Peking University Health Science Center, Beijing, ChinaDepartment of Oncology, People’s Hospital of Deyang City, Deyang, ChinaDepartment of Oncology, People’s Hospital of Deyang City, Deyang, ChinaDepartment of Oncology, People’s Hospital of Deyang City, Deyang, ChinaDepartment of Oncology, People’s Hospital of Deyang City, Deyang, ChinaDepartment of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, ChinaState Key Laboratory of Nuclear Physics and Technology and the Key Laboratory of HEDP of the Ministry of Education, CAPT, Peking University, Beijing, ChinaNational Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, ChinaLaboratory Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, ChinaInstitute of Medical Technology, Peking University Health Science Center, Beijing, ChinaPurposeTo propose and validate a comprehensive novel metric balancing the registration accuracy and imaging dose for image-guided-radiotherapy based on real patient data.Materials and methodsWith written informed consent and ethical approval, 56 patients were scanned using 6MV CBCT, 140 kV CBCT, and 100 kV CBCT on Halcyon system for three consecutive treatment fractions. Online registration was performed by various on-duty therapists under routine clinical pressure and time limitation. Offline registration was carried out by an experienced physicist without pressure. The consistency between the online and offline results was used as a surrogate of the missing ground-truth of registration accuracy, which was usually developed by introducing ‘known’ setup errors and rescan the phantoms, yet is ethnically not applicable to real patients. The registration differences (ΔD) between various imaging methods and observers were analyzed. The weighted CT dose index (CTDIw) for kV and MV CBCT was acquired using the PTW CTDI head phantom. The weighted-Dose-Accuracy-Product (DAPw) index was defined as DAPw =ΔD(mm) w1* CTDIw(mGy) w2, where w1 and w2 are the weighting factors of accuracy and dose respectively (w1+w2 = 1).ResultsThe mean and interquartile range (IQR) of ΔD decreased monotonically for MV CBCT, 100 kV CBCT, and 140 kV CBCT, supporting the registration consistency as a surrogate metric of image quality. Significant differences of ΔD were observed between the online and offline registration across three imaging methods (P<0.05). The 140 kV CBCT provides superior positioning accuracy, less dependency on observer subjectivity and time pressure of clinical workflow. Using w1=w2 = 0.5 as an example, the smallest mean, standard deviation, and IQR of DAPw were observed on the 100 kV CBCT, indicating optimal balance between dose and accuracy than the other two methods. Analysis of variance (ANOVA) showed statistically significant differences in DAPw among the different imaging methods (P<0.01, F=50.57).ConclusionUsing registration consistency as a surrogate indicator of image quality, this study proposed and validated a novel “DAPw” parameter based on real patient data, providing a purpose-specific tool for balancing setup accuracy and radiation dose in clinic.https://www.frontiersin.org/articles/10.3389/fonc.2024.1463219/fullIGRTCBCTsetup errorimaging doseHalcyon |
| spellingShingle | Jiang Liu Xinhui Fu Xinhui Fu Zhiyao Luo Chuou Yin Qiao Li Xigang Fan Tian Li Chen Lin Shouping Xu Yibao Zhang Yibao Zhang A novel comprehensive metric balancing imaging dose and setup accuracy in image-guided radiotherapy: concept proposal and clinical validation Frontiers in Oncology IGRT CBCT setup error imaging dose Halcyon |
| title | A novel comprehensive metric balancing imaging dose and setup accuracy in image-guided radiotherapy: concept proposal and clinical validation |
| title_full | A novel comprehensive metric balancing imaging dose and setup accuracy in image-guided radiotherapy: concept proposal and clinical validation |
| title_fullStr | A novel comprehensive metric balancing imaging dose and setup accuracy in image-guided radiotherapy: concept proposal and clinical validation |
| title_full_unstemmed | A novel comprehensive metric balancing imaging dose and setup accuracy in image-guided radiotherapy: concept proposal and clinical validation |
| title_short | A novel comprehensive metric balancing imaging dose and setup accuracy in image-guided radiotherapy: concept proposal and clinical validation |
| title_sort | novel comprehensive metric balancing imaging dose and setup accuracy in image guided radiotherapy concept proposal and clinical validation |
| topic | IGRT CBCT setup error imaging dose Halcyon |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2024.1463219/full |
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