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- Unkelbach, Jan, et al.
(author)
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The role of computational methods for automating and improving clinical target volume definition
- 2020
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In: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140 .- 1879-0887. ; 153, s. 15-25
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Journal article (peer-reviewed)abstract
- Treatment planning in radiotherapy distinguishes three target volume concepts: the gross tumor volume(GTV), the clinical target volume (CTV), and the planning target volume (PTV). Over time, GTV definitionand PTV margins have improved through the development of novel imaging techniques and better imageguidance, respectively. CTV definition is sometimes considered the weakest element in the planning pro-cess. CTV definition is particularly complex since the extension of microscopic disease cannot be seenusing currently available in-vivo imaging techniques. Instead, CTV definition has to incorporate knowl-edge of the patterns of tumor progression. While CTV delineation has largely been considered the domainof radiation oncologists, this paper, arising from a 2019 ESTRO Physics research workshop, discusses thecontributions that medical physics and computer science can make by developing computational meth-ods to support CTV definition. First, we overview the role of image segmentation algorithms, which mayin part automate CTV delineation through segmentation of lymph node stations or normal tissues repre-senting anatomical boundaries of microscopic tumor progression. The recent success of deep convolu-tional neural networks has also enabled learning entire CTV delineations from examples. Second, wediscuss the use of mathematical models of tumor progression for CTV definition, using as example theapplication of glioma growth models to facilitate GTV-to-CTV expansion for glioblastoma that is consis-tent with neuroanatomy. We further consider statistical machine learning models to quantify lymphaticmetastatic progression of tumors, which may eventually improve elective CTV definition. Lastly, we dis-cuss approaches to incorporate uncertainty in CTV definition into treatment plan optimization as well asgeneral limitations of the CTV concept in the case of infiltrating tumors without natural boundaries.
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| 2. |
- Wang, Yibing, et al.
(author)
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An individualized strategy to estimate the effect of deformable registration uncertainty on accumulated dose in the upper abdomen
- 2018
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In: Physics in Medicine and Biology. - : IOP PUBLISHING LTD. - 0031-9155 .- 1361-6560. ; 63:12
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Journal article (peer-reviewed)abstract
- In the abdomen, it is challenging to assess the accuracy of deformable image registration (DIR) for individual patients, due to the lack of clear anatomical landmarks, which can hamper clinical applications that require high accuracy DIR, such as adaptive radiotherapy. In this study, we propose and evaluate a methodology for estimating the impact of uncertainties in DIR on calculated accumulated dose in the upper abdomen, in order to aid decision making in adaptive treatment approaches. Sixteen liver metastasis patients treated with SBRT were evaluated. Each patient had one planning and three daily treatment CT-scans. Each daily CT scan was deformably registered 132 times to the planning CT-scan, using a wide range of parameter settings for the registration algorithm. A subset of realistic registrations was then objectively selected based on distances between mapped and target contours. The underlying 3D transformations of these registrations were used to assess the corresponding uncertainties in voxel positions, and delivered dose, with a focus on accumulated maximum doses in the hollow OARs, i.e. esophagus, stomach, and duodenum. The number of realistic registrations varied from 5 to 109, depending on the patient, emphasizing the need for individualized registration parameters. Considering for all patients the realistic registrations, the 99th percentile of the voxel position uncertainties was 5.6 +/- 3.3 mm. This translated into a variation (difference between 1st and 99th percentile) in accumulated Dmax in hollow OARs of up to 3.3 Gy. For one patient a violation of the accumulated stomach dose outside the uncertainty band was detected. The observed variation in accumulated doses in the OARs related to registration uncertainty, emphasizes the need to investigate the impact of this uncertainty for any DIR algorithm prior to clinical use for dose accumulation. The proposed method for assessing on an individual patient basis the impact of uncertainties in DIR on accumulated dose is in principle applicable for all DIR algorithms allowing variation in registration parameters.
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