- Email: [email protected]
15. Cardiac magnetic resonance imaging damages evaluation using T1 values and apparent diffusion coefficient in left-sided breast cancer radiotherapy: A case report
Abstracts / Physica Medica 56 (2018) 59–132
one (c%) and mean c-values (cmean). Alert criteria of ±5% for R ratio, c% < 90% and cmean > 0.67 were chosen. Results. 50 transit EPID images were acquired. For the patients treated with ABC spirometer, the results reported a high level of accuracy in dose delivery with 100% of tests within ± 5%. The canalysis showed a cmean of 0.21 ± 0.10 and a mean c% equal to 96.9 ± 3.9%. Relevant discrepancies were observed only for the two patients treated without ABC, all described by the c% tests which dropped below 90% for all the tests. and mainly due to a blurring dose effect due to residual respiratory motion. Conclusions. Our method provided a fast and accurate procedure in clinical routine for verifying delivered dose as well as for detecting errors. https://doi.org/10.1016/j.ejmp.2018.04.023
14. Commissioning of the RayStation treatment planning system and dosimetric comparison with Pinnacle A. Savini, V. D’Errico, E. Menghi, E. Mezzenga, M.L. Belli, G. Feliciani, V. Ravaglia, A. Sarnelli Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy Purpose. To present our results regarding the commissioning of the RayStation TPS and to compare its dosimetric accuracy with the clinical Pinnacle TPS. Methods. A 6 MV beam quality of an Elekta Synergy was considered for modeling in RayStation. The dose calculation accuracy was tested in several situations. Firstly, measured PDD and profiles were compared with calculations using the 1D-gamma analysis. Secondly, using the test fields from the ESTRO booklet No. 7, absolute point doses were measured in a water phantom and compared with calculated values. Then, IMRT and VMAT techniques were tested performing pre-treatment verifications with the PTW-Octavius4D system. For this purpose, the AAPM TG-119 test cases as well as 20 clinical patients with various treatment sites were considered. The agreement between measurements and calculations was assessed with 3D-gamma analysis. Finally, 10 VMAT clinical cases optimized with Pinnacle were recalculated in RayStation. Dose distributions from both TPSs were compared with measurements. Results. maximum values of 1D-gamma confidence-level were 0.6 for PDDs (2%-2 mm, local normalization, Table 1) and 0.75 for profiles (3%-2 mm, local normalization). Absolute point dose measure-
69
Table 1
c confidence levels ðc-CL ¼ c þ 1:96cðcÞÞ for evaluating the agreement between measured and computed PDDs. Energy (MV)
FieldSize (X Y) (cm2)
c-CL (1.96r)
6.00 6.00 6.00 6.00 6.00 6.00 6.00 6.00 6.00 6.00
40.0 40.0 30.0 30.0 20.0 20.0 20.0 5.0 10.0 10.0 5.0 20.0 5.0 5.0 4.0 4.0 3.0 3.0 2.0 2.0
0.59 0.34 0.21 0.42 0.39 0.47 0.40 0.39 0.31 0.32
(2%-2 mm – local)
ments agreed with calculated values within 1.5%. 3D-gamma passrates for the TG-119 cases and patient-specific verifications were within the ranges [97.2% - 99.7%] and [89.0% - 97.5%] for 3%-3 mm global and local normalization, espectively. Absolute differences between average gamma pass-rates of patient-specific verifications were 0.1% (3%-3 mm, global normalization) and 1.1% (3%-3 mm, local normalization). These differences were not statistically significant (minimum p-value for a Wilcoxon-signed-rank test was 0.51, Fig. 1). Conclusions. RayStation was commissioned for a 6 MV beam quality of an Elekta Synergy. The dosimetric accuracy was tested in several situations, including standard international protocols. The agreement between measurements and calculations was clinically acceptable. Furthermore, RayStation accuracy was comparable with the clinically established Pinnacle TPS. https://doi.org/10.1016/j.ejmp.2018.04.024
15. Cardiac magnetic resonance imaging damages evaluation using T1 values and apparent diffusion coefficient in left-sided breast cancer radiotherapy: A case report E. Belligotti a,b, A. Coniglio b, A. Abella c, G. Della Longa c, G. Mazzarella d, A. Bufacchi b, P. Di Renzi c a
A.O. Ospedali Riuniti Marche Nord, Medical Physics Department, Pesaro, Italy b S. Giovanni Calibita Hospital, Fatebenefratelli, Medical Physics Department, Rome, Italy c S. Giovanni Calibita Hospital, Fatebenefratelli, Department of Radiology, Rome, Italy d S. Giovanni Calibita Hospital, Fatebenefratelli, Department of Radiotherapy, Rome, Italy
70
Abstracts / Physica Medica 56 (2018) 59–132
Purpose . Clinical importance of radiation-induced heart disease (RIHD) has been recognized only recently [1]. RIHD is not extensively studied because of the latent period; his pathological expressions include acute and chronic pericarditis, myocardial fibrosis and late ischemic cardiomyopathy. To evaluate RIHD in a patient who underwent radiotherapy treatment (RT) for left-sided breast cancer, cardiac magnetic resonance imaging (CMRI) was performed and myocardial T1 and apparent diffusion coefficient (ADC) calculated. Methods. A woman 43 y with left-sided breast cancer, underwent chemo-RT treatment with a total dose of 50 Gy. FEVS remained constant (70%) pre, during and post RT. The patient received a mean dose of 3.5 Gy to the heart. Cardiac morphological and functional evaluation was executed performing CMRI before RT, after 9 irradiations and 1 month later the end of RT. Single slice axial echo planar imaging (EPI) with b-values equal to 0–350 s/mm2and 3dimensional inversion recovery sequences were used to calculate, respectively, myocardial ADC and T1 values using a bespoke MATLABÒcode. Reported T1 represents the mean T1 value calculated over 10 slices acquired in short axis view. Except for the acquisition performed during RT, T1 values were evaluated after intravenous contrast medium administration. Results. We found a reduction of myocardial mean T1 value from 547 ± 40 ms pre-RT to 473 ± 35 ms post-RT, with lower value in apical region (434 ± 26 ms). ADC maps shows a reduction of 50% of ADC value (3.0 ± 1.6 lm2/ms) during irradiation and confrontable value pre-RT (6.3 ± 0.9 lm2/ms) and post-RT (6.1 ± 1.3 lm2/ms). Conclusions. Our results show a reduction of T1 value after irradiation that could be referred to a possible asymptomatic early state of diffuse fibrosis. A variation of ADC during RT could be associated to a possible inflammatory condition that could be recovered 1 month after RT. Reference 1. Madan R, Benson R, Sharma DN, Julka PK, Rath GK. Radiation induced heart disease: pathogenesis, management and review literature. J Egypt Natl Canc Inst. 2015;27:187–93.
excision were included in this study. Patients with complete (tumour regression grade, TRG = 1) or near complete (TRG = 2) regression were defined as responders (pR+), while patients with moderate (TRG = 3) to no regression (TRG = 5) were considered as non-responders (pR) [1,2]. Before implementing texture analysis, tumours were semi-automatically segmented on T2-w MRI, ADC maps and PET/CT acquisitions. From the segmented tumours, the following quantitative features were extracted from T2-w, ADC and PET images: (a) first-order parameters: median, mean, percentiles (10th, 25th, and 75th), (b) SUV, metabolic volume and glycolytic volume only for PET images, and (c) 22 s-order texture parameters, derived from Haralick analysis [3]. Multivariate logistic regression was performed to identify features most correlated with TRG. Results. Overall, 26 patients were classified as pR, and 21 as pR+ after total mesorectal excision. Parameters included in the multivariate regression were ‘‘10th percentile PET”, ‘‘10th percentile T2-w”, ‘‘Homogeneity ADC”, ‘‘Homogeneity PET”, ‘‘Information measure of correlation T2-w” (p = 0.002). The area under the ROC curve was 0.83 (95% confidence interval = 0.69–0.93), sensitivity and specificity were 75% and 76%, respectively, in detecting responders. Conclusions. Texture analysis could provide useful information in assessing response to neoadjuvant treatment in LARC patients. These preliminary results, if confirmed on larger dataset, could be useful to personalize the oncological pathway for patients, delaying or advancing surgery, according to the prediction of treatment response. References 1. Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 1994;73(11):2680–6. 2. Santos MD, Silva C, Rocha A, Matos E, Nogueira C, Lopes C. Tumor regression grades: can they influence rectal cancer therapy decision tree? Int J Surg Oncol 2013;2013:572149. 3. Haralick RM, Shanmugam K, Dinstein I. Textural features for image classification. IEEE Trans Syst Man Cybern 1973;SMC3:610–21.
https://doi.org/10.1016/j.ejmp.2018.04.025 https://doi.org/10.1016/j.ejmp.2018.04.026
16. Predicting neoadjuvant therapy response in locally advanced rectal cancer using texture features S. Mazzetti a,b, V. Giannini a,b, A. Di Dia c, C. Bracco c, S. Bresciani c, S. Cauda d, T. Varetto d, E. Del Mastro e, P. Gabriele e, D. Regge a,b, M. Stasi c a
Candiolo Cancer Institute – FPO, IRCCS, Imaging Unit, Candiolo, Torino, Italy b University of Torino, Department of Surgical Sciences, Torino, Italy c Candiolo Cancer Institute – FPO, IRCCS, Medical Physics Unit, Candiolo, Torino, Italy d Candiolo Cancer Institute – FPO, IRCCS, Nuclear Medicine Unit, Candiolo, Torino, Italy e Candiolo Cancer Institute – FPO, IRCCS, Radiotherapy Unit, Candiolo, Torino, Italy Purpose. To predict pathological response to neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal carcinoma (LARC), using a classifier based on texture features derived from MRI and PET acquisitions. Methods. 47 patients with: (a) histologically diagnosis of LARC, (b) pre-treatment MRI and PET/CT, (c) neoadjuvant treatment consisting of 46–55 Gy in 23–30 RT fractions alone or in association with either infusional 5-FU or oral Capecitabine, and (d) total mesorectal
17. Evaluation of MR and PET compatibility of dedicated radiotherapy positioning devices – a preliminary study A. Zorz a, M. Gianelli b, A. Scaggion a, M. Fusella a, M. Branchini a, P. Turco c, A. Capotosto c, P. Zucchetta c, M. Paiusco a a
Veneto Institute of Oncology IOV – IRCCS, Medical Physics Department, Padua, Italy b Azienda Ospedaliera Universitaria Pisana, Medical Physics Department, Pisa, Italy c Azienda Ospedaliera di Padova, Nuclear Medicine Department, Padua, Italy Purpose. The aim of this preliminary study was to assess the compatibility of dedicated positioning devices developed for MR/PET imaging integration into radiotherapy planning. Methods. The X-Tend Flat Table Top and specifically designed radiofrequency coil holders were tested on an integrated Biograph mMR MR/PET scanner (Siemens Healthcare). Magnetic field homogeneity and MR image quality in terms of artifacts and signal-tonoise ratio (SNR), with and without the radiotherapy positioning devices, were evaluated by means of a field sequence with 0.1 ppm/line and a clinical T2-weighted sequence, respectively. Acquisitions of a cylindrical (diameter 16 cm) doped (NiSO4) water phantom were
one (c%) and mean c-values (cmean). Alert criteria of ±5% for R ratio, c% < 90% and cmean > 0.67 were chosen. Results. 50 transit EPID images were acquired. For the patients treated with ABC spirometer, the results reported a high level of accuracy in dose delivery with 100% of tests within ± 5%. The canalysis showed a cmean of 0.21 ± 0.10 and a mean c% equal to 96.9 ± 3.9%. Relevant discrepancies were observed only for the two patients treated without ABC, all described by the c% tests which dropped below 90% for all the tests. and mainly due to a blurring dose effect due to residual respiratory motion. Conclusions. Our method provided a fast and accurate procedure in clinical routine for verifying delivered dose as well as for detecting errors. https://doi.org/10.1016/j.ejmp.2018.04.023
14. Commissioning of the RayStation treatment planning system and dosimetric comparison with Pinnacle A. Savini, V. D’Errico, E. Menghi, E. Mezzenga, M.L. Belli, G. Feliciani, V. Ravaglia, A. Sarnelli Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, FC, Italy Purpose. To present our results regarding the commissioning of the RayStation TPS and to compare its dosimetric accuracy with the clinical Pinnacle TPS. Methods. A 6 MV beam quality of an Elekta Synergy was considered for modeling in RayStation. The dose calculation accuracy was tested in several situations. Firstly, measured PDD and profiles were compared with calculations using the 1D-gamma analysis. Secondly, using the test fields from the ESTRO booklet No. 7, absolute point doses were measured in a water phantom and compared with calculated values. Then, IMRT and VMAT techniques were tested performing pre-treatment verifications with the PTW-Octavius4D system. For this purpose, the AAPM TG-119 test cases as well as 20 clinical patients with various treatment sites were considered. The agreement between measurements and calculations was assessed with 3D-gamma analysis. Finally, 10 VMAT clinical cases optimized with Pinnacle were recalculated in RayStation. Dose distributions from both TPSs were compared with measurements. Results. maximum values of 1D-gamma confidence-level were 0.6 for PDDs (2%-2 mm, local normalization, Table 1) and 0.75 for profiles (3%-2 mm, local normalization). Absolute point dose measure-
69
Table 1
c confidence levels ðc-CL ¼ c þ 1:96cðcÞÞ for evaluating the agreement between measured and computed PDDs. Energy (MV)
FieldSize (X Y) (cm2)
c-CL (1.96r)
6.00 6.00 6.00 6.00 6.00 6.00 6.00 6.00 6.00 6.00
40.0 40.0 30.0 30.0 20.0 20.0 20.0 5.0 10.0 10.0 5.0 20.0 5.0 5.0 4.0 4.0 3.0 3.0 2.0 2.0
0.59 0.34 0.21 0.42 0.39 0.47 0.40 0.39 0.31 0.32
(2%-2 mm – local)
ments agreed with calculated values within 1.5%. 3D-gamma passrates for the TG-119 cases and patient-specific verifications were within the ranges [97.2% - 99.7%] and [89.0% - 97.5%] for 3%-3 mm global and local normalization, espectively. Absolute differences between average gamma pass-rates of patient-specific verifications were 0.1% (3%-3 mm, global normalization) and 1.1% (3%-3 mm, local normalization). These differences were not statistically significant (minimum p-value for a Wilcoxon-signed-rank test was 0.51, Fig. 1). Conclusions. RayStation was commissioned for a 6 MV beam quality of an Elekta Synergy. The dosimetric accuracy was tested in several situations, including standard international protocols. The agreement between measurements and calculations was clinically acceptable. Furthermore, RayStation accuracy was comparable with the clinically established Pinnacle TPS. https://doi.org/10.1016/j.ejmp.2018.04.024
15. Cardiac magnetic resonance imaging damages evaluation using T1 values and apparent diffusion coefficient in left-sided breast cancer radiotherapy: A case report E. Belligotti a,b, A. Coniglio b, A. Abella c, G. Della Longa c, G. Mazzarella d, A. Bufacchi b, P. Di Renzi c a
A.O. Ospedali Riuniti Marche Nord, Medical Physics Department, Pesaro, Italy b S. Giovanni Calibita Hospital, Fatebenefratelli, Medical Physics Department, Rome, Italy c S. Giovanni Calibita Hospital, Fatebenefratelli, Department of Radiology, Rome, Italy d S. Giovanni Calibita Hospital, Fatebenefratelli, Department of Radiotherapy, Rome, Italy
70
Abstracts / Physica Medica 56 (2018) 59–132
Purpose . Clinical importance of radiation-induced heart disease (RIHD) has been recognized only recently [1]. RIHD is not extensively studied because of the latent period; his pathological expressions include acute and chronic pericarditis, myocardial fibrosis and late ischemic cardiomyopathy. To evaluate RIHD in a patient who underwent radiotherapy treatment (RT) for left-sided breast cancer, cardiac magnetic resonance imaging (CMRI) was performed and myocardial T1 and apparent diffusion coefficient (ADC) calculated. Methods. A woman 43 y with left-sided breast cancer, underwent chemo-RT treatment with a total dose of 50 Gy. FEVS remained constant (70%) pre, during and post RT. The patient received a mean dose of 3.5 Gy to the heart. Cardiac morphological and functional evaluation was executed performing CMRI before RT, after 9 irradiations and 1 month later the end of RT. Single slice axial echo planar imaging (EPI) with b-values equal to 0–350 s/mm2and 3dimensional inversion recovery sequences were used to calculate, respectively, myocardial ADC and T1 values using a bespoke MATLABÒcode. Reported T1 represents the mean T1 value calculated over 10 slices acquired in short axis view. Except for the acquisition performed during RT, T1 values were evaluated after intravenous contrast medium administration. Results. We found a reduction of myocardial mean T1 value from 547 ± 40 ms pre-RT to 473 ± 35 ms post-RT, with lower value in apical region (434 ± 26 ms). ADC maps shows a reduction of 50% of ADC value (3.0 ± 1.6 lm2/ms) during irradiation and confrontable value pre-RT (6.3 ± 0.9 lm2/ms) and post-RT (6.1 ± 1.3 lm2/ms). Conclusions. Our results show a reduction of T1 value after irradiation that could be referred to a possible asymptomatic early state of diffuse fibrosis. A variation of ADC during RT could be associated to a possible inflammatory condition that could be recovered 1 month after RT. Reference 1. Madan R, Benson R, Sharma DN, Julka PK, Rath GK. Radiation induced heart disease: pathogenesis, management and review literature. J Egypt Natl Canc Inst. 2015;27:187–93.
excision were included in this study. Patients with complete (tumour regression grade, TRG = 1) or near complete (TRG = 2) regression were defined as responders (pR+), while patients with moderate (TRG = 3) to no regression (TRG = 5) were considered as non-responders (pR) [1,2]. Before implementing texture analysis, tumours were semi-automatically segmented on T2-w MRI, ADC maps and PET/CT acquisitions. From the segmented tumours, the following quantitative features were extracted from T2-w, ADC and PET images: (a) first-order parameters: median, mean, percentiles (10th, 25th, and 75th), (b) SUV, metabolic volume and glycolytic volume only for PET images, and (c) 22 s-order texture parameters, derived from Haralick analysis [3]. Multivariate logistic regression was performed to identify features most correlated with TRG. Results. Overall, 26 patients were classified as pR, and 21 as pR+ after total mesorectal excision. Parameters included in the multivariate regression were ‘‘10th percentile PET”, ‘‘10th percentile T2-w”, ‘‘Homogeneity ADC”, ‘‘Homogeneity PET”, ‘‘Information measure of correlation T2-w” (p = 0.002). The area under the ROC curve was 0.83 (95% confidence interval = 0.69–0.93), sensitivity and specificity were 75% and 76%, respectively, in detecting responders. Conclusions. Texture analysis could provide useful information in assessing response to neoadjuvant treatment in LARC patients. These preliminary results, if confirmed on larger dataset, could be useful to personalize the oncological pathway for patients, delaying or advancing surgery, according to the prediction of treatment response. References 1. Mandard AM, Dalibard F, Mandard JC, et al. Pathologic assessment of tumor regression after preoperative chemoradiotherapy of esophageal carcinoma. Clinicopathologic correlations. Cancer 1994;73(11):2680–6. 2. Santos MD, Silva C, Rocha A, Matos E, Nogueira C, Lopes C. Tumor regression grades: can they influence rectal cancer therapy decision tree? Int J Surg Oncol 2013;2013:572149. 3. Haralick RM, Shanmugam K, Dinstein I. Textural features for image classification. IEEE Trans Syst Man Cybern 1973;SMC3:610–21.
https://doi.org/10.1016/j.ejmp.2018.04.025 https://doi.org/10.1016/j.ejmp.2018.04.026
16. Predicting neoadjuvant therapy response in locally advanced rectal cancer using texture features S. Mazzetti a,b, V. Giannini a,b, A. Di Dia c, C. Bracco c, S. Bresciani c, S. Cauda d, T. Varetto d, E. Del Mastro e, P. Gabriele e, D. Regge a,b, M. Stasi c a
Candiolo Cancer Institute – FPO, IRCCS, Imaging Unit, Candiolo, Torino, Italy b University of Torino, Department of Surgical Sciences, Torino, Italy c Candiolo Cancer Institute – FPO, IRCCS, Medical Physics Unit, Candiolo, Torino, Italy d Candiolo Cancer Institute – FPO, IRCCS, Nuclear Medicine Unit, Candiolo, Torino, Italy e Candiolo Cancer Institute – FPO, IRCCS, Radiotherapy Unit, Candiolo, Torino, Italy Purpose. To predict pathological response to neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal carcinoma (LARC), using a classifier based on texture features derived from MRI and PET acquisitions. Methods. 47 patients with: (a) histologically diagnosis of LARC, (b) pre-treatment MRI and PET/CT, (c) neoadjuvant treatment consisting of 46–55 Gy in 23–30 RT fractions alone or in association with either infusional 5-FU or oral Capecitabine, and (d) total mesorectal
17. Evaluation of MR and PET compatibility of dedicated radiotherapy positioning devices – a preliminary study A. Zorz a, M. Gianelli b, A. Scaggion a, M. Fusella a, M. Branchini a, P. Turco c, A. Capotosto c, P. Zucchetta c, M. Paiusco a a
Veneto Institute of Oncology IOV – IRCCS, Medical Physics Department, Padua, Italy b Azienda Ospedaliera Universitaria Pisana, Medical Physics Department, Pisa, Italy c Azienda Ospedaliera di Padova, Nuclear Medicine Department, Padua, Italy Purpose. The aim of this preliminary study was to assess the compatibility of dedicated positioning devices developed for MR/PET imaging integration into radiotherapy planning. Methods. The X-Tend Flat Table Top and specifically designed radiofrequency coil holders were tested on an integrated Biograph mMR MR/PET scanner (Siemens Healthcare). Magnetic field homogeneity and MR image quality in terms of artifacts and signal-tonoise ratio (SNR), with and without the radiotherapy positioning devices, were evaluated by means of a field sequence with 0.1 ppm/line and a clinical T2-weighted sequence, respectively. Acquisitions of a cylindrical (diameter 16 cm) doped (NiSO4) water phantom were