Precision of 2 Low-dose Abdomen/Pelvis Cone Beam Computed Tomography Protocols for Alignment to Bone and Soft Tissue in Pediatric Patients Receiving Image Guided Radiation Therapy

Avani D. Rao, Junghoon Lee, Wei Fu, Sarah Nicholas, Sara Alcorn, Joseph Moore, Matthew Ladra, Mahadevappa Mahesh, Steven Bartolac, Stephanie A. Terezakis

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate the precision of 2 low-dose cone (LD) beam computed tomography (CBCT) protocols to align to bone and soft tissue for pediatric patients receiving image guided radiation therapy (IGRT) to the abdomen and pelvis. Methods and Materials: Image-quality evaluation was done for 858 CBCT scans from 46 pediatric patients treated with IGRT from January 2015 to December 2017. The evaluations guided the development of 2 significantly dose-reduced protocols, LD-CBCT1 and a further dose-reduced LD-CBCT2. Representative scans from LD-CBCT1 and LD-CBCT2 from 8 patients with at least 1 CBCT scan from both protocols were registered separately to a bone and soft-tissue landmark on the simulation computed tomography scan. Eighteen identical blinded random offsets were applied to each patient's LD-CBCT1 and LD-CBCT2 from a starting registration that was then realigned using rigid registration. The residual offset between the baseline registration and the final registration attempt was calculated and analyzed using a 1-sided, 1 sample t test to evaluate whether LD-CBCT1, delivering a higher dose, was superior to the lower-dose LD-CBCT2 for bone and soft-tissue alignment. Results: In comparing 288 registrations with a bone landmark across 8 patients, no difference was found in the vector magnitude offsets using LD-CBCT 1 (mean [x¯], 0.73 mm; standard deviation [σ], 0.39 mm) and LD-CBCT2 (x¯ 0.74 mm; σ 0.40 mm; P =.425). Comparing 216 registrations with a soft-tissue landmark across 6 patients, alignment using LD-CBCT2 (x¯ 1.55 mm; σ 1.08 mm) resulted in larger differences in the vector magnitude of the offsets compared with LD-CBCT1 (x¯ 1.37 mm; σ 0.74 mm; P =.049). Conclusions: Clinics treating pediatric patients should consider implementing a protocol mirroring LD-CBCT2 for abdomen and pelvis IGRT bone alignment. Further evaluation of the precision of LD-CBCTs for soft-tissue alignment is necessary.

Original languageEnglish (US)
JournalPractical Radiation Oncology
DOIs
StatePublished - Jan 1 2019

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Image-Guided Radiotherapy
Cone-Beam Computed Tomography
Pelvis
Abdomen
Pediatrics
Bone and Bones
Tomography

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

@article{878a10bc05a3434ebc9426c0c3b042a9,
title = "Precision of 2 Low-dose Abdomen/Pelvis Cone Beam Computed Tomography Protocols for Alignment to Bone and Soft Tissue in Pediatric Patients Receiving Image Guided Radiation Therapy",
abstract = "Purpose: To evaluate the precision of 2 low-dose cone (LD) beam computed tomography (CBCT) protocols to align to bone and soft tissue for pediatric patients receiving image guided radiation therapy (IGRT) to the abdomen and pelvis. Methods and Materials: Image-quality evaluation was done for 858 CBCT scans from 46 pediatric patients treated with IGRT from January 2015 to December 2017. The evaluations guided the development of 2 significantly dose-reduced protocols, LD-CBCT1 and a further dose-reduced LD-CBCT2. Representative scans from LD-CBCT1 and LD-CBCT2 from 8 patients with at least 1 CBCT scan from both protocols were registered separately to a bone and soft-tissue landmark on the simulation computed tomography scan. Eighteen identical blinded random offsets were applied to each patient's LD-CBCT1 and LD-CBCT2 from a starting registration that was then realigned using rigid registration. The residual offset between the baseline registration and the final registration attempt was calculated and analyzed using a 1-sided, 1 sample t test to evaluate whether LD-CBCT1, delivering a higher dose, was superior to the lower-dose LD-CBCT2 for bone and soft-tissue alignment. Results: In comparing 288 registrations with a bone landmark across 8 patients, no difference was found in the vector magnitude offsets using LD-CBCT 1 (mean [x¯], 0.73 mm; standard deviation [σ], 0.39 mm) and LD-CBCT2 (x¯ 0.74 mm; σ 0.40 mm; P =.425). Comparing 216 registrations with a soft-tissue landmark across 6 patients, alignment using LD-CBCT2 (x¯ 1.55 mm; σ 1.08 mm) resulted in larger differences in the vector magnitude of the offsets compared with LD-CBCT1 (x¯ 1.37 mm; σ 0.74 mm; P =.049). Conclusions: Clinics treating pediatric patients should consider implementing a protocol mirroring LD-CBCT2 for abdomen and pelvis IGRT bone alignment. Further evaluation of the precision of LD-CBCTs for soft-tissue alignment is necessary.",
author = "Rao, {Avani D.} and Junghoon Lee and Wei Fu and Sarah Nicholas and Sara Alcorn and Joseph Moore and Matthew Ladra and Mahadevappa Mahesh and Steven Bartolac and Terezakis, {Stephanie A.}",
year = "2019",
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doi = "10.1016/j.prro.2019.01.005",
language = "English (US)",
journal = "Practical Radiation Oncology",
issn = "1879-8500",
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T1 - Precision of 2 Low-dose Abdomen/Pelvis Cone Beam Computed Tomography Protocols for Alignment to Bone and Soft Tissue in Pediatric Patients Receiving Image Guided Radiation Therapy

AU - Rao, Avani D.

AU - Lee, Junghoon

AU - Fu, Wei

AU - Nicholas, Sarah

AU - Alcorn, Sara

AU - Moore, Joseph

AU - Ladra, Matthew

AU - Mahesh, Mahadevappa

AU - Bartolac, Steven

AU - Terezakis, Stephanie A.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: To evaluate the precision of 2 low-dose cone (LD) beam computed tomography (CBCT) protocols to align to bone and soft tissue for pediatric patients receiving image guided radiation therapy (IGRT) to the abdomen and pelvis. Methods and Materials: Image-quality evaluation was done for 858 CBCT scans from 46 pediatric patients treated with IGRT from January 2015 to December 2017. The evaluations guided the development of 2 significantly dose-reduced protocols, LD-CBCT1 and a further dose-reduced LD-CBCT2. Representative scans from LD-CBCT1 and LD-CBCT2 from 8 patients with at least 1 CBCT scan from both protocols were registered separately to a bone and soft-tissue landmark on the simulation computed tomography scan. Eighteen identical blinded random offsets were applied to each patient's LD-CBCT1 and LD-CBCT2 from a starting registration that was then realigned using rigid registration. The residual offset between the baseline registration and the final registration attempt was calculated and analyzed using a 1-sided, 1 sample t test to evaluate whether LD-CBCT1, delivering a higher dose, was superior to the lower-dose LD-CBCT2 for bone and soft-tissue alignment. Results: In comparing 288 registrations with a bone landmark across 8 patients, no difference was found in the vector magnitude offsets using LD-CBCT 1 (mean [x¯], 0.73 mm; standard deviation [σ], 0.39 mm) and LD-CBCT2 (x¯ 0.74 mm; σ 0.40 mm; P =.425). Comparing 216 registrations with a soft-tissue landmark across 6 patients, alignment using LD-CBCT2 (x¯ 1.55 mm; σ 1.08 mm) resulted in larger differences in the vector magnitude of the offsets compared with LD-CBCT1 (x¯ 1.37 mm; σ 0.74 mm; P =.049). Conclusions: Clinics treating pediatric patients should consider implementing a protocol mirroring LD-CBCT2 for abdomen and pelvis IGRT bone alignment. Further evaluation of the precision of LD-CBCTs for soft-tissue alignment is necessary.

AB - Purpose: To evaluate the precision of 2 low-dose cone (LD) beam computed tomography (CBCT) protocols to align to bone and soft tissue for pediatric patients receiving image guided radiation therapy (IGRT) to the abdomen and pelvis. Methods and Materials: Image-quality evaluation was done for 858 CBCT scans from 46 pediatric patients treated with IGRT from January 2015 to December 2017. The evaluations guided the development of 2 significantly dose-reduced protocols, LD-CBCT1 and a further dose-reduced LD-CBCT2. Representative scans from LD-CBCT1 and LD-CBCT2 from 8 patients with at least 1 CBCT scan from both protocols were registered separately to a bone and soft-tissue landmark on the simulation computed tomography scan. Eighteen identical blinded random offsets were applied to each patient's LD-CBCT1 and LD-CBCT2 from a starting registration that was then realigned using rigid registration. The residual offset between the baseline registration and the final registration attempt was calculated and analyzed using a 1-sided, 1 sample t test to evaluate whether LD-CBCT1, delivering a higher dose, was superior to the lower-dose LD-CBCT2 for bone and soft-tissue alignment. Results: In comparing 288 registrations with a bone landmark across 8 patients, no difference was found in the vector magnitude offsets using LD-CBCT 1 (mean [x¯], 0.73 mm; standard deviation [σ], 0.39 mm) and LD-CBCT2 (x¯ 0.74 mm; σ 0.40 mm; P =.425). Comparing 216 registrations with a soft-tissue landmark across 6 patients, alignment using LD-CBCT2 (x¯ 1.55 mm; σ 1.08 mm) resulted in larger differences in the vector magnitude of the offsets compared with LD-CBCT1 (x¯ 1.37 mm; σ 0.74 mm; P =.049). Conclusions: Clinics treating pediatric patients should consider implementing a protocol mirroring LD-CBCT2 for abdomen and pelvis IGRT bone alignment. Further evaluation of the precision of LD-CBCTs for soft-tissue alignment is necessary.

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