Near real-time assessment of anatomic and dosimetric variations for head and neck radiation therapy via graphics processing unit-based dose deformation framework

X. Sharon Qi, Anand Santhanam, John Neylon, Yugang Min, Tess Armstrong, Ke Sheng, Robert J. Staton, Jason Pukala, Andrew Pham, Daniel A. Low, Steve P. Lee, Michael Steinberg, Rafael Manon, Allen M. Chen, Patrick Kupelian

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose The purpose of this study was to systematically monitor anatomic variations and their dosimetric consequences during intensity modulated radiation therapy (IMRT) for head and neck (H&N) cancer by using a graphics processing unit (GPU)-based deformable image registration (DIR) framework. Methods and Materials Eleven IMRT H&N patients undergoing IMRT with daily megavoltage computed tomography (CT) and weekly kilovoltage CT (kVCT) scans were included in this analysis. Pretreatment kVCTs were automatically registered with their corresponding planning CTs through a GPU-based DIR framework. The deformation of each contoured structure in the H&N region was computed to account for nonrigid change in the patient setup. The Jacobian determinant of the planning target volumes and the surrounding critical structures were used to quantify anatomical volume changes. The actual delivered dose was calculated accounting for the organ deformation. The dose distribution uncertainties due to registration errors were estimated using a landmark-based gamma evaluation. Results Dramatic interfractional anatomic changes were observed. During the treatment course of 6 to 7 weeks, the parotid gland volumes changed up to 34.7%, and the center-of-mass displacement of the 2 parotid glands varied in the range of 0.9 to 8.8 mm. For the primary treatment volume, the cumulative minimum and mean and equivalent uniform doses assessed by the weekly kVCTs were lower than the planned doses by up to 14.9% (P=.14), 2% (P=.39), and 7.3% (P=.05), respectively. The cumulative mean doses were significantly higher than the planned dose for the left parotid (P=.03) and right parotid glands (P=.006). The computation including DIR and dose accumulation was ultrafast (∼45 seconds) with registration accuracy at the subvoxel level. Conclusions A systematic analysis of anatomic variations in the H&N region and their dosimetric consequences is critical in improving treatment efficacy. Nearly real-time assessment of anatomic and dosimetric variations is feasible using the GPU-based DIR framework. Clinical implementation of this technology may enable timely plan adaptation and improved outcome.

Original languageEnglish (US)
Pages (from-to)415-422
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume92
Issue number2
DOIs
StatePublished - Jun 1 2015

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Anatomic Variation
Parotid Gland
radiation therapy
Neck
Radiotherapy
Head
dosage
salivary glands
Tomography
Uncertainty
planning
Technology
tomography
Therapeutics
landmarks
Neoplasms
determinants
organs
pretreatment
center of mass

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Near real-time assessment of anatomic and dosimetric variations for head and neck radiation therapy via graphics processing unit-based dose deformation framework. / Qi, X. Sharon; Santhanam, Anand; Neylon, John; Min, Yugang; Armstrong, Tess; Sheng, Ke; Staton, Robert J.; Pukala, Jason; Pham, Andrew; Low, Daniel A.; Lee, Steve P.; Steinberg, Michael; Manon, Rafael; Chen, Allen M.; Kupelian, Patrick.

In: International Journal of Radiation Oncology Biology Physics, Vol. 92, No. 2, 01.06.2015, p. 415-422.

Research output: Contribution to journalArticle

Qi, XS, Santhanam, A, Neylon, J, Min, Y, Armstrong, T, Sheng, K, Staton, RJ, Pukala, J, Pham, A, Low, DA, Lee, SP, Steinberg, M, Manon, R, Chen, AM & Kupelian, P 2015, 'Near real-time assessment of anatomic and dosimetric variations for head and neck radiation therapy via graphics processing unit-based dose deformation framework', International Journal of Radiation Oncology Biology Physics, vol. 92, no. 2, pp. 415-422. https://doi.org/10.1016/j.ijrobp.2015.01.033
Qi, X. Sharon ; Santhanam, Anand ; Neylon, John ; Min, Yugang ; Armstrong, Tess ; Sheng, Ke ; Staton, Robert J. ; Pukala, Jason ; Pham, Andrew ; Low, Daniel A. ; Lee, Steve P. ; Steinberg, Michael ; Manon, Rafael ; Chen, Allen M. ; Kupelian, Patrick. / Near real-time assessment of anatomic and dosimetric variations for head and neck radiation therapy via graphics processing unit-based dose deformation framework. In: International Journal of Radiation Oncology Biology Physics. 2015 ; Vol. 92, No. 2. pp. 415-422.
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abstract = "Purpose The purpose of this study was to systematically monitor anatomic variations and their dosimetric consequences during intensity modulated radiation therapy (IMRT) for head and neck (H&N) cancer by using a graphics processing unit (GPU)-based deformable image registration (DIR) framework. Methods and Materials Eleven IMRT H&N patients undergoing IMRT with daily megavoltage computed tomography (CT) and weekly kilovoltage CT (kVCT) scans were included in this analysis. Pretreatment kVCTs were automatically registered with their corresponding planning CTs through a GPU-based DIR framework. The deformation of each contoured structure in the H&N region was computed to account for nonrigid change in the patient setup. The Jacobian determinant of the planning target volumes and the surrounding critical structures were used to quantify anatomical volume changes. The actual delivered dose was calculated accounting for the organ deformation. The dose distribution uncertainties due to registration errors were estimated using a landmark-based gamma evaluation. Results Dramatic interfractional anatomic changes were observed. During the treatment course of 6 to 7 weeks, the parotid gland volumes changed up to 34.7{\%}, and the center-of-mass displacement of the 2 parotid glands varied in the range of 0.9 to 8.8 mm. For the primary treatment volume, the cumulative minimum and mean and equivalent uniform doses assessed by the weekly kVCTs were lower than the planned doses by up to 14.9{\%} (P=.14), 2{\%} (P=.39), and 7.3{\%} (P=.05), respectively. The cumulative mean doses were significantly higher than the planned dose for the left parotid (P=.03) and right parotid glands (P=.006). The computation including DIR and dose accumulation was ultrafast (∼45 seconds) with registration accuracy at the subvoxel level. Conclusions A systematic analysis of anatomic variations in the H&N region and their dosimetric consequences is critical in improving treatment efficacy. Nearly real-time assessment of anatomic and dosimetric variations is feasible using the GPU-based DIR framework. Clinical implementation of this technology may enable timely plan adaptation and improved outcome.",
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AU - Santhanam, Anand

AU - Neylon, John

AU - Min, Yugang

AU - Armstrong, Tess

AU - Sheng, Ke

AU - Staton, Robert J.

AU - Pukala, Jason

AU - Pham, Andrew

AU - Low, Daniel A.

AU - Lee, Steve P.

AU - Steinberg, Michael

AU - Manon, Rafael

AU - Chen, Allen M.

AU - Kupelian, Patrick

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N2 - Purpose The purpose of this study was to systematically monitor anatomic variations and their dosimetric consequences during intensity modulated radiation therapy (IMRT) for head and neck (H&N) cancer by using a graphics processing unit (GPU)-based deformable image registration (DIR) framework. Methods and Materials Eleven IMRT H&N patients undergoing IMRT with daily megavoltage computed tomography (CT) and weekly kilovoltage CT (kVCT) scans were included in this analysis. Pretreatment kVCTs were automatically registered with their corresponding planning CTs through a GPU-based DIR framework. The deformation of each contoured structure in the H&N region was computed to account for nonrigid change in the patient setup. The Jacobian determinant of the planning target volumes and the surrounding critical structures were used to quantify anatomical volume changes. The actual delivered dose was calculated accounting for the organ deformation. The dose distribution uncertainties due to registration errors were estimated using a landmark-based gamma evaluation. Results Dramatic interfractional anatomic changes were observed. During the treatment course of 6 to 7 weeks, the parotid gland volumes changed up to 34.7%, and the center-of-mass displacement of the 2 parotid glands varied in the range of 0.9 to 8.8 mm. For the primary treatment volume, the cumulative minimum and mean and equivalent uniform doses assessed by the weekly kVCTs were lower than the planned doses by up to 14.9% (P=.14), 2% (P=.39), and 7.3% (P=.05), respectively. The cumulative mean doses were significantly higher than the planned dose for the left parotid (P=.03) and right parotid glands (P=.006). The computation including DIR and dose accumulation was ultrafast (∼45 seconds) with registration accuracy at the subvoxel level. Conclusions A systematic analysis of anatomic variations in the H&N region and their dosimetric consequences is critical in improving treatment efficacy. Nearly real-time assessment of anatomic and dosimetric variations is feasible using the GPU-based DIR framework. Clinical implementation of this technology may enable timely plan adaptation and improved outcome.

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