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Cella L.,CNR Institute of Neuroscience | Cella L.,University of Naples Federico II | Conson M.,University of Naples Federico II | Pressello M.C.,S Camillo Forlanini Hospital | And 7 more authors.
Radiation Oncology | Year: 2013

Background: Purpose of this study is to explore the trade-offs between radio-induced toxicities and second malignant neoplasm (SMN) induction risk of different emerging radiotherapy techniques for Hodgkin's lymphoma (HL) through a comprehensive dosimetric analysis on a representative clinical model.Methods: Three different planning target volume (PTVi) scenarios of a female patient with supradiaphragmatic HL were used as models for the purpose of this study. Five treatment radiation techniques were simulated: an anterior-posterior parallel-opposed (AP-PA), a forward intensity modulated (FIMRT), an inverse intensity modulated (IMRT), a Tomotherapy (TOMO), a proton (PRO) technique. A radiation dose of 30 Gy or CGE was prescribed. Dose-volume histograms of PTVs and organs-at-risk (OARs) were calculated and related to available dose-volume constraints. SMN risk for breasts, thyroid, and lungs was estimated through the Organ Equivalent Dose model considering cell repopulation and inhomogeneous organ doses. Results: With similar level of PTVi coverage, IMRT, TOMO and PRO plans generally reduced the OARs' dose and accordingly the related radio-induced toxicities. However, only TOMO and PRO plans were compliant with all constraints in all scenarios. For the IMRT and TOMO plans an increased risk of development of breast, and lung SMN compared with AP-PA and FIMRT techniques was estimated. Only PRO plans seemed to reduce the risk of predicted SMN compared with AP-PA technique.Conclusions: Our model-based study supports the use of advanced RT techniques to successfully spare OARs and to reduce the risk of radio-induced toxicities in HL patients. However, the estimated increase of SMNs' risk inherent to TOMO and IMRT techniques should be carefully considered in the evaluation of a risk-adapted therapeutic strategy. © 2013 Cella et al.; licensee BioMed Central Ltd. Source

Fattori G.,Polytechnic of Milan | Riboldi M.,Polytechnic of Milan | Riboldi M.,Centro Nazionale Of Adroterapia Oncologica Foundation | Desplanques M.,Centro Nazionale Of Adroterapia Oncologica Foundation | And 7 more authors.
IEEE Transactions on Biomedical Engineering | Year: 2012

We propose a novel method for radio-opaque external marker localization in CT scans for infrared (IR) patient set-up in radiotherapy. Efforts were focused on the quantification of uncertainties in marker localization in the CT dataset as a function of algorithm performance. We implemented a 3-D approach to fiducial localization based on surface extraction and marker recognition according to geometrical prior knowledge. The algorithm parameters were optimized on a clinical CT dataset coming from 35 cranial and extra-cranial patients; the localization accuracy was benchmarked at variable image resolution versus laser tracker measurements. The applicability of conventional IR optical tracking systems for localizing external surrogates in daily patient set-up procedures was also investigated in 121 proton therapy treatment sessions. Our study shows that the implemented algorithm features surrogates localization with uncertainties lower than 0.3mm and with a true positive rate of 90.1, being this latter mainly influenced by fiducial homogeneity in the CT images. The reported clinical validation in proton therapy confirmed the submillimetric accuracy and the expected algorithm sensitivity. Geometrical prior knowledge allows judging the reliability of the extracted fiducial coordinates, ensuring the highest accuracy in patient set-up. © 2012 IEEE. Source

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