A comparative study of automatic image segmentation algorithms for target tracking in MR-IGRT.

On-board magnetic resonance (MR) image guidance during radiation therapy offers the potential for more accurate treatment delivery. To utilize the real-time image information, a crucial prerequisite is the ability to successfully segment and track regions of interest (ROI). The purpose of this work is to evaluate the performance of different segmentation algorithms using motion images (4 frames per second) acquired using a MR image-guided radiotherapy (MR-IGRT) system. Manual con-tours of the kidney, bladder, duodenum, and a liver tumor by an experienced radiation oncologist were used as the ground truth for performance evaluation. Besides the manual segmentation, images were automatically segmented using thresholding, fuzzy k-means (FKM), k-harmonic means (KHM), and reaction-diffusion level set evolution (RD-LSE) algorithms, as well as the tissue tracking algorithm provided by the ViewRay treatment planning and delivery system (VR-TPDS). The performance of the five algorithms was evaluated quantitatively by comparing with the manual segmentation using the Dice coefficient and target registration error (TRE) measured as the distance between the centroid of the manual ROI and the centroid of the automatically segmented ROI. All methods were able to successfully segment the bladder and the kidney, but only FKM, KHM, and VR-TPDS were able to segment the liver tumor and the duodenum. The performance of the thresholding, FKM, KHM, and RD-LSE algorithms degraded as the local image contrast decreased, whereas the performance of the VP-TPDS method was nearly independent of local image contrast due to the reference registration algorithm. For segmenting high-contrast images (i.e., kidney), the thresholding method provided the best speed (< 1 ms) with a satisfying accuracy (Dice = 0.95). When the image contrast was low, the VR-TPDS method had the best automatic contour. Results suggest an image quality determination procedure before segmentation and a combination of different methods for optimal segmentation with the on-board MR-IGRT system.

A safety run-in and randomized phase 2 study of cilengitide combined with chemoradiation for newly diagnosed glioblastoma (NABTT 0306).

BACKGROUND: Cilengitide is a selective integrin inhibitor that is well tolerated and has demonstrated biologic activity in patients with recurrent malignant glioma. The primary objectives of this randomized phase 2 trial were to determine the safety and efficacy of cilengitide when combined with radiation and temozolomide for patients with newly diagnosed glioblastoma multiforme and to select a dose for comparative clinical testing. METHODS: In total, 112 patients were accrued. Eighteen patients received standard radiation and temozolomide with cilengitide in a safety run-in phase followed by a randomized phase 2 trial with 94 patients assigned to either a 500 mg dose group or 2000 mg dose group. The trial was designed to estimate overall survival benefit compared with a New Approaches to Brain Tumor Therapy (NABTT) Consortium internal historic control and data from the published European Organization for Research and Treatment of Cancer (EORTC) trial EORTC 26981. RESULTS: Cilengitide at all doses studied was well tolerated with radiation and temozolomide. The median survival was 19.7 months for all patients, 17.4 months for the patients in the 500 mg dose group, 20.8 months for patients in the 2000 mg dose group, 30 months for patients who had methylated O6-methylguanine-DNA methyltransferase (MGMT) status, and 17.4 months for patients who had unmethylated MGMT status. For patients aged ≤70 years, the median survival and survival at 24 months was superior to what was observed in the EORTC trial (20.7 months vs 14.6 months and 41% vs 27%, respectively; P = .008). CONCLUSIONS: Cilengitide was well tolerated when combined with standard chemoradiation and may improve survival for patients newly diagnosed with glioblastoma multiforme regardless of MGMT methylation status. The authors concluded that, from an efficacy and safety standpoint, future trials of this agent in this population should use the 2000 mg dose.

Control of overwintering filbertworm (Lepidoptera: Tortricidae) larvae with Steinernema carpocapsae.

Filbertworm, Cydia latiferreana (Walsingham) (Lepidoptera: Tortricidae), is a key insect pest associated with hazelnuts, Corylus avellana L. (Fagales: Betulaceae), in North America. This study investigated the feasibility of entomopathogenic nematodes as an alternative strategy for filbertworm control. Laboratory and field experiments were conducted between October 2007 and May 2008 in Benton County, OR, to evaluate the ability of the nematode Steinernema carpocapsae (Weiser) (Rhabditida: Steinernematidae) to infect filbertworm larvae and pupae. The susceptibility of larvae with and without hibernacula as well as pupae to S. carpocapsae was tested in laboratory bioassays using nematode concentrations between 40 and 200 infective juveniles (IJs) per cm2. Percentage of nematode infection was not significantly affected by the presence of hibernacula (infection range, 90-92%) compared with larvae without hibernacula (80-95%), or by pupal stage (50-75%) compared with larvae (65-75%). In additional field trials, the effect of nematode rate, water application rate, and orchard floor cover on nematode efficacy was determined in October 2007 and May/June 2008. Sentinel filbertworm larvae in plots with either bare soil or debris (leaves, twigs, husks, and blank nuts) were treated with S. carpocapsae at rates ranging from 40 to 150 IJs per cm2 applied in 75 or 190 ml/m2 water. Average filbertworm mortality ranged from 2 to 11% and from 50 to 78% in October and May, respectively. Larval mortality increased with increasing nematode concentration, but was not significantly affected by water application rate or orchard floor cover. Our experiments suggest that S. carpocapsae can play a role in the control of filbertworm larvae overwintering on the orchard floor.

Quality of Intensity Modulated Radiation Therapy Treatment Plans Using a 6°Co Magnetic Resonance Image Guidance Radiation Therapy System.

PURPOSE: This work describes a commercial treatment planning system, its technical features, and its capabilities for creating (60)Co intensity modulated radiation therapy (IMRT) treatment plans for a magnetic resonance image guidance radiation therapy (MR-IGRT) system. METHODS AND MATERIALS: The ViewRay treatment planning system (Oakwood Village, OH) was used to create (60)Co IMRT treatment plans for 33 cancer patients with disease in the abdominal, pelvic, thorax, and head and neck regions using physician-specified patient-specific target coverage and organ at risk (OAR) objectives. Backup plans using a third-party linear accelerator (linac)-based planning system were also created. Plans were evaluated by attending physicians and approved for treatment. The (60)Co and linac plans were compared by evaluating conformity numbers (CN) with 100% and 95% of prescription reference doses and heterogeneity indices (HI) for planning target volumes (PTVs) and maximum, mean, and dose-volume histogram (DVH) values for OARs. RESULTS: All (60)Co IMRT plans achieved PTV coverage and OAR sparing that were similar to linac plans. PTV conformity for (60)Co was within <1% and 3% of linac plans for 100% and 95% prescription reference isodoses, respectively, and heterogeneity was on average 4% greater. Comparisons of OAR mean dose showed generally better sparing with linac plans in the low-dose range <20 Gy, but comparable sparing for organs with mean doses >20 Gy. The mean doses for all (60)Co plan OARs were within clinical tolerances. CONCLUSIONS: A commercial (60)Co MR-IGRT device can produce highly conformal IMRT treatment plans similar in quality to linac IMRT for a variety of disease sites. Additional work is in progress to evaluate the clinical benefit of other novel features of this MR-IGRT system.

Breadboard testing of a phase-conjugate engine with an interferometric wave-front sensor and a microelectromechanical systems-based spatial light modulator.

Laboratory breadboard results of a high-speed adaptive-optics system are presented. The wave-front sensor for the adaptive-optics system is based on a quadrature interferometer, which directly measures the turbulence-induced phase aberrations. The spatial light modulator used in the phase-conjugate engine was a microelectromechanical systems-based piston-only correction device with 1024 actuators. Laboratory experiments were conducted with this system utilizing Kolmogorov phase screens to simulate atmospheric phase distortions. The adaptive-optics system achieved correction speeds in excess of 800 Hz and Strehl ratios greater than 0.5 with the Kolmogorov phase screens.