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1.
Eur Respir Rev ; 31(163)2022 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-35022258

RESUMO

Stereotactic body radiation therapy is an alternative to surgery for early-stage, inoperable peripheral non-small cell lung cancer. As opposed to linear accelerator (linac)-based (e.g. gating) and free-breathing techniques, CyberKnife® with Synchrony® technology allows accurate radiation delivery by means of a real-time respiratory motion tracking system using, in most cases, metal fiducial markers (FMs) placed in the vicinity of the target. The aims of this review are as follows. First, to describe the safety and efficacy of the transthoracic, endovascular and endobronchial FM insertion techniques for peripheral pulmonary lesions (PPLs). Second, to analyse performance in terms of the migration and tracking rates of different FM types. Recent developments in FM tracking for central lesions will also be reviewed. In conclusion, for PPLs, the endobronchial approach provides a low rate of pneumothorax, offers the possibility of concurrent diagnostic sampling for both the PPL and the lymph nodes, and, finally, reduces the intervention time compared to other techniques. In this context, coil-tailed and coil-spring FMs have shown the lowest migration rate with a consequently high tracking rate.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Neoplasias Pulmonares , Radiocirurgia , Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Marcadores Fiduciais , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Radiocirurgia/efeitos adversos
2.
Br J Radiol ; 95(1129): 20200381, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34672681

RESUMO

OBJECTIVES: To evaluate the effect of the position of microcoil proximal end on the incidence of microcoil dislocation during CT-guided microcoil localization of pulmonary nodules (PNs). METHODS: This retrospective study included all patients with PNs who received CT-guided microcoil localization before video-assisted thoracoscopic urgery (VATS) resection from June 2016 to December 2019 in our institution. The microcoil distal end was less than 1 cm away from the nodule, and the microcoil proximal end was in the pleural cavity (the pleural cavity group) or chest wall (the chest wall group). The length of microcoil outside the pleura was measured and divided into less than 0.5 cm (group A), 0.5 to 2 cm (group B) and more than 2 cm (group C). Microcoil dislocation was defined as complete retraction into the lung (type I) or complete withdrawal from the lung (type II). The rate of microcoil dislocation between different groups was compared. RESULTS: A total of 519 consecutive patients with 571 PNs were included in this study. According to the position of microcoils proximal end on post-marking CT, there were 95 microcoils in the pleural cavity group and 476 in the chest wall group. The number of microcoils in group A, B, and C were 67, 448 and 56, respectively. VATS showed dislocation of 42 microcoils, of which 30 were type II and 12 were type I. There was no statistical difference in the rate of microcoil dislocation between the pleural cavity group and the chest wall group (6.3% vs 7.6%, x2 = 0.18, p = 0.433). The difference in the rate of microcoil dislocation among group A, B, and C was statistically significant (11.9%, 5.8%, and 14.3% for group A, B, and C, respectively, x2 = 7.60, p = 0.008). In group A, 75% (6/8) of dislocations were type I, while all eight dislocations were type II in group C. CONCLUSIONS: During CT-guided microcoil localization of PNs, placing the microcoil proximal end in the pleura cavity or chest wall had no significant effect on the incidence of microcoil dislocation. The length of microcoil outside the pleura should be 0.5 to 2 cm to reduce the rate of microcoil dislocation. ADVANCES IN KNOWLEDGE:: CT-guided microcoil localization can effectively guide VATS to resect invisible and impalpable PNs. Microcoil dislocation is the main cause of localization failure. The length of microcoil outside the pleura is significantly correlated with the rate and type of microcoil dislocation. Placing the microcoil proximal end in the pleura cavity or chest wall has no significant effect on the rate of microcoil dislocation.


Assuntos
Marcadores Fiduciais , Neoplasias Pulmonares/diagnóstico por imagem , Nódulos Pulmonares Múltiplos/diagnóstico por imagem , Radiografia Intervencionista/métodos , Nódulo Pulmonar Solitário/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Idoso , Feminino , Marcadores Fiduciais/efeitos adversos , Marcadores Fiduciais/estatística & dados numéricos , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Nódulos Pulmonares Múltiplos/cirurgia , Cavidade Pleural/diagnóstico por imagem , Estudos Retrospectivos , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Torácica Vídeoassistida , Parede Torácica/diagnóstico por imagem
3.
Nihon Hoshasen Gijutsu Gakkai Zasshi ; 77(12): 1400-1410, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34924476

RESUMO

In liver stereotactic body radiotherapy (SBRT) using fiducial markers, the accuracy of automatic image recognition of fiducial markers is important, and the imaging dose cannot be neglected in image-guided radiotherapy. Optimal imaging parameters of fiducial markers were investigated for automatic image recognition and imaging dose. We investigated automatic recognition with fiducial markers of different shapes and sizes. In addition, the optimum imaging conditions were examined based on the automatic recognition when the presence or absence of a filter, focal spot size, and phantom thickness were altered using the fiducial markers with a high automatic recognition. The results for different shapes and sizes of fiducial markers showed that larger markers were recognized more automatically, whereas shorter markers were recognized in the correct position. By using the filter, we were able to reduce the imaging dose by one third or one half compared to the case without the filter. The results for the focal spot size showed that using a larger size resulted in higher automatic recognition accuracy than using a smaller size. For the relationship between the automatically recognized imaging conditions and the air kerma when the phantom thickness was altered, it was necessary to keep the tube current-time product constant and increase the tube voltage in order to avoid poor recognition accuracy. The parameters we proposed are effective in shortening the treatment time and reducing the imaging dose because they allow us to acquire images with low doses and high accuracy of automatic recognition.


Assuntos
Marcadores Fiduciais , Radiocirurgia , Fígado/diagnóstico por imagem
4.
Med Phys ; 48(11): 7323-7332, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34559413

RESUMO

PURPOSE: Precise correlation between three-dimensional (3D) imaging and histology can aid biomechanical modeling of the breast. We develop a framework to register ex vivo images to histology using a novel cryo-fluorescence tomography (CFT) device. METHODS: A formalin-fixed cadaveric breast specimen, including chest wall, was subjected to high-resolution magnetic resonance (MR) imaging. The specimen was then frozen and embedded in an optimal cutting temperature (OCT) compound. The OCT block was placed in a CFT device with an overhead camera and 50 µm thick slices were successively shaved off the block. After each shaving, the block-face was photographed. At select locations including connective/adipose tissue, muscle, skin, and fibroglandular tissue, 20 µm sections were transferred onto cryogenic tape for manual hematoxylin and eosin staining, histological assessment, and image capture. A 3D white-light image was automatically reconstructed from the photographs by aligning fiducial markers embedded in the OCT block. The 3D MR image, 3D white-light image, and photomicrographs were rigidly registered. Target registration errors (TREs) were computed based on 10 pairs of points marked at fibroglandular intersections. The overall MR-histology registration was used to compare the MR intensities at tissue extraction sites with a one-way analysis of variance. RESULTS: The MR image to CFT-captured white-light image registration achieved a mean TRE of 0.73 ± 0.25 mm (less than the 1 mm MR slice resolution). The block-face white-light image and block-face photomicrograph registration showed visually indistinguishable alignment of anatomical structures and tissue boundaries. The MR intensities at the four tissue sites identified from histology differed significantly (p < 0.01). Each tissue pair, except the skin-connective/adipose tissue pair, also had significantly different MR intensities (p < 0.01). CONCLUSIONS: Fine sectioning in a highly controlled imaging/sectioning environment enables accurate registration between the MR image and histology. Statistically significant differences in MR signal intensities between histological tissues are indicators for the specificity of correlation between MRI and histology.


Assuntos
Técnicas Histológicas , Imageamento Tridimensional , Mama/diagnóstico por imagem , Marcadores Fiduciais , Humanos , Imageamento por Ressonância Magnética
5.
Med Phys ; 48(11): 7271-7282, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34482551

RESUMO

PURPOSE: We explore the potential use of radar technology for fiducial marker tracking for monitoring of respiratory tumor motion during radiotherapy. Historically microwave radar technology has been widely deployed in various military and civil aviation applications to provide detection, position, and tracking of single or multiples objects from far away and even through barriers. Recently, due to many advantages of the microwave technology, it has been successfully demonstrated to detect breast tumor, and to monitor vital signs in real time such as breathing signals or heart rates. We demonstrate a proof-of-concept for radar-based fiducial marker tracking through the synthetic human tissue phantom. METHODS: We performed a series of experiments with the vector network analyzer (VNA) and wideband directional horn antenna. We considered the frequency range from 2.0 to 6.0 GHz, with a maximum power of 3 dBm. A horn antenna, transmitting and receiving radar pulses, was connected to the vector network analyzer to probe a gold fiducial marker through a customized synthetic human tissue phantom, consisting of 1-mm thickness of skin, 5-mm fat, and 25-mm muscle layers. A 1.2 × 10-mm gold fiducial marker was exploited as a motion surrogate, which was placed behind the phantom and statically positioned with an increment of 12.7 mm to simulate different marker displacements. The returned signals from the marker were acquired and analyzed to evaluate the localization accuracy as a function of the marker position. RESULTS: The fiducial marker was successfully localized at various measurement positions through a simplified phantom study. The averaged localization accuracy across measurements was 3.5 ± 1.3 mm, with a minimum error of 1.9 mm at the closest measurement location and a maximum error of 4.9 mm at the largest measurement location. CONCLUSIONS: We demonstrated that the 2-6 GHz radar can penetrate through the attenuating tissues and localize a fiducial marker. This successful feasibility study establishes a foundation for further investigation of radar technology as a non-ionizing tumor localization device for radiotherapy.


Assuntos
Marcadores Fiduciais , Radar , Estudos de Viabilidade , Humanos , Micro-Ondas , Imagens de Fantasmas
6.
J Appl Clin Med Phys ; 22(9): 242-251, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34339590

RESUMO

PURPOSE: Carbon ion radiotherapy for prostate cancer was performed using two fine needle Gold Anchor (GA) markers for patient position verification in Osaka Heavy Ion Medical Accelerator in Kansai (Osaka HIMAK). The present study examined treatment plans for prostate cases using beam-specific planning target volume (bsPTV) based on the effect of the markers on dose distribution and analysis of target movements. MATERIALS AND METHODS: Gafchromic EBT3 film was used to measure dose perturbations caused by markers. First, the relationships between the irradiated film density and absolute dose with different linear energy transfer distributions within a spread-out Bragg peak (SOBP) were confirmed. Then, to derive the effect of markers, two types of markers, including GA, were placed at the proximal, center, and distal depths within the same SOBP, and dose distributions behind the markers were measured using the films. The amount of internal motion of prostate was derived from irradiation results and analyzed to determine the margins of the bsPTV. RESULTS: The linearity of the film densities against absolute doses was constant within the SOBP and the amount of dose perturbations caused by the markers was quantitatively estimated from the film densities. The dose perturbation close behind the markers was smallest (<10% among depths within the SOBP regardless of types of markers) and increased with depth. The effect of two types of GAs on dose distributions was small and could be ignored in the treatment planning. Based on the analysis results of internal motions of prostate, required margins of the bsPTV were found to be 8, 7, and 7 mm in left-right (LR), anterior-posterior (AP), and superior-inferior (SI) directions, respectively. CONCLUSION: We evaluated the dose reductions caused by markers and determined the margins of the bsPTV, which was applied to the treatment using fiducial markers, using the analysis results of prostate movements.


Assuntos
Radioterapia com Íons Pesados , Íons Pesados , Neoplasias da Próstata , Marcadores Fiduciais , Humanos , Masculino , Neoplasias da Próstata/radioterapia , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador
7.
Comput Methods Programs Biomed ; 209: 106296, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34380076

RESUMO

BACKGROUND AND OBJECTIVE: The research is done in the field of Augmented Reality (AR) for patient positioning in radiation therapy is scarce. We propose an efficient and cost-effective algorithm for tracking the scene and the patient to interactively assist the patient's positioning process by providing visual feedback to the operator. Up to our knowledge, this is the first framework that can be employed for mobile interactive AR to guide patient positioning. METHODS: We propose a pointcloud processing method that, combined with a fiducial marker-mapper algorithm and the generalized ICP algorithm, tracks the patient and the camera precisely and efficiently only using the CPU unit. The 3D reference model and body marker map alignment is calculated employing an efficient body reconstruction algorithm. RESULTS: Our quantitative evaluation shows that the proposed method achieves a translational and rotational error of 4.17 mm/0.82∘ at 9 fps. Furthermore, the qualitative results demonstrate the usefulness of our algorithm in patient positioning on different human subjects. CONCLUSION: Since our algorithm achieves a relatively high frame rate and accuracy employing a regular laptop (without a dedicated GPU), it is a very cost-effective AR-based patient positioning method. It also opens the way for other researchers by introducing a framework that could be improved upon for better mobile interactive AR patient positioning solutions in the future.


Assuntos
Realidade Aumentada , Algoritmos , Análise Custo-Benefício , Marcadores Fiduciais , Humanos , Posicionamento do Paciente
8.
Int J Comput Assist Radiol Surg ; 16(11): 2055-2066, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34382176

RESUMO

PURPOSE: To reduce reoperation rates for image-guided breast-conserving surgery, the enhanced sensitivity of magnetic resonance (MR) supine imaging may be leveraged. However, accurate tissue correspondence between images and their physical counterpart in the surgical presentation is challenging due to breast deformations (e.g., from patient/arm position changes, and operating room table rotation differences). In this study, standard rigid registration methods are employed and tissue deformation is characterized. METHODS: On n = 10 healthy breasts, surface displacements were measured by comparing intraoperative fiducial locations as the arm was moved from conventional MR scanning positions (arm-down and arm-up) to the laterally extended surgical configuration. Supine MR images in the arm-down and arm-up positions were registered to mock intraoperative presentations. RESULTS: Breast displacements from a supine MR imaging configuration to a mock surgical presentation were 28.9 ± 9.2 mm with shifts occurring primarily in the inferior/superior direction. With respect to supine MR to surgical alignment, the average fiducial, target, and maximum target registration errors were 9.0 ± 1.7 mm, 9.3 ± 1.7 mm, and 20.0 ± 7.6 mm, respectively. Even when maintaining similar arm positions in the MR image and mock surgery, the respective averages were 6.0 ± 1.0 mm, 6.5 ± 1.1 mm, and 12.5 ± 2.8 mm. CONCLUSION: From supine MR positioning to surgical presentation, the breast undergoes large displacements (9.9-70.1 mm). The data also suggest that significant nonrigid deformations (9.3 ± 1.7 mm with 20.0 mm average maximum) exist that need to be considered in image guidance and modeling applications.


Assuntos
Neoplasias da Mama , Cirurgia Assistida por Computador , Mama/diagnóstico por imagem , Mama/cirurgia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Feminino , Marcadores Fiduciais , Humanos , Imageamento por Ressonância Magnética
9.
Sensors (Basel) ; 21(16)2021 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-34450848

RESUMO

The paper describes the process of designing a simple fiducial marker. The marker is meant for use in augmented reality applications. Unlike other systems, it does not encode any information, but it can be used for obtaining the position, rotation, relative size, and projective transformation. Also, the system works well with motion blur and is resistant to the marker's imperfections, which could theoretically be drawn only by hand. Previous systems put constraints on colors that need to be used to form the marker. The proposed system works with any saturated color, leading to better blending with the surrounding environment. The marker's final shape is a rectangular area of a solid color with three lines of a different color going from the center to three corners of the rectangle. Precise detection can be achieved using neural networks, given that the training set is very varied and well designed. A detailed literature review was performed, and no such system was found. Therefore, the proposed design is novel for localization in the spatial scene. The testing proved that the system works well both indoor and outdoor, and the detections are precise.


Assuntos
Realidade Aumentada , Marcadores Fiduciais , Redes Neurais de Computação , Percepção Espacial
10.
Med Phys ; 48(9): 5311-5326, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34260755

RESUMO

PURPOSE: To show the feasibility of real-time CT image generation technique utilizing internal fiducial markers that facilitate the evaluation of internal deformation. METHODS: In the proposed method, a linear regression model that can derive internal deformation from the displacement of fiducial markers is built for each voxel in the training process before the treatment session. Marker displacement and internal deformation are derived from the four-dimensional computed tomography (4DCT) dataset. In the treatment session, the three-dimensional deformation vector field is derived according to the marker displacement, which is monitored by the real-time imaging system. The whole CT image can be synthesized by deforming the reference CT image with a deformation vector field in real-time. To show the feasibility of the technique, image synthesis accuracy and tumor localization accuracy were evaluated using the dataset generated by extended NURBS-Based Cardiac-Torso (XCAT) phantom and clinical 4DCT datasets from six patients, containing 10 CT datasets each. In the validation with XCAT phantom, motion range of the tumor in training data and validation data were about 10 and 15 mm, respectively, so as to simulate motion variation between 4DCT acquisition and treatment session. In the validation with patient 4DCT dataset, eight CT datasets from the 4DCT dataset were used in the training process. Two excluded inhale CT datasets can be regarded as the datasets with large deformations more than training dataset. CT images were generated for each respiratory phase using the corresponding marker displacement. Root mean squared error (RMSE), normalized RMSE (NRMSE), and structural similarity index measure (SSIM) between the original CT images and the synthesized CT images were evaluated as the quantitative indices of the accuracy of image synthesis. The accuracy of tumor localization was also evaluated. RESULTS: In the validation with XCAT phantom, the mean NRMSE, SSIM, and three-dimensional tumor localization error were 7.5 ± 1.1%, 0.95 ± 0.02, and 0.4 ± 0.3 mm, respectively. In the validation with patient 4DCT dataset, the mean RMSE, NRMSE, SSIM, and three-dimensional tumor localization error in six patients were 73.7 ± 19.6 HU, 9.2 ± 2.6%, 0.88 ± 0.04, and 0.8 ± 0.6 mm, respectively. These results suggest that the accuracy of the proposed technique is adequate when the respiratory motion is within the range of the training dataset. In the evaluation with a marker displacement larger than that of the training dataset, the mean RMSE, NRMSE, and tumor localization error were about 100 HU, 13%, and <2.0 mm, respectively, except for one case having large motion variation. The performance of the proposed method was similar to those of previous studies. Processing time to generate the volumetric image was <100 ms. CONCLUSION: We have shown the feasibility of the real-time CT image generation technique for volumetric imaging.


Assuntos
Marcadores Fiduciais , Neoplasias , Tomografia Computadorizada Quadridimensional , Humanos , Movimento (Física) , Imagens de Fantasmas
11.
J Med Imaging Radiat Sci ; 52(3): 409-416, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34229986

RESUMO

OBJECTIVE: To evaluate the technical success and safety of transbronchial (bronchoscopic) fiducial placement compared to percutaneous CT-guided fiducial placement for stereotactic body radiotherapy (SBRT) of lung tumors. MATERIALS AND METHODS: This IRB-approved, HIPAA-compliant retrospective study was performed at a single tertiary institution. Consecutive patients undergoing lung fiducial placement for purposes of guiding SBRT (CyberKnife®, Accuray, Inc.) between September 2005 to January 2013 were included in the study. Fiducial seeds were placed percutaneously with CT guidance or transbronchially with bronchoscopic guidance. We compared procedure-related complications (pneumothorax, chest tube placement), technical success (defined as implantation enabling adequate treatment planning with CT simulation) and migration rate. The need for repeat procedures and their mode was noted. Statistical analysis was performed using Fisher exact and Chi square probability tests. RESULTS: Two hundred and forty-four patients with lung tumors and 272 fiducial seed placements were included in the study. Two hundred and twenty-one of the 272 (81.2%) fiducial markers were placed percutaneously and 51/272 (18.8%) were placed transbronchially. Pneumothorax was seen in 73/221 (33%) of percutaneously-placed fiducials and in 4/51 (7.8%) of transbronchial placements (p<0.001). No significant difference was seen in the rate of chest tube placement between the two groups: 20/221 (9%) of percutaneously placed fiducials and 2/51 (3.9%) of transbronchially placed fiducials (p=0.39). Fifteen of the 51 (29%) of fiducial placements with transbronchial approach were unsuccessful, as discovered at radiotherapy planning session, and required a repeat procedure. Nine of the 15 (60%) of repeat procedures were performed percutaneously, 5/15 (33%) were placed during repeat bronchoscopy, and 1/15 (7%) was placed at transesophageal endoscopic ultrasound. No repeat fiducial placements were required for patients who had the fiducials placed percutaneously (p<0.001), with a technical success rate of 100%. CONCLUSION: Transbronchial fiducial marker placement has a significantly higher rate of failed seed placements requiring repeat procedures in comparison to percutaneous placement. Complication rate of pneumothorax requiring chest drain placement is similar between the two approaches.


Assuntos
Neoplasias Pulmonares , Radiocirurgia , Marcadores Fiduciais , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/radioterapia , Radiocirurgia/efeitos adversos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
12.
Med Phys ; 48(10): 5991-6006, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34287934

RESUMO

PURPOSE: Estimation of the accuracy of 2D-3D registration is paramount for a correct evaluation of its outcome in both research and clinical studies. Publicly available datasets with standardized evaluation methodology are necessary for validation and comparison of 2D-3D registration techniques. Given the large use of 2D-3D registration in biomechanics, we introduced the first gold standard validation dataset for computed tomography (CT)-to-x-ray registration of the hip joint, based on fluoroscopic images with large rotation angles. As the ground truth computed with fiducial markers is affected by localization errors in the image datasets, we proposed a new methodology based on uncertainty propagation to estimate the accuracy of a gold standard dataset. METHODS: The gold standard dataset included a 3D CT scan of a female hip phantom and 19 2D fluoroscopic images acquired at different views and voltages. The ground truth transformations were estimated based on the corresponding pairs of extracted 2D and 3D fiducial locations. These were assumed to be corrupted by Gaussian noise, without any restrictions of isotropy. We devised the multiple projective points criterion (MPPC) that jointly optimizes the transformations and the noisy 3D fiducial locations for all views. The accuracy of the transformations obtained with the MPPC was assessed in both synthetic and real experiments using different formulations of the target registration error (TRE), including a novel formulation of the TRE (uTRE) derived from the uncertainty analysis of the MPPC. RESULTS: The proposed MPPC method was statistically more accurate compared to the validation methods for 2D-3D registration that did not optimize the 3D fiducial positions or wrongly assumed the isotropy of the noise. The reported results were comparable to previous published works of gold standard datasets. However, a formulation of the TRE commonly found in these gold standard datasets was found to significantly miscalculate the true TRE computed in synthetic experiments with known ground truths. In contrast, the uncertainty-based uTRE was statistically closer to the true TRE. CONCLUSIONS: We proposed a new gold standard dataset for the validation of CT-to-X-ray registration of the hip joint. The gold standard transformations were derived from a novel method modeling the uncertainty in extracted 2D and 3D fiducials. Results showed that considering possible noise anisotropy and including corrupted 3D fiducials in the optimization resulted in improved accuracy of the gold standard. A new uncertainty-based formulation of the TRE also appeared as a good alternative to the unknown true TRE that has been replaced in previous works by an alternative TRE not fully reflecting the gold standard accuracy.


Assuntos
Marcadores Fiduciais , Imageamento Tridimensional , Algoritmos , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Imagens de Fantasmas , Incerteza
13.
Medicine (Baltimore) ; 100(24): e26338, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34128879

RESUMO

ABSTRACT: The purpose of this study is to compare the longitudinal location of endoscopically-defined gross tumor volume (GTV) and positron emission tomography-based metabolic tumor volume (MTV) of esophageal cancer.A retrospective review of medical records was performed of the nine patients who underwent endoscopic placement of fiducial markers for radiotherapy of esophageal squamous cell carcinoma. Endoscopic hemoclips were used as the fiducial markers, and GTV was newly delineated solely based on the locations of the fiducial markers. The standardized uptake value (SUV) threshold corresponding to the superior and inferior borders of GTV was defined as the highest threshold that made MTV reach each border of GTV.The median fixed relative and absolute thresholds were 32% and 3.8, respectively. The coefficient of variation of the threshold values was 0.781 for the fixed relative threshold method and 0.400 for the fixed absolute threshold method, indicating more consistent results from the fixed absolute threshold method. All but two GTV borders were included in MTV with a SUV threshold of 2.5. Esophageal tumors with a maximum SUV > 20 tended to have closer threshold values corresponding to the GTV borders to 2.5 (median 2.8 vs 3.6, P = .069).The fixed absolute threshold method was suitable for determining the MTV threshold for esophageal lesions. A SUV of 2.5 was appropriate for esophageal tumors with a maximum SUV > 20. Endoscopic hemoclips were stable enough for using as the fiducial marker.


Assuntos
Endossonografia , Neoplasias Esofágicas/patologia , Carcinoma de Células Escamosas do Esôfago/patologia , Tomografia por Emissão de Pósitrons , Carga Tumoral , Idoso , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/diagnóstico por imagem , Carcinoma de Células Escamosas do Esôfago/diagnóstico por imagem , Feminino , Marcadores Fiduciais , Fluordesoxiglucose F18 , Humanos , Masculino , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos , Planejamento da Radioterapia Assistida por Computador/métodos , Estudos Retrospectivos
14.
Gastrointest Endosc ; 94(5): 953-958, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34081967

RESUMO

BACKGROUND AND AIMS: Image-guided radiation therapy (IGRT) often relies on EUS-guided fiducial markers. Previously used manually backloaded fiducial needles have multiple potential limitations including safety and efficiency concerns. Our aim was to evaluate the efficacy, feasibility, and safety of EUS-guided placement of gold fiducials using a novel preloaded 22-gauge needle compared with a traditional, backloaded 19-gauge needle. METHODS: This was a single-center comparative cohort study. Patients with pancreatic and hepatobiliary malignancy who underwent EUS-guided fiducial placement (EUS-FP) between October 2014 and February 2018 were included. The main outcome was the technical success of fiducial placement. Secondary outcomes were mean procedure time, fiducial visibility during IGRT, technical success of IGRT delivery, and adverse events. RESULTS: One hundred fourteen patients underwent EUS-FP during the study period. Of these, 111 patients had successful placement of a minimum of 2 fiducials. Fifty-six patients underwent placement using a backloaded 19-gauge needle and 58 patients underwent placement using a 22-gauge preloaded needle. The mean number of fiducials placed successfully at the target site was significantly higher in the 22-gauge group compared with the 19-gauge group (3.53 ± .96 vs 3.11 ± .61, respectively; P = .006). In the 22-gauge group, the clinical goal of placing 4 fiducials was achieved in 78%, compared with 23% in the 19-gauge group (P < .001). In univariate analyses, gender, age, procedure time, tumor size, and location did not influence the number of successfully placed fiducials. Technical success of IGRT with fiducial tracking was high in both the 19-gauge (51/56, 91%) and the 22-gauge group (47/58, 81%; P = .12). CONCLUSIONS: EUS-FP using a preloaded 22-gauge needle is feasible, effective, and safe and allows for a higher number of fiducials placed when compared with the traditional backloaded 19-gauge needle.


Assuntos
Radioterapia Guiada por Imagem , Estudos de Coortes , Endossonografia , Marcadores Fiduciais , Humanos , Agulhas
15.
J Urol ; 206(4): 894-902, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34100650

RESUMO

PURPOSE: The freehand (FH) technique of transperineal prostate biopsy using commercialized needle access systems facilitates a reduction in anesthesia requirements from general to local or local/sedation. We sought to compare the efficacy and complication rates of the FH method with those of the standard grid-based (GB) method. MATERIALS AND METHODS: The GB method was performed from 2014 to 2018, and the updated FH technique was performed from 2018 to 2020, yielding comparative cohorts of 174 and 304, respectively. RESULTS: The FH and GB techniques demonstrated equivalent yields of ≥Gleason grade group (GGG)-2 prostate cancer (PCa). The FH group had a significantly higher mean number of cores with ≥GGG-2 PCa involvement (p=0.011) but a significantly lower mean number of biopsy samples (p <0.01). The urinary retention rate of the GB group (10%) was significantly higher than that of the FH group (1%; p <0.01). The rates of ≥GGG-2 PCa involvement in the anterior (GB, 31%) and anteromedial (FH, 22%) sectors were higher than those in other sectors (range, 0%-9%). For multiparametric magnetic resonance imaging, the rate of ≥GGG-2 PCa detection in the anteromedial prostate (23%) was nearly half that in other locations (range, 38%-55%). CONCLUSIONS: Compared with GB transperineal biopsy, FH transperineal biopsy demonstrates an equivalent cancer yield with no risk of sepsis, a significantly reduced risk of urinary retention, and reduced anesthesia needs. The higher number of cores with ≥GGG-2 PCa involvement in the FH group suggests that FH transperineal biopsy can sample the prostate better than GB-transperineal biopsy can.


Assuntos
Biópsia com Agulha de Grande Calibre/métodos , Biópsia Guiada por Imagem/métodos , Complicações Pós-Operatórias/epidemiologia , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Idoso , Biópsia com Agulha de Grande Calibre/efeitos adversos , Biópsia com Agulha de Grande Calibre/instrumentação , Biópsia com Agulha de Grande Calibre/estatística & dados numéricos , Marcadores Fiduciais , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/instrumentação , Biópsia Guiada por Imagem/estatística & dados numéricos , Imagem por Ressonância Magnética Intervencionista/instrumentação , Masculino , Pessoa de Meia-Idade , Períneo/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , Estudos Retrospectivos
16.
Sci Rep ; 11(1): 13162, 2021 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-34162977

RESUMO

Correlative light and electron microscopy (CLEM) is a powerful tool for defining the ultrastructural context of molecularly-labeled biological specimens, particularly when superresolution fluorescence microscopy (SRM) is used for CLEM. Current CLEM, however, is limited by the stark differences in sample preparation requirements between the two modalities. For CLEM using SRM, the small region of interest (ROI) of either or both modalities also leads to low success rate and imaging throughput. To overcome these limitations, here we present a CLEM workflow based on a novel focused ion beam/scanning electron microscope (FIB/SEM) compatible with common SRM for imaging biological specimen with ultrahigh 3D resolution and improved imaging throughput. By using a reactive oxygen source in a plasma FIB (PFIB) and a rotating sample stage, the novel FIB/SEM was able to achieve several hundreds of micrometer large area 3D analysis of resin embedded cells through a process named oxygen serial spin mill (OSSM). Compared with current FIB mechanisms, OSSM offers gentle erosion, highly consistent slice thickness, reduced charging during SEM imaging, and improved SEM contrast without increasing the dose of post-staining and fixation. These characteristics of OSSM-SEM allowed us to pair it with interferometric photoactivated localization microscopy (iPALM), a recent SRM technique that affords 10-20 nm isotropic spatial resolution on hydrated samples, for 3D CLEM imaging. We demonstrate a CLEM workflow generalizable to using other SRM strategies using mitochondria in human osteosarcoma (U2OS) cells as a model system, where immunostained TOM20, a marker for the mitochondrial outer membrane, was used for iPALM. Owing to the large scan area of OSSM-SEM, it is now possible to select as many FOVs as needed for iPALM and conveniently re-locate them in EM, this improving the imaging throughput. The significantly reduced dose of post-fixation also helped to better preserve the sample ultrastructures as evidenced by the excellent 3D registration between OSSM-SEM and iPALM images and by the accurate localization of TOM20 (by iPALM) to the peripheries of mitochondria (by OSSM-SEM). These advantages make OSSM-SEM an ideal modality for CLEM applications. As OSSM-SEM is still in development, we also discuss some of the remaining issues and the implications to biological imaging with SEM alone or with CLEM.


Assuntos
Células Cultivadas/ultraestrutura , Processamento de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Microscopia de Varredura por Sonda/métodos , Microscopia/métodos , Neoplasias Ósseas/patologia , Linhagem Celular Tumoral , Marcadores Fiduciais , Corantes Fluorescentes , Ouro , Humanos , Microscopia Eletrônica de Varredura , Mitocôndrias/ultraestrutura , Nanotubos , Osteossarcoma/patologia , Fluxo de Trabalho
17.
Med Eng Phys ; 92: 88-92, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34167716

RESUMO

The purpose of this work was to assess the resolution to which micro-CT and intra-operative CT systems can quantify distances between radiopaque fiducial markers. Twenty-two markers were cast in a silicone phantom, then imaged at ten random rotations and translations within the field of view of a micro-CT and an intraoperative CT. A bounding box method and a mask-based weighted binary method were used to calculate the location of all markers in an image, then the Euclidian distance between neighbouring marker coordinates was calculated. The standard deviation in the inter-marker distance measurements from each of the marker position methods across the ten repeated trials was calculated for each marker identification method to provide a measure of the precision of the strain measurement with each scanner. The imaging systems measured 3D distances between markers to within 0.007 mm and 0.028 mm in the micro-CT and intra-operative CT, respectively, using the bounding box method, and to within 0.011 mm and 0.040 mm in the micro-CT and intra-operative systems, respectively, using the weighted-mask method. The bounding box method was found to be the most precise and is highly promising for applications in high resolution regional soft-tissue strain measurements.


Assuntos
Marcadores Fiduciais , Imagens de Fantasmas
18.
Sci Rep ; 11(1): 10406, 2021 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001966

RESUMO

In intra-operative navigation, a registration procedure is performed to register the patient's position to the pre-operative imaging data. The registration process is the main factor that determines accuracy of the navigation feedback. In this study, a novel registration protocol for craniofacial surgery is presented, that utilizes a virtual splint with marker points. The accuracy of the proposed method was evaluated by two observers in five human cadaver heads, for optical and electromagnetic navigation, and compared to maxillary bone-anchored fiducial registration (optical and electromagnetic) and surface-based registration (electromagnetic). The results showed minimal differences in accuracy compared to bone-anchored fiducials at the level of the infra-orbital rim. Both point-based techniques had lower error estimates at the infraorbital rim than surface-based registration, but surface-based registration had the lowest loss of accuracy over target distance. An advantage over existing point-based registration methods (bone-anchored fiducials, existing splint techniques) is that radiological imaging does not need to be repeated, since the need for physical fiducials to be present in the image volume is eradicated. Other advantages include reduction of invasiveness compared to bone-achnored fiducials and a possible reduction of human error in the registration process.


Assuntos
Marcadores Fiduciais , Imageamento Tridimensional/instrumentação , Posicionamento do Paciente/métodos , Contenções , Cirurgia Assistida por Computador/métodos , Pontos de Referência Anatômicos , Cadáver , Fenômenos Eletromagnéticos , Humanos , Imageamento Tridimensional/métodos , Maxila/anatomia & histologia , Maxila/diagnóstico por imagem , Maxila/cirurgia , Órbita/anatomia & histologia , Órbita/diagnóstico por imagem , Órbita/cirurgia , Tomografia Computadorizada por Raios X/métodos
19.
BMC Cancer ; 21(1): 494, 2021 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-33941111

RESUMO

BACKGROUND: Stereotactic Ablative Body Radiotherapy (SABR) is a non-invasive treatment which allows delivery of an ablative radiation dose with high accuracy and precision. SABR is an established treatment for both primary and secondary liver malignancies, and technological advances have improved its efficacy and safety. Respiratory motion management to reduce tumour motion and image guidance to achieve targeting accuracy are crucial elements of liver SABR. This phase II multi-institutional TROG 17.03 study, Liver Ablative Radiotherapy using Kilovoltage intrafraction monitoring (LARK), aims to investigate and assess the dosimetric impact of the KIM real-time image guidance technology. KIM utilises standard linear accelerator equipment and therefore has the potential to be a widely available real-time image guidance technology for liver SABR. METHODS: Forty-six patients with either hepatocellular carcinoma or oligometastatic disease to the liver suitable for and treated with SABR using Kilovoltage Intrafraction Monitoring (KIM) guidance will be included in the study. The dosimetric impact will be assessed by quantifying accumulated patient dose distribution with or without the KIM intervention. The patient treatment outcomes of local control, toxicity and quality of life will be measured. DISCUSSION: Liver SABR is a highly effective treatment, but precise dose delivery is challenging due to organ motion. Currently, there is a lack of widely available options for performing real-time tumour localisation to assist with accurate delivery of liver SABR. This study will provide an assessment of the impact of KIM as a potential solution for real-time image guidance in liver SABR. TRIAL REGISTRATION: This trial was registered on December 7th 2016 on ClinicalTrials.gov under the trial-ID NCT02984566 .


Assuntos
Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Movimentos dos Órgãos , Radiocirurgia/métodos , Radioterapia Guiada por Imagem/métodos , Austrália , Carcinoma Hepatocelular/secundário , Dinamarca , Marcadores Fiduciais , Humanos , Neoplasias Hepáticas/secundário , Qualidade de Vida , Radiocirurgia/efeitos adversos , Radiocirurgia/instrumentação , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/efeitos adversos , Radioterapia de Intensidade Modulada/métodos , Respiração , Resultado do Tratamento
20.
Oper Neurosurg (Hagerstown) ; 21(3): E193-E198, 2021 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-34038952

RESUMO

BACKGROUND: With the advent of intraoperative computed tomography (CT) for image guidance, numerous examples of accurate navigation being applied to cranial and spinal pathology have come to light. For spinal disorders, the utilization of image guidance for the placement of percutaneous spinal instrumentation, complex osteotomies, and minimally invasive approaches are frequently utilized in trauma, degenerative, and oncological pathologies. The use of intraoperative CT for navigation, however, requires a low target registration error that must be verified throughout the procedure to confirm the accuracy of image guidance. OBJECTIVE: To present the use of skin staples as a sterile, economical fiducial marker for minimally invasive spinal procedures requiring intraoperative CT navigation. METHODS: Staples are applied to the skin prior to obtaining the registration CT scan and maintained throughout the remainder of the surgery to facilitate confirmation of image guidance accuracy. RESULTS: This low-cost, simple, sterile approach provides surface landmarks that allow reliable verification of navigation accuracy during percutaneous spinal procedures using intraoperative CT scan image guidance. CONCLUSION: The utilization of staples as a fiducial marker represents an economical and easily adaptable technique for ensuring accuracy of image guidance with intraoperative CT navigation.


Assuntos
Doenças da Coluna Vertebral , Cirurgia Assistida por Computador , Marcadores Fiduciais , Humanos , Procedimentos Neurocirúrgicos , Doenças da Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X
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