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Article ; Online: Adding customized electron energy beams to TrueBeam linear accelerators.

Gao, Song / Muruganandham, Manickam / Du, Weiliang / Ohrt, Jared / Kudchadker, Rajat J / Balter, Peter A

Journal of applied clinical medical physics

2022 Volume 23, Issue 7, Page(s) e13633

Abstract: Purpose: To better meet clinical needs and facilitate optimal treatment planning, we added two new electron energy beams (7 and 11 MeV) to two Varian TrueBeam linacs.: Methods: We worked with the vendor to create two additional customized electron ... ...

Abstract	Purpose: To better meet clinical needs and facilitate optimal treatment planning, we added two new electron energy beams (7 and 11 MeV) to two Varian TrueBeam linacs. Methods: We worked with the vendor to create two additional customized electron energies without hardware modifications. For each beam, we set the bending magnet current and then optimized other beam-specific parameters to achieve depths of 50% ionization (I Results: The I Conclusion: We were able to add two new beam energies with no hardware modifications. Tuning of the new beams was facilitated by the ICP/DW system allowing us to have the procedures done in a few hours and achieve highly consistent results across two linacs. PACS numbers: 87.55.Qr, 87.56.Fc.
MeSH term(s)	Electrons ; Humans ; Particle Accelerators ; Phantoms, Imaging ; Radiometry ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted/methods
Language	English
Publishing date	2022-05-09
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010347-5
ISSN	1526-9914 ; 1526-9914
ISSN (online)	1526-9914
ISSN	1526-9914
DOI	10.1002/acm2.13633
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Article: A Novel Multimodal Approach to Refractory Brain Metastases: A Case Report.

Katlowitz, Kalman A / Beckham, Thomas H / Kudchadker, Rajat J / Wefel, Jeffrey / Elamin, Yasir Y / Weinberg, Jeffrey S

Advances in radiation oncology

2023 Volume 9, Issue 2, Page(s) 101349

Language	English
Publishing date	2023-08-15
Publishing country	United States
Document type	Case Reports
ISSN	2452-1094
ISSN	2452-1094
DOI	10.1016/j.adro.2023.101349
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Article ; Online: Prospective Evaluation of Prostate and Organs at Risk Segmentation Software for MRI-based Prostate Radiation Therapy.

Sanders, Jeremiah W / Kudchadker, Rajat J / Tang, Chad / Mok, Henry / Venkatesan, Aradhana M / Thames, Howard D / Frank, Steven J

Radiology. Artificial intelligence

2022 Volume 4, Issue 2, Page(s) e210151

Abstract: The segmentation of the prostate and surrounding organs at risk (OARs) is a necessary workflow step for performing dose-volume histogram analyses of prostate radiation therapy procedures. Low-dose-rate prostate brachytherapy (LDRPBT) is a curative ... ...

Abstract	The segmentation of the prostate and surrounding organs at risk (OARs) is a necessary workflow step for performing dose-volume histogram analyses of prostate radiation therapy procedures. Low-dose-rate prostate brachytherapy (LDRPBT) is a curative prostate radiation therapy treatment that delivers a single fraction of radiation over a period of days. Prior studies have demonstrated the feasibility of fully convolutional networks to segment the prostate and surrounding OARs for LDRPBT dose-volume histogram analyses. However, performance evaluations have been limited to measures of global similarity between algorithm predictions and a reference. To date, the clinical use of automatic segmentation algorithms for LDRPBT has not been evaluated, to the authors' knowledge. The purpose of this work was to assess the performance of fully convolutional networks for prostate and OAR delineation on a prospectively identified cohort of patients who underwent LDRPBT by using clinically relevant metrics. Thirty patients underwent LDRPBT and were imaged with fully balanced steady-state free precession MRI after implantation. Custom automatic segmentation software was used to segment the prostate and four OARs. Dose-volume histogram analyses were performed by using both the original automatically generated contours and the physician-refined contours. Dosimetry parameters of the prostate, external urinary sphincter, and rectum were compared without and with the physician refinements. This study observed that physician refinements to the automatic contours did not significantly affect dosimetry parameters.
Language	English
Publishing date	2022-01-26
Publishing country	United States
Document type	Journal Article
ISSN	2638-6100
ISSN (online)	2638-6100
DOI	10.1148/ryai.210151
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Article: A Novel Polymer-Encapsulated Multi-Imaging Modality Fiducial Marker with Positive Signal Contrast for Image-Guided Radiation Therapy.

Wang, Li / Sanders, Jeremiah / Ward, John F / Lee, Stephen R / Poenisch, Falk / Swanson, David Michael / Sahoo, Narayan / Zhu, Xiaorong Ronald / Ma, Jingfei / Kudchadker, Rajat J / Choi, Seungtaek L / Nguyen, Quynh-Nhu / Mayo, Lauren L / Shah, Shalin J / Frank, Steven J

Cancers

2024 Volume 16, Issue 3

Abstract: Background: Current fiducial markers (FMs) in external-beam radiotherapy (EBRT) for prostate cancer (PCa) cannot be positively visualized on magnetic resonance imaging (MRI) and create dose perturbation and significant imaging artifacts on computed ... ...

Abstract	Background: Current fiducial markers (FMs) in external-beam radiotherapy (EBRT) for prostate cancer (PCa) cannot be positively visualized on magnetic resonance imaging (MRI) and create dose perturbation and significant imaging artifacts on computed tomography (CT) and MRI. We report our initial experience with clinical imaging of a novel multimodality FM, NOVA. Methods: We tested Gold Anchor [G-FM], BiomarC [carbon, C-FM], and NOVA FMs in phantoms imaged with kilovoltage (kV) X-rays, transrectal ultrasound (TRUS), CT, and MRI. Artifacts of the FMs on CT were quantified by the relative streak artifacts level (rSAL) metric. Proton dose perturbations (PDPs) were measured with Gafchromic EBT3 film, with FMs oriented either perpendicular to or parallel with the beam axis. We also tested the performance of NOVA-FMs in a patient. Results: NOVA-FMs were positively visualized on all 4 imaging modalities tested. The rSAL on CT was 0.750 ± 0.335 for 2-mm reconstructed slices. In F-tests, PDP was associated with marker type and depth of measurement ( Conclusions: NOVA-FMs were positively visible and produced less PDP than G-FMs or C-FMs. NOVA-FMs facilitated MRI/CT fusion and identification of regions of interest.
Language	English
Publishing date	2024-01-31
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers16030625
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Article ; Online: Uncertainty in magnetic resonance imaging-based prostate postimplant dosimetry: Results of a 10-person human observer study, and comparisons with automatic postimplant dosimetry.

Sanders, Jeremiah W / Tang, Chad / Kudchadker, Rajat J / Venkatesan, Aradhana M / Mok, Henry / Hanania, Alexander N / Thames, Howard D / Bruno, Teresa L / Starks, Christine / Santiago, Edwin / Cunningham, Mandy / Frank, Steven J

Brachytherapy

2023 Volume 22, Issue 6, Page(s) 822–832

Abstract: Purpose: Uncertainties in postimplant quality assessment (QA) for low-dose-rate prostate brachytherapy (LDRPBT) are introduced at two steps: seed localization and contouring. We quantified how interobserver variability (IoV) introduced in both steps ... ...

Abstract	Purpose: Uncertainties in postimplant quality assessment (QA) for low-dose-rate prostate brachytherapy (LDRPBT) are introduced at two steps: seed localization and contouring. We quantified how interobserver variability (IoV) introduced in both steps impacts dose-volume-histogram (DVH) parameters for MRI-based LDRPBT, and compared it with automatically derived DVH parameters. Methods and materials: Twenty-five patients received MRI-based LDRPBT. Seven clinical observers contoured the prostate and four organs at risk, and 4 dosimetrists performed seed localization, on each MRI. Twenty-eight unique manual postimplant QAs were created for each patient from unique observer pairs. Reference QA and automatic QA were also performed for each patient. IoV of prostate, rectum, and external urinary sphincter (EUS) DVH parameters owing to seed localization and contouring was quantified with coefficients of variation. Automatically derived DVH parameters were compared with those of the reference plans. Results: Coefficients of variation (CoVs) owing to contouring variability (CoV Conclusions: Seed localization introduces substantially less variability in postimplant QA than does contouring for MRI-based LDRPBT. While automatic seed localization may potentially help improve workflow efficiency, it has limited potential for improving the consistency and quality of postimplant dosimetry.
MeSH term(s)	Male ; Humans ; Prostate/diagnostic imaging ; Prostate/pathology ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Prostatic Neoplasms/pathology ; Uncertainty ; Brachytherapy/methods ; Radiotherapy Dosage ; Tomography, X-Ray Computed/methods ; Magnetic Resonance Imaging/methods
Language	English
Publishing date	2023-09-15
Publishing country	United States
Document type	Journal Article
ZDB-ID	2098608-7
ISSN	1873-1449 ; 1538-4721
ISSN (online)	1873-1449
ISSN	1538-4721
DOI	10.1016/j.brachy.2023.08.001
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Article ; Online: Independent evaluation of the effectiveness of IsoCal in improving image center accuracy on Varian TrueBeam and Clinac machines.

Du, Weiliang / Gao, Song / Jiang, Wei / Kudchadker, Rajat J

Journal of applied clinical medical physics

2018 Volume 19, Issue 5, Page(s) 483–490

Abstract: Modern medical linear accelerators (linacs) are often equipped with image guidance systems that are capable of megavolt (MV), kilovolt (kV), planar, or volumetric imaging. On Varian TrueBeam linacs, the isocenter accuracies of the imaging systems are ... ...

Abstract	Modern medical linear accelerators (linacs) are often equipped with image guidance systems that are capable of megavolt (MV), kilovolt (kV), planar, or volumetric imaging. On Varian TrueBeam linacs, the isocenter accuracies of the imaging systems are calibrated with a procedure named IsoCal. On Clinac series linacs from Varian, installation of IsoCal is optional and the effects of IsoCal on the imaging systems can be turned on or off after the IsoCal procedure is performed. In this study, we report on the effectiveness of IsoCal in improving the coincidence of the image centers with the radiation isocenter, using an independent Winston-Lutz (WL) method to locate the radiation isocenter. A ball-bearing phantom was imaged with 2D MV, 2D kV, and cone beam computed radiography systems on two TrueBeam and two Clinac machines. Using the same phantom, digital WL tests with 16 combinations of gantry and collimator angles were performed to locate the radiation isocenter. The offsets between the IsoCal-calibrated image centers and the WL radiation isocenter were found to be within 0.4 mm on the four linacs in this study. When IsoCal was turned off, the maximal offsets of the image centers were greater than 1.0 mm on the two Clinac machines. The method developed in this study can be used as a vendor-independent quality assurance tool to assess the isocentricity of the image centers and radiation central axes.
MeSH term(s)	Linear Models ; Particle Accelerators ; Phantoms, Imaging
Language	English
Publishing date	2018-06-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010347-5
ISSN	1526-9914 ; 1526-9914
ISSN (online)	1526-9914
ISSN	1526-9914
DOI	10.1002/acm2.12402
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Article ; Online: Development and clinical implementation of SeedNet: A sliding-window convolutional neural network for radioactive seed identification in MRI-assisted radiosurgery (MARS).

Sanders, Jeremiah W / Frank, Steven J / Kudchadker, Rajat J / Bruno, Teresa L / Ma, Jingfei

Magnetic resonance in medicine

2019 Volume 81, Issue 6, Page(s) 3888–3900

Abstract: Purpose: To develop and evaluate a sliding-window convolutional neural network (CNN) for radioactive seed identification in MRI of the prostate after permanent implant brachytherapy.: Methods: Sixty-eight patients underwent prostate cancer low-dose- ... ...

Abstract	Purpose: To develop and evaluate a sliding-window convolutional neural network (CNN) for radioactive seed identification in MRI of the prostate after permanent implant brachytherapy. Methods: Sixty-eight patients underwent prostate cancer low-dose-rate (LDR) brachytherapy using radioactive seeds stranded with positive contrast MR-signal seed markers and were scanned using a balanced steady-state free precession pulse sequence with and without an endorectal coil (ERC). A sliding-window CNN algorithm (SeedNet) was developed to scan the prostate images using 3D sub-windows and to identify the implanted radioactive seeds. The algorithm was trained on sub-windows extracted from 18 patient images. Seed detection performance was evaluated by computing precision, recall, F Results: SeedNet achieved 97.6 ± 2.2% recall and 97.2 ± 1.9% precision for radioactive seed detection and 0.19 ± 0.04 mm RMSE for seed localization in the images acquired with an ERC. Without the ERC, the recall remained high, but the false-positive rate increased; the RMSE of the seed locations increased marginally. The clinical integration of SeedNet slightly increased the run-time, but the overall run-time was still low. Conclusion: SeedNet can be used to perform automated radioactive seed identification in prostate MRI after LDR brachytherapy. Image quality improvement through pulse sequence optimization is expected to improve SeedNet's performance when imaging without an ERC.
MeSH term(s)	Algorithms ; Brachytherapy/instrumentation ; Brachytherapy/methods ; Humans ; Image Processing, Computer-Assisted/methods ; Magnetic Resonance Imaging, Interventional/methods ; Male ; Neural Networks, Computer ; Prostate/diagnostic imaging ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Radiosurgery/instrumentation ; Radiosurgery/methods ; Retrospective Studies
Language	English
Publishing date	2019-02-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	605774-3
ISSN	1522-2594 ; 0740-3194
ISSN (online)	1522-2594
ISSN	0740-3194
DOI	10.1002/mrm.27677
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Article ; Online: Noninferiority of Hypofractionated vs Conventional Postprostatectomy Radiotherapy for Genitourinary and Gastrointestinal Symptoms: The NRG-GU003 Phase 3 Randomized Clinical Trial.

JAMA oncology

2024

Abstract: Importance: No prior trial has compared hypofractionated postprostatectomy radiotherapy (HYPORT) to conventionally fractionated postprostatectomy (COPORT) in patients primarily treated with prostatectomy.: Objective: To determine if HYPORT is ... ...

Abstract	Importance: No prior trial has compared hypofractionated postprostatectomy radiotherapy (HYPORT) to conventionally fractionated postprostatectomy (COPORT) in patients primarily treated with prostatectomy. Objective: To determine if HYPORT is noninferior to COPORT for patient-reported genitourinary (GU) and gastrointestinal (GI) symptoms at 2 years. Design, setting, and participants: In this phase 3 randomized clinical trial, patients with a detectable prostate-specific antigen (PSA; ≥0.1 ng/mL) postprostatectomy with pT2/3pNX/0 disease or an undetectable PSA (<0.1 ng/mL) with either pT3 disease or pT2 disease with a positive surgical margin were recruited from 93 academic, community-based, and tertiary medical sites in the US and Canada. Between June 2017 and July 2018, a total of 296 patients were randomized. Data were analyzed in December 2020, with additional analyses occurring after as needed. Intervention: Patients were randomized to receive 62.5 Gy in 25 fractions (HYPORT) or 66.6 Gy in 37 fractions (COPORT). Main outcomes and measures: The coprimary end points were the 2-year change in score from baseline for the bowel and urinary domains of the Expanded Prostate Cancer Composite Index questionnaire. Secondary objectives were to compare between arms freedom from biochemical failure, time to progression, local failure, regional failure, salvage therapy, distant metastasis, prostate cancer-specific survival, overall survival, and adverse events. Results: Of the 296 patients randomized (median [range] age, 65 [44-81] years; 100% male), 144 received HYPORT and 152 received COPORT. At the end of RT, the mean GU change scores among those in the HYPORT and COPORT arms were neither clinically significant nor different in statistical significance and remained so at 6 and 12 months. The mean (SD) GI change scores for HYPORT and COPORT were both clinically significant and different in statistical significance at the end of RT (-15.52 [18.43] and -7.06 [12.78], respectively; P < .001). However, the clinically and statistically significant differences in HYPORT and COPORT mean GI change scores were resolved at 6 and 12 months. The 24-month differences in mean GU and GI change scores for HYPORT were noninferior to COPORT using noninferiority margins of -5 and -6, respectively, rejecting the null hypothesis of inferiority (mean [SD] GU score: HYPORT, -5.01 [15.10] and COPORT, -4.07 [14.67]; P = .005; mean [SD] GI score: HYPORT, -4.17 [10.97] and COPORT, -1.41 [8.32]; P = .02). With a median follow-up for censored patients of 2.1 years, there was no difference between HYPORT vs COPORT for biochemical failure, defined as a PSA of 0.4 ng/mL or higher and rising (2-year rate, 12% vs 8%; P = .28). Conclusions and relevance: In this randomized clinical trial, HYPORT was associated with greater patient-reported GI toxic effects compared with COPORT at the completion of RT, but both groups recovered to baseline levels within 6 months. At 2 years, HYPORT was noninferior to COPORT in terms of patient-reported GU or GI toxic effects. HYPORT is a new acceptable practice standard for patients receiving postprostatectomy radiotherapy. Trial registration: ClinicalTrials.gov Identifier: NCT03274687.
Language	English
Publishing date	2024-03-14
Publishing country	United States
Document type	Journal Article
ISSN	2374-2445
ISSN (online)	2374-2445
DOI	10.1001/jamaoncol.2023.7291
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Article ; Online: On the selection of gantry and collimator angles for isocenter localization using Winston-Lutz tests.

Du, Weiliang / Johnson, Jennifer L / Jiang, Wei / Kudchadker, Rajat J

Journal of applied clinical medical physics

2016 Volume 17, Issue 1, Page(s) 167–178

Abstract: In Winston-Lutz (WL) tests, the isocenter of a linear accelerator (linac) is determined as the intersection of radiation central axes (CAX) from multiple gantry, collimator, and couch angles. It is well known that the CAX can wobble due to mechanical ... ...

Abstract	In Winston-Lutz (WL) tests, the isocenter of a linear accelerator (linac) is determined as the intersection of radiation central axes (CAX) from multiple gantry, collimator, and couch angles. It is well known that the CAX can wobble due to mechanical imperfections of the linac. Previous studies suggested that the wobble varies with gantry and collimator angles. Therefore, the isocenter determined in the WL tests has a profound dependence on the gantry and collimator angles at which CAX are sampled. In this study, we evaluated the systematic and random errors in the iso-centers determined with different CAX sampling schemes. Digital WL tests were performed on six linacs. For each WL test, 63 CAX were sampled at nine gantry angles and seven collimator angles. Subsets of these data were used to simulate the effects of various CAX sampling schemes. An isocenter was calculated from each subset of CAX and compared against the reference isocenter, which was calculated from 48 opposing CAX. The differences between the calculated isocenters and the reference isocenters ranged from 0 to 0.8 mm. The differences diminished to less than 0.2 mm when 24 or more CAX were sampled. Isocenters determined with collimator 0° were vertically lower than those determined with collimator 90° and 270°. Isocenter localization errors in the longitudinal direction (along the axis of gantry rotation) showed a strong dependence on the collimator angle selected. The errors in all directions were significantly reduced when opposing collimator angles and opposing gantry angles were employed. The isocenter localization errors were less than 0.2 mm with the common CAX sampling scheme, which used four cardinal gantry angles and two opposing collimator angles. Reproducibility stud-ies on one linac showed that the mean and maximum variations of CAX during the WL tests were 0.053 mm and 0.30 mm, respectively. The maximal variation in the resulting isocenters was 0.068 mm if 48 CAX were used, or 0.13 mm if four CAX were used. Quantitative results from this study are useful for understanding and minimizing the isocenter uncertainty in WL tests.
MeSH term(s)	Humans ; Image Processing, Computer-Assisted/methods ; Particle Accelerators/instrumentation ; Phantoms, Imaging ; Software
Language	English
Publishing date	2016--08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010347-5
ISSN	1526-9914 ; 1526-9914
ISSN (online)	1526-9914
ISSN	1526-9914
DOI	10.1120/jacmp.v17i1.5792
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Article ; Online: The American Brachytherapy Society and Indian Brachytherapy Society consensus statement for the establishment of high-dose-rate brachytherapy programs for gynecological malignancies in low- and middle-income countries.

Grover, Surbhi / Lichter, Katie E / Likhacheva, Anna / Jang, Joanne W / Ning, Matthew S / Robin, Tyler P / Small, William / Kudchadker, Rajat J / Swamidas, Jamema / Chopra, Supriya / Rai, Bhavana / Sharma, Sunil Dutt / Sharma, Daya N / Kuppusamy, Thayalan / Yang, Ruijie / Berger, Daniel / Mendez, Lisbeth Cordero / Glaser, Scott / Erickson, Delnora L /

Chino, Junzo / Mourtada, Firas / Abdel-Wahab, May / Jhingran, Anuja / Simonds, Hannah / Mahantshetty, Umesh

Brachytherapy

2023 Volume 22, Issue 6, Page(s) 716–727

Abstract: Purpose: The global cervical cancer burden is disproportionately high in low- and middle-income countries (LMICs), and outcomes can be governed by the accessibility of appropriate screening and treatment. High-dose-rate (HDR) brachytherapy plays a ... ...

Abstract	Purpose: The global cervical cancer burden is disproportionately high in low- and middle-income countries (LMICs), and outcomes can be governed by the accessibility of appropriate screening and treatment. High-dose-rate (HDR) brachytherapy plays a central role in cervical cancer treatment, improving local control and overall survival. The American Brachytherapy Society (ABS) and Indian Brachytherapy Society (IBS) collaborated to provide this succinct consensus statement guiding the establishment of brachytherapy programs for gynecological malignancies in resource-limited settings. Methods and materials: ABS and IBS members with expertise in brachytherapy formulated this consensus statement based on their collective clinical experience in LMICs with varying levels of resources. Results: The ABS and IBS strongly encourage the establishment of HDR brachytherapy programs for the treatment of gynecological malignancies. With the consideration of resource variability in LMICs, we present 15 minimum component requirements for the establishment of such programs. Guidance on these components, including discussion of what is considered to be essential and what is considered to be optimal, is provided. Conclusions: This ABS/IBS consensus statement can guide the successful and safe establishment of HDR brachytherapy programs for gynecological malignancies in LMICs with varying levels of resources.
MeSH term(s)	Female ; Humans ; United States ; Brachytherapy/methods ; Uterine Cervical Neoplasms/radiotherapy ; Uterine Cervical Neoplasms/pathology ; Developing Countries ; Genital Neoplasms, Female/radiotherapy ; Radiotherapy Dosage
Language	English
Publishing date	2023-09-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2098608-7
ISSN	1873-1449 ; 1538-4721
ISSN (online)	1873-1449
ISSN	1538-4721
DOI	10.1016/j.brachy.2023.07.003
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