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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Biomedical Engineering".

Deadline for manuscript submissions: closed (20 April 2024) | Viewed by 22853

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Dr. Anna Sarnelli

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Medical Physics Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola, Italy
Interests: medical physics; nuclear medicine (imaging and therapy); radiotherapy; models for radiobiology

Special Issue Information

Dear Colleagues,

Radiotherapy technologies and modalities have been greatly improved during the last years, bringing benefits in terms of precision and accuracy in both therapy delivery and verification. These improvements were also allowed, among other technological advances, by the growing role of imaging dedicated to the radiotherapy workflow. Imaging applications in radiotherapy span over different steps of the therapy process, starting from diagnosis and staging, passing through imaging dedicated to treatment planning and delivery, and finally to post therapy follow-up. Unfortunately, the image quality is not uniform over the whole workflow with lower image quality usually obtained in the phase of treatment verification.

As a result of the increasing role of imaging in the field, each patient is associated to a set of images, usually of different modalities, that enriches the information on disease evolution, which is not fully exploited.

Commonly, with “image guided radiotherapy” we refer to imaging used in the radiotherapy delivery process, in order to verify the proper position of the patient each day of treatment. We think that time has come to extend this definition to the whole radiotherapy workflow and not only to the patient position verification. In fact, nowadays with this expression we may also refer to the role of all images acquired during radiotherapy process, as the information derived from the whole images set acquired pre, post and during radiotherapy may provide useful information, which could impact the treatment strategy.

It is worthwhile to stress also the emerging role of radionuclide therapy, not only in the field of rare disease. Also in this branch of radiotherapy, the imaging is crucial to verify disease extension and modification among treatment cycles, to quantify the dose delivered to tumour and healthy tissue and also to optimize the treatment schedule.

The field of application of the imaging modalities in radiotherapy workflow is wide and it is not easy to get a general overview of all the opportunities as well as their implications and pitfalls. Therefore, the present Special Issue aims to summarize the main aspects of diagnostic imaging application in the framework of radiotherapy.

Topics of interest for this Special Issue include but are not limited to:

role of imaging in radiotherapy planning
role of imaging in post therapy follow-up
image based adaptive radiotherapy
hybrid technologies (e.g. MRI radiotherapy, ...)
artificial intelligence and radiomics applied to radiotherapy
role of imaging in re-irradiation
role of imaging in the radionuclide therapy

The authors are free and encouraged to delineated the topics among all field of radiotherapy modalities, such as external beam radiotherapy (EBRT), brachytherapy, hadrontherapy, and Nuclear Medicine Therapy.

Dr. Anna Sarnelli
Guest Editor

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Published Papers (10 papers)

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11 pages, 2761 KiB

Open AccessArticle

A Deep Learning Approach for the Fast Generation of Synthetic Computed Tomography from Low-Dose Cone Beam Computed Tomography Images on a Linear Accelerator Equipped with Artificial Intelligence

by Luca Vellini, Sergio Zucca, Jacopo Lenkowicz, Sebastiano Menna, Francesco Catucci, Flaviovincenzo Quaranta, Elisa Pilloni, Andrea D'Aviero, Michele Aquilano, Carmela Di Dio, Martina Iezzi, Alessia Re, Francesco Preziosi, Antonio Piras, Althea Boschetti, Danila Piccari, Gian Carlo Mattiucci and Davide Cusumano

Appl. Sci. 2024, 14(11), 4844; https://doi.org/10.3390/app14114844 - 3 Jun 2024

Viewed by 902

Abstract

Artificial Intelligence (AI) is revolutionising many aspects of radiotherapy (RT), opening scenarios that were unimaginable just a few years ago. The aim of this study is to propose a Deep Leaning (DL) approach able to quickly generate synthetic Computed Tomography (CT) images from low-dose Cone Beam CT (CBCT) acquired on a modern linear accelerator integrating AI. Methods: A total of 53 patients treated in the pelvic region were enrolled and split into training (30), validation (9), and testing (14). A Generative Adversarial Network (GAN) was trained for 200 epochs. The image accuracy was evaluated by calculating the mean and mean absolute error (ME and ME) between sCT and CT. RT treatment plans were calculated on CT and sCT images, and dose accuracy was evaluated considering Dose Volume Histogram (DVH) and gamma analysis. Results: A total of 4507 images were selected for training. The MAE and ME values in the test set were 36 ± 6 HU and 7 ± 6 HU, respectively. Mean gamma passing rates for 1%/1 mm, 2%/2 mm, and 3%/3 mm tolerance criteria were respectively 93.5 ± 3.4%, 98.0 ± 1.3%, and 99.2 ± 0.7%, with no difference between curative and palliative cases. All the DVH parameters analysed were within 1 Gy of the difference between sCT and CT. Conclusion: This study demonstrated that sCT generation using the DL approach is feasible on low-dose CBCT images. The proposed approach can represent a valid tool to speed up the online adaptive procedure and remove CT simulation from the RT workflow. Full article

(This article belongs to the Special Issue Developments of Diagnostic Imaging Applied in Radiotherapy)

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12 pages, 2271 KiB

Open AccessArticle

New-Generation ASiR-V for Dose Reduction While Maintaining Image Quality in CT: A Phantom Study

by Sara Ungania, Francesco Maria Solivetti, Marco D’Arienzo, Francesco Quagliani, Isabella Sperduti, Aldo Morrone, Carlo de Mutiis, Vicente Bruzzaniti and Antonino Guerrisi

Appl. Sci. 2023, 13(9), 5639; https://doi.org/10.3390/app13095639 - 3 May 2023

Cited by 2 | Viewed by 3122

Abstract

Over the last few decades, the need to reduce and optimize patient medical radiation exposure has prompted the introduction of novel reconstruction algorithms in computed tomography (CT). Against this backdrop, the present study aimed to assess whether reduced radiation dose CT images reconstructed with the new-generation adaptive statistical iterative reconstruction (ASiR-V) maintain the same image quality as that of routine image reconstruction. In addition, the optimization of image quality parameters for the ASiR-V algorithm (e.g., an optimal combination of blending percentage and noise index (NI)) was investigated. An abdominal reference phantom was imaged using the routine clinical protocol (fixed noise index of 18 and 40% ASiR reconstruction). Reduced radiation dose CT scans were performed with varying NI (22, 24, and 30) and using the ASiR-V reconstruction algorithm. Quantitative and qualitative analyses of image noise, contrast, and resolution were performed against NI and reconstruction blending percentages. Our results confirm the ability of the ASiR-V algorithm to provide images of high diagnostic quality while reducing the patient dose. All the parameters were improved in ASiR-V images as compared to ASiR. Both quantitative and qualitative analyses showed that the best agreement was obtained for the images reconstructed using ASiR-V with NI24 and a high percentage of blending (70–100%). This preliminary study results show that ASiR-V allows for a significant reduction in patient dose (about 40%) while maintaining a good overall image quality when appropriate NI (i.e., 24) is used. Full article

(This article belongs to the Special Issue Developments of Diagnostic Imaging Applied in Radiotherapy)

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16 pages, 3681 KiB

Open AccessArticle

How the Rigid and Deformable Image Registration Approaches Affect the Absorbed Dose Estimation Using Images Collected before and after Transarterial Radioembolization with ⁹⁰Y Resin Microspheres in a Clinical Setting

by Giuseppe Della Gala, Miriam Santoro, Giulia Paolani, Silvia Strolin, Alberta Cappelli, Cristina Mosconi, Elisa Lodi Rizzini and Lidia Strigari

Appl. Sci. 2022, 12(24), 12767; https://doi.org/10.3390/app122412767 - 12 Dec 2022

Cited by 1 | Viewed by 1865

Abstract

Background: Transarterial radioembolization (TARE) relies on directly injected ⁹⁰Y- or ¹⁶⁶Ho-loaded microspheres in the hepatic arteries. The activity to be injected is generally based on pre-TARE ^99mTc-macro-aggregated-albumin (MAA) imaging, while the actual dose distribution is based on post-treatment images. The volume of interest (VOIs) propagation methods (i.e., rigid and deformable) from pre- to post-TARE imaging might affect the estimation of the mean absorbed dose in the tumor and non-tumoral liver (NTL), i.e., D_T and D_NTL, respectively. Methods: In 101 consecutive patients, liver and tumor were delineated on pre-TARE images and semi-automatically transferred on ⁹⁰Y-PET/CT images with a rigid or deformable registration approach. Pre- and post-TARE volumes and D_T/D_NTL/D_L were compared using correlation coefficient (CC) indexes, such as intra-class (ICC), Pearson’s (PCC), concordance (CCCo) and Bland–Altman analyses. The Kaplan–Meier curves of overall survival (OS) were calculated according to D_T. Results: All computed CCs indicated very good (>0.92) agreement for volume comparison, while they suggested good (ICC ≥ 0.869, PCC ≥ 0.876 and CCCo ≥ 0.790) and moderate agreement in the intra- and inter-modality D_T/D_NTL/D_L comparisons, respectively. Bland–Altman analyses showed percentage differences between the manual and deformable approaches of up to about −31%, 9% and 62% for tumoral volumes, D_T and D_NTL, respectively. The overall survival analysis showed statistically significant differences using D_T cutoffs of 110, 90 and 85 Gy for the manual, rigid and deformable approaches, respectively. Conclusions: The semi-automatic transfer of VOIs from pre- and post-TARE imaging is feasible, but the selected method might affect prognostic D_T/D_NTL constraints. Full article

(This article belongs to the Special Issue Developments of Diagnostic Imaging Applied in Radiotherapy)

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14 pages, 1203 KiB

Open AccessArticle

Dosimetric Evaluation of the Inter-Fraction Motion of Organs at Risk in SBRT for Nodal Oligometastatic Prostate Cancer

by Francesco La Fauci, Matteo Augugliaro, Giovanni Carlo Mazzola, Stefania Comi, Matteo Pepa, Mattia Zaffaroni, Maria Giulia Vincini, Giulia Corrao, Francesco Alessandro Mistretta, Stefano Luzzago, Cristiana Fodor, Gennaro Musi, Salvatore Gallo, Giuseppe Petralia, Ottavio De Cobelli, Roberto Orecchia, Federica Cattani, Giulia Marvaso and Barbara Alicja Jereczek-Fossa

Appl. Sci. 2022, 12(21), 10949; https://doi.org/10.3390/app122110949 - 28 Oct 2022

Cited by 1 | Viewed by 1984

Abstract

In this paper, we aim to evaluate the entity of inter-fraction organ motion and deformation in stereotactic body radiotherapy (SBRT) treatments for nodal oligometastatic prostate cancer (PCa). Thirty-three patients with lymph nodes showing oligometastatic PCa treated with SBRT were included. Organs at risk (OARs) were delineated using both simulation computer tomography (s-CT) and daily cone beam CTs (CBCTs) using the Raystation planning system. For each OAR, the union volume (UV) between all the CBCTs and s-CT was computed. An expanded volume (EV) of the s-CT OARs was applied using six different margins (3, 5, 8, 10, 15, and 20 mm). A percentage volume (V%) was computed to assess the intersection between each EV and UV. The OAR deformation and motion were further evaluated using the dice similarity coefficient (DSC) and mean distance to agreement (Mean_DA). The percentage maximum dose variations for all the OARs were estimated. A recalculation with higher dose prescriptions was performed by prescribing 36 Gy/3 fx, as well as 45 Gy/3 fx. The cauda showed the highest matching (DSC = 0.72; Mean_DA = 0.14 cm), and the colon showed the lowest one (DSC = 0.37; Mean_DA = 0.44 cm). The minimum margin, which ensured a V% > 95%, was 3 mm (97.5%) for the cauda and 15 mm (96.6%) for the colon. All the OARs reached the compliance of the constraints in each session. Regarding 36 Gy-plans, the ileum punctual compliance Dmax failed in 58.8% of patients, and it failed in 70.6% of the patients for the ileum, 7.14% for the colon, and 12.5% for the bladder in the case of 45 Gy-plans. This study is an ancillary study of the RADIOSA clinical trial (AIRC IG-22159) and can be used as a benchmark for dose escalation. Full article

(This article belongs to the Special Issue Developments of Diagnostic Imaging Applied in Radiotherapy)

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13 pages, 4907 KiB

Open AccessArticle

A Workflow for Dosimetry of ⁹⁰Y Radioembolization Based on Quantitative ^99mTc-MAA SPECT/CT Imaging and a 3D-Printed Phantom

by Sara Ungania, Marco D’Arienzo, Emilio Mezzenga, Giuseppe Pizzi, Giulio Vallati, Anna Ianiro, Sandra Rea, Rosa Sciuto, Antonella Soriani and Lidia Strigari

Appl. Sci. 2022, 12(20), 10541; https://doi.org/10.3390/app122010541 - 19 Oct 2022

Cited by 3 | Viewed by 1896

Abstract

At a time of increasing evidence for dose-effect relationships in radioembolization (RE) with ⁹⁰Y-microspheres, the general consensus is that there is an urgent need for accurate treatment planning and dose assessment in patients undergoing RE treatment. This work aimed at assessing the usefulness of ^99mTc macroaggregated albumin (MAA) SPECT/CT imaging for personalized provisional RE dosimetry considering a 3D-printed patientlike phantom (AdboMan phantom). A homemade tool was developed in MATLAB for image analysis and absorbed dose calculation. Two dose calculaton methods were implemented and used to calculate dose volume histograms: (I) dose kernel method and (II) local energy deposition method. The accuracy of the two different dosimetric methods was evaluated by means of 3D

γ

-index (1%–1 mm and 2%–2 mm) implemented in the tool. Differences between the two dose calculation methods using the 3D

γ

-index are within 1%–1 mm and 2%–2 mm for all AbdoMan inserts, with a passing rate of 99.9% and 100%, respectively, proving a good agreement between the two calculation methods. The present study supports the use of ^99mTc-MAA SPECT acquisition for provisional dosimetry along with the local energy deposition method to convert reconstructed SPECT data into absorbed dose maps. As long as ^99mTc-MAA SPECT acquisitions are performed on liver lesions larger than 40 mm, the absorbed dose computed by means of the local energy deposition method can lead to results in line with those obtained by Monte Carlo calculations. Full article

(This article belongs to the Special Issue Developments of Diagnostic Imaging Applied in Radiotherapy)

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17 pages, 4267 KiB

Open AccessArticle

Optimization of ^99mTc-MAA SPECT/CT Imaging for ⁹⁰Y Radioembolization Using a 3D-Printed Phantom

by Sara Ungania, Marco D’Arienzo, Sandro Nocentini, Marco D’Andrea, Vicente Bruzzaniti, Raffaella Marconi, Emilio Mezzenga, Bartolomeo Cassano, Erminia Infusino, Antonino Guerrisi, Antonella Soriani and Lidia Strigari

Appl. Sci. 2022, 12(19), 10022; https://doi.org/10.3390/app121910022 - 6 Oct 2022

Cited by 1 | Viewed by 1844

Abstract

Radioembolization (RE) with ⁹⁰Y-microspheres has gained widespread acceptance as a safe and effective technique for treating liver malignancies. Accurate quantification in RE is a key step in treatment planning optimization and is becoming a pressing issue in light of the Directive 2013/59/EURATOM. The aim of this study was to develop a SPECT/CT imaging protocol for quantitative imaging optimization in RE based on cutting edge imaging technology (Symbia IntevoTM system provided with the innovative xSPECT software) and a novel anthropomorphic 3D-printed phantom. In the present study, ^99mTc-labeled macroaggregated albumin was used as a surrogate radiopharmaceutical for treatment planning. Gamma camera calibration factors and recovery coefficients were determined performing preliminary SPECT/CT acquisitions of a point source, a cylindrical homogeneous phantom and the NEMA/IEC phantom. Data reconstruction was performed using the built-in xSPECT package, using both the Ordered Subset Expectation–Maximization (OSEM) and the Ordered Subset Conjugated Gradient (OSCG) algorithm. Specific regions of interest (ROIs) were drawn on the MIM 6.1.7 system according to the physical volume. The quantification procedure was validated using the anthropomorphic phantom provided with a fillable liver section and spheres of different diameters (20 mm, 40 mm and a 40 mm spherical shell). The measured activity concentration in all geometries is consistent within 4%, demonstrating that the xSPECT software permit an absolute quantification in anthropomorphic geometry largely within the 10% recommended from the manufacturer. Caution is advised in the presence of spherical objects with a necrotic core, as underestimations in the order of 20% were obtained. Full article

(This article belongs to the Special Issue Developments of Diagnostic Imaging Applied in Radiotherapy)

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18 pages, 1999 KiB

Open AccessArticle

Evaluating the Quality of Patient-Specific Deformable Image Registration in Adaptive Radiotherapy Using a Digitally Enhanced Head and Neck Phantom

by Elisabetta Cagni, Andrea Botti, Matteo Orlandi, Marco Galaverni, Cinzia Iotti, Mauro Iori, Geraint Lewis and Emiliano Spezi

Appl. Sci. 2022, 12(19), 9493; https://doi.org/10.3390/app12199493 - 22 Sep 2022

Cited by 1 | Viewed by 2000

Abstract

Despite the availability of national and international guidelines, an accurate and efficient, patient-specific, deformable image registration (DIR) validation methodology is not yet established, and several groups have found an incompatibility of the various digital phantoms with the commercial systems. To evaluate the quality of the computed tomography (CT) and on-board cone-beam CT (CBCT) DIRs, a novel methodology was developed and tested on 10 head and neck (HN) patients, using CT and CBCT anthropomorphic HN phantom images, digitally reprocessed to include the common organs at risk. Reference DVFs (refDVFs) were generated from the clinical patient CT-CBCT fused images using an independent registration software. The phantom CT images were artificially deformed, using the refDVFs, and registered with the phantom CBCT images, using the clinical registration software, generating a test DVF (testDVF) dataset. The clinical plans were recalculated on the daily patient ‘deformed’ CTs, and the dose maps transferred to the patient-planning CT, using both the refDVF and testDVF. The spatial and dosimetric errors were quantified and the DIR performance evaluated using an established operative tolerance level. The method showed the ability to quantify the DIR spatial errors and assess their dose impact at the voxel level and could be applied to patient-specific DIR evaluation during adaptive HN radiotherapy in routine practice. Full article

(This article belongs to the Special Issue Developments of Diagnostic Imaging Applied in Radiotherapy)

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9 pages, 3189 KiB

Open AccessCommunication

Up-to-Date Optimization of the 90Y-PET/CT Reconstruction Protocol for Volumetric Quantification in Trans-Arterial RadioEmbolization (TARE) Procedures in the Era of Theranostics

by Amedeo Capotosti, Roberto Moretti, Alessia Milano, Matteo Nardini, Davide Cusumano, Salvatore Annunziata, Marco Capogni, Marco D’Arienzo, Lorenzo Placidi and Luca Indovina

Appl. Sci. 2022, 12(17), 8418; https://doi.org/10.3390/app12178418 - 23 Aug 2022

Cited by 6 | Viewed by 1440

Abstract

(1) Background: New generation of PET-CT scanners allows performing volumetric dosimetry based on 90Y-activity distribution. The aim of this study was to perform an up-to-date evaluation of the optimal 90Y-PET-CT reconstruction parameters for a Siemens Biograph mCT scanner. (2) Methods: A cylindrical uniform phantom (P1), IEC NEMA Body-phantom (P2) and IEC NEMA Torso-phantom (P3) filled with 90Y were acquired. The matrix size and number of Equivalent Iterations (E.I.) were evaluated through the Recovery Coefficient (RC) and the Coefficient of Variation (CoV). The optimal post-reconstruction Gaussian Filter (GF) was assessed through an analysis of Root Mean Square Error (RMSE) and Full Width at Half Maximum (FWHM) in DVHs. (3) Results: For P1, RC values showed constant trends varying the matrix size (slope m = 1.25 × 10⁻³) or E.I. (slope m = −2.16 × 10⁻⁴). For P2, CoV decreased increasing the matrix size and it grew increasing the E.I. For P3, RMSE and mean dose values showed constant trends varying the Gaussian filter (slope m = 1.51 × 10⁻²) while FWHM decreased increasing filter. For smaller volumes, RMSE grew increasing the filter (from 34% to 74%) and the use of larger filters resulted in a dose underestimation (from 172 to 133 Gy). (4) Conclusions: The optimal reconstruction parameters for the Siemens Biograph mCT PET/CT scanner are presented, combining old metrics with new ones involving a dosimetric approach. Full article

(This article belongs to the Special Issue Developments of Diagnostic Imaging Applied in Radiotherapy)

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18 pages, 4381 KiB

Open AccessArticle

The Role of a DirectDensity^® CT Reconstruction in a Radiotherapy Workflow: A Phantom Study

by Giacomo Feliciani, Claretta Guidi, Maria Luisa Belli, Vincenzo D’Errico, Emiliano Loi, Emilio Mezzenga and Anna Sarnelli

Appl. Sci. 2022, 12(15), 7845; https://doi.org/10.3390/app12157845 - 4 Aug 2022

Cited by 4 | Viewed by 2448

Abstract

The DirectDensity^® CT reconstruction algorithm provides a reconstruction approach independent of the tube voltage, directly reconstructing the CT projection data into CT numbers related to the electron densities of the materials. This work examines the efficacy of DirectDensity^® in the treatment planning process with both tissues and metallic materials. CT scans of a Cheese phantom were acquired at 80, 100, 120 and 140 kVp and reconstructed with different algorithms. Calibration curves were built for each kVp and reconstruction technique. To evaluate the flexibility of the DirectDensity^® in dose calculations, a prostate cancer treatment plan was simulated on phantom images with and without metal inserts. Moreover, the robustness of the algorithm was tested by simulating a possible error in the selection of the calibration curve. As expected, the calibration curves related to DirectDensity^® showed a tube voltage dependence only for densities above 1.82 g/cm³. The maximum percentage differences in dose distributions comparations never exceeded the 3% of tolerance and the 3D gamma analysis always returned indices greater than 90%. The results suggest that the DD reconstruction algorithm can be employed in most clinical cases and allows for a personalized radiotherapy cancer treatment workflow, maintaining its robustness and simplicity. Full article

(This article belongs to the Special Issue Developments of Diagnostic Imaging Applied in Radiotherapy)

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Review

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18 pages, 1016 KiB

Open AccessReview

The Role of PET and SPECT Imaging in Prostate Cancer Targeted Alpha Therapy: When and How?

by Viviana Frantellizzi, Maria Ricci, Andrea Cimini, Luca Filippi, Miriam Conte, Maria Silvia De Feo and Giuseppe De Vincentis

Appl. Sci. 2023, 13(3), 1890; https://doi.org/10.3390/app13031890 - 1 Feb 2023

Cited by 3 | Viewed by 4321

Abstract

This review discusses the current state of Targeted Alpha Therapy (TAT) in prostate cancer, particularly in mCRPCT (metastatic castration-resistant prostate cancer). This review describes the widely used Radium-223 and the novel trend in the TAT field with a special focus on prostate-specific membrane antigen (PSMA)-based alpha therapy. With this in-depth discussion on the growing field of PSMA-based alpha therapy, we aim also to analyze the most useful diagnostic tools in the patient selection and in the treatment monitoring. We explored the diagnostic tools used in clinical practice and in research settings in order to clarify the imaging procedures that may support the PSMA-based TAT management, including both the patient’s selection and the therapy response monitoring, with a special focus on diagnostic PSMA-PET/CT imaging. Further multicenter trials are needed, but a better understanding of the strengths and limitations of molecular imaging in PSMA-based TAT management may help in creating an effective therapeutic algorithm for mCRPC and designing a rational approach to treatment. Full article

(This article belongs to the Special Issue Developments of Diagnostic Imaging Applied in Radiotherapy)

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