Biomedical subjects

Jian-Yue Jin

Publications and source records attributed to Jian-Yue Jin.

9 recordsLinked to original sources

PubMed2007

Partial volume tolerance of the spinal cord and complications of single-dose radiosurgery.

BACKGROUND: Spine radiosurgery causes a rapid dose fall-off within the spinal cord. The tolerance of partial volume of the spinal cord may determine the extent of clinical application. The study analyzed the partial volume tolerance of the human spinal cord to single fraction radiosurgery. METHODS: A total of 230 lesions with spine metastases in 177 patients were treated with radiosurgery with single fraction of 8 to 18 Gy, prescribed to the 90% isodose line that encompassed the target volume. Spinal cord volume was defined as 6 mm above and below the radiosurgery target volume. Spinal cord dose was calculated from the radiation dose/spinal cord volume histogram and correlated with clinical/neurological status and radiographic studies. Median follow-up was 6.4 months (range, 0.5-49 months). The 1-year survival rate was 49%. RESULTS: The average spinal cord volume defined at the treated spinal segment was 5.9 +/- 2.2 mL. The average dose to the 10% spinal cord volume was 9.8 +/- 1.5 Gy, calculated from the dose-volume histogram in the group of 18 Gy prescribed dose. The spinal cord volume that received higher than 80% of the prescribed dose was 0.07 +/- 0.10 mL, which represented 1.3 +/- 1.8% of the cord volume. Among the 86 patients who survived longer than 1 year there was 1 case of radiation-induced cord injury after 13 months of radiosurgery. There were no other cases of spinal cord sequelae. CONCLUSIONS: Whereas the maximum spinal cord tolerance to single-dose radiation is not known, partial volume tolerance of the human spinal cord is at least 10 Gy to 10% of the spinal cord volume defined as 6 mm above and below the radiosurgery target.

Adolescent↗

PubMed2006

A technique of using gated-CT images to determine internal target volume (ITV) for fractionated stereotactic lung radiotherapy.

BACKGROUND AND PURPOSE: To develop and evaluate a technique and procedure of using gated-CT images in combination with PET image to determine the internal target volume (ITV), which could reduce the planning target volume (PTV) with adequate target coverage. PATIENTS AND METHODS: A skin marker-based gating system connected to a regular single slice CT scanner was used for this study. A motion phantom with adjustable motion amplitude was used to evaluate the CT gating system. Specifically, objects of various sizes/shapes, considered as virtual tumors, were placed on the phantom to evaluate the number of phases of gated images required to determine the ITV while taking into account tumor size, shape and motion. A procedure of using gated-CT and PET images to define ITV for patients was developed and was tested in patients enrolled in an IRB approved protocol. RESULTS: The CT gating system was capable of removing motion artifacts for target motion as large as 3-cm when it was gated at optimal phases. A phantom study showed that two gated-CT scans at the end of expiration and the end of inspiration would be sufficient to determine the ITV for tumor motion less than 1-cm, and another mid-phase scan would be required for tumors with 2-cm motion, especially for small tumors. For patients, the ITV encompassing visible tumors in all sets of gated-CT and regular spiral CT images seemed to be consistent with the target volume determined from PET images. PTV expanded from the ITV with a setup uncertainty margin had less volume than PTVs from spiral CT images with a 10-mm generalized margin or an individualized margin determined at fluoroscopy. CONCLUSIONS: A technique of determining the ITV using gated-CT images was developed and was clinically implemented successfully for fractionated stereotactic lung radiotherapy.

Algorithms↗

PubMed2006

18F-FDG PET definition of gross tumor volume for radiotherapy of non-small cell lung cancer: is a single standardized uptake value threshold approach appropriate?

UNLABELLED: PET with (18)F-FDG has been used in radiation treatment planning for non-small cell lung cancer (NSCLC). Thresholds of 15%-50% the maximum standardized uptake value (SUV(max)) have been used for gross tumor volume (GTV) delineation by PET (PET(GTV)), with 40% being the most commonly used value. Recent studies indicated that 15%-20% may be more appropriate. The purposes of this study were to determine which threshold generates the best volumetric match to GTV delineation by CT (CT(GTV)) for peripheral NSCLC and to determine whether that threshold can be generalized to tumors of various sizes. METHODS: Data for patients who had peripheral NSCLC with well-defined borders on CT and SUV(max) of greater than 2.5 were reviewed. PET/CT datasets were reviewed, and a volume of interest was determined to represent the GTV. The CT(GTV) was delineated by using standard lung windows and reviewed by a radiation oncologist. The PET(GTV) was delineated automatically by use of various percentages of the SUV(max). The PET(GTV)-to-CT(GTV) ratios were compared at various thresholds, and a ratio of 1 was considered the best match, or the optimal threshold. RESULTS: Twenty peripheral NSCLCs with volumes easily defined on CT were evaluated. The SUV(max) (mean +/- SD) was 12 +/- 8, and the mean CT(GTV) was 198 cm(3) (97.5% confidence interval, 5-1,008). The SUV(max) were 16 +/- 5, 13 +/- 9, and 3.0 +/- 0.4 for tumors measuring greater than 5 cm, 3-5 cm, and less than 3 cm, respectively. The optimal thresholds (mean +/- SD) for the best match were 15% +/- 6% for tumors measuring greater than 5 cm, 24% +/- 9% for tumors measuring 3-5 cm, 42% +/- 2% for tumors measuring less than 3 cm, and 24% +/- 13% for all tumors. The PET(GTV) at the 40% and 20% thresholds underestimated the CT(GTV) for 16 of 20 and 14 of 20 lesions, respectively. The mean difference in the volumes (PET(GTV) minus CT(GTV) [PET(GTV) - CT(GTV)]) at the 20% threshold was 79 cm(3) (97.5% confidence interval, -922 to 178). The PET(GTV) at the 20% threshold overestimated the CT(GTV) for all 4 tumors measuring less than 3 cm and underestimated the CT(GTV) for all 6 tumors measuring greater than 5 cm. The CT(GTV) was inversely correlated with the PET(GTV) - CT(GTV) at the 20% threshold (R(2) = 0.90, P < 0.0001). The optimal threshold was inversely correlated with the CT(GTV) (R(2) = 0.79, P < 0.0001). CONCLUSION: No single threshold delineating the PET(GTV) provides accurate volume definition, compared with that provided by the CT(GTV), for the majority of NSCLCs. The strong correlation of the optimal threshold with the CT(GTV) warrants further investigation.

Carcinoma, Non-Small-Cell Lung↗

PubMed2005

An improved internal mammary irradiation technique in radiation treatment of locally advanced breast cancers.

The purpose of the present study was to compare a new internal mammary irradiation technique with traditional techniques for locally advanced breast cancers in terms of sparing ipsilateral lung and heart and reducing the "cold" and "hot spots"in breast tissue. The new technique uses wide tangential fields for the first eight fractions of treatment. A medial internal mammary field (IMF) of electrons matched with narrowed tangential fields is used for the remaining fractions. Intensity-modulated radiation therapy (IMRT) by means of segmented multileaf collimation (SMLC) is used in the narrowed tangential fields to improve the match between the electron and the photon fields. Treatment planning was performed to compare this technique to a wide-tangential-only technique and to a traditional oblique IMF technique for three patients with differing habitus. Film dosimetry was performed in a solid water phantom to confirm the planning results. For all three patients, the mean doses of the ipsilateral lung and the heart were significantly reduced with the new technique. The lung and the heart volumes were remarkably reduced at lowdose levels (< or =12 Gy) compared to the traditional IMF technique, and significantly reduced at all dose levels compared to the wide tangential technique. The new technique also reduced the "cold" and "hot spots" along the match plane between the IMF and the tangential fields compared to the traditional IMF technique. In conclusion, the new IMF technique shows dosimetric improvement compared to the traditional IMF technique in terms of the critical organ sparing and target dose uniformity.

Body Burden↗

PubMed2005

Dosimetric study using different leaf-width MLCs for treatment planning of dynamic conformal arcs and intensity-modulated radiosurgery.

This paper systematically studied the dosimetric difference between a 3 mm micro multileaf collimator (MLC), a 5 mm MLC, and a 10 mm MLC for stereotactic radiosurgery using the Brainscan treatment planning system. Thirty-four cases treated with the dynamic conformal arcs technique and 20 cases treated with the intensity modulated radiosurgery/fractionated radiotherapy (IMRS/ IMRT) technique were retrospectively studied. The conformity index, the percentage target coverage, and the dose-volume histogram (DVH) for organs-at-risk (OARs) were used for dosimetric analysis and comparison for different treatment techniques, target volumes, and treatment sites. For the dynamic conformal arcs technique, there were statistically significant differences in the conformity indices between different leaf-width MLCs. The ratio of the conformity indices between different MLCs depended on the target volume. The average conformity index ratios between the 5 mm MLC and the 3 mm MLC were 1.37+/-0.09, 1.12+/-0.04, 1.08+/-0.02 and 1.04+/-0.01, respectively, for patients with the target volume (V) in groups: (1) V< 1 cm3, (2) 1 cm3 < V< 8 cm3, (3) 8 cm3 < V< 27 cm3, and (4) V> 27 CC. The average conformity index ratios between the 10 and 3 mm MLCs were 2.00+/-0.33, 1.45+/-0.09, 1.28+/-0.09, and 1.18+/-0.05 for patients in these four volume groups, respectively. No statistically significant difference was found for the target coverage among different MLCs. For the IMRS/IMRT technique, the average conformity index and target coverage ratios were 1.01+/-0.05 and 1.00+/-0.02, respectively, between the 5 and 3 mm MLCs, and were 1.04+/-0.07 and 0.97+/-0.02, respectively, between the 10 and 3 mm MLCs. The 3 mm MLC showed slightly better overall OAR DVHs than the 5 and 10 mm MLCs, especially for the cranial site with small-volume OARs defined. The results suggest that for the dynamic conformal arcs technique, the narrower leaf-width MLC provides better dose conformity than the wider leaf-width MLCs. This advantage decreases when the target volume increases. For the IMRS/IMRT technique, the narrower leaf-width MLC could have better sparing of small OARs than the wider leaf-width MLC.

Body Burden↗

PubMed2005

Time delay measurement for linac based treatment delivery in synchronized respiratory gating radiotherapy.

A time delay in a respiratory gating system could cause an unexpected phase mismatch for synchronized gating radiotherapy. This study presents a method of identifying and measuring the time delay in a gating system. Various port films were taken for a motion phantom at different gating window levels with a very narrow window size. The time delay for the gating system was determined by comparing the motion curve (the position of a moving object versus the gating time) measured in the port films to the motion curve determined by the video cameras. The measured time delay for a linac-based gating system was 0.17+/-0.03 s. This time delay could induce target missing if it was not properly taken into account for the synchronized gating radiotherapy. Measurement/verification of the time delay should be considered as an important part of the accepting/commissioning test before the clinical use of the gating system.

Equipment Design↗

PubMed2004

Comparison of two treatment techniques for breast irradiation including internal mammary nodes.

Techniques to treat breast cancer inclusive of the internal mammary lymph node chain (IMC) vary. This study compared a presently accepted technique implemented at the Radiation Oncology Department at Barnes-Jewish Hospital/Washington University School of Medicine (BJ/WU) to a proposed technique for irradiation of breast tissue and the IMC. The present technique consists of parallel-opposed breast tangential beams in combination with photon and electron IMC fields angled along the chest wall. The proposed method involves a wide medial tangent field covering the IMC, with an angled electron IMC field for a portion of the treatment regimen and an opposed lateral breast-only tangent. This technique uses a multileaf collimation (MLC) reduction to treat the IMC aspect following the wide medial tangent, to supplement the IMC to a tumorcidal dose. These techniques were compared by reviewing isodoses with subsequent isodensity confirmation. Computerized tomography imaging sets of patients with various body types (chest wall, small and large breasts) for left-sided tumors were planned using a three-dimensional treatment planning system (FOCUS, Computerized Medical Systems). The plans were evaluated by comparing irradiated heart and lung volumes and the respective dose distribution at the IMC field/medial tangent junction. Specific treatment aids and photon/electron energies were employed to produce desirable isodose distributions, with a dose prescription of 4680-cGy total dose. The efficiency of the radiation treatments itself was also evaluated. The proposed technique decreases treatment time by eliminating an additional IMC field that involves repositioning and placement of a block. Phantom-based film isodensity measurements were evaluated to validate the calculated dosimetry for these techniques.

Breast↗

PubMed2004

A simple method of independent treatment time verification in gamma knife radiosurgery using integral dose.

The purpose of this study is to develop a simple independent dose calculation method to verify treatment plans for Leksell Gamma Knife radiosurgery. Our approach uses the total integral dose within the skull as an end point for comparison. The total integral dose is computed using a spreadsheet and is compared to that obtained from Leksell GammaPlan. It is calculated as the sum of the integral doses of 201 beams, each passing through a cylindrical volume. The average length of the cylinders is estimated from the Skull-Scaler measurement data taken before treatment. Correction factors are applied to the length of the cylinder depending on the location of a shot in the skull. The radius of the cylinder corresponds to the collimator aperture of the helmet, with a correction factor for the beam penumbra and scattering. We have tested our simple spreadsheet program using treatment plans of 40 patients treated with Gamma Knife in our center. These patients differ in geometry, size, lesion locations, collimator helmet, and treatment complexities. Results show that differences between our calculations and treatment planning results are typically within +/-3%, with a maximum difference of +/-3.8%. We demonstrate that our spreadsheet program is a convenient and effective independent method to verify treatment planning irradiation times prior to implementation of Gamma Knife radiosurgery.

Algorithms↗

PubMed2004

Image-guided procedures for intensity-modulated spinal radiosurgery. Technical note.

Radiosurgery for brain tumors has been well established in the radiation oncology and neurosurgery fields. Radiosurgery of extracranial tumors such as those involving the spine is, however, still in the early stage because of difficulties in patient immobilization and organ motion. The authors describe an image-guided procedure for intensity-modulated spinal radiosurgery that was developed at Henry Ford Hospital.

Algorithms↗