The Effect of Injected and Oral Computed Tomography Contrast Agent on Helical Tomotherapy Dose Calculating in Rectal Cancer
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Abstract
Purpose: This study aimed to evaluate the impact of Contrast-Enhanced Computed Tomography (CECT) on treatment planning for rectal cancer using Helical Tomotherapy (HT).
Materials and Methods: A total of patients with known rectal tumors were included, and both CECT and non-CECT images were obtained. Patients adhered to a low-fat diet and received oral and intravenous iodine-based contrast agents. Target volumes, including Gross Tumor Volume (GTV), Clinical Target Volume (CTV), and Planning Target Volume (PTV), were delineated by a radiation oncologist using DICOM images. Intensity-Modulated Radiation Therapy (IMRT) techniques with Simultaneous Integrated Boost (SIB) methods were employed to optimize dose delivery while minimizing exposure to Organs at Risks (OARs).
Results: The analysis revealed that the use of CECT significantly increased. Hounsfield Unit (HU) values across all structures, enhancing visibility and accuracy in target volume delineation. Dosimetric evaluations indicated minimal differences in dose distributions between CECT and non-CECT plans. However, certain indices such as Dmax, Dmin, Dmean, Homogeneity Index (HI), and Conformity Index (CI) showed significant changes that could influence clinical outcomes.
Conclusion: The incorporation of CECT in radiation therapy planning for rectal cancer improves the delineation of critical structures, potentially leading to better treatment outcomes. The findings underscore the importance of using contrast media in enhancing imaging quality, which is crucial for effective target volume definition and OAR contouring. Future research should explore the long-term clinical implications of these findings on patient outcomes and quality of life post-treatment.
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31- R. Bhaskaran, et al., , "Comparison of dose volumetric parameters of oesophagus in the radiation treatment of carcinoma breast with and without oesophagus delineation." Journal of Radiotherapy in Practice, Vol. 22(2023).
32- AlMohsen S Elawadi AA, AlGendy R, Allazkani H, Mohamed RA, AlAssaf H, Nisbet A, Alshanqity M, "The effect of contrast agents on dose calculations of volumetric modulated arc radiotherapy plans for critical structures." Applied Sciences , Vol. 11 (No. 18), p. 8355, (2021 ).
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34- M. Werner-Wasik, et al., "Radiation dose-volume effects in the esophagus." International Journal of Radiation Oncology* Biology* Physics, Vol. 76 (No. 3), pp. 86-93, (2010).
35- S. Pawiro, A. Azzi, and D. Soejoko, "A Monte Carlo study of photon beam characteristics on various linear accelerator filters." Journal of Biomedical Physics & Engineering, Vol. 10 (No. 613), p. 5, (2020).
36- Mikaeil M Nasrollah J, Omid E, Mojtaba SS, Ahad Z., " Influence of the intravenous contrast media on treatment planning dose calculations of lower esophageal and rectal cancers." Journal of cancer research and therapeutics, Vol. 10 (No. 1), pp. 147-52, (2014 Jan ).
37- Liu C Shi W, Lu B, Yeung A, Newlin HE, Amdur RJ, Olivier KR., "The effect of intravenous contrast on photon radiation therapy dose calculations for lung cancer." American journal of clinical oncology, Vol. 33 (No. 2), pp. 153-6, (2010).
38- Naruse A Shibamoto Y, Fukuma H, Ayakawa S, Sugie C, Tomita N. , "Influence of contrast materials on dose calculation in radiotherapy planning using computed tomography for tumors at various anatomical regions: a prospective study." Radiotherapy and Oncology, Vol. 84 (No. 1), pp. 52-5, (2007 ).
39- Rowbottom CG Burridge NA, Burt PA. Effect of contrast‐enhanced CT scans on heterogeneity corrected dose computations in the lung, Journal of Applied Clinical Medical Physics, Vol. 7 (No. 4), pp. 1-2, (2006 ).
2- M. Taghipour, et al., "Post-treatment 18F-FDG-PET/CT versus contrast-enhanced CT in patients with oropharyngeal squamous cell carcinoma: comparative effectiveness study." Nuclear medicine communications, Vol. 3 (No. 38), pp. 250-58, (2017).
3- A.T. Davis, et al., "Assessment of the variation in CT scanner performance (image quality and Hounsfield units) with scan parameters, for image optimisation in radiotherapy treatment planning." Physica Medica, (No. 45), pp. 59-64, (2018).
4- U. Schneider, E. Pedroni, and A. Lomax, "The calibration of CT Hounsfield units for radiotherapy treatment planning." Physics in Medicine & Biology, Vol. 41 (No. 1), p. 111, (1996).
5- P. McLaughlin, et al. , "Non-contrast CT at comparable dose to an abdominal radiograph in patients with acute renal colic; impact of iterative reconstruction on image quality and diagnostic performance." Insights into imaging, Vol. 5pp. 217-30, ( 2014).
6- M. AlShurbaji, et al., " Investigating the Effect of Patient-Related Factors on Computed Tomography Radiation Dose Using Regression and Correlation Analysis." Applied Sciences, Vol. 14 (No. 3), p. 1071, (2024 ).
7- S.S.M. Amin, et al., "Comparison of esophagus dose in breast cancer patients undergoing supraclavicular irradiation with and without esophagus countering." Journal of Cancer Research and Therapeutics, (2023).
8- K. Kraus, et al., "Helical tomotherapy: Comparison of Hi-ART and Radixact clinical patient treatments at the Technical University of Munich." Scientific reports, Vol. 10 (No. 1), p. 4928, (2020).
9- Y.W. and H.S. Thomsen Nielsen, "Contrast Media in Computed Tomography Imaging. Multi-Detector CT Imaging: Principles, Head, Neck, and Vascular Systems, ." Vol. 1p. 69 (2013).
10- L. Caschera, et al., "Contrast agents in diagnostic imaging: Present and future." Pharmacological research, Vol. 110pp. 65-75, (2016).
11- K.P. Murphy, et al., "Imaging the small bowel." Current opinion in gastroenterology, Vol. 30 (No. 2), pp. 134-40, (2014).
12- V. and T Grégoire, "Mackie, State of the art on dose prescription, reporting and recording in Intensity-Modulated Radiation Therapy (ICRU report No. 83)." Cancer/Radiothérapie, Vol. 15 (No. 6-7), pp. 555-59, (2011).
13- J. Zhao, et al., "Concomitant dose escalation with image-guided Tomotherapy in locally advanced mid–low rectal cancer: a single-center study." Cancer management and research, pp. 1579-86, (2019).
14- J.S. and I.S. Grills Parzen, "Intensity-Modulated Radiation Therapy and Volumetric Modulated Arc Therapy for Lung Cancer, in Advances in Radiation Oncology in Lung Cancer. Springer." pp. 1021-47, (2022).
15- R. Mohamed, et al., "Factors Affecting Isocenter Displacement and Planning Target Volume Margin for Patients With Rectal Cancer Receiving Radiation Therapy." Advances in Radiation Oncology, Vol. 7 (No. 6), p. 101060, (2022).
16- B.H. and O. Elmas Bakkal, "Dosimetric comparison of organs at risk in 5 different radiotherapy plans in patients with preoperatively irradiated rectal cancer." Medicine, Vol. 100 (No. 1), p. e24266, (2021).
17- M. Yu, et al., "Dosimetric evaluation of Tomotherapy and four-box field conformal radiotherapy in locally advanced rectal cancer." Radiation oncology journal, Vol. 31 (No. 4), p. 252, (2013).
18- T. Gevaert, et al. " Implementation of HybridArc treatment technique in preoperative radiotherapy of rectal cancer: dose patterns in target lesions and organs at risk as compared to helical Tomotherapy and RapidArc." Radiation Oncology, Vol. 7pp. 1-7, (2012).
19- C. Cozzarini, et al., "Hypofractionated adjuvant radiotherapy with helical Tomotherapy after radical prostatectomy: Planning data and toxicity results of a Phase I–II study " Radiotherapy and Oncology, Vol. 88 (No. 1), pp. 26-33, (2008).
20- F. Jin, Y. Wang, and Y. Wu, "A novel correction factor based on extended volume to complement the conformity index." The British journal of radiology, Vol. 85 (No. 1016), pp. 523-29, (2012).
21- Xu Y Yan L, Chen X, Xie X, Liang B, Dai J, "A new homogeneity index definition for evaluation of radiotherapy plans." Journal of applied clinical medical physics, Vol. 20 (No. 11), pp. 50-6, (2019).
22- T. Kataria, et al., "Homogeneity Index: An objective tool for assessment of conformal radiation treatments." Journal of medical physics, Vol. 37 (No. 4), pp. 207-13, (2012).
23- Reitz B Semenenko VA, Day E, Qi XS, Miften M, Li XA, "Evaluation of a commercial biologically based IMRT treatment planning system." Medical physics, Vol. 35 (No. 12), pp. 5851-60, (2008).
24- Mohan R Wu Q, Morris M, Lauve A, Schmidt-Ullrich R., "Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results." International Journal of Radiation Oncology* Biology* Physics, Vol. 56 (No. 2), pp. 573-85, (2003).
25- X. Gu, X. Jia, and S.B. Jiang, , "GPU-based fast gamma index calculation." Physics in Medicine & Biology, Vol. 56 (No. 5), p. 1431, (2011).
26- M. Hussein, C. Clark, and A. Nisbet, "Challenges in calculation of the gamma index in radiotherapy–towards good practice." Physica Medica, Vol. 36pp. 1-11, (2017).
27- Koide Y Shimizu H, Sasaki K, Watanabe Y, Haimoto S, Aoyama T, Tachibana H, Iwata T, Kitagawa T, Kodaira T., "Dosimetric analysis on computed tomography myelography based treatment planning in stereotactic body radiotherapy for spinal metastases " Medical Dosimetry, Vol. 48 (No. 3), pp. 187-92, (2023 Sep 1).
28- Kim JK Choi Y, Lee HS, Hur WJ, Hong YS, Park S, Ahn K, Cho H., "Influence of intravenous contrast agent on dose calculations of intensity modulated radiation therapy plans for head and neck cancer." Radiotherapy and oncology Vol. 81 (No. 2), pp. 158-62, (2006 Nov ).
29- Chen JH Li HS, Zhang W, Shang DP, Li BS, Sun T, Lin XT, Yin Y., "Influence of intravenous contrast medium on dose calculation using CT in treatment planning for oesophageal cancer." Asian Pacific Journal of Cancer Prevention, Vol. 14 (No. 1609-14), 3, (2013).
30- H. Jing, et al., "Oral contrast agents lead to underestimation of dose calculation in volumetric-modulated arc therapy planning for pelvic irradiation." Chinese Medical Journal, Vol. 133 (No. 17), pp. 2061-70, (2020).
31- R. Bhaskaran, et al., , "Comparison of dose volumetric parameters of oesophagus in the radiation treatment of carcinoma breast with and without oesophagus delineation." Journal of Radiotherapy in Practice, Vol. 22(2023).
32- AlMohsen S Elawadi AA, AlGendy R, Allazkani H, Mohamed RA, AlAssaf H, Nisbet A, Alshanqity M, "The effect of contrast agents on dose calculations of volumetric modulated arc radiotherapy plans for critical structures." Applied Sciences , Vol. 11 (No. 18), p. 8355, (2021 ).
33- H. Jing, et al., "Oral contrast agents lead to underestimation of dose calculation in volumetric-modulated arc therapy planning for pelvic irradiation." Chinese Medical Journal, Vol. 133 (No. 17), pp. 2061-70, (2020).
34- M. Werner-Wasik, et al., "Radiation dose-volume effects in the esophagus." International Journal of Radiation Oncology* Biology* Physics, Vol. 76 (No. 3), pp. 86-93, (2010).
35- S. Pawiro, A. Azzi, and D. Soejoko, "A Monte Carlo study of photon beam characteristics on various linear accelerator filters." Journal of Biomedical Physics & Engineering, Vol. 10 (No. 613), p. 5, (2020).
36- Mikaeil M Nasrollah J, Omid E, Mojtaba SS, Ahad Z., " Influence of the intravenous contrast media on treatment planning dose calculations of lower esophageal and rectal cancers." Journal of cancer research and therapeutics, Vol. 10 (No. 1), pp. 147-52, (2014 Jan ).
37- Liu C Shi W, Lu B, Yeung A, Newlin HE, Amdur RJ, Olivier KR., "The effect of intravenous contrast on photon radiation therapy dose calculations for lung cancer." American journal of clinical oncology, Vol. 33 (No. 2), pp. 153-6, (2010).
38- Naruse A Shibamoto Y, Fukuma H, Ayakawa S, Sugie C, Tomita N. , "Influence of contrast materials on dose calculation in radiotherapy planning using computed tomography for tumors at various anatomical regions: a prospective study." Radiotherapy and Oncology, Vol. 84 (No. 1), pp. 52-5, (2007 ).
39- Rowbottom CG Burridge NA, Burt PA. Effect of contrast‐enhanced CT scans on heterogeneity corrected dose computations in the lung, Journal of Applied Clinical Medical Physics, Vol. 7 (No. 4), pp. 1-2, (2006 ).
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| Tomotherapy; Rectal Cancer Contrast Media Radiotherapy Planning Dosimetry | ||
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How to Cite
1.
Tabatabayi F, Eghdam-Zamiri R, Molazadeh M, Mortezazadeh T, Kargar N. The Effect of Injected and Oral Computed Tomography Contrast Agent on Helical Tomotherapy Dose Calculating in Rectal Cancer. Frontiers Biomed Technol. 2025;.
