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Purpose: We report the clinical outcomes of patients with soft tissue sarcomas (STS) arising in extremities treated with image-guided intensity modulated radiotherapy (IG-IMRT) at our institute. Local control of the tumors treated with RT was the primary end point of this study. Analyzing overall survival and long-term toxicities were the secondary objectives., Methods and Materials: The database of the patients with STS who received wide local excision and IG-IMRT at our institution from January 2012 to December 2020 was reviewed. Radiation was offered either preoperatively or postoperatively as part of multi-modality treatment., Results: Thirty-three consecutive patients were identified and included for analysis. Twenty-eight patients (84.8%) received postoperative adjuvant radiotherapy. Dedicated MRI simulation studies were performed in 31 patients (93.9%) in the treatment position. RapidArc IMRT technique was used in 31 patients (93.9%). A total of 2954 images were acquired during 991 treatment sessions. Errors exceeding 1 mm in the x, y and z directions were corrected online before the treatment. With a median follow-up of 36 months, two patients (6.1%) developed local recurrence. The 3-year local control was 90.9% (95% CI, 0.76 - 0.98), and the 5-year overall survival was 71.7% (95% CI, 0.44 - 0.88). One patient (3.03%) sustained a pathological fracture during the follow-up period., Conclusion: Our results showed that IMRT with daily imaging offered excellent local control with acceptable long-term toxicity, as well as being feasible and practical to implement in our routine clinical practice., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: It is imperative to spare functioning kidneys from high radiation doses when they are near enough to radiotherapy (RT) target volumes in patients with polycystic kidney disease (PKD). To achieve this intent, we designed the unique approach that we report here., Methods and Materials: The patient who has PKD, presented with B-cell lymphoma involving paraaortic lymph nodes. After completing chemotherapy, RT was planned to the residual nodal disease. The diagnostic positron emission tomography computed tomography (PETCT) scan was fused with the RT planning CT scan. 18F-2-deoxy-2(F)-fluro-d-glucose (FDG) avid active kidneys were contoured separately, and the treatment plan was optimized to avoid these volumes., Results: The functional volume was 17.52% of the right kidney whereas it was 7.44% of the left. The mean doses were 4.61 Gy and 4.2 Gy, respectively. The baseline estimated glomerular filtration rate (eGFR) was >60 mL/min; at 18 months follow-up, it was 62 mL/min., Conclusions: Delineation of functional nephrons was feasible while utilizing the staging FDG-PETCT scan for radiotherapy contouring in our patient, which aided to achieve the optimal dose-volume constraints. Further studies are warranted to analyze and quantify the benefit of this easily accessible method in the future., (Copyright © 2022. Published by Elsevier Ltd.)

Objective: To develop a method for the assessment and characterization of 3D geometric distortion as part of routine quality assurance for MRI scanners commissioned for Radiation Therapy planning., Materials and Methods: In this study, the in-plane and through-plane geometric distortions on a 1.5T GE MRI-SIM unit are characterized and the 2D and 3D correction algorithms provided by the vendor are evaluated. We used a phantom developed by GE Healthcare that covers a large field of view of 500mm, and consists of layers of foam embedded with a matrix of ellipsoidal markers. An in-house Java-based software module was developed to automatically assess the geometric distortion by calculating the center of each marker using the center of mass method, correcting of gross rotation errors and comparing the corrected positions with a CT gold standard data set. Spatial accuracy of typical pulse sequences used in RT planning was assessed (2D T1/T2 FSE, 3D CUBE, T1 SPGR) using the software. The accuracy of vendor specific geometric distortion correction (GDC) algorithms was quantified by measuring distortions before and after the application of the 2D and 3D correction algorithms., Results: Our algorithm was able to accurately calculate geometric distortion with sub-pixel precision. For all typical MR sequences used in Radiotherapy, the vendor's GDC was able to substantially reduce the distortions. Our results showed also that the impact of the acquisition produced a maximum variation of 0.2mm over a radial distance of 200mm. It has been shown that while the 2D correction algorithm remarkably reduces the in-plane geometric distortion, 3D geometric distortion further reduced the geometric distortion by correcting both in-plane and through-plane distortions in all acquisitions., Conclusion: The presented methods represent a valuable tool for routine quality assurance of MR applications that require stringent spatial accuracy assessment such as radiotherapy. The phantom used in this study provides three dimensional arrays of control points. These tools and the detailed results can be also used for developing new geometric distortion correction algorithms or improving the existing ones., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: To develop and validate a large field of view phantom and quality assurance software tool for the assessment and characterization of geometric distortion in MRI scanners commissioned for radiation therapy planning., Materials and Methods: A purpose built phantom was developed consisting of 357 rods (6mm in diameter) of polymethyl-methacrylat separated by 20mm intervals, providing a three dimensional array of control points at known spatial locations covering a large field of view up to a diameter of 420mm. An in-house software module was developed to allow automatic geometric distortion assessment. This software module was validated against a virtual dataset of the phantom that reproduced the exact geometry of the physical phantom, but with known translational and rotational displacements and warping. For validation experiments, clinical MRI sequences were acquired with and without the application of a commercial 3D distortion correction algorithm (Gradwarp™). The software module was used to characterize and assess system-related geometric distortion in the sequences relative to a benchmark CT dataset, and the efficacy of the vendor geometric distortion correction algorithms (GDC) was also assessed., Results: Results issued from the validation of the software against virtual images demonstrate the algorithm's ability to accurately calculate geometric distortion with sub-pixel precision by the extraction of rods and quantization of displacements. Geometric distortion was assessed for the typical sequences used in radiotherapy applications and over a clinically relevant 420mm field of view (FOV). As expected and towards the edges of the field of view (FOV), distortion increased with increasing FOV. For all assessed sequences, the vendor GDC was able to reduce the mean distortion to below 1mm over a field of view of 5, 10, 15 and 20cm radius respectively., Conclusion: Results issued from the application of the developed phantoms and algorithms demonstrate a high level of precision. The results indicate that this platform represents an important, robust and objective tool to perform routine quality assurance of MR-guided therapeutic applications, where spatial accuracy is paramount., (Copyright © 2015 Elsevier Inc. All rights reserved.)