Geoffrey D Hugo

Geoffrey D Hugo
Washington University in St. Louis | WUSTL , Wash U · Department of Radiation Oncology

Ph.D.

About

226
Publications
8,597
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
2,349
Citations

Publications

Publications (226)
Article
Purpose: Disparities in radiation oncology (RO) can be attributed to geographic location, socioeconomic status, race, sex, and other societal factors. One potential solution is to implement a fully mobile (FM) RO system to bring radiotherapy to rural areas and reduce barriers to access. We use Monte Carlo simulation to quantify techno-economic fea...
Article
Purpose/Objective(s) Care coordination for inpatients requiring palliative radiotherapy remains a challenge. One such challenge is timely CT simulation. Previously published data demonstrate that rapid radiotherapy delivery is associated with improved patient satisfaction and reduced duration of hospitalization. The purpose of this study was to ass...
Article
Purpose/Objective(s) Disparities in radiation oncology (RO) care exist, in part, due to geographic barriers in access to care. A first step to mitigate these barriers is the development of a semi-mobile RO system for single-facility, temporary care (∼months), which has been successfully implemented in several locations across the United States. To...
Article
Purpose/Objective(s) Planning on diagnostic scans may eliminate the need for simulation while reducing wait times for palliative patients. The purpose of this retrospective study is to determine the fidelity of the radiation planned versus delivered in simulation-free palliative radiotherapy (SF-RT). Materials/Methods 28 palliative patients receiv...
Article
Purpose/Objective(s) Noninvasive cardiac radioablation (CRA) is increasingly used for treatment of high-risk ventricular tachycardia (VT). In an effort to promote consistency and disseminate best practices learned from our experience and that of other centers, we developed a remote education and peer review program via our Center for Noninvasive Ca...
Article
Purpose/Objective(s) The RO-APM will trial an episode-based payment schema over a five-year period starting in 2022. Practices were randomly selected for mandatory inclusion in the RO-APM. Participating departments have different case mixes, patients, and clinical practices that will dictate the relative impact of the RO-APM. It is our aim to creat...
Article
Purpose Widespread implementation of automated treatment planning in radiation therapy remains elusive due to variability in clinic and physician preferences making it difficult to ensure consistent plan parameters. We have developed an open-source class library with the aim to improve efficiency and consistency for automated treatment planning in...
Article
Full-text available
Purpose: Ethos adaptive radiotherapy (ART) is emerging with AI-enhanced adaptive planning and high-quality cone-beam computed tomography (CBCT). Although a respiratory motion management solution is critical for reducing motion artifacts on abdominothoracic CBCT and improving tumor motion control during beam delivery, our institutional Ethos system...
Article
Purpose: To develop and evaluate deep learning based auto-segmentation of cardiac substructures from non-contrast planning computed tomography (CT) images in patients undergoing breast cancer radiotherapy and to investigate the algorithm sensitivity to out-of-distribution data such as CT image artifacts. Methods: Nine substructures including Aor...
Article
During the last decade, radiation oncology departments have integrated MRI equipment, procedures, and expertise into their practices. MRI safety is an important consideration since a large percentage of patients receiving radiation therapy have histories of multiple surgeries and implanted devices. However, MRI safety guidelines and workflows were...
Article
Purpose: Noninvasive cardiac radioablation is increasingly used for treatment of refractory ventricular tachycardia. Attempts to limit normal tissue exposure are important, including managing motion of the target. An interplay between cardiac and respiratory motion exists for cardiac radioablation, which has not been studied in depth. The objectiv...
Article
Full-text available
The past decade has seen the increasing integration of magnetic resonance (MR) imaging into radiation therapy (RT). This growth can be contributed to multiple factors, including hardware and software advances that have allowed the acquisition of high‐resolution volumetric data of RT patients in their treatment position (also known as MR simulation)...
Article
Purpose: To characterize the shielding design and leakage radiation from a newly released ring gantry linac (Halcyon, Varian Medical Systems). Methods: To assess the radiation leakage surrounding headshield and the radiation level after the beam stopper, measurements were made with GafChromic films. To evaluate the in-room radiation levels, the...
Article
Full-text available
The not-for-profit organization La LIGA Nacional Contra el Cáncer, with its hospital Instituto de Cancerología (INCAN), is responsible for cancer treatment of much of the indigent population in Guatemala, a country with a population of 16 million. Annually, approximately 70% of patients at INCAN are seen in late stages of cancer, which places a gre...
Article
Full-text available
Purpose: To develop an efficient and automated methodology for beam data validation for a preconfigured ring gantry linear accelerator using scripting and a one-dimensional (1D) tank with automated couch motions. Materials and methods: Using an application programming interface, a program was developed to allow the user to choose a set of beam d...
Article
Full-text available
Purpose: To perform a comprehensive validation of plans generated on a preconfigured Halcyon 2.0 with preloaded beam model, including evaluations of new features and implementing the patient specific quality assurance (PSQA) process with multiple detectors. Methods: A total of 56 plans were generated in Eclipse V15.6 (Varian Medical System) with...
Article
Full-text available
Background and Purposes: The COVID-19 pandemic has placed an increased importance on physical distancing to minimize the risk of transmission in radiation oncology departments. The pandemic has also increased the use of hypo-fractionated treatment schedules where MR-guided online adaptive radiotherapy (ART) can aid in dose escalation. This speciali...
Preprint
Full-text available
INTRODUCTION: During the COVID-19 pandemic, alternative methods of care are needed to reduce the relative risk of transmission in departments. Also needed is the ability to provide vital radiation oncological care if radiation oncologists (RO) are reallocated to other departments. We implemented a novel remote RO SBRT coverage practice, requiring i...
Article
Full-text available
Introduction During the COVID-19 pandemic, alternative methods of care are needed to reduce the relative risk of transmission in departments. Also needed is the ability to provide vital radiation oncological care if radiation oncologists (RO) are reallocated to other departments. We implemented a novel remote RO SBRT coverage practice, requiring it...
Article
Full-text available
Purpose To test the feasibility of a simplified, robust, workflow for intracranial stereotactic radiation therapy (SRT) using a ring gantry linear accelerator (RGLA) equipped with a dual-layer stacked, staggered, and interdigitating multileaf collimator. Materials and Methods Twenty recent clinical SRT cases treated using a radiosurgery c-arm line...
Article
We develop a fully automated QA process to compare the image quality of all kV CBCT protocols on a Halcyon linac with ring gantry design, and evaluate image quality stability over a 10-month period. A total of 19 imaging scan and reconstruction protocols were characterized with measurement on a newly released QUART phantom. A set of image analysis...
Article
Purpose: To evaluate the Combatting Batch effect (ComBat) harmonization algorithm's ability to reduce the variation in radiomic features arising from different imaging protocols and independently verify published results. Methods: The Gammex computed tomography (CT) electron density phantom and Quasar body phantom were imaged using 32 different...
Article
Purpose: Ring gantry radiotherapy devices are often limited to deliver beams in the axial plane, severely limiting beam entrance angles and rendering non-coplanar beam delivery impossible. However, a ring gantry geometry greatly simplifies delivery machines and increases the efficiency of treatment with the potential to decrease the overall costs...
Article
Full-text available
Background: This study intends to develop an efficient field-in-field (FiF) planning technique with the Eclipse treatment planning system (TPS) to determine the feasibility of using the Halcyon treatment delivery system for 3D treatment of breast cancer. Methods: Ten treatment plans were prepared on the Halcyon treatment planning system and comp...
Article
Purpose: To develop and evaluate a method to automatically identify and quantify deformable image registration (DIR) errors between lung CT scans for quality assurance purposes. Methods: We propose a deep learning method to ag registration errors. The method involves preparation of a dataset for machine learning model training and testing, desig...
Article
Full-text available
Purpose: Superficial dose is an important parameter in breast cancer radiation therapy. When treated with conventional linacs, bolus is commonly applied to improve target coverage near the surface while also managing the risk of severe skin reactions and negative cosmesis. With the introduction of modern linacs with 6X flattening filter free (FFF)...
Article
Adaptive radiotherapy emerged over 20 years ago and is now an established clinical practice in a number of organ sites. No one solution for adaptive therapy exists. Rather, adaptive radiotherapy is a process which combines multiple tools for imaging, assessment of need for adaptation, treatment planning, and quality assurance of this process. Workf...
Article
Purpose: Currently 4D cone-beam CT (CBCT) requires a 3-4 minute full-fan scan to ensure usable image quality. Recent advancements in sparse-view 4D-CBCT reconstruction have opened the possibility to reduce scan time and dose. The aim of this study is to provide a common framework for systematically evaluating algorithms for 4D-CBCT reconstruction...
Article
To evaluate the repeatability of MRI and CT derived texture features and to investigate the feasibility of use in predictive single and multi-modality models for radiotherapy of non-small cell lung cancer, 59 texture features were extracted from unfiltered and wavelet filtered images. Repeatability of test-retest features from helical 4D CT scans,...
Article
Purpose: A prospective phase 1/2 trial for electrophysiologic guided noninvasive cardiac radioablation treatment of ventricular tachycardia (ENCORE-VT) demonstrating efficacy for arrhythmia control has recently been reported. The treatment workflow, report dose-volume metrics, and overall process improvements are described here. Methods and mater...
Article
Purpose: This study aims to characterize the performance of a prototype rapid kilovoltage (kV) x-ray image guidance system onboard the newly released Halcyon 2.0 linear accelerator (Varian Medical Systems, Palo Alto, CA) by use of conventional and innovatively designed testing procedures. Methods: Basic imaging system performance tests and radia...
Article
Background: Case studies have suggested the efficacy of catheter-free, electrophysiology-guided noninvasive cardiac radioablation for ventricular tachycardia (VT) using stereotactic body radiation therapy, although prospective data are lacking. Methods: We conducted a prospective phase I/II trial of noninvasive cardiac radioablation in adults wi...
Article
Purpose: To develop a quality control method to improve the accuracy of corresponding landmark sets used for deformable image registration (DIR) evaluation in the lung parenchyma. Methods: An iterative workflow was developed as a method for quality assurance of landmark sets. Starting with the initial landmark set for a given image pair, a landm...
Article
Background: Radiographic radiation induced lung injury (RILI) is frequently observed after stereotactic body radiotherapy (SBRT). Models of radiographic change can identify patient risk factors that predict clinical toxicity. We examined the association between radiographic lung changes and lung tissue dose-density response over time with clinical...
Article
Purpose: To demonstrate the feasibility of using a purely data-driven, a posteriori respiratory motion modeling and reconstruction compensation method to improve 4D-CBCT image quality under clinically relevant image acquisition conditions. Methods: Evaluated workflows that utilized a combination of groupwise deformable image registration and mot...
Article
Full-text available
Purpose Radiographic lung changes after stereotactic body radiation therapy (SBRT) vary widely between patients. Standardized descriptions of acute (≤6 months after treatment) and late (>6 months after treatment) benign lung changes have been proposed but the reliable application of these classification systems has not been demonstrated. Herein, we...
Article
Background: The impact of radiation dose to the heart in early-stage lung cancer patients treated with definitive stereotactic body radiation therapy (SBRT) is not well known. We, therefore, analyzed whether higher radiation dose to the heart would lead to an increase in cardiac toxicity and overall mortality. Methods: Seventy-four patients with...
Article
Purpose: Locally-advanced non-small cell lung cancer (NSCLC) patients may experience dramatic changes in anatomy during radiotherapy and could benefit from adaptive radiotherapy (ART). Deformable image registration (DIR) is necessary to accurately accumulate dose during plan adaptation, but current algorithms perform poorly in the presence of larg...
Conference Paper
In this paper, a method that detects an image-based respiratory signal automatically in Cone Beam Computed Tomography (CBCT) projection datasets is proposed. The proposed Intensity Flow Dimensionality Reduction method (IFDR) uses optical flow tracking to estimate a set of dense intensity flow vectors from every adjacent pair of projections in the p...
Article
Full-text available
Purpose: Radiographic lung changes after stereotactic body radiation therapy (SBRT) vary widely between patients. Standardized descriptions of acute (≤6 months after treatment) and late (>6 months after treatment) benign lung changes have been proposed but the reliable application of these classification systems has not been demonstrated. Herein, w...
Article
Purpose: To evaluate potential organ at risk dose-sparing by using dose-mass-histogram (DMH) objective functions compared with dose-volume-histogram (DVH) objective functions. Methods: Treatment plans were retrospectively optimized for 10 locally advanced non-small cell lung cancer patients based on DVH and DMH objectives. DMH-objectives were th...
Article
Purpose: 4D cone-beam CT (CBCT) has potential applications in soft tissue alignment and tumor motion verification at the time of radiation treatment. However, prominent streak artifacts with conventional image reconstructions have limited its clinical use and alternative reconstructions are generally too computationally expensive for the time avai...
Article
Purpose Target delineation in lung cancer radiotherapy using CT and/or PET-CT is affected by large variability. MRI has excellent soft tissue visualization and better spatial resolution than PET-CT. The main purpose of this study is to analyze delineation variability for lung cancer using MRI. Methods and materials Seven physicians delineated the...
Article
Accurate sorting of beam projections is important in four-dimensional Cone Beam Computed Tomography (4D CBCT) to improve the quality of the reconstructed 4D CBCT image by removing motion-induced artifacts. We propose Image Registration-based Projection Binning (IRPB), a novel marker-less binning method for 4D CBCT projections, which combines Intens...
Article
Purpose To investigate the hypothesis that positional and anatomic variations during radiation therapy induce changes in lung and heart volumes and associated radiation doses. Methods and Materials In this longitudinal investigation, variations in lung and heart volumes and standard dose parameters of mean lung dose, lung V20Gy, mean heart dose, a...