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Goodall SK, Rampant PL. Initial end-to-end testing of the ExacTrac dynamic deep inspiration breath hold workflow using a breath hold breast phantom. Phys Eng Sci Med 2023; 46:1239-1247. [PMID: 37349630 PMCID: PMC10480281 DOI: 10.1007/s13246-023-01291-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 06/16/2023] [Indexed: 06/24/2023]
Abstract
ExacTrac Dynamic (ETD) provides a Deep Inspiration Breath Hold (DIBH) workflow for breast patients. Stereoscopic x-ray imaging combined with optical and thermal mapping allows localisation against simulation imaging, alongside surface guided breath hold monitoring. This work aimed to determine appropriate imaging parameters, the optimal Hounsfield Unit (HU) threshold for patient contour generation and workflow evaluation via end-to-end (E2E) positioning using a custom breast DIBH phantom. After localisation via existing Image Guidance (IG), stereoscopic imaging was performed with a range of parameters to determine best agreement. Similarly, residual errors in prepositioning were minimised using a range of HU threshold contours. E2E positioning was completed for clinical workflows allowing residual isocentre position error measurement and existing IG comparison. Parameters of 60 kV and 25mAs were determined appropriate for patient imaging and HU thresholds between -600 HU and -200 HU enabled adequate prepositioning. The average and standard deviation in residual isocentre position error was 1.0 ± 0.9 mm, 0.4 ± 1.0 mm and 0.1 ± 0.5 mm in the lateral, longitudinal and vertical directions, respectively. Errors measured using existing IG were -0.6 ± 1.1 mm, 0.5 ± 0.7 mm and 0.2 ± 0.4 mm in the lateral, longitudinal and vertical directions, and 0.0 ± 1.0o, 0.5 ± 1.7o and -0.8 ± 1.8o for pitch roll and yaw. The use of bone weighted matching increased residual error, while simulated reduction of DIBH volume maintained isocentre positioning accuracy despite anatomical changes. This initial testing indicated suitability for clinical implementation during DIBH breast treatments.
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Affiliation(s)
- Simon K Goodall
- School of Physics, Mathematics, and Computing, Faculty of Engineering and Mathematical Sciences, University of Western Australia, Crawley, WA, 6009, Australia.
- GenesisCare, 24 Salvado Road, Wembley, WA, 6014, Australia.
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Bolderston A, Brydon M. Letter in response to Laing et al., "An evaluation of radiation therapy patient body mass index trends and potential impact on departmental resource planning". J Med Radiat Sci 2023. [PMID: 37182908 DOI: 10.1002/jmrs.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023] Open
Abstract
"An evaluation of radiation therapy patient body mass index trends and potential impact on departmental resource planning" by Laing et al. The authors' comment that research into the experiences of larger bodied patients should focus on compassionately improving care for this patient population rather than framing large-bodied patients as a burden or problem, and should include commentary on the effects of weight-bias in the healthcare system.
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Laing B, Caldwell P, Vincent D, Rattray G. An evaluation of radiation therapy patient body mass index trends and potential impact on departmental resource planning. J Med Radiat Sci 2023. [PMID: 36703595 DOI: 10.1002/jmrs.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Radiation therapy (RT) offers a less invasive management option for bariatric cancer patients. As the proportion of Australians categorised overweight or obese approaches 70%, it is not well understood how this growth will impact RT departments. The aim of this study was to evaluate the current and potential future body mass index (BMI) of RT patients at one centre, with the purpose of identifying variables that may impact resource planning decisions. METHODS De-identified demographic data including gender, age, diagnosis code, activity code and BMI were obtained from MOSAIQ® oncology information system for 5548 courses of RT commenced between 2017 and 2020, and retrospectively analysed. Descriptive statistics were used to summarise the data. Simple and multiple linear regression was used to analyse for statistically significant relationships between variables. RESULTS Of all patient courses, 64% were overweight or obese. Average BMI increased over time by 0.3 kg/m2 per year. Courses related to the young and elderly had a lower average BMI. Breast, brain/skull, and pelvis/prostate treatment sites had a significant association with a higher average BMI. Thorax treatment sites had a lower average BMI, but this average is increasing at the fastest rate of all treatment sites. Prone breast courses had an average BMI 5.58 kg/m2 higher than IMRT/VMAT courses. CONCLUSION Results demonstrate that patient BMI is increasing. Resources related to breast courses (breast board, prone board) and thorax courses (lung board) may experience increased strain in the future. Modifications to department workflow and scheduling are likely required. Further research into staffing implications is recommended.
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Affiliation(s)
- Branagh Laing
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.,Cancer Care Services, Department of Radiation Oncology, Royal Brisbane & Women's Hospital, Butterfield Street, Herston, Queensland, Australia
| | - Peter Caldwell
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Debra Vincent
- Cancer Care Services, Department of Radiation Oncology, Royal Brisbane & Women's Hospital, Butterfield Street, Herston, Queensland, Australia
| | - Gregory Rattray
- Cancer Care Services, Department of Radiation Oncology, Royal Brisbane & Women's Hospital, Butterfield Street, Herston, Queensland, Australia
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4
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Gnerucci A, Esposito M, Ghirelli A, Pini S, Paoletti L, Barca R, Fondelli S, Alpi P, Grilli B, Rossi F, Scoccianti S, Russo S. Surface-guided DIBH radiotherapy for left breast cancer: impact of different thresholds on intrafractional motion monitoring and DIBH stability. Strahlenther Onkol 2023; 199:55-66. [PMID: 36229656 DOI: 10.1007/s00066-022-02008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/15/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare two left breast cancer patient cohorts (tangential vs. locoregional deep-inspiration breath-hold - DIBH treatment) with different predefined beam gating thresholds and to evaluate their impact on motion management and DIBH stability. METHODS An SGRT-based clinical workflow was adopted for the DIBH treatment. Intrafractional monitoring was performed by tracking both the respiratory signal and the real-time displacement between the isocenter on the daily reference surface and on the live surface ("SGRT shift"). Beam gating tolerances were 5 mm/4 mm for the SGRT shifts and 5 mm/3 mm for the gating window amplitude for breast tangential and breast + lymph nodes locoregional treatments, respectively. A total of 24 patients, 12 treated with a tangential technique and 12 with a locoregional technique, were evaluated for a total number of 684 fractions. Statistical distributions of SGRT shift and respiratory signal for each treatment fraction, for each patient treatment, and for the two population samples were generated. RESULTS Lateral cumulative distributions of SGRT shifts for both locoregional and tangential samples were consistent with a null shift, whereas longitudinal and vertical ones were slightly negative (mean values < 1 mm). The distribution of the percentage of beam on time with SGRT shift > 3 mm, > 4 mm, or > 5 mm was extended toward higher values for the tangential sample than for the locoregional sample. The variability in the DIBH respiration signal was significantly greater for the tangential sample. CONCLUSION Different beam gating thresholds for surface-guided DIBH treatment of left breast cancer can impact motion management and DIBH stability by reducing the frequency of the maximum SGRT shift and increasing respiration signal stability when tighter thresholds are adopted.
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Affiliation(s)
- A Gnerucci
- Department of Physics and Astronomy, University of Florence, Florence, Italy.
| | - M Esposito
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - A Ghirelli
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - S Pini
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
| | - L Paoletti
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - R Barca
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - S Fondelli
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - P Alpi
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - B Grilli
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - F Rossi
- Radiotherapy Unit, Azienda USL Toscana Sud Est, Grosseto, Italy
| | - S Scoccianti
- Radiotherapy Unit, Azienda USL Toscana Centro, Florence, Italy
| | - S Russo
- Medical Physics Unit, Azienda USL Toscana Centro, Florence, Italy
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Costin IC, Marcu LG. Factors impacting on patient setup analysis and error management during breast cancer radiotherapy. Crit Rev Oncol Hematol 2022; 178:103798. [PMID: 36031175 DOI: 10.1016/j.critrevonc.2022.103798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/28/2022] [Accepted: 08/21/2022] [Indexed: 12/24/2022] Open
Abstract
Radiotherapy is required to deliver an accurate dose to the tumor while protecting surrounding normal tissues. Breast cancer radiotherapy involves a number of factors that can influence patient setup and error management, including the immobilization device used, the verification system and the patient's treatment position. The aim of this review is to compile and discuss the setup errors that occur due to the above-mentioned factors. In view of this, a systematic search of the scientific literature in the Medline/PubMed databases was performed over the 1990-2021 time period, with 93 articles found to be relevant for the study. To be accessible to all, this study not only aims to identify factors impacting on patient setup analysis, but also seeks to evaluate the role of each verification device, board immobilization and position in influencing these errors.
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Affiliation(s)
- Ioana-Claudia Costin
- West University of Timisoara, Faculty of Physics, Timisoara, Romania; "Dr. Gavril Curteanu" County Hospital, Oradea 410469, Romania
| | - Loredana G Marcu
- West University of Timisoara, Faculty of Physics, Timisoara, Romania; Faculty of Informatics & Science, University of Oradea, Oradea 410087, Romania; Cancer Research Institute, University of South Australia, Adelaide, SA 5001, Australia.
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Lee HY, Yen YH, Tsai YL, Tu PC, Pu CM, Lin CH, Lui LT, Shaw S, Wu CJ, Nien HH. Critical Factors of Dose Distribution in Breast Cancer Tomotherapy With Metallic Port Breast Tissue Expander: Image Correction, Delivery Mode, and Volume Impact. Technol Cancer Res Treat 2022; 21:15330338221093148. [PMID: 35435772 PMCID: PMC9019329 DOI: 10.1177/15330338221093148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives: Breast reconstruction helps patients enhance their body image after mastectomy. Metallic ports in tissue expanders lead to dose attenuation during radiotherapy. Tissue expander volume shifts the metallic port position, possibly causing various dose alterations. This study aimed to evaluate the impact of the MAGNA-SITETM tissue expander volume on tomotherapy. Methods: Boluses and MAGNA-SITETM were placed on a Rando phantom to simulate the tissue expander under the pectoralis major. Computed tomography simulation images were transformed through replacing the electron density of (a) metallic artifact region only (Image metallic port) and (b) metallic port and artifact regions (Image Homo). Planning was calculated using fixed-beam and helical-mode techniques. Radiation was delivered with different volumes of the tissue expander. Results: Integrated 997 dose points were calculated. Planning with Image metallic port provided a calculated dose significantly closer to a realistic dose. The percentage of doses achieving the prescribed dose was significantly higher in the helical mode. In layer 2, the 100-mL tissue expander had a significantly lower measurement dose than all other volumes. Volume 150 mL had the highest increase in the measured dose difference from the plan dose at layer 2. Volume 250 mL had the highest percentage of measurement doses passing the 5% dose difference from plan dose. The coldest dose areas were noted in layers 1 and 2, especially in the metallic port–direct image mode. The average dose reduction of the measured cold areas was 6.03 ± 1.94%. Conclusion: Dose distribution was affected by the volume of the metallic port tissue expander. Tomotherapy with proper image heterogeneity correction and helical mode can reduce the attenuation from the metallic port. A tissue expander volume of 150 to 250 mL is suitable. Patients with high risk at the chest wall should be evaluated carefully to avoid underdosing. Radiation oncologists should closely cooperate with plastic surgeons to optimize treatment for each patient.
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Affiliation(s)
- Hsing-Yi Lee
- Department of Radiation Oncology, Oncology Treatment Center, 124851Sijhih Cathay General Hospital, New Taipei City, Taiwan
| | - Yu-Hsiu Yen
- Division of Plastic Surgery, Department of Surgery, 60616Cathay General Hospital, Taipei, Taiwan.,School of Medicine, 34903Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Lun Tsai
- Department of Radiation Oncology, 60616Cathay General Hospital, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, College of Public Health, 33561National Taiwan University, Taipei, Taiwan
| | - Pei-Chih Tu
- Department of Radiation Oncology, Oncology Treatment Center, 124851Sijhih Cathay General Hospital, New Taipei City, Taiwan
| | - Chi-Ming Pu
- Division of Plastic Surgery, Department of Surgery, 60616Cathay General Hospital, Taipei, Taiwan.,School of Medicine, 34903Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chia-Hong Lin
- Department of Radiation Oncology, Oncology Treatment Center, 124851Sijhih Cathay General Hospital, New Taipei City, Taiwan
| | - Louis Tak Lui
- Department of Radiation Oncology, Oncology Treatment Center, 124851Sijhih Cathay General Hospital, New Taipei City, Taiwan.,Department of Radiation Oncology, 60616Cathay General Hospital, Taipei, Taiwan
| | - Suzun Shaw
- Department of Radiation Oncology, Oncology Treatment Center, 124851Sijhih Cathay General Hospital, New Taipei City, Taiwan.,Department of Radiation Oncology, 60616Cathay General Hospital, Taipei, Taiwan
| | - Ching-Jung Wu
- Department of Radiation Oncology, Oncology Treatment Center, 124851Sijhih Cathay General Hospital, New Taipei City, Taiwan.,Department of Radiation Oncology, 60616Cathay General Hospital, Taipei, Taiwan.,Department of Radiation Oncology, National Defense Medical Center, Taipei, Taiwan.,Department of Biomedical Engineering, I-Shou University, Kaohsiung, Taiwan
| | - Hsin-Hua Nien
- School of Medicine, 34903Fu Jen Catholic University, New Taipei City, Taiwan.,Department of Radiation Oncology, 60616Cathay General Hospital, Taipei, Taiwan.,Institute of Biomedical Engineering, College of Electrical and Computer Engineering, 34914National Yang Ming Chiao Tung University, Hsinchu, Taiwan
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Dong F, Weng X, Deng X, Yang Y, Xu B, Li X. Clinical utility of a new immobilization method in image-guided intensity-modulated radiotherapy for breast cancer patients after radical mastectomy. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:641-655. [PMID: 35367978 DOI: 10.3233/xst-221127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate clinical utility of a new immobilization method in image-guided intensity-modulated radiotherapy (IMRT) for breast cancer patients after radical mastectomy. MATERIALS AND METHODS Forty patients with breast cancer who underwent radical mastectomy and postoperative IMRT were prospectively enrolled. The patients were randomly and equally divided into two groups using both a carbon-fiber support board and a hollowed-out cervicothoracic thermoplastic mask (Group A) and using only the board (Group B). An iSCOUT image-guided system was used for acquiring and correcting pretreatment setup errors for each treatment fraction. Initial setup errors and residual errors were obtained by aligning iSCOUT images with digitally reconstructed radiograph (DRR) images generated from planning CT. Totally 600 initial and residual errors were compared and analyzed between two groups, and the planning target volume (PTV) margins before and after the image-guided correction were calculated. RESULTS The initial setup errors of Group A and Group B were (3.14±3.07), (2.21±1.92), (2.45±1.92) mm and (3.14±2.97), (2.94±3.35), (2.80±2.47) mm in the left-right (LAT), superior-inferior (LONG), anterior-posterior (VERT) directions, respectively. The initial errors in Group A were smaller than those in Group B in the LONG direction (P < 0.05). No significant difference was found in the distribution of three initial error ranges (≤3 mm, 3-5 mm and > 5 mm) in each of the three translational directions for the two groups (P > 0.05). The residual errors of Group A and Group B were (1.74±1.03), (1.62±0.92), (1.66±0.91) mm and (1.70±0.97), (1.68±1.18), (1.58±0.98) mm in the three translational directions, respectively. No significant difference was found in the residual errors between two groups (P > 0.05). With the image-guided correction, PTV margins were reduced from 8.01, 5.44, 5.45 mm to 3.54, 2.99, 2.89 mm in three translational directions of Group A, respectively, and from 8.14, 10.89, 6.29 mm to 2.67, 3.64, 2.74 mm in those of Group B, respectively. CONCLUSION The use of hollowed-out cervicothoracic thermoplastic masks combined with a carbon-fiber support board showed better inter-fraction immobilization than the single use of the board in reducing longitudinal setup errors for breast cancer patients after radical mastectomy during IMRT treatment course, which has potential to reduce setup errors and improve the pretreatment immobilization accuracy for breast cancer IMRT after radical mastectomy.
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Affiliation(s)
- Fangfen Dong
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
| | - Xing Weng
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
| | - Xianzhi Deng
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Yong Yang
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
| | - Benhua Xu
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
| | - Xiaobo Li
- College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
- Fujian Key Laboratory of Intelligent Imaging and Precision Radiotherapy for Tumors (Fujian Medical University), Fuzhou, China
- Clinical Research Center for Radiology and Radiotherapy of Fujian Province (Digestive, Hematological and Breast Malignancies), Fuzhou, China
- Department of Engineering Physics, Tsinghua University, Beijing, China
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8
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Borm KJ, Junker Y, Düsberg M, Devečka M, Münch S, Dapper H, Oechsner M, Combs SE. Impact of CBCT frequency on target coverage and dose to the organs at risk in adjuvant breast cancer radiotherapy. Sci Rep 2021; 11:17378. [PMID: 34462489 PMCID: PMC8405651 DOI: 10.1038/s41598-021-96836-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
The current study aims to assess the effect of cone beam computed tomography (CBCT) frequency during adjuvant breast cancer radiotherapy with simultaneous integrated boost (SIB) on target volume coverage and dose to the organs at risk (OAR). 50 breast cancer patients receiving either non-hypofractionated or hypofractionated radiotherapy after lumpectomy including a SIB to the tumor bed were selected for this study. All patients were treated in volumetric modulated arc therapy (VMAT) technique and underwent daily CBCT imaging. In order to estimate the delivered dose during the treatment, the applied fraction doses were recalculated on daily CBCT scans and accumulated using deformable image registration. Based on a total of 2440 dose recalculations, dose coverage in the clinical target volumes (CTV) and OAR was compared depending on the CBCT frequency. The estimated delivered dose (V95%) for breast-CTV and SIB-CTV was significantly lower than the planned dose distribution, irrespective of the CBCT-frequency. Between daily CBCT and CBCT on alternate days, no significant dose differences were found regarding V95% for both, breast-CTV and SIB-CTV. Dose distribution in the OAR was similar for both imaging protocols. Weekly CBCT though led to a significant decrease in dose coverage compared to daily CBCT and a small but significant dose increase in most OAR. Daily CBCT imaging might not be necessary to ensure adequate dose coverage in the target volumes while efficiently sparing the OAR during adjuvant breast cancer radiotherapy with SIB.
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Affiliation(s)
- Kai J Borm
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany.
| | - Yannis Junker
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Mathias Düsberg
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Michal Devečka
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Stefan Münch
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Hendrik Dapper
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum Rechts Der Isar, Medical School, Technical University Munich, Ismaningerstraße 22, 81675, Munich, Germany.,Deutsches Konsortium Für Translationale Krebsforschung (DKTK)-Partner Site Munich, Munich, Germany.,Institute of Radiation Medicine, Helmholtzzentrum München, Munich, Germany
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Laaksomaa M, Moser T, Kritz J, Pynnönen K, Rossi M. Comparison of three differently shaped ROIs in free breathing breast radiotherapy setup using surface guidance with AlignRT ®. Rep Pract Oncol Radiother 2021; 26:545-552. [PMID: 34434570 DOI: 10.5603/rpor.a2021.0062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 02/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background Setup accuracy within adjuvant radiotherapy of breast cancer treated in free breathing is well studied, but a comparison of the typical regions of interest (ROI) used in surface guided radiation therapy (SGRT) does not exist. The aim of this study was to estimate the setup accuracy obtained with differently shaped ROIs in SGRT. Materials and methods A total of 573 orthogonal image pairs were analyzed from free breathing breast patients in two groups: positioning using AlignRT® surface guidance system (Group A, n = 20), and setup using conventional laser and tattoo setup (Group L, n = 20). For SGRT, three different setup ROIs were used: a Breast-shaped, O-shaped and T-shaped (B-O and T-ROI). We evaluated the isocenter-, rotation-, pitch and arm position accuracy and residual errors for the chest wall and shoulder joint in kV orthogonal and tangential setup images with laser- or SGRT-based setup. Results Less isocenter variance was found in Group A than in Group L. Rotations and posture errors were larger in group L than in Group A (p ≤ 0.05). Rotation error was smaller with T-shaped ROI than with O- or B-shape (p = 0.01-0.04). Conclusion Setup with AlignRT® improves reproducibility compared to laser setup. Between the different ROI shapes only small differences were found in the patient posture or the isocenter position in the images. The T-ROI is recommended to set up the chest wall bony structure and an additional B-ROI may be used to fine-tune the soft tissue accuracy.
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Affiliation(s)
- Marko Laaksomaa
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | | | - Julia Kritz
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Kiira Pynnönen
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Maija Rossi
- Department of Oncology, Tampere University Hospital, Tampere, Finland.,Department of Medical Physics, Tampere University Hospital, Tampere, Finland
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Hafez A, Abdelaziz DM, Khalil MM, El-Nagdy MS. The necessity of using deep inspiration breath-hold in the radiotherapy of left breast cancer patients who undergo the UK FAST trial. Biomed Phys Eng Express 2021; 7:015004. [DOI: 10.1088/2057-1976/abc9f7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Abstract
Aim
: The purpose of the current study was to compare between deep inspiration breath-hold (DIBH) and free-breathing (FB) method in the setup reproducibility and to perform a dosimetric comparison between both methods in left-sided breast cancer patients who undergo the UK FAST trial.
Materials and methods
: The online matching correction data were retrospectively collected for 50 patients treated with the FAST trial. They were equally divided into DIBH and FB groups to compare between both methods in the setup reproducibility and create the appropriate planning target volume (PTV) margin. Ten patients out of the fifty were scanned in DIBH and FB to perform a dosimetric comparison with the strict acceptance criteria of the FAST trial.
Results
: All heart dosimetric parameters of the DIBH was significantly lower than that of FB (p < 0.001), and the lung V30% of DIBH plans was significantly lower than FB plans (p = 0.03). There was no statistically significant difference between the two methods in the other organs at risk doses. To fulfill the heart and lung constraints in FB plans, the PTV V90% was reduced by 3.4%, and three plans would not attain the PTV acceptance criteria. There was no significant difference between the systematic or random setup errors between both methods except the left-right random shift was significantly lower in DIBH cases (p = 0.004). The calculated PTV margins were (4 mm, 3 mm, and 4 mm) for DIBH group, and (5 mm, 6 mm, and 8 mm) for FB group in the anterior-posterior, superior-inferior, and left-right shifts, respectively.
Conclusion
: It is highly warranted to treat left-sided breast cancer patients with the DIBH technique when the UK FAST trial is employed for treatment.
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Bryce-Atkinson A, de Jong R, Bel A, Aznar MC, Whitfield G, van Herk M. Evaluation of Ultra-low-dose Paediatric Cone-beam Computed Tomography for Image-guided Radiotherapy. Clin Oncol (R Coll Radiol) 2020; 32:835-844. [PMID: 33067079 DOI: 10.1016/j.clon.2020.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/11/2020] [Accepted: 09/29/2020] [Indexed: 01/01/2023]
Abstract
AIMS In image-guided radiotherapy, daily cone-beam computed tomography (CBCT) is rarely applied to children due to concerns over imaging dose. Simulating low-dose CBCT can aid clinical protocol design by allowing visualisation of new scan protocols in patients without delivering additional dose. This work simulated ultra-low-dose CBCT and evaluated its use for paediatric image-guided radiotherapy by assessment of image registration accuracy and visual image quality. MATERIALS AND METHODS Ultra-low-dose CBCT was simulated by adding the appropriate amount of noise to projection images prior to reconstruction. This simulation was validated in phantoms before application to paediatric patient data. Scans from 20 patients acquired at our current clinical protocol (0.8 mGy) were simulated for a range of ultra-low doses (0.5, 0.4, 0.2 and 0.125 mGy) creating 100 scans in total. Automatic registration accuracy was assessed in all 100 scans. Inter-observer registration variation was next assessed for a subset of 40 scans (five scans at each simulated dose and 20 scans at the current clinical protocol). This subset was assessed for visual image quality by Likert scale grading of registration performance and visibility of target coverage, organs at risk, soft-tissue structures and bony anatomy. RESULTS Simulated and acquired phantom scans were in excellent agreement. For patient scans, bony atomy registration discrepancies for ultra-low-dose scans fell within 2 mm (translation) and 1° (rotation) compared with the current clinical protocol, with excellent inter-observer agreement. Soft-tissue registration showed large discrepancies. Bone visualisation and registration performance reached over 75% acceptability (rated 'well' or 'very well') down to the lowest doses. Soft-tissue visualisation did not reach this threshold for any dose. CONCLUSION Ultra-low-dose CBCT was accurately simulated and evaluated in patient data. Patient scans simulated down to 0.125 mGy were appropriate for bony anatomy set-up. The large dose reduction could allow for more frequent (e.g. daily) image guidance and, hence, more accurate set-up for paediatric radiotherapy.
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Affiliation(s)
- A Bryce-Atkinson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
| | - R de Jong
- Department of Radiation Oncology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - A Bel
- Department of Radiation Oncology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - M C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK; Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - G Whitfield
- Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK; The Children's Brain Tumour Research Network, The University of Manchester, Royal Manchester Children's Hospital, Manchester, UK
| | - M van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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12
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Shen K, Xiong J, Wang Z, Wang W, Li W, Zhou J, Deng Z, Li B, Zhong R. Design of a new breast vacuum bag to reduce the global and local setup errors and to reduce PTV margin in post-mastectomy radiation therapy. JOURNAL OF RADIATION RESEARCH 2020; 61:985-992. [PMID: 32823282 PMCID: PMC7674700 DOI: 10.1093/jrr/rraa066] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/09/2020] [Indexed: 02/05/2023]
Abstract
To design a new breast vacuum bag to reduce global and local setup errors in post-mastectomy radiation therapy (PMRT). A total of 24 PMRT patients were immobilized with an old vacuum bag and 26 PMRT patients were immobilized with a new vacuum bag. The registration results were analysed using four regions of interest (ROI): the global ROI [including the whole region of the planning target volume (PTV), GROI], the supraclavicular area (SROI), the ipsilateral chest wall region (CROI) and the ipsilateral arm region (AROI). The global and local setup errors of the two groups were compared. The global setup errors of the new vacuum group were significantly smaller than those in the old vacuum group with the exception of yaw axes (P < 0.05). The systematic error (Σ) and random error (σ) ranged from 1.21 to 2.13 mm. In the new vacuum group, the local setup errors in the medial-lateral (ML) direction and roll axes for CROI (the Σ and σ ranged from 0.65 to 1.35 mm), and the local setup errors in ML and superior-inferior (SI) directions for SROI were significantly smaller than those in the old vacuum group. The total required PTV margins for the chest wall in ML, SI, and anterior-posterior (AP) were 4.40, 3.12 and 3.77 mm respectively. The new vacuum bag can significantly reduce the global setup errors and local setup errors in PMRT. The respiratory motion of the chest wall was negligible, and the 5 mm PTV margin could cover the local setup errors in PMRT using the new vacuum bag with cone beam CT (CBCT) correction.
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Affiliation(s)
- Konglong Shen
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Jie Xiong
- Radiology Department, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Zhiguo Wang
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Weifeng Wang
- Jingzhou Central Hospital, the Second Clinical Medical College, Yangtze University, Jinzhou 121001, P.R. China
| | - Wan Li
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Jidan Zhou
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Zhonghua Deng
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Bin Li
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
| | - Renming Zhong
- Department of Radiotherapy, Division of Radiation Physics, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, P.R. China
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13
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Yoon SW, Taunk NK, Freedman GM, Hubley E, O'Reilly S, Teo BKK, Anamalayil S, Dong L, Kennedy C, Zou W, Metz JM, Li T. Per-fraction positional and dosimetric performance of prone breast tangential radiotherapy on Halcyon™ linear accelerator assessed with daily rapid kilo-voltage cone beam computed tomography: a single-institution pilot study. Radiat Oncol 2020; 15:258. [PMID: 33160370 PMCID: PMC7648956 DOI: 10.1186/s13014-020-01700-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study investigates daily breast geometry and delivered dose to prone-positioned patients undergoing tangential whole breast radiation therapy (WBRT) on an O-ring linear accelerator with 6X flattening filter free mode (6X-FFF), planned with electronic compensation (ECOMP) method. Most practices rely on skin marks or daily planar image matching for prone breast WBRT. This system provides low dose daily CBCT, which was used to study daily robustness of delivered dose parameters for prone-positioned WBRT. Methods Eight patients treated with 16-fraction prone-breast WBRT were retrospectively studied. Planning CTs were deformed to daily CBCT to generate daily synthetic CTs, on which delivered dose distributions were calculated. A total of 8 × 16 = 128 synthetic CTs were generated. Consensus ASTRO definition was used to contour Breast PTV Eval for each daily deformed CT. Breast PTV Eval coverage (V90%) and hotspot (V105% and Dmax) were monitored daily to compare prescription dose with daily delivered dose. Various predictors including patient weight, breast width diameter (BWD), and Dice similarity coefficient (DSC) were fit into an analysis of covariance model predicting V90% and V105% deviation from prescribed (ΔV90%, ΔV105%). Statistical significance is indicated with asterisks (* for p < 0.05; ** for p < 0.001). Results Daily delivered Breast PTV Eval V90% was moderately smaller than prescribed (median ΔV90% = − 0.1%*), while V105% was much larger (median ΔV105% = + 10.1%** or + 92.4 cc**). Patient’s weight loss correlated with significantly increased ΔV105% (+ 4.6%/ − 1% weight, R2 = 0.4**) and moderately decreased ΔV90% (− 0.071%/ − 1% wt., R2 = 0.2**). Comprehensive ANCOVA models indicated three factors affect ΔV90% and ΔV105% the most: (1) BWD decrease (− 0.09%* and + 10%**/ − 1 cm respectively), (2) PTV Eval volume decrease (− 0.4%** and + 9%**/ − 100 cc), and for ΔV105% only, (3) the extent of breast deformation (+ 10%**/ − 0.01 DSC). Breast PTV Eval volume also decreased with time (− 2.21*cc/fx), possibly indicating seroma resolution and increase in V105% over time. Conclusions Daily CBCT revealed key delivered dose parameters vary significantly for patients undergoing tangential prone breast WBRT planned with ECOMP using 6X-FFF. Patient weight, BWD, and breast shape deformation could be used to predict dosimetric variations from prescribed. Preliminary findings suggest an adaptive plan based on daily CBCT could reduce excessive dose to the breast.
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Affiliation(s)
- Suk W Yoon
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, Philadelphia, PA, USA.
| | - Neil K Taunk
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Gary M Freedman
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Emily Hubley
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Shannon O'Reilly
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Boon- Keng K Teo
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Shibu Anamalayil
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Lei Dong
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Christopher Kennedy
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Wei Zou
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - James M Metz
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, Philadelphia, PA, USA
| | - Taoran Li
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Perelman Center for Advanced Medicine, 3400 Civic Center Blvd, Philadelphia, PA, USA
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14
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Introducing operator characteristic curves to define appropriate frequency of quality control tests: A case study involving whole breast radiotherapy image guidance. Phys Med 2020; 69:275-280. [DOI: 10.1016/j.ejmp.2019.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/05/2019] [Accepted: 12/10/2019] [Indexed: 11/21/2022] Open
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15
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Bandyopadhyay R. Patient setup variations for treatment planning for breast cancer. JOURNAL OF MARINE MEDICAL SOCIETY 2020. [DOI: 10.4103/jmms.jmms_79_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Meyer J, Smith W, Geneser S, Koger B, Kalet AM, Young LA, Cao N, Price RG, Norris C, Horton T, Womeldorf J, Alexandrian AN, Wootton LS. Characterizing a deformable registration algorithm for surface-guided breast radiotherapy. Med Phys 2019; 47:352-362. [PMID: 31724177 DOI: 10.1002/mp.13921] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Surface-guided radiation therapy (SGRT) is a nonionizing imaging approach for patient setup guidance, intra-fraction monitoring, and automated breath-hold gating of radiation treatments. SGRT employs the premise that the external patient surface correlates to the internal anatomy, to infer the treatment isocenter position at time of treatment delivery. Deformations and posture variations are known to impact the correlation between external and internal anatomy. However, the degree, magnitude, and algorithm dependence of this impact are not intuitive and currently no methods exist to assess this relationship. The primary aim of this work was to develop a framework to investigate and understand how a commercial optical surface imaging system (C-RAD, Uppsala, Sweden), which uses a nonrigid registration algorithm, handles rotations and surface deformations. METHODS A workflow consisting of a female torso phantom and software-introduced transformations to the corresponding digital reference surface was developed. To benchmark and validate the approach, known rigid translations and rotations were first applied. Relevant breast radiotherapy deformations related to breast size, hunching/arching back, distended/deflated abdomen, and an irregular surface to mimic a cover sheet over the lower part of the torso were investigated. The difference between rigid and deformed surfaces was evaluated as a function of isocenter location. RESULTS For all introduced rigid body transformations, C-RAD computed isocenter shifts were determined within 1 mm and 1˚. Additional translational shifts to correct for rotations as a function of isocenter location were determined with the same accuracy. For yaw setup errors, the difference in shift corrections between a plan with an isocenter placed in the center of the breast (BrstIso) and one located 12 cm superiorly (SCFIso) was 2.3 mm/1˚ in lateral direction. Pitch setup errors resulted in a difference of 2.1 mm/1˚ in vertical direction. For some of the deformation scenarios, much larger differences up to 16 mm and 7˚ in the calculated shifts between BrstIso and SCFIso were observed that could lead to large unintended gaps or overlap between adjacent matched fields if uncorrected. CONCLUSIONS The methodology developed lends itself well for quality assurance (QA) of SGRT systems. The deformable C-RAD algorithm determined accurate shifts for rigid transformations, and this was independent of isocenter location. For surface deformations, the position of the isocenter had considerable impact on the registration result. It is recommended to avoid off-axis isocenters during treatment planning to optimally utilize the capabilities of the deformable image registration algorithm, especially when multiple isocenters are used with fields that share a field edge.
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Affiliation(s)
- Juergen Meyer
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Wade Smith
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Northwest Hospital, 1560 N 115th St, Seattle, WA, 98125, USA
| | - Sarah Geneser
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA
| | - Brandon Koger
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA
| | - Alan M Kalet
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Lori A Young
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Ning Cao
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Ryan G Price
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Northwest Hospital, 1560 N 115th St, Seattle, WA, 98125, USA
| | - Chris Norris
- Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Tony Horton
- Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
| | - Jeff Womeldorf
- Department of Radiation Oncology, Northwest Hospital, 1560 N 115th St, Seattle, WA, 98125, USA
| | - Ara N Alexandrian
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA
| | - Landon S Wootton
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific Street, Box 356043, Seattle, WA, 98195, USA.,Department of Radiation Oncology, Seattle Cancer Care Alliance, 825 Eastlake Ave. E, Seattle, WA, 98109, USA
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17
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Laaksomaa M, Sarudis S, Rossi M, Lehtonen T, Pehkonen J, Remes J, Luukkanen H, Skyttä T, Kapanen M. AlignRT ® and Catalyst™ in whole-breast radiotherapy with DIBH: Is IGRT still needed? J Appl Clin Med Phys 2019; 20:97-104. [PMID: 30861276 PMCID: PMC6414178 DOI: 10.1002/acm2.12553] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/16/2019] [Accepted: 01/31/2019] [Indexed: 12/20/2022] Open
Abstract
Purpose Surface guided radiotherapy (SGRT) is reported as a feasible setup technique for whole‐breast radiotherapy in deep inspiration breath hold (DIBH), but position errors of bony structures related to deeper parts of the target are not fully known. The aim of this study was to estimate patient setup accuracy and margins obtained with two different SGRT workflows with and without daily kV‐ and/or MV‐based image guidance (IGRT). Methods A total of 50 breast cancer patients were treated in DIBH, using SGRT for the patient setup, and IGRT for isocenter corrections. The patients were treated at two different departments, one using AlignRT® (25 patients) and the other using Catalyst™ (25 patients). Inter‐fractional position errors were analyzed retrospectively in orthogonal and tangential setup images, and analyzed with and without IGRT. Results In the orthogonal kV‐kV images, the systematic residual errors of the bony structures were ≤ 3 mm in both groups with SGRT‐only. When fine‐adjusted by daily IGRT, the errors decreased to ≤ 2 mm; except for the shoulder joint. The residual errors of the ribs in tangential images were between 1 and 2 mm with both workflows. The heart planning margins were between 3 and 7 mm. Conclusions The frequency of IGRT may be considerably reduced with a well‐planned SGRT‐workflow for whole‐breast DIBH with residual errors ≤ 3 mm. This accuracy can be further improved with an IGRT scheme.
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Affiliation(s)
- Marko Laaksomaa
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Sebastian Sarudis
- Department of Medical Physics, Länssjukhuset Ryhov, Jönköping, Sweden
| | - Maija Rossi
- Department of Oncology, Tampere University Hospital, Tampere, Finland.,Department of Medical Physics, Medical Imaging Center, Tampere University Hospital, Tampere, Finland
| | - Turkka Lehtonen
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Jani Pehkonen
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Jenny Remes
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Helmi Luukkanen
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Tanja Skyttä
- Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Mika Kapanen
- Department of Oncology, Tampere University Hospital, Tampere, Finland.,Department of Medical Physics, Medical Imaging Center, Tampere University Hospital, Tampere, Finland
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18
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Barsky AR, O'Grady F, Kennedy C, Taunk NK, Dong L, Metz JM, Li T, Freedman GM. Initial Clinical Experience Treating Patients with Breast Cancer on a 6-MV Flattening-Filter-Free O-Ring Linear Accelerator. Adv Radiat Oncol 2019; 4:571-578. [PMID: 31673650 PMCID: PMC6817541 DOI: 10.1016/j.adro.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose Three-dimensional (3D) conformal radiation therapy is the standard technique used for adjuvant breast radiation. We report the clinical use of a novel 6-MV flattening-filter-free O-ring linear accelerator (6X-FFF ORL) for breast cancer that may improve upon 3D conformal radiation therapy with its higher dose rate and faster rotation and leaf speed than traditional C-arm gantries. Methods and Materials We retrospectively identified consecutive women with breast cancer who underwent surgery followed by radiation therapy to the breast or chest wall on Halcyon (Varian Medical Systems, Palo Alto, CA), a novel 6X-FFF ORL. We report their clinicopathologic information, radiation therapy details, acute toxicities, dose-volume histogram data, couch corrections, and treatment times. Results Thirty-four women were treated for breast cancer on a 6X-FFF ORL between February 2018 and September 2018. All patients underwent lumpectomy (92%) or mastectomy (8%). Tumors were left sided in 44% and bilateral in 9%, and 9% included comprehensive nodal radiation therapy. Twelve percent of patients were treated prone and 29% with deep-inspiration breath hold. Standard target and normal-tissue constraints were met in nearly all plans. The 3D vector couch correction average was 0.77 ± 0.05 cm. The mean beam-on time was 2.0 ± 0.3 minutes, and mean treatment time from start of imaging to beam-off was 4.4 ± 0.4 minutes. Grade 2 dermatitis, fatigue, and breast pain occurred in 18%, 9%, and 3% of patients, respectively. Conclusions In this first clinical report of breast radiation therapy with a 6X-FFF ORL, treatment was versatile and fast for complex setups and techniques, with acceptable toxicity and organ-at-risk doses. Thus, a 6X-FFF ORL can increase throughput or reduce length of day compared with a conventional C-arm linear accelerator in departments with a busy breast service.
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Wang W, Yu T, Xu M, Shao Q, Zhang Y, Li J. Setup Error Assessment and Correction in Planar kV Image- Versus Cone Beam CT Image-Guided Radiation Therapy: A Clinical Study of Early Breast Cancer Treated With External Beam Partial Breast Irradiation. Technol Cancer Res Treat 2019; 18:1533033819853847. [PMID: 31159668 PMCID: PMC6552346 DOI: 10.1177/1533033819853847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective: To compare differences in setup error assessment and correction between planar kilovolt images and cone beam computed tomography images for external beam partial breast irradiation during free breathing. Methods: Nineteen patients who received external beam partial breast irradiation after breast-conserving surgery were recruited. Interfraction setup error was acquired using planar kilovolt images and cone beam computed tomography. After online setup correction, the residual error was calculated, and the setup error was compared. The residual error and setup margin were quantified for planar kilovolt and cone beam computed tomography images. Results: The largest setup error was observed in the anteroposterior direction for both cone beam computed tomography and planar kilovolt imaging (−1.45 mm, 1.74 mm). The cone beam computed tomography–based setup error (systematic error [Σ]) was less than the planar kilovolt images based on Σ in the anteroposterior direction (–1.2 mm vs 2.00 mm; P = .005), and no significant differences were observed for random error (σ) in 3 dimensions (P = .948, .376, .314). After online setup correction, cone beam computed tomography significantly reduced the residual setup error compared with planar kilovolt images in the anteroposterior direction (Σ: −0.20 mm vs 0.50 mm, P = .008; σ: 0.45 mm vs 1.34 mm, P = .002). The cone beam computed tomography–based setup margin was smaller than the planar kilovolt image-based setup margin in the anteroposterior direction (−1.39 mm vs 5.57 mm, P = .003; 0.00 mm vs 3.20 mm, P = .003). Conclusions: Discrepancy between the setup errors observed with planar kilovolt and cone beam computed tomography was obvious in the anteroposterior direction. Compared to cone beam computed tomography, the elapsed treatment time was smaller when the initial alignment used kilovolt planar imaging. Whether using planar kilovolt or cone beam computed tomography, residual errors can be reduced to 1.5 mm for external beam partial breast irradiation procedures.
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Affiliation(s)
- Wei Wang
- 1 Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Ting Yu
- 1 Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China.,2 Department of Graduate School, Tianjin Medical University, Tianjin, China
| | - Min Xu
- 1 Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Qian Shao
- 1 Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Yingjie Zhang
- 1 Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
| | - Jianbin Li
- 1 Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
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20
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Xu H, Lee SW, Guerrero M, Yi BY, Chen S, Becker SJ, Chung H, Cheston SB. Dosimetric effects of the kV based image-guided radiation therapy of prone breast external beam radiation: Towards the optimized imaging frequency. J Appl Clin Med Phys 2018; 20:212-219. [PMID: 30550644 PMCID: PMC6333126 DOI: 10.1002/acm2.12511] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/10/2018] [Accepted: 11/20/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE For prone breast treatment, daily image-guided radiation therapy (IGRT) allows couch shifting to correct breast position relative to the treatment field. This work investigates the dosimetric effect of reducing kV imaging frequencies and the feasibility of optimizing the frequency using patient anatomy or their first 3-day shifts. METHOD Thirty-seven prone breast patients who had been treated with skin marker alignment followed by daily kV were retrospectively analyzed. Three IGRT schemes (daily-kV, weekly-kV, no-kV) were simulated, assuming that fractions with kV imaging deliver a dose distribution equivalent to that in computed tomography (CT) planning, whereas other fractions yield a dose distribution as recreated by shifting the CT plan isocenter back to its position before the couch shift was applied. Treatment dose to targets (breast and lumpectomy cavity [LPC]) and organs at risks (OAR)s (heart, ipsilateral lung) in different schemes were calculated. Patient anatomy information on CT plans and first 3-day couch shift data were analyzed to investigate whether these factors could guide imaging scheme optimization. RESULTS When kV imaging frequency was reduced, the percentage dose changes (δD) for breast and LPC objectives (average <1%) were smaller than those for heart and lung (average 28%-31% for Dmean ). In general, the δD of no-kV imaging was approximately that of weekly kV imaging × a factor of 1.2-1.4. Although most dose objectives were not affected, the potential higher heart dose may be of concern. No strong correlation was found between δD for different kV frequencies and patient anatomy size/distance or the first 3-day couch shift data. CONCLUSIONS Despite resulting in lower imaging dose, time, cost, and similar target coverage, a reduction in kV imaging frequency may introduce higher heart complication risk. Daily kVs are needed more in left-sided breast patients. A less frequent imaging schedule, if considered, cannot be individually optimized using CT anatomic features or early shift data.
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Affiliation(s)
- Huijun Xu
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Sung-Woo Lee
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Mariana Guerrero
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Byong Yong Yi
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Shifeng Chen
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Stewart J Becker
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | | | - Sally B Cheston
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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21
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Mohandass P, Khanna D, Kumar TM, Thiyagaraj T, Saravanan C, Bhalla NK, Puri A. Study to Compare the Effect of Different Registration Methods on Patient Setup Uncertainties in Cone-beam Computed Tomography during Volumetric Modulated Arc Therapy for Breast Cancer Patients. J Med Phys 2018; 43:207-213. [PMID: 30636845 PMCID: PMC6299751 DOI: 10.4103/jmp.jmp_67_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 10/02/2018] [Accepted: 10/12/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This study compared three different methods used in registering cone-beam computed tomography (CBCT) image set with planning CT image set for determining patient setup uncertainties during volumetric modulated arc therapy (VMAT) for breast cancer patients. MATERIALS AND METHODS Seven breast cancer patients treated with 50 Gy in 25 fractions using VMAT technique were chosen for this study. A total of 105 CBCT scans were acquired by image guidance protocol for patient setup verification. Approved plans' CT images were used as the reference image sets for registration with their corresponding CBCT image sets. Setup errors in mediolateral, craniocaudal, and anteroposterior direction were determined using gray-scale matching between the reference CT images and onboard CBCT images. Patient setup verification was performed using clip-box registration (CBR) method during online imaging. Considering the CBR method as the reference, two more registrations were performed using mask registration (MR) method and dual registration (DR) (CBR + MR) method in the offline mode. For comparison, systematic error (∑), random error (σ), mean displacement vector (R), mean setup error (M), and registration time (R t) were analyzed. Post hoc Tukey's honest significant difference test was performed for multiple comparisons. RESULTS Systematic and random errors were less in CBR as compared to MR and DR (P > 0.05). The mean displacement error and mean setup errors were less in CBR as compared to MR and DR (P > 0.05). Increased R t was observed in DR as compared to CBR and MR (P < 0.05). In addition, multiple comparisons did not show any significant difference in patient setup error (P > 0.05). CONCLUSION For breast VMAT plan delivery, all three registration methods show insignificant variation in patient setup error. One can use any of the three registration methods for patient setup verification.
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Affiliation(s)
- P. Mohandass
- Department of Physics, Karunya Institute of Technology and Sciences, Coimbatore, Tamil Nadu, India
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - D. Khanna
- Department of Physics, Karunya Institute of Technology and Sciences, Coimbatore, Tamil Nadu, India
| | - T. Manoj Kumar
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - T. Thiyagaraj
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - C. Saravanan
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - Narendra Kumar Bhalla
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
| | - Abhishek Puri
- Department of Radiation Oncology, Fortis Cancer Institute, Fortis Hospital, Mohali, Punjab, India
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22
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Kammerer E, Fenoglietto P, Bourgier C. [Modalities and advantages of image guided radiation therapy of breast cancer in adjuvant setting]. Cancer Radiother 2018; 22:581-585. [PMID: 30145089 DOI: 10.1016/j.canrad.2018.07.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/07/2018] [Indexed: 11/18/2022]
Abstract
In adjuvant setting, breast cancer radiotherapy volumes include whole mammary gland or chest wall, and when indicated, nodal area such as axilla, supraclavicular, and internal mammary chain. An accurate patients positioning is required due to some geometric complexity of target volumes closed to organs at risk as heart and lung. Image guided radiation therapy allows such accuracy. Here we propose a review on image guided radiotherapy for breast cancer.
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Affiliation(s)
- E Kammerer
- Centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - P Fenoglietto
- Institut régional du cancer de Montpellier (ICM), Val d'Aurelle, 208, avenue des Apothicaires, 34298 Montpellier, France
| | - C Bourgier
- Institut régional du cancer de Montpellier (ICM), Val d'Aurelle, 208, avenue des Apothicaires, 34298 Montpellier, France; Inserm U1194, 641, avenue du Doyen Gaston-Giraud, 34000 Montpellier, France; Faculté de médecine, université de Montpellier, 641, avenue du Doyen Gaston-Giraud, 34000 Montpellier, France.
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23
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Breast-shape changes during radiation therapy after breast-conserving surgery. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2018; 6:71-76. [PMID: 33458392 PMCID: PMC7807602 DOI: 10.1016/j.phro.2018.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/15/2018] [Accepted: 05/23/2018] [Indexed: 11/20/2022]
Abstract
Background & purpose With the introduction of more conformal techniques for breast cancer radiation therapy (RT), motion management is becoming increasingly important. We studied the breast-shape variability during RT after breast-conserving surgery (BCS). Materials & Methods Planning computed tomography (CT) and follow-up cone-beam CT (CBCT) scans were available for 71 fractions of 17 patients undergoing RT after BCS. First, the CT and the CBCT scans were registered on bones. Subsequently, breast-contour data were generated. The CBCT contours were analyzed in 3D in terms of deviations (mean and standard deviation) relative to the contour of the CT scan for the upper medial, lower medial, upper lateral, and lower lateral breast quadrants, and the axilla. Results Regional systematic and random standard deviations of the breast quadrants varied between 1.5 and 2.1 mm and 1.0–1.6 mm, respectively, and were larger for the axilla (3.0 mm). An absolute average shape change of ≥4.0 mm in at least one region was present in 21/71 fractions (30%), predominantly in breast volumes > 800 cc (p = <0.01). Furthermore, seroma was associated with larger shape changes (p = 0.04). Conclusions Breast-shape variability varies between anatomic locations. Changes in the order of 4 mm are frequently observed during RT, especially for large breasts. This should be taken into account in the development of protocols for partial breast irradiation and boost treatment.
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24
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Zegers CML, Baeza JA, van Elmpt W, Murrer LHP, Verhoeven K, Boersma L, Verhaegen F, Nijsten SMJJG. Three-dimensional dose evaluation in breast cancer patients to define decision criteria for adaptive radiotherapy. Acta Oncol 2017; 56:1487-1494. [PMID: 28849731 DOI: 10.1080/0284186x.2017.1349334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Dose-guided adaptive radiation therapy (DGART) is the systematic evaluation and adaptation of the dose delivery during treatment for an individual patient. The aim of this study is to define quantitative action levels for DGART by evaluating changes in 3D dose metrics in breast cancer and correlate them with clinical expert evaluation. MATERIAL AND METHODS Twenty-three breast cancer treatment plans were evaluated, that were clinically adapted based on institutional IGRT guidelines. Reasons for adaptation were variation in seroma, hematoma, edema, positioning or problems using voluntary deep inspiration breath hold. Sixteen patients received a uniform dose to the breast (clinical target volume 1; CTV1). Six patients were treated with a simultaneous integrated boost to CTV2. The original plan was copied to the CT during treatment (re-CT) or to the stitched cone-beam CT (CBCT). Clinical expert evaluation of the re-calculated dose distribution and extraction of dose-volume histogram (DVH) parameters were performed. The extreme scenarios were evaluated, assuming all treatment fractions were given to the original planning CT (pCT), re-CT or CBCT. Reported results are mean ± SD. RESULTS DVH results showed a mean dose (Dmean) difference between pCT and re-CT of -0.4 ± 1.4% (CTV1) and -1.4 ± 2.1% (CTV2). The difference in V95% was -2.6 ± 4.4% (CTV1) and -9.8 ± 8.3% (CTV2). Clinical evaluation and DVH evaluation resulted in a recommended adaptation in 17/23 or 16/23 plans, respectively. Applying thresholds on the DVH parameters: Dmean CTV, V95% CTV, Dmax, mean lung dose, volume exceeding 107% (uniform dose) or 90% (SIB) of the prescribed dose enabled the identification of patients with an assumed clinically relevant dose difference, with a sensitivity of 0.89 and specificity of 1.0. Re-calculation on CBCT imaging identified the same plans for adaptation as re-CT imaging. CONCLUSIONS Clinical expert evaluation can be related to quantitative DVH parameters on re-CT or CBCT imaging to select patients for DGART.
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Affiliation(s)
- Catharina M. L. Zegers
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jose A. Baeza
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Lars H. P. Murrer
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Karolien Verhoeven
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Liesbeth Boersma
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Frank Verhaegen
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sebastiaan M. J. J. G. Nijsten
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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25
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Jensen CA, Abramova T, Frengen J, Lund J. Monitoring deep inspiration breath hold for left-sided localized breast cancer radiotherapy with an in-house developed laser distance meter system. J Appl Clin Med Phys 2017; 18:117-123. [PMID: 28755403 PMCID: PMC5875834 DOI: 10.1002/acm2.12137] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 05/16/2017] [Accepted: 06/04/2017] [Indexed: 12/12/2022] Open
Abstract
Deep inspiration breath hold (DIBH) in left-sided breast cancer radiotherapy is a technique to reduce cardiac and pulmonary doses while maintaining target coverage. This study aims at evaluating an in-house developed DIBH system. Free-breathing (FB) and DIBH plans were generated for 22 left-sided localized breast cancer patients who had radiation therapy (RT) after breast-conserving surgery. All patients were treated utilizing an in-house laser distance measuring system. 50 Gy was prescribed, and parameters of interest were target coverage, left anterior descending coronary artery, (LAD) and heart doses. Portal images were acquired and the reproducibility and stability of DIBH treatment were compared to FB. The comparing result shows there is a significant reduction in all LAD and heart dose statistics for DIBH compared to FB plans without compromising the target coverage. The maximum LAD dose was reduced from 43.7 Gy to 29.0 Gy and the volume of the heart receiving >25 Gy was reduced from 3.3% to 1.0% using the in-house system, both statistically significant. The in-house system gave a reproducible and stable DIBH treatment where the systematic error ∑, and random error σ, were less than 2.2 mm in all directions, but were not significantly better than at FB. The system was well tolerated and all patients completed their treatment sessions with DIBH.
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Affiliation(s)
| | | | - Jomar Frengen
- Clinic of OncologySt. Olavs HospitalTrondheim University HospitalTrondheimNorway
| | - Jo‐Åsmund Lund
- Department of OncologyÅlesund HospitalÅlesundNorway
- Department of Cancer Research and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
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26
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Batumalai V, Holloway LC, Kumar S, Dundas K, Jameson MG, Vinod SK, Delaney GP. Survey of image-guided radiotherapy use in Australia. J Med Imaging Radiat Oncol 2016; 61:394-401. [PMID: 27863010 DOI: 10.1111/1754-9485.12556] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/13/2016] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This study aimed to evaluate the current use of imaging technologies for planning and delivery of radiotherapy (RT) in Australia. METHODS An online survey was emailed to all Australian RT centres in August 2015. The survey inquired about imaging practices during planning and treatment delivery processes. Participants were asked about the types of image-guided RT (IGRT) technologies and the disease sites they were used for, reasons for implementation, frequency of imaging and future plans for IGRT use in their department. RESULTS The survey was completed by 71% of Australian RT centres. All respondents had access to computed tomography (CT) simulators and regularly co-registered the following scans to the RT: diagnostic CT (50%), diagnostic magnetic resonance imaging (MRI) (95%), planning MRI (34%), planning positron emission tomography (PET) (26%) and diagnostic PET (97%) to aid in tumour delineation. The main reason for in-room IGRT implementation was the use of highly conformal techniques, while the most common reason for under-utilisation was lack of equipment capability. The most commonly used IGRT modalities were kilovoltage (kV) cone-beam CT (CBCT) (97%), kV electronic portal image (EPI) (89%) and megavoltage (MV) EPI (75%). Overall, participants planned to increase IGRT use in planning (33%) and treatment delivery (36%). CONCLUSIONS IGRT is widely used among Australian RT centres. On the basis of future plans of respondents, the installation of new imaging modalities is expected to increase for both planning and treatment.
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Affiliation(s)
- Vikneswary Batumalai
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Lois Charlotte Holloway
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, New South Wales, Australia
| | - Shivani Kumar
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Kylie Dundas
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Geoffrey Jameson
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Shalini Kavita Vinod
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Geoff P Delaney
- Liverpool and Macarthur Cancer Therapy Centres, Sydney, New South Wales, Australia.,Ingham Institute of Applied Medical Research, Sydney, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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27
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Batumalai V, Phan P, Choong C, Holloway L, Delaney GP. Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy. J Med Radiat Sci 2016; 63:224-231. [PMID: 27741383 PMCID: PMC5167282 DOI: 10.1002/jmrs.180] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/29/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction To compare the differences in setup errors measured with electronic portal image (EPI) and cone‐beam computed tomography (CBCT) in patients undergoing tangential breast radiotherapy (RT). Relationship between setup errors, body mass index (BMI) and breast size was assessed. Methods Twenty‐five patients undergoing postoperative RT to the breast were consented for this study. Weekly CBCT scans were acquired and retrospectively registered to the planning CT in three dimensions, first using bony anatomy for bony registration (CBCT‐B) and again using breast tissue outline for soft tissue registration (CBCT‐S). Digitally reconstructed radiographs (DRR) generated from CBCT to simulate EPI were compared to the planning DRR using bony anatomy in the V (parallel to the cranio‐caudal axis) and U (perpendicular to V) planes. The systematic (Σ) and random (σ) errors were calculated and correlated with BMI and breast size. Results The systematic and random errors for EPI (ΣV = 3.7 mm, ΣU = 2.8 mm and σV = 2.9 mm, σU = 2.5) and CBCT‐B (ΣV = 3.5 mm, ΣU = 3.4 mm and σV = 2.8 mm, σU = 2.8) were of similar magnitude in the V and U planes. Similarly, the differences in setup errors for CBCT‐B and CBCT‐S in three dimensions were less than 1 mm. Only CBCT‐S setup error correlated with BMI and breast size. Conclusions CBCT and EPI show insignificant variation in their ability to detect setup error. These findings suggest no significant differences that would make one modality considered superior over the other and EPI should remain the standard of care for most patients. However, there is a correlation with breast size, BMI and setup error as detected by CBCT‐S, justifying the use of CBCT‐S for larger patients.
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Affiliation(s)
- Vikneswary Batumalai
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Penny Phan
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
| | - Callie Choong
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia
| | - Lois Holloway
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Sydney, New South Wales, Australia.,School of Physics, University of Sydney, Liverpool, New South Wales, Australia
| | - Geoff P Delaney
- Liverpool Cancer Therapy Centre, Liverpool, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia.,South Western Clinical School, University of New South Wales, Liverpool, New South Wales, Australia.,School of Medicine, University of Western Sydney, New South Wales, Australia
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