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Mast M, Leong A, Korreman S, Lee G, Probst H, Scherer P, Tsang Y. ESTRO-ACROP guideline for positioning, immobilisation and setup verification for local and loco-regional photon breast cancer irradiation. Tech Innov Patient Support Radiat Oncol 2023; 28:100219. [PMID: 37745181 PMCID: PMC10511493 DOI: 10.1016/j.tipsro.2023.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- M.E. Mast
- Department of Radiation Oncology, Haaglanden Medical Center, Leidschendam, The Netherlands
| | - A. Leong
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
- Bowen Icon Cancer Centre, Wellington, New Zealand
| | - S.S. Korreman
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Oncology, Aarhus University Hospital, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - G. Lee
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - H. Probst
- Sheffield Hallam University, Sheffield, United Kingdom
| | - P. Scherer
- Department of Radiotherapy and Radio-Oncology, LKH Salzburg, Paracelsus Medical University Clinics, Salzburg, Austria
| | - Y. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
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Evaluation of the clinical implementation of a tattoo-free positioning technique in breast cancer radiotherapy using ExacTrac. Phys Med 2022; 98:81-87. [DOI: 10.1016/j.ejmp.2022.04.014] [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: 06/22/2021] [Revised: 02/28/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
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Mankinen M, Virén T, Seppälä J, Hakkarainen H, Koivumäki T. Dosimetric effect of respiratory motion on planned dose in whole-breast volumetric modulated arc therapy using moderate and ultra-hypofractionation. Radiat Oncol 2022; 17:46. [PMID: 35248114 PMCID: PMC8898500 DOI: 10.1186/s13014-022-02014-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background and purpose The interplay effect of respiratory motion on the planned dose in free-breathing right-sided whole-breast irradiation (WBI) were studied by simulating hypofractionated VMAT treatment courses. Materials and methods Ten patients with phase-triggered 4D-CT images were included in the study. VMAT plans targeting the right breast were created retrospectively with moderately hypofractionated (40.05 Gy in 15 fractions of 2.67 Gy) and ultra-hypofractionated (26 Gy 5 fractions of 5.2 Gy) schemes. 3D-CRT plans were generated as a reference. All plans were divided into respiratory phase-specific plans and calculated in the corresponding phase images. Fraction-specific dose was formed by deforming and summing the phase-specific doses in the planning image for each fraction. The fraction-specific dose distributions were deformed and superimposed onto the planning image, forming the course-specific respiratory motion perturbed dose distribution. Planned and respiratory motion perturbed doses were compared and changes due to respiratory motion and choice of fractionation were evaluated. Results The respiratory motion perturbed PTV coverage (V95%) decreased by 1.7% and the homogeneity index increased by 0.02 for VMAT techniques, compared to the planned values. Highest decrease in CTV coverage was 0.7%. The largest dose differences were located in the areas of steep dose gradients parallel to respiratory motion. The largest difference in DVH parameters between fractionation schemes was 0.4% of the prescribed dose. Clinically relevant changes to the doses of organs at risk were not observed. One patient was excluded from the analysis due to large respiratory amplitude. Conclusion Respiratory motion of less than 5 mm in magnitude did not result in clinically significant changes in the planned free-breathing WBI dose. The 5 mm margins were sufficient to account for the respiratory motion in terms of CTV dose homogeneity and coverage for VMAT techniques. Steep dose gradients near the PTV edges might decrease the CTV coverage. No clinical significance was found due to the choice of fractionation. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-022-02014-5.
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Target motion management in breast cancer radiation therapy. Radiol Oncol 2021; 55:393-408. [PMID: 34626533 PMCID: PMC8647788 DOI: 10.2478/raon-2021-0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/04/2021] [Indexed: 12/25/2022] Open
Abstract
Background Over the last two decades, breast cancer remains the main cause of cancer deaths in women. To treat this type of cancer, radiation therapy (RT) has proved to be efficient. RT for breast cancer is, however, challenged by intrafractional motion caused by respiration. The problem is more severe for the left-sided breast cancer due to the proximity to the heart as an organ-at-risk. While particle therapy results in superior dose characteristics than conventional RT, due to the physics of particle interactions in the body, particle therapy is more sensitive to target motion. Conclusions This review highlights current and emerging strategies for the management of intrafractional target motion in breast cancer treatment with an emphasis on particle therapy, as a modern RT technique. There are major challenges associated with transferring real-time motion monitoring technologies from photon to particles beams. Surface imaging would be the dominant imaging modality for real-time intrafractional motion monitoring for breast cancer. The magnetic resonance imaging (MRI) guidance and ultra high dose rate (FLASH)-RT seem to be state-of-the-art approaches to deal with 4D RT for breast cancer.
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Lei R, Zhang X, Li J, Sun H, Yang R. Auxiliary Structures-Assisted Radiotherapy Improvement for Advanced Left Breast Cancer. Front Oncol 2021; 11:702171. [PMID: 34367986 PMCID: PMC8340769 DOI: 10.3389/fonc.2021.702171] [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: 04/29/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background To improve the quality of plan for the radiation treatment of advanced left breast cancer by introducing the auxiliary structures (ASs) which are used to spare the regions with no intact delineated structures adjacent to the target volume. Methods CT data from 20 patients with left-sided advanced breast cancer were selected. An AS designated as A1 was created to spare the regions of the aorta, pulmonary artery, superior vena ava, and contralateral tissue of the upper chest and neck, and another, designated as A2, was created in the regions of the cardia and fundus of the stomach, left liver lobe, and splenic flexure of the colon. IMRT and VMAT plans were created for cases with and without the use of the AS dose constraints in plan optimization. Dosimetric parameters of the target and organs at risk (OARs) were compared between the separated groups. Results With the use of AS dose constraints, both the IMRT and VMAT plans were clinically acceptable and deliverable, even showing a slight improvement in dose distribution of both the target and OARs compared with the AS-unused plans. The ASs significantly realized the dose sparing for the regions and brought a better conformity index (p < 0.05) and homogeneity index (p < 0.05) in VMAT plans. In addition, the volume receiving at least 20 Gy (V20) for the heart (p < 0.05), V40 for the left lung (p < 0.05), and V40 for the axillary-lateral thoracic vessel juncture region (p < 0.05) were all lower in VMAT plans. Conclusion The use of the defined AS dose constraints in plan optimization was effective in sparing the indicated regions, improving the target dose distribution, and sparing OARs for advanced left breast cancer radiotherapy, especially those that utilize VMAT plans.
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Affiliation(s)
- Runhong Lei
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Xile Zhang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Jinna Li
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
| | - Ruijie Yang
- Department of Radiation Oncology, Peking University Third Hospital, Beijing, China
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Hafez A, Abdelaziz DM, Khalil MM, El-Nagdy MS. Quantifying inter- and intra-fraction variations of breast cancer radiotherapy with skin dose measurements. Biomed Phys Eng Express 2021; 7. [PMID: 34126605 DOI: 10.1088/2057-1976/ac0afe] [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: 03/30/2021] [Accepted: 06/14/2021] [Indexed: 11/11/2022]
Abstract
Aim. The aim of the current study was to compare between the deep inspiration breath-hold (DIBH) technique and free-breathing (FB) method in the treatment delivery uncertainty of breast cancer radiotherapy using skin dose measurements.Methods. In a prospective manner, eighty patients were randomly selected for skin dose measurements, and they were assigned to two groups. DIBH (40 patients) and FB (40 patients). The systematic inter-fraction dose variation was quantified using the mean percentage error (MPE) between the average measured total dose per session in three consecutive sessions and the corresponding calculated point dose from the treatment planning system. The random inter-fraction dose variation was quantified using the standard deviation (SD) of the dose delivered by the medial or lateral tangential fields, or the total session dose in the three sessions (SDMT, SDLT, or SDtotal, respectively). While the random intra-fraction dose variation was quantified using the SD of the dose difference between the medial and lateral tangential fields in three consecutive sessions (SDMT-LT).Results. There was no statistically significant difference in MPE between the DIBH and FB groups (p = 0.583). Moreover, the mean SDtotaland SDMTof the DIBH group were significantly lower than that of the FB group (2.75 ± 2.33 cGy versus 4.45 cGy ± 4.33, p = 0.048) and (1.94 ± 1.63 cGy versus 3.76 ± 3.42 cGy, p = 0.007), respectively. However, there was no significant difference in the mean SDLTand SDMT-LTbetween the two groups (p > 0.05).Conclusion. In addition to the advantage of reducing the cardiopulmonary radiation doses in left breast cancer, the DIBH technique could reduce the treatment delivery uncertainty compared to the FB method due to the significant reduction in the random inter-fraction dose variations.
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Affiliation(s)
- Abdelrahman Hafez
- Department of Physics, Faculty of Science, Helwan University, Cairo, Egypt.,Radiotherapy Department, Baheya center for early detection and treatment of breast cancer, Giza, Egypt
| | - Dina M Abdelaziz
- Radiotherapy Department, Baheya center for early detection and treatment of breast cancer, Giza, Egypt.,Radiotherapy Department, National Cancer Institute, Cairo, Egypt
| | - Magdy M Khalil
- Department of Physics, Faculty of Science, Helwan University, Cairo, Egypt
| | - Mohamed S El-Nagdy
- Department of Physics, Faculty of Science, Helwan University, Cairo, Egypt
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Zheng Y, Samant P, Merill J, Chen Y, Ahmad S, Li D, Xiang L. X-ray-induced acoustic computed tomography for guiding prone stereotactic partial breast irradiation: a simulation study. Med Phys 2020; 47:4386-4395. [PMID: 32428252 PMCID: PMC7674271 DOI: 10.1002/mp.14245] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 04/22/2020] [Accepted: 05/11/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the feasibility of x-ray-induced acoustic computed tomography (XACT) as an image guidance tool for tracking x-ray beam location and monitoring radiation dose delivered to the patient during stereotactic partial breast irradiation (SPBI). METHODS An in-house simulation workflow was developed to assess the ability of XACT to act as an in vivo dosimetry tool for SPBI. To evaluate this simulation workflow, a three-dimensional (3D) digital breast phantom was created by a series of two-dimensional (2D) breast CT slices from a patient. Three different tissue types (skin, adipose tissue, and glandular tissue) were segmented and the postlumpectomy seroma was simulated inside the digital breast phantom. A treatment plan was made with three beam angles to deliver radiation dose to the seroma in breast to simulate SPBI. The three beam angles for 2D simulations were 17°, 90° and 159° (couch angles were 0 degrees) while the angles were 90 degrees (couch angles were 0°, 27°, 90°) in 3D simulation. A multi-step simulation platform capable of modelling XACT was developed. First, the dose distribution was converted to an initial pressure distribution. The propagation of this pressure disturbance in the form of induced acoustic waves was then modeled using the k-wave MATLAB toolbox. The waves were then detected by a hemispherical-shaped ultrasound transducer array (6320 transducer locations distributed on the surface of the breast). Finally, the time-varying pressure signals detected at each transducer location were used to reconstruct an image of the initial pressure distribution using a 3D time-reversal reconstruction algorithm. Finally, the reconstructed XACT images of the radiation beams were overlaid onto the structure breast CT. RESULTS It was found that XACT was able to reconstruct the dose distribution of SPBI in 3D. In the reconstructed 3D volumetric dose distribution, the average doses in the GTV (Gross Target Volume) and PTV (Planning Target Volume) were 86.15% and 80.89%, respectively. When compared to the treatment plan, the XACT reconstructed dose distribution in the GTV and PTV had a RMSE (root mean square error) of 2.408 % and 2.299 % over all pixels. The 3D breast XACT imaging reconstruction with time-reversal reconstruction algorithm can be finished within several minutes. CONCLUSIONS This work explores the feasibility of using the novel imaging modality of XACT as an in vivo dosimeter for SPBI radiotherapy. It shows that XACT imaging can provide the x-ray beam location and dose information in deep tissue during the treatment in real time in 3D. This study lays the groundwork for a variety of future studies related to the use of XACT as a dosimeter at different cancer sites.
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Affiliation(s)
- Yue Zheng
- Shandong Key Laboratory of Medical Physics and Image Processing & Shandong Provincial Engineering and Technical Center of Light Manipulations, School of Physics and Electronics, Shandong Normal University, Jinan 250358, China; School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Pratik Samant
- School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Jack Merill
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA
| | - Yong Chen
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Salahuddin Ahmad
- Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Dengwang Li
- Shandong Key Laboratory of Medical Physics and Image Processing & Shandong Provincial Engineering and Technical Center of Light Manipulations, School of Physics and Electronics, Shandong Normal University, Jinan 250358, China
| | - Liangzhong Xiang
- School of Electrical and Computer Engineering, University of Oklahoma, Norman, OK 73019, USA
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Dosimetric and isocentric variations due to patient setup errors in CT-based treatment planning for breast cancer by electronic portal imaging. Med J Armed Forces India 2020; 76:51-57. [PMID: 32020969 DOI: 10.1016/j.mjafi.2018.07.008] [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: 06/21/2017] [Accepted: 07/12/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Inaccuracies in treatment setup during radiation therapy for breast cancers may increase risks to surrounding normal tissue toxicities, i.e. organs at risks (OARs), and compromise disease control. This study was planned to evaluate the dosimetric and isocentric variations and determine setup reproducibility and errors using an online electronic portal imaging (EPI) protocol. METHODS A total of 360 EPIs in 60 patients receiving breast/chest wall irradiation were evaluated. Cumulative dose-volume histograms (DVHs) were analyzed for mean doses to lung (V20) and heart (V30), setup source to surface distance (SSD) and central lung distance (CLD), and shifts in anterior-posterior (AP), superior-inferior (SI), and medial lateral (ML) directions. RESULTS Random errors ranged from 2 to 3 mm for the breast/chest wall (medial and lateral) tangential treatments and 2-2.5 mm for the anterior supraclavicular nodal field. Systematic errors ranged from 3 to 5 mm in the AP direction for the tangential fields and from 2.5 to 5 mm in the SI and ML direction for the anterior supraclavicular nodal field. For right-sided patients, V20 was 0.69-3.96 Gy, maximum lung dose was 40.5 Gy, V30 was 1.4-3 Gy, and maximum heart dose was 50.5 Gy. Similarly, for left-sided patients, the CLD (treatment planning system) was 25 mm-30 mm, CLD (EPIs) was 30-40 mm, V20 was 0.9-5.9 Gy, maximum lung dose was 45 Gy, V30 was 2.4-4.1 Gy, and maximum heart dose was 55 Gy. CONCLUSION Online assessment of patient position with matching of EPIs with digitally reconstructed radiographs (DRRs) is a useful method in evaluation of interfraction reproducibility in breast irradiation.
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Hattel SH, Andersen PA, Wahlstedt IH, Damkjaer S, Saini A, Thomsen JB. Evaluation of setup and intrafraction motion for surface guided whole-breast cancer radiotherapy. J Appl Clin Med Phys 2019; 20:39-44. [PMID: 31187538 PMCID: PMC6560238 DOI: 10.1002/acm2.12599] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 03/26/2019] [Accepted: 04/03/2019] [Indexed: 12/31/2022] Open
Abstract
Surface Guided Radiotherapy (SGRT) is a relatively new technique for positioning patients and for monitoring patient movement during treatment. SGRT is completely non-invasive since it uses visible light for determining the position of the patient surface. A reduction in daily imaging for patient setup is possible if the accuracy of SGRT is comparable to imaging. It allows for monitoring of intrafraction motion and the radiation beam can be held beyond a certain threshold resulting in a more accurate irradiation. The purpose of this study was to investigate setup uncertainty and the intrafraction motion in non-gated whole breast cancer radiotherapy treatment using an integrated implementation of AlignRT (OSMS) system as SGRT. In initial setup, SGRT was compared to three-point setup using tattoos on the patient and orthogonal kV imaging. For the investigation of intrafraction motion, OSMS monitored the patient with six degrees of freedom during treatment. Using three-point setup resulted in a setup root-mean-square error from the isocenter of 5.4 mm. This was improved to 4.2 mm using OSMS. For the translational directions, OSMS showed improvements in the lateral direction (P = 0.0009, Wilcoxon rank-sum), but for the longitudinal direction and rotation it was not possible to show improvements (P = 0.96 and P = 0.46, respectively). The vertical direction proved more accurate for three-point setup than OSMS (P = 0.000004). Intrafraction motion was very limited with a translational median of 1.1 mm from the isocenter. While OSMS showed marked improvements over laser and tattoo setup, the system did not prove accurate enough to replace the daily orthogonal kV images aligned to bony anatomy.
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Affiliation(s)
- Sandra Helene Hattel
- Department of Electrical Engineering, Technical University of Denmark, Lyngby, Denmark
| | | | - Isak Hannes Wahlstedt
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
| | - Sidsel Damkjaer
- Department of Clinical Oncology and Radiotherapy, Zealand University Hospital, Naestved, Denmark
| | - Arpit Saini
- Department of Clinical Oncology and Radiotherapy, Zealand University Hospital, Naestved, Denmark
| | - Jakob Borup Thomsen
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
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Byrne M, Archibald‐Heeren B, Hu Y, Fong A, Chong L, Teh A. Comparison of semiautomated tangential VMAT with 3DCRT for breast or chest wall and regional nodes. J Appl Clin Med Phys 2018; 19:684-693. [PMID: 30125454 PMCID: PMC6123166 DOI: 10.1002/acm2.12442] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/16/2018] [Accepted: 07/26/2018] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy to the breast after surgery sometimes requires adjoining nodes to be included in the treatment volume. In these cases, the traditional approach has been a complex 3-Dimensional Conformal Radiotherapy (3DCRT) beam arrangement which can result in significant dose heterogeneity at the beam junctions. A Volumetric Modulated Arc Therapy (VMAT) beam arrangement has previously been proposed for breast cases, where the chest wall/breast is treated with a limited angle (partial arc) tangential VMAT technique (Virén et al. [2015] Radiat Oncol. 10:79). In our study, this approach is extended to breast and chest wall cases with adjoining nodes by adding a separate conventional VMAT arc field specifically limited to the superior nodes. This VMAT method was implemented using a semiautomated approach on 27 patients, and the resultant plan compared to a monoisocentric 3DCRT plan. Plan statistics, Dose-Volume Histogram (DVH) analysis and Radiation Oncologist (RO) preference were assessed. When compared to the 3DCRT technique, the VMAT planning method was found to result in better target volume coverage, high doses to organs at risk (OAR) were reduced but greater OAR volumes received low doses. Having said that, the volume receiving low doses with this tangential VMAT technique was less than that of other VMAT planning methods described in the literature, and the integral dose was less than the 3DCRT method. The VMAT technique also resulted in more robust junction doses that the 3DCRT method. RO review found that the VMAT technique was preferred in 81% of cases. Specifically, the VMAT plans were preferred in all categories of patients except left chest wall cases where the intermammary nodes were also treated. The VMAT technique described here is a useful addition to the treatment options available for breast/chest wall and nodal patients.
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Affiliation(s)
- Mikel Byrne
- Radiation Oncology CentresSydney Adventist HospitalWahroongaNSWAustralia
| | - Ben Archibald‐Heeren
- Radiation Oncology CentresSydney Adventist HospitalWahroongaNSWAustralia
- Radiation Oncology CentresGosfordNSWAustralia
| | - Yunfei Hu
- Centre of Medical Radiation PhysicsUniversity of WollongongWollongongNSWAustralia
- Radiation Oncology CentresGosfordNSWAustralia
| | - Andrew Fong
- Radiation Oncology CentresSydney Adventist HospitalWahroongaNSWAustralia
| | - Leena Chong
- Radiation Oncology CentresSydney Adventist HospitalWahroongaNSWAustralia
| | - Amy Teh
- Radiation Oncology CentresSydney Adventist HospitalWahroongaNSWAustralia
- Centre of Medical Radiation PhysicsUniversity of WollongongWollongongNSWAustralia
- Sydney Adventist Hospital Clinical SchoolSydney Medical SchoolUniversity of SydneySydneyNSWAustralia
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Tyran M, Tallet A, Resbeut M, Ferre M, Favrel V, Fau P, Moureau-Zabotto L, Darreon J, Gonzague L, Benkemouche A, Varela-Cagetti L, Salem N, Farnault B, Acquaviva MA, Mailleux H. Safety and benefit of using a virtual bolus during treatment planning for breast cancer treated with arc therapy. J Appl Clin Med Phys 2018; 19:463-472. [PMID: 29959819 PMCID: PMC6123145 DOI: 10.1002/acm2.12398] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/25/2018] [Accepted: 05/31/2018] [Indexed: 12/19/2022] Open
Abstract
Purpose This study evaluates the benefit of a virtual bolus method for volumetric modulated arc therapy (VMAT) plan optimization to compensate breast modifications that may occur during breast treatment. Methods Ten files were replanned with VMAT giving 50 Gy to the breast and 47 Gy to the nodes within 25 fractions. The planning process used a virtual bolus for the first optimization, then the monitors units were reoptimized without bolus, after fixing the segments shapes. Structures and treatment planning were exported on a second scanner (CT) performed during treatment as a consequence to modifications in patient's anatomy. The comparative end‐point was clinical target volume's coverage. The first analysis compared the VMAT plans made using the virtual bolus method (VB‐VMAT) to the plans without using it (NoVB‐VMAT) on the first simulation CT. Then, the same analysis was performed on the second CT. Finally, the level of degradation of target volume coverage between the two CT using VB‐VMAT was compared to results using a standard technique of forward‐planned multisegment technique (Tan‐IMRT). Results Using a virtual bolus for VMAT does not degrade dosimetric results on the first CT. No significant result in favor of the NoVB‐VMAT plans was noted. The VB‐VMAT method led to significant better dose distribution on a second CT with modified anatomies compared to NoVB‐VMAT. The clinical target volume's coverage by 95% (V95%) of the prescribed dose was 98.9% [96.1–99.6] on the second CT for VB‐VMAT compared to 92.6% [85.2–97.7] for NoVB‐VMAT (P = 0.0002). The degradation of the target volume coverage for VB‐VMAT is not worse than for Tan‐IMRT: the median differential of V95% between the two CT was 0.9% for VMAT and 0.7% for Tan‐IMRT (P = 1). Conclusion This study confirms the safety and benefit of using a virtual bolus during the VMAT planning process to compensate potential breast shape modifications.
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Affiliation(s)
- Marguerite Tyran
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Agnes Tallet
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Michel Resbeut
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Marjorie Ferre
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Veronique Favrel
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Pierre Fau
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Julien Darreon
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Laurence Gonzague
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Ahcene Benkemouche
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Naji Salem
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Bertrand Farnault
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Hugues Mailleux
- Department of Radiation-Oncology, Institut Paoli-Calmettes, Marseille, France
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Chiu TD, Parsons D, Zhang Y, Hrycushko B, Zhao B, Chopra R, Kim N, Spangler A, Rahimi A, Timmerman R, Jiang SB, Lu W, Gu X. Prototype volumetric ultrasound tomography image guidance system for prone stereotactic partial breast irradiation: proof-of-concept. Phys Med Biol 2018; 63:055004. [PMID: 29405123 DOI: 10.1088/1361-6560/aaad1f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Accurate dose delivery in stereotactic partial breast irradiation (S-PBI) is challenging because of the target position uncertainty caused by breast deformation, the target volume changes caused by lumpectomy cavity shrinkage, and the target delineation uncertainty on simulation computed tomography (CT) images caused by poor soft tissue contrast. We have developed a volumetric ultrasound tomography (UST) image guidance system for prone position S-PBI. The system is composed of a novel 3D printed rotation water tank, a patient-specific resin breast immobilization cup, and a 1D array ultrasound transducer. Coronal 2D US images were acquired in 5° increments over a 360° range, and planes were acquired every 2 mm in elevation. A super-compounding technique was used to reconstruct the image volume. The image quality of UST was evaluated with a BB-1 breast phantom and BioZorb surgical marker, and the results revealed that UST offered better soft tissue contrast than CT and similar image quality to MR. In the evaluated plane, the size and location of five embedded objects were measured and compared to MR, which is considered as the ground truth. Objects' diameters and the distances between objects in UST differ by approximately 1 to 2 mm from those in MR, which showed that UST offers the image quality required for S-PBI. In future work we will develop a robotic system that will be ultimately implemented in the clinic.
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Affiliation(s)
- Tsuicheng D Chiu
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America. Tsuicheng Chiu and David Parsons contributed equally to this study
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Evaluation of RayStation robust optimisation for superficial target coverage with setup variation in breast IMRT. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2016; 39:705-16. [DOI: 10.1007/s13246-016-0466-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
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Jacob J, Heymann S, Borget I, Dumas I, Riahi E, Maroun P, Ezra P, Roberti E, Rivera S, Deutsch E, Bourgier C. Dosimetric Effects of the Interfraction Variations during Whole Breast Radiotherapy: A Prospective Study. Front Oncol 2015; 5:199. [PMID: 26442211 PMCID: PMC4584980 DOI: 10.3389/fonc.2015.00199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022] Open
Abstract
Introduction The aim of this work was to assess the dosimetric impact of the interfraction variations during breast radiotherapy. Materials and methods Daily portal imaging measurements were prospectively performed in 10 patients treated with adjuvant whole breast irradiation (50 Gy/25 fractions). Margins between the clinical target volume and the planning target volume (PTV) were 5 mm in the three dimensions. Parameters of interest were the central lung distance (CLD) and the inferior central margin (ICM). Daily movements were applied to the baseline treatment planning (TP1) to design a further TP (TP2). The PTV coverage and organ at risk exposure were measured on both TP1 and TP2, before being compared. Results A total of 241 portal images were analyzed. The random and systematic errors were 2.6 and 3.7 mm for the CLD, 4.3 and 6.9 mm for the ICM, respectively. No significant consequence on the PTV treatments was observed (mean variations: +0.1%, p = 0.56 and −1.8%, p = 0.08 for the breast and the tumor bed, respectively). The ipsilateral lung and heart exposure was not significantly modified. Conclusion In our series, the daily interfraction variations had no significant effect on the PTV coverage or healthy tissue exposure during breast radiotherapy.
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Affiliation(s)
- Julian Jacob
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Steve Heymann
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Isabelle Borget
- Department of Biostatistics and Epidemiology, Gustave Roussy , Villejuif , France ; University Paris-Sud , Kremlin-Bicêtre , France
| | - Isabelle Dumas
- Department of Physics, Gustave Roussy , Villejuif , France
| | - Elyes Riahi
- Department of Physics, Gustave Roussy , Villejuif , France
| | - Pierre Maroun
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Patrick Ezra
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Elena Roberti
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Sofia Rivera
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Eric Deutsch
- Department of Radiotherapy, Gustave Roussy , Villejuif , France ; University Paris-Sud , Kremlin-Bicêtre , France
| | - Céline Bourgier
- Department of Oncologic Radiotherapy, Institut du Cancer de Montpellier , Montpellier , France
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