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Fu W, Zhang Y, Mehta K, Chen A, Musunuru HB, Pucci P, Kubis J, Huq MS. Evaluating intra-fractional tumor motion in lung stereotactic radiotherapy with deep inspiration breath-hold. J Appl Clin Med Phys 2024:e14414. [PMID: 38803045 DOI: 10.1002/acm2.14414] [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: 02/27/2024] [Revised: 04/19/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE To evaluate the intra-fractional tumor motion in lung stereotactic body radiotherapy (SBRT) with deep inspiration breath-hold (DIBH), and to investigate the adequacy of the current planning target volume (PTV) margins. METHODS Twenty-eight lung SBRT patients with DIBH were selected in this study. Among the lesions, twenty-three were at right or left lower lobe, two at right middle lobe, and three at right or left upper lobe. Post-treatment gated cone-beam computed tomography (CBCT) was acquired to quantify the intra-fractional tumor shift at each treatment. These obtained shifts were then used to calculate the required PTV margin, which was compared with the current applied margin of 5 mm margin in anterior-posterior (AP) and right-left (RL) directions and 8 mm in superior-inferior (SI) direction. The beam delivery time was prolonged with DIBH. The actual beam delivery time with DIBH (Tbeam_DIBH) was compared with the beam delivery time without DIBH (Tbeam_wo_DIBH) for the corresponding SBRT plan. RESULTS A total of 113 treatments were analyzed. At six treatments (5.3%), the shifts exceeded the tolerance defined by the current PTV margin. The average shifts were 0.0 ± 1.9 mm, 0.1±1.5 mm, and -0.5 ± 3.7 mm in AP, RL, and SI directions, respectively. The required PTV margins were determined to be 4.5, 3.9, and 7.4 mm in AP, RL, and SI directions, respectively. The average Tbeam_wo_DIBH and Tbeam_DIBH were 2.4 ± 0.4 min and 3.6 ± 1.5 min, respectively. The average treatment slot for lung SBRT with DIBH was 25.3 ± 7.9 min. CONCLUSION Intra-fractional tumor motion is the predominant source of treatment uncertainties in CBCT-guided lung SBRT with DIBH. The required PTV margin should be determined based on data specific to each institute, considering different techniques and populations. Our data indicate that our current applied PTV margin is adequate, and it is possible to reduce further in the RL direction. The time increase of Tbeam_DIBH, relative to the treatment slot, is not clinically significant.
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Affiliation(s)
- Weihua Fu
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Yongqian Zhang
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Kiran Mehta
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Alex Chen
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Hima Bindu Musunuru
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Pietro Pucci
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Jason Kubis
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - M Saiful Huq
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
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Guo HL, Wu WW, Huan Y, Zhang HW. SGRT-based stereotactic body radiotherapy for lung cancer setup accuracy and margin of the PTV. J Appl Clin Med Phys 2024; 25:e14195. [PMID: 37915300 DOI: 10.1002/acm2.14195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/09/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Surface-guided radiation therapy (SGRT, AlignRT) was used to analyze motion during stereotactic body radiotherapy (SBRT) in lung cancer patients and to explore the margin of the planning target volume (PTV). METHODS The residual errors of the AlignRT were evaluated based on grayscale cone-beam computed tomography registration results before each treatment. AlignRT log file was used to analyze the correlation between the frequency and longest duration of errors larger than 2 mm and lasting longer than 2 s and maximum error with age and treatment duration. The displacement value at the end of treatment, the average displacement value, and the 95% probability density displacement interval were defined as intrafraction errors, and PTV1, PTV2, PTV3 were calculated by Van Herk formula or Z score analysis. Organ dosimetric differences were compared after the experience-based margin was replaced with PTV3. RESULTS The interfraction residual errors were Vrt0 , 0.06 ± 0.18 cm; Lng0 , -0.03 ± 0.19 cm; Lat0 , 0.02 ± 0.15 cm; Pitch0 , 0.23 ± 0.7°; Roll0 , 0.1 ± 0.69°; Rtn0 , -0.02 ± 0.79°. The frequency, longest duration and maximum error in vertical direction were correlated with treatment duration (r = 0.404, 0.353, 0.283, p < 0.05, respectively). In the longitudinal direction, the frequency was correlated with age and treatment duration (r = 0.376, 0.283, p < 0.05, respectively), maximum error was correlated with age (r = 0.4, P < 0.05). Vertical, longitudinal, lateral margins of PTV1, PTV2, PTV3 were 2 mm, 4 mm, 2 mm; 2 mm, 2 mm, 2 mm, 3 mm, 5 mm, 3 mm, respectively. After replacing the original PTV, mean lung dose (MLD), 2-cm3 chest wall dose (CD), lung V20 decreased by 0.2 Gy, 2.1 Gy, 0.5%, respectively (p < 0.05). CONCLUSION AlignRT can be used for interfraction setup and monitoring intrafraction motion. It is more reasonable to use upper and lower limits of the 95% probability density interval as an intrafraction error.
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Affiliation(s)
- Hai-Liang Guo
- Department of Oncology, the First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Wei-Wei Wu
- Department of Radiotherapy, the Affiliated Cancer Hospital of Gannan Medical University, GanZhou Cancer Hospital, Ganzhou, China
| | - Yan Huan
- Department of Oncology, People's Hospital of Qianxinan Buyi and Miao Minority Autonomous Prefecture, Qian xinan, China
| | - Huai-Wen Zhang
- Department of Radiotherapy, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, NHC Key Laboratory of Personalized Diagnosis and Treatment of Nasopharyngeal Carcinoma, Nanchang, China
- Department of Oncology, The Third People's Hospital of Jingdezhen, Jingdezhen, China
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Essers M, Mesch L, Beugeling M, Dekker J, de Kruijf W. Setup and intra-fractional motion measurements using surface scanning in head and neck cancer radiotherapy- A feasibility study. Phys Imaging Radiat Oncol 2024; 29:100563. [PMID: 38444887 PMCID: PMC10912619 DOI: 10.1016/j.phro.2024.100563] [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: 08/31/2023] [Revised: 12/30/2023] [Accepted: 02/15/2024] [Indexed: 03/07/2024] Open
Abstract
Background and purpose Surface-guided radiotherapy (SGRT) is applied to improve patient set-up and to monitor intra-fraction motion. Head and neck cancer (H&N) patients are usually fixated using 5-point thermoplastic masks, that are experienced as uncomfortable or even stressful. Therefore, the feasibility of irradiating H&N patients without a mask by using SGRT was examined. Material and methods Nineteen H&N patients were included in a simulation study. Once a week, before the standard treatment, a maskless treatment was simulated, using SGRT for setup and intrafraction motion monitoring. Initial patient setup accuracy and intrafraction motion was determined using ConeBeam CT (CBCT) images as well as SGRT before and after the (simulated) treatment. The clinical target volume to planning target volume (CTV-PTV) margin for intrafraction motion was calculated. Using patient questionnaires, the patient-friendliness H&N irradiation with and without mask was determined. Results Maskless setup with SGRT and CBCT was as accurate as with a mask. SGRT showed that intrafraction motion was gradual during the treatment. The CTV-PTV margin correcting for intrafraction motion was 1.7 mm for maskless treatment without interventions, and 1.2 mm if corrected for motions > 2 mm. For 19 % of fractions, the intrafraction motion, as detected by both SGRT and CBCT, was larger than 2 mm in at least one direction. Sixteen patients preferred maskless treatment, while 3 worried they would move too much. Conclusions Using SGRT and a standard head rest resulted in a patient-friendly treatment with accurate patient setup and acceptably small intrafraction motion for H&N patients.
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Affiliation(s)
- Marion Essers
- Institute Verbeeten, Medical Physics & Instrumentation, PO Box 90120, 5000 LA Tilburg, the Netherlands
| | - Lennart Mesch
- Institute Verbeeten, Radiotherapy, PO Box 90120, 5000 LA Tilburg, the Netherlands
| | - Maaike Beugeling
- Institute Verbeeten, Radiotherapy, PO Box 90120, 5000 LA Tilburg, the Netherlands
| | - Janita Dekker
- Institute Verbeeten, Medical Physics & Instrumentation, PO Box 90120, 5000 LA Tilburg, the Netherlands
| | - Willy de Kruijf
- Institute Verbeeten, Medical Physics & Instrumentation, PO Box 90120, 5000 LA Tilburg, the Netherlands
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Psarras M, Stasinou D, Stroubinis T, Protopapa M, Zygogianni A, Kouloulias V, Platoni K. Surface-Guided Radiotherapy: Can We Move on from the Era of Three-Point Markers to the New Era of Thousands of Points? Bioengineering (Basel) 2023; 10:1202. [PMID: 37892932 PMCID: PMC10604452 DOI: 10.3390/bioengineering10101202] [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: 09/06/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
The surface-guided radiotherapy (SGRT) technique improves patient positioning with submillimeter accuracy compared with the conventional positioning technique of lasers using three-point tattoos. SGRT provides solutions to considerations that arise from the conventional setup technique, such as variability in tattoo position and the psychological impact of the tattoos. Moreover, SGRT provides monitoring of intrafractional motion. PURPOSE This literature review covers the basics of SGRT systems and examines whether SGRT can replace the traditional positioning technique. In addition, it investigates SGRT's potential in reducing positioning times, factors affecting SGRT accuracy, the effectiveness of live monitoring, and the impact on patient dosage. MATERIALS AND METHODS This study focused on papers published from 2016 onward that compared SGRT with the traditional positioning technique and investigated factors affecting SGRT accuracy and effectiveness. RESULTS/CONCLUSIONS SGRT provides the same or better results regarding patient positioning. The implementation of SGRT can reduce overall treatment time. It is an effective technique for detecting intrafraction patient motion, improving treatment accuracy and precision, and creating a safe and comfortable environment for the patient during treatment.
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Affiliation(s)
- Michalis Psarras
- Medical Physics Unit, 2nd Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
| | - Despoina Stasinou
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
| | - Theodoros Stroubinis
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
| | - Maria Protopapa
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
| | - Anna Zygogianni
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Vassilis Kouloulias
- Radiation Oncology Unit, 2nd Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Kalliopi Platoni
- Medical Physics Unit, 2nd Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
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Ehrbar S, Schrader M, Marvaso G, Perryck S, Van Timmeren JE, Pavic M, Moreira A, Tanadini-Lang S, Guckenberger M, Andratschke N, Garcia Schüler H. Intra- and inter-fraction breath-hold variations and margins for radiotherapy of abdominal targets. Phys Imaging Radiat Oncol 2023; 28:100509. [PMID: 38045640 PMCID: PMC10692905 DOI: 10.1016/j.phro.2023.100509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/20/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023] Open
Abstract
Radiotherapy in expiration breath-hold (EBH) has the potential to reduce treatment volumes of abdominal targets compared to an internal target volume concept in free-breathing. The reproducibility of EBH and required safety margins were investigated to quantify this volumetric benefit. Pre- and post-treatment diaphragm position difference and the positioning variability were determined on computed tomography. Systematic and random errors for EBH position reproducibility and positioning variability were calculated, resulting in margins of 7 to 12 mm depending on the prescription isodose and fractionation. A reduced volume was shown for EBH for lesions with superior-inferior breathing motion above 4 to 8 mm.
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Affiliation(s)
- Stefanie Ehrbar
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Markus Schrader
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giulia Marvaso
- Department of Radiation Oncology, European Institute of Oncology IRCSS, Milan, Italy
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Sophie Perryck
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Janita E. Van Timmeren
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matea Pavic
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Amanda Moreira
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Helena Garcia Schüler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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