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Håkansson K, Josipovic M, Ottosson W, Behrens CP, Vogelius IR, Persson G. Evaluating the dosimetric effect of intra-fractional variations in deep inspiration breath-hold radiotherapy - a proof-of-concept study. Acta Oncol 2023; 62:1246-1250. [PMID: 37738385 DOI: 10.1080/0284186x.2023.2259084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/10/2023] [Indexed: 09/24/2023]
Affiliation(s)
- K Håkansson
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - M Josipovic
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - W Ottosson
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - C P Behrens
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Roskilde, Denmark
| | - I R Vogelius
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
| | - G Persson
- Department of Clinical Medicine, Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
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Mørkeset ST, Lervåg C, Lund JÅ, Jensen C. Clinical experience of volumetric-modulated flattening filter free stereotactic body radiation therapy of lesions in the lung with deep inspiration breath-hold. J Appl Clin Med Phys 2022; 23:e13733. [PMID: 35867387 PMCID: PMC9512343 DOI: 10.1002/acm2.13733] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/19/2022] [Accepted: 06/23/2022] [Indexed: 11/05/2022] Open
Abstract
This clinical study aimed to evaluate lung cancer patients' ability to perform deep inspiration breath-hold (DIBH) during CT simulation and throughout the treatment course of stereotactic body radiation therapy (SBRT). In addition, target sizes, organ at risk (OAR) sizes, and doses to the respective volumes in filter-free volumetric-modulated arc therapy plans performed under free-breathing (FB) and DIBH conditions were evaluated. Twenty-one patients with peripheral lesions were included, of which 13 were eligible for SBRT. All patients underwent training for breath-hold during CT, and if they complied with the requirements, two CT scans were obtained: CT scan in DIBH and a four-dimensional CT scan in FB. The treatment plans in FB and DIBH were generated, and the dose parameters and volume sizes were compared. The endpoints for evaluation were patient compliance, target dose coverage, and doses to the OARs. This clinical study showed high patient DIBH compliance during both CT simulation and treatment for patients with lung cancer. A significant reduction in target volumes was achieved with SBRT in DIBH, in addition to significantly decreased doses to the heart, chest wall, and lungs. DIBH in SBRT of lung lesions is feasible, and a routine to manage intra-fractional deviation should be established upon implementation.
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Affiliation(s)
- Siri T Mørkeset
- Department of Oncology and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Christoffer Lervåg
- Department of Oncology and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
| | - Jo-Åsmund Lund
- Department of Oncology and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway.,Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway
| | - Christer Jensen
- Department of Health Sciences in Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Ålesund, Norway.,Department of Medicine and Healthcare, Møre and Romsdal Hospital Trust, Ålesund Hospital, Ålesund, Norway
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Harris W, Yorke E, Li H, Czmielewski C, Chawla M, Lee RP, Hotca-Cho A, McKnight D, Rimner A, Lovelock DM. Can bronchoscopically implanted anchored electromagnetic transponders be used to monitor tumor position and lung inflation during deep inspiration breath-hold lung radiotherapy? Med Phys 2022; 49:2621-2630. [PMID: 35192211 PMCID: PMC9007909 DOI: 10.1002/mp.15565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/22/2022] [Accepted: 02/05/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate the efficacy of using bronchoscopically implanted anchored electromagnetic transponders (EMTs) as surrogates for 1) tumor position and 2) repeatability of lung inflation during deep-inspiration breath-hold (DIBH) lung radiotherapy. METHODS 41 patients treated with either hypofractionated (HF) or conventional (CF) lung radiotherapy on an IRB approved prospective protocol using coached DIBH were evaluated for this study. Three anchored EMTs were bronchoscopically implanted into small airways near or within the tumor. DIBH treatment was gated by tracking the EMT positions. Breath-hold cone-beam-CTs (CBCTs) were acquired prior to every HF treatment or weekly for CF patients. Retrospectively, rigid registrations between each CBCT and the breath-hold planning CT were performed to match to 1) spine 2) EMTs and 3) tumor. Absolute differences in registration between EMTs and spine were analyzed to determine surrogacy of EMTs for lung inflation. Differences in registration between EMTs and tumor were analyzed to determine surrogacy of EMTs for tumor position. The stability of the EMTs was evaluated by analyzing the difference between inter-EMT displacements recorded at treatment from that of the plan for the CF patients, as well as the geometric residual (GR) recorded at the time of treatment. RESULTS 219 CBCTs were analyzed. The average differences between EMT centroid and spine registration among all CBCTs were 0.45±0.42cm, 0.29±0.28cm, and 0.18±0.15cm in superior-inferior (SI), anterior-posterior (AP) and lateral directions, respectively. Only 59% of CBCTs had differences in registration <0.5cm for EMT centroid compared to spine, indicating that lung inflation is not reproducible from simulation to treatment. The average differences between EMT centroid and tumor registration among all CBCTs were 0.13±0.13cm, 0.14±0.13cm and 0.12±0.12cm in SI, AP and lateral directions, respectively. 95% of CBCTs resulted in <0.5cm change between EMT centroid and tumor registration, indicating that EMT positions correspond well with tumor position during treatments. Six out of the 7 recorded CF patients had average differences in inter-EMT displacements to be ≤0.26cm and average GR ≤0.22cm, indicating that the EMTs are stable throughout treatment. CONCLUSIONS Bronchoscopically implanted anchored EMTs are good surrogates for tumor position and are reliable for maintaining tumor position when tracked during DIBH treatment, as long as the tumor size and shape are stable. Large differences in registration between EMTs and spine for many treatments suggest that lung inflation achieved at simulation is often not reproduced. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Wendy Harris
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Henry Li
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Christian Czmielewski
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Mohit Chawla
- Department of Medicine, Pulmonary Service, Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Robert P Lee
- Department of Medicine, Pulmonary Service, Section of Interventional Pulmonology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Alexandra Hotca-Cho
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Dominique McKnight
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
| | - D Michael Lovelock
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065
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Josipovic M, Aznar MC, Thomsen JB, Scherman J, Damkjaer SM, Nygård L, Specht L, Pøhl M, Persson GF. Deep inspiration breath hold in locally advanced lung cancer radiotherapy: validation of intrafractional geometric uncertainties in the INHALE trial. Br J Radiol 2019; 92:20190569. [PMID: 31544478 DOI: 10.1259/bjr.20190569] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Patients with locally advanced non-small cell lung cancer (NSCLC) were included in a prospective trial for radiotherapy in deep inspiration breath hold (DIBH). We evaluated DIBH compliance and target position reproducibility. METHODS Voluntary, visually guided DIBHs were performed with optical tracking. Patients underwent three consecutive DIBH CT scans for radiotherapy planning. We evaluated the intrafractional uncertainties in the position of the peripheral tumour, lymph nodes and differential motion between them, enabling PTV margins calculation. Patients who underwent all DIBH imaging and had tumour position reproducibility <8 mm were up-front DIBH compliant. Patients who performed DIBHs throughout the treatment course were overall DIBH compliant. Clinical parameters and DIBH-related uncertainties were validated against our earlier pilot study. RESULTS 69 of 88 included patients received definitive radiotherapy. 60/69 patients (87%) were up-front DIBH compliant. DIBH plan was not superior in seven patients and three lost DIBH ability during the treatment, leaving 50/69 patients (72%) overall DIBH compliant.The systematic and random errors between consecutive DIBHs were small but differed from the pilot study findings. This led to slightly different PTV margins between the two studies. CONCLUSIONS DIBH compliance and reproducibility was high. Still, this validation study highlighted the necessity of designing PTV margins in larger, representative patient cohorts. ADVANCES IN KNOWLEDGE We demonstrated high DIBH compliance in locally advanced NSCLC patients. DIBH does not eliminate but mitigates the target position uncertainty, which needs to be accounted for in treatment margins. Margin design should be based on data from larger representative patient groups.
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Affiliation(s)
- Mirjana Josipovic
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, Faculty of Science, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark
| | - Marianne C Aznar
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, Faculty of Science, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark.,Manchester Cancer Research Centre, Division of Cancer Science, University of Manchester, c/o the Christie NHS, Wilmslow Road, Manchester M20 4BX, UK.,Department of Clinical Medicine, Faculty of Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark
| | - Jakob B Thomsen
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jonas Scherman
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Niels Bohr Institute, Faculty of Science, University of Copenhagen, Blegdamsvej 17, 2100 Copenhagen, Denmark.,Department of Hematology and Oncology Radiation Physics, Skåne University Hospital, 21185 Lund, Sweden
| | - Sidsel Ms Damkjaer
- Department of Hematology and Oncology Radiation Physics, Skåne University Hospital, 21185 Lund, Sweden
| | - Lotte Nygård
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lena Specht
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark
| | - Mette Pøhl
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Gitte F Persson
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark.,Department of Oncology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark
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Josipovic M, Persson GF, Rydhög JS, Smulders B, Thomsen JB, Aznar MC. Advanced dose calculation algorithms in lung cancer radiotherapy: Implications for SBRT and locally advanced disease in deep inspiration breath hold. Phys Med 2018; 56:50-57. [PMID: 30527089 DOI: 10.1016/j.ejmp.2018.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 11/01/2018] [Accepted: 11/18/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE Evaluating performance of modern dose calculation algorithms in SBRT and locally advanced lung cancer radiotherapy in free breathing (FB) and deep inspiration breath hold (DIBH). METHODS For 17 patients with early stage and 17 with locally advanced lung cancer, a plan in FB and in DIBH were generated with Anisotropic Analytical Algorithm (AAA). Plans for early stage were 3D-conformal SBRT, 45 Gy in 3 fractions, prescribed to 95% isodose covering 95% of PTV and aiming for 140% dose centrally in the tumour. Locally advanced plans were volumetric modulated arc therapy, 66 Gy in 33 fractions, prescribed to mean PTV dose. Calculation grid size was 1 mm for SBRT and 2.5 mm for locally advanced plans. All plans were recalculated with AcurosXB with same MU as in AAA, for comparison on target coverage and dose to risk organs. RESULTS Lung volume increased in DIBH, resulting in decreased lung density (6% for early and 13% for locally-advanced group). In SBRT, AAA overestimated mean and near-minimum PTV dose (p-values < 0.01) compared to AcurosXB, with largest impact in DIBH (differences of up to 11 Gy). These clinically relevant differences may be a combination of small targets and large dose gradients within the PTV. In locally advanced group, AAA overestimated mean GTV, CTV and PTV doses by median less than 0.8 Gy and near-minimum doses by median 0.4-2.7 Gy. No clinically meaningful difference was observed for lung and heart dose metrics between the algorithms, for both FB and DIBH. CONCLUSIONS AAA overestimated target coverage compared to AcurosXB, especially in DIBH for SBRT.
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Affiliation(s)
- Mirjana Josipovic
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Blegdamsvej17, 2100 Copenhagen, Denmark.
| | - Gitte Fredberg Persson
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jonas Scherman Rydhög
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Niels Bohr Institute, Faculty of Science, University of Copenhagen, Blegdamsvej17, 2100 Copenhagen, Denmark; Department of Radiation Physics, Skåne University Hospital, Lund University, 221 85 Lund, Sweden.
| | - Bob Smulders
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jakob Borup Thomsen
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Marianne Camille Aznar
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Faculty of Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark; Manchester Cancer Research Centre, Division of Cancer Science, University of Manchester, Wilmslow Road, Manchester M20 4BX, UK; Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
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Medical physics in radiation Oncology: New challenges, needs and roles. Radiother Oncol 2017; 125:375-378. [PMID: 29150160 DOI: 10.1016/j.radonc.2017.10.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 12/21/2022]
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Sibolt P, Andersen CE, Ottosson W, Behrens CF. Time-resolved plastic scintillator dosimetry in a dynamic thorax phantom. RADIAT MEAS 2017. [DOI: 10.1016/j.radmeas.2017.04.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Persson GF, Scherman Rydhög J, Josipovic M, Maraldo MV, Nygård L, Costa J, Berthelsen AK, Specht L, Aznar MC. Deep inspiration breath-hold volumetric modulated arc radiotherapy decreases dose to mediastinal structures in locally advanced lung cancer. Acta Oncol 2016; 55:1053-6. [PMID: 26935017 DOI: 10.3109/0284186x.2016.1142115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/05/2016] [Accepted: 01/10/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Gitte F Persson
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
| | - Jonas Scherman Rydhög
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
- b Faculty of Science , Niels Bohr Institute, Copenhagen University , Copenhagen , Denmark
| | - Mirjana Josipovic
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
- b Faculty of Science , Niels Bohr Institute, Copenhagen University , Copenhagen , Denmark
| | - Maja V Maraldo
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
| | - Lotte Nygård
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
| | - Junia Costa
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
- c Department of Clinical Physiology, Nuclear Medicine and PET , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
| | - Anne K Berthelsen
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
- c Department of Clinical Physiology, Nuclear Medicine and PET , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
| | - Lena Specht
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
- d Faculty of Medical Sciences , Panum Institute, Copenhagen University , Copenhagen , Denmark
| | - Marianne C Aznar
- a Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark
- b Faculty of Science , Niels Bohr Institute, Copenhagen University , Copenhagen , Denmark
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The advantage of deep-inspiration breath-hold and cone-beam CT based soft-tissue registration for locally advanced lung cancer radiotherapy. Radiother Oncol 2016; 119:432-7. [DOI: 10.1016/j.radonc.2016.03.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 03/17/2016] [Accepted: 03/18/2016] [Indexed: 11/18/2022]
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