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Liang E, Dolan JL, Morris ED, Vono J, Bazan LF, Lu M, Glide-Hurst CK. Application of Continuous Positive Airway Pressure for Thoracic Respiratory Motion Management: An Assessment in a Magnetic Resonance Imaging–Guided Radiation Therapy Environment. Adv Radiat Oncol 2022; 7:100889. [PMID: 35198838 PMCID: PMC8844850 DOI: 10.1016/j.adro.2021.100889] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/06/2021] [Indexed: 12/22/2022] Open
Abstract
Purpose Patient tolerability of magnetic resonance (MR)–guided radiation treatment delivery is limited by the need for repeated deep inspiratory breath holds (DIBHs). This volunteer study assessed the feasibility of continuous positive airway pressure (CPAP) with and without DIBH for respiratory motion management during radiation treatment with an MR-linear accelerator (MR-linac). Methods and Materials MR imaging safety was first addressed by placing the CPAP device in an MR-safe closet and configuring a tube circuit via waveguide to the magnet bore. Reproducibility and linearity of the final configuration were assessed. Six healthy volunteers underwent thoracic imaging in a 0.35T MR-linac, with one free breathing (FB) and 2 DIBH acquisitions being obtained at 5 pressures from 0 to 15 cm-H2O. Lung and heart volumes and positions were recorded; repeatability was assessed by comparing 2 consecutive DIBH scans. Blinded reviewers graded images for motion artifact using a 3-point grading scale. Participants completed comfort and perception surveys before and after imaging sessions. Results Compared with FB alone, FB-10, FB-12, and FB-15 cm H2O significantly increased lung volumes (+23%, +34%, +44%; all P <.05) and inferiorly displaced the heart (0.86 cm, 0.96 cm, 1.18 cm; all P < . 05). Lung volumes were significantly greater with DIBH-0 cm H2O compared with FB-15 cm H2O (+105% vs +44%, P = .01), and DIBH-15 cm H2O yielded additional volume increase (+131% vs +105%, P = .01). Adding CPAP to DIBH decreased lung volume differences between consecutive breath holds (correlation coefficient 0.97 at 15 cm H2O vs 0.00 at 0 cm H2O). The addition of 15 cm H2O CPAP reduced artifact scores (P = .03) compared with FB; all DIBH images (0-15 cm H2O) had less artifact (P < .01). Conclusions This work demonstrates the feasibility of integrating CPAP in an MR-linac environment in healthy volunteers. Extending this work to a larger patient cohort is warranted to further establish the role of CPAP as an alternative and concurrent approach to DIBH in MR-guided radiation therapy.
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Affiliation(s)
- Evan Liang
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Corresponding author: Evan Liang, MD
| | - Jennifer L. Dolan
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Eric D. Morris
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Jonathan Vono
- Department of Pulmonary and Sleep Medicine, Henry Ford Health System, Detroit, Michigan
| | - Luisa F. Bazan
- Department of Pulmonary and Sleep Medicine, Henry Ford Health System, Detroit, Michigan
| | - Mei Lu
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
| | - Carri K. Glide-Hurst
- Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin
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Li H, Dong L, Bert C, Chang J, Flampouri S, Jee KW, Lin L, Moyers M, Mori S, Rottmann J, Tryggestad E, Vedam S. Report of AAPM Task Group 290: Respiratory motion management for particle therapy. Med Phys 2022; 49:e50-e81. [PMID: 35066871 PMCID: PMC9306777 DOI: 10.1002/mp.15470] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 12/28/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Dose uncertainty induced by respiratory motion remains a major concern for treating thoracic and abdominal lesions using particle beams. This Task Group report reviews the impact of tumor motion and dosimetric considerations in particle radiotherapy, current motion‐management techniques, and limitations for different particle‐beam delivery modes (i.e., passive scattering, uniform scanning, and pencil‐beam scanning). Furthermore, the report provides guidance and risk analysis for quality assurance of the motion‐management procedures to ensure consistency and accuracy, and discusses future development and emerging motion‐management strategies. This report supplements previously published AAPM report TG76, and considers aspects of motion management that are crucial to the accurate and safe delivery of particle‐beam therapy. To that end, this report produces general recommendations for commissioning and facility‐specific dosimetric characterization, motion assessment, treatment planning, active and passive motion‐management techniques, image guidance and related decision‐making, monitoring throughout therapy, and recommendations for vendors. Key among these recommendations are that: (1) facilities should perform thorough planning studies (using retrospective data) and develop standard operating procedures that address all aspects of therapy for any treatment site involving respiratory motion; (2) a risk‐based methodology should be adopted for quality management and ongoing process improvement.
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Affiliation(s)
- Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Lei Dong
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Christoph Bert
- Department of Radiation Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Joe Chang
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stella Flampouri
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Kyung-Wook Jee
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Liyong Lin
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | - Michael Moyers
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, Fudan University Cancer Hospital, Shanghai, China
| | - Shinichiro Mori
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan
| | - Joerg Rottmann
- Center for Proton Therapy, Proton Therapy Singapore, Proton Therapy Pte Ltd, Singapore
| | - Erik Tryggestad
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sastry Vedam
- Department of Radiation Oncology, University of Maryland, Baltimore, USA
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van Amerongen MJ, Mariappan P, Voglreiter P, Flanagan R, Jenniskens SFM, Pollari M, Kolesnik M, Moche M, Fütterer JJ. Software-based planning of ultrasound and CT-guided percutaneous radiofrequency ablation in hepatic tumors. Int J Comput Assist Radiol Surg 2021; 16:1051-1057. [PMID: 33974224 PMCID: PMC8166805 DOI: 10.1007/s11548-021-02394-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/28/2021] [Indexed: 11/24/2022]
Abstract
Objectives Radiofrequency ablation (RFA) can be associated with local recurrences in the treatment of liver tumors. Data obtained at our center for an earlier multinational multicenter trial regarding an in-house developed simulation software were re-evaluated in order to analyze whether the software was able to predict local recurrences. Methods Twenty-seven RFA ablations for either primary or secondary hepatic tumors were included. Colorectal liver metastases were shown in 14 patients and hepatocellular carcinoma in 13 patients. Overlap of the simulated volume and the tumor volume was automatically generated and defined as positive predictive value (PPV) and additionally visually assessed. Local recurrence during follow-up was defined as gold standard. Sensitivity and specificity were calculated using the visual assessment and gold standard. Results Mean tumor size was 18 mm (95% CI 15–21 mm). Local recurrence occurred in 5 patients. The PPV of the simulation showed a mean of 0.89 (0.84–0.93 95% CI). After visual assessment, 9 incomplete ablations were observed, of which 4 true positives and 5 false positives for the detection of an incomplete ablation. The sensitivity and specificity were, respectively, 80% and 77% with a correct prediction in 78% of cases. No significant correlation was found between size of the tumor and PPV (Pearson Correlation 0.10; p = 0.62) or between PPV and recurrence rates (Pearson Correlation 0.28; p = 0.16). Conclusions The simulation software shows promise in estimating the completeness of liver RFA treatment and predicting local recurrence rates, but could not be performed real-time. Future improvements in the field of registration could improve results and provide a possibility for real-time implementation.
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Affiliation(s)
- M J van Amerongen
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands.
| | - P Mariappan
- NUMA Engineering Services Ltd., Louth, Ireland.,Department of Mathematics and Statistics, IIT Tirupati, Tirupati, India
| | - P Voglreiter
- Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria
| | - R Flanagan
- NUMA Engineering Services Ltd., Louth, Ireland
| | - S F M Jenniskens
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - M Pollari
- Department of Computer Science, Aalto University School of Science and Technology, Espoo, Finland
| | - M Kolesnik
- Fraunhofer Institute for Applied Information Technology FIT, Sankt Augustin, Germany
| | - M Moche
- Department of Interventional Radiology, Helios Park-Klinikum Leipzig, Leipzig, Germany
| | - J J Fütterer
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands.,Robotics and Mechatronics (RaM), University of Twente, Enschede, The Netherlands
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Percussion assisted radiation therapy in Hodgkin lymphoma allows a marked reduction in heart dose. Radiother Oncol 2020; 152:163-168. [PMID: 32448409 DOI: 10.1016/j.radonc.2019.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE Early-stage Hodgkin lymphoma (HL) is a highly curable disease but the treatment can induce late complications many years later. Irradiation of the healthy heart is inevitable during radiation treatment of mediastinal sites. We developed a novel method to induce a prolonged apnea-like state that can help decrease the dose to organs at risk during radiation therapy. We present the results of the first 8 HL patients treated routinely with percussion assisted radiation therapy (PART) in our clinic. MATERIAL AND METHODS We used a newly developed high-frequency non-invasive ventilation system to suppress respiratory motion for prolonged periods and push the heart away from the treated volume. RESULTS All 8 patients were able to rapidly learn the technique and had an advantage to be treated by PART. We lowered the mean heart dose by an average of 3 Gy with similar target coverage compared to a classical free breathing treatment plan. They were all treated for 15 radiotherapy sessions by PART without any notable side effects. CONCLUSIONS Percussion assisted radiation therapy can be used routinely to reduce the dose to the heart in Hodgkin lymphoma.
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Effect of continuous positive airway pressure administration during lung stereotactic ablative radiotherapy: a comparative planning study. Strahlenther Onkol 2018; 194:591-599. [DOI: 10.1007/s00066-018-1278-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 01/29/2018] [Indexed: 12/25/2022]
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van Breugel JMM, Wijlemans JW, Vaessen HHB, de Greef M, Moonen CTW, van den Bosch MAAJ, Ries MG. Procedural sedation and analgesia for respiratory-gated MR-HIFU in the liver: a feasibility study. J Ther Ultrasound 2016; 4:19. [PMID: 27478615 PMCID: PMC4966712 DOI: 10.1186/s40349-016-0063-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 07/08/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Previous studies demonstrated both pre-clinically and clinically the feasibility of magnetic resonance-guided high-intensity focused ultrasound (MR-HIFU) ablations in the liver. To overcome the associated problem of respiratory motion of the ablation area, general anesthesia (GA) and mechanical ventilation was used in conjunction with either respiratory-gated energy delivery or energy delivery during induced apnea. However, clinical procedures requiring GA are generally associated with increased mortality, morbidity, and complication rate compared to procedural sedation and analgesia (PSA). Furthermore, PSA is associated with faster recovery and an increased eligibility for non- and mini-invasive interventions. METHODS In this study, we investigate both in an animal model and on a small patient group the kinetics of the diaphragm during free-breathing, when a tailored remifentanil/propofol-based PSA protocol inducing partial respiratory depression is used. Subsequently, we demonstrate in an animal study the compatibility of the resulting respiratory pattern of the PSA protocol with a gated HIFU ablation in the liver by direct comparison with gated ablations conducted under GA. Wilcoxon signed-rank tests were performed for statistical analysis of non-perfused and necrosed tissue volumes. Duty cycles (ratio or percentage of the breathing cycle with the diaphragm in its resting position, such that acoustic energy delivery with MR-HIFU was allowed) were statistically compared for both GA and PSA using student's t tests. RESULTS In both animal and human experiments, the breathing frequency was decreased below 9/min, while maintaining stable vital functions. Furthermore an end-exhalation resting phase was induced by this PSA protocol during which the diaphragm is virtually immobile. Median non-perfused volumes, non-viable volumes based on NADH staining, and duty cycles were larger under PSA than under GA or equal. CONCLUSIONS We conclude that MR-HIFU ablations of the liver under PSA are feasible and potentially increase the non-invasive nature of this type of intervention.
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Affiliation(s)
- Johanna M. M. van Breugel
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Radiology, University Medical Center Utrecht, Postbox: 85500, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Joost W. Wijlemans
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Martijn de Greef
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chrit T. W. Moonen
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Mario G. Ries
- Division of Imaging, University Medical Center Utrecht, Utrecht, The Netherlands
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Lesser TG, Schubert H, Güllmar D, Reichenbach JR, Wolfram F. One-lung flooding reduces the ipsilateral diaphragm motion during mechanical ventilation. Eur J Med Res 2016; 21:9. [PMID: 26957315 PMCID: PMC4784448 DOI: 10.1186/s40001-016-0205-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 02/26/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Diaphragm motion during spontaneous or mechanical respiration hinders image-guided percutaneous interventions of tumours in lung and upper abdomen. Motion-tracking methods can be applied but increase procedure complexity and procedure time. One-lung flooding (OLF) generates a suitable acoustic pathway to lung tumours and likely suppress diaphragm motion. The aim of this study was to quantify the effect of OLF on ipsilateral diaphragm motion during contralateral one-lung ventilation. METHODS To measure the diaphragm motion, M-mode ultrasonography of the right hemidiaphragm was performed during spontaneous breathing and mechanical ventilation, as well as after right-side lung flooding, in three pigs. Diaphragm motion was analysed using magnetic resonance images during left-side lung flooding and mechanical ventilation, in four pigs. RESULTS Double-lung ventilation increased the diaphragm movement in comparison with spontaneous breathing (17.8 ± 4.4 vs. 12.2 ± 3.4 mm, p = 0.014). Diaphragm movement on the flooded side during contralateral one-lung ventilation was significantly reduced compared to that during double-lung ventilation (3.9 ± 1.0 vs. 17.8 ± 4.4 mm, p = 0.041). By analysing the magnetic resonance images, the hemidiaphragm on the flooded side showed an average displacement of 4.2 mm, a maximum displacement of 15 mm close to the ventilated lung and no displacement at the lateral side. CONCLUSION OLF leads to a drastic reduction of diaphragm motion on the ipsilateral side which implies that targeting and motion compensation algorithms for interventions like high-intensity focused ultrasound ablation of intrapulmonary and hepatic lesions might not be required.
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Affiliation(s)
- Thomas Günther Lesser
- Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller University of Jena, Strasse des Friedens 122, 07548, Gera, Germany.
| | - Harald Schubert
- Institute of Animal Experimentation and Animal Welfare, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.
| | - Daniel Güllmar
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.
| | - Jürgen R Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany.
| | - Frank Wolfram
- Department of Thoracic and Vascular Surgery, SRH Wald-Klinikum Gera, Teaching Hospital of Friedrich-Schiller University of Jena, Strasse des Friedens 122, 07548, Gera, Germany.
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8
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Reply to: high-frequency jet ventilation for HIFU. Cardiovasc Intervent Radiol 2014; 37:1399-400. [PMID: 25063476 DOI: 10.1007/s00270-014-0938-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 04/03/2014] [Indexed: 01/18/2023]
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9
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Santiago A, Jelen U, Ammazzalorso F, Engenhart-Cabillic R, Fritz P, Mühlnickel W, Enghardt W, Baumann M, Wittig A. Reproducibility of target coverage in stereotactic spot scanning proton lung irradiation under high frequency jet ventilation. Radiother Oncol 2013; 109:45-50. [PMID: 24128803 DOI: 10.1016/j.radonc.2013.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 09/13/2013] [Accepted: 09/20/2013] [Indexed: 12/21/2022]
Abstract
PURPOSE To investigate scanned-beam proton dose distribution reproducibility in the lung under high frequency jet ventilation (HFJV). MATERIALS AND METHODS For 11 patients (12 lesions), treated with single-fraction photon stereotactic radiosurgery under HFJV, scanned-beam proton plans were prepared with the TRiP98 treatment planning system using 2, 3-4 and 5-7 beams. The planning objective was to deliver at least 95% of the prescription of 33 Gy (RBE) to 98% of the PTV. Plans were subsequently recomputed on localization CT scans. Additionally, for selected cases, the effects of range uncertainties were investigated. RESULTS Median GTV V(98%) was 98.7% in the original 2-field plans and 93.7% in their recomputation (p=0.039). The respective values were 99.0% and 98.0% (p=0.039) for the 3-4-field plans and 100.0% and 99.6% (p=0.125) for the 5-7-field plans. CT calibration uncertainties of ±3.5% led to a GTV V(98%) reduction below 1.5 percentual points in most cases and reaching 3 percentual points for 2-field plans with beam undershoot. CONCLUSIONS Through jet ventilation, reproducible tumor fixation for proton radiotherapy of lung lesions is achievable, ensuring excellent target coverage in most cases. In few cases, non-optimal patient setup reproducibility induced density changes across beam entrance channels, leading to dosimetric deterioration between planning and delivery.
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Affiliation(s)
- Alina Santiago
- University of Marburg, Department of Radiotherapy and Radiation Oncology, Germany.
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10
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Boda-Heggemann J, Mai S, Fleckenstein J, Siebenlist K, Simeonova A, Ehmann M, Steil V, Wenz F, Lohr F, Stieler F. Flattening-filter-free intensity modulated breath-hold image-guided SABR (Stereotactic ABlative Radiotherapy) can be applied in a 15-min treatment slot. Radiother Oncol 2013; 109:505-9. [PMID: 24128805 DOI: 10.1016/j.radonc.2013.09.014] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 09/13/2013] [Accepted: 09/15/2013] [Indexed: 11/18/2022]
Abstract
Hypofractionated image-guided stereotactic ablative radiotherapy (igSABR) is effective in small lung/liver lesions. Computer-assisted breath-hold reduces intrafraction motion but, as every gating/triggering strategy, reduces the duty cycle, resulting in long fraction times if combined with intensity-modulated radiotherapy (IMRT). 10 MV flattening-filter-free IMRT reduces daily fraction duration to <10 min for single doses of 5-20 Gy.
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Affiliation(s)
- Judit Boda-Heggemann
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany.
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Muller A, Petrusca L, Auboiroux V, Valette PJ, Salomir R, Cotton F. Management of Respiratory Motion in Extracorporeal High-Intensity Focused Ultrasound Treatment in Upper Abdominal Organs: Current Status and Perspectives. Cardiovasc Intervent Radiol 2013; 36:1464-1476. [DOI: 10.1007/s00270-013-0713-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 05/08/2013] [Indexed: 12/25/2022]
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CT-guided Navigation of Percutaneous Hepatic and Renal Radiofrequency Ablation under High-frequency Jet Ventilation: Feasibility Study. J Vasc Interv Radiol 2011; 22:1275-8. [DOI: 10.1016/j.jvir.2011.04.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 04/22/2011] [Accepted: 04/29/2011] [Indexed: 12/31/2022] Open
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Raiten J, Elkassabany N, Gao W, Mandel JE. Medical intelligence article: novel uses of high frequency ventilation outside the operating room. Anesth Analg 2011; 112:1110-3. [PMID: 21372275 DOI: 10.1213/ane.0b013e318212b851] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
High frequency jet ventilation (HFJV) is a technique that is most frequently used in the intensive care unit and during tracheal and otorhinolaryngologic surgery. The utility of HFJV for procedures performed outside of the intensive care unit and operating room is currently being explored. The ability of HFJV to provide mechanical ventilation, yet achieve near static conditions of the chest and abdomen, makes it a very appealing technique for procedures such as pulmonary vein isolation and ablation for atrial fibrillation, targeted radiation therapy for lung and liver tumors, and certain diagnostic imaging techniques.
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Affiliation(s)
- Jesse Raiten
- Department of Anesthesiology and Critical Care, University of Pennsylvania School of Medicine, 3400 Spruce St., Dulles 6, Philadelphia, PA 19104, USA.
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Mandel JE, Perry I, Boonn WW, Litt H. Use of high-frequency jet ventilation for respiratory immobilization during coronary artery CT angiography. J Clin Anesth 2010; 21:599-601. [PMID: 20122593 DOI: 10.1016/j.jclinane.2008.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 12/08/2008] [Accepted: 12/11/2008] [Indexed: 11/25/2022]
Abstract
Multidetector ECG-gated CT angiography permits imaging of structures such as the coronary arteries and pulmonary veins with peripheral administration of contrast media. Respiratory motion artifact limits the applicability of this technique in critically ill patients due to an inability to cooperate with prolonged breath holds necessary for quality images. A case in which high-frequency jet ventilation via an uncuffed tracheostomy tube in an unmedicated patient permitted respiratory immobilization sufficient to acquire diagnostic images, is presented.
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Affiliation(s)
- Jeff E Mandel
- Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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Fritz P, Kraus HJ, Mühlnickel W, Sassmann V, Hering W, Strauch K. High-frequency jet ventilation for complete target immobilization and reduction of planning target volume in stereotactic high single-dose irradiation of stage I non-small cell lung cancer and lung metastases. Int J Radiat Oncol Biol Phys 2009; 78:136-42. [PMID: 19910142 DOI: 10.1016/j.ijrobp.2009.07.1678] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 05/26/2009] [Accepted: 07/06/2009] [Indexed: 12/26/2022]
Abstract
PURPOSE To demonstrate the feasibility of complete target immobilization by means of high-frequency jet ventilation (HFJV); and to show that the saving of planning target volume (PTV) on the stereotactic body radiation therapy (SBRT) under HFJV, compared with SBRT with respiratory motion, can be predicted with reliable accuracy by computed tomography (CT) scans at peak inspiration phase. METHODS AND MATERIALS A comparison regarding different methods for defining the PTV was carried out in 22 patients with tumors that clearly moved with respiration. A movement span of the gross tumor volume (GTV) was defined by fusing respiration-correlated CT scans. The PTV enclosed the GTV positions with a safety margin throughout the breathing cycle. To create a PTV from CT scans acquired under HFJV, the same margins were drawn around the immobilized target. In addition, peak inspiration phase CT images (PIP-CTs) were used to approximate a target immobilized by HFJV. RESULTS The resulting HFJV-PTVs were between 11.6% and 45.4% smaller than the baseline values calculated as respiration-correlated CT-PTVs (median volume reduction, 25.4%). Tentative planning by means of PIP-CT PTVs predicted that in 19 of 22 patients, use of HFJV would lead to a reduction in volume of >or=20%. Using this threshold yielded a positive predictive value of 0.89, as well as a sensitivity of 0.94 and a specificity of 0.5. CONCLUSIONS In all patients, SBRT under HFJV provided a reliable immobilization of the GTVs and achieved a reduction in PTVs, regardless of patient compliance. Tentative planning facilitated the selection of patients who could better undergo radiation in respiratory standstill, both with greater accuracy and lung protection.
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Affiliation(s)
- Peter Fritz
- Department of Radiotherapy, St Marien-Krankenhaus, Siegen, Germany.
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Fritz P, Kraus HJ, Mühlnickel W, Hammer U, Dölken W, Engel-Riedel W, Chemaissani A, Stoelben E. Stereotactic, single-dose irradiation of stage I non-small cell lung cancer and lung metastases. Radiat Oncol 2006; 1:30. [PMID: 16919172 PMCID: PMC1579222 DOI: 10.1186/1748-717x-1-30] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 08/20/2006] [Indexed: 01/12/2023] Open
Abstract
Background We prospectively reviewed response rates, local control, and side effects after non-fractionated stereotactic high single-dose body radiation therapy for lung tumors. Methods Fifty-eight patients underwent radiosurgery involving single-dose irradiation. With 25 patients, 31 metastases in the lungs were irradiated; with each of 33 patients, stage I non-small cell lung cancer (NSCLC) was subject to irradiation. The standard dose prescribed to the isocenter was 30 Gy with an axial safety margin of 10 mm and a longitudinal safety margin of 15 mm. The planning target volume (PTV) was defined using three CT scans with reference to the phases of respiration so that the movement span of the clinical target volume (CTV) was enclosed. Results The volume of the metastases (CTV) varied from 2.8 to 55.8 cm3 (median: 6.0 cm3) and the PTV varied from 12.2 to 184.0 cm3 (median: 45.0 cm3). The metastases ranged from 0.7 to 4.5 cm in largest diameter. The volume of the bronchial carcinomas varied from 4.2 to 125.4 cm3(median: 17.5 cm3) and the PTV from 15.6 to 387.3 cm3 (median: 99.8 cm3). The bronchial carcinomas ranged from 1.7 to 10 cm in largest diameter. Follow-up periods varied from 6.8 to 63 months (median: 22 months for metastases and 18 months for NSCLC). Local control was achieved with 94% of NSCLC and 87% of metastases. No serious symptomatic side effects were observed. According to the Kaplan-Meier method the overall survival probability rates of patients with lung metastases were as follows: 1 year: 97%, 2 years: 73%, 3 years: 42%, 4 years: 42%, 5 years: 42% (median survival: 26 months); of those with NSCLC: 1 year: 83%, 2 years: 63%, 3 years: 53%, 4 years: 39%: (median survival: 20.4 months). Conclusion Non-fractionated single-dose irradiation of metastases in the lungs or of small, peripheral bronchial carcinomas is an effective and safe form of local treatment and might become a viable alternative to invasive techniques.
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Affiliation(s)
- Peter Fritz
- St. Marien-Krankenhaus, (Medical Education Hospital of the University of Marburg), Department of Radiotherapy, D-57072 Siegen, Germany
| | - Hans-Jörg Kraus
- St. Marien-Krankenhaus, (Medical Education Hospital of the University of Marburg), Department of Radiotherapy, D-57072 Siegen, Germany
| | - Werner Mühlnickel
- St. Marien-Krankenhaus, (Medical Education Hospital of the University of Marburg), Department of Radiotherapy, D-57072 Siegen, Germany
| | - Udo Hammer
- St. Marien-Krankenhaus, (Medical Education Hospital of the University of Marburg), Department of Radiology, D-57072 Siegen, Germany
| | - Wolfram Dölken
- St. Marien-Krankenhaus, (Medical Education Hospital of the University of Marburg), Department of Radiology, D-57072 Siegen, Germany
| | - Walburga Engel-Riedel
- Cologne Metropolitan General Hospital, Clinic for Thoracic Disease, D-51109 Köln, Germany
| | - Assad Chemaissani
- Cologne Metropolitan General Hospital, Clinic for Thoracic Disease, D-51109 Köln, Germany
| | - Erich Stoelben
- Cologne Metropolitan General Hospital, Clinic for Thoracic Disease, D-51109 Köln, Germany
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N/A. N/A. Shijie Huaren Xiaohua Zazhi 2006; 14:1755-1761. [DOI: 10.11569/wcjd.v14.i18.1755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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