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Ergen SA, Karacam S, Catal TK, Dincbas FO, Oksuz DC, Sahinler I. Comparison of two different respiratory monitoring systems with 4D-CT images for target volume definition in patients undergoing para-aortic nodal irradiation. North Clin Istanb 2024; 11:120-126. [PMID: 38757101 PMCID: PMC11095336 DOI: 10.14744/nci.2023.06856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/14/2023] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE Today, respiratory movement can be monitored and recorded with different methods during a simulation on a four-dimensional (4D) computed tomography (CT) device to be used in radiotherapy planning. A synchronized respiratory monitoring system (RPM) with an externally equipped device is one of these methods. Another method is to create 4D images of the patient's breathing phases without the need for extra equipment, with an anatomy-based software program integrated into the CT device. Our aim is to compare the RPM system and the software system (Deviceless) which are two different respiratory monitoring methods used in tracking moving targets during 4D-CT imaging and to assess their clinical usability. METHODS Ten patients who underwent paraaortic nodal irradiation were enrolled. The simulation was performed using intravenous contrast material on a 4D-CT device with both respiratory monitoring methods. The right/left kidneys and renal arteries were chosen as references to evaluate abdominal organ movement. It was then manually contoured one by one on both sets of images. The images were compared volumetrically and geometrically after rigid reconstruction. The similarity between the contours was determined by the Dice index. Wilcoxon test was used for statistical comparisons. RESULTS The motion of the kidneys in all three directions was found to be 0.0 cm in both methods. The shifts in the right/left renal arteries were submillimetric. The Dice index showed a high similarity in both kidney and renal artery contours. CONCLUSION In our study, no difference was found between RPM and Deviceless systems used for tracking and detection of moving targets during simulation in 4D-CT. Both methods can be used safely for radiotherapy planning according to the available possibilities in the clinic.
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Affiliation(s)
- Sefika Arzu Ergen
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkiye
| | - Songul Karacam
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkiye
| | - Tuba Kurt Catal
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkiye
| | - Fazilet Oner Dincbas
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkiye
| | - Didem Colpan Oksuz
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkiye
| | - Ismet Sahinler
- Department of Radiation Oncology, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkiye
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Kapoor R, Gupta A, Miriyala R, Oinam AS, Singh G. Effects of four-dimensional simulation of boost radiation after breast conservation surgery: A prospective dosimetric and volumetric analysis. PRECISION RADIATION ONCOLOGY 2018. [DOI: 10.1002/pro6.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Rakesh Kapoor
- Department of Radiotherapy; PGIMER; Chandigarh India
| | - Anil Gupta
- Department of Radiotherapy; PGIMER; Chandigarh India
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Wang W, Li J, Xing J, Xu M, Shao Q, Fan T, Guo B, Liu S. Analysis of the variability among radiation oncologists in delineation of the postsurgical tumor bed based on 4D-CT. Oncotarget 2018; 7:70516-70523. [PMID: 27655639 PMCID: PMC5342570 DOI: 10.18632/oncotarget.12044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 08/24/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study investigated interobserver and intraobserver variability in radiation oncologists' definition of the tumor bed (TB) after breast-conserving surgery (BCS). RESULTS The TB volume, CVS and number of surgical clips were not significantly related to intraobserver variability. Moreover, no correlation was noted between CT slice thickness and interobserver variability (Δinter, DSCinter) in TB delineation, and no significant difference was noted among the three groups. The TB volume was negatively correlated with Δinter. DSCinter improved significantly with increased TB volume and decreased Δinter. DSCinter also increased significantly in patients with a CVS of 3 to 5 compared with patients with a CVS of 1 to 2. DSCinter was thus positively correlated with the CVS, with a correlation coefficient of 0.451. The use of 7 to 9 surgical clips neither decreased Δinter nor increased DSCinter. MATERIALS AND METHODS Five or more surgical clips were placed at the TB during lumpectomy. The TB was delineated on the end expiration scan. The data were stratified based on the cavity visualization score (CVS), CT slice thickness and surgical clip number. The Dice similarity coefficient (DSC) and inter(intra)observer variability (Δinter and Δintra) in different groups were evaluated and compared. CONCLUSIONS Inter(intra)observer variability in TB delineation was decreased for breast cancer patients implanted with 5 or more surgical clips in the cohort with a higher CVS and a larger TB. The use of more than 6 surgical clips did not significantly improve TB delineation, so 5 to 6 surgical clips are likely adequate to delineate the TB.
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Affiliation(s)
- Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China, 250117
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China, 250117
| | - Jun Xing
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China, 250117
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China, 250117
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China, 250117
| | - Tingyong Fan
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China, 250117
| | - Bing Guo
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China, 250117
| | - Shanshan Liu
- Department of Radiation Oncology, Shandong Cancer Hospital affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong province, China, 250117
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[Respiratory synchronization and breast radiotherapy]. Cancer Radiother 2016; 20:576-82. [PMID: 27592267 DOI: 10.1016/j.canrad.2016.07.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 07/04/2016] [Indexed: 11/21/2022]
Abstract
Adjuvant radiation therapy following breast cancer surgery continues to improve locoregional control and overall survival. But the success of highly targeted-conformal radiotherapy such as intensity-modulated techniques, can be compromised by respiratory motion. The intrafraction motion can potentially result in significant under- or overdose, and also expose organs at risk. This article summarizes the respiratory motion and its effects on imaging, dose calculation and dose delivery by radiotherapy for breast cancer. We will review the methods of respiratory synchronization available for breast radiotherapy to minimize the respiratory impact and to spare organs such as heart and lung.
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