3D Ultrasound Can Contribute to Planning CT to Define the Target for Partial Breast Radiotherapy

Berrang, Tanya; Truong, Pauline T.; Popescu, C.; Drever, Laura; Kader, Hosam A.; Hilts, Michelle; Mitchell, Tracy; Soh, S.; Sands, Letricia; Silver, Stuart F.; Olivotto, Ivo A.

doi:10.1016/j.ijrobp.2008.04.041

Cited by 47 publications

(32 citation statements)

References 24 publications

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“…In our study group, a 93% visibility of seroma makes the application of 3DUS guidance a practical tool for IGRT in breast cancer. These observations are comparable to reports by Wong et al and Berrang et al [10,11,18]. Although CT/3DUS fused datasets were not used for contouring GTV in this study, visual inspection of the fusion showed complementary information as suggested by others [18].…”

Section: Discussionsupporting

confidence: 91%

“…The scanning technique requires a sweep over the area of interest with negligible probe pressure through a thick layer of high viscosity gel [18]. In addition, the Ultrapath feature within Clarity illustrates the scanning path of the probe used at the initial simulation as a reference that facilitates reproducibility of image capture on each treatment day.…”

Section: Methodsmentioning

confidence: 99%

“…Further, it has illustrated that breast density and cavity size, which sometimes limits cavity visualization on CT images, do not compromise visualization of the target when 3DUS is used. Fusion of CT and 3DUS have been shown to provide complementary information for defining the target [10,17,18]. …”

Section: Introductionmentioning

confidence: 99%

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Image guidance using 3D-ultrasound (3D-US) for daily positioning of lumpectomy cavity for boost irradiation

et al. 2011

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PurposeThe goal of this study was to evaluate the use of 3D ultrasound (3DUS) breast IGRT for electron and photon lumpectomy site boost treatments.Materials and methods20 patients with a prescribed photon or electron boost were enrolled in this study. 3DUS images were acquired both at time of simulation, to form a coregistered CT/3DUS dataset, and at the time of daily treatment delivery. Intrafractional motion between treatment and simulation 3DUS datasets were calculated to determine IGRT shifts. Photon shifts were evaluated isocentrically, while electron shifts were evaluated in the beam's-eye-view. Volume differences between simulation and first boost fraction were calculated. Further, to control for the effect of change in seroma/cavity volume due to time lapse between the 2 sets of images, interfraction IGRT shifts using the first boost fraction as reference for all subsequent treatment fractions were also calculated.ResultsFor photon boosts, IGRT shifts were 1.1 ± 0.5 cm and 50% of fractions required a shift >1.0 cm. Volume change between simulation and boost was 49 ± 31%. Shifts when using the first boost fraction as reference were 0.8 ± 0.4 cm and 24% required a shift >1.0 cm. For electron boosts, shifts were 1.0 ± 0.5 cm and 52% fell outside the dosimetric penumbra. Interfraction analysis relative to the first fraction noted the shifts to be 0.8 ± 0.4 cm and 36% fell outside the penumbra.ConclusionThe lumpectomy cavity can shift significantly during fractionated radiation therapy. 3DUS can be used to image the cavity and correct for interfractional motion. Further studies to better define the protocol for clinical application of IGRT in breast cancer is needed.

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Section: Discussionsupporting

confidence: 91%

Section: Methodsmentioning

confidence: 99%

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Image guidance using 3D-ultrasound (3D-US) for daily positioning of lumpectomy cavity for boost irradiation

et al. 2011

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“…Therefore, in the current study, the TB boundaries for patients with a smaller TB exhibited low delineation concordance, despite the placement of surgical clips within the TB. CT imaging with MRI, 3D-US or PET/CT would benefit patients with a low-volume TB, which is associated with low simulation and TB delineation variability [13, 32, 33]. …”

Section: Discussionmentioning

confidence: 99%

Analysis of the variability among radiation oncologists in delineation of the postsurgical tumor bed based on 4D-CT

Wang

Xing

et al. 2016

Oncotarget

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ObjectiveThis study investigated interobserver and intraobserver variability in radiation oncologists' definition of the tumor bed (TB) after breast-conserving surgery (BCS).ResultsThe 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 MethodsFive 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.ConclusionsInter(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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“…Recently, Berrang et al reported on the usefulness of combining 3D-breast ultrasound (3D-US) with the CT scan in treatment planning for APBI. Indeed, they showed that less inter-observer variability was seen when contouring seroma with 3D-US, with smaller seroma volumes when they were outlined using 3D-US [15]. However, 3D-US has never been evaluated in cases of remodelled breast tissue alone, the most frequent type of breast-conserving surgery in France, without the presence of seroma.…”

Section: Discussionmentioning

confidence: 99%

3D-conformal Accelerated Partial Breast Irradiation treatment planning: the value of surgical clips in the delineation of the lumpectomy cavity

et al. 2009

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BackgroundAccurate localisation of the lumpectomy cavity (LC) volume is one of the most critical points in 3D-conformal Partial breast irradiation (3D-APBI) treatment planning because the irradiated volume is restricted to a small breast volume. Here, we studied the role of the placement of surgical clips at the 4 cardinal points of the lumpectomy cavity in target delineation.MethodsForty CT-based 3D-APBI plans were retrieved on which a total of 4 radiation oncologists, two trainee and two experienced physicians, outlined the lumpectomy cavity. The inter-observer variability of LC contouring was assessed when the CTV was defined as the delineation that encompassed both surgical clips and remodelled breast tissue.ResultsThe conformity index of tumour bed delineation was significantly improved by the placement of surgical clips within the LC (median at 0.65). Furthermore, a better conformity index of LC was observed according to the experience of the physicians (median CI = 0.55 for trainee physicians vs 0.65 for experienced physicians).ConclusionsThe placement of surgical clips improved the accuracy of lumpectomy cavity delineation in 3D-APBI. However, a learning curve is needed to improve the conformity index of the lumpectomy cavity.

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3D Ultrasound Can Contribute to Planning CT to Define the Target for Partial Breast Radiotherapy

Cited by 47 publications

References 24 publications

Image guidance using 3D-ultrasound (3D-US) for daily positioning of lumpectomy cavity for boost irradiation

Image guidance using 3D-ultrasound (3D-US) for daily positioning of lumpectomy cavity for boost irradiation

Analysis of the variability among radiation oncologists in delineation of the postsurgical tumor bed based on 4D-CT

3D-conformal Accelerated Partial Breast Irradiation treatment planning: the value of surgical clips in the delineation of the lumpectomy cavity

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