A Voluntary Breath-Hold Treatment Technique for the Left Breast With Unfavorable Cardiac Anatomy Using Surface Imaging

Deep inspiration breath‐hold (DIBH) radiotherapy for left‐sided breast cancer can reduce cardiac exposure and internal motion. We modified our in‐house treatment planning system (TPS) to retrospectively analyze breath‐hold motion log files to calculate the dosimetric effect of the motion during breath hold. Thirty left‐sided supine DIBH breast patients treated using AlignRT were studied. Breath‐hold motion was recorded — three translational and three rotational displacements of the treatment surface — the Real Time Deltas (RTD). The corresponding delivered dose was estimated using the beam‐on portions of the RTDs. Each motion was used to calculate dose, and the final estimated dose was the equally weighted average of the multiple resultant doses. Ten of thirty patients had internal mammary nodes (IMN) purposefully included in the tangential fields, and we evaluated the percentage of IMN covered by 40 Gy. The planned and delivered heart mean dose, lungs V20 (volume of the lungs receiving >20 Gy), percentage of IMN covered by 40 Gy, and IMN mean dose were compared. The averaged mean and standard deviation of the beam‐on portions of the absolute RTDs were 0.81±1.29 mm, 0.68±0.85 mm, 0.76±0.85 mm, 0.96°±0.49°,0.93°±0.43°, and 1.03°±0.50°, for vertical, longitudinal, lateral, yaw, roll, and pitch, respectively. The averaged planned and delivered mean heart dose were 99 and 101 cGy. Lungs V20 were 6.59% and 6.74%. IMN 40 Gy coverage was 83% and 77%, and mean IMN dose was 4642 and 4518 cGy. The averaged mean motion during DIBH was smaller than 1 mm and 1°, which reflects the relative reproducibility of the patient breath hold. On average, the mean heart dose and lungs V20 were reasonably close to what have been planned. IMN 40 Gy coverage might be modestly reduced for certain cases.PACS number: 87.55.km, 87.55.N

\pm 3 mm

and

\pm 3 °

as the RTD tolerance, and the Gierga study used

\pm 5 mm

(no rotational tolerance was reported).…”

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 94%

Dosimetric effect due to the motion during deep inspiration breath hold for left‐sided breast cancer radiotherapy

Tang

Cullip

Dooley

et al. 2015

“…Many techniques have been proposed for DIBH radiation of left‐side breast cancer to minimize cardiac doses, including involuntary breath‐hold with active breathing control, (8) and voluntary breath‐hold using various devices 9 , 10 , 11 , 12 , 13 . McIntosh et al (13) reported voluntary deep inhalation breath‐hold using an RPM signal as a surrogate, in which 43%–60% dose reductions of cardiac doses were observed.…”

Section: Discussionmentioning

confidence: 99%

Clinical experience using a video‐guided spirometry system for deep inhalation breath‐hold radiotherapy of left‐sided breast cancer

Yang

McKenzie

Burnison

et al. 2015

The purpose was to report clinical experience of a video‐guided spirometry system in applying deep inhalation breath‐hold (DIBH) radiotherapy for left‐sided breast cancer, and to study the systematic and random uncertainties, intra‐ and interfraction motion and impact on cardiac dose associated with DIBH. The data from 28 left‐sided breast cancer patients treated with spirometer‐guided DIBH radiation were studied. Dosimetric comparisons between free‐breathing (FB) and DIBH plans were performed. The distance between the heart and chest wall measured on the digitally reconstructed radiographs (DRR) and MV portal images, dDRR(DIBH) and dport(DIBH), respectively, was compared as a measure of DIBH setup uncertainty. The difference (Δd) between dDRR(DIBH) and dport(DIBH) was defined as the systematic uncertainty. The standard deviation of Δd for each patient was defined as the random uncertainty. MV cine images during radiation were acquired. Affine registrations of the cine images acquired during one fraction and multiple fractions were performed to study the intra‐ and interfraction motion of the chest wall. The median chest wall motion was used as the metric for intra‐ and interfraction analysis. Breast motions in superior–inferior (SI) direction and “AP” (defined on the DRR or MV portal image as the direction perpendicular to the SI direction) are reported. Systematic and random uncertainties of 3.8 mm and 2 mm, respectively, were found for this spirometer‐guided DIBH treatment. MV cine analysis showed that intrafraction chest wall motions during DIBH were 0.3 mm in “AP” and 0.6 mm in SI. The interfraction chest wall motions were 3.6 mm in “AP” and 3.4 mm in SI. Utilization of DIBH with this spirometry system led to a statistically significant reduction of cardiac dose relative to FB treatment. The DIBH using video‐guided spirometry provided reproducible cardiac sparing with minimal intra‐ and interfraction chest wall motion, and thus is a valuable adjunct to modern breast treatment techniques.PACS number: 87.55.kh, 87.55.ne, 87.55.tg

“…The position of the box is tattooed on the patient, since its placement can influence the breath hold and could increase the dose to the skin if placed within the field borders due to the build‐up effect. Noninvasive systems like the Catalyst (C‐RAD Positioning, Uppsala, Sweden) and GateRT (Vision RT Ltd, London, UK) have recently entered the market 19, 20, 21. These systems project a light‐pattern onto the patient which is scanned by one or two CCD cameras.…”

Section: Introductionmentioning

confidence: 99%

Monitoring deep inspiration breath hold for left‐sided localized breast cancer radiotherapy with an in‐house developed laser distance meter system

Jensen

Абрамова

Frengen

et al. 2017

Deep inspiration breath hold (DIBH) in left‐sided breast cancer radiotherapy is a technique to reduce cardiac and pulmonary doses while maintaining target coverage. This study aims at evaluating an in‐house developed DIBH system. Free‐breathing (FB) and DIBH plans were generated for 22 left‐sided localized breast cancer patients who had radiation therapy (RT) after breast‐conserving surgery. All patients were treated utilizing an in‐house laser distance measuring system. 50 Gy was prescribed, and parameters of interest were target coverage, left anterior descending coronary artery, (LAD) and heart doses. Portal images were acquired and the reproducibility and stability of DIBH treatment were compared to FB. The comparing result shows there is a significant reduction in all LAD and heart dose statistics for DIBH compared to FB plans without compromising the target coverage. The maximum LAD dose was reduced from 43.7 Gy to 29.0 Gy and the volume of the heart receiving >25 Gy was reduced from 3.3% to 1.0% using the in‐house system, both statistically significant. The in‐house system gave a reproducible and stable DIBH treatment where the systematic error ∑, and random error σ, were less than 2.2 mm in all directions, but were not significantly better than at FB. The system was well tolerated and all patients completed their treatment sessions with DIBH.