Clinical experience with 3-dimensional surface matching-based deep inspiration breath hold for left-sided breast cancer radiation therapy

Tang, Xiaoli; Zagar, Timothy M.; Bair, Eric; Jones, Ellen L.; Fried, David; Zhang, Longzhen; Tracton, Gregg; Xu, Zongbin; Leach, Traci; Chang, S; Marks, Lawrence B.

doi:10.1016/j.prro.2013.05.004

Cited by 53 publications

(61 citation statements)

References 11 publications

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“…Interfraction variability with DIBH has been reported, with characteristically higher treatment times early in RT courses, which likely reflects a DIBH "learning curve," which can be overcome quickly. 15,22 Differences in setup time or imaging were not recorded, but there were no adjustments to daily treatment schedules to accommodate DIBH patients and no uniform policy of filming patients differently based on treatment modality.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prospective assessment of deep inspiration breath-hold using 3-dimensional surface tracking for irradiation of left-sided breast cancer

Tanguturi¹,

Lyatskaya

Chen

et al. 2015

Practical Radiation Oncology

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Section: Discussionmentioning

confidence: 99%

“…Voluntary DIBH with AlignRT is reproducible with interfraction setup uncertainties of 0.7 to 2 mm. 22 In this light, voluntary DIBH is an accessible modality of DIBH that may be more comfortable and reproducible than ABC-DIBH.…”

Section: Discussionmentioning

confidence: 99%

Prospective assessment of deep inspiration breath-hold using 3-dimensional surface tracking for irradiation of left-sided breast cancer

Tanguturi¹,

Lyatskaya

Chen

et al. 2015

Practical Radiation Oncology

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“…Nevertheless, this is a reasonable assumption, given the goals of the analysis. Surface has been proven to be a reasonable surrogate for DIBH patient setup from a port film analysis in Tang et al (20) A total of 270 port films from 50 patients was analyzed to assess patient surface based setup accuracy. The distance between the field edge and the anterior pericardial shadow was measured on port films and corresponding digitally reconstructed radiographs (DRR).…”

Section: Discussionmentioning

confidence: 99%

“…However, there is always a certain level of motion and thus predetermined RTD tolerances (

\pm 3 mm

and

\pm 3 °

) are used clinically. Our DIBH clinical planning guidelines can be found in Tang et al (20) …”

Section: Methodsmentioning

confidence: 99%

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

Tang

Cullip

Dooley

et al. 2015

J Applied Clin Med Phys

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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

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“…All of the patients reported in this study were lying supine on the slant board with no restraint. However, it has been reported that with use of a Vac‐Lok bag (Elekta Medical Intelligence, Atlanta, GA), the correlation coefficient between

d_{DRR}

and

d_{port}

is higher than for those without a Vac‐Lok bag, which leads to a reduced setup uncertainty (16) . Other studies also have reported that the use of cradles for breast patients can improve the reproducibility of the setup (17) …”

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

J Applied Clin Med Phys

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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

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Clinical experience with 3-dimensional surface matching-based deep inspiration breath hold for left-sided breast cancer radiation therapy

Cited by 53 publications

References 11 publications

Prospective assessment of deep inspiration breath-hold using 3-dimensional surface tracking for irradiation of left-sided breast cancer

Prospective assessment of deep inspiration breath-hold using 3-dimensional surface tracking for irradiation of left-sided breast cancer

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

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

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