Continuous breath-hold assessment during breast radiotherapy using portal imaging

Doebrich, Marcus; Downie, Janine; Lehmann, Jöerg

doi:10.1016/j.phro.2018.02.006

Cited by 10 publications

(23 citation statements)

References 19 publications

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“…Several authors have evaluated setup errors and breath-hold performance using portal images. Both Doebrich et al [30] and Lutz et al [25] assessed the intra-breath hold lung depth (the tangential AP axis in our study), but do not measure the superior-inferior variability during RPM-guided tangential breath-hold treatments.…”

Section: Discussionmentioning

confidence: 84%

Spirometer-guided breath-hold breast VMAT verified with portal images and surface tracking

Delombaerde

Petillion

Weltens

et al. 2021

Radiotherapy and Oncology

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Background and purpose: Fast rotating closed-bore gantry linacs are ideally suited for breath-hold treatments due to reduced imaging and delivery times. We evaluated the reproducibility and stability of spirometer-guided breath-hold breast treatments, using intra-bore surface monitoring and portal imaging on Halcyon (Varian Medical Systems). Materials and methods: Seven left-sided breast cancer patients were treated in breath-hold using the SDX spirometer (Dyn'R) with an integrated boost volumetric arc protocol on Halcyon. A dual depth-camera surface scanning system monitored the left breast. The interfraction, intrafraction and intrabreath-hold motion was determined in the anterior-posterior (AP) and superior-inferior (SI) direction. Portal images (PI), acquired at a tangential gantry angle were manually registered to the planning-CT to determine inter-and intrafraction breath-hold errors for the SI and tangential-anterior-posterior (''AP") axis. Correlations between PI and surface imaging deviations were investigated. To evaluate workflow efficiency, the total time and the number of breath-holds were recorded. Results: Systematic and random variability of breath-hold amplitude was below 0.7 mm for the AP and below 1.2 mm for the SI component as detected by surface monitoring (N = 130). Systematic and random errors retrieved from portal images (N = 140) were below 1.2 mm for the ''AP" and 2.1 mm for SI axis. A limited correlation was found between PI and surface monitoring deviations for both the SI and ''AP" axes (R 2 = 0.27/0.38, p < 0.01). 75% of fractions were completed using four breath-holds and 82% within 10 min. Conclusion: Surface imaging indicated spirometer-guided breath-hold VMAT breast radiotherapy can be accurately and quickly performed on a closed-bore gantry linac. Intra-bore surface scanning proved a valuable technique for monitoring breathing motion in closed-bore systems.

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Section: Discussionmentioning

confidence: 84%

Spirometer-guided breath-hold breast VMAT verified with portal images and surface tracking

Delombaerde

Petillion

Weltens

et al. 2021

Radiotherapy and Oncology

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“…This could lead to significant errors. 13,14 Real-time assessment of the LD in MV EPID images can conceptually offer a stronger correlation to the motion of the target for monitoring of the quality of DIBH during tangential breast RT than the external surrogatebased techniques. This study introduces a new system for real-time measurements of LD and SD and evaluates its accuracy and precision.…”

Section: Discussionmentioning

confidence: 99%

“…12 Retrospective measurements of CLD in Megavolt (MV) EPID images of patients acquired continuously during tangential breast RT with DIBH levels monitored by the Varian's RPM system found significant deviations from the intended treatment for some patients. 13,14 A number of in-house image processing tools were reported for retrospective assessment of the quality of DIBH, displaying the trajectories of free breathing motion, and assessment of heart radiation exposure in MV images of tangential breast fields. Doebrich et al 14 utilized an interactive image analysis routine (MATLAB, MathWorks, Natick, MA, USA) to calculate the CLD as the distance between the inflection point of the pixel intensity profile of the posterior field edge and the adjacent local maximum representing the bony chest wall.…”

Section: Introductionmentioning

confidence: 99%

“…13,14 A number of in-house image processing tools were reported for retrospective assessment of the quality of DIBH, displaying the trajectories of free breathing motion, and assessment of heart radiation exposure in MV images of tangential breast fields. Doebrich et al 14 utilized an interactive image analysis routine (MATLAB, MathWorks, Natick, MA, USA) to calculate the CLD as the distance between the inflection point of the pixel intensity profile of the posterior field edge and the adjacent local maximum representing the bony chest wall. Jensen et al 15 developed a program to detect the position of the chest wall edge applying a Canny filter.…”

Section: Introductionmentioning

confidence: 99%

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A system for real‐time monitoring of breath‐hold via assessment of internal anatomy in tangential breast radiotherapy

Vasina

Greer

Thwaites

et al. 2021

J Applied Clin Med Phys

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The deep inspiration breath-hold (DIBH) technique assists in sparing the heart, lungs, and liver during breast radiotherapy (RT). The quality of DIBH is currently assessed via surrogates which correlate to varying degrees with the patient's internal anatomy. Since modern linacs are equipped with an electronic portal imaging device (EPID), images of the irradiated anatomy streamed from EPIDs and analyzed in real time could significantly improve assessment of the quality of DIBH. A system has been developed to quantify the quality of DIBH during tangential breast RT by analyzing the "beam's eye view" images of the treatment fields. The system measures the lung depth (LD) and the distance from the breast surface to the posterior tangential radiation field edge (skin distance, SD) at three user-defined locations. LD and SD measured in real time in EPID images of two RT phantoms showing different geometrical characteristics of their chest wall regions (computed tomography dose index [CTDI] and "END-TO-END" stereotactic body radiation therapy [E2E SBRT]) were compared with ground truth displacements provided by a precision motion platform. Performance of the new system was evaluated via static and dynamic (sine wave motion) measurements of LD and SD, covering clinical situations with stable and unstable breath-hold. The accuracy and precision of the system were calculated as the mean and standard deviation of the differences between the ground truth and measured values. The accuracy of the static measurements of LD and SD for the CTDI phantom was 0.31 (1.09) mm [mean (standard deviation)] and -0.10 (0.14) mm, respectively. The accuracy of the static measurements for E2E SBRT phantom was 0.01 (0.18) mm and 0.05 (0.08) mm. The accuracy of the dynamic LD and SD measurements for the CTDI phantom was -0.50 (1.18) mm and 0.01 (0.12) mm, respectively. The accuracy of the dynamic measurements for E2E SBRT phantom was -0.03 (0.19) mm and 0.01 (0.11) mm. K E Y W O R D S central lung distance, deep inspiration breath-hold (DIBH), EPID, lung depth, monitoring of internal anatomy, real-time portal imaging, tangential breast radiotherapy This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…a reflective marker block placed on the patient’s abdomen [1] , the volume of inhaled air [2] , the skin surface [3] , [4] , the radiation field lights or the treatment room lasers [5] . Depending on the patient’s size and anatomy, the surrogate-based systems can make incorrect assessments of the position of the target and the organs at risk, potentially leading to significant deviations of the delivered dose from the planned dose [6] .…”

Section: Introductionmentioning

confidence: 99%

First clinical experience with real-time portal imaging-based breath-hold monitoring in tangential breast radiotherapy

Vasina

Kong

Greer

et al. 2022

Physics and Imaging in Radiation Oncology

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Continuous breath-hold assessment during breast radiotherapy using portal imaging

Cited by 10 publications

References 19 publications

Spirometer-guided breath-hold breast VMAT verified with portal images and surface tracking

Spirometer-guided breath-hold breast VMAT verified with portal images and surface tracking

A system for real‐time monitoring of breath‐hold via assessment of internal anatomy in tangential breast radiotherapy

First clinical experience with real-time portal imaging-based breath-hold monitoring in tangential breast radiotherapy

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