Does irregular breathing impact on respiratory gated radiation therapy of lung stereotactic body radiation therapy treatments?

Savanović, Milovan; Allali, Sophiane; Jaroš, Dražan; Foulquier, J.N.

doi:10.1016/j.meddos.2022.01.001

Cited by 5 publications

(8 citation statements)

References 20 publications

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“…The target is underdosed consistently due to the persistent phase‐based error, whilst surrounding normal tissues are overdosed. Though just a specific case, this is a greater dose difference compared with calculations made by Savanovic et al 11 . for gated delivery with irregular breathing in a phantom.…”

Section: Discussionmentioning

confidence: 70%

“…The target is underdosed consistently due to the persistent phase-based error, whilst surrounding normal tissues are overdosed. Though just a specific case, this is a greater dose difference compared with calculations made by Savanovic et al 11 for gated delivery with irregular breathing in a phantom. However, Sarker et al observed a 50% error in motion for an irregular waveform which matches the phase offset calculated for our clinical scenario.…”

Section: Discussionmentioning

confidence: 71%

“…indicated that the RGSC system only showed a 76% agreement with the programmed test data within ± 5% tolerance in terms of fitting period 10 . Another study suggested that irregular breathing could almost double the dose difference to planned dose when compared with delivery from a regular breathing trace 11 . A phantom study that compared the MIP‐based ITVs from 4DCT to those from dMRI showed that the errors in the former correlated linearly with the subjects’ respiratory variability, and therefore using a 4DCT MIP image to define the ITV might cause underdosing 12 .…”

Section: Introductionmentioning

confidence: 98%

“… 10 Another study suggested that irregular breathing could almost double the dose difference to planned dose when compared with delivery from a regular breathing trace. 11 A phantom study that compared the MIP‐based ITVs from 4DCT to those from dMRI showed that the errors in the former correlated linearly with the subjects’ respiratory variability, and therefore using a 4DCT MIP image to define the ITV might cause underdosing. 12 However, most of the existing studies are based on phantom measurements and therefore can quantify neither inter‐fractional motion variability of the same patient nor breathing‐trace differences among different patients.…”

Section: Introductionmentioning

confidence: 99%

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Individualized breathing trace quality assurance for lung radiotherapy patients undergoing 4DCT simulation

Rijken¹,

Hiscoke³

2023

J Applied Clin Med Phys

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4DCT simulation is a popular solution for radiotherapy simulation of lung cancer patients as it allows the clinician to gain an appreciation for target motion during the patient breathing cycle. Resultant binning of images and production of the 4DCT dataset relies heavily on the recorded breathing trace; but quality assurance is not routinely performed on these and there lacks any substantial recommendations thereof. An application was created for Windows in C# that was able to analyze the VXP breathing trace files from Varian RPM/RGSC and quantify various metrics associated with the patient breathing cycle. This data was then used to consider errors in voluming of targets for several example cases in order to justify recommendations on quality assurance. For 281 real patient breathing traces from 4DCT simulation of lung targets, notable differences were found between RGSC and application calculations of phase data. For any new patient without individualized QA, the average marked phase calculation (which is used for 4DCT reconstruction) is only accurate to within 19% of the actual phases. The error in BPM within the scan due to breathing rate variation is 37%. The uncertainty in amplitude due to breathing variation is 34% in the mean. Phase uncertainty leads to misbinning which we have shown can lead to missing 66% of the target for gated treatment. Variation in inhalation/exhalation level leads to voluming errors which, without individualized QA, can be assumed to be 11% (PTV is smaller than actual). Without individualized quality assurance of patient breathing traces, large uncertainties have to be assumed for metrics of both phase and amplitude, leading to clinically significant uncertainties in treatment. It is recommended to perform individualized quality assurance as this provides the clinician with an accurate quantification of uncertainty for their patient.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 71%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Individualized breathing trace quality assurance for lung radiotherapy patients undergoing 4DCT simulation

Rijken¹,

Hiscoke³

2023

J Applied Clin Med Phys

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“…Additionally, the diversity of respiratory movements and tumor positions among individual patients can result in various tumor trajectories (Spoelstra et al 2008). Savanović et al (2022) reported that irregular breathing patterns would impact deliver time, especially in the amplitude-gated mode. Therefore, simulations of treatment plan that rely solely on monotonous tumor trajectories would be insufficient.…”

Section: Introductionmentioning

confidence: 99%

A 3D-printed phantom for stereotactic body radiation therapy simulation

Yu,

Yen,

Hung

et al. 2024

Biomed. Phys. Eng. Express

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In modern radiation therapy for lung cancer, examining the uncertainty between tumor motion and beam delivery is vitally important. To lower the radiation dose delivery to the patient’s normal tissue, narrowing the irradiation field margin to hit the tumor accurately is critical. Thus we proposed a phantom that simulates the thorax and lung tumor’s motions by employing a 3D printing technique. Thelung tumor is controlled by a linear miniature Delta robot arm, with a maximum displacement of 20 mm in each direction. When we simulated the thoracic breathing movements at 12 mm in A–P (Anterior-Posterior), the control errors were within 10 %. The average tracking errors of the prosthetic tumor were within 1.1 mm. Therefore, the 3D-printed phantom with a robot arm can provide a reliable simulation for training and dosimetry measurement before lung radiotherapy, especially SBRT.

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A novel internal target volume definition based on velocity and time of respiratory target motion for external beam radiotherapy

Yamanaka,

Nishio,

Iwabuchi

et al. 2024

Radiol Phys Technol

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Does irregular breathing impact on respiratory gated radiation therapy of lung stereotactic body radiation therapy treatments?

Cited by 5 publications

References 20 publications

Individualized breathing trace quality assurance for lung radiotherapy patients undergoing 4DCT simulation

Individualized breathing trace quality assurance for lung radiotherapy patients undergoing 4DCT simulation

A 3D-printed phantom for stereotactic body radiation therapy simulation

A novel internal target volume definition based on velocity and time of respiratory target motion for external beam radiotherapy

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