Evaluation of a 3D surface imaging system for deep inspiration breath-hold patient positioning and intra-fraction monitoring

Hamming, Vincent C; Visser, C.; Batin, Estelle; McDermott, L. N.; Busz, D.; Both, Stefan; Langendijk, Johannes A.; Sijtsema, Nanna M.

doi:10.1186/s13014-019-1329-6

Cited by 52 publications

(67 citation statements)

References 43 publications

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“…Kügele et al reported that the intrafractional reproducibility for tangential and locoregional treatment was as low as 1 mm (median over 40 patients) in all three translational directions, but during a single treatment session the maximum deviation was up to 5 mm, which resulted in large effects on the target coverage and OAR doses [70]. The accuracy of SGRT systems have been reported within 5 mm for DIBH positioning and monitoring [71], and are similar to those reported in studies using spirometrybased positioning [68].…”

Section: Breath-holdmentioning

confidence: 99%

Recent advances in Surface Guided Radiation Therapy

et al. 2020

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The growing acceptance and recognition of Surface Guided Radiation Therapy (SGRT) as a promising imaging technique has supported its recent spread in a large number of radiation oncology facilities. Although this technology is not new, many aspects of it have only recently been exploited. This review focuses on the latest SGRT developments, both in the field of general clinical applications and special techniques. SGRT has a wide range of applications, including patient positioning with real-time feedback, patient monitoring throughout the treatment fraction, and motion management (as beam-gating in free-breathing or deep-inspiration breath-hold). Special radiotherapy modalities such as accelerated partial breast irradiation, particle radiotherapy, and pediatrics are the most recent SGRT developments. The fact that SGRT is nowadays used at various body sites has resulted in the need to adapt SGRT workflows to each body site. Current SGRT applications range from traditional breast irradiation, to thoracic, abdominal, or pelvic tumor sites, and include intracranial localizations. Following the latest SGRT applications and their specifications/requirements, a stricter quality assurance program needs to be ensured. Recent publications highlight the need to adapt quality assurance to the radiotherapy equipment type, SGRT technology, anatomic treatment sites, and clinical workflows, which results in a complex and extensive set of tests. Moreover, this review gives an outlook on the leading research trends. In particular, the potential to use deformable surfaces as motion surrogates, to use SGRT to detect anatomical variations along the treatment course, and to help in the establishment of personalized patient treatment (optimized margins and motion management strategies) are increasingly important research topics. SGRT is also emerging in the field of patient safety and integrates measures to reduce common radiotherapeutic risk events (e.g. facial and treatment accessories recognition). This review covers the latest clinical practices of SGRT and provides an outlook on potential applications of this imaging technique. It is intended to provide guidance for new users during the implementation, while triggering experienced users to further explore SGRT applications.

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Section: Breath-holdmentioning

confidence: 99%

Recent advances in Surface Guided Radiation Therapy

et al. 2020

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“…Surface guided radiation therapy (SGRT) offers the possibility to monitor patient movements in real-time using a non-invasive approach, without any additional radiation exposure. SGRT has also proven to be a reliable tool for patient positioning by complementing in-room laser-assisted positioning, as well as for intrafraction monitoring during breast radiotherapy [18][19][20][21]. Moreover, SGRT may even reduce the frequency of conventional imaging during breast DIBH RT [22].…”

Section: Introductionmentioning

confidence: 99%

Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer

et al. 2020

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Purpose: Patients with left-sided breast cancer frequently receive deep inspiration breath-hold (DIBH) radiotherapy to reduce the risk of cardiac side effects. The aim of the present study was to analyze intra-breath-hold stability and inter-fraction breath-hold reproducibility in clinical practice. Material and methods: Overall, we analyzed 103 patients receiving left-sided breast cancer radiotherapy using a surface-guided DIBH technique. During each treatment session the vertical motion of the patient was continuously measured by a surface guided radiation therapy (SGRT) system and automated gating control (beam on/off) was performed using an audiovisual patient feedback system. Dose delivery was automatically triggered when the tracking point was within a predefined gating window. Intra-breath-hold stability and inter-fraction reproducibility across all fractions of the entire treatment course were analyzed per patient. Results: In the present series, 6013 breath-holds during beam-on time were analyzed. The mean amplitude of the gating window from the baseline breathing curve (maximum expiration during free breathing) was 15.8 mm (95%confidence interval: [8.5-30.6] mm) and had a width of 3.5 mm (95%-CI: [2-4.3] mm). As a measure of intra-breathhold stability, the median standard deviation of the breath-hold level during DIBH was 0.3 mm (95%-CI: [0.1-0.9] mm). Similarly, the median absolute intra-breath-hold linear amplitude deviation was 0.4 mm (95%-CI: [0.01-2.1] mm). Reproducibility testing showed good inter-fractional reliability, as the maximum difference in the breathing amplitudes in all patients and all fractions were 1.3 mm on average (95%-CI: [0.5-2.6] mm). Conclusion: The clinical integration of an optical surface scanner enables a stable and reliable DIBH treatment delivery during SGRT for left-sided breast cancer in clinical routine.

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“…These phantoms were validated with hybrid plan measurements and an end-to-end test of a VMAT- The phantoms were fully compliant with the AlignRT surface scanning system, which is increasingly used for setup of breast cancer patients at radiotherapy departments. 5,19,20 The shape and red color of the PLA resulted in a stable surface registration result. During RTT training and hardware and software upgrade verification of the surface scanning system, we now use the E2E breasts compared to the vender-provided geometric phantom.…”

Section: Discussionmentioning

confidence: 99%

Technical Note: Development of 3D‐printed breast phantoms for end‐to‐end testing of whole breast volumetric arc radiotherapy

Delombaerde

Petillion

Weltens

et al. 2020

J Applied Clin Med Phys

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End-to-end testing of a new breast radiotherapy technique preferably requires realistic phantom geometries, which is challenging to achieve using currently commercially available solutions. We have developed a series of three-dimensional (3D)-printed breast phantoms, with ionization chamber and radiochromic film inserts, which can be attached to a commercial anthropomorphic thorax phantom. A contoured left breast from a patient's planning CT was mapped onto a CT of the CIRS E2E thorax phantom (CIRS Inc.) and cropped to fit the surface. Four versions of the breast were 3D printed, containing a cavity for an ionization chamber and slits for radiochromic film insertion in the three cardinal planes, respectively. The phantoms were fully compatible with surface scanning technology used for setup. The phantoms were validated using a whole-breast volumetric modulated arc therapy protocol with a simultaneous integrated boost to the tumor bed (VMAT-SIB). Six patient plans and one original plan on the breast phantom were verified with planar portal imaging, point dose, and film measurements in the MultiCube phantom and planar γ-analysis using ArcCHECK diode array. Six patient plans were recalculated on the breast phantom (hybrid plans) and delivered with point dose and film measurements with 3% (local)/2 mm γ-analysis. One complete end-to-end test on the breast phantom was performed. All plan quality verifications had point dose differences below 2.4% from the calculated dose and γ-agreement scores (γAS) > 87.3% for film measurements in the MultiCube, portal dosimetry, and ArcCHECK. Point dose differences in the 3D-printed phantoms were below 2.6% (median −1.4%, range −2.6%; 0.3%). Median γAS was 96.4% (range 80.1%-99.7%) for all film inserts. The proposed 3D-printed attachable breast dosimetry phantoms have been shown to be a valuable tool for end-to-end testing of a new radiotherapy protocol. The workflow described in this report can aid users to create their own phantomspecific breast 3D-printed phantoms.

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Evaluation of a 3D surface imaging system for deep inspiration breath-hold patient positioning and intra-fraction monitoring

Cited by 52 publications

References 43 publications

Recent advances in Surface Guided Radiation Therapy

Recent advances in Surface Guided Radiation Therapy

Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer

Technical Note: Development of 3D‐printed breast phantoms for end‐to‐end testing of whole breast volumetric arc radiotherapy

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