Experience with an abdominal compression band for radiotherapy of upper abdominal tumours

Gelder, Rebecca Van; Wong, Shelley; Le, Andrew; Podreka, Alexander; Briggs, Adam; Haddad, Carol; Hardcastle, Nicholas

doi:10.1002/jmrs.254

Cited by 13 publications

(8 citation statements)

References 9 publications

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“…The use of abdominal compression has been widely used in radiotherapy for cancers of the lung, liver, pancreas 3,14,26,27 . Our institution has been reluctant to use compression for pancreatic radiotherapy due to the perception it increases contact with the healthy duodenum.…”

Section: Discussionmentioning

confidence: 99%

MRI evaluation of normal tissue deformation and breathing motion under an abdominal compression device

Lee

Simeonov

Stanescu

et al. 2021

J Applied Clin Med Phys

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Purpose Abdominal compression can minimize breathing motion in stereotactic radiotherapy, though it may impact the positioning of dose‐limiting normal tissues. This study quantified the reproducibility of abdominal normal tissues and respiratory motion with the use of an abdominal compression device using MR imaging. Methods Twenty healthy volunteers had repeat MR over 3 days under an abdominal compression plate device. Normal tissues were delineated on daily axial T2‐weighted MR and compared on days 2 and 3 relative to day 1, after adjusting for baseline shifts relative to bony anatomy. Inter‐fraction organ deformation was computed using deformable registration of axial T2 images. Deformation > 5 mm was assumed to be clinically relevant. Inter‐fraction respiratory amplitude changes and intra‐fraction baseline drifts during imaging were quantified on daily orthogonal cine‐MR (70 s each), and changes > 3 mm were assumed to be relevant. Results On axial MR, the mean inter‐fraction normal tissue deformation was > 5 mm for all organs (range 5.1–13.4 mm). Inter‐fraction compression device misplacements > 5 mm and changes in stomach volume > 50% occurred at a rate of 93% and 38%, respectively, in one or more directions and were associated with larger adjacent organ deformation, in particular for the duodenum. On cine‐MR, inter‐fraction amplitude changes > 3 mm on day 2 and 3 relative to day 1 occurred at a rate of < 12.5% (mean superior–inferior change was 1.6 mm). Intra‐fraction baseline drifts > 3 mm during any cine‐MR acquisition occurred at a rate of 23% (mean superior–inferior changes was 2.4 mm). Conclusions Respiratory motion under abdominal compression is reproducible in most subjects within 3 mm. However, inter‐fraction deformations greater than 5 mm in normal tissues were common and larger than inter‐ and intra‐fraction respiratory changes. Deformations were driven mostly by variable stomach contents and device positioning. The magnitude of this motion may impact normal tissue dosimetry during stereotactic radiotherapy.

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Section: Discussionmentioning

confidence: 99%

MRI evaluation of normal tissue deformation and breathing motion under an abdominal compression device

Lee

Simeonov

Stanescu

et al. 2021

J Applied Clin Med Phys

View full text Add to dashboard Cite

show abstract

“…The method used in this study to extract image matching times corresponds with that used in previous research also looking at image matching times [18] Further prospective study could provide definitive information as to whether image assessment time is greater for uncompressed patients than for compressed patients although observations may have to be done surreptitiously to avoid undue influence on image matching time assessment. Additional studies may also benefit from testing out other forms of compression equipment such as pneumatic belts [6,19].…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown to be effective in minimizing tumour motion attributed to respiration in abdominal and lung patients [4,5]. The motion reduction attributed to AC can vary from patient to patient [6] as well as vary in magnitude depending on direction [7]. Gender and body mass index have also been shown to affect AC efficacy in liver patients [8].…”

Section: Introductionmentioning

confidence: 99%

Impact of abdominal compression on setup error and image matching during radical abdominal radiotherapy

Chu

Cooke

Heuvel

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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To determine the impact of abdominal compression (AC) on setup error and image matching time. Materials and methods: This study included 72 liver, pancreas and abdominal node patients treated radically from 2016 to 2019 in a single centre. Patients received either SBRT or conventional radical fractionation (CRF). Compressed patients were supine, arms up with kneefix and AC equipment. Uncompressed patients were supine, arms up with kneefix. All patients received daily online-matched CBCTs before treatment. Initial setup error was determined for all patients. Registration error was assessed for 10 liver and 10 pancreas patients. Image matching times were determined using beam on times. Statistical tests conducted were an F-test to compare variances in setup error, Student's t-tests for setup error and average image analysis, and a Wilcoxon Mann Whitney test for imaging matching time analysis. Results: Initial setup displacement was similar between compressed and uncompressed patients. Displacements > 1 cm occurred more frequently in the longitudinal direction for most patients. SBRT patients required more additional manual positioning following imaging. Mean absolute registration error in the SI direction was 5.4 mm and 3.3 mm for uncompressed and compressed pancreas patients respectively and 1.7 mm and 0.8 mm for uncompressed and compressed liver patients respectively. Compressed patients required less time for image matching and fewer images per fraction on average. Repeat imaging occurred more frequently in SBRT and uncompressed patients. Conclusions: Although abdominal compression has no significant impact on setup error, it can reduce imaging matching times resulting in improved treatment accuracy.

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“…Conversely, cardiac 4D CT acquires imaging data over the patient’s entire cardiac cycle but requires respiratory motion suppression techniques such as breath hold, abdominal compression, or single bin gating (imaging only during peak inhale or exhale) to reduce respiratory related artifacts. Similar techniques must then be utilized during treatment and have had variable success across patients [ 21 – 23 ].…”

Section: Introductionmentioning

confidence: 99%

CArdiac and REspiratory adaptive Computed Tomography (CARE-CT): a proof-of-concept digital phantom study

et al. 2022

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Current respiratory 4DCT imaging for high-dose rate thoracic radiotherapy treatments are negatively affected by the complex interaction of cardiac and respiratory motion. We propose an imaging method to reduce artifacts caused by thoracic motion, CArdiac and REspiratory adaptive CT (CARE-CT), that monitors respiratory motion and ECG signals in real-time, triggering CT acquisition during combined cardiac and respiratory bins. Using a digital phantom, conventional 4DCT and CARE-CT acquisitions for nineteen patient-measured physiological traces were simulated. Ten respiratory bins were acquired for conventional 4DCT scans and ten respiratory bins during cardiac diastole were acquired for CARE-CT scans. Image artifacts were quantified for 10 common thoracic organs at risk (OAR) substructures using the differential normalized cross correlation between axial slices (ΔNCC), mean squared error (MSE) and sensitivity. For all images, on average, CARE-CT improved the ΔNCC for 18/19 and the MSE and sensitivity for all patient traces. The ΔNCC was reduced for all cardiac OARs (mean reduction 21%). The MSE was reduced for all OARs (mean reduction 36%). In the digital phantom study, the average scan time was increased from 1.8 ± 0.4 min to 7.5 ± 2.2 min with a reduction in average beam on time from 98 ± 28 s to 45 s using CARE-CT compared to conventional 4DCT. The proof-of-concept study indicates the potential for CARE-CT to image the thorax in real-time during the cardiac and respiratory cycle simultaneously, to reduce image artifacts for common thoracic OARs.

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Experience with an abdominal compression band for radiotherapy of upper abdominal tumours

Cited by 13 publications

References 9 publications

MRI evaluation of normal tissue deformation and breathing motion under an abdominal compression device

MRI evaluation of normal tissue deformation and breathing motion under an abdominal compression device

Impact of abdominal compression on setup error and image matching during radical abdominal radiotherapy

CArdiac and REspiratory adaptive Computed Tomography (CARE-CT): a proof-of-concept digital phantom study

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