Geometric uncertainties in voluntary deep inspiration breath hold radiotherapy for locally advanced lung cancer

Josipović, Mirjana; Persson, G.; Dueck, Jenny; Bangsgaard, J.P.; Westman, Gunnar; Specht, Lena; Aznar, Marianne C.

doi:10.1016/j.radonc.2015.11.004

Cited by 45 publications

(61 citation statements)

References 29 publications

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“…18 The inclusion criterion was the ability to perform voluntary DIBH for 20 s. The study was approved by the local ethical committee (H-2-2011-153).…”

Section: Methodsmentioning

confidence: 99%

“…18 In order to investigate the influence of inter-DIBH baseline shifts on CBCT image quality without the presence of deformations, we acquired CBCT scans of a phantom (Intensity-modulated RT thorax phantom; Computerized Imaging Reference Systems Inc., Norfolk, VA) with a cylindrical 9-mm-high nodule with half-sphere (radius 9 mm) on top, inserted to emulate a lung tumour. A planning CT scan and four CBCT scans were acquired: one with continuous CBCT acquisition (CBCT0) and three with CBCT acquisition interrupted after 120°and 240°to mimic 20-s DIBHs.…”

Section: Phantom Studymentioning

confidence: 99%

“…13,14 Initial experience with DIBH CBCT as image guidance has been reported for SBRT, 6,8,15,16 whereas the only study focusing on image guidance in DIBH for locally advanced disease used continuous CBCT acquisition, including both DIBH and periods of free breathing (FB) during CBCT acquisition. 17 Although geometrical uncertainties in both voluntary 18 and forced DIBH have been reported, 19,20 uncertainties of the image registration process have not yet been investigated. Since CBCT acquisition typically takes 1 min, it exceeds the maximum tolerable DIBH duration, and therefore, several DIBHs are needed to acquire a single CBCT.…”

Section: Introductionmentioning

confidence: 99%

“…Since CBCT acquisition typically takes 1 min, it exceeds the maximum tolerable DIBH duration, and therefore, several DIBHs are needed to acquire a single CBCT. Owing to intrafractional tumour baseline shifts between repeated DIBHs, 18,21 image quality may be impaired. In this study, the impact of both DIBH and tumour baseline shifts between consecutive DIBHs on image quality of CBCT was investigated.…”

Section: Introductionmentioning

confidence: 99%

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Deep inspiration breath-hold radiotherapy for lung cancer: impact on image quality and registration uncertainty in cone beam CT image guidance

Persson¹,

Bangsgaard²,

Specht³

et al. 2016

The British Journal of Radiology

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Objective: We investigated the impact of deep inspiration breath-hold (DIBH) and tumour baseline shifts on image quality and registration uncertainty in imageguided DIBH radiotherapy (RT) for locally advanced lung cancer. Methods: Patients treated with daily cone beam CT (CBCT)-guided free-breathing (FB) RT had an additional CBCT in DIBH at three fractions. These CBCT scans were offline rigidly registered (on tumour) to FB and DIBH CT scans acquired at planning. All registrations were repeated to evaluate the intraobserver uncertainty. CBCT scans were scored on degree of streak artefacts and visualization of tumour and anatomical structures. We examined the impact of tumour baseline shift between consecutive DIBHs on CBCT image quality. Results: CBCT scans from 15 patients were analysed. Intraobserver image registration uncertainty was approximately 2 mm in both FB and DIBH, except for the craniocaudal direction in FB, where it was .3 mm. On the 31st fraction, the intraobserver uncertainty increased compared with the second fraction. This increase was more pronounced in FB. Image quality scores improved in DIBH compared with FB for all parameters in all patients. Simulated tumour baseline shifts #2 mm did not affect the CBCT image quality considerably. Conclusion: DIBH CBCT improved image quality and reduced registration uncertainty in the craniocaudal direction in image-guided RT of locally advanced lung cancer. Baseline shifts #2 mm in DIBH during CBCT acquisition did not affect image quality. Advances in knowledge: DIBH RT has dosimetric advantages over FB; this work demonstrates an additional benefit of DIBH in terms of registration accuracy because of improved image quality.

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“…18 The inclusion criterion was the ability to perform voluntary DIBH for 20 s. The study was approved by the local ethical committee (H-2-2011-153).…”

Section: Methodsmentioning

confidence: 99%

Section: Phantom Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Deep inspiration breath-hold radiotherapy for lung cancer: impact on image quality and registration uncertainty in cone beam CT image guidance

Persson¹,

Bangsgaard²,

Specht³

et al. 2016

The British Journal of Radiology

Self Cite

View full text Add to dashboard Cite

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“…Another approach to reducing the impact is to minimize the motion itself by incorporating compression belts27 to restrict diaphragm contraction and expansion, implementing breath hold techniques23, 28, 29, 30 or gating the treatment by restricting delivery to particular components of the breathing cycle 14, 20, 25, 31, 32. Recent works from several research groups have also investigated the tracking of tumor by dynamic correction of MLC positions 33, 34, 35, 36, 37.…”

Section: Introductionmentioning

confidence: 99%

Robust optimization of VMAT for lung cancer: Dosimetric implications of motion compensation techniques

Archibald-Heeren

Byrne

et al. 2017

J Applied Clin Med Phys

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In inverse planning of lung radiotherapy, techniques are required to ensure dose coverage of target disease in the presence of tumor motion as a result of respiration. A range of published techniques for mitigating motion effects were compared for dose stability across 5 breath cycles of ±2 cm. Techniques included planning target volume (PTV) expansions, internal target volumes with (OITV) and without tissue override (ITV), average dataset scans (ADS), and mini‐max robust optimization. Volumetric arc therapy plans were created on a thorax phantom and verified with chamber and film measurements. Dose stability was compared by DVH analysis in calculations across all geometries. The lung override technique resulted in a substantial lack of dose coverage (−10%) to the tumor in the presence of large motion. PTV, ITV and ADS techniques resulted in substantial (up to 25%) maximum dose increases where solid tissue travelled into low density optimized regions. The results highlight the need for care in optimization of highly heterogeneous where density variations may occur with motion. Robust optimization was shown to provide greater stability in both maximum (<3%) and minimum dose variations (<2%) over all other techniques.

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Clinical experience of volumetric‐modulated flattening filter free stereotactic body radiation therapy of lesions in the lung with deep inspiration breath‐hold

Mørkeset

Lervåg

Lund

et al. 2022

J Applied Clin Med Phys

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This clinical study aimed to evaluate lung cancer patients'ability to perform deep inspiration breath-hold (DIBH) during CT simulation and throughout the treatment course of stereotactic body radiation therapy (SBRT). In addition, target sizes, organ at risk (OAR) sizes, and doses to the respective volumes in filterfree volumetric-modulated arc therapy plans performed under free-breathing (FB) and DIBH conditions were evaluated. Twenty-one patients with peripheral lesions were included, of which 13 were eligible for SBRT. All patients underwent training for breath-hold during CT, and if they complied with the requirements, two CT scans were obtained: CT scan in DIBH and a four-dimensional CT scan in FB.The treatment plans in FB and DIBH were generated,and the dose parameters and volume sizes were compared. The endpoints for evaluation were patient compliance, target dose coverage, and doses to the OARs. This clinical study showed high patient DIBH compliance during both CT simulation and treatment for patients with lung cancer. A significant reduction in target volumes was achieved with SBRT in DIBH, in addition to significantly decreased doses to the heart, chest wall, and lungs. DIBH in SBRT of lung lesions is feasible, and a routine to manage intra-fractional deviation should be established upon implementation.

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Geometric uncertainties in voluntary deep inspiration breath hold radiotherapy for locally advanced lung cancer

Cited by 45 publications

References 29 publications

Deep inspiration breath-hold radiotherapy for lung cancer: impact on image quality and registration uncertainty in cone beam CT image guidance

Deep inspiration breath-hold radiotherapy for lung cancer: impact on image quality and registration uncertainty in cone beam CT image guidance

Robust optimization of VMAT for lung cancer: Dosimetric implications of motion compensation techniques

Clinical experience of volumetric‐modulated flattening filter free stereotactic body radiation therapy of lesions in the lung with deep inspiration breath‐hold

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