Guidelines for respiratory motion management in radiation therapy

Matsuo, Yukinori; Oda, Hiroshi; Nakagawa, Keiichi; Nakamura, Mitsuhiro; Ariji, Takaki; Kumazaki, Yu; Shimbo, Munefumi; Tohyama, Naoki; Nishio, Teiji; Okumura, Masahiko; Shirato, Hiroki; Hiraoka, Masahiro

doi:10.1093/jrr/rrs122

Cited by 46 publications

(31 citation statements)

References 3 publications

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“…They can be classified into two major types [12]. One type of approach is to minimize the tumor motion using inhalation of oxygen, abdominal compression, learning of regular respiratory patterns, or a breath-hold technique [13–16]. However, these methods are generally associated with modest efficacy and/or poor reproducibility.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous fiducial marker placement under CT fluoroscopic guidance for stereotactic body radiotherapy of the lung: an initial experience

Ohta

Iwata

Hashizume

et al. 2013

Journal of Radiation Research

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The aim of this study is to describe our initial experience with the VISICOIL, which is the first percutaneous fiducial marker approved for stereotactic body radiotherapy in Japan, and to evaluate its technical and clinical efficacy, and safety. Eight patients underwent this procedure under CT fluoroscopic guidance. One patient had two tumors, so the total number of procedures was nine. We evaluated the technical and clinical success rates of the procedure and the frequencies of complications. Technical success was defined as when the fiducial marker could be placed at the target site, and clinical success was defined as when stereotactic body radiotherapy could be performed without the marker dropping out of position. The technical success rate was 78% (7/9). In one of the two failed cases, we aimed to place the marker inside the tumor, but misplaced it beside the tumor. In the other failed case, we successfully placed the marker beside the tumor as planned; however, the marker migrated to near the pleura after the patient stopped holding their breath. None of the markers dropped out of place, so the clinical success rate was 100% (9/9). The complication rates were as follows: pneumothorax: 56% (5/9), pneumothorax necessitating chest tube placement: 44% (4/9), focal intrapulmonary hemorrhaging: 67% (6/9), hemoptysis: 11% (1/9), mild hemothorax 11% (1/9), air embolism 0% (0/9), and death 0% (0/9). In conclusion, this new percutaneous fiducial marker appears to be useful for stereotactic body radiotherapy due to its good stability.

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Section: Discussionmentioning

confidence: 99%

Percutaneous fiducial marker placement under CT fluoroscopic guidance for stereotactic body radiotherapy of the lung: an initial experience

Ohta

Iwata

Hashizume

et al. 2013

Journal of Radiation Research

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“…The gimbal mechanism enables tracing of tumor motion. [2][3][4] Electronic portal imaging devices (EPIDs), two sets of kilovolt x-ray tubes and flat panel detectors (FPDs), are mounted on the O-ring for IGRT. The Vero4DRT has many functionalities, including image-matching, 5D positional correction using a robotic couch, and real-time fluoroscopic monitoring during treatment.…”

Section: Introductionmentioning

confidence: 99%

Development of an expanded‐field irradiation technique using a gimbaled x‐ray head

et al. 2014

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“…One method by which to reduce the high dose to such organs is management of respiratory motion 5 , 6 . Several researchers have reported that pancreatic tumor motion due to breathing exceeded 10 mm using cine magnetic resonance images, four‐dimensional computed tomography (CT), electromagnetic transponders, and cone‐beam CT (CBCT) 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 .…”

Section: Introductionmentioning

confidence: 99%

“…(3,4) One method by which to reduce the high dose to such organs is management of respiratory motion. (5,6) Several researchers have reported that pancreatic tumor motion due to breathing exceeded 10 mm using cine magnetic resonance images, four-dimensional computed tomography (CT), electromagnetic transponders, and cone-beam CT (CBCT). (7)(8)(9)(10)(11)(12)(13)(14) Without respiratory management, a large planning target volume (PTV) is needed to cover such internal motion, resulting in inclusion of a large volume of OARs.…”

Section: Introductionmentioning

confidence: 99%

Interfraction positional variation in pancreatic tumors using daily breath‐hold cone‐beam computed tomography with visual feedback

Nakamura

Akimoto

Ono

et al. 2015

J Applied Clin Med Phys

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We assessed interfraction positional variation in pancreatic tumors using daily breath‐hold cone‐beam computed tomography at end‐exhalation (EE) with visual feedback (BH‐CBCT). Eleven consecutive patients with pancreatic cancer who underwent BH intensity‐modulated radiation therapy with visual feedback were enrolled. All participating patients stopped oral intake, with the exception of drugs and water, for >3 hr before treatment planning and daily treatment. Each patient was fixed in the supine position on an individualized vacuum pillow. An isotropic margin of 5 mm was added to the clinical target volume to create the planning target volume (PTV). The prescription dose was 42 to 51 Gy in 15 fractions. After correcting initial setup errors based on bony anatomy, the first BH‐CBCT scans were performed before beam delivery in every fraction. BH‐CBCT acquisition was obtained in three or four times breath holds by interrupting the acquisition two or three times, depending on the patient's BH ability. The image acquisition time for a 360° gantry rotation was approximately 90 s, including the interruption time due to BH. The initial setup errors were corrected based on bony structure, and the residual errors in the target position were then recorded. The magnitude of the interruptions variation in target position was assessed for 165 fractions. The systematic and random errors were 1.2 and 1.8 mm, 1.1 and 1.8 mm, and 1.7 and 2.9 mm in the left–right (LR), anterior–posterior (AP), and superior–inferior (SI) directions, respectively. Absolute interfraction variations of >5 mm were observed in 18 fractions (11.0%) from seven patients because of EE‐BH failure. In conclusion, target matching is required to correct interfraction variation even with visual feedback, especially to ensure safe delivery of escalated doses to patients with pancreatic cancer.PACS number: 87.57.Q‐, 87.57.‐s, 87.55.Qr

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Guidelines for respiratory motion management in radiation therapy

Cited by 46 publications

References 3 publications

Percutaneous fiducial marker placement under CT fluoroscopic guidance for stereotactic body radiotherapy of the lung: an initial experience

Percutaneous fiducial marker placement under CT fluoroscopic guidance for stereotactic body radiotherapy of the lung: an initial experience

Development of an expanded‐field irradiation technique using a gimbaled x‐ray head

Interfraction positional variation in pancreatic tumors using daily breath‐hold cone‐beam computed tomography with visual feedback

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