Impact of Immobilization on Intrafraction Motion for Spine Stereotactic Body Radiotherapy Using Cone Beam Computed Tomography

Li, Winnie; Sahgal, Arjun; Foote, Matthew; Millar, B; Jaffray, David A.; Létourneau, D.

doi:10.1016/j.ijrobp.2011.12.039

Cited by 89 publications

(75 citation statements)

References 21 publications

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“…These differences could have been influenced by the online shifts performed by the RT matching the images online, highlighting some minor differences between treating staff and the five trained image reviewers. There is no statistical difference between the three devices, which correlates with the results from other studies, having mean intra‐fraction differences of less than 1 mm for bony anatomy matching and 3 mm for tumour matching 4, 5, 16, 17, 19…”

Section: Discussionsupporting

confidence: 88%

“…As prolonged treatment times can increase patient discomfort, reducing the treatment duration can result in less intra‐fractional movement 4, 12. The literature notes a similar pattern with treatment times from verification to post‐treatment cone beam CT (CBCT), with the vacuum fixation time of 29.40 ± 5.57 min as opposed to 24.17 ± 5.54 for the evacuated cushion only group 5. Winnie et al4 demonstrated similar efficiency to this study, with the evacuated cushion with abdominal compression taking the longest time of 32.54 ± 8.07 min, the evacuated cushion time of 29.33 ± 8.20 min and chest board time of 30.17 ± 5.56 min.…”

Section: Discussionmentioning

confidence: 85%

“…Patient immobilisation is important for conventionally fractionated radiotherapy and stereotactic body radiotherapy (SBRT) 1, 2, 3, 4, 5, 6. The risk of a geographical miss or positioning error for hypo‐fractionated techniques can be greater than with conventional fractionation 1, 7, 8, 9, 10, 11, 12, 13.…”

Section: Introductionmentioning

confidence: 99%

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A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers

et al. 2016

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IntroductionPatient immobilisation is critically important for both highly conformal conventionally fractionated radiotherapy and for stereotactic body radiotherapy. Different immobilisation devices are available to maintain patient position for radiotherapy but the most suitable one remains unknown.MethodsForty‐five patients were randomly allocated to one of three immobilisation devices; the Q fix arm shuttle, BodyFIX without wrap or BodyFIX with wrap. Patients were imaged before and after treatment to ascertain intra‐fraction and inter‐fraction motion. Bony anatomy was used for matching to determine the positional accuracy of each device. Treatments were timed using a standard method. Patient comfort and staff satisfaction questionnaires were also issued to determine comfort, ease of use and preferences for each device.ResultsThe BodyFIX without wrap was the more accurate device; however, the differences between the devices were not statistically significant. The BodyFIX with wrap was found to take significantly longer to set up and set down compared to the arm shuttle and the BodyFIX without wrap (all P < 0.001). Patients (37%) marginally preferred the BodyFIX with wrap. Most (81%) staff preferred the BodyFIX without wrap.ConclusionImmobilisation using the BodyFIX without wrap was deemed to be suitable for clinical use. It was a clinically accurate device, the more efficient in terms of set up and set down time, the most preferred by staff and was accepted by patients.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 85%

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A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers

et al. 2016

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“…Step 4 delineation of PTV CTV-to-PTV margins ranged between 0 mm and 2 mm according to institutional protocol [17,25]. Margins for generation of the PRV spinal cord ranged between 1 mm and 2 mm.…”

Section: Resultsmentioning

confidence: 99%

Variability in Spine Radiosurgery Treatment Planning -- Results of an International Multi-institutional Study

Gückenberger

Sweeney

Flíckinger

et al. 2012

International Journal of Radiation Oncology*Biology*Physics

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“…SBRT to the spine has been demonstrated to be feasible and safe in a phase I study; however, concerns over the possibility of vertebral compression fracture and radiation‐induced myelitis remain and are an active area of investigation 26, 27, 28. Techniques for planning and immobilization are of special interest in regards to limiting toxicity by keeping treatment times and intrafraction motion to a minimum 29, 30. In this report, we retrospectively evaluate VMAT plans for thoracic spinal metastases using SBRT in terms of plan quality, treatment efficiency, and accuracy.…”

Section: Introductionmentioning

confidence: 99%

Volumetric modulated arc therapy treatment planning of thoracic vertebral metastases using stereotactic body radiotherapy

Mallory

Pokhrel

Badkul

et al. 2018

J Applied Clin Med Phys

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Purpose/ObjectivesTo retrospectively evaluate the plan quality, treatment efficiency, and accuracy of volumetric modulated arc therapy (VMAT) plans for thoracic spine metastases using stereotactic body radiotherapy (SBRT).Materials/MethodsSeven patients with thoracic vertebral metastases treated with noncoplanar hybrid arcs (NCHA) (1 to 2 3D‐conformal partial arcs +7 to 9 IMRT beams) were re‐optimized with VMAT plans using three coplanar arcs. Tumors were located between T2 and T7 and PTVs ranged between 24.3 and 240.1 cc (median 48.1 cc). All prescriptions were 30 Gy in 5 fractions with 6 MV beams treated using the Novalis Tx linac equipped with high definition multileaf collimators (HDMLC). MR images were fused with planning CTs for target and OAR contouring. Plans were compared for target coverage using conformality index (CI), homogeneity index (HI), D90, D98, D2, and Dmedian. Normal tissue sparing was evaluated by comparing doses to the spinal cord (Dmax, D0.35, and D1.2 cc), esophagus (Dmax and D5 cc), heart (Dmax, D15 cc), and lung (V5 and V10). Data analysis was performed with a two‐sided t‐test for each set of parameters. Dose delivery efficiency and accuracy of each VMAT plan was assessed via quality assurance (QA) using a MapCHECK device. The Beam‐on time (BOT) was recorded, and a gamma index was used to compare dose agreement between the planned and measured doses.Results VMAT plans resulted in improved CI (1.02 vs. 1.36, P = 0.05), HI (0.14 vs. 0.27, P = 0.01), D98 (28.4 vs. 26.8 Gy, P = 0.03), D2 (32.9 vs. 36.0 Gy, P = 0.02), and Dmedian (31.4 vs. 33.7 Gy, P = 0.01). D90 was improved but not statistically significant (30.4 vs. 31.0 Gy, P = 0.38). VMAT plans showed statistically significant improvements in normal tissue sparing: Esophagus Dmax (22.5 vs. 27.0 Gy, P = 0.03), Esophagus 5 cc (17.6 vs. 21.5 Gy, P = 0.02), and Heart Dmax (13.1 vs. 15.8 Gy, P = 0.03). Improvements were also observed in spinal cord and lung sparing as well but were not statistically significant. The BOT showed significant reduction for VMAT, 4.7 ± 0.6 min vs. 7.1 ± 1 min for NCHA (not accounting for couch kicks). VMAT plans demonstrated an accurate dose delivery of 95.5 ± 1.0% for clinical gamma passing rate of 3%/3 mm criteria, which was similar to NCHA plans.Conclusions VMAT plans have shown improved dose distributions and normal tissue sparing compared to NCHA plans. Significant reductions in treatment time could potentially minimize patient discomfort and intrafraction movement errors. VMAT planning for SBRT is an attractive option for the treatment of metastases to thoracic vertebrae, and further investigation using alternative fractionation schedules is warranted.

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Impact of Immobilization on Intrafraction Motion for Spine Stereotactic Body Radiotherapy Using Cone Beam Computed Tomography

Cited by 89 publications

References 21 publications

A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers

A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers

Variability in Spine Radiosurgery Treatment Planning -- Results of an International Multi-institutional Study

Volumetric modulated arc therapy treatment planning of thoracic vertebral metastases using stereotactic body radiotherapy

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