Interfractional diaphragm changes during breath-holding in stereotactic body radiotherapy for liver cancer

Kawahara, Daisuke; Ozawa, Shogo; Nakashima, Takeo; Tsuda, S.; Ochi, Yusuke; Okumura, Takuro; Masuda, Hirokazu; Hioki, Kazunari; Suzuki, Tathsuhiko; Ohno, Yoshimi; Kimura, Tomoki; Murakami, Yuji; Nagata, Yasushi

doi:10.1016/j.rpor.2018.01.007

Cited by 12 publications

(27 citation statements)

References 23 publications

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“…Although there are many reports on the setup method in SBRT for liver cancer, [11][12][13] there are few reports in PT. It is often observed that the diaphragm location changes from the time of the 1st-CT during the course of PSPT for HCC.…”

Section: Discussionmentioning

confidence: 99%

“…In modern radiation therapy techniques such as SBRT or PT for HCC, the vertebral body, diaphragm, and marker (metal marker or lipiodol accumulation) are generally used as indicators of setup depending on the tumor location. [10][11][12][13] The diaphragm, a typical surrogate for liver motion, is often tracked given its visibility on x-ray images. The setup performed in our institution performs vertebral body matching (VM) in orthogonal x-ray imaging, and then performs matching using the diaphragm or marker as an index.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, even if it is possible to reduce spatial misalignment by using such an index, proton beams have a finite range, so the water equivalent length of the beam path may change in some cases, the dose coverage for the target and the normal liver dose may be deteriorated. Although there are some reports on the setup using the DM as an index, [11][12][13] there are no reports on the effect of this method on dose distribution in PT. In addition, the DM is often performed by using on-board CBCT, [11][12][13] however, there is no report detailing a method using simple orthogonal x-ray images that can be implemented at any facility.…”

Section: Introductionmentioning

confidence: 99%

“…Although there are some reports on the setup using the DM as an index, [11][12][13] there are no reports on the effect of this method on dose distribution in PT. In addition, the DM is often performed by using on-board CBCT, [11][12][13] however, there is no report detailing a method using simple orthogonal x-ray images that can be implemented at any facility. In this study, we investigated the impact of different setup methods, VM, DM, and MM, on the dose distribution in PT for HCC.…”

Section: Introductionmentioning

confidence: 99%

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The impact of different setup methods on the dose distribution in proton therapy for hepatocellular carcinoma

Takemasa

Katō

Narita

et al. 2021

J Applied Clin Med Phys

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To investigate the impact of different setup methods, vertebral body matching (VM), diaphragm matching (DM), and marker matching (MM), on the dose distribution in proton therapy (PT) for hepatocellular carcinoma (HCC). Materials and Methods: Thirty-eight HCC lesions were studied retrospectively to assess changes in the dose distribution on two computed tomography (CT) scans. One was for treatment planning (1st-CT), and the other was for dose confirmation acquired during the course of PT (2nd-CT). The dose coverage of the clinical target volume (CTV-D 98) and normal liver volume that received 30 Gy relative biological effectiveness (RBE) (liver-V 30) were evaluated under each condition. Initial treatment planning on the 1st-CT was defined as reference, and three dose distributions recalculated using VM, DM, and MM on the 2nd-CT, were compared to it, respectively. In addition, the relationship between the CTV-D 98 of each method and the distance between the center of mass (COM) of the CTV and the right diaphragm top was evaluated. Results: For CTV-D 98 , significant differences were observed between the reference and VM and DM, respectively (P = 0.013, P = 0.015). There were also significant differences between MM and VM and DM, respectively (P = 0.018, P = 0.036). Regarding liver-V 30 , there was no significant difference in any of the methods, and there were no discernable difference due to the different setup methods. In DM, only two out of 34 cases with a distance from right diaphragm top to COM of CTV of 90 mm or less that CTV-D 98 difference was 5% or more and CTV-D 98 was worse than VM were confirmed. Conclusion: Although MM is obviously the most effective method, it is suggested that DM may be particularly effective in cases where the distance from right diaphragm top to COM of CTV of 90 mm or less.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The impact of different setup methods on the dose distribution in proton therapy for hepatocellular carcinoma

Takemasa

Katō

Narita

et al. 2021

J Applied Clin Med Phys

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“…Hence, position reproducibility is important for accurate position matching in breath-hold irradiation. Previous studies have shown good positional reproducibility results for breath-hold irradiation in end exhalation [ 12 , 14 , 15 ]. Although various methods have evaluated the positional reproducibility of breath-hold irradiation, most of them require manual operation.…”

Section: Introductionmentioning

confidence: 99%

Determination of reproducibility of end-exhaled breath-holding in stereotactic body radiation therapy

Sasaki

Ikushima

Sakuragawa

et al. 2020

Journal of Radiation Research

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Methods to evaluate the positional reproducibility of breath-hold irradiation mostly require manual operation. The purpose of this study is to propose a method to determine the reproducibility of breath-hold irradiation of lung tumors between fractions using non-artificial methods. This study included 13 patients who underwent terminal exhaled breath-hold irradiation for primary and metastatic lung cancer. All subjects received a prescribed dose of 60 Gy/8 fractions. The contours of the gross tumor volume (GTV) were extracted by threshold processing using treatment-planning computed tomography (CT) and cone-beam CT (CBCT), which was done just before the beginning of the treatment. The method proposed in this study evaluates the dice similarity coefficient (DSC) and Hausdorff distance (HD) by comparing two volumes, the GTVCTS (GTV obtained from treatment-planning CT) and GTVCBCT (GTV obtained from CBCT). The reference contours for DSC and HD are represented by GTVCTS. The results demonstrated good visual agreement for cases with a DSC of ~0.7. However, apparent misalignment occurred when the DSC was <0.5. HD was >2 mm in 3 out of 13 cases, and when the DSC was ~0.7, the HD was ~1 mm. In addition, cases with greater HD also demonstrated more significant variability. It was found that the DSC and HD evaluation methods for the positional reproducibility of breath-hold irradiation proposed in this study are straightforward and can be performed without the involvement of humans. Our study is of extreme significance in the field of radiation studies.

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Online verification of breath‐hold reproducibility using kV‐triggered imaging for liver stereotactic body radiation therapy

Guo

Stephans

Woody

et al. 2023

J Applied Clin Med Phys

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PurposeTo introduce a new technique for online breath‐hold verification for liver stereotactic body radiation therapy (SBRT) based on kilovoltage‐triggered imaging and liver dome positions.Material and MethodsTwenty‐five liver SBRT patients treated with deep inspiration breath‐hold were included in this IRB‐approved study. To verify the breath‐hold reproducibility during treatment, a KV‐triggered image was acquired at the beginning of each breath‐hold. The liver dome position was visually compared with the expected upper/lower liver boundaries created by expanding/contracting the liver contour 5 mm in the superior‐inferior direction. If the liver dome was within the boundaries, delivery continued; otherwise, beam was held manually, and the patient was instructed to take another breath‐hold until the liver dome fell within boundaries. The liver dome was delineated on each triggered image. The mean distance between the delineated liver dome to the projected planning liver contour was defined as liver dome position error edome. The mean and maximum edome of each patient were compared between no breath‐hold verification (all triggered images) and with online breath‐hold verification (triggered images without beam‐hold).ResultsSeven hundred thirteen breath‐hold triggered images from 92 fractions were analyzed. For each patient, an average of 1.5 breath‐holds (range 0–7 for all patients) resulted in beam‐hold, accounting for 5% (0–18%) of all breath‐holds; online breath‐hold verification reduced the mean edome from 3.1 mm (1.3–6.1 mm) to 2.7 mm (1.2–5.2 mm) and the maximum edome from 8.6 mm (3.0–18.0 mm) to 6.7 mm (3.0–9.0 mm). The percentage of breath‐holds with edome >5 mm was reduced from 15% (0–42%) without breath‐hold verification to 11% (0–35%) with online breath‐hold verification. online breath‐hold verification eliminated breath‐holds with edome >10 mm, which happened in 3% (0–17%) of all breath‐holds.ConclusionIt is clinically feasible to monitor the reproducibility of each breath‐hold during liver SBRT treatment using triggered images and liver dome. Online breath‐hold verification improves the treatment accuracy for liver SBRT.

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Interfractional diaphragm changes during breath-holding in stereotactic body radiotherapy for liver cancer

Cited by 12 publications

References 23 publications

The impact of different setup methods on the dose distribution in proton therapy for hepatocellular carcinoma

The impact of different setup methods on the dose distribution in proton therapy for hepatocellular carcinoma

Determination of reproducibility of end-exhaled breath-holding in stereotactic body radiation therapy

Online verification of breath‐hold reproducibility using kV‐triggered imaging for liver stereotactic body radiation therapy

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