Intra-breath-hold residual motion of image-guided DIBH liver-SBRT: An estimation by ultrasound-based monitoring correlated with diaphragm position in CBCT

Vogel, Lena; Sihono, Dwi Seno Kuncoro; Weiß, Christel; Lohr, Frank; Stieler, Florian; Wertz, H.; Swietochowski, Sandra von; Simeonova-Chergou, Anna; Wenz, Frederik; Blessing, Manuel; Boda-Heggemann, Judit

doi:10.1016/j.radonc.2018.07.007

Cited by 35 publications

(31 citation statements)

References 39 publications

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“…Liver motion monitoring using an adapted Vivid 7 Dimension probe (GE Healthcare, USA) was evaluated against Calypso in a free-breathing patient immediately after liver SBRT (Ipsen et al 2017 ). Another group has pioneered the use of an experimental version of Clarity to monitor the 3D position of the liver in 13 patients during RT delivered in breath hold (Boda-Heggemann et al 2016 , Sihono et al 2017 , Vogel et al 2018 ). A 3D US probe was held using a mechanical arm against the rib-cage throughout planning CT, CBCT and RT delivery, without interfering with treatment delivery (Boda-Heggemann et al 2016 ).…”

Section: Real-time Intrafraction Motion Monitoring Methodsmentioning

confidence: 99%

Real-time intrafraction motion monitoring in external beam radiotherapy

et al. 2019

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Radiotherapy (RT) aims to deliver a spatially conformal dose of radiation to tumours while maximizing the dose sparing to healthy tissues. However, the internal patient anatomy is constantly moving due to respiratory, cardiac, gastrointestinal and urinary activity. The long term goal of the RT community to ‘see what we treat, as we treat’ and to act on this information instantaneously has resulted in rapid technological innovation. Specialized treatment machines, such as robotic or gimbal-steered linear accelerators (linac) with in-room imaging suites, have been developed specifically for real-time treatment adaptation. Additional equipment, such as stereoscopic kilovoltage (kV) imaging, ultrasound transducers and electromagnetic transponders, has been developed for intrafraction motion monitoring on conventional linacs. Magnetic resonance imaging (MRI) has been integrated with cobalt treatment units and more recently with linacs. In addition to hardware innovation, software development has played a substantial role in the development of motion monitoring methods based on respiratory motion surrogates and planar kV or Megavoltage (MV) imaging that is available on standard equipped linacs. In this paper, we review and compare the different intrafraction motion monitoring methods proposed in the literature and demonstrated in real-time on clinical data as well as their possible future developments. We then discuss general considerations on validation and quality assurance for clinical implementation. Besides photon RT, particle therapy is increasingly used to treat moving targets. However, transferring motion monitoring technologies from linacs to particle beam lines presents substantial challenges. Lessons learned from the implementation of real-time intrafraction monitoring for photon RT will be used as a basis to discuss the implementation of these methods for particle RT.

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Section: Real-time Intrafraction Motion Monitoring Methodsmentioning

confidence: 99%

Real-time intrafraction motion monitoring in external beam radiotherapy

et al. 2019

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“…For all motion management techniques, the PTV margin has to be enlarged such that all uncertainties from motion representation in planning imaging and all uncertainties related to the particular motion management strategy during treatment previously not considered are covered [89,107]. Examples of motion management uncertainties arise from uncompensated residual target motion, rotation, and deformation [81, 108,109], differential target and surrogate motion (e.g., of target and implanted fiducials or diaphragm [66]), target-surrogate correlation modeling [80], motion monitoring and correlation model update frequency [110], and motion prediction modeling due to latency times of the motion tracking systems [111,112]. Typically for stereotactic radiotherapy, PTV margins range from 0-2 mm for intracranial/spinal targets to 3-5 mm for moving extracranial targets.…”

Section: Target Volume Definitionmentioning

confidence: 99%

Technological quality requirements for stereotactic radiotherapy

et al. 2020

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This review details and discusses the technological quality requirements to ensure the desired quality for stereotactic radiotherapy using photon external beam radiotherapy as defined by the DEGRO Working Group Radiosurgery and Stereotactic Radiotherapy and the DGMP Working Group for Physics and Technology in Stereotactic Radiotherapy. The covered aspects of this review are 1) imaging for target volume definition, 2) patient positioning and target volume localization, 3) motion management, 4) collimation of the irradiation and beam directions, 5) dose calculation, 6) treatment unit accuracy, and 7) dedicated quality assurance measures. For each part, an expert review for current state-of-the-art techniques and their particular technological quality requirement to reach the necessary accuracy for stereotactic radiotherapy divided into intracranial stereotactic radiosurgery in one single fraction (SRS), intracranial fractionated stereotactic radiotherapy (FSRT), and extracranial stereotactic body radiotherapy (SBRT) is presented. All recommendations and suggestions for all mentioned aspects of stereotactic radiotherapy are formulated and related uncertainties and potential sources of error discussed. Additionally, further research and development needs in terms of insufficient data and unsolved problems for stereotactic radiotherapy are identified, which will serve as The authors D. Schmitt and O. Blanck contributed equally to the manuscript.

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“…All patients had prospectively given consent for their anonymised data sets to be used for research purposes. The Planning Target Volume (PTV) was defined as the Gross Tumour Volume (GTV) plus a 5 mm isotropic margin, assuming treatment delivery in breathhold using Active Breathing Coordinator (ABC) [18,19]. The duodenum, stomach, small bowel, large bowel, liver, kidneys, and spinal cord were identified as OAR and delineated.…”

Section: Patientsmentioning

confidence: 99%

Comparison of the dose escalation potential for two hypofractionated radiotherapy regimens for locally advanced pancreatic cancer

Bertholet

Hunt

Dunlop

et al. 2019

Clinical and Translational Radiation Oncology

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Objectives: To determine the potential for dose escalation to a biological equivalent dose BED 10 ffi100 Gy in hypofractionated radiotherapy for locally advanced pancreatic cancer (LAPC). Materials and methods: Ten unselected LAPC patients were retrospectively included in the study. Two fractionation regimens were compared (5 and 15 fractions). The aim was to cover 95% of the Planning Target Volume (PTV) with a BED 10 = 54 Gy (base dose = 33 Gy in 5 fractions, 42.5 Gy in 15 fractions) whilst respecting organs-at-risk (OAR) constraints. Once the highest PTV coverage was achieved dose escalation to a BED 10 ffi100 Gy (escalated dose = 50 Gy in 5 fractions, 67.5 Gy in 15 fractions) was attempted, limiting the PTV maximum dose to 130% of the escalated dose. Results: In 5 fractions, 95% PTV coverage by both base and escalated doses could be achieved for one patient with PTV more than 1 cm away from OAR. 95% and 90% PTV coverage by the base dose was achieved in one and two patients respectively. In all other patients, coverage even by the base dose had to be compromised to comply with OAR constraints. In 15 fractions, 95% PTV coverage by the base dose was feasible for all patients except one. Dose escalation allowed improvement in target coverage by the base dose in both fractionation regimen whilst covering a sub-volume of the PTV with a BED 10 ffi100 Gy. Both fractionation schemes were equivalent in terms of dose escalation potential. Conclusion: LAPC patients with OAR close to the PTV are generally not eligible for hypofractionation with dose escalation. However, this planning study shows that it is possible to cover PTV sub-volumes with a BED 10 ffi100 Gy in addition to delivering a BED 10 = 54 Gy to 90-95% of the PTV as commonly prescribed to this population. Combined with an adaptive approach, this may maximize PTV coverage by a high BED on days with favourable anatomy.

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Intra-breath-hold residual motion of image-guided DIBH liver-SBRT: An estimation by ultrasound-based monitoring correlated with diaphragm position in CBCT

Cited by 35 publications

References 39 publications

Real-time intrafraction motion monitoring in external beam radiotherapy

Real-time intrafraction motion monitoring in external beam radiotherapy

Technological quality requirements for stereotactic radiotherapy

Comparison of the dose escalation potential for two hypofractionated radiotherapy regimens for locally advanced pancreatic cancer

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