Monitoring ABC‐assisted deep inspiration breath hold for left‐sided breast radiotherapy with an optical tracking system

Mittauer, K.E.; Deraniyagala, Rohan; Li, Jonathan G.; Lü, Bo; Liu, Chihray; Samant, S; Lightsey, Judith L.; Yan, G

doi:10.1118/1.4903511

Cited by 25 publications

(25 citation statements)

References 38 publications

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“…McIntosh et al [7] determined a rigid heart shifting method to estimate heart doses when using the same system that was investigated in our study. This technique was then applied by Mittauer et al [19] when evaluating DIBH using an active breathing coordinator (ABC)-assisted breath-hold technique (Elekta Oncology Systems, Crawley, UK). The same LD can be achieved on imaging for very different levels of inspiration, which may represent a different heart dose when MV imaging is used to evaluate the position of the target with respect to the treatment unit because the marker block technique measures the distance moved from a baseline that is independent from the treatment unit position.…”

Section: Discussionmentioning

confidence: 99%

Continuous breath-hold assessment during breast radiotherapy using portal imaging

Doebrich

Downie

Lehmann

2018

Physics and Imaging in Radiation Oncology

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Section: Discussionmentioning

confidence: 99%

Continuous breath-hold assessment during breast radiotherapy using portal imaging

Doebrich

Downie

Lehmann

2018

Physics and Imaging in Radiation Oncology

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“…In theory, reduced liver motion can lead to reduced ITV . Therefore, it is important to manage and/or account for respiratory liver motion through means such as abdominal compression (AC), which uses a constant force applied to the abdomen to reduce liver motion, respiratory gating techniques to deliver radiation only to the tumor during the respiratory cycle, and active breathing control (ABC), which achieves temporary and reproducible inhibition of respiration‐induced motion by monitoring the patient's breathing cycle and implementing a breath hold at a predefined stage of respiration and air flow direction. However, each technology has its own indications.…”

Section: Discussionmentioning

confidence: 99%

Does liver resection/transplantation affect respiratory induced liver motion in patients with hepatocellular carcinoma?

Zhou

Chen

et al. 2017

J Applied Clin Med Phys

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The purpose of this study was to evaluate the changes in magnitude of three‐dimensional (3D) liver motion after liver resection/transplantation in patients with hepatocellular carcinoma (HCC) using four‐dimensional (4D)‐computed tomography (CT) images. From January 2012 to April 2016, 74 HCC patients underwent 4D‐CT scans under a free‐breathing state to assess respiratory liver motion. Of the 74 patients, 40 did not have a liver resection/transplantation (Group A), 34 with liver resection/transplantation. 15 underwent major or minor resection in the right liver lobe (Group B), 14 underwent major or minor resection in the left liver lobe (Group C), and five underwent liver transplantation (Group D). The 4D‐CT images were sorted into 10 image series according to the respiratory phase from the end inspiration to the end expiration, and then transferred to treatment planning software. All liver contours were drawn by a single physician and confirmed by a second. Liver relative coordinates were automatically generated to calculate liver respiratory motion in different axial directions and compiled into a single composite image. Differences in respiratory liver motion were assessed using one‐way ANOVA. The average liver respiratory motion in the cranial‐caudal direction and 3D magnitude were 10.46 ± 2.78 mm (range, 5.60–18.80 mm) and 11.74 ± 2.65 mm (range, 7.45–20.79 mm) for patients without liver resection/transplantation, and 7.74 ± 2.79 mm (range, 2.20–12.90 mm) and 9.07 ± 2.38 mm (range, 4.79–14.08 mm) for posthepatectomy/post‐transplant patients respectively. There were significant differences between Group A and B, Group A and C, Group A and D. However, there were no significant differences among Group B, C, and D. Liver resection/transplantation greatly affected respiratory‐induced liver motion in patients with HCC. We, therefore, recommend discriminatory internal target volume (ITV) determination for patients with or without liver resection/transplantation undergoing external radiotherapy for hepatic tumors while respiratory motion management is unavailable.

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“…Scatter plots illustrate the respiratory liver motion in the X , Y , and Z axial directions in the four patient groups. 10.99 ± 2.42 mm (range 7.49-15.59 mm), and 10.94 ± 2.28 mm (range 4.70-16.34 mm) for groups A, B, C, and D, respectively, with a significant difference between the groups (F = 34.40, p < 0.001; see Table II). There was a significant correlation between the DTS and the 3D vector (r = 0.941, p < 0.001) when the compression plate was placed between the subxiphoid area and umbilicus.…”

Section: C 3d Vectorsmentioning

confidence: 93%

“…Respiration-induced liver motion (i.e., respiratory liver motion) is anisotropic, occurring primarily in the cephalic-caudal direction and reaching a range of motion from 5 to 50 mm. 1,2 Therefore, it is imperative to manage and/or account for respiratory liver motion through means such as abdominal compression (AC), [3][4][5] which uses a constant force applied to the abdomen to reduce liver motion, respiratory gating techniques [6][7][8] to deliver radiation only to the tumor during the respiratory cycle, and active breathing control, 9,10 which achieves temporary and reproducible inhibition of respiration-induced motion by monitoring the patient's breathing cycle and implementing a breath hold at a predefined stage of respiration and air flow direction. The Body Pro-Lok™ system 11 is an easy-touse modular structure that can facilitate the administration of complex stereotactic body radiotherapy through AC by bridging a respiratory belt and plate and thus providing a number of options to help control the amount of liver motion resulting from patient breathing.…”

Section: Introductionmentioning

confidence: 99%

4D‐CT scans reveal reduced magnitude of respiratory liver motion achieved by different abdominal compression plate positions in patients with intrahepatic tumors undergoing helical tomotherapy

Zhou

Chen

et al. 2016

Medical Physics

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Purpose: While abdominal compression (AC) can be used to reduce respiratory liver motion in patients receiving helical tomotherapy for hepatocellular carcinoma, the nature and extent of this effect is not well described. The purpose of this study was to evaluate the changes in magnitude of three-dimensional liver motion with abdominal compression using four-dimensional (4D) computed tomography (CT) images of several plate positions. Methods: From January 2012 to October 2015, 72 patients with intrahepatic carcinoma and divided into four groups underwent 4D-CT scans to assess respiratory liver motion. Of the 72 patients, 19 underwent abdominal compression of the cephalic area between the subxiphoid and umbilicus (group A), 16 underwent abdominal compression of the caudal region between the subxiphoid area and the umbilicus (group B), 11 patients underwent abdominal compression of the caudal umbilicus (group C), and 26 patients remained free breathing (group D). 4D-CT images were sorted into ten-image series, according to the respiratory phase from the end inspiration to the end expiration, and then transferred to treatment planning software. All liver contours were drawn by a single physician and confirmed by a second physician. Liver relative coordinates were automatically generated to calculate the liver respiratory motion in different axial directions to compile the 10 ten contours into a single composite image. Differences in respiratory liver motion were assessed with a one-way analysis of variance test of significance. Results: The average respiratory liver motion in the Y axial direction was 4.53 ± 1.16, 7.56 ± 1.30, 9.95 ± 2.32, and 9.53 ± 2.62 mm in groups A, B, C, and D, respectively, with a significant change among the four groups (p < 0.001). Abdominal compression was most effective in group A (compression plate on the subxiphoid area), with liver displacement being 2.53 ± 0.93, 4.53 ± 1.16, and 2.14 ± 0.92 mm on the X-, Y -, and Z-axes, respectively. There was no significant difference in respiratory liver motion between group C (displacement: 3.23 ± 1.47, 9.95 ± 2.32, and 2.92 ± 1.10 mm on the X-, Y -, and Z-axes, respectively) and group D (displacement: 3.35 ± 1.55, 9.53 ± 2.62, and 3.35 ± 1.73 mm on the X-, Y -, and Z-axes, respectively). Abdominal compression was least effective in group C (compression on caudal umbilicus), with liver motion in this group similar to that of free-breathing patients (group D). Conclusions: 4D-CT scans revealed significant liver motion control via abdominal compression of the subxiphoid area; however, this control of liver motion was not observed with compression of the caudal umbilicus. The authors, therefore, recommend compression of the subxiphoid area in patients undergoing external radiotherapy for intrahepatic carcinoma. C 2016 Author(s). All article content, except where otherwise noted, is licensed under a Creative Commons Attribution (CC BY) license

show abstract

Monitoring ABC‐assisted deep inspiration breath hold for left‐sided breast radiotherapy with an optical tracking system

Abstract: In ABC-assisted DIBH, large positional variation can occur in some patients, due to their different BH maneuvers. The authors' study has shown that OTS can be a valuable tool for real-time quality control of ABC-assisted DIBH.

Cited by 25 publications

References 38 publications

Continuous breath-hold assessment during breast radiotherapy using portal imaging

Continuous breath-hold assessment during breast radiotherapy using portal imaging

Does liver resection/transplantation affect respiratory induced liver motion in patients with hepatocellular carcinoma?

4D‐CT scans reveal reduced magnitude of respiratory liver motion achieved by different abdominal compression plate positions in patients with intrahepatic tumors undergoing helical tomotherapy

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