Quantifying Interfraction and Intrafraction Tumor Motion in Lung Stereotactic Body Radiotherapy Using Respiration-Correlated Cone Beam Computed Tomography

Bissonnette, Jean Pierre; Franks, K.; Purdie, Thomas G.; Moseley, D; Sonke, Jan‐Jakob; Jaffray, David A.; Dawson, Laura A.; Bezjak, Andrea

doi:10.1016/j.ijrobp.2008.11.066

Cited by 152 publications

(147 citation statements)

References 30 publications

(40 reference statements)

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“…There have been many studies that address the effects of interfraction motion for various different clinical situations. [10][11][12][13][14] In contrast, intrafraction motion refers to the motion of the patient and/or internal organs during delivery of a treatment fraction. A number of authors have investigated internal organ motion in a variety of tumor sites, including lung, 15 liver, [16][17][18] prostate, 19,20 and breast.…”

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confidence: 99%

Quality assurance for nonradiographic radiotherapy localization and positioning systems: Report of Task Group 147

Willoughby

Lehmann

Bencomo³

et al. 2012

Medical Physics

108

126

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New technologies continue to be developed to improve the practice of radiation therapy. As several of these technologies have been implemented clinically, the Therapy Committee and the Quality Assurance and Outcomes Improvement Subcommittee of the American Association of Physicists in Medicine commissioned Task Group 147 to review the current nonradiographic technologies used for localization and tracking in radiotherapy. The specific charge of this task group was to make recommendations about the use of nonradiographic methods of localization, specifically; radiofrequency, infrared, laser, and video based patient localization and monitoring systems. The charge of this task group was to review the current use of these technologies and to write quality assurance guidelines for the use of these technologies in the clinical setting. Recommendations include testing of equipment for initial installation as well as ongoing quality assurance. As the equipment included in this task group continues to evolve, both in the type and sophistication of technology and in level of integration with treatment devices, some of the details of how one would conduct such testing will also continue to evolve. This task group, therefore, is focused on providing recommendations on the use of this equipment rather than on the equipment itself, and should be adaptable to each user's situation in helping develop a comprehensive quality assurance program.

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mentioning

confidence: 99%

Quality assurance for nonradiographic radiotherapy localization and positioning systems: Report of Task Group 147

Willoughby

Lehmann

Bencomo³

et al. 2012

Medical Physics

108

126

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“…Excessive radiation dose to normal lung tissue will increase the odds of radiation pneumonitis (25) . However, the treatment course of hypofractionated SBRT is usually short and several studies demonstrate no significant volume reduction during SBRT treatment, no matter which kind of image method was used for verification 26 , 27 , 28 . It is reported that significant decrease of tumor volume often occurs after four weeks of SBRT treatment (29) .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of interfractional variation of the centroid position and volume of internal target volume during stereotactic body radiotherapy of lung cancer using cone‐beam computed tomography

Sun

Cheng

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to determine interfractional variation of the centroid position and volume of internal target volume (ITV) during stereotactic body radiation therapy (SBRT) of lung cancer. From January 2014 to August 2014, a total of 32 patients with 37 primary or metastatic lung tumors were enrolled in our study. All patients received SBRT treatment in 4–5 fractions to a median dose of 48 Gy. Both 3D CT and 4D CT scans were used for radiotherapy treatment planning. 3D CBCT was acquired prior to treatment delivery to verify patient positioning. A total of 163 3D CBCT images were available for evaluation. 3D CBCT scans acquired for verification were registered with simulation CT scans. The ITVs were contoured on all verification 3D CBCT scans and compared to the initial gross target volume (GTV) or ITV in treatment planning system. GTV was based on 3D CT while ITV was based on both 3D CT and 4D CT. To assess the interfractional variation of ITV centroid position, we used vertebrae body adjacent to the tumor as reference point when performing the registration procedure. To eliminate the effect of time on tumor volume between simulation CT scan and the first fraction, the interfractional variation of ITV was evaluated from the first fraction to the last fraction. The overall 3D vector shift was 4.4±2.5 mm (range: 0.4−13.8 mm). The interfractional variation of ITV centroid position in superior‐inferior, anterior‐posterior, and left‐right directions were −0.7±2.7 mm, −1.4±3.4 mm, and −0.5±2.2 mm, respectively. No significant difference was observed between three directions (p=0.147). Large interfractional variations (≥5 mm) were observed in 12 fractions (9.3%) in superior‐inferior direction, 24 fractions (18.6%) in anterior‐posterior direction, and 5 fractions (3.9%) in left‐right direction. No time trend of tumor volume change measured in 3D CBCT was detected during four fractions (p=0.074). A significant (p=0.010) time trend was detected when evaluating the time trend of ITV change during 5 fractions and diameter was found to be significantly correlated with the ITV change (p=0.000). ITV did not show significant regression during SBRT treatment, but interfractional variation in the ITV centroid position was observed, especially in anterior‐posterior direction. An isotropic margin of 7 mm around ITV might be necessary for adequate coverage of interfractional variation of ITV centroid position, but only in case no soft tissue‐based setup is performed during SBRT treatment.PACS number(s): 87.55.dk

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“…The visible portion was in the upper lung in seven patients, middle lung in two patients, and lower lung in two patients. The range of GTV volumes attached to the mediastinum was 40-290 cm 3 and the range of GTV in lung was 5-73 cm 3 . Each patient received an RCCT at simulation (Light Speed, GE Health Care, Waukesha, WI) with breathing recorded by an external monitor (Real-time Position Management (RPM), Varian Medical Systems, Palo Alto, CA).…”

Section: Methodsmentioning

confidence: 95%

A study of respiration‐correlated cone‐beam CT scans to correct target positioning errors in radiotherapy of thoracic cancer

et al. 2012

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Purpose: There is increasingly widespread usage of cone-beam CT (CBCT) for guiding radiation treatment in advanced-stage lung tumors, but difficulties associated with daily CBCT in conventionally fractionated treatments include imaging dose to the patient, increased workload and longer treatment times. Respiration-correlated cone-beam CT (RC-CBCT) can improve localization accuracy in mobile lung tumors, but further increases the time and workload for conventionally fractionated treatments. This study investigates whether RC-CBCT-guided correction of systematic tumor deviations in standard fractionated lung tumor radiation treatments is more effective than 2D imagebased correction of skeletal deviations alone. A second study goal compares respiration-correlated vs respiration-averaged images for determining tumor deviations. Methods: Eleven stage II-IV nonsmall cell lung cancer patients are enrolled in an IRB-approved prospective off-line protocol using RC-CBCT guidance to correct for systematic errors in GTV position. Patients receive a respiration-correlated planning CT (RCCT) at simulation, daily kilovoltage RC-CBCT scans during the first week of treatment and weekly scans thereafter. Four types of correction methods are compared: (1) systematic error in gross tumor volume (GTV) position, (2) systematic error in skeletal anatomy, (3) daily skeletal corrections, and (4) weekly skeletal corrections. The comparison is in terms of weighted average of the residual GTV deviations measured from the RC-CBCT scans and representing the estimated residual deviation over the treatment course. In the second study goal, GTV deviations computed from matching RCCT and RC-CBCT are compared to deviations computed from matching respiration-averaged images consisting of a CBCT reconstructed using all projections and an average-intensity-projection CT computed from the RCCT. Results: Of the eleven patients in the GTV-based systematic correction protocol, two required no correction, seven required a single correction, one required two corrections, and one required three corrections. Mean residual GTV deviation (3D distance) following GTV-based systematic correction (mean ± 1 standard deviation 4.8 ± 1.5 mm) is significantly lower than for systematic skeletal-based (6.5 ± 2.9 mm, p = 0.015), and weekly skeletal-based correction (7.2 ± 3.0 mm, p = 0.001), but is not significantly lower than daily skeletal-based correction (5.4 ± 2.6 mm, p = 0.34). In two cases, first-day CBCT images reveal tumor changes-one showing tumor growth, the other showing large tumor displacement-that are not readily observed in radiographs. Differences in computed GTV deviations between respiration-correlated and respiration-averaged images are 0.2 ± 1.8 mm in the superior-inferior direction and are of similar magnitude in the other directions. Conclusions: An off-line protocol to correct GTV-based systematic error in locally advanced lung tumor cases can be effective at reducing tumor deviations, although the findings need confirmation with larger patient s...

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Quantifying Interfraction and Intrafraction Tumor Motion in Lung Stereotactic Body Radiotherapy Using Respiration-Correlated Cone Beam Computed Tomography

Cited by 152 publications

References 30 publications

Quality assurance for nonradiographic radiotherapy localization and positioning systems: Report of Task Group 147

Quality assurance for nonradiographic radiotherapy localization and positioning systems: Report of Task Group 147

Evaluation of interfractional variation of the centroid position and volume of internal target volume during stereotactic body radiotherapy of lung cancer using cone‐beam computed tomography

A study of respiration‐correlated cone‐beam CT scans to correct target positioning errors in radiotherapy of thoracic cancer

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