Radiotherapy setup displacements in breast cancer patients: 3D surface imaging experience

Sá, Ana Cravo; Fermento, Ana; Neves, Dalila; Ferreira, Sara; Silva, Teresa; Coelho, Carina Marques; Vaandering, A.; Roma, Ana; Quaresma, S. Da Rita; Bonnarens, Emmanuel

doi:10.1016/j.rpor.2017.12.007

Cited by 47 publications

(36 citation statements)

References 19 publications

(39 reference statements)

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“…Furthermore, both the global setup errors and the local setup errors can be affected by different radiotherapist groups in immobilization, CT simulation and treatment. To ensure the accuracy of radiation therapy and reduce the patient’s additional radiation dose, optical surface imaging (OSI) systems [ 17 , 18 ] play an increasingly important role in breast radiation therapy. Furthermore, to reduce the radiation dose to the lung and the heart, changing the patient’s position [ 13 , 19 , 20 ] and using deep inspiration breath-hold (DIBH) [ 21 , 22 ] technology were studied.…”

Section: Discussionmentioning

confidence: 99%

Design of a new breast vacuum bag to reduce the global and local setup errors and to reduce PTV margin in post-mastectomy radiation therapy

Shen

Xiong

Wang

et al. 2020

Journal of Radiation Research

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To design a new breast vacuum bag to reduce global and local setup errors in post-mastectomy radiation therapy (PMRT). A total of 24 PMRT patients were immobilized with an old vacuum bag and 26 PMRT patients were immobilized with a new vacuum bag. The registration results were analysed using four regions of interest (ROI): the global ROI [including the whole region of the planning target volume (PTV), GROI], the supraclavicular area (SROI), the ipsilateral chest wall region (CROI) and the ipsilateral arm region (AROI). The global and local setup errors of the two groups were compared. The global setup errors of the new vacuum group were significantly smaller than those in the old vacuum group with the exception of yaw axes (P < 0.05). The systematic error (Σ) and random error (σ) ranged from 1.21 to 2.13 mm. In the new vacuum group, the local setup errors in the medial-lateral (ML) direction and roll axes for CROI (the Σ and σ ranged from 0.65 to 1.35 mm), and the local setup errors in ML and superior-inferior (SI) directions for SROI were significantly smaller than those in the old vacuum group. The total required PTV margins for the chest wall in ML, SI, and anterior-posterior (AP) were 4.40, 3.12 and 3.77 mm respectively. The new vacuum bag can significantly reduce the global setup errors and local setup errors in PMRT. The respiratory motion of the chest wall was negligible, and the 5 mm PTV margin could cover the local setup errors in PMRT using the new vacuum bag with cone beam CT (CBCT) correction.

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Section: Discussionmentioning

confidence: 99%

Design of a new breast vacuum bag to reduce the global and local setup errors and to reduce PTV margin in post-mastectomy radiation therapy

Shen

Xiong

Wang

et al. 2020

Journal of Radiation Research

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“…Next, we compare our set-up results for the crawl couch to the results for supine positioning 14,15,18,26,29,[32][33][34][35][36][37][38][39][40] (Table 6). We found our LL margins were higher than the mean of reported margins in these publications (8.1 mm).…”

Section: Discussionmentioning

confidence: 99%

Crawl positioning improves set-up precision and patient comfort in prone whole breast irradiation

Deseyne

Speleers

Neve

et al. 2020

Sci Rep

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Prone positioning for whole-breast irradiation (WBI) reduces dose to organs at risk, but reduces set-up speed, precision, and comfort. We aimed to improve these problems by placing patients in prone crawl position on a newly developed crawl couch (CrC). A group of 10 right-sided breast cancer patients requiring WBI were randomized in this cross-over trial, comparing the CrC to a standard prone breastboard (BB). Laterolateral (LL), craniocaudal (CC) and anterioposterior (AP) set-up errors were evaluated with cone beam CT. Comfort, preference and set-up time (SUT) were assessed. Forty left and right-sided breast cancer patients served as a validation group. For BB versus CrC, AP, LL and CC mean patient shifts were − 0.8 ± 2.8, 0.2 ± 11.7 and − 0.6 ± 4.4 versus − 0.2 ± 3.3, − 0.8 ± 2.5 and − 1.9 ± 5.7 mm. LL shift spread was reduced significantly. Nine out of 10 patients preferred the CrC. SUT did not differ significantly. The validation group had mean patient shifts of 1.7 ± 2.9 (AP), 0.2 ± 3.6 (LL) and − 0.2 ± 3.3 (CC) mm. Mean SUT in the validation group was 1 min longer (P < 0.05) than the comparative group. Median SUT was 3 min in all groups. The CrC improved precision and comfort compared to BB. Set-up errors compare favourably to other prone-WBI trials and rival supine positioning.

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“…Other studies have already proven the benefit of AlignRT in patient positioning. Cravo Sá et al [25] showed that positioning patients with AlignRT is more accurate than when only skin marks are used. Batin et al [26] showed for post-mastectomy patients that positioning with AlignRT after laser alignment resulted in a significant reduction of the residual errors than when positioning with laser alignment alone.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a 3D surface imaging system for deep inspiration breath-hold patient positioning and intra-fraction monitoring

et al. 2019

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Purpose To determine the accuracy of a surface guided radiotherapy (SGRT) system for positioning of breast cancer patients in breath-hold (BH) with respect to cone-beam computed tomography (CBCT). Secondly, to evaluate the thorax position stability during BHs with SGRT, when using an air-volume guidance system. Methods and materials Eighteen left-sided breast cancer patients were monitored with SGRT during CBCT and treatment, both in BH. CBCT scans were matched on the target volume and the patient surface. The setup error differences were evaluated, including with linear regression analysis. The intra-fraction variability and stability of the air-volume guided BHs were determined from SGRT measurements. The variability was determined from the maximum difference between the different BH levels within one treatment fraction. The stability was determined from the difference between the start and end position of each BH. Results SGRT data correlated well with CBCT data. The correlation was stronger for surface-to-CBCT (0.61) than target volume-to-CBCT (0.44) matches. Systematic and random setup error differences were ≤ 2 mm in all directions. The 95% limits of agreement (mean ± 2SD) were 0.1 ± 3.0, 0.6 ± 4.1 and 0.4 ± 3.4 mm in the three orthogonal directions, for the surface-to-CBCT matches. For air-volume guided BHs, the variability detected with SGRT was 2.2, 2.8 and 2.3 mm, and the stability − 1.0, 2.1 and 1.5 mm, in three orthogonal directions. Furthermore, the SGRT system could detect unexpected patient movement, undetectable by the air-volume BH system. Conclusion With SGRT, left-sided breast cancer patients can be positioned and monitored continuously to maintain position errors within 5 mm. Low intra-fraction variability and good stability can be achieved with the air-volume BH system, however, additional patient position information is available with SGRT, that cannot be detected with air-volume BH systems.

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Radiotherapy setup displacements in breast cancer patients: 3D surface imaging experience

Abstract: AlignRT could help the positioning of breast cancer patients; however, it should be used with another imaging method.

Cited by 47 publications

References 19 publications

Design of a new breast vacuum bag to reduce the global and local setup errors and to reduce PTV margin in post-mastectomy radiation therapy

Design of a new breast vacuum bag to reduce the global and local setup errors and to reduce PTV margin in post-mastectomy radiation therapy

Crawl positioning improves set-up precision and patient comfort in prone whole breast irradiation

Evaluation of a 3D surface imaging system for deep inspiration breath-hold patient positioning and intra-fraction monitoring

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