Setup error and motion during deep inspiration breath-hold breast radiotherapy measured with continuous portal imaging

Lutz, Christina; Poulsen, Per Rugaard; Fledelius, Walther; Offersen, Birgitte Vrou; Thomsen, M.S.

doi:10.3109/0284186x.2015.1045625

Cited by 41 publications

(76 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The same observation was made by Fassi et al [19] using a spirometerbased DIBH with external skin markers. Lutz et al [11] used continuous portal imaging to evaluate the setup error and motion during vDIBH and found that despite a small gating window, large errors occurred in the chest wall position in some patients. In a study by McIntosh et al [12], the BHL was measured from LAT kV images.…”

Section: Discussionmentioning

confidence: 99%

“…In studies by Hayden et al [5], Sung et al [6] and Bruzzatini et al [4], the marker block was placed below the xiphoid process on soft abdominal wall with gating windows of ±2.5 mm, ±1.5 mm and ±5 mm, respectively. Lutz et al [11] used two different marker block positions in their study: one on the inferior part of the sternum and the other laterally from the xiphoid process with a reported gating window from 1.6 mm to 3.6 mm.…”

Section: Discussionmentioning

confidence: 99%

“…Utilizing patient-based monitors for the visual guidance of vDIBH increases the daily reproducibility of this technique [6]. However, large inter-fraction setup errors have been found [9][10][11].…”

mentioning

confidence: 99%

See 2 more Smart Citations

Improving the reproducibility of voluntary deep inspiration breath hold technique during adjuvant left-sided breast cancer radiotherapy

et al. 2016

View full text Add to dashboard Cite

Background: Adjuvant radiotherapy (RT) of left-sided breast cancer (LSBC) with voluntary deep inspiration breath hold (vDIBH) technique reduces the cardiac dose. In this study, the effect of marker block position and the efficacy of breath hold level (BHL) correction based on lateral kV setup images are evaluated to improve the daily reproducibility. Material and methods: A total of 148 consecutive LSBC patients treated with vDIBH RT were included in this study. The real-time position management (RPM) marker block was placed on the abdominal wall in 63 patients (group A) and on the sternum in 85 patients (group S). Acquired 900 (group A) þ 1040 (group S) orthogonal image pairs were retrospectively analyzed. The actual BHL was determined from the lateral kV images. The height of the BHL gating window in RPM was corrected if errors of the actual BHL exceeded 4 mm. Setup margins were calculated for the chest wall and for bony surrogates of the lymph node regions. Results: The sternal marker block reduced the random residual errors in the actual BHL (p < 0.05). The BHL correction was required for 26/63 patients in group A and for 26/85 patients in group S. Correction of the BHL window significantly reduced both the systematic and the random residual error in both groups. In patients with lymph node irradiation, the effect of both marker placement and BHL window correction was significant in the superior-inferior direction. Correction of the BHL reduced the mean cardiac dose by 0.5 Gy (p < 0.01) in group A and 0.6 Gy (p < 0.05) in group S. Conclusions: Reproducibility of the BHL can be improved by placing the marker block on the sternum and correcting the height of the BHL window based on lateral kV setup images. Acquisition of lateral kV images in the first 3 fractions and once a week during RT is recommended.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Improving the reproducibility of voluntary deep inspiration breath hold technique during adjuvant left-sided breast cancer radiotherapy

et al. 2016

View full text Add to dashboard Cite

show abstract

“…This has been confirmed by studies comparing patient setup reproducibility during breath hold using different marker block positions. Lutz et al found a statistically significant reduction of the inter‐field random shift and an overall tendency for smaller setup errors, shifts, and chest wall motion with the marker block placed medially on the inferior part of the sternum when compared to marker block placement 5 cm to the right at the level of the xiphoid process. Similarly, a recent prospective trial examined the effect of two‐dot marker block location on daily breath hold position reproducibility for 148 consecutive left‐breast DIBH patients.…”

Section: Introductionmentioning

confidence: 99%

Technical Note: Issues related to external marker block placement for deep inspiration breath hold breast radiotherapy

Conroy

Guebert²,

Smith

2017

Medical Physics

View full text Add to dashboard Cite

show abstract

“…When applying respiratory-gated or breath-holding techniques; theoretically, the displacement of surgical clips would be mitigated. Nevertheless, a recent study [23] consisting of 58 patients with the analysis of setup errors during deep inspiration breath-hold (DIBH) disclosed the inter-fraction systematic error (∑) and random error (σ) was 1.4 mm and 1.7 mm respectively, which was comparable to those observed in their previous work for patients irradiated in free breathing (∑ = 1.1 mm, σ = 1.5 mm) [24]. Therefore, they concluded that the main benefit of the DIBH is to separate the heart from the target rather than irradiating the target more accurately.…”

Section: Discussionmentioning

confidence: 99%

A topology-based method to mitigate the dosimetric uncertainty caused by the positional variation of the boost volume in breast conservative radiotherapy

et al. 2017

View full text Add to dashboard Cite

BackgroundTo improve local control rate in patients with breast cancer receiving adjuvant radiotherapy after breast conservative surgery, additional boost dose to the tumor bed could be delivered simultaneously via the simultaneous integrated boost (SIB) modulated technique. However, the position of tumor bed kept changing during the treatment course as the treatment position was aligned to bony anatomy. This study aimed to analyze the positional uncertainties between bony anatomy and tumor bed, and a topology-based approach was derived to stratify patients with high variation in tumor bed localization.MethodsSixty patients with early-stage breast cancer or ductal carcinoma in situ were enrolled. All received adjuvant whole breast radiotherapy with or without local boost via SIB technique. The delineation of tumor bed was defined by incorporating the anatomy of seroma, adjacent surgical clips, and any architectural distortion on computed tomography simulation. A total of 1740 on-board images were retrospectively analyzed. Positional uncertainty of tumor bed was assessed by four components: namely systematic error (SE), and random error (RE), through anterior-posterior (AP), cranial-caudal (CC), left-right (LR) directions and couch rotation (CR). Age, tumor location, and body-mass factors including volume of breast, volume of tumor bed, breast thickness, and body mass index (BMI) were analyzed for their predictive role. The appropriate margin to accommodate the positional uncertainty of the boost volume was assessed, and the new plans with this margin for the tumor bed was designed as the high risk planning target volume (PTV-H) were created retrospectively to evaluate the impact on organs at risk.ResultsIn univariate analysis, a larger breast thickness, larger breast volume, higher BMI, and different tumor locations correlated with a greater positional uncertainty of tumor bed. However, BMI was the only factor associated with displacements of surgical clips in the multivariate analysis and patients with higher BMI were stratified as high variation group. When image guidance was aligned to bony structures, the SE and RE of clip displacement were consistently larger in the high variation group. The corresponding PTV-H margins for the high- and low-variation groups were 7, 10, 10 mm and 4, 9, 6 mm in AP, CC, LR directions, respectively. The heart dose between the two plans was not significantly different, whereas the dosimetric parameters for the ipsilateral lung were generally higher in the new plans.ConclusionsIn patients with breast cancer receiving adjuvant radiotherapy, a higher BMI is associated with a greater positional uncertainty of the boost tumor volume. More generous margin should be considered and it can be safely applied through proper design of beam arrangement with advanced treatment techniques.

show abstract

Setup error and motion during deep inspiration breath-hold breast radiotherapy measured with continuous portal imaging

Cited by 41 publications

References 27 publications

Improving the reproducibility of voluntary deep inspiration breath hold technique during adjuvant left-sided breast cancer radiotherapy

Improving the reproducibility of voluntary deep inspiration breath hold technique during adjuvant left-sided breast cancer radiotherapy

Technical Note: Issues related to external marker block placement for deep inspiration breath hold breast radiotherapy

A topology-based method to mitigate the dosimetric uncertainty caused by the positional variation of the boost volume in breast conservative radiotherapy

Contact Info

Product

Resources

About