Single‐institution report of setup margins of voluntary deep‐inspiration breath‐hold (<scp>DIBH</scp>) whole breast radiotherapy implemented with real‐time surface imaging

Xiao, Annie; Crosby, Jennie; Malin, Martha; Kang, Hyejoo; Washington, M.; Hasan, Yasmin; Chmura, Steven J.; Al‐Hallaq, Hania

doi:10.1002/acm2.12368

Cited by 35 publications

(57 citation statements)

References 33 publications

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“…Kügele et al reported that the intrafractional reproducibility for tangential and locoregional treatment was as low as 1 mm (median over 40 patients) in all three translational directions, but during a single treatment session the maximum deviation was up to 5 mm, which resulted in large effects on the target coverage and OAR doses [ 70 ]. The accuracy of SGRT systems have been reported within 5 mm for DIBH positioning and monitoring [ 71 ], and are similar to those reported in studies using spirometry-based positioning [ 68 ].…”

Section: Introductionsupporting

confidence: 76%

“…SGRT systems offer the possibility of evaluating intra-DIBH stability, which has been reported with ≤0.7 mm, together with an intra-fractional reproducibility of ≤2.2 mm [68] and with 0.3 mm as the median standard deviation of the BH level during DIBH [69]. Kügele et al reported that the intrafractional reproducibility for tangential and locoregional treatment was as low as 1 mm (median over 40 patients) in all three translational directions, but during a single treatment session the maximum deviation was up to 5 mm, which resulted in large effects on the target coverage and OAR doses [70].…”

Section: Breath-holdmentioning

confidence: 99%

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Recent advances in Surface Guided Radiation Therapy

et al. 2020

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The growing acceptance and recognition of Surface Guided Radiation Therapy (SGRT) as a promising imaging technique has supported its recent spread in a large number of radiation oncology facilities. Although this technology is not new, many aspects of it have only recently been exploited. This review focuses on the latest SGRT developments, both in the field of general clinical applications and special techniques. SGRT has a wide range of applications, including patient positioning with real-time feedback, patient monitoring throughout the treatment fraction, and motion management (as beam-gating in free-breathing or deep-inspiration breath-hold). Special radiotherapy modalities such as accelerated partial breast irradiation, particle radiotherapy, and pediatrics are the most recent SGRT developments. The fact that SGRT is nowadays used at various body sites has resulted in the need to adapt SGRT workflows to each body site. Current SGRT applications range from traditional breast irradiation, to thoracic, abdominal, or pelvic tumor sites, and include intracranial localizations. Following the latest SGRT applications and their specifications/requirements, a stricter quality assurance program needs to be ensured. Recent publications highlight the need to adapt quality assurance to the radiotherapy equipment type, SGRT technology, anatomic treatment sites, and clinical workflows, which results in a complex and extensive set of tests. Moreover, this review gives an outlook on the leading research trends. In particular, the potential to use deformable surfaces as motion surrogates, to use SGRT to detect anatomical variations along the treatment course, and to help in the establishment of personalized patient treatment (optimized margins and motion management strategies) are increasingly important research topics. SGRT is also emerging in the field of patient safety and integrates measures to reduce common radiotherapeutic risk events (e.g. facial and treatment accessories recognition). This review covers the latest clinical practices of SGRT and provides an outlook on potential applications of this imaging technique. It is intended to provide guidance for new users during the implementation, while triggering experienced users to further explore SGRT applications.

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Section: Introductionsupporting

confidence: 76%

Section: Breath-holdmentioning

confidence: 99%

Recent advances in Surface Guided Radiation Therapy

et al. 2020

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“…In this study, the intra-fraction BH position variability is on average 2.4 mm (range 2.2–2.8 mm). This result is in agreement with previous studies, where the average variability was within 0.5 mm [33], 2.2 mm [34], 1 mm [6] and 3.4 mm [35] (calculation of the variability was consistent with this study) and 4 mm (variability determined as the average standard deviation over BH positions) [36]. Other studies have also shown low variability in BH positions with the ABC system [37, 38] and other spirometer based systems [39, 40].…”

Section: Discussionsupporting

confidence: 94%

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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“…The same authors found a DIBH-stability of < 0.7 mm and a reproducibility of < 2.2 mm, which is similar to the present results. They analyzed the median of the 5th-95th percentile range of the translational displacement during a single breathhold or during all breath-holds throughout a single treatment session [26]. Unfortunately, only the vertical amplitude could be evaluated with the Catalyst™ system, which is a limitation of the present study.…”

Section: Discussionmentioning

confidence: 99%

Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer

et al. 2020

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Purpose: Patients with left-sided breast cancer frequently receive deep inspiration breath-hold (DIBH) radiotherapy to reduce the risk of cardiac side effects. The aim of the present study was to analyze intra-breath-hold stability and inter-fraction breath-hold reproducibility in clinical practice. Material and methods: Overall, we analyzed 103 patients receiving left-sided breast cancer radiotherapy using a surface-guided DIBH technique. During each treatment session the vertical motion of the patient was continuously measured by a surface guided radiation therapy (SGRT) system and automated gating control (beam on/off) was performed using an audiovisual patient feedback system. Dose delivery was automatically triggered when the tracking point was within a predefined gating window. Intra-breath-hold stability and inter-fraction reproducibility across all fractions of the entire treatment course were analyzed per patient. Results: In the present series, 6013 breath-holds during beam-on time were analyzed. The mean amplitude of the gating window from the baseline breathing curve (maximum expiration during free breathing) was 15.8 mm (95%confidence interval: [8.5-30.6] mm) and had a width of 3.5 mm (95%-CI: [2-4.3] mm). As a measure of intra-breathhold stability, the median standard deviation of the breath-hold level during DIBH was 0.3 mm (95%-CI: [0.1-0.9] mm). Similarly, the median absolute intra-breath-hold linear amplitude deviation was 0.4 mm (95%-CI: [0.01-2.1] mm). Reproducibility testing showed good inter-fractional reliability, as the maximum difference in the breathing amplitudes in all patients and all fractions were 1.3 mm on average (95%-CI: [0.5-2.6] mm). Conclusion: The clinical integration of an optical surface scanner enables a stable and reliable DIBH treatment delivery during SGRT for left-sided breast cancer in clinical routine.

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Single‐institution report of setup margins of voluntary deep‐inspiration breath‐hold (DIBH) whole breast radiotherapy implemented with real‐time surface imaging

Cited by 35 publications

References 33 publications

Recent advances in Surface Guided Radiation Therapy

Recent advances in Surface Guided Radiation Therapy

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

Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer

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