Target position reproducibility in left‐breast irradiation with deep inspiration breath‐hold using multiple optical surface control points

Fassi, Aurora; Ivaldi, Giovanni Battista; Fatis, Paola Tabarelli de; Liotta, M.; Meaglia, Ilaria; Pantano, Patrizia; Regolo, L.; Riboldi, Marco; Baroni, Guido

doi:10.1002/acm2.12321

Cited by 21 publications

(29 citation statements)

References 27 publications

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“…Although the DIBH procedure limited the external marker motion to within 3 mm, the internal motion magnitudes were often found larger, about 5 mm in average, and in some extreme cases could exceed 1 cm. This is consistent with other studies about the correlation between the external surrogate motion and internal tumor motion in general …”

Section: Resultssupporting

confidence: 93%

“…In this study, we used the deep inspiration breath hold (DIBH) approach to limit the respiratory motion in treating pancreatic cancer. DIBH has been used for many years for motion management in the treatment of breast, lung, and liver cancers . For example, Dawson et al studied the reproducibility of organ position with active breathing control for 8 liver patients, a total of 262 fractions of treatment, by using repeated fluoroscopy taken before each fraction of treatment .…”

Section: Introductionmentioning

confidence: 99%

“…Typically, breath hold treatment relies on some sort of surrogate to reflect the internal target motion. The correlation between the external surrogate motion and the internal target motion have been investigated for breast patients by several groups . To the best of our knowledge, the tumor/organ motion management in DIBH pancreatic cancer treatment has not been studied to date.…”

Section: Introductionmentioning

confidence: 99%

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Intrafraction tumor motion during deep inspiration breath hold pancreatic cancer treatment

Zeng

Xiong

et al. 2019

J Applied Clin Med Phys

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Purpose Beam gating with deep inspiration breath hold (DIBH) has been widely used for motion management in radiotherapy. Normally it relies on some external surrogate for estimating the internal target motion, while the exact internal motion is unknown. In this study, we used the intrafraction motion review (IMR) application to directly track an internal target and characterized the residual motion during DIBH treatment for pancreatic cancer patients through their full treatment courses. Methods and Materials Eight patients with pancreatic cancer treated with DIBH volumetric modulated arc therapy in 2017 and 2018 were selected for this study, each with some radiopaque markers (fiducial or surgical clips) implanted near or inside the target. The Varian Real‐time Position Management (RPM) system was used to monitor the breath hold, represented by the anterior‐posterior displacement of an external surrogate, namely reflective markers mounted on a plastic block placed on the patient's abdomen. Before each treatment, a cone beam computed tomography (CBCT) scan under DIBH was acquired for patient setup. For scan and treatment, the breath hold reported by RPM had to lie within a 3 mm window. IMR kV images were taken every 20° or 40° gantry rotation during dose delivery, resulting in over 5000 images for the cohort. The internal markers were manually identified in the IMR images. The residual motion amplitudes of the markers as well as the displacement from their initial positions located in the setup CBCT images were analyzed. Results Even though the external markers indicated that the respiratory motion was within 3 mm in DIBH treatment, significant residual internal target motion was observed for some patients. The range of average motion was from 3.4 to 7.9 mm, with standard deviation ranging from 1.2 to 3.5 mm. For all patients, the target residual motions seemed to be random with mean positions around their initial setup positions. Therefore, the absolute target displacement relative to the initial position was small during DIBH treatment, with the mean and the standard deviation 0.6 and 2.9 mm, respectively. Conclusions Internal target motion may differ from external surrogate motion in DIBH treatment. Radiographic verification of target position at the beginning and during each fraction is necessary for precise RT delivery. IMR can serve as a useful tool to directly monitor the internal target motion.

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Section: Resultssupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intrafraction tumor motion during deep inspiration breath hold pancreatic cancer treatment

Zeng

Xiong

et al. 2019

J Applied Clin Med Phys

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“…One challenge with DIBH is the reproducibility of the location of both the breast and the normal structures. Most breast plans delivery requires multiple respiratory cycles, which can introduce a critical level of error [12,13]. In addition, in order to complete the treatment, it requires a cooperative and able patient.…”

Section: Discussionmentioning

confidence: 99%

CPAP (Continuous Positive Airway Pressure) is an effective and stable solution for heart sparing radiotherapy of left sided breast cancer

et al. 2020

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Purpose: Limiting the heart dose in left sided breast cancer radiotherapy is critical. We sought to study the effect of using CPAP (continuous positive airway pressure) as an aid in reducing heart dose in breast cancer radiotherapy. Methods: Patients with left sided breast cancer receiving adjuvant radiotherapy were enrolled on a prospective IRB (institutional review board) approved clinical trial utilizing CPAP during radiotherapy. Each patient was simulated and planned with and without CPAP and the best dosimetric results determined the patient's treatment. Data on the differences in lung and heart volume and position as well as boost cavity position with and without CPAP were analyzed. Results: Twenty-four women from 10/16 to 10/18 were enrolled. Seven patients were not treated on study; only two of these were due to treatment issues. Median age was 54 years. 70% had breast only radiation and 30% were treated to breast\CW (chest wall) and regional nodes. The median lung volume with CPAP was 60% larger than without CPAP. (1637 vs. 996 cc) p < 0.001. The median heart volume decreased 12% with CPAP. (338 vs. 382 cc) In regards to the DVH, CPAP decreased mean heart dose from 3.02 to 1.6Gy (p = .0075) and V20 of the lungs from 17.1 to 13.8 with CPAP but this was not significant. Conclusion: CPAP assisted radiotherapy was tolerable and produced superior treatment plans in left sided breast cancer. This method is worthy of further investigation as a method to normal tissue sparing treatment of left sided breast cancer patients.

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“…Initial approaches of frameless stereotactic treatment employed series of x-rays or cone-beam CTs to detect intra-fractional tumor motion [9][10][11]. Some technologies tried to limit additional exposure from ionizing x-rays by utilizing non-ionizing technologies such as attaching optical ducials to a bite block customized to the patient in order to monitor motion and further prevent rotational motion [12,13]. Yet, these systems may encounter the inability to treat patients with poor dentition or potential movement of the ducial at the site of attachment.…”

Section: Introductionmentioning

confidence: 99%

Performance Assessment of Two Motion Management Systems for Frameless Stereotactic Radiosurgery

Wang

Zhou

Grantham

et al. 2020

Preprint

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Background/PurposeFrameless stereotactic radiosurgery (SRS) requires dedicated systems to monitor patient motion in order to avoid inaccurate radiation delivery due to involuntary shifts. The purpose of this study is to assess the accuracy and sensitivity of two distinct motion monitoring systems used for frameless SRS.MethodsA surface image-guided system known as Optical Surface Monitoring System (OSMS), and a fiducial marker-based system known as High Definition Motion Management (HDMM) as part of the latest Gamma Knife Icon® were compared with each other. A 3D printer-based cranial motion phantom was developed to evaluate the accuracy and sensitivity of these two systems in terms of: (1) the capability to recognize predefined shifts up to 3 cm, and (2) the capability to recognize predefined speeds up to 3 cm/s. The performance of OSMS, in terms of different reference surfaces, was also evaluated.ResultsTranslational motion could be accurately detected by both systems, with an accuracy of 0.3 mm for displacement up to 1 cm, and 0.5 mm for larger displacements. The reference surface selection had an impact OSMS performance, with flat surface resulting in less accuracy. HDMM was in general more sensitive when compared with OSMS in capturing the motion, due to its faster frame rate, but a delay in response was observed with faster speeds. Both systems were less sensitive in detection of superior-inferior motion when compared to lateral or vertical displacement directions.ConclusionTranslational motion can be accurately and sensitively detected by OSMS and HDMM real-time monitoring systems. However, performance variations were observed along different motion directions, as well as amongst the selection of reference images. Caution is needed when using real-time monitoring systems for frameless SRS treatment.

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Target position reproducibility in left‐breast irradiation with deep inspiration breath‐hold using multiple optical surface control points

Cited by 21 publications

References 27 publications

Intrafraction tumor motion during deep inspiration breath hold pancreatic cancer treatment

Intrafraction tumor motion during deep inspiration breath hold pancreatic cancer treatment

CPAP (Continuous Positive Airway Pressure) is an effective and stable solution for heart sparing radiotherapy of left sided breast cancer

Performance Assessment of Two Motion Management Systems for Frameless Stereotactic Radiosurgery

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