The role of surface-guided radiation therapy for improving patient safety

Al‐Hallaq, Hania; Batista, V.; Kügele, M.; Ford, Eric; Viscariello, Natalie; Meyer, Juergen

doi:10.1016/j.radonc.2021.08.008

Cited by 23 publications

(31 citation statements)

References 45 publications

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“…Another important decision when establishing clinical protocols is the choice of the reference-surface (DICOM or camera-acquired). Although many vendors emphasize the technical advantage of a camera-acquired reference, the use of a DICOM reference provides more confidence to the users because it matches the CT simulation position [2] , [20] . Respondents indicated that it was the predominant reference surface used in all the treatment sites.…”

Section: Discussionmentioning

confidence: 99%

“…Given that this non-ionizing imaging modality can be used to increase treatment safety and quality via intra-fractional monitoring and the support of DIBH, as well as increase efficiency via the support of patient setup [20] , institutions would benefit from consensus guidelines on SGRT to expedite its safe adoption.…”

Section: Discussionmentioning

confidence: 99%

“…SGRT has been reported to either improve patient’s positioning [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , or provide comparable accuracy as 3-point localization [6] , [9] , [16] while improving efficiency [15] , [17] , [18] , [19] . Due to increased information about the patient position and the standardised workflows, SGRT has the potential to greatly impact the quality and safety of radiation treatments [20] . Different installation settings are possible, as a result of several commercially available SGRT-systems, combined with most simulation and delivery systems.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Surface guided radiation therapy: An international survey on current clinical practice

Batista

Gober

Moura

et al. 2022

Technical Innovations & Patient Support in Radiation Oncolo

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Surface guided radiation therapy: An international survey on current clinical practice

Batista

Gober

Moura

et al. 2022

Technical Innovations & Patient Support in Radiation Oncolo

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“…For patient setup, an alternative to volumetric imaging that has become standard of care in most radiotherapy centers is surface guidance, based upon optical scanners 55 . These are especially important in areas of soft tissue anatomy, where restraints are not used and where daily setup requires body manipulation.…”

Section: Imaging For Setup Correction Delivery and Adaptationmentioning

confidence: 99%

“…These are especially important in areas of soft tissue anatomy, where restraints are not used and where daily setup requires body manipulation. However, perhaps most relevant to FLASH‐RT are the gating capabilities, which can be used to synchronize delivery to parts of the breathing cycle for upper anatomy, such as breast irradiation 55 . Given the instantaneous delivery of FLASH, the ability to time‐gate the delivery to the precise body position will be quite important, and if applied to areas of the upper anatomy, 56 the use of surface guidance technologies may become critical to avoid small location mistakes in the delivery.…”

Section: Imaging For Setup Correction Delivery and Adaptationmentioning

confidence: 99%

Image guidance for FLASH radiotherapy

et al. 2022

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FLASH radiotherapy (FLASH-RT) is an emerging ultra-high dose (>40 Gy/s) delivery that promises to improve the therapeutic potential by limiting toxicities compared to conventional RT while maintaining similar tumor eradication efficacy. Image guidance is an essential component of modern RT that should be harnessed to meet the special emerging needs of FLASH-RT and its associated high risks in planning and delivering of such ultra-high doses in short period of times. Hence, this contribution will elaborate on the imaging requirements and possible solutions in the entire chain of FLASH-RT treatment, from the planning, through the setup and delivery with online in vivo imaging and dosimetry, up to the assessment of biological mechanisms and treatment response. In patient setup and delivery, higher temporal sampling than in conventional RT should ensure that the short treatment is delivered precisely to the targeted region. Additionally, conventional imaging tools such as cone-beam computed tomography will continue to play an important role in improving patient setup prior to delivery, while techniques based on magnetic resonance imaging or positron emission tomography may be extremely valuable for either linear accelerator (Linac) or particle FLASH therapy, to monitor and track anatomical changes during delivery. In either planning or assessing outcomes, quantitative functional imaging could supplement conventional imaging for more accurate utilization of the biological window of the FLASH effect, selecting for or verifying things such as tissue oxygen and existing or transient hypoxia on the relevant timescales of FLASH-RT delivery. Perhaps most importantly at this time, these tools might help improve the understanding of the biological mechanisms of FLASH-RT response in tumor and normal tissues. The high dose deposition of FLASH provides an opportunity to utilize pulse-to-pulse imaging tools such as Cherenkov or radiation acoustic emission imaging. These could provide individual pulse mapping or assessing the 3D dose delivery superficially or at tissue depth, respectively. In summary, the most promising components of modern RT should be used for safer application of FLASH-RT, and new promising developments could be advanced to cope with its novel demands but also exploit new opportunities in connection with the unique nature of pulsed delivery at unprecedented dose rates, opening a new era of biological image guidance and ultrafast, pulsebased in vivo dosimetry.

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Evidence‐based region of interest (ROI) definition for surface‐guided radiotherapy (SGRT) of abdominal cancers using deep‐inspiration breath‐hold (DIBH)

Song

Zhai

Liang

et al. 2022

J Applied Clin Med Phys

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To define and evaluate the appropriate abdominal region of interest (ROI) as a surrogate of diaphragm positioning in deep‐inspiration breath‐hold (DIBH) for surface‐guided radiotherapy (SGRT) of abdominal cancers using 3D optical surface imaging (OSI). Six potential abdominal ROIs were evaluated to calculate their correlations with the diaphragm position using 4DCT images of 20 abdominal patients. Twelve points of interest (POIs) were defined (six on the central soft tissue and six on the bilateral ribs) at three superior–inferior levels, and different sub‐groups represented different ROIs. ROI‐1 was the largest, containing all 12 POIs from the xiphoid to the umbilicus and between the lateral body midlines while ROI‐2 had only eight inferior POIs, ROI‐3 had six lateral POIs, and ROI‐4 had four superior‐lateral POIs over the ribs, ROI‐5 contained six central and two most inferior‐lateral POIs and ROI‐6 contained six central and four inferior‐lateral POIs. Internally, the right diaphragm dome was used to represent its positions in 4DCT (0% and 50% within the cycle). The Pearson correlation coefficients were calculated between the diaphragm dome and all 12 external POIs individually or grouped as six ROIs. The quality of the abdominal ROIs was evaluated as potential internal surrogates and, therefore, potential ROIs for SGRT DIBH setup. The four most inferior POIs show the highest mean correlation (r = 0.75) with diaphragmatic motion, and the correlation decreases as POIs move superiorly. The mean correlations are the highest for ROIs with little or no rib support: r = 0.67 for ROI‐2, r = 0.64 for ROI‐5, and r = 0.63 for ROI‐6, while lower for ROIs with rib support: ROI‐1 has r = 0.60, ROI‐3 has r = 0.50, and ROI‐4 has only r = 0.28. This study demonstrates that the rectangular/triangular soft‐tissue ROI (with little rib support) is an optimal surrogate for body positioning and diaphragmatic motion, even when treating tumors under the rib cage. This evidence‐based ROI definition should be utilized when treating abdominal cancers with free‐breathing (FB) and/or DIBH setup.

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The role of surface-guided radiation therapy for improving patient safety

Cited by 23 publications

References 45 publications

Surface guided radiation therapy: An international survey on current clinical practice

Surface guided radiation therapy: An international survey on current clinical practice

Image guidance for FLASH radiotherapy

Evidence‐based region of interest (ROI) definition for surface‐guided radiotherapy (SGRT) of abdominal cancers using deep‐inspiration breath‐hold (DIBH)

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