Tumor localization accuracy for high-precision radiotherapy during active breath-hold

Lee, Soyoung; Zheng, Yiran; Podder, Tarun; Biswas, Tithi; Verma, Vivek; Goss, Matthew; Colonias, Athanasios; Fuhrer, Russell; Zhai, Yongjun; Parda, David S.; Sohn, Jason W.

doi:10.1016/j.radonc.2019.04.036

Cited by 9 publications

(12 citation statements)

References 37 publications

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“…In addition, lung volumes in DIBH may not necessarily always be the same for every breath-hold, although SGRT may confirm a match within a ROI on the patient's body surface to the corresponding reference surface. Such variations in lung volumes during breath-hold were recently reported to have an impact on target localization (31).…”

Section: Discussionmentioning

confidence: 98%

“…Previous work on employing active breathing coordinator (ABC TM )-controlled breath-hold for lung and liver SBRT reported good intrafractional reproducibility of liver position in the majority of patients. However, interfractional reproducibility was worse, suggesting a need for daily image guidance ( 31 – 33 ). Another study, conducted by Lu et al, also found higher interfractional than intrafractional motion but observed clinically significant intrafractional motion >3 mm in 26 and 47% of patients with liver and lung cancer, respectively ( 34 ).…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of Optical Surface-Guidance for Position Verification and Monitoring of Stereotactic Body Radiotherapy in Deep-Inspiration Breath-Hold

et al. 2020

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Background: Reductions in tumor movement allow for more precise and accurate radiotherapy with decreased dose delivery to adjacent normal tissue that is crucial in stereotactic body radiotherapy (SBRT). Deep inspiration breath-hold (DIBH) is an established approach to mitigate respiratory motion during radiotherapy. We assessed the feasibility of combining modern optical surface-guided radiotherapy (SGRT) and image-guided radiotherapy (IGRT) to ensure and monitor reproducibility of DIBH and to ensure accurate tumor localization for SBRT as an imaging-guided precision medicine. Methods: We defined a new workflow for delivering SBRT in DIBH for lung and liver tumors incorporating SGRT and IGRT with cone beam computed tomography (CBCT) twice per treatment fraction. Daily position corrections were analyzed and for every patient two points retrospectively characterized: an anatomically stable landmark (predominately Schmorl's nodes or spinal enostosis) and a respiratory-dependent landmark (predominately surgical clips or branching vessel). The spatial distance of these points was compared for each CBCT and used as surrogate for intra-and interfractional variability. Differences between the lung and liver targets were assessed using the Welch t-test. Finally, the planning target volumes were compared to those of free-breathing plans, prepared as a precautionary measure in case of technical or patient-related problems with DIBH. Results: Ten patients were treated with SBRT according this workflow (7 liver, 3 lung). Planning target volumes could be reduced significantly from an average of 148 ml in free breathing to 110 ml utilizing DIBH (p < 0.001, paired t-test). After SGRT-based patient setup , subsequent IGRT in DIBH yielded significantly higher mean corrections for liver targets compared to lung targets (9 mm vs. 5 mm, p = 0.017). Analysis of spatial

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Feasibility of Optical Surface-Guidance for Position Verification and Monitoring of Stereotactic Body Radiotherapy in Deep-Inspiration Breath-Hold

et al. 2020

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“…Lung volumes can change throughout inspiration repetitions during treatment, however the surface within the ROI may remain similar giving a false sense of security. Lung volume changes during treatment may impact target localisation and this needs to be further evaluated when using SG [24] .…”

Section: Discussionmentioning

confidence: 99%

A review of surface guidance in extracranial stereotactic body radiotherapy (SBRT/SABR) for set-up and intra-fraction motion management

Lawler¹

2022

Technical Innovations & Patient Support in Radiation Oncolo

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Introduction Surface guidance (SG) radiotherapy (RT) is now used by many radiotherapy departments globally and has expanded in popularity over the last number of years. A number of commercial systems are available. SG has routinely been used and is well established for cranial stereotactic radiosurgery (SRS) patient set ups and intra-fraction motion monitoring. However, data is limited in relation to its clinical use for extracranial stereotactic body radiotherapy (SBRT), particularly for targets which are impacted by respiratory motion such as the lung and liver. Objective & Information Source A review of available literature was carried out on 24th October 2021 to assess the clinical feasibility and use of SG in SBRT via PubMed. Methods Eligibility Criteria The search criteria involved identifying articles where SG is used in extracranial SBRT. Risk of Bias To eliminate the risk of bias, any particular commercial system was not the focus of the review and not included in the search criteria. Numerous clinical terms for similar things were used to reduce the risk of missing papers e.g. SBRT and SABR. Search Criteria The PRISMA checklist was used. Searching for “surface guidance and radiotherapy” yielded 3271 results, where as “SGRT” alone returned 72 results, when the search term was narrowed down using different iterations of SG and SBRT, only 6 results were available. Of these, 4 had reviewed clinical data in relation to SG and SBRT for patient set up and intra-fraction motion monitoring. Results The 4 studies indicate positive results for using SG with sufficient image guidance (IG) for both patient set up and intra-fraction monitoring during SBRT. This was observed both in free breathing and in patients with respiratory motion management being employed such as deep inspiration breath-hold (DIBH) techniques. All used multiple IGRT solutions to verify localisation pre-treatment in conjunction with SG. Limitations The number of studies available which report using SG in SBRT is extremely limited. All centres had also installed SG systems therefore this could result in an unconditional bias in using the system positively. Conclusion SG can be used for SBRT set-ups and intra-fraction motion monitoring once sufficient IG is used to verify target localisation for treatment.

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“…Deep inspiration breath hold with the Active Breathing Coordinator device (ABC-DIBH) can minimize breathing motion and consequently augments cardiac sparing in radiotherapy of breast cancer by increasing the distance between heart and PTV. In contrast to self-sustained breath hold (4.1% variability of lung volume), the ABC device was proved with better intra-session and inter-session reproducibility of respiratory capacity (1.8% and 3% variability of lung volume) on account of the function that induced breath hold automatically at a preset inhaled or exhaled air volume during a predetermined time ( 14 , 15 ). Note that the ABC device utilizes the sensor to count the rotations of turbine impeller for a known respiratory capacity.…”

Section: Introductionmentioning

confidence: 99%

The effect of respiratory capacity for dose sparing in left-sided breast cancer irradiation with active breathing coordinator technique

et al. 2022

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Background and aimA subsequent cardiac toxicity is deemed to be dose-dependent for left-sided breast cancer irradiation. This study aims to demonstrate the effect of respiratory capacity for dose sparing when the deep inspiration breath hold with Active Breathing Coordinator technique (ABC-DIBH) is used in left-sided breast cancer irradiation.Methods74 left-sided breast cancer patients, who received whole breast or post-mastectomy chest wall radiotherapy with ABC-DIBH between 2020 and 2021 in our center, were retrospectively reviewed in this study. CT scans of free breath (FB) and ABC-DIBH were done for each patient, and two treatment plans with a prescription dose of 5000 cGy/25 Fr were designed separately. The dose to heart, left anterior descending artery (LAD) and lungs was compared between FB and ABC-DIBH. The correlation between individual parameters (dose to organs at risk (OARs) and minimum heart distance (MHD)) was analyzed, and the effect of respiratory capacity for dose sparing was assessed.ResultsThe plans with ABC-DIBH achieved lower Dmean for heart (34.80%, P < 0.01) and LAD (29.33%, P < 0.01) than those with FB. Regression analysis revealed that both Dmean and D2 of heart were negatively correlated with MHD in the plans with FB and ABC-DIBH, which decreased with the increase in MHD by 37.8 cGy and 309.9 cGy per 1mm, respectively. Besides, a lower Dmean of heart was related to a larger volume of ipsilateral lung in plans with FB. With the increase in volume of ipsilateral lung, the linear correlation was getting weaker and weaker until the volume of ipsilateral lung reached 1700 cc. Meanwhile, a negative linear correlation between Dmean of LAD and MHD in plans with FB and ABC-DIBH was observed, whose slope was 162.5 and 135.9 cGy/mm, respectively. Furthermore, when the respiratory capacity of ABC-DIBH reached 1L, and the relative ratio (ABC-DIBH/FB) reached 3.6, patients could obtain the benefit of dose sparing. The larger difference in respiratory capacity had no significant effect in the larger difference of MHD, Dmean of heart and Dmean of LAD between FB and ABC-DIBH.ConclusionThis study demonstrates the sufficiently good effect of ABC-DIBH when utilizing for cardiac sparing. It also reveals the correlations among individual parameters and the effect of respiratory capacity for dose sparing. This helps take optimal advantage of the ABC-DIBH technique and predict clinical benefits.

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Tumor localization accuracy for high-precision radiotherapy during active breath-hold

Cited by 9 publications

References 37 publications

Feasibility of Optical Surface-Guidance for Position Verification and Monitoring of Stereotactic Body Radiotherapy in Deep-Inspiration Breath-Hold

Feasibility of Optical Surface-Guidance for Position Verification and Monitoring of Stereotactic Body Radiotherapy in Deep-Inspiration Breath-Hold

A review of surface guidance in extracranial stereotactic body radiotherapy (SBRT/SABR) for set-up and intra-fraction motion management

The effect of respiratory capacity for dose sparing in left-sided breast cancer irradiation with active breathing coordinator technique

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