Voluntary breath-holding for breast cancer radiotherapy is consistent and stable

Colgan, R.; James, Matthew D.; Bartlett, F.; Kirby, Anna M.; Donovan, Ellen M.

doi:10.1259/bjr.20150309

Cited by 15 publications

(22 citation statements)

References 19 publications

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“…8,9 EPI dosimetry and cine, or movie loop, data have been reported and demonstrated good consistency and stability within fractions and throughout the radiotherapy episode. 10,11 It was thus likely that doses received by the heart during treatment would be close to those predicted from the CT planning study. This work has enabled quantification of that agreement and in 80% of cases, the differences were no >0.25 Gy with none >0.5 Gy.…”

Section: Discussionmentioning

confidence: 83%

“…8,9 Electronic portal imaging (EPI) movie loops and EPI dosimetry confirm consistency and stability during radiation delivery. 10,11 These imply that radiation dose received by the heart is maintained close to the level predicted in the radiotherapy treatment plan. There will be differences in received dose from that predicted as setup and breath-hold variations, although small, do occur fraction to fraction, and often thresholds are used in breast cancer radiotherapy so that setup error is not corrected below an action level.…”

Section: Introductionmentioning

confidence: 72%

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Mean heart dose variation over a course of breath-holding breast cancer radiotherapy

Dunkerley

Bartlett

Kirby

et al. 2016

BJR

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Objective:The purpose of the work was to estimate the dose received by the heart throughout a course of breath-holding breast radiotherapy.Methods:113 cone-beam CT (CBCT) scans were acquired for 20 patients treated within the HeartSpare 1A study, in which both an active breathing control (ABC) device and a voluntary breath-hold (VBH) method were used. Predicted mean heart doses were obtained from treatment plans. CBCT scans were imported into a treatment planning system, heart outlines defined, images registered to the CT planning scan and mean heart dose recorded. Two observers outlined two cases three times each to assess interobserver and intraobserver variation.Results:There were no statistically significant differences between ABC and VBH heart dose data from CT planning scans, or in the CBCT-based estimates of heart dose, and no effect from the order of the breath-hold method. Variation in mean heart dose per fraction over the three imaged fractions was <6 cGy without setup correction, decreasing to 3.3 cGy with setup correction. If scaled to 15 fractions, all differences between predicted and estimated mean heart doses were <0.5 Gy and in 80% of cases, they were <0.25 Gy.Conclusion:Variation in mean heart dose was at an acceptable level over the duration of breath-holding radiotherapy and was well predicted by the planning system.Advances in knowledge:Mean heart dose was not adversely affected by fraction-to-fraction variations throughout a course of heart-sparing radiotherapy using two well-established breath-holding methods.

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Section: Discussionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 72%

Mean heart dose variation over a course of breath-holding breast cancer radiotherapy

Dunkerley

Bartlett

Kirby

et al. 2016

BJR

Self Cite

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“…Using the HeartSpare VBH protocol, Colgan et al (21) recently reported < 1 mm displacement during beam delivery for 93% of patients using offline matching of cine images. We found that 97.3% of beams had breath-hold stability within 3 mm in the μ direction (D BEAM ), with with 6/222 beams from 4/42 patients falling outside this range.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of target and cardiac position during visually monitored deep inspiration breath‐hold for breast radiotherapy

Conroy

Yeung

Watt

et al. 2016

J Applied Clin Med Phys

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A low-resource visually monitored deep inspiration breath-hold (VM-DIBH) technique was successfully implemented in our clinic to reduce cardiac dose in left-sided breast radiotherapy. In this study, we retrospectively characterized the chest wall and heart positioning accuracy of VM-DIBH using cine portal images from 42 patients. Central chest wall position from field edge and in-field maximum heart distance (MHD) were manually measured on cine images and compared to the planned positions based on the digitally reconstructed radiographs (DRRs). An in-house program was designed to measure left anterior descending artery (LAD) and chest wall separation on the planning DIBH CT scan with respect to breathhold level (BHL) during simulation to determine a minimum BHL for VM-DIBH eligibility. Systematic and random setup uncertainties of 3.0 mm and 2.6 mm, respectively, were found for VM-DIBH treatment from the chest wall measurements. Intrabeam breath-hold stability was found to be good, with over 96% of delivered fields within 3 mm. Average treatment MHD was significantly larger for those patients where some of the heart was planned in the field compared to patients whose heart was completely shielded in the plan (p < 0.001). No evidence for a minimum BHL was found, suggesting that all patients who can tolerate DIBH may yield a benefit from it. PACS number(s): 87.53. Jw, 87.53.Kn,

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“…The monitoring method was considered feasible if there were no more than one unsuccessful collection of a complete trace. Patients who had previously been treated with left breast radiotherapy using a VIBH breathing protocol as participants in the UK HeartSpare trial were eligible for this feasibility study 6, 9. Local and external ethics approval was obtained from the Leicester South NRES East Midlands Research Ethics Committee and 10 patients were invited to participate.…”

Section: Methodsmentioning

confidence: 99%

“…There is potential for the light fields/lasers to be occluded from view by the gantry if used for these treatments, which may inhibit visual monitoring of VIBH, hence requiring equipment‐assisted methods to be used. In addition, the visual monitoring method, whilst shown to be safe and effective,9 does not allow for automatic gating of the linac in the event of a sudden patient movement such as a cough. We propose using the Microsoft Kinect version 2 (Kinect v2) device as a simple, low cost, noncontact monitoring method as a potential solution.…”

Section: Introductionmentioning

confidence: 99%

Low‐cost Kinect Version 2 imaging system for breath hold monitoring and gating: Proof of concept study for breast cancer VMAT radiotherapy

Edmunds

Gothard

Khabra

et al. 2018

J Applied Clin Med Phys

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Voluntary inspiration breath hold (VIBH) for left breast cancer patients has been shown to be a safe and effective method of reducing radiation dose to the heart. Currently, VIBH protocol compliance is monitored visually. In this work, we establish whether it is possible to gate the delivery of radiation from an Elekta linac using the Microsoft Kinect version 2 (Kinect v2) depth sensor to measure a patient breathing signal. This would allow contactless monitoring during VMAT treatment, as an alternative to equipment–assisted methods such as active breathing control (ABC). Breathing traces were acquired from six left breast radiotherapy patients during VIBH. We developed a gating interface to an Elekta linac, using the depth signal from a Kinect v2 to control radiation delivery to a programmable motion platform following patient breathing patterns. Radiation dose to a moving phantom with gating was verified using point dose measurements and a Delta4 verification phantom. 60 breathing traces were obtained with an acquisition success rate of 100%. Point dose measurements for gated deliveries to a moving phantom agreed to within 0.5% of ungated delivery to a static phantom using both a conventional and VMAT treatment plan. Dose measurements with the verification phantom showed that there was a median dose difference of better than 0.5% and a mean (3% 3 mm) gamma index of 92.6% for gated deliveries when using static phantom data as a reference. It is possible to use a Kinect v2 device to monitor voluntary breath hold protocol compliance in a cohort of left breast radiotherapy patients. Furthermore, it is possible to use the signal from a Kinect v2 to gate an Elekta linac to deliver radiation only during the peak inhale VIBH phase.

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Voluntary breath-holding for breast cancer radiotherapy is consistent and stable

Abstract: These data provide further reassurance that VBH is a safe technique for cardiac sparing breast radiotherapy and support its rapid, widespread implementation.

Cited by 15 publications

References 19 publications

Mean heart dose variation over a course of breath-holding breast cancer radiotherapy

Mean heart dose variation over a course of breath-holding breast cancer radiotherapy

Evaluation of target and cardiac position during visually monitored deep inspiration breath‐hold for breast radiotherapy

Low‐cost Kinect Version 2 imaging system for breath hold monitoring and gating: Proof of concept study for breast cancer VMAT radiotherapy

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