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Crop F, Laffarguette J, Achag I, Pasquier D, Mirabel X, Cayez R, Lacornerie T. Evaluation of surface image guidance and Deep inspiration Breath Hold technique for breast treatments with Halcyon. Phys Med 2023; 108:102564. [PMID: 36989980 DOI: 10.1016/j.ejmp.2023.102564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/13/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE To evaluate the accuracy/agreement of a three-camera Catalyst Surface Guided Radiation Therapy (SGRT) system on a closed-gantry Halcyon for Free-Breathing (FB) and Deep Inspiration Breath Hold (DIBH) breast-only treatments. METHODS The SGRT positioning agreement with Halcyon couch and cone-beam computed tomography (CBCT) was evaluated on phantom and by evaluation of 2401 FB and 855 DIBH breast-only treatment sessions. The DIBH agreement was evaluated using a programmable moving support. Dose agreement was evaluated for manual SGRT-assisted beam interruption and Halcyon arc beam interruption. RESULTS Geometrical phantom agreement was < 0.4 mm. Couch and SGRT agreement for an anthropomorphic phantom resulted in 95% limits of agreement in Right-Left/Feet-Head/Posterior-Anterior (RL/FH/PA) directions of respectively ± 0.4/0.8/0.5 mm and ± 1.1/1.1/0.6 mm in the virtual and real isocenter. FB-SGRT-assisted patient positioning compared to CBCT positioning resulted in RL/FH/PA systematic differences of -0.1/0.1/2.0 mm with standard deviations of 2.7/2.8/2.4 mm. This mean systematic difference had three origins: a) couch sag/isocenter difference of ≤ 0.5 mm. b) Average reconstructed FB-CBCT images do not visually represent the average respiratory position. c) CBCT-based positioning focused on the inner thoracic interface, which can introduce a mean positioning difference between SGRT and CBCT. Manual SGRT-assisted beam interruption and arc interruptions resulted in mean gamma passing rates > 97% (0.5%/0.5 mm) and mean absolute differences < 0.3%. CONCLUSIONS Accuracy was comparable with breast-only C-arm SGRT techniques, with different tradeoffs. Depending on the patient's morphology, real-time tracking accuracy in the real isocenter can be reduced. This study demonstrates possible discordances between SGRT and CBCT positioning for breast.
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Nguyen D, Reinoso R, Farah J, Yossi S, Lorchel F, Passerat V, Louet E, Pouchard I, Khodri M, Barbet N. Reproducibility of surface-based deep inspiration breath-hold technique for lung stereotactic body radiotherapy on a closed-bore gantry linac. Phys Imaging Radiat Oncol 2023; 26:100448. [PMID: 37252251 PMCID: PMC10213090 DOI: 10.1016/j.phro.2023.100448] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023] Open
Abstract
Background and purpose Tumor motion and delivery efficiency are two main challenges of lung stereotactic body radiotherapy (SBRT). The present work implemented the deep inspiration breath hold technique (DIBH) with surface guided radiation therapy (SGRT) on closed-bore linacs and investigated the correlation between SGRT data and internal target position. Materials and methods Thirteen lung SBRT patients treated in DIBH using a closed-bore gantry linac and a ring-mounted SGRT system were retrospectively analysed. Visual coaching was used to achieve DIBH with a ± 1 mm threshold window in the anterior-posterior direction. Three kV-CBCTs were added to the treatment workflow and examined offline to verify intra-fraction tumor position. Surface-based DIBH was analysed using SGRT treatment reports and an in-house python script. Data from 73 treatment sessions and 175 kV-CBCTs were studied. Correlations between target and surface positions were studied with Linear Mixed Models. Results Median intra-fraction tumor motion was 0.8 mm (range: 0.7-1.3 mm) in the anterior-posterior direction, 1.2 mm (range: 1-1.7 mm) in the superior-inferior direction, and 1 mm (range: 0.7-1.1 mm) in the left-right direction, with rotations of <1° (range: 0.6°-1.1°) degree in all three directions. Planned target volumes and healthy lung volumes receiving 12.5 Gy and 13.5 Gy were reduced on average by 67% and 54%, respectively. Conclusions Lung SBRT in DIBH with the ring-mounted SGRT system proved reproducible. The surface monitoring provided by SGRT was found to be a reliable surrogate for internal target motion. Moreover, the implementation of DIBH technique helped reduce target volumes and lung doses.
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Affiliation(s)
- Daniel Nguyen
- ORLAM’s Group, Department of Radiation Oncology, Mâcon, Villeurbanne, Lyon, France
| | - Rebeca Reinoso
- ORLAM’s Group, Department of Radiation Oncology, Mâcon, Villeurbanne, Lyon, France
| | - Jad Farah
- Vision RT Ltd., Dove House, Arcadia Avenue, London N3 2JU, United Kingdom
| | - Sena Yossi
- ORLAM’s Group, Department of Radiation Oncology, Mâcon, Villeurbanne, Lyon, France
| | - Fabrice Lorchel
- ORLAM’s Group, Department of Radiation Oncology, Mâcon, Villeurbanne, Lyon, France
| | - Victor Passerat
- ORLAM’s Group, Department of Radiation Oncology, Mâcon, Villeurbanne, Lyon, France
| | - Estelle Louet
- ORLAM’s Group, Department of Radiation Oncology, Mâcon, Villeurbanne, Lyon, France
| | - Isabelle Pouchard
- ORLAM’s Group, Department of Radiation Oncology, Mâcon, Villeurbanne, Lyon, France
| | - Mustapha Khodri
- ORLAM’s Group, Department of Radiation Oncology, Mâcon, Villeurbanne, Lyon, France
| | - Nicolas Barbet
- ORLAM’s Group, Department of Radiation Oncology, Mâcon, Villeurbanne, Lyon, France
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Vander Veken L, Van Ooteghem G, Razavi A, Da Rita Quaresma S, Longton E, Kirkove C, Ledoux B, Vandermeulen A, Abdel Massih C, Henderickx P, Gabriels M, Delvaux C, Salah F, Vaandering A, Geets X. Voluntary versus mechanically-induced deep inspiration breath-hold for left breast cancer: A randomized controlled trial. Radiother Oncol 2023; 183:109598. [PMID: 36898583 DOI: 10.1016/j.radonc.2023.109598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/14/2023] [Accepted: 02/28/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND AND PURPOSE Deep inspiration breath-hold (DIBH) protects critical organs-at-risk (OARs) for adjuvant breast radiotherapy. Guidance systems e.g. surface guided radiation therapy (SGRT) improve the positional breast reproducibility and stability during DIBH. In parallel, OARs sparing with DIBH is enhanced through different techniques e.g. prone position, continuous positive airway pressure (CPAP). By inducing repeated DIBH with the same level of positive pressure, mechanically-assisted and non-invasive ventilation (MANIV) could potentially combine these DIBH optimizations. MATERIALS AND METHODS We conducted a randomized, open-label, multicenter and single-institution non-inferiority trial. Sixty-six patients eligible for adjuvant left whole-breast radiotherapy in supine position were equally assigned between mechanically-induced DIBH (MANIV-DIBH) and voluntary DIBH guided by SGRT (sDIBH). The co-primary endpoints were positional breast stability and reproducibility with a non-inferiority margin of 1 mm. Secondary endpoints were tolerance assessed daily via validated scales, treatment time, dose to OARs and their inter-fraction positional reproducibility. RESULTS Differences between both arms for positional breast reproducibility and stability occurred at a sub-millimetric level (p < 0.001 for non-inferiority). The left anterior descending artery near-max dose (14,6 ± 12,0 Gy vs. 7,7 ± 7,1 Gy, p = 0,018) and mean dose (5,0 ± 3,5 Gy vs. 3,0 ± 2,0 Gy, p = 0,009) were improved with MANIV-DIBH. The same applied for the V5Gy of the left ventricle (2,4 ± 4,1 % vs. 0,8 ± 1,6 %, p = 0,001) as well as for the left lung V20Gy (11,4 ± 2,8 % vs. 9,7 ± 2,7 %, p = 0,019) and V30Gy (8,0 ± 2,6 % vs. 6,5 ± 2,3 %, p = 0,0018). Better heart's inter-fraction positional reproducibility was observed with MANIV-DIBH. Tolerance and treatment time were similar. CONCLUSION Mechanical ventilation provides the same target irradiation accuracy as with SGRT while better protecting and repositioning OARs.
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Affiliation(s)
- Loïc Vander Veken
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), 1200 Brussels, Belgium; Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium.
| | - Geneviève Van Ooteghem
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), 1200 Brussels, Belgium; Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Ariane Razavi
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | | | - Eleonore Longton
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Carine Kirkove
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Benjamin Ledoux
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Ad Vandermeulen
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Christel Abdel Massih
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Pascale Henderickx
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Mortimer Gabriels
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Céline Delvaux
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Faycal Salah
- Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Aude Vaandering
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), 1200 Brussels, Belgium; Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
| | - Xavier Geets
- UCLouvain, Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), 1200 Brussels, Belgium; Radiation Oncology Department, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium
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Carr MA, Gargett M, Stanton C, Zwan B, Byrne HL, Booth JT. A method for beam's eye view breath-hold monitoring during breast volumetric modulated arc therapy. Phys Imaging Radiat Oncol 2023; 25:100419. [PMID: 36875326 PMCID: PMC9975298 DOI: 10.1016/j.phro.2023.100419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
Background and purpose Deep inspiration breath-hold (DIBH) is a technique that is widely utilised to spare the heart and lungs during breast radiotherapy. In this study, a method was developed to validate directly the intrafraction accuracy of DIBH during breast volumetric modulated arc therapy (VMAT) via internal chest wall (CW) monitoring. Materials and methods In-house software was developed to automatically extract and compare the treatment position of the CW in cine-mode electronic portal image device (EPID) images with the planned CW position in digitally reconstructed radiographs (DRR) for breast VMAT treatments. Feasibility of this method was established by evaluating the percentage of total dose delivered to the target volume when the CW was sufficiently visible for monitoring. Geometric accuracy of the approach was quantified by applying known displacements to an anthropomorphic thorax phantom. The software was used to evaluate (offline) the geometric treatment accuracy for ten patients treated using real-time position management (RPM)-guided DIBH. Results The CW could be monitored within the tangential sub-arcs which delivered a median 89% (range 73% to 97%) of the dose to target volume. The phantom measurements showed a geometric accuracy within 1 mm, with visual inspection showing good agreement between the software-derived and user-determined CW positions. For the RPM-guided DIBH treatments, the CW was found to be within ±5 mm of the planned position in 97% of EPID frames in which the CW was visible. Conclusion An intrafraction monitoring method with sub-millimetre accuracy was successfully developed to validate target positioning during breast VMAT DIBH.
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Affiliation(s)
- M A Carr
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, New South Wales, Australia
| | - M Gargett
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.,School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - C Stanton
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - B Zwan
- Central Coast Cancer Centre, Gosford Hospital, Gosford, New South Wales, Australia
| | - H L Byrne
- ACRF Image-X Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - J T Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia.,Institute of Medical Physics, School of Physics, The University of Sydney, Sydney, New South Wales, Australia
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Li G. Advances and potential of optical surface imaging in radiotherapy. Phys Med Biol 2022; 67:10.1088/1361-6560/ac838f. [PMID: 35868290 PMCID: PMC10958463 DOI: 10.1088/1361-6560/ac838f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/22/2022] [Indexed: 11/12/2022]
Abstract
This article reviews the recent advancements and future potential of optical surface imaging (OSI) in clinical applications as a four-dimensional (4D) imaging modality for surface-guided radiotherapy (SGRT), including OSI systems, clinical SGRT applications, and OSI-based clinical research. The OSI is a non-ionizing radiation imaging modality, offering real-time 3D surface imaging with a large field of view (FOV), suitable for in-room interactive patient setup, and real-time motion monitoring at any couch rotation during radiotherapy. So far, most clinical SGRT applications have focused on treating superficial breast cancer or deep-seated brain cancer in rigid anatomy, because the skin surface can serve as tumor surrogates in these two clinical scenarios, and the procedures for breast treatments in free-breathing (FB) or at deep-inspiration breath-hold (DIBH), and for cranial stereotactic radiosurgery (SRS) and radiotherapy (SRT) are well developed. When using the skin surface as a body-position surrogate, SGRT promises to replace the traditional tattoo/laser-based setup. However, this requires new SGRT procedures for all anatomical sites and new workflows from treatment simulation to delivery. SGRT studies in other anatomical sites have shown slightly higher accuracy and better performance than a tattoo/laser-based setup. In addition, radiographical image-guided radiotherapy (IGRT) is still necessary, especially for stereotactic body radiotherapy (SBRT). To go beyond the external body surface and infer an internal tumor motion, recent studies have shown the clinical potential of OSI-based spirometry to measure dynamic tidal volume as a tumor motion surrogate, and Cherenkov surface imaging to guide and assess treatment delivery. As OSI provides complete datasets of body position, deformation, and motion, it offers an opportunity to replace fiducial-based optical tracking systems. After all, SGRT has great potential for further clinical applications. In this review, OSI technology, applications, and potential are discussed since its first introduction to radiotherapy in 2005, including technical characterization, different commercial systems, and major clinical applications, including conventional SGRT on top of tattoo/laser-based alignment and new SGRT techniques attempting to replace tattoo/laser-based setup. The clinical research for OSI-based tumor tracking is reviewed, including OSI-based spirometry and OSI-guided tumor tracking models. Ongoing clinical research has created more SGRT opportunities for clinical applications beyond the current scope.
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Affiliation(s)
- Guang Li
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, United States of America
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Freislederer P, Batista V, Öllers M, Buschmann M, Steiner E, Kügele M, Fracchiolla F, Corradini S, de Smet M, Moura F, Perryck S, Dionisi F, Nguyen D, Bert C, Lehmann J. ESTRO-ACROP guideline on surface guided radiation therapy. Radiother Oncol 2022; 173:188-196. [PMID: 35661677 DOI: 10.1016/j.radonc.2022.05.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 10/18/2022]
Abstract
Surface guidance systems enable patient positioning and motion monitoring without using ionising radiation. Surface Guided Radiation Therapy (SGRT) has therefore been widely adopted in radiation therapy in recent years, but guidelines on workflows and specific quality assurance (QA) are lacking. This ESTRO-ACROP guideline aims to give recommendations concerning SGRT roles and responsibilities and highlights common challenges and potential errors. Comprehensive guidelines for procurement, acceptance, commissioning, and QA of SGRT systems installed on computed tomography (CT) simulators, C-arm linacs, closed-bore linacs, and particle therapy treatment systems are presented that will help move to a consensus among SGRT users and facilitate a safe and efficient implementation and clinical application of SGRT.
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Affiliation(s)
- P Freislederer
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany.
| | - V Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Germany; Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - M Öllers
- Department of Radiotherapy, MAASTRO, Maastricht, The Netherlands
| | - M Buschmann
- Department of Radiation Oncology, Medical University of Vienna/AKH Wien, Austria
| | - E Steiner
- Institute for Radiation Oncology and Radiotherapy, Landesklinikum Wiener Neustadt, Austria
| | - M Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - F Fracchiolla
- Azienda Provinciale per i Servizi Sanitari (APSS) Protontherapy Department, Trento, Italy
| | - S Corradini
- Department of Radiation Oncology, LMU University Hospital, Munich, Germany
| | - M de Smet
- Department of Medical Physics & Instrumentation, Institute Verbeeten, Tilburg, The Netherlands
| | - F Moura
- Hospital CUF Descobertas, Department of Radiation Oncology, Lisbon, Portugal
| | - S Perryck
- Department of Radiation Oncology, University Hospital Zürich, Switzerland
| | - F Dionisi
- Department of Radiation Oncology, IRCSS Regina Elena National Cancer Institute, Rome, Italy
| | - D Nguyen
- Centre de Radiothérapie de Mâcon, France
| | - C Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany
| | - J Lehmann
- Radiation Oncology Department, Calvary Mater Newcastle, Australia; School of Information and Physical Sciences, University of Newcastle, Australia; Institute of Medical Physics, University of Sydney, Australia
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Lee H, Park JM, Kim KH, Lee DH, Sohn MJ. Accuracy evaluation of surface registration algorithm using normal distribution transform in stereotactic body radiotherapy/radiosurgery: A phantom study. J Appl Clin Med Phys 2022; 23:e13521. [PMID: 34985179 PMCID: PMC8906233 DOI: 10.1002/acm2.13521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/06/2021] [Accepted: 12/18/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To evaluate a feasibility of normal distribution transform (NDT) algorithm compared with the iterative closest point (ICP) method as a useful surface registration in stereotactic body radiotherapy (SBRT)/stereotactic radiosurgery (SRS). METHODS Point cloud images using the 3D triangulation technology were obtained from a depth camera-based optical imaging (OSI) system equipped in a radiosurgery room. Two surface registration algorithms, NDT and ICP, were used to measure and compare the discrepancy values between the reference and the current surfaces during the positioning of the patient. The performance evaluation was investigated by calculating the registration error and root-mean-square (RMS) values for the surface model, reposition, and target accuracy, which were analyzed statistically using a paired t-test. RESULTS For surface model accuracy, the average of the registration error and RMS values were measured as 3.56 ± 2.20 mm and 6.98 ± 1.89 mm for ICP method, and 1.76 ± 1.32 mm and 3.58 ± 1.30 mm for NDT method (p < 0.05). For reposition accuracy, the average registration error and RMS values were calculated as 1.41 ± 0.98 mm and 2.53 ± 1.64 mm using ICP method, and 0.92 ± 0.61 mm and 1.75 ± 0.80 mm using NDT method (p = 0.005). The overall target accuracy using the NDT method reduced the average of the reposition error and overall RMS value by 0.71 and 1.32 mm, respectively, compared to the ICP method (p = 0.03). CONCLUSIONS We found that the surface registration algorithm based on NDT method provides more reliable accuracy in the values of surface model, reposition, and target accuracies than the classic ICP method. The NDT method in OSI systems offers reasonable accuracy in SBRT/SRS.
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Affiliation(s)
- Haenghwa Lee
- Department of Neurosurgery, Neuroscience, & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, College of Medicine, Goyang, Republic of Korea
| | - Jeong-Mee Park
- Department of Neurosurgery, Neuroscience, & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, College of Medicine, Goyang, Republic of Korea
| | - Kwang Hyeon Kim
- Department of Neurosurgery, Neuroscience, & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, College of Medicine, Goyang, Republic of Korea
| | - Dong-Hoon Lee
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Moon-Jun Sohn
- Department of Neurosurgery, Neuroscience, & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, College of Medicine, Goyang, Republic of Korea
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Intra-fraction motion monitoring during fast modulated radiotherapy delivery in a closed-bore gantry linac. Phys Imaging Radiat Oncol 2021; 20:51-55. [PMID: 34765749 PMCID: PMC8572954 DOI: 10.1016/j.phro.2021.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/25/2022] Open
Abstract
Surface scanning allows for continuous intra fraction monitoring in a closed-bore gantry. Patient baseline drift during fast cone-beam computed tomography imaging is non-negligible. Peak-to-peak breathing amplitude is smaller than baseline drift in 69% of fractions.
Background and purpose New closed-bore linacs allow for highly streamlined workflows and fast treatment delivery resulting in brief treatment sessions. Motion management technology has only recently been integrated inside the bore, yet is required in future online adaptive workflows. We measured patient motion during every step of the workflow: image acquisition, evaluation and treatment delivery using surface scanning. Materials and methods Nineteen patients treated for breast, lung or esophageal cancer were prospectively monitored from the end of setup to the end of treatment delivery in the Halcyon linac (Varian Medical Systems). Motion of the chest was tracked by way of 6 degrees-of-freedom surface tracking. Baseline drift and rate of drift were determined. The influence of fraction number, patient and fraction duration were analyzed with multi-way ANOVA. Results Median fraction duration was 4 min 48 s including the IGRT procedure (kV-CBCT acquisition and evaluation) (N = 221). Baseline drift at the end of the fraction was −1.8 ± 1.5 mm in the anterior-posterior, −0.0 ± 1.7 mm in the cranio-caudal direction and 0.1 ± 1.8 mm in the medio-lateral direction of which 75% occurred during the IGRT procedure. The highest rate of baseline drift was observed between 1 and 2 min after the end of patient setup (-0.62 mm/min). Baseline drift was patient and fraction duration dependent (p < 0.001), but fraction number was not significant (p = 0.33). Conclusion Even during short treatment sessions, patient baseline drift is not negligible. Drift is largest during the initial minutes after completion of patient setup, during verification imaging and evaluation. Patients will need to be monitored during extended contouring and re-planning procedures in online adaptive workflows.
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González-Sanchis A, Brualla-González L, Fuster-Diana C, Gordo-Partearroyo JC, Piñeiro-Vidal T, García-Hernandez T, López-Torrecilla JL. Surface-guided radiation therapy for breast cancer: more precise positioning. Clin Transl Oncol 2021; 23:2120-2126. [PMID: 33840013 DOI: 10.1007/s12094-021-02617-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Hypofractionated radiation therapy for breast cancer requires highly precise delivery through the use of image-guided radiotherapy (IGRT). Surface-guided radiation therapy (SGRT) is being increasingly used for patient positioning in breast radiotherapy. We aimed to assess the role of SGRT for verification of breast radiotherapy and the tumour bed. MATERIALS AND METHODS Prospective study of 252 patients with early stage breast cancer. A total of 1170 determinations of daily positioning were performed. Breast surface positioning was determined with SGRT (AlignRT) and correlated with the surgical clips in the tumour bed, verified by IGRT (ExacTrac). RESULTS SGRT improved surface matching by a mean of 5.3 points compared to conventional skin markers (98.0 vs. 92.7), a statistically significant difference (p < 0.01, Wilcoxon Test). For surface matching values > 95%, ≥ 3 clips coincided in 99.7% of the determinations and all markers coincided in 92.5%. For surface matching rates > 90%, the location of ≥ 3 clips coincided in 99.55% of determinations. CONCLUSIONS SGRT improves patient positioning accuracy compared to skin markers. Optimal breast SGRT can accurately verify the localisation of the tumour bed, ensuring matching with ≥ 3 surgical clips. SGRT can eliminate unwanted radiation from IGRT verification systems.
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Affiliation(s)
- A González-Sanchis
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia (CHGUV), Avenida Tres Cruces, No. 2, 46014, Valencia, Spain.
| | - L Brualla-González
- Department of Radiophysics, ERESA, Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - C Fuster-Diana
- Department of Surgery, Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - J C Gordo-Partearroyo
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia (CHGUV), Avenida Tres Cruces, No. 2, 46014, Valencia, Spain
| | - T Piñeiro-Vidal
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia (CHGUV), Avenida Tres Cruces, No. 2, 46014, Valencia, Spain
| | - T García-Hernandez
- Department of Radiophysics, ERESA, Hospital General Universitario de Valencia (CHGUV), Valencia, Spain
| | - J L López-Torrecilla
- Department of Radiation Oncology, ERESA, Hospital General Universitario de Valencia (CHGUV), Avenida Tres Cruces, No. 2, 46014, Valencia, Spain
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Freislederer P, Kügele M, Öllers M, Swinnen A, Sauer TO, Bert C, Giantsoudi D, Corradini S, Batista V. Recent advanced in Surface Guided Radiation Therapy. Radiat Oncol 2020; 15:187. [PMID: 32736570 PMCID: PMC7393906 DOI: 10.1186/s13014-020-01629-w] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/21/2020] [Indexed: 01/27/2023] Open
Abstract
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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Affiliation(s)
- P. Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - M. Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - M. Öllers
- Maastricht Radiation Oncology (MAASTRO), Maastricht, the Netherlands
| | - A. Swinnen
- Maastricht Radiation Oncology (MAASTRO), Maastricht, the Netherlands
| | - T.-O. Sauer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C. Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - D. Giantsoudi
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - S. Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - V. Batista
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
- Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
- National Center for Tumor diseases (NCT), Heidelberg, Germany
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