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Brown E, Barry T, Mai T, Harvey J. Clinical experience of a tattoo application device. Tech Innov Patient Support Radiat Oncol 2024; 30:100254. [PMID: 38784599 PMCID: PMC11112350 DOI: 10.1016/j.tipsro.2024.100254] [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: 12/05/2023] [Revised: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Introduction The use of tattoos for radiation therapy (RT) treatment is common practice. The Comfort Marker 2.0 (CQ Medical, Iowa, USA) has been designed to apply tattoos with a controlled depth injection, potentially resulting in tattoos that fade over time. The aim of this study was to investigate the clinical implementation of the Comfort Marker 2.0 tattoo device including the patient experience and clinical workflow. Methods Patients undergoing RT treatment for breast cancer were invited to participate in this prospective pilot study. Patients completed a questionnaire after the planning session rating the level of pain experienced during tattoo application. Staff rated ease of use after each patient recording any feedback regarding the device. To evaluate tattoo fading, patients were followed up at 6 and 12 months after treatment to assess if tattoos could be visualised. Results Between August and December 2021, 50 breast cancer patients were recruited to the study. All patients received at least 3 tattoos. The majority of patients (80%) rated their pain between not hurting or hurting a little. More than 85% of staff indicated the device was easy or very easy to use. The three most common areas staff identified for improvement were: cordless device (39.1%), pen size (20.3%) and consumable rubbish (13.0%). All tattoos remained visible at the final follow up appointment. Conclusion Clinical implementation of the Comfort Marker tattoo device has been successful. Overall, patients found the process reasonably painless and staff found the device easy to use, providing a consistent result.
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Affiliation(s)
- Elizabeth Brown
- Radiation Oncology Princess Alexandra Hospital – Ipswich Road, Brisbane, Australia
| | - Tamara Barry
- Radiation Oncology Princess Alexandra Hospital – Ipswich Road, Brisbane, Australia
| | - Tao Mai
- Radiation Oncology Princess Alexandra Hospital – Ipswich Road, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Jennifer Harvey
- Radiation Oncology Princess Alexandra Hospital – Ipswich Road, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Yamauchi R, Ito R, Itazawa T, Tomita F, Kawamori J. Psychological stress associated with skin marking during radiotherapy on breast cancer patients. J Med Imaging Radiat Sci 2024; 55:289-296. [PMID: 38677900 DOI: 10.1016/j.jmir.2024.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/02/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION This study aimed to further understand the psychological distress associated with skin marking during radiotherapy among patients with breast cancer. The potential benefits of skin mark-free radiotherapy were also explored. MATERIALS AND METHODS The study population included female breast cancer patients scheduled for radiation therapy and skin marking. A 12-item survey was administered, encompassing demographics (age, treatment site and mode, and duration of hospital visits), awareness of skin marking, stress induced by skin marking in various life contexts, and perceived advantages of a skin mark-free alternative. Responses were recorded on a 5-point Likert scale. RESULTS The survey was completed by 107 patients, of whom 90 (84%) underwent whole breast irradiation, 15 (14%) received breast/chest wall and supraclavicular lymph node irradiation, and 2 (2%) were unspecified. The common sources of stress were from the presence of skin markings (33%), bathing (41%), clothing selection (25%), and skincare (30%), whereas 17 patients (16%) were not stressed by any of those factors. Meanwhile, 73% of patients reported taking precautions to prevent the skin marks from fading. Most patients (63%, n = 76) expressed preference for a skin mark-free radiotherapy option, with many willing to spend extra finances and time for this. CONCLUSIONS A significant proportion of female breast cancer patients experience stress from skin markings in various aspects of their daily lives. A preference for skin mark-free radiotherapy was noted among many patients, that next-generation technologies, such as surface-guided radiotherapy, could alleviate patient stress. IMPLICATIONS FOR PRACTICE The need for permanent or temporary skin markings in the era of state-of-the-art imaging technology should be reconsidered.
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Affiliation(s)
- Ryohei Yamauchi
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Ryoko Ito
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Tomoko Itazawa
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Fumihiro Tomita
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Jiro Kawamori
- Department of Radiation Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
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Yamashita K, Shimizu T, Miyabayashi K, Iwase T, Togasaki G, Hara R. Utility of a skin marker-less setup procedure using surface-guided imaging: a comparison with the traditional laser-based setup in extremity irradiation. Radiol Phys Technol 2024; 17:569-577. [PMID: 38668937 DOI: 10.1007/s12194-024-00806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/27/2024]
Abstract
This study aimed to assess the feasibility of a skin marker-less patient setup using a surface-guided radiotherapy (SGRT) system for extremity radiotherapy. Twenty-five patients who underwent radiotherapy to the extremities were included in this retrospective study. The first group consisted of 10 patients and underwent a traditional setup procedure using skin marks and lasers. The second group comprised 15 patients and had a skin marker-less setup procedure that used an SGRT system only. To compare the two setup procedures for setup accuracy, the mean 3D vector shift magnitude was 0.9 mm for the traditional setup procedure and 0.5 mm for the skin marker-less setup procedure (p < 0.01). In addition, SGRT systems have been suggested to improve the accuracy and reproducibility of patient setups and consistently reduce interfractional setup errors. These results indicate that a skin marker-less patient setup procedure using an SGRT system is useful for extremity irradiation.
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Affiliation(s)
- Kei Yamashita
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan.
| | - Takayuki Shimizu
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan
| | - Kanae Miyabayashi
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan
| | - Tsutomu Iwase
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan
| | - Gentaro Togasaki
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan
| | - Ryusuke Hara
- Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan
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Seravalli E, Kroon PS, Bolle S, Dunlea C, Harrabi SB, Laprie A, Lassen-Ramshad Y, Whitfield G, Janssens GO. Surface guided radiotherapy practice in paediatric oncology: a survey on behalf of the SIOPE Radiation Oncology Working Group. Br J Radiol 2024; 97:1044-1049. [PMID: 38445717 DOI: 10.1093/bjr/tqae049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/06/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Surface guided radiotherapy (SGRT) is increasingly being implemented to track patient's surface movement and position during radiation therapy. However, limited information is available on the SGRT use in paediatrics. The aim of this double survey was to map SIOPE (European Society for Paediatric Oncology)-affiliated centres using SGRT and to gain information on potential indications, observed, or expected benefits. METHODS A double online survey was distributed to 246 SIOPE-affiliated radiotherapy (RT) centres. Multiple choices, yes/no, and open answers were included. The first survey (41 questions) was active from February to March 2021. A shortened version (13 questions) was repeated in March 2023 to detect trends in SGRT use within the same community. RESULTS Respectively, 76/142 (54%) and 28/142 (20%) responding centres used and planned to use SGRT clinically, including 4/34 (12%) new centres since 2021. Among the SGRT users, 33/76 (43%) already applied this technology to paediatric treatments. The main benefits of improved patient comfort, better monitoring of intrafraction motion, and more accurate initial patient set-up expected by future users did not differ from current SGRT-users (P = .893). Among non-SGRT users, the main hurdles to implement SGRT were costs and time for installation. In paediatrics, SGRT is applied to all anatomical sites. CONCLUSION This work provides information on the practice of SGRT in paediatrics across SIOPE-affiliated RT centres which can serve as a basis for departments when considering the purchase of SGRT systems. ADVANCES IN KNOWLEDGE Since little information is available in the literature on the use of SGRT in paediatrics, the results of this double survey can serve as a basis for departments treating children when considering the purchase of an SGRT system.
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Affiliation(s)
- Enrica Seravalli
- Department of Radiation Oncology, University Medical Center Utrecht, 3508 GA, The Netherlands
| | - Petra S Kroon
- Department of Radiation Oncology, University Medical Center Utrecht, 3508 GA, The Netherlands
| | - Stephanie Bolle
- Department of Radiation Oncology, Gustave Roussy Campus, Villejuif 94 800, France
| | - Cathy Dunlea
- Department of Oncology, University College London Hospitals NHS Foundation Trust, London NW1 2PB, United Kingdom
| | - Semi B Harrabi
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Anne Laprie
- Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse 31100, France
| | - Yasmin Lassen-Ramshad
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Gillian Whitfield
- The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, Manchester M20 4BX, United Kingdom
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht, 3508 GA, The Netherlands
- Princess Maxima Center for Pediatric Oncology, Utrecht 3582CS, The Netherlands
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Hardy-Abeloos C, Gorovets D, Lewis A, Ji W, Lozano A, Tung CC, Yu F, Hanlon A, Lin H, Kha A, Yamada Y, Kabarriti R, Lazarev S, Hasan S, Chhabra AM, Simone CB, Choi JI. Prospective evaluation of patient-reported outcomes of invisible ink tattoos for the delivery of external beam radiation therapy: the PREFER trial. Front Oncol 2024; 14:1374258. [PMID: 38590650 PMCID: PMC10999588 DOI: 10.3389/fonc.2024.1374258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 03/11/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Invisible ink tattoos (IITs) avoid cosmetic permanence of visible ink tattoos (VITs) while serving as more reliable landmarks for radiation setup than tattooless setups. This trial evaluated patient-reported preference and feasibility of IIT implementation. Methods and materials In an IRB-approved, single institution, prospective trial, patients receiving proton therapy underwent IIT-based treatment setup. A survey tool assessed patient preference on tattoos using a Likert scale. Matched patients treated using our institutional standard tattooless setup were identified; treatment times and image guidance requirements were evaluated between tattooless and IIT-based alignment approaches. Distribution differences were estimated using Wilcoxon rank-sum tests or Chi-square tests. Results Of 94 eligible patients enrolled, median age was 58 years, and 58.5% were female. Most common treatment sites were breast (18.1%), lung (17.0%) and pelvic (14.9%). Patients preferred to receive IITs versus VITs (79.8% pre-treatment and 75.5% post-treatment, respectively). Patients were willing to travel farther from home to avoid VITs versus IITs (p<0.01). Females were willing to travel (45.5% vs. 23.1%; p=0.04) and pay additional money to avoid VITs (34.5% vs. 5.1%; p<0.01). Per-fraction average +treatment time and time from on table/in room to first beam were shorter with IIT-based vs. tattooless setup (12.3min vs. 14.1min; p=0.04 and 24.1min vs. 26.2min; p=0.02, respectively). Discussion In the largest prospective trial on IIT-based radiotherapy setup to date, we found that patients prefer IITs to VITs. Additionally, IIT-based alignment is an effective and efficient strategy in comparison with tattooless setup. Standard incorporation of IITs for patient setup should be strongly considered.
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Affiliation(s)
- Camille Hardy-Abeloos
- Department of Radiation Oncology, NYU School of Medicine, New York, NY, United States
| | - Daniel Gorovets
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- New York Proton Center, New York, NY, United States
| | - Aurora Lewis
- New York Proton Center, New York, NY, United States
- Rutgers Robert Wood Johnson Medical School, Newark, NJ, United States
| | - Wenyan Ji
- Center for Biostatistics and Health Data Science, Department of Statistics, Virginia Tech, Roanoke, VA, United States
| | - Alicia Lozano
- Center for Biostatistics and Health Data Science, Department of Statistics, Virginia Tech, Roanoke, VA, United States
| | | | - Francis Yu
- New York Proton Center, New York, NY, United States
| | - Alexandra Hanlon
- Center for Biostatistics and Health Data Science, Department of Statistics, Virginia Tech, Roanoke, VA, United States
| | - Haibo Lin
- New York Proton Center, New York, NY, United States
| | - Anh Kha
- New York Proton Center, New York, NY, United States
| | - Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- New York Proton Center, New York, NY, United States
| | - Rafi Kabarriti
- New York Proton Center, New York, NY, United States
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, United States
| | - Stanislav Lazarev
- New York Proton Center, New York, NY, United States
- Department of Radiation Oncology, Mount Sinai Health System, New York, NY, United States
| | - Shaakir Hasan
- New York Proton Center, New York, NY, United States
- Department of Radiation Oncology, Montefiore Medical Center, Bronx, NY, United States
| | - Arpit M. Chhabra
- New York Proton Center, New York, NY, United States
- Department of Radiation Oncology, Mount Sinai Health System, New York, NY, United States
| | - Charles B. Simone
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- New York Proton Center, New York, NY, United States
| | - J. Isabelle Choi
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- New York Proton Center, New York, NY, United States
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Lai J, Luo Z, Jiang L, Hu H, Gao C, Zhang C, Chen L, Wu J, Wu Z. Skin marker combined with surface-guided auto-positioning for breast DIBH radiotherapy daily initial patient setup: An optimal schedule for both accuracy and efficiency. J Appl Clin Med Phys 2024:e14319. [PMID: 38522035 DOI: 10.1002/acm2.14319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND AND PURPOSE By employing three surface-guided radiotherapy (SGRT)-assisted positioning methods, we conducted a prospective study of patients undergoing SGRT-based deep inspiration breath-hold (DIBH) radiotherapy using a Sentine/Catalys system. The aim of this study was to optimize the initial positioning workflow of SGRT-DIBH radiotherapy for breast cancer. MATERIALS AND METHODS A total of 124 patients were divided into three groups to conduct a prospective comparative study of the setup accuracy and efficiency for the daily initial setup of SGRT-DIBH breast radiotherapy. Group A was subjected to skin marker plus SGRT verification, Group B underwent SGRT optical feedback plus auto-positioning, and Group C was subjected to skin marker plus SGRT auto-positioning. We evaluated setup accuracy and efficiency using cone-beam computed tomography (CBCT) verification data and the total setup time. RESULTS In groups A, B, and C, the mean and standard deviation of the translational setup-error vectors were small, with the highest values of the three directions observed in group A (2.4 ± 1.6, 2.9 ± 1.8, and 2.8 ± 2.1 mm). The rotational vectors in group B (1.8 ± 0.7°, 2.1 ± 0.8°, and 1.8 ± 0.7°) were significantly larger than those in groups A and C, and the Group C setup required the shortest amount of time, at 1.5 ± 0.3 min, while that of Group B took the longest time, at 2.6 ± 0.9 min. CONCLUSION SGRT one-key calibration was found to be more suitable when followed by skin marker/tattoo and in-room laser positioning, establishing it as an optimal daily initial set-up protocol for breast DIBH radiotherapy. This modality also proved to be suitable for free-breathing breast cancer radiotherapy, and its widespread clinical use is recommended.
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Affiliation(s)
- Jianjun Lai
- Instiute of Intelligent Control and Robotics, Hangzhou Dianzi University, Hangzhou, China
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Zhizeng Luo
- Instiute of Intelligent Control and Robotics, Hangzhou Dianzi University, Hangzhou, China
| | - Lu Jiang
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Haili Hu
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Chang Gao
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Chuanfeng Zhang
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Liting Chen
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Jing Wu
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
| | - Zhibing Wu
- Department of Radiation Oncology, Zhejiang Hospital, Hangzhou, China
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Pires AM, Carvalho L, Santos AC, Vilaça AM, Coelho AR, Oliveira C, Costa C, Fernandes F, Moreira L, Lima J, Vieira R, Ferraz MJ, Silva M, Silva P, Matias R, Zorro S, Costa S, Sarandão S, Barros AF. Radiation Therapy Skin Marking with Lancets Versus Electric Marking Pen (COMFORTATTOO)-6 Months Results on Cosmesis, Fading, and Patients' Satisfaction From a Randomized, Double-Blind Trial. Adv Radiat Oncol 2024; 9:101404. [PMID: 38292889 PMCID: PMC10823085 DOI: 10.1016/j.adro.2023.101404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 10/05/2023] [Indexed: 02/01/2024] Open
Abstract
Purpose Most of radiation oncology centers rely on set-up skin markings for patient setup during treatment delivery. Permanent dark-ink tattooing is the most popular marking method. COMFORTATTOO is a unicentric, randomized trial testing 2 permanent methods: lancets against an electric marking pen (Comfort Marker 2.0, CM). One substudy was undertaken to test if using the CM translates into a cosmesis, fading, or satisfaction benefit compared with the lancets. Methods and Materials Patients aged 18 years or older referred to our department to receive RT were recruited. They were randomly assigned, in a 1:1 ratio, to receive set-up markings using lancets or CM. This substudy aimed to recruit all the living participants included in the main study. The primary endpoints were tattoos cosmesis, tattoos fading, and patients' satisfaction 6 months after finishing the RT. Cosmetic and fading assessments were scored on a 5-point ascending scale and patients' satisfaction on a 10-point ascending scale. The trial is registered at ClinicalTrials.gov (number NCT05371795). Results Between April and September 2022, 92 patients were enrolled (45 assigned to lancets and 47 to CM) and assessed for the outcomes. Patients receiving CM had significantly better cosmetic markings, with a median score of 4.4 (vs 3.7 for lancets, P<.001). On the fading assessment, the CM was associated with lower scores compared with the lancets (median score of 1.3 and 3.3, respectively; P<.001). No differences in patients' satisfaction were observed with either method (median score of 10 for both arms, P=.952). Conclusions Our substudy results demonstrated that, 6 months after the end of RT, the CM produces better cosmetic markings with less fading compared with the lancets. These differences didn't translate into patients' satisfaction superiority toward any method.
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Affiliation(s)
- André M. Pires
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Luísa Carvalho
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Ana C. Santos
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Ana M. Vilaça
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Ana R. Coelho
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Celeste Oliveira
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Céline Costa
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Flávia Fernandes
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Liliana Moreira
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - João Lima
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Rafaela Vieira
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Maria J. Ferraz
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Marta Silva
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Pedro Silva
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Rafael Matias
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Sara Zorro
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Susana Costa
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Susana Sarandão
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
| | - Ana F. Barros
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr António Bernardino de Almeida, Porto, Portugal
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Lastrucci A, Serventi E, Francolini G, Marciello L, Fedeli L, Meucci F, Marzano S, Esposito M, Ricci R. A retrospective comparison of setup accuracy from CBCT and SGRT data in breast cancer patients. J Med Imaging Radiat Sci 2024; 55:29-36. [PMID: 38016852 DOI: 10.1016/j.jmir.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 11/30/2023]
Abstract
INTRODUCTION Both cone-beam computed tomography (CBCT) and surface-guided radiotherapy (SGRT) are used for breast patient positioning verification before treatment delivery. SGRT may reduce treatment time and imaging dose by potentially reduce the number of CBCT needed. The aim of this study was to compare the displacements resulting in positioning from the Image Guided Radiation Therapy (IGRT) 3D and SGRT methods and to design a clinical workflow for SGRT implementation in breast radiotherapy to establish an imaging strategy based on the data obtained. METHODS For this study 128 breast cancer patients treated with 42.5 Gy in 16 fractions using 3D conformal radiotherapy with free breathing technique were enroled. A total of 366 CBCT images were evaluated for patient setup verification and compared with SGRT. Image registrations between planning CT images and CBCT images were performed in mutual agreement and in online mode by three health professionals. Student's paired t-test was used to compare the absolute difference in vector shift, measured in mm, for each orthogonal axis (x, y, z) between SGRT and CBCT methods. The multidisciplinary team evaluated a review of the original clinical workflow for SGRT implementation and data about patients treated with the updated workflow were reported. RESULTS Comparison of the shifts obtained with IGRT and SGRT for each orthogonal axis (for the x-axes the average displacement was 0.9 ± 0.7 mm, y = 1.1 ± 0.8 mm and z = 1.0 ± 0.7 mm) revealed no significant statistical differences (p > 0.05). Using the updated workflow the difference between SGRT and IGRT displacements was <3 mm in 91.4 % of patients with a reduction in total treatment time of approximately 20 %, due to the reduce frequency of the CBCT images acquisition and matching. CONCLUSIONS This study has shown that IGRT and SGRT agree in positioning patients with breast cancer within a millimetre tolerance. SGRT can be used for patient positioning, with the advantages of reducing radiation exposure and shorter overall treatment time.
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Affiliation(s)
- Andrea Lastrucci
- Radiation Oncology Unit, Santo Stefano Hospital, Department of Allied Health Professions, Azienda USL Toscana Centro, Prato 59100, Italy.
| | - Eva Serventi
- Radiation Oncology Unit, Santo Stefano Hospital, Department of Allied Health Professions, Azienda USL Toscana Centro, Prato 59100, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
| | - Luisa Marciello
- Radiation Oncology Unit, Santo Stefano Hospital, Department of Oncology, Azienda USL Toscana Centro, Prato 59100, Italy
| | - Luca Fedeli
- Medical Physics Unit, Santo Stefano Hospital, Azienda USL Toscana Centro, Prato-Pistoia 59100, Italy
| | - Francesco Meucci
- Medical Physics Unit, Santo Stefano Hospital, Azienda USL Toscana Centro, Prato-Pistoia 59100, Italy
| | - Salvino Marzano
- Radiation Oncology Unit, Santo Stefano Hospital, Department of Oncology, Azienda USL Toscana Centro, Prato 59100, Italy
| | - Marco Esposito
- Medical Physics, The Abdus Salam International Centre for Theoretical Physics, Trieste 34151, Italy
| | - Renzo Ricci
- Department of Allied Health Professions, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy
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Young K, Wright EA. Automated Test for Monthly Quality Assurance of Optical Surface Imaging Dynamic Localization Accuracy. Cureus 2024; 16:e56242. [PMID: 38618470 PMCID: PMC11016349 DOI: 10.7759/cureus.56242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/16/2024] Open
Abstract
The American Association of Physicists in Medicine (AAPM) recently published the report of Task Group (TG) 302, which provides recommendations on acceptance, commissioning, and ongoing routine quality assurance (QA) for surface-guided radiation therapy (SGRT) systems. One of the recommended monthly QA tests is a dynamic localization accuracy test. This work aimed to develop an automated procedure for monthly SGRT dynamic localization QA. An anthropomorphic head phantom was rigidly attached to the 6-dof couch of a TrueBeam linac. TrueBeam Developer Mode was used to take an MV image of the phantom at the starting position, then automatically drive the couch through a series of translations and rotations, taking an MV image after each translation. The Identify SGRT system monitored the motion of the phantom surface from the starting position. Translations assessed on MV images were compared to translations reported in trajectory log files and Identify log files. Rotations were compared between trajectory log files and Identify log files. Three experiments were conducted. None of the translations or rotations from any experiment exceeded the tolerance values for stereotactic ablative body radiation therapy (SABR) recommended by AAPM TG-142. Maximum deviations from the expected translation values from MV imaging, trajectory log files, and Identify log files were -0.94mm, -0.11mm, and -0.78mm, respectively. Maximum deviations from the expected rotation values from trajectory log files and Identify log files were 0.01 and -0.2 degrees, respectively. The proposed method is a simple automated way to complete monthly dynamic localization QA of SGRT systems.
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Affiliation(s)
- Kaleigh Young
- Medical Physics, University of British Columbia - Okanagan Campus, Kelowna, CAN
| | - Eric A Wright
- Medical Physics, Sunnybrook Health Sciences Centre Odette Cancer Centre, Toronto, CAN
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10
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Schöpe M, Sahlmann J, Jaschik S, Findeisen A, Klautke G. Comparison of patient setup accuracy for optical surface-guided and X-ray-guided imaging with respect to the impact on intracranial stereotactic radiotherapy. Strahlenther Onkol 2024; 200:60-70. [PMID: 37971534 DOI: 10.1007/s00066-023-02170-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 10/11/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The objective of this work is to estimate the patient positioning accuracy of a surface-guided radiation therapy (SGRT) system using an optical surface scanner compared to an X‑ray-based imaging system (IGRT) with respect to their impact on intracranial stereotactic radiotherapy (SRT) and intracranial stereotactic radiosurgery (SRS). METHODS Patient positioning data, both acquired with SGRT and IGRT systems at the same linacs, serve as a basis for determination of positioning accuracy. A total of 35 patients with two different open face masks (578 datasets) were positioned using X‑ray stereoscopic imaging and the patient position inside the open face mask was recorded using SGRT. The measurement accuracy of the SGRT system (in a "standard" and an SRS mode with higher resolution) was evaluated using both IGRT and SGRT patient positioning datasets taking into account the measurement errors of the X‑ray system. Based on these clinically measured datasets, the positioning accuracy was estimated using Monte Carlo (MC) simulations. The relevant evaluation criterion, as standard of practice in cranial SRT, was the 95th percentile. RESULTS The interfractional measurement displacement vector of the SGRT system, σSGRT, in high resolution mode was estimated at 2.5 mm (68th percentile) and 5 mm (95th percentile). If the standard resolution was used, σSGRT increased by about 20%. The standard deviation of the axis-related σSGRT of the SGRT system ranged between 1.5 and 1.8 mm interfractionally and 0.5 and 1.0 mm intrafractionally. The magnitude of σSGRT is mainly due to the principle of patient surface scanning and not due to technical limitations or vendor-specific issues in software or hardware. Based on the resulting σSGRT, MC simulations served as a measure for the positioning accuracy for non-coplanar couch rotations. If an SGRT system is used as the only patient positioning device in non-coplanar fields, interfractional positioning errors of up to 6 mm and intrafractional errors of up to 5 mm cannot be ruled out. In contrast, MC simulations resulted in a positioning error of 1.6 mm (95th percentile) using the IGRT system. The cause of positioning errors in the SGRT system is mainly a change in the facial surface relative to a defined point in the brain. CONCLUSION In order to achieve the necessary geometric accuracy in cranial stereotactic radiotherapy, use of an X‑ray-based IGRT system, especially when treating with non-coplanar couch angles, is highly recommended.
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Affiliation(s)
- Michael Schöpe
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany
| | - Jacob Sahlmann
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany
| | - Stefan Jaschik
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany.
| | - Anne Findeisen
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany
| | - Gunther Klautke
- Department of Radiation Oncology, Klinikum Chemnitz gGmbH, Bürgerstraße 2, 09113, Chemnitz, Germany
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11
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Zeng C, Fan Q, Li X, Song Y, Kuo L, Aristophanous M, Cervino LI, Hong L, Powell S, Li G. A Potential Pitfall and Clinical Solutions in Surface-Guided Deep Inspiration Breath Hold Radiation Therapy for Left-Sided Breast Cancer. Adv Radiat Oncol 2023; 8:101276. [PMID: 38047221 PMCID: PMC10692299 DOI: 10.1016/j.adro.2023.101276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/18/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose Deep inspiration breath hold (DIBH) is an effective technique to spare the heart in treating left-sided breast cancer. Surface-guided radiation therapy (SGRT) is increasingly applied in DIBH setup and motion monitoring. Patient-specific breathing behavior, either thoracically driven or abdominally driven (A-DIBH), should be unaltered, online identified, and monitored accordingly to ensure reproducible heart-sparing treatment. Methods and Materials Sixty patients with left-sided breast cancer treated with SGRT were analyzed: 20 A-DIBH patients with vertical chest elevation (VCE ≤ 5 mm) were prospectively identified, and 40 control patients were retrospectively and randomly selected for comparison. At simulation, both free-breathing (FB) and DIBH computed tomography (CT) were acquired, guided by a motion surrogate placed around the xiphoid process. For SGRT treatment setups, the region of interest (ROI) was defined on the CT chest surface, and the surrogate-based setup was a backup. For all 60 patients, the VCE was measured as the average of the FB-to-DIBH elevations at the breast and xiphoid process, together with abdominal elevation. In the 40-patient control group, A-DIBH patients (VCE ≤ 5 mm) were identified. Of the 20 A-DIBH patients, 10 were treated with volumetric modulated arc therapy plans, and 10 patients were treated with tangent plans. Clinical DIBH plans were recalculated on FB CT to compare maximum dose (DMax), 5% of the maximum dose (D5%), mean dose (DMean), and V30Gy, V20Gy, and V5Gy of the heart and lungs and their significance. Results In the 20 A-DIBH patients, VCE = 3 ± 2 mm, surrogate motion (9 ± 6 mm), and abdomen motion of 14 ± 5 mm are found. Heart dose reduction from FB to DIBH is significant (P < .01): ∆DMax = -8.4 ± 9.8 Gy, ∆D5% = -2.4 ± 4.4 Gy, and ∆DMean = -0.6 ± 0.9 Gy. Six out of 40 control patients (15%) are found to have VCE ≤ 5 mm. Conclusions A-DIBH (VCE ≤ 5 mm) patient population is significant (15%), and they should be identified in the SGRT workflow and monitored accordingly. A new abdominal ROI or an abdominal surrogate should be used instead of the conventional chest-only ROI. Patient-specific DIBH should be preserved for higher reproducibility to ensure heart sparing.
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Affiliation(s)
- Chuan Zeng
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Qiyong Fan
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Xiang Li
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yulin Song
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Licheng Kuo
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michalis Aristophanous
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura I. Cervino
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Linda Hong
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Simon Powell
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Guang Li
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
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12
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Psarras M, Stasinou D, Stroubinis T, Protopapa M, Zygogianni A, Kouloulias V, Platoni K. Surface-Guided Radiotherapy: Can We Move on from the Era of Three-Point Markers to the New Era of Thousands of Points? Bioengineering (Basel) 2023; 10:1202. [PMID: 37892932 PMCID: PMC10604452 DOI: 10.3390/bioengineering10101202] [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: 09/06/2023] [Revised: 10/10/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
The surface-guided radiotherapy (SGRT) technique improves patient positioning with submillimeter accuracy compared with the conventional positioning technique of lasers using three-point tattoos. SGRT provides solutions to considerations that arise from the conventional setup technique, such as variability in tattoo position and the psychological impact of the tattoos. Moreover, SGRT provides monitoring of intrafractional motion. PURPOSE This literature review covers the basics of SGRT systems and examines whether SGRT can replace the traditional positioning technique. In addition, it investigates SGRT's potential in reducing positioning times, factors affecting SGRT accuracy, the effectiveness of live monitoring, and the impact on patient dosage. MATERIALS AND METHODS This study focused on papers published from 2016 onward that compared SGRT with the traditional positioning technique and investigated factors affecting SGRT accuracy and effectiveness. RESULTS/CONCLUSIONS SGRT provides the same or better results regarding patient positioning. The implementation of SGRT can reduce overall treatment time. It is an effective technique for detecting intrafraction patient motion, improving treatment accuracy and precision, and creating a safe and comfortable environment for the patient during treatment.
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Affiliation(s)
- Michalis Psarras
- Medical Physics Unit, 2nd Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
| | - Despoina Stasinou
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
| | - Theodoros Stroubinis
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
| | - Maria Protopapa
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
| | - Anna Zygogianni
- Radiation Oncology Unit, 1st Department of Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, 115 28 Athens, Greece
| | - Vassilis Kouloulias
- Radiation Oncology Unit, 2nd Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Kalliopi Platoni
- Medical Physics Unit, 2nd Department of Radiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 124 62 Athens, Greece
- Department of Radiation Oncology and Stereotactic Radiosurgery, Mediterraneo Hospital, 166 75 Athens, Greece
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13
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Zhao H, Sarkar V, Paxton A, Huang YJ, Haacke C, Price RG, Frances Su FC, Szegedi M, Rassiah P, Salter B. Technical note: Clinical evaluation of a newly released surface-guided radiation therapy system on DIBH for left breast radiation therapy. Med Phys 2023; 50:5978-5986. [PMID: 37683108 DOI: 10.1002/mp.16699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND It has been shown that a significant reduction of mean heart dose and left anterior descending artery (LAD) dose can be achieved through the use of DIBH for left breast radiation therapy. Surface-guided DIBH has been widely adopted during the last decade, and there are mainly three commercially available SGRT systems. The reports of the performance of a newly released SGRT system for DIBH application are currently very limited. PURPOSE To evaluate the clinical performance of a newly released SGRT system on DIBH for left breast radiation therapy. METHODS Twenty-five left breast cancer patients treated with DIBH utilizing Varian's Identify system were included (total 493-fraction treatments). Four aspects of the clinical performance were evaluated: Identify offsets of free breathing post patient setup from tattoos, Identify offsets during DIBH, Identify agreement with radiographic ports during DIBH, and DIBH reference surface re-capture post patient shifts. The systematic and random errors of free breathing Identify offsets post patient setup were calculated for each patient, as well as for offsets during DIBH. Radiographic ports were taken when the patient's DIBH position was within the clinical tolerance of (± 0.3 cm, ± 30 ), and these were then compared with treatment field DRRs. If the ports showed that the patient alignment did not agree with the DRRs within 3 mm, a patient shift was performed. A new reference surface was captured and verification ports were taken. RESULTS The all-patient average systematic and random errors of Identify offsets for free breathing were within (0.4 cm, 1.50 ) post tattoo setup. The maximum per-patient systematic and random errors were (1.1 cm, 6.20 ) and (0.9 cm, 20 ), and the maximum amplitude of Identify offsets were (2.59 cm, 90 ). All 493-fraction DIBH treatments were delivered and successfully guided by the Identify SGRT system. The systematic and random errors of Identify offsets for DIBH were within (0.2 cm, 2.30 ). Seven patients needed re-captured surface references due to surface variation or position shifts based on the ports. All patient DIBH verification ports guided by Identify were approved by attending physicians. CONCLUSION This evaluation showed that the Identify system performed effectively for surface-guided patient setup and surface-guided DIBH imaging and treatment delivery. The feature of color-coded real-time patient surface matching feedback facilitated the evaluation of the patient alignment accuracy and the adjustment of the patient position to match the reference.
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Affiliation(s)
- Hui Zhao
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Vikren Sarkar
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Adam Paxton
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Y Jessica Huang
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Christine Haacke
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Ryan G Price
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Fan-Chi Frances Su
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas, USA
| | - Martin Szegedi
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Prema Rassiah
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
| | - Bill Salter
- Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, USA
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14
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Zhao H, Haacke C, Sarkar V, Paxton A, Jessica Huang Y, Szegedi M, Price RG, Frances Su FC, Rassiah-Szegedi P, Salter B. Initial clinical evaluation of a novel combined biometric, radio-frequency identification, and surface imaging system. Phys Med 2023; 114:103146. [PMID: 37778208 DOI: 10.1016/j.ejmp.2023.103146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/15/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023] Open
Abstract
PURPOSE To evaluate and characterize the overall clinical functionality and workflow of the newly released Varian Identify system (version 2.3). METHODS Three technologies included in the Varian Identify system were evaluated: patient biometric authentication, treatment accessory device identification, and surface-guided radiation therapy (SGRT) function. Biometric authentication employs a palm vein reader. Treatment accessory device verification utilizes two technologies: device presence via Radio Frequency Identification (RFID) and position via optical markers. Surface-guidance was evaluated on both patient orthopedic setup at loading position and surface matching and tracking at treatment isocenter. A phantom evaluation of the consistency and accuracy for Identify SGRT function was performed, including a system consistency test, a translational shift and rotational accuracy test, a pitch and roll accuracy test, a continuous recording test, and an SGRT vs Cone-Beam CT (CBCT) agreement test. RESULTS 201 patient authentications were verified successfully with palm reader. All patient treatment devices were successfully verified for their presences and positions (indexable devices). The patient real-time orthopedic pose was successfully adjusted to match the reference surface captured at simulation. SGRT-reported shift consistency against couch readout was within (0.1 mm, 0.030). The shift accuracy was within (0.3 mm, 0.10). In continuous recording mode, the maximum variation was 0.2 ± 0.12 mm, 0.030 ± 0.020. The difference between Identify SGRT offset and CBCT was within (1 mm, 10). CONCLUSIONS This clinical evaluation confirms that Identify accurately functions for patient palm identification and patient treatment device presence and position verification. Overall SGRT consistency and accuracy was within (1 mm, 10), within the 2 mm criteria of AAPM TG302.
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Affiliation(s)
- Hui Zhao
- University of Utah, United States.
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Sasaki M, Matsushita N, Fujimoto T, Nakata M, Ono Y, Yoshimura M, Mizowaki T. New patient setup procedure using surface-guided imaging to reduce body touch and skin marks in whole-breast irradiation during the COVID-19 pandemic. Radiol Phys Technol 2023; 16:422-429. [PMID: 37474738 DOI: 10.1007/s12194-023-00735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 07/22/2023]
Abstract
This study aimed to assess the effectiveness of a new patient-setup procedure using surface-guided imaging during the coronavirus disease 2019 (COVID-19) pandemic for left-sided whole-breast irradiation with deep inspiration breath-hold. Two setup procedures were compared regarding patient positioning accuracy for the first 22 patients. The first was a traditional setup (T-setup) procedure that used a surface-guided system after patient setup with traditional skin marks and lasers. The second procedure involved a new setup (N-setup) that used only a surface-guided system. The positioning accuracy of the remaining 23 patients was assessed using a setup that combined marker reduction and the N-setup procedure. No significant difference was observed in positioning accuracy between the two setups. The positioning accuracy of the marker-reduction setup was within 3 mm in all directions. The N-setup procedure may be a useful strategy for preventing infection during or after the COVID-19 pandemic.
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Affiliation(s)
- Makoto Sasaki
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, Kyoto, 606-8507, Japan.
| | - Norimasa Matsushita
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, Kyoto, 606-8507, Japan
| | - Takahiro Fujimoto
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, Kyoto, 606-8507, Japan
| | - Manabu Nakata
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawahara-Cho, Shogoin, Sakyo-Ku, Kyoto, Kyoto, 606-8507, Japan
| | - Yuka Ono
- Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Michio Yoshimura
- Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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16
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Lee J, Kim YJ, Goh Y, Yang E, Kim HU, Song SY, Kim YS. Application of surface-guided radiation therapy in prostate cancer: comparative analysis of differences with skin marking-guided patient setup. Radiat Oncol J 2023; 41:172-177. [PMID: 37793626 PMCID: PMC10556842 DOI: 10.3857/roj.2023.00521] [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: 06/21/2023] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSE Surface-guided radiation therapy is an image-guided method using optical surface imaging that has recently been adopted for patient setup and motion monitoring during treatment. We aimed to determine whether the surface guide setup is accurate and efficient compared to the skin-marking guide in prostate cancer treatment. MATERIALS AND METHODS The skin-marking setup was performed, and vertical, longitudinal, and lateral couch values (labeled as "M") were recorded. Subsequently, the surface-guided setup was conducted, and couch values (labeled as "S") were recorded. After performing cone-beam computed tomography (CBCT), the final couch values was recorded (labeled as "C"), and the shift value was calculated (labeled as "Gap (M-S)," "Gap (M-C)," "Gap (S-C)") and then compared. Additionally, the setup times for the skin marking and surface guides were also compared. RESULTS One hundred and twenty-five patients were analyzed, totaling 2,735 treatment fractions. Gap (M-S) showed minimal differences in the vertical, longitudinal, and lateral averages (-0.03 cm, 0.07 cm, and 0.06 cm, respectively). Gap (M-C) and Gap (S-C) exhibited a mean difference of 0.04 cm (p = 0.03) in the vertical direction, a mean difference of 0.35 cm (p = 0.52) in the longitudinal direction, and a mean difference of 0.11 cm (p = 0.91) in the lateral direction. There was no correlation between shift values and patient characteristics. The average setup time of the skin-marking guide was 6.72 minutes, and 7.53 minutes for the surface guide. CONCLUSION There was no statistically significant difference between the surface and skin-marking guides regarding final CBCT shift values and no correlation between translational shift values and patient characteristics. We also observed minimal difference in setup time between the two methods. Therefore, the surface guide can be considered an accurate and time-efficient alternative to skin-marking guides.
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Affiliation(s)
- Jaeha Lee
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yeon Joo Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Youngmoon Goh
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eunyeong Yang
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ha Un Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Si Yeol Song
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Seok Kim
- Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Mueller B, Song Y, Chia-Ko W, Hsu HY, Zhai X, Tamas P, Powell S, Cahlon O, McCormick B, Khan A, Gillespie E, Cervino L, Zhao B, Hong L, Braunstein LZ. Accuracy and Efficiency of Patient Setup Using Surface Imaging versus Skin Tattoos for Accelerated Partial Breast Irradiation. Adv Radiat Oncol 2023; 8:101183. [PMID: 36896216 PMCID: PMC9991531 DOI: 10.1016/j.adro.2023.101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
Purpose Skin tattoos represent the standard approach for surface alignment and setup of breast cancer radiation therapy, yet permanent skin markings contribute to adverse cosmesis and patient dissatisfaction. With the advent of contemporary surface-imaging technology, we evaluated setup accuracy and timing between "tattoo-less" and traditional tattoo-based setup techniques. Methods and Materials Patients receiving accelerated partial breast irradiation (APBI) underwent traditional tattoo-based setup (TTB), alternating daily with a tattoo-less setup via surface imaging using AlignRT (ART). Following initial setup, position was verified via daily kV imaging, with matching on surgical clips representing ground truth. Translational shifts (TS) and rotational shifts (RS) were ascertained, as were setup time and total in-room time. Statistical analyses used the Wilcoxon signed rank test and Pitman-Morgan variance test. Results A total of 43 patients receiving APBI and 356 treatment fractions were analyzed (174 TTB fractions and 182 using ART). For tattoo-less setup via ART, the median absolute TS were 0.31 cm in the vertical (range, 0.08-0.82), 0.23 cm in the lateral (0.05-0.86), and 0.26 cm in the longitudinal (0.02-0.72) axes. For TTB setup, the corresponding median TS were 0.34 cm (0.05-1.98), 0.31 cm (0.09-1.84), and 0.34 cm (0.08-1.25), respectively. The median magnitude shifts were 0.59 (0.30-1.31) for ART and 0.80 (0.27-2.13) for TTB. ART was not statistically distinguishable from TTB in terms of TS, except in the longitudinal direction (P = .154, .059, and .021, respectively), and was superior to TTB for magnitude shift (P < .001). The variance of each TS variable was significantly narrower for ART compared with TTB (P ≤ .001 vertical, P = .001 lateral, P = .005 longitudinal). The median absolute RS for ART was 0.64° rotation (range, 0.00-1.90), 0.65° roll (0.05-2.90), and 0.30° pitch (0.00-1.50). The corresponding median RS for TTB were 0.80° (0.00-2.50), 0.64° (0.00-3.00), and 0.46° (0.00-2.90), respectively. ART setup was not statistically different from TTB in terms of RS (P = .868, .236, and .079, respectively). ART showed lower variance than TTB in terms of pitch (P = .009). The median total in-room time was shorter for ART than TTB (15.42 vs 17.25 minutes; P = .008), as was the median setup time (11.12 vs 13.00 minutes; P = .001). Moreover, ART had a narrower distribution of setup time with fewer lengthy outliers versus TTB. Conclusions These findings suggest that a tattoo-less setup approach with AlignRT may be sufficiently accurate and expeditious to supplant surface tattoos for patients receiving APBI. Further analyses with larger cohorts will determine whether tattoo-based approaches can be replaced by noninvasive surface imaging.
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Affiliation(s)
- Boris Mueller
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yulin Song
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Wang Chia-Ko
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hao-Yun Hsu
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Xingchen Zhai
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul Tamas
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Simon Powell
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Oren Cahlon
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Beryl McCormick
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Atif Khan
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin Gillespie
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Laura Cervino
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bo Zhao
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Linda Hong
- Departments of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lior Z Braunstein
- Departments of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Gorecki A, Sorgato V, Mazzara C, Clément S, Fric D, Farah J. SurVolT: Surface to Volume conversion Tool. A proof of concept. Phys Med 2023; 108:102566. [PMID: 36989979 DOI: 10.1016/j.ejmp.2023.102566] [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: 09/06/2022] [Revised: 02/02/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE To develop SurVolT, a conversion tool able to apply volumetric changes to DICOM Computed Tomography (CT) data using daily surface (obj) data acquired with AlignRT® (VisionRT Ltd.), primarily designed and validated for breast treatments. MATERIALS AND METHODS SurVolT proceeds in 4 steps: 1. AlignRT .obj files extraction, 2. Contour deformation where the surface data points are matched to the initial external contour on a Region Of Interest, ROImatch, on which the anatomy is supposed to be unchanged. Then, external contour substitution is performed on the ROIttt covering the treated breast area. This is validated on a female torso phantom with a tissue-equivalent bolus mimicking an edema. The Planning Treatment Volume (PTV) contour from the initial CT is also deformed according to the new external contour in the ROIttt. 3. Volumetric data estimation according to the new external contour, validated on an anthropomorphic pelvis phantom. 4. Import of new DICOM data into the Treatment Planning System (TPS). Finally, the workflow is applied on a first patient presenting an anatomical change during the treatment. RESULTS The validation of step 2 and 3 shows a bolus thickness estimation of 5.8±1.2mm (expected 5 mm) and the non-rigid deformation of initial CT images follows the new external contour at the ROIttt bolus site while revealing negligible deformation elsewhere. CONCLUSION This first proof of concept introducing a Surface Guided Radiotherapy (SGRT) tool allowing daily surface data to volume conversion is a fundamental step toward SGRT-based adaptive radiotherapy.
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Flood T, O Neill A, Oliveira CM, Barbosa B, Soares AL, Muscat K, Guille S, McClure P, Hughes C, McFadden S. Patients' perspectives of the skills and competencies of therapy radiographers/radiation therapists (TRs/RTTs) in the UK, Portugal and Malta; a qualitative study from the SAFE Europe project. Radiography (Lond) 2023; 29 Suppl 1:S117-S127. [PMID: 36959043 DOI: 10.1016/j.radi.2023.03.002] [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: 12/09/2022] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 03/25/2023]
Abstract
INTRODUCTION The role of the Therapy Radiographer/Radiation Therapist (TR/RTT) is to provide radiotherapy to patients with a cancer diagnosis. This includes, not only administration of treatment, but also management of side-effects and provision of support/care. Despite this role being consistent throughout Europe, there is currently no standardisation of education for TRs/RTTs. The SAFE EUROPE project aims to standardize TR/RTT education to enable 'safe and free exchange' of TRs/RTTs across Europe. Consequently, this study aims to explore patients' perspectives regarding the current skills and competencies of TRs/RTTs. METHODS From May 2021 to February 2022, semi-structured interviews were conducted with patients who had recently received radiotherapy in the UK, Malta and Portugal. Ethical approval for this study was granted by the NHS Research Ethics Committee with additional local approvals obtained. RESULTS Forty-eight participants from the UK (n = 18), Portugal (n = 19), and Malta (n = 11) completed interviews. Participants described high satisfaction with TRs'/RTTs' competence and skills in all three countries. The main theme arising from the analysis was the importance of trust building with TRs/RTTs. Six factors were identified as influencing levels of trust: communication; side-effect management; team consistency; relational skills; patient dignity; and competence. A small number of patients reported feeling rushed and not having their physical and emotional needs met by TRs/RTTs. CONCLUSION This multicentre study demonstrated that patients perceive TRs/RTTs in the UK, Malta and Portugal as highly competent and skilled. Practical recommendations are provided to address identified deficits in practice, which can be addressed through adaptation of TR/RTT education/training and clinical practice. IMPLICATIONS FOR PRACTICE Recommendations arising from this study are important to ensure that TRs/RTTs have transferable skills that provide consistently high quality care to patients throughout Europe.
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Affiliation(s)
- T Flood
- Lecturer in Radiotherapy and Oncology, Ulster University Northern Ireland, UK.
| | - A O Neill
- Ulster University, Northern Ireland, UK.
| | - C M Oliveira
- Radiotherapy Department, Instituto Português de Oncologia Do Porto (IPO Porto), R. Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal.
| | - B Barbosa
- Radiotherapy Department, Instituto Português de Oncologia Do Porto (IPO Porto), R. Dr. António Bernardino de Almeida 865, 4200-072 Porto, Portugal.
| | - A L Soares
- Medical Physics Service,Portuguese Oncology Institute of Porto, Porto, Portugal.
| | - K Muscat
- University of Malta, MSD 2080, Malta.
| | - S Guille
- Ulster University, Northern Ireland, UK.
| | - P McClure
- Ulster University, Northern Ireland, UK.
| | - C Hughes
- School of Nursing and School of Health Sciences, Ulster University, Northern Ireland, UK.
| | - S McFadden
- Senior Lecturer, Ulster University, Northern Ireland, UK.
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20
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Pires AM, Carvalho L, Santos AC, Vilaça AM, Coelho AR, Fernandes F, Moreira L, Lima J, Vieira R, Ferraz MJ, Silva M, Silva P, Matias R, Zorro S, Costa S, Sarandão S, Barros AF. Radiotherapy skin marking with lancets versus electric marking pen - Comfort, satisfaction, effectiveness and cosmesis results from the randomized, double-blind COMFORTATTOO trial. Radiography (Lond) 2023; 29:171-177. [PMID: 36410128 DOI: 10.1016/j.radi.2022.10.030] [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: 06/07/2022] [Revised: 10/13/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Set-up skin markings are performed, in several centers, for radiotherapy (RT) treatments. This study aimed to compare two permanent methods: lancets and an electric marking pen, the Comfort Marker 2.0® (CM). METHODS This was a prospective, unicentric, randomized study. Patients aged 18 years or older referred to our department to receive RT were recruited. Patients were randomly assigned, in a 1:1 ratio, to receive set-up markings using lancets or CM. The markings arrangement followed our departmental protocols. The coprimary endpoints were patients' comfort and effectiveness. Secondary endpoints included radiation therapists (RTTs) satisfaction and cosmesis. RESULTS Between October 2021 and January 2022, 100 patients were enrolled (50 received lancets and 50 CM) and assessed for the comfort and satisfaction outcomes. CM was significantly less painful than the lancets, with 44% and 16% of the patients, respectively, considering the tattooing process painless (RR = 2.75; 95% IC: 1.36 - 5.58). On the RTT-reported satisfaction, CM had significantly easier processes than lancets (98.0% vs. 78.0%, respectively; RR = 1.26; 95% CI: 1.08 - 1.46). For effectiveness and cosmesis assessment, 98 patients were analyzed (48 received lancets and 50 CM). Patients receiving CM had a significantly higher proportion of markings graded as good and excellent compared to those receiving lancets (98.0% and 50.0%, respectively, had ≥75% of the tattoos assessed as good/excellent, RR = 1.96; 95% CI: 1.47 - 2.61). On the cosmetic evaluation, patients receiving CM had significantly better cosmetic markings, with a median score of 4.4 (vs. 3.5 for lancets, p <0.001). CONCLUSION The trial results demonstrated that tattooing with the CM is significantly less painful, more effective, easier to apply, and cosmetically superior to tattooing with lancets. IMPLICATIONS FOR PRACTICE Tattooing with CM allows for better results regarding pain, quality, ease and cosmesis.
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Affiliation(s)
- A M Pires
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal.
| | - L Carvalho
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - A C Santos
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - A M Vilaça
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - A R Coelho
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - F Fernandes
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - L Moreira
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - J Lima
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - R Vieira
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - M J Ferraz
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - M Silva
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - P Silva
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - R Matias
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - S Zorro
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - S Costa
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - S Sarandão
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
| | - A F Barros
- Radiation Oncology Department, Portuguese Institute of Oncology of Porto, R. Dr. António Bernardino de Almeida 865, 4200-072, Porto, Portugal
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Giantsoudi D, Lalonde A, Barra C, Vanbenthuysen L, Taghian AG, Gierga DP, Jimenez RB. Tattoo-Free Setup for Patients With Breast Cancer Receiving Regional Nodal Irradiation. Pract Radiat Oncol 2023; 13:e20-e27. [PMID: 35948179 DOI: 10.1016/j.prro.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 08/01/2022] [Accepted: 08/01/2022] [Indexed: 01/10/2023]
Abstract
PURPOSE Patients undergoing regional nodal irradiation (RNI) with either 3-dimensional conformal radiation therapy (3DCRT) planning or volumetric modulated arc therapy (VMAT) receive permanent tattoos to assist with daily setup alignment and verification. With the advent of surface imaging, tattoos may not be necessary to ensure setup accuracy. We compared the accuracy of conventional tattoo-based setups to those without reference to tattoos. METHODS AND MATERIALS Forty-eight patients receiving RNI at our institution from July 2019 to December 2020 were identified. All patients received tattoos per standard of care. Twenty-four patients underwent setup using tattoos for initial positioning followed by surface and x-ray imaging. A subsequent 24 patients underwent positioning using surface imaging followed by x-ray imaging without reference to tattoos. Patient cohorts were balanced by treatment technique and use of deep inspiration breath hold. Treatment (including setup and delivery) time and x-ray-based shifts after surface imaging were recorded. RESULTS Among patients in the tattoo group receiving 3DCRT RNI, the average treatment time per fraction was 21.35 versus 19.75 minutes in the 3DCRT RNI no-tattoo cohort (P = .03). Mean 3D vector shifts for patients in the tattoo cohort were 5.6 versus 4.4 mm in the no-tattoo cohort. The average treatment time per fraction for the tattoo VMAT RNI cohort was 23.16 versus 20.82 minutes in the no-tattoo VMAT RNI cohort (P = .08). Mean 3D vector shifts for the patients in the tattoo VMAT cohort were 5.5 versus 7.1 mm in the no-tattoo VMAT cohort. Breath hold technique and body mass index did not affect accuracy in a consistent or clinically relevant way. CONCLUSIONS Using a combination of surface and x-ray imaging, without reference to tattoos, provides excellent accuracy in alignment and setup verification among patients receiving RNI for breast cancer, regardless of treatment technique and with reduced treatment time. Skin-based tattoos are no longer warranted for patients receiving supine RNI.
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Affiliation(s)
- Drosoula Giantsoudi
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Arthur Lalonde
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Colleen Barra
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Liam Vanbenthuysen
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - David P Gierga
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rachel B Jimenez
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
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22
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Qubala A, Schwahofer A, Jersemann S, Eskandarian S, Harrabi S, Naumann P, Winter M, Ellerbrock M, Shafee J, Abtehi S, Herfarth K, Debus J, Jäkel O. Optimizing the Patient Positioning Workflow of Patients with Pelvis, Limb, and Chest/Spine Tumors at an Ion-Beam Gantry based on Optical Surface Guidance. Adv Radiat Oncol 2022; 8:101105. [PMID: 36624871 PMCID: PMC9822948 DOI: 10.1016/j.adro.2022.101105] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/01/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Surface-guided radiation therapy (SGRT) has been investigated intensively to ensure correct patient positioning during a radiation therapy course. Although the implementation is well defined for photon-beam facilities, only a few analyses have been published for ion-beam therapy centers. To investigate the accuracy, reliability, and efficiency of SGRT used in ion-beam treatments against the conventional skin marks, a retrospective study of a unique SGRT installation in an ion gantry treatment room was conducted, where the environment is quite different to conventional radiation therapy. Methods and Materials There were 32 patients, divided into 3 cohorts-pelvis, limb, and chest/spine tumors-and treated with ion-beams. Two patient positioning workflows based on 300 fractions were compared: workflow with skin marks and workflow with SGRT. Position verification was followed by planar kilo voltage imaging. After image matching, 6 degrees of freedom corrections were recorded to assess interfraction positioning errors. In addition, the time required for patient positioning, image matching, and the number of repeated kilo voltage imaging also were gathered. Results SGRT decreased the translational magnitude shifts significantly (P < .05) by 0.5 ± 1.4 mm for pelvis and 1.9 ± 0.5 mm for limb, whereas for chest/spine, it increased by 0.7 ± 0.3 mm. Rotational corrections were predominantly lowered with SGRT for all cohorts with significant differences in pitch for pelvis (P = .002) and chest/spine (P = .009). The patient positioning time decreased by 18%, 9%, and 15% for pelvis, limb, and chest/spine, respectively, compared with skin marks. By using SGRT, 53% of all studied patients had faster positioning time, and 87.5% had faster matching time. Repositioning and consequent reimaging decreased from about 7% to 2% with a statistically significant difference of .042. Conclusions The quality of patient positioning before ion-beam treatments has been optimized by using SGRT without additional imaging dose. SGRT clearly reduced inefficiencies in the patient positioning workflow.
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Affiliation(s)
- Abdallah Qubala
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,Faculty of Medicine, University of Heidelberg, Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Corresponding author: Abdallah Qubala, MSc
| | - Andrea Schwahofer
- National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Stefan Jersemann
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Saleh Eskandarian
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Semi Harrabi
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Patrick Naumann
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Marcus Winter
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Malte Ellerbrock
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Jehad Shafee
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,Saarland University of Applied Sciences, Saarbruecken, Germany
| | - Samira Abtehi
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany
| | - Klaus Herfarth
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Jürgen Debus
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany,National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Oliver Jäkel
- Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany,National Center for Radiation Research in Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany,Department of Medical Physics in Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany,National Center for Tumor Diseases (NCT), Heidelberg, Germany
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23
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Svestad JG, Heydari M, Mikalsen SG, Flote VG, Nordby F, Hellebust TP. Surface-guided positioning eliminates the need for skin markers in radiotherapy of right sided breast cancer: A single center randomized crossover trial. Radiother Oncol 2022; 177:46-52. [PMID: 36309152 DOI: 10.1016/j.radonc.2022.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/20/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND AND PURPOSE To prospectively investigate whether surface guided setup of right sided breast cancer patients can increase efficiency and accuracy compared to traditional skin marker/tattoo based setup. MATERIAL AND METHODS Twenty-five patients were included in this study. Each patient was positioned using skin marks and tattoos (procedure A) for half of the fractions and surface guidance using AlignRT (procedure B) for the other half of the fractions. The order of the two procedures was randomized. Pretreatment CBCT was acquired at every fraction for both setup procedures. A total of ten time points were recorded during every treatment session. Applied couch shifts after CBCT match were recorded and used for potential error calculations if no CBCT had been used. RESULTS In the vertical direction procedure B showed significant smaller population based systematic (Ʃ) and random (σ) errors. However, a significant larger systematic error on the individual patient level (M) was also shown. This was found to be due to patient relaxation between setup and CBCT matching. Procedure B also showed a significant smaller random error in the lateral direction, while no significant differences were seen in the longitudinal direction. No significant difference in setup time was found between the two procedures. CONCLUSION Setup of right sided breast cancer patients using surface guidance yields higher accuracy than setup using skin marks/tattoos and lasers with the same setup time. Patient alignment for this patient group can safely be done without the use of permanent tattoos and skin marks when utilizing surface-guided patient positioning. However, CBCT should still be used as final setup verification.
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Affiliation(s)
| | - Mojgan Heydari
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | | | | | - Fredrik Nordby
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Taran Paulsen Hellebust
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway; Department of Physics, University of Oslo, Norway.
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24
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Machine learning-based treatment couch parameter prediction in support of surface guided radiation therapy. Tech Innov Patient Support Radiat Oncol 2022; 23:15-20. [PMID: 36039333 PMCID: PMC9418545 DOI: 10.1016/j.tipsro.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022] Open
Abstract
Optimizing surface guided radiation therapy workflow. Machine learning-based automatic treatment couch parameters prediction. quality assurance for patient positioning.
Purpose A fully independent, machine learning-based automatic treatment couch parameters prediction was developed to support surface guided radiation therapy (SGRT)-based patient positioning protocols. Additionally, this approach also acts as a quality assurance tool for patient positioning. Materials/Methods Setup data of 183 patients, divided into four different groups based on used setup devices, was used to calculate the difference between the predicted and the acquired treatment couch value. Results Couch parameters can be predicted with high precision μ=0.90,σ=0.92. A significant difference (p < 0.01) between the variances of Lung and Brain patients was found. Outliers were not related to the prediction accuracy, but are due to inconsistencies during initial patient setup. Conclusion Couch parameters can be predicted with high accuracy and can be used as starting point for SGRT-based patient positioning. In case of large deviations (>1.5 cm), patient setup has to be verified to optimally use the surface scanning system.
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25
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Zhao H, Paxton A, Sarkar V, Price RG, Huang J, Su FCF, Li X, Rassiah P, Szegedi M, Salter B. Surface-Guided Patient Setup Versus Traditional Tattoo Markers for Radiation Therapy: Is Tattoo-Less Setup Feasible for Thorax, Abdomen and Pelvis Treatment? Cureus 2022; 14:e28644. [PMID: 36196310 PMCID: PMC9525098 DOI: 10.7759/cureus.28644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose: In this study, patient setup accuracy was compared between surface guidance and tattoo markers for radiation therapy treatment sites of the thorax, abdomen and pelvis. Methods and materials: A total of 608 setups performed on 59 patients using both surface-guided and tattoo-based patient setups were analyzed. During treatment setup, patients were aligned to room lasers using their tattoos, and then the six-degree-of-freedom (6DOF) surface-guided offsets were calculated and recorded using AlignRT system. While the patient remained in the same post-tattoo setup position, target localization imaging (radiographic or ultrasound) was performed and these image-guided shifts were recorded. Finally, surface-guided vs tattoo-based offsets were compared to the final treatment position (based on radiographic or ultrasound imaging) to evaluate the accuracy of the two setup methods. Results: The overall average offsets of tattoo-based and surface-guidance-based patient setups were comparable within 3.2 mm in three principal directions, with offsets from tattoo-based setups being slightly less. The maximum offset for tattoo setups was 2.2 cm vs. 4.3 cm for surface-guidance setups. Larger offsets (ranging from 2.0 to 4.3 cm) were observed for surface-guided setups in 14/608 setups (2.3%). For these same cases, the maximum observed tattoo-based offset was 0.7 cm. Of the cases with larger surface-guided offsets, 13/14 were for abdominal/pelvic treatment sites. Additionally, larger rotations (>3°) were recorded in 18.6% of surface-guided setups. The majority of these larger rotations were observed for abdominal and pelvic sites (~84%). Conclusions: The small average differences observed between tattoo-based and surface-guidance-based patient setups confirm the general equivalence of the two potential methods, and the feasibility of tattoo-less patient setup. However, a significant number of larger surface-guided offsets (translational and rotational) were observed, especially in the abdominal and pelvic regions. These cases should be anticipated and contingency setup methods planned for.
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26
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Song Y, Zhai X, Liang Y, Zeng C, Mueller B, Li G. Evidence-based region of interest (ROI) definition for surface-guided radiotherapy (SGRT) of abdominal cancers using deep-inspiration breath-hold (DIBH). J Appl Clin Med Phys 2022; 23:e13748. [PMID: 35946900 PMCID: PMC9680570 DOI: 10.1002/acm2.13748] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/27/2022] [Accepted: 07/20/2022] [Indexed: 01/19/2023] Open
Abstract
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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Affiliation(s)
- Yulin Song
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Xingchen Zhai
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Yubei Liang
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Chuan Zeng
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Boris Mueller
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Guang Li
- Department of Medical PhysicsMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
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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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Naidoo W, Leech M. Feasibility of surface guided radiotherapy for patient positioning in breast radiotherapy versus conventional tattoo-based setups- a systematic review. Tech Innov Patient Support Radiat Oncol 2022; 22:39-49. [PMID: 35481261 PMCID: PMC9035716 DOI: 10.1016/j.tipsro.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/07/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Background Traditionally tattoos are used for patient setup in radiotherapy. However they may pose challenges for the radiotherapists to achieve precise patient alignment, and serve as a permanent visual reminder of the patient’s diagnosis and often challenging cancer journey. The psychological impact of tattoos has been recognized in recent years. The increasing complexity of treatment techniques and the utilization of hypofractionated regimes, requires an enhanced level of accuracy and safety. Surface guided radiotherapy (SGRT) enables improvements in the accuracy and reproducibility of patient isocentric and postural alignment, enhanced efficiency, and safety in breast radiotherapy. Purpose The aim of this review was to compare the accuracy and reproducibility of SGRT to conventional tattoo-based setups in free-breathing breast radiotherapy and to determine if SGRT can reduce the frequency of routine image guided radiotherapy (IGRT). Materials and Methods A systematic literature review was performed as per PRISMA guidelines. Papers identified through PubMed, Embase, Web of Science and Google Scholar database searches between 2010 and 2021, were critically appraised. Systematic, random, mean residual errors and 3D vector shifts as determined by IGRT verification were analysed. Results A review of 13 full papers suggests SGRT improves the accuracy and reproducibility of patient setup in breast radiotherapy with consistent reductions in the residual errors. There appears to be a good correlation between SGRT setups and radiographic imaging. The frequency of IGRT and the corresponding dose could potentially be reduced. Additionally, SGRT improves treatment efficiency. Conclusion SGRT appears to have improved the accuracy and reproducibility of patient setup and treatment efficiency of breast radiotherapy compared to conventional tattoo/laser-based method, with the potential to reduce the frequency of routine IGRT. The reliance on tattoos in breast radiotherapy are likely to become obsolete with positive implications for both patients and clinical practice.
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Evaluation of the clinical implementation of a tattoo-free positioning technique in breast cancer radiotherapy using ExacTrac. Phys Med 2022; 98:81-87. [DOI: 10.1016/j.ejmp.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/28/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
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Eliminating tattoos for short course palliative radiation therapy: Set-up error, satisfaction and cost. J Med Imaging Radiat Sci 2022; 53:S56-S62. [PMID: 35523652 DOI: 10.1016/j.jmir.2022.04.004] [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: 11/05/2021] [Revised: 01/10/2022] [Accepted: 04/05/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE Palliative patients are living longer thanks to advancements in systemic therapies and radiotherapy technologies. Prior to image guided radiotherapy, permanent ink tattoos were used to ensure set up accuracy. Permanent marks can cause psychological damage, physical pain and can reduce a patient's quality of life. In recent years, image guided radiation therapy (IGRT) has become standard practice and may eliminate the need for permanent tattoos in this patient population. METHODS Twenty-five patients were consecutively chosen from the Palliative Radiation Oncology Program (PROP). Each received 5 fractions of radiotherapy commencing within 72 hours of CT simulation. In place of permanent tattoos, patients were marked with permanent marker and an adherent transparent film dressing (Tegaderm TM ) was placed over the mark. Patients were educated on maintaining the marks and dressing. Daily cone beam CT (CBCT) isocentre mismatch values were compared with 25 patients who received tattoos for radiotherapy to similar body regions. Radiation therapist concerns, cost, variations in isocentre shift values and additional imaging requirements were obtained. RESULTS Isocentre shift values were similar (p<0.05) for Tegaderm TM vs. tattoo patients in the anterior-posterior (AP) and right-left (RL) directions. The mean shift value in the superior-inferior (SI) direction was larger for Tegaderm TM than for tattoos (p=0.01), however the magnitude was only 2 mm, which is clinically insignificant as these shifts were prior to IGRT guided correction. No patient required a repeat CBCT or a resimulation. The cost of the Tegaderm TM dressing was substantially less than the tattoo group. Radiation Therapists' satifaction with Tegaderm TM was overall high, however some expressed concerns with their durability and longevity. CONCLUSIONS We found that the use of Tegaderm TM dressing did not result in increased set-up time, mismatch error or additional imaging procedures (CBCT or CTsimulation) and moreover cost substantially less than permanent ink tattoos.
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Asada H, Takahashi Y, Ono Y, Kishi N, Matsuo Y, Mizowaki T, Nakayama T. Emotional Experiences of Skin Markings Among Patients Undergoing Radiotherapy and Related Factors: A Questionnaire-Based Cross-Sectional Study. Patient Prefer Adherence 2022; 16:1359-1369. [PMID: 35651663 PMCID: PMC9150759 DOI: 10.2147/ppa.s361916] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/13/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Patients undergoing radiotherapy often have their skin marked. Previous studies on skin markings examined the durability and physical effects of the markings, but no study has focused on patients' emotional experiences toward the markings. This study aimed to clarify how patients undergoing radiotherapy feel about skin markings, as well as factors that affect patients' emotional experiences. PATIENTS AND METHODS We conducted a cross-sectional study using a self-administered questionnaire and medical records. Participants were patients aged ≥20 years undergoing cancer radiotherapy at a designated cancer care hospital. The primary outcome was the level of uncomfortable emotions toward skin markings, and the secondary outcome was the level of favorable ratings on skin markings. To examine factors related to uncomfortable emotions, ordinal logistic regression analysis was performed. RESULTS Questionnaire forms were distributed to 153 patients, and responses were collected from 132 (86%). Among 108 patients included in the analysis, 56% (59/105, excluding 3 who did not answer this question) responded that they were uncomfortable with skin markings. The proportion of patients who favorably rated skin markings was 63% (59/93, excluding 15 who did not answer this question). No factors were significantly associated with the primary outcome. CONCLUSION Many patients accepted skin markings with resignation, as they understood the necessity of the markings in their treatment. Medical staff should understand the emotional experiences of patients toward skin markings and take sufficient care to ensure that they are provided with explanations, including the impact of skin markings on their daily lives, as well as a sense of security that treatment is being performed in a precise manner.
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Affiliation(s)
- Hiromi Asada
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, 606-8501, Japan
- Correspondence: Hiromi Asada, Department of Health Informatics, Kyoto University School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan, Tel/Fax +81-75-753-9479, Email
| | - Yoshimitsu Takahashi
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, 606-8501, Japan
| | - Yuka Ono
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriko Kishi
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinori Matsuo
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, 606-8501, Japan
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Lim LH, Pang EPP, Sultana R, Kusumawidjaja G, Wong RX, Yeo RMC, Ho BS, Ng WL, Lim FLWT, Chua ET, Sim AYF, Wong FY. A Prospective Randomized Controlled Trial to Compare the Use of Conventional Dark-Ink Tattoo and Ultraviolet-Ink Tattoo for Patients Undergoing Breast Radiation Therapy. Pract Radiat Oncol 2021; 11:463-469. [PMID: 34411756 DOI: 10.1016/j.prro.2021.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Permanent tattoo marks used in radiation therapy remain for the duration of treatment and essentially for the rest of the patient's life. This study compared the initial positioning setup errors and body image perception between patients with ultraviolet (UV) and conventional dark ink tattoos. METHODS AND MATERIALS Thirty-four patients from February 2018 to March 2019, who underwent radiation therapy (RT) to the breast or chest wall for ductal carcinoma in situ or breast cancer were prospectively recruited and randomized (1:1) to receive either conventional dark ink or UV ink tattoos. Each patient received the assigned tattoos during computed tomography (CT) simulation and initial treatment setup shifts were compared. A 9-item body-image survey was administered to all patients at 3 time points: CT simulation, last week of RT, and 6 weeks post-RT. Feedback from CT and treatment staff in terms of setup time and challenges were collated. RESULTS The median age of the patient cohort was 46 years old. No statistically significant difference was observed between the mean setup errors for the conventional dark ink group (0.11 cm inferior, 0.01 cm left, 0.11 cm posterior) and UV ink group (0.01 cm superior, 0.01 cm right, 0.06 cm posterior; P = NS). Similar responses were observed in the body-image survey between the 2 groups across all time points (P = NS). The majority of the patients (dark ink 82.3% vs UV ink 88.2%) did not feel less sexually attractive as a result of the tattoo at 6 weeks post-RT. At 6 weeks post-RT, patients in both groups were satisfied with the appearance of the tattoo and did not feel cautious about their choice of clothes (82.4% vs 88.2%; P = NS). In addition, 88.6% of staff (n = 35) felt minimum effect of UV ink on the overall setup time, and 94.3% found no difficulty localizing the UV ink tattoos during patient positioning. CONCLUSIONS No difference in setup accuracy was found using UV ink tattoos, and it could be implemented clinically with minimal effect on the existing workflow. Patients expressed high satisfaction and self-confidence with the use of UV ink tattoos.
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Affiliation(s)
- Li Hoon Lim
- Division of Radiation Oncology, National Cancer Centre Singapore, Hospital Crescent, Singapore.
| | - Eric Pei Ping Pang
- Division of Radiation Oncology, National Cancer Centre Singapore, Hospital Crescent, Singapore
| | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Grace Kusumawidjaja
- Division of Radiation Oncology, National Cancer Centre Singapore, Hospital Crescent, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Ru Xin Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Hospital Crescent, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Richard Ming Chert Yeo
- Division of Radiation Oncology, National Cancer Centre Singapore, Hospital Crescent, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Bryan Shihan Ho
- Division of Radiation Oncology, National Cancer Centre Singapore, Hospital Crescent, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Wee Loon Ng
- Division of Radiation Oncology, National Cancer Centre Singapore, Hospital Crescent, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Faye Lynette Wei Tching Lim
- Division of Radiation Oncology, National Cancer Centre Singapore, Hospital Crescent, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Eu Tiong Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Hospital Crescent, Singapore; Duke-NUS Graduate Medical School, Singapore
| | - Avelyn Yun Fang Sim
- Division of Radiation Oncology, National Cancer Centre Singapore, Hospital Crescent, Singapore
| | - Fuh Yong Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Hospital Crescent, Singapore; Duke-NUS Graduate Medical School, Singapore
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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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Lee SK, Huang S, Zhang L, Ballangrud AM, Aristophanous M, Cervino Arriba LI, Li G. Accuracy of surface-guided patient setup for conventional radiotherapy of brain and nasopharynx cancer. J Appl Clin Med Phys 2021; 22:48-57. [PMID: 33792186 PMCID: PMC8130230 DOI: 10.1002/acm2.13241] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/16/2021] [Accepted: 03/14/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the accuracy of surface‐guided radiotherapy (SGRT) in cranial patient setup by direct comparison between optical surface imaging (OSI) and cone‐beam computed tomography (CBCT), before applying SGRT‐only setup for conventional radiotherapy of brain and nasopharynx cancer. Methods and Materials Using CBCT as reference, SGRT setup accuracy was examined based on 269 patients (415 treatments) treated with frameless cranial stereotactic radiosurgery (SRS) during 2018‐2019. Patients were immobilized in customized head molds and open‐face masks and monitored using OSI during treatment. The facial skin area in planning CT was used as OSI region of interest (ROI) for automatic surface alignment and the skull was used as the landmark for automatic CBCT/CT registration. A 6 degrees of freedom (6DOF) couch was used. Immediately after CBCT setup, an OSI verification image was captured, recording the SGRT setup differences. These differences were analyzed in 6DOFs and as a function of isocenter positions away from the anterior surface to assess OSI‐ROI bias. The SGRT in‐room setup time was estimated and compared with CBCT and orthogonal 2D kilovoltage (2DkV) setups. Results The SGRT setup difference (magnitude) is found to be 1.0 ± 2.5 mm and 0.1˚±1.4˚ on average among 415 treatments and within 5 mm/3˚ with greater than 95% confidence level (P < 0.001). Outliers were observed for very‐posterior isocenters: 15 differences (3.6%) are >5.0mm and 9 (2.2%) are >3.0˚. The setup differences show minor correlations (|r| < 0.45) between translational and rotational DOFs and a minor increasing trend (<1.0 mm) in the anterior‐to‐posterior direction. The SGRT setup time is 0.8 ± 0.3 min, much shorter than CBCT (5 ± 2 min) and 2DkV (2 ± 1 min) setups. Conclusion This study demonstrates that SGRT has sufficient accuracy for fast in‐room patient setup and allows real‐time motion monitoring for beam holding during treatment, potentially useful to guide radiotherapy of brain and nasopharynx cancer with standard fractionation.
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Affiliation(s)
- Sang Kyu Lee
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sheng Huang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lei Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ase M Ballangrud
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Michalis Aristophanous
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Laura I Cervino Arriba
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Guang Li
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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