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Miyasaka Y, ono T, Chai H, Souda H, Lee SH, Ishizawa M, Akamatsu H, Sato H, Iwai T. A robust treatment planning approach for chest motion in postmastectomy chest wall intensity modulated radiation therapy. J Appl Clin Med Phys 2024; 25:e14217. [PMID: 38018758 PMCID: PMC10795451 DOI: 10.1002/acm2.14217] [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: 06/09/2023] [Revised: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSE Chest wall postmastectomy radiation therapy (PMRT) should consider the effects of chest wall respiratory motion. The purpose of this study is to evaluate the effectiveness of robustness planning intensity modulated radiation therapy (IMRT) for respiratory movement, considering respiratory motion as a setup error. MATERIAL AND METHODS This study analyzed 20 patients who underwent PMRT (10 left and 10 right chest walls). The following three treatment plans were created for each case and compared. The treatment plans are a planning target volume (PTV) plan (PP) that covers the PTV within the body contour with the prescribed dose, a virtual bolus plan (VP) that sets a virtual bolus in contact with the body surface and prescribing the dose that includes the PTV outside the body contour, and a robust plan (RP) that considers respiratory movement as a setup uncertainty and performs robust optimization. The isocenter was shifted to reproduce the chest wall motion pattern and the doses were recalculated for comparison for each treatment plan. RESULT No significant difference was found between the PP and the RP in terms of the tumor dose in the treatment plan. In contrast, VP had 3.5% higher PTV Dmax and 5.5% lower PTV V95% than RP (p < 0.001). The RP demonstrated significantly higher lung V20Gy and Dmean by 1.4% and 0.4 Gy, respectively, than the PP. The RP showed smaller changes in dose distribution affected by chest wall motion and significantly higher tumor dose coverage than the PP and VP. CONCLUSION We revealed that the RP demonstrated comparable tumor doses to the PP in treatment planning and was robust for respiratory motion compared to both the PP and the VP. However, the organ at risk dose in the RP was slightly higher; therefore, its clinical use should be carefully considered.
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Affiliation(s)
- Yuya Miyasaka
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Takuya ono
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Hongbo Chai
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Hikaru Souda
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Sung Hyun Lee
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Miyu Ishizawa
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
| | - Hiroko Akamatsu
- Department of RadiologyYamagata University Faculty of MedicineYamagataJapan
| | - Hiraku Sato
- Department of RadiologyYamagata University Faculty of MedicineYamagataJapan
| | - Takeo Iwai
- Department of Heavy Particle Medical ScienceYamagata University Graduate School of Medical ScienceYamagataJapan
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Wang L, Li T, Cai J, Chang HC. Motion-resolved four-dimensional abdominal diffusion-weighted imaging using PROPELLER EPI (4D-DW-PROPELLER-EPI). Magn Reson Med 2023; 90:2454-2471. [PMID: 37486854 DOI: 10.1002/mrm.29802] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE To develop a distortion-free motion-resolved four-dimensional diffusion-weighted PROPELLER EPI (4D-DW-PROPELLER-EPI) technique for benefiting clinical abdominal radiotherapy (RT). METHODS An improved abdominal 4D-DWI technique based on 2D diffusion-weighted PROPELLER-EPI (2D-DW-PROPELLER-EPI), termed 4D-DW-PROPELLER-EPI, was proposed to improve the frame rate of repeated data acquisition and produce distortion-free 4D-DWI images. Since the radial or PROPELLER sampling with golden-angle rotation can achieve an efficient k-space coverage with a flexible time-resolved acquisition, the golden-angle multi-blade acquisition was used in the proposed 4D-DW-PROPELLER-EPI to improve the performance of data sorting. A new k-space and blade (K-B) amplitude binning method was developed for the proposed 4D-DW-PROPELLER-EPI to optimize the number of blades and the k-space uniformity before performing conventional PROPELLER-EPI reconstruction, by using two metrics to evaluate the adequacy of the acquired data. The proposed 4D-DW-PROPELLER-EPI was preliminarily evaluated in both simulation experiments and in vivo experiments with varying frame rates and different numbers of repeated acquisition. RESULTS The feasibility of achieving distortion-free 4D-DWI images by using the proposed 4D-DW-PROPELLER-EPI technique was demonstrated in both digital phantom and healthy subjects. Evaluation of the 4D completeness metrics shows that the K-B amplitude binning method could simultaneously improve the acquisition efficiency and data reconstruction performance for 4D-DW-PROPELLER-EPI. CONCLUSION 4D-DW-PROPELLER-EPI with K-B amplitude binning is an advanced technique that can provide distortion-free 4D-DWI images for resolving respiratory motion, and may benefit the application of image-guided abdominal RT.
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Affiliation(s)
- Lu Wang
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
- Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tian Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Jing Cai
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Hing-Chiu Chang
- Department of Biomedical Engineering, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Multi-Scale Medical Robotics Center, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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Nobnop W, Lertananpipat N, Watcharawipha A, Kongsa A, Tippanya D, Thongsuk W, Chitapanarux I. Impact of Respiratory Motion on the Skin Dose for Breast Cancer in Tomotherapy: A Study in the In-house Moving Phantom. Technol Cancer Res Treat 2023; 22:15330338231197520. [PMID: 37774753 PMCID: PMC10561551 DOI: 10.1177/15330338231197520] [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: 04/30/2023] [Revised: 07/27/2023] [Accepted: 08/08/2023] [Indexed: 10/01/2023] Open
Abstract
Purpose: The dose expansion methods as the skin flash and virtual bolus were used to solve intrafraction movement for breast planning due to breathing motion. We investigated the skin dose in each planning method by using optically stimulated luminescence on an in-house moving phantom for breast cancer treatment in tomotherapy. The impact of respiratory motion on skin dose between static and dynamic phantom's conditions was evaluated. Methods: A phantom was developed with movement controlled by the respirator for generating the respiratory waveforms to simulate respiratory motion. Five optically stimulated luminescence dosimeters were placed on the phantom surface to investigate the skin dose for the TomoDirect and TomoHelical under static and dynamic conditions. Eight treatment plans were generated with and without skin flash or virtual bolus by varying the thickness. The difference in skin dose between the two phantom conditions for each plan was explored. Results: All plans demonstrated a skin dose of more than 87% of the prescription dose under static conditions. However, the skin dose was reduced to 84.1% (TomoDirect) and 78.9% (TomoHelical) for dynamic conditions. The treatment plans without skin flash or virtual bolus showed significant skin dose differences under static and dynamic conditions by 4.83% (TomoDirect) and 9.43% (TomoHelical), whereas the skin flash with two leaves (TomoDirect 2L) or virtual bolus of at least 1.0 cm thickness (VB1.0) application compensated the skin dose in case of intrafraction movements by presenting a skin dose difference of less than 2% between the static and dynamic conditions. Conclusion: The skin dose was reduced under dynamic conditions due to breathing motion. The skin flash method with TomoDirect 2L or virtual bolus application with 1.0 cm thickness was useful for maintaining skin dose following the prescription by compensating for intrafraction movement due to respiratory motion for breast cancer in tomotherapy.
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Affiliation(s)
- Wannapha Nobnop
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nattaphol Lertananpipat
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anirut Watcharawipha
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anupong Kongsa
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Damrongsak Tippanya
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Warit Thongsuk
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Imjai Chitapanarux
- Division of Radiation Oncology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Dose verification of virtual bolus application for helical tomotherapy. Med Dosim 2022; 48:16-19. [PMID: 36307296 DOI: 10.1016/j.meddos.2022.09.002] [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: 07/27/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 11/06/2022]
Abstract
The objective of the study is to verify the dose delivered on helical tomotherapy based on treatment plan with varying virtual bolus (VB) thickness. The target was localized on the ArcCHECK image by 3 mm margin from the phantom surface. The dimension of target, which includes the ArcCHECK's detectors, with the 4.0 cm width and length 12.0 cm along the phantom The 5 treatment plans were generated, 1 plan without VB application (NoVB) and the 4 plans with varying of VB thickness on the phantom surface by 0.5 cm (VB0.5), 1.0 cm (VB1.0), 1.5 cm (VB1.5), and 2.0 cm (VB2.0), in treatment planning but absent during irradiation. For measurement analysis, the ionization chamber and the ArcCHECK detectors were used for point dose and dose distribution by investigating the percentage of dose difference and the gamma passing rate. The VB thickness 0.5, 1.0 and 1.5 cm showed acceptable value with less than 2% for dose difference by 0.37% (VB0.5), -0.11% (VB1.0) and -0.37% (VB1.5) at the center of ArcCHECK. The accuracy of dose distribution showed an acceptable gamma passing rate of 99.8% (VB0.5), 100% (VB1.0), and 90.2% (VB1.5) for gamma criteria by 3%/3mm for absolute dose analysis. However, the gamma passing rate of VB2.0 down to 71.2% of absolute mode for gamma criteria by 3%/3mm. The treatment plans with VB thickness less than 15 mm deliver doses that are comparable to treatment plans without virtual bolus based on gamma analysis. However, the deviation showed a trend increasing when VB thickness increased. The VB2.0 was not acceptable for point dose and dose distribution verification by more than 2% dose difference and less than 90% of gamma passing rate.
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Zang C, Zhang C, Zhang M, Niu Q. An RFID-Based Method for Multi-Person Respiratory Monitoring. SENSORS (BASEL, SWITZERLAND) 2022; 22:6166. [PMID: 36015926 PMCID: PMC9416178 DOI: 10.3390/s22166166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 06/15/2023]
Abstract
Respiratory monitoring is widely used in the field of health care. Traditional respiratory monitoring methods bring much inconvenience to users. In recent years, a great number of respiratory monitoring methods based on wireless technology have emerged, but multi-person respiratory monitoring is still very challenging; therefore, this paper explores multi-person respiratory monitoring. Firstly, the characteristics of human respiratory movement have been analyzed, and a suitable tag deployment method for respiratory monitoring is proposed. Secondly, aiming at the ambiguity and entanglement of radio frequency identification (RFID) phase data, a method of removal of phase ambiguity and phase wrapping is given. Then, in order to monitor multi-person respiration in a noisy environment, the frequency extraction method and waveform reconstruction method of multi-person respiration are proposed. Finally, the feasibility of the method is verified by experiments.
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Affiliation(s)
- Chaowei Zang
- School of Computer Science and Technology, China University of Mining and Technology, Xuzhou 221116, China
- China Pingmei Shenma Group, Pingdingshan 467000, China
| | - Chi Zhang
- School of Computer Science and Technology, China University of Mining and Technology, Xuzhou 221116, China
| | - Min Zhang
- School of Computer Science and Technology, China University of Mining and Technology, Xuzhou 221116, China
| | - Qiang Niu
- School of Computer Science and Technology, China University of Mining and Technology, Xuzhou 221116, China
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Jeon H, Ki Y, Kim DW, Kim W, Nam J, Kim D, Park D, Park J, Joo JH. Influence of respiratory movement during post mastectomy radiotherapy on targets and heart for breast cancer. Asia Pac J Clin Oncol 2022; 19:e54-e59. [PMID: 35652574 DOI: 10.1111/ajco.13773] [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: 05/27/2021] [Revised: 05/27/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIM This study aimed to compare the dosimetric consequences of respiratory movement in volumetric-modulated arc therapy (VMAT) and three-dimensional conformal radiation therapy (3D-CRT) during postmastectomy radiation therapy, including internal mammary nodes (IMNs). MATERIALS AND METHODS Respiratory motion was implemented to a phantom using a dynamic device. The plans were delivered during cranial-caudal and ventral-dorsal movement in 5-mm (R05) and 10-mm (R10) amplitudes. RESULTS At the IMN, the dose errors were -2.8% (R05) and -6.2% (R10) for 3D-CRT and -4.9% (R05) and -8.5% (R10) for VMAT. The dose errors in chest wall were -.5% (R05) and -6.0% (R10) for 3D-CRT and -1.9% (R05) and -5.3% (R10) for VMAT. The left anterior descending doses showed significantly small absolute values. The gamma pass rates of VMAT were higher than those of 3D-CRT. CONCLUSIONS The benefit of VMAT technique in dose distribution was maintained, except in occasional instances of large breathing motion.
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Affiliation(s)
- Hosang Jeon
- Department of Radiation Oncology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yongkan Ki
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, South Korea.,Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Dong Woon Kim
- Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Wontaek Kim
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, South Korea.,Department of Radiation Oncology, Pusan National University Hospital, Busan, South Korea
| | - Jiho Nam
- Department of Radiation Oncology, Pusan National University Hospital, Busan, South Korea
| | - Donghyun Kim
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, South Korea.,Department of Radiation Oncology, Pusan National University Hospital, Busan, South Korea
| | - Dahl Park
- Department of Radiation Oncology, Pusan National University Hospital, Busan, South Korea
| | - Jongmoo Park
- Department of Radiation Oncology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Ji Hyeon Joo
- Department of Radiation Oncology, Pusan National University School of Medicine, Yangsan, South Korea.,Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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Habatsch M, Schneider M, Requardt M, Doussin S. Movement assessment of breast and organ-at-risks using free-breathing, self-gating 4D magnetic resonance imaging workflow for breast cancer radiation therapy. Phys Imaging Radiat Oncol 2022; 22:111-114. [PMID: 35619641 PMCID: PMC9127201 DOI: 10.1016/j.phro.2022.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022] Open
Abstract
Motion management is essential in treatment planning of radiotherapy for breast cancer. This study assessed the movement of organs-at-risk and the breast using 4D magnetic resonance imaging (MRI). A self-gating respiration-resolved radial 3D gradient echo sequence was used. Five healthy volunteers were imaged at 1.5 T during free-breathing in supine position making use of a breast board. Median distances between heart and chest wall in axial views were 2.4 cm (range: 1.5 cm) and 3.0 cm (range: 1.7 cm) for end-of-exhale and end-of-inhale. 4D-MRI allowed organ delineation and might be a promising addition to novel RT planning for breast cancer patients.
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Cheyne-Stokes Respiration Perception via Machine Learning Algorithms. ELECTRONICS 2022. [DOI: 10.3390/electronics11060958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
With the development of science and technology, transparent, non-invasive general computing is gradually applied to disease diagnosis and medical detection. Universal software radio peripherals (USRP) enable non-contact awareness based on radio frequency signals. Cheyne-Stokes respiration has been reported as a common symptom in patients with heart failure. Compared with the disadvantages of traditional detection equipment, a microwave sensing method based on channel state information (CSI) is proposed to qualitatively detect the normal breathing and Cheyne-Stokes breathing of patients with heart failure in a non-contact manner. Firstly, USRP is used to collect subjects’ respiratory signals in real time. Then the CSI waveform is filtered, smoothed and normalized, and the relevant features are defined and extracted from the signal. Finally, the machine learning classification algorithm is used to establish a recognition model to detect the Cheyne-Stokes respiration of patients with heart failure. The results show that the system accuracy of support vector machine (SVM) is 97%, which can assist medical workers to identify Cheyne-Stokes respiration symptoms of patients with heart failure.
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Dou C, Huan H. Full Respiration Rate Monitoring Exploiting Doppler Information with Commodity Wi-Fi Devices. SENSORS 2021; 21:s21103505. [PMID: 34069847 PMCID: PMC8157398 DOI: 10.3390/s21103505] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/10/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022]
Abstract
Respiration rate is an essential indicator of vital signs, which can demonstrate the physiological condition of the human body and provide clues to some diseases. Commercial Wi-Fi devices can provide a non-invasive, cost-effective and long-term respiration rate-monitoring scheme for home scenarios. However, previous studies show that the breathing depth and location may affect the detectability of respiratory signals. In this study, we leverage the variation of the Doppler spectral energy extracted from the channel state information (CSI) collected by Wi-Fi devices to track the chest displacement induced by respiration. First, the random phase is eliminated by phase-fitting method to obtain the complex CSI containing the Doppler shift. Then, the multipath decomposition of CSI is carried out to obtain the channel impulse response, which eliminates the interference phase of the time delay and retains the Doppler shift. The dynamic path units are also separate from the multipath, which overcomes the indoor multipath effect. Finally, we conduct a time–frequency analysis to dynamic units to accumulate Doppler spectral energy. Based on these ideas, we design a complete respiration rate-monitoring system to obtain the respiration rate by using the consistency between the Doppler energy change period and the respiratory cycle. We evaluate our system through extensive experiments in several typical home environments filled with multipath. Experimental results show that the errors of the three scenarios are approximate, the maximum error is less than 0.7 bpm, and the average errors are approximately 0.15 bpm. This result indicates that our scheme can achieve high precision respiration monitoring and has good anti-multipath ability compared with existing methods.
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Abubakar A, Zin HM. Characterisation of Time-of-Flight (ToF) imaging system for application in monitoring deep inspiration breath-hold radiotherapy (DIBH-RT). Biomed Phys Eng Express 2020; 6. [DOI: 10.1088/2057-1976/abc635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/30/2020] [Indexed: 12/24/2022]
Abstract
Abstract
The purpose of this study is to develop a method for characterisation of time-of-flight (ToF) imaging system for application in deep inspiration breath-hold radiotherapy (DIBH-RT). The performance of an Argos 3D P330 ToF camera (Bluetechnix, Austria) was studied for patient surface monitoring during DIBH-RT using a phantom to simulate the intra-patient and inter-patient stability of the camera. Patient setup error was also simulated by positioning the phantom at predefined shift positions (2, 5 and 10 mm) from the isocentre. The localisation accuracy of the phantom was measured using ToF imaging system and repeated using CBCT imaging alone (CBCT) and simultaneously using ToF imaging during CBCT imaging (ToF-CBCT). The mean and SD of the setup errors obtained from each of the imaging methods were calculated. Student t-test was used to compare the mean setup errors. Correlation and Bland-Altman analysis were also performed. The intra-and inter-patient stability of the camera were within 0.31 mm and 0.74 mm, respectively. The localisation accuracy in terms of the mean ±SD of the measured setup errors were 0.34 ± 0.98 mm, 0.12 ± 0.34 mm, and −0.24 ± 1.42 mm for ToF, CBCT and ToF-CBCT imaging, respectively. A strong correlation was seen between the phantom position and the measured position using ToF (r = 0.96), CBCT (r = 0.99) as well as ToF-CBCT (r = 0.92) imaging. The limits of agreement from Bland Altman analysis between the phantom position and ToF, CBCT and ToF-CBCT measured positions were −1.52, 2.31 mm, −0.55, 0.78 mm; and −3.03, 2.55 mm, respectively. The sensor shows good stability and high accuracy comparable to similar sensors in the market. The method developed is useful for characterisation of an optical surface imaging system for application in monitoring DIBH-RT.
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Torres MA, Horst KC, Freedman GM. Postmastectomy and Regional Nodal Radiation for Breast Cancer. J Clin Oncol 2020; 38:2299-2309. [PMID: 32442076 DOI: 10.1200/jco.19.02908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mylin A Torres
- Department of Radiation Oncology, Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Kathleen C Horst
- Department of Radiation Oncology, Stanford Cancer Institute, Stanford University, Stanford, CA
| | - Gary M Freedman
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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