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Kügele M, Mannerberg A, Nørring Bekke S, Alkner S, Berg L, Mahmood F, Thornberg C, Edvardsson A, Bäck SÅJ, Behrens CF, Ceberg S. Surface guided radiotherapy (SGRT) improves breast cancer patient setup accuracy. J Appl Clin Med Phys 2019; 20:61-68. [PMID: 31478615 PMCID: PMC6753725 DOI: 10.1002/acm2.12700] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/13/2019] [Accepted: 07/26/2019] [Indexed: 11/11/2022] Open
Abstract
PURPOSE The purpose of the study was to investigate if surface guided radiotherapy (SGRT) can decrease setup deviations for tangential and locoregional breast cancer patients compared to conventional laser-based setup (LBS). MATERIALS AND METHODS Both tangential (63 patients) and locoregional (76 patients) breast cancer patients were enrolled in this study. For LBS, the patients were positioned by aligning skin markers to the room lasers. For the surface based setup (SBS), an optical surface scanning system was used for daily setup using both single and three camera systems. To compare the two setup methods, the patient position was evaluated using verification imaging (field images or orthogonal images). RESULTS For both tangential and locoregional treatments, SBS decreased the setup deviation significantly compared to LBS (P < 0.01). For patients receiving tangential treatment, 95% of the treatment sessions were within the clinical tolerance of ≤ 4 mm in any direction (lateral, longitudinal or vertical) using SBS, compared to 84% for LBS. Corresponding values for patients receiving locoregional treatment were 70% and 54% for SBS and LBS, respectively. No significant difference was observed comparing the setup result using a single camera system or a three camera system. CONCLUSIONS Conventional laser-based setup can with advantage be replaced by surface based setup. Daily SGRT improves patient setup without additional imaging dose to breast cancer patients regardless if a single or three camera system was used.
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Affiliation(s)
- Malin Kügele
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Annika Mannerberg
- Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Susanne Nørring Bekke
- Radiotherapy Research Unit, Department of Oncology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sara Alkner
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - Lovisa Berg
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Faisal Mahmood
- Department of Oncology, Odense University Hospital, Odense C, Denmark
| | - Charlotte Thornberg
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Anneli Edvardsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sven Å J Bäck
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Claus F Behrens
- Radiotherapy Research Unit, Department of Oncology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Sofie Ceberg
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of Clinical Sciences, Lund University, Lund, Sweden
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Haraldsson A, Engleson J, Bäck SÅJ, Engelholm S, Engström PE. A Helical tomotherapy as a robust low-dose treatment alternative for total skin irradiation. J Appl Clin Med Phys 2019; 20:44-54. [PMID: 31033159 PMCID: PMC6522990 DOI: 10.1002/acm2.12579] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 11/06/2022] Open
Abstract
Mycosis fungoides is a disease with manifestation of the skin that has traditionally been treated with electron therapy. In this paper, we present a method of treating the entire skin with megavoltage photons using helical tomotherapy (HT), verified through a phantom study and clinical dosimetric data from our first two treated patients. A whole body phantom was fitted with a wetsuit as bolus, and scanned with computer tomography. We accounted for variations in daily setup using virtual bolus in the treatment plan optimization. Positioning robustness was tested by moving the phantom, and recalculating the dose at different positions. Patient treatments were verified with in vivo film dosimetry and dose reconstruction from daily imaging. Reconstruction of the actual delivered dose to the patients showed similar target dose as the robustness test of the phantom shifted 10 mm in all directions, indicating an appropriate approximation of the anticipated setup variation. In vivo film measurements agreed well with the calculated dose confirming the choice of both virtual and physical bolus parameters. Despite the complexity of the treatment, HT was shown to be a robust and feasible technique for total skin irradiation. We believe that this technique can provide a viable option for Tomotherapy centers without electron beam capability.
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Affiliation(s)
- André Haraldsson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of clinical sciences, Lund University, Lund, Sweden
| | - Jens Engleson
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Sven Å J Bäck
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden.,Medical Radiation Physics, Department of clinical sciences, Lund University, Lund, Sweden
| | - Silke Engelholm
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Per E Engström
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
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Jönsson M, Ceberg S, Nordström F, Thornberg C, Bäck SÅJ. Technical evaluation of a laser-based optical surface scanning system for prospective and retrospective breathing adapted computed tomography. Acta Oncol 2015; 54:261-5. [PMID: 25383452 DOI: 10.3109/0284186x.2014.948059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND For breathing adapted radiotherapy, the same motion monitoring system can be used for imaging and triggering of the accelerator. PURPOSE To evaluate a new technique for prospective gated computed tomography (CT) and four-dimensional CT (4DCT) using a laser based surface scanning system (Sentinel(™), C-RAD, Uppsala, Sweden). The system was compared to the AZ-733V respiratory gating system (Anzai Medical, Tokyo, Japan) and the Real-Time Position Management System (RPM(™)) (Varian Medical Systems, Palo Alto, CA, USA). MATERIAL AND METHODS Temporal accuracy was evaluated using a moving phantom programmed to move a platform along trajectories following a sin(6)(ωt) function with amplitudes from 6 to 20 mm and periods from 2 to 5 s during 120 s while the motion was recorded. The recorded data was Fourier transformed and the peak area at the fundamental and harmonic frequencies compared to data generated using the same sinusoidal function. For verification of the 4DCT reconstruction process, the phantom was programmed to move along a sinusoidal trajectory. Ten phase series were reconstructed. The distance from the couch to the platform was measured in each image. By fitting the function sin(ωt-ϕ) to the values measured in the images corresponding to each slice, the phase of each image was verified. RESULTS AND CONCLUSION In the recorded data, the peak area at the fundamental frequency covered on average 104 ± 4%, 102 ± 4% and 91 ± 27% of the peak area in the generated data for the Sentinel(™), RPM(™) and AZ-733V systems, respectively. All systems managed to resolve both harmonic frequencies. The second experiment showed that all images were sorted into the correct series using breathing data recorded by each system. The systems generated very similar results, however, it is preferable to use the same system both for imaging and treatment.
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Affiliation(s)
- Mattias Jönsson
- Department of Medical Radiation Physics, Department of Clinical Sciences Malmö, Lund University , Malmö , Sweden
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Svensson H, Skyt PS, Ceberg S, Doran S, Muren LP, Balling P, Petersen JBB, Bäck SÅJ. Feasibility study using MRI and two optical CT scanners for readout of polymer gel and PresageTM. ACTA ACUST UNITED AC 2013. [DOI: 10.1088/1742-6596/444/1/012079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Gel dosimetry measures the absorbed radiation dose with high spatial resolution in 3D. However, recently published data show that the response of metacrylic-based polymer gels depends on the segmented delivery pattern, which could potentially be a considerable disadvantage for measurements of modern dynamic radiotherapy techniques. The aim of this study is to design a dynamic compartment model for the response of a gel dosimeter, exposed to an arbitrary irradiation pattern (segmented delivery and intensity modulation), in order to evaluate the associated effects on absorbed dose measurements. The model is based on the separation of the protons affecting the magnetic resonance signal (i.e. the R2 value) into six compartments, described by a set of differential equations. The model is used to calculate R2 values for a number of different segmented delivery patterns between 0-4 Gy over 1-33 fractions. Very good agreement is found between calculated and measured R2 values, with an average difference of 0.3 ± 1.1% (1 SD). The model is also used to predict the behaviour of a gel dosimeter exposed to irradiation according to typical IMRT, VMAT and respiratory gating scenarios. The calculated R2 values are approximately independent of the segmented delivery, given that the same total dose is delivered during the same total time. It is concluded that this study helps to improve the theoretical understanding of the dependence of metacrylic-based polymer gel response to segmented radiation delivery.
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Affiliation(s)
- Sofie Ceberg
- Department of Medical Radiation Physics, Lund University, Lund, Sweden.
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Ceberg S, Karlsson A, Gustavsson H, Wittgren L, Bäck SÅJ. Verification of dynamic radiotherapy: the potential for 3D dosimetry under respiratory-like motion using polymer gel. Phys Med Biol 2008; 53:N387-96. [DOI: 10.1088/0031-9155/53/20/n02] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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