Effect of Immobilization and Performance Status on Intrafraction Motion for Stereotactic Lung Radiotherapy: Analysis of 133 Patients

Li, Winnie; Purdie, Thomas G.; Taremi, Mojgan; Fung, Sharon; Brade, Anthony; Cho, B. C.John; Hope, Andrew; Sun, Alexander; Jaffray, David A.; Bezjak, Andrea; Bissonnette, Jean Pierre

doi:10.1016/j.ijrobp.2010.09.035

Cited by 85 publications

(93 citation statements)

References 23 publications

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“…These differences could have been influenced by the online shifts performed by the RT matching the images online, highlighting some minor differences between treating staff and the five trained image reviewers. There is no statistical difference between the three devices, which correlates with the results from other studies, having mean intra‐fraction differences of less than 1 mm for bony anatomy matching and 3 mm for tumour matching 4, 5, 16, 17, 19…”

Section: Discussionsupporting

confidence: 88%

“…Although not statistically significant, small differences in the range of motion and stability of a device might be clinically important when treating with tighter margins and hypo‐fractionated treatment. The BodyFIX with wrap had large inter‐fraction variations in the superior‐to‐inferior direction (see Table 2), which the literature agrees with this worsening during treatment 4. The BodyFIX without wrap had the smallest range of movement and overall maintains the patient position to millimetre accuracy which is a requirement for SBRT 16, 20, 21…”

Section: Discussionmentioning

confidence: 53%

“…Patient immobilisation is important for conventionally fractionated radiotherapy and stereotactic body radiotherapy (SBRT) 1, 2, 3, 4, 5, 6. The risk of a geographical miss or positioning error for hypo‐fractionated techniques can be greater than with conventional fractionation 1, 7, 8, 9, 10, 11, 12, 13.…”

Section: Introductionmentioning

confidence: 99%

“…The results showed a decrease in motion in all three directions when applying vacuum pressure using the BodyFIX system, reducing tumour motion in the superior‐to‐inferior direction from 6.1 mm with free breathing to 5.3 mm with the vacuum pressure. Winnie et al4 investigated the effect of performance status and immobilisation on intra‐fraction motion and treatment time, finding that the evacuated cushion with abdominal compression was the most consistent, with 73% mid‐treatment and 68% post‐treatment still being within a 3 mm tolerance, whereas the chest board alone had only 58% mid‐treatment and 46% post‐treatment. The evacuated cushion with abdominal compression had the longest treatment time of 32.54 ± 8.07 min.…”

Section: Introductionmentioning

confidence: 99%

“…The evacuated cushion with abdominal compression had the longest treatment time of 32.54 ± 8.07 min. The authors did not state how this time was achieved, however, for an SBRT patient this difference is small, but when using conventional fractionation, additional time could reduce efficiency when treating a longer course and may influence the decision to use the device or not 4. Siva et al16 compared the BodyFIX system versus no BodyFIX system on the volume of tumour motion, finding that the immobilisation reduced the volume of tumour displacement by a mean of 83% ( P = 0.021).…”

Section: Introductionmentioning

confidence: 99%

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A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers

et al. 2016

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IntroductionPatient immobilisation is critically important for both highly conformal conventionally fractionated radiotherapy and for stereotactic body radiotherapy. Different immobilisation devices are available to maintain patient position for radiotherapy but the most suitable one remains unknown.MethodsForty‐five patients were randomly allocated to one of three immobilisation devices; the Q fix arm shuttle, BodyFIX without wrap or BodyFIX with wrap. Patients were imaged before and after treatment to ascertain intra‐fraction and inter‐fraction motion. Bony anatomy was used for matching to determine the positional accuracy of each device. Treatments were timed using a standard method. Patient comfort and staff satisfaction questionnaires were also issued to determine comfort, ease of use and preferences for each device.ResultsThe BodyFIX without wrap was the more accurate device; however, the differences between the devices were not statistically significant. The BodyFIX with wrap was found to take significantly longer to set up and set down compared to the arm shuttle and the BodyFIX without wrap (all P < 0.001). Patients (37%) marginally preferred the BodyFIX with wrap. Most (81%) staff preferred the BodyFIX without wrap.ConclusionImmobilisation using the BodyFIX without wrap was deemed to be suitable for clinical use. It was a clinically accurate device, the more efficient in terms of set up and set down time, the most preferred by staff and was accepted by patients.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers

et al. 2016

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Effects of collimator angle, couch angle, and starting phase on motion‐tracking dynamic conformal arc therapy (4D DCAT)

Yao

Podgorsak

et al. 2017

J Applied Clin Med Phys

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PurposeThe aim of this study was to find an optimized configuration of collimator angle, couch angle, and starting tracking phase to improve the delivery performance in terms of MLC position errors, maximal MLC leaf speed, and total beam‐on time of DCAT plans with motion tracking (4D DCAT).Method and materialsNontracking conformal arc plans were first created based on a single phase (maximal exhalation phase) of a respiratory motion phantom with a spherical target. An ideal model was used to simulate the target motion in superior‐inferior (SI), anterior‐posterior (AP), and left‐right (LR) dimensions. The motion was decomposed to the MLC leaf position coordinates for motion compensation and generating 4D DCAT plans. The plans were studied with collimator angle ranged from 0° to 90°; couch angle ranged from 350°(−10°) to 10°; and starting tracking phases at maximal inhalation (θ=π/2) and exhalation (θ=0) phases. Plan performance score (PPS) evaluates the plan complexity including the variability in MLC leaf positions, degree of irregularity in field shape and area. PPS ranges from 0 to 1, where low PPS indicates a plan with high complexity. The 4D DCAT plans with the maximal and the minimal PPS were selected and delivered on a Varian TrueBeam linear accelerator. Gafchromic‐EBT3 dosimetry films were used to measure the dose delivered to the target in the phantom. Gamma analysis for film measurements with 90% passing rate threshold using 3%/3 mm criteria and trajectory log files were analyzed for plan delivery accuracy evaluation.ResultsThe maximal PPS of all the plans was 0.554, achieved with collimator angle at 87°, couch angle at 350°, and starting phase at maximal inhalation (θ=π/2). The maximal MLC leaf speed, MLC leaf errors, total leaf travel distance, and beam‐on time were 20 mm/s, 0.39 ± 0.16 mm, 1385 cm, and 157 s, respectively. The starting phase, whether at maximal inhalation or exhalation had a relatively small contribution to PPS (0.01 ± 0.05).ConclusionsBy selecting collimator angle, couch angle, and starting tracking phase, 4D DCAT plans with the maximal PPS demonstrated less MLC leaf position errors, lower maximal MLC leaf speed, and shorter beam‐on time which improved the performance of 4D motion‐tracking DCAT delivery.

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Evaluation of plan quality and treatment efficiency for single‐isocenter/two‐lesion lung stereotactic body radiation therapy

Sanford

Molloy

Kumar

et al. 2018

J Applied Clin Med Phys

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Purpose/objectivesTo evaluate the plan quality and treatment delivery efficiency of single‐isocenter/two‐lesions volumetric modulated arc therapy (VMAT) lung stereotactic body radiation therapy (SBRT).Materials/methodsEight consecutive patients with two peripherally located early stage nonsmall‐cell‐lung cancer (NSCLC) lung lesions underwent single‐isocenter highly conformal noncoplanar VMAT SBRT treatment in our institution. A single‐isocenter was placed between the two lesions. Doses were 54 or 50 Gy in 3 and 5 fractions respectively. Patients were treated every other day. Plans were calculated in Eclipse with AcurosXB algorithm and normalized to at least 95% of the planning target volume (PTV) receiving 100% of the prescribed dose. For comparison, two‐isocenter plans (isocenter placed centrally in each target) were retrospectively created. Conformity indices (CIs), heterogeneity index (HI), gradient index (GI), gradient distance (GD), and D2cm were calculated. The normal lung V5, V10, V20, mean lung dose (MLD) and other organs at risk (OARs) doses were evaluated. Total number of monitor units (MUs), beam‐on time, and patient‐specific quality assurance (QA) results were recorded.ResultsThe mean isocenter to tumor distance was 6.7 ± 2.3 cm. The mean combined PTV was 44.0 ± 23.4 cc. There was no clinically significant difference in CI, HI, GD, GI, D2cm, and V20 including most of the OARs between single‐isocenter and two‐isocenter lung SBRT plans, evaluated per RTOG guidelines. However, for single‐isocenter plans as the distance between the lesions increased, the V5, V10, and MLD increased, marginally. The total number of MUs and beam‐on time was reduced by a factor of 1.5 for a single‐isocenter plan compared to a two‐isocenter plan. The single‐isocenter/two‐lesions VMAT lung SBRT QA plans demonstrated an accurate dose delivery of 98.1 ± 3.2% for clinical gamma passing rate of 3%/3 mm.ConclusionThe SBRT treatment of two peripherally located lung lesions with a centrally placed single‐isocenter was dosimetrically equivalent to two‐isocenter plans. Faster treatment delivery for single‐isocenter treatment can improve patient compliance and reduce the amount of intrafraction motion errors for well‐suited patients.

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Effect of Immobilization and Performance Status on Intrafraction Motion for Stereotactic Lung Radiotherapy: Analysis of 133 Patients

Cited by 85 publications

References 23 publications

A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers

A randomised comparison of three different immobilisation devices for thoracic and abdominal cancers

Effects of collimator angle, couch angle, and starting phase on motion‐tracking dynamic conformal arc therapy (4D DCAT)

Evaluation of plan quality and treatment efficiency for single‐isocenter/two‐lesion lung stereotactic body radiation therapy

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