ESTRO ACROP guidelines for positioning, immobilisation and position verification of head and neck patients for radiation therapists

Leech, Michelle; Coffey, Mary; Mast, M.; Moura, Filipe; Osztavics, A.; Pasini, D.; Vaandering, A.

doi:10.1016/j.tipsro.2016.12.001

Cited by 31 publications

(31 citation statements)

References 9 publications

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“…First, in our clinical workflow two RTTs register the CBCT scans together to reduce inter-observer variation in making a TLP decision. They are educated with the Advisory Committee on Radiation Oncology Practice (ACROP) guidelines for position verification for HNC patients [17]. On top of that, we devised an in-house schooling program for using the TLP.…”

Section: Discussionmentioning

confidence: 99%

Protocolised way to cope with anatomical changes in head & neck cancer during the course of radiotherapy

Beek¹,

Jonker²,

Hamming‐Vrieze

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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Introduction: During a course of radiotherapy for head-and-neck-cancer (HNC), non-rigid anatomical changes can be observed on daily Cone Beam CT (CBCT). To objectify responses to these changes, we use a decision support system (traffic light protocol). Action levels orange and red may lead to replanning. The purpose of this study was to evaluate how often re-planning was done for non-rigid anatomical changes, which anatomical changes led to re-planning and in which subgroups of patients treatment adaptation was deemed necessary. Materials and methods: A consecutive series of 388 HNC patients were retrospectively selected using the digital log of CBCT scans. The logs were analyzed for the number of new plans on an original planning CT scan (O-pCT) or a new pCT scan (N-pCT). Reasons for re-planning were categorized into: target volume increase/decrease, body contour decrease/increase and local shift of target volume. Subgroup analysis was performed to investigate relative differences of re-planning between treatment modalities. Results: For 33 patients the treatment plan was adapted due to anatomical changes, resulting in 37 new plans in total. Re-planning on a N-pCT with complete re-delineation was done 22 times. In fifteen cases a new plan was created after adjustment of contours on the O-pCT. Main reasons for re-planning were target volume increase, body contour decrease and local shifts of target volume. Most re-planning (23%) was seen in patients treated with chemoradiotherapy. Conclusion: Visual detection of anatomical changes on CBCT during treatment of HNC, results in replanning in 1 out of 10 patients.

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Section: Discussionmentioning

confidence: 99%

Protocolised way to cope with anatomical changes in head & neck cancer during the course of radiotherapy

Beek¹,

Jonker²,

Hamming‐Vrieze

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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“…However, the widespread implementation of CBCT used for DIR as a sole dose verification modality in the clinical setting is constrained by its limitations and complexity. In particular, DIR remains problematic in cases where large changes in patient contour are identified [1,4,13].…”

Section: Verification At Mid-treatment Sct Vs Pct2mentioning

confidence: 99%

“…The modality and scheduling of verification images for IGRT and adaptive radiotherapy (ART) are not standardised across UK departments. Repeat computed tomography (CT) or cone-beam CT (CBCT) are often applied although protocols are dependent on available clinical resources rather than established best practice [4,7,[11][12][13]. No guidelines support optimal time points for dose to be verified during H&N RT, however some studies suggest dosimetric changes occur early in the treatment course [8,14,15].…”

Section: Introductionmentioning

confidence: 99%

Analysis of dose using CBCT and synthetic CT during head and neck radiotherapy: A single centre feasibility study

Hay

Paterson

McLoone

et al. 2020

Technical Innovations & Patient Support in Radiation Oncolo

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a b s t r a c tObjectives: The study aimed to assess the suitability of deformable image registration (DIR) software to generate synthetic CT (sCT) scans for dose verification during radiotherapy to the head and neck. Planning and synthetic CT dose volume histograms were compared to evaluate dosimetric changes during the treatment course. Methods: Eligible patients had locally advanced (stage III, IVa and IVb) oropharyngeal cancer treated with primary radiotherapy. Weekly CBCT images were acquired post treatment at fractions 1, 6, 11, 16, 21 and 26 over a 30 fraction treatment course. Each CBCT was deformed with the planning CT to generate a sCT which was used to calculate the dose at that point in the treatment. A repeat planning CT2 was acquired at fraction 16 and deformed with the fraction 16 CBCT to compare differences between the calculations mid-treatment. Results: 20 patients were evaluated generating 138 synthetic CT sets. The single fraction mean dose to PTV_HR between the synthetic and planning CT did not vary, although dose to 95% of PTV_HR was smaller at week 6 compared to planning (difference 2.0%, 95% CI (0.8 to 3.1), p = 0.0). There was no statistically significant difference in PRV_brainstem or PRV_spinal cord maximum dose, although greater variation using the sCT calculations was reported. The mean dose to structures based on the fraction 16 sCT and CT2 scans were similar. Conclusions: Synthetic CT provides comparable dose calculations to those of a repeat planning CT; however the limitations of DIR must be understood before it is applied within the clinical setting.

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“…Five-point fixation is recommended with fixation at head, neck and shoulders as standard to minimise sub regional variations in set up errors in the lower neck and shoulders [22][23][24]. Open face masks are growing in popularity as they can minimise distress in claustrophobic patients [25,26].…”

Section: Immobilisationmentioning

confidence: 99%

“…In Europe 97% of patients are treated using highly complex and conformal planning techniques such as 3-Dimensional Conformal RT (3DCRT) and Intensity Modulated RT (IMRT) [7]. Unlike 3DCRT and conventional RT, a rapid fall off in dose is characteristic of IMRT planning -permitting delivery of a highly conformal dose to the Planning Target Volume (PTV) and improved sparing of surrounding Organs at Risk (OARs) [8,9].…”

Section: Introductionmentioning

confidence: 99%

A review of Image Guided Radiation Therapy in head and neck cancer from 2009–2019 – Best Practice Recommendations for RTTs in the Clinic

Kearney

Coffey

Leong

2020

Technical Innovations & Patient Support in Radiation Oncolo

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Radiation therapy (RT) is beneficial in Head and Neck Cancer (HNC) in both the definitive and adjuvant setting. Highly complex and conformal planning techniques are becoming standard practice in delivering increased doses in HNC. A sharp falloff in dose outside the high dose area is characteristic of highly complex techniques and geometric uncertainties must be minimised to prevent under dosage of the target volume and possible over dosage of surrounding critical structures. CTV-PTV margins are employed to account for geometric uncertainties such as set up errors and both interfraction and intrafraction motion. Robust immobilisation and Image Guided Radiation Therapy (IGRT) is also essential in this group of patients to minimise discrepancies in patient position during the treatment course. IGRT has evolved with increased 2-Dimensional (2D) and 3-Dimensional (3D) IGRT modalities available for geometric verification. 2D and 3D IGRT modalities are both beneficial in geometric verification while 3D imaging is a valuable tool in assessing volumetric changes that may have dosimetric consequences for this group of patients. IGRT if executed effectively and efficiently provides clinicians with confidence to reduce CTV-PTV margins thus limiting treatment related toxicities in patients. Accumulated exposure dose from IGRT vary considerably and may be incorporated into the treatment plan to avoid excess dose. However, there are considerable variations in the application of IGRT in RT practice. This paper aims to summarise the advances in IGRT in HNC treatment and provide clinics with recommendations for an IGRT strategy for HNC in the clinic.

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ESTRO ACROP guidelines for positioning, immobilisation and position verification of head and neck patients for radiation therapists

Cited by 31 publications

References 9 publications

Protocolised way to cope with anatomical changes in head & neck cancer during the course of radiotherapy

Protocolised way to cope with anatomical changes in head & neck cancer during the course of radiotherapy

Analysis of dose using CBCT and synthetic CT during head and neck radiotherapy: A single centre feasibility study

A review of Image Guided Radiation Therapy in head and neck cancer from 2009–2019 – Best Practice Recommendations for RTTs in the Clinic

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