Evaluating the accuracy of the <scp>XVI</scp> dual registration tool compared with manual soft tissue matching to localise tumour volumes for post‐prostatectomy patients receiving radiotherapy

Campbell, Amelia; Owen, Robert; Brown, Elizabeth; Pryor, David; Bernard, Anne; Lehman, Margot

doi:10.1111/1754-9485.12332

Cited by 12 publications

(24 citation statements)

References 12 publications

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“…A sliding scale is then used to find the best ‘compromise’ match between the two surrogates. Successful application of this software has been reported for patients receiving radiotherapy for lung cancer and regional lymph nodes, multiple lung metastases and for post‐prostatectomy surgical bed …”

Section: Discussionmentioning

confidence: 99%

“…Successful application of this software has been reported for patients receiving radiotherapy for lung cancer and regional lymph nodes, 36 multiple lung metastases 37 and for post-prostatectomy surgical bed. 38 In conclusion, for disease sites that require the concurrent irradiation of multiple, independently moving CTVs, there is a complex geometric interplay between the magnitude of CTV displacement differences, the PTV margins and the image guidance strategy applied. This study demonstrated the feasibility of a simple compromise position image guidance strategy to accommodate simultaneous displacements of two independently moving CTVs during pelvic radiotherapy for high risk prostate cancer.…”

Section: Discussionmentioning

confidence: 99%

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‘Compromise position’ image alignment to accommodate independent motion of multiple clinical target volumes during radiotherapy: A high risk prostate cancer example

et al. 2016

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This study demonstrated the feasibility of a compromise position image guidance strategy to accommodate simultaneous displacements of two independently moving CTVs. Application of this strategy was facilitated by correlation between the CTV displacements and resulted in no geometric excursions of the CTVs beyond standard sized PTVs. This simple image guidance strategy may also be applicable to other disease sites that concurrently irradiate multiple CTVs, such as head and neck, lung and cervix cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

‘Compromise position’ image alignment to accommodate independent motion of multiple clinical target volumes during radiotherapy: A high risk prostate cancer example

et al. 2016

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“…Radiographers found the multiple ROI easy to use with little additional workload and that it helped to identify patients for re-planning 12 . This software is not commercially available for routine clinical use; however, Elekta Dual Registration (DR) is available 14 . DR allows the registration of two separate regions of anatomy, calculating their positional offsets independently, and proposing joint correction that best fit both ROIs.…”

Section: Introductionmentioning

confidence: 99%

“…Manual corrections can be made to the proposed correction via applying a sliding-scale weighting to favour one ROI's over the other prior to applying the correction. Pre-set limits also alert the radiographer if a treatment target structure has moved closer to a critical structure 14 .…”

Section: Introductionmentioning

confidence: 99%

“…In anatomical sites other than head and neck, Campbell et al 14 demonstrated in post prostatectomy patients that DR can be a more efficient registration which could improve patient experience such as comfort 15 while also reducing inter-observer variability. There is limited evidence to demonstrate the clinical impact and processes of using DR in head and neck patients.…”

Section: Introductionmentioning

confidence: 99%

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A Pilot Study Evaluating the Effectiveness of Dual-Registration Image-Guided Radiotherapy in Patients with Oropharyngeal Cancer

Goldsworthy

Leslie-Dakers

Higgins

et al. 2017

Journal of Medical Imaging and Radiation Sciences

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The purpose of the article was to determine the impact of Dual Registration (DR) image-guided radiotherapy (IGRT) on clinical judgement and treatment delivery for patients with oropharyngeal cancer prior to implementation. METHODS Ninety Cone Beam Computed Tomography images from ten retrospective patients were matched using standard clipbox registration (SCR) and DR. Three image guided radiotherapy specialist radiographers performed all registrations and evaluated by; intra-class correlation to determine interrater agreement, Bland-Altman with 95% Limits of Agreement to determine differences between SCR and DR procedures, changes in clinical judgment, time taken to perform registrations and radiographer satisfaction. RESULTS Interrater agreement between radiographers using both SCR and DR was high (0.867 and 0.917 p=<0.0001). The 95% Limits of Agreement between SCR and DR procedures in the medio-lateral, cranial caudal, and ventro-dorsal translational directions were-6.40 to +4.91,-7.49 to +6.05, and-7.00 to +5.44 mm respectively. The medio-lateral direction demonstrated significant proportional bias (p=<0.001) suggesting non-agreement between SCR and DR. 80% of DR matches resulted in a change in clinical judgement to ensure maximum target coverage. Mean registration times for SCR and DR were 94 and 115 seconds respectively and radiographer's found DR feasible and satisfactory. CONCLUSION The standard method using SCR in patients with oropharyngeal cancer underestimates the deviation in the lower neck. In these patients DR is an effective

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Implementing daily soft tissue image guidance with reduced margins for post‐prostatectomy radiotherapy: research‐based changes to clinical practice

Bell

Eade

Hruby

et al. 2019

J of Medical Radiation Sci

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IntroductionWe have previously demonstrated that daily soft tissue matching with reduced anisotropic margins provides an ideal balance between prostate bed coverage and meeting organ at risk constraints. The aim of this study was to evaluate the implementation of this approach in clinical practice.MethodsThirty‐eight radiation therapists (RTs) completed offline IGRT training involving six patients. After training was completed, this approach was implemented clinically. The first 24 patients were evaluated with a central review of match displacements and geographic miss (GM). An assessment of treatment times and planning parameters was also performed.ResultsDuring offline training, the anterior–posterior (AP) match discrepancy had the largest mean variation ranging from −0.46 to 0.06 cm and undetected geographic miss occurred in 17% of alignments. The mean time taken to treat the first 24 patients ranged from 12.2 to 20.6 min. The smaller anisotropic margin resulted in similar target coverage but achieved reduced doses to the bladder (V65Gy from 36% to 27%, V40Gy from 54% to 51%) and rectum (V65Gy from 20% to 19%, V60Gy from 27% to 24%, V40Gy from 42% to 38%). The matches of 806 CBCT images in 24 patients were reviewed. The mean match ranged from −0.12 to 0.17 cm AP, −0.14 to 0.14 cm superior–inferior (SI) and −0.04 to 0.04 cm left–right (LR). An undetected geographic miss was found in the prostate bed in 17 (2.1%) images and lymph nodes in 2 (0.2%) images.ConclusionsDaily soft tissue IGRT with reduced anisotropic margins for post‐prostatectomy radiotherapy has been successfully implemented. RTs performed better with real‐time online matching than they did in offline training, perhaps influenced by having several RTs perform online matching. Daily soft tissue IGRT did not prolong treatment time.

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Evaluating the accuracy of the XVI dual registration tool compared with manual soft tissue matching to localise tumour volumes for post‐prostatectomy patients receiving radiotherapy

Abstract: XVI's DRT is comparable with RTs manually matching soft tissue on CBCT. The DRT can minimise RT inter-observer variability; however, involuntary bladder and rectal filling can influence the tools accuracy, highlighting the need for RT evaluation of the DRT match.

Cited by 12 publications

References 12 publications

‘Compromise position’ image alignment to accommodate independent motion of multiple clinical target volumes during radiotherapy: A high risk prostate cancer example

‘Compromise position’ image alignment to accommodate independent motion of multiple clinical target volumes during radiotherapy: A high risk prostate cancer example

A Pilot Study Evaluating the Effectiveness of Dual-Registration Image-Guided Radiotherapy in Patients with Oropharyngeal Cancer

Implementing daily soft tissue image guidance with reduced margins for post‐prostatectomy radiotherapy: research‐based changes to clinical practice

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