Intra-fraction respiratory motion and baseline drift during breast Helical Tomotherapy

Ricotti, R.; Ciardo, D.; Fattori, Giovanni; Leonardi, Maria Cristina; Morra, Anna; Rojas, Damaris Patricia; Pansini, F.; Cambria, Raffaella; Cattani, Federica; Gianoli, Chiara; Spinelli, Chiara; Riboldi, Marco; Baroni, Guido; Orecchia, Roberto; Jereczek‐Fossa, Barbara Alicja

doi:10.1016/j.radonc.2016.07.019

Cited by 31 publications

(27 citation statements)

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“…Baseline shift and range of motion stayed within a few millimeters. [23] An optical approach method to measure intra-fractional motions was recently reported by Ricotti et al [12], who used an optical system with infrared reflective surface markers for motion tracking. Based on their high sample frequency, the investigators were able to divide the motion into a baseline drift and respiratory-caused changes.…”

Section: Discussionmentioning

confidence: 99%

“…However, the findings reported by Ricotti and colleagues seem to be comparable to our analyses; the authors calculated a baseline drift of 0 ± 1.1 mm in the lateral direction, − 0.5 ± 1.7 mm in the longitudinal and − 1.4 ± 1.8 mm in the vertical direction. [12] Regarding the influence of duration of the RT session, Wiant et al analyzed data of 33 patients during 831 monitoring sessions. Most patients stayed within a 5 mm drift range.…”

Section: Discussionmentioning

confidence: 99%

“…The mean baseline drift was 0 ± 0.7 mm in right-left, − 0.5 ± 1.7 mm in inferior-superior and − 1.4 ± 1.8 mm in posterior-anterior direction. [12] Furthermore, Gaisberger et al used 3D body surface imaging and noticed intrafractional shifts of 1.2 ± 0.7 mm during the first 2 min of observation. [13] The aim of the present study was to quantify the uncertainties of possible intra-fractional chest motion during breast radiotherapy by using the real-time optical surface imaging system Catalyst™.…”

Section: Introductionmentioning

confidence: 99%

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Real-time intra-fraction motion management in breast cancer radiotherapy: analysis of 2028 treatment sessions

et al. 2018

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BackgroundIntra-fraction motion represents a crucial issue in the era of precise radiotherapy in several settings, including breast irradiation. To date, only few data exist on real-time measured intra-fraction motion in breast cancer patients. Continuous surface imaging using visible light offers the capability to monitor patient movements in three-dimensional space without any additional radiation exposure. The aim of the present study was to quantify the uncertainties of possible intra-fractional motion during breast radiotherapy.Material and methodsOne hundred and four consecutive patients that underwent postoperative radiotherapy following breast conserving surgery or mastectomy were prospectively evaluated during 2028 treatment sessions. During each treatment session the patients’ motion was continuously measured using the Catalyst™ optical surface scanner (C-RAD AB, Sweden) and compared to a reference scan acquired at the beginning of each session. The Catalyst system works through an optical surface imaging with light emitting diode (LED) light and reprojection captured by a charge coupled device (CCD) camera, which provide target position control during treatment delivery with a motion detection accuracy of 0.5 mm. For 3D surface reconstruction, the system uses a non-rigid body algorithm to calculate the distance between the surface and the isocentre and using the principle of optical triangulation. Three-dimensional deviations and relative position differences during the whole treatment fraction were calculated by the system and analyzed statistically.ResultsOverall, the maximum magnitude of the deviation vector showed a mean change of 1.93 mm ± 1.14 mm (standard deviation [SD]) (95%-confidence interval: [0.48–4.65] mm) and a median change of 1.63 mm during dose application (beam-on time only). Along the lateral and longitudinal axis changes were quite similar (0.18 mm ± 1.06 mm vs. 0.17 mm ± 1.32 mm), on the vertical axis the mean change was 0.68 mm ± 1.53 mm. The mean treatment session time was 154 ± 53 (SD) seconds and the mean beam-on time only was 55 ± 16 s. According to Friedman’s test differences in the distributions of the three possible directions (lateral, longitudinal and vertical) were significant (p < 0.01), in post-hoc analysis there were no similarities between any two of the three directions.ConclusionThe optical surface imaging system is an accurate and easy tool for real-time motion management in breast cancer radiotherapy. Intra-fraction motion was reported within five millimeters in all directions. Thus, intra-fraction motion in our series of 2028 treatment sessions seems to be of minor clinical relevance in postoperative radiotherapy of breast cancer.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Real-time intra-fraction motion management in breast cancer radiotherapy: analysis of 2028 treatment sessions

et al. 2018

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“…For a patient receiving treatment with DIBH technique, several deep-inspiration breathing holds will need to be taken to complete the treatment. The reproducibility would not be perfect for every breathing hold and the perfection of each breathing hold decreases along with the increase of treatment time [ 21 , 22 ]. More instability leads to more unexpected radiation exposure to organs we are concerned with.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric analysis of tangent-based volumetric modulated arc therapy with deep inspiration breath-hold technique for left breast cancer patients

Tsai

et al. 2018

Radiat Oncol

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BackgroundTangent-based intensity modulated radiation therapy (TIMRT) is a common adjuvant radiotherapy strategy for breast cancer patients. This study compared the dosimetric characteristics of tangent-based volumetric modulated arc therapy (TVMAT) and TIMRT for left breast cancer patients during deep inspiration breath-hold (DIBH) and free breathing (FB) techniques.MethodsFourteen patients with left breast cancer after breast-conserving surgery were included. The first arc started at 331.8–353.6 degrees and stopped at 281.8–315.0 degrees. The third arc started at 123.2–149.1 degrees and stopped at 88.0–96.0 degrees. The second and fourth arcs were reverse arcs of first and third arcs. DIBH-TIMRT inversing plans were generated using opposing tangential fields. Wilcoxon signed rank test and Spearman correlation were used to examine the significance of dose difference.ResultsCompared with FB-TVMAT, the mean heart dose of DIBH-TVMAT plans was reduced from 7.9 Gy to 3.2 Gy (p < 0.001). The average left lung volume receiving 30 Gy or more (V30Gy) was reduced from 12.9 to 5.7% (p < 0.001). DIBH-TVAMT plans resulted in a lower mean dose to the contralateral breast and lung (2 Gy and 0.7 Gy vs 3.4 Gy and 1.5 Gy, respectively) as compared to FB-TVMAT plans. Compared with DIBH-TIMRT, the average left lung V30Gy of DIBH-TVMAT plans was reduced from 8.5 to 5.7% (p = 0.031). As for low-dose areas, exposure of the left lung, right breast, heart and right lung volume with 10 Gy or more was not significantly different between the IMRT- and VMAT-plans.ConclusionsDIBH-TVMAT for left breast cancer treatment retains treatment plan quality similar to the DIBH-IMRT technique without compromising dose restrictions to the heart, right breast and right lung. DIBH-TVMAT increased left lung protection but still had higher V5Gy to right breast and substantially higher V5Gy to heart. For left breast cancer patients receiving treatment with the DIBH technique, DIBH-TVMAT provides better treatment quality and is a safe and feasible treatment strategy.

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“…The intrafractional motion during normal breathing was studied for breast cancer patients [10]. Helical Tomotherapy treatment showed increased treatment duration, which may cause intrafractional uncertainties.…”

Section: Discussionmentioning

confidence: 99%

Benefits and Limitations of Volumetric Modulated Arc Therapy in Treating Bilateral Breast Cancer with Regional Lymph Nodes

Srivastava¹,

Vandeputte²,

Wagter³

2020

ABCR

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Purpose: The study was performed comparing dosimetric characteristics of volumetric modulated arc therapy (VMAT) and field-in-field (FiF) techniques on a patient with synchronous bilateral breast carcinoma. Methods: The patients with bilateral breast cancer treatment were included in this study. A total dose of 40.05 Gy in 15 fractions was prescribed to the Planning Target Volume (PTV) of the whole bilateral breast cancer with the supraclavicular and infraclavicular nodes, with a complementary boost of 10 Gy in 4 fractions to the surgical bed (PTV boost). For both radiotherapy techniques, several V xGy parameters were analyzed for the PTVs, together with the Conformity index (CI), the Homogeneity index (HI) and the critical organs at risk (OARs), lungs and heart. Results: The patient was treated by the VMAT technique and the daily treatment time was less than 20 minutes with daily CBCT imaging. In the VMAT plan, the PTV 95% dose covered 38.89 ± 0.81 Gy, compared to 37.26 ± 1.02 Gy in the FiF technique. The VMAT plan improved the dose homogeneity index and lower dose in lung towards high dose region. Conclusion: The study demonstrates the viability of the VMAT technique in the treatment of bilateral breast cancer. The introduced single isocentric VMAT technique is fast to deliver and it increases the dose homogeneity of the target volume with some limitations. The treatment was well tolerated, without interruption of the treatment courses caused by treatmentrelated toxicities.

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Intra-fraction respiratory motion and baseline drift during breast Helical Tomotherapy

Cited by 31 publications

References 37 publications

Real-time intra-fraction motion management in breast cancer radiotherapy: analysis of 2028 treatment sessions

Real-time intra-fraction motion management in breast cancer radiotherapy: analysis of 2028 treatment sessions

Dosimetric analysis of tangent-based volumetric modulated arc therapy with deep inspiration breath-hold technique for left breast cancer patients

Benefits and Limitations of Volumetric Modulated Arc Therapy in Treating Bilateral Breast Cancer with Regional Lymph Nodes

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