Movement assessment of breast and organ-at-risks using free-breathing, self-gating 4D magnetic resonance imaging workflow for breast cancer radiation therapy

Habatsch, Melanie; Schneider, Manuel; Requardt, Martin; Doussin, Sylvain

doi:10.1016/j.phro.2022.05.007

Cited by 8 publications

(7 citation statements)

References 23 publications

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“…There is evidence that 4D-MRI is a promising technique for lung tumor delineation and motion assessment with greater robustness against inter-fractional changes than 4D-CT-based radiotherapy [ 37 ]. Previous studies have reported results when applying 4D-MRI for target volumes [ 37 ], whereas thoracic OARs were studied less frequently [ 38 ]. Thus, when considering motion management in SBRT for central lung tumors, 4D-MRI can be considered a promising technology for an optimal balance of toxicities and tumor control [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

And Yet It Moves: Clinical Outcomes and Motion Management in Stereotactic Body Radiation Therapy (SBRT) of Centrally Located Non-Small Cell Lung Cancer (NSCLC): Shedding Light on the Internal Organ at Risk Volume (IRV) Concept

Habermann,

Schmitt,

Failing

et al. 2024

Cancers

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The internal organ at risk volume (IRV) concept might improve toxicity profiles in stereotactic body radiation therapy (SBRT) for non-small cell lung cancer (NSCLC). We studied (1) clinical aspects in central vs. peripheral tumors, (2) the IRV concept in central tumors, (3) organ motion, and (4) associated normal tissue complication probabilities (NTCPs). We analyzed patients who received SBRT for NSCLC (clinical aspects, n = 78; motion management, n = 35). We found lower biologically effective doses, larger planning target volume sizes, higher lung doses, and worse locoregional control for central vs. peripheral tumors. Organ motion was greater in males and tall patients (bronchial tree), whereas volume changes were lower in patients with a high body mass index (BMI) (esophagus). Applying the IRV concept (retrospectively, without new optimization), we found an absolute increase of >10% in NTCPs for the bronchial tree in three patients. This study emphasizes the need to optimize methods to balance dose escalation with toxicities in central tumors. There is evidence that organ motion/volume changes could be more pronounced in males and tall patients, and less pronounced in patients with higher BMI. Since recent studies have made efforts to further subclassify central tumors to refine treatment, the IRV concept should be considered for optimal risk assessment.

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Section: Discussionmentioning

confidence: 99%

And Yet It Moves: Clinical Outcomes and Motion Management in Stereotactic Body Radiation Therapy (SBRT) of Centrally Located Non-Small Cell Lung Cancer (NSCLC): Shedding Light on the Internal Organ at Risk Volume (IRV) Concept

Habermann,

Schmitt,

Failing

et al. 2024

Cancers

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“…Surface-guided radiotherapy (SGRT) systems are commercially available for monitoring the breast tissue during radiotherapy without additional imaging dose [12] , [17] , however, alignment errors observed by SGRT have been found to have a weak correlation with alignment errors observed in internal anatomy [15] and so cannot be used to replace a comprehensive image-guided radiotherapy regime [18] . 4DMRI studies have demonstrated intra-fraction motion of organs at risk [19] and complex motion of breast and nodal volumes [20] .The combination of SGRT with real-time EPID monitoring would be complementary, allowing for simultaneous monitoring of the breast surface and internal anatomy on conventional linacs.…”

Section: Discussionmentioning

confidence: 99%

A method for beam’s eye view breath-hold monitoring during breast volumetric modulated arc therapy

Carr

Gargett²,

Stanton³

et al. 2023

Physics and Imaging in Radiation Oncology

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“…It is necessary to accurately evaluate the displacement of the heart and its substructures caused by periodic cardiac activity and calculate the compensatory extension range that could be directive in clinical practice when creating a radiotherapy plan. Many studies have proven that delineation of the pericardium, heart, LVM, and CA system based on planning CT fails to show the real margin of the substructures mentioned above during the cardiac cycle ( 9 - 14 ), and a compensatory margin should be applied. Tong et al calculated the displacements of 1.2±0.9, 0.6±0.5, and 0.6±0.5 mm for the heart, 0.5±0.4, 0.4±0.3, and 0.8±0.6 mm for the pericardium, and 1.0±0.8, 4.1±2.8, and 1.9±1.2 mm for the LVM in the left-right, ventral-dorsal, and caudal-cranial directions by 4D-CT ( 9 ), while Kataria et al suggest radial and cranio-caudal margins of 7 mm and 4 mm, respectively, would cover the range of motions of the coronary artery (CA) on CECT ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…In addition to respiratory movement, the heart is especially influenced by periodic cardiac movement ( 7 , 8 ). According to previous studies ( 9 - 14 ), planning CT that displayed images of the heart and its substructures failed to represent its real morphology, volume, and location, and volume-dose parameters based on planning CT were inaccurate due to these displacements. Tong et al calculated the displacements of 1.2±0.9, 0.6±0.5, and 0.6±0.5 mm for the heart, 0.5±0.4, 0.4±0.3, and 0.8±0.6 mm for the pericardium, and 1.0±0.8, 4.1±2.8, and 1.9±1.2 mm for the left ventricular muscle (LVM) in the left-right, ventral-dorsal, and caudal-cranial directions by 4-dimensional CT (4D-CT) ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

Analysis of heart displacement during thoracic radiotherapy based on electrocardiograph-gated 4-dimensional magnetic resonance imaging

Yang¹,

Gong²,

Fu³

et al. 2023

J Thorac Dis

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Background Periodic cardiac movement may expose the heart to radiation field induced damage, leading to radiation-induced heart disease (RIHD). Studies have proven that delineation of the heart based on planning CT fails to show the real margin of the substructures and a compensatory margin should be applied. The purpose of this study was to quantify the dynamic changes and the compensatory extension range by breath-hold and electrocardiogram gated 4-dimensional magnetic resonance imaging (4D-MRI), which had the advantage of discriminating soft tissues. Methods Eventually, 15 patients with oesophageal or lung cancers were enrolled, including one female and nine males aged from 59 to 77 years from December 10 th , 2018, to March 4 th , 2020. The displacement of the heart and its substructures was measured through a fusion volume and the compensatory expansion range was calculated by expending the boundary on the planning CT to that of the fusion volume. The differences were tested through the Kruskal-Wallis H test and were considered significant at a two-side P<0.05. Results The extent of movement of heart and its substructures during one cardiac cycle were approximately 4.0–26.1 millimetre (mm) in anterior-posterior (AP), left-right (LR), and cranial-caudal (CC) axes, and the compensatory margins should be applied to planning CT by extending the margins by 1.7, 3.6, 1.8, 3.0, 2.1, and 2.9 centimetres (cm) for pericardium; 1.2, 2.5, 1.0, 2.8, 1.8, and 3.3 cm for heart; 3.8, 3.4, 3.1, 2.8, 0.9, and 2.0 cm for interatrial septum; 3.3, 4.9, 2.0, 4.1, 1.1, and 2.9 cm for interventricular septum; 2.2, 3.0, 1.1, 5.3, 1.8, and 2.4 cm for left ventricular muscle (LVM); 5.9, 3.4, 2.1, 6.1, 5.4, and 3.6 cm for antero-lateral papillary muscle (ALPM); and 6.6, 2.9, 2.6, 6.6, 3.9, and 4.8 cm for postero-medial papillary muscle (PMPM) in anterior, posterior, left, right, cranial, and caudal directions, respectively. Conclusions Periodic cardiac activity causes obvious displacement of the heart and its substructures, and the motion amplitude of substructures differs. Extending a certain margin as the compensatory extension to represent the organs at risk (OAR) and then limiting the dose–volume parameters could be performed in clinical practice.

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Movement assessment of breast and organ-at-risks using free-breathing, self-gating 4D magnetic resonance imaging workflow for breast cancer radiation therapy

Cited by 8 publications

References 23 publications

And Yet It Moves: Clinical Outcomes and Motion Management in Stereotactic Body Radiation Therapy (SBRT) of Centrally Located Non-Small Cell Lung Cancer (NSCLC): Shedding Light on the Internal Organ at Risk Volume (IRV) Concept

And Yet It Moves: Clinical Outcomes and Motion Management in Stereotactic Body Radiation Therapy (SBRT) of Centrally Located Non-Small Cell Lung Cancer (NSCLC): Shedding Light on the Internal Organ at Risk Volume (IRV) Concept

A method for beam’s eye view breath-hold monitoring during breast volumetric modulated arc therapy

Analysis of heart displacement during thoracic radiotherapy based on electrocardiograph-gated 4-dimensional magnetic resonance imaging

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