Prostate Bed Radiation Therapy: The Utility of Ultrasound Volumetric Imaging of the Bladder

Haworth, Annette; Paneghel, A.; Bressel, Mathias; Herschtal, Alan; Pham, Daniel; Tai, Keen‐Hun; Oates, Richard; Gawthrop, Janet; Cray, Alison; Foroudi, Farshad

doi:10.1016/j.clon.2014.08.010

Cited by 8 publications

(6 citation statements)

References 17 publications

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“…When comparing our work with literature in the area, as experienced by Haworth et al, 14 heavy departmental workload frequently impacted adversely on our quality of data collection. Direct comparisons with other papers are mostly confounded due to study variations; most detail experience with prostate patients, with differing methodologies and statistical analyses.…”

Section: Discussionmentioning

confidence: 80%

Implementation of ultrasound bladder volume scanning for patients receiving intensity-modulated radiotherapy to the cervix or endometrium: clinical experiences from a United Kingdom radiotherapy department

Claxton

Appleyard

2017

J Radiother Pract

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Background and purposeAchieving daily consistent bladder volume is acknowledged as challenging for patients undergoing radiotherapy to the cervix or endometrium. We investigated if use of an ultrasound bladder volume scanner (BioCon-700) improves bladder reproducibility when used during an active volume correction protocol.Materials and methodsDuring our method-comparison study, prospectively recruited patients (n=20) followed a fluid-loading protocol to achieve acceptable bladder volume. Bladder ultrasound was performed daily to verify planned volume, with patients actively correcting volumes outside a planned range up to a maximum of three times. Using the Bland–Altman method, we compared mean ultrasound readings (USMean) with mean cone-beam computed tomography (CBCT) volumes (CBCTMean). We also conducted staff focus groups exploring issues encountered during implementation of bladder scanning.ResultsComparing USMean with CBCTMean produced a mean of the differences −10±49·92 mL (1 SD), demonstrating that bladder volume scanning is equivalent to our standard measure for the stated confidence levels. The cohort mean bladder volume decrease from week 1 to 5 was only 8·4%. Mean USMean was 323 mL, mean CBCTMean was 313 mL. Staff experience with the scanner overall was positive.ConclusionsThe BioCon-700 is suitable for the purpose of daily pre-treatment volume verification, facilitating daily assessment and modification of bladder volume, resulting in reproducible treatment volumes.

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Section: Discussionmentioning

confidence: 80%

Implementation of ultrasound bladder volume scanning for patients receiving intensity-modulated radiotherapy to the cervix or endometrium: clinical experiences from a United Kingdom radiotherapy department

Claxton

Appleyard

2017

J Radiother Pract

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“…Previous studies have shown that the use of an ultrasound bladder scanner has potential to improve BV reproducibility over the course of radiotherapy treatment by modification of individual drinking protocols 7,[17][18][19][20][21] ; however, target BVs and tolerances vary widely in the literature, as summarised in Table S2.…”

Section: Discussionmentioning

confidence: 99%

Assessment of an ultrasound bladder scanner in prostate radiotherapy: A validation study and analysis of bladder filling variability

et al. 2021

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Introduction During prostate radiotherapy treatment, it is important to ensure the position of the bladder and prostate is consistent between treatments. The aim of this study was to provide a quantitative basis for incorporating ultrasound bladder volume estimates into local practice for prostate radiotherapy. Methods Agreement between bladder volume estimates obtained using computed tomography (CT) and ultrasound was assessed. Analysis of bladder volumes between planning and treatment scans was used to quantify expected variations in bladder volume over the course of radiotherapy. Dose–volume statistics were estimated and compared to planned dose constraints to propose a target bladder volume and tolerance. Results Bladder volume measurements were obtained from 19 radiotherapy patients using ultrasound and CT. Ultrasound underestimated bladder volume compared to CT with a mean bias of –28 ± 30 ml. Pre-treatment (planning) bladder volumes varied from 71 to 383 ml with a mean of 200 ml. Treatment bladder volumes reduced by more than half in 9% of patients during the course of their treatment, potentially leading to a 30% increase in mean bladder dose. Patients with pre-treatment bladder volumes < 200 ml were most likely to exhibit differences in bladder volume, resulting in ‘out of tolerance’ increases in dose. Conclusions A pragmatic individualised drinking protocol, aimed at achieving a minimum ultrasound bladder volume of 200 ml at planning CT, may be beneficial to reproducibility in radiotherapy treatment. Ultrasound measurements prior to treatment should ideally confirm that bladder volume is at least half the volume measured at planning.

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“…Another strategy is employing frequent ultrasound bladder scans to ensure consistent bladder filling. Bladder scans have high correlation with CT bladder volumes in rectum and prostate RT literature [11,12,18] and further investigation into bladder scan and/or PRV to minimize and account for SB motion may help inform clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Bag and loop small bowel contouring strategies differentially estimate small bowel dose for post-hysterectomy women receiving pencil beam scanning proton therapy

Kirk

Zhai

et al. 2016

Acta Oncologica

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Background Small bowel (SB) dose-volume relationships established during initial computed tomography (CT) simulations may change throughout therapy due to organ displacement and motion. We investigated the impact of organ motion on SB dose-volume histograms (DVHs) in women with gynecologic malignancies treated with pencil beam scanning (PBS) proton therapy and compared PBS SB DVHs to intensity-modulated radiation therapy (IMRT). Material and methods Post-hysterectomy patients (n ¼ 11) treated for gynecologic cancers were enrolled on an image-guided proton therapy protocol involving CT simulation with full (CT F ) and empty (CT E ) bladders and weekly/biweekly on-treatment scans. IMRT plans were generated for comparative analysis. SB was contoured as bowel loops or bowel bag. Wilcoxon signed-rank tests were used for matched-pair comparisons of SB, bladder, and rectum dose-volumes between CT scans and between PBS and IMRT plans. Results In PBS loops analysis, on-treatment DVH was significantly higher than CT F for doses <45 Gy (p < 0.05), and not significantly different than CT E . Specifically, V15 for loops was higher on-treatment (median 240 cm 3 ) compared to CT F (median 169 cm 3 , p ¼ 0.03). In PBS bag analysis, on-treatment DVH was not significantly different from CT F across all dose ranges. Bowel bag V45 was not significantly different between on-treatment (median 540 cm 3 ) and CT F (median 499 cm 3 , p ¼ 0.53). Decreasing bladder volume was associated with increasing V15 for loops and V45 for bowel bag (p < 0.005, both). Comparing PBS and IMRT, PBS resulted in significantly lower DVHs at low dose regions (<38 Gy) and higher DVHs at high dose regions (42.5-45.5 Gy) in both loops and bag analysis. IMRT plans demonstrated higher on-treatment SB loop DVHs and only minimal differences in bowel bag DVHs compared to CT F . Conclusions SB DVHs were well estimated by CT F bowel bag and underestimated by CT F loops in the setting of inconsistent bladder filling. Verifying bladder filling prior to treatment or using CT E for planning may more conservatively estimate SB dose-volume relationships.

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Prostate Bed Radiation Therapy: The Utility of Ultrasound Volumetric Imaging of the Bladder

Cited by 8 publications

References 17 publications

Implementation of ultrasound bladder volume scanning for patients receiving intensity-modulated radiotherapy to the cervix or endometrium: clinical experiences from a United Kingdom radiotherapy department

Implementation of ultrasound bladder volume scanning for patients receiving intensity-modulated radiotherapy to the cervix or endometrium: clinical experiences from a United Kingdom radiotherapy department

Assessment of an ultrasound bladder scanner in prostate radiotherapy: A validation study and analysis of bladder filling variability

Bag and loop small bowel contouring strategies differentially estimate small bowel dose for post-hysterectomy women receiving pencil beam scanning proton therapy

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