Prototype volumetric ultrasound tomography image guidance system for prone stereotactic partial breast irradiation: proof-of-concept

Chiu, Tsuicheng; Parsons, David; Zhang, Yue; Hrycushko, Brian; Zhao, Bo; Chopra, Rajiv; Kim, Nathan; Spangler, Ann; Rahimi, A.S.; Timmerman, Robert; Jiang, Steve B; Lu, Weiguo; Gu, Xuejun

doi:10.1088/1361-6560/aaad1f

Cited by 3 publications

(4 citation statements)

References 37 publications

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“…In one patient with the BioZorb, the authors showed that the device could be visualized on mammography, ultrasound, magnetic resonance imaging (MRI), and computed tomography (CT). Chiu et al built a water tank with a resin breast model containing the BioZorb device and showed that ultrasound tomography offered better soft tissue contrast than CT and similar image quality to magnetic resonance (MR) for dose delivery of stereotactic partial breast irradiation with use of the BioZorb device …”

Section: Discussionmentioning

confidence: 99%

Utilization of BioZorb implantable device in breast‐conserving surgery

Srour

Chung

2019

Breast J

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BioZorb fiducial marker is an implantable device made of six clips to mark the surgical site of tissue removal in three dimensions. The marker facilitates focused radiation therapy, while allowing for tissue ingrowth during the healing process with resorption by the body overtime. Current literature investigating the use of the BioZorb is limited and focused on its value for radiation treatment. Our objective was to investigate the feasibility and surgical complications associated with the BioZorb in breast-conserving surgery. From April 2015 to June 2018, 89 patients who underwent 91 partial mastectomies with planned adjuvant radiation therapy and placement of the BioZorb.Demographics, type of BioZorb used, complication rate, and postoperative examinations were analyzed. A total of 89 patients who were a median age of 59 years (range 34-84) underwent 91 operations with BioZorb placement-86.8% underwent a partial mastectomy (n = 79), and 13.2% underwent a breast wide re-excision for margins at the time of BioZorb placement (n = 12). Of the 79 partial mastectomies, 21.5% (n = 17) were palpable tumors. Location of the tumor and subsequent BioZorb placement was most often in the upper outer quadrant (40.7%), followed by upper inner (27.5%), lower outer (20.9%), and lower inner quadrants (10.9%). 92.3% (n = 84) had a single BioZorb placed, 5.5% (n = 5) had two BioZorbs placed in a single lumpectomy cavity, and 2.2% (n = 2) had two BioZorbs placed in separate lumpectomy cavities of the same breast. Of the 10 different tissue marker sizes used, a 2 × 3 cm BioZorb was most commonly used (37/98, 37.8%), followed by 3 × 4 cm (25/98, 25.5%) and 1 × 3 × 2 (9/98, 9.2%). A total of five patients underwent immediate bilateral breast reduction following placement of the BioZorb. Of the 91 operations, 22 patients had a subsequent reoperation for positive margins after initial placement of the BioZorb, of which 86.4% retained the BioZorb. During these reoperations, only 1 patient had the BioZorb removed due to discomfort (4.5%) and two had it removed due to subsequent mastectomy (9.1%). At a median time of 1.1 years, the BioZorb continued to be palpable on clinical breast examination in 63.6% of patients. The longest time that the BioZorb continued to be palpable was 2.8 years. Additional imaging was ordered because a clinician palpated a mass, unaware it was the BioZorb 8.8% of the time 2 × 3 37/98 (37.8) 3 × 3 7/98 (7.1) 3 × 4 25/98 (25.5) 4 × 4 3/98 (3.1) 4 × 5 4/98 (4.1) Low-profile device sizes 1 × 3 × 2 9/98 (9.2) 1 × 3 × 3 3/98 (3.1) 2 × 1 × 1 1/98 (1.0) 2 × 2 × 1 4/98 (4.1) Abbreviation: cm, centimeters.

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Section: Discussionmentioning

confidence: 99%

Utilization of BioZorb implantable device in breast‐conserving surgery

Srour

Chung

2019

Breast J

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“…4 In recent years, SBRT has been investigated to apply for early-stage breast cancer, that is, stereotactic partial breast irradiation (SPBI). [5][6][7][8] It is essential for SPBI to deliver accurate radiation dose to tumor; however, traditional radiotherapy workflow cannot meet this requirement. 5 In addition, the occurrence of lumpectomy shrinkage and radiation-induced breast swelling leads to large interfraction geometric uncertainties.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8] It is essential for SPBI to deliver accurate radiation dose to tumor; however, traditional radiotherapy workflow cannot meet this requirement. 5 In addition, the occurrence of lumpectomy shrinkage and radiation-induced breast swelling leads to large interfraction geometric uncertainties. 9,10 There also appear some unpredictable intrafraction geometric uncertainties because of the involuntary breathing movement.…”

Section: Introductionmentioning

confidence: 99%

“…As a new technology, stereotactic body radiotherapy (SBRT) not only improves normal tissue sparing, but also delivers higher radiation dose to the tumor through several fractions 4 . In recent years, SBRT has been investigated to apply for early‐stage breast cancer, that is, stereotactic partial breast irradiation (SPBI) 5–8 . It is essential for SPBI to deliver accurate radiation dose to tumor; however, traditional radiotherapy workflow cannot meet this requirement 5 .…”

Section: Introductionmentioning

confidence: 99%

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X‐ray‐induced acoustic computed tomography for guiding prone stereotactic partial breast irradiation: a simulation study

et al. 2020

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The aim of this study is to investigate the feasibility of x-ray-induced acoustic computed tomography (XACT) as an image guidance tool for tracking x-ray beam location and monitoring radiation dose delivered to the patient during stereotactic partial breast irradiation (SPBI). Methods: An in-house simulation workflow was developed to assess the ability of XACT to act as an in vivo dosimetry tool for SPBI. To evaluate this simulation workflow, a three-dimensional (3D) digital breast phantom was created by a series of two-dimensional (2D) breast CT slices from a patient. Three different tissue types (skin, adipose tissue, and glandular tissue) were segmented and the postlumpectomy seroma was simulated inside the digital breast phantom. A treatment plan was made with three beam angles to deliver radiation dose to the seroma in breast to simulate SPBI. The three beam angles for 2D simulations were 17°, 90°and 159°(couch angles were 0 degrees) while the angles were 90 degrees (couch angles were 0°, 27°, 90°) in 3D simulation. A multi-step simulation platform capable of modelling XACT was developed. First, the dose distribution was converted to an initial pressure distribution. The propagation of this pressure disturbance in the form of induced acoustic waves was then modeled using the k-wave MATLAB toolbox. The waves were then detected by a hemispherical-shaped ultrasound transducer array (6320 transducer locations distributed on the surface of the breast). Finally, the time-varying pressure signals detected at each transducer location were used to reconstruct an image of the initial pressure distribution using a 3D time-reversal reconstruction algorithm. Finally, the reconstructed XACT images of the radiation beams were overlaid onto the structure breast CT. Results: It was found that XACT was able to reconstruct the dose distribution of SPBI in 3D. In the reconstructed 3D volumetric dose distribution, the average doses in the GTV (Gross Target Volume) and PTV (Planning Target Volume) were 86.15% and 80.89%, respectively. When compared to the treatment plan, the XACT reconstructed dose distribution in the GTV and PTV had a RMSE (root mean square error) of 2.408 % and 2.299 % over all pixels. The 3D breast XACT imaging reconstruction with time-reversal reconstruction algorithm can be finished within several minutes. Conclusions: This work explores the feasibility of using the novel imaging modality of XACT as an in vivo dosimeter for SPBI radiotherapy. It shows that XACT imaging can provide the x-ray beam location and dose information in deep tissue during the treatment in real time in 3D. This study lays the groundwork for a variety of future studies related to the use of XACT as a dosimeter at different cancer sites.

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