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

Reitz, D.; Ganter, Carl; Schönecker, S.; Pazos, Montserrat; Freislederer, P.; Niyazi, Maximilian; Ganswindt, Ute; Alongi, Filippo; Reiner, M. J.; Belka, Claus; Corradini, Stefanie

doi:10.1186/s13014-018-1072-4

Cited by 50 publications

(38 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Surface guided radiation therapy (SGRT) offers the possibility to monitor patient movements in real-time using a non-invasive approach, without any additional radiation exposure. SGRT has also proven to be a reliable tool for patient positioning by complementing in-room laser-assisted positioning, as well as for intrafraction monitoring during breast radiotherapy [18][19][20][21]. Moreover, SGRT may even reduce the frequency of conventional imaging during breast DIBH RT [22].…”

Section: Introductionmentioning

confidence: 99%

Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer

et al. 2020

Self Cite

View full text Add to dashboard Cite

Purpose: Patients with left-sided breast cancer frequently receive deep inspiration breath-hold (DIBH) radiotherapy to reduce the risk of cardiac side effects. The aim of the present study was to analyze intra-breath-hold stability and inter-fraction breath-hold reproducibility in clinical practice. Material and methods: Overall, we analyzed 103 patients receiving left-sided breast cancer radiotherapy using a surface-guided DIBH technique. During each treatment session the vertical motion of the patient was continuously measured by a surface guided radiation therapy (SGRT) system and automated gating control (beam on/off) was performed using an audiovisual patient feedback system. Dose delivery was automatically triggered when the tracking point was within a predefined gating window. Intra-breath-hold stability and inter-fraction reproducibility across all fractions of the entire treatment course were analyzed per patient. Results: In the present series, 6013 breath-holds during beam-on time were analyzed. The mean amplitude of the gating window from the baseline breathing curve (maximum expiration during free breathing) was 15.8 mm (95%confidence interval: [8.5-30.6] mm) and had a width of 3.5 mm (95%-CI: [2-4.3] mm). As a measure of intra-breathhold stability, the median standard deviation of the breath-hold level during DIBH was 0.3 mm (95%-CI: [0.1-0.9] mm). Similarly, the median absolute intra-breath-hold linear amplitude deviation was 0.4 mm (95%-CI: [0.01-2.1] mm). Reproducibility testing showed good inter-fractional reliability, as the maximum difference in the breathing amplitudes in all patients and all fractions were 1.3 mm on average (95%-CI: [0.5-2.6] mm). Conclusion: The clinical integration of an optical surface scanner enables a stable and reliable DIBH treatment delivery during SGRT for left-sided breast cancer in clinical routine.

show abstract

Section: Introductionmentioning

confidence: 99%

Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…7,8 In this study we employ SGRT for positioning patients treated with whole breast irradiation in free breathing. 7,8 In this study we employ SGRT for positioning patients treated with whole breast irradiation in free breathing.…”

mentioning

confidence: 99%

“…RMS of setup displacement for each patient sorted in ascending patient age. A study by Reitz et al used the C-rad SGRT system (Uppsala, Sweden) for monitoring intrafraction motion in a large cohort and reported a median deviation vector of 1.63 mm 7. A study by Reitz et al used the C-rad SGRT system (Uppsala, Sweden) for monitoring intrafraction motion in a large cohort and reported a median deviation vector of 1.63 mm 7.…”

mentioning

confidence: 99%

“…Intrafraction motion during radiotherapy has also been investigated and reported to be within the usual treatment margins of the order of 5 mm. 7,8 In this study we employ SGRT for positioning patients treated with whole breast irradiation in free breathing. We compare setup strategies using either three-point localization with tattoos on the thorax of the patient or SGRT followed by orthogonal kV images.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of setup and intrafraction motion for surface guided whole‐breast cancer radiotherapy

Hattel

Andersen

Wahlstedt

et al. 2019

J Applied Clin Med Phys

View full text Add to dashboard Cite

Surface Guided Radiotherapy (SGRT) is a relatively new technique for positioning patients and for monitoring patient movement during treatment. SGRT is completely non‐invasive since it uses visible light for determining the position of the patient surface. A reduction in daily imaging for patient setup is possible if the accuracy of SGRT is comparable to imaging. It allows for monitoring of intrafraction motion and the radiation beam can be held beyond a certain threshold resulting in a more accurate irradiation. The purpose of this study was to investigate setup uncertainty and the intrafraction motion in non‐gated whole breast cancer radiotherapy treatment using an integrated implementation of AlignRT (OSMS) system as SGRT. In initial setup, SGRT was compared to three‐point setup using tattoos on the patient and orthogonal kV imaging. For the investigation of intrafraction motion, OSMS monitored the patient with six degrees of freedom during treatment. Using three‐point setup resulted in a setup root‐mean‐square error from the isocenter of 5.4 mm. This was improved to 4.2 mm using OSMS. For the translational directions, OSMS showed improvements in the lateral direction (P = 0.0009, Wilcoxon rank‐sum), but for the longitudinal direction and rotation it was not possible to show improvements (P = 0.96 and P = 0.46, respectively). The vertical direction proved more accurate for three‐point setup than OSMS (P = 0.000004). Intrafraction motion was very limited with a translational median of 1.1 mm from the isocenter. While OSMS showed marked improvements over laser and tattoo setup, the system did not prove accurate enough to replace the daily orthogonal kV images aligned to bony anatomy.

show abstract

“…3DSI are powerful imaging devices that have already found widespread application in the field of plastic surgery, where they are advantageously affecting the process of planning and documenting breast-surgical procedures. One of the used imaging methods is depth sensor-based tracking of the body contour, which is also used for Surface Image Guided Radiation Therapy [15][16][17][18]. Other technologies, such as stereo-photogrammetric or structured light 3DSI, are also viable options for clinical applications [19].…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional surface imaging in breast cancer: a new tool for clinical studies?

Koban

Etzel

et al. 2020

Radiat Oncol

View full text Add to dashboard Cite

Background: Three-dimensional Surface Imaging (3DSI) is a well-established method to objectively monitor morphological changes in the female breast in the field of plastic surgery. In contrast, in radiation oncology we are still missing effective tools, which can objectively and reproducibly assess and document adverse events in breast cancer radiotherapy within the framework of clinical studies. The aim of the present study was to apply structuredlight technology as a non-invasive and objective approach for the documentation of cosmetic outcome and early effects of breast radiotherapy as a proof of principle. Methods: Weekly 3DSI images of patients receiving either conventionally fractionated radiation treatment (CF-RT) or hypofractionated radiation treatment (HF-RT) were acquired during the radiotherapy treatment and clinical follow-up. The portable Artec Eva scanner (Artec 3D Inc., Luxembourg) recorded 3D surface images for the analysis of breast volumes and changes in skin appearance. Statistical analysis compared the impact of the two different fractionation regimens and the differences between the treated and the contralateral healthy breast. Results: Overall, 38 patients and a total of 214 breast imaging sessions were analysed. Patients receiving CF-RT showed a significantly higher frequency of breast erythema compared to HF-RT (93.3% versus 34.8%, p = 0.003) during all observed imaging sessions. Moreover, we found a statistically significant (p < 0.05) volumetric increase of the treated breast of the entire cohort between baseline (379 ± 196 mL) and follow-up imaging at 3 months (437 ± 224 mL), as well as from week 3 of radiotherapy (391 ± 198 mL) to follow-up imaging. In both subgroups of patients undergoing either CF-RT or HF-RT, there was a statistically significant increase (p < 0.05) in breast volumes between baseline and 3 months follow-up. There were no statistically significant skin or volumetric changes of the untreated healthy breasts. Conclusions: This is the first study utilizing 3D structured-light technology as a non-invasive and objective approach for the documentation of patients receiving breast radiotherapy. 3DSI offers potential as a non-invasive tool to objectively and precisely monitor the female breast in a radiooncological setting, allowing clinicians to objectively distinguish outcomes of different therapy modalities.

show abstract

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

Cited by 50 publications

References 28 publications

Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer

Stability and reproducibility of 6013 deep inspiration breath-holds in left-sided breast cancer

Evaluation of setup and intrafraction motion for surface guided whole‐breast cancer radiotherapy

Three-dimensional surface imaging in breast cancer: a new tool for clinical studies?

Contact Info

Product

Resources

About