Reproducibility of diaphragm position assessed with a voluntary breath-holding device

Takamatsu, Shigeyuki; Takanaka, Tsuyoshi; Kumano, Tomoyasu; Mizuno, Ei-ichi; Shibata, Satoshi; Ohashi, Shizuko; Kurata, Yoshiyuki; Ueda, Shuichi; Hori, Naoaki; Shouji, Saori; Noto, Kimiya; Kojima, Hironori; Matsui, Osamu

doi:10.1007/s11604-013-0199-3

Cited by 10 publications

(11 citation statements)

References 16 publications

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“…The liver moves in association with respiration [ 11 , 12 , 13 ]. There are many techniques to reduce the internal target volume (ITV) margin by decreasing respiratory motion using oxygen inhalation, abdominal compression, respiratory-gated treatment with/without implanting fiducial markers, and a voluntary breath-holding device [ 9 , 10 , 14 , 15 , 16 ]. In SBRT and PBT for liver neoplasms, fiducial markers are often used to aid in positioning [ 9 , 10 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Proton Beam Therapy without Fiducial Markers Using Four-Dimensional CT Planning for Large Hepatocellular Carcinomas

Shibata

Takamatsu

Yamamoto

et al. 2018

Cancers

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We evaluated the effectiveness and toxicity of proton beam therapy (PBT) for hepatocellular carcinomas (HCC) >5 cm without fiducial markers using four-dimensional CT (4D-CT) planning. The subjects were 29 patients treated at our hospital between March 2011 and March 2015. The median total dose was 76 Cobalt Gray Equivalents (CGE) in 20 fractions (range; 66–80.5 CGE in 10–32 fractions). Therapy was delivered with end-expiratory phase gating. An internal target volume (ITV) margin was added through the analysis of respiratory movement with 4D-CT. Patient age ranged from 38 to 87 years (median, 71 years). Twenty-four patients were Child–Pugh class A and five patients were class B. Tumor size ranged from 5.0 to 13.9 cm (median, 6.9 cm). The follow-up period ranged from 2 to 72 months (median; 27 months). All patients completed PBT according to the treatment protocol without grade 4 (CTCAE v4.03 (draft v5.0)) or higher adverse effects. The two-year local tumor control (LTC), progression-free survival (PFS), and overall survival (OS) rates were 95%, 22%, and 61%, respectively. The LTC was not inferior to that of previous reports using fiducial markers. Respiratory-gated PBT with 4D-CT planning without fiducial markers is a less invasive and equally effective treatment for large HCCs as PBT with fiducial markers.

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Section: Introductionmentioning

confidence: 99%

Proton Beam Therapy without Fiducial Markers Using Four-Dimensional CT Planning for Large Hepatocellular Carcinomas

Shibata

Takamatsu

Yamamoto

et al. 2018

Cancers

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“…The fiducial marker positions were contoured on a DRR image window of the XVI display. Subsequently, the marker contours were manually copied onto a fluoroscopic image window of the XVI display using a transparent sheet and a pen, similar to the procedure described by Takamatsu et al 5 …”

Section: Methodsmentioning

confidence: 99%

“…Meanwhile, a real-time fluoroscopic image-guided approach was proposed by comparing the diaphragm position between digitally reconstructed radiography (DRR) and real-time kilovolt fluoroscopic images during beam delivery 5 to assist the clinical staff with manually starting and interrupting the treatment beam during multiple breath-hold treatment. This technique was based on the spatial comparison between the diaphragm contour drawn on the DRR image and the real-time fluoroscopic diaphragm image; therefore, fixed-field beam delivery such as non-coplanar static fields were employed for treating tumours that move with respiration.…”

Section: Introductionmentioning

confidence: 99%

Multiple breath-hold segmented volumetric modulated arc therapy under real-time fluoroscopic image guidance with implanted fiducial markers: preliminary clinical experience

et al. 2017

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A technique for multiple breath-hold segmented volumetric modulated arc therapy (VMAT) has been proposed under real-time fluoroscopic image guidance with implanted fiducial markers. Fiducial markers were embedded as close as possible to a tumour and the patient was asked to breathe in slowly under fluoroscopy. Immediately after the marker positions on the fluoroscopic image moved inside the planned marker contours transferred from a digitally reconstructed radiographic image at each gantry start angle, the patient was asked to hold their breath and a segmented VMAT beam was delivered. During beam delivery, the breath-hold status was continuously monitored by viewing a pointer in a breath monitoring system, Abches (Apex Medical, Tokyo, Japan), with the aid of a video camera installed in the treatment room. As long as the pointer stayed still, the segmented VMAT delivery continued for a preset period of 15–30 s, depending on the breath-hold capability of each patient. As soon as each segmented delivery was completed, the beam interrupt button was pushed; subsequently, the patient was asked to breathe freely. Because the preset breath-hold period was determined in order for each patient to hold their breath without fail, an intermediate beam interrupt due to breath-hold failure during the segmented beam delivery was not observed. This procedure was repeated until all the segmented VMAT beams were delivered. A case of pancreatic cancer is reported here as a preliminary study. The proposed technique may be clinically advantageous for treating tumours that move with respiration, including pancreatic cancer, lung tumour and other abdominal cancers.

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“…The Abches breathing monitoring device has been described in previous publications [1,[4][5][6][7]. The device allows patients to self-monitor their breathing during imaging and/or treatment.…”

Section: Breathing Control Devicementioning

confidence: 99%

“…The benefits of Abches monitoring device to ensure reproducible BH radiotherapy treatment have been established in several previous studies [1,[4][5][6][7]. This device has been extensively used, particularly in Asia, to treat multiple sites, including lung, liver, and breast cancer.…”

Section: Figure 3: Ct Images and Treatment Isodoses Of A Marginal Bhmentioning

confidence: 99%

Accuracy of Breath-hold CT in Treatment Planning for Lung Stereotactic Ablative Radiotherapy

Mathieu¹,

Martel²,

Campeau³

et al. 2014

Cureus

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Reproducibility of diaphragm position assessed with a voluntary breath-holding device

Abstract: This technique has good interfractional reproducibility and visibility of the diaphragm during irradiation. Its use is feasible in the routine clinical setting and irradiation.

Cited by 10 publications

References 16 publications

Proton Beam Therapy without Fiducial Markers Using Four-Dimensional CT Planning for Large Hepatocellular Carcinomas

Proton Beam Therapy without Fiducial Markers Using Four-Dimensional CT Planning for Large Hepatocellular Carcinomas

Multiple breath-hold segmented volumetric modulated arc therapy under real-time fluoroscopic image guidance with implanted fiducial markers: preliminary clinical experience

Accuracy of Breath-hold CT in Treatment Planning for Lung Stereotactic Ablative Radiotherapy

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