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

Reitz, D.; Walter, Franziska; Schönecker, S.; Freislederer, P.; Pazos, Montserrat; Niyazi, Maximilian; Landry, Guillaume; Alongi, Filippo; Bölke, Edwin; Matuschek, Christiane; Reiner, M. J.; Belka, Claus; Corradini, Stefanie

doi:10.1186/s13014-020-01572-w

Cited by 40 publications

(43 citation statements)

References 29 publications

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“…Similar deviations are observed; between 1 and 2 mm of median intra-breath hold deviation. Surface scanning based gating shows better intra breath-hold stability, as was measured by Reitz et al [23] using a linear fit, similar to our approach. They detect median drift of only 0.4 mm within the gating window.…”

Section: Discussionsupporting

confidence: 83%

Spirometer-guided breath-hold breast VMAT verified with portal images and surface tracking

Delombaerde

Petillion

Weltens

et al. 2021

Radiotherapy and Oncology

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Background and purpose: Fast rotating closed-bore gantry linacs are ideally suited for breath-hold treatments due to reduced imaging and delivery times. We evaluated the reproducibility and stability of spirometer-guided breath-hold breast treatments, using intra-bore surface monitoring and portal imaging on Halcyon (Varian Medical Systems). Materials and methods: Seven left-sided breast cancer patients were treated in breath-hold using the SDX spirometer (Dyn'R) with an integrated boost volumetric arc protocol on Halcyon. A dual depth-camera surface scanning system monitored the left breast. The interfraction, intrafraction and intrabreath-hold motion was determined in the anterior-posterior (AP) and superior-inferior (SI) direction. Portal images (PI), acquired at a tangential gantry angle were manually registered to the planning-CT to determine inter-and intrafraction breath-hold errors for the SI and tangential-anterior-posterior (''AP") axis. Correlations between PI and surface imaging deviations were investigated. To evaluate workflow efficiency, the total time and the number of breath-holds were recorded. Results: Systematic and random variability of breath-hold amplitude was below 0.7 mm for the AP and below 1.2 mm for the SI component as detected by surface monitoring (N = 130). Systematic and random errors retrieved from portal images (N = 140) were below 1.2 mm for the ''AP" and 2.1 mm for SI axis. A limited correlation was found between PI and surface monitoring deviations for both the SI and ''AP" axes (R 2 = 0.27/0.38, p < 0.01). 75% of fractions were completed using four breath-holds and 82% within 10 min. Conclusion: Surface imaging indicated spirometer-guided breath-hold VMAT breast radiotherapy can be accurately and quickly performed on a closed-bore gantry linac. Intra-bore surface scanning proved a valuable technique for monitoring breathing motion in closed-bore systems.

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Section: Discussionsupporting

confidence: 83%

Spirometer-guided breath-hold breast VMAT verified with portal images and surface tracking

Delombaerde

Petillion

Weltens

et al. 2021

Radiotherapy and Oncology

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“…SGRT systems offer the possibility of evaluating intra-DIBH stability, which has been reported with ≤0.7 mm, together with an intra-fractional reproducibility of ≤2.2 mm [68] and with 0.3 mm as the median standard deviation of the BH level during DIBH [69]. Kügele et al reported that the intrafractional reproducibility for tangential and locoregional treatment was as low as 1 mm (median over 40 patients) in all three translational directions, but during a single treatment session the maximum deviation was up to 5 mm, which resulted in large effects on the target coverage and OAR doses [70].…”

Section: Breath-holdmentioning

confidence: 99%

Recent advances in Surface Guided Radiation Therapy

et al. 2020

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The growing acceptance and recognition of Surface Guided Radiation Therapy (SGRT) as a promising imaging technique has supported its recent spread in a large number of radiation oncology facilities. Although this technology is not new, many aspects of it have only recently been exploited. This review focuses on the latest SGRT developments, both in the field of general clinical applications and special techniques. SGRT has a wide range of applications, including patient positioning with real-time feedback, patient monitoring throughout the treatment fraction, and motion management (as beam-gating in free-breathing or deep-inspiration breath-hold). Special radiotherapy modalities such as accelerated partial breast irradiation, particle radiotherapy, and pediatrics are the most recent SGRT developments. The fact that SGRT is nowadays used at various body sites has resulted in the need to adapt SGRT workflows to each body site. Current SGRT applications range from traditional breast irradiation, to thoracic, abdominal, or pelvic tumor sites, and include intracranial localizations. Following the latest SGRT applications and their specifications/requirements, a stricter quality assurance program needs to be ensured. Recent publications highlight the need to adapt quality assurance to the radiotherapy equipment type, SGRT technology, anatomic treatment sites, and clinical workflows, which results in a complex and extensive set of tests. Moreover, this review gives an outlook on the leading research trends. In particular, the potential to use deformable surfaces as motion surrogates, to use SGRT to detect anatomical variations along the treatment course, and to help in the establishment of personalized patient treatment (optimized margins and motion management strategies) are increasingly important research topics. SGRT is also emerging in the field of patient safety and integrates measures to reduce common radiotherapeutic risk events (e.g. facial and treatment accessories recognition). This review covers the latest clinical practices of SGRT and provides an outlook on potential applications of this imaging technique. It is intended to provide guidance for new users during the implementation, while triggering experienced users to further explore SGRT applications.

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“…These setup margins were large, and so the errors would be overestimated. Recent reports evaluated intra- and inter-fractional chest wall motion during DIBH [ 19 , 21 ]. However, there are no reports that effectively provide appropriate PTV margins without overestimation of systematic errors.…”

Section: Introductionmentioning

confidence: 99%

Appropriate margin for planning target volume for breast radiotherapy during deep inspiration breath-hold by variance component analysis

et al. 2021

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Background This study aimed to quantify errors by using a cine electronic portal imaging device (cine EPID) during deep inspiration breath-hold (DIBH) for left-sided breast cancer and to estimate the planning target volume (PTV) by variance component analysis. Methods This study included 25 consecutive left-sided breast cancer patients treated with whole-breast irradiation (WBI) using DIBH. Breath-holding was performed while monitoring abdominal anterior–posterior (AP) motion using the Real-time Position Management (RPM) system. Cine EPID was used to evaluate the chest wall displacements in patients. Cine EPID images of the patients (309,609 frames) were analyzed to detect the edges of the chest wall using a Canny filter. The errors that occurred during DIBH included differences between the chest wall position detected by digitally reconstructed radiographs and that of all cine EPID images. The inter-patient, inter-fraction, and intra-fractional standard deviations (SDs) in the DIBH were calculated, and the PTV margin was estimated by variance component analysis. Results The median patient age was 55 (35–79) years, and the mean irradiation time was 20.4 ± 1.7 s. The abdominal AP motion was 1.36 ± 0.94 (0.14–5.28) mm. The overall mean of the errors was 0.30 mm (95% confidence interval: − 0.05–0.65). The inter-patient, inter-fraction, and intra-fractional SDs in the DIBH were 0.82 mm, 1.19 mm, and 1.63 mm, respectively, and the PTV margin was calculated as 3.59 mm. Conclusions Errors during DIBH for breast radiotherapy were monitored using EPID images and appropriate PTV margins were estimated by variance component analysis.

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

Cited by 40 publications

References 29 publications

Spirometer-guided breath-hold breast VMAT verified with portal images and surface tracking

Spirometer-guided breath-hold breast VMAT verified with portal images and surface tracking

Recent advances in Surface Guided Radiation Therapy

Appropriate margin for planning target volume for breast radiotherapy during deep inspiration breath-hold by variance component analysis

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