The Potential Role of Lung Ultrasound B‐Lines for Detection of Lung Radio‐Induced Toxicity in Breast Cancer Patients after Radiation Therapy

Petruzzelli, Maria Fonte; Vasti, Maria Pia; Tramacere, Francesco; D’Errico, Maria Patrizia; Gianicolo, Emilio Antonio Luca; M.Sc., Maria Grazia Andreassi; Portaluri, Maurizio

doi:10.1111/echo.13249

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…In the treatment of breast with VMAT, the dose distribution to the lungs is normally grossly different from what is achieved with the conformal tangential beams. In a recent report, Petruzzelli et al 21 evaluated the number of B-lines in lung ultrasound examination (I lung and C lung ) on patients treated for breast cancer. Authors found a significantly larger amount of B-lines in the I lung ; in particular, the pattern was mainly in the anterior rather than the posterior chest, i.e.…”

Section: 10mentioning

confidence: 99%

Dosimetric trade-offs in breast treatment with VMAT technique

Fogliata

Seppälä

Reggiori

et al. 2017

The British Journal of Radiology

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Objective: Breast planning with volumetric modulated arc therapy (VMAT) has been explored, especially for leftsided breast treatments, with the primary intent of lowering the heart dose and improving target dose homogeneity. As a trade-off, larger healthy tissue volumes would receive low dose levels, with the potential risk of increasing late toxicities and secondary cancer induction, although no clinical data are available today to confirm the risk level. The scope of this work is to explore the dosimetric trade-offs using two different VMAT plans. Methods: Two planning strategies for dual-partial-arc VMAT, RA_avoid and RA_full, with and without avoidance sectors, were explored in a cohort of 20 patients, for whole left breast irradiation for 40.05 Gy to the mean target dose in 15 fractions. Common dose objectives included a stringent dose homogeneity, mean dose to the heart ,5 Gy, ipsilateral lung (I lung ) ,8 Gy, contralateral lung (C lung ) ,2 Gy and contralateral breast (C breast ) ,3 Gy.Results: RA_full showed a better dose conformity, lower high-dose spillage in the healthy tissue and lower skin dose. RA_avoid presented a reduction of the mean doses for all critical structures: 51% to the heart, 12% to the I lung , 81% to the C lung and 73% to the C breast . All differences were significant with p , 0.0001. Conclusion: The adaptation of VMAT options to planning objectives reduced significantly the healthy tissue dose levels at the price of some high-dose spillage. Evaluation of the trade-offs for application to the different critical structures should drive in improving the usage of the VMAT technique for breast cancer treatment. Advances in knowledge: Different planning strategies in the same VMAT technique could give significant variations in dose distributions. The choice of the trade-offs would affect the possible future late toxicity and secondary cancer induction risk. INTRODUCTIONRadiotherapy treatment is an integral part of the standard of care of patients with breast cancer after breast-conserving surgery. Different fractionation schemes have been applied, from the conventional 50 Gy in 25 fractions to hypofractionated regimes like 40.05 Gy delivered in 15 fractions, as proposed by the START (UK Standardisation of Breast Radiotherapy) Trial B.

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Section: 10mentioning

confidence: 99%

Dosimetric trade-offs in breast treatment with VMAT technique

Fogliata

Seppälä

Reggiori

et al. 2017

The British Journal of Radiology

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“…The B-lines are vertical hyperechoic lines, which emanate from the pleural line, move with the breathing cycle, erase the A-lines, and extend to the viewing screen's lower limit (Figure 2B). The finding of three or more B-lines between two ribs indicates interstitial pulmonary syndrome, such as pulmonary congestion 8,9 . The comet tail is a short reverberation artifact, hyperechoic, move with lung sliding, whose appearance is obviously different from B-lines and can be seen in normal lungs 10,11 .…”

Section: Lung Artifactsmentioning

confidence: 99%

Lung ultrasound: an opportunity to increase the accuracy of the physical examination by the nephrologist

Bastos

2021

Rev. Assoc. Med. Bras.

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“…[18][19][20] B lines and other artifacts may be present in association with lung or pleural modifications in many interstitial lung diseases and other diffuse parenchymal lung diseases, including idiopathic pulmonary fibrosis (IPF), systemic sclerosis, interstitial pneumonia, rheumatoid arthritis, nephrotic syndrome, ARDS, radiation fibrosis. [21][22][23][24][25][26] As B lines are a type of reverberation artifact mainly generating when sound waves excite the fluid trapped between air bubbles causing the fluid to resonate, the number of B lines will increase in all those pathological pleuro-pulmonary conditions where the proportion of air/liquid film changed. However, despite many recent attempts of counting artefacts for the diagnosis of pulmonary fibrosis, pulmonary oedema, or any extra-vascular lung water have been proposed, these artifacts lack any disease-specificity.…”

Section: Resultsmentioning

confidence: 99%

Transthoracic ultrasound versus intraoperative ultrasound in patients with pulmonary fibrosis: Reappraisal of artifacts

et al. 2019

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In the last years, transthoracic ultrasound (TUS) has regained a growing interest from both clinicians and radiologists as a useful and non-invasive diagnostic tool for the study of many pleuro-pulmonary conditions, including interstitial lung diseases. Intraoperative lung ultrasound (ILU) is an ultrasound technique, developed for lung surface assessment during video-assisted thoracoscopic surgery procedures. It has been developed considering ultrasound basic physics principles for images generation and interpretation. Most of the TUS findings are due to the high difference in acoustic impedance between the chest-wall structures and the air in the lungs. In this brief communication, we compared ILU and TUS images in interstitial lung diseases. Most of the TUS artifacts-based diagnostic algorithms should be reappraised.

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The Potential Role of Lung Ultrasound B‐Lines for Detection of Lung Radio‐Induced Toxicity in Breast Cancer Patients after Radiation Therapy

Abstract: Among women receiving radiotherapy after breast cancer, B-lines are present predominantly in the irradiated lung. These data suggest that B-lines by LUS could provide, at a subclinical stage, a radiation-free biomarker of radiotherapy-induced lung damage.

Cited by 9 publications

References 21 publications

Dosimetric trade-offs in breast treatment with VMAT technique

Dosimetric trade-offs in breast treatment with VMAT technique

Lung ultrasound: an opportunity to increase the accuracy of the physical examination by the nephrologist

Transthoracic ultrasound versus intraoperative ultrasound in patients with pulmonary fibrosis: Reappraisal of artifacts

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