Top

Published in:

Open Access 01-12-2019 | Computed Tomography | Research

Evaluation of a 3D surface imaging system for deep inspiration breath-hold patient positioning and intra-fraction monitoring

Authors: Vincent C. Hamming, Christa Visser, Estelle Batin, Leah N. McDermott, Dianne M. Busz, Stefan Both, Johannes A. Langendijk, Nanna M. Sijtsema

Published in: Radiation Oncology | Issue 1/2019

Abstract

Purpose

To determine the accuracy of a surface guided radiotherapy (SGRT) system for positioning of breast cancer patients in breath-hold (BH) with respect to cone-beam computed tomography (CBCT). Secondly, to evaluate the thorax position stability during BHs with SGRT, when using an air-volume guidance system.

Methods and materials

Eighteen left-sided breast cancer patients were monitored with SGRT during CBCT and treatment, both in BH. CBCT scans were matched on the target volume and the patient surface. The setup error differences were evaluated, including with linear regression analysis. The intra-fraction variability and stability of the air-volume guided BHs were determined from SGRT measurements. The variability was determined from the maximum difference between the different BH levels within one treatment fraction. The stability was determined from the difference between the start and end position of each BH.

Results

SGRT data correlated well with CBCT data. The correlation was stronger for surface-to-CBCT (0.61) than target volume-to-CBCT (0.44) matches. Systematic and random setup error differences were ≤ 2 mm in all directions. The 95% limits of agreement (mean ± 2SD) were 0.1 ± 3.0, 0.6 ± 4.1 and 0.4 ± 3.4 mm in the three orthogonal directions, for the surface-to-CBCT matches. For air-volume guided BHs, the variability detected with SGRT was 2.2, 2.8 and 2.3 mm, and the stability − 1.0, 2.1 and 1.5 mm, in three orthogonal directions. Furthermore, the SGRT system could detect unexpected patient movement, undetectable by the air-volume BH system.

Conclusion

With SGRT, left-sided breast cancer patients can be positioned and monitored continuously to maintain position errors within 5 mm. Low intra-fraction variability and good stability can be achieved with the air-volume BH system, however, additional patient position information is available with SGRT, that cannot be detected with air-volume BH systems.

Hooning MJ, Botma A, Aleman BMP, Baaijens MHA, Bartelink H, Klijn JGM, et al. Long-term risk of cardiovascular disease in 10-year survivors of breast cancer. J Natl Cancer Inst. 2007;99:365–75.CrossRef

Sripathi LK, Ahlawat P, Simson DK, Khadanga CR, Kamarsu L, Surana SK, et al. Cardiac dose reduction with deep-inspiratory breath hold technique of radiotherapy for left-sided breast cancer. J Med Phys. 2017;42:123–7 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618457/. India: Medknow Publications & Media Pvt Ltd.CrossRef

Bartlett FR, Colgan RM, Donovan EM, Carr K, Landeg S, Clements N, et al. Voluntary breath-hold technique for reducing heart dose in left breast radiotherapy. J Vis Exp. 2014:1–9 Available from: http://www.jove.com/video/51578/voluntary-breath-hold-technique-for-reducing-heart-dose-left-breast.

Yeung R, Conroy L, Long K, Walrath D, Li H, Smith W, et al. Cardiac dose reduction with deep inspiration breath hold for left-sided breast cancer radiotherapy patients with and without regional nodal irradiation. Radiat Oncol; 2015;10:1–6. Available from: https://doi.org/10.1186/s13014-015-0511-8.

Mulliez T, Veldeman L, Speleers B, Mahjoubi K, Remouchamps V, Van Greveling A, et al. Heart dose reduction by prone deep inspiration breath hold in left-sided breast irradiation. Radiother Oncol. Elsevier Ireland Ltd; 2015;114:79–84. Available from: https://doi.org/10.1016/j.radonc.2014.11.038 CrossRef

Kügele M, Edvardsson A, Berg L, Alkner S, Andersson Ljus C, Ceberg S. Dosimetric effects of intrafractional isocenter variation during deep inspiration breath-hold for breast cancer patients using surface-guided radiotherapy. J Appl Clin Med Phys. 2018;19:25–38.CrossRef

Wong JW, Sharpe MB, Jaffray DA, Kini VR, Robertson JM, Stromberg JS, et al. The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Radiat Oncol Biol Phys. 1999;44:911–9.CrossRef

White B, Wuenschel S, Zhao T, Lamb J, Low D. SU-GG-J-90: quantification of the thorax-to-abdomen breathing ratio for breathing motion modeling. Med Phys. 2010;37:3166.CrossRef

Goyal S, Kataria T. Image guidance in radiation therapy: techniques and applications. Radiol Res Pract. 2014;2014:1–10 Available from: http://www.hindawi.com/journals/rrp/2014/705604/. Hindawi Publishing Corporation.CrossRef

10.

Hoisak JDP, Pawlicki T. The role of optical surface imaging Systems in Radiation Therapy. Semin Radiat Oncol. Elsevier; 2018;28:185–193. Available from: https://doi.org/10.1016/j.semradonc.2018.02.003 CrossRef

11.

Pan H, Cerviño LI, Pawlicki T, Jiang SB, Alksne J, Detorie N, et al. Frameless, real-time, surface imaging-guided RadiosurgeryClinical outcomes for brain metastases. Neurosurgery 2012;71:844–852. Available from: https://doi.org/10.1227/NEU.0b013e3182647ad5.CrossRef

12.

Bartlett FR, Colgan RM, Carr K, Donovan EM, McNair HA, Locke I, et al. The UK HeartSpare Study: Randomised evaluation of voluntary deep-inspiratory breath-hold in women undergoing breast radiotherapy. Radiother Oncol; 2013;108:242–247. Available from: https://doi.org/10.1016/j.radonc.2013.04.021. Elsevier Ireland LtdCrossRef

13.

Hamid S, Ceberg S, Kügele M, Bergh L, Gunnlaugsson A. A comparison of surface based and laser based setup for rectal cancer patients in radiotherapy. 2017 [cited 2018 Jul 6]. Available from: http://lup.lub.lu.se/student-papers/record/8927723

14.

Crop F, Pasquier D, Baczkiewic A, Doré J, Bequet L, Steux E, et al. Surface imaging, laser positioning or volumetric imaging for breast cancer with nodal involvement treated by helical TomoTherapy. J Appl Clin Med Phys. 2016;17:200–11.CrossRef

15.

Fayad H, Wentz T, Pan T, Visvikis D. SU-E-J-148: correlation of respiratory motion between external patient surface and internal anatomical landmarks. Med Phys. 2011;38:3477.CrossRef

16.

Jensen CA, Roa AMA, Johansen M, Lund JÅ, Frengen J. Robustness of VMAT and 3DCRT plans toward setup errors in radiation therapy of locally advanced left-sided breast cancer with DIBH. Phys Medica. 2018;45:198–204.CrossRef

17.

Alderliesten T, Sonke JJ, Betgen A, Honnef J, Van Vliet-Vroegindeweij C, Remeijer P. Accuracy evaluation of a 3-dimensional surface imaging system for guidance in deep-inspiration breath-hold radiation therapy. Int J Radiat Oncol Biol Phys. Elsevier Inc.; 2013;85:536–542. Available from: https://doi.org/10.1016/j.ijrobp.2012.04.004 CrossRef

18.

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;327:307–10 Available from: http://www.sciencedirect.com/science/article/pii/S0140673686908378.CrossRef

19.

Shah AP, Dvorak T, Curry MS, Buchholz DJ, Meeks SL. Clinical evaluation of interfractional variations for whole breast radiotherapy using 3-dimensional surface imaging. Pract Radiat Oncol. 2013;3:16–25 Available from: http://www.sciencedirect.com/science/article/pii/S1879850012000409.CrossRef

20.

Krengli M, Gaiano S, Mones E, Ballarè A, Beldì D, Bolchini C, et al. Reproducibility of patient setup by surface image registration system in conformal radiotherapy of prostate cancer. Radiat Oncol. 2009;4:1–10.CrossRef

21.

Bartoncini S, Fiandra C, Ruo Redda MG, Allis S, Munoz F, Ricardi U. Target registration errors with surface imaging system in conformal radiotherapy for prostate cancer: study on 19 patients. Radiol Med. 2012;117:1419–28. Available from. https://doi.org/10.1007/s11547-012-0823-9.CrossRefPubMed

22.

Padilla L, Kang H, Washington M, Hasan Y, Chmura SJ, Al-Hallaq H. Assessment of interfractional variation of the breast surface following conventional patient positioning for whole-breast radiotherapy. J Appl Clin Med Phys. 2014;15:177–89.CrossRef

23.

Deantonio L, Masini L, Loi G, Gambaro G, Bolchini C, Krengli M. Detection of setup uncertainties with 3D surface registration system for conformal radiotherapy of breast cancer. Rep Pract Oncol Radiother. Wielkopolskie Centrum Onkologii; 2011;16:77–81. Available from: https://doi.org/10.1016/j.rpor.2011.02.003.CrossRef

24.

Wolken T. Comparing the accuracy of AlignRT and exactrac at intrafractional time points during cranial stereotactic radiosurgery and stereotactic radiotherapy treatments; 2018.

25.

Cravo Sá A, Fermento A, Neves D, Ferreira S, Silva T, Marques Coelho C, et al. Radiotherapy setup displacements in breast cancer patients: 3D surface imaging experience. Rep Pract Oncol Radiother. Greater Poland Cancer Centre; 2018;23:61–67. Available from: https://doi.org/10.1016/j.rpor.2017.12.007.CrossRef

26.

Batin E, Depauw N, MacDonald S, Lu H-M. Can surface imaging improve the patient setup for proton postmastectomy chest wall irradiation? Pract Radiat Oncol. 2016;6:e235–41 Available from: http://www.sciencedirect.com/science/article/pii/S1879850016000503.CrossRef

27.

Adriaenssens N, Belsack D, Buyl R, Ruggiero L, Breucq C, De Mey J, et al. Ultrasound elastography as an objective diagnostic measurement tool for lymphoedema of the treated breast in breast cancer patients following breast conserving surgery and radiotherapy. Radiol Oncol. 2012;46:284–95.CrossRef

28.

Adriaenssens N, Verbelen H, Lievens P, Lamote J. Lymphedema of the operated and irradiated breast in breast cancer patients following breast conserving surgery and radiotherapy. Lymphology. 2012;45:154–64 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23700762.PubMed

29.

Toledano A, Garaud P, Serin D, Fourquet A, Bosset JF, Breteau N, et al. Concurrent administration of adjuvant chemotherapy and radiotherapy after breast-conserving surgery enhances late toxicities: Long-term results of the ARCOSEIN multicenter randomized study. Int J Radiat Oncol Biol Phys. 2006;65:324–32.CrossRef

30.

Dawson LA, Brock KK, Kazanjian S, Fitch D, McGinn CJ, Lawrence TS, et al. The reproducibility of organ position using active breathing control (ABC) during liver radiotherapy. Int J Radiat Oncol Biol Phys. 2001;51:1410–21.CrossRef

31.

Garcia R, Oozeer R, Le Thanh H, Chastel D, Doyen JC, Chauvet B, et al. Radiothérapie des du poumon: Le blocage en inspiration sous contrôle spirométrique. Cancer/Radiotherapie. 2002;6:30–8.CrossRef

32.

Kaza E, Dunlop A, Panek R, Collins DJ, Orton M, Symonds-Tayler R, et al. Lung volume reproducibility under ABC control and self-sustained breath-holding. J Appl Clin Med Phys. 2017;18:154–62.CrossRef

33.

Betgen A, Alderliesten T, Sonke JJ, Van Vliet-Vroegindeweij C, Bartelink H, Remeijer P. Assessment of set-up variability during deep inspiration breath hold radiotherapy for breast cancer patients by 3D-surface imaging. Radiother Oncol. Elsevier Ireland Ltd; 2013;106:225–230. Available from: https://doi.org/10.1016/j.radonc.2012.12.016 CrossRef

34.

Xiao A, Crosby J, Malin M, Kang H, Washington M, Hasan Y, et al. Single-institution report of setup margins of voluntary deep-inspiration breath-hold (DIBH) whole breast radiotherapy implemented with real-time surface imaging. J Appl Clin Med Phys. 2018;19:205–13.CrossRef

35.

Fassi A, Ivaldi GB, Meaglia I, Porcu P, Tabarelli de Fatis P, Liotta M, et al. Reproducibility of the external surface position in left-breast DIBH radiotherapy with spirometer-based monitoring. J Appl Clin Med Phys. 2014;15:4909.

36.

Moran JM, Balter JM, Ben-David MA, Marsh RB, Van Herk M, Pierce LJ. Short-term displacement and reproducibility of the breast and nodal targets under active breathing control. Int J Radiat Oncol Biol Phys. 2007;68:541–6.CrossRef

37.

Mittauer KE, Deraniyagala R, Li JG, Lu B, Liu C, Samant SS, et al. Monitoring ABC-assisted deep inspiration breath hold for left-sided breast radiotherapy with an optical tracking system. Med Phys. 2015;42:134–43.CrossRef

38.

Remouchamps VM, Letts N, Vicini FA, Sharpe MB, Kestin LL, Chen PY, et al. Initial clinical experience with moderate deep-inspiration breath hold using an active breathing control device in the treatment of patients with left-sided breast cancer using external beam radiation therapy. Int J Radiat Oncol Biol Phys. 2003;56:704–15.CrossRef

39.

Rosenzweig KE, Hanley J, Mah D, Mageras GS, Hunt M, Toner S, et al. The deep inspiration breath-hold technique in the treatment of inoperable non-small-cell lung cancer. Int J Radiat Oncol Biol Phys. 2000;48:81–7.CrossRef

40.

Mah D, Hanley J, Rosenzweig KE, Yorke E, Braban L, Ling CC, et al. Technical aspects of the deep inspiration breath-hold technique in the treatment of thoracic cancer. Int J Radiat Oncol Biol Phys. 2000;48:1175–85.CrossRef

41.

Cerviño LI, Gupta S, Rose MA, Yashar C, Jiang SB. Using surface imaging and visual coaching to improve the reproducibility and stability of deep-inspiration breath hold for left-breast-cancer radiotherapy. Phys Med Biol. 2009;54:6853–65.CrossRef

42.

Harron EC, McCallum HM, Lambert EL, Lee D, Lambert GD. Dosimetric effects of setup uncertainties on breast treatment delivery. Med Dosim. 2008;33:293–8.CrossRef

43.

Guadagnolo BA, Liu CC, Cormier JN, Du XL. Evaluation of trends in the use of intensity-modulated radiotherapy for head and neck cancer from 2000 through 2005: socioeconomic disparity and geographic variation in a large population-based cohort. Cancer. 2010;116:3505–12.CrossRef

Title: Evaluation of a 3D surface imaging system for deep inspiration breath-hold patient positioning and intra-fraction monitoring
Authors: Vincent C. Hamming
Christa Visser
Estelle Batin
Leah N. McDermott
Dianne M. Busz
Stefan Both
Johannes A. Langendijk
Nanna M. Sijtsema
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Computed Tomography
Computed Tomography
Breast Cancer
Breast Cancer
Radiotherapy
Published in: Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/s13014-019-1329-6

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Evaluation of a 3D surface imaging system for deep inspiration breath-hold patient positioning and intra-fraction monitoring

Abstract

Purpose

Methods and materials

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods and materials

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

Feasibility and preliminary clinical results of linac-based Stereotactic Body Radiotherapy for spinal metastases using a dedicated contouring and planning system

Reduction of dose to duodenum with a refined delineation method of Para-aortic region in patients with locally advanced cervical Cancer receiving prophylactic extended-field radiotherapy

Perspectives of cellular communication through tunneling nanotubes in cancer cells and the connection to radiation effects

Delta-radiomics signature predicts treatment outcomes after preoperative chemoradiotherapy and surgery in rectal cancer

Salivary gland carcinoma (SGC) with perineural spread and/or positive resection margin – high locoregional control rates after photon (chemo) radiotherapy - experience from a monocentric analysis

Comparison of salvage therapies for isolated para-aortic lymph node recurrence in patients with uterine cervical cancer after definitive treatment