Highlights
- •CatalystHD biofeedback-based surface imaging system improved breath-hold accuracy over a Calypso audio feedback based system.
- •Patients treated using CatalystHD showed increased stability of breath-hold motion during treatment over Calypso system.
- •Increased stability and accuracy in biofeedback-based system was consistent throughout course of radiation therapy treatment.
Abstract
Purpose
To characterize reproducibility of patient breath-hold positioning and compare tracking
system performance for Deep Inspiration Breath Hold (DIBH) gated left breast radiotherapy.
Methods
29 consecutive left breast DIBH patients (655 fractions) were treated under the guidance
of Calypso surface beacons with audio-feedback and 35 consecutive patients (631 fractions)
were treated using C-RAD Catalyst HD surface imaging with audiovisual feedback. The
Calypso system tracks a centroid determined by two radio-frequency transponders, with
a manually enforced institutional tolerance, while the surface image based CatalystHD
system utilizes real-time biometric feedback to track a pre-selected point with an
institutional tolerance enforced by the Elekta Response gating interface. DIBH motion
data from Calypso was extracted to obtain the displacement of breath hold marker in
ant/post direction from a set-zero reference point. Ant/post point displacement data
from CatalystHD was interpreted by computing the difference between raw tracking points
and the center of individual gating windows. Mean overall errors were compared using
Welsh’s unequal variance t-test. Wilcoxon rank sum test were used for statistical
analysis with P < 0.05 considered significant.
Results
Mean overall error for Calypso and CatalystHD were 0.33 ± 1.17 mm and 0.22 ± 0.43 mm,
respectively, with t-test comparison P-value < 0.034. Absolute errors for Calypso
and CatalystHD were 0.95 ± 0.75 mm and 0.38 ± 0.30 mm, respectively, with Wilcoxon
rank sum test P-value . Average standard deviation per fraction was found to be 0.74 ± 0.44 mm for Calypso
patients versus 0.54 ± 0.22 mm for CatalystHD.
Conclusion
Reduced error distribution widths in overall positioning, deviation of position, and
per fraction deviation suggest that the use of functionalities available in CatalystHD
such as audiovisual biofeedback and patient surface matching improves accuracy and
stability during DIBH gated left breast radiotherapy.
Keywords
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Article info
Publication history
Published online: April 09, 2019
Accepted:
March 24,
2019
Received in revised form:
March 14,
2019
Received:
October 3,
2018
Identification
Copyright
© 2019 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
