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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References
- Heart-sparing radiotherapy in patients with breast cancer: what are the techniques used in the clinical routine?: A pattern of practice survey in the german-speaking countries.Med Dosim. 2017; 42: 197-202
- Deep inspiration breath hold-based radiation therapy: a clinical review.Int J Radiat Oncol Biol Phys. 2016; 94: 478-492
- Breathing adapted radiotherapy of breast cancer: reduction of cardiac and pulmonary doses using voluntary inspiration breath-hold.Radiother Oncol. 2004; 72: 53-60
- The deep inspiration breath hold technique using abches reduces cardiac dose in patients undergoing left-sided breast irradiation.Radiat Oncol J. 2013; 31: 239
- ”Quantifying the reproducibility of heart position during treatment and corresponding delivered heart dose in voluntary deep inhalation breath hold for left breast cancer patients treated with external beam radiotherapy.Int J Radiat Oncol Biol Phys. 2011; 81: e569-e576
- Dosimetric and clinical advantages of deep inspiration breath-hold (dibh) during radiotherapy of breast cancer.J Exp Clin Cancer Res. 2013; 32: 88
- Review of deep inspiration breath-hold techniques for the treatment of breast cancer.J Med Radiat Sci. 2015; 62: 74-81
- The use of magnetic sensors to monitor moderate deep inspiration breath hold during breast irradiation with dynamic mlc compensators.Radiother Oncol. 2007; 82: 341-348
- Improving intra-fractional target position accuracy using a 3d surface surrogate for left breast irradiation using the respiratory-gated deep-inspiration breath-hold technique.PLoS One. 2014; 9e97933
- Clinical evaluation of interfractional variations for whole breast radiotherapy using 3-dimensional surface imaging.Practical Radiat Oncol. 2013; 3: 16-25
- Multi-modal surface registration for markerless initial patient setup in radiation therapy using microsoft’s kinect sensor.in: Computer vision workshops (ICCV workshops), 2011 IEEE international conference on. IEEE, 2011: 1175-1181
- Application of 3d surface imaging in breast cancer radiotherapy.in: Medical imaging 2012: image-guided procedures, robotic interventions, and modeling. International Society for Optics and Photonics, 2012: 83160A (vol. 8316)
- Monitoring deep inspiration breath hold for left-sided localized breast cancer radiotherapy with an in-house developed laser distance meter system.J Appl Clin Med Phys. 2017; 18: 117-123
- Radiotherapy setup displacements in breast cancer patients: 3d surface imaging experience.Rep Pract Oncol Radiother. 2018; 23: 61-67
- Short-term displacement and reproducibility of the breast and nodal targets under active breathing control.Int J Radiat Oncol Biol Phys. 2007; 68: 541-546
- Reproducibility of the external surface position in left-breast dibh radiotherapy with spirometer-based monitoring.J Appl Clin Med Phys. 2014; 15: 130-140
- Six-year experience routinely utilizing moderate deep inspiration breath-hold (mdibh) for the reduction of cardiac dose in left-sided breast irradiation for patients with early stage or locally advanced breast cancer.Am J Clin Oncol. 2013; 36: 24
- Deep inspiration breath hold with electromagnetic confirmation of chest wall position for adjuvant therapy of left-sided breast cancer: technique and accuracy.Pract Radiat Oncol. 2016; 6: e195-e202
- Positioning accuracy of a new image-guided radiotherapy system.Med Phys. 2011; 38: 2535-2541
- Breathing guidance in radiation oncology and radiology: a systematic review of patient and healthy volunteer studies.Med Phys. 2015; 42: 5490-5509
- Quasi-breath-hold technique using personalized audio-visual biofeedback for respiratory motion management in radiotherapy.Med Phys. 2011; 38: 3114-3124
- Audiovisual biofeedback improves the correlation between internal/external surrogate motion and lung tumor motion.Med Phys. 2018; 45: 1009-1017
- Respiratory motion management using audio-visual biofeedback for respiratory-gated radiotherapy of synchrotron-based pulsed heavy-ion beam delivery.Med Phys. 2014; 41
- 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
- A phantom evaluation of sentinel, a commercial laser/camera surface imaging system for patient setup verification in radiotherapy.Med Phys. 2012; 39: 706-712
- Clinical evaluation of a laser surface scanning system in 120 patients for improving daily setup accuracy in fractionated radiation therapy.Phys Int J Radiat Oncol Biol. 2013; 85: 846-853
- Evaluation of daily patient positioning for radiotherapy with a commercial 3d surface-imaging system (catalyst).Radiat Oncol. 2016; 11: 154
- Treatment planning and evaluation of gated radiotherapy in left-sided breast cancer patients using the catalyst tm/sentinel tm system for deep inspiration breath-hold (dibh).Radiat Oncol. 2016; 11: 143
- Characteristics of gated treatment using an optical surface imaging and gating system on an elekta linac.Radiat Oncol. 2015; 10: 68
- Deep inspiration breath hold and respiratory gating strategies for reducing organ motion in radiation treatment.Seminars in radiation oncology. 14. Elsevier, 2004: 65-75
- Accuracy of a wireless localization system for radiotherapy.Int J Radiat Oncol Biol Phys. 2005; 61: 933-937
- Validation of the calypso surface beacon transponder.J Appl Clin Med Phys. 2016; 17: 223-234
- Correlation of respiratory motion between external patient surface and internal anatomical landmarks.Med Phys. 2011; 38: 3157-3164
- Depth sensor-based realtime tumor tracking for accurate radiation therapy.in: Eurographics (Short Papers). 2014: 1-4
- R language definition.R Foundation for Statistical Computing, Vienna, Austria2000
- A two-sample test for a linear hypothesis whose power is independent of the variance.Ann Math Stat. 1945; 16: 243-258
- Su-e-j- 32: Calypso (r) and laser-based localization systems comparison for left-sided breast cancer patients using deep inspiration breath hold.Med Phys. 2014; 41 (162–162)
- Novel method of cardiac sparing with deep-inspiration breath-hold utilizing surface electromagnetic transponders in women with left-sided breast cancer.Int J Radiat Oncol Biol Phys. 2013; 87: S69
- Automated daily breath hold stability measurements by real-time imaging in radiotherapy of breast cancer.Radiother Oncol. 2016; 119: 61-64
- Effects of multiple breath hold reproducibility on treatment localization and dosimetric accuracy in radiotherapy of left-sided breast cancer with voluntary deep inspiration breath hold technique.Med Dosim. 2017; 42: 177-184
- Robustness of vmat and 3dcrt plans toward setup errors in radiation therapy of locally advanced left-sided breast cancer with dibh.Physica Med. 2018; 45: 12-18
- Assessment of set-up variability during deep inspiration breath hold radiotherapy for breast cancer patients by 3d-surface imaging.Radiother Oncol. 2013; 106: 225-230
- 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;
- The systematic and random errors determination using realtime 3d surface tracking system in breast cancer.in: Journal of Physics: Conference Series. vol. 694. IOP Publishing, 2016: 012005
- Real-time intra-fraction motion management in breast cancer radiotherapy: analysis of 2028 treatment sessions.Radiat Oncol. 2018; 13: 128
- Heart position variability during voluntary moderate deep inspiration breath-hold radiotherapy for breast cancer determined by repeat cbct scans.Physica Med. 2017; 40: 88-94
- Comparison of initial patient setup accuracy between surface imaging and three point localization: a retrospective analysis.J Appl Clin Med Phys. 2017; 18: 58-61
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.