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Reproducibility of heart and thoracic wall position in repeated deep inspiration breath holds for radiotherapy of left-sided breast cancer patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medical Radiation Science.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medical Radiation Science.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Experimental and Clinical Oncology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology, Medical Radiation Science.
2018 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 57, no 10, p. 1318-1324Article in journal (Refereed) Published
Abstract [en]

Background: Deep inspiration breath hold (DIBH) for radiotherapy of left-sided breast cancer patientscan effectively move the heart away from the target and reduce the heart dose compared to treatmentsin free breathing. This study aims to investigate the positional reproducibility of heart edge(HE) and thoracic wall (TW) during repeated DIBHs.

Material and methods: At three occasions, 11 left-sided breast cancer patients were CT imaged during6 minutes of repeated DIBHs with 60 cine CT series. The series were evenly distributed over threebed positions and for each bed position, the heart edge associated maximum heart distance (MHD)and thoracic wall-associated maximum lung distance (MLD) from a reference line were retrospectivelyanalyzed. The high temporal resolution of the CT series enabled intrinsic heart movements to beresolved from breath hold variations. A body surface laser scanning system continuously extracted thethorax height and displayed it in a pair of goggles for patient feedback. To check for ‘fake-breathing’movements, e.g. that the patient lifts its back from the couch to reach DIBH, the couch-to-spine distancewas also measured in all CT series.

Results: The analysis was done for 1432 cine CTs captured during 292 breath holds. The DIBH movedthe heart on average 15mm in medial direction compared with free breathing. For the three bed positionsstudied, the mean value of the max range, across all patients, was between 11–13mm for theMHD and 4–8mm for the MLD. The MHD variation due to breath hold variation was twice as large asthe MHD variation due to intrinsic heart movement. The couch-to-spine distance varied less than3mm for all fractions, i.e., no fake-breathing was discovered.

Conclusions: The heart edge and thoracic wall reproducibility was high in relation to the medial heartdisplacement induced by the DIBH.

Place, publisher, year, edition, pages
2018. Vol. 57, no 10, p. 1318-1324
Keywords [en]
Radiotherapy, Deep Inspiration Breath Hold, Breast Cancer
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:uu:diva-358938DOI: 10.1080/0284186X.2018.1490027ISI: 000448595500006PubMedID: 30074438OAI: oai:DiVA.org:uu-358938DiVA, id: diva2:1243884
Available from: 2018-08-31 Created: 2018-08-31 Last updated: 2020-12-16Bibliographically approved
In thesis
1. Patient Positioning in Radiotherapy Using Body Surface Scanning
Open this publication in new window or tab >>Patient Positioning in Radiotherapy Using Body Surface Scanning
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

External radiotherapy uses ionising radiation to damage the DNA of the tumour cells and thereby inhibit their uncontrolled proliferation. The technical development regarding imaging and visualisation for radiotherapy has increased considerably during the last decades. By a submillimetre accuracy, a body surface laser scanning (BSLS) system maps the patient body contour in the treatment position by scanning a transversal laser line and detecting its reflection. A treatment plan is created for each patient to find a treatment that delivers a high dose to the tumour whilst keeping the dose to the surrounding normal tissue as low as possible. The setup done for treatment planning must be reproduced in the treatment room. Commonly patient skin-marks are aligned to room lasers to setup the patient in the treatment position. The setup is then verified by the BSLS and a cone-beam CT (CBCT) system. For left-sided-breast cancer patients, the dose to radiosensitive parts of the heart can be decreased by letting the patient take a deep breath and hold it in deep inspiration breath-hold (DIBH) position during treatment. The BSLS system can guide the patient to this position via visual and audial instructions to the patient. The breathing trace of a lung cancer patient can be monitored by the BSLS system to estimate the quality of the images used for treatment planning and also to support the treatment target definition process. The number of application of the BSLS system has increased over the years. Together with its increased accuracy and robustness, surface scanning has now reached a level where it can be used as a primary setup system, replacing skin-marks (paper I), guiding left-sided breast cancer patient to a reproducible DIBH position (paper II) and lung tumour motion can be determined more accurately (paper III and IV).

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2021. p. 45
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1711
Keywords
Radiotherapy, positioning, body surface, laser scanning, cancer, SGRT, ITV, lung cancer, surrogate, tumour motion, 4DCT
National Category
Cancer and Oncology
Research subject
Medical Radiophysics
Identifiers
urn:nbn:se:uu:diva-427519 (URN)978-91-513-1097-8 (ISBN)
Public defence
2021-02-19, H:son Holmdahlsalen, Akademiska sjukhuset, ing. 100, 751 85 Uppsala, Uppsala, 13:00 (English)
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Supervisors
Available from: 2021-01-28 Created: 2020-12-16 Last updated: 2021-03-04

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Wikström, KennethIsacsson, UlfNilsson, KristinaAhnesjö, Anders

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