Three-dimensional evaluation of intra- and interfraction immobilization of lung and chest wall using active breathing control: A reproducibility study with breast cancer patients

Vincent M. Remouchamps, Nicola Letts, Di Yan, Frank A. Vicini, Michel Moreau, Julie A. Zielinski, Jian Liang, Larry L. Kestin, Alvaro A. Martinez, John Wong

Research output: Contribution to journalArticle

Abstract

Purpose: A CT-based three-dimensional (3D) method was used to analyze the intra- and interfraction reproducibility of lung immobilization during moderate deep inspiration breath hold (mDIBH), defined as 75% of the maximal inspiration using an active breathing control (ABC) apparatus. Methods and Materials: The ABC apparatus was used to immobilize the breathing motion with a computer-controlled valve. Immobilization of the lungs in breast cancer patients was used as a model to evaluate the reproducibility of mDIBH using the ABC apparatus. CT scans were acquired twice at mDIBH in the same session for 30 breast cancer patients. Twenty-three of them were immobilized with an α-cradle, of which 14 had a repeat scan at mDIBH 1-4 weeks later. Twelve of those patients received intensity-modulated radiotherapy to the left breast at mDIBH to displace the heart from the beam. The remaining patients were treated at free breathing, with either intensity-modulated irradiation to the whole breast or conformal partial breast irradiation. To remove the component of setup error, mDIBH scans were registered with respect to the vertebrae. The lungs and carina were auto-contoured to form 3D surfaces for each data set. The closest distance-to-agreement (DTA) for each point between the 3D surfaces of the corresponding CT scans was displayed on a 3D surface map. For analysis, each lung was divided along its inferior to superior extent into six regions, from the basal 10%, the next four consecutive 20% sections in height, to the last apical 10%. Likewise, the carina was divided into regions of the trachea and bifurcation. The mean and standard deviation (SD) of the DTA for each of these regions was computed. Results: With the patient positioned in an α-cradle, the mean ± SD intrafraction DTA was 1.5 ± 1.4 mm for the left lung and 1.0 ± 1.4 mm for the right lung. The corresponding values without the use of an α-cradle were significantly greater, with 1. 9 ± 2.1 mm and 2.2 ± 2.2 mm for the left and right lung, respectively (p

Original languageEnglish (US)
Pages (from-to)968-978
Number of pages11
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume57
Issue number4
DOIs
StatePublished - Nov 15 2003
Externally publishedYes

Fingerprint

inspiration
chest
Thoracic Wall
breathing
immobilization
breast
Immobilization
lungs
Respiration
cancer
Breast Neoplasms
Lung
evaluation
Breast
standard deviation
trachea
vertebrae
Intensity-Modulated Radiotherapy
irradiation
Trachea

Keywords

  • 3D conformal radiotherapy
  • Breathing immobilization
  • Internal margin

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Three-dimensional evaluation of intra- and interfraction immobilization of lung and chest wall using active breathing control : A reproducibility study with breast cancer patients. / Remouchamps, Vincent M.; Letts, Nicola; Yan, Di; Vicini, Frank A.; Moreau, Michel; Zielinski, Julie A.; Liang, Jian; Kestin, Larry L.; Martinez, Alvaro A.; Wong, John.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 57, No. 4, 15.11.2003, p. 968-978.

Research output: Contribution to journalArticle

Remouchamps, Vincent M. ; Letts, Nicola ; Yan, Di ; Vicini, Frank A. ; Moreau, Michel ; Zielinski, Julie A. ; Liang, Jian ; Kestin, Larry L. ; Martinez, Alvaro A. ; Wong, John. / Three-dimensional evaluation of intra- and interfraction immobilization of lung and chest wall using active breathing control : A reproducibility study with breast cancer patients. In: International Journal of Radiation Oncology, Biology, Physics. 2003 ; Vol. 57, No. 4. pp. 968-978.
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abstract = "Purpose: A CT-based three-dimensional (3D) method was used to analyze the intra- and interfraction reproducibility of lung immobilization during moderate deep inspiration breath hold (mDIBH), defined as 75{\%} of the maximal inspiration using an active breathing control (ABC) apparatus. Methods and Materials: The ABC apparatus was used to immobilize the breathing motion with a computer-controlled valve. Immobilization of the lungs in breast cancer patients was used as a model to evaluate the reproducibility of mDIBH using the ABC apparatus. CT scans were acquired twice at mDIBH in the same session for 30 breast cancer patients. Twenty-three of them were immobilized with an α-cradle, of which 14 had a repeat scan at mDIBH 1-4 weeks later. Twelve of those patients received intensity-modulated radiotherapy to the left breast at mDIBH to displace the heart from the beam. The remaining patients were treated at free breathing, with either intensity-modulated irradiation to the whole breast or conformal partial breast irradiation. To remove the component of setup error, mDIBH scans were registered with respect to the vertebrae. The lungs and carina were auto-contoured to form 3D surfaces for each data set. The closest distance-to-agreement (DTA) for each point between the 3D surfaces of the corresponding CT scans was displayed on a 3D surface map. For analysis, each lung was divided along its inferior to superior extent into six regions, from the basal 10{\%}, the next four consecutive 20{\%} sections in height, to the last apical 10{\%}. Likewise, the carina was divided into regions of the trachea and bifurcation. The mean and standard deviation (SD) of the DTA for each of these regions was computed. Results: With the patient positioned in an α-cradle, the mean ± SD intrafraction DTA was 1.5 ± 1.4 mm for the left lung and 1.0 ± 1.4 mm for the right lung. The corresponding values without the use of an α-cradle were significantly greater, with 1. 9 ± 2.1 mm and 2.2 ± 2.2 mm for the left and right lung, respectively (p",
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AU - Letts, Nicola

AU - Yan, Di

AU - Vicini, Frank A.

AU - Moreau, Michel

AU - Zielinski, Julie A.

AU - Liang, Jian

AU - Kestin, Larry L.

AU - Martinez, Alvaro A.

AU - Wong, John

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N2 - Purpose: A CT-based three-dimensional (3D) method was used to analyze the intra- and interfraction reproducibility of lung immobilization during moderate deep inspiration breath hold (mDIBH), defined as 75% of the maximal inspiration using an active breathing control (ABC) apparatus. Methods and Materials: The ABC apparatus was used to immobilize the breathing motion with a computer-controlled valve. Immobilization of the lungs in breast cancer patients was used as a model to evaluate the reproducibility of mDIBH using the ABC apparatus. CT scans were acquired twice at mDIBH in the same session for 30 breast cancer patients. Twenty-three of them were immobilized with an α-cradle, of which 14 had a repeat scan at mDIBH 1-4 weeks later. Twelve of those patients received intensity-modulated radiotherapy to the left breast at mDIBH to displace the heart from the beam. The remaining patients were treated at free breathing, with either intensity-modulated irradiation to the whole breast or conformal partial breast irradiation. To remove the component of setup error, mDIBH scans were registered with respect to the vertebrae. The lungs and carina were auto-contoured to form 3D surfaces for each data set. The closest distance-to-agreement (DTA) for each point between the 3D surfaces of the corresponding CT scans was displayed on a 3D surface map. For analysis, each lung was divided along its inferior to superior extent into six regions, from the basal 10%, the next four consecutive 20% sections in height, to the last apical 10%. Likewise, the carina was divided into regions of the trachea and bifurcation. The mean and standard deviation (SD) of the DTA for each of these regions was computed. Results: With the patient positioned in an α-cradle, the mean ± SD intrafraction DTA was 1.5 ± 1.4 mm for the left lung and 1.0 ± 1.4 mm for the right lung. The corresponding values without the use of an α-cradle were significantly greater, with 1. 9 ± 2.1 mm and 2.2 ± 2.2 mm for the left and right lung, respectively (p

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KW - 3D conformal radiotherapy

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