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Briana Welsh, Michael Chao, Farshad Foroudi
INTRODUCTION: When irradiating the left breast, a small portion of the heart and left anterior descending coronary artery (LAD) are often included in the treatment field. Deep inspiration breath-hold (DIBH) techniques reduce dose to coronary structures, but are resource intensive and may not be tolerated by all patients. The aim of this study was to evaluate a simple multi-leaf collimator (MLC) modification technique with respect to target coverage and organ-at-risk sparing. METHODS: Forty nine patients with left-sided breast cancer, planned with a simultaneous integrated boost technique were retrospectively replanned with additional shielding of the LAD...
September 9, 2016: Journal of Medical Radiation Sciences
Luciana Lastrucci, Simona Borghesi, Silvia Bertocci, Chiara Gasperi, Andrea Rampini, Giovanna Buonfrate, Paola Pernici, Roberta De Majo, Pietro Giovanni Gennari
PURPOSE: To compare 3D-conformal radiotherapy (3D-CRT) treatment plans based on free-breathing (FB) and deep inspiration breath hold (DIBH) and investigated whether DIBH technique enables a decrease of cardiac left anterior descending coronary artery (LADCA) and lungs dose with respect to the FB. METHODS: Twenty-three left-sided breast cancer patients referred for breast radiotherapy were included. The planning target volume (PTV) encompassed the breast and organs at risk including heart, LADCA, lungs, and contralateral breast, which were contoured in FB and DIBH CT scans...
September 27, 2016: Tumori
Mirjana Josipovic, Gitte F Persson, Jens Peter Bangsgaard, Lena Specht, Marianne C Aznar
OBJECTIVES: We investigated the impact of deep inspiration breath-hold (DIBH) and tumour baseline shifts on image quality and registration uncertainty in image guided DIBH radiotherapy for locally advanced lung cancer. METHODS: Patients treated with daily cone beam CT (CBCT) guided free-breathing (FB) radiotherapy had an additional CBCT in DIBH at three fractions. These CBCTs were off-line rigidly registered (on tumour) to FB and DIBH CTs acquired at planning. All registrations were repeated to evaluate the intra-observer uncertainty...
October 6, 2016: British Journal of Radiology
V A Dumane, K Saksornchai, Y Zhou, L Hong, A Y Ho
No abstract text is available yet for this article.
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
H Chaudhry, S Souri, S Teckie, E E Klein
No abstract text is available yet for this article.
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
C Tamburella, G Guibert, P Weber, P Tsoutsou
No abstract text is available yet for this article.
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Leigh Conroy, Rosanna Yeung, Elizabeth Watt, Sarah Quirk, Karen Long, Alana Hudson, Tien Phan, Wendy L Smith
A low-resource visually monitored deep inspiration breath-hold (VM-DIBH) technique was successfully implemented in our clinic to reduce cardiac dose in left-sided breast radiotherapy. In this study, we retrospectively characterized the chest wall and heart positioning accuracy of VM-DIBH using cine portal images from 42 patients. Central chest wall position from field edge and in-field maximum heart distance (MHD) were manually measured on cine images and compared to the planned positions based on the digitally reconstructed radiographs (DRRs)...
2016: Journal of Applied Clinical Medical Physics
Philippe Meyer, Claudine Niederst, Maximilien Scius, Delphine Jarnet, Nicolas Dehaynin, Matthieu Gantier, Waisse Waissi, Nicolas Poulin, Diran Karamanoukian
BACKGROUND AND PURPOSE: TomoDirect (TD) can only operate in free-breathing. The purpose of this study is to compare TD with breath-hold 3D conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT) techniques for left breast treatments, and to determine if the lack of respiratory gating is a handicap for cardiac sparing. MATERIALS AND METHODS: 15 patients treated for left breast had two computed tomography simulation, in free breathing (FB) and in deep-inspiration breath-hold (DIBH)...
May 2016: Physica Medica: PM
Trang T Pham, Rachel Ward, Drew Latty, Catherine Owen, Val Gebski, Jacek Chojnowski, Christopher Kelly, Verity Ahern, Kenneth Tiver, Kirsty Stuart, Wei Wang
INTRODUCTION: Left-sided breast cancer radiotherapy has been associated with an increase in cardiac mortality. This study investigated the potential heart-sparing effect of volumetric-modulated arc radiotherapy (VMAT). We compared VMAT to tangential intensity-modulated radiotherapy (t-IMRT) in the loco-regional treatment of left-sided breast cancer, including internal mammary nodal irradiation, based on deep inspiration breath-hold (DIBH) and free-breathing (FB). METHODS: Radiotherapy for 15 patients was re-planned...
August 2016: Journal of Medical Imaging and Radiation Oncology
Wiviann Ottosson, Fatma Rahma, David Sjöström, Claus F Behrens, Patrik Sibolt
BACKGROUND AND PURPOSE: Three cone-beam computed tomography (CBCT) registration strategies combined with deep-inspiration breath-hold (DIBH) and free-breathing (FB) were explored, in terms of obtaining the smallest planning target volume (PTV). MATERIAL AND METHODS: CBCT images were acquired pre- and post-treatment in FB and DIBH, for 17 locally advanced lung cancer patients. Bony registration on the spine, and soft-tissue registrations on the primary gross tumor volume (GTV-T) and GTV-Total, including malignant lymph nodes (GTV-N), were retrospectively analyzed...
June 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
C Lowanichkiattikul, M Dhanachai, C Sitathanee, S Khachonkham, P Khaothong
To determine the chest wall movement of each patient during deep inspiratory breath hold (DIBH) and expiratory breath hold (EBH) in postoperative breast cancer patients. Postoperative breast cancer patients who underwent CT simulation for 3D radiotherapy treatment planning during December 2012 to November 2013 were included. Before scanning the radio-opaque wire was placed on the surface for breast and chest wall visualization on CT images, then the patient underwent three phases of CT scanning (free breathing, DIBH, and EBH, respectively)...
2016: SpringerPlus
Madeera Kathpal, Brent Tinnel, Kelly Sun, Stephanie Ninneman, Cynthia Malmer, Stacie Wendt, Sheena Buff, David Valentich, Marisa Gossweiler, Dusten Macdonald
PURPOSE: With most patients now living long after their breast cancer diagnosis, minimizing long-term side effects of breast cancer treatment, such as reducing late cardiac and pulmonary side effects of radiation therapy (RT), is particularly important. It is now possible to use an electromagnetic tracking system to allow real-time tracking of chest wall (CW) position during the delivery of RT. Here, we report our experience using electromagnetic surface transponders as an added measure of CW position during deep inspiration breath hold (DIBH)...
September 2016: Practical Radiation Oncology
Angela Lin, Waseem Sharieff, Janos Juhasz, Tim Whelan, Do-Hoon Kim
BACKGROUND: This study aims to evaluate the reduction of cardiac radiation dose and volume with deep inspiration breath hold (DIBH) technique compared to free breathing (FB) in patients with left-sided breast cancer. The study also aims to evaluate whether the benefits of DIBH vary in patients who had whole breast radiotherapy (RT) after breast-conserving surgery (BCS) and those who had chest wall RT post-mastectomy (M). METHODS: FB and DIBH plans were generated for 15 consecutive post-BCS patients and 17 post-M patients who underwent RT with DIBH using varian real-time position management (RPM) system...
February 17, 2016: Breast Cancer: the Journal of the Japanese Breast Cancer Society
Judit Boda-Heggemann, Antje-Christin Knopf, Anna Simeonova-Chergou, Hansjörg Wertz, Florian Stieler, Anika Jahnke, Lennart Jahnke, Jens Fleckenstein, Lena Vogel, Anna Arns, Manuel Blessing, Frederik Wenz, Frank Lohr
Several recent developments in linear accelerator-based radiation therapy (RT) such as fast multileaf collimators, accelerated intensity modulation paradigms like volumeric modulated arc therapy and flattening filter-free (FFF) high-dose-rate therapy have dramatically shortened the duration of treatment fractions. Deliverable photon dose distributions have approached physical complexity limits as a consequence of precise dose calculation algorithms and online 3-dimensional image guided patient positioning (image guided RT)...
March 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Anna Simeonova-Chergou, Anika Jahnke, Kerstin Siebenlist, Florian Stieler, Sabine Mai, Judit Boda-Heggemann, Frederik Wenz, Frank Lohr, Lennart Jahnke
BACKGROUND: High-dose radiotherapy of lung cancer is challenging. Tumors may move by up to 2 cm in craniocaudal and anteroposterior directions as a function of breathing cycle. Tumor displacement increases with treatment time, which consequentially increases the treatment uncertainty. OBJECTIVE: This study analyzed whether automatically gated cone-beam-CT (CBCT)-controlled intensity modulated fast deep inspiration breath hold (DIBH) stereotactic body radiation therapy (SBRT) in flattening filter free (FFF) technique and normofractionated lung DIBH intensity-modulated radiotherapy (IMRT)/volumetric-modulated arc therapy (VMAT) treatments delivered with a flattening filter can be applied with sufficient accuracy within a clinically acceptable timeslot...
March 2016: Strahlentherapie und Onkologie: Organ der Deutschen Röntgengesellschaft ... [et Al]
Ji Hyeon Joo, Su Ssan Kim, Seung Do Ahn, Jungwon Kwak, Chiyoung Jeong, Sei-Hyun Ahn, Byung-Ho Son, Jong Won Lee
BACKGROUND: Radiation therapy (RT) for a left-sided breast cancer often involves some incidental exposure of the heart and increase in the rate of major coronary events. One method to reduce the dose to the heart during a tangential breast irradiation is the deep inspiration breath hold (DIBH) technique. Our department adopted DIBH for selected left breast cancer patients with a maximum cardiac distance ≥ 10 mm. We evaluated the effect of the DIBH on cardiac dose compared to normal free breathing (FB)...
2015: Radiation Oncology
Mirjana Josipovic, Gitte F Persson, Jenny Dueck, Jens Peter Bangsgaard, Gunnar Westman, Lena Specht, Marianne C Aznar
BACKGROUND AND PURPOSE: Deep inspiration breath hold (DIBH) increases lung volume and can potentially reduce treatment-related toxicity in locally advanced lung cancer. We estimated geometric uncertainties in visually guided voluntary DIBH and derived the appropriate treatment margins for different image-guidance strategies. MATERIAL AND METHODS: Seventeen patients were included prospectively. An optical marker-based respiratory monitoring with visual guidance enabled comfortable DIBHs, adjusted to each patient's performance...
March 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
David Wiant, Stacy Wentworth, Han Liu, Benjamin Sintay
PURPOSE: Deep inspiration breath hold (DIBH) for left-sided breast cancer has been shown to reduce heart dose. Surface imaging helps to ensure accurate breast positioning, but it does not guarantee a reproducible breath hold (BH) at DIBH treatments. We examine the effects of variable BH positions for DIBH treatments. METHODS AND MATERIALS: Twenty-five patients who underwent free breathing (FB) and DIBH scans were reviewed. Four plans were created for each patient: FB, DIBH, FB_DIBH (the DIBH plans were copied to the FB images and recalculated, and image registration was based on breast tissue), and P_DIBH (a partial BH with the heart shifted midway between the FB and DIBH positions)...
November 15, 2015: International Journal of Radiation Oncology, Biology, Physics
A Kapfhammer, T Winkens, T Lesser, A Reissig, M Steinert, M Freesmeyer
AIM: To retrospectively evaluate the feasibility and value of CT-CT image fusion to assess the shift of peripheral lung cancers with/-out chest wall infiltration, comparing computed tomography acquisitions in shallow-breathing (SB-CT) and deep-inspiration breath-hold (DIBH-CT) in patients undergoing FDG-PET/CT for lung cancer staging. METHODS: Image fusion of SB-CT and DIBH-CT was performed with a multimodal workstation used for nuclear medicine fusion imaging. The distance of intrathoracic landmarks and the positional shift of tumours were measured using semi-transparent overlay of both CT series...
2015: Nuklearmedizin. Nuclear Medicine
Rosanna Yeung, Leigh Conroy, Karen Long, Daphne Walrath, Haocheng Li, Wendy Smith, Alana Hudson, Tien Phan
BACKGROUND: Deep inspiration breath hold (DIBH) reduces heart and left anterior descending artery (LAD) dose during left-sided breast radiation therapy (RT); however there is limited information about which patients derive the most benefit from DIBH. The primary objective of this study was to determine which patients benefit the most from DIBH by comparing percent reduction in mean cardiac dose conferred by DIBH for patients treated with whole breast RT ± boost (WBRT) versus those receiving breast/chest wall plus regional nodal irradiation, including internal mammary chain (IMC) nodes (B/CWRT + RNI) using a modified wide tangent technique...
2015: Radiation Oncology
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