| 1. |
- Al-Hallaq, Hania A., et al.
(author)
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AAPM task group report 302 : Surface-guided radiotherapy
- 2022
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In: Medical Physics. - : Wiley. - 0094-2405 .- 2473-4209. ; 49:4, s. 82-112
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Journal article (peer-reviewed)abstract
- The clinical use of surface imaging has increased dramatically, with demonstrated utility for initial patient positioning, real-time motion monitoring, and beam gating in a variety of anatomical sites. The Therapy Physics Subcommittee and the Imaging for Treatment Verification Working Group of the American Association of Physicists in Medicine commissioned Task Group 302 to review the current clinical uses of surface imaging and emerging clinical applications. The specific charge of this task group was to provide technical guidelines for clinical indications of use for general positioning, breast deep-inspiration breath hold treatment, and frameless stereotactic radiosurgery. Additionally, the task group was charged with providing commissioning and on-going quality assurance (QA) requirements for surface-guided radiation therapy (SGRT) as part of a comprehensive QA program including risk assessment. Workflow considerations for other anatomic sites and for computed tomography simulation, including motion management, are also discussed. Finally, developing clinical applications, such as stereotactic body radiotherapy (SBRT) or proton radiotherapy, are presented. The recommendations made in this report, which are summarized at the end of the report, are applicable to all video-based SGRT systems available at the time of writing.
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| 2. |
- Al-Hallaq, Hania, et al.
(author)
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The role of surface-guided radiation therapy for improving patient safety
- 2021
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In: Radiotherapy and Oncology. - : Elsevier BV. - 1879-0887 .- 0167-8140. ; 163, s. 229-236
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Journal article (peer-reviewed)abstract
- Emerging data indicates SGRT could improve safety and quality by preventing errors in its capacity as an independent system in the treatment room. The aim of this work is to investigate the utility of SGRT in the context of safety and quality. Three incident learning systems (ILS) were reviewed to categorize and quantify errors that could have been prevented with SGRT: SAFRON (International Atomic Energy Agency), UW-ILS (University of Washington) and AvIC (Skåne University Hospital). A total of 849/9737 events occurred during the pre-treatment review/verification and treatment stages. Of these, 179 (21%) events were predicted to have been preventable with SGRT. The most common preventable events were wrong isocentre (43%) and incorrect accessories (34%), which appeared at comparable rates among SAFRON and UW-ILS. The proportion of events due to wrong accessories was much smaller in the AvIC ILS, which may be attributable to the mandatory use of SGRT in Sweden. Several case scenarios are presented to demonstrate that SGRT operates as a valuable complement to other quality-improvement tools routinely used in radiotherapy. Cases are noted in which SGRT itself caused incidents. These were mostly related to workflow issues and were of low severity. Severity data indicated that events with the potential to be mitigated by SGRT were of higher severity for all categories except wrong accessories. Improved vendor integration of SGRT systems within the overall workflow could further enhance its clinical utility. SGRT is a valuable tool with the potential to increase patient safety and treatment quality in radiotherapy.
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| 3. |
- Batista, Vania, et al.
(author)
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Clinical paradigms and challenges in surface guided radiation therapy : Where do we go from here?
- 2020
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In: Radiotherapy and Oncology. - : Elsevier BV. - 0167-8140. ; 153, s. 34-42
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Research review (peer-reviewed)abstract
- Surface guided radiotherapy (SGRT) is becoming a routine tool for patient positioning for specific clinical sites in many clinics. However, it has not yet gained its full potential in terms of widespread adoption. This vision paper first examines some of the difficulties in transitioning to SGRT before exploring the current and future role of SGRT alongside and in concert with other imaging techniques. Finally, future horizons and innovative ideas that may shape and impact the direction of SGRT going forward are reviewed.
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| 4. |
- Batista, Vania, et al.
(author)
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Surface guided radiation therapy: : An international survey on current clinical practice
- 2022
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In: Technical Innovations and Patient Support in Radiation Oncology. - : Elsevier BV. - 2405-6324. ; 22, s. 1-8
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Journal article (peer-reviewed)abstract
- Introduction: Surface Guided Radiation Therapy (SGRT) is being increasingly implemented into clinical practiceacross a number of techniques and irradiation-sites. This technology, which is provided by different vendors, canbe used with most simulation- and delivery-systems. However, limited guidelines and the complexity of clinicalsettings have led to diverse patterns of operation. With the aim to understand current clinical practice a surveywas designed focusing on specifics of the clinical implementation and usage.Materials and methods: A 32-question survey covered: type and number of systems, quality assurance (QA),clinical workflows, and identification of strengths/limitations. Respondents from different professional groupsand countries were invited to participate. The survey was distributed internationally via ESTRO-membership,social media and vendors.Results: Of the 278 institutions responding, 172 had at least one SGRT-system and 136 use SGRT clinically.Implementation and QA were primarily based on the vendors’ recommendations and phantoms. SGRT wasmainly implemented in breast RT (116/136), with strong but diverse representation of other sites. Many (58/135) reported at least partial elimination of skin-marks and a third (43/126) used open-masks. The most commonimaging protocol reported included the combination of radiographic imaging with SGRT. Patient positioning(115/136), motion management (104/136) and DIBH (99/136) were the main applications.Main barriers to broader application were cost, system integration issues and lack of demonstrated clinical value.A lack of guidelines in terms of QA of the system was highlighted.Conclusions: This overview of the SGRT status has the potential to support users, vendors and organisations in thedevelopment of practices, products and guidelines.
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| 5. |
- Ceberg, Sofie, et al.
(author)
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Surface guided radiotherapy decreases the uncertainty in breast cancer patient setup
- 2018
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Conference paper (peer-reviewed)abstract
- (Sunday, 7/29/2018) 3:00 PM - 6:00 PMRoom: Exhibit HallPurpose: The aim was to investigate if the setup of breast cancer patients could be improved using surface guided radiotherapy, compared to the conventional method using lasers and skin markings.Methods: Forty-seven patients, who received tangential or locoregional adjuvant radiotherapy, were positioned using a surface-based setup (SBS). Thirty-eight patients were positioned using the conventional laser-based setup (LBS). For the patient group positioned using a SBS, correction for posture was performed under guidance of a color map projected onto the patients' skin in real time. The surface tolerance for the color map was 5 mm. For both setup techniques the deviation of the breast position was measured using verification images. In total, 897 images were analysed. The frequency distributions of the deviations were analysed.Results: The result showed a significant improvement in the interfractional variation of the setup deviation for SBS compared to the LBS (pConclusion: Conventional laser-based setup can be replaced by surface-based setup, both for tangential and locoregional breast cancer treatments.
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| 6. |
- Edvardsson, Anneli, et al.
(author)
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Comparative treatment planning study for mediastinal Hodgkin’s lymphoma : impact on normal tissue dose using deep inspiration breath hold proton and photon therapy
- 2019
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In: Acta Oncologica. - 0284-186X. ; 58:1, s. 95-104
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Journal article (peer-reviewed)abstract
- Background: Late effects induced by radiotherapy (RT) are of great concern for mediastinal Hodgkin’s lymphoma (HL) patients and it is therefore important to reduce normal tissue dose. The aim of this study was to investigate the impact on the normal tissue dose and target coverage, using various combinations of intensity modulated proton therapy (IMPT), volumetric modulated arc therapy (VMAT) and 3-dimensional conformal RT (3D-CRT), planned in both deep inspiration breath hold (DIBH) and free breathing (FB). Material and methods: Eighteen patients were enrolled in this study and planned with involved site RT. Two computed tomography images were acquired for each patient, one during DIBH and one during FB. Six treatment plans were created for each patient; 3D-CRT in FB, 3D-CRT in DIBH, VMAT in FB, VMAT in DIBH, IMPT in FB and IMPT in DIBH. Dosimetric impact on the heart, left anterior descending (LAD) coronary artery, lungs, female breasts, target coverage, and also conformity index and integral dose (ID), was compared between the different treatment techniques. Results: The use of DIBH significantly reduced the lung dose for all three treatment techniques, however, no significant difference in the dose to the female breasts was observed. Regarding the heart and LAD doses, large individual variations were observed. For VMAT, the mean heart and LAD doses were significantly reduced using DIBH, but no significant difference was observed for 3D-CRT and IMPT. Both IMPT and VMAT resulted in improved target coverage and more conform dose distributions compared to 3D-CRT. IMPT generally showed the lowest organs at risk (OAR) doses and significantly reduced the ID compared to both 3D-CRT and VMAT. Conclusions: The majority of patients benefited from treatment in DIBH, however, the impact on the normal tissue dose was highly individual and therefore comparative treatment planning is encouraged. The lowest OAR doses were generally observed for IMPT in combination with DIBH.
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| 7. |
- Jönsson, Mattias, et al.
(author)
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Technical evaluation of different motion-monitoring systems for respiratory gating in radiation therapy
- 2013
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In: Medical Physics in the Baltic States. - 1822-5721. ; , s. 38-41
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Conference paper (peer-reviewed)abstract
- The purpose of this work was to evaluate three motion-monitoring systems: Sentinel (TM), Catalyst (TM) (both C-RAD) and Real-time Position Management (RPM (TM)) system (Varian Medical Systems Inc) for respiratory gating in radiotherapy. To measure the systems. latency, an in-house built circuit with a microcontroller operating a piston was used. The trigger pulse was sent from the gating systems to the accelerator within 300 mu s. However, the response time of the accelerator could be over 300 ms
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| 8. |
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| 9. |
- Kügele, Malin, et al.
(author)
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Dosimetric effects of intrafractional isocenter variation during deep inspiration breath-hold for breast cancer patients using surface-guided radiotherapy
- 2018
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In: Journal of Applied Clinical Medical Physics. - : Wiley. - 1526-9914. ; 19:1, s. 25-38
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Journal article (peer-reviewed)abstract
- The aim of this study was to investigate potential dose reductions to the heart, left anterior descending coronary artery (LAD), and ipsilateral lung for left-sided breast cancer using visually guided deep inspiration breath-hold (DIBH) with the optical surface scanning system Catalyst™, and how these potential dosimetric benefits are affected by intrafractional motion in between breath holds. For both DIBH and free breathing (FB), treatment plans were created for 20 tangential and 20 locoregional left-sided breast cancer patients. During DIBH treatment, beam-on was triggered by a region of interest on the xiphoid process using a 3 mm gating window. Using a novel nonrigid algorithm, the Catalyst™ system allows for simultaneous real-time tracking of the isocenter position, which was used to calculate the intrafractional DIBH isocenter reproducibility. The 50% and 90% cumulative probabilities and maximum values of the intrafractional DIBH isocenter reproducibility were calculated and to obtain the dosimetric effect isocenter shifts corresponding to these values were performed in the treatment planning system. For both tangential and locoregional treatment, the dose to the heart, LAD and ipsilateral lung was significantly reduced for DIBH compared to FB. The intrafractional DIBH isocenter reproducibility was very good for the majority of the treatment sessions, with median values of approximately 1 mm in all three translational directions. However, for a few treatment sessions, intrafractional DIBH isocenter reproducibility of up to 5 mm was observed, which resulted in large dosimetric effects on the target volume and organs at risk. Hence, it is of importance to set tolerance levels on the intrafractional isocenter motion and not only perform DIBH based on the xiphoid process.
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| 10. |
- Kügele, Malin
(author)
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Surface guided radiotherapy
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Modern radiotherapy aims to treat the decease while minimizing the radiation dose to the adjacent normal tissue, to minimize acute and late effects of the treatment. The foremost technological approaches have been intensity modulated radiotherapy (IMRT) and intensity modulated proton therapy (IMPT) in combination with image guided radiotherapy (IGRT). IMRT and IMPT is characterized by a more conform dose distribution, often accompanied by steep dose gradients. In turn, accurate patient localization and motion management becomes more important. Several image guidance systems are available for radiotherapy (RT), with 3-dimensional (3D) volumetric images with cone beam computed tomography (CBCT) as a gold standard. In recent years, surface imaging (SI) using an optical surface scanning system has been included in the IGRT toolbox. The SI system CatalystTM (C-rad Positioning AB, Uppsala Sweden) visualize 3D surface images of the patient topography, and direct correlate the patient localization to the initial planned position. SI offers the largest field-of-view in RT, does not contribute to radiation exposure, provides real-time feedback and sub-millimeter spatial resolution. These characteristics are suitable for both patient positioning and motion management during RT.Integration with the linac provides beam control and automatic couch shifts, which imposes rigorous attention to quality assurance (QA) of the SI systems. In order to integrate the beam control, beam latency times (beam-on and beam-off) should be characterized, which required the development PIN diode circuit as a QA tool. Of extra importance was the measurements of the beam-off latency time, since it represents the time the linac continues to irradiate after the beam hold signal was sent from the SI system. The automatic couch shift is calculated by a deformable image registration (DIR) algorithm, unique for the CatalystTM surface scanning system. Positioning accuracy is dependent on the image registration, and hence, a deformable thorax phantom was developed to investigate accuracy of the DIR with anatomical realistic deformations present as a QA tool.Compared to traditional 3-point localization for patient positioning, this thesis has shown that SI improve the positioning for both breast and prostate cancer patients. Also, the SI workflow has shown to be time efficient for positioning of prostate cancer patients. A respiratory motion management technique is deep inspiration breath hold (DIBH), where the patient is instructed to hold his/her breath during the treatment delivery. The aim using DIBH, is to create an anatomical distance between the treatment volume and surrounding organs-at-risk (OARs). Comparative treatment planning studies, within the work of this thesis, showed that DIBH can be an effective method for both left sided breast cancer and Hodgkin’s lymphoma (HL) in order to spare dose to the heart. For HL, the combination of IMPT and DIBH was found to spare dose to OARs, however, due to the spread in target localization individual deviations from this treatment technique were observed. The real-time feedback from the surface image system was used to investigate the reproducibility of the DIBH to ensure correct dose distribution during the treatment delivery. High reproducibility of the isocenter position during DIBH was observed, however, for a few breath holds larger deviations occurred which urges the need to use beam control tolerance for the isocenter. The overall conclusion is that optical imaging systems, developed within the work of this thesis, can be used as an imaging tool for accurate and faster patient setup, intrafractional motion monitoring and reduced dose to OARs during treatment in DIBH.
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