Target position uncertainty during visually guided deep-inspiration breath-hold radiotherapy in locally advanced lung cancer

Jonas Scherman Rydhog, Steen Riisgaard de Blanck, Mirjana Josipovic, Rasmus Irming Jølck, Klaus Richter Larsen, Paul Clementsen, Thomas Lars Andersen, Per Rugaard Poulsen, Gitte Fredberg Persson, Per Munck af Rosenschold

    Research output: Contribution to journalJournal articleResearchpeer-review

    Abstract

    Purpose: The purpose of this study was to estimate the uncertainty in voluntary deep-inspiration breath hold (DISH) radiotherapy for locally advanced non-small cell lung cancer (NSCLC) patients.Methods: Perpendicular fluoroscopic movies were acquired in free breathing (FB) and DIBH during a course of visually guided DIBH radiotherapy of nine patients with NSCLC. Patients had liquid markers injected in mediastinal lymph nodes and primary tumours. Excursion, systematic- and random errors, and inter-breath-hold position uncertainty were investigated using an image based tracking algorithm.Results: A mean reduction of 2-6 mm in marker excursion in DIBH versus FB was seen in the anterior posterior (AP), left-right (LR) and cranio-caudal (CC) directions. Lymph node motion during DIBH originated from cardiac motion. The systematic-(standard deviation (SD) of all the mean marker positions) and random errors (root-mean-square of the intra-BH SD) during DIBH were 0.5 and 0.3 mm (AP), 0.5 and 0.3 mm (LR), 0.8 and 0.4 mm (CC), respectively. The mean inter-breath-hold shifts were -0.3 mm (AP), -0.2 mm (LR), and -0.2 mm (CC).Conclusion: Intra- and inter-breath-hold uncertainty of tumours and lymph nodes were small in visually guided breath-hold radiotherapy of NSCLC. Target motion could be substantially reduced, but not eliminated, using visually guided DIBH. (C) 2017 Elsevier B.V. All rights reserved.
    Original languageEnglish
    JournalRadiotherapy and Oncology
    Volume123
    Issue number1
    Pages (from-to)78-84
    Number of pages7
    ISSN0167-8140
    DOIs
    Publication statusPublished - 2017

    Keywords

    • Image based tracking
    • Image-guided radiotherapy
    • Liquid fiducial marker

    Cite this

    Rydhog, J. S., de Blanck, S. R., Josipovic, M., Jølck, R. I., Larsen, K. R., Clementsen, P., ... af Rosenschold, P. M. (2017). Target position uncertainty during visually guided deep-inspiration breath-hold radiotherapy in locally advanced lung cancer. Radiotherapy and Oncology, 123(1), 78-84. https://doi.org/10.1016/j.radonc.2017.02.003
    Rydhog, Jonas Scherman ; de Blanck, Steen Riisgaard ; Josipovic, Mirjana ; Jølck, Rasmus Irming ; Larsen, Klaus Richter ; Clementsen, Paul ; Andersen, Thomas Lars ; Poulsen, Per Rugaard ; Persson, Gitte Fredberg ; af Rosenschold, Per Munck. / Target position uncertainty during visually guided deep-inspiration breath-hold radiotherapy in locally advanced lung cancer. In: Radiotherapy and Oncology. 2017 ; Vol. 123, No. 1. pp. 78-84.
    @article{8ff02f927da64cdfb2dd1deaee94fb81,
    title = "Target position uncertainty during visually guided deep-inspiration breath-hold radiotherapy in locally advanced lung cancer",
    abstract = "Purpose: The purpose of this study was to estimate the uncertainty in voluntary deep-inspiration breath hold (DISH) radiotherapy for locally advanced non-small cell lung cancer (NSCLC) patients.Methods: Perpendicular fluoroscopic movies were acquired in free breathing (FB) and DIBH during a course of visually guided DIBH radiotherapy of nine patients with NSCLC. Patients had liquid markers injected in mediastinal lymph nodes and primary tumours. Excursion, systematic- and random errors, and inter-breath-hold position uncertainty were investigated using an image based tracking algorithm.Results: A mean reduction of 2-6 mm in marker excursion in DIBH versus FB was seen in the anterior posterior (AP), left-right (LR) and cranio-caudal (CC) directions. Lymph node motion during DIBH originated from cardiac motion. The systematic-(standard deviation (SD) of all the mean marker positions) and random errors (root-mean-square of the intra-BH SD) during DIBH were 0.5 and 0.3 mm (AP), 0.5 and 0.3 mm (LR), 0.8 and 0.4 mm (CC), respectively. The mean inter-breath-hold shifts were -0.3 mm (AP), -0.2 mm (LR), and -0.2 mm (CC).Conclusion: Intra- and inter-breath-hold uncertainty of tumours and lymph nodes were small in visually guided breath-hold radiotherapy of NSCLC. Target motion could be substantially reduced, but not eliminated, using visually guided DIBH. (C) 2017 Elsevier B.V. All rights reserved.",
    keywords = "Image based tracking, Image-guided radiotherapy, Liquid fiducial marker",
    author = "Rydhog, {Jonas Scherman} and {de Blanck}, {Steen Riisgaard} and Mirjana Josipovic and J{\o}lck, {Rasmus Irming} and Larsen, {Klaus Richter} and Paul Clementsen and Andersen, {Thomas Lars} and Poulsen, {Per Rugaard} and Persson, {Gitte Fredberg} and {af Rosenschold}, {Per Munck}",
    year = "2017",
    doi = "10.1016/j.radonc.2017.02.003",
    language = "English",
    volume = "123",
    pages = "78--84",
    journal = "Radiotherapy & Oncology",
    issn = "0167-8140",
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    Rydhog, JS, de Blanck, SR, Josipovic, M, Jølck, RI, Larsen, KR, Clementsen, P, Andersen, TL, Poulsen, PR, Persson, GF & af Rosenschold, PM 2017, 'Target position uncertainty during visually guided deep-inspiration breath-hold radiotherapy in locally advanced lung cancer', Radiotherapy and Oncology, vol. 123, no. 1, pp. 78-84. https://doi.org/10.1016/j.radonc.2017.02.003

    Target position uncertainty during visually guided deep-inspiration breath-hold radiotherapy in locally advanced lung cancer. / Rydhog, Jonas Scherman; de Blanck, Steen Riisgaard; Josipovic, Mirjana; Jølck, Rasmus Irming; Larsen, Klaus Richter; Clementsen, Paul; Andersen, Thomas Lars; Poulsen, Per Rugaard; Persson, Gitte Fredberg; af Rosenschold, Per Munck.

    In: Radiotherapy and Oncology, Vol. 123, No. 1, 2017, p. 78-84.

    Research output: Contribution to journalJournal articleResearchpeer-review

    TY - JOUR

    T1 - Target position uncertainty during visually guided deep-inspiration breath-hold radiotherapy in locally advanced lung cancer

    AU - Rydhog, Jonas Scherman

    AU - de Blanck, Steen Riisgaard

    AU - Josipovic, Mirjana

    AU - Jølck, Rasmus Irming

    AU - Larsen, Klaus Richter

    AU - Clementsen, Paul

    AU - Andersen, Thomas Lars

    AU - Poulsen, Per Rugaard

    AU - Persson, Gitte Fredberg

    AU - af Rosenschold, Per Munck

    PY - 2017

    Y1 - 2017

    N2 - Purpose: The purpose of this study was to estimate the uncertainty in voluntary deep-inspiration breath hold (DISH) radiotherapy for locally advanced non-small cell lung cancer (NSCLC) patients.Methods: Perpendicular fluoroscopic movies were acquired in free breathing (FB) and DIBH during a course of visually guided DIBH radiotherapy of nine patients with NSCLC. Patients had liquid markers injected in mediastinal lymph nodes and primary tumours. Excursion, systematic- and random errors, and inter-breath-hold position uncertainty were investigated using an image based tracking algorithm.Results: A mean reduction of 2-6 mm in marker excursion in DIBH versus FB was seen in the anterior posterior (AP), left-right (LR) and cranio-caudal (CC) directions. Lymph node motion during DIBH originated from cardiac motion. The systematic-(standard deviation (SD) of all the mean marker positions) and random errors (root-mean-square of the intra-BH SD) during DIBH were 0.5 and 0.3 mm (AP), 0.5 and 0.3 mm (LR), 0.8 and 0.4 mm (CC), respectively. The mean inter-breath-hold shifts were -0.3 mm (AP), -0.2 mm (LR), and -0.2 mm (CC).Conclusion: Intra- and inter-breath-hold uncertainty of tumours and lymph nodes were small in visually guided breath-hold radiotherapy of NSCLC. Target motion could be substantially reduced, but not eliminated, using visually guided DIBH. (C) 2017 Elsevier B.V. All rights reserved.

    AB - Purpose: The purpose of this study was to estimate the uncertainty in voluntary deep-inspiration breath hold (DISH) radiotherapy for locally advanced non-small cell lung cancer (NSCLC) patients.Methods: Perpendicular fluoroscopic movies were acquired in free breathing (FB) and DIBH during a course of visually guided DIBH radiotherapy of nine patients with NSCLC. Patients had liquid markers injected in mediastinal lymph nodes and primary tumours. Excursion, systematic- and random errors, and inter-breath-hold position uncertainty were investigated using an image based tracking algorithm.Results: A mean reduction of 2-6 mm in marker excursion in DIBH versus FB was seen in the anterior posterior (AP), left-right (LR) and cranio-caudal (CC) directions. Lymph node motion during DIBH originated from cardiac motion. The systematic-(standard deviation (SD) of all the mean marker positions) and random errors (root-mean-square of the intra-BH SD) during DIBH were 0.5 and 0.3 mm (AP), 0.5 and 0.3 mm (LR), 0.8 and 0.4 mm (CC), respectively. The mean inter-breath-hold shifts were -0.3 mm (AP), -0.2 mm (LR), and -0.2 mm (CC).Conclusion: Intra- and inter-breath-hold uncertainty of tumours and lymph nodes were small in visually guided breath-hold radiotherapy of NSCLC. Target motion could be substantially reduced, but not eliminated, using visually guided DIBH. (C) 2017 Elsevier B.V. All rights reserved.

    KW - Image based tracking

    KW - Image-guided radiotherapy

    KW - Liquid fiducial marker

    U2 - 10.1016/j.radonc.2017.02.003

    DO - 10.1016/j.radonc.2017.02.003

    M3 - Journal article

    VL - 123

    SP - 78

    EP - 84

    JO - Radiotherapy & Oncology

    JF - Radiotherapy & Oncology

    SN - 0167-8140

    IS - 1

    ER -