Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-10T14:46:33.976Z Has data issue: false hasContentIssue false
  • English
  • Français

Fraction-specific post-treatment quality assurance for active breath-hold radiation therapy

Published online by Cambridge University Press:  18 February 2019

Rajesh Thiyagarajan Open the ORCID record for Rajesh Thiyagarajan [Opens in a new window] ,
Arunai Nambiraj Open the ORCID record for Arunai Nambiraj [Opens in a new window] ,
Durai Manigandan ,
Tamilseivan Singaravelu ,
Rajesh Selvaraj  and
Tejinder Kataria
Rajesh Thiyagarajan*
Affiliation:
Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India
Arunai Nambiraj
Affiliation:
Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT) VIT University, Vellore, Tamil Nadu, India
Durai Manigandan
Affiliation:
Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India
Tamilseivan Singaravelu
Affiliation:
Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India
Rajesh Selvaraj
Affiliation:
Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India
Tejinder Kataria
Affiliation:
Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India
*
Author for correspondence: Rajesh Thiyagarajan, Senior Medical Physicist & RSO, Division of Radiation Oncology, Medanta Cancer Institute, Medanta The Medicity, Sector 38, Gurugram, Haryana, India. E-mail: trajesh.tpt2000@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose

The purpose of this study is to evaluate variation in the treatment hold pattern and quantify its dosimetric impact in breath-hold radiotherapy, using fraction-specific post-treatment quality assurance.

Material and Methods

A patient with lung mets treated using intensity-modulated radiation therapy (IMRT) with active breath coordinator (ABC) was recruited for the study. Treatment beam hold conditions were recorded for all the 25 fractions. The linearity and reproducibility of the dosimetric system were measured. Variation in the dose output of unmodulated open beam with beam hold was studied. Patient-specific quality assurance (PSQA) was performed with and without beam hold, and the results were compared to quantify the dosimetric impact of beam hold.

Results

There was a considerable amount of variation observed in the number of beam hold for the given field and the monitor unit at which the beam held. Linearity and reproducibility of the dosimetric system were found within the acceptable limits. The average difference over the 25 measurements was 0·044% (0·557 to −0·318%) with standard deviation of 0·248.

Conclusion

Patient comfort with the ABC system and responsiveness to the therapist communication help to maintain consistent breathing pattern, in turn consistent treatment delivery pattern. However, the magnitude of dosimetric error is much less than the acceptable limits recommended by IROC. The dosimetric error induced by the beam hold is over and above the dose difference observed in conventional PSQA.

Keywords

active breath coordinatordeep inspiration breath holdpatient-specific quality assuranceverification
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 18 , Issue 3 , September 2019 , pp. 262 - 270
Copyright
© Cambridge University Press 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Cite this article: Thiyagarajan R, Nambiraj A, Manigandan D, Singaravelu T, Selvaraj R, Kataria T. (2019) Fraction-specific post-treatment quality assurance for active breath-hold radiation therapy. Journal of Radiotherapy in Practice18: 262–270. doi: 10.1017/S1460396919000049

References

1. Jonathan, D T, Christopher, J A, David, K G, Glen, M B. Radiation therapy and skin cancer, modern practices in radiation therapy. InTeched 2012; 2012: 207–246.Google Scholar
2. ICRU. ICRU Report. 1999. Vol. 62. Bethesda: International Commission on Radiation Units and Measurements. Prescribing, recording, and reporting photon beam therapy (Supplement to ICRU report 50).Google Scholar
3. Keall, P J, Mageras, G S, Balter, J M et al. The management of respiratory motion in radiation oncology report of AAPM Task Group 76. Med Phys 2006; 3874–3900.10.1118/1.2349696Google Scholar
4. Rosenzweig, K E, Hanley, J, Mah, D et al. The deep inspiration breath-hold technique in the treatment of inoperable non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2000; 48 (1): 81–87.10.1016/S0360-3016(00)00583-6Google Scholar
5. Harriet, E H, Virginia, L, Albert, C et al. Active breathing coordinator reduces radiation dose to the heart and preserves local control in patients with left breast cancer: report of a prospective trial. Pract Radiat Oncol 2015; 5: 4–10.Google Scholar
6. Dawson, L A, Eccles, C, Bissonnette, J P, Brock, K K. Accuracy of daily image guidance for hypofractionated liver radiotherapy with active breathing control. Int J Radiat Oncol Biol Phys 2005; 62 (4): 1247–1252.10.1016/j.ijrobp.2005.03.072Google Scholar
7. Muralidhar, K R, Murthy, P N, Mahadev, D S et al. Magnitude of shift of tumor position as a function of moderated deep inspiration breath-hold: an analysis of pooled data of lung patients with active breath control in image-guided radiotherapy. J Med Phys 2008; 33: 147–153.10.4103/0971-6203.44475Google Scholar
8. Dawson, L A, Brock, K K, Kazanjian, S et al. The reproducibility of organ position using active breathing control (ABC) during liver radiotherapy. Int J Radiat Oncol Biol Phys 2001; 51: 1410–1421.10.1016/S0360-3016(01)02653-0Google Scholar
9. Welgemoed, C, Rogers, J, McNaught, P, Cleator, S, Riddle, P, Gujral, D. Deep inspirational breath hold to reduce cardiac dose in left-sided breast radiotherapy. J Radiother Pract 2017; 16 (3): 251–257.10.1017/S1460396917000152Google Scholar
10. Chui, C S, Spirou, S, LoSasso, T. Testing of dynamic multileaf collimation. Med Phys 1996; 23: 635–641.10.1118/1.597699Google Scholar
11. LoSasso, T, Chui, C S, Ling, C C. Physical and dosimetric aspects of a multileaf collimation system used in the dynamic mode for implementing intensity modulated radiotherapy. Med Phys 1998; 25: 1919–1927.10.1118/1.598381Google Scholar
12. LoSasso, T, Chui, C S, Ling, C C. Comprehensive quality assurance for the delivery of intensity modulated radiotherapy with a multileaf collimator used in the dynamic mode. Med Phys 2001; 28: 2209–2219.10.1118/1.1410123Google Scholar
13. Ezzell, G, Chungbin, S. The overshoot phenomenon in step-and-shoot IMRT delivery. J Appl Clin Med Phys 2001; 2: 138–148.10.1120/1.1386508Google Scholar
14. Bruzzaniti, V, Abate, A, Pinnarò, P et al. Dosimetric and clinical advantages of deep inspiration breath-hold (DIBH) during radiotherapy of breast cancer. J Exp Clin Cancer Res 2013; 32: 88.10.1186/1756-9966-32-88Google Scholar
15. Bergom, C, Currey, A, Desai, N, Tai, A, Jonathan, B. Strauss deep inspiration breath hold: techniques and advantages for cardiac sparing during breast cancer irradiation. Front Oncol 2018; 8 (87): 1–10.10.3389/fonc.2018.00087Google Scholar
16. Seco, J, Sharp, G C, Turcotte, J, Gierga, D, Bortfeld, T, Paganetti, H. Effects of organ motion on IMRT treatments with segments of few monitor units. Med Phys 2007; 34: 923–934.10.1118/1.2436972Google Scholar
17. ICRU. ICRU Report. 1993. Vol. 50. Bethesda: International Commission on Radiation Units and Measurements. Prescribing, recording, and reporting photon beam therapy.Google Scholar
18. Foster, R D, Speiser, M P, Solberg, T D. Commissioning and verification of the collapsed cone convolution superposition algorithm for SBRT delivery using flattening filter‐free beams. J Appl Clin Med Phys 2014; 15 (2): 39–49.10.1120/jacmp.v15i2.4631Google Scholar