Skip to main content

Investigating the impact of tumour motion on TomoTherapy stereotactic ablative body radiotherapy (SABR) deliveries on 3-dimensional and 4-dimensional computed tomography

Australasian Physical & Engineering Sciences in Medicine volume 42, pages 169–179 (2019)Cite this article

Abstract

TomoTherapy can provide highly accurate SABR deliveries, but currently it does not have any effective motion management techniques. Shallow breathing has been identified as one possible motion management solution on TomoTherapy, which has been made possible with the BreatheWell audiovisual biofeedback (AVB) device. Since both the shallow breathing technique and the clinical use of the BreatheWell device are novel, their implementation requires comprehensive verification and validation work. As the first stage of the validation, this paper investigates the impact of target motion on a TomoTherapy SABR delivery is assessed on both 3D CT and 4D CT using a 4D respiratory phantom. A dosimetric study on a 4D respiratory phantom was conducted, with the phantom’s insert designed to move at four different amplitudes in the superior-inferior direction. SABR plans on 3D and 4D CT scans were created and measured. Critical plan statistics and measurement results were compared. It is found that for TomoTherapy SABR deliveries, by reducing the targets respiratory motion, target coverage, organ-at-risk (OAR) sparing, and delivery accuracy were improved.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12

References

  1. Boggs H, Feigenberg S, Walter R, Patel DWB, Wu T, Rosen L (2012) Stereotactic body radiation therapy using tomotherapy for early stage NSCLC: the utility of mid-fraction CT scans to assess intrafraction tumour motion. Int J Radiat Oncol Biol Phys 84(3S):S559–S560

    Article  Google Scholar 

  2. Gallo JJ, Kaufman I, Powell R et al (2015) Single-fraction spine SBRT end-to-end testing on TomoTherapy, Vero, TrueBeam, and CyberKnife treatment platforms using a novel anthropomorphic phantom. J Appl Clin Med Phys 16(1):170–182

    Article  PubMed Central  Google Scholar 

  3. Hodge W, Tomé WA, Jaradat HA et al (2006) Feasibility report of image guided stereotactic body radiotherapy (IG-SBRT) with tomotherapy for early stage medically inoperable lung cancer using extreme hypofractionation. Acta Oncol 45(7):890–896

    Article  PubMed  Google Scholar 

  4. Nagai A, Shibamoto Y, Yoshida M, Inoda K, Kikuchi Y (2014) Safety and efficacy of intensity-modulated stereotactic body radiotherapy using helical tomotherapy for lung cancer and lung metastasis, Bio Med Res Int. https://doi.org/10.1155/2014/473173

    Article  Google Scholar 

  5. Lee D, Greer PB, Ludbrook J et al (2016) Audiovisual biofeedback improves cine-magnetic resonance imaging measured lung tumour motion consistency. Int J Radiat Oncol Biol Phys 94(3):628–636

    Article  PubMed  Google Scholar 

  6. Ekberg L, Holmberg O, Wittgren L, Bjelkengren G, Landberg T (1998) What margins should be added to the clinical target volume in radiotherapy treatment planning for lung cancer? Radiother Oncol 48:71–77

    Article  CAS  PubMed  Google Scholar 

  7. Barnes EA, Murray BR, Robinson DM, Underwood LJ, Hanson J, Roa WH (2001) Dosimetric evaluation of lung tumour immobilization using breath hold at deep inspiration. Int J Radiat Oncol Biol Phys 50(4):1091–1098

    Article  CAS  PubMed  Google Scholar 

  8. Kim T, Pollock S, Lee D, O’Brien R, Keall P (2012) Audiovisual biofeedback improves diaphragm motion reproducibility in MRI. Med Phys 39(11):6921–6928

    Article  PubMed  PubMed Central  Google Scholar 

  9. Davies SC, Hill AL, Holmes RB, Halliwell M, Jackson PC (1994) Ultrasound quantitation of respiratory organ motion in the upper abdomen. Br J Radiol 67(803):1096–1102

    Article  CAS  PubMed  Google Scholar 

  10. Suramo I, Paivansalo M, Myllyla V (1984) Cranio-caudal movements of the liver, pancreas and kidneys in respiration. Acta Radiol Diagn 25(2):129–131

    Article  CAS  Google Scholar 

  11. Korin HW, Ehman RL, Riederer SJ, Felmlee JP, Grimm RC (1992) Respiratory kinematics of the upper abdominal organs: a quantitative study. Magn Reson Med 23(1):172–178

    Article  CAS  PubMed  Google Scholar 

  12. Wade O (1954) Movement of the thoracic cage and diaphragm in respiration. J Physio 124:193–212

    Article  CAS  Google Scholar 

  13. O’Connell BF, Irvine FM, Cole AJ, Hanna GG, McGarry CK (2015) Optimizing geometric accuracy of four-dimensional CT scans quired using the wall- and couch-mounted Varian® Real-time Position Management™ camera systems. Br J Radiol 88(1046):20140624. https://doi.org/10.1259/bjr.20140624

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wong JW, Sharpe MB, Jaffray DA et al (1999) The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Radiat Oncol Bio Phys 44(4):911–919

    Article  CAS  Google Scholar 

  15. Remouchamps VM, Letts N, Vicini FA et al (2003) Initial clinical experience with moderate deep-inspiration breath hold using an active breathing control device in the treatment of patients with left-sided breast cancer using external beam radiation therapy. Int J Radiat Oncol Bio Phys 56(3):704–715

    Article  Google Scholar 

  16. Bert C, Metheany KG, Doppke K, Chen GT (2005) A phantom evaluation of a stereo-vision surface imaging system for radiotherapy patient setup. Med Phys 32(9):2753–2762

    Article  PubMed  Google Scholar 

  17. Giraud P, Houle A (2010) Respiratory gating for radiotherapy: main technical aspects and clinical benefits. Bull Cancer 97(7):847–856. https://doi.org/10.1684/bdc.2010.1143

    CAS  Article  PubMed  Google Scholar 

  18. Keall PJ, Mageras GS, Balter JM et al (2006) The management of respiratory motion in radiation oncology report of AAPM Task Group 76. Med Phys 33(10):3874–3900

    Article  Google Scholar 

  19. Byrne M, Hu Y, Archibald-Heeren B (2016) Evaluation of RayStation robust optimisation for superficial target coverage with setup variation in breast IMRT. Australas Phys Eng Sci Med 39:705–716

    Article  PubMed  Google Scholar 

  20. C-RAD Pty Ltd. CatalystTM Tomo–Improved Positioning Workflow for TomoTherapy [BROCHURE]. https://c-rad.se/content/uploads/2015/06/A4_C-RAD_folder_TomoTherapy_pages.pdf. Accessed 14th Dec 2018

  21. Opus Medical Pty Ltd. Breathe well patient information. https://breathewell.co/patient-information/. Accessed 3 Nov 2017

  22. Pollock S. Translational research of audiovisual biofeedback: an investigation of respiratory-guidance in lung and liver cancer patient radiation therapy (Doctoral dissertation). Retrieved from Sydney Digital Theses Database. http://hdl.handle.net/2123/15902. Accessed 8 Nov 2017

  23. Venkat RB, Sawant A, Suh Y, George R, Keall PJ (2008) Development and preliminary evaluation of a prototype audiovisual biofeedback device incorporating a patient-specific guiding waveform. Phys Med Biol 53(11):N197–N208

    Article  PubMed  Google Scholar 

  24. Modus Medical Devices Inc. State-of-the-art breathing simulator using patient respiratory waveforms. https://modusqa.com/motion/phantom. Accessed 8 Nov 2017

  25. Sangalli G, Passoni P, Cattaneo GM et al (2011) Planning design of locally advanced pancreatic carcinoma using 4DCT and IMRT/IGRT technologies. Acta Oncol 50:72–80

    Article  PubMed  Google Scholar 

  26. Kim YJ, Jang SJ, Han JB et al (2014) Motion and volume change of tumor tissue depending on patient position in liver cancer treatment with use of tomotherapy. Ann Nucl Energy 65:174–180

    Article  CAS  Google Scholar 

  27. Nakamura M, Narita Y, Matsuo Y et al (2008) Geometrical differences in target volumes between slow CT and 4D CT imaging in stereotactic body radiotherapy for lung tumours in the upper and middle lobe. Med Phys 35(9):4142–4148

    Article  PubMed  Google Scholar 

  28. Purdie TG, Moseley DJ, Bissonnette J et al (2006) Respiration correlated cone-beam computed tomography and 4DCT for evaluating target motion in Stereotactic Lung Radiation Therapy. Acta Oncol 45(7):915–922

    Article  PubMed  Google Scholar 

  29. Archibald-Herren B, Byrne M, Hu Y, Cai M, Wang Y (2017) Robust optimization of VMAT for lung cancer: dosimetric implications of motion compensation techniques. J Appl Clin Med Phys 18(5):104–116

    Article  Google Scholar 

  30. Wiant D, Vanderstraeten C, Maurer J, Pursley J, Terrell J, Sintay BJ (2014) On the validity of density overrides for VMAT lung SBRT planning. Med Phys 41(8):081707. https://doi.org/10.1118/1.4887778

    Article  PubMed  Google Scholar 

  31. Badkul R, Pokhrel D, Ramanjappa T, Jiang H, Lominska C, Wang F (2016) Measurement of dose blurring effect due to respiratory motion for lung stereotactic body radiation therapy (SBRT) using Monte Carlo based calculation algorithm. Med Phys 43(6):3592

    Article  Google Scholar 

  32. Yu CX, Jaffray DA, Wong JW (1998) The effects of intra-fraction organ motion on the delivery of dynamic intensity modulation. Phys Med Biol 43:91–104

    Article  CAS  PubMed  Google Scholar 

  33. Bortfeld T, Jokivarsi K, Goitein M, Kung JH, Jiang SB (2002) Effects of intra-fraction motion on IMRT dose delivery: statistical analysis and simulation. Phys Med Biol 47(13):2203–2220

    Article  PubMed  Google Scholar 

  34. Jiang SB, Pope C, Al Jarrah KM, Kung JH, Bortfeld T, Chen GT (2003) An experimental investigation on intra-fractional organ motion effects in lung IMRT treatments. Phys Med Biol 48(12):1773–1784

    Article  PubMed  Google Scholar 

  35. Kissick M, Boswell S, Jeraj R, Mackie TR (2005) Confirmation, refinement, and extension of a study in intrafraction motion interplay with sliding jaw motion. Med Phys 32(7):2346–2350

    Article  PubMed  Google Scholar 

  36. Kanagaki B, Read PW, Molloy JA, Larner JM, Sheng K (2007) A motion phantom study on helical tomotherapy: the dosimetric impacts of delivery technique and motion. Phys Med Biol 52:243–255

    Article  PubMed  Google Scholar 

  37. Zhu Z, Fu X (2015) The radiation techniques of tomotherapy and intensity-modulated radiation therapy applied to lung cancer. Transl Lung Cancer Res 4(3):265–274

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiation Oncology Centres Gosford, 41 William St, Gosford, NSW, 2250, Australia

    Yunfei Hu

  2. Radiation Oncology Centres Wahroonga, 185 Fox Valley Rd, Wahroonga, NSW, 2076, Australia

    Ben Archibald-Heeren & Mikel Byrne

  3. Icon Cancer Centre Revesby, 3/1 MacArthur Ave, Revesby, NSW, 2112, Australia

    Emma Cai & Yang Wang

Authors
  1. Yunfei Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ben Archibald-Heeren
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mikel Byrne
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Emma Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yang Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yunfei Hu.

Ethics declarations

Ethical approval

The authors declare that no ethical approval is required.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hu, Y., Archibald-Heeren, B., Byrne, M. et al. Investigating the impact of tumour motion on TomoTherapy stereotactic ablative body radiotherapy (SABR) deliveries on 3-dimensional and 4-dimensional computed tomography. Australas Phys Eng Sci Med 42, 169–179 (2019). https://doi.org/10.1007/s13246-019-00727-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13246-019-00727-8

Keywords

  • TomoTherapy
  • Shallow breathing
  • Stereotactic ablative body radiotherapy