A uniform and versatile surface-guided radiotherapy procedure and workflow for high-quality breast deep-inspiration breath-hold treatment in a multi-center institution Journal Article
| Authors: | Li, G.; Lu, W.; O'Grady, K.; Yan, I.; Yorke, E.; Cervino Arriba, L. I.; Powell, S.; Hong, L. |
| Article Title: | A uniform and versatile surface-guided radiotherapy procedure and workflow for high-quality breast deep-inspiration breath-hold treatment in a multi-center institution |
| Abstract: | Purpose: We share our experiences on uniformly implementing an effective and efficient SGRT procedure with a new clinical workflow for treating breast patients in deep-inspiration breath-hold (DIBH) among 9 clinical centers using 26 optical surface imaging (OSI) systems. Methods: Our procedures have five major components: (1) acquiring both free-breathing (FB) and DIBH computed tomography (CT) at simulation to quantify the rise of the anterior surface, (2) defining uniformly a large region of interest (ROI) to accommodate large variations in patient anatomy and treatment techniques, (3) performing two-step setup in FB by first aligning the arm and chin to minimize breast deformation and reproduce local lymphnode positions and then aligning the ROI, (4) aligning the vertical shift precisely from FB to DIBH, and (5) capturing a new on-site reference image at DIBH to separate residual setup errors from the DIBH motion monitoring uncertainties. Moreover, a new clinical workflow was developed for patient data preparation using 4 OSI offline workstations without interruption of SGRT treatment at 22 OSI online workstations. This procedure/workflow is suitable for all photon planning techniques, including 2-field, 3-field, 4-field, partial breast irradiation (PBI), and volumetric-modulated arc therapy (VMAT) with or without bolus. Results: Since 2019, we have developed and applied the uniform breast SGRT DIBH procedure with optimized clinical workflow and ensured treatment accuracy among the nine clinics within our institution. About 150 breast DIBH patients are treated daily and two major upgrades are achieved smoothly throughout our institution, owing to the uniform and versatile procedure, adequate staff training, and efficient workflow with effective clinical supports and backup strategies. Conclusion: The uniform and versatile breast SGRT DIBH procedure and workflow have been developed to ensure smooth and optimal clinical operations, simplify clinical staff training and clinical troubleshooting, and allow high-quality SGRT delivery in a busy multi-center institution. © 2022 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, LLC on behalf of The American Association of Physicists in Medicine. |
| Keywords: | clinical trial; intensity modulated radiation therapy; radiotherapy dosage; breast neoplasms; radiation response; radiotherapy, intensity-modulated; multicenter study; breast tumor; radiotherapy planning, computer-assisted; breath holding; heart; procedures; workflow; organs at risk; humans; human; female; radiotherapy planning system; unilateral breast neoplasms; optical surface imaging (osi); surface-guided radiotherapy (sgrt); deep-inspiration breast hold (dibh); left-sided breast radiotherapy |
| Journal Title: | Journal of Applied Clinical Medical Physics |
| Volume: | 23 |
| Issue: | 3 |
| ISSN: | 1526-9914 |
| Publisher: | American College of Medical Physics |
| Date Published: | 2022-03-01 |
| Start Page: | e13511 |
| Language: | English |
| DOI: | 10.1002/acm2.13511 |
| PUBMED: | 35049108 |
| PROVIDER: | scopus |
| PMCID: | PMC8906224 |
| DOI/URL: | |
| Notes: | Article -- Funding details: National Institutes of Health, NIH, P30 CA008748 -- Source: Scopus |
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