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Title: SU-F-T-636: Comprehensive Approach to Motion Assessment for Liver and Pancreas SBRT Patients

Abstract

Purpose: Our past practice for liver and pancreas SBRT consisted of free breathing (FB) with gated treatment delivery using a 30-70% phase window. We have recently adopted an assessment method leading to individualized motion management to minimize target motion. We present our results from 47 patients treated with this new approach. Methods: We perform an initial patient coaching and assessment session in our conventional simulator suite to observe the motion of the implanted fiducials with FB anterior and lateral 20-second cine acquisitions. The physician decides whether to attempt inhale or exhale breath-hold (BH). The patient is coached while observing with cine to ascertain their ability to achieve the desired BH mode for long periods as needed for treatment delivery. If the patient cannot comply, a FB approach is adopted using gating or simple ITV method (for patients without fiducials). After achieving a patient-specific motion management mode, we perform CT-simulation using the Varian RPM system to reproduce the chosen mode and record a reference session for treatment delivery. For pre-treatment imaging, the fiducials are observed under fluoro while coaching the patient. Results: Of 47 SBRT cases analyzed, 32 were liver and 15 were pancreas. The chosen techniques were: 32 exhale BHmore » (12 with abdominal compression), 7 FB gated, 4 inhale BH, and 4 FB ITV. Maximum fiducial motion amplitude was 5 mm for the FB gated patients, and less than 5 mm for all BH patients with most able to achieve a maximum amplitude of 3 mm. Conclusion: This study showed that an individualized motion management approach can reduce the target volume and, therefore, the volume of irradiated healthy tissue from liver or pancreas SBRT. Effective coaching is essential in achieving consistent BH with 3 mm amplitude. The fluoro/cine session is helpful in establishing the right coaching approach for each patient.« less

Authors:
; ;  [1]
  1. Lahey Hospital and Medical Center, Burlington, MA (United States)
Publication Date:
OSTI Identifier:
22649196
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; AMPLITUDES; BIOMEDICAL RADIOGRAPHY; DELIVERY; LIVER; PANCREAS; PATIENTS

Citation Formats

Halvorsen, P, Iftimia, I, and Hunter, K. SU-F-T-636: Comprehensive Approach to Motion Assessment for Liver and Pancreas SBRT Patients. United States: N. p., 2016. Web. doi:10.1118/1.4956821.
Halvorsen, P, Iftimia, I, & Hunter, K. SU-F-T-636: Comprehensive Approach to Motion Assessment for Liver and Pancreas SBRT Patients. United States. doi:10.1118/1.4956821.
Halvorsen, P, Iftimia, I, and Hunter, K. Wed . "SU-F-T-636: Comprehensive Approach to Motion Assessment for Liver and Pancreas SBRT Patients". United States. doi:10.1118/1.4956821.
@article{osti_22649196,
title = {SU-F-T-636: Comprehensive Approach to Motion Assessment for Liver and Pancreas SBRT Patients},
author = {Halvorsen, P and Iftimia, I and Hunter, K},
abstractNote = {Purpose: Our past practice for liver and pancreas SBRT consisted of free breathing (FB) with gated treatment delivery using a 30-70% phase window. We have recently adopted an assessment method leading to individualized motion management to minimize target motion. We present our results from 47 patients treated with this new approach. Methods: We perform an initial patient coaching and assessment session in our conventional simulator suite to observe the motion of the implanted fiducials with FB anterior and lateral 20-second cine acquisitions. The physician decides whether to attempt inhale or exhale breath-hold (BH). The patient is coached while observing with cine to ascertain their ability to achieve the desired BH mode for long periods as needed for treatment delivery. If the patient cannot comply, a FB approach is adopted using gating or simple ITV method (for patients without fiducials). After achieving a patient-specific motion management mode, we perform CT-simulation using the Varian RPM system to reproduce the chosen mode and record a reference session for treatment delivery. For pre-treatment imaging, the fiducials are observed under fluoro while coaching the patient. Results: Of 47 SBRT cases analyzed, 32 were liver and 15 were pancreas. The chosen techniques were: 32 exhale BH (12 with abdominal compression), 7 FB gated, 4 inhale BH, and 4 FB ITV. Maximum fiducial motion amplitude was 5 mm for the FB gated patients, and less than 5 mm for all BH patients with most able to achieve a maximum amplitude of 3 mm. Conclusion: This study showed that an individualized motion management approach can reduce the target volume and, therefore, the volume of irradiated healthy tissue from liver or pancreas SBRT. Effective coaching is essential in achieving consistent BH with 3 mm amplitude. The fluoro/cine session is helpful in establishing the right coaching approach for each patient.},
doi = {10.1118/1.4956821},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = {Wed Jun 15 00:00:00 EDT 2016},
month = {Wed Jun 15 00:00:00 EDT 2016}
}