Deep Inspiration breath Hold facilitates surgical cavity registration on cone beam imaging for Partial breast irradiation

• Published in: Radiotherapy and oncology Vol. 199; p. 110471
• Main Authors: Ali, Tauseef, Vellengara, Muhsina, Albalushi, Fatema Yousuf, Basheer, Rashid, Vidhyadharan, Abishek, Hassabelrasol, Aya, Aman, Abid Ali Mirza, Al-Ajmi, Amna, Pignol, Jean-Philippe
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.10.2024
• Subjects: Accelerated partial breast irradiation; Breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Breath Holding; CBCT; Cone-Beam Computed Tomography - methods; DIBH; Female; Humans; Inhalation; Middle Aged; Radiotherapy Planning, Computer-Assisted - methods; Radiotherapy, Image-Guided - methods; SGRT; Treatment registration accuracy; Accelerated partial breast irradiation; SGRT; Treatment registration accuracy; Breast cancer; DIBH; CBCT
• ISSN: 0167-8140; 1879-0887; 1879-0887
• DOI: 10.1016/j.radonc.2024.110471

•The utilization of Deep Inspiration Breath Hold (DIBH) with skin guided radiotherapy (SGRT) significantly improves the quality of breast CBCT images by controlling breathing motion.•The surgical cavity is more frequently identified in 76 % of the cases where motion control is utilized, compared to 56 % in its absence (p < 0.001).•This reduced the variability of registration shifts (p < 0.001).•For breast irradiation techniques like APBI where there is a high risk of geographical miss DIBH can improve treatment accuracy. The quality of the Cone Beam Computed Tomography (CBCT) images used for patient set-up is essential to avoid geographical miss when narrower margins or shorter fractionation are used for example in Accelerated Partial Breast Irradiation (APBI). This study evaluates deep inspiration breath hold (DIBH) with skin guided radiotherapy as a tool for image improvement reducing motion artifacts. Daily CBCT images of left and right breast cancer patients with well-defined surgical cavity on CT simulation were used for this study. Only left sided CBCT were acquired with DIBH. Trained and experienced radiation therapists were asked to evaluate the image quality using a cavity visualization score (CVS), an image quality Likert score, and to perform registration shifts. Images were anonymized and therapists were blinded to the use of DIBH. Images from 21 patients, with 15 CBCT each, were evaluated by 6 radiation therapists, generating 4,015 evaluation points. Statistically significant improvements were observed in CVS and image quality (p < 0.001) with DIBH. Also, the rate of surgical cavity identification increased to 76 % with DIBH compared to 56 % without (p < 0.001). DIBH significantly reduced the inter-observer variability in registration shift corrections (p < 0.001) Utilizing DIBH for motion control improves both the image quality and the surgical cavity identification. This results in a decrease in registration variability, which is important for APBI accuracy.