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Determination of the optimal matching position for setup images and minimal setup margins in adjuvant radiotherapy of breast and lymph nodes treated in voluntary deep inhalation breath-hold

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Determination of the optimal matching position for setup images and minimal setup margins in adjuvant radiotherapy of breast and lymph nodes treated in voluntary deep inhalation breath-hold. / Laaksomaa, Marko; Kapanen, Mika; Haltamo, Mikko; Skyttä, Tanja; Peltola, Seppo; Hyödynmaa, Simo; Kellokumpu-Lehtinen, Pirkko Liisa.

In: RADIATION ONCOLOGY, Vol. 10, No. 1, 76, 03.04.2015.

Research output: Contribution to journalArticleScientificpeer-review

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Laaksomaa, M., Kapanen, M., Haltamo, M., Skyttä, T., Peltola, S., Hyödynmaa, S., & Kellokumpu-Lehtinen, P. L. (2015). Determination of the optimal matching position for setup images and minimal setup margins in adjuvant radiotherapy of breast and lymph nodes treated in voluntary deep inhalation breath-hold. RADIATION ONCOLOGY, 10(1), [76]. https://doi.org/10.1186/s13014-015-0383-y

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Laaksomaa, Marko ; Kapanen, Mika ; Haltamo, Mikko ; Skyttä, Tanja ; Peltola, Seppo ; Hyödynmaa, Simo ; Kellokumpu-Lehtinen, Pirkko Liisa. / Determination of the optimal matching position for setup images and minimal setup margins in adjuvant radiotherapy of breast and lymph nodes treated in voluntary deep inhalation breath-hold. In: RADIATION ONCOLOGY. 2015 ; Vol. 10, No. 1.

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@article{b9ce2ef15c704d758850ba50c1b3b2ff,
title = "Determination of the optimal matching position for setup images and minimal setup margins in adjuvant radiotherapy of breast and lymph nodes treated in voluntary deep inhalation breath-hold",
abstract = "Background: Adjuvant radiotherapy (RT) of left-sided breast cancer is increasingly performed in voluntary deep inspiration breath-hold (vDIBH). The aim of this study was to estimate the reproducibility of breath-hold level (BHL) and to find optimal bony landmarks for matching of orthogonal setup images to minimise setup margins. Methods: 1067 sets of images with an orthogonal setup and tangential field from 67 patients were retrospectively analysed. Residual position errors were determined in the tangential treatment field images for different matches of the setup images. Variation of patient posture and BHL were analysed for position errors of the vertebrae, clavicula, ribs and sternum in the setup and tangential field images. The BHL was controlled with a Varian RPM{\circledR} system. Setup margins were calculated using the van Herk's formula. Patients who underwent lymph node irradiation were also investigated. Results: For the breast alone, the midway compromise of the ribs and sternum was the best general choice for matching of the setup images. The required margins were 6.5 mm and 5.3 mm in superior-inferior (SI) and lateral/anterior-posterior (LAT/AP) directions, respectively. With the individually optimised image matching position also including the vertebrae, slightly smaller margins of 6.0 mm and 4.8 mm were achieved, respectively. With the individually optimised match, margins of 7.5 mm and 10.8 mm should be used in LAT and SI directions, respectively, for the lymph node regions. These margins were considered too large. The reproducibility of the BHL was within 5 mm in the AP direction for 75{\%} of patients. Conclusions: The smallest setup margins were obtained when the matching position of the setup images was individually optimised for each patient. Optimal match for the breast alone is not optimal for the lymph node region, and, therefore, a threshold of 5 mm was introduced for residual position errors of the sternum, upper vertebrae, clavicula and chest wall to retain minimal setup margins of 5 mm. Because random interfraction variation in patient posture was large, we recommend daily online image guidance. The BHL should be verified with image guidance.",
keywords = "Breast cancer, Breath-hold, Image guidance, Radiotherapy, Setup errors",
author = "Marko Laaksomaa and Mika Kapanen and Mikko Haltamo and Tanja Skytt{\"a} and Seppo Peltola and Simo Hy{\"o}dynmaa and Kellokumpu-Lehtinen, {Pirkko Liisa}",
year = "2015",
month = "4",
day = "3",
doi = "10.1186/s13014-015-0383-y",
language = "English",
volume = "10",
journal = "RADIATION ONCOLOGY",
issn = "1748-717X",
publisher = "Springer Verlag",
number = "1",

}

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TY - JOUR

T1 - Determination of the optimal matching position for setup images and minimal setup margins in adjuvant radiotherapy of breast and lymph nodes treated in voluntary deep inhalation breath-hold

AU - Laaksomaa, Marko

AU - Kapanen, Mika

AU - Haltamo, Mikko

AU - Skyttä, Tanja

AU - Peltola, Seppo

AU - Hyödynmaa, Simo

AU - Kellokumpu-Lehtinen, Pirkko Liisa

PY - 2015/4/3

Y1 - 2015/4/3

N2 - Background: Adjuvant radiotherapy (RT) of left-sided breast cancer is increasingly performed in voluntary deep inspiration breath-hold (vDIBH). The aim of this study was to estimate the reproducibility of breath-hold level (BHL) and to find optimal bony landmarks for matching of orthogonal setup images to minimise setup margins. Methods: 1067 sets of images with an orthogonal setup and tangential field from 67 patients were retrospectively analysed. Residual position errors were determined in the tangential treatment field images for different matches of the setup images. Variation of patient posture and BHL were analysed for position errors of the vertebrae, clavicula, ribs and sternum in the setup and tangential field images. The BHL was controlled with a Varian RPM® system. Setup margins were calculated using the van Herk's formula. Patients who underwent lymph node irradiation were also investigated. Results: For the breast alone, the midway compromise of the ribs and sternum was the best general choice for matching of the setup images. The required margins were 6.5 mm and 5.3 mm in superior-inferior (SI) and lateral/anterior-posterior (LAT/AP) directions, respectively. With the individually optimised image matching position also including the vertebrae, slightly smaller margins of 6.0 mm and 4.8 mm were achieved, respectively. With the individually optimised match, margins of 7.5 mm and 10.8 mm should be used in LAT and SI directions, respectively, for the lymph node regions. These margins were considered too large. The reproducibility of the BHL was within 5 mm in the AP direction for 75% of patients. Conclusions: The smallest setup margins were obtained when the matching position of the setup images was individually optimised for each patient. Optimal match for the breast alone is not optimal for the lymph node region, and, therefore, a threshold of 5 mm was introduced for residual position errors of the sternum, upper vertebrae, clavicula and chest wall to retain minimal setup margins of 5 mm. Because random interfraction variation in patient posture was large, we recommend daily online image guidance. The BHL should be verified with image guidance.

AB - Background: Adjuvant radiotherapy (RT) of left-sided breast cancer is increasingly performed in voluntary deep inspiration breath-hold (vDIBH). The aim of this study was to estimate the reproducibility of breath-hold level (BHL) and to find optimal bony landmarks for matching of orthogonal setup images to minimise setup margins. Methods: 1067 sets of images with an orthogonal setup and tangential field from 67 patients were retrospectively analysed. Residual position errors were determined in the tangential treatment field images for different matches of the setup images. Variation of patient posture and BHL were analysed for position errors of the vertebrae, clavicula, ribs and sternum in the setup and tangential field images. The BHL was controlled with a Varian RPM® system. Setup margins were calculated using the van Herk's formula. Patients who underwent lymph node irradiation were also investigated. Results: For the breast alone, the midway compromise of the ribs and sternum was the best general choice for matching of the setup images. The required margins were 6.5 mm and 5.3 mm in superior-inferior (SI) and lateral/anterior-posterior (LAT/AP) directions, respectively. With the individually optimised image matching position also including the vertebrae, slightly smaller margins of 6.0 mm and 4.8 mm were achieved, respectively. With the individually optimised match, margins of 7.5 mm and 10.8 mm should be used in LAT and SI directions, respectively, for the lymph node regions. These margins were considered too large. The reproducibility of the BHL was within 5 mm in the AP direction for 75% of patients. Conclusions: The smallest setup margins were obtained when the matching position of the setup images was individually optimised for each patient. Optimal match for the breast alone is not optimal for the lymph node region, and, therefore, a threshold of 5 mm was introduced for residual position errors of the sternum, upper vertebrae, clavicula and chest wall to retain minimal setup margins of 5 mm. Because random interfraction variation in patient posture was large, we recommend daily online image guidance. The BHL should be verified with image guidance.

KW - Breast cancer

KW - Breath-hold

KW - Image guidance

KW - Radiotherapy

KW - Setup errors

UR - http://www.scopus.com/inward/record.url?scp=84927732965&partnerID=8YFLogxK

U2 - 10.1186/s13014-015-0383-y

DO - 10.1186/s13014-015-0383-y

M3 - Article

VL - 10

JO - RADIATION ONCOLOGY

JF - RADIATION ONCOLOGY

SN - 1748-717X

IS - 1

M1 - 76

ER -