See the published version of this article at BMC Cancer.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Impact of Breath-Hold Level on Positional Error Aligned by Stent/Lipiodol in Hepatobiliary Radiotherapy with Breath-Hold Respiratory Control
Jason Chia-Hsien Cheng
National Taiwan University Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2007-0220
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Cancer.
Background: Respiratory motion management with breath hold for patients with hepatobiliary cancers remain a challenge in the precise positioning for radiotherapy. We compared different image-guided alignment markers for estimating positional errors, and investigated the factors associated with positional errors under breath-hold control.
Methods: Spirometric motion management system (SDX) for breath holds was used in 44 patients with hepatobiliary tumor. Among them, 28 patients had a stent or embolized materials (lipiodol) as alignment markers. Cone-beam computed tomography (CBCT) and kV-orthogonal images were compared for accuracy between different alignment references. Breath-hold level (BHL) was practiced, and BHL variation (ΔBHL) was defined as the standard deviation in differences between actual BHLs and baseline BHL. Mean BHL, ΔBHL, and body-related factors were analyzed for the association with positional errors.
Results: Using the reference CBCT, the correlations of positional errors were significantly higher in those with stent/lipiodol than when the vertebral bone was used for alignment in three dimensions. Patients with mean BHL >1.4 L were significantly taller (167.6 cm vs. 161.6 cm, p=0.03) and heavier (67.1 kg vs. 57.4 kg, p=0.02), and had different positional error in the craniocaudal direction (-0.26 cm [caudally] vs. +0.09 cm [cranially], p=0.01) than those with mean BHL <1.4 L. Positional errors were similar for patients with ΔBHL<0.03 L and >0.03 L.
Conclusion: Under rigorous breath-hold respiratory control, BHL correlated with body weight and height. With more accurate alignment reference by stent/lipiodol, actual BHL but not breath-hold variation was associated with craniocaudal positional errors.
Keywords
Radiotherapy, Breath holding, Hepatocellular carcinoma, Patient positioning, Radiotherapy Planning, Computer-Assisted/methods
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
This is a list of supplementary files associated with this preprint. Click to download.
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 02 Jun, 2020
Published
On 01 Jul, 2020
No community comments so far
Editorial decision: Accept
On 16 Jun, 2020
Review #2 received
Received 08 Jun, 2020
Reviewer #2 agreed
On 04 Jun, 2020
Reviewers invited
Invitations sent on 02 Jun, 2020
Reviewer #1 agreed
On 02 Jun, 2020
Review #1 received
Received 02 Jun, 2020
Editor assigned
On 25 May, 2020
Submission checks complete
On 24 May, 2020
Editor invited
On 24 May, 2020
No comments provided
Editorial decision: Major revision
On 24 Apr, 2020
Review #2 received
Received 21 Apr, 2020
Reviewer #2 agreed
On 08 Apr, 2020
Review #1 received
Received 06 Mar, 2020
Reviewers invited
Invitations sent on 04 Mar, 2020
Reviewer #1 agreed
On 04 Mar, 2020
Editor assigned
On 10 Feb, 2020
Submission checks complete
On 09 Feb, 2020
Editor invited
On 09 Feb, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Learn more about our company.
This preprint is under consideration at BMC Cancer. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Impact of Breath-Hold Level on Positional Error Aligned by Stent/Lipiodol in Hepatobiliary Radiotherapy with Breath-Hold Respiratory Control
Jason Chia-Hsien Cheng
National Taiwan University Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2007-0220
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 02 Jun, 2020
Published
On 01 Jul, 2020
No community comments so far
Editorial decision: Accept
On 16 Jun, 2020
Review #2 received
Received 08 Jun, 2020
Reviewer #2 agreed
On 04 Jun, 2020
Reviewers invited
Invitations sent on 02 Jun, 2020
Reviewer #1 agreed
On 02 Jun, 2020
Review #1 received
Received 02 Jun, 2020
Editor assigned
On 25 May, 2020
Submission checks complete
On 24 May, 2020
Editor invited
On 24 May, 2020
No comments provided
Editorial decision: Major revision
On 24 Apr, 2020
Review #2 received
Received 21 Apr, 2020
Reviewer #2 agreed
On 08 Apr, 2020
Review #1 received
Received 06 Mar, 2020
Reviewers invited
Invitations sent on 04 Mar, 2020
Reviewer #1 agreed
On 04 Mar, 2020
Editor assigned
On 10 Feb, 2020
Submission checks complete
On 09 Feb, 2020
Editor invited
On 09 Feb, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Cancer.
Background: Respiratory motion management with breath hold for patients with hepatobiliary cancers remain a challenge in the precise positioning for radiotherapy. We compared different image-guided alignment markers for estimating positional errors, and investigated the factors associated with positional errors under breath-hold control.
Methods: Spirometric motion management system (SDX) for breath holds was used in 44 patients with hepatobiliary tumor. Among them, 28 patients had a stent or embolized materials (lipiodol) as alignment markers. Cone-beam computed tomography (CBCT) and kV-orthogonal images were compared for accuracy between different alignment references. Breath-hold level (BHL) was practiced, and BHL variation (ΔBHL) was defined as the standard deviation in differences between actual BHLs and baseline BHL. Mean BHL, ΔBHL, and body-related factors were analyzed for the association with positional errors.
Results: Using the reference CBCT, the correlations of positional errors were significantly higher in those with stent/lipiodol than when the vertebral bone was used for alignment in three dimensions. Patients with mean BHL >1.4 L were significantly taller (167.6 cm vs. 161.6 cm, p=0.03) and heavier (67.1 kg vs. 57.4 kg, p=0.02), and had different positional error in the craniocaudal direction (-0.26 cm [caudally] vs. +0.09 cm [cranially], p=0.01) than those with mean BHL <1.4 L. Positional errors were similar for patients with ΔBHL<0.03 L and >0.03 L.
Conclusion: Under rigorous breath-hold respiratory control, BHL correlated with body weight and height. With more accurate alignment reference by stent/lipiodol, actual BHL but not breath-hold variation was associated with craniocaudal positional errors.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5