The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning

Dundas, Kylie, Pogson, Elise M., Batumalai, Vikneswary, Delaney, Geoff P., Boxer, Miriam M., Yap, Mei Ling, Ahern, Verity, Chan, Christine, David, Steven, Dimigen, Marion, Harvey, Jennifer A., Koh, Eng-Siew, Lim, Karen, Papadatos, George, Lazarus, Elizabeth, Descellar, Joseph, Metcalfe, Peter and Holloway, Lois (2017) The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning. Practical Radiation Oncology, 8 3: e87-e97. doi:10.1016/j.prro.2017.07.007

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Author Dundas, Kylie
Pogson, Elise M.
Batumalai, Vikneswary
Delaney, Geoff P.
Boxer, Miriam M.
Yap, Mei Ling
Ahern, Verity
Chan, Christine
David, Steven
Dimigen, Marion
Harvey, Jennifer A.
Koh, Eng-Siew
Lim, Karen
Papadatos, George
Lazarus, Elizabeth
Descellar, Joseph
Metcalfe, Peter
Holloway, Lois
Title The impact of imaging modality (CT vs MRI) and patient position (supine vs prone) on tangential whole breast radiation therapy planning
Journal name Practical Radiation Oncology   Check publisher's open access policy
ISSN 1879-8519
Publication date 2017-07-14
Year available 2017
Sub-type Article (original research)
DOI 10.1016/j.prro.2017.07.007
Open Access Status File (Author Post-print)
Volume 8
Issue 3
Start page e87
End page e97
Total pages 11
Place of publication New York, NY, United States
Publisher Elsevier
Language eng
Subject 2730 Oncology
2741 Radiology Nuclear Medicine and imaging
Abstract Purpose: The purpose of this study was to evaluate the impact of magnetic resonance imaging (MRI) versus computed tomography (CT)-derived planning target volumes (PTVs), in both supine and prone positions, for whole breast (WB) radiation therapy. Methods and materials: Four WB radiation therapy plans were generated for 28 patients in which PTVs were generated based on CT or MRI data alone in both supine and prone positions. A 6-MV tangential intensity modulated radiation therapy technique was used, with plans designated as ideal, acceptable, or noncompliant. Dose metrics for PTVs and organs at risk were compared to analyze any differences based on imaging modality (CT vs MRI) or patient position (supine vs prone). Results: With respect to imaging modality 2/11 whole breast planning target volume (WB_PTV) dose metrics (percentage of PTV receiving 90% and 110% of prescribed dose) displayed statistically significant differences; however, these differences did not alter the average plan compliance rank. With respect to patient positioning, the odds of having an ideal plan versus a noncompliant plan were higher for the supine position compared with the prone position (P = .026). The minimum distance between the seroma cavity planning target volume (SC_PTV) and the chest wall was increased with prone positioning (P < .001, supine and prone values 1.1 mm and 8.7 mm, respectively). Heart volume was greater in the supine position (P = .005). Heart doses were lower in the supine position than prone (P < .01, mean doses 3.4 ± 1.55 Gy vs 4.4 ± 1.13 Gy for supine vs prone, respectively). Mean lung doses met ideal dose constraints in both positions, but were best spared in the prone position. The contralateral breast maximum dose to 1cc (D1cc) showed significantly lower doses in the supine position (P < .001, 4.64 Gy vs 9.51 Gy). Conclusions: Planning with PTVs generated from MRI data showed no clinically significant differences from planning with PTVs generated from CT with respect to PTV and doses to organs at risk. Prone positioning within this study reduced mean lung dose and whole heart volumes but increased mean heart and contralateral breast doses compared with supine.
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Sub-type: Article (original research)
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Created: Wed, 15 Nov 2017, 12:15:47 EST