Frontiers in oncology · 2026
Study on the application of thermo-optical surface monitoring + X-ray guidance system in DIBH for breast cancer.
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Tian Tian, Zhang Jicheng, Chen Fei, Gong Xiaoqin, Yang Wuyang, Huang Jian, You Tao
Аннотация
OBJECTIVE: To evaluate the clinical value of thermo-optical surface monitoring + X-ray guidance system(ExacTrac Dynamic, ETD) in assessing inter-fraction setup accuracy and intra-fraction motion monitoring during deep inspiration breath-hold (DIBH) radiotherapy after breast-conserving surgery for breast cancer.
METHODS: Clinical data were collected from 31 female patients with breast cancer who had undergone breast-conserving surgery. Cone-beam computed tomography (CBCT) was used to verify inter-fraction setup during the first three treatment fractions, as well as the 6th, 9th, 12th, and 15th fractions. Triple thermo-optical surface tracking, intra-fraction CBCT, and X-ray imaging were employed to monitor intra-fraction motion. Setup errors and treatment duration were recorded. Linear mixed-effects models were applied to analyze inter-fraction setup errors derived from CBCT and intra-fraction errors measured by X-ray.
RESULTS: After X-ray correction, mean setup errors in all dimensions were not significantly different from zero (P>0.05) and were independent of breast volume. Treatment duration had no significant impact on intra-fraction deviations. Surface monitoring detected mid-treatment drift, which was corrected by X-ray guidance, keeping all values within clinical tolerance. The radiation dose from X-ray planar imaging was substantially lower than from CBCT. Calculated planning target volume (PTV) margins (van Herk formula) were 5.10 mm (lateral), 5.22 mm (longitudinal), and 5.78 mm (vertical).
CONCLUSION: ETD provides setup accuracy comparable to CBCT with lower radiation dose, making it appropriate for inter-fraction verification. It allows stable real-time intra-fraction monitoring and can enhance treatment precision with mid-treatment X-ray correction.
METHODS: Clinical data were collected from 31 female patients with breast cancer who had undergone breast-conserving surgery. Cone-beam computed tomography (CBCT) was used to verify inter-fraction setup during the first three treatment fractions, as well as the 6th, 9th, 12th, and 15th fractions. Triple thermo-optical surface tracking, intra-fraction CBCT, and X-ray imaging were employed to monitor intra-fraction motion. Setup errors and treatment duration were recorded. Linear mixed-effects models were applied to analyze inter-fraction setup errors derived from CBCT and intra-fraction errors measured by X-ray.
RESULTS: After X-ray correction, mean setup errors in all dimensions were not significantly different from zero (P>0.05) and were independent of breast volume. Treatment duration had no significant impact on intra-fraction deviations. Surface monitoring detected mid-treatment drift, which was corrected by X-ray guidance, keeping all values within clinical tolerance. The radiation dose from X-ray planar imaging was substantially lower than from CBCT. Calculated planning target volume (PTV) margins (van Herk formula) were 5.10 mm (lateral), 5.22 mm (longitudinal), and 5.78 mm (vertical).
CONCLUSION: ETD provides setup accuracy comparable to CBCT with lower radiation dose, making it appropriate for inter-fraction verification. It allows stable real-time intra-fraction monitoring and can enhance treatment precision with mid-treatment X-ray correction.