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Nathaniel Miles

Research Literature Gap Activity

April, 13 2018

First Article - Accuracy evaluation of the optical surface monitoring system on EDGE linear
accelerator in a phantom study

This article studied the optical surface monitoring system’s (OSMS) effectiveness at accurately
assessing patient position. The authors used a phantom to study whether the OSMS could
accurately detect and correct predetermined couch shifts. The authors mention that future
research needs to be done on actual human subjects in order to determine the effectiveness under
real circumstances. Also the authors speak about how the system would need to be tested under
clinical conditions to fully assess the effectiveness in actual conditions. A future research project
could involve testing the OSMS system against traditional techniques to see if there are benefits
in less set-up error. The study could check the effectiveness using a contouring matching
software like Mobius to test the daily treatment match.

Second Article - A review of setup error in supine breast radiotherapy using cone-beam
computed tomography

This article studied whether CBCT was superior to traditional electronic portal imagery in
relation to number and size of setup errors. The article found that there was no clear relationship
between using CBCT or electronic portal imagery and setup error. The article mentions that
further studies would need to be conducted to see whether CBCT would be superior for large
breasted women and other instances when soft tissue deformation would be an issue. A future
study could be conducted specifically on large breasted women where CBCT were taken on a
number of days and electronic portal images were taken on a number of days to assess whether
one method of patient imaging was superior for setting up the patient.

Third Article - Heart-sparing radiotherapy in patients with breast cancer: What are the techniques
used in the clinical routine?: A pattern of practice survey in the German-speaking countries

In this article the authors sent a questionnaire to a number of clinics in order to assess their
method of heart-sparing in treatment of left sided breast cancer patients. The authors found that
there were a large number of different techniques being used. The authors attribute this to the
fact that there is a lack of evidence on which constraints are most important for late term heart
complications. Another gap in research that the authors mention is a lack of studies with long
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term follow up that take into account the different methods for heart sparing when assessing
heart dose parameters. One future study could assess the long term effect on patients that
exceeding different heart constraints caused across the literature. Another study could assess the
effectiveness of various techniques by using multiple techniques during simulation, running
plans on each of the techniques, and recording heart dose.

Fourth Article - Effects of multiple breath hold reproducibility on treatment localization and
dosimetric accuracy in radiotherapy of left-sided breast cancer with voluntary deep inspiration
breath hold technique

This article studied the setup error associated with using a breath hold technique for treatment in
order to spare heart dose in left sided breast cancer patients. The authors studied the
interfractional setup errors and intrafractional setup errors. Although the authors did not
specifically mention any gaps in research. They mention that a possible reason for the increase in
error for interfractional setup in supraclavicular lymph node and whole breast treatments was
that the patient got tired from taking so many breaths. In order to research whether the length of
treatment time might have an effect on quality of breath future research could look into whether
treatment time and number of breath holds required has any correlation to setup error. This could
be done by having the radiation therapists write down number of breath holds required and total
treatment time and comparing these values to setup error.

Fifth Article – Radiation induced rib fractures after hypofractionated stereotactic body radiation
therapy: risk factors and dose-volume relationship

This article studied the relationship between dose-volume and likelihood of rib fractures during
hypofractionated stereotactic body radiation therapy (SBRT). The article found that rib fractures
were common in patients that have a rib-tumor distance of less than 2cm. They mention other
causation factors that may contribute to rib fractures including obesity and diabetes. The author
states that because their study took place in Japan they may have a lower rib fracture likelihood
than other countries because of the low obesity and diabetes rates in Japan. A future study could
look into how much obesity and diabetes effects the likelihood of rib fractures. A simple way of
testing this theory is to run the exact study in America where there is a much higher level of
obesity and diabetes and compare the results.
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References

1. Mancosu P, Fogliata A, Stravato A, et al. Accuracy evaluation of the optical surface

monitoring system on EDGE linear accelerator in a phantom study. Med Dosim.
2016;41(2):173-179. https://doi.org/10.1016/j.meddos.2015.12.003
2. Batumalai V, Holloway L, Delaney G. A review of setup error in supine breast
radiotherapy using cone-beam computed tomography. Med Dosim. 2016;41(3):225-229.
https://doi.org/10.1016/j.meddos.2016.05.001
3. Duma MN, Münch S, Oechsner M, Combs S. Heart-sparing radiotherapy in patients with
breast cancer: What are the techniques used in the clinical routine?: A pattern of practice
survey in the German-speaking countries. Med Dosim. 2017;42(3):197-202.
https://doi.org/10.1016/j.meddos.2017.03.002
4. Kapanen M, Laaksomaa M, Pehkonen J, et al. Effects of multiple breath hold
reproducibility on treatment localization and dosimetric accuracy in radiotherapy of left-
sided breast cancer with voluntary deep inspiration breath hold technique. Med Dosim.
2017;42(3):177-184. https://doi.org/10.1016/j.meddos.2017.02.004
5. Asai K, Shioyama Y, Nakamura K, et al. Radiation induced rib fractures after
hypofractionated stereotactic body radiation therapy: risk factors and dose-volume
relationship. Int J Radiat Oncol Biol Phys. 2012;84(3):768-773.
https://doi.org/10.1016/j.ijrobp.2012.01.027