Mechanically assisted non-invasive ventilation for liver SABR: Improve CBCT, treat more accurately
Background and purpose: Cone-beam computed tomography (CBCT) for image-guided radiotherapy (IGRT) during liver stereotactic ablative radiotherapy (SABR) is degraded by respiratory motion artefacts, potentially jeopardising treatment accuracy. Mechanically assisted non-invasive ventilation-induced br...
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Elsevier
2025-07-01
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| Series: | Clinical and Translational Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630825000758 |
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| author | Julien Pierrard Nicolas Audag Christel Abdel Massih Maria Alvear Garcia Enrique Alvarez Moreno Andrea Colot Simon Jardinet Romain Mony Ana Francisca Nevez Marques Lola Servaes Thaïs Tison Valentin Van den Bossche Aniko Wale Etume Lamyae Zouheir Geneviève Van Ooteghem |
| author_facet | Julien Pierrard Nicolas Audag Christel Abdel Massih Maria Alvear Garcia Enrique Alvarez Moreno Andrea Colot Simon Jardinet Romain Mony Ana Francisca Nevez Marques Lola Servaes Thaïs Tison Valentin Van den Bossche Aniko Wale Etume Lamyae Zouheir Geneviève Van Ooteghem |
| author_sort | Julien Pierrard |
| collection | DOAJ |
| description | Background and purpose: Cone-beam computed tomography (CBCT) for image-guided radiotherapy (IGRT) during liver stereotactic ablative radiotherapy (SABR) is degraded by respiratory motion artefacts, potentially jeopardising treatment accuracy. Mechanically assisted non-invasive ventilation-induced breath-hold (MANIV-BH) can reduce these artefacts. This study compares MANIV-BH and free-breathing CBCTs regarding image quality, IGRT variability, automatic registration accuracy, and deep-learning auto-segmentation performance. Materials and methods: Liver SABR CBCTs were presented blindly to 14 operators: 25 patients with FB and 25 with MANIV-BH. They rated CBCT quality and IGRT ease (rigid registration with planning CT). Interoperator IGRT variability was compared between FB and MANIV-BH. Automatic gross tumour volume (GTV) mapping accuracy was compared using automatic rigid registration and image-guided deformable registration. Deep-learning organ-at-risk (OAR) auto-segmentation was rated by an operator, who recorded the time dedicated for manual correction of these volumes. Results: MANIV-BH significantly improved CBCT image quality (“Excellent”/“Good”: 83.4 % versus 25.4 % with FB, p < 0.001), facilitated IGRT (“Very easy”/“Easy”: 68.0 % versus 38.9 % with FB, p < 0.001), and reduced IGRT variability, particularly for trained operators (overall variability of 3.2 mm versus 4.6 mm with FB, p = 0.010). MANIV-BH improved deep-learning auto-segmentation performance (80.0 % rated “Excellent”/“Good” versus 4.0 % with FB, p < 0.001), and reduced median manual correction time by 54.2 % compared to FB (p < 0.001). However, automatic GTV mapping accuracy was not significantly different between MANIV-BH and FB. Conclusion: In liver SABR, MANIV-BH significantly improves CBCT quality, reduces interoperator IGRT variability, and enhances OAR auto-segmentation. Beyond being safe and effective for respiratory motion mitigation, MANIV increases accuracy during treatment delivery, although its implementation requires resources. |
| format | Article |
| id | doaj-art-cb2434a422cd4964bdba91fd32c47608 |
| institution | Kabale University |
| issn | 2405-6308 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj-art-cb2434a422cd4964bdba91fd32c476082025-08-20T03:30:49ZengElsevierClinical and Translational Radiation Oncology2405-63082025-07-015310098310.1016/j.ctro.2025.100983Mechanically assisted non-invasive ventilation for liver SABR: Improve CBCT, treat more accuratelyJulien Pierrard0Nicolas Audag1Christel Abdel Massih2Maria Alvear Garcia3Enrique Alvarez Moreno4Andrea Colot5Simon Jardinet6Romain Mony7Ana Francisca Nevez Marques8Lola Servaes9Thaïs Tison10Valentin Van den Bossche11Aniko Wale Etume12Lamyae Zouheir13Geneviève Van Ooteghem14Institut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, Brussels, Belgium; Department of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Corresponding author.Institut de Recherche Expérimentale et Clinique (IREC), Pôle de Pneumologie, ORL (airways) & Dermatologie (skin), Groupe Recherche en Kinésithérapie Respiratoire, Université Catholique de Louvain, Brussels, Belgium; Service de kinésithérapie et ergothérapie, Cliniques universitaires Saint-Luc, Brussels, BelgiumDepartment of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumDepartment of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumInstitut de Recherche Experimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Université Catholique de Louvain, Brussels, Belgium; Department of Radiation Oncology, Cliniques Universitaires Saint-Luc, Brussels, BelgiumBackground and purpose: Cone-beam computed tomography (CBCT) for image-guided radiotherapy (IGRT) during liver stereotactic ablative radiotherapy (SABR) is degraded by respiratory motion artefacts, potentially jeopardising treatment accuracy. Mechanically assisted non-invasive ventilation-induced breath-hold (MANIV-BH) can reduce these artefacts. This study compares MANIV-BH and free-breathing CBCTs regarding image quality, IGRT variability, automatic registration accuracy, and deep-learning auto-segmentation performance. Materials and methods: Liver SABR CBCTs were presented blindly to 14 operators: 25 patients with FB and 25 with MANIV-BH. They rated CBCT quality and IGRT ease (rigid registration with planning CT). Interoperator IGRT variability was compared between FB and MANIV-BH. Automatic gross tumour volume (GTV) mapping accuracy was compared using automatic rigid registration and image-guided deformable registration. Deep-learning organ-at-risk (OAR) auto-segmentation was rated by an operator, who recorded the time dedicated for manual correction of these volumes. Results: MANIV-BH significantly improved CBCT image quality (“Excellent”/“Good”: 83.4 % versus 25.4 % with FB, p < 0.001), facilitated IGRT (“Very easy”/“Easy”: 68.0 % versus 38.9 % with FB, p < 0.001), and reduced IGRT variability, particularly for trained operators (overall variability of 3.2 mm versus 4.6 mm with FB, p = 0.010). MANIV-BH improved deep-learning auto-segmentation performance (80.0 % rated “Excellent”/“Good” versus 4.0 % with FB, p < 0.001), and reduced median manual correction time by 54.2 % compared to FB (p < 0.001). However, automatic GTV mapping accuracy was not significantly different between MANIV-BH and FB. Conclusion: In liver SABR, MANIV-BH significantly improves CBCT quality, reduces interoperator IGRT variability, and enhances OAR auto-segmentation. Beyond being safe and effective for respiratory motion mitigation, MANIV increases accuracy during treatment delivery, although its implementation requires resources.http://www.sciencedirect.com/science/article/pii/S2405630825000758Image-guided radiotherapy Liver SABR Mechanically assisted non-invasive ventilation Respiratory motion managementCBCT quality |
| spellingShingle | Julien Pierrard Nicolas Audag Christel Abdel Massih Maria Alvear Garcia Enrique Alvarez Moreno Andrea Colot Simon Jardinet Romain Mony Ana Francisca Nevez Marques Lola Servaes Thaïs Tison Valentin Van den Bossche Aniko Wale Etume Lamyae Zouheir Geneviève Van Ooteghem Mechanically assisted non-invasive ventilation for liver SABR: Improve CBCT, treat more accurately Clinical and Translational Radiation Oncology Image-guided radiotherapy Liver SABR Mechanically assisted non-invasive ventilation Respiratory motion management CBCT quality |
| title | Mechanically assisted non-invasive ventilation for liver SABR: Improve CBCT, treat more accurately |
| title_full | Mechanically assisted non-invasive ventilation for liver SABR: Improve CBCT, treat more accurately |
| title_fullStr | Mechanically assisted non-invasive ventilation for liver SABR: Improve CBCT, treat more accurately |
| title_full_unstemmed | Mechanically assisted non-invasive ventilation for liver SABR: Improve CBCT, treat more accurately |
| title_short | Mechanically assisted non-invasive ventilation for liver SABR: Improve CBCT, treat more accurately |
| title_sort | mechanically assisted non invasive ventilation for liver sabr improve cbct treat more accurately |
| topic | Image-guided radiotherapy Liver SABR Mechanically assisted non-invasive ventilation Respiratory motion management CBCT quality |
| url | http://www.sciencedirect.com/science/article/pii/S2405630825000758 |
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