Bootstrap Framework 3.3.6

[lauren_weinstein]

Does anybody have any experience with using a surrogate part of the body for tracking during a DIBH treatment?  For example, we want to use VRT for an electron boost where the cameras are being blocked by the cone.  We were hoping to create an ROI on the contralateral breast to track on during treatment.  We are curious what a workflow for that would look like and what issues might arise from doing this that we may not have thought about.

Thank you!

[ellen_herron_bsrtt]

Hey Lauren! All of our DIBH electron boost patients are planned off of their Free Breathe CT scan. This eliminates the need for DIBH on an electron breast boost. We set up using VRT and then put the cone on and treat. We have had an electron patient (not breast) with a bigger cone where the cameras actually read through the gaps.

If  dosimetry is set on planning off DIBH scan then I would extend the ROI to cover both sides like you said. Then cameras will have enough information to pick up even if one camera gets blocked.

[jason]

To echo what Ellen said: Most of our electron boosts are planned for free breathing delivery. There are instances where DIBH electrons are called for. As you mentioned, the electron applicator blocks the immediate surface underneath. You have to omit that area directly under the cone from the tracking surface and include some additional track-able surface around the outside the applicator. Once that change is made, the setup is fairly routine.

[michael_tallhamer_msc_dabr]

Hey Lauren. Hope you are doing well. Good to see you on here.

We have moved all of our DIBH electron boosts to the free breathing scans as the others have indicated. If we feel the boost absolutely needs to happen on the DIBH scan we will setup as usual using the free breathing scan, have them take in a deep breath to the breath hold surface, then insert the cone and snap a new reference under a new boost field. That reference basically tells you what the cameras can and can't see and you can set your ROI appropriately for monitoring. I can say since we stopped using the DIBH scan for boosts we have probably only "needed" to do this 1-3 times in 3+ years.

Good Luck

[lauren_weinstein]

Thank you for your responses...very helpful.  Our rule of thumb here is that electron boosts are generally done on free breathing scans.  However, there have been a select few cases where the physician specifically requests doing it on breath hold.  For those cases, we are trying to develop a workflow to ease the treatments on the machine.  It seems like there is a general consensus that it is OK to include an ROI that is not necessarily being directly treated.  Thank you all for your help!