Figure 2 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
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A. patient surface scanned by Catalyst scanner in the treatment room. The red spot on the patient surface is monitored by the scanner for the vertical amplitude; b. The respiratory signal recorded by the surface scanner shows the stable deep-inspiration breath-hold (DIBh) during the "beam on time" shown by gray bars; c. graphical representation of the isocenter shift recorded by the surface scanner during one fraction illustrates mean deviation of about 1mm during the "beam on time" shown by gray areas
Source publication
Background:
The aim of the study is to evaluate the overall accuracy of the surface-guided radiotherapy (SGRT) workflow through a comprehensive commissioning and quality assurance procedures and assess the potential benefits of deep-inspiration breath-hold (DIBH) radiotherapy as a cardiac and lung dose reduction approach for left-sided breast canc...
Context in source publication
Context 1
... for all fractions. The plan isocenter shifts were assessed to check intrafractional DIBH isocenter reproducibility during the beam-on time during 10 fractions for each patient. The real-time isocenter position during the radiation, the breathing baseline, the width of the gating window, and the beam on/off status were driven from the c4D software (Fig. 2). The maximum difference between different DIBH levels was assessed as the reproducibility of the DIBHs, and the stability was also attributed to the maximum amplitude change between the initial and final points of a DIBH among all the DIBHs for each patient, as defined by Cervino et al. ...
Citations
... Chest discomfort or tightness, palpitations, dizziness, rise in resting heart rate Myocarditis, pericarditis, coronary artery disease [47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] ...
... During and after post-COVID-19 infection, various pathophysiological mechanisms can cause long-term hematological conditions, such as persistent thrombotic endothelialitis and systemic hypercoagulability, leading to the formation of fibrinaloid microclots, platelet hyperactivation, and endothelial dysfunction, and ultimately contributing to a range of clotting disorders [59]. One such disorder is COVID-19-induced coagulopathy, which is characterised by an abnormal immune response leading to both blood clotting and bleeding events [60,61]. Elevated levels of D-dimer and fibrinogen, along with mild thrombocytopenia, modest prolongation of prothrombin time, and activated partial thromboplastin time, are important markers of coagulopathy that have been frequently observed in severely ill COVID-19 patients [60]. ...
... One such disorder is COVID-19-induced coagulopathy, which is characterised by an abnormal immune response leading to both blood clotting and bleeding events [60,61]. Elevated levels of D-dimer and fibrinogen, along with mild thrombocytopenia, modest prolongation of prothrombin time, and activated partial thromboplastin time, are important markers of coagulopathy that have been frequently observed in severely ill COVID-19 patients [60]. Late-onset thrombocytopenia is a condition where the immune system becomes deregulated with time [128,129]. ...
Background: Post-acute sequelae of SARS-CoV-2 infection (PASC) is a complicated disease that affects millions of people all over the world. Previous studies have shown that PASC impacts 10% of SARS-CoV-2 infected patients of which 50–70% are hospitalised. It has also been shown that 10–12% of those vaccinated against COVID-19 were affected by PASC and its complications. The severity and the later development of PASC symptoms are positively associated with the early intensity of the infection. Results: The generated health complications caused by PASC involve a vast variety of organ systems. Patients affected by PASC have been diagnosed with neuropsychiatric and neurological symptoms. The cardiovascular system also has been involved and several diseases such as myocarditis, pericarditis, and coronary artery diseases were reported. Chronic hematological problems such as thrombotic endothelialitis and hypercoagulability were described as conditions that could increase the risk of clotting disorders and coagulopathy in PASC patients. Chest pain, breathlessness, and cough in PASC patients were associated with the respiratory system in long-COVID causing respiratory distress syndrome. The observed immune complications were notable, involving several diseases. The renal system also was impacted, which resulted in raising the risk of diseases such as thrombotic issues, fibrosis, and sepsis. Endocrine gland malfunction can lead to diabetes, thyroiditis, and male infertility. Symptoms such as diarrhea, nausea, loss of appetite, and taste were also among reported observations due to several gastrointestinal disorders. Skin abnormalities might be an indication of infection and long-term implications such as persistent cutaneous complaints linked to PASC. Conclusions: Long-COVID is a multidimensional syndrome with considerable public health implications, affecting several physiological systems and demanding thorough medical therapy, and more study to address its underlying causes and long-term effects is needed.
... During and post COVID19 infection, various pathophysiological mechanisms can cause long hematological conditions, such as: persistent thrombotic endothelialitis and systemic hypercoagulability, leading to the formation of fibrinaloid microclots, platelet hyperactivation, and endothelial dysfunction, ultimately contributing to a range of clotting disorders [59]. One of such disorder is COVID-19-induced coagulopathy, which is characterized by an abnormal immune response leading to both blood clotting and bleeding events [60,61]. Elevated levels of D-dimer and fibrinogen, along with mild thrombocytopenia, modest prolongation of prothrombin time, and 8 activated partial thromboplastin time, are important markers of coagulopathy that have been frequently observed in severely ill COVID-19 patients [60]. ...
... One of such disorder is COVID-19-induced coagulopathy, which is characterized by an abnormal immune response leading to both blood clotting and bleeding events [60,61]. Elevated levels of D-dimer and fibrinogen, along with mild thrombocytopenia, modest prolongation of prothrombin time, and 8 activated partial thromboplastin time, are important markers of coagulopathy that have been frequently observed in severely ill COVID-19 patients [60]. Late-onset thrombocytopenia is a condition where the immune system becomes deregulated with time [128,129]. ...
Background: Post-acute sequelae of SARS-CoV-2 infection (PASC) is a complicated disease that affects millions of people all over the world. Previous studies have shown that PASC impacts 10% of SARS-CoV-2 infected patients of which 50-70% are hospitalized. It has also been shown that 10-12% of those vaccinated against COVID-19 were affected with PASC and its complications. The severity and the later development of PASC symptoms is positively associated with the early intensity of the infection. Results: The generated health complications caused by PASC involve a vast variety of organ systems. Patients affected by PASC have been diagnosed with neuropsychiatric and neurological symptoms. Cardiovascular system also has been involved and several diseases such as myocarditis, pericarditis, and coronary artery diseases were reported. Chronic hematological problems such as thrombotic endothelialitis and hypercoagulability were described as a condition that could increase the risk of clotting disorders and coagulopathy in PASC patients. Chest pain, breathlessness, and cough in PASC patients were associated with respiratory system in long COVID-19 causing respiratory distress syndrome. The observed immune complications were notable, involving several diseases. Renal system also was impacted and result in raising the risk of diseases such as thrombotic issues, fibrosis, and sepsis. Endocrine gland malfunction can lead to diabetes, thyroiditis, and male infertility. Symptoms such as diarrhea, nausea, loss of appetite and taste were also among reported observations due to several gastrointestinal disorders. Skin abnormalities might be an indication of infection and long-term implications such as persistent cutaneous complaints were linked to PASC. Conclusions: Long COVID is a multidimensional syndrome with considerable public health implications, affecting several physiological systems and demanding thorough medical therapy as well as more study to address its underlying causes and long-term effects.
... While this adjuvant treatment approach can improve local control and overall survival, the benefits can be hindered by radiationinduced late side effects, such as cardiovascular disease and second primary cancers [8][9][10][11][12]. Deep Inspiration Breath Hold (DIBH) radiotherapy has been validated as an effective approach for cardiac and lung dose reduction in left breast radiotherapy [13][14][15][16][17][18]. Although most patients can benefit from respiratory management via DIBH, there is still a minority that cannot comply with DIBH and need alternative approaches for toxicity management. ...
... Similar results of high values for D2% were published by Poitevin-Chacón et al. and Vennarini et al [48,49]. Other studies showed lower heart and LAD mean doses compared with our study, but this may reflect our challenging population, where the majority of the patients are in advanced stages with supraclavicular, axillary, and internal mammary lymph nodes included in radiation fields [13,50]. While HT_FB inverse planning showed a significant (p < 0.05) reduction in the dose to the heart (except mean dose), LAD and ipsilateral lung compared to 3DCRT_DIBH, this came at the cost of an increased dose to contralateral organs. ...
Purpose:
To investigate the possibility to be able to offer left sided breast cancer patients, not suitable for DIBH, an organ at risk saving treatment.
Materials and methods:
Twenty patients receiving radiotherapy for left breast cancer in DIBH were enrolled in the study. Planning CT scans were acquired in the same supine treatment position in FB and DIBH. 3DCRT_DIBH plans were designed and optimized using two parallel opposed tangent beams (with some additional segments) for the breast and chest wall and anterior-posterior fields for regional lymph nodes irradiation. Additionally, FB helical tomotherapy plans were optimized to minimize heart and lung dose. All forty plans were optimized with at least 95% of the total CTV covered by the 95% of prescribed dose of 50 Gy in 25 fractions.
Results:
HT_FB plans showed significantly better dose homogeneity and conformity compared to the 3DCRT_DIBH specially for regional nodal irradiation. The heart mean dose was almost comparable in 3DCRT_DIBH and HT_FB while the volume (%) of the heart receiving 25 Gy had a statistically significant reduction from 7.90 ± 3.33 in 3DCRT_DIBH to 0.88 ± 0.66 in HT_FB. HT_FB was also more effective in left descending artery (LAD) mean dose reduction about 100% from 30.83 ± 9.2 Gy to 9.7 ± 3.1. The ipsilateral lung volume receiving 20 Gy has a further reduction of 43 % in HT_FB compared with 3DCRT_DIBH. For low dose comparison, 3DCRT_DIBH was superior for contralateral organ sparing compared to the HT_FB due to the limited angle for dose delivery.
Conclusion:
For patients who cannot be a candidate for DIBH for any reason, HT in free breathing may be a good alternative and provides heart and ipsilateral lung dose sparing, however with the cost of increased dose to contralateral breast and lung.
