TY - JOUR

T1 - Paediatric CBCT protocols for image-guided radiotherapy; outcome of a survey across SIOP Europe affiliated countries and literature review

AU - Østergaard, Daniella Elisabet

AU - Bryce-Atkinson, Abigail

AU - Skaarup, Mikkel

AU - Smulders, Bob

AU - Davies, Lucy Siew Chen

AU - Whitfield, Gillian

AU - Janssens, Geert O.

AU - Hjalgrim, Lisa Lyngsie

AU - Richter, Ivan Vogelius

AU - van Herk, Marcel

AU - Aznar, Marianne

AU - Vestmø Maraldo, Maja

N1 - Funding Information: MVM and DEØ was supported by the Danish Childhood Cancer Foundation (grant no 2015–9) and the Danish Cancer Society (ID: R248-A14714). MA acknowledge the support from Engineering and Physical Sciences Research Council (EPSRC), UK (grant number EP/T028017/1). ABA was supported by a SU2C-CRUK Pediatric Cancer New Discoveries Challenge Team Grant (grant no SU2C#RT6186). Funding Information: The authors are grateful for the critical input and endorsement by the steering committee members of the SIOP Europe Radiation Oncology Working Group.

PY - 2024

Y1 - 2024

N2 - BackgroundImplementation of daily cone-beam CT (CBCT) into clinical practice in paediatric image-guided radiotherapy (IGRT) lags behind compared to adults. Surveys report wide variation in practice for paediatric IGRT and technical information remains unreported. In this study we report on technical settings from applied paediatric CBCT protocols and review the literature for paediatric CBCT protocols.MethodsFrom September to October 2022, a survey was conducted among 246 SIOPE-affiliated centres across 35 countries. The survey consisted of 3 parts: 1) baseline information; technical CBCT exposure settings and patient set-up procedure for 2) brain/head, and 3) abdomen. Descriptive statistics was used to summarise current practice. The literature was reviewed systematically with two reviewers obtaining consensusResultsThe literature search revealed 22 papers concerning paediatric CBCT protocols. Seven papers focused on dose-optimisation. Responses from 50/246 centres in 25/35 countries were collected: 44/50 treated with photons and 10/50 with protons. In total, 48 brain/head and 53 abdominal protocols were reported. 42/50 centres used kV-CBCT for brain/head and 35/50 for abdomen; daily CBCT was used for brain/head = 28/48 (58%) and abdomen = 33/53 62%. Greater consistency was seen in brain/head protocols (dose range 0.32 – 67.7 mGy) compared to abdominal (dose range 0.27 – 119.7 mGy).ConclusionAlthough daily CBCT is now widely used in paediatric IGRT, our survey demonstrates a wide range of technical settings, suggesting an unmet need to optimise paediatric IGRT protocols. This is in accordance with the literature. However, there are only few paediatric optimisation studies suggesting that dose reduction is possible while maintaining image quality.

AB - BackgroundImplementation of daily cone-beam CT (CBCT) into clinical practice in paediatric image-guided radiotherapy (IGRT) lags behind compared to adults. Surveys report wide variation in practice for paediatric IGRT and technical information remains unreported. In this study we report on technical settings from applied paediatric CBCT protocols and review the literature for paediatric CBCT protocols.MethodsFrom September to October 2022, a survey was conducted among 246 SIOPE-affiliated centres across 35 countries. The survey consisted of 3 parts: 1) baseline information; technical CBCT exposure settings and patient set-up procedure for 2) brain/head, and 3) abdomen. Descriptive statistics was used to summarise current practice. The literature was reviewed systematically with two reviewers obtaining consensusResultsThe literature search revealed 22 papers concerning paediatric CBCT protocols. Seven papers focused on dose-optimisation. Responses from 50/246 centres in 25/35 countries were collected: 44/50 treated with photons and 10/50 with protons. In total, 48 brain/head and 53 abdominal protocols were reported. 42/50 centres used kV-CBCT for brain/head and 35/50 for abdomen; daily CBCT was used for brain/head = 28/48 (58%) and abdomen = 33/53 62%. Greater consistency was seen in brain/head protocols (dose range 0.32 – 67.7 mGy) compared to abdominal (dose range 0.27 – 119.7 mGy).ConclusionAlthough daily CBCT is now widely used in paediatric IGRT, our survey demonstrates a wide range of technical settings, suggesting an unmet need to optimise paediatric IGRT protocols. This is in accordance with the literature. However, there are only few paediatric optimisation studies suggesting that dose reduction is possible while maintaining image quality.

KW - cone-beam CT

KW - Image-guided radiotherapy

KW - Paediatric cancer

KW - Radiotherapy

U2 - 10.1016/j.radonc.2023.109963

DO - 10.1016/j.radonc.2023.109963

M3 - Journal article

C2 - 38406888

AN - SCOPUS:85175449494

VL - 190

JO - Radiotherapy & Oncology

JF - Radiotherapy & Oncology

SN - 0167-8140

M1 - 109963

ER -