Abstract
Objectives:Cone beam computed tomography (CBCT) is used for image guidance of stereotactic ablative radiotherapy (SABR), but it is susceptible to bowel motion artefacts. This trial evaluated the impact of hyoscine butylbromide (buscopan) on CBCT image quality and its feasibility within a radiotherapy workflow.Methods:A single-centre feasibility trial (ISRCTN24362767) was performed in patients treated with SABR for abdominal/pelvic oligorecurrence. Buscopan was administered to separate cohorts by intramuscular (IM) or intravenous (i.v.) injection on alternate fractions, providing within-patient control data. 4-point Likert scales were used to assess overall image quality (ranging from excellent to impossible to use) and bowel motion artefact (ranging from none to severe). Feasibility was determined by patient/radiographer questionnaires and toxicity assessment. Descriptive statistics are presented.Results:16 patients were treated (8 by IM and 8 by i.v. buscopan). The percentage of images of excellent quality with/without buscopan was 47 vs 29% for IM buscopan and 65 vs 40% for i.v. buscopan. The percentage of images with no bowel motion artefact with/without buscopan was 24.6 vs 8.9% for IM buscopan and 25.8 vs 7% for i.v. buscopan. Four patients (25%) reported dry mouth. 14 patients (93%) would accept buscopan as routine. 11 radiographers (92%) reported no delay in treatments.Conclusions:A trend towards improved image quality/reduced bowel motion artefact was observed with IM/i.v. buscopan. Buscopan was well tolerated with limited impact on workflow.Advances in knowledge:This is the first trial of buscopan within a radiotherapy workflow. It demonstrated a trend to improved image quality and feasibility of use.
Highlights
Stereotactic ablative radiotherapy (SABR) is increasingly used to treat limited sites of metastatic relapse in the abdomen/pelvis after primary treatment for malignancy.[1,2,3] SABR is ultra hypofractionated radiation, delivering large doses per fraction to a highly conformal target volume using steep dose gradients in a small number of fractions
We evaluated the impact of intramuscular (IM) and intravenous (i.v.) buscopan on cone beam computed tomography (CBCT) image quality and feasibility of its delivery during an abdominal/pelvic SABR workflow
Participants The trial schema is shown in Figure 1. 10 patients were excluded. 16 patients commenced treatment (8 in the IM cohort and 8 in the i.v. cohort); of these, one patient in the i.v. cohort experienced vertebral collapse and SABR was stopped early
Summary
Stereotactic ablative radiotherapy (SABR) is increasingly used to treat limited sites of metastatic relapse (so-called oligorecurrence) in the abdomen/pelvis after primary treatment for malignancy.[1,2,3] SABR is ultra hypofractionated radiation, delivering large doses per fraction to a highly conformal target volume using steep dose gradients in a small number of fractions. To safely deliver SABR, effective immobilisation and accurate target localisation within millimetre tolerances using image guidance and online correction for interfraction motion and set up errors are required.[4,5]. For linear accelerator-d elivered SABR, volumetric image guidance is commonly acquired using cone beam computed tomography (CBCT).[6] In contrast to diagnostic helical CT, CBCT image projections are typically acquired over at least 1–2 min and are susceptible to motion artefacts (including from bowel) that manifest after reconstruction into volumetric images.[7,8]. Hyoscine butylbromide (Buscopan® [Sanofi, Reading, UK], referred to as buscopan) is routinely used to reduce motion artefacts during MRI of the abdomen and pelvis (among other examinations).[9]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
