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Shinde P, Jadhav A, Shankar V, Dhoble SJ. Assessment of dosimetric impact of interfractional 6D setup error in tongue cancer treated with IMRT and VMAT using daily kV-CBCT. Rep Pract Oncol Radiother 2023; 28:224-240. [PMID: 37456705 PMCID: PMC10348325 DOI: 10.5603/rpor.a2023.0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/29/2023] [Indexed: 07/18/2023] Open
Abstract
Background This study aimed to evaluate the dosimetric influence of 6-dimensional (6D) interfractional setup error in tongue cancer treated with intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) using daily kilovoltage cone-beam computed tomography (kV-CBCT). Materials and methods This retrospective study included 20 tongue cancer patients treated with IMRT (10), VMAT (10), and daily kV-CBCT image guidance. Interfraction 6D setup errors along the lateral, longitudinal, vertical, pitch, roll, and yaw axes were evaluated for 600 CBCTs. Structures in the planning CT were deformed to the CBCT using deformable registration. For each fraction, a reference CBCT structure set with no rotation error was created. The treatment plan was recalculated on the CBCTs with the rotation error (RError), translation error (TError), and translation plus rotation error (T+RError). For targets and organs at risk (OARs), the dosimetric impacts of RError, TError, and T+RError were evaluated without and with moderate correction of setup errors. Results The maximum dose variation ΔD (%) for D98% in clinical target volumes (CTV): CTV-60, CTV-54, planning target volumes (PTV): PTV-60, and PTV-54 was -1.2%, -1.9%, -12.0%, and -12.3%, respectively, in the T+RError without setup error correction. The maximum ΔD (%) for D98% in CTV-60, CTV-54, PTV-60, and PTV-54 was -1.0%, -1.7%, -9.2%, and -9.5%, respectively, in the T+RError with moderate setup error correction. The dosimetric impact of interfractional 6D setup errors was statistically significant (p < 0.05) for D98% in CTV-60, CTV-54, PTV-60, and PTV-54. Conclusions The uncorrected interfractional 6D setup errors could significantly impact the delivered dose to targets and OARs in tongue cancer. That emphasized the importance of daily 6D setup error correction in IMRT and VMAT.
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Affiliation(s)
- Prashantkumar Shinde
- Department of Physics, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur, India
| | - Anand Jadhav
- Department of Radiation Oncology, Sir H N Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - V. Shankar
- Department of Radiation Oncology, Apollo Cancer Center, Chennai, India
| | - Sanjay J. Dhoble
- Department of Physics, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur, India
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Shinde P, Jadhav A, Gupta KK, Dhoble S. QUANTIFICATION OF 6D INTER-FRACTION TUMOUR LOCALISATION ERRORS IN TONGUE AND PROSTATE CANCER USING DAILY KV-CBCT FOR 1000 IMRT AND VMAT TREATMENT FRACTIONS. RADIATION PROTECTION DOSIMETRY 2022; 198:1265-1281. [PMID: 35870445 DOI: 10.1093/rpd/ncac145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/08/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to evaluate the 6D inter-fraction tumour localisation errors in 20 tongue and 20 prostate cancer patients treated with intensity-modulated radiation therapy and volumetric-modulated arc therapy. The patient tumour localisation errors in lateral, longitudinal and vertical translation axes and pitch, roll and yaw rotational axes were analysed by automatic image registration of daily pretreatment kilovoltage cone-beam computed tomography (kV-CBCT) with planning CT in 1000 fractions. The overall mean error (M), systematic error (Σ), random error (σ) and planning target volume (PTV) margins were evaluated. The frequency distributions of setup errors were normally distributed about the mean except for pitch in the tongue and prostate. The overall 3D vector length ≥ 5 mm was 14.2 and 49.8% in the ca-tongue and ca-prostate, respectively. The frequency of rotational errors ≥1 degree was a maximum of 37 and 59.5%, respectively, in ca-tongue and ca-prostate. The M, Σ and σ for all translational and rotational axes decreased with increasing frequency of verification correction in ca-tongue and ca-prostate patients. Similarly, the PTV margin was reduced with no correction to alternate day correction from a maximum of 4.7 to 2.5 mm in ca-tongue and from a maximum of 8.6 to 4.7 mm in ca-prostate. The results emphasised the vital role of the higher frequency of kV-CBCT based setup correction in reducing M, Σ, σ and PTV margins in ca-tongue and ca-prostate patients.
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Affiliation(s)
- Prashantkumar Shinde
- Department of Physics, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440033, India
| | - Anand Jadhav
- Department of Radiation Oncology, Sir H N Reliance Foundation Hospital & Research Centre, Mumbai 400004, India
| | - Karan Kumar Gupta
- Department of Chemical Engineering, National Taiwan University, Taipei, Taiwan 10617, ROC
| | - Sanjay Dhoble
- Department of Physics, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440033, India
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Wu VWC, Ho YY, Tang YS, Lam PW, Yeung HK, Lee SWY. Comparison of the verification performance and radiation dose between ExacTrac x-ray system and On-Board Imager-A phantom study. Med Dosim 2018; 44:15-19. [PMID: 29395461 DOI: 10.1016/j.meddos.2017.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 11/15/2017] [Accepted: 12/22/2017] [Indexed: 12/01/2022]
Abstract
Recently, On-Board Imager (OBI) and ExacTrac x-ray 6 degree-of-freedom system (ExacTrac) are increasingly used verification systems in local radiotherapy centers. This study aimed to compare the differences between these two systems in terms of verification accuracy, organ doses, and verification time for head-and-neck (H&N) and pelvic cases. Rando anthropomorphic phantoms of H&N and pelvic regions were positioned with known set-up deviations from the reference position in the linear accelerator. x-Ray verification images were then acquired using both systems. Verification accuracy was evaluated based on the residual positioning error (δD) after image registration. Thermoluminescence dose meters (TLD-100s) were placed in specific locations of the phantoms for the measurement of imaging doses at the organs of interest. Besides, the verification time was also recorded for comparison. Most average detection errors for both systems were within 1 mm. The detection error of ExacTrac was significantly larger than OBI in the H&N region in all directions (p < 0.05), but was significantly lower in the pelvis (p < 0.05). The mean imaging doses to all organs of interest from ExacTrac were significantly lower than OBI (p < 0.05). The mean verification time for ExacTrac was about 10 seconds, which was significantly shorter than the 100 seconds in OBI (p < 0.001). Both verification systems achieved satisfactory performance in the H&N and pelvic regions despite ExacTrac being better in terms of verification time and organ dose. The verification accuracy of Exactrac was better in pelvic region than the H&N region when compared with OBI.
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Affiliation(s)
- Vincent Wing-Cheung Wu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong.
| | - Yan-Yee Ho
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong
| | - Yu-Sum Tang
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong
| | - Po-Wa Lam
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong
| | - Ho-Kwan Yeung
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong
| | - Shara Wee-Yee Lee
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong
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Ciardo D, Alterio D, Jereczek-Fossa BA, Riboldi M, Zerini D, Santoro L, Preve E, Rondi E, Comi S, Serafini F, Laudati A, Ansarin M, Preda L, Baroni G, Orecchia R. Set-up errors in head and neck cancer patients treated with intensity modulated radiation therapy: Quantitative comparison between three-dimensional cone-beam CT and two-dimensional kilovoltage images. Phys Med 2015; 31:1015-1021. [PMID: 26459318 DOI: 10.1016/j.ejmp.2015.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/13/2015] [Accepted: 08/01/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To compare the patient set-up error detection capabilities of three-dimensional cone beam computed tomography (3D-CBCT) and two-dimensional orthogonal kilovoltage (2D-kV) techniques. METHODS 3D-CBCT and 2D-kV projections were acquired on 29 head-and-neck (H&N) patients undergoing Intensity Modulated Radiotherapy (IMRT) on the first day of treatment (time 0) and after the delivery of 40 Gy and 50 Gy. Set-up correction vectors were analyzed after fully automatic image registration as well as after revision by radiation oncologists. The dosimetric effects of the different sensitivities of the two image guidance techniques were assessed. RESULTS A statistically significant correlation among detected set-up deviations by the two techniques was found along anatomical axes (0.60 < ρ < 0.72, p < 0.0001); no correlation was found for table rotation (p = 0.41). No evidence of statistically significant differences between the indications provided along the course of the treatment was found; this was also the case when full automatic versus manually refined correction vectors were compared. The dosimetric effects analysis revealed slight statistically significant differences in the median values of the maximum relative dose to mandible, spinal cord and its 5 mm Planning Organ at Risk Volume (0.95%, 0.6% and 2.45%, respectively), with higher values (p < 0.01) observed when 2D-kV corrections were applied. CONCLUSION A similar sensitivity to linear set-up errors was observed for 2D-kV and 3D-CBCT image guidance techniques in our H&N patient cohort. Higher rotational deviations around the table vertical axis were detected by the 3D-CBCT with respect to the 2D-kV method, leading to a consistent better sparing of organs at risk.
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Affiliation(s)
- Delia Ciardo
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy.
| | - Daniela Alterio
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy; Department of Health Sciences, University of Milan, via Festa del Perdono 7, Milano 20122, Italy
| | - Marco Riboldi
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano, Italy; Centro Nazionale di Adroterapia Oncologica (CNAO), Strada Campeggi 53, Pavia 27100, Italy
| | - Dario Zerini
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Luigi Santoro
- Division of Epidemiology and Biostatistics, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Eleonora Preve
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Elena Rondi
- Unit of Medical Physics, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Stefania Comi
- Unit of Medical Physics, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Flavia Serafini
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Antonio Laudati
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy
| | - Mohssen Ansarin
- Division of Head and Neck Surgery, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Lorenzo Preda
- Department of Radiology, European Institute of Oncology, via Ripamonti 435, 20141 Milano, Italy
| | - Guido Baroni
- Dipartimento di Elettronica, Informazione e Bioingegneria (DEIB), Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano, Italy; Centro Nazionale di Adroterapia Oncologica (CNAO), Strada Campeggi 53, Pavia 27100, Italy
| | - Roberto Orecchia
- Division of Radiation Oncology, European Institute of Oncology, via Ripamonti 435, Milano 20141, Italy; Department of Health Sciences, University of Milan, via Festa del Perdono 7, Milano 20122, Italy
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Motegi K, Kohno R, Ueda T, Shibuya T, Ariji T, Kawashima M, Akimoto T. Evaluating positional accuracy using megavoltage cone-beam computed tomography for IMRT with head-and-neck cancer. JOURNAL OF RADIATION RESEARCH 2014; 55:568-574. [PMID: 24449713 PMCID: PMC4014166 DOI: 10.1093/jrr/rrt143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 11/17/2013] [Accepted: 11/18/2013] [Indexed: 06/03/2023]
Abstract
Accurate dose delivery is essential for the success of intensity-modulated radiation therapy (IMRT) for patients with head-and-neck (HN) cancer. Reproducibility of IMRT dose delivery to HN regions can be critically influenced by treatment-related changes in body contours. Moreover, some set-up margins may not be adaptable to positional uncertainties of HN structures at every treatment. To obtain evidence for appropriate set-up margins in various head and neck areas, we prospectively evaluated positional deviation (δ values) of four bony landmarks (i.e. the clivus and occipital protuberance for the head region, and the mental protuberance and C5 for the neck region) using megavoltage cone-beam computed tomography during a treatment course. Over 800 δ values were analyzed in each translational direction. Positional uncertainties for HN cancer patients undergoing IMRT were evaluated relative to the body mass index. Low positional accuracy was observed for the neck region compared with the head region. For the head region, most of the δ was distributed within ± 5 mm, and use of the current set-up margin was appropriate. However, the δ values for the neck region were within ± 8 mm. Especially for overweight patients, a few millimeters needed to be added to give an adequate set-up margin. For accurate dose delivery to targets and to avoid excess exposure to normal tissues, we recommend that the positional verification process be performed before every treatment.
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Affiliation(s)
- Kana Motegi
- Corresponding author. Tel: +81-4-7133-1111; FAX: +81-4-7134-7048;
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Worthy D, Wu Q. Dosimetric assessment of rigid setup error by CBCT for HN-IMRT. J Appl Clin Med Phys 2010; 11:3187. [PMID: 20717085 PMCID: PMC5720430 DOI: 10.1120/jacmp.v11i3.3187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 03/19/2010] [Accepted: 04/10/2010] [Indexed: 12/25/2022] Open
Abstract
Dose distributions in HN-IMRT are complex and may be sensitive to the treatment uncertainties. The goals of this study were to evaluate: 1) dose differences between plan and actual delivery and implications on margin requirement for HN-IMRT with rigid setup errors; 2) dose distribution complexity on setup error sensitivity; and 3) agreement between average dose and cumulative dose in fractionated radiotherapy. Rigid setup errors for HN-IMRT patients were measured using cone-beam CT (CBCT) for 30 patients and 896 fractions. These were applied to plans for 12HN patients who underwent simultaneous integrated boost (SIB) IMRT treatment. Dose distributions were recalculated at each fraction and summed into cumulative dose. Measured setup errors were scaled by factors of 2-4 to investigate margin adequacy. Two plans, direct machine parameter optimization (DMPO) and fluence only (FO), were available for each patient to represent plans of different complexity. Normalized dosimetric indices, conformity index (CI) and conformation number (CN) were used in the evaluation. It was found that current 5 mm margins are more than adequate to compensate for rigid setup errors, and that standard margin recipes overestimate margins for rigid setup error in SIB HN-IMRT because of differences in acceptance criteria used in margin evaluation. The CTV-to-PTV margins can be effectively reduced to 1.9 mm and 1.5 mm for CTV1 and CTV2. Plans of higher complexity and sharper dose gradients are more sensitive to setup error and require larger margins. The CI and CN are not recommended for cumulative dose evaluation because of inconsistent definition of target volumes used. For fractionated radiotherapy in HN-IMRT, the average fractional dose does not represent the true cumulative dose received by the patient through voxel-by-voxel summation, primarily due to the setup error characteristics, where the random component is larger than systematic and different target regions get underdosed at each fraction.
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Affiliation(s)
- Danielle Worthy
- Department of Radiation Oncology, Wayne State University, Detroit, Michigan 48201, USA
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Faddegon BA, Aubin M, Bani-Hashemi A, Gangadharan B, Gottschalk AR, Morin O, Sawkey D, Wu V, Yom SS. Comparison of patient megavoltage cone beam CT images acquired with an unflattened beam from a carbon target and a flattened treatment beama). Med Phys 2010; 37:1737-41. [DOI: 10.1118/1.3359822] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Szlag M, Slosarek K. Two-dimensional imaging of tumour control probabilities and normal tissue complication probabilities. Rep Pract Oncol Radiother 2010; 15:31-9. [PMID: 24376921 DOI: 10.1016/j.rpor.2010.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 11/04/2009] [Accepted: 02/07/2010] [Indexed: 11/24/2022] Open
Abstract
AIM To create a presentation method of TCP and NTCP distributions calculated based on dose distribution for a selected CT slice. MATERIALS AND METHODS Three 24-bit colour maps - of dose distribution, delineated structures and CT information - were converted into m-by-n-by-3 data arrays, containing intensities of red, green, and blue colour components for each pixel. All calculations were performed with Matlab v.6.5. The transformation function, which consists of five linear functions, was prepared to translate the colour map into a one-dimensional data array of dose values. A menu-driven application based on the transformation function and mathematical models of complication risk (NTCP) and treatment control probability (TCP) was designed to allow pixel-by-pixel translation of colour maps into one-dimensional arrays of TCP and NTCP values. RESULTS The result of this work is an application created to visualize the TCP and NTCP distribution for a single CT scan based on the spatial dose distribution calculated in the treatment planning system. The application allows 10 targets (PTV) and 10 organs at risks (OaR) to be defined. The interface allows alpha/beta values to be inserted for each delineated structure. The application computes TCP and NTCP matrices, which are presented as colour maps superimposed on the corresponding CT slice. There is a set of parameters used for TCP/NTCP calculations which can be defined by the user. CONCLUSION Our application is a prototype of an evaluation tool. Although limited to a single plane of the treatment plan, it is believed to be a starting point for further development.
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Affiliation(s)
- Marta Szlag
- Department of Radiotherapy and Brachytherapy Planning, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Poland
| | - Krzysztof Slosarek
- Department of Radiotherapy and Brachytherapy Planning, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology Gliwice Branch, Poland
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Effect of daily setup errors on individual dose distribution in conventional radiotherapy: an initial study. Radiol Phys Technol 2009; 2:151-8. [DOI: 10.1007/s12194-009-0059-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 04/08/2009] [Accepted: 04/09/2009] [Indexed: 12/01/2022]
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:132-41. [PMID: 19363348 DOI: 10.1097/moo.0b013e32832ad5ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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