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Eder MM, Reiner M, Heinz C, Garny S, Freislederer P, Landry G, Niyazi M, Belka C, Riboldi M. Single-isocenter stereotactic radiosurgery for multiple brain metastases: Impact of patient misalignments on target coverage in non-coplanar treatments. Z Med Phys 2022; 32:296-311. [PMID: 35504799 PMCID: PMC9948862 DOI: 10.1016/j.zemedi.2022.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 10/18/2022]
Abstract
Frameless single-isocenter non-coplanar stereotactic radiosurgery (SRS) for patients with multiple brain metastases is a treatment at high geometrical complexity. The goal of this study is to analyze the dosimetric impact of non-coplanar image guidance with stereoscopic X-ray imaging. Such an analysis is meant to provide insights on the adequacy of safety margins, and to evaluate the benefit of imaging at non-coplanar configurations. The ExacTrac® (ET) system (Brainlab AG, Munich, Germany) was used for stereoscopic X-ray imaging in frameless single-isocenter non-coplanar SRS for multiple brain metastases. Sub-millimeter precision was found for the ET-based pre-treatment setup, whereas a degradation was noted for non-coplanar treatment angles. Misalignments without intra-fractional positioning corrections were reconstructed in 6 degrees of freedom (DoF) to resemble the situation without non-coplanar image guidance. Dose recalculation in 20 SRS patients with applied positioning corrections did not reveal any significant differences in D98% for 75 planning target volumes (PTVs) and gross tumor volumes (GTVs). For recalculation without applied positioning corrections, significant differences (p<0.05) were reported in D98% for both PTVs and GTVs, with stronger effects for small PTV volumes. A worst-case analysis at increasing translational and rotational misalignment revealed that dosimetric changes are a complex function of the combination thereof. This study highlighted the important role of positioning correction with ET at non-coplanar configurations in frameless single-isocenter non-coplanar SRS for patients with multiple brain metastases. Uncorrected patient misalignments at non-coplanar couch angles were linked to a significant loss of PTV coverage, with effects varying according to the combination of single DoF and PTV geometrical properties.
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Affiliation(s)
- Michael Martin Eder
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; Department of Medical Physics, Ludwig-Maximilians University, Garching, Germany.
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
| | - Christian Heinz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
| | - Sylvia Garny
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
| | - Philipp Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; Department of Medical Physics, Ludwig-Maximilians University, Garching, Germany.
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany.
| | - Marco Riboldi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
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Sakuragawa K, Sasaki M, Kamomae T, Yokoishi M, Kasai R, Kajino A, Ikushima H. Differences in image density adjustment parameters on the image matching accuracy of a floor-mounted kV X-ray image-guided radiation therapy system. J Appl Clin Med Phys 2021; 23:e13505. [PMID: 34931431 PMCID: PMC8833277 DOI: 10.1002/acm2.13505] [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: 08/25/2021] [Revised: 10/22/2021] [Accepted: 12/04/2021] [Indexed: 11/07/2022] Open
Abstract
This study aimed to investigate the effect of two different image density adjustment parameters on the results of image matching at six degrees of freedom using radiographic images generated by the ExacTrac X‐ray system in brain stereotactic radiosurgery (SRS). This study comprised 32 patients who underwent brain SRS at our hospital from January 2020 to December 2020. In this study, (1) the default parameter (an image density parameter between “tissue” and “bone”) was an image density parameter for digitally reconstructed radiograph (DRR) generation used at many facilities, and (2) the bone parameter was the steepest contrast parameter used at our hospital. Of the 32 patients, 24 (75%) had a couch angle of 0.5 mm or more in the translational direction or 0.5° or more in the rotational direction, and 10 (31%) had a couch angle of 1.0 mm or more in the translational direction or 1.0° or more in the rotational direction. Among the 131 cases of all couch angles, 46 (35%) cases had a translational direction of 0.5 mm or more or a rotational direction of 0.5° or more, and 15 (11%) had a translational direction of 1.0 mm or more or a rotational direction of 1.0° or more. The results of this study indicate the usefulness of using appropriate DRR parameters for each case, rather than using the default settings. The use of appropriate DRR parameters can lead to accurate position matching results, leading to fewer image‐guided radiation therapy shots and a lower imaging dose.
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Affiliation(s)
- Kanako Sakuragawa
- Department of Radiological Technology, Tokushima University Hospital, Tokushima, 770-8503, Japan
| | - Motoharu Sasaki
- Department of Therapeutic Radiology Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503, Japan
| | - Takeshi Kamomae
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 466-8550, Japan
| | - Michihiro Yokoishi
- Department of Radiological Technology, Tokushima University Hospital, Tokushima, 770-8503, Japan
| | - Ryosuke Kasai
- Department of Radiological Technology, Tokushima University Hospital, Tokushima, 770-8503, Japan
| | - Akimi Kajino
- Graduate School of Health Sciences, Tokushima University, Tokushima, 770-8503, Japan
| | - Hitoshi Ikushima
- Department of Therapeutic Radiology Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, 770-8503, Japan
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Park SY, Choi N, Jang NY. Frameless immobilization system with roll correction for stereotactic radiosurgery of intracranial brain metastases. JOURNAL OF RADIATION RESEARCH 2021:rrab071. [PMID: 34373910 DOI: 10.1093/jrr/rrab071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/13/2021] [Accepted: 08/02/2021] [Indexed: 06/13/2023]
Abstract
The objectives of this study were to develop a frameless immobilization system that allows roll rotation corrections and to investigate the performance of this system for stereotactic radiosurgery (SRS) treatment. We designed the support frame of a frameless immobilization system based on the commercial Brainlab immobilization system. The support frame consisted of a fixed component and a rotating component. With rack and pinion gears and guide holes installed in the system, the rotating component was configured to be rotated along the longitudinal axis of the patient with respect to the fixed component. To evaluate the performance of the system, the six degree-of-freedom (6D) positioning corrections (translational and rotational corrections) were assessed by image verification between planning computed tomography (CT) and cone-beam computed tomography (CBCT) images. The commercial immobilization system was evaluated in the same manner for comparison. The mean translational shifts for the commercial system were 0.68 ± 0.19 mm, 0.73 ± 0.24 mm and 0.78 ± 0.19 mm, while those for the developed system were 0.44 ± 0.31 mm, 0.43 ± 0.25 mm and 0.60 ± 0.14 mm in the lateral, longitudinal and vertical directions, respectively. The mean rotational shifts for the commercial system were 0.37° ± 0.12°, 0.32° ± 0.16° and 0.38° ± 0.14°, while those for the developed system were 0.04° ± 0.04°, 0.11° ± 0.06° and 0.15° ± 0.12° along the lateral, vertical and longitudinal axes of the patient, respectively. For institutions that do not have 6D robotic couches installed, the use of the developed immobilization system can provide 6D corrections, resulting in shorter treatment times and higher patient positioning accuracy.
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Affiliation(s)
- So-Yeon Park
- Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, 05368, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, 03080, Republic of Korea
| | - Noorie Choi
- Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, 05368, Republic of Korea
| | - Na Young Jang
- Department of Radiation Oncology, Veterans Health Service Medical Center, Seoul, 05368, Republic of Korea
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Rojas-López JA, Díaz Moreno RM, Venencia CD. Use of genetic algorithm for PTV optimization in single isocenter multiple metastases radiosurgery treatments with Brainlab Elements™. Phys Med 2021; 86:82-90. [PMID: 34062337 DOI: 10.1016/j.ejmp.2021.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 05/15/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To optimize PTV margins for single isocenter multiple metastases stereotactic radiosurgery through a genetic algorithm (GA) that determines the maximum effective displacement of each target (GTV) due to rotations. METHOD 10 plans were optimized. The plans were created with Elements Multiple Mets™ (Brainlab AG, Munchen, Germany) from a predefined template. The mean number of metastases per plan was 5 ± 2 [3,9] and the mean volume of GTV was 1.1 ± 1.3 cc [0.02, 5.1]. PTV margin criterion was based on GTV-isocenter distance and target dimensions. The effective displacement to perform specific rotational combination (roll, pitch, yaw) was optimized by GA. The original plans were re-calculated using the PTV optimized margin and new dosimetric variations were obtained. The Dmean, D99, Paddick conformity index (PCI), gradient index (GI) and dose variations in healthy brain were studied. RESULTS Regarding targets located shorter than 50 mm from the isocenter, the maximum calculated displacement was 2.5 mm. The differences between both PTV margin criteria were statistically significant for Dmean (p = 0.0163), D99 (p = 0.0439), PCI (p = 0.0242), GI (p = 0.0160) and for healthy brain V12 (p = 0.0218) and V10 (p = 0.0264). CONCLUSION The GA allows to determine an optimized PTV margin based on the maximum displacement. Optimized PTV margins reduce the detriment of dosimetric parameters. Greater PTV margins are associated with an increase in healthy brain volume.
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Tsuruta Y, Nakata M, Nakamura M, Uto M, Takehana K, Hirashima H, Fujimoto T, Mizowaki T. Evaluation of intrafractional head motion for intracranial stereotactic radiosurgery with a thermoplastic frameless mask and ceiling-floor-mounted image guidance device. Phys Med 2021; 81:245-252. [PMID: 33485142 DOI: 10.1016/j.ejmp.2020.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/17/2020] [Accepted: 12/25/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To evaluate intrafractional head motion (IFM) in patients who underwent intracranial stereotactic radiosurgery with the ExacTrac X-ray system (ETX) and a frameless mask. METHODS A total of 143 patients who completed a pre-treatment examination for IFM were eligible for this study. The frameless mask type B R408 (Klarity Medical & Equipment Co., Ltd., Guangzhou, China), which covers the back of the head, and the entire face, was used for patient immobilization. After the initial 6D correction and first X-ray verification (IFM1), X-ray verification was performed every 3 min for a duration of 15 min. The IFMp (2 ≤ p ≤ 6) was calculated as the positional difference from IFM1. In addition, the inter-phase IFM (IP-IFM) and IFMm were calculated. The IP-IFM was defined as |IFMp - IFMp-1|, and IFMm as the difference between the values after all patients were asked to move their heads intentionally with the frameless mask on. RESULTS Both translational IFMp and IP-IFM exceeded 1 mm for a single patient, whereas, for all patients, the translational IFMm values were kept to within 1 mm in all directions. The proportions of the rotational IFMp, IP-IFM, and IFMm values within 0.5° were greater than 94.4%, 98.6%, and 90.2% for all of the rotational axes, respectively. CONCLUSIONS A frameless mask achieved highly accurate patient positioning in combination with ETX and a 6°-of-freedom robotic couch; however, a deviation over 1 mm and 0.5° was observed with low frequency. Therefore, X-ray verification and correction are required during treatment.
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Affiliation(s)
- Yusuke Tsuruta
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto 606-8507, Japan; Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Manabu Nakata
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Mitsuhiro Nakamura
- Division of Medical Physics, Department of Information Technology and Medical Engineering, Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan; Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan.
| | - Megumi Uto
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Keiichi Takehana
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Hideaki Hirashima
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Takahiro Fujimoto
- Division of Clinical Radiology Service, Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Takashi Mizowaki
- Department of Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
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Park J, McDermott R, Kim S, Huq MS. Prediction of conical collimator collision for stereotactic radiosurgery. J Appl Clin Med Phys 2020; 21:39-46. [PMID: 32627949 PMCID: PMC7497939 DOI: 10.1002/acm2.12963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/03/2020] [Accepted: 06/02/2020] [Indexed: 11/11/2022] Open
Abstract
The purpose of this study is to predict the collision clearance distance of stereotactic cones with treatment setup devices in cone-based stereotactic radiosurgery (SRS). The BrainLAB radiosurgery system with a Frameless Radiosurgery Positioning Array and dedicated couch top was targeted in this study. The positioning array and couch top were scanned with CT simulators, and their outer contours of were detected. The minimum clearance distance was estimated by calculating the Euclidian distances between the surface of the SRS cones and the nearest surface of the outer contours. The coordinate transformation of the outer contour was performed by incorporating the Beam's Eye View at a planned arc range and couch angle. From the minimum clearance distance, the collision-free gantry ranges for each couch angle were sequentially determined. An in-house software was developed to calculate the clearance distance between the cone surface and the outer contours, and thus determine the occurrence of a collision. The software was extensively tested for various combinations of couch and arc angles at multiple isocenter locations for two combinations of cone-couch systems. A total of 50 arcs were used to validate the calculation accuracies of the software for each system. The calculated minimum distances and collision-free angles from the software were verified by physical measurements. The calculated minimum distances were found to agree with the measurements to within 0.3 ± 0.9 mm. The collision-free arc angles from the software also agreed with the measurements to within 1.1 ± 1.1° with a 5-mm safety margin for 20 arcs. In conclusion, the in-house software was able to calculate the minimum clearance distance with <1.0 mm accuracy and to determine the collision-free arc range for the cone-based BrainLab SRS system.
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Affiliation(s)
- Jeonghoon Park
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Ryan McDermott
- Department of Radiation Oncology, The Medical Center at Bowling Green, Bowling Green, KY, USA
| | - Sangroh Kim
- Department of Radiation Oncology, Virginia Mason Medical Center, Seattle, WA, USA
| | - M Saiful Huq
- Department of Radiation Oncology, University of Pittsburgh School of Medicine and UPMC Hillman Cancer Center, Pittsburgh, PA, USA
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Positioning error analysis of the fraxion localization system in the intracranial stereotactic radiotherapy of tumors. Clin Transl Oncol 2020; 23:43-47. [PMID: 32462396 DOI: 10.1007/s12094-020-02382-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To investigate positioning error analysis of the Fraxion localization system in the intracranial stereotactic radiotherapy of tumors. METHODS 64 patients were divided into two groups: a control group (36 patients with the standard thermoplastic mask) and a model group (28 patients with the Fraxion localization system). 3D images of the treated position were obtained by cone-beam computed tomography (CBCT). Positioning errors were obtained by, respectively, registering these two sets of CBCT images to planning CT images, using a 6°-freedom robotic patient positioning system (HexaPOD Evo RT System). The changes in positioning errors with the Fraxion localization system and with the standard thermoplastic mask were analyzed. RESULTS CBCT scan results of the model group showed that the mean of linear error of three directions [superior-inferior (SI), lateral (LAT), and anterior-posterior (AP)] was 0.710 ± 0.676 mm, 0.817 ± 0.687 mm, and 0.710 ± 0.685 mm, respectively. The corresponding PTV was 1.23 mm, 1.26 mm, and 1.36 mm. The differences between the 3D images and the planned CT images were significant (p < 0.001). CONCLUSION The Fraxion radiotherapy system can not only improve the positioning accuracy and reduce positioning errors but also narrow the PTV margin and reduce the radiated volume of normal tissue.
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Prentou G, Pappas EP, Logothetis A, Koutsouveli E, Pantelis E, Papagiannis P, Karaiskos P. Dosimetric impact of rotational errors on the quality of VMAT-SRS for multiple brain metastases: Comparison between single- and two-isocenter treatment planning techniques. J Appl Clin Med Phys 2020; 21:32-44. [PMID: 32022447 PMCID: PMC7075408 DOI: 10.1002/acm2.12815] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/21/2019] [Accepted: 12/10/2019] [Indexed: 12/22/2022] Open
Abstract
Purpose In the absence of a 6D couch and/or assuming considerable intrafractional patient motion, rotational errors could affect target coverage and OAR‐sparing especially in multiple metastases VMAT‐SRS cranial cases, which often involve the concurrent irradiation of off‐axis targets. This work aims to study the dosimetric impact of rotational errors in such applications, under a comparative perspective between the single‐ and two‐isocenter treatment techniques. Methods Ten patients (36 metastases) were included in this study. Challenging cases were only considered, with several targets lying in close proximity to OARs. Two multiarc VMAT plans per patient were prepared, involving one and two isocenters, serving as the reference plans. Different degrees of angular offsets at various orientations were introduced, simulating rotational errors. Resulting dose distributions were evaluated and compared using commonly employed dose‐volume and plan quality indices. Results For single‐isocenter plans and 1⁰ rotations, plan quality indices, such as coverage, conformity index and D95%, deteriorated significantly (>5%) for distant targets from the isocenter (at> 4–6 cm). Contrarily, for two‐isocenter plans, target distances to nearest isocenter were always shorter (≤4 cm), and, consequently, 1⁰ errors were well‐tolerated. In the most extreme case considered (2⁰ around all axes) conformity index deteriorated by on‐average 7.2%/cm of distance to isocenter, if one isocenter is used, and 2.6%/cm, for plans involving two isocenters. The effect is, however, strongly associated with target volume. Regarding OARs, for single‐isocenter plans, significant increase (up to 63%) in Dmax and D0.02cc values was observed for any angle of rotation. Plans that could be considered clinically unacceptable were obtained even for the smallest angle considered, although rarer for the two‐isocenter planning approach. Conclusion Limiting the lesion‐to‐isocenter distance to ≤4 cm by introducing additional isocenter(s) appears to partly mitigate severe target underdosage, especially for smaller target sizes. If OAR‐sparing is also a concern, more stringent rotational error tolerances apply.
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Affiliation(s)
- Georgia Prentou
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleftherios P Pappas
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Logothetis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evaggelos Pantelis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Papagiannis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Pantelis Karaiskos
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Pan JH, Yu DD, Song QB, Ruan CL, Fu JG, Wu B, Ma GD, Wang LZ, Lei Y, Han G. Comparison of geometrical uncertainties in the radiotherapy for various treatment sites with two different immobilization marking methods. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2019; 27:703-714. [PMID: 31227680 DOI: 10.3233/xst-180467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The skin marking method (SMM) and bow-form-ruler marking method (BFRM) are two commonly used patient marking methods in mainland China. This study aims to evaluate SMM and BFRM by comparing the inter-fraction setup errors from using these two methods together with vacuum cushion immobilization in patients underwent radiotherapy for different treatment sites. MATERIALS AND METHODS Eighteen patients diagnosed with pelvic, abdominal and thoracic malignant tumors (with 6 patients per treatment site) were enrolled in this prospective study. All patients were immobilized with vacuum cushion. Each patient was marked by both SMM and BFRM before computed tomography (CT) simulation. Target location was verified by cone beam CT images with displacements assessed prior to each sampled treatment session. The localization errors in three translational and three rotational directions were recorded and analyzed. RESULTS Images from 108 fractions in 18 patients produced 324 translational and 324 rotational comparisons for SMM and BFRM. The setup errors of all treatment sites showed no difference in two marking methods in any directions (p > 0.05). In subgroups of treatment site analysis, SMM significantly lessened the lateral and yaw setup errors compared to BFRM in the pelvic sites (0.39±1.85 mm vs -1.28±1.13 mm, p < 0.01 and -0.19±0.59° vs -0.61±0.59°, p < 0.05). However, in the abdominal subgroup, BFRM was superior to SMM for reduced vertical errors (0.17±2.73 mm vs 2.28±3.16 mm, p < 0.05). For the underweight or obese patients (with Body Mass Index, BMI < 18.5 or BMI≥24), SMM resulted in less yaw errors compared to BFRM (-0.05±0.38° vs -0.43±0.48°, p < 0.05). No significant difference between SMM and BFRM in setup errors of normal weighted patients (18.5≤BMI < 24) was observed for all three studied treatment sites. CONCLUSIONS This study shows no significant difference in patient setup errors for various treatment sites between SMM and BFRM in general. SMM may be suitable for the pelvic tumor and patients with BMI < 18.5 or BMI≥24, while BFRM is recommended for the abdominal tumor sites.
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Affiliation(s)
- Jing-Hui Pan
- Department of Radiation Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dong-Dong Yu
- Department of Radiation Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qi-Bin Song
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chang-Li Ruan
- Department of Radiation Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing-Guo Fu
- Department of Radiation Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bing Wu
- Department of Radiation Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Guang-Dong Ma
- Department of Radiation Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lu-Zhou Wang
- Department of Radiation Oncology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yu Lei
- Department of Radiation Oncology, University of Nebraska Medical Centre, Omaha, NE, USA
| | - Guang Han
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tanabe S, Umetsu O, Sasage T, Utsunomiya S, Kuwabara R, Kuribayashi T, Takatou H, Kawaguchi G, Aoyama H. Clinical commissioning of a new patient positioning system, SyncTraX FX4, for intracranial stereotactic radiotherapy. J Appl Clin Med Phys 2018; 19:149-158. [PMID: 30273444 PMCID: PMC6236847 DOI: 10.1002/acm2.12467] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/04/2018] [Accepted: 09/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background & Aims A new real‐time tracking radiotherapy (RTRT) system, the SyncTraX FX4 (Shimadzu, Kyoto, Japan), consisting of four X‐ray tubes and four ceiling‐mounted flat panel detectors (FPDs) combined with a linear accelerator, was installed at Uonuma Kikan Hospital (Niigata, Japan) for the first time worldwide. In addition to RTRT, the SyncTraX FX4 system enables bony structure‐based patient verification. Here we provide the first report of this system's clinical commissioning for intracranial stereotactic radiotherapy (SRT). Materials & Methods A total of five tests were performed for the commissioning: evaluations of (1) the system's image quality; (2) the imaging and treatment coordinate coincidence; and (3) the localization accuracy of cone‐beam computed tomography (CBCT) and SyncTraX FX4; (4) the measurement of air kerma; (5) an end‐to‐end test. Results & Discussion The tests revealed the following. (1) All image quality evaluation items satisfied each acceptable criterion in all FPDs. (2) The maximum offsets among the centers were ≤0.40 mm in all combinations of the FPD and X‐ray tubes (preset). (3) The isocenter localization discrepancies between CBCT and preset #3 in the SyncTraX FX4 system were 0.29 ± 0.084 mm for anterior‐posterior, −0.19 ± 0.13 mm for superior‐inferior, 0.076 ± 0.11 mm for left‐right, −0.11 ± 0.066° for rotation, −0.14 ± 0.064° for pitch, and 0.072±0.058° for roll direction. the Pearson's product‐moment correlation coefficient between the two systems was >0.98 in all directions. (4) The mean air kerma value for preset #3 was 0.11 ± 0.0002 mGy in predefined settings (80 kV, 200 mA, 50 msec). (5) For 16 combinations of gantry and couch angles, median offset value in all presets was 0.31 mm (range 0.14–0.57 mm). Conclusion Our results demonstrate a competent performance of the SyncTraX FX4 system in terms of the localization accuracy for intracranial SRT.
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Affiliation(s)
- Satoshi Tanabe
- Department of Radiation Oncology, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Osamu Umetsu
- Department of Radiation Oncology, Uonuma Kikan Hospital, Niigata, Japan
| | - Toshikazu Sasage
- Department of Radiation Oncology, Uonuma Kikan Hospital, Niigata, Japan
| | - Satoru Utsunomiya
- Department of Radiological Technology, Niigata University Graduate School of Health Sciences, Niigata, Japan
| | - Ryota Kuwabara
- Department of Radiation Oncology, Uonuma Kikan Hospital, Niigata, Japan
| | | | - Hiromasa Takatou
- Department of Radiation Oncology, Uonuma Kikan Hospital, Niigata, Japan
| | - Gen Kawaguchi
- Department of Radiation Oncology, Uonuma Kikan Hospital, Niigata, Japan
| | - Hidefumi Aoyama
- Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Pappas EP, Seimenis I, Dellios D, Kollias G, Lampropoulos KI, Karaiskos P. Assessment of sequence dependent geometric distortion in contrast-enhanced MR images employed in stereotactic radiosurgery treatment planning. ACTA ACUST UNITED AC 2018; 63:135006. [DOI: 10.1088/1361-6560/aac7bf] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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