Top

Radiation Oncology

Published in:

Open Access 01-12-2011 | Research

Impact of the frequency of online verifications on the patient set-up accuracy and set-up margins

Authors: Volker Rudat, Mohamed Hammoud, Yogin Pillay, Abdul Aziz Alaradi, Adel Mohamed, Saleh Altuwaijri

Published in: Radiation Oncology | Issue 1/2011

Abstract

Purpose

The purpose of the study was to evaluate the patient set-up error of different anatomical sites, to estimate the effect of different frequencies of online verifications on the patient set-up accuracy, and to calculate margins to accommodate for the patient set-up error (ICRU set-up margin, SM).

Methods and materials

Alignment data of 148 patients treated with inversed planned intensity modulated radiotherapy (IMRT) or three-dimensional conformal radiotherapy (3D-CRT) of the head and neck (n = 31), chest (n = 72), abdomen (n = 15), and pelvis (n = 30) were evaluated. The patient set-up accuracy was assessed using orthogonal megavoltage electronic portal images of 2328 fractions of 173 planning target volumes (PTV). In 25 patients, two PTVs were analyzed where the PTVs were located in different anatomical sites and treated in two different radiotherapy courses. The patient set-up error and the corresponding SM were retrospectively determined assuming no online verification, online verification once a week and online verification every other day.

Results

The SM could be effectively reduced with increasing frequency of online verifications. However, a significant frequency of relevant set-up errors remained even after online verification every other day. For example, residual set-up errors larger than 5 mm were observed on average in 18% to 27% of all fractions of patients treated in the chest, abdomen and pelvis, and in 10% of fractions of patients treated in the head and neck after online verification every other day.

Conclusion

In patients where high set-up accuracy is desired, daily online verification is highly recommended.

Available only for authorised users

Kirby MC, Glendinning AG: Developments in electronic portal imaging systems. Br J Radiol 2006,79(Spec No 1):S50-65.CrossRefPubMed

Boda-Heggemann J, Lohr F, Wenz F, Flentje M, Guckenberger M: kV Cone-Beam CT-Based IGRT: A Clinical Review. Strahlenther Onkol 2011.

Rudat V, Flentje M, Engenhart R, Metzger M, Wannenmacher M: [The belly-board technic for the sparing of the small intestine. Studies on positioning accuracy taking into consideration conformational irradiation technics]. Strahlenther Onkol 1995,171(8):437-443.PubMed

Siddiqui F, Shi C, Papanikolaou N, Fuss M: Image-guidance protocol comparison: supine and prone set-up accuracy for pelvic radiation therapy. Acta Oncol 2008,47(7):1344-1350. 10.1080/02841860802304564CrossRefPubMed

Radiologists TRCo: On target: ensuring geometric accuracy in radiotherapy. London: The Royal College of Radiologists, Society and College of Radiographers, Institute of Physics and Engineering in Medicine.; 2008.

Higgins J, Bezjak A, Franks K, Le LW, Cho BC, Payne D, Bissonnette JP: Comparison of spine, carina, and tumor as registration landmarks for volumetric image-guided lung radiotherapy. Int J Radiat Oncol Biol Phys 2009,73(5):1404-1413. 10.1016/j.ijrobp.2008.06.1926CrossRefPubMed

van Herk M, Remeijer P, Rasch C, Lebesque JV: The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy. International Journal of Radiation Oncology*Biology*Physics 2000,47(4):1121-1135. 10.1016/S0360-3016(00)00518-6CrossRef

Walter C, Boda-Heggemann J, Wertz H, Loeb I, Rahn A, Lohr F, Wenz F: Phantom and in-vivo measurements of dose exposure by image-guided radiotherapy (IGRT): MV portal images vs. kV portal images vs. cone-beam CT. Radiother Oncol 2007,85(3):418-423. 10.1016/j.radonc.2007.10.014CrossRefPubMed

Rudat V, Flentje M, Oetzel D, Menke M, Schlegel W, Wannenmacher M: Influence of the positioning error on 3D conformal dose distributions during fractionated radiotherapy. Radiother Oncol 1994,33(1):56-63. 10.1016/0167-8140(94)90086-8CrossRefPubMed

10.

Rudat V, Schraube P, Oetzel D, Zierhut D, Flentje M, Wannenmacher M: Combined error of patient positioning variability and prostate motion uncertainty in 3D conformal radiotherapy of localized prostate cancer. Int J Radiat Oncol Biol Phys 1996,35(5):1027-1034. 10.1016/0360-3016(96)00204-0CrossRefPubMed

11.

Budrukkar A, Dutta D, Sharma D, Yadav P, Dantas S, Jalali R: Comparison of geometric uncertainties using electronic portal imaging device in focal three-dimensional conformal radiation therapy using different head supports. J Cancer Res Ther 2008,4(2):70-76. 10.4103/0973-1482.42252CrossRefPubMed

12.

Gupta T, Chopra S, Kadam A, Agarwal JP, Devi PR, Ghosh-Laskar S, Dinshaw KA: Assessment of three-dimensional set-up errors in conventional head and neck radiotherapy using electronic portal imaging device. Radiat Oncol 2007, 2: 44. 10.1186/1748-717X-2-44PubMedCentralCrossRefPubMed

13.

Nelson C, Starkschall G, Balter P, Morice RC, Stevens CW, Chang JY: Assessment of lung tumor motion and setup uncertainties using implanted fiducials. Int J Radiat Oncol Biol Phys 2007,67(3):915-923. 10.1016/j.ijrobp.2006.10.033CrossRefPubMed

14.

Pehlivan B, Pichenot C, Castaing M, Auperin A, Lefkopoulos D, Arriagada R, Bourhis J: Interfractional set-up errors evaluation by daily electronic portal imaging of IMRT in head and neck cancer patients. Acta Oncol 2009,48(3):440-445. 10.1080/02841860802400610CrossRefPubMed

15.

Samson MJ, van Sornsen de Koste JR, de Boer HC, Tankink H, Verstraate M, Essers M, Visser AG, Senan S: An analysis of anatomic landmark mobility and setup deviations in radiotherapy for lung cancer. Int J Radiat Oncol Biol Phys 1999,43(4):827-832. 10.1016/S0360-3016(98)00467-2CrossRefPubMed

16.

Santanam L, Esthappan J, Mutic S, Klein EE, Goddu SM, Chaudhari S, Wahab S, El Naqa IM, Low DA, Grigsby PW: Estimation of setup uncertainty using planar and MVCT imaging for gynecologic malignancies. Int J Radiat Oncol Biol Phys 2008,71(5):1511-1517. 10.1016/j.ijrobp.2008.03.070CrossRefPubMed

17.

Smith S, Yartsev S, Van Dyk J: Evaluation of megavoltage CT imaging protocols in patients with lung cancer. J Med Imaging Radiat Oncol 2010,54(1):62-68. 10.1111/j.1754-9485.2010.02139.xCrossRefPubMed

18.

Venables K, Miles EA, Hoskin PJ, Aird EG: Verification films: a study of the daily and weekly reproducibility of breast patient set-up in the START trial. Clin Oncol (R Coll Radiol) 2005,17(5):337-342.CrossRef

19.

Wu J, Haycocks T, Alasti H, Ottewell G, Middlemiss N, Abdolell M, Warde P, Toi A, Catton C: Positioning errors and prostate motion during conformal prostate radiotherapy using on-line isocentre set-up verification and implanted prostate markers. Radiother Oncol 2001,61(2):127-133. 10.1016/S0167-8140(01)00452-2CrossRefPubMed

20.

Alasti H, Petric MP, Catton CN, Warde PR: Portal imaging for evaluation of daily on-line setup errors and off-line organ motion during conformal irradiation of carcinoma of the prostate. Int J Radiat Oncol Biol Phys 2001,49(3):869-884. 10.1016/S0360-3016(00)01446-2CrossRefPubMed

21.

Greer PB, Dahl K, Ebert MA, Wratten C, White M, Denham JW: Comparison of prostate set-up accuracy and margins with off-line bony anatomy corrections and online implanted fiducial-based corrections. J Med Imaging Radiat Oncol 2008,52(5):511-516. 10.1111/j.1440-1673.2008.02005.xCrossRefPubMed

22.

Johnston ML, Vial P, Wiltshire KL, Bell LJ, Blome S, Kerestes Z, Morgan GW, O'Driscoll D, Shakespeare TP, Eade TN: Daily Online Bony Correction is Required for Prostate Patients Without Fiducial Markers or Soft-tissue Imaging. Clin Oncol (R Coll Radiol) 2011.

23.

Schallenkamp JM, Herman MG, Kruse JJ, Pisansky TM: Prostate position relative to pelvic bony anatomy based on intraprostatic gold markers and electronic portal imaging. Int J Radiat Oncol Biol Phys 2005,63(3):800-811. 10.1016/j.ijrobp.2005.02.022CrossRefPubMed

24.

Ludbrook JJ, Greer PB, Blood P, D'Yachkova Y, Coldman A, Beckham WA, Runkel J, Olivotto IA: Correction of systematic setup errors in prostate radiation therapy: how many images to perform? Med Dosim 2005,30(2):76-84. 10.1016/j.meddos.2005.03.003CrossRefPubMed

25.

Schiffner DC, Gottschalk AR, Lometti M, Aubin M, Pouliot J, Speight J, Hsu IC, Shinohara K, Roach M: Daily electronic portal imaging of implanted gold seed fiducials in patients undergoing radiotherapy after radical prostatectomy. Int J Radiat Oncol Biol Phys 2007,67(2):610-619. 10.1016/j.ijrobp.2006.09.042CrossRefPubMed

26.

Barney BM, Lee RJ, Handrahan D, Welsh KT, Cook JT, Sause WT: Image-Guided Radiotherapy (IGRT) for Prostate Cancer Comparing kV Imaging of Fiducial Markers With Cone Beam Computed Tomography (CBCT). Int J Radiat Oncol Biol Phys 2011,80(1):301-305. 10.1016/j.ijrobp.2010.06.007CrossRefPubMed

27.

Kupelian PA, Lee C, Langen KM, Zeidan OA, Manon RR, Willoughby TR, Meeks SL: Evaluation of image-guidance strategies in the treatment of localized prostate cancer. Int J Radiat Oncol Biol Phys 2008,70(4):1151-1157. 10.1016/j.ijrobp.2007.07.2371CrossRefPubMed

28.

Litzenberg DW, Balter JM, Hadley SW, Sandler HM, Willoughby TR, Kupelian PA, Levine L: Influence of intrafraction motion on margins for prostate radiotherapy. Int J Radiat Oncol Biol Phys 2006,65(2):548-553. 10.1016/j.ijrobp.2005.12.033CrossRefPubMed

29.

van Haaren PM, Bel A, Hofman P, van Vulpen M, Kotte AN, van der Heide UA: Influence of daily setup measurements and corrections on the estimated delivered dose during IMRT treatment of prostate cancer patients. Radiother Oncol 2009,90(3):291-298. 10.1016/j.radonc.2008.12.021CrossRefPubMed

30.

Skarsgard D, Cadman P, El-Gayed A, Pearcey R, Tai P, Pervez N, Wu J: Planning target volume margins for prostate radiotherapy using daily electronic portal imaging and implanted fiducial markers. Radiat Oncol 2010, 5: 52. 10.1186/1748-717X-5-52PubMedCentralCrossRefPubMed

31.

Chen J, Lee RJ, Handrahan D, Sause WT: Intensity-modulated radiotherapy using implanted fiducial markers with daily portal imaging: assessment of prostate organ motion. Int J Radiat Oncol Biol Phys 2007,68(3):912-919. 10.1016/j.ijrobp.2007.02.024CrossRefPubMed

32.

Millender LE, Aubin M, Pouliot J, Shinohara K, Roach M: Daily electronic portal imaging for morbidly obese men undergoing radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2004,59(1):6-10. 10.1016/j.ijrobp.2003.12.027CrossRefPubMed

33.

Hurkmans CW, Remeijer P, Lebesque JV, Mijnheer BJ: Set-up verification using portal imaging; review of current clinical practice. Radiother Oncol 2001,58(2):105-120. 10.1016/S0167-8140(00)00260-7CrossRefPubMed

34.

Stroom JC, Heijmen BJ: Geometrical uncertainties, radiotherapy planning margins, and the ICRU-62 report. Radiother Oncol 2002,64(1):75-83. 10.1016/S0167-8140(02)00140-8CrossRefPubMed

Title: Impact of the frequency of online verifications on the patient set-up accuracy and set-up margins
Authors: Volker Rudat
Mohamed Hammoud
Yogin Pillay
Abdul Aziz Alaradi
Adel Mohamed
Saleh Altuwaijri
Publication date: 01-12-2011
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2011
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-6-101

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Impact of the frequency of online verifications on the patient set-up accuracy and set-up margins

Abstract

Purpose

Methods and materials

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods and materials

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2011

Prognostic significance of IDH-1 and MGMT in patients with glioblastoma: One step forward, and one step back?

Phase i study of 'dose-dense' pemetrexed plus carboplatin/radiotherapy for locally advanced non-small cell lung carcinoma

Fast IMRT by increasing the beam number and reducing the number of segments

Dosimetric accuracy of tomotherapy dose calculation in thorax lesions

Virtual 3D tumor marking-exact intraoperative coordinate mapping improve post-operative radiotherapy

Adjuvant radiation therapy in metastatic lymph nodes from melanoma