IJMPCERO  Vol.5 No.2 , May 2016
An Evaluation of Inter-Fractional Set-Up Errors in Patients Treated with Distinct Immobilization Equipment for Varying Anatomical Regions
Abstract: This study aims to evaluate inter-fractional set-up errors in patients treated with distinct immobilization equipment (thermoplastic mask, knee-fix and feet-fix, wing board and vac-lok) for four anatomical regions including brain, head and neck (HN), thorax and pelvis. Data of randomly selected 140 patients who were treated for four anatomical regions were obtained using Hi-Art Helical Tomotherapy (HT) system. Pre-treatment planning was based on automatic registration readings of computed tomography (CT) and mega-voltage computed tomography (MVCT) on a daily basis. Distinct immobilization equipment was used for varying anatomical regions. Individual mean set-up error (M), systematic error (Σ), and random error (σ) values were calculated through daily translational and rotational deviation values. The size of translational, systematic and random error was 1.31 - 4.93 mm for brain, 2.28 - 4.88 mm for HN, 4.04 - 9.90 mm for thorax, and 6.34 - 14.68 mm for pelvis. Rotational values were as follows: 0.06° - 0.73° for brain, 0.42° - 0.6° for HN, 0.48° - 1.14° for thorax and 0.65° - 1.05° for pelvis. The highest translational, systematic and random error value was obtained from the pelvic regional. The highest standard and random error value in pitch and roll was produced in the rotational direction of the pelvis (0.05° and 0.71°), while the highest error value in yaw was (1.14°) produced from thorax. Inter-fractional set-up errors were most commonly produced in the pelvis, followed by thorax. Our study results suggest that the highest systematic and random errors are found for thorax and pelvis. Distinct immobilization equipment was important in these results. Safety margins around the clinical target volume (CTV) are changeable for different anatomical regions. A future work could be developed to new equipment for immobilization because of the reduced margins CTV.
Cite this paper: Karaca, S. , Başaran, H. , Koca, T. and Özbayrak, F. (2016) An Evaluation of Inter-Fractional Set-Up Errors in Patients Treated with Distinct Immobilization Equipment for Varying Anatomical Regions. International Journal of Medical Physics, Clinical Engineering and Radiation Oncology, 5, 121-129. doi: 10.4236/ijmpcero.2016.52013.

[1]   He, W., Vazquez, L.A., Dzintars, E., Papanikolaou, N. and Shi, C. (2010) Assessing the Dosimetric Consequence of Inter-Fractional Setup Shifts on Helical Tomotherapy Plans with Independent Dose Calculation. Journal of Cancer Science and Therapy, 2, 136-144.

[2]   Chmielewski, L., Kukolowicz, P.F., Gut, P. and Debrowski, A. (2002) Assessment of the Quality of Radiotherapy with the Use of Portal and Simulation Images the Method and the Software. Journal of Medical Informatics and Technologies, 3, 171-179.

[3]   Thasanthan, L., Piyasena, W.R.O., Croos, A.M.C., Dhanushia, R. and Narayanan, P.P. (2014) Assessment of Three-Dimensional Set-Up Errors in Pelvic Radiation Therapy. Journal of Cancer Prevention & Current Research, 1, Article ID: 00009.

[4]   Gonzalez, J., Lopez, J., Azinovic, I., et al. (2013) Systematic and Random Patient Set-Up Errors in a Single-Radiation Center. Reports of Practical Oncology and Radiotherapy, 18, 303-398.

[5]   Mcgea, K.P., Dougles, M.S., Fein, A., et al. (1997) The Value of Set-Up Portal Films as an Estimate of a Patient’s Position Throughout Fractionated Tangential Breast Irradiation: An On-line Study. Radiotherapy Oncology, 37, 223-228.

[6]   Kukolowicz, P.F., Debrowski, A., Chmielewski, L., et al. (2005) Evaluation of Set-Up Deviations during the Irradiation of Patients Suffering from Breast Cancer Treated with Two Different Techniques. Radiotherapy Oncology, 75, 22-27.

[7]   Sheng, K., Chow, J., Hunter, G., et al. (2008) Is Daily Computed Tomography Image Guidance Necessary for Nasal Cavity and Nasopharyngeal Radiotherapy? An Investigation Based on Helical Tomotherapy. The Journal of Applied Clinical Medical Physics, 9, 2686.

[8]   Pehlivan, B., Pichenot, C. and Castaing, M. (2009) Inter-Fractional Set-Up Errors Evaluation by Daily Electronic Portal Imaging of IMRT in Head and Neck Cancer Patients. Acta Oncologica, 48, 440-445.

[9]   Suh, S. and Schultheiss, T.E. (2013) Distance-to-Agreement Investigation of Tomotherapy’s Bony Anatomy-Based Autoregistration and Planning Target Volume Contour-Based Optimization. International Journal of Radiation Oncology Biology Physics, 85, 862-865.

[10]   Fang, J.L., Guo, R., Yu, X., et al. (2013) Evaluation of Inter-Fraction and Intra-Fraction Errors during Volumetric Modulated Arc Therapy in Nasopharyngeal Carcinoma. Radiotherapy Oncology, 8, 78.

[11]   Kaiser, A. and Schultheiss, T.E. (2005) Pitch. Roll and Yaw Variations in Patient Positioning. International Journal of Radiation Oncology Biology Physics, 66, 949-955.

[12]   Schubert, L.K., Westerly, D.C., Wolfgang, A.T., et al. (2009) A Comprehensive Assessment by Tumor Site of Patient Setup Using Daily MVCT Imaging from Over Three Thousand Eight Hundred Helical Tomotherapy Treatments. International Journal of Radiation Oncology Biology Physics, 73, 1260-1269.

[13]   Westerly, D.C., Soisson, E., Chen, Q., et al. (2009) Treatment Planning to Improve Delivery Accuracy and Patient Throughput in Helical Tomotherapy. International Journal of Radiation Oncology Biology Physics, 74, 1290-1297.

[14]   Welsh, J.S., Bradley, K., Ruchala, K.J., et al. (2004) Megavoltage Computed Tomography Imaging: A Potential Tool to Guide and Improve the Delivery of Thoracic Radiation Therapy. Clinical Lung Cancer, 5, 303-306.

[15]   Kubicek,. L.N., Seo, S., Chappell, R.J., et al. (2012) Helical Tomotherapy Setup Variations in Canine Nasal Tumor Patients Immobilized with A Bite Block. Veterinary Radiology Ultrasound, 53, 474-481.

[16]   Jining, Z. (2009) Organ Motion and Image Guidance in Radiation. VCU Theses and Dissertations, Paper 1681.

[17]   Murthy, V., Master, Z., Gupta, T., et al. (2010) Helical Tomotherapy for Head and Neck Squamous Cell Carcinoma: Dosimetric Comparison with Linear Accelerator-Based Step-and-Shoot IMRT. Journal of Cancer Research and Therapeutics, 6, 194-198.

[18]   Lian, J., Mackenzie, M. and Joseph, K. (2008) Assessment of Extended-Field Radiotherapy for Stage IIIC Endometrial Cancer Using Three-Dimensional Conformal Radiotherapy. Intensity-Modulated Radiotherapy and Helical Tomotherapy. International Journal of Radiation Oncology Biology Physics, 70, 935-943.

[19]   Mackie, T.R., Kapatoes, J., Ruchala, K., et al. (2003) Image Guidance for Precise Conformal Radiotherapy. International Journal of Radiation Oncology Biology Physics, 56, 89-105.

[20]   Ramsey, C.R., Langen, K.M., Kupeian, P.A., et al. (2006) A Technique for Adaptive Image-Guided Helical Tomotherapy for Lung Cancer. International Journal of Radiation Oncology Biology Physics, 64, 1237-1244.

[21]   You, S.H., Seong, J., Lee, I.J., et al. (2008) Treatment Margin Assessment Using Mega-Voltage Computed Tomography of a Tomotherapy Unit in the Radiotherapy of a Liver Tumor. The Journal of the Korean Society for Therapeutic Radiology and Oncology, 26, 280-288.

[22]   Mackie, T.R., Kapatoes, J., Ruchala, K., et al. (2003) Image Guidance for Precise Conformal Radiotherapy. International Journal of Radiation Oncology Biology Physics, 56, 89-105.

[23]   Arumugam., S., Xing, A., Vial1, P., et al. (2013) Impact of Patient Rotational Errors on Target and Critical Structure Dose in IMRT: A 3D Simulation Study. The 7th International Conference on 3D Radiation Dosimetry (IC3DDose), 444, Article ID: 012045.

[24]   Boswell, S.,Tome, W., Jeraj, R., et al. (2006) Automatic Registration of Megavoltage to Kilovoltage CT Images in Helical Tomotherapy: An Evaluation of the Setup Verification Process for the Special Case of a Rigid Head Phantom. Medical Physics, 33, 4395-4404.

[25]   Bijhold, J., Lebesque, J.V. and Hart, A.A. (1992) Maximizing Setup Accuracy Using Portal Images as Applied to a Conformal Boost Technique for Prostatic Cancer. Radiotherapy Oncology, 24, 261-271.

[26]   Van Herk, M. (2004) Errors and Margins in Radiotherapy. Seminars in Radiation Oncology, 14, 52-64.

[27]   The Royal College of Radiologist (2008) On Target: Ensuring Geometric Accuracy in Radiotherapy. The Royal College of Radiologist, London.

[28]   Li, A. and Qi, S. (2007) Inter-Fractional Variations in Patient Setup and Anatomic Change Assessed by Daily Computed Tomography. International Journal of Radiation Oncology Biology Physics, 68, 581-591.

[29]   Booth, J.T. and Zavgorodni, S.F. (1999) Set-Up Error and Organ Motion Uncertainty: A Review. Australasian Physical & Engineering Sciences in Medicine, 22, 29-47.

[30]   Tuntipumiamorn, L., Liammookda, P. and Dechawongsuwan, S. (2013) Assessment of Inter-Fraction Setup Error of Non-Extended Standard Thermoplastic Mask for Head and Neck Intensity-Modulated Radiation Therapy Patients. Siriraj Medical Journal, 65, 31-35.