Evaluation of Patient Set Up Errors in Head and Neck Three-Dimensional (3D) Conformal and Intensity-Modulated Radiotherapy Using Electronic Portal Imaging Device

Document Type : Original Paper

Authors

1 1. Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran 2. Medical Radiation Science Research Team, Tabriz University of Medical Sciences 3. Department of Medical Physics, Faculty of Medicine, Tabriz 4.

2 Medical Physics Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

3 Mashhad University Of Medical sciences

4 Department of medical physics, Faulty of medicine, Mashhad University of Medical Sciences, Mashhad, Iran

5 Medical physics Department, Reza Radiation Oncology Center, Mashhad, Iran

6 Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

7 Statistics research center, Mashhad university of Mathematical of sciences, Mashhad, Iran

Abstract

Introduction: Interfractional set-up variations may cause deviation of the delivered dose from the planned dose distribution. This study aimed at calculating random and systematic set-up errors using an electronic portal imaging device (EPID) to set the optimum planning target volume (PTV) margins in patients with head and neck cancer who were under treatment with three-dimensional conformal (3DCRT) and intensity-modulated radiotherapy (IMRT).
Material and Methods: In this study, 50 patients underwent 3DCRT along with weekly electronic portal image (EPI), and daily IMRT imaging was performed on 50 others. The EPIs were compared with Digitally Reconstructed Radiographs (DRRs) to quantify the systematic, random, and 3D vector length of set-up errors in three translational directions (X, Y, Z). The PTV margins were measured utilizing International Commission on Radiation Units and Measurements report 62, Stroom’s and van Herk’s models.
Results: For 3DCRT and IMRT techniques, the overall mean 3D vector length of displacement was obtained at 3.9 and 2.7 mm, respectively. The maximum systematic and random errors were 1.3 and 1.9 mm for the IMRT technique and 2 and 2.9 mm for 3DCRT, respectively. PTV margins in the three acquisition directions were 2-7.2 mm.
Conclusion: It was found that a 7 mm extension of the clinical target volume (CTV) to PTV margin ensures that 90% of head and neck cancer patients have received 95% of the planned dose.

Keywords

Main Subjects

References

  1. Unkelbach J, Alber M, Bangert M, Bokrantz R, Chan TC, Deasy JO, et al. Robust radiotherapy planning. Physics in Medicine & Biology. 2018;63(22):22TR02.
  2. Strbac B, Jokic VS. Evaluation of set-up errors in head and neck radiotherapy using electronic portal imaging. Physica Medica. 2013;29(5):531-6.
  3. Sá AC, Fermento A, Neves D, Ferreira S, Silva T, Coelho CM, et al. Radiotherapy setup displacements in breast cancer patients: 3D surface imaging experience. Reports of Practical Oncology & Radiotherapy. 2018;23(1):61-7.
  4. Skarsgard D, Cadman P, El-Gayed A, Pearcey R, Tai P, Pervez N, et al. Planning target volume margins for prostate radiotherapy using daily electronic portal imaging and implanted fiducial markers. Radiation oncology. 2010;5(1):1-11.
  5. Noghreiyan VV, Nasseri S, Anvari K, Naji M, Momennezhad M. Evaluation of set-up errors and determination of set-up margin in pelvic radiotherapy by electronic portal imaging device (EPID). Journal of Radiotherapy in Practice. 2020;19(2):150-6.
  6. Androjna S, Marcius VZ, Peterlin P, Strojan P. Assessment of set-up errors in the radiotherapy of patients with head and neck cancer: standard vs. individual head support. Radiology and oncology. 2020;1(ahead-of-print).
  7. Hoskin P, Gaze M, Greener T. On target: ensuring geometric accuracy in radiotherapy. The Royal College of Radiologist, London. 2008:1-78.
  8. Jones D. ICRU report 50—prescribing, recording and reporting photon beam therapy. Wiley Online Library; 1994.
  9. Wambersie A. ICRU report 62, prescribing, recording and reporting photon beam therapy (supplement to ICRU Report 50). ICRU News. 1999.
  10. Hodapp N. The ICRU Report 83: prescribing, recording and reporting photon-beam intensity-modulated radiation therapy (IMRT). Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft[et al]. 2012;188(1):97-9.
  11. 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):1121-35.
  12. Stroom JC, Heijmen BJ. Geometrical uncertainties, radiotherapy planning margins, and the ICRU-62 report. Radiotherapy and oncology. 2002;64(1):75-83.
  13. Szczurek Ł, Skrobała A, Piotrowski T, Jodda A. Evaluation of set-up verification with the analysis of systematic and random errors in radiotherapy-a study of the Great Poland Cancer Centre. Nukleonika. 2008;53:167-71.
  14. Dionisi F, Palazzi MF, Bracco F, Brambilla MG, Carbonini C, Asnaghi DD, et al. Set-up errors and planning target volume margins in head and neck cancer radiotherapy: a clinical study of image guidance with on-line cone-beam computed tomography. International journal of clinical oncology. 2013;18(3):418-27.
  15. Gupta T, Chopra S, Kadam A, Agarwal JP, Devi PR, Ghosh-Laskar S, et al. Assessment of three-dimensional set-up errors in conventional head and neck radiotherapy using electronic portal imaging device. Radiation Oncology. 2007;2(1):1-8.
  16. Zhang L, Garden AS, Lo J, Ang KK, Ahamad A, Morrison WH, et al. Multiple regions-of-interest analysis of setup uncertainties for head-and-neck cancer radiotherapy. International Journal of Radiation Oncology* Biology* Physics. 2006;64(5):1559-69.
  17. Gilbeau L, Octave-Prignot M, Loncol T, Renard L, Scalliet P, Grégoire V. Comparison of setup accuracy of three different thermoplastic masks for the treatment of brain and head and neck tumors. Radiotherapy and Oncology. 2001;58(2):155-62.
  18. Suzuki M, Nishimura Y, Nakamatsu K, Okumura M, Hashiba H, Koike R, et al. Analysis of interfractional set-up errors and intrafractional organ motions during IMRT for head and neck tumors to define an appropriate planning target volume (PTV)-and planning organs at risk volume (PRV)-margins. Radiotherapy and oncology. 2006;78(3):283-90.
  19. Pehlivan B, Pichenot C, Castaing M, Auperin A, Lefkopoulos D, Arriagada R, et al. Interfractional set-up errors evaluation by daily electronic portal imaging of IMRT in head and neck cancer patients. Acta Oncologica. 2009;48(3):440-5.
  20. Pramanik S, Ray DK, Bera S, Choudhury A, Iqbal A, Mondal S, et al. Analysis of setup uncertainties and determine the variation of the clinical target volume (CTV) to planning target volume (PTV) margin for various tumor sites treated with three-dimensional IGRT couch using KV-CBCT. Journal of Radiation Oncology. 2020;9:25-35.
  21. Xing L, Lin Z-X, Donaldson SS, Le QT, Tate D, Goffinet DR, et al. Dosimetric effects of patient displacement and collimator and gantry angle misalignment on intensity modulated radiation therapy. Radiotherapy and Oncology. 2000;56(1):97-108.

 

 

 

 

 

Iranian Journal of Medical Physics
Volume 19, Issue 5
September and October 2022
Pages 270-274

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History

  • Receive Date: 16 June 2021
  • Revise Date: 26 September 2021
  • Accept Date: 25 January 2022

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