Accuracy and efficiency of an infrared based positioning and tracking system for patient set-up and monitoring in image guided radiotherapy

From mega-voltage portal images acquired on an electronic system (EPID), technological research has developed 3D and recently 4D volumetric verification modalities, allowing a direct visualization of the target, a direct comparison with the planning-TC and an optimization of the treatment (reduction of set-up errors, verification of the need for re-planning), leading to the very modern Image Guided RadioTherapy (IGRT). IGRT allows different technical solutions through direct or indirect visualization of the tumor and the acquisition of pre-treatment verification images, allowing to identify, quantify and correct errors related to set-up and organ-tumor motion, obtaining a greater compliance of the delivered dose, decreasing the risk of "geographic miss" and toxicity to healthy tissues and reducing the margins from CTV to PTV for the implementation of "dose escalation" protocols.

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A multicentre observational study evaluating image-guided radiotherapy for more accurate partial-breast intensity-modulated radiotherapy: comparison with standard imaging technique

Efficacy and Mechanism Evaluation ◽

10.3310/eme01030 ◽

2014 ◽

Vol 1 (3) ◽

pp. 1-74 ◽

Cited By ~ 2

Author(s):

Emma J Harris ◽

Mukesh Mukesh ◽

Rajesh Jena ◽

Angela Baker ◽

Harry Bartelink ◽

...

Keyword(s):

Normal Tissue ◽

Breast Tissue ◽

Imaging Technique ◽

Probability Model ◽

Breast Radiotherapy ◽

Image Guided Radiotherapy ◽

Image Guided ◽

Safety Margins ◽

Integrated Boost ◽

Set Up

BackgroundWhole-breast radiotherapy (WBRT) is the standard treatment for breast cancer following breast-conserving surgery. Evidence shows that tumour recurrences occur near the original cancer: the tumour bed. New treatment developments include increasing dose to the tumour bed during WBRT (synchronous integrated boost) and irradiating only the region around the tumour bed, for patients at high and low risk of tumour recurrence, respectively. Currently, standard imaging uses bony anatomy to ensure accurate delivery of WBRT. It is debatable whether or not more targeted treatments such as synchronous integrated boost and partial-breast radiotherapy require image-guided radiotherapy (IGRT) focusing on implanted tumour bed clips (clip-based IGRT).ObjectivesPrimary – to compare accuracy of patient set-up using standard imaging compared with clip-based IGRT. Secondary – comparison of imaging techniques using (1) tumour bed radiotherapy safety margins, (2) volume of breast tissue irradiated around tumour bed, (3) estimated breast toxicity following development of a normal tissue control probability model and (4) time taken.DesignMulticentre observational study embedded within a national randomised trial: IMPORT-HIGH (Intensity Modulated and Partial Organ Radiotherapy – HIGHer-risk patient group) testing synchronous integrated boost and using clip-based IGRT.SettingFive radiotherapy departments, participating in IMPORT-HIGH.ParticipantsTwo-hundred and eighteen patients receiving breast radiotherapy within IMPORT-HIGH.InterventionsThere was no direct intervention in patients’ treatment. Experimental and control intervention were clip-based IGRT and standard imaging, respectively. IMPORT-HIGH patients received clip-based IGRT as routine; standard imaging data were obtained from clip-based IGRT images.Main outcome measuresDifference in (1) set-up errors, (2) safety margins, (3) volume of breast tissue irradiated, (4) breast toxicity and (5) time, between clip-based IGRT and standard imaging.ResultsThe primary outcome of overall mean difference in clip-based IGRT and standard imaging using daily set-up errors was 2–2.6 mm (p < 0.001). Heterogeneity testing between centres found a statistically significant difference in set-up errors at one centre. For four centres (179 patients), clip-based IGRT gave a mean decrease in the systematic set-up error of between 1 mm and 2 mm compared with standard imaging. Secondary outcomes were as follows: clip-based IGRT and standard imaging safety margins were less than 5 mm and 8 mm, respectively. Using clip-based IGRT, the median volume of tissue receiving 95% of prescribed boost dose decreased by 29 cm3(range 11–193 cm3) compared with standard imaging. Difference in median time required to perform clip-based IGRT compared with standard imaging was X-ray imaging technique dependent (range 8–76 seconds). It was not possible to estimate differences in breast toxicity, the normal tissue control probability model indicated that for breast fibrosis maximum radiotherapy dose is more important than volume of tissue irradiated.Conclusions and implications for clinical practiceMargins of less than 8 mm cannot be used safely without clip-based IGRT for patients receiving concomitant tumour bed boost, as there is a risk of geographical miss of the tumour bed being treated. In principle, smaller but accurately placed margins may influence local control and toxicity rates, but this needs to be evaluated from mature clinical trial data in the future.FundingThe National Institute for Health Research Efficacy and Mechanism Evaluation programme.

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Set-up Errors and Determination of Planning Target Volume Margins Protocol for Different Anatomical Sites in a Newly Established Tertiary Radiotherapy Centre in India

Asian Journal of Oncology ◽

10.1055/s-0040-1710146 ◽

2020 ◽

Vol 6 (02) ◽

pp. 81-87

Author(s):

Avik Mandal ◽

Pritanjali Singh ◽

Soumen Bera ◽

Avajeet Kumar ◽

Dharmendra Singh ◽

...

Keyword(s):

Head And Neck ◽

Planning Target Volume ◽

Random Error ◽

Target Volume ◽

Curative Intent ◽

Image Guided Radiotherapy ◽

Image Guided ◽

Number Of Patients ◽

Set Up ◽

The Brain

Abstract Objective Our study aimed to assess the set-up errors for image-guided radiotherapy at a newly established tertiary radiation center in India and to establish the departmental protocol of clinical target volume–planning target volume (CTV–PTV) margins for different anatomical sites. Materials and Methods This study enrolled the first 200 patients who were treated with curative intent at All India Institute of Medical Sciences, Patna, from February 2019 to September 2019. Number of patients were 53, 26, 53, 11, 6, 47, and 4 for head and neck, brain, breast, thorax, abdomen, pelvis, and craniospinal irradiation (CSI), respectively. The translational vectors for total 1,463 kV cone-beam computed tomography (CBCT) images were collected from the treatment record. Results For the systematic error, the largest value is found for the thoracic subset on the X and Y directions, and for breast patients on Z axis, whereas the smallest values were found for CSI. For random error, the largest value was found for pelvic in the X, Y direction, and for breast subset on Z axis, whereas the smallest values on X and Z axes were found in the brain and for head and neck on the Y axis. Largest value for systemic error is smaller than 5 mm in all directions and for all anatomical subsets. The highest random error value is 5.07 mm in Y axis for pelvic subset. The largest values for CTV–PTV margin are found for thoracic subset and the smallest for CSI followed by the brain. Significant reduction of set-up error observed for the last hundred patients as compared to the first half of the patient population. Conclusion Use of thermoplastic cast along with breast board and respiratory motion management should be recommended to reduce set-up error for breast and thoracic subset. Six degrees of freedom robotic couch system can also further rectify the set-up error in image-guided radiotherapy.

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MULTIPLE 3D MARKER LOCALIZATION AND TRACKING SYSTEM IN IMAGE-GUIDED RADIOTHERAPY

International Journal of Robotics and Automation ◽

10.2316/journal.206.2017.5.206-5027 ◽

2017 ◽

Vol 32 (5) ◽

Cited By ~ 1

Author(s):

Songan Mao ◽

Huanmei Wu ◽

Minghui Lu ◽

Chee-Wai Cheng

Keyword(s):

Tracking System ◽

Image Guided Radiotherapy ◽

Image Guided ◽

Localization And Tracking

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EP-1661: Six degree set up errors of spine tumors assessed by image guided radiotherapy

Radiotherapy and Oncology ◽

10.1016/s0167-8140(15)41653-6 ◽

2015 ◽

Vol 115 ◽

pp. S910

Author(s):

P. Jiang ◽

S. Zhou ◽

J.J. Wang ◽

R.J. Yang ◽

Z.Y. Liu ◽

...

Keyword(s):

Image Guided Radiotherapy ◽

Image Guided ◽

Spine Tumors ◽

Degree Set ◽

Set Up

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Electronic portal imagingvskilovoltage imaging in fiducial marker image-guided radiotherapy for prostate cancer: an analysis of set-up uncertainties

British Journal of Radiology ◽

10.1259/bjr/13553326 ◽

2012 ◽

Vol 85 (1010) ◽

pp. 176-182 ◽

Cited By ~ 7

Author(s):

S Gill ◽

J Thomas ◽

C Fox ◽

T Kron ◽

A Thompson ◽

...

Keyword(s):

Prostate Cancer ◽

Fiducial Marker ◽

Image Guided Radiotherapy ◽

Image Guided ◽

Set Up

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Set-up errors and planning margins in planar and CBCT image-guided radiotherapy using three different imaging systems: A clinical study for prostate and head-and-neck cancer

Physica Medica ◽

10.1016/j.ejmp.2015.09.002 ◽

2015 ◽

Vol 31 (8) ◽

pp. 1055-1059 ◽

Cited By ~ 22

Author(s):

Yvonne Dzierma ◽

Monica Beyhs ◽

Jan Palm ◽

Marcus Niewald ◽

Katharina Bell ◽

...

Keyword(s):

Head And Neck Cancer ◽

Clinical Study ◽

Head And Neck ◽

Neck Cancer ◽

Imaging Systems ◽

Image Guided Radiotherapy ◽

Image Guided ◽

Cbct Image ◽

Set Up

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Image-guided radiation therapy for carcinoma of gallbladder: implication on margin for set-up errors

Journal of Radiotherapy in Practice ◽

10.1017/s1460396912000313 ◽

2013 ◽

Vol 12 (3) ◽

pp. 263-271 ◽

Cited By ~ 1

Author(s):

Gagan Saini ◽

Vineeta Goel ◽

Anil K Anand ◽

Kamlesh Kumar Gupta

Keyword(s):

Radiation Therapy ◽

Gall Bladder ◽

Target Volume ◽

Image Guided Radiotherapy ◽

Image Guided Radiation Therapy ◽

Image Guided ◽

Thermoplastic Mask ◽

The Mean ◽

Set Up ◽

Upper Abdominal

AbstractPurposeA retrospective study was undertaken to analyse set-up variations in patients being treated with post-operative radiation therapy for carcinoma of gall bladder by image-guided radiotherapy (IGRT) using cone-beam computed tomography (CBCT) scans and paired kilovoltage beam portals (kVps).Materials and methodsThree consecutive patients receiving post-operative radiation therapy for carcinoma of gall bladder were studied. A total of 32 imaging studies were performed. The immobilisation system was an all-in-one system along with a thermoplastic mask, with knees either resting on the knee rest or in a vacuum cushion. The CBCT scans and kVps were reviewed in an off-line mode. The surrogate markers used for matching during co-registration were 12th rib, coeliac trunk, vertebral bodies and canal. Individual readings were used to calculate mean shifts (m); the mean of these means (M) was calculated to arrive at the systematic error in each direction and its standard deviation (Σ) was calculated. The margins for set-up error (SM) were then calculated.ResultsThere were a total of 32 readings of which 21 were CBCTs and 11 were kVps. The mean shifts in each direction for each patient were 0·06, 0·25 and 0·15 cm in vertical, longitudinal and lateral directions, respectively. The resultant planning target volume margins calculated were 0·24, 0·9 and 0·47 cm in vertical, longitudinal and lateral directions.ConclusionsIGRT for upper abdominal malignancies using CBCT and kVps is a useful method to keep the margins for set-up error low. The use of surrogates for matching should be relevant to the target volume. Good immobilisation system helps in keeping the margins low.

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