Choi M, Fuller CD, Wang SJ, et al. Effect of body mass index on shifts in ultrasound-based image-guided intensity-modulated radiation therapy for abdominal malignancies. Radiother Oncol. 91: 114-119

Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Radiotherapy and Oncology (Impact Factor: 4.36). 10/2008; 91(1):114-9. DOI: 10.1016/j.radonc.2008.08.002
Source: PubMed


We investigated whether corrective shifts determined by daily ultrasound-based image-guidance correlate with body mass index (BMI) of patients treated with image-guided intensity-modulated radiation therapy (IG-IMRT) for abdominal malignancies. The utility of daily image-guidance, particularly for patients with BMI>25.0, is examined.
Total 3162 ultrasound-directed shifts were performed in 86 patients. Direction and magnitude of shifts were correlated with pretreatment BMI. Bivariate statistical analysis and analysis of set-up correction data were performed using systematic and random error calculations.
Total 2040 daily alignments were performed. Average 3D vector of set-up correction for all patients was 12.1mm/fraction. Directional and absolute shifts and 3D vector length were significantly different between BMI cohorts. 3D displacement averaged 4.9 mm/fraction and 6.8mm/fraction for BMI < or = 25.0 and BMI>25.0, respectively. Systematic error in all axes and 3D vector was significantly greater for BMI>25.0. Differences in random error were not statistically significant.
Set-up corrections derived from daily ultrasound-based IG-IMRT of abdominal tumors correlated with BMI. Daily image-guidance may improve precision of IMRT delivery with benefits assessed for the entire population, particularly patients with increased habitus. Requisite PTV margins suggested in the absence of daily image-guidance are significantly greater in patients with BMI>25.0.

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    • "IMRT has numerous advantages over older technologies because it allows for homogeneous dose distribution in the planning target volume (PTV) while reducing doses to organs at risk (OARs) [1e4]. However, like all highly-conformal techniques, IMRT must confront numerous uncertainties (set-up variations, organ motion, and other potential errors) that could lead to geographical miss [5] [6]. "
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