Pitch, roll, and yaw variations in patient positioning.
ABSTRACT To use pretreatment megavoltage-computed tomography (MVCT) scans to evaluate positioning variations in pitch, roll, and yaw for patients treated with helical tomotherapy.
Twenty prostate and 15 head-and-neck cancer patients were selected. Pretreatment MVCT scans were performed before every treatment fraction and automatically registered to planning kilovoltage CT (KVCT) scans by bony landmarks. Image registration data were used to adjust patient setups before treatment. Corrections for pitch, roll, and yaw were recorded after bone registration, and data from fractions 1-5 and 16-20 were used to analyze mean rotational corrections.
For prostate patients, the means and standard deviations (in degrees) for pitch, roll, and yaw corrections were -0.60 +/- 1.42, 0.66 +/- 1.22, and -0.33 +/- 0.83. In head-and-neck patients, the means and standard deviations (in degrees) were -0.24 +/- 1.19, -0.12 +/- 1.53, and 0.25 +/- 1.42 for pitch, roll, and yaw, respectively. No significant difference in rotational variations was observed between Weeks 1 and 4 of treatment. Head-and-neck patients had significantly smaller pitch variation, but significantly larger yaw variation, than prostate patients. No difference was found in roll corrections between the two groups. Overall, 96.6% of the rotational corrections were less than 4 degrees.
The initial rotational setup errors for prostate and head-and-neck patients were all small in magnitude, statistically significant, but did not vary considerably during the course of radiotherapy. The data are relevant to couch hardware design for correcting rotational setup variations. There should be no theoretical difference between these data and data collected using cone beam KVCT on conventional linacs.
- SourceAvailable from: Peter N Munro[Show abstract] [Hide abstract]
ABSTRACT: Purpose: The aim of this work is to evaluate the geometric accuracy of a prerelease version of a new six degrees of freedom (6DoF) couch. Additionally, a quality assurance method for 6DoF couches is proposed.Methods: The main principle of the performance tests was to request a known shift for the 6DoF couch and to compare this requested shift with the actually applied shift by independently measuring the applied shift using different methods (graph paper, laser, inclinometer, and imaging system). The performance of each of the six axes was tested separately as well as in combination with the other axes. Functional cases as well as realistic clinical cases were analyzed. The tests were performed without a couch load and with a couch load of up to 200 kg and shifts in the range between -4 and +4 cm for the translational axes and between -3° and +3° for the rotational axes were applied. The quality assurance method of the new 6DoF couch was performed using a simple cube phantom and the imaging system.Results: The deviations (mean ± one standard deviation) accumulated over all performance tests between the requested shifts and the measurements of the applied shifts were -0.01 ± 0.02, 0.01 ± 0.02, and 0.01 ± 0.02 cm for the longitudinal, lateral, and vertical axes, respectively. The corresponding values for the three rotational axes couch rotation, pitch, and roll were 0.03° ± 0.06°, -0.04° ± 0.12°, and -0.01° ± 0.08°, respectively. There was no difference found between the tests with and without a couch load of up to 200 kg.Conclusions: The new 6DoF couch is able to apply requested shifts with high accuracy. It has the potential to be used for treatment techniques with the highest demands in patient setup accuracy such as those needed in stereotactic treatments. Shifts can be applied efficiently and automatically. Daily quality assurance of the 6DoF couch can be performed in an easy and efficient way. Long-term stability has to be evaluated in further tests.Medical Physics 11/2013; 40(11):111710. · 2.91 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: PURPOSE: Due to the often quite extended treatment fields in cervical cancer radiotherapy, uncorrected rotational set-up errors result in a potential risk of target miss. This study reports on the residual rotational set-up error after using daily cone beam computed tomography (CBCT) to position cervical cancer patients for radiotherapy treatment. METHODS AND MATERIALS: Twenty-five patients with locally advanced cervical cancer had daily CBCT scans (650 CBCTs in total) prior to treatment delivery. We retrospectively analyzed the translational shifts made in the clinic prior to each treatment fraction as well as the residual rotational errors remaining after translational correction. RESULTS: The CBCT-guided couch movement resulted in a mean translational 3D vector correction of 7.4mm. Residual rotational error resulted in a target shift exceeding 5mm in 57 of the 650 treatment fractions. Three patients alone accounted for 30 of these fractions. Nine patients had no shifts exceeding 5mm and 13 patients had 5 or less treatment fractions with such shifts. CONCLUSION: Twenty-two of the 25 patients have none or few treatment fractions with target shifts larger than 5mm due to residual rotational error. However, three patients display a significant number of shifts suggesting a more systematic set-up error.Radiotherapy and Oncology 09/2012; · 4.52 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The purpose of this work is to investigate the dosimetric influence of the residual rotational setup errors on head and neck carcinoma (HNC) intensity-modulated radiation therapy (IMRT) with routine 3 translational setup corrections and the adequacy of this routine correction. A total of 66 kV cone beam computed tomography (CBCT) image sets were acquired on the first day of treatment and weekly thereafter for 10 patients with HNC and were registered with the corresponding planning CT images, using 2 3-dimensional (3D) rigid registration methods. Method 1 determines the translational setup errors only, and method 2 determines 6-degree (6D) setup errors, i.e., both rotational and translational setup errors. The 6D setup errors determined by method 2 were simulated in the treatment planning system and were then corrected using the corresponding translational data determined by method 1. For each patient, dose distributions for 6 to 7 fractions with various setup uncertainties were generated, and a plan sum was created to determine the total dose distribution through an entire course and was compared with the original treatment plan. The average rotational setup errors were 0.7°± 1.0°, 0.1°±1.9°, and 0.3°±0.7° around left-right (LR), anterior-posterior (AP), and superior-inferior (SI) axes, respectively. With translational corrections determined by method 1 alone, the dose deviation could be large from fraction to fraction. For a certain fraction, the decrease in prescription dose coverage (V(p)) and the dose that covers 95% of target volume (D(95)) could be up to 15.8% and 13.2% for planning target volume (PTV), and the decrease in V(p) and the dose that covers 98% of target volume (D(98)) could be up to 9.8% and 5.5% for the clinical target volume (CTV). However, for the entire treatment course, for PTV, the plan sum showed that the average V(p) was decreased by 4.2% and D(95) was decreased by 1.2Gy for the first phase of IMRT with a prescription dose of 50Gy. For CTV, the plan sum showed that the average V(p) was decreased by 0.8% and D(98), relative to prescription dose, was not decreased. Among these 10 patients, the plan sum showed that the dose to 1-cm(3) spinal cord ( [Formula: see text] ) increased no more than 1Gy for 7 patients and more than 2Gy for 2 patients. The average increase in [Formula: see text] was 1.2Gy. The study shows that, with translational setup error correction, the overall CTV V(p) has a minor decrease with a 5-mm margin from CTV to PTV. For the spinal cord, a noticeable dose increase was observed for some patients. So to decide whether the routine clinical translational setup error correction is adequate for this HNC IMRT technique, the dosimetric influence of rotational setup errors should be evaluated carefully from case to case when organs at risk are in close proximity to the target.Medical dosimetry: official journal of the American Association of Medical Dosimetrists 12/2012; · 1.26 Impact Factor