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Title: Interfractional Variations in Patient Setup and Anatomic Change Assessed by Daily Computed Tomography

Abstract

Purpose: To analyze the interfractional variations in patient setup and anatomic changes at seven anatomic sites observed in image-guided radiotherapy. Methods and Materials: A total of 152 patients treated at seven anatomic sites using a Hi-Art helical tomotherapy system were analyzed. Daily tomotherapy megavoltage computed tomography images acquired before each treatment were fused to the planning kilovoltage computed tomography images to determine the daily setup errors and organ motions and deformations. The setup errors were corrected before treatment and were used, along with the organ motions, to determine the clinical target volume/planning target volume margins. The organ motions and deformations for 3 representative patient cases (pancreas, uterus, and soft-tissue sarcoma) and for 14 kidneys of 7 patients are presented. Results: Interfractional setup errors in the skull, brain, and head and neck are significantly smaller than those in the chest, abdomen, pelvis, and extremities. These site-specific relationships are statistically significant. The margins required to account for these setup errors range from 3 to 8 mm for the seven sites. The margin to account for both setup errors and organ motions for kidney is 16 mm. Substantial interfractional anatomic changes were observed. For example, the pancreas moved up to {+-}20 mm andmore » volumes of the uterus and sarcoma varied {<=}30% and 100%, respectively. Conclusion: The interfractional variations in patient setup and in shapes, sizes, and positions of both targets and normal structures are site specific and may be used to determine the site-specific margins. The data presented in this work dealing with seven anatomic sites may be useful in developing adaptive radiotherapy.« less

Authors:
 [1];  [2];  [2];  [2];  [2];  [2];  [2];  [2];  [2];  [2]
  1. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States). E-mail: ali@radonc.mcw.edu
  2. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)
Publication Date:
OSTI Identifier:
20951681
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 68; Journal Issue: 2; Other Information: DOI: 10.1016/j.ijrobp.2006.12.024; PII: S0360-3016(06)03653-4; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ABDOMEN; BRAIN; CHEST; COMPUTERIZED TOMOGRAPHY; ERRORS; HEAD; IMAGES; KIDNEYS; NECK; PANCREAS; PATIENTS; PELVIS; RADIOTHERAPY; SARCOMAS; SKULL; UTERUS

Citation Formats

Li, X. Allen, Qi, X. Sharon, Pitterle, Marissa, Kalakota, Kapila, Mueller, Kevin, Erickson, Beth A., Wang Dian, Schultz, Christopher J., Firat, Selim Y., and Wilson, J. Frank. Interfractional Variations in Patient Setup and Anatomic Change Assessed by Daily Computed Tomography. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.12.024.
Li, X. Allen, Qi, X. Sharon, Pitterle, Marissa, Kalakota, Kapila, Mueller, Kevin, Erickson, Beth A., Wang Dian, Schultz, Christopher J., Firat, Selim Y., & Wilson, J. Frank. Interfractional Variations in Patient Setup and Anatomic Change Assessed by Daily Computed Tomography. United States. doi:10.1016/j.ijrobp.2006.12.024.
Li, X. Allen, Qi, X. Sharon, Pitterle, Marissa, Kalakota, Kapila, Mueller, Kevin, Erickson, Beth A., Wang Dian, Schultz, Christopher J., Firat, Selim Y., and Wilson, J. Frank. Fri . "Interfractional Variations in Patient Setup and Anatomic Change Assessed by Daily Computed Tomography". United States. doi:10.1016/j.ijrobp.2006.12.024.
@article{osti_20951681,
title = {Interfractional Variations in Patient Setup and Anatomic Change Assessed by Daily Computed Tomography},
author = {Li, X. Allen and Qi, X. Sharon and Pitterle, Marissa and Kalakota, Kapila and Mueller, Kevin and Erickson, Beth A. and Wang Dian and Schultz, Christopher J. and Firat, Selim Y. and Wilson, J. Frank},
abstractNote = {Purpose: To analyze the interfractional variations in patient setup and anatomic changes at seven anatomic sites observed in image-guided radiotherapy. Methods and Materials: A total of 152 patients treated at seven anatomic sites using a Hi-Art helical tomotherapy system were analyzed. Daily tomotherapy megavoltage computed tomography images acquired before each treatment were fused to the planning kilovoltage computed tomography images to determine the daily setup errors and organ motions and deformations. The setup errors were corrected before treatment and were used, along with the organ motions, to determine the clinical target volume/planning target volume margins. The organ motions and deformations for 3 representative patient cases (pancreas, uterus, and soft-tissue sarcoma) and for 14 kidneys of 7 patients are presented. Results: Interfractional setup errors in the skull, brain, and head and neck are significantly smaller than those in the chest, abdomen, pelvis, and extremities. These site-specific relationships are statistically significant. The margins required to account for these setup errors range from 3 to 8 mm for the seven sites. The margin to account for both setup errors and organ motions for kidney is 16 mm. Substantial interfractional anatomic changes were observed. For example, the pancreas moved up to {+-}20 mm and volumes of the uterus and sarcoma varied {<=}30% and 100%, respectively. Conclusion: The interfractional variations in patient setup and in shapes, sizes, and positions of both targets and normal structures are site specific and may be used to determine the site-specific margins. The data presented in this work dealing with seven anatomic sites may be useful in developing adaptive radiotherapy.},
doi = {10.1016/j.ijrobp.2006.12.024},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 2,
volume = 68,
place = {United States},
year = {Fri Jun 01 00:00:00 EDT 2007},
month = {Fri Jun 01 00:00:00 EDT 2007}
}