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Title: Volumetric Image Guidance Using Carina vs Spine as Registration Landmarks for Conventionally Fractionated Lung Radiotherapy

Abstract

Purpose: To compare the relative accuracy of 2 image guided radiation therapy methods using carina vs spine as landmarks and then to identify which landmark is superior relative to tumor coverage. Methods and Materials: For 98 lung patients, 2596 daily image-guidance cone-beam computed tomography scans were analyzed. Tattoos were used for initial patient alignment; then, spine and carina registrations were performed independently. A separate analysis assessed the adequacy of gross tumor volume, internal target volume, and planning target volume coverage on cone-beam computed tomography using the initial, middle, and final fractions of radiation therapy. Coverage was recorded for primary tumor (T), nodes (N), and combined target (T+N). Three scenarios were compared: tattoos alignment, spine registration, and carina registration. Results: Spine and carina registrations identified setup errors {>=}5 mm in 35% and 46% of fractions, respectively. The mean vector difference between spine and carina matching had a magnitude of 3.3 mm. Spine and carina improved combined target coverage, compared with tattoos, in 50% and 34% (spine) to 54% and 46% (carina) of the first and final fractions, respectively. Carina matching showed greater combined target coverage in 17% and 23% of fractions for the first and final fractions, respectively; with spine matching,more » this was only observed in 4% (first) and 6% (final) of fractions. Carina matching provided superior nodes coverage at the end of radiation compared with spine matching (P=.0006), without compromising primary tumor coverage. Conclusion: Frequent patient setup errors occur in locally advanced lung cancer patients. Spine and carina registrations improved combined target coverage throughout the treatment course, but carina matching provided superior combined target coverage.« less

Authors:
; ;  [1];  [2]; ; ; ;  [1];  [1]
  1. Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, M5G 2M9 (Canada)
  2. Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario, M5G 2M9 (Canada)
Publication Date:
OSTI Identifier:
22149661
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 84; Journal Issue: 5; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The 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; ACCURACY; COMPUTERIZED TOMOGRAPHY; IMAGES; LUNGS; NEOPLASMS; PATIENTS; PLANNING; RADIOTHERAPY; VERTEBRAE

Citation Formats

Lavoie, Caroline, Higgins, Jane, Bissonnette, Jean-Pierre, Le, Lisa W., Sun, Alexander, Brade, Anthony, Hope, Andrew, Cho, John, and Bezjak, Andrea, E-mail: andrea.bezjak@rmp.uhn.on.ca. Volumetric Image Guidance Using Carina vs Spine as Registration Landmarks for Conventionally Fractionated Lung Radiotherapy. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.02.012.
Lavoie, Caroline, Higgins, Jane, Bissonnette, Jean-Pierre, Le, Lisa W., Sun, Alexander, Brade, Anthony, Hope, Andrew, Cho, John, & Bezjak, Andrea, E-mail: andrea.bezjak@rmp.uhn.on.ca. Volumetric Image Guidance Using Carina vs Spine as Registration Landmarks for Conventionally Fractionated Lung Radiotherapy. United States. doi:10.1016/J.IJROBP.2012.02.012.
Lavoie, Caroline, Higgins, Jane, Bissonnette, Jean-Pierre, Le, Lisa W., Sun, Alexander, Brade, Anthony, Hope, Andrew, Cho, John, and Bezjak, Andrea, E-mail: andrea.bezjak@rmp.uhn.on.ca. Sat . "Volumetric Image Guidance Using Carina vs Spine as Registration Landmarks for Conventionally Fractionated Lung Radiotherapy". United States. doi:10.1016/J.IJROBP.2012.02.012.
@article{osti_22149661,
title = {Volumetric Image Guidance Using Carina vs Spine as Registration Landmarks for Conventionally Fractionated Lung Radiotherapy},
author = {Lavoie, Caroline and Higgins, Jane and Bissonnette, Jean-Pierre and Le, Lisa W. and Sun, Alexander and Brade, Anthony and Hope, Andrew and Cho, John and Bezjak, Andrea, E-mail: andrea.bezjak@rmp.uhn.on.ca},
abstractNote = {Purpose: To compare the relative accuracy of 2 image guided radiation therapy methods using carina vs spine as landmarks and then to identify which landmark is superior relative to tumor coverage. Methods and Materials: For 98 lung patients, 2596 daily image-guidance cone-beam computed tomography scans were analyzed. Tattoos were used for initial patient alignment; then, spine and carina registrations were performed independently. A separate analysis assessed the adequacy of gross tumor volume, internal target volume, and planning target volume coverage on cone-beam computed tomography using the initial, middle, and final fractions of radiation therapy. Coverage was recorded for primary tumor (T), nodes (N), and combined target (T+N). Three scenarios were compared: tattoos alignment, spine registration, and carina registration. Results: Spine and carina registrations identified setup errors {>=}5 mm in 35% and 46% of fractions, respectively. The mean vector difference between spine and carina matching had a magnitude of 3.3 mm. Spine and carina improved combined target coverage, compared with tattoos, in 50% and 34% (spine) to 54% and 46% (carina) of the first and final fractions, respectively. Carina matching showed greater combined target coverage in 17% and 23% of fractions for the first and final fractions, respectively; with spine matching, this was only observed in 4% (first) and 6% (final) of fractions. Carina matching provided superior nodes coverage at the end of radiation compared with spine matching (P=.0006), without compromising primary tumor coverage. Conclusion: Frequent patient setup errors occur in locally advanced lung cancer patients. Spine and carina registrations improved combined target coverage throughout the treatment course, but carina matching provided superior combined target coverage.},
doi = {10.1016/J.IJROBP.2012.02.012},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 84,
place = {United States},
year = {Sat Dec 01 00:00:00 EST 2012},
month = {Sat Dec 01 00:00:00 EST 2012}
}