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Title: Image Guidance During Head-and-Neck Cancer Radiation Therapy: Analysis of Alignment Trends With In-Room Cone-Beam Computed Tomography Scans

Abstract

Purpose: On-board cone-beam computed tomography (CBCT) is currently available for alignment of patients with head-and-neck cancer before radiotherapy. However, daily CBCT is time intensive and increases the overall radiation dose. We assessed the feasibility of using the average couch shifts from the first several CBCTs to estimate and correct for the presumed systematic setup error. Methods and Materials: 56 patients with head-and-neck cancer who received daily CBCT before intensity-modulated radiation therapy had recorded shift values in the medial-lateral, superior-inferior, and anterior-posterior dimensions. The average displacements in each direction were calculated for each patient based on the first five or 10 CBCT shifts and were presumed to represent the systematic setup error. The residual error after this correction was determined by subtracting the calculated shifts from the shifts obtained using daily CBCT. Results: The magnitude of the average daily residual three-dimensional (3D) error was 4.8 {+-} 1.4 mm, 3.9 {+-} 1.3 mm, and 3.7 {+-} 1.1 mm for uncorrected, five CBCT corrected, and 10 CBCT corrected protocols, respectively. With no image guidance, 40.8% of fractions would have been >5 mm off target. Using the first five CBCT shifts to correct subsequent fractions, this percentage decreased to 19.0% of all fractions deliveredmore » and decreased the percentage of patients with average daily 3D errors >5 mm from 35.7% to 14.3% vs. no image guidance. Using an average of the first 10 CBCT shifts did not significantly improve this outcome. Conclusions: Using the first five CBCT shift measurements as an estimation of the systematic setup error improves daily setup accuracy for a subset of patients with head-and-neck cancer receiving intensity-modulated radiation therapy and primarily benefited those with large 3D correction vectors (>5 mm). Daily CBCT is still necessary until methods are developed that more accurately determine which patients may benefit from alternative imaging strategies.« less

Authors:
; ;  [1];  [1];  [1];  [1]; ; ;  [1];  [1]
  1. Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA (United States)
Publication Date:
OSTI Identifier:
22056412
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 83; Journal Issue: 2; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ACCURACY; COMPUTERIZED TOMOGRAPHY; HEAD; IMAGES; NECK; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Zumsteg, Zachary, DeMarco, John, Lee, Steve P, Steinberg, Michael L, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, Lin, Chun Shu, McBride, William, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, Lin, Kevin, Wang, Pin-Chieh, Kupelian, Patrick, Lee, Percy, and UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA. Image Guidance During Head-and-Neck Cancer Radiation Therapy: Analysis of Alignment Trends With In-Room Cone-Beam Computed Tomography Scans. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2011.08.001.
Zumsteg, Zachary, DeMarco, John, Lee, Steve P, Steinberg, Michael L, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, Lin, Chun Shu, McBride, William, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, Lin, Kevin, Wang, Pin-Chieh, Kupelian, Patrick, Lee, Percy, & UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA. Image Guidance During Head-and-Neck Cancer Radiation Therapy: Analysis of Alignment Trends With In-Room Cone-Beam Computed Tomography Scans. United States. https://doi.org/10.1016/J.IJROBP.2011.08.001
Zumsteg, Zachary, DeMarco, John, Lee, Steve P, Steinberg, Michael L, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, Lin, Chun Shu, McBride, William, UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA, Lin, Kevin, Wang, Pin-Chieh, Kupelian, Patrick, Lee, Percy, and UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA. 2012. "Image Guidance During Head-and-Neck Cancer Radiation Therapy: Analysis of Alignment Trends With In-Room Cone-Beam Computed Tomography Scans". United States. https://doi.org/10.1016/J.IJROBP.2011.08.001.
@article{osti_22056412,
title = {Image Guidance During Head-and-Neck Cancer Radiation Therapy: Analysis of Alignment Trends With In-Room Cone-Beam Computed Tomography Scans},
author = {Zumsteg, Zachary and DeMarco, John and Lee, Steve P and Steinberg, Michael L and UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA and Lin, Chun Shu and McBride, William and UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA and Lin, Kevin and Wang, Pin-Chieh and Kupelian, Patrick and Lee, Percy and UCLA Jonsson Comprehensive Cancer Center, Los Angeles, CA},
abstractNote = {Purpose: On-board cone-beam computed tomography (CBCT) is currently available for alignment of patients with head-and-neck cancer before radiotherapy. However, daily CBCT is time intensive and increases the overall radiation dose. We assessed the feasibility of using the average couch shifts from the first several CBCTs to estimate and correct for the presumed systematic setup error. Methods and Materials: 56 patients with head-and-neck cancer who received daily CBCT before intensity-modulated radiation therapy had recorded shift values in the medial-lateral, superior-inferior, and anterior-posterior dimensions. The average displacements in each direction were calculated for each patient based on the first five or 10 CBCT shifts and were presumed to represent the systematic setup error. The residual error after this correction was determined by subtracting the calculated shifts from the shifts obtained using daily CBCT. Results: The magnitude of the average daily residual three-dimensional (3D) error was 4.8 {+-} 1.4 mm, 3.9 {+-} 1.3 mm, and 3.7 {+-} 1.1 mm for uncorrected, five CBCT corrected, and 10 CBCT corrected protocols, respectively. With no image guidance, 40.8% of fractions would have been >5 mm off target. Using the first five CBCT shifts to correct subsequent fractions, this percentage decreased to 19.0% of all fractions delivered and decreased the percentage of patients with average daily 3D errors >5 mm from 35.7% to 14.3% vs. no image guidance. Using an average of the first 10 CBCT shifts did not significantly improve this outcome. Conclusions: Using the first five CBCT shift measurements as an estimation of the systematic setup error improves daily setup accuracy for a subset of patients with head-and-neck cancer receiving intensity-modulated radiation therapy and primarily benefited those with large 3D correction vectors (>5 mm). Daily CBCT is still necessary until methods are developed that more accurately determine which patients may benefit from alternative imaging strategies.},
doi = {10.1016/J.IJROBP.2011.08.001},
url = {https://www.osti.gov/biblio/22056412}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 2,
volume = 83,
place = {United States},
year = {Fri Jun 01 00:00:00 EDT 2012},
month = {Fri Jun 01 00:00:00 EDT 2012}
}