Comparison of setup uncertainties of two immobilization devices for pelvic external beam radiotherapy

Authors

  • Chutima Watjanawanitprapa Division of Radiation Oncology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University
  • Padet Yodjai Division of Radiation Oncology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University
  • Pimolpun Changkaew Division of Radiation Oncology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University
  • Chomporn Sitathanee Division of Radiation Oncology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University
  • Suphalak Khachonkham Division of Radiation Oncology, Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University

Keywords:

PTV margin, Setup uncertainty, Immobilization device

Abstract

Background: In pelvic external beam radiotherapy, patient immobilization has an important role in maintaining patient’s position during the course of treatment. This study compares positioning method of two immobilization devices between Vacuum Bag Cushion (VBC) and Feet Fix (FF) at Ramathibodi Hospital. The choice of an appropriate immobilization would lead to reduce setup uncertainties.

Objectives: The aim of this study was to quantify the setup uncertainties and to determine PTV margin in the pelvic radiation therapy of the two different immobilization devices: VBC and FF.  

Materials and methods: Fifty-three patients were included and divided into two groups based on using immobilization devices (VBC vs FF). The setup uncertainties were determined using the kV-kV imaging by matching between acquired image and reference DRRs image. The displacement in each direction: Vertical (VRT), Longitudinal (LONG), and Lateral (LAT) were recorded. The Total Vector Error (TVE), Systematic error, Random error and Planning Target Volume (PTV) margin were calculated and statistically analyzed for both devices.

Results: The TVE of the VBC group was 0.51 cm, and the FF was 0.57 cm. The differences were not statistically significant between the two devices. The PTV margins in VRT, LONG, and LAT were 0.53, 0.75, and 0.97 cm, respectively, for VBC device while those of FF device were 0.51, 0.69 and 1.12 cm, respectively.

Conclusion: The setup uncertainties evaluated from displacement in each direction for VBC and FF were in the same magnitude in pelvic external beam radiotherapy. The setup variation was found to be largest in the lateral direction. The PTV margin should be applied according to each immobilization system.

References

Dearnaley DP, Khoo VS, Norman AR, Meyer L, Nahum A, Tait D, et al. Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial. The Lancet. 1999;353:267-72.

Michalski JM, Winter K, Purdy JA, Parliament M, Wong H, Perez CA, et al. Toxicity after three-dimensional radiotherapy for prostate cancer on RTOG 9406 dose Level V. Int J Radiat Oncol Biol Phys. 2004;58:735-42.

Knapp P, Eva B, Reseigh G, Gibbs A, Sim L, Daly T, et al. The role of volumetric modulated arc therapy (VMAT) in gynaecological radiation therapy: A dosimetric comparison of intensity modulated radiation therapy versus VMAT. J Med Radiat Sci. 2019;66:44-53.

Van Herk M. Errors and margins in radiotherapy. Semin Radiat Oncol. 2004;14:52-64.

Leibel SA, Fuks Z, Zelefsky MJ, Hunt M, Burman CM, Mageras GS, et al. Technological advances in external-beam radiation therapy for the treatment of localized prostate cancer. Semin Oncol. 2003;30:596-615.

Mackie TR, Kapatoes J, Ruchala K, Lu W, Wu C, Olivera G, et al. Image guidance for precise conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2003;56:89-105.

Saw CB, Yakoob R, Enke CA, Lau TP, Ayyangar KM. Immobilization devices for intensity-modulated radiation therapy (IMRT). Med Dosim. 2001;26:71-7.

Rosenthal SA, Roach III M, Goldsmith BJ, Doggett EC, Pickett B, Yuo H-S, et al. Immobilization improves the reproducibility of patient positioning during six-field conformal radiation therapy for prostate carcinoma. Int J Radiat Oncol Biol Phys. 1993;27:921-6.

Soffen EM, Hanks GE, Hwang CC, Chu JC. Conformal static field therapy for low volume low grade prostate cancer with rigid immobilization. Int J Radiat Oncol Biol Phys. 1991;20:141-6.

Catton C, Lebar L, Warde P, Hao Y, Catton P, Gospodarowicz M, et al. Improvement in total positioning error for lateral prostatic fields using a soft immobilization device. Radiat Oncol. 1997;44:265-70.

Garcia R, Oozeer R, Le Thanh H, Chauvet B, Toy B, Reboul F. Conformational radiotherapy in cancers of the prostate: contribution of pelvic immobilization and new fiducial markers. Cancer Radiother. 1997;1:307-13.

Song PY, Washington M, Vaida F, Hamilton R, Spelbring D, Wyman B, et al. A comparison of four patient immobilization devices in the treatment of prostate cancer patients with three dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 1996;34:213-9.

Hall WA, Paulson E, Davis BJ, Feng F, Sandler HM, Lawton CA, et al. NRG oncology updated international consensus atlas on pelvic lymph node volumes for Intact and postoperative prostate cancer. Int J Radiat Oncol Biol Phys. 2021;109:174-85.

Myerson RJ, Garofalo MC, Naqa IE, Abrams RA, Apte A, Bosch WR, et al. Elective clinical target volumes for conformal therapy in anorectal Cancer: An RTOG consensus panel contouring atlas. Int J Radiat Oncol Biol Phys. 2009;74:824-30.

Small W Jr., Bosch WR, Harkenrider MM, Yashar CM, Winter KA, Gaffney DK, et al. NRG oncology/RTOG consensus guidelines for delineation of clinical target volume for intensity modulated pelvic radiation therapy in postoperative treatment of endometrial and cervical cancer: An update. Int J Radiat Oncol Biol Phys. 2021;109:413-24.

Kim DG, Jung JJ, Cho KH, Ryu MR, Moon SK, Bae SH, et al. Comparison of two different immobilization devices for pelvic region radiotherapy in tomotherapy. Med Phys. 2016;27:250-7.

นีรนุช ทวีบุญ, คฑา ตินทุการนนท์, สุธี เดชะวงศ์สุวรรณ. การศึกษาเปรียบเทียบความคลาดเคลื่อนของ ตำแหน่ง isocenter ระหว่างแนว เหนือ และ ใต้ ต่อ nipple สำหรับการฉายรังสีมะเร็งบริเวณทรวงอก และ ช่องท้อง โดยการใช้ภาพ KV Orthogonal หรือ Cone-beam computed tomography (CBCT) ของโรง พยาบาลศิริราช. J Thai Assos Radiat Oncol. 2018;24:25-34.

วรญา เงินเถื่อน. การเปรียบเทียบความคลาดเคลื่อนจากการจัดท่าผู้ป่วยฉายรังสีผู้ป่วยมะเร็งปอด โดยใช้ อุปกรณ์ยึดตรึงสองชนิด. J Thai Assos Radiat Oncol. 2018;24:29-37.

Udayashankar AH, Noorjahan S, Srikantia N, Babu KR, Muzumder S. Immobilization versus no immobilization for pelvic external beam radiotherapy. Rep Pract Oncol Radiother. 2018;23:233-41

Malone S, Szanto J, Perry G, Gerig L, Manion S, Dahrouge S, et al. A prospective comparison of three systems of patient immobilization for prostate radiotherapy. Int J Radiat Oncol Biol Phys. 2000;48:657-65.

White P, Yee CK, Shan LC, Chung LW, Man NH, Cheung YS. A comparison of two systems of patient immobilization for prostate radiotherapy. Radiat Oncol. 2014;9:1-12.

Ariyaratne H, Chesham H, Pattingell J, Alonzi R. Image-guided radiotherapy for prostate cancer with cone beam CT: dosimetric effects of imageing frequency and PTV margin. Radiat Oncol. 2016;121:103-8.

Kupelian PA, Lee C, Langen KM, Zeidan OA, Manon RR, Willoughby TR, et al. Evaluation of image-guidance strategies in the treatment of localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70:1151-7.

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Published

2021-11-11

How to Cite

1.
Watjanawanitprapa C, Yodjai P, Changkaew P, Sitathanee C, Khachonkham S. Comparison of setup uncertainties of two immobilization devices for pelvic external beam radiotherapy. J Thai Assn of Radiat Oncol [Internet]. 2021 Nov. 11 [cited 2024 Mar. 29];27(2):R116-130. Available from: https://he01.tci-thaijo.org/index.php/jtaro/article/view/251461

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