Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-10T17:18:54.680Z Has data issue: false hasContentIssue false
  • English
  • Français

CBCT image guidance in head and neck irradiation: the impact of daily and weekly imaging protocols

Published online by Cambridge University Press:  29 June 2015

Innocencia Nyarambi ,
Crispen Chamunyonga  and
Andrew Pearce
Innocencia Nyarambi*
Affiliation:
Sudbury Regional Hospital, Ontario, Canada
Crispen Chamunyonga
Affiliation:
School of Clinical Science, Queensland University of Technology, Queensland, Australia
Andrew Pearce
Affiliation:
Sudbury Regional Hospital, Ontario, Canada
*
Correspondence to: Innocencia Nyarambi, Sudbury Regional Hospital, 41Ramsey Lake Road, Sudbury, ON P3E 5J1, Canada. Tel: +1 705 522 6237. E-mail: INyarambi@hsnsudbury.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Purpose

This study evaluated the impact of a daily and weekly image-guided radiotherapy protocols in reducing setup errors and setting of appropriate margins in head and neck cancer patients.

Materials and methods

Interfraction and systematic shifts for the hypothetical day 1–3 plus weekly imaging were extrapolated from daily imaging data from 31 patients (964 cone beam computed tomography (CBCT) scans). In addition, residual setup errors were calculated by taking the average shifts in each direction for each patient based on the first three shifts and were presumed to represent systematic setup error. The clinical target volume (CTV) to planning target volume (PTV) margins were calculated using van Herk formula and analysed for each protocol.

Results

The mean interfraction shifts for daily imaging were 0·8, 0·3 and 0·5 mm in the S-I (superior-inferior), L-R (left-right) and A-P (anterior-posterior) direction, respectively. On the other hand the mean shifts for day 1–3 plus weekly imaging were 0·9, 1·8 and 0·5 mm in the S-I, L-R and A-P direction, respectively. The mean day 1–3 residual shifts were 1·5, 2·1 and 0·7 mm in the S-I, L-R and A-P direction, respectively. No significant difference was found in the mean setup error for the daily and hypothetical day 1–3 plus weekly protocol. However, the calculated CTV to PTV margins for the daily interfraction imaging data were 1·6, 3·8 and 1·4 mm in the S-I, L-R and A-P directions, respectively. Hypothetical day 1–3 plus weekly resulted in CTV–PTV margins of 5, 4·2 and 5 mm in the S-I, L-R and A-P direction.

Conclusions

The results of this study show that a daily CBCT protocol reduces setup errors and allows setup margin reduction in head and neck radiotherapy compared to a weekly imaging protocol.

Keywords

cancercone beam CThead and neckimage-guided radiotherapy
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 14 , Issue 4 , December 2015 , pp. 362 - 369
Check for updates
Copyright
© Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Feng, X, Wang, J, Bai, Set al. Interfractional and intrafractional set-up errors on radiotherapy for tumors analysed by cone beam computed tomography. Chin J Cancer 2008; 27 (10): 372–376.Google Scholar
2.Kapanen, M, Laaksomaa, M, Tulijoki, Tet al. Estimation of adequate set-up margins and threshold position errors requiring immediate attention in head and neck cancer radiotherapy based on 2D image guidance. Radiat Oncol 2013; 8: 212.CrossRefGoogle Scholar
3.Hong, T, Wofgang, T, Richard Chapelle, R Jet al. The impact of daily setup variations on head and neck intensity modulated radiation therapy. Int J Biol Rad Phys 2005; 61: 779–788.CrossRefGoogle ScholarPubMed
4.Zeidan, Q A, Langen, K M, Meeks, S Let al. Evaluation of image guidance protocols in the treatment of head and neck cancers. Int J Radiat Oncol Biol Phys 2007; 67: 670–677.CrossRefGoogle ScholarPubMed
5.Leclerc, M, Maingon, P, Hamoir, Met al. A dose escalation study with intensity modulated radiation therapy (IMRT) in T2N0, T2N1, T3N0 squamous cell carcinomas (SCC) of the oropharynx, larynx and hypopharynx using a simultaneous integrated boost (SIB) approach. Radiother Oncol 2013; 106 (3): 333–340.CrossRefGoogle ScholarPubMed
6.Jaffray, D, Kupelian, P, Djemil, Tet al. Review of image-guided radiation therapy. Expert Rev Anticancer Ther 2007; 85: 418.Google Scholar
7.Walter, C, Boda-Heggeman, J, Wertz, Het al. Phantom and in-vivo measurements of dose exposure by image guided radiotherapy (IGRT): MV portal images vs. kV portal images vs cone beam CT. Radiother Oncol 2007; 85: 418–423.CrossRefGoogle ScholarPubMed
8.Zhang, L, Garden, A, Lo, Jet al. Multiple regions-of-interest analysis of setup uncertainties for head-and-neck cancer radiotherapy. Int J Radiat Oncol Biol Phys 2006; 64 (5): 1559–1569.CrossRefGoogle ScholarPubMed
9.Bel, A, Keus, R, Virjlbrief, R Eet al. Setup deviations in wedged pair irradiation of parotid gland and tonsillor tumors, measured with electronic portal imaging device. Radiother Oncol 1995; 37: 153–159.CrossRefGoogle Scholar
10.van Herk, M, Remeijer, Pet al. The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy. Int J Radiat Oncol Biol Phys 2000; 47: 1121–1135.CrossRefGoogle ScholarPubMed
11.Qi, S, Wu, S, Newman, F. Evaluation of interfraction patient setup errors for image-guided prostate and head and neck radiotherapy using kilovoltage cone beam and megavoltage fan beam computed tomography. J Radio Pract 2013; 12: 334–343.CrossRefGoogle Scholar
12.Higgins, J, Beziak, A, Hope, Aet al. Effect of image-guidance frequency on geometric accuracy and setup margins in radiotherapy for locally advanced lung cancer. Int J Radiat Oncol Biol Phys 2010; p1–p8.Google ScholarPubMed
13.Oita, M, Ohmori, K, Obinata, Ket al. Uncertainties in treatment of head-and-neck tumours by use of intraoral mouthpiece and embedded fiducials. Int J Radiat Oncol Biol Phys 2006; 64: 1581–1588.CrossRefGoogle ScholarPubMed
14.Laurence, E, Court, A, Luciant, Wet al. Clinical experience of the importance of daily portal imaging for head and neck IMRT treatments. J Appl Clin Med Phys 2008; 9 (3).Google Scholar
15.de Boer, H C, Heijmen, B J. A protocol for the reduction of systematic patient setup errors with minimal portal imaging workload. Int J Radiat Oncol Biol Phys 2001; 50 (5): 1350–1365.CrossRefGoogle ScholarPubMed
16.de Boer, H C, Van Sornsen de Koste, J R, Creutzberg, C Let al. Electronic portal imaging assisted reduction of systematic set-up errors in head and neck irradiation. Radiother Oncol 2001; 61 (3): 299–308.CrossRefGoogle ScholarPubMed
17.de Boer, J C, Heijman, B J. A new approach to off-line setup corrections: combining safety with minimum workload. Med Phys 2002; 28: 1998–2012.CrossRefGoogle Scholar
18.Medical Imaging. Radiotherapy developments improve the quality of treatments of patients with head and neck cancer. 2009. www.medimaging.net/radiography/articles/294726942/radiotherapy. Accessed on 30th March 2014.Google Scholar
19.Den, R, Demer, A, Kubicek, Get al. Daily image guidance with cone-beam computed tomography for head-and-neck cancer intensity-modulated radiotherapy: a prospective study. Int J Radiat Biol Phys 2010; 76 (5): 1353–1359.CrossRefGoogle ScholarPubMed
20.Bradley, J, Paulson, E, Ahunbay, Eet al. Dynamic analysis of tumor and organ motion during rest and deglutition and margin assessment for radiotherapy of head and neck cancer. Int J Radiat Oncol Biol Phys 2011; 81 (5): 803–812.CrossRefGoogle ScholarPubMed
21.Stenson, K M, McCracken, E, List, Met al. Swallowing function in patients with head and neck cancer prior to treatment. Arch Otolaryngol Head Neck Surg 2000; 126: 371–377.CrossRefGoogle ScholarPubMed
22.Guckenburger, M, Meyer, J, Vordermark, Det al. Magnitude and clinical relevance of translational and rotational patient setup errors: cone beam CT study. Int J Biol Phys 2006; 65 (3): 934–942.Google Scholar
23.Kim, G Y, Pawlicki, T, Le, Q Tet al. Linac-based on-board imaging feasibility and dosimetric consequences of head roll in head-and-neck IMRT plans. Med Dosim 2008; 33: 93–99.CrossRefGoogle ScholarPubMed
24.Li, X A, Qi, X S, Pitterle, Met al. Interfractional variations in patient setup and anatomic change assessed by daily computed tomography. Int .J Radiat Oncol Biol Phys 2007; 68: 581–591.CrossRefGoogle ScholarPubMed
25.Daly, M J, Siewerdsen, J H, Morsely, D Jet al. Intra-operative cone-beam CT for guidance of head and neck surgery assessment of dose and image quality using a C-arm prototype. Med Phys 2006; 33: 3767–3780.CrossRefGoogle Scholar