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Evaluation of Interfractional Setup Uncertainties and Calculation of Adequate CTV-PTV Margin for Head and Neck Radiotherapy using Electronic Portal Imaging Device

Document Type : Original Research

Authors

1 Department of Medical Physics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Royal Adelaide Hospital, Department of Medical Physics, Adelaide, Australia

3 Department of Radiation Oncology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

4 Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran

10.31661/jbpe.v0i0.2211-1565

Abstract

Background: The evaluation of treatment-associated errors is important in the radiotherapy process, particularly those resulting related to patient setup.
Objective: This research aimed to assess the interfractional setup errors and determine the Clinical Target Volume to Planning Target Volume (CTV to PTV) margin in patients undergoing 3-Dimensional Conformal Radiation Therapy (3DCRT) for head and neck cancer by means of electronic portal imaging device.
Material and Methods: In this analytical study, 300 portal images were acquired from 50 patients undergoing 3DCRT for head and neck cancer. Using the portal images of Lateral (LAT) and Antero-Posterior (AP) fields, population systematic (∑) and random (σ) errors were obtained in the lateral, longitudinal, and vertical directions. Finally, based on the International Commission on Radiation Units and Measurements (ICRU) Report 62’s, Stroom’s and Van Herk’s methods, Planning target volume margins were determined.
Results: The translational shift ranges were 0-8.1 mm in the ML, 0-9 mm in the SI (AP), 0-8.8 mm in the SI (LAT), and 0-10 mm in the AP directions. The population systematic and random errors were respectively 3.230, 2.753, and 2.997 mm, and 1.476, 1.853, and 1.715 mm in X, Y, and Z directions. The calculated PTV margins using the ICRU-62, Stroom’s, and Van Herk’s formulae were ranging from 3.236-3.551, 6.605-7.493, and 7.932-9.108 mm, respectively. 
Conclusion: A PTV margin of 7.5-9.5 mm seems safe for ensuring adequate treatment volume coverage. In addition, the EPID is an effective equipment for verifying patient positioning and reducing treatment setup errors.

Highlights

Hamid Gholamhosseinian (Google Scholar)

Keywords

References
  1. Coca-Pelaz A, Rodrigo JP, Suárez C, Nixon IJ, Mäkitie A, Sanabria A, et al. The risk of second primary tumors in head and neck cancer: A systematic review. Head Neck. 2020;42(3):456-66. doi: 10.1002/hed.26016. PubMed PMID: 31750595.
  2. Perdomo S, Roa GM, Brennan P, Forman D, Sierra MS. Head and neck cancer burden and preventive measures in Central and South America. Cancer Epidemiology. 2016;44:S43-52. doi: 10.1016/j.canep.2016.03.012. PubMed PMID: 27678322.
  3. De Felice F, Polimeni A, Valentini V, Brugnoletti O, Cassoni A, Greco A, et al. Radiotherapy Controversies and Prospective in Head and Neck Cancer: A Literature-Based Critical Review. 2018;20(3):227-32. doi: 10.1016/j.neo.2018.01.002. PubMed PMID: 29448084. PubMed PMCID: PMC5849807.
  4. Kadeh H, Saravani S, Moradbeiki B. Epidemiological aspects of head and neck cancers in a population of south east region of Iran. Caspian Journal of Dental Research. 2015;4(2):33-9. doi: 10.22088/cjdr.4.2.33.
  5. Mirzaei M, Hosseini SA, Ghoncheh M, Soheilipour F, Soltani S, Soheilipour F, Salehiniya H. Epidemiology and Trend of Head and Neck Cancers in Iran. Glob J Health Sci. 2015;8(1):189-93. doi: 10.5539/gjhs.v8n1p189. PubMed PMID: 26234980. PubMed PMCID: PMC4803954.
  6. Mourad M, Jetmore T, Jategaonkar AA, Moubayed S, Moshier E, Urken ML. Epidemiological Trends of Head and Neck Cancer in the United States: A SEER Population Study. J Oral Maxillofac Surg. 2017;75(12):2562-72. doi: 10.1016/j.joms.2017.05.008. PubMed PMID: 28618252. PubMed PMCID: PMC6053274.
  7. Jomehzadeh A, Shokrani P, Mohammadi M, Amouheidari A. A quality assurance program for an amorphous silicon electronic portal imaging device using in-house developed phantoms: a method development for dosimetry purposes. Int J Radiat Res. 2014;12(3):257-64.
  8. Pehlivan B, Pichenot C, Castaing M, Auperin A, Lefkopoulos D, Arriagada R, Bourhis J. Interfractional set-up errors evaluation by daily electronic portal imaging of IMRT in head and neck cancer patients. Acta Oncol. 2009;48(3):440-5. doi: 10.1080/02841860802400610. PubMed PMID: 19031160.
  9. Strbac B, Jokic VS. Evaluation of set-up errors in head and neck radiotherapy using electronic portal imaging. Phys Med. 2013;29(5):531-6. doi: 10.1016/j.ejmp.2012.12.001. PubMed PMID: 23290565.
  10. Delishaj D, Ursino S, Pasqualetti F, Matteucci F, Cristaudo A, Soatti CP, Barcellini A, Paiar F. Set-up errors in head and neck cancer treated with IMRT technique assessed by cone-beam computed tomography: a feasible protocol. Radiat Oncol J. 2018;36(1):54-62. doi: 10.3857/roj.2017.00493. PubMed PMID: 29621873. PubMed PMCID: PMC5903362.
  11. Cubillos Mesías M, Boda-Heggemann J, Thoelking J, Lohr F, Wenz F, Wertz H. Quantification and Assessment of Interfraction Setup Errors Based on Cone Beam CT and Determination of Safety Margins for Radiotherapy. PLoS One. 2016;11(3):e0150326. doi: 10.1371/journal.pone.0150326. PubMed PMID: 26930196. PubMed PMCID: PMC4773093.
  12. Ciardo D, Alterio D, Jereczek-Fossa BA, Riboldi M, Zerini D, Santoro L, et al. Set-up errors in head and neck cancer patients treated with intensity modulated radiation therapy: Quantitative comparison between three-dimensional cone-beam CT and two-dimensional kilovoltage images. Phys Med. 2015;31(8):1015-21. doi: 10.1016/j.ejmp.2015.08.004. PubMed PMID: 26459318.
  13. Pramanik S, Ray DK, Bera S, Choudhury A, Iqbal A, Mondal S, et al. Analysis of setup uncertainties and determine the variation of the clinical target volume (CTV) to planning target volume (PTV) margin for various tumor sites treated with three-dimensional IGRT couch using KV-CBCT. Journal of Radiation Oncology. 2020;9:25-35. doi: 10.1007/s13566-020-00417-z.
  14. Herman MG, Balter JM, Jaffray DA, McGee KP, Munro P, Shalev S, et al. Clinical use of electronic portal imaging: report of AAPM Radiation Therapy Committee Task Group 58. Med Phys. 2001;28(5):712-37. doi: 10.1118/1.1368128. PubMed PMID: 11393467.
  15. Eldebawy E, Attalla E, Eldesoky I, Zaghloul MS. Geometrical uncertainty margins in 3D conformal radiotherapy in the pediatric age group. J Egypt Natl Canc Inst. 2011;23(2):55-60. doi: 10.1016/j.jnci.2011.09.001. PubMed PMID: 22099961.
  16. Herman MG, Kruse JJ, Hagness CR. Guide to clinical use of electronic portal imaging. J Appl Clin Med Phys. 2000;1(2):38-57. doi: 10.1120/jacmp.v1i2.2645. PubMed PMID: 11674818. PubMed PMCID: PMC5726148.
  17. Das IJ, Cao M, Cheng CW, Misic V, Scheuring K, Schüle E, Johnstone PA. A quality assurance phantom for electronic portal imaging devices. J Appl Clin Med Phys. 2011;12(2):3350. doi: 10.1120/jacmp.v12i2.3350. PubMed PMID: 21587179. PubMed PMCID: PMC5718680.
  18. Court LE, Wolfsberger L, Allen AM, James S, Tishler RB. Clinical experience of the importance of daily portal imaging for head and neck IMRT treatments. J Appl Clin Med Phys. 2008;9(3):26-33. doi: 10.1120/jacmp.v9i3.2756. PubMed PMID: 18716586. PubMed PMCID: PMC5722295.
  19. Stroom JC, Heijmen BJ. Geometrical uncertainties, radiotherapy planning margins, and the ICRU-62 report. Radiother Oncol. 2002;64(1):75-83. doi: 10.1016/s0167-8140(02)00140-8. PubMed PMID: 12208578.
  20. Stroom JC, De Boer HC, Huizenga H, Visser AG. Inclusion of geometrical uncertainties in radiotherapy treatment planning by means of coverage probability. Int J Radiat Oncol Biol Phys. 1999;43(4):905-19. doi: 10.1016/s0360-3016(98)00468-4. PubMed PMID: 10098447.
  21. Van Herk M, Remeijer P, Rasch C, Lebesque JV. The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy. Int J Radiat Oncol Biol Phys. 2000;47(4):1121-35. doi: 10.1016/s0360-3016(00)00518-6. PMID: 10863086.
  22. Gupta T, Chopra S, Kadam A, Agarwal JP, Devi PR, Ghosh-Laskar S, Dinshaw KA. Assessment of three-dimensional set-up errors in conventional head and neck radiotherapy using electronic portal imaging device. Radiat Oncol. 2007;2:44. doi: 10.1186/1748-717X-2-44. PubMed PMID: 18081927. PubMed PMCID: PMC2238756.
  23. Jalali R, Budrukkar A, Sarin R, Sharma DS. High precision conformal radiotherapy employing conservative margins in childhood benign and low-grade brain tumours. Radiother Oncol. 2005;74(1):37-44. doi: 10.1016/j.radonc.2004.09.014. PubMed PMID: 15683667.
  24. Bayman E, Ataman ÖU, Kinay M, Akman F. How to determine margins for planning target volume (PTV): from 2D to 3D planning in radiotherapy for head and neck cancer? Portal imaging assessment for set-up errors. Turkish Journal of Oncology. 2010;25(3):104-10.
  25. Xing L, Lin Z, Donaldson SS, Le QT, Tate D, Goffinet DR, et al. Dosimetric effects of patient displacement and collimator and gantry angle misalignment on intensity modulated radiation therapy. Radiother Oncol. 2000;56(1):97-108. doi: 10.1016/s0167-8140(00)00192-4. PubMed PMID: 10869760.
  26. Hess CF, Kortmann RD, Jany R, Hamberger A, Bamberg M. Accuracy of field alignment in radiotherapy of head and neck cancer utilizing individualized face mask immobilization: a retrospective analysis of clinical practice. Radiother Oncol. 1995;34(1):69-72. doi: 10.1016/0167-8140(94)01497-q. PubMed PMID: 7792401.
  27. Bentel GC, Marks LB, Hendren K, Brizel DM. Comparison of two head and neck immobilization systems. Int J Radiat Oncol Biol Phys. 1997;38(4):867-73. doi: 10.1016/s0360-3016(97)00075-8. PubMed PMID: 9240656.
  28. Gilbeau L, Octave-Prignot M, Loncol T, Renard L, Scalliet P, Grégoire V. Comparison of setup accuracy of three different thermoplastic masks for the treatment of brain and head and neck tumors. Radiother Oncol. 2001;58(2):155-62. doi: 10.1016/s0167-8140(00)00280-2. PubMed PMID: 11166866.
  29. De Boer HC, Van Sörnsen De Koste JR, Creutzberg CL, Visser AG, Levendag PC, Heijmen BJ. Electronic portal image assisted reduction of systematic set-up errors in head and neck irradiation. Radiother Oncol. 2001;61(3):299-308. doi: 10.1016/s0167-8140(01)00437-6. PubMed PMID: 11731000.
  30. Humphreys M, Guerrero Urbano MT, Mubata C, Miles E, Harrington KJ, Bidmead M, Nutting CM. Assessment of a customised immobilisation system for head and neck IMRT using electronic portal imaging. Radiother Oncol. 2005;77(1):39-44. doi: 10.1016/j.radonc.2005.06.039. PubMed PMID: 16154217.
  31. Suzuki M, Nishimura Y, Nakamatsu K, Okumura M, Hashiba H, Koike R, et al. Analysis of interfractional set-up errors and intrafractional organ motions during IMRT for head and neck tumors to define an appropriate planning target volume (PTV)- and planning organs at risk volume (PRV)-margins. Radiother Oncol. 2006;78(3):283-90. doi: 10.1016/j.radonc.2006.03.006. PubMed PMID: 16564594.
  32. Zhang L, Garden AS, Lo J, Ang KK, Ahamad A, Morrison WH, et al. Multiple regions-of-interest analysis of setup uncertainties for head-and-neck cancer radiotherapy. Int J Radiat Oncol Biol Phys. 2006;64(5):1559-69. doi: 10.1016/j.ijrobp.2005.12.023. PubMed PMID: 16580505.
  33. Hurkmans CW, Remeijer P, Lebesque JV, Mijnheer BJ. Set-up verification using portal imaging; review of current clinical practice. Radiother Oncol. 2001;58(2):105-20. doi: 10.1016/s0167-8140(00)00260-7. PubMed PMID: 11166861.
  34. Jones D. ICRU report 50-Prescribing, recording and reporting photon beam therapy. Med Phys. 1994;21(6):833-4. doi: 10.1118/1.597396.
  35. Budrukkar A, Dutta D, Sharma D, Yadav P, Dantas S, Jalali R. Comparison of geometric uncertainties using electronic portal imaging device in focal three-dimensional conformal radiation therapy using different head supports. J Cancer Res Ther. 2008;4(2):70-6. doi: 10.4103/0973-1482.42252. PubMed PMID: 18688122.
  36. Rosenthal SJ, Gall KP, Jackson M, Thornton AF Jr. A precision cranial immobilization system for conformal stereotactic fractionated radiation therapy. Int J Radiat Oncol Biol Phys. 1995;33(5):1239-45. doi: 10.1016/0360-3016(95)02009-8. PubMed PMID: 7493848.
  37. Molana S, Arbabi F, Sanei M, Hashemi E, Tajvidi M, Rostami A, et al. Evaluation of patient setup accuracy and determination of optimal setup margin for external beam radiation therapy using electronic portal imaging device. Canc Therapy & Oncol Int J. 2018;11(2):48-55. doi: 10.19080/CTOIJ.2018.11.555808.
  38. Beltran C, Krasin MJ, Merchant TE. Inter- and intrafractional positional uncertainties in pediatric radiotherapy patients with brain and head and neck tumors. Int J Radiat Oncol Biol Phys. 2011;79(4):1266-74. doi: 10.1016/j.ijrobp.2009.12.057. PubMed PMID: 20605345. PubMed PMCID: PMC3536549.
Journal of Biomedical Physics and Engineering
Volume 15, Issue 1
69
February 2025
Pages 5-14
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