Precision of Image-Guided Radiotherapy (IGRT) in Six Degrees of Freedom and Limitations in Clinical Practice

Gückenberger, Matthias; Meyer, Juergen; Wilbert, Juergen; Baier, Kurt; Sauer, Otto A.; Flentje, Michael

doi:10.1007/s00066-007-1695-0

Cited by 130 publications

(101 citation statements)

References 33 publications

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“…Simple automated corrective couch motions are possible, with limited deviations. Near-rigid body immobilization also reduces the potential for patient motion while the beam is on (intrafractional variation) and increases delivery accuracy, 22,52 and this is of critical importance in spine SBRT. A blanket for the patient was placed over the plastic to keep him warm.…”

Section: Patient-specific Near-rigid Body Immobilization Devicementioning

confidence: 99%

Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient

Sahgal

Bilsky

Chang³

et al. 2011

SPI

180

103

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Stereotactic body radiotherapy (SBRT) for spinal metastases is an emerging therapeutic option aimed at delivering high biologically effective doses to metastases while sparing the adjacent normal tissues. This technique has emerged following advances in radiation delivery that include sophisticated radiation treatment planning software, body immobilization devices, and capabilities of detecting and correcting patient positional deviations with imageguided radiotherapy. There are limited clinical data specifically supporting the role of SBRT as a superior alternative to conventional radiation in the postoperative patient. The focus of this review was to examine the evidence pertaining to spine SBRT in the treatment of spinal metastases and to provide a comprehensive analysis of published patterns of failure, with emphasis on the postoperative patient.

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Section: Patient-specific Near-rigid Body Immobilization Devicementioning

confidence: 99%

Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient

Sahgal

Bilsky

Chang³

et al. 2011

SPI

180

103

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“…Image‐guidance systems are now commonly used to minimize setup uncertainties 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 and have provided highly effective for quantifying patient setup errors and correcting target localization 20 , 21 A reduction in setup uncertainties would allow for a reduction in treatment margins, leading to dose escalation and an improvement in local control at the tumor site 22 , 23 , 24 , 25 , 26 …”

Section: Introductionmentioning

confidence: 99%

Assessment of setup uncertainties for various tumor sites when using daily CBCT for more than 2200 VMAT treatments

Baek

Kim

et al. 2014

J Applied Clin Med Phys

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The aim of this study was assess the patient setup errors for various tumor sites based on clinical data from a sufficient number of treatments with volumetric‐modulated arc therapy (VMAT) using daily pretreatment CBCT imaging guidance. In addition, we calculated and compared the planning target volume (PTV) margins for all disease sites based on an analysis of specific systematic and random errors in our institution. All patients underwent pretreatment kV‐CBCT imaging. The various tumor sites were divided into four categories; 21 brain (438 fractions), 35 head‐and‐neck tumors (H&N, 933 fractions), 19 thorax and abdomen tumors (T&A, 313 fractions), and 17 prostate cancer tumors (546 fractions). Overall distributions of setup corrections in all directions, frequencies of 3D vector lengths, institution‐specific setup error, and PTV margins were analyzed. The longitudinal distribution for the T&A site represented an asymmetric offset in the negative direction. Rotational distributions were comparable for all treatment sites, and the prostate site had the narrowest distribution of ≤±2∘. The cumulative frequencies of 3D vector length of ≥ 7 mm were rare for brain lesions and H&N, but more common for T&A and prostate lesions at 25.6% and 12.1%, respectively. The overall mean error for all treatment sites were within ±1 mm and ±0.1∘, with the exception of the T&A site, which had overall mean error of 2 mm in the negative longitudinal direction. The largest magnitude of systematic error and random error for the brain lesions and H&N was 1.4 mm in the translational directions, and 3.3 mm for T&A and prostate lesions. The PTV margins required in this analysis are ≤ 4 mm for the brain lesions and H&N in all translational directions, but ranged from 4 to 10 mm for T&A and prostate lesions. Analysis of each institution's specific setup errors using daily CBCT is essential for determining PTV margins and reducing setup uncertainties, because setup errors vary according to each immobilization system and patient.PACS number: 87.55.km

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“…Isocenter adjustments can be made remotely through table movements right after the CT scan and the treatment is carried out immediately thereafter. Treatment tables or couches have traditionally provided three axis translations, but six-degree of freedom tables offering rotational adjustments (pitch, roll and yaw) are entering the market [69]. Another IGRT technique often used for SBRT is a kV image pair obtained from either an in-room x-ray system ( Figure 2B) or on-board imager.…”

Section: Image Guidance Technologymentioning

confidence: 99%

Motion Management in Stereotactic Body Radiotherapy

Zhang

Yu²,

Stevens³

et al. 2013

J Nucl Med Radiat Ther

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With the technologic advancements in image guidance and dose delivery, stereotactic body radiotherapy (SBRT) is being widely used for cancer treatment in various anatomical locations as a noninvasive alternative to surgery. To deliver ablative doses to tumors with limited normal tissue toxicity, SBRT requires high accuracy in treatment setup which requires taking tumor motion into account. Techniques are also applied in SBRT to minimize tumor motion during dose delivery. This paper reviews techniques for motion management in SBRT.

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Precision of Image-Guided Radiotherapy (IGRT) in Six Degrees of Freedom and Limitations in Clinical Practice

Abstract: Very high precision in cranial and extracranial treatment of immobilized patients was demonstrated. Without application of adequate immobilization the correction of rotational errors and intrafractional patient motion significantly decreased the accuracy of the online correction protocol.

Cited by 130 publications

References 33 publications

Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient

Stereotactic body radiotherapy for spinal metastases: current status, with a focus on its application in the postoperative patient

Assessment of setup uncertainties for various tumor sites when using daily CBCT for more than 2200 VMAT treatments

Motion Management in Stereotactic Body Radiotherapy

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