Quality improvement process to assess tattoo alignment, set‐up accuracy and isocentre reproducibility in pelvic radiotherapy patients

Elsner, Kelly L.; Francis, Kate; Hruby, George; Roderick, Stephanie

doi:10.1002/jmrs.79

Cited by 6 publications

(4 citation statements)

References 15 publications

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“… 24 , 25 Thus, positioning patients with plump breasts using skin tattoos is challenging. 24 The degree of filling of the abdominal bladder directly affects the location of skin 26 tattoos, tumors, and internal organs. 27 Jhingran 28 et al.…”

Section: Discussionmentioning

confidence: 99%

Augmented reality‐guided positioning system for radiotherapy patients

et al. 2022

J Applied Clin Med Phys

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In modern radiotherapy, error reduction in the patients’ daily setup error is important for achieving accuracy. In our study, we proposed a new approach for the development of an assist system for the radiotherapy position setup by using augmented reality (AR). We aimed to improve the accuracy of the position setup of patients undergoing radiotherapy and to evaluate the error of the position setup of patients who were diagnosed with head and neck cancer, and that of patients diagnosed with chest and abdomen cancer. We acquired the patient's simulation CT data for the three‐dimensional (3D) reconstruction of the external surface and organs. The AR tracking software detected the calibration module and loaded the 3D virtual model. The calibration module was aligned with the Linac isocenter by using room lasers. And then aligned the virtual cube with the calibration module to complete the calibration of the 3D virtual model and Linac isocenter. Then, the patient position setup was carried out, and point cloud registration was performed between the patient and the 3D virtual model, such the patient's posture was consistent with the 3D virtual model. Twenty patients diagnosed with head and neck cancer and 20 patients diagnosed with chest and abdomen cancer in the supine position setup were analyzed for the residual errors of the conventional laser and AR‐guided position setup. Results show that for patients diagnosed with head and neck cancer, the difference between the two positioning methods was not statistically significant (P > 0.05). For patients diagnosed with chest and abdomen cancer, the residual errors of the two positioning methods in the superior and inferior direction and anterior and posterior direction were statistically significant (t = −5.80, −4.98, P < 0.05). The residual errors in the three rotation directions were statistically significant (t = −2.29 to −3.22, P < 0.05). The experimental results showed that the AR technology can effectively assist in the position setup of patients undergoing radiotherapy, significantly reduce the position setup errors in patients diagnosed with chest and abdomen cancer, and improve the accuracy of radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Augmented reality‐guided positioning system for radiotherapy patients

et al. 2022

J Applied Clin Med Phys

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“…Although, with the growth of the modern state‐of‐the‐art image guidance systems for use in Image Guided Radiation Therapy (IGRT), including surface imaging systems, the dependence on and relevance of these marks has been drastically reduced 8, 9. With current standards of care, where volumetric imaging is employed prior to treatment for 3D setup corrections, subcutaneous marks serve as a relic of the pre‐volumetric imaging standards or positioning.…”

Section: Discussionmentioning

confidence: 99%

Comparison of initial patient setup accuracy between surface imaging and three point localization: A retrospective analysis

Stanley

McConnell

Kirby

et al. 2017

J Applied Clin Med Phys

109

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PurposeHistorically, the process of positioning a patient prior to imaging verification used a set of permanent patient marks, or tattoos, placed subcutaneously. After aligning to these tattoos, plan specific shifts are applied and the position is verified with imaging, such as cone‐beam computed tomography (CBCT). Due to a variety of factors, these marks may deviate from the desired position or it may be hard to align the patient to these marks. Surface‐based imaging systems are an alternative method of verifying initial positioning with the entire skin surface instead of tattoos. The aim of this study was to retrospectively compare the CBCT‐based 3D corrections of patients initially positioned with tattoos against those positioned with the C‐RAD CatalystHD surface imager system.MethodsA total of 6000 individual fractions (600–900 per site per method) were randomly selected and the post‐CBCT 3D corrections were calculated and recorded. For both positioning methods, four common treatment site combinations were evaluated: pelvis/lower extremities, abdomen, chest/upper extremities, and breast. Statistical differences were evaluated using a paired sample Wilcoxon signed‐rank test with significance level of <0.01.ResultsThe average magnitudes of the 3D shift vectors for tattoos were 0.9 ± 0.4 cm, 1.0 ± 0.5 cm, 0.9 ± 0.6 cm and 1.4 ± 0.7 cm for the pelvis/lower extremities, abdomen, chest/upper extremities and breast, respectively. For the CatalystHD, the average magnitude of the 3D shifts for the pelvis/lower extremities, abdomen, chest/upper extremities and breast were 0.6 ± 0.3 cm, 0.5 ± 0.3 cm, 0.5 ± 0.3 cm and 0.6 ± 0.2 cm, respectively. Statistically significant differences (P < 0.01) in the 3D shift vectors were found for all four sites.ConclusionThis study shows that the overall 3D shift corrections for patients initially aligned with the C‐RAD CatalystHD were significantly smaller than those aligned with subcutaneous tattoos. Surface imaging systems can be considered a viable option for initial patient setup and may be preferable to permanent marks for specific clinics and patients.

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“…The use of additional lateral skin marks, with a single anterior mark, is recommended to minimise rotation. 10,11 While rotational errors could not be assessed in this analysis, Elsner et al 12 demonstrated lateral skin marks minimise rotation (roll and yaw) when used in conjunction with the anterior skin mark in pelvic patients. Similar to our study, systematic and random errors in the S-I directions were also reduced, and isocentre reproducibility improved.…”

Section: Discussionmentioning

confidence: 93%

Set-up variation in palliative radiotherapy: one versus three skin localisation marks

et al. 2019

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Background: Accuracy and reproducibility of the patient’s position is crucial for successful delivery of radiotherapy (RT). Data on palliative patients’ set-up uncertainties are sparse. The aim of this study was to calculate set-up errors observed for palliative patients positioned using one skin mark (Group 1) versus three skin marks (Group 2) and to assess the accuracy of both approaches. Methods: Displacements in the left–right (L–R) and superior–inferior (S–I) directions were retrospectively analysed for 175 sites treated with a course of fractionated palliative RT. Population mean, systematic and random errors were calculated in both directions for patients positioned with one and three skin marks. Frequency of deviations was also examined for both groups. Results: The population mean, systematic and random errors for Group 1 and 2 for the L–R direction were 0·0, 4·4, 4·8 and 0·4, 3·1 and 3·3 mm, respectively, and in the S–I direction: 0·1, 3·4, 4·2 and 1·2, 2·7 and 3·3 mm, respectively. Frequency of images within the clinical tolerance of 5 mm was 47·1% for Group 1 and 65·9% for Group 2. Conclusion: Three skin marks are recommended for patients receiving a fractionated course of palliative RT, as it reduces set-up error, reduces the number of gross displacements (>10 mm) and increases the number of displacements within the clinically acceptable tolerance of 5 mm.

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Quality improvement process to assess tattoo alignment, set‐up accuracy and isocentre reproducibility in pelvic radiotherapy patients

Cited by 6 publications

References 15 publications

Augmented reality‐guided positioning system for radiotherapy patients

Augmented reality‐guided positioning system for radiotherapy patients

Comparison of initial patient setup accuracy between surface imaging and three point localization: A retrospective analysis

Set-up variation in palliative radiotherapy: one versus three skin localisation marks

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