Skip to main content
SpringerLink
Log in

Utility of a skin marker–less setup procedure using surface-guided imaging: a comparison with the traditional laser-based setup in extremity irradiation

  • Clinical Technique
  • Published:
Radiological Physics and Technology Aims and scope Submit manuscript

Abstract

This study aimed to assess the feasibility of a skin marker–less patient setup using a surface-guided radiotherapy (SGRT) system for extremity radiotherapy. Twenty-five patients who underwent radiotherapy to the extremities were included in this retrospective study. The first group consisted of 10 patients and underwent a traditional setup procedure using skin marks and lasers. The second group comprised 15 patients and had a skin marker–less setup procedure that used an SGRT system only. To compare the two setup procedures for setup accuracy, the mean 3D vector shift magnitude was 0.9 mm for the traditional setup procedure and 0.5 mm for the skin marker–less setup procedure (p < 0.01). In addition, SGRT systems have been suggested to improve the accuracy and reproducibility of patient setups and consistently reduce interfractional setup errors. These results indicate that a skin marker–less patient setup procedure using an SGRT system is useful for extremity irradiation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data are not available.

References

  1. Gierga DP, Turcotte JC, Tong LW, et al. Analysis of setup uncertainties for extremity sarcoma patients using surface imaging. Pract Radiat Oncol. 2014;4(4):261–6. https://doi.org/10.1016/j.prro.2013.09.001.

    Article  PubMed  Google Scholar 

  2. Li XA, Qi XS, Pitterle M, et al. Interfractional variations in patient setup and anatomic change assessed by daily computed tomography. Int J Radiat Oncol Biol Phys. 2007;68:581–91. https://doi.org/10.1016/j.ijrobp.2006.12.024.

    Article  PubMed  Google Scholar 

  3. Dickie CI, Parent AL, Chung PW, et al. Measuring interfractional and intrafractional motion with cone beam computed tomography and an optical localization system for lower extremity soft tissue sarcoma patients treated with preoperative intensity-modulated radiation therapy. Int J Radiat Oncol Biol Phys. 2010;78:1437–44. https://doi.org/10.1016/j.ijrobp.2009.09.054.

    Article  PubMed  Google Scholar 

  4. Radiotherapy Kataroukai. Working group for standardizing skin marking. https://drive.google.com/file/d1qpgpCqZJOcG8V2VBbClHOdx5V8lE2d6m/view. (Accessed date Oct 2021)

  5. Asada H, Takahashi Y, Ono Y, et al. Emotional experiences of skin markings among patients undergoing radiotherapy and related factors: a questionnaire-based cross-sectional study. Patient Prefer Adherence. 2022;16:1359–69. https://doi.org/10.2147/PPA.S361916.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Stanley DN, McConnell KA, Kirby N, et al. Comparison of initial patient setup accuracy between surface imaging and three point localization: a retrospective analysis. J Appl Clin Med Phys. 2017;18(6):58–61. https://doi.org/10.1002/acm2.12183.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hoisak JDP, Pawlicki T. The role of optical surface imaging system in radiation therapy. Semin Radiat Oncol. 2018;28(3):185–93.

    Article  PubMed  Google Scholar 

  8. Rigley J, Robertson P, Scattergood L. Radiotherapy without tattoos: could this work? Radiography. 2020;26:288–93. https://doi.org/10.1016/j.radi.2020.02.008.

    Article  CAS  PubMed  Google Scholar 

  9. Batin E, Depauw N, MacDonald S, et al. Can surface imaging improve the patient setup for proton postmastectomy chest wall irradiation? Pract Radiat Oncol. 2016;6(6):e235–41. https://doi.org/10.1016/j.prro.2016.02.001.

    Article  PubMed  Google Scholar 

  10. van Herk M, Remeijer P, Rasch C, et al. The probability of correct target dosage: dose-population histograms for deriving treatment margins in radiotherapy. Int J Radiat Oncol Biol Phys. 2000;47:1121–35. https://doi.org/10.1016/S0360-3016(00)00518-6.

    Article  PubMed  Google Scholar 

  11. Ling CC, Yorke E, Fuks Z. From IMRT to IGRT: Frontierland or Neverland? Radiother Oncol. 2006;78:119–22. https://doi.org/10.1016/j.radonc.2005.12.005.

    Article  PubMed  Google Scholar 

  12. Islam MK, Purdie TG, Norrlinger BD, et al. Patient dose from kilovoltage cone beam computed tomography imaging in radiation therapy. Med Phys. 2006;33:1573–82. https://doi.org/10.1118/1.2198169.

    Article  PubMed  Google Scholar 

  13. Freislederer P, Batista V, Ollers M, et al. ESTRO-ACROP guideline on surface guided radiation therapy. Radiother Oncol. 2022;173:188–96. https://doi.org/10.1016/j.radonc.2022.05.026.

    Article  CAS  PubMed  Google Scholar 

  14. Yamaguchi H, Matsumoto M, Ohta S, et al. Analysis of statistical significance for difference of setup error between staff and new face in radiotherapy. Nihon Hoshasen Gijutsu Gakkai Zasshi. 2012;68(5):602–7. https://doi.org/10.6009/jjrt.2012_JSRT_68.5.602.

    Article  PubMed  Google Scholar 

  15. Greer PB, Mortensen TM. Anterior-posterior treatment localization in pelvic radiotherapy: tattoos or fixed couch-to-isocenter distance. Med Dosim. 1997;22:43–6. https://doi.org/10.1016/S0958-3947(96)00156-2.

    Article  CAS  PubMed  Google Scholar 

  16. Elsner K, Francis K, Hruby G, et al. Quality improvement process to assess tattoo alignment, set-up accuracy and isocentre reproducibility in pelvic radiotherapy patients. J Med Radiat Sci. 2014;61(4):246–52. https://doi.org/10.1002/jmrs.79.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Nguyen N-TA, Roberge D, Freeman CR, et al. Skin elasticity as a measure of radiation fibrosis: is it reproducible and does it correlate with patient and physician-reported measures. Technol Cancer Res Treat. 2014;13:469–76.

    PubMed  Google Scholar 

  18. Japanese Society of Radiological Technology. Radiotherapy Division. Journal of Radiotherapy Section. 202236(2):49-58; https://jsrt.or.jp/data/wp-content/uploads/2022/10/3tiryou_2022_10_secure.pdf. (Accessed date Apr 2022)

  19. Jimenez RB, Batin E, Giantsoudi D, et al. Tattoo free setup for partial breast irradiation: a feasibility study. J Appl Clin Med Phys. 2019;20:45–50. https://doi.org/10.1002/acm2.12557.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Naidoo W, Leech M. Feasibility of surface guided radiotherapy for patient positioning in breast radiotherapy versus conventional tattoo-based setups– a systematic review. Tech Innov Patient Support Radiat Oncol. 2022;22:39–49. https://doi.org/10.1016/j.tipsro.2022.03.001.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sasaki M, Matsushita N, Fujimoto T, et al. New patient setup procedure using surface-guided imaging to reduce body touch and skin marks in whole-breast irradiation during the COVID-19 pandemic. Radiol Phys Technol. 2023;16:422–9. https://doi.org/10.1007/s12194-023-00735-0.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Chiba Cancer Center, 666-2 Nitona-Chou, Chuo-ku, Chiba, 260-8717, Japan

    Kei Yamashita, Takayuki Shimizu, Kanae Miyabayashi, Tsutomu Iwase, Gentaro Togasaki & Ryusuke Hara

Authors
  1. Kei Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takayuki Shimizu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kanae Miyabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tsutomu Iwase
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gentaro Togasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ryusuke Hara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kei Yamashita.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures involving human participants were performed in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki Declaration and its later amendments. This study was approved by the Institutional Review Board of Chiba Cancer Center on June 23, 2023 (approval number: R05-127).

Informed consent

Informed consent was obtained from the opt-out option on our institution’s website. The patients’ right to privacy was preserved by anonymizing their data.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yamashita, K., Shimizu, T., Miyabayashi, K. et al. Utility of a skin marker–less setup procedure using surface-guided imaging: a comparison with the traditional laser-based setup in extremity irradiation. Radiol Phys Technol 17, 569–577 (2024). https://doi.org/10.1007/s12194-024-00806-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12194-024-00806-w

Keywords

Search

Navigation