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Inter-fractional error and intra-fractional motion of prostate and dosimetry comparisons of patient position registrations with versus without fiducial markers during treatment with carbon-ion radiotherapy

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Abstract

A few reports have discussed the influence of inter-fractional position error and intra-fractional motion on dose distribution, particularly regarding a spread-out Bragg peak. We investigated inter-fractional and intra-fractional prostate position error by monitoring fiducial marker positions. In 2020, data from 15 patients with prostate cancer who received carbon-ion beam radiotherapy (CIRT) with gold markers were investigated. We checked marker positions before and during irradiation to calculate the inter-fractional positioning and intra-fractional movement and evaluated the CIRT dose distribution by adjusting the planning beam isocenter and clinical target volume (CTV) position. We compared the CTV dose coverages (CTV receiving 95% [V95%] or 98% [V98%] of the prescribed dose) between skeletal and fiducial matching irradiation on the treatment planning system. For inter-fractional error, the mean distance between the marker position in the planning images and that in a patient starting irradiation with skeletal matching was 1.49 ± 1.11 mm (95th percentile = 1.85 mm). The 95th percentile (maximum) values of the intra-fractional movement were 0.79 mm (2.31 mm), 1.17 mm (2.48 mm), 1.88 mm (4.01 mm), 1.23 mm (3.00 mm), and 2.09 mm (8.46 mm) along the lateral, inferior, superior, dorsal, and ventral axes, respectively. The mean V95% and V98% were 98.2% and 96.2% for the skeletal matching plan and 99.5% and 96.8% for the fiducial matching plan, respectively. Fiducial matching irradiation improved the CTV dose coverage compared with skeletal matching irradiation for CIRT for prostate cancer.

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Data availability

The data that support the findings of this study are available on request from the corresponding author but restrictions apply to the availability of these data, which are not publicly available due to ethical restrictions.

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Acknowledgements

The authors would like to thank all members of the Quality Control Office of QST Hospital for their technical assistance.

Funding

This work was supported by Grants‐in‐Aid for Scientific Research (C) (21K07715) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

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Authors and Affiliations

  1. National Institutes for Quantum Science and Technology, QST Hospital, Chiba, Japan

    Yuma Iwai, Hitoshi Ishikawa, Noriyuki Okonogi, Kana Kobayashi, Masaru Wakatsuki & Shigeru Yamada

  2. Department of Accelerator and Medical Physics, Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba, 263-8555, Japan

    Shinichiro Mori, Nobuyuki Kanematsu, Shinnosuke Matsumoto & Taku Nakaji

  3. Department of Radiology, Chiba University Hospital, Chiba, Japan

    Takashi Uno

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  1. Yuma Iwai
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Correspondence to Shinichiro Mori.

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The institutional review board approved this study (No. 20–034).

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The contents of this paper were presented at the 34th Annual Meeting of the Japanese Society for Radiation Oncology.

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Iwai, Y., Mori, S., Ishikawa, H. et al. Inter-fractional error and intra-fractional motion of prostate and dosimetry comparisons of patient position registrations with versus without fiducial markers during treatment with carbon-ion radiotherapy. Radiol Phys Technol 17, 504–517 (2024). https://doi.org/10.1007/s12194-024-00808-8

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