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Residual Translational and Rotational Errors after kV X-Ray Image-Guided Correction of Prostate Location Using Implanted Fiducials

Residuale Translations- und Rotationsfehler nach röntgenbasierter bildgestützter Lagerungskorrektur der Prostata unter Verwendung implantierter Marker

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Abstract

Purpose:

To evaluate the residual errors and required safety margins after stereoscopic kilovoltage (kV) X-ray target localization of the prostate in image-guided radiotherapy (IGRT) using internal fiducials.

Patients and Methods:

Radiopaque fiducial markers (FMs) have been inserted into the prostate in a cohort of 33 patients. The ExacTrac/Novalis Body™ X-ray 6d image acquisition system (BrainLAB AG, Feldkirchen, Germany) was used. Corrections were performed in left-right (LR), anterior-posterior (AP), and superior-inferior (SI) direction. Rotational errors around LR (x-axis), AP (y) and SI (z) have been recorded for the first series of nine patients, and since 2007 for the subsequent 24 patients in addition corrected in each fraction by using the Robotic Tilt Module™ and Varian Exact Couch™. After positioning, a second set of X-ray images was acquired for verification purposes. Residual errors were registered and again corrected.

Results:

Standard deviations (SD) of residual translational random errors in LR, AP, and SI coordinates were 1.3, 1.7, and 2.2 mm. Residual random rotation errors were found for lateral (around x, tilt), vertical (around y, table), and longitudinal (around z, roll) and of 3.2°, 1.8°, and 1.5°. Planning target volume (PTV)-clinical target volume (CTV) margins were calculated in LR, AP, and SI direction to 2.3, 3.0, and 3.7 mm. After a second repositioning, the margins could be reduced to 1.8, 2.1, and 1.8 mm.

Conclusion:

On the basis of the residual setup error measurements, the margin required after one to two online X-ray corrections for the patients enrolled in this study would be at minimum 2 mm. The contribution of intrafractional motion to residual random errors has to be evaluated.

Zusammenfassung

Ziel:

Der residuale Lagerungsfehler und die erforderlichen Sicherheitsabstande in der bildgestutzten Lokalisation und Positionskorrektur der Prostata sollten ermittelt werden.

Patienten und Methodik:

In einer Gruppe von 33 Patienten wurden rontgendichte Marker in die Prostata implantiert. Die Autoren setzten das rontgenbasierte und automatisierte Positionierungs- und Verifikationssystem ExacTrac/Novalis Body™ (BrainLAB AG, Feldkirchen) ein. Fur die erste Serie von neun Patienten erfolgten tagliche Korrekturen des initalen Translationsfehlers in mediolateraler (ML), anteroposteriorer (AP) und superoinferiorer (SI) Richtung. Rotationsfehler um die seitliche (x), vertikale (y) und longitudinale Achse (z) wurden aufgezeichnet und seit 2007 fur die ubrigen 24 Patienten unter Verwendung des Robotic Tilt Module™ und der Varian Exact Couch™ vor jeder Fraktion ausgeglichen. Nach der Positionierung erfolgte eine Verifikation der Patientenposition mittels stereoskopischer Rontgenkontrollaufnahmen. Noch bestehende residuale Fehler wurden aufgezeichnet und erneut winkelgetreu korrigiert.

Ergebnisse:

Der residuale translationale Fehler betrug in LR, AP und SI (1 Standardabweichung [SD]) 1,3, 1,7 und 2,2 mm. Ermittelt wurden residuale Rotationsfehler (1 SD) um x, y und z von 3,2°, 1,8° und 1,5°. Die erforderlichen Sicherheitsabstande zwischen klinischem Zielvolumen (CTV) und Planungszielvolumen (PTV) wurden in ML, AP und SI mit 2,3, 3,0 und 3,7 mm berechnet. Nach einem zweiten Korrekturschritt konnten diese Sicherheitsabstande auf 1,8, 2,1 und 1,8 mm verringert werden.

Schlussfolgerung:

Auf der Grundlage der nach ein (oder zwei) Lagerungskorrekturen verbleibenden Restfehler der Patienten dieser Studie ist fur das PTV ein Sicherheitsabstand von mindestens 2 mm zum CTV erforderlich. Der Beitrag der intrafraktionellen Bewegung der Prostata fur den Lokalisationsfehler verbleibt das Thema weiterer Untersuchungen.

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Authors and Affiliations

  1. Department of Radiation Oncology, Charite – University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany

    Reinhold Graf, Dirk Boehmer, Volker Budach &  Peter Wust

  2. Klinik fur Strahlentherapie, Charite – Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

    Peter Wust

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  1. Reinhold Graf
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Correspondence to Peter Wust.

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Graf, R., Boehmer, D., Budach, V. et al. Residual Translational and Rotational Errors after kV X-Ray Image-Guided Correction of Prostate Location Using Implanted Fiducials. Strahlenther Onkol 186, 544–550 (2010). https://doi.org/10.1007/s00066-010-2030-8

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