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The first real-time intrafraction target position monitoring in pancreas SBRT on an Elekta linear accelerator

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Abstract

To perform implanted fiducial based real-time target position monitoring in pancreas stereotactic body radiotherapy (SBRT) using the x-ray imaging system available in a Elekta linear accelerator. An in-house system was developed and clinically utilised for real-time target position monitoring of pancreas SBRT delivery. The developed system was used for the target position monitoring of a pancreas cancer patient treated in free breathing treatment within the study entitled ‘Mfolfirinox And STEreotactic Radiotherapy for Patients with Locally Advanced paNcreas cancer (MASTERPLAN): a feasibility study’ (ACTRN 12617001642370) consisting of five treatment fractions. The clinical efficacy of the system was studied by performing a retrospective cumulative dose assessment of delivered dose using observed position deviations. The developed system identified two events of baseline shifts in target position that exceeded the accepted tolerance level of ± 3 mm from reference planned position. The retrospective dose assessment study showed that if the position deviations were not detected and corrected for, the maximum dose to duodenum would have increased from 34.6 to 38.8 Gy. The first real-time position monitoring in pancreas SBRT on an Elekta linear accelerator was successfully performed. The developed system was shown to improve the safety and accuracy of SBRT delivery.

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Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Liverpool, Sydney, NSW, Australia

    Sankar Arumugam & Lois Holloway

  2. South Western Clinical School, University of New South Wales, Sydney, NSW, Australia

    Sankar Arumugam & Lois Holloway

  3. Department of Radiology, Liverpool and Macarthur Cancer Therapy Centres and Ingham Institute, Liverpool, Sydney, NSW, Australia

    Darren Pavey

  4. Radiation Oncology Centre, Gold Coast University Hospital, Southport, QLD, Australia

    Andrew Oar

  5. Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia

    Lois Holloway

  6. Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia

    Lois Holloway

  7. Department of Radiation Oncology, Liverpool and Macarthur Cancer Therapy Centres, Liverpool, Sydney, NSW, Australia

    Mark Sidhom & Mark Lee

  8. Department of Medical Physics, Liverpool and Macarthur Cancer Therapy Centres, Liverpool Hospital, Sydney, NSW, 2170, Australia

    Sankar Arumugam

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  1. Sankar Arumugam
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Correspondence to Sankar Arumugam.

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The study was approved by a human research ethics committee, South Western Sydney Local Health District, Australia.

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Arumugam, S., Pavey, D., Oar, A. et al. The first real-time intrafraction target position monitoring in pancreas SBRT on an Elekta linear accelerator. Phys Eng Sci Med 44, 625–638 (2021). https://doi.org/10.1007/s13246-021-01007-0

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  • DOI: https://doi.org/10.1007/s13246-021-01007-0

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