Assessment of set-up variability during deep inspiration breath hold radiotherapy for breast cancer patients by 3D-surface imaging

Anja Betgen, Tanja Alderliesten, Jan-Jakob Sonke, Corine van Vliet-Vroegindeweij, Harry Bartelink, Peter Remeijer
Radiotherapy and Oncology 2013, 106 (2): 225-30

PURPOSE: To quantify set-up uncertainties during voluntary deep inspiration breath hold (DIBH) radiotherapy using 3D-surface imaging in patients with left sided breast cancer.

MATERIAL AND METHODS: Nineteen patients were included. Cone-beam CT-scan (CBCT) was used for online set-up correction while patients were instructed to perform a voluntary DIBH. The reproducibility of the DIBH during treatment was monitored with 2D-fluoroscopy and portal imaging. Simultaneously, a surface imaging system was used to capture 3D-surfaces throughout CBCT acquisition and delivery of treatment beams. Retrospectively, all captured surfaces were registered to the planning-CT surface. Interfraction, intra-fraction and intra-beam set-up variability were quantified in left-right, cranio-caudal and anterior-posterior direction.

RESULTS: Inter-fraction systematic (Σ) and random (σ) translational errors (1SD) before and after set-up correction were between 0.20-0.50 cm and 0.09-0.22 cm, respectively, whereas rotational Σ and σ errors were between 0.08 and 1.56°. The intra-fraction Σ and σ errors were ≤ 0.14 cm and ≤ 0.47°. The intra-beam SD variability was ≤ 0.08 cm and ≤ 0.28° in all directions.

CONCLUSION: Quantification of 3D set-up variability in DIBH RT showed that patients are able to perform a very stable and reproducible DIBH within a treatment fraction. However, relatively large inter-fraction variability requires online image guided set-up corrections.

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