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CBCT image guidance in head and neck irradiation: the impact of daily and weekly imaging protocols

Published online by Cambridge University Press:  29 June 2015

Innocencia Nyarambi ,
Crispen Chamunyonga  and
Andrew Pearce
Innocencia Nyarambi*
Affiliation:
Sudbury Regional Hospital, Ontario, Canada
Crispen Chamunyonga
Affiliation:
School of Clinical Science, Queensland University of Technology, Queensland, Australia
Andrew Pearce
Affiliation:
Sudbury Regional Hospital, Ontario, Canada
*
Correspondence to: Innocencia Nyarambi, Sudbury Regional Hospital, 41Ramsey Lake Road, Sudbury, ON P3E 5J1, Canada. Tel: +1 705 522 6237. E-mail: INyarambi@hsnsudbury.ca
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Abstract

Purpose

This study evaluated the impact of a daily and weekly image-guided radiotherapy protocols in reducing setup errors and setting of appropriate margins in head and neck cancer patients.

Materials and methods

Interfraction and systematic shifts for the hypothetical day 1–3 plus weekly imaging were extrapolated from daily imaging data from 31 patients (964 cone beam computed tomography (CBCT) scans). In addition, residual setup errors were calculated by taking the average shifts in each direction for each patient based on the first three shifts and were presumed to represent systematic setup error. The clinical target volume (CTV) to planning target volume (PTV) margins were calculated using van Herk formula and analysed for each protocol.

Results

The mean interfraction shifts for daily imaging were 0·8, 0·3 and 0·5 mm in the S-I (superior-inferior), L-R (left-right) and A-P (anterior-posterior) direction, respectively. On the other hand the mean shifts for day 1–3 plus weekly imaging were 0·9, 1·8 and 0·5 mm in the S-I, L-R and A-P direction, respectively. The mean day 1–3 residual shifts were 1·5, 2·1 and 0·7 mm in the S-I, L-R and A-P direction, respectively. No significant difference was found in the mean setup error for the daily and hypothetical day 1–3 plus weekly protocol. However, the calculated CTV to PTV margins for the daily interfraction imaging data were 1·6, 3·8 and 1·4 mm in the S-I, L-R and A-P directions, respectively. Hypothetical day 1–3 plus weekly resulted in CTV–PTV margins of 5, 4·2 and 5 mm in the S-I, L-R and A-P direction.

Conclusions

The results of this study show that a daily CBCT protocol reduces setup errors and allows setup margin reduction in head and neck radiotherapy compared to a weekly imaging protocol.

Keywords

cancercone beam CThead and neckimage-guided radiotherapy
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 14 , Issue 4 , December 2015 , pp. 362 - 369
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Copyright
© Cambridge University Press 2015 

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