Darren Zuro1, Stefano Vagge2, Sara Broggi3, Stefano Agostinelli2, Yutaka Takahashi4, Jamison Brooks5, Paulina Leszcynska6, An Liu5, Claudio Zucchetti7, Simonetta Saldi8, Chunhui Han5, Mauro Cattaneo3, Sebastian Giebel6, Marc Andre Mahe8, James F Sanchez5, Parham Alaei9, Chiara Anna3, Kathryn Dusenbery9, Antonio Pierini10, Guy Storme11, Cynthia Aristei8, Jeffrey Y C Wong5, Susanta Hui12. 1. Department of Radiation Oncology, Beckman Research Institute, City of Hope, Duarte, USA; Department of Radiation Oncology, University of Minnesota, Minneapolis, USA. 2. Deparment of Medical Imaging and Radiation Sciences, IRCCS Ospedale Policlinico San Martino, Genoa, Italy. 3. Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy. 4. Department of Radiation Oncology, Osaka University, Suita, Japan. 5. Department of Radiation Oncology, Beckman Research Institute, City of Hope, Duarte, USA. 6. Department of Radiotherapy Planning, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Poland. 7. Department of Radiation Oncology, University of Perugia, Italy. 8. Department of Radiation Oncology, University of Nantes, France. 9. Department of Radiation Oncology, University of Minnesota, Minneapolis, USA. 10. Division of Hematology and Clinical Immunology, Department of Medicine, University of Perugia, Italy. 11. Department of Radiotherapy UZ Brussel, Belgium. 12. Department of Radiation Oncology, Beckman Research Institute, City of Hope, Duarte, USA. Electronic address: shui@coh.org.
Abstract
PURPOSE: Total marrow irradiation (TMI) is a highly conformal treatment of the human skeleton structure requiring a high degree of precision and accuracy for treatment delivery. Although many centers worldwide initiated clinical studies using TMI, currently there is no standard for pretreatment patient setup. To this end, the accuracy of different patient setups was measured using pretreatment imaging. Their impact on dose delivery was assessed for multiple institutions. METHODS AND MATERIALS: Whole body imaging (WBI) or partial body imaging (PBI) was performed using pretreatment megavoltage computed tomography (MVCT) in a helical Tomotherapy machine. Rigid registration of MVCT and planning kilovoltage computed tomography images were performed to measure setup error and its effect on dose distribution. The entire skeleton was considered the planning target volume (PTV) with five sub regions: head/neck (HN), spine, shoulder and clavicle (SC), and one avoidance structure, the lungs. Sixty-eight total patients (>300 images) across six institutions were analyzed. RESULTS: Patient setup techniques differed between centers, creating variations in dose delivery. Registration accuracy varied by anatomical region and by imaging technique, with the lowest to the highest degree of pretreatment rigid shifts in the following order: spine, pelvis, HN, SC, and lungs. Mean fractional dose was affected in regions of high registration mismatch, in particular the lungs. CONCLUSIONS: MVCT imaging and whole body patient immobilization was essential for assessing treatment setup, allowing for the complete analysis of 3D dose distribution in the PTV and lungs (or avoidance structures).
PURPOSE: Total marrow irradiation (TMI) is a highly conformal treatment of the human skeleton structure requiring a high degree of precision and accuracy for treatment delivery. Although many centers worldwide initiated clinical studies using TMI, currently there is no standard for pretreatment patient setup. To this end, the accuracy of different patient setups was measured using pretreatment imaging. Their impact on dose delivery was assessed for multiple institutions. METHODS AND MATERIALS: Whole body imaging (WBI) or partial body imaging (PBI) was performed using pretreatment megavoltage computed tomography (MVCT) in a helical Tomotherapy machine. Rigid registration of MVCT and planning kilovoltage computed tomography images were performed to measure setup error and its effect on dose distribution. The entire skeleton was considered the planning target volume (PTV) with five sub regions: head/neck (HN), spine, shoulder and clavicle (SC), and one avoidance structure, the lungs. Sixty-eight total patients (>300 images) across six institutions were analyzed. RESULTS: Patient setup techniques differed between centers, creating variations in dose delivery. Registration accuracy varied by anatomical region and by imaging technique, with the lowest to the highest degree of pretreatment rigid shifts in the following order: spine, pelvis, HN, SC, and lungs. Mean fractional dose was affected in regions of high registration mismatch, in particular the lungs. CONCLUSIONS: MVCT imaging and whole body patient immobilization was essential for assessing treatment setup, allowing for the complete analysis of 3D dose distribution in the PTV and lungs (or avoidance structures).
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