SUVPLN is a statistically significant prognostic factor of PALN recurrence and survival after definitive CCRT for pelvic node-positive SCC of the uterine cervix.
PurposeTo evaluate the utility of implanted surgical clips for detecting interfractional errors in the treatment of hepatobiliary and pancreatic cancer with postoperative radiotherapy (PORT).Methods and MaterialsTwenty patients had been treated with PORT for locally advanced hepatobiliary or pancreatic cancer, from November 2014 to April 2016. Patients underwent computed tomography simulation and were treated in expiratory breathing phase. During treatment, orthogonal kilovoltage (kV) imaging was taken twice a week, and isocenter shifts were made to match bony anatomy. The difference in position of clips between kV images and digitally reconstructed radiographs was determined. Clips were consist of 3 proximal clips (clip_p, ≤2 cm) and 3 distal clips (clip_d, >2 cm), which were classified according to distance from treatment center. The interfractional displacements of clips were measured in the superior-inferior (SI), anterior-posterior (AP), and right-left (RL) directions.ResultsThe translocation of clip was well correlated with diaphragm movement in 90.4% (190/210) of all images. The clip position errors greater than 5 mm were observed in 26.0% in SI, 1.8% in AP, and 5.4% in RL directions, respectively. Moreover, the clip position errors greater than 10 mm were observed in 1.9% in SI, 0.2% in AP, and 0.2% in RL directions, despite respiratory control.ConclusionQuantitative analysis of surgical clip displacement reflect respiratory motion, setup errors and postoperative change of intraabdominal organ position. Furthermore, position of clips is distinguished easily in verification images. The identification of the surgical clip position may lead to a significant improvement in the accuracy of upper abdominal radiation therapy.
cc This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. In Tomotherapy the couch sags during the treatment due to the weight of the patient. In this study, we developed a simple method to obtain the amount of the sag and the pitch angle of the couch using the image processing technique of MVCT images in Tomotherapy. Using the method we evaluated the sag and pitch of couch for 22 head and neck patients and one craniospinal irradiation (CSI) patient. The sag and the average pitch angle of couch were 0.40∼1.54 mm and 0.7 o for head and neck patients, respectively. For head and neck patients, the sag increased as the longitudinal length of the irradiation volume increased and the pitch angle showed no relationship with the longitudinal length. For the CSI patient the sag was 4.97 mm. Using the method the amount of the couch sag could be measured easily and the measured data could be useful in determination of margins considering the table sag error.
Analysis of Couch Sag Using Image Processing of MVCT Images in Tomotherapy
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