Analysis of setup uncertainties for extremity sarcoma patients using surface imaging

Gierga, David P.; Turcotte, J; Tong, Long W.; Chen, Yen-Lin E.; DeLaney, Thomas F.

doi:10.1016/j.prro.2013.09.001

Cited by 23 publications

(22 citation statements)

References 17 publications

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“…In this work we have shown the advantages of using SGRT for initial setup of cranial treatments using the Halcyon linac. However there are other sites that could also benefit from this technique such as head and neck, extremities, breast and prostate as has been shown for C‐arm linacs . We identified two limitations of the current SGRT setup.…”

Section: Discussionmentioning

confidence: 99%

“…Surface Guided Radiation Therapy (SGRT) provides an option for improved patient setup and real‐time monitoring and has been used previously for intracranial and extracranial regions . SGRT is a nonradiographic localization technique that uses a system of 3D cameras to detect a light pattern projected onto the patient and use the information to reconstruct a 3D surface image.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the use of different imaging and delivery techniques for cranial treatments on the Halcyon linac

Flores‐Martinez

Cerviño

Pawlicki

et al. 2019

J Applied Clin Med Phys

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Purpose: In this work, we investigated the effect on the workflow and setup accuracy of using surface guided radiation therapy (SGRT) for patient setup, megavoltage cone beam CT (MVCBCT) or kilovoltage cone beam CT (kVCBCT) for imaging and fixed IMRT or volumetric-modulated arc therapy (VMAT) for treatment delivery with the Halcyon linac. Methods:We performed a retrospective investigation of 272 treatment fractions, using three different workflows. The first and second workflows used MVCBCT and fixed IMRT for imaging and treatment delivery, and the second one also used SGRT for patient setup. The third workflow used SGRT for setup, kVCBCT for imaging and VMAT for delivery. Workflows were evaluated by comparing the number of fractions requiring repeated imaging acquisitions and the time required for setup, imaging and treatment delivery. Setup position accuracy was assessed by comparing the daily kV-or MV-CBCT with the planning CT and measuring the residual rotational errors for pitch, yaw and roll angles.Results: Without the use of SGRT, the imaging fields were delivered more than once on 11.1% of the fractions, while re-imaging was necessary in 5.5% of the fractions using SGRT. The total treatment time, including setup, imaging, and delivery, for the three workflows was 531 ± 157 s, 503 ± 130 s and 457 ± 91 s, respectively. A statistically significant difference was observed when comparing the third workflow with the first two. The total residual rotational errors were 1.96 ± 1.29°, 1.28 ± 0.67°and 1.22 ± 0.76°and statistically significant differences were observed when comparing workflows with and without SGRT. Conclusions:The use of SGRT allowed for a reduction of re-imaging during patient setup and improved patient position accuracy by reducing residual rotational errors.A reduction in treatment time using kVCBCT with SGRT was observed. The most efficient workflow was the one including kVCBCT and SGRT for setup and VMAT for delivery. K E Y W O R D SAlignRT, Halcyon, rotational errors, SGRT, surface guided radiotherapy ---

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of the use of different imaging and delivery techniques for cranial treatments on the Halcyon linac

Flores‐Martinez

Cerviño

Pawlicki

et al. 2019

J Applied Clin Med Phys

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“…As noted in the introduction, the overall approach using MixR for patient setup is akin to SGRT in that it provides a live, visual reference, enabling real‐time feedback and on‐line correction. Several studies have quantified the benefits of SGRT in comparison with a transitional three‐point setup for breast, chest wall, and sarcoma patients 30–34 . These sites involve a higher degree of nonrigid alignment in comparison with the intracranial or prostate cases where shifts tend to be rigid in nature.…”

Section: Discussionmentioning

confidence: 99%

Patient posture correction and alignment using mixed reality visualization and the HoloLens 2

et al. 2021

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Purpose The purpose of this study was to develop and preliminarily test a radiotherapy system for patient posture correction and alignment using mixed reality (MixR) visualization. The write‐up of this work also provides an opportunity to introduce the concepts and technology of MixR for a medical physics audience who may be unfamiliar with the topic. Methods A MixR application was developed for on optical‐see‐through head‐mounted display (HoloLens 2) allowing a user to simultaneously and directly view a patient and a reference hologram derived from their simulation CT scan. The hologram provides a visual reference for the exact posture needed during treatment and is initialized in relation to the origin of a radiotherapy device using marker‐based tracking. The system further provides marker‐less tracking that allows the user tofreely navigate the room as they view and align the patient from various angles. The system was preliminarily tested using both a rigid (pelvis) and nonrigid (female mannequin) anthropomorphic phantom. Each phantom was aligned via hologram and accuracy quantified using CBCT and CT. Results A fully realized system was developed. Rigid registration accuracy was on the order of 3.0 ± 1.5 mm based on the performance of three users repeating alignment five times each. The lateral direction showed the most variability among users and was associated with the largest off‐sets (approximately 2.0 mm). For nonrigid alignment, the MixR setup outperformed a setup based on three‐point alignment and setup photos, the latter of which showed a difference in arm position of 2 cm and a torso roll of 6–7°. Conclusions MixR visualization is a rapidly emerging domain that has the potential to significantly impact the field of medicine. The current application is an illustration of this and highlights the advantages of MixR for patient setup in radiation oncology. The key feature of the system is the way in which it transforms nonrigid registration into rigid registration by providing an efficient, portable, and cost‐effective mechanism for reproducing patient posture without the use of ionizing radiation. Preliminary estimates of registration accuracy indicate clinical viability and form the foundation for further development and clinical testing.

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“…A further limitation is the small sample size; however, this study was similar to sample sizes presented in related studies. 7,19,20 This study did not evaluate the effect of rotational displacements, which may result in large displacements at the end of an elongated target. 21 In 1 IMRT study, rotations of greater than 3°were corrected for by repositioning.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Factors that affect setup include flexibility of the limb and changes in soft tissue and surface contours. 7 RT carries a risk of long-term side effects, including limb fibrosis, joint stiffness, lymphedema, and bone fractures. 8 The risk of late effects increases with postoperative RT because of higher doses and a larger treated volume.…”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of 3-dimensional conformal radiation therapy and intensity modulated radiation therapy and impact of setup errors in lower limb sarcoma radiation therapy

Arthurs

Gillham²,

O'Shea³

et al. 2016

Practical Radiation Oncology

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Analysis of setup uncertainties for extremity sarcoma patients using surface imaging

Cited by 23 publications

References 17 publications

Assessment of the use of different imaging and delivery techniques for cranial treatments on the Halcyon linac

Assessment of the use of different imaging and delivery techniques for cranial treatments on the Halcyon linac

Patient posture correction and alignment using mixed reality visualization and the HoloLens 2

Dosimetric comparison of 3-dimensional conformal radiation therapy and intensity modulated radiation therapy and impact of setup errors in lower limb sarcoma radiation therapy

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