Using the Cone Beam Computed Tomography, Evaluation of Setup Errors in Volumetric Intensity Modulated Arc Therapy by Dr. Rachid Errifai

Introduction

External radiation treatment protocols follow very exact steps. Accuracy is, however, constrained by a wide variety of error causes that occur throughout treatment planning and delivery. A significant source of inaccuracy that requires special attention is the challenge of consistently recreating the patient's location. The margin between the CTV and the PTV is determined by the estimation of these errors. Geometric precision is a crucial factor in the radiation of nasopharyngeal cancer. The purpose of this work is to present the method of computing systematic and random errors, in order to establish the positioning accuracy of patients on the treatment table on a daily basis.

Radiation Cancer

Ionizing radiation is most frequently utilized in radiotherapy to treat cancer. This method not only inhibits the growth of the tumor but also kills the cancerous cells, causing the tumor to go away. External radiation treatment protocols follow very exact steps.

Accuracy is, however, constrained by a wide variety of error causes that occur throughout treatment planning and delivery. A significant source of inaccuracy that requires special attention is the challenge of consistently recreating the patient's location. This geometric accuracy is a crucial factor, on par with sound dosimetric planning, in determining the efficacy of a treatment. Numerous research has been conducted on the severe repercussions that can result from mistakes These studies emphasize the importance of tracking the patient's positioning in relation to the required dose on a frequent basis and making any necessary adjustments by the following. Both systematic and random positional variations exist.

All treatment sessions include the former, which are the result of cumulative deviations during the treatment planning process. Additionally, the random variances are erratic from day to day and signify unpredictability in positioning. With the introduction of three-dimensional conformational radiotherapy, the International Commission on Radiation Units and Measurements (ICRU) advocated the development of a projected target volume to take into account these potential movements.

Planning Target Volume (PTV), which accounts for this uncertainty in repositioning Around ten potential. The patient's anatomical imaging Computed Tomography (CT SCAN) at time t0 is used to plan radiation therapy. Five to seven weeks of radiation are used for the treatments, with the rate of days a week, comprising one session per day. Then, interfraction changes might happen due to mistakes made while the patient is positioned on the treatment table or anatomical variations (tumor melting, weight loss, edoema, change in location and/or organ volumes, etc.). It's important to take into account intra-fraction fluctuations caused by internal physiological processes including breathing, swallowing, and beating. As a result, treatment planning cannot accurately reflect the treatment actually administered since variances could result in unfavorable outcomes like back-aging tumor volumes or overdosing healthy individuals. The accuracy with which the patient is repositioned, or more specifically, the volume that has to be exposed to radiation in respect to the machine's isocenter, determines how well a treatment will work. Practitioners employ a variety of confinement and tracking techniques to accurately recreate the patient's initial posture. The most popular technique makes use of mounted lasers in the treatment area. These lasers are placed with the patient's tattoos on his skin to position him for each session. In their clinical practice, the margins applied to the CTV volume to account for geometric uncertainties are quite small; the margin applied to create the PTV is 4 mm in, 5 mm in the craniocaudal direction, 5 mm in the right-left and anterior-posterior directions. These margins derive from a prior study conducted by their teams, which showed that 98% of portal imaging displacements were less than 4 mm and that no displacement exceeded 5 mm.

During the process of acquiring planning photos, tattoos are created. They create the tracking reference system. While it ensures the external structures' locations can be replicated, this technology does not allow for the control of internal organ positions where displacements can occur. When irradiating nasopharyngeal cancers, the margins between the PTV volume and the CTV volume must be carefully chosen since too wide of a margin increases the risk of toxicity while too narrow of a margin increases the risk of recurrence. This margin selection must be supported by a quantitative assessment of the displacements/deformations of the interest volumes and the inherent uncertainties in the applied irradiation procedures. In many institutions, it is routine procedure to measure installation mistakes using CBCT imaging. This allowed for the detection and mitigation of installation mistakes in a significant proportion of patients. The PTV-CTV margins of 7 mm are safe and acceptable in ordinary clinical practice, but one could allow them in certain special circumstances, such as the vicinity of the organs.

Recent Publication

Mini Review: Evaluation of Setup Errors in Radiotherapy with Volumetric Intensity Modulated Arc-Therapy Based On the Cone Beam Computed Tomography for Nasopharyngeal Cancer: Case of the Cheikh Zaid Hospital.

Journal homepage: https://www.iomcworld.org/european-clinical-oncology.html  

Submission Link: https://www.scholarscentral.org/submissions/european-clinical-oncology.html 


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