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• W2080342276 abstract "Purpose/Objective(s)In an effort to enhance patient comfort and improve interfraction setup variability, a simplified custom immobilization strategy was implemented in our clinic for prostate RT patients. Using captured IGRT target localization data, an analysis was performed to determine the influence of two different methods of patient immobilization on interfraction target localization.Materials/MethodsA total of 46 prostate patients receiving radiation therapy between Feb 2006 and Feb 2008 were analyzed. Each patient was treated daily with IMRT. Patients were setup supinely and custom immobilized with either the thermoplastic HipFix system, or beginning in May 2007, the Combifix knee and foot immobilization system (both by Civco Medical Solutions, Kalona, IA, USA). Daily localization was performed using commercial software (Isoloc, Civco) and 2 oblique orthogonal megavoltage portal images. 3 gold markers implanted under TRUS guidance prior to RT were easily identified on the portal images. Stereoscopic localization techniques were used to determine lateral (RL), superior/inferior (SI), and anterior/posterior (AP) translations needed to position the prostate (center-of-mass of implanted fiducials) at the treatment isocenter. Statistical analysis of the magnitude of systematic and random errors (represented by mean and standard deviation of sample data) in each direction (RL, SI, AP) were calculated per patient and for sample cohorts of patients (n = 10 per cohort) immobilized with the HipFix and Combifix systems. A two-sided Student's t test was used to assess the significance of differences between the groups.ResultsA total of 61% of all analyzed IGRT localizations (n = 1,253) had a displacement >5 mm. A majority of the localization displacements >5 mm were in the longitudinal direction for HipFix, and in the vertical direction for Combifix. No significant difference was seen between the HipFix and Combifix systems with regard to the mean systematic error in any direction (RL: 3.13 mm vs. 3.65 mm; SI: 4.44 mm vs. 3.54 mm; and AP: 4.04 mm vs. 4.14 mm). The magnitude of the mean random error was significantly less in the SI (3.07 mm vs. 2.28 mm) and AP (3.30 mm vs. 2.43 mm) directions using the Combifix immobilization system (p < 0.005).ConclusionsWhile the use of a daily IGRT correction strategy effectively removes both systematic and random uncertainties, the Combifix immobilization system provides custom patient immobilization while significantly reducing the mean random error in the SI and AP directions versus the HipFix system. Purpose/Objective(s)In an effort to enhance patient comfort and improve interfraction setup variability, a simplified custom immobilization strategy was implemented in our clinic for prostate RT patients. Using captured IGRT target localization data, an analysis was performed to determine the influence of two different methods of patient immobilization on interfraction target localization. In an effort to enhance patient comfort and improve interfraction setup variability, a simplified custom immobilization strategy was implemented in our clinic for prostate RT patients. Using captured IGRT target localization data, an analysis was performed to determine the influence of two different methods of patient immobilization on interfraction target localization. Materials/MethodsA total of 46 prostate patients receiving radiation therapy between Feb 2006 and Feb 2008 were analyzed. Each patient was treated daily with IMRT. Patients were setup supinely and custom immobilized with either the thermoplastic HipFix system, or beginning in May 2007, the Combifix knee and foot immobilization system (both by Civco Medical Solutions, Kalona, IA, USA). Daily localization was performed using commercial software (Isoloc, Civco) and 2 oblique orthogonal megavoltage portal images. 3 gold markers implanted under TRUS guidance prior to RT were easily identified on the portal images. Stereoscopic localization techniques were used to determine lateral (RL), superior/inferior (SI), and anterior/posterior (AP) translations needed to position the prostate (center-of-mass of implanted fiducials) at the treatment isocenter. Statistical analysis of the magnitude of systematic and random errors (represented by mean and standard deviation of sample data) in each direction (RL, SI, AP) were calculated per patient and for sample cohorts of patients (n = 10 per cohort) immobilized with the HipFix and Combifix systems. A two-sided Student's t test was used to assess the significance of differences between the groups. A total of 46 prostate patients receiving radiation therapy between Feb 2006 and Feb 2008 were analyzed. Each patient was treated daily with IMRT. Patients were setup supinely and custom immobilized with either the thermoplastic HipFix system, or beginning in May 2007, the Combifix knee and foot immobilization system (both by Civco Medical Solutions, Kalona, IA, USA). Daily localization was performed using commercial software (Isoloc, Civco) and 2 oblique orthogonal megavoltage portal images. 3 gold markers implanted under TRUS guidance prior to RT were easily identified on the portal images. Stereoscopic localization techniques were used to determine lateral (RL), superior/inferior (SI), and anterior/posterior (AP) translations needed to position the prostate (center-of-mass of implanted fiducials) at the treatment isocenter. Statistical analysis of the magnitude of systematic and random errors (represented by mean and standard deviation of sample data) in each direction (RL, SI, AP) were calculated per patient and for sample cohorts of patients (n = 10 per cohort) immobilized with the HipFix and Combifix systems. A two-sided Student's t test was used to assess the significance of differences between the groups. ResultsA total of 61% of all analyzed IGRT localizations (n = 1,253) had a displacement >5 mm. A majority of the localization displacements >5 mm were in the longitudinal direction for HipFix, and in the vertical direction for Combifix. No significant difference was seen between the HipFix and Combifix systems with regard to the mean systematic error in any direction (RL: 3.13 mm vs. 3.65 mm; SI: 4.44 mm vs. 3.54 mm; and AP: 4.04 mm vs. 4.14 mm). The magnitude of the mean random error was significantly less in the SI (3.07 mm vs. 2.28 mm) and AP (3.30 mm vs. 2.43 mm) directions using the Combifix immobilization system (p < 0.005). A total of 61% of all analyzed IGRT localizations (n = 1,253) had a displacement >5 mm. A majority of the localization displacements >5 mm were in the longitudinal direction for HipFix, and in the vertical direction for Combifix. No significant difference was seen between the HipFix and Combifix systems with regard to the mean systematic error in any direction (RL: 3.13 mm vs. 3.65 mm; SI: 4.44 mm vs. 3.54 mm; and AP: 4.04 mm vs. 4.14 mm). The magnitude of the mean random error was significantly less in the SI (3.07 mm vs. 2.28 mm) and AP (3.30 mm vs. 2.43 mm) directions using the Combifix immobilization system (p < 0.005). ConclusionsWhile the use of a daily IGRT correction strategy effectively removes both systematic and random uncertainties, the Combifix immobilization system provides custom patient immobilization while significantly reducing the mean random error in the SI and AP directions versus the HipFix system. While the use of a daily IGRT correction strategy effectively removes both systematic and random uncertainties, the Combifix immobilization system provides custom patient immobilization while significantly reducing the mean random error in the SI and AP directions versus the HipFix system." @default.
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• W2080342276 date "2008-09-01" @default.
• W2080342276 modified "2023-09-27" @default.
• W2080342276 title "Prostate IGRT using Implanted Fiducials: Influence of Patient Immobilization on Target Localization" @default.
• W2080342276 doi "https://doi.org/10.1016/j.ijrobp.2008.06.106" @default.
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