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• W2094062013 abstract "Analyze CBCT images in terms of CTV vector displacement and compare shifts to the PTV margins. Determine whether correcting the data set patient by patient for the systematic error of the first five days reduces the number of days that setup error was greater than vector. Ascertain whether the images taken every 5th day represent the overall patient scalar and vector shifts and determine if patient imaging dose could be reduced by decreasing the frequency of imaging. To date over 400 patients have been treated with combination IMRT and IGRT at UC Davis. In this study 996 CBCT images were assessed from 30 patients. Of the patients analyzed 15 were prostate (11 with intact gland, 4 post prostatectomy), 8 were head & neck and 7 were primary brain tumors. All patients were treated with IMRT and imaged daily with CBCT. Each patient was initially set to the isocenter based on marks / tattoos made at CT simulation. A CBCT was taken and shifts in the three orthogonal axes were applied to correct any displacement over 1 mm. The three scalar shifts (cranial-caudal, anterior-posterior and left-right) were processed as a shift vector but taking the root sum of the squares. Two effects were considered: the average scalar shift of the first five images was removed from all subsequent images for a given patient and the number of days in which the shift vector was greater than the 3D-CTV-PTV margin (5mm created with rolling ball technique) recorded. Separately, without any corrections, the scalar shifts from every fifth fraction were averaged to determine if the shift vector would be adequately sampled if CBCT was not performed daily. Systematic and random errors were determined (van Herk method), the maximum error being 3.6mm for the lt / rt shift of prostate cases. From the initial 996 CBCT scans there were 439 cases (mean 14.6 per patient, range, 1 - 31) were the vector shift was initially greater than 5mm. By correcting each patients data set by the average shift of their first five images the total was 305 out of 996 (mean 10.2 per patient, range, 1 - 34). However, this reduction was not statistically significant (p = 0.07). Then by considering only every 5th image of each patient data set it was determined that the mean scalar shifts were almost always (97%) equivalent to the full data set. In spite of this, the vector shifts were grossly under sampled as only 96 out of the total 439 would have caught by imaging every 5th day, yielding a significant underestimation of 3.1 cases per patient (p < 0.001). In order to know the 3D (vector) position of the CTV and to ensure that it is always within the PTV margin daily imaging is required. Correcting the data set by the average shift from the first five days does reduce the overall shift and the number of outlier days but not be a statistically significant amount." @default.
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• W2094062013 date "2008-09-01" @default.
• W2094062013 modified "2023-09-25" @default.
• W2094062013 title "Vector Analysis of Patient Setup with Image Guided Radiation Therapy (IGRT) via Kv Cone Beam CT (CBCT)" @default.
• W2094062013 doi "https://doi.org/10.1016/j.ijrobp.2008.06.306" @default.
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