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• W2324943034 abstract "Evaluate the residual error of the Nitinol stent-based-registration using online 4-D cone beam CT for the inoperable klatskin's tumor patients undergoing VMAT with concurrent Gemcitabine based chemotherapy. Three patients of inoperable klatskin tumor, who underwent stenting, were planned for further treatment with VMAT (54Gy/30#) using Monte Carlo-based biologic optimization. All patients underwent vacuum cushion immobilization, 4-D respiratory correlated image acquisition in cine mode which were phase sorted. Internal target volume (ITV), stent and all normal structures were delineated on post-contrast free breathing scan on focal 4-D workstation. Before each treatment, 4-D CBCT scans using one rotation-slow gantry speed technique, were obtained during free breathing mode on X-ray volume imaging. The time weighted (average) position of the stent on 4D-CBCT images were registered with stent localized on the reference dataset ie. free breathing planning CT scan, to obtain the residual translational and rotational set-up errors. Patients were repositioned for translational offsets >10 mm and rotational offsets >3degrees A total of ninety 4-D CBCT scans registered with the nitinol stent were analysed for the present study. Using stent for registration, population random setup errors (σ) were 2.8 mm (CC), 2.5 mm (ML), and 2.4 mm (AP), and systematic errors (Σ) were 1.1 mm, 1.9 mm, and 1.3 mm in the superior, medial, and posterior directions. Stent translational offsets >5 mm and >10mm were observed in 63% and 23% of treatments. Liver deformation >5 mm were observed in a minority of patients. Rotational errors >1° and >2° but < 3° were observed 90% and 65% respectively of treatments and were corrected by hexapod robotic couch with I-guide infrared tracking system. This study is the first of its kind reported in literature evaluating the feasibility of Stent based image registration for klatskin tumor chemorad treatments. Stent position after RT, guided with 4-D CBCT was within 5mm of planned position majority of patients. Rotational errors were evident possibly because of the liver deformation. With entire 4-D workflow from image acquisition, delineation and image guidance, stent based registration should improve accuracy of the treatments and better understanding of the deformation happening over the treatment period." @default.
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• W2324943034 date "2012-11-01" @default.
• W2324943034 modified "2023-09-26" @default.
• W2324943034 title "Accuracy of Stent-based 4-dimensional CBCT Image Guidance for Inoperable Klatskin Tumor Treated by Chemoradiation Therapy" @default.
• W2324943034 doi "https://doi.org/10.1016/j.ijrobp.2012.07.2035" @default.
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