Evaluation of Interfractional Setup Uncertainties and Calculation of Adequate CTV-PTV Margin for Head and Neck Radiotherapy Using Electronic Portal Imaging Device

Overview

Journal J Biomed Phys Eng

Publisher Shiraz University of Medical Sciences

Specialty Biomedical Engineering

Date 2025 Feb 20

PMID 39975521

Authors

Elham Ahmadi

Azam Eskandari

Mohammad Mohammadi

Maryam Naji

Shahrokh Naseri

Hamid Gholamhosseinian

Affiliations

Soon will be listed here.

Abstract

Background: The evaluation of treatment-associated errors is important in the radiotherapy process, particularly those resulting related to patient setup.

Objective: This research aimed to assess the interfractional setup errors and determine the Clinical Target Volume to Planning Target Volume (CTV to PTV) margin in patients undergoing 3-Dimensional Conformal Radiation Therapy (3DCRT) for head and neck cancer by means of electronic portal imaging device.

Material And Methods: In this analytical study, 300 portal images were acquired from 50 patients undergoing 3DCRT for head and neck cancer. Using the portal images of Lateral (LAT) and Antero-Posterior (AP) fields, population systematic (∑) and random (σ) errors were obtained in the lateral, longitudinal, and vertical directions. Finally, based on the International Commission on Radiation Units and Measurements (ICRU) Report 62's, Stroom's and Van Herk's methods, Planning target volume margins were determined.

Results: The translational shift ranges were 0-8.1 mm in the ML, 0-9 mm in the SI (AP), 0-8.8 mm in the SI (LAT), and 0-10 mm in the AP directions. The population systematic and random errors were respectively 3.230, 2.753, and 2.997 mm, and 1.476, 1.853, and 1.715 mm in X, Y, and Z directions. The calculated PTV margins using the ICRU-62, Stroom's, and Van Herk's formulae were ranging from 3.236-3.551, 6.605-7.493, and 7.932-9.108 mm, respectively.

Conclusion: A PTV margin of 7.5-9.5 mm seems safe for ensuring adequate treatment volume coverage. In addition, the EPID is an effective equipment for verifying patient positioning and reducing treatment setup errors.

References

Mirzaei M, Hosseini S, Ghoncheh M, Soheilipour F, Soltani S, Soheilipour F . Epidemiology and Trend of Head and Neck Cancers in Iran. Glob J Health Sci. 2015; 8(1):189-93. PMC: 4803954. DOI: 10.5539/gjhs.v8n1p189. View

Jalali R, Budrukkar A, Sarin R, Sharma D . High precision conformal radiotherapy employing conservative margins in childhood benign and low-grade brain tumours. Radiother Oncol. 2005; 74(1):37-44. DOI: 10.1016/j.radonc.2004.09.014. View

de Boer H, van Sornsen de Koste J, Creutzberg C, Visser A, Levendag P, Heijmen B . Electronic portal image assisted reduction of systematic set-up errors in head and neck irradiation. Radiother Oncol. 2001; 61(3):299-308. DOI: 10.1016/s0167-8140(01)00437-6. View

Gilbeau L, Octave-Prignot M, Loncol T, Renard L, Scalliet P, Gregoire V . Comparison of setup accuracy of three different thermoplastic masks for the treatment of brain and head and neck tumors. Radiother Oncol. 2001; 58(2):155-62. DOI: 10.1016/s0167-8140(00)00280-2. View

Beltran C, Krasin M, Merchant T . Inter- and intrafractional positional uncertainties in pediatric radiotherapy patients with brain and head and neck tumors. Int J Radiat Oncol Biol Phys. 2010; 79(4):1266-74. PMC: 3536549. DOI: 10.1016/j.ijrobp.2009.12.057. View

Rosenthal S, Gall K, Jackson M, Thornton Jr A . A precision cranial immobilization system for conformal stereotactic fractionated radiation therapy. Int J Radiat Oncol Biol Phys. 1995; 33(5):1239-45. DOI: 10.1016/0360-3016(95)02009-8. View

Gupta T, Chopra S, Kadam A, Agarwal J, Devi P, Ghosh-Laskar S . Assessment of three-dimensional set-up errors in conventional head and neck radiotherapy using electronic portal imaging device. Radiat Oncol. 2007; 2:44. PMC: 2238756. DOI: 10.1186/1748-717X-2-44. View

Herman M, Balter J, Jaffray D, McGee K, Munro P, Shalev S . Clinical use of electronic portal imaging: report of AAPM Radiation Therapy Committee Task Group 58. Med Phys. 2001; 28(5):712-37. DOI: 10.1118/1.1368128. View

Hess C, Kortmann R, Jany R, Hamberger A, Bamberg M . Accuracy of field alignment in radiotherapy of head and neck cancer utilizing individualized face mask immobilization: a retrospective analysis of clinical practice. Radiother Oncol. 1995; 34(1):69-72. DOI: 10.1016/0167-8140(94)01497-q. View

10.

Coca-Pelaz A, Rodrigo J, Suarez C, Nixon I, Makitie A, Sanabria A . The risk of second primary tumors in head and neck cancer: A systematic review. Head Neck. 2019; 42(3):456-466. DOI: 10.1002/hed.26016. View

11.

Court L, Wolfsberger L, Allen A, James S, Tishler R . Clinical experience of the importance of daily portal imaging for head and neck IMRT treatments. J Appl Clin Med Phys. 2008; 9(3):26-33. PMC: 5722295. DOI: 10.1120/jacmp.v9i3.2756. View

12.

Pehlivan B, Pichenot C, Castaing M, Auperin A, Lefkopoulos D, Arriagada R . Interfractional set-up errors evaluation by daily electronic portal imaging of IMRT in head and neck cancer patients. Acta Oncol. 2008; 48(3):440-5. DOI: 10.1080/02841860802400610. View

13.

Perdomo S, Martin Roa G, Brennan P, Forman D, Sierra M . Head and neck cancer burden and preventive measures in Central and South America. Cancer Epidemiol. 2016; 44 Suppl 1:S43-S52. DOI: 10.1016/j.canep.2016.03.012. View

14.

Humphreys M, Guerrero Urbano M, Mubata C, Miles E, Harrington K, Bidmead M . Assessment of a customised immobilisation system for head and neck IMRT using electronic portal imaging. Radiother Oncol. 2005; 77(1):39-44. DOI: 10.1016/j.radonc.2005.06.039. View

15.

Strbac B, Jokic V . Evaluation of set-up errors in head and neck radiotherapy using electronic portal imaging. Phys Med. 2013; 29(5):531-6. DOI: 10.1016/j.ejmp.2012.12.001. View

16.

Suzuki M, Nishimura Y, Nakamatsu K, Okumura M, Hashiba H, Koike R . Analysis of interfractional set-up errors and intrafractional organ motions during IMRT for head and neck tumors to define an appropriate planning target volume (PTV)- and planning organs at risk volume (PRV)-margins. Radiother Oncol. 2006; 78(3):283-90. DOI: 10.1016/j.radonc.2006.03.006. View

17.

Budrukkar A, Dutta D, Sharma D, Yadav P, Dantas S, Jalali R . Comparison of geometric uncertainties using electronic portal imaging device in focal three-dimensional conformal radiation therapy using different head supports. J Cancer Res Ther. 2008; 4(2):70-6. DOI: 10.4103/0973-1482.42252. View

18.

Herman M, Kruse J, Hagness C . Guide to clinical use of electronic portal imaging. J Appl Clin Med Phys. 2001; 1(2):38-57. PMC: 5726148. DOI: 10.1120/jacmp.v1i2.2645. View

19.

Stroom J, Heijmen B . Geometrical uncertainties, radiotherapy planning margins, and the ICRU-62 report. Radiother Oncol. 2002; 64(1):75-83. DOI: 10.1016/s0167-8140(02)00140-8. View

20.

Ciardo D, Alterio D, Jereczek-Fossa B, Riboldi M, Zerini D, Santoro L . Set-up errors in head and neck cancer patients treated with intensity modulated radiation therapy: Quantitative comparison between three-dimensional cone-beam CT and two-dimensional kilovoltage images. Phys Med. 2015; 31(8):1015-1021. DOI: 10.1016/j.ejmp.2015.08.004. View