Two-dimensional and Three-dimensional Image-guided Evaluation of Patient Positioning for Intensity-modulated Radiation Therapy of Head and Neck Cancer

Authors

  • Zul Iskandar Johari ᵃCentre for Diagnostic, Therapeutic, and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia; ᵇMedical Radiation Surveillance Division, Ministry of Health Malaysia, 62590 Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia
  • Nor Aniza Azmi Centre for Diagnostic, Therapeutic, and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia https://orcid.org/0000-0002-6825-2381
  • Nur Fa’izah Ab Muin Radiotherapy and Oncology Department, Hospital Canselor Tuanku Muhriz, 56000 Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia
  • Rukiah A Latiff Centre for Diagnostic, Therapeutic, and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
  • Muhammad Safwan Ahmad Fadzil Centre for Diagnostic, Therapeutic, and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia https://orcid.org/0000-0002-9707-9231
  • Rosmizan Ahmad Razali Radiotherapy and Oncology Department, Hospital Canselor Tuanku Muhriz, 56000 Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia

DOI:

https://doi.org/10.11113/mjfas.v19n5.3040

Keywords:

Cone-beam computed tomography, Set-up error, Image-guided patient positioning, Head and Neck Cancer, intensity-modulated radiation therapy

Abstract

Patient positioning accuracy is critical in radiation therapy, especially in intensity-modulated radiation therapy (IMRT) for head and neck cancer (HNC), as it can affect treatment effectiveness and safety. This retrospective study aimed to evaluate the accuracy of patient positioning techniques and compare the effectiveness of using multiple image-guided (IG) methods for IG-IMRT of HNC. Cone-beam computed tomography (CBCT) and kV-planar imaging (OBI) collected 3240 treatment couch coordinates in three translational directions from 60 HNC patients undergoing IMRT. Inter-fraction errors were assessed by registering the scans to the planning CT, and the population systematic set-up error (Σ), random error (σ), and planning target volume (PTV) margin were calculated. The results between OBI and CBCT were analyzed and compared using one-way ANOVA. The findings demonstrated that more than 80% of the image-guided patient positioning set-ups were acceptable. The mean couch displacement for image-guided techniques was negligible in all translational directions using OBI and CBCT. However, the PTV margin for both methods was more than 0.5 cm, except for the CBCTA-P direction. This study highlights the effectiveness of OBI and CBCT as modalities for evaluating and improving the accuracy of IMRT in HNC patients. Determination of the systematic and random errors and calculating the optimal PTV margin without rematching images can help improve the precision of patient positioning and ultimately lead to better treatment outcomes.

 

Author Biographies

Nor Aniza Azmi, Centre for Diagnostic, Therapeutic, and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia

 

 

Nur Fa’izah Ab Muin, Radiotherapy and Oncology Department, Hospital Canselor Tuanku Muhriz, 56000 Cheras, Wilayah Persekutuan Kuala Lumpur, Malaysia

 

 

Rukiah A Latiff, Centre for Diagnostic, Therapeutic, and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia

 

 

 

Muhammad Safwan Ahmad Fadzil, Centre for Diagnostic, Therapeutic, and Investigative Studies (CODTIS), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia

 

 

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Published

19-10-2023