Evaluation of Set-up Accuracy for Frame-based and Frameless Lung Stereotactic Body Radiation Therapy

Yunseo Ji; Byungchul Cho; Jungwon Kwak; Si Yeol Song; Eun Kyung Choi; Sang-wook Lee

doi:10.14316/pmp.2015.26.4.286

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Ji, Cho, Kwak, Song, Choi, and Lee: Evaluation of Set-up Accuracy for Frame-based and Frameless Lung Stereotactic Body Radiation Therapy

Original Article

Progress in Medical Physics 2015;26(4):286-293.

Published online: 20 January 2015

DOI: https://doi.org/10.14316/pmp.2015.26.4.286

Evaluation of Set-up Accuracy for Frame-based and Frameless Lung Stereotactic Body Radiation Therapy

Yunseo Ji, Kyung Hwan Chang, Byungchul Cho, Jungwon Kwak, Si Yeol Song, Eun Kyung Choi, Sang-wook Lee

Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence: Byungchul Cho (cho.byungchul@gmail.com) Tel: 82-2-3010-4437, Fax: 82-2-3010-6950 cc This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.o.byungchul@gmail.com)

Received 19 December 2015 Revised 21 December 2015 Accepted 23 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The purpose of this study was to evaluate the set up accuracy using stereotactic body frame and frameless immobilizer for lung stereotactic body radiation therapy (SBRT). For total 40 lung cancer patients treated by SBRT, 20 patients using stereotactic body frame and other 20 patients using frameless immobilizer were separately enrolled in each group. The setup errors of each group depending on the immobilization methods were compared and analyzed. All patients received the dose of 48∼60 Gy for 4 or 5 fractions. Before each treatment, a patient was first localized to the treatment isocenter using room lasers, and further aligned with a series of image guidance procedures; orthogonal kV radiographs, cone-beam CT, orthogonal fluoroscopy. The couch shifts during these procedures were recorded and analyzed for systematic and random errors of each group. Student t-test was performed to evaluate significant difference depending on the immobilization methods. The setup reproducibility was further analyzed using F-test with the random errors excluding the systematic setup errors. In addition, the ITV-PTV margin for each group was calculated. The setup errors for SBF were 0.05±0.25 cm in vertical direction, 0.20±0.38 cm in longitudinal direction, and 0.02±0.30 cm in lateral direction, respectively. However the setup errors for frameless immobilizer showed a significant increase of −0.24±0.25 cm in vertical direction while similar results of 0.06±0.34 cm, −0.02±0.25 cm in longitudinal and lateral directions. ITV-PTV margins for SBF were 0.67 cm (vertical), 0.99 cm (longitudinal), and 0.83 cm (lateral), respectively. On the other hand, ITV-PTV margins for Frameless immobilizer were 0.75 cm (vertical), 0.96 cm (longitudinal), and 0.72 cm (lateral), indicating less than 1 mm difference for all directions. In conclusion, stereotactic body frame improves reproducibility of patient setup, resulted in 0.1∼0.2 cm in both vertical and longitudinal directions. However the improvements are not substantial in clinic considering the effort and time consumption required for SBF setup.

Keywords: Stereotactic body radiation therapy, Stereotactic body frame, Frameless immobilizer, Interfraction motion, lung cancer

References

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Fig. 1.

Stereotactic Body Frame (a) with a vacuum cushion and Wing board (b) for stereotactic body radiation therapy in lung cancer.

Fig. 2.

Schematic diagram of patient setup correction protocol for lung stereotactic body radiation therapy.

Table 1.

Patient characteristics.

	Group
	Stereotactic body frame	Frameless immobilizer
Patients	n=20	n=20
Age (year) Range	50∼84	49∼83
Mean/median	69.45/71.5	67.95/68.5
Gender
Male Female	17 3	15 5
Tumor location
Right upper lobe (RUL)	2	4
Right middle lobe (RML)	1	0
Right lower lobe (RLL)	6	6
Left upper lobe (LUL)	9	1
Left lower lobe (LLL)	2	9
Tumor size Mean/median (cc) Range (cc)	9.64/6.04 0.42∼62.21	5.04/1.06 0.22∼33.7
Average diameter (cm)	2.21	1.57
Dose/fractionation
48 Gy/4 fx	3	1
50 Gy/5 fx	1	6
54 Gy/4 fx	0	2
60 Gy/4 fx	16	11

Table 2.

Setup errors for SBF (stereotactic body frame) and frameless immobilizer system.

Patient immobilization	Vertical (cm)	Longitudinal (cm)	Setup error Lateral (cm)	Rotation (^o)	3D (cm)
SBF (Stereotactic Body Frame)	0.05±0.25	0.20±0.38	0.02±0.30	0.08±0.63	0.50±0.27
Frameless immobilizer	−0.24±0.25	0.06±0.34	−0.02±0.25	0.01±0.56	0.50±0.21

Table 3.

Results of significant differences pairs of mean and variation setup error using T-test and F-test.

	Mean setup errors (T-test)				Variation of setup errors (F-test)
	Vertical	Longitudinal	Lateral	Rotation	Vertical	Longitudinal	Lateral	Rotation
	(cm)	(cm)	(cm)	(^o)	(cm)	(cm)	(cm)	(^o)
SBF (Stereotactic Body Frame)	0.05	0.20	0.02	0.08	0.28	0.26	0.36	0.72
Frameless immobilizer	−0.24	0.06	−0.02	0.01	0.49	0.44	0.37	0.80
p-value	3.2E–04	0.12	0.35	0.35	1.1E–06	1.1E–06	0.26	0.22

Table 4.

Margins calculated from systematic (∑) and random (σ) errors for all patients (N=40).

	SBF (Stereotactic Body Frame)			Frameless immobilizer
	Vertical (cm)	Longitudinal (cm)	Lateral (cm)	Vertical (cm)	Longitudinal (cm)	Lateral (cm)
∑	0.25	0.38	0.30	0.25	0.34	0.25
σ	0.28	0.26	0.36	0.49	0.44	0.37
M_PTV	0.72	1.03	0.91	0.89	1.07	0.80

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