NDLI: Potentials and limitations of guiding liver stereotactic body radiation therapy set-up on liver-implanted fiducial markers.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Wunderink, Wouter Méndez Romero, Alejandra Seppenwoolde, Yvette de Boer, Hans Levendag, Peter Heijmen, Ben
Description	Country affiliation: Netherlands Author Affiliation: Wunderink W ( Erasmus Medical Center-Daniel den Hoed Cancer Center, Department of Radiation Oncology, Groene Hilledijk 301, 3008AE Rotterdam, The Netherlands. w.wunderink@erasmusmc.nl)
Abstract	PURPOSE: We investigated the potentials and limitations of guiding liver stereotactic body radiation therapy (SBRT) set-up on liver-implanted fiducial markers. METHODS AND MATERIALS: Twelve patients undergoing compression-supported SBRT in a stereotactic body frame received fluoroscopy at treatment preparation and before each treatment fraction. In fluoroscopic videos we localized the markers and diaphragm tip at expiration and the spine (measurements on free-breathing and abdominal compression). Day-to-day displacements, rotations (markers only), and deformations were determined. Marker guidance was compared to conventional set-up strategies in treatment set-up simulations. RESULTS: For compression, day-to-day motion of markers with respect to their centers of mass (COM) was sigma = 0.9 mm (random error SD), Sigma = 0.4 mm (systematic error SD), and <2.1 mm (maximum). Consequently, assuming that markers were closely surrounding spherical tumors, marker COM-guided set-up would have required safety margins of approximately 2 mm. Using marker COM as the gold standard, other set-up methods (using no correction, spine registration, and diaphragm tip craniocaudal registration) resulted in set-up errors of 1.4 mm < sigma < 2.8 mm, 2.6 mm < Sigma < 5.1 mm, and 6.3 mm < max < 12.4 mm. Day-to-day intermarker motion of <16.7%, 2.2% median, and rotations between 3.5 degrees and 7.2 degrees were observed. For markers not surrounding the tumor, e.g., 5 cm between respective COMs, these changes could effect residual tumor set-up errors up to 8.4 mm, 1.1 mm median (deformations), and 3.1 mm to 6.3 mm (rotations). Compression did not systematically contribute to deformations and rotations, since similar results were observed for free-breathing. CONCLUSIONS: If markers can be implanted near and around the tumor, residual set-up errors by marker guidance are small compared to those of conventional set-up methods, allowing high-precision tumor radiation set-up. However, substantial errors may result if markers are not implanted precisely, requiring further research to obtain adequate safety margins.
File Format	HTM / HTML
ISSN	03603016
Issue Number	5
Volume Number	77
e-ISSN	1879355X
Journal	International Journal of Radiation OncologyastBiologyastPhysics
Language	English
Publisher	Elsevier
Publisher Date	2010-08-01
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Discipline Radiology Carcinoma, Hepatocellular Surgery Liver Neoplasms Movement Prostheses And Implants Radiosurgery Methods Radiotherapy Planning, Computer-assisted Diaphragm Humans Radiography Standards Respiration Rotation Spine Video Recording Journal Article
Content Type	Text
Resource Type	Article
Subject Domain (in MeSH)	Musculoskeletal System Eukaryota Neoplasms Diagnosis Therapeutics Equipment and Supplies Physical Phenomena Physiological Phenomena Circulatory and Respiratory Physiological Phenomena Information Science
Subject	Oncology Radiology, Nuclear Medicine and Imaging Cancer Research Radiation

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
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4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
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