Analysis of intra-fractional positioning correction performed by cone beam computed tomography in SBRT treatments

• Published in: Physica medica Vol. 125; p. 104502
• Main Authors: García-Acilu, P, García Ruiz-Zorrilla, J., Hernando, O., Prado, A., Chen-Zhao, X., Montero, A., Martí, J., Zucca, D., Alonso, L., De la Casa, M.A., Sánchez, E., Alonso, R., Rubio, C., Fernández-Letón, P.
• Format: Journal Article
• Language: English
• Published: Italy Elsevier Ltd 01.09.2024
• Subjects: Breath Holding; Cone-Beam Computed Tomography - methods; DIBH; Dose Fractionation, Radiation; Humans; Intra-fraction CBCT; Male; Particle Accelerators; Patient Positioning; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiosurgery - methods; Retrospective Studies; SBRT; Intra-fraction CBCT; SBRT; DIBH
• ISSN: 1120-1797; 1724-191X; 1724-191X
• DOI: 10.1016/j.ejmp.2024.104502

•Intra-fraction shifts during DIBH SBRTs are not negligible in the longitudinal axis.•Clarity system improves the prostate control in SBRT in the superior-inferior axis.•Both spirometer based and surface guided DIBH methods detected shifts < 1.1 mm.•Spirometer based DIBH system provides results slightly better than surface guided ones. This study aims to evaluate the positioning correction extracted from Intra-fraction Cone Beam (IF-CBCT) images obtained during Stereotactic Body Radiotherapy (SBRT) treatments, and to assess whether its magnitude justifies its acquisition. In addition, the results obtained in lung, liver, and pancreas SBRTs with two deep inspiration breath-hold systems (DIBH), and for prostate with/without ultrasound (US) monitoring were compared. 1449 treatments, performed with two linear accelerators (LINACs) were retrospectively analyzed. DIBH were performed either with a spirometry-based device or a surface-guidance system and one LINAC was equipped with US monitoring system for prostate. Significance tests were used to account for differences between units. Group systematic error (M) was approximately –0.7 mm for DIBH treatments in superior-inferior (SI) direction with no difference (p > 0.7) between LINACs. Moreover, there was a SI difference of 0.5 mm for prostate treatments (p = 0.008), in favor of the US monitored one. In anterior-posterior (AP) direction, only liver treatments exhibited differences between LINACs, with the spirometer-based system being 0.8 mm inferior (p = 0.003). M<0.4 mm in left–right (LR) direction was found for all locations and LINACs. The spirometer-based system resulted in lower standard deviation of systematic and random errors in most components and locations, with a greater effect observed in liver SBRTs. The corrections made with IF-CBCT during SBRT treatments were not negligible. Both DIBH systems were effective in managing respiratory movements. However, the spirometry-based system was slightly more accurate. In addition, US monitoring of the prostate appeared to be useful in reducing target shift.