Internal movement, set-up accuracy and margins for stereotactic body radiotherapy using a stereotactic body frame

The aim of this study was to evaluate the uncertainty of patient immobilization within the Elekta body frame (SBF) used for stereotactic body radiotherapy (SBRT) and to suggest margins sufficient to ensure dose coverage to the gross target volume (GTV). The study was based on the evaluation of repeated CT-scans of 30 patients treated by SBRT. The overall uncertainty was divided between uncertainty related to internal movement of the tumor and uncertainty in the patient set-up. Standard deviations of the overall tumor displacement were 2 mm, 3 mm and 4 mm in medial-lateral (m-l), anterior-posterior (a-p), and cranio-caudal (c-c) directions, respectively. In a model based on the data, an ellipsoid planned target volume (PTV) corresponding to the standard deviations in the orthogonal directions and a scaling factor, K defined a 3-dimentional (3-D) probability density. According to the model, a 90% probability of full dose coverage of the GTV was secured using margins of 9 mm (m-l), 9 mm (a-p) and 13 mm (c-c), respectively. The overall uncertainty was dominated by internal tumor movements whereas the set-up uncertainty of the patient in the SBF was less pronounced. It was concluded that the Elekta SBF is useful for immobilisation of patients for SBRT. However, due to internal movement conventional margins of 5 mm in m-l and a-p and 10 mm in the c-c directions may be insufficient for full dose coverage.