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Nonrigid patient setup errors in the head-and-neck region.

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Nonrigid setup errors in head-and-neck (H&N) cancer patients are significant. Relative motion margins exceed positioning margins, requiring adjustments in radiation therapy planning.

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Area of Science:

  • Radiation Oncology
  • Medical Imaging
  • Biomechanical Analysis

Background:

  • Accurate patient positioning is critical for effective radiation therapy.
  • The head-and-neck (H&N) region presents unique challenges due to anatomical mobility.
  • Treating H&N tumors often assumes a rigid patient anatomy, which may not always be accurate.

Purpose of the Study:

  • To quantify the magnitude of relative motion and nonrigid setup errors in the H&N region.
  • To assess the clinical relevance of these errors in radiation therapy.
  • To determine appropriate margins for compensating relative motion.

Main Methods:

  • Eleven H&N cancer patients were immobilized using thermoplastic head masks.
  • Kilovoltage cone-beam CT (kV CBCT) was used for verification in 100 treatment fractions.
  • Image registration was performed on five regions of interest (ROIs) to calculate relative motion between planning CT and verification CBCT.

Main Results:

  • Overall 3-D patient setup error was 3.2 mm +/- 1.7 mm.
  • No systematic relative motion was observed between planning and treatment.
  • Largest mobility was seen between the skull/mandible and C4-C6 (up to 4.7 mm).
  • Maximum relative rotation (nodding) was 11 degrees.
  • Required margins for relative motion (5-10 mm) exceeded those for patient positioning.

Conclusions:

  • Treating the H&N region as a rigid body introduces significant errors due to relative motion.
  • Margins needed to account for relative motion are larger than those for setup errors.
  • These findings necessitate re-evaluation of treatment planning margins for H&N radiotherapy.