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  • 1Department of Radiation Physics, MD Anderson Cancer Center, Houston, TX 77030, USA.

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|May 14, 2009
PubMed
Summary

This study shows that using internal and external fiducials for respiratory-gated radiotherapy of liver tumors is feasible and accurate. This method improves patient setup and verifies treatment accuracy for better outcomes.

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Area of Science:

  • Radiation Oncology
  • Medical Imaging

Background:

  • Image-guided radiotherapy (IGRT) for liver tumors faces challenges due to respiratory motion.
  • Accurate patient positioning is crucial for effective treatment delivery.

Purpose of the Study:

  • To assess the feasibility and accuracy of combining internal and external fiducials for respiratory-gated IGRT of liver tumors.
  • To evaluate patient eligibility for this technique using a mock treatment protocol.

Main Methods:

  • Five patients with liver tumors were enrolled.
  • Radio-opaque fiducials were implanted near the tumor for daily online positioning using electronic portal or kV imaging.
  • Patient eligibility was determined by correlating internal and external fiducials during a mock treatment.
  • Treatment delivery utilized modified amplitude-based gating.

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  • Offline verification of treatment accuracy was performed using cine mode imaging.

    • Main Results:

    • Interfractional random error was 2.0 mm (superior-inferior), and systematic error was 0.9 mm.
    • Intrafractional random error was 1.0 mm.
    • The technique demonstrated improved patient setup accuracy.
    • Daily image assessment confirmed treatment accuracy and identified setup issues.

    Conclusions:

    • Combining internal and external fiducials is a feasible and accurate method for respiratory-gated IGRT of liver tumors.
    • This approach enhances patient setup and allows for daily verification of treatment accuracy.
    • The technique holds promise for improving radiotherapy outcomes in liver cancer patients.