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Daily setup uncertainty analysis for craniospinal irradiation using helical tomotherapy.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Radiotherapy Planning

Background:

  • Craniospinal irradiation (CSI) is a complex radiotherapy technique requiring precise target volume delineation.
  • Helical tomotherapy offers advanced dose distribution capabilities but necessitates accurate patient setup.
  • Establishing optimal planning target volume (PTV) margins is crucial for ensuring adequate coverage of the clinical target volume (CTV) while minimizing dose to organs at risk.

Purpose of the Study:

  • To determine the optimal planning target volume (PTV) margin for craniospinal irradiation (CSI) patients treated with helical tomotherapy in the supine position.
  • To analyze setup deviations in CSI patients to inform PTV margin adjustments.
  • To evaluate the impact of daily image guidance on required PTV margins for CSI.

Main Methods:

  • Analysis of daily setup shifts from 27 CSI tomotherapy patients over 454 fractions using pretreatment megavoltage computed tomography (MVCT).
  • Evaluation of translational displacements in mediolateral (ML), craniocaudal (CC), and anteroposterior (AP) directions.
  • Calculation of systematic and random setup errors to derive PTV margins for scenarios with and without daily image guidance.

Main Results:

  • Individual patient mean shifts were -0.5 ± 2.1 mm (ML), 1.0 ± 2.7 mm (CC), and 0.7 ± 1.1 mm (AP).
  • Random setup errors were 1.9 mm (ML), 1.9 mm (CC), and 2.2 mm (AP).
  • Required PTV margins without daily imaging ranged up to 6.4 mm superiorly in the CC direction.

Conclusions:

  • A 3.0 mm PTV margin is adequate for CSI tomotherapy patients receiving daily MVCT image guidance.
  • When daily pretreatment verification imaging is omitted, a larger PTV margin, up to 6.4 mm in the CC direction, is necessary to account for setup uncertainties.
  • These findings aid in optimizing PTV margins for CSI to balance target coverage and treatment toxicity.