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Analysis of setup uncertainties for extremity sarcoma patients using surface imaging.

David P Gierga1, Julie C Turcotte2, Long W Tong2

  • 1Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.

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Summary

Surface imaging accurately quantifies patient setup errors for extremity sarcoma treatment. This technique can reduce setup variations, improving patient positioning accuracy in radiation therapy.

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Area of Science:

  • Radiation Oncology
  • Medical Imaging
  • Surgical Oncology

Background:

  • Accurate patient positioning is critical for effective radiation therapy, especially for extremity sarcoma tumors.
  • Setup uncertainties can compromise treatment efficacy and increase toxicity.

Purpose of the Study:

  • To quantify setup uncertainties in sarcoma patients using surface imaging.
  • To evaluate the potential of surface imaging to improve patient positioning accuracy.

Main Methods:

  • Collected 3D surface images for 16 patients over 236 treatments.
  • Quantified interfraction and intrafraction setup errors using offline surface registration.
  • Calculated required planning target volume (PTV) margins and assessed setup differences using RMS error analysis.

Main Results:

  • Intrafraction motion was minimal (mean 3D vector shift 2.1 mm).
  • Interfraction setup variations reached up to 9.5 mm, exceeding typical PTV margins.
  • Surface alignment reduced RMS errors from 4.7 mm to as low as 1.7 mm.

Conclusions:

  • Intrafraction motion is negligible, but interfraction motion requires daily imaging for correction.
  • Surface imaging is a feasible technique for daily image guidance, potentially reducing setup errors.
  • Utilizing daily imaging and surface guidance can improve patient positioning accuracy for sarcoma treatment.