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A Robust and Affordable Table Indexing Approach for Multi-isocenter Dosimetrically Matched Fields.

Amy Yu1, Benjamin Fahimian1, Lynn Million1

  • 1Department of Radiation Oncology, Stanford University School of Medicine.

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|June 28, 2017
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Summary

Total lymphoid irradiation (TLI) treatments require precise patient positioning. A new couch indexing technique significantly reduces setup errors in TLI radiotherapy, improving patient safety and treatment accuracy.

Keywords:
dosimetric match fieldssafetyshift errortable indexingtli

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Radiotherapy Treatment Planning

Background:

  • Extended volume radiotherapy, such as total lymphoid irradiation (TLI), necessitates multiple fields and precise dosimetric matching.
  • Conventional TLI planning involves complex patient repositioning (couch shifts and sliding) due to large irradiated volumes and equipment limitations.
  • Patient repositioning in TLI is a significant safety concern, prone to geometrical errors and medical events.

Purpose of the Study:

  • To develop and evaluate a practical couch indexing technique for total lymphoid irradiation (TLI) treatments.
  • To mitigate safety issues and reduce geometrical setup errors associated with conventional TLI delivery.
  • To improve the accuracy and reproducibility of patient positioning during extended volume radiotherapy.

Main Methods:

  • A modified slide board with notches and a headrest was developed for patient indexing.
  • A retrospective analysis compared couch position standard deviations (SDs) in patients treated with (n=20) and without (n=10) the indexing device.
  • Student's t-test was used to analyze differences in longitudinal, lateral, and vertical couch positioning between the two groups.

Main Results:

  • The indexing technique significantly reduced longitudinal positioning SD from 2.0-7.9 cm to 0.4-1.3 cm (p < 0.05).
  • Lateral positioning showed a slight but significant improvement (p < 0.05) with the indexing device.
  • No significant improvement was observed in the vertical positioning direction.

Conclusions:

  • Conventional matched-field TLI treatments are susceptible to geometrical setup errors.
  • The developed couch indexing technique is feasible for full indexing of TLI treatments.
  • This technique significantly reduces patient positioning and shifting errors, enhancing treatment safety and accuracy.