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A self-checking treatment couch coordinate calculation system in radiotherapy.

Pingfang Tsai1, Chihray Liu1, Darren L Kahler1

  • 1Department of Radiation Oncology, University of Florida, College of Medicine, Gainesville, FL, USA.

Journal of Applied Clinical Medical Physics
|November 19, 2019
PubMed
Summary

A new system accurately calculates radiotherapy treatment couch coordinates (TCCs) in advance, improving patient safety and reducing therapist workload. This streamlined process prevents errors like wrong-site treatment and minimizes setup time.

Keywords:
couch coordinateerror preventionpatient setupworkflow automation

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Area of Science:

  • Medical Physics
  • Radiotherapy Technology
  • Radiation Oncology

Background:

  • Traditional radiotherapy treatment couch coordinate (TCC) determination is performed at the time of treatment, increasing therapist pressure and error potential.
  • Errors such as wrong-site treatment or incorrect table shifts can occur due to the manual nature of TCC determination.
  • Existing methods lack a streamlined and robust system for pre-calculating TCCs.

Purpose of the Study:

  • To develop and validate an accurate, robust, and streamlined system for the advance calculation of treatment couch coordinates (TCCs).
  • To reduce the potential for errors in patient positioning during radiotherapy.
  • To improve the efficiency of the radiotherapy workflow.

Main Methods:

  • A novel system combining two calculation methods using an indexed immobilization device.
  • Method 1: Uses reference ball bearings (BBs) on the CT couch-top and the spatial offset of the treatment planning isocenter.
  • Method 2: Utilizes the direct mapping relationship between CT scanner DICOM coordinates and TCC system.
  • An integrated workflow with automated self-checking was implemented, validated on 275 patients using cone-beam CT for reference.

Main Results:

  • An efficient, transparent workflow for CT simulation and treatment was established.
  • The system is universally applicable to all treatment sites and compatible with any indexed immobilization device.
  • Both calculation methods demonstrated comparable accuracy, with 95% of results within 3 mm.
  • Inter-fraction variation was within ±1.0 cm for 95% of coordinates across all treatment sites.

Conclusions:

  • A robust, accurate, and streamlined system for advance TCC calculation has been successfully implemented.
  • The system alleviates pressure on therapists, reduces patient setup time, and enhances patient safety.
  • Implementation of this system significantly minimizes the risk of radiotherapy setup errors.