Independent review of 4DCT scans used for SABR treatment planning

Four-dimensional computerized tomography (4DCT) is required for stereotactic ablative body radiotherapy (SABR) of mobile targets to account for tumor motion during treatment planning and delivery. In this study, we report on the impact of an image review quality assurance process performed prior to treatment planning by medical physicists for 4DCT scans used for SABR treatment. Reviews were performed of 211 4DCT scans (193 patients) over a 3-yr period (October 2014 to October 2017). Treatment sites included lung (n = 168), kidney/adrenal/adrenal gland (n = 12), rib (n = 4), mediastinum (n = 10), liver (n = 2), T-spine (n = 1), and other abdominal sites (n = 14). It was found that in 23% (n = 49) of cases patient management was altered due to the review process. The most frequent intervention involved patient-specific contouring advice (n = 35 cases, 17%) including adjustment of internal target volume (ITV) margins. In 13 cases (6%) a rescan was requested due to extensive motion artifact rendering the scan inadequate for SABR treatment planning. 4DCT review by medical physicists was found to be an effective method to improve plan quality for SABR.