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Articulations of the Vertebral Column01:28

Articulations of the Vertebral Column

In addition to being held together by the intervertebral discs, adjacent vertebrae also articulate with each other at synovial joints formed between the superior and inferior articular processes called zygapophysial joints (facet joints). These are plane joints that provide for only limited motions between the vertebrae. The orientation of the articular processes at these joints varies in different regions of the vertebral column and serves to determine the types of motions available in each...

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Room to Move: Enhancing Head and Neck Radiotherapy With a Six-Degree-of-Freedom Couch.

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Rotational adjustments on six-degree-of-freedom couches significantly improve target coverage in head and neck cancer radiotherapy. These corrections are crucial for accurate patient alignment and effective treatment delivery, minimizing PTV coverage loss.

Keywords:
head and neck oncologyhead and neck radiationimage guided radiotherapyimmobilizationradiation simulation

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Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Image-guided radiation therapy (IGRT) relies on precise patient alignment.
  • Six-degree-of-freedom (6DoF) couches enable rotational adjustments for improved accuracy.
  • Head and neck (H&N) cancers often present large, irregular target volumes, increasing the risk of rotational errors.

Purpose of the Study:

  • To evaluate the impact of rotational adjustments on target coverage and organ at risk (OAR) dose in H&N cancer radiotherapy.
  • To assess the frequency of rotational corrections in H&N cancer treatment using 6DoF couches.
  • To determine optimal rotational error thresholds for H&N radiotherapy setup.

Main Methods:

  • Review of 214 radiotherapy fractions for H&N cancer patients treated with a 6DoF couch.
  • Recalculation of delivered dose with and without rotational components.
  • Analysis of planning target volume (PTV) V70Gy coverage deviations (3% and 5% thresholds).

Main Results:

  • Rotational shifts were applied in 212 of 214 fractions.
  • Excluding rotational shifts led to a median decrease in PTV V100% of 1.97%.
  • Twenty percent of fractions experienced a PTV coverage decrease of ≥3% without rotational shifts, often requiring ≥1.5° correction.

Conclusions:

  • Rotational corrections are frequently utilized and beneficial for PTV coverage in H&N radiotherapy.
  • OAR doses showed less dependency on rotational correction magnitude.
  • A setup goal of <1.5° rotational error in all planes is suggested for H&N radiotherapy.