Three-dimensional surface and ultrasound imaging for daily IGRT of prostate cancer.

Marco Krengli,Giuseppina Apicella,Gianfranco Loi,Carla Pisani,Marco Brambilla,Debora Beldì,Valentina Amisano

doi:10.1186/s13014-016-0734-3

Abstract

BackgroundImage guided radiotherapy (IGRT) is an essential pre-requisite for delivering high precision radiotherapy. We compared daily variation detected by two non-ionizing imaging modalities (surface imaging and trans-abdominal ultrasound, US) to verify prostate patient setup and internal organ variations.MethodsForty patients with organ confined prostate cancer and candidates to curative radiotherapy were enrolled in this prospective study. At each treatment session, after laser alignment, all patients received imaging by a 3D-surface and a 3D-US system. The shifts along the three directions (anterior-posterior AP, cranial-caudal CC, and later-lateral LL) were measured in terms of systematic and random errors. Then, we performed statistical analysis on the differences and the possible correlations between the two modalities.ResultsFor both IGRT modalities, surface imaging and US, 1318 acquisitions were collected. According with Shapiro Wilk test, the positioning error distributions were not Gaussian for both modalities.The differences between the systematic errors detected by the two modalities were statistically significant only in LL direction (p < 0.05), while the differences between the random errors were not statistically significant in any directions.The 95% confidence interval of the residual errors obtained by subtracting the random errors detected with surface images to those detected with US was included in the range from −7 mm to 7 mm corresponding to the minimum PTV margin adopted in AP direction in our clinical routine.ConclusionsFrom our data, it emerges that setup misalignments measured by surface imaging can be predictive of US displacements after the adjustment for systematic errors. Moreover, surface imaging can detect setup errors predictive of registration errors measured by US. This data suggest that the two IGRT modalities could be considered as complementary to each other and could represent a daily “low-cost” and non-invasive IGRT modality in prostate cancer patients.

Highlights

Image guided radiotherapy (IGRT) is an essential pre-requisite for delivering high precision radiotherapy
The analysis of the systematic errors for each imaging modality showed that the mean systematic error detected by AlignRT was 2.2 mm (SD = 3.4 mm) in AP direction, 3.1 mm (SD = 3.7 mm) in the CC direction and 0.7 mm (SD = 1.9 mm) in the LL direction and the mean systematic error detected by Clarity was 3.0 mm (SD = 3.1 mm) in AP direction, 2.2 mm (SD = 1.3 mm) in CC direction and −0.1 mm (SD = 1.0 mm) in LL direction
This study showed that Trans-abdominal ultrasound (3D-US) is comparable to cone beam computed tomography (CBCT)

Summary

Introduction

Image guided radiotherapy (IGRT) is an essential pre-requisite for delivering high precision radiotherapy. We compared daily variation detected by two non-ionizing imaging modalities (surface imaging and trans-abdominal ultrasound, US) to verify prostate patient setup and internal organ variations. To correct for daily setup errors and inter-fraction organ motion, image guided radiation therapy (IGRT) is used, allowing for IGRT can be performed by imaging modalities using ionizing radiations such as cone beam computed tomography (CBCT) [1] or electronic portal imaging device (EPID) with fiducials [2, 3], or by imaging techniques not delivering ionizing radiations such as ultrasounds (US) [4, 5], electromagnetic transponders [6] and surface imaging systems [7,8,9]. Compared to CBCT, surface imaging systems showed mean positioning errors in the range of 0.1 − 4.0 mm whereas 3D-US systems showed mean systematic errors in the range of 1.3–2.5 mm and random errors in the range of 2.3-2.7 mm [10, 11]

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