An analysis of intratreatment and intertreatment displacements in pelvic radiotherapy using electronic portal imaging

Alfred Tinger, Jeff M. Michalski, Walter R. Bosch, Richard K Valicenti, Daniel A. Low, Robert J. Myerson

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Purpose: To evaluate the relative frequency and magnitude of intratreatment and intertreatment displacements in the patient positioning for pelvic radiotherapy using electronic portal imaging. Methods and Materials: Five hundred ninety-four electronic portal images of seven patients treated with a four-field pelvic technique were evaluated. All patients were treated prone without an immobilization device. Two fields were treated per day, from which an average of two electronic portal images were obtained for each field. No treatment was interrupted or adjusted on the basis of these images. Each image was aligned to the corresponding simulation film to measure the displacements in the mediolateral, craniocaudal, and anteroposterior directions relative to the simulated center. The intertreatment displacement was the displacement measured from the initial image for each daily treated field. For each daily treated field the intratreatment displacement was calculated by subtracting the displacement measured on the initial image from the displacement measured on the final image. Results: The frequency of intertreatment displacements exceeding 10 mm was 3%, 16%, and 23% for the mediolateral, craniocaudal, and anteroposterior translations, respectively. There were no intratreatment displacements exceeding 10 mm (p < 0.001). The frequency of intertreatment displacements exceeding 5 mm was 40, 52, and 51% for the mediolateral, craniocaudal, and anteroposterior translations, respectively; whereas, the frequency of intratreatment displacements exceeding 5 mm was 1, 5, and 7% for the same translations, respectively (p < 0.001). The standard deviation of the intertreatment displacements was at least three times as great as the standard deviation of the intratreatment displacements for all translations. These deviations were greater than the precision limit of the measurement technique, which is approximately 1 mm. Each patient had one direction where systematic error predominated in intertreatment positioning. Random error predominated for intratreatment positioning and for the other two directions in intertreatment positioning. Conclusions: During a course of pelvic radiotherapy, the frequency of intertreatment displacements exceeding 5 and 10 mm is significantly greater than the frequency of intratreatment displacements of these magnitudes. Errors in intertreatment positioning are predominantly systematic in one direction for each patient, whereas intratreatment error is predominantly random. Because patients do not move considerably during the daily treatment of a pelvic field, a single electronic portal image per daily field may be considered representative of the treated position.

Original languageEnglish (US)
Pages (from-to)683-690
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume34
Issue number3
DOIs
StatePublished - Feb 1 1996
Externally publishedYes

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radiation therapy
Radiotherapy
electronics
positioning
Patient Positioning
Immobilization
Equipment and Supplies
Direction compound
standard deviation
Therapeutics
random errors
immobilization
systematic errors
deviation

Keywords

  • Electronic portal imaging
  • Intratreatment and intertreatment displacements
  • Pelvic radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

An analysis of intratreatment and intertreatment displacements in pelvic radiotherapy using electronic portal imaging. / Tinger, Alfred; Michalski, Jeff M.; Bosch, Walter R.; Valicenti, Richard K; Low, Daniel A.; Myerson, Robert J.

In: International Journal of Radiation Oncology Biology Physics, Vol. 34, No. 3, 01.02.1996, p. 683-690.

Research output: Contribution to journalArticle

Tinger, Alfred ; Michalski, Jeff M. ; Bosch, Walter R. ; Valicenti, Richard K ; Low, Daniel A. ; Myerson, Robert J. / An analysis of intratreatment and intertreatment displacements in pelvic radiotherapy using electronic portal imaging. In: International Journal of Radiation Oncology Biology Physics. 1996 ; Vol. 34, No. 3. pp. 683-690.
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AU - Michalski, Jeff M.

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AU - Low, Daniel A.

AU - Myerson, Robert J.

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N2 - Purpose: To evaluate the relative frequency and magnitude of intratreatment and intertreatment displacements in the patient positioning for pelvic radiotherapy using electronic portal imaging. Methods and Materials: Five hundred ninety-four electronic portal images of seven patients treated with a four-field pelvic technique were evaluated. All patients were treated prone without an immobilization device. Two fields were treated per day, from which an average of two electronic portal images were obtained for each field. No treatment was interrupted or adjusted on the basis of these images. Each image was aligned to the corresponding simulation film to measure the displacements in the mediolateral, craniocaudal, and anteroposterior directions relative to the simulated center. The intertreatment displacement was the displacement measured from the initial image for each daily treated field. For each daily treated field the intratreatment displacement was calculated by subtracting the displacement measured on the initial image from the displacement measured on the final image. Results: The frequency of intertreatment displacements exceeding 10 mm was 3%, 16%, and 23% for the mediolateral, craniocaudal, and anteroposterior translations, respectively. There were no intratreatment displacements exceeding 10 mm (p < 0.001). The frequency of intertreatment displacements exceeding 5 mm was 40, 52, and 51% for the mediolateral, craniocaudal, and anteroposterior translations, respectively; whereas, the frequency of intratreatment displacements exceeding 5 mm was 1, 5, and 7% for the same translations, respectively (p < 0.001). The standard deviation of the intertreatment displacements was at least three times as great as the standard deviation of the intratreatment displacements for all translations. These deviations were greater than the precision limit of the measurement technique, which is approximately 1 mm. Each patient had one direction where systematic error predominated in intertreatment positioning. Random error predominated for intratreatment positioning and for the other two directions in intertreatment positioning. Conclusions: During a course of pelvic radiotherapy, the frequency of intertreatment displacements exceeding 5 and 10 mm is significantly greater than the frequency of intratreatment displacements of these magnitudes. Errors in intertreatment positioning are predominantly systematic in one direction for each patient, whereas intratreatment error is predominantly random. Because patients do not move considerably during the daily treatment of a pelvic field, a single electronic portal image per daily field may be considered representative of the treated position.

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