Yao Lihong,Zhu Lihong,Wang Junjie,Cao Qianqian,Qu Ang,Zhou Shun,Jiang Shukun,Wang Min,Sun Haitao,Lin Lei.Setup errors and planning target margin by 6D radiotherapy couch combined with cone-beam CT during volumetric modulated arc therapy in gynecological cancer patients[J].Chinese Journal of Radiological Medicine and Protection,2015,35(3):206-209
Setup errors and planning target margin by 6D radiotherapy couch combined with cone-beam CT during volumetric modulated arc therapy in gynecological cancer patients
Received:July 26, 2014  
DOI:10.3760/cma.j.issn.0254-5098.2015.03.011
KeyWords:Cone beam computed tomography(CBCT)  6-degree-of-freedom treatment couch  Gynecological cancer  Setup errors  Target margin
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Author NameAffiliationE-mail
Yao Lihong Department of Radiation Oncology, Third Hospital of Peking University, Beijing 100191, China  
Zhu Lihong Department of Radiation Oncology, Third Hospital of Peking University, Beijing 100191, China zhulihong510@163.com 
Wang Junjie Department of Radiation Oncology, Third Hospital of Peking University, Beijing 100191, China  
Cao Qianqian Department of Radiation Oncology, Third Hospital of Peking University, Beijing 100191, China  
Qu Ang Department of Radiation Oncology, Third Hospital of Peking University, Beijing 100191, China  
Zhou Shun Department of Radiation Oncology, Third Hospital of Peking University, Beijing 100191, China  
Jiang Shukun Department of Radiation Oncology, Third Hospital of Peking University, Beijing 100191, China  
Wang Min Department of Radiation Oncology, Third Hospital of Peking University, Beijing 100191, China  
Sun Haitao Department of Radiation Oncology, Third Hospital of Peking University, Beijing 100191, China  
Lin Lei Department of Radiation Oncology, Third Hospital of Peking University, Beijing 100191, China  
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Abstract::
      Objective To evaluate inter-and intrafractional setup errors by 6-degree-of-freedom(6D)treatment couch in combination with kV cone-beam CT for gynecological cancer patients, and calculate planning target volume(PTV)margins.Methods Twenty postoperative gynecological cancer patients, who were scheduled to undergo volumetric modulated arc therapy(VMAT), were prospectively enrolled in the study. During the treatment, a CBCT was acquired on a daily basis after conventional position and was registered to the planning CT to determine initial inter-fraction error. Then, a second CBCT scan was performed to calculate residual inter-fraction error after the 6D couch online correction. After VMAT delivery, a final CBCT was acquired to assess intra-fraction motion. The PTV margins were calculated from the above setup variations.Results A total of 594 CBCT images were acquired from 20 patients. After the 6D couch online correction, the interfractional setup errors in y,z,Rx,Ry,Rz axis were significantly reduced(t=6.21,-8.60,2.13,-8.51,-3.48,P<0.05). The total PTV margins(MPTV)accounting for 6D couch online correction and intrafraction errors were 2.20, 3.43, 2.00 mm in the left-right(x axis), superior-inferior(y axis)and anterior-posterior(z axis)directions, respectively. After the 6D couch online correction, the reduction of MPTV ranged from 4.46 to 6.05 mm.Conclusions 6D in combination with CBCT could effectively improve the setup error accuracy of VMAT in postoperative gynecological cancer patients, while providing reliable basis for delineating the MPTV.
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