Wu Chuanfeng,Wu Jinchang,Gu Ke,Li Cheng,Shen Danqing,Hu Rui.Analysis of lower neck setup errors and planning target margin by CBCT for breast cancer radiation with breast bracket immobilized[J].Chinese Journal of Radiological Medicine and Protection,2016,36(10):753-756
Analysis of lower neck setup errors and planning target margin by CBCT for breast cancer radiation with breast bracket immobilized
Received:June 20, 2016  
DOI:10.3760/cma.j.issn.0254-5098.2016.10.007
KeyWords:Breast cancer  Setup error  Cone beam CT
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Author NameAffiliationE-mail
Wu Chuanfeng Department of Radiation Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzou Municipal Hospital, Suzhou 215000, China  
Wu Jinchang Department of Radiation Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzou Municipal Hospital, Suzhou 215000, China  
Gu Ke Department of Radiation Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzou Municipal Hospital, Suzhou 215000, China  
Li Cheng Department of Radiation Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzou Municipal Hospital, Suzhou 215000, China  
Shen Danqing Department of Radiation Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzou Municipal Hospital, Suzhou 215000, China  
Hu Rui Department of Radiation Oncology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzou Municipal Hospital, Suzhou 215000, China huuno@sohu.com 
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Abstract::
      Objective To evaluate the setup errors for lower neck with cone beam CT (CBCT) in breast cancer patients immobilized by breast bracket, and to probe the margins from supraclavicular clinical target volume (CTV) in 3 directions. Methods A total of 14 breast cancer patients with supraclavicular lymph node radiation were enrolled. All patients were immobilized by breast bracket, and each patient would undergo CBCT at the first, tenth and twentieth treatment after positioning, respectively. Then these CBCT images were registered to the planning CT to determine setup errors in translational and rotational direction, and evaluated correlation between them. At last, CTV margins were calculated from the systematic and random errors. Results The setup errors on x(left-ring), y (superior-inferior), z (anterior-posterior) translational directions were (2.89±2.52), (3.96±2.97), (4.21±2.24) mm and on θ(pitch degree), φ(roll degree), ψ(yaw degree) rotational direction were (2.38±1.97)°,(1.60±1.63)°,(1.91±1.54)°, respectively. The margins from CTV were 8.08, 8.13, 6.30 mm in x,y and z direction. On y and z directions translational errors were correlated significantly with φ and ψ degree rotational errors(Pearson=-0.515,-0.509, P<0.05). In inter-fraction only on z direction the setup changes were considered as correlative with ψ degree (Pearson=-0.583, P<0.05). Conclusions For supraclavicular region irradiation breast cancer patients immobilized with breast bracket, the margins from CTV were recommended as not less than 8.08, 8.13, 6.30 mm in x, y, z directions, respectively. The position immobilized method and the positioning workflow should be further improved in order to reduce the influence of the neck rotational on setup errors.
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