| Li Junyu,Wu Hao,Yang Jingxian,et al.Workflow and error analyses of patient setup based on open-face mask immobilization combined with AlignRT for head tumor radiotherapy[J].Chinese Journal of Radiological Medicine and Protection,2022,42(8):590-597 |
| Workflow and error analyses of patient setup based on open-face mask immobilization combined with AlignRT for head tumor radiotherapy |
| Received:May 10, 2022 |
| DOI：10.3760/cma.j.cn112271-20220510-00199 |
| KeyWords:Head tumor Optical surface guidance Open-face mask Setup workflow Setup errors |
| FundProject:北京市自然科学基金（1212011，1202009）；国家自然科学基金（12005007）；国家重点研发计划（2019YFF01014405）；北京大学肿瘤医院科学研究基金（2021-14KC2204） |
| Author Name | Affiliation | E-mail | | Li Junyu | Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China | | | Wu Hao | Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China | | | Yang Jingxian | Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China | | | Zhou Shun | Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China | | | Lu Zihong | Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China | | | Yu Songmao | Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China | | | Chen Jixiang | Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China | | | Wang Meijiao | Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China | | | Yao Kaining | Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China | | | Du Yi | Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China | yi.du@hotmail.com |
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| Abstract:: |
| Objective To propose a markless patient setup workflow based on the optical surface monitoring system (AlignRT) and open-face mask immobilization for whole-course head tumor radiotherapy, assess the setup time and repositioning frequency of the proposed workflow, and conduct a comparative analysis of the differences, correlation, and consistency of the setup errors of the AlignRT and cone beam CT (CBCT) systems.Methods A retrospective analysis was conducted for the data on the errors of 132 fractionated setup based on open-face mask immobilization of 33 head tumor patients. AlignRT-guided markless patient setup workflow was applied throughout the radiotherapy. Meanwhile, the body structures automatically generated by the treatment planning system were used as body references. The 6-degree-of-freedom (6DoF) setup errors (lateral, vertical, longitudinal, rotation, pitch, roll, and yaw directions), setup time, and repositioning frequency of the AlignRT and CBCT systems were recorded and analyzed. The Wilcoxon and Spearman analyses were used to statistically assess the differences and correlation of the setup errors of the two systems. Moreover, the Bland-Altman analysis was employed to evaluate the consistency of the two systems.Results The 6DoF setup errors of CBCT were within the clinical tolerance (linear motions:-0.30 to 0.30 cm; rotational motions:-2.0° to 2.0°). The setup time and repositioning frequency of CBCT were (98 ±31) s and 1.51% (2/132), respectively. There was no significant difference in setup errors between the two systems except those in x-axis (Z=-3.11, P=0.002), y-axis (Z=-7.40, P<0.001), and Pitch (Z=-4.48, P<0.001). There was a significant positive correlation between the setup errors along lateral (rs=0.47, P<0.001) and vertical (rs=0.29, P=0.001) directions, rotation (Rtn; rs=0.47, P<0.001), pitch (Pitch; rs=0.28, P=0.001) and roll (Roll; rs=0.45, P<0.001) of the two systems. The 95% limits of agreement (95% LoA) of 6DoF setup errors were -0.12 to 0.09 cm, -0.07 to 0.17 cm, -0.19 to 0.20 cm, -1.0° to 0.9 °, -1.0° to 1.5°, and -0.9° to 1.0°, respectively. The 95% confidence interval (95% CI) of 95% LoA was -0.14 to 0.11 cm, -0.09 to 0.19 cm, -0.23 to 0.23 cm, -1.2° to 1.1°, -1.2° to 1.7°, and-1.0° to 1.1°, respectively, all of which were within the permissible error ranges. The 6DoF setup error difference of 3.41% (27/792< 5%) was beyond the 95% LoA. The maximum absolute differences of 6DoF setup errors within the 95% LoA were 0.12, 0.16, 0.19 cm, 0.9°, 1.5°, and 1.0°, respectively.Conclusions The proposed markless setup workflow based on AlignRT combined with open-face mask immobilization for whole-course head tumor radiotherapy exhibits reasonable agreement and consistency with the patient setup using CBCT, with acceptable clinical efficiency. It can be applied to the first radiotherapy and the real-time monitoring of therapy to improve the safety and thus is of value in clinical applications. |
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