Open AccessComparison of initial patient setup accuracy between surface imaging and three point localization: A retrospective analysis
Author(s) -
Stanley Dennis N.,
McConnell Kristen A.,
Kirby Neil,
Gutiérrez Alonso N.,
Papanikolaou Nikos,
Rasmussen Karl
Publication year - 2017
Publication title -
journal of applied clinical medical physics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.83
H-Index - 48
ISSN - 1526-9914
DOI - 10.1002/acm2.12183
Subject(s) - pelvis , cone beam computed tomography , abdomen , medicine , nuclear medicine , wilcoxon signed rank test , radiology , computed tomography , mann–whitney u test
Purpose Historically, the process of positioning a patient prior to imaging verification used a set of permanent patient marks, or tattoos, placed subcutaneously. After aligning to these tattoos, plan specific shifts are applied and the position is verified with imaging, such as cone‐beam computed tomography ( CBCT ). Due to a variety of factors, these marks may deviate from the desired position or it may be hard to align the patient to these marks. Surface‐based imaging systems are an alternative method of verifying initial positioning with the entire skin surface instead of tattoos. The aim of this study was to retrospectively compare the CBCT ‐based 3D corrections of patients initially positioned with tattoos against those positioned with the C‐ RAD Catalyst HD surface imager system. Methods A total of 6000 individual fractions (600–900 per site per method) were randomly selected and the post‐ CBCT 3D corrections were calculated and recorded. For both positioning methods, four common treatment site combinations were evaluated: pelvis/lower extremities, abdomen, chest/upper extremities, and breast. Statistical differences were evaluated using a paired sample Wilcoxon signed‐rank test with significance level of <0.01. Results The average magnitudes of the 3D shift vectors for tattoos were 0.9 ± 0.4 cm, 1.0 ± 0.5 cm, 0.9 ± 0.6 cm and 1.4 ± 0.7 cm for the pelvis/lower extremities, abdomen, chest/upper extremities and breast, respectively. For the Catalyst HD , the average magnitude of the 3D shifts for the pelvis/lower extremities, abdomen, chest/upper extremities and breast were 0.6 ± 0.3 cm, 0.5 ± 0.3 cm, 0.5 ± 0.3 cm and 0.6 ± 0.2 cm, respectively. Statistically significant differences ( P < 0.01) in the 3D shift vectors were found for all four sites. Conclusion This study shows that the overall 3D shift corrections for patients initially aligned with the C‐ RAD Catalyst HD were significantly smaller than those aligned with subcutaneous tattoos. Surface imaging systems can be considered a viable option for initial patient setup and may be preferable to permanent marks for specific clinics and patients.