A dual centre study of setup accuracy for thoracic patients based on cone-beam CT data

Abstract

Background and purpose: To compare setup uncertainties at two different institutions by using identical imaging and analysis techniques for thoracic patients with different fixation equipments.

Methods and materials: Patient registration results from Cone-Beam CT (CBCT) scans of 174 patients were evaluated (1068 CBCT scans). Patients were fixated using a standard or custom made fixation at Royal Marsden Hospital and Odense University Hospital, respectively. Five imaging protocols were retrospectively simulated to compare the fixation equipments. Systematic and random setup uncertainties were calculated to estimate sufficient treatment margins.

Results: The setup uncertainties are of similar sizes at the two institutions and there is no observable drift in the precision of the fixation equipments during the treatment course. When a correcting imaging protocol is performed there is a significant increase of the systematic setup uncertainties in between imaging fractions. A margin reduction of ≥0.2 cm can be achieved for patients with peak-to-peak respiration amplitudes of ≥1.2 cm when changing from 4D-CT to Active Breathing Coordinator™ (ABC).

Conclusions: The setup uncertainties at the two institutions are the same despite different fixation equipments. Hence margins cannot be reduced by changing fixating equipment.