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Dosimetric Consequences of Setup Errors Using CBCT for SBRT Localization

E Mayyas

E Mayyas*, N Wen, D Liu, C Glide-Hurst, M Ajlouni, I Chetty, Henry Ford Health System, Detroit, MI

TU-E-BRB-10 Tuesday 2:00:00 PM - 3:50:00 PM Room: Ballroom B

Purpose: Steep dose gradients and high dose per fraction in stereotactic ablative radiation therapy (SABR or SBRT) necessitate highly accurate tumor localization. This study evaluates inter-fraction shifts, as defined by couch correction analysis, and investigates the effect of tumor location and internal target volume (ITV) on these shifts. In addition, residual errors associated with post-CBCT correction and their dosimetric consequences were quantified.

Methods: Daily free-breathing (FB) CBCT images used for daily localization of 78 patients with non-small cell lung cancer were retrospectively evaluated. Among the population, 39 patients also received pre-treatment kV images after CBCT alignment. ITV inter-fraction displacement was evaluated by matching the CBCT and the FB helical CT images, and setup errors were quantified using orthogonal kV images. Associations between ITV location and inter-fraction motion were studied by categorizing tumors into the following locations: chest-wall seated (CWS) and island, peripheral, central, or upper, middle and lower. Dosimetric consequences for the patient with the largest setup error were explored.

Results: ITV inter-fraction motion included the mean of the systematic error, µinter=(-1.4, 2.0, 1.6) mm, standard deviation (SD) of the systematic error, Σinter=(2.1, 4.2, 2.9) mm, and SD of random errors, sinter=(2.2, 3.2, 3.6) mm. No significant associations were observed between inter-fraction shifts and tumor location or volume. Using CBCT for image guidance reduced the observed errors to µsetup=(-0.3, 0.1, 0.0) mm, Σsetup=(0.6, 0.6, 0.4) mm and ssetup=(1.2, 0.7, 0.7) mm. Dosimetric consequences for the patient with the largest setup error were explored. It was shown that a 3.0 mm setup margin was sufficient to provide greater than 95% dose coverage to the ITV.

Conclusion: CBCT image guidance reduced setup errors significantly such that 2-3 mm, population-based, setup margins provided proper dose coverage to the ITV. Further investigation of inter-and intrafraction error classification by tumor location is warranted.

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