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Dosimetric Consequences of Uncorrected Rotational Setup Errors During Stereotactic Body Radiation Therapy (SBRT) Treatment of Pancreatic Cancers

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L Di Maso

L Di Maso1 , R Teboh Forbang2 , Y Zhang2 , J Herman2, J Lee2 (1) Chicago, IL, (2) John Hopkins University, Baltimore, MD


SU-E-J-170 (Sunday, July 12, 2015) 3:00 PM - 6:00 PM Room: Exhibit Hall

Purpose: To explore the dosimetric consequences of uncorrected rotational setup errors during SBRT for pancreatic cancer patients.

Methods: This was a retrospective study utilizing data from ten (n=10) previously treated SBRT pancreas patients. For each original planning CT, we applied rotational transformations to derive additional CT images representative of possible rotational setup errors. This resulted in 6 different sets of rotational combinations, creating a total of 60 CT planning images. The patients’ clinical dosimetric plans were then applied to their corresponding rotated CT images. The 6 rotation sets encompassed a 3, 2 and 1-degree rotation in each rotational direction and a 3-degree in just the pitch, a 3-degree in just the yaw and a 3-degree in just the roll. After the dosimetric plan was applied to the rotated CT images, the resulting plan was then evaluated and compared with the clinical plan for tumor coverage and normal tissue sparing.

Results: PTV coverage, defined here by V33 throughout all of the patients’ clinical plans, ranged from 92-98%. After an n degree rotation in each rotational direction that range decreased to 68-87%, 85-92%, and 88-94% for n=3, 2 and 1 respectively. Normal tissue sparing defined here by the proximal stomach V15 throughout all of the patients’ clinical plans ranged from 0-8.9 cc. After an n degree rotation in each rotational direction that range increased to 0-17 cc, 0-12 cc, and 0-10 cc for n=3, 2, and 1 respectively.

Conclusion: For pancreatic SBRT, small rotational setup errors in the pitch, yaw and roll direction on average caused under dosage to PTV and over dosage to proximal normal tissue. The 1-degree rotation was on average the least detrimental to the normal tissue and the coverage of the PTV. The 3-degree yaw created on average the lowest increase in volume coverage to normal tissue.

Funding Support, Disclosures, and Conflict of Interest: This research was sponsored by the AAPM Education Council through the AAPM Education and Research Fund for the AAPM Summer Undergraduate Fellowship Program.

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