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A Feasibility Study On KV-Based Whole Breast Radiation Patient Setup

Q Huang

Q Huang1*, M Zhang2 , N Yue2 , T Chen2 , (1) Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, (2) Rutgers University, New Brunswick, NJ,


SU-E-J-22 (Sunday, July 12, 2015) 3:00 PM - 6:00 PM Room: Exhibit Hall

In room kilovoltage x-ray (kV) imaging provides higher contrast than Megavoltage (MV) imaging with faster acquisition time compared with on-board cone-beam computed tomography (CBCT), thus improving patient setup accuracy and efficiency. In this study we evaluated the clinical feasibility of utilizing kV imaging for whole breast radiation patient setup.

For six breast cancer patients with whole breast treatment plans using two opposed tangential fields, MV-based patient setup was conducted by aligning patient markers with in room lasers and MV portal images. Beam-eye viewed kV images were acquired using Varian OBI system after the set up process. In house software was developed to transfer MLC blocks information overlaying onto kV images to demonstrate the field shape for verification. KV-based patient digital shift was derived by performing rigid registration between kV image and the digitally reconstructed radiography (DRR) to align the bony structure. This digital shift between kV-based and MV-based setup was defined as setup deviation.

Six sets of kV images were acquired for breast patients. The mean setup deviation was 2.3mm, 2.2mm and 1.8mm for anterior-posterior, superior-inferior and left-right direction respectively. The average setup deviation magnitude was 4.3±1.7mm for six patients. Patient with large breast had a larger setup deviation (4.4-6.2mm). There was no strong correlation between MV-based shift and setup deviation.

A preliminary clinical workflow for kV-based whole breast radiation setup was established and tested. We observed setup deviation of the magnitude below than 5mm. With the benefit of providing higher contrast and MLC block overlaid on the images for treatment field verification, it is feasible to use kV imaging for breast patient setup.

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