Study of setup error and dosimetry of postoperative intensity-modulated radiotherapy for breast cancer using skin lead marker and iSCOUT image-guided positioning system
Dong Fangfen1,2, Dai Liyan3, Huang Miaoyun1,2, Weng Xing2, Jiang Liuqing2, Xu Benhua1,2, Li Xiaobo1,2,4
1College of Medical Technology and Engineering, School of Clinical Medicine, Cancer Center, Fujian Medical University, Fuzhou 350122, China; 2Department of Radiotherapy, Fujian Medical University Union Hospital, Fuzhou 350001, China; 3Department of Radiotherapy, Renji Hospital Affiliated to Shanghai Jiao Tong University Medical School, Shanghai 200025, China; 4Department of Engineering Physics, Tsinghua University, Beijing 100084, China
Abstract：Objective To explore the application value of skin lead marker combined with iSCOUT image-guided positioning system in monitoring and correcting the setup error of intensity-modulated radiotherapy (IMRT) for breast cancer and calculate the PTV margin, aiming to provide reference for clinical practice. Methods 25 breast cancer patients treated with IMRT after modified radical mastectomy in Fujian Medical University Union Hospital from April to August 2019 were enrolled in this study. The skin lead marker combined with iSCOUT image-guided positioning system was employed for image-guided positioning based on the gold standard registration algorithm. Initial setup errors on the x (lateral), y (craniocaudal) and z (anteroposterior) axis and residual errors after the position correction were recorded and analyzed. The effect of the errors before and after image-guided correction upon the plan dose was compared and the reasonable PTV margin was calculated. Results 25 patients received 150 times of positioning verification using skin lead marker combined with iSCOUT image-guided positioning system. The absolute residual errors on the x-, y-and z-axis were (1.53±0.96),(1.30±0.99) and (1.34±0.92)mm, significantly smaller than the initial setup errors of (2.63±2.12),(2.41±2.45) and (3.07±2.77)mm (all P<0.001). The percentage of dose deviation due to residual errors was also smaller than that of the initial errors. Significant differences were observed in D98%, D2%, Dmax of PTV, Dmax of the heart, Dmax of the healthy breast, and Dmean of the affected lung and both lungs. The percentage deviation from the original plan was decreased from 2.18%, 3.19%, 10.66%, 8.75%, 48.21%, 10.50%, and 3.66% to 0.38%, 0.23%, 2.31%, 0.04%, 13.78%, 6.35% and 0.41%, respectively (all P<0.05). PTV margins on the x-, y-and z-axis after correction were calculated as 1.87, 1.75 and 1.69mm, respectively. Conclusion It is feasible and valuable to apply the skin lead marker combined with iSCOUT image-guided positioning system in the positioning verification and correction of breast cancer radiotherapy position, providing novel reference for clinical PTV margin.
Dong Fangfen,Dai Liyan,Huang Miaoyun et al. Study of setup error and dosimetry of postoperative intensity-modulated radiotherapy for breast cancer using skin lead marker and iSCOUT image-guided positioning system[J]. Chinese Journal of Radiation Oncology, 2021, 30(10): 1059-1064.
[1] Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424. DOI:10.3322/caac.21492. [2] Ibbott GS. Patient doses from image-guided radiation therapy[J]. Phys Med, 2020, 72(1):30-31. DOI:10.1016/j.ejmp.2020.03.005. [3] Hwang JM, Hung JY, Tseng YH, et al. Use of electronic portal images to evaluate setup error and intra-fraction motion during free-breathing breast IMRT treatment[J]. Med Dosim, 2019, 44(3):233-238. DOI:10.1016/j.meddos.2018.08.001. [4] Batumalai V, Phan P, Choong C, et al. Comparison of setup accuracy of three different image assessment methods for tangential breast radiotherapy[J]. J Med Radiat Sci, 2016, 63(4):224-231. DOI:10.1002/jmrs.180. [5] Wei X, Liu M, Ding Y, et al. Setup errors and effectiveness of Optical Laser 3D Surface imaging system (Sentinel) in postoperative radiotherapy of breast cancer[J]. Sci Rep, 2018, 8(1):7270. DOI:10.1038/s41598-018-25644-w. [6] Xiao A, Crosby J, Malin M, et al. Single-institution report of setup margins of voluntary deep-inspiration breath-hold (DIBH) whole breast radiotherapy implemented with real-time surface imaging[J]. J Appl Clin Med Phys, 2018, 19(4):205-213. DOI:10.1002/acm2.12368. [7] van Herk M. Errors and margins in radiotherapy[J]. Semin Radiat Oncol, 2004, 14(1):52-64.DOI:10.1053/j.semradonc.2003.10.003. [8] Wennstig AK, Wadsten C, Garmo H, et al. Long-term risk of ischemic heart disease after adjuvant radiotherapy in breast cancer:results from a large population-based cohort[J]. Breast Cancer Res, 2020, 22(1):10. DOI:10.1186/s13058-020-1249-2. [9] 夏校春,宁丽华,严森祥. 乳腺癌放疗中两种不同摆位方式的剂量分布及摆位误差比较[J]. 中华放射医学与防护杂志,2018, 38(9):675-679. DOI:10.3760/cma.j.issn.0254-5098.2018.09.007. Xia XC, Ning LH, Yan SX. Companison of dose distribution and setup error of two different positions and immobilization techniques in breast cancer radiotherapy[J]. Chin J Radiol Med Prot, 2018, 38(9):675-679. DOI:10.3760/cma.j.issn.0254-5098.2018.09.007. [10] Nishio T, Nakamura M, Okamoto H, et al. An overview of the medical-physics-related verification system for radiotherapy multicenter clinical trials by the Medical Physics Working Group in the Japan Clinical Oncology Group-Radiation Therapy Study Group[J]. J Radiat Res, 2020,61(6):999-1008. DOI:10.1093/jrr/rraa089. [11] Wang W, Yu T, Xu M, et al. Setup error assessment and correction in planar kV image-versus cone beam CT image-guided radiation therapy:a clinical study of early breast cancer treated with external beam partial breast irradiation[J]. Technol Cancer Res Treat, 2019, 18(1):1-6. DOI:10.1177/1533033819853847. [12] 屈超,梁广立,刘桂芝,等.iSCOUT图像引导定位技术在肺癌调强放疗中的临床应用[J]. 实用医学杂志,2019, 35(24):3848-3852. DOI:10.3969/j.issn.1006-5725.2019.24.025. Qu C, Liang GL, Liu GZ, et al. Clinical application of iSCOUT image guided position technology in intensity modulated radiation therapy for lung cancer[J]. J Pract Med, 2019, 35(24):3848-3852. DOI:10.3969/j.issn.1006-5725.2019.24.025. [13] 郭静钰,王伟,孙斌,等. 两种千伏级立体平面图像引导放射治疗系统临床一致性研究[J]. 中国医学装备,2020, 17(1):23-27. DOI:10.3969/J.ISSN.1672-8270.2020.01.007. Guo JY, Wang W, Sun B, et al. Study on clinical consistency of two radiotherapy systems under the guidance of kV stereoscopic planar image[J]. Chin Med Equip, 2020, 17(1):23-27. DOI:10.3969/J.ISSN.1672-8270.2020.01.007. [14] 李栋庆,林涛,于静萍,等. 乳腺癌术后容积调强放疗下移动误差对靶区剂量的影响[J]. 中华放射医学与防护杂志,2018, 38(11):819-823. DOI:10.3760/cma.j.issn.0254-5098.2018.11.004. Li DQ, Lin T, Yu JP, et al. Effect of movement error on target dose after breast cancer[J]. Chin J Radiol Med Protect, 2018, 38(11):819-823. DOI:10.3760/cma.j.issn.0254-5098.2018.11.004. [15] Havel L, Naik H, Ramirez L, et al. Impact of the SSO-ASTRO Margin guideline on rates of re-excision after lumpectomy for breast cancer:a meta-analysis[J]. Ann Surg Oncol, 2019, 26(5):1238-1244. DOI:10.1245/s10434-019-07247-5. [16] 谢欣,戴建荣. 图像配准方法在乳腺癌瘤床靶区勾画中的应用进展[J]. 中华放射肿瘤学杂志,2020, 29(10):919-924. DOI:10.3760/cma.j.cn113030-20190404-00120. Xie X, Dai JR. Research progress on application of image registration methods in target volume delineation of breast tumor bed[J]. Chin J Radiat Oncol, 2020, 29(10):919-924. DOI:10.3760/cma.j.cn113030-20190404-00120. [17] 谢金容,曹璐,陈佳艺.2018年乳腺癌放疗进展荟萃[J]. 中华放射肿瘤学杂志,2020, 29(10):913-918. DOI:10. 3760/cma.j.cn113030-20190401-00115. Xie JR, Cao L, Chen JY. Progress of radiotherapy for breast cancer in 2018[J]. Chin J Radiat Oncol, 2020, 29(10):913-918. DOI:10.3760/cma.j.cn113030-20190401-00115.
2021, Vol. 30 
