PMID- 20472368
OWN - NLM
STAT- MEDLINE
DCOM- 20101110
LR  - 20220331
IS  - 1879-355X (Electronic)
IS  - 0360-3016 (Linking)
VI  - 78
IP  - 4
DP  - 2010 Nov 15
TI  - Breast patient setup error assessment: comparison of electronic portal image 
      devices and cone-beam computed tomography matching results.
PG  - 1235-43
LID - 10.1016/j.ijrobp.2009.12.021 [doi]
AB  - PURPOSE: To quantify the differences in setup errors measured with the cone-beam 
      computed tomography (CBCT) and electronic portal image devices (EPID) in breast 
      cancer patients. METHODS AND MATERIALS: Repeat CBCT scan were acquired for 
      routine offline setup verification in 20 breast cancer patients. During the CBCT 
      imaging fractions, EPID images of the treatment beams were recorded. 
      Registrations of the bony anatomy for CBCT to planning CT and EPID to digitally 
      reconstructed-radiographs (DRRs) were compared. In addition, similar measurements 
      of an anthropomorphic thorax phantom were acquired. Bland-Altman and linear 
      regression analysis were performed for clinical and phantom registrations. 
      Systematic and random setup errors were quantified for CBCT and EPID-driven 
      correction protocols in the EPID coordinate system (U, V), with V parallel to the 
      cranial-caudal axis and U perpendicular to V and the central beam axis. RESULTS: 
      Bland-Altman analysis of clinical EPID and CBCT registrations yielded 4 to 6-mm 
      limits of agreement, indicating that both methods were not compatible. The 
      EPID-based setup errors were smaller than the CBCT-based setup errors. Phantom 
      measurements showed that CBCT accurately measures setup error whereas EPID 
      underestimates setup errors in the cranial-caudal direction. In the clinical 
      measurements, the residual bony anatomy setup errors after offline CBCT-based 
      corrections were Sigma(U) = 1.4 mm, Sigma(V) = 1.7 mm, and sigma(U) = 2.6 mm, sigma(V) = 3.1 mm. 
      Residual setup errors of EPID driven corrections corrected for underestimation 
      were estimated at Sigma(U) = 2.2mm, Sigma(V) = 3.3 mm, and sigma(U) = 2.9 mm, sigma(V) = 2.9 mm. 
      CONCLUSION: EPID registration underestimated the actual bony anatomy setup error 
      in breast cancer patients by 20% to 50%. Using CBCT decreased setup uncertainties 
      significantly.
CI  - Copyright (c) 2010 Elsevier Inc. All rights reserved.
FAU - Topolnjak, Rajko
AU  - Topolnjak R
AD  - Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van 
      Leeuwenhoek Hospital, Amsterdam, The Netherlands.
FAU - Sonke, Jan-Jakob
AU  - Sonke JJ
FAU - Nijkamp, Jasper
AU  - Nijkamp J
FAU - Rasch, Coen
AU  - Rasch C
FAU - Minkema, Danny
AU  - Minkema D
FAU - Remeijer, Peter
AU  - Remeijer P
FAU - van Vliet-Vroegindeweij, Corine
AU  - van Vliet-Vroegindeweij C
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20100514
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Breast Neoplasms/*diagnostic imaging/*radiotherapy
MH  - Cone-Beam Computed Tomography/*methods
MH  - Confidence Intervals
MH  - Female
MH  - Humans
MH  - Linear Models
MH  - *Phantoms, Imaging
MH  - Radiotherapy Planning, Computer-Assisted/*methods
MH  - Radiotherapy, Computer-Assisted/methods
MH  - Ribs/diagnostic imaging
MH  - Sternum/diagnostic imaging
EDAT- 2010/05/18 06:00
MHDA- 2010/11/11 06:00
CRDT- 2010/05/18 06:00
PHST- 2008/12/19 00:00 [received]
PHST- 2009/12/03 00:00 [revised]
PHST- 2009/12/08 00:00 [accepted]
PHST- 2010/05/18 06:00 [entrez]
PHST- 2010/05/18 06:00 [pubmed]
PHST- 2010/11/11 06:00 [medline]
AID - S0360-3016(09)03686-4 [pii]
AID - 10.1016/j.ijrobp.2009.12.021 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2010 Nov 15;78(4):1235-43. doi: 
      10.1016/j.ijrobp.2009.12.021. Epub 2010 May 14.