A comparison of patient position displacements from body surface laser scanning and cone beam CT bone registrations for radiotherapy of pelvic targets

Abstract

Background and purpose. Optical surface detection has attractive features as a mean in radiotherapy for patient positioning tasks such as set-up, monitoring and gating. To aid in hitting radiotherapy targets the correlation between detected surface displacements and internal structure displacements is crucial. In this study, we compare set-up displacements derived from a body surface laser scanning (BSLS) system to displacements derived from bone registrations with a cone beam computed tomography (CBCT) system in order to quantify the accuracy and applicability of BSLS for fractionated treatments in the pelvic region. Material and methods. Displacements from concurrent BSLS and CBCT registrations were compared for 40 patients treated in the pelvic region for a total of 170 set-ups. Surface data captured by BSLS at the first treatment fraction (BSLSref) was used as main reference for the BSLS system, while bony structures from the planning CT were used as a reference for the CBCT method. As comparison, the patient outline extracted from the planning CT was used as BSLS reference (CTref). The displacements detected by the CBCT system (skin-marks-only) was also used for comparison. Results. The mean differences (± 1 SD) between the BSLS and CBCT displacements were −0.01 (± 0.17) cm, 0.00 (± 0.21) cm and 0.01 (± 0.17) cm in the lateral, longitudinal and vertical directions, respectively. The median length of the difference was 0.26 cm (0.24–0.29 cm, 95% CI). The median of the difference between CBCT and BSLS displacements based on CTref was 0.37 cm (0.30–0.39 cm) and the median for skin-marks-only was 0.38 cm (0.34–0.42 cm). Conclusions. The BSLS system is a good supplement to the CBCT system for accurate set-up for fractions when no CBCT is deemed necessary for pelvic targets. Inter-fractional skin movement in relation to bone was estimated to be 0.2 cm in the lateral (X), longitudinal (Y) and vertical direction (Z), respectively.

Declaration of interest: The research was partly sponsored by C-rad AB, Uppsala, Sweden. The authors alone are responsible for the content and writing of the paper.

The authors would like to thank C-rad AB, Uppsala, Sweden for financial and technical support and Annica Hall for valuable input from her thesis work 2005 at Uppsala University Hospital. The following funds are acknowledged for financial support: Uppsala Cancer Society grant, Uppsala County Council grant for research and development, Uppsala University Hospital Development Foundation, Regional agreement on medical training and clinical research (ALF) between Uppsala County council and Uppsala University, Research foundation Stiftelsen Onkologiska Klinikens i Uppsala Forskningsfond. The research was partly sponsored by C-rad AB, Uppsala, Sweden.