The potential failure risk of the cone-beam computed tomography-based planning target volume margin definition for prost
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RESEARCH
Open Access
The potential failure risk of the cone-beam computed tomography-based planning target volume margin definition for prostate image-guided radiotherapy based on a prospective single-institutional hybrid analysis Katsumi Hirose1,3* , Mariko Sato1, Yoshiomi Hatayama1, Hideo Kawaguchi1, Fumio Komai2, Makoto Sohma2, Hideki Obara2, Masashi Suzuki2, Mitsuki Tanaka1, Ichitaro Fujioka1, Koji Ichise1, Yoshihiro Takai1,3† and Masahiko Aoki1†
Abstract Background: The purpose of this study was to evaluate the impact of markerless on-board kilovoltage (kV) conebeam computed tomography (CBCT)-based positioning uncertainty on determination of the planning target volume (PTV) margin by comparison with kV on-board imaging (OBI) with gold fiducial markers (FMs), and to validate a methodology for the evaluation of PTV margins for markerless kV-CBCT in prostate image-guided radiotherapy (IGRT). Methods: A total of 1177 pre- and 1177 post-treatment kV-OBI and 1177 pre- and 206 post-treatment kV-CBCT images were analyzed in 25 patients who received prostate IGRT with daily localization by implanted FMs. Intrafractional motion of the prostate was evaluated between each pre- and post-treatment image with these two different techniques. The differences in prostate deviations and intrafractional motions between matching by FM in kV-OBI (OBI-FM) and matching by soft tissues in kV-CBCT (CBCT-ST) were compared by Bland-Altman limits of agreement. Compensated PTV margins were determined and compensated by references. (Continued on next page)
* Correspondence: [email protected] † Yoshihiro Takai and Masahiko Aoki contributed equally to this work. 1 Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori 036-8562, Japan 3 Department of Radiation Oncology, Southern Tohoku BNCT Research Center, 7-10, Yatsuyamada, Koriyama, Fukushima 963-8052, Japan Full list of author information is available at the end of the article © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Hirose et al. Radiation Oncology (2018) 13:106
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Results: Mean differences between OBI-FM and CBCT-ST in the anterior to posterior (AP), superior to inferior (SI), and left to right (LR) directions were − 0.43 ± 1.45, − 0.09 ± 1.65, and − 0.12 ± 0.80 mm, respectively, with R2 = 0.85, 0.88, and 0.83, respectively. Intrafractional motions obtained from CBCT-ST were 0.00 ± 1.46, 0.02 ± 1.49, and
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