SU-E-J-15: A Patient-Centered Scheme to Mitigate Impacts of Treatment Setup Error




Current Intensity Modulated Radiation Therapy (IMRT) is plan-centered. At each treatment fraction, we position the patient to match the setup in treatment plan. Inaccurate setup can compromise delivered dose distribution, and hence leading to suboptimal treatments. Moreover, current setup approach via couch shift under image guidance can correct translational errors, while rotational and deformation errors are hard to address. To overcome these problems, we propose in this abstract a patient-centered scheme to mitigate impacts of treatment setup errors.


In the patient-centered scheme, we first position the patient on the couch approximately matching the planned-setup. Our Supercomputing Online Replanning Environment (SCORE) is then employed to design an optimal treatment plan based on the daily patient geometry. It hence mitigates the impacts of treatment setup error and reduces the requirements on setup accuracy. We have conducted simulations studies in 10 head-and-neck (HN) patients to investigate the feasibility of this scheme. Rotational and deformation setup errors were simulated. Specifically, 1, 3, 5, 7 degrees of rotations were put on pitch, roll, and yaw directions; deformation errors were simulated by splitting neck movements into four basic types: rotation, lateral bending, flexion and extension. Setup variation ranges are based on observed numbers in previous studies. Dosimetric impacts of our scheme were evaluated on PTVs and OARs in comparison with original plan dose with original geometry and original plan recalculated dose with new setup geometries.


With conventional plan-centered approach, setup error could lead to significant PTV D99 decrease (−0.25∼+32.42%) and contralateral-parotid Dmean increase (−35.09∼+42.90%). The patientcentered approach is effective in mitigating such impacts to 0∼+0.20% and −0.03∼+5.01%, respectively. Computation time is <128 s.


Patient-centered scheme is proposed to mitigate setup error impacts using replanning. Its superiority in terms of dosimetric impacts and feasibility has been shown through simulation studies on HN cases.