Treatment precision of image-guided liver SBRT using implanted fiducial markers depends on marker-tumour distance

Yvette Seppenwoolde, Wouter Wunderink, Stefanie van Veen, P Storchi, Alejandra Mendez Romero, Ben Heijmen

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90 Citations (Scopus)


The purpose of this study is to assess the accuracy of day-to-day predictions of liver tumour position using implanted gold markers as surrogates and to compare the method with alternative set-up strategies, i.e. no correction, vertebrae and 3D diaphragm-based set-up. Twenty patients undergoing stereotactic body radiation therapy (SBRT) with abdominal compression for primary or metastatic liver cancer were analysed. We determined the day-today correlation between gold marker and tumour positions in contrast-enhanced CT scans acquired at treatment preparation and before each treatment session. The influence of marker-tumour distance on the accuracy of prediction was estimated by introducing a method extension of the set-up error paradigm. The distance between gold markers and the centre of the tumour varied between 5 and 96 mm. Marker-guidance was superior to guiding treatment using other surrogates, although both the random and systematic components of the prediction error SD depended on the tumour-marker distance. For a marker-tumour distance of 4 cm, we observed sigma = 1.3 mm and Sigma = 1.6 mm. The 3D position of the diaphragm dome was the second best predictor. In conclusion, the tumour position can be predicted accurately using implanted markers, but marker-guided set-up accuracy decreases with increasing distance between implanted markers and the tumour.
Original languageUndefined/Unknown
Pages (from-to)5445-5468
Number of pages24
JournalPhysics in Medicine and Biology
Issue number17
Publication statusPublished - 2011

Research programs

  • EMC MM-03-32-04

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