Mitine C, Hoornaert M T, Dutreix A, Beauduin M
Department of Radiation Oncology, Jolimont Hospital, Haine Saint Paul, Belgium.
Radiother Oncol. 1999 Jul;52(1):19-27. doi: 10.1016/s0167-8140(99)00071-7.
To determine the distribution of set-up errors for patients treated with and without two rigid partial immobilisation devices for pelvic malignancies.
30 patients receiving pelvic irradiation with a four field technique underwent a total of 524 portal films. The patients are divided into 3 cohorts of 10 patients. The first cohort is treated on a standard treatment couch without immobilisation device (NI); the second and third cohorts are treated with a custom-made immobilisation device used in an attempt to improve set-up accuracy: an Alpha-Cradle mattress (AM) or an Orfit cast (OC). Set-up deviations are analysed in the X, Y, Z directions of a fixed coordinate system, corresponding to the lateral, cranio-caudal and antero-posterior direction, respectively.
Considering the percentage of discrepancies < or = 5 mm between the simulation films and the portal films as a measure of set-up accuracy, immobilisation devices seem to increase accuracy: 88.5% (X) 79% (Y) and 100% (Z) with AM; 84% (X-Y), 97.5% (Z) with OC and only 76.5% (X), 40% (Y) and 65.5% (Z) for NI. The distribution of the systematic set-up errors for the three patient cohorts, defined as the mean patient displacement for the treatment course, had a mean and a standard deviation of (0.7 +/- 2.7) mm in the X-axis, (-5.5 +/- 2.6) mm in the Y-axis and (-0.9 +/- 2.2) mm in the Z-axis when no immobilisation is added; (0.8 +/- 1.7) mm, (-2 +/- 2.7) mm and (0.3 +/- 0.4) mm for the Alpha-Cradle group; (0.3 +/- 1.4) mm, (0.5 +/- 1.1) mm and (0.5 +/- 0.6) mm for the Orfit cast group. The distribution of random errors about the mean approximated a normal distribution and the standard deviations are 4.4 mm (X), 4.2 mm (Y) and 4.8 mm (Z) for NI; 3.3, 3.5 and 2.5 mm for the AM; 3.4, 3.3 and 2.7 mm for the OC.
The two rigid immobilisation devices improve the reproducibility of a given pelvic field but there is a small benefit comparative to the cost and the cumbersome place of the devices.
