Assessing the impact of uncertainty in a VMAT plan for H&N cancer considering patient setup error (PSE)

IF 1.6 3区工程技术 Q3 CHEMISTRY, INORGANIC & NUCLEAR Applied Radiation and Isotopes Pub Date : 2025-02-27 DOI:10.1016/j.apradiso.2025.111757

Arvind Kumar , Kiran Sharma , C.P. Bhatt , Awanish Sharma

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引用次数: 0

Abstract

In radiotherapy, accurate radiation dose delivery is critical, despite the uncertainties that can cause discrepancies between the prescribed and administered doses. This study examines the influence of uncertainties caused by patient positioning errors on dose accuracy and evaluates the potential consequences if these errors remain uncorrected. The investigation involves 670 treatment plans, including 10 clinically implemented plans and 660 with artificially induced uncertainties. These plans target patients undergoing volumetric arc therapy (VMAT) for various head & neck cancers using the Halcyon™ medical linear accelerator. Two scenarios are analyzed: one reflecting actual patient positioning shifts and another involving deliberate displacements ranging from 1 to 10 mm to assess the impact of uncertainty in a VMAT plan. Dosimetric validation is performed using EPID and the Octavius 4D phantom to introduce and assess the impact of these uncertainties. Results indicate that target coverage falls below the acceptable V95% threshold along the (X+, X-), (Y+, Y-), and (Z+, Z-) axes, when positioning errors exceed 5 mm. Additionally, both parotid glands are significantly affected by positioning uncertainties. Patient-specific quality assurance (PSQA) assessments confirm that positioning errors substantially affect the accuracy of dose delivery. To minimize uncertainties, strict adherence to recommended QA, clinical guidelines, imaging protocols, and other SOPs is crucial in clinical practice. Independent dosimetric audits are essential for evaluating the accuracy of dose delivery in treatment.

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来源期刊

Applied Radiation and Isotopes 工程技术-核科学技术

CiteScore

3.00

自引率

12.50%

发文量

406

审稿时长

13.5 months

期刊介绍： Applied Radiation and Isotopes provides a high quality medium for the publication of substantial, original and scientific and technological papers on the development and peaceful application of nuclear, radiation and radionuclide techniques in chemistry, physics, biochemistry, biology, medicine, security, engineering and in the earth, planetary and environmental sciences, all including dosimetry. Nuclear techniques are defined in the broadest sense and both experimental and theoretical papers are welcome. They include the development and use of α- and β-particles, X-rays and γ-rays, neutrons and other nuclear particles and radiations from all sources, including radionuclides, synchrotron sources, cyclotrons and reactors and from the natural environment. The journal aims to publish papers with significance to an international audience, containing substantial novelty and scientific impact. The Editors reserve the rights to reject, with or without external review, papers that do not meet these criteria. Papers dealing with radiation processing, i.e., where radiation is used to bring about a biological, chemical or physical change in a material, should be directed to our sister journal Radiation Physics and Chemistry.