ArticleRadiation oncology (London, England)2020
Residual positioning errors and uncertainties for pediatric craniospinal irradiation and the impact of image guidance.
Article in Radiation oncology (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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6 citing papers in PubMed, 15 citations in OpenAlex.
- Application value of image-guided radiotherapy in reducing setup errors of head and neck tumors: a retrospective study.American journal of translational research · 2026Article
- Quality assurance of craniospinal irradiation in helical tomotherapy using a dose reconstruction tool based on leaf open time.Journal of applied clinical medical physics · 2025Article
- Diurnal variation of the distance between cranium and the third lumbar vertebra and its implications for craniospinal irradiation.Physics and imaging in radiation oncology · 2025Article
- Dosimetric consequences of adapting the craniocaudal isocenter distance to daily patient position in craniospinal irradiation using volumetric modulated arc therapy.Journal of applied clinical medical physics · 2025Article
- Analyzing the patient isocenter positional accuracy with portal imaging acquired at different gantry angles and its dosimetrical impact on the dose delivery for head and neck cancers.Precision radiation oncology · 2024Article
- Robustness and dosimetric verification of hippocampal-sparing craniospinal pencil beam scanning proton plans for pediatric medulloblastoma.Physics and imaging in radiation oncology · 2024Article
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Authors and funding
6 authors at 5 institutions in 3 countries.
Funding
Abstract
backgroundOptimal alignment is of utmost importance when treating pediatric patients with craniospinal irradiation (CSI), especially with regards to field junctions and multiple isocenters and techniques applying high dose gradients. Here, we investigated the setup errors and uncertainties for pediatric CSI using different setup verification protocols.
methodsA total of 38 pediatric patients treated with CSI were identified for whom treatment records and setup images were available. The setup images were registered retrospectively to the reference image using an automated tool and matching on bony anatomy, subsequently, the impact of different correction protocols was simulated.
resultsFor an action-level (AL)-protocol and a non-action level (NAL)-protocol, the translational residual setup error can be as large as 24 mm for an individual patient during a single fraction, and the rotational error as large as 6.1°. With daily IGRT, the maximum setup errors were reduced to 1 mm translational and 5.4° rotational versus 1 mm translational and 2.4° rotational for 3- and 6- degrees of freedom (DoF) couch shifts, respectively. With a daily 6-DoF IGRT protocol for a wide field junction irradiation technique, the residual positioning uncertainty was below 1 mm and 1° for translational and rotational directions, respectively. The largest rotational uncertainty was found for the patients' roll even though this was the least common type of rotational error, while the largest translational uncertainty was found in the patients' anterior-posterior-axis.
conclusionsThese results allow for informed margin calculation and robust optimization of treatments. Daily IGRT is the superior choice for setup of pediatric patients treated with CSI, although centers that do not have this option could use the results presented here to improve their margins and uncertainty estimates for a more accurate treatment alignment.
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