ArticleJournal of applied clinical medical physics2025
Impact of intrafraction fiducial tracking on planning target margins during prostate stereotactic body radiotherapy using Brainlab ExacTrac Dynamic with robotic couch correction.
Article in Journal of applied clinical medical physics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Impact of intrafraction fiducial tracking on planning target margins during prostate stereotactic body radiotherapy using Brainlab ExacTrac Dynamic with robotic couch correction.Journal of applied clinical medical physics · 2025Article
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4 authors.
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Abstract
backgroundPlanning target volume (PTV) margin reduction has been demonstrated to result in decreased acute genitourinary and gastrointestinal toxicity in patients treated with definitive stereotactic body radiotherapy (SBRT) for localized prostate cancer. PURPOSE: The purpose of this study was to assess the impact of stereoscopic x-ray-based intrafraction prostate fiducial tracking with six degrees of freedom (6DoF) robotic couch correction on PTV margin reduction during gantry-based prostate SBRT. MATERIALS AND
methodsIntrafraction prostate position data was analyzed for patients with localized prostate cancer treated using gantry-based SBRT with stereoscopic x-ray intrafraction fiducial monitoring using Brainlab ExacTrac Dynamic (ETD) and 6DoF couch correction at our institution. Fiducial displacements and rotations were calculated between each intrafraction measurement, and mean intrafraction deviations were determined for each fraction, patient, and the overall cohort. Minimum PTV margins required in each dimension were calculated using the van Herk method.
resultsThere were 2525 intrafraction stereoscopic fiducial verifications within the cohort. Intrafraction fiducial displacements were within 1.5 mm between 98.7%, 96.1%, and 95.1% consecutive fiducial verifications in the left/right (LR), superior/inferior (SI), and anterior/posterior (AP) dimensions, respectively. Rotational deviations were within 2° between 83.3%, 98.3%, and 99.4% consecutive fiducial verifications in the pitch, roll, and yaw directions, respectively. Twenty-three percent of stereoscopic verifications triggered a robotic couch correction based upon specified tolerances. Overall, 56% of treatment fractions required a 6DoF couch correction. Fiducial position verifications requiring couch correction were most often triggered by pitch, which occurred in 72% of instances. This corresponded to required minimum PTV margins of 1.23, 1.73, and 1.44 mm in the LR, SI, and AP dimensions, respectively.
conclusionsIntrafraction fiducial tracking using ETD stereoscopic x-ray verification with 6DoF robotic couch correction allows for reduced PTV margins when treating localized prostate cancer with gantry-based SBRT.
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