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Comparison of electronic portal image and port film in pelvic irradiation

Year 2006, Volume: 21 Issue: 1, 1 - 10, 01.02.2006

Abstract

OBJECTIVES In this study electronic portal images (EPIs) and port films were compared to detect set up errors and adequacy of image quality. METHODS In total 40 EPIs and 40 portal films from 20 patients receiving pelvic radiotherapy were evaluated. Image quality was graded by visibility of the selected anatomic landmarks and set-up deviations were examined in the x, y and z axes of the coordinate system. EPIs and port films were compared in terms of Image quality and shifts. RESULTS Visibility was significantly better for port films than EPIs. In both imaging techniques acetabulum, pelvic rims and symphisis pubis were more visible landmarks. Mean set-up displacements at the x, y and z axes were 1.47, 2.51 and 3.99 mm for port films; 2.16, 3.09 and 3.81 mm for EPIs respectively. Set-up errors were in acceptable levels in all directions, maximum errors were seen in z axis for both images. CONCLUSION Electronic portal imaging is used widely and takes places of port films. The use of EPI could provide more quick and practical evaluation of set-up errors than port films and also pretreatment correction of set-up errors and digital storage of the images are possible. However the major disadvantage of EPIs than port films is insufficient evaluation of the anatomical structures due to worse image quality.

References

  • 1. Michalski JM, Wong JW, Gerber RL, Yan D, Cheng A, Graham MV, et al. The use of on-line image verification to estimate the variation in radiation therapy dose delivery. Int J Radiat Oncol Biol Phys 1993;27(3):707-16.
  • 2. Kinzie JJ, Hanks GE, MacLean CJ, Kramer S. Patterns of care study: Hodgkin's disease relapse rates and adequacy of portals. Cancer 1983;52(12):2223-6. 3. White JE, Chen T, McCracken J, Kennedy P, Seydel HG, Hartman G, et al. The influence of radiation therapy quality control on survival, response and sites of relapse in oat cell carcinoma of the lung: preliminary report of a Southwest Oncology Group study. Cancer 1982;50(6):1084-90.
  • 4. Terahara A, Niemierko A, Goitein M, Finkelstein D, Hug E, Liebsch N, et al. Analysis of the relationship between tumor dose inhomogeneity and local control in patients with skull base chordoma. Int J Radiat Oncol Biol Phys 1999;45(2):351-8.
  • 5. Rabinowitz I, Broomberg J, Goitein M, McCarthy K, Leong J. Accuracy of radiation field alignment in clinical practice. Int J Radiat Oncol Biol Phys 1985;11(10):1857-67.
  • 6. Marks JE, Haus AG, Sutton HG, Griem ML. The value of frequent treatment verification films in reducing localization error in the irradiation of complex fields. Cancer 1976;37(6):2755-61.
  • 7. Griffiths SE, Pearcey RG, Thorogood J. Quality control in radiotherapy: the reduction of field placement errors. Int J Radiat Oncol Biol Phys 1987;13(10):1583-8.
  • 8. Mitine C, Dutreix A, van der Schueren E. Tangential breast irradiation: influence of technique of set-up on transfer errors and reproducibility. Radiother Oncol 1991;22(4):308-10.
  • 9. Goretzky EJ, Kind AL. Evaluation of films for use in portal imaging in radiation therapy--a study at the Saskatoon Cancer Centre. Can J Med Radiat Technol 1992;23(3):117-9.
  • 10. Hatherly K, Smylie J, Rodger A. A comparison of field-only electronic portal imaging hard copies with double exposure port films in radiation therapy treatment setup confirmation to determine its clinical application in a radiotherapy center. Int J Radiat Oncol Biol Phys 1999;45(3):791-6.
  • 11. Munro P. Portal Imaging Technology: Past, Present, and Future. Semin Radiat Oncol 1995;5(2):115-133.
  • 12.Bel A, Vos PH, Rodrigus PT, Creutzberg CL, Visser AG, Stroom JC, et al. High-precision prostate cancer irradiation by clinical application of an offline patient setup verification procedure, using portal imaging. Int J Radiat Oncol Biol Phys 1996;35(2):321-32.
  • 13. Herman MG, Balter JM, Jaffray DA, McGee KP, Munro P, Shalev S, et al. Clinical use of electronic portal imaging: report of AAPM Radiation Therapy Committee Task Group 58. Med Phys 2001;28(5):712-37.
  • 14.Clippe S, Sarrut D, Malet C, Miguet S, Ginestet C, Carrie C. Patient setup error measurement using 3D intensity-based image registration techniques. Int J Radiat Oncol Biol Phys 2003;56(1):259-65.
  • 15.Rosenman J. Incorporating functional imaging information into radiation treatment. Semin Radiat Oncol 2001;11(1):83-92.
  • 16. Langmack KA. Portal imaging. Br J Radiol 2001;74(885):789-804.
  • 17. Haslam JJ, Lujan AE, Mundt AJ, Bonta DV, Roeske JC. Setup errors in patients treated with intensitymodulated whole pelvic radiation therapy for gynecological malignancies. Med Dosim 2005;30(1):36-42.
  • 18. Schallenkamp JM, Herman MG, Kruse JJ, Pisansky TM. Prostate position relative to pelvic bony anatomy based on intraprostatic gold markers and electronic portal imaging. Int J Radiat Oncol Biol Phys 2005;63(3):800-11.
  • 19. Herman MG, Pisansky TM, Kruse JJ, Prisciandaro JI, Davis BJ, King BF. Technical aspects of daily online positioning of the prostate for three-dimensional conformal radiotherapy using an electronic portal imaging device. Int J Radiat Oncol Biol Phys 2003;57(4):1131-40.
  • 20. Steciw S, Warkentin B, Rathee S, Fallone BG. Threedimensional IMRT verification with a flat-panel EPID. Med Phys 2005;32(2):600-12.
  • 21. Valicenti RK, Michalski JM, Bosch WR, Gerber R, Graham MV, Cheng A, et al. Is weekly port filming adequate for verifying patient position in modern radiation therapy? Int J Radiat Oncol Biol Phys 1994;30(2):431-8.
  • 22. Gagel B, Schramm O, Harms W, Mulhern A, Wenz F, van Kampen M, et al. The electronic portal imaging system Siemens Beamview Plus versus the conventional verification films CEA-TVS and DuPont COL- 7. A critical appraisal of visual image quality. Strahlenther Onkol 2002;178(8):446-52.
  • 23. Perera T, Moseley J, Munro P. Subjectivity in interpretation of portal films. Int J Radiat Oncol Biol Phys 1999;45(2):529-34.
  • 24. Lavertu S, Girouard LM, Pouliot J. Observation study of electronic portal images for off-line verification. Radiother Oncol 2000;54(1):47-55.
  • 25. Kruse JJ, Herman MG, Hagness CR, Davis BJ, Garces YI, Haddock MG, et al. Electronic and film portal images: a comparison of landmark visibility and review accuracy. Int J Radiat Oncol Biol Phys 2002;54(2):584-91.
  • 26. Fielding AL, Evans PM, Clark CH. Verification of patient position and delivery of IMRT by electronic portal imaging. Radiother Oncol 2004;73(3):339-47.
  • 27. Hatherly KE, Smylie JC, Rodger A, Dally MJ, Davis SR, Millar JL. A double exposed portal image comparison between electronic portal imaging hard copies and port films in radiation therapy treatment setup confirmation to determine its clinical application in a radiotherapy center. Int J Radiat Oncol Biol Phys 2001;49(1):191-8.
  • 28. Weber DC, Nouet P, Rouzaud M, Miralbell R. Patient positioning in prostate radiotherapy: is prone better than supine? Int J Radiat Oncol Biol Phys 2000;47(2):365-71.
  • 29. Haslam JJ, Lujan AE, Mundt AJ, Bonta DV, Roeske JC. Setup errors in patients treated with intensitymodulated whole pelvic radiation therapy for gynecological malignancies. Med Dosim 2005;30(1):36-42.
  • 30. Hurkmans CW, Remeijer P, Lebesque JV, Mijnheer BJ. Set-up verification using portal imaging; review of current clinical practice. Radiother Oncol 2001;58(2):105-20.
  • 31.Bieri S, Miralbell R, Nouet P, Delorme H, Rouzaud M. Reproducibility of conformal radiation therapy in localized carcinoma of the prostate without rigid immobilization. Radiother Oncol 1996;38(3):223-30.
  • 32. Washington M, Vijayakumar S, Vaida F, Sen S, Wyman B, Harrison J, et al. Comparison of three immobilisation devices in the 3 D conformal radiation therapy of prostate cancer. Int J Radiat Oncol Biol Phys 1994;30(Suppl. 1):174.
  • 33.Bentel GC, Marks LB, Sherouse GW, Spencer DP, Anscher MS. The effectiveness of immobilization during prostate irradiation. Int J Radiat Oncol Biol Phys 1995;31(1):143-8.
  • 34. Mitine C, Hoornaert MT, Dutreix A, Beauduin M. Radiotherapy of pelvic malignancies: impact of two types of rigid immobilisation devices on localisation errors. Radiother Oncol 1999;52(1):19-27.
  • 35. Amer AM, Mackay RI, Roberts SA, Hendry JH, Williams PC. The required number of treatment imaging days for an effective off-line correction of systematic errors in conformal radiotherapy of prostate canc e r--a radiobiological analysis. Radiother Oncol 2001;61(2):143-50.
  • 36. Yan D, Wong J, Vicini F, Michalski J, Pan C, Frazier A, et al. Adaptive modification of treatment planning to minimize the deleterious effects of treatment setup errors. Int J Radiat Oncol Biol Phys 1997;38(1):197- 206.
  • 37.Boxwala AA, Chaney EL, Fritsch DS, Raghavan S, Coffey CS, Major SA, et al. Comparison of computer workstation with light box for detecting setup errors from portal images. Int J Radiat Oncol Biol Phys 1999;44(3):711-6.
  • 38. Lewis DG, Ryan KR, Smith CW. Observer variability when evaluating patient movement from electronic portal images of pelvic radiotherapy fields. Radiother Oncol 2005;74(3):275-81.

Pelvik bölge radyoterapi uygulamalarında port film ve elektronik portal görüntülemenin karşılaştırılması

Year 2006, Volume: 21 Issue: 1, 1 - 10, 01.02.2006

Abstract

AMAÇ Bu çalışmada elektronik portal görüntü (EPI) ve port filmlerinin, ayar 'set-up' hatalarını değerlendirmedeki etkinliği ve görüntü kaliteleri karşılaştırıldı. GEREÇ VE YÖNTEM Pelvik radyoterapi alan 20 hastaya ait toplam 40 EPI ve 40 port film değerlendirildi. Görüntü kalitesi, seçilen anatomik yapıların görülebilirliğine göre derecelendirildi; 'set-up' hataları ise koordinat sisteminin x, y ve z eksenlerinde hesaplandı. EPI ve port filmler görüntü kalitesi ve hesaplanan alan kaymaları yönünden karşılaştırıldı. BULGULAR Görüntü kalitesi port filmlerde EPI'ye göre anlamlı olarak daha iyi bulundu. Her iki görüntüleme tekniğinde de en iyi görülebilen anatomik yapılar; asetabulum, pelvik rimler ve Symphysis pubis idi. Ortalama 'set-up' kaymaları x, y ve z eksenlerinde sırasıyla port filmlerde 1.47, 2.51 ve 3.99 mm; EPI'de ise 2.16, 3.09 ve 3.81 mm idi. 'Set-up' hataları tüm yönlerde kabul edilebilir düzeyde olduğu halde en fazla alan kayması her iki görüntüleme yönteminde de z eksenindeydi. SONUÇ Elektronik portal görüntüleme çok yaygın olarak kullanılmakta ve port filmlerin yerini almaktadır. Elektronik portal görüntü kullanımı port filmine göre 'set-up' hatalarını daha hızlı ve pratik değerlendirme olanağı vermektedir. Ayrıca 'set-up' hatalarının tedavi öncesi düzeltilmesi ve görüntülerin dijital ortamda arşivlenmesi mümkündür. Ancak EPI'nin port filmlerine göre en önemli dezavantajı görüntü kalitesinin kötü olması nedeniyle anatomik yapıların net değerlendirilememesidir.

References

  • 1. Michalski JM, Wong JW, Gerber RL, Yan D, Cheng A, Graham MV, et al. The use of on-line image verification to estimate the variation in radiation therapy dose delivery. Int J Radiat Oncol Biol Phys 1993;27(3):707-16.
  • 2. Kinzie JJ, Hanks GE, MacLean CJ, Kramer S. Patterns of care study: Hodgkin's disease relapse rates and adequacy of portals. Cancer 1983;52(12):2223-6. 3. White JE, Chen T, McCracken J, Kennedy P, Seydel HG, Hartman G, et al. The influence of radiation therapy quality control on survival, response and sites of relapse in oat cell carcinoma of the lung: preliminary report of a Southwest Oncology Group study. Cancer 1982;50(6):1084-90.
  • 4. Terahara A, Niemierko A, Goitein M, Finkelstein D, Hug E, Liebsch N, et al. Analysis of the relationship between tumor dose inhomogeneity and local control in patients with skull base chordoma. Int J Radiat Oncol Biol Phys 1999;45(2):351-8.
  • 5. Rabinowitz I, Broomberg J, Goitein M, McCarthy K, Leong J. Accuracy of radiation field alignment in clinical practice. Int J Radiat Oncol Biol Phys 1985;11(10):1857-67.
  • 6. Marks JE, Haus AG, Sutton HG, Griem ML. The value of frequent treatment verification films in reducing localization error in the irradiation of complex fields. Cancer 1976;37(6):2755-61.
  • 7. Griffiths SE, Pearcey RG, Thorogood J. Quality control in radiotherapy: the reduction of field placement errors. Int J Radiat Oncol Biol Phys 1987;13(10):1583-8.
  • 8. Mitine C, Dutreix A, van der Schueren E. Tangential breast irradiation: influence of technique of set-up on transfer errors and reproducibility. Radiother Oncol 1991;22(4):308-10.
  • 9. Goretzky EJ, Kind AL. Evaluation of films for use in portal imaging in radiation therapy--a study at the Saskatoon Cancer Centre. Can J Med Radiat Technol 1992;23(3):117-9.
  • 10. Hatherly K, Smylie J, Rodger A. A comparison of field-only electronic portal imaging hard copies with double exposure port films in radiation therapy treatment setup confirmation to determine its clinical application in a radiotherapy center. Int J Radiat Oncol Biol Phys 1999;45(3):791-6.
  • 11. Munro P. Portal Imaging Technology: Past, Present, and Future. Semin Radiat Oncol 1995;5(2):115-133.
  • 12.Bel A, Vos PH, Rodrigus PT, Creutzberg CL, Visser AG, Stroom JC, et al. High-precision prostate cancer irradiation by clinical application of an offline patient setup verification procedure, using portal imaging. Int J Radiat Oncol Biol Phys 1996;35(2):321-32.
  • 13. Herman MG, Balter JM, Jaffray DA, McGee KP, Munro P, Shalev S, et al. Clinical use of electronic portal imaging: report of AAPM Radiation Therapy Committee Task Group 58. Med Phys 2001;28(5):712-37.
  • 14.Clippe S, Sarrut D, Malet C, Miguet S, Ginestet C, Carrie C. Patient setup error measurement using 3D intensity-based image registration techniques. Int J Radiat Oncol Biol Phys 2003;56(1):259-65.
  • 15.Rosenman J. Incorporating functional imaging information into radiation treatment. Semin Radiat Oncol 2001;11(1):83-92.
  • 16. Langmack KA. Portal imaging. Br J Radiol 2001;74(885):789-804.
  • 17. Haslam JJ, Lujan AE, Mundt AJ, Bonta DV, Roeske JC. Setup errors in patients treated with intensitymodulated whole pelvic radiation therapy for gynecological malignancies. Med Dosim 2005;30(1):36-42.
  • 18. Schallenkamp JM, Herman MG, Kruse JJ, Pisansky TM. Prostate position relative to pelvic bony anatomy based on intraprostatic gold markers and electronic portal imaging. Int J Radiat Oncol Biol Phys 2005;63(3):800-11.
  • 19. Herman MG, Pisansky TM, Kruse JJ, Prisciandaro JI, Davis BJ, King BF. Technical aspects of daily online positioning of the prostate for three-dimensional conformal radiotherapy using an electronic portal imaging device. Int J Radiat Oncol Biol Phys 2003;57(4):1131-40.
  • 20. Steciw S, Warkentin B, Rathee S, Fallone BG. Threedimensional IMRT verification with a flat-panel EPID. Med Phys 2005;32(2):600-12.
  • 21. Valicenti RK, Michalski JM, Bosch WR, Gerber R, Graham MV, Cheng A, et al. Is weekly port filming adequate for verifying patient position in modern radiation therapy? Int J Radiat Oncol Biol Phys 1994;30(2):431-8.
  • 22. Gagel B, Schramm O, Harms W, Mulhern A, Wenz F, van Kampen M, et al. The electronic portal imaging system Siemens Beamview Plus versus the conventional verification films CEA-TVS and DuPont COL- 7. A critical appraisal of visual image quality. Strahlenther Onkol 2002;178(8):446-52.
  • 23. Perera T, Moseley J, Munro P. Subjectivity in interpretation of portal films. Int J Radiat Oncol Biol Phys 1999;45(2):529-34.
  • 24. Lavertu S, Girouard LM, Pouliot J. Observation study of electronic portal images for off-line verification. Radiother Oncol 2000;54(1):47-55.
  • 25. Kruse JJ, Herman MG, Hagness CR, Davis BJ, Garces YI, Haddock MG, et al. Electronic and film portal images: a comparison of landmark visibility and review accuracy. Int J Radiat Oncol Biol Phys 2002;54(2):584-91.
  • 26. Fielding AL, Evans PM, Clark CH. Verification of patient position and delivery of IMRT by electronic portal imaging. Radiother Oncol 2004;73(3):339-47.
  • 27. Hatherly KE, Smylie JC, Rodger A, Dally MJ, Davis SR, Millar JL. A double exposed portal image comparison between electronic portal imaging hard copies and port films in radiation therapy treatment setup confirmation to determine its clinical application in a radiotherapy center. Int J Radiat Oncol Biol Phys 2001;49(1):191-8.
  • 28. Weber DC, Nouet P, Rouzaud M, Miralbell R. Patient positioning in prostate radiotherapy: is prone better than supine? Int J Radiat Oncol Biol Phys 2000;47(2):365-71.
  • 29. Haslam JJ, Lujan AE, Mundt AJ, Bonta DV, Roeske JC. Setup errors in patients treated with intensitymodulated whole pelvic radiation therapy for gynecological malignancies. Med Dosim 2005;30(1):36-42.
  • 30. Hurkmans CW, Remeijer P, Lebesque JV, Mijnheer BJ. Set-up verification using portal imaging; review of current clinical practice. Radiother Oncol 2001;58(2):105-20.
  • 31.Bieri S, Miralbell R, Nouet P, Delorme H, Rouzaud M. Reproducibility of conformal radiation therapy in localized carcinoma of the prostate without rigid immobilization. Radiother Oncol 1996;38(3):223-30.
  • 32. Washington M, Vijayakumar S, Vaida F, Sen S, Wyman B, Harrison J, et al. Comparison of three immobilisation devices in the 3 D conformal radiation therapy of prostate cancer. Int J Radiat Oncol Biol Phys 1994;30(Suppl. 1):174.
  • 33.Bentel GC, Marks LB, Sherouse GW, Spencer DP, Anscher MS. The effectiveness of immobilization during prostate irradiation. Int J Radiat Oncol Biol Phys 1995;31(1):143-8.
  • 34. Mitine C, Hoornaert MT, Dutreix A, Beauduin M. Radiotherapy of pelvic malignancies: impact of two types of rigid immobilisation devices on localisation errors. Radiother Oncol 1999;52(1):19-27.
  • 35. Amer AM, Mackay RI, Roberts SA, Hendry JH, Williams PC. The required number of treatment imaging days for an effective off-line correction of systematic errors in conformal radiotherapy of prostate canc e r--a radiobiological analysis. Radiother Oncol 2001;61(2):143-50.
  • 36. Yan D, Wong J, Vicini F, Michalski J, Pan C, Frazier A, et al. Adaptive modification of treatment planning to minimize the deleterious effects of treatment setup errors. Int J Radiat Oncol Biol Phys 1997;38(1):197- 206.
  • 37.Boxwala AA, Chaney EL, Fritsch DS, Raghavan S, Coffey CS, Major SA, et al. Comparison of computer workstation with light box for detecting setup errors from portal images. Int J Radiat Oncol Biol Phys 1999;44(3):711-6.
  • 38. Lewis DG, Ryan KR, Smith CW. Observer variability when evaluating patient movement from electronic portal images of pelvic radiotherapy fields. Radiother Oncol 2005;74(3):275-81.
There are 37 citations in total.

Details

Primary Language Turkish
Journal Section Articles
Authors

M. Gamze Aksu This is me

Nina Tunçel This is me

Musa Altun This is me

Publication Date February 1, 2006
Published in Issue Year 2006 Volume: 21 Issue: 1

Cite

APA Aksu, M. G., Tunçel, N., & Altun, M. (2006). Pelvik bölge radyoterapi uygulamalarında port film ve elektronik portal görüntülemenin karşılaştırılması. Türk Onkoloji Dergisi, 21(1), 1-10.
AMA Aksu MG, Tunçel N, Altun M. Pelvik bölge radyoterapi uygulamalarında port film ve elektronik portal görüntülemenin karşılaştırılması. Türk Onkoloji Dergisi. February 2006;21(1):1-10.
Chicago Aksu, M. Gamze, Nina Tunçel, and Musa Altun. “Pelvik bölge Radyoterapi uygulamalarında Port Film Ve Elektronik Portal görüntülemenin karşılaştırılması”. Türk Onkoloji Dergisi 21, no. 1 (February 2006): 1-10.
EndNote Aksu MG, Tunçel N, Altun M (February 1, 2006) Pelvik bölge radyoterapi uygulamalarında port film ve elektronik portal görüntülemenin karşılaştırılması. Türk Onkoloji Dergisi 21 1 1–10.
IEEE M. G. Aksu, N. Tunçel, and M. Altun, “Pelvik bölge radyoterapi uygulamalarında port film ve elektronik portal görüntülemenin karşılaştırılması”, Türk Onkoloji Dergisi, vol. 21, no. 1, pp. 1–10, 2006.
ISNAD Aksu, M. Gamze et al. “Pelvik bölge Radyoterapi uygulamalarında Port Film Ve Elektronik Portal görüntülemenin karşılaştırılması”. Türk Onkoloji Dergisi 21/1 (February 2006), 1-10.
JAMA Aksu MG, Tunçel N, Altun M. Pelvik bölge radyoterapi uygulamalarında port film ve elektronik portal görüntülemenin karşılaştırılması. Türk Onkoloji Dergisi. 2006;21:1–10.
MLA Aksu, M. Gamze et al. “Pelvik bölge Radyoterapi uygulamalarında Port Film Ve Elektronik Portal görüntülemenin karşılaştırılması”. Türk Onkoloji Dergisi, vol. 21, no. 1, 2006, pp. 1-10.
Vancouver Aksu MG, Tunçel N, Altun M. Pelvik bölge radyoterapi uygulamalarında port film ve elektronik portal görüntülemenin karşılaştırılması. Türk Onkoloji Dergisi. 2006;21(1):1-10.