Abstract
Purpose
This study was undertaken to study the role of fiducial markers for image-guided partial breast irradiation (IG-PBI), and to compare the shifts based on bony anatomy and fiducial markers.
Materials and methods
Fifteen patients underwent IGPBI. Three fiducial markers were placed in the tumour bed at the time of surgery. Daily orthogonal anterior/ posterior and lateral kV-images were taken before each fraction and compared with the digitally-reconstructed radiographs, both using bony landmarks and fiducial markers as reference. The Student’s t test was used to detect a meaningful difference of 3 mm in between the two methods.
Results
A total of 105 image-guided radiation therapy (IGRT) sessions were obtained. The mean superior/inferior, right/left, and anterior/posterior shifts obtained using the bony landmarks vs. the fiducial markers were 2 mm [standard deviation (SD) 10 mm] vs. 0 mm (SD 7 mm), 0 mm (SD 7 mm) vs. 1 mm (SD 4 mm), and 1 mm (SD 7 mm) vs. 0 mm (SD 5 mm), respectively. The mean shift differences in absolute value between the two methods, along the superior/inferior, right/left and anterior/posterior directions were 5 mm (p=0.001), 3 mm [p=not significant (ns)], and 3 mm (p=ns), respectively.
Conclusions
Fiducial markers for IG-PBI increase set-up accuracy compared to the bony landmarks, in particular along the superior/inferior direction.
Riassunto
Obiettivo
Scopo del presente lavoro è stato studiare il ruolo dei marcatori fiduciali nell’irradiazione parziale della mammella guidata dalle immagini (IG-PBI) e confrontare gli spostamenti basati sui reperi ossei rispetto ai marcatori fiduciali.
Materiali e metodi
Sono state sottoposte a IG-PBI 15 pazienti. Al momento della chirurgia sono stati posizionati tre marcatori fiduciali nel letto tumorale. Prima di ogni frazione giornaliera di radioterapia sono state ottenute immagini kV ortogonali e confrontate con le radiografie ricostruite digitalmente, utilizzando come riferimento reperi ossei e marcatori fiduciali. è stato utilizzato il test t di Student per identificare differenze significative di 3 mm tra i due metodi.
Risultati
Sono state studiate 105 sessioni di radioterapia guidata dalle immagini (IGRT). Gli spostamenti medi nella direzione superiore/inferiore, destra/sinistra e anteriore/posteriore ottenuti utilizzando i reperi ossei vs. i marcatori fiduciali sono risultati di 2 mm [deviazione standard (SD) 10 m] vs. 0 mm (SD 7 mm), 0 mm (SD 7 mm) vs. 1 mm (SD 4 mm), e 1 mm (SD 7 mm) vs. 0 mm (SD 5 mm), rispettivamente. La differenza media in valore assoluto tra gli spostamenti ottenuti con i due metodi nelle direzioni superiore/inferiore, destra/sinistra e anteriore/ posteriore sono risultati di 5 mm (p=0,001), 3 mm [p=non significativo (ns)], e 3 mm (p=ns), rispettivamente.
Conclusioni
L’ utilizzo di marcatori fiduciali nella IG-PBI permette di migliorare l’accuratezza del set-up rispetto all’allineamento basato sui reperi ossei, in particolare nella direzione superiore/inferiore.
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Trovo, M., Polesel, J., Biasutti, C. et al. Fiducial markers for image-guided partial breast irradiation. Radiol med 118, 1212–1219 (2013). https://doi.org/10.1007/s11547-013-0967-2
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DOI: https://doi.org/10.1007/s11547-013-0967-2