A SINGLE INSTITUTIONAL AUDIT OF SETUP ERRORS FOR 3DCRT RECTAL CANCERS

Received 2019-08-20; Accepted 2019-11-01; Published 2020-01-29

Authors

  • Wei Zhuen Chew International Medical University, Bukit Jalil, Kuala Lumpur, Malaysia.
  • Wei Loong Jong Clinical Oncology Department, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
  • Zulaikha Jamaluddin Clinical Oncology Department, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
  • Haiza Fasha Zakaraiah Clinical Oncology Department, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
  • Atiqah Kadri Clinical Oncology Department, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
  • Mohamad Afandi Azman Clinical Oncology Department, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
  • Jasmin Pei Yuin Loh Clinical Oncology Department, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.
  • Gwo Fuang Ho Clinical Oncology Department, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.

DOI:

https://doi.org/10.22452/jummec.vol23no1.2

Keywords:

Audit, radiotherapy, setup errors, 3DCRT

Abstract

Background: Set-up errors are errors which are inevitable in radiotherapy. However, they should be kept to a minimum to achieve the maximum radiation dose to a tumour as to maximise treatment efficacy. This study aims to quantify those errors and assess if they remain within the tolerance limit of 5 mm in all directions. This study will also determine the adequacy of the margins for set up error for 3DCRT of rectal cancers at University of Malaya Medical Centre (UMMC).
Methods: A total of 20 rectal cancer patients (July 2018 to May 2019) who were treated with radiotherapy amounting to a total of 119 CBCT images were included in the study. Population systematic errors and random setup errors were calculated.
Results: Population systematic errors and random setup errors in the vertical, longitudinal and lateral direction were tabulated in Table 1. There is a large deviation (>5 mm) noted in some patients’ setup between the first 3 days and the next successive day of imaging. Clinical target volume (CTV) to planning target volume (PTV) margin were calculated using Van Herk’s margin recipe (M=2.5Σ+0.7σ). The margins were 5.0 mm, 6.2 mm, and 4.0 mm for vertical, longitudinal and lateral directions, respectively. The systematic error for the population was 1.1 mm, 0.9 mm, 0.9 mm in the vertical, longitudinal and lateral directions respectively, while the random error is 3.2 mm, 5.7 mm and 2.5 mm in the vertical, longitudinal and lateral directions respectively.
Conclusion: All of the patients involved in the study were within tolerance limits at some point in their treatment. The results demonstrated that a larger margin is needed in the longitudinal direction. Weekly CBCT is also necessary after the initial 3-day imaging to ensure that patients are kept within the tolerance limits.

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Published

2020-01-29

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Research article

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