Image-guided radiotherapy (IGRT) reduces setup errors and thus minimizes
the margin between clinical target volume (CTV) and planning target volume
(PTV). Two-dimensional megavoltage
imaging with the therapy beam enables
matching/positioning relative to bony
structures only [1]. Cone-beam computed
tomography (CBCT) has been widely adopted and provides the most accurate patient positioning with a relatively low extra imaging dose to the patient [1, 2]. A remaining positioning issue is target motion
during dose delivery in the treatment of
lung and liver metastases. Multiple strategies have been developed to compensate
for this intrafractional tumor motion [3].
An alternative positioning strategy
is based on surface tracking. The current surface scan is compared to the reference surface (based on planning CT)
and a shift vector is calculated [4, 5, 6,
7]. These systems may reduce the number of CBCT scans and thus limit the imaging dose to patients. The system described in this study uses a new scanning
method with a near-visible light projector
and a charge-coupled device (CCD) camera. It projects the calculated regional patient shift directly onto the patient’s surface in order to simplify the patient positioning process. It also provides a surveillance function to detect patient movement
or breathing during treatment (intrafractional movement); a functional modality
that can also be used to drive the gating
interface of a linear accelerator.
The surveillance function, the new
scanning approach and gating may further improve the accuracy of liver and
lung treatments [3], provided that the inherent accuracy of the system is sufficient.
As a first step, we investigated the basic
performance and accuracy of the new
scanning method of the Catalyst (C-RAD,
Uppsala, Sweden) system in a non-gated
environment. These issues were addressed
in both phantom experiments mimicking
different clinical situations and in a prospective clinical study covering three anatomical region