title: Intra-fraction setup variability: IR optical localization vs. X-ray imaging in a hypofractionated patient population.
abstract: BACKGROUND
  The purpose of this study is to investigate intra-fraction setup variability in hypo-fractionated cranial and body radiotherapy; this is achieved by means of integrated infrared optical localization and stereoscopic kV X-ray imaging.
  
  
  METHODS
  We analyzed data coming from 87 patients treated with hypo-fractionated radiotherapy at cranial and extra-cranial sites. Patient setup was realized through the ExacTrac X-ray 6D system (BrainLAB, Germany), consisting of 2 infrared TV cameras for external fiducial localization and X-ray imaging in double projection for image registration. Before irradiation, patients were pre-aligned relying on optical marker localization. Patient position was refined through the automatic matching of X-ray images to digitally reconstructed radiographs, providing 6 corrective parameters that were automatically applied using a robotic couch. Infrared patient localization and X-ray imaging were performed at the end of treatment, thus providing independent measures of intra-fraction motion.
  
  
  RESULTS
  According to optical measurements, the size of intra-fraction motion was (median ± quartile) 0.3 ± 0.3 mm, 0.6 ± 0.6 mm, 0.7 ± 0.6 mm for cranial, abdominal and lung patients, respectively. X-ray image registration estimated larger intra-fraction motion, equal to 0.9 ± 0.8 mm, 1.3 ± 1.2 mm, 1.8 ± 2.2 mm, correspondingly.
  
  
  CONCLUSIONS
  Optical tracking highlighted negligible intra-fraction motion at both cranial and extra-cranial sites. The larger motion detected by X-ray image registration showed significant inter-patient variability, in contrast to infrared optical tracking measurement. Infrared localization is put forward as the optimal strategy to monitor intra-fraction motion, featuring robustness, flexibility and less invasivity with respect to X-ray based techniques.
authors.affiliation: Department of Experimental and Clinical Medicine, Università degli Studi Magna Græcia, Catanzaro, Italy. mariafrancesca.spadea@polimi.it
authors.forename: Maria Francesca
authors.initials: MF
authors.lastname: Spadea
authors.forename: Barbara
authors.initials: B
authors.lastname: Tagaste
authors.forename: Marco
authors.initials: M
authors.lastname: Riboldi
authors.forename: Eleonora
authors.initials: E
authors.lastname: Preve
authors.forename: Daniela
authors.initials: D
authors.lastname: Alterio
authors.forename: Gaia
authors.initials: G
authors.lastname: Piperno
authors.forename: Cristina
authors.initials: C
authors.lastname: Garibaldi
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
authors.forename: Antonio
authors.initials: A
authors.lastname: Pedotti
authors.forename: Guido
authors.initials: G
authors.lastname: Baroni
mesh_terms: D000008:Abdominal Neoplasms / Q000532:radiotherapy*; D001932:Brain Neoplasms / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D006801:Humans; D007103:Immobilization; D007259:Infrared Rays; D008175:Lung Neoplasms / Q000532:radiotherapy*; D009068:Movement; D056888:Patient Positioning; D016896:Treatment Outcome; D014965:X-Rays