title: A comparison between radiation therapists and medical specialists in the use of kilovoltage cone-beam computed tomography scans for potential lung cancer radiotherapy target verification and adaptation.
abstract: Target volume matching using cone-beam computed tomography (CBCT) is the preferred treatment verification method for lung cancer in many centers. However, radiation therapists (RTs) are trained in bony matching and not soft tissue matching. The purpose of this study was to determine whether RTs were equivalent to radiation oncologists (ROs) and radiologists (RDs) in alignment of the treatment CBCT with the gross tumor volume (GTV) defined at planning and in delineating the GTV on the treatment CBCT, as may be necessary for adaptive radiotherapy. In this study, 10 RTs, 1 RO, and 1 RD performed a manual tumor alignment and correction of the planning GTV to a treatment CBCT to generate an isocenter correction distance for 15 patient data sets. Participants also contoured the GTV on the same data sets. The isocenter correction distance and the contoured GTVs from the RTs were compared with the RD and RO. The mean difference in isocenter correction distances was 0.40cm between the RO and RD, 0.51cm between the RTs, and RO and 0.42cm between the RTs and RD. The 95% CIs were smaller than the equivalence limit of 0.5cm, indicating that the RTs were equivalent to the RO and RD. For GTV delineation comparisons, the RTs were not found to be equivalent to the RD or RO. The alignment of the planning defined GTV and treatment CBCT using soft tissue matching by the RTs has been shown to be equivalent to those by the RO and RD. However, tumor delineation by the RTs on the treatment CBCT was not equivalent to that of the RO and RD. Thus, it may be appropriate for RTs to undertake soft tissue alignment based on CBCT; however, further investigation may be necessary before RTs undertake delineation for adaptive radiotherapy purposes.
authors.affiliation: Liverpool and Macarthur Cancer Therapy Centres, NSW, Australia; University of Sydney, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia. Electronic address: sandie.watt@sswahs.gov.au.
authors.forename: Sandie Carolyn
authors.initials: SC
authors.lastname: Watt
authors.affiliation: Liverpool and Macarthur Cancer Therapy Centres, NSW, Australia; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; South Western Sydney Clinical School, The University of New South Wales, Liverpool, NSW, Australia; Department of Radiation Oncology, Prince of Wales Hospital, NSW, Australia.
authors.forename: Shalini K
authors.initials: SK
authors.lastname: Vinod
authors.affiliation: Department of Radiology, Liverpool Hospital, NSW, Australia; Department of Radiation Oncology, Prince of Wales Hospital, NSW, Australia.
authors.forename: Marion
authors.initials: M
authors.lastname: Dimigen
authors.affiliation: Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; South Western Sydney Clinical School, The University of New South Wales, Liverpool, NSW, Australia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Descallar
authors.affiliation: Department of Radiation Oncology, Prince of Wales Hospital, NSW, Australia.
authors.forename: Branimere
authors.initials: B
authors.lastname: Zogovic
authors.affiliation: University of Sydney, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Atyeo
authors.affiliation: University of Western Sydney, NSW, Australia.
authors.forename: Sian
authors.initials: S
authors.lastname: Wallis
authors.affiliation: Liverpool and Macarthur Cancer Therapy Centres, NSW, Australia; University of Sydney, Sydney, NSW, Australia; Institute of Medical Physics, University of Sydney, Sydney, NSW, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia.; Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
authors.forename: Lois C
authors.initials: LC
authors.lastname: Holloway
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data*; D054893:Cone-Beam Computed Tomography; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D061089:Radiotherapy, Image-Guided / Q000592:standards* / Q000706:statistics & numerical data
keywords: IGRT; Treatment verification; kVCBCT