Evaluation and correlation of patient movement during online adaptive radiotherapy with CBCT and a surface imaging system

Purpose: With the clinical implementation of kV-CBCT-based daily online-adaptive radiotherapy, the ability to monitor, quantify, and correct patient movement during adaptive sessions is paramount. With sessions lasting between 20-45 min, the ability to detect and correct for small movements without restarting the entire session is critical to the adaptive workflow and dosimetric outcome. The purpose of this study was to quantify and evaluate the correlation of observed patient movement with machine logs and a surface imaging (SI) system during adaptive radiation therapy. Methods: Treatment machine logs and SGRT registration data log files for 1972 individual sessions were exported and analyzed. For each session, the calculated shifts from a pre-delivery position verification CBCT were extracted from the machine logs and compared to the SGRT registration data log files captured during motion monitoring. The SGRT calculated shifts were compared to the reported shifts of the machine logs for comparison for all patients and eight disease site categories. Results: The average (+/- STD) net displacement of the SGRT shifts were 2.6 +/- 3.4 mm, 2.6 +/- 3.5 mm, and 3.0 +/- 3.2 in the lateral, longitudinal, and vertical directions, respectively. For the treatment machine logs, the average net displacements in the lateral, longitudinal, and vertical directions were 2.7 +/- 3.7 mm, 2.6 +/- 3.7 mm, and 3.2 +/- 3.6 mm. The average difference (Machine-SGRT) was -0.1 +/- 1.8 mm, 0.2 +/- 2.1 mm, and -0.5 +/- 2.5 mm for the lateral, longitudinal, and vertical directions. On average, a movement of 5.8 +/- 5.6 mm and 5.3 +/- 4.9 mm was calculated prior to delivery for the CBCT and SGRT systems, respectively. The Pearson correlation coefficient between CBCT and SGRT shifts was r = 0.88. The mean and median difference between the treatment machine logs and SGRT log files was less than 1 mm for all sites. Conclusion: Surface imaging should be used to monitor and quantify patient movement during adaptive radiotherapy.