Indirect Evaluation of Pretreatment Imaging Protocols and Their Clinical Impact on Patient Dose Delivery in Radiotherapy

Objective Pretreatment imaging plays a crucial role in determining geometric positional uncertainty of the patient during radiotherapy. Our purpose is to investigate the effect of frequent pretreatment imaging protocol (scenario) on actual dose delivery in radiotherapy. This paper presents a critical analysis of frequent imaging protocol with respect to Idealized daily imaging protocol (IDIP). Methods and materials Retrospective patients of Ca-carcinoma cervix, Ca-buccal mucosa, Ca-tongue treated with intensity-modulated radiation therapy (IMRT) undergoing daily cone beam computed tomography (CBCT) imaging protocol was selected for this study. Every treated fraction of these patients was simulated considering its daily geometrical setup uncertainties occurred. Indirect evaluation of virtual treatment plans was conducted in the treatment planning system (TPS) for 3 days a week, 2 days a week, and 1 day a week frequency imaging protocols. Results obtained from these frequent imaging protocols were compared with IDIP. Result Deviation between predicted and delivered dose found increasing with decreasing frequency of imaging. Significant deviations were observed in all the estimated plan quality parameters for patients treated with frequent imaging protocols and IDIP. Deviations were found more in case of pelvis sites than head and neck sites. Conclusion This study plays a vital role in establishing optimum pretreatment imaging protocols in busy clinics. Three days a week imaging protocol is the best suit protocol found with minimal deviation and ample implementation feasibility. This study proposed an opinion pertaining to the revision of setup margin formula in order to accommodate variation due to imaging techniques and frequency of imaging attempted during radiotherapy.