Quantitative Evaluation of Setup Error for Whole Body Stereotactic Radiosurgery by Image Registration Technique

Whole body stereotactic radiosurgery (WBSRS) technique is believed to be useful for the metastatic lesions as well as relatively small primary tumors in the trunk. Unlike stereotactic radiosurgery to intracranial lesion, inherent limitation on immobilization of whole body makes it difficult to achieve the reliable setup reproducibility. For this reason, it is essential to develop an objective and quantitative method of evaluating setup error for WBSRS. An evaluation technique using image registration has been developed for this purpose. Point pair image registrations with WBSRS frame coordinates were performed between two sets of CT images acquired before each treatment. Positional displacements could be determined by means of volumetric planning target volume (PTV) comparison between the reference and the registered image sets. Twenty eight sets of CT images from 19 WBSRS patients treated in Asan Medical Center have been analyzed by this method for determination of setup random error of each treatment. It is objective and clinically useful to analyze setup error quantitatively by image registration technique with WBSRS frame coordinates.