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Evaluation of intrafractional prostate displacement during prostate radiotherapy using real-time ultrasound system

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Abstract

Transperineal ultrasound (TPUS) is an image-guided radiotherapy system used for tracking intrafraction prostate displacements in real time. The objectives of this study are to evaluate intrafraction prostate displacements and derive planning target volume (PTV) margins for prostate radiotherapy at our institution. The ultrasound (US) data of nine prostate cancer patients referred for VMAT radiotherapy was retrieved. Prior to beam on, patient position was set up with the US probe positioned transperineally with the aid of reference images (fused US and computed tomography images). In each fraction, prostate displacements in three directions [superior/inferior (SI), left/right (LR) and anterior/posterior (AP)] were recorded. PTV margins were determined using Van Herk’s formula. To assess the prostate displacement time trend, continuous displacement data were plotted in 30-s intervals for eight minutes. The intrafraction prostate monitoring found a population mean setup error (Mp) of 0.8, 0.1, − 1.7 mm, a systematic error of (∑p) 0.7, 0.4, 0.9 mm and random error (σp) of 0.2, 0.1, 0.3 mm in SI, LR and AP directions, respectively. The PTV margin was found to be the largest in the AP direction at 2.5 mm compared with 1.9 mm and 1.1 mm for SI and LR directions, respectively. The PTV margin allowed for prostate radiotherapy at our institution was 2.5 mm in all directions. The prostate displacement time trend showed an increase in intrafraction displacements, with most patients were observed to have strong positive correlation between time and intrafraction prostate displacements in SI direction. TPUS is feasible for monitoring intrafraction displacement of the prostate and may facilitate PTV margin generation to account for such displacements during radiotherapy.

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Funding

This research was funded by the Malaysia Ministry of Higher Education Fundamental Research Grant Scheme (FRGS/1/2020/SKK03/UM/02/1).

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Authors and Affiliations

  1. Clinical Oncology Unit, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

    Nur Syazana Mohd Zahir, Marniza Saad, Adlinda Alip, Munira Rejab, Zulaikha Jamalludin, Nur Diyana Afrina Hizam & Ngie Min Ung

  2. Medical Physics Unit, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia

    Munira Rejab

  3. Department of Biomedical Engineering, Faculty of Engineering, Universiti Malaya, Kuala Lumpur, Malaysia

    Yih Miin Liew

Authors
  1. Nur Syazana Mohd Zahir
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  2. Marniza Saad
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  3. Adlinda Alip
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  4. Munira Rejab
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  5. Zulaikha Jamalludin
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  6. Nur Diyana Afrina Hizam
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  7. Yih Miin Liew
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  8. Ngie Min Ung
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by NSMZ, MR, and NMU. The first draft of the manuscript was written by NSMZ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ngie Min Ung.

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The authors have no relevant financial or non-financial interests to disclose.

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This study is approved by the Human Research Ethics Committee of University of Malaya Medical Centre (UMMC) (Approval reference number MREC ID No 2018213-6028).

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Zahir, N.S.M., Saad, M., Alip, A. et al. Evaluation of intrafractional prostate displacement during prostate radiotherapy using real-time ultrasound system. Phys Eng Sci Med 46, 405–412 (2023). https://doi.org/10.1007/s13246-023-01230-x

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  • DOI: https://doi.org/10.1007/s13246-023-01230-x

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