Calculating radiotherapy margins based on Bayesian modelling of patient specific random errors

Alan Herschtal, Luc te Marvelde, Kerrie L Mengersen, Zahra Hosseinifard, Farshad Foroudi, Thomas Devereux, Daniel T Pham, David Lee Ball, Peter B Greer, Peter Pichler, Thomas N Eade, Andrew B Kneebone, Leonard B Bell, Hannah L Caine, Benjamin R Hindson, Tomas Kron

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Collected real-life clinical target volume (CTV) displacement data show that some patients undergoing external beam radiotherapy (EBRT) demonstrate significantly more fraction-to-fraction variability in their displacement ( random error ) than others. This contrasts with the common assumption made by historical recipes for margin estimation for EBRT, that the random error is constant across patients. In this work we present statistical models of CTV displacements in which random errors are characterised by an inverse gamma (IG) distribution in order to assess the impact of random error variability on CTV-to-PTV margin widths, for eight real world patient cohorts from four institutions, and for different sites of malignancy. We considered a variety of clinical treatment requirements and penumbral widths. The eight cohorts consisted of a total of 874 patients and 27?391 treatment sessions. Compared to a traditional margin recipe that assumes constant random errors across patients, for a typical 4?mm penumbral width, the IG based margin model mandates that in order to satisfy the common clinical requirement that 90 of patients receive at least 95 of prescribed RT dose to the entire CTV, margins be increased by a median of 10 (range over the eight cohorts -19 to +35 ). This substantially reduces the proportion of patients for whom margins are too small to satisfy clinical requirements.
Original languageEnglish
Pages (from-to)1793 - 1805
Number of pages13
JournalPhysics in Medicine & Biology
Issue number5
Publication statusPublished - 2015

Cite this

Herschtal, A., Marvelde, L. T., Mengersen, K. L., Hosseinifard, Z., Foroudi, F., Devereux, T., Pham, D. T., Ball, D. L., Greer, P. B., Pichler, P., Eade, T. N., Kneebone, A. B., Bell, L. B., Caine, H. L., Hindson, B. R., & Kron, T. (2015). Calculating radiotherapy margins based on Bayesian modelling of patient specific random errors. Physics in Medicine & Biology, 60(5), 1793 - 1805.