Utilization of optical tracking to assess efficacy of intracranial immobilization techniques in proton therapy

We present a quantitative methodology to measure head interfraction movements within intracranial masks of commercial immobilization devices used for proton radiotherapy. A three-points tracking (3PtTrack) method was developed to measure the mask location for each treatment field over an average of 10 fractions for seven patients. Five patients were treated in supine with the Qfix Base-of-Skull (BoS) headframe, and two patients were treated in prone with the CIVCO Uni-frame baseplate. Patients were first localized by an in-room, image-guidance (IG) system, and then the mask location was measured using the 3PtTrack method. Measured mask displacements from initial location at the first fraction are considered equivalent to the head interfraction movement within the mask. The trends of head movements and couch displacements and rotation were analyzed in three major directions. The accuracy of 3PtTrack method was shown to be within 1.0mm based on daily measurements of a QA device after localization by the IG system for a period of three months. For seven patients, mean values of standard deviation (SD) in anterior-posterior, lateral, and superior-inferior directions were 1.1mm, 1.4 mm, and 1.6 mm for head movements, and were 1.4 mm, 1.8 mm, and 3.4mm for couch displacements. The mean SD values of couch rotations were 1.1°, 0.9°, and 1.1° for yaw, pitch, and roll, respectively. The overall patterns of head movements and couch displacements were similar for patients treated in either supine or prone, with larger deviations in the superior-inferior (SI) direction. A suboptimal mask fixation to the frame of the mask to the H&N frame is likely the cause for the observed larger head movements and couch displacements in the SI direction compared to other directions. The optical-tracking methodology provided a quantitative assessment of the magnitude of head motion.