Figure 1
![Automatic clip box carina registration with manual alignment check. Target contours (gross tumour volume [GTV] inner contour, planning target volume [PTV] outer contour) are imported for target registration.](https://sciendo-parsed.s3.eu-central-1.amazonaws.com/647356744e662f30ba53ab78/j_raon-2022-0048_fig_001.jpg?X-Amz-Algorithm=AWS4-HMAC-SHA256&X-Amz-Content-Sha256=UNSIGNED-PAYLOAD&X-Amz-Credential=ASIA6AP2G7AKHDZFKGBU%2F20260305%2Feu-central-1%2Fs3%2Faws4_request&X-Amz-Date=20260305T082618Z&X-Amz-Expires=3600&X-Amz-Security-Token=IQoJb3JpZ2luX2VjEAAaDGV1LWNlbnRyYWwtMSJHMEUCIEviR%2FUxjQmP%2FZP23tT5%2F2abpqtoZa%2FkWTwoUVN0ln%2BOAiEA%2BNmg%2FIupDARafPvVMNsdAwA57NKxKY0tphb8eI%2BfI%2BwqxgUIyf%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FARACGgw5NjMxMzQyODk5NDAiDChBbB43cNv67n8OeyqaBd4BSghDh2wqxqpq8fOAw6CYmRbb6Ig9acN%2FTzqX3rzLUw8gC8rUq2Iai6BAS4uFk262UGaUVJJScwVS4hAGuouTL5wpYLgJUIhl6cSz3UvJWeednrvv2I29bz1oTTg0cN3zvsk1YAKVnzYvP2ZCMVlAt1gplIPP5o5z9DHtIRmZ56wir8QFo0GHKHFADbRTsy9m060Z4JImnz8UhTiiTnAm2U%2FdAjCU2w5GnLXFFviedxwmJDML2bbACt%2BQyqNfem9pCJa%2BiUdEuthQTyGkgPU7WRslu033AZtw%2BhYQ%2BX38cpskGjrRiSeC9vobfJ4DIxYuIYPVakIgMKmsWxhJesTZshrrv8Xzq8vSCf0qgluOj%2F%2FbJbUaN9fGxZk5e%2BnW0j9UfYy5i3GoJjDp6mye%2FyM0tIA%2FcSADCVa8pDOtyQv1KRKZMk0hcJ3sja9c2T%2FIHDaCcSjQ8IguIUGJdFvQAYWTjEaQUJM%2FcuU5sUvSFIB3APRvnGphvVUYUYIDqio6cvty1Z7ujhKq2ABIQTyS4m1JDYCLDIEL2jNDI80vD6uBv3LvdIFeL9AUydEYMdDRVZg%2BasgfYLgbSs5HZSaTEjk8wPvu%2BZd9hAVsZz9koGqf8MPp4s52BpSx2MH8%2BriPd6ucVRjXc5AWTIPtr5hXaIRv7ff4AjrkMWGy3%2B%2FWlh2k%2FkEl4qX2dNjOh1qhQRtyQCNFBY1u%2B0SjuctsNR10godw4fqo7FxsFNil3%2Fn1lIgJXLKa5PyOLOycLfa4ZMm3gQzNiGqvNV%2FYQHtjfD1I%2FTAqdXLOLPtR7LxCNZxyTkpNFJ5zGANnm9zPz1m%2BKFvj3sNwNNXj8verS3oqfIh0PRYwSuvNdCIkEVLphlqml8F7ti33%2BSuCRHGdTTC15aTNBjqxAZfGBjAfK8mQh2yE%2FepqhmqYpnmKIUJmcKXYR0TbfHBVIx4rWgxTTJXmXyg2gtOeqWsy8FZVvA%2BOidhZhZ3hcJA%2BpiyR05SKsoD%2F60KX%2Boj%2FrefbRdlNpyTtdKxRrJQbZpnqMxroC1tEaZA72CdTcGRg8dRxNaRrNxg7JT3HtCPs455mSV3XaP0p1bjpoj5ZtASkvrZ4bm7lqPJj46bZ1g4xfAVZb2HEPYcWD2%2FaiqZmIA%3D%3D&X-Amz-Signature=496a3db2e033ef57a7a85f27384d0ccf7b7a13c0f3736d16e9064401ef665c91&X-Amz-SignedHeaders=host&x-amz-checksum-mode=ENABLED&x-id=GetObject)
Figure 2
Spine/target registration deviation according to tumour location
| Fraction | LAT mean (mm) | p value | LONG mean (mm) | p value | VERT mean (mm) | p value | |||
|---|---|---|---|---|---|---|---|---|---|
| Central | Peripheral | Central | Peripheral | Central | Peripheral | ||||
| 1st | 0.71 | 1.77 | 0.048 | 1.18 | 3.91 | 0.002 | 1.12 | 1.32 | NS |
| 10th | 0.76 | 1.77 | 0.008 | 1.53 | 2.41 | NS | 1.41 | 1.86 | 0.017 |
| 15th | 1.47 | 1.55 | NS | 2.59 | 2.32 | NS | 1.35 | 1.45 | NS |
| 20th | 1.94 | 1.27 | NS | 2.29 | 3.14 | NS | 1.29 | 1.09 | NS |
Mean set-up deviation difference (DD) comparison according to spine/target vs_ carina/target registration
| LAT deviation mean (mm) | LONG deviation mean (mm) | VRT deviation mean (mm) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Fraction | Spine/target | Carina/target | DD | p value | Spine/target | Carina/target | DD | p value | Spine/target | Carina/target | DD | p value |
| 1st | 1.28 | 0.90 | 0.38 | NS | 2.65 | 1.80 | 0.85 | NS | 1.20 | 1.43 | -0.23 | NS |
| 10th | 1.30 | 1.08 | 0.22 | NS | 2.03 | 1.53 | 0.50 | NS | 1.68 | 1.10 | 0.58 | 0.04 |
| 15th | 1.48 | 1.08 | 0.4 | NS | 2.38 | 1.65 | 0.73 | 0.05 | 1.38 | 1.38 | 0 | NS |
| 20th | 1.53 | 1.05 | 0.48 | NS | 2.73 | 2.15 | 0.58 | NS | 1.2 | 1.43 | -0.23 | NS |
| All measurements | 1.39 | 1.03 | 0.37 | 0.003 | 2.44 | 1.78 | 0.66 | 0.002 | 1.36 | 1.33 | 0.03 | NS |
Patients, disease, and treatment characteristics
| N = 40 | ||
|---|---|---|
| Gender | Female | 16 (40 %) |
| Male | 24 (60 %) | |
| Age (years) | Median (range) | 67 (53–81) |
| RUL | 15 (37.5%) | |
| RML | 3 (7.5%) | |
| Tumour location* | RLL | 7 (17.5%) |
| LUL | 8 (20%) | |
| LLL | 8 (20%) | |
| Central (C)/ | C | 17 (42.5%) |
| peripheral (P) tumour location** | P | 22 (55%) |
| Histology | NSCLC | 31 (77.5%) |
| SCLC | 9 (22.5%) | |
| De novo lung cancer | 32 (80%) | |
| Local progression | 1 (2.5%) | |
| Disease treated | Local recurrence reirradiation | 2 (5%) |
| Regional recurrence | 1 (2.5%) | |
| Locoregional recurrence reirradiation | 4 (10%) | |
| Concurrent chemotherapy | 13 (32.5%) | |
| Systemic treatment | Sequential chemotherapy | 16 (40%) |
| Target therapy | 1 (2.5%) | |
| None | 10 (25%) | |
| T0 | 1 (2.5%) | |
| T1 | 4 (10%) | |
| Tumour (T) stage | T2 | 14 (35%) |
| T3 | 8 (20%) | |
| T4 | 13 (32.5%) | |
| N0 | 9 (22.5%) | |
| Lymph nodes (N) | N1 | 1 (2.5%) |
| stage | N2 | 14 (35%) |
| N3 | 16 (40%) | |
| Fractionation | Conventional | 37 (92.5%) |
| Hypofractionation | 3 (7.5%) | |
| Radiation technique | VMAT | 40 (100%) |
Carina/target registration deviation according to tumour location
| Fraction | LAT mean (mm) | p value | LONG mean (mm) | p value | VERT mean (mm) | p value | |||
|---|---|---|---|---|---|---|---|---|---|
| Central | Peripheral | Central | Peripheral | Central | Peripheral | ||||
| 1st | 0.65 | 1.14 | NS | 1.65 | 2.00 | NS | 1.06 | 1.77 | NS |
| 10th | 0.53 | 1.55 | 0.002 | 1.18 | 1.86 | 0.041 | 0.82 | 1.32 | NS |
| 15th | 0.71 | 1.41 | 0.049 | 1.00 | 2.23 | 0.027 | 0.88 | 1.77 | NS |
| 20th | 1.00 | 1.14 | NS | 0.94 | 3.14 | 0.019 | 0.88 | 1.82 | NS |