Investigating the impact of non-standard positioning on the accuracy of skull tracking algorithms using dual-panel imaging systems

Since fiducial tracking is not affected by patient or phantom positioning, this study compares the registration results of 6D-skull tracking with fiducial tracking under the same conditions. The results show minimal deviations and no statistically significant differences, indicating that 6D-skull tracking is not dependent on the skull's positioning angle. Furthermore, the gamma passing rate analysis was conducted to quantitatively assess the dosimetric differences arising from variations in patient positioning. Our results demonstrated that under all tested conditions, the gamma passing rates exceeded the clinically accepted threshold of 95%, confirming the clinical adequacy of both tracking methods in maintaining treatment precision. In clinical practice, patients do not need to maintain a strict supine position; the algorithm can accurately perform registration even if patients need to rotate their heads or lie prone. Clinical recommendations should prioritize patient comfort and safety without imposing overly strict requirements.