title: Immobilization improves the reproducibility of patient positioning during six-field conformal radiation therapy for prostate carcinoma.
abstract: OBJECTIVE
  To determine the magnitude of patient positioning errors associated with six field conformal therapy for carcinoma of the prostate, and to assess the impact of alpha-cradle immobilization on these errors.
  
  
  METHODS
  The records of 22 patients, treated at two of the treatment facilities within our department, using computed tomography-planned conformal six field therapy for carcinoma of the prostate, were reviewed. At one facility (UCD), patients were routinely treated with immobilization, while at the other (UCSF) no rigid immobilization was used. Portal films of patients treated at both facilities were subsequently reviewed, and the deviation of each portal from the simulation film was determined (simulation-to-treatment variability). In addition, for each patient, the average deviation of each portal film from the average portal film (treatment-to-treatment variability) was determined.
  
  
  RESULTS
  The mean and median simulation-to-treatment variability was 0.4 cm for those patients treated with immobilization, versus 0.6 cm for those treated without immobilization. The 90th percentile of simulation-to-treatment variability was 0.7 cm for those patients treated with immobilization, versus 1.1 cm for those not immobilized. There was a significant reduction in the number of portals observed with errors of > or = 0.50 cm (132/201 vs. 37/87, 66% vs. 43%; p < 0.001), 0.75 cm (184/201 vs. 59/87, 92% vs. 68%; p < 0.001), and 1.0 cm (196/201 vs. 74/87, 98% vs. 85%; p < 0.001) for patients treated with immobilization. There was also a significant reduction in the number of patients with treatment-to-treatment variability > or = 0.5 cm (1/10 vs. 8/12; p = 0.01) for patients treated with immobilization.
  
  
  CONCLUSIONS
  The use of immobilization devices significantly reduces errors in patient positioning, potentially permitting the use of smaller treatment volumes. Immobilization should be a component of conformal radiation therapy programs for prostate carcinoma.
authors.affiliation: Department of Radiation Oncology, University of California, San Francisco.
authors.forename: S A
authors.initials: SA
authors.lastname: Rosenthal
authors.forename: M
authors.initials: M
authors.lastname: Roach
authors.forename: B J
authors.initials: BJ
authors.lastname: Goldsmith
authors.forename: E C
authors.initials: EC
authors.lastname: Doggett
authors.forename: B
authors.initials: B
authors.lastname: Pickett
authors.forename: H S
authors.initials: HS
authors.lastname: Yuo
authors.forename: E M
authors.initials: EM
authors.lastname: Soffen
authors.forename: R L
authors.initials: RL
authors.lastname: Stern
authors.forename: J K
authors.initials: JK
authors.lastname: Ryu
mesh_terms: D003198:Computer Simulation; D006801:Humans; D007103:Immobilization; D008297:Male; D011187:Posture; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D011882:Radiotherapy, High-Energy / Q000379:methods*; D012189:Retrospective Studies