title: The effect of setup uncertainties on the treatment of nasopharynx cancer.
abstract: OBJECTIVE
  As radiation treatment techniques become more complicated, the need to understand the effect of uncertainties on dose distributions increases. This study investigates the effect of positional uncertainities for patients with nasopharynx carcinoma treated with a multiple field conformal boost technique. Three dimensional setup errors were measured for six patients and the effect on patient dose was evaluated using dose volume histograms.
  
  
  METHODS
  A method is presented for determining 3-dimensional translational and rotational setup errors by identifying anatomical landmarks on two treatment field images and their corresponding simulation images. Measurements were made on a daily basis for six patients undergoing conformal treatment.
  
  
  RESULTS
  The average magnitude of the translational errors was between 1.5 and 3 mm while the average distance between simulation and treatment isocenters was 5 mm. Both systematic and random setup errors were observed. Dose volume histograms incorporating these uncertainties for standard parallel opposed and conformal techniques were generated for patients experiencing random and systematic setup errors.
  
  
  CONCLUSIONS
  The data imply that positional uncertainties effect the daily dose distributions for target and critical structures differently and that the effect may be treatment technique dependent. These results demonstrate the need to measure setup uncertainties for all sites and to develop techniques for incorporating dose uncertainties in treatment plans.
authors.affiliation: Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: M A
authors.initials: MA
authors.lastname: Hunt
authors.forename: G J
authors.initials: GJ
authors.lastname: Kutcher
authors.forename: C
authors.initials: C
authors.lastname: Burman
authors.forename: D
authors.initials: D
authors.lastname: Fass
authors.forename: L
authors.initials: L
authors.lastname: Harrison
authors.forename: S
authors.initials: S
authors.lastname: Leibel
authors.forename: Z
authors.initials: Z
authors.lastname: Fuks
mesh_terms: D002138:Calibration; D006801:Humans; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D011187:Posture; D011879:Radiotherapy Dosage