title: On-line set-up corrections during radiotherapy of patients with gynecologic tumors.
abstract: OBJECTIVE
  Positioning of patients with gynecologic tumors for radiotherapy has proven to be relatively inaccurate. To improve the accuracy and reduce the margins from clinical target volume (CTV) to planning target volume (PTV), on-line set-up corrections were investigated.
  
  
  METHODS
  Anterior-posterior portal images of 14 patients were acquired using the first six monitor units (MU) of each irradiation fraction. The set-up deviation was established by matching three user-defined landmarks in portal and simulator image. If the two-dimensional deviation exceeded 4 mm, the table position was corrected. A second portal image was acquired using 30 MU of the remaining dose. This image was analyzed off-line using a semiautomatic contour match to obtain the final set-up accuracy. To verify the landmark match accuracy, the contour match was retrospectively performed on the six MU images as well.
  
  
  RESULTS
  The standard deviation (SD) of the distribution of systematic set-up deviations after correction was < 1 mm in left-right and cranio-caudal directions. The average random deviation was < 2 mm in these directions (1 SD). Before correction, all standard deviations were 2 to 3 mm. The landmark match procedure was sufficiently accurate and added on average 3 min to the treatment time. The application of on-line corrections justifies a CTV-to-PTV margin reduction to about 5 mm.
  
  
  CONCLUSIONS
  On-line set-up corrections significantly improve the positioning accuracy. The procedure increases treatment time but might be used effectively in combination with off-line corrections.
authors.affiliation: Division of Clinical Physics and Instrumentation, University Hospital Rotterdam, Daniel den Hoed Cancer Center, The Netherlands. stroom@kfih.azr.nl
authors.forename: J C
authors.initials: JC
authors.lastname: Stroom
authors.forename: M J
authors.initials: MJ
authors.lastname: Olofsen-van Acht
authors.forename: S
authors.initials: S
authors.lastname: Quint
authors.forename: M
authors.initials: M
authors.lastname: Seven
authors.forename: M
authors.initials: M
authors.lastname: de Hoog
authors.forename: C L
authors.initials: CL
authors.lastname: Creutzberg
authors.forename: H C
authors.initials: HC
authors.lastname: de Boer
authors.forename: A G
authors.initials: AG
authors.lastname: Visser
mesh_terms: D005260:Female; D005833:Genital Neoplasms, Female / Q000532:radiotherapy*; D006801:Humans; D055585:Physical Phenomena; D010825:Physics; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D013997:Time Factors