title: Intrafraction prostate motion during IMRT for prostate cancer.
abstract: OBJECTIVE
  Although the interfraction motion of the prostate has been previously studied through the use of fiducial markers, CT scans, and ultrasound-based systems, intrafraction motion is not well documented. In this report, the B-mode, Acquisition, and Targeting (BAT) ultrasound system was used to measure intrafraction prostate motion during 200 intensity-modulated radiotherapy (IMRT) sessions for prostate cancer.
  
  
  METHODS
  Twenty men receiving treatment with IMRT for clinically localized prostate cancer were selected for the study. Pre- and posttreatment BAT ultrasound alignment images were collected immediately before and after IMRT on 10 treatment days for a total of 400 BAT alignment procedures. Any ultrasound shifts of the prostate borders in relation to the planning CT scan were recorded in 3 dimensions: right-left (RL), anteroposterior (AP), and superior-inferior (SI). Every ultrasound procedure was evaluated for image quality and alignment according to a 3-point grading scale.
  
  
  RESULTS
  All the BAT images were judged to be of acceptable quality and alignment. The dominant directions of intrafraction prostate motion were anteriorly and superiorly. The mean magnitude of shifts (+/-SD) was 0.01 +/- 0.4 mm, 0.2 +/- 1.3 mm, and 0.1 +/- 1.0 mm in the left, anterior, and superior directions, respectively. The maximal range of motion occurred in the AP dimension, from 6.8 mm anteriorly to 4.6 mm posteriorly. The percentage of treatments during which prostate motion was judged to be <or=5 mm was 100%, 99%, and 99.5% in the RL, AP, and SI directions, respectively. Three of the measurements were >5 mm. The extent of intrafraction motion was much smaller than that of interfraction motion. Linear regression analysis showed very little correlation between the two types of motion (r = 0.014, 0.029, and 0.191, respectively) in the RL, AP, and SI directions.
  
  
  CONCLUSIONS
  Using an ultrasound-based system, intrafraction prostate motion occurred predominantly in the anterior and superior directions, but was clinically insignificant. Intrafraction motion was much smaller than interfraction motion, and the two types of movement did not correlate.
authors.affiliation: Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Huang
authors.forename: Lei
authors.initials: L
authors.lastname: Dong
authors.forename: Anurag
authors.initials: A
authors.lastname: Chandra
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kuban
authors.forename: Isaac I
authors.initials: II
authors.lastname: Rosen
authors.forename: Anissa
authors.initials: A
authors.lastname: Evans
authors.forename: Alan
authors.initials: A
authors.lastname: Pollack
mesh_terms: D006801:Humans; D016014:Linear Models; D008297:Male; D009068:Movement; D011467:Prostate / Q000000981:diagnostic imaging*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D020266:Radiotherapy, Conformal / Q000379:methods*; D014463:Ultrasonography