title: Set-up improvement in head and neck radiotherapy using a 3D off-line EPID-based correction protocol and a customised head and neck support.
abstract: OBJECTIVE
  First, to investigate the set-up improvement resulting from the introduction of a customised head and neck (HN) support system in combination with a technologist-driven off-line correction protocol in HN radiotherapy. Second, to define margins for planning target volume definition, accounting for systematic and random set-up uncertainties.
  
  
  METHODS
  In 63 patients 498 treatment fractions were evaluated to develop and implement a 3D shrinking action level correction protocol. In the comparative study two different HN-supports were compared: a flexible 'standard HN-support' and a 'customised HN-support". For all three directions (x, y and z) random and systematic set-up deviations (1 S.D.) were measured.
  
  
  RESULTS
  The customised HN-support improves the patient positioning compared to the standard HN-support. The 1D systematic errors in the x, y and z directions were reduced from 2.2-2.3 mm to 1.2-2.0 mm (1 S.D.). The 1D random errors for the y and z directions were reduced from 1.6 and 1.6 mm to 1.1 and 1.0 mm (1S.D.). The correction protocol reduced the 1D systematic errors further to 0.8-1.1 mm (1 S.D.) and all deviations in any direction were within 5 mm. Treatment time per measured fraction was increased from 10 to 13 min. The total time required per patient, for the complete correction procedure, was approximately 40 min.
  
  
  CONCLUSIONS
  Portal imaging is a powerful tool in the evaluation of the department specific patient positioning procedures. The introduction of a comfortable customised HN-support, in combination with an electronic portal imaging device-based correction protocol, executed by technologists, led to an improvement of overall patient set-up. As a result, application of proposed recipes for CTV-PTV margins indicates that these can be reduced to 3-4 mm.
authors.affiliation: Department of Radiation Oncology, University Medical Centre Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
authors.forename: Emile N J Th
authors.initials: EN
authors.lastname: van Lin
authors.forename: Lisette
authors.initials: L
authors.lastname: van der Vight
authors.forename: Henk
authors.initials: H
authors.lastname: Huizenga
authors.forename: Johannes H A M
authors.initials: JH
authors.lastname: Kaanders
authors.forename: Andries G
authors.initials: AG
authors.lastname: Visser
mesh_terms: D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007103:Immobilization; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation; D011881:Radiotherapy, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000295:instrumentation; D013679:Technology, Radiologic; D014057:Tomography, X-Ray Computed