title: Daily electronic portal imaging for morbidly obese men undergoing radiotherapy for localized prostate cancer.
abstract: OBJECTIVE
  We summarize our experience with a series of morbidly obese men treated using daily online portal imaging and implanted gold markers to guide external beam radiation therapy (EBRT).
  
  
  METHODS
  Three consecutive morbidly obese men were treated with EBRT for localized prostate cancer. Daily electronic portal imaging was used to verify patient position. The magnitude and direction of patient positioning error were documented for each fraction.
  
  
  RESULTS
  The absolute magnitude of positioning error was greatest in the left-right direction with a mean of 11.4 mm/fraction (median, 8 mm; range, 0-42 mm). Mean error in the superior-inferior direction was also substantial at 7.2 mm/fraction (median, 5 mm; range, 0-47 mm). Anteroposterior error was the least problematic with a mean value of 2.6 mm/fraction (median, 2.5 mm; range, 0-8 mm).
  
  
  CONCLUSIONS
  Daily electronic portal imaging combined with gold fiducial markers dramatically improves the precision of EBRT in the treatment of morbidly obese men with prostate cancer. Setup error rather than organ motion appears to be the dominant force in positioning error in obese men.
authors.affiliation: Department of Radiation Oncology, University of California San Francisco, Comprehensive Cancer Center, San Francisco, CA 94143, USA.
authors.forename: Laura Ellen
authors.initials: LE
authors.lastname: Millender
authors.forename: Michele
authors.initials: M
authors.lastname: Aubin
authors.forename: Jean
authors.initials: J
authors.lastname: Pouliot
authors.forename: Katsuto
authors.initials: K
authors.lastname: Shinohara
authors.forename: Mack
authors.initials: M
authors.lastname: Roach
mesh_terms: D006046:Gold; D006801:Humans; D008297:Male; D009068:Movement; D009767:Obesity, Morbid / Q000150:complications / Q000000981:diagnostic imaging*; D011471:Prostatic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D011859:Radiography; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*
chemical_list: D006046:Gold