title: Setup errors in patients treated with intensity-modulated whole pelvic radiation therapy for gynecological malignancies.
abstract: Intensity-modulated whole pelvic radiation therapy (IM-WPRT) has decreased the incidence of gastrointestinal complications by reducing the volume of normal tissue irradiated in gynecologic patients. However, IM-WPRT plans result in steep dose gradients around the target volume, and thus accurate patient setup is essential. To quantify the accuracy of our patient positioning, we examined the weekly portal films of 46 women treated with IM-WPRT at our institution. All patients were positioned using a customized immobilization device that was indexed to the treatment table. Setup errors were evaluated by comparing portal images to simulation images using an algorithm that registers user-defined open curve segments drawn on both sets of film. The setup errors, which were separated into systematic and random components, ranged from 1.9 to 3.7 mm for the translations and 1.3 degrees to 4.4 degrees for the 2 in-plane translations. The systematic errors were all less than the respective random errors, with the largest error in the anterior/posterior direction. In addition, there was no correlation between the magnitude of these errors and patient-specific factors (age, weight, height). In the future, we will investigate the effect of these setup errors on the delivered dose distribution.
authors.affiliation: Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Haslam
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Lujan
authors.forename: Arno J
authors.initials: AJ
authors.lastname: Mundt
authors.forename: Dacian V
authors.initials: DV
authors.lastname: Bonta
authors.forename: John C
authors.initials: JC
authors.lastname: Roeske
mesh_terms: D000465:Algorithms; D015992:Body Mass Index; D005260:Female; D005833:Genital Neoplasms, Female / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D006801:Humans; D007103:Immobilization / Q000295:instrumentation; D010388:Pelvis / Q000528:radiation effects; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome