title: Dosimetric consequences of the application of off-line setup error correction protocols and a hull-volume definition strategy for intensity modulated radiotherapy of prostate cancer.
abstract: OBJECTIVE
  To evaluate the consequences of a planning volume definition based on multiple CTs and the application of off-line setup error correction for the treatment of prostate cancer with intensity-modulated radiotherapy (IMRT). Further, to compare various setup correction protocols (SCP) by their influence on the average dose distributions.
  
  
  METHODS
  A planning target volume (PTV) consisting of the bounding volume of prostate contours of five CTs (CTV_hull) plus an additional margin of 5mm and a virtual Rectum_hull volume (the solid bounding volume of the five corresponding rectum contours) are used for treatment planning. Simulations of treatment courses with the non-parametric bootstrap method allow to estimate the distribution of the expected equivalent uniform dose (EUD). The impact of off-line setup error correction protocols is evaluated based on estimated EUD distributions.
  
  
  RESULTS
  Off-line SCP allow to achieve the intended prostate and rectum EUD and a reliable coverage of the CTV despite the reduced margins. The EUD of the virtual hull volumes is a good estimate for the EUD of prostate and rectal wall.
  
  
  CONCLUSIONS
  Treatment planning based on Rectum_hull and CTV_hull plus setup margin as PTV in combination with SCP results in a robust and safe IMRT planning concept.
authors: Sektion für Biomedizinische Physik, Universitätsklinik für Radioonkologie, Universität Tübingen, Deutschland. christoph.baum@gmx.de
authors: Christoph
authors: C
authors: Baum
authors: Mattias
authors: M
authors: Birkner
authors: Markus
authors: M
authors: Alber
authors: Frank
authors: F
authors: Paulsen
authors: Fridtjof
authors: F
authors: Nüsslin
mesh_terms: D006801:Humans; D008297:Male; D011467:Prostate / Q000528:radiation effects; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated; D012007:Rectum / Q000528:radiation effects