title: X-ray volume imaging in bladder radiotherapy verification.
abstract: OBJECTIVE
  To assess the clinical utility of X-ray volume imaging (XVI) for verification of bladder radiotherapy and to quantify geometric error in bladder radiotherapy delivery.
  
  
  METHODS
  Twenty subjects undergoing conformal bladder radiotherapy were recruited. X-ray volume images and electronic portal images (EPIs) were acquired for the first 5 fractions and then once weekly. X-ray volume images were co-registered with the planning computed tomography scan and clinical target volume coverage assessed in three dimensions (3D). Interfraction bladder volume change was described by quantifying changes in bladder volume with time. Bony setup errors were compared from both XVI and EPI.
  
  
  RESULTS
  The bladder boundary was clearly visible on coronal XVI views in nearly all images, allowing accurate 3D treatment verification. In 93.5% of imaged fractions, the clinical target volume was within the planning target volume. Most subjects displayed consistent bladder volumes, but 25% displayed changes that could be predicted from the first three XVIs. Bony setup errors were similar whether calculated from XVI or EPI.
  
  
  CONCLUSIONS
  Coronal XVI can be used to verify 3D bladder radiotherapy delivery. Image-guided interventions to reduce geographic miss and normal tissue toxicity are feasible with this technology.
authors.affiliation: Academic Department of Radiation Oncology, University of Manchester, Manchester, United Kingdom. amhenry@doctors.net.uk
authors.forename: Ann M
authors.initials: AM
authors.lastname: Henry
authors.forename: Julia
authors.initials: J
authors.lastname: Stratford
authors.forename: Claire
authors.initials: C
authors.lastname: McCarthy
authors.forename: Julie
authors.initials: J
authors.lastname: Davies
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Sykes
authors.forename: Ali
authors.initials: A
authors.lastname: Amer
authors.forename: Tom
authors.initials: T
authors.lastname: Marchant
authors.forename: Richard
authors.initials: R
authors.lastname: Cowan
authors.forename: James
authors.initials: J
authors.lastname: Wylie
authors.forename: John
authors.initials: J
authors.lastname: Logue
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Livsey
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Khoo
authors.forename: Chris
authors.initials: C
authors.lastname: Moore
authors.forename: Pat
authors.initials: P
authors.lastname: Price
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D002295:Carcinoma, Transitional Cell / Q000000981:diagnostic imaging* / Q000532:radiotherapy; D005260:Female; D005740:Gases; D006801:Humans; D008297:Male; D009068:Movement; D011446:Prospective Studies; D020266:Radiotherapy, Conformal / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods; D001743:Urinary Bladder / Q000000981:diagnostic imaging*; D001749:Urinary Bladder Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy
chemical_list: D005740:Gases