title: CT image fusion as a tool for measuring in 3D the setup errors during conformal radiotherapy for prostate cancer.
abstract: OBJECTIVE
  The importance of optimal daily patient positioning has been stressed in order to ensure treatment reproducibility and gain in accuracy and precision. We report our data on the 3D setup uncertainty during radiation therapy for prostate cancer using the CT image fusion technique.
  
  
  METHODS
  Ten consecutive patients scheduled for radiation therapy for prostate cancer underwent 5 prone position CT scans using an individualized immobilization cast. These different setups were analyzed using the image fusion module of the ERGO 3D-Line Medical System (Milan, Italy) treatment planning system. The isocenter and the body marker displacements were measured.
  
  
  RESULTS
  The 3D isocenter dislocations were quantified: systematic error was sigma(3D) = 3.9 mm, whereas random error was sigma(3D) = 1 mm. The mean of the minimum displacements was 0.2 +/- 1 mm showing that the immobilization device used allows an accurate setup to be obtained. Single direction errors were also measured showing systematic errors, sigma(AP), = 2.6 mm, sigma(LL) = 0.6 mm, SigmaSI = 3 mm in the anterior-posterior, latero-lateral, superior-inferior direction, respectively. Related random errors were sigma(AP), = 1 mm, sigma(LL) = 0.6 mm, sigma(SI) = 1.2 mm. In terms of accuracy, our uncertainties are similar to those reported in the literature.
  
  
  CONCLUSIONS
  By applying the CT image fusion technique, a 3D study on setup accuracy was performed. We demonstrated that the use of an individualized immobilization system for prostate treatment is adequate to obtain good setup accuracy, as long as a high-quality positioning control method, such as the stereoscopic X-ray-based positioning system, is used.
authors.affiliation: Medical Physics Department, European Institute of Oncology, Milan, Italy. raffaella.cambria@ieo.it
authors.forename: Raffaella
authors.initials: R
authors.lastname: Cambria
authors.forename: Federica
authors.initials: F
authors.lastname: Cattani
authors.forename: Mario
authors.initials: M
authors.lastname: Ciocca
authors.forename: Cristina
authors.initials: C
authors.lastname: Garibaldi
authors.forename: Giampiero
authors.initials: G
authors.lastname: Tosi
authors.forename: Roberto
authors.initials: R
authors.lastname: Orecchia
mesh_terms: D000368:Aged; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011857:Radiographic Image Interpretation, Computer-Assisted; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D020266:Radiotherapy, Conformal / Q000379:methods* / Q000592:standards*; D014057:Tomography, X-Ray Computed