title: Evaluation of image-guidance protocols in the treatment of head and neck cancers.
abstract: OBJECTIVE
  The aim of this study was to assess the residual setup error of different image-guidance (IG) protocols in the alignment of patients with head and neck cancer. The protocols differ in the percentage of treatment fractions that are associated with image guidance. Using data from patients who were treated with daily IG, the residual setup errors for several different protocols are retrospectively calculated.
  
  
  METHODS
  Alignment data from 24 patients (802 fractions) treated with daily IG on a helical tomotherapy unit were analyzed. The difference between the daily setup correction and the setup correction that would have been made according to a specific protocol was used to calculate the residual setup errors for each protocol.
  
  
  RESULTS
  The different protocols are generally effective in reducing systematic setup errors. Random setup errors are generally not reduced for fractions that are not image guided. As a consequence, if every other treatment is image guided, still about 11% of all treatments (IG and not IG) are subject to three-dimensional setup errors of at least 5 mm. This frequency increases to about 29% if setup errors >3 mm are scored. For various protocols that require 15% to 31% of the treatments to be image guided, from 50% to 60% and from 26% to 31% of all fractions are subject to setup errors >3 mm and >5 mm, respectively.
  
  
  CONCLUSIONS
  Residual setup errors reduce with increasing frequency of IG during the course of external-beam radiotherapy for head-and-neck cancer patients. The inability to reduce random setup errors for fractions that are not image guided results in notable residual setup errors.
authors.affiliation: Department of Radiation Oncology, M. D. Anderson Cancer Center Orlando, Orlando, FL 32806, USA. omar.zeidan@orhs.org
authors.forename: Omar A
authors.initials: OA
authors.lastname: Zeidan
authors.forename: Katja M
authors.initials: KM
authors.lastname: Langen
authors.forename: Sanford L
authors.initials: SL
authors.lastname: Meeks
authors.forename: Rafael R
authors.initials: RR
authors.lastname: Manon
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Wagner
authors.forename: Twyla R
authors.initials: TR
authors.lastname: Willoughby
authors.forename: D Wayne
authors.initials: DW
authors.lastname: Jenkins
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Kupelian
mesh_terms: D000465:Algorithms; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D019047:Phantoms, Imaging; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods* / Q000592:standards; D036542:Tomography, Spiral Computed / Q000379:methods* / Q000592:standards