title: Evaluation of image-guidance strategies in the treatment of localized prostate cancer.
abstract: OBJECTIVE
  To compare different image-guidance strategies in the alignment of prostate cancer patients. Using data from patients treated using daily image guidance, the remaining setup errors for several different strategies were retrospectively calculated.
  
  
  METHODS
  The alignment data from 74 patients treated with helical tomotherapy were analyzed, resulting in a data set of 2,252 fractions during which a megavoltage computed tomography image was used for image guidance with intraprostatic metallic fiducials. Given the daily positional adjustments, a variety of protocols, differing in imaging frequency and method, were retrospectively studied. The residual setup errors were determined for each protocol.
  
  
  RESULTS
  As expected, the systematic errors were effectively reduced with imaging. However, the random errors were unaffected. Even when image guidance was performed every other day with a running mean of the previous displacements, residual setup errors>5 mm occurred in 24% of all fractions. This frequency increased to about 40% if setup errors>3 mm were scored.
  
  
  CONCLUSIONS
  Setup errors increased with decreasing frequency of image guidance. However, residual errors were still significant at the 5-mm level, even with imaging was performed every other day. This suggests that localizations must be performed daily in the set up of prostate cancer patients during a course of external beam radiotherapy.
authors: Department of Radiation Oncology, M.D. Anderson Cancer Center Orlando, Orlando, FL 32806, USA. patrick.kupelian@orhs.org
authors: Patrick A
authors: PA
authors: Kupelian
authors: Choonik
authors: C
authors: Lee
authors: Katja M
authors: KM
authors: Langen
authors: Omar A
authors: OA
authors: Zeidan
authors: Rafael R
authors: RR
authors: Mañon
authors: Twyla R
authors: TR
authors: Willoughby
authors: Sanford L
authors: SL
authors: Meeks
mesh_terms: D000465:Algorithms; D019583:Dose Fractionation, Radiation; D006801:Humans; D008297:Male; D009068:Movement; D011467:Prostate; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D019736:Prostheses and Implants; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D016526:Workload