title: A comparison of the use of bony anatomy and internal markers for offline verification and an evaluation of the potential benefit of online and offline verification protocols for prostate radiotherapy.
abstract: OBJECTIVE
  To evaluate the utility of intraprostatic markers in the treatment verification of prostate cancer radiotherapy. Specific aims were: to compare the effectiveness of offline correction protocols, either using gold markers or bony anatomy; to estimate the potential benefit of online correction protocol's using gold markers; to determine the presence and effect of intrafraction motion.
  
  
  METHODS
  Thirty patients with three gold markers inserted had pretreatment and posttreatment images acquired and were treated using an offline correction protocol and gold markers. Retrospectively, an offline protocol was applied using bony anatomy and an online protocol using gold markers.
  
  
  RESULTS
  The systematic errors were reduced from 1.3, 1.9, and 2.5 mm to 1.1, 1.1, and 1.5 mm in the right-left (RL), superoinferior (SI), and anteroposterior (AP) directions, respectively, using the offline correction protocol and gold markers instead of bony anatomy. The subsequent decrease in margins was 1.7, 3.3, and 4 mm in the RL, SI, and AP directions, respectively. An offline correction protocol combined with an online correction protocol in the first four fractions reduced random errors further to 0.9, 1.1, and 1.0 mm in the RL, SI, and AP directions, respectively. A daily online protocol reduced all errors to <1 mm. Intrafraction motion had greater impact on the effectiveness of the online protocol than the offline protocols.
  
  
  CONCLUSIONS
  An offline protocol using gold markers is effective in reducing the systematic error. The value of online protocols is reduced by intrafraction motion.
authors.affiliation: Department of Radiotherapy, Royal Marsden NHS Trust and Institute of Cancer Research, Sutton, Surrey, United Kingdom. Helen.McNair@rmh.nhs.uk
authors.forename: Helen A
authors.initials: HA
authors.lastname: McNair
authors.forename: Vibeke N
authors.initials: VN
authors.lastname: Hansen
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Parker
authors.forename: Phil M
authors.initials: PM
authors.lastname: Evans
authors.forename: Andrew
authors.initials: A
authors.lastname: Norman
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Miles
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Harris
authors.forename: Louise
authors.initials: L
authors.lastname: Del-Acroix
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Smith
authors.forename: Richard
authors.initials: R
authors.lastname: Keane
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Khoo
authors.forename: Alan C
authors.initials: AC
authors.lastname: Thompson
authors.forename: David P
authors.initials: DP
authors.lastname: Dearnaley
mesh_terms: D000368:Aged; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002985:Clinical Protocols; D005240:Feasibility Studies; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging; D006046:Gold; D006801:Humans; D008297:Male; D008875:Middle Aged; D009068:Movement; D011467:Prostate / Q000000981:diagnostic imaging; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D019736:Prostheses and Implants; D011859:Radiography; D012189:Retrospective Studies
chemical_list: D006046:Gold