title: Stereographic targeting in prostate radiotherapy: speed and precision by daily automatic positioning corrections using kilovoltage/megavoltage image pairs.
abstract: OBJECTIVE
  A fully automated, fast, on-line prostate repositioning scheme using implanted markers, kilovoltage/megavoltage imaging, and remote couch movements has been developed and clinically applied. The initial clinical results of this stereographic targeting (SGT) method, as well as phantom evaluations, are presented.
  
  
  METHODS
  Using the SGT method, portal megavoltage images are acquired with the first two to six monitor units of a treatment beam, immediately followed by acquisition of an orthogonal kilovoltage image without gantry motion. The image pair is automatically analyzed to obtain the marker positions and three-dimensional prostate displacement and rotation. Remote control couch shifts are applied to correct for the displacement. The SGT performance was measured using both phantom images and images from 10 prostate cancer patients treated using SGT.
  
  
  RESULTS
  With phantom measurements, the accuracy of SGT was 0.5, 0.2, and 0.3 mm (standard deviation [SD]) for the left-right, craniocaudal, and anteroposterior directions, respectively, for translations and 0.5 degrees (SD) for the rotations around all axes. Clinically, the success rate for automatic marker detection was 99.5%, and the accuracy was 0.3, 0.5 and 0.8 mm (SD) in the left-right, craniocaudal, and anteroposterior axes. The SDs of the systematic center-of-mass positioning errors (Sigma) were reduced from 4.0 mm to <0.5 mm for all axes. The corresponding SD of the random (sigma) errors was reduced from 3.0 to <0.8 mm. These small residual errors were achieved with a treatment time extension of <1 min.
  
  
  CONCLUSIONS
  Stereographic targeting yields systematic and random prostate positioning errors of <1 mm with <1 min of added treatment time.
authors.affiliation: Department of Radiation Oncology, Division of Medical Physics, Erasmus Medical Center-Daniel den Hoed Oncology Center, Rotterdam, The Netherlands. t.mutanga@erasmusmc.nl
authors.forename: Theodore F
authors.initials: TF
authors.lastname: Mutanga
authors.forename: Hans C J
authors.initials: HC
authors.lastname: de Boer
authors.forename: Gerard J
authors.initials: GJ
authors.lastname: van der Wielen
authors.forename: Davy
authors.initials: D
authors.lastname: Wentzler
authors.forename: Jaco
authors.initials: J
authors.lastname: Barnhoorn
authors.forename: Luca
authors.initials: L
authors.lastname: Incrocci
authors.forename: Ben J M
authors.initials: BJ
authors.lastname: Heijmen
mesh_terms: D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D008297:Male; D019047:Phantoms, Imaging; D011187:Posture; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation / Q000379:methods; D011881:Radiotherapy, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity