title: Dosimetric consequences of intrafraction prostate motion.
abstract: OBJECTIVE
  To analyze characteristics of intrafraction prostate motion, monitored using the Calypso system, and investigate dosimetric consequences of the motion for different clinical target volume (CTV) to planning target volume (PTV) margins.
  
  
  METHODS
  Motion characteristics were analyzed for 1,267 tracking sessions and 35 patients. Using prostate-PTV margins of 0, 1, 2, 3, and 5 mm, dose metrics for the prostate gland, bladder, and rectum were evaluated for scenarios including patient population, individual patients showing the greatest motion during the course of treatment, and the individual session with the largest overall movement. Composite dose distributions incorporating motion blurring were calculated by convolving static intensity-modulated radiotherapy plans with corresponding motion probability functions.
  
  
  RESULTS
  For prostate-PTV margins of 2 mm or greater, intrafraction motion did not compromise prostate dose coverage for either the patient population or individual patients. For the patient showing the largest overall movement, the prostate equivalent uniform dose was reduced by only 17.4 cGy (0.23%), and the minimum prostate dose remained greater than 95% of the nominal dose. For margins less than 2 mm, the prostate dose-volume histogram in the same patient was slightly compromised, and the equivalent uniform dose was reduced by 38.5 cGy (0.51%). Sparing of the bladder and rectum was improved substantially by reducing margins.
  
  
  CONCLUSIONS
  Although significant motion can be observed during individual fractions, the dosimetric consequences are insignificant during a typical course of radiotherapy (30-40 fractions) with CTV-PTV margins of 2 mm or greater provided that the Calypso system is applied for pretreatment localization. Further reduction of the margin is possible if intrafraction realignment is performed.
authors.affiliation: Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA. haisenli@unmc.edu
authors.forename: Haisen S
authors.initials: HS
authors.lastname: Li
authors.forename: Indrin J
authors.initials: IJ
authors.lastname: Chetty
authors.forename: Charles A
authors.initials: CA
authors.lastname: Enke
authors.forename: Ryan D
authors.initials: RD
authors.lastname: Foster
authors.forename: Twyla R
authors.initials: TR
authors.lastname: Willoughby
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Kupellian
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Solberg
mesh_terms: D006801:Humans; D008297:Male; D009068:Movement; D009928:Organ Specificity; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011874:Radiometry / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012062:Relative Biological Effectiveness