The influence of a dietary protocol on cone beam CT-guided radiotherapy for prostate cancer patients.
OBJECTIVE
To evaluate the influence of a dietary protocol on cone beam computed tomography (CBCT) image quality, which is an indirect indicator for short-term (intrafraction) prostate motion, and on interfraction motion. Image quality is affected by motion (e.g., moving gas) during imaging and influences the performance of automatic prostate localization on CBCT scans.


METHODS
Twenty-six patients (336 CBCT scans) followed the dietary protocol and 23 patients (240 CBCT scans) did not. Prostates were automatically localized by using three dimensional (3D) gray-value registration (GR). Feces and (moving) gas occurrence in the CBCT scans, the success rate of 3D-GR, and the statistics of prostate motion data were assessed.


RESULTS
Feces, gas, and moving gas significantly decreased from 55%, 61%, and 43% of scans in the nondiet group to 31%, 47%, and 28% in the diet group (all p < 0.001). Since there is a known relation between gas and short-term prostate motion, intrafraction prostate motion probably also decreased. The success rate of 3D-GR improved from 83% to 94% (p < 0.001). A decrease in random interfraction prostate motion also was found, which was not significant after Bonferroni's correction. Significant deviations from planning CT position for rotations around the left-right axis were found in both groups.


CONCLUSIONS
The dietary protocol significantly decreased the incidence of feces and (moving) gas. As a result, CBCT image quality and the success rate of 3D-GR significantly increased. A trend exists that random interfraction prostate motion decreases. Using a dietary protocol therefore is advisable, also without CBCT-based image guidance.
Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands. m.smithsmans@nki.nl
Monique H P
MH
Smitsmans
Floris J
FJ
Pos
Josien
J
de Bois
Wilma D
WD
Heemsbergen
Jan-Jakob
JJ
Sonke
Joos V
JV
Lebesque
Marcel
M
van Herk
D004032:Diet; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D011856:Radiographic Image Enhancement / Q000379:methods*; D011881:Radiotherapy, Computer-Assisted / Q000379:methods*