title: Inter-fraction motion and dosimetric consequences during breast intensity-modulated radiotherapy (IMRT).
abstract: OBJECTIVE
  Intensity-modulated radiotherapy (IMRT) can improve dose homogeneity within the breast planned target volume (PTV), but may be more susceptible to patient/organ motion than standard tangential radiotherapy (RT). We used daily cone-beam CT (CBCT) imaging to assess inter-fraction motion during breast IMRT and its subsequent impact on IMRT and standard RT dose homogeneity.
  
  
  METHODS
  Ten breast cancer patients selected for IMRT were studied. CBCT images were acquired immediately after daily treatment. Automatic image co-registration was used to determine patient positioning variations. Daily PTV contours were used to calculate PTV variations and daily delivered IMRT and theoretically planned tangential RT dose.
  
  
  RESULTS
  Group systematic (and random) setup errors detected by CBCT were 5.7 (3.9)mm laterally, 2.8 (3.5)mm vertically and 2.3 (3.2)mm longitudinally. Rotations >2 degrees in any axis occurred on 53/106 (50%) occasions. Daily PTV volume varied up to 23%. IMRT dose homogeneity was superior at planning and throughout the treatment compared with standard RT (1.8% vs. 15.8% PTV received >105% planned mean dose), despite increased motion sensitivity.
  
  
  CONCLUSIONS
  CBCT revealed inadequacies of current patient positioning and verification procedures during breast RT and confirmed improved dose homogeneity using IMRT for the patients studied.
authors.affiliation: Academic Department of Radiation Oncology, The University of Manchester, Manchester M20 4BX, UK.
authors.forename: Pooja
authors.initials: P
authors.lastname: Jain
authors.forename: Tom
authors.initials: T
authors.lastname: Marchant
authors.forename: Melanie
authors.initials: M
authors.lastname: Green
authors.forename: Gillian
authors.initials: G
authors.lastname: Watkins
authors.forename: Julie
authors.initials: J
authors.lastname: Davies
authors.forename: Claire
authors.initials: C
authors.lastname: McCarthy
authors.forename: Juliette
authors.initials: J
authors.lastname: Loncaster
authors.forename: Alan
authors.initials: A
authors.lastname: Stewart
authors.forename: Brian
authors.initials: B
authors.lastname: Magee
authors.forename: Christopher
authors.initials: C
authors.lastname: Moore
authors.forename: Pat
authors.initials: P
authors.lastname: Price
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D016014:Linear Models; D009038:Motion; D011187:Posture; D011446:Prospective Studies; D015641:Radiography, Interventional; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome