title: Characterization of target volume changes during breast radiotherapy using implanted fiducial markers and portal imaging.
abstract: OBJECTIVE
  To determine target volume changes by using volume and shape analysis for patients receiving radiotherapy after breast conservation surgery and to compare different methods of automatically identifying changes in target volume, position, size, and shape during radiotherapy for use in adaptive radiotherapy.
  
  
  METHODS
  Eleven patients undergoing whole breast radiotherapy had fiducial markers sutured into the excision cavity at the time of surgery. Patients underwent imaging using computed tomography (for planning and at the end of treatment) and during treatment by using portal imaging. A marker volume (MV) was defined by using the measured marker positions. Changes in both individual marker positions and MVs were identified manually and using six automated similarity indices. Comparison of the two types of analysis (manual and automated) was undertaken to establish whether similarity indices can be used to automatically detect changes in target volumes.
  
  
  RESULTS
  Manual analysis showed that 3 patients had significant MV reduction. This analysis also showed significant changes between planning computed tomography and the start of treatment for 9 patients, including single and multiple marker movement, deformation (shape change), and rotation. Four of the six similarity indices were shown to be sensitive to the observed changes.
  
  
  CONCLUSIONS
  Significant changes in size, shape, and position occur to the fiducial marker-defined volume. Four similarity indices can be used to identify these changes, and a protocol for their use in adaptive radiotherapy is suggested.
authors.affiliation: Joint Department of Physics, Institute of Cancer Research and Royal Marsden Foundation Trust, Sutton, United Kingdom. eharris@icr.ac.uk
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Harris
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Donovan
authors.forename: John R
authors.initials: JR
authors.lastname: Yarnold
authors.forename: Charlotte E
authors.initials: CE
authors.lastname: Coles
authors.forename: Philip M
authors.initials: PM
authors.lastname: Evans
mesh_terms: D000465:Algorithms; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D015588:Observer Variation; D019736:Prostheses and Implants; D011879:Radiotherapy Dosage; D014057:Tomography, X-Ray Computed / Q000379:methods*; D047368:Tumor Burden