title: Clinical experience with image-guided radiotherapy in an accelerated partial breast intensity-modulated radiotherapy protocol.
abstract: OBJECTIVE
  To explore the feasibility of fiducial markers for the use of image-guided radiotherapy (IGRT) in an accelerated partial breast intensity modulated radiotherapy protocol.
  
  
  METHODS
  Nineteen patients consented to an institutional review board approved protocol of accelerated partial breast intensity-modulated radiotherapy with fiducial marker placement and treatment with IGRT. Patients (1 patient with bilateral breast cancer; 20 total breasts) underwent ultrasound guided implantation of three 1.2- x 3-mm gold markers placed around the surgical cavity. For each patient, table shifts (inferior/superior, right/left lateral, and anterior/posterior) and minimum, maximum, mean error with standard deviation were recorded for each of the 10 BID treatments. The dose contribution of daily orthogonal films was also examined.
  
  
  RESULTS
  All IGRT patients underwent successful marker placement. In all, 200 IGRT treatment sessions were performed. The average vector displacement was 4 mm (range, 2-7 mm). The average superior/inferior shift was 2 mm (range, 0-5 mm), the average lateral shift was 2 mm (range, 1-4 mm), and the average anterior/posterior shift was 3 mm (range, 1 5 mm).
  
  
  CONCLUSIONS
  This study shows that the use of IGRT can be successfully used in an accelerated partial breast intensity-modulated radiotherapy protocol. The authors believe that this technique has increased daily treatment accuracy and permitted reduction in the margin added to the clinical target volume to form the planning target volume.
authors.affiliation: Rocky Mountain Cancer Centers, Littleton, CO 80120, USA. charles.leonard@usoncology.com
authors.forename: Charles E
authors.initials: CE
authors.lastname: Leonard
authors.forename: Michael
authors.initials: M
authors.lastname: Tallhamer
authors.forename: Tim
authors.initials: T
authors.lastname: Johnson
authors.forename: Kari
authors.initials: K
authors.lastname: Hunter
authors.forename: Kathryn
authors.initials: K
authors.lastname: Howell
authors.forename: Jane
authors.initials: J
authors.lastname: Kercher
authors.forename: Jodi
authors.initials: J
authors.lastname: Widener
authors.forename: Terese
authors.initials: T
authors.lastname: Kaske
authors.forename: Devchand
authors.initials: D
authors.lastname: Paul
authors.forename: Scot
authors.initials: S
authors.lastname: Sedlacek
authors.forename: Dennis L
authors.initials: DL
authors.lastname: Carter
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006046:Gold; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D019736:Prostheses and Implants; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D013653:Tattooing; D018084:Ultrasonography, Interventional
chemical_list: D006046:Gold