title: Effect of translational and rotational errors on complex dose distributions with off-line and on-line position verification.
abstract: OBJECTIVE
  To investigate the influence of translational and rotational errors on prostate intensity-modulated radiotherapy (IMRT) with an integrated boost to the tumor and to evaluate the effect of the use of an on-line correction protocol.
  
  
  METHODS
  For 19 patients, who had been treated with prostate IMRT and fiducial marker-based position verification, highly inhomogeneous IMRT plans, including an integrated tumor boost, were made using varying margins (2, 4, 6, and 8 mm). The measured translational and rotational errors were used to calculate the dose using two positioning strategies: an off-line and an on-line protocol to correct the translational shifts. The estimated dose to the targets and the organs at risk was compared with the intended dose.
  
  
  RESULTS
  Residual deviations after off-line correction led to statistically significant, but very small, reductions in dose coverage. Even when a 2-mm margin was used, the average reduction in dose to 99% of the volume was 1.4 +/- 1.9 Gy for the tumor, 1.5 +/- 1.5 Gy for the prostate without seminal vesicles (boost volume), and 4.3 +/- 4.6 Gy, including the seminal vesicles (clinical target volume). Patients with large systematic rotational errors demonstrated a substantial decrease in dose, especially for the clinical target volume. If an on-line correction protocol was used, the average mean dose and dose to 99% of the volume of the targets improved. However, the extensive dose reduction for patients with large rotational errors barely recovered with on-line correction.
  
  
  CONCLUSIONS
  For complex prostate IMRT with an integrated tumor boost, the use of an on-line correction protocol yields little improvement without the correction of rotational errors.
authors.affiliation: Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. I.M.Lips@umcutrecht.nl
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lips
authors.forename: Uulke A
authors.initials: UA
authors.lastname: van der Heide
authors.forename: Alexis N T J
authors.initials: AN
authors.lastname: Kotte
authors.forename: Marco
authors.initials: M
authors.lastname: van Vulpen
authors.forename: Arjan
authors.initials: A
authors.lastname: Bel
mesh_terms: D006046:Gold; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011467:Prostate / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D019736:Prostheses and Implants; D011859:Radiography; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012007:Rectum / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D012669:Seminal Vesicles / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D047368:Tumor Burden; D001743:Urinary Bladder / Q000033:anatomy & histology / Q000000981:diagnostic imaging
chemical_list: D006046:Gold