title: Dosimetric consequences of uncorrected setup errors in helical Tomotherapy treatments of breast-cancer patients.
abstract: OBJECTIVE
  The Tomotherapy Hi-Art II system allows acquisition of pre-treatment MVCT images to correct patient position. This work evaluates the dosimetric impact of uncorrected setup errors in breast-cancer radiation therapy.
  
  
  METHODS
  Breast-cancer patient-positioning errors were simulated by shifting the patient computed-tomography (CT) dataset relative to the planned photon fluence and re-computing the dose distributions. To properly evaluate the superficial region, film measurements were compared against the Tomotherapy treatment planning system (TPS) calculations. A simulation of the integrated dose distribution was performed to evaluate the setup error impact over the course of treatment.
  
  
  RESULTS
  Significant dose differences were observed for 11-mm shifts in the anterolateral and 3-mm shifts in the posteromedial directions. The results of film measurements in the superficial region showed that the TPS overestimated the dose by 14% at a 1-mm depth, improving to 3% at depths >or=5mm. Significant dose reductions in PTV were observed in the dose distributions simulated over the course of treatment.
  
  
  CONCLUSIONS
  Tomotherapy's rotational delivery provides sufficient photon fluence extending beyond the skin surface to allow an up to 7-mm uncorrected setup error in the anterolateral direction. However, the steep dose falloff that conforms to the lung surface leads to compromised dose distributions with uncorrected posteromedial shifts. Therefore, daily image guidance and consequent patient repositioning is warranted for breast-cancer patients.
authors.affiliation: Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, MO 63110, USA. sgoddu@radonc.wustl.edu
authors.forename: S Murty
authors.initials: SM
authors.lastname: Goddu
authors.forename: Sridhar
authors.initials: S
authors.lastname: Yaddanapudi
authors.forename: Olga L
authors.initials: OL
authors.lastname: Pechenaya
authors.forename: Summer R
authors.initials: SR
authors.lastname: Chaudhari
authors.forename: Eric E
authors.initials: EE
authors.lastname: Klein
authors.forename: Divya
authors.initials: D
authors.lastname: Khullar
authors.forename: Issam
authors.initials: I
authors.lastname: El Naqa
authors.forename: Sasa
authors.initials: S
authors.lastname: Mutic
authors.forename: Sasha
authors.initials: S
authors.lastname: Wahab
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Santanam
authors.forename: Imran
authors.initials: I
authors.lastname: Zoberi
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Low
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D019300:Medical Errors; D011832:Radiation Injuries / Q000517:prevention & control*; D011857:Radiographic Image Interpretation, Computer-Assisted; D011874:Radiometry; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D055425:Respiratory-Gated Imaging Techniques; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed; D016896:Treatment Outcome