title: Assessment of spatial uncertainties in the radiotherapy process with the Novalis system.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the accuracy of a new version of the ExacTrac X-ray (ETX) system with statistical analysis retrospectively in order to determine the tolerance of systematic components of spatial uncertainties with the Novalis system.
  
  
  METHODS
  Three factors of geometrical accuracy related to the ETX system were evaluated by phantom studies. First, location dependency of the detection ability of the infrared system was evaluated. Second, accuracy of the automated calculation by the image fusion algorithm in the patient registration software was evaluated. Third, deviation of the coordinate scale between the ETX isocenter and the mechanical isocenter was evaluated. From the values of these examinations and clinical experiences, the total spatial uncertainty with the Novalis system was evaluated.
  
  
  RESULTS
  As to the location dependency of the detection ability of the infrared system, the detection errors between the actual position and the detected position were 1% in translation shift and 0.1 degrees in rotational angle, respectively. As to the accuracy of patient verification software, the repeatability and the coincidence of the calculation value by image fusion were good when the contrast of the X-ray image was high. The deviation of coordinates between the ETX isocenter and the mechanical isocenter was 0.313 +/- 0.024 mm, in a suitable procedure.
  
  
  CONCLUSIONS
  The spatial uncertainty will be less than 2 mm when suitable treatment planning, optimal patient setup, and daily quality assurance for the Novalis system are achieved in the routine workload.
authors.affiliation: Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, Nagoya, Japan. nahayashi-rad@umin.net
authors.forename: Naoki
authors.initials: N
authors.lastname: Hayashi
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Obata
authors.forename: Yukio
authors.initials: Y
authors.lastname: Uchiyama
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Mori
authors.forename: Chisa
authors.initials: C
authors.lastname: Hashizume
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kobayashi
mesh_terms: D000465:Algorithms; D002138:Calibration; D004867:Equipment Design; D019047:Phantoms, Imaging; D016634:Radiosurgery / Q000295:instrumentation* / Q000379:methods / Q000592:standards; D011880:Radiotherapy Planning, Computer-Assisted / Q000592:standards*; D012189:Retrospective Studies; D012984:Software / Q000592:standards; D035501:Uncertainty