Correction of systematic set-up error in breast and head and neck irradiation through a no-action level (NAL) protocol.
OBJECTIVE
To quantify systematic and random patient set-up errors in breast and head and neck conventional irradiation and to evaluate a no-action level (NAL) protocol for systematic set-up error off-line correction in head and neck cancer and breast cancer patients.


METHODS
Verification electronic portal images of orthogonal set-up fields were obtained daily for the initial four consecutive fractions for 20 patients treated for breast cancer and for 20 head and neck cancer patients. The calculated systematic error was used to shift the isocentre accordingly on the fifth treatment day. From then until the end of the treatment course, pair orthogonal portal images of set-up fields were obtained weekly. To assess the impact of the protocol, pre- and post-correction systematic errors were compared and PTV margins were estimated before and after correction using published margin recipes.


RESULTS
Population systematic set-up error decreased in the breast cancer patient group after the implementation of NAL protocol from 4.0 to 1.7 mm on the x-axis, from 4.7 to 2.1 mm on the y-axis and from 2.8 to 0.9 mm on the z axis. The percentage of patients with individual systematic set-up error reduction was 80%, 90% and 80% on the x-, y and z-axes respectively. Population systematic set-up error decreased also in the head and neck cancer patient group from 2.3 to 1.1 mm on the x-axis, from 1.6 to 1.4 mm on the y-axis and from 1.7 to 0.7 mm on the z-axis. The percentage of patients with individual systematic set-up error reduction was 70%, 65% and 85% on the x-, y- and z-axes respectively. Margin reduction achievable with NAL protocol implementation on the x-, y- and z-axes was 6.3, 7.2 and 4.8 mm for breast cancer patients and 3.3, 0.6 and 2.8 mm for head and neck cancer patients.


CONCLUSIONS
NAL off-line protocol is useful for systematic set-up error correction and PTV margin reduction in conventional breast and head and neck irradiation.
Servicio de Oncología Radioterápica, Hospital General de Ciudad Real, Ciudad Real, Spain.
Eva M
EM
Lozano
Luis A
LA
Pérez
Javier
J
Torres
Carmen
C
Carrascosa
Miguel
M
Sanz
Fermín
F
Mendicote
Antonio
A
Gil
D000465:Algorithms; D001943:Breast Neoplasms / Q000532:radiotherapy*; D002277:Carcinoma / Q000532:radiotherapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods / Q000592:standards; D019300:Medical Errors / Q000517:prevention & control*; D056888:Patient Positioning; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000009:adverse effects / Q000379:methods* / Q000592:standards*; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods / Q000592:standards
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