title: Detection of setup uncertainties with 3D surface registration system for conformal radiotherapy of breast cancer.
abstract: OBJECTIVE
  To investigate the clinical application of a technique for patient set-up verification in breast cancer radiotherapy based on a 3D surface image registration system.
  
  
  BACKGROUND
  Accurate and reproducible patient set-up is a prerequisite to correctly deliver fractionated radiotherapy. Various approaches are available to verify and correct patient setup for 3D image acquisition in a radiation treatment room.
  
  
  METHODS
  The study analyzed the setup reproducibility of 15 patients affected by breast cancer and candidates for conformal radiotherapy by using the AlignRT system (VisionRT, London, UK). At the initial setup, electronic portal imaging device (EPID) images were compared with Digitally Reconstructed Radiographs (DRRs) and a reference three-dimensional (3D) surface image was obtained by AlignRT. Surface images were acquired prior to every subsequent setup procedure. The systematic and random errors along longitudinal and vertical directions were measured and compared for the two systems.
  
  
  RESULTS
  The procedure for surface registration, image acquisition and comparison with the reference image took less than 1 min on average. The T test for systematic error showed no significant difference between the 2 verification systems along the longitudinal (p = 0.69) and vertical (p = 0.67) axes. The T-test for random error showed a significant difference between the 2 systems along the vertical axis (p = 0.05).
  
  
  CONCLUSIONS
  AlignRT is fast, simple, non-invasive and seems to be reliable in detecting patient setup errors. Our results suggest that it could be used to assess the setup reproducibility for breast cancer patients.
authors.affiliation: Department of Radiotherapy, University Hospital "Maggiore della Carità", Novara, Italy.
authors.forename: Letizia
authors.initials: L
authors.lastname: Deantonio
authors.affiliation: Department of Radiotherapy, University Hospital "Maggiore della Carità", Novara, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Masini
authors.affiliation: Department of Medical Physics, University Hospital "Maggiore della Carità", Novara, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Loi
authors.affiliation: Department of Radiotherapy, University Hospital "Maggiore della Carità", Novara, Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Gambaro
authors.affiliation: Department of Radiotherapy, University Hospital "Maggiore della Carità", Novara, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Bolchini
authors.affiliation: Department of Radiotherapy, University Hospital "Maggiore della Carità", Novara, Italy ; Department of Clinical and Experimental Medicine, University of "Piemonte Orientale", Novara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Krengli
keywords: Breast cancer; Patient setup; Radiotherapy; Surface imaging