title: Intra-fraction motion of the prostate is not increased by patient couch shifts.
abstract: BACKGROUND
  During a fraction of external beam radiotherapy for prostate cancer, a mismatch between target volume and dose coverage may accumulate over time due to intra-fraction motion. One way to remove the residual error is to perform a couch shift in opposite direction. In principle, such couch shifts could cause secondary displacements of the patient and prostate. Hence it is interesting to investigate if couch shifts might amplify intra-fraction motion.
  
  
  RESULTS
  Intra-fraction motion of the prostate and patient couch position were simultaneously recorded during 359 fractions in 15 patients. During this time, a total of 22 couch shifts of up to 31.5 mm along different axes were recorded. Prostate position and couch position were plotted before, during and after each couch shift. There was no visible impact of couch shifts on prostate motion. The standard deviation of prostate position was calculated before, during and after each couch shift. The standard deviation did not significantly increase during couch shifts (by 3 % on average, p = 0.88) and even slightly decreased after a couch shift (by 37 % on average; p = 0.02).
  
  
  CONCLUSIONS
  Shifts of the patient couch did not adversely affect the motion of the prostate relative to the patient couch. Hence, shifts of the patient couch may be a viable way to correct the position of the prostate relative to the dose distribution.
authors.affiliation: University Hospital of LMU Munich, Department of Radiation Oncology, Marchioninistraße 15, 81377, Munich, Germany. Hendrik.Ballhausen@med.uni-muenchen.de.
authors.forename: Hendrik
authors.initials: H
authors.lastname: Ballhausen
authors.affiliation: University Hospital of LMU Munich, Department of Radiation Oncology, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Ganswindt
authors.affiliation: University Hospital of LMU Munich, Department of Radiation Oncology, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Belka
authors.affiliation: University Hospital of LMU Munich, Department of Radiation Oncology, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Minglun
authors.initials: M
authors.lastname: Li
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D009038:Motion; D009068:Movement; D056888:Patient Positioning; D011467:Prostate / Q000528:radiation effects*; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D015203:Reproducibility of Results
keywords: Intra-fraction motion; Prostate; Radiotherapy