Setup deviations for whole-breast radiotherapy with TomoDirect: A comparison of weekly and biweekly image-guided protocols

The purpose of this study was to compare patient setup deviations for different image-guided protocols (weekly vs. biweekly) that are used in TomoDirect three-dimensional conformal radiotherapy (TD-3DCRT) for whole-breast radiation therapy (WBRT). A total of 138 defined megavoltage computed tomography (MVCT) image sets from 46 breast cancer cases were divided into two groups based on the imaging acquisition times: weekly or biweekly. The mean error, three-dimensional setup displacement error (3D-error), systematic error (Σ), and random error (σ) were calculated for each group. The 3D-errors were 4.29 ± 1.11 mm and 5.02 ± 1.85 mm for the weekly and biweekly groups, respectively; the biweekly error was 14.6% higher than the weekly error. The systematic errors in the roll angle and the x, y, and z directions were 0.48°, 1.72 mm, 2.18 mm, and 1.85 mm for the weekly protocol and 0.21°, 1.24 mm, 1.39 mm, and 1.85 mm for the biweekly protocol. Random errors in the roll angle and the x, y, and z directions were 25.7%, 40.6%, 40.0%, and 40.8% higher in the biweekly group than in the weekly group. For the x, y, and z directions, the distributions of the treatment frequency at less than 5 mm were 98.6%, 91.3%, and 94.2% in the weekly group and 94.2%, 89.9%, and 82.6% in the biweekly group. Moreover, the roll angles with 0 − 1° were 79.7% and 89.9% in the weekly and the biweekly groups, respectively. Overall, the evaluation of setup deviations for the two protocols revealed no significant differences (p > 0.05). Reducing the frequency of MVCT imaging could have promising effects on imaging doses and machine times during treatment. However, the biweekly protocol was associated with increased random setup deviations in the treatment. We have demonstrated a biweekly protocol of TD-3DCRT for WBRT, and we anticipate that our method may provide an alternative approach for considering the uncertainties in the patient setup.