Errors and margins in radiotherapy

Clinical radiotherapy procedures aim at high accuracy. However, there are many error sources that act during treatment preparation and execution that limit the accuracy. As a consequence, a safety margin is required to ensure that the planned dose is actually delivered to the target for (almost) all patients. Before treatment planning, a planning computed tomography scan is made. In particular, motion of skin with respect to the internal anatomy limits the reproducibility of this step, introducing a systematic setup error. The second important error source is organ motion. The tumor is imaged in an arbitrary position, leading to a systematic organ motion error. The image may also be distorted because of the interference of the scanning process and organ motion. A further systematic error introduced during treatment planning is caused by the delineation process. During treatment, the most important errors are setup error and organ motion leading to day-to-day variations. There are many ways to define the margins required for these errors. In this article, an overview is given of errors in radiotherapy and margin recipes, based on physical and biological considerations. Respiration motion is treated separately.