Evaluation of image-guidance strategies with helical tomotherapy for localised prostate cancer

Set-up accuracy of different image-guidance (IG) protocols using reduced imaging frequency was compared with daily IG. Anatomical characteristics were investigated for their potential to help select the suitable IG protocols for individual patients.

Set-up corrections from 26 prostate cancer patients treated with daily IG on helical tomotherapy were used to simulate IG protocols with reduced imaging frequency, where average set-up corrections from a subset of initial IG sessions were used for subsequent fractions with no IG. Residual set-up error, the difference between the average set-up correction and the actual correction required, was used to evaluate the accuracy of each protocol. Adaptive treatment margins required to encompass these errors were calculated. Body mass index and daily bladder and rectum cross-sectional areas (CSAs) were measured, and their correlations with set-up corrections were evaluated. We also investigated the use of reduced imaging schedules to estimate changes in bladder and rectum CSAs.

As expected, residual set-up errors and adaptive treatment margins were effectively reduced with frequent imaging. For the majority of patients (81%), 10 IG sessions were sufficient to reduce residual set-up errors to within the adaptive treatment margins. Daily IG was more suitable than using a reduced IG protocol for a minority of patients (19%) with residual set-up errors that consistently exceeded the margins for >10% of fractions. These patients could be identified with 10 imaging sessions via the analysis of anatomical variations.

The accuracy of modified IG protocols should be validated in the context of institutional practice regarding patient set-up and bowel/bladder preparation.