Comparison of two methods for anterior-posterior isocenter localization in pelvic radiotherapy using electronic portal imaging

Purpose: The two setup methods commonly used to determine the anterior-posterior isocenter location in pelvic radiotherapy are to align lateral localization lasers with lateral skin tattoos on the patient, or to set the couch height so that the isocenter is at a fixed height (determined during simulation or treatment planning) above the couch top. This study was implemented to determine which technique gives more accurate patient treatment by comparison of the anterior-posterior setup variation measured with electronic portal imaging. Methods and Materials: Eleven supine prostate patients were treated with tattoo localization and 159 left-lateral portal images were taken during the treatments. The field displacements were then determined by template matching. These patients were compared to nine patients (205 images) set up to a fixed isocenter height. Similarly, eight prone rectal patients (136 right-lateral images) set up to tattoos were compared to six patients (108 images) set up to a fixed height. The patients were not immobilized and were all treated with three field techniques on a hard couch top. The overall mean treatment position deviation and the standard deviation of the displacements (total setup variation) were calculated for each patient group along with the systematic (simulator-to-treatment) and the random (treatment-to-treatment) setup variation. Results: The mean treatment position deviations were 3.3 mm anterior and 5.2 mm posterior with the tattoo method for the prostate and rectal patients, respectively, These mean position deviations were 0.4/0.1 mm anterior with the fixed height technique. The total setup variations were 4.6/5.2 mm (1 SD) with tattoo localization and 1.7/1.5 mm (1 SD) with the fixed height method. Similarly, random variation was 2.3/3.3 mm (1 SD) with the tattoo method compared to 1.3/1.2 mm (1 SD) with the fixed height method. Systematic variation was 3.7/4.5 mm (1 SD) compared to 1.2/1.1 mm (1 SD). Conclusion: The fixed height technique gives much more accurate localization of the anterior-posterior isocenter in pelvic radiotherapy than lateral skin tattoos. (C) 1998 Elsevier Science Inc.