SU-E-J-24: Can Fiducial Marker-Based Setup Using ExacTrac Be An Alternative to Soft Tissue-Based Setup Using Cone-Beam CT for Prostate IMRT?

Purpose: To assess an accuracy of fiducial maker-based setup using ExacTrac (ExT-based setup) as compared with soft tissue-based setup using Cone-beam CT (CBCT-based setup) for patients with prostate cancer receiving intensity-modulated radiation therapy (IMRT) for the purpose of investigating whether ExT-based setup can be an alternative to CBCT-based setup. Methods: The setup accuracy was analyzed prospectively for 7 prostate cancer patients with implanted three fiducial markers received IMRT. All patients were treated after CBCT-based setup was performed and corresponding shifts were recorded. ExacTrac images were obtained before and after CBCT-based setup. The fiducial marker-based shifts were calculated based on those two images and recorded on the assumption that the setup correction was carried out by fiducial marker-based auto correction. Mean and standard deviation of absolute differences and the correlation between CBCT and ExT shifts were estimated. Results: A total of 178 image dataset were analyzed. On the differences between CBCT and ExT shifts, 133 (75%) of 178 image dataset resulted in smaller differences than 3 mm in all dimensions. Mean differences in the anterior-posterior (AP), superior-inferior (SI), and left-right (LR) dimensions were 1.8 ± 1.9 mm, 0.7 ± 1.9 mm, and 0.6 ± 0.8 mm, respectively. The percentages of shiftmore » agreements within ±3 mm were 76% for AP, 90% for SI, and 100% for LR. The Pearson coefficient of correlation for CBCT and ExT shifts were 0.80 for AP, 0.80 for SI, and 0.65 for LR. Conclusion: This work showed that the accuracy of ExT-based setup was correlated with that of CBCT-based setup, implying that ExT-based setup has a potential ability to be an alternative to CBCT-based setup. The further work is to specify the conditions that ExT-based setup can provide the accuracy comparable to CBCT-based setup.« less