Title:
Clinical evaluation of a laser surface scanning system in 120 patients for improving daily setup accuracy in fractionated radiation therapy.

Abstract:
To evaluate the clinical suitability of a specific optical surface imaging system to detect setup errors in fractionated radiation therapy.
The setup correction accuracy of a 3-dimensional laser imaging system was analyzed for 6 different tumor locations with 20 patients each. For each patient, the setup corrections of the megavoltage computed tomography (MVCT) images of a TomoTherapy unit (TomoTherapy, Madison, WI) were compared with those of the laser system for the first 10 fractions. For the laser system, the reference surface either was obtained from the DICOM (Digital Imaging and Communications in Medicine) surface structure delineated on the planning computed tomography images or was acquired with the system itself at the first fraction after the MVCT-based setup correction. Data analysis was performed for both reference types.
By use of the DICOM reference image, systematic shifts between 3 and 9 mm were found, depending on the tumor location. For the optical reference, no clinically relevant systematic shifts were found. MVCT-based setup corrections were detected with high accuracy, and only small movements were observed during treatment.
Using a reference image acquired with the laser system itself after MVCT-based setup correction appears more reliable than importing the DICOM reference surface. After generation of the optical reference, the laser system may be used to derive setup corrections over a certain number of fractions, but additional radiologic imaging may still be necessary on a regular basis (eg, weekly) or if the corrections of the optical system appear implausibly large. Nevertheless, such a combined application may help to reduce the imaging dose for the patient.