Evaluation of set-up errors and estimation of set-up margin during external beam radiation therapy of prostate cancer using electronic portal imaging device (EPID)

Aim: In radiation therapy, accurate dose distribution in target volume requires accurate treatment setup. The set-up errors are unwanted and inherent in the treatment process. By achieving these errors, a set-up margin (SM) of clinical target volume (CTV) to planning target volume (PTV) can be determined. In the current study, systematic and random set-up errors that occurred during prostate cancer radiotherapy were measured by an electronic portal imaging device (EPID). The obtained values were used to propose the optimum CTV-to-PTV margin in prostate cancer radiotherapy. Materials and methods: A total of 21 patients with prostate cancer treated with external beam radiation therapy (EBRT) participated in this study. A total of 280 portal images were acquired during 12 months. Gross, population systematic (Sigma) and random (sigma) errors were obtained based on the portal images in Anterior-Posterior (AP), Medio-Lateral (ML) and Superior-Inferior (SI) directions. The SM of CTV to PTV were then calculated and compared by using the formulas presented by the International Commission on Radiation Units and Measurements (ICRU) 62, Stroom and Heijmen and Van Herk et al. Results: The findings showed that the population systematic errors during prostate cancer radiotherapy in AP, ML and SI directions were 1.40, 1.95 and 1.94 mm, respectively. The population random errors in AP, ML and SI directions were 2.09, 1.85 and 2.29 mm, respectively. The SM of CTV to PTV calculated in accordance with the formula of ICRU 62 in AP, ML and SI directions were 2.51, 2.68 and 3.00 mm, respectively. And according to Stroom and Heijmen, formula were 4.23, 5.19 and 548 mm, respectively. And Van Herk et al. formula were 4.96, 6.17 and 6.45 mm, respectively. Findings: The SM of CTV to PTV in all directions, based on the formulas of ICRU 62, Stroom and Heijmen and van Herk et al., were equal to 2.73, 4.98 and 5.86 mm, respectively; these values were obtained by averaging the margins in all directions.