ABSTRACT
Our image-guided radiation therapy (IGRT) protocol for post-prostatectomy patients involves acquiring a kV cone beam computed tomography (CBCT) dataset at each fraction and shifting the treatment couch to align the surgical clips. This IGRT strategy requires significant resources, and delivers non-negligible dose to normal tissues. The objective of this work is to evaluate this IGRT protocol against two alternative strategies in terms of the dose-volume statistics for target and organ at risk regions. Our method involves deforming the planning CT to the CBCT dataset acquired at each fraction, computing dose on the deformed dataset, and inversely transforming the dose back onto the original planning CT dataset. The treatments of six patients were evaluated assuming three IGRT scenarios: no IGRT, daily IGRT using the clinically employed couch shifts, and alternating day IGRT. The doses delivered to the clinical target volumes are within approximately 3.2, 1.3, and 2.1% of the plan for the non-IGRT, daily, and alternating day IGRT protocols, respectively. Doses to relevant portions of the organs at risk deviate from the plan by up to 10.5, 13.1 and 10.7% for non-IGRT, daily IGRT, and alternating day IGRT protocols, respectively. Some cases do not differ significantly between IGRT and non-IGRT protocols in terms of cumulative DVHs, highlighting the difficult task of correcting prostate bed deformations via the treatment couch translations. In general, the alternating day IGRT protocol was found to result in a clinically insignificant deviation in delivered dose while providing a significant reduction in resource use and patient imaging dose.
