Clinical evaluation of interfractional variations for whole breast radiotherapy using 3- dimensional surface imaging Amish P. Shah, PhD, Tomas Dvorak,

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Clinical evaluation of interfractional variations for whole breast radiotherapy using 3- dimensional surface imaging Amish P. Shah, PhD, Tomas Dvorak, MD, Michael S. Curry, MS, Daniel J. Buchholz, MD, Sanford L. Meeks, PhD Practical Radiation Oncology Volume 3, Issue 1, Pages 16-25 (January 2013) DOI: 10.1016/j.prro.2012.03.002 Copyright © 2013 American Society for Radiation Oncology Terms and Conditions

Figure 1 Examples of AlignRT reference and verification surface images: (A) reference (pink) and verification surface (green) daily registration and (B) the registered region of interest within 2 mm of the reference surface after registration. Practical Radiation Oncology 2013 3, 16-25DOI: (10.1016/j.prro.2012.03.002) Copyright © 2013 American Society for Radiation Oncology Terms and Conditions

Figure 2 Schematic showing the sequence of events for patient setup for whole breast radiotherapy when using the AlignRT system. MV, megavoltage; ROI, regions of interest; RT, radiotherapy. Practical Radiation Oncology 2013 3, 16-25DOI: (10.1016/j.prro.2012.03.002) Copyright © 2013 American Society for Radiation Oncology Terms and Conditions

Figure 3 Initial target offsets for each fraction: left/right (○), sup/inf (+), ant/post (◊), and 3-dimensional (3D) vector length (■) for (A) 1 patient (No. 7) with moderate AlignRT offsets from skin marks and (B) 1 patient (No. 32) with excessive AlignRT offsets from skin marks. Practical Radiation Oncology 2013 3, 16-25DOI: (10.1016/j.prro.2012.03.002) Copyright © 2013 American Society for Radiation Oncology Terms and Conditions

Figure 4 Histograms showing percent of fractions binned by size of initial target offsets for all patients and all fractions: (A) ant/post; (B) sup/inf; (C) left/right; (D) 3-dimensional (3D) vector length. Practical Radiation Oncology 2013 3, 16-25DOI: (10.1016/j.prro.2012.03.002) Copyright © 2013 American Society for Radiation Oncology Terms and Conditions

Figure 5 Planned and delivered dose-volume histograms of heart, lung, and volume of prescription isodose line from the treatment plan for (A) patient (No.7) with moderate AlignRT offsets from skin marks; (B) patient (No. 32) with excessive AlignRT offsets from skin marks (data displayed in Fig 3); and (C) left-sided breast cancer patient's treatment (Tx) plan, combined with a separate patient's daily offsets in order to display a possible “worst-case” scenario from daily laser and skin mark alignments with large systematic error. Practical Radiation Oncology 2013 3, 16-25DOI: (10.1016/j.prro.2012.03.002) Copyright © 2013 American Society for Radiation Oncology Terms and Conditions