Relationship of imaging frequency and planning margin to account for intrafraction prostate motion: analysis based on real-time monitoring data.

PURPOSE: Correction for intrafraction prostate motion becomes important for hypofraction treatment of prostate cancer. The purpose of this study was to estimate an ideal planning margin to account for intrafraction prostate motion as a function of imaging and repositioning frequency in the absence of continuous prostate motion monitoring.

METHODS AND MATERIALS: For 31 patients receiving intensity modulated radiation therapy treatment, prostate positions sampled at 10 Hz during treatment using the Calypso system were analyzed. Using these data, we simulated multiple, less frequent imaging protocols, including intervals of every 10, 15, 20, 30, 45, 60, 90, 120, 180, and 240 seconds. For each imaging protocol, the prostate displacement at the imaging time was corrected by subtracting prostate shifts from the subsequent displacements in that fraction. Furthermore, we conducted a principal component analysis to quantify the direction of prostate motion.

RESULTS: Averaging histograms of every 240 and 60 seconds for all patients, vector displacements of the prostate were, respectively, within 3 and 2 mm for 95% of the treatment time. A vector margin of 1 mm achieved 91.2% coverage of the prostate with 30 second imaging. The principal component analysis for all fractions showed the largest variance in prostate position in the midsagittal plane at 54° from the anterior direction, indicating that anterosuperior to inferoposterior is the direction of greatest motion. The smallest prostate motion is in the left-right direction.

CONCLUSIONS: The magnitudes of intrafraction prostate motion along the superior-inferior and anterior-posterior directions are comparable, and the smallest motion is in the left-right direction. In the absence of continuous prostate motion monitoring, and under ideal circumstances, 1-, 2-, and 3-mm vector planning margins require a respective imaging frequency of every 15, 60, and 240 to account for intrafraction prostate motion while achieving adequate geometric target coverage for 95% of the time.