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Precise patient positioning and thus precise positioning of the planningtarget volume (PTV) is a prerequisite for effective treatment in percutaneousradiation therapy. Conventional imaging modalities used to ensure exactpositioning for treatment typically involve additional radiation exposure ofthe patient. A different approach to patient alignment without additionalexposure is provided by optical 3D surface scanning and registration systems.  We investigated two systems Catalyst and AlignRT, which allowed us togenerate and validate surface images of 50 patients undergoing irradiation on aTomotherapy system. We compared the positions proposed by these two surfaceimaging systems (SIS) with the actual adjustments in patient positions made onthe basis of MVCT scans. With the two SIS, the surface of every single patientwas repeatedly recorded throughout treatment. In addition, we performed asystematic analysis of both systems using a body phantom.  At least 10 surface images were available from each patient included in theanalysis. The large number of patients allowed us to subdivide the studypopulation into three groups by body region treated: head & neck, chest, andpelvic. The results for each of these three body regions were separatelyanalyzed. Thus, the focus of our investigation is on body regions registeredwith the two systems rather than tumor entities. For AlignRT, for instance, wefound an improvement in positioning for the Pelvic region of 0.9mm in 75% and6.4mm in 95% of the collected data in comparison to conventional markeralignment.  The two systems were most accurate in the head & neck region, whereconventional mask alignment is already sufficiently accurate. The other twobody regions, pelvic and chest, might benefit from positioning by SIS. But forboth systems there is still a need for improvement to reduce statisticalvariation.

Clinical Validation of two Surface Imaging Systems for Patient Positioning in Percutaneous Radiotherapy