Evaluation of setup errors at the skin surface position for whole breast radiotherapy of breast cancer patients

We used image-processing software to analyze the setup errors at the skin surface position of breast cancer patients (n=66) who underwent post-operative whole breast irradiation at our hospital in 2014-2015. The sixty- six digital reconstructed radiographs (DRR) were created at the treatment planning for each patient. The lineacgraphies (n=377) were taken after the patients' setup during radiotherapy. The lineacgraphies and DRR were superimposed at the skin surface position for each patient with the image-processing software. We measured the deviations of the isocenters for the nipple-lung (X) direction and craniocaudal (Y) direction and the deviation of the rotation angle of the XY axes between the lineacgraphy and DRR on the superimposed images. The systematic error (μ, S) and random error (s) were calculated from the X and Y deviations and rotation angle deviation. The μ of X, Y, and rotation angle were 0.01 mm, -1.2 mm, and 0.05°, respectively. The S of X, Y, and rotation angle were 1.8 mm, 1.5 mm, and 0.9°, respectively. The s of X, Y, and rotation angle were 2.0 mm, 1.5 mm, and 1.0°, respectively. Our analyses thus revealed that evaluations using image-processing software at the skin surface position in routine breast radiotherapy result in sufficiently small setup errors.