RESUMEN
BACKGROUND AND OBJECTIVE: The magnitude of intra-fractional prostate displacement (change from initial position over time) is associated with the duration of the patient lying on the radiotherapy treatment couch. This study reports a minute-by-minute association and calculates the impact of this displacement on duration-dependent margins using real-time intra-fractional position data monitored by four-dimensional transperineal ultrasound (4D TPUS). MATERIALS AND METHODS: A total of 55 patients were recruited prospectively. Intra-fractional position of the prostate was monitored in real-time using a 4D TPUS Clarity® system. A total of 1745 monitoring sessions were analysed. Van Herk's margin recipe (2.5∑â¯+ 1.64((σ2â¯+ σp2)1/2â¯- σp)) was used to estimate the duration-dependant margins for every minute, up to the 15th minute. Linear regression analysis was then performed on the overall margins against time and direction. RESULTS: The mean intra-fractional position was 0.76â¯mm Inferior (Inf), 0â¯mm Lateral (Lat) and 0.94â¯mm Posterior (Post) at the 15th minute. A minimum margin expansion of 2.42â¯mm (Superior/Inf), 1.02â¯mm (Left/Right) and 2.65â¯mm (Anterior/Post) was required for an 8minute treatment compared to 4.29â¯mm (Sup/Inf), 1.84â¯mm (Lt/Rt) and 4.63â¯mm (Ant/Post) for a 15-minute treatment. The required margin expansion increased linearly (R2â¯= 0.99) in all directions (pâ¯< 0.01). However, while there was no statistically significant difference (pâ¯= 0.10) in the required margin expansion in the Sup/Inf and Ant/Post directions respective of the time duration, the margins were much bigger compared to those in the Lt/Rt direction (pâ¯< 0.01). CONCLUSION: We report our experience in deriving the minimum duration-dependant margin to generate the required planning target volume for prostate radiotherapy. The required margin increases linearly in all directions within the 15-min duration; thus, the margin will depend on the duration of the technique chosen (IMRT/VMAT/3DCRT/proton).