Purpose/Objective: It is known that a CT-on-rails system is useful for precise radiotherapy as visualizing either a static target or a moving target before treatment. We tried evaluating 3D set-up accuracy for moving pulmonary tumors on a CT-on-rails system using fluoroscopic real-time tumor-tracking radiotherapy (RTRT) system which has been installed in the same treatment room. Materials/Methods: Gold markers of 1.5 mm in diameter as an internal fiducial marker were embedded in a static phantom and adjacent area to patient pulmonary tumors. An in-room CT scans were performed. CT helical imaging parameters were as follows: pitch, 1.5; FOV, 400 mm; slice thickness, 3 mm. Gold marker positions were projected to surface of the skin and surface of an immobilization device with three laser localizers equipped in CT. They were marked at three points with a pen. Then a couch was rotated 180 degrees from CT to a linac RTRT system and the gold marker was placed to the isocenter of RTRT system after shifting the couch three dimensionally with laser alignment. A position of the gold marker was measured with two sets of fluoroscopy on RTRT system. Two image intensifiers are mounted to the ceiling and corresponding x-ray generators are embedded under the floor of the treatment room. (1) As a control study, a static phantom with twenty gold markers was scanned five times with the CT. Set-up error for each marker was measured with RTRT system after a CT-guided marking(n=100).(2) In clinical study, six patients with pulmonary tumor underwent breath-hold helical CT scans at the expiratory phase before every RTRT treatment in order to verify spatial relationship between a gold marker and a target. Set-up error for eight gold markers was measured with RTRT system after a CT-guided marking(n=45). Results: (1) Mean discrepancy±standard deviation(n=100) was 0.48±0.39 mm, 0.79±0.55 mm, 0.28±0.23 mm in the each x, y, z axis for the static phantom in the measurement using fluoroscopic RTRT. (2) Mean discrepancy±standard deviation(n=45) was 0.95±0.74 mm, 1.85±1.73 mm, 1.23±1.08 mm in the each x, y, z axis for eight gold markers in 6 patients in the measurement using fluoroscopic RTRT. x, y, z represent right-left direction, head-foot direction, anterior-posterior direction, respectively. Conclusions: 3D set-up accuracy of our CT-on-rails system for moving pulmonary tumors was estimated to be within a few mm using RTRT system. Physiological dynamic volume change of the lung during expiratory phase might affect our results.
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