T
he mean rotational difference between the BSLS and CBCT registrations were less than 1° for the BSLS ref surface and less than 2° for the CT ref surface. The standard deviation of the rotational difference was about 1–2° (Table II ).
Using the standard deviation of Δ as presented in Table I together with the previously determined standard deviation of dS and dB, the standard deviation of dBS was estimated to be less than 0.2 cm, 0.2 cm and 0.2 cm in the lateral, longitudinal and vertical directions, respectively, for all reference surfaces except the full CTref where dBS was estimated to 0.4 cm in longitudinal and vertical direction.
Discussion and conclusions
Set-up displacements derived from the BSLS system was compared to set-up displacements derived from bone registrations with the CBCT system. The BSLS system verified the position of patients treated in the pelvic region with a radial accuracy of 0.25 cm (0.23–0.28 cm, 95% CI) relative to the CBCT system with the BSLSref method. The BSLS system thereby constitutes a good complement to skin-marks with additional information about pose and supplements the objectiveness of the CBCT system for fractions when no CBCT is acquired or else available.
T
he surface registrations based on BSLSref had less deviation to the CBCT registrations compared to the deviation between surface registrations based on CTref and CBCT registrations. This is congruent with results presented by Moser et al. [16] but not with results presented by Pallotta et al. [27]. It has previously been shown that delineation of patient outline contour from the treatment planning system is critical and may not correspond to the surface detected by the BSLS system thus risking the introduction of a systematic deviation for the CTref method [14,16]. Another important aspect is that the BSLSref method benefits over the CTref method because the BSLSref is corrected according to the CBCT registration, i.e. most of the systematic errors introduced prior to the first treatment fraction are avoided in the BSLSref method. The method of skin-marks-only also benefits over CTref method because skin-marks are redrawn if the systematic deviation, as determined from the first three CBCT registrations, exceeded 0.2 cm.