Cone beam CT (CBCT) evaluation of inter- and intra-fraction motion for patients undergoing brain radiotherapy immobilized using a commercial thermoplastic mask on a robotic couch.

Patients receiving fractionated intensity-modulated radiation therapy (IMRT) for brain tumors are often immobilized with a thermoplastic mask; however, masks do not perfectly re-orient the patient due to factors including the maximum pressure which can be applied to the face, deformations of the mask assembly, patient compliance, etc. Consequently, ~3-5mm PTV margins (beyond the CTV) are often recommended. We aimed to determine if smaller PTV margins are feasible using mask immobilization coupled with 1) a gantry mounted CBCT image guidance system and 2) position corrections provided by a full six-degree of freedom (6-DOF) robotic couch.