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The purpose of this study was to analyze the rotational errors of roll, pitch, and yaw in the whole breast cancertreated by the three-dimensional radiation therapy (3D-CRT) using TomoDirect (TD). Twenty-patient previouslytreated with TD 3D-CRT was selected. We performed a retrospective clinical analysis based on 80 images ofmegavoltage computed tomography (MVCT) including the systematic and random variation with patient setuperrors and treatment setup margin (mm). In addition, a rotational error (degree) for each patient was analyzedusing the automatic image registration. The treatment margin of X, Y, and Z directions were 4.2 mm, 6.2 mm,and 6.4 mm, respectively. The mean value of the rotational error for roll, pitch, and yaw were 0.3°, 0.5°, 0.1°,and all of systematic and random error was within 1.0°. The errors of patient positioning with the Y and Z directionshave generally been mainly higher than the X direction. The percentage in treatment fractions in less than 2°at roll, pitch, and yaw are 95.1%, 98.8%, and 97.5%, respectively. However, the edge of upper and lower (i.e.,bottom) based on the center of therapy region (point) will quite a possibility that it is expected to twist evenlonger as the length of treatment region. The patient-specific characters should be considered for the accuracyand reproducibility of treatment and it is necessary to confirm periodically the rotational errors, including patientrepositioning and repeating MVCT scan.

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