TY - JOUR
T1 - Target position uncertainty during visually guided deep-inspiration breath-hold radiotherapy in locally advanced lung cancer
AU - Scherman Rydhög, Jonas
AU - Riisgaard de Blanck, Steen
AU - Josipovic, Mirjana
AU - Irming Jølck, Rasmus
AU - Larsen, Klaus Richter
AU - Clementsen, Paul
AU - Lars Andersen, Thomas
AU - Poulsen, Per Rugaard
AU - Fredberg Persson, Gitte
AU - Munck Af Rosenschold, Per
N1 - Copyright © 2017 Elsevier B.V. All rights reserved.
PY - 2017/4
Y1 - 2017/4
N2 - PURPOSE: The purpose of this study was to estimate the uncertainty in voluntary deep-inspiration breath-hold (DIBH) radiotherapy for locally advanced non-small cell lung cancer (NSCLC) patients.METHODS: Perpendicular fluoroscopic movies were acquired in free breathing (FB) and DIBH during a course of visually guided DIBH radiotherapy of nine patients with NSCLC. Patients had liquid markers injected in mediastinal lymph nodes and primary tumours. Excursion, systematic- and random errors, and inter-breath-hold position uncertainty were investigated using an image based tracking algorithm.RESULTS: A mean reduction of 2-6mm in marker excursion in DIBH versus FB was seen in the anterior-posterior (AP), left-right (LR) and cranio-caudal (CC) directions. Lymph node motion during DIBH originated from cardiac motion. The systematic- (standard deviation (SD) of all the mean marker positions) and random errors (root-mean-square of the intra-BH SD) during DIBH were 0.5 and 0.3mm (AP), 0.5 and 0.3mm (LR), 0.8 and 0.4mm (CC), respectively. The mean inter-breath-hold shifts were -0.3mm (AP), -0.2mm (LR), and -0.2mm (CC).CONCLUSION: Intra- and inter-breath-hold uncertainty of tumours and lymph nodes were small in visually guided breath-hold radiotherapy of NSCLC. Target motion could be substantially reduced, but not eliminated, using visually guided DIBH.
AB - PURPOSE: The purpose of this study was to estimate the uncertainty in voluntary deep-inspiration breath-hold (DIBH) radiotherapy for locally advanced non-small cell lung cancer (NSCLC) patients.METHODS: Perpendicular fluoroscopic movies were acquired in free breathing (FB) and DIBH during a course of visually guided DIBH radiotherapy of nine patients with NSCLC. Patients had liquid markers injected in mediastinal lymph nodes and primary tumours. Excursion, systematic- and random errors, and inter-breath-hold position uncertainty were investigated using an image based tracking algorithm.RESULTS: A mean reduction of 2-6mm in marker excursion in DIBH versus FB was seen in the anterior-posterior (AP), left-right (LR) and cranio-caudal (CC) directions. Lymph node motion during DIBH originated from cardiac motion. The systematic- (standard deviation (SD) of all the mean marker positions) and random errors (root-mean-square of the intra-BH SD) during DIBH were 0.5 and 0.3mm (AP), 0.5 and 0.3mm (LR), 0.8 and 0.4mm (CC), respectively. The mean inter-breath-hold shifts were -0.3mm (AP), -0.2mm (LR), and -0.2mm (CC).CONCLUSION: Intra- and inter-breath-hold uncertainty of tumours and lymph nodes were small in visually guided breath-hold radiotherapy of NSCLC. Target motion could be substantially reduced, but not eliminated, using visually guided DIBH.
KW - Breath Holding
KW - Carcinoma, Non-Small-Cell Lung
KW - Female
KW - Fluoroscopy
KW - Humans
KW - Lung Neoplasms
KW - Male
KW - Uncertainty
KW - Journal Article
U2 - 10.1016/j.radonc.2017.02.003
DO - 10.1016/j.radonc.2017.02.003
M3 - Journal article
C2 - 28245908
SN - 0167-8140
VL - 123
SP - 78
EP - 84
JO - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
JF - Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
IS - 1
ER -