Assessing Respiration-Induced Tumor Motion and Internal Target Volume Using Four-Dimensional Computed Tomography for Radiotherapy of Lung Cancer

The purpose of this study was to compare positional and volumetric differences of planning target volumes (PTVs) defined on axial three dimensional CT (3D CT) and four dimensional CT (4D CT) for liver cancer. Fourteen patients with liver cancer underwent 3D CT and 4D CT simulation scans during free breathing. The tumor motion was measured by 4D CT. Three internal target volumes (ITVs) were produced based on the clinical target volume from 3DCT (CTV3D): i) A conventional ITV (ITVconv) was produced by adding 10 mm in CC direction and 5 mm in LR and and AP directions to CTV3D; ii) A specific ITV (ITVspec) was created using a specific margin in transaxial direction; iii) ITVvector was produced by adding an isotropic margin derived from the individual tumor motion vector. ITV4D was defined on the fusion of CTVs on all phases of 4D CT. PTVs were generated by adding a 5 mm setup margin to ITVs. The average centroid shifts between PTVs derived from 3DCT and PTV4D in left–right (LR), anterior–posterior (AP), and cranial–caudal (CC) directions were close to zero. Comparing PTV4D to PTVconv, PTVspec, and PTVvector resulted in a decrease in volume size by 33.18% ±12.39%, 24.95% ±13.01%, 48.08% ±15.32%, respectively. The mean degree of inclusions (DI) of PTV4D in PTVconv, and PTV4D in PTVspec, and PTV4D in PTVvector was 0.98, 0.97, and 0.99, which showed no significant correlation to tumor motion vector (r=‐0.470, 0.259, and 0.244; p=0.090, 0.371, and 0.401). The mean DIs of PTVconv in PTV4D, PTVspec in PTV4D, and PTVvector in PTV4D was 0.66, 0.73, and 0.52. The size of individual PTV from 4D CT is significantly less than that of PTVs from 3DCT. The position of targets derived from axial 3DCT images scatters around the center of 4D targets randomly. Compared to conventional PTV, the use of 3D CT‐based PTVs with individual margins cannot significantly reduce normal tissues being unnecessarily irradiated, but may contribute to reducing the risk of missing targets for tumors with large motion.PACS number: 87

Section: Discussionmentioning

confidence: 96%

“…The use of 4D CT scanning is not only able to determine the intrafractional tumor motion, 6 , 8 but also to eliminate respiration motion artifacts 9 , 11 . Moreover, the size of PTVs of lung cancers can be reduced using the technique of 4D CT compared with the technique of 3D CT 5 , 12 , 13 .…”

Section: Introductionmentioning

confidence: 99%

Analysis of the advantage of individual PTVs defined on axial 3D CT and 4D CT images for liver cancer

Xing

et al. 2012

“…Currently, there is no standard for perturbed dose computation. The shifted values used (±3 mm, ±5 mm, ±3 mm) in this study were based on empirical data from other published studies 16, 17 and from our clinical experience. Perturbed doses of D 99 , D 98 , and D 95 were computed for all robust optimization plans and results showed that D 99 ≥95% of D p , D 98 ≥96.6% of D p , and D 95 ≥98% of D p .…”

Section: Discussionmentioning

confidence: 99%

Robust optimization in lung treatment plans accounting for geometric uncertainty

Zhang

Rong

Morrill

et al. 2018

Robust optimization generates scenario‐based plans by a minimax optimization method to find optimal scenario for the trade‐off between target coverage robustness and organ‐at‐risk (OAR) sparing. In this study, 20 lung cancer patients with tumors located at various anatomical regions within the lungs were selected and robust optimization photon treatment plans including intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) plans were generated. The plan robustness was analyzed using perturbed doses with setup error boundary of ±3 mm in anterior/posterior (AP), ±3 mm in left/right (LR), and ±5 mm in inferior/superior (IS) directions from isocenter. Perturbed doses for D99, D98, and D95 were computed from six shifted isocenter plans to evaluate plan robustness. Dosimetric study was performed to compare the internal target volume‐based robust optimization plans (ITV‐IMRT and ITV‐VMAT) and conventional PTV margin‐based plans (PTV‐IMRT and PTV‐VMAT). The dosimetric comparison parameters were: ITV target mean dose (Dmean), R95(D95/Dprescription), Paddick's conformity index (CI), homogeneity index (HI), monitor unit (MU), and OAR doses including lung (Dmean, V20 Gy and V15 Gy), chest wall, heart, esophagus, and maximum cord doses. A comparison of optimization results showed the robust optimization plan had better ITV dose coverage, better CI, worse HI, and lower OAR doses than conventional PTV margin‐based plans. Plan robustness evaluation showed that the perturbed doses of D99, D98, and D95 were all satisfied at least 99% of the ITV to received 95% of prescription doses. It was also observed that PTV margin‐based plans had higher MU than robust optimization plans. The results also showed robust optimization can generate plans that offer increased OAR sparing, especially for normal lungs and OARs near or abutting the target. Weak correlation was found between normal lung dose and target size, and no other correlation was observed in this study.

“…However, the substantial breathing‐induced tumor motion limits their applications. Studies have reported that up to 40% of lung tumors move by more than 5 mm, of those 10% to 12% move more than 1 cm 5 , 6 . Since conventional radiation therapy accounted for no tumor motion during treatment simulation, the planning target volume (PTV) thus formed with extensive margin to avoid geometrical misses of the target.…”

Section: Introductionmentioning

confidence: 99%

A design of a DICOM‐RT‐based tool box for nonrigid 4D dose calculation

Wong

Baker

Leung

et al. 2016

The study was aimed to introduce a design of a DICOM‐RT‐based tool box to facilitate 4D dose calculation based on deformable voxel‐dose registration. The computational structure and the calculation algorithm of the tool box were explicitly discussed in the study. The tool box was written in MATLAB in conjunction with CERR. It consists of five main functions which allow a) importation of DICOM‐RT‐based 3D dose plan, b) deformable image registration, c) tracking voxel doses along breathing cycle, d) presentation of temporal dose distribution at different time phase, and e) derivation of 4D dose. The efficacy of using the tool box for clinical application had been verified with nine clinical cases on retrospective‐study basis. The logistic and the robustness of the tool box were tested with 27 applications and the results were shown successful with no computational errors encountered. In the study, the accumulated dose coverage as a function of planning CT taken at end‐inhale, end‐exhale, and mean tumor position were assessed. The results indicated that the majority of the cases (67%) achieved maximum target coverage, while the planning CT was taken at the temporal mean tumor position and 56% at the end‐exhale position. The comparable results to the literature imply that the studied tool box can be reliable for 4D dose calculation. The authors suggest that, with proper application, 4D dose calculation using deformable registration can provide better dose evaluation for treatment with moving target.PACS number(s): 87.55.kh