Interfractional renal and diaphragmatic position variation during radiotherapy in children and adults: is there a difference?

Dijk, Irma W.E.M. van; Huijskens, Sophie C.; Jong, Rianne de; Visser, Jelle; Fajardo, Raquel Dávila; Rasch, Coen R. N.; Alderliesten, Tanja; Bel, Arjan

doi:10.1080/0284186x.2017.1299936

Cited by 12 publications

(20 citation statements)

References 19 publications

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“…180-760) between children and adults. However, for each patient, a sufficient amount of projection images was available for tracking diaphragm motion, representing sufficient breathing cycles (approximately 10-30) for the calculation of our parameters.Although the differences in respiratory motion characteristics between children and adults are smaller, our present results on intrafractional organ motion are in line with findings from our previous study, in which we demonstrated that interfractional abdominal organ motion in children differed from that in adults 33. This underscores the need, also in children, for a more individualized approach using 4DCT to define safety margins.…”

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confidence: 92%

The effectiveness of 4DCT in children and adults: A pooled analysis

Huijskens

Dijk

Visser

et al. 2018

J Applied Clin Med Phys

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BackgroundWhile four‐dimensional computed tomography (4DCT) is extensively used in adults, reluctance remains to use 4DCT in children. Day‐to‐day (interfractional) variability and irregular respiration (intrafractional variability) have shown to be limiting factors of 4DCT effectiveness in adults. In order to evaluate 4DCT applicability in children, the purpose of this study is to quantify inter‐ and intrafractional variability of respiratory motion in children and adults. The pooled analysis enables a solid comparison to reveal if 4DCT application for planning purposes in children could be valid.Methods/materialsWe retrospectively included 90 patients (45 children and 45 adults), for whom the diaphragm was visible on abdominal/thoracic free‐breathing cone beam CTs (480 pediatric, 524 adult CBCTs). For each CBCT, the cranial–caudal position of end‐exhale and end‐inhale positions of the right diaphragm dome were manually selected in the projection images. The difference in position between both phases defines the amplitude. Cycle time equaled inspiratory plus expiratory time. We analyzed the variability of the inter‐ and intrafractional respiratory‐induced diaphragm motion.ResultsRanges of respiratory motion characteristics were large in both children and adults (amplitude: 4–17 vs 5–24 mm, cycle time 2.1–3.9 vs 2.7–6.5 s). The mean amplitude was slightly smaller in children than in adults (10.7 vs 12.3 mm; P = 0.06). Interfractional amplitude variability was statistically significantly smaller in children than in adults (1.4 vs 2.2 mm; P = 0.00). Mean cycle time was statistically significantly shorter in children (2.9 vs 3.6 s; P = 0.00). Additionally, intrafractional cycle time variability was statistically significantly smaller in children (0.5 vs 0.7 s; P = 0.00).ConclusionsOverall variability is smaller in children than in adults, indicating that respiratory motion is more regular in children than in adults. This implies that a single pretreatment 4DCT could be a good representation of daily respiratory motion in children and will be at least equally beneficial for planning purposes as it is in adults.

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confidence: 92%

The effectiveness of 4DCT in children and adults: A pooled analysis

Huijskens

Dijk

Visser

et al. 2018

J Applied Clin Med Phys

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“…Motion and/or patient set-up uncertainties have already been studied for abdominal tumors in adults [8][9][10] and in children [11][12][13][14][15][16][17][18]. Four-dimensional computed tomography (4D-CT) [11,12] and 4D magnetic resonance imaging (MRI) [13] are used to estimate the breathing uncertainty and daily cone-beam CT-scans (CBCT) are used to assess both intra-and inter-fraction uncertainties [14][15][16][17][18]. However, none of these studies with pediatric patients has investigated both intraand inter-fraction TB and OAR motion and patient set-up uncertainties for a homogeneous disease patient cohort at a single institute.…”

Section: Introductionmentioning

confidence: 99%

Intra- and inter-fraction uncertainties during IGRT for Wilms’ tumor

et al. 2018

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“…Van Dijk et al analyzed 850 CBCT datasets of 35 children and 35 adults treated with thoracic/abdominal RT to determine pediatric safety margins. 15 Interfractional diaphragm position errors were 2.1, 9.9, and 4.9 mm (M, Σ, and σ, respectively) in the SI direction for adults. Variations in diaphragm position in the other directions were not measured.…”

Section: Discussionmentioning

confidence: 88%

“…The authors suggested that differences in daily breath‐holding had a large effect on interfractional diaphragm changes. Van Dijk et al analyzed 850 CBCT datasets of 35 children and 35 adults treated with thoracic/abdominal RT to determine pediatric safety margins 15 . Interfractional diaphragm position errors were 2.1, 9.9, and 4.9 mm (M, Σ, and σ, respectively) in the SI direction for adults.…”

Section: Discussionmentioning

confidence: 99%

Interfractional diaphragmatic position variation according to stomach volume change during respiratory‐gated radiotherapy for hepatocellular carcinoma

et al. 2021

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Purpose We evaluated the correlation between stomach volume change and interfractional baseline shifts of the diaphragm in image‐guided radiotherapy (IGRT) for hepatocellular carcinoma (HCC). Materials and methods Twenty‐four patients with HCC underwent ten fractions of IGRT, and a total of 240 cone beam computed tomography (CBCT) and on‐board imager (OBI) kV image sets were acquired. These image sets were retrospectively analyzed. Baseline shifts of the diaphragm relative to bone and stomach volume change ratios were evaluated using four‐dimensional simulation CT, kV image, and CBCT images. Associations between baseline shifts and patient physiologic factors were investigated. Results The average baseline shift of the diaphragm in the superior‐inferior (SI) direction was 1.5 mm (standard deviation 4.6 mm), which was higher than the shift in other directions (0.7, 2.0 mm and 0.9, 2.6 mm in right‐left (RL) and anterior‐posterior (AP) directions, respectively). Interfractional baseline shifts of the diaphragm in the SI and AP directions were positively correlated with the stomach volume change ratio (Pearson's r: 0.416 and 0.302, p‐value: <0.001 and <0.001, respectively). Conclusions The interfractional baseline shifts of the diaphragm in the SI and AP directions correlated well with stomach volume changes. Efforts to maintain a constant stomach volume before the simulation and each treatment, such as fasting, may reduce interfractional baseline shifts of liver tumors.

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Interfractional renal and diaphragmatic position variation during radiotherapy in children and adults: is there a difference?

Cited by 12 publications

References 19 publications

The effectiveness of 4DCT in children and adults: A pooled analysis

The effectiveness of 4DCT in children and adults: A pooled analysis

Intra- and inter-fraction uncertainties during IGRT for Wilms’ tumor

Interfractional diaphragmatic position variation according to stomach volume change during respiratory‐gated radiotherapy for hepatocellular carcinoma

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