Investigation of the change in marker geometry during respiration motion: a preliminary study for dynamic-multi-leaf real-time tumor tracking

Radiation Oncology

Takeshi Nishioka²  Takao Koike⁵  Hiroki Shirato³  Hiroyuki Date²  Seiko Nishioka⁴  Rie Yamazaki¹ 

[1] Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan;Department of Biomedical Sciences and Engineering, Faculty of Health Science, Hokkaido University N12W5, Sapporo, Kita-ku, 060-0812, Japan;Department of Radiology, Hokkaido University School of Medicine, Sapporo, Japan;Department of Radiology, NTT East Japan Sapporo Hospital, Sapporo, Japan;Department of Internal Medicine, NTT East Japan Sapporo Hospital, Sapporo, Japan

关键词: Radiotherapy;    Lung cancer;    Dynamic multi-leaf collimator;    Tumor tracking;   

Others  :  1154883
DOI  :  10.1186/1748-717X-7-218

 received in 2012-10-04, accepted in 2012-12-08,  发布年份 2012

【 摘 要 】

Background

The use of stereotactic body radiotherapy (SBRT) is rapidly increasing. Presently, the most accurate method uses fiducial markers implanted near the tumor. A shortcoming of this method is that the beams turn off during the majority of the respiratory cycle, resulting in a prolonged treatment time. Recent advances in collimation technology have enabled continuous irradiation to a moving tumor. However, the lung is a dynamic organ characterized by inhalation exhalation cycles, during which marker/tumor geometry may change (i.e., misalignment), resulting in under-dosing to the tumor.

Findings

Eight patients with lung cancer who were candidates for stereotactic radiotherapy were examined with 4D high-resolution CT. As a marker surrogate, virtual bronchoscopy using the pulmonary artery (VBPA) was conducted. To detect possible marker/tumor misalignment during the respiration cycle, the distance between the peripheral bronchus, where a marker could be implanted, and the center of gravity of a tumor were calculated for each respiratory phase. When the respiration cycle was divided into 10 phases, the median value was significantly larger for the 30%-70% respiratory phases compared to that for the 10% respiratory phase (P<0.05, Mann–Whitney U-test).

Conclusions

These results demonstrate that physiological aspect must be considered when continuous tumor tracking is applied to a moving tumor. To minimize an “additional” internal target volume (ITV) margin, a marker should be placed approximately 2.5 cm from the tumor.

【 授权许可】

   
2012 Yamazaki et al.; licensee BioMed Central Ltd.

【 图 表 】

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