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Measuring breathing induced oesophageal motion and its dosimetric impact
Institution:1. Division of Medical Physics, Department of Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Germany;2. German Cancer Consortium (DKTK). Partner Site Freiburg, Germany;3. Department of Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Germany;1. Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA;2. Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA;3. Department of Urology, Institute of Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden;4. University of California-San Diego, San Diego, CA, USA;5. Uropartners, Westchester, IL, USA;1. Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, Maryland;2. Radiology Department, Complutense University Medical School, Madrid, Spain;3. International Atomic Energy Agency, Vienna, Austria;1. Department of Radiology, University of California-Davis School of Medicine, Sacramento, CA 95817, USA;2. Signal and Image Processing Institute, University of Southern California, Los Angeles, CA 90089, USA;3. Department of Biomedical Engineering, University of California-Davis, Davis, CA 95616, USA;1. Department of Medical Imaging, Nimes University Hospital, Univ Montpellier, Medical Imaging Group Nimes, EA 2992, France;2. Department of Medical Physics, CHU Nimes, Univ Montpellier, Montpellier, France;3. ISERIS Imagerie médicale, 25 rue de Clémentville, Montpellier, France;1. Department of Thoracic Radiation Oncology, Shandong Cancer Hospital and Institute, Jinan, China;2. School of Medicine, Shandong University, Jinan, China;3. Medical Imaging Department, Shandong Cancer Hospital and Institute, Jinan, China
Abstract:Purpose: Stereotactic body radiation therapy allows for a precise dose delivery. Organ motion bears the risk of undetected high dose healthy tissue exposure. An organ very susceptible to high dose is the oesophagus. Its low contrast on CT and the oblong shape render motion estimation difficult. We tackle this issue by modern algorithms to measure oesophageal motion voxel-wise and estimate motion related dosimetric impacts.Methods: Oesophageal motion was measured using deformable image registration and 4DCT of 11 internal and 5 public datasets. Current clinical practice of contouring the organ on 3DCT was compared to timely resolved 4DCT contours. Dosimetric impacts of the motion were estimated by analysing the trajectory of each voxel in the 4D dose distribution. Finally an organ motion model for patient-wise comparisons was built.Results: Motion analysis showed mean absolute maximal motion amplitudes of 4.55 ± 1.81 mm left-right, 5.29 ± 2.67 mm anterior-posterior and 10.78 ± 5.30 mm superior-inferior. Motion between cohorts differed significantly. In around 50% of the cases the dosimetric passing criteria was violated. Contours created on 3DCT did not cover 14% of the organ for 50% of the respiratory cycle and were around 38% smaller than the union of all 4D contours. The motion model revealed that the maximal motion is not limited to the lower part of the organ. Our results showed motion amplitudes higher than most reported values in the literature and that motion is very heterogeneous across patients.Conclusions: Individual motion information should be considered in contouring and planning.
Keywords:Intra-fraction motion  Oesophagus  Lung cancer  SBRT  4DCT  4D Dose  Deformable image registration
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