OPEN IN READ APP
JOURNAL ARTICLE

Inter- and intrafraction variability in liver position in non-breath-hold stereotactic body radiotherapy

Robert B Case, Jan-Jakob Sonke, Douglas J Moseley, John Kim, Kristy K Brock, Laura A Dawson
International Journal of Radiation Oncology, Biology, Physics 2009 September 1, 75 (1): 302-8
19628342

PURPOSE: The inter- and intrafraction variability of liver position was assessed in patients with liver cancer treated with kilovoltage cone-beam computed tomography (CBCT)-guided stereotactic body radiotherapy.

METHODS AND MATERIALS: A total of 314 CBCT scans obtained in the treatment position immediately before and after each fraction were evaluated from 29 patients undergoing six-fraction, non-breath-hold stereotactic body radiotherapy for unresectable liver cancer. Off-line, the CBCT scans were sorted into 10 bins, according to the phase of respiration. The liver position (relative to the vertebral bodies) was measured using rigid alignment of the exhale CBCT liver with the exhale planning CT liver, following the alignment of the vertebrae. The interfraction liver position change was measured by comparing the pretreatment CBCT scans, and the intrafraction change was measured from the CBCT scans obtained immediately before and after each fraction.

RESULTS: The mean amplitude of liver motion for all patients was 1.8 mm (range, 0.1-5.7), 8.0 mm (range, 0.1-18.8), and 4.3 mm (range 0.1-12.1) in the medial-lateral (ML), craniocaudal (CC), and anteroposterior (AP) directions, respectively. The mean absolute ML, CC, and AP interfraction changes in liver position were 2.0 mm (90th percentile, 4.2), 3.5 mm (90th percentile, 7.3), and 2.3 mm (90th percentile, 4.7). The mean absolute intrafraction ML, CC, and AP changes were 1.3 mm (90th percentile, 2.9), 1.6 mm (90th percentile, 3.6), and 1.5 mm (90th percentile, 3.1), respectively. The interfraction changes were significantly larger than the intrafraction changes, with a CC systematic error of 2.9 and 1.1 mm, respectively. The intraobserver reproducibility (sigma, n = 29 fractions) was 1.3 mm in the ML, 1.4 mm in the CC, and 1.6 mm in the AP direction.

CONCLUSION: Interfraction liver position changes relative to the vertebral bodies are an important source of geometric uncertainty, providing a rationale for prefraction soft-tissue image guidance. The intrafraction change in liver position from the beginning to the end of each fraction was small for most patients.

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Available on the App Store

Available on the Play Store
Remove bar
Read by QxMD icon Read
19628342
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"