Highlights
- •We investigated the feasibility of diaphragm matching for liver tumors.
- •Diaphragm matching suppresses variations in respiratory tumor motion.
- •Diaphragm matching was useful in all (C-C, A-P, L-R) direction.
- •Although it was not showed in our previous study, PTV margin could be reduced.
Abstract
Purpose
Image-guided radiotherapy (IGRT) based on bone matching can produce large target-positioning
errors because of expiration breath-hold reproducibility during stereotactic body
radiation therapy (SBRT) for liver tumors. Therefore, the feasibility of diaphragm-based
3D image matching between planning computed tomography (CT) and pretreatment cone-beam
CT was investigated.
Methods
In 59 liver SBRT cases, Lipiodol uptake after transarterial chemoembolization was
defined as a tumor marker. Further, the relative isocenter coordinate that was obtained
by Lipiodol matching was defined as the reference coordinate. The distance between
the relative isocenter coordinate and reference coordinate, which was obtained from
diaphragm matching and bone matching techniques, was defined as the target positioning
error. Furthermore, the target positioning error between liver matching and Lipiodol
matching was evaluated.
Results
The positioning errors in all directions by the diaphragm matching were significantly
smaller than those obtained by using by the bone matching technique (p < 0.05). Further,
the positioning errors in the A-P and C-C directions that were obtained by using liver
matching were significantly smaller than those obtained by using bone matching (p < 0.05).
The estimated PTV margins calculated by the formula proposed by van Herk for diaphragm
matching, liver matching, and bone matching were 5.0 mm, 5.0 mm, and 11.6 mm in the
C-C direction; 3.6 mm, 2.4 mm, and 6.9 mm in the A-P direction; and 2.6 mm, 4.1 mm,
and 4.6 mm in the L-R direction, respectively.
Conclusions
Diaphragm matching-based IGRT may be an alternative image matching technique for determining
liver tumor positions in patients.
Graphical Abstract
Keywords
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Article info
Publication history
Published online: March 21, 2016
Accepted:
February 23,
2016
Received in revised form:
February 13,
2016
Received:
July 29,
2015
Footnotes
This work was partially presented at the 56th Annual Meeting & Exhibition of The American Association of Physicists in Medicine (AAPM) in Austin, TX, USA, July 20–24, 2014.
Identification
Copyright
© 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.
