Jonas Scherman Rydhög1, Steen Riisgaard de Blanck2, Mirjana Josipovic3, Rasmus Irming Jølck4, Klaus Richter Larsen5, Paul Clementsen6, Thomas Lars Andersen7, Per Rugaard Poulsen8, Gitte Fredberg Persson2, Per Munck Af Rosenschold3. 1. Department of Oncology, Section of Radiotherapy, 3994, Rigshospitalet, Copenhagen, Denmark; Niels Bohr Institute, University of Copenhagen, Denmark. Electronic address: Jonas.Scherman-Rydhog@Skane.se. 2. Department of Oncology, Section of Radiotherapy, 3994, Rigshospitalet, Copenhagen, Denmark. 3. Department of Oncology, Section of Radiotherapy, 3994, Rigshospitalet, Copenhagen, Denmark; Niels Bohr Institute, University of Copenhagen, Denmark. 4. DTU Nanotech, Department of Micro-and Nanotechnology, Center for Nanomedicine and Theranostics, Technical University of Denmark, Denmark; Nanovi Radiotherapy A/S, Denmark. 5. Department of Clinical Medicine, Bispebjerg Hospital, Copenhagen, Denmark. 6. Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Rigshospitalet, Denmark. 7. DTU Nanotech, Department of Micro-and Nanotechnology, Center for Nanomedicine and Theranostics, Technical University of Denmark, Denmark. 8. Department of Oncology, Aarhus University Hospital, Denmark.
Abstract
PURPOSE: The purpose of this study was to estimate the uncertainty in voluntary deep-inspiration breath-hold (DIBH) radiotherapy for locally advanced non-small cell lung cancer (NSCLC) patients. METHODS: Perpendicular fluoroscopic movies were acquired in free breathing (FB) and DIBH during a course of visually guided DIBH radiotherapy of nine patients with NSCLC. Patients had liquid markers injected in mediastinal lymph nodes and primary tumours. Excursion, systematic- and random errors, and inter-breath-hold position uncertainty were investigated using an image based tracking algorithm. RESULTS: A mean reduction of 2-6mm in marker excursion in DIBH versus FB was seen in the anterior-posterior (AP), left-right (LR) and cranio-caudal (CC) directions. Lymph node motion during DIBH originated from cardiac motion. The systematic- (standard deviation (SD) of all the mean marker positions) and random errors (root-mean-square of the intra-BH SD) during DIBH were 0.5 and 0.3mm (AP), 0.5 and 0.3mm (LR), 0.8 and 0.4mm (CC), respectively. The mean inter-breath-hold shifts were -0.3mm (AP), -0.2mm (LR), and -0.2mm (CC). CONCLUSION: Intra- and inter-breath-hold uncertainty of tumours and lymph nodes were small in visually guided breath-hold radiotherapy of NSCLC. Target motion could be substantially reduced, but not eliminated, using visually guided DIBH.
PURPOSE: The purpose of this study was to estimate the uncertainty in voluntary deep-inspiration breath-hold (DIBH) radiotherapy for locally advanced non-small cell lung cancer (NSCLC) patients. METHODS: Perpendicular fluoroscopic movies were acquired in free breathing (FB) and DIBH during a course of visually guided DIBH radiotherapy of nine patients with NSCLC. Patients had liquid markers injected in mediastinal lymph nodes and primary tumours. Excursion, systematic- and random errors, and inter-breath-hold position uncertainty were investigated using an image based tracking algorithm. RESULTS: A mean reduction of 2-6mm in marker excursion in DIBH versus FB was seen in the anterior-posterior (AP), left-right (LR) and cranio-caudal (CC) directions. Lymph node motion during DIBH originated from cardiac motion. The systematic- (standard deviation (SD) of all the mean marker positions) and random errors (root-mean-square of the intra-BH SD) during DIBH were 0.5 and 0.3mm (AP), 0.5 and 0.3mm (LR), 0.8 and 0.4mm (CC), respectively. The mean inter-breath-hold shifts were -0.3mm (AP), -0.2mm (LR), and -0.2mm (CC). CONCLUSION: Intra- and inter-breath-hold uncertainty of tumours and lymph nodes were small in visually guided breath-hold radiotherapy of NSCLC. Target motion could be substantially reduced, but not eliminated, using visually guided DIBH.
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