Davide Cusumano1, Jennifer Dhont2, Luca Boldrini3, Giuditta Chiloiro4, Stefania Teodoli5, Mariangela Massaccesi6, Bruno Fionda6, Francesco Cellini6, Luigi Azario7, Jef Vandemeulebroucke8, Marco De Spirito7, Vincenzo Valentini4, Dirk Verellen9. 1. U.O.C. Fisica Sanitaria, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia; Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia. 2. Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Pleinlaan 2, B-1050 Brussels, Belgium; Vrije Universiteit Brussel (VUB), Department of Electronics and Informatics (ETRO), Pleinlaan 2, B-1050 Brussels, Belgium; imec, Kapeldreef 75, B-3001 Leuven, Belgium. 3. Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia. Electronic address: luca.boldrini@unicatt.it. 4. Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italia; U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Roma, Italia. 5. U.O.C. Fisica Sanitaria, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia. 6. U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A.Gemelli" IRCCS, Roma, Italia. 7. U.O.C. Fisica Sanitaria, Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Roma, Italia; Istituto di Fisica, Università Cattolica del Sacro Cuore, Roma, Italia. 8. Vrije Universiteit Brussel (VUB), Department of Electronics and Informatics (ETRO), Pleinlaan 2, B-1050 Brussels, Belgium; imec, Kapeldreef 75, B-3001 Leuven, Belgium. 9. Vrije Universiteit Brussel (VUB), Faculty of Medicine and Pharmacy, Pleinlaan 2, B-1050 Brussels, Belgium; Department of Radiotherapy, GZA Ziekenhuizen - Sint Augustinus, Iridium Kankernetwerk, Antwerp, Belgium.
Abstract
INTRODUCTION: Aim of this study was to investigate the ability of pre-treatment four dimensional computed tomography (4DCT) to capture respiratory-motion observed in thoracic and abdominal lesions during treatment. Treatment motion was acquired using full-treatment cine-MR acquisitions. Results of this analysis were compared to the ability of 30 seconds (s) cine Magnetic Resonance (MR) to estimate the same parameters. METHODS: A 4DCT and 30 s cine-MR (ViewRay, USA) were acquired on the simulation day for 7 thoracic and 13 abdominal lesions. Mean amplitude, intra- and inter-fraction amplitude variability, and baseline drift were extracted from the full treatment data acquired by 2D cine-MR, and correlated to the motion on pre-treatment 30 s cine-MR and 4DCT. Using the full treatment data, safety margins on the ITV, necessary to account for all motion variability from 4DCT observed during treatment, were calculated. Mean treatment amplitudes were 2 ± 1 mm and 5 ± 3 mm in the anteroposterior (AP) and craniocaudal (CC) direction, respectively. Differences between mean amplitude during treatment and amplitude on 4DCT or during 30 s cine-MR were not significant, but 30 s cine-MR was more accurate than 4DCT. Intra-fraction amplitude variability was positively correlated with both 30 s cine-MR and 4DCT amplitude. Inter-fraction amplitude variability was minimal. RESULTS: Mean baseline drift over all fractions and patients equalled 1 ± 1 mm in both CC and AP direction, but drifts per fraction up to 16 mm (CC) and 12 mm (AP) were observed. Margins necessary on the ITV ranged from 0 to 8 mm in CC and 0 to 5 mm in AP direction. Neither amplitude on 4DCT nor during 30 s cine MR is correlated to the magnitude of drift or the necessary margins in both directions. CONCLUSION: Lesions moving with small amplitude show limited amplitude variability throughout treatment, making passive motion management strategies seem adequate. However, other variations such as baseline drifts and shifts still cause significant geometrical uncertainty, favouring real-time monitoring and an active approach for all lesions influenced by respiratory motion.
INTRODUCTION: Aim of this study was to investigate the ability of pre-treatment four dimensional computed tomography (4DCT) to capture respiratory-motion observed in thoracic and abdominal lesions during treatment. Treatment motion was acquired using full-treatment cine-MR acquisitions. Results of this analysis were compared to the ability of 30 seconds (s) cine Magnetic Resonance (MR) to estimate the same parameters. METHODS: A 4DCT and 30 s cine-MR (ViewRay, USA) were acquired on the simulation day for 7 thoracic and 13 abdominal lesions. Mean amplitude, intra- and inter-fraction amplitude variability, and baseline drift were extracted from the full treatment data acquired by 2D cine-MR, and correlated to the motion on pre-treatment 30 s cine-MR and 4DCT. Using the full treatment data, safety margins on the ITV, necessary to account for all motion variability from 4DCT observed during treatment, were calculated. Mean treatment amplitudes were 2 ± 1 mm and 5 ± 3 mm in the anteroposterior (AP) and craniocaudal (CC) direction, respectively. Differences between mean amplitude during treatment and amplitude on 4DCT or during 30 s cine-MR were not significant, but 30 s cine-MR was more accurate than 4DCT. Intra-fraction amplitude variability was positively correlated with both 30 s cine-MR and 4DCT amplitude. Inter-fraction amplitude variability was minimal. RESULTS: Mean baseline drift over all fractions and patients equalled 1 ± 1 mm in both CC and AP direction, but drifts per fraction up to 16 mm (CC) and 12 mm (AP) were observed. Margins necessary on the ITV ranged from 0 to 8 mm in CC and 0 to 5 mm in AP direction. Neither amplitude on 4DCT nor during 30 s cine MR is correlated to the magnitude of drift or the necessary margins in both directions. CONCLUSION: Lesions moving with small amplitude show limited amplitude variability throughout treatment, making passive motion management strategies seem adequate. However, other variations such as baseline drifts and shifts still cause significant geometrical uncertainty, favouring real-time monitoring and an active approach for all lesions influenced by respiratory motion.
Authors: Luca Boldrini; Angela Romano; Silvia Mariani; Davide Cusumano; Francesco Catucci; Lorenzo Placidi; Gian Carlo Mattiucci; Giuditta Chiloiro; Francesco Cellini; Maria Antonietta Gambacorta; Luca Indovina; Vincenzo Valentini Journal: J Cancer Res Clin Oncol Date: 2021-01-04 Impact factor: 4.553
Authors: Laila König; Matthias F Häfner; Sonja Katayama; Stefan A Koerber; Eric Tonndorf-Martini; Denise Bernhardt; Bastian von Nettelbladt; Fabian Weykamp; Philipp Hoegen; Sebastian Klüter; Matthew S Susko; Jürgen Debus; Juliane Hörner-Rieber Journal: Radiat Oncol Date: 2020-02-04 Impact factor: 3.481
Authors: Mariangela Massaccesi; Davide Cusumano; Luca Boldrini; Nicola Dinapoli; Bruno Fionda; Stefania Teodoli; Luigi Azario; Gian Carlo Mattiucci; Mario Balducci; Francesco Cellini; Vincenzo Valentini Journal: J Appl Clin Med Phys Date: 2019-05-04 Impact factor: 2.102