title: Determination of ventilatory liver movement via radiographic evaluation of diaphragm position.
abstract: OBJECTIVE
  To determine the accuracy of estimation of liver movement inferred by observing diaphragm excursion on radiographic images.
  
  
  METHODS
  Eight patients with focal liver cancer had platinum embolization microcoils implanted in their livers during catheterization of the hepatic artery for delivery of regional chemotherapy. These patients underwent fluoroscopy, during which normal breathing movement was recorded on videotape. Movies of breathing movement were digitized, and the relative projected positions of the diaphragm and coils were recorded. For 6 patients, daily radiographs were also acquired during treatment. Retrospective measurements of coil position were taken after the diaphragm was aligned with the superior portion of the liver on digitally reconstructed radiographs.
  
  
  RESULTS
  Coil movement of 4.9 to 30.4 mm was observed during normal breathing. Diaphragm position tracked inferior-superior coil displacement accurately (population sigma 1.04 mm) throughout the breathing cycle. The range of coil movement was predicted by the range of diaphragm movement with an accuracy of 2.09 mm (sigma). The maximum error observed measuring coil movement using diaphragm position was 3.8 mm for a coil 9.8 cm inferior to the diaphragm. However, the distance of the coil from the top of the diaphragm did not correlate significantly with the error in predicting liver excursion. Analysis of daily radiographs showed that the error in predicting coil position using the diaphragm as an alignment landmark was 1.8 mm (sigma) in the inferior-superior direction and 2.2 mm in the left-right direction, similar in magnitude to the inherent uncertainty in alignment.
  
  
  CONCLUSIONS
  This study demonstrated that the range of ventilatory movement of different locations within the liver is predicted by diaphragm position to an accuracy that matches or exceeds existing systems for ventilatory tracking. This suggests that the diaphragm is an acceptable anatomic landmark for radiographic estimation of liver movement in anterior-posterior projections for most patients.
authors.affiliation: Department of Radiation Oncology, University of Michigan Health Systems, Ann Arbor, MI 48109-0010, USA. jbalter@umich.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Balter
authors.forename: L A
authors.initials: LA
authors.lastname: Dawson
authors.forename: S
authors.initials: S
authors.lastname: Kazanjian
authors.forename: C
authors.initials: C
authors.lastname: McGinn
authors.forename: K K
authors.initials: KK
authors.lastname: Brock
authors.forename: T
authors.initials: T
authors.lastname: Lawrence
authors.forename: R
authors.initials: R
authors.lastname: Ten Haken
mesh_terms: D003964:Diaphragm / Q000000981:diagnostic imaging*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging*; D009068:Movement; D011859:Radiography; D012119:Respiration