title: Lung volume assessment for a cross-comparison of two breathing-adapted techniques in radiotherapy.
abstract: OBJECTIVE
  To assess the validity of gated radiotherapy of lung by using a cross-check methodology based on four-dimensional (4D)-computed tomography (CT) exams. Variations of volume of a breathing phantom was used as an indicator.
  
  
  METHODS
  A balloon was periodically inflated and deflated by a medical ventilator. The volume variation (DeltaV) of the balloon was measured simultaneously by a spirometer, taken as reference, and by contouring 4D-CT series (10 phases) acquired by the real-time position management system (RPM). Similar cross-comparison was performed for 2 lung patients, 1 with free breathing (FB), the other with deep-inspiration breath-hold (DIBH) technique.
  
  
  RESULTS
  During FB, DeltaV measured by the spirometer and from 4D-CT were in good agreement: the mean differences for all phases were 8.1 mL for the balloon and 10.5 mL for a patient-test. End-inspiration lung volume has been shown to be slightly underestimated by the 4D-CT. The discrepancy for DeltaV between DIBH and end-expiration, measured from CT and from spirometer, respectively, was less than 3%.
  
  
  CONCLUSIONS
  Provided that each slice series is correctly associated with the proper breathing phase, 4D-CT allows an accurate assessment of lung volume during the whole breathing cycle (DeltaV error <3% compared with the spirometer signal). Taking the lung volume variation into account is a central issue in the evaluation and control of the toxicity for lung radiation treatments.
authors.affiliation: Department of Radiation Oncology, Institut Curie, 26 rue d'Ulm, 75005 Paris, France. luc.simon@curie.net
authors.forename: Luc
authors.initials: L
authors.lastname: Simon
authors.forename: Philippe
authors.initials: P
authors.lastname: Giraud
authors.forename: Vincent
authors.initials: V
authors.lastname: Servois
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Rosenwald
mesh_terms: D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D008175:Lung Neoplasms / Q000532:radiotherapy*; D009068:Movement; D019047:Phantoms, Imaging; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012119:Respiration; D013147:Spirometry / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*