title: Is a single respiratory correlated 4D-CT study sufficient for evaluation of breathing motion?
abstract: OBJECTIVE
  Respiratory correlated computed tomography has been shown to be effective for evaluation of breathing-induced motion of pulmonary tumors. This study investigated whether a single four-dimensional CT study (4D-CT) is representative and sufficient for treatment planning in stereotactic body radiotherapy (SBRT).
  
  
  METHODS
  Four repeated helical 4D-CT studies were acquired every 10 min for 10 patients with 14 pulmonary metastases. Patients remained immobilized in a stereotactic body frame (SBF) for 30 min; abdominal compression was applied to seven patients. Using amplitude based sorting, eight phases equally distributed over the breathing cycle were reconstructed for each 4D-CT study. Tumor position was defined in a total of 406 CT series and variability of breathing motion and mean tumor position were evaluated.
  
  
  RESULTS
  Peak-to-peak tumor motion was 9.9 mm +/- 6.8 mm (mean +/- standard deviation) and 9.0 mm +/- 7.4 mm at time point 0 min (t(0)) and t(30), respectively. In one patient with poor pulmonary function, continuous increase of breathing motion from 17.4 mm at t(0) to 28.3 mm at t(30) was seen. In five and two lesions, respectively, a drift of the mean tumor position greater than 3 mm and 5 mm was observed. A borderline significance was calculated for larger tumor position variability in midventilation phases compared with peak-ventilation phases of the breathing cycle (p = 0.08).
  
  
  CONCLUSIONS
  Treatment planning based on a single 4D-CT study is reliable for the majority of patients. Increased intrafractional uncertainties were seen for patients with poor pulmonary function and with tumors located in the lower lobe.
authors: Department of Radiation Oncology, Julius-Maximilians University of Wuerzburg, Wuerzburg, Germany. guckenberg_m@klinik.uni-wuerzburg.de
authors: Matthias
authors: M
authors: Guckenberger
authors: Juergen
authors: J
authors: Wilbert
authors: Juergen
authors: J
authors: Meyer
authors: Kurt
authors: K
authors: Baier
authors: Anne
authors: A
authors: Richter
authors: Michael
authors: M
authors: Flentje
mesh_terms: D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy / Q000556:secondary; D009068:Movement; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012119:Respiration; D013238:Stereotaxic Techniques; D014057:Tomography, X-Ray Computed / Q000379:methods*