title: Determination of patient-specific internal gross tumor volumes for lung cancer using four-dimensional computed tomography.
abstract: BACKGROUND
  To determine the optimal approach to delineating patient-specific internal gross target volumes (IGTV) from four-dimensional (4-D) computed tomography (CT) image data sets used in the planning of radiation treatment for lung cancers.
  
  
  METHODS
  We analyzed 4D-CT image data sets of 27 consecutive patients with non-small-cell lung cancer (stage I: 17, stage III: 10). The IGTV, defined to be the envelope of respiratory motion of the gross tumor volume in each 4D-CT data set was delineated manually using four techniques: (1) combining the gross tumor volume (GTV) contours from ten respiratory phases (IGTVAllPhases); (2) combining the GTV contours from two extreme respiratory phases (0% and 50%) (IGTV2Phases); (3) defining the GTV contour using the maximum intensity projection (MIP) (IGTVMIP); and (4) defining the GTV contour using the MIP with modification based on visual verification of contours in individual respiratory phase (IGTVMIP-Modified). Using the IGTVAllPhases as the optimum IGTV, we compared volumes, matching indices, and extent of target missing using the IGTVs based on the other three approaches.
  
  
  RESULTS
  The IGTVMIP and IGTV2Phases were significantly smaller than the IGTVAllPhases (p < 0.006 for stage I and p < 0.002 for stage III). However, the values of the IGTVMIP-Modified were close to those determined from IGTVAllPhases (p = 0.08). IGTVMIP-Modified also matched the best with IGTVAllPhases.
  
  
  CONCLUSIONS
  IGTVMIP and IGTV2Phases underestimate IGTVs. IGTVMIP-Modified is recommended to improve IGTV delineation in lung cancer.
authors.affiliation: Department of Radiation Oncology, The University of Texas M, D, Anderson Cancer Center, Houston, USA. veniezhil@hotmail.com
authors.forename: Muthuveni
authors.initials: M
authors.lastname: Ezhil
authors.forename: Sastry
authors.initials: S
authors.lastname: Vedam
authors.forename: Peter
authors.initials: P
authors.lastname: Balter
authors.forename: Bum
authors.initials: B
authors.lastname: Choi
authors.forename: Dragan
authors.initials: D
authors.lastname: Mirkovic
authors.forename: George
authors.initials: G
authors.lastname: Starkschall
authors.forename: Joe Y
authors.initials: JY
authors.lastname: Chang
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D054893:Cone-Beam Computed Tomography / Q000379:methods; D006801:Humans; D007206:Individuality; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008954:Models, Biological; D009367:Neoplasm Staging; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D047368:Tumor Burden