Mid-ventilation concept for mobile pulmonary tumors: internal tumor trajectory versus selective reconstruction of four-dimensional computed tomography frames based on external breathing motion.
OBJECTIVE
To evaluate the accuracy of direct reconstruction of mid-ventilation and peak-phase four-dimensional (4D) computed tomography (CT) frames based on the external breathing signal.


METHODS
For 11 patients with 15 pulmonary targets, a respiration-correlated CT study (4D CT) was acquired for treatment planning. After retrospective time-based sorting of raw projection data and reconstruction of eight CT frames equally distributed over the breathing cycle, mean tumor position (P(mean)), mid-ventilation frame, and breathing motion were evaluated based on the internal tumor trajectory. Analysis of the external breathing signal (pressure sensor around abdomen) with amplitude-based sorting of projections was performed for direct reconstruction of the mid-ventilation frame and frames at peak phases of the breathing cycle.


RESULTS
On the basis of the eight 4D CT frames equally spaced in time, tumor motion was largest in the craniocaudal direction, with 12 +/- 7 mm on average. Tumor motion between the two frames reconstructed at peak phases was not different in the craniocaudal and anterior-posterior directions but was systematically smaller in the left-right direction by 1 mm on average. The 3-dimensional distance between P(mean) and the tumor position in the mid-ventilation frame based on the internal tumor trajectory was 1.2 +/- 1 mm. Reconstruction of the mid-ventilation frame at the mean amplitude position of the external breathing signal resulted in tumor positions 2.0 +/- 1.1 mm distant from P(mean). Breathing-induced motion artifacts in mid-ventilation frames caused negligible changes in tumor volume and shape.


CONCLUSIONS
Direct reconstruction of the mid-ventilation frame and frames at peak phases based on the external breathing signal was reliable. This makes the reconstruction of only three 4D CT frames sufficient for application of the mid-ventilation technique in clinical practice.
Guckenberger
Matthias
M
Department of Radiation Oncology, Julius-Maximilians University, Würzburg, Germany. guckenberger_m@klinik.uni-wuerzburg.de
Wilbert
Juergen
J
Krieger
Thomas
T
Richter
Anne
A
Baier
Kurt
K
Flentje
Michael
M
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009068:Movement; D016634:Radiosurgery; D012119:Respiration; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*