title: Investigation of respiration induced intra- and inter-fractional tumour motion using a standard Cone Beam CT.
abstract: BACKGROUND
  To investigate whether a standard Cone beam CT (CBCT) scan can be used to determined the intra- and inter-fractional tumour motion for lung tumours that have infiltrated the mediastinum.
  
  
  METHODS
  This study includes 23 patients with non small cell lung cancer (NSCLC). The intra-fractional tumour motion was analysed for each patient on a 4D-CT scan as well as on three 4D-CBCT (fraction 3, 10 and 20). The 4D-CBCT was reconstructed from a standard 3D-CBCT using in-house developed software. The tumour (GTV) was delineated in the first phase of the 4D-CT. Registration of phase one from the 4D-CT and 4D-CBCT was used to copy the GTV to the CBCT scans. Hereafter the motion of the outlined GTV was tracked in the planning 4D-CT and the three 4D-CBCT using Pinnacle(®) version 8.1w (research version). Additionally, the inter-fractional tumour movement, relative to the bony structure, was obtained from the difference in tumour position between the 3D-CT and the standard 3D-CBCT.
  
  
  RESULTS
  It is possible to track a lung tumour with mediastinal infiltration in the 4D-CBCT scan based on a standard 3D-CBCT. The respiration motion in the 4D-CBCT is not significantly different from the result found from the initial 4D-CT. Likewise, no differences in respiration motion was found between fractions 3, 10 and 20.
  
  
  CONCLUSIONS
  This study shows that it is possible to track tumour motion for NSCLC patients with mediastinal infiltration using a standard 3D-CBCT. No change in the intra-fractional tumour motion of clinically relevance was observed during the fractionated treatment course. The inter-fractional tumour motion found underlines the importance of using daily IGRT with online match on soft tissue in order to be able to reduce treatment margins.
authors.affiliation: Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark. karina.lindberg@ouh.regionsyddanmark.dk
authors.forename: Karina Lindberg
authors.initials: KL
authors.lastname: Gottlieb
authors.forename: Christian R
authors.initials: CR
authors.lastname: Hansen
authors.forename: Olfred
authors.initials: O
authors.lastname: Hansen
authors.forename: Jonas
authors.initials: J
authors.lastname: Westberg
authors.forename: Carsten
authors.initials: C
authors.lastname: Brink
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D019583:Dose Fractionation, Radiation; D056973:Four-Dimensional Computed Tomography / Q000379:methods; D006801:Humans; D021621:Imaging, Three-Dimensional; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy; D009068:Movement / Q000502:physiology*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods; D012119:Respiration; D015656:Respiratory Mechanics / Q000502:physiology; D012189:Retrospective Studies; D047368:Tumor Burden / Q000502:physiology