title: Dosimetric comparison of treatment plans based on free breathing, maximum, and average intensity projection CTs for lung cancer SBRT.
abstract: OBJECTIVE
  To determine whether there is a CT dataset may be more favorable for planning and dose calculation by comparing dosimetric characteristics between treatment plans calculated using free breathing (FB), maximum and average intensity projection (MIP and AIP, respectively) CTs for lung cancer patients receiving stereotactic body radiation therapy (SBRT).
  
  
  METHODS
  Twenty lung cancer SBRT patients, treated on a linac with 2.5 mm width multileaf-collimator (MLC), were analyzed retrospectively. Both FB helical and four-dimensional CT scans were acquired for each patient. Internal target volume (ITV) was delineated based on MIP CTs and modified based on both ten-phase datasets and FB CTs. Planning target volume (PTV) was then determined by adding additional setup margin to ITV. The PTVs and beams in the optimized treatment plan based on FB CTs were copied to MIP and AIP CTs, with the same isocenters, MLC patterns and monitor units. Mean effective depth (MED) of beams, and some dosimetric parameters for both PTVs and most important organ at risk (OAR), lung minus PTV, were compared between any two datasets using two-tail paired t test.
  
  
  RESULTS
  The MEDs in FB and AIP plans were similar but significantly smaller (Ps < 0.001) than that in MIP plans. Minimum dose, mean dose, dose covering at least 90% and 95% of PTVs in MIP plans were slightly higher than two other plans (Ps < 0.008). The absolute volume of lung minus PTV receiving greater than 5, 10, and 20 Gy in MIP plans were significantly smaller than those in both FB and AIP plans (Ps < 0.008). Conformity index for FB plans showed a small but statistically significantly higher.
  
  
  CONCLUSIONS
  Dosimetric characteristics of AIP plans are similar to those of FB plans. Slightly better target volume coverage and significantly lower low-dose region (≤30 Gy) in lung was observed in MIP plans. The decrease in low-dose region in lung was mainly caused by the change of lung volume contoured on two datasets rather than the differences of dose distribution between AIP and MIP plans. Compare with AIP datasets, FB datasets were more prone to significant image artifacts and MIP datasets may overestimate or underestimate the target volume when the target is closer to the denser tissue, so AIP seems favorable for planning and dose calculation for lung SBRT.
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Tian
authors.forename: Zhiheng
authors.initials: Z
authors.lastname: Wang
authors.forename: Hong
authors.initials: H
authors.lastname: Ge
authors.forename: Tian
authors.initials: T
authors.lastname: Zhang
authors.forename: Jing
authors.initials: J
authors.lastname: Cai
authors.forename: Christopher
authors.initials: C
authors.lastname: Kelsey
authors.forename: David
authors.initials: D
authors.lastname: Yoo
authors.forename: Fang-Fang
authors.initials: FF
authors.lastname: Yin
mesh_terms: D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D011874:Radiometry; D016634:Radiosurgery / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D012119:Respiration; D014057:Tomography, X-Ray Computed / Q000379:methods*