title: 4D registration and 4D verification of lung tumor position for stereotactic volumetric modulated arc therapy using respiratory-correlated cone-beam CT.
abstract: We propose a clinical workflow of stereotactic volumetric modulated arc therapy (VMAT) for a lung tumor from planning to tumor position verification using 4D planning computed tomography (CT) and 4D cone-beam CT (CBCT). A 4D CT scanner, an Anzai belt and a BodyFix were employed to obtain 10-phase respiratory-correlated CT data for a lung patient under constrained breathing conditions. A planning target volume (PTV) was defined by adding a 5-mm margin to an internal target volume created from 10 clinical target volumes, each of which was delineated on each of the 10-phase planning CT data. A single-arc VMAT plan was created with a D(95) prescription dose of 50 Gy in four fractions on the maximum exhalation phase CT images. The PTV contours were exported to a kilovoltage CBCT X-ray Volume Imaging (XVI) equipped with a linear accelerator (linac). Immediately before treatment, 10-phase 4D CBCT images were reconstructed leading to animated lung tumor imaging. Initial bone matching was performed between frame-averaged 4D planning CT and frame-averaged 4D CBCT datasets. Subsequently, the imported PTV contours and the animated moving tumor were simultaneously displayed on the XVI monitor, and a manual 4D registration was interactively performed on the monitor until the moving tumor was symmetrically positioned inside the PTV. A VMAT beam was delivered to the patient and during the delivery further 4D CBCT projection data were acquired to verify the tumor position. The entire process was repeated for each fraction. It was confirmed that the moving tumor was positioned inside the PTV during the VMAT delivery.
authors: Department of Radiology, University of Tokyo Hospital, 7-3-1 Hongo Bunkyo-ku, Tokyo 113-8655, Japan. k-nak@fg7.so-net.ne.jp
authors: Keiichi
authors: K
authors: Nakagawa
authors: Akihiro
authors: A
authors: Haga
authors: Satoshi
authors: S
authors: Kida
authors: Yoshitaka
authors: Y
authors: Masutani
authors: Hideomi
authors: H
authors: Yamashita
authors: Wataru
authors: W
authors: Takahashi
authors: Akira
authors: A
authors: Sakumi
authors: Naoya
authors: N
authors: Saotome
authors: Takashi
authors: T
authors: Shiraki
authors: Kuni
authors: K
authors: Ohtomo
authors: Yoshio
authors: Y
authors: Iwai
authors: Kiyoshi
authors: K
authors: Yoda
mesh_terms: D056973:Four-Dimensional Computed Tomography / Q000379:methods*; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D016634:Radiosurgery / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D015203:Reproducibility of Results; D055425:Respiratory-Gated Imaging Techniques / Q000379:methods*; D012680:Sensitivity and Specificity; D013382:Subtraction Technique