title: Four-dimensional dose evaluation using deformable image registration in radiotherapy for liver cancer.
abstract: OBJECTIVE
  In order to evaluate the dosimetric impact of respiratory motion on the dose delivered to the target volume and critical organs during free-breathing radiotherapy, a four-dimensional dose was evaluated using deformable image registration (DIR).
  
  
  METHODS
  Four-dimensional computed tomography (4DCT) images were acquired for 11 patients who were treated for liver cancer. Internal target volume-based treatment planning and dose calculation (3D dose) were performed using the end-exhalation phase images. The four-dimensional dose (4D dose) was calculated based on DIR of all phase images from 4DCT to the planned image. Dosimetric parameters from the 4D dose, were calculated and compared with those from the 3D dose.
  
  
  RESULTS
  There was no significant change of the dosimetric parameters for gross tumor volume (p > 0.05). The increase D(mean) and generalized equivalent uniform dose (gEUD) for liver were by 3.1% ± 3.3% (p = 0.003) and 2.8% ± 3.3% (p = 0.008), respectively, and for duodenum, they were decreased by 15.7% ± 11.2% (p = 0.003) and 15.1% ± 11.0% (p = 0.003), respectively. The D(max) and gEUD for stomach was decreased by 5.3% ± 5.8% (p = 0.003) and 9.7% ± 8.7% (p = 0.003), respectively. The D(max) and gEUD for right kidney was decreased by 11.2% ± 16.2% (p = 0.003) and 14.9% ± 16.8% (p = 0.005), respectively. For left kidney, D(max) and gEUD were decreased by 11.4% ± 11.0% (p = 0.003) and 12.8% ± 12.1% (p = 0.005), respectively. The NTCP values for duodenum and stomach were decreased by 8.4% ± 5.8% (p = 0.003) and 17.2% ± 13.7% (p = 0.003), respectively.
  
  
  CONCLUSIONS
  The four-dimensional dose with a more realistic dose calculation accounting for respiratory motion revealed no significant difference in target coverage and potentially significant change in the physical and biological dosimetric parameters in normal organs during free-breathing treatment.
authors.affiliation: Department of Radiation Oncology, University of Ulsan College of Medicine, Seoul, South Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Jung
authors.forename: Sang Min
authors.initials: SM
authors.lastname: Yoon
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Park
authors.forename: Byungchul
authors.initials: B
authors.lastname: Cho
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Park
authors.forename: Jinhong
authors.initials: J
authors.lastname: Jung
authors.forename: Jin-Hong
authors.initials: JH
authors.lastname: Park
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Seung Do
authors.initials: SD
authors.lastname: Ahn
mesh_terms: D056973:Four-Dimensional Computed Tomography; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000532:radiotherapy*; D009068:Movement; D058958:Organs at Risk / Q000528:radiation effects; D011829:Radiation Dosage; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D012119:Respiration