title: Technical Note: Simulation of 4DCT tumor motion measurement errors.
abstract: OBJECTIVE
  To determine if and by how much the commercial 4DCT protocols under- and overestimate tumor breathing motion.
  
  
  METHODS
  1D simulations were conducted that modeled a 16-slice CT scanner and tumors moving proportionally to breathing amplitude. External breathing surrogate traces of at least 5-min duration for 50 patients were used. Breathing trace amplitudes were converted to motion by relating the nominal tumor motion to the 90th percentile breathing amplitude, reflecting motion defined by the more recent 5DCT approach. Based on clinical low-pitch helical CT acquisition, the CT detector moved according to its velocity while the tumor moved according to the breathing trace. When the CT scanner overlapped the tumor, the overlapping slices were identified as having imaged the tumor. This process was repeated starting at successive 0.1 s time bin in the breathing trace until there was insufficient breathing trace to complete the simulation. The tumor size was subtracted from the distance between the most superior and inferior tumor positions to determine the measured tumor motion for that specific simulation. The effect of the scanning parameter variation was evaluated using two commercial 4DCT protocols with different pitch values. Because clinical 4DCT scan sessions would yield a single tumor motion displacement measurement for each patient, errors in the tumor motion measurement were considered systematic. The mean of largest 5% and smallest 5% of the measured motions was selected to identify over- and underdetermined motion amplitudes, respectively. The process was repeated for tumor motions of 1-4 cm in 1 cm increments and for tumor sizes of 1-4 cm in 1 cm increments.
  
  
  RESULTS
  In the examined patient cohort, simulation using pitch of 0.06 showed that 30% of the patients exhibited a 5% chance of mean breathing amplitude overestimations of 47%, while 30% showed a 5% chance of mean breathing amplitude underestimations of 36%; with a separate simulation using pitch of 0.1 showing, respectively, 37% overestimation and 61% underestimation.
  
  
  CONCLUSIONS
  The simulation indicates that commercial low-pitch helical 4DCT processes potentially yield large tumor motion measurement errors, both over- and underestimating the tumor motion.
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California 90095.
authors.forename: Tai H
authors.initials: TH
authors.lastname: Dou
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California 90095.
authors.forename: David H
authors.initials: DH
authors.lastname: Thomas
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California 90095.
authors.forename: Dylan
authors.initials: D
authors.lastname: O'Connell
authors.affiliation: Department of Radiation Oncology, Washington University of St. Louis School of Medicine, St. Louis, Missouri 63110.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Bradley
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California 90095.
authors.forename: James M
authors.initials: JM
authors.lastname: Lamb
authors.affiliation: Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California 90095.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Low
mesh_terms: D000008:Abdominal Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology; D056973:Four-Dimensional Computed Tomography; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019300:Medical Errors; D008962:Models, Theoretical; D009068:Movement; D012119:Respiration