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• W1986529498 abstract "Purpose/Objective(s)In radiation therapy planning, the dose distribution is usually calculated based on simulation CT of a single respiratory phase. Actually, however, the dose distribution is influenced by respiration. The purpose of this study was to analyze changes in dose distribution due to respiration using 4D-CT and to examine the dose distribution.Materials/MethodsTen patients undergoing respiratory-gated SBRT between June 2012 and March 2013 were analyzed. Simulation CT was performed with breath-holding during exhalation. 4D-CT images were obtained under audio instructions, and were reconstructed into 10 phases of the respiratory cycle. GTV and CTV were delineated on each 4D-CT image and then copied to the simulation CT images. Phases of the gating were determined individually in such a way that the tumor motion was within 5 mm around end-expiration position on 4D-CT. ITV, PTV and OARs were created on the simulation CT. Fields and beam arrangements were determined, and dose calculation was carried out as a routine procedure for the planning. The dose was prescribed at the isocenter. ITV, PTV and beams with the same isocenter were copied onto each 4D-CT image. Dose distribution was recomputed on each 4D-CT using the monitor units identical to the simulation CT. Dose-volumetric parameters of CTV, ITV, PTV and the lung were calculated on all respiratory phases.ResultsDose distributions moved with changes of the respiratory phase. Dose-volumetric parameters varied even within the gating phases. Fluctuations of D95 and V90 of CTV were up to 2.1% and 3.2%, respectively. Fluctuations of D95 of ITV and PTV were up to 2.1% and 1.5%, but V90 of those fluctuated up to 11.5% and 7.7%, respectively. Fluctuations of lung V5, V10, V20 and mean lung dose (MLD) remained in 1.6% at maximum. Phase shift caused the rapid decrease of dose to CTV and increase of dose to the perilesional chest wall. 10% phase shift caused up to 49.7% and 31.5% decrease of D95 and V90, respectively, of CTV, 7.6% decrease of ITV V90, and 8.3% decrease of PTV V90. There were differences in dose-volumetric parameters of CTV, ITV and PTV between the simulation CT and 4D-CT. In a case where a part of CTV on simulation CT protruded outside ITV, differences of D95 and V90 of CTV, ITV and PTV were up to 7.6% and 13.4%, 2.1% and 18.1%, and 1.9% and 17.0%, respectively. Differences of lung V5, V10, V20 and MLD were up to 3.7%.ConclusionsThe isodose lines move together with tumor motion by dose build-up at the tumor, but dose to CTV is maintained within an acceptable range if it moves within ITV. The dose distributions vary with changes of the respiratory phase, and the differences may occur between simulation CT and 4D-CT. Dose distributions should be evaluated not only on a single respiratory phase but on all respiratory phases. Purpose/Objective(s)In radiation therapy planning, the dose distribution is usually calculated based on simulation CT of a single respiratory phase. Actually, however, the dose distribution is influenced by respiration. The purpose of this study was to analyze changes in dose distribution due to respiration using 4D-CT and to examine the dose distribution. In radiation therapy planning, the dose distribution is usually calculated based on simulation CT of a single respiratory phase. Actually, however, the dose distribution is influenced by respiration. The purpose of this study was to analyze changes in dose distribution due to respiration using 4D-CT and to examine the dose distribution. Materials/MethodsTen patients undergoing respiratory-gated SBRT between June 2012 and March 2013 were analyzed. Simulation CT was performed with breath-holding during exhalation. 4D-CT images were obtained under audio instructions, and were reconstructed into 10 phases of the respiratory cycle. GTV and CTV were delineated on each 4D-CT image and then copied to the simulation CT images. Phases of the gating were determined individually in such a way that the tumor motion was within 5 mm around end-expiration position on 4D-CT. ITV, PTV and OARs were created on the simulation CT. Fields and beam arrangements were determined, and dose calculation was carried out as a routine procedure for the planning. The dose was prescribed at the isocenter. ITV, PTV and beams with the same isocenter were copied onto each 4D-CT image. Dose distribution was recomputed on each 4D-CT using the monitor units identical to the simulation CT. Dose-volumetric parameters of CTV, ITV, PTV and the lung were calculated on all respiratory phases. Ten patients undergoing respiratory-gated SBRT between June 2012 and March 2013 were analyzed. Simulation CT was performed with breath-holding during exhalation. 4D-CT images were obtained under audio instructions, and were reconstructed into 10 phases of the respiratory cycle. GTV and CTV were delineated on each 4D-CT image and then copied to the simulation CT images. Phases of the gating were determined individually in such a way that the tumor motion was within 5 mm around end-expiration position on 4D-CT. ITV, PTV and OARs were created on the simulation CT. Fields and beam arrangements were determined, and dose calculation was carried out as a routine procedure for the planning. The dose was prescribed at the isocenter. ITV, PTV and beams with the same isocenter were copied onto each 4D-CT image. Dose distribution was recomputed on each 4D-CT using the monitor units identical to the simulation CT. Dose-volumetric parameters of CTV, ITV, PTV and the lung were calculated on all respiratory phases. ResultsDose distributions moved with changes of the respiratory phase. Dose-volumetric parameters varied even within the gating phases. Fluctuations of D95 and V90 of CTV were up to 2.1% and 3.2%, respectively. Fluctuations of D95 of ITV and PTV were up to 2.1% and 1.5%, but V90 of those fluctuated up to 11.5% and 7.7%, respectively. Fluctuations of lung V5, V10, V20 and mean lung dose (MLD) remained in 1.6% at maximum. Phase shift caused the rapid decrease of dose to CTV and increase of dose to the perilesional chest wall. 10% phase shift caused up to 49.7% and 31.5% decrease of D95 and V90, respectively, of CTV, 7.6% decrease of ITV V90, and 8.3% decrease of PTV V90. There were differences in dose-volumetric parameters of CTV, ITV and PTV between the simulation CT and 4D-CT. In a case where a part of CTV on simulation CT protruded outside ITV, differences of D95 and V90 of CTV, ITV and PTV were up to 7.6% and 13.4%, 2.1% and 18.1%, and 1.9% and 17.0%, respectively. Differences of lung V5, V10, V20 and MLD were up to 3.7%. Dose distributions moved with changes of the respiratory phase. Dose-volumetric parameters varied even within the gating phases. Fluctuations of D95 and V90 of CTV were up to 2.1% and 3.2%, respectively. Fluctuations of D95 of ITV and PTV were up to 2.1% and 1.5%, but V90 of those fluctuated up to 11.5% and 7.7%, respectively. Fluctuations of lung V5, V10, V20 and mean lung dose (MLD) remained in 1.6% at maximum. Phase shift caused the rapid decrease of dose to CTV and increase of dose to the perilesional chest wall. 10% phase shift caused up to 49.7% and 31.5% decrease of D95 and V90, respectively, of CTV, 7.6% decrease of ITV V90, and 8.3% decrease of PTV V90. There were differences in dose-volumetric parameters of CTV, ITV and PTV between the simulation CT and 4D-CT. In a case where a part of CTV on simulation CT protruded outside ITV, differences of D95 and V90 of CTV, ITV and PTV were up to 7.6% and 13.4%, 2.1% and 18.1%, and 1.9% and 17.0%, respectively. Differences of lung V5, V10, V20 and MLD were up to 3.7%. ConclusionsThe isodose lines move together with tumor motion by dose build-up at the tumor, but dose to CTV is maintained within an acceptable range if it moves within ITV. The dose distributions vary with changes of the respiratory phase, and the differences may occur between simulation CT and 4D-CT. Dose distributions should be evaluated not only on a single respiratory phase but on all respiratory phases. The isodose lines move together with tumor motion by dose build-up at the tumor, but dose to CTV is maintained within an acceptable range if it moves within ITV. The dose distributions vary with changes of the respiratory phase, and the differences may occur between simulation CT and 4D-CT. Dose distributions should be evaluated not only on a single respiratory phase but on all respiratory phases." @default.
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• W1986529498 date "2014-09-01" @default.
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• W1986529498 title "Analysis of Changes in Dose Distribution due to Respiration in Respiratory-Gated Stereotactic Body Radiation Therapy (SBRT) for Lung Tumors Using 4D-CT" @default.
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