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• W2014313462 abstract "The standard CTV to PTV margin for partial breast irradiation is 1 cm, trimmed away from the skin. This margin is intended to encompass both set-up errors and respiratory motion. A recent study of breast respiratory motion allows us to more accurately predict the population requirements for a partial breast treatment ITV. We examined the external thoracic motion of 25 healthy volunteers using a Real-time Position Management system with a marker block placed between the nipples. Respiratory amplitude, variability, and baseline drift were analyzed. Probability distribution functions (PDFs) of breast location were produced. As expected, respiratory motion is not normally distributed about the standard end-exhale set-up position. The simplest margin formula (Mtime) can be extracted from the respiratory PDFs. In this case, the breast position is within Mtime of the end-exhale set-up position 95% of the time for 95% of patients. More sophisticated margin formula divides the margin into random and systematic components. In our study, baseline drifts were observed in both directions, so they form low frequency random changes, while each cycle produces a higher frequency random variation. Setting up over several breathing cycles give a more accurate estimate of end-exhale position. Finally, a typical dose fall-off in the anterior-posterior (AP) direction for a 3D partial breast irradiation is convolved with the respiratory PDF, and the margin for 100% of the PTV of 95% of patients to be covered by the 95% dose line is found. The PDF of AP external motion was found for the 25 volunteers by setting the average end exhale position to zero for each patient and then accumulating a single PDF. From this PDF an optimized margin was determined by adjusting weighting from end exhale to end inhale to include 95% of the points in the PDF. Resultant margins for a range of cutoffs from 0% inhale and 5% exhale to 5% inhale and 0% exhale points were examined and the optimal margin found to be 5.1 mm with a cutoff of 1.5% exhale and 3.5% inhale. Baseline drift is often seen in patient respiratory traces. Our study showed that 95% of volunteers had a percent baseline drift of < 5%; however, our study of external abdominal motion from 125 patient showed that 95% had a percent baseline drift at least 10%. The disparity between studies may be due to differences in respiratory function, increased stress involved in receiving radiation therapy, and/or the different location to the marker block (thoracic/abdominal). Assuming breast patients under the stress of radiation therapy treatment would have a baseline drift closer to the 10% patient baseline drift, we expand ITV to 5.5 mm. Mtime is calculated from the population PDF to include 95% percent of points and found to be 5.1 mm. Baseline drift increases the total symmetric margin to 6 mm in the AP direction." @default.
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• W2014313462 date "2012-11-01" @default.
• W2014313462 modified "2023-09-27" @default.
• W2014313462 title "Partial Breast ITV Margin From Population Respiratory PDF" @default.
• W2014313462 doi "https://doi.org/10.1016/j.ijrobp.2012.07.678" @default.
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