Interfractional diaphragm changes during breath-holding in stereotactic body radiotherapy for liver cancer

Publication date: March–April 2018
Source:Reports of Practical Oncology & Radiotherapy, Volume 23, Issue 2
Author(s): Daisuke Kawahara, Shuichi Ozawa, Takeo Nakashima, Shintaro Tsuda, Yusuke Ochi, Takuro Okumura, Hirokazu Masuda, Kazunari Hioki, Tathsuhiko Suzuki, Yoshimi Ohno, Tomoki Kimura, Yuji Murakami, Yasushi Nagata
Aim and backgroundIGRT based on bone matching may produce a large target positioning error in terms of the reproducibility of expiration breath-holding on SBRT for liver cancer. We evaluated the intrafractional and interfractional errors using the diaphragm position at the end of expiration by utilising Abches and analysed the factor of the interfractional error.Materials and methodsIntrafractional and interfractional errors were measured using a couple of frontal kV images, planning computed tomography (pCT) and daily cone-beam computed tomography (CBCT). Moreover, max–min diaphragm position within daily CBCT image sets with respect to pCT and the maximum value of diaphragm position difference between CBCT and pCT were calculated.ResultsThe mean±SD (standard deviation) of the intra-fraction diaphragm position variation in the frontal kV images was 1.0±0.7mm in the C-C direction. The inter-fractional diaphragm changes were 0.4±4.6mm in the C-C direction, 1.4±2.2mm in the A-P direction, and −0.6±1.8mm in the L-R direction. There were no significant differences between the maximum value of the max–min diaphragm position within daily CBCT image sets with respect to pCT and the maximum value of diaphragm position difference between CBCT and pCT.ConclusionsResidual intrafractional variability of diaphragm position is minimal, but large interfractional diaphragm changes were observed. There was a small effect in the patient condition difference between pCT and CBCT. The impact of the difference in daily breath-holds on the interfractional diaphragm position was large or the difference in daily breath-holding heavily influenced the interfractional diaphragm change.



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