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Title: Four-dimensional computed tomographic analysis of esophageal mobility during normal respiration

Abstract

Background: Chemo-radiotherapy for thoracic tumors can result in high-grade radiation esophagitis. Treatment planning to reduce esophageal irradiation requires organ motion to be accounted for. In this study, esophageal mobility was assessed using four-dimensional computed tomography (4DCT). Methods and Materials: Thoracic 4DCT scans were acquired on a 16-slice CT scanner in 29 patients. The outer esophageal wall was contoured in two extreme phases of respiration in 9 patients with nonesophageal malignancies. The displacement of the center of contour was measured at 2-cm intervals. In 20 additional patients with Stage I lung cancer, the esophagus was contoured in all 10 phases of each 4DCT at five defined anatomic levels. Both approaches were then applied to 4DCT scans of 4 patients who each had two repeat scans performed. A linear mixed effects model was constructed with fixed effects: measurement direction, measurement type, and measurement location along the cranio-caudal axis. Results: Measurement location and direction were significant descriptive parameters (Wald F-tests, p < 0.001), and the interaction term between the two was significant (p = 0.02). Medio-lateral mobility exceeded dorso-ventral mobility in the lower half of the esophagus but was of a similar magnitude in the upper half. Margins that would have incorporated allmore » movement in medio-lateral and dorso-ventral directions were 5 mm proximally, 7 mm and 6 mm respectively in the mid-esophagus, and 9 mm and 8 mm respectively in the distal esophagus. Conclusions: The distal esophagus shows more mobility. Margins for mobility that can encompass all movement were derived for use in treatment planning, particularly for stereotactic radiotherapy.« less

Authors:
 [1];  [2];  [3];  [1];  [1];  [1]
  1. Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands)
  2. Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands). E-mail: s.senan@vumc.nl
  3. Department of Bioinformatics, Antoni van Leeuwenhoek Hospital, Amsterdam (Netherlands)
Publication Date:
OSTI Identifier:
20944728
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 67; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2006.09.054; PII: S0360-3016(06)03365-7; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; COMPUTERIZED TOMOGRAPHY; ESOPHAGUS; IRRADIATION; LUNGS; MOBILITY; PATIENTS; PLANNING; RADIOTHERAPY; RESPIRATION; TOXICITY

Citation Formats

Dieleman, Edith, Senan, Suresh, Vincent, Andrew, Lagerwaard, Frank J., Slotman, Ben J., and Soernsen de Koste, John R. van. Four-dimensional computed tomographic analysis of esophageal mobility during normal respiration. United States: N. p., 2007. Web. doi:10.1016/j.ijrobp.2006.09.054.
Dieleman, Edith, Senan, Suresh, Vincent, Andrew, Lagerwaard, Frank J., Slotman, Ben J., & Soernsen de Koste, John R. van. Four-dimensional computed tomographic analysis of esophageal mobility during normal respiration. United States. doi:10.1016/j.ijrobp.2006.09.054.
Dieleman, Edith, Senan, Suresh, Vincent, Andrew, Lagerwaard, Frank J., Slotman, Ben J., and Soernsen de Koste, John R. van. Thu . "Four-dimensional computed tomographic analysis of esophageal mobility during normal respiration". United States. doi:10.1016/j.ijrobp.2006.09.054.
@article{osti_20944728,
title = {Four-dimensional computed tomographic analysis of esophageal mobility during normal respiration},
author = {Dieleman, Edith and Senan, Suresh and Vincent, Andrew and Lagerwaard, Frank J. and Slotman, Ben J. and Soernsen de Koste, John R. van},
abstractNote = {Background: Chemo-radiotherapy for thoracic tumors can result in high-grade radiation esophagitis. Treatment planning to reduce esophageal irradiation requires organ motion to be accounted for. In this study, esophageal mobility was assessed using four-dimensional computed tomography (4DCT). Methods and Materials: Thoracic 4DCT scans were acquired on a 16-slice CT scanner in 29 patients. The outer esophageal wall was contoured in two extreme phases of respiration in 9 patients with nonesophageal malignancies. The displacement of the center of contour was measured at 2-cm intervals. In 20 additional patients with Stage I lung cancer, the esophagus was contoured in all 10 phases of each 4DCT at five defined anatomic levels. Both approaches were then applied to 4DCT scans of 4 patients who each had two repeat scans performed. A linear mixed effects model was constructed with fixed effects: measurement direction, measurement type, and measurement location along the cranio-caudal axis. Results: Measurement location and direction were significant descriptive parameters (Wald F-tests, p < 0.001), and the interaction term between the two was significant (p = 0.02). Medio-lateral mobility exceeded dorso-ventral mobility in the lower half of the esophagus but was of a similar magnitude in the upper half. Margins that would have incorporated all movement in medio-lateral and dorso-ventral directions were 5 mm proximally, 7 mm and 6 mm respectively in the mid-esophagus, and 9 mm and 8 mm respectively in the distal esophagus. Conclusions: The distal esophagus shows more mobility. Margins for mobility that can encompass all movement were derived for use in treatment planning, particularly for stereotactic radiotherapy.},
doi = {10.1016/j.ijrobp.2006.09.054},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 3,
volume = 67,
place = {United States},
year = {Thu Mar 01 00:00:00 EST 2007},
month = {Thu Mar 01 00:00:00 EST 2007}
}