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Title: Intensity modulation with respiratory gating for radiotherapy of the pleural space

Abstract

We wanted to describe a technique for the implementation of intensity-modulated radiotherapy (IMRT) with a real-time position monitor (RPM) respiratory gating system for the treatment of pleural space with intact lung. The technique is illustrated by a case of pediatric osteosarcoma, metastatic to the pleura of the right lung. The patient was simulated in the supine position where a breathing tracer and computed tomography (CT) scans synchronized at end expiration were acquired using the RPM system. The gated CT images were used to define target volumes and critical structures. Right pleural gated IMRT delivered at end expiration was prescribed to a dose of 44 Gy, with 55 Gy delivered to areas of higher risk via simultaneous integrated boost (SIB) technique. IMRT was necessary to avoid exceeding the tolerance of intact lung. Although very good coverage of the target volume was achieved with a shell-shaped dose distribution, dose over the targets was relatively inhomogeneous. Portions of target volumes necessarily intruded into the right lung, the liver, and right kidney, limiting the degree of normal tissue sparing that could be achieved. The radiation doses to critical structures were acceptable and well tolerated. With intact lung, delivering a relatively high dose to themore » pleura with acceptable doses to surrounding normal tissues using respiratory gated pleural IMRT is feasible. Treatment delivery during a limited part of the respiratory cycle allows for reduced CT target volume motion errors, with reduction in the portion of the planning margin that accounts for respiratory motion, and subsequent increase in the therapeutic ratio.« less

Authors:
 [1];  [1];  [1];  [1];  [1];  [2]
  1. Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL (United States)
  2. Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, AL (United States). E-mail: suzrusso@msn.com
Publication Date:
OSTI Identifier:
20975197
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Dosimetry; Journal Volume: 32; Journal Issue: 1; Other Information: DOI: 10.1016/j.meddos.2006.10.002; PII: S0958-3947(06)00151-8; Copyright (c) 2007 Elsevier Science B.V., Amsterdam, The 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; COMPUTERIZED TOMOGRAPHY; ERRORS; HEALTH HAZARDS; KIDNEYS; LIVER; LUNGS; METASTASES; MODULATION; OSTEOSARCOMAS; PATIENTS; PEDIATRICS; PLANNING; PLEURA; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Ahmed, Raef S., Shen, Sui, Ove, Roger, Duan, Jun, Fiveash, John B., and Russo, Suzanne M. Intensity modulation with respiratory gating for radiotherapy of the pleural space. United States: N. p., 2007. Web. doi:10.1016/j.meddos.2006.10.002.
Ahmed, Raef S., Shen, Sui, Ove, Roger, Duan, Jun, Fiveash, John B., & Russo, Suzanne M. Intensity modulation with respiratory gating for radiotherapy of the pleural space. United States. doi:10.1016/j.meddos.2006.10.002.
Ahmed, Raef S., Shen, Sui, Ove, Roger, Duan, Jun, Fiveash, John B., and Russo, Suzanne M. Sun . "Intensity modulation with respiratory gating for radiotherapy of the pleural space". United States. doi:10.1016/j.meddos.2006.10.002.
@article{osti_20975197,
title = {Intensity modulation with respiratory gating for radiotherapy of the pleural space},
author = {Ahmed, Raef S. and Shen, Sui and Ove, Roger and Duan, Jun and Fiveash, John B. and Russo, Suzanne M.},
abstractNote = {We wanted to describe a technique for the implementation of intensity-modulated radiotherapy (IMRT) with a real-time position monitor (RPM) respiratory gating system for the treatment of pleural space with intact lung. The technique is illustrated by a case of pediatric osteosarcoma, metastatic to the pleura of the right lung. The patient was simulated in the supine position where a breathing tracer and computed tomography (CT) scans synchronized at end expiration were acquired using the RPM system. The gated CT images were used to define target volumes and critical structures. Right pleural gated IMRT delivered at end expiration was prescribed to a dose of 44 Gy, with 55 Gy delivered to areas of higher risk via simultaneous integrated boost (SIB) technique. IMRT was necessary to avoid exceeding the tolerance of intact lung. Although very good coverage of the target volume was achieved with a shell-shaped dose distribution, dose over the targets was relatively inhomogeneous. Portions of target volumes necessarily intruded into the right lung, the liver, and right kidney, limiting the degree of normal tissue sparing that could be achieved. The radiation doses to critical structures were acceptable and well tolerated. With intact lung, delivering a relatively high dose to the pleura with acceptable doses to surrounding normal tissues using respiratory gated pleural IMRT is feasible. Treatment delivery during a limited part of the respiratory cycle allows for reduced CT target volume motion errors, with reduction in the portion of the planning margin that accounts for respiratory motion, and subsequent increase in the therapeutic ratio.},
doi = {10.1016/j.meddos.2006.10.002},
journal = {Medical Dosimetry},
number = 1,
volume = 32,
place = {United States},
year = {Sun Apr 01 00:00:00 EDT 2007},
month = {Sun Apr 01 00:00:00 EDT 2007}
}