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Title: Respiration Induced Heart Motion and Indications of Gated Delivery for Left-Sided Breast Irradiation

Abstract

Purpose: To investigate respiration-induced heart motion for left-sided breast irradiation using a four-dimensional computed tomography (4DCT) technique and to determine novel indications to assess heart motion and identify breast patients who may benefit from a gated treatment. Methods and Materials: Images of 4DCT acquired during free breathing for 20 left-sided breast cancer patients, who underwent whole breast irradiation with or without regional nodal irradiation, were analyzed retrospectively. Dose distributions were reconstructed in the phases of 0%, 20%, and 50%. The intrafractional heart displacement was measured in three selected transverse CT slices using D{sub LAD} (the distance from left ascending aorta to a fixed line [connecting middle point of sternum and the body] drawn on each slice) and maximum heart depth (MHD, the distance of the forefront of the heart to the line). Linear regression analysis was used to correlate these indices with mean heart dose and heart dose volume at different breathing phases. Results: Respiration-induced heart displacement resulted in observable variations in dose delivered to the heart. During a normal free-breathing cycle, heart-induced motion D{sub LAD} and MHD changed up to 9 and 11 mm respectively, resulting in up to 38% and 39% increases of mean doses and V{sub 25.2}more » for the heart. MHD and D{sub LAD} were positively correlated with mean heart dose and heart dose volume. Respiratory-adapted gated treatment may better spare heart and ipsilateral-lung compared with the conventional non-gated plan in a subset of patients with large D{sub LAD} or MHD variations. Conclusion: Proposed indices offer novel assessment of heart displacement based on 4DCT images. MHD and D{sub LAD} can be used independently or jointly as selection criteria for respiratory gating procedure before treatment planning. Patients with great intrafractional MHD variations or tumor(s) close to the diaphragm may particularly benefit from the gated treatment.« less

Authors:
 [1];  [1];  [2];  [1]; ; ; ;  [2]
  1. Department of Radiation Oncology, University of Colorado Denver, Aurora, CO (United States)
  2. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)
Publication Date:
OSTI Identifier:
22056203
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 82; Journal Issue: 5; Other Information: Copyright (c) 2012 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; AORTA; COMPUTERIZED TOMOGRAPHY; DIAPHRAGM; HEART; IRRADIATION; LUNGS; MAMMARY GLANDS; NEOPLASMS; PATIENTS; PLANNING; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; REGRESSION ANALYSIS; RESPIRATION

Citation Formats

Qi, X. Sharon, E-mail: xiangrong.qi@ucdenver.edu, Hu, Angela, Wang Kai, Newman, Francis, Crosby, Marcus, Hu Bin, White, Julia, and Li, X. Allen. Respiration Induced Heart Motion and Indications of Gated Delivery for Left-Sided Breast Irradiation. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2011.01.042.
Qi, X. Sharon, E-mail: xiangrong.qi@ucdenver.edu, Hu, Angela, Wang Kai, Newman, Francis, Crosby, Marcus, Hu Bin, White, Julia, & Li, X. Allen. Respiration Induced Heart Motion and Indications of Gated Delivery for Left-Sided Breast Irradiation. United States. doi:10.1016/J.IJROBP.2011.01.042.
Qi, X. Sharon, E-mail: xiangrong.qi@ucdenver.edu, Hu, Angela, Wang Kai, Newman, Francis, Crosby, Marcus, Hu Bin, White, Julia, and Li, X. Allen. Sun . "Respiration Induced Heart Motion and Indications of Gated Delivery for Left-Sided Breast Irradiation". United States. doi:10.1016/J.IJROBP.2011.01.042.
@article{osti_22056203,
title = {Respiration Induced Heart Motion and Indications of Gated Delivery for Left-Sided Breast Irradiation},
author = {Qi, X. Sharon, E-mail: xiangrong.qi@ucdenver.edu and Hu, Angela and Wang Kai and Newman, Francis and Crosby, Marcus and Hu Bin and White, Julia and Li, X. Allen},
abstractNote = {Purpose: To investigate respiration-induced heart motion for left-sided breast irradiation using a four-dimensional computed tomography (4DCT) technique and to determine novel indications to assess heart motion and identify breast patients who may benefit from a gated treatment. Methods and Materials: Images of 4DCT acquired during free breathing for 20 left-sided breast cancer patients, who underwent whole breast irradiation with or without regional nodal irradiation, were analyzed retrospectively. Dose distributions were reconstructed in the phases of 0%, 20%, and 50%. The intrafractional heart displacement was measured in three selected transverse CT slices using D{sub LAD} (the distance from left ascending aorta to a fixed line [connecting middle point of sternum and the body] drawn on each slice) and maximum heart depth (MHD, the distance of the forefront of the heart to the line). Linear regression analysis was used to correlate these indices with mean heart dose and heart dose volume at different breathing phases. Results: Respiration-induced heart displacement resulted in observable variations in dose delivered to the heart. During a normal free-breathing cycle, heart-induced motion D{sub LAD} and MHD changed up to 9 and 11 mm respectively, resulting in up to 38% and 39% increases of mean doses and V{sub 25.2} for the heart. MHD and D{sub LAD} were positively correlated with mean heart dose and heart dose volume. Respiratory-adapted gated treatment may better spare heart and ipsilateral-lung compared with the conventional non-gated plan in a subset of patients with large D{sub LAD} or MHD variations. Conclusion: Proposed indices offer novel assessment of heart displacement based on 4DCT images. MHD and D{sub LAD} can be used independently or jointly as selection criteria for respiratory gating procedure before treatment planning. Patients with great intrafractional MHD variations or tumor(s) close to the diaphragm may particularly benefit from the gated treatment.},
doi = {10.1016/J.IJROBP.2011.01.042},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 5,
volume = 82,
place = {United States},
year = {Sun Apr 01 00:00:00 EDT 2012},
month = {Sun Apr 01 00:00:00 EDT 2012}
}