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Medical Physics / Volume 38 / Issue 7 / RADIATION THERAPY PHYSICS

Med. Phys. 38, 3971 (2011); http://dx.doi.org/10.1118/1.3598434 (10 pages)

Management of the baseline shift using a new and simple method for respiratory-gated radiation therapy: Detectability and effectiveness of a flexible monitoring system

Hidenobu Tachibana, Nozomi Kitamura, Yasushi Ito, Daisuke Kawai, and Masaru Nakajima

Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation of Cancer Research, Tokyo 1358550, Japan

Akihisa Tsuda

Department of Nuclear Engineering and Management, Graduate School of Engineering, University of Tokyo, Tokyo 1130032, Japan

Hisao Shiizuka

Department of Information Design, Kogakuin University, Tokyo 1638677, Japan

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(Received 11 March 2011; accepted 17 May 2011; revised 17 May 2011; published online 17 June 2011)

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Purpose: In respiratory-gated radiation therapy, a baseline shift decreases the accuracy of target coverage and organs at risk (OAR) sparing. The effectiveness of audio-feedback and audio-visual feedback in correcting the baseline shift in the breathing pattern of the patient has been demonstrated previously. However, the baseline shift derived from the intrafraction motion of the patient’s body cannot be corrected by these methods. In the present study, the authors designed and developed a simple and flexible system.Methods: The system consisted of a web camera and a computer running our in-house software. The in-house software was adapted to template matching and also to no preimage processing. The system was capable of monitoring the baseline shift in the intrafraction motion of the patient’s body. Another marker box was used to monitor the baseline shift due to the flexible setups required of a marker box for gated signals. The system accuracy was evaluated by employing a respiratory motion phantom and was found to be within AAPM Task Group 142 tolerance (positional accuracy <2 mm and temporal accuracy <100 ms) for respiratory-gated radiation therapy. Additionally, the effectiveness of this flexible and independent system in gated treatment was investigated in healthy volunteers, in terms of the results from the differences in the baseline shift detectable between the marker positions, which the authors evaluated statistically.Results: The movement of the marker on the sternum [1.599 ± 0.622 mm (1 SD)] was substantially decreased as compared with the abdomen [6.547 ± 0.962 mm (1 SD)]. Additionally, in all of the volunteers, the baseline shifts for the sternum [−0.136 ± 0.868 (2 SD)] were in better agreement with the nominal baseline shifts than was the case for the abdomen [−0.722 ± 1.56 mm (2 SD)]. The baseline shifts could be accurately measured and detected using the monitoring system, which could acquire the movement of the marker on the sternum. The baseline shift-monitoring system with the displacement-based methods for highly accurate respiratory-gated treatments should be used to make most of the displacement-based gating methods.Conclusions: The advent of intensity modulated radiation therapy and volumetric modulated radiation therapy facilitates margin reduction for the planning target volumes and the OARs, but highly accurate irradiation is needed to achieve target coverage and OAR sparing with a small margin. The baseline shifts can affect treatment not only with the respiratory gating system but also without the system. Our system can manage the baseline shift and also enables treatment irradiation to be undertaken with high accuracy.

© 2011 American Association of Physicists in Medicine

ACKNOWLEDGMENTS

The authors wish to thank all co-workers at The Cancer Institute Hospital of JFCR. Special thanks go to Yuko Ohtomo and Shinichi Yoshino for their help, as well as to Keiko Murofushi and Takuyo Kozuka for fruitful discussions. Furthermore, they are grateful to Yasushi Ito, Shinichi Yoshino, Taro Takahashi, Hiroshi Ito, Minoru Yoshioka, and Tomoharu Sato, for acting as volunteers in this study.

Article Outline

  1. INTRODUCTION
  2. METHODS AND MATERIALS
    1. Design of the baseline shift-monitoring system
    2. Evaluation of the accuracy of our system in measuring the baseline shift in a respiratory motion phantom
    3. Statistical analysis of the differences in baseline shift detectability using the markers in two different positions in volunteers
  3. RESULTS
    1. Evaluation of the accuracy of our system in measuring respiratory motion using the phantom
    2. Statistical analysis of the differences in the baseline shift detectability using the markers in two different positions in volunteers
  4. DISCUSSION
  5. CONCLUSION
Digital Object Identifier
http://dx.doi.org/10.1118/1.3598434

KEYWORDS and PACS

Keywords

patient monitoring, phantoms, pneumodynamics, radiation therapy, respiratory gated treatment, intrafractional patient motion, baseline shifts, template matching

PACS

PUBLICATION DATA

ISSN

0094-2405 (print)  

Publisher

$abstract.society.value is a Member of CrossRef American Association of Physicists in Medicine

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Medical Physics is an official science journal of the AAPM and of the COMP/CCPM/IOMP
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Departments of Radiology, Radiation Oncology, Biophysics, Community and Public Health, Medical College of Wisconsin
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