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

Abstract

Aim and background

IGRT 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 methods

Intrafractional 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.

Results

The mean[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]SD (standard deviation) of the intra-fraction diaphragm position variation in the frontal kV images was 1.0[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]0.7[[ce:hsp sp="0.25"/]]mm in the C-C direction. The inter-fractional diaphragm changes were 0.4[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]4.6[[ce:hsp sp="0.25"/]]mm in the C-C direction, 1.4[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]2.2[[ce:hsp sp="0.25"/]]mm in the A-P direction, and −0.6[[ce:hsp sp="0.25"/]]±[[ce:hsp sp="0.25"/]]1.8[[ce:hsp sp="0.25"/]]mm 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.

Conclusions

Residual 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.