Intrafractional gastric motion and interfractional stomach deformity using CT images

To evaluate the intra- and interfractional gastric motion using repeated CT scans, six consecutive patients with gastric lymphoma treated at our institution between 2006 and 2008 were included in this study. We performed a simulation and delivered RT before lunch after an overnight fast to minimize the stomach volume. These patients underwent repeated CT scanning at mild inhale and exhale before their course of treatment. The repeated CT scans were matched on bony anatomy to the planning scan. The center of stomach was determined in the X (lateral), Y (superior-inferior), and Z (ventro-dorsal) coordinate system to evaluate the intra- and interfractional motion of the stomach on each CT scan. We then calculated the treatment margins. Each patient was evaluated four to five times before their course of RT. The average intrafractional motions were -12.1, 2.4 and 4.6 mm for the superior-inferior (SI), lateral (LAT), and ventro-dorsal (VD) direction. The average interfractional motions of the center of the stomach were -4.1, 1.9 and 1.5 mm for the SI, LAT and VD direction. The average of the vector length was 13.0 mm. The systematic and random errors in SI direction were 5.1, and 4.6 mm, respectively. The corresponding figures in LAT and VD directions were 10.9, 5.4, 10.0, and 6.5 mm, respectively. Thus, the 15.9, 31.0 and 29.6 mm of margins are required for the SI, LAT, and VD directions, respectively. We have demonstrated not only intrafractional stomach motion, but also interfractional motion is considerable.