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Intrafraction variability and deformation quantification in the breast.

Carri K Glide-Hurst1, Mira M Shah1, Ryan G Price2

  • 1Department of Radiation Oncology, Henry Ford Health Systems, Detroit, Michigan.

International Journal of Radiation Oncology, Biology, Physics
|February 15, 2015
PubMed
Summary
This summary is machine-generated.

Intrafraction motion and deformation of the lumpectomy cavity (LC) and breast vary significantly. A 4-dimensional CT (4DCT) approach for planning target volumes (PTVs) offers patient-specific margins, improving accuracy over free-breathing CT (FBCT).

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Area of Science:

  • Radiotherapy Physics
  • Medical Imaging
  • Oncology

Background:

  • Accurate radiation therapy planning for breast cancer requires precise definition of the lumpectomy cavity (LC) and surrounding tissues.
  • Intrafraction motion and deformation can significantly impact treatment accuracy, necessitating advanced imaging techniques.

Purpose of the Study:

  • To quantify intrafraction variability and deformation of the lumpectomy cavity (LC), breast, and adjacent organs during free-breathing.
  • To compare the accuracy of planning target volumes (PTVs) generated using free-breathing CT (FBCT) versus 4-dimensional CT (4DCT).

Main Methods:

  • Utilized 4-dimensional CT (4DCT) and free-breathing CT (FBCT) on 17 post-lumpectomy breast cancer patients.
  • Employed deformable image registration to analyze deformation of the breast, LC, heart, and lungs between respiratory phases.
  • Compared PTVs derived from FBCT (PTV(FBCT)) with an isotropic 10 mm expansion to PTVs derived from 4DCT (PTV(4DCT)) with a 5 mm margin.

Main Results:

  • Observed significant 3D vector excursions for the LC (2.5 ± 1.0 mm) and ipsilateral breast (2.0 ± 0.8 mm).
  • PTV(FBCT) was substantially larger (51.5%) than PTV(4DCT), with significant differences in all lateral, anterior-posterior, and superior-inferior dimensions.
  • Found significant correlations between breast and cavity deformation but no dependency on proximity to the chest wall or breast surface.

Conclusions:

  • Lumpectomy cavity and breast motion exhibit considerable intrafraction variability.
  • A 4DCT-based PTV approach provides more accurate, patient-specific margins compared to FBCT, especially when combined with robust interfraction setup analysis.