방사선의학 웹진

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Abstract
Purpose: We evaluated the correlation between stomach volume change and interfractional baseline shifts of the diaphragm in image-guided radiotherapy (IGRT) for hepatocellular carcinoma (HCC).

Materials and methods: Twenty-four patients with HCC underwent ten fractions of IGRT, and a total of 240 cone beam computed tomography (CBCT) and on-board imager (OBI) kV image sets were acquired. These image sets were retrospectively analyzed. Baseline shifts of the diaphragm relative to bone and stomach volume change ratios were evaluated using four-dimensional simulation CT, kV image, and CBCT images. Associations between baseline shifts and patient physiologic factors were investigated.

Results: The average baseline shift of the diaphragm in the superior-inferior (SI) direction was 1.5 mm (standard deviation 4.6 mm), which was higher than the shift in other directions (0.7, 2.0 mm and 0.9, 2.6 mm in right-left (RL) and anterior-posterior (AP) directions, respectively). Interfractional baseline shifts of the diaphragm in the SI and AP directions were positively correlated with the stomach volume change ratio (Pearson's r: 0.416 and 0.302, p-value: <0.001 and <0.001, respectively).

Conclusions: The interfractional baseline shifts of the diaphragm in the SI and AP directions correlated well with stomach volume changes. Efforts to maintain a constant stomach volume before the simulation and each treatment, such as fasting, may reduce interfractional baseline shifts of liver tumors.

Affiliations

Tae Gyu Kim 1, Ki Mun Kang 2, Byungdo Park 1, Jeehoon Park 1, Yun Gyu Song 3, Kwang Min Kim 4, Sanggoon Shim 4, Kil Jong Yu 4, Hyoun Wook Lee 5
1Department of Radiation Oncology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
2Department of Radiation Oncology and Institute of Health Science, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea.
3Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
4Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.
5Department of Pathology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea.