Quantifying intra and inter-fractional motion in breast radiotherapy

Jones, Scott, Fitzgerald, Rhys, Owen, Rebecca and Ramsay, Jonathan (2015) Quantifying intra and inter-fractional motion in breast radiotherapy. Journal of Medical Radiation Sciences, 62 1: 40-46. doi:10.1002/jmrs.61

Author Jones, Scott
Fitzgerald, Rhys
Owen, Rebecca
Ramsay, Jonathan
Title Quantifying intra and inter-fractional motion in breast radiotherapy
Journal name Journal of Medical Radiation Sciences   Check publisher's open access policy
ISSN 2051-3909
Publication date 2015-03-01
Year available 2014
Sub-type Article (original research)
DOI 10.1002/jmrs.61
Open Access Status DOI
Volume 62
Issue 1
Start page 40
End page 46
Total pages 7
Place of publication Philadelphia, United States
Publisher Elsevier
Language eng
Formatted abstract
Introduction: The magnitude of intra- and inter-fractional variation in the set up of breast cancer patients treated with tangential megavoltage photon beams was investigated using an electronic portal imaging device (EPID).

Methods: Daily cine-EPID images were captured during delivery of the tangential fields for ten breast cancer patients treated in the supine position. Measurements collected from each image included the central lung distance (CLD), central flash distance (CFD), superior axial measurement (SAM) and the inferior axial measurement (IAM). The variation of motion within a fraction (intra-fraction) and the variation between fractions (inter-fraction) was analysed to quantify set up variation and motion due to respiration.

Results: Altogether 3775 EPID images were collected from 10 patients. The effect of respiratory motion during treatment was <0.1 cm standard deviation (SD) in the anterior-posterior (AP) direction. The inter-fraction movement caused by variations in daily set up was larger at 0.28 cm SD in the AP direction. Superior-inferior (SI) variation was more difficult to summarise and proved unreliable as the measurements were taken to an ambiguous point on the images. It was difficult to discern true SI movement from that implicated by AP movement.

Conclusion: There is minimal intra-fractional chest wall motion due to respiration during treatment. Inter-fractional variation was larger, however, on average it remained within departmental tolerance (0.5 cm) for set up variations. This review of our current breast technique provides confidence in the feasibility of utilising advanced treatment techniques (field-in-field, intensity modulated radiotherapy or volumetric modulated arc therapy) following a review of the current imaging protocol.
Keyword Breast cancer
Radiotherapy set up errors
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 3 times in Thomson Reuters Web of Science Article | Citations
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Created: Wed, 13 Jan 2016, 21:50:41 EST by Jonathan Ramsay on behalf of Medicine - Princess Alexandra Hospital