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J Korean Soc Ther Radiol Oncol > Volume 22(1); 2004 > Article
The Journal of the Korean Society for Therapeutic Radiology and Oncology 2004;22(1): 55-63.
Impact of the Planning CT Scan Time on the Reflection of the Lung Tumor Motion
Su Ssan Kim, Sung Whan Ha, Eun Kyung Choi, Byong Yong Yi
1Department of Radiation Oncology, Asan Medical Center, College of Medicine, University of Ulsan, Korea. yiby@amc.seoul.kr
2Department of Therapeutic Radiology, Seoul National University College of Medicine, Korea.
To evaluate the reflection of tumor motion according to the planning CT scan time. MATERIAL AND
A model of N-shape, which moved along the longitudinal axis during the ventilation caused by a mechanical ventilator, was produced. The model was scanned by planning CT, while setting the relative CT scan time (T; CT scan time/ventilatory period) to 0.33, 0.50, 0.67, 0.75, 1.00, 1.33 T, and 1.53 T. In addition, three patients with non-small cell lung cancer who received stereotactic radiosurgery in the Department of Radiation Oncology, Asan Medical Center from 03/19/2002 to 05/21/2002 were scanned. Slow (IQ Premier, Picker, scan time 2.0 seconds per slice) and fast CT scans (LightSpeed, GE Medical Systems, with a scan time of 0.8 second per slice) were performed for each patient. The magnitude of reflected movement of the N-shaped model was evaluated by measuring the transverse length, which reflected the movement of the declined bar of the model at each slice. For patients' scans, all CT data sets were registered using a stereotactic body frame scale with the gross tumor volumes delineated in one CT image set. The volume and three-dimensional diameter of the gross tumor volume were measured and analyzed between the slow and fast CT scans.
The reflection degree of longitudinal movement of the model increased in proportion to the relative CT scan times below 1.00 T, but remained constant above 1.00 T. Assuming the mean value of scanned transverse lengths with CT scan time 1.00 T to be 100%, CT scans with scan times of 0.33, 0.50, 0.67, and 0.75 T missed the tumor motion by 30, 27, 20, and 7.0% respectively. Slow (scan time 2.0 sec) and Fast (scan time 0.8 sec) CT scans of three patients with longitudinal movement of 3, 5, and 10 mm measured by fluoroscopy revealed the increases in the diameter along the longitudinal axis increased by 6.3, 17, and 23% in the slow CT scans.
As the relative CT scan time increased, the reflection of the respiratory tumor movement on planning CT also increased, but remained constant with relative CT scan times above 1.00 T. When setting the planning CT scan time above one respiration period (>1.00 T), only the set-up margin is needed to delineate the planning target volume. Therefore, therapeutic ratio can be increased by reducing the radiation dose delivered to normal lung tissue.
Key Words: CT scan time, Lung neoplasms, Radiation therapy, Planning target volume
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