Four-dimensional computed tomographic analysis of esophageal mobility during normal respiration

Edith M.T. Dieleman, Suresh Senan, Andrew Vincent, Frank J. Lagerwaard, Ben J. Slotman, John R. van Sörnsen de Koste

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Background: Chemo-radiotherapy for thoracic tumors can result in high-grade radiation esophagitis. Treatment planning to reduce esophageal irradiation requires organ motion to be accounted for. In this study, esophageal mobility was assessed using four-dimensional computed tomography (4DCT). Methods and Materials: Thoracic 4DCT scans were acquired on a 16-slice CT scanner in 29 patients. The outer esophageal wall was contoured in two extreme phases of respiration in 9 patients with nonesophageal malignancies. The displacement of the center of contour was measured at 2-cm intervals. In 20 additional patients with Stage I lung cancer, the esophagus was contoured in all 10 phases of each 4DCT at five defined anatomic levels. Both approaches were then applied to 4DCT scans of 4 patients who each had two repeat scans performed. A linear mixed effects model was constructed with fixed effects: measurement direction, measurement type, and measurement location along the cranio-caudal axis. Results: Measurement location and direction were significant descriptive parameters (Wald F-tests, p < 0.001), and the interaction term between the two was significant (p = 0.02). Medio-lateral mobility exceeded dorso-ventral mobility in the lower half of the esophagus but was of a similar magnitude in the upper half. Margins that would have incorporated all movement in medio-lateral and dorso-ventral directions were 5 mm proximally, 7 mm and 6 mm respectively in the mid-esophagus, and 9 mm and 8 mm respectively in the distal esophagus. Conclusions: The distal esophagus shows more mobility. Margins for mobility that can encompass all movement were derived for use in treatment planning, particularly for stereotactic radiotherapy.

LanguageEnglish
Pages775-780
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume67
Issue number3
DOIs
Publication statusPublished - 1 Mar 2007
Externally publishedYes

Keywords

  • Esophagus
  • Four-dimensional computed tomography
  • Margins
  • Mobility
  • Radiation toxicity

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Dieleman, Edith M.T. ; Senan, Suresh ; Vincent, Andrew ; Lagerwaard, Frank J. ; Slotman, Ben J. ; van Sörnsen de Koste, John R. / Four-dimensional computed tomographic analysis of esophageal mobility during normal respiration. In: International Journal of Radiation Oncology Biology Physics. 2007 ; Vol. 67, No. 3. pp. 775-780.
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Four-dimensional computed tomographic analysis of esophageal mobility during normal respiration. / Dieleman, Edith M.T.; Senan, Suresh; Vincent, Andrew; Lagerwaard, Frank J.; Slotman, Ben J.; van Sörnsen de Koste, John R.

In: International Journal of Radiation Oncology Biology Physics, Vol. 67, No. 3, 01.03.2007, p. 775-780.

Research output: Contribution to journalArticle

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AU - Senan, Suresh

AU - Vincent, Andrew

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AU - Slotman, Ben J.

AU - van Sörnsen de Koste, John R.

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