Cumulative Lung Dose for Several Motion Management Strategies as a Function of Pretreatment Patient Parameters

Geoffrey D. Hugo, Jonathon Campbell, Tiezhi Zhang, Di Yan

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Purpose: To evaluate patient parameters that may predict for relative differences in cumulative four-dimensional (4D) lung dose among several motion management strategies. Methods and Materials: Deformable image registration and dose accumulation were used to generate 4D treatment plans for 18 patients with 4D computed tomography scans. Three plans were generated to simulate breath hold at normal inspiration, target tracking with the beam aperture, and mid-ventilation aperture (control of the target at the mean daily position and application of an iteratively computed margin to compensate for respiration). The relative reduction in mean lung dose (MLD) between breath hold and mid-ventilation aperture (ΔMLDBH) and between target tracking and mid-ventilation aperture (ΔMLDTT) was calculated. Associations between these two variables and parameters of the lesion (excursion, size, location, and deformation) and dose distribution (local dose gradient near the target) were also calculated. Results: The largest absolute and percentage differences in MLD were 1.0 Gy and 21.5% between breath hold and mid-ventilation aperture. ΔMLDBH was significantly associated (p < 0.05) with tumor excursion. The ΔMLDTT was significantly associated with excursion, deformation, and local dose gradient. A linear model was constructed to represent ΔMLD vs. excursion. For each 5 mm of excursion, target tracking reduced the MLD by 4% compared with the results of a mid-ventilation aperture plan. For breath hold, the reduction was 5% per 5 mm of excursion. Conclusions: The relative difference in MLD among different motion management strategies varied with patient and tumor characteristics for a given dosimetric target coverage. Tumor excursion is useful to aid in stratifying patients according to appropriate motion management strategies.

Original languageEnglish
Pages (from-to)593-601
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Issue number2
StatePublished - Jun 1 2009


  • 4D radiotherapy
  • 4DCT
  • Lung cancer
  • Respiratory motion


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