Prog Med Phys.  2019 Sep;30(3):65-73. 10.14316/pmp.2019.30.3.65.

Dosimetric Effects of Intrafractional Organ Motion in Field-in-Field Technique for Whole-Breast Irradiation

• Hong CS
• Ju SG
• Choi DH
• Han Y
• Huh SJ
• Park W
• Ahn YC
• Kim JS
• Lim DH

• KMID: 2459445
• DOI: http://doi.org/10.14316/pmp.2019.30.3.65

Abstract

PURPOSE
We evaluated the motion-induced dosimetric effects on the field-in-field (FIF) technique for whole-breast irradiation (WBI) using actual patient organ motion data obtained from cine electronic portal imaging device (cine EPID) images during treatment.
MATERIALS AND METHODS
Ten breast cancer patients who received WBI after breast-conserving surgery were selected. The static FIF (SFIF) plan involved the application of two parallel opposing tangential and boost FIFs. To obtain the amplitude of the internal organ motion during treatment, cine EPID images were acquired five times for each patient. The outside contour of the breast (OCB) and chest wall (CW) contour were tracked using in-house motion analysis software. Intrafractional organ motion was analyzed. The dynamic FIF (DFIF) reflecting intrafractional organ motion incorporated into the SFIF plan was calculated and compared with the SFIF in terms of the dose homogeneity index (DHI(90/10)) for the target and Vâ‚‚â‚€ for the ipsilateral lung.
RESULTS
The average motion amplitudes along the X and Y directions were 1.84±1.09 mm and 0.69±0.50 mm for OCB and 1.88±1.07 mm and 1.66±1.49 mm for CW, respectively. The maximum motion amplitudes along the X and Y directions were 5.53 and 2.08 mm for OCB and 5.22 and 6.79 mm for CW, respectively. Significant differences in DHI(90/10) values were observed between SFIF and DFIF (0.94 vs 0.95, P<0.05) in statistical analysis. The average Vâ‚‚â‚€ for the lung in the DFIF was slightly higher than that of the SFIF in statistical analysis (19.21 vs 19.00, P<0.05).
CONCLUSION
Our findings indicate that the FIF technique can form a safe and effective treatment method for WBI. Regular monitoring using cine EPID images can be effective in reducing motion-induced dosimetric errors.

Keyword

Dose variation; Field-in-field technique; Organ motion; Whole-breast irradiation

MeSH Terms

Breast
Breast Neoplasms
Humans
Lung
Mastectomy, Segmental
Methods
Thoracic Wall

Figure

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  Fig. 1 Design of field-in-field (FIF) treatment plan. The FIF plan involves the application of (a) two tangential beams and (b, c) sub-boost fields to compensate for the dose inhomogeneity in the target and reduce the lung dose.

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  Fig. 2 (a) In-house motion analysis software and (b) the result of motion analysis for whole-breast irradiation. Solid-lines (breast skin contour) and dotted (chest wall contour) boxes represent surrogates for organ motion tracking based on a pattern matching algorithm.

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  Fig. 3 Comparison of dose distribution (sagittal view) between the application of (a) a conventional tangential field and (b) a conventional field-in-field (FIF) boost technique. Regions subject to high dosage with the conventional field exhibited a significant reduction with the FIF technique (white arrow) along with significant reduction in the lung dose also (red arrow).

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  Fig. 4 Comparison of dose distribution between (a) static FIF (SFIF) and (b) dynamic FIF (DFIF). A partial dose increase in the lung (red arrow) and dose decrease in the target (white arrow) were observed for the DFIF plan because of organ motion.

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  Fig. 5 An extreme example of dose-volume histogram (DVH) for target volume and lung. The ipsilateral lung dose and target dose increased slightly in dynamic FIF (DFIF, dotted line, applied maximum of the organ motion along -X direction) compared to static FIF (SFIF).

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