Diaphragm as an anatomic surrogate for lung tumor motion

TL;DR

This study evaluates the diaphragm's potential as an external surrogate for lung tumor motion during radiotherapy, demonstrating high correlation in most cases but emphasizing the need for patient-specific assessment.

Contribution

It introduces a quantitative analysis of diaphragm-tumor motion correlation, including models that account for phase delays, to improve tumor motion prediction accuracy.

Findings

High correlation (up to 0.98) between diaphragm and tumor motion in most patients.

Prediction errors are approximately 0.8mm on average, with 2.1mm at 95% confidence.

Correlation varies significantly among patients, requiring individual assessment.

Abstract

Lung tumor motion due to respiration poses a challenge in the application of modern three-dimensional conformal radiotherapy. Direct tracking of the lung tumor during radiation therapy is very difficult without implanted fiducial markers. Indirect tracking relies on the correlation of the tumor's motion and the surrogate's motion. The present paper presents an analysis of the correlation between the tumor motion and the diaphragm motion in order to evaluate the potential use of diaphragm as a surrogate for tumor motion. We have analyzed the correlation between diaphragm motion and superior-inferior lung tumor motion in 32 fluoroscopic image sequences from 10 lung cancer patients. A simple linear model and a more complex linear model that accounts for phase delays between the two motions have been used. Results show that the diaphragm is a good surrogate for tumor motion prediction for most patients, resulting in an average correlation factor of 0.94 and 0.98 with each model respectively. The model that accounts for delays leads to an average localization prediction error of 0.8mm and an error at the 95% confidence level of 2.1mm. However, for one patient studied, the correlation is much weaker compared to other patients. This indicates that, before using diaphragm for lung tumor prediction, the correlation should be examined on a patient-by-patient basis.