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Determination of internal target volume for radiation treatment planning of esophageal cancer by using 4-dimensional computed tomography (4DCT).
[esophageal carcinoma]
To
determine
an
efficient
strategy
for
the
generation
of
the
internal
target
volume
(
ITV
)
for
radiation
treatment
planning
for
esophageal
cancer
using
4
-
dimensional
computed
tomography
(
4
DCT
)
.
4
DCT
sets
acquired
for
20
patients
with
esophageal
carcinoma
were
analyzed
.
Each
of
the
4
DCT
sets
was
binned
into
10
respiratory
phases
.
For
each
patient
,
the
gross
tumor
volume
(
GTV
)
was
delineated
on
the
4
DCT
set
at
each
phase
.
Various
strategies
to
derive
ITV
were
explored
,
including
the
volume
from
the
maximum
intensity
projection
(
MIP
;
ITV
_
MIP
)
,
unions
of
the
GTVs
from
selected
multiple
phases
ITV
2
(
0
%
and
50
%
phases
)
,
ITV
3
(
ITV
2
plus
80
%
)
,
and
ITV
4
(
ITV
3
plus
60
%
)
,
as
well
as
the
volumes
expanded
from
ITV
2
and
ITV
3
with
a
uniform
margin
.
These
ITVs
were
compared
to
ITV
10
(
the
union
of
the
GTVs
for
all
10
phases
)
and
the
differences
were
measured
with
the
overlap
ratio
(
OR
)
and
relative
volume
ratio
(
RVR
)
relative
to
ITV
10
(
ITVx
/
ITV
10
)
.
For
all
patients
studied
,
the
average
GTV
from
a
single
phase
was
84
.
9
%
of
ITV
10
.
The
average
ORs
were
91
.
2
%
,
91
.
3
%
,
94
.
5
%
,
and
96
.
4
%
for
ITV
_
MIP
,
ITV
2
,
ITV
3
,
and
ITV
4
,
respectively
.
Low
ORs
were
associated
with
irregular
breathing
patterns
.
ITV
3
s
plus
1
mm
uniform
margins
(
ITV
3
+
1
)
led
to
an
average
OR
of
98
.
1
%
and
an
average
RVR
of
106
.
4
%
.
The
ITV
generated
directly
from
MIP
underestimates
the
range
of
the
respiration
motion
for
esophageal
cancer
.
The
ITV
generated
from
3
phases
(
ITV
3
)
may
be
used
for
regular
breathers
,
whereas
the
ITV
generated
from
4
phases
(
ITV
4
)
or
ITV
3
plus
a
1
-
mm
uniform
margin
may
be
applied
for
irregular
breathers
.
Diseases
Validation
Diseases presenting
"relative volume ratio"
symptom
esophageal carcinoma
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