Estimating uncertainties of the geometrical range of particle radiotherapy during respiration

Purpose: To propose a method for estimating uncertainties of the range calculation in particle radiotherapy associated with patient respiration. Methods and Materials: A set of sequential CT images at every 0.2 s was reconstructed from continuous X-ray projection data accumulated by dynamic helical scanning. At the same time that CT data was acquired, the respiratory signal of the patient and the X-ray on/off signal on CT scanner were recorded. Each CT image was timed according to the phase of respiration waveform. Conversion of the CT number to the water equivalent path length (WEL) was performed with our treatment planning system that included a conversion table. As an illustration, the CT images of a patient with liver cancer at the right upper lobe were analyzed. The geometric size of the liver and WELs from body surface to isocenter were measured in each CT image. Results: Variations of WEL from body surface to isocenter at the anterior-posterior and posterior-anterior direction were 6.2 mm and 18.9 mm, respectively. Liver size changed by 35.2 mm. However, these variations were shown to be considerably reduced by gated irradiation. Conclusion: A method using sequential CT images with respiration waveform was proposed. It appeared to be useful in evaluating the uncertainties of the range calculation associated with patient breathing. (C) 2003 Elsevier Inc.