Comparison of pancreatic respiratory motion management with three abdominal corsets for particle radiation therapy: Case study

• Published in: Journal of applied clinical medical physics Vol. 20; no. 6; pp. 111 - 119
• Main Authors: Dolde, Kai, Schneider, Sergej, Stefanowicz, Sarah, Alimusaj, Merkur, Flügel, Beate, Saito, Nami, Troost, Esther G. C., Pfaffenberger, Asja, Hoffmann, Aswin L.
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.06.2019; John Wiley and Sons Inc
• Subjects: 4D‐MRI; Abdomen; Abdomen - diagnostic imaging; Abdomen - pathology; abdominal corset; Adenocarcinoma - diagnostic imaging; Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Cooperation; Customization; Fasteners; Female; Four-Dimensional Computed Tomography; Humans; image‐guided radiotherapy; Magnetic Resonance Imaging - methods; Male; Manufacturing; motion management; Movement; NMR; Nuclear magnetic resonance; Pancreas - diagnostic imaging; Pancreas - radiation effects; Pancreatic cancer; Pancreatic Neoplasms - diagnostic imaging; Pancreatic Neoplasms - pathology; Pancreatic Neoplasms - radiotherapy; particle therapy; Patients; Polyethylene; Radiation Oncology Physics; Radiation therapy; Respiration; Respiratory-Gated Imaging Techniques - methods; Tumors; Germany; abdominal corset; 4D-MRI; pancreatic cancer; particle therapy; motion management; image-guided radiotherapy
• ISSN: 1526-9914; 1526-9914
• DOI: 10.1002/acm2.12613

Background and purpose Abdominal organ motion seriously compromises the targeting accuracy for particle therapy in patients with pancreatic adenocarcinoma. This study compares three different abdominal corsets regarding their ability to reduce pancreatic motion and their potential usability in particle therapy. Materials and methods A patient‐individualized polyurethane (PU), a semi‐individualized polyethylene (PE), and a patient‐individualized three‐dimensional‐scan based polyethylene (3D‐PE) corset were manufactured for one healthy volunteer. Time‐resolved volumetric four‐dimensional‐magnetic resonance imaging (4D‐MRI) and single‐slice two‐dimensional (2D) cine‐MRI scans were acquired on two consecutive days to compare free‐breathing motion patterns with and without corsets. The corset material properties, such as thickness variance, material homogeneity in Hounsfield units (HU) on computed tomography (CT) scans, and manufacturing features were compared. The water equivalent ratio (WER) of corset material samples was measured using a multi‐layer ionization chamber for proton energies of 150 and 200 MeV. Results All corsets reduced the pancreatic motion on average by 9.6 mm in inferior–superior and by 3.2 mm in anterior‐posterior direction. With corset, the breathing frequency was approximately doubled and the day‐to‐day motion variations were reduced. The WER measurements showed an average value of 0.993 and 0.956 for the PE and 3DPE corset, respectively, and of 0.298 for the PU corset. The PE and 3DPE corsets showed a constant thickness of 2.8 ± 0.2 and 3.8 ± 0.2 mm, respectively and a homogeneous material composition with a standard deviation (SD) of 31 and 32 HU, respectively. The PU corset showed a variable thickness of 4.2 − 25.6 mm and a heterogeneous structure with air inclusions with an SD of 113 HU. Conclusion Abdominal corsets may be effective devices to reduce pancreatic motion. For particle therapy, PE‐based corsets are preferred over PU‐based corset due to their material homogeneity and constant thickness.