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dc.contributor.authorDing, Yijun
dc.contributor.authorBarrett, Harrison H
dc.contributor.authorKupinski, Matthew A
dc.contributor.authorVinogradskiy, Yevgeniy
dc.contributor.authorMiften, Moyed
dc.contributor.authorJones, Bernard L
dc.date.accessioned2019-08-08T17:46:14Z
dc.date.available2019-08-08T17:46:14Z
dc.date.issued2019-07-01
dc.identifier.citationDing, Y. , Barrett, H. H., Kupinski, M. A., Vinogradskiy, Y. , Miften, M. and Jones, B. L. (2019), Objective assessment of the effects of tumor motion in radiation therapy. Med. Phys., 46: 3311-3323. doi:10.1002/mp.13601en_US
dc.identifier.issn0094-2405
dc.identifier.pmid31111961
dc.identifier.doi10.1002/mp.13601
dc.identifier.urihttp://hdl.handle.net/10150/633755
dc.description.abstractPurpose Internal organ motion reduces the accuracy and efficacy of radiation therapy. However, there is a lack of tools to objectively (based on a medical or scientific task) assess the dosimetric consequences of motion, especially on an individual basis. We propose to use therapy operating characteristic (TOC) analysis to quantify the effects of motion on treatment efficacy for individual patients. We demonstrate the application of this tool with pancreatic stereotactic body radiation therapy (SBRT) clinical data and explore the origin of motion sensitivity. Methods The technique is described as follows. (a) Use tumor-motion data measured from patients to calculate the motion-convolved dose of the gross tumor volume (GTV) and the organs at risk (OARs). (b) Calculate tumor control probability (TCP) and normal tissue complication probability (NTCP) from the motion-convolved dose-volume histograms. (c) Construct TOC curves from TCP and NTCP models. (d) Calculate the area under the TOC curve (AUTOC) and use it as a figure of merit for treatment efficacy. We used tumor motion data measured from patients to calculate the relation between AUTOC and motion magnitude for 25 pancreatic SBRT treatment plans. Furthermore, to explore the driving factor of motion sensitivity of a given plan, we compared the dose distribution of motion-sensitive plans and motion-robust plans and studied the dependence of motion sensitivity to motion directions. Results Our technique is able to recognize treatment plans that are sensitive to motion. Under the presence of motion, the treatment efficacy of some plans changes from providing high tumor control and low risks of complications to providing no tumor control and high risks of side effects. Several treatment plans experience falloffs in AUTOC at a smaller magnitude of motion than other plans. In our dataset, a potential indicator of a motion-sensitive treatment plan is that the duodenum is in proximity to the tumor in the SI direction. Conclusions The TOC framework can serve as a tool to quantify the effects of internal organ motion in radiation therapy. With pancreatic SBRT clinical data, we applied this tool to study the change in treatment efficacy induced by motion for individual treatment plans. This framework could potentially be used clinically to understand the effects of motion in an individual patient and to design a patient-specific motion management plan. This framework could also be used in research to evaluate different components of the treatment process, such as motion-management techniques, treatment-planning algorithms, and treatment margins.en_US
dc.description.sponsorshipNIH [K12-CA086913, 5-P41-EB002035, R01-EB000803]; University of Colorado Cancer Center/ACS IRG [57-001-53]; Boettcher Foundation; Varian Medical Systemsen_US
dc.language.isoenen_US
dc.publisherWILEYen_US
dc.rights© 2019 American Association of Physicists in Medicine.en_US
dc.rights.urihttp://rightsstatements.org/vocab/InC/1.0/
dc.subjectNTCPen_US
dc.subjectTCPen_US
dc.subjectTOCen_US
dc.subjecttreatment efficacyen_US
dc.subjecttumor motionen_US
dc.titleObjective assessment of the effects of tumor motion in radiation therapyen_US
dc.typeArticleen_US
dc.contributor.departmentUniv Arizona, Coll Opt Scien_US
dc.contributor.departmentUniv Arizona, Dept Med Imagingen_US
dc.identifier.journalMEDICAL PHYSICSen_US
dc.description.note12 month embargo; published online: 21 May 2019en_US
dc.description.collectioninformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.en_US
dc.eprint.versionFinal accepted manuscripten_US
dc.source.journaltitleMedical physics


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