VOLUMETRIC IMAGING BY MEGAVOLTAGE COMPUTED TOMOGRAPHY FOR ASSESSMENT OF INTERNAL ORGAN MOTION DURING RADIOTHERAPY FOR CERVICAL CANCER

Purpose: To assess the internal organ motion of the cervix and uterus by megavoltage computed tomography (MVCT) during intensity-modulated radiotherapy (IMRT). Methods and Materials: Ten patients with Stage IIB IVA cervical cancer underwent daily MVCT imaging. Internal organ motion was evaluated on 150 pretreatment MVCT images by measuring shifts in their boundaries between the MVCT and kilovoltage (kV) planning CT scan in the anterior, posterior, left and right lateral, and superior and inferior direction. Additional intrafractional patient movement was evaluated on 50 posttreatment MVCT images. Results: Measured cervical motion (mean +/- SD) was 0.4 +/- 10.1 mm in the anterior, 3.0 +/- 6.9 mm in the posterior direction, 3.5 +/- 4.9 mm in the left and 0.2 +/- 4.5 mm in the right lateral direction, 2.2 +/- 8.0 mm in the superior and 0.5 +/- 5.0 mm in the inferior direction. Compared to the cervix, larger uterine motion was observed. Patient movement during treatment was limited to 1.1 +/- 1.3 mm, 0.3 +/- 1.6 mm, and 0.2 +/- 2.3 mm in anteroposterior, laterolateral and superoinferior direction respectively. Conclusions: MVCT imaging can be used to study patient setup accuracy and cervical and uterine motion during IMRT. This data may be used to refine treatment margins. (C) 2010 Elsevier Inc.