A Novel Respiratory Motion Perturbation Model Adaptable to Patient Breathing Irregularities

Purpose: To develop a physical, adaptive motion perturbation model to predict tumor motion using feedback from dynamic measurement of breathing conditions to compensate for breathing irregularities. Methods and Materials: A novel respiratory motion perturbation (RMP) model was developed to predict tumor motion variations caused by breathing irregularities. This model contained 2 terms: the initial tumor motion trajectory, measured from 4-dimensional computed tomography (4DCT) images, and motion perturbation, calculated from breathing variations in tidal volume (TV) and breathing pattern (BP). The motion perturbation was derived from the patient-specific anatomy, tumor-specific location, and time-dependent breathing variations. Ten patients were studied, and 2 amplitude-binned 4DCT images for each patient were acquired within 2 weeks. The motion trajectories of 40 corresponding bifurcation points in both 4DCT images of each patient were obtained using deformable image registration. An in-house 4D data processing toolbox was developed to calculate the TV and BP as functions of the breathing phase. The motion was predicted from the simulation 4DCT scan to the treatment 4DCT scan, and vice versa, resulting in 800 predictions. For comparison, noncorrected motion differences and the predictions from a published 5-dimensional model were used. Results: The average motion range in the superoinferior direction was 9.4 +/- 4.4 mm, the average DTV ranged from 10 to 248 mm 3 (-26% to 61%), and the DBP ranged from 0 to 0.2 (-71% to 333%) between the 2 4DCT scans. The mean noncorrected motion difference was 2.0 +/- 2.8 mm between 2 4DCT motion trajectories. After applying the RMP model, the mean motion difference was reduced significantly to 1.2 +/- 1.8 mm (P=.0018), a 40% improvement, similar to the 1.2 +/- 1.8 mm (P=.72) predicted with the 5-dimensional model. Conclusions: A novel physical RMP model was developed with an average accuracy of 1.2 +/- 1.8 mm for interfraction motion prediction, similar to that of a published lung motion model. This physical RMP was analytically derived and is able to adapt to breathing irregularities. Further improvement of this RMP model is under investigation. (C) 2016 Elsevier Inc. All rights reserved.