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Published online before print January 25, 2002, 10.1148/radiol.2223010639
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(Radiology 2002;222:681-686.)
© RSNA, 2002

Radiation Oncology

Conformal Therapy for Pancreatic Cancer: Variation of Organ Position due to Gastrointestinal Distention—Implications for Treatment Planning1

Eckehard Horst, MD, Oliver Micke, MD, Christos Moustakis, PhD, Andreas Schuck, MD, Ulrich Schäfer, MD and Normann A. Willich, MD

1 From the Department of Radiation Oncology, University of Münster, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany. From the 2000 RSNA scientific assembly. Received March 19, 2001; revision requested April 17; revision received July 5; accepted July 27. Address correspondence to E.H. (e-mail: horste@uni-muenster.de).

PURPOSE: To quantify nonrespiratory organ motion in the pancreatic region and its effect on clinical target volume.

MATERIALS AND METHODS: Three-dimensional translations of the geometric centers of the volumes of interest—pancreatic head, body, and tail; left and right kidney; and the superior mesenteric artery—were measured in 20 patients by analyzing three spiral computed tomographic (CT) protocols performed at static exhalation and representing differential gastrointestinal distention. Wilcoxon test for paired differences was applied to determine statistical significance (P < .05). Spearman rank correlation coefficients were calculated between combinations of statistically significant translations. With the assumption that the organ positions were represented by a three-dimensional Gaussian distribution that occurs during treatment, clinical target volume expansions were calculated to account for organ motion and a typical setup error.

RESULTS: Significant translations of the volume of interest were observed. The most mobile parts of the target organs were the pancreatic tail (P = .001) and the superior mesenteric artery (P = .01). Larger variations from the mean in the planning CT protocol in which negative contrast material was used usually resulted in a slightly larger clinical target volume expansion.

CONCLUSION: Our data may provide a basis for further studies of organ motion and ways of modifying treatment margins.

© RSNA, 2002

Index terms: Pancreas, CT, 77.12111, 77.12112, 77.12115, 77.12117 • Pancreas, therapeutic radiology, 77.125 • Treatment planning






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