Implementation of IMRT with 4DCT simulation offers possibility to correlate the respiratory movements and position of tumor volume during radiotherapy treatment. The aim of this study is to quantify movements of primary tumor during IMRT treatment in three axes-Z-superoinferiorSI, X-mediolateral ML, Y -anteroposterior AP.This study included 15 patients with lung carcinomareferred to radical radiotherapy. Contouring of GTV was done in the phases FB-GTV FB, phase 0-GTV0, phase 50-GTV 50, and phase MIP-GTV MIP. Comparison was done with GTV FB as basic value. Evaluation was done in three axis-SI, AP, ML. The movements of GTV in relation to X axis were in the range 0.02-0.47 cm, in relation to Y axis in the range from 0.01-0.56 cm, and according to the Z axis in the range of 0.00-0.79 cm. Based on the results of t-test there was a statistically significant difference (p<0.05) related to X axis between the upper and lower lobe. There was no statistically significant difference (p>0.05) between the upper, lower and middle lobes related to Y and Z axis. The test results which were obtained after the 4D CT simulation and planning of IMRT treatment show the importance of high-quality and precise radiation therapy treatment.
ApstraktImplementacijom Intenzitetom modulisane zrač-ne terapijeuz 4DCT simulaciju moguće je korelirati disajne pokrete i poziciju tumorskog volumena tokom zračnog tretmana. Cilj ovog ispitivanja je kvantifikovanje pokreta primarnog tumora tokom IMRT tretmana u tri osovine: Z-superoinferiornoj SI,X-mediolateralnoj ML, te Y-anteroposteriornoj AP. U ispitivanje je uključeno15 pacijenata sa karcinom pluća kod kojih je indikovana radikalna radioterapija. Kod svih pacijenata konturiran je makroskopski tumorski volumen-GTV u fazama: FB-GTV FB, faza0-GTV0, faza50-GTV 50,f aza MIP-GTV MIP. Komparacija je uradjena u odnosu na GTV FB kao osnovnu vrijednost. Za svaki od ovih volumena komparirani su pokreti GTV u osovinama SI, AP,ML.Pokreti GTV volumena po X osi su bili u rasponu 0.02-0.47cm, u odnosu na Y osu u rasponu od 0.01-0.56cm, te prema Z osi u rasponu 0.00-0.79cm. Na osnovu rezultata T-testa zaključeno je da postoji statistički značajna razlika (p<0,05) u odstupanju po X osi između gornjeg i donjeg lobusa. T-test je pokazao da ne postoji statistički značajna razlika (p>0, 05) između gornjeg, donjeg i srednjeg lobusa u odstupanju po Y i Z osi.Rezultati ispitivanja koji su dobijeni nakon 4DCT simulacije i planiranja IMRT tretmana ukazuju na unaprijeđen kvalitet i preciznost zračnog tretmana.Ključne reči: 4D CT simulacija, IMRT, makroskopski tumorski volumen