Intrafraction motion during radiotherapy of breast tumor, breast tumor bed, and individual axillary lymph nodes on cine magnetic resonance imaging.

Abstract

In (ultra-)hypofractionation, the contribution of intrafraction motion to treatment accuracy becomes increasingly important. Our purpose was to evaluate intrafraction motion and resulting geometric uncertainties for breast tumor (bed) and individual axillary lymph nodes, and to compare prone and supine position for the breast tumor (bed). During 1-3min of free breathing, we acquired transverse/sagittal interleaved 1.5T cine magnetic resonance imaging (MRI) of the breast tumor (bed) in prone and supine position and coronal/sagittal cine MRI of individual axillary lymph nodes in supine position. A total of 31 prone and 23 supine breast cine MRI (in 23 women) and 52 lymph node cine MRI (in 24 women) were included. Maximum displacement, breathing amplitude, and drift were analyzed using deformable image registration. Geometric uncertainties were calculated for all displacements and for breathing motion only. Median maximum displacements (range over the three orthogonal orientations) were 1.1-1.5mm for the breast tumor (bed) in prone and 1.8-3.0mm in supine position, and 2.2-2.4mm for lymph nodes. Maximum displacements were significantly smaller in prone than in supine position, mainly due to smaller breathing amplitude: 0.6-0.9mm in prone vs. 0.9-1.4mm in supine. Systematic and random uncertainties were 0.1-0.4mm in prone position and 0.2-0.8mm in supine position for the tumor (bed), and 0.4-0.6mm for the lymph nodes. Intrafraction motion of breast tumor (bed) and individual lymph nodes was small. Motion of the tumor (bed) was smaller in prone than in supine position.