Practical approaches to four-dimensional heavy-charged-particle lung therapy

Shinichiro Mori, Ziji Wu, Michael R. Folkert, Motoki Kumagai, Suguru Dobashi, Toshio Sugane, Masayuki Baba

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


We have developed new design algorithms for compensating boli to facilitate the implementation of four-dimensional charged-particle lung therapy in clinical applications. Four-dimensional CT (4DCT) data for eight lung cancer patients were acquired with a 16-slice CT under free breathing. Six compensating boli were developed that may be categorized into three classes: (1) boli-based on contoured gross tumor volumes (GTV) from a 4DCT data set during each respiratory phase, subsequently combined into one (GTV-4DCT bolus); (2) boli-based on contoured internal target volume (ITV) from image-processed 3DCT data only [temporal-maximum-intensity-projection (TMIP)/temporal-average- intensity-projection (TAIP)] with calculated boli (ITV-TMIP and ITV-TAIP boli); and (3) boli-based on contoured ITV utilizing image-processed 3DCT data, applied to 4DCT for design of boli for each phase, which were then combined. The carbon beam dose distribution within each bolus was calculated as a function of time and compared to plans in which respiratory-ungated/gated strategies were used. The GTV-4DCT treatment plan required a prohibitively long time for contouring the GTV manually for each respiratory phase, but it delivered more than 95% of the prescribed dose to the target volume. The TMIP and TAIP treatments, although more time-efficient, resulted in an unacceptable excess dose to normal tissues and underdosing of the target volume. The dose distribution for the ITV-4DCT bolus was similar to that for the GTV-4DCT bolus and required significantly less practitioner time. The ITV-4DCT bolus treatment plan is time-efficient and provides a high-quality dose distribution, making it a practical alternative to the GTV-4DCT bolus treatment plan.

Original languageEnglish (US)
Pages (from-to)23-33
Number of pages11
JournalRadiological Physics and Technology
Issue number1
StatePublished - Jan 2010


  • Charged particle
  • Computed tomography
  • Four-dimensional
  • Lung cancer
  • Respiration
  • Target volume

ASJC Scopus subject areas

  • Radiation
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Radiology Nuclear Medicine and imaging


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