@article{oai:repo.qst.go.jp:00047494,
 author = {熊谷, 始紀 and 森, 慎一郎 and 山本, 直敬 and 熊谷 始紀 and 森 慎一郎 and 山本 直敬},
 issue = {1050},
 journal = {The British journal of radiology},
 month = {Apr},
 note = {Objectives: When using a fixed irradiation port, treatment couch rotation is necessary to increase beam angle selection. We evaluated dose variations associated with positional morphologic changes to organs.
Methods: We retrospectively chose the datasets of ten lung cancer patients who underwent respiratory-gated CT at three different couch rotation angles (0°, 20°, and -20°). The respective CT datasets are referred to as CT0, CT20 and CT-20. Three treatment plans were generated as follows: in Plan 1, all compensating bolus designs and dose distributions were calculated using CT0. To evaluate the rotation effect without considering morphology changes, in Plan 2, the compensating boli designed using CT0 were applied to the CT±20 images. Plan 3 involved compensating boli designed using the CT±20 images. The accumulated dose distributions were calculated using deformable image registration (DIR).
Results: A sufficient prescribed dose was calculated for the planning target volume (PTV) in Plan 1 (D95 > 95.8%). In contrast, Plan 2 showed degraded dose conformation to the PTV (D95 > 90%) due to mismatch of the bolus design to the morphologic positional changes in the respective CT. The dose assessment results of Plan 3 were very close to those of Plan 1.
Conclusions: Dose distribution is significantly affected by whether or not positional organ morphology changes are factored into dose planning. 
Advances in knowledge: In treatment planning using multiple CT scans with different couch positions, it is mandatory to calculate the accumulated dose using DIR.},
 pages = {20140734-1--20140734-6},
 title = {Impact of treatment planning with deformable image registration on dose distribution for carbon-ion beam lung treatment using a fixed irradiation port and rotating couch},
 volume = {88},
 year = {2015}
}