[Availability of using diaphragm matching in stereotactic body radiotherapy (SBRT) at the time in breath-holding SBRT for liver cancer].

PURPOSE: Liver image guided radiation therapy (IGRT) based on bone matching risks generating serious target positioning errors for reasons of lack of reproducibility of expiration breath hold. We therefore investigated the feasibility of 3D image matching between planning CT images and pretreatment cone-beam computed tomography (CBCT) images based on diaphragm surface matching. METHOD: 27 liver stereotactic body radiotherapy (SBRT) cases in whom trancecatheter arterial chemoembolization (TACE) had been performed in advance of radiotherapy were manually image-matched based on contrast, Lipiodol used in the TACE as the marker of the tumor, and the relative coordinates of the isocenter obtained by contrast matching, defined as the reference coordinate. The target positioning difference between diaphragm matching and bone matching were evaluated by using relative coordinates of the isocenter from the reference obtained for each matching technique. RESULTS: The target positioning error using diaphragm matching and bone matching was 1.31±0.83 and 3.10±2.80 mm in the cranial-caudal (C-C) direction, 1.04±0.95 and 1.62±1.02 mm in the anterior-posterior (A-P) direction, and 0.93±1.19 and 1.12±0.94 mm in the left-right (L-R) direction, respectively. The positioning error due to diaphragm matching was significantly smaller than for bone matching in the C-C direction (p<0.05). CONCLUSION: IGRT based on diaphragm matching has potential as an alternative image matching technique for the positioning of liver patients.