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Stereotactic body radiation therapy allows for a precise and accurate dosedelivery. Organ motion during treatment bears the risk of undetected high dosehealthy tissue exposure. An organ very susceptible to high dose is theoesophagus. Its low contrast on CT and the oblong shape renders motionestimation difficult. We tackle this issue by modern algorithms to measure theoesophageal motion voxel-wise and to estimate motion related dosimetric impact.Oesophageal motion was measured using deformable image registration and 4DCT of11 internal and 5 public datasets. Current clinical practice of contouring theorgan on 3DCT was compared to timely resolved 4DCT contours. The dosimetricimpact of the motion was estimated by analysing the trajectory of each voxel inthe 4D dose distribution. Finally an organ motion model was built, allowing foreasier patient-wise comparisons. Motion analysis showed mean absolute maximalmotion amplitudes of 4.55 +/- 1.81 mm left-right, 5.29 +/- 2.67 mmanterior-posterior and 10.78 +/- 5.30 mm superior-inferior. Motion between thecohorts differed significantly. In around 50 % of the cases the dosimetricpassing criteria was violated. Contours created on 3DCT did not cover 14 % ofthe organ for 50 % of the respiratory cycle and the 3D contour is around 38 %smaller than the union of all 4D contours. The motion model revealed that themaximal motion is not limited to the lower part of the organ. Our resultsshowed motion amplitudes higher than most reported values in the literature andthat motion is very heterogeneous across patients. Therefore, individual motioninformation should be considered in contouring and planning.

Measuring breathing induced oesophageal motion and its dosimetric impact