NDLI: Timing matters: diurnal spine length variation in pediatric patients during radiotherapy

Content Provider	Springer Nature : BioMed Central
Author	Meijer, Karin M. van Dijk, Irma W.E.M. Schonk, Tamara J. Balgobind, Brian V. Loginova, Anna van Wieringen, Niek Bel, Arjan
Abstract	Background During the day-night cycle, gravity and applied stress to the body mass and spine causes a decrease in body height, which is restored overnight. This diurnal spine length variation has not yet been quantified during radiotherapy. Therefore, we aimed to quantify diurnal spine length variation on cone beam CTs (CBCTs) of pediatric patients (< 18 years) who underwent radiotherapy. Methods For this retrospective study, we included 32 patients (mean age 10.0, range 2.7–16.1 years) who received image guided radiotherapy between 2012 and 2018 in two institutes. Patients were included when they had two fractions per day, or when fractions were scheduled on varying time slots over the course of treatment. Daily CBCTs were registered to the planning CTs using two automatic registrations relative to the bony anatomy; one to vertebra T11 and one to vertebra L4. For each CBCT, the differences between the cranial-caudal (CC) position of the T11 and L4 vertebrae were calculated. To determine the diurnal spine length variation, the difference in vertebrae position between the morning and afternoon CBCTs was calculated. Furthermore, we investigated the possible correlation of diurnal spine length variation with the time slot differences (time interval) between CBCTs (Spearman’s ρ). Results Overall, the median spine length variation was -1.0 (range -3.9–0.1) mm, and we found a significant reduction in spine length over the day (p < 0.001) with substantial variations between patients. Time intervals between CBCTs ranging from 4.0 to 9.5 h were not correlated with spine length reduction (ρ=-0.01; p = 0.95). Conclusions We found a small but significant reduction in spine length (vertebrae T11 to L4) over the course of day in pediatric patients undergoing radiotherapy, measured on CBCT imaging. Spine length reduction did not correlate with CBCT time intervals. However, our results indicate that diurnal spine length reduction could induce a setup error during treatment, and therefore should be considered in pediatric radiotherapy.
Related Links	https://ro-journal.biomedcentral.com/counter/pdf/10.1186/s13014-024-02548-w.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
DOI	10.1186/s13014-024-02548-w
Journal	Radiation Oncology
Issue Number	1
Volume Number	19
Language	English
Publisher	BioMed Central
Publisher Date	2024-11-20
Access Restriction	Open
Subject Keyword	Cancer Research Oncology Radiotherapy Imaging Radiology Pediatric cancer Diurnal spine length variation Geometrical uncertainties
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Oncology
Journal Impact Factor	3.3/2023
5-Year Journal Impact Factor	3.6/2023

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