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. 2023 Dec;24(12):e14129.
doi: 10.1002/acm2.14129. Epub 2023 Aug 26.

Relative thoracic changes from supine to upright patient position: A proton collaborative group study

Joseph Marano  1 , Michael W Kissick  2 , Tracy S A Underwood  3 , Steven J Laub  1 , Michelle Lis  2 , Andries N Schreuder  2 , Brad Kreydick  1 , Mark Pankuch  1
Affiliations

Relative thoracic changes from supine to upright patient position: A proton collaborative group study

Joseph Marano et al. J Appl Clin Med Phys. 2023 Dec.

Abstract

This study presents position changes of a few radiotherapy-relevant thoracic organs between upright and typical supine patient orientations. Using tools in a commercial treatment planning system (TPS), key anatomical distances were measured for four-dimensional CT data sets and analyzed for the two patient orientations. The uncertainty was calculated as the 95% confidence interval (CI) on the relative difference for each of the four analyzed changes for upright relative to supine, as follows: the distance of the bottom of the heart to the top of the sternum, it changed +2.6% or +4 mm (95% CI [+0.30%,+4.9%]); the distance of the center of the C3 vertebra to the backrest, it changed +29% (95% CI [+22%,+36%]); the contoured left and right lungs increased their volumes respectively: +17% (95% CI [+12%,+21%]) for the left, and +9.9% (95% CI [+4.1%,+16%]); and lastly, the distance from the top of the sternum to the top of the liver, but its uncertainty far exceeded the average change by a factor of two. This last result is therefore inconclusive, the others show that with 95% confidence that a change in internal positions is observed for lung volumes and heart position that could be important for upright treatments.

Keywords: patient positioning; proton therapy; seated treatment.

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Conflict of interest statement

This study was partially funded by Leo Cancer Care

Figures

FIGURE 1
FIGURE 1
Example measurements, screenshots from the TPS, for patient nine in the upright position. The red boxes indicate the measurement value provided by the software. The red arrows indicate where the thin measurement line ends: (a) heart location measurement example, (b) patient positioning measurement example. TPS, treatment planning system.
FIGURE 2
FIGURE 2
Example measurements, screenshots from the TPS, for patient nine in the supine position.  The red boxes indicate the transversal/axial slice height provided by the software.  The red arrows indicate the landmarks that determine which slices to use: (a) top of sternum slice measurement example, (b) top of liver slice measurement example. TPS, treatment planning system.
FIGURE 3
FIGURE 3
The percentage change in lung volume between the supine and upright position for the left (red bars) and the right (blue bars) lungs respectively.
FIGURE 4
FIGURE 4
The difference in diaphragm excursion between the upright and supine positions. The change in excursions are relative to the Supine position that is, a positive value means that the excursion is larger in the supine position and vice versa.
See this image and copyright information in PMC

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