Discrepancies between Calculated and Delivered Dose Distributions of Respiratory Gated IMRT Fields according to the Target Motion Ranges for Lung and Liver Cancer Patients

Youngkuk Kim; Sangwook Lim; Ji Hoon Choi; Sun Young Ma; Tae Sig Jeung; Tae Ik Ro

doi:10.14316/pmp.2014.25.4.242

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Kim, Lim, Choi, Ma, Jeung, and Ro: Discrepancies between Calculated and Delivered Dose Distributions of Respiratory Gated IMRT Fields according to the Target Motion Ranges for Lung and Liver Cancer Patients

Original Article

Progress in Medical Physics 2014;25(4):242-247.

Published online: 20 January 2014

DOI: https://doi.org/10.14316/pmp.2014.25.4.242

Discrepancies between Calculated and Delivered Dose Distributions of Respiratory Gated IMRT Fields according to the Target Motion Ranges for Lung and Liver Cancer Patients

Youngkuk Kim^∗,^†, Sangwook Lim^∗, Ji Hoon Choi^∗, Sun Young Ma^∗, Tae Sig Jeung^∗, Tae Ik Ro^†

^∗Department of Radiation Oncology, Kosin University College of Medicine, Busan, Korea

^†Department of Physics, Dong-A University, Busan, Korea

Correspondence: Sangwook Lim (medicalphysics@hotmail.com)Tel: 82-51-990-6393, Fax: 82-2-6280-6247

Received 15 October 2014 Revised 12 November 2014 Accepted 19 November 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

To see the discrepancies between the calculated and the delivered dose distribution of IMRT fields for respiratory-induced moving target according to the motion ranges. Four IMRT plans in which there are five fields, for lung and liver patients were selected. The gantry angles were set to 0° for every field and recalculated using TPS (Eclipse Ver 8.1, Varian Medical Systems, Inc., USA). The ion-chamber array detector (MatriXX, IBA Dosimetry, Germany) was placed on the respiratory simulating platform and made it to move with ranges of 1, 2, and 3 cm, respectively. The IMRT fields were delivered to the detector with 30∼70% gating windows. The comparison was performed by gamma index with tolerance of 3 mm and 3%. The average pass rate was 98.63% when there's no motion. When 1.0, 2.0, 3.0 cm motion ranges were simulated, the average pass rate were 98.59%, 97.82%, and 95.84%, respectively. Therefore, ITV margin should be increased or gating windows should be decreased for targets with large motion ranges.

Keywords: Gated radiation therapy, IMRT, Gamma index, Moving phantom

References

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Fig. 1.

To simulate the patients' respiratory motion, the moving platform was fabricated in laboratory. The solid water phantom with thickness of 1.3 cm and the MatriXX were placed on the simulating platform as shown figure. The SSD was 100 cm and the depth of measurement layer became 1.6 cm, which D_max for 6 MV photon beams. We let the platform move with range of 0, 1, 2, and 3 cm and with cycle of 3.6 s.

Fig. 2.

Example of five respiratory gated IMRT fields for case of A patient; the phantom simulated respiratory motion with four scenario (0, 1, 2, and 3 cm motion range and 3.6 s cycle). Gamma index were used with 3 mm/3% tolerance to compare calculated and measured dose distribution. White and black area in the figures represent pass and fail respectively.

Table 1.

Respiratory patterns for 48 lung and liver cancer patients (SD: Standard deviation).

Treatment site	Number of patients	Breathing period (s)		Motion range (cm)
Treatment site	Number of patients	Mean±SD	Range	Mean±SD	Range
Lung	25	3.4±0.5	2.6∼4.9	1.3±0.6	0.2∼2.4
Liver	23	4.0±0.8	2.6∼6.0	1.2±0.5	0.2∼2.3
Total	48	3.6±0.7	2.6∼6.0	1.3±0.6	0.2∼2.4

Table 2.

The pass rate according to the motion ranges: The pass rate for the calculated and the measured dose distribution for the gated IMRT according to the target motion ranges; The pass rates tend to decrease with the motion range.

Patient	Motion range	Field number
Patient	Motion range	1	2	3	4	5
A	0 cm	98.14%	99.90%	99.98%	99.84%	99.66%
	1 cm	99.44%	99.61%	99.65%	99.74%	98.65%
	2 cm	98.52%	99.18%	98.26%	99.26%	98.31%
	3 cm	97.22%	97.79%	95.96%	98.31%	94.88%
B	0 cm	99.62%	99.65%	99.52%	99.70%	99.60%
	1 cm	99.22%	99.22%	99.13%	99.39%	99.31%
	2 cm	98.91%	98.91%	98.78%	99.00%	98.91%
	3 cm	98.18%	98.13%	98.13%	98.13%	98.09%
C	0 cm	97.77%	99.68%	95.59%	93.90%	95.83%
	1 cm	97.14%	99.26%	94.14%	93.27%	95.92%
	2 cm	94.92%	98.65%	93.14%	92.14%	94.97%
	3 cm	91.28%	94.02%	91.19%	85.33%	92.27%
D	0 cm	99.76%	99.89%	97.78%	99.09%	97.78%
	1 cm	99.87%	100.00%	99.91%	99.18%	99.70%
	2 cm	98.87%	99.57%	99.22%	98.22%	98.65%
	3 cm	97.53%	98.39%	97.53%	97.18%	97.22%

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