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Quantifying the effect of intrafraction motion during breast IMRT planning and dose delivery.

Publication ,  Journal Article
George, R; Keall, PJ; Kini, VR; Vedam, SS; Siebers, JV; Wu, Q; Lauterbach, MH; Arthur, DW; Mohan, R
Published in: Med Phys
April 2003

Respiratory motion during intensity modulated radiation therapy (IMRT) causes two types of problems. First, the clinical target volume (CTV) to planning target volume (PTV) margin needed to account for respiratory motion means that the lung and heart dose is higher than would occur in the absence of such motion. Second, because respiratory motion is not synchronized with multileaf collimator (MLC) motion, the delivered dose is not the same as the planned dose. The aims of this work were to evaluate these problems to determine (a) the effects of respiratory motion and setup error during breast IMRT treatment planning, (b) the effects of the interplay between respiratory motion and multileaf collimator (MLC) motion during breast IMRT delivery, and (c) the potential benefits of breast IMRT using breath-hold, respiratory gated, and 4D techniques. Seven early stage breast cancer patient data sets were planned for IMRT delivered with a dynamic MLC (DMLC). For each patient case, eight IMRT plans with varying respiratory motion magnitudes and setup errors (and hence CTV to PTV margins) were created. The effects of respiratory motion and setup error on the treatment plan were determined by comparing the eight dose distributions. For each fraction of these plans, the effect of the interplay between respiratory motion and MLC motion during IMRT delivery was simulated by superimposing the respiratory trace on the planned DMLC leaf motion, facilitating comparisons between the planned and expected dose distributions. When considering respiratory motion in the CTV-PTV expansion during breast IMRT planning, our results show that PTV dose heterogeneity increases with respiratory motion. Lung and heart doses also increase with respiratory motion. Due to the interplay between respiratory motion and MLC motion during IMRT delivery, the planned and expected dose distributions differ. This difference increases with respiratory motion. The expected dose varies from fraction to fraction. However, for the seven patients studied and respiratory trace used, for no breathing, shallow breathing, and normal breathing, there were no statistically significant differences between the planned and expected dose distributions. Thus, for breast IMRT, intrafraction motion degrades treatment plans predominantly by the necessary addition of a larger CTV to PTV margin than would be required in the absence of such motion. This motion can be limited by breath-hold, respiratory gated, or 4D techniques.

Duke Scholars

Published In

Med Phys

DOI

ISSN

0094-2405

Publication Date

April 2003

Volume

30

Issue

4

Start / End Page

552 / 562

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Respiratory Mechanics
  • Reproducibility of Results
  • Radiotherapy, Conformal
  • Radiotherapy Planning, Computer-Assisted
  • Radiotherapy Dosage
  • Radiometry
  • Radiography
  • Radiation Protection
  • Quality Control
 

Citation

APA
Chicago
ICMJE
MLA
NLM
George, R., Keall, P. J., Kini, V. R., Vedam, S. S., Siebers, J. V., Wu, Q., … Mohan, R. (2003). Quantifying the effect of intrafraction motion during breast IMRT planning and dose delivery. Med Phys, 30(4), 552–562. https://doi.org/10.1118/1.1543151
George, R., P. J. Keall, V. R. Kini, S. S. Vedam, J. V. Siebers, Q. Wu, M. H. Lauterbach, D. W. Arthur, and R. Mohan. “Quantifying the effect of intrafraction motion during breast IMRT planning and dose delivery.Med Phys 30, no. 4 (April 2003): 552–62. https://doi.org/10.1118/1.1543151.
George R, Keall PJ, Kini VR, Vedam SS, Siebers JV, Wu Q, et al. Quantifying the effect of intrafraction motion during breast IMRT planning and dose delivery. Med Phys. 2003 Apr;30(4):552–62.
George, R., et al. “Quantifying the effect of intrafraction motion during breast IMRT planning and dose delivery.Med Phys, vol. 30, no. 4, Apr. 2003, pp. 552–62. Pubmed, doi:10.1118/1.1543151.
George R, Keall PJ, Kini VR, Vedam SS, Siebers JV, Wu Q, Lauterbach MH, Arthur DW, Mohan R. Quantifying the effect of intrafraction motion during breast IMRT planning and dose delivery. Med Phys. 2003 Apr;30(4):552–562.

Published In

Med Phys

DOI

ISSN

0094-2405

Publication Date

April 2003

Volume

30

Issue

4

Start / End Page

552 / 562

Location

United States

Related Subject Headings

  • Sensitivity and Specificity
  • Respiratory Mechanics
  • Reproducibility of Results
  • Radiotherapy, Conformal
  • Radiotherapy Planning, Computer-Assisted
  • Radiotherapy Dosage
  • Radiometry
  • Radiography
  • Radiation Protection
  • Quality Control