Investigation of the dosimetric effect of respiratory motion using four-dimensional weighted radiotherapy

We have developed a four-dimensional weighted radiotherapy (4DW-RT) technique. This method involves designing the motion of the linear accelerator beam to coincide with the tumour motion determined from 4D-CT imaging while including a weighting factor to account for irregular motion and limitations of the delivery system. Experiments were conducted with a moving phantom to assess limitations of the delivery system when applying this method. Although the multi-leaf collimator motion remains within the tolerance of the linear accelerator, the extent of motion was less than 1 mm larger than the designed one, and there was a net system latency of approximately 0.2 s. The dose distributions were measured and simulated using different weighting factors and motion scenarios. The breathing characteristics (period, extent of motion, drift and standard deviations) of 32 patients were evaluated using the Varian RPM system. Breathing variability was assessed by plotting the average breathing motion as a function of the breathing phase. Simulations were carried out to determine the optimal weighting factor based on typical patient breathing characteristics. These results establish that the 4DW-RT method demonstrates potential for dose escalation without increasing exposure to healthy tissue.