The intrafraction motion induced dosimetric impacts in breast 3D radiation treatment: a 4DCT based study

The question remains regarding the dosimetric impact of intrafraction motion in 3D breast treatment. This study was conducted to investigate this issue utilizing the 4DCT scan. The 4D and helical CT scan sets were acquired for 12 breast cancer patients. For each of these patients, based on the helical CT scan, a conventional 3D conformal plan was generated. The breast treatment was then simulated based on the 4DCT scan. In each phase of the 4DCT scan, dose distribution was generated with the same beam parameters as the conventional plan. A software package was developed to compute the cumulative dose distribution from all the phases. Since the intrafraction organ motion is reflected by the 4DCT images, the cumulative dose computed based on the 4DCT images should be closer to what the patient received during treatment. Various dosimetric parameters were obtained from the plan and 4D cumulative dose distribution for the target volume and heart, and were compared to deduce the motion-induced impacts. The studies were performed for both whole breast and partial breast treatment. In the whole breast treatment, the average intrafraction motion induced changes in D95, D90, V100, V95, and V90 of the target volume were -5.4%, -3.1%, -13.4%, -5.1%, and -3.2%, respectively, with the largest values at -26.2%, -14.1%, -91.0%, -15.1%, and -9.0%, respectively. Motion had little impact on the Dmax of the target volume, but its impact on the Dmin of the target volume was significant. For left breast treatment, the motion-induced Dmax change to the heart could be negative or positive, with the largest increase at about 6 Gy. In partial breast treatment, the only non-insignificant impact was in the Dmin of the CTV (ranging from -15.2% to 11.7%). The results showed that the intrafraction motion may compromise target dose coverage in breast treatments and the degree of that compromise was correlated with motion magnitude. However, the dosimetric impact of the motion on the heart dose may be limited.