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Target-tracking deliveries using conventional multileaf collimators planned with 4D direct-aperture optimization.

D McQuaid¹, S Webb

¹Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHSF Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.

Physics in Medicine and Biology

|July 10, 2008

Summary

Dynamic target tracking in intensity-modulated radiotherapy corrects respiratory motion. A new 4D direct-aperture optimization method improves treatment accuracy by accounting for tissue motion during breathing cycles.

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Area of Science:

Medical Physics
Radiation Oncology
Image-Guided Therapy

Background:

Respiratory motion significantly degrades radiotherapy accuracy.
Conventional methods struggle to compensate for real-time anatomical changes during treatment delivery.

Purpose of the Study:

To introduce and evaluate a novel 4D direct-aperture optimization method for intensity-modulated radiotherapy.
To assess the impact of incorporating 4D patient models into treatment planning and delivery.

Main Methods:

Developed a 4D direct-aperture optimization system using a 4D patient model accounting for tissue deformation and property changes.
Optimized static and dynamic radiotherapy plans based on 4D models and compared them to static single-phase plans.
Evaluated plan quality using tumor dose spread and normal lung tissue complication probability.

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Main Results:

A static plan optimized on a 4D phantom degraded by 30% due to motion.
Dynamic leaf tracking optimized on a 4D phantom improved plan cost by 16%.
In 4D patient models, benefits were reduced but 4D planning still improved plan cost by ~8%.

Conclusions:

4D direct-aperture optimization effectively mitigates respiratory motion artifacts in radiotherapy.
Dynamic leaf tracking integrated with 4D planning offers significant improvements in treatment accuracy and plan quality.
The clinical benefit is more pronounced with greater observed tissue motion.