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4D dose simulation in volumetric arc therapy: Accuracy and affecting parameters.

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Accurate 4D VMAT dose simulations are crucial for quality assurance in stereotactic radiotherapy of moving tumors. This study validates simulation accuracy against phantom measurements, finding high agreement and identifying key influencing parameters for reliable treatment planning.

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Quality Assurance

Background:

  • Stereotactic radiotherapy, particularly volumetric arc therapy (VMAT), is increasingly used for lung and liver lesions.
  • Respiratory motion significantly impacts VMAT dose delivery, necessitating advanced quality assurance (QA) methods.
  • Current 4D QA approaches include phantom-based measurements and computational dose simulations, each with limitations.

Purpose of the Study:

  • To investigate the accuracy of 4D VMAT dose simulation for moving targets.
  • To identify and assess the impact of key parameters on 4D VMAT dose simulation reliability.
  • To validate simulation-based 4D QA as a tool for assessing VMAT treatment plans in the context of patient motion.

Main Methods:

  • Generated VMAT treatment plans for a motion phantom simulating various respiratory motion scenarios.
  • Performed 4D VMAT dose simulations and compared them to dosimetric measurements using 3%/3mm gamma-evaluation.
  • Assessed the influence of temporal discretization and phase alignment on simulation accuracy.

Main Results:

  • Simulated doses showed high agreement with measured doses, with overall gamma-passing rates ranging from 97% to 100% (mean 98% ± 1%).
  • Temporal discretization and accurate breathing phase alignment were identified as critical parameters for simulation accuracy.
  • The study demonstrated the reliability of simulations for assessing VMAT motion effects.

Conclusions:

  • 4D VMAT dose simulation provides a reliable method for quality assurance of VMAT treatment plans for moving targets.
  • Simulation-based 4D QA can effectively verify target coverage in hypofractionated radiotherapy.
  • Further research is warranted to address remaining discrepancies between simulations and measurements.