4D Monte Carlo dose reconstructions using surface motion measurements

To investigate the feasibility of a 4D Monte Carlo based dose reconstruction method to study the dosimetric impact of respiratory motion using surface motion measurements for patients undergoing VMAT treatments for Non-Small Cell Lung Cancer.

The 4Ddefdosxyznrc/EGSnrc algorithm was used to reconstruct VMAT doses delivered to the patients using machine log files and respiratory traces measured with the RADPOS 4D dosimetry system. The RADPOS sensor was adhered to the patient's abdomen prior to each treatment fraction and its position was used as a surrogate for tumour motion. Treatment log files were synchronized with the patient respiratory traces. Patient specific respiratory models were generated from deformable registration of the inhale and exhale 4DCT images and the respiratory traces. The reconstructed doses were compared to planned doses calculated with DOSXYZnrc/EGSnrc on the average-intensity and the exhale phase CT images.

Respiratory motion measurements and log files were acquired for 2 patients over 5 treatment fractions each. The motion was predominantly along the anterior/posterior direction (A/P). The average respiratory amplitudes were 8.7 ± 2.7 mm and 10.0 ± 1.2 mm for Patient 1 and 2, respectively. Both patients displayed inter- and intra-fractional variations in the baseline position. Small inter-fractional differences were observed in the reconstructed doses for each patient. Differences between the reconstructed and planned doses were attributed to differences in organ volumes.

The 4D reconstruction method was successfully implemented for the two patients studied. Small differences between the planned and reconstructed doses were observed due to the small tumour motion of these patients.