Influence of inter-fractional respiratory motion changes on dose delivery accuracy in dynamic conformal arc lung...

To evaluate the influence of inter-fractional respiratory motion variation on dose delivery accuracy in dynamic conformal arc lung stereotactic body radiotherapy (SBRT) using glass dosimeter and QUASARTM respiratory motion phantom.

Four-dimensional computed tomography (4D-CT) was acquired using a sinusoidal respiratory waveform (amplitude: 10 mm, breaths per minute [BPM]: 20). Three glass dosimeters were positioned at the superior edge, geometric center, and inferior edge of the tumor target. Internal target volume (ITV)-SBRT and gated-SBRT plans were created and delivered under nine respiratory conditions (BPM: 10-30, amplitude: 5-30 mm). Treatment was considered acceptable if the delivered dose to the glass dosimeters remained within the D5%-D95% of the gross tumor volume.

BPM had minimal effect on ITV-SBRT, with the doses delivered to the target remaining within the acceptable range for all BPMs. However, amplitude significantly affected SBRT accuracy. For ITV-SBRT, increase in amplitude caused underdose at both the superior and inferior edges. In gated-SBRT, higher amplitude led to significant underdosing at superior edge of the target than that observed in ITV-SBRT, while inferior edge remained within the acceptable dose range. Underdose worsened with increasing amplitude, and 10 mm increase from the reference caused it to fall below the acceptable range (D95%).

Respiratory motion significantly affects dose delivery accuracy in lung SBRT, with amplitude playing a critical role. An amplitude increase of ≥ 10 mm from CT acquisition during SBRT delivery resulted in a significant target underdosing below the clinically acceptable threshold.