title: DMLC motion tracking of moving targets for intensity modulated arc therapy treatment: a feasibility study.
abstract: OBJECTIVE
  Intensity modulated arc therapy offers great advantages with the capability of delivering a fast and highly conformal treatment. However, moving targets represent a major challenge. By monitoring a moving target it is possible to make the beam follow the motion, shaped by a Dynamic MLC (DMLC). The aim of this work was to evaluate the dose delivered to moving targets using the RapidArc (Varian Medical Systems, Inc.) technology with and without a DMLC tracking algorithm.
  
  
  METHODS
  A Varian Clinac iX was equipped with a preclinical RapidArc and a 3D DMLC tracking application. A motion platform was placed on the couch, with the detectors on top: a PTW seven29 and a Scandidos Delta4. One lung plan and one prostate plan were delivered. Motion was monitored using a Real-time Position Management (RPM) system. Reference measurements were performed for both plans with both detectors at state (0) "static, no tracking". Comparing measurements were made at state (1) "motion, no tracking" and state (2) "motion, tracking".
  
  
  RESULTS
  Gamma analysis showed a significant improvement from measurements of state (1) to measurements of state (2) compared to the state (0) measurements: Lung plan; from 87 to 97% pass. Prostate plan; from 81 to 88% pass. Sub-beam information gave a much reduced pattern of periodically spatial deviating dose points for state (2) than for state (1). Iso-dose curve comparisons showed a slightly better agreement between state (0) and state (2) than between state (0) and state (1).
  
  
  CONCLUSIONS
  DMLC tracking together with RapidArc make a feasible combination and is capable of improving the dose distribution delivered to a moving target. It seems to be of importance to minimize noise influencing the tracking, to gain the full benefit from the application.
authors: Department of Radiation Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. jens.zimmerman@rh.regionh.dk
authors: Jens
authors: J
authors: Zimmerman
authors: Stine
authors: S
authors: Korreman
authors: Gitte
authors: G
authors: Persson
authors: Herb
authors: H
authors: Cattell
authors: Michelle
authors: M
authors: Svatos
authors: Amit
authors: A
authors: Sawant
authors: Raghu
authors: R
authors: Venkat
authors: David
authors: D
authors: Carlson
authors: Paul
authors: P
authors: Keall
mesh_terms: D000465:Algorithms; D005240:Feasibility Studies; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy; D008297:Male; D009068:Movement / Q000502:physiology*; D010315:Particle Accelerators; D019047:Phantoms, Imaging; D011471:Prostatic Neoplasms / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation* / Q000379:methods*; D012119:Respiration; D012542:Scattering, Radiation