title: Correlation between dosimetric effect and intrafraction motion during prostate treatments delivered with helical tomotherapy.
abstract: The dosimetric impact of intrafraction prostate motion was investigated for helical tomotherapy treatments. Measured motion tracks were used to calculate the dosimetric impact on delivered target dose distributions. A dynamic dose calculation engine was developed to facilitate this evaluation. It was found that the D95% (minimum dose to 95% of the volume) changes in the prostate were well correlated with D95% changes in the PTV. This means that the dosimetric impact of intrafraction motion is not restricted to the periphery of the target. The amount of motion was not well correlated with the dosimetric impact (measured in target D95% changes) of motion. The relationship between motion and its dosimetric impact is complex and depends on the timing and direction of the movement. These findings have implications for motion management techniques. It appears that the use of target margins is not an effective strategy to protect the prostate from the effects of observed intrafraction motion. The complex relationship between motion and its dosimetric effect renders simple threshold-based intervention schemes inefficient. Monitoring of actual prostate motion would allow the documentation of the dosimetric impact and implementation of corrective action if needed. However, when motion management techniques are evaluated, it should be kept in mind that the dosimetric impact of observed prostate motion is small for the majority of fractions.
authors.affiliation: Department of Radiation Oncology, M. D. Anderson Cancer Center Orlando, 1400 South Orange Av., Orlando, FL 32806, USA. katja.langen@orhs.org
authors.forename: Katja M
authors.initials: KM
authors.lastname: Langen
authors.forename: Weiguo
authors.initials: W
authors.lastname: Lu
authors.forename: Wilfred
authors.initials: W
authors.lastname: Ngwa
authors.forename: Twyla R
authors.initials: TR
authors.lastname: Willoughby
authors.forename: Bhavin
authors.initials: B
authors.lastname: Chauhan
authors.forename: Sanford L
authors.initials: SL
authors.lastname: Meeks
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Kupelian
authors.forename: Gustavo
authors.initials: G
authors.lastname: Olivera
mesh_terms: D004307:Dose-Response Relationship, Radiation; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D009038:Motion; D009068:Movement; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011874:Radiometry / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000295:instrumentation* / Q000379:methods; D015203:Reproducibility of Results; D013997:Time Factors