title: Delivery of four-dimensional radiotherapy with TrackBeam for moving target using an AccuKnife dual-layer MLC: dynamic phantoms study.
abstract: Respiratory motion has been considered a clinical challenge for lung tumor treatments due to target motion. In this study, we aimed to perform an experimental evaluation based on dynamic phantoms using MLC-based beam tracking. TrackBeam, a prototype real-time beam tracking system, has been assembled and evaluated in our clinic. TrackBeam includes an orthogonal dual-layer micro multi-leaf collimator (DmMLC), an on-board mega-voltage (MV) portal imaging device, and an image processing workstation. With a fiducial marker implanted in a moving target, the on-board imaging device can capture the motion. The TrackBeam workstation processes the online MV fluence and detects and predicts tumor motion. The DmMLC system then dynamically repositions each leaf to form new beam apertures based on the movement of the fiducial marker. In this study, a dynamic phantom was used for the measurements. Three delivery patterns were evaluated for dosimetric verification based on radiographic films: no-motion-lung-tumor (NMLT), three-dimensional conformal radiotherapy (3DCRT), and four-dimensional tracking radiotherapy (4DTRT). The displacement between the DmMLC dynamic beam isocenter and the fiducial marker was in the range of 0.5 mm to 1.5 mm. With radiographic film analysis, the planar dose histogram difference between 3DCRT and NLMT was 48.6% and 38.0% with dose difference tolerances of 10% and 20%. The planar dose histogram difference between 4DTRT and NLMT was 15.2% and 4.0% respectively. Based-on dose volume histogram analysis, 4DTRT reduces the mean dose for the surrounding tissue from 35.4 Gy to 19.5 Gy, reduces the relative volume of the total lung from 28% to 18% at V20, and reduces the amount of dose from 35.2 Gy to 15.0 Gy at D20. The experimental results show that MLC-based real-time beam tracking delivery provides a potential solution to respiratory motion control. Beam tracking delivers a highly conformal dose to a moving target, while sparing surrounding normal tissue.
authors.affiliation: University of Texas Health Science Center, Radiation Oncology Department, San Antonio, TX, USA.
authors.forename: Yaxi
authors.initials: Y
authors.lastname: Liu
authors.affiliation: University of Texas Health Science Center, Radiation Oncology Department, San Antonio, TX, USA.
authors.forename: Chengyu
authors.initials: C
authors.lastname: Shi
authors.affiliation: University of Texas Health Science Center, Radiation Oncology Department, San Antonio, TX, USA.
authors.forename: Bryan
authors.initials: B
authors.lastname: Lin
authors.affiliation: University of Texas Health Science Center, Radiation Oncology Department, San Antonio, TX, USA.
authors.forename: Chul Soo
authors.initials: CS
authors.lastname: Ha
authors.affiliation: University of Texas Health Science Center, Radiation Oncology Department, San Antonio, TX, USA.
authors.forename: Niko
authors.initials: N
authors.lastname: Papanikolaou
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000532:radiotherapy*; D010315:Particle Accelerators; D019047:Phantoms, Imaging; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation* / Q000379:methods