title: Evaluation of the interplay effect when using RapidArc to treat targets moving in the craniocaudal or right-left direction.
abstract: OBJECTIVE
  We have investigated the dosimetric errors caused by the interplay between the motions of the LINAC and the tumor during the delivery of a volume modulated arc therapy treatment. This includes the development of an IMRT QA technique, applied here to evaluate RapidArc plans of varying complexity.
  
  
  METHODS
  An IMRT QA technique was developed, which involves taking a movie of the delivered dose (0.2 s frames) using a 2D ion chamber array. Each frame of the movie is then moved according to a respiratory trace and the cumulative dose calculated. The advantage of this approach is that the impact of turning the beam on at different points in the respiratory trace, and of different types of motion, can be evaluated using data from a single irradiation. We evaluated this technique by comparing with the results when we actually moved the phantom during irradiation. RapidArc plans were created to treat a 62 cc spherical tumor in a lung phantom (16 plans) and a 454 cc irregular tumor in an actual patient (five plans). The complexity of each field was controlled by adjusting the MU (312-966 MU). Each plan was delivered to a phantom, and a movie of the delivered dose taken using a 2D ion chamber array. Patient motion was modeled by shifting each dose frame according to a respiratory trace, starting the motion at different phases. The expected dose distribution was calculated by blurring the static dose distribution with the target motion. The dose error due to the interplay effect was then calculated by comparing the delivered dose with the expected dose distribution. Peak-to-peak motion of 0.5, 1.0, and 2.0 cm in the craniocaudal and right-left directions, with target periods of 3 and 5 s, were evaluated for each plan (252 different target motion/plan combinations).
  
  
  RESULTS
  The daily dose error due to the interplay effect was less than 10% for 98.4% of all pixels in the target for all plans investigated. The percentage of pixels for which the daily dose error could be larger than 5% increased with increasing plan complexity (field MU), but was less than 15% for all plans if the motion was 1 cm or less. For 2 cm motion, the dose error could be larger than 5% for 40% of pixels, but was less than 5% for more than 80% of pixels for MU < 550, and was less than 10% for 99% of all pixels. The interplay effect was smaller for 3 s periods than for 5 s periods.
  
  
  CONCLUSIONS
  The interplay between the motions of the LINAC and the target can result in an error in the delivered dose. This effect increases with plan complexity, and with target magnitude and period. It may average out after many fractions.
authors.affiliation: Department of Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts 02115, USA. lcourt@lroc.harvard.edu
authors.forename: Laurence
authors.initials: L
authors.lastname: Court
authors.forename: Matthew
authors.initials: M
authors.lastname: Wagar
authors.forename: Ross
authors.initials: R
authors.lastname: Berbeco
authors.forename: Adam
authors.initials: A
authors.lastname: Reisner
authors.forename: Brian
authors.initials: B
authors.lastname: Winey
authors.forename: Debbie
authors.initials: D
authors.lastname: Schofield
authors.forename: Dan
authors.initials: D
authors.lastname: Ionascu
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Allen
authors.forename: Richard
authors.initials: R
authors.lastname: Popple
authors.forename: Tania
authors.initials: T
authors.lastname: Lingos
mesh_terms: D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D009038:Motion; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012984:Software; D012986:Software Validation