title: Simulation of respiratory motion during IMRT dose delivery.
abstract: BACKGROUND
  When intensity modulated radiation therapy (IMRT) is realised with dynamic multi-leaf collimators (MLC) and given under respiratory motion, dosimetric errors may occur. These errors are a consequence of the dose blurring and the interplay between the organ motion and the leaf motion. In the present study, a model for evaluating these dosimetric effects for patient-specific cases has been developed and tested.
  
  
  METHODS
  In the purpose written software, three dimensional (3D) dose distributions can be calculated both with and without a generated breathing cycle. To validate the presented model and illustrate its application, periodic breathing cycles were generated, where the starting phase was set randomly for each field during the calculations. Respiration in the anterior-posterior (AP), superior-inferior (SI) and left-right (LR) direction was tested and verified. To illustrate the application of the presented model, two 5-fields IMRT plans with different complexity were calculated with a 2 cm peak-to-peak motion in the AP direction for one fraction and for 25 fractions.
  
  
  RESULTS
  The results showed that the calculation method is of good accuracy, in particular for IMRT plans consisting of several fields, where 97% of the pixels within the body fulfilled a tolerance set to 4% dose difference and 4 mm distance to agreement (DTA). For the two IMRT plans with different complexity, pronounced respiratory induced dose errors, which increased with increasing complexity, were found for both one fraction and 25 fractions, but due to the random stating phase the interplay effect was considerably reduced for the plans consisting of 25 fractions. This illustrates how the dosimetric effects will vary depending on the dose plan and on the number of fractions investigated.
  
  
  CONCLUSIONS
  For patient specific cases, the model can with good accuracy calculate 3D dose distributions both with and without respiratory motion, and evaluate the dosimetric effects.
authors.affiliation: Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway. Silje.mohn@helse-bergen.no
authors.forename: Silje
authors.initials: S
authors.lastname: Mohn
authors.forename: Ellen
authors.initials: E
authors.lastname: Wasbø
mesh_terms: D000465:Algorithms; D003198:Computer Simulation; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D008954:Models, Biological; D009369:Neoplasms / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated; D012119:Respiration