title: Computing proton dose to irregularly moving targets.
abstract: OBJECTIVE
  While four-dimensional computed tomography (4DCT) and deformable registration can be used to assess the dose delivered to regularly moving targets, there are few methods available for irregularly moving targets. 4DCT captures an idealized waveform, but human respiration during treatment is characterized by gradual baseline shifts and other deviations from a periodic signal. This paper describes a method for computing the dose delivered to irregularly moving targets based on 1D or 3D waveforms captured at the time of delivery.
  
  
  METHODS
  The procedure uses CT or 4DCT images for dose calculation, and 1D or 3D respiratory waveforms of the target position at time of delivery. Dose volumes are converted from their Cartesian geometry into a beam-specific radiological depth space, parameterized in 2D by the beam aperture, and longitudinally by the radiological depth. In this new frame of reference, the proton doses are translated according to the motion found in the 1D or 3D trajectory. These translated dose volumes are weighted and summed, then transformed back into Cartesian space, yielding an estimate of the dose that includes the effect of the measured breathing motion. The method was validated using a synthetic lung phantom and a single representative patient CT. Simulated 4DCT was generated for the phantom with 2 cm peak-to-peak motion.
  
  
  RESULTS
  A passively-scattered proton treatment plan was generated using 6 mm and 5 mm smearing for the phantom and patient plans, respectively. The method was tested without motion, and with two simulated breathing signals: a 2 cm amplitude sinusoid, and a 2 cm amplitude sinusoid with 3 cm linear drift in the phantom. The tumor positions were equally weighted for the patient calculation. Motion-corrected dose was computed based on the mid-ventilation CT image in the phantom and the peak exhale position in the patient. Gamma evaluation was 97.8% without motion, 95.7% for 2 cm sinusoidal motion, 95.7% with 3 cm drift in the phantom (2 mm, 2%), and 90.8% (3 mm, 3%)for the patient data.
  
  
  CONCLUSIONS
  We have demonstrated a method for accurately reproducing proton dose to an irregularly moving target from a single CT image. We believe this algorithm could prove a useful tool to study the dosimetric impact of baseline shifts either before or during treatment.
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Phillips
authors.forename: Gueorgui
authors.initials: G
authors.lastname: Gueorguiev
authors.forename: James A
authors.initials: JA
authors.lastname: Shackleford
authors.forename: Clemens
authors.initials: C
authors.lastname: Grassberger
authors.forename: Stephen
authors.initials: S
authors.lastname: Dowdell
authors.forename: Harald
authors.initials: H
authors.lastname: Paganetti
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Sharp
mesh_terms: D000465:Algorithms; D056973:Four-Dimensional Computed Tomography / Q000379:methods; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D009038:Motion; D019047:Phantoms, Imaging; D011522:Protons; D011874:Radiometry / Q000379:methods*; D012119:Respiration
chemical_list: D011522:Protons