Investigation of dose homogeneity for loose helical tomotherapy delivery in the context of breath-hold radiation therapy.
ABSTRACT Loose helical delivery is a potential solution to account for respiration-driven tumour motion in helical tomotherapy (HT). In this approach, a treatment is divided into a set of interlaced 'loose' helices commencing at different gantry angles. Each loose helix covers the entire target length in one gantry rotation during a single breath-hold. The dosimetric characteristics of loose helical delivery were investigated by delivering a 6 MV photon beam in a HT-like manner. Multiple scenarios of conventional 'tight' HT and loose helical deliveries were modelled in treatment planning software, and carried out experimentally with Kodak EDR2 film. The advantage of loose helical delivery lies in its ability to produce a more homogeneous dose distribution by eliminating the 'thread' effect-an inherent characteristic of HT, which results in dose modulations away from the axis of gantry rotation. However, loose helical delivery was also subjected to undesirable dose modulations in the direction of couch motion (termed 'beating' effect), when the ratio between the number of beam projections per gantry rotation (n) and pitch factor (p) was a non-integer. The magnitude of dose modulations decreased with an increasing n/p ratio. The results suggest that for the current HT unit (n = 51), dose modulations could be kept under 5% by selecting a pitch factor smaller than 7. A pitch factor of this magnitude should be able to treat a target up to 30 cm in length. Loose helical delivery should increase the total session time only by a factor of 2, while the planning time should stay the same since the total number of beam projections remains unchanged. Considering its dosimetric advantage and clinical practicality, loose helical delivery is a promising solution for the future HT treatments of respiration-driven targets.
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ABSTRACT: Tumor motion is a particular concern for a complex treatment modality such as helical tomotherapy, where couch position, gantry rotation and MLC leaf opening all change with time. In the present study, we have investigated the impact of tumor motion for helical tomotherapy, which could result in three distinct motion-induced dose artifacts, namely (1) dose rounding, (2) dose rippling and (3) IMRT leaf opening asynchronization effect. Dose rounding and dose rippling effects have been previously described, while the IMRT leaf opening asynchronization effect is a newly discovered motion-induced dose artifact. Dose rounding is the penumbral widening of a delivered dose distribution near the edges of a target volume along the direction of tumor motion. Dose rippling is a series of periodic dose peaks and valleys observed within the target region along the direction of couch motion, due to an asynchronous interplay between the couch motion and the longitudinal component of tumor motion. The IMRT leaf opening asynchronization effect is caused by an asynchronous interplay between the temporal patterns of leaf openings and tumor motion. The characteristics of each dose artifact were investigated individually as functions of target motion amplitude and period for both non-IMRT and IMRT helical tomotherapy cases, through computer simulation modeling and experimental verification. The longitudinal dose profiles generated by the simulation program agreed with the experimental data within +/-0.5% and +/-1.5% inside the PTV region for the non-IMRT and IMRT cases, respectively. The dose rounding effect produced a penumbral increase up to 20.5 mm for peak-to-peak target motion amplitudes ranging from 1.0 cm to 5.0 cm. Maximum dose rippling magnitude of 25% was calculated, when the target motion period approached an unusually high value of 10 s. The IMRT leaf opening asynchronization effect produced dose differences ranging from -29% to 7% inside the PTV region. This information on the potential motion-induced dose artifacts will be important in defining the optimal motion mitigation strategies for lung tomotherapy.Physics in Medicine and Biology 10/2009; 54(19):5707-34. · 2.70 Impact Factor
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ABSTRACT: Gated radiotherapy of lung lesions is particularly complex for helical tomotherapy, due to the simultaneous motions of its three subsystems (gantry, couch and collimator). We propose a new way to implement gating for helical tomotherapy, namely multi-pass respiratory gating. In this method, gating is achieved by delivering only the beam projections that occur within a respiratory gating window, while blocking the rest of the beam projections by fully closing all collimator leaves. Due to the continuous couch motion, the planned beam projections must be delivered over multiple passes of radiation deliveries. After each pass, the patient couch is reset to its starting position, and the treatment recommences at a different phase of tumour motion to 'fill in' the previously blocked beam projections. The gating process may be repeated until the plan dose is delivered (full gating), or halted after a certain number of passes, with the entire remaining dose delivered in a final pass without gating (partial gating). The feasibility of the full gating approach was first tested for sinusoidal target motion, through experimental measurements with film and computer simulation. The optimal gating parameters for full and partial gating methods were then determined for various fractionation schemes through computer simulation, using a patient respiratory waveform. For sinusoidal motion, the PTV dose deviations of -29 to 5% observed without gating were reduced to range from -1 to 3% for a single fraction, with a 4 pass full gating. For a patient waveform, partial gating required fewer passes than full gating for all fractionation schemes. For a single fraction, the maximum allowed residual motion was only 4 mm, requiring large numbers of passes for both full (12) and partial (7 + 1) gating methods. The number of required passes decreased significantly for 3 and 30 fractions, allowing residual motion up to 7 mm. Overall, the multi-pass gating technique was shown to be a promising way to reduce the impact of lung tumour motion during helical tomotherapy.Physics in Medicine and Biology 10/2010; 55(22):6673-94. · 2.70 Impact Factor
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ABSTRACT: The longitudinal dose ripple on the off-axis caused by helical radiation delivery, such as the TomoTherapy system, has been observed, and its relation with respect to pitch has been studied with empirically found optimal pitches, 0.86∕n, by Kissick et al. [Med. Phys. 32, 1414-1423 (2005)]. This ripple artifact referred to as the thread effect is periodic in nature and is caused by various periodic factors. In this work, the factors that cause the thread effect were unveiled, including jaw profile divergence, the inverse square law, attenuation, and the cone effect, and their impact on the thread effect were studied. Mathematical formulation for individual and combined factors were set up. Based on theoretical analysis and simulations, optimal pitches that result in local minima of the ripple amplitude with respect to the jaw width and off-axis distance were identified and verified. The effectiveness of optimization in reducing the thread effect were also studied. Analysis and simulation based on the square-shaped jaw profiles well characterize the thread effect. Simulations based on the real jaw profiles show reduced ripples and very good agreement of optimal pitches compared with those based on the square profiles. The optimal pitches were found to have little jaw width dependence, except for the real jaw profile of small width (1.05 cm). The optimal pitches for the real jaw profile of width 1.05 cm are unidentifiable except for the largest ones, due to the relative smoothness of the jaw profile. With optimized intensity modulation, the thread effect can be largely suppressed. For real jaw profiles, the optimal pitches with or without dose optimization do not change much. The numbers 0.86∕n found by Kissick et al. well approximate the optimal pitches for off-axis distance of 5 cm. However, optimal pitches are not universal for different off-axis distances: they decrease as the off-axis distance increases. The thread effect can be well explained by the proposed model. Optimization can largely reduce the thread effect. However, an optimal pitch reduces the ripple much easier especially when optimization is limited by many constraints. The optimal pitches predicted by the proposed model could be used as a reference for pitch selection regardless the tumor is at large or small off-axis distance.Medical Physics 11/2011; 38(11):5945-60. · 2.91 Impact Factor