Image-guidance technique comparison on respiratory reproducibility and dose indexes for stereotactic body radiotherapy in lung tumor.

We investigated respiratory reproducibility from position errors of gold internal fiducial markers for breath-hold (BH) and real-time tumor tracking (RTT) techniques for stereotactic body radiotherapy in lung tumors. The relationship between position errors and dose indexes was checked for both techniques. The stereotactic body radiotherapy plan in lung tumors was planned for 29 patients. The tumor positioning was arranged using 1.5 mm diameter gold internal fiducial markers. First, CT images were acquired to analyze position errors of gold markers for BH and RTT techniques. The offset plans for both techniques were calculated by displacing the mean position errors. The dose indexes (D98, D95, D2, mean dose) in a planning target volume were evaluated from dose volume histograms for the original plan, BH, and RTT offset plans. The relationship between position errors and dose indexes was analyzed using the root mean square (RMS) for both techniques. For the BH, the RMS was 3.29 mm at the lower lobe. Similarly, it was 1.34 mm for the RTT. The difference for D98 by position error for BH was -7.0 ± 10.8% at the lower lobe and the difference of all dose indexes for the RTT was less than 1%. The D2 and mean dose for both techniques were nearly the same as those of the original plan. In conclusion, the adaptation of the BH technique should be ≤2 mm RMS. If the position error is >2 mm RMS, the RTT technique should be used instead of the BH technique.

Evaluation of the incident directional dependence of radiochromic film by use of Monte Carlo simulation and measurement.

In high-precision radiotherapy, absolute and relative doses are evaluated for patient-specific intensity-modulated radiation therapy (IMRT) quality assurance (QA). In our institution, we use GAFCHROMIC EBT3 (EBT3) for relative dose evaluation in IMRT QA. We usually use two directional film configurations, which are in the axial and sagittal planes. The QA in our institution shows some differences between the gamma pass rates in the axial and sagittal directions. The purpose of this study was to evaluate the incident directional dependence of EBT3 by using the percent depth dose (PDD) and the off-center ratio (OCR) between EBT3 films positioned perpendicular to the beam axis and along the beam axis. Furthermore, we compared the PDD in EBT3 films positioned perpendicular to the beam axis and the PDD by using an ionization chamber. In addition, PDDs in water phantoms with and without EBT3 films were calculated by Monte Carlo simulation. The results showed that the PDD in EBT3 films positioned perpendicular to the beam axis increased with the depth from the phantom surface. Monte Carlo simulation showed the same trend as did the film measurements. The OCR results were slightly different at dose levels below 20 %. The OCR in EBT3 films positioned along the beam axis was higher than that perpendicular to the beam axis. Thus, we conclude that EBT3 film has incident directional dependence. In IMRT QA, the gamma analysis results may be affected by the incident directional dependence of EBT3 film.

[Estimation of entrance skin dose from fluoroscopy for tracking fiducial markers during real-time tumor-tracking radiotherapy-simulation with a sine wave respiration model-].

The real-time tumor-tracking radiotherapy system includes two sets of fluoroscopes that detect the fiducial markers in or near the tumor constantly during radiotherapy. The treatment beam is irradiated to the tumor only when fiducial markers are located in the target position. Treatment time is extended in case of large respiratory tumor motion. A high-power fluoroscopic X-ray is required in the case of fiducial markers in parenchymal organs with heavy X-ray attenuation. It was a concern that radiodermatitis was caused by an increasing entrance skin dose from the fluoroscopic X-ray. In order to estimate the entrance skin dose from the fluoroscopic X-ray, we measured the entrance skin dose rate through the use of a method recommended by the Japanese Society of Radiological Technology. We applied sine wave simulation to resemble the respiratory motion of the tumor. In conclusion, we confirm that entrance skin dose from fluoroscopy during RTRT is lower than the threshold dose for radiodermatitis.