Type of Document Master's Thesis Author Matney, Jason Edward URN etd-11092008-142649 Title Determination of CTV-to-ITV Margins for Free-Breathing Respiratory-Gated Treatments Using 4DCT and the Novalis ExacTrac Gating System with Implanted Fiducials Degree Master of Science (M.S.) Department Physics & Astronomy Advisory Committee
Advisor Name Title Brent Parker Committee Co-Chair Kenneth Hogstrom Committee Co-Chair Daniel Neck Committee Member Greg Henkelmann Committee Member Isaac Rosen Committee Member James Matthews Committee Member Keywords
- lung cancer
- respiratory motion
- tumor motion
Date of Defense 2008-10-21 Availability unrestricted AbstractThe purpose of this project was to investigate the interplay between gating window characteristics and target margin required to compensate for residual motion during the gating window. This project investigated the accuracy of ExacTrac and 4DCT imaging localizing an implanted coil at various phases of respiration. Radiochromic film measured delivered dose patterns for selected gating intervals over a variety of respiratory patterns. In order to establish accurate dosimetry, this project implemented and tested an EBT radiochromic film dosimetry system.
Film testing showed that the performance of a medical grade Vidar Dosimetry Pro radiographic film scanner and an Epson V700 Photo flatbed scanner were very similar. Both scanners showed nearly the same performance in terms of measurement repeatability, noise, vertical and horizontal uniformity over a range of doses from 11.5-511.9 cGy. The Vidar was selected for these studies due to clinical availability.
Even at the greatest coil velocities observed, ExacTrac coil localization agreed with calculated coil motion to within 0.8 mm. 4DCT showed errors up to 5.5 mm resolving coil position during large respiratory-induced velocities. 4DCT accurately measured the coil length within 1 mm of actual coil length at end expiration/inhalation. 4DCT can provide an accurate representation of the phantom at end-respiration for treatment planning purposes, and ExacTrac can accurately localize the coil to determine target motion in all phases
For patient treatments it is suggested that target margins should be set using the residual motion during gating. For patients without implanted coils, the residual motion can be computed based on the target motion measured from 4DCT and the size of the gating window. For patients with implanted coils, the ExacTrac system can be used to directly measure residual tumor motion during gating.
The hypothesis of this work was that gated delivery combined with 4DCT could limit internal margins to less than 3 mm while maintaining 95% prescription dose coverage of moving targets. The hypothesis was found to be true for gating windows of 10% and 20% for target motions up to 25 mm and was true with gating windows up to 50% for smaller motions (5 & 10 mm).
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