Tumors in thoracic and upper abdomen regions such as lungs, liver, pancreas, esophagus, and breast move due to respiration. Respiration-induced motion introduces uncertainties in radiotherapy treatments of these sites and is regarded as a significant bottleneck in achieving highly conformal dose distributions. Recent developments in radiation therapy have resulted in (i) motion-encompassing, (ii) respiratory gating, and (iii) tracking methods for adapting the radiation beam aperture to account for the respiration-induced target motion. The purpose of this review is to discuss the magnitude, impact, and management of respiration-induced tumor motion.

Nowadays, volumetric modulated arc therapy (VMAT) is increasingly used in clinics, and this arc therapy enables us to acquire CBCT imaging simultaneously. But, the main issue of concurrent imaging is the "MV scatter" effect on CBCT imaging. This study aims to experimentally quantify the effect of MV scatter on CBCT image quality.

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The purpose of this study was to evaluate the capabilities of DMLC to deliver the respiratory motion‐synchronized dynamic IMRT (MS‐IMRT) treatments under various dose rates. In order to create MS‐IMRT plans, the DMLC leaf motions in dynamic IMRT plans of eight lung patients were synchronized with the respiratory motion of breathing period 4 sec and amplitude 2 cm (peak to peak) using an in‐house developed leaf position modification program. The MS‐IMRT plans were generated for the dose rates of 100 MU/min, 400 MU/min, and 600 MU/min. All the MS‐IMRT plans were delivered in a medical linear accelerator, and the fluences were measured using a 2D ion chamber array, placed over a moving platform. The accuracy of MS‐IMRT deliveries was evaluated with respect to static deliveries (no compensation for target motion) using gamma test. In addition, the fluences of gated delivery of 30% duty cycle and non‐MS‐IMRT deliveries were also measured and compared with static deliveries. The MS‐IMRT was better in terms of dosimetric accuracy, compared to gated and non‐MS‐IMRT deliveries. The dosimetric accuracy was observed to be significantly better for 100 MU/min MS‐IMRT. However, the use of high‐dose rate in a MS‐IMRT delivery introduced dose‐rate modulation/beam hold‐offs that affected the synchronization between the DMLC leaf motion and target motion. This resulted in more dose deviations in MS‐IMRT deliveries at the dose rate of 600 MU/min.PACS numbers: 87.53.kn, 87.56.N‐

The purpose of this study was to evaluate the dosimetric effect of the leaf width of a multileaf collimator (MLC) in intensity-modulated radiotherapy (IMRT) delivery techniques for small- and large-volume targets. We retrospectively selected previously treated 5 intracranial and 5 head-neck patients for this study to represent small- (range, 18.37-72.75 cc; mean, 42.99 cc) and large-volume (range, 312.31-472.84 cc; mean, 361.14 cc) targets. A 6-MV photon beam data was configured for Brianlab m3 (3 mm), Varian Millennium 120 (5 mm) and Millennium 80 (10 mm) MLCs in the Eclipse treatment-planning system. Sliding window and step-shoot IMRT plans were generated for intracranial patients using all the above-mentioned MLCs; but due to the field size limitation of Brainlab MLC, we used only 5-mm and 10-mm MLCs in the head-and-neck patients. Target conformity, dose to the critical organs and dose to normal tissues were recorded and evaluated. Although the 3-mm MLC resulted in better target conformity (mean difference of 7.7% over 5-mm MLC and 12.7% over 10-mm MLC) over other MLCs for small-volume targets, it increased the total monitor units of the plans. No appreciable differences in terms of target conformity, organ at risk and normal-tissue sparing were observed between the 5-mm and 10-mm MLCs for large-volume targets. The effect of MLC leaf width was not quantifiably different in sliding window and step and shoot techniques. In addition, we observed that there was no additional benefit to the sliding-window (SW) technique when compared to the step-shoot (SS) technique as a result of reduction of MLC leaf width.