Analysis of the interplay effect in lung stereotactic ablative radiation therapy based on both breathing motion and plan characteristics

Abstract

Introduction: Stereotactic ablative radiotherapy (SABR) is susceptible to challenges for tumours affected by intrafraction organ motion. This study aims to investigate the effect of breathing characteristics and plan complexity on the interplay effect. Methods: A patient-specific interplay effect evaluation was performed using in-house software with an alpha version of the treatment planning verification software Verisoft (PTW-Freiburg, Germany) on VMAT plans. The OCTAVIUS 4D phantom was used to acquire the static dose distribution, and the simulation approach was utilised to generate the moving dose distribution. The influence of plan complexity, PTV size, number of breaths, and motion amplitudes on the interplay effect were examined. The dose distribution of two extreme phases—end-inhale and end-exhale—was considered using the gamma criteria of 2%/2 mm for the interplay effect evaluation. Results: A strong correlation was found between the motion amplitude (p < 0.001) and the NBs (p < 0.001) with the gamma-passing rate. No correlation was found between the gamma-passing rate and the PTV size or plan complexity. Conclusion: The simulation tool allowed the analysis of a large number of breathing traces, demonstrating how free-breathing patients, suspected of high interplay, could be selected for other motion management solutions. The simulated cases showed strong interplay effects for long breathing periods with extended motion amplitudes in a small group of patients.

Wobbling nature of gamma passing rate as a function of calibration field sizes in patient-specific quality assurance

“…While simple ion chamber measurements can provide one-dimensional (1D) information, it may not be sufficient for identifying errors in complex volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) plans. To obtain two-dimensional (2D) or three-dimensional (3D) dose information, many commercial array-based detectors are available, [3][4][5][6][7] equipped with built-in analyzing software. The planned dose and measured dose can be compared using the gamma index, quantifying the gamma passing rate (GPR) in percentage.…”