Quality Assurance for Respiratory-Gated Radiotherapy Using the Real-Time Tumor-Tracking Radiotherapy System

Purpose: Respiratory-gated radiation therapy (RT) using the real-time tumor-tracking radiotherapy (RTRT) system is an effective technique for managing tumor motion. High dosimetric and geometric accuracy is needed; however, quality assurance (QA) for respiratory-gated RT using the RTRT system has not been reported. The purpose of this study was to perform QA for respiratorygated RT using the RTRT system. Materials and Methods: The RTRT system detected the position of the fiducial marker and radiation delivery gated to the motion of the marker was performed. The dynamic anthropomorphic thorax phantom was positioned at the isocenter using the fiducial marker in the phantom. The phantom was irradiated only when the fiducial marker was within a three-dimensional gating window of ±2 mm from the planned position. First, the absolute doses were measured using anionization chamber inserted in the phantom under the stationary, gating and non-gating state for sinusoidal (nadir-to-peak amplitude [A]: 20 - 40 mm, breathing period [T]: 2 - 4 s) and the basic respiratory patterns. Second, the dose profiles were measured using Gafchromic films in the phantom under the same conditions. Differences between dose profiles were calculated to evaluate the dosimetric and geometric accuracy. Finally, differences between the actual and measured position of the fiducial marker were calculated to evaluate the tracking accuracy for sinusoidal and basic respiratory patterns. Results: For the sinusoidal patterns, the relative doses were 0.93 for non-gating and 0.99 for gating (A = 20 mm, T = 2 s), 0.94 for non-gating and 1.00 for gating (A = 20 mm, T = 4 s), 0.55 for non-gating and 1.00 for gating (A = 40 mm, T = 4 s), respectively. For the basic respiratory pattern, the relative doses were 1.00 for non-gating and 1.00 for gating, respectively. Compared to the stationary conditions, the differences in lateral distance between the 90% dose of dose profiles were 6.23 mm for non-gating and 0.36 mm for gating (A = 20 mm, T = 2 s), 8.79 mm for non-gating and 1.73 mm for gating (A = 20 mm, T = 4 s), 18.37 mm for non-gating and 0.67 mm for gating (A = 40 mm, T = 4 s), respectively. For the basic respiratory pattern, those were 5.23 mm for non-gating and 0.35 mm for gating. The root mean square (RMS) values of the tracking error were 0.18 mm (A = 20 mm, T = 2 s), 0.14 mm (A = 20 mm, T = 4 s), and 0.21 mm (A = 40 mm, T = 4 s) for sinusoidal and 0.79 mm for the basic respiratory pattern, respectively. Conclusion: We conducted QA for respiratory-gated RT using the RTRT system. The respiratory-gated RT using the RTRT system reduced the blurring effects on dose distribution with high dosimetric and geometric accuracy.