Quantitative analysis of dose distribution to determine optimal width of respiratory gating window using Gafchromic EBT2 film

The purpose of this study was to determine the dependence of the dose distribution on the width of the respiratory gating window by using radiochromic Gafchromic EBT2 film. An in-house three-dimensional breathing simulator was used with a 4-s cycle and a 3-cm movement. The gamma index and the 50, 95, and 20–80% dose distributions were individually analyzed with regard to static, 100 (full motion), 60, 40, 30, 20, and 15% respiratory gating windows. In addition, dose differences based on the different extents of exposure were compared and analyzed along with total beam delivery time. Dose distributions became increasingly similar to the static value with decreasing respiratory gating window width. The extent differences from the static case for the low-dose region were not significant; neither were the extent differences for the high-dose region and 30, 20, and 15% gating windows (P = 0.388, 0.275, respectively). However, the 40% gating window showed a significant difference (P = 0.001). Moreover, the treatment time for the 30% gating window was reduced by more than half compared to that for the 15% gating window. Thus, the 30% window would be a reasonable choice for maximizing the range of the gating window while markedly decreasing the dose difference and the treatment time.