To analyze the dosimetric and geometrical variations due to irregular breathing patterns on normal helical CT and 4D CT datasets for lung cancer SBRT treatments. Regular and irregular motion models were created and imported into a dynamic thorax phantom for imaging, planning and does measurement 64-slice CT, 6-MV photon beams and a treatment planning system were used. The regular motion was a sine wave with longitudinal range of ±1.5 cm and period of 4 sec. The irregular motions were generated by extracting the RPM cycles of different degrees of amplitude or phase variations from patients. Two 20 mm diameter and soft-tissue equivalent semispherical target was embedded in a motion rod for use with the phantom. Helical CT for static target, and 4D CT for motion target in regular and all irregular motions were performed. Phase bin, maximum and average intensity projection (MIP, AIP) CTs were reconstructed to evaluate the target position and geometric distortion. Static plan, and the motion plans for different patterns with phase-based gating (interval of 30–70%) and non-gating treatment were generated using RaipArc and IMRT techniques. EBT3 film was used for dose measurement. Dose profile comparison and gamma analysis (±3%/1 mm criteria) were used to quantify the dose agreement between measurements and calculations. Compare with static CT, MIP images shown a slight higher HU (value of 50) in the target region. By contrast to MIP images with a homogeneous HU distribution in the target region, AIP images were with a much lower HU and with a shape of Gauss distribution (-780 to -350). Phase bin with 10 phases or 20 phases have similar geometrical shapes. Phase bin images with higher target motion velocity (phase 25% and 75%) have a significantly larger target center position errors (3.0 to 3.4 mm). The variations of target volume for static CT and regular motion phase bin CTs were within 2.5%, AIP and MIP CTs showed a volume reduction of -6.7% and -3.8%, respectively. For irregular motions, slightly differences (-6.2 to -7.7%) on ITV between AIP and MIP images (AIP/MIP) were found for gated plans, and had a larger differences (-12.3 to -15.2%) for non-gated plans. Dosimetric comparisons showed a high passing rate (>98.5%) for static plan in the target region, AIP and MIP gated plans have average passing rates of 92.2±5.3% and 85.8±8.9%, respectively. Non-gated plans have significantly lower and deviated passing rates, AIP and MIP plans were with passing rates of 43.6±20.8% and 66.7±36.4%, respectively (p < 0.05). Faster motion results in larger position errors in 4D CT image acquisition, and Irregular breathing motion leads to volume reduction for AIP images; therefore, plan CT should avoid using fast period CT, breath coaching should be used to maintain regular motion, and the ITV in AIP CT should be verified. For Irregular motions during treatment, phase-based gated plans have target doses more consistent with the plans than the non-gated plans.
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