Doctor of Philosophy
Dr. Jerry Battista, Dr. Jeff Chen
Tumour motion presents a significant limitation for effective radiotherapy of lung cancer, and more specifically for helical tomotherapy. The simultaneous and continuous movements of tomotherapy subsystems (gantry, couch, and binary multi-leaf collimator) can lead to inaccurate dose delivery, when combined with tumour motion. In this thesis, we have investigated the impact of tumour motion and strategies to reduce the resulting dose discrepancies for helical tomotherapy, through computer simulations and film measurements performed in a dynamic body phantom. Three distinctively different types of dose discrepancies have been isolated: dose rounding, dose rippling, and the intensity-modulated radiation therapy (IMRT) asynchronization effect. Each effect was shown to be affected by different combinations of tumour motion and treatment parameters. In clinical practice using a conventional fractionation scheme, the dose rounding effect remains the major concern, which can be compensated by assigning a larger treatment margin around the tumour volume. For hypofractionation schemes, the IMRT asynchronization effect can become an additional concern by introducing dose discrepancies inside the target volume, necessitating the use of a motion management technique.
Two new motion management techniques have thus been developed for helical tomotherapy: loose helical tomotherapy with breath-holding and multi-pass respiratory gating. Both methods require the treatment couch to be reset to its starting position to repeat the entire helical treatment, until nearly all planned dose is delivered. For sinusoidal target motion, employing multi-pass respiratory gating was shown to reduce the dose deviation inside the target volume from 14% to 2% for a single fraction, using 4 gated passes. For non-sinusoidal tumour motion causing a dose deviation of 6% within the tumour volume, the required number of passes to keep the dose deviation below 1% was approximately 4 passes for 30 fractions and 5 passes for 3 fractions, demonstrating the feasibility of the multi-pass respiratory gating approach. Clinical implementation of the multi-pass respiratory gating technique would require a number of electronic control and communication modifications to the existing tomotherapy machine, which would lead to significant improvements in the dose distributions delivered for lung tomotherapy treatments – especially for patients exhibiting large tumour motion who are treated with hypofractionation schemes.
Kim, Bryan, "Strategies for Reducing the Impact of Tumour Motion During Helical Tomotherapy" (2011). University of Western Ontario - Electronic Thesis and Dissertation Repository. Paper 256.