Aperture maneuver with compelled breath (AMC) for moving tumors: a feasibility study with a moving phantom

Med Phys. 2004 Apr;31(4):760-6. doi: 10.1118/1.1650565.

Abstract

Respiration causes target motion, which is known to be one of the technical bottlenecks in radiotherapy, especially for stereotactic radio-surgery and intensity modulated radiotherapy (IMRT). To overcome this problem, aperture maneuver with compelled breath (AMC) has been developed. In order to simulate compelled respiratory motion, a moving phantom using a ventilator was designed. As the air flow was forced to the bellows, which simulates the lungs, by a ventilator, a film connected to the ventilator moved like the respiratory target motion. A software was developed to transfer multileaf collimator motion from breathless to actual periodic breathing conditions. Static fields as well as step-and-shoot IMRT fields were modified in accordance with moving shapes to follow the target position, using the software with the controlled breathing information. Film dosimetry for a small field and for IMRT fields with a moving phantom was performed. To evaluate clinical implementation, five healthy volunteers were tested to breathe through a ventilator, and all of them could adapt the compelled breath without any difficulties. Additive margins for a moving target with AMC were not larger than 3 mm for respiratory organ motions up to 18 mm, while those with the static beam were 9 mm. For IMRT fields, large discrepancies were present between a static target and a moving target with the static beam, while they coincided well with AMC. Clinical acceptable differences between the dose distributions from a static target with the static beam and from a moving target with AMC revealed that this technique could be applied clinically.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Algorithms
  • Feasibility Studies
  • Feedback
  • Humans
  • Motion
  • Movement*
  • Neoplasms / physiopathology*
  • Neoplasms / radiotherapy*
  • Radiometry / methods*
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted / methods*
  • Radiotherapy, Computer-Assisted / methods*
  • Respiration*
  • Sensitivity and Specificity