Respiratory gating and 4-D tomotherapy

Helical tomotherapy is a new intensity-modulated radiotherapy (IMRT) delivery process developed at the University of Wisconsin and TomoTherapy Inc. Tomotherapy may be of advantage in lung cancer treatment due to its rotational delivery mode. As with conventional IMRT delivery, however, intrafraction respiratory motion during a tomotherapy treatment causes unnecessary radiation to the healthy tissue. Possible solutions to these problems associated with intrafraction motion have been studied in this thesis. A spirometer is useful for monitoring breathing because of its direct correlation with lung volume changes. However, its inherent drift prevents its application in long-term breathing monitoring. With calibration and stabilization algorithms, a spirometer is able to provide accurate, long-term lung volume change measurements. Such a spirometer system is most suited for deep inspiration breath-hold (DIBH) treatments. An improved laser-spirometer combined system has also been developed for target tracking in 4-D treatment. Spirometer signals are used to calibrate the displacement measurements into lung volume changes, thereby eliminating scaling errors from daily setup variations. The laser displacement signals may also be used to correct spirometer drifts during operation. A new 4-D treatment technique has been developed to account for intrafraction motion in treatment planning. The patient’s breathing and the beam delivery are synchronized, and the target motion/deformation is incorporated into treatment plan optimization. Results show that this new 4D treatment technique significantly reduces motion effects and provides improved patient tolerance.