Dosimetric impact of baseline drift in volumetric modulated arc therapy with breath holding

Abstract

Background

We investigated the change of dose distributions in volumetric modulated arc therapy (VMAT) under baseline drift (BD) during breath holding.

Materials and methods

Ten VMAT plans recalculated to a static field at a gantry angle of 0° were prepared for measurement with a 2D array device and five original VMAT plans were prepared for measurement with gafchromic films. These measurement approaches were driven by a waveform reproducing breath holding with BD. We considered breath holding times of 15 and 10 s, and BD at four speeds; specifically, BD0 (0 mm/s), BD0.2 (0.2 mm/s), BD0.3 (0.3 mm/s), and BD0.4 (0.4 mm/s). The BD was periodically reproduced from the isocenter along the craniocaudal direction and the shift during breath holding (Shift_BH) ranged 0–6 mm.

The dose distribution of BD0.2, BD0.3 and BD0.4 were compared to that of BD0 using gamma analysis with the criterion of 2%/2 mm.

Results

The mean pass rates of each Shift_BH were 99.8% and 98.9% at 0 mm, 96.8% and 99.4% at 2 mm, 94.9% and 98.6% at 3 mm, 91.5% and 98.4% at 4 mm, 70.8% and 94.1% at 4.5 mm, and 55.0% and 83.6% at 6 mm for the array and film measurements, respectively.

Conclusion

We found significant differences in Shift_BH above 4 mm (ρ < 0.05). Hence, it is recommended that breath holding time should be shortened for patients to preserve the reproducibility of dose distributions.