To investigate the impact of respiratory movement to determine the target volume on cone beam CT (CBCT) for lung tumor, we used CIRS dynamic thorax phantom (Model-CIRS008) to simulate the sinusoidal motion of lung tumor. With a constant amplitude, the ratio of the time of near-end-expiratory and near-end-inspiratory (E/I) changed when it was scanned with CBCT. We analyzed the contrast changes of target by extracting the CT value of each pixel on the center line of the target movement direction. The targets were contoured with region growing method and compared with the motion volume generated by the tumor trajectory method. The result showed that the contrast of near-end-expiratory increased and the contrast of near-end-inspiratory decreased with increasing E/I. The contoured volume generated by region growing method decreased with increasing E/I. When E/I = 4, the amplitude A = 1 cm, diameter of 1 cm and 3 cm target volumes were reduced by 48.2% and 22.7%. The study showed that CBCT was not suitable to be used to accurately determine the range of lung tumor movement. The internal target volume (ITV) may be underestimated in CBCT images.
Cone-Beam Computed Tomography ; Humans ; Lung Neoplasms ; diagnostic imaging ; Movement ; Phantoms, Imaging ; Respiration

Objective To evaluate the characteristics and clinical suitability of the ArcCHECK diode array for volumetric-modulated arc therapy (VMAT) verification.Methods The intrinsic sensitivity,short and long term reproducibility,dose and dose rate dependence,dose per pulsed dependence,field sizes dependence and directional response of the diodes were measured.The results of the diodes were compared with the measurement results of an ionization chamber and calculated results of treatment planning system.Gamma index was used to analyze the dose difference between the calculation and measurement for random selected 211 verified VMAT plans.Results The ArcCHECK performed well for all tests except directional dependence,which varies from a minimum of-3.9％ (seen only when the beam was incident on the diode at 180°) to a maximum of 7.7％ (approximately at 255°).Average gamma analysis passing rates with 3 mm/3％ for 113 nasopharyngeal cancer,48 cervical cancer and 50 rectal cancer patients VMAT plans were 93.5％,95.7％ and 97.5％,respectively,statistical significance has been found between either two of the groups (t=-12.69-4.88,all P＜ 0.01).Conclusions With proposed calibration method,the ArcCHECK diode array is very suitable for VMAT pretreatment verification,the complexity of VMAT plan is the main factor affecting the passing rate.

Objective To establish and evaluate a morning check system for linac based on electronic portal image device (EPID).Methods Delivered fluence maps of open and wedge fields at 10 cm×10 cm field size of Synergy Linac were measured by EPID.Figure features from these two images were extracted with matlab codes and analyzed to realize a quick morning check.The repeatability of dose response and mechanical setup,relationship between gray value and machine unit (MU),accuracy of output and field size test were investigated with both EPID and DailyQA3.The status of Synergy linac was monitored both by DailyQA3 and EPID for two months.Results EPID was able to test the linac consistently with a testing error of 0.50 mm,1.00 mm for field size and center,respectively.Both of the test accuracy for flatness and symmetry was 0.17％.The mechanical accuracy test and dosimetric repeatability test were also consistent.The dose response of EPID was linearly related to the linac output (R2＞0.999).EPID was highly sensitive to the change of output and radiation field size.The measurement deviations between EPID and DailyQA3 were consistent and within clinical acceptable tolerance.Conclusions EPID showed great accuracy and stability on monitoring the performance of linac.The established daily check tool based-on EPID is accurate and reliable for clinical usage.