Development of a geometry-based respiratory motion-simulating patient model for radiation treatment dosimetry

Temporal and spatial anatomic changes caused by respiration during radiation treatment delivery can lead to discrepancies between prescribed and actual radiation doses. The present paper documents a study to construct a respiratory-motion-simulating, four-dimensional (4D) anatomic and dosimetry model for the study of the dosimetric effects of organ motion for various radiation treatment plans and delivery strategies. The non-uniform rational B-splines (NURBS) method has already been used to reconstruct a three-dimensional (3D) VIP-Man ("visible photographic man") model that can reflect the deformation of organs during respiration by using time-dependent equations to manipulate surface control points. The EGS4 (Electron Gamma Shower, version 4) Monte Carlo code is then used to apply the 4D model to dose simulation. We simulated two radiation therapy delivery scenarios: gating treatment and 4D image-guided treatment. For each delivery scenario, we developed one conformal plan and one intensity-modulated radiation therapy plan. A lesion in the left lung was modeled to investigate the effect of respiratory motion on radiation dose distributions. Based on target dose-volume histograms, the importance of using accurate gating to improve the dose distribution is demonstrated. The results also suggest that, during 4D image-guided treatment delivery, monitoring of the patient's breathing pattern is critical. This study demonstrates the potential of using a "standard" motion-simulating patient model for 4D treatment planning and motion management.