Sci—Sat AM: Stereo — 04: Evaluation of VMAT interplay effect for lung SABR using TrueBeam 10XFFF beam

During a VMAT treatment delivery, the interplay effect between the moving target and varying machine parameters result in dose distributions that are different from those initially planned. In this work, we investigate this effect for lung SABR by using 4D dose calculation derived from the Varian TrueBeam trajectory log file. The impact of treatment start phase is also evaluated. A QUASAR™ respiratory motion phantom was scanned with motion amplitudes of 0.4, 1, 2 and 3 cm with a 4 second period. MIP and the average dataset were generated from the 4DCT. A static CT was also acquired with the tumor in its centre position. Plans were optimized with 10X FFF beam until PTV and fictitious critical structures met the dose constraints. Ten temporally interleaved plans were constructed with the temporal machine parameter information from the trajectory log file. Ten plans were calculated with isocentre shifts to simulate respiratory motion and then summed. For each motion amplitude, three separate sum plans were created with various phase shifts (no phase shift, maximum inhalation and maximum exhalation) to assess the impact of treatment start phase. For all the phase shifts investigated, the DVH for PTV demonstrated good dose coverage. However, a careful review of slice by slice plan comparison indicates dose "holes" are observed within PTV. The PTV dose difference between various treatment start phases can be as high as 19%. This assumes all treatment fractions have identical treatment start phase. Our future work includes evaluation of interplay effect for various breathing periods