Gating-by-rotation: a solution to the problem of intratreatment motion in helical tomotherapy

Purpose: To assess the feasibility of addressing intratreatment motion issues in helical tomotherapy by gating the treatments by rotation. Intratreatment motion is a problem common to all IMRT techniques. Traditional methods of gating in conformal radiotherapy and some forms of IMRT are not applicable to helical tomotherapy due to the continuous rotation of the gantry. An alternative method is presented. Materials and Methods: Rotation-gating in helical tomotherapy is the process in which one rotation of treatment is immediately followed by a rotation of non-treatment. This on-off strategy is repeated for the full treatment volume. During the treatment rotations, the patient is required to hold their breath while the intensity-modulated fan beam deposits dose. For the non-treatment rotations, the patient is allowed to breathe freely as all leaves of the MLC will be closed, the accelerator disabled, or both. The couch indexes normally for treatment rotations and holds the patient stationary during non-treatment rotations. An investigation was conducted to assess the feasibility of rotation-gating. Film was placed between two hemispheres of a water phantom and a continuous helical delivery was carried out with all leaves opened. The film was replaced and another treatment was performed employing rotation-gating. The two films were compared to assess the process. The films were irradiated to dose levels within the linear region of the film response curve (maximum film dose ∼35 cGy). Films were also acquired with all leaves closed to quantify leakage dose through the collimation systems. Results: Central profiles for the inferior-superior direction (parallel to the direction of translation) for both films are displayed in Figure 1. The profiles agree very well, illustrating that a rotation-gated treatment closely mimics a continuous helical delivery. The only significant discrepancy lay in the tails of the profiles: a higher film dose is seen for the rotation-gated treatment as the leakage dose is higher for this delivery strategy. There are two possibilities for addressing this leakage dose: 1. it can be used to image the patient and thus provide information (albeit motion-blurred) regarding the patient position during the non-treatment rotations, 2. it can be completely removed by disabling the beam pulses during these rotations using the accelerator's gridded-gun feature. Conclusion: Rotation-gating is a feasible solution for solving the problem of intratreatment motion in helical tomotherapy. Further studies are planned on the helical tomotherapy prototype at the University of Wisconsin