Real-time motion-adaptive delivery (MAD) using binary MLC: I. Static beam (topotherapy) delivery

Intra-fraction target motion hits the fundamental basis of IMRT where precise target positions are assumed. Real-time motion compensation is necessary to ensure that the same dose is delivered as planned. Strategies for conventional IMRT delivery for moving targets by dynamic multi-leaf collimators (MLC) tracking are well published. Binary MLC-based IMRT, such as TomoTherapy®, requires synchronized motion of MLC, the couch and the gantry, which suggests a unique motion management strategy. Thanks to its ultra-fast leaf response and fast projection rate, real-time motion compensation for binary MLC-based IMRT is feasible. Topotherapy is a new IMRT delivery technique, which can be implemented in commercial helical TomoTherapy® machines using only fixed gantry positions. In this paper, we present a novel approach for TopoTherapy delivery that adjusts for moving targets without additional hardware and control requirement. This technique uses the planned leaf sequence but rearranges the projection and leaf indices. It does not involve time-consuming operations, such as reoptimization. Unlike gating or breath-hold-based methods, this technique can achieve nearly a 100% duty cycle with little breath control. Unlike dynamic MLC-based tracking methods, this technique requires neither the whole target motion trajectory nor the velocity of target motion. Instead, it only requires instantaneous target positions, which greatly simplifies the system implementation. Extensive simulations, including the worst-case scenarios, validated the presented technique to be applicable to relatively regular or mild irregular respirations. The delivered dose conforms well to the target, and significant margin reduction can be achieved provided that accurate, real-time tumor localization is available.