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Evaluation of motion management strategies based on required margins

Strategies for delivering radiation to a moving lesion each require a margin to compensate for uncertainties in treatment. These motion margins have been determined here by separating the total uncertainty into components. Probability density functions for the individual sources of uncertainty were calculated for ten motion traces obtained from the literature. Motion margins required to compensate for the center of mass motion of the clinical treatment volume were found by convolving the individual sources of uncertainty. For measurements of position at a frequency of 33 Hz, system latency was the dominant source of positional uncertainty. Averaged over the ten motion traces, the motion margin for tracking with a latency of 200 ms was 4.6 mm. Gating with a duty cycle of 33% required a mean motion margin of 3.2–3.4 mm, and tracking with a latency of 100 ms required a motion margin of 3.1 mm. Feasible reductions in the effects of the sources of uncertainty, for example by using a simple prediction algorithm to anticipate the lesion position at the end of the latency period, resulted in a mean motion margin of 1.7 mm for tracking with a latency of 100 ms, 2.4 mm for tracking with a latency of 200 ms, and 2.1–2.2 mm for the gating strategies with duty cycles of 33%. A crossover tracking latency of 150 ms was found, below which tracking strategies could take advantage of narrower motion margins than gating strategies. The methods described here provide a means to guide selection of a motion management strategy for a given patient.