Quality assurance evaluation of delivery of respiratory‐gated treatments

We describe a method for evaluating the quality of respiratory-gated radiation delivery using a commercially available device. During irradiation, gating traces for one field for each treatment were extracted from the system for each of 14 patients. The data were then transferred to a spreadsheet. Software was developed to evaluate the following parameters: duty cycle, amplitude of fiducial motion, fraction of amplitude of motion during gated delivery, and respiratory cycle time. Criteria were established for acceptability of gating traces. In our sample, over 85% of the traces indicated acceptability. An example of results for one patient extracted from analyzed gating traces is as follows: mean duty cycle, 57%, average amplitude of motion, 0.89 cm, average fraction of motion during gated delivery, 0.45; mean respiratory cycle time, 4.5 s. This technique can be used to evaluate delivery of respiratory-gated radiation therapy for quality assurance purposes and to assess various techniques for improving delivery of gated therapy. A hardcopy of the gating traces can be used to document gated treatment delivery for potential billing of the gated delivery process.