Development and Validation of a MATLAB Software Program for Decoding the Treatment Errors in Real-time Position Management™ Gating-generated Breathing Trace

INTRODUCTION: The Real-time Position Management™ (RPM) is used as a motion management tool to reduce normal tissue complication. However, no commercial software is available to quantify the “beam-on” errors in RPM-generated breathing traces. This study aimed to develop and validate an in-house-coded MATLAB program to quantify the “beam-on” errors in the breathing trace. MATERIALS AND METHODS: A graphical user interface (GUI) was developed using MATLAB (Matrix Laboratory Ra2016) software. The GUI was validated using two phantoms (Varian-gated phantom and Brainlab ET gating phantom) with three regular motion profiles. Treatment time delay was calculated using regular sinusoidal motion profile. Ten patient's irregular breathing profiles were also analyzed using this GUI. RESULTS: The beam-on comparison between the recorded reference trace and irradiated trace profile was done in two ways: (1) beam-on time error and (2) beam-on displacement error. These errors were ≤1.5% with no statistical difference for phase- and amplitude-based treatments. The predicated amplitude levels of reference phase-based profiles, and the actual amplitude levels of amplitude-based irradiated profiles were almost equal. The average treatment time delay was 47 ± 0.003 ms. The irregular breathing profile analysis showed that the amplitude-based gating treatment was more accurate than phase based. CONCLUSION: The developed GUI gave the same and acceptable results for all regular profiles. These errors were due to the lag time of the linear accelerator with gating treatment. This program can be used as to quantifying the intrafraction “beam-on” errors in breathing trace with both mode of gating techniques for irregular breathing trace, and in addition, it is capable to convert phase-based gating parameters to amplitude-based gating parameters for treatment.