The treatment of moving tumors with a scanned ion beam is challenging due to interplay effects and changing beam range. We propose multigating, as a method for 4D-treatment optimization and delivery. In 3D beam tracking, tracking vectors are added during delivery to beam spot positions based on the detected motion phase. This has the disadvantage of dose errors in case of complex motion patterns and an uncertain out-of-target dose distribution. In multigating, the motion phase for each beam spot is predefined, which allows to add the tracking vector prior to beam weight optimization on all motion phases. The synchronization of delivery and target motion is assured by fast gating. The feasibility of the delivery was shown in a film experiment and required only minor software modification to the treatment planning system. In a treatment planning study in 4 lung cancer patients, target coverage could be restored to the level of a static reference plan by multigating (V95 > 99%) but not by standard beam tracking (V95 < 95%). The conformity of the multigating plans was only slightly lower than those of the static plan, with a conformity number of 72.0% (median, range 64.6–76.6%) compared to 75.8% (70.8–81.5%) in spite of target motion of up to 22 mm. In conclusion, we showed the technical feasibility of multigating, a 4D-optimization and delivery method using scanned beams that allows for conformal and homogeneous dose delivery to moving targets also in case of complex motion.
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