Dosimetric comparison of hybrid volumetric-modulated arc therapy, volumetric-modulated arc therapy, and intensity-modulated radiation therapy for left-sided early breast cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lin, Jia-Fu; Yeh, Dah-Cherng; Yeh, Hui-Ling, E-mail: hlyeh@vghtc.gov.tw

2015-10-01

To compare the dosimetric performance of 3 different treatment techniques: hybrid volumetric-modulated arc therapy (hybrid-VMAT), pure-VMAT, and fixed-field intensity-modulated radiation therapy (F-IMRT) for whole-breast irradiation of left-sided early breast cancer. The hybrid-VMAT treatment technique and 2 other treatment techniques—pure-VMAT and F-IMRT—were compared retrospectively in 10 patients with left-sided early breast cancer. The treatment plans of these patients were replanned using the same contours based on the original computed tomography (CT) data sets. Dosimetric parameters were calculated to evaluate plan quality. Total monitor units (MUs) and delivery time were also recorded and evaluated. The hybrid-VMAT plan generated the best results inmore » dose coverage of the target and the dose uniformity inside the target (p < 0.0001 for conformal index [CI]; p = 0.0002 for homogeneity index [HI] of planning target volume [PTV]{sub 50.4} {sub Gy} and p < 0.0001 for HI of PTV{sub 62} {sub Gy}). Volumes of ipsilateral lung irradiated to doses of 20 Gy (V{sub 20} {sub Gy}) and 5 Gy (V{sub 5} {sub Gy}) by the hybrid-VMAT plan were significantly less than those of the F-IMRT and the pure-VMAT plans. The volume of ipsilateral lung irradiated to a dose of 5 Gy was significantly less using the hybrid-VMAT plan than that using the F-IMRT or the pure-VMAT plan. The total mean MUs for the hybrid-VMAT plan were significantly less than those for the F-IMRT or the pure-VMAT plan. The mean machine delivery time was 3.23 ± 0.29 minutes for the hybrid-VMAT plans, which is longer than that for the pure-VMAT plans but shorter than that for the F-IMRT plans. The hybrid-VMAT plan is feasible for whole-breast irradiation of left-sided early breast cancer.« less

Implementation of a volumetric modulated arc therapy treatment planning solution for kidney and adrenal stereotactic body radiation therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sonier, Marcus, E-mail: Marcus.Sonier@bccancer.bc.ca; Chu, William; Department of Radiation Oncology, University of Toronto, Toronto, ON

To develop a volumetric modulated arc therapy (VMAT) treatment planning solution in the treatment of primary renal cell carcinoma and oligometastatic adrenal lesions with stereotactic body radiation therapy. Single-arc VMAT plans (n = 5) were compared with clinically delivered step-and-shoot intensity-modulated radiotherapy (IMRT) with planning target volume coverage normalized between techniques. Target volume conformity, organ-at-risk (OAR) dose, treatment time, and monitor units were compared. A VMAT planning solution, created from a combination of arc settings and optimization constraints, auto-generated treatment plans in a single optimization. The treatment planning solution was evaluated on 15 consecutive patients receiving kidney and adrenal stereotacticmore » body radiation therapy. Treatment time was reduced from 13.0 ± 2.6 to 4.0 ± 0.9 minutes for IMRT and VMAT, respectively. The VMAT planning solution generated treatment plans with increased target homogeneity, improved 95% conformity index, and a reduced maximum point dose to nearby OARs but with increased intermediate dose to distant OARs. The conformity of the 95% isodose improved from 1.32 ± 0.39 to 1.12 ± 0.05 for IMRT and VMAT treatment plans, respectively. Evaluation of the planning solution showed clinically acceptable dose distributions for 13 of 15 cases with tight conformity of the prescription isodose to the planning target volume of 1.07 ± 0.04, delivering minimal dose to OARs. The introduction of a stereotactic body radiation therapy VMAT treatment planning solution improves the efficiency of planning and delivery time, producing treatment plans of comparable or superior quality to IMRT in the case of primary renal cell carcinoma and oligometastatic adrenal lesions.« less

MO-AB-BRA-01: A Global Level Set Based Formulation for Volumetric Modulated Arc Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nguyen, D; Lyu, Q; Ruan, D

2016-06-15

Purpose: The current clinical Volumetric Modulated Arc Therapy (VMAT) optimization is formulated as a non-convex problem and various greedy heuristics have been employed for an empirical solution, jeopardizing plan consistency and quality. We introduce a novel global direct aperture optimization method for VMAT to overcome these limitations. Methods: The global VMAT (gVMAT) planning was formulated as an optimization problem with an L2-norm fidelity term and an anisotropic total variation term. A level set function was used to describe the aperture shapes and adjacent aperture shapes were penalized to control MLC motion range. An alternating optimization strategy was implemented to solvemore » the fluence intensity and aperture shapes simultaneously. Single arc gVMAT plans, utilizing 180 beams with 2° angular resolution, were generated for a glioblastoma multiforme (GBM), lung (LNG), and 2 head and neck cases—one with 3 PTVs (H&N3PTV) and one with 4 PTVs (H&N4PTV). The plans were compared against the clinical VMAT (cVMAT) plans utilizing two overlapping coplanar arcs. Results: The optimization of the gVMAT plans had converged within 600 iterations. gVMAT reduced the average max and mean OAR dose by 6.59% and 7.45% of the prescription dose. Reductions in max dose and mean dose were as high as 14.5 Gy in the LNG case and 15.3 Gy in the H&N3PTV case. PTV coverages (D95, D98, D99) were within 0.25% of the prescription dose. By globally considering all beams, the gVMAT optimizer allowed some beams to deliver higher intensities, yielding a dose distribution that resembles a static beam IMRT plan with beam orientation optimization. Conclusions: The novel VMAT approach allows for the search of an optimal plan in the global solution space and generates deliverable apertures directly. The single arc VMAT approach fully utilizes the digital linacs’ capability in dose rate and gantry rotation speed modulation. Varian Medical Systems, NIH grant R01CA188300, NIH grant R43CA183390.« less

SU-F-T-446: Improving Craniospinal Irradiation Technique Using Volumetric Modulated Arc Therapy (VMAT) Planning and Its Dosimetric Verification

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, X; Tejani, M; Jiang, X

2016-06-15

Purpose: The purpose of this study is to investigate a volumetric modulated arc therapy (VMAT) treatment planning technique for supine craniospinal irradiation (CSI). Evaluate the suitability of VMAT for CSI with dosimetric measurements and compare it to 3D conformal planning using specific plan metrics such as dose conformity, homogeneity, and dose of organs at risk (OAR). Methods: Ten CSI patients treated with conventional 3D technique were re-planned with VMAT. The PTV was contoured to include the whole contents of the brain and spinal canal with a uniform margin of 5 mm. VMAT plans were generated with two partial arcs coveringmore » the brain, two partial arcs for the superior portion of the spinal cord and two partial arcs covering the remaining inferior portion of the spinal cord. Conformity index (CI), heterogeneity indexes (HI) and max and mean doses of OAR were compared to 3D plans. VMAT plans were delivered onto an anthropomorphic phantom loaded with Gafchromic films and OSLDs placed at specific positions to evaluate the plan dose at the junctions and as well as the plan dose distributions. Results: This VMAT technique was validated with a clinical study of 10 patients. The average CI was 1.03±0.02 for VMAT plans and 1.96±0.32 for conformal plans. And the average HI was 1.15±0.01 for VMAT plans and 1.51±0.21 for conformal plans. The mean and max doses to the all OARs for VMAT plans were significantly lower than conformal plans. The measured dose in phantom for VAMT plans was comparable to the calculated dose in Eclipse and the doses at junctions were verified. Conclusion: VMAT CSI was able to achieve better dose conformity and heterogeneity as well as significantly reducing the dose to Heart, esophagus and larynx. VMAT CSI appears to be a dosimterically advantageous, faster delivery, has better reproducibility CSI treatment.« less

Dosimetric and efficiency comparison of high-dose radiotherapy for esophageal cancer: volumetric modulated arc therapy versus fixed-field intensity-modulated radiotherapy.

PubMed

Lin, C-Y; Huang, W-Y; Jen, Y-M; Chen, C-M; Su, Y-F; Chao, H-L; Lin, C-S

2014-08-01

The aim of this study was to compare high-dose volumetric modulated arc therapy (VMAT) and fixed-field intensity-modulated radiotherapy (ff-IMRT) plans for the treatment of patients with middle-thoracic esophageal cancer. Eight patients with cT2-3N0M0 middle-thoracic esophageal cancer were enrolled. The treatment planning system was the version 9 of the Pinnacle(3) with SmartArc (Philips Healthcare, Fitchburg, WI, USA). VMAT and ff-IMRT treatment plans were generated for each case, and both techniques were used to deliver 50 Gy to the planning target volume (PTV(50)) and then provided a 16-Gy boost (PTV(66)). The VMAT plans provided superior PTV(66) coverage compared with the ff-IMRT plans (P = 0.034), whereas the ff-IMRT plans provided more appropriate dose homogeneity to the PTV(50) (P = 0.017). In the lung, the V(5) and V(10) were lower for the ff-IMRT plans than for the VMAT plans, whereas the V(20) was lower for the VMAT plans. The delivery time was significantly shorter for the VMAT plans than for the ff-IMRT plans (P = 0.012). In addition, the VMAT plans delivered fewer monitor units. The VMAT technique required a shorter planning time than the ff-IMRT technique (3.8 ± 0.8 hours vs. 5.4 ± 0.6 hours, P = 0.011). The major advantages of VMAT plans are higher efficiency and an approximately 50% reduction in delivery time compared with the ff-IMRT plans, with comparable plan quality. Further clinical investigations to evaluate the use of high-dose VMAT for the treatment of esophageal cancer are warranted. © 2013 Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

SU-E-T-811: Volumetric Modulated Arc Therapy Vs. C-IMRT for the Treatment of Upper Thoracic Esophageal Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, W; Wu, L; Lu, J

2015-06-15

Purpose: To compare plans using volumetric-modulated arc therapy (VMAT) with conventional sliding window intensity-modulated radiation therapy (c-IMRT) to treat upper thoracic esophageal cancer (EC). Methods: CT datasets of 11 patients with upper thoracic EC were identified. Four plans were generated for each patient: c-IMRT with 5 fields (5F) and VMAT with a single arc (1A), two arcs (2A), or three arcs (3A). The prescribed doses were 64 Gy/32 F for the primary tumor (planning target volume 64, PTV64). The dose-volume histogram data, the number of monitoring units (MUs) and the treatment time (TT) for the different plans were compared. Results:more » All of the plans generated similar dose distributions for PTVs and organs at risk (OARs), except that the 2A- and 3A-VMAT plans yielded a significantly higher conformity index (CI) than the c-IMRT plan. The CI of the PTV64 was improved by increasing the number of arcs in the VMAT plans. The maximum spinal cord dose and the planning risk volume of the spinal cord dose for the two techniques were similar. The 2A- and 3A-VMAT plans yielded lower mean lung doses and heart V50 than the c-IMRT. The V20 and V30 for the lungs in all of the VMAT plans were lower than those in the c-IMRT plan, at the expense of increasing V5, V10 and V13. The VMAT plan resulted in significant reductions in MUs and TT. Conclusion: The 2A-VMAT plan appeared to spare the lungs from moderate-dose irradiation most effectively of all plans, at the expense of increasing the low-dose irradiation volume, and also significantly reduced the number of required MUs and the TT. The CI of the PTVs and the OARs was improved by increasing the arc-number from 1 to 2. however, no significant improvement was observed using the 3A-VMAT, except for an increase in the TT. This work was sponsored by Shantou University Medical College Clinical Research Enhancement Initiative(NO.201424)« less

Ultrafast treatment plan optimization for volumetric modulated arc therapy (VMAT)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Men Chunhua; Romeijn, H. Edwin; Jia Xun

2010-11-15

Purpose: To develop a novel aperture-based algorithm for volumetric modulated arc therapy (VMAT) treatment plan optimization with high quality and high efficiency. Methods: The VMAT optimization problem is formulated as a large-scale convex programming problem solved by a column generation approach. The authors consider a cost function consisting two terms, the first enforcing a desired dose distribution and the second guaranteeing a smooth dose rate variation between successive gantry angles. A gantry rotation is discretized into 180 beam angles and for each beam angle, only one MLC aperture is allowed. The apertures are generated one by one in a sequentialmore » way. At each iteration of the column generation method, a deliverable MLC aperture is generated for one of the unoccupied beam angles by solving a subproblem with the consideration of MLC mechanic constraints. A subsequent master problem is then solved to determine the dose rate at all currently generated apertures by minimizing the cost function. When all 180 beam angles are occupied, the optimization completes, yielding a set of deliverable apertures and associated dose rates that produce a high quality plan. Results: The algorithm was preliminarily tested on five prostate and five head-and-neck clinical cases, each with one full gantry rotation without any couch/collimator rotations. High quality VMAT plans have been generated for all ten cases with extremely high efficiency. It takes only 5-8 min on CPU (MATLAB code on an Intel Xeon 2.27 GHz CPU) and 18-31 s on GPU (CUDA code on an NVIDIA Tesla C1060 GPU card) to generate such plans. Conclusions: The authors have developed an aperture-based VMAT optimization algorithm which can generate clinically deliverable high quality treatment plans at very high efficiency.« less

Ultrafast treatment plan optimization for volumetric modulated arc therapy (VMAT).

PubMed

Men, Chunhua; Romeijn, H Edwin; Jia, Xun; Jiang, Steve B

2010-11-01

To develop a novel aperture-based algorithm for volumetric modulated are therapy (VMAT) treatment plan optimization with high quality and high efficiency. The VMAT optimization problem is formulated as a large-scale convex programming problem solved by a column generation approach. The authors consider a cost function consisting two terms, the first enforcing a desired dose distribution and the second guaranteeing a smooth dose rate variation between successive gantry angles. A gantry rotation is discretized into 180 beam angles and for each beam angle, only one MLC aperture is allowed. The apertures are generated one by one in a sequential way. At each iteration of the column generation method, a deliverable MLC aperture is generated for one of the unoccupied beam angles by solving a subproblem with the consideration of MLC mechanic constraints. A subsequent master problem is then solved to determine the dose rate at all currently generated apertures by minimizing the cost function. When all 180 beam angles are occupied, the optimization completes, yielding a set of deliverable apertures and associated dose rates that produce a high quality plan. The algorithm was preliminarily tested on five prostate and five head-and-neck clinical cases, each with one full gantry rotation without any couch/collimator rotations. High quality VMAT plans have been generated for all ten cases with extremely high efficiency. It takes only 5-8 min on CPU (MATLAB code on an Intel Xeon 2.27 GHz CPU) and 18-31 s on GPU (CUDA code on an NVIDIA Tesla C1060 GPU card) to generate such plans. The authors have developed an aperture-based VMAT optimization algorithm which can generate clinically deliverable high quality treatment plans at very high efficiency.

Volumetric Modulated Arc Therapy vs. c-IMRT for the Treatment of Upper Thoracic Esophageal Cancer

PubMed Central

Lu, Jia-Yang; Chen, Jian-Zhou; Chen, Zhi-Jian; Li, De-Rui; Chen, Chuang-Zhen

2015-01-01

Objective To compare plans using volumetric-modulated arc therapy (VMAT) with conventional sliding window intensity-modulated radiation therapy (c-IMRT) to treat upper thoracic esophageal cancer (EC). Methods CT datasets of 11 patients with upper thoracic EC were identified. Four plans were generated for each patient: c-IMRT with 5 fields (5F) and VMAT with a single arc (1A), two arcs (2A), or three arcs (3A). The prescribed doses were 64 Gy/32 F for the primary tumor (PTV64). The dose-volume histogram data, the number of monitoring units (MUs) and the treatment time (TT) for the different plans were compared. Results All of the plans generated similar dose distributions for PTVs and organs at risk (OARs), except that the 2A- and 3A-VMAT plans yielded a significantly higher conformity index (CI) than the c-IMRT plan. The CI of the PTV64 was improved by increasing the number of arcs in the VMAT plans. The maximum spinal cord dose and the planning risk volume of the spinal cord dose for the two techniques were similar. The 2A- and 3A-VMAT plans yielded lower mean lung doses and heart V50 values than the c-IMRT. The V20 and V30 for the lungs in all of the VMAT plans were lower than those in the c-IMRT plan, at the expense of increasing V5, V10 and V13. The VMAT plan resulted in significant reductions in MUs and TT. Conclusion The 2A-VMAT plan appeared to spare the lungs from moderate-dose irradiation most effectively of all plans, at the expense of increasing the low-dose irradiation volume, and also significantly reduced the number of required MUs and the TT. The CI of the PTVs and the OARs was improved by increasing the arc-number from 1 to 2; however, no significant improvement was observed using the 3A-VMAT, except for an increase in the TT. PMID:25815477

Robust Proton Pencil Beam Scanning Treatment Planning for Rectal Cancer Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blanco Kiely, Janid Patricia, E-mail: jkiely@sas.upenn.edu; White, Benjamin M.

2016-05-01

Purpose: To investigate, in a treatment plan design and robustness study, whether proton pencil beam scanning (PBS) has the potential to offer advantages, relative to interfraction uncertainties, over photon volumetric modulated arc therapy (VMAT) in a locally advanced rectal cancer patient population. Methods and Materials: Ten patients received a planning CT scan, followed by an average of 4 weekly offline CT verification CT scans, which were rigidly co-registered to the planning CT. Clinical PBS plans were generated on the planning CT, using a single-field uniform-dose technique with single-posterior and parallel-opposed (LAT) fields geometries. The VMAT plans were generated on the planningmore » CT using 2 6-MV, 220° coplanar arcs. Clinical plans were forward-calculated on verification CTs to assess robustness relative to anatomic changes. Setup errors were assessed by forward-calculating clinical plans with a ±5-mm (left–right, anterior–posterior, superior–inferior) isocenter shift on the planning CT. Differences in clinical target volume and organ at risk dose–volume histogram (DHV) indicators between plans were tested for significance using an appropriate Wilcoxon test (P<.05). Results: Dosimetrically, PBS plans were statistically different from VMAT plans, showing greater organ at risk sparing. However, the bladder was statistically identical among LAT and VMAT plans. The clinical target volume coverage was statistically identical among all plans. The robustness test found that all DVH indicators for PBS and VMAT plans were robust, except the LAT's genitalia (V5, V35). The verification CT plans showed that all DVH indicators were robust. Conclusions: Pencil beam scanning plans were found to be as robust as VMAT plans relative to interfractional changes during treatment when posterior beam angles and appropriate range margins are used. Pencil beam scanning dosimetric gains in the bowel (V15, V20) over VMAT suggest that using PBS to treat rectal cancer may reduce radiation treatment–related toxicity.« less

SU-E-J-127: Implementation of An Online Replanning Tool for VMAT Using Flattening Filter-Free Beams

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ates, O; Ahunbay, E; Li, X

2015-06-15

Purpose: This is to report the implementation of an online replanning tool based on segment aperture morphing (SAM) for VMAT with flattening filter free (FFF) beams. Methods: Previously reported SAM algorithm modified to accommodate VMAT with FFF beams was implemented in a tool that was interfaced with a treatment planning system (Monaco, Elekta). The tool allows (1) to output the beam parameters of the original VMAT plan from Monaco, and (2) to input the apertures generated from the SAM algorithm into Monaco for the dose calculation on daily CT/CBCT/MRI in the following steps:(1) Quickly generating target contour based on themore » image of the day, using an auto-segmentation tool (ADMIRE, Elekta) with manual editing if necessary; (2) Morphing apertures based on the SAM in the original VMAT plan to account for the interfractional change of the target from the planning to the daily images; (3) Calculating dose distribution for new apertures with the same numbers of MU as in the original plan; (4) Transferring the new plan into a record & verify system (MOSAIQ, Elekta); (5) Performing a pre-delivery QA based on software; (6) Delivering the adaptive plan for the fraction.This workflow was implemented on a 16-CPU (2.6 GHz dual-core) hardware with GPU and was tested for sample cases of prostate, pancreas and lung tumors. Results: The online replanning process can be completed within 10 minutes. The adaptive plans generally have improved the plan quality when compared to the IGRT repositioning plans. The adaptive plans with FFF beams have better normal tissue sparing as compared with those of FF beams. Conclusion: The online replanning tool based on SAM can quickly generate adaptive VMAT plans using FFF beams with improved plan quality than those from the IGRT repositioning plans based on daily CT/CBCT/MRI and can be used clinically. This research was supported by Elekta Inc. (Crawley, UK)« less

Statistical process control analysis for patient-specific IMRT and VMAT QA.

PubMed

Sanghangthum, Taweap; Suriyapee, Sivalee; Srisatit, Somyot; Pawlicki, Todd

2013-05-01

This work applied statistical process control to establish the control limits of the % gamma pass of patient-specific intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) quality assurance (QA), and to evaluate the efficiency of the QA process by using the process capability index (Cpml). A total of 278 IMRT QA plans in nasopharyngeal carcinoma were measured with MapCHECK, while 159 VMAT QA plans were undertaken with ArcCHECK. Six megavolts with nine fields were used for the IMRT plan and 2.5 arcs were used to generate the VMAT plans. The gamma (3%/3 mm) criteria were used to evaluate the QA plans. The % gamma passes were plotted on a control chart. The first 50 data points were employed to calculate the control limits. The Cpml was calculated to evaluate the capability of the IMRT/VMAT QA process. The results showed higher systematic errors in IMRT QA than VMAT QA due to the more complicated setup used in IMRT QA. The variation of random errors was also larger in IMRT QA than VMAT QA because the VMAT plan has more continuity of dose distribution. The average % gamma pass was 93.7% ± 3.7% for IMRT and 96.7% ± 2.2% for VMAT. The Cpml value of IMRT QA was 1.60 and VMAT QA was 1.99, which implied that the VMAT QA process was more accurate than the IMRT QA process. Our lower control limit for % gamma pass of IMRT is 85.0%, while the limit for VMAT is 90%. Both the IMRT and VMAT QA processes are good quality because Cpml values are higher than 1.0.

Study for reducing lung dose of upper thoracic esophageal cancer radiotherapy by auto-planning: volumetric-modulated arc therapy vs intensity-modulated radiation therapy.

PubMed

Chen, Hua; Wang, Hao; Gu, Hengle; Shao, Yan; Cai, Xuwei; Fu, Xiaolong; Xu, Zhiyong

2017-10-27

This study aimed to investigate the dosimetric differences and lung sparing between volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) in the treatment of upper thoracic esophageal cancer with T3N0M0 for preoperative radiotherapy by auto-planning (AP). Sixteen patient cases diagnosed with upper thoracic esophageal cancer T3N0M0 for preoperative radiotherapy were retrospectively studied, and 3 plans were generated for each patient: full arc VMAT AP plan with double arcs, partial arc VMAT AP plan with 6 partial arcs, and conventional IMRT AP plan. A simultaneous integrated boost with 2 levels was planned in all patients. Target coverage, organ at risk sparing, treatment parameters including monitor units and treatment time (TT) were evaluated. Wilcoxon signed-rank test was used to check for significant differences (p < 0.05) between datasets. VMAT plans (pVMAT and fVMAT) significantly reduced total lung volume treated above 20 Gy (V 20 ), 25 Gy (V 25 ), 30 Gy (V 30 ), 35 Gy (V 35 ), 40 Gy (V 40 ), and without increasing the value of V 10 , V 13 , and V 15 . For V 5 of total lung value, pVMAT was similar to aIMRT, and it was better than fVMAT. Both pVMAT and fVMAT improved the target dose coverage and significantly decreased maximum dose for the spinal cord, monitor unit, and TT. No significant difference was observed with respect to V 10 and V 15 of body. VMAT AP plan was a good option for treating upper thoracic esophageal cancer with T3N0M0, especially partial arc VMAT AP plan. It had the potential to effectively reduce lung dose in a shorter TT and with superior target coverage and dose homogeneity. Copyright © 2017 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

SU-F-BRD-05: Dosimetric Comparison of Protocol-Based SBRT Lung Treatment Modalities: Statistically Significant VMAT Advantages Over Fixed- Beam IMRT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Best, R; Harrell, A; Geesey, C

2014-06-15

Purpose: The purpose of this study is to inter-compare and find statistically significant differences between flattened field fixed-beam (FB) IMRT with flattening-filter free (FFF) volumetric modulated arc therapy (VMAT) for stereotactic body radiation therapy SBRT. Methods: SBRT plans using FB IMRT and FFF VMAT were generated for fifteen SBRT lung patients using 6 MV beams. For each patient, both IMRT and VMAT plans were created for comparison. Plans were generated utilizing RTOG 0915 (peripheral, 10 patients) and RTOG 0813 (medial, 5 patients) lung protocols. Target dose, critical structure dose, and treatment time were compared and tested for statistical significance. Parametersmore » of interest included prescription isodose surface coverage, target dose heterogeneity, high dose spillage (location and volume), low dose spillage (location and volume), lung dose spillage, and critical structure maximum- and volumetric-dose limits. Results: For all criteria, we found equivalent or higher conformality with VMAT plans as well as reduced critical structure doses. Several differences passed a Student's t-test of significance: VMAT reduced the high dose spillage, evaluated with conformality index (CI), by an average of 9.4%±15.1% (p=0.030) compared to IMRT. VMAT plans reduced the lung volume receiving 20 Gy by 16.2%±15.0% (p=0.016) compared with IMRT. For the RTOG 0915 peripheral lesions, the volumes of lung receiving 12.4 Gy and 11.6 Gy were reduced by 27.0%±13.8% and 27.5%±12.6% (for both, p<0.001) in VMAT plans. Of the 26 protocol pass/fail criteria, VMAT plans were able to achieve an average of 0.2±0.7 (p=0.026) more constraints than the IMRT plans. Conclusions: FFF VMAT has dosimetric advantages over fixed beam IMRT for lung SBRT. Significant advantages included increased dose conformity, and reduced organs-at-risk doses. The overall improvements in terms of protocol pass/fail criteria were more modest and will require more patient data to establish difference trends of more statistical significance.« less

Technical Note: A fast online adaptive replanning method for VMAT using flattening filter free beams

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ates, Ozgur; Ahunbay, Ergun E.; Li, X. Allen, E-mail: ali@mcw.edu

Purpose: To develop a fast replanning algorithm based on segment aperture morphing (SAM) for online replanning of volumetric modulated arc therapy (VMAT) with flattening filter free (FFF) beams. Methods: A software tool was developed to interface with a VMAT research planning system, which enables the input and output of beam and machine parameters of VMAT plans. The SAM algorithm was used to modify multileaf collimator positions for each segment aperture based on the changes of the target from the planning (CT/MR) to daily image [CT/CBCT/magnetic resonance imaging (MRI)]. The leaf travel distance was controlled for large shifts to prevent themore » increase of VMAT delivery time. The SAM algorithm was tested for 11 patient cases including prostate, pancreatic, and lung cancers. For each daily image set, three types of VMAT plans, image-guided radiation therapy (IGRT) repositioning, SAM adaptive, and full-scope reoptimization plans, were generated and compared. Results: The SAM adaptive plans were found to have improved the plan quality in target and/or critical organs when compared to the IGRT repositioning plans and were comparable to the reoptimization plans based on the data of planning target volume (PTV)-V100 (volume covered by 100% of prescription dose). For the cases studied, the average PTV-V100 was 98.85% ± 1.13%, 97.61% ± 1.45%, and 92.84% ± 1.61% with FFF beams for the reoptimization, SAM adaptive, and repositioning plans, respectively. The execution of the SAM algorithm takes less than 10 s using 16-CPU (2.6 GHz dual core) hardware. Conclusions: The SAM algorithm can generate adaptive VMAT plans using FFF beams with comparable plan qualities as those from the full-scope reoptimization plans based on daily CT/CBCT/MRI and can be used for online replanning to address interfractional variations.« less

Volumetric modulated arc therapy versus step-and-shoot intensity modulated radiation therapy in the treatment of large nerve perineural spread to the skull base: a comparative dosimetric planning study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gorayski, Peter; Fitzgerald, Rhys; Barry, Tamara

Cutaneous squamous cell carcinoma with large nerve perineural (LNPN) infiltration of the base of skull is a radiotherapeutic challenge given the complex target volumes to nearby organs at risk (OAR). A comparative planning study was undertaken to evaluate dosimetric differences between volumetric modulated arc therapy (VMAT) versus intensity modulated radiation therapy (IMRT) in the treatment of LNPN. Five consecutive patients previously treated with IMRT for LNPN were selected. VMAT plans were generated for each case using the same planning target volumes (PTV), dose prescriptions and OAR constraints as IMRT. Comparative parameters used to assess target volume coverage, conformity and homogeneitymore » included V95 of the PTV (volume encompassed by the 95% isodose), conformity index (CI) and homogeneity index (HI). In addition, OAR maximum point doses, V20, V30, non-target tissue (NTT) point max doses, NTT volume above reference dose, monitor units (MU) were compared. IMRT and VMAT plans generated were comparable for CI (P = 0.12) and HI (P = 0.89). VMAT plans achieved better V95 (P = < 0.001) and reduced V20 and V30 by 652 cubic centimetres (cc) (28.5%) and 425.7 cc (29.1%), respectively. VMAT increased MU delivered by 18% without a corresponding increase in NTT dose. Compared with IMRT plans for LNPN, VMAT achieved comparable HI and CI.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xu, H; Cape Breton Cancer Centre, Sydney, NS

Purpose: To perform the comparison of dose distributions and dosevolume- histograms generated by VMAT and conventional field-in-field technique for left-sided breast and chestwall cancers; to determine whether VMAT offers more dosimetric benefits than does the field-in-field technique. Methods: All VMAT and field-in-filed plans were produced in Eclipse(version 10). Five plans were generated for left-sided breast and leftsided chestwall with supraclavicular nodes, respectively. A clockwise arc (CW) and a counter-clockwise arc (CCW) were used with start and stop angles being 310o±10o and 140o±10o. Collimator angles were 30o for CW and 330o for CCW. The conformity index (CI) is the ratio ofmore » V95% over PTV. The homogeneity index (HI) is the ratio of the difference between D2% and D98% over the prescribed dose. The V5, as an indicator of low dose bath to organs-at-risk, was used for ipsilateral lung, heart, contralateral lung, and contralateral breast. The V20, as an indicator of radiation pneumonitis, was used for ipsilateral lung. Results: Breast/chestwall VMAT delivers much higher low dose bath to ipsilateral lung, contralateral lung and contralateral breast/chestwall for both intact breast and chestwall with nodes. V5 for heart is increased in VMAT plans. V20 for ipsilateral lung is lower in VMAT plans. PTV coverage is similar for both techniques. For one particular chestwall patient with supraclavicular and internal mammary nodes, VMAT offers superior dose coverage of PTVs with slightly more low-dose-wash to heart, contralateral lung and contralateral breast. Conclusion: This study indicates that there is generally no benefit using VMAT for left-sided intact breast, due to large low-dose-bath (5Gy) to normal tissues with insignificant improvement in PTV coverage. Dosimetric benefits will be seen in VMAT plans for some chestwall patients with large size, and/or internal mammary nodes, etc. Whether a chestwall patient is treated with VMAT should be carefully analyzed on an individual basis.« less

TH-E-BRE-04: An Online Replanning Algorithm for VMAT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ahunbay, E; Li, X; Moreau, M

2014-06-15

Purpose: To develop a fast replanning algorithm based on segment aperture morphing (SAM) for online replanning of volumetric modulated arc therapy (VMAT) with flattening filtered (FF) and flattening filter free (FFF) beams. Methods: A software tool was developed to interface with a VMAT planning system ((Monaco, Elekta), enabling the output of detailed beam/machine parameters of original VMAT plans generated based on planning CTs for FF or FFF beams. A SAM algorithm, previously developed for fixed-beam IMRT, was modified to allow the algorithm to correct for interfractional variations (e.g., setup error, organ motion and deformation) by morphing apertures based on themore » geometric relationship between the beam's eye view of the anatomy from the planning CT and that from the daily CT for each control point. The algorithm was tested using daily CTs acquired using an in-room CT during daily IGRT for representative prostate cancer cases along with their planning CTs. The algorithm allows for restricted MLC leaf travel distance between control points of the VMAT delivery to prevent SAM from increasing leaf travel, and therefore treatment delivery time. Results: The VMAT plans adapted to the daily CT by SAM were found to improve the dosimetry relative to the IGRT repositioning plans for both FF and FFF beams. For the adaptive plans, the changes in leaf travel distance between control points were < 1cm for 80% of the control points with no restriction. When restricted to the original plans' maximum travel distance, the dosimetric effect was minimal. The adaptive plans were delivered successfully with similar delivery times as the original plans. The execution of the SAM algorithm was < 10 seconds. Conclusion: The SAM algorithm can quickly generate deliverable online-adaptive VMAT plans based on the anatomy of the day for both FF and FFF beams.« less

Sci—Sat AM: Stereo — 02: Implementation of a VMAT class solution for kidney SBRT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sonier, M; Lalani, N; Korol, R

An emerging treatment option for inoperable primary renal cell carcinoma and oligometastatic adrenal lesions is stereotactic body radiation therapy (SBRT). At our center, kidney SBRT treatments were originally planned with IMRT. The goal was to plan future patients using VMAT to improve treatment delivery efficiency. The purpose of this work was twofold: 1) to develop a VMAT class solution for the treatment of kidney SBRT; and, 2) to assess VMAT plan quality when compared to IMRT plans. Five patients treated with IMRT for kidney SBRT were reviewed and replanned in Pinnacle using a single VMAT arc with a 15° collimatormore » rotation, constrained leaf motion and 4° gantry spacing. In comparison, IMRT plans utilized 7–9 6MV beams, with various collimator rotations and up to 2 non-coplanar beams for maximum organ-at-risk (OAR) sparing. Comparisons were made concerning target volume conformity, homogeneity, dose to OARs, treatment time and monitor units (MUs). There was no difference in MUs; however, VMAT reduced the treatment time from 13.0±2.6min, for IMRT, to 4.0±0.9min. The collection of target and OAR constraints and SmartArc parameters, produced a class solution that generated VMAT plans with increased target homogeneity and improved 95% conformity index calculated at < 1.2. In general, the VMAT plans displayed a reduced maximum point dose to nearby OARs with increased intermediate dose to distant OARs. Overall, the introduction of a VMAT class solution for kidney SBRT improves efficiency by reducing treatment planning and delivery time.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maurer, J; Sintay, B; Manning, M

Purpose: This study evaluates a novel algorithm that can be used with any treatment planning system for simple and rapid generation of stereotactic radiosurgery (SRS) plans for treating multiple brain metastases using a single isocenter dynamic conformal arc (DCA) approach. This technique is compared with a single isocenter volumetric modulated arc therapy (VMAT) technique in terms of delivery time, conformity, low dose spread and delivery accuracy. Methods: Five patients, with a total of 37 (5 – 11) targets were planned using a previously published method for generating optimal VMAT plans and using the proposed DCA algorithm. All planning target volumesmore » (PTVs) were planned to 20 Gy, meeting a minimum 99% coverage and maximum 135 % hot spot for both techniques. Quality assurance was performed using radiochromic film, with films placed in the high dose regions of each PTV. Normal tissue volumes receiving 12 Gy and 6 Gy (V12 and V6) were computed for each plan. Conformity index (CI) and gamma evaluations (95% of points passing 4%/0.5mm) were computed for each PTV. Results: Delivery times, including beam on and table rotation times, were comparable: 17 – 22 minutes for all deliveries. V12s for DCA plans were (18.5±15.2 cc) vs. VMAT (19.7±14.4 cc). V6s were significantly lower for DCA (69.0±52.0 cc) compared with VMAT (154.0±91.0 cc) (p <<0.05). CIs for VMAT targets were (1.38±0.50) vs. DCA (1.61±0.41). 36 of 37 DCA planned targets passed gamma tests, while 29 of 37 VMAT planned targets passed. Conclusion: Single isocenter DCA plans were easily achieved. The evaluation suggests that DCA may represent a favorable technique compared with VMAT for multiple target SRS by reducing dose to normal tissue and more accurately depicting deliverable dose.« less

Dosimetric evaluation of magnetic resonance-generated synthetic CT for radiation treatment of rectal cancer.

PubMed

Wang, Hesheng; Du, Kevin; Qu, Juliet; Chandarana, Hersh; Das, Indra J

2018-01-01

The purpose of this study was to assess the dosimetric equivalence of magnetic resonance (MR)-generated synthetic CT (synCT) and simulation CT for treatment planning in radiotherapy of rectal cancer. This study was conducted on eleven patients who underwent whole-body PET/MR and PET/CT examination in a prospective IRB-approved study. For each patient synCT was generated from Dixon MR using a model-based method. Standard treatment planning directives were used to create a four-field box (4F), an oblique four-field (O4F) and a volumetric modulated arc therapy (VMAT) plan on synCT for treatment of rectal cancer. The plans were recalculated on CT with the same monitor units (MUs) as that of synCT. Dose-volume metrics of planning target volume (PTV) and organs at risk (OARs) as well as gamma analysis of dose distributions were evaluated to quantify the difference between synCT and CT plans. All plans were calculated using the analytical anisotropic algorithm (AAA). The VMAT plans on synCT and CT were also calculated using the Acuros XB algorithm for comparison with the AAA calculation. Medians of absolute differences in PTV metrics between synCT and CT plans were 0.2%, 0.2% and 0.3% for 4F, O4F and VMAT respectively. No significant differences were observed in OAR dose metrics including bladder V40Gy, mean dose in bladder, bowel V45Gy and femoral head V30Gy in any techniques. Gamma analysis with 2%/2mm dose difference/distance to agreement criteria showed median passing rates of 99.8% (range: 98.5 to 100%), 99.9% (97.2 to 100%), and 99.9% (99.4 to 100%) for 4F, O4F and VMAT, respectively. Using Acuros XB dose calculation, 2%/2mm gamma analysis generated a passing rate of 99.2% (97.7 to 99.9%) for VMAT plans. SynCT enabled dose calculation equivalent to conventional CT for treatment planning of 3D conformal treatment as well as VMAT of rectal cancer. The dosimetric agreement between synCT and CT calculated doses demonstrated the potential of MR-only treatment planning for rectal cancer using MR generated synCT.

Quality of tri-Co-60 MR-IGRT treatment plans in comparison with VMAT treatment plans for spine SABR.

PubMed

Choi, Chang Heon; Park, So-Yeon; Kim, Jung-In; Kim, Jin Ho; Kim, Kyubo; Carlson, Joel; Park, Jong Min

2017-02-01

To investigate the plan quality of tri-Co-60 intensity-modulated radiation therapy (IMRT) plans for spine stereotactic ablative radiotherapy (SABR). A total of 20 patients with spine metastasis were retrospectively selected. For each patient, a tri-Co-60 IMRT plan and a volumetric-modulated arc therapy (VMAT) plan were generated. The spinal cords were defined based on MR images for the tri-Co-60 IMRT, while isotropic 1-mm margins were added to the spinal cords for the VMAT plans. The VMAT plans were generated with 10-MV flattening filter-free photon beams of TrueBeam STx ™ (Varian Medical Systems, Palo Alto, CA), while the tri-Co-60 IMRT plans were generated with the ViewRay ™ system (ViewRay inc., Cleveland, OH). The initial prescription dose was 18 Gy (1 fraction). If the tolerance dose of the spinal cord was not met, the prescription dose was reduced until the spinal cord tolerance dose was satisfied. The mean dose to the target volumes, conformity index and homogeneity index of the VMAT and tri-Co-60 IMRT were 17.8 ± 0.8 vs 13.7 ± 3.9 Gy, 0.85 ± 0.20 vs 1.58 ± 1.29 and 0.09 ± 0.04 vs 0.24 ± 0.19, respectively. The integral doses and beam-on times were 16,570 ± 1768 vs 22,087 ± 2.986 Gy cm 3 and 3.95 ± 1.13 vs 48.82 ± 10.44 min, respectively. The tri-Co-60 IMRT seems inappropriate for spine SABR compared with VMAT. Advances in knowledge: For spine SABR, the tri-Co-60 IMRT is inappropriate owing to the large penumbra, large leaf width and low dose rate of the ViewRay system.

Quality of tri-Co-60 MR-IGRT treatment plans in comparison with VMAT treatment plans for spine SABR

PubMed Central

Choi, Chang Heon; Park, So-Yeon; Kim, Jung-in; Kim, Jin Ho; Kim, Kyubo; Carlson, Joel

2017-01-01

Objective: To investigate the plan quality of tri-Co-60 intensity-modulated radiation therapy (IMRT) plans for spine stereotactic ablative radiotherapy (SABR). Methods: A total of 20 patients with spine metastasis were retrospectively selected. For each patient, a tri-Co-60 IMRT plan and a volumetric-modulated arc therapy (VMAT) plan were generated. The spinal cords were defined based on MR images for the tri-Co-60 IMRT, while isotropic 1-mm margins were added to the spinal cords for the VMAT plans. The VMAT plans were generated with 10-MV flattening filter-free photon beams of TrueBeam STx™ (Varian Medical Systems, Palo Alto, CA), while the tri-Co-60 IMRT plans were generated with the ViewRay™ system (ViewRay inc., Cleveland, OH). The initial prescription dose was 18 Gy (1 fraction). If the tolerance dose of the spinal cord was not met, the prescription dose was reduced until the spinal cord tolerance dose was satisfied. Results: The mean dose to the target volumes, conformity index and homogeneity index of the VMAT and tri-Co-60 IMRT were 17.8 ± 0.8 vs 13.7 ± 3.9 Gy, 0.85 ± 0.20 vs 1.58 ± 1.29 and 0.09 ± 0.04 vs 0.24 ± 0.19, respectively. The integral doses and beam-on times were 16,570 ± 1768 vs 22,087 ± 2.986 Gy cm3 and 3.95 ± 1.13 vs 48.82 ± 10.44 min, respectively. Conclusion: The tri-Co-60 IMRT seems inappropriate for spine SABR compared with VMAT. Advances in knowledge: For spine SABR, the tri-Co-60 IMRT is inappropriate owing to the large penumbra, large leaf width and low dose rate of the ViewRay system. PMID:27781486

SU-F-P-64: The Impact of Plan Complexity Parameters On the Plan Quality and Deliverability of Volumetric Modulated Arc Therapy with Canonical Correlation Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jin, X; Yi, J; Xie, C

Purpose: To evaluate the impact of complexity indices on the plan quality and deliverability of volumetric modulated arc therapy (VMAT), and to determine the most significant parameters in the generation of an ideal VMAT plan. Methods: A multi-dimensional exploratory statistical method, canonical correlation analysis (CCA) was adopted to study the correlations between VMAT parameters of complexity, quality and deliverability, as well as their contribution weights with 32 two-arc VMAT nasopharyngeal cancer (NPC) patients and 31 one-arc VMAT prostate cancer patients. Results: The MU per arc (MU/Arc) and MU per control point (MU/CP) of NPC were 337.8±25.2 and 3.7±0.3, respectively, whichmore » were significantly lower than those of prostate cancer patients (MU/Arc : 506.9±95.4, MU/CP : 5.6±1.1). The plan complexity indices indicated that two-arc VMAT plans were more complex than one-arc VMAT plans. Plan quality comparison confirmed that one-arc VMAT plans had a high quality than two-arc VMAT plans. CCA results implied that plan complexity parameters were highly correlated with plan quality with the first two canonical correlations of 0.96, 0.88 (both p<0.001) and significantly correlated with deliverability with the first canonical correlation of 0.79 (p<0.001), plan quality and deliverability was also correlated with the first canonical correlation of 0.71 (p=0.02). Complexity parameters of MU/CP, segment area (SA) per CP, percent of MU/CP less 3 and planning target volume (PTV) were weighted heavily in correlation with plan quality and deliveability . Similar results obtained from individual NPC and prostate CCA analysis. Conclusion: Relationship between complexity, quality, and deliverability parameters were investigated with CCA. MU, SA related parameters and PTV volume were found to have strong effect on the plan quality and deliverability. The presented correlation among different quantified parameters could be used to improve the plan quality and the efficiency of the radiotherapy process when creating a complex VMAT plan.« less

SU-E-T-615: Plan Comparison Between Photon IMRT and Proton Plans Incorporating Uncertainty Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheng, C; Wessels, B; Jesseph, F

2015-06-15

Purpose: In this study, we investigate the effect of setup uncertainty on DVH calculations which may impact plan comparison. Methods: Treatment plans (6 MV VMAT calculated on Pinnacle TPS) were chosen for different disease sites: brain, prostate, H&N and spine in this retrospective study. A proton plan (PP) using double scattering beams was generated for each selected VMAT plan subject to the same set of dose-volume constraints as in VMAT. An uncertainty analysis was incorporated on the DVH calculations in which isocenter shifts from 1 to 5 mm in each of the ±x, ±y and ±z directions were used tomore » simulate the setup uncertainty and residual positioning errors. A total of 40 different combinations of isocenter shifts were used in the re-calculation of DVH of the PTV and the various OARs for both the VMAT and the corresponding PT. Results: For the brain case, both VMAT and PP are comparable in PTV coverage and OAR sparing, and VMAT is a clear choice for treatment due to its ease of delivery. However, when incorporating isoshifts in DVH calculations, a significant change in dose-volume relationship emerges. For example, both VMAT and PT provide adequate coverage, even with ±3mm isoshift. However, +3mm isoshift results in increase of V40(Lcochlea, VMAT) from 7.2% in the original plan to 45% and V40(R cochlea, VMAT) from 75% to 92%. For protons, V40(Lcochlea, PT) increases from 62% in the initial plan to 75%, while V40(Rcochea, PT) increases from 7% to 26%. Conclusion: DVH alone may not be sufficient to allow an unequivocal decision in plan comparison, especially when two rival plans are very similar in both PTV coverage and OAR sparing. It is a good practice to incorporate uncertainty analysis on photon and proton plan comparison studies to test the plan robustness in plan evaluation.« less

Validation of the relative insensitivity of volumetric-modulated arc therapy (VMAT) plan quality to gantry space resolution

PubMed Central

Cora, Stefania; Khan, Ehsan Ullah

2017-01-01

Abstract Volumetric-modulated arc therapy (VMAT) is an efficient form of radiotherapy used to deliver intensity-modulated radiotherapy beams. The aim of this study was to investigate the relative insensitivity of VMAT plan quality to gantry angle spacing (GS). Most previous VMAT planning and dosimetric work for GS resolution has been conducted for single arc VMAT. In this work, a quantitative comparison of dose–volume indices (DIs) was made for partial-, single- and double-arc VMAT plans optimized at 2°, 3° and 4° GS, representing a large variation in deliverable multileaf collimator segments. VMAT plans of six prostate cancer and six head-and-neck cancer patients were simulated for an Elekta SynergyS® Linac (Elekta Ltd, Crawley, UK), using the SmartArc™ module of Pinnacle³ TPS, (version 9.2, Philips Healthcare). All optimization techniques generated clinically acceptable VMAT plans, except for the single-arc for the head-and-neck cancer patients. Plan quality was assessed by comparing the DIs for the planning target volume, organs at risk and normal tissue. A GS of 2°, with finest resolution and consequently highest intensity modulation, was considered to be the reference, and this was compared with GS 3° and 4°. The differences between the majority of reference DIs and compared DIs were <2%. The metrics, such as treatment plan optimization time and pretreatment (phantom) dosimetric calculation time, supported the use of a GS of 4°. The ArcCHECK™ phantom–measured dosimetric agreement verifications resulted in a >95.0% passing rate, using the criteria for γ (3%, 3 mm). In conclusion, a GS of 4° is an optimal choice for minimal usage of planning resources without compromise of plan quality. PMID:27974507

Is volumetric modulated arc therapy with constant dose rate a valid option in radiation therapy for head and neck cancer patients?

PubMed

Didona, Annamaria; Lancellotta, Valentina; Zucchetti, Claudio; Panizza, Bianca Moira; Frattegiani, Alessandro; Iacco, Martina; Di Pilato, Anna Concetta; Saldi, Simonetta; Aristei, Cynthia

2018-01-01

Intensity-modulated radiotherapy (IMRT) improves dose distribution in head and neck (HN) radiation therapy. Volumetric-modulated arc therapy (VMAT), a new form of IMRT, delivers radiation in single or multiple arcs, varying dose rates (VDR-VMAT) and gantry speeds, has gained considerable attention. Constant dose rate VMAT (CDR-VMAT) associated with a fixed gantry speed does not require a dedicated linear accelerator like VDR-VMAT. The present study explored the feasibility, efficiency and delivery accuracy of CDR-VMAT, by comparing it with IMRT and VDR-VMAT in treatment planning for HN cancer. Step and shoot IMRT (SS-IMRT), CDR-VMAT and VDR-VMAT plans were created for 15 HN cancer patients and were generated by Pinnacle 3 TPS (v 9.8) using 6 MV photon energy. Three PTVs were defined to receive respectively prescribed doses of 66 Gy, 60 Gy and 54 Gy, in 30 fractions. Organs at risk (OARs) included the mandible, spinal cord, brain stem, parotids, salivary glands, esophagus, larynx and thyroid. SS-IMRT plans were based on 7 co-planar beams at fixed gantry angles. CDR-VMAT and VDR-VMAT plans, generated by the SmartArc module, used a 2-arc technique: one clockwise from 182° to 178° and the other one anti-clockwise from 178° to 182°. Comparison parameters included dose distribution to PTVs ( D mean , D 2% , D 50% , D 95% , D 98% and Homogeneity Index), maximum or mean doses to OARs, specific dose-volume data, the monitor units and treatment delivery times. Compared with SS-IMRT, CDR-VMAT significantly reduced the maximum doses to PTV1 and PTV2 and significantly improved all PTV3 parameters, except D 98% and D 95% . It significantly spared parotid and submandibular glands and was associated with a lower D mean to the larynx. Compared with VDR-VMAT, CDR-VMAT was linked to a significantly better D mean , to the PTV3 but results were worse for the parotids, left submandibular gland, esophagus and mandible. Furthermore, the D mean to the larynx was also worse. Compared with SS-IMRT and VDR-VMAT, CDR-VMAT was associated with higher average monitor unit values and significantly shorter average delivery times. CDR-VMAT appeared to be a valid option in Radiation Therapy Centers that lack a dedicated linear accelerator for volumetric arc therapy with variable dose-rates and gantry velocities, and are unwilling or unable to sanction major expenditure at present but want to adopt volumetric techniques.

Critical Structure Sparing in Stereotactic Ablative Radiotherapy for Central Lung Lesions: Helical Tomotherapy vs. Volumetric Modulated Arc Therapy

PubMed Central

Chi, Alexander; Ma, Pan; Fu, Guishan; Hobbs, Gerry; Welsh, James S.; Nguyen, Nam P.; Jang, Si Young; Dai, Jinrong; Jin, Jing; Komaki, Ritsuko

2013-01-01

Background Helical tomotherapy (HT) and volumetric modulated arc therapy (VMAT) are both advanced techniques of delivering intensity-modulated radiotherapy (IMRT). Here, we conduct a study to compare HT and partial-arc VMAT in their ability to spare organs at risk (OARs) when stereotactic ablative radiotherapy (SABR) is delivered to treat centrally located early stage non-small-cell lung cancer or lung metastases. Methods 12 patients with centrally located lung lesions were randomly chosen. HT, 2 & 8 arc (Smart Arc, Pinnacle v9.0) plans were generated to deliver 70 Gy in 10 fractions to the planning target volume (PTV). Target and OAR dose parameters were compared. Each technique’s ability to meet dose constraints was further investigated. Results HT and VMAT plans generated essentially equivalent PTV coverage and dose conformality indices, while a trend for improved dose homogeneity by increasing from 2 to 8 arcs was observed with VMAT. Increasing the number of arcs with VMAT also led to some improvement in OAR sparing. After normalizing to OAR dose constraints, HT was found to be superior to 2 or 8-arc VMAT for optimal OAR sparing (meeting all the dose constraints) (p = 0.0004). All dose constraints were met in HT plans. Increasing from 2 to 8 arcs could not help achieve optimal OAR sparing for 4 patients. 2/4 of them had 3 immediately adjacent structures. Conclusion HT appears to be superior to VMAT in OAR sparing mainly in cases which require conformal dose avoidance of multiple immediately adjacent OARs. For such cases, increasing the number of arcs in VMAT cannot significantly improve OAR sparing. PMID:23577071

SU-E-T-209: Comparison of Plan Quality Between Arm Avoidance (AA) Vs. Non Arm Avoidance VMAT Planning Techniques for Breast Cancer Patients with Bilateral Implant Reconstructions Receiving Postmastectomy Radiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kuo, L; Ballangrud, A; Ho, A

Purpose: Breast cancer patients with bilateral implant reconstructions who require postmastectomy radiotherapy can pose unique treatment planning challenges. The use of VMAT may provide advantages over conventional tangent or multi-beam IMRT techniques. Moreover, daily setup uncertainly of the arm position, however, could have significant impact on accurate dose delivery. This study compares the plan qualities between non-AA and AA VMAT techniques. Methods: Three breast cancer patients receiving left chest wall and regional nodal irradiation with bilateral implant reconstructions were studied. PTV included chest wall and IMNs (PTV-CW), and supraclavicular and axillary lymph nodes (PTV-SCV). For each patient, one non-AA VMATmore » plan (VMAT-S) with 4 partial arcs encompassing the ipsilateral arm and three AA VMAT plans where no arcs were entering or existing through the ipsilateral arm were generated. VMAT-AA1 uses 2 arcs for PTV-CW and 2 arcs for PTV-SCV. VMAT-AA2 used two static fields for PTV-SCV with 2 arcs for PTV-CW. VMAT-AA3 used 2 narrow arcs for PTV-CW and 2 long arcs for all PTVs. Prescription dose (PD) was 50 Gy (25 fractions). All plans were normalized to have 95% of PD to 95 % of PTV. PTV dose inhomogeneity and dose to the heart, left lung, right thyroid dose and left humerus were evaluated. Results: For VMAT-S, VMAT-AA1, VMAT-AA2 and VMAT-AA3, respectively, the average and standard deviation (in Gy unless specified otherwise) of PTV D05 are 54.7±0.9, 55.9±0.4, 56.7±0.7 and 55.7±0.4; mean Heart dose: 7.1±0.7, 7.2±0.8, 7.3±0.9 and 6.9±1.0; left lung V20Gy (in %): 28.1±1.0, 28.8+2.2, 32.2±4.1 and 27.8±2.0; mean right thyroid dose: 8.1±0.6, 5.1±2.1, 2.1±0.4 and 5.0±2.0; mean left humerus dose: 20.0±4.4,15.6±4.4, 15.2±8.2 and 15.3±4.6. Conclusion: AA VMAT can produce acceptable clinical plans while eliminating dosimetric impact related to arm setup uncertainty. These data require validation in larger planning studies prior to routine clinical implantation.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu, J-Y; Huang, B-T; Zhang, W-Z

Purpose: To compare volumetric modulated arc radiotherapy (VMAT) technique with fixed-gantry intensity-modulated radiotherapy (IMRT) technique for early-stage nasopharyngeal carcinoma. Methods: CT datasets of ten patients with early-stage nasopharyngeal carcinoma were included. Dual-arc VMAT and nine-field IMRT plans were generated for each case, and were then compared in terms of planning-target-volume (PTV) coverage, conformity index (CI) and homogeneity index (HI), as well as organ-at-risk (OAR) sparing, planning time, monitor units (MUs) and delivery time. Results: Compared with the IMRT plans, the VMAT plans provided comparable HI and CI of PTVnx (PTV of primary tumor of nasopharynx), superior CI and inferior HImore » of PTVnd (PTV of lymph nodes), as well as superior CI and comparable HI of PTV60 (high-risk PTV). The VMAT plans provided better sparing of the spinal cord, oral cavity and normal tissue, but inferior sparing of the brainstem planning OAR volume (PRV), larynx and parotids, as well as comparable sparing of the spinal cord PRV, brainstem, lenses, optic nerves, optic chiasm. Moreover, the average planning time (181.6 ± 36.0 min) for the VMAT plans was 171% more than that of the IMRT plans (68.1 ± 7.6 min). The MUs of the VMAT plans (609 ± 43) were 70% lower than those of the IMRT plans (2071 ± 262), while the average delivery time (2.2 ± 0.1 min) was 66% less than that of the IMRT plans (6.6 ± 0.4 min). Conclusion: Compared with the IMRT technique, the VMAT technique can achieve similar or slightly superior target dose distribution, with no significant advantages on OAR sparing, and it can achieve significant reductions of MUs and delivery time.« less

SU-E-T-395: Multi-GPU-Based VMAT Treatment Plan Optimization Using a Column-Generation Approach

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tian, Z; Shi, F; Jia, X

Purpose: GPU has been employed to speed up VMAT optimizations from hours to minutes. However, its limited memory capacity makes it difficult to handle cases with a huge dose-deposition-coefficient (DDC) matrix, e.g. those with a large target size, multiple arcs, small beam angle intervals and/or small beamlet size. We propose multi-GPU-based VMAT optimization to solve this memory issue to make GPU-based VMAT more practical for clinical use. Methods: Our column-generation-based method generates apertures sequentially by iteratively searching for an optimal feasible aperture (referred as pricing problem, PP) and optimizing aperture intensities (referred as master problem, MP). The PP requires accessmore » to the large DDC matrix, which is implemented on a multi-GPU system. Each GPU stores a DDC sub-matrix corresponding to one fraction of beam angles and is only responsible for calculation related to those angles. Broadcast and parallel reduction schemes are adopted for inter-GPU data transfer. MP is a relatively small-scale problem and is implemented on one GPU. One headand- neck cancer case was used for test. Three different strategies for VMAT optimization on single GPU were also implemented for comparison: (S1) truncating DDC matrix to ignore its small value entries for optimization; (S2) transferring DDC matrix part by part to GPU during optimizations whenever needed; (S3) moving DDC matrix related calculation onto CPU. Results: Our multi-GPU-based implementation reaches a good plan within 1 minute. Although S1 was 10 seconds faster than our method, the obtained plan quality is worse. Both S2 and S3 handle the full DDC matrix and hence yield the same plan as in our method. However, the computation time is longer, namely 4 minutes and 30 minutes, respectively. Conclusion: Our multi-GPU-based VMAT optimization can effectively solve the limited memory issue with good plan quality and high efficiency, making GPUbased ultra-fast VMAT planning practical for real clinical use.« less

SU-E-T-812: Volumetric Modulated Arc Therapy-Total Body Irradiation (VMAT-TBI) V.s. Conventional Extended SSD-TBI (cTBI): A Dosimetric Comparisom

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ouyang, L; Folkerts, M; Lee, H

2015-06-15

Purpose: To perform a dosimetric evaluation on a new developed volumetric modulated arc therapy based total body irradiation (VMAT-TBI). Methods: Three patients were CT scanned with an indexed rotatable body frame to get whole body CT images. Concatenated CT images were imported in Pinnacle treatment planning system and whole body and lung were contoured as PTV and organ at risk, respectively. Treatment plans were generated by matching multiple isocenter volumetric modulated arc (VMAT) fields of the upper body and multiple isocenter parallel-opposed fields of the lower body. For each plan, 1200 cGy in 8 fractions was prescribed to the wholemore » body volume and the lung dose was constrained to a mean dose of 750 cGy. Such a two-level dose plan was achieved by inverse planning of the torso VMAT fields. For comparison, conventional standing TBI (cTBI) plans were generated on the same whole body CT images at an extended SSD (550cm).The shape of compensators and lung blocks are simulated using body segments and lung contours Compensation was calculated based on the patient CT images, in mimic of the standing TBI treatment. The whole body dose distribution of cTBI plans were calculated with a home-developed GPU Monte Carlo dose engine. Calculated cTBI dose distribution was prescribed to the mid-body point at umbilical level. Results: The VMAT-TBI treatment plans of three patients’ plans achieved 80.2%±5.0% coverage of the total body volume within ±10% of the prescription dose, while cTBI treatment plans achieved 72.2%±4.0% coverage of the total body volume. The averaged mean lung dose of all three patients is lower for VMAT-TBI (7.48 cGy) than for cTBI (8.96 cGy). Conclusion: The proposed patient comfort-oriented VMAT-TBI technique provides for a uniform dose distribution within the total body while reducing the dose to the lungs.« less

SU-E-T-426: Feasibility of Stereotactic Body Radiation Therapy (SBRT) Treatment of Pancreatic Cancer Using Volumetric Modulated Arc Therapy (VMAT) with Active Breathing Control (ABC)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Y; Jackson, J; Davies, G

2015-06-15

Purpose: SBRT shows excellent tumor control and toxicity rates for patients with locally advanced pancreatic cancer (PCA). Herein, we evaluate the feasibility of using VMAT with ABC for PCA SBRT. Methods: Nine PCA patients previously treated via SBRT utilizing 11-beam step-and-shoot IMRT technique in our center were retrospectively identified, among whom eight patients received 3300cGy in 5 fractions while one received 3000cGy in 5 fractions. A VMAT plan was generated on each patient’s planning CT in Pinnacle v9.8 on Elekta Synergy following the same PCA SBRT clinical protocol. Three partial arcs (182°–300°, 300°-60°, and 60°-180°) with 2°/4° control-point spacing weremore » used. The dosimetric difference between the VMAT and the original IMRT plans was analyzed. IMRT QA was performed for the VMAT plans using MapCheck2 in MapPHAN and the total delivery time was recorded. To mimic the treatment situation with ABC, where patients hold their breath for 20–30 seconds, the delivery was intentionally interrupted every 20–30 seconds. For each plan, the QA was performed with and without beam interruption. Gamma analysis (2%/2mm) was used to compare the planned and measured doses. Results: All VMAT plans with 2mm dose grid passed the clinic protocol with similar PTV coverage and OARs sparing, where PTV V-RxDose was 92.7±2.1% (VMAT) vs. 92.1±2.6% (IMRT), and proximal stomach V15Gy was 3.60±2.69 cc (VMAT) vs. 4.80±3.13 cc (IMRT). The mean total MU and delivery time of the VMAT plans were 2453.8±531.1 MU and 282.1±56.0 seconds. The gamma passing rates of absolute dose were 94.9±3.4% and 94.5±4.0% for delivery without and with interruption respectively, suggesting the dosimetry of VMAT delivery with ABC for SBRT won’t be compromised. Conclusion: This study suggests that PCA SBRT using VMAT with ABC is a feasible technique without compromising plan dosimetry. The combination of VMAT with ABC will potentially reduce the SBRT treatment time.« less

Improving Delivery Accuracy of Stereotactic Body Radiotherapy to a Moving Tumor Using Simplified Volumetric Modulated Arc Therapy

PubMed Central

Ko, Young Eun; Cho, Byungchul; Kim, Su Ssan; Song, Si Yeol; Choi, Eun Kyung; Ahn, Seung Do; Yi, Byongyong

2016-01-01

Purpose To develop a simplified volumetric modulated arc therapy (VMAT) technique for more accurate dose delivery in thoracic stereotactic body radiation therapy (SBRT). Methods and Materials For each of the 22 lung SBRT cases treated with respiratory-gated VMAT, a dose rate modulated arc therapy (DrMAT) plan was retrospectively generated. A dynamic conformal arc therapy plan with 33 adjoining coplanar arcs was designed and their beam weights were optimized by an inverse planning process. All sub-arc beams were converted into a series of control points with varying MLC segment and dose rates and merged into an arc beam for a DrMAT plan. The plan quality of original VMAT and DrMAT was compared in terms of target coverage, compactness of dose distribution, and dose sparing of organs at risk. To assess the delivery accuracy, the VMAT and DrMAT plans were delivered to a motion phantom programmed with the corresponding patients’ respiratory signal; results were compared using film dosimetry with gamma analysis. Results The plan quality of DrMAT was equivalent to that of VMAT in terms of target coverage, dose compactness, and dose sparing for the normal lung. In dose sparing for other critical organs, DrMAT was less effective than VMAT for the spinal cord, heart, and esophagus while being well within the limits specified by the Radiation Therapy Oncology Group. Delivery accuracy of DrMAT to a moving target was similar to that of VMAT using a gamma criterion of 2%/2mm but was significantly better using a 2%/1mm criterion, implying the superiority of DrMAT over VMAT in SBRT for thoracic/abdominal tumors with respiratory movement. Conclusion We developed a DrMAT technique for SBRT that produces plans of a quality similar to that achieved with VMAT but with better delivery accuracy. This technique is well-suited for small tumors with motion uncertainty. PMID:27333199

Multidimensional correlation among plan complexity, quality and deliverability parameters for volumetric-modulated arc therapy using canonical correlation analysis.

PubMed

Shen, Lanxiao; Chen, Shan; Zhu, Xiaoyang; Han, Ce; Zheng, Xiaomin; Deng, Zhenxiang; Zhou, Yongqiang; Gong, Changfei; Xie, Congying; Jin, Xiance

2018-03-01

A multidimensional exploratory statistical method, canonical correlation analysis (CCA), was applied to evaluate the impact of complexity parameters on the plan quality and deliverability of volumetric-modulated arc therapy (VMAT) and to determine parameters in the generation of an ideal VMAT plan. Canonical correlations among complexity, quality and deliverability parameters of VMAT, as well as the contribution weights of different parameters were investigated with 71 two-arc VMAT nasopharyngeal cancer (NPC) patients, and further verified with 28 one-arc VMAT prostate cancer patients. The average MU and MU per control point (MU/CP) for two-arc VMAT plans were 702.6 ± 55.7 and 3.9 ± 0.3 versus 504.6 ± 99.2 and 5.6 ± 1.1 for one-arc VMAT plans, respectively. The individual volume-based 3D gamma passing rates of clinical target volume (γCTV) and planning target volume (γPTV) for NPC and prostate cancer patients were 85.7% ± 9.0% vs 92.6% ± 7.8%, and 88.0% ± 7.6% vs 91.2% ± 7.7%, respectively. Plan complexity parameters of NPC patients were correlated with plan quality (P = 0.047) and individual volume-based 3D gamma indices γ(IV) (P = 0.01), in which, MU/CP and segment area (SA) per control point (SA/CP) were weighted highly in correlation with γ(IV) , and SA/CP, percentage of CPs with SA < 5 × 5 cm2 (%SA < 5 × 5 cm2) and PTV volume were weighted highly in correlation with plan quality with coefficients of 0.98, 0.68 and -0.99, respectively. Further verification with one-arc VMAT plans demonstrated similar results. In conclusion, MU, SA-related parameters and PTV volume were found to have strong effects on the plan quality and deliverability.

Multidimensional correlation among plan complexity, quality and deliverability parameters for volumetric-modulated arc therapy using canonical correlation analysis

PubMed Central

Shen, Lanxiao; Chen, Shan; Zhu, Xiaoyang; Han, Ce; Zheng, Xiaomin; Deng, Zhenxiang; Zhou, Yongqiang; Gong, Changfei; Jin, Xiance

2018-01-01

Abstract A multidimensional exploratory statistical method, canonical correlation analysis (CCA), was applied to evaluate the impact of complexity parameters on the plan quality and deliverability of volumetric-modulated arc therapy (VMAT) and to determine parameters in the generation of an ideal VMAT plan. Canonical correlations among complexity, quality and deliverability parameters of VMAT, as well as the contribution weights of different parameters were investigated with 71 two-arc VMAT nasopharyngeal cancer (NPC) patients, and further verified with 28 one-arc VMAT prostate cancer patients. The average MU and MU per control point (MU/CP) for two-arc VMAT plans were 702.6 ± 55.7 and 3.9 ± 0.3 versus 504.6 ± 99.2 and 5.6 ± 1.1 for one-arc VMAT plans, respectively. The individual volume-based 3D gamma passing rates of clinical target volume (γCTV) and planning target volume (γPTV) for NPC and prostate cancer patients were 85.7% ± 9.0% vs 92.6% ± 7.8%, and 88.0% ± 7.6% vs 91.2% ± 7.7%, respectively. Plan complexity parameters of NPC patients were correlated with plan quality (P = 0.047) and individual volume-based 3D gamma indices γ(IV) (P = 0.01), in which, MU/CP and segment area (SA) per control point (SA/CP) were weighted highly in correlation with γ(IV) , and SA/CP, percentage of CPs with SA < 5 × 5 cm2 (%SA < 5 × 5 cm2) and PTV volume were weighted highly in correlation with plan quality with coefficients of 0.98, 0.68 and −0.99, respectively. Further verification with one-arc VMAT plans demonstrated similar results. In conclusion, MU, SA-related parameters and PTV volume were found to have strong effects on the plan quality and deliverability. PMID:29415196

Stereotactic body radiation therapy planning with duodenal sparing using volumetric-modulated arc therapy vs intensity-modulated radiation therapy in locally advanced pancreatic cancer: A dosimetric analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kumar, Rachit; Wild, Aaron T.; Ziegler, Mark A.

2013-10-01

Stereotactic body radiation therapy (SBRT) achieves excellent local control for locally advanced pancreatic cancer (LAPC), but may increase late duodenal toxicity. Volumetric-modulated arc therapy (VMAT) delivers intensity-modulated radiation therapy (IMRT) with a rotating gantry rather than multiple fixed beams. This study dosimetrically evaluates the feasibility of implementing duodenal constraints for SBRT using VMAT vs IMRT. Non–duodenal sparing (NS) and duodenal-sparing (DS) VMAT and IMRT plans delivering 25 Gy in 1 fraction were generated for 15 patients with LAPC. DS plans were constrained to duodenal D{sub max} of<30 Gy at any point. VMAT used 1 360° coplanar arc with 4° spacingmore » between control points, whereas IMRT used 9 coplanar beams with fixed gantry positions at 40° angles. Dosimetric parameters for target volumes and organs at risk were compared for DS planning vs NS planning and VMAT vs IMRT using paired-sample Wilcoxon signed rank tests. Both DS VMAT and DS IMRT achieved significantly reduced duodenal D{sub mean}, D{sub max}, D{sub 1cc}, D{sub 4%}, and V{sub 20} {sub Gy} compared with NS plans (all p≤0.002). DS constraints compromised target coverage for IMRT as demonstrated by reduced V{sub 95%} (p = 0.01) and D{sub mean} (p = 0.02), but not for VMAT. DS constraints resulted in increased dose to right kidney, spinal cord, stomach, and liver for VMAT. Direct comparison of DS VMAT and DS IMRT revealed that VMAT was superior in sparing the left kidney (p<0.001) and the spinal cord (p<0.001), whereas IMRT was superior in sparing the stomach (p = 0.05) and the liver (p = 0.003). DS VMAT required 21% fewer monitor units (p<0.001) and delivered treatment 2.4 minutes faster (p<0.001) than DS IMRT. Implementing DS constraints during SBRT planning for LAPC can significantly reduce duodenal point or volumetric dose parameters for both VMAT and IMRT. The primary consequence of implementing DS constraints for VMAT is increased dose to other organs at risk, whereas for IMRT it is compromised target coverage. These findings suggest clinical situations where each technique may be most useful if DS constraints are to be employed.« less

4D dose simulation in volumetric arc therapy: Accuracy and affecting parameters.

PubMed

Sothmann, Thilo; Gauer, Tobias; Werner, René

2017-01-01

Radiotherapy of lung and liver lesions has changed from normofractioned 3D-CRT to stereotactic treatment in a single or few fractions, often employing volumetric arc therapy (VMAT)-based techniques. Potential unintended interference of respiratory target motion and dynamically changing beam parameters during VMAT dose delivery motivates establishing 4D quality assurance (4D QA) procedures to assess appropriateness of generated VMAT treatment plans when taking into account patient-specific motion characteristics. Current approaches are motion phantom-based 4D QA and image-based 4D VMAT dose simulation. Whereas phantom-based 4D QA is usually restricted to a small number of measurements, the computational approaches allow simulating many motion scenarios. However, 4D VMAT dose simulation depends on various input parameters, influencing estimated doses along with mitigating simulation reliability. Thus, aiming at routine use of simulation-based 4D VMAT QA, the impact of such parameters as well as the overall accuracy of the 4D VMAT dose simulation has to be studied in detail-which is the topic of the present work. In detail, we introduce the principles of 4D VMAT dose simulation, identify influencing parameters and assess their impact on 4D dose simulation accuracy by comparison of simulated motion-affected dose distributions to corresponding dosimetric motion phantom measurements. Exploiting an ITV-based treatment planning approach, VMAT treatment plans were generated for a motion phantom and different motion scenarios (sinusoidal motion of different period/direction; regular/irregular motion). 4D VMAT dose simulation results and dose measurements were compared by local 3% / 3 mm γ-evaluation, with the measured dose distributions serving as ground truth. Overall γ-passing rates of simulations and dynamic measurements ranged from 97% to 100% (mean across all motion scenarios: 98% ± 1%); corresponding values for comparison of different day repeat measurements were between 98% and 100%. Parameters of major influence on 4D VMAT dose simulation accuracy were the degree of temporal discretization of the dose delivery process (the higher, the better) and correct alignment of the assumed breathing phases at the beginning of the dose measurements and simulations. Given the high γ-passing rates between simulated motion-affected doses and dynamic measurements, we consider the simulations to provide a reliable basis for assessment of VMAT motion effects that-in the sense of 4D QA of VMAT treatment plans-allows to verify target coverage in hypofractioned VMAT-based radiotherapy of moving targets. Remaining differences between measurements and simulations motivate, however, further detailed studies.

SU-F-T-522: Dosimetric Study of Junction Dose in Double Isocenter Flatten and Flatten Filter Free IMRT and VMAT Plan Delivery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Samuvel, K; Yadav, G; Bhushan, M

2016-06-15

Purpose: To quantify the dosimetric accuracy of junction dose in double isocenter flattened and flatten filter free(FFF) intensity modulated radiation therapy(IMRT) and volumetric modulated arc therapy(VMAT) plan delivery using pelvis phantom. Methods: Five large field pelvis patients were selected for this study. Double isocenter IMRT and VMAT treatment plans were generated in Eclipse Treatment planning System (V.11.0) using 6MV FB and FFF beams. For all the plans same distance 17.0cm was kept between one isocenter to another isocenter. IMRT Plans were made with 7 coplanar fields and VMAT plans were made with full double arcs. Dose calculation was performed usingmore » AAA algorithms with dose grid size of 0.25 cm. Verification plans were calculated on Scanditronix Wellhofer pelvis slab phantom. Measurement point was selected and calculated, where two isocenter plan fields are overlapping, this measurement point was kept at distance 8.5cm from both isocenter. The plans were delivered using Varian TrueBeamTM machine on pelvis slab phantom. Point dose measurements was carried out using CC13 ion chamber volume of 0.13cm3. Results: The measured junction point dose are compared with TPS calculated dose. The mean difference observed was 4.5%, 6.0%, 4.0% and 7.0% for IMRT-FB,IMRT-FFF, VMAT-FB and VMAT-FFF respectively. The measured dose results shows closer agreement with calculated dose in Flatten beam planning in both IMRT and VMAT, whereas in FFF beam plan dose difference are more compared with flatten beam plan. Conclusion: Dosimetry accuracy of Large Field junction dose difference was found less in Flatten beam compared with FFF beam plan delivery. Even though more dosimetric studies are required to analyse junction dose for FFF beam planning using multiple point dose measurements and fluence map verification in field junction area.« less

SU-E-T-62: Cardiac Toxicity in Dynamic Conformal Arc Therapy, Intensity-Modulated Radiation Therapy and Volumetric Modulated Arc Therapy of Lung Cancers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ming, X; Zhang, Y; Yale University, New Haven, CT, US

2014-06-01

Purpose: The cardiac toxicity for lung cancer patients, each treated with dynamic conformal arc therapy (DAT), intensity-modulated radiation therapy (IMRT), or volumetric modulated arc therapy (VMAT) is investigated. Methods: 120 lung patients were selected for this study: 25 treated with DAT, 50 with IMRT and 45 with VMAT. For comparison, all plans were generated in the same treatment planning system, normalized such that the 100% isodose lines encompassed 95% of planning target volume. The plan quality was evaluated in terms of homogeneity index (HI) and 95% conformity index (%95 CI) for target dose coverage and mean dose, maximum dose, V{submore » 30} Gy as well as V{sub 5} Gy for cardiac toxicity analysis. Results: When all the plans were analyzed, the VMAT plans offered the best target coverage with 95% CI = 0.992 and HI = 1.23. The DAT plans provided the best heart sparing with mean heart dose = 2.3Gy and maximum dose = 11.6Gy, as compared to 5.7 Gy and 31.1 Gy by IMRT as well as 4.6 Gy and 30.9 Gy by VMAT. The mean V30Gy and V5Gy of the heart in the DAT plans were up to 11.7% lower in comparison to the IMRT and VMAT plans. When the tumor volume was considered, the VMAT plans spared up to 70.9% more doses to the heart when the equivalent diameter of the tumor was larger than 4cm. Yet the maximum dose to the heart was reduced the most in the DAT plans with up to 139.8% less than that of the other two plans. Conclusion: Overall, the VMAT plans achieved the best target coverage among the three treatment modalities, and would spare the heart the most for the larger tumors. The DAT plans appeared advantageous in delivering the least maximum dose to the heart as compared to the IMRT and VMAT plans.« less

SU-E-T-398: Feasibility of Automated Tools for Robustness Evaluation of Advanced Photon and Proton Techniques in Oropharyngeal Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, H; Liang, X; Kalbasi, A

2014-06-01

Purpose: Advanced radiotherapy (RT) techniques such as proton pencil beam scanning (PBS) and photon-based volumetric modulated arc therapy (VMAT) have dosimetric advantages in the treatment of head and neck malignancies. However, anatomic or alignment changes during treatment may limit robustness of PBS and VMAT plans. We assess the feasibility of automated deformable registration tools for robustness evaluation in adaptive PBS and VMAT RT of oropharyngeal cancer (OPC). Methods: We treated 10 patients with bilateral OPC with advanced RT techniques and obtained verification CT scans with physician-reviewed target and OAR contours. We generated 3 advanced RT plans for each patient: protonmore » PBS plan using 2 posterior oblique fields (2F), proton PBS plan using an additional third low-anterior field (3F), and a photon VMAT plan using 2 arcs (Arc). For each of the planning techniques, we forward calculated initial (Ini) plans on the verification scans to create verification (V) plans. We extracted DVH indicators based on physician-generated contours for 2 target and 14 OAR structures to investigate the feasibility of two automated tools (contour propagation (CP) and dose deformation (DD)) as surrogates for routine clinical plan robustness evaluation. For each verification scan, we compared DVH indicators of V, CP and DD plans in a head-to-head fashion using Student's t-test. Results: We performed 39 verification scans; each patient underwent 3 to 6 verification scan. We found no differences in doses to target or OAR structures between V and CP, V and DD, and CP and DD plans across all patients (p > 0.05). Conclusions: Automated robustness evaluation tools, CP and DD, accurately predicted dose distributions of verification (V) plans using physician-generated contours. These tools may be further developed as a potential robustness screening tool in the workflow for adaptive treatment of OPC using advanced RT techniques, reducing the need for physician-generated contours.« less

Dosimetric study of uniform scanning proton therapy planning for prostate cancer patients with a metal hip prosthesis, and comparison with volumetric‐modulated arc therapy

PubMed Central

Cheng, ChihYao; Zheng, Yuanshui; Hsi, Wen; Zeidan, Omar; Schreuder, Niek; Vargas, Carlos; Larson, Gary

2014-01-01

The main purposes of this study were to 1) investigate the dosimetric quality of uniform scanning proton therapy planning (USPT) for prostate cancer patients with a metal hip prosthesis, and 2) compare the dosimetric results of USPT with that of volumetric‐modulated arc therapy (VMAT). Proton plans for prostate cancer (four cases) were generated in XiO treatment planning system (TPS). The beam arrangement in each proton plan consisted of three fields (two oblique fields and one lateral or slightly angled field), and the proton beams passing through a metal hip prosthesis was avoided. Dose calculations in proton plans were performed using the pencil beam algorithm. From each proton plan, planning target volume (PTV) coverage value (i.e., relative volume of the PTV receiving the prescription dose of 79.2 CGE) was recorded. The VMAT prostate planning was done using two arcs in the Eclipse TPS utilizing 6 MV X‐rays, and beam entrance through metallic hip prosthesis was avoided. Dose computation in the VMAT plans was done using anisotropic analytical algorithm, and calculated VMAT plans were then normalized such that the PTV coverage in the VMAT plan was the same as in the proton plan of the corresponding case. The dose‐volume histograms of calculated treatment plans were used to evaluate the dosimetric quality of USPT and VMAT. In comparison to the proton plans, on average, the maximum and mean doses to the PTV were higher in the VMAT plans by 1.4% and 0.5%, respectively, whereas the minimum PTV dose was lower in the VMAT plans by 3.4%. The proton plans had lower (or better) average homogeneity index (HI) of 0.03 compared to the one for VMAT (HI = 0.04). The relative rectal volume exposed to radiation was lower in the proton plan, with an average absolute difference ranging from 0.1% to 32.6%. In contrast, using proton planning, the relative bladder volume exposed to radiation was higher at high‐dose region with an average absolute difference ranging from 0.4% to 0.8%, and lower at low‐ and medium‐dose regions with an average absolute difference ranging from 2.7% to 10.1%. The average mean dose to the rectum and bladder was lower in the proton plans by 45.1% and 22.0%, respectively, whereas the mean dose to femoral head was lower in VMAT plans by an average difference of 79.6%. In comparison to the VMAT, the proton planning produced lower equivalent uniform dose (EUD) for the rectum (43.7 CGE vs. 51.4 Gy) and higher EUD for the femoral head (16.7 CGE vs. 9.5 Gy), whereas both the VMAT and proton planning produced comparable EUDs for the prostate tumor (76.2 CGE vs. 76.8 Gy) and bladder (50.3 CGE vs. 51.1 Gy). The results presented in this study show that the combination of lateral and oblique fields in USPT planning could potentially provide dosimetric advantage over the VMAT for prostate cancer involving a metallic hip prosthesis. PACS number: 87.55.D‐, 87.55.ne, 87.55.dk PMID:24892333

Automatic treatment planning facilitates fast generation of high-quality treatment plans for esophageal cancer.

PubMed

Hansen, Christian Rønn; Nielsen, Morten; Bertelsen, Anders Smedegaard; Hazell, Irene; Holtved, Eva; Zukauskaite, Ruta; Bjerregaard, Jon Kroll; Brink, Carsten; Bernchou, Uffe

2017-11-01

The quality of radiotherapy planning has improved substantially in the last decade with the introduction of intensity modulated radiotherapy. The purpose of this study was to analyze the plan quality and efficacy of automatically (AU) generated VMAT plans for inoperable esophageal cancer patients. Thirty-two consecutive inoperable patients with esophageal cancer originally treated with manually (MA) generated volumetric modulated arc therapy (VMAT) plans were retrospectively replanned using an auto-planning engine. All plans were optimized with one full 6MV VMAT arc giving 60 Gy to the primary target and 50 Gy to the elective target. The planning techniques were blinded before clinical evaluation by three specialized oncologists. To supplement the clinical evaluation, the optimization time for the AU plan was recorded along with DVH parameters for all plans. Upon clinical evaluation, the AU plan was preferred for 31/32 patients, and for one patient, there was no difference in the plans. In terms of DVH parameters, similar target coverage was obtained between the two planning methods. The mean dose for the spinal cord increased by 1.8 Gy using AU (p = .002), whereas the mean lung dose decreased by 1.9 Gy (p < .001). The AU plans were more modulated as seen by the increase of 12% in mean MUs (p = .001). The median optimization time for AU plans was 117 min. The AU plans were in general preferred and showed a lower mean dose to the lungs. The automation of the planning process generated esophageal cancer treatment plans quickly and with high quality.

Integration of radiobiological modeling and indices in comparative plan evaluation: A study comparing VMAT and 3D-CRT in patients with NSCLC.

PubMed

Roy, Soumyajit; Badragan, Iulian; Ahmed, Sheikh Nisar; Sia, Michael; Singh, Jorawur; Bahl, Gaurav

2018-03-01

The purpose of this article was to generate an algorithm to calculate radiobiological endpoints and composite indices and use them to compare volumetric modulated arc therapy (VMAT) and 3-dimensional conformal radiation therapy (3D-CRT) techniques in patients with locally advanced non-small cell lung cancer. The study included 25 patients with locally advanced non-small cell lung cancer treated with 3D-CRT at our center between January 1, 2010, and December 31, 2014. The planner generated VMAT plans using clones of the original computed tomography scans and regions of interest volumes, which did not include the original 3D plans. Both 3D-CRT and VMAT plans were generated using the same dose-volume constraint worksheet. The dose-volume histogram parameters for planning target volume and relevant organs at risk (OAR) were reviewed. The calculation engine was written in the R programming language; the user interface was developed with the "shiny" R Web library. Dose-volume histogram data were imported into the calculation engine and tumor control probability (TCP), normal tissue complication probability (NTCP), composite cardiopulmonary toxicity index (CPTI), morbidity index: MI = ∑ j = 1 #ofrelevantOARs (w j  ∗ NTCP j ), uncomplicated TCP (UTCP=TCP∗∏k=1#ofOARs1-NTCP K 100, and therapeutic gain (TG): ie, TG = TCP ∗ (100 - MI) were calculated. TCP was better with 3D-CRT (12.62% vs 11.71%, P < .001), whereas VMAT demonstrated superior NTCP esophagus (4.45% vs 7.39%, P = .02). NTCP spinal cord (0.001% vs 0.009%, P = .001), and NTCP heart/perfusion defect (44.57% vs 56.42%, P = .016). There was no difference in NTCP lung (6.27% vs 7.62%, P = .221) and NTCP heart/pericarditis (0.001% vs 0.15%, P = .129) between 2 techniques. VMAT showed substantial improvement in morbidity index (11.06% vs. 14.31%, P = 0.01), CPTI (47.59% vs 59.41%, P = .03), TG (P = .035), and trend toward superiority in UTCP (5.89 vs 4.75, P=.057). The study highlights the utility of the radiobiological algorithm and summary indices in comparative plan evaluation and demonstrates benefits of VMAT over 3D-CRT. Copyright © 2018 Elsevier Inc. All rights reserved.

SU-F-BRB-04: Comparison of Coplanar VMAT, Non-Coplanar VMAT, and 4π Treatment Plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Woods, K; Nguyen, D; Tran, A

2015-06-15

Purpose: The 4π non-coplanar radiotherapy delivery technique has demonstrated significantly better normal tissue sparing and dose conformality than the clinically used volumetric modulated arc therapy (VMAT). It is unclear whether this is a fundamental limitation of VMAT delivery or the coplanar nature of its typical clinical plans. The non-coplanar basis of 4π is incorporated into VMAT treatment planning to compare its effect on plan quality. Methods: Clinical stereotactic body radiation therapy plans for 9 liver patients treated with 30–60 Gy using coplanar VMAT (cVMAT) were re-planned using non-coplanar VMAT (nVMAT) with 3 arcs and 4 π with 20 intensity-modulated non-coplanarmore » fields. All plans were optimized to deliver 100% of the prescribed dose to 95% of the planning target volume (PTV), and nVMAT and 4π plans were tailored to match the maximum and mean PTV dose from the clinical plan. The conformality index (CI), 50% dose spillage volume (R50), normal liver volume receiving >15 Gy (VL>15), and doses to organs at risk (OARs) were compared for all three treatment plans. Results: Compared to cVMAT, the nVMAT and 4π plans reduced VL>15 by an average of 30.6 cm3 and 96.3 cm3, respectively. The average CI was also reduced from 1.22 (cVMAT) to 1.17 (nVMAT) and 1.14 (4π), indicating higher conformality in the same order. Similarly, R50 was reduced from 3.87 (cVMAT) to 3.58 (nVMAT) and 2.74 (4π). With the exception of the mean right kidney dose, which increased by an average of only 0.6 Gy for nVMAT, the dose differences to OARs were not statistically significant between the two VMAT plans. 4π plans either significantly decreased or maintained OAR doses. Conclusion: While the manual selection of intuitive non-coplanar arcs does show some improvement over coplanar VMAT, the automated beam selection for 4π still results in superior plan quality. This project is supported in part by Varian Medical Systems and NIH R43 CA183390.« less

Functional Image-Guided Radiotherapy Planning in Respiratory-Gated Intensity-Modulated Radiotherapy for Lung Cancer Patients With Chronic Obstructive Pulmonary Disease

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kimura, Tomoki, E-mail: tkkimura@hiroshima-u.ac.jp; Nishibuchi, Ikuno; Murakami, Yuji

2012-03-15

Purpose: To investigate the incorporation of functional lung image-derived low attenuation area (LAA) based on four-dimensional computed tomography (4D-CT) into respiratory-gated intensity-modulated radiotherapy (IMRT) or volumetric modulated arc therapy (VMAT) in treatment planning for lung cancer patients with chronic obstructive pulmonary disease (COPD). Methods and Materials: Eight lung cancer patients with COPD were the subjects of this study. LAA was generated from 4D-CT data sets according to CT values of less than than -860 Hounsfield units (HU) as a threshold. The functional lung image was defined as the area where LAA was excluded from the image of the total lung.more » Two respiratory-gated radiotherapy plans (70 Gy/35 fractions) were designed and compared in each patient as follows: Plan A was an anatomical IMRT or VMAT plan based on the total lung; Plan F was a functional IMRT or VMAT plan based on the functional lung. Dosimetric parameters (percentage of total lung volume irradiated with {>=}20 Gy [V20], and mean dose of total lung [MLD]) of the two plans were compared. Results: V20 was lower in Plan F than in Plan A (mean 1.5%, p = 0.025 in IMRT, mean 1.6%, p = 0.044 in VMAT) achieved by a reduction in MLD (mean 0.23 Gy, p = 0.083 in IMRT, mean 0.5 Gy, p = 0.042 in VMAT). No differences were noted in target volume coverage and organ-at-risk doses. Conclusions: Functional IGRT planning based on LAA in respiratory-guided IMRT or VMAT appears to be effective in preserving a functional lung in lung cancer patients with COPD.« less

SU-F-J-124: Reduction in Dosimetric Impact of Motion Using VMAT Compared to IMRT in Hypofractionated Prostate Cancer Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ravindranath, B; Xiong, J; Happersett, L

2016-06-15

Purpose: To quantify and compare the dosimetric impact of motion management correction strategies during VMAT and IMRT for hypofractionated prostate treatment. Methods: Two arc VMAT and 9 field IMRT plans were generated for two prostate cancer patients undergoing hypofractionated radiotherapy (7.5Gy × 5 and 8Gy × 5). 212 motion traces were retrospectively extracted from treatment records of prostate cancer patients with implanted Calypso beacons. Dose to the CTV and normal tissues was reconstructed for each trace and plan taking into account the actual treatment delivery time. Following motion correction scenarios were simulated: (1) VMAT plan – (a) No correction, (b)more » correction between arcs, (c) correction every 20 degrees of gantry rotation and (2) IMRT plan - (a) No correction,(b) correction between fields. Two mm action threshold for position correction was assumed. The 5–95% confidence interval (CI) range was extracted from the family of DVHs for each correction scenario. Results: Treatment duration for 8Gy plan (VMAT vs IMRT) was 3 vs 12 mins and for 7.5Gy plan was 3 vs 9 mins. In the absence of correction, the VMAT 5–−95% CI dose spread was, on average, less than the IMRT dose spread by 2% for CTVD95, 9% for rectalwall (RW) D1cc and 9% for bladderwall (BW) D53. Further, VMAT b/w arcs correction strategy reduced the spread about the planned value compared to IMRT b/w fields correction by: 1% for CTVD95, 2.6% for RW1cc and 2% for BWD53. VMAT 20 degree strategy led to greater reduction in dose spread compared to IMRT by: 2% for CTVD95, 4.5% for RW1cc and 6.7% for BWD53. Conclusion: In the absence of a correction strategy, the limited motion during VMAT’s shorter delivery times translates into less motion-induced dosimetric degradation than IMRT. Performing limited periodic motion correction during VMAT can yield excellent conformity to planned values that is superior to IMRT. This work was partially supported by Varian Medical Systems.« less

SU-F-T-402: The Effect of Extremely Narrow MLC Leaf Width On the Plan Quality of VMAT for Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kim, J; Park, S; Kim, J

2016-06-15

Purpose: To investigate the effect of multi-leaf collimators (MLCs) with leaf width of 1.25 mm on the plan quality of volumetric modulated arc therapy (VMAT) for prostate cancer. Methods: A total of 20 patients with prostate cancer were retrospectively selected. Using a high definition MLC (HD MLC), primary and boost VMAT plans with two full arcs were generated for each patient (original plan). After that, by shifting patient CT images by 1.25 mm in the cranio-caudal direction between the 1st and the 2nd arc, we simulated fluences made with MLCs with leaf width of 1.25 mm. After shifting, primary andmore » boost plans were generated for each patient (shifted plan). A sum plan was generated by summation of the primary and boost plan for each patient. Dose-volumetric parameters were calculated and compared. Results: Both homogeneity index (HI) and conformity index (CI) of the shifted plans were better than those of the original plans in primary plans (HI = 0.044 vs. 0.040 with p < 0.001 and CI = 1.056 vs. 1.044 with p = 0.006). Similarly, the shifted plans for boost target volume showed better homogeneity and conformity than did the original plans (HI = 0.042 vs. 0.037 with p = 0.006 and CI = 1.015 vs. 1.009 with p < 0.001). The total body volumes of the original plans irradiated by the prescription dose were larger than those of the shifted plans in sum plans (60.9 cc vs. 49.0 cc with p = 0.007). Conclusion: Use of extremely narrow MLCs could increase dose homogeneity and conformity of the target volume for prostate VMAT. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. 2015R1C1A1A02036331).« less

Multi-GPU implementation of a VMAT treatment plan optimization algorithm.

PubMed

Tian, Zhen; Peng, Fei; Folkerts, Michael; Tan, Jun; Jia, Xun; Jiang, Steve B

2015-06-01

Volumetric modulated arc therapy (VMAT) optimization is a computationally challenging problem due to its large data size, high degrees of freedom, and many hardware constraints. High-performance graphics processing units (GPUs) have been used to speed up the computations. However, GPU's relatively small memory size cannot handle cases with a large dose-deposition coefficient (DDC) matrix in cases of, e.g., those with a large target size, multiple targets, multiple arcs, and/or small beamlet size. The main purpose of this paper is to report an implementation of a column-generation-based VMAT algorithm, previously developed in the authors' group, on a multi-GPU platform to solve the memory limitation problem. While the column-generation-based VMAT algorithm has been previously developed, the GPU implementation details have not been reported. Hence, another purpose is to present detailed techniques employed for GPU implementation. The authors also would like to utilize this particular problem as an example problem to study the feasibility of using a multi-GPU platform to solve large-scale problems in medical physics. The column-generation approach generates VMAT apertures sequentially by solving a pricing problem (PP) and a master problem (MP) iteratively. In the authors' method, the sparse DDC matrix is first stored on a CPU in coordinate list format (COO). On the GPU side, this matrix is split into four submatrices according to beam angles, which are stored on four GPUs in compressed sparse row format. Computation of beamlet price, the first step in PP, is accomplished using multi-GPUs. A fast inter-GPU data transfer scheme is accomplished using peer-to-peer access. The remaining steps of PP and MP problems are implemented on CPU or a single GPU due to their modest problem scale and computational loads. Barzilai and Borwein algorithm with a subspace step scheme is adopted here to solve the MP problem. A head and neck (H&N) cancer case is then used to validate the authors' method. The authors also compare their multi-GPU implementation with three different single GPU implementation strategies, i.e., truncating DDC matrix (S1), repeatedly transferring DDC matrix between CPU and GPU (S2), and porting computations involving DDC matrix to CPU (S3), in terms of both plan quality and computational efficiency. Two more H&N patient cases and three prostate cases are used to demonstrate the advantages of the authors' method. The authors' multi-GPU implementation can finish the optimization process within ∼ 1 min for the H&N patient case. S1 leads to an inferior plan quality although its total time was 10 s shorter than the multi-GPU implementation due to the reduced matrix size. S2 and S3 yield the same plan quality as the multi-GPU implementation but take ∼4 and ∼6 min, respectively. High computational efficiency was consistently achieved for the other five patient cases tested, with VMAT plans of clinically acceptable quality obtained within 23-46 s. Conversely, to obtain clinically comparable or acceptable plans for all six of these VMAT cases that the authors have tested in this paper, the optimization time needed in a commercial TPS system on CPU was found to be in an order of several minutes. The results demonstrate that the multi-GPU implementation of the authors' column-generation-based VMAT optimization can handle the large-scale VMAT optimization problem efficiently without sacrificing plan quality. The authors' study may serve as an example to shed some light on other large-scale medical physics problems that require multi-GPU techniques.

4D dose simulation in volumetric arc therapy: Accuracy and affecting parameters

PubMed Central

Werner, René

2017-01-01

Radiotherapy of lung and liver lesions has changed from normofractioned 3D-CRT to stereotactic treatment in a single or few fractions, often employing volumetric arc therapy (VMAT)-based techniques. Potential unintended interference of respiratory target motion and dynamically changing beam parameters during VMAT dose delivery motivates establishing 4D quality assurance (4D QA) procedures to assess appropriateness of generated VMAT treatment plans when taking into account patient-specific motion characteristics. Current approaches are motion phantom-based 4D QA and image-based 4D VMAT dose simulation. Whereas phantom-based 4D QA is usually restricted to a small number of measurements, the computational approaches allow simulating many motion scenarios. However, 4D VMAT dose simulation depends on various input parameters, influencing estimated doses along with mitigating simulation reliability. Thus, aiming at routine use of simulation-based 4D VMAT QA, the impact of such parameters as well as the overall accuracy of the 4D VMAT dose simulation has to be studied in detail–which is the topic of the present work. In detail, we introduce the principles of 4D VMAT dose simulation, identify influencing parameters and assess their impact on 4D dose simulation accuracy by comparison of simulated motion-affected dose distributions to corresponding dosimetric motion phantom measurements. Exploiting an ITV-based treatment planning approach, VMAT treatment plans were generated for a motion phantom and different motion scenarios (sinusoidal motion of different period/direction; regular/irregular motion). 4D VMAT dose simulation results and dose measurements were compared by local 3% / 3 mm γ-evaluation, with the measured dose distributions serving as ground truth. Overall γ-passing rates of simulations and dynamic measurements ranged from 97% to 100% (mean across all motion scenarios: 98% ± 1%); corresponding values for comparison of different day repeat measurements were between 98% and 100%. Parameters of major influence on 4D VMAT dose simulation accuracy were the degree of temporal discretization of the dose delivery process (the higher, the better) and correct alignment of the assumed breathing phases at the beginning of the dose measurements and simulations. Given the high γ-passing rates between simulated motion-affected doses and dynamic measurements, we consider the simulations to provide a reliable basis for assessment of VMAT motion effects that–in the sense of 4D QA of VMAT treatment plans–allows to verify target coverage in hypofractioned VMAT-based radiotherapy of moving targets. Remaining differences between measurements and simulations motivate, however, further detailed studies. PMID:28231337

SU-F-T-359: Incorporating Dose Volume Histogram Prediction Into Auto-Planning for Volumetric-Modulated Arc Therapy in Rectal Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, K; Chen, X; Wang, J

Purpose: To incorporate dose volume histogram (DVH) prediction into Auto-Planning for volumetric-modulated arc therapy (VMAT) treatment planning and investigate the benefit of this new technique for rectal cancer. Methods: Ninety clinically accepted VMAT plans for patients with rectal cancer were selected and trained in the RapidPlan for DVH prediction. Both internal and external validations were performed before implementing the prediction model. A new VMAT planning method (hybrid-VMAT) was created with combining the DVH prediction and Auto-Planning. For each new patient, the DVH will be predicted and individual DVH constrains will be obtained and were exported as the original optimization parametersmore » to the Auto-Planning (Pinnacle3 treatment planning system, v9.10) for planning. A total of 20 rectal cancer patients previously treated with manual VMAT (manual-VMAT) plans were replanned using this new method. Dosimetric comparisons were performed between manual VMAT and new method plans. Results: Hybrid-VMAT shows similar PTV coverage to manual-VMAT in D2%, D98% and HI (p>0.05) and superior coverage in CI (p=0.000). For the bladder, the means of V40 and mean dose are 36.0% and 35.6Gy for hybrid-VMAT and 42% and 38.0Gy for the manual-VMAT. For the left (right) femur, the means of V30 and mean dose are 10.6% (11.6%) and 17.9Gy (19.2Gy) for the hybrid-VMAT and 25.6% (24.1%) and 27.3Gy (26.2Gy) for the manual-VMAT. The hybrid-VMAT has significantly improved the organs at risk sparing. Conclusion: The integration of DVH prediction and Auto-Planning significantly improve the VMAT plan quality in the rectal cancer radiotherapy. Our results show the benefit of the new method and will be further investigated in other tumor sites.« less

Monte Carlo simulation for scanning technique with scattering foil free electron beam: A proof of concept study

PubMed Central

Sung, Wonmo; Park, Jong In; Kim, Jung-in; Carlson, Joel; Ye, Sung-Joon

2017-01-01

This study investigated the potential of a newly proposed scattering foil free (SFF) electron beam scanning technique for the treatment of skin cancer on the irregular patient surfaces using Monte Carlo (MC) simulation. After benchmarking of the MC simulations, we removed the scattering foil to generate SFF electron beams. Cylindrical and spherical phantoms with 1 cm boluses were generated and the target volume was defined from the surface to 5 mm depth. The SFF scanning technique with 6 MeV electrons was simulated using those phantoms. For comparison, volumetric modulated arc therapy (VMAT) plans were also generated with two full arcs and 6 MV photon beams. When the scanning resolution resulted in a larger separation between beams than the field size, the plan qualities were worsened. In the cylindrical phantom with a radius of 10 cm, the conformity indices, homogeneity indices and body mean doses of the SFF plans (scanning resolution = 1°) vs. VMAT plans were 1.04 vs. 1.54, 1.10 vs. 1.12 and 5 Gy vs. 14 Gy, respectively. Those of the spherical phantom were 1.04 vs. 1.83, 1.08 vs. 1.09 and 7 Gy vs. 26 Gy, respectively. The proposed SFF plans showed superior dose distributions compared to the VMAT plans. PMID:28493940

Monte Carlo simulation for scanning technique with scattering foil free electron beam: A proof of concept study.

PubMed

Sung, Wonmo; Park, Jong In; Kim, Jung-In; Carlson, Joel; Ye, Sung-Joon; Park, Jong Min

2017-01-01

This study investigated the potential of a newly proposed scattering foil free (SFF) electron beam scanning technique for the treatment of skin cancer on the irregular patient surfaces using Monte Carlo (MC) simulation. After benchmarking of the MC simulations, we removed the scattering foil to generate SFF electron beams. Cylindrical and spherical phantoms with 1 cm boluses were generated and the target volume was defined from the surface to 5 mm depth. The SFF scanning technique with 6 MeV electrons was simulated using those phantoms. For comparison, volumetric modulated arc therapy (VMAT) plans were also generated with two full arcs and 6 MV photon beams. When the scanning resolution resulted in a larger separation between beams than the field size, the plan qualities were worsened. In the cylindrical phantom with a radius of 10 cm, the conformity indices, homogeneity indices and body mean doses of the SFF plans (scanning resolution = 1°) vs. VMAT plans were 1.04 vs. 1.54, 1.10 vs. 1.12 and 5 Gy vs. 14 Gy, respectively. Those of the spherical phantom were 1.04 vs. 1.83, 1.08 vs. 1.09 and 7 Gy vs. 26 Gy, respectively. The proposed SFF plans showed superior dose distributions compared to the VMAT plans.

Treatment planning and dosimetric comparison study on two different volumetric modulated arc therapy delivery techniques

PubMed Central

Kumar, S.A. Syam; Holla, Raghavendra; Sukumar, Prabakar; Padmanaban, Sriram; Vivekanandan, Nagarajan

2012-01-01

Aim To compare and evaluate the performance of two different volumetric modulated arc therapy delivery techniques. Background Volumetric modulated arc therapy is a novel technique that has recently been made available for clinical use. Planning and dosimetric comparison study was done for Elekta VMAT and Varian RapidArc for different treatment sites. Materials and methods Ten patients were selected for the planning comparison study. This includes 2 head and neck, 2 oesophagus, 1 bladder, 3 cervix and 2 rectum cases. Total dose of 50 Gy was given for all the plans. All plans were done for RapidArc using Eclipse and for Elekta VMAT with Monaco treatment planning system. All plans were generated with 6 MV X-rays for both RapidArc and Elekta VMAT. Plans were evaluated based on the ability to meet the dose volume histogram, dose homogeneity index, radiation conformity index, estimated radiation delivery time, integral dose and monitor units needed to deliver the prescribed dose. Results RapidArc plans achieved the best conformity (CI95% = 1.08 ± 0.07) while Elekta VMAT plans were slightly inferior (CI95% = 1.10 ± 0.05). The in-homogeneity in the PTV was highest with Elekta VMAT with HI equal to 0.12 ± 0.02 Gy when compared to RapidArc with 0.08 ± 0.03. Significant changes were observed between the RapidArc and Elekta VMAT plans in terms of the healthy tissue mean dose and integral dose. Elekta VMAT plans show a reduction in the healthy tissue mean dose (6.92 ± 2.90) Gy when compared to RapidArc (7.83 ± 3.31) Gy. The integral dose is found to be inferior with Elekta VMAT (11.50 ± 6.49) × 104 Gy cm3 when compared to RapidArc (13.11 ± 7.52) × 104 Gy cm3. Both Varian RapidArc and Elekta VMAT respected the planning objective for all organs at risk. Gamma analysis result for the pre-treatment quality assurance shows good agreement between the planned and delivered fluence for 3 mm DTA, 3% DD for all the evaluated points inside the PTV, for both VMAT and RapidArc techniques. Conclusion The study concludes that a variable gantry speed with variable dose rate is important for efficient arc therapy delivery. RapidArc presents a slight improvement in the OAR sparing with better target coverage when compared to Elekta VMAT. Trivial differences were noted in all the plans for organ at risk but the two techniques provided satisfactory conformal avoidance and conformation. PMID:24416535

Dosimetric comparison of peripheral NSCLC SBRT using Acuros XB and AAA calculation algorithms.

PubMed

Ong, Chloe C H; Ang, Khong Wei; Soh, Roger C X; Tin, Kah Ming; Yap, Jerome H H; Lee, James C L; Bragg, Christopher M

2017-01-01

There is a concern for dose calculation in highly heterogenous environments such as the thorax region. This study compares the quality of treatment plans of peripheral non-small cell lung cancer (NSCLC) stereotactic body radiation therapy (SBRT) using 2 calculation algorithms, namely, Eclipse Anisotropic Analytical Algorithm (AAA) and Acuros External Beam (AXB), for 3-dimensional conformal radiation therapy (3DCRT) and volumetric-modulated arc therapy (VMAT). Four-dimensional computed tomography (4DCT) data from 20 anonymized patients were studied using Varian Eclipse planning system, AXB, and AAA version 10.0.28. A 3DCRT plan and a VMAT plan were generated using AAA and AXB with constant plan parameters for each patient. The prescription and dose constraints were benchmarked against Radiation Therapy Oncology Group (RTOG) 0915 protocol. Planning parameters of the plan were compared statistically using Mann-Whitney U tests. Results showed that 3DCRT and VMAT plans have a lower target coverage up to 8% when calculated using AXB as compared with AAA. The conformity index (CI) for AXB plans was 4.7% lower than AAA plans, but was closer to unity, which indicated better target conformity. AXB produced plans with global maximum doses which were, on average, 2% hotter than AAA plans. Both 3DCRT and VMAT plans were able to achieve D95%. VMAT plans were shown to be more conformal (CI = 1.01) and were at least 3.2% and 1.5% lower in terms of PTV maximum and mean dose, respectively. There was no statistically significant difference for doses received by organs at risk (OARs) regardless of calculation algorithms and treatment techniques. In general, the difference in tissue modeling for AXB and AAA algorithm is responsible for the dose distribution between the AXB and the AAA algorithms. The AXB VMAT plans could be used to benefit patients receiving peripheral NSCLC SBRT. Copyright © 2017 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Acar, H; Cebe, M; Mabhouti, H

Purpose: Stereotactic body radiosurgery (SBRT) for spine metastases involves irradiation using a single high dose fraction. The purpose of this study was to investigate a Hybrid VMAT/IMRT technique which combines volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) for spine SBRT in terms of its dosimetric quality and treatment efficiency using Radiation Therapy Oncology Group (RTOG) 0631 guidelines. Methods: 7 fields IMRT, 2 full arcs VMAT and Hybrid VMAT/IMRT were created for ten previously treated patients. The Hybrid VMAT/IMRT technique consisted of 1 full VMAT arc and 5 IMRT fields. Hybrid VMAT/IMRT plans were compared with IMRTmore » and VMAT plans in terms of the dose distribution, spinal cord sparing, homogeneity, conformity and gradient indexies, monitor unit (MU) and beam on time (BOT). RTOG 0631 recommendations were applied for treatment planning. All plans were normalized and prescribed to deliver 18.0 Gy in a single fraction to 90% of the target volume. Results: The Hybrid VMAT/IMRT technique significantly improved target dose homogeneity and conformity compared with IMRT and VMAT techniques. Providing sharp dose gradient Hybrid VMAT/IMRT plans spare the spinal cord and healthy tissue more effectively. Although, both MU and BOT slightly increased in Hybrid VMAT/IMRT plans there is no statistically meaningful difference between VMAT and Hybrid VMAT/IMRT plans. Conclusion: In IMRT, a smaller volume of healthy tissue can be irradiated in the low dose region, VMAT plans provide better target volume coverage, favorable dose gradient, conformity and better OAR sparing and also they require a much smaller number of MUs and thus a shorter treatment time than IMRT plans. Hybrid plan offers a sinergy through combination of these two techniques with slightly increased number of MU and thus more treatment time.« less

Volumetric-modulated arc therapy vs c-IMRT in esophageal cancer: A treatment planning comparison

PubMed Central

Yin, Li; Wu, Hao; Gong, Jian; Geng, Jian-Hao; Jiang, Fan; Shi, An-Hui; Yu, Rong; Li, Yong-Heng; Han, Shu-Kui; Xu, Bo; Zhu, Guang-Ying

2012-01-01

AIM: To compare the volumetric-modulated arc therapy (VMAT) plans with conventional sliding window intensity-modulated radiotherapy (c-IMRT) plans in esophageal cancer (EC). METHODS: Twenty patients with EC were selected, including 5 cases located in the cervical, the upper, the middle and the lower thorax, respectively. Five plans were generated with the eclipse planning system: three using c-IMRT with 5 fields (5F), 7 fields (7F) and 9 fields (9F), and two using VMAT with a single arc (1A) and double arcs (2A). The treatment plans were designed to deliver a dose of 60 Gy to the planning target volume (PTV) with the same constrains in a 2.0 Gy daily fraction, 5 d a week. Plans were normalized to 95% of the PTV that received 100% of the prescribed dose. We examined the dose-volume histogram parameters of PTV and the organs at risk (OAR) such as lungs, spinal cord and heart. Monitor units (MU) and normal tissue complication probability (NTCP) of OAR were also reported. RESULTS: Both c-IMRT and VMAT plans resulted in abundant dose coverage of PTV for EC of different locations. The dose conformity to PTV was improved as the number of field in c-IMRT or rotating arc in VMAT was increased. The doses to PTV and OAR in VMAT plans were not statistically different in comparison with c-IMRT plans, with the following exceptions: in cervical and upper thoracic EC, the conformity index (CI) was higher in VMAT (1A 0.78 and 2A 0.8) than in c-IMRT (5F 0.62, 7F 0.66 and 9F 0.73) and homogeneity was slightly better in c-IMRT (7F 1.09 and 9F 1.07) than in VMAT (1A 1.1 and 2A 1.09). Lung V30 was lower in VMAT (1A 12.52 and 2A 12.29) than in c-IMRT (7F 14.35 and 9F 14.81). The humeral head doses were significantly increased in VMAT as against c-IMRT. In the middle and lower thoracic EC, CI in VMAT (1A 0.76 and 2A 0.74) was higher than in c-IMRT (5F 0.63 Gy and 7F 0.67 Gy), and homogeneity was almost similar between VMAT and c-IMRT. V20 (2A 21.49 Gy vs 7F 24.59 Gy and 9F 24.16 Gy) and V30 (2A 9.73 Gy vs 5F 12.61 Gy, 7F 11.5 Gy and 9F 11.37 Gy) of lungs in VMAT were lower than in c-IMRT, but low doses to lungs (V5 and V10) were increased. V30 (1A 48.12 Gy vs 5F 59.2 Gy, 7F 58.59 Gy and 9F 57.2 Gy), V40 and V50 of heart in VMAT was lower than in c-IMRT. MUs in VMAT plans were significantly reduced in comparison with c-IMRT, maximum doses to the spinal cord and mean doses of lungs were similar between the two techniques. NTCP of spinal cord was 0 for all cases. NTCP of lungs and heart in VMAT were lower than in c-IMRT. The advantage of VMAT plan was enhanced by doubling the arc. CONCLUSION: Compared with c-IMRT, VMAT, especially the 2A, slightly improves the OAR dose sparing, such as lungs and heart, and reduces NTCP and MU with a better PTV coverage. PMID:23066322

Volumetric-modulated arc therapy vs. c-IMRT in esophageal cancer: a treatment planning comparison.

PubMed

Yin, Li; Wu, Hao; Gong, Jian; Geng, Jian-Hao; Jiang, Fan; Shi, An-Hui; Yu, Rong; Li, Yong-Heng; Han, Shu-Kui; Xu, Bo; Zhu, Guang-Ying

2012-10-07

To compare the volumetric-modulated arc therapy (VMAT) plans with conventional sliding window intensity-modulated radiotherapy (c-IMRT) plans in esophageal cancer (EC). Twenty patients with EC were selected, including 5 cases located in the cervical, the upper, the middle and the lower thorax, respectively. Five plans were generated with the eclipse planning system: three using c-IMRT with 5 fields (5F), 7 fields (7F) and 9 fields (9F), and two using VMAT with a single arc (1A) and double arcs (2A). The treatment plans were designed to deliver a dose of 60 Gy to the planning target volume (PTV) with the same constrains in a 2.0 Gy daily fraction, 5 d a week. Plans were normalized to 95% of the PTV that received 100% of the prescribed dose. We examined the dose-volume histogram parameters of PTV and the organs at risk (OAR) such as lungs, spinal cord and heart. Monitor units (MU) and normal tissue complication probability (NTCP) of OAR were also reported. Both c-IMRT and VMAT plans resulted in abundant dose coverage of PTV for EC of different locations. The dose conformity to PTV was improved as the number of field in c-IMRT or rotating arc in VMAT was increased. The doses to PTV and OAR in VMAT plans were not statistically different in comparison with c-IMRT plans, with the following exceptions: in cervical and upper thoracic EC, the conformity index (CI) was higher in VMAT (1A 0.78 and 2A 0.8) than in c-IMRT (5F 0.62, 7F 0.66 and 9F 0.73) and homogeneity was slightly better in c-IMRT (7F 1.09 and 9F 1.07) than in VMAT (1A 1.1 and 2A 1.09). Lung V30 was lower in VMAT (1A 12.52 and 2A 12.29) than in c-IMRT (7F 14.35 and 9F 14.81). The humeral head doses were significantly increased in VMAT as against c-IMRT. In the middle and lower thoracic EC, CI in VMAT (1A 0.76 and 2A 0.74) was higher than in c-IMRT (5F 0.63 Gy and 7F 0.67 Gy), and homogeneity was almost similar between VMAT and c-IMRT. V20 (2A 21.49 Gy vs. 7F 24.59 Gy and 9F 24.16 Gy) and V30 (2A 9.73 Gy vs. 5F 12.61 Gy, 7F 11.5 Gy and 9F 11.37 Gy) of lungs in VMAT were lower than in c-IMRT, but low doses to lungs (V5 and V10) were increased. V30 (1A 48.12 Gy vs. 5F 59.2 Gy, 7F 58.59 Gy and 9F 57.2 Gy), V40 and V50 of heart in VMAT was lower than in c-IMRT. MUs in VMAT plans were significantly reduced in comparison with c-IMRT, maximum doses to the spinal cord and mean doses of lungs were similar between the two techniques. NTCP of spinal cord was 0 for all cases. NTCP of lungs and heart in VMAT were lower than in c-IMRT. The advantage of VMAT plan was enhanced by doubling the arc. Compared with c-IMRT, VMAT, especially the 2A, slightly improves the OAR dose sparing, such as lungs and heart, and reduces NTCP and MU with a better PTV coverage.

A planning study investigating dual-gated volumetric arc stereotactic treatment of primary renal cell carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Devereux, Thomas, E-mail: thomas.devereux@petermac.org; Pham, Daniel; Kron, Tomas

2015-04-01

This is a planning study investigating the dosimetric advantages of gated volumetric-modulated arc therapy (VMAT) to the end-exhale and end-inhale breathing phases for patients undergoing stereotactic treatment of primary renal cell carcinoma. VMAT plans were developed from the end-inhale (VMATinh) and the end-exhale (VMATexh) phases of the breathing cycle as well as a VMAT plan and 3-dimensional conformal radiation therapy plan based on an internal target volume (ITV) (VMATitv). An additional VMAT plan was created by giving the respective gated VMAT plan a 50% weighting and summing the inhale and exhale plans together to create a summed gated plan. Dosemore » to organs at risk (OARs) as well as comparison of intermediate and low-dose conformity was evaluated. There was no difference in the volume of healthy tissue receiving the prescribed dose for the planned target volume (PTV) (CI100%) for all the VMAT plans; however, the mean volume of healthy tissue receiving 50% of the prescribed dose for the PTV (CI50%) values were 4.7 (± 0.2), 4.6 (± 0.2), and 4.7 (± 0.6) for the VMATitv, VMATinh, and VMATexh plans, respectively. The VMAT plans based on the exhale and inhale breathing phases showed a 4.8% and 2.4% reduction in dose to 30 cm{sup 3} of the small bowel, respectively, compared with that of the ITV-based VMAT plan. The summed gated VMAT plans showed a 6.2% reduction in dose to 30 cm{sup 3} of the small bowel compared with that of the VMAT plans based on the ITV. Additionally, when compared with the inhale and the exhale VMAT plans, a 4% and 1.5%, respectively, reduction was observed. Gating VMAT was able to reduce the amount of prescribed, intermediate, and integral dose to healthy tissue when compared with VMAT plans based on an ITV. When summing the inhale and exhale plans together, dose to healthy tissue and OARs was optimized. However, gating VMAT plans would take longer to treat and is a factor that needs to be considered.« less

Potential for Improved Intelligence Quotient Using Volumetric Modulated Arc Therapy Compared With Conventional 3-Dimensional Conformal Radiation for Whole-Ventricular Radiation in Children

DOE Office of Scientific and Technical Information (OSTI.GOV)

Qi, X. Sharon, E-mail: xqi@mednet.ucla.edu; Department of Radiation Oncology, University of Colorado Denver, Aurora, Colorado; Stinauer, Michelle

Purpose: To compare volumetric modulated arc therapy (VMAT) with 3-dimensional conformal radiation therapy (3D-CRT) in the treatment of localized intracranial germinoma. We modeled the effect of the dosimetric differences on intelligence quotient (IQ). Method and Materials: Ten children with intracranial germinomas were used for planning. The prescription doses were 23.4 Gy to the ventricles followed by 21.6 Gy to the tumor located in the pineal region. For each child, a 3D-CRT and full arc VMAT was generated. Coverage of the target was assessed by computing a conformity index and heterogeneity index. We also generated VMAT plans with explicit temporal lobemore » sparing and with smaller ventricular margin expansions. Mean dose to the temporal lobe was used to estimate IQ 5 years after completion of radiation, using a patient age of 10 years. Results: Compared with the 3D-CRT plan, VMAT improved conformality (conformity index 1.10 vs 1.85), with slightly higher heterogeneity (heterogeneity index 1.09 vs 1.06). The averaged mean doses for left and right temporal lobes were 31.3 and 31.7 Gy, respectively, for VMAT plans and 37.7 and 37.6 Gy for 3D-CRT plans. This difference in mean temporal lobe dose resulted in an estimated IQ difference of 3.1 points at 5 years after radiation therapy. When the temporal lobes were explicitly included in the VMAT optimization, the mean temporal lobe dose was reduced 5.6-5.7 Gy, resulting in an estimated IQ difference of an additional 3 points. Reducing the ventricular margin from 1.5 cm to 0.5 cm decreased mean temporal lobe dose 11.4-13.1 Gy, corresponding to an estimated increase in IQ of 7 points. Conclusion: For treatment of children with intracranial pure germinomas, VMAT compared with 3D-CRT provides increased conformality and reduces doses to normal tissue. This may result in improvements in IQ in these children.« less

Dosimetric benefits of IMRT and VMAT in the treatment of middle thoracic esophageal cancer: is the conformal radiotherapy still an alternative option?

PubMed

Wu, Zhiqin; Xie, Congying; Hu, Meilong; Han, Ce; Yi, Jinling; Zhou, Yongqiang; Yuan, Huawei; Jin, Xiance

2014-05-08

The purpose of this study is to investigate the dosimetric differences among conformal radiotherapy (CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated radiotherapy (VMAT) in the treatment of middle thoracic esophageal cancer, and determine the most appropriate treatment modality. IMRT and one-arc VMAT plans were generated for eight middle thoracic esophageal cancer patients treated previous with CRT. The planning target volume (PTV) coverage and protections on organs at risk of three planning schemes were compared. All plans have sufficient PTV coverage and no significant differences were observed, except for the conformity and homogeneity. The lung V5, V10, and V13 in CRT were 47.9% ± 6.1%, 36.5% ± 4.6%, and 33.2% ± 4.2%, respectively, which were greatly increased to 78.2% ± 13.7% (p < 0.01), 80.8% ± 14.9% (p < 0.01), 48.4% ± 8.2% (p = 0.05) in IMRT and 58.6% ± 10.5% (p = 0.03), 67.7% ± 14.0% (p < 0.01), and 53.0% ± 10.1% (p < 0.01) in VMAT, respectively. The lung V20 (p = 0.03) in VMAT and the V30 (p = 0.04) in IMRT were lower than those in CRT. Both IMRT and VMAT achieved a better protection on heart. However, the volumes of the healthy tissue outside of PTV irradiated by a low dose were higher for IMRT and VMAT. IMRT and VMAT also had a higher MU, optimization time, and delivery time compared to CRT. In conclusion, all CRT, IMRT, and VMAT plans are able to meet the prescription and there is no clear distinction on PTV coverage. IMRT and VMAT can only decrease the volume of lung and heart receiving a high dose, but at a cost of delivering low dose to more volume of lung and normal tissues. CRT is still a feasible option for middle thoracic esophageal cancer radiotherapy, especially for the cost-effective consideration.

SU-F-T-442: Dose Distribution Comparison for Post-Laryngectomy Stoma Area Between Conventional AP and VMAT Plans with Or Without Bolus

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, B; Zhang, J; Cho-Lim, J

Purpose: To compare dose distributions of conventional AP vs. VMAT treatment plans with or without bolus around post-laryngectomy stoma. Methods: Radiation dose coverage for post-laryngectomy stoma was analyzed using a set of real-case CT-simulation images. After meticulous contouring of the catheter cuff, stoma lumen, peri-stoma skin and subclinical tumor bed at the larynx, the resulting dosimetry plans were analyzed with or without a 5 mm bolus placement. Wet gauze was used to minimize the effect of any air gap. Four plans were generated: AP superclavicular (SCV) plan with or without bolus, and VMAT plan with or without bolus. A dosemore » of 60Gy in 30 fractions was prescribed at 3 cm depth for AP SCV plan, and to 95% of the PTV volume for VMAT plan. Results: For the conventional AP SCV plan, the peri-stoma skin dose is sensitive to bolus placement as well as air gap compensation by wetted gauze (V95% of 20.7%, 33.0% and 94.8% for no bolus, bolus without and with air gap compensation, respectively). For stoma lumen, the dose drops off rapidly in depth. The catheter cuff may have certain dose-buildup effect, but air gap around it and under the bolus placed can pose a more serious problem. The dose distributions of the two VMAT plans are moderately different for peri-stoma skin (V95% of 95.0% with bolus and air gap compensation, and 82.3% without bolus), but nearly identical for stoma lumen (V95% of 91.5% and 92.0%, respectively). VMAT allows beamlets with different angles of incidence that helped achieve such dose distribution around the stoma even without bolus placement. Conclusion: Overall, the dose coverage around the stoma in the VMAT plan is better than the conventional AP SCV plan. To achieve optimal dose distribution, it is still recommended to place physical bolus and reduce the air gaps.« less

SU-E-P-51: Dosimetric Comparison to Organs at Risk Sparing Using Volumetric-Modulated Arc Therapy Versus Intensity-Modulated Radiotherapy in Postoperative Radiotherapy of Left-Sided Breast Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Qiao, L; Deng, G; Xie, J

2015-06-15

Purpose: To compare the dosimetric characteristics of volumetric-modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) techniques in treatment planning for left-sided breast cancer patients with modified radical mastectomy. Methods: Twenty-four left-sided breast cancer patients treated with modified radical mastectomy were selected in this study. The planning target volume (PTV) was generated by using 7-mm uniform expansion of the clinical target volume (CTV) in all direction except the skin surface. The organs at risk (OARs) included heart, left lung, right lung, and right breast. Dose volume histograms (DVHs) were utilized to evaluate the dose distribution in PTV and OARs. Results: Bothmore » VMAT and IMRT plans met the requirement of PTV coverage. VMAT was superior to IMRT in terms of conformity, with a statistically significant difference (p=0.024). Mean doses, V5 and V10 of heart and both lungs in VMAT plans were significantly decreased compared to IMRT plans (P<0.05), but in terms of heart volume irradiated by high doses (V30 and V45), no significant differences were observed (P>0.05). For right breast, VMAT showed the reduction of V5 in comparison with IMRT (P<0.05). Additionally, the mean number of monitor units (MU) and treatment time in VMAT (357.21, 3.62 min) were significantly less than those in IMRT (1132.85, 8.74 min). Conclusion: VMAT showed similar PTV coverage and significant advantage in OARs sparing compared with IMRT, especially in terms of decreased volumes irradiated by low doses, while significantly reducing the treatment time and MU number.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ma, C; Lin, M; Chen, L

Purpose: Recent in vitro and in vivo experimental findings provided strong evidence that pulsed low-dose-rate radiotherapy (PLDR) produced equivalent tumor control as conventional radiotherapy with significantly reduced normal tissue toxicities. This work aimed to implement a PLDR clinical protocol for the management of recurrent cancers utilizing IMRT and VMAT. Methods: Our PLDR protocol requires that the daily 2Gy dose be delivered in 0.2Gy×10 pulses with a 3min interval between the pulses. To take advantage of low-dose hyper-radiosensitivity the mean dose to the target is set at 0.2Gy and the maximum dose is limited to 0.4Gy per pulse. Practical planning strategiesmore » were developed for IMRT and VMAT: (1) set 10 ports for IMRT and 10 arcs for VMAT with each angle/arc as a pulse; (2) set the mean dose (0.2Gy) and maximum dose (0.4Gy) to the target per pulse as hard constraints (no constraints to OARs); (3) select optimal port/arc angles to avoid OARs; and (4) use reference structures in or around target/OARs to reduce maximum dose to the target/OARs. IMRT, VMAT and 3DCRT plans were generated for 60 H and N, breast, lung, pancreas and prostate patients and compared. Results: All PLDR treatment plans using IMRT and VMAT met the dosimetry requirements of the PLDR protocol (mean target dose: 0.20Gy±0.01Gy; maximum target dose < 0.4Gy). In comparison with 3DCRT, IMRT and VMAT exhibited improved target dose conformity and OAR dose sparing. A single arc can minimize the difference in the target dose due to multi-angle incidence although the delivery time is longer than 3DCRT and IMRT. Conclusion: IMRT and VMAT are better modalities for PLDR treatment of recurrent cancers with superior target dose conformity and critical structure sparing. The planning strategies/guidelines developed in this work are practical for IMRT/VMAT treatment planning to meet the dosimetry requirements of the PLDR protocol.« less

Simultaneous integrated boost (SIB) radiation therapy of right sided breast cancer with and without flattening filter - A treatment planning study.

PubMed

Maier, Johannes; Knott, Bernadette; Maerz, Manuel; Loeschel, Rainer; Koelbl, Oliver; Dobler, Barbara

2016-08-31

The aim of the study was to compare the two irradiation modes with (FF) and without flattening filter (FFF) for three different treatment techniques for simultaneous integrated boost radiation therapy of patients with right sided breast cancer. An Elekta Synergy linac with Agility collimating device is used to simulate the treatment of 10 patients. Six plans were generated in Monaco 5.0 for each patient treating the whole breast and a simultaneous integrated boost (SIB) volume: intensity modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT) and a tangential arc VMAT (tVMAT), each with and without flattening filter. Plan quality was assessed considering target coverage, sparing of the contralateral breast, the lungs, the heart and the normal tissue. All plans were verified by a 2D-ionisation-chamber-array and delivery times were measured and compared. The Wilcoxon test was used for statistical analysis with a significance level of 0.05. Significantly best target coverage and homogeneity was achieved using VMAT FFF with V95% = (98.7 ± 0.8) % and HI = (8.2 ± 0.9) % for the SIB and V95% = (98.3 ± 0.7) % for the PTV, whereas tVMAT showed significantly lowest doses to the contralateral organs at risk with a Dmean of (0.7 ± 0.1) Gy for the contralateral lung, (1.0 ± 0.2) Gy for the contralateral breast and (1.4 ± 0.2) Gy for the heart. All plans passed the gamma evaluation with a mean passing rate of (99.2 ± 0.8) %. Delivery times were significantly reduced for VMAT and tVMAT but increased for IMRT, when FFF was used. Lowest delivery times were observed for tVMAT FFF with (1:20 ± 0:07) min. Balancing target coverage, OAR sparing and delivery time, VMAT FFF and tVMAT FFF are considered the preferable of the investigated treatment options in simultaneous integrated boost irradiation of right sided breast cancer for the combination of an Elekta Synergy linac with Agility and the treatment planning system Monaco 5.0.

A retrospective planning analysis comparing intensity modulated radiation therapy (IMRT) to volumetric modulated arc therapy (VMAT) using two optimization algorithms for the treatment of early-stage prostate cancer

PubMed Central

Elith, Craig A; Dempsey, Shane E; Warren-Forward, Helen M

2013-01-01

Introduction The primary aim of this study is to compare intensity modulated radiation therapy (IMRT) to volumetric modulated arc therapy (VMAT) for the radical treatment of prostate cancer using version 10.0 (v10.0) of Varian Medical Systems, RapidArc radiation oncology system. Particular focus was placed on plan quality and the implications on departmental resources. The secondary objective was to compare the results in v10.0 to the preceding version 8.6 (v8.6). Methods Twenty prostate cancer cases were retrospectively planned using v10.0 of Varian's Eclipse and RapidArc software. Three planning techniques were performed: a 5-field IMRT, VMAT using one arc (VMAT-1A), and VMAT with two arcs (VMAT-2A). Plan quality was assessed by examining homogeneity, conformity, the number of monitor units (MUs) utilized, and dose to the organs at risk (OAR). Resource implications were assessed by examining planning and treatment times. The results obtained using v10.0 were also compared to those previously reported by our group for v8.6. Results In v10.0, each technique was able to produce a dose distribution that achieved the departmental planning guidelines. The IMRT plans were produced faster than VMAT plans and displayed improved homogeneity. The VMAT plans provided better conformity to the target volume, improved dose to the OAR, and required fewer MUs. Treatments using VMAT-1A were significantly faster than both IMRT and VMAT-2A. Comparison between versions 8.6 and 10.0 revealed that in the newer version, VMAT planning was significantly faster and the quality of the VMAT dose distributions produced were of a better quality. Conclusion VMAT (v10.0) using one or two arcs provides an acceptable alternative to IMRT for the treatment of prostate cancer. VMAT-1A has the greatest impact on reducing treatment time. PMID:26229615

Improvement of VMAT plan quality for head and neck cancer with high resolution fluences generated by couch shift between arcs.

PubMed

Park, Jong Min; Park, So-Yeon; Wu, Hong-Gyun; Kim, Jung-In

2018-02-01

To investigate the changes in quality of the volumetric modulated arc therapy (VMAT) plans with couch-shift between arcs by half of a multi-leaf collimator (MLC) leaf width. A total of 22 patients with head-and-neck cancer were retrospectively selected. Since the smallest MLC leaf width was 5 mm in this study, the couch was shifted by 2.5 mm in the longitudinal-direction between arcs to increase the resolution of fluence map. A total of three types of VMAT plans were generated for each patient; the three types of plans were a two-full-arc plan without couch-shift (NS plan), a two-half-arc-pair plan with couch-shift (HAS plan), and a two-full-arc pair plan with couch-shift (FAS plan). Changes in the dose-volumetric parameters were investigated. The FAS plan showed the best plan quality for the target volumes and organs at risk compared to the NS and HAS plans. However, the magnitudes of differences among the three types of plans were minimal, and every plan was clinically acceptable. The average integral doses of the NS, HAS, and FAS plans were 160,549 ± 37,600 Gy-cc, 147,828 ± 33,343 Gy-cc, and 156,030 ± 36,263 Gy-cc, respectively. The average monitor unit of the NS, HAS, and FAS plans were 717 ± 120 MU, 648 ± 100 MU, and 763 ± 158 MU, respectively. The HAS plan was better than the others in terms of normal tissue sparing and plan efficiency. By shifting the couch by half of the MLC leaf width in the longitudinal direction between arcs, the VMAT plan quality could be improved. Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Textural feature calculated from segmental fluences as a modulation index for VMAT.

PubMed

Park, So-Yeon; Park, Jong Min; Kim, Jung-In; Kim, Hyoungnyoun; Kim, Il Han; Ye, Sung-Joon

2015-12-01

Textural features calculated from various segmental fluences of volumetric modulated arc therapy (VMAT) plans were optimized to enhance its performance to predict plan delivery accuracy. Twenty prostate and twenty head and neck VMAT plans were selected retrospectively. Fluences were generated for each VMAT plan by summations of segments at sequential groups of control points. The numbers of summed segments were 5, 10, 20, 45, 90, 178 and 356. For each fluence, we investigated 6 textural features: angular second moment, inverse difference moment, contrast, variance, correlation and entropy (particular displacement distances, d = 1, 5 and 10). Spearman's rank correlation coefficients (rs) were calculated between each textural feature and several different measures of VMAT delivery accuracy. The values of rs of contrast (d = 10) with 10 segments to both global and local gamma passing rates with 2%/2 mm were 0.666 (p <0.001) and 0.573 (p <0.001), respectively. It showed rs values of -0.895 (p <0.001) and 0.727 (p <0.001) to multi-leaf collimator positional errors and gantry angle errors during delivery, respectively. The number of statistically significant rs values (p <0.05) to the changes in dose-volumetric parameters during delivery was 14 among a total of 35 tested parameters. Contrast (d = 10) with 10 segments showed higher correlations to the VMAT delivery accuracy than did the conventional modulation indices. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Texture analysis on the fluence map to evaluate the degree of modulation for volumetric modulated arc therapy.

PubMed

Park, So-Yeon; Kim, Il Han; Ye, Sung-Joon; Carlson, Joel; Park, Jong Min

2014-11-01

Texture analysis on fluence maps was performed to evaluate the degree of modulation for volumetric modulated arc therapy (VMAT) plans. A total of six textural features including angular second moment, inverse difference moment, contrast, variance, correlation, and entropy were calculated for fluence maps generated from 20 prostate and 20 head and neck VMAT plans. For each of the textural features, particular displacement distances (d) of 1, 5, and 10 were adopted. To investigate the deliverability of each VMAT plan, gamma passing rates of pretreatment quality assurance, and differences in modulating parameters such as multileaf collimator (MLC) positions, gantry angles, and monitor units at each control point between VMAT plans and dynamic log files registered by the Linac control system during delivery were acquired. Furthermore, differences between the original VMAT plan and the plan reconstructed from the dynamic log files were also investigated. To test the performance of the textural features as indicators for the modulation degree of VMAT plans, Spearman's rank correlation coefficients (rs) with the plan deliverability were calculated. For comparison purposes, conventional modulation indices for VMAT including the modulation complexity score for VMAT, leaf travel modulation complexity score, and modulation index supporting station parameter optimized radiation therapy (MISPORT) were calculated, and their correlations were analyzed in the same way. There was no particular textural feature which always showed superior correlations with every type of plan deliverability. Considering the results comprehensively, contrast (d = 1) and variance (d = 1) generally showed considerable correlations with every type of plan deliverability. These textural features always showed higher correlations to the plan deliverability than did the conventional modulation indices, except in the case of modulating parameter differences. The rs values of contrast to the global gamma passing rates with criteria of 2%/2 mm, 2%/1 mm, and 1%/2 mm were 0.536, 0.473, and 0.718, respectively. The respective values for variance were 0.551, 0.481, and 0.688. In the case of local gamma passing rates, the rs values of contrast were 0.547, 0.578, and 0.620, respectively, and those of variance were 0.519, 0.527, and 0.569. All of the rs values in those cases were statistically significant (p < 0.003). In the cases of global and local gamma passing rates, MISPORT showed the highest correlations among the conventional modulation indices. For global passing rates, rs values of MISPORT were -0.420, -0.330, and -0.632, respectively, and those for local passing rates were -0.455, -0.490 and -0.502. The values of rs of contrast, variance, and MISPORT with the MLC errors were -0.863, -0.828, and 0.795, respectively, all with statistical significances (p < 0.001). The correlations with statistical significances between variance and dose-volumetric differences were observed more frequently than the others. The contrast (d = 1) and variance (d = 1) calculated from fluence maps of VMAT plans showed considerable correlations with the plan deliverability, indicating their potential use as indicators for assessing the degree of modulation of VMAT plans. Both contrast and variance consistently showed better performance than the conventional modulation indices for VMAT.

SU-F-T-358: Is Auto-Planning Useful for Volumetric-Modulated Arc Therapy Planning in Rectal Cancer Radiotherapy?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, K; Chang, X; Wang, J

Purpose: To evaluate whether Auto-Planning based volumetric-modulated radiotherapy (auto-VMAT) can reduce manual interaction time during treatment planning and improve plan quality for rectal cancer radiotherapy. Methods: Ten rectal cancer patients (stage II and III) after radical resection using Dixon surgery were enrolled. All patients were treated with VMAT technique. The manual VMAT plans (man-VMAT) were designed in the Pinnacle treatment planning system (Version 9.10) following the standard treatment planning procedure developed in our department. Clinical plans were manually designed by our experienced dosimetrists. Additionally, an auto-VMAT plan was created for each patient using Auto-Planning module. However, manual interaction was stillmore » applied to meet the clinical requirements. The treatment planning time and plan quality surrogated by the DVH parameters were compared between manual and automated plans. Results: The total planning time and manual interaction time were 50.38 and 4.47 min for the auto-VMAT and 36.81 and 16.94 min for the man-VMAT (t=60.14,−23.86; p=0.000, 0.000). In terms of plan quality, both plans meet the clinical requirements. The PTV homogeneity index (HI) and conformity index (CI) were 0.054 and 0.822 for the auto-VMAT and 0.059 and 0.815 for the man-VMAT (t=−1.72, 0.36;p=0.119,0.730).Compared to the man-VMAT, the auto-VMAT showed reduction of 11.9% and 0.7% in V40 and V50 of the bladder, respectively.The V30 and D mean were reduced by 14.0% and 5.1Gy in the left femur and 12.2% and 3.8Gy in the right femur. Conclusion: The Auto-Planning based VMAT plans not only shows similar or superior plan quality to the manual ones in the rectal cancer radiotherapy, but also improve the planning efficiency significantly. However, manual interactions are still required to achieve a clinically acceptable plan based on our experiences.« less

SU-E-T-365: Dosimetric Impact of Dental Amalgam CT Image Artifacts On IMRT and VMAT Head and Neck Plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cao, N; Young, L; Parvathaneni, U

Purpose: The presence of high density dental amalgam in patient CT image data sets causes dose calculation errors for head and neck (HN) treatment planning. This study assesses and compares dosimetric variations in IMRT and VMAT treatment plans due to dental artifacts. Methods: Sixteen HN patients with similar treatment sites (oropharynx), tumor volume and extensive dental artifacts were divided into two groups: IMRT (n=8, 6 to 9 beams) and VMAT (n=8, 2 arcs with 352° rotation). All cases were planned with the Pinnacle 9.2 treatment planning software using the collapsed cone convolution superposition algorithm and a range of prescription dosemore » from 60 to 72Gy. Two different treatment plans were produced, each based on one of two image sets: (a)uncorrected; (b)dental artifacts density overridden (set to 1.0g/cm{sup 3}). Differences between the two treatment plans for each of the IMRT and VMAT techniques were quantified by the following dosimetric parameters: maximum point dose, maximum spinal cord and brainstem dose, mean left and right parotid dose, and PTV coverage (V95%Rx). Average differences generated for these dosimetric parameters were compared between IMRT and VMAT plans. Results: The average absolute dose differences (plan a minus plan b) for the VMAT and IMRT techniques, respectively, caused by dental artifacts were: 2.2±3.3cGy vs. 37.6±57.5cGy (maximum point dose, P=0.15); 1.2±0.9cGy vs. 7.9±6.7cGy (maximum spinal cord dose, P=0.026); 2.2±2.4cGy vs. 12.1±13.0cGy (maximum brainstem dose, P=0.077); 0.9±1.1cGy vs. 4.1±3.5cGy (mean left parotid dose, P=0.038); 0.9±0.8cGy vs. 7.8±11.9cGy (mean right parotid dose, P=0.136); 0.021%±0.014% vs. 0.803%±1.44% (PTV coverage, P=0.17). Conclusion: For the HN plans studied, dental artifacts demonstrated a greater dose calculation error for IMRT plans compared to VMAT plans. Rotational arcs appear on the average to compensate dose calculation errors induced by dental artifacts. Thus, compared to VMAT, density overrides for dental artifacts are more important when planning IMRT of HN.« less

A fast optimization approach for treatment planning of volumetric modulated arc therapy.

PubMed

Yan, Hui; Dai, Jian-Rong; Li, Ye-Xiong

2018-05-30

Volumetric modulated arc therapy (VMAT) is widely used in clinical practice. It not only significantly reduces treatment time, but also produces high-quality treatment plans. Current optimization approaches heavily rely on stochastic algorithms which are time-consuming and less repeatable. In this study, a novel approach is proposed to provide a high-efficient optimization algorithm for VMAT treatment planning. A progressive sampling strategy is employed for beam arrangement of VMAT planning. The initial beams with equal-space are added to the plan in a coarse sampling resolution. Fluence-map optimization and leaf-sequencing are performed for these beams. Then, the coefficients of fluence-maps optimization algorithm are adjusted according to the known fluence maps of these beams. In the next round the sampling resolution is doubled and more beams are added. This process continues until the total number of beams arrived. The performance of VMAT optimization algorithm was evaluated using three clinical cases and compared to those of a commercial planning system. The dosimetric quality of VMAT plans is equal to or better than the corresponding IMRT plans for three clinical cases. The maximum dose to critical organs is reduced considerably for VMAT plans comparing to those of IMRT plans, especially in the head and neck case. The total number of segments and monitor units are reduced for VMAT plans. For three clinical cases, VMAT optimization takes < 5 min accomplished using proposed approach and is 3-4 times less than that of the commercial system. The proposed VMAT optimization algorithm is able to produce high-quality VMAT plans efficiently and consistently. It presents a new way to accelerate current optimization process of VMAT planning.

SU-F-T-87: Comparison of Advanced Radiotherapy Techniques for Post- Mastectomy Breast Cancer Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heins, D; Zhang, R; Hogstrom, K

2016-06-15

Purpose: To determine if bolus electron conformal therapy (Bolus-ECT) combined with intensity modulated x-ray therapy (IMXT) and flattening filter free volumetric modulated arc therapy (FFF-VMAT (6x and 10x)) can maintain equal or better dose coverage than standard volumetric modulated arc therapy (Std-VMAT) while reducing doses to organs at risk (OARs). Methods: Bolus-ECT with IMXT, FFF-VMAT, and Std-VMAT treatment plans were produced for ten post-mastectomy radiotherapy (PMRT) patients previously treated at our clinic. The treatment plans were created on commercially available treatment planning system (TPS) and all completed treatment plans were reviewed and approved by a radiation oncologist. The plans weremore » evaluated based on planning target volume (PTV) coverage, tumor control probability (TCP), dose homogeneity index (DHI), conformity index (CI), and dose to organs at risk (OAR). Results: All techniques produced clinically acceptable PMRT plans. Overall, Bolus-ECT with IMXT exhibited higher maximum dose compared to all VMAT techniques. Bolus-ECT with IMXT and FFF-VMAT10x had slightly improved TCP over FFF-VMAT6x and Std-VMAT. However, all VMAT techniques showed improved CI and DHI over Bolus-ECT with IMXT. All techniques showed very similar mean lung dose. Bolus-ECT with IMXT exhibited a reduced mean heart dose over Std-VMAT. Both FFF-VMAT techniques had higher mean heart dose compared to Std-VMAT. In addition, Bolus-ECT with IMXT was able to reduce mean dose to the contralateral breast compared to Std-VMAT and both FFF-VMAT techniques had comparable but slightly reduced dose compared to Std-VMAT. Conclusion: This work has shown that Bolus-ECT with IMXT produces clinically acceptable plans while reducing OAR doses. Both FFF-VMAT techniques are comparable to Std-VMAT with slight improvements. Even though all VMAT techniques produce more homogenous and conformal dose distributions, Bolus-ECT with IMXT is a viable option for treating post-mastectomy patients possibly leading to reduced risks of normal tissue complications.« less

SU-F-T-437: 3 Field VMAT Technique for Irradiation of Large Pelvic Tumors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stakhursky, V

2016-06-15

Purpose: VMAT treatment planning for large pelvic volume irradiation could be suboptimal due to inability of Varian linac to split MLC carriage during VMAT delivery for fields larger than 14.5cm in X direction (direction of leaf motion). We compare the dosimetry between 3 VMAT planning techniques, two 2-arc field techniques and a 3-arc field technique: a) two small in X direction (less than 14.5cm) arc fields, complementing each other to cover the whole lateral extent of target during gantry rotation, b) two large arc fields, each covering the targets completely during the rotation, c) a 3 field technique with 2more » small in X direction arcs and 1 large field covering whole target. Methods: 5 GYN cancer patients were selected to evaluate the 3 VMAT planning techniques. Treatment plans were generated using Varian Eclipse (ver. 11) TPS. Dose painting technique was used to deliver 5300 cGy to primary target and 4500 cGy to pelvic/abdominal node target. All the plans were normalized so that the prescription dose of 5300 cGy covered 95% of primary target volume. PTV and critical structures DVH curves were compared to evaluate all 3 planning techniques. Results: The dosimetric differences between the two 2-arc techniques were minor. The small field 2-arc technique showed a colder hot spot (0.4% averaged), while variations in maximum doses to critical structures were statistically nonsignificant (under 1.3%). In comparison, the 3-field technique demonstrated a colder hot spot (1.1% less, 105.8% averaged), and better sparing of critical structures. The maximum doses to larger bowel, small bowel and gluteal fold were 3% less, cord/cauda sparing was 4.2% better, and bladder maximum dose was 4.6% less. The differences in maximum doses to stomach and rectum were statistically nonsignificant. Conclusion: 3-arc VMAT technique for large field irradiation of pelvis demonstrates dosimetric advantages compared to 2-arc VMAT techniques.« less

Efficiency gains for spinal radiosurgery using multicriteria optimization intensity modulated radiation therapy guided volumetric modulated arc therapy planning.

PubMed

Chen, Huixiao; Winey, Brian A; Daartz, Juliane; Oh, Kevin S; Shin, John H; Gierga, David P

2015-01-01

To evaluate plan quality and delivery efficiency gains of volumetric modulated arc therapy (VMAT) versus a multicriteria optimization-based intensity modulated radiation therapy (MCO-IMRT) for stereotactic radiosurgery of spinal metastases. MCO-IMRT plans (RayStation V2.5; RaySearch Laboratories, Stockholm, Sweden) of 10 spinal radiosurgery cases using 7-9 beams were developed for clinical delivery, and patients were replanned using VMAT with partial arcs. The prescribed dose was 18 Gy, and target coverage was maximized such that the maximum dose to the planning organ-at-risk volume (PRV) of the spinal cord was 10 or 12 Gy. Dose-volume histogram (DVH) constraints from the clinically acceptable MCO-IMRT plans were utilized for VMAT optimization. Plan quality and delivery efficiency with and without collimator rotation for MCO-IMRT and VMAT were compared and analyzed based upon DVH, planning target volume coverage, homogeneity index, conformity number, cord PRV sparing, total monitor units (MU), and delivery time. The VMAT plans were capable of matching most DVH constraints from the MCO-IMRT plans. The ranges of MU were 4808-7193 for MCO-IMRT without collimator rotation, 3509-5907 for MCO-IMRT with collimator rotation, 4444-7309 for VMAT without collimator rotation, and 3277-5643 for VMAT with collimator of 90 degrees. The MU for the VMAT plans were similar to their corresponding MCO-IMRT plans, depending upon the complexity of the target and PRV geometries, but had a larger range. The delivery times of the MCO-IMRT and VMAT plans, both with collimator rotation, were 18.3 ± 2.5 minutes and 14.2 ± 2.0 minutes, respectively (P < .05). The MCO-IMRT and VMAT can create clinically acceptable plans for spinal radiosurgery. The MU for MCO-IMRT and VMAT can be reduced significantly by utilizing a collimator rotation following the orientation of the spinal cord. Plan quality for VMAT is similar to MCO-IMRT, with similar MU for both modalities. Delivery times can be reduced by nominally 25% with VMAT. Copyright © 2015 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

Early-stage central lung cancer and volumetric modulated arc therapy: a dosimetric case study with literature review.

PubMed

Valakh, Vladimir; Chan, Philip; D'Adamo, Karen; Micaily, Bizhan

2013-10-01

In the present article we review on the use of Volumetric Modulated Arc Therapy (VMAT) for a small lung nodule that was centrally located in close proximity to the mediastinal structures. An inoperable patient with central, clinical stage IA adenocarcinoma of the right lung was treated with external-beam radiation therapy of 52.5 Gy in 15 factions. A single 360° coplanar arc VMAT plan (360-VMAT) was used for treatment and compared to step-and-shoot Intensity Modulation Radiotherapy (IMRT) and a single 180° ipsilateral partial arc VMAT plan (180-VMAT). Planning Target Volume (PTV) coverage was not different, and 360-VMAT had the highest dose homogeneity. Both 360-VMAT and 180-VMAT reduced esophageal dose compared to IMRT. While IMRT had the lowest lung dose, all 3 plans achieved acceptable sparing of the lung. 180-VMAT had the highest dose conformity. Both 360-VMAT and 180-VMAT improved esophageal sparing compared to IMRT. Use of VMAT in early-stage, centrally located NSCLC is a promising treatment approach and merits additional investigation.

Multi-GPU implementation of a VMAT treatment plan optimization algorithm

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tian, Zhen, E-mail: Zhen.Tian@UTSouthwestern.edu, E-mail: Xun.Jia@UTSouthwestern.edu, E-mail: Steve.Jiang@UTSouthwestern.edu; Folkerts, Michael; Tan, Jun

Purpose: Volumetric modulated arc therapy (VMAT) optimization is a computationally challenging problem due to its large data size, high degrees of freedom, and many hardware constraints. High-performance graphics processing units (GPUs) have been used to speed up the computations. However, GPU’s relatively small memory size cannot handle cases with a large dose-deposition coefficient (DDC) matrix in cases of, e.g., those with a large target size, multiple targets, multiple arcs, and/or small beamlet size. The main purpose of this paper is to report an implementation of a column-generation-based VMAT algorithm, previously developed in the authors’ group, on a multi-GPU platform tomore » solve the memory limitation problem. While the column-generation-based VMAT algorithm has been previously developed, the GPU implementation details have not been reported. Hence, another purpose is to present detailed techniques employed for GPU implementation. The authors also would like to utilize this particular problem as an example problem to study the feasibility of using a multi-GPU platform to solve large-scale problems in medical physics. Methods: The column-generation approach generates VMAT apertures sequentially by solving a pricing problem (PP) and a master problem (MP) iteratively. In the authors’ method, the sparse DDC matrix is first stored on a CPU in coordinate list format (COO). On the GPU side, this matrix is split into four submatrices according to beam angles, which are stored on four GPUs in compressed sparse row format. Computation of beamlet price, the first step in PP, is accomplished using multi-GPUs. A fast inter-GPU data transfer scheme is accomplished using peer-to-peer access. The remaining steps of PP and MP problems are implemented on CPU or a single GPU due to their modest problem scale and computational loads. Barzilai and Borwein algorithm with a subspace step scheme is adopted here to solve the MP problem. A head and neck (H and N) cancer case is then used to validate the authors’ method. The authors also compare their multi-GPU implementation with three different single GPU implementation strategies, i.e., truncating DDC matrix (S1), repeatedly transferring DDC matrix between CPU and GPU (S2), and porting computations involving DDC matrix to CPU (S3), in terms of both plan quality and computational efficiency. Two more H and N patient cases and three prostate cases are used to demonstrate the advantages of the authors’ method. Results: The authors’ multi-GPU implementation can finish the optimization process within ∼1 min for the H and N patient case. S1 leads to an inferior plan quality although its total time was 10 s shorter than the multi-GPU implementation due to the reduced matrix size. S2 and S3 yield the same plan quality as the multi-GPU implementation but take ∼4 and ∼6 min, respectively. High computational efficiency was consistently achieved for the other five patient cases tested, with VMAT plans of clinically acceptable quality obtained within 23–46 s. Conversely, to obtain clinically comparable or acceptable plans for all six of these VMAT cases that the authors have tested in this paper, the optimization time needed in a commercial TPS system on CPU was found to be in an order of several minutes. Conclusions: The results demonstrate that the multi-GPU implementation of the authors’ column-generation-based VMAT optimization can handle the large-scale VMAT optimization problem efficiently without sacrificing plan quality. The authors’ study may serve as an example to shed some light on other large-scale medical physics problems that require multi-GPU techniques.« less

SU-E-T-311: Dosimetric Comparison of Volumetric Modulated Arc Therapy Plans for Preoperative Radiotherapy Rectal Cancer Using Flattening Filter-Free and Flattening Filter Modes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, W; Zhang, J; Lu, J

Purpose: To compare the dosimetric difference of volumetric modulated arc therapy(VMAT) for preoperative radiotherapy rectal cancer using 6MV X-ray flattening filter free(FFF) and flattening filter(FF) modes. Methods: FF-VMAT and FFF-VMAT plans were designed to 15 rectal cancer patients with preoperative radiotherapy by planning treatment system(Eclipse 10.0),respectively. Dose prescription was 50 Gy in 25 fractions. All plans were normalized to 50 Gy to 95% of PTV. The Dose Volume Histogram (DVH), target and risk organ doses, conformity indexes (CI), homogeneity indexes (HI), low dose volume of normal tissue(BP), monitor units(MU) and treatment time (TT) were compared between the two kinds ofmore » plans. Results: FF-VMAT provided the lower Dmean, V105, HI, and higher CI as compared with FFF-VMAT. The small intestine of D5, Bladder of D5, Dmean, V40, V50, L-femoral head of V40, R-femoral head of Dmean were lower in FF-VMAT than in FFF-VMAT. FF-VMAT had higher BP of V5, but no significantly different of V10, V15, V20, V30 as compared with FFF-VMAT. FF-VMAT reduceed the monitor units(MU) by 21%(P<0.05), as well as the treatment time(TT) was no significantly different(P>0.05), as compared with FFF-VMAT. Conclusion: The plan qualities of FF and FFF VMAT plans were comparable and both clinically acceptable. FF-VMAT as compared with FFF-VMAT, showing better target coverage, some of OARs sparing, the MUs of FFF-VMAT were higher than FF-VMAT, yet were delivered within the same time. This work was supported by the Medical Scientific Research Foundation of Guangdong Procvince (A2014455 to Changchun Ma)« less

SU-F-T-429: Craniospinal Irradiation by VMAT Technique: Impact of FFF Beam and High Resolution MLC On Plan Quality

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ganesh, T; Sarkar, B; Munshi, A

2016-06-15

Purpose: Objective of this study was to evaluate the impact of using flattening filter free (FFF) beam with 0.5 cm multileaf collimator (MLC) leaves over conventional flattened beam with 1 cm leaf width MLC on the treatment plan quality in cranio-spinal irradiation (CSI). Methods: For five medulloblastoma cases (3 males and 2 females), who were previously treated by volumetric modulated arc therapy (VMAT) technique using conventional flattened beam shaped by 1 cm width MLC leaves, four test plans were generated and compared against the delivered plan. These retrospective plans consisted of four different combinations of flattened and FFF beams frommore » Elekta’s Agility treatment head with 0.5 cm width MLC leaves. Sparing of organs at risks (OAR) in terms of dose to 5%, 50%, 75% and 90% volumes, mean and maximum dose were evaluated. Results: All plans satisfied the planning objective of covering 95% of PTV by at least 95% of prescription dose. Marginal variation of dose spillage was observed between different VMAT plans at very low dose range (1–5 Gy). Variation in dose statistics for PTVs and OARs were within 1% or 1 Gy. Amongst the five plans, the plan with flattened beam with 1 cm MLC had the highest number of MUs, 2.13 times higher than the plan with Agility MLC with FFF beam that had the least number of MUs. No statistically significant difference (p≥0.05) was observed between the reference plan and the retrospectively generated plans in terms of PTV coverage, cold spot, hot spot and organ at risk doses. Conclusion: In the treatment of CSI cases by VMAT technique, FFF beams and/or finer width MLC did not exhibit advantage over the flattened beams or wider MLC in terms of plan quality except for reduction in MUs.« less

Applying the technique of volume-modulated arc radiotherapy to upper esophageal carcinoma.

PubMed

Ma, Pan; Wang, Xiaozhen; Xu, Yingjie; Dai, Jianrong; Wang, Luhua

2014-05-08

This study aims to evaluate the possibility of using the technique of volume-modulated arc therapy (VMAT) to combine the advantages of simplified intensity-modulated radiation therapy (sIMRT) with that of regular intensity-modulated radiation therapy (IMRT) in upper esophageal cancer. Ten patients with upper esophageal carcinoma were randomly chosen in this retrospective study. sIMRT, IMRT, and VMAT plans were generated to deliver 60 Gy in 30 fractions to the planning target volume (PTV). For each patient, with the same clinical requirements (target dose prescription, and dose/dose-volume constraints to organs at risk (OARs)), three plans were designed for sIMRT (five equispaced coplanar beams), IMRT (seven equispaced coplanar beams), and VMAT (two complete arcs). Comparisons were performed for dosimetric parameters of PTV and of OARs (lungs, spinal cord PRV, heart and normal tissue (NT)). All the plans were delivered to a phantom to evaluate the treatment time. The Wilcoxon matched-pairs, signed-rank test was used for intragroup comparison. For all patients, compared to sIMRT plans, VMAT plans statistically provide: a) significant improvement in HI and CI for PTV; b) significant decrease in delivery time, lung V20, MLD, heart V30 and spinal cord PRV D1cc; c) significant increase in NT V5; and d) no significant reduction in lung V5, V10, and heart MD. For all patients, compared to IMRT plans, VMAT plans statistically provide: a) significant improvement in CI for PTV; b) significant decrease in delivery time, lung V20, MLD, NT and spinal cord PRV D1cc; c) significant increase in NT V5; and d) no significant reduction in HI for PTV, lung V5, V10, heart V30 and heart MD. For patients with upper esophageal carcinoma, using VMAT significantly reduces the delivery time and the dose to the lungs compared with IMRT, and consequently saves as much treatment time as sIMRT. Considering those significant advantages, compared to sIMRT and IMRT, VMAT is the first choice of radiotherapy techniques for upper esophageal carcinoma.

Dosimetric comparison between Volumetric Modulated Arc Therapy (VMAT) vs Intensity Modulated Radiation Therapy (IMRT) for radiotherapy of mid esophageal carcinoma.

PubMed

Kataria, Tejinder; Govardhan, H B; Gupta, Deepak; Mohanraj, U; Bisht, Shyam Singh; Sambasivaselli, R; Goyal, S; Abhishek, A; Srivatsava, A; Pushpan, L; Kumar, V; Vikraman, S

2014-01-01

Dosimetric comparison of VMAT with IMRT in middle third esophageal cancer for planning target volume (PTV) and organs at risk (OAR). Ten patients in various stages from I‒III were inducted in the neo-adjuvant chemoradiation protocol for this study. The prescribed dose was 4500 cGy in 25 fractions. Both VMAT and IMRT plan were generated in all cases and Dose Volume Histogram (DVH) comparative analysis was performed for PTV and OAR. Paired t-test was used for statistical analysis. The PTV Dmean and D95 in IMRT and VMAT plan were 4566.6±50.6 cGy vs 4462.8±81.8 cGy (P=0.1) and 4379.8±50.6 cGy Vs 4424.3±109.8 cGy (P=0.1), respectively. The CI and HI for PTV in IMRT vs VMAT plans were 0.96±0.02 vs 0.97±0.01 (P=0.4) and 10.58±3.07 vs 9.45±2.42 (P=0.2), respectively. Lung doses for VMAT vs IMRT were 4.19 vs 2.59% (P=0.03) for V35-7.63 vs 4.76% (P=0.01) for V30-13.6 vs 9.98% (P=0.01) for V25-24.77 vs 18.57% (P=0.04) for V20-46.5 vs 34.73% (P=0.002) for V15. The Mean Lung Dose (MLD) was reduced by VMAT technique compared to IMRT; 1524.6±308.37 cGy and 1353±186.32 cGy (P=0.012). There was no change in Dmax to spinal cord in both the techniques. There was a dose reduction by VMAT compared to IMRT to the heart but it was statistically insignificant; V35-6.75% vs 5.55% (P=0.223); V30-12.3% vs 10.91% (P=0.352); V25-21.81% vs 20.16% (P=0.459); V20-38.11% vs 32.88% (P=0.070); V15-61.05% vs 54.2% (P=0.10). VMAT can be a better option in treating mid esophageal carcinoma as compared to IMRT. The VMAT plans resulted in equivalent or superior dose distribution with a reduction in the dose to lung and heart.

SU-F-J-169: A Feasibility Study of Using MRI Alone in Abdominal Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zawisza, I; Hsu, S; Peng, Q

Purpose: To demonstrate the feasibility of a MRI alone workflow to support treatment planning and image guidance for abdominal radiotherapy. Methods: Abdominal MR images (in-phase/out-phase/fat/water) were acquired for a patient with breath-hold using a Dixon pulse sequence. Air masks were created on in-phase images using intensity thresholding and morphological processing methods in order to separate air from bone. Pseudo-CT and DRRs were generated using a published method. To investigate the effect of heterogeneity corrections on dose calculations using pseudo-CT, three different plans (3-field 3D, 5-field IMRT and 2-arc VMAT) were performed to mimic pancreatic treatments (1.8Gy/fraction over 28 fractions). Results:more » The DRRs created from pseudo-CT were of comparable quality as those created from CT. Comparing dose calculations with and without heterogeneity corrections between the 3 different plans, the biggest dosimetric differences were seen in the VMAT plan where modulation must occur across air-tissue interfaces such as those of the stomach and bowel. The DVHs for the VMAT plan showed ∼84cc difference at V50Gy in the small bowel. In terms of pseudo-CT quality, some small volumes of air in the bowel and stomach were misclassified as bone. The VMAT plan was re-optimized on pseudo-CT with 0 HU in the misclassified areas. The V50Gy in the small bowel differed by ∼90cc between the new VMAT plan with and without heterogeneity corrections. Conclusion: We found that the use of MRI alone is feasible for abdominal treatment planning and image guidance. A difference between calculations with and without heterogeneity corrections was found that is most pronounced for VMAT where the traversal of air-tissue interfaces is unavoidable. Future work will be performed to minimize misclassification between bone and air.« less

Texture analysis on the fluence map to evaluate the degree of modulation for volumetric modulated arc therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Park, So-Yeon; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744; Biomedical Research Institute, Seoul National University College of Medicine, Seoul 110-744

Purpose: Texture analysis on fluence maps was performed to evaluate the degree of modulation for volumetric modulated arc therapy (VMAT) plans. Methods: A total of six textural features including angular second moment, inverse difference moment, contrast, variance, correlation, and entropy were calculated for fluence maps generated from 20 prostate and 20 head and neck VMAT plans. For each of the textural features, particular displacement distances (d) of 1, 5, and 10 were adopted. To investigate the deliverability of each VMAT plan, gamma passing rates of pretreatment quality assurance, and differences in modulating parameters such as multileaf collimator (MLC) positions, gantrymore » angles, and monitor units at each control point between VMAT plans and dynamic log files registered by the Linac control system during delivery were acquired. Furthermore, differences between the original VMAT plan and the plan reconstructed from the dynamic log files were also investigated. To test the performance of the textural features as indicators for the modulation degree of VMAT plans, Spearman’s rank correlation coefficients (r{sub s}) with the plan deliverability were calculated. For comparison purposes, conventional modulation indices for VMAT including the modulation complexity score for VMAT, leaf travel modulation complexity score, and modulation index supporting station parameter optimized radiation therapy (MI{sub SPORT}) were calculated, and their correlations were analyzed in the same way. Results: There was no particular textural feature which always showed superior correlations with every type of plan deliverability. Considering the results comprehensively, contrast (d = 1) and variance (d = 1) generally showed considerable correlations with every type of plan deliverability. These textural features always showed higher correlations to the plan deliverability than did the conventional modulation indices, except in the case of modulating parameter differences. The r{sub s} values of contrast to the global gamma passing rates with criteria of 2%/2 mm, 2%/1 mm, and 1%/2 mm were 0.536, 0.473, and 0.718, respectively. The respective values for variance were 0.551, 0.481, and 0.688. In the case of local gamma passing rates, the r{sub s} values of contrast were 0.547, 0.578, and 0.620, respectively, and those of variance were 0.519, 0.527, and 0.569. All of the r{sub s} values in those cases were statistically significant (p < 0.003). In the cases of global and local gamma passing rates, MI{sub SPORT} showed the highest correlations among the conventional modulation indices. For global passing rates, r{sub s} values of MI{sub SPORT} were −0.420, −0.330, and −0.632, respectively, and those for local passing rates were −0.455, −0.490 and −0.502. The values of r{sub s} of contrast, variance, and MI{sub SPORT} with the MLC errors were −0.863, −0.828, and 0.795, respectively, all with statistical significances (p < 0.001). The correlations with statistical significances between variance and dose-volumetric differences were observed more frequently than the others. Conclusions: The contrast (d = 1) and variance (d = 1) calculated from fluence maps of VMAT plans showed considerable correlations with the plan deliverability, indicating their potential use as indicators for assessing the degree of modulation of VMAT plans. Both contrast and variance consistently showed better performance than the conventional modulation indices for VMAT.« less

Study of impacts of different evaluation criteria on gamma pass rates in VMAT QA using MatriXX and EPID

NASA Astrophysics Data System (ADS)

Noufal, Manthala Padannayil; Abdullah, Kallikuzhiyil Kochunny; Niyas, Puzhakkal; Subha, Pallimanhayil Abdul Raheem

2017-12-01

Aim: This study evaluates the impacts of using different evaluation criteria on gamma pass rates in two commercially available QA methods employed for the verification of VMAT plans using different hypothetical planning target volumes (PTVs) and anatomical regions. Introduction: Volumetric modulated arc therapy (VMAT) is a widely accepted technique to deliver highly conformal treatment in a very efficient manner. As their level of complexity is high in comparison to intensity-modulated radiotherapy (IMRT), the implementation of stringent quality assurance (QA) before treatment delivery is of paramount importance. Material and Methods: Two sets of VMAT plans were generated using Eclipse planning systems, one with five different complex hypothetical three-dimensional PTVs and one including three anatomical regions. The verification of these plans was performed using a MatriXX ionization chamber array embedded inside a MultiCube phantom and a Varian EPID dosimetric system attached to a Clinac iX. The plans were evaluated based on the 3%/3 mm, 2%/2 mm, and 1%/1 mm global gamma criteria and with three low-dose threshold values (0%, 10%, and 20%). Results: The gamma pass rates were above 95% in all VMAT plans, when the 3%/3mm gamma criterion was used and no threshold was applied. In both systems, the pass rates decreased as the criteria become stricter. Higher pass rates were observed when no threshold was applied and they tended to decrease for 10% and 20% thresholds. Conclusion: The results confirm the suitability of the equipments used and the validity of the plans. The study also confirmed that the threshold settings greatly affect the gamma pass rates, especially for lower gamma criteria.

Dosimetric comparison of volumetric modulated Arc therapy, step-and-shoot, and sliding window IMRT for prostate cancer

NASA Astrophysics Data System (ADS)

Schnell, Erich; Herman, Tania De La Fuente; Young, Julie; Hildebrand, Kim; Algan, Ozer; Syzek, Elizabeth; Herman, Terence; Ahmad, Salahuddin

2012-10-01

This study aims to evaluate treatment plans generated by Step-and-Shoot (SS), Sliding Window (SW) and Volumetric Modulated Arc Therapy (VMAT) in order to assess the differences in dose volume histograms of planning target volume (PTV) and organs at risk (OAR), conformity indices, radiobiological evaluations, and plan quality for prostate cancer cases. Six prostate cancer patients treated in our center were selected for this retrospective study. Treatment plans were generated with Eclipse version 8.9 using 10 MV photon beams. For VMAT, Varian Rapid Arc with 1 or 2 arcs, and for SS and SW IMRT, 7-9 fields were used. Each plan had three PTVs with prescription doses of 81, 59.4, and 45 Gy to prostate, to prostate and lymph nodes, and to pelvis, respectively. Doses to PTV and OAR and the conformal indices (COIN) were compared among three techniques. The equivalent uniform dose (EUD), tumor control probability (TCP) and normal tissue complication probability (NTCP) were calculated and compared. The mean doses to the PTV prostate on average were 83 Gy and the percent differences of mean dose among all techniques were below 0.28. For bladder and rectum, the percent differences of mean dose among all techniques were below 2.2. The COIN did not favour any particular delivery method over the other. The TCP was higher with SS and SW for four patients and higher with VMAT for two patients. The NTCP for the rectum was the lowest with VMAT in five out of the six patients. The results show similar target coverage in general.

SU-G-BRC-14: Multi-Lesion, Multi-Rx, Brain Radiosurgery with Novel Single Isocenter Technique

DOE Office of Scientific and Technical Information (OSTI.GOV)

Honig, N; Alani, S; Schlocker, A

Purpose: There is a strong trend to treat multiple brain metastases with radiosurgery rather than whole brain irradiation. This feasibility study investigates a novel planning technique for radio-surgical treatment of multiple brain lesions with differing dose prescriptions, a single isocenter, and dynamic conformal arcs. The novel technique will be compared to the well-established single-isocenter volumetric modulated arc therapy (VMAT) technique commonly used for treating brain lesions. Methods: Six patients with metastatic brain lesions were selected for a prospective treatment planning study to evaluate Interdigitating MLC Dynamic Conformal Arc (IMDCA) technique. Arcs were planned for simultaneous irradiation to maximize beam deliverymore » efficiency. To accommodate varying PTV dose prescriptions, selected arcs were re-irradiated in reverse. Beam weights were adjusted until all prescription constraints were met. The number of lesions ranged between 2 to 4 (mode = 3). For comparison, SRS VMAT plans were generated utilizing an established single-isocenter, 3 arc planning template. All plans were compared by means of Paddick conformity index (PCI), RTOG Conformity Index (RCI), gradient index (GI), and the normal brain volume receiving 10% (V10) of the highest prescription dose. The monitor units and delivery time were tabulated for each plan. Results: IMDCA achieved conformal plans (PCI = 0.72±0.03, RCI = 1.33±0.03) with steep dose fall-off (GI = 3.79±0.03) on average for all of the plans evaluated. The VMAT plans had slightly better conformity (PCI = 0.85 ± 0.03, RCI = 1.13 ± 0.03) than IMDCA, but overall worse GI (4.29 ± 0.06). IMDCA plans had lower V10% values, required 50% fewer MUs, and had 34% shorter beam delivery time on average compared to VMAT plans. Conclusion: IMDCA plans with varying dose prescriptions for multiple lesions, had comparable dosimetric coverage as VMAT plans, but were obtained with significantly lower integral dose, fewer monitor units, and quicker delivery time.« less

SU-F-T-298: The Impact of Modeling the Treatment Couch On Patient Specific VMAT QA

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gelover, E; Dalhart, A; Hyer, D

2016-06-15

Purpose: The aim of this work is to quantify the impact of modeling the treatment couch on the passing rate of ion chamber measurements during VMAT quality assurance. Methods: For the initial characterization, attenuation and surface dose measurements were performed following the guidelines of TG-176 for the Civco Universal couch top using an Elekta VersaHD accelerator at an energy of 6 MV. A simulation CT was performed to aid in the creation of contours for representing the shape and size of the couch top in the treatment planning system (TPS). A uniform value of density for the couch wall wasmore » determined by comparing the ratios of ion chamber measurements made in a 30×30×11 cm3 water phantom with the TPS dose values of a plan with the same geometry. At our institution, patient specific quality assurance is performed using a Sun Nuclear ArcCheck with a multi-plug for chamber measurements, a 0.125cc PTW TN31010 chamber, and a Sun Nuclear 1010 electrometer. Ten VMAT plans were transferred into the phantom geometry created in the TPS with two settings: with and without the couch. The chamber measurements were compared to both treatment plans. Results: A maximum attenuation of 3.6% was observed when the gantry angle was set to 120 and 240 degrees, passing obliquely through the couch. A uniform density of 0.6 g/cm3 for the couch wall was determined in the TPS by comparison with measured data. The VMAT ion chamber measurement/plan ratios systematically improved by 1.79% ±0.53% for all patients when the couch was included in the calculation. Conclusion: The attenuation and surface dose changes produced by the Civco couch can generate observable dose difference in VMAT plans. Including a couch model in the phantom plan used for patient specific VMAT QA can improve the ionization chamber agreement by up to ∼2%.« less

Intensity modulated radiotherapy with fixed collimator jaws for locoregional left-sided breast cancer irradiation.

PubMed

Wang, Juanqi; Yang, Zhaozhi; Hu, Weigang; Chen, Zhi; Yu, Xiaoli; Guo, Xiaomao

2017-05-16

The purpose of this study is to evaluate the intensity modulated radiotherapy (IMRT) with the fixed collimator jaws technique (FJT) for the left breast and regional lymph node. The targeted breast tissue and the lymph nodes, and the normal tissues were contoured for 16 left-sided breast cancer patients previously treated with radiotherapy after lumpectomy. For each patient, treatment plans using different planning techniques, i.e., volumetric modulated arc therapy (VMAT), tangential IMRT (tangential-IMRT), and IMRT with FJT (FJT-IMRT) were developed for dosimetric comparisons. A dose of 50Gy was prescribed to the planning target volume. The dose-volume histograms were generated, and the paired t-test was used to analyze the dose differences. FJT-IMRT had similar mean heart volume receiving 30Gy (V30 Gy) with tangential-IMRT (1.5% and 1.6%, p = 0.41), but inferior to the VMAT (0.8%, p < 0.001). In the average heart mean dose comparison, FJT-IMRT had the lowest value, and it was 0.6Gy lower than that for the VMAT plans (p < 0.01). A significant dose increase in the contralateral breast and lung was observed in VMAT plans. Compared with tangential-IMRT and VMAT plans, FJT-IMRT reduced the mean dose of thyroid, humeral head and cervical esophageal by 47.6% (p < 0.01) and 45.7% (p < 0.01), 74.3% (p =< 0.01) and 73% (p =< 0.01), and 26.7% (p =< 0.01) and 29.2% (p =< 0.01). In conclusion, compared with tangential-IMRT and VMAT, FJT-IMRT plan has the lowest thyroid, humeral head and cervical esophageal mean dose and it can be a reasonable treatment option for a certain subgroup of patients, such as young left-breast cancer patients and/or patients with previous thyroid disease.

Assessing the Dosimetric Accuracy of Magnetic Resonance-Generated Synthetic CT Images for Focal Brain VMAT Radiation Therapy.

PubMed

Paradis, Eric; Cao, Yue; Lawrence, Theodore S; Tsien, Christina; Feng, Mary; Vineberg, Karen; Balter, James M

2015-12-01

The purpose of this study was to assess the dosimetric accuracy of synthetic CT (MRCT) volumes generated from magnetic resonance imaging (MRI) data for focal brain radiation therapy. A study was conducted in 12 patients with gliomas who underwent both MR and CT imaging as part of their simulation for external beam treatment planning. MRCT volumes were generated from MR images. Patients' clinical treatment planning directives were used to create 12 individual volumetric modulated arc therapy (VMAT) plans, which were then optimized 10 times on each of their respective CT and MRCT-derived electron density maps. Dose metrics derived from optimization criteria, as well as monitor units and gamma analyses, were evaluated to quantify differences between the imaging modalities. Mean differences between planning target volume (PTV) doses on MRCT and CT plans across all patients were 0.0% (range: -0.1 to 0.2%) for D(95%); 0.0% (-0.7 to 0.6%) for D(5%); and -0.2% (-1.0 to 0.2%) for D(max). MRCT plans showed no significant changes in monitor units (-0.4%) compared to CT plans. Organs at risk (OARs) had average D(max) differences of 0.0 Gy (-2.2 to 1.9 Gy) over 85 structures across all 12 patients, with no significant differences when calculated doses approached planning constraints. Focal brain VMAT plans optimized on MRCT images show excellent dosimetric agreement with standard CT-optimized plans. PTVs show equivalent coverage, and OARs do not show any overdose. These results indicate that MRI-derived synthetic CT volumes can be used to support treatment planning of most patients treated for intracranial lesions. Copyright © 2015 Elsevier Inc. All rights reserved.

Assessing the Dosimetric Accuracy of Magnetic Resonance-Generated Synthetic CT Images for Focal Brain VMAT Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Paradis, Eric, E-mail: eparadis@umich.edu; Cao, Yue; Department of Radiology, University of Michigan Hospital and Health Systems, Ann Arbor, Michigan

2015-12-01

Purpose: The purpose of this study was to assess the dosimetric accuracy of synthetic CT (MRCT) volumes generated from magnetic resonance imaging (MRI) data for focal brain radiation therapy. Methods and Materials: A study was conducted in 12 patients with gliomas who underwent both MR and CT imaging as part of their simulation for external beam treatment planning. MRCT volumes were generated from MR images. Patients' clinical treatment planning directives were used to create 12 individual volumetric modulated arc therapy (VMAT) plans, which were then optimized 10 times on each of their respective CT and MRCT-derived electron density maps. Dosemore » metrics derived from optimization criteria, as well as monitor units and gamma analyses, were evaluated to quantify differences between the imaging modalities. Results: Mean differences between planning target volume (PTV) doses on MRCT and CT plans across all patients were 0.0% (range: −0.1 to 0.2%) for D{sub 95%}; 0.0% (−0.7 to 0.6%) for D{sub 5%}; and −0.2% (−1.0 to 0.2%) for D{sub max}. MRCT plans showed no significant changes in monitor units (−0.4%) compared to CT plans. Organs at risk (OARs) had average D{sub max} differences of 0.0 Gy (−2.2 to 1.9 Gy) over 85 structures across all 12 patients, with no significant differences when calculated doses approached planning constraints. Conclusions: Focal brain VMAT plans optimized on MRCT images show excellent dosimetric agreement with standard CT-optimized plans. PTVs show equivalent coverage, and OARs do not show any overdose. These results indicate that MRI-derived synthetic CT volumes can be used to support treatment planning of most patients treated for intracranial lesions.« less

Dosimetric and radiobiological characterizations of prostate intensity-modulated radiotherapy and volumetric-modulated arc therapy: A single-institution review of ninety cases

PubMed Central

Khan, Muhammad Isa; Jiang, Runqing; Kiciak, Alexander; ur Rehman, Jalil; Afzal, Muhammad; Chow, James C. L.

2016-01-01

This study reviewed prostate volumetric-modulated arc therapy (VMAT) plans with intensity-modulated radiotherapy (IMRT) plans after prostate IMRT technique was replaced by VMAT in an institution. Characterizations of dosimetry and radiobiological variation in prostate were determined based on treatment plans of 40 prostate IMRT patients (planning target volume = 77.8–335 cm3) and 50 VMAT patients (planning target volume = 120–351 cm3) treated before and after 2013, respectively. Both IMRT and VMAT plans used the same dose-volume criteria in the inverse planning optimization. Dose-volume histogram, mean doses of target and normal tissues (rectum, bladder and femoral heads), dose-volume points (D99% of planning target volume; D30%, D50%, V30 Gy and V35 Gy of rectum and bladder; D5%, V14 Gy, V22 Gy of femoral heads), conformity index (CI), homogeneity index (HI), gradient index (GI), prostate tumor control probability (TCP), and rectal normal tissue complication probability (NTCP) based on the Lyman-Burman-Kutcher algorithm were calculated for each IMRT and VMAT plan. From our results, VMAT plan was found better due to its higher (1.05%) CI, lower (0.83%) HI and (0.75%) GI than IMRT. Comparing doses in normal tissues between IMRT and VMAT, it was found that IMRT mostly delivered higher doses of about 1.05% to the normal tissues than VMAT. Prostate TCP and rectal NTCP were found increased (1%) for VMAT than IMRT. It is seen that VMAT technique can decrease the dose-volume evaluation criteria for the normal tissues. Based on our dosimetric and radiobiological results in treatment plans, it is concluded that our VMAT implementation could produce comparable or slightly better target coverage and normal tissue sparing with a faster treatment time in prostate radiotherapy. PMID:27651562

Investigation of pulsed IMRT and VMAT for re-irradiation treatments: dosimetric and delivery feasibilities

NASA Astrophysics Data System (ADS)

Lin, Mu-Han; Price, Robert A., Jr.; Li, Jinsheng; Kang, Shengwei; Li, Jie; Ma, C.-M.

2013-11-01

Many tumor cells demonstrate hyperradiosensitivity at doses below ˜50 cGy. Together with the increased normal tissue repair under low dose rate, the pulsed low dose rate radiotherapy (PLDR), which separates a daily fractional dose of 200 cGy into 10 pulses with 3 min interval between pulses (˜20 cGy/pulse and effective dose rate 6.7 cGy min-1), potentially reduces late normal tissue toxicity while still providing significant tumor control for re-irradiation treatments. This work investigates the dosimetric and technical feasibilities of intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT)-based PLDR treatments using Varian Linacs. Twenty one cases (12 real re-irradiation cases) including treatment sites of pancreas, prostate, pelvis, lung, head-and-neck, and breast were recruited for this study. The lowest machine operation dose rate (100 MU min-1) was employed in the plan delivery. Ten-field step-and-shoot IMRT and dual-arc VMAT plans were generated using the Eclipse TPS with routine planning strategies. The dual-arc plans were delivered five times to achieve a 200 cGy daily dose (˜20 cGy arc-1). The resulting plan quality was evaluated according to the heterogeneity and conformity indexes (HI and CI) of the planning target volume (PTV). The dosimetric feasibility of retaining the hyperradiosensitivity for PLDR was assessed based on the minimum and maximum dose in the target volume from each pulse. The delivery accuracy of VMAT and IMRT at the 100 MU min-1 machine operation dose rate was verified using a 2D diode array and ion chamber measurements. The delivery reproducibility was further investigated by analyzing the Dynalog files of repeated deliveries. A comparable plan quality was achieved by the IMRT (CI 1.10-1.38 HI 1.04-1.10) and the VMAT (CI 1.08-1.26 HI 1.05-1.10) techniques. The minimum/maximum PTV dose per pulse is 7.9 ± 5.1 cGy/33.7 ± 6.9 cGy for the IMRT and 12.3 ± 4.1 cGy/29.2 ± 4.7 cGy for the VMAT. Six out of the 186 IMRT pulses (fields) were found to exceed 50 cGy maximum PTV dose per pulse while the maximum PTV dose per pulse was within 40 cGy for all the VMAT pulses (arcs). However, for VMAT plans, the dosimetric quality of the entire treatment plan was less superior for the breast cases and large irregular targets. The gamma passing rates for both techniques at the 100 MU min-1 dose rate were at least 94.1% (3%/3 mm) and the point dose measurements agreed with the planned values to within 2.2%. The average root mean square error of the leaf position was 0.93 ± 0.83 mm for IMRT and 0.53 ± 0.48 mm for VMAT based on the Dynalog file analysis. The RMS error of the leaf position was nearly identical for the repeated deliveries of the same plans. In general, both techniques are feasible for PLDR treatments. VMAT was more advantageous for PLDR with more uniform target dose per pulse, especially for centrally located tumors. However, for large, irregular and/or peripheral tumors, IMRT could produce more favorable PLDR plans. By taking the biological benefit of PLDR delivery and the dosimetric benefit of IMRT and VMAT, the proposed methods have a great potential for those previously-irradiated recurrent patients.

SU-E-J-228: MRI-Based Planning: Dosimetric Feasibility of Dose Painting for ADCDefined Intra-Prostatic Tumor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, X; Dalah, E; Prior, P

Purpose: Apparent diffusion coefficient (ADC) map may help to delineate the gross tumor volume (GTV) in prostate gland. Dose painting with external beam radiotherapy for GTV might increase the local tumor control. The purpose of this study is to explore the maximum boosting dose on GTV using VMAT without sacrificing sparing of organs at risk (OARs) in MRI based planning. Methods: VMAT plans for 5 prostate patients were generated following the commonly used dose volume (DV) criteria based on structures contoured on T2 weighted MRI with bulk electron density assignment using electron densities derived from ICRU46. GTV for each patientmore » was manually delineated based on ADC maps and fused to T2-weighted image set for planning study. A research planning system with Monte Carlo dose engine (Monaco, Elekta) was used to generate the VMAT plans with boosting dose on GTV gradually increased from 85Gy to 100Gy. DV parameters, including V(boosting-dose) (volume covered by boosting dose) for GTV, V75.6Gy for PTV, V45Gy, V70Gy, V72Gy and D1cc (Maximum dose to 1cc volume) for rectum and bladder, were used to measure plan quality. Results: All cases achieve at least 99.0% coverage of V(boosting-dose) on GTV and 95% coverage of V75.6Gy to the PTV. All the DV criteria, V45Gy≤50% and V70Gy≤15% for bladder and rectum, D1cc ≤77Gy (Rectum) and ≤80Gy (Bladder), V72Gy≤5% (rectum and bladder) were maintained when boosting GTV to 95Gy for all cases studied. Except for two patients, all the criteria were also met when the boosting dose goes to 100Gy. Conclusion: It is dosimetrically feasible safe to boost the dose to at least 95Gy to ADC defined GTV in prostate cancer using MRI guided VMAT delivery. Conclusion: It is dosimetrically feasible safe to boost the dose to at least 95Gy to ADC defined GTV in prostate cancer using MRI guided VMAT delivery. This research is partially supported by Elekta Inc.« less

Relative plan robustness of step-and-shoot vs rotational intensity–modulated radiotherapy on repeat computed tomographic simulation for weight loss in head and neck cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thomson, David J.; The University of Manchester, Manchester Academic Health Science Centre, Institute of Cancer Sciences, Manchester; Beasley, William J.

Introduction: Interfractional anatomical alterations may have a differential effect on the dose delivered by step-and-shoot intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT). The increased degrees of freedom afforded by rotational delivery may increase plan robustness (measured by change in target volume coverage and doses to organs at risk [OARs]). However, this has not been evaluated for head and neck cancer. Materials and methods: A total of 10 patients who required repeat computed tomography (CT) simulation and replanning during head and neck IMRT were included. Step-and-shoot IMRT and VMAT plans were generated from the original planning scan. The initial andmore » second CT simulation scans were fused and targets/OAR contours transferred, reviewed, and modified. The plans were applied to the second CT scan and doses recalculated without repeat optimization. Differences between step-and-shoot IMRT and VMAT for change in target volume coverage and doses to OARs between first and second CT scans were compared by Wilcoxon signed rank test. Results: There were clinically relevant dosimetric changes between the first and the second CT scans for both the techniques (reduction in mean D{sub 95%} for PTV2 and PTV3, D{sub min} for CTV2 and CTV3, and increased mean doses to the parotid glands). However, there were no significant differences between step-and-shoot IMRT and VMAT for change in any target coverage parameter (including D{sub 95%} for PTV2 and PTV3 and D{sub min} for CTV2 and CTV3) or dose to any OARs (including parotid glands) between the first and the second CT scans. Conclusions: For patients with head and neck cancer who required replanning mainly due to weight loss, there were no significant differences in plan robustness between step-and-shoot IMRT and VMAT. This information is useful with increased clinical adoption of VMAT.« less

SU-F-T-392: Superior Brainstem and Cochlea Sparing with VMAT for Glioblastoma Multiforme

DOE Office of Scientific and Technical Information (OSTI.GOV)

Briere, TM; McAleer, MF; Levy, LB

Purpose: Volumetric arc therapy (VMAT) can provide similar target coverage and normal tissue sparing as IMRT but with shorter treatment times. At our institution VMAT was adopted for the treatment glioblastoma multiforme (GBM) after a small number of test plans demonstrated its non-inferiority. In this study, we compare actual clinical treatment plans for a larger cohort of patients treated with either VMAT or IMRT. Methods: 90 GBM patients were included in this study, 45 treated with IMRT and 45 with VMAT. All planning target volumes (PTVs) were prescribed a dose of 50 Gy, with a simultaneous integrated boost to 60more » Gy. Most IMRT plans used 5 non-coplanar beams, while most VMAT plans used 2 coplanar beams. Statistical analysis was performed using Fisher’s exact test or the Wilcoxon-Mann-Whitney rank sum test. Included in the analysis were patient and treatment characteristics as well as the doses to the target volumes and organs at risk. Results: Treatment times for the VMAT plans were reduced by 5 minutes compared with IMRT. The PTV coverage was similar, with at least 95% covered for all plans, while the median boost PTV dose differed by 0.1 Gy between the IMRT and VMAT cohorts. The doses to the brain, optic chiasm, optic nerves and eyes were not significantly different. The mean dose to the brainstem, however, was 9.4 Gy less with VMAT (p<0.001). The dose to the ipsilateral and contralateral cochleae were respectively 19.7 and 9.5 Gy less (p<0.001). Conclusion: Comparison of clinical treatment plans for separate IMRT and VMAT cohorts demonstrates that VMAT can save substantial treatment time while providing similar target coverage and superior sparing of the brainstem and cochleae. To our knowledge this is the first study to demonstrate this benefit of VMAT in the management of GBM.« less

Vector-model-supported approach in prostate plan optimization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Eva Sau Fan; Department of Health Technology and Informatics, The Hong Kong Polytechnic University; Wu, Vincent Wing Cheung

Lengthy time consumed in traditional manual plan optimization can limit the use of step-and-shoot intensity-modulated radiotherapy/volumetric-modulated radiotherapy (S&S IMRT/VMAT). A vector model base, retrieving similar radiotherapy cases, was developed with respect to the structural and physiologic features extracted from the Digital Imaging and Communications in Medicine (DICOM) files. Planning parameters were retrieved from the selected similar reference case and applied to the test case to bypass the gradual adjustment of planning parameters. Therefore, the planning time spent on the traditional trial-and-error manual optimization approach in the beginning of optimization could be reduced. Each S&S IMRT/VMAT prostate reference database comprised 100more » previously treated cases. Prostate cases were replanned with both traditional optimization and vector-model-supported optimization based on the oncologists' clinical dose prescriptions. A total of 360 plans, which consisted of 30 cases of S&S IMRT, 30 cases of 1-arc VMAT, and 30 cases of 2-arc VMAT plans including first optimization and final optimization with/without vector-model-supported optimization, were compared using the 2-sided t-test and paired Wilcoxon signed rank test, with a significance level of 0.05 and a false discovery rate of less than 0.05. For S&S IMRT, 1-arc VMAT, and 2-arc VMAT prostate plans, there was a significant reduction in the planning time and iteration with vector-model-supported optimization by almost 50%. When the first optimization plans were compared, 2-arc VMAT prostate plans had better plan quality than 1-arc VMAT plans. The volume receiving 35 Gy in the femoral head for 2-arc VMAT plans was reduced with the vector-model-supported optimization compared with the traditional manual optimization approach. Otherwise, the quality of plans from both approaches was comparable. Vector-model-supported optimization was shown to offer much shortened planning time and iteration number without compromising the plan quality.« less

Simultaneous optimization of photons and electrons for mixed beam radiotherapy

NASA Astrophysics Data System (ADS)

Mueller, S.; Fix, M. K.; Joosten, A.; Henzen, D.; Frei, D.; Volken, W.; Kueng, R.; Aebersold, D. M.; Stampanoni, M. F. M.; Manser, P.

2017-07-01

The aim of this work is to develop and investigate an inverse treatment planning process (TPP) for mixed beam radiotherapy (MBRT) capable of performing simultaneous optimization of photon and electron apertures. A simulated annealing based direct aperture optimization (DAO) is implemented to perform simultaneous optimization of photon and electron apertures, both shaped with the photon multileaf collimator (pMLC). Validated beam models are used as input for Monte Carlo dose calculations. Consideration of photon pMLC transmission during DAO and a weight re-optimization of the apertures after deliverable dose calculation are utilized to efficiently reduce the differences between optimized and deliverable dose distributions. The TPP for MBRT is evaluated for an academic situation with a superficial and an enlarged PTV in the depth, a left chest wall case including the internal mammary chain and a squamous cell carcinoma case. Deliverable dose distributions of MBRT plans are compared to those of modulated electron radiotherapy (MERT), photon IMRT and if available to those of clinical VMAT plans. The generated MBRT plans dosimetrically outperform the MERT, photon IMRT and VMAT plans for all investigated situations. For the clinical cases of the left chest wall and the squamous cell carcinoma, the MBRT plans cover the PTV similarly or more homogeneously than the VMAT plans, while OARs are spared considerably better with average reductions of the mean dose to parallel OARs and D 2% to serial OARs by 54% and 26%, respectively. Moreover, the low dose bath expressed as V 10% to normal tissue is substantially reduced by up to 45% compared to the VMAT plans. A TPP for MBRT including simultaneous optimization is successfully implemented and the dosimetric superiority of MBRT plans over MERT, photon IMRT and VMAT plans is demonstrated for academic and clinical situations including superficial targets with and without deep-seated part.

Simultaneous optimization of photons and electrons for mixed beam radiotherapy.

PubMed

Mueller, S; Fix, M K; Joosten, A; Henzen, D; Frei, D; Volken, W; Kueng, R; Aebersold, D M; Stampanoni, M F M; Manser, P

2017-06-26

The aim of this work is to develop and investigate an inverse treatment planning process (TPP) for mixed beam radiotherapy (MBRT) capable of performing simultaneous optimization of photon and electron apertures. A simulated annealing based direct aperture optimization (DAO) is implemented to perform simultaneous optimization of photon and electron apertures, both shaped with the photon multileaf collimator (pMLC). Validated beam models are used as input for Monte Carlo dose calculations. Consideration of photon pMLC transmission during DAO and a weight re-optimization of the apertures after deliverable dose calculation are utilized to efficiently reduce the differences between optimized and deliverable dose distributions. The TPP for MBRT is evaluated for an academic situation with a superficial and an enlarged PTV in the depth, a left chest wall case including the internal mammary chain and a squamous cell carcinoma case. Deliverable dose distributions of MBRT plans are compared to those of modulated electron radiotherapy (MERT), photon IMRT and if available to those of clinical VMAT plans. The generated MBRT plans dosimetrically outperform the MERT, photon IMRT and VMAT plans for all investigated situations. For the clinical cases of the left chest wall and the squamous cell carcinoma, the MBRT plans cover the PTV similarly or more homogeneously than the VMAT plans, while OARs are spared considerably better with average reductions of the mean dose to parallel OARs and D 2% to serial OARs by 54% and 26%, respectively. Moreover, the low dose bath expressed as V 10% to normal tissue is substantially reduced by up to 45% compared to the VMAT plans. A TPP for MBRT including simultaneous optimization is successfully implemented and the dosimetric superiority of MBRT plans over MERT, photon IMRT and VMAT plans is demonstrated for academic and clinical situations including superficial targets with and without deep-seated part.

SU-E-T-67: A Quality Assurance Procedure for VMAT Delivery Technique with Multiple Verification Metric Using TG-119 Protocol

DOE Office of Scientific and Technical Information (OSTI.GOV)

Katsuta, Y; Kadoya, N; Shimizu, E

2015-06-15

Purpose: A successful VMAT plan delivery includes precise modulations of dose rate, gantry rotational and multi-leaf collimator shapes. The purpose of this research is to construct routine QA protocol which focuses on VMAT delivery technique and to obtain a baseline including dose error, fluence distribution and mechanical accuracy during VMAT. Methods: The mock prostate, head and neck (HN) cases supplied from AAPM were used in this study. A VMAT plans were generated in Monaco TPS according to TG-119 protocol. Plans were created using 6 MV and 10 MV photon beams for each case. The phantom based measurement, fluence measurement andmore » log files analysis were performed. The dose measurement was performed using 0.6 cc ion chamber, which located at isocenter. The fluence distribution were acquired using the MapCHECK2 mounted in the MapPHAN. The trajectory log files recorded inner 20 leaf pairs and gantry angle positions at every 0.25 sec interval were exported to in-house software developed by MATLAB and determined those RMS values. Results: The dose difference is expressed as a ratio of the difference between measured and planned doses. The dose difference for 6 MV was 0.91%, for 10 MV was 0.67%. In turn, the fluence distribution using gamma criteria of 2%/2 mm with a 50% minimum dose threshold for 6 MV was 98.8%, for 10 MV was 97.5%, respectively. The RMS values of MLC for 6 MV and 10 MV were 0.32 mm and 0.37 mm, of gantry were 0.33 degree and 0.31 degree. Conclusion: In this study, QA protocol to assess VMAT delivery accuracy is constructed and results acquired in this study are used as a baseline of VMAT delivery performance verification.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Edgington, Samantha; Cotter, Christopher; Busse, Paul

Purpose: To report the first experiences and perspectives in using direct multicriteria optimization (MCO) on volumetric-modulated arc therapy (VMAT) for head and neck (H&N) cancer. Methods: Ten prior patients with tumors in representative H&N regions were selected to evaluate direct MCO-VMAT in RayStation v5.0 beta. The patients were previously treated by intensity-modulated radiation therapy (IMRT) with MCO on an Elekta linear accelerator with Agility multileaf collimator. To avoid radiating eyes and shoulders, MCO-VMAT required one to three partial-arc groups, with each group consisting of single or dual arcs. All MCO-VMAT plans were approved by a radiation oncologist. The MCO-VMAT andmore » MCO-IMRT plans were compared using V{sub 100}, D{sub 5}, homogeneity index (HI) and conformity index (CI) for planning target volume (PTV), D{sub mean} and D{sub 50} for six parallel organs and D{sub max} for five serial organs. Patient-specific quality assurance (QA) was performed using ArcCHECK for MCO-VMAT and Matrixx for MCO-IMRT with results analyzed using gamma criteria of 3%/3mm. Results: MCO-VMAT provided better V{sub 100} (+0.8%) lower D{sub 5}(− 0.3 Gy), lower HI (−0.27) and comparable CI (+0.05). MCO-VMAT decreased D{sub mean} and D{sub 50} for multiple parallel organs in seven of the ten patients. On average the reduction ranged from 2.1 (larynx) to 7.6 Gy (esophagus). For the nasal cavity and nasopharynx plans significant reduction in D{sub max} was observed for optics (up to 11 Gy) brainstem (6.4 Gy), cord (2.1 Gy) and mandible (6.7 Gy). All MCO-VMAT and -IMRT plans passed clinical QA. MCO-VMAT required slightly longer planning time due to the more complex VMAT optimization. The net beam-on time for the MCO-VMAT plans ranged from 80 to 242 seconds, up to 9 minutes shorter than MCO-IMRT. Conclusion: With similar target coverage, reduced organ dose, comparable planning time, and significantly faster treatment, MCO-VMAT is very likely to become the modality of choice in RayStation v5.0 for H&N cancer.« less

MO-FG-303-06: Evaluation of the Performance of Very High-Energy Electron (VHEE) Beams in Radiotherapy: Five Clinical Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Palma, B; Bazalova-Carter, M; Qu, B

Purpose: To evaluate the performance of 100–120 MeV very-high energy electron (VHEE) scanning pencil beams to radiotherapy by means of Monte Carlo (MC) simulations. Methods: We selected five clinical cases with target sizes of 1.2 cm{sup 3} to 990.4 cm{sup 3}. We calculated VHEE treatment plans using the MC EGSnrc code implemented in a MATLAB-based graphical user interface developed by our group. We generated phase space data for beam energies: 100 and 120 MeV and pencil beam spot sizes of 1, 3, and 5 mm at FWHM. The number of equidistant beams considered in this work was 16 or 32.more » Dose was calculated and then imported into a research version of RayStation where treatment plan optimization was performed. We compared the VHEE plans with the clinically delivered volumetric modulated arc therapy (VMAT) plan to evaluate VHEE plans performance. Results: VHEE plans provided the same PTV coverage and dose homogeneity than VMAT plans for all the cases. In average, the mean dose to organs at risk (OARs) was 24% lower for the VHEE plans. The structures that benefited the most from using VHEE were: large bowel for the esophagus case, chest wall for the liver case, brainstem for the acoustic case, carina for the lung case, and genitalia for the anal case, with 23.7–34.6% lower dose. VHEE dose distributions were more conformal than VMAT solution as confirmed by conformity indices CI100 and CI50. Integral dose to the body was in average 19.6% (9.2%–36.5%) lower for the VHEE plans. Conclusion: We have shown that VHEE plans resulted in similar or superior dose distributions compared to clinical VMAT plans for five different cases and a wide range of target volumes, including a case with a small target (1.2 cm{sup 3}), which represents a challenge for VMAT planning and might require the use of more complex non-coplanar VMAT plans. B Palma: None. M Bazalova: None. B Hardemark: Employee, RaySearch Laboratories AB. E Hynning: Employee, RaySearch Laboratories AB. B Qu: None. B Loo Jr.: Research support, RaySearch, Varian. P Maxim: Research support, RaySearch, Varian.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Qu, H; Yu, N; Qi, P

Purpose: In commercial secondary dose calculation system, an average effective depth is used to calculate the Monitor Units for an arc beam from the volumetric modulated arc (VMAT) plans. Typically, an arithmetic mean of the effective depths (AMED) of a VMAT arc beam is used, which may result in large MU discrepancy from that of the primary treatment planning system. This study is to demonstrate the use of a dose weighted mean effective depth (DWED) can improve accuracy of MU calculation for the secondary MU verification. Methods: In-house scripts were written in the primary treatment planning system (TPS) to firstmore » convert a VMAT arc beam to a series of static step & shoot beams (every 4 degree). The computed dose and effective depth of each static beam were then used to obtain the dose weighted mean effective depth (DWED) for the VMAT beam. The DWED was used for the secondary MU calculation for VMAT plans. Six lung SBRT VMAT plans, eight head and neck VMAT plans and ten prostate VMAT plans that had > 5% MU deviations (failed MU verification) using the AMED method were recalculated with the DWED. For comparison, same number VMAT plans that had < 5% MU deviations (passed MU verification) using AMED method were also reevaluated with the dose weighted mean effective depth method. Results: For MU verification passed plans, the mean and standard deviation of MU differences between the TPS and the secondary calculation program were 2.2%±1.5% for the AMED and 2.1%±1.7% for the DMED method. For the failed plans, the mean and standard deviation of MU differences of TPS to the secondary calculation program were 9.9%±4.7% and 4.7%±2.6, respectively. Conclusion: The dose weighted mean effective depth improved MU calculation accuracy which can be used for the pre-treatment MU verification of VMAT plans.« less

SU-F-T-356: DosimetricComparison of VMAT Vs Step and Shoot IMRT Plans for Stage III Lung CancerPatients with Mediastinal Involvement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pearson, D; Bogue, J

Purpose: For Stage III lung cancers that entail treatment of some or all of the mediastinum, anterior-posterior focused Step and Shoot IMRT (SS-IMRT) and VMAT plans have been clinically used to deliver the prescribed dose while working to minimize lung dose and avoid other critical structures. A comparison between the two planning methods was completed to see which treatment method is superior and minimizes dose to healthy lung tissue. Methods: Ten patients who were recently treated with SS-IMRT or VMAT plans for Stage III lung cancer with mediastinal involvement were selected. All patients received a simulation CT for treatment planning,more » as well as a 4D CT and PET/CT fusion for target delineation. Plans were prescribed 6250 cGy in 25 fractions and normalized such that 100% of the prescription dose covered 95% of the PTV. Clinically approved SS-IMRT or VMAT plans were then copied and planned using the alternative modality with identical optimization criteria. SS-IMRT plans utilized seven to nine beams distributed around the patient while the VMAT plans consisted of two full 360 degree arcs. Plans were compared for the lung volume receiving 20 Gy (V20). Results: Both SS-IMRT and VMAT can be used to achieve clinical treatment plans for patients with Stage III Lung cancer with targets encompassing the mediastinum. VMAT plans produced an average V20 of 23.0+/−8.3% and SS-IMRT produced an average of 24.2+/−10.0%. Conclusion: Results indicate that either method can achieve comparable dose distributions, however, VMAT can allow the optimizer to distribute dose over paths of minimal lung tissue and reduce the V20. Therefore, creating a VMAT with constraints identical to an SS-IMRT plan could help to reduce the V20 in clinical treatment plans.« less

Cardiac dose-sparing effects of deep-inspiration breath-hold in left breast irradiation : Is IMRT more beneficial than VMAT?

PubMed

Sakka, Mazen; Kunzelmann, Leonie; Metzger, Martin; Grabenbauer, Gerhard G

2017-10-01

Given the reduction in death from breast cancer, as well as improvements in overall survival, adjuvant radiotherapy is considered the standard treatment for breast cancer. However, left-sided breast irradiation was associated with an increased rate of fatal cardiovascular events due to incidental irradiation of the heart. Recently, considerable efforts have been made to minimize cardiac toxicity of left-sided breast irradiation by new treatment methods such as deep-inspiration breath-hold (DIBH) and new radiation techniques, particularly intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). The primary aim of this study was to evaluate the effect of DIBH irradiation on cardiac dose compared with free-breathing (FB) irradiation, while the secondary objective was to compare the advantages of IMRT versus VMAT plans in both the FB and the DIBH position for left-sided breast cancer. In all, 25 consecutive left-sided breast cancer patients underwent CT simulation in the FB and DIBH position. Five patients were excluded with no cardiac displacement following DIBH-CT simulation. The other 20 patients were irradiated in the DIBH position using respiratory gating. Four different treatment plans were generated for each patient, an IMRT and a VMAT plan in the DIBH and in the FB position, respectively. The following parameters were used for plan comparison: dose to the heart, left anterior descending coronary artery (mean dose, maximum dose, D25% and D45%), ipsilateral, contralateral lung (mean dose, D20%, D30%) and contralateral breast (mean dose). The percentage in dose reduction for organs at risk achieved by DIBH for both IMRT and VMAT plans was calculated and compared for each patient by each treatment plan. DIBH irradiation significantly reduced mean dose to the heart and left anterior descending coronary artery (LADCA) using both IMRT (heart -20%; p = 0.0002, LADCA -9%; p = 0.001) and VMAT (heart -23%; p = 0.00003, LADCA -16%; p = 0.01) techniques as compared with FB radiation. There were no significant changes in left lung dose by IMRT; however, with VMAT planning, mean dose to the left lung was reduced by -4% (p = 0.0004). In addition, DIBH significantly increased the mean dose to the contralateral breast with IMRT (+14%, p = 0.002) and significantly reduced the dose to the contralateral breast with VMAT planning (-9%, p = 0.003) compared with the FB position. Additionally, in comparison with VMAT, the IMRT technique reduced mean heart dose both in the FB and the DIBH-position by -30% (p = 0.0004) and -26% (p = 0.002), respectively. Furthermore, IMRT increased the mean dose to the left lung in both the FB and the DIBH position (+5%, p = 0.003, p = 0.006), respectively. There were no significant changes in dose to the right lung and contralateral breast either in the FB or DIBH position between IMRT and VMAT techniques. Left-sided breast irradiation is best performed in the DIBH position, since a considerable dose sparing to the heart and LADCA can be achieved by using either IMRT or VMAT techniques. A significant additional decrease in heart and LADCA dose by IMRT in both FB and DIBH irradiation was seen compared with VMAT.

SU-F-T-625: Optimal Treatment Planning Strategy Among Arc Arrangements for Prostate SBRT with VMAT Technique

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chung, J; Kim, J; Eom, K

Purpose: The purpose of this study is to determine the optimal treatment planning strategy among the different arc arrangements for prostate stereotactic body radiotherapy (SBRT) plans with volumetric modulated arc therapy (VMAT). Methods: Ten patients with prostate cancer were selected. The SBRT-VMAT plans for each patient were generated with single-full (181° to 179°; 1FA), single-partial (240° to 120°; 1PA), double-full (181° to 179° and 179° to 181°; 2FA), and double-partial (240° to 120° and 120° to 240°; 2PA) arc arrangements. The prescription dose was 42.7 Gy in 7 fractions. Dose distribution was calculated using a 10-MV flattening-filter-free beam and themore » Acuros XB algorithm. Dosimetric parameters of target volume and organs at risk (OARs) were evaluated from cumulative dose-volume histograms on prostate SBRT-VMAT plans between single-arc (1FA and 1PA) and double-arc (2FA and 2PA) arrangements. Results: All plans using four arc arrangements were highly conformal with conformity index (CI)<1.05 and conformation number (CN)=0.91, and the doses to target volume were homogeneous (homogeneity index (HI)= 0.09 0.12). Pertaining to the dose to the OARs, there were significant differences in the rectum, left and right femoral head doses while having no difference in the bladder dose. The partial-arc (1PA and 2PA) had relatively high reductions for the mean rectum dose compared to full-arc (1FA and 2FA). The near-to-maximum dose (D2%) and mean dose of the left and right femoral head were always lower on prostate SBRT-VMAT plan using the full-arc, when compared to the partial-arc arrangement. Conclusion: This study confirmed that prostate SBRT-VMAT using 1PA was feasible fast delivery time and produced equivalent target coverage and better rectum sparing, although the D2% and mean dose of the left and right femoral head increased slightly. Therefore, the results of this study suggest that the use of 1PA is an attractive choice for delivering prostate SBRT-VMAT.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, R; Liu, T; Qi, S

Purposes: There has been growing interest in treating breast cancer using VMAT technique. Our goal is to compare the dosimetry and treatment delivery parameters for the left-sided breast cancer treatment using various VMAT platforms from commercially available planning systems. Methods: Five consecutive left-sided breast cancer patients initially treated with conventional 3D-conformal radiotherapy (3DCRT) were selected. Four VMAT plans using most popular treatment planning systems, including Eclipse (Version 11, Varian), Pinnacle (Version 9.8, Philips), Monaco (Version 2.03, Elekta) and helical Tomotherapy (V4.0, Accuray). The same structure set and same planning goals were used for all VMAT plans. The dosimetric parameters includingmore » target coverage and minimum/maximum/mean, dose-volume endpoints for the selected normal structures: the heart, ipsilateral-/contralateral lung and breast, were evaluated. Other dosimetric indices including heterogeneity index (HI) were evaluated. The treatment delivery parameters, such as monitor unit (MUs) and delivery time were also compared. Results: VMAT increases dose homogeneity to the treated volume and reduces the irradiated heart and left-lung volumes. Compared to the 3DCRT technique, all VMAT plans offer better heart and left-lung dose sparing; the mean heart doses were 4.5±1.6(Monaco), 1.2±0.4(Pinnacle), 1.3± (Eclipse) and 5.6±4.4(Tomo), the mean left-lung doses were 5.9±1.5(Monaco), 3.7±0.7(Pinnacle), 1.4± (Eclipse) and 5.2±1.6 (Tomo), while for the 3DCRT plan, the mean heart and left-Lung doses were 2.9±2.0, and 6.8±4.4 (Gy) respectively. The averaged contralateral-breast and lung mean doses were higher in VMAT plans than the 3DCRT plans but were not statistically significant. Among all the VMAT plans, the Pinnacle plans often yield the lowest right-lung/breast mean doses, and slightly better heterogeneity indices that are similar to Tomotherapy plans. Treatment delivery time of the VMAT plans (except helical Tomotherapy IMRT) is estimated to be comparable with the conventional 3DCRT. Conclusion: VMAT achieves equal or better PTV coverage and comparable OARs sparing compared to the conventional 3DCRT techniques.« less

SU-E-T-29: A Dosimetric Study of Volumetric Modulated Arc Therapy with Simultaneous Integrated Boost for Rectal Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sun, T; Lin, X; Yin, Y

Purpose: To compare the dosimetric differences among fixed field intensity-modulated radiotherapy (IMRT) and double-arc volumetricmodulated arc therapy (VMAT) plans with simultaneous integrated boost in rectal cancer. Methods: Ten patients with rectal cancer previously treated with IMRT were included in this analysis. For each patient, two treatment techniques were designed for each patient: the fixed 7 fields IMRT and double-arc VMAT with RapidArc technique. The treatment plan was designed to deliver in one process with simultaneous integrated boost (SIB). The prescribed doses to the planning target volume of the subclinical disease (PTV1) and the gross disease (PTV2) were 45 Gy andmore » 55 Gy in 25 fractions, respectively. The dose distribution in the target, the dose to the organs at risk, total MU and the delivery time in two techniques were compared to explore the dosimetric differences. Results: For the target dose and homogeneity in PTV1 and PTV2, no statistically differences were observed in the two plans. VMAT plans showed a better conformity in PTV1. VMAT plans reduced the mean dose to bladder, small bowel, femur heads and iliac wings. For iliac wings, VMAT plans resulted in a statistically significant reduction in irradiated volume of 15 Gy, 20 Gy, 30 Gy but increased the 10 Gy irradiated volume. VMAT plans reduced the small bowel irradiated volume of 20 Gy and 30 Gy. Compared with IMRT plans, VMAT plans showed a significant reduction of monitor units by nearly 30% and reduced treatment time by an average of 70% Conclusion: Compared to IMRT plans, VMAT plans showed the similar target dose and reduced the dose of the organs at risk, especially for small bowel and iliac wings. For rectal cancer, VMAT with simultaneous integrated boost can be carried out with high quality and efficiency.« less

SU-E-T-268: Differences in Treatment Plan Quality and Delivery Between Two Commercial Treatment Planning Systems for Volumetric Arc-Based Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, S; Zhang, H; Zhang, B

2015-06-15

Purpose: To clinically evaluate the differences in volumetric modulated arc therapy (VMAT) treatment plan and delivery between two commercial treatment planning systems. Methods: Two commercial VMAT treatment planning systems with different VMAT optimization algorithms and delivery approaches were evaluated. This study included 16 clinical VMAT plans performed with the first system: 2 spine, 4 head and neck (HN), 2 brain, 4 pancreas, and 4 pelvis plans. These 16 plans were then re-optimized with the same number of arcs using the second treatment planning system. Planning goals were invariant between the two systems. Gantry speed, dose rate modulation, MLC modulation, planmore » quality, number of monitor units (MUs), VMAT quality assurance (QA) results, and treatment delivery time were compared between the 2 systems. VMAT QA results were performed using Mapcheck2 and analyzed with gamma analysis (3mm/3% and 2mm/2%). Results: Similar plan quality was achieved with each VMAT optimization algorithm, and the difference in delivery time was minimal. Algorithm 1 achieved planning goals by highly modulating the MLC (total distance traveled by leaves (TL) = 193 cm average over control points per plan), while maintaining a relatively constant dose rate (dose-rate change <100 MU/min). Algorithm 2 involved less MLC modulation (TL = 143 cm per plan), but greater dose-rate modulation (range = 0-600 MU/min). The average number of MUs was 20% less for algorithm 2 (ratio of MUs for algorithms 2 and 1 ranged from 0.5-1). VMAT QA results were similar for all disease sites except HN plans. For HN plans, the average gamma passing rates were 88.5% (2mm/2%) and 96.9% (3mm/3%) for algorithm 1 and 97.9% (2mm/2%) and 99.6% (3mm/3%) for algorithm 2. Conclusion: Both VMAT optimization algorithms achieved comparable plan quality; however, fewer MUs were needed and QA results were more robust for Algorithm 2, which more highly modulated dose rate.« less

SU-F-T-539: Dosimetric Comparison of Volumetric Modulated Arc Therapy and Intensity Modulated Radiation Therapy for Whole Brain Hippocampal Sparing Radiation Therapy Treatments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kendall, E; Higby, C; Algan, O

2016-06-15

Purpose: To compare the treatment plan quality and dose gradient near the hippocampus between VMAT (RapidArc) and IMRT delivery techniques for whole brain radiation therapy. Methods: Fifteen patients were evaluated in this retrospective study. All treatments were planned on Varian Eclipse TPS, using 3-Arc VMAT and 9-Field IMRT, following NRG Oncology protocol NRG-CC001 guidelines evaluated by a single radiation oncologist. Prescribed doses in all plans were 30 Gy delivered over 10 fractions normalized to a minimum of 100% of the dose covering 95% of the target volume. Identical contour sets and dose-volume constraints following protocol guidelines were also applied inmore » all plans. A paired t-test analysis was used to compare VMAT and IMRT plans. Results: NRG-CC001 protocol dose-volume constraints were met for all VMAT and IMRT plans. For the planning target volume (PTV), the average values for D2% and D98% were 6% lower and 4% higher in VMAT than in IMRT, respectively. The average mean and maximum hippocampus doses in Gy for VMAT vs IMRT plans were (11.85±0.81 vs. 12.24±0.56, p=0.10) and (16.27±0.78 vs. 16.59±0.71, p=0.24), respectively. In VMAT, the average mean and maximum chiasm doses were 3% and 1% higher than in IMRT plans, respectively. For the left optic nerve, the average mean and maximum doses were 10% and 5% higher in VMAT than in IMRT plans, respectively. These values were 12% and 3% for the right optic nerve. The average percentage of dose gradient around the hippocampus in the 0–5mm and 5–10mm abutted regions for VMAT vs. IMRT were (4.42%±2.22% /mm vs. 3.95%±2.61% /mm, p=0.43) and (4.54%±1.50% /mm vs. 4.39%±1.28% /mm, p=0.73), respectively. Conclusion: VMAT plans can achieve higher hippocampus sparing with a faster dose fall-off than IMRT plans. Though statistically insignificant, VMAT offers better PTV coverage with slightly higher doses to OARs.« less

TU-H-BRC-03: Evaluation of Very High-Energy Electron (VHEE) Beams in Comparison to VMAT and PBS Treatment Plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schueler, E; Loo, B; Maxim, P

2016-06-15

Purpose: The aim of this study was to evaluate the performance of very high-energy electron (VHEE) beams in comparison to clinically delivered treatment plans generated with volumetric modulated arc therapy (VMAT) and proton pencil beam scanning (PBS) technology. Methods: Three clinical cases were selected (prostate, lung, and pediatric CNS). The VHEE plans were calculated in the Monte Carlo EGSnrc code and pencil beam doses were calculated using the DOSxyznrc MC code for 100 and 200 MeV beams. Treatment plans with VHEE, VMAT, and PBS were optimized in a research version of RayStation using an in house build script in ordermore » to minimize operator bias between the different techniques. Results: For the prostate cancer case, the PBS plan showed lower mean organ at risk (OAR) doses compared to the other modalities. An exception was the femoral heads, due to the lateral beam arrangements. The VMAT plan showed lower mean doses to the rectum and the bladder compared to the 100 MeV VHEE plan. The lung cancer case showed minor differences between the three modalities. However, the PBS plan showed a lower contralateral lung dose. The pediatric CNS case showed a better conformity and lower spinal cord dose for the 100 MeV VHEE plan. For all cases, the 200 MeV VHEE plans were found to be similar to or better than the 100 MeV VHEE plans. Conclusion: The present study showed that VHEE plans are similar or superior to VMAT plans with reduced mean OAR dose and increased target conformity for a variety of clinical cases. With increased VHEE energy, better conformity and even higher reductions in mean OAR doses can be achieved. Funding: DoD, Award#:W81XWH-13-1-0165, Weston Havens Foundation, Bio-X (Stanford University), the Office of the Dean of the Medical School, the Office of the Provost (Stanford University), and the Swedish Childhood Cancer Foundation. BL and PM are founders of TibaRay,Inc. BL and PM have received research grants from Varian and RaySearch Laboratory.« less

Log file-based patient dose calculations of double-arc VMAT for head-and-neck radiotherapy.

PubMed

Katsuta, Yoshiyuki; Kadoya, Noriyuki; Fujita, Yukio; Shimizu, Eiji; Majima, Kazuhiro; Matsushita, Haruo; Takeda, Ken; Jingu, Keiichi

2018-04-01

The log file-based method cannot display dosimetric changes due to linac component miscalibration because of the insensitivity of log files to linac component miscalibration. The purpose of this study was to supply dosimetric changes in log file-based patient dose calculations for double-arc volumetric-modulated arc therapy (VMAT) in head-and-neck cases. Fifteen head-and-neck cases participated in this study. For each case, treatment planning system (TPS) doses were produced by double-arc and single-arc VMAT. Miscalibration-simulated log files were generated by inducing a leaf miscalibration of ±0.5 mm into the log files that were acquired during VMAT irradiation. Subsequently, patient doses were estimated using the miscalibration-simulated log files. For double-arc VMAT, regarding planning target volume (PTV), the change from TPS dose to miscalibration-simulated log file dose in D mean was 0.9 Gy and that for tumor control probability was 1.4%. As for organ-at-risks (OARs), the change in D mean was <0.7 Gy and normal tissue complication probability was <1.8%. A comparison between double-arc and single-arc VMAT for PTV showed statistically significant differences in the changes evaluated by D mean and radiobiological metrics (P < 0.01), even though the magnitude of these differences was small. Similarly, for OARs, the magnitude of these changes was found to be small. Using the log file-based method for PTV and OARs, the log file-based method estimate of patient dose using the double-arc VMAT has accuracy comparable to that obtained using the single-arc VMAT. Copyright © 2018 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

[Comparison of planning quality and delivery efficiency between volumetric modulated arc therapy and dynamic intensity modulated radiation therapy for nasopharyngeal carcinoma with more than 4 prescribed dose levels].

PubMed

Jia, Pengfei; Xu, Jun; Zhou, Xiaoxi; Chen, Jian; Tang, Lemin

2017-12-01

The aim of this study is to compare the planning quality and delivery efficiency between dynamic intensity modulated radiation therapy (d-IMRT) and dual arc volumetric modulated arc therapy (VMAT) systematically for nasopharyngeal carcinoma (NPC) patients with multi-prescribed dose levels, and to analyze the correlations between target volumes and plan qualities. A total of 20 patients of NPC with 4-5 prescribed dose levels to achieve simultaneous integrated boost (SIB) treated by sliding window d-IMRT in our department from 2014 to 2015 were re-planned with dual arc VMAT. All optimization objectives for each VMAT plan were as the same as the corresponding d-IMRT plan. The dose parameters for targets and organ at risk (OAR), the delivery time and monitor units (MU) in two sets of plans were compared respectively. The treatment accuracy was tested by three dimensional dose validation system. Finally, the correlations between the difference of planning quality and the volume of targets were discussed. The conform indexes (CIs) of planning target volumes (PTVs) in VMAT plans were obviously high than those in d-IMRT plans ( P < 0.05), but no significant correlations between the difference of CIs and the volume of targets were discovered ( P > 0.05). The target coverage and heterogeneity indexes (HIs) of PTV 1 and PGTV nd and PTV 3 in two sets of plans were consistent. The doses of PTV 2 decreased and HIs were worse in VMAT plans. VMAT could provide better spinal cord and brainstem sparing, but increase mean dose of parotids. The average number of MUs and delivery time for d-IMRT were 3.32 and 2.19 times of that for VMAT. The γ-index (3 mm, 3%) analysis for each plans was more than 97% in COMPASS ® measurement for quality assurance (QA). The results show that target dose coverages in d-IMRT and VMAT plans are similar for NPC with multi-prescribed dose levels. VMAT could improve the the CIs of targets, but reduce the dose to the target volume in neck except for PGTV nd . The biggest advantages of VMAT over d-IMRT are delivery efficiency and QA.

SU-F-T-388: Comparison of Biophysical Indices in Hippocampal-Avoidance Whole Brain VMAT and IMRT Radiation Therapy Treatment Plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kendall, E; Ahmad, S; Algan, O

2016-06-15

Purpose: To compare biophysical indices of Volumetric Modulated Arc Therapy (VMAT) and Intensity Modulated Radiation Therapy (IMRT) treatment plans for whole brain radiation therapy following the NRG-CC001 protocol. Methods: In this retrospective study, a total of fifteen patients were planned with Varian Eclipse Treatment Planning System using VMAT (RapidArc) and IMRT techniques. The planning target volume (PTV) was defined as the whole brain volume excluding a uniform three-dimensional 5mm expansion of the hippocampus volume. Prescribed doses in all plans were 30 Gy delivered over 10 fractions normalized to a minimum of 95% of the target volume receiving 100% of themore » prescribed dose. The NRG Oncology protocol guidelines were followed for contouring and dose-volume constraints. A single radiation oncologist evaluated all treatment plans. Calculations of statistical significance were performed using Student’s paired t-test. Results: All VMAT and IMRT plans met the NRG-CC001 protocol dose-volume criteria. The average equivalent uniform dose (EUD) for the PTV for VMAT vs. IMRT was respectively (19.05±0.33 Gy vs. 19.38±0.47 Gy) for α/β of 2 Gy and (19.47±0.30 Gy vs. 19.84±0.42 Gy) for α/β of 10 Gy. For the PTV, the average mean and maximum doses were 2% and 5% lower in VMAT plans than in IMRT plans, respectively. The average EUD and the normal tissue complication probability (NTCP) for the hippocampus in VMAT vs. IMRT plans were (15.28±1.35 Gy vs. 15.65±0.99 Gy, p=0.18) and (0.305±0.012 Gy vs. 0.308±0.008 Gy, p=0.192), respectively. The average EUD and NTCP for the optic chiasm were both 2% higher in VMAT than in IMRT plans. Conclusion: Though statistically insignificant, VMAT plans indicate a lower hippocampus EUD than IMRT plans. Also, a small variation in NTCP was found between plans.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Casey, K; Wong, P; Tung, S

Purpose: To quantify the dosimetric impact of interfractional shoulder motion on targets in the low neck for head and neck patients treated with volume modulated arc therapy (VMAT). Methods: Three patients with head and neck cancer were selected. All three required treatment to nodal regions in the low neck in addition to the primary tumor. The patients were immobilized during simulation and treatment with a custom thermoplastic mask covering the head and shoulders. One VMAT plan was created for each patient utilizing two full 360° arcs. A second plan was created consisting of two superior VMAT arcs matched to anmore » inferior static AP supraclavicular field. A CT-on-rails alignment verification was performed weekly during each patient's treatment course. The weekly CT images were registered to the simulation CT and the target contours were deformed and applied to the weekly CT. The two VMAT plans were copied to the weekly CT datasets and recalculated to obtain the dose to the low neck contours. Results: The average observed shoulder position shift in any single dimension relative to simulation was 2.5 mm. The maximum shoulder shift observed in a single dimension was 25.7 mm. Low neck target mean doses, normalized to simulation and averaged across all weekly recalculations were 0.996, 0.991, and 1.033 (Full VMAT plan) and 0.986, 0.995, and 0.990 (Half-Beam VMAT plan) for the three patients, respectively. The maximum observed deviation in target mean dose for any individual weekly recalculation was 6.5%, occurring with the Full VMAT plan for Patient 3. Conclusion: Interfractional variation in dose to low neck nodal regions was quantified for three head and neck patients treated with VMAT. Mean dose was 3.3% higher than planned for one patient using a Full VMAT plan. A Half-Beam technique is likely a safer choice when treating the supraclavicular region with VMAT.« less

Assessment of multi-criteria optimization (MCO) for volumetric modulated arc therapy (VMAT) in hippocampal avoidance whole brain radiation therapy (HA-WBRT).

PubMed

Zieminski, Stephen; Khandekar, Melin; Wang, Yi

2018-03-01

This study compared the dosimetric performance of (a) volumetric modulated arc therapy (VMAT) with standard optimization (STD) and (b) multi-criteria optimization (MCO) to (c) intensity modulated radiation therapy (IMRT) with MCO for hippocampal avoidance whole brain radiation therapy (HA-WBRT) in RayStation treatment planning system (TPS). Ten HA-WBRT patients previously treated with MCO-IMRT or MCO-VMAT on an Elekta Infinity accelerator with Agility multileaf collimators (5-mm leaves) were re-planned for the other two modalities. All patients received 30 Gy in 15 fractions to the planning target volume (PTV), namely, PTV30 expanded with a 2-mm margin from the whole brain excluding hippocampus with margin. The patients all had metastatic lesions (up to 12) of variable sizes and proximity to the hippocampus, treated with an additional 7.5 Gy from a simultaneous integrated boost (SIB) to PTV37.5. The IMRT plans used eight to eleven non-coplanar fields, whereas the VMAT plans used two coplanar full arcs and a vertex half arc. The averaged target coverage, dose to organs-at-risk (OARs) and monitor unit provided by the three modalities were compared, and a Wilcoxon signed-rank test was performed. MCO-VMAT provided statistically significant reduction of D100 of hippocampus compared to STD-VMAT, and Dmax of cochleas compared to MCO-IMRT. With statistical significance, MCO-VMAT improved V30 of PTV30 by 14.2% and 4.8%, respectively, compared to MCO-IMRT and STD-VMAT. It also raised D95 of PTV37.5 by 0.4 Gy compared to both MCO-IMRT and STD-VMAT. Improved plan quality parameters such as a decrease in overall plan Dmax and total monitor units (MU) were also observed for MCO-VMAT. MCO-VMAT is found to be the optimal modality for HA-WBRT in terms of PTV coverage, OAR sparing and delivery efficiency, compared to MCO-IMRT or STD-VMAT. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Single-arc volumetric-modulated arc therapy (sVMAT) as adjuvant treatment for gastric cancer: Dosimetric comparisons with three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Xin; Li, Guangjun; Zhang, Yingjie

2013-01-01

To compare the dosimetric differences between the single-arc volumetric-modulated arc therapy (sVMAT), 3-dimensional conformal radiotherapy (3D-CRT), and intensity-modulated radiotherapy (IMRT) techniques in treatment planning for gastric cancer as adjuvant radiotherapy. Twelve patients were retrospectively analyzed. In each patient's case, the parameters were compared based on the dose-volume histogram (DVH) of the sVMAT, 3D-CRT, and IMRT plans, respectively. Three techniques showed similar target dose coverage. The maximum and mean doses of the target were significantly higher in the sVMAT plans than that in 3D-CRT plans and in the 3D-CRT/IMRT plans, respectively, but these differences were clinically acceptable. The IMRT and sVMATmore » plans successfully achieved better target dose conformity, reduced the V{sub 20/30}, and mean dose of the left kidney, as well as the V{sub 20/30} of the liver, compared with the 3D-CRT plans. And the sVMAT technique reduced the V{sub 20} of the liver much significantly. Although the maximum dose of the spinal cord were much higher in the IMRT and sVMAT plans, respectively (mean 36.4 vs 39.5 and 40.6 Gy), these data were still under the constraints. Not much difference was found in the analysis of the parameters of the right kidney, intestine, and heart. The IMRT and sVMAT plans achieved similar dose distribution to the target, but superior to the 3D-CRT plans, in adjuvant radiotherapy for gastric cancer. The sVMAT technique improved the dose sparings of the left kidney and liver, compared with the 3D-CRT technique, but showed few dosimetric advantages over the IMRT technique. Studies are warranted to evaluate the clinical benefits of the VMAT treatment for patients with gastric cancer after surgery in the future.« less

Dosimetric comparison between step-shoot intensity-modulated radiotherapy and volumetric-modulated arc therapy for upper thoracic and cervical esophageal carcinoma.

PubMed

Gao, Min; Li, Qilin; Ning, Zhonghua; Gu, Wendong; Huang, Jin; Mu, Jinming; Pei, Honglei

2016-01-01

To compare and analyze the dosimetric characteristics of volumetric modulated arc therapy (VMAT) vs step-shoot intensity-modulated radiation therapy (sIMRT) for upper thoracic and cervical esophageal carcinoma. Single-arc VMAT (VMAT1), dual-arc VMAT (VMAT2), and 7-field sIMRT plans were designed for 30 patients with upper thoracic or cervical esophageal carcinoma. Planning target volume (PTV) was prescribed to 50.4Gy in 28 fractions, and PTV1 was prescribed to 60Gy in 28 fractions. The parameters evaluated included dose homogeneity and conformality, dose to organs at risk (OARs), and delivery efficiency. (1) In comparison to sIMRT, VMAT provided a systematic improvement in PTV1 coverage. The homogeneity index of VMAT1 was better than that of VMAT2. There were no significant differences among sIMRT, VMAT1, and VMAT2 in PTV coverage. (2) VMAT1 and VMAT2 reduced the maximum dose of spinal cord as compared with sIMRT (p < 0.05). The rest dose-volume characteristics of OARs were similar. (3) Monitor units of VMAT2 and VMAT1 were more than sIMRT. However, the treatment time of VMAT1, VMAT2, and sIMRT was (2.0 ± 0.2), (2.8 ± 0.3), and (9.8 ± 0.8) minutes, respectively. VMAT1 was the fastest, and the difference was statistically significant. In the treatment of upper thoracic and cervical esophageal carcinoma by the AXESSE linac, compared with 7-field sIMRT, VMAT showed better PTV1 coverage and superior spinal cord sparing. Single-arc VMAT had similar target volume coverage and the sparing of OAR to dual-arc VMAT, with shortest treatment time and highest treatment efficiency in the 3 kinds of plans. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Dosimetric comparison between step-shoot intensity-modulated radiotherapy and volumetric-modulated arc therapy for upper thoracic and cervical esophageal carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gao, Min; Li, Qilin; Ning, Zhonghua

2016-07-01

To compare and analyze the dosimetric characteristics of volumetric modulated arc therapy (VMAT) vs step-shoot intensity-modulated radiation therapy (sIMRT) for upper thoracic and cervical esophageal carcinoma. Single-arc VMAT (VMAT1), dual-arc VMAT (VMAT2), and 7-field sIMRT plans were designed for 30 patients with upper thoracic or cervical esophageal carcinoma. Planning target volume (PTV) was prescribed to 50.4 Gy in 28 fractions, and PTV1 was prescribed to 60 Gy in 28 fractions. The parameters evaluated included dose homogeneity and conformality, dose to organs at risk (OARs), and delivery efficiency. (1) In comparison to sIMRT, VMAT provided a systematic improvement in PTV1 coverage.more » The homogeneity index of VMAT1 was better than that of VMAT2. There were no significant differences among sIMRT, VMAT1, and VMAT2 in PTV coverage. (2) VMAT1 and VMAT2 reduced the maximum dose of spinal cord as compared with sIMRT (p < 0.05). The rest dose-volume characteristics of OARs were similar. (3) Monitor units of VMAT2 and VMAT1 were more than sIMRT. However, the treatment time of VMAT1, VMAT2, and sIMRT was (2.0 ± 0.2), (2.8 ± 0.3), and (9.8 ± 0.8) minutes, respectively. VMAT1 was the fastest, and the difference was statistically significant. In the treatment of upper thoracic and cervical esophageal carcinoma by the AXESSE linac, compared with 7-field sIMRT, VMAT showed better PTV1 coverage and superior spinal cord sparing. Single-arc VMAT had similar target volume coverage and the sparing of OAR to dual-arc VMAT, with shortest treatment time and highest treatment efficiency in the 3 kinds of plans.« less

Evaluation of dosimetric effect caused by slowing with multi-leaf collimator (MLC) leaves for volumetric modulated arc therapy (VMAT)

PubMed Central

Wang, Iris Z.; Kumaraswamy, Lalith K.; Podgorsak, Matthew B.

2016-01-01

Background This study is to report 1) the sensitivity of intensity modulated radiation therapy (IMRT) QA method for clinical volumetric modulated arc therapy (VMAT) plans with multi-leaf collimator (MLC) leaf errors that will not trigger MLC interlock during beam delivery; 2) the effect of non-beam-hold MLC leaf errors on the quality of VMAT plan dose delivery. Materials and methods. Eleven VMAT plans were selected and modified using an in-house developed software. For each control point of a VMAT arc, MLC leaves with the highest speed (1.87-1.95 cm/s) were set to move at the maximal allowable speed (2.3 cm/s), which resulted in a leaf position difference of less than 2 mm. The modified plans were considered as ‘standard’ plans, and the original plans were treated as the ‘slowing MLC’ plans for simulating ‘standard’ plans with leaves moving at relatively lower speed. The measurement of each ‘slowing MLC’ plan using MapCHECK®2 was compared with calculated planar dose of the ‘standard’ plan with respect to absolute dose Van Dyk distance-to-agreement (DTA) comparisons using 3%/3 mm and 2%/2 mm criteria. Results All ‘slowing MLC’ plans passed the 90% pass rate threshold using 3%/3 mm criteria while one brain and three anal VMAT cases were below 90% with 2%/2 mm criteria. For ten out of eleven cases, DVH comparisons between ‘standard’ and ‘slowing MLC’ plans demonstrated minimal dosimetric changes in targets and organs-at-risk. Conclusions For highly modulated VMAT plans, pass rate threshold (90%) using 3%/3mm criteria is not sensitive in detecting MLC leaf errors that will not trigger the MLC leaf interlock. However, the consequential effects of non-beam hold MLC errors on target and OAR doses are negligible, which supports the reliability of current patient-specific IMRT quality assurance (QA) method for VMAT plans. PMID:27069458

Validation of measurement‐guided 3D VMAT dose reconstruction on a heterogeneous anthropomorphic phantom

PubMed Central

Opp, Daniel; Nelms, Benjamin E.; Zhang, Geoffrey; Stevens, Craig

2013-01-01

3DVH software (Sun Nuclear Corp., Melbourne, FL) is capable of generating a volumetric patient VMAT dose by applying a volumetric perturbation algorithm based on comparing measurement‐guided dose reconstruction and TPS‐calculated dose to a cylindrical phantom. The primary purpose of this paper is to validate this dose reconstruction on an anthropomorphic heterogeneous thoracic phantom by direct comparison to independent measurements. The dosimetric insert to the phantom is novel, and thus the secondary goal is to demonstrate how it can be used for the hidden target end‐to‐end testing of VMAT treatments in lung. A dosimetric insert contains a 4 cm diameter unit‐density spherical target located inside the right lung (0.21g/cm3 density). It has 26 slots arranged in two orthogonal directions, milled to hold optically stimulated luminescent dosimeters (OSLDs). Dose profiles in three cardinal orthogonal directions were obtained for five VMAT plans with varying degrees of modulation. After appropriate OSLD corrections were applied, 3DVH measurement‐guided VMAT dose reconstruction agreed 100% with the measurements in the unit density target sphere at 3%/3 mm level (composite analysis) for all profile points for the four less‐modulated VMAT plans, and for 96% of the points in the highly modulated C‐shape plan (from TG‐119). For this latter plan, while 3DVH shows acceptable agreement with independent measurements in the unit density target, in the lung disagreement with experiment is relatively high for both the TPS calculation and 3DVH reconstruction. For the four plans excluding the C‐shape, 3%/3mm overall composite analysis passing rates for 3DVH against independent measurement ranged from 93% to 100%. The C‐shape plan was deliberately chosen as a stress test of the algorithm. The dosimetric spatial alignment hidden target test demonstrated the average distance to agreement between the measured and TPS profiles in the steep dose gradient area at the edge of the 2 cm target to be 1.0±0.7,0.3±0.3, and 0.3±0.3mm for the IEC X, Y, and Z directions, respectively. PACS number: 87.55Qr PMID:23835381

FusionArc optimization: a hybrid volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) planning strategy.

PubMed

Matuszak, Martha M; Steers, Jennifer M; Long, Troy; McShan, Daniel L; Fraass, Benedick A; Romeijn, H Edwin; Ten Haken, Randall K

2013-07-01

To introduce a hybrid volumetric modulated arc therapy/intensity modulated radiation therapy (VMAT/IMRT) optimization strategy called FusionArc that combines the delivery efficiency of single-arc VMAT with the potentially desirable intensity modulation possible with IMRT. A beamlet-based inverse planning system was enhanced to combine the advantages of VMAT and IMRT into one comprehensive technique. In the hybrid strategy, baseline single-arc VMAT plans are optimized and then the current cost function gradients with respect to the beamlets are used to define a metric for predicting which beam angles would benefit from further intensity modulation. Beams with the highest metric values (called the gradient factor) are converted from VMAT apertures to IMRT fluence, and the optimization proceeds with the mixed variable set until convergence or until additional beams are selected for conversion. One phantom and two clinical cases were used to validate the gradient factor and characterize the FusionArc strategy. Comparisons were made between standard IMRT, single-arc VMAT, and FusionArc plans with one to five IMRT∕hybrid beams. The gradient factor was found to be highly predictive of the VMAT angles that would benefit plan quality the most from beam modulation. Over the three cases studied, a FusionArc plan with three converted beams achieved superior dosimetric quality with reductions in final cost ranging from 26.4% to 48.1% compared to single-arc VMAT. Additionally, the three beam FusionArc plans required 22.4%-43.7% fewer MU∕Gy than a seven beam IMRT plan. While the FusionArc plans with five converted beams offer larger reductions in final cost--32.9%-55.2% compared to single-arc VMAT--the decrease in MU∕Gy compared to IMRT was noticeably smaller at 12.2%-18.5%, when compared to IMRT. A hybrid VMAT∕IMRT strategy was implemented to find a high quality compromise between gantry-angle and intensity-based degrees of freedom. This optimization method will allow patients to be simultaneously planned for dosimetric quality and delivery efficiency without switching between delivery techniques. Example phantom and clinical cases suggest that the conversion of only three VMAT segments to modulated beams may result in a good combination of quality and efficiency.

MO-H-19A-01: FEATURED PRESENTATION - Treatment Planning Tool for Radiotherapy with Very High-Energy Electron Beams

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bazalova, M; Qu, B; Palma, B

2014-06-15

Purpose: To develop a tool for treatment planning optimization for fast radiotherapy delivered with very high-energy electron beams (VHEE) and to compare VHEE plans to state-of-the-art plans for challenging pelvis and H'N cases. Methods: Treatment planning for radiotherapy delivered with VHEE scanning pencil beams was performed by integrating EGSnrc Monte Carlo (MC) dose calculations with spot scanning optimization run in a research version of RayStation. A Matlab GUI for MC beamlet generation was developed, in which treatment parameters such as the pencil beam size and spacing, energy and number of beams can be selected. Treatment planning study for H'N andmore » pelvis cases was performed and the effect of treatment parameters on the delivered dose distributions was evaluated and compared to the clinical treatment plans. The pelvis case with a 691cm3 PTV was treated with 2-arc 15MV VMAT and the H'N case with four PTVs with total volume of 531cm3 was treated with 4-arc 6MV VMAT. Results: Most studied VHEE plans outperformed VMAT plans. The best pelvis 80MeV VHEE plan with 25 beams resulted in 12% body dose sparing and 8% sparing to the bowel and right femur compared to the VMAT plan. The 100MeV plan was superior to the 150MeV plan. Mixing 100 and 150MeV improved dose sparing to the bladder by 7% compared to either plan. Plans with 16 and 36 beams did not significantly affect the dose distributions compared to 25 beam plans. The best H'N 100MeV VHEE plan decreased mean doses to the brainstem, chiasm, and both globes by 10-42% compared to the VMAT plan. Conclusion: The pelvis and H'N cases suggested that sixteen 100MeV beams might be sufficient specifications of a novel VHEE treatment machine. However, optimum machine parameters will be determined with the presented VHEE treatment-planning tool for a large number of clinical cases. BW Loo and P Maxim received research support from RaySearch Laboratories. E Hynning and B Hardemark are employees of RaySearch Laboratories.« less

Volumetric-modulated arc therapy (VMAT) for whole brain radiotherapy: not only for hippocampal sparing, but also for reduction of dose to organs at risk.

PubMed

Sood, Sumit; Pokhrel, Damodar; McClinton, Christopher; Lominska, Christopher; Badkul, Rajeev; Jiang, Hongyu; Wang, Fen

2017-01-01

A prospective clinical trial, Radiation Therapy Oncology Group (RTOG) 0933, has demonstrated that whole brain radiotherapy (WBRT) using conformal radiation delivery technique with hippocampal avoidance is associated with less memory complications. Further sparing of other organs at risk (OARs) including the scalp, ear canals, cochleae, and parotid glands could be associated with reductions in additional toxicities for patients treated with WBRT. We investigated the feasibility of WBRT using volumetric-modulated arc therapy (VMAT) to spare the hippocampi and the aforementioned OARs. Ten patients previously treated with nonconformal WBRT (NC-WBRT) using opposed lateral beams were retrospectively re-planned using VMAT with hippocampal sparing according to the RTOG 0933 protocol. The OARs (scalp, auditory canals, cochleae, and parotid glands) were considered as dose-constrained structures. VMAT plans were generated for a prescription dose of 30 Gy in 10 fractions. Comparison of the dosimetric parameters achieved by VMAT and NC-WBRT plans was performed using paired t-tests using upper bound p-value of < 0.001. Average beam on time and monitor units (MUs) delivered to the patients on VMAT were compared with those obtained with NC-WBRT. All VMAT plans met RTOG 0933 dosimetric criteria including the dose to hippocampi of 100% of the volume (D 100% ) of 8.4 ± 0.3 Gy and maximum dose of 15.6 ± 0.4 Gy, respectively. A statistically significant dose reduction (p < 0.001) to all OARs was achieved. The mean and maximum scalp doses were reduced by an average of 9 Gy (32%) and 2 Gy (6%), respectively. The mean and maximum doses to the auditory canals were reduced from 29.5 ± 0.5 Gy and 31.0 ± 0.4 Gy with NC-WBRT, to 21.8 ± 1.6 Gy (26%) and 27.4 ± 1.4 Gy (12%) with VMAT. VMAT also reduced mean and maximum doses to the cochlea by an average of 4 Gy (13%) and 2 Gy (6%), respectively. The parotid glands mean and maximum doses with VMAT were 4.4 ± 1.9 Gy and 15.7 ± 5.0 Gy, compared to 12.8 ± 4.9 Gy and 30.6 ± 0.5 Gy with NC-WBRT, respectively. The average dose reduction of mean and maximum of parotid glands from VMAT were 65% and 50%, respectively. The average beam on time and MUs were 2.3minutes and 719 on VMAT, and 0.7 minutes and 350 on NC-WBRT. This study demonstrated the feasibility of WBRT using VMAT to not only spare the hippocampi, but also significantly reduce dose to OARs. These advantages of VMAT could potentially decrease the toxicities associated with NC-WBRT and improve patients' quality of life, especially for patients with favorable prognosis receiving WBRT or patients receiving prophylactic cranial irradiation (PCI). Published by Elsevier Inc.

SU-E-T-325: The New Evaluation Method of the VMAT Plan Delivery Using Varian DynaLog Files and Modulation Complexity Score (MCS)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tateoka, K; Graduate School of Medicine, Sapporo Medical University, Sapporo, JP; Fujimomo, K

2014-06-01

Purpose: The aim of the study is to evaluate the use of Varian DynaLog files to verify VMAT plans delivery and modulation complexity score (MCS) of VMAT. Methods: Delivery accuracy of machine performance was quantified by multileaf collimator (MLC) position errors, gantry angle errors and fluence delivery accuracy for volumetric modulated arc therapy (VMAT). The relationship between machine performance and plan complexity were also investigated using the modulation complexity score (MCS). Plan and Actual MLC positions, gantry angles and delivered fraction of monitor units were extracted from Varian DynaLog files. These factors were taken from the record and verify systemmore » of MLC control file. Planned and delivered beam data were compared to determine leaf position errors and gantry angle errors. Analysis was also performed on planned and actual fluence maps reconstructed from those of the DynaLog files. This analysis was performed for all treatment fractions of 5 prostate VMAT plans. The analysis of DynaLog files have been carried out by in-house programming in Visual C++. Results: The root mean square of leaf position and gantry angle errors were about 0.12 and 0.15, respectively. The Gamma of planned and actual fluence maps at 3%/3 mm criterion was about 99.21. The gamma of the leaf position errors were not directly related to plan complexity as determined by the MCS. Therefore, the gamma of the gantry angle errors were directly related to plan complexity as determined by the MCS. Conclusion: This study shows Varian dynalog files for VMAT plan can be diagnosed delivery errors not possible with phantom based quality assurance. Furthermore, the MCS of VMAT plan can evaluate delivery accuracy for patients receiving of VMAT. Machine performance was found to be directly related to plan complexity but this is not the dominant determinant of delivery accuracy.« less

TU-AB-BRC-12: Optimized Parallel MonteCarlo Dose Calculations for Secondary MU Checks

DOE Office of Scientific and Technical Information (OSTI.GOV)

French, S; Nazareth, D; Bellor, M

Purpose: Secondary MU checks are an important tool used during a physics review of a treatment plan. Commercial software packages offer varying degrees of theoretical dose calculation accuracy, depending on the modality involved. Dose calculations of VMAT plans are especially prone to error due to the large approximations involved. Monte Carlo (MC) methods are not commonly used due to their long run times. We investigated two methods to increase the computational efficiency of MC dose simulations with the BEAMnrc code. Distributed computing resources, along with optimized code compilation, will allow for accurate and efficient VMAT dose calculations. Methods: The BEAMnrcmore » package was installed on a high performance computing cluster accessible to our clinic. MATLAB and PYTHON scripts were developed to convert a clinical VMAT DICOM plan into BEAMnrc input files. The BEAMnrc installation was optimized by running the VMAT simulations through profiling tools which indicated the behavior of the constituent routines in the code, e.g. the bremsstrahlung splitting routine, and the specified random number generator. This information aided in determining the most efficient compiling parallel configuration for the specific CPU’s available on our cluster, resulting in the fastest VMAT simulation times. Our method was evaluated with calculations involving 10{sup 8} – 10{sup 9} particle histories which are sufficient to verify patient dose using VMAT. Results: Parallelization allowed the calculation of patient dose on the order of 10 – 15 hours with 100 parallel jobs. Due to the compiler optimization process, further speed increases of 23% were achieved when compared with the open-source compiler BEAMnrc packages. Conclusion: Analysis of the BEAMnrc code allowed us to optimize the compiler configuration for VMAT dose calculations. In future work, the optimized MC code, in conjunction with the parallel processing capabilities of BEAMnrc, will be applied to provide accurate and efficient secondary MU checks.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu, J-Y; Huang, B-T; Zhang, W-Z

Purpose: To compare volumetric modulated arc radiotherapy (VMAT) technique with fixed-gantry intensity-modulated radiotherapy (IMRT) technique for locally advanced laryngeal carcinoma. Methods: CT datasets of eleven patients were included. Dual-arc VMAT and 7-field IMRT plans, which were created based on the Eclipse treatment planning system, were compared in terms of dose-volume parameters, conformity index (CI) and homogeneity index (HI) of planning target volume (PTV), as well as organ-at-risk (OAR) sparing, planning time, monitor units (MUs) and delivery time. Results: Compared with the IMRT plans, the VMAT plans provided lower D2% and better CI/HI for the high-risk PTV (PTV1), and provided bettermore » CI and comparable HI for the low-risk PTV (PTV2). Concerning the OAR sparing, the VMAT plans demonstrated significantly lower Dmax of the spinal cord (planning OAR volume, PRV) and brainstem (PRV), as well as lower Dmean and V30Gy of the right parotid. No significant differences were observed between the two plans concerning the doses delivered to the thyroid, carotid, oral cavity and left parotid. Moreover, the VMAT planning (147 ± 18 min) consumed 213% more time than the IMRT planning (48 ± 10 min). The MUs of the VMAT plans (556 ± 52) were 64% less than those of the IMRT plans (1684 ± 409), and the average delivery time (2.1 ± 0.1 min) was 66% less than that of the IMRT plans (6.3 ± 0.7 min). Conclusion: Compared with the IMRT technique, the VMAT technique can achieve superior target dose distribution and better sparing of the spinal cord, brainstem and right parotid, with less MUs and less delivery time. It is recommended for the radiotherapy of locally advanced laryngeal carcinoma.« less

Comparing conformal, arc radiotherapy and helical tomotherapy in craniospinal irradiation planning.

PubMed

Myers, Pamela A; Mavroidis, Panayiotis; Papanikolaou, Nikos; Stathakis, Sotirios

2014-09-08

Currently, radiotherapy treatment plan acceptance is based primarily on dosimetric performance measures. However, use of radiobiological analysis to assess benefit in terms of tumor control and harm in terms of injury to normal tissues can be advantageous. For pediatric craniospinal axis irradiation (CSI) patients, in particular, knowing the technique that will optimize the probabilities of benefit versus injury can lead to better long-term outcomes. Twenty-four CSI pediatric patients (median age 10) were retrospectively planned with three techniques: three-dimensional conformal radiation therapy (3D CRT), volumetric-modulated arc therapy (VMAT), and helical tomotherapy (HT). VMAT plans consisted of one superior and one inferior full arc, and tomotherapy plans were created using a 5.02cm field width and helical pitch of 0.287. Each plan was normalized to 95% of target volume (whole brain and spinal cord) receiving prescription dose 23.4Gy in 13 fractions. Using an in-house MATLAB code and DVH data from each plan, the three techniques were evaluated based on biologically effective uniform dose (D=), the complication-free tumor control probability (P+), and the width of the therapeutically beneficial range. Overall, 3D CRT and VMAT plans had similar values of D= (24.1 and 24.2 Gy), while HT had a D= slightly lower (23.6 Gy). The average values of the P+ index were 64.6, 67.4, and 56.6% for 3D CRT, VMAT, and HT plans, respectively, with the VMAT plans having a statistically significant increase in P+. Optimal values of D= were 28.4, 33.0, and 31.9 Gy for 3D CRT, VMAT, and HT plans, respectively. Although P+ values that correspond to the initial dose prescription were lower for HT, after optimizing the D= prescription level, the optimal P+ became 94.1, 99.5, and 99.6% for 3D CRT, VMAT, and HT, respectively, with the VMAT and HT plans having statistically significant increases in P+. If the optimal dose level is prescribed using a radiobiological evaluation method, as opposed to a purely dosimetric one, the two IMRT techniques, VMAT and HT, will yield largest overall benefit to CSI patients by maximizing tumor control and limiting normal tissue injury. Using VMAT or HT may provide these pediatric patients with better long-term outcomes after radiotherapy.

SU-F-T-465: Two Years of Radiotherapy Treatments Analyzed Through MLC Log Files

DOE Office of Scientific and Technical Information (OSTI.GOV)

Defoor, D; Kabat, C; Papanikolaou, N

Purpose: To present treatment statistics of a Varian Novalis Tx using more than 90,000 Varian Dynalog files collected over the past 2 years. Methods: Varian Dynalog files are recorded for every patient treated on our Varian Novalis Tx. The files are collected and analyzed daily to check interfraction agreement of treatment deliveries. This is accomplished by creating fluence maps from the data contained in the Dynalog files. From the Dynalog files we have also compiled statistics for treatment delivery times, MLC errors, gantry errors and collimator errors. Results: The mean treatment time for VMAT patients was 153 ± 86 secondsmore » while the mean treatment time for step & shoot was 256 ± 149 seconds. Patient’s treatment times showed a variation of 0.4% over there treatment course for VMAT and 0.5% for step & shoot. The average field sizes were 40 cm2 and 26 cm2 for VMAT and step & shoot respectively. VMAT beams contained and average overall leaf travel of 34.17 meters and step & shoot beams averaged less than half of that at 15.93 meters. When comparing planned and delivered fluence maps generated using the Dynalog files VMAT plans showed an average gamma passing percentage of 99.85 ± 0.47. Step & shoot plans showed an average gamma passing percentage of 97.04 ± 0.04. 5.3% of beams contained an MLC error greater than 1 mm and 2.4% had an error greater than 2mm. The mean gantry speed for VMAT plans was 1.01 degrees/s with a maximum of 6.5 degrees/s. Conclusion: Varian Dynalog files are useful for monitoring machine performance treatment parameters. The Dynalog files have shown that the performance of the Novalis Tx is consistent over the course of a patients treatment with only slight variations in patient treatment times and a low rate of MLC errors.« less

Evaluation of the trade-offs encountered in planning and treating locally advanced head and neck cancer: intensity-modulated radiation therapy vs dual-arc volumetric-modulated arc therapy

PubMed Central

Oliver, M; McConnell, D; Romani, M; McAllister, A; Pearce, A; Andronowski, A; Wang, X; Leszczynski, K

2012-01-01

Objective The primary purpose of this study was to assess the practical trade-offs between intensity-modulated radiation therapy (IMRT) and dual-arc volumetric-modulated arc therapy (DA-VMAT) for locally advanced head and neck cancer (HNC). Methods For 15 locally advanced HNC data sets, nine-field step-and-shoot IMRT plans and two full-rotation DA-VMAT treatment plans were created in the Pinnacle3 v. 9.0 (Philips Medical Systems, Fitchburg, WI) treatment planning environment and then delivered on a Clinac iX (Varian Medical Systems, Palo Alto, CA) to a cylindrical detector array. The treatment planning goals were organised into four groups based on their importance: (1) spinal cord, brainstem, optical structures; (2) planning target volumes; (3) parotids, mandible, larynx and brachial plexus; and (4) normal tissues. Results Compared with IMRT, DA-VMAT plans were of equal plan quality (p>0.05 for each group), able to be delivered in a shorter time (3.1 min vs 8.3 min, p<0.0001), delivered fewer monitor units (on average 28% fewer, p<0.0001) and produced similar delivery accuracy (p>0.05 at γ2%/2mm and γ3%/3mm). However, the VMAT plans took more planning time (28.9 min vs 7.7 min per cycle, p<0.0001) and required more data for a three-dimensional dose (20 times more, p<0.0001). Conclusions Nine-field step-and-shoot IMRT and DA-VMAT are both capable of meeting the majority of planning goals for locally advanced HNC. The main trade-offs between the techniques are shorter treatment time for DA-VMAT but longer planning time and the additional resources required for implementation of a new technology. Based on this study, our clinic has incorporated DA-VMAT for locally advanced HNC. Advances in knowledge DA-VMAT is a suitable alternative to IMRT for locally advanced HNC. PMID:22806619

Comparison of 3DCRT,VMAT and IMRT techniques in metastatic vertebra radiotherapy: A phantom Study

NASA Astrophysics Data System (ADS)

Gedik, Sonay; Tunc, Sema; Kahraman, Arda; Kahraman Cetintas, Sibel; Kurt, Meral

2017-09-01

Vertebra metastases can be seen during the prognosis of cancer patients. Treatment ways of the metastasis are radiotherapy, chemotherapy and surgery. Three-dimensional conformal therapy (3D-CRT) is widely used in the treatment of vertebra metastases. Also, Intensity Modulated Radiotherapy (IMRT) and Volumetric Arc Therapy (VMAT) are used too. The aim of this study is to examine the advantages and disadvantages of the different radiotherapy techniques. In the aspect of this goal, it is studied with a randophantom in Uludag University Medicine Faculty, Radiation Oncology Department. By using a computerized tomography image of the phantom, one 3DCRT plan, two VMAT and three IMRT plans for servical vertebra and three different 3DCRT plans, two VMAT and two IMRT plans for lomber vertebra are calculated. To calculate 3DCRT plans, CMS XiO Treatment System is used and to calculate VMAT and IMRT plans Monaco Treatment Planning System is used in the department. The study concludes with the dosimetric comparison of the treatment plans in the spect of critical organ doses, homogeneity and conformity index. As a result of this study, all critical organ doses are suitable for QUANTEC Dose Limit Report and critical organ doses depend on the techniques which used in radiotherapy. According to homogeneity and conformity indices, VMAT and IMRT plans are better than one in 3DCRT plans in servical and lomber vertebra radiotherapy plans.

Evaluation of volumetric modulated arc therapy for cranial radiosurgery using multiple noncoplanar arcs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Audet, Chantal; Poffenbarger, Brett A.; Chang, Pauling

2011-11-15

Purpose: To evaluate a commercial volumetric modulated arc therapy (VMAT), using multiple noncoplanar arcs, for linac-based cranial radiosurgery, as well as evaluate the combined accuracy of the VMAT dose calculations and delivery. Methods: Twelve patients with cranial lesions of variable size (0.1-29 cc) and two multiple metastases patients were planned (Eclipse RapidArc AAA algorithm, v8.6.15) using VMAT (1-6 noncoplanar arcs), dynamic conformal arc (DCA, {approx}4 arcs), and IMRT (nine static fields). All plans were evaluated according to a conformity index (CI), healthy brain tissue doses and volumes, and the dose to organs at risk. A 2D dose distribution was measuredmore » (Varian Novalis Tx, HD120 MLC, 1000 MU/min, 6 MV beam) for the {approx}4 arc VMAT treatment plans using calibrated film dosimetry. Results: The CI (0-1 best) average for all plans was best for {approx}4 noncoplanar arc VMAT at 0.86 compared with {approx}0.78 for IMRT and a single arc VMAT and 0.68 for DCA. The volumes of healthy brain receiving 50% of the prescribed target coverage dose or more (V{sub 50%}) were lowest for the four arc VMAT [RA(4)] and DCA plans. The average ratio of the V{sub 50%} for the other plans to the RA(4) V{sub 50%} were 1.9 for a single noncoplanar arc VMAT [RA(1nc)], 1.4 for single full coplanar arc VMAT [RA(1f)] and 1.3 for IMRT. The V{sub 50%} improved significantly for single isocenter multiple metastases plan when two noncoplanar VMAT arcs were added to a full single coplanar one. The maximum dose to 5 cc of the outer 1 cm rim of healthy brain which one may want to keep below nonconsequential doses of 300-400 cGy, was 2-3 times greater for IMRT, RA(1nc) and RA(1f) plans compared with the multiple noncoplanar arc DCA and RA(4) techniques. Organs at risk near (0-4 mm) to targets were best spared by (i) single noncoplanar arcs when the targets are lateral to the organ at risk and (ii) by skewed nonvertical planes of IMRT fields when the targets are not lateral to the organ at risk. The highest dose gradient observed between an organ at risk and a target at the edge of a VMAT arc plane or plane of IMRT fields was 17%/mm. The average absolute percent difference between the measured and calculated central axis dose for all the VMAT plans was 3.6 {+-} 2.2%. The measured perpendicular profile widths and shifts were on average within 0.5 mm of planned values. The average total MUs for VMAT plans was double the DCA average and similar to the IMRT average. Conclusions: For the aforementioned planning and delivery system and cranial lesions greater than 7 mm in diameter, multiple noncoplanar arc VMAT consistently provides accurate and high quality cranial radiosurgery dose distributions with low doses to healthy brain tissue and high dose conformity to the target. These qualities may make multiple noncoplanar arc VMAT suitable for a greater range of prescription doses or larger and more irregular lesions. For smaller and/or rounder lesions there are other clinically acceptable treatment techniques that may involve fewer couch angles or arcs and reduce treatment times.« less

SU-E-T-302: Dosimetric Comparison Between Volumetric Modulated Arc Radiotherapy and Intensity-Modulated Radiotherapy for Locally Recurrent Nasopharyngeal Carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu, J-Y; Huang, B-T; Zhang, J-Y

2015-06-15

Purpose: To compare volumetric modulated arc radiotherapy (VMAT) technique with fixed-gantry intensity-modulated radiotherapy (IMRT) technique for locally recurrent nasopharyngeal carcinoma. Methods: CT datasets of eleven nasopharyngeal-carcinoma patients were included. Dual-arc VMAT and seven-field IMRT plans were created for each case, and were then compared in terms of conformity index (CI), homogeneity index (HI) of the planning target volume (PTV), organ-at-risk (OAR) sparing, monitor unit (MU) and delivery time. Results: The D98% (near-minimal dose) of PTV in the VMAT plans was slightly lower than that of the IMRT plans (P < 0.05), while the CI was higher than that of themore » IMRT plans (P < 0.05). No significant difference was found in the HI between the two plans (P > 0.05). Compared with the IMRT plans, the VMAT plans demonstrated lower Dmean (mean dose) of the bilateral temporal lobes and the whole surrounding normal tissue (P < 0.05), but slightly higher Dmean of brainstem (P < 0.05). In terms of the other OARs, no significant differences were found (P > 0.05). The MUs of the VMAT plans (672 ± 112) was significantly lower than that of the IMRT plans (917 ± 206), by 25 ± 13% (P < 0.05). The average delivery time of the VMAT plans (2.3 ± 0.1 min) was less than that of the IMRT plans (5.1 ± 0.4 min), by 54 ± 3%. Conclusion: For locally recurrent nasopharyngeal carcinoma, the VMAT technique could achieve equivalent or superior dose distribution of the target and better protect the bilateral temporal lobes, compared with the IMRT technique. Moreover, it could reduce the MU and delivery time effectively.« less

SU-E-T-416: VMAT Dose Calculations Using Cone Beam CT Images: A Preliminary Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yu, S; Sehgal, V; Kuo, J

Purpose: Cone beam CT (CBCT) images have been used routinely for patient positioning throughout the treatment course. However, use of CBCT for dose calculation is still investigational. The purpose of this study is to assess the utility of CBCT images for Volumetric Modulated Arc Therapy (VMAT) plan dose calculation. Methods: A CATPHAN 504 phantom (The Phantom Laboratory, Salem, NY) was used to compare the dosimetric and geometric accuracy between conventional CT and CBCT (in both full and half fan modes). Hounsfield units (HU) profiles at different density areas were evaluated. A C shape target that surrounds a central avoidance structuremore » was created and a VMAT plan was generated on the CT images and copied to the CBCT phantom images. Patient studies included three brain patients, and one head and neck (H'N) patient. VMAT plans generated on the patients treatment planning CT was applied to CBCT images obtained during the first treatment. Isodose distributions and dosevolume- histograms (DVHs) were compared. Results: For the phantom study, the HU difference between CT and CBCT is within 100 (maximum 96 HU for Teflon CBCT images in full fan mode). The impact of these differences on the calculated dose distributions was clinically insignificant. In both phantom and patient studies, target DVHs based on CBCT images were in excellent agreement with those based on planning CT images. Mean, Median, near minimum (D98%), and near maximum (D2%) doses agreed within 0-2.5%. A slightly larger discrepancy is observed in the patient studies compared to that seen in the phantom study, (0-1% vs. 0 - 2.5%). Conclusion: CBCT images can be used to accurately predict dosimetric results, without any HU correction. It is feasible to use CBCT to evaluate the actual dose delivered at each fraction. The dosimetric consequences resulting from tumor response and patient geometry changes could be monitored.« less

SU-F-BRD-02: Incorporating Uncertainty Analysis in Plan Comparison of VMAT, Double Scattering Proton Plan and IMPT for Lung Irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheng, C; Wessels, B; Mansur, D

2015-06-15

Purpose: We investigate the effect of residual setup and motion errors in lung irradiation for VMAT, double scattering (DS) proton beams and spot scanning (IMPT) in a case study. Methods: The CT image and contour sets of a lung patient treated with 6 MV VMAT is re-planned with DS as well as IMPT subject to the same constraints; V20(lung), V10(lung) and V5(lung)< 15%, 20% and 25% respectively, V20(heart)<25% and V100%(PTV)≥95%. In addition, uncertainty analysis in the form of isocenter shifts (±1–3mm) was incorporated in the DVH calculations to assess the plan robustness. Results: Only the IMPT plan satisfies all themore » specified constraints. The 3D-conformal DS proton plan is able to achieve better sparing of the lung and heart dose compared to VMAT. For the lung, V20, V10 and V5 are 13%, 19% and 25% respectively for IMPT, 18%, 23% and 30% respectively for DS, and 20%, 30% and 42% respectively for VMAT. For heart: 0.6% for IMPT, 2.4% for DS and 30% for VMAT. When incorporating isocenter shifts in DVH calculations, the maximum changes in V20, V10 and V5 for lung are 14%, 21% and 28% respectively for IMPT. The corresponding max changes are19%, 24% and 32% respectively for DS, and 22%, 32% and 44% respectively for VMAT. The largest change occurs in the PTV coverage. For IMPT, V100%(PTV) varies between 88–96%, while V100%(PTV) for VMAT suffers a larger change compared to DS (Δ=5.5% vs 3.3%). Conclusion: While only IMPT satisfies the stringent dose-volume constraints for the lung irradiation, it is not as robust as the 3D conformal DS plan. DS also has better sparing in lung and heart compared to VMAT and similar PTV coverage. By including isocenter shifts in dose-volume calculations in treatment planning of lung, DS appears to be more robust than VMAT.« less

Comparing four volumetric modulated arc therapy beam arrangements for the treatment of early-stage prostate cancer

PubMed Central

Elith, Craig A; Dempsey, Shane E; Warren-Forward, Helen M

2014-01-01

Introduction This study compared four different volumetric modulated arc therapy (VMAT) beam arrangements for the treatment of early-stage prostate cancer examining plan quality and the impact on a radiotherapy department's resources. Methods Twenty prostate cases were retrospectively planned using four VMAT beam arrangements (1) a partial arc (PA), (2) one arc (1A), (3) one arc plus a partial arc (1A + PA) and (4) two arcs (2A). The quality of the dose distributions generated were compared by examining the overall plan quality, the homogeneity and conformity to the planning target volume (PTV), the number of monitor units and the dose delivered to the organs at risk. Departmental resources were considered by recording the planning time and beam delivery time. Results Each technique produced a plan of similar quality that was considered adequate for treatment; though some differences were noted. The 1A, 1A + PA and 2A plans demonstrated a better conformity to the PTV which correlated to improved sparing of the rectum in the 60–70 Gy range for the 1A + PA and 2A techniques. The time needed to generate the plans was different for each technique ranging from 13.1 min for 1A + PA to 17.8 min for 1A. The PA beam delivery time was fastest with a mean time of 0.9 min. Beam-on times then increased with an increase in the number of arcs up to an average of 2.2 min for the 2A technique. Conclusion Which VMAT technique is best suited for clinical implementation for the treatment of prostate cancer may be dictated by the individual patient and the availability of departmental resources. PMID:26229643

Robust optimization in lung treatment plans accounting for geometric uncertainty.

PubMed

Zhang, Xin; Rong, Yi; Morrill, Steven; Fang, Jian; Narayanasamy, Ganesh; Galhardo, Edvaldo; Maraboyina, Sanjay; Croft, Christopher; Xia, Fen; Penagaricano, Jose

2018-05-01

Robust optimization generates scenario-based plans by a minimax optimization method to find optimal scenario for the trade-off between target coverage robustness and organ-at-risk (OAR) sparing. In this study, 20 lung cancer patients with tumors located at various anatomical regions within the lungs were selected and robust optimization photon treatment plans including intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) plans were generated. The plan robustness was analyzed using perturbed doses with setup error boundary of ±3 mm in anterior/posterior (AP), ±3 mm in left/right (LR), and ±5 mm in inferior/superior (IS) directions from isocenter. Perturbed doses for D 99 , D 98 , and D 95 were computed from six shifted isocenter plans to evaluate plan robustness. Dosimetric study was performed to compare the internal target volume-based robust optimization plans (ITV-IMRT and ITV-VMAT) and conventional PTV margin-based plans (PTV-IMRT and PTV-VMAT). The dosimetric comparison parameters were: ITV target mean dose (D mean ), R 95 (D 95 /D prescription ), Paddick's conformity index (CI), homogeneity index (HI), monitor unit (MU), and OAR doses including lung (D mean , V 20 Gy and V 15 Gy ), chest wall, heart, esophagus, and maximum cord doses. A comparison of optimization results showed the robust optimization plan had better ITV dose coverage, better CI, worse HI, and lower OAR doses than conventional PTV margin-based plans. Plan robustness evaluation showed that the perturbed doses of D 99 , D 98 , and D 95 were all satisfied at least 99% of the ITV to received 95% of prescription doses. It was also observed that PTV margin-based plans had higher MU than robust optimization plans. The results also showed robust optimization can generate plans that offer increased OAR sparing, especially for normal lungs and OARs near or abutting the target. Weak correlation was found between normal lung dose and target size, and no other correlation was observed in this study. © 2018 University of Arkansas for Medical Sciences. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Trajectory optimization for dynamic couch rotation during volumetric modulated arc radiotherapy

NASA Astrophysics Data System (ADS)

Smyth, Gregory; Bamber, Jeffrey C.; Evans, Philip M.; Bedford, James L.

2013-11-01

Non-coplanar radiation beams are often used in three-dimensional conformal and intensity modulated radiotherapy to reduce dose to organs at risk (OAR) by geometric avoidance. In volumetric modulated arc radiotherapy (VMAT) non-coplanar geometries are generally achieved by applying patient couch rotations to single or multiple full or partial arcs. This paper presents a trajectory optimization method for a non-coplanar technique, dynamic couch rotation during VMAT (DCR-VMAT), which combines ray tracing with a graph search algorithm. Four clinical test cases (partial breast, brain, prostate only, and prostate and pelvic nodes) were used to evaluate the potential OAR sparing for trajectory-optimized DCR-VMAT plans, compared with standard coplanar VMAT. In each case, ray tracing was performed and a cost map reflecting the number of OAR voxels intersected for each potential source position was generated. The least-cost path through the cost map, corresponding to an optimal DCR-VMAT trajectory, was determined using Dijkstra’s algorithm. Results show that trajectory optimization can reduce dose to specified OARs for plans otherwise comparable to conventional coplanar VMAT techniques. For the partial breast case, the mean heart dose was reduced by 53%. In the brain case, the maximum lens doses were reduced by 61% (left) and 77% (right) and the globes by 37% (left) and 40% (right). Bowel mean dose was reduced by 15% in the prostate only case. For the prostate and pelvic nodes case, the bowel V50 Gy and V60 Gy were reduced by 9% and 45% respectively. Future work will involve further development of the algorithm and assessment of its performance over a larger number of cases in site-specific cohorts.

SU-G-JeP2-05: Dose Effects of a 1.5T Magnetic Field On Air-Tissue and Lung-Tissue Interfaces in MRI-Guided Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Xinfeng; Prior, Phillip; Chen, Guangpei

Purpose: The purpose of the study is to investigate the dose effects of electron-return-effect (ERE) at air-tissue and lung-tissue interfaces under a 1.5T transverse-magnetic-field (TMF). Methods: IMRT and VMAT plans for representative pancreas, lung, breast and head & neck (H&N) cases were generated following clinical dose volume (DV) criteria. The air-cavity walls, as well as the lung wall, were delineated to examine the ERE. In each case, the original plan generated without TMF is compared with the reconstructed plan (generated by recalculating the original plan with the presence of TMF) and the optimized plan (generated by a full optimization withmore » TMF), using a variety of DV parameters, including V100%, D95% and dose heterogeneity index for PTV, Dmax, and D1cc for OARs (organs at risk) and tissue interface. Results: The dose recalculation under TMF showed the presence of the 1.5 T TMF can slightly reduce V100% and D95% for PTV, with the differences being less than 4% for all but lung case studied. The TMF results in considerable increases in Dmax and D1cc on the skin in all cases, mostly between 10-35%. The changes in Dmax and D1cc on air cavity walls are dependent upon site, geometry, and size, with changes ranging up to 15%. In general, the VMAT plans lead to much smaller dose effects from ERE compared to fixed-beam IMRT. When the TMF is considered in the plan optimization, the dose effects of the TMF at tissue interfaces are significantly reduced in most cases. Conclusion: The doses on tissue interfaces can be significantly changed by the presence of a 1.5T TMF during MR-guided RT when the TMF is not included in plan optimization. These changes can be substantially reduced or even removed during VMAT/IMRT optimization that specifically considers the TMF, without deteriorating overall plan quality.« less

SU-E-T-309: Dosimetric Comparison of Simultaneous Integrated Boost Treatment Plan Between Intensity Modulated Radiotherapies (IMRTs), Dual Arc Volumetric Modulated Arc Therapy (DA-VMAT) and Single Arc Volumetric Modulated Arc Therapy (SA-VMAT) for Nasopharyngeal Carcinoma (NPC)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sivakumar, R; Janardhan, N; Bhavani, P

Purpose: To compare the plan quality and performance of Simultaneous Integrated Boost (SIB) Treatment plan between Seven field (7F) and Nine field(9F) Intensity Modulated Radiotherapies and Single Arc (SA) and Dual Arc (DA) Volumetric Modulated Arc Therapy( VMAT). Methods: Retrospective planning study of 16 patients treated in Elekta Synergy Platform (mlci2) by 9F-IMRT were replanned with 7F-IMRT, Single Arc VMAT and Dual Arc VMAT using CMS, Monaco Treatment Planning System (TPS) with Monte Carlo simulation. Target delineation done as per Radiation Therapy Oncology Protocols (RTOG 0225&0615). Dose Prescribed as 70Gy to Planning Target Volumes (PTV70) and 61Gy to PTV61 inmore » 33 fraction as a SIB technique. Conformity Index(CI), Homogeneity Index(HI) were used as analysis parameter for Target Volumes as well as Mean dose and Max dose for Organ at Risk(OAR,s).Treatment Delivery Time(min), Monitor unit per fraction (MU/fraction), Patient specific quality assurance were also analysed. Results: A Poor dose coverage and Conformity index (CI) was observed in PTV70 by 7F-IMRT among other techniques. SA-VMAT achieved poor dose coverage in PTV61. No statistical significance difference observed in OAR,s except Spinal cord (P= 0.03) and Right optic nerve (P=0.03). DA-VMAT achieved superior target coverage, higher CI (P =0.02) and Better HI (P=0.03) for PTV70 other techniques (7F-IMRT/9F-IMRT/SA-VMAT). A better dose spare for Parotid glands and spinal cord were seen in DA-VMAT. The average treatment delivery time were 5.82mins, 6.72mins, 3.24mins, 4.3mins for 7F-IMRT, 9F-IMRT, SA-VMAT and DA-VMAT respectively. Significance difference Observed in MU/fr (P <0.001) and Patient quality assurance pass rate were >95% (Gamma analysis (Γ3mm, 3%). Conclusion: DA-VAMT showed better target dose coverage and achieved better or equal performance in sparing OARs among other techniques. SA-VMAT offered least Treatment Time than other techniques but achieved poor target coverage. DA-VMAT offered shorter delivery time than 7F-IMRT and 9F-IMRT without compromising the plan quality.« less

The effect of MLC speed and acceleration on the plan delivery accuracy of VMAT

PubMed Central

Park, J M; Wu, H-G; Kim, J H; Carlson, J N K

2015-01-01

Objective: To determine a new metric utilizing multileaf collimator (MLC) speeds and accelerations to predict plan delivery accuracy of volumetric modulated arc therapy (VMAT). Methods: To verify VMAT delivery accuracy, gamma evaluations, analysis of mechanical parameter difference between plans and log files, and analysis of changes in dose–volumetric parameters between plans and plans reconstructed with log files were performed with 40 VMAT plans. The average proportion of leaf speeds ranging from l to h cm s−1 (Sl–h and l–h = 0–0.4, 0.4–0.8, 0.8–1.2, 1.2–1.6 and 1.6–2.0), mean and standard deviation of MLC speeds were calculated for each VMAT plan. The same was carried out for accelerations in centimetre per second squared (Al–h and l–h = 0–4, 4–8, 8–12, 12–16 and 16–20). The correlations of those indicators to plan delivery accuracy were analysed with Spearman's correlation coefficient (rs). Results: The S1.2–1.6 and mean acceleration of MLCs showed generally higher correlations to plan delivery accuracy than did others. The highest rs values were observed between S1.2–1.6 and global 1%/2 mm (rs = −0.698 with p < 0.001) as well as mean acceleration and global 1%/2 mm (rs = −0.650 with p < 0.001). As the proportion of MLC speeds and accelerations >0.4 and 4 cm s−2 increased, the plan delivery accuracy of VMAT decreased. Conclusion: The variations in MLC speeds and accelerations showed considerable correlations to VMAT delivery accuracy. Advances in knowledge: As the MLC speeds and accelerations increased, VMAT delivery accuracy reduced. PMID:25734490

SU-E-T-417: The Impact of Normal Tissue Constraints On PTV Dose Homogeneity for Intensity Modulated Radiotherapy (IMRT), Volume Modulated Arc Therapy (VMAT) and Tomotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Peng, J; McDonald, D; Ashenafi, M

2014-06-01

Purpose: Complex intensity modulated arc therapy tends to spread low dose to normal tissue(NT)regions to obtain improved target conformity and homogeneity and OAR sparing.This work evaluates the trade-offs between PTV homogeneity and reduction of the maximum dose(Dmax)spread to NT while planning of IMRT,VMAT and Tomotherapy. Methods: Ten prostate patients,previously planned with step-and-shoot IMRT,were selected.To fairly evaluate how PTV homogeneity was affected by NT Dmax constraints,original IMRT DVH objectives for PTV and OARs(femoral heads,and rectal and bladder wall)applied to 2 VMAT plans in Pinnacle(V9.0), and Tomotherapy(V4.2).The only constraint difference was the NT which was defined as body contours excluding targets,OARs andmore » dose rings.NT Dmax constraint for 1st VMAT was set to the prescription dose(Dp).For 2nd VMAT(VMAT-NT)and Tomotherapy,it was set to the Dmax achieved in IMRT(~70-80% of Dp).All NT constraints were set to the lowest priority.Three common homogeneity indices(HI),RTOG-HI=Dmax/Dp,moderated-HI=D95%/D5% and complex-HI=(D2%-D98%)/Dp*100 were calculated. Results: All modalities with similar dosimetric endpoints for PTV and OARs.The complex-HI shows the most variability of indices,with average values of 5.9,4.9,9.3 and 6.1 for IMRT,VMAT,VMAT-NT and Tomotherapy,respectively.VMAT provided the best PTV homogeneity without compromising any OAR/NT sparing.Both VMAT-NT and Tomotherapy,planned with more restrictive NT constraints,showed reduced homogeneity,with VMAT-NT showing the worst homogeneity(P<0.0001)for all HI.Tomotherapy gave the lowest NT Dmax,with slightly decreased homogeneity compared to VMAT. Finally, there was no significant difference in NT Dmax or Dmean between VMAT and VMAT-NT. Conclusion: PTV HI is highly dependent on permitted NT constraints. Results demonstrated that VMAT-NT with more restrictive NT constraints does not reduce Dmax NT,but significantly receives higher Dmax and worse target homogeneity.Therefore, it is critical that planners do not use too restrictive NT constraints during VMAT optimization.Tomotherapy plan was not as sensitive to NT constraints,however,care shall be taken to ensure NT is not pushed too hard.These results are relevant for clinical practice.The biological effect of higher Dmax and increased target heterogeneity needs further study.« less

TH-C-17A-03: Dynamic Visualization and Dosimetry of IMRT and VMAT Treatment Plans by Video-Rate Imaging of Cherenkov Radiation in Pure Water

DOE Office of Scientific and Technical Information (OSTI.GOV)

Glaser, A; Andreozzi, J; Davis, S

Purpose: A novel optical dosimetry technique for the QA and verification of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) radiotherapy plans was investigated for the first time by capturing images of the induced Cherenkov radiation in water. Methods: An intensified CCD camera (ICCD) was used to acquire a two-dimensional (2D) projection image of the Cherenkov radiation induced by IMRT and VMAT plans, based on the Task Group 119 C-Shape geometry. Plans were generated using the Varian Eclipse treatment planning system (TPS) and delivered using 6 MV x-rays from a Varian TrueBeam Linear Accelerator (Linac) incident on a watermore » tank. The ICCD acquisition was gated to the Linac, operated for single pulse imaging, and binned to a resolution of 512×512 pixels. The resulting videos were analyzed temporally for regions of interest (ROI) covering the planning target volume (PTV) and organ at risk (OAR) and summed to obtain an overall light distribution, which was compared to the expected dose distribution from the TPS using a gammaindex analysis. Results: The chosen camera settings resulted in data at 23.5 frames per second. Temporal intensity plots of the PTV and OAR ROIs confirmed the preferential delivery of dose to the PTV versus the OAR, and the gamma analysis yielded 95.2% and 95.6% agreement between the light distribution and expected TPS dose distribution based upon a 3% / 3 mm dose difference and distance-to-agreement criterion for the IMRT and VMAT plans respectively. Conclusion: The results from this initial study demonstrate the first documented use of Cherenkov radiation for optical dosimetry of dynamic IMRT and VMAT treatment plans. The proposed modality has several potential advantages over alternative methods including the real-time nature of the acquisition, and upon future refinement may prove to be a robust and novel dosimetry method with both research and clinical applications. NIH R01CA109558 and R21EB017559.« less

Video-rate optical dosimetry and dynamic visualization of IMRT and VMAT treatment plans in water using Cherenkov radiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Glaser, Adam K., E-mail: Adam.K.Glaser@dartmouth.edu, E-mail: Brian.W.Pogue@dartmouth.edu; Andreozzi, Jacqueline M.; Davis, Scott C.

Purpose: A novel technique for optical dosimetry of dynamic intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) plans was investigated for the first time by capturing images of the induced Cherenkov radiation in water. Methods: A high-sensitivity, intensified CCD camera (ICCD) was configured to acquire a two-dimensional (2D) projection image of the Cherenkov radiation induced by IMRT and VMAT plans, based on the Task Group 119 (TG-119) C-Shape geometry. Plans were generated using the Varian Eclipse treatment planning system (TPS) and delivered using 6 MV x-rays from a Varian TrueBeam Linear Accelerator (Linac) incident on a water tank dopedmore » with the fluorophore quinine sulfate. The ICCD acquisition was gated to the Linac target trigger pulse to reduce background light artifacts, read out for a single radiation pulse, and binned to a resolution of 512 × 512 pixels. The resulting videos were analyzed temporally for various regions of interest (ROI) covering the planning target volume (PTV) and organ at risk (OAR), and summed to obtain an overall light intensity distribution, which was compared to the expected dose distribution from the TPS using a gamma-index analysis. Results: The chosen camera settings resulted in 23.5 frames per second dosimetry videos. Temporal intensity plots of the PTV and OAR ROIs confirmed the preferential delivery of dose to the PTV versus the OAR, and the gamma analysis yielded 95.9% and 96.2% agreement between the experimentally captured Cherenkov light distribution and expected TPS dose distribution based upon a 3%/3 mm dose difference and distance-to-agreement criterion for the IMRT and VMAT plans, respectively. Conclusions: The results from this initial study demonstrate the first documented use of Cherenkov radiation for video-rate optical dosimetry of dynamic IMRT and VMAT treatment plans. The proposed modality has several potential advantages over alternative methods including the real-time nature of the acquisition, and upon future refinement may prove to be a robust and novel dosimetry method with both research and clinical applications.« less

An in vivo dose verification method for SBRT-VMAT delivery using the EPID.

PubMed

McCowan, P M; Van Uytven, E; Van Beek, T; Asuni, G; McCurdy, B M C

2015-12-01

Radiation treatments have become increasingly more complex with the development of volumetric modulated arc therapy (VMAT) and the use of stereotactic body radiation therapy (SBRT). SBRT involves the delivery of substantially larger doses over fewer fractions than conventional therapy. SBRT-VMAT treatments will strongly benefit from in vivo patient dose verification, as any errors in delivery can be more detrimental to the radiobiology of the patient as compared to conventional therapy. Electronic portal imaging devices (EPIDs) are available on most commercial linear accelerators (Linacs) and their documented use for dosimetry makes them valuable tools for patient dose verification. In this work, the authors customize and validate a physics-based model which utilizes on-treatment EPID images to reconstruct the 3D dose delivered to the patient during SBRT-VMAT delivery. The SBRT Linac head, including jaws, multileaf collimators, and flattening filter, were modeled using Monte Carlo methods and verified with measured data. The simulation provides energy spectrum data that are used by their "forward" model to then accurately predict fluence generated by a SBRT beam at a plane above the patient. This fluence is then transported through the patient and then the dose to the phosphor layer in the EPID is calculated. Their "inverse" model back-projects the EPID measured focal fluence to a plane upstream of the patient and recombines it with the extra-focal fluence predicted by the forward model. This estimate of total delivered fluence is then forward projected onto the patient's density matrix and a collapsed cone convolution algorithm calculates the dose delivered to the patient. The model was tested by reconstructing the dose for two prostate, three lung, and two spine SBRT-VMAT treatment fractions delivered to an anthropomorphic phantom. It was further validated against actual patient data for a lung and spine SBRT-VMAT plan. The results were verified with the treatment planning system (TPS) (ECLIPSE AAA) dose calculation. The SBRT-VMAT reconstruction model performed very well when compared to the TPS. A stringent 2%/2 mm χ-comparison calculation gave pass rates better than 91% for the prostate plans, 88% for the lung plans, and 86% for the spine plans for voxels containing 80% or more of the prescribed dose. Patient data were 86% for the lung and 95% for the spine. A 3%/3 mm χ-comparison was also performed and gave pass rates better than 93% for all plan types. The authors have customized and validated a robust, physics-based model that calculates the delivered dose to a patient for SBRT-VMAT delivery using on-treatment EPID images. The accuracy of the results indicates that this approach is suitable for clinical implementation. Future work will incorporate this model into both offline and real-time clinical adaptive radiotherapy.

Feasibility study of volumetric modulated arc therapy with constant dose rate for endometrial cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Ruijie; Wang, Junjie, E-mail: junjiewang47@yahoo.com; Xu, Feng

2013-10-01

To investigate the feasibility, efficiency, and delivery accuracy of volumetric modulated arc therapy with constant dose rate (VMAT-CDR) for whole-pelvic radiotherapy (WPRT) of endometrial cancer. The nine-field intensity-modulated radiotherapy (IMRT), VMAT with variable dose-rate (VMAT-VDR), and VMAT-CDR plans were created for 9 patients with endometrial cancer undergoing WPRT. The dose distribution of planning target volume (PTV), organs at risk (OARs), and normal tissue (NT) were compared. The monitor units (MUs) and treatment delivery time were also evaluated. For each VMAT-CDR plan, a dry run was performed to assess the dosimetric accuracy with MatriXX from IBA. Compared with IMRT, the VMAT-CDRmore » plans delivered a slightly greater V{sub 20} of the bowel, bladder, pelvis bone, and NT, but significantly decreased the dose to the high-dose region of the rectum and pelvis bone. The MUs decreased from 1105 with IMRT to 628 with VMAT-CDR. The delivery time also decreased from 9.5 to 3.2 minutes. The average gamma pass rate was 95.6% at the 3%/3 mm criteria with MatriXX pretreatment verification for 9 patients. VMAT-CDR can achieve comparable plan quality with significant shorter delivery time and smaller number of MUs compared with IMRT for patients with endometrial cancer undergoing WPRT. It can be accurately delivered and be an alternative to IMRT on the linear accelerator without VDR capability.« less

TU-E-BRB-08: Dual Gated Volumetric Modulated Arc Therapy.

PubMed

Wu, J; Fahimian, B; Wu, H; Xing, L

2012-06-01

Gated Volumetric Modulated Arc Therapy (VMAT) is an emerging treatment modality for Stereotactic Body Radiotherapy (SBRT). However, gating significantly prolongs treatment time. In order to enhance treatment efficiency, a novel dual gated VMAT, in which dynamic arc deliveries are executed sequentially in alternating exhale and inhale phases, is proposed and evaluated experimentally. The essence of dual gated VMAT is to take advantage of the natural pauses that occur at inspiration and exhalation by alternatively delivering the dose at the two phases, instead of the exhale window only. The arc deliveries at the two phases are realized by rotating gantry forward at the exhale window and backward at the inhale in an alternative fashion. Custom XML scripts were developed in Varian's TrueBeam STx Developer Mode to enable dual gated VMAT delivery. RapidArc plans for a lung case were generated for both inhale and exhale phases. The two plans were then combined into a dual gated arc by interleaving the arc treatment nodes of the two RapidArc plans. The dual gated plan was delivered in the development mode of TrueBeam LINAC onto a motion phantom and the delivery was measured by using pinpoint chamber/film/diode array (delta 4). The measured dose distribution was compared with that computed using Eclipse AAA algorithm. The treatment delivery time was recorded and compared with the corresponding single gated plans. Relative to the corresponding single gated delivery, it was found that treatment time efficiency was improved by 95.5% for the case studied here. Pinpoint chamber absolute dose measurement agreed the calculation to within 0.7%. Diode chamber array measurements revealed that 97.5% of measurement points of dual gated RapidArc delivery passed the 3% and 3mm gamma-test criterion. A dual gated VMAT treatment has been developed and implemented successfully with nearly doubled treatment delivery efficiency. © 2012 American Association of Physicists in Medicine.

SU-F-T-618: Evaluation of a Mono-Isocentric Treatment Planning Software for Stereotactic Radiosurgery of Multiple Brain Metastases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sham, E; Sattarivand, M; Mulroy, L

Purpose: To evaluate planning performance of an automated treatment planning software (BrainLAB; Elements) for stereotactic radiosurgery (SRS) of multiple brain metastases. Methods: Brainlab’s Multiple Metastases Elements (MME) uses single isocentric technique to treat up to 10 cranial planning target volumes (PTVs). The planning algorithm of the MME accounts for multiple PTVs overlapping with one another on the beam eyes view (BEV) and automatically selects a subset of all overlapping PTVs on each arc for sparing normal tissues in the brain. The algorithm also optimizes collimator angles, margins between multi-leaf collimators (MLCs) and PTVs, as well as monitor units (MUs) usingmore » minimization of conformity index (CI) for all targets. Planning performance was evaluated by comparing the MME-calculated treatment plan parameters with the same parameters calculated with the Volumetric Modulated Arc Therapy (VMAT) optimization on Varian’s Eclipse platform. Results: Figures 1 to 3 compare several treatment plan outcomes calculated between the MME and VMAT for 5 clinical multi-targets SRS patient plans. Prescribed target dose was volume-dependent and defined based on the RTOG recommendation. For a total number of 18 PTV’s, mean values for the CI, PITV, and GI were comparable between the MME and VMAT within one standard deviation (σ). However, MME-calculated MDPD was larger than the same VMAT-calculated parameter. While both techniques delivered similar maximum point doses to the critical cranial structures and total MU’s for the 5 patient plans, the MME required less treatment planning time by an order of magnitude compared to VMAT. Conclusion: The MME and VMAT produce similar plan qualities in terms of MUs, target dose conformation, and OAR dose sparing. While the selective use of PTVs for arc-optimization with the MME reduces significantly the total planning time in comparison to VMAT, the target dose homogeneity was also compromised due to its simplified inverse planning algorithm used.« less

Influence of multiple brain metastases’ size and number on the quality of SRS - VMAT dose delivery

NASA Astrophysics Data System (ADS)

Prentou, G.; Koutsouveli, E.; Pantelis, E.; Papagiannis, P.; Georgiou, E.; Karaiskos, P.

2017-11-01

Stereotactic radiosurgery with volumetric modulated arc therapy (SRS-VMAT) has recently been introduced for treatment of multiple brain metastases with a single isocenter. The technique’s high efficiency is nevertheless dependent of metastatic tumors’ characteristics such as size and number. In this work the impact of the metastases’ size and number on the plan quality indices clinically used for plan evaluation and acceptance is investigated. Fifteen targets with a diameter of 1 cm and average volume of 0.7 cm3 and ten targets with a diameter of 2 cm and average volume of 6.5 cm3 were contoured on an anonymized patient CT dataset, in Monaco (Elekta) treatment planning system. VMAT plans for different target volumes (1 and 2 cm in diameter) and various target numbers (1-15) were generated using four non-coplanar arcs and the Agility (Elekta) linear accelerator (5 mm MLC width) using a Monte Carlo dose calculation algorithm and 1mm dose calculation grid resolution. Conformity index (CI), gradient index (GI) and heterogeneity index (HI) were determined for each target. High quality plans were created for both 1 cm and 2 cm in diameter targets for limited (<6) number of targets per plan. For increased number of irradiated targets (>6) both CI and GI, clinically used for plan evaluation and acceptance, were found to deteriorate.

The role of complexity metrics in a multi-institutional dosimetry audit of VMAT

PubMed Central

Agnew, Christina E; Hussein, Mohammad; Tsang, Yatman; McWilliam, Alan; Hounsell, Alan R; Clark, Catharine H

2016-01-01

Objective: To demonstrate the benefit of complexity metrics such as the modulation complexity score (MCS) and monitor units (MUs) in multi-institutional audits of volumetric-modulated arc therapy (VMAT) delivery. Methods: 39 VMAT treatment plans were analysed using MCS and MU. A virtual phantom planning exercise was planned and independently measured using the PTW Octavius® phantom and seven29® 2D array (PTW-Freiburg GmbH, Freiburg, Germany). MCS and MU were compared with the median gamma index pass rates (2%/2 and 3%/3 mm) and plan quality. The treatment planning systems (TPS) were grouped by VMAT modelling being specifically designed for the linear accelerator manufacturer's own treatment delivery system (Type 1) or independent of vendor for VMAT delivery (Type 2). Differences in plan complexity (MCS and MU) between TPS types were compared. Results: For Varian® linear accelerators (Varian® Medical Systems, Inc., Palo Alto, CA), MCS and MU were significantly correlated with gamma pass rates. Type 2 TPS created poorer quality, more complex plans with significantly higher MUs and MCS than Type 1 TPS. Plan quality was significantly correlated with MU for Type 2 plans. A statistically significant correlation was observed between MU and MCS for all plans (R = −0.84, p < 0.01). Conclusion: MU and MCS have a role in assessing plan complexity in audits along with plan quality metrics. Plan complexity metrics give some indication of plan deliverability but should be analysed with plan quality. Advances in knowledge: Complexity metrics were investigated for a national rotational audit involving 34 institutions and they showed value. The metrics found that more complex plans were created for planning systems which were independent of vendor for VMAT delivery. PMID:26511276

The role of complexity metrics in a multi-institutional dosimetry audit of VMAT.

PubMed

McGarry, Conor K; Agnew, Christina E; Hussein, Mohammad; Tsang, Yatman; McWilliam, Alan; Hounsell, Alan R; Clark, Catharine H

2016-01-01

To demonstrate the benefit of complexity metrics such as the modulation complexity score (MCS) and monitor units (MUs) in multi-institutional audits of volumetric-modulated arc therapy (VMAT) delivery. 39 VMAT treatment plans were analysed using MCS and MU. A virtual phantom planning exercise was planned and independently measured using the PTW Octavius(®) phantom and seven29(®) 2D array (PTW-Freiburg GmbH, Freiburg, Germany). MCS and MU were compared with the median gamma index pass rates (2%/2 and 3%/3 mm) and plan quality. The treatment planning systems (TPS) were grouped by VMAT modelling being specifically designed for the linear accelerator manufacturer's own treatment delivery system (Type 1) or independent of vendor for VMAT delivery (Type 2). Differences in plan complexity (MCS and MU) between TPS types were compared. For Varian(®) linear accelerators (Varian(®) Medical Systems, Inc., Palo Alto, CA), MCS and MU were significantly correlated with gamma pass rates. Type 2 TPS created poorer quality, more complex plans with significantly higher MUs and MCS than Type 1 TPS. Plan quality was significantly correlated with MU for Type 2 plans. A statistically significant correlation was observed between MU and MCS for all plans (R = -0.84, p < 0.01). MU and MCS have a role in assessing plan complexity in audits along with plan quality metrics. Plan complexity metrics give some indication of plan deliverability but should be analysed with plan quality. Complexity metrics were investigated for a national rotational audit involving 34 institutions and they showed value. The metrics found that more complex plans were created for planning systems which were independent of vendor for VMAT delivery.

VMAT optimization with dynamic collimator rotation.

PubMed

Lyu, Qihui; O'Connor, Daniel; Ruan, Dan; Yu, Victoria; Nguyen, Dan; Sheng, Ke

2018-04-16

Although collimator rotation is an optimization variable that can be exploited for dosimetric advantages, existing Volumetric Modulated Arc Therapy (VMAT) optimization uses a fixed collimator angle in each arc and only rotates the collimator between arcs. In this study, we develop a novel integrated optimization method for VMAT, accounting for dynamic collimator angles during the arc motion. Direct Aperture Optimization (DAO) for Dynamic Collimator in VMAT (DC-VMAT) was achieved by adding to the existing dose fidelity objective an anisotropic total variation term for regulating the fluence smoothness, a binary variable for forming simple apertures, and a group sparsity term for controlling collimator rotation. The optimal collimator angle for each beam angle was selected using the Dijkstra's algorithm, where the node costs depend on the estimated fluence map at the current iteration and the edge costs account for the mechanical constraints of multi-leaf collimator (MLC). An alternating optimization strategy was implemented to solve the DAO and collimator angle selection (CAS). Feasibility of DC-VMAT using one full-arc with dynamic collimator rotation was tested on a phantom with two small spherical targets, a brain, a lung and a prostate cancer patient. The plan was compared against a static collimator VMAT (SC-VMAT) plan using three full arcs with 60 degrees of collimator angle separation in patient studies. With the same target coverage, DC-VMAT achieved 20.3% reduction of R50 in the phantom study, and reduced the average max and mean OAR dose by 4.49% and 2.53% of the prescription dose in patient studies, as compared with SC-VMAT. The collimator rotation co-ordinated with the gantry rotation in DC-VMAT plans for deliverability. There were 13 beam angles in the single-arc DC-VMAT plan in patient studies that requires slower gantry rotation to accommodate multiple collimator angles. The novel DC-VMAT approach utilizes the dynamic collimator rotation during arc delivery. In doing so, DC-VMAT affords more sophisticated intensity modulation, alleviating the limitation previously imposed by the square beamlet from the MLC leaf thickness and achieves higher effective modulation resolution. Consequently, DC-VMAT with a single arc manages to achieve superior dosimetry than SC-VMAT with three full arcs. © 2018 American Association of Physicists in Medicine.

Dosimetric Comparison between Single and Dual Arc-Volumetric Modulated Arc Radiotherapy and Intensity Modulated Radiotherapy for Nasopharyngeal Carcinoma Using a Simultaneous Integrated Boost Technique

PubMed Central

Radhakrishnan, Sivakumar; Chandrasekaran, Anuradha; Sarma, Yugandhar; Balakrishnan, Saranganathan; Nandigam, Janardhan

2017-01-01

Backround: Plan quality and performance of dual arc (DA) volumetric modulated arc therapy (VMAT), single arc (SA) VMAT and nine field (9F) intensity modulated radiotherapy were compared using a simultaneous integrated boost (SIB) technique. Methods: Twelve patients treated in Elekta Synergy Platform (mlci2) by 9F-IMRT were replanned with SA/DA-VMAT using a CMS Monaco Treatment Planning System (TPS) with Monte Carlo simulation. Target delineation was conducted as per Radiation Therapy Oncology Protocols (RTOG0225 and 0615). A 70Gy dose prescribed to PTV70 and 61Gy to PTV61 in 33 fractions was applied for the SIB technique. The conformity index (CI) and homogeneity index (HI) for targets and the mean dose and maximum dose for OAR’s, treatment delivery time (min), monitor units (MUs) per fraction, normal tissue integral dose and patient specific quality assurance were analysed. Results: Acceptable target coverage was achieved for PTV70 and PTV61 with all the planning techniques. No significant differences were observed except for D98 (PTV61), CI(PTV70) and HI(PTV61). Maximum dose (Dmax) to the spinal cord was lower in DA-VMAT than 9F-IMRT (p=0.002) and SA-VMAT (p=0.001). D50 (%) of parotid glands was better controlled by 9F-IMRT (p=0.001) and DA-VMAT (p=0.001) than SA-VMAT. A lower mean dose to the larynx was achieved with 9F-IMRT (P=0.001) and DA-VMAT (p=0.001) than with SA-VMAT. DA-VMAT achieved higher CI of PTV70 (P= 0.005) than SA-VMAT. For PTV61, DA-VMAT (P=0.001) and 9F-IMRT (P=0.001) achieved better HI than SA-VMAT. The average treatment delivery times were 7.67mins, 3.35 mins, 4.65 mins for 9F-IMRT, SA-VMAT and DA-VMAT, respectively. No significant difference were observed in MU/fr (p=0.9) and NTID (P=0.90) and the patient quality assurance pass rates were >95% (gamma analysis I3mm, 3%). Conclusion: DA-VMAT showed better conformity over target dose and spared the OARs better or equal to IMRT. SA-VMAT could not spare the OARs well. DA-VMAT offered shorter delivery time than IMRT without compromising the plan quality. PMID:28612593

Dosimetric Comparison between Single and Dual Arc-Volumetric Modulated Arc Radiotherapy and Intensity Modulated Radiotherapy for Nasopharyngeal Carcinoma Using a Simultaneous Integrated Boost Technique

PubMed

Radhakrishnan, Sivakumar; Chandrasekaran, Anuradha; Sarma, Yugandhar; Balakrishnan, Saranganathan; Nandigam, Janardhan

2017-05-01

Backround: Plan quality and performance of dual arc (DA) volumetric modulated arc therapy (VMAT) , single arc (SA) VMAT and nine field (9F) intensity modulated radiotherapy were compared using a simultaneous integrated boost (SIB) technique. Methods: Twelve patients treated in Elekta Synergy Platform (mlci2) by 9F-IMRT were replanned with SA/DA-VMAT using a CMS Monaco Treatment Planning System (TPS) with Monte Carlo simulation. Target delineation was conducted as per Radiation Therapy Oncology Protocols (RTOG0225 and 0615). A 70Gy dose prescribed to PTV70 and 61Gy to PTV61 in 33 fractions was applied for the SIB technique. The conformity index (CI) and homogeneity index (HI) for targets and the mean dose and maximum dose for OAR’s, treatment delivery time (min), monitor units (MUs) per fraction, normal tissue integral dose and patient specific quality assurance were analysed. Results: Acceptable target coverage was achieved for PTV70 and PTV61 with all the planning techniques. No significant differences were observed except for D98 (PTV61), CI(PTV70) and HI(PTV61). Maximum dose (Dmax) to the spinal cord was lower in DA-VMAT than 9F-IMRT (p=0.002) and SA-VMAT (p=0.001). D50 (%) of parotid glands was better controlled by 9F-IMRT (p=0.001) and DA-VMAT (p=0.001) than SA-VMAT. A lower mean dose to the larynx was achieved with 9F-IMRT (P=0.001) and DA-VMAT (p=0.001) than with SA-VMAT. DA-VMAT achieved higher CI of PTV70 (P= 0.005) than SA-VMAT. For PTV61, DA-VMAT (P=0.001) and 9F-IMRT (P=0.001) achieved better HI than SA-VMAT. The average treatment delivery times were 7.67mins, 3.35 mins, 4.65 mins for 9F- IMRT, SA-VMAT and DA-VMAT, respectively. No significant difference were observed in MU/fr (p=0.9) and NTID (P=0.90) and the patient quality assurance pass rates were >95% (gamma analysis Ґ3mm, 3%). Conclusion: DA-VMAT showed better conformity over target dose and spared the OARs better or equal to IMRT. SA-VMAT could not spare the OARs well. DA-VMAT offered shorter delivery time than IMRT without compromising the plan quality. Creative Commons Attribution License

SU-F-T-615: Comparison of Plan Quality for Linac-Based Stereotactic Radiosurgery (SRS) Using Single- and Multi-Isocenter Techniques

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chang, J; Dept of Radiation Oncology, NewYork Hospital/Weill Cornell Medical College, New York, NY; Wernicke, A

2016-06-15

Purpose: To compare the plan quality of linear accelerator (linac)-based stereotactic radiosurgery (SRS) using single-isocenter volumetric arc therapy (SI-VMAT), restricted single-isocenter dynamic-arc (RSI-DARC), and multi-isocenter DARC (MI-DARC) techniques. Methods: Fifteen SRS cases were randomly selected and re-planned using the SI-VMAT (Pinnacle), RSI-DARC (iPlanNet) and MI-DARC (iPlanNet). The number of planning target volumes (PTVs) for each plan ranged from 1 to 6. For SI-VMAT, a single isocenter and 3-4 VMAT beams are used for all PTVs, while for MI-DARC, each PTV has its own isocetner with 3 DARC beams. RSI-DARC uses one isocnter with 3-6 DARC beams to irradiate all PTVsmore » within 2.5-cm radius. Both SI-DARC and RSI-DARC plans were optimized manually. The prescription dose was 20 Gy to each PTV. The maximal dose was 25 Gy for RSI-DARC and MI-DARC, but could not be controlled for SI-VMAT due to the nature of VMAT planning. Plan quality indexes including PTV coverage, mean dose of PTV (PTVmean) and tissue (Tmean), V12Gy, conformity index (CI), and V10Gy/VPTV were calculated and compared. Results: Full PTV coverage was achieved for all three techniques. Using the MI-DARC plans as the gold standard, the PTVmean of the SI-VMAT plans was 12.5%±8.3% (mean±standard deviation) higher, in comparison to 0.7%±1.4% for the RSI-DARC plans. Similar trend was observed for other indexes including V12Gy (39.4%±27.3% vs. 9.3%±7.8%), Tmean (35.0%±26.8% vs. 2.8%±3.4%), and V10Gy/VPTV (42.2%±31.5% vs. 9.9%±8.2%). CI is comparable (6.2%±14.2% vs. 6.3%±7.2%). Assuming the treatment time is proportional to the number of isocenters, the reduction of the treatment time in comparison to MI-DARC was 70% for SI-VMAT and 42% for RSI-DARC. Conclusion: Although the SI-VMAT can save a considerable amount of treatment time, the plan indexes also significantly deviates from the gold standard, MI-DARC. RSI-DARC, on the other hand, provides a good compromise between the treatment time and plan quality.« less

Dosimetric effect of limited aperture multileaf collimator on VMAT plan quality: A study of prostate and head-and-neck cancers.

PubMed

Murtaza, Ghulam; Mehmood, Shahid; Rasul, Shahid; Murtaza, Imran; Khan, Ehsan Ullah

2018-01-01

The aim of study was to evaluate the dosimetric effect of collimator-rotation on VMAT plan quality, when using limited aperture multileaf collimator of Elekta Beam Modulator™ providing a maximum aperture of 21 cm × 16 cm. The increased use of VMAT technique to deliver IMRT from conventional to very specialized treatments present a challenge in plan optimization. In this study VMAT plans were optimized for prostate and head and neck cancers using Elekta Beam-Modulator TM , whereas previous studies were reported for conventional Linac aperture. VMAT plans for nine of each prostate and head-and-neck cancer patients were produced using the 6 MV photon beam for Elekta-SynergyS ® Linac using Pinnacle 3 treatment planning system. Single arc, dual arc and two combined independent-single arcs were optimized for collimator angles (C) 0°, 90° and 0°-90° (0°-90°; i.e. the first-arc was assigned C0° and second-arc was assigned C90°). A treatment plan comparison was performed among C0°, C90° and C(0°-90°) for single-arc dual-arc and two independent-single-arcs VMAT techniques to evaluate the influence of extreme collimator rotations (C0° and 90°) on VMAT plan quality. Plan evaluation criteria included the target coverage, conformity index, homogeneity index and doses to organs at risk. A 'two-sided student t -test' ( p  ≤ 0.05) was used to determine if there was a significant difference in dose volume indices of plans. For both prostate and head-and-neck, plan quality at collimator angles C0° and C(0°-90°) was clinically acceptable for all VMAT-techniques, except SA for head-and-neck. Poorer target coverage, higher normal tissue doses and significant p -values were observed for collimator angle 90° when compared with C0° and C(0°-90°). A collimator rotation of 0° provided significantly better target coverage and sparing of organs-at-risk than a collimator rotation of 90° for all VMAT techniques.

Plan averaging for multicriteria navigation of sliding window IMRT and VMAT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Craft, David, E-mail: dcraft@partners.org; Papp, Dávid; Unkelbach, Jan

2014-02-15

Purpose: To describe a method for combining sliding window plans [intensity modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT)] for use in treatment plan averaging, which is needed for Pareto surface navigation based multicriteria treatment planning. Methods: The authors show that by taking an appropriately defined average of leaf trajectories of sliding window plans, the authors obtain a sliding window plan whose fluence map is the exact average of the fluence maps corresponding to the initial plans. In the case of static-beam IMRT, this also implies that the dose distribution of the averaged plan is the exact dosimetricmore » average of the initial plans. In VMAT delivery, the dose distribution of the averaged plan is a close approximation of the dosimetric average of the initial plans. Results: The authors demonstrate the method on three Pareto optimal VMAT plans created for a demanding paraspinal case, where the tumor surrounds the spinal cord. The results show that the leaf averaged plans yield dose distributions that approximate the dosimetric averages of the precomputed Pareto optimal plans well. Conclusions: The proposed method enables the navigation of deliverable Pareto optimal plans directly, i.e., interactive multicriteria exploration of deliverable sliding window IMRT and VMAT plans, eliminating the need for a sequencing step after navigation and hence the dose degradation that is caused by such a sequencing step.« less

SU-E-T-644: Evaluation of Angular Dependence Correction for 2D Array Detector Using for Quality Assurance of Volumetric Modulated Arc Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karthikeyan, N; Ganesh, K M; Vikraman, S

2014-06-15

Purpose: To evaluate the angular dependence correction for Matrix Evolution 2D array detector in quality assurance of volumetric modulated arc therapy(VMAT). Methods: Total ten patients comprising of different sites were planned for VMAT and taken for the study. Each plan was exposed on Matrix Evolution 2D array detector with Omnipro IMRT software based on the following three different methods using 6MV photon beams from Elekta Synergy linear accelerator. First method, VMAT plan was delivered on Matrix Evolution detector as it gantry mounted with dedicated holder with build-up of 2.3cm. Second, the VMAT plan was delivered with the static gantry anglemore » on to the table mounted setup. Third, the VMAT plan was delivered with actual gantry angle on Matrix Evolution detector fixed in Multicube phantom with gantry angle sensor and angular dependence correction were applied to quantify the plan quality. For all these methods, the corresponding QA plans were generated in TPS and the dose verification was done for both point and 2D fluence analysis with pass criteria of 3% dose difference and 3mm distance to agreement. Results: The measured point dose variation for the first method was observed as 1.58±0.6% of mean and SD with TPS calculated. For second and third method, the mean and standard deviation(SD) was observed as 1.67±0.7% and 1.85±0.8% respectively. The 2D fluence analysis of measured and TPS calculated has the mean and SD of 97.9±1.1%, 97.88±1.2% and 97.55±1.3% for first, second and third methods respectively. The calculated two-tailed Pvalue for point dose and 2D fluence analysis shows the insignificance with values of 0.9316 and 0.9015 respectively, among the different methods of QA. Conclusion: The qualitative evaluation of angular dependence correction for Matrix Evolution 2D array detector shows its competency in accuracy of quality assurance measurement of composite dose distribution of volumetric modulated arc therapy.« less

SU-E-T-766: Treatment Planning Comparison Study On Two Different Multileaf Collimators Delivered with Volumetric Modulated Arc Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, R; Xiaomei, F; Bai, W

2015-06-15

Purpose: To compare and evaluate the performance of two different multileaf collimators(MLCi2 and Agility) delivery with volumetric modulated arc therapy techniques. Methods: Treatment plans were graded four (Low, Moderate, Moderate-High and High complexity) accorrding to the complexity. This includes 1 Low complexity(brain metastasis), 2 Moderate complexity(Lung and Liver), 1 Moderate-High complexity(prostate) and 1 High complexity ( head and neck) cases. Total dose of 60 Gy was given for all the plans. All cases were desigined two VMAT plans, one with MLCi2(group A) and the other with Agility(group B). All plans were done on Elekta VMAT with Monaco treatment planning system.more » All plans were generated with 6 MV X-rays for both Plan A and Plan B. Plans were evaluated based on the ability to meet the dose volume histogram, radiation conformity index, estimated radiation delivery time, dose homogeneity index(HI) and monitor units(MU) needed to deliver the prescribed dose. Results: Plans of group B achieved the best HI (HI = 1.05 Vs. 1.06) at the Low complexity cases while plans of group A were slightly better at the high complexity cases (HI = 1.12 Vs. 1.14). Faster VMAT plan delivery with Agility than with MLCi2 as plan complexity increased (Low complexity:52s Vs.52s, Moderate complexity:58s Vs. 55s, Moderate-High complexity: 171s Vs.152s, High complexity : 326s Vs. 202s ), especially for the most complex paradigms delivered time can be decresed 38%. No Significant changes were observed between the group B and group A plans in terms of the healthy tissue mean dose and MU. Both plans respected the planning objective for all organs at risk. Conclusion: The study concludes that VMAT plans with the novel Agility MLC can significant decrease the delivering time at the high complexity cases, while a slight compromise in the dose homogeneity index should be noted. This work was supported by The Medical Science Foundation of The health department of Hebei Province (No. 20130253)« less

Optimization of Craniospinal Irradiation for Pediatric Medulloblastoma Using VMAT and IMRT.

PubMed

Al-Wassia, Rolina K; Ghassal, Noor M; Naga, Adly; Awad, Nesreen A; Bahadur, Yasir A; Constantinescu, Camelia

2015-10-01

Intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) provide highly conformal target radiation doses, but also expose large volumes of healthy tissue to low-dose radiation. With improving survival, more children with medulloblastoma (MB) are at risk of late adverse effects of radiotherapy, including secondary cancers. We evaluated the characteristics of IMRT and VMAT craniospinal irradiation treatment plans in children with standard-risk MB to compare radiation dose delivery to target organs and organs at risk (OAR). Each of 10 children with standard-risk MB underwent both IMRT and VMAT treatment planning. Dose calculations used inverse planning optimization with a craniospinal dose of 23.4 Gy followed by a posterior fossa boost to 55.8 Gy. Clinical and planning target volumes were demarcated on axial computed tomography images. Dose distributions to target organs and OAR for each planning technique were measured and compared with published dose-volume toxicity data for pediatric patients. All patients completed treatment planning for both techniques. Analyses and comparisons of dose distributions and dose-volume histograms for the planned target volumes, and dose delivery to the OAR for each technique demonstrated the following: (1) VMAT had a modest, but significantly better, planning target volume-dose coverage and homogeneity compared with IMRT; (2) there were different OAR dose-sparing profiles for IMRT versus VMAT; and (3) neither IMRT nor VMAT demonstrated dose reductions to the published pediatric dose limits for the eyes, the lens, the cochlea, the pituitary, and the brain. The use of both IMRT and VMAT provides good target tissue coverage and sparing of the adjacent tissue for MB. Both techniques resulted in OAR dose delivery within published pediatric dose guidelines, except those mentioned above. Pediatric patients with standard-risk MB remain at risk for late endocrinologic, sensory (auditory and visual), and brain functional impairments.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nguyen, Kham, E-mail: khamdiep@gmail.com; UT MD Anderson Cancer Center, School of Health Professions—Unit 2, Houston, TX; Cummings, David

The purpose of this study was to evaluate the differences between volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) in the treatment of nasal cavity carcinomas. The treatment of 10 patients, who had completed IMRT treatment for resected tumors of the nasal cavity, was replanned with the Philips Pinnacle{sup 3} Version 9 treatment-planning system. The IMRT plans used a 9-beam technique whereas the VMAT (known as SmartArc) plans used a 3-arc technique. Both types of plans were optimized using Philips Pinnacle{sup 3} Direct Machine Parameter Optimization algorithm. IMRT and VMAT plans' quality was compared by evaluating the maximum,more » minimum, and mean doses to the target volumes and organs at risk, monitor units (MUs), and the treatment delivery time. Our results indicate that VMAT is capable of greatly reducing treatment delivery time and MUs compared with IMRT. The reduction of treatment delivery time and MUs can decrease the effects of intrafractional uncertainties that can occur because of patient movement during treatment delivery. VMAT's plans further reduce doses to critical structures that are in close proximity to the target volume.« less

SU-E-T-321: Dosimetric Evaluation of Non-Coplanar Arcs in VMAT Planning for SBRT Lung Cases: A Planning Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu, S; Gardner, S; Doemer, A

Purpose: Investigate use of standardized non-coplanar arcs to improve plan quality in lung Stereotactic Body Radiation Therapy(SBRT) VMAT planning. Methods: VMAT planning was performed for 9 patients previously treated with SBRT for peripheral lung tumors (tumor size:12.7cc to 32.5cc). For each patient, 7 VMAT plans (couch rotation values:0,5,10,15,20,25,and 30 deg) were generated; the coplanar plans were pushed to meet the RTOG0915 constraints and each non-coplanar plans utilized the same optimization constraints. The following plan dose metrics were used (taken from RTOG 0915): D-2cm: the maximum dose at 2 cm from the PTV, conformality index (CI), gradient index (GI), lung volumemore » receiving 5 Gy (V5) and lung volume receiving 20 Gy (V20). The couch collision clearance was checked for each plan through a dry run using the couch position from the patient’s treatment. Results: Of the 9 cases, one coplanar plan failed to meet two protocol guidelines (both gradient index and D-2cm parameter), and an additional plan failed the D-2cm parameter. When introducing at least 5 degree couch rotation, all plans met the protocol guidelines. The largest feasible couch angle available was 15 to 20 degrees due to gantry collision issues. Non-coplanar plans resulted in the average (standard deviation) reduction of the following metrics: GI by 7.3% (3.7%); lung V20 by 11.1% (3.2%); D-2cm by 12.7% (3.9%). The CI was unchanged (−0.3%±0.6%), and lung V5 increased (3.8%±8.2%). Conclusion: The use of couch rotations as little as 5 degrees allows for plan quality that will meet RTOG0915 constraints while reducing D-2cm, GI, and lung V20. Using default couch rotations while planning SBRT cases will allow for more efficient planning with the stated goal of meeting RTOG0915 criteria for all clinical cases. Gantry clearance checks in the treatment room may be necessary to ensure safe treatments for larger couch rotation values.« less

SU-E-T-421: Feasibility Study of Volumetric Modulated Arc Therapy with Constant Dose Rate for Endometrial Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, R; Wang, J

2014-06-01

Purpose: To investigate the feasibility, efficiency, and delivery accuracy of volumetric modulated arc therapy with constant dose rate (VMAT-CDR) for whole-pelvic radiotherapy (WPRT) of endometrial cancer. Methods: The nine-Field intensity-modulated radiotherapy (IMRT), VMAT with variable dose-rate (VMAT-VDR), and VMAT-CDR plans were created for 9 patients with endometrial cancer undergoing WPRT. The dose distribution of planning target volume (PTV), organs at risk (OARs), and normal tissue (NT) were compared. The monitor units (MUs) and treatment delivery time were also evaluated. For each VMAT-CDR plan, a dry Run was performed to assess the dosimetric accuracy with MatriXX from IBA. Results: Compared withmore » IMRT, the VMAT-CDR plans delivered a slightly greater V20 of the bowel, bladder, pelvis bone, and NT, but significantly decreased the dose to the high-dose region of the rectum and pelvis bone. The MUs Decreased from 1105 with IMRT to 628 with VMAT-CDR. The delivery time also decreased from 9.5 to 3.2 minutes. The average gamma pass rate was 95.6% at the 3%/3 mm criteria with MatriXX pretreatment verification for 9 patients. Conclusion: VMAT-CDR can achieve comparable plan quality with significant shorter delivery time and smaller number of MUs compared with IMRT for patients with endometrial cancer undergoing WPRT. It can be accurately delivered and be an alternative to IMRT on the linear accelerator without VDR capability. This work is supported by the grant project, National Natural; Science Foundation of China (No. 81071237)« less

Simultaneous integrated boost to intraprostatic lesions using different energy levels of intensity-modulated radiotherapy and volumetric-arc therapy

PubMed Central

Sonmez, S; Erbay, G; Guler, O C; Arslan, G

2014-01-01

Objective: This study compared the dosimetry of volumetric-arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) with a dynamic multileaf collimator using the Monte Carlo algorithm in the treatment of prostate cancer with and without simultaneous integrated boost (SIB) at different energy levels. Methods: The data of 15 biopsy-proven prostate cancer patients were evaluated. The prescribed dose was 78 Gy to the planning target volume (PTV78) including the prostate and seminal vesicles and 86 Gy (PTV86) in 39 fractions to the intraprostatic lesion, which was delineated by MRI or MR-spectroscopy. Results: PTV dose homogeneity was better for IMRT than VMAT at all energy levels for both PTV78 and PTV86. Lower rectum doses (V30–V50) were significantly higher with SIB compared with PTV78 plans in both IMRT and VMAT plans at all energy levels. The bladder doses at high dose level (V60–V80) were significantly higher in IMRT plans with SIB at all energy levels compared with PTV78 plans, but no significant difference was observed in VMAT plans. VMAT plans resulted in a significant decrease in the mean monitor units (MUs) for 6, 10, and 15 MV energy levels both in plans with and those without SIB. Conclusion: Dose escalation to intraprostatic lesions with 86 Gy is safe without causing serious increase in organs at risk (OARs) doses. VMAT is advantageous in sparing OARs and requiring less MU than IMRT. Advances in knowledge: VMAT with SIB to intraprostatic lesion is a feasible method in treating prostate cancer. Additionally, no dosimetric advantage of higher energy is observed. PMID:24319009

Dosimetric effects of weight loss or gain during volumetric modulated arc therapy and intensity-modulated radiation therapy for prostate cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pair, Matthew L.; Du, Weiliang; Rojas, Hector D.

Weight loss or gain during the course of radiation therapy for prostate cancer can alter the planned dose to the target volumes and critical organs. Typically, source-to-surface distance (SSD) measurements are documented by therapists on a weekly basis to ensure that patients' exterior surface and isocenter-to-skin surface distances remain stable. The radiation oncology team then determines whether the patient has undergone a physical change sufficient to require a new treatment plan. The effect of weight change (SSD increase or decrease) on intensity-modulated radiation therapy (IMRT) or volumetric modulated arc therapy (VMAT) dosimetry is not well known, and it is unclearmore » when rescanning or replanning is needed. The purpose of this study was to determine the effects of weight change (SSD increase or decrease) on IMRT or VMAT dose delivery in patients with prostate cancer and to determine the SSD change threshold for replanning. Whether IMRT or VMAT provides better dose stability under weight change conditions was also determined. We generated clinical IMRT and VMAT prostate and seminal vesicle treatment plans for varying SSDs for 10 randomly selected patients with prostate cancer. The differences due to SSD change were quantified by a specific dose change for a specified volume of interest. The target mean dose, decreased or increased by 2.9% per 1-cm SSD decrease or increase in IMRT and by 3.6% in VMAT. If the SSD deviation is more than 1 cm, the radiation oncology team should determine whether to continue treatment without modifications, to adjust monitor units, or to resimulate and replan.« less

Using individual patient anatomy to predict protocol compliance for prostate intensity-modulated radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Caine, Hannah; Whalley, Deborah; Kneebone, Andrew

If a prostate intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) plan has protocol violations, it is often a challenge knowing whether this is due to unfavorable anatomy or suboptimal planning. This study aimed to create a model to predict protocol violations based on patient anatomical variables and their potential relationship to target and organ at risk (OAR) end points in the setting of definitive, dose-escalated IMRT/VMAT prostate planning. Radiotherapy plans from 200 consecutive patients treated with definitive radiation for prostate cancer using IMRT or VMAT were analyzed. The first 100 patient plans (hypothesis-generating cohort) were examined to identifymore » anatomical variables that predict for dosimetric outcome, in particular OAR end points. Variables that scored significance were further assessed for their ability to predict protocol violations using a Classification and Regression Tree (CART) analysis. These results were then validated in a second group of 100 patients (validation cohort). In the initial analysis of the hypothesis-generating cohort, percentage of rectum overlap in the planning target volume (PTV) (%OR) and percentage of bladder overlap in the PTV (%OB) were highlighted as significant predictors of rectal and bladder dosimetry. Lymph node treatment was also significant for bladder outcomes. For the validation cohort, CART analysis showed that %OR of < 6%, 6% to 9% and > 9% predicted a 13%, 63%, and 100% rate of rectal protocol violations respectively. For the bladder, %OB of < 9% vs > 9% is associated with 13% vs 88% rate of bladder constraint violations when lymph nodes were not treated. If nodal irradiation was delivered, plans with a %OB of < 9% had a 59% risk of violations. Percentage of rectum and bladder within the PTV can be used to identify individual plan potential to achieve dose-volume histogram (DVH) constraints. A model based on these factors could be used to reduce planning time, improve work flow, and strengthen plan quality and consistency.« less

SU-F-J-108: TMR Correction Factor Based Online Adaptive Radiotherapy for Stereotactic Radiosurgery (SRS) of L-Spine Tumors Using Cone Beam CT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ghaffar, I; Balik, S; Zhuang, T

Purpose: To investigate the feasibility of using TMR ratio correction factors for a fast online adaptive plan to compensate for anatomical changes in stereotactic radiosurgery (SRS) of L-spine tumors. Methods: Three coplanar treatment plans were made for 11 patients: Uniform (9 IMRT beams equally distributed around the patient); Posterior (IMRT with 9 posterior beams every 20 degree) and VMAT (2 360° arcs). For each patient, the external body and bowel gas were contoured on the planning CT and pre-treatment CBCT. After registering CBCT and the planning CT by aligning to the tumor, the CBCT contours were transferred to the planningmore » CT. To estimate the actual delivered dose while considering patient’s anatomy of the treatment day, a hybrid CT was created by overriding densities in planning CT using the differences between CT and CBCT external and bowel gas contours. Correction factors (CF) were calculated using the effective depth information obtained from the planning system using the hybrid CT: CF = TMR (delivery)/TMR (planning). The adaptive plan was generated by multiplying the planned Monitor Units with the CFs. Results: The mean absolute difference (MAD) in V16Gy of the target between planned and estimated delivery with and without TMR correction was 0.8 ± 0.7% vs. 2.4 ± 1.3% for Uniform and 1.0 ± 0.9% vs. 2.6 ± 1.3% for VMAT plans(p<0.05), respectively. For V12Gy of cauda-equina with and without TMR correction, MAD was 0.24 ± 0.19% vs. 1.2 ± 1.02% for Uniform and 0.23 ± 0.20% vs. 0.78 ± 0.79% for VMAT plans(p<0.05), respectively. The differences between adaptive and original plans were not significant for posterior plans. Conclusion: The online adaptive strategy using TMR ratios and pre-treatment CBCT information was feasible strategy to compensate for anatomical changes for the patients treated for L-spine tumors, particularly for equally spaced IMRT and VMAT plans.« less

Correlation analysis between 2D and quasi-3D gamma evaluations for both intensity-modulated radiation therapy and volumetric modulated arc therapy

PubMed Central

Kim, Jung-in; Choi, Chang Heon; Wu, Hong-Gyun; Kim, Jin Ho; Kim, Kyubo; Park, Jong Min

2017-01-01

The aim of this work was to investigate correlations between 2D and quasi-3D gamma passing rates. A total of 20 patients (10 prostate cases and 10 head and neck cases, H&N) were retrospectively selected. For each patient, both intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans were generated. For each plan, 2D gamma evaluation with radiochromic films and quasi-3D gamma evaluation with fluence measurements were performed with both 2%/2 mm and 3%/3 mm criteria. Gamma passing rates were grouped together according to delivery techniques and treatment sites. Statistical analyses were performed to examine the correlation between 2D and quasi-3D gamma evaluations. Statistically significant difference was observed between delivery techniques only in the quasi-3D gamma passing rates with 2%/2 mm. Statistically significant differences were observed between treatment sites in the 2D gamma passing rates (differences of less than 8%). No statistically significant correlations were observed between 2D and quasi-3D gamma passing rates except the VMAT group and the group including both IMRT and VMAT with 3%/3 mm (r = 0.564 with p = 0.012 for theVMAT group and r = 0.372 with p = 0.020 for the group including both IMRT and VMAT), however, those were not strong. No strong correlations were observed between 2D and quasi-3D gamma evaluations. PMID:27690300

SU-E-T-550: Modulation Index for VMAT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Park, J; Park, S; Kim, J

2015-06-15

Purpose: To present modulation indices (MIs) for volumetric modulated arc therapy (VMAT). Methods: A total of 40 VMAT plans were retrospectively selected. To investigate the delivery accuracy of each VMAT plan, gamma passing rates, differences in modulating parameters between plans and log files, and differences between the original plans and the plans reconstructed with the log files were acquired. A modulation index (MIt) was designed by multiplications of the weighted quantifications of MLC speeds, MLC accelerations, gantry accelerations and dose-rate variations. Textural features including angular second moment, inverse difference moment, contrast, variance, correlation and entropy were calculated from the fluencesmore » of each VMAT plan. To test the performance of suggested MIs, Spearman’s rank correlation coefficients (r) with the plan delivery accuracy were calculated. Conventional modulation indices for VMAT including the modulation complexity score for VMAT (MCSv), leaf travel modulation complexity score (LTMCS) and MI by Li & Xing were calculated, and their correlations were also analyzed in the same way. Results: The r values of contrast (particular displacement distance, d = 1), variance (d = 1), MIt, MCSv, LTMCS and MI by Li&Xing to the local gamma passing rates with 2%/2 mm were 0.547 (p < 0.001), 0.519 (p < 0.001), −0.658 (p < 0.001), 0.186 (p = 0.251), 0.312 (p = 0.05) and −0.455 (p = 0.003), respectively. The r values of those to the MLC errors were −0.863, −0.828, 0.917, −0.635, − 0.857 and 0.795, respectively (p < 0.001). For dose-volumetric parameters, MIt showed higher statistically significant correlations than did the conventional modulation indices. Conclusion: The MIt, contrast (d = 1) and variance (d = 1) showed good performance to predict the VMAT delivery accuracy showing higher correlations to the results of various types of verification methods for VMAT. This work was in part supported by the National Research Foundation of Korea (NRF) grant (no. 490-20140029 and no. 490-20130047) funded by the Korea government.« less

SU-F-T-378: Evaluation of Dose-Volume Variability and Parameters Between Prostate IMRT and VMAT Plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chow, J; Jiang, R; Kiciak, A

2016-06-15

Purpose: This study compared the rectal dose-volume consistency, equivalent uniform dose (EUD) and normal tissue complication probability (NTCP) in prostate intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). Methods: For forty prostate IMRT and fifty VMAT patients treated using the same dose prescription (78 Gy/39 fraction) and dose-volume criteria in inverse planning optimization, the rectal EUD and NTCP were calculated for each patient. The rectal dose-volume consistency, showing the variability of dose-volume histogram (DVH) among patients, was defined and calculated based on the deviation between the mean and corresponding rectal DVH. Results: From both the prostate IMRT andmore » VMAT plans, the rectal EUD and NTCP were found decreasing with the rectal volume. The decrease rates for the IMRT plans (EUD = 0.47 × 10{sup −3} Gy cm{sup −3} and NTCP = 3.94 × 10{sup −2} % cm{sup −3}) were higher than those for the VMAT (EUD = 0.28 × 10{sup −3} Gy cm{sup −3} and NTCP = 2.61 × 10{sup −2} % cm{sup −3}). In addition, the dependences of the rectal EUD and NTCP on the dose-volume consistency were found very similar between the prostate IMRT and VMAT plans. This shows that both delivery techniques have similar variations of the rectal EUD and NTCP on the dose-volume consistency. Conclusion: Dependences of the dose-volume consistency on the rectal EUD and NTCP were compared between the prostate IMRT and VMAT plans. It is concluded that both rectal EUD and NTCP decreased with an increase of the rectal volume. The variation rates of the rectal EUD and NTCP on the rectal volume were higher for the IMRT plans than VMAT. However, variations of the rectal dose-volume consistency on the rectal EUD and NTCP were found not significant for both delivery techniques.« less

Pancreatic cancer planning: Complex conformal vs modulated therapies.

PubMed

Chapman, Katherine L; Witek, Matthew E; Chen, Hongyu; Showalter, Timothy N; Bar-Ad, Voichita; Harrison, Amy S

2016-01-01

To compare the roles of intensity-modulated radiation therapy (IMRT) and volumetric- modulated arc therapy (VMAT) therapy as compared to simple and complex 3-dimensional chemoradiotherpy (3DCRT) planning for resectable and borderline resectable pancreatic cancer. In all, 12 patients who received postoperative radiotherapy (8) or neoadjuvant concurrent chemoradiotherapy (4) were evaluated retrospectively. Radiotherapy planning was performed for 4 treatment techniques: simple 4-field box, complex 5-field 3DCRT, 5 to 6-field IMRT, and single-arc VMAT. All volumes were approved by a single observer in accordance with Radiation Therapy Oncology Group (RTOG) Pancreas Contouring Atlas. Plans included tumor/tumor bed and regional lymph nodes to 45Gy; with tumor/tumor bed boosted to 50.4Gy, at least 95% of planning target volume (PTV) received the prescription dose. Dose-volume histograms (DVH) for multiple end points, treatment planning, and delivery time were assessed. Complex 3DCRT, IMRT, and VMAT plans significantly (p < 0.05) decreased mean kidney dose, mean liver dose, liver (V30, V35), stomach (D10%), stomach (V45), mean right kidney dose, and right kidney (V15) as compared with the simple 4-field plans that are most commonly reported in the literature. IMRT plans resulted in decreased mean liver dose, liver (V35), and left kidney (V15, V18, V20). VMAT plans decreased small bowel (D10%, D15%), small bowel (V35, V45), stomach (D10%, D15%), stomach (V35, V45), mean liver dose, liver (V35), left kidney (V15, V18, V20), and right kidney (V18, V20). VMAT plans significantly decreased small bowel (D10%, D15%), left kidney (V20), and stomach (V45) as compared with IMRT plans. Treatment planning and delivery times were most efficient for simple 4-field box and VMAT. Excluding patient setup and imaging, average treatment delivery was within 10minutes for simple and complex 3DCRT, IMRT, and VMAT treatments. This article shows significant improvements in 3D plan performance with complex planning over the more frequently compared 3- or 4-field simple 3D planning techniques. VMAT plans continue to demonstrate potential for the most organ sparing. However, further studies are required to identify if dosimetric benefits associated with inverse optimized planning can be translated into clinical benefits and if these treatment techniques are value-added therapies for this group of patients with cancer. Published by Elsevier Inc.

Comparison of plan quality and delivery time between volumetric arc therapy (RapidArc) and Gamma Knife radiosurgery for multiple cranial metastases.

PubMed

Thomas, Evan M; Popple, Richard A; Wu, Xingen; Clark, Grant M; Markert, James M; Guthrie, Barton L; Yuan, Yu; Dobelbower, Michael C; Spencer, Sharon A; Fiveash, John B

2014-10-01

Volumetric modulated arc therapy (VMAT) has been shown to be feasible for radiosurgical treatment of multiple cranial lesions with a single isocenter. To investigate whether equivalent radiosurgical plan quality and reduced delivery time could be achieved in VMAT for patients with multiple intracranial targets previously treated with Gamma Knife (GK) radiosurgery. We identified 28 GK treatments of multiple metastases. These were replanned for multiarc and single-arc, single-isocenter VMAT (RapidArc) in Eclipse. The prescription for all targets was standardized to 18 Gy. Each plan was normalized for 100% prescription dose to 99% to 100% of target volume. Plan quality was analyzed by target conformity (Radiation Therapy Oncology Group and Paddick conformity indices [CIs]), dose falloff (area under the dose-volume histogram curve), as well as the V4.5, V9, V12, and V18 isodose volumes. Other end points included beam-on and treatment time. Compared with GK, multiarc VMAT improved median plan conformity (CIVMAT = 1.14, CIGK = 1.65; P < .001) with no significant difference in median dose falloff (P = .269), 12 Gy isodose volume (P = .500), or low isodose spill (P = .49). Multiarc VMAT plans were associated with markedly reduced treatment time. A predictive model of the 12 Gy isodose volume as a function of tumor number and volume was also developed. For multiple target stereotactic radiosurgery, 4-arc VMAT produced clinically equivalent conformity, dose falloff, 12 Gy isodose volume, and low isodose spill, and reduced treatment time compared with GK. Because of its similar plan quality and increased delivery efficiency, single-isocenter VMAT radiosurgery may constitute an attractive alternative to multi-isocenter radiosurgery for some patients.

Gamma-index method sensitivity for gauging plan delivery accuracy of volumetric modulated arc therapy.

PubMed

Park, Jong In; Park, Jong Min; Kim, Jung-In; Park, So-Yeon; Ye, Sung-Joon

2015-12-01

The aim of this study was to investigate the sensitivity of the gamma-index method according to various gamma criteria for volumetric modulated arc therapy (VMAT). Twenty head and neck (HN) and twenty prostate VMAT plans were retrospectively selected for this study. Both global and local 2D gamma evaluations were performed with criteria of 3%/3 mm, 2%/2 mm, 1%/2 mm and 2%/1 mm. In this study, the global and local gamma-index calculated the differences in doses relative to the maximum dose and the dose at the current measurement point, respectively. Using log files acquired during delivery, the differences in parameters at every control point between the VMAT plans and the log files were acquired. The differences in dose-volumetric parameters between reconstructed VMAT plans using the log files and the original VMAT plans were calculated. The Spearman's rank correlation coefficients (rs) were calculated between the passing rates and those differences. Considerable correlations with statistical significances were observed between global 1%/2 mm, local 1%/2 mm and local 2%/1 mm and the MLC position differences (rs = -0.712, -0.628 and -0.581). The numbers of rs values with statistical significance between the passing rates and the changes in dose-volumetric parameters were largest in global 2%/2 mm (n = 16), global 2%/1 mm (n = 15) and local 2%/1 mm (n = 13) criteria. Local gamma-index method with 2%/1 mm generally showed higher sensitivity to detect deviations between a VMAT plan and the delivery of the VMAT plan. Copyright © 2015 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Dosimetric comparison of 3D conformal, IMRT, and V-MAT techniques for accelerated partial-breast irradiation (APBI)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Qiu, Jian-Jian; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai

2014-07-01

The purpose is to dosimetrically compare the following 3 delivery techniques: 3-dimensional conformal radiation therapy (3D-CRT), intensity-modulated arc therapy (IMRT), and volumetric-modulated arc therapy (V-MAT) in the treatment of accelerated partial-breast irradiation (APBI). Overall, 16 patients with T1/2N0 breast cancer were treated with 3D-CRT (multiple, noncoplanar photon fields) on the RTOG 0413 partial-breast trial. These cases were subsequently replanned using static gantry IMRT and V-MAT technology to understand dosimetric differences among these 3 techniques. Several dosimetric parameters were used in plan quality evaluation, including dose conformity index (CI) and dose-volume histogram analysis of normal tissue coverage. Quality assurance studies includingmore » gamma analysis were performed to compare the measured and calculated dose distributions. The IMRT and V-MAT plans gave more conformal target dose distributions than the 3D-CRT plans (p < 0.05 in CI). The volume of ipsilateral breast receiving 5 and 10 Gy was significantly less using the V-MAT technique than with either 3D-CRT or IMRT (p < 0.05). The maximum lung dose and the ipsilateral lung volume receiving 10 (V{sub 10}) or 20 Gy (V{sub 20}) were significantly less with both V-MAT and IMRT (p < 0.05). The IMRT technique was superior to 3D-CRT and V-MAT of low dose distributions in ipsilateral lung (p < 0.05 in V{sub 5} and D{sub 5}). The total mean monitor units (MUs) for V-MAT (621.0 ± 111.9) were 12.2% less than those for 3D-CRT (707.3 ± 130.9) and 46.5% less than those for IMRT (1161.4 ± 315.6) (p < 0.05). The average machine delivery time was 1.5 ± 0.2 minutes for the V-MAT plans, 7.0 ± 1.6 minutes for the 3D-CRT plans, and 11.5 ± 1.9 minutes for the IMRT plans, demonstrating much less delivery time for V-MAT. Based on this preliminary study, V-MAT and IMRT techniques offer improved dose conformity as compared with 3D-CRT techniques without increasing dose to the ipsilateral lung. In terms of MU and delivery time, V-MAT is significantly more efficient for APBI than for conventional 3D-CRT and static-beam IMRT.« less

An in vivo dose verification method for SBRT–VMAT delivery using the EPID

DOE Office of Scientific and Technical Information (OSTI.GOV)

McCowan, P. M., E-mail: peter.mccowan@cancercare.mb.ca; Medical Physics Department, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9; Van Uytven, E.

2015-12-15

Purpose: Radiation treatments have become increasingly more complex with the development of volumetric modulated arc therapy (VMAT) and the use of stereotactic body radiation therapy (SBRT). SBRT involves the delivery of substantially larger doses over fewer fractions than conventional therapy. SBRT–VMAT treatments will strongly benefit from in vivo patient dose verification, as any errors in delivery can be more detrimental to the radiobiology of the patient as compared to conventional therapy. Electronic portal imaging devices (EPIDs) are available on most commercial linear accelerators (Linacs) and their documented use for dosimetry makes them valuable tools for patient dose verification. In thismore » work, the authors customize and validate a physics-based model which utilizes on-treatment EPID images to reconstruct the 3D dose delivered to the patient during SBRT–VMAT delivery. Methods: The SBRT Linac head, including jaws, multileaf collimators, and flattening filter, were modeled using Monte Carlo methods and verified with measured data. The simulation provides energy spectrum data that are used by their “forward” model to then accurately predict fluence generated by a SBRT beam at a plane above the patient. This fluence is then transported through the patient and then the dose to the phosphor layer in the EPID is calculated. Their “inverse” model back-projects the EPID measured focal fluence to a plane upstream of the patient and recombines it with the extra-focal fluence predicted by the forward model. This estimate of total delivered fluence is then forward projected onto the patient’s density matrix and a collapsed cone convolution algorithm calculates the dose delivered to the patient. The model was tested by reconstructing the dose for two prostate, three lung, and two spine SBRT–VMAT treatment fractions delivered to an anthropomorphic phantom. It was further validated against actual patient data for a lung and spine SBRT–VMAT plan. The results were verified with the treatment planning system (TPS) (ECLIPSE AAA) dose calculation. Results: The SBRT–VMAT reconstruction model performed very well when compared to the TPS. A stringent 2%/2 mm χ-comparison calculation gave pass rates better than 91% for the prostate plans, 88% for the lung plans, and 86% for the spine plans for voxels containing 80% or more of the prescribed dose. Patient data were 86% for the lung and 95% for the spine. A 3%/3 mm χ-comparison was also performed and gave pass rates better than 93% for all plan types. Conclusions: The authors have customized and validated a robust, physics-based model that calculates the delivered dose to a patient for SBRT–VMAT delivery using on-treatment EPID images. The accuracy of the results indicates that this approach is suitable for clinical implementation. Future work will incorporate this model into both offline and real-time clinical adaptive radiotherapy.« less

Dosimetric impact of different CT datasets for stereotactic treatment planning using 3D conformal radiotherapy or volumetric modulated arc therapy.

PubMed

Oechsner, Markus; Odersky, Leonhard; Berndt, Johannes; Combs, Stephanie Elisabeth; Wilkens, Jan Jakob; Duma, Marciana Nona

2015-12-01

The purpose of this study was to assess the impact on dose to the planning target volume (PTV) and organs at risk (OAR) by using four differently generated CT datasets for dose calculation in stereotactic body radiotherapy (SBRT) of lung and liver tumors. Additionally, dose differences between 3D conformal radiotherapy and volumetric modulated arc therapy (VMAT) plans calculated on these CT datasets were determined. Twenty SBRT patients, ten lung cases and ten liver cases, were retrospectively selected for this study. Treatment plans were optimized on average intensity projection (AIP) CTs using 3D conformal radiotherapy (3D-CRT) and volumetric modulated arc therapy (VMAT). Afterwards, the plans were copied to the planning CTs (PCT), maximum intensity projection (MIP) and mid-ventilation (MidV) CT datasets and dose was recalculated keeping all beam parameters and monitor units unchanged. Ipsilateral lung and liver volumes and dosimetric parameters for PTV (Dmean, D2, D98, D95), ipsilateral lung and liver (Dmean, V30, V20, V10) were determined and statistically analysed using Wilcoxon test. Significant but small mean differences were found for PTV dose between the CTs (lung SBRT: ≤2.5 %; liver SBRT: ≤1.6 %). MIPs achieved the smallest lung and the largest liver volumes. OAR mean doses in MIP plans were distinctly smaller than in the other CT datasets. Furthermore, overlapping of tumors with the diaphragm results in underestimated ipsilateral lung dose in MIP plans. Best agreement was found between AIP and MidV (lung SBRT). Overall, differences in liver SBRT were smaller than in lung SBRT and VMAT plans achieved slightly smaller differences than 3D-CRT plans. Only small differences were found for PTV parameters between the four CT datasets. Larger differences occurred for the doses to organs at risk (ipsilateral lung, liver) especially for MIP plans. No relevant differences were observed between 3D-CRT or VMAT plans. MIP CTs are not appropriate for OAR dose assessment. PCT, AIP and MidV resulted in similar doses. If a 4DCT is acquired PCT can be omitted using AIP or MidV for treatment planning.

Dosimetric comparison of helical tomotherapy, intensity-modulated radiation therapy, volumetric-modulated arc therapy, and 3-dimensional conformal therapy for the treatment of T1N0 glottic cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ekici, Kemal, E-mail: drkemal06@hotmail.com; Pepele, Eda K.; Yaprak, Bahaddin

2016-01-01

Various radiotherapy planning methods for T1N0 laryngeal cancer have been proposed to decrease normal tissue toxicity. We compare helical tomotherapy (HT), linac-based intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT), and 3-D conformal radiotherapy (3D-CRT) techniques for T1N0 laryngeal cancer. Overall, 10 patients with T1N0 laryngeal cancer were selected and evaluated. Furthermore, 10 radiotherapy treatment plans have been created for all 10 patients, including HT, IMRT, VMAT, and 3D-CRT. IMRT, VMAT, and HT plans vs 3D-CRT plans consistently provided superior planning target volume (PTV) coverage. Similar target coverage was observed between the 3 IMRT modalities. Compared with 3D-CRT, IMRT, HT,more » and VMAT significantly reduced the mean dose to the carotid arteries. VMAT resulted in the lowest mean dose to the submandibular and thyroid glands. Compared with 3D-CRT, IMRT, HT, and VMAT significantly increased the maximum dose to the spinal cord It was observed that the 3 IMRT modalities studied showed superior target coverage with less variation between each plan in comparison with 3D-CRT. The 3D-CRT plans performed better at the D{sub max} of the spinal cord. Clinical investigation is warranted to determine if these treatment approaches would translate into a reduction in radiation therapy–induced toxicities.« less

Comparative analysis of SmartArc‐based dual arc volumetric‐modulated arc radiotherapy (VMAT) versus intensity‐modulated radiotherapy (IMRT) for nasopharyngeal carcinoma

PubMed Central

Chao, Pei‐Ju; Ting, Hui‐Min; Lo, Su‐Hua; Wang, Yu‐Wen; Tuan, Chiu‐Ching; Fang, Fu‐Min

2011-01-01

The purpose of this study was to evaluate and quantify the planning performance of SmartArc‐based volumetric‐modulated arc radiotherapy (VMAT) versus fixed‐beam intensity‐modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC) using a sequential mode treatment plan. The plan quality and performance of dual arc‐VMAT (DA‐VMAT) using the Pinnacle3 Smart‐Arc system (clinical version 9.0; Philips, Fitchburg, WI, USA) were evaluated and compared with those of seven‐field (7F)‐IMRT in 18 consecutive NPC patients. Analysis parameters included the conformity index (CI) and homogeneity index (HI) for the planning target volume (PTV), maximum and mean dose, normal tissue complication probability (NTCP) for the specified organs at risk (OARs), and comprehensive quality index (CQI) for an overall evaluation in the 11 OARs. Treatment delivery time, monitor units per fraction (MU/fr), and gamma (Γ3mm,3%) evaluations were also analyzed. DA‐VMAT achieved similar target coverage and slightly better homogeneity than conventional 7F‐IMRT with a similar CI and HI. NTCP values were only significantly lower in the left parotid gland (for xerostomia) for DA‐VMAT plans. The mean value of CQI at 0.98±0.02 indicated a 2% benefit in sparing OARs by DA‐VMAT. The MU/fr used and average delivery times appeared to show improved efficiencies in DA‐VMAT. Each technique demonstrated high accuracy in dose delivery in terms of a high‐quality assurance (QA) passing rate (>98%) of the (Γ3mm,3%) criterion. The major difference between DA‐VMAT and 7F‐IMRT using a sequential mode for treating NPC cases appears to be improved efficiency, resulting in a faster delivery time and the use of fewer MU/fr. PACS number: 87.53.Tf, 87.55.x, 87.55.D, 87.55.dk PMID:22089015

DOE Office of Scientific and Technical Information (OSTI.GOV)

Giaddui, T; Hardin, M; Keller, J

Purpose: To evaluate patient specific quality assurance (PSQA) for the delivery of volumetric modulated arc therapy (VMAT) by disease site. To compare planning-delivery system (PDS) PSQA pass rates in a dual vendor institution. Methods: PSQA is performed for VMAT plans using a ScandiDos Delta4 phantom. Verification plans are calculated using Varian Eclipse and Elekta Monaco treatment planning systems (TPS) for patients treated using Varian Truebeam and Elekta linear accelerators respectively. Individual arcs are delivered to the Delta4 phantoms and assessed using the gamma index pass criterion(3% Dose Deviation(DD%), 3mm Distance to Agreement(DTA),10% dose threshold and 90% gamma index). Results: Amore » total of 287 VMAT plans and 680 arcs were analyzed. The passing rates for VMAT QA plans were 95% and 98% for head/neck and pelvis/prostate plans respectively, and 100% for chest/abdomen, spine, lung Stereotactic Body Radiotherapy (SBRT) and Stereotactic Radiosurgery(SRS) plans. Average gamma indices were: (99 ± 2) % for pelvis/prostate, chest/abdomen and lung SBRT plans, (97 ± 4) % for head and neck plans and (98 ± 3) % for spine plans. The average DD% and DTA pass rates ranged from 82% to 90% and 98% to 99% respectively for plans in different disease sites. Paired t-test analysis (two tails) indicated no significant differences in the gamma indices between plans delivered using different PDS; the P values were: 0.08, 0.45, and 0.94 for lung SBRT, head/neck and pelvis/prostate plans respectively. The statistical power for comparing PDS in different disease sites with an alpha of 0.05 is 1. Conclusion: The Gamma indices based on 3% DD%, 3 mm DTA and 10% dose threshold for the VMAT QA plans in all disease sites were well above 90%, suggesting the possibility of using a more stringent PSQA criterion. No significant differences were observed in the QA of VMAT plans delivered using different PDS.« less

SU-E-T-76: A Software System to Monitor VMAT Plan Complexity in a Large Radiotherapy Centre

DOE Office of Scientific and Technical Information (OSTI.GOV)

Arumugam, S; Xing, A; Ingham Institute, Sydney, NSW

2015-06-15

Purpose: To develop a system that analyses and reports the complexity of Volumetric Modulated Arc Therapy (VMAT) plans to aid in the decision making for streamlining patient specific dosimetric quality assurance (QA) tests. Methods: A software system, Delcheck, was developed in-house to calculate VMAT plan and delivery complexity using the treatment delivery file. Delcheck has the functionality to calculate multiple plan complexity metrics including the Li-Xing Modulation Index (LI-MI), multiplicative combination of Leaf Travel and Modulation Complexity Score (LTMCSv), Monitor Units per prescribed dose (MU/D) and the delivery complexity index (MIt) that incorporates the modulation of dose rate, leaf speedmore » and gantry speed. Delcheck includes database functionality to store and compare plan metrics for a specified treatment site. The overall plan and delivery complexity is assessed based on the 95% conformance limit of the complexity metrics as Similar, More or Less complex. The functionality of the software was tested using 42 prostate conventional, 10 prostate SBRT and 15 prostate bed VMAT plans generated for an Elekta linear accelerator. Results: The mean(σ) of LI-MI for conventional, SBRT and prostate bed plans were 1690(486), 3215.4(1294) and 3258(982) respectively. The LTMCSv of the studied categories were 0.334(0.05), 0.325(0.07) and 0.3112(0.09). The MU/D of the studied categories were 2.4(0.4), 2.7(0.7) and 2.5(0.5). The MIt of the studied categories were 21.6(3.4), 18.2(3.0) and 35.9(6.6). The values of the complexity metrics show that LI-MI appeared to resolve the plan complexity better than LTMCSv and MU/D. The MIt value increased as the delivery complexity increased. Conclusion: The developed software was shown to be working as expected. In studied treatment categories Prostate bed plans are more complex in both plan and delivery and SBRT is more complex in plan and less complex in delivery as demonstrated by LI-MI and MIt. This project was funded through a Cancer Council NSW Project Grant (RG14-11)« less

Radiation Planning Assistant - A Streamlined, Fully Automated Radiotherapy Treatment Planning System

PubMed Central

Court, Laurence E.; Kisling, Kelly; McCarroll, Rachel; Zhang, Lifei; Yang, Jinzhong; Simonds, Hannah; du Toit, Monique; Trauernicht, Chris; Burger, Hester; Parkes, Jeannette; Mejia, Mike; Bojador, Maureen; Balter, Peter; Branco, Daniela; Steinmann, Angela; Baltz, Garrett; Gay, Skylar; Anderson, Brian; Cardenas, Carlos; Jhingran, Anuja; Shaitelman, Simona; Bogler, Oliver; Schmeller, Kathleen; Followill, David; Howell, Rebecca; Nelson, Christopher; Peterson, Christine; Beadle, Beth

2018-01-01

The Radiation Planning Assistant (RPA) is a system developed for the fully automated creation of radiotherapy treatment plans, including volume-modulated arc therapy (VMAT) plans for patients with head/neck cancer and 4-field box plans for patients with cervical cancer. It is a combination of specially developed in-house software that uses an application programming interface to communicate with a commercial radiotherapy treatment planning system. It also interfaces with a commercial secondary dose verification software. The necessary inputs to the system are a Treatment Plan Order, approved by the radiation oncologist, and a simulation computed tomography (CT) image, approved by the radiographer. The RPA then generates a complete radiotherapy treatment plan. For the cervical cancer treatment plans, no additional user intervention is necessary until the plan is complete. For head/neck treatment plans, after the normal tissue and some of the target structures are automatically delineated on the CT image, the radiation oncologist must review the contours, making edits if necessary. They also delineate the gross tumor volume. The RPA then completes the treatment planning process, creating a VMAT plan. Finally, the completed plan must be reviewed by qualified clinical staff. PMID:29708544

Dose verification for respiratory-gated volumetric modulated arc therapy (VMAT)

PubMed Central

Qian, Jianguo; Xing, Lei; Liu, Wu; Luxton, Gary

2011-01-01

A novel commercial medical linac system (TrueBeam™, Varian Medical Systems, Palo Alto, CA) allows respiratory-gated volumetric modulated arc therapy (VMAT), a new modality for treating moving tumors with high precision and improved accuracy by allowing for regular motion associated with a patient's breathing during VMAT delivery. The purpose of this work is to adapt a previously-developed dose reconstruction technique to evaluate the fidelity of VMAT treatment during gated delivery under clinic-relevant periodic motion related to patient breathing. A Varian TrueBeam system was used in this study. VMAT plans were created for three patients with lung or pancreas tumors. Conventional 6 MV and 15 MV beams with flattening filter and high dose-rate 10 MV beams with no flattening filter were used in these plans. Each patient plan was delivered to a phantom first without gating and then with gating for three simulated respiratory periods (3, 4.5 and 6 seconds). Using the adapted log file-based dose reconstruction procedure supplemented with ion chamber array (Seven29™, PTW, Freiburg, Germany) measurements, the delivered dose was used to evaluate the fidelity of gated VMAT delivery. Comparison of Seven29 measurements with and without gating showed good agreement with gamma-index passing rates above 99% for 1%/1mm dose accuracy/distance-to-agreement criteria. With original plans as reference, gamma-index passing rates were 100% for the reconstituted plans (1%/1 mm criteria) and 93.5–100% for gated Seven29 measurements (3%/3 mm criteria). In the presence of leaf error deliberately introduced into the gated delivery of a pancreas patient plan, both dose reconstruction and Seven29 measurement consistently indicated substantial dosimetric differences from the original plan. In summary, a dose reconstruction procedure was demonstrated for evaluating the accuracy of respiratory-gated VMAT delivery. This technique showed that under clinical operation, the TrueBeam system faithfully realized treatment plans with gated delivery. This methodology affords a useful tool for machine and patient-specific quality assurance of the newly available respiratory-gated VMAT. PMID:21753232

SU-E-T-504: Usefulness of CT-MR Fusion in Radiotherapy Planning for Prostate Cancer Patient with Bilateral Hip Replacements

DOE Office of Scientific and Technical Information (OSTI.GOV)

He, R.; Giri, Shankar; VA Medical Center at Jackson, Mississippi

2014-06-01

Purpose: Target localization of prostate for Intensity Modulated Radiation Therapy (IMRT) in patients with bilateral hip replacements is difficult due to artifacts in Computed Tomography (CT) images generated from the prostheses high Z materials. In this study, Magnetic Resonance (MR) images fused with CT images are tested as a solution. Methods: CT images of 2.5 mm slice thickness were acquired on a GE Lightspeed scanner with a flat-topped couch for a prostate cancer patient with bilateral hip replacements. T2 weighted images of 5 mm separation were acquired on a MR Scanner. After the MR-CT registration on a radiotherapy treatment planningmore » system (Eclipse, Varian), the target volumes were defined by the radiation oncologists on MR images and then transferred to CT images for planning and dose calculation. The CT Hounsfield Units (HU) was reassigned to zero (as water) for artifacts. The Varian flat panel treatment couch was modeled for dose calculation accuracy with heterogeneity correction. A Volume Matrix Arc Therapy (VMAT) and a seven-field IMRT plans were generated, each avoiding any beam transversing the prostheses; the two plans were compared. The superior VMAT plan was used for treating the patient. In-vivo dosimetry was performed using MOSFET (Best Canada) placed in a surgical tube inserted into the patient rectum during therapy. The measured dose was compared with planned dose for MOSFET location. Results: The registration of MR-CT images and the agreement of target volumes were confirmed by three physicians. VMAT plan was deemed superior to IMRT based on dose to critical nearby structures and overall conformality of target dosing. In-vivo measured dose compared with calculated dose was -4.5% which was likely due to attenuation of the surgical tube surrounding MOSFET. Conclusion: When artifacts are present on planning CT due to bilateral hip prostheses, MR-CT image fusion is a feasible solution for target delineation.« less

Applicator-guided volumetric-modulated arc therapy for low-risk endometrial cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cilla, Savino, E-mail: savinocilla@gmail.com; Macchia, Gabriella; Sabatino, Domenico

2013-04-01

The aim of this study was to report the feasibility of volumetric-modulated arc therapy (VMAT) in the postoperative irradiation of the vaginal vault. Moreover, the VMAT technique was compared with 3D conformal radiotherapy (3D-CRT) and fixed-field intensity-modulated radiotherapy (IMRT), in terms of target coverage and organs at risk sparing. The number of monitor units and the delivery time were analyzed to score the treatment efficiency. All plans were verified in a dedicated solid water phantom using a 2D array of ionization chambers. Twelve patients with endometrial carcinoma who underwent radical hystero-adenexectomy and fixed-field IMRT treatments were retrospectively included in thismore » analysis; for each patient, plans were compared in terms of dose-volume histograms, homogeneity index, and conformity indexes. All techniques met the prescription goal for planning target volume coverage, with VMAT showing the highest level of conformity at all dose levels. VMAT resulted in significant reduction of rectal and bladder volumes irradiated at all dose levels compared with 3D-CRT. No significant differences were found with respect to IMRT. Moreover, a significant improvement of the dose conformity was reached by VMAT technique not only at the 95% dose level (0.74 vs. 0.67 and 0.62) but also at 50% and 75% levels of dose prescription. In addition, VMAT plans showed a significant reduction of monitor units by nearly 28% with respect to IMRT, and reduced treatment time from 11 to <3 minutes for a single 6-Gy fraction. In conclusion, VMAT plans can be planned and carried out with high quality and efficiency for the irradiation of vaginal vault alone, providing similar or better sparing of organs at risk to fixed-field IMRT and resulting in the most efficient treatment option. VMAT is currently our standard approach for radiotherapy of low-risk endometrial cancer.« less

SU-F-T-364: Monte Carlo-Dose Verification of Volumetric Modulated Arc Therapy Plans Using AAPM TG-119 Test Patterns

DOE Office of Scientific and Technical Information (OSTI.GOV)

Onizuka, R; Araki, F; Ohno, T

2016-06-15

Purpose: To investigate the Monte Carlo (MC)-based dose verification for VMAT plans by a treatment planning system (TPS). Methods: The AAPM TG-119 test structure set was used for VMAT plans by the Pinnacle3 (convolution/superposition), using a Synergy radiation head of a 6 MV beam with the Agility MLC. The Synergy was simulated with the EGSnrc/BEAMnrc code, and VMAT dose distributions were calculated with the EGSnrc/DOSXYZnrc code by the same irradiation conditions as TPS. VMAT dose distributions of TPS and MC were compared with those of EBT3 film, by 2-D gamma analysis of ±3%/3 mm criteria with a threshold of 30%more » of prescribed doses. VMAT dose distributions between TPS and MC were also compared by DVHs and 3-D gamma analysis of ±3%/3 mm criteria with a threshold of 10%, and 3-D passing rates for PTVs and OARs were analyzed. Results: TPS dose distributions differed from those of film, especially for Head & neck. The dose difference between TPS and film results from calculation accuracy for complex motion of MLCs like tongue and groove effect. In contrast, MC dose distributions were in good agreement with those of film. This is because MC can model fully the MLC configuration and accurately reproduce the MLC motion between control points in VMAT plans. D95 of PTV for Prostate, Head & neck, C-shaped, and Multi Target was 97.2%, 98.1%, 101.6%, and 99.7% for TPS and 95.7%, 96.0%, 100.6%, and 99.1% for MC, respectively. Similarly, 3-D gamma passing rates of each PTV for TPS vs. MC were 100%, 89.5%, 99.7%, and 100%, respectively. 3-D passing rates of TPS reduced for complex VMAT fields like Head & neck because MLCs are not modeled completely for TPS. Conclusion: MC-calculated VMAT dose distributions is useful for the 3-D dose verification of VMAT plans by TPS.« less

Influence of jaw tracking in intensity-modulated and volumetric-modulated arc radiotherapy for head and neck cancers: a dosimetric study.

PubMed

Mani, Karthick Raj; Upadhayay, Sagar; Das, K J Maria

2017-03-01

To Study the dosimetric advantage of the Jaw tracking technique in intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) for Head and Neck Cancers. We retrospectively selected 10 previously treated head and neck cancer patients stage (T1/T2, N1, M0) in this study. All the patients were planned for IMRT and VMAT with simultaneous integrated boost technique. IMRT and VMAT plans were performed with jaw tracking (JT) and with static jaw (SJ) technique by keeping the same constraints and priorities for a particular patient. Target conformity, dose to the critical structures and low dose volumes were recorded and analyzed for IMRT and VMAT plans with and without JT for all the patients. The conformity index average of all patients followed by standard deviation ([Formula: see text] ± [Formula: see text]) of the JT-IMRT, SJ-IMRT, JT-VMAT, and SJ-VMAT were 1.72 ± 0.56, 1.67 ± 0.57, 1.83 ± 0.65, and 1.85 ± 0.64, and homogeneity index were 0.059 ± 0.05, 0.064 ± 0.05, 0.064 ± 0.04, and 0.064 ± 0.05. JT-IMRT shows significant mean reduction in right parotid and left parotid shows of 7.64% (p < 0.001) and 7.45% (p < 0.001) compare to SJ-IMRT. JT-IMRT plans also shows considerable dose reduction to thyroid, inferior constrictors, spinal cord and brainstem compared to the SJ-IMRT plans. Significant dose reductions were observed for critical structure in the JT-IMRT compared to SJ-IMRT technique. In JT-VMAT plans dose reduction to the critical structure were not significant compared to the SJ-IMRT due to relatively lesser monitor units.

Quasi-VMAT in high-grade glioma radiation therapy.

PubMed

Fadda, G; Massazza, G; Zucca, S; Durzu, S; Meleddu, G; Possanzini, M; Farace, P

2013-05-01

To compare a quasi-volumetric modulated arc therapy (qVMAT) with three-dimensional conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) for the treatment of high-grade gliomas. The qVMAT technique is a fast method of radiation therapy in which multiple equispaced beams analogous to those in rotation therapy are radiated in succession. This study included 12 patients with a planning target volume (PTV) that overlapped at least one organ at risk (OAR). 3D-CRT was planned using 2-3 non-coplanar beams, whereby the field-in-field technique (FIF) was used to divide each field into 1-3 subfields to shield the OAR. The qVMAT strategy was planned with 15 equispaced beams and IMRT was planned using 9 beams with a total of 80 segments. Inverse planning for qVMAT and IMRT was performed by direct machine parameter optimization (DMPO) to deliver a homogenous dose distribution of 60 Gy within the PTV and simultaneously limit the dose received by the OARs to the recommended values. Finally, the effect of introducing a maximum dose objective (max. dose < 54 Gy) for a virtual OAR in the form of a 0.5 cm ring around the PTV was investigated. The qVMAT method gave rise to significantly improved PTV95% and conformity index (CI) values in comparison to 3D-CRT (PTV95% = 90.7 % vs. 82.0 %; CI = 0.79 vs. 0.74, respectively). A further improvement was achieved by IMRT (PTV95% = 94.4 %, CI = 0.78). In qVMAT and IMRT, the addition of a 0.5 cm ring around the PTV produced a significant increase in CI (0.87 and 0.88, respectively), but dosage homogeneity within the PTV was considerably reduced (PTV95% = 88.5 % and 92.3 %, respectively). The time required for qVMAT dose delivery was similar to that required using 3D-CRT. These findings suggest that qVMAT should be preferred to 3D-CRT for the treatment of high-grade gliomas. The qVMAT method could be applied in hospitals, for example, which have limited departmental resources and are not equipped with systems capable of VMAT delivery.

SU-E-T-18: A Comparison of Planning Techniques for Bilateral Reconstructed Chest Wall Patients Undergoing Whole Breast Irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Volpe, T; Margiasso, R; Saleh, Z

2015-06-15

Purpose: As we continuously see more bilateral reconstructed chest wall cases, new challenges are being presented to deliver left-sided breast irradiation. We herein compare three Deep Inspiration Breath Hold (DIBH) planning techniques (tangents, VMAT, and IMRT) and two free breathing techniques (VMAT and IMRT). Methods: Three left-sided chest wall patients with bilateral implants were studied. Tangents, VMAT, and IMRT plans were created for DIBH scans. VMAT and IMRT plans were created for free breathing scans. All plans were normalized so that 95% of the prescription dose was delivered to 95% of the planning target volume (PTV). The maximum point dosemore » was constrained to less than 120% of the prescription dose. Since the success of DIBH delivery largely depends on patient’s ability to perform consistent breath hold during beam on time, smaller number of Monitor Units (MU) is in general desired. For each patient, the following information was collected to compare the planning techniques: heart mean dose, left and right lung V20 Gy, contra-lateral (right) breast mean dose, cord max dose, and MU. Results: The average heart mean dose over all patients are 1561, 692, 985, 1245, and 1121 cGy, for DIBH tangents, VMAT, IMRT, free breathing VMAT and IMRT, respectively. For left lung V20 are 60%, 28%, 26%, 30%, and 29%. For contra-lateral breast mean dose are 244, 687, 616, 783, 438 cGy. MU are 253, 853, 2048, 1035, and 1874 MUs. Conclusion: In the setting of bilateral chest wall reconstruction, opposed tangent beams cannot consistently achieve desired heart and left lung sparing. DIBH consistently achieves better healthy tissue sparing. VMAT appears to be preferential to IMRT for planning and delivering radiation to patients with bilaterally reconstructed chest walls being treated with DIBH.« less

SU-F-T-613: Multi-Lesion Cranial SRS VMAT Plan Quality

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ballangrud, A; Kuo, L; Happersett, L

Purpose: Cranial SRS VMAT plans must have steep dose gradient around each target to reduce dose to normal brain. This study reports on the correlation between gradient index (GI=V50%/V100%), target size and target dose heterogeneity index (HI=PTV Dmax/prescription dose) for multi-lesion cranial SRS VMAT plans. Methods: VMAT plans for 10 cranial cases with 3 to 6 lesions (total 39 lesions) generated in Varian Eclipse V11.0.47 with a fine-tuned AAA beam model and 0.125 cm dose grid were analyzed. One or two iso centers were used depending on the spatial distribution of lesions. Two to nine coplanar and non-coplanar arcs weremore » used per isocenter. Conformity index (CI= V100%/VPTV), HI, and GI were determined for each lesion. Dose to critical structures were recorded. Results: Lesion size ranged from 0.05–11.00 cm3. HI ranged from 1.2–1.4, CI ranged from 1.0–2.8 and GI from 3.1–8.4. Maximum dose to brainstem, chiasm, lenses, optic nerves and eyes ranged from 120–1946 cGy, 47–463 cGy, 9–121 cGy, 14–512 cGy, and 17–294 cGy, respectively. Brain minus PTV (Brain-PTV) V7Gy was in the range 1.1–6.5%, and Brain-PTV Dmean was in the range 94–324 cGy. Conclusion: This work shows that a GI < 5 can be achieved for lesions > 0.4cc. For smaller lesions, GI increases rapidly. GI is lower when HI is increased. Based on this study, recommend HI is 1.4, and recommended GI is for volumes <0.1cc GI<9, 0.1–0.4cc GI<6, 0.4–0.1.0cc GI<5, and for volumes >1.0cc GI<4. CI is < 1.3 for all lesions except for targets < 0.1cc. Cranial SRS VMAT plans must be optimized to lower the GI to reduce the dose to normal brain tissue.« less

SU-F-T-306: Validation of Mobius 3D and FX for Elekta Linear Accelerators

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nelson, C; Garcia, M; Calderon, E

2016-06-15

Purpose: Log file based IMRT and VMAT QA is a system that analyzes treatment log files and uses delivery parameters to compute the dose to the patient/phantom. This system was previously commissioned for Varian machines, the purpose of this work is to describe the process for commissioning Mobius for use with Elekta machines. Methods: Twelve IMRT and VMAT plans (6×) were planned and delivered and dose was measured using MapCheck, the results were compared to that computed by Mobius. For 10x and 18x, plans were generated, copied to a phantom and delivered, the dose was measured using a single ionmore » chamber. The difference in measured dose to computed dose (Mobius) was used to adjust the dynamic leaf gap (DLG) in Mobius to achieve optimal agreement between measurements, Mobius and treatment plans. Results: For the measured dose comparison, the average 3%/3mm gamma 97.1% of pixels passed criteria using MapCheck where Mobius computed 96.9% of voxels passing. For 10×, a DLG of −5.5 was determined to achieve optimal results for TPS and measured ion chamber data with an average 0.1% difference and −1.7% respectively. For 18×, a DLG of −3 was determined to achieve optimal results from the TPS and measured data with an average of −0.7% and −1.4% difference on average from a set of IMRT and VMAT plans. The 6x data needed no DLG correction to arrive at agreement with the TPS and the MapCheck measured data. Conclusion: We have validated with measurements for IMRT and VMAT cases the use of Mobius FX with Elekta treatment machines for IMRT and VMAT QA. For 6×, no adjustments to the DLG were required to obtain good results utilizing Mobius whereas for 10× and 18×, the DLG had to be adjusted to obtain optimum agreement with measured data and our TPS.« less

Pancreatic cancer planning: Complex conformal vs modulated therapies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chapman, Katherine L.; Witek, Matthew E.; Chen, Hongyu

To compare the roles of intensity-modulated radiation therapy (IMRT) and volumetric- modulated arc therapy (VMAT) therapy as compared to simple and complex 3-dimensional chemoradiotherpy (3DCRT) planning for resectable and borderline resectable pancreatic cancer. In all, 12 patients who received postoperative radiotherapy (8) or neoadjuvant concurrent chemoradiotherapy (4) were evaluated retrospectively. Radiotherapy planning was performed for 4 treatment techniques: simple 4-field box, complex 5-field 3DCRT, 5 to 6-field IMRT, and single-arc VMAT. All volumes were approved by a single observer in accordance with Radiation Therapy Oncology Group (RTOG) Pancreas Contouring Atlas. Plans included tumor/tumor bed and regional lymph nodes to 45more » Gy; with tumor/tumor bed boosted to 50.4 Gy, at least 95% of planning target volume (PTV) received the prescription dose. Dose-volume histograms (DVH) for multiple end points, treatment planning, and delivery time were assessed. Complex 3DCRT, IMRT, and VMAT plans significantly (p < 0.05) decreased mean kidney dose, mean liver dose, liver (V{sub 30}, V{sub 35}), stomach (D{sub 10}%), stomach (V{sub 45}), mean right kidney dose, and right kidney (V{sub 15}) as compared with the simple 4-field plans that are most commonly reported in the literature. IMRT plans resulted in decreased mean liver dose, liver (V{sub 35}), and left kidney (V{sub 15}, V{sub 18}, V{sub 20}). VMAT plans decreased small bowel (D{sub 10}%, D{sub 15}%), small bowel (V{sub 35}, V{sub 45}), stomach (D{sub 10}%, D{sub 15}%), stomach (V{sub 35}, V{sub 45}), mean liver dose, liver (V{sub 35}), left kidney (V{sub 15}, V{sub 18}, V{sub 20}), and right kidney (V{sub 18}, V{sub 20}). VMAT plans significantly decreased small bowel (D{sub 10}%, D{sub 15}%), left kidney (V{sub 20}), and stomach (V{sub 45}) as compared with IMRT plans. Treatment planning and delivery times were most efficient for simple 4-field box and VMAT. Excluding patient setup and imaging, average treatment delivery was within 10 minutes for simple and complex 3DCRT, IMRT, and VMAT treatments. This article shows significant improvements in 3D plan performance with complex planning over the more frequently compared 3- or 4-field simple 3D planning techniques. VMAT plans continue to demonstrate potential for the most organ sparing. However, further studies are required to identify if dosimetric benefits associated with inverse optimized planning can be translated into clinical benefits and if these treatment techniques are value-added therapies for this group of patients with cancer.« less

Verification of Dosimetric Commissioning Accuracy of Intensity Modulated Radiation Therapy and Volumetric Modulated Arc Therapy Delivery using Task Group-119 Guidelines.

PubMed

Kaviarasu, Karunakaran; Nambi Raj, N Arunai; Hamid, Misba; Giri Babu, A Ananda; Sreenivas, Lingampally; Murthy, Kammari Krishna

2017-01-01

The purpose of this study is to verify the accuracy of the commissioning of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) based on the recommendation of the American Association of Physicists in Medicine Task Group 119 (TG-119). TG-119 proposes a set of clinical test cases to verify the accuracy of IMRT planning and delivery system. For these test cases, we generated two sets of treatment plans, the first plan using 7-9 IMRT fields and a second plan utilizing two-arc VMAT technique for both 6 MV and 15 MV photon beams. The template plans of TG-119 were optimized and calculated by Varian Eclipse Treatment Planning System (version 13.5). Dose prescription and planning objectives were set according to the TG-119 goals. The point dose (mean dose to the contoured chamber volume) at the specified positions/locations was measured using compact (CC-13) ion chamber. The composite planar dose was measured with IMatriXX Evaluation 2D array with OmniPro IMRT Software (version 1.7b). The per-field relative gamma was measured using electronic portal imaging device in a way similar to the routine pretreatment patient-specific quality assurance. Our planning results are compared with the TG-119 data. Point dose and fluence comparison data where within the acceptable confident limit. From the obtained data in this study, we conclude that the commissioning of IMRT and VMAT delivery were found within the limits of TG-119.

Verification of Dosimetric Commissioning Accuracy of Intensity Modulated Radiation Therapy and Volumetric Modulated Arc Therapy Delivery using Task Group-119 Guidelines

PubMed Central

Kaviarasu, Karunakaran; Nambi Raj, N. Arunai; Hamid, Misba; Giri Babu, A. Ananda; Sreenivas, Lingampally; Murthy, Kammari Krishna

2017-01-01

Aim: The purpose of this study is to verify the accuracy of the commissioning of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) based on the recommendation of the American Association of Physicists in Medicine Task Group 119 (TG-119). Materials and Methods: TG-119 proposes a set of clinical test cases to verify the accuracy of IMRT planning and delivery system. For these test cases, we generated two sets of treatment plans, the first plan using 7–9 IMRT fields and a second plan utilizing two-arc VMAT technique for both 6 MV and 15 MV photon beams. The template plans of TG-119 were optimized and calculated by Varian Eclipse Treatment Planning System (version 13.5). Dose prescription and planning objectives were set according to the TG-119 goals. The point dose (mean dose to the contoured chamber volume) at the specified positions/locations was measured using compact (CC-13) ion chamber. The composite planar dose was measured with IMatriXX Evaluation 2D array with OmniPro IMRT Software (version 1.7b). The per-field relative gamma was measured using electronic portal imaging device in a way similar to the routine pretreatment patient-specific quality assurance. Results: Our planning results are compared with the TG-119 data. Point dose and fluence comparison data where within the acceptable confident limit. Conclusion: From the obtained data in this study, we conclude that the commissioning of IMRT and VMAT delivery were found within the limits of TG-119. PMID:29296041

SU-F-T-27: A Comparative Case Study Among Four Modalities for the Superficial Treatment of Squamous Cell Carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ashenafi, M; Koch, N; Peng, J

Purpose: We performed a comparative planning study among High Dose Rate (HDR) brachytherapy, superficial electrons, Volume Modulated Arc Therapy (VMAT), and Helical IMRT (Tomotherapy) for squamous cell carcinoma of the abdominal wall with consideration for the underlining bowel. Methods: A 69-year old female presented with squamous cell carcinoma protruding 8mm beyond the anterior skin surface of the midabdomen was considered for treatment. The patient had a ventral hernia which resulted in the reduction of the abdominal wall thickness and the adjacent small bowel being the dose limiting structure. Four plans were generated using different treatment modalities: a) an enface electronmore » field (eMC, Eclipse v. 11), b) Tomotherapy (HI-Art II v.5.0.5), c) VMAT (Acuros, Eclipse v. 11), and d) HDR using a Freiburg applicator (Oncentra v. 4.3). The following plan objectives were used for all four plans: for the CTV target, V90% ≥90% (61.8Gy2/2).For the small bowel, D0.1cc < 56.2 Gy2/2 was a hard constraint and expressed as a percentage of the prescription for comparison to demonstrate the dose fall-off achieved among the modalities.For HDR, V200% <0.1cc was an additional constraint. Multiple dosimetric parameters, including those listed above, were compared among the four modalities. Results: The HDR plan showed comparable target coverage compared to the Tomotherapy plan and better coverage compared to the electron plan. Small bowel doses (D0.1cc) were lower in HDR plan compared to Tomotherapy, electron, & VMAT plans (88.8%, 89.6%, 90.9%, & 96.6%). Integral dose to the whole body (V5%) was much higher for HDR, VMAT, and Tomotherapy when compared to electron plan by factors of seven, eight, and ten, respectively. After reviewing all treatment modalities, the physician selected HDR owing to better control of the small bowel dose while maintaining adequate target coverage. Conclusion: This case study demonstrated HDR can successfully treat superficial lesions with superior sparing of underlying structures.« less

Treatment planning for radiotherapy with very high-energy electron beams and comparison of VHEE and VMAT plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bazalova-Carter, Magdalena; Qu, Bradley; Palma, Bianey

2015-05-15

Purpose: The aim of this work was to develop a treatment planning workflow for rapid radiotherapy delivered with very high-energy electron (VHEE) scanning pencil beams of 60–120 MeV and to study VHEE plans as a function of VHEE treatment parameters. Additionally, VHEE plans were compared to clinical state-of-the-art volumetric modulated arc therapy (VMAT) photon plans for three cases. Methods: VHEE radiotherapy treatment planning was performed by linking EGSnrc Monte Carlo (MC) dose calculations with inverse treatment planning in a research version of RayStation. In order to study the effect of VHEE treatment parameters on VHEE dose distributions, a MATLAB graphicalmore » user interface (GUI) for calculation of VHEE MC pencil beam doses was developed. Through the GUI, pediatric case MC simulations were run for a number of beam energies (60, 80, 100, and 120 MeV), number of beams (13, 17, and 36), pencil beam spot (0.1, 1.0, and 3.0 mm) and grid (2.0, 2.5, and 3.5 mm) sizes, and source-to-axis distance, SAD (40 and 50 cm). VHEE plans for the pediatric case calculated with the different treatment parameters were optimized and compared. Furthermore, 100 MeV VHEE plans for the pediatric case, a lung, and a prostate case were calculated and compared to the clinically delivered VMAT plans. All plans were normalized such that the 100% isodose line covered 95% of the target volume. Results: VHEE beam energy had the largest effect on the quality of dose distributions of the pediatric case. For the same target dose, the mean doses to organs at risk (OARs) decreased by 5%–16% when planned with 100 MeV compared to 60 MeV, but there was no further improvement in the 120 MeV plan. VHEE plans calculated with 36 beams outperformed plans calculated with 13 and 17 beams, but to a more modest degree (<8%). While pencil beam spacing and SAD had a small effect on VHEE dose distributions, 0.1–3 mm pencil beam sizes resulted in identical dose distributions. For the 100 MeV VHEE pediatric plan, OAR doses were up to 70% lower and the integral dose was 33% lower for VHEE compared to 6 MV VMAT. Additionally, VHEE conformity indices (CI{sub 100} = 1.09 and CI{sub 50} = 4.07) were better than VMAT conformity indices (CI{sub 100} = 1.30 and CI{sub 50} = 6.81). The 100 MeV VHEE lung plan resulted in mean dose decrease to all OARs by up to 27% for the same target coverage compared to the clinical 6 MV flattening filter-free (FFF) VMAT plan. The 100 MeV prostate plan resulted in 3% mean dose increase to the penile bulb and the urethra, but all other OAR mean doses were lower compared to the 15 MV VMAT plan. The lung case CI{sub 100} and CI{sub 50} conformity indices were 3% and 8% lower, respectively, in the VHEE plan compared to the VMAT plan. The prostate case CI{sub 100} and CI{sub 50} conformity indices were 1% higher and 8% lower, respectively, in the VHEE plan compared to the VMAT plan. Conclusions: The authors have developed a treatment planning workflow for MC dose calculation of pencil beams and optimization for treatment planning of VHEE radiotherapy. The authors have demonstrated that VHEE plans resulted in similar or superior dose distributions for pediatric, lung, and prostate cases compared to clinical VMAT plans.« less

SU-E-T-308: Dosimetric Comparison of SBRT VMAT Treatment Plans Generated for 6 MV, 6 MV FFF, and 10 MV FFF Photon Beams

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wilson, D; Wang, B; Dunlap, N

2015-06-15

Purpose: To assess differences in treatment plan quality between VMAT stereotactic body plans generated using the 6 MV, 6 MV FFF, and 10 MV FFF modalities available in our clinic. Plans for lung, spine, and other sites were compared to see if there is any advantage of one modality over the other. Methods: Treatment plans done for actual SBRT patients were selected. Groups of ten lung plans, five spine plans, and five plans from other sites were selected. New treatment plans were generated for each plan using the Varian Eclipse AAA algorithm. The constraints were kept the same as usedmore » in the actual plans, but the same version of software was used to generate plans for the three modalities. In addition, because there are natural variations in plans re-done with the same dose constraints, one of the lung plans was repeated ten times to assess those differences. Volumes of the 100%, 90%, 50%, 20% and 10% isodose surfaces were compared. Maximum dose two centimeters from the PTV were compared, as well as the volume of the 105% isodose surface outside of the PTV. In addition, the 20 Gray lung volume was compared for the lung plans. The values of these parameters were divided by the values for the 6 MV plans for comparison. Average and standard deviations were obtained for quantities in each group. The Student t test was done to determine if differences were seen at the 95% confidence level. Results: Comparison of the treatment plans showed no significant differences when assessing these volumes and doses. There were not any trends seen when comparing modalities as a function of PTV volume either. Conclusion: There is no obvious dosimetric advantage in selection of one modality over another for these types of SBRT plans.« less

SU-F-T-629: Effect of Multi-Leaf Collimator (MLC) Width On Plan Quality of Single-Isocenter VMAT Intracranial Stereotactic Radiosurgery for Multiple Metastases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kraus, J; Thomas, E; Wu, X

2016-06-15

Purpose: Single-isocenter VMAT has been shown able to create high quality plans for complex intracranial multiple metastasis SRS cases. Linacs capable of the technique are typically outfitted with an MLC that consists of a combination of 5 mm and 10 mm leaves (standard) or 2.5 mm and 5 mm leaves (high-definition). In this study, we test the hypothesis that thinner collimator leaves are associated with improved plan quality. Methods: Ten multiple metastasis cases were identified and planned for VMAT SRS using a 10 MV flattening filter free beam. Plans were created for a standard (std) and a high-definition (HD) MLC.more » Published values for leaf transmission factor and dosimetric leaf gap were utilized. All other parameters were invariant. Conformity (plan and individual target), moderate isodose spill (V50%), and low isodose spill (mean brain dose) were selected for analysis. Results: Compared to standard MLC, HD-MLC improved overall plan conformity (median: Paddick CI-HD = 0.83, Paddick CI-std = 0.79; p = 0.004 and median: RTOG CI-HD =1.18, RTOG CI-std =1.24; p = 0.01 ), improved individual lesion conformity (median: Paddick CI-HD,i =0.77, Paddick CI-std,i =0.72; p < 0.001 and median: RTOG CI-HD,i = 1.28, RTOG CI-std,i =1.35; p < 0.001), improved moderate isodose spill (median: V50%-HD = 37.0 cc, V50%-std = 45.7 cc; p = 0.002), and improved low dose spill (median: dmean-HD = 2.90 Gy, dmean-std = 3.19 Gy; p = 0.002). Conclusion: For the single-isocenter VMAT SRS of multiple metastasis plans examined, use of HD-MLC modestly improved conformity, moderate isodose, and low isodose spill compared to standard MLC. However, in all cases we were able to generate clinically acceptable plans with the standard MLC. More work is need to further quantify the difference in cases with higher numbers of small targets and to better understand any potential clinical significance. This research was supported in part by Varian Medical Systems.« less

Clinical experience with Mobius FX software for 3D dose verification for prostate VMAT plans and comparison with physical measurements

NASA Astrophysics Data System (ADS)

Vazquez-Quino, L. A.; Huerta-Hernandez, C. I.; Rangaraj, D.

2017-05-01

MobiusFX, an add-on software module from Mobius Medical Systems for IMRT and VMAT QA, uses measurements in linac treatment logs to calculate and verify the 3D dose delivered to patients. In this study, 10 volumetric-modulated arc therapy (VMAT) prostate plans were planned and delivered in a Varian TrueBeam linac. The plans consisted of beams with 6 and 10 MV energy and 2 to 3 arcs per plan. The average gamma value with criterion of 3% and 3mm MobiusFX and TPS: 99.96%, 2% and 2mm MobiusFX and TPS: 98.70 %. Further comparison with ArcCheck measurements was conducted.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guida, K; Qamar, K; Thompson, M

Purpose: The RTOG 1005 trial offered a hypofractionated arm in delivering WBRT+SIB. Traditionally, treatments were planned at our institution using field-in-field (FiF) tangents with a concurrent 3D conformal boost. With the availability of VMAT, it is possible that a hybrid VMAT-3D planning technique could provide another avenue in treating WBRT+SIB. Methods: A retrospective study of nine patients previously treated using RTOG 1005 guidelines was performed to compare FiF+3D plans with the hybrid technique. A combination of static tangents and partial VMAT arcs were used in base-dose optimization. The hybrid plans were optimized to deliver 4005cGy to the breast PTVeval andmore » 4800cGy to the lumpectomy PTVeval over 15 fractions. Plans were optimized to meet the planning goals dictated by RTOG 1005. Results: Hybrid plans yielded similar coverage of breast and lumpectomy PTVs (average D95 of 4013cGy compared to 3990cGy for conventional), while reducing the volume of high dose within the breast; the average D30 and D50 for the hybrid technique were 4517cGy and 4288cGy, compared to 4704cGy and 4377cGy for conventional planning. Hybrid plans increased conformity as well, yielding CI95% values of 1.22 and 1.54 for breast and lumpectomy PTVeval volumes; in contrast, conventional plans averaged 1.49 and 2.27, respectively. The nearby organs at risk (OARs) received more low dose with the hybrid plans due to low dose spray from the partial arcs, but all hybrid plans did meet the acceptable constraints, at a minimum, from the protocol. Treatment planning time was also reduced, as plans were inversely optimized (VMAT) rather than forward optimized. Conclusion: Hybrid-VMAT could be a solution in delivering WB+SIB, as plans yield very conformal treatment plans and maintain clinical standards in OAR sparing. For treating breast cancer patients with a simultaneously-integrated boost, Hybrid-VMAT offers superiority in dosimetric conformity and planning time as compared to FIF techniques.« less

Volumetric modulated arc therapy vs. IMRT for the treatment of distal esophageal cancer.

PubMed

Van Benthuysen, Liam; Hales, Lee; Podgorsak, Matthew B

2011-01-01

Several studies have demonstrated that volumetric modulated arc therapy (VMAT) has the ability to reduce monitor units and treatment time when compared with intensity-modulated radiation therapy (IMRT). This study aims to demonstrate that VMAT is able to provide adequate organs at risk (OAR) sparing and planning target volume (PTV) coverage for adenocarcinoma of the distal esophagus while reducing monitor units and treatment time. Fourteen patients having been treated previously for esophageal cancer were planned using both VMAT and IMRT techniques. Dosimetric quality was evaluated based on doses to several OARs, as well as coverage of the PTV. Treatment times were assessed by recording the number of monitor units required for dose delivery. Body V(5) was also recorded to evaluate the increased volume of healthy tissue irradiated to low doses. Dosimetric differences in OAR sparing between VMAT and IMRT were comparable. PTV coverage was similar for the 2 techniques but it was found that IMRT was capable of delivering a slightly more homogenous dose distribution. Of the 14 patients, 12 were treated with a single arc and 2 were treated with a double arc. Single-arc plans reduced monitor units by 42% when compared with the IMRT plans. Double-arc plans reduced monitor units by 67% when compared with IMRT. The V(5) for the body was found to be 18% greater for VMAT than for IMRT. VMAT has the capability to decrease treatment times over IMRT while still providing similar OAR sparing and PTV coverage. Although there will be a smaller risk of patient movement during VMAT treatments, this advantage comes at the cost of delivering small doses to a greater volume of the patient. Copyright © 2011 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

SU-F-T-635: Lung SBRT: Dosimetric and Treatment Time Comparison of Volumetric-Modulated Arc Therapy and Three-Dimensional Conformal Radiotherapy in Clinically Treated Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Han, J; Xu, Z; Baker, J

Purpose: To compare three-dimensional conformal radiotherapy (3D CRT) and volumetric-modulated arc therapy (VMAT) in lung stereotactic body radiation therapy (SBRT) Methods: A retrospective study of clinically treated lung SBRT cases treated between 2010 and 2015 at our hospital was performed. All treatment modalities were included in this evaluation (VMAT, 3D CRT, static IMRT, and dynamic conformal arc therapy). However, the majority of treatment modalities were either VMAT or 3D CRT. Treatment times of patients and dosimetric plan quality metrics were compared. Treatment times were calculated based on the time the therapist opened and closed the patient’s treatment plan. This treatmentmore » time closely approximates the utilization time of the treatment room. The dosimetric plan quality metrics evaluated include ICRU conformity index, the volume of 105% prescribed dose outside PTV, the ratio of volume of 50% prescribed dose to the volume of PTV, the percentage of maximum dose at 2 cm away from PTV to the prescribed dose, and the V20 (percentage of lung volume receiving 20 Gy or more). Results: Treatment time comparisons show that on average VMAT has shorter treatment times than 3D CRT. Dose conformity, defined by the ICRU conformity index, and high dose spillage, defined by the volume of 105% dose outside the PTV, is reduced when using VMAT compared to 3D CRT. V20 and intermediate dose spillage/fall-off metrics of VMAT and 3D are not significantly different. Conclusion: Clinically treated lung SBRT cases indicate VMAT is superior to 3D with regard to shorter treatment times, plan dose conformity, and plan high dose spillage.« less

SU-F-T-432: Magnetic Field Dose Effects for Various Radiation Beam Geometries for Patients Treated with Hypofractionated Partial Breast Irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lim-Reinders, S; University of Toronto, Department of Physics; Keller, B

Purpose: Hypofractionated partial breast irradiation (HPBI) is being used at our clinic to treat inoperable breast cancer patients who have advanced disease. We are investigating how these patients could benefit from being treated in an MRI-linac, where real-time daily MRI tumor imaging and plan adaptation would be possible. As a first step, this study evaluates the dosimetric impact of the magnetic field for different radiation beam geometries on relevant OARs. Methods: Five patients previously treated using HPBI were selected. Six treatment plans were generated for each patient, evaluating three beam geometries (VMAT, IMRT, 3DCRT) with and without B{sub 0}=1.5 T.more » The Monaco TPS was used with the Elekta MRI-Linac beam model, where the magnetic field is orthogonal to the radiation beam. All plans were re-scaled to the same isocoverage with a prescription of 40Gy/5 to the PTV. Plans were evaluated for the effect of the magnetic field and beam modality on skin V{sub 3} {sub 0}, lung V{sub 2} {sub 0} and mean heart dose. Results: Averaged over all patients, skin V{sub 3} {sub 0}for 3DCRT was higher than VMAT and IMRT (by +22% and +21%, with B{sub 0}-ON). The magnetic field caused larger increases in skin V{sub 3} {sub 0}for 3DCRT (+8%) than VMAT (+3%) and IMRT (+4%) compared with B{sub 0}-OFF. With B{sub 0}-ON, 3DCRT had a markedly lower mean heart dose than VMAT (by 538cGy) and IMRT (by 562cGy); for lung V{sub 2} {sub 0}, 3DCRT had a marginally lower dose than VMAT (by −2.2%) and IMRT (also −2.2%). The magnetic field had minimal effect on the mean heart dose and lung V{sub 2} {sub 0} for all geometries. Conclusion: The decreased skin dose in VMAT and IMRT can potentially mitigate the effects of skin reactions for HPBI in an MRI-linac. This study illustrated that more beam angles may result in lower skin toxicity and better tumor conformality, with the trade-off of elevated heart and lung doses. We are receiving funding support from Elekta.« less

Dose rate mapping of VMAT treatments

NASA Astrophysics Data System (ADS)

Podesta, Mark; Antoniu Popescu, I.; Verhaegen, Frank

2016-06-01

Human tissues exhibit a varying response to radiation dose depending on the dose rate and fractionation scheme used. Dose rate effects have been reported for different radiations, and tissue types. The literature indicates that there is not a significant difference in response for low-LET radiation when using dose rates between 1 Gy min-1 and 12 Gy min-1 but lower dose rates have an observable sparing effect on tissues and a differential effect between tissues. In intensity-modulated radiotherapy such as volumetric modulated arc therapy (VMAT) the dose can be delivered with a wide range of dose rates. In this work we developed a method based on time-resolved Monte Carlo simulations to quantify the dose rate frequency distribution for clinical VMAT treatments for three cancer sites, head and neck, lung, and pelvis within both planning target volumes (PTV) and normal tissues. The results show a wide range of dose rates are used to deliver dose in VMAT and up to 75% of the PTV can have its dose delivered with dose rates  <1 Gy min-1. Pelvic plans on average have a lower mean dose rate within the PTV than lung or head and neck plans but a comparable mean dose rate within the organs at risk. Two VMAT plans that fulfil the same dose objectives and constraints may be delivered with different dose rate distributions, particularly when comparing single arcs to multiple arc plans. It is concluded that for dynamic plans, the dose rate range used varies to a larger degree than previously assumed. The effect of the dose rate range in VMAT on clinical outcome is unknown.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liang, J; Kim, S; Hristov, D

Purpose: To assess the potential benefit of trajectory modulated arc therapy (TMAT) for treatments of small benign intracranial tumor, pituitary adenoma. Methods: A TMAT planning platform that incorporates complex source motion trajectory involving synchronized gantry rotation with translational and rotational couch movement was used for the study. The platform couples an interactive trajectory generation tool with a VMAT algorithm that performs multi-resolution, progressive sampling MLC optimization on a user-designed trajectory. A continuous couch rotation of 160° angular span with ±20° mini gantry arcs was used to emulate a non-coplanar horizontal arc-like trajectory. Compared to conventional non-coplanar gantry arcs (60°-100° gantrymore » rotation with couch kicks), TMAT limited the unnecessary low to medium dose spread in the anterior and posterior directions, where primary OARs (e.g., brainstem, optic chiasm, optic nerves, and lens) are in close proximity to the targeted pituitary tumor volume. For 5 standard fractionation pituitary adenoma cases (50.4Gy/28fractions), TMAT and non-coplanar VMAT plans were generated and compared under equivalent objectives/constraints. TMAT delivery was implemented and demonstrated on Varian TrueBeam via XML scripts. Results: Both techniques showed good target coverage while OARs were able to meet the constraints on QUANTEC guidelines. Notably, TMAT decreased the dose deposition in the anterior-to-posterior direction surrounding PTV. TMAT significantly reduced the mean doses on brainstem, optic nerves, eyes and lens by 47.29%±13.17%, 28.51%±8.68%, 80.82%±8.71% and 65.38%±19.99% compared with VMAT, all p≤0.01. Percentage reductions of maximum point dose in eyes and lens were 75.68%±10.30% and 70.72%±18.62% respectively for TMAT versus VMAT, all p≤0.01. A representative isocentric TMAT pituitary plan was delivered via an XML script with 200 control points and 282 MUs. Conclusion: Deliverable TMAT plans were achieved in developer mode in TrueBeam. TMAT was shown to be superior for pituitary adenoma irradiation in terms of OARs sparing.« less

Comparison of testicular dose delivered by intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in patients with prostate cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Martin, Jeffrey M.; Handorf, Elizabeth A.; Price, Robert A.

A small decrease in testosterone level has been documented after prostate irradiation, possibly owing to the incidental dose to the testes. Testicular doses from prostate external beam radiation plans with either intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT) were calculated to investigate any difference. Testicles were contoured for 16 patients being treated for localized prostate cancer. For each patient, 2 plans were created: 1 with IMRT and 1 with VMAT. No specific attempt was made to reduce testicular dose. Minimum, maximum, and mean doses to the testicles were recorded for each plan. Of the 16 patients, 4 receivedmore » a total dose of 7800 cGy to the prostate alone, 7 received 8000 cGy to the prostate alone, and 5 received 8000 cGy to the prostate and pelvic lymph nodes. The mean (range) of testicular dose with an IMRT plan was 54.7 cGy (21.1 to 91.9) and 59.0 cGy (25.1 to 93.4) with a VMAT plan. In 12 cases, the mean VMAT dose was higher than the mean IMRT dose, with a mean difference of 4.3 cGy (p = 0.019). There was a small but statistically significant increase in mean testicular dose delivered by VMAT compared with IMRT. Despite this, it unlikely that there is a clinically meaningful difference in testicular doses from either modality.« less

SU-F-T-106: A Dosimetric Study of Intensity Modulated Radiation Therapy to Decrease Radiation Dose to the Thoracic Vertebral Bodies in Patients Receiving Concurrent Chemoradiation for Lung Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

DiCostanzo, Dominic; Barney, Christian L.; Bazan, Jose G.

Purpose: Recent clinical studies have shown a correlation between radiation dose to the thoracic vertebral bodies (TVB) and the development of hematologic toxicity (HT) in patients receiving chemoradiation (CRT) for lung cancer (LuCa). The feasibility of a bone-marrow sparing (BMS) approach in this group of patients is unknown. We hypothesized that radiation dose to the TVB can be reduced with an intensity modulated radiation therapy(IMRT)/volumetric modulated arc radiotherapy(VMAT) without affecting plan quality. Methods: We identified LuCa cases treated with curative intent CRT using IMRT/VMAT from 4/2009 to 2/2015. The TVBs from T1–T10 were retrospectively contoured. No constraints were placed onmore » the TVB structure initially. A subset were re-planned with BMS-IMRT/VMAT with an objective or reducing the mean TVB dose to <23 Gy. The following data were collected on the initial and BMS plans: mean dose to planning target volume (PTV), lungs-PTV, esophagus, heart; lung V20; cord max dose. Pairwise comparisons were performed using the signed rank test. Results: 94 cases received CRT with IMRT/VMAT. We selected 11 cases (7 IMRT, 4 VMAT) with a range of initial mean TVB doses (median 35.7 Gy, range 18.9–41.4 Gy). Median prescription dose was 60 Gy. BMS-IMRT/VMAT significantly reduced the mean TVB dose by a median of 10.2 Gy (range, 1.0–16.7 Gy, p=0.001) and reduced the cord max dose by 2.9 Gy (p=0.014). BMS-IMRT/VMAT had no impact on lung mean (median +17 cGy, p=0.700), lung V20 (median +0.5%, p=0.898), esophagus mean (median +13 cGy, p=1.000) or heart mean (median +16 cGy, p=0.365). PTV-mean dose was not affected by BMS-IMRT/VMAT (median +13 cGy, p=0.653). Conclusion: BMS-IMRT/VMAT was able to significantly reduce radiation dose to the TVB without compromising plan quality. Prospective evaluation of BMS-IMRT/VMAT in patients receiving CRT for LuCa is warranted to determine if this approach results in clinically significant reductions in HT.« less

Poster - 22: Retrospective analysis of portal dosimetry based QA of Prostate VMAT Plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Badu, Shyam; Darko, Johnson; Fleck, Andre

2016-08-15

Purpose: The purpose of this study is to retrospectively analyze the portal dosimetry based quality assurance of prostate VMAT plans. Methods: Our standard quality assurance of VMAT treatment plans are performed using EPID installed on Varian TrueBeam Linac. In our current study we analyzed 84 prostate pretreatment VMAT plans. All plans consisted of two arcs, 7800cGy in 39 fractions with a 6MV beam. For each of these VMAT plans, the measured fluence for each arc is compared with the reference fluence using gamma index analysis. Results: We have compared the gamma passing rates for three criteria; 3%/3mm, 2%/2mm and 1%/1mm.more » Out of 168 arcs measured, the number below the gamma passing rate 95% using the area, Field+1cm, are 0, 2, and 124 for 3%/3mm, 2%/2mm and 1%/1mm criteria respectively. Corresponding numbers for MLC CIAO are 0, 2, and 139 respectively. The average gamma passing rate for all arcs measured using Field+1cm are 99.9±0.4, 99.6±1.2, and 90.9±6.5 for 3%/3mm, 2%/2mm and 1%/1mm respectively. Similarly if the MLC CIAO area is analyzed, a passing rate of 99.9±0.2, 99.2±1.2 and 87.2±8.5 respectively was observed. The average of the maximum gamma was also found to increase with tighter criteria. Conclusion: Analysis of prostate VMAT quality assurance plans indicate that the gamma passing rate is sensitive to the criteria and the area analyzed.« less

Technical Note: Dose effects of 1.5 T transverse magnetic field on tissue interfaces in MRI-guided radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Xinfeng; Prior, Phil; Chen, Guang-Pei

Purpose: The integration of MRI with a linear accelerator (MR-linac) offers great potential for high-precision delivery of radiation therapy (RT). However, the electron deflection resulting from the presence of a transverse magnetic field (TMF) can affect the dose distribution, particularly the electron return effect (ERE) at tissue interfaces. The purpose of the study is to investigate the dose effects of ERE at air-tissue and lung-tissue interfaces during intensity-modulated radiation therapy (IMRT) planning. Methods: IMRT and volumetric modulated arc therapy (VMAT) plans for representative pancreas, lung, breast, and head and neck (HN) cases were generated following commonly used clinical dose volumemore » (DV) criteria. In each case, three types of plans were generated: (1) the original plan generated without a TMF; (2) the reconstructed plan generated by recalculating the original plan with the presence of a TMF of 1.5 T (no optimization); and (3) the optimized plan generated by a full optimization with TMF = 1.5 T. These plans were compared using a variety of DV parameters, including V{sub 100%}, D{sub 95%}, DHI [dose heterogeneity index: (D{sub 20%}–D{sub 80%})/D{sub prescription}], D{sub max}, and D{sub 1cc} in OARs (organs at risk) and tissue interface. All the optimizations and calculations in this work were performed on static data. Results: The dose recalculation under TMF showed the presence of the 1.5 T TMF can slightly reduce V{sub 100%} and D{sub 95%} for PTV, with the differences being less than 4% for all but one lung case studied. The TMF results in considerable increases in D{sub max} and D{sub 1cc} on the skin in all cases, mostly between 10% and 35%. The changes in D{sub max} and D{sub 1cc} on air cavity walls are dependent upon site, geometry, and size, with changes ranging up to 15%. The VMAT plans lead to much smaller dose effects from ERE compared to fixed-beam IMRT in pancreas case. When the TMF is considered in the plan optimization, the dose effects of the TMF at tissue interfaces (e.g., air-cavity wall, lung-tissue interfaces, skin) are significantly reduced in most cases. Conclusions: The doses on tissue interfaces can be significantly changed by the presence of a TMF during MR-guided RT when the magnetic field is not included in plan optimization. These changes can be substantially reduced or even eliminated during VMAT/IMRT optimization that specifically considers the TMF, without deteriorating overall plan quality.« less

SU-E-T-628: Predicted Risk of Post-Irradiation Cerebral Necrosis in Pediatric Brain Cancer Patients: A Treatment Planning Comparison of Proton Vs. Photon Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Freund, D; Zhang, R; Sanders, M

Purpose: Post-irradiation cerebral necrosis (PICN) is a severe late effect that can Result from brain cancers treatment using radiation therapy. The purpose of this study was to compare the treatment plans and predicted risk of PICN after volumetric modulated arc therapy (VMAT) to the risk after passively scattered proton therapy (PSPT) and intensity modulated proton therapy (IMPT) in a cohort of pediatric patients. Methods: Thirteen pediatric patients with varying age and sex were selected for this study. A clinical treatment volume (CTV) was constructed for 8 glioma patients and 5 ependymoma patients. Prescribed dose was 54 Gy over 30 fractionsmore » to the planning volume. Dosimetric endpoints were compared between VMAT and proton plans. The normal tissue complication probability (NTCP) following VMAT and proton therapy planning was also calculated using PICN as the biological endpoint. Sensitivity tests were performed to determine if predicted risk of PICN was sensitive to positional errors, proton range errors and selection of risk models. Results: Both PSPT and IMPT plans resulted in a significant increase in the maximum dose and reduction in the total brain volume irradiated to low doses compared with the VMAT plans. The average ratios of NTCP between PSPT and VMAT were 0.56 and 0.38 for glioma and ependymoma patients respectively and the average ratios of NTCP between IMPT and VMAT were 0.67 and 0.68 for glioma and ependymoma plans respectively. Sensitivity test revealed that predicted ratios of risk were insensitive to range and positional errors but varied with risk model selection. Conclusion: Both PSPT and IMPT plans resulted in a decrease in the predictive risk of necrosis for the pediatric plans studied in this work. Sensitivity analysis upheld the qualitative findings of the risk models used in this study, however more accurate models that take into account dose and volume are needed.« less

[Investigation of Elekta linac characteristics for VMAT].

PubMed

Luo, Guangwen; Zhang, Kunyi

2012-01-01

The aim of this study is to investigate the characteristics of Elekta delivery system for volumetric modulated arc therapy (VMAT). Five VMAT plans were delivered in service mode and dose rates, and speed of gantry and MLC leaves were analyzed by log files. Results showed that dose rates varied between 6 dose rates. Gantry and MLC leaf speed dynamically varied during delivery. The technique of VMAT requires linac to dynamically control more parameters, and these key dynamic variables during VMAT delivery can be checked by log files. Quality assurance procedure should be carried out for VMAT related parameter.

SU-E-T-274: Radiation Therapy with Very High-Energy Electron (VHEE) Beams in the Presence of Metal Implants

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jensen, C; Palma, B; Qu, B

2014-06-01

Purpose: To evaluate the effect of metal implants on treatment plans for radiation therapy with very high-energy electron (VHEE) beams. Methods: The DOSXYZnrc/BEAMnrc Monte Carlo (MC) codes were used to simulate 50–150MeV VHEE beam dose deposition and its effects on steel and titanium (Ti) heterogeneities in a water phantom. Heterogeneities of thicknesses ranging from 0.5cm to 2cm were placed at 10cm depth. MC was also used to calculate electron and photon spectra generated by the VHEE beams' interaction with metal heterogeneities. The original VMAT patient dose calculation was planned in Eclipse. Patient dose calculations with MC-generated beamlets were planned usingmore » a Matlab GUI and research version of RayStation. VHEE MC treatment planning was performed on water-only geometry and water with segmented prostheses (steel and Ti) geometries with 100MeV and 150MeV beams. Results: 100MeV PDD 5cm behind steel/Ti heterogeneity was 51% less than in the water-only phantom. For some cases, dose enhancement lateral to the borders of the phantom increased the dose by up to 22% in steel and 18% in Ti heterogeneities. The dose immediately behind steel heterogeneity decreased by an average of 6%, although for 150MeV, the steel heterogeneity created a 23% increase in dose directly behind it. The average dose immediately behind Ti heterogeneities increased 10%. The prostate VHEE plans resulted in mean dose decrease to the bowel (20%), bladder (7%), and the urethra (5%) compared to the 15MV VMAT plan. The average dose to the body with prosthetic implants was 5% higher than to the body without implants. Conclusion: Based on MC simulations, metallic implants introduce dose perturbations to VHEE beams from lateral scatter and backscatter. However, when performing clinical planning on a prostate case, the use of multiple beams and inverse planning still produces VHEE plans that are dosimetrically superior to photon VMAT plans. BW Loo and P Maxim received research support from RaySearch laboratories; B Hardemark and E Hynning are employees of RaySearch.« less

SU-D-BRD-01: Cloud-Based Radiation Treatment Planning: Performance Evaluation of Dose Calculation and Plan Optimization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Na, Y; Kapp, D; Kim, Y

2014-06-01

Purpose: To report the first experience on the development of a cloud-based treatment planning system and investigate the performance improvement of dose calculation and treatment plan optimization of the cloud computing platform. Methods: A cloud computing-based radiation treatment planning system (cc-TPS) was developed for clinical treatment planning. Three de-identified clinical head and neck, lung, and prostate cases were used to evaluate the cloud computing platform. The de-identified clinical data were encrypted with 256-bit Advanced Encryption Standard (AES) algorithm. VMAT and IMRT plans were generated for the three de-identified clinical cases to determine the quality of the treatment plans and computationalmore » efficiency. All plans generated from the cc-TPS were compared to those obtained with the PC-based TPS (pc-TPS). The performance evaluation of the cc-TPS was quantified as the speedup factors for Monte Carlo (MC) dose calculations and large-scale plan optimizations, as well as the performance ratios (PRs) of the amount of performance improvement compared to the pc-TPS. Results: Speedup factors were improved up to 14.0-fold dependent on the clinical cases and plan types. The computation times for VMAT and IMRT plans with the cc-TPS were reduced by 91.1% and 89.4%, respectively, on average of the clinical cases compared to those with pc-TPS. The PRs were mostly better for VMAT plans (1.0 ≤ PRs ≤ 10.6 for the head and neck case, 1.2 ≤ PRs ≤ 13.3 for lung case, and 1.0 ≤ PRs ≤ 10.3 for prostate cancer cases) than for IMRT plans. The isodose curves of plans on both cc-TPS and pc-TPS were identical for each of the clinical cases. Conclusion: A cloud-based treatment planning has been setup and our results demonstrate the computation efficiency of treatment planning with the cc-TPS can be dramatically improved while maintaining the same plan quality to that obtained with the pc-TPS. This work was supported in part by the National Cancer Institute (1R01 CA133474) and by Leading Foreign Research Institute Recruitment Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (MSIP) (Grant No.2009-00420)« less

SU-E-T-29: A Web Application for GPU-Based Monte Carlo IMRT/VMAT QA with Delivered Dose Verification

DOE Office of Scientific and Technical Information (OSTI.GOV)

Folkerts, M; University of California, San Diego, La Jolla, CA; Graves, Y

Purpose: To enable an existing web application for GPU-based Monte Carlo (MC) 3D dosimetry quality assurance (QA) to compute “delivered dose” from linac logfile data. Methods: We added significant features to an IMRT/VMAT QA web application which is based on existing technologies (HTML5, Python, and Django). This tool interfaces with python, c-code libraries, and command line-based GPU applications to perform a MC-based IMRT/VMAT QA. The web app automates many complicated aspects of interfacing clinical DICOM and logfile data with cutting-edge GPU software to run a MC dose calculation. The resultant web app is powerful, easy to use, and is ablemore » to re-compute both plan dose (from DICOM data) and delivered dose (from logfile data). Both dynalog and trajectorylog file formats are supported. Users upload zipped DICOM RP, CT, and RD data and set the expected statistic uncertainty for the MC dose calculation. A 3D gamma index map, 3D dose distribution, gamma histogram, dosimetric statistics, and DVH curves are displayed to the user. Additional the user may upload the delivery logfile data from the linac to compute a 'delivered dose' calculation and corresponding gamma tests. A comprehensive PDF QA report summarizing the results can also be downloaded. Results: We successfully improved a web app for a GPU-based QA tool that consists of logfile parcing, fluence map generation, CT image processing, GPU based MC dose calculation, gamma index calculation, and DVH calculation. The result is an IMRT and VMAT QA tool that conducts an independent dose calculation for a given treatment plan and delivery log file. The system takes both DICOM data and logfile data to compute plan dose and delivered dose respectively. Conclusion: We sucessfully improved a GPU-based MC QA tool to allow for logfile dose calculation. The high efficiency and accessibility will greatly facilitate IMRT and VMAT QA.« less

Volumetric-modulated arc therapy in postprostatectomy radiotherapy patients: A planning comparison study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Forde, Elizabeth, E-mail: eforde@tcd.ie; Kneebone, Andrew; Northern Clinical School, University of Sydney, New South Wales

2013-10-01

The purpose of this study was to compare postprostatectomy planning for volumetric-modulated arc therapy (VMAT) with both single arc (SA) and double arcs (DA) against dynamic sliding window intensity-modulated radiotherapy (IMRT). Ten cases were planned with IMRT, SA VMAT, and DA VMAT. All cases were planned to achieve a minimum dose of 68 Gy to 95% of the planning target volume (PTV) and goals to limit rectal volume >40 Gy to 35% and >65 Gy to 17%, and bladder volumes >40 Gy to 50% and >65 Gy to 25%. Plans were averaged across the 10 patients and compared for meanmore » dose, conformity, homogeneity, rectal and bladder doses, and monitor units. The mean dose to the clinical target volume and PTV was significantly higher (p<0.05) for SA compared with DA or IMRT. The homogeneity index was not significantly different: SA = 0.09; DA = 0.08; and IMRT = 0.07. The rectal V40 was lowest for the DA plan. The rectal V20 was significantly lower (p<0.05) for both the VMAT plans compared with IMRT. There were no significant differences for bladder V40 or rectal and bladder V65. The IMRT plans required 1400 MU compared with 745 for DA and 708 for SA. This study shows that for equivalent dose coverage, SA and DA VMAT plans result in higher mean doses to the clinical target volume and PTV. This greater dose heterogeneity is balanced by improved low-range rectal doses and halving of the monitor units.« less

A review of stereotactic body radiotherapy – is volumetric modulated arc therapy the answer?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sapkaroski, Daniel, E-mail: daniel.sapkaroski@gmail.com; Osborne, Catherine; Knight, Kellie A

2015-06-15

Stereotactic body radiotherapy (SBRT) is a high precision radiotherapy technique used for the treatment of small to moderate extra-cranial tumours. Early studies utilising SBRT have shown favourable outcomes. However, major disadvantages of static field SBRT include long treatment times and toxicity complications. Volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) may potentially mitigate these disadvantages. This review aims to assess the feasibility of emerging VMAT and IMRT-based SBRT treatment techniques and qualify which offers the best outcome for patients, whilst identifying any emerging and advantageous SBRT planning trends. A review and synthesis of data from current literature upmore » to September 2013 was conducted on EMBASE, Medline, PubMed, Science Direct, Proquest central, Google Scholar and the Cochrane Database of Systematic reviews. Only full text papers comparing VMAT and or IMRT and or Static SBRT were included. Ten papers were identified that evaluated the results of VMAT/IMRT SBRT. Five related to medically inoperable stage 1 and 2 non-small-cell lung cancer (NSCLC), three to spinal metastasis, one related to abdominal lymph node malignancies, with the final one looking at pancreatic adenocarcinoma. Overall treatment times with VMAT were reduced by 66–70% for lung, 46–58% for spine, 42% and 21% for lymph node and pancreatic metastasis respectively, planning constraints were met with several studies showing improved organs at risk sparing with IMRT/VMAT to static SBRT. Both IMRT and VMAT were able to meet all planning constraints in the studies reviewed, with VMAT offering the greatest treatment efficiency. Early clinical outcomes with VMAT and IMRT SBRT have demonstrated excellent local control and favourable survival outcomes.« less

Penalization of aperture complexity in inversely planned volumetric modulated arc therapy

PubMed Central

Younge, Kelly C.; Matuszak, Martha M.; Moran, Jean M.; McShan, Daniel L.; Fraass, Benedick A.; Roberts, Donald A.

2012-01-01

Purpose: Apertures obtained during volumetric modulated arc therapy (VMAT) planning can be small and irregular, resulting in dosimetric inaccuracies during delivery. Our purpose is to develop and integrate an aperture-regularization objective function into the optimization process for VMAT, and to quantify the impact of using this objective function on dose delivery accuracy and optimized dose distributions. Methods: An aperture-based metric (“edge penalty”) was developed that penalizes complex aperture shapes based on the ratio of MLC side edge length and aperture area. To assess the utility of the metric, VMAT plans were created for example paraspinal, brain, and liver SBRT cases with and without incorporating the edge penalty in the cost function. To investigate the dose calculation accuracy, Gafchromic EBT2 film was used to measure the 15 highest weighted apertures individually and as a composite from each of two paraspinal plans: one with and one without the edge penalty applied. Films were analyzed using a triple-channel nonuniformity correction and measurements were compared directly to calculations. Results: Apertures generated with the edge penalty were larger, more regularly shaped and required up to 30% fewer monitor units than those created without the edge penalty. Dose volume histogram analysis showed that the changes in doses to targets, organs at risk, and normal tissues were negligible. Edge penalty apertures that were measured with film for the paraspinal plan showed a notable decrease in the number of pixels disagreeing with calculation by more than 10%. For a 5% dose passing criterion, the number of pixels passing in the composite dose distributions for the non-edge penalty and edge penalty plans were 52% and 96%, respectively. Employing gamma with 3% dose/1 mm distance criteria resulted in a 79.5% (without penalty)/95.4% (with penalty) pass rate for the two plans. Gradient compensation of 3%/1 mm resulted in 83.3%/96.2% pass rates. Conclusions: The use of the edge penalty during optimization has the potential to markedly improve dose delivery accuracy for VMAT plans while still maintaining high quality optimized dose distributions. The penalty regularizes aperture shape and improves delivery efficiency. PMID:23127107

The Dosimetric Importance of Six Degree of Freedom Couch End to End Quality Assurance for SRS/SBRT Treatments when Comparing Intensity Modulated Radiation Therapy to Volumetric Modulated Arc Therapy

NASA Astrophysics Data System (ADS)

Ulizio, Vincent Michael

With the advancement of technology there is an increasing ability for lesions to be treated with higher radiation doses each fraction. This also allows for low fractionated treatments. Because the patient is receiving a higher dose of radiation per fraction and because of the fast dose falloff in these targets there must be extreme accuracy in the delivery. The 6 DOF couch allows for extra rotational corrections and for a more accurate set-up. The movement of the couch needs to be verified to be accurate and because of this, end to end quality assurance tests for the couch have been made. After the set-up is known to be accurate then different treatment techniques can be studied. SBRT of the Spine has a very fast dose falloff near the spinal cord and was typically treated with IMRT. Treatment plans generated using this technique tend to have streaks of low dose radiation, so VMAT is being studied to determine if this treatment technique can reduce the low dose radiation volume as well as improve OAR sparing. For the 6 DOF couch QA, graph paper is placed on the anterior and right lateral sides of the VisionRT OSMS Cube Phantom. Each rotational shift is then applied individually, with a 3 degree shift in the positive and negative directions for pitch and roll. A mark is drawn on the paper to record each shift. A CBCT is then taken of the Cube and known shifts are applied and then an additional CBCT is taken to return the Cube to isocenter. The original IMRT plans for SBRT of the Spine are evaluated and then a plan is made utilizing VMAT. These plans are then compared for low dose radiation, OAR sparing, and conformity. If the original IMRT plan is determined to be an inferior treatment to what is acceptable, then this will be re-planned and compared to the VMAT plan. The 6 DOF couch QA tests have proven to be accurate and reproducible. The average deviations in the 3 degree and -3 degree pitch and roll directions were 0.197, 0.068, 0.091, and 0.110 degrees, respectively. The average CBCT shift errors all came out less than 0.05 cm in translational directions and less than 0.05 degrees in all rotational directions. The VMAT plans had similar OAR sparing, target coverage, and conformity. In all cases the 50% isodose volume was lower for the VMAT plans. All of the tests for the 6 DOF couch are accurate and good to use in our monthly tests. VMAT has shown to be better than IMRT for Spine SBRT and should be used in all cases, when treating the Spine.

Evaluation of a mixed beam therapy for post-mastectomy breast cancer patients: bolus electron conformal therapy combined with intensity modulated photon radiotherapy and volumetric modulated photon arc therapy.

PubMed

Zhang, Rui; Heins, David; Sanders, Mary; Guo, Beibei; Hogstrom, Kenneth

2018-05-10

The purpose of this study was to assess the potential benefits and limitations of a mixed beam therapy, which combined bolus electron conformal therapy (BECT) with intensity modulated photon radiotherapy (IMRT) and volumetric modulated photon arc therapy (VMAT), for left-sided post-mastectomy breast cancer patients. Mixed beam treatment plans were produced for nine post-mastectomy radiotherapy (PMRT) patients previously treated at our clinic with VMAT alone. The mixed beam plans consisted of 40 Gy to the chest wall area using BECT, 40 Gy to the supraclavicular area using parallel opposed IMRT, and 10 Gy to the total planning target volume (PTV) by optimizing VMAT on top of the BECT+IMRT dose distribution. The treatment plans were created in a commercial treatment planning system (TPS), and all plans were evaluated based on PTV coverage, dose homogeneity index (DHI), conformity index (CI), dose to organs at risk (OARs), normal tissue complication probability (NTCP), and secondary cancer complication probability (SCCP). The standard VMAT alone planning technique was used as the reference for comparison. Both techniques produced clinically acceptable PMRT plans but with a few significant differences: VMAT showed significantly better CI (0.70 vs. 0.53, p < 0.001) and DHI (0.12 vs. 0.20, p < 0.001) over mixed beam therapy. For normal tissues, mixed beam therapy showed better OAR sparing and significantly reduced NTCP for cardiac mortality (0.23% vs. 0.80%, p = 0.01) and SCCP for contralateral breast (1.7% vs. 3.1% based on linear model, and 1.2% vs. 1.9% based on linear-exponential model, p < 0.001 in both cases), but showed significantly higher mean (50.8 Gy vs. 49.3 Gy, p < 0.001) and maximum skin doses (59.7 Gy vs. 53.3 Gy, p < 0.001) compared with VMAT. Patients with more tissue (minimum distance between the distal PTV surface and lung approximately > 0.5 cm and volume of tissue between the distal PTV surface and heart or lung approximately > 250 cm 3 ) between distal PTV surface and lung may benefit the most from mixed beam therapy. This work has demonstrated that mixed beam therapy (BECT+IMRT : VMAT = 4 : 1) produces clinically acceptable plans having reduced OAR doses and risks of side effects compared with VMAT. Even though VMAT alone produces more homogenous and conformal dose distributions, mixed beam therapy remains as a viable option for treating post-mastectomy patients, possibly leading to reduced normal tissue complications. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

SU-E-T-618: Plan Robustness Study of Volumetric-Modulated Arc Therapy Vs. Intensity-Modulated Radiation Therapy for Head and Neck Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, W; Patel, S; Shen, J

Purpose: Lack of plan robustness may contribute to local failure in volumetric-modulated arc therapy (VMAT) to treat head and neck (H&N) cancer. Thus we compared plan robustness of VMAT with intensity-modulated radiation therapy (IMRT). Methods: VMAT and IMRT plans were created for 9 H&N cancer patients. For each plan, six new perturbed dose distributions were computed — one each for ± 3mm setup deviations along the S-I, A-P and L-R directions. We used three robustness quantification tools: (1) worst-case analysis (WCA); (2) dose-volume histograms (DVHs) band (DVHB); and (3) root-mean-square-dose deviation (RMSD) volume histogram (DDVH). DDVH represents the relative volumemore » (y) on the vertical axis and the RMSD (x) on the horizontal axis. Similar to DVH, this means that y% of the volume of the indicated structure has the RMSD at least x Gy[RBE].The width from the first two methods at different target DVH indices (such as D95 and D5) and the area under the DDVH curves (AUC) for the target were used to indicate plan robustness. In these robustness quantification tools, the smaller the value, the more robust the plan is. Plan robustness evaluation metrics were compared using Wilcoxon test. Results: DVHB showed the width at D95 from IMRT to be larger than from VMAT (unit Gy) [1.59 vs 1.18 (p=0.49)], while the width at D5 from IMRT was found to be slightly larger than from VMAT [0.59 vs 0.54 (p=0.84)]. WCA showed similar results [D95: 3.28 vs 3.00 (p=0.56); D5: 1.68 vs 1.95 (p=0.23)]. DDVH showed the AUC from IMRT to be slightly smaller than from VMAT [1.13 vs 1.15 (p=0.43)]. Conclusion: VMAT plan robustness is comparable to IMRT plan robustness. The plan robustness conclusions from WCA and DVHB are DVH parameter dependent. On the other hand DDVH captures the overall effect of uncertainties on the dose to a volume of interest. NIH/NCI K25CA168984; Eagles Cancer Research Career Development; The Lawrence W. and Marilyn W. Matteson Fund for Cancer Research Mayo ASU Seed Grant; The Kemper Marley Foundation.« less

SU-E-T-490: Independent Three-Dimensional (3D) Dose Verification of VMAT/SBRT Using EPID and Cloud Computing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ding, A; Han, B; Bush, K

Purpose: Dosimetric verification of VMAT/SBRT is currently performed on one or two planes in a phantom with either film or array detectors. A robust and easy-to-use 3D dosimetric tool has been sought since the advent of conformal radiation therapy. Here we present such a strategy for independent 3D VMAT/SBRT plan verification system by a combined use of EPID and cloud-based Monte Carlo (MC) dose calculation. Methods: The 3D dosimetric verification proceeds in two steps. First, the plan was delivered with a high resolution portable EPID mounted on the gantry, and the EPID-captured gantry-angle-resolved VMAT/SBRT field images were converted into fluencemore » by using the EPID pixel response function derived from MC simulations. The fluence was resampled and used as the input for an in-house developed Amazon cloud-based MC software to reconstruct the 3D dose distribution. The accuracy of the developed 3D dosimetric tool was assessed using a Delta4 phantom with various field sizes (square, circular, rectangular, and irregular MLC fields) and different patient cases. The method was applied to validate VMAT/SBRT plans using WFF and FFF photon beams (Varian TrueBeam STX). Results: It was found that the proposed method yielded results consistent with the Delta4 measurements. For points on the two detector planes, a good agreement within 1.5% were found for all the testing fields. Patient VMAT/SBRT plan studies revealed similar level of accuracy: an average γ-index passing rate of 99.2± 0.6% (3mm/3%), 97.4± 2.4% (2mm/2%), and 72.6± 8.4 % ( 1mm/1%). Conclusion: A valuable 3D dosimetric verification strategy has been developed for VMAT/SBRT plan validation. The technique provides a viable solution for a number of intractable dosimetry problems, such as small fields and plans with high dose gradient.« less

SU-E-T-126: Dosimetric Comparisons of VMAT, IMRT and 3DCRT for Locally Advanced Rectal Cancer with Simultaneous Integrated Boost

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhao, J; Wang, J; Zhang, Z

2014-06-01

Purpose: The purpose of this study is to compare the dosimetric differences among volumetric modulated arc therapy (VMAT), fixed-field intensity modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) for the preoperative locally advanced rectal cancer (LARC). Methods: Ten LARC patients treated in our department using the simultaneous escalate strategy were retrospectively analyzed in this study. All patients had T3 with N+/− and were treated with IMRT. Two additional VMAT and 3DCRT plans were created for each patient. Both IMRT and VMAT had similar optimization objectives. The prescription was 50Gy to the PTV and 55Gy to the GTV. The target coveragemore » and organs at risk were compared for all the techniques.The paired, two-tailed Wilcoxcon signed-rank test was applied for statistical analysis. Results: IMRT and VMAT plans achieved comparable tumor response except for the conformality index (1.07 vs 1.19 and 1.08 vs 1.03 of IMRT vs VMAT for PTV-G and PTV-C respectively). Compared to VMAT, IMRT showed superior or similar dose sparing in the small bowel, bladder, femoral head. Both IMRT and VMAT had better organs at risk sparing and homogeneity index of PTV-G. Conclusion: All 3DCRT, IMRT and VMAT meet the prescript. The IMRT and VMAT provided comparable dosemitric parameters for target volume. IMRT shows better sparing for small bowel, bladder, femoral heads and normal tissue to 3DCRT and VMAT.« less

Left-sided breast cancer irradiation using rotational and fixed-field radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Qi, X. Sharon, E-mail: xqi@mednet.ucla.edu; Liu, Tian X.; Liu, Arthur K.

2014-10-01

The 3-dimensional conformal radiotherapy (3DCRT) technique is the standard for breast cancer radiotherapy. During treatment planning, not only the coverage of the planning target volume (PTV) but also the minimization of the dose to critical structures, such as the lung, heart, and contralateral breast tissue, need to be considered. Because of the complexity and variations of patient anatomy, more advanced radiotherapy techniques are sometimes desired to better meet the planning goals. In this study, we evaluated external-beam radiation treatment techniques for left breast cancer using various delivery platforms: fixed-field including TomoDirect (TD), static intensity-modulated radiotherapy (sIMRT), and rotational radiotherapy includingmore » Elekta volumetric-modulated arc therapy (VMAT) and tomotherapy helical (TH). A total of 10 patients with left-sided breast cancer who did or did not have positive lymph nodes and were previously treated with 3DCRT/sIMRT to the entire breast were selected, their treatment was planned with Monaco VMAT, TD, and TH. Dosimetric parameters including PTV coverage, organ-at-risk (OAR) sparing, dose-volume histograms, and target minimum/maximum/mean doses were evaluated. It is found that for plans providing comparable PTV coverage, the Elekta VMAT plans were generally more inhomogeneous than the TH and TD plans. For the cases with regional node involvement, the average mean doses administered to the heart were 9.2 (± 5.2) and 8.8 (± 3.0) Gy in the VMAT and TH plans compared with 11.9 (± 6.4) and 11.8 (± 9.2) Gy for the 3DCRT and TD plans, respectively, with slightly higher doses given to the contralateral lung or breast or both. On average, the total monitor units for VMAT plans are 11.6% of those TH plans. Our studies have shown that VMAT and TH plans offer certain dosimetric advantages over fixed-field IMRT plans for advanced breast cancer requiring regional nodal treatment. However, for early-stage breast cancer fixed-field radiotherapy is potentially more beneficial in terms of OAR sparing.« less

Left-sided breast cancer irradiation using rotational and fixed-field radiotherapy.

PubMed

Qi, X Sharon; Liu, Tian X; Liu, Arthur K; Newman, Francis; Rabinovitch, Rachel; Kavanagh, Brian; Hu, Y Angie

2014-01-01

The 3-dimensional conformal radiotherapy (3DCRT) technique is the standard for breast cancer radiotherapy. During treatment planning, not only the coverage of the planning target volume (PTV) but also the minimization of the dose to critical structures, such as the lung, heart, and contralateral breast tissue, need to be considered. Because of the complexity and variations of patient anatomy, more advanced radiotherapy techniques are sometimes desired to better meet the planning goals. In this study, we evaluated external-beam radiation treatment techniques for left breast cancer using various delivery platforms: fixed-field including TomoDirect (TD), static intensity-modulated radiotherapy (sIMRT), and rotational radiotherapy including Elekta volumetric-modulated arc therapy (VMAT) and tomotherapy helical (TH). A total of 10 patients with left-sided breast cancer who did or did not have positive lymph nodes and were previously treated with 3DCRT/sIMRT to the entire breast were selected, their treatment was planned with Monaco VMAT, TD, and TH. Dosimetric parameters including PTV coverage, organ-at-risk (OAR) sparing, dose-volume histograms, and target minimum/maximum/mean doses were evaluated. It is found that for plans providing comparable PTV coverage, the Elekta VMAT plans were generally more inhomogeneous than the TH and TD plans. For the cases with regional node involvement, the average mean doses administered to the heart were 9.2 (± 5.2) and 8.8 (± 3.0)Gy in the VMAT and TH plans compared with 11.9 (± 6.4) and 11.8 (± 9.2)Gy for the 3DCRT and TD plans, respectively, with slightly higher doses given to the contralateral lung or breast or both. On average, the total monitor units for VMAT plans are 11.6% of those TH plans. Our studies have shown that VMAT and TH plans offer certain dosimetric advantages over fixed-field IMRT plans for advanced breast cancer requiring regional nodal treatment. However, for early-stage breast cancer fixed-field radiotherapy is potentially more beneficial in terms of OAR sparing. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

VMAT vs. 7-Field-IMRT: Assessing the Dosimetric Parameters of Prostate Cancer Treatment with a 292-Patient Sample

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kopp, Robert W.; Duff, Michael, E-mail: mduff@cancercarewny.com; Catalfamo, Frank

2011-01-01

We compared normal tissue radiation dose for the treatment of prostate cancer using 2 different radiation therapy delivery methods: volumetric modulated arc therapy (VMAT) vs. fixed-field intensity-modulated radiation therapy (IMRT). Radiotherapy plans for 292 prostate cancer patients treated with VMAT to a total dose of 7740 cGy were analyzed retrospectively. Fixed-angle, 7-field IMRT plans were created using the same computed tomography datasets and contours. Radiation doses to the planning target volume (PTV) and organs at risk (bladder, rectum, penile bulb, and femoral heads) were measured, means were calculated for both treatment methods, and dose-volume comparisons were made with 2-tailed, pairedmore » t-tests. The mean dose to the bladder was lower with VMAT at all measured volumes: 5, 10, 15, 25, 35, and 50% (p < 0.05). The mean doses to 5 and 10% of the rectum, the high-dose regions, were lower with VMAT (p < 0.05). The mean dose to 15% of the rectal volume was not significantly different (p = 0.95). VMAT exposed larger rectal volumes (25, 35, and 50%) to more radiation than fixed-field IMRT (p < 0.05). Average mean dose to the penile bulb (p < 0.05) and mean dose to 10% of the femoral heads (p < 0.05) were lower with VMAT. VMAT therapy for prostate cancer has dosimetric advantages for critical structures, notably for high-dose regions compared with fixed-field IMRT, without compromising PTV coverage. This may translate into reduced acute and chronic toxicity.« less

Reduced lung dose during radiotherapy for thoracic esophageal carcinoma: VMAT combined with active breathing control for moderate DIBH.

PubMed

Gong, Guanzhong; Wang, Ruozheng; Guo, Yujie; Zhai, Deyin; Liu, Tonghai; Lu, Jie; Chen, Jinhu; Liu, Chengxin; Yin, Yong

2013-12-20

Lung radiation injury is a critical complication of radiotherapy (RT) for thoracic esophageal carcinoma (EC). Therefore, the goal of this study was to investigate the feasibility and dosimetric effects of reducing the lung tissue irradiation dose during RT for thoracic EC by applying volumetric modulated arc radiotherapy (VMAT) combined with active breathing control (ABC) for moderate deep inspiration breath-hold (mDIBH). Fifteen patients with thoracic EC were randomly selected to undergo two series of computed tomography (CT) simulation scans with ABC used to achieve mDIBH (representing 80% of peak DIBH value) versus free breathing (FB). Gross tumor volumes were contoured on different CT images, and planning target volumes (PTVs) were obtained using different margins. For PTV-FB, intensity-modulated radiotherapy (IMRT) was designed with seven fields, and VMAT included two whole arcs. For PTV-DIBH, VMAT with three 135° arcs was applied, and the corresponding plans were named: IMRT-FB, VMAT-FB, and VMAT-DIBH, respectively. Dosimetric differences between the different plans were compared. The heart volumes decreased by 19.85%, while total lung volume increased by 52.54% in mDIBH, compared to FB (p < 0.05). The mean conformality index values and homogeneity index values for VMAT-DIBH (0.86, 1.07) were slightly worse than those for IMRT-FB (0.90, 1.05) and VMAT-FB (0.90, 1.06) (p > 0.05). Furthermore, compared to IMRT-FB and VMAT-FB, VMAT-DIBH reduced the mean total lung dose by 18.64% and 17.84%, respectively (p < 0.05); moreover, the V5, V10, V20, and V30 values for IMRT-FB and VMAT-FB were reduced by 10.84% and 10.65% (p > 0.05), 12.5% and 20% (p < 0.05), 30.77% and 33.33% (p < 0.05), and 50.33% and 49.15% (p < 0.05), respectively. However, the heart dose-volume indices were similar between VMAT-DIBH and VMAT-FB which were lower than IMRT-FB without being statistically significant (p > 0.05). The monitor units and treatment time of VMAT-DIBH were also the lowest (p < 0.05). VMAT combined with ABC to achieve mDIBH is a feasible approach for RT of thoracic EC. Furthermore, this method has the potential to effectively reduce lung dose in a shorter treatment time and with better targeting accuracy.

Dosimetric quality, accuracy, and deliverability of modulated radiotherapy treatments for spinal metastases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kairn, Tanya, E-mail: t.kairn@gmail.com; School of Chemistry, Physics, and Mechanical Engineering, Queensland University of Technology, Brisbane; Papworth, Daniel

2016-10-01

Cancer often metastasizes to the vertebra, and such metastases can be treated successfully using simple, static posterior or opposed-pair radiation fields. However, in some cases, including when re-irradiation is required, spinal cord avoidance becomes necessary and more complex treatment plans must be used. This study evaluated 16 sample intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) treatment plans designed to treat 6 typical vertebral and paraspinal volumes using a standard prescription, with the aim of investigating the advantages and limitations of these treatment techniques and providing recommendations for their optimal use in vertebral treatments. Treatment plan quality and beammore » complexity metrics were evaluated using the Treatment And Dose Assessor (TADA) code. A portal-imaging–based quality assurance (QA) system was used to evaluate treatment delivery accuracy, and radiochromic film measurements were used to provide high-resolution verification of treatment plan dose accuracy, especially in the steep dose gradient regions between each vertebral target and spinal cord. All treatment modalities delivered approximately the same doses and the same levels of dose heterogeneity to each planning target volume (PTV), although the minimum PTV doses in the vertebral plans were substantially lower than the prescription, because of the requirement that the plans meet a strict constraint on the dose to the spinal cord and cord planning risk volume (PRV). All plans met required dose constraints on all organs at risk, and all measured PTV-cord dose gradients were steeper than planned. Beam complexity analysis suggested that the IMRT treatment plans were more deliverable (less complex, leading to greater QA success) than the VMAT treatment plans, although the IMRT plans also took more time to deliver. The accuracy and deliverability of VMAT treatment plans were found to be substantially increased by limiting the number of monitor units (MU) per beam at the optimization stage, and thereby limiting beam modulation complexity. The VMAT arcs that were optimized with MU limitation had higher QA pass rates as well as higher modulation complexity scores (less complexity), lower modulation indices (less modulation), lower MU per beam, larger beam segments, and fewer small apertures than the VMAT arcs that were optimized without MU limitation. It is recommended that VMAT treatments for vertebral volumes, where the PTV abuts or surrounds the spinal cord, should be optimized with MU limitation. IMRT treatments may be preferable to the VMAT treatments, for dosimetry and deliverability reasons, but may be inappropriate for some patients because of their increased treatment delivery time.« less

Efficacy of robust optimization plan with partial-arc VMAT for photon volumetric-modulated arc therapy: A phantom study.

PubMed

Miura, Hideharu; Ozawa, Shuichi; Nagata, Yasushi

2017-09-01

This study investigated position dependence in planning target volume (PTV)-based and robust optimization plans using full-arc and partial-arc volumetric modulated arc therapy (VMAT). The gantry angles at the periphery, intermediate, and center CTV positions were 181°-180° (full-arc VMAT) and 181°-360° (partial-arc VMAT). A PTV-based optimization plan was defined by 5 mm margin expansion of the CTV to a PTV volume, on which the dose constraints were applied. The robust optimization plan consisted of a directly optimized dose to the CTV under a maximum-uncertainties setup of 5 mm. The prescription dose was normalized to the CTV D 99% (the minimum relative dose that covers 99% of the volume of the CTV) as an original plan. The isocenter was rigidly shifted at 1 mm intervals in the anterior-posterior (A-P), superior-inferior (S-I), and right-left (R-L) directions from the original position to the maximum-uncertainties setup of 5 mm in the original plan, yielding recalculated dose distributions. It was found that for the intermediate and center positions, the uncertainties in the D 99% doses to the CTV for all directions did not significantly differ when comparing the PTV-based and robust optimization plans (P > 0.05). For the periphery position, uncertainties in the D 99% doses to the CTV in the R-L direction for the robust optimization plan were found to be lower than those in the PTV-based optimization plan (P < 0.05). Our study demonstrated that a robust optimization plan's efficacy using partial-arc VMAT depends on the periphery CTV position. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

SU-E-T-332: Dosimetric Impact of Photon Energy and Treatment Technique When Knowledge Based Auto-Planning Is Implemented in Radiotherapy of Localized Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Z; Kennedy, A; Larsen, E

2015-06-15

Purpose: The aim of this study was to investigate the dosimetric impact of the combination of photon energy and treatment technique on radiotherapy of localized prostate cancer when knowledge based planning was used. Methods: A total of 16 patients with localized prostate cancer were retrospectively retrieved from database and used for this study. For each patient, four types of treatment plans with different combinations of photon energy (6X and 10X) and treatment techniques (7-field IMRT and 2-arc VMAT) were created using a prostate DVH estimation model in RapidPlan™ and Eclipse treatment planning system (Varian Medical System). For any beam arrangement,more » DVH objectives and weighting priorities were generated based on the geometric relationship between the OAR and PTV. Photon optimization algorithm was used for plan optimization and AAA algorithm was used for final dose calculation. Plans were evaluated in terms of the pre-defined dosimetric endpoints for PTV, rectum, bladder, penile bulb, and femur heads. A Student’s paired t-test was used for statistical analysis and p > 0.05 was considered statistically significant. Results: For PTV, V95 was statistically similar among all four types of plans, though the mean dose of 10X plans was higher than that of 6X plans. VMAT plans showed higher heterogeneity index than IMRT plans. No statistically significant difference in dosimetry metrics was observed for rectum, bladder, and penile bulb among plan types. For left and right femur, VMAT plans had a higher mean dose than IMRT plans regardless of photon energy, whereas the maximum dose was similar. Conclusion: Overall, the dosimetric endpoints were similar regardless of photon energy and treatment techniques when knowledge based auto planning was used. Given the similarity in dosimetry metrics of rectum, bladder, and penile bulb, the genitourinary and gastrointestinal toxicities should be comparable among the selections of photon energy and treatment techniques.« less

Comparison of organ-at-risk sparing and plan robustness for spot-scanning proton therapy and volumetric modulated arc photon therapy in head-and-neck cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barten, Danique L. J., E-mail: d.barten@vumc.nl; Tol, Jim P.; Dahele, Max

Purpose: Proton radiotherapy for head-and-neck cancer (HNC) aims to improve organ-at-risk (OAR) sparing over photon radiotherapy. However, it may be less robust for setup and range uncertainties. The authors investigated OAR sparing and plan robustness for spot-scanning proton planning techniques and compared these with volumetric modulated arc therapy (VMAT) photon plans. Methods: Ten HNC patients were replanned using two arc VMAT (RapidArc) and spot-scanning proton techniques. OARs to be spared included the contra- and ipsilateral parotid and submandibular glands and individual swallowing muscles. Proton plans were made using Multifield Optimization (MFO, using three, five, and seven fields) and Single-field Optimizationmore » (SFO, using three fields). OAR sparing was evaluated using mean dose to composite salivary glands (Comp{sub Sal}) and composite swallowing muscles (Comp{sub Swal}). Plan robustness was determined for setup and range uncertainties (±3 mm for setup, ±3% HU) evaluating V95% and V107% for clinical target volumes. Results: Averaged over all patients Comp{sub Sal}/Comp{sub Swal} mean doses were lower for the three-field MFO plans (14.6/16.4 Gy) compared to the three-field SFO plans (20.0/23.7 Gy) and VMAT plans (23.0/25.3 Gy). Using more than three fields resulted in differences in OAR sparing of less than 1.5 Gy between plans. SFO plans were significantly more robust than MFO plans. VMAT plans were the most robust. Conclusions: MFO plans had improved OAR sparing but were less robust than SFO and VMAT plans, while SFO plans were more robust than MFO plans but resulted in less OAR sparing. Robustness of the MFO plans did not increase with more fields.« less

Effect of collimator angles on the dosimetric results of volumetric modulated arc therapy planning for patients with a locally-advanced nasopharyngeal carcinoma

NASA Astrophysics Data System (ADS)

Kim, Yong Ho; Park, Dahl; Park, Ha Ryung; Kim, Won Taek; Kim, Dong Hyun; Bae, Jin Suk; Jeon, Gye Rok; Ro, Jung Hoon; Ki, Yongkan

2017-03-01

In volumetric modulated arc therapy (VMAT) planning, usually the collimator is rotated to minimize interleaf leakage and the tongue-and-groove effect. The objective of this study was to evaluate the effect of collimator angle on the dosimetric results of VMAT plans for patients with a locally-advanced nasopharyngeal carcinoma (LA-NPC). VMAT treatment planning sets were generated using the same planning parameters, but with different collimator angles for 11 LA-NPC patients. Each set was composed of 10 plans with collimator angles at 0, 5, 10, 15, 20, 25, 35, 40, and 45 degrees. Dosimetric parameters, such as target coverage, organs at risk (OAR), and dose conformity, were analyzed at various collimator angles. With increasing collimator angles, the absorbed doses to the optic apparatus were increased by up to 35% comparing to that at a collimator angle of 0°. The best value of the conformity index (CI) was 0.971 ± 0.023 at collimator angles of 20° and 30°. The worst value of CI was 0.917 ± 0.051 at a collimator angle of 0°. The homogeneity index (HI)95 and HI98 had the best values of 0.106 ± 0.040 and 0.079 ± 0.031, respectively, at a collimator angle of 25°. The worst values of HI95 and HI98 were 0.136 ± 0.039 and 0.105 ± 0.032, respectively, at a collimator angle of of 0°. The maximum doses for some OARs (body, ear, parotid gland, mandible, and brainstem) and the HI did not show any statistically significant differences. However, the mean doses had positive correlations ( r = 0.449 0.773, p<0.001) with the irradiated volume. The CI had a weak positive correlation ( r = 0.316, p<0.001) with the irradiated volume. Other comparison parameters were evaluated as functions of the collimator angle. These findings will give useful information for choosing the collimator angle in VMAT plans for patients with a LA-NPC.

Comparison between DCA - SSO - VDR and VMAT dose delivery techniques for 15 SRS/SRT patients

NASA Astrophysics Data System (ADS)

Tas, B.; Durmus, I. F.

2018-02-01

To evaluate dose delivery between Dynamic Conformal Arc (DCA) - Segment Shape Optimization (SSO) - Variation Dose Rate (VDR) and Volumetric Modulated Arc Therapy (VMAT) techniques for fifteen SRS patients using Versa HD® lineer accelerator. Fifteen SRS / SRT patient's optimum treatment planning were performed using Monaco5.11® treatment planning system (TPS) with 1 coplanar and 3 non-coplanar fields for VMAT technique, then the plans were reoptimized with the same optimization parameters for DCA - SSO - VDR technique. The advantage of DCA - SSO - VDR technique were determined less MUs and beam on time, also larger segments decrease dosimetric uncertainities of small fields quality assurance. The advantage of VMAT technique were determined a little better GI, CI, PCI, brain V12Gy and brain mean dose. The results show that the clinical objectives and plans for both techniques satisfied all organs at risks (OARs) dose constraints. Depends on the shape and localization of target, we could choose one of these techniques for linear accelerator based SRS / SRT treatment.

SU-F-T-264: VMAT QA with 2D Radiation Measuring Equipment Attached to Gantry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fung, A

2016-06-15

Purpose: To introduce a method of VMAT QA by 2D measuring device. The 2D device is attached to the gantry throughout measurement duration. This eliminates error caused by the angular dependence of the radiation detectors. Methods: A 2D radiation measuring device was attached to the gantry of linear accelerator. The center of the detector plane was at the isocenter. For each patient plan, two verification plans were created for QA purpose. One was like an ordinary VMAT plan, to be used for radiation delivery. The other is a plan with gantry angle fixed at zero, so the dose distribution asmore » seen by the rotating 2D device. Points above 10% dose threshold were analyzed. Data is in tolerance if it fits within the 3 mm or 3% dose gamma criteria. For each patient, the plan was passed when 95% of all the points in the 2D matrix fit the gamma criteria. The following statistics were calculated: number of patient plans passed, percentage of all points passed, average percentage difference of all points. Results: VMAT QA was performed for patients during one year in our department, and the results were analyzed. All irradiation was with 6 MV photon beam. Each plan has calculated and measured doses compared. After collecting one year’s result, with 81 patient plans analyzed, all (100%) of the plans passed the gamma criteria. Of the points analyzed from all plans, 98.8% of all points passed. Conclusion: This method of attaching a 2D measuring device on the linac gantry proves to be an accurate way for VMAT QA. It is simple to use and low cost, and it eliminates the problem of directional dependence.« less

Comparative dosimetry of volumetric modulated arc therapy and limited-angle static intensity-modulated radiation therapy for early-stage larynx cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Riegel, Adam C.; Antone, Jeffrey; Schwartz, David L., E-mail: dschwartz3@nshs.edu

2013-04-01

To compare relative carotid and normal tissue sparing using volumetric-modulated arc therapy (VMAT) or intensity-modulated radiation therapy (IMRT) for early-stage larynx cancer. Seven treatment plans were retrospectively created on 2 commercial treatment planning systems for 11 consecutive patients with T1-2N0 larynx cancer. Conventional plans consisted of opposed-wedged fields. IMRT planning used an anterior 3-field beam arrangement. Two VMAT plans were created, a full 360° arc and an anterior 180° arc. Given planning target volume (PTV) coverage of 95% total volume at 95% of 6300 cGy and maximum spinal cord dose below 2500 cGy, mean carotid artery dose was pushed asmore » low as possible for each plan. Deliverability was assessed by comparing measured and planned planar dose with the gamma (γ) index. Full-arc planning provided the most effective carotid sparing but yielded the highest mean normal tissue dose (where normal tissue was defined as all soft tissue minus PTV). Static IMRT produced next-best carotid sparing with lower normal tissue dose. The anterior half-arc produced the highest carotid artery dose, in some cases comparable with conventional opposed fields. On the whole, carotid sparing was inversely related to normal tissue dose sparing. Mean γ indexes were much less than 1, consistent with accurate delivery of planned treatment. Full-arc VMAT yields greater carotid sparing than half-arc VMAT. Limited-angle IMRT remains a reasonable alternative to full-arc VMAT, given its ability to mediate the competing demands of carotid and normal tissue dose constraints. The respective clinical significance of carotid and normal tissue sparing will require prospective evaluation.« less

Volumetric modulated arc therapy: a review of current literature and clinical use in practice

PubMed Central

Teoh, M; Clark, C H; Wood, K; Whitaker, S; Nisbet, A

2011-01-01

Volumetric modulated arc therapy (VMAT) is a novel radiation technique, which can achieve highly conformal dose distributions with improved target volume coverage and sparing of normal tissues compared with conventional radiotherapy techniques. VMAT also has the potential to offer additional advantages, such as reduced treatment delivery time compared with conventional static field intensity modulated radiotherapy (IMRT). The clinical worldwide use of VMAT is increasing significantly. Currently the majority of published data on VMAT are limited to planning and feasibility studies, although there is emerging clinical outcome data in several tumour sites. This article aims to discuss the current use of VMAT techniques in practice and review the available data from planning and clinical outcome studies in various tumour sites including prostate, pelvis (lower gastrointestinal, gynaecological), head and neck, thoracic, central nervous system, breast and other tumour sites. PMID:22011829

Volumetric modulated arc therapy of head-and-neck cancer on a fast-rotating O-ring linac: Plan quality and delivery time comparison with a C-arm linac.

PubMed

Michiels, Steven; Poels, Kenneth; Crijns, Wouter; Delombaerde, Laurence; De Roover, Robin; Vanstraelen, Bianca; Haustermans, Karin; Nuyts, Sandra; Depuydt, Tom

2018-05-05

Linac improvements in gantry speed, leaf speed and dose rate may increase the time-efficiency of volumetric modulated arc therapy (VMAT) delivery. The plan quality achievable with faster VMAT however remains to be investigated. In this study, a fast-rotating O-ring linac with fast-moving leaves is compared with a C-arm linac in terms of plan quality and delivery time for VMAT of head-and-neck cancer (HNC). For 30 patients with HNC, treatment planning was performed using dual-arc (HA2) and triple-arc (HA3) VMAT on a Halcyon fast-rotating O-ring linac and using dual-arc VMAT on a TrueBeam C-arm linac (TB2). Target coverage metrics and complication probabilities were compared. Plan delivery was verified using 3%/3 mm gamma-index analysis of helical diode array measurements. Volumetric image acquisition and plan delivery times were compared. All studied VMAT-techniques fulfilled the target coverage objectives. D 2% to the boost volume was higher for HA2 (median 103.7%, 1st-3rd quartile [103.5%;104.0%]) and HA3 (103.2% [103.0%;103.7%)] than for TB2 (102.6% [102.3%;103.0%)], resulting in an increased boost target dose heterogeneity for HA2 and HA3. Complication probabilities were comparable between HA2 and TB2, while HA3 showed a xerostomia probability reduction (0.8% [0.2%;1.8%]) and dysphagia probability reduction (1.0% [0.2%;1.8%]) compared with TB2. Gamma-index agreement scores were never below 93.0% for HA2, HA3 and TB2. Volumetric imaging and plan delivery time was shorter for HA2 (1 m 24 s ± 1 s) and HA3 (1 m 54 s ± 1 s) than for TB2 (2 m 47 s ± 1 s). For VMAT of HNC, the fast-rotating O-ring linac at least maintains the plan quality of two arcs on a C-arm linac while reducing the image acquisition and plan delivery time. Copyright © 2018 Elsevier B.V. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Uchida, Y; Tachibana, H

Purpose: For head and neck VMAT (HN-VMAT), variations of position and deformation of patient’s shoulders is a concern to affect inaccuracy of dose distribution. It has been reported that the setup error of the shoulders was variable from 5 mm – 1 cm. The beams of the HN-VMAT pass through the shoulders. We assessed the impact of shoulder deformation to dose distribution for HN-VMAT. Methods: One HN-VMAT plan was generated using a patient’s CT. The patient’s CT was deformed using ImSimQA (Oncology Systems Limited, Shrewsbury, Shropshire, UK) to generate several patterns of the shoulders’ deformations when the right and leftmore » humeral heads were shifted with 3, 6, and 15 mm in the superior and inferior directions (SI), 3, 5, and 15 mm in the anterior and posterior directions (AP), and 5 and 15 mm in the right or left direction (LR). DVH comparison was performed in the different deformation patterns. The dosimetric parameters of D95% for CTV70Gy, CTV60Gy and CTV54Gy and dmax for Spinal cord were also measured. Gamma index evaluation (Criteria: 3%/2mm) was performed to exhibit clinically tolerable area in the comparison. Results: DVH comparison shows similar for all structures. As the comparison for the dosimetric parameters, the variations of D95% in the LR and AP were within 1%. There were larger variations in the SI than those in the other directions, however were within 1.5%. In gamma index evaluation, the small spots with higher gamma index values were appeared when the shift was 6 mm, however the pass ratio was 99.13%. Conclusion: HN-VMAT should be robust for shoulder deformation and geometric accuracy within 6 mm from patient’s setup and image-guided radiotherapy may be clinically acceptable for target dose coverage or normal tissue dose sparing.« less

SU-F-T-590: Modeling PTV Dose Fall-Off for Cervical Cancer SBRT Treatment Planning Using VMAT and Step-And-Shoot IMRT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Delgado, A Brito; Cohen, D; Eng, T

Purpose: Due to the high dose per fraction in SBRT, dose conformity and dose fall-off are critical. In patients with cervical cancer, rapid dose fall-off is particularly important to limit dose to the nearby rectum, small bowel, and bladder. This study compares the target volume dose fall-off for two radiation delivery techniques, fixed-field IMRT & VMAT, using non-coplanar beam geometries. Further comparisons are made between 6 and 10MV photon beam energies. Methods: Eleven (n=11) patients were planned in Pinnacle3 v9.10 with a NovalisTx (HD120 MLC) machine model using 6 and 10 MV photons. The following three techniques were used: (1)more » IMRT (10 non-coplanar beams) (2) Dual, coplanar 360° VMAT arcs (4° spacing), and (3) Triple, non-coplanar VMAT arcs (1 full arc and dual partial arcs). All plans were normalized such that 98% of the PTV received at least 28Gy/4Fx. Dose was calculated using a 2.0mm isotropic dose grid. To assess dose fall-off, twenty concentric 2mm thick rings were created around the PTV. The maximum dose in each ring was recorded and the data was fitted to model dose fall-off. A separate analysis was performed by separating target volumes into small (0–50cc), medium (51–80cc), and large (81–110cc). Results: Triple, non-coplanar VMAT arcs showed the best dose fall-off for all patients evaluated. All fitted regressions had an R{sup 2}≥0.99. At 10mm from the PTV edge, 10 MV VMAT3-arc had an absolute improvement in dose fall-off of 3.8% and 6.9% over IMRT and VMAT2-arc, respectively. At 30mm, 10 MV VMAT3-arc had an absolute improvement of 12.0% and 7.0% over IMRT and VMAT2-arc, respectively. Faster dose fall-off was observed for small volumes as opposed to medium and large ones—9.6% at 20mm. Conclusion: Triple, non-coplanar VMAT arcs offer the sharpest dose fall-off for cervical SBRT plans. This improvement is most pronounced when treating smaller target volumes.« less

A comparison of volumetric modulated arc therapy and sliding-window intensity-modulated radiotherapy in the treatment of Stage I-II nasal natural killer/T-cell lymphoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Xianfeng; Yang, Yong; Jin, Fu

This article is aimed to compare the dosimetric differences between volumetric modulated arc therapy (VMAT) and intensity-modulated radiotherapy (IMRT) for Stage I-II nasal natural killer/T-cell lymphoma (NNKTL). Ten patients with Stage I-II NNKTL treated with IMRT were replanned with VMAT (2 arcs). The prescribed dose of the planning target volume (PTV) was 50 Gy in 25 fractions. The VMAT plans with the Anisotropic Analytical Algorithm (Version 8.6.15) were based on an Eclipse treatment planning system; the monitor units (MUs) and treatment time (T) were scored to measure the expected treatment efficiency. All the 10 patients under the study were subjectmore » to comparisons regarding the quality of target coverage, the efficiency of delivery, and the exposure of normal adjacent organs at risk (OARs). The study shows that VMAT was associated with a better conformal index (CI) and homogeneity index (HI) (both p < 0.05) but slightly higher dose to OARs than IMRT. The MUs with VMAT (650.80 ± 24.59) were fewer than with IMRT (1300.10 ± 57.12) (relative reduction of 49.94%, p = 0.00) when using 2-Gy dose fractions. The treatment time with VMAT (3.20 ± 0.02 minutes) was shorter than with IMRT (7.38 ± 0.18 minutes) (relative reduction of 56.64%, p = 0.00). We found that VMAT and IMRT both provide satisfactory target dosimetric coverage and OARs sparing clinically. Likely to deliver a bit higher dose to OARs, VMAT in comparison with IMRT, is still a better choice for treatment of patients with Stage I-II NNKTL, thanks to better dose distribution, fewer MUs, and shorter delivery time.« less

SU-E-T-338: Dosimetric Study of Volumetric Modulated Arc Therapy (VMAT) and Intensity Modulated Radiation Therapy (IMRT) for Stereotactic Body Radiation Therapy (SBRT) in Early Stage Lung Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ahmad, I; Quinn, K; Seebach, A

2015-06-15

Purpose: This study evaluates the dosimetric differences using volumetric modulated arc therapy (VMAT) in patients previously treated with intensity modulated radiation therapy IMRT for stereotactic body radiotherapy (SBRT) in early stage lung cancer. Methods: We evaluated 9 consecutive medically inoperable lung cancer patients at the start of the SBRT program who were treated with IMRT from November 2010 to October 2011. These patients were treated using 6 MV energy. The 9 cases were then re-planned with VMAT performed with arc therapy using 6 MV flattening filter free (FFF) energy with the same organs at risk (OARS) constraints. Data collected formore » the treatment plans included target coverage, beam on time, dose to OARS and gamma pass rate. Results: Five patients were T1N0 and four patients were T2N0 with all tumors less than 5 cm. The average GTV was 13.02 cm3 (0.83–40.87) and average PTV was 44.65 cm3 (14.06–118.08). The IMRT plans had a mean of 7.2 angles (6–9) and 5.4 minutes (3.6–11.1) per plan. The VMAT plans had a mean of 2.8 arcs (2–3) and 4.0 minutes (2.2–6.0) per plan. VMAT had slightly more target coverage than IMRT with average increase in D95 of 2.68% (1.24–5.73) and D99 of 3.65% (0.88–8.77). VMAT produced lower doses to all OARs. The largest reductions were in maximum doses to the spinal cord with an average reduction of 24.1%, esophagus with an average reduction of 22.1%, and lung with an average reduction in the V20 of 16.3% The mean gamma pass rate was 99.8% (99.2–100) at 3 mm and 3% for VMAT with comparable values for IMRT. Conclusion: These findings suggest that using VMAT for SBRT in early stage lung cancer is superior to IMRT in terms of dose coverage, OAR dose and a lower treatment delivery time with a similar gamma pass rate.« less

SU-E-T-184: Clinical VMAT QA Practice Using LINAC Delivery Log Files

DOE Office of Scientific and Technical Information (OSTI.GOV)

Johnston, H; Jacobson, T; Gu, X

2015-06-15

Purpose: To evaluate the accuracy of volumetric modulated arc therapy (VMAT) treatment delivery dose clouds by comparing linac log data to doses measured using an ionization chamber and film. Methods: A commercial IMRT quality assurance (QA) process utilizing a DICOM-RT framework was tested for clinical practice using 30 prostate and 30 head and neck VMAT plans. Delivered 3D VMAT dose distributions were independently checked using a PinPoint ionization chamber and radiographic film in a solid water phantom. DICOM RT coordinates were used to extract the corresponding point and planar doses from 3D log file dose distributions. Point doses were evaluatedmore » by computing the percent error between log file and chamber measured values. A planar dose evaluation was performed for each plan using a 2D gamma analysis with 3% global dose difference and 3 mm isodose point distance criteria. The same analysis was performed to compare treatment planning system (TPS) doses to measured values to establish a baseline assessment of agreement. Results: The mean percent error between log file and ionization chamber dose was 1.0%±2.1% for prostate VMAT plans and −0.2%±1.4% for head and neck plans. The corresponding TPS calculated and measured ionization chamber values agree within 1.7%±1.6%. The average 2D gamma passing rates for the log file comparison to film are 98.8%±1.0% and 96.2%±4.2% for the prostate and head and neck plans, respectively. The corresponding passing rates for the TPS comparison to film are 99.4%±0.5% and 93.9%±5.1%. Overall, the point dose and film data indicate that log file determined doses are in excellent agreement with measured values. Conclusion: Clinical VMAT QA practice using LINAC treatment log files is a fast and reliable method for patient-specific plan evaluation.« less

Left-sided breast cancer and risks of secondary lung cancer and ischemic heart disease : Effects of modern radiotherapy techniques.

PubMed

Corradini, Stefanie; Ballhausen, Hendrik; Weingandt, Helmut; Freislederer, Philipp; Schönecker, Stephan; Niyazi, Maximilian; Simonetto, Cristoforo; Eidemüller, Markus; Ganswindt, Ute; Belka, Claus

2018-03-01

Modern breast cancer radiotherapy techniques, such as respiratory-gated radiotherapy in deep-inspiration breath-hold (DIBH) or volumetric-modulated arc radiotherapy (VMAT) have been shown to reduce the high dose exposure of the heart in left-sided breast cancer. The aim of the present study was to comparatively estimate the excess relative and absolute risks of radiation-induced secondary lung cancer and ischemic heart disease for different modern radiotherapy techniques. Four different treatment plans were generated for ten computed tomography data sets of patients with left-sided breast cancer, using either three-dimensional conformal radiotherapy (3D-CRT) or VMAT, in free-breathing (FB) or DIBH. Dose-volume histograms were used for organ equivalent dose (OED) calculations using linear, linear-exponential, and plateau models for the lung. A linear model was applied to estimate the long-term risk of ischemic heart disease as motivated by epidemiologic data. Excess relative risk (ERR) and 10-year excess absolute risk (EAR) for radiation-induced secondary lung cancer and ischemic heart disease were estimated for different representative baseline risks. The DIBH maneuver resulted in a significant reduction of the ERR and estimated 10-year excess absolute risk for major coronary events compared to FB in 3D-CRT plans (p = 0.04). In VMAT plans, the mean predicted risk reduction through DIBH was less pronounced and not statistically significant (p = 0.44). The risk of radiation-induced secondary lung cancer was mainly influenced by the radiotherapy technique, with no beneficial effect through DIBH. VMAT plans correlated with an increase in 10-year EAR for radiation-induced lung cancer as compared to 3D-CRT plans (DIBH p = 0.007; FB p = 0.005, respectively). However, the EARs were affected more strongly by nonradiation-associated risk factors, such as smoking, as compared to the choice of treatment technique. The results indicate that 3D-CRT plans in DIBH pose the lowest risk for both major coronary events and secondary lung cancer.

SU-F-T-395: Evaluation of Best Dosimetry Achievable with VMAT and IMRT Treatment Techniques Targeting Borderline Resectable Pancreatic Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Harpool, K; Schnell, E; Herman, T

Purpose: To determine from retrospective study the most appropriate technique for targeting small borderline operable pancreatic cancer surrounding blood vessels by evaluating the dosimetry and normal tissue sparing achievable using Volumetric Modulated Arc Therapy (VMAT) and Intensity Modulated Radiation Therapy (IMRT). Methods: Treatment plans from ten patients who have undergone treatment with a prescribed dose of 4950 cGy, at 275 cGy per fraction, were analyzed. All plans were replanned using Eclipse TPS (Varian Medical Systems, Palo Alto, CA) with complementary VMAT or IMRT techniques to obtain paired data sets for comparison. The coverage to at least 95% of the plannedmore » target volume (PTV) was normalized to receive 100% of the prescription dose. The normal tissue constraints followed the quantitative analysis of normal tissue effects in the clinic (QUANTEC) guidelines and the organs at risks (OARs) were liver, kidneys, spinal cord and bowel. The plan evaluation was based on conformity index (CI), homogeneity index (HI), uniformity index (UI), DVH parameters, and student’s-t statistics (2 tails). Results: The VMAT technique delivered less maximum dose to the right kidney, left kidney, total kidney, liver, spinal cord, and bowel by 9.3%, 5.9%, 6.7%, 3.9%, 15.1%, 3.9%, and 4.3%, respectively. The averaged V15 for the total kidney was 10.21% for IMRT and 7.29% for VMAT. The averaged V20 for the bowel was 19.89% for IMRT and 14.06% for VMAT. On average, the CI for IMRT was 1.20 and 1.16 for VMAT (p = 0.20). The HI was 0.08 for both techniques (p = 0.91) and UI was 1.05 and 1.06 for IMRT and VMAT respectively (p = 0.59). Conclusion: Both techniques achieve adequate PTV coverage. Although VMAT techniques show better normal tissue sparing from excessive dose, no significant differences were observed. Slight discrepancies may rise from different versions of calculation algorithms.« less

SU-E-T-315: Dosimetric Effects of Couch Top Shift On VMAT Delivery in Absence of Indexing

DOE Office of Scientific and Technical Information (OSTI.GOV)

Islam, M; Jin, H; Ferguson, S

2015-06-15

Purpose: To investigate dosimetric effects of couch top shift for volumetric-modulated arc therapy (VMAT) in absence of indexing of immobilization devices. Methods: A total of twelve VMAT treatment plans were selected from three regions (lung, abdomen, and pelvis) to account for the variation of the patient position relative to the couch top. The treatment plans were generated using the Varian Eclipse system. A pinpoint ionization chamber (PTW TN31014) was placed at the center of 16-cm solid water phantom and the dose was delivered using the Varian TrueBeam STx with BrainLAB ExacTrac couch top. To simulate the day-to-day variation of themore » patient position relative to couch top, the couch top was laterally shifted up to 50 mm, with an increment of 5 mm from 0 to 20 mm; and of 10 mm afterwards, and the phantom was moved back to 0 cm shift for measurement. The dose was also delivered using a Varian tennis racket grid insert at 0 cm shift to simulate the absence of couch top. The treatment plans were delivered with 6, 10, and 15 MV photons using the same leaf sequencing to investigate the energy dependence of couch top shift. The dose difference was normalized to 0 cm shift for the regular couch top for comparison. Results: The percent difference of dose was found to increase with lateral shift for all energies; however, the average differences were close to 0% and the maximum difference was within 1% along the lateral shifts. The differences with the absence of couch top were 2.2±0.5% (6MV), 1.7±0.3% (10MV), and 1.6±0.2% (15MV), respectively. Conclusion: The inclusion of couch top is recommended in treatment planning to minimize the dosimetric uncertainty between calculated and delivered dose even in absence of indexing of immobilization devices in VMAT delivery.« less

Potential of Proton Therapy to Reduce Acute Hematologic Toxicity in Concurrent Chemoradiation Therapy for Esophageal Cancer.

PubMed

Warren, Samantha; Hurt, Christopher N; Crosby, Thomas; Partridge, Mike; Hawkins, Maria A

2017-11-01

Radiation therapy dose escalation using a simultaneous integrated boost (SIB) is predicted to improve local tumor control in esophageal cancer; however, any increase in acute hematologic toxicity (HT) could limit the predicted improvement in patient outcomes. Proton therapy has been shown to significantly reduce HT in lung cancer patients receiving concurrent chemotherapy. Therefore, we investigated the potential of bone marrow sparing with protons for esophageal tumors. Twenty-one patients with mid-esophageal cancer who had undergone conformal radiation therapy (3D50) were selected. Two surrogates for bone marrow were created by outlining the thoracic bones (bone) and only the body of the thoracic vertebrae (TV) in Eclipse. The percentage of overlap of the TV with the planning treatment volume was recorded for each patient. Additional plans were created retrospectively, including a volumetric modulated arc therapy (VMAT) plan with the same dose as for 3D50; a VMAT SIB plan with a dose prescription of 62.5 Gy to the high-risk subregion within the planning treatment volume; a reoptimized TV-sparing VMAT plan; and a proton therapy plan with the same SIB dose prescription. The bone and TV dose metrics were recorded and compared across all plans and variations with respect to PTV and percentage of overlap for each patient. The 3D50 plans showed the highest bone mean dose and TV percentage of volume receiving ≥30 Gy (V 30Gy ) for each patient. The VMAT plans irradiated a larger bone V 10Gy than did the 3D50 plans. The reoptimized VMAT62.5 VT plans showed improved sparing of the TV volume, but only the proton plans showed significant sparing for bone V 10Gy and bone mean dose, especially for patients with a larger PTV. The results of the present study have shown that proton therapy can reduced bone marrow toxicity. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Simultaneous integrated boost therapy of carcinoma of the hypopharynx/larynx with and without flattening filter - a treatment planning and dosimetry study.

PubMed

Dobler, Barbara; Obermeier, Tina; Hautmann, Matthias G; Khemissi, Amine; Koelbl, Oliver

2017-07-05

The aim of this study was to investigate if the flattening filter free (FFF) irradiation mode of a linear accelerator (linac) is advantageous as compared to the flat beam (FF) irradiation mode in intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) for carcinoma of the hypopharynx / larynx. Four treatment plans were created for each of 10 patients for an Elekta Synergy linac with Agility collimating device, a dual arc VMAT and a nine field step and shoot IMRT each with and without flattening filter. Plan quality was compared considering target coverage and dose to the organs at risk. All plans were verified by a 2D-ionization-chamber-array and delivery times were compared. Peripheral point doses were determined as a measure of second cancer risk. The Wilcoxon test was used for statistical analysis with a significance level of 0.05. Plan quality was similar for all four treatment plans without statistically significant differences of clinical relevance. The clinical goals were met in all plans for the PTV-SIB (V 95%  > 95%), the spinal cord (D 1ccm  < 45 Gy) and the brain stem (D 1ccm  < 48 Gy). For the parotids, the goal of D 50%  < 30 Gy was met in 70% and 60% of the plans for the left and right parotid respectively, and the V 95% of the SIB reached an average of 94%. Delivery times were similar for FF and FFF and significantly decreased by around 70% for VMAT as compared to IMRT. Peripheral doses were significantly reduced by 18% in FFF mode as compared to FF and by 26% for VMAT as compared to IMRT. Lowest peripheral doses were found for VMAT FFF, followed by VMAT FF. The FFF mode of a linear accelerator is advantageous for the treatment of hypopharynx/larynx carcinoma only with respect to reduction of second cancer induction in peripheral organs for the combination of Elekta Synergy linacs and Oncentra® External Beam v4.5 treatment planning system. This might be of interest in a therapy with curative intent.

Linac-based total body irradiation (TBI) with volumetric modulated arc therapy (VMAT)

NASA Astrophysics Data System (ADS)

Tas, B.; Durmus, I. F.; Okumus, A.; Uzel, O. E.

2017-02-01

To evaluate dose distribution of Volumetric modulated arc therapy (VMAT) planning tecnique using Versa HD® lineer accelerator to deliver Total Body Irradiation (TBI) on the coach. Eight TBI patient's Treatment Planning System (TPS) were performed with dual arc VMAT for each patient. The VMAT-TBI consisted of three isocentres and three dual overlapping arcs. The prescribed dose was 12 Gy. Mean dose to lung and kidney were restricted less than 10 Gy and max. dose to lens were restricted less than 6 Gy. The plans were verified using 2D array and ion chamber. The comparison between calculation and measurement were made by γ-index analysis and absolute dose. An average total delivery time was determined 923±34 seconds and an average MU was determined 2614±228 MUs for dual arc VMAT. Mean dose to lungs was 9.7±0.2 Gy, mean dose to kidneys was 8.8±0.3 Gy, max. dose to lens was 5.5±0.3 Gy and max. dose was 14.6±0.3 Gy, HI of PTV was 1.13±0.2, mean dose to PTV was 12.6±1.5 Gy and mean γ-index pass rate was %97.1±1.9. The results show that the tecnique for TBI using VMAT on the treatment coach is feasible.

Dosimetric and radiobiological comparison of volumetric modulated arc therapy, high-dose rate brachytherapy, and low-dose rate permanent seeds implant for localized prostate cancer.

PubMed

Yang, Ruijie; Zhao, Nan; Liao, Anyan; Wang, Hao; Qu, Ang

2016-01-01

To investigate the dosimetric and radiobiological differences among volumetric modulated arc therapy (VMAT), high-dose rate (HDR) brachytherapy, and low-dose rate (LDR) permanent seeds implant for localized prostate cancer. A total of 10 patients with localized prostate cancer were selected for this study. VMAT, HDR brachytherapy, and LDR permanent seeds implant plans were created for each patient. For VMAT, planning target volume (PTV) was defined as the clinical target volume plus a margin of 5mm. Rectum, bladder, urethra, and femoral heads were considered as organs at risk. A 78Gy in 39 fractions were prescribed for PTV. For HDR and LDR plans, the dose prescription was D90 of 34Gy in 8.5Gy per fraction, and 145Gy to clinical target volume, respectively. The dose and dose volume parameters were evaluated for target, organs at risk, and normal tissue. Physical dose was converted to dose based on 2-Gy fractions (equivalent dose in 2Gy per fraction, EQD2) for comparison of 3 techniques. HDR and LDR significantly reduced the dose to rectum and bladder compared with VMAT. The Dmean (EQD2) of rectum decreased 22.36Gy in HDR and 17.01Gy in LDR from 30.24Gy in VMAT, respectively. The Dmean (EQD2) of bladder decreased 6.91Gy in HDR and 2.53Gy in LDR from 13.46Gy in VMAT. For the femoral heads and normal tissue, the mean doses were also significantly reduced in both HDR and LDR compared with VMAT. For the urethra, the mean dose (EQD2) was 80.26, 70.23, and 104.91Gy in VMAT, HDR, and LDR brachytherapy, respectively. For localized prostate cancer, both HDR and LDR brachytherapy were clearly superior in the sparing of rectum, bladder, femoral heads, and normal tissue compared with VMAT. HDR provided the advantage in sparing of urethra compared with VMAT and LDR. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Dosimetric and radiobiological comparison of volumetric modulated arc therapy, high-dose rate brachytherapy, and low-dose rate permanent seeds implant for localized prostate cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, Ruijie, E-mail: ruijyang@yahoo.com; Zhao, Nan; Liao, Anyan

To investigate the dosimetric and radiobiological differences among volumetric modulated arc therapy (VMAT), high-dose rate (HDR) brachytherapy, and low-dose rate (LDR) permanent seeds implant for localized prostate cancer. A total of 10 patients with localized prostate cancer were selected for this study. VMAT, HDR brachytherapy, and LDR permanent seeds implant plans were created for each patient. For VMAT, planning target volume (PTV) was defined as the clinical target volume plus a margin of 5 mm. Rectum, bladder, urethra, and femoral heads were considered as organs at risk. A 78 Gy in 39 fractions were prescribed for PTV. For HDR andmore » LDR plans, the dose prescription was D{sub 90} of 34 Gy in 8.5 Gy per fraction, and 145 Gy to clinical target volume, respectively. The dose and dose volume parameters were evaluated for target, organs at risk, and normal tissue. Physical dose was converted to dose based on 2-Gy fractions (equivalent dose in 2 Gy per fraction, EQD{sub 2}) for comparison of 3 techniques. HDR and LDR significantly reduced the dose to rectum and bladder compared with VMAT. The D{sub mean} (EQD{sub 2}) of rectum decreased 22.36 Gy in HDR and 17.01 Gy in LDR from 30.24 Gy in VMAT, respectively. The D{sub mean} (EQD{sub 2}) of bladder decreased 6.91 Gy in HDR and 2.53 Gy in LDR from 13.46 Gy in VMAT. For the femoral heads and normal tissue, the mean doses were also significantly reduced in both HDR and LDR compared with VMAT. For the urethra, the mean dose (EQD{sub 2}) was 80.26, 70.23, and 104.91 Gy in VMAT, HDR, and LDR brachytherapy, respectively. For localized prostate cancer, both HDR and LDR brachytherapy were clearly superior in the sparing of rectum, bladder, femoral heads, and normal tissue compared with VMAT. HDR provided the advantage in sparing of urethra compared with VMAT and LDR.« less

SU-E-T-187: Feasibility Study of Stereotactic Liver Radiation Therapy Using Multiple Divided Partial Arcs in Volumetric Modulated Arc Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lin, Y; Ozawa, S; Tsegmed, U

2014-06-01

Purpose: To verify volumetric modulated arc therapy (VMAT) using flattening filter free (FFF) mode with jaw tracking (JT) feature for single breath hold as long as 15 s per arc in liver stereotactic body radiation therapy (SBRT) against intensity modulated radiation therapy (IMRT) FFF-JT. Methods: Ten hepatocellular carcinoma (HCC) cases were planned with 10 MV FFF using Pinnacle3 treatment planning system which delivered by TrueBeam to administer 48 Gy/ 4 fractions. Eight non-coplanar beams were assigned to IMRT using step-and-shoot technique. For VMAT, two or three non-coplanar partial arcs (up to 180 degrees) were further divided into subarcs with gantrymore » rotation less than 80 degrees to limit delivery time within 15 s. Dose distributions were verified using OCTAVIUS II system and pass rates were evaluated using gamma analysis with criteria of 3%/3 mm at threshold of 5% to the maximum dose. The actual irradiation time was measured. Results: The VMAT-FFF-JT of partial-arcs with sub-divided arcs was able to produce a highly conformal plan as well as IMRT-FFF-JT. Isodose lines and DVH showed slight improvement in dosimetry when JT was employed for both IMRT and VMAT. Consequently, VMAT-FFF-JT was superior in reducing the dose to liver minus gross tumor volume. VMAT-FFF-JT has shorter total treatment time compared with 3D conformal radiation therapy (3D-CRT) FFF because the gantry was rotated simultaneously with the beam delivery in VMAT. Moreover, due to the small and regular shape of HCC, VMAT-FFF-JT offered less multileaf collimator motion, thus the interplay effect is expected to be reduced. The patient specific QA of IMRT and VMAT acquired the pass rates higher than 90%. Conclusion: VMAT-FFF-JT could be a promising technique for liver SBRT as the sub-divided arcs method was able to accommodate a single breath hold irradiation time of less than 15 s without deterioration of the dose distribution compared with IMRT-FFF-JT.« less

Interplay effect on a 6-MV flattening-filter-free linear accelerator with high dose rate and fast multi-leaf collimator motion treating breast and lung phantoms.

PubMed

Netherton, Tucker; Li, Yuting; Nitsch, Paige; Shaitelman, Simona; Balter, Peter; Gao, Song; Klopp, Ann; Muruganandham, Manickam; Court, Laurence

2018-06-01

Using a new linear accelerator with high dose rate (800 MU/min), fast MLC motions (5.0 cm/s), fast gantry rotation (15 s/rotation), and 1 cm wide MLCs, we aimed to quantify the effects of complexity, arc number, and fractionation on interplay for breast and lung treatments under target motion. To study lung interplay, eight VMAT plans (1-6 arcs) and four-nine-field sliding-window IMRT plans varying in complexity were created. For the breast plans, four-four-field sliding-window IMRT plans were created. Using the Halcyon 1.0 linear accelerator, each plan was delivered five times each under sinusoidal breathing motion to a phantom with 20 implanted MOSFET detectors; MOSFET dose (cGy), delivery time, and MU/cGy values were recorded. Maximum and mean dose deviations were calculated from MOSFET data. The number of MOSFETs with at least 19 of 20 detectors agreeing with their expected dose within 5% per fraction was calculated across 10 6 iterations to model dose deviation as function of fraction number for all plan variants. To put interplay plans into clinical context, additional IMRT and VMAT plans were created and delivered for the sites of head and neck, prostate, whole brain, breast, pelvis, and lung. Average modulation and interplay effect were compared to those from conventional linear accelerators, as reported from previous studies. The mean beam modulation for plans created for the Halcyon 1.0 linear accelerator was 2.9 MU/cGy (two- to four-field IMRT breast plans), 6.2 MU/cGy (at least five-field IMRT), and 3.6 MU/cGy (four-arc VMAT). To achieve treatment plan objectives, Halcyon 1.0 VMAT plans require more arcs and modulation than VMAT on conventional linear accelerators. Maximum and mean dose deviations increased with increasing plan complexity under tumor motion for breast and lung treatments. Concerning VMAT plans under motion, maximum, and mean dose deviations were higher for one arc than for two arcs regardless of plan complexity. For plan variants with maximum dose deviations greater than 3.7%, dose deviation as a function of fraction number was protracted. For treatments on the Halcyon 1.0 linear accelerator, the convergence of dose deviation with fraction number happened more slowly than reported for conventional linear accelerators. However, if plan complexity is reduced for IMRT and if tumor motion is less than ~10-mm, interplay is greatly reduced. To minimize dose deviations across multiple fractions for dynamic targets, we recommend limiting treatment plan complexity and avoiding one-arc VMAT on the Halcyon 1.0 linear accelerator when interplay is a concern. © 2018 American Association of Physicists in Medicine.

Online adaptation and verification of VMAT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Crijns, Wouter, E-mail: wouter.crijns@uzleuven.be; Defraene, Gilles; Depuydt, Tom

2015-07-15

Purpose: This work presents a method for fast volumetric modulated arc therapy (VMAT) adaptation in response to interfraction anatomical variations. Additionally, plan parameters extracted from the adapted plans are used to verify the quality of these plans. The methods were tested as a prostate class solution and compared to replanning and to their current clinical practice. Methods: The proposed VMAT adaptation is an extension of their previous intensity modulated radiotherapy (IMRT) adaptation. It follows a direct (forward) planning approach: the multileaf collimator (MLC) apertures are corrected in the beam’s eye view (BEV) and the monitor units (MUs) are corrected usingmore » point dose calculations. All MLC and MU corrections are driven by the positions of four fiducial points only, without need for a full contour set. Quality assurance (QA) of the adapted plans is performed using plan parameters that can be calculated online and that have a relation to the delivered dose or the plan quality. Five potential parameters are studied for this purpose: the number of MU, the equivalent field size (EqFS), the modulation complexity score (MCS), and the components of the MCS: the aperture area variability (AAV) and the leaf sequence variability (LSV). The full adaptation and its separate steps were evaluated in simulation experiments involving a prostate phantom subjected to various interfraction transformations. The efficacy of the current VMAT adaptation was scored by target mean dose (CTV{sub mean}), conformity (CI{sub 95%}), tumor control probability (TCP), and normal tissue complication probability (NTCP). The impact of the adaptation on the plan parameters (QA) was assessed by comparison with prediction intervals (PI) derived from a statistical model of the typical variation of these parameters in a population of VMAT prostate plans (n = 63). These prediction intervals are the adaptation equivalent of the tolerance tables for couch shifts in the current clinical practice. Results: The proposed adaptation of a two-arc VMAT plan resulted in the intended CTV{sub mean} (Δ ≤ 3%) and TCP (ΔTCP ≤ 0.001). Moreover, the method assures the intended CI{sub 95%} (Δ ≤ 11%) resulting in lowered rectal NTCP for all cases. Compared to replanning, their adaptation is faster (13 s vs 10 min) and more intuitive. Compared to the current clinical practice, it has a better protection of the healthy tissue. Compared to IMRT, VMAT is more robust to anatomical variations, but it is also less sensitive to the different correction steps. The observed variations of the plan parameters in their database included a linear dependence on the date of treatment planning and on the target radius. The MCS is not retained as QA metric due to a contrasting behavior of its components (LSV and AAV). If three out of four plan parameters (MU, EqFS, AAV, and LSV) need to lie inside a 50% prediction interval (3/4—50%PI), all adapted plans will be accepted. In contrast, all replanned plans do not meet this loose criterion, mainly because they have no connection to the initially optimized and verified plan. Conclusions: A direct (forward) VMAT adaptation performs equally well as (inverse) replanning but is faster and can be extended to real-time adaptation. The prediction intervals for the machine parameters are equivalent to the tolerance tables for couch shifts in the current clinical practice. A 3/4—50%PI QA criterion accepts all the adapted plans but rejects all the replanned plans.« less

Dosimetric and radiobiological comparison of Forward Tangent Intensity Modulated Radiation Therapy (FT-IMRT) and Volumetric Modulated Arc Therapy (VMAT) for early stage whole breast cancer

NASA Astrophysics Data System (ADS)

Moshiri Sedeh, Nader

Intensity Modulated Radiation Therapy (IMRT) is a well-known type of external beam radiation therapy. The advancement in technology has had an inevitable influence in radiation oncology as well that has led to a newer and faster dose delivery technique called Volumetric Modulated Arc Therapy (VMAT). Since the presence of the VMAT modality in clinics in the late 2000, there have been many studies in order to compare the results of the VMAT modality with the current popular modality IMRT for various tumor sites in the body such as brain, prostate, head and neck, cervix and anal carcinoma. This is the first study to compare VMAT with IMRT for breast cancer. The results show that the RapidArc technique in Eclipse version 11 does not improve all aspects of the treatment plans for the breast cases automatically and easily, but it needs to be manipulated by extra techniques to create acceptable plans thus further research is needed.

On-line Adaptive Radiation Treatment of Prostate Cancer

DTIC Science & Technology

2009-01-01

12]. For intensity modulated radiation therapy (IMRT) plans , the beamlet weight can be re-optimized on a daily basis to mini- mize the dose to the OAR...Thongphiew D, Wang Z, Mathayomchan B, Chankong V, Yoo S, et al. On-line re-optimization of prostate IMRT plans for adaptive radiation therapy . Phys Med Biol...time. The treatment planning method for VMAT however is not mature. We are developing a robust VMAT treatment planning method which incorporates

SU-F-J-13: Choosing An IMRT Technique in the Treatment of Head and Neck Cancer with Daily Localization Uncertainties

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lin, T; Wang, L; Galloway, T

Purpose: Head and Neck cancer treatment with IMRT/VMAT has two choices: split-filed IMRT(SFI), in which the LAN is treated with a separate anterior field and the extended whole-field IMRT(WFI) in which LAN is included with the IMRT/VMAT field. This study shows that under the same dose limit criteria, choosing the technique becomes a critical issue if daily localization and immobilization altered the dose distribution. Methods: Nine common head-and-neck cancer cases were chosen to illustrate how the daily localization and immobilization uncertainties affect to choose between SFI and WFI. Both SFI and WFI at upper target coverage were generated with VMAT.more » For each case, the same planning criteria were applied to the target and critical structures; therefore, similar target coverage and dose falloff can be observed in both techniques. Thirty days of kV cone beam CT(CBCT) images on each case were also delineated with contralateral and ipsilateral target as well as larynx as critical structure. About 300 CBCT images with daily delivered doses were analyzed and compared in a form of dose-volume histograms. Results: While both plans for SFI and WFI with VMAT planning utilized and meet the criteria of D95>prescription dose and for not-involved larynx with mean dose <35Gy and V55<10%, the daily localization and immobilization has a great contribution to the resulted dose delivery. With WFI, the better daily contralateral and ipsilateral neck target coverage can reflect a simpler or shorter localization; however, a much superior avoidance (WFI: mean dose a 42.5Gy; SFI: mean dose a 18.9Gy) of the non-involved larynx from the SFI is preferred. Conclusion: Dosimetrically, SFI and WFI are equally well for head and Neck cancer treatment with VMAT technique; however, if considering the contribution of daily localization(CBCT) method uncertainties, SFI is better with sparing non-involved larynx and WFI has better target coverage.« less

SU-G-BRB-17: Dosimetric Evaluation of the Respiratory Interplay Effect During VMAT Delivery Using IPAGAT Polymer Gel Dosimeter

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ono, K; Fujimoto, S; Akagi, Y

Purpose: To evaluate the dosimetric impact of the interplay effect between multileaf collimator (MLC) movement and tumor respiratory motion during delivery of volumetric modulate arc therapy (VMAT) by using customized polymer gel dosimeter. Methods: Polyacrylamide-based gel dosimeter contained magnesium chloride as a sensitizer (iPAGAT) was used in this study. An excellent gas barrier PAN (BAREX) techno bottle (φ8 cm, 650 mL) filled with iPAGAT was set to the QUASAR™ respiratory motion phantom, and was moved with motion amplitudes of 1 and 2 cm with a 4 second period during VMAT delivery by the Novalis Tx linear accelerator (Varian/BrainLAB). Two sphericalmore » tumors with a 2 cm diameter (GTV1 and GTV2) were defined, and ITV1 (GTV1+1 cm) and ITV2 (GTV2+2 cm) with expansion in the superior-inferior (S-I) direction were also defined with simulated respiratory motion. PTV margin was 2 mm around the ITV considering the setup uncertainty. Two single arc VMAT plans with 30 Gy at 3 Gy per fraction (GTV: D98>100%, PTV: D95=100%) were generated by the Varian Eclipse treatment planning system. Three-dimensional dose distribution in iPAGAT was read out by the Signa 1.5T MRI system (GE), and was evaluated by dose-volume histogram (DVH) using in-house developed software. Results: According to DVH analysis by iPAGAT, D98 of GTV1 and GTV2 were more than 100% of the prescribed dose. In contrast, D95 of PTV1 and PTV2 were about 85% and 65%, respectively. Furthermore, low-to-intermediate dose was widespread with motion amplitude of 2 cm. Conclusion: DVH analysis using iPAGAT polymer gel dosimeter was performed in this study. As a result, interplay effect was negligible, since dose coverage of GTV was sufficient during VMAT delivery with simulated respiratory motion. However, the dose reduction of PTV and the spread of low-to-intermediate dose compared to the planned dose require scrupulous attention for large tumor respiratory motion.« less

SU-F-T-637: Single-Isocenter Versus Multiple-Isocenter VMAT SRS for Unusual Multiple Metastasis Case with Two Widely Separated Lesions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thomas, EM; Popple, RA; Fiveash, JB

Purpose: Single-isocenter (SI) volumetric modulated arc therapy has been shown to be an effective and efficient approach to multiple metastasis radiosurgery. However, certain extreme cases raise the question of whether multiple-isocenter (MI) approaches can still generate superior plans. In this study, we ask this question with respect to a clinical case with two very widely separated lesions. Methods: A patient with two widely separated (d = 12cm) tumors was treated with SI-VMAT SRS using 10MV flattening filter free (FFF) beam with high-definition multi-leaf collimator (HD-MLC, 2.5/5mm) in two non-coplanar arcs using concentric rings to enforce steep gradient. Because of lesionmore » positioning with respect to collimator angle selection, lesions were treated by 5mm leaves. We re-planned the case with a congruent arc arrangement but separate isocenter for each lesion. In this manner, lesions were treated by 2.5mm leaves. Conformity index (CI), V50%, and mean brain dose were compared. Results: Neither conformity (CI-SI = 1.12, CI-MI = 1.08) nor V50% (V50%-SI =8.82cc, V50%-MI =8.81cc) were improved by utilizing a separate isocenter for each lesion. Mean brain dose was slightly reduced (dmean-SI = 118.4 cGy, dmean-MI = 88.7 cGy) by using multiple isocenters. Conclusion: For this case with a lesion at the apex of the brain and another distantly located at the base of skull, employing a separate isocenter for each target did not meaningfully improve plan quality. Single-isocenter VMAT has been shown feasible and equivalent to multiple-isocenter VMAT for multiple metastasis cases in general. In this extreme case, single- and multiple- isocenter VMAT were also equivalent. If rotational setup errors are appropriately corrected, the increased delivery efficiency of the single-isocenter approach renders it preferable to the multiple isocenter approach. Dr’s Thomas, Popple, and Fiveash have all received honoraria from Varian Medical Systems for discussing their experiences with stereotactic radiosurgery.« less

VMAT linear accelerator commissioning and quality assurance: dose control and gantry speed tests

PubMed Central

Rowshanfarzad, Pejman; Greer, Peter B.

2016-01-01

In VMAT treatment delivery the ability of the linear accelerator (linac) to accurately control dose versus gantry angle is critical to delivering the plan correctly. A new VMAT test delivery was developed to specifically test the dose versus gantry angle with the full range of allowed gantry speeds and dose rates. The gantry‐mounted IBA MatriXX with attached inclinometer was used in movie mode to measure the instantaneous relative dose versus gantry angle during the plan every 0.54 s. The results were compared to the expected relative dose at each gantry angle calculated from the plan. The same dataset was also used to compare the instantaneous gantry speeds throughout the delivery compared to the expected gantry speeds from the plan. Measurements performed across four linacs generally show agreement between measurement and plan to within 1.5% in the constant dose rate regions and dose rate modulation within 0.1 s of the plan. Instantaneous gantry speed was measured to be within 0.11∘/s of the plan (1 SD). An error in one linac was detected in that the nominal gantry speed was incorrectly calibrated. This test provides a practical method to quality‐assure critical aspects of VMAT delivery including dose versus gantry angle and gantry speed control. The method can be performed with any detector that can acquire time‐resolved dosimetric information that can be synchronized with a measurement of gantry angle. The test fulfils several of the aims of the recent Netherlands Commission on Radiation Dosimetry (NCS) Report 24, which provides recommendations for comprehensive VMAT quality assurance. PACS number(s): 87.55.Qr PMID:27167282

SU-F-T-272: Patient Specific Quality Assurance of Prostate VMAT Plans with Portal Dosimetry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Darko, J; Osei, E; University of Waterloo, Waterloo, ON

Purpose: To evaluate the effectiveness of using the Portal Dosimetry (PD) method for patient specific quality assurance of prostate VMAT plans. Methods: As per institutional protocol all VMAT plans were measured using the Varian Portal Dosimetry (PD) method. A gamma evaluation criterion of 3%-3mm with a minimum area gamma pass rate (gamma <1) of 95% is used clinically for all plans. We retrospectively evaluated the portal dosimetry results for 170 prostate patients treated with VMAT technique. Three sets of criterions were adopted for re-evaluating the measurements; 3%-3mm, 2%-2mm and 1%-1mm. For all criterions two areas, Field+1cm and MLC-CIAO were analysed.Tomore » ascertain the effectiveness of the portal dosimetry technique in determining the delivery accuracy of prostate VMAT plans, 10 patients previously measured with portal dosimetry, were randomly selected and their measurements repeated using the ArcCHECK method. The same criterion used in the analysis of PD was used for the ArcCHECK measurements. Results: All patient plans reviewed met the institutional criteria for Area Gamma pass rate. Overall, the gamma pass rate (gamma <1) decreases for 3%-3mm, 2%-2mm and 1%-1mm criterion. For each criterion the pass rate was significantly reduced when the MLC-CIAO was used instead of FIELD+1cm. There was noticeable change in sensitivity for MLC-CIAO with 2%-2mm criteria and much more significant reduction at 1%-1mm. Comparable results were obtained for the ArcCHECK measurements. Although differences were observed between the clockwise verses the counter clockwise plans in both the PD and ArcCHECK measurements, this was not deemed to be statistically significant. Conclusion: This work demonstrates that Portal Dosimetry technique can be effectively used for quality assurance of VMAT plans. Results obtained show similar sensitivity compared to ArcCheck. To reveal certain delivery inaccuracies, the use of a combination of criterions may provide an effective way in improving the overall sensitivity of PD. Funding provided in part by the Prostate Ride for Dad, Kitchener-Waterloo, Canada.« less

Linac-based extracranial radiosurgery with Elekta volumetric modulated arc therapy and an anatomy-based treatment planning system: Feasibility and initial experience

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cilla, Savino, E-mail: savinocilla@gmail.com; Deodato, Francesco; Macchia, Gabriella

We reported our initial experience in using Elekta volumetric modulated arc therapy (VMAT) and an anatomy-based treatment planning system (TPS) for single high-dose radiosurgery (SRS-VMAT) of liver metastases. This study included a cohort of 12 patients treated with a 26-Gy single fraction. Single-arc VMAT plans were generated with Ergo++ TPS. The prescription isodose surface (IDS) was selected to fulfill the 2 following criteria: 95% of planning target volume (PTV) reached 100% of the prescription dose and 99% of PTV reached a minimum of 90% of prescription dose. A 1-mm multileaf collimator (MLC) block margin was added around the PTV. Formore » a comparison of dose distributions with literature data, several conformity indexes (conformity index [CI], conformation number [CN], and gradient index [GI]) were calculated. Treatment efficiency and pretreatment dosimetric verification were assessed. Early clinical data were also reported. Our results reported that target and organ-at-risk objectives were met for all patients. Mean and maximum doses to PTVs were on average 112.9% and 121.5% of prescribed dose, respectively. A very high degree of dose conformity was obtained, with CI, CN, and GI average values equal to 1.29, 0.80, and 3.63, respectively. The beam-on-time was on average 9.3 minutes, i.e., 0.36 min/Gy. The mean number of monitor units was 3162, i.e., 121.6 MU/Gy. Pretreatment verification (3%-3 mm) showed an optimal agreement with calculated values; mean γ value was 0.27 and 98.2% of measured points resulted with γ < 1. With a median follow-up of 16 months complete response was observed in 12/14 (86%) lesions; partial response was observed in 2/14 (14%) lesions. No radiation-induced liver disease (RILD) was observed in any patients as well no duodenal ulceration or esophagitis or gastric hemorrhage. In conclusion, this analysis demonstrated the feasibility and the appropriateness of high-dose single-fraction SRS-VMAT in liver metastases performed with Elekta VMAT and Ergo++ TPS. Preliminary clinical outcomes showed a high rate of local control and minimum incidence of acute toxicity.« less

Treatment of left sided breast cancer for a patient with funnel chest: Volumetric-modulated arc therapy vs. 3D-CRT and intensity-modulated radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Haertl, Petra M., E-mail: petra.haertl@klinik.uni-regensburg.de; Pohl, Fabian; Weidner, Karin

2013-04-01

This case study presents a rare case of left-sided breast cancer in a patient with funnel chest, which is a technical challenge for radiation therapy planning. To identify the best treatment technique for this case, 3 techniques were compared: conventional tangential fields (3D conformal radiotherapy [3D-CRT]), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT). The plans were created for a SynergyS® (Elekta, Ltd, Crawley, UK) linear accelerator with a BeamModulator™ head and 6-MV photons. The planning system was Oncentra Masterplan® v3.3 SP1 (Nucletron BV, Veenendal, Netherlands). Calculations were performed with collapsed cone algorithm. Dose prescription was 50.4 Gy to themore » average of the planning target volume (PTV). PTV coverage and homogeneity was comparable for all techniques. VMAT allowed reducing dose to the ipsilateral organs at risk (OAR) and the contralateral breast compared with IMRT and 3D-CRT: The volume of the left lung receiving 20 Gy was 19.3% for VMAT, 26.1% for IMRT, and 32.4% for 3D-CRT. In the heart, a D{sub 15%} of 9.7 Gy could be achieved with VMAT compared with 14 Gy for IMRT and 46 Gy for 3D-CRT. In the contralateral breast, D{sub 15%} was 6.4 Gy for VMAT, 8.8 Gy for IMRT, and 10.2 Gy for 3D-CRT. In the contralateral lung, however, the lowest dose was achieved with 3D-CRT with D{sub 10%} of 1.7 Gy for 3D-CRT, and 6.7 Gy for both IMRT and VMAT. The lowest number of monitor units (MU) per 1.8-Gy fraction was required by 3D-CRT (192 MU) followed by VMAT (518 MU) and IMRT (727 MU). Treatment time was similar for 3D-CRT (3 min) and VMAT (4 min) but substantially increased for IMRT (13 min). VMAT is considered the best treatment option for the presented case of a patient with funnel chest. It allows reducing dose in most OAR without compromising target coverage, keeping delivery time well below 5 minutes.« less

Volumetric modulated arc radiotherapy sparing the thyroid gland for early-stage glottic cancer: A dosimetrical analysis.

PubMed

Kim, Eun Seok; Yeo, Seung-Gu

2014-06-01

Previous studies on advanced radiotherapy (RT) techniques for early stage glottic cancer have focused on sparing the carotid artery. However, the aim of the present study was to evaluate the dosimetric advantages of volumetric modulated arc therapy (VMAT) in terms of sparing the thyroid gland in early-stage glottic cancer patients. In total, 15 cT1N0M0 glottic cancer patients treated with definitive RT using VMAT were selected, and for dosimetric comparison, a conventional RT plan comprising opposed-lateral wedged fields was generated for each patient. The carotid artery, thyroid gland and spinal cord were considered organs at risk. The prescription dose was 63 Gy at 2.25 Gy per fraction. For the thyroid gland and carotid artery, all compared parameters were significantly lower with VMAT compared with conventional RT. For the thyroid gland, the median reduction rates of the mean dose (D mean ), the volume receiving ≥30% of the prescription dose (V 30 ) and the V 50 were 32.6, 40.9 and 46.0%, respectively. The D mean was 14.7±2.6 Gy when using VMAT compared with 22.2±3.9 Gy when using conventional RT. The differences between the techniques in terms of planning target volume coverage and dose homogeneity were not significant. When considering a recent normal tissue complication probability model, which indicated the mean thyroid gland dose as the most significant predictor of radiation-induced hypothyroidism, the dosimetric advantage shown in this study may be valuable in reducing hypothyroidism following RT for early stage glottic cancer patients.

Optimizing highly noncoplanar VMAT trajectories: the NoVo method.

PubMed

Langhans, Marco; Unkelbach, Jan; Bortfeld, Thomas; Craft, David

2018-01-16

We introduce a new method called NoVo (Noncoplanar VMAT Optimization) to produce volumetric modulated arc therapy (VMAT) treatment plans with noncoplanar trajectories. While the use of noncoplanar beam arrangements for intensity modulated radiation therapy (IMRT), and in particular high fraction stereotactic radiosurgery (SRS), is common, noncoplanar beam trajectories for VMAT are less common as the availability of treatment machines handling these is limited. For both IMRT and VMAT, the beam angle selection problem is highly nonconvex in nature, which is why automated beam angle selection procedures have not entered mainstream clinical usage. NoVo determines a noncoplanar VMAT solution (i.e. the simultaneous trajectories of the gantry and the couch) by first computing a [Formula: see text] solution (beams from every possible direction, suitably discretized) and then eliminating beams by examing fluence contributions. Also all beam angles are scored via geometrical considerations only to find out the usefulness of the whole beam space in a very short time. A custom path finding algorithm is applied to find an optimized, continuous trajectory through the most promising beam angles using the calculated score of the beam space. Finally, using this trajectory a VMAT plan is optimized. For three clinical cases, a lung, brain, and liver case, we compare NoVo to the ideal [Formula: see text] solution, nine beam noncoplanar IMRT, coplanar VMAT, and a recently published noncoplanar VMAT algorithm. NoVo comes closest to the [Formula: see text] solution considering the lung case (brain and liver case: second), as well as improving the solution time by using geometrical considerations, followed by a time effective iterative process reducing the [Formula: see text] solution. Compared to a recently published noncoplanar VMAT algorithm, using NoVo the computation time is reduced by a factor of 2-3 (depending on the case). Compared to coplanar VMAT, NoVo reduces the objective function value by 24%, 49% and 6% for the lung, brain and liver cases, respectively.

Optimizing highly noncoplanar VMAT trajectories: the NoVo method

NASA Astrophysics Data System (ADS)

Langhans, Marco; Unkelbach, Jan; Bortfeld, Thomas; Craft, David

2018-01-01

We introduce a new method called NoVo (Noncoplanar VMAT Optimization) to produce volumetric modulated arc therapy (VMAT) treatment plans with noncoplanar trajectories. While the use of noncoplanar beam arrangements for intensity modulated radiation therapy (IMRT), and in particular high fraction stereotactic radiosurgery (SRS), is common, noncoplanar beam trajectories for VMAT are less common as the availability of treatment machines handling these is limited. For both IMRT and VMAT, the beam angle selection problem is highly nonconvex in nature, which is why automated beam angle selection procedures have not entered mainstream clinical usage. NoVo determines a noncoplanar VMAT solution (i.e. the simultaneous trajectories of the gantry and the couch) by first computing a 4π solution (beams from every possible direction, suitably discretized) and then eliminating beams by examing fluence contributions. Also all beam angles are scored via geometrical considerations only to find out the usefulness of the whole beam space in a very short time. A custom path finding algorithm is applied to find an optimized, continuous trajectory through the most promising beam angles using the calculated score of the beam space. Finally, using this trajectory a VMAT plan is optimized. For three clinical cases, a lung, brain, and liver case, we compare NoVo to the ideal 4π solution, nine beam noncoplanar IMRT, coplanar VMAT, and a recently published noncoplanar VMAT algorithm. NoVo comes closest to the 4π solution considering the lung case (brain and liver case: second), as well as improving the solution time by using geometrical considerations, followed by a time effective iterative process reducing the 4π solution. Compared to a recently published noncoplanar VMAT algorithm, using NoVo the computation time is reduced by a factor of 2-3 (depending on the case). Compared to coplanar VMAT, NoVo reduces the objective function value by 24%, 49% and 6% for the lung, brain and liver cases, respectively.

Feasibility study on dosimetry verification of volumetric-modulated arc therapy-based total marrow irradiation.

PubMed

Liang, Yun; Kim, Gwe-Ya; Pawlicki, Todd; Mundt, Arno J; Mell, Loren K

2013-03-04

The purpose of this study was to develop dosimetry verification procedures for volumetric-modulated arc therapy (VMAT)-based total marrow irradiation (TMI). The VMAT based TMI plans were generated for three patients: one child and two adults. The planning target volume (PTV) was defined as bony skeleton, from head to mid-femur, with a 3 mm margin. The plan strategy similar to published studies was adopted. The PTV was divided into head and neck, chest, and pelvic regions, with separate plans each of which is composed of 2-3 arcs/fields. Multiple isocenters were evenly distributed along the patient's axial direction. The focus of this study is to establish a dosimetry quality assurance procedure involving both two-dimensional (2D) and three-dimensional (3D) volumetric verifications, which is desirable for a large PTV treated with multiple isocenters. The 2D dose verification was performed with film for gamma evaluation and absolute point dose was measured with ion chamber, with attention to the junction between neighboring plans regarding hot/cold spots. The 3D volumetric dose verification used commercial dose reconstruction software to reconstruct dose from electronic portal imaging devices (EPID) images. The gamma evaluation criteria in both 2D and 3D verification were 5% absolute point dose difference and 3 mm of distance to agreement. With film dosimetry, the overall average gamma passing rate was 98.2% and absolute dose difference was 3.9% in junction areas among the test patients; with volumetric portal dosimetry, the corresponding numbers were 90.7% and 2.4%. A dosimetry verification procedure involving both 2D and 3D was developed for VMAT-based TMI. The initial results are encouraging and warrant further investigation in clinical trials.

Bladder radiotherapy treatment: A retrospective comparison of 3-dimensional conformal radiotherapy, intensity-modulated radiation therapy, and volumetric-modulated arc therapy plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pasciuti, Katia, E-mail: k.pasciuti@virgilio.it; Kuthpady, Shrinivas; Anderson, Anne

To examine tumor's and organ's response when different radiotherapy plan techniques are used. Ten patients with confirmed bladder tumors were first treated using 3-dimensional conformal radiotherapy (3DCRT) and subsequently the original plans were re-optimized using the intensity-modulated radiation treatment (IMRT) and volumetric-modulated arc therapy (VMAT)-techniques. Targets coverage in terms of conformity and homogeneity index, TCP, and organs' dose limits, including integral dose analysis were evaluated. In addition, MUs and treatment delivery times were compared. Better minimum target coverage (1.3%) was observed in VMAT plans when compared to 3DCRT and IMRT ones confirmed by a statistically significant conformity index (CI) results.more » Large differences were observed among techniques in integral dose results of the femoral heads. Even if no statistically significant differences were reported in rectum and tissue, a large amount of energy deposition was observed in 3DCRT plans. In any case, VMAT plans provided better organs and tissue sparing confirmed also by the normal tissue complication probability (NTCP) analysis as well as a better tumor control probability (TCP) result. Our analysis showed better overall results in planning using VMAT techniques. Furthermore, a total time reduction in treatment observed among techniques including gantry and collimator rotation could encourage using the more recent one, reducing target movements and patient discomfort.« less

SU-E-T-483: In Vivo Dosimetry of Conventional and Rotational Intensity Modulated Radiotherapy Using Integral Quality Monitor (IQM)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lin, L; Qian, J; Gonzales, R

Purpose: To investigate the accuracy, sensitivity and constancy of integral quality monitor (IQM), a new system for in vivo dosimetry of conventional intensity modulated radiation therapy (IMRT) or rotational volumetric modulated arc therapy (VMAT) Methods: A beta-version IQM system was commissioned on an Elekta Infinity LINAC equipped with 160-MLCs Agility head. The stationary and rotational dosimetric constancy of IQM was evaluated, using five-field IMRT and single-or double-arc VMAT plans for prostate and head-and-neck (H&N) patients. The plans were delivered three times over three days to assess the constancy of IQM response. Picket fence (PF) fields were used to evaluate themore » sensitivity of detecting MLC leaf errors. A single leaf offset was intentionally introduced during delivery of various PF fields with segment apertures of 3×1, 5×1, 10×1, and 24×1cm2. Both 2mm and 5mm decrease in the field width were used. Results: Repeated IQM measurements of prostate and H&N IMRT deliveries showed 0.4 and 0.5% average standard deviation (SD) for segment-by-segment comparison and 0.1 and 0.2% for cumulative comparison. The corresponding SDs for VMAT deliveries were 6.5, 9.4% and 0.7, 1.3%, respectively. Statistical analysis indicates that the dosimetric differences detected by IQM were significant (p < 0.05) in all PF test deliveries. The largest average IQM signal response of a 2 mm leaf error was found to be 2.1% and 5.1% by a 5mm leaf error for 3×1 cm2 field size. The same error in 24×1 cm2 generates a 0.7% and 1.4% difference in the signal. Conclusion: IQM provides an effective means for real-time dosimetric verification of IMRT/ VMAT treatment delivery. For VMAT delivery, the cumulative dosimetry of IQM needs to be used in clinical practice.« less

SU-F-T-643: Feasibility of Performing Patient Specific VMAT QA On Single Linac for Plans Treated in Beam-Matched Elekta Agility Linacs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Leung, R; Lee, V; Cheung, S

2016-06-15

Purpose: The increasing application of VMAT demands a more efficient workflow and QA solution. This study aims to investigate the feasibility of performing VMAT QA measurements on one linac for plans treated on other beam-matched Elekta Agility linacs. Methods: A single model was used to create 24 clinically approved VMAT plans (12 head-and-neck and 12 prostate using 6MV and 10MV respectively) on Pinnacle v9.10 (Philips, Einhoven, Netherlands). All head-and-neck plans were delivered on three beam-matched machines while all prostate cases were delivered on two beam-matched 10MV Agility machines. All plans were delivered onto PTW Octavius 4D phantom with 1500 detectormore » array (PTW, Freiburg, Germany). Reconstructed volume doses were then compared with the Pinnacle reference plans in Verisoft 6.1 under 3%/3mm gamma criteria at local dose. Plans were considered clinically acceptable if >90% of the voxels passing the gamma criteria. Results: All measurements were passed (3D gamma passing rate >90%) and the result shows that the mean difference of 3D gamma of 12 head-and-neck cases is 1.2% with standard deviation of 0.6%. While for prostate cases, the mean difference of 3D gamma is 0.9% with standard deviation of 0.7%. Maximum difference of 3D gamma of all measurements between beam-matched machines is less than 2.5%. The differences of passing rates between different machines were statistically insignificant (p>0.05). Conclusion. The result suggests that ther Conclusion: The result suggests that there exists a 3D gamma threshold, in our case 92.5%, above which the VMAT QA performed in any one of beam-matched machine will also pass in another one. Therefore, VMAT QA efficiency may be increased and phantom set up time can be saved by implementing such method. A constant performance across all beam matched machines must be maintained to make this QA approach feasible.« less

Skin dose differences between intensity-modulated radiation therapy and volumetric-modulated arc therapy and between boost and integrated treatment regimens for treating head and neck and other cancer sites in patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Penoncello, Gregory P.; Ding, George X., E-mail: george.ding@vanderbilt.edu

The purpose of this study was (1) to evaluate dose to skin between volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) treatment techniques for target sites in the head and neck, pelvis, and brain and (2) to determine if the treatment dose and fractionation regimen affect the skin dose between traditional sequential boost and integrated boost regimens for patients with head and neck cancer. A total of 19 patients and 48 plans were evaluated. The Eclipse (v11) treatment planning system was used to plan therapy in 9 patients with head and neck cancer, 5 patients with prostate cancer, andmore » 5 patients with brain cancer with VMAT and static-field IMRT. The mean skin dose and the maximum dose to a contiguous volume of 2 cm{sup 3} for head and neck plans and brain plans and a contiguous volume of 5 cm{sup 3} for pelvis plans were compared for each treatment technique. Of the 9 patients with head and neck cancer, 3 underwent an integrated boost regimen. One integrated boost plan was replanned with IMRT and VMAT using a traditional boost regimen. For target sites located in the head and neck, VMAT reduced the mean dose and contiguous hot spot most noticeably in the shoulder region by 5.6% and 5.4%, respectively. When using an integrated boost regimen, the contiguous hot spot skin dose in the shoulder was larger on average than a traditional boost pattern by 26.5% and the mean skin dose was larger by 1.7%. VMAT techniques largely decrease the contiguous hot spot in the skin in the pelvis by an average of 36% compared with IMRT. For the same target coverage, VMAT can reduce the skin dose in all the regions of the body, but more noticeably in the shoulders in patients with head and neck and pelvis cancer. We also found that using integrated boost regimens in patients with head and neck cancer leads to higher shoulder skin doses compared with traditional boost regimens.« less

SU-F-T-186: A Treatment Planning Study of Normal Tissue Sparing with Robustness Optimized IMPT, 4Pi IMRT, and VMAT for Head and Neck Cases

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, J; Li, X; Ding, X

Purpose: We performed a retrospective dosimetric comparison study between the robustness optimized Intensity Modulated Proton Therapy (RO-IMPT), volumetric-modulated arc therapy (VMAT), and the non-coplanar 4? intensity modulated radiation therapy (IMRT). These methods represent the most advanced radiation treatment methods clinically available. We compare their dosimetric performance for head and neck cancer treatments with special focus on the OAR sparing near the tumor volumes. Methods: A total of 11 head and neck cases, which include 10 recurrent cases and one bilateral case, were selected for the study. Different dose levels were prescribed to tumor target depending on disease and location. Threemore » treatment plans were created on commercial TPS systems for a novel noncoplanar 4π method (20 beams), VMAT, and RO-IMPT technique (maximum 4 fields). The maximum patient positioning error was set to 3 mm and the maximum proton range uncertainty was set to 3% for the robustness optimization. Line dose profiles were investigated for OARs close to tumor volumes. Results: All three techniques achieved 98% coverage of the CTV target and most photon plans had less than 110% of the hot spots. The RO-IMPT plans show superior tumor dose homogeneity than 4? and VMAT plans. Although RO-IMPT has greater R50 dose spillage to the surrounding normal tissue than 4π and VMAT, the RO-IMPT plans demonstrate better or comparable OAR (parotid, mandible, carotid, oral cavity, pharynx, and etc.) sparing for structures closely abutting tumor targets. Conclusion: The RO-IMPT’s ability of OAR sparing is benchmarked against the C-arm linac based non-coplanar 4π technique and the standard VMAT method. RO-IMPT consistently shows better or comparable OAR sparing even for tissue structures closely abutting treatment target volume. RO-IMPT further reduces treatment uncertainty associated with proton therapy and delivers robust treatment plans to both unilateral and bilateral head and neck cancer patients with desirable treatment time.« less

Poster — Thur Eve — 30: 4D VMAT dose calculation methodology to investigate the interplay effect: experimental validation using TrueBeam Developer Mode and Gafchromic film

DOE Office of Scientific and Technical Information (OSTI.GOV)

Teke, T; Milette, MP; Huang, V

2014-08-15

The interplay effect between the tumor motion and the radiation beam modulation during a VMAT treatment delivery alters the delivered dose distribution from the planned one. This work present and validate a method to accurately calculate the dose distribution in 4D taking into account the tumor motion, the field modulation and the treatment starting phase. A QUASAR™ respiratory motion phantom was 4D scanned with motion amplitude of 3 cm and with a 3 second period. A static scan was also acquired with the lung insert and the tumor contained in it centered. A VMAT plan with a 6XFFF beam wasmore » created on the averaged CT and delivered on a Varian TrueBeam and the trajectory log file was saved. From the trajectory log file 10 VMAT plans (one for each breathing phase) and a developer mode XML file were created. For the 10 VMAT plans, the tumor motion was modeled by moving the isocentre on the static scan, the plans were re-calculated and summed in the treatment planning system. In the developer mode, the tumor motion was simulated by moving the couch dynamically during the treatment. Gafchromic films were placed in the QUASAR phantom static and irradiated using the developer mode. Different treatment starting phase were investigated (no phase shift, maximum inhalation and maximum exhalation). Calculated and measured isodose lines and profiles are in very good agreement. For each starting phase, the dose distribution exhibit significant differences but are accurately calculated with the methodology presented in this work.« less

Influence of metallic dental implants and metal artefacts on dose calculation accuracy.

PubMed

Maerz, Manuel; Koelbl, Oliver; Dobler, Barbara

2015-03-01

Metallic dental implants cause severe streaking artefacts in computed tomography (CT) data, which inhibit the correct representation of shape and density of the metal and the surrounding tissue. The aim of this study was to investigate the impact of dental implants on the accuracy of dose calculations in radiation therapy planning and the benefit of metal artefact reduction (MAR). A second aim was to determine the treatment technique which is less sensitive to the presence of metallic implants in terms of dose calculation accuracy. Phantoms consisting of homogeneous water equivalent material surrounding dental implants were designed. Artefact-containing CT data were corrected using the correct density information. Intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans were calculated on corrected and uncorrected CT data and compared to 2-dimensional dose measurements using GafChromic™ EBT2 films. For all plans the accuracy of dose calculations is significantly higher if performed on corrected CT data (p = 0.015). The agreement of calculated and measured dose distributions is significantly higher for VMAT than for IMRT plans for calculations on uncorrected CT data (p = 0.011) as well as on corrected CT data (p = 0.029). For IMRT and VMAT the application of metal artefact reduction significantly increases the agreement of dose calculations with film measurements. VMAT was found to provide the highest accuracy on corrected as well as on uncorrected CT data. VMAT is therefore preferable over IMRT for patients with metallic implants, if plan quality is comparable for the two techniques.

Sci-Fri PM: Radiation Therapy, Planning, Imaging, and Special Techniques - 05: A novel respiratory motion simulation program for VMAT treatment plans: a phantom validation study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hubley, Emily; Pierce, Greg; Ploquin, Nicolas

Purpose: To develop and validate a computational method to simulate craniocaudal respiratory motion in a VMAT treatment plan. Methods: Three 4DCTs of the QUASAR respiratory motion phantom were acquired with a 2cm water-density spherical tumour embedded in cedar to simulate lung. The phantom was oscillating sinusoidally with an amplitude of 2cm and periods of 3, 4, and 5 seconds. An ITV was contoured and 5mm PTV margin was added. High and a low modulation factor VMAT plans were created for each scan. An in-house program was developed to simulate respiratory motion in the treatment plans by shifting the MLC leafmore » positions relative to the phantom. Each plan was delivered to the phantom and the dose was measured using Gafchromic film. The measured and calculated plans were compared using an absolute dose gamma analysis (3%/3mm). Results: The average gamma pass rate for the low modulation plan and high modulation plans were 91.1% and 51.4% respectively. The difference between the high and low modulation plans gamma pass rates is likely related to the different sampling frequency of the respiratory curve and the higher MLC leaf speeds in the high modulation plan. A high modulation plan has a slower gantry speed and therefore samples the breathing cycle at a coarser frequency leading to inaccuracies between the measured and planned doses. Conclusion: A simple program, including a novel method for increasing sampling frequency beyond the control point frequency, has been developed to simulate respiratory motion in VMAT plans by shifting the MLC leaf positions.« less

Commissioning and validation of COMPASS system for VMAT patient specific quality assurance

NASA Astrophysics Data System (ADS)

Pimthong, J.; Kakanaporn, C.; Tuntipumiamorn, L.; Laojunun, P.; Iampongpaiboon, P.

2016-03-01

Pre-treatment patient specific quality assurance (QA) of advanced treatment techniques such as volumetric modulated arc therapy (VMAT) is one of important QA in radiotherapy. The fast and reliable dosimetric device is required. The objective of this study is to commission and validate the performance of COMPASS system for dose verification of VMAT technique. The COMPASS system is composed of an array of ionization detectors (MatriXX) mounted to the gantry using a custom holder and software for the analysis and visualization of QA results. We validated the COMPASS software for basic and advanced clinical application. For the basic clinical study, the simple open field in various field sizes were validated in homogeneous phantom. And the advanced clinical application, the fifteen prostate and fifteen nasopharyngeal cancers VMAT plans were chosen to study. The treatment plans were measured by the MatriXX. The doses and dose-volume histograms (DVHs) reconstructed from the fluence measurements were compared to the TPS calculated plans. And also, the doses and DVHs computed using collapsed cone convolution (CCC) Algorithm were compared with Eclipse TPS calculated plans using Analytical Anisotropic Algorithm (AAA) that according to dose specified in ICRU 83 for PTV.

A novel approach to EPID-based 3D volumetric dosimetry for IMRT and VMAT QA

NASA Astrophysics Data System (ADS)

Alhazmi, Abdulaziz; Gianoli, Chiara; Neppl, Sebastian; Martins, Juliana; Veloza, Stella; Podesta, Mark; Verhaegen, Frank; Reiner, Michael; Belka, Claus; Parodi, Katia

2018-06-01

Intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) are relatively complex treatment delivery techniques and require quality assurance (QA) procedures. Pre-treatment dosimetric verification represents a fundamental QA procedure in daily clinical routine in radiation therapy. The purpose of this study is to develop an EPID-based approach to reconstruct a 3D dose distribution as imparted to a virtual cylindrical water phantom to be used for plan-specific pre-treatment dosimetric verification for IMRT and VMAT plans. For each depth, the planar 2D dose distributions acquired in air were back-projected and convolved by depth-specific scatter and attenuation kernels. The kernels were obtained by making use of scatter and attenuation models to iteratively estimate the parameters from a set of reference measurements. The derived parameters served as a look-up table for reconstruction of arbitrary measurements. The summation of the reconstructed 3D dose distributions resulted in the integrated 3D dose distribution of the treatment delivery. The accuracy of the proposed approach was validated in clinical IMRT and VMAT plans by means of gamma evaluation, comparing the reconstructed 3D dose distributions with Octavius measurement. The comparison was carried out using (3%, 3 mm) criteria scoring 99% and 96% passing rates for IMRT and VMAT, respectively. An accuracy comparable to the one of the commercial device for 3D volumetric dosimetry was demonstrated. In addition, five IMRT and five VMAT were validated against the 3D dose calculation performed by the TPS in a water phantom using the same passing rate criteria. The median passing rates within the ten treatment plans was 97.3%, whereas the lowest was 95%. Besides, the reconstructed 3D distribution is obtained without predictions relying on forward dose calculation and without external phantom or dosimetric devices. Thus, the approach provides a fully automated, fast and easy QA procedure for plan-specific pre-treatment dosimetric verification.

A planning comparison of 3-dimensional conformal multiple static field, conformal arc, and volumetric modulated arc therapy for the delivery of stereotactic body radiotherapy for early stage lung cancer.

PubMed

Dickey, Mike; Roa, Wilson; Drodge, Suzanne; Ghosh, Sunita; Murray, Brad; Scrimger, Rufus; Gabos, Zsolt

2015-01-01

The primary objective of this study was to compare dosimetric variables as well as treatment times of multiple static fields (MSFs), conformal arcs (CAs), and volumetric modulated arc therapy (VMAT) techniques for the treatment of early stage lung cancer using stereotactic body radiotherapy (SBRT). Treatments of 23 patients previously treated with MSF of 48Gy to 95% of the planning target volume (PTV) in 4 fractions were replanned using CA and VMAT techniques. Dosimetric parameters of the Radiation Therapy Oncology Group (RTOG) 0915 trial were evaluated, along with the van׳t Riet conformation number (CN), monitor units (MUs), and actual and calculated treatment times. Paired t-tests for noninferiority were used to compare the 3 techniques. CA had significant dosimetric improvements over MSF for the ratio of the prescription isodose volume to PTV (R100%, p < 0.0001), the maximum dose 2cm away from the PTV (D2cm, p = 0.005), and van׳t Riet CN (p < 0.0001). CA was not statistically inferior to MSF for the 50% prescription isodose volume to PTV (R50%, p = 0.05). VMAT was significantly better than CA for R100% (p < 0.0001), R50% (p < 0.0001), D2cm (p = 0.006), and CN (p < 0.0001). CA plans had significantly shorter treatment times than those of VMAT (p < 0.0001). Both CA and VMAT planning showed significant dosimetric improvements and shorter treatment times over those of MSF. VMAT showed the most favorable dosimetry of all 3 techniques; however, the dosimetric effect of tumor motion was not evaluated. CA plans were significantly faster to treat, and minimize the interplay of tumor motion and dynamic multileaf collimator (MLC) motion effects. Given these results, CA has become the treatment technique of choice at our facility. Copyright © 2015 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

SU-F-T-238: Analyzing the Performance of MapCHECK2 and Delta4 Quality Assurance Phantoms in IMRT and VMAT Plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lu, SH; Tsai, YC; Lan, HT

2016-06-15

Purpose: Intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) have been widely investigated for use in radiotherapy and found to have a highly conformal dose distribution. Delta{sup 4} is a novel cylindrical phantom consisting of 1069 p-type diodes with true treatments measured in the 3D target volume. The goal of this study was to compare the performance of a Delta{sup 4} diode array for IMRT and VMAT planning with ion chamber and MapCHECK2. Methods: Fifty-four IMRT (n=9) and VMAT (n=45) plans were imported to Philips Pinnacle Planning System 9.2 for recalculation with a solid water phantom, MapCHECK2, and themore » Delta4 phantom. To evaluate the difference between the measured and calculated dose, we used MapCHECK2 and Delta{sup 4} for a dose-map comparison and an ion chamber (PTW 31010 Semiflex 0.125 cc) for a point-dose comparison. Results: All 54 plans met the criteria of <3% difference for the point dose (at least two points) by ion chamber. The mean difference was 0.784% with a standard deviation of 1.962%. With a criteria of 3 mm/3% in a gamma analysis, the average passing rates were 96.86%±2.19% and 98.42%±1.97% for MapCHECK2 and Delta{sup 4}, respectively. The student t-test of MapCHECK2/Delta{sup 4}, ion chamber/Delta{sup 4}, and ion chamber/MapCHECK2 were 0.0008, 0.2944, and 0.0002, respectively. There was no significant difference in passing rates between MapCHECK2 and Delta{sup 4} for the IMRT plan (p = 0.25). However, a higher pass rate was observed in Delta{sup 4} (98.36%) as compared to MapCHECK2 (96.64%, p < 0.0001) for the VMAT plan. Conclusion: The Pinnacle planning system can accurately calculate doses for VMAT and IMRT plans. The Delta{sup 4} shows a similar result when compared to ion chamber and MapCHECK2, and is an efficient tool for patient-specific quality assurance, especially for rotation therapy.« less

Whole-brain hippocampal sparing radiation therapy: Volume-modulated arc therapy vs intensity-modulated radiation therapy case study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Katrina, E-mail: Trinabena23@gmail.com; Lenards, Nishele; Holson, Janice

The hippocampus is responsible for memory and cognitive function. An ongoing phase II clinical trial suggests that sparing dose to the hippocampus during whole-brain radiation therapy can help preserve a patient's neurocognitive function. Progressive research and advancements in treatment techniques have made treatment planning more sophisticated but beneficial for patients undergoing treatment. The aim of this study is to evaluate and compare hippocampal sparing whole-brain (HS-WB) radiation therapy treatment planning techniques using volume-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT). We randomly selected 3 patients to compare different treatment techniques that could be used for reducing dose to themore » hippocampal region. We created 2 treatment plans, a VMAT and an IMRT, from each patient's data set and planned on the Eclipse 11.0 treatment planning system (TPS). A total of 6 plans (3 IMRT and 3 VMAT) were created and evaluated for this case study. The physician contoured the hippocampus as per the Radiation Therapy Oncology Group (RTOG) 0933 protocol atlas. The organs at risk (OR) were contoured and evaluated for the plan comparison, which included the spinal cord, optic chiasm, the right and left eyes, lenses, and optic nerves. Both treatment plans produced adequate coverage on the planning target volume (PTV) while significantly reducing dose to the hippocampal region. The VMAT treatment plans produced a more homogenous dose distribution throughout the PTV while decreasing the maximum point dose to the target. However, both treatment techniques demonstrated hippocampal sparing when irradiating the whole brain.« less

Consistency and reproducibility of the VMAT plan delivery using three independent validation methods

PubMed Central

Chandraraj, Varatharaj; Manickam, Ravikumar; Esquivel, Carlos; Supe, Sanjay S; Papanikolaou, Nikos

2010-01-01

The complexity of VMAT delivery requires new methods and potentially new tools for the commissioning of these systems. It appears that great consideration is needed for quality assurance (QA) of these treatments since there are limited devices that are dedicated to the QA of rotational delivery. In this present study, we have evaluated the consistency and reproducibility of one prostate and one lung VMAT plans for 31 consecutive days using three different approaches: 1) MLC DynaLog files, 2) in vivo measurements using the multiwire ionization chamber DAVID, and 3) using PTWseven29 2D ARRAY with the OCTAVIUS phantom at our Varian Clinac linear accelerator. Overall, the three methods of testing the reproducibility and consistency of the VMAT delivery were in agreement with each other. All methods showed minimal daily deviations that contributed to clinically insignificant dose variations from day to day. Based on our results, we conclude that the VMAT delivery using a Varian 2100CD linear accelerator equipped with 120 MLC is highly reproducible. PACS numbers: 87.55.Qr and 87.56.Fc

MO-FG-CAMPUS-TeP2-05: Optimizing Stereotactic Radiosurgery Treatment of Multiple Brain Metastasis Lesions with Individualized Rotational Arc Trajectories

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dong, P; Xing, L; Ma, L

Purpose: Radiosurgery of multiple (n>4) brain metastasis lesions requires 3–4 noncoplanar VMAT arcs with excessively high monitor units and long delivery time. We investigated whether an improved optimization technique would decrease the needed arc numbers and increase the delivery efficiency, while improving or maintaining the plan quality. Methods: The proposed 4pi arc space optimization algorithm consists of two steps: automatic couch angle selection followed by aperture generation for each arc with optimized control points distribution. We use a greedy algorithm to select the couch angles. Starting from a single coplanar arc plan we search through the candidate noncoplanar arcs tomore » pick a single noncoplanar arc that will bring the best plan quality when added into the existing treatment plan. Each time, only one additional noncoplanar arc is considered making the calculation time tractable. This process repeats itself until desired number of arc is reached. The technique is first evaluated in coplanar arc delivery scheme with testing cases and then applied to noncoplanar treatments of a case with 12 brain metastasis lesions. Results: Clinically acceptable plans are created within minutes. For the coplanar testing cases the algorithm yields singlearc plans with better dose distributions than that of two-arc VMAT, simultaneously with a 12–17% reduction in the delivery time and a 14–21% reduction in MUs. For the treatment of 12 brain mets while Paddick conformity indexes of the two plans were comparable the SCG-optimization with 2 arcs (1 noncoplanar and 1 coplanar) significantly improved the conventional VMAT with 3 arcs (2 noncoplanar and 1 coplanar). Specifically V16 V10 and V5 of the brain were reduced by 11%, 11% and 12% respectively. The beam delivery time was shortened by approximately 30%. Conclusion: The proposed 4pi arc space optimization technique promises to significantly reduce the brain toxicity while greatly improving the treatment efficiency.« less

SU-F-T-448: Use of Mixed Photon Energy Beam in Volumetric Modulated Arc Therapy (VMAT) Treatment Plan for Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Manigandan, D; Kumar, M; Mohandas, P

Purpose: To study the impact of different photon beam combination during VMAT planning and treatment delivery. Methods: Five prostate patients with no nodal involvement were chosen for the study and only prostate was considered as target (7920cGy/44fractions). In each case, three different VMAT plans were generated with two arcs (200°–160°&160°–200°). First plan used only 6MV in both arcs (6X-6X) and second utilized 6MV&15MV (6X-15X), whereas third one used 15MV&15MV (15X-15X). For consistency, all the plans were generated by the same planner using Monaco− treatment planning system (V5.1) for Elekta Synergy− linear accelerator with 1cm leaf-width. For plan comparison, target meanmore » dose, conformity index (CI)=Planning target volume (PTV) covered by 95% of prescription dose/PTV were analyzed. Mean doses of bladder, rectum, left femur and right femur were analyzed. Integral dose (liter-Gray) to normal tissue (patient volume minus PTV), total monitor unit (MU) required to deliver a plan and gamma pass rate for each plan was analyzed. Results: The CI for PTV was 0.9937±0.0037, 0.9917±0.0033, and 0.9897±0.0048 for 6X-6X, 6X-15X and 15X-15X, respectively. Mean dose to target slightly increases with the decrease of energy. Mean doses to bladder were 3546.23±692.13cGy, 3487.43±715.53cGy and 3504.40±683.1cGy for 6X-6X, 6X-15X and 15X-15X, respectively. Mean doses to rectum were 4294.60±309.5cGy, 4277.07±279.93cGy and 4290.77±379.07cGy. Mean doses to left femur were 2737.13±545.93cGy, 2668.67±407.12cGy and 2416.77±300.73cGy and mean doses to the right femur were 2682.70±460.81cGy, 2722.58±541.92cGy and 2598.57±481.83cGy. Higher Integral doses to normal tissue observed for 6X-6X (163.06±24.6 Litre-Gray) followed by 6X-15X (154.35±24.74 Litre-Gray) and 15X-15X (145.84±26.03 Litre-Gray). Average MU required to deliver one fraction was 680.75±72.09, 634.81±95.07 and 605.06±114.65. Gamma pass rates were 99.83±0.21, 99.53±0.27 and 99.2±0.20. Conclusion: 6X-15X VMAT plan offer dosimetric advantage compared to 6X-6X in terms of lesser MU and integral dose without significant compromise in plan quality, where as in 15X-15X, neutron contamination risk is relatively higher.« less

SU-E-T-138: Dosimetric Verification For Volumetric Modulated Arc Therapy Cranio-Spinal Irradiation Technique

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goksel, E; Bilge, H; Yildiz, Yarar

2014-06-01

Purpose: Dosimetric feasibility of cranio-spinal irradiation with volumetric modulated arc therapy (VMAT-CSI) technique in terms of dose distribution accuracy was investigated using a humanlike phantom. Methods: The OARs and PTV volumes for the Rando phantom were generated on supine CT images. Eclipse (version 8.6) TPS with AAA algorithm was used to create the treatment plan with VMAT-CSI technique. RapidArc plan consisted of cranial, upper spinal (US) and lower spinal (LS) regions that were optimized in the same plan. US field was overlapped by 3cm with cranial and LS fields. Three partial arcs for cranium and 1 full arc for eachmore » US and LS region were used. The VMAT-CSI dose distribution inside the Rando phantom was measured with thermoluminescent detectors (TLD) and film dosimetry, and was compared to the calculated doses of field junctions, target and OARs. TLDs were placed at 24 positions throughout the phantom. The measured TLD doses were compared to the calculated point doses. Planar doses for field junctions were verified with Gafchromic films. Films were analyzed in PTW Verisoft application software using gamma analysis method with the 4 mm distance to agreement (DTA) and 4% dose agreement criteria. Results: TLD readings demonstrated accurate dose delivery, with a median dose difference of -0.3% (range: -8% and 12%) when compared with calculated doses for the areas inside the treatment portal. The maximum dose difference was 12% higher in testicals that are outside the treatment region and 8% lower in lungs where the heterogeinity was higher. All planar dose verifications for field junctions passed the gamma analysis and measured planar dose distributions demonstrated average 97% agreement with calculated doses. Conclusion: The dosimetric data verified with TLD and film dosimetry shows that VMAT-CSI technique provides accurate dose distribution and can be delivered safely.« less

Comparison of a new noncoplanar intensity-modulated radiation therapy technique for craniospinal irradiation with 3 coplanar techniques

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hansen, Anders T., E-mail: andehans@rm.dk; Lukacova, Slavka; Lassen-Ramshad, Yasmin

2015-01-01

When standard conformal x-ray technique for craniospinal irradiation is used, it is a challenge to achieve satisfactory dose coverage of the target including the area of the cribriform plate, while sparing organs at risk. We present a new intensity-modulated radiation therapy (IMRT), noncoplanar technique, for delivering irradiation to the cranial part and compare it with 3 other techniques and previously published results. A total of 13 patients who had previously received craniospinal irradiation with standard conformal x-ray technique were reviewed. New treatment plans were generated for each patient using the noncoplanar IMRT-based technique, a coplanar IMRT-based technique, and a coplanarmore » volumetric-modulated arch therapy (VMAT) technique. Dosimetry data for all patients were compared with the corresponding data from the conventional treatment plans. The new noncoplanar IMRT technique substantially reduced the mean dose to organs at risk compared with the standard radiation technique. The 2 other coplanar techniques also reduced the mean dose to some of the critical organs. However, this reduction was not as substantial as the reduction obtained by the noncoplanar technique. Furthermore, compared with the standard technique, the IMRT techniques reduced the total calculated radiation dose that was delivered to the normal tissue, whereas the VMAT technique increased this dose. Additionally, the coverage of the target was significantly improved by the noncoplanar IMRT technique. Compared with the standard technique, the coplanar IMRT and the VMAT technique did not improve the coverage of the target significantly. All the new planning techniques increased the number of monitor units (MU) used—the noncoplanar IMRT technique by 99%, the coplanar IMRT technique by 122%, and the VMAT technique by 26%—causing concern for leak radiation. The noncoplanar IMRT technique covered the target better and decreased doses to organs at risk compared with the other techniques. All the new techniques increased the number of MU compared with the standard technique.« less

Comparison of MLC error sensitivity of various commercial devices for VMAT pre-treatment quality assurance.

PubMed

Saito, Masahide; Sano, Naoki; Shibata, Yuki; Kuriyama, Kengo; Komiyama, Takafumi; Marino, Kan; Aoki, Shinichi; Ashizawa, Kazunari; Yoshizawa, Kazuya; Onishi, Hiroshi

2018-05-01

The purpose of this study was to compare the MLC error sensitivity of various measurement devices for VMAT pre-treatment quality assurance (QA). This study used four QA devices (Scandidos Delta4, PTW 2D-array, iRT systems IQM, and PTW Farmer chamber). Nine retrospective VMAT plans were used and nine MLC error plans were generated for all nine original VMAT plans. The IQM and Farmer chamber were evaluated using the cumulative signal difference between the baseline and error-induced measurements. In addition, to investigate the sensitivity of the Delta4 device and the 2D-array, global gamma analysis (1%/1, 2%/2, and 3%/3 mm), dose difference (1%, 2%, and 3%) were used between the baseline and error-induced measurements. Some deviations of the MLC error sensitivity for the evaluation metrics and MLC error ranges were observed. For the two ionization devices, the sensitivity of the IQM was significantly better than that of the Farmer chamber (P < 0.01) while both devices had good linearly correlation between the cumulative signal difference and the magnitude of MLC errors. The pass rates decreased as the magnitude of the MLC error increased for both Delta4 and 2D-array. However, the small MLC error for small aperture sizes, such as for lung SBRT, could not be detected using the loosest gamma criteria (3%/3 mm). Our results indicate that DD could be more useful than gamma analysis for daily MLC QA, and that a large-area ionization chamber has a greater advantage for detecting systematic MLC error because of the large sensitive volume, while the other devices could not detect this error for some cases with a small range of MLC error. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

A novel method for routine quality assurance of volumetric-modulated arc therapy.

PubMed

Wang, Qingxin; Dai, Jianrong; Zhang, Ke

2013-10-01

Volumetric-modulated arc therapy (VMAT) is delivered through synchronized variation of gantry angle, dose rate, and multileaf collimator (MLC) leaf positions. The delivery dynamic nature challenges the parameter setting accuracy of linac control system. The purpose of this study was to develop a novel method for routine quality assurance (QA) of VMAT linacs. ArcCheck is a detector array with diodes distributing in spiral pattern on cylindrical surface. Utilizing its features, a QA plan was designed to strictly test all varying parameters during VMAT delivery on an Elekta Synergy linac. In this plan, there are 24 control points. The gantry rotates clockwise from 181° to 179°. The dose rate, gantry speed, and MLC positions cover their ranges commonly used in clinic. The two borders of MLC-shaped field seat over two columns of diodes of ArcCheck when the gantry rotates to the angle specified by each control point. The ratio of dose rate between each of these diodes and the diode closest to the field center is a certain value and sensitive to the MLC positioning error of the leaf crossing the diode. Consequently, the positioning error can be determined by the ratio with the help of a relationship curve. The time when the gantry reaches the angle specified by each control point can be acquired from the virtual inclinometer that is a feature of ArcCheck. The gantry speed between two consecutive control points is then calculated. The aforementioned dose rate is calculated from an acm file that is generated during ArcCheck measurements. This file stores the data measured by each detector in 50 ms updates with each update in a separate row. A computer program was written in MATLAB language to process the data. The program output included MLC positioning errors and the dose rate at each control point as well as the gantry speed between control points. To evaluate this method, this plan was delivered for four consecutive weeks. The actual dose rate and gantry speed were compared with the QA plan specified. Additionally, leaf positioning errors were intentionally introduced to investigate the sensitivity of this method. The relationship curves were established for detecting MLC positioning errors during VMAT delivery. For four consecutive weeks measured, 98.4%, 94.9%, 89.2%, and 91.0% of the leaf positioning errors were within ± 0.5 mm, respectively. For the intentionally introduced leaf positioning systematic errors of -0.5 and +1 mm, the detected leaf positioning errors of 20 Y1 leaf were -0.48 ± 0.14 and 1.02 ± 0.26 mm, respectively. The actual gantry speed and dose rate closely followed the values specified in the VMAT QA plan. This method can assess the accuracy of MLC positions and the dose rate at each control point as well as the gantry speed between control points at the same time. It is efficient and suitable for routine quality assurance of VMAT.

Retrospective evaluation of dosimetric quality for prostate carcinomas treated with 3D conformal, intensity modulated and volumetric modulated arc radiotherapy

PubMed Central

Crowe, Scott B; Kairn, Tanya; Middlebrook, Nigel; Hill, Brendan; Christie, David R H; Knight, Richard T; Kenny, John; Langton, Christian M; Trapp, Jamie V

2013-01-01

Introduction This study examines and compares the dosimetric quality of radiotherapy treatment plans for prostate carcinoma across a cohort of 163 patients treated across five centres: 83 treated with three-dimensional conformal radiotherapy (3DCRT), 33 treated with intensity modulated radiotherapy (IMRT) and 47 treated with volumetric modulated arc therapy (VMAT). Methods Treatment plan quality was evaluated in terms of target dose homogeneity and organs at risk (OAR), through the use of a set of dose metrics. These included the mean, maximum and minimum doses; the homogeneity and conformity indices for the target volumes; and a selection of dose coverage values that were relevant to each OAR. Statistical significance was evaluated using two-tailed Welch's T-tests. The Monte Carlo DICOM ToolKit software was adapted to permit the evaluation of dose metrics from DICOM data exported from a commercial radiotherapy treatment planning system. Results The 3DCRT treatment plans offered greater planning target volume dose homogeneity than the other two treatment modalities. The IMRT and VMAT plans offered greater dose reduction in the OAR: with increased compliance with recommended OAR dose constraints, compared to conventional 3DCRT treatments. When compared to each other, IMRT and VMAT did not provide significantly different treatment plan quality for like-sized tumour volumes. Conclusions This study indicates that IMRT and VMAT have provided similar dosimetric quality, which is superior to the dosimetric quality achieved with 3DCRT. PMID:26229621

Clinical implementation of a knowledge based planning tool for prostate VMAT.

PubMed

Powis, Richard; Bird, Andrew; Brennan, Matthew; Hinks, Susan; Newman, Hannah; Reed, Katie; Sage, John; Webster, Gareth

2017-05-08

A knowledge based planning tool has been developed and implemented for prostate VMAT radiotherapy plans providing a target average rectum dose value based on previously achievable values for similar rectum/PTV overlap. The purpose of this planning tool is to highlight sub-optimal clinical plans and to improve plan quality and consistency. A historical cohort of 97 VMAT prostate plans was interrogated using a RayStation script and used to develop a local model for predicting optimum average rectum dose based on individual anatomy. A preliminary validation study was performed whereby historical plans identified as "optimal" and "sub-optimal" by the local model were replanned in a blinded study by four experienced planners and compared to the original clinical plan to assess whether any improvement in rectum dose was observed. The predictive model was then incorporated into a RayStation script and used as part of the clinical planning process. Planners were asked to use the script during planning to provide a patient specific prediction for optimum average rectum dose and to optimise the plan accordingly. Plans identified as "sub-optimal" in the validation study observed a statistically significant improvement in average rectum dose compared to the clinical plan when replanned whereas plans that were identified as "optimal" observed no improvement when replanned. This provided confidence that the local model can identify plans that were suboptimal in terms of rectal sparing. Clinical implementation of the knowledge based planning tool reduced the population-averaged mean rectum dose by 5.6Gy. There was a small but statistically significant increase in total MU and femoral head dose and a reduction in conformity index. These did not affect the clinical acceptability of the plans and no significant changes to other plan quality metrics were observed. The knowledge-based planning tool has enabled substantial reductions in population-averaged mean rectum dose for prostate VMAT patients. This suggests plans are improved when planners receive quantitative feedback on plan quality against historical data.

SU-F-T-308: Mobius FX Evaluation and Comparison Against a Commercial 4D Detector Array for VMAT Plan QA

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vazquez Quino, L; Huerta Hernandez, C; Morrow, A

2016-06-15

Purpose: To evaluate the use of MobiusFX as a pre-treatment verification IMRT QA tool and compare it with a commercial 4D detector array for VMAT plan QA. Methods: 15 VMAT plan QA of different treatment sites were delivered and measured by traditional means with the 4D detector array ArcCheck (Sun Nuclear corporation) and at the same time measurement in linac treatment logs (Varian Dynalogs files) were analyzed from the same delivery with MobiusFX software (Mobius Medical Systems). VMAT plan QAs created in Eclipse treatment planning system (Varian) in a TrueBeam linac machine (Varian) were delivered and analyzed with the gammamore » analysis routine from SNPA software (Sun Nuclear corporation). Results: Comparable results in terms of the gamma analysis with 99.06% average gamma passing with 3%,3mm passing rate is observed in the comparison among MobiusFX, ArcCheck measurements, and the Treatment Planning System dose calculated. When going to a stricter criterion (1%,1mm) larger discrepancies are observed in different regions of the measurements with an average gamma of 66.24% between MobiusFX and ArcCheck. Conclusion: This work indicates the potential for using MobiusFX as a routine pre-treatment patient specific IMRT method for quality assurance purposes and its advantages as a phantom-less method which reduce the time for IMRT QA measurement. MobiusFX is capable of produce similar results of those by traditional methods used for patient specific pre-treatment verification VMAT QA. Even the gamma results comparing to the TPS are similar the analysis of both methods show that the errors being identified by each method are found in different regions. Traditional methods like ArcCheck are sensitive to setup errors and dose difference errors coming from the linac output. On the other hand linac log files analysis record different errors in the VMAT QA associated with the MLCs and gantry motion that by traditional methods cannot be detected.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kumaran Nair, C; Hoffman, D; Wright, C

Purpose: We aim to evaluate a new commercial dose mimicking inverse-planning application that was designed to provide cross-platform treatment planning, for its dosimetric quality and efficiency. The clinical benefit of this application allows patients treated on O-shaped linac to receive an equivalent plan on conventional L-shaped linac as needed for workflow or machine downtime. Methods: The dose mimicking optimization process seeks to create a similar DVH of an O-shaped linac-based plans with an alternative treatment technique (IMRT or VMAT), by maintaining target conformity, and penalizing dose falloff outside the target. Ten head and neck (HN) helical delivery plans, including simplemore » and complex cases were selected for re-planning with the dose mimicking application. All plans were generated for a 6 MV beam model, using 7-field/ 9-field IMRT and VMAT techniques. PTV coverage (D1, D99 and homogeneity index [HI]), and OARs avoidance (Dmean / Dmax) were compared. Results: The resulting dose mimicked HN plans achieved acceptable PTV coverage for HI (VMAT 7.0±2.3, 7-fld 7.3±2.4, and 9-fld 7.0±2.4), D99 (98.0%±0.7%, 97.8%±0.7%, and 98.0%±0.7%), as well as D1 (106.4%±2.1%, 106.5%±2.2%, and 106.4%±2.1%), respectively. The OAR dose discrepancy varied: brainstem (2% to 4%), cord (3% to 6%), esophagus (−4% to −8%), larynx (−4% to 2%), and parotid (4% to 14%). Mimicked plans would typically be needed for 1–5 fractions of a treatment course, and we estimate <1% variance would be introduced in target coverage while maintaining comparable low dose to OARs. All mimicked plans were approved by independent physician and passed patient specific QA within our established tolerance. Conclusion: Dose mimicked plans provide a practical alternative for responding to clinical workflow issues, and provide reliability for patient treatment. The quality of dose mimicking for HN patients highly depends on the delivery technique, field numbers and angles, as well as user selection of structures.« less

Poster - 56: Preliminary comparison of FF- and FFF-VMAT for prostate plans with higher rectal dose

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liu, Baochang; Darko, Johnson; Osei, Ernest

2016-08-15

Purpose: A recent retrospective study found 53 patients previously treated to 78Gy/39 using flattened filtered (FF) 6X-VMAT at GRRCC had rectal DVH more than one standard deviation higher than the average. This study was to investigate if using 6FFFor10FFF beams could reduce these DVHs without compromising target coverage. Methods: Twenty patients’ plans were re-planed with 2-arc 6X-VMAT, 6FFF-VMAT and 10FFF-VMAT using the Eclipse TPS following departmental protocol. All plans had the same optimization and normalization, and were evaluated against the acceptance criteria from the QUANTEC and Emami. Statistical differences in the mean dose to OARs (D{sub m}) and PTV homogeneitymore » index (HI) between energies were tested using the paired sample Wilcoxon signed rank statistical method (p<0.05). Beam delivery accuracy was checked on five patients using portal dosimetry (PD). Results: The PTV HI for the 10FFF shows no statistical difference from the 6X. All the OARs, except left femoral head with 6FFF, have significantly lower Dm using 6FFF and 10FFF .There is no difference in the maximum doses to rectum and bladder and are limited by the prescribed doses. Measurements show good agreements in the gamma evaluation (3%/3mm) for all energies. Conclusion: This preliminary study shows that doses to the OARs are reduced using 10FFF for the same target coverage. The plans using 6FFF result in lower doses to some OARs, and statistically different PTV HI. All plans showed very good agreement with measurements.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Balderson, Michael, E-mail: michael.balderson@rmp.uhn.ca; Brown, Derek; Johnson, Patricia

The purpose of this work was to compare static gantry intensity-modulated radiation therapy (IMRT) with volume-modulated arc therapy (VMAT) in terms of tumor control probability (TCP) under scenarios involving large geometric misses, i.e., those beyond what are accounted for when margin expansion is determined. Using a planning approach typical for these treatments, a linear-quadratic–based model for TCP was used to compare mean TCP values for a population of patients who experiences a geometric miss (i.e., systematic and random shifts of the clinical target volume within the planning target dose distribution). A Monte Carlo approach was used to account for themore » different biological sensitivities of a population of patients. Interestingly, for errors consisting of coplanar systematic target volume offsets and three-dimensional random offsets, static gantry IMRT appears to offer an advantage over VMAT in that larger shift errors are tolerated for the same mean TCP. For example, under the conditions simulated, erroneous systematic shifts of 15 mm directly between or directly into static gantry IMRT fields result in mean TCP values between 96% and 98%, whereas the same errors on VMAT plans result in mean TCP values between 45% and 74%. Random geometric shifts of the target volume were characterized using normal distributions in each Cartesian dimension. When the standard deviations were doubled from those values assumed in the derivation of the treatment margins, our model showed a 7% drop in mean TCP for the static gantry IMRT plans but a 20% drop in TCP for the VMAT plans. Although adding a margin for error to a clinical target volume is perhaps the best approach to account for expected geometric misses, this work suggests that static gantry IMRT may offer a treatment that is more tolerant to geometric miss errors than VMAT.« less

Comparing Treatment Plan in All Locations of Esophageal Cancer

PubMed Central

Lin, Jang-Chun; Tsai, Jo-Ting; Chang, Chih-Chieh; Jen, Yee-Min; Li, Ming-Hsien; Liu, Wei-Hsiu

2015-01-01

Abstract The aim of this study was to compare treatment plans of volumetric modulated arc therapy (VMAT) with intensity-modulated radiotherapy (IMRT) for all esophageal cancer (EC) tumor locations. This retrospective study from July 2009 to June 2014 included 20 patients with EC who received definitive concurrent chemoradiotherapy with radiation doses >50.4 Gy. Version 9.2 of Pinnacle3 with SmartArc was used for treatment planning. Dosimetric quality was evaluated based on doses to several organs at risk, including the spinal cord, heart, and lung, over the same coverage of gross tumor volume. In upper thoracic EC, the IMRT treatment plan had a lower lung mean dose (P = 0.0126) and lung V5 (P = 0.0037) compared with VMAT; both techniques had similar coverage of the planning target volumes (PTVs) (P = 0.3575). In middle thoracic EC, a lower lung mean dose (P = 0.0010) and V5 (P = 0.0145), but higher lung V20 (P = 0.0034), spinal cord Dmax (P = 0.0262), and heart mean dose (P = 0.0054), were observed for IMRT compared with VMAT; IMRT provided better PTV coverage. Patients with lower thoracic ECs had a lower lung mean dose (P = 0.0469) and V5 (P = 0.0039), but higher spinal cord Dmax (P = 0.0301) and heart mean dose (P = 0.0020), with IMRT compared with VMAT. PTV coverage was similar (P = 0.0858) for the 2 techniques. IMRT provided a lower mean dose and lung V5 in upper thoracic EC compared with VMAT, but exhibited different advantages and disadvantages in patients with middle or lower thoracic ECs. Thus, choosing different techniques for different EC locations is warranted. PMID:25929910

Comparing treatment plan in all locations of esophageal cancer: volumetric modulated arc therapy versus intensity-modulated radiotherapy.

PubMed

Lin, Jang-Chun; Tsai, Jo-Ting; Chang, Chih-Chieh; Jen, Yee-Min; Li, Ming-Hsien; Liu, Wei-Hsiu

2015-05-01

The aim of this study was to compare treatment plans of volumetric modulated arc therapy (VMAT) with intensity-modulated radiotherapy (IMRT) for all esophageal cancer (EC) tumor locations.This retrospective study from July 2009 to June 2014 included 20 patients with EC who received definitive concurrent chemoradiotherapy with radiation doses >50.4 Gy. Version 9.2 of Pinnacle with SmartArc was used for treatment planning. Dosimetric quality was evaluated based on doses to several organs at risk, including the spinal cord, heart, and lung, over the same coverage of gross tumor volume.In upper thoracic EC, the IMRT treatment plan had a lower lung mean dose (P = 0.0126) and lung V5 (P = 0.0037) compared with VMAT; both techniques had similar coverage of the planning target volumes (PTVs) (P = 0.3575). In middle thoracic EC, a lower lung mean dose (P = 0.0010) and V5 (P = 0.0145), but higher lung V20 (P = 0.0034), spinal cord Dmax (P = 0.0262), and heart mean dose (P = 0.0054), were observed for IMRT compared with VMAT; IMRT provided better PTV coverage. Patients with lower thoracic ECs had a lower lung mean dose (P = 0.0469) and V5 (P = 0.0039), but higher spinal cord Dmax (P = 0.0301) and heart mean dose (P = 0.0020), with IMRT compared with VMAT. PTV coverage was similar (P = 0.0858) for the 2 techniques.IMRT provided a lower mean dose and lung V5 in upper thoracic EC compared with VMAT, but exhibited different advantages and disadvantages in patients with middle or lower thoracic ECs. Thus, choosing different techniques for different EC locations is warranted.

Method of predicting the mean lung dose based on a patient's anatomy and dose-volume histograms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zawadzka, Anna, E-mail: a.zawadzka@zfm.coi.pl; Nesteruk, Marta; Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich

The aim of this study was to propose a method to predict the minimum achievable mean lung dose (MLD) and corresponding dosimetric parameters for organs-at-risk (OAR) based on individual patient anatomy. For each patient, the dose for 36 equidistant individual multileaf collimator shaped fields in the treatment planning system (TPS) was calculated. Based on these dose matrices, the MLD for each patient was predicted by the homemade DosePredictor software in which the solution of linear equations was implemented. The software prediction results were validated based on 3D conformal radiotherapy (3D-CRT) and volumetric modulated arc therapy (VMAT) plans previously prepared formore » 16 patients with stage III non–small-cell lung cancer (NSCLC). For each patient, dosimetric parameters derived from plans and the results calculated by DosePredictor were compared. The MLD, the maximum dose to the spinal cord (D{sub max} {sub cord}) and the mean esophageal dose (MED) were analyzed. There was a strong correlation between the MLD calculated by the DosePredictor and those obtained in treatment plans regardless of the technique used. The correlation coefficient was 0.96 for both 3D-CRT and VMAT techniques. In a similar manner, MED correlations of 0.98 and 0.96 were obtained for 3D-CRT and VMAT plans, respectively. The maximum dose to the spinal cord was not predicted very well. The correlation coefficient was 0.30 and 0.61 for 3D-CRT and VMAT, respectively. The presented method allows us to predict the minimum MLD and corresponding dosimetric parameters to OARs without the necessity of plan preparation. The method can serve as a guide during the treatment planning process, for example, as initial constraints in VMAT optimization. It allows the probability of lung pneumonitis to be predicted.« less

A modular approach to intensity-modulated arc therapy optimization with noncoplanar trajectories

NASA Astrophysics Data System (ADS)

Papp, Dávid; Bortfeld, Thomas; Unkelbach, Jan

2015-07-01

Utilizing noncoplanar beam angles in volumetric modulated arc therapy (VMAT) has the potential to combine the benefits of arc therapy, such as short treatment times, with the benefits of noncoplanar intensity modulated radiotherapy (IMRT) plans, such as improved organ sparing. Recently, vendors introduced treatment machines that allow for simultaneous couch and gantry motion during beam delivery to make noncoplanar VMAT treatments possible. Our aim is to provide a reliable optimization method for noncoplanar isocentric arc therapy plan optimization. The proposed solution is modular in the sense that it can incorporate different existing beam angle selection and coplanar arc therapy optimization methods. Treatment planning is performed in three steps. First, a number of promising noncoplanar beam directions are selected using an iterative beam selection heuristic; these beams serve as anchor points of the arc therapy trajectory. In the second step, continuous gantry/couch angle trajectories are optimized using a simple combinatorial optimization model to define a beam trajectory that efficiently visits each of the anchor points. Treatment time is controlled by limiting the time the beam needs to trace the prescribed trajectory. In the third and final step, an optimal arc therapy plan is found along the prescribed beam trajectory. In principle any existing arc therapy optimization method could be incorporated into this step; for this work we use a sliding window VMAT algorithm. The approach is demonstrated using two particularly challenging cases. The first one is a lung SBRT patient whose planning goals could not be satisfied with fewer than nine noncoplanar IMRT fields when the patient was treated in the clinic. The second one is a brain tumor patient, where the target volume overlaps with the optic nerves and the chiasm and it is directly adjacent to the brainstem. Both cases illustrate that the large number of angles utilized by isocentric noncoplanar VMAT plans can help improve dose conformity, homogeneity, and organ sparing simultaneously using the same beam trajectory length and delivery time as a coplanar VMAT plan.

SU-D-BRB-01: A Comparison of Learning Methods for Knowledge Based Dose Prediction for Coplanar and Non-Coplanar Liver Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tran, A; Ruan, D; Woods, K

Purpose: The predictive power of knowledge based planning (KBP) has considerable potential in the development of automated treatment planning. Here, we examine the predictive capabilities and accuracy of previously reported KBP methods, as well as an artificial neural networks (ANN) method. Furthermore, we compare the predictive accuracy of these methods on coplanar volumetric-modulated arc therapy (VMAT) and non-coplanar 4π radiotherapy. Methods: 30 liver SBRT patients previously treated using coplanar VMAT were selected for this study. The patients were re-planned using 4π radiotherapy, which involves 20 optimally selected non-coplanar IMRT fields. ANNs were used to incorporate enhanced geometric information including livermore » and PTV size, prescription dose, patient girth, and proximity to beams. The performance of ANN was compared to three methods from statistical voxel dose learning (SVDL), wherein the doses of voxels sharing the same distance to the PTV are approximated by either taking the median of the distribution, non-parametric fitting, or skew-normal fitting. These three methods were shown to be capable of predicting DVH, but only median approximation can predict 3D dose. Prediction methods were tested using leave-one-out cross-validation tests and evaluated using residual sum of squares (RSS) for DVH and 3D dose predictions. Results: DVH prediction using non-parametric fitting had the lowest average RSS with 0.1176(4π) and 0.1633(VMAT), compared to 0.4879(4π) and 1.8744(VMAT) RSS for ANN. 3D dose prediction with median approximation had lower RSS with 12.02(4π) and 29.22(VMAT), compared to 27.95(4π) and 130.9(VMAT) for ANN. Conclusion: Paradoxically, although the ANNs included geometric features in addition to the distances to the PTV, it did not perform better in predicting DVH or 3D dose compared to simpler, faster methods based on the distances alone. The study further confirms that the prediction of 4π non-coplanar plans were more accurate than VMAT. NIH R43CA183390 and R01CA188300.« less

SU-C-201-02: Dosimetric Verification of SBRT with FFF-VMAT Using a 3-D Radiochromic/Optical-CT Dosimetry System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Na, Y; Black, P; Wuu, C

2016-06-15

Purpose: With an increasing use of small field size and high dose rate irradiation in the advances of radiotherapy techniques, such as stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery (SRS), an in-depth quality assurance (QA) system is required. The purpose of this study is to investigate a high resolution optical CT-based 3D radiochromic dosimetry system for SBRT with intensity modulated radiotherapy (IMRT) and flattening filter free (FFF) volumetric modulated arc therapy (VMAT). Methods: Cylindrical PRESAGE radiochromic dosimeters of 10cm height and 11cm diameter were used to validate SBRT. Four external landmarks were placed on the surface of each dosimeter tomore » define the isocenter of target. SBRT plans were delivered using a Varian TrueBeam™ linear accelerator (LINAC). Three validation plans, SBRT with IMRT (6MV 600MU/min), FFF-VMAT (10MV 2400MU/min), and mixed FFF-VMAT (6MV 1400MU/min, 10MV 2400MU/min), were delivered to the PRESAGE dosimeters. Each irradiated PRESAGE dosimeter was scanned using a single laser beam optical CT scanner and reconstructed with a 1mm × 1mm high spatial resolution. The comparison of measured dose distributions of irradiated PRESAGE dosimeters to those calculated by Pinnacle{sup 3} treatment planning system (TPS) were performed with a 10% dose threshold, 3% dose difference (DD), and 3mm distance-to-agreement (DTA) Gamma criteria. Results: The average pass rates for the gamma comparisons between PRESAGE and Pinnacle{sup 3} in the transverse, sagittal, coronal planes were 94.6%, 95.9%, and 96.4% for SBRT with IMRT, FFF-VMAT, and mixed FFF-VMAT plans, respectively. A good agreement of the isodose distributions of those comparisons were shown at the isodose lines 50%, 70%, 80%, 90% and 98%. Conclusion: This study demonstrates the feasibility of the high resolution optical CT-based 3D radiochromic dosimetry system for validation of SBRT with IMRT and FFF-VMAT. This dosimetry system offers higher precision QA with 3D dose information for small beams compared to what is currently available.« less

Volumetric-modulated arc therapy vs conventional fixed-field intensity-modulated radiotherapy in a whole-ventricular irradiation: A planning comparison study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sakanaka, Katsuyuki; Mizowaki, Takashi, E-mail: mizo@kuhp.kyoto-u.ac.jp; Sato, Sayaka

This study evaluated the dosimetric difference between volumetric-modulated arc therapy (VMAT) and conventional fixed-field intensity-modulated radiotherapy (cIMRT) in whole-ventricular irradiation. Computed tomography simulation data for 13 patients were acquired to create plans for VMAT and cIMRT. In both plans, the same median dose (100% = 24 Gy) was prescribed to the planning target volume (PTV), which comprised a tumor bed and whole ventricles. During optimization, doses to the normal brain and body were reduced, provided that the dose constraints of the target coverage were satisfied. The dose-volume indices of the PTV, normal brain, and body as well as monitor unitsmore » were compared between the 2 techniques by using paired t-tests. The results showed no significant difference in the homogeneity index (0.064 vs 0.065; p = 0.824) of the PTV and conformation number (0.78 vs 0.77; p = 0.065) between the 2 techniques. In the normal brain and body, the dose-volume indices showed no significant difference between the 2 techniques, except for an increase in the volume receiving a low dose in VMAT; the absolute volume of the normal brain and body receiving 1 Gy of radiation significantly increased in VMAT by 1.6% and 8.3%, respectively, compared with that in cIMRT (1044 vs 1028 mL for the normal brain and 3079.2 vs 2823.3 mL for the body; p<0.001). The number of monitor units to deliver a 2.0-Gy fraction was significantly reduced in VMAT compared with that in cIMRT (354 vs 873, respectively; p<0.001). In conclusion, VMAT delivers IMRT to complex target volumes such as whole ventricles with fewer monitor units, while maintaining target coverage and conformal isodose distribution comparable to cIMRT; however, in addition to those characteristics, the fact that the volume of the normal brain and body receiving a low dose would increase in VMAT should be considered.« less

SU-E-T-628: A Cloud Computing Based Multi-Objective Optimization Method for Inverse Treatment Planning.

PubMed

Na, Y; Suh, T; Xing, L

2012-06-01

Multi-objective (MO) plan optimization entails generation of an enormous number of IMRT or VMAT plans constituting the Pareto surface, which presents a computationally challenging task. The purpose of this work is to overcome the hurdle by developing an efficient MO method using emerging cloud computing platform. As a backbone of cloud computing for optimizing inverse treatment planning, Amazon Elastic Compute Cloud with a master node (17.1 GB memory, 2 virtual cores, 420 GB instance storage, 64-bit platform) is used. The master node is able to scale seamlessly a number of working group instances, called workers, based on the user-defined setting account for MO functions in clinical setting. Each worker solved the objective function with an efficient sparse decomposition method. The workers are automatically terminated if there are finished tasks. The optimized plans are archived to the master node to generate the Pareto solution set. Three clinical cases have been planned using the developed MO IMRT and VMAT planning tools to demonstrate the advantages of the proposed method. The target dose coverage and critical structure sparing of plans are comparable obtained using the cloud computing platform are identical to that obtained using desktop PC (Intel Xeon® CPU 2.33GHz, 8GB memory). It is found that the MO planning speeds up the processing of obtaining the Pareto set substantially for both types of plans. The speedup scales approximately linearly with the number of nodes used for computing. With the use of N nodes, the computational time is reduced by the fitting model, 0.2+2.3/N, with r̂2>0.99, on average of the cases making real-time MO planning possible. A cloud computing infrastructure is developed for MO optimization. The algorithm substantially improves the speed of inverse plan optimization. The platform is valuable for both MO planning and future off- or on-line adaptive re-planning. © 2012 American Association of Physicists in Medicine.

Evaluations of secondary cancer risk in spine radiotherapy using 3DCRT, IMRT, and VMAT: A phantom study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rehman, Jalil ur, E-mail: jalil_khanphy@yahoo.com; Department of Radiation Physics, UT MD Anderson Cancer Center, Houston, TX; Tailor, Ramesh C.

2015-04-01

This study evaluated the secondary cancer risk from volumetric-modulated arc therapy (VMAT) for spine radiotherapy compared with intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal radiotherapy (3DCRT). Computed tomography images of an Radiological Physics Center spine anthropomorphic phantom were exported to a treatment planning system (Pinnacle{sup 3}, version 9.4). Radiation treatment plans for spine were prepared using VMAT (dual-arc), 7-field IMRT (beam angles: 110°, 130°, 150°, 180°, 210°, 230°, and 250°), and 4-field 3DCRT technique. The mean and maximum doses, dose-volume histograms, and volumes receiving more than 2 and 4 Gy to organs at risk (OARs) were calculated and compared. The lifetimemore » risk for secondary cancers was estimated according to the National Cancer Registry Programme Report 116. VMAT delivered the lowest maximum dose to the esophagus (4.03 Gy), bone (8.11 Gy), heart (2.11 Gy), spinal cord (6.45 Gy), and whole lung (5.66 Gy) as compared with other techniques (IMRT and 3DCRT). The volumes of OAR (esophagus) receiving more than 4 Gy were 0% for VMAT, 27.06% for IMRT, and up to 32.35% for 3DCRT. The estimated risk for secondary cancer in the respective OAR is considerably lower in VMAT compared with other techniques. The results of maximum doses and volumes of OARs suggest that the risk of secondary cancer induction for the spine in VMAT is lower than IMRT and 3DCRT, whereas VMAT has the best target coverage compared with the other techniques.« less

SU-E-T-370: Evaluating Plan Quality and Dose Delivery Accuracy of Tomotherapy SBRT Treatments for Lung Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Blake, S; Thwaites, D; Hansen, C

2015-06-15

Purpose: This study evaluated the plan quality and dose delivery accuracy of stereotactic body radiotherapy (SBRT) helical Tomotherapy (HT) treatments for lung cancer. Results were compared with those previously reported by our group for flattening filter (FF) and flattening filter free (FFF) VMAT treatments. This work forms part of an ongoing multicentre and multisystem planning and dosimetry audit on FFF beams for lung SBRT. Methods: CT datasets and DICOM RT structures delineating the target volume and organs at risk for 6 lung cancer patients were selected. Treatment plans were generated using the HT treatment planning system. Tumour locations were classifiedmore » as near rib, near bronchial tree or in free lung with prescribed doses of 48Gy/4fr, 50Gy/5fr and 54Gy/3fr respectively. Dose constraints were specified by a modified RTOG0915 protocol used for an Australian SBRT phase II trial. Plan quality was evaluated using mean PTV dose, PTV volume receiving 100% of the prescribed dose (V100%), target conformity (CI=VD100%/VPTV) and low dose spillage (LDS=VD50%/VPTV). Planned dose distributions were compared to those measured using an ArcCheck phantom. Delivery accuracy was evaluated using a gamma-index pass rate of 95% with 3% (of max dose) and 3mm criteria. Results: Treatment plans for all patients were clinically acceptable in terms of quality and accuracy of dose delivery. The following DVH metrics are reported as averages (SD) of all plans investigated: mean PTV dose was 115.3(2.4)% of prescription, V100% was 98.8(0.9)%, CI was 1.14(0.03) and LDS was 5.02(0.37). The plans had an average gamma-index passing rate of 99.3(1.3)%. Conclusion: The results reported in this study for HT agree within 1 SD to those previously published by our group for VMAT FF and FFF lung SBRT treatments. This suggests that HT delivers lung SBRT treatments of comparable quality and delivery accuracy as VMAT using both FF and FFF beams.« less

Modeling the target dose fall-off in IMRT and VMAT planning techniques for cervical SBRT.

PubMed

Brito Delgado, A; Cohen, D; Eng, T Y; Stanley, D N; Shi, Z; Charlton, M; Gutiérrez, A N

2018-01-01

There has been growing interest in the use of stereotactic body radiotherapy (SBRT) technique for the treatment of cervical cancer. The purpose of this study was to characterize dose distributions as well as model the target dose fall-off for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) delivery techniques using 6 and 10 MV photon beam energies. Fifteen (n = 15) patients with non-bulky cervical tumors were planned in Pinnacle 3 with a Varian Novalis Tx (HD120 MLC) using 6 and 10 MV photons with the following techniques: (1) IMRT with 10 non-coplanar beams (2) dual, coplanar 358° VMAT arcs (4° spacing), and (3) triple, non-coplanar VMAT arcs. Treatment volumes and dose prescriptions were segmented according to University of Texas Southwestern (UTSW) Phase II study. All plans were normalized such that 98% of the planning target volume (PTV) received 28 Gy (4 fractions). For the PTV, the following metrics were evaluated: homogeneity index, conformity index, D 2cc , D mean , D max , and dose fall-off parameters. For the organs at risk (OARs), D 2cc , D 15cc , D 0.01cc , V 20 , V 40 , V 50 , V 60 , and V 80 were evaluated for the bladder, bowel, femoral heads, rectum, and sigmoid. Statistical differences were evaluated using a Friedman test with a significance level of 0.05. To model dose fall-off, expanding 2-mm-thick concentric rings were created around the PTV, and doses were recorded. Statistically significant differences (p < 0.05) were noted in the dose fall-off when using 10 MV and VMAT 3-arc , as compared with IMRT. VMAT 3-arc improved the bladder V 40 , V 50 , and V 60 , and the bowel V 20 and V 50 . All fitted regressions had an R 2  ≥ 0.98. For cervical SBRT plans, a VMAT 3-arc approach offers a steeper dose fall-off outside of the target volume. Faster dose fall-off was observed in smaller targets as opposed to medium and large targets, denoting that OAR sparing is dependent on target size. These improvements are further pronounced with the use of 10-MV photons. Published by Elsevier Inc.

SU-E-J-80: Interplay Effect Between VMAT Intensity Modulation and Tumor Motion in Hypofractioned Lung Treatment, Investigated with 3D Pressage Dosimeter

DOE Office of Scientific and Technical Information (OSTI.GOV)

Touch, M; Duke University Medical Center, Durham, NC; Wu, Q

2014-06-01

Purpose: To demonstrate an embedded tissue equivalent presage dosimeter for measuring 3D doses in moving tumors and to study the interplay effect between the tumor motion and intensity modulation in hypofractioned Volumetric Modulated Arc Therapy(VMAT) lung treatment. Methods: Motion experiments were performed using cylindrical Presage dosimeters (5cm diameter by 7cm length) mounted inside the lung insert of a CIRS thorax phantom. Two different VMAT treatment plans were created and delivered in three different scenarios with the same prescribed dose of 18 Gy. Plan1, containing a 2 centimeter spherical CTV with an additional 2mm setup margin, was delivered on a stationarymore » phantom. Plan2 used the same CTV except expanded by 1 cm in the Sup-Inf direction to generate ITV and PTV respectively. The dosimeters were irradiated in static and variable motion scenarios on a Truebeam system. After irradiation, high resolution 3D dosimetry was performed using the Duke Large Field-of-view Optical-CT Scanner, and compared to the calculated dose from Eclipse. Results: In the control case (no motion), good agreement was observed between the planned and delivered dose distributions as indicated by 100% 3D Gamma (3% of maximum planned dose and 3mm DTA) passing rates in the CTV. In motion cases gamma passing rates was 99% in CTV. DVH comparisons also showed good agreement between the planned and delivered dose in CTV for both control and motion cases. However, differences of 15% and 5% in dose to PTV were observed in the motion and control cases respectively. Conclusion: With very high dose nature of a hypofraction treatment, significant effect was observed only motion is introduced to the target. This can be resulted from the motion of the moving target and the modulation of the MLC. 3D optical dosimetry can be of great advantage in hypofraction treatment dose validation studies.« less

SU-F-T-568: QA of a Multi-Target Multi-Dose VMAT SRS

DOE Office of Scientific and Technical Information (OSTI.GOV)

Roa, D; Kuo, J; Gonzales, A

2016-06-15

Purpose: To, experimentally, corroborated the prescribed doses utilizing dosimeters (e.g. films and TLDs) that can provide high spatial resolution, allow dose measurement of multiple targets at once, and provide accurate dosimetric results. Methods: A single-isocenter 6FFF SRS VMAT plan consisting of one 358° arc at 0° couch angle and four 179° arcs at 30°, 60°, 330° and 300° couch angles respectively, was generated in ECLIPSE v.11 using a Rando-Alderson anthropomorphic head phantom CT study. This plan was a reproduction of a clinical plan generated for a stage-IV melanoma patient diagnosed with 19 intracranial lesions. The phantom was loaded with axiallymore » mounted (between phantom slabs) Gafchromic EBT3 film and TLDs strategically positioned within various target volumes. Film and TLDS were calibrated according to established protocols. Target prescription doses were 16 Gy (3cc≤, 3 lesions), 18 Gy (∼1–3cc, 10 lesions) and 20 Gy (≤1cc, 6 lesions). Phantom setup was verified through CBCT imaging prior to irradiation. Gafchromic films were scanned in transmission mode and TLDs were read, respectively, ∼24 hrs after irradiation. Results: Dose calibrated Gafchromic film data were compared to the ECLIPSE calculated data using a 3% / 3mm gamma function analysis. Results for the gamma values were 96–99% in agreement with the calculated data and with 84–90% of the film pixels within the 3% dose difference. TLD data showed a dose difference of 0.4–8% while the film data for those same locations yielded a difference of 0.4–4%. It was observed that the highest dose discrepancies correlated with the location of the small volume targets. Conclusion: Overall this study corroborated that a VMAT SRS treatment, employing various treatment table rotations and arcs, to multiple intracranial lesions with multiple dose prescriptions can be delivered accurately with the existing radiotherapy technology.« less

Whole-brain hippocampal sparing radiation therapy: Volume-modulated arc therapy vs intensity-modulated radiation therapy case study.

PubMed

Lee, Katrina; Lenards, Nishele; Holson, Janice

2016-01-01

The hippocampus is responsible for memory and cognitive function. An ongoing phase II clinical trial suggests that sparing dose to the hippocampus during whole-brain radiation therapy can help preserve a patient׳s neurocognitive function. Progressive research and advancements in treatment techniques have made treatment planning more sophisticated but beneficial for patients undergoing treatment. The aim of this study is to evaluate and compare hippocampal sparing whole-brain (HS-WB) radiation therapy treatment planning techniques using volume-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT). We randomly selected 3 patients to compare different treatment techniques that could be used for reducing dose to the hippocampal region. We created 2 treatment plans, a VMAT and an IMRT, from each patient׳s data set and planned on the Eclipse 11.0 treatment planning system (TPS). A total of 6 plans (3 IMRT and 3 VMAT) were created and evaluated for this case study. The physician contoured the hippocampus as per the Radiation Therapy Oncology Group (RTOG) 0933 protocol atlas. The organs at risk (OR) were contoured and evaluated for the plan comparison, which included the spinal cord, optic chiasm, the right and left eyes, lenses, and optic nerves. Both treatment plans produced adequate coverage on the planning target volume (PTV) while significantly reducing dose to the hippocampal region. The VMAT treatment plans produced a more homogenous dose distribution throughout the PTV while decreasing the maximum point dose to the target. However, both treatment techniques demonstrated hippocampal sparing when irradiating the whole brain. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

SU-E-T-306: Dosimetric Comparison of Leaf with Or Without Interdigitation in Multiple Brain Metastasis VMAT Treatment Planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

Purpose: To evaluate the effects of leaf with or without interdigitation in multiple brain metastasis volumetric modulated arc therapy (VMAT) plans. Methods: Twenty patients with 2 to 6 brain metastases of our hospital were retrospectively studied to be planned with dual arc VMAT using Monaco 3.3 TPS on the Elekta Synergy linear accelerator. The prescription dose of PTV was 60Gy/30 fractions. Two plans with or without leaf interdigitation were designed. The homogeneity index (HI), conformity index (CI), dose volume histograms (DVHs), monitor unit (MU), treatment time (T), the segments, the dose coverage of the target, were all evaluated. Results: Themore » plans with leaf interdigitation could achieve better CI (p<0.05) than without leaf interdigitation, while no significant difference were found in HI (p> 0.05) and the dose coverage of the target (p> 0.05).The MU,T, and the segments of the plan with leaf interdigitation were more than the plan without leaf interdigitation (p<0.05). There was no significant difference found in radiation dose of spinal cord, lenses and parotids, while the maximum dose of brain stem of leaf without interdigitation was higher than leaf with interdigitation (p< 0.05). It was worth noting that the areas of low dose regions with leaf interdigitation plan were much less than the without leaf interdigitation plan in the doublication planes (p< 0.05). Conclusion: This study shows that leaf with interdigitation has some advantages than leaf without interdigitation in multiple brain metastasis VMAT plans although the clinical relevance remains to be proven.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jassal, K; Sarkar, B; Ganesh, T

Purpose: The study investigates the effect of fluence smoothing parameter on VMAT plans for ten head-neck cancer patients using Monaco5.00.04. Methods: VMAT plans were created using Monaco5.00.04 planning system for 10 head-neck patients. Four plans were generated for each patient using available smoothing parameters i.e. high, medium, low and off. The number of monitor units required to deliver 1 cGy was defined as a modulation degree; and was taken as a measure of plan complexity. Routinely used plan quality parameters Conformity index (CI) and Homogeneity index (HI) were used in the study. As a protocol our center, practices “medium” smoothingmore » for clinical implementation. Plans with medium smoothing were opted as reference plans due to the clinical acceptance and dosimetric verifications made on these plans. Plans were generated by varying the smoothing parameter and re-optimization was done. The PTV was evaluated for D98%, D95%, D50%, D1% and prescription isodose volume (PIV). For critical organs; spine and parotids the parameters recorded were D1cc and Dmean respectively. Results: The cohort had the median prescription as 6000 cGy in the range of 6600 cGy - 4500 cGy. The modulation degree was observed to increase up to 6% from reference to the most complex plan. High smoothing had about 11% increase in segments which marginally (0.5 to 1%) increased the homogeneity index while conformity index remains constant. For spine the maximum D1cc was observed in medium smoothing as 4639.8 cGy, this plan was clinically accepted and dosimetrically verified. Similarly for parotids, the Dmean was 2011.9 cGy and 1817.05 cGy. Conclusion: The sensitivity of plan quality in terms of smoothing options (high, medium, low and off) available in Monaco 5.00.04 was resulted in minimal difference in terms of target coverage, conformity index and homogeneity index. Similarly changing smoothing did not result in any enhanced advantage in sparing of critical organs.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yang, K; Yu, Z; Chen, H

Purpose: To implement VMAT in RayStation with the Elekta Synergy linac with the new Agility MLC, and to utilize the same vendor softwares to determine the optimum Elekta VMAT machine parameters in RayStation for accurate modeling and robust delivery. Methods: iCOMCat is utilized to create various beam patterns with user defined dose rate, gantry, MLC and jaw speed for each control point. The accuracy and stability of the output and beam profile are qualified for each isolated functional component of VMAT delivery using ion chamber and Profiler2 with isocentric mounting fixture. Service graphing on linac console is used to verifymore » the mechanical motion accuracy. The determined optimum Elekta VMAT machine parameters were configured in RayStation v4.5.1. To evaluate the system overall performance, TG-119 test cases and nine retrospective VMAT patients were planned on RayStation, and validated using both ArcCHECK (with plug and ion chamber) and MapCHECK2. Results: Machine output and profile varies <0.3% when only variable is dose rate (35MU/min-600MU/min). <0.9% output and <0.3% profile variation are observed with additional gantry motion (0.53deg/s–5.8deg/s both directions). The output and profile variation are still <1% with additional slow leaf motion (<1.5cm/s both direction). However, the profile becomes less symmetric, and >1.5% output and 7% profile deviation is seen with >2.5cm/s leaf motion. All clinical cases achieved comparable plan quality as treated IMRT plans. The gamma passing rate is 99.5±0.5% on ArcCheck (<3% iso center dose deviation) and 99.1±0.8% on MapCheck2 using 3%/3mm gamma (10% lower threshold). Mechanical motion accuracy in all VMAT deliveries is <1°/1mm. Conclusion: Accurate RayStation modeling and robust VMAT delivery is achievable on Elekta Agility for <2.5cm/s leaf motion and full range of dose rate and gantry speed determined by the same vendor softwares. Our TG-119 and patient results have provided us with the confidence to use VMAT clinically.« less

The influence of plan modulation on the interplay effect in VMAT liver SBRT treatments.

PubMed

Hubley, Emily; Pierce, Greg

2017-08-01

Volumetric modulated arc therapy (VMAT) uses multileaf collimator (MLC) leaves, gantry speed, and dose rate to modulate beam fluence, producing the highly conformal doses required for liver radiotherapy. When targets that move with respiration are treated with a dynamic fluence, there exists the possibility for interplay between the target and leaf motions. This study employs a novel motion simulation technique to determine if VMAT liver SBRT plans with an increase in MLC leaf modulation are more susceptible to dosimetric differences in the GTV due to interplay effects. For ten liver SBRT patients, two VMAT plans with different amounts of MLC leaf modulation were created. Motion was simulated using a random starting point in the respiratory cycle for each fraction. To isolate the interplay effect, motion was also simulated using four specific starting points in the respiratory cycle. The dosimetric differences caused by different starting points were examined by subtracting resultant dose distributions from each other. When motion was simulated using random starting points for each fraction, or with specific starting points, there were significantly more dose differences in the GTV (maximum 100cGy) for more highly modulated plans, but the overall plan quality was not adversely affected. Plans with more MLC leaf modulation are more susceptible to interplay effects, but dose differences in the GTV are clinically negligible in magnitude. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

TU-CD-304-03: Dosimetric Verification and Preliminary Comparison of Dynamic Wave Arc for SBRT Treatments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Burghelea, M; BRAINLAB AG, Munich; Babes Bolyai University, Cluj-Napoca

2015-06-15

Purpose: To evaluate the potential dosimetric benefits and verify the delivery accuracy of Dynamic Wave Arc, a novel treatment delivery approach for the Vero SBRT system. Methods: Dynamic Wave Arc (DWA) combines simultaneous movement of gantry/ring with inverse planning optimization, resulting in an uninterrupted non-coplanar arc delivery technique. Thirteen SBRT complex cases previously treated with 8–10 conformal static beams (CRT) were evaluated in this study. Eight primary centrally-located NSCLC (prescription dose 4×12Gy or 8×7.5Gy) and five oligometastatic cases (2×2 lesions, 10×5Gy) were selected. DWA and coplanar VMAT plans, partially with dual arcs, were generated for each patient using identical objectivemore » functions for target volumes and OARs on the same TPS (RayStation, RaySearch Laboratories). Dosimetric differences and delivery time among these three planning schemes were evaluated. The DWA delivery accuracy was assessed using the Delta4 diode array phantom (ScandiDos AB). The gamma analysis was performed with the 3%/3mm dose and distance-to-agreement criteria. Results: The target conformity for CRT, VMAT and DWA were 0.95±0.07, 0.96±0.04 and 0.97±0.04, while the low dose spillage gradient were 5.52±1.36, 5.44±1.11, and 5.09±0.98 respectively. Overall, the bronchus, esophagus and spinal cord maximum doses were similar between VMAT and DWA, but highly reduced compared with CRT. For the lung cases, the mean dose and V20Gy were lower for the arc techniques compares with CRT, while for the liver cases, the mean dose and the V30Gy presented slightly higher values. The average delivery time of VMAT and DWA were 2.46±1.10 min and 4.25±1.67 min, VMAT presenting shorter treatment time in all cases. The DWA dosimetric verification presented an average gamma index passing rate of 95.73±1.54% (range 94.2%–99.8%). Conclusion: Our preliminary data indicated that the DWA is deliverable with clinically acceptable accuracy and has the potential to further improve the plan quality. This collaborative work was supported by the Flemish government through the Hercules foundation and corporate funding from BrainLab AG. The first and the sixth author are financially supported by Brainlab AG. The other authors have no conflict of interest.« less

Skin dose differences between intensity-modulated radiation therapy and volumetric-modulated arc therapy and between boost and integrated treatment regimens for treating head and neck and other cancer sites in patients.

PubMed

Penoncello, Gregory P; Ding, George X

2016-01-01

The purpose of this study was (1) to evaluate dose to skin between volumetric-modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) treatment techniques for target sites in the head and neck, pelvis, and brain and (2) to determine if the treatment dose and fractionation regimen affect the skin dose between traditional sequential boost and integrated boost regimens for patients with head and neck cancer. A total of 19 patients and 48 plans were evaluated. The Eclipse (v11) treatment planning system was used to plan therapy in 9 patients with head and neck cancer, 5 patients with prostate cancer, and 5 patients with brain cancer with VMAT and static-field IMRT. The mean skin dose and the maximum dose to a contiguous volume of 2cm(3) for head and neck plans and brain plans and a contiguous volume of 5cm(3) for pelvis plans were compared for each treatment technique. Of the 9 patients with head and neck cancer, 3 underwent an integrated boost regimen. One integrated boost plan was replanned with IMRT and VMAT using a traditional boost regimen. For target sites located in the head and neck, VMAT reduced the mean dose and contiguous hot spot most noticeably in the shoulder region by 5.6% and 5.4%, respectively. When using an integrated boost regimen, the contiguous hot spot skin dose in the shoulder was larger on average than a traditional boost pattern by 26.5% and the mean skin dose was larger by 1.7%. VMAT techniques largely decrease the contiguous hot spot in the skin in the pelvis by an average of 36% compared with IMRT. For the same target coverage, VMAT can reduce the skin dose in all the regions of the body, but more noticeably in the shoulders in patients with head and neck and pelvis cancer. We also found that using integrated boost regimens in patients with head and neck cancer leads to higher shoulder skin doses compared with traditional boost regimens. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Single-fraction flattening filter–free volumetric modulated arc therapy for lung cancer: Dosimetric results and comparison with flattened beams technique

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barbiero, Sara; Specialty School in Medical Physics, University of Pisa, Pisa; Rink, Alexandra

2016-01-01

Purpose: To report on single-fraction stereotactic body radiotherapy (RT) (SBRT) with flattening filter (FF)–free (FFF) volumetric modulated arc therapy (VMAT) for lung cancer and to compare dosimetric results with VMAT with FF. Methods and materials: Overall, 25 patients were treated with 6-MV FFF VMAT (Varian TrueBeam STx LINAC) to a prescribed dose of 24 Gy in a single fraction. Treatment plans were recreated using FF VMAT. Dose-volume indices, monitor units (MU), and treatment times were compared between FFF and FF VMAT techniques. Results: Dose constraints to PTV, spinal cord, and lungs were reached in FFF and FF plans. In FFFmore » plans, average conformity index was 1.13 (95% CI: 1.07 to1.38). Maximum doses to spinal cord, heart, esophagus, and trachea were 2.9 Gy (95% CI: 0.4 to 6.7 Gy), 0.8 Gy (95% CI: 0 to 3.6 Gy), 3.3 Gy (95% CI: 0.02 to 13.9 Gy), and 1.5 Gy (95% CI: 0 to 4.9 Gy), respectively. Average V7 Gy, V7.4 Gy, and mean dose to the healthy lung were 126.5 cc (95% CI: 41.3 to 248.9 cc), 107.3 cc (95% CI: 18.7 to 232.8 cc), and 1.1 Gy (95% CI: 0.3 to 2.2 Gy), respectively. No statistically significant differences were found in dosimetric results and MU between FF and FFF treatments. Treatment time was reduced by an average factor of 2.31 (95% CI: 2.15 to 2.43) from FF treatments to FFF, and the difference was statistically significant. Conclusions: FFF VMAT for lung SBRT provides equivalent dosimetric results to the target and organs at risk as FF VMAT while significantly reducing treatment time.« less

SU-E-T-106: An Institutional Review of Using Commercially Available Software to Evaluate Treatment Plan Quality for Various Treatment Sites and Beam Deliveries

DOE Office of Scientific and Technical Information (OSTI.GOV)

Esquivel, C; Patton, L; Walker, S

Purpose: Use Sun Nuclear Quality Reports™ with PlanIQ™ to evaluate different treatment delivery techniques for various treatment sites. Methods: Fifteen random patients with different treatment sites were evaluated. These include the Head/Neck, prostate, pelvis, lung, esophagus, axilla, bladder and abdomen. Initially, these sites were planned on the Pinnacle {sup 3} V9.6 treatment planning system and utilized nine 6MV step-n-shoot IMRT fields. The RT plan, dose and structure sets were sent to Quality Reports™ where a DVH was recreated and the plans were compared to a unique Plan Algorithm for each treatment site. Each algorithm has its own plan quality metricsmore » and objectives, which include the PTV coverage, PTV maximum dose, the prescription dose outside the target, doses to the critical structures, and the global maximum dose and its location. Each plan was scored base on meeting each objective. Plans may have been reoptimized and reevaluated with Quality Reports™ based on the initial score. PlanIQ™ was used to evaluate if any objective not met was achievable or difficult to obtain. A second plan using VMAT delivery was created for each patient and scored with Quality Reports™. Results: There were a wide range of scores for the different treatment sites with some scoring better for IMRT plans and some better for the VMAT deliveries. The variation in the scores could be attributed to the treatment site, location, and shape of the target. Most deliveries were chosen for the VMAT due to the short treatment times and quick patient throughput with acceptable plan scores. Conclusion: The tools are provided for both physician and dosimetrist to objectively evaluate the use of VMAT delivery versus the step-n-shoot IMRT delivery for various sites. PlanIQ validates if objectives can be met. For the physicist, a concise pass/fail report is created for plan evaluation.« less

Intensity-modulated radiation therapy and volumetric-modulated arc therapy for adult craniospinal irradiation—A comparison with traditional techniques

DOE Office of Scientific and Technical Information (OSTI.GOV)

Studenski, Matthew T., E-mail: matthew.studenski@jeffersonhospital.org; Shen, Xinglei; Yu, Yan

2013-04-01

Craniospinal irradiation (CSI) poses a challenging planning process because of the complex target volume. Traditional 3D conformal CSI does not spare any critical organs, resulting in toxicity in patients. Here the dosimetric advantages of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) are compared with classic conformal planning in adults for both cranial and spine fields to develop a clinically feasible technique that is both effective and efficient. Ten adult patients treated with CSI were retrospectively identified. For the cranial fields, 5-field IMRT and dual 356° VMAT arcs were compared with opposed lateral 3D conformal radiotherapy (3D-CRT) fields. Formore » the spine fields, traditional posterior-anterior (PA) PA fields were compared with isocentric 5-field IMRT plans and single 200° VMAT arcs. Two adult patients have been treated using this IMRT technique to date and extensive quality assurance, especially for the junction regions, was performed. For the cranial fields, the IMRT technique had the highest planned target volume (PTV) maximum and was the least efficient, whereas the VMAT technique provided the greatest parotid sparing with better efficiency. 3D-CRT provided the most efficient delivery but with the highest parotid dose. For the spine fields, VMAT provided the best PTV coverage but had the highest mean dose to all organs at risk (OAR). 3D-CRT had the highest PTV and OAR maximum doses but was the most efficient. IMRT provides the greatest OAR sparing but the longest delivery time. For those patients with unresectable disease that can benefit from a higher, definitive dose, 3D-CRT–opposed laterals are the most clinically feasible technique for cranial fields and for spine fields. Although inefficient, the IMRT technique is the most clinically feasible because of the increased mean OAR dose with the VMAT technique. Quality assurance of the beams, especially the junction regions, is essential.« less

Improving plan quality for prostate volumetric-modulated arc therapy.

PubMed

Wright, Katrina; Ferrari-Anderson, Janet; Barry, Tamara; Bernard, Anne; Brown, Elizabeth; Lehman, Margot; Pryor, David

2017-01-01

We critically evaluated the quality and consistency of volumetric-modulated arc therapy (VMAT) prostate planning at a single institution to quantify objective measures for plan quality and establish clear guidelines for plan evaluation and quality assurance. A retrospective analysis was conducted on 34 plans generated on the Pinnacle 3 version 9.4 and 9.8 treatment planning system to deliver 78 Gy in 39 fractions to the prostate only using VMAT. Data were collected on contoured structure volumes, overlaps and expansions, planning target volume (PTV) and organs at risk volumes and relationship, dose volume histogram, plan conformity, plan homogeneity, low-dose wash, and beam parameters. Standard descriptive statistics were used to describe the data. Despite a standardized planning protocol, we found variability was present in all steps of the planning process. Deviations from protocol contours by radiation oncologists and radiation therapists occurred in 12% and 50% of cases, respectively, and the number of optimization parameters ranged from 12 to 27 (median 17). This contributed to conflicts within the optimization process reflected by the mean composite objective value of 0.07 (range 0.01 to 0.44). Methods used to control low-intermediate dose wash were inconsistent. At the PTV rectum interface, the dose-gradient distance from the 74.1 Gy to 40 Gy isodose ranged from 0.6 cm to 2.0 cm (median 1.0 cm). Increasing collimator angle was associated with a decrease in monitor units and a single full 6 MV arc was sufficient for the majority of plans. A significant relationship was found between clinical target volume-rectum distance and rectal tolerances achieved. A linear relationship was determined between the PTV volume and volume of 40 Gy isodose. Objective values and composite objective values were useful in determining plan quality. Anatomic geometry and overlap of structures has a measurable impact on the plan quality achieved for prostate patients being treated with VMAT. By evaluating multiple planning variables, we have been able to determine important factors influencing plan quality and develop predictive models for quality metrics that have been incorporated into our new protocol and will be tested and refined in future studies. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Dosimetric impact of a change in breathing period on VMAT stereotactic ablative body radiotherapy

NASA Astrophysics Data System (ADS)

Olding, T.; Alexander, KM

2017-05-01

The dosimetric impact of a change in breathing period during treatment was assessed for a volumetric modulated arc therapy (VMAT) stereotactic ablative radiotherapy (SABR) lung plan optimized according to our centre’s planning protocol. Plan delivery was evaluated at three breathing rates ranging from 7 to 23 breaths-per-minute (BPM) against the planning anatomy (15 BPM) calculated dose. Dynamic ion chamber, EBT3 film and Fricke-xylenol orange-gelatin (FXG) gel measurements were acquired using a motion phantom with appropriate inserts for each dosimeter. The results show good agreement between measured and calculated plan dose within the internal gross tumour volume (IGTV) target.

Empirical determination of collimator scatter data for use in Radcalc commercial monitor unit calculation software: Implication for prostate volumetric modulated-arc therapy calculations.

PubMed

Richmond, Neil; Tulip, Rachael; Walker, Chris

2016-01-01

The aim of this work was to determine, by measurement and independent monitor unit (MU) check, the optimum method for determining collimator scatter for an Elekta Synergy linac with an Agility multileaf collimator (MLC) within Radcalc, a commercial MU calculation software package. The collimator scatter factors were measured for 13 field shapes defined by an Elekta Agility MLC on a Synergy linac with 6MV photons. The value of the collimator scatter associated with each field was also calculated according to the equation Sc=Sc(mlc)+Sc(corr)(Sc(open)-Sc(mlc)) with Sc(corr) varied between 0 and 1, where Sc(open) is the value of collimator scatter calculated from the rectangular collimator-defined field and Sc(mlc) the value using only the MLC-defined field shape by applying sector integration. From this the optimum value of the correction was determined as that which gives the minimum difference between measured and calculated Sc. Single (simple fluence modulation) and dual-arc (complex fluence modulation) treatment plans were generated on the Monaco system for prostate volumetric modulated-arc therapy (VMAT) delivery. The planned MUs were verified by absolute dose measurement in phantom and by an independent MU calculation. The MU calculations were repeated with values of Sc(corr) between 0 and 1. The values of the correction yielding the minimum MU difference between treatment planning system (TPS) and check MU were established. The empirically derived value of Sc(corr) giving the best fit to the measured collimator scatter factors was 0.49. This figure however was not found to be optimal for either the single- or dual-arc prostate VMAT plans, which required 0.80 and 0.34, respectively, to minimize the differences between the TPS and independent-check MU. Point dose measurement of the VMAT plans demonstrated that the TPS MUs were appropriate for the delivered dose. Although the value of Sc(corr) may be obtained by direct comparison of calculation with measurement, the efficacy of the value determined for VMAT-MU calculations are very much dependent on the complexity of the MLC delivery. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

SU-F-T-285: Evaluation of a Patient DVH-Based IMRT QA System

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhen, H; Redler, G; Chu, J

2016-06-15

Purpose: To evaluate the clinical performance of a patient DVH-based QA system for prostate VMAT QA. Methods: Mobius3D(M3D) is a QA software with an independent beam model and dose engine. The MobiusFX(MFX) add-on predicts patient dose using treatment machine log files. We commissioned the Mobius beam model in two steps. First, the stock beam model was customized using machine commissioning data, then verified against the TPS with 12 simple phantom plans and 7 clinical 3D plans. Secondly, the Dosimetric Leaf Gap(DLG) in the Mobius model was fine-tuned for VMAT treatment based on ion chamber measurements for 6 clinical VMAT plans.more » Upon successful commissioning, we retrospectively performed IMRT QA for 12 VMAT plans with the Mobius system as well as the ArcCHECK-3DVH system. Selected patient DVH values (PTV D95, D50; Bladder D2cc, Dmean; Rectum D2cc) were compared between TPS, M3D, MFX, and 3DVH. Results: During the first commissioning step, TPS and M3D calculated target Dmean for 3D plans agree within 0.7%±0.7%, with 3D gamma passing rates of 98%±2%. In the second commissioning step, the Mobius DLG was adjusted by 1.2mm from the stock value, reducing the average difference between MFX calculation and ion chamber measurement from 3.2% to 0.1%. In retrospective prostate VMAT QA, 5 of 60 MFX calculated DVH values have a deviation greater than 5% compared to TPS. One large deviation at high dose level was identified as a potential QA failure. This echoes the 3DVH QA result, which identified 2 instances of large DVH deviation on the same structure. For all DVH’s evaluated, M3D and MFX show high level of agreement (0.1%±0.2%), indicating that the observed deviation is likely from beam modelling differences rather than delivery errors. Conclusion: Mobius system provides a viable solution for DVH based VMAT QA, with the capability of separating TPS and delivery errors.« less

Rounded leaf end modeling in Pinnacle VMAT treatment planning for fixed jaw linacs

PubMed Central

Yang, Fei; Cao, Ning; Meyer, Juergen

2016-01-01

During volume‐modulated arc therapies (VMAT), dosimetric errors are introduced by multiple open dynamic leaf gaps that are present in fixed diaphragm linear accelerators. The purpose of this work was to develop a methodology for adjusting the rounded leaf end modeling parameters to improve out‐of‐field dose agreement in SmartArc VMAT treatment plans delivered by fixed jaw linacs where leaf gap dose is not negligible. Leaf gap doses were measured for an Elekta beam modulator linac with 0.4 cm micro‐multileaf collimators (MLC) using an A16 micro‐ionization chamber, a MatriXX ion chamber detector array, and Kodak EDR2 film dosimetry in a solid water phantom. The MLC offset and rounded end tip radius were adjusted in the Pinnacle treatment planning system (TPS) to iteratively arrive at the optimal configuration for 6 MV and 10 MV photon energies. Improvements in gamma index with a 3%/3 mm acceptance criteria and an inclusion threshold of 5% of maximum dose were measured, analyzed, and validated using an ArcCHECK diode detector array for field sizes ranging from 1.6 to 14 cm square field arcs and Task Group (TG) 119 VMAT test cases. The best results were achieved for a rounded leaf tip radius of 13 cm with a 0.1 cm MLC offset. With the optimized MLC model, measured gamma indices ranged between 99.9% and 91.7% for square field arcs with sizes between 3.6 cm and 1.6 cm, with a maximum improvement of 42.7% for the 1.6 cm square field size. Gamma indices improved up to 2.8% in TG‐119 VMAT treatment plans. Imaging and Radiation Oncology Core (IROC) credentialing of a VMAT plan with the head and neck phantom passed with a gamma index of 100%. Fine‐tune adjustments to MLC rounded leaf ends may improve patient‐specific QA pass rates and provide more accurate predictions of dose deposition to avoidance structures. PACS number(s): 87.55.D‐, 87.55.kd, 87.55.kh PMID:27929490

Dosimetric comparison between VMAT and RC3D techniques: case of prostate treatment

NASA Astrophysics Data System (ADS)

Chemingui, Fatima Zohra; Benrachi, Fatima; Bali, Mohamed Saleh; Ladjal, Hamid

2017-09-01

Considered as the second men cancer in Algeria, prostate cancer is treated in 70% by radiation. That's why radiation therapy is therapeutic weapon for prostate cancer. Conformational Radiotherapy in 3D is the most common technique [1-5]. The use of conventionally optimized treatment plans was compared at case scenario of optimized treatment plans VMAT for prostate cancer. The evaluation of the two optimizations strategies focused on the resulting plans ability to retain dose objectives under the influence of patient set up. Dose Volume Histogram in the Planning Target Volume and dose in the Organs At Risks were used to calculate the conformity index, and evaluation ratio of irradiated volume which represent the main tool of comparison [6,7]. The situation was analysed systematically. The 14% dose increase in the target leads to a decrease in the dose in adjacent organs with 39% in the bladder. Therefore, the criterion for better efficacy and less toxicity reveal that VMAT is the best choice.

Application programming in C# environment with recorded user software interactions and its application in autopilot of VMAT/IMRT treatment planning.

PubMed

Wang, Henry; Xing, Lei

2016-11-08

An autopilot scheme of volumetric-modulated arc therapy (VMAT)/intensity-modulated radiation therapy (IMRT) planning with the guidance of prior knowl-edge is established with recorded interactions between a planner and a commercial treatment planning system (TPS). Microsoft (MS) Visual Studio Coded UI is applied to record some common planner-TPS interactions as subroutines. The TPS used in this study is a Windows-based Eclipse system. The interactions of our application program with Eclipse TPS are realized through a series of subrou-tines obtained by prerecording the mouse clicks or keyboard strokes of a planner in operating the TPS. A strategy to autopilot Eclipse VMAT/IMRT plan selection process is developed as a specific example of the proposed "scripting" method. The autopiloted planning is navigated by a decision function constructed with a reference plan that has the same prescription and similar anatomy with the case at hand. The calculation proceeds by alternating between the Eclipse optimization and the outer-loop optimization independent of the Eclipse. In the C# program, the dosimetric characteristics of a reference treatment plan are used to assess and modify the Eclipse planning parameters and to guide the search for a clinically sensible treatment plan. The approach is applied to plan a head and neck (HN) VMAT case and a prostate IMRT case. Our study demonstrated the feasibility of application programming method in C# environment with recorded interactions of planner-TPS. The process mimics a planner's planning process and automatically provides clinically sensible treatment plans that would otherwise require a large amount of manual trial and error of a planner. The proposed technique enables us to harness a commercial TPS by application programming via the use of recorded human computer interactions and provides an effective tool to greatly facilitate the treatment planning process. © 2016 The Authors.

Application programming in C# environment with recorded user software interactions and its application in autopilot of VMAT/IMRT treatment planning

PubMed Central

Wang, Henry

2016-01-01

An autopilot scheme of volumetric‐modulated arc therapy (VMAT)/intensity‐modulated radiation therapy (IMRT) planning with the guidance of prior knowledge is established with recorded interactions between a planner and a commercial treatment planning system (TPS). Microsoft (MS) Visual Studio Coded UI is applied to record some common planner‐TPS interactions as subroutines. The TPS used in this study is a Windows‐based Eclipse system. The interactions of our application program with Eclipse TPS are realized through a series of subroutines obtained by prerecording the mouse clicks or keyboard strokes of a planner in operating the TPS. A strategy to autopilot Eclipse VMAT/IMRT plan selection process is developed as a specific example of the proposed “scripting” method. The autopiloted planning is navigated by a decision function constructed with a reference plan that has the same prescription and similar anatomy with the case at hand. The calculation proceeds by alternating between the Eclipse optimization and the outer‐loop optimization independent of the Eclipse. In the C# program, the dosimetric characteristics of a reference treatment plan are used to assess and modify the Eclipse planning parameters and to guide the search for a clinically sensible treatment plan. The approach is applied to plan a head and neck (HN) VMAT case and a prostate IMRT case. Our study demonstrated the feasibility of application programming method in C# environment with recorded interactions of planner‐TPS. The process mimics a planner's planning process and automatically provides clinically sensible treatment plans that would otherwise require a large amount of manual trial and error of a planner. The proposed technique enables us to harness a commercial TPS by application programming via the use of recorded human computer interactions and provides an effective tool to greatly facilitate the treatment planning process. PACS number(s): 87.55.D‐, 87.55.kd, 87.55.de PMID:27929493

SU-F-T-399: Migration of Treatment Planning Systems Without Beam Data Measurement

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tolakanahalli, R; Tewatia, D

2016-06-15

Purpose: Data acquisition for commissioning is steered by Treatment Planning System (TPS) requirements which can be cumbersome and time consuming involving significant clinic downtime. The purpose of this abstract is to answer if we could circumvent this by extracting data from existing TPS and speed up the process. Methods: Commissioning beam data was obtained from a clinically commissioned TPS (Pinnacle™) using Matlab™ generated Pinnacle™ executable scripts to commission a secondary 3D dose verification TPS (Eclipse™). Profiles and output factors for commissioning as required by Eclipse™ were computed on a 50 cm{sup 3} water phantom at a dose grid resolution ofmore » 2mm3. Verification doses were computed and compared to clinical TPS dose profiles as per TG-106 guidelines. Standard patient plans from Pinnacle™ including IMRT and VMAT plans were re-computed keeping the same monitor units (in order to perform true comparison) using Eclipse™. Computed dose was exported back to Pinnacle for comparison to original plans. This methodology enables us to alleviate all ambiguities that arise in such studies. Results: Profile analysis using in-house software for 6x, showed that for all field sizes including small MLC generated fields, 100% of infield and penumbra data points of Eclipse™ match Pinnacle™ generated and measured profiles with 2%/2 mm gamma criteria. Excellent agreement was observed in the penumbra regions, with all data points passing DTA criteria for complex C-shaped and S-shaped profiles. Patient plan dose volume histograms (DVHs) and isodose lines agreed well to within a 1.5% for target coverage. Conclusion: Secondary 3D dose checking is of utmost importance with advanced techniques such as IMRT and VMAT. Migration of TPS is possible without compromising accuracy or enduring the cumbersome measurement of commissioning data. Economizing time for commissioning such a verification system or for migration of TPS can add great QA value and minimize downtime.« less

Linking log files with dosimetric accuracy--A multi-institutional study on quality assurance of volumetric modulated arc therapy.

PubMed

Pasler, Marlies; Kaas, Jochem; Perik, Thijs; Geuze, Job; Dreindl, Ralf; Künzler, Thomas; Wittkamper, Frits; Georg, Dietmar

2015-12-01

To systematically evaluate machine specific quality assurance (QA) for volumetric modulated arc therapy (VMAT) based on log files by applying a dynamic benchmark plan. A VMAT benchmark plan was created and tested on 18 Elekta linacs (13 MLCi or MLCi2, 5 Agility) at 4 different institutions. Linac log files were analyzed and a delivery robustness index was introduced. For dosimetric measurements an ionization chamber array was used. Relative dose deviations were assessed by mean gamma for each control point and compared to the log file evaluation. Fourteen linacs delivered the VMAT benchmark plan, while 4 linacs failed by consistently terminating the delivery. The mean leaf error (±1SD) was 0.3±0.2 mm for all linacs. Large MLC maximum errors up to 6.5 mm were observed at reversal positions. Delivery robustness index accounting for MLC position correction (0.8-1.0) correlated with delivery time (80-128 s) and depended on dose rate performance. Dosimetric evaluation indicated in general accurate plan reproducibility with γ(mean)(±1 SD)=0.4±0.2 for 1 mm/1%. However single control point analysis revealed larger deviations and attributed well to log file analysis. The designed benchmark plan helped identify linac related malfunctions in dynamic mode for VMAT. Log files serve as an important additional QA measure to understand and visualize dynamic linac parameters. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

SU-E-P-56: Dosimetric Comparison of Three Post Modified Radical Mastectomy Radiotherapy Techniques for Locally Advanced Left-Sided Breast Cancer and Beyond

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ma, C; Zhang, W; Lu, J

2015-06-15

Purpose: To compare the dosimetry of post modified radical mastectomy radiotherapy (PMRMRT) for left-sided breast cancer using 3-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). Methods: We created ten sets of PMRMRT plans for ten consecutive patients and utilized two tangential and one or two supraclavicular beams in 3DCRT, a total of 5 beams in IMRT and two optimized partial arcs in VMAT. The difference in results between any two of the three new plans, between new and previous 3DCRT plans were compared and analyzed by ANOVA (α =0.05) and paired-sample t-test respectively. Pmore » values less than 0.05 were considered statistically significant. Results: Both IMRT and VMAT plans had similar PTV coverage, hotspot area and conformity (all p>0.05), and significantly higher PTV coverage compared with new 3DCRT (both p<0.001). IMRT plans had significantly less heart and left lung radiation exposure compared with VMAT (all p<0.05). The 3DCRT plans with larger estimated CTV displacement had better target coverage but worse OARs sparing compared to those with smaller one. Conclusion: IMRT has dosimetrical advantages over the other two techniques in PMRMRT for left-sided breast cancer. Individually quantifying and minimizing CTV displacement can significantly improve dosage distribution. This work was supported by the Medical Scientific Research Foundation of Guangdong Procvince (A2014455 to Changchun Ma)« less

Estimation of Risk of Normal-tissue Toxicity Following Gastric Cancer Radiotherapy with Photon- or Scanned Proton-beams.

PubMed

Mondlane, Gracinda; Ureba, Ana; Gubanski, Michael; Lind, Pehr A; Siegbahn, Albert

2018-05-01

Gastric cancer (GC) radiotherapy involves irradiation of large tumour volumes located in the proximities of critical structures. The advantageous dose distributions produced by scanned-proton beams could reduce the irradiated volumes of the organs at risk (OARs). However, treatment-induced side-effects may still appear. The aim of this study was to estimate the normal tissue complication probability (NTCP) following proton therapy of GC, compared to photon radiotherapy. Eight GC patients, previously treated with volumetric-modulated arc therapy (VMAT), were retrospectively planned with scanned proton beams carried out with the single-field uniform-dose (SFUD) method. A beam-specific planning target volume was used for spot positioning and a clinical target volume (CTV) based robust optimisation was performed considering setup- and range-uncertainties. The dosimetric and NTCP values obtained with the VMAT and SFUD plans were compared. With SFUD, lower or similar dose-volume values were obtained for OARs, compared to VMAT. NTCP values of 0% were determined with the VMAT and SFUD plans for all OARs (p>0.05), except for the left kidney (p<0.05), for which lower toxicity was estimated with SFUD. The NTCP reduction, determined for the left kidney with SFUD, can be of clinical relevance for preserving renal function after radiotherapy of GC. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Modulation indices for volumetric modulated arc therapy.

PubMed

Park, Jong Min; Park, So-Yeon; Kim, Hyoungnyoun; Kim, Jin Ho; Carlson, Joel; Ye, Sung-Joon

2014-12-07

The aim of this study is to present a modulation index (MI) for volumetric modulated arc therapy (VMAT) based on the speed and acceleration analysis of modulating-parameters such as multi-leaf collimator (MLC) movements, gantry rotation and dose-rate, comprehensively. The performance of the presented MI (MIt) was evaluated with correlation analyses to the pre-treatment quality assurance (QA) results, differences in modulating-parameters between VMAT plans versus dynamic log files, and differences in dose-volumetric parameters between VMAT plans versus reconstructed plans using dynamic log files. For comparison, the same correlation analyses were performed for the previously suggested modulation complexity score (MCS(v)), leaf travel modulation complexity score (LTMCS) and MI by Li and Xing (MI Li&Xing). In the two-tailed unpaired parameter condition, p values were acquired. The Spearman's rho (r(s)) values of MIt, MCSv, LTMCS and MI Li&Xing to the local gamma passing rate with 2%/2 mm criterion were -0.658 (p < 0.001), 0.186 (p = 0.251), 0.312 (p = 0.05) and -0.455 (p = 0.003), respectively. The values of rs to the modulating-parameter (MLC positions) differences were 0.917, -0.635, -0.857 and 0.795, respectively (p < 0.001). For dose-volumetric parameters, MIt showed higher statistically significant correlations than the conventional MIs. The MIt showed good performance for the evaluation of the modulation-degree of VMAT plans.

Impact of database quality in knowledge-based treatment planning for prostate cancer.

PubMed

Wall, Phillip D H; Carver, Robert L; Fontenot, Jonas D

2018-03-13

This article investigates dose-volume prediction improvements in a common knowledge-based planning (KBP) method using a Pareto plan database compared with using a conventional, clinical plan database. Two plan databases were created using retrospective, anonymized data of 124 volumetric modulated arc therapy (VMAT) prostate cancer patients. The clinical plan database (CPD) contained planning data from each patient's clinically treated VMAT plan, which were manually optimized by various planners. The multicriteria optimization database (MCOD) contained Pareto-optimal plan data from VMAT plans created using a standardized multicriteria optimization protocol. Overlap volume histograms, incorporating fractional organ at risk volumes only within the treatment fields, were computed for each patient and used to match new patient anatomy to similar database patients. For each database patient, CPD and MCOD KBP predictions were generated for D 10 , D 30 , D 50 , D 65 , and D 80 of the bladder and rectum in a leave-one-out manner. Prediction achievability was evaluated through a replanning study on a subset of 31 randomly selected database patients using the best KBP predictions, regardless of plan database origin, as planning goals. MCOD predictions were significantly lower than CPD predictions for all 5 bladder dose-volumes and rectum D 50 (P = .004) and D 65 (P < .001), whereas CPD predictions for rectum D 10 (P = .005) and D 30 (P < .001) were significantly less than MCOD predictions. KBP predictions were statistically achievable in the replans for all predicted dose-volumes, excluding D 10 of bladder (P = .03) and rectum (P = .04). Compared with clinical plans, replans showed significant average reductions in D mean for bladder (7.8 Gy; P < .001) and rectum (9.4 Gy; P < .001), while maintaining statistically similar planning target volume, femoral head, and penile bulb dose. KBP dose-volume predictions derived from Pareto plans were more optimal overall than those resulting from manually optimized clinical plans, which significantly improved KBP-assisted plan quality. This work investigates how the plan quality of knowledge databases affects the performance and achievability of dose-volume predictions from a common knowledge-based planning approach for prostate cancer. Bladder and rectum dose-volume predictions derived from a database of standardized Pareto-optimal plans were compared with those derived from clinical plans manually designed by various planners. Dose-volume predictions from the Pareto plan database were significantly lower overall than those from the clinical plan database, without compromising achievability. Copyright © 2018 Elsevier Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jeong, K; Basavatia, A; Mynampati, D

Purpose: To compare VMAT SRS plans, dynamic conformal arc (DCA) plans, and Brainlab iPlan’s capability of planning and delivering brain SRS plans by employing HybridArc. HybridArc utilizes both DCA and IMRT. Using HybridArc, the amount of DCA versus IMRT needs to be optimized. Methods: Four SRS patients with the aim of reducing brainstem dose were selected for this study. All patients were contoured in iPlan and transferred to Eclipse for VMAT planning. In iPlan, DCA plans were created for each case. Moreover, nine HybridArc plans with DCA-IMRT ratios between 9:1 through 1:9 were created with a single ring structure generatedmore » by subtracting 3 mm expansion of target from a 10 mm expansion of the target. Two static IMRT beams were used in each of the five DCA arcs for HybridArc. The dose was prescribed to DCA only and HybridArc plans and normalized so that the target volume (TV) receives 100% dose to 99.5% of the TV to achieve 120% ∼ 130% max dose within targets. Following metrics were compared: PITV, V12Gy, CGIc, CGIg, CGI, brainstem max dose, and total monitor units (MUs). Results: A brainstem max dose comparable with VMAT from 30% IMRT and less with 50% or more IMRT could be achieved. PITV decreased with increasing IMRT portion and begins to saturate past an IMRT portion of 30%. The CGIg index, which represents how fast the dose falls off, was better with HybridArc in all HybridArc plans. Total MUs increased with increasing IMRT but less than VMAT in all cases. Conclusion: Overall, a lower brainstem max dose and a lower V12Gy with fewer MUs can be achieved with HybridArc. Considering all factors, it would be best to use a DCA-IMRT ratio of either 7:3 or 6:4.« less

A retrospective analysis for patient-specific quality assurance of volumetric-modulated arc therapy plans.

PubMed

Li, Guangjun; Wu, Kui; Peng, Guang; Zhang, Yingjie; Bai, Sen

2014-01-01

Volumetric-modulated arc therapy (VMAT) is now widely used clinically, as it is capable of delivering a highly conformal dose distribution in a short time interval. We retrospectively analyzed patient-specific quality assurance (QA) of VMAT and examined the relationships between the planning parameters and the QA results. A total of 118 clinical VMAT cases underwent pretreatment QA. All plans had 3-dimensional diode array measurements, and 69 also had ion chamber measurements. Dose distribution and isocenter point dose were evaluated by comparing the measurements and the treatment planning system (TPS) calculations. In addition, the relationship between QA results and several planning parameters, such as dose level, control points (CPs), monitor units (MUs), average field width, and average leaf travel, were also analyzed. For delivered dose distribution, a gamma analysis passing rate greater than 90% was obtained for all plans and greater than 95% for 100 of 118 plans with the 3%/3-mm criteria. The difference (mean ± standard deviation) between the point doses measured by the ion chamber and those calculated by TPS was 0.9% ± 2.0% for all plans. For all cancer sites, nasopharyngeal carcinoma and gastric cancer have the lowest and highest average passing rates, respectively. From multivariate linear regression analysis, the dose level (p = 0.001) and the average leaf travel (p < 0.001) showed negative correlations with the passing rate, and the average field width (p = 0.003) showed a positive correlation with the passing rate, all indicating a correlation between the passing rate and the plan complexity. No statistically significant correlation was found between MU or CP and the passing rate. Analysis of the results of dosimetric pretreatment measurements as a function of VMAT plan parameters can provide important information to guide the plan parameter setting and optimization in TPS. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

A retrospective analysis for patient-specific quality assurance of volumetric-modulated arc therapy plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Guangjun; Wu, Kui; Peng, Guang

2014-01-01

Volumetric-modulated arc therapy (VMAT) is now widely used clinically, as it is capable of delivering a highly conformal dose distribution in a short time interval. We retrospectively analyzed patient-specific quality assurance (QA) of VMAT and examined the relationships between the planning parameters and the QA results. A total of 118 clinical VMAT cases underwent pretreatment QA. All plans had 3-dimensional diode array measurements, and 69 also had ion chamber measurements. Dose distribution and isocenter point dose were evaluated by comparing the measurements and the treatment planning system (TPS) calculations. In addition, the relationship between QA results and several planning parameters,more » such as dose level, control points (CPs), monitor units (MUs), average field width, and average leaf travel, were also analyzed. For delivered dose distribution, a gamma analysis passing rate greater than 90% was obtained for all plans and greater than 95% for 100 of 118 plans with the 3%/3-mm criteria. The difference (mean ± standard deviation) between the point doses measured by the ion chamber and those calculated by TPS was 0.9% ± 2.0% for all plans. For all cancer sites, nasopharyngeal carcinoma and gastric cancer have the lowest and highest average passing rates, respectively. From multivariate linear regression analysis, the dose level (p = 0.001) and the average leaf travel (p < 0.001) showed negative correlations with the passing rate, and the average field width (p = 0.003) showed a positive correlation with the passing rate, all indicating a correlation between the passing rate and the plan complexity. No statistically significant correlation was found between MU or CP and the passing rate. Analysis of the results of dosimetric pretreatment measurements as a function of VMAT plan parameters can provide important information to guide the plan parameter setting and optimization in TPS.« less

SU-F-T-377: Monte Carlo Re-Evaluation of Volumetric-Modulated Arc Plans of Advanced Stage Nasopharygeal Cancers Optimized with Convolution-Superposition Algorithm

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, K; Leung, R; Law, G

Background: Commercial treatment planning system Pinnacle3 (Philips, Fitchburg, WI, USA) employs a convolution-superposition algorithm for volumetric-modulated arc radiotherapy (VMAT) optimization and dose calculation. Study of Monte Carlo (MC) dose recalculation of VMAT plans for advanced-stage nasopharyngeal cancers (NPC) is currently limited. Methods: Twenty-nine VMAT prescribed 70Gy, 60Gy, and 54Gy to the planning target volumes (PTVs) were included. These clinical plans achieved with a CS dose engine on Pinnacle3 v9.0 were recalculated by the Monaco TPS v5.0 (Elekta, Maryland Heights, MO, USA) with a XVMC-based MC dose engine. The MC virtual source model was built using the same measurement beam datasetmore » as for the Pinnacle beam model. All MC recalculation were based on absorbed dose to medium in medium (Dm,m). Differences in dose constraint parameters per our institution protocol (Supplementary Table 1) were analyzed. Results: Only differences in maximum dose to left brachial plexus, left temporal lobe and PTV54Gy were found to be statistically insignificant (p> 0.05). Dosimetric differences of other tumor targets and normal organs are found in supplementary Table 1. Generally, doses outside the PTV in the normal organs are lower with MC than with CS. This is also true in the PTV54-70Gy doses but higher dose in the nasal cavity near the bone interfaces is consistently predicted by MC, possibly due to the increased backscattering of short-range scattered photons and the secondary electrons that is not properly modeled by the CS. The straight shoulders of the PTV dose volume histograms (DVH) initially resulted from the CS optimization are merely preserved after MC recalculation. Conclusion: Significant dosimetric differences in VMAT NPC plans were observed between CS and MC calculations. Adjustments of the planning dose constraints to incorporate the physics differences from conventional CS algorithm should be made when VMAT optimization is carried out directly with MC dose engine.« less

SU-F-T-563: Delivered Dose Reconstruction of Moving Targets for Gated Volumetric Modulated Arc Therapy (VMAT)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chung, H; Cho, S; Jeong, C

2016-06-15

Purpose: Actual delivered dose of moving tumors treated with gated volumetric arc therapy (VMAT) may significantly differ from the planned dose assuming static target. In this study, we developed a method which reconstructs actual delivered dose distribution of moving target by taking into account both tumor motion and dynamic beam delivery of gated VMAT, and applied to abdominal tumors. Methods: Fifteen dual-arc VMAT plans (Eclipse, Varian Medical Systems) for 5 lung, 5 pancreatic, and 5 liver cancer patients treated with gated VMAT stereotactic body radiotherapy (SBRT) were studied. For reconstruction of the delivered dose distribution, we divided each original arcmore » beam into control-point-wise sub-beams, and applied beam isocenter shifting to each sub-beam to reflect the tumor motion. The tumor positions as a function of beam delivery were estimated by synchronizing the beam delivery with the respiratory signal which acquired during treatment. For this purpose, an in-house program (MATLAB, Mathworks) was developed to convert the original DICOM plan data into motion-involved treatment plan. The motion-involved DICOM plan was imported into Eclipse for dose calculation. The reconstructed delivered dose was compared to the plan dose using the dose coverage of gross tumor volume (GTV) and dose distribution of organs at risk (OAR). Results: The mean GTV dose coverage difference between the reconstructed delivered dose and the plan dose was 0.2 % in lung and pancreas cases, and no difference in liver cases. Mean D1000cc of ipsilateral lungs was reduced (0.8 ± 1.4cGy). Conclusion: We successfully developed a method of delivered dose reconstruction taking into account both respiratory tumor motion and dynamic beam delivery, and applied it to abdominal tumors treated with gated VAMT. No significant deterioration of delivered dose distribution indicates that interplay effect would be minimal even in the case of gated SBRT. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. 2015038710)« less

Prostate volumetric‐modulated arc therapy: dosimetry and radiobiological model variation between the single‐arc and double‐arc technique

PubMed Central

Jiang, Runqing

2013-01-01

This study investigates the dosimetry and radiobiological model variation when a second photon arc was added to prostate volumetric‐modulated arc therapy (VMAT) using the single‐arc technique. Dosimetry and radiobiological model comparison between the single‐arc and double‐arc prostate VMAT plans were performed on five patients with prostate volumes ranging from 29−68.1 cm3. The prescription dose was 78 Gy/39 fractions and the photon beam energy was 6 MV. Dose‐volume histogram, mean and maximum dose of targets (planning and clinical target volume) and normal tissues (rectum, bladder and femoral heads), dose‐volume criteria in the treatment plan (D99% of PTV; D30%,D50%,V17Gy and V35Gy of rectum and bladder; D5% of femoral heads), and dose profiles along the vertical and horizontal axis crossing the isocenter were determined using the single‐arc and double‐arc VMAT technique. For comparison, the monitor unit based on the RapidArc delivery method, prostate tumor control probability (TCP), and rectal normal tissue complication probability (NTCP) based on the Lyman‐Burman‐Kutcher algorithm were calculated. It was found that though the double‐arc technique required almost double the treatment time than the single‐arc, the double‐arc plan provided a better rectal and bladder dose‐volume criteria by shifting the delivered dose in the patient from the anterior–posterior direction to the lateral. As the femoral head was less radiosensitive than the rectum and bladder, the double‐arc technique resulted in a prostate VMAT plan with better prostate coverage and rectal dose‐volume criteria compared to the single‐arc. The prostate TCP of the double‐arc plan was found slightly increased (0.16%) compared to the single‐arc. Therefore, when the rectal dose‐volume criteria are very difficult to achieve in a single‐arc prostate VMAT plan, it is worthwhile to consider the double‐arc technique. PACS number: 87.55.D‐, 87.55.dk, 87.55.K‐, 87.55.Qr

Comparing photon and proton-based hypofractioned SBRT for prostate cancer accounting for robustness and realistic treatment deliverability.

PubMed

Goddard, Lee C; Brodin, N Patrik; Bodner, William R; Garg, Madhur K; Tomé, Wolfgang A

2018-05-01

To investigate whether photon or proton-based stereotactic body radiation therapy (SBRT is the preferred modality for high dose hypofractionation prostate cancer treatment. Achievable dose distributions were compared when uncertainties in target positioning and range uncertainties were appropriately accounted for. 10 patients with prostate cancer previously treated at our institution (Montefiore Medical Center) with photon SBRT using volumetric modulated arc therapy (VMAT) were identified. MRI images fused to the treatment planning CT allowed for accurate target and organ at risk (OAR) delineation. The clinical target volume was defined as the prostate gland plus the proximal seminal vesicles. Critical OARs include the bladder wall, bowel, femoral heads, neurovascular bundle, penile bulb, rectal wall, urethra and urogenital diaphragm. Photon plan robustness was evaluated by simulating 2 mm isotropic setup variations. Comparative proton SBRT plans employing intensity modulated proton therapy (IMPT) were generated using robust optimization. Plan robustness was evaluated by simulating 2 mm setup variations and 3% or 1% Hounsfield unit (HU) calibration uncertainties. Comparable maximum OAR doses are achievable between photon and proton SBRT, however, robust optimization results in higher maximum doses for proton SBRT. Rectal maximum doses are significantly higher for Robust proton SBRT with 1% HU uncertainty compared to photon SBRT (p = 0.03), whereas maximum doses were comparable for bladder wall (p = 0.43), urethra (p = 0.82) and urogenital diaphragm (p = 0.50). Mean doses to bladder and rectal wall are lower for proton SBRT, but higher for neurovascular bundle, urethra and urogenital diaphragm due to increased lateral scatter. Similar target conformality is achieved, albeit with slightly larger treated volume ratios for proton SBRT, >1.4 compared to 1.2 for photon SBRT. Similar treatment plans can be generated with IMPT compared to VMAT in terms of target coverage, target conformality, and OAR sparing when range and HU uncertainties are neglected. However, when accounting for these uncertainties during robust optimization, VMAT outperforms IMPT in terms of achievable target conformity and OAR sparing. Advances in knowledge: Comparison between achievable dose distributions using modern, robust optimization of IMPT for high dose per fraction SBRT regimens for the prostate has not been previously investigated.

Motion induced interplay effects for VMAT radiotherapy.

PubMed

Edvardsson, Anneli; Nordström, Fredrik; Ceberg, Crister; Ceberg, Sofie

2018-04-19

The purpose of this study was to develop a method to simulate breathing motion induced interplay effects for volumetric modulated arc therapy (VMAT), to verify the proposed method with measurements, and to use the method to investigate how interplay effects vary with different patient- and machine specific parameters. VMAT treatment plans were created on a virtual phantom in a treatment planning system (TPS). Interplay effects were simulated by dividing each plan into smaller sub-arcs using an in-house developed software and shifting the isocenter for each sub-arc to simulate a sin 6 breathing motion in the superior-inferior direction. The simulations were performed for both flattening-filter (FF) and flattening-filter free (FFF) plans and for different breathing amplitudes, period times, initial breathing phases, dose levels, plan complexities, CTV sizes, and collimator angles. The resulting sub-arcs were calculated in the TPS, generating a dose distribution including the effects of motion. The interplay effects were separated from dose blurring and the relative dose differences to 2% and 98% of the CTV volume (ΔD 98% and ΔD 2% ) were calculated. To verify the simulation method, measurements were carried out, both static and during motion, using a quasi-3D phantom and a motion platform. The results of the verification measurements during motion were comparable to the results of the static measurements. Considerable interplay effects were observed for individual fractions, with the minimum ΔD 98% and maximum ΔD 2% being  -16.7% and 16.2%, respectively. The extent of interplay effects was larger for FFF compared to FF and generally increased for higher breathing amplitudes, larger period times, lower dose levels, and more complex treatment plans. Also, the interplay effects varied considerably with the initial breathing phase, and larger variations were observed for smaller CTV sizes. In conclusion, a method to simulate motion induced interplay effects was developed and verified with measurements, which allowed for a large number of treatment scenarios to be investigated. The simulations showed large interplay effects for individual fractions and that the extent of interplay effects varied with the breathing pattern, FFF/FF, dose level, CTV size, collimator angle, and the complexity of the treatment plan.

Comparison of the progressive resolution optimizer and photon optimizer in VMAT optimization for stereotactic treatments.

PubMed

Liu, Han; Sintay, Benjamin; Pearman, Keith; Shang, Qingyang; Hayes, Lane; Maurer, Jacqueline; Vanderstraeten, Caroline; Wiant, David

2018-05-20

The photon optimization (PO) algorithm was recently released by Varian Medical Systems to improve volumetric modulated arc therapy (VMAT) optimization within Eclipse (Version 13.5). The purpose of this study is to compare the PO algorithm with its predecessor, progressive resolution optimizer (PRO) for lung SBRT and brain SRS treatments. A total of 30 patients were selected retrospectively. Previously, all the plans were generated with the PRO algorithm within Eclipse Version 13.6. In the new version of PO algorithm (Version 15), dynamic conformal arcs (DCA) were first conformed to the target, then VMAT inverse planning was performed to achieve the desired dose distributions. PTV coverages were forced to be identical for the same patient for a fair comparison. SBRT plan quality was assessed based on selected dose-volume parameters, including the conformity index, V 20 for lung, V 30 Gy for chest wall, and D 0.035 cc for other critical organs. SRS plan quality was evaluated based on the conformity index and normal tissue volumes encompassed by the 12 and 6 Gy isodose lines (V 12 and V 6 ). The modulation complexity score (MCS) was used to compare plan complexity of two algorithms. No statistically significant differences between the PRO and PO algorithms were found for any of the dosimetric parameters studied, which indicates both algorithms produce comparable plan quality. Significant improvements in the gamma passing rate (increased from 97.0% to 99.2% for SBRT and 96.1% to 98.4% for SRS), MCS (average increase of 0.15 for SBRT and 0.10 for SRS), and delivery efficiency (MU reduction of 29.8% for SBRT and 28.3% for SRS) were found for the PO algorithm. MCS showed a strong correlation with the gamma passing rate, and an inverse correlation with total MUs used. The PO algorithm offers comparable plan quality to the PRO, while minimizing MLC complexity, thereby improving the delivery efficiency and accuracy. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Motion induced interplay effects for VMAT radiotherapy

NASA Astrophysics Data System (ADS)

Edvardsson, Anneli; Nordström, Fredrik; Ceberg, Crister; Ceberg, Sofie

2018-04-01

The purpose of this study was to develop a method to simulate breathing motion induced interplay effects for volumetric modulated arc therapy (VMAT), to verify the proposed method with measurements, and to use the method to investigate how interplay effects vary with different patient- and machine specific parameters. VMAT treatment plans were created on a virtual phantom in a treatment planning system (TPS). Interplay effects were simulated by dividing each plan into smaller sub-arcs using an in-house developed software and shifting the isocenter for each sub-arc to simulate a sin6 breathing motion in the superior–inferior direction. The simulations were performed for both flattening-filter (FF) and flattening-filter free (FFF) plans and for different breathing amplitudes, period times, initial breathing phases, dose levels, plan complexities, CTV sizes, and collimator angles. The resulting sub-arcs were calculated in the TPS, generating a dose distribution including the effects of motion. The interplay effects were separated from dose blurring and the relative dose differences to 2% and 98% of the CTV volume (ΔD98% and ΔD2%) were calculated. To verify the simulation method, measurements were carried out, both static and during motion, using a quasi-3D phantom and a motion platform. The results of the verification measurements during motion were comparable to the results of the static measurements. Considerable interplay effects were observed for individual fractions, with the minimum ΔD98% and maximum ΔD2% being  ‑16.7% and 16.2%, respectively. The extent of interplay effects was larger for FFF compared to FF and generally increased for higher breathing amplitudes, larger period times, lower dose levels, and more complex treatment plans. Also, the interplay effects varied considerably with the initial breathing phase, and larger variations were observed for smaller CTV sizes. In conclusion, a method to simulate motion induced interplay effects was developed and verified with measurements, which allowed for a large number of treatment scenarios to be investigated. The simulations showed large interplay effects for individual fractions and that the extent of interplay effects varied with the breathing pattern, FFF/FF, dose level, CTV size, collimator angle, and the complexity of the treatment plan.

SU-F-T-273: Using a Diode Array to Explore the Weakness of TPS DoseCalculation Algorithm for VMAT and Sliding Window Techniques

DOE Office of Scientific and Technical Information (OSTI.GOV)

Park, J; Lu, B; Yan, G

Purpose: To identify the weakness of dose calculation algorithm in a treatment planning system for volumetric modulated arc therapy (VMAT) and sliding window (SW) techniques using a two-dimensional diode array. Methods: The VMAT quality assurance(QA) was implemented with a diode array using multiple partial arcs that divided from a VMAT plan; each partial arc has the same segments and the original monitor units. Arc angles were less than ± 30°. Multiple arcs delivered through consecutive and repetitive gantry operating clockwise and counterclockwise. The source-toaxis distance setup with the effective depths of 10 and 20 cm were used for a diodemore » array. To figure out dose errors caused in delivery of VMAT fields, the numerous fields having the same segments with the VMAT field irradiated using different delivery techniques of static and step-and-shoot. The dose distributions of the SW technique were evaluated by creating split fields having fine moving steps of multi-leaf collimator leaves. Calculated doses using the adaptive convolution algorithm were analyzed with measured ones with distance-to-agreement and dose difference of 3 mm and 3%.. Results: While the beam delivery through static and step-and-shoot techniques showed the passing rate of 97 ± 2%, partial arc delivery of the VMAT fields brought out passing rate of 85%. However, when leaf motion was restricted less than 4.6 mm/°, passing rate was improved up to 95 ± 2%. Similar passing rate were obtained for both 10 and 20 cm effective depth setup. The calculated doses using the SW technique showed the dose difference over 7% at the final arrival point of moving leaves. Conclusion: Error components in dynamic delivery of modulated beams were distinguished by using the suggested QA method. This partial arc method can be used for routine VMAT QA. Improved SW calculation algorithm is required to provide accurate estimated doses.« less

Under conditions of large geometric miss, tumor control probability can be higher for static gantry intensity-modulated radiation therapy compared to volume-modulated arc therapy for prostate cancer.

PubMed

Balderson, Michael; Brown, Derek; Johnson, Patricia; Kirkby, Charles

2016-01-01

The purpose of this work was to compare static gantry intensity-modulated radiation therapy (IMRT) with volume-modulated arc therapy (VMAT) in terms of tumor control probability (TCP) under scenarios involving large geometric misses, i.e., those beyond what are accounted for when margin expansion is determined. Using a planning approach typical for these treatments, a linear-quadratic-based model for TCP was used to compare mean TCP values for a population of patients who experiences a geometric miss (i.e., systematic and random shifts of the clinical target volume within the planning target dose distribution). A Monte Carlo approach was used to account for the different biological sensitivities of a population of patients. Interestingly, for errors consisting of coplanar systematic target volume offsets and three-dimensional random offsets, static gantry IMRT appears to offer an advantage over VMAT in that larger shift errors are tolerated for the same mean TCP. For example, under the conditions simulated, erroneous systematic shifts of 15mm directly between or directly into static gantry IMRT fields result in mean TCP values between 96% and 98%, whereas the same errors on VMAT plans result in mean TCP values between 45% and 74%. Random geometric shifts of the target volume were characterized using normal distributions in each Cartesian dimension. When the standard deviations were doubled from those values assumed in the derivation of the treatment margins, our model showed a 7% drop in mean TCP for the static gantry IMRT plans but a 20% drop in TCP for the VMAT plans. Although adding a margin for error to a clinical target volume is perhaps the best approach to account for expected geometric misses, this work suggests that static gantry IMRT may offer a treatment that is more tolerant to geometric miss errors than VMAT. Copyright © 2016 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

SU-E-J-164: Estimation of DVH Variation for PTV Due to Interfraction Organ Motion in Prostate VMAT Using Gaussian Error Function

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lewis, C; Jiang, R; Chow, J

2015-06-15

Purpose: We developed a method to predict the change of DVH for PTV due to interfraction organ motion in prostate VMAT without repeating the CT scan and treatment planning. The method is based on a pre-calculated patient database with DVH curves of PTV modelled by the Gaussian error function (GEF). Methods: For a group of 30 patients with different prostate sizes, their VMAT plans were recalculated by shifting their PTVs 1 cm with 10 increments in the anterior-posterior, left-right and superior-inferior directions. The DVH curve of PTV in each replan was then fitted by the GEF to determine parameters describingmore » the shape of curve. Information of parameters, varying with the DVH change due to prostate motion for different prostate sizes, was analyzed and stored in a database of a program written by MATLAB. Results: To predict a new DVH for PTV due to prostate interfraction motion, prostate size and shift distance with direction were input to the program. Parameters modelling the DVH for PTV were determined based on the pre-calculated patient dataset. From the new parameters, DVH curves of PTVs with and without considering the prostate motion were plotted for comparison. The program was verified with different prostate cases involving interfraction prostate shifts and replans. Conclusion: Variation of DVH for PTV in prostate VMAT can be predicted using a pre-calculated patient database with DVH curve fitting. The computing time is fast because CT rescan and replan are not required. This quick DVH estimation can help radiation staff to determine if the changed PTV coverage due to prostate shift is tolerable in the treatment. However, it should be noted that the program can only consider prostate interfraction motions along three axes, and is restricted to prostate VMAT plan using the same plan script in the treatment planning system.« less

Quantification of residual dose estimation error on log file-based patient dose calculation.

PubMed

Katsuta, Yoshiyuki; Kadoya, Noriyuki; Fujita, Yukio; Shimizu, Eiji; Matsunaga, Kenichi; Matsushita, Haruo; Majima, Kazuhiro; Jingu, Keiichi

2016-05-01

The log file-based patient dose estimation includes a residual dose estimation error caused by leaf miscalibration, which cannot be reflected on the estimated dose. The purpose of this study is to determine this residual dose estimation error. Modified log files for seven head-and-neck and prostate volumetric modulated arc therapy (VMAT) plans simulating leaf miscalibration were generated by shifting both leaf banks (systematic leaf gap errors: ±2.0, ±1.0, and ±0.5mm in opposite directions and systematic leaf shifts: ±1.0mm in the same direction) using MATLAB-based (MathWorks, Natick, MA) in-house software. The generated modified and non-modified log files were imported back into the treatment planning system and recalculated. Subsequently, the generalized equivalent uniform dose (gEUD) was quantified for the definition of the planning target volume (PTV) and organs at risks. For MLC leaves calibrated within ±0.5mm, the quantified residual dose estimation errors that obtained from the slope of the linear regression of gEUD changes between non- and modified log file doses per leaf gap are in head-and-neck plans 1.32±0.27% and 0.82±0.17Gy for PTV and spinal cord, respectively, and in prostate plans 1.22±0.36%, 0.95±0.14Gy, and 0.45±0.08Gy for PTV, rectum, and bladder, respectively. In this work, we determine the residual dose estimation errors for VMAT delivery using the log file-based patient dose calculation according to the MLC calibration accuracy. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Poster — Thur Eve — 31: Dosimetric Effect of Respiratory Motion on RapidArc Lung SBRT Treatment Delivered by TrueBeam Linear Accelerator

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jiang, Runqing; Zhan, Lixin; Osei, Ernest

2014-08-15

Volumetric modulated arc therapy (VMAT) allows fast delivery of stereotactic radiotherapy. However, the discrepancies between the calculated and delivered dose distributions due to respiratory motion and dynamic multileaf collimators (MLCs) interplay are not avoidable. The purpose of this study is to investigate RapidArc lung SBRT treatment delivered by the flattening filter-free (FFF) beam and flattened beam with Varian TrueBeam machine. CIRS Dynamic Thorax Phantom with in-house made lung tumor insertion was CT scanned both in free breathing and 4DCT. 4DCT was used to determine the internal target volume. The free breathing CT scan was used for treatment planning. A 5more » mm margin was given to ITV to generate a planning target volume. Varian Eclipse treatment planning was used to generate RapidArc plans based on the 6 MV flattened beam and 6MV FFF beam. The prescription dose was 48 Gy in 4 fractions. At least 95% of PTV was covered by the prescribed dose. The RapidArc plans with 6 MV flattened beam and 6MV FFF beam were delivered with Varian TrueBeam machine. The dosimetric measurements were performed with Gafchromic XR-RV3 film, which was placed in the lung tumor insertion. The interplay between the dynamic MLC-based delivery of VMAT and the respiratory motion of the tumor degraded target coverage and created undesired hot or cold dose spots inside the lung tumor. Lung SBRT RapidArc treatments delivered by the FFF beam of TrueBeam linear accelerator is superior to the flattened beam. Further investigation will be performed by Monte Carlo simulation.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Katsuta, Y; Tohoku University Graduate School of Medicine, Sendal, Miyagi; Kadoya, N

Purpose: In this study, we developed a system to calculate three dimensional (3D) dose that reflects dosimetric error caused by leaf miscalibration for head and neck and prostate volumetric modulated arc therapy (VMAT) without additional treatment planning system calculation on real time. Methods: An original system called clarkson dose calculation based dosimetric error calculation to calculate dosimetric error caused by leaf miscalibration was developed by MATLAB (Math Works, Natick, MA). Our program, first, calculates point doses at isocenter for baseline and modified VMAT plan, which generated by inducing MLC errors that enlarged aperture size of 1.0 mm with clarkson dosemore » calculation. Second, error incuced 3D dose was generated with transforming TPS baseline 3D dose using calculated point doses. Results: Mean computing time was less than 5 seconds. For seven head and neck and prostate plans, between our method and TPS calculated error incuced 3D dose, the 3D gamma passing rates (0.5%/2 mm, global) are 97.6±0.6% and 98.0±0.4%. The dose percentage change with dose volume histogram parameter of mean dose on target volume were 0.1±0.5% and 0.4±0.3%, and with generalized equivalent uniform dose on target volume were −0.2±0.5% and 0.2±0.3%. Conclusion: The erroneous 3D dose calculated by our method is useful to check dosimetric error caused by leaf miscalibration before pre treatment patient QA dosimetry checks.« less

SU-F-T-520: Dosimetric Comparison of Radiation Treatment Plans for Whole Breast Irradiation Between 3D Conformal in Prone and Supine Positions Vs. VMAT and IMRT in Supine Positions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bejarano Buele, A; Parsai, E

Purpose: The target volume for Whole Breast Irradiation (WBI) is dictated by location of tumor mass, breast tissue distribution, and involvement of lymph nodes. Dose coverage and Organs at Risk (OARs) sparing can be difficult to achieve in patients with unfavorable thoracic geometries. For these cases, inverse-planned and 3D-conformal prone treatments can be alternatives to traditional supine 3D-conformal plans. A dosimetric comparison can determine which of these techniques achieve optimal target coverage while sparing OARs. Methods: This study included simulation datasets for 8 patients, 5 of whom were simulated in both supine and prone positions. Positioning devices included breast boardsmore » and Vaclok bags for the supine position, and prone breast boards for the prone position. WBI 3-D conformal plans were created for patients simulated in both positions. Additional VMAT and IMRT WBI plans were made for all patients in the supine position. Results: Prone and supine 3D conformal plans had comparable PTV coverage. Prone 3D conformal plans received a significant 50% decrease to V20, V10, V5 and V30% for the ipsilateral lung in contrast to the supine plans. The heart also experienced a 10% decrease in maximum dose in the prone position, and V20, V10, V5 and V2 had significantly lower values than the supine plan. Supine IMRT and VMAT breast plans obtained comparable PTV coverage. The heart experienced a 10% decrease in maximum dose with inverse modulated plans when compared to the supine 3D conformal plan, while V20, V10, V5 and V2 showed higher values with inverse modulated plans than with supine 3D conformal plans. Conclusion: Prone 3D-conformal, and supine inverse planned treatments were generally superior in sparing OARs to supine plans with comparable PTV coverage. IMRT and VMAT plans offer sparing of OARs from high dose regions with an increase of irradiated volume in the low dose regions.« less

Volumetric-modulated arc therapy for the treatment of a large planning target volume in thoracic esophageal cancer.

PubMed

Abbas, Ahmar S; Moseley, Douglas; Kassam, Zahra; Kim, Sun Mo; Cho, Charles

2013-05-06

Recently, volumetric-modulated arc therapy (VMAT) has demonstrated the ability to deliver radiation dose precisely and accurately with a shorter delivery time compared to conventional intensity-modulated fixed-field treatment (IMRT). We applied the hypothesis of VMAT technique for the treatment of thoracic esophageal carcinoma to determine superior or equivalent conformal dose coverage for a large thoracic esophageal planning target volume (PTV) with superior or equivalent sparing of organs-at-risk (OARs) doses, and reduce delivery time and monitor units (MUs), in comparison with conventional fixed-field IMRT plans. We also analyzed and compared some other important metrics of treatment planning and treatment delivery for both IMRT and VMAT techniques. These metrics include: 1) the integral dose and the volume receiving intermediate dose levels between IMRT and VMATI plans; 2) the use of 4D CT to determine the internal motion margin; and 3) evaluating the dosimetry of every plan through patient-specific QA. These factors may impact the overall treatment plan quality and outcomes from the individual planning technique used. In this study, we also examined the significance of using two arcs vs. a single-arc VMAT technique for PTV coverage, OARs doses, monitor units and delivery time. Thirteen patients, stage T2-T3 N0-N1 (TNM AJCC 7th edn.), PTV volume median 395 cc (range 281-601 cc), median age 69 years (range 53 to 85), were treated from July 2010 to June 2011 with a four-field (n = 4) or five-field (n = 9) step-and-shoot IMRT technique using a 6 MV beam to a prescribed dose of 50 Gy in 20 to 25 F. These patients were retrospectively replanned using single arc (VMATI, 91 control points) and two arcs (VMATII, 182 control points). All treatment plans of the 13 study cases were evaluated using various dose-volume metrics. These included PTV D99, PTV D95, PTV V9547.5Gy(95%), PTV mean dose, Dmax, PTV dose conformity (Van't Riet conformation number (CN)), mean lung dose, lung V20 and V5, liver V30, and Dmax to the spinal canal prv3mm. Also examined were the total plan monitor units (MUs) and the beam delivery time. Equivalent target coverage was observed with both VMAT single and two-arc plans. The comparison of VMATI with fixed-field IMRT demonstrated equivalent target coverage; statistically no significant difference were found in PTV D99 (p = 0.47), PTV mean (p = 0.12), PTV D95 and PTV V9547.5Gy (95%) (p = 0.38). However, Dmax in VMATI plans was significantly lower compared to IMRT (p = 0.02). The Van't Riet dose conformation number (CN) was also statistically in favor of VMATI plans (p = 0.04). VMATI achieved lower lung V20 (p = 0.05), whereas lung V5 (p = 0.35) and mean lung dose (p = 0.62) were not significantly different. The other OARs, including spinal canal, liver, heart, and kidneys showed no statistically significant differences between the two techniques. Treatment time delivery for VMATI plans was reduced by up to 55% (p = 5.8E-10) and MUs reduced by up to 16% (p = 0.001). Integral dose was not statistically different between the two planning techniques (p = 0.99). There were no statistically significant differences found in dose distribution of the two VMAT techniques (VMATI vs. VMATII) Dose statistics for both VMAT techniques were: PTV D99 (p = 0.76), PTV D95 (p = 0.95), mean PTV dose (p = 0.78), conformation number (CN) (p = 0.26), and MUs (p = 0.1). However, the treatment delivery time for VMATII increased significantly by two-fold (p = 3.0E-11) compared to VMATI. VMAT-based treatment planning is safe and deliverable for patients with thoracic esophageal cancer with similar planning goals, when compared to standard IMRT. The key benefit for VMATI was the reduction in treatment delivery time and MUs, and improvement in dose conformality. In our study, we found no significant difference in VMATII over single-arc VMATI for PTV coverage or OARs doses. However, we observed significant increase in delivery time for VMATII compared to VMATI.

MO-F-CAMPUS-T-02: Optimizing Orientations of Hundreds of Intensity-Modulated Beams to Treat Multiple Brain Targets

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ma, L; Dong, P; Larson, D

Purpose: To investigate a new modulated beam orientation optimization (MBOO) approach maximizing treatment planning quality for the state-of-the-art flattening filter free (FFF) beam that has enabled rapid treatments of multiple brain targets. Methods: MBOO selects and optimizes a large number of intensity-modulated beams (400 or more) from all accessible beam angles surrounding a patient’s skull. The optimization algorithm was implemented on a standalone system that interfaced with the 3D Dicom images and structure sets. A standard published data set that consisted of 1 to 12 metastatic brain tumor combinations was selected for MBOO planning. The planning results from various coplanarmore » and non-coplanar configurations via MBOO were then compared with the results obtained from a clinical volume modulated arc therapy (VMAT) delivery system (Truebeam RapidArc, Varian Oncology). Results: When planning a few number of targets (n<4), MBOO produced results equivalent to non-coplanar multi-arc VMAT planning in terms of target volume coverage and normal tissue sparing. For example, the 12-Gy and 4-Gy normal brain volumes for the 3-target plans differed by less than 1 mL ( 3.0 mLvs 3.8 mL; and 35.2 mL vs 36.3 mL, respectively) for MBOO versus VMAT. However, when planning a larger number of targets (n≥4), MBOO significantly reduced the dose to the normal brain as compared to VMAT, though the target volume coverage was equivalent. For example, the 12-Gy and 4-Gy normal brain volumes for the 12-target plans were 10.8 mL vs. 18.0 mL and 217.9 mL vs. 390.0 mL, respectively for the non-coplanar MBOO versus the non-coplanar VMAT treatment plans, yielding a reduction in volume of more than 60% for the case. Conclusion: MBOO is a unique approach for maximizing normal tissue sparing when treating a large number (n≥4) of brain tumors with FFF linear accelerators. Dr Ma and Dr Sahgal are currently on the board of international society of stereotactic radiosurgery. Dr Sahgal has received support for educational presentations from Elekta company.« less

SU-F-T-338: Flattening Filter Free Photon Beams Can Achieve the Same Plan Quality as Conventional Flattened Beams for Prostate Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kolar, M; Szwedowski, R; Greskovich, J

Purpose: Some modern linear accelerators are equipped with one low energy flat beam and two flattening filter free (FFF) beams at high and low energies. The purpose of this study is to investigate whether the high energy FFF beam can produce the same plan quality as the conventional low energy flat beam, using a volumetric modulated arc (VMAT) technique for prostate patients. Methods: Ten prostate cancer patients were selected with a prescription of 78Gy. For each patient, three plans were created: (a) double arc flat 6MV plan used clinically; (b) double arc 10MV FFF plan; (c) single arc 10MV FFFmore » plan. Each plan was prescribed so that at least 95% of the PTV received the prescription dose. The following dosimetric endpoints were evaluated: volume receiving 78Gy (V78) of the CTV and PTV, PTV conformality index (CI, ratio of prescription isodose volume to the PTV volume), bladder volume receiving 70Gy (V70) and 60Gy (V60), rectum volume receiving 70Gy (V70) and 50Gy (V50), dose to 10cc of the rectum, and volume of both femoral heads receiving 50Gy (V50). Total monitor units for each plan were recorded. Results: No significant difference was found for all dosimetric endpoints between all plans (p>0.05). Compared to the 6MV plans, monitor units were higher with the double arc 10MV FFF plans and lower with the single arc 10MV FFF plans, 29% and 4% respectively. Conclusion: Both single arc and double arc 10MV FFF VMAT can achieve equivalent plan quality as 6MV flat beam double arc treatment plans. With the gantry speed restriction, a high dose rate of 2400MU/min may allow the optimizer to use more MUs than actually needed. Single arc 10MV FFF VMAT plans are a reasonable alternative to double arc 6MV flat beam VMAT plans.« less

Under-reported dosimetry errors due to interplay effects during VMAT dose delivery in extreme hypofractionated stereotactic radiotherapy.

PubMed

Gauer, Tobias; Sothmann, Thilo; Blanck, Oliver; Petersen, Cordula; Werner, René

2018-06-01

Radiotherapy of extracranial metastases changed from normofractioned 3D CRT to extreme hypofractionated stereotactic treatment using VMAT beam techniques. Random interaction between tumour motion and dynamically changing beam parameters might result in underdosage of the CTV even for an appropriately dimensioned ITV (interplay effect). This study presents a clinical scenario of extreme hypofractionated stereotactic treatment and analyses the impact of interplay effects on CTV dose coverage. For a thoracic/abdominal phantom with an integrated high-resolution detector array placed on a 4D motion platform, dual-arc treatment plans with homogenous target coverage were created using a common VMAT technique and delivered in a single fraction. CTV underdosage through interplay effects was investigated by comparing dose measurements with and without tumour motion during plan delivery. Our study agrees with previous works that pointed out insignificant interplay effects on target coverage for very regular tumour motion patterns like simple sinusoidal motion. However, we identified and illustrated scenarios that are likely to result in a clinically relevant CTV underdosage. For tumour motion with abnormal variability, target coverage quantified by the CTV area receiving more than 98% of the prescribed dose decreased to 78% compared to 100% at static dose measurement. This study is further proof of considerable influence of interplay effects on VMAT dose delivery in stereotactic radiotherapy. For selected conditions of an exemplary scenario, interplay effects and related motion-induced target underdosage primarily occurred in tumour motion pattern with increased motion variability and VMAT plan delivery using complex MLC dose modulation.

Three-dimensional radiochromic film dosimetry for volumetric modulated arc therapy using a spiral water phantom.

PubMed

Tanooka, Masao; Doi, Hiroshi; Miura, Hideharu; Inoue, Hiroyuki; Niwa, Yasue; Takada, Yasuhiro; Fujiwara, Masayuki; Sakai, Toshiyuki; Sakamoto, Kiyoshi; Kamikonya, Norihiko; Hirota, Shozo

2013-11-01

We validated 3D radiochromic film dosimetry for volumetric modulated arc therapy (VMAT) using a newly developed spiral water phantom. The phantom consists of a main body and an insert box, each of which has an acrylic wall thickness of 3 mm and is filled with water. The insert box includes a spiral film box used for dose-distribution measurement, and a film holder for positioning a radiochromic film. The film holder has two parallel walls whose facing inner surfaces are equipped with spiral grooves in a mirrored configuration. The film is inserted into the spiral grooves by its side edges and runs along them to be positioned on a spiral plane. Dose calculation was performed by applying clinical VMAT plans to the spiral water phantom using a commercial Monte Carlo-based treatment-planning system, Monaco, whereas dose was measured by delivering the VMAT beams to the phantom. The calculated dose distributions were resampled on the spiral plane, and the dose distributions recorded on the film were scanned. Comparisons between the calculated and measured dose distributions yielded an average gamma-index pass rate of 87.0% (range, 91.2-84.6%) in nine prostate VMAT plans under 3 mm/3% criteria with a dose-calculation grid size of 2 mm. The pass rates were increased beyond 90% (average, 91.1%; range, 90.1-92.0%) when the dose-calculation grid size was decreased to 1 mm. We have confirmed that 3D radiochromic film dosimetry using the spiral water phantom is a simple and cost-effective approach to VMAT dose verification.

SU-E-T-77: Comparison of 2D and 3D Gamma Analysis in Patient-Specific QA for Prostate VMAT Plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Clemente, F; Perez, C

2014-06-01

Purpose: Patient-specific QA procedures for IMRT and VMAT are traditionally performed by comparing TPS calculations with measured single point values and plane dose distributions by means of gamma analysis. New QA devices permit us to calculate 3D dose distributions on patient anatomy as redundant secondary check and reconstruct it from measurements taken with 2D and 3D detector arrays. 3D dose calculations allow us to perform DVH-based comparisons with clinical relevance, as well as 3D gamma analysis. One of these systems (Compass, IBA Dosimetry) combines traditional 2D with new anatomical-based 3D gamma analysis. This work shows the ability of this systemmore » by comparing 2D and 3D gamma analysis in pre-treatment QA for several VMAT prostate plans. Methods: Compass is capable of calculating dose as secondary check from DICOM TPS data and reconstructing it from measurements taken by a 2D ion chamber array (MatriXX Evolution, IBA Dosimetry). Both 2D and 3D gamma tests are available to compare calculated and reconstructed dose in Compass with TPS RT Dose. Results: 15 VMAT prostate plans have been measured with Compass. Dose is reconstructed with Compass for these plans. 2D gamma comparisons can be done for any plane from dose matrix. Mean gamma passing rates for isocenter planes (axial, coronal, sagittal) are (99.7±0.2)%, (99.9±0.1)%, (99.9±0.1)% for reconstructed dose planes. 3D mean gamma passing rates are (98.5±1.7)% for PTVs, (99.1±1.5)% for rectum, (100.0±0.0)% for bladder, (99.6±0.7)% for femoral heads and (98.1±4.1)% for penile bulb. Conclusion: Compass is a powerful tool to perform a complete pre-treatment QA analysis, from 2D techniques to 3D DVH-based techniques with clinical relevance. All reported values for VMAT prostate plans are in good agreement with TPS values. This system permits us to ensure the accuracy in the delivery of VMAT treatments completing a full patient-specific QA program.« less

SU-F-T-443: Quantification of Dosimetric Effects of Dental Metallic Implant On VMAT Plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lin, C; Jiang, W; Feng, Y

Purpose: To evaluate the dosimetric impact of metallic implant that correlates with the size of targets and metallic implants and distance in between on volumetric-modulated arc therapy (VMAT) plans for head and neck (H&N) cancer patients with dental metallic implant. Methods: CT images of H&N cancer patients with dental metallic implant were used. Target volumes with different sizes and locations were contoured. Metal artifact regions excluding surrounding critical organs were outlined and assigned with CT numbers close to water (0HU). VMAT plans with half-arc, one-full-arc and two-full-arcs were constructed and same plans were applied to structure sets with and withoutmore » CT number assignment of metal artifact regions and compared. D95% was utilized to investigate PTV dose coverage and SNC Patient− Software was used for the analysis of dose distribution difference slice by slice. Results: For different targets sizes, variation of PTV dose coverage (Delta-D95%) with and without CT number replacement reduced with larger target volume for all half-arc, one-arc and two-arc VMAT plans even though there were no clinically significant differences. Additionally, there were no significant variations of the maximum percent difference (max.%diff) of dose distribution. With regard to the target location, Delta-D95% and max. %diff dropped with increasing distance between target and metallic implant. Furthermore, half-arc plans showed greater impact than one-arc plans, and two-arc plans had smallest influence for PTV dose coverage and dose distribution. Conclusion: The target size has less correlation of doseimetric impact than the target location relative to metallic implants. Plans with more arcs alleviate the dosimetric effect of metal artifact because of less contribution to the target dose from beams going through the regions with metallic artifacts. Incorrect CT number causes inaccurate dose distribution, therefore appropriately overwriting metallic artifact regions with reasonable CT numbers is recommended. More patient data are collected and under further analysis.« less

Dosimetric Analysis of Unflattened (FFFB) and Flattened (FB) Photon Beam Energy for Gastric Cancers Using IMRT and VMAT-a Comparative Study.

PubMed

Bhushan, Manindra; Yadav, Girigesh; Tripathi, Deepak; Kumar, Lalit; Kishore, Vimal; Dewan, Abhinav; Kumar, Gourav; Wahi, Inderjit Kaur; Gairola, Munish

2018-03-08

To evaluate the feasibility of flattening filter free beam (FFFB) for the treatment of gastric tumors and to review their benefits over 6MV flatten beam (6MV_FFB). Fifteen patients with histologically proven gastric carcinoma were selected. CT scans with slice thickness of 0.3 cm were acquired and planning target volume (PTV) and organ at risk (OAR) were delineated. Plans were made retrospectively for each patient for the prescription dose of 45 Gy/25 fractions to the PTV. Four isocentric plans were compared in the present study on Varian TrueBeam linear accelerator (Varian Medical Systems, Palo Alto, CA, USA). PTV D98% was 44.41 ± 0.12, 44.38 ± 0.13, 44.59 ± 0.14, and 44.49 ± 0.19 Gy for IMRT 6MV_FFB, IMRT 6MV_FFFB, VMAT 6MV_FFB, and VMAT 6MV_FFFB respectively. 6MV_FFFB beam minimizes the mean heart dose D mean (P = 0.001). VMAT dominates over IMRT when it came to kidney doses V 12Gy (P = 0.02), V 23Gy (P = 0.015), V 28Gy (P = 0.011), and D max (P < 0.01). VMAT has significantly reduced the doses to kidneys. It was analyzed that 6MV_FFFB significantly reduces the dose to normal tissues (P = 0.006 and P = 0.018). VMAT significantly reduces the TMU, which is required to deliver the similar dose by IMRT (P < 0.01). Unflattened beam spares the organs at risk significantly to avoid the chances of secondary malignancies and reduces the intra-fraction motion during treatment due to provision of higher dose rate. Hence, we conclude that 6MV unflattened beam can be used to treat gastric carcinoma.

MO-FG-202-04: Gantry-Resolved Linac QA for VMAT: A Comprehensive and Efficient System Using An Electronic Portal Imaging Device

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zwan, B J; University of Newcastle, Newcastle, NSW; Barnes, M

2016-06-15

Purpose: To automate gantry-resolved linear accelerator (linac) quality assurance (QA) for volumetric modulated arc therapy (VMAT) using an electronic portal imaging device (EPID). Methods: A QA system for VMAT was developed that uses an EPID, frame-grabber assembly and in-house developed image processing software. The system relies solely on the analysis of EPID image frames acquired without the presence of a phantom. Images were acquired at 8.41 frames per second using a frame grabber and ancillary acquisition computer. Each image frame was tagged with a gantry angle from the linac’s on-board gantry angle encoder. Arc-dynamic QA plans were designed to assessmore » the performance of each individual linac component during VMAT. By analysing each image frame acquired during the QA deliveries the following eight machine performance characteristics were measured as a function of gantry angle: MLC positional accuracy, MLC speed constancy, MLC acceleration constancy, MLC-gantry synchronisation, beam profile constancy, dose rate constancy, gantry speed constancy, dose-gantry angle synchronisation and mechanical sag. All tests were performed on a Varian iX linear accelerator equipped with a 120 leaf Millennium MLC and an aS1000 EPID (Varian Medical Systems, Palo Alto, CA, USA). Results: Machine performance parameters were measured as a function of gantry angle using EPID imaging and compared to machine log files and the treatment plan. Data acquisition is currently underway at 3 centres, incorporating 7 treatment units, at 2 weekly measurement intervals. Conclusion: The proposed system can be applied for streamlined linac QA and commissioning for VMAT. The set of test plans developed can be used to assess the performance of each individual components of the treatment machine during VMAT deliveries as a function of gantry angle. The methodology does not require the setup of any additional phantom or measurement equipment and the analysis is fully automated to allow for regular routine testing.« less

SU-D-201-01: A Multi-Institutional Study Quantifying the Impact of Simulated Linear Accelerator VMAT Errors for Nasopharynx

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pogson, E; Liverpool and Macarthur Cancer Therapy Centres, Liverpool, NSW; Ingham Institute for Applied Medical Research, Sydney, NSW

Purpose: To quantify the impact of differing magnitudes of simulated linear accelerator errors on the dose to the target volume and organs at risk for nasopharynx VMAT. Methods: Ten nasopharynx cancer patients were retrospectively replanned twice with one full arc VMAT by two institutions. Treatment uncertainties (gantry angle and collimator in degrees, MLC field size and MLC shifts in mm) were introduced into these plans at increments of 5,2,1,−1,−2 and −5. This was completed using an in-house Python script within Pinnacle3 and analysed using 3DVH and MatLab. The mean and maximum dose were calculated for the Planning Target Volume (PTV1),more » parotids, brainstem, and spinal cord and then compared to the original baseline plan. The D1cc was also calculated for the spinal cord and brainstem. Patient average results were compared across institutions. Results: Introduced gantry angle errors had the smallest effect of dose, no tolerances were exceeded for one institution, and the second institutions VMAT plans were only exceeded for gantry angle of ±5° affecting different sided parotids by 14–18%. PTV1, brainstem and spinal cord tolerances were exceeded for collimator angles of ±5 degrees, MLC shifts and MLC field sizes of ±1 and beyond, at the first institution. At the second institution, sensitivity to errors was marginally higher for some errors including the collimator error producing doses exceeding tolerances above ±2 degrees, and marginally lower with tolerances exceeded above MLC shifts of ±2. The largest differences occur with MLC field sizes, with both institutions reporting exceeded tolerances, for all introduced errors (±1 and beyond). Conclusion: The plan robustness for VMAT nasopharynx plans has been demonstrated. Gantry errors have the least impact on patient doses, however MLC field sizes exceed tolerances even with relatively low introduced errors and also produce the largest errors. This was consistent across both departments. The authors acknowledge funding support from the NSW Cancer Council.« less

SU-E-T-541: Bolus Effect of Thermoplastic Masks in IMRT and VMAT Head and Neck Treatments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhen, H; Nedzi, L; Chen, S

2014-06-01

Purpose: To quantitatively evaluate the bolus effect of thermoplalstic mask on patient skin dose during multi-field IMRT and VMAT treatment. Methods: The clinically approved target contours for five head and neck patients were deformably registered to an anthropomorphic Rando phantom. Two plans: Multifield IMRT plan with 7-9 beams and VMAT plan with 2-4 arcs were created for each patient following same dose constraints. 3mm skin was excluded from PTVs but not constrained during optimization. The prescription dose was 200-220 cGy/fraction. A thermoplastic head and shoulder mask was customized for the Rando phantom. Each plan was delivered to the phantom twicemore » with and without mask. During each delivery, two rectangular strips of EBT3 films (1cm x 6.8cm) were placed across the anterior upper and lower neck near PTVs to measure the surface dose. For consistency films were positioned at same locations for same patient. A total of 8 film strips were obtained for each patient. Film dose was calibrated in the range of 0-400cGy on the day of plan delivery. For dose comparison 3 regions of interests (ROIs) of 1×1 cm{sup 2} were selected at left, right and middle part of each film, resulting in 6 point doses at each plan delivery. Results: The films without mask show relatively uniform dose distribution while those with mask clearly show mesh pattern of mask, usually indicating an increase in skin dose. On average the increase in skin dose over all ROIs with mask was 31.9%(±14.8%) with a range of 11.4%- 58.4%. There is no statistically significant difference (p=0.44) between skin dose increase in VMAT (30.8%±15.3%) and IMRT delivery (33.0%±14.9%). Conclusion: Thermoplastic immobilization masks increase surface dose for HN patient by around 30%. The magnitude is comparable between multi-field IMRT and VMAT. Radiochromic EBT3 film serves as an effective tool to quantify bolus effect.« less

Cardiac Exposure in the Dynamic Conformal Arc Therapy, Intensity-Modulated Radiotherapy and Volumetric Modulated Arc Therapy of Lung Cancer

PubMed Central

Ming, Xin; Feng, Yuanming; Liu, Huan; Zhang, Ying; Zhou, Li; Deng, Jun

2015-01-01

Purpose To retrospectively evaluate the cardiac exposure in three cohorts of lung cancer patients treated with dynamic conformal arc therapy (DCAT), intensity-modulated radiotherapy (IMRT), or volumetric modulated arc therapy (VMAT) at our institution in the past seven years. Methods and Materials A total of 140 lung cancer patients were included in this institutional review board approved study: 25 treated with DCAT, 70 with IMRT and 45 with VMAT. All plans were generated in a same commercial treatment planning system and have been clinically accepted and delivered. The dose distribution to the heart and the effects of tumor laterality, the irradiated heart volume and the beam-to-heart distance on the cardiac exposure were investigated. Results The mean dose to the heart among all 140 plans was 4.5 Gy. Specifically, the heart received on average 2.3, 5.2 and 4.6 Gy in the DCAT, IMRT and VMAT plans, respectively. The mean heart doses for the left and right lung tumors were 4.1 and 4.8 Gy, respectively. No patients died with evidence of cardiac disease. Three patients (2%) with preexisting cardiac condition developed cardiac disease after treatment. Furthermore, the cardiac exposure was found to increase linearly with the irradiated heart volume while decreasing exponentially with the beam-to-heart distance. Conclusions Compared to old technologies for lung cancer treatment, modern radiotherapy treatment modalities demonstrated better heart sparing. But the heart dose in lung cancer radiotherapy is still higher than that in the radiotherapy of breast cancer and Hodgkin’s disease where cardiac complications have been extensively studied. With strong correlations of mean heart dose with beam-to-heart distance and irradiated heart volume, cautions should be exercised to avoid long-term cardiac toxicity in the lung cancer patients undergoing radiotherapy. PMID:26630566

An improved distance-to-dose correlation for predicting bladder and rectum dose-volumes in knowledge-based VMAT planning for prostate cancer

NASA Astrophysics Data System (ADS)

Wall, Phillip D. H.; Carver, Robert L.; Fontenot, Jonas D.

2018-01-01

The overlap volume histogram (OVH) is an anatomical metric commonly used to quantify the geometric relationship between an organ at risk (OAR) and target volume when predicting expected dose-volumes in knowledge-based planning (KBP). This work investigated the influence of additional variables contributing to variations in the assumed linear DVH-OVH correlation for the bladder and rectum in VMAT plans of prostate patients, with the goal of increasing prediction accuracy and achievability of knowledge-based planning methods. VMAT plans were retrospectively generated for 124 prostate patients using multi-criteria optimization. DVHs quantified patient dosimetric data while OVHs quantified patient anatomical information. The DVH-OVH correlations were calculated for fractional bladder and rectum volumes of 30, 50, 65, and 80%. Correlations between potential influencing factors and dose were quantified using the Pearson product-moment correlation coefficient (R). Factors analyzed included the derivative of the OVH, prescribed dose, PTV volume, bladder volume, rectum volume, and in-field OAR volume. Out of the selected factors, only the in-field bladder volume (mean R  =  0.86) showed a strong correlation with bladder doses. Similarly, only the in-field rectal volume (mean R  =  0.76) showed a strong correlation with rectal doses. Therefore, an OVH formalism accounting for in-field OAR volumes was developed to determine the extent to which it improved the DVH-OVH correlation. Including the in-field factor improved the DVH-OVH correlation, with the mean R values over the fractional volumes studied improving from  -0.79 to  -0.85 and  -0.82 to  -0.86 for the bladder and rectum, respectively. A re-planning study was performed on 31 randomly selected database patients to verify the increased accuracy of KBP dose predictions by accounting for bladder and rectum volume within treatment fields. The in-field OVH led to significantly more precise and fewer unachievable KBP predictions, especially for lower bladder and rectum dose-volumes.

Poster — Thur Eve — 27: Flattening Filter Free VMAT Quality Assurance: Dose Rate Considerations for Detector Response

DOE Office of Scientific and Technical Information (OSTI.GOV)

Viel, Francis; Duzenli, Cheryl; British Columbia Cancer Agency, Department of Medical Physics, Vancouver Centre

2014-08-15

Introduction: Radiation detector responses can be affected by dose rate. Due to higher dose per pulse and wider range of mu rates in FFF beams, detector responses should be characterized prior to implementation of QA protocols for FFF beams. During VMAT delivery, the MU rate may also vary dramatically within a treatment fraction. This study looks at the dose per pulse variation throughout a 3D volume for typical VMAT plans and the response characteristics for a variety of detectors, and makes recommendations on the design of QA protocols for FFF VMAT QA. Materials and Methods: Linac log file data andmore » a simplified dose calculation algorithm are used to calculate dose per pulse for a variety of clinical VMAT plans, on a voxel by voxel basis, as a function of time in a cylindrical phantom. Diode and ion chamber array responses are characterized over the relevant range of dose per pulse and dose rate. Results: Dose per pulse ranges from <0.1 mGy/pulse to 1.5 mGy/pulse in a typical VMAT treatment delivery using the 10XFFF beam. Diode detector arrays demonstrate increased sensitivity to dose (+./− 3%) with increasing dose per pulse over this range. Ion chamber arrays demonstrate decreased sensitivity to dose (+/− 1%) with increasing dose rate over this range. Conclusions: QA protocols should be designed taking into consideration inherent changes in detector sensitivity with dose rate. Neglecting to account for changes in detector response with dose per pulse can lead to skewed QA results.« less

Optimization of Treatment Geometry to Reduce Normal Brain Dose in Radiosurgery of Multiple Brain Metastases with Single-Isocenter Volumetric Modulated Arc Therapy.

PubMed

Wu, Qixue; Snyder, Karen Chin; Liu, Chang; Huang, Yimei; Zhao, Bo; Chetty, Indrin J; Wen, Ning

2016-09-30

Treatment of patients with multiple brain metastases using a single-isocenter volumetric modulated arc therapy (VMAT) has been shown to decrease treatment time with the tradeoff of larger low dose to the normal brain tissue. We have developed an efficient Projection Summing Optimization Algorithm to optimize the treatment geometry in order to reduce dose to normal brain tissue for radiosurgery of multiple metastases with single-isocenter VMAT. The algorithm: (a) measures coordinates of outer boundary points of each lesion to be treated using the Eclipse Scripting Application Programming Interface, (b) determines the rotations of couch, collimator, and gantry using three matrices about the cardinal axes, (c) projects the outer boundary points of the lesion on to Beam Eye View projection plane, (d) optimizes couch and collimator angles by selecting the least total unblocked area for each specific treatment arc, and (e) generates a treatment plan with the optimized angles. The results showed significant reduction in the mean dose and low dose volume to normal brain, while maintaining the similar treatment plan qualities on the thirteen patients treated previously. The algorithm has the flexibility with regard to the beam arrangements and can be integrated in the treatment planning system for clinical application directly.

Dynamic Collimator Angle Adjustments During Volumetric Modulated Arc Therapy to Account for Prostate Rotations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Boer, Johan de; Wolf, Anne Lisa; Szeto, Yenny Z.

2015-04-01

Purpose: Rotations of the prostate gland induce considerable geometric uncertainties in prostate cancer radiation therapy. Collimator and gantry angle adjustments can correct these rotations in intensity modulated radiation therapy. Modern volumetric modulated arc therapy (VMAT) treatments, however, include a wide range of beam orientations that differ in modulation, and corrections require dynamic collimator rotations. The aim of this study was to implement a rotation correction strategy for VMAT dose delivery and validate it for left-right prostate rotations. Methods and Materials: Clinical VMAT treatment plans of 5 prostate cancer patients were used. Simulated left-right prostate rotations between +15° and −15° weremore » corrected by collimator rotations. We compared corrected and uncorrected plans by dose volume histograms, minimum dose (D{sub min}) to the prostate, bladder surface receiving ≥78 Gy (S78) and rectum equivalent uniform dose (EUD; n=0.13). Each corrected plan was delivered to a phantom, and its deliverability was evaluated by γ-evaluation between planned and delivered dose, which was reconstructed from portal images acquired during delivery. Results: On average, clinical target volume minimum dose (D{sub min}) decreased up to 10% without corrections. Negative left-right rotations were corrected almost perfectly, whereas D{sub min} remained within 4% for positive rotations. Bladder S78 and rectum EUD of the corrected plans matched those of the original plans. The average pass rate for the corrected plans delivered to the phantom was 98.9% at 3% per 3 mm gamma criteria. The measured dose in the planning target volume approximated the original dose, rotated around the simulated left-right angle, well. Conclusions: It is feasible to dynamically adjust the collimator angle during VMAT treatment delivery to correct for prostate rotations. This technique can safely correct for left-right prostate rotations up to 15°.« less

Epithelioid hemangioendothelioma of the spine treated with RapidArc volumetric-modulated radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Guy, Jean-Baptiste; Trone, Jane-Chloé; Chargari, Cyrus

2014-10-01

Radiotherapy for epithelioid hemangioendothelioma (EHE) using volumetric intensity-modulated arc radiotherapy (VMAT). A 48-year-old woman was referred for curative irradiation of a vertebral EHE after failure of surgery. A comparison between VMAT and conventional conformal tridimensional (3D) dosimetry was performed and potential advantage of VMAT for sparing critical organs from irradiation's side effects was discussed. The total delivered dose on the planning target volume was 54 Gy in 27 fractions. The patient was finally treated with VMAT. The tolerance was excellent. There was no acute toxicity, including no increase in pain. With a follow-up of 18 months, no delayed toxicity wasmore » reported. The clinical response consisted of a decrease in the dorsal pain. The D{sub max} for the spinal cord was reduced from 55 Gy (3D-radiotherapy [RT]) (which would be an unacceptable dose to the spine because of the risk of myelopathy) to 42.8 Gy (VMAT), which remains below the recommended dose threshold (45 Gy). The dose delivered to 20% of organ volume (D{sub 20}) was reduced from 47 Gy (3D-RT) to 3 Gy (VMAT) for the spinal cord. The study shows that VMAT allows the delivery of curative treatment for vertebral EHEs because of critical organ sparing.« less

SU-D-202-01: Functional Lung Avoidance and Response-Adaptive Escalation (FLARE) RT: Feasibility of a Precision Radiation Oncology Strategy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bowen, S; Lee, E; Miyaoka, R

Purpose: NSCLC patient RT is planned without consideration of spatial heterogeneity in lung function or tumor response, which may have contributed to failed uniform dose escalation in a randomized trial. The feasibility of functional lung avoidance and response-adaptive escalation (FLARE) RT to reduce dose to [{sup 99m}Tc]MAA-SPECT/CT perfused lung while redistributing 74Gy within [{sup 18}F]FDG-PET/CT biological target volumes was assessed. Methods: Eight Stage IIB–IIIB NSCLC patients underwent FDG-PET/CT and MAA-SPECT/CT treatment planning scans. Perfused lung objectives were derived from scatter/collimator/attenuation-corrected MAA-SPECT uptake relative to ITV-subtracted lung to maintain <20Gy mean lung dose (MLD). Prescriptions included 60Gy to PTV and concomitantmore » boost of 74Gy mean to biological target volumes (BTV=GTV+PET margin) scaled to each BTV voxel by relative FDG-PET SUV. Dose-painting-by-numbers prescriptions were integrated into commercial TPS via previously reported ROI discretization. Dose constraints for lung, heart, cord, and esophagus were defined. FLARE RT plans were optimized with VMAT, proton pencil beam scanning (PBS) with 3%-3mm robust optimization, and combination PBS (avoidance) plus VMAT (escalation). Dosimetric differences were evaluated by Friedman non-parametric paired test with multiple sampling correction. Results: PTV and normal tissue objectives were not violated in 24 FLARE RT plans. Population median of mean BTV dose was 73.7Gy (68.5–75.5Gy), mean FDG-PET peak dose was 89.7Gy (73.5–103Gy), MLD was 12.3Gy (7.5–19.6Gy), and perfused MLD was 4.8Gy (0.9–12.1Gy). VMAT achieved higher dose to the FDG-PET peak subvolume (p=0.01), while PBS delivered lower dose to lung (p<0.001). Voxelwise linear correlation between BTV dose and FDG-PET uptake was higher for VMAT (R=0.93) and PBS+VMAT (R=0.94) compared to PBS alone (R=0.89). Conclusion: FLARE RT is feasible with VMAT and PBS. A combination of PBS for functional lung avoidance and VMAT for FDG-PET dose escalation balances target/normal tissue objective tradeoffs. These results support future testing of FLARE RT safety and efficacy within a precision radiation oncology trial. This work was supported by a Research Scholar grant from the Radiological Society of North American Research & Education Foundation.« less

TH-EF-BRB-02: Feasibility of Optimization for Dynamic Trajectory Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fix, MK; Frei, D; Volken, W

2016-06-15

Purpose: Over the last years, volumetric modulated arc therapy (VMAT) has been widely introduced into clinical routine using a coplanar delivery technique. However, VMAT might be improved by including dynamic couch and collimator rotations, leading to dynamic trajectory radiotherapy (DTRT). In this work the feasibility and the potential benefit of DTRT was investigated. Methods: A general framework for the optimization was developed using the Eclipse Scripting Research Application Programming Interface (ESRAPI). Based on contoured target and organs at risk (OARs), the structures are extracted using the ESRAPI. Sampling potential beam directions, regularly distributed on a sphere using a Fibanocci-lattice, themore » fractional volume-overlap of each OAR and the target is determined and used to establish dynamic gantry-couch movements. Then, for each gantry-couch track the most suitable collimator angle is determined for each control point by optimizing the area between the MLC leaves and the target contour. The resulting dynamic trajectories are used as input to perform the optimization using a research version of the VMAT optimization algorithm and the ESRAPI. The feasibility of this procedure was tested for a clinically motivated head and neck case. Resulting dose distributions for the VMAT plan and for the dynamic trajectory treatment plan were compared based on DVH-parameters. Results: While the DVH for the target is virtually preserved, improvements in maximum dose for the DTRT plan were achieved for all OARs except for the inner-ear, where maximum dose remains the same. The major improvements in maximum dose were 6.5% of the prescribed dose (66 Gy) for the parotid and 5.5% for the myelon and the eye. Conclusion: The result of this work suggests that DTRT has a great potential to reduce dose to OARs with similar target coverage when compared to conventional VMAT treatment plans. This work was supported by Varian Medical Systems. This work was supported by Varian Medical Systems.« less

Time dependent pre-treatment EPID dosimetry for standard and FFF VMAT.

PubMed

Podesta, Mark; Nijsten, Sebastiaan M J J G; Persoon, Lucas C G G; Scheib, Stefan G; Baltes, Christof; Verhaegen, Frank

2014-08-21

Methods to calibrate Megavoltage electronic portal imaging devices (EPIDs) for dosimetry have been previously documented for dynamic treatments such as intensity modulated radiotherapy (IMRT) using flattened beams and typically using integrated fields. While these methods verify the accumulated field shape and dose, the dose rate and differential fields remain unverified. The aim of this work is to provide an accurate calibration model for time dependent pre-treatment dose verification using amorphous silicon (a-Si) EPIDs in volumetric modulated arc therapy (VMAT) for both flattened and flattening filter free (FFF) beams. A general calibration model was created using a Varian TrueBeam accelerator, equipped with an aS1000 EPID, for each photon spectrum 6 MV, 10 MV, 6 MV-FFF, 10 MV-FFF. As planned VMAT treatments use control points (CPs) for optimization, measured images are separated into corresponding time intervals for direct comparison with predictions. The accuracy of the calibration model was determined for a range of treatment conditions. Measured and predicted CP dose images were compared using a time dependent gamma evaluation using criteria (3%, 3 mm, 0.5 sec). Time dependent pre-treatment dose verification is possible without an additional measurement device or phantom, using the on-board EPID. Sufficient data is present in trajectory log files and EPID frame headers to reliably synchronize and resample portal images. For the VMAT plans tested, significantly more deviation is observed when analysed in a time dependent manner for FFF and non-FFF plans than when analysed using only the integrated field. We show EPID-based pre-treatment dose verification can be performed on a CP basis for VMAT plans. This model can measure pre-treatment doses for both flattened and unflattened beams in a time dependent manner which highlights deviations that are missed in integrated field verifications.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, S; Zheng, Y; Albani, D

Purpose: To reduce internal target volume (ITV), respiratory management is a must in imaging and treatment for lung, liver, and breast cancers. We investigated the dosimetric accuracy of VMAT treatment delivery with a Response™ gating system linked to linear accelerator. Methods: The Response™ gating module designed to directly control radiation beam by breath-holding with a ABC system (Elekta AB, Stockholm, Sweden) was tested for VMAT treatments. Seven VMAT plans including three conventional and four stereotactic body radiotherapy (SBRT) cases were evaluated. Each plan was composed of two or four arcs of 6MV radiation beam with prescribed dose ranged from 1.8more » to 9 Gy per fraction. Each plan was delivered continuously without gating and delivered with multiple interruptions by the ResponseTM gating module with a 20 or 30 second breath-holding period. MapCheck2 and Gafchromic EBT3 films sandwiched in MapPHAN were used to measure the delivered dose with and without gating. Films were scanned on a flatbed color scanner, and red channel was extracted for film dosimetry. Gamma analysis was performed to analyze the dosimetrical accuracy of the radiation delivery with gating. Results: The measured doses with gating remarkably agree with the planned dose distributions in the results of gamma index passing rate (within 20% isodose; >98% for 3%/3mm and >92% for 2%/2mm in MapCheck2, and >91% for 3%/3mm criteria in EBT3 film except one case which was for large target and highly modulated). No significant difference (student t-test: p-value < 0.0005) was shown between the doses delivered with and without gating. There was no indication of radiation gap or overlapping during deliver interruption in film dosimetry. Conclusion: The Response™ gating system can be safely used during VMAT treatment. The accurate performance of the gating system linked to ABC can contribute to ITV reduction for SBRT using VMAT.« less

Ipsilateral kidney sparing in treatment of pancreatic malignancies using volumetric-modulated arc therapy avoidance sectors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chan, Raymond W., E-mail: rwc3b@alumni.virginia.edu; Podgorsak, Matthew B.

Recent research has shown treating pancreatic cancer with volumetric-modulated arc therapy (VMAT) to be superior to either intensity-modulated radiation therapy or 3-dimensional conformal radiotherapy (3D-CRT), with respect to reducing normal tissue toxicity, monitor units, and treatment time. Furthermore, using avoidance sectors with RapidArc planning can further reduce normal tissue dose while maintaining target conformity. This study looks at the methods in reducing dose to the ipsilateral kidney, in pancreatic head cases, while observing dose received by other critical organs using avoidance sectors. Overall, 10 patients were retrospectively analyzed. Each patient had preoperative/unresectable pancreatic tumor and were selected based on themore » location of the right kidney being situated within the traditional 3D-CRT treatment field. The target planning target volume (286.97 ± 85.17 cm{sup 3}) was prescribed to 50.4 Gy using avoidance sectors of 30°, 40°, and 50° and then compared with VMAT as well as 3D-CRT. Analysis of the data shows that the mean dose to the right kidney was reduced by 11.6%, 15.5%, and 21.9% for avoidance angles of 30°, 40°, and 50°, respectively, over VMAT. The mean dose to the total kidney also decreased by 6.5%, 8.5%, and 11.0% for the same increasing angles. Spinal cord maximum dose, however, increased as a function of angle by 3.7%, 4.8%, and 6.1% compared with VMAT. Employing avoidance sector angles as a complement to VMAT planning can significantly reduce high dose to the ipsilateral kidney while not greatly overdosing other critical organs.« less

Three-dimensional radiochromic film dosimetry for volumetric modulated arc therapy using a spiral water phantom

PubMed Central

Tanooka, Masao; Doi, Hiroshi; Miura, Hideharu; Inoue, Hiroyuki; Niwa, Yasue; Takada, Yasuhiro; Fujiwara, Masayuki; Sakai, Toshiyuki; Sakamoto, Kiyoshi; Kamikonya, Norihiko; Hirota, Shozo

2013-01-01

We validated 3D radiochromic film dosimetry for volumetric modulated arc therapy (VMAT) using a newly developed spiral water phantom. The phantom consists of a main body and an insert box, each of which has an acrylic wall thickness of 3 mm and is filled with water. The insert box includes a spiral film box used for dose-distribution measurement, and a film holder for positioning a radiochromic film. The film holder has two parallel walls whose facing inner surfaces are equipped with spiral grooves in a mirrored configuration. The film is inserted into the spiral grooves by its side edges and runs along them to be positioned on a spiral plane. Dose calculation was performed by applying clinical VMAT plans to the spiral water phantom using a commercial Monte Carlo-based treatment-planning system, Monaco, whereas dose was measured by delivering the VMAT beams to the phantom. The calculated dose distributions were resampled on the spiral plane, and the dose distributions recorded on the film were scanned. Comparisons between the calculated and measured dose distributions yielded an average gamma-index pass rate of 87.0% (range, 91.2–84.6%) in nine prostate VMAT plans under 3 mm/3% criteria with a dose-calculation grid size of 2 mm. The pass rates were increased beyond 90% (average, 91.1%; range, 90.1–92.0%) when the dose-calculation grid size was decreased to 1 mm. We have confirmed that 3D radiochromic film dosimetry using the spiral water phantom is a simple and cost-effective approach to VMAT dose verification. PMID:23685667

Poster — Thur Eve — 28: Enabling trajectory-based radiotherapy on a TrueBeam accelerator with the Eclipse treatment planning system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mullins, J; Asiev, K; DeBlois, F

2014-08-15

The TrueBeam linear accelerator platform has a developer's mode which permits the user dynamic control over many of the machine's mechanical and radiation systems. Using this research tool, synchronous couch and gantry motion can be programmed to simulate isocentric treatment with a shortened SAD, with benefits such as smaller projected MLC leaf widths and an increased dose rate. In this work, water tank measurements were used to commission a virtual linear accelerator with an 85 cm SAD in Eclipse, from which several arc-based radiotherapy treatments were generated, including an inverse optimized VMAT delivery. For each plan, the pertinent treatment deliverymore » information was extracted from control points specified in the Eclipse-exported DICOM files using the pydicom package in Python, allowing construction of an XML control file. The dimensions of the jaws and MLC positions, defined for an 85 cm SAD in Eclipse, were scaled for delivery on a conventional SAD linear accelerator, and translational couch motion was added as a function of gantry angle to simulate delivery at 85 cm SAD. Ionization chamber and Gafchromic film measurements were used to compare the radiation delivery to dose calculations in Eclipse. With the exception of the VMAT delivery, ionization chamber measurements agreed within 3.3% of the Eclipse calculations. For the VMAT delivery, the ionization chamber was located in an inhomogeneous region, but gamma evaluation of the Gafchromic film plane resulted in a 94.5% passing rate using criteria of 3 mm/3%. The results indicate that Eclipse calculation infrastructure can be used.« less

Use of volumetric-modulated arc therapy for treatment of Hodgkin lymphoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Young K., E-mail: Young.Lee@rmh.nhs.uk; Bedford, James L.; Taj, Mary

To evaluate volumetric-modulated arc therapy (VMAT) for treatment of Hodgkin lymphoma (HL) in patients where conventional radiotherapy was not deliverable. A planning computed tomography (CT) scan was acquired for a twelve-year-old boy with Stage IIIB nodular sclerosing HL postchemotherapy with positive positron emission tomography scan. VMAT was used for Phase 1 (19.8 Gy in 11 fractions) and Phase 2 (10.8 Gy in 6 fractions) treatment plans. Single anticlockwise arc plans were constructed using SmartArc (Philips Radiation Oncology Systems, Fitchburg, WI) with control points spaced at 4°. The inverse-planning objectives were to uniformly irradiate the planning target volume (PTV) with themore » prescription dose while keeping the volume of lung receiving greater than 20 Gy (V{sub 20} {sub Gy}) to less than 30% and minimize the dose to the other adjacent organs at risk (OAR). Pretreatment verification was conducted and the treatment delivery was on an MLCi Synergy linear accelerator (Elekta Ltd, Crawley, UK). The planning results were retrospectively confirmed in a further 4 patients using a single PTV with a prescribed dose of 19.8 Gy in 11 fractions. Acceptable dose coverage and homogeneity were achieved for both Phase 1 and 2 plans while keeping the lung V{sub 20} {sub Gy} at 22.5% for the composite plan. The beam-on times for Phase 1 and Phase 2 plans were 109 and 200 seconds, respectively, and the total monitor units were 337.2 MU and 292.5 MU, respectively. The percentage of measured dose points within 3% and 3 mm for Phase 1 and Phase 2 were 92% and 98%, respectively. Both plans were delivered successfully. The retrospective planning study showed that VMAT improved PTV dose uniformity and reduced the irradiated volume of heart and lung, although the volume of lung irradiated to low doses increased. Two-phased VMAT offers an attractive option for large volume sites, such as HL, giving a high level of target coverage and significant OAR sparing together with efficient delivery.« less

A novel technique for VMAT QA with EPID in cine mode on a Varian TrueBeam linac

NASA Astrophysics Data System (ADS)

Liu, Bo; Adamson, Justus; Rodrigues, Anna; Zhou, Fugen; Yin, Fang-fang; Wu, Qiuwen

2013-10-01

Volumetric modulated arc therapy (VMAT) is a relatively new treatment modality for dynamic photon radiation therapy. Pre-treatment quality assurance (QA) is necessary and many efforts have been made to apply electronic portal imaging device (EPID)-based IMRT QA methods to VMAT. It is important to verify the gantry rotation speed during delivery as this is a new variable that is also modulated in VMAT. In this paper, we present a new technique to perform VMAT QA using an EPID. The method utilizes EPID cine mode and was tested on Varian TrueBeam in research mode. The cine images were acquired during delivery and converted to dose matrices after profile correction and dose calibration. A sub-arc corresponding to each cine image was extracted from the original plan and its portal image prediction was calculated. Several analyses were performed including 3D γ analysis (2D images + gantry angle axis), 2D γ analysis, and other statistical analyses. The method was applied to 21 VMAT photon plans of 3 photon energies. The accuracy of the cine image information was investigated. Furthermore, this method's sensitivity to machine delivery errors was studied. The pass rate (92.8 ± 1.4%) for 3D γ analysis was comparable to those from Delta4 system (99.9 ± 0.1%) under similar criteria (3%, 3 mm, 5% threshold and 2° angle to agreement) at 6 MV. The recorded gantry angle and start/stop MUs were found to have sufficient accuracy for clinical QA. Machine delivery errors can be detected through combined analyses of 3D γ, gantry angle, and percentage dose difference. In summary, we have developed and validated a QA technique that can simultaneously verify the gantry angle and delivered MLC fluence for VMAT treatment.This technique is efficient and its accuracy is comparable to other QA methods.

WE-A-BRD-01: Innovation in Radiation Therapy Planning I: Knowledge Guided Treatment Planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, Q; Olsen, L

2014-06-15

Intensity modulated radiation therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) offer the capability of normal tissues and organs sparing. However, the exact amount of sparing is often unknown until the plan is complete. This lack of prior guidance has led to the iterative, trial and-error approach in current planning practice. Even with this effort the search for patient-specific optimal organ sparing is still strongly influenced by planner's experience. While experience generally helps in maximizing the dosimetric advantages of IMRT/VMAT, there have been several reports showing unnecessarily high degree of plan quality variability at individual institutions and amongst different institutions,more » even with a large amount of experience and the best available tools. Further, when physician and physicist evaluate a plan, the dosimetric quality of the plan is often compared with a standard protocol that ignores individual patient anatomy and tumor characteristic variations. In recent years, developments of knowledge models for clinical IMRT/VMAT planning guidance have shown promising clinical potentials. These knowledge models extract past expert clinical experience into mathematical models that predict dose sparing references at patient-specific level. For physicians and planners, these references provide objective values that reflect best achievable dosimetric constraints. For quality assurance, applying patient-specific dosimetry requirements will enable more quantitative and objective assessment of protocol compliance for complex IMRT planning. Learning Objectives: Modeling and representation of knowledge for knowledge-guided treatment planning. Demonstrations of knowledge-guided treatment planning with a few clinical caanatomical sites. Validation and evaluation of knowledge models for cost and quality effective standardization of plan optimization.« less

Monte Carlo modeling of HD120 multileaf collimator on Varian TrueBeam linear accelerator for verification of 6X and 6X FFF VMAT SABR treatment plans

PubMed Central

Gete, Ermias; Duzenli, Cheryl; Teke, Tony

2014-01-01

A Monte Carlo (MC) validation of the vendor‐supplied Varian TrueBeam 6 MV flattened (6X) phase‐space file and the first implementation of the Siebers‐Keall MC MLC model as applied to the HD120 MLC (for 6X flat and 6X flattening filterfree (6X FFF) beams) are described. The MC model is validated in the context of VMAT patient‐specific quality assurance. The Monte Carlo commissioning process involves: 1) validating the calculated open‐field percentage depth doses (PDDs), profiles, and output factors (OF), 2) adapting the Siebers‐Keall MLC model to match the new HD120‐MLC geometry and material composition, 3) determining the absolute dose conversion factor for the MC calculation, and 4) validating this entire linac/MLC in the context of dose calculation verification for clinical VMAT plans. MC PDDs for the 6X beams agree with the measured data to within 2.0% for field sizes ranging from 2 × 2 to 40 × 40 cm2. Measured and MC profiles show agreement in the 50% field width and the 80%‐20% penumbra region to within 1.3 mm for all square field sizes. MC OFs for the 2 to 40 cm2 square fields agree with measurement to within 1.6%. Verification of VMAT SABR lung, liver, and vertebra plans demonstrate that measured and MC ion chamber doses agree within 0.6% for the 6X beam and within 2.0% for the 6X FFF beam. A 3D gamma factor analysis demonstrates that for the 6X beam, > 99% of voxels meet the pass criteria (3%/3 mm). For the 6X FFF beam, > 94% of voxels meet this criteria. The TrueBeam accelerator delivering 6X and 6X FFF beams with the HD120 MLC can be modeled in Monte Carlo to provide an independent 3D dose calculation for clinical VMAT plans. This quality assurance tool has been used clinically to verify over 140 6X and 16 6X FFF TrueBeam treatment plans. PACS number: 87.55.K‐ PMID:24892341

Critical appraisal of volumetric-modulated arc therapy compared with electrons for the radiotherapy of cutaneous Kaposi's sarcoma of lower extremities with bone sparing.

PubMed

Nicolini, G; Abraham, S; Fogliata, A; Jordaan, A; Clivio, A; Vanetti, E; Cozzi, L

2013-03-01

To evaluate the use of volumetric-modulated arc therapy [VMAT, RapidArc® (RA); Varian Medical Systems, Palo Alto, CA] for the treatment of cutaneous Kaposi's sarcoma (KS) of lower extremities with adequate target coverage and high bone sparing, and to compare VMAT with electron beam therapy. 10 patients were planned with either RA or electron beams. The dose was prescribed to 30 Gy, 10 fractions, to mean the planning target volume (PTV), and significant maximum dose to bone was limited to 30 Gy. Plans were designed for 6-MV photon beams for RA and 6 MeV for electrons. Dose distributions were computed with AcurosXB® (Varian Medical Systems) for photons and with a Monte Carlo algorithm for electrons. V(90%) was 97.3±1.2 for RA plans and 78.2±2.6 for electrons; similarly, V(107%) was 2.5±2.2 and 37.7±3.4, respectively. RA met coverage criteria. Concerning bone sparing, D(2%) was 29.6±1.1 for RA and 31.0±2.4 for electrons. Although acceptable for bone involvement, pronounced target coverage violations were obtained for electron plans. Monitor units were similar for electrons and RA, although for the latter they increased when superior bone sparing was imposed. Delivery times were 12.1±4.0 min for electrons and 4.8±1.3 min for the most modulated RA plans. High plan quality was shown for KS in the lower extremities using VMAT, and this might simplify their management in comparison with the more conventional usage of electrons, particularly in institutes with limited staff resources and heavy workloads. VMAT is also dosimetrically extremely advantageous in a typology of treatments where electron beam therapy is mainly considered to be effective owing to the limited penetration of the beams.

Optimizing fiducial visibility on periodically acquired megavoltage and kilovoltage image pairs during prostate volumetric modulated arc therapy

PubMed Central

Zhang, Pengpeng; Happersett, Laura; Ravindranath, Bosky; Zelefsky, Michael; Mageras, Gig; Hunt, Margie

2016-01-01

Purpose: Robust detection of implanted fiducials is essential for monitoring intrafractional motion during hypofractionated treatment. The authors developed a plan optimization strategy to ensure clear visibility of implanted fiducials and facilitate 3D localization during volumetric modulated arc therapy (VMAT). Methods: Periodic kilovoltage (kV) images were acquired at 20° gantry intervals and paired with simultaneously acquired 4.4° short arc megavoltage digital tomosynthesis (MV-DTS) to localize three fiducials during VMAT delivery for hypofractionated prostate cancer treatment. Beginning with the original optimized plan, control point segments where fiducials were consistently blocked by multileaf collimator (MLC) within each 4.4° MV-DTS interval were first identified. For each segment, MLC apertures were edited to expose the fiducial that led to the least increase in the cost function. Subsequently, MLC apertures of all control points not involved with fiducial visualization were reoptimized to compensate for plan quality losses and match the original dose–volume histogram. MV dose for each MV-DTS was also kept above 0.4 MU to ensure acceptable image quality. Different imaging (gantry) intervals and visibility margins around fiducials were also evaluated. Results: Fiducials were consistently blocked by the MLC for, on average, 36% of the imaging control points for five hypofractionated prostate VMAT plans but properly exposed after reoptimization. Reoptimization resulted in negligible dosimetric differences compared with original plans and outperformed simple aperture editing: on average, PTV D98 recovered from 87% to 94% of prescription, and PTV dose homogeneity improved from 9% to 7%. Without violating plan objectives and compromising delivery efficiency, the highest imaging frequency and largest margin that can be achieved are a 10° gantry interval, and 15 mm, respectively. Conclusions: VMAT plans can be made to accommodate MV-kV imaging of fiducials. Fiducial visualization rate and workflow efficiency are significantly improved with an automatic modification and reoptimization approach. PMID:27147314

SU-F-T-296: Modulated Therapy Down Under: A Survey of IMRT & VMAT Physics Practice in Australia and New Zealand

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barber, J; School of Physics, University of Sydney; Vial, P

Purpose: A comprehensive survey of Australasian radiation oncology physics departments was undertaken to capture a snapshot of current usage, commissioning and QA practices for intensity-modulated therapies. Methods: An online survey was developed and advertised to Australian and New Zealand radiation oncology physicists through the local college (ACPSEM) in April 2015. The survey consisted of 147 questions in total, covering IMRT, VMAT and Tomotherapy, and details specific to different treatment planning systems. Questions captured detailed information on equipment, policies and procedures for the commissioning and QA of each treatment technique. Results: 41 partial or complete responses were collected, representing 59 departmentsmore » out of the 78 departments operational. 137 and 84 linacs from these departments were using IMRT and VMAT respectively, from a total 150 linacs. 100% and 78% of respondents were treating with IMRT and VMAT respectively. There are at least 8 different treatment planning systems being used for IMRT or VMAT, and large variations in all aspects of QA policies and procedures. 29 responses indicated 72 methods routinely used for pre-treatment QA, when breaking down by device and analysis type. Similar numbers of departments use field-by-field analysis compared to composite analysis (56% to 44%) while a majority use true gantry angle delivery compared to fixed gantry at 0° (72% to 28%). 19 different implementations of gamma index analysis parameters were reported from 33 responses. A follow-up one-day workshop to highlight the results, discuss the role of QA and share equipment-specific knowledge across users was conducted in November 2015. Conclusion: While IMRT and VMAT are almost universally available in Australasia, large variations in practice indicate a need for national or consensus guidelines.« less

SU-F-J-129: Verification of Geometric and Dosimetric Accuracy of Respiratory Management Systems Using Homemade Phantom

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goksel, E; Kucucuk, H; Senkesen, O

Purpose: Different placements of Infrared Cameras (IRC) in CT and treatment rooms can cause gating window level (GWL) variations leading to differences between GWL used for planning and treatments. Although, Varian Clinac DHX-OBI sytem and CT are equipped with the same kind of IRC, Truebeam STx (TB) has a different type of IRC known as banana type. In this study; geometric and dosimetric accuracy of respiratory management system (RPM) for different machines were investigated with a special homemade phantom. Methods: Special phantom was placed on the respiratory simulator machine and a CT data set was obtained at the end ofmore » the expirium phase (EOE). Conformal and IMRT plans were generated on the EOE CT image series for both DHX-OBI and TB LINACs while a VMAT plan was generated only for TB.The acquired respiratory graphs in the CT were directly sent to DHX-OBI system, and they were converted with software before sending to TB. EBT3 films were placed inside the phantom and were irradiated using RPM system with two machines for different plans. Planar dose distributions were compared with gamma analysis (GA) method (3mm, %3) to evaluate planned-measured dose differences. In addition, radio-opac marker was placed in the center of the phantom to evaluate the geometric accuracy of treatment field with gated flouroscopy (GF). Results: There were no shifts detected between planning and treeatment GWL for both DHX-OBI and TB. Difference on the GF image between digital graticule and radio-opac marker was <1mm for TB and 1mm for DHX-OBI. Although, GA agreement was 97% for conformal and IMRT techniques in TB, it was 96% for VMAT technique. While GA agreement was 98% for conformal technique in DHX-OBI, IMRT was 95%.ConclusionThis study showed that RPM can be used accurately in spite of different IRC placements or different types of ICR used.« less

Treatment Plan Technique and Quality for Single-Isocenter Stereotactic Ablative Radiotherapy of Multiple Lung Lesions with Volumetric-Modulated Arc Therapy or Intensity-Modulated Radiosurgery

PubMed Central

Quan, Kimmen; Xu, Karen M.; Lalonde, Ron; Horne, Zachary D.; Bernard, Mark E.; McCoy, Chuck; Clump, David A.; Burton, Steven A.; Heron, Dwight E.

2015-01-01

The aim of this study is to provide a practical approach to the planning technique and evaluation of plan quality for the multi-lesion, single-isocenter stereotactic ablative radiotherapy (SABR) of the lung. Eleven patients with two or more lung lesions underwent single-isocenter volumetric-modulated arc therapy (VMAT) radiosurgery or IMRS. All plans were normalized to the target maximum dose. For each plan, all targets were treated to the same dose. Plan conformity and dose gradient were maximized with dose-control tuning structures surrounding targets. For comparison, multi-isocenter plans were retrospectively created for four patients. Conformity index (CI), homogeneity index (HI), gradient index (GI), and gradient distance (GD) were calculated for each plan. V5, V10, and V20 of the lung and organs at risk (OARs) were collected. Treatment time and total monitor units (MUs) were also recorded. One patient had four lesions and the remainder had two lesions. Six patients received VMAT and five patients received intensity-modulated radiosurgery (IMRS). For those treated with VMAT, two patients received 3-arc VMAT and four received 2-arc VMAT. For those treated with IMRS, two patients were treated with 10 and 11 beams, respectively, and the rest received 12 beams. Prescription doses ranged from 30 to 54 Gy in three to five fractions. The median prescribed isodose line was 84% (range: 80–86%). The median maximum dose was 57.1 Gy (range: 35.7–65.1 Gy). The mean combined PTV was 49.57 cm3 (range: 14.90–87.38 cm3). For single-isocenter plans, the median CI was 1.15 (range: 0.97–1.53). The median HI was 1.19 (range: 1.16–1.28). The median GI was 4.60 (range: 4.16–7.37). The median maximum radiation dose (Dmax) to total lung was 55.6 Gy (range: 35.7–62.0 Gy). The median mean radiation dose to the lung (Dmean) was 4.2 Gy (range: 1.1–9.3 Gy). The median lung V5 was 18.7% (range: 3.8–41.3%). There was no significant difference in CI, HI, GI, GD, V5, V10, and V20 (lung, heart, trachea, esophagus, and spinal cord) between single-isocenter and multi-isocenter plans. This multi-lesion, single-isocenter lung SABR planning technique demonstrated excellent plan quality and clinical efficiency and is recommended for radiosurgical treatment of two or more lung targets for well-suited patients. PMID:26500888

A Dosimetric Evaluation of The Eclipse and Pinnacle Treatment Planning Systems in Treatment of Vertebral Bodies Using IMRT and VMAT with Modeled and Commissioned Flattening Filter Free (FFF) Fields

NASA Astrophysics Data System (ADS)

Ajo, Ramzi, Jr.

Modern treatment planning systems (TPS's) utilize different algorithms in computing dose within the patient medium. The algorithms rely on properly modeled clinical setups in order to perform optimally. Aside from various parameters of the beam, modifiers, such as multileaf collimators (MLC's), must also be modeled properly. That could not be more true today, where dynamic delivery such as intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) are being increasingly utilized due to their ability to deliver higher dose precisely to the target while sparing more surrounding normal tissue. Two of the most popular TPS's, Pinnacle (Philips) and Eclipse (Varian), were compared, with special emphasis placed on parameterization of the dosimetric leaf gap (DLG) in Eclipse. The DLG is a parameter that accounts for Varian's rounded MLC leaf ends. While Pinnacle accounts for the rounded leaf end by modeling the MLC's, Eclipse uses a measured parameter. This study investigated whether a single value measured DLG is sufficient for dynamic delivery. Using five planning volumes for vertebral body SBRT treatments, each prescribed for 3000 cGy in 5 fractions, an array of 20 treatment plans was generated using varying energies of 6MV-FFF and 10MV-FFF. Treatment techniques consisted of 9-field Step-and-shoot IMRT, and dual-arc VMAT using patient specific optimization criteria in the Pinnacle TPS v9.8. Each plan was normalized to ensure coverage of 3000cGy to 95% of the target volume. The dose was computed in Pinnacle v9.8, with the Collapsed Cone Convolution Superposition algorithm and Eclipse v11, with the Acuros XB algorithm, using a dose grid resolution of 2 mm in both systems. Dose volume histograms (DVH's) were generated for a comparison of max and mean dose to the targets and spinal cord, as well as 95% coverage of the targets and the volume of the spinal cord receiving 14.5 Gy (V14.5). Patient specific quality assurance (PSQA) fields were generated and then delivered, using a Varian Edge linear accelerator, to a 4D QA phantom for a gamma analysis and distance to agreement (DTA) comparison. All Eclipse calculations were made for both measured and optimized DLG parameters. Calculated vs. measured point dose for the Pinnacle TPS had an average difference of 2.79 +/- 2.00%. Gamma analysis using a 3% and 3 mm DTA had 99/100 fields passing at > 95%. Using measured values of the DLG in Eclipse, calculated vs. measured point dose was -4.44 +/- 1.97%, and DTA had 33/110 fields passing at > 95%. After an optimization of the DLG in Eclipse, calculated vs. measured point dose had an average difference of 2.20 +/- 2.23%, and DTA with 95/110 fields passing at > 95%. This study looked at the performance of the Pinnacle and Eclipse TPS's, with special consideration given to the DLG parameterization used by Eclipse. The results support the idea that a single valued DLG is not sufficient for dynamic delivery. An optimization of the parameter is necessary to account for the high modulation of IMRT and VMAT techniques.

Sci-Fri PM: Radiation Therapy, Planning, Imaging, and Special Techniques - 02: Feasibility of using multileaf collimation for stereotactic radiosurgery of arteriovenous malformation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, Young; Ruschin, Mark

SRS using linac and cones offers steep dose fall-off but a tradeoff exists between conformality and treatment time, which depends on the number of isocentres. Purpose of this study is to quantify planning metrics between cones- and MLC-based SRS for arteriovenous malformation(AVM). Seven AVM cases treated with cones were re-planned with MLC on Pinnacle treatment planning system. Planning target volume(PTV) was created with 1mm uniform margin to the AVM to account for MLC positional variation. Clinically-planned prescription dose(15–25Gy) was used. Four plans were generated per case:non-coplanar VMAT(ncV), single-arc VMAT(saV), non-coplanar IMRT(ncI), non-coplanar conformal(ncC). Plans were compared for conformity(CI), heterogeneity(HI) andmore » gradient(GI) indices and brain doses. Estimated treatment times and monitor units(MU) were compared. Cone-based plans required 2–6 isocentres. Though CI-RTOG was similar for plans(median=0.98), CI-Paddick was most favourable for ncV(median=0.86) and worst for cones(0.54). HI for MLC plans(median=1.19–1.27) were lower than cone-based plans(1.43). GI was similar for all plans. For 2/7 ncC had brainstem maximum dose>16.7Gy and therefore were clinically unacceptable. Brain V12Gy,V10Gy,V2Gy were lowest in the cones plan. ncV brain V12Gy,V10Gy,V2Gy were lowest of all MLC-based plans studied. Treatment MUs were similar for MLC-based plans and up to 70% lower than clinically delivered plans. ncV showed best conformality in this study. Of the MLC-based plans, ncV also showed lowest normal tissue dose with reasonable treatment time.« less

An Analysis of Plan Robustness for Esophageal Tumors: Comparing Volumetric Modulated Arc Therapy Plans and Spot Scanning Proton Planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Warren, Samantha, E-mail: samantha.warren@oncology.ox.ac.uk; Partridge, Mike; Bolsi, Alessandra

Purpose: Planning studies to compare x-ray and proton techniques and to select the most suitable technique for each patient have been hampered by the nonequivalence of several aspects of treatment planning and delivery. A fair comparison should compare similarly advanced delivery techniques from current clinical practice and also assess the robustness of each technique. The present study therefore compared volumetric modulated arc therapy (VMAT) and single-field optimization (SFO) spot scanning proton therapy plans created using a simultaneous integrated boost (SIB) for dose escalation in midesophageal cancer and analyzed the effect of setup and range uncertainties on these plans. Methods andmore » Materials: For 21 patients, SIB plans with a physical dose prescription of 2 Gy or 2.5 Gy/fraction in 25 fractions to planning target volume (PTV){sub 50Gy} or PTV{sub 62.5Gy} (primary tumor with 0.5 cm margins) were created and evaluated for robustness to random setup errors and proton range errors. Dose–volume metrics were compared for the optimal and uncertainty plans, with P<.05 (Wilcoxon) considered significant. Results: SFO reduced the mean lung dose by 51.4% (range 35.1%-76.1%) and the mean heart dose by 40.9% (range 15.0%-57.4%) compared with VMAT. Proton plan robustness to a 3.5% range error was acceptable. For all patients, the clinical target volume D{sub 98} was 95.0% to 100.4% of the prescribed dose and gross tumor volume (GTV) D{sub 98} was 98.8% to 101%. Setup error robustness was patient anatomy dependent, and the potential minimum dose per fraction was always lower with SFO than with VMAT. The clinical target volume D{sub 98} was lower by 0.6% to 7.8% of the prescribed dose, and the GTV D{sub 98} was lower by 0.3% to 2.2% of the prescribed GTV dose. Conclusions: The SFO plans achieved significant sparing of normal tissue compared with the VMAT plans for midesophageal cancer. The target dose coverage in the SIB proton plans was less robust to random setup errors and might be unacceptable for certain patients. Robust optimization to ensure adequate target coverage of SIB proton plans might be beneficial.« less

An Analysis of Plan Robustness for Esophageal Tumors: Comparing Volumetric Modulated Arc Therapy Plans and Spot Scanning Proton Planning

PubMed Central

Warren, Samantha; Partridge, Mike; Bolsi, Alessandra; Lomax, Anthony J.; Hurt, Chris; Crosby, Thomas; Hawkins, Maria A.

2016-01-01

Purpose Planning studies to compare x-ray and proton techniques and to select the most suitable technique for each patient have been hampered by the nonequivalence of several aspects of treatment planning and delivery. A fair comparison should compare similarly advanced delivery techniques from current clinical practice and also assess the robustness of each technique. The present study therefore compared volumetric modulated arc therapy (VMAT) and single-field optimization (SFO) spot scanning proton therapy plans created using a simultaneous integrated boost (SIB) for dose escalation in midesophageal cancer and analyzed the effect of setup and range uncertainties on these plans. Methods and Materials For 21 patients, SIB plans with a physical dose prescription of 2 Gy or 2.5 Gy/fraction in 25 fractions to planning target volume (PTV)50Gy or PTV62.5Gy (primary tumor with 0.5 cm margins) were created and evaluated for robustness to random setup errors and proton range errors. Dose–volume metrics were compared for the optimal and uncertainty plans, with P<.05 (Wilcoxon) considered significant. Results SFO reduced the mean lung dose by 51.4% (range 35.1%-76.1%) and the mean heart dose by 40.9% (range 15.0%-57.4%) compared with VMAT. Proton plan robustness to a 3.5% range error was acceptable. For all patients, the clinical target volume D98 was 95.0% to 100.4% of the prescribed dose and gross tumor volume (GTV) D98 was 98.8% to 101%. Setup error robustness was patient anatomy dependent, and the potential minimum dose per fraction was always lower with SFO than with VMAT. The clinical target volume D98 was lower by 0.6% to 7.8% of the prescribed dose, and the GTV D98 was lower by 0.3% to 2.2% of the prescribed GTV dose. Conclusions The SFO plans achieved significant sparing of normal tissue compared with the VMAT plans for midesophageal cancer. The target dose coverage in the SIB proton plans was less robust to random setup errors and might be unacceptable for certain patients. Robust optimization to ensure adequate target coverage of SIB proton plans might be beneficial. PMID:27084641

An Analysis of Plan Robustness for Esophageal Tumors: Comparing Volumetric Modulated Arc Therapy Plans and Spot Scanning Proton Planning.

PubMed

Warren, Samantha; Partridge, Mike; Bolsi, Alessandra; Lomax, Anthony J; Hurt, Chris; Crosby, Thomas; Hawkins, Maria A

2016-05-01

Planning studies to compare x-ray and proton techniques and to select the most suitable technique for each patient have been hampered by the nonequivalence of several aspects of treatment planning and delivery. A fair comparison should compare similarly advanced delivery techniques from current clinical practice and also assess the robustness of each technique. The present study therefore compared volumetric modulated arc therapy (VMAT) and single-field optimization (SFO) spot scanning proton therapy plans created using a simultaneous integrated boost (SIB) for dose escalation in midesophageal cancer and analyzed the effect of setup and range uncertainties on these plans. For 21 patients, SIB plans with a physical dose prescription of 2 Gy or 2.5 Gy/fraction in 25 fractions to planning target volume (PTV)50Gy or PTV62.5Gy (primary tumor with 0.5 cm margins) were created and evaluated for robustness to random setup errors and proton range errors. Dose-volume metrics were compared for the optimal and uncertainty plans, with P<.05 (Wilcoxon) considered significant. SFO reduced the mean lung dose by 51.4% (range 35.1%-76.1%) and the mean heart dose by 40.9% (range 15.0%-57.4%) compared with VMAT. Proton plan robustness to a 3.5% range error was acceptable. For all patients, the clinical target volume D98 was 95.0% to 100.4% of the prescribed dose and gross tumor volume (GTV) D98 was 98.8% to 101%. Setup error robustness was patient anatomy dependent, and the potential minimum dose per fraction was always lower with SFO than with VMAT. The clinical target volume D98 was lower by 0.6% to 7.8% of the prescribed dose, and the GTV D98 was lower by 0.3% to 2.2% of the prescribed GTV dose. The SFO plans achieved significant sparing of normal tissue compared with the VMAT plans for midesophageal cancer. The target dose coverage in the SIB proton plans was less robust to random setup errors and might be unacceptable for certain patients. Robust optimization to ensure adequate target coverage of SIB proton plans might be beneficial. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Assessment of the Monitor Unit Objective tool for VMAT in the Eclipse treatment planning system.

PubMed

Jiménez-Puertas, Sara; Sánchez-Artuñedo, David; Hermida-López, Marcelino

2018-01-01

This work aims to achieve the highest possible monitor units (MU) reduction using the MU Objective tool included in the Eclipse treatment planning system, while preserving the plan quality. The treatment planning system Eclipse (Varian Medical Systems, Palo Alto, CA) includes a control mechanism for the number of monitor units of volumetric modulated arc therapy (VMAT) plans, named the MU Objective tool. Forty prostate plans, 20 gynecological plans and 20 head and neck plans designed with VMAT were retrospectively studied. Each plan ( base plan ) was optimized without using the MU Objective tool, and it was re-optimized with different values of the Maximum MU ( MaxMU ) parameter of the MU Objective tool. MU differences were analyzed with a paired samples t -test and changes in plan quality were assessed with a set of parameters for OARs and PTVs. The average relative MU difference [Formula: see text] considering all treatment sites, was the highest when MaxMU  = 400 (-4.2%, p  < 0.001). For prostate plans, the lowest [Formula: see text] was obtained (-3.7%, p  < 0.001). For head and neck plans [Formula: see text] was -7.3% ( p  < 0.001) and for gynecological plans [Formula: see text] was 7.0% ( p  = 0.002). Although similar MU reductions were observed for both sites, for some gynecological plans maximum differences were greater than 10%. All the assessed parameters for PTVs and OARs sparing showed average differences below 2%. For the three studied clinical sites, establishing MaxMU  = 400 led to the optimum MU reduction, maintaining the original dose distribution and dosimetric parameters practically unaltered.

Dosimetric comparison between VMAT with different dose calculation algorithms and protons for soft-tissue sarcoma radiotherapy.

PubMed

Fogliata, Antonella; Scorsetti, Marta; Navarria, Piera; Catalano, Maddalena; Clivio, Alessandro; Cozzi, Luca; Lobefalo, Francesca; Nicolini, Giorgia; Palumbo, Valentina; Pellegrini, Chiara; Reggiori, Giacomo; Roggio, Antonella; Vanetti, Eugenio; Alongi, Filippo; Pentimalli, Sara; Mancosu, Pietro

2013-04-01

To appraise the potential of volumetric modulated arc therapy (VMAT, RapidArc) and proton beams to simultaneously achieve target coverage and enhanced sparing of bone tissue in the treatment of soft-tissue sarcoma with adequate target coverage. Ten patients presenting with soft-tissue sarcoma of the leg were collected for the study. Dose was prescribed to 66.5 Gy in 25 fractions to the planning target volume (PTV) while significant maximum dose to the bone was constrained to 50 Gy. Plans were optimised according to the RapidArc technique with 6 MV photon beams or for intensity modulated protons. RapidArc photon plans were computed with: 1) AAA; 2) Acuros XB as dose to medium; and 3) Acuros XB as dose to water. All plans acceptably met the criteria of target coverage (V95% >90-95%) and bone sparing (D(1 cm3) <50 Gy). Significantly higher PTV dose homogeneity was found for proton plans. Near-to-maximum dose to bone was similar for RapidArc and protons, while volume receiving medium/low dose levels was minimised with protons. Similar results were obtained for the remaining normal tissue. Dose distributions calculated with the dose to water option resulted ~5% higher than corresponding ones computed as dose to medium. High plan quality was demonstrated for both VMAT and proton techniques when applied to soft-tissue sarcoma.

SU-D-19A-06: The Effect of Beam Parameters On Very High-Energy Electron Radiotherapy: A Planning Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Palma, B; Bazalova, M; Qu, B

Purpose: We evaluated the effect of very high-energy electron (VHEE) beam parameters on the planning of a lung cancer case by means of Monte Carlo simulations. Methods: We simulated VHEE radiotherapy plans using the EGSnrc/BEAMnrc-DOSXYZnrc code. We selected a lung cancer case that was treated with 6MV photon VMAT to be planned with VHEE. We studied the effect of beam energy (80 MeV, 100 MeV, and 120 MeV), number of equidistant beams (16 or 32), and beamlets sizes (3 mm, 5 mm or 7 mm) on PTV coverage, sparing of organs at risk (OARs) and dose conformity. Inverse-planning optimization wasmore » performed in a research version of RayStation (RaySearch Laboratories AB) using identical objective functions and constraints for all VHEE plans. Results: Similar PTV coverage and dose conformity was achieved by all the VHEE plans. The 100 MeV and 120 MeV VHEE plans were equivalent amongst them and were superior to the 80 MeV plan in terms of OARs sparing. The effect of using 16 or 32 equidistant beams was a mean difference in average dose of 2.4% (0%–7.7%) between the two plans. The use of 3 mm beamlet size systematically reduced the dose to all the OARs. Based on these results we selected the 100MeV-16beams-3mm-beamlet-size plan to compare it against VMAT. The selected VHEE plan was more conformal than VMAT and improved OAR sparing (heart and trachea received 125% and 177% lower dose, respectively) especially in the low-dose region. Conclusion: We determined the VHEE beam parameters that maximized the OAR dose sparing and dose conformity of the actually delivered VMAT plan of a lung cancer case. The selected parameters could be used for the planning of other treatment sites with similar size, shape, and location. For larger targets, a larger beamlet size might be used without significantly increasing the dose. B Palma: None. M Bazalova: None. B Hardemark: Employee, RaySearch Americas. E Hynning: Employee, RaySearch Americas. B Qu: None. B Loo Jr.: Research support, RaySearch, Varian. P Maxim: Research support, RaySearch, Varian.« less

The risk of radiation-induced second cancers in the high to medium dose region: a comparison between passive and scanned proton therapy, IMRT and VMAT for pediatric patients with brain tumors

NASA Astrophysics Data System (ADS)

Moteabbed, Maryam; Yock, Torunn I.; Paganetti, Harald

2014-06-01

The incidence of second malignant tumors is a clinically observed adverse late effect of radiation therapy, especially in organs close to the treatment site, receiving medium to high doses (>2.5 Gy). For pediatric patients, choosing the least toxic radiation modality is of utmost importance, due to their high radiosensitivity and small size. This study aims to evaluate the risk of second cancer incidence in the vicinity of the primary radiation field, for pediatric patients with brain/head and neck tumors and compare four treatment modalities: passive scattering and pencil beam scanning proton therapy (PPT and PBS), intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT). For a cohort of six pediatric patients originally treated with PPT, additional PBS, IMRT and VMAT plans were created. Dose distributions from these plans were used to calculate the excess absolute risk (EAR) and lifetime attributable risk (LAR) for developing a second tumor in soft tissue and skull. A widely used risk assessment formalism was employed and compared with a linear model based on recent clinical findings. In general, LAR was found to range between 0.01%-2.8% for PPT/PBS and 0.04%-4.9% for IMRT/VMAT. PBS was associated with the lowest risk for most patients using carcinoma and sarcoma models, whereas IMRT and VMAT risks were comparable and the highest among all modalities. The LAR for IMRT/VMAT relative to PPT ranged from 1.3-4.6 for soft tissue and from 3.5-9.5 for skull. Larger absolute LAR was observed for younger patients and using linear risk models. The number of fields used in proton therapy and IMRT had minimal effect on the risk. When planning treatments and deciding on the treatment modality, the probability of second cancer incidence should be carefully examined and weighed against the possibility of developing acute side effects for each patient individually.

SU-F-T-502: FFF Beams, Jaw-Tracking and Treatment Techniques: Out of Field Dose Considerations for Pediatric Radiation Therapy Delivery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ben Bouchta, Y; Bergman, A; Vancouver Cancer Center-British Columbia Cancer Agency, Vancouver, BC

Purpose: To compare the extended dose profile delivered by 3DCRT and VMAT techniques for flattened and flattening-filter-free(FFF) photon beams (6X, 6XFFF,10XFFF), with and without jaw-tracking (JT) on Varian TrueBeam linac. The goal is to determine which treatment technique/modality will minimize the peripheral photon dose exposure (and ultimately minimize the risk of second malignant neoplasms (SMN)) in pediatric patients. Methods: 3DCRT, VMAT, and jaw tracking VMAT (JTVMAT) plans with 6X, 6XFFF and 10XFFF x-ray beams were created on a 30×60×22.5cm solid water phantom with a 551 cc PTV. The 3DCRT plans consisted of a 4FLD arrangement. The optimization objectives for themore » single-arc VMAT plans was V95%Rx=98% to PTV and minimize dose to a 5cm diameter organ at risk (OAR). The OAR to PTV distance varied from 0–30cm along the long axis at 7.5cm depth. The dose to the center of the OAR was measured using a 0.6cc ion chamber. Results: Relative to the 6X flattened beam, the 10XFFF photon beam had the lowest dose in the penumbra and peripheral region (>15 cm) region by up to 20% and 40%, respectively for all modalities (3DCRT, VMAT, JTVMAT). The 6XFFF beams only showed a dose reduction in the peripheral region (by up to 20%). JT did not significantly affect the peripheral dose for all modalities and energies. Conclusion: Treating pediatric patients with a 10XFFF beam is the most effective way to reduce photon scatter dose in both the penumbra and peripheral regions. However, the neutron dose contribution resulting from the 10MV beam still needs to be considered. For all modalities, 6XFFF was the next effective method to reduce peripheral photon doses. 3DCRT beams had the lowest peripheral doses for all energies compared to VMAT and JTVMAT, however previous publications have shown that this comes at the expense of PTV conformity and OAR sparing.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, L; Wang, H; Kuang, Y

Purpose: To investigate the utility of {sup 18}F-choline positron emission tomography (PET) scans guidance for SBRT dose painting in patients with prostate cancer and its impact on tumor control probability (TCP) and normal tissue complication probability (NTCP). Methods: Twenty seven patients with localized prostate cancer who had {sup 18}F-choline PET/CT scan prior to treatment were included. A pair of nested intraprostatic dominant lesion (IDL) contours (IDL{sub suv60%} and IDL{sub suv70%}) were generated for each patient based on 60% and 70% of maximum prostate uptake on the {sup 18}F-choline PET images. GTV{sub reg} was delineated on prostate according to the glandmore » boundary seen on CT images. The PTVs (PTV{sub suv60%} and PTV{sub suv70%}) were defined as respective IDLs with a 3-mm margin posteriorly and 5 mm in all other dimensions. Two 5-fraction SBRT plans using VMAT technique along with 10 MV FFF beams, plan{sub 36Gy} and plan{sub 50–55Gy}, were generated for each patient. All plans included a dose of 36.25 Gy prescribed to PTV{sub reg}. The Plan{sub 50–55Gy} also included a simultaneous boost dose of 50 Gy and 55 Gy prescribed to the PTV{sub suv60%} and PTV{sub suv70%}, respectively. The utility of {sup 18}F-Choline PET-guided SBRT dose escalation was evaluated by its ability to achieve the prescription dose objectives while adhering to organ-at-risk (OAR) dose constraints. The TCP and NTCP calculated by radiological models were also compared between two plans for each patient. Results: In all 54 SBRT plans generated, the planning objectives and dose constraints were met without exception. Plan{sub 50–55Gy} had a significantly higher dose in PTV{sub suv60%} and PTV{sub suv70%} than those in Plan{sub 36Gy} (p < 0.05), respectively, while still maintaining a safe OAR sparing profile. In addition, plan{sub 50–55Gy} had significantly higher TCP than plan{sub 36Gy}. Conclusion: Using VMAT with FFF beams to incorporate a simultaneous {sup 18}F-choline PET-guided radiation boost dose up to 55 Gy into a SBRT plan is technically feasible. This work was supported in part by Congressionally Directed Medical Research Programs Prostate Cancer Research Program grant PC04130, National Institutes of Health/National Cancer Institute grant R41CA110121, and the UNLV Lincy Endowed Assistant Professorship.« less

Postoperative radiotherapy following mastectomy for patients with left-sided breast cancer: A comparative dosimetric study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Jiahao, E-mail: mashenglin@medmail.com.cn; Li, Xiadong; Deng, Qinghua

2015-10-01

The purposes of this article were to compare the biophysical dosimetry for postmastectomy left-sided breast cancer using 4 different radiotherapy (RT) techniques. In total, 30 patients with left-sided breast cancer were randomly selected for this treatment planning study. They were planned using 4 RT techniques, including the following: (1) 3-dimensional conventional tangential fields (TFs), (2) tangential intensity-modulated therapy (T-IMRT), (3) 4 fields IMRT (4F-IMRT), and (4) single arc volumetric-modulated arc therapy (S-VMAT). The planning target volume (PTV) dose was prescribed 50 Gy, the comparison of target dose distribution, conformity index, homogeneity index, dose to organs at risk (OARs), tumor controlmore » probability (TCP), normal tissue complication probability (NTCP), and number of monitor units (MUs) between 4 plans were investigated for their biophysical dosimetric difference. The target conformity and homogeneity of S-VMAT were better than the other 3 kinds of plans, but increased the volume of OARs receiving low dose (V{sub 5}). TCP of PTV and NTCP of the left lung showed no statistically significant difference in 4 plans. 4F-IMRT plan was superior in terms of target coverage and protection of OARs and demonstrated significant advantages in decreasing the NTCP of heart by 0.07, 0.03, and 0.05 compared with TFs, T-IMRT, and S-VMAT plan. Compared with other 3 plans, TFs reduced the average number of MUs. Of the 4 techniques studied, this analysis supports 4F-IMRT as the most appropriate balance of target coverage and normal tissue sparing.« less

TU-C-BRE-11: 3D EPID-Based in Vivo Dosimetry: A Major Step Forward Towards Optimal Quality and Safety in Radiation Oncology Practice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mijnheer, B; Mans, A; Olaciregui-Ruiz, I

Purpose: To develop a 3D in vivo dosimetry method that is able to substitute pre-treatment verification in an efficient way, and to terminate treatment delivery if the online measured 3D dose distribution deviates too much from the predicted dose distribution. Methods: A back-projection algorithm has been further developed and implemented to enable automatic 3D in vivo dose verification of IMRT/VMAT treatments using a-Si EPIDs. New software tools were clinically introduced to allow automated image acquisition, to periodically inspect the record-and-verify database, and to automatically run the EPID dosimetry software. The comparison of the EPID-reconstructed and planned dose distribution is donemore » offline to raise automatically alerts and to schedule actions when deviations are detected. Furthermore, a software package for online dose reconstruction was also developed. The RMS of the difference between the cumulative planned and reconstructed 3D dose distributions was used for triggering a halt of a linac. Results: The implementation of fully automated 3D EPID-based in vivo dosimetry was able to replace pre-treatment verification for more than 90% of the patient treatments. The process has been fully automated and integrated in our clinical workflow where over 3,500 IMRT/VMAT treatments are verified each year. By optimizing the dose reconstruction algorithm and the I/O performance, the delivered 3D dose distribution is verified in less than 200 ms per portal image, which includes the comparison between the reconstructed and planned dose distribution. In this way it was possible to generate a trigger that can stop the irradiation at less than 20 cGy after introducing large delivery errors. Conclusion: The automatic offline solution facilitated the large scale clinical implementation of 3D EPID-based in vivo dose verification of IMRT/VMAT treatments; the online approach has been successfully tested for various severe delivery errors.« less

Assessment of PlanIQ Feasibility DVH for head and neck treatment planning.

PubMed

Fried, David V; Chera, Bhishamjit S; Das, Shiva K

2017-09-01

Designing a radiation plan that optimally delivers both target coverage and normal tissue sparing is challenging. There are limited tools to determine what is dosimetrically achievable and frequently the experience of the planner/physician is relied upon to make these determinations. PlanIQ software provides a tool that uses target and organ at risk (OAR) geometry to indicate the difficulty of achieving different points for organ dose-volume histograms (DVH). We hypothesized that PlanIQ Feasibility DVH may aid planners in reducing dose to OARs. Clinically delivered head and neck treatments (clinical plan) were re-planned (re-plan) putting high emphasis on maximally sparing the contralateral parotid gland, contralateral submandibular gland, and larynx while maintaining routine clinical dosimetric objectives. The planner was blinded to the results of the clinically delivered plan as well as the Feasibility DVHs from PlanIQ. The re-plan treatments were designed using 3-arc VMAT in Raystation (RaySearch Laboratories, Sweden). The planner was then given the results from the PlanIQ Feasibility DVH analysis and developed an additional plan incorporating this information using 4-arc VMAT (IQ plan). The DVHs across the three treatment plans were compared with what was deemed "impossible" by PlanIQ's Feasibility DVH (Impossible DVH). The impossible DVH (red) is defined as the DVH generated using the minimal dose that any voxel outside the targets must receive given 100% target coverage. The re-plans performed blinded to PlanIQ Feasibilty DVH achieved superior sparing of aforementioned OARs compared to the clinically delivered plans and resulted in discrepancies from the impossible DVHs by an average of 200-700 cGy. Using the PlanIQ Feasibility DVH led to additionalOAR sparing compared to both the re-plans and clinical plans and reduced the discrepancies from the impossible DVHs to an average of approximately 100 cGy. The dose reduction from clinical to re-plan and re-plan to IQ plan were significantly different even when taking into account multiple hypothesis testing for both the contralateral parotid and the larynx (P < 0.004 for all comparisons). No significant differences were observed between the three plans for the contralateral parotid when considering multiple hypothesis testing. Clinical treatment plans and blinded re-plans were found to suboptimally spare OARs. PlanIQ could aid planners in generating treatment plans that push the limits of OAR sparing while maintaining routine clinical target coverage goals. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

SU-F-T-382: Volumetric Modulated Arc Therapy (VMAT) Beam Angle Optimization in Pulsed Partial Brain Irradiation (PPBI) for Newly Diagnosed Glioblastoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhou, J; Wang, Y; Ding, X

Purpose: To optimize VMAT beam parameters in PPBI to minimize treatment time. We investigate the coverage and organs at risk (OR) avoidance capability of shorter arcs with shorter treatment times. Methods: We evaluated the treatment plans for eleven previously treated PPBI patients. Each patient received 46Gy (2Gy×23) to the initial target and an additional 14Gy (2Gy×7) as a sequential boost. Each daily 2-Gy fraction was delivered as ten 0.2-Gy pulses separated by 3-minute intervals using VMAT. Each pulse was delivered using the same arc and covered at least 95% of the PTV with at least 95% of the prescription dose.more » To optimize the VMAT beam angle, an initial 360° full-arc VMAT plan was implemented. Beam control points and their corresponding dose rates were exported. A curve of the product of control point and dose rate was plotted against treatment beam angle. The optimum angle range was determined from this relationship. We chose the minimum continuous angle range that covered 85% of the area under the curve. Planning parameters, including treatment time for each pulse (T-pulse), PTV coverage, maximum dose (Dmax), homogeneity index (HI=D5/D95), R50 (50%IDL/PTV), and Dmax to ORs, were compared. Results: Mean PTV volume was 364.1±181.5cc. Mean T-pulse of partial-arc beams was 34.3±10.6s, vs. 63.0±1.7s (p<0.001) for that of full-arc beams. No significant differences were found for PTV V95, Dmax and R50, 99.4%±1.2% vs. 99.7%±0.5% (p=0.066), 108.0%±1.2% vs. 107.5%±1.1% (p=0.107), 2.95±0.38 vs. 2.87±0.35 (p=0.165), for the plans with partial-arc and full-arc beams, respectively. However, plans using full-arc do provide better PTV V100 and HI, 96.0%±3.0% vs. 97.2%±2.0% (p=0.025) and 1.06±0.03 vs. 1.04±0.01 (p=0.009). No significant difference was found on Dmax to ORs. Conclusion: PPBI with optimized partial-arc plans are clinically comparable to full-arc plans, while treatment time be significantly reduced, average saving of 287s for a 10-pulse treatment.« less

Toward a web-based real-time radiation treatment planning system in a cloud computing environment.

PubMed

Na, Yong Hum; Suh, Tae-Suk; Kapp, Daniel S; Xing, Lei

2013-09-21

To exploit the potential dosimetric advantages of intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), an in-depth approach is required to provide efficient computing methods. This needs to incorporate clinically related organ specific constraints, Monte Carlo (MC) dose calculations, and large-scale plan optimization. This paper describes our first steps toward a web-based real-time radiation treatment planning system in a cloud computing environment (CCE). The Amazon Elastic Compute Cloud (EC2) with a master node (named m2.xlarge containing 17.1 GB of memory, two virtual cores with 3.25 EC2 Compute Units each, 420 GB of instance storage, 64-bit platform) is used as the backbone of cloud computing for dose calculation and plan optimization. The master node is able to scale the workers on an 'on-demand' basis. MC dose calculation is employed to generate accurate beamlet dose kernels by parallel tasks. The intensity modulation optimization uses total-variation regularization (TVR) and generates piecewise constant fluence maps for each initial beam direction in a distributed manner over the CCE. The optimized fluence maps are segmented into deliverable apertures. The shape of each aperture is iteratively rectified to be a sequence of arcs using the manufacture's constraints. The output plan file from the EC2 is sent to the simple storage service. Three de-identified clinical cancer treatment plans have been studied for evaluating the performance of the new planning platform with 6 MV flattening filter free beams (40 × 40 cm(2)) from the Varian TrueBeam(TM) STx linear accelerator. A CCE leads to speed-ups of up to 14-fold for both dose kernel calculations and plan optimizations in the head and neck, lung, and prostate cancer cases considered in this study. The proposed system relies on a CCE that is able to provide an infrastructure for parallel and distributed computing. The resultant plans from the cloud computing are identical to PC-based IMRT and VMAT plans, confirming the reliability of the cloud computing platform. This cloud computing infrastructure has been established for a radiation treatment planning. It substantially improves the speed of inverse planning and makes future on-treatment adaptive re-planning possible.

Toward a web-based real-time radiation treatment planning system in a cloud computing environment

NASA Astrophysics Data System (ADS)

Hum Na, Yong; Suh, Tae-Suk; Kapp, Daniel S.; Xing, Lei

2013-09-01

To exploit the potential dosimetric advantages of intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT), an in-depth approach is required to provide efficient computing methods. This needs to incorporate clinically related organ specific constraints, Monte Carlo (MC) dose calculations, and large-scale plan optimization. This paper describes our first steps toward a web-based real-time radiation treatment planning system in a cloud computing environment (CCE). The Amazon Elastic Compute Cloud (EC2) with a master node (named m2.xlarge containing 17.1 GB of memory, two virtual cores with 3.25 EC2 Compute Units each, 420 GB of instance storage, 64-bit platform) is used as the backbone of cloud computing for dose calculation and plan optimization. The master node is able to scale the workers on an ‘on-demand’ basis. MC dose calculation is employed to generate accurate beamlet dose kernels by parallel tasks. The intensity modulation optimization uses total-variation regularization (TVR) and generates piecewise constant fluence maps for each initial beam direction in a distributed manner over the CCE. The optimized fluence maps are segmented into deliverable apertures. The shape of each aperture is iteratively rectified to be a sequence of arcs using the manufacture’s constraints. The output plan file from the EC2 is sent to the simple storage service. Three de-identified clinical cancer treatment plans have been studied for evaluating the performance of the new planning platform with 6 MV flattening filter free beams (40 × 40 cm2) from the Varian TrueBeamTM STx linear accelerator. A CCE leads to speed-ups of up to 14-fold for both dose kernel calculations and plan optimizations in the head and neck, lung, and prostate cancer cases considered in this study. The proposed system relies on a CCE that is able to provide an infrastructure for parallel and distributed computing. The resultant plans from the cloud computing are identical to PC-based IMRT and VMAT plans, confirming the reliability of the cloud computing platform. This cloud computing infrastructure has been established for a radiation treatment planning. It substantially improves the speed of inverse planning and makes future on-treatment adaptive re-planning possible.

Monaco and film dosimetry of 3D CRT, IMRT and VMAT cases in a realistic pelvic prosthetic phantom

NASA Astrophysics Data System (ADS)

Ade, Nicholas; du Plessis, F. C. P.

2018-04-01

The dosimetry of patients with metallic hip implants during irradiation of pelvic lesions is challenging due to dose distortions caused by implants. This work presents a dosimetric comparison of various multi-field photon-beam dose distributions in the presence of unilateral hip titanium prosthesis (UHTiP) embedded in a unique pelvic phantom made out of water-equivalent nylon slices. The impact of the UHTiP on the accuracy of dose calculations from a Monaco TPS (treatment planning system) using the X-ray voxel Monte Carlo (XVMC) algorithm was benchmarked against measured dose data using Gafchromic EBT3 film. Multi-field beam arrangements including a 4-field box, 5-field 3DCRT (three-dimensional conformal radiation therapy), 6-field IMRT (intensity modulated radiation therapy) and a single-arc VMAT (volumetric modulated arc therapy) plan were set up for 6 MV and 15 MV beams. These plans were generated for the pelvic phantom that contains the prosthesis with film inserted. Compared to Monaco TPS dose calculations, film measurements showed enhanced dose in the prosthesis which was not predicted by Monaco due to its limitation in relative density assignment. The enhanced prosthesis dose increased with increase in beam energy and decreased with the complexity of the treatment plans, with VMAT giving the least escalated dose. The dose increased between 5% and 19% for 6 MV and between 6% and 21% for 15 MV. A gamma index analysis showed that 70-92% of dose points (excluding the prosthesis) were within 3% discrepancy. Increasing the number of treatment fields increases target dose coverage and improves the agreement between film and Monaco. When the relative electron density (RED) in the prosthesis was varied between 3.72 and 15 the dose discrepancy between film and Monaco increased from 30% to 57% for 6 MV and from 30% to 50% for 15 MV. The study indicates that beam weights for fields that pass through the prosthesis should be minimised and its RED must be correct for accurate dose calculation on Monaco.

TH-AB-201-10: Portal Dosimetry with Elekta IViewDose:Performance of the Simplified Commissioning Approach Versus Full Commissioning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kydonieos, M; Folgueras, A; Florescu, L

2016-06-15

Purpose: Elekta recently developed a solution for in-vivo EPID dosimetry (iViewDose, Elekta AB, Stockholm, Sweden) in conjunction with the Netherlands Cancer Institute (NKI). This uses a simplified commissioning approach via Template Commissioning Models (TCMs), consisting of a subset of linac-independent pre-defined parameters. This work compares the performance of iViewDose using a TCM commissioning approach with that corresponding to full commissioning. Additionally, the dose reconstruction based on the simplified commissioning approach is validated via independent dose measurements. Methods: Measurements were performed at the NKI on a VersaHD™ (Elekta AB, Stockholm, Sweden). Treatment plans were generated with Pinnacle 9.8 (Philips Medical Systems,more » Eindhoven, The Netherlands). A farmer chamber dose measurement and two EPID images were used to create a linac-specific commissioning model based on a TCM. A complete set of commissioning measurements was collected and a full commissioning model was created.The performance of iViewDose based on the two commissioning approaches was compared via a series of set-to-work tests in a slab phantom. In these tests, iViewDose reconstructs and compares EPID to TPS dose for square fields, IMRT and VMAT plans via global gamma analysis and isocentre dose difference. A clinical VMAT plan was delivered to a homogeneous Octavius 4D phantom (PTW, Freiburg, Germany). Dose was measured with the Octavius 1500 array and VeriSoft software was used for 3D dose reconstruction. EPID images were acquired. TCM-based iViewDose and 3D Octavius dose distributions were compared against the TPS. Results: For both the TCM-based and the full commissioning approaches, the pass rate, mean γ and dose difference were >97%, <0.5 and <2.5%, respectively. Equivalent gamma analysis results were obtained for iViewDose (TCM approach) and Octavius for a VMAT plan. Conclusion: iViewDose produces similar results with the simplified and full commissioning approaches. Good agreement is obtained between iViewDose (simplified approach) and the independent measurement tool. This research is funded by Elekta Limited.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Huang, M; Brezovich, I; Duan, J

Purpose: To demonstrate a patient specific, image-guided quality assurance method that tests both dosimetric and geometric accuracy for single-isocenter multiple-target VMAT radiosurgery (SIMT-VMAT-SRS) Method: We used a new film type, EBT-XD (optimal range 0.4–40Gy), and an in-house PMMA phantom having a coronal plane for film and a 0.125 cm3 ionization chamber (IC). The phantom contained fiducial features for kV image guided setup and for accurate film marking. Five patient plans with multiple targets sizes ranging from 3 to 21mm in diameter and prescribed doses from 14 to 18 Gy were selected. Two verification plans were generated for each case withmore » the film plane passing through the center of the largest and smallest targets. For the four largest targets we obtained an IC measurement. For each case, a calibration film was irradiated using a custom designed step pattern. The films were scanned using a flatbed color scanner and converted to dose using the calibration film and the three channel calibration method. Image registration was performed between film and treatment planning system calculations to evaluate the geometric accuracy. Results: The mean registration vector had an average magnitude of 0.47 mm (range from 0.13mm to 0.64 mm). For the four largest targets, the mean ratio of the IC and film measurement to expected dose was 0.990 (range 0.968 to 1.009) and 1.032 (1.021 to 1.046), respectively. The fraction of pixels having gamma index < 1 for criteria of 3%/3mm, 3%/2mm, 3%/1mm was 98.8%, 97.5% and 87.2% before geometric registration and 99.1%, 98.3% and 94.8% after registration. Conclusion: We have demonstrated an image-guided QA method can assess both geometric and dosimetric accuracy. The phantom was positioned with sub-millimeter accuracy. Absolute film dosimetry using EBT-XD film was sufficiently accurate for assessment of dose to multi-targets too small for IC measurement in SRS VMAT plans.« less

Development and evaluation of a clinical model for lung cancer patients using stereotactic body radiotherapy (SBRT) within a knowledge-based algorithm for treatment planning.

PubMed

Chin Snyder, Karen; Kim, Jinkoo; Reding, Anne; Fraser, Corey; Gordon, James; Ajlouni, Munther; Movsas, Benjamin; Chetty, Indrin J

2016-11-08

The purpose of this study was to describe the development of a clinical model for lung cancer patients treated with stereotactic body radiotherapy (SBRT) within a knowledge-based algorithm for treatment planning, and to evaluate the model performance and applicability to different planning techniques, tumor locations, and beam arrangements. 105 SBRT plans for lung cancer patients previously treated at our institution were included in the development of the knowledge-based model (KBM). The KBM was trained with a combination of IMRT, VMAT, and 3D CRT techniques. Model performance was validated with 25 cases, for both IMRT and VMAT. The full KBM encompassed lesions located centrally vs. peripherally (43:62), upper vs. lower (62:43), and anterior vs. posterior (60:45). Four separate sub-KBMs were created based on tumor location. Results were compared with the full KBM to evaluate its robustness. Beam templates were used in conjunction with the optimizer to evaluate the model's ability to handle suboptimal beam placements. Dose differences to organs-at-risk (OAR) were evaluated between the plans gener-ated by each KBM. Knowledge-based plans (KBPs) were comparable to clinical plans with respect to target conformity and OAR doses. The KBPs resulted in a lower maximum spinal cord dose by 1.0 ± 1.6 Gy compared to clinical plans, p = 0.007. Sub-KBMs split according to tumor location did not produce significantly better DVH estimates compared to the full KBM. For central lesions, compared to the full KBM, the peripheral sub-KBM resulted in lower dose to 0.035 cc and 5 cc of the esophagus, both by 0.4Gy ± 0.8Gy, p = 0.025. For all lesions, compared to the full KBM, the posterior sub-KBM resulted in higher dose to 0.035 cc, 0.35 cc, and 1.2 cc of the spinal cord by 0.2 ± 0.4Gy, p = 0.01. Plans using template beam arrangements met target and OAR criteria, with an increase noted in maximum heart dose (1.2 ± 2.2Gy, p = 0.01) and GI (0.2 ± 0.4, p = 0.01) for the nine-field plans relative to KBPs planned with custom beam angles. A knowledge-based model for lung SBRT consisting of multiple treatment modalities and lesion loca-tions produced comparable plan quality to clinical plans. With proper training and validation, a robust KBM can be created that encompasses both IMRT and VMAT techniques, as well as different lesion locations. © 2016 The Authors.

Commissioning and quality assurance for VMAT delivery systems: An efficient time-resolved system using real-time EPID imaging.

PubMed

Zwan, Benjamin J; Barnes, Michael P; Hindmarsh, Jonathan; Lim, Seng B; Lovelock, Dale M; Fuangrod, Todsaporn; O'Connor, Daryl J; Keall, Paul J; Greer, Peter B

2017-08-01

An ideal commissioning and quality assurance (QA) program for Volumetric Modulated Arc Therapy (VMAT) delivery systems should assess the performance of each individual dynamic component as a function of gantry angle. Procedures within such a program should also be time-efficient, independent of the delivery system and be sensitive to all types of errors. The purpose of this work is to develop a system for automated time-resolved commissioning and QA of VMAT control systems which meets these criteria. The procedures developed within this work rely solely on images obtained, using an electronic portal imaging device (EPID) without the presence of a phantom. During the delivery of specially designed VMAT test plans, EPID frames were acquired at 9.5 Hz, using a frame grabber. The set of test plans was developed to individually assess the performance of the dose delivery and multileaf collimator (MLC) control systems under varying levels of delivery complexities. An in-house software tool was developed to automatically extract features from the EPID images and evaluate the following characteristics as a function of gantry angle: dose delivery accuracy, dose rate constancy, beam profile constancy, gantry speed constancy, dynamic MLC positioning accuracy, MLC speed and acceleration constancy, and synchronization between gantry angle, MLC positioning and dose rate. Machine log files were also acquired during each delivery and subsequently compared to information extracted from EPID image frames. The largest difference between measured and planned dose at any gantry angle was 0.8% which correlated with rapid changes in dose rate and gantry speed. For all other test plans, the dose delivered was within 0.25% of the planned dose for all gantry angles. Profile constancy was not found to vary with gantry angle for tests where gantry speed and dose rate were constant, however, for tests with varying dose rate and gantry speed, segments with lower dose rate and higher gantry speed exhibited less profile stability. MLC positional accuracy was not observed to be dependent on the degree of interdigitation. MLC speed was measured for each individual leaf and slower leaf speeds were shown to be compensated for by lower dose rates. The test procedures were found to be sensitive to 1 mm systematic MLC errors, 1 mm random MLC errors, 0.4 mm MLC gap errors and synchronization errors between the MLC, dose rate and gantry angle controls systems of 1°. In general, parameters measured by both EPID and log files agreed with the plan, however, a greater average departure from the plan was evidenced by the EPID measurements. QA test plans and analysis methods have been developed to assess the performance of each dynamic component of VMAT deliveries individually and as a function of gantry angle. This methodology relies solely on time-resolved EPID imaging without the presence of a phantom and has been shown to be sensitive to a range of delivery errors. The procedures developed in this work are both comprehensive and time-efficient and can be used for streamlined commissioning and QA of VMAT delivery systems. © 2017 American Association of Physicists in Medicine.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chang, Chiou-Shiung, E-mail: et000417@gmail.com; Department of Radiation Oncology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan; Hwang, Jing-Min

Stereotactic radiosurgery (SRS) is a well-established technique that is replacing whole-brain irradiation in the treatment of intracranial lesions, which leads to better preservation of brain functions, and therefore a better quality of life for the patient. There are several available forms of linear accelerator (LINAC)–based SRS, and the goal of the present study is to identify which of these techniques is best (as evaluated by dosimetric outcomes statistically) when the target is located adjacent to brainstem. We collected the records of 17 patients with lesions close to the brainstem who had previously been treated with single-fraction radiosurgery. In all, 5more » different lesion catalogs were collected, and the patients were divided into 2 distance groups—1 consisting of 7 patients with a target-to-brainstem distance of less than 0.5 cm, and the other of 10 patients with a target-to-brainstem distance of ≥ 0.5 and < 1 cm. Comparison was then made among the following 3 types of LINAC-based radiosurgery: dynamic conformal arcs (DCA), intensity-modulated radiosurgery (IMRS), and volumetric modulated arc radiotherapy (VMAT). All techniques included multiple noncoplanar beams or arcs with or without intensity-modulated delivery. The volume of gross tumor volume (GTV) ranged from 0.2 cm{sup 3} to 21.9 cm{sup 3}. Regarding the dose homogeneity index (HI{sub ICRU}) and conformity index (CI{sub ICRU}) were without significant difference between techniques statistically. However, the average CI{sub ICRU} = 1.09 ± 0.56 achieved by VMAT was the best of the 3 techniques. Moreover, notable improvement in gradient index (GI) was observed when VMAT was used (0.74 ± 0.13), and this result was significantly better than those achieved by the 2 other techniques (p < 0.05). For V{sub 4} {sub Gy} of brainstem, both VMAT (2.5%) and IMRS (2.7%) were significantly lower than DCA (4.9%), both at the p < 0.05 level. Regarding V{sub 2} {sub Gy} of normal brain, VMAT plans had attained 6.4 ± 5%; this was significantly better (p < 0.05) than either DCA or IMRS plans, at 9.2 ± 7% and 8.2 ± 6%, respectively. Owing to the multiple arc or beam planning designs of IMRS and VMAT, both of these techniques required higher MU delivery than DCA, with the averages being twice as high (p < 0.05). If linear accelerator is only 1 modality can to establish for SRS treatment. Based on statistical evidence retrospectively, we recommend VMAT as the optimal technique for delivering treatment to tumors adjacent to brainstem.« less

SU-F-T-433: Evaluation of a New Dose Mimicking Application for Clinical Flexibility and Reliability

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hoffman, D; Nair, C Kumaran; Wright, C

2016-06-15

Purpose: Clinical workflow and machine down time occasionally require patients to be temporarily treated on a system other than the initial treatment machine. A new commercial dose mimicking application provides automated cross-platform treatment planning to expedite this clinical flexibility. The aim of this work is to evaluate the feasibility of automatic plan creation and establish a robust clinical workflow for prostate and pelvis patients. Methods: Five prostate and five pelvis patients treated with helical plans were selected for re-planning with the dose mimicking application, covering both simple and complex scenarios. Two-arc VMAT and 7- and 9-field IMRT plans were generatedmore » for each case, with the objective function of achieving similar dose volume histogram from the initial helical plans. Dosimetric comparisons include target volumes and organs at risk (OARs) (rectum, bladder, small bowel, femoral heads, etc.). Dose mimicked plans were evaluated by a radiation oncologist, and patient-specific QAs were performed to validate delivery. Results: Overall plan generation and transfer required around 30 minutes of dosimetrist’s time once the dose-mimicking protocol is setup for each site. The resulting VMAT and 7- and 9-field IMRT plans achieved equivalent PTV coverage and homogeneity (D99/DRx = 97.3%, 97.2%, 97.2% and HI = 6.0, 5.8, and 5.9, respectively), compared to helical plans (97.6% and 4.6). The OAR dose discrepancies were up to 6% in rectum Dmean, but generally lower in bladder, femoral heads, bowel and penile bulb. In the context of 1–5 fractions, the radiation oncologist evaluated the dosimetric changes as not clinically significant. All delivery QAs achieved >90% pass with a 3%/3mm gamma criteria. Conclusion: The automated dose-mimicking workflow offers a strategy to avoid missing treatment fractions due to machine down time with non-clinically significant changes in dosimetry. Future work will further optimize dose mimicking plans and investigate other cross-platform treatment delivery options.« less

Assessment of three-dimensional setup errors in image-guided pelvic radiotherapy for uterine and cervical cancer using kilovoltage cone-beam computed tomography and its effect on planning target volume margins.

PubMed

Patni, Nidhi; Burela, Nagarjuna; Pasricha, Rajesh; Goyal, Jaishree; Soni, Tej Prakash; Kumar, T Senthil; Natarajan, T

2017-01-01

To achieve the best possible therapeutic ratio using high-precision techniques (image-guided radiation therapy/volumetric modulated arc therapy [IGRT/VMAT]) of external beam radiation therapy in cases of carcinoma cervix using kilovoltage cone-beam computed tomography (kV-CBCT). One hundred and five patients of gynecological malignancies who were treated with IGRT (IGRT/VMAT) were included in the study. CBCT was done once a week for intensity-modulated radiation therapy and daily in IGRT/VMAT. These images were registered with the planning CT scan images and translational errors were applied and recorded. In all, 2078 CBCT images were studied. The margins of planning target volume were calculated from the variations in the setup. The setup variation was 5.8, 10.3, and 5.6 mm in anteroposterior, superoinferior, and mediolateral direction. This allowed adequate dose delivery to the clinical target volume and the sparing of organ at risks. Daily kV-CBCT is a satisfactory method of accurate patient positioning in treating gynecological cancers with high-precision techniques. This resulted in avoiding geographic miss.

Assessing dose rate distributions in VMAT plans

NASA Astrophysics Data System (ADS)

Mackeprang, P.-H.; Volken, W.; Terribilini, D.; Frauchiger, D.; Zaugg, K.; Aebersold, D. M.; Fix, M. K.; Manser, P.

2016-04-01

Dose rate is an essential factor in radiobiology. As modern radiotherapy delivery techniques such as volumetric modulated arc therapy (VMAT) introduce dynamic modulation of the dose rate, it is important to assess the changes in dose rate. Both the rate of monitor units per minute (MU rate) and collimation are varied over the course of a fraction, leading to different dose rates in every voxel of the calculation volume at any point in time during dose delivery. Given the radiotherapy plan and machine specific limitations, a VMAT treatment plan can be split into arc sectors between Digital Imaging and Communications in Medicine control points (CPs) of constant and known MU rate. By calculating dose distributions in each of these arc sectors independently and multiplying them with the MU rate, the dose rate in every single voxel at every time point during the fraction can be calculated. Independently calculated and then summed dose distributions per arc sector were compared to the whole arc dose calculation for validation. Dose measurements and video analysis were performed to validate the calculated datasets. A clinical head and neck, cranial and liver case were analyzed using the tool developed. Measurement validation of synthetic test cases showed linac agreement to precalculated arc sector times within  ±0.4 s and doses  ±0.1 MU (one standard deviation). Two methods for the visualization of dose rate datasets were developed: the first method plots a two-dimensional (2D) histogram of the number of voxels receiving a given dose rate over the course of the arc treatment delivery. In similarity to treatment planning system display of dose, the second method displays the dose rate as color wash on top of the corresponding computed tomography image, allowing the user to scroll through the variation over time. Examining clinical cases showed dose rates spread over a continuous spectrum, with mean dose rates hardly exceeding 100 cGy min-1 for conventional fractionation. A tool to analyze dose rate distributions in VMAT plans with sub-second accuracy was successfully developed and validated. Dose rates encountered in clinical VMAT test cases show a continuous spectrum with a mean less than or near 100 cGy min-1 for conventional fractionation.

Critical appraisal of volumetric-modulated arc therapy compared with electrons for the radiotherapy of cutaneous Kaposi’s sarcoma of lower extremities with bone sparing

PubMed Central

Abraham, S; Fogliata, A; Jordaan, A; Clivio, A; Vanetti, E; Cozzi, L

2013-01-01

Objective: To evaluate the use of volumetric-modulated arc therapy [VMAT, RapidArc® (RA); Varian Medical Systems, Palo Alto, CA] for the treatment of cutaneous Kaposi’s sarcoma (KS) of lower extremities with adequate target coverage and high bone sparing, and to compare VMAT with electron beam therapy. Methods: 10 patients were planned with either RA or electron beams. The dose was prescribed to 30 Gy, 10 fractions, to mean the planning target volume (PTV), and significant maximum dose to bone was limited to 30 Gy. Plans were designed for 6-MV photon beams for RA and 6 MeV for electrons. Dose distributions were computed with AcurosXB® (Varian Medical Systems) for photons and with a Monte Carlo algorithm for electrons. Results: V90% was 97.3±1.2 for RA plans and 78.2±2.6 for electrons; similarly, V107% was 2.5±2.2 and 37.7±3.4, respectively. RA met coverage criteria. Concerning bone sparing, D2% was 29.6±1.1 for RA and 31.0±2.4 for electrons. Although acceptable for bone involvement, pronounced target coverage violations were obtained for electron plans. Monitor units were similar for electrons and RA, although for the latter they increased when superior bone sparing was imposed. Delivery times were 12.1±4.0 min for electrons and 4.8±1.3 min for the most modulated RA plans. Conclusion: High plan quality was shown for KS in the lower extremities using VMAT, and this might simplify their management in comparison with the more conventional usage of electrons, particularly in institutes with limited staff resources and heavy workloads. Advances in knowledge: VMAT is also dosimetrically extremely advantageous in a typology of treatments where electron beam therapy is mainly considered to be effective owing to the limited penetration of the beams. PMID:23392192

SU-E-T-489: Incorporating Skin Flash Into VMAT WBI: Impacts On Surface Dosimetry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Buele, A Bejarano; Tanny, S; Warrell, G

Purpose: Increased use of inverse planning limits the amount of skin flash in whole breast irradiation (WBI). Strategies to incorporate flash into inverse-planned treatments involve overriding air to the density of water or tissue. This introduces uncertainties to the superficial dose distribution, potentially degrading the coverage at the skin-bolus interface. We investigate the accuracy of various commonly used bolus materials to incorporate flash in VMAT WBI plans while minimizing the perturbation near the skin. Methods: We obtained a CT-simulation of an anthropomorphic phantom with a breast attachment. Three VMAT plans were created with different boluses: 1 cm of 1 g/cm{supmore » 3} bolus (Superflab), 1 cm of 0.65 g/cm{sup 3} bolus (wet towels), and 1 cm of g/cm{sup 3} bolus with 2 dose levels accounting for the difference between bolus and tissue density. The PTV was extended into the bolus, outside the patient body contour to incorporate flash. OSLDs were used to obtain surface doses at the medial, lateral and tip sites of the breast. Each plan was irradiated four times using CBCT for positioning and dosimeter localization. Results: The average thickness of the wet-towel bolus on delivery was 8 mm with a CBCT-measured density of 0.6 g/cm{sup 3}. OSLD measurements demonstrated good agreement with predicted doses from Pinnacle. Average deviations were −5.7%, −2.5%, and −2.6% for plans 1, 2, and 3, respectively. OSLDs placed at the medial and lateral portions of the breast showed the largest average deviations. The maximum recorded deviation from planned values was −8.6%. The largest dose fluctuations occurred near areas where the bolus failed to properly conform to the breast contour. Conclusion: Use of wet-towel bolus improved dose delivery accuracy compared to standard Superflab bolus. Areas of poor bolus conformity adversely affected dose delivery. We recommend the use of wet-towel bolus over Superflab bolus for VMAT WBI.« less

SU-E-T-436: Fluence-Based Trajectory Optimization for Non-Coplanar VMAT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smyth, G; Bamber, JC; Bedford, JL

2015-06-15

Purpose: To investigate a fluence-based trajectory optimization technique for non-coplanar VMAT for brain cancer. Methods: Single-arc non-coplanar VMAT trajectories were determined using a heuristic technique for five patients. Organ at risk (OAR) volume intersected during raytracing was minimized for two cases: absolute volume and the sum of relative volumes weighted by OAR importance. These trajectories and coplanar VMAT formed starting points for the fluence-based optimization method. Iterative least squares optimization was performed on control points 24° apart in gantry rotation. Optimization minimized the root-mean-square (RMS) deviation of PTV dose from the prescription (relative importance 100), maximum dose to the brainstemmore » (10), optic chiasm (5), globes (5) and optic nerves (5), plus mean dose to the lenses (5), hippocampi (3), temporal lobes (2), cochleae (1) and brain excluding other regions of interest (1). Control point couch rotations were varied in steps of up to 10° and accepted if the cost function improved. Final treatment plans were optimized with the same objectives in an in-house planning system and evaluated using a composite metric - the sum of optimization metrics weighted by importance. Results: The composite metric decreased with fluence-based optimization in 14 of the 15 plans. In the remaining case its overall value, and the PTV and OAR components, were unchanged but the balance of OAR sparing differed. PTV RMS deviation was improved in 13 cases and unchanged in two. The OAR component was reduced in 13 plans. In one case the OAR component increased but the composite metric decreased - a 4 Gy increase in OAR metrics was balanced by a reduction in PTV RMS deviation from 2.8% to 2.6%. Conclusion: Fluence-based trajectory optimization improved plan quality as defined by the composite metric. While dose differences were case specific, fluence-based optimization improved both PTV and OAR dosimetry in 80% of cases.« less

Comparison of forward- and back-projection in vivo EPID dosimetry for VMAT treatment of the prostate

NASA Astrophysics Data System (ADS)

Bedford, James L.; Hanson, Ian M.; Hansen, Vibeke N.

2018-01-01

In the forward-projection method of portal dosimetry for volumetric modulated arc therapy (VMAT), the integrated signal at the electronic portal imaging device (EPID) is predicted at the time of treatment planning, against which the measured integrated image is compared. In the back-projection method, the measured signal at each gantry angle is back-projected through the patient CT scan to give a measure of total dose to the patient. This study aims to investigate the practical agreement between the two types of EPID dosimetry for prostate radiotherapy. The AutoBeam treatment planning system produced VMAT plans together with corresponding predicted portal images, and a total of 46 sets of gantry-resolved portal images were acquired in 13 patients using an iViewGT portal imager. For the forward-projection method, each acquisition of gantry-resolved images was combined into a single integrated image and compared with the predicted image. For the back-projection method, iViewDose was used to calculate the dose distribution in the patient for comparison with the planned dose. A gamma index for 3% and 3 mm was used for both methods. The results were investigated by delivering the same plans to a phantom and repeating some of the deliveries with deliberately introduced errors. The strongest agreement between forward- and back-projection methods is seen in the isocentric intensity/dose difference, with moderate agreement in the mean gamma. The strongest correlation is observed within a given patient, with less correlation between patients, the latter representing the accuracy of prediction of the two methods. The error study shows that each of the two methods has its own distinct sensitivity to errors, but that overall the response is similar. The forward- and back-projection EPID dosimetry methods show moderate agreement in this series of prostate VMAT patients, indicating that both methods can contribute to the verification of dose delivered to the patient.

SU-E-T-295: Simultaneous Beam Sampling and Aperture Shape Optimization for Station Parameter Optimized Radiation Therapy (SPORT)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zarepisheh, M; Li, R; Xing, L

Purpose: Station Parameter Optimized Radiation Therapy (SPORT) was recently proposed to fully utilize the technical capability of emerging digital LINACs, in which the station parameters of a delivery system, (such as aperture shape and weight, couch position/angle, gantry/collimator angle) are optimized altogether. SPORT promises to deliver unprecedented radiation dose distributions efficiently, yet there does not exist any optimization algorithm to implement it. The purpose of this work is to propose an optimization algorithm to simultaneously optimize the beam sampling and aperture shapes. Methods: We build a mathematical model whose variables are beam angles (including non-coplanar and/or even nonisocentric beams) andmore » aperture shapes. To solve the resulting large scale optimization problem, we devise an exact, convergent and fast optimization algorithm by integrating three advanced optimization techniques named column generation, gradient method, and pattern search. Column generation is used to find a good set of aperture shapes as an initial solution by adding apertures sequentially. Then we apply the gradient method to iteratively improve the current solution by reshaping the aperture shapes and updating the beam angles toward the gradient. Algorithm continues by pattern search method to explore the part of the search space that cannot be reached by the gradient method. Results: The proposed technique is applied to a series of patient cases and significantly improves the plan quality. In a head-and-neck case, for example, the left parotid gland mean-dose, brainstem max-dose, spinal cord max-dose, and mandible mean-dose are reduced by 10%, 7%, 24% and 12% respectively, compared to the conventional VMAT plan while maintaining the same PTV coverage. Conclusion: Combined use of column generation, gradient search and pattern search algorithms provide an effective way to optimize simultaneously the large collection of station parameters and significantly improves quality of resultant treatment plans as compared with conventional VMAT or IMRT treatments.« less

SU-F-T-349: Dosimetric Comparison of Three Different Simultaneous Integrated Boost Irradiation Techniques for Multiple Brain Metastases: Intensity-Modulatedradiotherapy, Hybrid Intensity-Modulated Radiotherapy and Volumetric Modulated Arc Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lin, X; Sun, T; Yin, Y

Purpose: To study the dosimetric impact of intensity-modulated radiotherapy (IMRT), hybrid intensity-modulated radiotherapy (h-IMRT) and volumetric modulated arc therapy(VMAT) for whole-brain radiotherapy (WBRT) with simultaneous integrated boost in patients with multiple brain metastases. Methods: Ten patients with multiple brain metastases were included in this analysis. The prescribed dose was 45 Gy to the whole brain (PTVWBRT) and 55 Gy to individual brain metastases (PTVboost) delivered simultaneously in 25 fractions. Three treatment techniques were designed: the 7 equal spaced fields IMRT plan, hybrid IMRT plan and VMAT with two 358°arcs. In hybrid IMRT plan, two fields(90°and 270°) were planned to themore » whole brain. This was used as a base dose plan. Then 5 fields IMRT plan was optimized based on the two fields plan. The dose distribution in the target, the dose to the organs at risk and total MU in three techniques were compared. Results: For the target dose, conformity and homogeneity in PTV, no statistically differences were observed in the three techniques. For the maximum dose in bilateral lens and the mean dose in bilateral eyes, IMRT and h-IMRT plans showed the highest and lowest value respectively. No statistically significant differences were observed in the dose of optic nerve and brainstem. For the monitor units, IMRT and VMAT plans showed the highest and lowest value respectively. Conclusion: For WBRT with simultaneous integrated boost in patients with multiple brain metastases, hybrid IMRT could reduce the doses to lens and eyes. It is feasible for patients with brain metastases.« less

SU-E-T-392: Evaluation of Ion Chamber/film and Log File Based QA to Detect Delivery Errors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nelson, C; Mason, B; Kirsner, S

2015-06-15

Purpose: Ion chamber and film (ICAF) is a method used to verify patient dose prior to treatment. More recently, log file based QA has been shown as an alternative for measurement based QA. In this study, we delivered VMAT plans with and without errors to determine if ICAF and/or log file based QA was able to detect the errors. Methods: Using two VMAT patients, the original treatment plan plus 7 additional plans with delivery errors introduced were generated and delivered. The erroneous plans had gantry, collimator, MLC, gantry and collimator, collimator and MLC, MLC and gantry, and gantry, collimator, andmore » MLC errors. The gantry and collimator errors were off by 4{sup 0} for one of the two arcs. The MLC error introduced was one in which the opening aperture didn’t move throughout the delivery of the field. For each delivery, an ICAF measurement was made as well as a dose comparison based upon log files. Passing criteria to evaluate the plans were ion chamber less and 5% and film 90% of pixels pass the 3mm/3% gamma analysis(GA). For log file analysis 90% of voxels pass the 3mm/3% 3D GA and beam parameters match what was in the plan. Results: Two original plans were delivered and passed both ICAF and log file base QA. Both ICAF and log file QA met the dosimetry criteria on 4 of the 12 erroneous cases analyzed (2 cases were not analyzed). For the log file analysis, all 12 erroneous plans alerted a mismatch in delivery versus what was planned. The 8 plans that didn’t meet criteria all had MLC errors. Conclusion: Our study demonstrates that log file based pre-treatment QA was able to detect small errors that may not be detected using an ICAF and both methods of were able to detect larger delivery errors.« less

Towards real-time VMAT verification using a prototype, high-speed CMOS active pixel sensor.

PubMed

Zin, Hafiz M; Harris, Emma J; Osmond, John P F; Allinson, Nigel M; Evans, Philip M

2013-05-21

This work investigates the feasibility of using a prototype complementary metal oxide semiconductor active pixel sensor (CMOS APS) for real-time verification of volumetric modulated arc therapy (VMAT) treatment. The prototype CMOS APS used region of interest read out on the chip to allow fast imaging of up to 403.6 frames per second (f/s). The sensor was made larger (5.4 cm × 5.4 cm) using recent advances in photolithographic technique but retains fast imaging speed with the sensor's regional read out. There is a paradigm shift in radiotherapy treatment verification with the advent of advanced treatment techniques such as VMAT. This work has demonstrated that the APS can track multi leaf collimator (MLC) leaves moving at 18 mm s(-1) with an automatic edge tracking algorithm at accuracy better than 1.0 mm even at the fastest imaging speed. Evaluation of the measured fluence distribution for an example VMAT delivery sampled at 50.4 f/s was shown to agree well with the planned fluence distribution, with an average gamma pass rate of 96% at 3%/3 mm. The MLC leaves motion and linac pulse rate variation delivered throughout the VMAT treatment can also be measured. The results demonstrate the potential of CMOS APS technology as a real-time radiotherapy dosimeter for delivery of complex treatments such as VMAT.

Comparison of intensity-modulated radiotherapy and volumetric-modulated arc therapy dose measurement for head and neck cancer using optical stimulated luminescence dosimeter

NASA Astrophysics Data System (ADS)

Lai, Lu-Han; Chuang, Keh-Shih; Lin, Hsin-Hon; Liu, Yi-Chi; Kuo, Chiung-Wen; Lin, Jao-Perng

2017-11-01

The in-vivo dose distributions of intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT), a newly developed technique, for head and neck cancer have been investigated for several years. The present study used a head-and-neck RANDO phantom to simulate the clinical conditions of nasopharyngeal carcinoma and compare the radiation doses between VMAT and IMRT. Three types of planning target volume (PTV) profiles were targeted by reducing the PTV surface margin by 0, 3, and 5 mm. An optically stimulated luminescence dosimeter was used to measure the surface doses. The results revealed that VMAT provided on average 16.8-13.8% lower surface doses within the PTV target areas than IMRT. When the PTV margin was reduced by 0 mm, the surface doses for IMRT reached their maximum value, accounting for 75.1% of its prescribed dose (Dp); however, the Dp value of VMAT was only 61.1%. When the PTV margin was reduced by 3 or 5 mm, the surface doses decreased considerably. The observed surface doses were insufficient when the tumours invaded the body surface; however, VMAT exerted larger skin-sparing effects than IMRT when the tumours away from the skin. These results suggest that the skin doses for these two techniques are insufficient for surface tumours. Notably, VMAT can provide lower skin doses for deep tumours.

The NCS code of practice for the quality assurance and control for volumetric modulated arc therapy

NASA Astrophysics Data System (ADS)

Mans, Anton; Schuring, Danny; Arends, Mark P.; Vugts, Cornelia A. J. M.; Wolthaus, Jochem W. H.; Lotz, Heidi T.; Admiraal, Marjan; Louwe, Rob J. W.; Öllers, Michel C.; van de Kamer, Jeroen B.

2016-10-01

In 2010, the NCS (Netherlands Commission on Radiation Dosimetry) installed a subcommittee to develop guidelines for quality assurance and control for volumetric modulated arc therapy (VMAT) treatments. The report (published in 2015) has been written by Dutch medical physicists and has therefore, inevitably, a Dutch focus. This paper is a condensed version of these guidelines, the full report in English is freely available from the NCS website www.radiationdosimetry.org. After describing the transition from IMRT to VMAT, the paper addresses machine quality assurance (QA) and treatment planning system (TPS) commissioning for VMAT. The final section discusses patient specific QA issues such as the use of class solutions, measurement devices and dose evaluation methods.

SU-E-T-355: A Comparative Study of Robotic and Linac-Based Stereotactitc Body Radiation Therapy for Lumbar Spinal Tumors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bossart, E; Monterroso, M; Couto, M

Purpose: Dosimetrically compare CyberKnife (CK) and linac-based (LB) stereotactic body radiotherapy (SBRT) plans for lumbar spine. Methods: Ten patient plans with lumbar spine tumors treated with CK were selected and retrospectively optimized using three techniques: CK, volumetric modulated arc (VMAT, three arcs), and 9-field-intensity modulated radiotherapy (IMRT). For the LB plans, the target volume was expanded by 1mm to accommodate additional uncertainty in patient positioning. All plans were optimized to a prescription dose of 27Gy in 3 fractions covering 90% of the PTV. If the dose constraints to the cauda equina (cauda) were not met, the prescription dose was loweredmore » to 24Gy. Parameters evaluated included Paddick Conformity-Index (CI) and Gradient-Index (GI). A two-tailed paired t-test was used to establish statistically significant differences in cauda doses. Results: Target volumes for LB plans were on average 38% larger. In terms of the indices, the closer the index values to unity the steeper the dose falloff and the higher the dose conformity to the target. The results showed that LB plans were in general statistically superior to CK plans. The IMRT plan showed the best average gradient index of 2.995, with VMAT and CK GI values of 3.699 and 5.476, respectively. Similarly, the same trend occurs with the average CI results: 0.821, 0.814, and 0.758, corresponding to IMRT, VMAT, and CK. Notably, in one CK plan the target dose was reduced to 24Gy to meet cauda constraints. Additionally, there was a statistically significant dose difference for the cauda between the CK and LB plans. Conclusion: This study demonstrates that LB plans for lumbar spine SBRT can be as effective or even better than CK plans. Despite the expansion of the target volume, the LB plans did not demonstrate dosimetric inferiority. The LB plans Resultin 2-to-3 fold decrease of treatment time.« less

SU-E-T-312: Dosimetric Consideration for the Agility MLC When Planning Rotational SRT/SBRT Treatments

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kong, X; Harris, J; Spitznagel, D

2015-06-15

Purpose: To analyze the radiation transmission of the Agility MLC and make recommendation based on the MLC dosimetric characteristics for SRT, SBRT and VMAT planning Method and Materials: Agility MLC is the newest model from Elekta and has no back up diaphragm behind leaves for this generation. Leaves are single focused with rounded end; composed of leafs each 0.5cm wide, 9cm thick, constructed from tungsten alloy and provide low transmission <0.5%. Total radiation transmission from leaves and diaphragm is <0.13%. A 360degree arc was generated using iCom tools; leaves were programmed closed while keeping the diaphragm fully open to maximizemore » the MLC transmission effect. Gafchromic EBT films were sandwiched between 4cm of solid water and situated at midplane to take dose measurement. 5000MU was delivered using 6MV VersaHD, various collimator angles, and a 5cm central axis offset was tested also. Films were scanned with Epson 10000XL scanner and analyzed using DoseLab Pro. Results: Due to the rounded leaf end and nature of rotation therapy, dose accumulation through the leaf gap is significant. By offsetting the leaf gap from central axis, this accumulation can be greatly reduced. There are dark bands showing accumulation of interleaf transmission which is improved by increasing collimator angle from 0 to 45dgree. However for 45 degree, in most cases, there are larger volumes sweeping under MLC alone, which needs considered planning. Conclusions: While inter-leaf leakage is minimized by using collimator angles greater than 0 degrees, the location of the leaf gap must also be managed. The leaf gap position becomes critically important when the treatment area is off axis such is the case when more than one PTV is being treated. With VMAT for SRT, SBRT becoming a more popular planning technique, special attention needs to be paid when initially setting up the field geometry.« less

On the use of volumetric-modulated arc therapy for single-fraction thoracic vertebral metastases stereotactic body radiosurgery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pokhrel, Damodar, E-mail: damodar.pokhrel@uky.edu; Sood, Sumit; McClinton, Christopher

To retrospectively evaluate quality, efficiency, and delivery accuracy of volumetric-modulated arc therapy (VMAT) plans for single-fraction treatment of thoracic vertebral metastases using image-guided stereotactic body radiosurgery (SBRS) after RTOG 0631 dosimetric compliance criteria. After obtaining credentialing for MD Anderson spine phantom irradiation validation, 10 previously treated patients with thoracic vertebral metastases with noncoplanar hybrid arcs using 1 to 2 3D-conformal partial arcs plus 7 to 9 intensity-modulated radiation therapy beams were retrospectively re-optimized with VMAT using 3 full coplanar arcs. Tumors were located between T2 and T12. Contrast-enhanced T1/T2-weighted magnetic resonance images were coregistered with planning computed tomography and planningmore » target volumes (PTV) were between 14.4 and 230.1 cc (median = 38.0 cc). Prescription dose was 16 Gy in 1 fraction with 6 MV beams at Novalis-TX linear accelerator consisting of micro multileaf collimators. Each plan was assessed for target coverage using conformality index, the conformation number, the ratio of the volume receiving 50% of the prescription dose over PTV, R50%, homogeneity index (HI), and PTV-1600 coverage per RTOG 0631 requirements. Organs-at-risk doses were evaluated for maximum doses to spinal cord (D{sub 0.03} {sub cc}, D{sub 0.35} {sub cc}), partial spinal cord (D{sub 10%}), esophagus (D{sub 0.03} {sub cc} and D{sub 5} {sub cc}), heart (D{sub 0.03} {sub cc} and D{sub 15} {sub cc}), and lung (V{sub 5}, V{sub 10}, and maximum dose to 1000 cc of lung). Dose delivery efficiency and accuracy of each VMAT-SBRS plan were assessed using quality assurance (QA) plan on MapCHECK device. Total beam-on time was recorded during QA procedure, and a clinical gamma index (2%/2 mm and 3%/3 mm) was used to compare agreement between planned and measured doses. All 10 VMAT-SBRS plans met RTOG 0631 dosimetric requirements for PTV coverage. The plans demonstrated highly conformal and homogenous coverage of the vertebral PTV with mean HI, conformality index, conformation number, and R{sub 50%} values of 0.13 ± 0.03 (range: 0.09 to 0.18), 1.03 ± 0.04 (range: 0.98 to 1.09), 0.81 ± 0.06 (range: 0.72 to 0.89), and 4.2 ± 0.94 (range: 2.7 to 5.4), respectively. All 10 patients met protocol guidelines with maximum dose to spinal cord (average: 8.83 ± 1.9 Gy, range: 5.9 to 10.9 Gy); dose to 0.35 cc of spinal cord (average: 7.62 ± 1.7 Gy, range: 5.4 to 9.6 Gy); and dose to 10% of partial spinal cord (average 6.31 ± 1.5 Gy, range: 3.5 to 8.5 Gy) less than 14, 10, and 10 Gy, respectively. For all 10 patients, the maximum dose to esophagus (average: 9.41 ± 4.3 Gy, range: 1.5 to 14.9 Gy) and dose to 5 cc of esophagus (average: 7.43 ± 3.8 Gy, range: 1.1 to 11.8 Gy) were kept less than protocol requirements 16 Gy and 11.9 Gy, respectively. In a similar manner, all 10 patients met protocol compliance criteria with maximum dose to heart (average: 4.62 ± 3.5 Gy, range: 1.3 to 10.2 Gy) and dose to 15 cc of heart (average: 2.23 ± 1.8 Gy, range: 0.3 to 5.6 Gy) less than 22 and 16 Gy, respectively. The dose to the lung was retained much lower than protocol guidelines for all 10 patients. The total number of monitor units was, on average, 6919 ± 1187. The average beam-on time was 11.5 ± 2.0 minutes. The VMAT plans demonstrated dose delivery accuracy of 95.8 ± 0.7%, on average, for clinical gamma passing rate with 2%/2 mm criteria and 98.3 ± 0.8%, on average, with 3%/3 mm criteria. All VMAT-SBRS plans were considered clinically acceptable per RTOG 0631 dosimetric compliance criteria. VMAT planning provided highly conformal and homogenous dose distributions for the lower-dose vertebral PTV and the spinal cord as well as organs-at-risk such as esophagus, heart, and lung. Higher QA pass rates and shorter beam-on time suggest that VMAT-SBRS is a clinically feasible, fast, and effective treatment option for patients with thoracic vertebral metastases.« less

Marvin: an anatomical phantom for dosimetric evaluation of complex radiotherapy of the head and neck.

PubMed

Aitkenhead, A H; Rowbottom, C G; Mackay, R I

2013-10-07

We report on the design of Marvin, a Model Anatomy for Radiotherapy Verification and audit In the head and Neck and present results demonstrating its use in the development of the Elekta volumetric modulated arc therapy (VMAT) technique at the Christie, and in the audit of TomoTherapy and Varian RapidArc at other institutions. The geometry of Marvin was generated from CT datasets of eight male and female patients lying in the treatment position, with removable inhomogeneities modelling the sinuses and mandible. A modular system allows the phantom to be used with a range of detectors, with the locations of the modules being based on an analysis of a range of typical treatment plans (27 in total) which were mapped onto the phantom geometry. Results demonstrate the use of Gafchromic EBT2/EBT3 film for measurement of relative dose in a plane through the target and organs-at-risk, and the use of a small-volume ionization chamber for measurement of absolute dose in the target and spinal cord. Measurements made during the development of the head and neck VMAT protocol at the Christie quantified the improvement in plan delivery resulting from the installation of the Elekta Integrity upgrade (which permits an effectively continuously variable dose rate), with plans delivered before and after the upgrade having 88.5 ± 9.4% and 98.0 ± 2.2% respectively of points passing a gamma analysis (at 4%, 4 mm, global). Audits of TomoTherapy and Varian RapidArc neck techniques at other institutions showed a similar quality of plan delivery as for post-Integrity Elekta VMAT: film measurements for both techniques had >99% of points passing a gamma analysis at the clinical criteria of 4%, 4 mm, global, and >95% of points passing at tighter criteria of 3%, 3 mm, global; and absolute dose measurements in the PTV and spinal cord were within 1.5% and 3.5% of the planned doses respectively for both techniques. The results demonstrate that Marvin is an efficient and effective means of assessing the quality of delivery of complex radiotherapy in the head and neck, and is a useful tool to assist development and audit of these techniques.

Marvin: an anatomical phantom for dosimetric evaluation of complex radiotherapy of the head and neck

NASA Astrophysics Data System (ADS)

Aitkenhead, A. H.; Rowbottom, C. G.; Mackay, R. I.

2013-10-01

We report on the design of Marvin, a Model Anatomy for Radiotherapy Verification and audit In the head and Neck and present results demonstrating its use in the development of the Elekta volumetric modulated arc therapy (VMAT) technique at the Christie, and in the audit of TomoTherapy and Varian RapidArc at other institutions. The geometry of Marvin was generated from CT datasets of eight male and female patients lying in the treatment position, with removable inhomogeneities modelling the sinuses and mandible. A modular system allows the phantom to be used with a range of detectors, with the locations of the modules being based on an analysis of a range of typical treatment plans (27 in total) which were mapped onto the phantom geometry. Results demonstrate the use of Gafchromic EBT2/EBT3 film for measurement of relative dose in a plane through the target and organs-at-risk, and the use of a small-volume ionization chamber for measurement of absolute dose in the target and spinal cord. Measurements made during the development of the head and neck VMAT protocol at the Christie quantified the improvement in plan delivery resulting from the installation of the Elekta Integrity upgrade (which permits an effectively continuously variable dose rate), with plans delivered before and after the upgrade having 88.5 ± 9.4% and 98.0 ± 2.2% respectively of points passing a gamma analysis (at 4%, 4 mm, global). Audits of TomoTherapy and Varian RapidArc neck techniques at other institutions showed a similar quality of plan delivery as for post-Integrity Elekta VMAT: film measurements for both techniques had >99% of points passing a gamma analysis at the clinical criteria of 4%, 4 mm, global, and >95% of points passing at tighter criteria of 3%, 3 mm, global; and absolute dose measurements in the PTV and spinal cord were within 1.5% and 3.5% of the planned doses respectively for both techniques. The results demonstrate that Marvin is an efficient and effective means of assessing the quality of delivery of complex radiotherapy in the head and neck, and is a useful tool to assist development and audit of these techniques.

SU-E-T-583: Operated Left Breast and Chest Wall Radiotherapy: A Dosimetric Comparison Between 3DCRT, IMRT and VMAT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sarkar, B; Roy, S; Munshi, A

2015-06-15

Purpose: To evaluate the comparative dosimetric efficacy between field and field 3DCRT(FnF), multiple field Intensity modulated radiotherapy (SnS IMRT) and, partial arc volumetric modulated arc therapy (VMAT) in case of post operative left side breast and chest wall irradiation. Methods: CT study set of fifteen post-operative left breast and chest wall patient was tested for a treatment plan of 50Gy in 25 fraction using partial arc VMAT, SnSIMRT and tangential beam 3DCRT . 3DCRT FnF gantry angle was ranging for left medial tangential 290±17{sup 0} and Lt lateral tangential l14°±12{sup 0}. For IMRT four fixed beam at gantry angle G130{supmore » 0} G110{sup 0} G300{sup 0} and G330{sup 0} was used, in case of insufficient dose another beam G150{sup 0} was added. In case of partial arc VMAT, lateral tangential arc G130{sup 0}-G100{sup 0} and medial tangential arc G280{sup 0}-G310{sup 0}. Inverse optimization was opted to cover at least 95%PTV by 95% prescription dose (RxD) and a strong weightage on reduction of heart and lung dose. PTV coverage was evaluated for it’s clinically acceptability depending on the tumor spatial location and its quadrant. Out of the three plans, any one was used for the actual patient treatment. Results: Dosimetric analysis done for breast PTV, left lung, heart and the opposite breast. PTV mean dose and maximum dose was 5129.8±214.8cGy, 4749.0±329.7cGy, 5024.6±73.4cGy and 5855.2±510.7cGy, 5340.7±146.1cGy, 5347.2±196.8cGy for FnF, VMAT and IMRT respectively. Ipsilateral lung volume receiving 20Gy and 5Gy was 23.6±9.5cGy and 32.7±10.3cGy for FnF, 18.6±8.7cGy and 38.8±15.2cGy for VMAT and 25.7±9.6cGy and 50.7±8.4cGy for IMRT respectively. Heart mean and 2cc dose was 867.9±456.7cGy and 5038.5±184.3cGy for FnF, 532.6±263cGy and 3632.1±990.6 for VMAT, 711±229.9cGy and 4421±463.7cGy for IMRT respectively. VMAT shows minimum contralateral breast dose 168±113.8cGy. Conclusion: VMAT shows a better tumor conformity, minimum heart, ipsilateral lung and opposite breast dose. Cardiac Toxicity and risk of contralateral breast cancer can be reduce using VMAT.« less

Volumetric‐modulated arc therapy for the treatment of a large planning target volume in thoracic esophageal cancer

PubMed Central

Moseley, Douglas; Kassam, Zahra; Kim, Sun Mo; Cho, Charles

2013-01-01

Recently, volumetric‐modulated arc therapy (VMAT) has demonstrated the ability to deliver radiation dose precisely and accurately with a shorter delivery time compared to conventional intensity‐modulated fixed‐field treatment (IMRT). We applied the hypothesis of VMAT technique for the treatment of thoracic esophageal carcinoma to determine superior or equivalent conformal dose coverage for a large thoracic esophageal planning target volume (PTV) with superior or equivalent sparing of organs‐at‐risk (OARs) doses, and reduce delivery time and monitor units (MUs), in comparison with conventional fixed‐field IMRT plans. We also analyzed and compared some other important metrics of treatment planning and treatment delivery for both IMRT and VMAT techniques. These metrics include: 1) the integral dose and the volume receiving intermediate dose levels between IMRT and VMATI plans; 2) the use of 4D CT to determine the internal motion margin; and 3) evaluating the dosimetry of every plan through patient‐specific QA. These factors may impact the overall treatment plan quality and outcomes from the individual planning technique used. In this study, we also examined the significance of using two arcs vs. a single‐arc VMAT technique for PTV coverage, OARs doses, monitor units and delivery time. Thirteen patients, stage T2‐T3 N0‐N1 (TNM AJCC 7th edn.), PTV volume median 395 cc (range 281–601 cc), median age 69 years (range 53 to 85), were treated from July 2010 to June 2011 with a four‐field (n=4) or five‐field (n=9) step‐and‐shoot IMRT technique using a 6 MV beam to a prescribed dose of 50 Gy in 20 to 25 F. These patients were retrospectively replanned using single arc (VMATI, 91 control points) and two arcs (VMATII, 182 control points). All treatment plans of the 13 study cases were evaluated using various dose‐volume metrics. These included PTV D99, PTV D95, PTV V9547.5Gy(95%), PTV mean dose, Dmax, PTV dose conformity (Van't Riet conformation number (CN)), mean lung dose, lung V20 and V5, liver V30, and Dmax to the spinal canal prv3mm. Also examined were the total plan monitor units (MUs) and the beam delivery time. Equivalent target coverage was observed with both VMAT single and two‐arc plans. The comparison of VMATI with fixed‐field IMRT demonstrated equivalent target coverage; statistically no significant difference were found in PTV D99 (p=0.47), PTV mean (p=0.12), PTV D95 and PTV V9547.5Gy (95%) (p=0.38). However, Dmax in VMATI plans was significantly lower compared to IMRT (p=0.02). The Van't Riet dose conformation number (CN) was also statistically in favor of VMATI plans (p=0.04). VMATI achieved lower lung V20 (p=0.05), whereas lung V5 (p=0.35) and mean lung dose (p=0.62) were not significantly different. The other OARs, including spinal canal, liver, heart, and kidneys showed no statistically significant differences between the two techniques. Treatment time delivery for VMATI plans was reduced by up to 55% (p=5.8E−10) and MUs reduced by up to 16% (p=0.001). Integral dose was not statistically different between the two planning techniques (p=0.99). There were no statistically significant differences found in dose distribution of the two VMAT techniques (VMATI vs. VMATII) Dose statistics for both VMAT techniques were: PTV D99 (p=0.76), PTV D95 (p=0.95), mean PTV dose (p=0.78), conformation number (CN) (p=0.26), and MUs (p=0.1). However, the treatment delivery time for VMATII increased significantly by two‐fold (p=3.0E−11) compared to VMATI. VMAT‐based treatment planning is safe and deliverable for patients with thoracic esophageal cancer with similar planning goals, when compared to standard IMRT. The key benefit for VMATI was the reduction in treatment delivery time and MUs, and improvement in dose conformality. In our study, we found no significant difference in VMATII over single‐arc VMATI for PTV coverage or OARs doses. However, we observed significant increase in delivery time for VMATII compared to VMATI. PACS number: 87.53.Kn, 87.55.‐x PMID:23652258

Volumetric modulated arc therapy planning for primary prostate cancer with selective intraprostatic boost determined by 18F-choline PET/CT.

PubMed

Kuang, Yu; Wu, Lili; Hirata, Emily; Miyazaki, Kyle; Sato, Miles; Kwee, Sandi A

2015-04-01

This study evaluated expected tumor control and normal tissue toxicity for prostate volumetric modulated arc therapy (VMAT) with and without radiation boosts to an intraprostatically dominant lesion (IDL), defined by (18)F-choline positron emission tomography/computed tomography (PET/CT). Thirty patients with localized prostate cancer underwent (18)F-choline PET/CT before treatment. Two VMAT plans, plan79 Gy and plan100-105 Gy, were compared for each patient. The whole-prostate planning target volume (PTVprostate) prescription was 79 Gy in both plans, but plan100-105 Gy added simultaneous boost doses of 100 Gy and 105 Gy to the IDL, defined by 60% and 70% of maximum prostatic uptake on (18)F-choline PET (IDLsuv60% and IDLsuv70%, respectively, with IDLsuv70% nested inside IDLsuv60% to potentially enhance tumor specificity of the maximum point dose). Plan evaluations included histopathological correspondence, isodose distributions, dose-volume histograms, tumor control probability (TCP), and normal tissue complication probability (NTCP). Planning objectives and dose constraints proved feasible in 30 of 30 cases. Prostate sextant histopathology was available for 28 cases, confirming that IDLsuv60% adequately covered all tumor-bearing prostate sextants in 27 cases and provided partial coverage in 1 case. Plan100-105 Gy had significantly higher TCP than plan79 Gy across all prostate regions for α/β ratios ranging from 1.5 Gy to 10 Gy (P<.001 for each case). There were no significant differences in bladder and femoral head NTCP between plans and slightly lower rectal NTCP (endpoint: grade ≥ 2 late toxicity or rectal bleeding) was found for plan100-105 Gy. VMAT can potentially increase the likelihood of tumor control in primary prostate cancer while observing normal tissue tolerances through simultaneous delivery of a steep radiation boost to a (18)F-choline PET-defined IDL. Copyright © 2015 Elsevier Inc. All rights reserved.

SU-E-T-478: Sliding Window Multi-Criteria IMRT Optimization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Craft, D; Papp, D; Unkelbach, J

2014-06-01

Purpose: To demonstrate a method for what-you-see-is-what-you-get multi-criteria Pareto surface navigation for step and shoot IMRT treatment planning. Methods: We show mathematically how multiple sliding window treatment plans can be averaged to yield a single plan whose dose distribution is the dosimetric average of the averaged plans. This is incorporated into the Pareto surface navigation based approach to treatment planning in such a way that as the user navigates the surface, the plans he/she is viewing are ready to be delivered (i.e. there is no extra ‘segment the plans’ step that often leads to unacceptable plan degradation in step andmore » shoot Pareto surface navigation). We also describe how the technique can be applied to VMAT. Briefly, sliding window VMAT plans are created such that MLC leaves paint out fluence maps every 15 degrees or so. These fluence map leaf trajectories are averaged in the same way the static beam IMRT ones are. Results: We show mathematically that fluence maps are exactly averaged using our leaf sweep averaging algorithm. Leaf transmission and output factor corrections effects, which are ignored in this work, can lead to small errors in terms of the dose distributions not being exactly averaged even though the fluence maps are. However, our demonstrations show that the dose distributions are almost exactly averaged as well. We demonstrate the technique both for IMRT and VMAT. Conclusions: By turning to sliding window delivery, we show that the problem of losing plan fidelity during the conversion of an idealized fluence map plan into a deliverable plan is remedied. This will allow for multicriteria optimization that avoids the pitfall that the planning has to be redone after the conversion into MLC segments due to plan quality decline. David Craft partially funded by RaySearch Laboratories.« less

Optimal Patient Positioning (Prone Versus Supine) for VMAT in Gynecologic Cancer: A Dosimetric Study on the Effect of Different Margins

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heijkoop, Sabrina T., E-mail: s.heijkoop@erasmusmc.nl; Westerveld, Henrike; Bijker, Nina

Purpose/Objective: It is unknown whether the historically found dosimetric advantages of treating gynecologic cancer with the patient in a prone position with use of a small-bowel displacement device (belly-board) remain when volumetric arc therapy (VMAT) is used and whether these advantages depend on the necessary margin between clinical target volume (CTV) and planning target volume (PTV). The aim of this study is to determine the best patient position (prone or supine) in terms of sparing organs at risk (OAR) for various CTV-to-PTV margins and VMAT dose delivery. Methods and Materials: In an institutional review board—approved study, 26 patients with gynecologicmore » cancer scheduled for primary (9) or postoperative (17) radiation therapy were scanned in a prone position on a belly-board and in a supine position on the same day. The primary tumor CTV, nodal CTV, bladder, bowel, and rectum were delineated on both scans. The PTVs were created each with a different margin for the primary tumor and nodal CTV. The VMAT plans were generated with our in-house system for automated treatment planning. For all margin combinations, the supine and prone plans were compared with consideration of all OAR dose-volume parameters but with highest priority given to bowel cavity V{sub 45Gy} (cm{sup 3}). Results: For both groups, the prone position reduced the bowel cavity V{sub 45Gy}, in particular for nodal margins ≥10 mm (ΔV{sub 45Gy} = 23.9 ± 10.6 cm{sup 3}). However, for smaller margins, the advantage was much less pronounced (ΔV{sub 45Gy} = 6.5 ± 3.0 cm{sup 3}) and did not reach statistical significance. The rectum mean dose (D{sub mean}) was significantly lower (ΔD{sub mean} = 2.5 ± 0.3 Gy) in the prone position for both patient groups and for all margins, and the bladder D{sub mean} was significantly lower in the supine position (ΔD{sub mean} = 2.6 ± 0.4 Gy) only for the postoperative group. The advantage of the prone position was not present if it needed a larger margin than the supine position. Conclusion: For patients with gynecologic cancer, the historically found dosimetric advantages for the prone position remain for modern dose delivery techniques if large margins are needed. However, the advantage is lost for small margins and if the prone position needs a larger margin than the supine position.« less

Multicentre knowledge sharing and planning/dose audit on flattening filter free beams for SBRT lung

NASA Astrophysics Data System (ADS)

Hansen, C. R.; Sykes, J. R.; Barber, J.; West, K.; Bromley, R.; Szymura, K.; Fisher, S.; Sim, J.; Bailey, M.; Chrystal, D.; Deshpande, S.; Franji, I.; Nielsen, T. B.; Brink, C.; Thwaites, D. I.

2015-01-01

When implementing new technology into clinical practice, there will always be a need for large knowledge gain. The aim of this study was twofold, (I) audit the treatment planning and dose delivery of Flattening Filter Free (FFF) beam technology for Stereotactic Body Radiation Therapy (SBRT) of lung tumours across a range of treatment planning systems compared to the conventional Flatting Filter (FF) beams, (II) investigate how sharing knowledge between centres of different experience can improve plan quality. All vendor/treatment planning system (TPS) combinations investigated were able to produce acceptable treatment plans and the dose accuracy was clinically acceptable for all plans. By sharing knowledge between the different centres, the minor protocol violations (MPV) could be significantly reduced, from an average of 1.9 MPV per plan to 0.6 after such sharing of treatment planning knowledge. In particular, for the centres with less SBRT and/or volumetric- modulated arc therapy (VMAT) experience the MPV average per plan improved. All vendor/TPS combinations were also able to successfully deliver the FF and FFF SBRT VMAT plans. The plan quality and dose accuracy were found to be clinically acceptable.

SU-D-201-06: Remote Dosmetric Auditing of VMAT Deliveries for Clinical Trials Using EPID

DOE Office of Scientific and Technical Information (OSTI.GOV)

Legge, K; Miri, N; Lehmann, J

2016-06-15

Purpose: To develop a method for remote dosimetric auditing the delivery of VMAT using EPID which allows for simple, inexpensive and time efficient dosimetric credentialing for clinical trials. Methods: Remote centers are provided with CT datasets and planning guidelines to produce VMAT plans for a head and neck and a post-prostatectomy treatment. Plans are transferred in the planning system to two virtual water equivalent phantoms, one flat and one cylindrical. Cine images are acquired during VMAT delivery to the EPID in air with gantry angle recorded in image headers. Centers also deliver provided calibration plans to enable EPID signal tomore » dose conversion, determination of the central axis, and correction of EPID sag prior to analysis. EPID images and planned doses are sent to the central site. EPID cine images are converted to dose in the virtual phantoms using an established backprojection method (King et al., Med.Phys. 2012) with EPID backscatter correction. Individual arcs (with gantry angles collapsed to zero) are evaluated at 10 cm depth in the flat phantom using 2D gamma, and total doses are evaluated in the cylindrical phantom using 3D gamma. Results are reported for criteria of 3%,3mm, 3%,2mm and 2%,2mm for all points greater than 10% of global maximum. Results: The pilot study for Varian centers has commenced, and three centers have been audited for head and neck plans and two for post-prostatectomy plans to date. The mean pass rate for arc-by-arc 2D analysis at 3%,3mm is 99.5% and for 3D analysis is 95.8%. A method for Elekta linacs using an inclinometer for gantry angle information is under development. Conclusion: Preliminary results for this new method are promising. The method takes advantage of EPID equipment available at most centers and clinically established software to provide a feasible, low cost solution to credentialing centers for clinical trials. Funding has been provided from Calvary Mater Newcastle Department of Radiation Oncology, TROG Cancer Research and the University of Newcastle. Kimberley Legge is the recipient of an Australian Postgraduate Award. Narges Miri is a recipient of a University of Newcastle postgraduate scholarship.« less

SU-E-P-14: Dosimetric Effects of Magnetic Field in MRI-Guided Radiation Therapy Delivery for Breast Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, G; Currey, A; Li, X

2015-06-15

Purpose: MRI-guided radiation therapy (RT) delivery would be beneficial for breast irradiation. The electron return effect due to the presence of a transverse magnetic field (TMF) may cause dosimetric issues on dose on skin and at the lung-tissue interface. The purpose of this study is to investigate these issues. Methods: IMRT plans with tangential beams and VMAT plans with 200 degree arcs to cover ipsilateral breast were generated for 10 randomly selected breast cancer cases using a research planning system (Monaco, Elekta) utilizing Monte Carlo dose calculation with or without a TMF of 1.5 T. Plans were optimized to delivermore » uniform dose to the whole breast with an exclusion of 5 mm tissue under the skin (PTV-EVAL). All four plans for each patient were re-scaled to have the same PTV-EVAL volume to receive the same prescription dose. The skin is defined as the first 5 mm of ipsilateral-breast tissue, plus extensions in the surrounding region. Results: The presence of 1.5 T TMF resulted in (1)increased skin dose, with the mean and maximum skin dose increase of 5% and 9%, respectively; (2) similar dose homogeneity within the PTV-EVAL; (3) the slightly improved (3%) dose homogeneity in the whole breast; (4) Averages of 9 and 16% increases in V5 and V20, respectively, for ipsilateral lung; and (5) increased the mean heart dose by 34%. VMAT plans don’t improve whole breast dose uniformity as compared that to the tangential plans. Conclusion: The presence of transverse magnetic field in MRI-guided RT delivery for whole breast irradiation can Result in slightly improved dose homogeneity in the whole breast, increased dose to the ipsilateral lung, heart, and skin. Plan optimization with additional specific dose volume constraints may eliminate/reduce these dose increases. This work is partially supported by Elekta Inc.« less

SU-F-T-422: Detection of Optimal Tangential Partial Arc Span for VMAT Planning in IntactLeft-Breast Treatment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Giri, U; Sarkar, B; Munshi, A

Purpose: This study was designed to investigate an appropriate arc span for intact partial Left breast irradiation by VMAT planning. Methods: Four cases of carcinoma left intact breast was chosen randomly for this study. Both medial tangential and left-lateral tangential arc (G20°, G25°, G30°, G35°, G40°) were used having the same length and bilaterally symmetric. For each patient base plan was generated for 30° arc and rest of other arc plans were generated by keeping all plan parameters same, only arc span were changed. All patient plans were generated on treatment planning system Monaco (V 5.00.02) for 50 Gy dosemore » in 25 fractions. PTV contours were clipped 3 mm from skin (patient). All plans were normalized in such a way that 95 % of prescription dose would cover 96 % of PTV volume. Results: Mean MU for 20°, 25°, 30°, 35° and 40° were 509 ± 18.8, 529.1 ± 20.2, 544.4 ± 20.8, 579.1 ±51.8, 607.2 ± 40.2 similarly mean hot spot (volume covered by 105% of prescription dose) were 2.9 ± 1.2, 3.7 ± 3.0, 1.5 ± 1.7, 1.3±0.6, 0.4 ± 0.4, mean contralateral breast dose (cGy) were 180.4 ± 242.3, 71.5 ± 52.7, 76.2 ± 58.8, 85.9 ± 70.5, 90.7 ± 70.1, mean heart dose (cGy) were 285.8 ± 87.2, 221.2 ± 62.8, 274.5 ± 95.5, 234.8 ± 73.8, 263.2 ± 81.6, V20 for ipsilateral lung were 15.4 ± 5.3, 14.3 ± 3.6, 15.3 ± 2.9, 14.2 ± 3.9, 14.7 ± 3.2 and V5 for ipsilateral lung were 33.9 ± 8.2, 31.0 ± 3.5, 42.6 ±15.6, 36.4 ± 12.9, 37.0 ± 7.5. Conclusion: The study concluded that appropriate arc span used for tangential intact breast treatment was optimally 30° because larger arc span were giving lower isodose spill in ipsilateral lung and smaller arc were giving heterogeneous dose distribution in PTV.« less

SU-F-T-287: A Preliminary Study On Patient Specific VMAT Verification Using a Phosphor-Screen Based Geometric QA System (Raven QA)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lee, M; Yi, B; Wong, J

Purpose: The RavenQA system (LAP Laser, Germany) is a QA device with a phosphor screen detector for performing the QA tasks of TG-142. This study tested if it is feasible to use the system for the patient specific QA of the Volumetric Modulated Arc Therapy (VMAT). Methods: Water equivalent material (5cm) is attached to the front of the detector plate of the RavenQA for dosimetry purpose. Then the plate is attached to the gantry to synchronize the movement between the detector and the gantry. Since the detector moves together with gantry, The ’Reset gantry to 0’ function of the Eclipsemore » planning system (Varian, CA) is used to simulate the measurement situation when calculating dose of the detector plate. The same gantry setup is used when delivering the treatment beam for feasibility test purposes. Cumulative dose is acquired for each arc. The optical scatter component of each captured image from the CCD camera is corrected by deconvolving the 2D spatial invariant optical scatter kernel (OSK). We assume that the OSK is a 2D isotropic point spread function with inverse-squared decrease as a function of radius from the center. Results: Three cases of VMAT plans including head & neck, whole pelvis and abdomen-pelvis are tested. Setup time for measurements was less than 5 minutes. Passing rates of absolute gamma were 99.3, 98.2, 95.9 respectively for 3%/3mm criteria and 96.2, 97.1, 86.4 for 2%/2mm criteria. The abdomen-pelvis field has long treatment fields, 37cm, which are longer than the detector plate (25cm). This plan showed relatively lower passing rate than other plans. Conclusion: An algorithm for IMRT/VMAT verification using the RavenQA has been developed and tested. The model of spatially invariant OSK works well for deconvolution purpose. It is proved that the RavenQA can be used for the patient specific verification of VMAT. This work is funded in part by a Maryland Industrial Partnership Program grant to University of Maryland and to JPLC who owns the Raven technology. John Wong is a co-founder of JPLC.« less

Portal dosimetry for VMAT using integrated images obtained during treatment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bedford, James L., E-mail: James.Bedford@icr.ac.uk; Hanson, Ian M.; Hansen, Vibeke Nordmark

2014-02-15

Purpose: Portal dosimetry provides an accurate and convenient means of verifying dose delivered to the patient. A simple method for carrying out portal dosimetry for volumetric modulated arc therapy (VMAT) is described, together with phantom measurements demonstrating the validity of the approach. Methods: Portal images were predicted by projecting dose in the isocentric plane through to the portal image plane, with exponential attenuation and convolution with a double-Gaussian scatter function. Appropriate parameters for the projection were selected by fitting the calculation model to portal images measured on an iViewGT portal imager (Elekta AB, Stockholm, Sweden) for a variety of phantommore » thicknesses and field sizes. This model was then used to predict the portal image resulting from each control point of a VMAT arc. Finally, all these control point images were summed to predict the overall integrated portal image for the whole arc. The calculated and measured integrated portal images were compared for three lung and three esophagus plans delivered to a thorax phantom, and three prostate plans delivered to a homogeneous phantom, using a gamma index for 3% and 3 mm. A 0.6 cm{sup 3} ionization chamber was used to verify the planned isocentric dose. The sensitivity of this method to errors in monitor units, field shaping, gantry angle, and phantom position was also evaluated by means of computer simulations. Results: The calculation model for portal dose prediction was able to accurately compute the portal images due to simple square fields delivered to solid water phantoms. The integrated images of VMAT treatments delivered to phantoms were also correctly predicted by the method. The proportion of the images with a gamma index of less than unity was 93.7% ± 3.0% (1SD) and the difference between isocenter dose calculated by the planning system and measured by the ionization chamber was 0.8% ± 1.0%. The method was highly sensitive to errors in monitor units and field shape, but less sensitive to errors in gantry angle or phantom position. Conclusions: This method of predicting integrated portal images provides a convenient means of verifying dose delivered using VMAT, with minimal image acquisition and data processing requirements.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Thomas, S; Yuen, C; Huang, V

Purpose: In this abstract we implement and validate a 4D VMAT Acuros XB dose calculation using Gafchromic film. Special attention is paid to the physical material assignment in the CT dataset and to reported dose to water and dose to medium. Methods: A QUASAR phantom with a 3 cm sinusoidal tumor motion and 5 second period was scanned using 4D computed tomography. A CT was also obtained of the static QUASAR phantom with the tumor at the central position. A VMAT plan was created on the average CT dataset and was delivered on a Varian TrueBeam linear accelerator. The trajectorymore » log file from this treatment was acquired and used to create 10 VMAT subplans (one for each portion of the breathing cycle). Motion for each subplan was simulated by moving the beam isocentre in the superior/inferior direction in the Treatment Planning System on the static CT scan. The 10 plans were calculated (both dose to medium and dose to water) and summed for 1) the original HU values from the static CT scan and 2) the correct physical material assignment in the CT dataset. To acquire a breathing phase synchronized film measurements the trajectory log was used to create a VMAT delivery plan which includes dynamic couch motion using the Developer Mode. Three different treatment start phases were investigated (mid inhalation, full inhalation and full exhalation). Results: For each scenario the coronal dose distributions were measured using Gafchromic film and compared to the corresponding calculation with Film QA Pro Software using a Gamma test with a 3%/3mm distance to agreement criteria. Good agreement was found between calculation and measurement. No statistically significant difference in agreement was found between calculations to original HU values vs calculations to over-written (material-assigned) HU values. Conclusion: The investigated 4D dose calculation method agrees well with measurement.« less

WE-A-BRE-01: Debate: To Measure or Not to Measure

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moran, J; Miften, M; Mihailidis, D

2014-06-15

Recent studies have highlighted some of the limitations of patient-specific pre-treatment IMRT QA measurements with respect to assessing plan deliverability. Pre-treatment QA measurements are frequently performed with detectors in phantoms that do not involve any patient heterogeneities or with an EPID without a phantom. Other techniques have been developed where measurement results are used to recalculate the patient-specific dose volume histograms. Measurements continue to play a fundamental role in understanding the initial and continued performance of treatment planning and delivery systems. Less attention has been focused on the role of computational techniques in a QA program such as calculation withmore » independent dose calculation algorithms or recalculation of the delivery with machine log files or EPID measurements. This session will explore the role of pre-treatment measurements compared to other methods such as computational and transit dosimetry techniques. Efficiency and practicality of the two approaches will also be presented and debated. The speakers will present a history of IMRT quality assurance and debate each other regarding which types of techniques are needed today and for future quality assurance. Examples will be shared of situations where overall quality needed to be assessed with calculation techniques in addition to measurements. Elements where measurements continue to be crucial such as for a thorough end-to-end test involving measurement will be discussed. Operational details that can reduce the gamma tool effectiveness and accuracy for patient-specific pre-treatment IMRT/VMAT QA will be described. Finally, a vision for the future of IMRT and VMAT plan QA will be discussed from a safety perspective. Learning Objectives: Understand the advantages and limitations of measurement and calculation approaches for pre-treatment measurements for IMRT and VMAT planning Learn about the elements of a balanced quality assurance program involving modulated techniques Learn how to use tools and techniques such as an end-to-end test to enhance your IMRT and VMAT QA program.« less

Dosimetric validation and clinical implementation of two 3D dose verification systems for quality assurance in volumetric-modulated arc therapy techniques.

PubMed

Clemente-Gutiérrez, Francisco; Pérez-Vara, Consuelo

2015-03-08

A pretreatment quality assurance program for volumetric techniques should include redundant calculations and measurement-based verifications. The patient-specific quality assurance process must be based in clinically relevant metrics. The aim of this study was to show the commission, clinical implementation, and comparison of two systems that allow performing a 3D redundant dose calculation. In addition, one of them is capable of reconstructing the dose on patient anatomy from measurements taken with a 2D ion chamber array. Both systems were compared in terms of reference calibration data (absolute dose, output factors, percentage depth-dose curves, and profiles). Results were in good agreement for absolute dose values (discrepancies were below 0.5%) and output factors (mean differences were below 1%). Maximum mean discrepancies were located between 10 and 20 cm of depth for PDDs (-2.7%) and in the penumbra region for profiles (mean DTA of 1.5 mm). Validation of the systems was performed by comparing point-dose measurements with values obtained by the two systems for static, dynamic fields from AAPM TG-119 report, and 12 real VMAT plans for different anatomical sites (differences better than 1.2%). Comparisons between measurements taken with a 2D ion chamber array and results obtained by both systems for real VMAT plans were also performed (mean global gamma passing rates better than 87.0% and 97.9% for the 2%/2 mm and 3%/3 mm criteria). Clinical implementation of the systems was evaluated by comparing dose-volume parameters for all TG-119 tests and real VMAT plans with TPS values (mean differences were below 1%). In addition, comparisons between dose distributions calculated by TPS and those extracted by the two systems for real VMAT plans were also performed (mean global gamma passing rates better than 86.0% and 93.0% for the 2%/2 mm and 3%/ 3 mm criteria). The clinical use of both systems was successfully evaluated.

SU-C-BRA-01: 18F-NaF PET/CT-Directed Dose Escalation in Stereotactic Body Radiotherapy for Spine Oligometastases From Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wu, L; University of Nevada, Las Vegas, Las Vegas, NV; Zhang, W

2015-06-15

Purpose: To investigate the technical feasibility of SBRT dose painting using {sup 18}F-NaF positron emission tomography (PET) scans guidance in patients with spine oligometastases from prostate cancer. Methods: As a proof of concept, six patients with 14 spine oligometastatic lesions from prostate cancer who had {sup 18}F-NaF PET/CT scan prior to treatment were retrospectively included. GTV{sub reg} was delineated according to the regular tumor boundary shown on PET and/or CT images; and GTV{sub MATV} was contoured based on a net metabolically active tumor volume (MATV) defined by 60% of the SUV{sub max} values on {sup 18}F-NaF PET images. The PTVsmore » (PTV{sub reg} and PTV{sub MATV}) were defined as respective GTVs (plus involved entire vertebral body for PTV{sub reg}) with a 3-mm isotropic expansion margin. Three 1-fraction SBRT plans using VMAT technique along with 10 MV FFF beams (Plan{sub 24Gy}, Plan{sub 24–27Gy}, and Plan{sub 24–30Gy}) were generated for each patient. All plans included a dose of 24 Gy prescribed to PTV{sub reg}. The Plan{sub 24–27Gy} and Plan{sub 24–30Gy} also included a simultaneous boost dose of 27 Gy or 30 Gy prescribed to the PTV{sub MATV}, respectively. The feasibility of 18F-NaF PET-guided SBRT dose escalation was evaluated by its ability to achieve the prescription dose objectives while adhering to organ-at-risk (OAR) dose constraints. The normal tissue complication probabilities (NTCP) calculated by radiological models were also compared between the plans. Results: In all 33 SBRT plans generated, the planning objectives and dose constraints were met without exception. Plan{sub 24–27Gy} and Plan{sub 24–30Gy} had a significantly higher dose in PTV{sub MATV} than Plan{sub 24Gy} (p < 0.05), respectively, while maintaining a similar OAR sparing profile and NTCP values. Conclusion: Using VMAT with FFF beams to incorporate a simultaneous {sup 18}F-NaF PET-guided radiation boost dose up to 30 Gy into a SBRT plan is technically feasible. The relationship between local control and normal tissue toxicity in SBRT dose painting should be validated in clinical trials.« less

A Swiss cheese error detection method for real-time EPID-based quality assurance and error prevention.

PubMed

Passarge, Michelle; Fix, Michael K; Manser, Peter; Stampanoni, Marco F M; Siebers, Jeffrey V

2017-04-01

To develop a robust and efficient process that detects relevant dose errors (dose errors of ≥5%) in external beam radiation therapy and directly indicates the origin of the error. The process is illustrated in the context of electronic portal imaging device (EPID)-based angle-resolved volumetric-modulated arc therapy (VMAT) quality assurance (QA), particularly as would be implemented in a real-time monitoring program. A Swiss cheese error detection (SCED) method was created as a paradigm for a cine EPID-based during-treatment QA. For VMAT, the method compares a treatment plan-based reference set of EPID images with images acquired over each 2° gantry angle interval. The process utilizes a sequence of independent consecutively executed error detection tests: an aperture check that verifies in-field radiation delivery and ensures no out-of-field radiation; output normalization checks at two different stages; global image alignment check to examine if rotation, scaling, and translation are within tolerances; pixel intensity check containing the standard gamma evaluation (3%, 3 mm) and pixel intensity deviation checks including and excluding high dose gradient regions. Tolerances for each check were determined. To test the SCED method, 12 different types of errors were selected to modify the original plan. A series of angle-resolved predicted EPID images were artificially generated for each test case, resulting in a sequence of precalculated frames for each modified treatment plan. The SCED method was applied multiple times for each test case to assess the ability to detect introduced plan variations. To compare the performance of the SCED process with that of a standard gamma analysis, both error detection methods were applied to the generated test cases with realistic noise variations. Averaged over ten test runs, 95.1% of all plan variations that resulted in relevant patient dose errors were detected within 2° and 100% within 14° (<4% of patient dose delivery). Including cases that led to slightly modified but clinically equivalent plans, 89.1% were detected by the SCED method within 2°. Based on the type of check that detected the error, determination of error sources was achieved. With noise ranging from no random noise to four times the established noise value, the averaged relevant dose error detection rate of the SCED method was between 94.0% and 95.8% and that of gamma between 82.8% and 89.8%. An EPID-frame-based error detection process for VMAT deliveries was successfully designed and tested via simulations. The SCED method was inspected for robustness with realistic noise variations, demonstrating that it has the potential to detect a large majority of relevant dose errors. Compared to a typical (3%, 3 mm) gamma analysis, the SCED method produced a higher detection rate for all introduced dose errors, identified errors in an earlier stage, displayed a higher robustness to noise variations, and indicated the error source. © 2017 American Association of Physicists in Medicine.

Technical Note: Evaluation of plastic scintillator detector for small field stereotactic patient-specific quality assurance.

PubMed

Qin, Yujiao; Gardner, Stephen J; Kim, Joshua; Huang, Yimei; Wen, Ning; Doemer, Anthony; Chetty, Indrin J

2017-10-01

To evaluate the performance of a commercial plastic scintillator detector (PSD) for small-field stereotactic patient-specific quality assurance (QA) measurements using flattening-filter-free beam. A total of 10 spherical targets [volume range: (0.03 cc-2 cc)] were planned with two techniques: (a) dynamic conformal arc (DCA-10 plans) and (b) volumetric modulated arc therapy (VMAT-10 plans). All plans were generated using Varian Eclipse treatment planning system, and AcurosXB v.13 algorithm in 1.0 mm grid size. Additionally, 14 previously treated cranial and spine SRS plans were evaluated [6 DCA, 8 VMAT, volume range: (0.04 cc-119.02 cc)]. Plan modulation was quantified via two metrics: MU per prescription dose (MU/Rx) and Average Leaf Pair Opening (ALPO). QA was performed on the Varian Edge linear accelerator equipped with HDMLC. Three detectors were used: (a) PinPoint ion chamber (PTW; active volume 0.015 cc), (b) Exradin W1 PSD (Standard Imaging; active volume 0.002 cc), and (c) Gafchromic EBT3 film (Ashland). PinPoint chamber and PSD were positioned perpendicular to beam axis in a Lucy phantom (Standard Imaging); films were placed horizontally capturing the coronal plane. PSD, film, and PinPoint chamber measured average differences of 1.00 ± 1.54%, 1.30 ± 1.69%, and -0.66 ± 2.36%, respectively, compared to AcurosXB dose calculation. As the target volume decreased, PinPoint chamber measured lower doses (maximum -5.07% at 0.07 cc target), while PSD and film measured higher doses (2.87% and 2.54% at 0.03 cc target) than AcurosXB. Film agreed with the benchmark detector PSD by an average difference of 0.31 ± 1.20%, but suffered from larger uncertainty; PinPoint chamber underestimated dose by more than 4% for targets smaller than 0.2 cc. Taking PSD as the measurement standard, DCA plans achieved good QA results across all volumes studied, with an average of -0.07 ± 0.89%; for VMAT plans, PSD measured consistently higher dose (1.95 ± 1.36%) than AcurosXB. Correlation study revealed that plan modulation quantified by both MU/Rx and ALPO correlated significantly with QA results. Among all three detectors, PSD demonstrated superior performances in plans with small fields and heavy modulation. High consistency and low uncertainty made PSD a suitable detector for clinical routine SRS QA. PinPoint chamber should be avoided for targets smaller than 0.2 cc; film dosimetry can be utilized with careful evaluation of its uncertainty bracket. Compared to PSD measurements, AcurosXB calculation demonstrated high accuracy for nonmodulated small fields. The positive correlation between plan modulation and QA discrepancy calls for our attention for clinical SRS plans with high modulation. © 2017 American Association of Physicists in Medicine.

Initial characterization, dosimetric benchmark and performance validation of Dynamic Wave Arc.

PubMed

Burghelea, Manuela; Verellen, Dirk; Poels, Kenneth; Hung, Cecilia; Nakamura, Mitsuhiro; Dhont, Jennifer; Gevaert, Thierry; Van den Begin, Robbe; Collen, Christine; Matsuo, Yukinori; Kishi, Takahiro; Simon, Viorica; Hiraoka, Masahiro; de Ridder, Mark

2016-04-29

Dynamic Wave Arc (DWA) is a clinical approach designed to maximize the versatility of Vero SBRT system by synchronizing the gantry-ring noncoplanar movement with D-MLC optimization. The purpose of this study was to verify the delivery accuracy of DWA approach and to evaluate the potential dosimetric benefits. DWA is an extended form of VMAT with a continuous varying ring position. The main difference in the optimization modules of VMAT and DWA is during the angular spacing, where the DWA algorithm does not consider the gantry spacing, but only the Euclidian norm of the ring and gantry angle. A preclinical version of RayStation v4.6 (RaySearch Laboratories, Sweden) was used to create patient specific wave arc trajectories for 31 patients with various anatomical tumor regions (prostate, oligometatstatic cases, centrally-located non-small cell lung cancer (NSCLC) and locally advanced pancreatic cancer-LAPC). DWA was benchmarked against the current clinical approaches and coplanar VMAT. Each plan was evaluated with regards to dose distribution, modulation complexity (MCS), monitor units and treatment time efficiency. The delivery accuracy was evaluated using a 2D diode array that takes in consideration the multi-dimensionality of DWA during dose reconstruction. In centrally-located NSCLC cases, DWA improved the low dose spillage with 20 %, while the target coverage was increased with 17 % compared to 3D CRT. The structures that significantly benefited from using DWA were proximal bronchus and esophagus, with the maximal dose being reduced by 17 % and 24 %, respectively. For prostate and LAPC, neither technique seemed clearly superior to the other; however, DWA reduced with more than 65 % of the delivery time over IMRT. A steeper dose gradient outside the target was observed for all treatment sites (p < 0.01) with DWA. Except the oligometastatic cases, where the DWA-MCSs indicate a higher modulation, both DWA and VMAT modalities provide plans of similar complexity. The average ɣ (3 % /3 mm) passing rate for DWA plans was 99.2 ± 1 % (range from 96.8 to 100 %). DWA proven to be a fully functional treatment technique, allowing additional flexibility in dose shaping, while preserving dosimetrically robust delivery and treatment times comparable with coplanar VMAT.

Implementation of IMRT and VMAT using Delta4 phantom and portal dosimetry as dosimetry verification tools

DOE Office of Scientific and Technical Information (OSTI.GOV)

Daci, Lulzime, E-mail: lulzime.daci@nodlandssykehuset.no; Malkaj, Partizan, E-mail: malkaj-p@hotmail.com

2016-03-25

In this study we analyzed and compared the dose distribution of different IMRT and VMAT plans with the intent to provide pre-treatment quality assurance using two different tools. Materials/Methods: We have used the electronic portal imaging device EPID after calibration to dose and correction for the background offset signal and also the Delta4 phantom after en evaluation of angular sensitivity. The Delta4 phantom has a two-dimensional array with ionization chambers. We analyzed three plans for each anatomical site calculated by Eclipse treatment planning system. The measurements were analyzed using γ-evaluation method with passing criteria 3% absolute dose and 3 mm distancemore » to agreement (DTA). For all the plans the range of score has been from 97% to 99% for gantry fixed at 0° while for rotational planes there was a slightly decreased pass rates and above 95%. Point measurement with a ionization chamber were done in additional to see the accuracy of portal dosimetry and to evaluate the Delta4 device to various dose rates. Conclusions: Both Delt4 and Portal dosimetry shows good results between the measured and calculated doses. While Delta4 is more accurate in measurements EPID is more time efficient. We have decided to use both methods in the first steps of IMRT and VMAT implementation and later on to decide which of the tools to use depending on the complexity of plans, how much accurate we want to be and the time we have on the machine.« less

Minimizing dose variation from the interplay effect in stereotactic radiation therapy using volumetric modulated arc therapy for lung cancer.

PubMed

Kubo, Kazuki; Monzen, Hajime; Tamura, Mikoto; Hirata, Makoto; Ishii, Kentaro; Okada, Wataru; Nakahara, Ryuta; Kishimoto, Shun; Kawamorita, Ryu; Nishimura, Yasumasa

2018-03-01

It is important to improve the magnitude of dose variation that is caused by the interplay effect. The aim of this study was to investigate the impact of the number of breaths (NBs) to the dose variation for VMAT-SBRT to lung cancer. Data on respiratory motion and multileaf collimator (MLC) sequence were collected from the cases of 30 patients who underwent radiotherapy with VMAT-SBRT for lung cancer. The NBs in the total irradiation time with VMAT and the maximum craniocaudal amplitude of the target were calculated. The MLC sequence complexity was evaluated using the modulation complexity score for VMAT (MCSv). Static and dynamic measurements were performed using a cylindrical respiratory motion phantom and a micro ionization chamber. The 1 standard deviation which were obtained from 10 dynamic measurements for each patient were defined as dose variation caused by the interplay effect. The dose distributions were also verified with radiochromic film to detect undesired hot and cold dose spot. Dose measurements were also performed with different NBs in the same plan for 16 patients in 30 patients. The correlations between dose variations and parameters assessed for each treatment plan including NBs, MCSv, the MCSv/amplitude quotient (TMMCSv), and the MCSv/amplitude quotient × NBs product (IVS) were evaluated. Dose variation was decreased with increasing NBs, and NBs of >40 times maintained the dose variation within 3% in 15 cases. The correlation between dose variation and IVS which were considered NBs was shown stronger (R 2  = 0.43, P < 0.05) than TMMCSv (R 2  = 0.32, P < 0.05). The NBs is an important factor to reduce the dose variation. The patient who breathes >40 times during irradiation of two partial arcs VMAT (i.e., NBs = 16 breaths per minute) may be suitable for VMAT-SBRT for lung cancer. © 2018 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

MO-DE-210-07: Investigation of Treatment Interferences of a Novel Robotic Ultrasound Radiotherapy Guidance System with Clinical VMAT Plans for Liver SBRT Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gong, R; Bruder, R; Schweikard, A

Purpose: To evaluate the proportion of liver SBRT cases in which robotic ultrasound image guidance concurrent with beam delivery can be deployed without interfering with clinically used VMAT beam configurations. Methods: A simulation environment incorporating LINAC, couch, planning CT, and robotic ultrasound guidance hardware was developed. Virtual placement of the robotic ultrasound hardware was guided by a target visibility map rendered on the CT surface. The map was computed on GPU by using the planning CT to simulate ultrasound propagation and attenuation along rays connecting skin surface points to a rasterized imaging target. The visibility map was validated in amore » prostate phantom experiment by capturing live ultrasound images of the prostate from different phantom locations. In 20 liver SBRT patients treated with VMAT, the simulation environment was used to place the robotic hardware and ultrasound probe at imaging locations indicated on the visibility map. Imaging targets were either entire PTV (range 5.9–679.5 ml) or entire GTV (range 0.9–343.4 ml). Presence or absence of mechanical collisions with LINAC, couch, and patient body as well as interferences with treated beams were recorded. Results: For PTV targets, robotic ultrasound guidance without mechanical collision was possible in 80% of the cases and guidance without beam interference was possible in 60% of the cases. For the smaller GTV targets, these proportions were 95% and 85% correspondingly. GTV size (1/20), elongated shape (1/20), and depth (1/20) were the main factors limiting the availability of non-interfering imaging positions. Conclusion: This study indicates that for VMAT liver SBRT, robotic ultrasound tracking of a relevant internal target would be possible in 85% of cases while using treatment plans currently deployed in the clinic. With beam re-planning in accordance with the presence of robotic ultrasound guidance, intra-fractional ultrasound guidance may be an option for 95% of the liver SBRT cases. This project was funded by NIH Grant R41CA174089.« less

SU-E-T-269: Quality Assurance of Spine Volumetric Modulated Arc Therapy with Flattening Filter Free Beams Using Gafchromic EBT3 Films

DOE Office of Scientific and Technical Information (OSTI.GOV)

Choi, Y; Cho, B; Kwak, J

2014-06-01

Purpose: We implemented the Gafchromic film-based patient specific QA of volumetric modulated arc therapy (VMAT) with flattening-filter free (FFF) beams for spine metastases and validated the accuracy of fast arc delivery. Methods: EBT3 films and a homemade cylindrical QA phantom were employed for dosimetric verification of VMATs. For 14 FFF VMAT plans (10 with 10-MV FFF beams and 4 with 6-MV FFF beams), the doses were recalculated on the phantom and delivered by a TrueBeam STx accelerator equipped with a high-definition 120 leaf MLC. The EBT3 films were scanned using an Epson 10000XL scanner through the FilmQA Pro software. Allmore » the irradiated film images were converted to dose map using a calibration response curve. The resulting dose map of film measurement was compared with treatment plan and evaluated using gamma analysis with dose tolerance of 2% within 2 mm. In addition, the point-dose measurement in the phantom using an ion chamber was evaluated as a reference in a ratio of measured and planned doses. Results: The gamma pass rates averaged over all FFF plans for composite-field measurements were 96.0 ± 3.6% (88.9%–99.5%). When adopting a tolerance level of 3% - 3 mm, the gamma pass rates were improved with the ranges from 98% to 100%. In addition, dose profiles and dose distributions showed that spinal cord was protected by the rapid dose fall-off and by delivering the treatment with high precision. In point-dose measurements, the average differences between the measured and planned doses were 0.5% ± 1.0% of the prescription dose. Conclusion: We demonstrated that Gafchromic EBT3 film would be an effective patient-specific QA tool, especially for VMAT of spine SBRT with treatment of small fields and highly gradient dose distributions. The results of film QA verified that the dosimetric accuracy of spine SBRT utilizing RapidArc with FFF beams in our institution is reliable.« less

SU-E-T-215: Comparison of VMAT-SABR Treatment Plans with Flattened Filter (FF) Beam and Flattening Filter-Free (FFF) Beam for Localized Prostate Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chung, J; Kim, J; Kang, S

2015-06-15

Purpose: The purpose of this study is to access VMAT-SABR plan using flattening filter (FF) and flattening filter-free (FFF) beam, and compare the verification results for all pretreatment plans. Methods: SABR plans for 20 prostate patients were optimized in the Eclipse treatment planning system. A prescription dose was 42.7 Gy/7 fractions. Four SABR plans for each patient were calculated using Acuros XB algorithm with both FF and FFF beams of 6- and 10-MV. The dose-volume histograms (DVH) and technical parameters were recorded and compared. A pretreatment verification was performed and the gamma analysis was used to quantify the agreement betweenmore » calculations and measurements. Results: For each patient, the DVHs are closely similar for plans of four different beams. There are small differences showed in dose distributions and corresponding DVHs when comparing the each plan related to the same patient. Sparing on bladder and rectum was slightly better on plans with 10-MV FF and FFF than with 6-MV FF and FFF, but this difference was negligible. However, there was no significance in the other OARs. The mean agreement of 3%/3mm criteria was higher than 97% in all plans. The mean MUs and deliver time employed was 1701±101 and 3.02±0.17 min for 6-MV FF, 1870±116 and 1.69±0.08 min for 6-MV FFF, 1471±86 and 2.68±0.14 min for 10-MV FF, and 1619±101 and 0.98±0.04 min for 10-MV FFF, respectively. Conclusion: Dose distributions on prostate SABR plans using FFF beams were similar to those generated by FF beams. However, the use of FFF beam offers a clear benefit in delivery time when compared to FF beam. Verification of pretreatment also represented the acceptable and comparable results in all plans using FF beam as well as FFF beam. Therefore, this study suggests that the use of FFF beam is feasible and efficient technique for prostate SABR.« less

An efficient inverse radiotherapy planning method for VMAT using quadratic programming optimization.

PubMed

Hoegele, W; Loeschel, R; Merkle, N; Zygmanski, P

2012-01-01

The purpose of this study is to investigate the feasibility of an inverse planning optimization approach for the Volumetric Modulated Arc Therapy (VMAT) based on quadratic programming and the projection method. The performance of this method is evaluated against a reference commercial planning system (eclipse(TM) for rapidarc(TM)) for clinically relevant cases. The inverse problem is posed in terms of a linear combination of basis functions representing arclet dose contributions and their respective linear coefficients as degrees of freedom. MLC motion is decomposed into basic motion patterns in an intuitive manner leading to a system of equations with a relatively small number of equations and unknowns. These equations are solved using quadratic programming under certain limiting physical conditions for the solution, such as the avoidance of negative dose during optimization and Monitor Unit reduction. The modeling by the projection method assures a unique treatment plan with beneficial properties, such as the explicit relation between organ weightings and the final dose distribution. Clinical cases studied include prostate and spine treatments. The optimized plans are evaluated by comparing isodose lines, DVH profiles for target and normal organs, and Monitor Units to those obtained by the clinical treatment planning system eclipse(TM). The resulting dose distributions for a prostate (with rectum and bladder as organs at risk), and for a spine case (with kidneys, liver, lung and heart as organs at risk) are presented. Overall, the results indicate that similar plan qualities for quadratic programming (QP) and rapidarc(TM) could be achieved at significantly more efficient computational and planning effort using QP. Additionally, results for the quasimodo phantom [Bohsung et al., "IMRT treatment planning: A comparative inter-system and inter-centre planning exercise of the estro quasimodo group," Radiother. Oncol. 76(3), 354-361 (2005)] are presented as an example for an extreme concave case. Quadratic programming is an alternative approach for inverse planning which generates clinically satisfying plans in comparison to the clinical system and constitutes an efficient optimization process characterized by uniqueness and reproducibility of the solution.

The Use of an On-Board MV Imager for Plan Verification of Intensity Modulated Radiation Therapy and Volumetrically Modulated Arc Therapy

NASA Astrophysics Data System (ADS)

Walker, Justin A.

The introduction of complex treatment modalities such as IMRT and VMAT has led to the development of many devices for plan verification. One such innovation in this field is the repurposing of the portal imager to not only be used for tumor localization but for recording dose distributions as well. Several advantages make portal imagers attractive options for this purpose. Very high spatial resolution allows for better verification of small field plans than may be possible with commercially available devices. Because the portal imager is attached to the gantry set up is simpler than any other method available, requiring no additional accessories, and often can be accomplished from outside the treatment room. Dose images capture by the portal imager are in digital format make permanent records that can be analyzed immediately. Portal imaging suffers from a few limitations however that must be overcome. Images captured contain dose information and a calibration must be maintained for image to dose conversion. Dose images can only be taken perpendicular to the treatment beam allowing only for planar dose comparison. Planar dose files are themself difficult to obtain for VMAT treatments and an in-house script had to be developed to create such a file before analysis could be performed. Using the methods described in this study, excellent agreement between planar dose files generated and dose images taken were found. The average agreement for IMRT field analyzed being greater than 97% for non-normalized images at 3mm and 3%. Comparable agreement for VAMT plans was found as well with the average agreement being greater than 98%.

Poster – 13: Evaluation of an in-house CCD camera film dosimetry imaging system for small field deliveries

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lalonde, Michel; Alexander, Kevin; Olding, Tim

Purpose: Radiochromic film dosimetry is a standard technique used in clinics to verify modern conformal radiation therapy delivery, and sometimes in research to validate other dosimeters. We are using film as a standard for comparison as we improve high-resolution three-dimensional gel systems for small field dosimetry; however, precise film dosimetry can be technically challenging. We report here measurements for fractionated stereotactic radiation therapy (FSRT) delivered using volumetric modulated arc therapy (VMAT) to investigate the accuracy and reproducibility of film measurements with a novel in-house readout system. We show that radiochromic film can accurately and reproducibly validate FSRT deliveries and alsomore » benchmark our gel dosimetry work. Methods: VMAT FSRT plans for metastases alone (PTV{sub MET}) and whole brain plus metastases (WB+PTV{sub MET}) were delivered onto a multi-configurational phantom with a sheet of EBT3 Gafchromic film inserted mid-plane. A dose of 400 cGy was prescribed to 4 small PTV{sub MET} structures in the phantom, while a WB structure was prescribed a dose of 200 cGy in the WB+PTV{sub MET} iterations. Doses generated from film readout with our in-house system were compared to treatment planned doses. Each delivery was repeated multiple times to assess reproducibility. Results and Conclusions: The reproducibility of film optical density readout was excellent throughout all experiments. Doses measured from the film agreed well with plans for the WB+PTV{sub MET} delivery. But, film doses for PTV{sub MET} only deliveries were significantly below planned doses. This discrepancy is due to stray/scattered light perturbations in our system during readout. Corrections schemes will be presented.« less

SU-E-T-449: Hippocampal Sparing Radiotherapy Using Intensity Modulated Radiotherapy and Volumetric Modulated Arc Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moon, S; Kyung Hee University Hospital at Gangdong, Gangdong-gu; Kim, D

2015-06-15

Purpose: The hippocampus sparing during the cranial irradiation has become interesting because it may mitigate radiation-induced neurocognitive toxicity. Herein we report our preliminary study for sparing the hippocampus with and without tilling condition for patient with brain metastases. Methods: Ten patients previously treated with whole brain were reviewed. Five patients tilted the head to around 30 degrees and others were treated without tilting. Treatment plans of linear accelerator (Linac)-based volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) were generated for prescription dose of 30 Gy in 15 fractions. Hippocampal avoidance regions were created with 5-mm volumetric expansion aroundmore » the hippocampus. Whole brain, hippocampus and hippocampal avoidance volume were 1372cm3, 6cm3 and 30cm3 and hippocampal avoidance volume was 2.2% of the whole brain planned target volume in average. Organs at risk (OARs) are hippocampus, eyes, lens, and cochleae. Coverage index (CVI), conformity index (CI), homogeneity index (HI) and mean dose to OARs were used to compare dose characteristic of tilted and non-tilted cases. Results: In IMRT, when CI, CVI and HI of whole brain were 0.88, 0.09 and 0.98 in both tilted and non-tilted cases, absorbed dose of hippocampal avoidance volume in tilted cases were 10% lower than non-tilted cases. Doses in other OARs such as eyes, lens, and cochleae were also decreased about 20% when tilting the head. When CI, HI and CVI in VMAT were 0.9, 0.08 and 0.99, the dose-decreased ratio of OARs in both with and without tilting cases were almost the same with IMRT. But absolute dose of hippocampal avoidance volume in VMAT was 30% lower than IMRT. Conclusion: This study confirms that dose to hippocampus decreases if patients tilt the head. When treating the whole brain with head tilted, patients can acquire the same successful treatment Result and also preserve their valuable memory.« less

The effect of different control point sampling sequences on convergence of VMAT inverse planning

NASA Astrophysics Data System (ADS)

Pardo Montero, Juan; Fenwick, John D.

2011-04-01

A key component of some volumetric-modulated arc therapy (VMAT) optimization algorithms is the progressive addition of control points to the optimization. This idea was introduced in Otto's seminal VMAT paper, in which a coarse sampling of control points was used at the beginning of the optimization and new control points were progressively added one at a time. A different form of the methodology is also present in the RapidArc optimizer, which adds new control points in groups called 'multiresolution levels', each doubling the number of control points in the optimization. This progressive sampling accelerates convergence, improving the results obtained, and has similarities with the ordered subset algorithm used to accelerate iterative image reconstruction. In this work we have used a VMAT optimizer developed in-house to study the performance of optimization algorithms which use different control point sampling sequences, most of which fall into three different classes: doubling sequences, which add new control points in groups such that the number of control points in the optimization is (roughly) doubled; Otto-like progressive sampling which adds one control point at a time, and equi-length sequences which contain several multiresolution levels each with the same number of control points. Results are presented in this study for two clinical geometries, prostate and head-and-neck treatments. A dependence of the quality of the final solution on the number of starting control points has been observed, in agreement with previous works. We have found that some sequences, especially E20 and E30 (equi-length sequences with 20 and 30 multiresolution levels, respectively), generate better results than a 5 multiresolution level RapidArc-like sequence. The final value of the cost function is reduced up to 20%, such reductions leading to small improvements in dosimetric parameters characterizing the treatments—slightly more homogeneous target doses and better sparing of the organs at risk.

Impact of spot size on plan quality of spot scanning proton radiosurgery for peripheral brain lesions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wang, Dongxu, E-mail: dongxu-wang@uiowa.edu; Dirksen, Blake; Hyer, Daniel E.

Purpose: To determine the plan quality of proton spot scanning (SS) radiosurgery as a function of spot size (in-air sigma) in comparison to x-ray radiosurgery for treating peripheral brain lesions. Methods: Single-field optimized (SFO) proton SS plans with sigma ranging from 1 to 8 mm, cone-based x-ray radiosurgery (Cone), and x-ray volumetric modulated arc therapy (VMAT) plans were generated for 11 patients. Plans were evaluated using secondary cancer risk and brain necrosis normal tissue complication probability (NTCP). Results: For all patients, secondary cancer is a negligible risk compared to brain necrosis NTCP. Secondary cancer risk was lower in proton SSmore » plans than in photon plans regardless of spot size (p = 0.001). Brain necrosis NTCP increased monotonically from an average of 2.34/100 (range 0.42/100–4.49/100) to 6.05/100 (range 1.38/100–11.6/100) as sigma increased from 1 to 8 mm, compared to the average of 6.01/100 (range 0.82/100–11.5/100) for Cone and 5.22/100 (range 1.37/100–8.00/100) for VMAT. An in-air sigma less than 4.3 mm was required for proton SS plans to reduce NTCP over photon techniques for the cohort of patients studied with statistical significance (p = 0.0186). Proton SS plans with in-air sigma larger than 7.1 mm had significantly greater brain necrosis NTCP than photon techniques (p = 0.0322). Conclusions: For treating peripheral brain lesions—where proton therapy would be expected to have the greatest depth-dose advantage over photon therapy—the lateral penumbra strongly impacts the SS plan quality relative to photon techniques: proton beamlet sigma at patient surface must be small (<7.1 mm for three-beam single-field optimized SS plans) in order to achieve comparable or smaller brain necrosis NTCP relative to photon radiosurgery techniques. Achieving such small in-air sigma values at low energy (<70 MeV) is a major technological challenge in commercially available proton therapy systems.« less

Comparison of Radiation Treatment Plans for Breast Cancer between 3D Conformal in Prone and Supine Positions in Contrast to VMAT and IMRT Supine Positions

NASA Astrophysics Data System (ADS)

Bejarano Buele, Ana Isabel

The treatment regimen for breast cancer patients typically involves Whole Breast Irradiation (WBI). The coverage and extent of the radiation treatment is dictated by location of tumor mass, breast tissue distribution, involvement of lymph nodes, and other factors. The current standard treatment approach used at our institution is a 3D tangential beam geometry, which involves two fields irradiating the breast, or a four field beam arrangement covering the whole breast and involved nodes, while decreasing the dose to organs as risk (OARs) such as the lung and heart. The coverage of these targets can be difficult to achieve in patients with unfavorable thoracic geometries, especially in those cases in which the planning target volume (PTV) is extended to the chest wall. It is a well-known fact that exposure of the heart to ionizing radiation has been proved to increase the subsequent rate of ischemic heart disease. In these cases, inverse planned treatments have become a proven alternative to the 3D approach. The goal of this research project is to evaluate the factors that affect our current techniques as well as to adapt the development of inverse modulated techniques for our clinic, in which breast cancer patients are one of the largest populations treated. For this purpose, a dosimetric comparison along with the evaluation of immobilization devices was necessary. Radiation treatment plans were designed and dosimetrically compared for 5 patients in both, supine and prone positions. For 8 patients, VMAT and IMRT plans were created and evaluated in the supine position. Skin flash incorporation for inverse modulated plans required measurement of the surface dose as well as an evaluation of breast volume changes during a treatment course. It was found that prone 3D conformal plans as well as the VMAT and IMRT plans are generally superior in sparing OARs to supine plans with comparable PTV coverage. Prone setup leads to larger shifts in breast volume as well as in positioning due to the difference in target geometry and nature of the immobilization device. IMRT and VMAT plans offer sparing of OARs from high dose regions with an increase of irradiated volume in the low dose regions. Skin flash incorporation was found to be accurate with the use of virtual bolus in the TPS for inverse modulated plans. Various factors influencing dose delivery in breast cancer radiation treatments were examined and quantified. Practical recommendations developed in the course of this project can improve our current techniques and provide alternatives to treat unique and challenging clinical cases.

SU-F-T-348: The Impact of Model Library Population On RapidPlan Based Dose-Volume Histograms (DVHs) Prediction for Rectal Cancer Patients Treated with Volumetric-Modulated Radiotherapy (VMAT)

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, K; Zhou, L; Chen, Z

Purpose: RapidPlan uses a library consisting of expert plans from different patients to create a model that can predict achievable dose-volume histograms (DVHs) for new patients. The goal of this study is to investigate the impacts of model library population (plan numbers) on the DVH prediction for rectal cancer patients treated with volumetric-modulated radiotherapy (VMAT) Methods: Ninety clinically accepted rectal cancer patients’ VMAT plans were selected to establish 3 models, named as Model30, Model60 and Model90, with 30,60, and 90 plans in the model training. All plans had sufficient target coverage and bladder and femora sparings. Additional 10 patients weremore » enrolled to test the DVH prediction differences with these 3 models. The predicted DVHs from these 3 models were compared and analyzed. Results: Predicted V40 (Vx, percent of volume that received x Gy for the organs at risk) and Dmean (mean dose, cGy) of the bladder were 39.84±13.38 and 2029.4±141.6 for the Model30,37.52±16.00 and 2012.5±152.2 for the Model60, and 36.33±18.35 and 2066.5±174.3 for the Model90. Predicted V30 and Dmean of the left femur were 23.33±9.96 and 1443.3±114.5 for the Model30, 21.83±5.75 and 1436.6±61.9 for the Model60, and 20.31±4.6 and 1415.0±52.4 for the Model90.There were no significant differences among the 3 models for the bladder and left femur predictions. Predicted V40 and Dmean of the right femur were 19.86±10.00 and 1403.6±115.6 (Model30),18.97±6.19 and 1401.9±68.78 (Model60), and 21.08±7.82 and 1424.0±85.3 (Model90). Although a slight lower DVH prediction of the right femur was found on the Model60, the mean differences for V30 and mean dose were less than 2% and 1%, respectively. Conclusion: There were no significant differences among Model30, Model60 and Model90 for predicting DVHs on rectal patients treated with VMAT. The impact of plan numbers for model library might be limited for cancers with similar target shape.« less

Beam’s-eye-view dosimetrics (BEVD) guided rotational station parameter optimized radiation therapy (SPORT) planning based on reweighted total-variation minimization

NASA Astrophysics Data System (ADS)

Kim, Hojin; Li, Ruijiang; Lee, Rena; Xing, Lei

2015-03-01

Conventional VMAT optimizes aperture shapes and weights at uniformly sampled stations, which is a generalization of the concept of a control point. Recently, rotational station parameter optimized radiation therapy (SPORT) has been proposed to improve the plan quality by inserting beams to the regions that demand additional intensity modulations, thus formulating non-uniform beam sampling. This work presents a new rotational SPORT planning strategy based on reweighted total-variation (TV) minimization (min.), using beam’s-eye-view dosimetrics (BEVD) guided beam selection. The convex programming based reweighted TV min. assures the simplified fluence-map, which facilitates single-aperture selection at each station for single-arc delivery. For the rotational arc treatment planning and non-uniform beam angle setting, the mathematical model needs to be modified by additional penalty term describing the fluence-map similarity and by determination of appropriate angular weighting factors. The proposed algorithm with additional penalty term is capable of achieving more efficient and deliverable plans adaptive to the conventional VMAT and SPORT planning schemes by reducing the dose delivery time about 5 to 10 s in three clinical cases (one prostate and two head-and-neck (HN) cases with a single and multiple targets). The BEVD guided beam selection provides effective and yet easy calculating methodology to select angles for denser, non-uniform angular sampling in SPORT planning. Our BEVD guided SPORT treatment schemes improve the dose sparing to femoral heads in the prostate and brainstem, parotid glands and oral cavity in the two HN cases, where the mean dose reduction of those organs ranges from 0.5 to 2.5 Gy. Also, it increases the conformation number assessing the dose conformity to the target from 0.84, 0.75 and 0.74 to 0.86, 0.79 and 0.80 in the prostate and two HN cases, while preserving the delivery efficiency, relative to conventional single-arc VMAT plans.

SU-F-T-320: Assessing Placement Error of Optically Stimulated Luminescent in Vivo Dosimeters Using Cone-Beam Computed Tomography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Riegel, A; Klein, E; Tariq, M

Purpose: Optically-stimulated luminescent dosimeters (OSLDs) are increasingly utilized for in vivo dosimetry of complex radiation delivery techniques such as intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT). Evaluation of clinical uncertainties such as placement error has not been performed. This work retrospectively investigates the magnitude of placement error using conebeam computed tomography (CBCT) and its effect on measured/planned dose agreement. Methods: Each OSLD was placed at a physicist-designated location on the patient surface on a weekly basis. The location was given in terms of a gantry angle and two-dimensional offset from central axis. The OSLDs were placed before dailymore » image guidance. We identified 77 CBCTs from 25 head-and-neck patients who received IMRT or VMAT, where OSLDs were visible on the CT image. Grossly misplaced OSLDs were excluded (e.g. wrong laterality). CBCTs were registered with the treatment plan and the distance between the planned and actual OSLD location was calculated in two dimensions in the beam’s eye view. Distances were correlated with measured/planned dose percent differences. Results: OSLDs were grossly misplaced for 5 CBCTs (6.4%). For the remaining 72 CBCTs, average placement error was 7.0±6.0 mm. These errors were not correlated with measured/planned dose percent differences (R{sup 2}=0.0153). Generalizing the dosimetric effect of placement errors may be unreliable. Conclusion: Correct placement of OSLDs for IMRT and VMAT treatments is critical to accurate and precise in vivo dosimetry. Small placement errors could produce large disagreement between measured and planned dose. Further work includes expansion to other treatment sites, examination of planned dose at the actual point of OSLD placement, and the influence of imageguided shifts on measured/planned dose agreement.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kuang, Yu; Wu, Lili; Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong

Purpose: This study evaluated expected tumor control and normal tissue toxicity for prostate volumetric modulated arc therapy (VMAT) with and without radiation boosts to an intraprostatically dominant lesion (IDL), defined by {sup 18}F-choline positron emission tomography/computed tomography (PET/CT). Methods and Materials: Thirty patients with localized prostate cancer underwent {sup 18}F-choline PET/CT before treatment. Two VMAT plans, plan{sub 79} {sub Gy} and plan{sub 100-105} {sub Gy}, were compared for each patient. The whole-prostate planning target volume (PTV{sub prostate}) prescription was 79 Gy in both plans, but plan{sub 100-105} {sub Gy} added simultaneous boost doses of 100 Gy and 105 Gy to the IDL, definedmore » by 60% and 70% of maximum prostatic uptake on {sup 18}F-choline PET (IDL{sub suv60%} and IDL{sub suv70%}, respectively, with IDL{sub suv70%} nested inside IDL{sub suv60%} to potentially enhance tumor specificity of the maximum point dose). Plan evaluations included histopathological correspondence, isodose distributions, dose-volume histograms, tumor control probability (TCP), and normal tissue complication probability (NTCP). Results: Planning objectives and dose constraints proved feasible in 30 of 30 cases. Prostate sextant histopathology was available for 28 cases, confirming that IDL{sub suv60%} adequately covered all tumor-bearing prostate sextants in 27 cases and provided partial coverage in 1 case. Plan{sub 100-105} {sub Gy} had significantly higher TCP than plan{sub 79} {sub Gy} across all prostate regions for α/β ratios ranging from 1.5 Gy to 10 Gy (P<.001 for each case). There were no significant differences in bladder and femoral head NTCP between plans and slightly lower rectal NTCP (endpoint: grade ≥ 2 late toxicity or rectal bleeding) was found for plan{sub 100-105} {sub Gy}. Conclusions: VMAT can potentially increase the likelihood of tumor control in primary prostate cancer while observing normal tissue tolerances through simultaneous delivery of a steep radiation boost to a {sup 18}F-choline PET-defined IDL.« less

Comparison between In-house developed and Diamond commercial software for patient specific independent monitor unit calculation and verification with heterogeneity corrections.

PubMed

Kuppusamy, Vijayalakshmi; Nagarajan, Vivekanandan; Jeevanandam, Prakash; Murugan, Lavanya

2016-02-01

The study was aimed to compare two different monitor unit (MU) or dose verification software in volumetric modulated arc therapy (VMAT) using modified Clarkson's integration technique for 6 MV photons beams. In-house Excel Spreadsheet based monitor unit verification calculation (MUVC) program and PTW's DIAMOND secondary check software (SCS), version-6 were used as a secondary check to verify the monitor unit (MU) or dose calculated by treatment planning system (TPS). In this study 180 patients were grouped into 61 head and neck, 39 thorax and 80 pelvic sites. Verification plans are created using PTW OCTAVIUS-4D phantom and also measured using 729 detector chamber and array with isocentre as the suitable point of measurement for each field. In the analysis of 154 clinically approved VMAT plans with isocentre at a region above -350 HU, using heterogeneity corrections, In-house Spreadsheet based MUVC program and Diamond SCS showed good agreement TPS. The overall percentage average deviations for all sites were (-0.93% + 1.59%) and (1.37% + 2.72%) for In-house Excel Spreadsheet based MUVC program and Diamond SCS respectively. For 26 clinically approved VMAT plans with isocentre at a region below -350 HU showed higher variations for both In-house Spreadsheet based MUVC program and Diamond SCS. It can be concluded that for patient specific quality assurance (QA), the In-house Excel Spreadsheet based MUVC program and Diamond SCS can be used as a simple and fast accompanying to measurement based verification for plans with isocentre at a region above -350 HU. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

CBCT-based volumetric and dosimetric variation evaluation of volumetric modulated arc radiotherapy in the treatment of nasopharyngeal cancer patients

PubMed Central

2013-01-01

Objective To investigate the anatomic and dosimetric variations of volumetric modulated arc therapy (VMAT) in the treatment of nasopharyngeal cancer (NPC) patients based on weekly cone beam CT (CBCT). Materials and methods Ten NPC patients treated by VMAT with weekly CBCT for setup corrections were reviewed retrospectively. Deformed volumes of targets and organs at risk (OARs) in the CBCT were compared with those in the planning CT. Delivered doses were recalculated based on weekly CBCT and compared with the planned doses. Results No significant volumetric changes on targets, brainstem, and spinal cord were observed. The average volumes of right and left parotid measured from the fifth CBCT were about 4.4 and 4.5 cm3 less than those from the first CBCT, respectively. There were no significant dose differences between average planned and delivered doses for targets, brainstem and spinal cord. For right parotid, the delivered mean dose was 10.5 cGy higher (p = 0.004) than the planned value per fraction, and the V26 and V32 increased by 7.5% (p = 0.002) and 7.4% (p = 0.01), respectively. For the left parotid, the D50 (dose to the 50% volume) was 8.8 cGy higher (p = 0.03) than the planned values per fraction, and the V26 increased by 8.8% (p = 0.002). Conclusion Weekly CBCTs were applied directly to study the continuous volume changes and resulting dosimetric variations of targets and OARs for NPC patients undergoing VMAT. Significant volumetric and dosimetric variations were observed for parotids. Replanning after 30 Gy will benefit the protection on parotids. PMID:24289312

SU-E-T-548: How To Decrease Spine Dose In Patients Who Underwent Sterotactic Spine Radiosurgery?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Acar, H; Altinok, A; Kucukmorkoc, E

2014-06-01

Purpose: Stereotactic radiosurgery for spine metastases involves irradiation using a single high dose fraction. The purpose of this study was to dosimetrically compare stereotactic spine radiosurgery(SRS) plans using a recently new volumetric modulated arc therapy(VMAT) technique against fix-field intensity-modulated radiotherapy(IMRT). Plans were evaluated for target conformity and spinal cord sparing. Methods: Fifteen previously treated patients were replanned using the Eclipse 10.1 TPS AAA calculation algorithm. IMRT plans with 7 fields were generated. The arc plans used 2 full arc configurations. Arc and IMRT plans were normalized and prescribed to deliver 16.0 Gy in a single fraction to 90% of themore » planning target volume(PTV). PTVs consisted of the vertebral body expanded by 3mm, excluding the PRV-cord, where the cord was expanded by 2mm.RTOG 0631 recommendations were applied for treatment planning. Partial spinal cord volume was defined as 5mm above and below the radiosurgery target volume. Plans were compared for conformity and gradient index as well as spinal cord sparing. Results: The conformity index values of fifteen patients for two different treatment planning techniques were shown in table 1. Conformity index values for 2 full arc planning (average CI=0.84) were higher than that of IMRT planning (average CI=0.79). The gradient index values of fifteen patients for two different treatment planning techniques were shown in table 2. Gradient index values for 2 full arc planning (average GI=3.58) were higher than that of IMRT planning (average GI=2.82).The spinal cord doses of fifteen patients for two different treatment planning techniques were shown in table 3. D0.35cc, D0.03cc and partial spinal cord D10% values in 2 full arc plannings (average D0.35cc=819.3cGy, D0.03cc=965.4cGy, 10%partial spinal=718.1cGy) were lower than IMRT plannings (average D0.35cc=877.4cGy, D0.03c=1071.4cGy, 10%partial spinal=805.1cGy). Conclusions: The two arc VMAT technique is superior to 7 field IMRT technique in terms of both spinal cord sparing and better conformity and gradient indexes.« less

Clinical implementation and evaluation of the Acuros dose calculation algorithm.

PubMed

Yan, Chenyu; Combine, Anthony G; Bednarz, Greg; Lalonde, Ronald J; Hu, Bin; Dickens, Kathy; Wynn, Raymond; Pavord, Daniel C; Saiful Huq, M

2017-09-01

The main aim of this study is to validate the Acuros XB dose calculation algorithm for a Varian Clinac iX linac in our clinics, and subsequently compare it with the wildely used AAA algorithm. The source models for both Acuros XB and AAA were configured by importing the same measured beam data into Eclipse treatment planning system. Both algorithms were validated by comparing calculated dose with measured dose on a homogeneous water phantom for field sizes ranging from 6 cm × 6 cm to 40 cm × 40 cm. Central axis and off-axis points with different depths were chosen for the comparison. In addition, the accuracy of Acuros was evaluated for wedge fields with wedge angles from 15 to 60°. Similarly, variable field sizes for an inhomogeneous phantom were chosen to validate the Acuros algorithm. In addition, doses calculated by Acuros and AAA at the center of lung equivalent tissue from three different VMAT plans were compared to the ion chamber measured doses in QUASAR phantom, and the calculated dose distributions by the two algorithms and their differences on patients were compared. Computation time on VMAT plans was also evaluated for Acuros and AAA. Differences between dose-to-water (calculated by AAA and Acuros XB) and dose-to-medium (calculated by Acuros XB) on patient plans were compared and evaluated. For open 6 MV photon beams on the homogeneous water phantom, both Acuros XB and AAA calculations were within 1% of measurements. For 23 MV photon beams, the calculated doses were within 1.5% of measured doses for Acuros XB and 2% for AAA. Testing on the inhomogeneous phantom demonstrated that AAA overestimated doses by up to 8.96% at a point close to lung/solid water interface, while Acuros XB reduced that to 1.64%. The test on QUASAR phantom showed that Acuros achieved better agreement in lung equivalent tissue while AAA underestimated dose for all VMAT plans by up to 2.7%. Acuros XB computation time was about three times faster than AAA for VMAT plans, and computation time for other plans will be discussed at the end. Maximum difference between dose calculated by AAA and dose-to-medium by Acuros XB (Acuros_D m,m ) was 4.3% on patient plans at the isocenter, and maximum difference between D 100 calculated by AAA and by Acuros_D m,m was 11.3%. When calculating the maximum dose to spinal cord on patient plans, differences between dose calculated by AAA and Acuros_D m,m were more than 3%. Compared with AAA, Acuros XB improves accuracy in the presence of inhomogeneity, and also significantly reduces computation time for VMAT plans. Dose differences between AAA and Acuros_D w,m were generally less than the dose differences between AAA and Acuros_D m,m . Clinical practitioners should consider making Acuros XB available in clinics, however, further investigation and clarification is needed about which dose reporting mode (dose-to-water or dose-to-medium) should be used in clinics. © 2017 The Authors. Journal of Applied Clinical Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

Sci-Thur PM - Colourful Interactions: Highlights 08: ARC TBI using Single-Step Optimized VMAT Fields

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hudson, Alana; Gordon, Deborah; Moore, Roseanne

Purpose: This work outlines a new TBI delivery technique to replace a lateral POP full bolus technique. The new technique is done with VMAT arc delivery, without bolus, treating the patient prone and supine. The benefits of the arc technique include: increased patient experience and safety, better dose conformity, better organ at risk sparing, decreased therapist time and reduction of therapist injuries. Methods: In this work we build on a technique developed by Jahnke et al. We use standard arc fields with gantry speeds corrected for varying distance to the patient followed by a single step VMAT optimization on amore » patient CT to increase dose inhomogeneity and to reduce dose to the lungs (vs. blocks). To compare the arc TBI technique to our full bolus technique, we produced plans on patient CTs for both techniques and evaluated several dosimetric parameters using an ANOVA test. Results and Conclusions: The arc technique is able reduce both the hot areas to the body (D2% reduced from 122.2% to 111.8% p<0.01) and the lungs (mean lung dose reduced from 107.5% to 99.1%, p<0.01), both statistically significant, while maintaining coverage (D98% = 97.8% vs. 94.6%, p=0.313, not statistically significant). We developed a more patient and therapist-friendly TBI treatment technique that utilizes single-step optimized VMAT plans. It was found that this technique was dosimetrically equivalent to our previous lateral technique in terms of coverage and statistically superior in terms of reduced lung dose.« less

Dopamine transporter and vesicular monoamine transporter knockout mice : implications for Parkinson's disease.

PubMed

Miller, G W; Wang, Y M; Gainetdinov, R R; Caron, M G

2001-01-01

One of the most valuable methods for understanding the function of a particular protein is the generation of animals that have had the gene encoding for the protein of interest disrupted, commonly known as a "quo;knockout"quo; or null mutant. By incorporating a sequence of DNA (typically encoding antibiotic resistance to aid in the selection of the mutant gene) into embryonic stem cells by homologous recombination, the normal transcription of the gene is effectively blocked (Fig. 1). Since a particular protein is encoded by two copies of a gene, it is necessary to have the gene on both alleles "quo;knocked out."quo; This is performed by cross-breeding animals with one affected allele (heterozygote) to generate offspring that have inherited two mutant alleles (homozygote). This procedure has been used to generate animals lacking either the plasma membrane dopamine transporter (DAT; Fig. 2) or the vesicular monoamine transporter (VMAT2; Fig. 3). Both DAT and VMAT2 are essential for dopamine homeostasis and are thought to participate in the pathogenesis of Parkinson's disease (1-5). Fig. 1. Maps of the targeting vector and the mock construct. The mouse genomic fragment (clone 11) was isolated from a Stratagene 129 SvJ library by standard colony hybridization using a PCR probe from the 5' end of rat cDNA. The restriction site abbreviations are as follows: H, HindIII; N, NotI; Sc, SacI; Sn, SnaI; X, XbaI; and Xh, XhoI. The region between HindIII and SnaI on clone 11 containing the coding sequence from transmembrane domains 3 and 4 of VMAT2 was deleted and replaced with PGK-neo. The 3' fragment of clone 11 was reserved as an external probe for Southern analysis. To facilitate PCR screening of embryonic stem cell clones, a mock construct containing the SnaI/XbaI fragment and part of the Neo cassette was generated as a positive control. pPNT and pGEM4Z were used to construct knockout and mock vectors, respectively. (Reproduced with permission from ref. 1). Fig. 2. DAT and VMAT2 expression in wild-type and DAT knockout midbrain. DAT immunoreactivity in wild-type (A) and DAT knockout midbrain (B). VMAT2 immunoreactivity in wild-type (C) and DAT knockout midbrain (D). Robust immunoreactivity was observed in the ventral tegmental area and substantia nigra pars compacta and reticulata in the wild-type brain. Note absence of DAT immunoreactivity and modest reduction of VMAT2 immunoreactivity in the DAT knockout. Fig. 3. Characterization of VMAT2 gene disruption. (A) Southern blot analysis of mouse genomic DNA. The Southern blot was prepared with 15 μg of genomic DNA per lane and probed with a 1.4-kb 3' external genomic fragment. +/+, wild type littermates; +/-, heterozygote; -/-, homozygote. (B) RT-PCR analysis of mouse brain poly(A)+ RNA. For each reverse transcription assay, 0.5 μg of poly(A)+ RNA was used. Equal volumes of cDNA templates were used for each PCR assay. The PCR primers used flank the neomycin cassette for the purpose of detecting potential readthrough of the neomycin DNA. The heterozygote has a reduced amount of transcripts compared with the wild-type littermate; the homozygote is devoid of VMAT2 transcripts. G3PDH was used as internal control. (C) Western blot analysis of wholebrain synaptic vesicles. Samples (25 μg) of vesicles were solubilized and separated by SDS-PAGE, transferred to nitrocellulose, subjected to Western blot analysis with anti-VMAT2-Ct (top) or anti-a-tubulin (bottom) antibodies, and developed with chemiluminescence. Molecular mass markers (kDa) are shown to the left. To confirm equal loading and transfer of proteins, the blots were stripped and reprobed with an antibody to α-tubulin. (Reproduced with permission from ref. 1). The importance of DAT in neuronal function is highlighted in animals in which DAT has been genetically deleted (DAT KO) (3). In the homozygote DAT KO mice, released dopamine remains in the extracellular space up to 300 times longer than normal. As expected, these animals display behaviors consistent with persistent activation of dopamine receptors, such as hyperlocomotion. Genetic deletion of VMAT2 reveals the essential role of vesicular storage and release of monoamines. Homozygote VMAT2 knockout mice survive for only a few days, whereas heterozygotes appear normal. Studies performed in homozygote pups and heterozygote adults clearly show that the level of VMAT2 expression calibrates the level of vesicular filling (1,2,bi4). With only 50% of normal VMAT2, heterozygote animals have reduced vesicular filling and release. These alterations in presynaptic monoamine function in the heterozygotes are thought to be responsible for the observed sensitization to the psychostimulants cocaine and amphetamine and to ethanol (1). Knockout animals also appear to parallel the changes that occur in reserpinized animals, suggesting that the adverse actions of this drug are mediated by VMAT2.

Frame average optimization of cine-mode EPID images used for routine clinical in vivo patient dose verification of VMAT deliveries

DOE Office of Scientific and Technical Information (OSTI.GOV)

McCowan, P. M., E-mail: pmccowan@cancercare.mb.ca; McCurdy, B. M. C.; Medical Physics Department, CancerCare Manitoba, 675 McDermot Avenue, Winnipeg, Manitoba R3E 0V9

Purpose: The in vivo 3D dose delivered to a patient during volumetric modulated arc therapy (VMAT) delivery can be calculated using electronic portal imaging device (EPID) images. These images must be acquired in cine-mode (i.e., “movie” mode) in order to capture the time-dependent delivery information. The angle subtended by each cine-mode EPID image during an arc can be changed via the frame averaging number selected within the image acquisition software. A large frame average number will decrease the EPID’s angular resolution and will result in a decrease in the accuracy of the dose information contained within each image. Alternatively, lessmore » EPID images acquired per delivery will decrease the overall 3D patient dose calculation time, which is appealing for large-scale clinical implementation. Therefore, the purpose of this study was to determine the optimal frame average value per EPID image, defined as the highest frame averaging that can be used without an appreciable loss in 3D dose reconstruction accuracy for VMAT treatments. Methods: Six different VMAT plans and six different SBRT-VMAT plans were delivered to an anthropomorphic phantom. Delivery was carried out on a Varian 2300ix model linear accelerator (Linac) equipped with an aS1000 EPID running at a frame acquisition rate of 7.5 Hz. An additional PC was set up at the Linac console area, equipped with specialized frame-grabber hardware and software packages allowing continuous acquisition of all EPID frames during delivery. Frames were averaged into “frame-averaged” EPID images using MATLAB. Each frame-averaged data set was used to calculate the in vivo dose to the patient and then compared to the single EPID frame in vivo dose calculation (the single frame calculation represents the highest possible angular resolution per EPID image). A mean percentage dose difference of low dose (<20% prescription dose) and high dose regions (>80% prescription dose) was calculated for each frame averaged scenario for each plan. The authors defined their unacceptable loss of accuracy as no more than a ±1% mean dose difference in the high dose region. Optimal frame average numbers were then determined as a function of the Linac’s average gantry speed and the dose per fraction. Results: The authors found that 9 and 11 frame averages were suitable for all VMAT and SBRT-VMAT treatments, respectively. This resulted in no more than a 1% loss to any of the dose region’s mean percentage difference when compared to the single frame reconstruction. The optimized number was dependent on the treatment’s dose per fraction and was determined to be as high as 14 for 12 Gy/fraction (fx), 15 for 8 Gy/fx, 11 for 6 Gy/fx, and 9 for 2 Gy/fx. Conclusions: The authors have determined an optimal EPID frame averaging number for multiple VMAT-type treatments. These are given as a function of the dose per fraction and average gantry speed. These optimized values are now used in the authors’ clinical, 3D, in vivo patient dosimetry program. This provides a reduction in calculation time while maintaining the authors’ required level of accuracy in the dose reconstruction.« less

Intrafraction Motion in Stereotactic Body Radiation Therapy for Non-Small Cell Lung Cancer: Intensity Modulated Radiation Therapy Versus Volumetric Modulated Arc Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rossi, Maddalena M.G.; Peulen, Heike M.U.; Belderbos, Josè S.A.

Purpose: Stereotactic body radiation therapy (SBRT) for early-stage inoperable non-small cell lung cancer (NSCLC) patients delivers high doses that require high-precision treatment. Typically, image guidance is used to minimize day-to-day target displacement, but intrafraction position variability is often not corrected. Currently, volumetric modulated arc therapy (VMAT) is replacing intensity modulated radiation therapy (IMRT) in many departments because of its shorter delivery time. This study aimed to evaluate whether intrafraction variation in VMAT patients is reduced in comparison with patients treated with IMRT. Methods and Materials: NSCLC patients (197 IMRT and 112 VMAT) treated with a frameless SBRT technique to amore » prescribed dose of 3 × 18 Gy were evaluated. Image guidance for both techniques was identical: pretreatment cone beam computed tomography (CBCT) (CBCT{sub precorr}) for setup correction followed immediately before treatment by postcorrection CBCT (CBCT{sub postcorr}) for verification. Then, after either a noncoplanar IMRT technique or a VMAT technique, a posttreatment (CBCT{sub postRT}) scan was acquired. The CBCT{sub postRT} and CBCT{sub postcorr} scans were then used to evaluate intrafraction motion. Treatment delivery times, systematic (Σ) and random (σ) intrafraction variations, and associated planning target volume (PTV) margins were calculated. Results: The median treatment delivery time was significantly reduced by 20 minutes (range, 32-12 minutes) using VMAT compared with noncoplanar IMRT. Intrafraction tumor motion was significantly larger for IMRT in all directions up to 0.5 mm systematic (Σ) and 0.7 mm random (σ). The required PTV margins for IMRT and VMAT differed by less than 0.3 mm. Conclusion: VMAT-based SBRT for NSCLC was associated with significantly shorter delivery times and correspondingly smaller intrafraction motion compared with noncoplanar IMRT. However, the impact on the required PTV margin was small.« less

SU-F-J-99: Dose Accumulation and Evaluation in Lung SBRT Among All Phases of Respiration

DOE Office of Scientific and Technical Information (OSTI.GOV)

Azcona, JD; Barbes, B; Aristu, J

Purpose: To calculate the total planning dose on lung tumors (GTV) by accumulating the dose received in all respiration phases. Methods: A patient 4D planning CT (phase-binned, from a Siemens Somatom CT) was used to locate the GTV of a lung tumor in all respiratory phases with Pinnacle (v9.10). GTV contours defined in all phases were projected to the reference phase, where the ITV was defined. Centroids were calculated for all the GTV projections. No deformation or rotation was taken into account. The only GTV contour as defined in the reference phase was voxelized to track each voxel individually. Wemore » accumulated the absorbed dose in different phases on each voxel. A 3DCRT and a VMAT plan were designed on the reference phase fulfilling the ITV dosimetric requirements, using the 10MV FFF photon model from an Elekta Versa linac. ITV-to-PTV margins were set to 5mm. In-house developed MATLAB code was used for tumor voxeling and dose accumulation, assuming that the dose distribution planned in the reference phase behaved as a “dose-cloud” during patient breathing. Results: We tested the method on a patient 4DCT set of images exhibiting limited tumor motion (<5mm). For the 3DCRT plan, D95 was calculated for the GTV with motion and for the ITV, showing an agreement of 0.04%. For the VMAT plan, we calculated the D95 for every phase as if the GTV in that phase had received the whole treatment. Differences in D95 for all phases are within 1%, and estimate the potential interplay effect during delivery. Conclusion: A method for dose accumulation and assessment was developed that can compare GTV motion with ITV dosage, and estimate the potential interplay effect for VMAT plans. Work in progress includes the incorporation of deformable image registration and 4D CBCT dose calculation for dose reconstruction and assessment during treatment.« less

SU-G-BRC-04: Collimator Angle Optimization in Volumetric Modulated Arc Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Andersen, A; Johnson, C; Bartlett, G

2016-06-15

Purpose: Volumetric modulated arc therapy (VMAT) has revolutionized radiation treatment by decreasing treatment time and monitor units, thus reducing scattered and whole body radiation dose. As the collimator angle changes the apparent leaf gap becomes larger which can impact plan quality, organ at risk (OAR) sparing as well as IMRT QA passing rate which is investigated. Methods: Two sites (prostate and head and neck) that have maximum utilization of VMAT were investigated. Two previously treated VMAT patients were chosen. For each patient 10 plans were created by maintaining constant optimization constraints while varying collimator angles from 0-90 deg at anmore » interval of 10 degrees for the first arc and the appropriate complimentary angle for the second arc. Plans were created with AAA algorithm using 6 MV beam on a Varian IX machine with Millennium 120 MLC. The dose-volume histogram (DVH) for each plan was exported and dosimetric parameters (D98, D95, D50, D2) as well homogeneity index (HI) and conformity index (CI) were computed. Each plan was validated for QA using ArcCheck with gamma index passing criteria of 2%/2 mm and 3%/3 mm. Additionally, normal tissue complication probability (NTCP) for each OAR was computed using Uzan-Nahum software. Results: The CI values for both sites had no impact as target volume coverage in every collimator angle were the same since it was optimized for adequate coverage. The HI which is representative of DVH gradient or dose uniformity in PTV showed a clear trend in both sites. The NTCP for OAR (brain and cochlea) in H&N plan and (bladder and rectum) in prostate plan showed a distinct superiority for collimator angles between 15-30 deg. The gamma passing rates were not correlated with angle. Conclusion: Based on CI, HI, NTCP and gamma passing index, it can be concluded that collimator angles should be maintained within 15–30 deg.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Camingue, Pamela; Christian, Rochelle; Ng, Davin

The purpose of this study was to compare 4 different external beam radiation therapy treatment techniques for the treatment of T1-2, N0, M0 glottic cancers: traditional lateral beams with wedges (3D), 5-field intensity-modulated radiation therapy (IMRT), volumetric modulated arc therapy (VMAT), and proton therapy. Treatment plans in each technique were created for 10 patients using consistent planning parameters. The photon treatment plans were optimized using Philips Pinnacle{sub 3} v.9 and the IMRT and VMAT plans used the Direct Machine Parameter Optimization algorithm. The proton treatment plans were optimized using Varian Eclipse Proton v.8.9. The prescription used for each plan wasmore » 63 Gy in 28 fractions. The contours for spinal cord, right carotid artery, left carotid artery, and normal tissue were created with respect to the patient's bony anatomy so that proper comparisons of doses could be made with respect to volume. An example of the different isodose distributions will be shown. The data collection for comparison purposes includes: clinical treatment volume coverage, dose to spinal cord, dose to carotid arteries, and dose to normal tissue. Data comparisons will be displayed graphically showing the maximum, mean, median, and ranges of doses.« less

Dosimetric validation and clinical implementation of two 3D dose verification systems for quality assurance in volumetric‐modulated arc therapy techniques

PubMed Central

Pérez‐Vara, Consuelo

2015-01-01

A pretreatment quality assurance program for volumetric techniques should include redundant calculations and measurement‐based verifications. The patient‐specific quality assurance process must be based in clinically relevant metrics. The aim of this study was to show the commission, clinical implementation, and comparison of two systems that allow performing a 3D redundant dose calculation. In addition, one of them is capable of reconstructing the dose on patient anatomy from measurements taken with a 2D ion chamber array. Both systems were compared in terms of reference calibration data (absolute dose, output factors, percentage depth‐dose curves, and profiles). Results were in good agreement for absolute dose values (discrepancies were below 0.5%) and output factors (mean differences were below 1%). Maximum mean discrepancies were located between 10 and 20 cm of depth for PDDs (‐2.7%) and in the penumbra region for profiles (mean DTA of 1.5 mm). Validation of the systems was performed by comparing point‐dose measurements with values obtained by the two systems for static, dynamic fields from AAPM TG‐119 report, and 12 real VMAT plans for different anatomical sites (differences better than 1.2%). Comparisons between measurements taken with a 2D ion chamber array and results obtained by both systems for real VMAT plans were also performed (mean global gamma passing rates better than 87.0% and 97.9% for the 2%/2 mm and 3%/3 mm criteria). Clinical implementation of the systems was evaluated by comparing dose‐volume parameters for all TG‐119 tests and real VMAT plans with TPS values (mean differences were below 1%). In addition, comparisons between dose distributions calculated by TPS and those extracted by the two systems for real VMAT plans were also performed (mean global gamma passing rates better than 86.0% and 93.0% for the 2%/2 mm and 3%/3 mm criteria). The clinical use of both systems was successfully evaluated. PACS numbers: 87.56.Fc, 87.56.‐v, 87.55.dk, 87.55.Qr, 87.55.‐x, 07.57.Kp, 85.25.Pb PMID:26103189

SU-E-T-633: Preparation and Planning of a VMAT Multi - Arc Radiation Therapy Technique for Full Scalp Treatment

DOE Office of Scientific and Technical Information (OSTI.GOV)

Araujo, C; Bardock, A; Berkelaar, S

2015-06-15

Purpose: The target volume for angiosarcoma of the scalp encompasses the entire scalp. Full scalp radiotherapy (FSRT) requires careful design of required bolus, immobilization and marking of the field before the patient CT is acquired. A VMAT multi-arc technique was designed to deliver FSRT for a patient with angiosarcoma of the scalp to a dose of 6000cGy in 25 fractions. Methods: A custom bolus helmet was fabricated from a 0.5 cm thick sheet of aquaplast material, which was molded to the patient’s head. With the bolus helmet in place the patient was then positioned supine on a H&N immobilization board.more » A custom vaclock bag positioned on a standard headrest and a thermoplastic mask were used to immobilize the patient. Additional bolus to cover the remaining treatment area was attached to the mask. We acquired two CT scans of the patient’s head, one in treatment position and an additional scan without the immobilization mask with wires marking the treatment area that the oncologist had delineated on the patient’s skin. The second scan was registered to the first and used to define the treatment CTV. A four-arc VMAT treatment planned using Varian-Eclipse was optimized to cover the skin with a PTV margin while sparing the brain and limiting the dose to the optic apparatus and lacrimal glands. Daily treatment setup was verified using anterior and lateral kV on-board-imaging. To verify the treated dose, TLDs were positioned on the patient’s scalp during one fraction. Results: With full dose coverage to the PTV, the mean dose to the brain was less than 24 Gy. The dose measured by the TLDs (mean difference 1%, standard deviation 4%)showed excellent agreement with the treatment planning calculation. Conclusion: FSRT delivered with a bolus helmet and a VMAT multi-arc technique can be accurately delivered with high dose uniformity and conformality.« less

Online dose reconstruction for tracked volumetric arc therapy: Real-time implementation and offline quality assurance for prostate SBRT.

PubMed

Kamerling, Cornelis Ph; Fast, Martin F; Ziegenhein, Peter; Menten, Martin J; Nill, Simeon; Oelfke, Uwe

2017-11-01

Firstly, this study provides a real-time implementation of online dose reconstruction for tracked volumetric arc therapy (VMAT). Secondly, this study describes a novel offline quality assurance tool, based on commercial dose calculation algorithms. Online dose reconstruction for VMAT is a computationally challenging task in terms of computer memory usage and calculation speed. To potentially reduce the amount of memory used, we analyzed the impact of beam angle sampling for dose calculation on the accuracy of the dose distribution. To establish the performance of the method, we planned two single-arc VMAT prostate stereotactic body radiation therapy cases for delivery with dynamic MLC tracking. For quality assurance of our online dose reconstruction method we have also developed a stand-alone offline dose reconstruction tool, which utilizes the RayStation treatment planning system to calculate dose. For the online reconstructed dose distributions of the tracked deliveries, we could establish strong resemblance for 72 and 36 beam co-planar equidistant beam samples with less than 1.2% deviation for the assessed dose-volume indicators (clinical target volume D98 and D2, and rectum D2). We could achieve average runtimes of 28-31 ms per reported MLC aperture for both dose computation and accumulation, meeting our real-time requirement. To cross-validate the offline tool, we have compared the planned dose to the offline reconstructed dose for static deliveries and found excellent agreement (3%/3 mm global gamma passing rates of 99.8%-100%). Being able to reconstruct dose during delivery enables online quality assurance and online replanning strategies for VMAT. The offline quality assurance tool provides the means to validate novel online dose reconstruction applications using a commercial dose calculation engine. © 2017 The Authors. Medical Physics published by Wiley Periodicals, Inc. on behalf of American Association of Physicists in Medicine.

TH-EF-BRB-11: Volumetric Modulated Arc Therapy for Total Body Irradiation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ouyang, L; Folkerts, M; Hrycushko, B

Purpose: To develop a modern, patient-comfortable total body irradiation (TBI) technique suitable for standard-sized linac vaults. Methods: An indexed rotatable immobilization system (IRIS) was developed to make possible total-body CT imaging and radiation delivery on conventional couches. Treatment consists of multi-isocentric volumetric modulated arc therapy (VMAT) to the upper body and parallel-opposed fields to the lower body. Each isocenter is indexed to the couch and includes a 180° IRIS rotation between the upper and lower body fields. VMAT fields are optimized to satisfy lung dose objectives while achieving a uniform therapeutic dose to the torso. End-to-end tests with a randomore » phantom were used to verify dosimetric characteristics. Treatment plan robustness regarding setup uncertainty was assessed by simulating global and regional isocenter setup shifts on patient data sets. Dosimetric comparisons were made with conventional extended distance, standing TBI (cTBI) plans using a Monte Carlo-based calculation. Treatment efficiency was assessed for eight courses of patient treatment. Results: The IRIS system is level and orthogonal to the scanned CT image plane, with lateral shifts <2mm following rotation. End-to-end tests showed surface doses within ±10% of the prescription dose, field junction doses within ±15% of prescription dose. Plan robustness tests showed <15% changes in dose with global setup errors up to 5mm in each direction. Local 5mm relative setup errors in the chest resulted in < 5% dose changes. Local 5mm shift errors in the pelvic and upper leg junction resulted in <10% dose changes while a 10mm shift error causes dose changes up to 25%. Dosimetric comparison with cTBI showed VMAT-TBI has advantages in preserving chest wall dose with flexibility in leveraging the PTV-body and PTV-lung dose. Conclusion: VMAT-TBI with the IRIS system was shown clinically feasible as a cost-effective approach to TBI for standard-sized linac vaults.« less

SU-E-T-247: Multi-Leaf Collimator Model Adjustments Improve Small Field Dosimetry in VMAT Plans

DOE Office of Scientific and Technical Information (OSTI.GOV)

Young, L; Yang, F

2014-06-01

Purpose: The Elekta beam modulator linac employs a 4-mm micro multileaf collimator (MLC) backed by a fixed jaw. Out-of-field dose discrepancies between treatment planning system (TPS) calculations and output water phantom measurements are caused by the 1-mm leaf gap required for all moving MLCs in a VMAT arc. In this study, MLC parameters are optimized to improve TPS out-of-field dose approximations. Methods: Static 2.4 cm square fields were created with a 1-mm leaf gap for MLCs that would normally park behind the jaw. Doses in the open field and leaf gap were measured with an A16 micro ion chamber andmore » EDR2 film for comparison with corresponding point doses in the Pinnacle TPS. The MLC offset table and tip radius were adjusted until TPS point doses agreed with photon measurements. Improvements to the beam models were tested using static arcs consisting of square fields ranging from 1.6 to 14.0 cm, with 45° collimator rotation, and 1-mm leaf gap to replicate VMAT conditions. Gamma values for the 3-mm distance, 3% dose difference criteria were evaluated using standard QA procedures with a cylindrical detector array. Results: The best agreement in point doses within the leaf gap and open field was achieved by offsetting the default rounded leaf end table by 0.1 cm and adjusting the leaf tip radius to 13 cm. Improvements in TPS models for 6 and 10 MV photon beams were more significant for smaller field sizes 3.6 cm or less where the initial gamma factors progressively increased as field size decreased, i.e. for a 1.6cm field size, the Gamma increased from 56.1% to 98.8%. Conclusion: The MLC optimization techniques developed will achieve greater dosimetric accuracy in small field VMAT treatment plans for fixed jaw linear accelerators. Accurate predictions of dose to organs at risk may reduce adverse effects of radiotherapy.« less

Novel, full 3D scintillation dosimetry using a static plenoptic camera.

PubMed

Goulet, Mathieu; Rilling, Madison; Gingras, Luc; Beddar, Sam; Beaulieu, Luc; Archambault, Louis

2014-08-01

Patient-specific quality assurance (QA) of dynamic radiotherapy delivery would gain from being performed using a 3D dosimeter. However, 3D dosimeters, such as gels, have many disadvantages limiting to quality assurance, such as tedious read-out procedures and poor reproducibility. The purpose of this work is to develop and validate a novel type of high resolution 3D dosimeter based on the real-time light acquisition of a plastic scintillator volume using a plenoptic camera. This dosimeter would allow for the QA of dynamic radiation therapy techniques such as intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). A Raytrix R5 plenoptic camera was used to image a 10 × 10 × 10 cm(3) EJ-260 plastic scintillator embedded inside an acrylic phantom at a rate of one acquisition per second. The scintillator volume was irradiated with both an IMRT and VMAT treatment plan on a Clinac iX linear accelerator. The 3D light distribution emitted by the scintillator volume was reconstructed at a 2 mm resolution in all dimensions by back-projecting the light collected by each pixel of the light-field camera using an iterative reconstruction algorithm. The latter was constrained by a beam's eye view projection of the incident dose acquired using the portal imager integrated with the linac and by physical consideration of the dose behavior as a function of depth in the phantom. The absolute dose difference between the reconstructed 3D dose and the expected dose calculated using the treatment planning software Pinnacle(3) was on average below 1.5% of the maximum dose for both integrated IMRT and VMAT deliveries, and below 3% for each individual IMRT incidences. Dose agreement between the reconstructed 3D dose and a radiochromic film acquisition in the same experimental phantom was on average within 2.1% and 1.2% of the maximum recorded dose for the IMRT and VMAT delivery, respectively. Using plenoptic camera technology, the authors were able to perform millimeter resolution, water-equivalent dosimetry of an IMRT and VMAT plan over a whole 3D volume. Since no moving parts are required in the dosimeter, the incident dose distribution can be acquired as a function of time, thus enabling the validation of static and dynamic radiation delivery with photons, electrons, and heavier ions.

Novel, full 3D scintillation dosimetry using a static plenoptic camera

PubMed Central

Goulet, Mathieu; Rilling, Madison; Gingras, Luc; Beddar, Sam; Beaulieu, Luc; Archambault, Louis

2014-01-01

Purpose: Patient-specific quality assurance (QA) of dynamic radiotherapy delivery would gain from being performed using a 3D dosimeter. However, 3D dosimeters, such as gels, have many disadvantages limiting to quality assurance, such as tedious read-out procedures and poor reproducibility. The purpose of this work is to develop and validate a novel type of high resolution 3D dosimeter based on the real-time light acquisition of a plastic scintillator volume using a plenoptic camera. This dosimeter would allow for the QA of dynamic radiation therapy techniques such as intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). Methods: A Raytrix R5 plenoptic camera was used to image a 10 × 10 × 10 cm3 EJ-260 plastic scintillator embedded inside an acrylic phantom at a rate of one acquisition per second. The scintillator volume was irradiated with both an IMRT and VMAT treatment plan on a Clinac iX linear accelerator. The 3D light distribution emitted by the scintillator volume was reconstructed at a 2 mm resolution in all dimensions by back-projecting the light collected by each pixel of the light-field camera using an iterative reconstruction algorithm. The latter was constrained by a beam's eye view projection of the incident dose acquired using the portal imager integrated with the linac and by physical consideration of the dose behavior as a function of depth in the phantom. Results: The absolute dose difference between the reconstructed 3D dose and the expected dose calculated using the treatment planning software Pinnacle3 was on average below 1.5% of the maximum dose for both integrated IMRT and VMAT deliveries, and below 3% for each individual IMRT incidences. Dose agreement between the reconstructed 3D dose and a radiochromic film acquisition in the same experimental phantom was on average within 2.1% and 1.2% of the maximum recorded dose for the IMRT and VMAT delivery, respectively. Conclusions: Using plenoptic camera technology, the authors were able to perform millimeter resolution, water-equivalent dosimetry of an IMRT and VMAT plan over a whole 3D volume. Since no moving parts are required in the dosimeter, the incident dose distribution can be acquired as a function of time, thus enabling the validation of static and dynamic radiation delivery with photons, electrons, and heavier ions. PMID:25086549

Time-resolved dosimetry using a pinpoint ionization chamber as quality assurance for IMRT and VMAT

DOE Office of Scientific and Technical Information (OSTI.GOV)

Louwe, Robert J. W., E-mail: rob.louwe@ccdbh.org.nz; Satherley, Thomas; Day, Rebecca A.

Purpose: To develop a method to verify the dose delivery in relation to the individual control points of intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) using an ionization chamber. In addition to more effective problem solving during patient-specific quality assurance (QA), the aim is to eventually map out the limitations in the treatment chain and enable a targeted improvement of the treatment technique in an efficient way. Methods: Pretreatment verification was carried out for 255 treatment plans that included a broad range of treatment indications in two departments using the equipment of different vendors. In-house developed softwaremore » was used to enable calculation of the dose delivery for the individual beamlets in the treatment planning system (TPS), for data acquisition, and for analysis of the data. The observed deviations were related to various delivery and measurement parameters such as gantry angle, field size, and the position of the detector with respect to the field edge to distinguish between error sources. Results: The average deviation of the integral fraction dose during pretreatment verification of the planning target volume dose was −2.1% ± 2.2% (1 SD), −1.7% ± 1.7% (1 SD), and 0.0% ± 1.3% (1 SD) for IMRT at the Radboud University Medical Center (RUMC), VMAT (RUMC), and VMAT at the Wellington Blood and Cancer Centre, respectively. Verification of the dose to organs at risk gave very similar results but was generally subject to a larger measurement uncertainty due to the position of the detector at a high dose gradient. The observed deviations could be related to limitations of the TPS beam models, attenuation of the treatment couch, as well as measurement errors. The apparent systematic error of about −2% in the average deviation of the integral fraction dose in the RUMC results could be explained by the limitations of the TPS beam model in the calculation of the beam penumbra. Conclusions: This study showed that time-resolved dosimetry using an ionization chamber is feasible and can be largely automated which limits the required additional time compared to integrated dose measurements. It provides a unique QA method which enables identification and quantification of the contribution of various error sources during IMRT and VMAT delivery.« less

A dosimetric evaluation of knowledge-based VMAT planning with simultaneous integrated boosting for rectal cancer patients.

PubMed

Wu, Hao; Jiang, Fan; Yue, Haizhen; Li, Sha; Zhang, Yibao

2016-11-08

RapidPlan, a commercial knowledge-based optimizer, has been tested on head and neck, lung, esophageal, breast, liver, and prostate cancer patients. To appraise its performance on VMAT planning with simultaneous integrated boosting (SIB) for rectal cancer, this study configured a DVH (dose-volume histogram) estimation model consisting 80 best-effort manual cases of this type. Using the model-generated objectives, the MLC (multileaf collimator) sequences of other 70 clinically approved plans were reoptimized, while the remaining parameters, such as field geometry and photon energy, were maintained. Dosimetric outcomes were assessed by comparing homogeneity index (HI), conformal index (CI), hot spots (volumes receiving over 107% of the prescribed dose, V107%), mean dose and dose to the 50% volume of femoral head (Dmean_FH and D50%_FH), and urinary bladder (Dmean_UB and D50%_UB), and the mean DVH plotting. Paired samples t-test or Wilcoxon signed-rank test suggested that comparable CI were achieved by RapidPlan (0.99± 0.04 for PTVboost, and 1.03 ± 0.02 for PTV) and original plans (1.00 ± 0.05 for PTVboost and 1.03 ± 0.02 for PTV), respectively (p > 0.05). Slightly improved HI of planning target volume (PTVboost) and PTV were observed in the RapidPlan cases (0.05 ± 0.01 for PTVboost, and 0.26 ± 0.01 for PTV) than the original plans (0.06 ± 0.01 for PTVboost and 0.26 ± 0.01 for PTV), p < 0.05. More cases with positive V107% were found in the original (18 plans) than the RapidPlan group (none). RapidPlan significantly reduced the D50%_FH (by 1.53 Gy / 9.86% from 15.52 ± 2.17 to 13.99± 1.16 Gy), Dmean_FH (by 1.29 Gy / 7.78% from 16.59± 2.07 to 15.30 ± 0.70 G), D50%_UB (by 4.93 Gy / 17.50% from 28.17 ± 3.07 to 23.24± 2.13 Gy), and Dmean_UB (by 3.94Gy / 13.43% from 29.34 ± 2.34 to 25.40 ± 1.36 Gy), respectively. The more concentrated distribution of RapidPlan data points indicated an enhanced consis-tency of plan quality. © 2016 The Authors.

The dosimetric effects of photon energy on the quality of prostate volumetric modulated arc therapy.

PubMed

Mattes, Malcolm D; Tai, Cyril; Lee, Alvin; Ashamalla, Hani; Ikoro, N C

2014-01-01

Studies comparing the dosimetric effects of high- and low-energy photons to treat prostate cancer using 3-dimensional conformal and intensity modulated radiation therapy have yielded mixed results. With the advent of newer radiation delivery systems like volumetric modulated arc therapy (VMAT), the impact of changing photon energy is readdressed. Sixty-five patients treated for prostate cancer at our institution from 2011 to 2012 underwent CT simulation. A target volume encompassing the prostate and entire seminal vesicles was treated to 50.4 Gy, followed by a boost to the prostate and proximal seminal vesicles to a total dose of 81 Gy. The VMAT plans were generated for 6-MV and 10-MV photons under identical optimization conditions using the Eclipse system version 8.6 (Varian Medical Systems, Palo Alto, CA). The analytical anisotropic algorithm was used for all dose calculations. Plans were normalized such that 98% of the planning target volume (PTV) received 100% of the prescribed dose. Dose-volumetric data from the treatment planning system was recorded for both 6-MV and 10-MV plans, which were compared for both the entire cohort and subsets of patients stratified according to the anterior-posterior separation. Plans using 10-MV photons had statistically significantly lower relative integral dose (4.1%), gradient measure (4.1%), skin Dmax (16.9%), monitor units (13.0%), and bladder V(30) (3.1%) than plans using 6-MV photons (P < .05). There was no difference in rectal dose, high-dose-region bladder dose, PTV coverage, or conformity index. The benefit of 10-MV photons was more pronounced for thicker patients (anterior-posterior separation >21 cm) for most parameters, with statistically significant differences in bladder V(30), bladder V(65), integral dose, conformity index, and monitor units. The main dosimetric benefits of 10-MV as compared with 6-MV photons are seen in thicker patients, though for the entire cohort 10-MV plans resulted in a lower integral dose, gradient measure, skin Dmax, monitor units, and bladder V(30), possibly at the expense of higher rectum V(81). Copyright © 2014 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

SU-E-T-87: Comparison Study of Dose Reconstruction From Cylindrical Diode Array Measurements, with TLD Measurements and Treatment Planning System Calculations in Anthropomorphic Head and Neck and Lung Phantoms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Benhabib, S; Cardan, R; Huang, M

Purpose: To assess dose calculated by the 3DVH software (Sun Nuclear Systems, Melbourne, FL) against TLD measurements and treatment planning system calculations in anthropomorphic phantoms. Methods: The IROC Houston (RPC) head and neck (HN) and lung phantoms were scanned and plans were generated using Eclipse (Varian Medical Systems, Milpitas, CA) following IROC Houston procedures. For the H and N phantom, 6 MV VMAT and 9-field dynamic MLC (DMLC) plans were created. For the lung phantom 6 MV VMAT and 15 MV 9-field dynamic MLC (DMLC) plans were created. The plans were delivered to the phantoms and to an ArcCHECK (Sunmore » Nuclear Systems, Melbourne, FL). The head and neck phantom contained 8 TLDs located at PTV1 (4), PTV2 (2), and OAR Cord (2). The lung phantom contained 4 TLDs, 2 in the PTV, 1 in the cord, and 1 in the heart. Daily outputs were recorded before each measurement for correction. 3DVH dose reconstruction software was used to project the calculated dose to patient anatomy. Results: For the HN phantom, the maximum difference between 3DVH and TLDs was -3.4% and between 3DVH and Eclipse was 1.2%. For the lung plan the maximum difference between 3DVH and TLDs was 4.3%, except for the spinal cord for which 3DVH overestimated the TLD dose by 12%. The maximum difference between 3DVH and Eclipse was 0.3%. 3DVH agreed well with Eclipse because the dose reconstruction algorithm uses the diode measurements to perturb the dose calculated by the treatment planning system; therefore, if there is a problem in the modeling or heterogeneity correction, it will be carried through to 3DVH. Conclusion: 3DVH agreed well with Eclipse and TLD measurements. Comparison of 3DVH with film measurements is ongoing. Work supported by PHS grant CA10953 and CA81647 (NCI, DHHS)« less

Evaluation of volume change in rectum and bladder during application of image-guided radiotherapy for prostate carcinoma

NASA Astrophysics Data System (ADS)

Luna, J. A.; Rojas, J. I.

2016-07-01

All prostate cancer patients from Centro Médico Radioterapia Siglo XXI receive Volumetric Modulated Arc Therapy (VMAT). This therapy uses image-guided radiotherapy (IGRT) with the Cone Beam Computed Tomography (CBCT). This study compares the planned dose in the reference CT image against the delivered dose recalculate in the CBCT image. The purpose of this study is to evaluate the anatomic changes and related dosimetric effect based on weekly CBCT directly for patients with prostate cancer undergoing volumetric modulated arc therapy (VMAT) treatment. The collected data were analyzed using one-way ANOVA.

Emulating proton-induced conformational changes in the vesicular monoamine transporter VMAT2 by mutagenesis.

PubMed

Yaffe, Dana; Vergara-Jaque, Ariela; Forrest, Lucy R; Schuldiner, Shimon

2016-11-22

Neurotransporters located in synaptic vesicles are essential for communication between nerve cells in a process mediated by neurotransmitters. Vesicular monoamine transporter (VMAT), a member of the largest superfamily of transporters, mediates transport of monoamines to synaptic vesicles and storage organelles in a process that involves exchange of two H + per substrate. VMAT transport is inhibited by the competitive inhibitor reserpine, a second-line agent to treat hypertension, and by the noncompetitive inhibitor tetrabenazine, presently in use for symptomatic treatment of hyperkinetic disorders. During the transport cycle, VMAT is expected to occupy at least three different conformations: cytoplasm-facing, occluded, and lumen-facing. The lumen- to cytoplasm-facing transition, facilitated by protonation of at least one of the essential membrane-embedded carboxyls, generates a binding site for reserpine. Here we have identified residues in the cytoplasmic gate and show that mutations that disrupt the interactions in this gate also shift the equilibrium toward the cytoplasm-facing conformation, emulating the effect of protonation. These experiments provide significant insight into the role of proton translocation in the conformational dynamics of a mammalian H + -coupled antiporter, and also identify key aspects of the mode of action and binding of two potent inhibitors of VMAT2: reserpine binds the cytoplasm-facing conformation, and tetrabenazine binds the lumen-facing conformation.

An efficient Volumetric Arc Therapy treatment planning approach for hippocampal-avoidance whole-brain radiation therapy (HA-WBRT).

PubMed

Shen, Jin; Bender, Edward; Yaparpalvi, Ravindra; Kuo, Hsiang-Chi; Basavatia, Amar; Hong, Linda; Bodner, William; Garg, Madhur K; Kalnicki, Shalom; Tomé, Wolfgang A

2015-01-01

An efficient and simple class solution is proposed for hippocampal-avoidance whole-brain radiation therapy (HA-WBRT) planning using the Volumetric Arc Therapy (VMAT) delivery technique following the NRG Oncology protocol NRG-CC001 treatment planning guidelines. The whole-brain planning target volume (PTV) was subdivided into subplanning volumes that lie in plane and out of plane with the hippocampal-avoidance volume. To further improve VMAT treatment plans, a partial-field dual-arc technique was developed. Both the arcs were allowed to overlap on the in-plane subtarget volume, and in addition, one arc covered the superior out-of-plane sub-PTV, while the other covered the inferior out-of-plane subtarget volume. For all plans (n = 20), the NRG-CC001 protocol dose-volume criteria were met. Mean values of volumes for the hippocampus and the hippocampal-avoidance volume were 4.1 cm(3) ± 1.0 cm(3) and 28.52 cm(3) ± 3.22 cm(3), respectively. For the PTV, the average values of D(2%) and D(98%) were 36.1 Gy ± 0.8 Gy and 26.2 Gy ± 0.6 Gy, respectively. The hippocampus D(100%) mean value was 8.5 Gy ± 0.2 Gy and the maximum dose was 15.7 Gy ± 0.3 Gy. The corresponding plan quality indices were 0.30 ± 0.01 (homogeneity index), 0.94 ± 0.01 (target conformality), and 0.75 ± 0.02 (confirmation number). The median total monitor unit (MU) per fraction was 806 MU (interquartile range [IQR]: 792 to 818 MU) and the average beam total delivery time was 121.2 seconds (IQR: 120.6 to 121.35 seconds). All plans passed the gamma evaluation using the 5-mm, 4% criteria, with γ > 1 of not more than 9.1% data points for all fields. An efficient and simple planning class solution for HA-WBRT using VMAT has been developed that allows all protocol constraints of NRG-CC001 to be met. Copyright © 2015 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

The influence of the dose calculation resolution of VMAT plans on the calculated dose for eye lens and optic pathway.

PubMed

Park, Jong Min; Park, So-Yeon; Kim, Jung-In; Carlson, Joel; Kim, Jin Ho

2017-03-01

To investigate the effect of dose calculation grid on calculated dose-volumetric parameters for eye lenses and optic pathways. A total of 30 patients treated using the volumetric modulated arc therapy (VMAT) technique, were retrospectively selected. For each patient, dose distributions were calculated with calculation grids ranging from 1 to 5 mm at 1 mm intervals. Identical structures were used for VMAT planning. The changes in dose-volumetric parameters according to the size of the calculation grid were investigated. Compared to dose calculation with 1 mm grid, the maximum doses to the eye lens with calculation grids of 2, 3, 4 and 5 mm increased by 0.2 ± 0.2 Gy, 0.5 ± 0.5 Gy, 0.9 ± 0.8 Gy and 1.7 ± 1.5 Gy on average, respectively. The Spearman's correlation coefficient between dose gradients near structures vs. the differences between the calculated doses with 1 mm grid and those with 5 mm grid, were 0.380 (p < 0.001). For the accurate calculation of dose distributions, as well as efficiency, using a grid size of 2 mm appears to be the most appropriate choice.

An assessment of a 3D EPID-based dosimetry system using conventional two- and three-dimensional detectors for VMAT.

PubMed

Stevens, S; Dvorak, P; Spevacek, V; Pilarova, K; Bray-Parry, M; Gesner, J; Richmond, A

2018-01-01

To provide a 3D dosimetric evaluation of a commercial portal dosimetry system using 2D/3D detectors under ideal conditions using VMAT. A 2D ion chamber array, radiochromic film and gel dosimeter were utilised to provide a dosimetric evaluation of transit phantom and pre-treatment 'fluence' EPID back-projected dose distributions for a standard VMAT plan. In-house 2D and 3D gamma methods compared pass statistics relative to each dosimeter and TPS dose distributions. Fluence mode and transit EPID dose distributions back-projected onto phantom geometry produced 2D gamma pass rates in excess of 97% relative to other tested detectors and exported TPS dose planes when a 3%, 3 mm global gamma criterion was applied. Use of a gel dosimeter within a glass vial allowed comparison of measured 3D dose distributions versus EPID 3D dose and TPS calculated distributions. 3D gamma comparisons between modalities at 3%, 3 mm gave pass rates in excess of 92%. Use of fluence mode was indicative of transit results under ideal conditions with slightly reduced dose definition. 3D EPID back projected dose distributions were validated against detectors in both 2D and 3D. Cross validation of transit dose delivered to a patient is limited due to reasons of practicality and the tests presented are recommended as a guideline for 3D EPID dosimetry commissioning; allowing direct comparison between detector, TPS, fluence and transit modes. The results indicate achievable gamma scores for a complex VMAT plan in a homogenous phantom geometry and contributes to growing experience of 3D EPID dosimetry. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

Examination of the properties of IMRT and VMAT beams and evaluation against pre-treatment quality assurance results

NASA Astrophysics Data System (ADS)

Crowe, S. B.; Kairn, T.; Middlebrook, N.; Sutherland, B.; Hill, B.; Kenny, J.; Langton, C. M.; Trapp, J. V.

2015-03-01

This study aimed to provide a detailed evaluation and comparison of a range of modulated beam evaluation metrics, in terms of their correlation with QA testing results and their variation between treatment sites, for a large number of treatments. Ten metrics including the modulation index (MI), fluence map complexity, modulation complexity score (MCS), mean aperture displacement (MAD) and small aperture score (SAS) were evaluated for 546 beams from 122 intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) treatment plans targeting the anus, rectum, endometrium, brain, head and neck and prostate. The calculated sets of metrics were evaluated in terms of their relationships to each other and their correlation with the results of electronic portal imaging based quality assurance (QA) evaluations of the treatment beams. Evaluation of the MI, MAD and SAS suggested that beams used in treatments of the anus, rectum, head and neck were more complex than the prostate and brain treatment beams. Seven of the ten beam complexity metrics were found to be strongly correlated with the results from QA testing of the IMRT beams (p < 0.00008). For example, values of SAS (with multileaf collimator apertures narrower than 10 mm defined as ‘small’) less than 0.2 also identified QA passing IMRT beams with 100% specificity. However, few of the metrics are correlated with the results from QA testing of the VMAT beams, whether they were evaluated as whole 360° arcs or as 60° sub-arcs. Select evaluation of beam complexity metrics (at least MI, MCS and SAS) is therefore recommended, as an intermediate step in the IMRT QA chain. Such evaluation may also be useful as a means of periodically reviewing VMAT planning or optimiser performance.

Comparison of the extent of hippocampal sparing according to the tilt of a patient's head during WBRT using linear accelerator-based IMRT and VMAT.

PubMed

Moon, Sun Young; Yoon, Myonggeun; Chung, Mijoo; Chung, Weon Kuu; Kim, Dong Wook

2016-05-01

In this paper, we report the results of our investigation into whole brain radiotherapy (WBRT) using linear accelerator-based intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) in lung cancer patients with a high risk of metastasis to the brain. Specifically, we assessed the absorbed dose and the rate of adverse effects for several organs at risk (OAR), including the hippocampus, according to the tilt of a patient's head. We arbitrarily selected five cases where measurements were made with the patients' heads tilted forward and five cases without such tilt. We set the entire brain as the planning target volume (PTV), and the hippocampi, the lenses, the eyes, and the cochleae as the main OAR, and formulated new plans for IMRT (coplanar, non-coplanar) and VMAT (coplanar, non-coplanar). Using the dose-volume histogram (DVH), we calculated and compared the effective uniform dose (EUD), normal tissue complication probability (NTCP) of the OAR and the mean and the maximum doses of hippocampus. As a result, if the patient tilted the head forward when receiving the Linac-based treatment, for the same treatment effect in the PTV, we confirmed that a lower dose entered the OAR, such as the hippocampus, eye, lens, and cochlea. Moreover, the damage to the hippocampus was expected to be the least when receiving coplanar VMAT with the head tilted forward. Accordingly, if patients tilt their heads forward when undergoing Linac-based WBRT, we anticipate that a smaller dose would be transmitted to the OAR, resulting in better quality of life following treatment. Copyright © 2016 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.