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Sample records for helical tomotherapy intensity-modulated

  1. Stereotactic Image-Guided Intensity Modulated Radiotherapy Using the HI-ART II Helical Tomotherapy System

    International Nuclear Information System (INIS)

    Holmes, Timothy W.; Hudes, Richard; Dziuba, Sylwester; Kazi, Abdul; Hall, Mark; Dawson, Dana

    2008-01-01

    The highly integrated adaptive radiation therapy (HI-ART II) helical tomotherapy unit is a new radiotherapy machine designed to achieve highly precise and accurate treatments at all body sites. The precision and accuracy of the HI-ART II is similar to that provided by stereotactic radiosurgery systems, hence the historical distinction between external beam radiotherapy and stereotactic procedures based on differing precision requirements is removed for this device. The objectives of this work are: (1) to describe stereotactic helical tomotherapy processes (SRS, SBRT); (2) to show that the precision and accuracy of the HI-ART meet the requirements defined for SRS and SBRT; and (3) to describe the clinical implementation of a stereotactic image-guided intensity modulated radiation therapy (IG-IMRT) system that incorporates optical motion management

  2. Dosimetric aspects of breast radiotherapy with three-dimensional and intensity-modulated radiotherapy helical tomotherapy planning modules

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    Yadav, Poonam [Department of Human Oncology, University of Wisconsin-Madison, Madison, WI (United States); Service of Radiation Therapy, University of Wisconsin Aspirus Cancer Center, Wisconsin Rapids, WI (United States); Yan, Yue, E-mail: yyan5@mdanderson.org [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX (United States); Ignatowski, Tasha [Service of Radiation Therapy, University of Wisconsin Aspirus Cancer Center, Wisconsin Rapids, WI (United States); Olson, Anna [Department of Human Oncology, University of Wisconsin-Madison, Madison, WI (United States); Service of Radiation Therapy, University of Wisconsin Aspirus Cancer Center, Wisconsin Rapids, WI (United States)

    2017-04-01

    In this work, we investigated the dosimetric differences between the intensity-modulated radiotherapy (IMRT) plans and the three-dimensional (3D) helical plans based on the TomoTherapy system. A total of 15 patients with supine setup were randomly selected from the data base. For patients with lumpectomy planning target volume (PTV), regional lymph nodes were also included as part of the target. For dose sparing, the significant differences between the helical IMRT and helical 3D were only found in the heart and contralateral breast. For the dose to the heart, helical IMRT reduced the maximum point dose by 6.98 Gy compared to the helical 3D plan (p = 0.01). For contralateral breast, the helical IMRT plans significantly reduced the maximum point dose by 5.6 Gy compared to the helical 3D plan. However, compared to the helical 3D plan, the helical IMRT plan increased the volume for lower dose (13.08% increase in V{sub 5} {sub Gy}, p = 0.01). In general, there are no significant differences in dose sparing between helical IMRT and helical 3D plans.

  3. Dosimetric aspects of breast radiotherapy with three-dimensional and intensity-modulated radiotherapy helical tomotherapy planning modules

    International Nuclear Information System (INIS)

    Yadav, Poonam; Yan, Yue; Ignatowski, Tasha; Olson, Anna

    2017-01-01

    In this work, we investigated the dosimetric differences between the intensity-modulated radiotherapy (IMRT) plans and the three-dimensional (3D) helical plans based on the TomoTherapy system. A total of 15 patients with supine setup were randomly selected from the data base. For patients with lumpectomy planning target volume (PTV), regional lymph nodes were also included as part of the target. For dose sparing, the significant differences between the helical IMRT and helical 3D were only found in the heart and contralateral breast. For the dose to the heart, helical IMRT reduced the maximum point dose by 6.98 Gy compared to the helical 3D plan (p = 0.01). For contralateral breast, the helical IMRT plans significantly reduced the maximum point dose by 5.6 Gy compared to the helical 3D plan. However, compared to the helical 3D plan, the helical IMRT plan increased the volume for lower dose (13.08% increase in V 5 Gy , p = 0.01). In general, there are no significant differences in dose sparing between helical IMRT and helical 3D plans.

  4. Safety and Efficacy of Intensity-Modulated Stereotactic Body Radiotherapy Using Helical Tomotherapy for Lung Cancer and Lung Metastasis

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    Aiko Nagai

    2014-01-01

    Full Text Available Stereotactic body radiotherapy (SBRT proved to be an effective treatment with acceptable toxicity for lung tumors. However, the use of helical intensity-modulated (IM SBRT is controversial. We investigated the outcome of lung tumor patients treated by IMSBRT using helical tomotherapy with a Japanese standard fractionation schedule of 48 Gy in 4 fractions (n=37 or modified protocols of 50–60 Gy in 5–8 fractions (n=35. Median patient’s age was 76 years and median follow-up period for living patients was 20 months (range, 6–46. The median PTV was 6.9 cc in the 4-fraction group and 14 cc in the 5- to 8-fraction group (P=0.001. Grade 2 radiation pneumonitis was seen in 2 of 37 patients in the 4-fraction group and in 2 of 35 patients in the 5- to 8-fraction group (log-rank P=0.92. Other major complications were not observed. The LC rates at 2 years were 87% in the 4-fraction group and 83% in the 5- to 8-fraction group. Helical IMSBRT for lung tumors is safe and effective. Patients with a high risk of developing severe complications may also be safely treated using 5–8 fractions. The results of the current study warrant further studies of helical IMSBRT.

  5. Radiotherapy for Adult Medulloblastoma: Evaluation of Helical Tomotherapy, Volumetric Intensity Modulated Arc Therapy, and Three-Dimensional Conformal Radiotherapy and the Results of Helical Tomotherapy Therapy

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    Sun Zong-wen

    2018-01-01

    Full Text Available Introduction. All adult medulloblastoma (AMB patients should be treated with craniospinal irradiation (CSI postoperatively. Because of the long irradiation range, multiple radiation fields must be designed for conventional radiotherapy technology. CSI can be completed in only one session with helical tomotherapy (HT. We evaluated the dose of HT, volumetric intensity modulated arc therapy (VMAT, and three-dimensional conformal radiotherapy (3D-CRT of AMB and the results of 5 cases of AMB treated with HT. Methods. Complete craniospinal and posterior cranial fossa irradiation with HT, VMAT, and 3D-CRT and dose evaluation were performed. And results of 5 cases of AMB treated with HT were evaluated. Results. A large volume of tissue was exposed to low dose radiation in the organs at risk (OAR, while a small volume was exposed to high dose radiation with HT. The conformity and uniformity of the targets were good with HT and VMAT, and the volume of targets exposed to high dose with VMAT was larger than that of HT. The uniformity of 3D-CRT was also good, but the dose conformity was poor. The main toxicity was hematologic toxicity, without 4th-degree bone marrow suppression. There was 3rd-degree inhibition in the white blood cells, hemoglobin, and platelets. The three female patients suffered menstrual disorders during the course of radiation. Two female patients with heavy menstruation suffered 3rd-degree anemia inhibition, and 2 patients suffered amenorrhea after radiotherapy. Although menstrual cycle was normal, the third patient was not pregnant. Conclusion. CSI with HT is convenient for clinical practice, and the side effects are mild. With good conformity and uniformity, VMAT can also be used for selection in CSI. For poor conformity, 3D-CRT should not be the priority selection for CSI. In female patients, the ovaries should be protected.

  6. Preliminary comp arison of helical tomotherapy and mixed beams of unmodulated electrons and intensity modulated radiation therapy for treating superficial cancers of the parotid gland and nasal cavity

    International Nuclear Information System (INIS)

    Blasi, Olivier; Fontenot, Jonas D; Fields, Robert S; Gibbons, John P; Hogstrom, Kenneth R

    2011-01-01

    To investigate combining unmodulated electron beams with intensity-modulated radiation therapy to improve dose distributions for superficial head and neck cancers, and to compare mixed beam plans with helical tomotherapy. Mixed beam and helical tomotherapy dose plans were developed for two patients with parotid gland tumors and two patients with nasal cavity tumors. Mixed beam plans consisted of various weightings of a enface electron beam and IMRT, which was optimized after calculation of the electron dose to compensate for heterogeneity in the electron dose distribution within the target volume. Helical tomotherapy plans showed dose conformity and homogeneity in the target volume that was equal to or better than the mixed beam plans. Electron-only plans tended to show the lowest doses to normal tissues, but with markedly worse dose conformity and homogeneity than in the other plans. However, adding a 20% IMRT dose fraction (i.e., IMRT:electron weighting = 1:4) to the electron plan restored target conformity and homogeneity to values comparable to helical tomotherapy plans, while maintaining lower normal tissue dose. Mixed beam treatments offer some dosimetric advantages over IMRT or helical tomotherapy for target depths that do not exceed the useful range of the electron beam. Adding a small IMRT component (e.g., IMRT:electron weighting = 1:4) to electron beam plans markedly improved target dose homogeneity and conformity for the cases examined in this study

  7. Helical Tomotherapy Versus Single-Arc Intensity-Modulated Arc Therapy: A Collaborative Dosimetric Comparison Between Two Institutions

    International Nuclear Information System (INIS)

    Rong Yi; Tang, Grace; Welsh, James S.; Mohiuddin, Majid M.; Paliwal, Bhudatt; Yu, Cedric X.

    2011-01-01

    Purpose: Both helical tomotherapy (HT) and single-arc intensity-modulated arc therapy (IMAT) deliver radiation using rotational beams with multileaf collimators. We report a dual-institution study comparing dosimetric aspects of these two modalities. Methods and Materials: Eight patients each were selected from the University of Maryland (UMM) and the University of Wisconsin Cancer Center Riverview (UWR), for a total of 16 cases. Four cancer sites including brain, head and neck (HN), lung, and prostate were selected. Single-arc IMAT plans were generated at UMM using Varian RapidArc (RA), and HT plans were generated at UWR using Hi-Art II TomoTherapy. All 16 cases were planned based on the identical anatomic contours, prescriptions, and planning objectives. All plans were swapped for analysis at the same time after final approval. Dose indices for targets and critical organs were compared based on dose-volume histograms, the beam-on time, monitor units, and estimated leakage dose. After the disclosure of comparison results, replanning was done for both techniques to minimize diversity in optimization focus from different operators. Results: For the 16 cases compared, the average beam-on time was 1.4 minutes for RA and 4.8 minutes for HT plans. HT provided better target dose homogeneity (7.6% for RA and 4.2% for HT) with a lower maximum dose (110% for RA and 105% for HT). Dose conformation numbers were comparable, with RA being superior to HT (0.67 vs. 0.60). The doses to normal tissues using these two techniques were comparable, with HT showing lower doses for more critical structures. After planning comparison results were exchanged, both techniques demonstrated improvements in dose distributions or treatment delivery times. Conclusions: Both techniques created highly conformal plans that met or exceeded the planning goals. The delivery time and total monitor units were lower in RA than in HT plans, whereas HT provided higher target dose uniformity.

  8. Xerostomia in patients treated for oropharyngeal carcinoma: comparing linear accelerator-based intensity-modulated radiation therapy with helical tomotherapy.

    Science.gov (United States)

    Fortin, Israël; Fortin, Bernard; Lambert, Louise; Clavel, Sébastien; Alizadeh, Moein; Filion, Edith J; Soulières, Denis; Bélair, Manon; Guertin, Louis; Nguyen-Tan, Phuc Felix

    2014-09-01

    In comparison to sliding-window intensity-modulated radiation therapy (sw-IMRT), we hypothesized that helical tomotherapy (HT) would achieve similar locoregional control and, at the same time, decrease the parotid gland dose, thus leading to a xerostomia reduction. The association between radiation techniques, mean parotid dose, and xerostomia incidence, was reviewed in 119 patients with advanced oropharyngeal carcinoma treated with concurrent chemoradiation using sw-IMRT (n = 59) or HT (n = 60). Ipsilateral and contralateral parotid mean doses were significantly lower for patients treated with HT versus sw-IMRT: 24 Gy versus 32 Gy ipsilaterally and 20 Gy versus 25 Gy contralaterally. The incidence of grade ≥2 xerostomia was significantly lower in the HT group than in the sw-IMRT group: 12% versus 78% at 6 months, 3% versus 51% at 12 months, and 0% versus 25% at 24 months. Total parotid mean dose xerostomia at 6, 12, and 24 months. This retrospective series suggests that using HT can better spare the parotid glands while respecting quantitative analysis of normal tissue effects in the clinic (QUANTEC)'s criteria. Copyright © 2013 Wiley Periodicals, Inc.

  9. Dosimetric comparison between helical tomotherapy and intensity-modulated radiation therapy plans for non-small cell lung cancer.

    Science.gov (United States)

    Meng, Ling-Ling; Feng, Lin-Chun; Wang, Yun-Lai; Dai, Xiang-Kun; Xie, Chuan-Bin

    2011-06-01

    Helical tomotherapy (HT) is a new image-guided intensity-modulated radiation therapy (IMRT) technique. It is reported that HT plan for non-small-cell lung cancer (NSCLC) can give better dose uniformity, dose gradients, and protection for the lung than IMRT plan. We compared the dosimetric characteristics of HT for NSCLC with those of conventional IMRT to observe the superiority of HT. There was a comparative case series comprising 10 patients with NSCLC. Computed tomographic (CT) images of delineated targets were transferred to the PrecisePlan planning system (IMRT) and Tomo planning system (HT). The prescription doses were 70 Gy/33F for the gross tumor volume (GTV) and the visible lymph nodes (GTVnd), and 60 Gy/33F for the clinical target volume (CTV) and the clinical target volume of the visible lymph nodes (CTVnd). The dose restrictions for organs at risk were as follows: the maximum dose to spinal cord ≤ 45 Gy, V20 to the total lungs 0.05). The maximum doses to the spinal cord, heart, esophagus and trachea in the HT plan were lower than those in the IMRT plan, but the differences were not statistically significant. The HT plan provids better dose uniformity, dose gradients, and protection for the organs at risk. It can reduce the high-dose radiation volume for lung and the MLD, but may deliver a larger lung volume of low-dose radiation.

  10. A treatment planning study comparing helical tomotherapy with intensity-modulated radiotherapy for the treatment of anal cancer

    International Nuclear Information System (INIS)

    Joseph, Kurian Jones; Syme, Alasdair; Small, Cormac; Warkentin, Heather; Quon, Harvey; Ghosh, Sunita; Field, Colin; Pervez, Nadeem; Tankel, Keith; Patel, Samir; Usmani, Nawaid; Severin, Diane; Nijjar, Tirath; Fallone, Gino; Pedersen, John

    2010-01-01

    Purpose: A planning study to compare helical tomotherapy (HT) and intensity-modulated radiotherapy (IMRT) for the treatment of anal canal cancer. Materials and methods: Sixteen (8 males and 8 females) patients with anal cancer previously treated radically were identified. HT and IMRT plans were generated and dosimetric comparisons of the plans were performed. The planning goals were to deliver 54 Gy to the tumor (PTV 54Gy ) and 48 Gy to the nodes at risk (PTV Node ) in 30 fractions. Results: PTVs: HT plans were more homogeneous for both men and women. Male patients: HT vs. IMRT: D max : 55.87 ± 0.58 vs. 59.17 ± 3.24 (p = 0.036); D min : 52.91 ± 0.36 vs. 44.09 ± 6.84 (p = 0.012); female patients: HT vs. IMRT: D max : 56.14 ± 0.71 vs. 59.47 ± 0.81 (p = 0.012); D min : 52.36 ± 0.87 vs. 50.97 ± 1.42 (p = 0.028). OARs: In general, HT plans delivered a lower dose to the peritoneal cavity, external genitalia and the bladder and IMRT plans resulted in greater sparing of the pelvic bones (iliac crest/femur) for both men and women. Iliac crest/femur: the difference was significant only for the mean V10 Gy of iliac crest in women (p ≤ 0.012). External genitalia: HT plans achieved better sparing in women compared to men (p ≤ 0.046). For men, the mean doses were 18.96 ± 3.17 and 15.72 ± 3.21 for the HT and IMRT plan, respectively (p ≤ 0.017). Skin: both techniques achieved comparable sparing of the non-target skin (p = NS). Conclusions: HT and IMRT techniques achieved comparable target dose coverage and organ sparing, whereas HT plans were more homogeneous for both men and women.

  11. Hippocampal-Sparing Whole-Brain Radiotherapy: A 'How-To' Technique Using Helical Tomotherapy and Linear Accelerator-Based Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Gondi, Vinai; Tolakanahalli, Ranjini; Mehta, Minesh P.; Tewatia, Dinesh; Rowley, Howard; Kuo, John S.; Khuntia, Deepak; Tome, Wolfgang A.

    2010-01-01

    Purpose: Sparing the hippocampus during cranial irradiation poses important technical challenges with respect to contouring and treatment planning. Herein we report our preliminary experience with whole-brain radiotherapy using hippocampal sparing for patients with brain metastases. Methods and Materials: Five anonymous patients previously treated with whole-brain radiotherapy with hippocampal sparing were reviewed. The hippocampus was contoured, and hippocampal avoidance regions were created using a 5-mm volumetric expansion around the hippocampus. Helical tomotherapy and linear accelerator (LINAC)-based intensity-modulated radiotherapy (IMRT) treatment plans were generated for a prescription dose of 30 Gy in 10 fractions. Results: On average, the hippocampal avoidance volume was 3.3 cm 3 , occupying 2.1% of the whole-brain planned target volume. Helical tomotherapy spared the hippocampus, with a median dose of 5.5 Gy and maximum dose of 12.8 Gy. LINAC-based IMRT spared the hippocampus, with a median dose of 7.8 Gy and maximum dose of 15.3 Gy. On a per-fraction basis, mean dose to the hippocampus (normalized to 2-Gy fractions) was reduced by 87% to 0.49 Gy 2 using helical tomotherapy and by 81% to 0.73 Gy 2 using LINAC-based IMRT. Target coverage and homogeneity was acceptable with both IMRT modalities, with differences largely attributed to more rapid dose fall-off with helical tomotherapy. Conclusion: Modern IMRT techniques allow for sparing of the hippocampus with acceptable target coverage and homogeneity. Based on compelling preclinical evidence, a Phase II cooperative group trial has been developed to test the postulated neurocognitive benefit.

  12. Intensity-modulated radiation therapy using static ports of tomotherapy (TomoDirect): comparison with the TomoHelical mode

    International Nuclear Information System (INIS)

    Murai, Taro; Shibamoto, Yuta; Manabe, Yoshihiko; Murata, Rumi; Sugie, Chikao; Hayashi, Akihiro; Ito, Hiroya; Miyoshi, Yoshihito

    2013-01-01

    With the new mode of Tomotherapy, irradiation can be delivered using static ports of the TomoDirect mode. The purpose of this study was to evaluate the characteristics of TomoDirect plans compared to conventional TomoHelical plans. TomoDirect and TomoHelical plans were compared in 46 patients with a prostate, thoracic wall or lung tumor. The mean target dose was used as the prescription dose. The minimum coverage dose of 95% of the target (D95%), conformity index (CI), uniformity index (UI), dose distribution in organs at risk and treatment time were evaluated. For TomoDirect, 2 to 5 static ports were used depending on the tumor location. For the prostate target volume, TomoDirect plans could not reduce the rectal dose and required a longer treatment time than TomoHelical. For the thoracic wall target volume, the V5Gy of the lung or liver was lower in TomoDirect than in TomoHelical (p = 0.02). For the lung target volume, TomoDirect yielded higher CI (p = 0.009) but smaller V5Gy of the lung (p = 0.005) than TomoHelical. Treatment time did not differ significantly between the thoracic wall and lung plans. Prostate cancers should be treated with the TomoHelical mode. Considering the risk of low-dose radiation to the lung, the TomoDirect mode could be an option for thoracic wall and lung tumors

  13. Radiobiologic comparison of helical tomotherapy, intensity modulated radiotherapy, and conformal radiotherapy in treating lung cancer accounting for secondary malignancy risks

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    Komisopoulos, Georgios [Department of Medical Physics, Medical School, University of Patras, Patras (Greece); Mavroidis, Panayiotis, E-mail: mavroidis@uthscsa.edu [Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX (United States); Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, Stockholm (Sweden); Rodriguez, Salvador; Stathakis, Sotirios; Papanikolaou, Nikos [Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, San Antonio, TX (United States); Nikiforidis, Georgios C.; Sakellaropoulos, Georgios C. [Department of Medical Physics, Medical School, University of Patras, Patras (Greece)

    2014-01-01

    The aim of the present study is to examine the importance of using measures to predict the risk of inducing secondary malignancies in association with the clinical effectiveness of treatment plans in terms of tumor control and normal tissue complication probabilities. This is achieved by using radiobiologic parameters and measures, which may provide a closer association between clinical outcome and treatment delivery. Overall, 4 patients having been treated for lung cancer were examined. For each of them, 3 treatment plans were developed based on the helical tomotherapy (HT), multileaf collimator-based intensity modulated radiation therapy (IMRT), and 3-dimensional conformal radiation therapy (CRT) modalities. The different plans were evaluated using the complication-free tumor control probability (p{sub +}), the overall probability of injury (p{sub I}), the overall probability of control/benefit (p{sub B}), and the biologically effective uniform dose (D{sup ¯¯}). These radiobiologic measures were used to develop dose-response curves (p-D{sup ¯¯} diagram), which can help to evaluate different treatment plans when used in conjunction with standard dosimetric criteria. The risks for secondary malignancies in the heart and the contralateral lung were calculated for the 3 radiation modalities based on the corresponding dose-volume histograms (DVHs) of each patient. Regarding the overall evaluation of the different radiation modalities based on the p{sub +} index, the average values of the HT, IMRT, and CRT are 67.3%, 61.2%, and 68.2%, respectively. The corresponding average values of p{sub B} are 75.6%, 70.5%, and 71.0%, respectively, whereas the average values of p{sub I} are 8.3%, 9.3%, and 2.8%, respectively. Among the organs at risk (OARs), lungs show the highest probabilities for complications, which are 7.1%, 8.0%, and 1.3% for the HT, IMRT, and CRT modalities, respectively. Similarly, the biologically effective prescription doses (D{sub B}{sup ¯¯}) for the

  14. Image-guided intensity modulated radiotherapy with helical tomotherapy for postoperative treatment of high-risk oral cavity cancer

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    Chen Yu-Jen

    2011-01-01

    Full Text Available Abstract Background The aim of this study was to assess the treatment results and toxicity profiles of helical tomotherapy (HT for postoperative high-risk oral cavity cancer. Methods From December 6, 2006 through October 9, 2009, 19 postoperative high-risk oral cavity cancer patients were enrolled. All of the patients received HT with (84% or without (16% chemotherapy. Results The median follow-up time was 17 months. The 2-year overall survival, disease-free survival, locoregional control, and distant metastasis-free rates were 94%, 84%, 92%, and 94%, respectively. The package of overall treatment time > 13 wk, the interval between surgery and radiation ≤ 6 wk, and the overall treatment time of radiation ≤ 7 wk was 21%, 84%, and 79%, respectively. The percentage of grade 3 mucositis, dermatitis, and leucopenia was 42%, 5% and 5%, respectively. Conclusions HT achieved encouraging clinical outcomes for postoperative high-risk oral cavity cancer patients with high compliance. A long-term follow-up study is needed to confirm these preliminary findings.

  15. Image-guided intensity modulated radiotherapy with helical tomotherapy for postoperative treatment of high-risk oral cavity cancer

    International Nuclear Information System (INIS)

    Hsieh, Chen-Hsi; Hsieh, Yen-Ping; Lin, Shoei Long; Chen, Chun-Yi; Chen, Chien-An; Shueng, Pei-Wei; Kuo, Ying-Shiung; Liao, Li-Jen; Hu, Kawang-Yu; Lin, Shih-Chiang; Wu, Le-Jung; Lin, Yu-Chin; Chen, Yu-Jen; Wang, Li-Ying

    2011-01-01

    The aim of this study was to assess the treatment results and toxicity profiles of helical tomotherapy (HT) for postoperative high-risk oral cavity cancer. From December 6, 2006 through October 9, 2009, 19 postoperative high-risk oral cavity cancer patients were enrolled. All of the patients received HT with (84%) or without (16%) chemotherapy. The median follow-up time was 17 months. The 2-year overall survival, disease-free survival, locoregional control, and distant metastasis-free rates were 94%, 84%, 92%, and 94%, respectively. The package of overall treatment time > 13 wk, the interval between surgery and radiation ≤ 6 wk, and the overall treatment time of radiation ≤ 7 wk was 21%, 84%, and 79%, respectively. The percentage of grade 3 mucositis, dermatitis, and leucopenia was 42%, 5% and 5%, respectively. HT achieved encouraging clinical outcomes for postoperative high-risk oral cavity cancer patients with high compliance. A long-term follow-up study is needed to confirm these preliminary findings

  16. Superiority of conventional intensity-modulated radiotherapy over helical tomotherapy in locally advanced non-small cell lung cancer. A comparative plan analysis

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    Song, C. [National Cancer Center, Research Institute and Hospital, Goyang (Korea, Republic of). Proton Therapy Center; Seoul National Univ. College of Medicine (Korea, Republic of). Dept. of Radiation Oncology; Pyo, H.; Kim, J. [Sungkyunkwan Univ. School of Medicine, Samsung Medical Center, Seoul (Korea, Republic of). Dept. of Radiation Oncology; Lim, Y.K.; Kim, D.W.; Cho, K.H. [National Cancer Center, Research Institute and Hospital, Goyang (Korea, Republic of). Proton Therapy Center; Kim, W.C. [Inha Univ. School of Medicine, Incheon (Korea, Republic of). Dept. of Radiation Oncology; Kim, H.J. [Seoul National Univ. College of Medicine (Korea, Republic of). Dept. of Radiation Oncology

    2012-10-15

    Purpose: To compare helical tomotherapy (HT) and conventional intensity-modulated radiotherapy (IMRT) using a variety of dosimetric and radiobiologic indexes in patients with locally advanced non-small cell lung cancer (LA-NSCLC). Patients and methods: A total of 20 patients with LA-NSCLC were enrolled. IMRT plans with 4-6 coplanar beams and HT plans were generated for each patient. Dose distributions and dosimetric indexes for the tumors and critical structures were computed for both plans and compared. Results: Both modalities created highly conformal plans. They did not differ in the volumes of lung exposed to > 20 Gy of radiation. The average mean lung dose, volume receiving {>=} 30 Gy, and volume receiving {>=} 10 Gy in HT planning were 18.3 Gy, 18.5%, and 57.1%, respectively, compared to 19.4 Gy, 25.4%, and 48.9%, respectively, with IMRT (p = 0.004, p < 0.001, and p < 0.001). The differences between HT and IMRT in lung volume receiving {>=} 10-20 Gy increased significantly as the planning target volume (PTV) increased. For 6 patients who had PTV greater than 700 cm{sup 3}, IMRT was superior to HT for 5 patients in terms of lung volume receiving {>=} 5-20 Gy. The integral dose to the entire thorax in HT plans was significantly higher than in IMRT plans. Conclusion: HT gave significantly better control of mean lung dose and volume receiving {>=} 30-40 Gy, whereas IMRT provided better control of the lung volume receiving {>=} 5-15 Gy and the integral dose to entire thorax. In most patients with PTV greater than 700 cm{sup 3}, IMRT was superior to HT in terms of lung volume receiving {>=} 5-20 Gy. It is therefore advised that caution should be exercised when planning LA-NSCLC using HT. (orig.)

  17. Rapid Arc, helical tomotherapy, sliding window intensity modulated radiotherapy and three dimensional conformal radiation for localized prostate cancer: A dosimetric comparison

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    Rajesh A Kinhikar

    2014-01-01

    Full Text Available Objective: The objective of this study was to investigate the potential role of RapidArc (RA compared with helical tomotherapy (HT, sliding window intensity modulated radiotherapy (SW IMRT and three-dimensional conformal radiation therapy (3D CRT for localized prostate cancer. Materials and Methods: Prescription doses ranged from 60 Gy to planning target volume (PTV and 66.25 Gy for clinical target volume prostate (CTV-P over 25-30 fractions. PTV and CTV-P coverage were evaluated by conformity index (CI and homogeneity index (HI. Organ sparing comparison was done with mean doses to rectum and bladder. Results: CI 95 were 1.0 ± 0.01 (RA, 0.99 ± 0.01 (HT, 0.97 ± 0.02 (IMRT, 0.98 ± 0.02 (3D CRT for PTV and 1.0 ± 0.00 (RA, HT, SW IMRT and 3D CRT for CTV-P. HI was 0.11 ± 0.03 (RA, 0.16 ± 0.08 (HT, 0.12 ± 0.03 (IMRT, 0.06 ± 0.01 (3D CRT for PTV and 0.03 ± 0.00 (RA, 0.05 ± 0.01 (HT, 0.03 ± 0.01 (SW IMRT and 3D CRT for CTV-P. Mean dose to bladder were 23.68 ± 13.23 Gy (RA, 24.55 ± 12.51 Gy (HT, 19.82 ± 11.61 Gy (IMRT and 23.56 ± 12.81 Gy (3D CRT, whereas mean dose to rectum was 36.85 ± 12.92 Gy (RA, 33.18 ± 11.12 Gy (HT, IMRT and 38.67 ± 12.84 Gy (3D CRT. Conclusion: All studied intensity-modulated techniques yield treatment plans of significantly improved quality when compared with 3D CRT, with HT providing best organs at risk sparing and RA being the most efficient treatment option, reducing treatment time to 1.45-3.7 min and monitor unit to <400 for a 2 Gy fraction.

  18. Radiation characteristics of helical tomotherapy

    International Nuclear Information System (INIS)

    Jeraj, Robert; Mackie, Thomas R.; Balog, John; Olivera, Gustavo; Pearson, Dave; Kapatoes, Jeff; Ruchala, Ken; Reckwerdt, Paul

    2004-01-01

    Helical tomotherapy is a dedicated intensity modulated radiation therapy (IMRT) system with on-board imaging capability (MVCT) and therefore differs from conventional treatment units. Different design goals resulted in some distinctive radiation field characteristics. The most significant differences in the design are the lack of flattening filter, increased shielding of the collimators, treatment and imaging operation modes and narrow fan beam delivery. Radiation characteristics of the helical tomotherapy system, sensitivity studies of various incident electron beam parameters and radiation safety analyses are presented here. It was determined that the photon beam energy spectrum of helical tomotherapy is similar to that of more conventional radiation treatment units. The two operational modes of the system result in different nominal energies of the incident electron beam with approximately 6 MeV and 3.5 MeV in the treatment and imaging modes, respectively. The off-axis mean energy dependence is much lower than in conventional radiotherapy units with less than 5% variation across the field, which is the consequence of the absent flattening filter. For the same reason the transverse profile exhibits the characteristic conical shape resulting in a 2-fold increase of the beam intensity in the center. The radiation leakage outside the field was found to be negligible at less than 0.05% because of the increased shielding of the collimators. At this level the in-field scattering is a dominant source of the radiation outside the field and thus a narrow field treatment does not result in the increased leakage. The sensitivity studies showed increased sensitivity on the incident electron position because of the narrow fan beam delivery and high sensitivity on the incident electron energy, as common to other treatment systems. All in all, it was determined that helical tomotherapy is a system with some unique radiation characteristics, which have been to a large extent

  19. The helical tomotherapy thread effect

    International Nuclear Information System (INIS)

    Kissick, M.W.; Fenwick, J.; James, J.A.; Jeraj, R.; Kapatoes, J.M.; Keller, H.; Mackie, T.R.; Olivera, G.; Soisson, E.T.

    2005-01-01

    Inherent to helical tomotherapy is a dose variation pattern that manifests as a 'ripple' (peak-to-trough relative to the average). This ripple is the result of helical beam junctioning, completely unique to helical tomotherapy. Pitch is defined as in helical CT, the couch travel distance for a complete gantry rotation relative to the axial beam width at the axis of rotation. Without scattering or beam divergence, an analytical posing of the problem as a simple integral predicts minima near a pitch of 1/n where n is an integer. A convolution-superposition dose calculator (TomoTherapy, Inc.) included all the physics needed to explore the ripple magnitude versus pitch and beam width. The results of the dose calculator and some benchmark measurements demonstrate that the ripple has sharp minima near p=0.86(1/n). The 0.86 factor is empirical and caused by a beam junctioning of the off-axis dose profiles which differ from the axial profiles as well as a long scatter tail of the profiles at depth. For very strong intensity modulation, the 0.86 factor may vary. The authors propose choosing particular minima pitches or using a second delivery that starts 180 deg off-phase from the first to reduce these ripples: 'Double threading'. For current typical pitches and beam widths, however, this effect is small and not clinically important for most situations. Certain extremely large field or high pitch cases, however, may benefit from mitigation of this effect

  20. Intensity-Modulated Radiotherapy (IMRT) vs Helical Tomotherapy (HT) in Concurrent Chemoradiotherapy (CRT) for Patients with Anal Canal Carcinoma (ACC): an analysis of dose distribution and toxicities

    International Nuclear Information System (INIS)

    Yeung, Rosanna; McConnell, Yarrow; Warkentin, Heather; Graham, Darren; Warkentin, Brad; Joseph, Kurian; Doll, Corinne M

    2015-01-01

    Intensity-modulated radiotherapy (IMRT) and helical tomotherapy (HT) have been adopted for radiotherapy treatment of anal canal carcinoma (ACC) due to better conformality, dose homogeneity and normal-tissue sparing compared to 3D-CRT. To date, only one published study compares dosimetric parameters of IMRT vs HT in ACC, but there are no published data comparing toxicities. Our objectives were to compare dosimetry and toxicities between these modalities. This is a retrospective study of 35 ACC patients treated with radical chemoradiotherapy at two tertiary cancer institutions from 2008–2010. The use of IMRT vs HT was primarily based on center availability. The majority of patients received fluorouracil (5-FU) and 1–2 cycles of mitomycin C (MMC); 2 received 5-FU and cisplatin. Primary tumor and elective nodes were prescribed to ≥54Gy and ≥45Gy, respectively. Patients were grouped into two cohorts: IMRT vs HT. The primary endpoint was a dosimetric comparison between the cohorts; the secondary endpoint was comparison of toxicities. 18 patients were treated with IMRT and 17 with HT. Most IMRT patients received 5-FU and 1 MMC cycle, while most HT patients received 2 MMC cycles (p < 0.01), based on center policy. HT achieved more homogenous coverage of the primary tumor (HT homogeneity and uniformity index 0.14 and 1.02 vs 0.29 and 1.06 for IMRT, p = 0.01 and p < 0.01). Elective nodal coverage did not differ. IMRT achieved better bladder, femoral head and peritoneal space sparing (V30 and V40, p ≤ 0.01), and lower mean skin dose (p < 0.01). HT delivered lower bone marrow (V10, p < 0.01) and external genitalia dose (V20 and V30, p < 0.01). Grade 2+ hematological and non-hematological toxicities were similar. Febrile neutropenia and unscheduled treatment breaks did not differ (both p = 0.13), nor did 3-year overall and disease-free survival (p = 0.13, p = 0.68). Chemoradiotherapy treatment of ACC using IMRT vs HT results in differences in dose homogenity and

  1. Helical Tomotherapy Quality Assurance

    International Nuclear Information System (INIS)

    Balog, John; Soisson, Emilie

    2008-01-01

    Helical tomotherapy uses a dynamic delivery in which the gantry, treatment couch, and multileaf collimator leaves are all in motion during treatment. This results in highly conformal radiotherapy, but the complexity of the delivery is partially hidden from the end-user because of the extensive integration and automation of the tomotherapy control systems. This presents a challenge to the medical physicist who is expected to be both a system user and an expert, capable of verifying relevant aspects of treatment delivery. A related issue is that a clinical tomotherapy planning system arrives at a customer's site already commissioned by the manufacturer, not by the clinical physicist. The clinical physicist and the manufacturer's representative verify the commissioning at the customer site before acceptance. Theoretically, treatment could begin immediately after acceptance. However, the clinical physicist is responsible for the safe and proper use of the machine. In addition, the therapists and radiation oncologists need to understand the important machine characteristics before treatment can proceed. Typically, treatment begins about 2 weeks after acceptance. This report presents an overview of the tomotherapy system. Helical tomotherapy has unique dosimetry characteristics, and some of those features are emphasized. The integrated treatment planning, delivery, and patient-plan quality assurance process is described. A quality assurance protocol is proposed, with an emphasis on what a clinical medical physicist could and should check. Additionally, aspects of a tomotherapy quality assurance program that could be checked automatically and remotely because of its inherent imaging system and integrated database are discussed

  2. Helical tomo-therapy in the anal canal cancer: dosimetric comparison with conformal radiotherapy with intensity modulation and classical conformal radiotherapy

    International Nuclear Information System (INIS)

    Ozsahin, M.; Ugurluer, G.; Ballerini, G.; Letenneur, G.; Zouhair, A.; Mirimanoff, R.O.

    2009-01-01

    A dosimetry comparison was made between helical tomo-therapy, I.M.R.T. and classical conformal three dimensional radiotherapy for twelve first patients that received a image guided radiotherapy, the toxicity was tackled with a minimum follow-up of fourteen months. In conclusion, the CT-guided radiotherapy allows to save organs at risks superior to I.M.R.T. and conformal radiotherapy and a best homogeneity in the target volume. the toxicity is moderated and the break time is limited. (N.C.)

  3. Total scalp irradiation using helical tomotherapy

    International Nuclear Information System (INIS)

    Orton, Nigel; Jaradat, Hazim; Welsh, James; Tome, Wolfgang

    2005-01-01

    Homogeneous irradiation of the scalp poses technical and dosimetric challenges due to the extensive, superficial, curved treatment volume. Conventional treatments on a linear accelerator use multiple matched electron fields or a combination of electron and photon fields. Problems with these techniques include dose heterogeneity in the target due to varying source-to-skin distance (SSD) and angle of beam incidence, significant dose to the brain, and the potential for overdose or underdose at match lines between the fields. Linac-based intensity-modulated radiation therapy (IMRT) plans have similar problems. This work presents treatment plans for total scalp irradiation on a helical tomotherapy machine. Helical tomotherapy is well-suited for scalp irradiation because it has the ability to deliver beamlets that are tangential to the scalp at all points. Helical tomotherapy also avoids problems associated with field matching and use of more than one modality. Tomotherapy treatment plans were generated and are compared to plans for treatment of the same patient on a linac. The resulting tomotherapy plans show more homogeneous target dose and improved critical structure dose when compared to state-of-the-art linac techniques. Target equivalent uniform dose (EUD) for the best tomotherapy plan was slightly higher than for the linac plan, while the volume of brain tissue receiving over 30 Gy was reduced by two thirds. Furthermore, the tomotherapy plan can be more reliably delivered than linac treatments, because the patient is aligned prior to each treatment based on megavoltage computed tomography (MVCT)

  4. 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

    International Nuclear Information System (INIS)

    Ekici, Kemal; Pepele, Eda K.; Yaprak, Bahaddin; Temelli, Oztun; Eraslan, Aysun F.; Kucuk, Nadir; Altınok, Ayse Y.; Sut, Pelin A.; Alpak, Ozlem D.; Colak, Cemil; Mayadagli, Alpaslan

    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, 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 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.

  5. Encouraging Early Clinical Outcomes With Helical Tomotherapy-Based Image-Guided Intensity-Modulated Radiation Therapy for Residual, Recurrent, and/or Progressive Benign/Low-Grade Intracranial Tumors: A Comprehensive Evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, Tejpal [Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Kharghar, Navi Mumbai (India); Wadasadawala, Tabassum; Master, Zubin; Phurailatpam, Reena; Pai-Shetty, Rajershi; Jalali, Rakesh [Department of Radiation Oncology, ACTREC/TMH, Tata Memorial Centre, Kharghar, Navi Mumbai (India)

    2012-02-01

    Purpose: To report early clinical outcomes of helical tomotherapy (HT)-based image-guided intensity-modulated radiation therapy (IMRT) in brain tumors of varying shape, size, and location. Materials and Methods: Patients with residual, recurrent, and/or progressive low-grade intracranial and skull-base tumors were treated on a prospective protocol of HT-based IMRT and followed clinicoradiologically. Standardized metrics were used for plan evaluation and outcome analysis. Results: Twenty-seven patients with 30 lesions were treated to a median radiotherapy dose of 54 Gy in 30 fractions. All HT plans resulted in excellent target volume coverage with steep dose-gradients. The mean (standard deviation) dose homogeneity index and conformity index was 0.07 (0.05) and 0.71 (0.08) respectively. At first response assessment, 20 of 30 lesions were stable, whereas 9 showed partial regression. One patient with a recurrent clival chordoma though neurologically stable showed imaging-defined progression, whereas another patient with stable disease on serial imaging had sustained neurologic worsening. With a median follow-up of 19 months (interquartile range, 11-26 months), the 2-year clinicoradiological progression-free survival and overall survival was 93.3% and 100% respectively. Conclusions: Careful selection of radiotherapy technique is warranted for benign/low-grade brain tumors to achieve durable local control with minimum long-term morbidity. Large or complex-shaped tumors benefit most from IMRT. Our early clinical experience of HT-based IMRT for brain tumors has been encouraging.

  6. Quality assurance of a helical tomotherapy machine

    International Nuclear Information System (INIS)

    Fenwick, J D; Tome, W A; Jaradat, H A; Hui, S K; James, J A; Balog, J P; DeSouza, C N; Lucas, D B; Olivera, G H; Mackie, T R; Paliwal, B R

    2004-01-01

    Helical tomotherapy has been developed at the University of Wisconsin, and 'Hi-Art II' clinical machines are now commercially manufactured. At the core of each machine lies a ring-gantry-mounted short linear accelerator which generates x-rays that are collimated into a fan beam of intensity-modulated radiation by a binary multileaf, the modulation being variable with gantry angle. Patients are treated lying on a couch which is translated continuously through the bore of the machine as the gantry rotates. Highly conformal dose-distributions can be delivered using this technique, which is the therapy equivalent of spiral computed tomography. The approach requires synchrony of gantry rotation, couch translation, accelerator pulsing and the opening and closing of the leaves of the binary multileaf collimator used to modulate the radiation beam. In the course of clinically implementing helical tomotherapy, we have developed a quality assurance (QA) system for our machine. The system is analogous to that recommended for conventional clinical linear accelerator QA by AAPM Task Group 40 but contains some novel components, reflecting differences between the Hi-Art devices and conventional clinical accelerators. Here the design and dosimetric characteristics of Hi-Art machines are summarized and the QA system is set out along with experimental details of its implementation. Connections between this machine-based QA work, pre-treatment patient-specific delivery QA and fraction-by-fraction dose verification are discussed

  7. Evaluation of two tomotherapy-based techniques for the delivery of whole-breast intensity-modulated radiation therapy

    International Nuclear Information System (INIS)

    Gonzalez, Victor J.; Buchholz, Daniel J.; Langen, Katja M.; Olivera, Gustavo H.; Chauhan, Bhavin; Meeks, Sanford L.; Ruchala, Kenneth J.; Haimerl, Jason; Lu Weiguo; Kupelian, Patrick A.

    2006-01-01

    Purpose: To evaluate two different techniques for whole-breast treatments delivered using the Hi-ART II tomotherapy device. Methods and Materials: Tomotherapy uses the standard rotational helical delivery. Topotherapy uses a stationary gantry while delivering intensity-modulated treatments. CT scans from 5 breast cancer patients were used. The prescription dose was 50.4 Gy. Results: On average, 99% of the target volume received 95% of prescribed dose with either technique. If treatment times are restricted to less than 9 min, the average percentage ipsilateral lung receiving ≥20 Gy was 22% for tomotherapy vs. 10% for topotherapy. The ipsilateral lung receiving ≥50.4 Gy was 4 cc for tomotherapy vs. 27 cc for topotherapy. The percentage of left ventricle receiving ≥30 Gy was 14% with tomotherapy vs. 4% for topotherapy. The average doses to the contralateral breast and lung were 0.6 and 0.8 Gy, respectively, for tomotherapy vs. 0.4 and 0.3 Gy for topotherapy. Conclusions: Tomotherapy provides improved target dose homogeneity and conformality over topotherapy. If delivery times are restricted, topotherapy reduces the amount of heart and ipsilateral lung volumes receiving low doses. For whole-breast treatments, topotherapy is an efficient technique that achieves adequate target uniformity while maintaining low doses to sensitive structures

  8. Standard and Nonstandard Craniospinal Radiotherapy Using Helical TomoTherapy

    International Nuclear Information System (INIS)

    Parker, William; Brodeur, Marylene; Roberge, David; Freeman, Carolyn

    2010-01-01

    Purpose: To show the advantages of planning and delivering craniospinal radiotherapy with helical TomoTherapy (TomoTherapy Inc., Madison, WI) by presenting 4 cases treated at our institution. Methods and Materials: We first present a standard case of craniospinal irradiation in a patient with recurrent myxopapillary ependymoma (MPE) and follow this with 2 cases requiring differential dosing to multiple target volumes. One of these, a patient with recurrent medulloblastoma, required a lower dose to be delivered to the posterior fossa because the patient had been previously irradiated to the full dose, and the other required concurrent boosts to leptomeningeal metastases as part of his treatment for newly diagnosed MPE. The final case presented is a patient with pronounced scoliosis who required spinal irradiation for recurrent MPE. Results: The four cases presented were planned and treated successfully with Helical Tomotherapy. Conclusions: Helical TomoTherapy delivers continuous arc-based intensity-modulated radiotherapy that gives high conformality and excellent dose homogeneity for the target volumes. Increased healthy tissue sparing is achieved at higher doses albeit at the expense of larger volumes of tissue receiving lower doses. Helical TomoTherapy allows for differential dosing of multiple targets, resulting in very elegant dose distributions. Daily megavoltage computed tomography imaging allows for precision of patient positioning, permitting a reduction in planning margins and increased healthy tissue sparing in comparison with standard techniques.

  9. Conformal avoidance helical tomotherapy for dogs with nasopharyngeal tumors

    International Nuclear Information System (INIS)

    Welsh, J.S.; Turek, M.; Mackie, T.R.; Miller, P.; Mehta, M.P.; Forrest, L.J.

    2003-01-01

    Helical tomotherapy provides a unique means of delivering intensity-modulated radiation therapy (IMRT) using a novel treatment unit, which merges features of a linear accelerator with a helical CT scanner. Thanks to the CT imaging capacity, targeted regions can be visualized prior to, during, or immediately after each treatment. Such image-guidance through megavoltage CT will allow the realization and refinement of the concept of adaptive radiotherapy - the reconstruction of the actually delivered daily dose (as opposed to planned dose) accompanied by prescription adjustments when appropriate. In addition to this unique feature, helical tomotherapy promises further improvements in the specific avoidance of critical normal structures, i.e. conformal avoidance, the counterpart of conformal therapy. The first definitive treatment protocol using helical tomotherapy is presently underway for dogs with nasopharyngeal tumors. In general, such tumors can be treated with conventional external beam radiation therapy but at the cost of severe ocular toxicity due to the anatomy of the canine head. These are readily measurable toxicities and are almost universal in incidence; therefore, the canine nasopharyngeal tumor presents an ideal model to assess the ability to conformally avoid critical structures. It is hoped that conformal avoidance helical tomotherapy will improve tumor control via dose-escalation while reducing ocular toxicity in these veterinary patients. A total of 10 fractions are scheduled for these patients; the first 3 dogs have all received at least 7 fractions delivered via helical tomotherapy. Although preliminary, the first 3 dogs treated have not shown any evidence of ocular toxicity in this ongoing study

  10. A delivery transfer function (DTF) analysis for helical tomotherapy

    International Nuclear Information System (INIS)

    Kissick, Michael W; Mackie, Thomas Rockwell; Jeraj, Robert

    2007-01-01

    The previous theoretical work of a delivery transfer function (DTF) in radiotherapy is expanded to include the unique intensity modulation method of helical tomotherapy. In addition to the collimation of each beamlet, and the Gaussian scatter convolution spreading of the dose that other radiotherapy units have, helical tomotherapy uses 51 small arcs of varying lengths to adjust the intensity. The blurring from these arcs is not taken into account during treatment planning. A theoretical DTF is constructed, and a calculation is performed which includes this unique source motion in relation to the other DTF components. Various typical delivery parameters are used to generate resolution maps for a constant intensity projection. Near the isocenter, the transverse (to a given beam direction) blurring is small but at larger radii (>6 cm), the source blurring dominates over leaf size. For most clinical situations, this inherent source motion blurring is expected to be negligible

  11. A Prospective Evaluation of Helical Tomotherapy

    International Nuclear Information System (INIS)

    Bauman, Glenn; Yartsev, Slav; Rodrigues, George; Lewis, Craig; Venkatesan, Varagur M.; Yu, Edward; Hammond, Alex; Perera, Francisco; Ash, Robert; Dar, A. Rashid; Lock, Michael; Baily, Laura; Coad, Terry C; Trenka, Kris C.; Warr, Barbara; Kron, Tomas; Battista, Jerry; Van Dyk, Jake

    2007-01-01

    Purpose: To report results from two clinical trials evaluating helical tomotherapy (HT). Methods and Materials: Patients were enrolled in one of two prospective trials of HT (one for palliative and one for radical treatment). Both an HT plan and a companion three-dimensional conformal radiotherapy (3D-CRT) plan were generated. Pretreatment megavoltage computed tomography was used for daily image guidance. Results: From September 2004 to January 2006, a total of 61 sites in 60 patients were treated. In all but one case, a clinically acceptable tomotherapy plan for treatment was generated. Helical tomotherapy plans were subjectively equivalent or superior to 3D-CRT in 95% of plans. Helical tomotherapy was deemed equivalent or superior in two thirds of dose-volume point comparisons. In cases of inferiority, differences were either clinically insignificant and/or reflected deliberate tradeoffs to optimize the HT plan. Overall imaging and treatment time (median) was 27 min (range, 16-91 min). According to a patient questionnaire, 78% of patients were satisfied to very satisfied with the treatment process. Conclusions: Helical tomotherapy demonstrated clear advantages over conventional 3D-CRT in this diverse patient group. The prospective trials were helpful in deploying this technology in a busy clinical setting

  12. Adaptive radiotherapy using helical tomotherapy system

    International Nuclear Information System (INIS)

    Jeswani, Sam; Ruchala, Kenneth; Olivera, Gustavo; Mackie, T.R.

    2008-01-01

    As commonly known in the field, adaptive radiation therapy (ART) is the use of feedback to modify a radiotherapy treatment. There are numerous ways in which this feedback can be received and used, and this presentation will discuss some of the implementations of ART being investigated with a helical TomoTherapy system

  13. Risk of radiation-induced pneumonitis after helical and static-port tomotherapy in lung cancer patients and experimental rats

    International Nuclear Information System (INIS)

    Zhang, Xianglan; Shin, You Keun; Zheng, Zhenlong; Zhu, Lianhua; Lee, Ik Jae

    2015-01-01

    Radiotherapy (RT) is one of the major non-operative treatment modalities for treating lung cancer. Tomotherapy is an advanced type of intensity-modulated radiotherapy (IMRT) in which radiation may be delivered in a helical fashion. However, unexpected pneumonitis may occur in patients treated with tomotherapy, especially in combination with chemotherapy, as a result of extensive low-dose radiation of large lung volumes. The aim of our study was to investigate the risk of radiation-induced pneumonitis after helical-mode and static-mode tomotherapy in patients with lung cancer and in an animal model. A total of 63 patients with primary lung cancer who were treated with static or helical tomotherapy with or without concurrent chemoradiotherapy (CCRT) were analyzed. Additionally, rats with radiation-induced pulmonary toxicity, which was induced by the application of helical or static tomography with or without CCRT, were evaluated. Helical-mode tomotherapy resulted in a significantly higher rate of late radiation pneumonitis in lung cancer patients than static-mode tomotherapy when evaluated by the Radiation Therapy Oncology Group (RTOG) and National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) scoring system. In the animal model, helical tomotherapy alone induced significantly higher expression of interleukin (IL)-1α, IL-1β, IL-6, and transforming growth factor (TGF)-β in lung specimens, especially on the untreated side, compared to static tomotherapy alone. Additionally, rats treated with helical tomotherapy and CCRT demonstrated significantly higher expression of inflammatory cytokines compared to those treated with static tomotherapy and CCRT. Rat models treated with tomotherapy with or without CCRT could present similar patterns of pulmonary toxicity to those shown in lung cancer patients. The models can be used in further investigations of radiation induced pulmonary toxicity

  14. Multi-centre experience of implementing image-guided intensity-modulated radiotherapy using the TomoTherapy platform

    International Nuclear Information System (INIS)

    Dean, J.C.; Tudor, G.S.J.; Mott, J.H.; Dunlop, P.R.; Morris, S.L.; Harron, E.C.; Christian, J.A.; Sanghera, P.; Elsworthy, M.; Burnet, N.G.

    2013-01-01

    Use of image guided (IG) intensity modulated radiotherapy (IMRT) is increasing, and helical tomotherapy provides an effective, integrated solution. Practical experience of implementation, shared at a recent UK TomoTherapy Users' meeting, may help centres introducing these techniques using TomoTherapy or other platforms. Seven centres participated, with data shared from 6, varying from 2500 - 4800 new patients per year. Case selection of patients “most likely” to benefit from IG-IMRT was managed in all centres by multi-professional groups comprising clinical oncologists, physicists, treatment planners and radiographers. Radical treatments ranged from 94% to 100%. The proportions of tumour types varied substantially: head and neck: range 0%–100% (mean of centres 50%), prostate: 3%–96% (mean of centres 28%). Head and neck cases were considered most likely to benefit from IMRT, prostate cases from IGRT, or IG-IMRT if pelvic nodes were being treated. IMRT was also selected for complex target volumes, to avoid field junctions, for technical treatment difficulties, and retreatments. Across the centres, every patient was imaged every day, with positional correction before treatment. In one centre, for prostate patients including pelvic treatment, the pelvis was also imaged weekly. All centres had designed a ‘ramp up’ of patient numbers, which was similar in 5. One centre, treating 96% prostate patients, started with 3 and increased to 36 patients per day within 3 months. The variation in case mix implies wide applicability of IG-IMRT. Daily on-line IGRT with IMRT can be routinely implemented into busy departments

  15. Integral dose delivered to normal brain with conventional intensity-modulated radiotherapy (IMRT) and helical tomotherapy IMRT during partial brain radiotherapy for high-grade gliomas with and without selective sparing of the hippocampus, limbic circuit and neural stem cell compartment

    International Nuclear Information System (INIS)

    Marsh, James C.; Ziel, Ellis G; Diaz, Aidnag Z; Turian, Julius V; Wendt, Julie A.; Gobole, Rohit

    2013-01-01

    We compared integral dose with uninvolved brain (ID brain ) during partial brain radiotherapy (PBRT) for high-grade glioma patients using helical tomotherapy (HT) and seven field traditional inverse-planned intensity-modulated radiotherapy (IMRT) with and without selective sparing (SPA) of contralateral hippocampus, neural stem cell compartment (NSC) and limbic circuit. We prepared four PBRT treatment plans for four patients with high-grade gliomas (60Gy in 30 fractions delivered to planning treatment volume (PTV60Gy)). For all plans, a structure denoted 'uninvolved brain' was created, which included all brain tissue not part of PTV or standard (STD) organs at risk (OAR). No dosimetric constraints were included for uninvolved brain. Selective SPA plans were prepared with IMRT and HT; contralateral hippocampus, NSC and limbic circuit were contoured; and dosimetric constraints were entered for these structures without compromising dose to PTV or STD OAR. We compared V100 and D95 for PTV46Gy and PTV60Gy, and ID brain for all plans. There were no significant differences in V100 and D95 for PTV46Gy and PTV60Gy. ID brain was lower in traditional IMRT versus HT plans for STD and SPA plans (mean ID brain 23.64Gy vs. 28Gy and 18.7Gy vs. 24.5Gy, respectively) and in SPA versus STD plans both with IMRT and HT (18.7Gy vs. 23.64Gy and 24.5Gy vs. 28Gy, respectively). n the setting of PBRT for high-grade gliomas, IMRT reduces ID brain compared with HT with or without selective SPA of contralateral hippocampus, limbic circuit and NSC, and the use of selective SPA reduces ID brain compared with STD PBRT delivered with either traditional IMRT or HT.

  16. Helical Tomotherapy-Based STAT RT: Dosimetric Evaluation for Clinical Implementation of a Rapid Radiation Palliation Program

    International Nuclear Information System (INIS)

    McIntosh, Alyson; Dunlap, Neal; Sheng, Ke; Geezey, Constance; Turner, Benton; Blackhall, Leslie; Weiss, Geoffrey; Lappinen, Eric; Larner, James M.; Read, Paul W.

    2010-01-01

    Helical tomotherapy-based STAT radiation therapy (RT) uses an efficient software algorithm for rapid intensity-modulated treatment planning, enabling conformal radiation treatment plans to be generated on megavoltage computed tomography (MVCT) scans for CT simulation, treatment planning, and treatment delivery in one session. We compared helical tomotherapy-based STAT RT dosimetry with standard linac-based 3D conformal plans and standard helical tomotherapy-based intensity-modulated radiation therapy (IMRT) dosimetry for palliative treatments of whole brain, a central obstructive lung mass, multilevel spine disease, and a hip metastasis. Specifically, we compared the conformality, homogeneity, and dose with regional organs at risk (OARs) for each plan as an initial step in the clinical implementation of a STAT RT rapid radiation palliation program. Hypothetical planning target volumes (PTVs) were contoured on an anthropomorphic phantom in the lung, spine, brain, and hip. Treatment plans were created using three planning techniques: 3D conformal on Pinnacle 3 , helical tomotherapy, and helical tomotherapy-based STAT RT. Plan homogeneity, conformality, and dose to OARs were analyzed and compared. STAT RT and tomotherapy improved conformality indices for spine and lung plans (CI spine = 1.21, 1.17; CI lung = 1.20, 1.07, respectively) in comparison with standard palliative anteroposterior/posteroanterior (AP/PA) treatment plans (CI spine = 7.01, CI lung = 7.30), with better sparing of heart, esophagus, and spinal cord. For palliative whole-brain radiotherapy, STAT RT and tomotherapy reduced maximum and mean doses to the orbits and lens (maximum/mean lens dose: STAT RT = 2.94/2.65 Gy, tomotherapy = 3.13/2.80 Gy, Lateral opposed fields = 7.02/3.65 Gy), with an increased dose to the scalp (mean scalp dose: STAT RT = 16.19 Gy, tomotherapy = 15.61 Gy, lateral opposed fields = 14.01 Gy). For bony metastatic hip lesions, conformality with both tomotherapy techniques (CI = 1

  17. Verification of helical tomotherapy delivery using autoassociative kernel regression

    International Nuclear Information System (INIS)

    Seibert, Rebecca M.; Ramsey, Chester R.; Garvey, Dustin R.; Wesley Hines, J.; Robison, Ben H.; Outten, Samuel S.

    2007-01-01

    Quality assurance (QA) is a topic of major concern in the field of intensity modulated radiation therapy (IMRT). The standard of practice for IMRT is to perform QA testing for individual patients to verify that the dose distribution will be delivered to the patient. The purpose of this study was to develop a new technique that could eventually be used to automatically evaluate helical tomotherapy treatments during delivery using exit detector data. This technique uses an autoassociative kernel regression (AAKR) model to detect errors in tomotherapy delivery. AAKR is a novel nonparametric model that is known to predict a group of correct sensor values when supplied a group of sensor values that is usually corrupted or contains faults such as machine failure. This modeling scheme is especially suited for the problem of monitoring the fluence values found in the exit detector data because it is able to learn the complex detector data relationships. This scheme still applies when detector data are summed over many frames with a low temporal resolution and a variable beam attenuation resulting from patient movement. Delivery sequences from three archived patients (prostate, lung, and head and neck) were used in this study. Each delivery sequence was modified by reducing the opening time for random individual multileaf collimator (MLC) leaves by random amounts. The error and error-free treatments were delivered with different phantoms in the path of the beam. Multiple autoassociative kernel regression (AAKR) models were developed and tested by the investigators using combinations of the stored exit detector data sets from each delivery. The models proved robust and were able to predict the correct or error-free values for a projection, which had a single MLC leaf decrease its opening time by less than 10 msec. The model also was able to determine machine output errors. The average uncertainty value for the unfaulted projections ranged from 0.4% to 1.8% of the detector

  18. Asymmetric fan beams (AFB) for improvement of the craniocaudal dose distribution in helical tomotherapy delivery

    International Nuclear Information System (INIS)

    Gladwish, Adam; Kron, Tomas; McNiven, Andrea; Bauman, Glenn; Van Dyk, Jake

    2004-01-01

    Helical tomotherapy (HT) is a novel radiotherapy technique that utilizes intensity modulated fan beams that deliver highly conformal dose distributions in a helical beam trajectory. The most significant limitation in dose delivery with a constant fan beam thickness (FBT) is the penumbra width of the dose distribution in the craniocaudal direction, which is equivalent to the FBT. We propose to employ a half-blocked fan beam at start and stop location to reduce the penumbra width by half. By opening the jaw slowly during the helical delivery until the desired FBT is achieved it is possible to create a sharper edge in the superior and inferior direction from the target. The technique was studied using a tomotherapy beam model implemented on a commercial treatment planning system (Theraplan Plus V3.0). It was demonstrated that the dose distribution delivered using a 25 mm fan beam can be improved significantly, to reduce the dose to normal structures located superiorly and inferiorly of the target. Dosimetry for this technique is straightforward down to a FBT of 15 mm and implementation should be simple as no changes in couch movement are required compared to a standard HT delivery. We conclude that the use of asymmetric collimated fan beams for the start and stop of the helical tomotherapeutic dose delivery has the potential of significantly improving the dose distribution in helical tomotherapy

  19. Multibeam tomotherapy: A new treatment unit devised for multileaf collimation, intensity-modulated radiation therapy

    International Nuclear Information System (INIS)

    Achterberg, Nils; Mueller, Reinhold G.

    2007-01-01

    A fully integrated system for treatment planning, application, and verification for automated multileaf collimator (MLC) based, intensity-modulated, image-guided, and adaptive radiation therapy (IMRT, IGRT and ART, respectively) is proposed. Patient comfort, which was the major development goal, will be achieved through a new unit design and short treatment times. Our device for photon beam therapy will consist of a new dual energy linac with five fixed treatment heads positioned evenly along one plane but one electron beam generator only. A minimum of moving parts increases technical reliability and reduces motion times to a minimum. Motion is allowed solely for the MLCs, the robotic patient table, and the small angle gantry rotation of ±36 deg. . Besides sophisticated electron beam guidance, this compact setup can be built using existing modules. The flattening-filter-free treatment heads are characterized by reduced beam-on time and contain apertures restricted in one dimension to the area of maximum primary fluence output. In the case of longer targets, this leads to a topographic intensity modulation, thanks to the combination of ''step and shoot'' MLC delivery and discrete patient couch motion. Owing to the limited number of beam directions, this multislice cone beam serial tomotherapy is referred to as ''multibeam tomotherapy.'' Every patient slice is irradiated by one treatment head at any given moment but for one subfield only. The electron beam is then guided to the next head ready for delivery, while the other heads are preparing their leaves for the next segment. The ''Multifocal MLC-positioning'' algorithm was programmed to enable treatment planning and optimize treatment time. We developed an overlap strategy for the longitudinally adjacent fields of every beam direction, in doing so minimizing the field match problem and the effects of possible table step errors. Clinical case studies show for the same or better planning target volume coverage

  20. Helical tomotherapy as a new treatment technique for whole abdominal irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Rochet, N.; Sterzing, F.; Jensen, A.; Herfarth, K.; Schubert, K.; Debus, J.; Harms, W. [Heidelberg Univ. (Germany). Dept. of Radiation Oncology; Dinkel, J. [German Cancer Research Center (dkfz), Heidelberg (Germany). Dept. of Radiology; Eichbaum, M.; Schneeweiss, A.; Sohn, C. [Heidelberg Univ. (Germany). Dept. of Gynecology and Obstetrics

    2008-03-15

    Purpose: To describe a new intensity-modulated radiotherapy (IMRT) technique using helical tomotherapy for whole abdominal irradiation (WAI) in patients with advanced ovarian cancer. Material and Methods: A patient with radically operated ovarian cancer FIGO stage IIIc was treated in a prospective clinical trial with WAI to a total dose of 30 Gy in 1.5-Gy fractions as an additional therapy after adjuvant platinum-based chemotherapy. The planning target volume (PTV) included the entire peritoneal cavity. PTV was adapted according to breathing motion as detected in a four-dimensional respiratory-triggered computed tomography (4D-CT). Inverse treatment planning was done with the Hi-Art tomotherapy planning station. Organs at risk (OARs) were kidneys, liver, bone marrow, spinal cord, thoracic and lumbosacral vertebral bodies, and pelvic bones. Daily control of positioning accuracy was performed with megavoltage computed tomography (MV-CT). Results: Helical tomotherapy enabled a very homogeneous dose distribution with excellent sparing of OARs and coverage of the PTV (V90 of 93.1%, V95 of 86.9%, V105 of 1.9%, and V110 of 0.01%). Mean liver dose was 21.57 Gy and mean kidney doses were 9.75 Gy and 9.14 Gy, respectively. Treatment could be performed in 18.1 min daily and no severe side effects occurred. Conclusion: Helical tomotherapy is feasible and fast for WAI. Tomotherapy enabled excellent coverage of the PTV and effective sparing of liver, kidneys and bone marrow. (orig.)

  1. Helical tomotherapy as a new treatment technique for whole abdominal irradiation

    International Nuclear Information System (INIS)

    Rochet, N.; Sterzing, F.; Jensen, A.; Herfarth, K.; Schubert, K.; Debus, J.; Harms, W.; Dinkel, J.; Eichbaum, M.; Schneeweiss, A.; Sohn, C.

    2008-01-01

    Purpose: To describe a new intensity-modulated radiotherapy (IMRT) technique using helical tomotherapy for whole abdominal irradiation (WAI) in patients with advanced ovarian cancer. Material and Methods: A patient with radically operated ovarian cancer FIGO stage IIIc was treated in a prospective clinical trial with WAI to a total dose of 30 Gy in 1.5-Gy fractions as an additional therapy after adjuvant platinum-based chemotherapy. The planning target volume (PTV) included the entire peritoneal cavity. PTV was adapted according to breathing motion as detected in a four-dimensional respiratory-triggered computed tomography (4D-CT). Inverse treatment planning was done with the Hi-Art tomotherapy planning station. Organs at risk (OARs) were kidneys, liver, bone marrow, spinal cord, thoracic and lumbosacral vertebral bodies, and pelvic bones. Daily control of positioning accuracy was performed with megavoltage computed tomography (MV-CT). Results: Helical tomotherapy enabled a very homogeneous dose distribution with excellent sparing of OARs and coverage of the PTV (V90 of 93.1%, V95 of 86.9%, V105 of 1.9%, and V110 of 0.01%). Mean liver dose was 21.57 Gy and mean kidney doses were 9.75 Gy and 9.14 Gy, respectively. Treatment could be performed in 18.1 min daily and no severe side effects occurred. Conclusion: Helical tomotherapy is feasible and fast for WAI. Tomotherapy enabled excellent coverage of the PTV and effective sparing of liver, kidneys and bone marrow. (orig.)

  2. Treatment of folliculitis decalvans using intensity-modulated radiation via tomotherapy

    International Nuclear Information System (INIS)

    Elsayad, Khaled; Kriz, Jan; Haverkamp, Uwe; Eich, Hans Theodor; Plachouri, Kerasia-Maria; Jeskowiak, Antonia; Sunderkoetter, Cord

    2015-01-01

    Folliculitis decalvans (FD) is a form of primary neutrophilic scarring alopecia that is characterized clinically by chronic suppurative folliculitis and often associated with pruritus or even pain. Treatment of FD is often difficult. Herein, we report a case of recalcitrant and painful folliculitis decalvans refractory to antibiotic and anti-inflammatory therapies, which was successfully treated by intensity-modulated radiotherapy (IMRT) in order to irreversibly eliminate hair follicles that prove to be one etiological trigger. A 45-year-old male patient with a refractory FD presented with a crusting suppurative folliculitis and atrophic scarring patches on the scalp associated with pain and pruritus. We attempted relief of symptoms by reducing scalp inflammation and eliminating hair follicles through radiation. We delivered 11.0 Gy in two radiation series using tomotherapy, 5.0 Gy in 5 equivalent fractions as a first radiation course. The symptoms markedly decreased but did not totally disappear. Therefore, we delivered a second radiation series 4 months later with an additional 6 Gy. This led to almost complete epilation on the scalp and abolished pain and pruritus on the capillitium. The patient was regularly followed up until 26 months after radiotherapy. Draining lesions or exudation did not recur. He only experienced discrete hair regrowth in the occipital region with folliculitis 12 months after radiotherapy. These residual lesions are currently treated with laser epilation therapy. A radical approach to eliminating hair follicles by repeated radiation therapy may induce lasting relief of symptoms in chronic suppurative FD associated with persistent trichodynia. (orig.) [de

  3. Performance characteristics of an independent dose verification program for helical tomotherapy

    Directory of Open Access Journals (Sweden)

    Isaac C. F. Chang

    2017-01-01

    Full Text Available Helical tomotherapy with its advanced method of intensity-modulated radiation therapy delivery has been used clinically for over 20 years. The standard delivery quality assurance procedure to measure the accuracy of delivered radiation dose from each treatment plan to a phantom is time-consuming. RadCalc®, a radiotherapy dose verification software, has released specifically for beta testing a module for tomotherapy plan dose calculations. RadCalc®'s accuracy for tomotherapy dose calculations was evaluated through examination of point doses in ten lung and ten prostate clinical plans. Doses calculated by the TomoHDA™ tomotherapy treatment planning system were used as the baseline. For lung cases, RadCalc® overestimated point doses in the lung by an average of 13%. Doses within the spinal cord and esophagus were overestimated by 10%. Prostate plans showed better agreement, with overestimations of 6% in the prostate, bladder, and rectum. The systematic overestimation likely resulted from limitations of the pencil beam dose calculation algorithm implemented by RadCalc®. Limitations were more severe in areas of greater inhomogeneity and less prominent in regions of homogeneity with densities closer to 1 g/cm3. Recommendations for RadCalc® dose calculation algorithms and anatomical representation were provided based on the results of the study.

  4. Independent quality assurance of a helical tomotherapy machine using the dose magnifying glass

    International Nuclear Information System (INIS)

    Wong, J.H.D.; Rosenfeld, A.B.; Hardcastle, N.; Bayliss, A.; Tolakanahalli, R.; Tome, W.

    2010-01-01

    Full text: Helical tomotherapy presents a new paradigm in cancer treatment integrating image guidance and intensity modulated radiation therapy in one system. Many of the tomotherapy QAs involve using the MYCT detector to QA the unit itself. Although convenient, they lack independence from the system under measurement. This work describes the use of a novel silicon detector as an independent tool for tomotherapy QA. The dose magnifying glass (DMG) is a 128 channel array of Si strip detectors. It was used to measure three tomotherapy QA parameters, (a) MLC alignment, (b) leaf latency and (c) leaf output factor (LOF). MLC alignment test measures the alignment of the MLC bank and the gantry center of rotation. Leaf latency is defined as the time taken for the leaf to travel from a closed state to an open state (and vice versa). Measurement are acquired at a 3 ms sampling rate with the detector pitch of 0.2 mm. Leaf latency for 50-400 ms projection time were measured. LOF measures the effect of the state of the adjacent leaves on a selected leaf of interest. For the tomotherapy unit tested, the DMG measured a 1.3 mm misalignment in the MLC alignment test. The leaf latency (Fig. I) shows a large non linearity in projection times <200 ms. The DMG measured a LOF of up to 25.3% when both adjacent leaves were opened. DMG with its high spatial and temporal resolutions presents a unique and independent tool for measuring selected tomotherapy QA parameters. (author)

  5. Simultaneous Multitarget Irradiation Using Helical Tomotherapy for Advanced Hepatocellular Carcinoma With Multiple Extrahepatic Metastases

    International Nuclear Information System (INIS)

    Jang, Jeong Won; Kay, Chul Seung; You, Chan Ran; Kim, Chang Wook; Bae, Si Hyun.; Choi, Jong Young; Yoon, Seung Kew; Han, Chi Wha; Jung, Hyun Suk; Choi, Ihl Bong

    2009-01-01

    Purpose: The prognosis of hepatocellular carcinoma (HCC) patients with extrahepatic metastases is extremely poor. Helical tomotherapy, an image-guided, intensity-modulated radiotherapy system, can allow for simultaneous and precise targeting of multiple cancerous lesions, while sparing normal tissues. This study evaluated the feasibility and outcome of tomotherapy for advanced HCC with metastases. Patients and Methods: A total of 42 consecutive HCC patients with metastases were treated with tomotherapy using the Hi-Art system. A total of 152 intra- and extrahepatic lesions (3.5 lesions/patient) were treated simultaneously, with a dose of 51.03 Gy (range, 30-57.61) in 10 fractions. Transarterial chemolipiodolization using epirubicin (50 mg) and cisplatin (60 mg) was repeated in patients with intrahepatic HCC (mean size, 9.0 cm) after tomotherapy. Results: An objective response (complete response and partial response) was achieved in 45.2% of patients with intrahepatic tumors, 68.4% of patients with pulmonary lesions, 60.0% of patients with lymph node/adrenal lesions, and 66.7% of patients with soft-tissue metastases. The complete response rate for those with pulmonary and lymph node/adrenal metastases was 26.3% and 5.0%, respectively. The overall survival rate at 1 and 2 years was 50.1% and 14.9%, respectively, with a median survival of 12.3 months. The actuarial in-field tumor control rate for ≤1 year was 79.0%. No cases of Grade 4-5 acute toxicity occurred. Conclusion: The results of this study have shown that helical tomotherapy is safe and feasible without major toxicities for the treatment of advanced HCC and results in excellent tumor control and a potential survival benefit. This approach is expected to be a useful palliative option for selected HCC patients with metastases.

  6. Gating-by-rotation: a solution to the problem of intratreatment motion in helical tomotherapy

    International Nuclear Information System (INIS)

    Kapatoes, J.M.; Olivera, G.H.; Schloesser, E.A.; Pearson, D.W.; Balog, J.P.; Ruchala, K.J.; Schmidt, R.; Reckwerdt, P.J.; Mehta, M.P.; Mackie, T.R.

    2001-01-01

    Purpose: To assess the feasibility of addressing intratreatment motion issues in helical tomotherapy by gating the treatments by rotation. Intratreatment motion is a problem common to all IMRT techniques. Traditional methods of gating in conformal radiotherapy and some forms of IMRT are not applicable to helical tomotherapy due to the continuous rotation of the gantry. An alternative method is presented. Materials and Methods: Rotation-gating in helical tomotherapy is the process in which one rotation of treatment is immediately followed by a rotation of non-treatment. This on-off strategy is repeated for the full treatment volume. During the treatment rotations, the patient is required to hold their breath while the intensity-modulated fan beam deposits dose. For the non-treatment rotations, the patient is allowed to breathe freely as all leaves of the MLC will be closed, the accelerator disabled, or both. The couch indexes normally for treatment rotations and holds the patient stationary during non-treatment rotations. An investigation was conducted to assess the feasibility of rotation-gating. Film was placed between two hemispheres of a water phantom and a continuous helical delivery was carried out with all leaves opened. The film was replaced and another treatment was performed employing rotation-gating. The two films were compared to assess the process. The films were irradiated to dose levels within the linear region of the film response curve (maximum film dose ∼35 cGy). Films were also acquired with all leaves closed to quantify leakage dose through the collimation systems. Results: Central profiles for the inferior-superior direction (parallel to the direction of translation) for both films are displayed in Figure 1. The profiles agree very well, illustrating that a rotation-gated treatment closely mimics a continuous helical delivery. The only significant discrepancy lay in the tails of the profiles: a higher film dose is seen for the rotation

  7. Treatment of folliculitis decalvans using intensity-modulated radiation via tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Elsayad, Khaled; Kriz, Jan; Haverkamp, Uwe; Eich, Hans Theodor [University Hospital of Muenster, Department of Radiation Oncology, Muenster (Germany); Plachouri, Kerasia-Maria; Jeskowiak, Antonia [University Hospital of Muenster, Department of Dermatology, Muenster (Germany); Sunderkoetter, Cord [University Hospital of Muenster, Department of Dermatology, Muenster (Germany); University Hospital of Muenster, Department of Translational Dermatoninfectiology, Muenster (Germany)

    2015-11-15

    Folliculitis decalvans (FD) is a form of primary neutrophilic scarring alopecia that is characterized clinically by chronic suppurative folliculitis and often associated with pruritus or even pain. Treatment of FD is often difficult. Herein, we report a case of recalcitrant and painful folliculitis decalvans refractory to antibiotic and anti-inflammatory therapies, which was successfully treated by intensity-modulated radiotherapy (IMRT) in order to irreversibly eliminate hair follicles that prove to be one etiological trigger. A 45-year-old male patient with a refractory FD presented with a crusting suppurative folliculitis and atrophic scarring patches on the scalp associated with pain and pruritus. We attempted relief of symptoms by reducing scalp inflammation and eliminating hair follicles through radiation. We delivered 11.0 Gy in two radiation series using tomotherapy, 5.0 Gy in 5 equivalent fractions as a first radiation course. The symptoms markedly decreased but did not totally disappear. Therefore, we delivered a second radiation series 4 months later with an additional 6 Gy. This led to almost complete epilation on the scalp and abolished pain and pruritus on the capillitium. The patient was regularly followed up until 26 months after radiotherapy. Draining lesions or exudation did not recur. He only experienced discrete hair regrowth in the occipital region with folliculitis 12 months after radiotherapy. These residual lesions are currently treated with laser epilation therapy. A radical approach to eliminating hair follicles by repeated radiation therapy may induce lasting relief of symptoms in chronic suppurative FD associated with persistent trichodynia. (orig.) [German] Die Folliculitis decalvans (FD) ist eine Form der primaer neutrophilen Alopezie, welche klinisch durch Schmerzen und eitrige Follikel gekennzeichnet ist. Da es bisher kein einheitliches Behandlungskonzept gibt, wird hier ueber eine FD berichtet, welche trotz mehrfacher antibiotischer

  8. Intensity-modulated radiation therapy: dynamic MLC (DMLC) therapy, multisegment therapy and tomotherapy. An example of QA in DMLC therapy

    International Nuclear Information System (INIS)

    Webb, S.

    1998-01-01

    Intensity-modulated radiation therapy will make a quantum leap in tumor control. It is the new radiation therapy for the new millennium. The major methods to achieve IMRT are: 1. Dynamic multileaf collimator (DMLC) therapy, 2. multisegment therapy, and 3. tomotherapy. The principles of these 3 techniques are briefly reviewed. Each technique presents unique QA issues which are outlined. As an example this paper will present the results of a recent new study of an important QA concern in DMLC therapy. (orig.) [de

  9. Independent quality assurance of a helical tomotherapy machine using the dose magnifying glass

    International Nuclear Information System (INIS)

    Wong, J. H. D.; Hardcastle, N.; Tome, W. A.

    2011-01-01

    Purpose: Helical tomotherapy is a complex delivery technique, integrating CT image guidance and intensity modulated radiotherapy in a single system. The integration of the CT detector ring on the gantry not only allows patient position verification but is also often used to perform various QA procedures. This convenience lacks the rigor of a machine-independent QA process. Methods: In this article, a Si strip detector, known as the Dose Magnifying Glass (DMG), was used to perform machine-independent QA measurements of the multileaf collimator alignment, leaf open time threshold, and leaf fluence output factor (LFOF). Results: The DMG measurements showed good agreements with EDR2 film for the MLC alignment test while the CT detector agrees well with DMG measurements for leaf open time threshold and LFOF measurements. The leaf open time threshold was found to be approximately 20 ms. The LFOF measured with the DMG agreed within error with the CT detector measured LFOF. Conclusions: The DMG with its 0.2 mm spatial resolution coupled to TERA ASIC allowed real-time high temporal resolution measurements of the tomotherapy leaf movement. In conclusion, DMG was shown to be a suitable tool for machine-independent QA of a tomotherapy unit.

  10. Independent quality assurance of a helical tomotherapy machine using the dose magnifying glass.

    Science.gov (United States)

    Wong, J H D; Hardcastle, N; Tomé, W A; Bayliss, A; Tolakanahalli, R; Lerch, M L F; Petasecca, M; Carolan, M; Metcalfe, P; Rosenfeld, A B

    2011-04-01

    Helical tomotherapy is a complex delivery technique, integrating CT image guidance and intensity modulated radiotherapy in a single system. The integration of the CT detector ring on the gantry not only allows patient position verification but is also often used to perform various QA procedures. This convenience lacks the rigor of a machine-independent QA process. In this article, a Si strip detector, known as the Dose Magnifying Glass (DMG), was used to perform machine-independent QA measurements of the multileaf collimator alignment, leaf open time threshold, and leaf fluence output factor (LFOF). The DMG measurements showed good agreements with EDR2 film for the MLC alignment test while the CT detector agrees well with DMG measurements for leaf open time threshold and LFOF measurements. The leaf open time threshold was found to be approximately 20 ms. The LFOF measured with the DMG agreed within error with the CT detector measured LFOF. The DMG with its 0.2 mm spatial resolution coupled to TERA ASIC allowed real-time high temporal resolution measurements of the tomotherapy leaf movement. In conclusion, DMG was shown to be a suitable tool for machine-independent QA of a tomotherapy unit.

  11. Dosimetric verification of helical tomotherapy for total scalp irradiation

    International Nuclear Information System (INIS)

    Hardcastle, Nicholas; Soisson, Emilie; Metcalfe, Peter; Rosenfeld, Anatoly B.; Tome, Wolfgang A.

    2008-01-01

    Total scalp irradiation is a treatment technique used for a variety of superficial malignancies. Helical tomotherapy is an effective technique used for total scalp irradiation. Recent published work has shown the TomoTherapy planning system to overestimate the superficial dose. In this study, the superficial doses for a helical tomotherapy total scalp irradiation have been measured on an anthropomorphic phantom using radiochromic and radiographic film as well as a new skin dosimeter, the MOSkin. The superficial dose was found to be accurately calculated by the TomoTherapy planning system. This is in contrast to recent reports, probably due to a combination of the smaller dose grid resolution used in planning and this particular treatment primarily consisting of beamlets tangential to the scalp. The superficial dose was found to increase from 33.6 to 41.2 Gy and 36.0 to 42.0 Gy over the first 2 mm depth in the phantom in selected regions of the PTV, measured with radiochromic film. The prescription dose was 40 Gy. The superficial dose was at the prescription dose or higher in some regions due to the bolus effect of the thermoplastic head mask and the head rest used to aid treatment setup. It is suggested that to achieve the prescription dose at the surface (≤2 mm depth) bolus or a custom thermoplastic helmet is used.

  12. Image-guided total marrow and total lymphatic irradiation using helical tomotherapy

    International Nuclear Information System (INIS)

    Schultheiss, Timothy E.; Wong, Jeffrey; Liu, An; Olivera, Gustavo; Somlo, George

    2007-01-01

    Purpose: To develop a treatment technique to spare normal tissue and allow dose escalation in total body irradiation (TBI). We have developed intensity-modulated radiotherapy techniques for the total marrow irradiation (TMI), total lymphatic irradiation, or total bone marrow plus lymphatic irradiation using helical tomotherapy. Methods and Materials: For TBI, we typically use 12 Gy in 10 fractions delivered at an extended source-to-surface distance (SSD). Using helical tomotherapy, it is possible to deliver equally effective doses to the bone marrow and lymphatics while sparing normal organs to a significant degree. In the TMI patients, whole body skeletal bone, including the ribs and sternum, comprise the treatment target. In the total lymphatic irradiation, the target is expanded to include the spleen and major lymph node areas. Sanctuary sites for disease (brain and testes) are included when clinically indicated. Spared organs include the lungs, esophagus, parotid glands, eyes, oral cavity, liver, kidneys, stomach, small and large intestine, bladder, and ovaries. Results: With TBI, all normal organs received the TBI dose; with TMI, total lymphatic irradiation, and total bone marrow plus lymphatic irradiation, the visceral organs are spared. For the first 6 patients treated with TMI, the median dose to organs at risk averaged 51% lower than would be achieved with TBI. By putting greater weight on the avoidance of specific organs, greater sparing was possible. Conclusion: Sparing of normal tissues and dose escalation is possible using helical tomotherapy. Late effects such as radiation pneumonitis, veno-occlusive disease, cataracts, neurocognitive effects, and the development of second tumors should be diminished in severity and frequency according to the dose reduction realized for the organs at risk

  13. Phase II Study of Preoperative Helical Tomotherapy With a Simultaneous Integrated Boost for Rectal Cancer

    International Nuclear Information System (INIS)

    Engels, Benedikt; Tournel, Koen; Everaert, Hendrik; Hoorens, Anne; Sermeus, Alexandra; Christian, Nicolas; Storme, Guy; Verellen, Dirk; De Ridder, Mark

    2012-01-01

    Purpose: The addition of concomitant chemotherapy to preoperative radiotherapy is considered the standard of care for patients with cT3–4 rectal cancer. The combined treatment modality increases the complete response rate and local control (LC), but has no impact on survival or the incidence of distant metastases. In addition, it is associated with considerable toxicity. As an alternative strategy, we explored prospectively, preoperative helical tomotherapy with a simultaneous integrated boost (SIB). Methods and Materials: A total of 108 patients were treated with intensity-modulated and image-guided radiotherapy using the Tomotherapy Hi-Art II system. A dose of 46 Gy, in daily fractions of 2 Gy, was delivered to the mesorectum and draining lymph nodes, without concomitant chemotherapy. Patients with an anticipated circumferential resection margin (CRM) of less than 2 mm, based on magnetic resonance imaging, received a SIB to the tumor up to a total dose of 55.2 Gy. Acute and late side effects were scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Results: A total of 102 patients presented with cT3–4 tumors; 57 patients entered the boost group and 51 the no-boost group. One patient in the no-boost group developed a radio-hypersensitivity reaction, resulting in a complete tumor remission, a Grade 3 acute and Grade 5 late enteritis. No other Grade ≥3 acute toxicities occurred. With a median follow-up of 32 months, Grade ≥3 late gastrointestinal and urinary toxicity were observed in 6% and 4% of the patients, respectively. The actuarial 2-year LC, progression-free survival and overall survival were 98%, 79%, and 93%. Conclusions: Preoperative helical tomotherapy displays a favorable acute toxicity profile in patients with cT3–4 rectal cancer. A SIB can be safely administered in patients with a narrow CRM and resulted in a promising LC.

  14. Parotid Gland Sparing With Helical Tomotherapy in Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Voordeckers, Mia; Farrag, Ashraf; Everaert, Hendrik; Tournel, Koen; Storme, Guy; Verellen, Dirk; De Ridder, Mark

    2012-01-01

    Purpose: This study evaluated the ability of helical tomotherapy to spare the function of the parotid glands in patients with head-and-neck cancer by analyzing dose–volume histograms, salivary gland scintigraphy, and quality of life assessment. Methods and Materials: Data from 76 consecutive patients treated with helical tomotherapy (Hi-Art Tomotherapy) at University Hospital Brussel were analyzed. During planning, priority was given to planning target volume (PTV) coverage: ≥95% of the dose must be delivered to ≥95% of the PTV. Elective nodal regions received 54 Gy (1.8 Gy/fraction). A dose of 70.5 Gy (2.35 Gy/fraction) was prescribed to the primary tumor and pathologic lymph nodes (simultaneous integrated boost scheme). Objective scoring of salivary excretion was performed by salivary gland scintigraphy. Subjective scoring of salivary gland function was evaluated by the European Organization for Research and Treatment of Cancer quality of life questionnaires Quality of Life Questionnaire—C30 (QLQ-C30) and Quality of Life Questionnaire—Head and Neck 35 (H and N35). Results: Analysis of dose–volume histograms (DVHs) showed excellent coverage of the PTV. The volume of PTV receiving 95% of the prescribed dose (V95%) was 99.4 (range, 96.3–99.9). DVH analysis of parotid gland showed a median value of the mean parotid dose of 32.1 Gy (range, 17.5–70.3 Gy). The median parotid volume receiving a dose <26 Gy was 51.2%. Quality of life evaluation demonstrated an initial deterioration of almost all scales and items in QLQ-C30 and QLQ-H and N35. Most items improved in time, and some reached baseline values 18 months after treatment. Conclusion: DVH analysis, scintigraphic evaluation of parotid function, and quality of life assessment of our patient group showed that helical tomotherapy makes it possible to preserve parotid gland function without compromising disease control. We recommend mean parotid doses of <34 Gy and doses <26 Gy to a maximum 47% of the

  15. Helical tomotherapy. Experiences of the first 150 patients in Heidelberg

    Energy Technology Data Exchange (ETDEWEB)

    Sterzing, F.; Schubert, K.; Sroka-Perez, G.; Kalz, J.; Debus, J.; Herfarth, K. [Dept. of Radiation Oncology, Univ. of Heidelberg (Germany)

    2008-01-15

    Background and purpose: helical tomotherapy was introduced into clinical routine at the Department of Radiation Oncology, University Hospital of Heidelberg, Germany, in July 2006. This report is intended to describe the experience with the first 150 patients treated with helical tomotherapy. Patient selection, time effort, handling of daily image guidance with megavoltage (MV) CT, and quality of radiation plans shall be assessed. Patients and methods: between July 2006 and May 2007, 150 patients were treated with helical tomotherapy in the University Hospital of Heidelberg. Mean age was 60 years with a minimum of 30 years and a maximum of 85 years. 79 of these patients received radiotherapy as a part of multimodal treatment pre- or postoperatively, 17 patients received treatment as a combined radiochemotherapy. 76% were treated with curative intent. Radiotherapy sites were central nervous system (n = 7), head and neck (n = 28), thoracic (n = 37), abdominal (n = 58) and skeletal system (n = 20). Most common tumor entities were prostate cancer (n = 28), breast cancer (n = 17), gastrointestinal tumors (n = 19), pharyngeal carcinoma (n = 14), lymphoma (n = 13), metastatic disease (bone n = 14, liver n = 6, lung n = 4, lymph node n = 2), sarcoma (n = 8), malignant pleural mesothelioma (n = 5), ovarian cancer treated with whole abdominal irradiation (n = 4), lung cancer (n = 3), skin malignancies (n = 3), chordoma (n = 2), meningioma (n = 2), one ependymoma and one medulloblastoma treated with craniospinal axis irradiation (n = 2), and others (n = 4). Nine patients were treated with single-fraction radiosurgery, nine with image-guided spinal reirradiation, and twelve patients were treated at multiple targets simultaneously. A pretreatment MV-CT scan was performed in 98.2% of the 3,026 fractions applied. After matching with the kilovoltage planning CT, corrections for translations and rotation around longitudinal axis (roll) were done. Results: mean time on table was 24

  16. Serial tomotherapy vs. MLC-IMRT (Multileaf Collimator Intensity Modulated Radiotherapy) for simultaneous boost treatment large intracerebral lesions

    International Nuclear Information System (INIS)

    Wolff, Dirk; Lohr, Frank; Mai, Sabine; Polednik, Martin; Wenz, Frederik; Dobler, Barbara

    2009-01-01

    Introduction: Recent data suggest that a radiosurgery boost treatment for up to three brain metastases in addition to whole brain radiotherapy (WBRT) is beneficial. Sequential treatment of multiple metastatic lesions is time-consuming and optimal normal tissue sparing is not trivial for larger metastases when separate plans are created and are only superimposed afterwards. Sequential Tomotherapy with noncoplanar arcs and Multi-field IMRT may streamline the process and enable easy simultaneous treatment. We compared plans for 2-3 intracerebral targets calculated with Intensity Modulated Radiotherapy (IMRT) based on treatment with MLC or sequential Tomotherapy using the Peacock-System. Treatment time was not to exceed 90 min on a linac with standart dose rate. MIMiC plans without treatment-time restrictions were created as a benchmark. Materials and methods: Calculations are based on a Siemens KD2 linac with a dose rate of 200 MU/min. Step-and-Shoot IMRT is performed with a standard MLC (2 x 29 leaves, 1 cm), serial Tomotherapy with the Multivane-Collimator MIMiC (NOMOS Inc. USA). Treatment plans are created with Corvus 5.0. To create plans with good conformity we chose a noncoplanar beam- and arc geometry for each approach (IMRT 4-, MIMiC 5-couch angles). The benchmark MIMiC plans with maximally steep dose gradients had 9 couch angles. For plan comparison reasons, 10Gy were prescribed to 90% of the PTV. Steepness of dose gradients, homogeneity and conformity were assessed by the following parameters: Volume encompassed by certain isodoses outside the target as well as homogeneity and conformity as indicated by Homogeneity- and Conformity-Index. Results: Plans without treatment-time restrictions had slightest dose to organ at risk (OAR), normal tissue and least Conformity-index. MIMiC- and MLC-IMRT based plans can be treated within the intended period of 90 min, all plans met the required dose. MLC based plans resulted in higher dose to organs at risk (OAR) and dose

  17. Motion-induced dose artifacts in helical tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bryan; Chen, Jeff; Battista, Jerry [London Regional Cancer Program, London Health Sciences Centre, London, ON (Canada); Kron, Tomas [Peter MacCallum Cancer Center, Melbourne (Australia)], E-mail: bryan.kim@lhsc.on.ca

    2009-10-07

    Tumor motion is a particular concern for a complex treatment modality such as helical tomotherapy, where couch position, gantry rotation and MLC leaf opening all change with time. In the present study, we have investigated the impact of tumor motion for helical tomotherapy, which could result in three distinct motion-induced dose artifacts, namely (1) dose rounding, (2) dose rippling and (3) IMRT leaf opening asynchronization effect. Dose rounding and dose rippling effects have been previously described, while the IMRT leaf opening asynchronization effect is a newly discovered motion-induced dose artifact. Dose rounding is the penumbral widening of a delivered dose distribution near the edges of a target volume along the direction of tumor motion. Dose rippling is a series of periodic dose peaks and valleys observed within the target region along the direction of couch motion, due to an asynchronous interplay between the couch motion and the longitudinal component of tumor motion. The IMRT leaf opening asynchronization effect is caused by an asynchronous interplay between the temporal patterns of leaf openings and tumor motion. The characteristics of each dose artifact were investigated individually as functions of target motion amplitude and period for both non-IMRT and IMRT helical tomotherapy cases, through computer simulation modeling and experimental verification. The longitudinal dose profiles generated by the simulation program agreed with the experimental data within {+-}0.5% and {+-}1.5% inside the PTV region for the non-IMRT and IMRT cases, respectively. The dose rounding effect produced a penumbral increase up to 20.5 mm for peak-to-peak target motion amplitudes ranging from 1.0 cm to 5.0 cm. Maximum dose rippling magnitude of 25% was calculated, when the target motion period approached an unusually high value of 10 s. The IMRT leaf opening asynchronization effect produced dose differences ranging from -29% to 7% inside the PTV region. This information

  18. Dose-escalated simultaneous integrated-boost treatment of prostate cancer patients via helical tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Geier, M.; Astner, S.T.; Duma, M.N.; Putzhammer, J.; Winkler, C.; Molls, M.; Geinitz, H. [Technische Univ. Muenchen (Germany). Klinik und Poliklinik fuer Strahlentherapie und Radiologische Onkologie; Jacob, V. [Universitaetsklinikum Freiburg (Germany). Klinik fuer Strahlenheilkunde; Nieder, C. [Nordland Hospital, Bodoe (Norway). Dept. of Oncology and Palliative Care; Tromsoe Univ. (Norway). Inst. of Clinical Medicine

    2012-05-15

    The goal of this work was to assess the feasibility of moderately hypofractionated simultaneous integrated-boost intensity-modulated radiotherapy (SIB-IMRT) with helical tomotherapy in patients with localized prostate cancer regarding acute side effects and dose-volume histogram data (DVH data). Acute side effects and DVH data were evaluated of the first 40 intermediate risk prostate cancer patients treated with a definitive daily image-guided SIB-IMRT protocol via helical tomotherapy in our department. The planning target volume including the prostate and the base of the seminal vesicles with safety margins was treated with 70 Gy in 35 fractions. The boost volume containing the prostate and 3 mm safety margins (5 mm craniocaudal) was treated as SIB to a total dose of 76 Gy (2.17 Gy per fraction). Planning constraints for the anterior rectal wall were set in order not to exceed the dose of 76 Gy prescribed to the boost volume. Acute toxicity was evaluated prospectively using a modified CTCAE (Common Terminology Criteria for Adverse Events) score. SIB-IMRT allowed good rectal sparing, although the full boost dose was permitted to the anterior rectal wall. Median rectum dose was 38 Gy in all patients and the median volumes receiving at least 65 Gy (V65), 70 Gy (V70), and 75 Gy (V75) were 13.5%, 9%, and 3%, respectively. No grade 4 toxicity was observed. Acute grade 3 toxicity was observed in 20% of patients involving nocturia only. Grade 2 acute intestinal and urological side effects occurred in 25% and 57.5%, respectively. No correlation was found between acute toxicity and the DVH data. This institutional SIB-IMRT protocol using daily image guidance as a precondition for smaller safety margins allows dose escalation to the prostate without increasing acute toxicity. (orig.)

  19. Calibration of helical tomotherapy machine using EPR/alanine dosimetry.

    Science.gov (United States)

    Perichon, Nicolas; Garcia, Tristan; François, Pascal; Lourenço, Valérie; Lesven, Caroline; Bordy, Jean-Marc

    2011-03-01

    Current codes of practice for clinical reference dosimetry of high-energy photon beams in conventional radiotherapy recommend using a 10 x 10 cm2 square field, with the detector at a reference depth of 10 cm in water and 100 cm source to surface distance (SSD) (AAPM TG-51) or 100 cm source-to-axis distance (SAD) (IAEA TRS-398). However, the maximum field size of a helical tomotherapy (HT) machine is 40 x 5 cm2 defined at 85 cm SAD. These nonstandard conditions prevent a direct implementation of these protocols. The purpose of this study is twofold: To check the absorbed dose in water and dose rate calibration of a tomotherapy unit as well as the accuracy of the tomotherapy treatment planning system (TPS) calculations for a specific test case. Both topics are based on the use of electron paramagnetic resonance (EPR) using alanine as transfer dosimeter between the Laboratoire National Henri Becquerel (LNHB) 60Co-gamma-ray reference beam and the Institut Curie's HT beam. Irradiations performed in the LNHB reference 60Co-gamma-ray beam allowed setting up the calibration method, which was then implemented and tested at the LNHB 6 MV linac x-ray beam, resulting in a deviation of 1.6% (at a 1% standard uncertainty) relative to the reference value determined with the standard IAEA TRS-398 protocol. HT beam dose rate estimation shows a difference of 2% with the value stated by the manufacturer at a 2% standard uncertainty. A 4% deviation between measured dose and the calculation from the tomotherapy TPS was found. The latter was originated by an inadequate representation of the phantom CT-scan values and, consequently, mass densities within the phantom. This difference has been explained by the mass density values given by the CT-scan and used by the TPS which were not the true ones. Once corrected using Monte Carlo N-Particle simulations to validate the accuracy of this process, the difference between corrected TPS calculations and alanine measured dose values was then

  20. Technical Note: Output and energy fluctuations of the tomotherapy Hi-Art helical tomotherapy system

    International Nuclear Information System (INIS)

    Mahan, Stephen L.; Chase, Daniel J.; Ramsey, Chester R.

    2004-01-01

    The output and energy calibrations for the first clinical Hi-Art 2.0 helical tomotherapy system have been reviewed. Fixed-gantry/fixed-couch and rotational-gantry/fixed-couch measurements were made on a daily basis over a period of 20 weeks to investigate system stability. Static gantry measurements were taken at 10 cm depth in a rectangular stack of Virtual Water at an SSD distance of 90 cm and a field size of 5x40 cm. Rotational gantry measurements were taken in a cylindrical phantom Virtual Water phantom for a field size of 5x40 cm. The Hi-Art 2.0 system has maintained its calibration to within ±2% and energy to within ±1.5% over the initial 20 week period

  1. An absolute dose determination of helical tomotherapy accelerator, TomoTherapy High-Art II

    International Nuclear Information System (INIS)

    Bailat, Claude J.; Buchillier, Thierry; Pachoud, Marc; Moeckli, Raphaeel; Bochud, Francois O.

    2009-01-01

    Purpose: A helical tomotherapy accelerator presents a dosimetric challenge because, to this day, there is no internationally accepted protocol for the determination of the absolute dose. Because of this reality, we investigated the different alternatives for characterizing and measuring the absolute dose of such an accelerator. We tested several dosimetric techniques with various metrological traceabilities as well as using a number of phantoms in static and helical modes. Methods: Firstly, the relationship between the reading of ionization chambers and the absorbed dose is dependent on the beam quality value of the photon beam. For high energy photons, the beam quality is specified by the tissue phantom ratio (TPR 20,10 ) and it is therefore necessary to know the TPR 20,10 to calculate the dose delivered by a given accelerator. This parameter is obtained through the ratio of the absorbed dose at 20 and 10 cm depths in water and was measured in the particular conditions of the tomotherapy accelerator. Afterward, measurements were performed using the ionization chamber (model A1SL) delivered as a reference instrument by the vendor. This chamber is traceable in absorbed dose to water in a Co-60 beam to a water calorimeter of the American metrology institute (NIST). Similarly, in Switzerland, each radiotherapy department is directly traceable to the Swiss metrology institute (METAS) in absorbed dose to water based on a water calorimeter. For our research, this traceability was obtained by using an ionization chamber traceable to METAS (model NE 2611A), which is the secondary standard of our institute. Furthermore, in order to have another fully independent measurement method, we determined the dose using alanine dosimeters provided by and traceable to the British metrology institute (NPL); they are calibrated in absorbed dose to water using a graphite calorimeter. And finally, we wanted to take into account the type of chamber routinely used in clinical practice and

  2. Prospective Phase I-II Trial of Helical Tomotherapy With or Without Chemotherapy for Postoperative Cervical Cancer Patients

    International Nuclear Information System (INIS)

    Schwarz, Julie K.; Wahab, Sasa; Grigsby, Perry W.

    2011-01-01

    Purpose: To investigate, in a prospective trial, the acute and chronic toxicity of patients with cervical cancer treated with surgery and postoperative intensity-modulated radiotherapy (RT) delivered using helical tomotherapy, with or without the administration of concurrent chemotherapy. Patients and Methods: A total of 24 evaluable patients entered the study between March 2006 and August 2009. The indications for postoperative RT were tumor size, lymphovascular space invasion, and the depth of cervical stromal invasion in 15 patients; 9 patients underwent postoperative RT because of surgically positive lymph nodes. All patients underwent pelvic RT delivered with helical tomotherapy and intracavitary high-dose-rate brachytherapy. Treatment consisted of concurrent weekly platinum in 17, sequential carboplatin/Taxol in 1, and RT alone in 6. The patients were monitored for acute and chronic toxicity using the Common Toxicity Criteria, version 3.0. Results: The median follow-up was 24 months (range, 4–49). At the last follow-up visit, 23 patients were alive and disease free. Of the 24 patients, 12 (50%) experienced acute Grade 3 gastrointestinal toxicity (anorexia in 5, diarrhea in 4, and nausea in 3). One patient developed acute Grade 4 genitourinary toxicity (vesicovaginal fistula). For patients treated with concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 71% and 24%, respectively. For patients treated without concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 29% and 14%, respectively. Two long-term toxicities occurred (vesicovaginal fistula at 25 months and small bowel obstruction at 30 months). The overall and progression-free survival rate at 3 years for all patients was 100% and 89%, respectively. Conclusion: The results of our study have shown that postoperative external RT for cervical cancer delivered with helical tomotherapy and high-dose-rate brachytherapy and with or without

  3. Prospective Phase I-II Trial of Helical Tomotherapy With or Without Chemotherapy for Postoperative Cervical Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Schwarz, Julie K., E-mail: jschwarz@radonc.wustl.edu [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Department of Cell Biology and Physiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Wahab, Sasa [Cobb Center for Radiation Oncology Center, Austell, GA (United States); Grigsby, Perry W. [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Department of Obstetrics and Gynecology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States)

    2011-12-01

    Purpose: To investigate, in a prospective trial, the acute and chronic toxicity of patients with cervical cancer treated with surgery and postoperative intensity-modulated radiotherapy (RT) delivered using helical tomotherapy, with or without the administration of concurrent chemotherapy. Patients and Methods: A total of 24 evaluable patients entered the study between March 2006 and August 2009. The indications for postoperative RT were tumor size, lymphovascular space invasion, and the depth of cervical stromal invasion in 15 patients; 9 patients underwent postoperative RT because of surgically positive lymph nodes. All patients underwent pelvic RT delivered with helical tomotherapy and intracavitary high-dose-rate brachytherapy. Treatment consisted of concurrent weekly platinum in 17, sequential carboplatin/Taxol in 1, and RT alone in 6. The patients were monitored for acute and chronic toxicity using the Common Toxicity Criteria, version 3.0. Results: The median follow-up was 24 months (range, 4-49). At the last follow-up visit, 23 patients were alive and disease free. Of the 24 patients, 12 (50%) experienced acute Grade 3 gastrointestinal toxicity (anorexia in 5, diarrhea in 4, and nausea in 3). One patient developed acute Grade 4 genitourinary toxicity (vesicovaginal fistula). For patients treated with concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 71% and 24%, respectively. For patients treated without concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 29% and 14%, respectively. Two long-term toxicities occurred (vesicovaginal fistula at 25 months and small bowel obstruction at 30 months). The overall and progression-free survival rate at 3 years for all patients was 100% and 89%, respectively. Conclusion: The results of our study have shown that postoperative external RT for cervical cancer delivered with helical tomotherapy and high-dose-rate brachytherapy and with or without

  4. Comparison of IMRT Treatment Plans Between Linac and Helical Tomotherapy Based on Integral Dose and Inhomogeneity Index

    International Nuclear Information System (INIS)

    Shi Chengyu; Penagaricano, Jose; Papanikolaou, Niko

    2008-01-01

    Intensity modulated radiotherapy (IMRT) is an advanced treatment technology for radiation therapy. There are several treatment planning systems (TPS) that can generate IMRT plans. These plans may show different inhomogeneity indices to the planning target volume (PTV) and integral dose to organs at risk (OAR). In this study, we compared clinical cases covering different anatomical treatment sites, including head and neck, brain, lung, prostate, pelvis, and cranio-spinal axis. Two treatment plans were developed for each case using Pinnacle 3 and helical tomotherapy (HT) TPS. The inhomogeneity index of the PTV and the non-tumor integral dose (NTID) were calculated and compared for each case. Despite the difference in the number of effective beams, in several cases, NTID did not increase from HT as compared to the step-and-shoot delivery method. Six helical tomotherapy treatment plans for different treatment sites have been analyzed and compared against corresponding step-and-shoot plans generated with the Pinnacle 3 planning system. Results show that HT may produce plans with smaller integral doses to healthy organs, and fairly homogeneous doses to the target as compared to linac-based step-and-shoot IMRT planning in special treatment site such as cranio-spinal

  5. Helical Tomotherapy in Children and Adolescents: Dosimetric Comparisons, Opportunities and Issues

    Energy Technology Data Exchange (ETDEWEB)

    Mascarin, Maurizio, E-mail: mascarin@cro.it [Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) (Italy); Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) (Italy); Giugliano, Francesca Maria [Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) (Italy); Seconda Università di Napoli, Napoli 80138 (Italy); Coassin, Elisa [Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) (Italy); Drigo, Annalisa; Chiovati, Paola; Dassie, Andrea [Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) (Italy); Department of Medical Physics, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) (Italy); Franchin, Giovanni; Minatel, Emilio; Trovò, Mauro Gaetano [Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) (Italy)

    2011-10-25

    Helical Tomotherapy (HT) is a highly conformal image-guided radiation technique, introduced into clinical routine in 2006 at the Centro di Riferimento Oncologico Aviano (Italy). With this new technology, intensity-modulated radiotherapy (IMRT) is delivered using a helicoidal method. Here we present our dosimetric experiences using HT in 100 children, adolescents and young adults treated from May 2006 to February 2011. The median age of the patients was 13 years (range 1–24). The most common treated site was the central nervous system (50; of these, 24 were craniospinal irradiations), followed by thorax (22), head and neck (10), abdomen and pelvis (11), and limbs (7). The use of HT was calculated in accordance to the target dose conformation, the target size and shape, the dose to critical organs adjacent to the target, simultaneous treatment of multiple targets, and re-irradiation. HT has demonstrated to improve target volume dose homogeneity and the sparing of critical structures, when compared to 3D Linac-based radiotherapy (RT). In standard cases this technique represented a comparable alternative to IMRT delivered with conventional linear accelerator. In certain cases (e.g., craniospinal and pleural treatments) only HT generated adequate treatment plans with good target volume coverage. However, the gain in target conformality should be balanced with the spread of low-doses to distant areas. This remains an open issue for the potential risk of secondary malignancies (SMNs) and longer follow-up is mandatory.

  6. Helical tomotherapy shielding calculation for an existing LINAC treatment room: sample calculation and cautions

    International Nuclear Information System (INIS)

    Wu Chuan; Guo Fanqing; Purdy, James A

    2006-01-01

    This paper reports a step-by-step shielding calculation recipe for a helical tomotherapy unit (TomoTherapy Inc., Madison, WI, USA), recently installed in an existing Varian 600C treatment room. Both primary and secondary radiations (leakage and scatter) are explicitly considered. A typical patient load is assumed. Use factor is calculated based on an analytical formula derived from the tomotherapy rotational beam delivery geometry. Leakage and scatter are included in the calculation based on corresponding measurement data as documented by TomoTherapy Inc. Our calculation result shows that, except for a small area by the therapists' console, most of the existing Varian 600C shielding is sufficient for the new tomotherapy unit. This work cautions other institutions facing the similar situation, where an HT unit is considered for an existing LINAC treatment room, more secondary shielding might be considered at some locations, due to the significantly increased secondary shielding requirement by HT. (note)

  7. Dose-volume and biological-model based comparison between helical tomotherapy and (inverse-planned) IMAT for prostate tumours

    International Nuclear Information System (INIS)

    Iori, Mauro; Cattaneo, Giovanni Mauro; Cagni, Elisabetta; Fiorino, Claudio; Borasi, Gianni; Riccardo, Calandrino; Iotti, Cinzia; Fazio, Ferruccio; Nahum, Alan E.

    2008-01-01

    Background and purpose: Helical tomotherapy (HT) and intensity-modulated arc therapy (IMAT) are two arc-based approaches to the delivery of intensity-modulated radiotherapy (IMRT). Through plan comparisons we have investigated the potential of IMAT, both with constant (conventional or IMAT-C) and variable (non-conventional or IMAT-NC, a theoretical exercise) dose-rate, to serve as an alternative to helical tomotherapy. Materials and methods: Six patients with prostate tumours treated by HT with a moderately hypo-fractionated protocol, involving a simultaneous integrated boost, were re-planned as IMAT treatments. A method for IMAT inverse-planning using a commercial module for static IMRT combined with a multi-leaf collimator (MLC) arc-sequencing was developed. IMAT plans were compared to HT plans in terms of dose statistics and radiobiological indices. Results: Concerning the planning target volume (PTV), the mean doses for all PTVs were similar for HT and IMAT-C plans with minimum dose, target coverage, equivalent uniform dose (EUD) and tumour control probability (TCP) values being generally higher for HT; maximum dose and degree of heterogeneity were instead higher for IMAT-C. In relation to organs at risk, mean doses and normal tissue complication probability (NTCP) values were similar between the two modalities, except for the penile bulb where IMAT was significantly better. Re-normalizing all plans to the same rectal toxicity (NTCP = 5%), the HT modality yielded higher TCP than IMAT-C but there was no significant difference between HT and IMAT-NC. The integral dose with HT was higher than that for IMAT. Conclusions: with regards to the plan analysis, the HT is superior to IMAT-C in terms of target coverage and dose homogeneity within the PTV. Introducing dose-rate variation during arc-rotation, not deliverable with current linac technology, the simulations result in comparable plan indices between (IMAT-NC) and HT

  8. 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

    Energy Technology Data Exchange (ETDEWEB)

    Peng, J; McDonald, D; Ashenafi, M; Ellis, A; Vanek, K [Medical University of South Carolina, Charleston, SC (United States)

    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 and 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

  9. Should helical tomotherapy replace brachytherapy for cervical cancer? Case report.

    Science.gov (United States)

    Hsieh, Chen-Hsi; Wei, Ming-Chow; Hsu, Yao-Peng; Chong, Ngot-Swan; Chen, Yu-Jen; Hsiao, Sheng-Mou; Hsieh, Yen-Ping; Wang, Li-Ying; Shueng, Pei-Wei

    2010-11-23

    Stereotactic body radiation therapy (SBRT) administered via a helical tomotherapy (HT) system is an effective modality for treating lung cancer and metastatic liver tumors. Whether SBRT delivered via HT is a feasible alternative to brachytherapy in treatment of locally advanced cervical cancer in patients with unusual anatomic configurations of the uterus has never been studied. A 46-year-old woman presented with an 8-month history of abnormal vaginal bleeding. Biopsy revealed squamous cell carcinoma of the cervix. Magnetic resonance imaging (MRI) showed a cervical tumor with direct invasion of the right parametrium, bilateral hydronephrosis, and multiple uterine myomas. International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical cancer was diagnosed. Concurrent chemoradiation therapy (CCRT) followed by SBRT delivered via HT was administered instead of brachytherapy because of the presence of multiple uterine myomas with bleeding tendency. Total abdominal hysterectomy was performed after 6 weeks of treatment because of the presence of multiple uterine myomas. Neither pelvic MRI nor results of histopathologic examination at X-month follow-up showed evidence of tumor recurrence. Only grade 1 nausea and vomiting during treatment were noted. Lower gastrointestinal bleeding was noted at 14-month follow-up. No fistula formation and no evidence of haematological, gastrointestinal or genitourinary toxicities were noted on the most recent follow-up. CCRT followed by SBRT appears to be an effective and safe modality for treatment of cervical cancer. Larger-scale studies are warranted.

  10. Should helical tomotherapy replace brachytherapy for cervical cancer? Case report

    Directory of Open Access Journals (Sweden)

    Chen Yu-Jen

    2010-11-01

    Full Text Available Abstract Background Stereotactic body radiation therapy (SBRT administered via a helical tomotherapy (HT system is an effective modality for treating lung cancer and metastatic liver tumors. Whether SBRT delivered via HT is a feasible alternative to brachytherapy in treatment of locally advanced cervical cancer in patients with unusual anatomic configurations of the uterus has never been studied. Case Presentation A 46-year-old woman presented with an 8-month history of abnormal vaginal bleeding. Biopsy revealed squamous cell carcinoma of the cervix. Magnetic resonance imaging (MRI showed a cervical tumor with direct invasion of the right parametrium, bilateral hydronephrosis, and multiple uterine myomas. International Federation of Gynecology and Obstetrics (FIGO stage IIIB cervical cancer was diagnosed. Concurrent chemoradiation therapy (CCRT followed by SBRT delivered via HT was administered instead of brachytherapy because of the presence of multiple uterine myomas with bleeding tendency. Total abdominal hysterectomy was performed after 6 weeks of treatment because of the presence of multiple uterine myomas. Neither pelvic MRI nor results of histopathologic examination at X-month follow-up showed evidence of tumor recurrence. Only grade 1 nausea and vomiting during treatment were noted. Lower gastrointestinal bleeding was noted at 14-month follow-up. No fistula formation and no evidence of haematological, gastrointestinal or genitourinary toxicities were noted on the most recent follow-up. Conclusions CCRT followed by SBRT appears to be an effective and safe modality for treatment of cervical cancer. Larger-scale studies are warranted.

  11. Should helical tomotherapy replace brachytherapy for cervical cancer? Case report

    International Nuclear Information System (INIS)

    Hsieh, Chen-Hsi; Wei, Ming-Chow; Hsu, Yao-Peng; Chong, Ngot-Swan; Chen, Yu-Jen; Hsiao, Sheng-Mou; Hsieh, Yen-Ping; Wang, Li-Ying; Shueng, Pei-Wei

    2010-01-01

    Stereotactic body radiation therapy (SBRT) administered via a helical tomotherapy (HT) system is an effective modality for treating lung cancer and metastatic liver tumors. Whether SBRT delivered via HT is a feasible alternative to brachytherapy in treatment of locally advanced cervical cancer in patients with unusual anatomic configurations of the uterus has never been studied. A 46-year-old woman presented with an 8-month history of abnormal vaginal bleeding. Biopsy revealed squamous cell carcinoma of the cervix. Magnetic resonance imaging (MRI) showed a cervical tumor with direct invasion of the right parametrium, bilateral hydronephrosis, and multiple uterine myomas. International Federation of Gynecology and Obstetrics (FIGO) stage IIIB cervical cancer was diagnosed. Concurrent chemoradiation therapy (CCRT) followed by SBRT delivered via HT was administered instead of brachytherapy because of the presence of multiple uterine myomas with bleeding tendency. Total abdominal hysterectomy was performed after 6 weeks of treatment because of the presence of multiple uterine myomas. Neither pelvic MRI nor results of histopathologic examination at X-month follow-up showed evidence of tumor recurrence. Only grade 1 nausea and vomiting during treatment were noted. Lower gastrointestinal bleeding was noted at 14-month follow-up. No fistula formation and no evidence of haematological, gastrointestinal or genitourinary toxicities were noted on the most recent follow-up. CCRT followed by SBRT appears to be an effective and safe modality for treatment of cervical cancer. Larger-scale studies are warranted

  12. Unilateral and bilateral neck SIB for head and neck cancer patients. Intensity-modulated proton therapy, tomotherapy, and RapidArc

    Energy Technology Data Exchange (ETDEWEB)

    Stromberger, Carmen; Budach, Volker; Ghadjar, Pirus; Wlodarczyk, Waldemar; Marnitz, Simone [Charite - Universitaetsmedizin Berlin, Department of Radiation Oncology and Radiotherapy, Berlin (Germany); Cozzi, Luca; Fogliata, Antonella [Humanitas Cancer Center Milan, Radiotherapy and Radiosurgery Department, Milan (Italy); Jamil, Basil [Klinikum Frankfurt Oder, Praxis fuer Strahlentherapie, Frankfurt Oder (Germany); Raguse, Jan D. [Clinic for Oral and Maxillofacial Surgery, Berlin (Germany); Boettcher, Arne [Charite - Universitaetsmedizin Berlin, Department of Otorhinolaryngology, Berlin (Germany)

    2016-04-15

    To compare simultaneous integrated boost plans for intensity-modulated proton therapy (IMPT), helical tomotherapy (HT), and RapidArc therapy (RA) for patients with head and neck cancer. A total of 20 patients with squamous cell carcinoma of the head and neck received definitive chemoradiation with bilateral (n = 14) or unilateral (n = 6) neck irradiation and were planned using IMPT, HT, and RA with 54.4, 60.8, and 70.4 GyE/Gy in 32 fractions. Dose distributions, coverage, conformity, homogeneity to planning target volumes (PTV)s and sparing of organs at risk and normal tissue were compared. All unilateral and bilateral plans showed excellent PTV coverage and acceptable dose conformity. For unilateral treatment, IMPT delivered substantially lower mean doses to contralateral salivary glands (< 0.001-1.1 Gy) than both rotational techniques did (parotid gland: 6-10 Gy; submandibular gland: 15-20 Gy). Regarding the sparing of classical organs at risk for bilateral treatment, IMPT and HT were similarly excellent and RA was satisfactory. For unilateral neck irradiation, IMPT may minimize the dry mouth risk in this subgroup but showed no advantage over HT for bilateral neck treatment regarding classical organ-at-risk sparing. All methods satisfied modern standards regarding toxicity and excellent target coverage for unilateral and bilateral treatment of head and neck cancer at the planning level. (orig.) [German] Planvergleich von intensitaetsmodulierter Protonentherapie (IMPT), Tomotherapie (HT) und RapidArc-Therapie (RA) fuer Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region unter Anwendung des simultan integrierten Boost-Konzepts (SIB). Fuer 20 Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region und bilateraler (n = 14) oder unilateraler (n = 6) zervikaler primaerer Radiochemotherapie erfolgte eine IMPT-, HT- und RA-Planung mit 54,4, 60,8 und 70,4 GyE/Gy in 32 Fraktionen. Die Dosisverteilung, Abdeckung, Konformitaet und Homogenitaet der PTVs sowie die

  13. Postmastectomy radiotherapy with integrated scar boost using helical tomotherapy

    International Nuclear Information System (INIS)

    Rong Yi; Yadav, Poonam; Welsh, James S.; Fahner, Tasha; Paliwal, Bhudatt

    2012-01-01

    The purpose of this study was to evaluate helical tomotherapy dosimetry in postmastectomy patients undergoing treatment for chest wall and positive nodal regions with simultaneous integrated boost (SIB) in the scar region using strip bolus. Six postmastectomy patients were scanned with a 5-mm-thick strip bolus covering the scar planning target volume (PTV) plus 2-cm margin. For all 6 cases, the chest wall received a total cumulative dose of 49.3–50.4 Gy with daily fraction size of 1.7–2.0 Gy. Total dose to the scar PTV was prescribed to 58.0–60.2 Gy at 2.0–2.5 Gy per fraction. The supraclavicular PTV and mammary nodal PTV received 1.7–1.9 dose per fraction. Two plans (with and without bolus) were generated for all 6 cases. To generate no-bolus plans, strip bolus was contoured and overrode to air density before planning. The setup reproducibility and delivered dose accuracy were evaluated for all 6 cases. Dose-volume histograms were used to evaluate dose-volume coverage of targets and critical structures. We observed reduced air cavities with the strip bolus setup compared with what we normally see with the full bolus. The thermoluminescence dosimeters (TLD) in vivo dosimetry confirmed accurate dose delivery beneath the bolus. The verification plans performed on the first day megavoltage computed tomography (MVCT) image verified that the daily setup and overall dose delivery was within 2% accuracy compared with the planned dose. The hotspot of the scar PTV in no-bolus plans was 111.4% of the prescribed dose averaged over 6 cases compared with 106.6% with strip bolus. With a strip bolus only covering the postmastectomy scar region, we observed increased dose uniformity to the scar PTV, higher setup reproducibility, and accurate dose delivered beneath the bolus. This study demonstrates the feasibility of using a strip bolus over the scar using tomotherapy for SIB dosimetry in postmastectomy treatments.

  14. [Technique of complex mammary irradiation: Mono-isocentric 3D conformational radiotherapy and helical tomotherapy].

    Science.gov (United States)

    Vandendorpe, B; Guilbert, P; Champagne, C; Antoni, T; Nguyen, T D; Gaillot-Petit, N; Servagi Vernat, S

    2017-12-01

    To evaluate the dosimetric contribution of helical tomotherapy for breast cancers compared with conformal radiotherapy in mono-isocentric technique. For 23 patients, the dosimetric results in mono-isocentric 3D conformational radiotherapy did not satisfy the constraints either of target volumes nor organs at risk. A prospective dosimetric comparison between mono-isocentric 3D conformational radiotherapy and helical tomotherapy was therefore carried out. The use of helical tomotherapy showed a benefit in these 23 patients, with either an improvement in the conformity index or homogeneity, but with an increase in low doses. Of the 23 patients, two had pectus excavatum, five had past thoracic irradiation and two required bilateral irradiation. The other 14 patients had a combination of morphology and/or indication of lymph node irradiation. For these patients, helical tomotherapy was therefore preferred to mono-isocentric 3D conformational radiotherapy. Tomotherapy appears to provide better homogeneity and tumour coverage. This technique of irradiation may be justified in the case of morphological situations such as pectus exavatum and in complex clinical situations. In other cases, conformal radiotherapy in mono-isocentric technique remains to be favoured. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  15. Helical Tomotherapy Planning for Lung Cancer Based on Ventilation Magnetic Resonance Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Cai Jing; McLawhorn, Robert [Department of Radiation Oncology, University of Virginia, Charlottesville, VA (United States); Altes, Tallisa A.; Lange, Eduard de [Department of Radiology, University of Virginia, Charlottesville, VA (United States); Read, Paul W.; Larner, James M.; Benedict, Stanley H. [Department of Radiation Oncology, University of Virginia, Charlottesville, VA (United States); Sheng Ke, E-mail: ks2mc@virginia.edu [Department of Radiation Oncology, University of Virginia, Charlottesville, VA (United States)

    2011-01-01

    To investigate the feasibility of lung ventilation-based treatment planning, computed tomography and hyperpolarized (HP) helium-3 (He-3) magnetic resonance imaging (MRI) ventilation images of 6 subjects were coregistered for intensity-modulated radiation therapy planning in Tomotherapy. Highly-functional lungs (HFL) and less-functional lungs (LFL) were contoured based on their ventilation image intensities, and a cylindrical planning-target-volume was simulated at locations adjacent to both HFL and LFL. Annals of an anatomy-based plan (Plan 1) and a ventilation-based plan (Plan 2) were generated. The following dosimetric parameters were determined and compared between the 2 plans: percentage of total/HFL volume receiving {>=}20 Gy, 15 Gy, 10 Gy, and 5 Gy (TLV{sub 20}, HFLV{sub 20}, TLV{sub 15}, HFLV{sub 15}, TLV{sub 10}, HFLV{sub 10}, TLV{sub 5}, HFLV{sub 5}), mean total/HFL dose (MTLD/HFLD), maximum doses to all organs at risk (OARs), and target dose conformality. Compared with Plan 1, Plan 2 reduced mean HFLD (mean reduction, 0.8 Gy), MTLD (mean reduction, 0.6 Gy), HFLV{sub 20} (mean reduction, 1.9%), TLV{sub 20} (mean reduction, 1.5%), TLV{sub 15} (mean reduction, 1.7%), and TLV{sub 10} (mean reduction, 2.1%). P-values of the above comparisons are less than 0.05 using the Wilcoxon signed rank test. For HFLV{sub 15}, HFLV{sub 10}, TLV{sub 5}, and HTLV{sub 5}, Plan 2 resulted in lower values than plan 1 but the differences are not significant (P-value range, 0.063-0.219). Plan 2 did not significantly change maximum doses to OARs (P-value range, 0.063-0.563) and target conformality (P = 1.000). HP He-3 MRI of patients with lung disease shows a highly heterogeneous ventilation capacity that can be utilized for functional treatment planning. Moderate but statistically significant improvements in sparing functional lungs were achieved using helical tomotherapy plans.

  16. A dosimetric selectivity intercomparison of HDR brachytherapy, IMRT and helical tomotherapy in prostate cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Hermesse, Johanne; Biver, Sylvie; Jansen, Nicolas; Coucke, Philippe [Dept. of Radiation Oncology, Liege Univ. Hospital (Belgium); Lenaerts, Eric [Dept. of Medical Physics, Liege Univ. Hospital (Belgium); De Patoul, Nathalie; Vynckier, Stefaan [Dept. of Medical Physics, St Luc Univ. Hospital, Brussels (Belgium); Scalliet, Pierre [Dept. of Radiation Oncology, St Luc Univ. Hospital, Brussels (Belgium); Nickers, Philippe [Dept. of Radiation Oncology, Oscar Lambret Center, Lille (France)

    2009-11-15

    Background and purpose: dose escalation in order to improve the biochemical control in prostate cancer requires the application of irradiation techniques with high conformality. The dosimetric selectivity of three radiation modalities is compared: high-dose-rate brachytherapy (HDR-BT), intensity-modulated radiation radiotherapy (IMRT), and helical tomotherapy (HT). Patients and methods: ten patients with prostate adenocarcinoma treated by a 10-Gy HDR-BT boost after external-beam radiotherapy were investigated. For each patient, HDR-BT, IMRT and HT theoretical treatment plans were realized using common contour sets. A 10-Gy dose was prescribed to the planning target volume (PTV). The PTVs and critical organs' dose-volume histograms obtained were compared using Student's t-test. Results: HDR-BT delivers spontaneously higher mean doses to the PTV with smaller cold spots compared to IMRT and HT. 33% of the rectal volume received a mean HDR-BT dose of 3.86 {+-} 0.3 Gy in comparison with a mean IMRT dose of 6.57 {+-} 0.68 Gy and a mean HT dose of 5.58 {+-} 0.71 Gy (p < 0.0001). HDR-BT also enables to better spare the bladder. The hot spots inside the urethra are greater with HDR-BT. The volume of healthy tissue receiving 10% of the prescribed dose is reduced at least by a factor of 8 with HDR-BT (p < 0.0001). Conclusion: HDR-BT offers better conformality in comparison with HT and IMRT and reduces the volume of healthy tissue receiving a low dose. (orig.)

  17. Split-Field Helical Tomotherapy With or Without Chemotherapy for Definitive Treatment of Cervical Cancer

    International Nuclear Information System (INIS)

    Chang, Albert J.; Richardson, Susan; Grigsby, Perry W.; Schwarz, Julie K.

    2012-01-01

    Objective: The objective of this study was to investigate the chronic toxicity, response to therapy, and survival outcomes of patients with cervical cancer treated with definitive pelvic irradiation delivered by helical tomotherapy (HT), with or without concurrent chemotherapy. Methods and Materials: There were 15 patients with a new diagnosis of cervical cancer evaluated in this study from April 2006 to February 2007. The clinical stages of their disease were Stage Ib1 in 3 patients, Ib2 in 3, IIa in 2, IIb in 4, IIIb in 2, and IVa in 1 patient. Fluorodeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) simulation was performed in all patients. All patients received pelvic irradiation delivered by HT and high-dose-rate (HDR) brachytherapy. Four patients also received para-aortic irradiation delivered by HT. Thirteen patients received concurrent chemotherapy. Patients were monitored for chronic toxicity using the Common Terminology Criteria for Adverse Events version 3.0 criteria. Results: The median age of the cohort was 51 years (range, 29-87 years), and the median follow-up for all patients alive at time of last follow-up was 35 months. The median overall radiation treatment time was 54 days. One patient developed a chronic Grade 3 GI complication. No other Grade 3 or 4 complications were observed. At last follow-up, 3 patients had developed a recurrence, with 1 patient dying of disease progression. The 3-year progression-free and cause-specific survival estimates for all patients were 80% and 93%, respectively. Conclusion: Intensity-modulated radiation therapy delivered with HT and HDR brachytherapy with or without chemotherapy for definitive treatment of cervical cancer is feasible, with acceptable levels of chronic toxicity.

  18. QA for helical tomotherapy: Report of the AAPM Task Group 148

    Energy Technology Data Exchange (ETDEWEB)

    Langen, Katja M.; Papanikolaou, Niko; Balog, John; Crilly, Richard; Followill, David; Goddu, S. Murty; Grant, Walter III; Olivera, Gustavo; Ramsey, Chester R.; Shi Chengyu [Department of Radiation Oncology, M. D. Anderson Cancer Center Orlando, Orlando, Florida 32806 (United States); Department of Radiation Oncology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229 (United States); Mohawk Valley Medical Physics, Rome, New York 13440 (United States); Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon 97239 (United States); Section of Outreach Physics, University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030 (United States); Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri 63110 (United States); Department of Radiology/Section of Radiation Oncology, Baylor College of Medicine, Methodist Hospital, Houston, Texas 77030 (United States); TomoTherapy, Inc., Madison, Wisconsin 53717 and Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53706 (United States); Thompson Cancer Survival Center, Knoxville, Tennessee 37916 (United States); Department of Radiation Oncology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229 (United States)

    2010-09-15

    Helical tomotherapy is a relatively new modality with integrated treatment planning and delivery hardware for radiation therapy treatments. In view of the uniqueness of the hardware design of the helical tomotherapy unit and its implications in routine quality assurance, the Therapy Physics Committee of the American Association of Physicists in Medicine commissioned Task Group 148 to review this modality and make recommendations for quality assurance related methodologies. The specific objectives of this Task Group are: (a) To discuss quality assurance techniques, frequencies, and tolerances and (b) discuss dosimetric verification techniques applicable to this unit. This report summarizes the findings of the Task Group and aims to provide the practicing clinical medical physicist with the insight into the technology that is necessary to establish an independent and comprehensive quality assurance program for a helical tomotherapy unit. The emphasis of the report is to describe the rationale for the proposed QA program and to provide example tests that can be performed, drawing from the collective experience of the task group members and the published literature. It is expected that as technology continues to evolve, so will the test procedures that may be used in the future to perform comprehensive quality assurance for helical tomotherapy units.

  19. Measurement and correction of leaf open times in helical tomotherapy

    International Nuclear Information System (INIS)

    Sevillano, David; Mínguez, Cristina; Sánchez, Alicia; Sánchez-Reyes, Alberto

    2012-01-01

    Purpose: The binary multileaf collimator (MLC) is one of the most important components in helical tomotherapy (HT), as it modulates the dose delivered to the patient. However, methods to ensure MLC quality in HT treatments are lacking. The authors obtained data on the performance of the MLC in treatments administered in their department in order to assess possible delivery errors due to the MLC. Correction methods based on their data are proposed. Methods: Twenty sinograms from treatments delivered using both of the authors HT systems were measured and analyzed by recording the fluence collected by the imaging detector. Planned and actual sinograms were compared using distributions of leaf open time (LOT) errors, as well as differences in fluence reconstructed at each of the 51 projections into which the treatment planning system divides each rotation for optimization purposes. They proposed and applied a method based on individual leaf error correction and the increase in projection time to prevent latency effects when LOT is close to projection time. In order to analyze the dosimetric impact of the corrections, inphantom measurements were made for four corrected treatments. Results: The LOTs measured were consistent with those planned. Most of the mean errors in LOT distributions were within 1 ms with standard deviations of over 4 ms. Reconstructed fluences showed good results, with over 90% of points passing the 3% criterion, except in treatments with a short mean LOT, where the percentage of passing points was as low as 66%. Individual leaf errors were as long as 4 ms in some cases. Corrected sinograms improved error distribution, with standard deviations of over 3 ms and increased percentages of points passing 3% in the fluence per angle analysis, especially in treatments with a short mean LOT and those that were more subject to latency effects. The minimum percentage of points within 3% increased to 86%. In-phantom measurements of the corrected treatments

  20. Measurement and correction of leaf open times in helical tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Sevillano, David; Minguez, Cristina; Sanchez, Alicia; Sanchez-Reyes, Alberto [Department of Medical Physics, Tomotherapy Unit, Grupo IMO, Madrid 28010 (Spain)

    2012-11-15

    Purpose: The binary multileaf collimator (MLC) is one of the most important components in helical tomotherapy (HT), as it modulates the dose delivered to the patient. However, methods to ensure MLC quality in HT treatments are lacking. The authors obtained data on the performance of the MLC in treatments administered in their department in order to assess possible delivery errors due to the MLC. Correction methods based on their data are proposed. Methods: Twenty sinograms from treatments delivered using both of the authors HT systems were measured and analyzed by recording the fluence collected by the imaging detector. Planned and actual sinograms were compared using distributions of leaf open time (LOT) errors, as well as differences in fluence reconstructed at each of the 51 projections into which the treatment planning system divides each rotation for optimization purposes. They proposed and applied a method based on individual leaf error correction and the increase in projection time to prevent latency effects when LOT is close to projection time. In order to analyze the dosimetric impact of the corrections, inphantom measurements were made for four corrected treatments. Results: The LOTs measured were consistent with those planned. Most of the mean errors in LOT distributions were within 1 ms with standard deviations of over 4 ms. Reconstructed fluences showed good results, with over 90% of points passing the 3% criterion, except in treatments with a short mean LOT, where the percentage of passing points was as low as 66%. Individual leaf errors were as long as 4 ms in some cases. Corrected sinograms improved error distribution, with standard deviations of over 3 ms and increased percentages of points passing 3% in the fluence per angle analysis, especially in treatments with a short mean LOT and those that were more subject to latency effects. The minimum percentage of points within 3% increased to 86%. In-phantom measurements of the corrected treatments

  1. Helical tomotherapy with dynamic running-start-stop delivery compared to conventional tomotherapy delivery

    Energy Technology Data Exchange (ETDEWEB)

    Rong, Yi, E-mail: yi.rong@osumc.edu [Department of Radiation Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio 43210 (United States); Chen, Yu; Lu, Weiguo [21st Century Oncology, Madison, Wisconsin 53719 (United States); Shang, Lu [Guangxi Polytechnic of Construction and Technology, Nanning (China); Zuo, Li [Radiologic Sciences and Respiratory Therapy Division, School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, Ohio 43210 (United States); Chen, Quan [Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia 22904 (United States)

    2014-05-15

    Purpose: Despite superior target dose uniformity, helical tomotherapy{sup ®} (HT) may involve a trade-off between longitudinal dose conformity and beam-on time (BOT), due to the limitation of only three available jaw sizes with the conventional HT (1.0, 2.5, and 5.0 cm). The recently introduced dynamic running-start-stop (RSS) delivery allows smaller jaw opening at the superior and inferior ends of the target when a sharp penumbra is needed. This study compared the dosimetric performance of RSS delivery with the fixed jaw HT delivery. Methods: Twenty patient cases were selected and deidentified prior to treatment planning, including 16 common clinical cases (brain, head and neck (HN), lung, and prostate) and four special cases of whole brain with hippocampus avoidance (WBHA) that require a high degree of dose modulation. HT plans were generated for common clinical cases using the fixed 2.5 cm jaw width (HT2.5) and WBHA cases using 1.0 cm (HT1.0). The jaw widths for RSS were preset with a larger size (RSS5.0 vs HT2.5 and RSS2.5 vs HT1.0). Both delivery techniques were planned based on identical contours, prescriptions, and planning objectives. Dose indices for targets and critical organs were compared using dose-volume histograms, BOT, and monitor units. Results: The average BOT was reduced from 4.8 min with HT2.5 to 2.5 min with RSS5.0. Target dose homogeneity with RSS5.0 was shown comparable to HT2.5 for common clinical sites. Superior normal tissue sparing was observed in RSS5.0 for optic nerves and optic chiasm in brain and HN cases. RSS5.0 demonstrated improved dose sparing for cord and esophagus in lung cases, as well as penile bulb in prostate cases. The mean body dose was comparable for both techniques. For the WBHA cases, the target homogeneity was significantly degraded in RSS2.5 without distinct dose sparing for hippocampus, compared to HT1.0. Conclusions: Compared to the fixed jaw HT delivery, RSS combined with a larger jaw width provides faster

  2. Helical tomotherapy with dynamic running-start-stop delivery compared to conventional tomotherapy delivery

    International Nuclear Information System (INIS)

    Rong, Yi; Chen, Yu; Lu, Weiguo; Shang, Lu; Zuo, Li; Chen, Quan

    2014-01-01

    Purpose: Despite superior target dose uniformity, helical tomotherapy ® (HT) may involve a trade-off between longitudinal dose conformity and beam-on time (BOT), due to the limitation of only three available jaw sizes with the conventional HT (1.0, 2.5, and 5.0 cm). The recently introduced dynamic running-start-stop (RSS) delivery allows smaller jaw opening at the superior and inferior ends of the target when a sharp penumbra is needed. This study compared the dosimetric performance of RSS delivery with the fixed jaw HT delivery. Methods: Twenty patient cases were selected and deidentified prior to treatment planning, including 16 common clinical cases (brain, head and neck (HN), lung, and prostate) and four special cases of whole brain with hippocampus avoidance (WBHA) that require a high degree of dose modulation. HT plans were generated for common clinical cases using the fixed 2.5 cm jaw width (HT2.5) and WBHA cases using 1.0 cm (HT1.0). The jaw widths for RSS were preset with a larger size (RSS5.0 vs HT2.5 and RSS2.5 vs HT1.0). Both delivery techniques were planned based on identical contours, prescriptions, and planning objectives. Dose indices for targets and critical organs were compared using dose-volume histograms, BOT, and monitor units. Results: The average BOT was reduced from 4.8 min with HT2.5 to 2.5 min with RSS5.0. Target dose homogeneity with RSS5.0 was shown comparable to HT2.5 for common clinical sites. Superior normal tissue sparing was observed in RSS5.0 for optic nerves and optic chiasm in brain and HN cases. RSS5.0 demonstrated improved dose sparing for cord and esophagus in lung cases, as well as penile bulb in prostate cases. The mean body dose was comparable for both techniques. For the WBHA cases, the target homogeneity was significantly degraded in RSS2.5 without distinct dose sparing for hippocampus, compared to HT1.0. Conclusions: Compared to the fixed jaw HT delivery, RSS combined with a larger jaw width provides faster treatment

  3. A Comparison of Helical Intensity-Modulated Radiotherapy, Intensity-Modulated Radiotherapy, and 3D-Conformal Radiation Therapy for Pancreatic Cancer

    International Nuclear Information System (INIS)

    Poppe, Matthew M.; Narra, Venkat; Yue, Ning J.; Zhou Jinghao; Nelson, Carl; Jabbour, Salma K.

    2011-01-01

    We assessed dosimetric differences in pancreatic cancer radiotherapy via helical intensity-modulated radiotherapy (HIMRT), linac-based IMRT, and 3D-conformal radiation therapy (3D-CRT) with regard to successful plan acceptance and dose to critical organs. Dosimetric analysis was performed in 16 pancreatic cases that were planned to 54 Gy; both post-pancreaticoduodenectomy (n = 8) and unresected (n = 8) cases were compared. Without volume modification, plans met constraints 75% of the time with HIMRT and IMRT and 13% with 3D-CRT. There was no statistically significantly improvement with HIMRT over conventional IMRT in reducing liver V35, stomach V45, or bowel V45. HIMRT offers improved planning target volume (PTV) dose homogeneity compared with IMRT, averaging a lower maximum dose and higher volume receiving the prescription dose (D100). HIMRT showed an increased mean dose over IMRT to bowel and liver. Both HIMRT and IMRT offer a statistically significant improvement over 3D-CRT in lowering dose to liver, stomach, and bowel. The results were similar for both unresected and resected patients. In pancreatic cancer, HIMRT offers improved dose homogeneity over conventional IMRT and several significant benefits to 3D-CRT. Factors to consider before incorporating IMRT into pancreatic cancer therapy are respiratory motion, dose inhomogeneity, and mean dose.

  4. Results of a two-year quality control program for a helical tomotherapy unit

    International Nuclear Information System (INIS)

    Broggi, Sara; Mauro Cattaneo, Giovanni; Molinelli, Silvia; Maggiulli, Eleonora; Del Vecchio, Antonella; Longobardi, Barbara; Perna, Lucia; Fazio, Ferruccio; Calandrino, Riccardo

    2008-01-01

    Background and purpose: Image-guided helical tomotherapy (HT) is a new modality for delivering intensity modulated radiation therapy (IMRT) with helical irradiation: the slip ring continuously rotates while the couch moves into the bore. The radiation source (Linac, 6 MV) is collimated into a fan beam and modulated by means of a binary multileaf collimator (MLC). A xenon detector array, opposite the radiation source, allows a megavoltage-CT (MVCT) acquisition of patient images for set-up verification. The aim of this paper is to report the results of a two-year quality control (QC) program for the physical and dosimetric characterization of an HT unit installed at our Institute and clinically activated in November 2004, in order to monitor and verify the stability and the reliability of this promising radiation treatment unit. Materials and methods: Conventional Linac acceptance protocols (ATP) and QC protocols were adapted to HT with the addition of specific items reflecting important differences between the two irradiation modalities. QC tests can be summarized as: (a) mechanical and geometrical characterization of the system's components: evaluation of alignment among radiation source-gantry rotation plan-jaws-MLC-MVCT; (b) treatment beam configuration in static condition: depth dose curves (PDD) and profiles, output factors, output reproducibility and linearity; (c) dynamic component characterization: accuracy and reproducibility of MLC positioning; rotational output reproducibility and linearity, leaf latency, couch movement constancy; (d) gantry-couch and MLC-gantry synchronization; and (e) MVCT image quality. Peculiar periodicity specific tolerance and action levels were defined. Ionization chambers (Exradin A1SL 0.056 cc), films (XOmat-V/EDR2), water and solid water phantoms were used to perform quality assurance measurements. Results: Over a two-year period the final average output variation after possible beam output adjustment was -0.2 ± 1% for the

  5. Conversion of helical tomotherapy plans to step-and-shoot IMRT plans--Pareto front evaluation of plans from a new treatment planning system.

    Science.gov (United States)

    Petersson, Kristoffer; Ceberg, Crister; Engström, Per; Benedek, Hunor; Nilsson, Per; Knöös, Tommy

    2011-06-01

    The resulting plans from a new type of treatment planning system called SharePlan have been studied. This software allows for the conversion of treatment plans generated in a TomoTherapy system for helical delivery, into plans deliverable on C-arm linear accelerators (linacs), which is of particular interest for clinics with a single TomoTherapy unit. The purpose of this work was to evaluate and compare the plans generated in the SharePlan system with the original TomoTherapy plans and with plans produced in our clinical treatment planning system for intensity-modulated radiation therapy (IMRT) on C-arm linacs. In addition, we have analyzed how the agreement between SharePlan and TomoTherapy plans depends on the number of beams and the total number of segments used in the optimization. Optimized plans were generated for three prostate and three head-and-neck (H&N) cases in the TomoTherapy system, and in our clinical treatment planning systems (TPS) used for IMRT planning with step-and-shoot delivery. The TomoTherapy plans were converted into step-and-shoot IMRT plans in SharePlan. For each case, a large number of Pareto optimal plans were created to compare plans generated in SharePlan with plans generated in the Tomotherapy system and in the clinical TPS. In addition, plans were generated in SharePlan for the three head-and-neck cases to evaluate how the plan quality varied with the number of beams used. Plans were also generated with different number of beams and segments for other patient cases. This allowed for an evaluation of how to minimize the number of required segments in the converted IMRT plans without compromising the agreement between them and the original TomoTherapy plans. The plans made in SharePlan were as good as or better than plans from our clinical system, but they were not as good as the original TomoTherapy plans. This was true for both the head-and-neck and the prostate cases, although the differences between the plans for the latter were

  6. Whole pelvic helical tomotherapy for locally advanced cervical cancer: technical implementation of IMRT with helical tomothearapy

    International Nuclear Information System (INIS)

    Hsieh, Chen-Hsi; Shueng, Pei-Wei; Wei, Ming-Chow; Lee, Hsing-Yi; Hsiao, Sheng-Mou; Chen, Chien-An; Wang, Li-Ying; Hsieh, Yen-Ping; Tsai, Tung-Hu; Chen, Yu-Jen

    2009-01-01

    To review the experience and to evaluate the treatment plan of using helical tomotherapy (HT) for the treatment of cervical cancer. Between November 1st, 2006 and May 31, 2009, 10 cervical cancer patients histologically confirmed were enrolled. All of the patients received definitive concurrent chemoradiation (CCRT) with whole pelvic HT (WPHT) followed by brachytherapy. During WPHT, all patients were treated with cisplatin, 40 mg/m 2 intravenously weekly. Toxicity of treatment was scored according to the Common Terminology Criteria for Adverse Events v3.0 (CTCAE v3.0). The mean survival was 25 months (range, 3 to 27 months). The actuarial overall survival, disease-free survival, locoregional control and distant metastasis-free rates at 2 years were 67%, 77%, 90% and 88%, respectively. The average of uniformity index and conformal index was 1.06 and 1.19, respectively. One grade 3 of acute toxicity for diarrhea, thrombocytopenia and three grade 3 leucopenia were noted during CCRT. Only one grade 3 of subacute toxicity for thrombocytopenia was noted. There were no grade 3 or 4 subacute toxicities of anemia, leucopenia, genitourinary or gastrointestinal effects. Compared with conventional whole pelvic radiation therapy (WPRT), WPHT decreases the mean dose to rectum, bladder and intestines successfully. HT provides feasible clinical outcomes in locally advanced cervical cancer patients. Long-term follow-up and enroll more locally advanced cervical carcinoma patients by limiting bone marrow radiation dose with WPHT technique is warranted

  7. Dosimetric comparison between conformational irradiation and helical tomo-therapy in supra-diaphragmatic Hodgkin disease in paediatrics; Comparaison dosimetrique entre l'irradiation conformationelle et la tomotherapie helicoidale dans la maladie de Hodgkin sus-diaphragmatique en pediatrie

    Energy Technology Data Exchange (ETDEWEB)

    Padovani, L.; Taright, N.; Muraracciole, X.; Nomikossof, N.; Capdeville, S.; Portal, T.; Cowen, D. [Assistance publique-hopitaux de Marseille (France)

    2011-10-15

    The authors report the comparison of dosimetry when using three-dimensional conformational radiotherapy or intensity-modulated conformational radiotherapy (IMRT) in the case of 13 children treated for a Hodgkin disease. The comparison is made in terms of previsional target volume (PTV) coverage and of doses received at the level of organs at risk. Coverage is almost the same for both techniques. Helical tomo-therapy allows the reduction of doses delivered to the heart, spine and lungs, including low doses (V5 and V10) while respecting an identical PTV coverage. This dose reduction could result in a reduction of toxicity on the long term, which is a major challenge for cured children. Short communication

  8. Feasibility study of helical tomotherapy for total body or total marrow irradiation

    International Nuclear Information System (INIS)

    Hui, Susanta K.; Kapatoes, Jeff; Fowler, Jack; Henderson, Douglas; Olivera, Gustavo; Manon, Rafael R.; Gerbi, Bruce; Mackie, T. R.; Welsh, James S.

    2005-01-01

    Total body radiation (TBI) has been used for many years as a preconditioning agent before bone marrow transplantation. Many side effects still plague its use. We investigated the planning and delivery of total body irradiation (TBI) and selective total marrow irradiation (TMI) and a reduced radiation dose to sensitive structures using image-guided helical tomotherapy. To assess the feasibility of using helical tomotherapy (A) we studied variations in pitch, field width, and modulation factor on total body and total marrow helical tomotherapy treatments. We varied these parameters to provide a uniform dose along with a treatment times similar to conventional TBI (15-30 min). (B) We also investigated limited (head, chest, and pelvis) megavoltage CT (MVCT) scanning for the dimensional pretreatment setup verification rather than total body MVCT scanning to shorten the overall treatment time per treatment fraction. (C) We placed thermoluminescent detectors (TLDs) inside a Rando phantom to measure the dose at seven anatomical sites, including the lungs. A simulated TBI treatment showed homogeneous dose coverage (±10%) to the whole body. Doses to the sensitive organs were reduced by 35%-70% of the target dose. TLD measurements on Rando showed an accurate dose delivery (±7%) to the target and critical organs. In the TMI study, the dose was delivered conformally to the bone marrow only. The TBI and TMI treatment delivery time was reduced (by 50%) by increasing the field width from 2.5 to 5.0 cm in the inferior-superior direction. A limited MVCT reduced the target localization time 60% compared to whole body MVCT. MVCT image-guided helical tomotherapy offers a novel method to deliver a precise, homogeneous radiation dose to the whole body target while reducing the dose significantly to all critical organs. A judicious selection of pitch, modulation factor, and field size is required to produce a homogeneous dose distribution along with an acceptable treatment time. In

  9. Evaluation of image-guided helical tomotherapy for the retreatment of spinal metastasis

    International Nuclear Information System (INIS)

    Mahan, Stephen L.; Ramsey, Chester R.; Scaperoth, Daniel D.; Chase, Daniel J.; Byrne, Thomas E.

    2005-01-01

    Introduction: Patients with vertebral metastasis that receive radiation therapy are typically treated to the spinal cord tolerance dose. As such, it is difficult to successfully deliver a second course of radiation therapy for patients with overlapping treatment volumes. In this study, an image-guided helical tomotherapy system was evaluated for the retreatment of previously irradiated vertebral metastasis. Methods and Materials: Helical tomotherapy dose gradients and maximum cord doses were measured in a cylindrical phantom for geometric test cases with separations between the planning target volume (PTV) and the spinal cord organ at risk (OAR) of 2 mm, 4 mm, 6 mm, 8 mm, and 10 mm. Megavoltage computed tomography (CT) images were examined for their ability to localize spinal anatomy for positioning purposes by repeat imaging of the cervical spine in an anthropomorphic phantom. In addition to the phantom studies, 8 patients with cord compressions that had received previous radiation therapy were retreated to a mean dose of 28 Gy using conventional fractionation. Results and Discussion: Megavoltage CT images were capable of positioning an anthropomorphic phantom to within ±1.2 mm (2σ) superior-inferiorly and within ±0.6 mm (2σ) anterior-posteriorly and laterally. Dose gradients of 10% per mm were measured in phantom while PTV uniformity indices of less than 11% were maintained. The calculated maximum cord dose was 25% of the prescribed dose for a 10-mm PTV-to-OAR separation and 71% of the prescribed dose for a PTV-to-OAR separation of 2 mm. Eight patients total have been treated without radiation-induced myelopathy or any other adverse effects from treatment. Conclusions: A technique has been evaluated for the retreatment of vertebral metastasis using image-guided helical tomotherapy. Phantom and patient studies indicated that a tomotherapy system is capable of delivering dose gradients of 10% per mm and positioning the patient within 1.2 mm without the use of

  10. Intensity modulated conformal radiotherapy

    International Nuclear Information System (INIS)

    Noel, Georges; Moty-Monnereau, Celine; Meyer, Aurelia; David, Pauline; Pages, Frederique; Muller, Felix; Lee-Robin, Sun Hae; David, Denis Jean

    2006-12-01

    This publication reports the assessment of intensity-modulated conformal radiotherapy (IMCR). This assessment is based on a literature survey which focussed on indications, efficiency and safety on the short term, on the risk of radio-induced cancer on the long term, on the role in the therapeutic strategy, on the conditions of execution, on the impact on morbidity-mortality and life quality, on the impact on the health system and on public health policies and program. This assessment is also based on the opinion of a group of experts regarding the technical benefit of IMCR, its indications depending on the cancer type, safety in terms of radio-induced cancers, and conditions of execution. Before this assessment, the report thus indicates indications for which the use of IMCR can be considered as sufficient or not determined. It also proposes a technical description of IMCR and helical tomo-therapy, discusses the use of this technique for various pathologies or tumours, analyses the present situation of care in France, and comments the identification of this technique in foreign classifications

  11. Treatment Planning for Pulsed Reduced Dose-Rate Radiotherapy in Helical Tomotherapy

    International Nuclear Information System (INIS)

    Rong Yi; Paliwal, Bhudatt; Howard, Steven P.; Welsh, James

    2011-01-01

    Purpose: Pulsed reduced dose-rate radiotherapy (PRDR) is a valuable method of reirradiation because of its potential to reduce late normal tissue toxicity while still yielding significant tumoricidal effect. A typical method using a conventional linear accelerator (linac) is to deliver a series of 20-cGy pulses separated by 3-min intervals to give an effective dose-rate of just under 7 cGy/min. Such a strategy is fraught with difficulties when attempted on a helical tomotherapy unit. We investigated various means to overcome this limitation. Methods and Materials: Phantom and patient cases were studied. Plans were generated with varying combinations of field width (FW), pitch, and modulation factor (MF) to administer 200 cGy per fraction to the planning target in eight subfractions, thereby mimicking the technique used on conventional linacs. Plans were compared using dose-volume histograms, homogeneity indices, conformation numbers, and treatment time. Plan delivery quality assurance was performed to assess deliverability. Results: It was observed that for helical tomotherapy, intrinsic limitations in leaf open time in the multileaf collimator deteriorate plan quality and deliverability substantially when attempting to deliver very low doses such as 20-40 cGy. The various permutations evaluated revealed that the combination of small FW (1.0 cm), small MF (1.3-1.5), and large pitch (∼0.86), along with the half-gantry-angle-blocked scheme, can generate clinically acceptable plans with acceptable delivery accuracy (±3%). Conclusion: Pulsed reduced dose-rate radiotherapy can be accurately delivered using helical tomotherapy for tumor reirradiation when the appropriate combination of FW, MF, and pitch is used.

  12. Development of a software tool for the management of quality control in a helical tomotherapy unit

    International Nuclear Information System (INIS)

    Garcia Repiso, S.; Hernandez Rodriguez, J.; Martin Rincon, C.; Ramos Pacho, J. A.; Verde Velasco, J. M.; Delgado Aparacio, J. M.; Perez Alvarez, M. e.; Gomez Gonzalez, N.; Cons Perez, V.; Saez Beltran, M.

    2013-01-01

    The large amount of data and information that is managed in units of external radiotherapy quality control tests makes necessary the use of tools that facilitate, on the one hand, the management of measures and results in real time, and on other tasks of management, file, query and reporting of stored data. This paper presents an application of software of own development which is used for the integral management of the helical TomoTherapy unit in the aspects related to the roles and responsibilities of the hospital Radiophysics. (Author)

  13. A novel method to correct for pitch and yaw patient setup errors in helical tomotherapy

    International Nuclear Information System (INIS)

    Boswell, Sarah A.; Jeraj, Robert; Ruchala, Kenneth J.; Olivera, Gustavo H.; Jaradat, Hazim A.; James, Joshua A.; Gutierrez, Alonso; Pearson, Dave; Frank, Gary; Mackie, T. Rock

    2005-01-01

    An accurate means of determining and correcting for daily patient setup errors is important to the cancer outcome in radiotherapy. While many tools have been developed to detect setup errors, difficulty may arise in accurately adjusting the patient to account for the rotational error components. A novel, automated method to correct for rotational patient setup errors in helical tomotherapy is proposed for a treatment couch that is restricted to motion along translational axes. In tomotherapy, only a narrow superior/inferior section of the target receives a dose at any instant, thus rotations in the sagittal and coronal planes may be approximately corrected for by very slow continuous couch motion in a direction perpendicular to the scanning direction. Results from proof-of-principle tests indicate that the method improves the accuracy of treatment delivery, especially for long and narrow targets. Rotational corrections about an axis perpendicular to the transverse plane continue to be implemented easily in tomotherapy by adjustment of the initial gantry angle

  14. Usefulness of Non-coplanar Helical Tomotherapy Using Variable Axis Baseplate

    International Nuclear Information System (INIS)

    Ha, Jin Sook; Chung, Yoon Sun; Lee, Ik Jae; Shin, Dong Bong; Kim, Jong Dae; Kim, Sei Joon; Jeon, Mi Jin; Chok, Yoon Jin; Kim, Ki Kwang; Lee, Seul Bee

    2011-01-01

    Helical Tomotherapy allows only coplanar beam delivery because it does not allow couch rotation. We investigated a method to introduce non-coplanar beam by tilting a patient's head for Tomotherapy. The aim of this study was to compare intrafractional movement during Tomotherapy between coplanar and non-coplanar patient's setup. Helical Tomotherapy was used for treating eight patients with intracranial tumor. The subjects were divided into three groups: one group (coplanar) of 2 patients who lay on S-plate with supine position and wore thermoplastic mask for immobilizing the head, second group (non-coplanar) of 3 patients who lay on S-plate with supine position and whose head was tilted with Variable Axis Baseplate and wore thermoplastic mask, and third group (non-coplanar plus mouthpiece) of 3 patients whose head was tilted and wore a mouthpiece immobilization device and thermoplastic mask. The patients were treated with Tomotherapy after treatment planning with Tomotherapy Planning System. Megavoltage computed tomography (MVCT) was performed before and after treatment, and the intrafractional error was measured with lateral(X), longitudinal(Y), vertical(Z) direction movements and vector (√x 2 +√y 2 +√z 2 ) value for assessing overall movement. Intrafractional error was compared among three groups by taking the error of MVCT taken after the treatment. As the correction values (X, Y, Z) between MVCT image taken after treatment and CT-simulation image are close to zero, the patient movement is small. When the mean values of movement of each direction for non-coplanar setup were compared with coplanar setup group, X-axis movement was decreased by 13%, but Y-axis and Z-axis movement were increased by 109% and 88%, respectively. Movements of Y-axis and Z-axis with non-coplanar setup were relatively greater than that of X-axis since a tilted head tended to slip down. The mean of X-axis movement of the group who used a mouthpiece was greater by 9.4% than the group

  15. Clinical Study of Nasopharyngeal Carcinoma Treated by Helical Tomotherapy in China: 5-Year Outcomes

    Directory of Open Access Journals (Sweden)

    Lei Du

    2014-01-01

    Full Text Available Background. To evaluate the outcomes of nasopharyngeal carcinoma (NPC patients treated with helical tomotherapy (HT. Methods. Between September 2007 and August 2012, 190 newly diagnosed NPC patients were treated with HT. Thirty-one patients were treated with radiation therapy as single modality, 129 with additional cisplatin-based chemotherapy with or without anti-EGFR monoclonal antibody therapy, and 30 with concurrent anti-EGFR monoclonal antibody therapy. Results. Acute radiation related side effects were mainly grade 1 or 2. Grade 3 and greater toxicities were rarely noted. The median followup was 32 (3–38 months. The local relapse-free survival (LRFS, nodal relapse-free survival (NRFS, distant metastasis-free survival (DMFS, and overall survival (OS were 96.1%, 98.2%, 92.0%, and 86.3%, respectively, at 3 years. Cox multivariate regression analysis showed that age and T stage were independent predictors for 3-year OS. Conclusions. Helical tomotherapy for NPC patients achieved excellent 3-year locoregional control, distant metastasis-free survival, and overall survival, with relatively minor acute and late toxicities. Age and T stage were the main prognosis factors.

  16. Critical structure sparing in stereotactic ablative radiotherapy for central lung lesions: helical tomotherapy vs. volumetric modulated arc therapy.

    Directory of Open Access Journals (Sweden)

    Alexander Chi

    Full Text Available 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.

  17. Independent calculation of dose distributions for helical tomotherapy using a conventional treatment planning system

    Energy Technology Data Exchange (ETDEWEB)

    Klüter, Sebastian, E-mail: sebastian.klueter@med.uni-heidelberg.de; Schubert, Kai; Lissner, Steffen; Sterzing, Florian; Oetzel, Dieter; Debus, Jürgen [Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany, and Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany, and German Consortium for Translational Cancer Research (DKTK), Im Neuenheimer Feld 400, 69120 Heidelberg (Germany); Schlegel, Wolfgang [German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Oelfke, Uwe [German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany and Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG (United Kingdom); Nill, Simeon [Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London SM2 5NG (United Kingdom)

    2014-08-15

    Purpose: The dosimetric verification of treatment plans in helical tomotherapy usually is carried out via verification measurements. In this study, a method for independent dose calculation of tomotherapy treatment plans is presented, that uses a conventional treatment planning system with a pencil kernel dose calculation algorithm for generation of verification dose distributions based on patient CT data. Methods: A pencil beam algorithm that directly uses measured beam data was configured for dose calculation for a tomotherapy machine. Tomotherapy treatment plans were converted into a format readable by an in-house treatment planning system by assigning each projection to one static treatment field and shifting the calculation isocenter for each field in order to account for the couch movement. The modulation of the fluence for each projection is read out of the delivery sinogram, and with the kernel-based dose calculation, this information can directly be used for dose calculation without the need for decomposition of the sinogram. The sinogram values are only corrected for leaf output and leaf latency. Using the converted treatment plans, dose was recalculated with the independent treatment planning system. Multiple treatment plans ranging from simple static fields to real patient treatment plans were calculated using the new approach and either compared to actual measurements or the 3D dose distribution calculated by the tomotherapy treatment planning system. In addition, dose–volume histograms were calculated for the patient plans. Results: Except for minor deviations at the maximum field size, the pencil beam dose calculation for static beams agreed with measurements in a water tank within 2%/2 mm. A mean deviation to point dose measurements in the cheese phantom of 0.89% ± 0.81% was found for unmodulated helical plans. A mean voxel-based deviation of −0.67% ± 1.11% for all voxels in the respective high dose region (dose values >80%), and a mean local

  18. Independent calculation of dose distributions for helical tomotherapy using a conventional treatment planning system

    International Nuclear Information System (INIS)

    Klüter, Sebastian; Schubert, Kai; Lissner, Steffen; Sterzing, Florian; Oetzel, Dieter; Debus, Jürgen; Schlegel, Wolfgang; Oelfke, Uwe; Nill, Simeon

    2014-01-01

    Purpose: The dosimetric verification of treatment plans in helical tomotherapy usually is carried out via verification measurements. In this study, a method for independent dose calculation of tomotherapy treatment plans is presented, that uses a conventional treatment planning system with a pencil kernel dose calculation algorithm for generation of verification dose distributions based on patient CT data. Methods: A pencil beam algorithm that directly uses measured beam data was configured for dose calculation for a tomotherapy machine. Tomotherapy treatment plans were converted into a format readable by an in-house treatment planning system by assigning each projection to one static treatment field and shifting the calculation isocenter for each field in order to account for the couch movement. The modulation of the fluence for each projection is read out of the delivery sinogram, and with the kernel-based dose calculation, this information can directly be used for dose calculation without the need for decomposition of the sinogram. The sinogram values are only corrected for leaf output and leaf latency. Using the converted treatment plans, dose was recalculated with the independent treatment planning system. Multiple treatment plans ranging from simple static fields to real patient treatment plans were calculated using the new approach and either compared to actual measurements or the 3D dose distribution calculated by the tomotherapy treatment planning system. In addition, dose–volume histograms were calculated for the patient plans. Results: Except for minor deviations at the maximum field size, the pencil beam dose calculation for static beams agreed with measurements in a water tank within 2%/2 mm. A mean deviation to point dose measurements in the cheese phantom of 0.89% ± 0.81% was found for unmodulated helical plans. A mean voxel-based deviation of −0.67% ± 1.11% for all voxels in the respective high dose region (dose values >80%), and a mean local

  19. Investigation of Accelerated Partial Breast Patient Alignment and Treatment With Helical Tomotherapy Unit

    International Nuclear Information System (INIS)

    Langen, Katja M.; Buchholz, Daniel J.; Burch, Doug R. C.; Burkavage, Rob C.; Limaye, Arti U.; Meeks, Sanford L.; Kupelian, Patrick A.; Ruchala, Kenneth J.; Haimerl, Jason; Henderson, Doug; Olivera, Gustavo H.

    2008-01-01

    Purpose: To determine the precision of megavoltage computed tomography (MVCT)-based alignment of the seroma cavity for patients undergoing partial breast irradiation; and to determine whether accelerated partial breast irradiation (APBI) plans can be generated for TomoTherapy deliveries that meet the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-39/Radiation Therapy Oncology Group (RTOG) 0413 protocol guidelines for target coverage and normal tissue dose limitations. Methods and Materials: We obtained 50 MVCT images from 10 patients. An interuser study was designed to assess the alignment precision. Using a standard helical and a fixed beam prototype ('topotherapy') optimizer, two APBI plans for each patient were developed. Results: The precision of the MVCT-based seroma cavity alignment was better than 2 mm if averaged over the patient population. Both treatment techniques could be used to generate acceptable APBI plans for patients that fulfilled the recommended NSABP B-39/RTOG-0413 selection criteria. For plans of comparable treatment time, the conformation of the prescription dose to the target was greater for helical deliveries, while the ipsilateral lung dose was significantly reduced for the topotherapy plans. Conclusions: The inherent volumetric imaging capabilities of a TomoTherapy Hi-Art unit allow for alignment of patients undergoing partial breast irradiation that is determined from the visibility of the seroma cavity on the MVCT image. The precision of the MVCT-based alignment was better than 2 mm (± standard deviation) when averaged over the patient population. Using the NSABP B-39/RTOG-0413 guidelines, acceptable APBI treatment plans can be generated using helical- or topotherapy-based delivery techniques

  20. Helical tomotherapy for extramedullary hematopoiesis involving the pericardium in a patient with chronic myeloid leukemia.

    Science.gov (United States)

    Toms, Daniel R; Cannick, Leander; Stuart, Robert K; Jenrette, Joseph M; Terwiliger, Lacy

    2010-07-01

    Extramedullary hematopoiesis (EMH) refers to the development of foci of hematopoiesis outside its normal location in the bone marrow. This occurs normally during fetal development but is abnormal postpartum. The most common sites of EMH are the spleen and liver. The phenomenon occurs in a number of disease states, notably in myelofibrosis, thalassemia, immune thrombocytopenic purpura, sickle cell anemia, polycythemia vera, and myelodysplastic syndrome. Affected patients often develop symptoms related to the location of the EMH. Reported treatments include red blood cell transfusions, surgical excision, decompressive laminectomy in cases of cord compression, chemotherapy, and irradiation. Radiation therapy is highly effective for treating hematopoietic tissue because such tissues are extremely radiosensitive. Megavoltage helical tomotherapy is a technical advance in the delivery of radiation therapy, allowing more conformal and precise treatments. The present case report describes a patient with the diagnosis of atypical chronic myeloid leukemia and myelofibrosis who subsequently developed EMH of the pericardium with effusion and tamponade. By utilizing tomotherapy we were able to treat the pericardium while sparing much of the myocardium. The patient tolerated treatment well without acute adverse effects. His symptoms were alleviated, but he died approximately 1 year later.

  1. The use of a commercial QA device for daily output check of a helical tomotherapy unit

    International Nuclear Information System (INIS)

    Alaei, Parham; Hui, Susanta K.; Higgins, Patrick D.; Gerbi, Bruce J.

    2006-01-01

    Helical tomotherapy radiation therapy units, due to their particular design and differences from a traditional linear accelerator, require different procedures by which to perform routine quality assurance (QA). One of the principal QA tasks that should be performed daily on any radiation therapy equipment is the output constancy check. The daily output check on a Hi-Art TomoTherapy unit is commonly performed utilizing ionization chambers placed inside a solid water phantom. This provides a good check of output at one point, but does not give any information on either energy or symmetry of the beam, unless more than one point is measured. This also has the added disadvantage that it has to be done by the physics staff. To address these issues, and to simplify the process, such that it can be performed by radiation therapists, we investigated the use of a commercially available daily QA device to perform this task. The use of this device simplifies the task of daily output constancy checks and eliminates the need for continued physics involvement. This device can also be used to monitor the constancy of beam energy and cone profile and can potentially be used to detect gross errors in the couch movement or laser alignment

  2. A virtual source model for Monte Carlo simulation of helical tomotherapy.

    Science.gov (United States)

    Yuan, Jiankui; Rong, Yi; Chen, Quan

    2015-01-08

    The purpose of this study was to present a Monte Carlo (MC) simulation method based on a virtual source, jaw, and MLC model to calculate dose in patient for helical tomotherapy without the need of calculating phase-space files (PSFs). Current studies on the tomotherapy MC simulation adopt a full MC model, which includes extensive modeling of radiation source, primary and secondary jaws, and multileaf collimator (MLC). In the full MC model, PSFs need to be created at different scoring planes to facilitate the patient dose calculations. In the present work, the virtual source model (VSM) we established was based on the gold standard beam data of a tomotherapy unit, which can be exported from the treatment planning station (TPS). The TPS-generated sinograms were extracted from the archived patient XML (eXtensible Markup Language) files. The fluence map for the MC sampling was created by incorporating the percentage leaf open time (LOT) with leaf filter, jaw penumbra, and leaf latency contained from sinogram files. The VSM was validated for various geometry setups and clinical situations involving heterogeneous media and delivery quality assurance (DQA) cases. An agreement of < 1% was obtained between the measured and simulated results for percent depth doses (PDDs) and open beam profiles for all three jaw settings in the VSM commissioning. The accuracy of the VSM leaf filter model was verified in comparing the measured and simulated results for a Picket Fence pattern. An agreement of < 2% was achieved between the presented VSM and a published full MC model for heterogeneous phantoms. For complex clinical head and neck (HN) cases, the VSM-based MC simulation of DQA plans agreed with the film measurement with 98% of planar dose pixels passing on the 2%/2 mm gamma criteria. For patient treatment plans, results showed comparable dose-volume histograms (DVHs) for planning target volumes (PTVs) and organs at risk (OARs). Deviations observed in this study were consistent

  3. Clinical benefits of new immobilization system for hypofractionated radiotherapy of intrahepatic hepatocellular carcinoma by helical tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Yong; Zhou, Yong-Kang; Chen, Yi-Xing; Shi, Shi-Ming; Zeng, Zhao-Chong, E-mail: zeng.zhaochong@zs-hospital.sh.cn

    2017-04-01

    Objective: A comprehensive clinical evaluation was conducted, assessing the Body Pro-Lok immobilization and positioning system to facilitate hypofractionated radiotherapy of intrahepatic hepatocellular carcinoma (HCC), using helical tomotherapy to improve treatment precision. Methods: Clinical applications of the Body Pro-Lok system were investigated (as above) in terms of interfractional and intrafractional setup errors and compressive abdominal breath control. To assess interfractional setup errors, a total of 42 patients who were given 5 to 20 fractions of helical tomotherapy for intrahepatic HCC were analyzed. Overall, 15 patients were immobilized using simple vacuum cushion (group A), and the Body Pro-Lok system was used in 27 patients (group B), performing megavoltage computed tomography (MVCT) scans 196 times and 435 times, respectively. Pretreatment MVCT scans were registered to the planning kilovoltage computed tomography (KVCT) for error determination, and group comparisons were made. To establish intrafractional setup errors, 17 patients with intrahepatic HCC were selected at random for immobilization by Body Pro-Lok system, undergoing MVCT scans after helical tomotherapy every week. A total of 46 MVCT re-scans were analyzed for this purpose. In researching breath control, 12 patients, randomly selected, were immobilized by Body Pro-Lok system and subjected to 2-phase 4-dimensional CT (4DCT) scans, with compressive abdominal control or in freely breathing states, respectively. Respiratory-induced liver motion was then compared. Results: Mean interfractional setup errors were as follows: (1) group A: X, 2.97 ± 2.47 mm; Y, 4.85 ± 4.04 mm; and Z, 3.77 ± 3.21 mm; pitch, 0.66 ± 0.62°; roll, 1.09 ± 1.06°; and yaw, 0.85 ± 0.82°; and (2) group B: X, 2.23 ± 1.79 mm; Y, 4.10 ± 3.36 mm; and Z, 1.67 ± 1.91 mm; pitch, 0.45 ± 0.38°; roll, 0.77 ± 0.63°; and yaw, 0.52 ± 0.49°. Between-group differences were statistically significant in 6 directions (p

  4. Conventional patient specific IMRT QA and 3DVH verification of dose distribution for helical tomotherapy

    International Nuclear Information System (INIS)

    Sharma, Prabhat Krishna; Joshi, Kishore; Epili, D.; Gavake, Umesh; Paul, Siji; Reena, Ph.; Jamema, S.V.

    2016-01-01

    In recent years, patient-specific IMRT QA has transitioned from point dose measurements by ion chambers to films to 2D array measurements. 3DVH software has taken this transition a step further by estimating the 3D dose delivered to the patient volume from 2D diode measurements using a planned dose perturbation (PDP) algorithm. This algorithm was developed to determine, if the conventional IMRT QA though sensitive at detecting errors, has any predictive power in detecting dose errors of clinical significance related to dose to the target volume and organs at risk (OAR). The aim of this study is to compare the conventional IMRT patient specific QA and 3DVH dose distribution for patients treated with helical tomotherapy (HT)

  5. Clinical benefits of new immobilization system for hypofractionated radiotherapy of intrahepatic hepatocellular carcinoma by helical tomotherapy

    International Nuclear Information System (INIS)

    Hu, Yong; Zhou, Yong-Kang; Chen, Yi-Xing; Shi, Shi-Ming; Zeng, Zhao-Chong

    2017-01-01

    Objective: A comprehensive clinical evaluation was conducted, assessing the Body Pro-Lok immobilization and positioning system to facilitate hypofractionated radiotherapy of intrahepatic hepatocellular carcinoma (HCC), using helical tomotherapy to improve treatment precision. Methods: Clinical applications of the Body Pro-Lok system were investigated (as above) in terms of interfractional and intrafractional setup errors and compressive abdominal breath control. To assess interfractional setup errors, a total of 42 patients who were given 5 to 20 fractions of helical tomotherapy for intrahepatic HCC were analyzed. Overall, 15 patients were immobilized using simple vacuum cushion (group A), and the Body Pro-Lok system was used in 27 patients (group B), performing megavoltage computed tomography (MVCT) scans 196 times and 435 times, respectively. Pretreatment MVCT scans were registered to the planning kilovoltage computed tomography (KVCT) for error determination, and group comparisons were made. To establish intrafractional setup errors, 17 patients with intrahepatic HCC were selected at random for immobilization by Body Pro-Lok system, undergoing MVCT scans after helical tomotherapy every week. A total of 46 MVCT re-scans were analyzed for this purpose. In researching breath control, 12 patients, randomly selected, were immobilized by Body Pro-Lok system and subjected to 2-phase 4-dimensional CT (4DCT) scans, with compressive abdominal control or in freely breathing states, respectively. Respiratory-induced liver motion was then compared. Results: Mean interfractional setup errors were as follows: (1) group A: X, 2.97 ± 2.47 mm; Y, 4.85 ± 4.04 mm; and Z, 3.77 ± 3.21 mm; pitch, 0.66 ± 0.62°; roll, 1.09 ± 1.06°; and yaw, 0.85 ± 0.82°; and (2) group B: X, 2.23 ± 1.79 mm; Y, 4.10 ± 3.36 mm; and Z, 1.67 ± 1.91 mm; pitch, 0.45 ± 0.38°; roll, 0.77 ± 0.63°; and yaw, 0.52 ± 0.49°. Between-group differences were statistically significant in 6 directions (p

  6. Clinic results of 121 nasopharyngeal carcinoma patients treated by helical tomotherapy

    International Nuclear Information System (INIS)

    Du Lei; Ma Lin; Feng Linchun; Zhou Guixia; Qu Baolin; Ren Gang; Xu Shouping; Xie Chuanbin; Zhang Xinxin; Li Fang

    2012-01-01

    Objective: To summarize the outcome of nasopharyngeal carcinoma (NPC) treated by helical tomotherapy in the Chinese PLA general hospital. Methods: Between September 2007 and August 2010, 121 newly diagnosed NPC patients were treated by radiotherapy with Tomotherapy system, with (n =90) or without (n = 31) concurrent chemotherapy or molecular target therapy. The prescription dose was 70 - 74 Gy/33f to primary tumor and positive lymph node planning target volume, 60.0 - 62.7 Gy/33f to high risk planning target volume, and 52 -56 Gy/33f to low risk planning target volume. Acute side-effects were evaluated with RTOG/EORTC criteria. Results: The remission rate of primary lesion and positive lymph nodes was 95.0% and 99.0%, respectively. The follow-up rate was 100%. The number of patients with 1, 2 and 3 years followed-up were 99, 49, and 7. The 1-, 2-and 3-year local relapse-free survival rates were 97.30%, 97.3% and 97.3%, respectively. The 1-, 2-and 3-year nodal relapse-free survival rates were 100%, 100% and 100%, respectively. The 1-, 2-and 3-year distant metastasis-free survival rates were 98.4%, 96.3% and 96.3%, respectively. The 1-, 2-and 3-year overall survival rates were 96.5%, 92.6% and 86.8%, respectively. Acute toxicities of skin, oral mucosa and xerostomia with grade 0, 1, 2 and 3 were 5.0%, 74.4%, 15.7% and 4.9%; 0.8%, 37.2%, 57.9% and 4.1%; 3.3%, 53.7%, 43.0% and 0%, respectively. Xerostomia restored with time, no grade 2 or more xerostomia was observed 1 year after radiation therapy. Concurrent chemotherapy significantly increased incidence of mucositis, esophagitis and tracheitis. Conclusion: Helical tomotherapy is efficient, secure and effective modality for the treatment of nasopharyngeal carcinoma. (authors)

  7. Helical Tomotherapy Planning for Left-Sided Breast Cancer Patients With Positive Lymph Nodes: Comparison to Conventional Multiport Breast Technique

    International Nuclear Information System (INIS)

    Goddu, S. Murty; Chaudhari, Summer; Mamalui-Hunter, Maria; Pechenaya, Olga L.; Pratt, David; Mutic, Sasa; Zoberi, Imran; Jeswani, Sam; Powell, Simon N.; Low, Daniel A.

    2009-01-01

    Purpose: To evaluate the feasibility of using helical tomotherapy for locally advanced left-sided breast cancer. Methods and Materials: Treatment plans were generated for 10 left-sided breast cancer patients with positive lymph nodes comparing a multiport breast (three-dimensional) technique with the tomotherapy treatment planning system. The planning target volumes, including the chest wall/breast, supraclavicular, axillary, and internal mammary lymph nodes, were contoured. The treatment plans were generated on the tomotherapy treatment planning system to deliver 50.4 Gy to the planning target volume. To spare the contralateral tissues, directional blocking was applied to the right breast and right lung. The optimization goals were to protect the lungs, heart, and right breast. Results: The tomotherapy plans increased the minimal dose to the planning target volume (minimal dose received by 99% of target volume = 46.2 ± 1.3 Gy vs. 27.9 ± 17.1 Gy) while improving the dose homogeneity (dose difference between the minimal dose received by 5% and 95% of the planning target volume = 7.5 ± 1.8 Gy vs. 37.5 ± 26.9 Gy). The mean percentage of the left lung volume receiving ≥20 Gy in the tomotherapy plans decreased from 32.6% ± 4.1% to 17.6% ± 3.5%, while restricting the right-lung mean dose to <5 Gy. However, the mean percentage of volume receiving ≥5 Gy for the total lung increased from 25.2% ± 4.2% for the three-dimensional technique to 46.9% ± 8.4% for the tomotherapy plan. The mean volume receiving ≥35 Gy for the heart decreased from 5.6% ± 4.8% to 2.2% ± 1.5% in the tomotherapy plans. However, the mean heart dose for tomotherapy delivery increased from 7.5 ± 3.4 Gy to 12.2 ± 1.8 Gy. Conclusion: The tomotherapy plans provided better dose conformity and homogeneity than did the three-dimensional plans for treatment of left-sided breast tumors with regional lymph node involvement, while allowing greater sparing of the heart and left lung from doses

  8. Prostate cancer treated with image-guided helical TomoTherapy {sup registered} and image-guided LINAC-IMRT. Correlation between high-dose bladder volume, margin reduction, and genitourinary toxicity

    Energy Technology Data Exchange (ETDEWEB)

    Drozdz, Sonia; Wendt, Thomas G. [University Hospital Jena, Friedrich-Schiller-University Jena, Department of Radiation Oncology, Jena (Germany); Schwedas, Michael; Salz, Henning [University Hospital Jena, Friedrich-Schiller-University Jena, Department of Radiation Oncology, Section of Medical Physics, Jena (Germany); Foller, Susan [University Hospital Jena, Friedrich-Schiller-University Jena, Department of Urology, Jena (Germany)

    2016-04-15

    We compared different image-guidance (IG) strategies for prostate cancer with high-precision IG intensity-modulated radiation therapy (IMRT) using TomoTherapy {sup registered} (Accuray Inc., Madison, WI, USA) and linear accelerator (LINAC)-IMRT and their impact on planning target volume (PTV) margin reduction. Follow-up data showed reduced bladder toxicity in TomoTherapy patients compared to LINAC-IMRT. The purpose of this study was to quantify whether the treatment delivery technique and decreased margins affect reductions in bladder toxicity. Setup corrections from 30 patients treated with helical TomoTherapy and 30 treated with a LINAC were analyzed. These data were used to simulate three IG protocols based on setup error correction and a limited number of imaging sessions. For all patients, gastrointestinal (GI) and genitourinary (GU) toxicity was documented and correlated with the treatment delivery technique. For fiducial marker (FM)-based RT, a margin reduction of up to 3.1, 3.0, and 4.8 mm in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions, respectively, could be achieved with calculation of a setup correction from the first three fractions and IG every second day. Although the bladder volume was treated with mean doses of 35 Gy in the TomoTherapy group vs. 22 Gy in the LINAC group, we observed less GU toxicity after TomoTherapy. Intraprostate FMs allow for small safety margins, help decrease imaging frequency after setup correction, and minimize the dose to bladder and rectum, resulting in lower GU toxicity. In addition, IMRT delivered with TomoTherapy helps to avoid hotspots in the bladder neck, a critical anatomic structure associated with post-RT urinary toxicity. (orig.) [German] Wir haben im Rahmen der Prostatakarzinombehandlung verschiedene bildgefuehrte (IG) Strategien der hochpraezisen intensitaetsmodulierten Radiotherapie (IMRT) unter Einsatz der Tomotherapie (TomoTherapy {sup registered}, Accuray Inc., Madison

  9. Dosimetric effects of rotational output variation and x-ray target degradation on helical tomotherapy plans

    International Nuclear Information System (INIS)

    Staton, Robert J.; Langen, Katja M.; Kupelian, Patrick A.; Meeks, Sanford L.

    2009-01-01

    In this study, two potential sources of IMRT delivery error have been identified for helical tomotherapy delivery using the HiART system (TomoTherapy, Inc., Madison, WI): Rotational output variation and target degradation. The HiArt system is known to have output variation, typically about ±2%, due to the absence of a dose servo system. On the HiArt system, x-ray target replacement is required approximately every 10-12 months due to target degradation. Near the end of target life, the target thins and causes a decrease in the beam energy and a softening of the beam profile at the lateral edges of the beam. The purpose of this study is to evaluate the dosimetric effects of rotational output variation and target degradation by modeling their effects and incorporating them into recalculated treatment plans for three clinical scenarios: Head and neck, partial breast, and prostate. Models were created to emulate both potential sources of error. For output variation, a model was created using a sine function to match the amplitude (±2%), frequency, and phase of the measured rotational output variation data. A second model with a hypothetical variation of ±7% was also created to represent the largest variation that could exist without violating the allowable dose window in the delivery system. A measured beam profile near the end of target life was used to create a modified beam profile model for the target degradation. These models were then incorporated into the treatment plan by modifying the leaf opening times in the delivery sinogram. A new beam model was also created to mimic the change in beam energy seen near the end of target life. The plans were then calculated using a research version of the PLANNED ADAPTIVE treatment planning software from TomoTherapy, Inc. Three plans were evaluated in this study: Head and neck, partial breast, and prostate. The D 50 of organs at risk, the D 95 for planning target volumes (PTVs), and the local dose difference were used to

  10. Daily measure of the constancy of rotation in the evaluation of geometric and dosimetric parameters of the tomotherapy

    International Nuclear Information System (INIS)

    Erzilbengoa, M.; Moral, S.; Bragado, L.; Guisasola, M. A.

    2011-01-01

    The daily test performance called ''Rotating Constancia'', based on the methodology developed by Balog ''Helical tomotherapy dynamic quality assurance'' (2006), has allowed us over these 2 years to assess the response to TomoTherapy machine parameters given dose, travel speed table offset of the same, position of the green lasers, field size, rotation time and energy index of the beam parameters can be measured without intensity modulation.

  11. Dosimetric Comparison of Three Dimensional Conformal Radiation Radiotherapy and Helical Tomotherapy Partial Breast Cancer

    International Nuclear Information System (INIS)

    Kim, Dae Woong; Kim, Jong Won; Choi, Yun Kyeong; Kim, Jung Soo; Hwang, Jae Woong; Jeong, Kyeong Sik; Choi, Gye Suk

    2008-01-01

    The goal of radiation treatment is to deliver a prescribed radiation dose to the target volume accurately while minimizing dose to normal tissues. In this paper, we comparing the dose distribution between three dimensional conformal radiation radiotherapy (3D-CRT) and helical tomotherapy (TOMO) plan for partial breast cancer. Twenty patients were included in the study, and plans for two techniques were developed for each patient (left breast:10 patients, right breast:10 patients). For each patient 3D-CRT planning was using pinnacle planning system, inverse plan was made using Tomotherapy Hi-Art system and using the same targets and optimization goals. We comparing the Homogeneity index (HI), Conformity index (CI) and sparing of the organs at risk for dose-volume histogram. Whereas the HI, CI of TOMO was significantly better than the other, 3D-CRT was observed to have significantly poorer HI, CI. The percentage ipsilateral non-PTV breast volume that was delivered 50% of the prescribed dose was 3D-CRT (mean: 40.4%), TOMO (mean: 18.3%). The average ipsilateral lung volume percentage receiving 20% of the PD was 3D-CRT (mean: 4.8%), TOMO (mean: 14.2), concerning the average heart volume receiving 20% and 10% of the PD during treatment of left breast cancer 3D-CRT (mean: 1.6%, 3.0%), TOMO (mean: 9.7%, 26.3%) In summary, 3D-CRT and TOMO techniques were found to have acceptable PTV coverage in our study. However, in TOMO, high conformity to the PTV and effective breast tissue sparing was achieved at the expense of considerable dose exposure to the lung and heart.

  12. Dose-volume histogram comparison between static 5-field IMRT with 18-MV X-rays and helical tomotherapy with 6-MV X-rays.

    Science.gov (United States)

    Hayashi, Akihiro; Shibamoto, Yuta; Hattori, Yukiko; Tamura, Takeshi; Iwabuchi, Michio; Otsuka, Shinya; Sugie, Chikao; Yanagi, Takeshi

    2015-03-01

    We treated prostate cancer patients with static 5-field intensity-modulated radiation therapy (IMRT) using linac 18-MV X-rays or tomotherapy with 6-MV X-rays. As X-ray energies differ, we hypothesized that 18-MV photon IMRT may be better for large patients and tomotherapy may be more suitable for small patients. Thus, we compared dose-volume parameters for the planning target volume (PTV) and organs at risk (OARs) in 59 patients with T1-3 N0M0 prostate cancer who had been treated using 5-field IMRT. For these same patients, tomotherapy plans were also prepared for comparison. In addition, plans of 18 patients who were actually treated with tomotherapy were analyzed. The evaluated parameters were homogeneity indicies and a conformity index for the PTVs, and D2 (dose received by 2% of the PTV in Gy), D98, Dmean and V10-70 Gy (%) for OARs. To evaluate differences by body size, patients with a known body mass index were grouped by that index ( 25 kg/m(2)). For the PTV, all parameters were higher in the tomotherapy plans compared with the 5-field IMRT plans. For the rectum, V10 Gy and V60 Gy were higher, whereas V20 Gy and V30 Gy were lower in the tomotherapy plans. For the bladder, all parameters were higher in the tomotherapy plans. However, both plans were considered clinically acceptable. Similar trends were observed in 18 patients treated with tomotherapy. Obvious trends were not observed for body size. Tomotherapy provides equivalent dose distributions for PTVs and OARs compared with 18-MV 5-field IMRT. Tomotherapy could be used as a substitute for high-energy photon IMRT for prostate cancer regardless of body size. © The Author 2015. Published by Oxford University Press on behalf of The Japan Radiation Research Society and Japanese Society for Radiation Oncology.

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

    Science.gov (United States)

    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

  14. An assessment of the use of skin flashes in helical tomotherapy using phantom and in-vivo dosimetry

    International Nuclear Information System (INIS)

    Tournel, Koen; Verellen, Dirk; Duchateau, Michael; Fierens, Yves; Linthout, Nadine; Reynders, Truus; Voordeckers, Mia; Storme, Guy

    2007-01-01

    Background and purpose: In helical tomotherapy the nature of the optimizing and planning systems allows the delivery of dose on the skin using a build-up compensating technique (skin flash). However, positioning errors or changes in the patient's contour can influence the correct dosage in these regions. This work studies the behavior of skin-flash regions using phantom and in-vivo dosimetry. Materials and methods: The dosimetric accuracy of the tomotherapy planning system in skin-flash regions is checked using film and TLD on phantom. Positioning errors are induced and the effect on the skin dose is investigated. Further a volume decrease is simulated using bolus material and the results are compared. Results: Results show that the tomotherapy planning system calculates dose on skin regions within 2 SD using TLD measurements. Film measurements show drops of dose of 2.8% and 26% for, respectively, a 5 mm and 10 mm mispositioning of the phantom towards air and a dose increase of 9% for a 5 mm shift towards tissue. These measurements are confirmed by TLD measurements. A simulated volume reduction shows a similar behavior with a 2.6% and 19.4% drop in dose, measured with TLDs. Conclusion: The tomotherapy system allows adequate planning and delivery of dose using skin flashes. However, exact positioning is crucial to deliver the dose at the exact location

  15. Conformal radiotherapy by intensity modulation of pediatrics tumors

    International Nuclear Information System (INIS)

    Leseur, J.; Le Prise, E.; Carrie, C.; Bernier, V.; Beneyton, V.; Mahe, M.A.; Supiot, S.

    2009-01-01

    The objective of this study is to take stock on the validated and potential indications of the conformal radiotherapy with intensity modulation ( intensity modulated radiotherapy I.M.R.T.) in pediatrics and to propose recommendations for its use as well as the adapted dose constraints. About 40 to 50% of children treated for a cancer are irradiated. The I.M.R.T., by linear accelerator or helical tomo-therapy has for aim to give a homogenous dose to the target volume and to save organs at risk. Its use in pediatrics seems particularly interesting because of the complexity of target volumes and the closeness of organs at risk. In compensation for these positive elements, the importance of low doses irradiation given in big volumes makes fear event consequences on growth and an increased incidence of secondary cancers in children suffering from tumors with high cure rates and long life expectancy. (N.C.)

  16. Image Guided Hypofractionated Radiotherapy by Helical Tomotherapy for Prostate Carcinoma: Toxicity and Impact on Nadir PSA

    Directory of Open Access Journals (Sweden)

    Salvina Barra

    2014-01-01

    Full Text Available Aim. To evaluate the toxicity of a hypofractionated schedule for primary radiotherapy (RT of prostate cancer as well as the value of the nadir PSA (nPSA and time to nadir PSA (tnPSA as surrogate efficacy of treatment. Material and Methods. Eighty patients underwent hypofractionated schedule by Helical Tomotherapy (HT. A dose of 70.2 Gy was administered in 27 daily fractions of 2.6 Gy. Acute and late toxicities were graded on the RTOG/EORTC scales. The nPSA and the tnPSA for patients treated with exclusive RT were compared to an equal cohort of 20 patients treated with conventional fractionation and standard conformal radiotherapy. Results. Most of patients (83% did not develop acute gastrointestinal (GI toxicity and 50% did not present genitourinary (GU toxicity. After a median follow-up of 36 months only grade 1 of GU and GI was reported in 6 and 3 patients as late toxicity. Average tnPSA was 30 months. The median value of nPSA after exclusive RT with HT was 0.28 ng/mL and was significantly lower than the median nPSA (0.67 ng/mL of the conventionally treated cohort (P=0.02. Conclusions. Hypofractionated RT schedule with HT for prostate cancer treatment reports very low toxicity and reaches a low level of nPSA that might correlate with good outcomes.

  17. Tumor cell survival dependence on helical tomotherapy, continuous arc and segmented dose delivery

    International Nuclear Information System (INIS)

    Yang Wensha; Wang Li; Larner, James; Read, Paul; Benedict, Stan; Sheng Ke

    2009-01-01

    The temporal pattern of radiation delivery has been shown to influence the tumor cell survival fractions for the same radiation dose. To study the effect more specifically for state of the art rotational radiation delivery modalities, 2 Gy of radiation dose was delivered to H460 lung carcinoma, PC3 prostate cancer cells and MCF-7 breast tumor cells by helical tomotherapy (HT), seven-field LINAC (7F), and continuous dose delivery (CDD) over 2 min that simulates volumetric rotational arc therapy. Cell survival was measured by the clonogenic assay. The number of viable H460 cell colonies was 23.2 ± 14.4% and 27.7 ± 15.6% lower when irradiated by CDD compared with HT and 7F, respectively, and the corresponding values were 36.8 ± 18.9% and 35.3 ± 18.9% lower for MCF7 cells (p < 0.01). The survival of PC3 was also lower when irradiated by CDD than by HT or 7F but the difference was not as significant (p = 0.06 and 0.04, respectively). The higher survival fraction from HT delivery was unexpected because 90% of the 2 Gy was delivered in less than 1 min at a significantly higher dose rate than the other two delivery techniques. The results suggest that continuous dose delivery at a constant dose rate results in superior in vitro tumor cell killing compared with prolonged, segmented or variable dose rate delivery.

  18. Encouraging Early Clinical Outcomes With Helical Tomotherapy–Based Image-Guided Intensity-Modulated Radiation Therapy for Residual, Recurrent, and/or Progressive Benign/Low-Grade Intracranial Tumors: A Comprehensive Evaluation

    International Nuclear Information System (INIS)

    Gupta, Tejpal; Wadasadawala, Tabassum; Master, Zubin; Phurailatpam, Reena; Pai-Shetty, Rajershi; Jalali, Rakesh

    2012-01-01

    Purpose: To report early clinical outcomes of helical tomotherapy (HT)-based image-guided intensity-modulated radiation therapy (IMRT) in brain tumors of varying shape, size, and location. Materials and Methods: Patients with residual, recurrent, and/or progressive low-grade intracranial and skull-base tumors were treated on a prospective protocol of HT-based IMRT and followed clinicoradiologically. Standardized metrics were used for plan evaluation and outcome analysis. Results: Twenty-seven patients with 30 lesions were treated to a median radiotherapy dose of 54 Gy in 30 fractions. All HT plans resulted in excellent target volume coverage with steep dose-gradients. The mean (standard deviation) dose homogeneity index and conformity index was 0.07 (0.05) and 0.71 (0.08) respectively. At first response assessment, 20 of 30 lesions were stable, whereas 9 showed partial regression. One patient with a recurrent clival chordoma though neurologically stable showed imaging-defined progression, whereas another patient with stable disease on serial imaging had sustained neurologic worsening. With a median follow-up of 19 months (interquartile range, 11–26 months), the 2-year clinicoradiological progression-free survival and overall survival was 93.3% and 100% respectively. Conclusions: Careful selection of radiotherapy technique is warranted for benign/low-grade brain tumors to achieve durable local control with minimum long-term morbidity. Large or complex-shaped tumors benefit most from IMRT. Our early clinical experience of HT-based IMRT for brain tumors has been encouraging.

  19. Clinical observation in nasopharyngeal carcinoma (NPC) treated with the anti-EGFR monoclonal antibody followed by helical tomotherapy

    International Nuclear Information System (INIS)

    Hou Jun; Feng Linchun; Cai Boning; Lu Na; Du Lei; Ma Lin; Xu Shouping; Xie Chuanbin

    2011-01-01

    Objective: To evaluate the clinical outcome and the acute toxicity in nasopharyngeal carcinoma (NPC) treated with tomotherapy followed by the anti-EGFR monoclonal antibody. Methods: Between March 2008 and November 2009, 34 newly diagnosed NPC patients were treated with helical tomotherapy combined with nimotuzumab or cetuximab. All the patients underwent tomotherapy at the dose of 70 Gy/33F for the gross tumor volume (pGTV ns ) and positive lymphnodes (GTV nd ), and 60 Gy/33F for the high risk clinical target volume (PTV 1 ), and 56 Gy/33 F for the low risk clinical target volume (PTV 2 ), respectively. 17 patients in group N were given weekly injection of 200 mg for 6-7 times and 17 patients in group C were given initial dosage 400 mg/m 2 followed by subsequent weekly dosage of 250 mg/m 2 for 6-7 times. Acute lesions were evaluated with the RTOG/EORTC criteria. Result: The median follow-up time was 22 months. The effective rates (CR + PR) in 3, 6 and 12 months were 14/17, 12/17, 12/17 in group N and 15/17, 14/17, 14/17 in group C. The 1 year survival rate was 15/17 in group Nand 17/17 in group C. Nimotuzumab had less acute mucositis reaction (u=2.25, P< 0.05), weight loss (t=2.56, P=0.02) and rash (u=4.36, P<0.01) compared with cetuximab. Conclusions: Helical tomotherapy combined with nimotuzumab or cetuximab was effective and made no difference in the short-term efficacy and 1 year survival rate for the patients with NPC. Nimotuzumab has less acute reaction than cetuximab. More studies should be done to prove long-term effects. (authors)

  20. Feasibility study of multi-pass respiratory-gated helical tomotherapy of a moving target via binary MLC closure

    Science.gov (United States)

    Kim, Bryan; Chen, Jeff; Kron, Tomas; Battista, Jerry

    2010-11-01

    Gated radiotherapy of lung lesions is particularly complex for helical tomotherapy, due to the simultaneous motions of its three subsystems (gantry, couch and collimator). We propose a new way to implement gating for helical tomotherapy, namely multi-pass respiratory gating. In this method, gating is achieved by delivering only the beam projections that occur within a respiratory gating window, while blocking the rest of the beam projections by fully closing all collimator leaves. Due to the continuous couch motion, the planned beam projections must be delivered over multiple passes of radiation deliveries. After each pass, the patient couch is reset to its starting position, and the treatment recommences at a different phase of tumour motion to 'fill in' the previously blocked beam projections. The gating process may be repeated until the plan dose is delivered (full gating), or halted after a certain number of passes, with the entire remaining dose delivered in a final pass without gating (partial gating). The feasibility of the full gating approach was first tested for sinusoidal target motion, through experimental measurements with film and computer simulation. The optimal gating parameters for full and partial gating methods were then determined for various fractionation schemes through computer simulation, using a patient respiratory waveform. For sinusoidal motion, the PTV dose deviations of -29 to 5% observed without gating were reduced to range from -1 to 3% for a single fraction, with a 4 pass full gating. For a patient waveform, partial gating required fewer passes than full gating for all fractionation schemes. For a single fraction, the maximum allowed residual motion was only 4 mm, requiring large numbers of passes for both full (12) and partial (7 + 1) gating methods. The number of required passes decreased significantly for 3 and 30 fractions, allowing residual motion up to 7 mm. Overall, the multi-pass gating technique was shown to be a promising

  1. Feasibility study of multi-pass respiratory-gated helical tomotherapy of a moving target via binary MLC closure

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bryan; Chen, Jeff; Battista, Jerry [London Regional Cancer Program, London Health Sciences Centre, London, ON (Canada); Kron, Tomas, E-mail: bryan.kim@lhsc.on.c [Peter MacCallum Cancer Center, Melbourne (Australia)

    2010-11-21

    Gated radiotherapy of lung lesions is particularly complex for helical tomotherapy, due to the simultaneous motions of its three subsystems (gantry, couch and collimator). We propose a new way to implement gating for helical tomotherapy, namely multi-pass respiratory gating. In this method, gating is achieved by delivering only the beam projections that occur within a respiratory gating window, while blocking the rest of the beam projections by fully closing all collimator leaves. Due to the continuous couch motion, the planned beam projections must be delivered over multiple passes of radiation deliveries. After each pass, the patient couch is reset to its starting position, and the treatment recommences at a different phase of tumour motion to 'fill in' the previously blocked beam projections. The gating process may be repeated until the plan dose is delivered (full gating), or halted after a certain number of passes, with the entire remaining dose delivered in a final pass without gating (partial gating). The feasibility of the full gating approach was first tested for sinusoidal target motion, through experimental measurements with film and computer simulation. The optimal gating parameters for full and partial gating methods were then determined for various fractionation schemes through computer simulation, using a patient respiratory waveform. For sinusoidal motion, the PTV dose deviations of -29 to 5% observed without gating were reduced to range from -1 to 3% for a single fraction, with a 4 pass full gating. For a patient waveform, partial gating required fewer passes than full gating for all fractionation schemes. For a single fraction, the maximum allowed residual motion was only 4 mm, requiring large numbers of passes for both full (12) and partial (7 + 1) gating methods. The number of required passes decreased significantly for 3 and 30 fractions, allowing residual motion up to 7 mm. Overall, the multi-pass gating technique was shown to be a

  2. Clinical effectiveness, toxicity, and failure patterns of helical tomotherapy for postoperative oral cavity cancer patients

    Directory of Open Access Journals (Sweden)

    Hsieh CH

    2014-03-01

    Full Text Available Chen-Hsi Hsieh,1–3 Pei-Wei Shueng,1,4 Li-Ying Wang,5 Li-Jen Liao,6 Yu-Chin Lin,7 Ying-Shiung Kuo,8 Wu-Chia Lo,6 Chien-Fu Tseng,8 Hui-Ju Tien,1 Hsiu-Ling Chou,9,10 Yen-Ping Hsieh,11 Le-Jung Wu,1 Yu-Jen Chen3,12–14 1Department of Radiation Oncology, Far Eastern Memorial Hospital, 2Department of Medicine, 3Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, 4Department of Radiation Oncology, National Defense Medical Center, 5School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, 6Department of Otolaryngology, 7Division of Medical Oncology and Hematology, Department of Internal Medicine, 8Department of Dentistry and Oral Surgery, 9Department of Nursing, Far Eastern Memorial Hospital, 10Department of Nursing, Oriental Institute of Technology, Taipei, 11Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, 12Department of Radiation Oncology, 13Department of Medical Research, Mackay Memorial Hospital, 14Graduate Institute of Sport Coaching Science, Chinese Culture University, Taipei, Taiwan Background: The outcome of postoperative high- and intermediate-risk oral cavity cancer (OCC patients receiving helical tomotherapy (HT remains limited. Materials and methods: Between November 2006 and November 2012, 53 postoperative high- and intermediate-risk OCC patients treated with HT were enrolled. Results: The 4-year locoregional, local, and regional control rates were 66%, 76.4%, and 94.3%, respectively. The 4-year locoregional control rates of oral tongue and buccal mucosa cancer were 88.3% and 37.1%, respectively (P=0.012. Eleven (20.8% patients experienced locoregional failure. In-field failure occurred in six of 53 (11.3% in the primary area and three of 53 (5.7% in the regional lymph-node area. No marginal failure was noted. Two of 53 (3.8% experienced out-of-field failure. The rates of grade 3 dermatitis

  3. The helical tomo-therapy: appeal to projects Inca 2005 first assessment of the three equipped establishments

    International Nuclear Information System (INIS)

    Zefkili, S.; Francois, P.; Giraud, P.; Caron, J.; Dejean, C.; Kantor, G.; Munos, C.; Mahe, M.A.; Lisbona, A.

    2007-01-01

    The centers of fight against cancer ( C.L.C.C.) Institute Curie of Paris, Institute Bergonie of Bordeaux, Center Rene Gauducheau of Nantes have got to exploit the helical radiotherapy (tomo-therapy) in the frame of an appeal to projects launched in 2005 by the National Institute of cancer (I.n.c.a.) in relation with the innovating techniques in radiotherapy and presenting one of the measures of the Cancer plan 2003-2007. This communication constitutes a step report in the installation and use of equipments. (N.C.)

  4. TU-H-BRC-07: Therapeutic Benefit in Spatially Fractionated Radiotherapy (GRID) Using Helical Tomotherapy

    International Nuclear Information System (INIS)

    Narayanasamy, G; Zhang, X; Paudel, N; Morrill, S; Maraboyina, S; Peacock, L; Penagaricano, J; Meigooni, A; Liang, X

    2016-01-01

    Purpose: The aim of this project is to study the therapeutic ratio (TR) for helical Tomotherapy (HT) based spatially fractionated radiotherapy (GRID). Estimation of TR was based on the linear-quadratic cell survival model by comparing the normal cell survival in a HT GRID to that of a uniform dose delivery in an open-field for the same tumor survival. Methods: HT GRID plan was generated using a patient specific virtual GRID block pattern of non-divergent, cylinder shaped holes using MLCs. TR was defined as the ratio of normal tissue surviving fraction (SF) under HT GRID irradiation to an open field irradiation with an equivalent dose that result in the same tumor cell SF. The ratio was estimated from DVH data on ten patient plans with deep seated, bulky tumor approved by the treating radiation oncologist. Dependence of the TR values on radio-sensitivity of the tumor cells and prescription dose were also analyzed. Results: The mean ± standard deviation (SD) of TR was 4.0±0.7 (range: 3.1 to 5.5) for the 10 patients with single fraction dose of 20 Gy and tumor cell SF of 0.5 at 2 Gy. In addition, mean±SD of TR = 1±0.1 and 18.0±5.1 were found for tumor with SF of 0.3 and 0.7, respectively. Reducing the prescription dose to 15 and 10 Gy lowered the TR to 2.0±0.2 and 1.2±0.04 for a tumor cell SF of 0.5 at 2 Gy. In this study, the SF of normal cells was assumed to be 0.5 at 2 Gy. Conclusion: HT GRID displayed a significant therapeutic advantage over uniform dose from an open field irradiation. TR increases with the radioresistance of the tumor cells and with prescription dose.

  5. Feasibility and response of helical tomotherapy in patients with metastatic colorectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yong Ho [Dept. of Radiation Oncology, Catholic Kwandong University International St. Mary' s Hospital, Incheon (Korea, Republic of); Bae, Sun yun; Moon, Seong Kwon; Cho, Kwang Hwan; Shin, Eung Jin; Lee, Moon Sung; Ryu, Chang Beom; Ko, Bong Min; Yun, Ji Na [Soonchunhyang University College of Medicine, Bucheon (Korea, Republic of)

    2015-12-15

    To investigate the treatment outcome and the toxicity of helical tomotherapy (HT) in patients with metastatic colorectal cancer (mCRC). We retrospectively reviewed 18 patients with 31 lesions from mCRC treated with HT between 2009 and 2013. The liver (9 lesions) and lymph nodes (9 lesions) were the most frequent sites. The planning target volume (PTV) ranged from 12 to 1,110 mL (median, 114 mL). The total doses ranged from 30 to 70 Gy in 10-30 fractions. When the alpha/beta value for the tumor was assumed to be 10 Gy for the biologically equivalent dose (BED), the total doses ranged from 39 to 119 Gy{sub 10} (median, 55 Gy{sub 10}). Nineteen lesions were treated with concurrent chemotherapy (CCRT). With a median follow-up time of 16 months, the median overall survival for 18 patients was 33 months. Eight lesions (26%) achieved complete response. The 1- and 3-year local progression free survival (LPFS) rates for 31 lesions were 45% and 34%, respectively. On univariate analysis, significant parameters influencing LPFS rates were chemotherapy response before HT, aim of HT, CCRT, PTV, BED, and adjuvant chemotherapy. On multivariate analysis, PTV < or =113 mL and BED >48 Gy{sub 10} were associated with a statistically significant improvement in LFPS. During HT, four patients experienced grade 3 hematologic toxicities, each of whom had also received CCRT. The current study demonstrates the efficacy and tolerability of HT for mCRC. To define optimal RT dose according to tumor size of mCRC, further study should be needed.

  6. The role of helical tomotherapy in the treatment of bone plasmacytoma.

    Science.gov (United States)

    Chargari, Cyrus; Hijal, Tarek; Bouscary, Didier; Caussa, Lucas; Dendale, Remi; Zefkili, Sofia; Fourquet, Alain; Kirova, Youlia M

    2012-01-01

    We evaluated the early clinical outcome of patients with solitary bone plasmacytoma (SP) or a solitary lesion of multiple myeloma (MM) treated with helical tomotherapy (HT) compared with 3D conformal radiotherapy (3D-CRT), in terms of target coverage and exposure of critical organs. Ten patients with SP and 3 patients with a solitary lesion of MM underwent radiation therapy (RT) delivered by HT, to a dose of 40 Gy in 20 fractions. Treatment planning was then performed with 3D-CRT and the dosimetric parameters of both techniques were compared. Patients were also assessed for response to treatment and acute toxicities. With a median follow-up of 13 months, 78% of patients with pain before RT had resolution of their symptoms. Coverage of target lesion was adequate with both techniques in 12 of 13 patients. Target coverage was significantly lower for HT (V(95%) = 98.55% vs. 97.15%; p = 0.04, for 3D-CRT and HT, respectively). Target overdoses were also lower with HT (V(105%) = 2.01% vs. 0.19%; p= 0.16), although nonsignificant. Finally, there were no significant differences in organs-at-risk irradiation between both techniques. The early treatment tolerance was excellent, with no toxicity higher than grade I. RT of SP and MM with a solitary lesion can be safely delivered with HT, with no major acute side effects and good symptomatic control. Finally, HT provides a dosimetry similar to that of 3D-CRT in terms of organs-at-risk sparing and target volume coverage. Copyright © 2012 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  7. The role of helical tomotherapy in the treatment of bone plasmacytoma

    International Nuclear Information System (INIS)

    Chargari, Cyrus; Hijal, Tarek; Bouscary, Didier; Caussa, Lucas; Dendale, Remi; Zefkili, Sofia; Fourquet, Alain; Kirova, Youlia M.

    2012-01-01

    We evaluated the early clinical outcome of patients with solitary bone plasmacytoma (SP) or a solitary lesion of multiple myeloma (MM) treated with helical tomotherapy (HT) compared with 3D conformal radiotherapy (3D-CRT), in terms of target coverage and exposure of critical organs. Ten patients with SP and 3 patients with a solitary lesion of MM underwent radiation therapy (RT) delivered by HT, to a dose of 40 Gy in 20 fractions. Treatment planning was then performed with 3D-CRT and the dosimetric parameters of both techniques were compared. Patients were also assessed for response to treatment and acute toxicities. With a median follow-up of 13 months, 78% of patients with pain before RT had resolution of their symptoms. Coverage of target lesion was adequate with both techniques in 12 of 13 patients. Target coverage was significantly lower for HT (V 95% = 98.55% vs. 97.15%; p = 0.04, for 3D-CRT and HT, respectively). Target overdoses were also lower with HT (V 105% = 2.01% vs. 0.19%; p= 0.16), although nonsignificant. Finally, there were no significant differences in organs-at-risk irradiation between both techniques. The early treatment tolerance was excellent, with no toxicity higher than grade I. RT of SP and MM with a solitary lesion can be safely delivered with HT, with no major acute side effects and good symptomatic control. Finally, HT provides a dosimetry similar to that of 3D-CRT in terms of organs-at-risk sparing and target volume coverage.

  8. The role of helical tomotherapy in the treatment of bone plasmacytoma

    Energy Technology Data Exchange (ETDEWEB)

    Chargari, Cyrus; Hijal, Tarek [Department of Radiation Oncology, Institut Curie, Paris (France); Bouscary, Didier [Department of Hematology, Hopital Cochin, Paris (France); Caussa, Lucas; Dendale, Remi; Zefkili, Sofia; Fourquet, Alain [Department of Radiation Oncology, Institut Curie, Paris (France); Kirova, Youlia M., E-mail: youlia.kirova@curie.net [Department of Radiation Oncology, Institut Curie, Paris (France)

    2012-04-01

    We evaluated the early clinical outcome of patients with solitary bone plasmacytoma (SP) or a solitary lesion of multiple myeloma (MM) treated with helical tomotherapy (HT) compared with 3D conformal radiotherapy (3D-CRT), in terms of target coverage and exposure of critical organs. Ten patients with SP and 3 patients with a solitary lesion of MM underwent radiation therapy (RT) delivered by HT, to a dose of 40 Gy in 20 fractions. Treatment planning was then performed with 3D-CRT and the dosimetric parameters of both techniques were compared. Patients were also assessed for response to treatment and acute toxicities. With a median follow-up of 13 months, 78% of patients with pain before RT had resolution of their symptoms. Coverage of target lesion was adequate with both techniques in 12 of 13 patients. Target coverage was significantly lower for HT (V{sub 95%} = 98.55% vs. 97.15%; p = 0.04, for 3D-CRT and HT, respectively). Target overdoses were also lower with HT (V{sub 105%} = 2.01% vs. 0.19%; p= 0.16), although nonsignificant. Finally, there were no significant differences in organs-at-risk irradiation between both techniques. The early treatment tolerance was excellent, with no toxicity higher than grade I. RT of SP and MM with a solitary lesion can be safely delivered with HT, with no major acute side effects and good symptomatic control. Finally, HT provides a dosimetry similar to that of 3D-CRT in terms of organs-at-risk sparing and target volume coverage.

  9. SU-E-T-371: Validation of Organ Doses Delivered During Craniospinal Irradiation with Helical Tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Perez-Andujar, A; Chen, J; Garcia, A; Haas-Kogan, D [University of San Francisco, San Francisco, CA (United States)

    2014-06-01

    Purpose: New techniques have been developed to deliver more conformal treatments to the craniospinal axis. One concern, however, is the widespread low dose delivered and implications for possible late effects. The purpose of this work is for the first time to validate the organ doses calculated by the treatment planning system (TPS), including out-of-field doses for a pediatric craniospinal treatment (CSI). Methods: A CSI plan prescribed to 23.4 Gy and a posterior fossa boost plan to 30.6 Gy (total dose 54.0 Gy) was developed for a pediatric anthropomorphic phantom representing a 13 yearold- child. For the CSI plan, the planning target volumes (PTV) consisted of the brain and spinal cord with 2 mm and 5 mm expansions, respectively. Organs at risk (OAR) were contoured and included in the plan optimization. The plans were delivered on a helical tomotherapy unit. Thermoluminescent dosimeters (TLDs) were used to measure the dose at 54 positions within the PTV and OARs. Results: For the CSI treatment, the mean percent difference between TPS dose calculations and measurements was 5% for the PTV and 10% for the OARs. For the boost, the average was 3% for the PTV. The percent difference for the OARs, which lie outside the field and received a small fraction of the prescription dose, varied from 15% to 200%. However in terms of absolute dose, the average difference between measurement and TPS per treatment Gy was 2 cGy/Gy and 3 mGy/Gy for the CSI and boost plans, respectively. Conclusion: There was good agreement between doses calculated by the TPS and measurements for the CSI treatment. Higher percent differences were observed for out-of-field doses in the boost plan, but absolute dose differences were very small compared to the prescription dose. These findings can help in the estimation of late effects after radiotherapy for pediatric patients.

  10. Feasibility of Helical Tomotherapy for Debulking Irradiation Before Stem Cell Transplantation in Malignant Lymphoma

    International Nuclear Information System (INIS)

    Chargari, Cyrus; Vernant, Jean-Paul; Tamburini, Jerome; Zefkili, Sofia; Fayolle, Maryse; Campana, Francois; Fourquet, Alain; Kirova, Youlia M.

    2011-01-01

    Purpose: Preliminary clinical experience has suggested that radiation therapy (RT) may be effectively incorporated into conditioning therapy before transplant for patients with refractory/relapsed malignant lymphoma. We investigated the feasibility of debulking selective lymph node irradiation before autologous and/or allogeneic stem cell transplantation (SCT) using helical tomotherapy (HT). Methods and Materials: Six consecutive patients with refractory malignant lymphoma were referred to our institution for salvage HT before SCT. All patients had been previously heavily treated but had bulky residual tumor despite chemotherapy (CT) intensification. Two patients had received previous radiation therapy. HT delivered 30-40 Gy in the involved fields (IF), using 6 MV photons, 2 Gy per daily fraction. Total duration of treatment was 28 to 35 days. Results: Using HT, doses to critical organs (heart, lungs, esophagu, and parotids) were significantly decreased and highly conformational irradiation could be delivered to all clinical target volumes. HT delivery was technically possible, even in patients with lesions extremely difficult to irradiate in other conditions or in patients with previous radiation therapy. No Grade 2 or higher toxicity occurred. Four months after the end of HT, 5 patients experienced complete clinical, radiologic, and metabolic response and were subsequently referred for SCT. Conclusions: By more effectively sparing critical organs, HT may contribute to improving the tolerance of debulking irradiation before allograft. Quality of life may be preserved, and doses to the heart may be decreased. This is particularly relevant in heavily treated patients who are at risk for subsequent heart disease. These preliminary results require further prospective assessment.

  11. Preliminary analysis of risk factors for late rectal toxicity after helical tomotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Tomita, Natsuo; Soga, Norihito; Ogura, Yuji

    2013-01-01

    The purpose of this study is to examine risk factors for late rectal toxicity for localized prostate cancer patients treated with helical tomotherapy (HT). The patient cohort of this retrospective study was composed of 241 patients treated with HT and followed up regularly. Toxicity levels were scored according to the Radiation Therapy Oncology Group grading scale. The clinical and dosimetric potential factors increasing the risk of late rectal toxicity, such as age, diabetes, anticoagulants, prior abdominal surgery, prescribed dose, maximum dose of the rectum, and the percentage of the rectum covered by 70 Gy (V70), 60 Gy (V60), 40 Gy (V40) and 20 Gy (V20) were compared between ≤ Grade 1 and ≥ Grade 2 toxicity groups using the Student's t-test. Multivariable logistic regression analysis of the factors that appeared to be associated with the risk of late rectal toxicity (as determined by the Student's t-test) was performed. The median follow-up time was 35 months. Late Grade 2-3 rectal toxicity was observed in 18 patients (7.4%). Age, the maximum dose of the rectum, V70 and V60 of the ≥ Grade 2 toxicity group were significantly higher than in those of the ≤ Grade 1 toxicity group (P=0.00093, 0.048, 0.0030 and 0.0021, respectively). No factor was significant in the multivariable analysis. The result of this study indicates that the risk of late rectal toxicity correlates with the rectal volume exposed to high doses of HT for localized prostate cancer. Further follow-up and data accumulation may establish dose-volume modeling to predict rectal complications after HT. (author)

  12. A Monte Carlo derived TG-51 equivalent calibration for helical tomotherapy

    International Nuclear Information System (INIS)

    Thomas, S.D.; Mackenzie, M.; Rogers, D.W.O.; Fallone, B.G.

    2005-01-01

    Helical tomotherapy (HT) requires a method of accurately determining the absorbed dose under reference conditions. In the AAPM's TG-51 external beam dosimetry protocol, the quality conversion factor, k Q , is presented as a function of the photon component of the percentage depth-dose at 10 cm depth, %dd(10) x , measured under the reference conditions of a 10x10 cm 2 field size and a source-to-surface distance (SSD) of 100 cm. The value of %dd(10) x from HT cannot be used for the determination of k Q because the design of the HT does not meet the following TG-51 reference conditions: (i) the field size and the practical SSD required by TG-51 are not obtainable and (ii) the absence of the flattening filter changes the beam quality thus affecting some components of k Q . The stopping power ratio is not affected because of its direct relationship to %dd(10) x . We derive a relationship for the Exradin A1SL ion chamber converting the %dd(10) x measured under HT 'reference conditions' of SSD=85 cm and a 5x10 cm 2 field-size [%dd(10) x[HTRef] ], to the dosimetric equivalent value under for TG-51 reference conditions [%dd(10) x[HTTG-51] ] for HT. This allows the determination of k Q under the HT reference conditions. The conversion results in changes of 0.1% in the value of k Q for our particular unit. The conversion relationship should also apply to other ion chambers with possible errors on the order of 0.1%

  13. Validation of a computational method for assessing the impact of intra-fraction motion on helical tomotherapy plans

    Energy Technology Data Exchange (ETDEWEB)

    Ngwa, Wilfred; Meeks, Sanford L; Kupelian, Patrick A; Langen, Katja M [Department of Radiation Oncology, M D Anderson Cancer Center Orlando, 1400 South Orange Avenue, Orlando, FL 32806 (United States); Schnarr, Eric [TomoTherapy, Inc., 1240 Deming Way, Madison, WI 53717 (United States)], E-mail: wilfred.ngwa@orlandohealth.com

    2009-11-07

    In this work, a method for direct incorporation of patient motion into tomotherapy dose calculations is developed and validated. This computational method accounts for all treatment dynamics and can incorporate random as well as cyclical motion data. Hence, interplay effects between treatment dynamics and patient motion are taken into account during dose calculation. This allows for a realistic assessment of intra-fraction motion on the dose distribution. The specific approach entails modifying the position and velocity events in the tomotherapy delivery plan to accommodate any known motion. The computational method is verified through phantom and film measurements. Here, measured prostate motion and simulated respiratory motion tracks were incorporated in the dose calculation. The calculated motion-encoded dose profiles showed excellent agreement with the measurements. Gamma analysis using 3 mm and 3% tolerance criteria showed over 97% and 96% average of points passing for the prostate and breathing motion tracks, respectively. The profile and gamma analysis results validate the accuracy of this method for incorporating intra-fraction motion into the dose calculation engine for assessment of dosimetric effects on helical tomotherapy dose deliveries.

  14. Performance characterization of megavoltage computed tomography imaging on a helical tomotherapy unit

    International Nuclear Information System (INIS)

    Meeks, Sanford L.; Harmon, Joseph F. Jr.; Langen, Katja M.; Willoughby, Twyla R.; Wagner, Thomas H.; Kupelian, Patrick A.

    2005-01-01

    Helical tomotherapy is an innovative means of delivering IGRT and IMRT using a device that combines features of a linear accelerator and a helical computed tomography (CT) scanner. The HI-ART II can generate CT images from the same megavoltage x-ray beam it uses for treatment. These megavoltage CT (MVCT) images offer verification of the patient position prior to and potentially during radiation therapy. Since the unit uses the actual treatment beam as the x-ray source for image acquisition, no surrogate telemetry systems are required to register image space to treatment space. The disadvantage to using the treatment beam for imaging, however, is that the physics of radiation interactions in the megavoltage energy range may force compromises between the dose delivered and the image quality in comparison to diagnostic CT scanners. The performance of the system is therefore characterized in terms of objective measures of noise, uniformity, contrast, and spatial resolution as a function of the dose delivered by the MVCT beam. The uniformity and spatial resolutions of MVCT images generated by the HI-ART II are comparable to that of diagnostic CT images. Furthermore, the MVCT scan contrast is linear with respect to the electron density of material imaged. MVCT images do not have the same performance characteristics as state-of-the art diagnostic CT scanners when one objectively examines noise and low-contrast resolution. These inferior results may be explained, at least partially, by the low doses delivered by our unit; the dose is 1.1 cGy in a 20 cm diameter cylindrical phantom. In spite of the poorer low-contrast resolution, these relatively low-dose MVCT scans provide sufficient contrast to delineate many soft-tissue structures. Hence, these images are useful not only for verifying the patient's position at the time of therapy, but they are also sufficient for delineating many anatomic structures. In conjunction with the ability to recalculate radiotherapy doses on

  15. Effect of CT contrast on volumetric arc therapy planning (RapidArc and helical tomotherapy) for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Alan J.; Vora, Nayana [Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA (United States); Suh, Steve [Department of Radiation Physics, City of Hope National Medical Center, Duarte, CA (United States); Liu, An, E-mail: aliu@coh.org [Department of Radiation Physics, City of Hope National Medical Center, Duarte, CA (United States); Schultheiss, Timothy E. [Department of Radiation Physics, City of Hope National Medical Center, Duarte, CA (United States); Wong, Jeffrey Y.C. [Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA (United States)

    2015-04-01

    The objectives of the study were to evaluate the effect of intravenous contrast in the dosimetry of helical tomotherapy and RapidArc treatment for head and neck cancer and determine if it is acceptable during the computed tomography (CT) simulation to acquire only CT with contrast for treatment planning of head and neck cancer. Overall, 5 patients with head and neck cancer (4 men and 1 woman) treated on helical tomotherapy were analyzed retrospectively. For each patient, 2 consecutive CT scans were performed. The first CT set was scanned before the contrast injection and secondary study set was scanned 45 seconds after contrast. The 2 CTs were autoregistered using the same Digital Imaging and Communications in Medicine coordinates. Tomotherapy and RapidArc plans were generated on 1 CT data set and subsequently copied to the second CT set. Dose calculation was performed, and dose difference was analyzed to evaluate the influence of intravenous contrast media. The dose matrix used for comparison included mean, minimum and maximum doses of planning target volume (PTV), PTV dose coverage, and V{sub 45} {sub Gy}, V{sub 30} {sub Gy}, and V{sub 20} {sub Gy} organ doses. Treatment planning on contrasted images generally showed a lower dose to both organs and target than plans on noncontrasted images. The doses for the points of interest placed in the organs and target rarely changed more than 2% in any patient. In conclusion, treatment planning using a contrasted image had insignificant effect on the dose to the organs and targets. In our opinion, only CT with contrast needs to be acquired during the CT simulation for head and neck cancer. Dose calculations performed on contrasted images can potentially underestimate the delivery dose slightly. However, the errors of planning on a contrasted image should not affect the result in clinically significant way.

  16. Investigation of Pitch and Jaw Width to Decrease Delivery Time of Helical Tomotherapy Treatments for Head and Neck Cancer

    International Nuclear Information System (INIS)

    Moldovan, Monica; Fontenot, Jonas D.; Gibbons, John P.; Lee, Tae Kyu; Rosen, Isaac I.; Fields, Robert S.; Hogstrom, Kenneth R.

    2011-01-01

    Helical tomotherapy plans using a combination of pitch and jaw width settings were developed for 3 patients previously treated for head and neck cancer. Three jaw widths (5, 2.5, and 1 cm) and 4 pitches (0.86, 0.43, 0.287, and 0.215) were used with a (maximum) modulation factor setting of 4. Twelve plans were generated for each patient using an identical optimization procedure (e.g., number of iterations, objective weights, and penalties, etc.), based on recommendations from TomoTherapy (Madison, WI). The plans were compared using isodose plots, dose volume histograms, dose homogeneity indexes, conformity indexes, radiobiological models, and treatment times. Smaller pitches and jaw widths showed better target dose homogeneity and sparing of normal tissue, as expected. However, the treatment time increased inversely proportional to the jaw width, resulting in delivery times of 24 ± 1.9 min for the 1-cm jaw width. Although treatment plans produced with the 2.5-cm jaw were dosimetrically superior to plans produced with the 5-cm jaw, subsequent calculations of tumor control probabilities and normal tissue complication probabilities suggest that these differences may not be radiobiologically meaningful. Because treatment plans produced with the 5-cm jaw can be delivered in approximately half the time of plans produced with the 2.5-cm jaw (5.1 ± 0.6 min vs. 9.5 ± 1.1 min), use of the 5-cm jaw in routine treatment planning may be a viable approach to decreasing treatment delivery times from helical tomotherapy units.

  17. Whole brain helical Tomotherapy with integrated boost for brain metastases in patients with malignant melanoma–a randomized trial

    International Nuclear Information System (INIS)

    Hauswald, Henrik; Habl, Gregor; Krug, David; Kehle, Denise; Combs, Stephanie E; Bermejo, Justo Lorenzo; Debus, Jürgen; Sterzing, Florian

    2013-01-01

    Patients with malignant melanoma may develop brain metastases during the course of the disease, requiring radiotherapeutic treatment. In patients with 1–3 brain metastases, radiosurgery has been established as a treatment option besides surgery. For patients with 4 or more brain metastases, whole brain radiotherapy is considered the standard treatment. In certain patients with brain metastases, radiation treatment using whole brain helical Tomotherapy with integrated boost and hippocampal-sparing may improve prognosis of these patients. The present prospective, randomized two-armed trial aims to exploratory investigate the treatment response to conventional whole brain radiotherapy applying 30 Gy in 10 fractions versus whole brain helical Tomotherapy applying 30 Gy in 10 fractions with an integrated boost of 50 Gy to the brain metastases as well as hippocampal-sparing in patients with brain metastases from malignant melanoma. The main inclusion criteria include magnetic resonance imaging confirmed brain metastases from a histopathologically confirmed malignant melanoma in patients with a minimum age of 18 years. The main exclusion criteria include a previous radiotherapy of the brain and not having recovered from acute high-grade toxicities of prior therapies. The primary endpoint is treatment-related toxicity. Secondary endpoints include imaging response, local and loco-regional progression-free survival, overall survival and quality of life

  18. Helical tomotherapy in the treatment of pediatric malignancies: a preliminary report of feasibility and acute toxicity

    Directory of Open Access Journals (Sweden)

    Beltrán César

    2011-08-01

    Full Text Available Abstract Background Radiation therapy plays a central role in the management of many childhood malignancies and Helical Tomotherapy (HT provides potential to decrease toxicity by limiting the radiation dose to normal structures. The aim of this article was to report preliminary results of our clinical experience with HT in pediatric malignancies. Methods In this study 66 consecutive patients younger than 14 years old, treated with HT at our center between January 2006 and April 2010, have been included. We performed statistical analyses to assess the relationship between acute toxicity, graded according to the RTOG criteria, and several clinical and treatment characteristics such as a dose and irradiation volume. Results The median age of patients was 5 years. The most common tumor sites were: central nervous system (57%, abdomen (17% and thorax (6%. The most prevalent histological types were: medulloblastoma (16 patients, neuroblastoma (9 patients and rhabdomyosarcoma (7 patients. A total of 52 patients were treated for primary disease and 14 patients were treated for recurrent tumors. The majority of the patients (72% were previously treated with chemotherapy. The median prescribed dose was 51 Gy (range 10-70 Gy. In 81% of cases grade 1 or 2 acute toxicity was observed. There were 11 cases (16,6% of grade 3 hematological toxicity, two cases of grade 3 skin toxicity and one case of grade 3 emesis. Nine patients (13,6% had grade 4 hematological toxicity. There were no cases of grade 4 non-hematological toxicities. On the univariate analysis, total dose and craniospinal irradiation (24 cases were significantly associated with severe toxicity (grade 3 or more, whereas age and chemotherapy were not. On the multivariate analysis, craniospinal irradiation was the only significant independent risk factor for grade 3-4 toxicity. Conclusion HT in pediatric population is feasible and safe treatment modality. It is characterized by an acceptable level of

  19. Fast Helical Tomotherapy in a head and neck cancer planning study: is time priceless?

    International Nuclear Information System (INIS)

    Van Gestel, Dirk; De Kerf, Geert; Wouters, Kristien; Crijns, Wouter; Vermorken, Jan B.; Gregoire, Vincent; Verellen, Dirk

    2015-01-01

    The last few years, in radiotherapy there has been a growing focus on speed of treatment delivery (largely driven by economical and commercial interests). This study investigates the influence of treatment time on plan quality for helical tomotherapy (HT), using delivery times with Volumetric Modulated Arc Therapy (VMAT; Rapid Arc [RA]) as reference. In a previous study, double arc RA (Eclipse) and standard HT plans (TomoHD™) were created for five oropharyngeal cancer patients and reported according to ICRU 83 guidelines. By modifying the beam width from 2.5 to 5.0 cm, elevating the pitch and lowering the modulation factor, “TomoFast” (TF) plans were generated with treatment times equal to RA plans. To quantify the impact of TF’s craniocaudal gradient, similar plans were generated on TomoEdge TM (TomoEdgeFast;TEF). The homogeneity index (HI), conformity index (CI), mean dose, D near-max (D2) and D near-min (D98) of the PTVs were analyzed as well as the mean dose, specific critical doses and volumes of 26 organs at risk (OARs). Data were analyzed using repeated measures ANOVA. With a mean treatment time of 3.05 min (RA), 2.89 min (TF) and 2.95 min (TEF), PTV therapeutic coverage was more homogeneous with TF (HI.07;SE.01) and TEF (HI.08;SE.01) compared to RA (HI.10;SE.01), while PTV prophylactic was most homogeneous with RA. Mean doses to parotid glands were comparable for RA, TF, TEF: 25.62, 25.34, 23.09 Gy for contralateral and 32.02, 31.96, 30.01 Gy for ipsilateral glands, respectively. OARs’ mean doses varied between different approaches not favoring a particular technique. TF’s higher dose to OARs at the cranial-caudal edges of the PTVs and its higher integral dose, both due to the extended cranial-caudal gradient, seems to be solved by the new TomoEdge™ software. However, all these faster techniques lose part of standard TomoHD’s OAR sparing capacity It is possible to treat oropharyngeal cancer patients using HT (TF/TEF) within time

  20. Dosimetric Comparison of Helical Tomotherapy and Dynamic Conformal Arc Therapy in Stereotactic Radiosurgery for Vestibular Schwannomas

    International Nuclear Information System (INIS)

    Lee, Tsair-Fwu; Chao, Pei-Ju; Wang, Chang-Yu; Lan, Jen-Hong; Huang, Yu-Je; Hsu, Hsuan-Chih; Sung, Chieh-Cheng; Su, Te-Jen; Lian, Shi-Long; Fang, Fu-Min

    2011-01-01

    The dosimetric results of stereotactic radiosurgery (SRS) for vestibular schwannoma (VS) performed using dynamic conformal arc therapy (DCAT) with the Novalis system and helical TomoTherapy (HT) were compared using plan quality indices. The HT plans were created for 10 consecutive patients with VS previously treated with SRS using the Novalis system. The dosimetric indices used to compare the techniques included the conformity index (CI) and homogeneity index (HI) for the planned target volume (PTV), the comprehensive quality index (CQI) for nine organs at risk (OARs), gradient score index (GSI) for the dose drop-off outside the PTV, and plan quality index (PQI), which was verified using the plan quality discerning power (PQDP) to incorporate 3 plan indices, to evaluate the rival plans. The PTV ranged from 0.27-19.99 cm 3 (median 3.39 cm 3 ), with minimum required PTV prescribed doses of 10-16 Gy (median 12 Gy). Both systems satisfied the minimum required PTV prescription doses. HT conformed better to the PTV (CI: 1.51 ± 0.23 vs. 1.94 ± 0.34; p < 0.01), but had a worse drop-off outside the PTV (GSI: 40.3 ± 10.9 vs. 64.9 ± 13.6; p < 0.01) compared with DCAT. No significant difference in PTV homogeneity was observed (HI: 1.08 ± 0.03 vs. 1.09 ± 0.02; p = 0.20). HT had a significantly lower maximum dose in 4 OARs and significant lower mean dose in 1 OAR; by contrast, DCAT had a significantly lower maximum dose in 1 OAR and significant lower mean dose in 2 OARs, with the CQI of the 9 OARs = 0.92 ± 0.45. Plan analysis using PQI (HT 0.37 ± 0.12 vs. DCAT 0.65 ± 0.08; p < 0.01), and verified using the PQDP, confirmed the dosimetric advantage of HT. However, the HT system had a longer beam-on time (33.2 ± 7.4 vs. 4.6 ± 0.9 min; p < 0.01) and consumed more monitor units (16772 ± 3803 vs. 1776 ± 356.3; p < 0.01). HT had a better dose conformity and similar dose homogeneity but worse dose gradient than DCAT. Plan analysis confirmed the dosimetric advantage of HT

  1. Adaptive radiotherapy for soft tissue changes during helical tomotherapy for head and neck cancer

    Energy Technology Data Exchange (ETDEWEB)

    Duma, M.N.; Kampfer, S.; Winkler, C.; Geinitz, H. [Universitaetsklinikum rechts der Isar, Muenchen (Germany). Dept. of Radiation Oncology; Schuster, T. [Universitaetsklinikum rechts der Isar, Muenchen (Germany). Inst. of Medical Statistics and Epidemiology

    2012-03-15

    The goal of the present study was to assess the frequency and impact of replanning triggered solely by soft tissue changes observed on the daily setup mega-voltage CT (MVCT) in head and neck cancer (H and N) helical tomotherapy (HT). A total of 11 patients underwent adaptive radiotherapy (ART) using MVCT. Preconditions were a soft tissue change > 0.5 cm and a tight mask. The dose-volume histograms (DVHs) derived from the initial planning kVCT (inPlan), the recalculated DVHs of the fraction (fx) when replanning was decided (actSit) and the DVHs of the new plan (adaptPlan) were compared. Assessed were the following: maximum dose (D{sub max}), minimum dose (D{sub min}), and mean dose (D{sub mean}) to the planning target volume (PTV) normalized to the prescribed dose; the D{sub mean}/fx to the parotid glands (PG), oral cavity (OC), and larynx (Lx); and the D{sub max}/fx to the spinal cord (SC) in Gy/fx. No patient had palpable soft tissue changes. The median weight loss at the moment of replanning was 2.3 kg. The median PTV D{sub mean} was 100% for inPlan, 103% for actSit, and 100% for adaptPlan. The PTV was always covered by the prescribed dose. A statistically significant increase was noted for all organs at risk (OAR) in the actSit. The D{sub mean} to the Lx, the D{sub mean} to the OC and the D{sub max} to the SC were statistically better in the adaptPlan. No statistically significant improvement was achieved by ART for the PGs. No significant correlations between weight and volume loss or between the volume changes of the organs to each other were observed, except a strong positive correlation of the shrinkage of the PGs ({rho} = + 0.77, p = 0.005). Soft tissue shrinkage without clinical palpable changes will not affect the coverage of the PTV, but translates into a higher delivered dose to the PTV itself and the normal tissue outside the PTV. The gain by ART in individual patients - especially in patients who receive doses close to the tolerance doses of the OAR

  2. Helical tomotherapy in the treatment of pediatric malignancies: a preliminary report of feasibility and acute toxicity

    International Nuclear Information System (INIS)

    Mesbah, Latifa; Marsiglia, Hugo; Matute, Raúl; Usychkin, Sergey; Marrone, Immacolata; Puebla, Fernando; Mínguez, Cristina; García, Rafael; García, Graciela; Beltrán, César

    2011-01-01

    Radiation therapy plays a central role in the management of many childhood malignancies and Helical Tomotherapy (HT) provides potential to decrease toxicity by limiting the radiation dose to normal structures. The aim of this article was to report preliminary results of our clinical experience with HT in pediatric malignancies. In this study 66 consecutive patients younger than 14 years old, treated with HT at our center between January 2006 and April 2010, have been included. We performed statistical analyses to assess the relationship between acute toxicity, graded according to the RTOG criteria, and several clinical and treatment characteristics such as a dose and irradiation volume. The median age of patients was 5 years. The most common tumor sites were: central nervous system (57%), abdomen (17%) and thorax (6%). The most prevalent histological types were: medulloblastoma (16 patients), neuroblastoma (9 patients) and rhabdomyosarcoma (7 patients). A total of 52 patients were treated for primary disease and 14 patients were treated for recurrent tumors. The majority of the patients (72%) were previously treated with chemotherapy. The median prescribed dose was 51 Gy (range 10-70 Gy). In 81% of cases grade 1 or 2 acute toxicity was observed. There were 11 cases (16,6%) of grade 3 hematological toxicity, two cases of grade 3 skin toxicity and one case of grade 3 emesis. Nine patients (13,6%) had grade 4 hematological toxicity. There were no cases of grade 4 non-hematological toxicities. On the univariate analysis, total dose and craniospinal irradiation (24 cases) were significantly associated with severe toxicity (grade 3 or more), whereas age and chemotherapy were not. On the multivariate analysis, craniospinal irradiation was the only significant independent risk factor for grade 3-4 toxicity. HT in pediatric population is feasible and safe treatment modality. It is characterized by an acceptable level of acute toxicity that we have seen in this highly

  3. A technique for adaptive image-guided helical tomotherapy for lung cancer

    International Nuclear Information System (INIS)

    Ramsey, Chester R.; Langen, Katja M.; Kupelian, Patrick A.; Scaperoth, Daniel D.; Meeks, Sanford L.; Mahan, Stephen L.; Seibert, Rebecca M.

    2006-01-01

    Purpose: The gross tumor volume (GTV) for many lung cancer patients can decrease during the course of radiation therapy. As the tumor reduces in size during treatment, the margin added around the GTV effectively becomes larger, which can result in the excessive irradiation of normal lung tissue. The specific goal of this study is to evaluate the feasibility of using image-guided adaptive radiation therapy to adjust the planning target volume weekly based on the previous week's CT image sets that were used for image-guided patient setup. Methods and Materials: Megavoltage computed tomography (MVCT) images of the GTV were acquired daily on a helical tomotherapy system. These images were used to position the patient and to measure reduction in GTV volume. A planning study was conducted to determine the amount of lung-sparing that could have been achieved if adaptive therapy had been used. Treatment plans were created in which the target volumes were reduced after tumor reduction was measured. Results: A total of 158 MVCT imaging sessions were performed on 7 lung patients. The GTV was reduced by 60-80% during the course of treatment. The tumor reduction in the first 60 days of treatment can be modeled using the second-order polynomial R 0.0002t 2 - 0.0219t + 1.0, where R is the percent reduction in GTV, and t is the number of elapsed days. Based on these treatment planning studies, the absolute volume of ipsilateral lung receiving 20 Gy can be reduced between 17% and 23% (21% mean) by adapting the treatment delivery. The benefits of adaptive therapy are the greatest for tumor volumes ≥25 cm 3 and are directly dependent on GTV reduction during treatment. Conclusions: Megavoltage CT-based image guidance can be used to position lung cancer patients daily. This has the potential to decrease margins associated with daily setup error. Furthermore, the adaptive therapy technique described in this article can decrease the volume of healthy lung tissue receiving above 20 Gy

  4. Tomotherapy – a different way of dose delivery in radiotherapy

    Science.gov (United States)

    Skórska, Małgorzata; Jodda, Agata; Ryczkowski, Adam; Kaźmierska, Joanna; Adamska, Krystyna; Karczewska-Dzionk, Aldona; Żmijewska-Tomczak, Małgorzata; Włodarczyk, Hanna

    2012-01-01

    Aim of the study Helical tomotherapy is one of the methods of radiotherapy. This method enables treatment implementation for a wide spectrum of clinical cases. The vast array of therapeutic uses of helical tomotherapy results directly from the method of dose delivery, which is significantly different from the classic method developed for conventional linear accelerators. The paper discusses the method of dose delivery by a tomotherapy machine. Moreover, an analysis and presentation of treatment plans was performed in order to show the therapeutic possibilities of the applied technology. Dose distributions were obtained for anaplastic medulloblastoma, multifocal metastases to brain, vulva cancer, tongue cancer, metastases to bones, and advanced skin cancer. Tomotherapy treatment plans were compared with conventional linear accelerator plans. Results Following the comparative analysis of tomotherapy and conventional linear accelerator plans, in each case we obtained the increase in dose distribution conformity manifested in greater homogeneity of doses in the radiation target area for anaplastic medulloblastoma, multifocal metastases to brain, vulva cancer, metastases to bones, and advanced skin cancer, and the reduction of doses in organs at risk (OAR) for anaplastic medulloblastoma, vulva cancer, tongue cancer, and advanced skin cancer. The time of treatment delivery in the case of a tomotherapy machine is comparable to the implementation of the plan prepared in intensity-modulated radiotherapy (IMRT) technique for a conventional linear accelerator. In the case of tomotherapy the application of a fractional dose was carried out in each case during one working period of the machine. For a conventional linear accelerator the total value of the fractional dose in the case of anaplastic medulloblastoma and metastases to bones was delivered using several treatment plans, for which a change of set-up was necessary during a fraction. Conclusion The obtained results

  5. SU-F-T-267: A Clarkson-Based Independent Dose Verification for the Helical Tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Nagata, H [Shonan Kamakura General Hospital, Kamakura, Kanagawa, (Japan); Juntendo University, Hongo, Tokyo (Japan); Hongo, H [Shonan Kamakura General Hospital, Kamakura, Kanagawa, (Japan); Tsukuba University, Tsukuba, Ibaraki (Japan); Kawai, D [Kanagawa Cancer Center, Yokohama, Kanagawa (Japan); Takahashi, R [Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto, Tokyo (Japan); Hashimoto, H [Shonan Fujisawa Tokushukai Hospital, Fujisawa, Kanagawa (Japan); Tachibana, H [National Cancer Center, Kashiwa, Chiba (Japan)

    2016-06-15

    Purpose: There have been few reports for independent dose verification for Tomotherapy. We evaluated the accuracy and the effectiveness of an independent dose verification system for the Tomotherapy. Methods: Simple MU Analysis (SMU, Triangle Product, Ishikawa, Japan) was used as the independent verification system and the system implemented a Clarkson-based dose calculation algorithm using CT image dataset. For dose calculation in the SMU, the Tomotherapy machine-specific dosimetric parameters (TMR, Scp, OAR and MLC transmission factor) were registered as the machine beam data. Dose calculation was performed after Tomotherapy sinogram from DICOM-RT plan information was converted to the information for MU and MLC location at more segmented control points. The performance of the SMU was assessed by a point dose measurement in non-IMRT and IMRT plans (simple target and mock prostate plans). Subsequently, 30 patients’ treatment plans for prostate were compared. Results: From the comparison, dose differences between the SMU and the measurement were within 3% for all cases in non-IMRT plans. In the IMRT plan for the simple target, the differences (Average±1SD) were −0.70±1.10% (SMU vs. TPS), −0.40±0.10% (measurement vs. TPS) and −1.20±1.00% (measurement vs. SMU), respectively. For the mock prostate, the differences were −0.40±0.60% (SMU vs. TPS), −0.50±0.90% (measurement vs. TPS) and −0.90±0.60% (measurement vs. SMU), respectively. For patients’ plans, the difference was −0.50±2.10% (SMU vs. TPS). Conclusion: A Clarkson-based independent dose verification for the Tomotherapy can be clinically available as a secondary check with the similar tolerance level of AAPM Task group 114. This research is partially supported by Japan Agency for Medical Research and Development (AMED)

  6. Helical tomotherapy for SIB and hypo-fractionated treatments in lung carcinomas: A 4D Monte Carlo treatment planning study

    International Nuclear Information System (INIS)

    Sterpin, Edmond; Janssens, Guillaume; Orban de Xivry, Jonathan; Goossens, Samuel; Wanet, Marie; Lee, John A.; Delor, Antoine; Bol, Vanesa; Vynckier, Stefaan; Gregoire, Vincent; Geets, Xavier

    2012-01-01

    Purpose: To evaluate the impact of intra-fraction motion induced by regular breathing on treatment quality for helical tomotherapy treatments. Material and methods: Four patients treated by simultaneous-integrated boost (SIB) and three by hypo-fractionated stereotactic treatments (hypo-fractionated, 18 Gy/fraction) were included. All patients were coached to ensure regular breathing. For the SIB group, the tumor volume was delineated using CT information only (CTV CT ) and the boost region was based on PET information (GTV PET , no CTV extension). In the hypo-fractionated group, a GTV based on CT information was contoured. In both groups, ITVs were defined according to 4D data. The PTV included the ITV plus a setup error margin. The treatment was planned using the tomotherapy TPS on 3D CT images. In order to verify the impact of intra-fraction motion and interplay effects, dose calculations were performed using a previously validated Monte Carlo model of tomotherapy (TomoPen): first on the planning 3D CT (“planned dose”) and second, on the 10 phases of the 4D scan. For the latter, two dose distributions, termed “interplay simulated” or “no interplay” were computed with and without beamlet-phase correlation over the 10 phases and combined using deformable dose registration. Results: In all cases, DVHs of “interplay simulated” dose distributions complied within 1% of the original clinical objectives used for planning, defined according to ICRU (report 83) and RTOG (trials 0236 and 0618) recommendations, for SIB and hypo-fractionated groups, respectively. For one patient in the hypo-fractionated group, D mean to the CTV CT was 2.6% and 2.5% higher than “planned” for “interplay simulated” and “no interplay”, respectively. Conclusion: For the patients included in this study, assuming regular breathing, the results showed that interplay of breathing and tomotherapy delivery motions did not affect significantly plan delivery accuracy. Hence

  7. Investigating output and energy variations and their relationship to delivery QA results using Statistical Process Control for helical tomotherapy.

    Science.gov (United States)

    Binny, Diana; Mezzenga, Emilio; Lancaster, Craig M; Trapp, Jamie V; Kairn, Tanya; Crowe, Scott B

    2017-06-01

    The aims of this study were to investigate machine beam parameters using the TomoTherapy quality assurance (TQA) tool, establish a correlation to patient delivery quality assurance results and to evaluate the relationship between energy variations detected using different TQA modules. TQA daily measurement results from two treatment machines for periods of up to 4years were acquired. Analyses of beam quality, helical and static output variations were made. Variations from planned dose were also analysed using Statistical Process Control (SPC) technique and their relationship to output trends were studied. Energy variations appeared to be one of the contributing factors to delivery output dose seen in the analysis. Ion chamber measurements were reliable indicators of energy and output variations and were linear with patient dose verifications. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  8. Intensity-modulated radiotherapy for cancers in childhood

    International Nuclear Information System (INIS)

    Leseur, J.; Le Prise, E.; Leseur, J.; Carrie, C.; Beneyton, V.; Bernier, V.; Beneyton, V.; Mahee, M.A.; Supiot, S.

    2009-01-01

    Approximately 40-50% of children with cancer will be irradiated during their treatment. Intensity-modulated radiotherapy (I.M.R.T.) by linear accelerator or helical tomo-therapy improves dose distribution in target volumes and normal tissue sparing. This technology could be particularly useful for pediatric patients to achieve an optimal dose distribution in complex volumes close to critical structures. The use of I.M.R.T. can increase the volume of tissue receiving low-dose radiation, and consequently carcinogenicity in childhood population with a good overall survival and long period of life expectancy. This review will present the current and potential I.M.R.T. indications for cancers in childhood, and discuss the benefits and problems of this technology aiming to define recommendations in the use of I.M.R.T. and specific doses constraints in Pediatrics. (authors)

  9. Dosimetric comparison between helical tomotherapy and volumetric modulated arc-therapy for non-anaplastic thyroid cancer treatment.

    Science.gov (United States)

    Khalifa, Jonathan; Vieillevigne, Laure; Boyrie, Sabrina; Ouali, Monia; Filleron, Thomas; Rives, Michel; Laprie, Anne

    2014-11-26

    To evaluate and compare dosimetric parameters of volumetric modulated arctherapy (VMAT) and helical tomotherapy (HT) for non-anaplastic thyroid cancer adjuvant radiotherapy. Twelve patients with non-anaplastic thyroid cancer at high risk of local relapse received adjuvant external beam radiotherapy with curative intent in our institution, using a two-dose level prescription with a simultaneous integrated boost approach. Each patient was re-planned by the same physicist twice using both VMAT and HT. Several dosimetric quality indexes were used: target coverage index (proportion of the target volume covered by the reference isodose), healthy tissue conformity index (proportion of the reference isodose volume including the target volume), conformation number (combining both previous indexes), Dice Similarity Coefficient (DSC), and homogeneity index ((D2%-D98%)/prescribed dose). Dose-volume histogram statistics were also compared. HT provided statistically better target coverage index and homogeneity index for low risk PTV in comparison with VMAT (respectively 0.99 vs. 0.97 (p=0.008) and 0.22 vs. 0.25 (p=0.016)). However, HT provided poorer results for healthy tissue conformity index, conformation number and DSC with low risk and high risk PTV. As regards organs at risk sparing, by comparison with VMAT, HT statistically decreased the D2% to medullary canal (25.3 Gy vs. 32.6 Gy (p=0.003)). Besides, HT allowed a slight sparing dose for the controlateral parotid (Dmean: 4.3 Gy vs. 6.6 Gy (p=0.032)) and for the controlateral sub-maxillary gland (Dmean: 29.1 Gy vs. 33.1 Gy (p=0.041)). Both VMAT and HT techniques for adjuvant treatment of non-anaplastic thyroid cancer provide globally attractive treatment plans with slight dosimetric differences. However, helical tomotherapy clearly provides a benefit in term of medullary canal sparing.

  10. Sparing of the hippocampus and limbic circuit during whole brain radiation therapy: a dosimetric study using helical tomotherapy

    International Nuclear Information System (INIS)

    Marsh, J.C.; Gielda, B.T.; Herskovic, A.M.; Turian, J.V.

    2010-01-01

    Full text: The study aims to assess the feasibility of dosimetrically sparing the limbic circuit during whole brain radiation therapy (WBRT) and prophylactic cranial irradiation (PCI). Methods and Materials: We contoured the brain/brainstem on fused MRI and CT as the target volume (PTV) in 11 patients, excluding the hippocampus and the rest of the limbic circuit, which were considered organs at risk (OARs). PCI and WBRT helical tomotherapy plans were prepared for each patient with a 1.0-cm field width, pitch 0.285, initial modulation factor = 2.5. We attempted to spare the hippocampus and the rest of the limbic circuit while treating the rest of the brain to 30 Gy in 15 fractions (PCI) or 35 Gy in 14 fractions (WBRT) with VlOO ∼ 95%. The quality of the plans was assessed by calculating mean dose and equivalent uniform dose (EUD) for OARs and the % volume of the PTV receiving the prescribed dose, V 100. Results: In the PCI plans, mean doses/EUD were: hippocampus 12.5 Gy/ 14.23 Gy, rest of limbic circuit 17.0 Gy/19.02 Gy. In the WBRT plans, mean doses/EUD were: hippocampus 14.3 Gy/16.07 Gy, rest of limbic circuit 17.9 Gy/20.74 Gy. The mean VlOO for the rest of the brain (PTV) were 94.7% (PCl) and 95.1 % (WBRT). Mean PCI and WBRT treatment times were essentially identical (mean 15.23 min, range 14.27-17.5). Conclusions: It is dosimetrically feasible to spare the hippocampus and the rest of the limbic circuit using helical tomotherapy while treating the rest of the brain to full dose.

  11. Helical tomotherapy in patients with breast cancer and complex treatment volumes.

    Science.gov (United States)

    Cendales, Ricardo; Schiappacasse, Luis; Schnitman, Franco; García, Graciela; Marsiglia, Hugo

    2011-04-01

    To describe early clinical results of tomotherapy treatment in patients with breast cancer and complex treatment volumes. Ten patients were treated with tomotherapy between January 2009 and March 2010. Treatment planning objectives were to cover at least 95% of the planning target volume with the 95% isodose; to have a minimum dose of 90% and a maximum dose of 105%. All treatments included daily CT/megavoltage image guidance. Acute toxicity was recorded weekly. Six patients were treated because constraints were not accomplished for heart, lung or contralateral breast in a previous three-dimensional conformal plan; two for preexisting cardiac or pulmonary disease, and two more for bilateral breast irradiation. Treatment volumes included the whole breast in the majority of patients, as well as the supraclavicular and the internal mammary chain nodes when indicated. Most patients were older than 50 years, and had an early breast cancer, with positive oestrogen receptors, negative HER2 expression and a poorly differentiated, infiltrating ductal carcinoma. The majority of patients had received neoadjuvant chemotherapy associated to breast-conserving surgery and adjuvant hormonotherapy. Median homogeneity index was 1.09; median coverage index was 0.81. Median V20Gy and V10Gy for ipsilateral lung was 20% and 37.1% respectively. Median V25 and V35 for heart was 15% and 4% respectively. Median dose for contralateral breast was 7 Gy. Skin acute toxicity was grade 1 in 41.7% and grade 2 in 58.3%. Tomotherapy is a technique capable of delivering a well tolerated treatment with high homogeneity and coverage indexes and high capabilities for sparing the organs at risk in patients with anatomically complex breast cancer, bilateral breast cancer, indication for internal mammary chain node irradiation, cardiac toxicity derived from chemotherapy, or preexisting cardiac or pulmonary disease. Further studies are required to evaluate local control and late toxicity.

  12. Feasibility and efficacy of helical intensity-modulated radiotherapy for stage III non-small cell lung cancer in comparison with conventionally fractionated 3D-CRT.

    Science.gov (United States)

    He, Jian; Huang, Yan; Chen, Yixing; Shi, Shiming; Ye, Luxi; Hu, Yong; Zhang, Jianying; Zeng, Zhaochong

    2016-05-01

    The standard treatment for stage III non-small-cell lung cancer (NSCLC) is still 60 Gy in conventional fractions combined with concurrent chemotherapy; however, the resulting local controls are disappointing. The aim of this study was to compare and assess the feasibility and efficacy of hypofractionated chemoradiotherapy using helical tomotherapy (HT) with conventional fractionation as opposed to using three-dimensional conformal radiotherapy (3D-CRT) for stage III NSCLC. Sixty-nine patients with stage III (AJCC 7th edition) NSCLC who underwent definitive radiation treatment at our institution between July 2011 and November 2013 were reviewed and analyzed retrospectively. A dose of 60 Gy in 20 fractions was delivered in the HT group (n=34), whereas 60 Gy in 30 fractions in the 3D-CRT group (n=35). Primary endpoints were toxicity, overall response rate, overall survival (OS) and progression-free survival (PFS). The median follow-up period was 26.4 months. V20 (P=0.005), V30 (P=0.001), V40 (P=0.004), mean lung dose (P=0.000) and max dose of spinal cord (P=0.005) were significantly lower in the HT group than in the 3D-CRT group. There was no significant difference in the incidences of acute radiation pneumonitis (RP) ≥ grade 2 between the two groups, whereas the incidences of acute radiation esophagitis ≥ grade 2 were significantly lower in the HT group than in the 3D-CRT group (P=0.027). Two-year overall response rate was significantly higher in the HT group than in the 3D-CRT group (P=0.015). One- and 2-year OS rates were significantly higher in the HT group (95.0% and 68.7%, respectively) than in the 3D-CRT group (85.5% and 47.6%, respectively; P=0.0236). One- and 2-year PFS rates were significantly higher in the HT group (57.8% and 26.3%, respectively) than in the 3D-CRT group (32.7% and 11.4%, respectively; P=0.0351). Univariate analysis indicated that performance status (PS), T stage and radiotherapy technique were significant prognostic factors for both OS

  13. Effects of megavoltage computed tomographic scan methodology on setup verification and adaptive dose calculation in helical TomoTherapy.

    Science.gov (United States)

    Zhu, Jian; Bai, Tong; Gu, Jiabing; Sun, Ziwen; Wei, Yumei; Li, Baosheng; Yin, Yong

    2018-04-27

    To evaluate the effect of pretreatment megavoltage computed tomographic (MVCT) scan methodology on setup verification and adaptive dose calculation in helical TomoTherapy. Both anthropomorphic heterogeneous chest and pelvic phantoms were planned with virtual targets by TomoTherapy Physicist Station and were scanned with TomoTherapy megavoltage image-guided radiotherapy (IGRT) system consisted of six groups of options: three different acquisition pitches (APs) of 'fine', 'normal' and 'coarse' were implemented by multiplying 2 different corresponding reconstruction intervals (RIs). In order to mimic patient setup variations, each phantom was shifted 5 mm away manually in three orthogonal directions respectively. The effect of MVCT scan options was analyzed in image quality (CT number and noise), adaptive dose calculation deviations and positional correction variations. MVCT scanning time with pitch of 'fine' was approximately twice of 'normal' and 3 times more than 'coarse' setting, all which will not be affected by different RIs. MVCT with different APs delivered almost identical CT numbers and image noise inside 7 selected regions with various densities. DVH curves from adaptive dose calculation with serial MVCT images acquired by varied pitches overlapped together, where as there are no significant difference in all p values of intercept & slope of emulational spinal cord (p = 0.761 & 0.277), heart (p = 0.984 & 0.978), lungs (p = 0.992 & 0.980), soft tissue (p = 0.319 & 0.951) and bony structures (p = 0.960 & 0.929) between the most elaborated and the roughest serials of MVCT. Furthermore, gamma index analysis shown that, compared to the dose distribution calculated on MVCT of 'fine', only 0.2% or 1.1% of the points analyzed on MVCT of 'normal' or 'coarse' do not meet the defined gamma criterion. On chest phantom, all registration errors larger than 1 mm appeared at superior-inferior axis, which cannot be avoided with the smallest AP and RI

  14. Dosimetric Comparison of 6 MV and 15 MV Single Arc Rapidarc to Helical TomoTherapy for the Treatment of Pancreatic Cancer

    International Nuclear Information System (INIS)

    Cai Jing; Yue Jinbo; McLawhorn, Robert; Yang Wensha; Wijesooriya, Krishni; Dunlap, Neal E.; Sheng Ke; Yin Fangfang; Benedict, Stanley H.

    2011-01-01

    We conducted a planning study to compare Varian's RapidArc (RA) and helical TomoTherapy (HT) for the treatment of pancreatic cancer. Three intensity-modulated radiotherapy (IMRT) plans were generated for 8 patients with pancreatic cancer: one using HT with 6-MV beam (Plan HT6 ), one using single-arc RA with 6-MV beam (Plan RA6 ), and one using single-arc RA with 15-MV beam (Plan RA15 ). Dosimetric indices including high/low conformality index (CI 100% /CI 50% ), heterogeneity index (HI), monitor units (MUs), and doses to organs at risk (OARs) were compared. The mean CI 100% was statistically equivalent with respect to the 2 treatment techniques, as well as beam energy (0.99, 1.01, and 1.02 for Plan HT6 , Plan RA6 , and Plan RA156, respectively). The CI 50% and HI were improved in both RA plans over the HT plan. The RA plans significantly reduced MU (MU RA6 = 697, MU RA15 = 548) compared with HT (MU HT6 = 6177, p = 0.008 in both cases). The mean maximum cord dose was decreased from 29.6 Gy in Plan H T6 to 21.6 Gy (p = 0.05) in Plan RA6 and 21.7 Gy (p = 0.04) in Plan RA15 . The mean bowel dose decreased from 17.2 Gy in Plan HT6 to 15.2 Gy (p = 0.03) in Plan RA6 and 15.0 Gy (p = 0.03) Plan RA15 . The mean liver dose decreased from 8.4 Gy in Plan HT6 to 6.3 Gy (p = 0.04) in Plan RA6 and 6.2 Gy in Plan RA15 . Variations of the mean dose to the duodenum, kidneys, and stomach were statistically insignificant. RA and HT can both deliver conformal dose distributions to target volumes while limiting the dose to surrounding OARs in the treatment of pancreatic cancer. Dosimetric advantages might be gained by using RA over HT by reducing the dose to OARs and total MUs used for treatment.

  15. Stereotactic body radiation therapy via helical tomotherapy to replace brachytherapy for brachytherapy-unsuitable cervical cancer patients – a preliminary result

    Directory of Open Access Journals (Sweden)

    Hsieh CH

    2013-02-01

    Full Text Available Chen-Hsi Hsieh,1–3 Hui-Ju Tien,1 Sheng-Mou Hsiao,4 Ming-Chow Wei,4 Wen-Yih Wu,4 Hsu-Dong Sun,4 Li-Ying Wang,5 Yen-Ping Hsieh,6 Yu-Jen Chen,3,7–9 Pei-Wei Shueng1,101Department of Radiation Oncology, Far Eastern Memorial Hospital, Taipei, Taiwan; 2Department of Medicine, 3Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 4Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Taipei, Taiwan; 5School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; 6Department of Senior Citizen Service Management, National Taichung University of Science and Technology, Taichung, Taiwan; 7Department of Radiation Oncology, 8Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan; 9Graduate Institute of Sport Coaching Science, Chinese Culture University, Taipei, Taiwan; 10Department of Radiation Oncology, National Defense Medical Center, Taipei, TaiwanAim: To review the experience and to evaluate the results of stereotactic body radiation therapy (SBRT via helical tomotherapy (HT, for the treatment of brachytherapy-unsuitable cervical cancer.Methods: Between September 1, 2008 to January 31, 2012, nine cervical cancer patients unsuitable for brachytherapy were enrolled. All of the patients received definitive whole pelvic radiotherapy with or without chemotherapy, followed by SBRT via HT.Results: The actuarial locoregional control rate at 3 years was 78%. The mean biological equivalent dose in 2-Gy fractions of the tumor, rectum, bladder, and intestines was 76.0 ± 7.3, 73.8 ± 13.2, 70.5 ± 10.0, and 43.1 ± 7.1, respectively. Only two had residual tumors after treatment, and the others were tumor-free. Two patients experienced grade 3 acute toxicity: one had diarrhea; and another experienced thrombocytopenia. There were no grade 3 or 4 subacute toxicities. Three patients suffered from manageable rectal bleeding in

  16. Efficacy of virtual block objects in reducing the lung dose in helical tomotherapy planning for cervical oesophageal cancer: a planning study.

    Science.gov (United States)

    Ito, Makoto; Shimizu, Hidetoshi; Aoyama, Takahiro; Tachibana, Hiroyuki; Tomita, Natsuo; Makita, Chiyoko; Koide, Yutaro; Kato, Daiki; Ishiguchi, Tsuneo; Kodaira, Takeshi

    2018-04-04

    Intensity-modulated radiotherapy is useful for cervical oesophageal carcinoma (CEC); however, increasing low-dose exposure to the lung may lead to radiation pneumonitis. Nevertheless, an irradiation technique that avoids the lungs has never been examined due to the high difficulty of dose optimization. In this study, we examined the efficacy of helical tomotherapy that can restrict beamlets passing virtual blocks during dose optimization computing (block plan) in reducing the lung dose. Fifteen patients with CEC were analysed. The primary/nodal lesion and prophylactic nodal region with adequate margins were defined as the planning target volume (PTV)-60 Gy and PTV-48 Gy, respectively. Nineteen plans per patient were made and compared (total: 285 plans), including non-block and block plans with several shapes and sizes. The most appropriate block model was semi-circular, 8 cm outside of the tracheal bifurcation, with a significantly lower lung dose compared to that of non-block plans; the mean lung volumes receiving 5 Gy, 10 Gy, 20 Gy, and the mean lung dose were 31.3% vs. 48.0% (p block and non-block plans were comparable in terms of the homogeneity and conformity indexes of PTV-60 Gy: 0.05 vs. 0.04 (p = 0.100) and 0.82 vs. 0.85 (p = 0.616), respectively. The maximum dose of the spinal cord planning risk volume increased slightly (49.4 Gy vs. 47.9 Gy, p = 0.002). There was no significant difference in the mean doses to the heart and the thyroid gland. Prolongation of the delivery time was less than 1 min (5.6 min vs. 4.9 min, p = 0.010). The block plan for CEC could significantly reduce the lung dose, with acceptable increment in the spinal dose and a slightly prolonged delivery time.

  17. Utility of Megavoltage Fan-Beam CT for Treatment Planning in a Head-And-Neck Cancer Patient with Extensive Dental Fillings Undergoing Helical Tomotherapy

    International Nuclear Information System (INIS)

    Yang, Claus; Liu Tianxiao; Jennelle, Richard L.; Ryu, Janice K.; Vijayakumar, Srinivasan; Purdy, James A.; Chen, Allen M.

    2010-01-01

    The purpose of this study was to demonstrate the potential utility of megavoltage fan-beam computed tomography (MV-FBCT) for treatment planning in a patient undergoing helical tomotherapy for nasopharyngeal carcinoma in the presence of extensive dental artifact. A 28-year-old female with locally advanced nasopharyngeal carcinoma presented for radiation therapy. Due to the extensiveness of the dental artifact present in the oral cavity kV-CT scan acquired at simulation, which made treatment planning impossible on tomotherapy planning system, MV-FBCT imaging was obtained using the HI-ART tomotherapy treatment machine, with the patient in the treatment position, and this information was registered with her original kV-CT scan for the purposes of structure delineation, dose calculation, and treatment planning. To validate the feasibility of the MV-FBCT-generated treatment plan, an electron density CT phantom (model 465, Gammex Inc., Middleton, WI) was scanned using MV-FBCT to obtain CT number to density table. Additionally, both a 'cheese' phantom (which came with the tomotherapy treatment machine) with 2 inserted ion chambers and a generic phantom called Quasar phantom (Modus Medical Devices Inc., London, ON, Canada) with one inserted chamber were used to confirm dosimetric accuracy. The MV-FBCT could be used to clearly visualize anatomy in the region of the dental artifact and provide sufficient soft-tissue contrast to assist in the delineation of normal tissue structures and fat planes. With the elimination of the dental artifact, the MV-FBCT images allowed more accurate dose calculation by the tomotherapy system. It was confirmed that the phantom material density was determined correctly by the tomotherapy MV-FBCT number to density table. The ion chamber measurements agreed with the calculations from the MV-FBCT generated phantom plan within 2%. MV-FBCT may be useful in radiation treatment planning for nasopharyngeal cancer patients in the setting of extensive

  18. Advances in the implementation of helical tomotherapy-based total marrow irradiation with a novel field junction technique

    Energy Technology Data Exchange (ETDEWEB)

    Zeverino, Michele, E-mail: michele.zeverino@istge.it [Medical Physics Department, IRCCS, Istituto Nazionale per la Ricerca sul cancro, Genoa (Italy); Agostinelli, Stefano; Taccini, Gianni; Cavagnetto, Francesca; Garelli, Stefania; Gusinu, Marco [Medical Physics Department, IRCCS, Istituto Nazionale per la Ricerca sul cancro, Genoa (Italy); Vagge, Stefano; Barra, Salvina; Corvo, Renzo [Radiation Oncology Department, IRCCS, Istituto Nazionale per la Ricerca sul cancro, Genoa (Italy)

    2012-10-01

    Given the limitations in the travel ability of the helical tomotherapy (HT) couch, total marrow irradiation (TMI) has to be split in 2 segments, with the lower limbs treated with feet first orientation. The aim of this work is to present a planning technique useful to reduce the dose inhomogeneity resulting from the matching of the 2 helical dose distributions. Three HT plans were generated for each of the 18 patients enrolled. Upper TMI (UTMI) and lower TMI (LTMI) were planned onto the whole-body computed tomography (CT) and on the lower-limb CT, respectively. A twin lower TMI plan (tLTMI) was designed on the whole-body CT. Agreement between LTMI and tLTMI plans was assessed by computing for each dose-volume histogram (DVH) structure the {gamma} index scored with 1% of dose and volume difference thresholds. UTMI and tLTMI plans were summed together on the whole-body CT, enabling the evaluation of dose inhomogeneity. Moreover, a couple of transition volumes were used to improve the dose uniformity in the abutment region. For every DVH, a number of points >99% passed the {gamma} analysis, validating the method used to generate the twin plan. The planned dose inhomogeneity at the junction level resulted within {+-}10% of the prescribed dose. Median dose reduction to organs at risk ranged from 30-80% of the prescribed dose. Mean conformity index was 1.41 (range 1.36-1.44) for the whole-body target. The technique provided a 'full helical' dose distribution for TMI treatments, which can be considered effective only if the dose agreement between LTMI and tLTMI plans is met. The planning of TMI with HT for the whole body with adequate dose homogeneity and conformity was shown to be feasible.

  19. SU-F-BRB-13: Correlation of Improved Target and Organ-At-Risk Dosimetric Quantities and Clinical Outcomes for Helical Tomotherapy Treated Mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Qi, S; Kishan, A; Alexander, S; Lee, P; Selch, M; Kupelian, P; Steiberg, M; Low, D [UCLA, Los Angeles, CA (United States)

    2015-06-15

    Purpose: We have observed improved local control probability (LCP) for adjuvant mesothelioma radiotherapy following pleurectomy/decortication using Tomotherapy compared to the conventional 3D technique (p<0.05). This work assesses the correlation between the improved clinical outcomes against dosimetry quantities. Methods: Thirty-eight mesothelioma cases consecutively treated at our clinic were retrospectively analyzed. Sixteen patients were treated using 3D technique planned on the Eclipse for c-arm accelerators prior to 7/2012; the other 22 cases were treated on Tomotherapy using helical IMRT after 7/2012. Typical 3D plans consisting of 15 MV AP/PA photon fields prescribed to 10 cm depth followed by matching electron fields with energy ranging from 8–16 MeV. Tomotherapy plans were designed using 2.5cm jaw, 0.287 pitch with directional blocking of the contralateral lung. The same prescription of 45 Gy (1.8GyX25) was used for both techniques. The dosimetry metrics for the critical structures: ipsilateral-/contralateral-lung, heart, cord, esophagus, etc were compared between two techniques. Results: Superior LCP is closely associated with improved target coverage. Tomotherapy plans yielded dramatically better target coverage and less dose heterogeneity despite of more advanced/larger disease. The averaged PTV volumes were 2287.3±569.9 (Tomotherapy) vs. 1904.8±312.3cc (3D); V100s were: 91.1±4.0 (%) vs. 47.8±12.7 (%) with heterogeneity indices of 1.20±0.1 vs.1.37±0.38 and for the Tomotherapy and 3D plans, respectively. Compared to the 3D technique, we observed significant lower maximum cord doses (p<0.001), lower mean esophagus doses (p<0.002), and lower heart mean doses when tumor was left-sided (p=0.002). For ipsilateral-/contralateral-lungs, however, the mean doses and V20, V5 of Tomotherapy plans were significantly higher than the 3D plans (p<0.01) regardless which sides of lung were treated. However, rates of radiation pneumonitis were no different

  20. An automatic dose verification system for adaptive radiotherapy for helical tomotherapy

    International Nuclear Information System (INIS)

    Mo, Xiaohu; Chen, Mingli; Parnell, Donald; Olivera, Gustavo; Galmarini, Daniel; Lu, Weiguo

    2014-01-01

    Purpose: During a typical 5-7 week treatment of external beam radiotherapy, there are potential differences between planned patient's anatomy and positioning, such as patient weight loss, or treatment setup. The discrepancies between planned and delivered doses resulting from these differences could be significant, especially in IMRT where dose distributions tightly conforms to target volumes while avoiding organs-at-risk. We developed an automatic system to monitor delivered dose using daily imaging. Methods: For each treatment, a merged image is generated by registering the daily pre-treatment setup image and planning CT using treatment position information extracted from the Tomotherapy archive. The treatment dose is then computed on this merged image using our in-house convolution-superposition based dose calculator implemented on GPU. The deformation field between merged and planning CT is computed using the Morphon algorithm. The planning structures and treatment doses are subsequently warped for analysis and dose accumulation. All results are saved in DICOM format with private tags and organized in a database. Due to the overwhelming amount of information generated, a customizable tolerance system is used to flag potential treatment errors or significant anatomical changes. A web-based system and a DICOM-RT viewer were developed for reporting and reviewing the results. Results: More than 30 patients were analysed retrospectively. Our in-house dose calculator passed 97% gamma test evaluated with 2% dose difference and 2mm distance-to-agreement compared with Tomotherapy calculated dose, which is considered sufficient for adaptive radiotherapy purposes. Evaluation of the deformable registration through visual inspection showed acceptable and consistent results, except for cases with large or unrealistic deformation. Our automatic flagging system was able to catch significant patient setup errors or anatomical changes. Conclusions: We developed an automatic

  1. Intra-fraction motion of the prostate during treatment with helical tomotherapy

    International Nuclear Information System (INIS)

    Thomas, Simon J.; Ashburner, Mark; Tudor, George Samuel J.; Treeby, Jo; Dean, June; Routsis, Donna; Rimmer, Yvonne L.; Russell, Simon G.; Burnet, Neil G.

    2013-01-01

    Background and purpose: To measure the geometric uncertainty resulting from intra-fraction motion and intra-observer image matching, for patients having image-guided prostate radiotherapy on TomoTherapy. Material and methods: All patients had already been selected for prostate radiotherapy on TomoTherapy, with daily MV-CT imaging. The study involved performing an additional MV-CT image at the end of treatment, on 5 occasions during the course of 37 treatments. 54 patients were recruited to the study. A new formula was derived to calculate the PTV margin for intra-fraction motion. Results: The mean values of the intra-fraction differences were 0.0 mm, 0.5 mm, 0.5 mm and 0.0° for LR, SI, AP and roll, respectively. The corresponding standard deviations were 1.1 mm, 0.8 mm, 0.8 mm and 0.6° for systematic uncertainties (Σ), 1.3 mm, 2.0 mm, 2.2 mm and 0.3° for random uncertainties (σ). This intra-fraction motion requires margins of 2.2 mm in LR, 2.1 mm in SI and 2.1 mm in AP directions. Inclusion of estimates of the effect of rotations and matching errors increases these margins to approximately 4 mm in LR and 5 mm in SI and AP directions. Conclusions: A new margin recipe has been developed to calculate margins for intra-fraction motion. This recipe is applicable to any measurement technique that is based on the difference between images taken before and after treatment

  2. Measurement of dosimetric parameters for Hi-ART helical tomotherapy unit

    International Nuclear Information System (INIS)

    Wang Yunlai; Sha Xiangyou; Dai Xiangkun; Ma Lin; Feng Linchun; Qu Baolin

    2008-01-01

    Objective: To develop a measurement method of dosimetric parameters for Hi-ART tomotherapy unit. Methods: Percentage depth doses and beam profiles were measured using the dedicated mini water phantom, and compared to the results of 6 MV X-ray from Primus accelerator. Following the AAPM TG51 protocol, absolute dose calibration was carried out under SSD of 8.5 cm at depth of 1.5 cm for field of 5 cm x 40 cm. The output linearity and reproducibility were evaluated. The output variation with the gantry rotation was also investigated using 0.6 cm 3 ion chamber in cylindrical perplex phantom and on-board MVCT detectors. Leaf fluence output factors were quantified for the leaf of interest and its adjacent leaves. Results: The buildup depth was around 1.0 cm. The PDD values at 10 cm for Hi-ART and Primus were 59.7% and 64.7%, respectively. Varying with the field width, the lateral and longitudinal beam profiles were not so homogeneous as the Primus fields. The measured dose rate was 848.38 cGy/min. The fitted linear function between the readings of dosimeter and the irradiated time was R(nC) =-0.017 + 0.256· t(sec), with a relative coefficient of 0.999. The maximum deviation and standard deviation of output were 1.6% and less than 0.5%; The maximum deviation and standard deviation of output changed by gantry angle were 1.1% and 0.5%, respectively. Leaf fluence output factors did not increase significantly when leaves were opened beyond the two adjacent leaves. Conclusions: Hi-ART Tomotherapy unit has a very high dose output and inhomogeneous beam profiles owing to its special design of the treatment head. This may be useful in dose calculation and treatment delivery. (authors)

  3. Prostate contouring uncertainty in megavoltage computed tomography images acquired with a helical tomotherapy unit during image-guided radiation therapy

    International Nuclear Information System (INIS)

    Song, William Y.; Chiu, Bernard; Bauman, Glenn S.; Lock, Michael; Rodrigues, George; Ash, Robert; Lewis, Craig; Fenster, Aaron; Battista, Jerry J.; Van Dyk, Jake

    2006-01-01

    Purpose: To evaluate the image-guidance capabilities of megavoltage computed tomography (MVCT), this article compares the interobserver and intraobserver contouring uncertainty in kilovoltage computed tomography (KVCT) used for radiotherapy planning with MVCT acquired with helical tomotherapy. Methods and Materials: Five prostate-cancer patients were evaluated. Each patient underwent a KVCT and an MVCT study, a total of 10 CT studies. For interobserver variability analysis, four radiation oncologists, one physicist, and two radiation therapists (seven observers in total) contoured the prostate and seminal vesicles (SV) in the 10 studies. The intraobserver variability was assessed by asking all observers to repeat the contouring of 1 patient's KVCT and MVCT studies. Quantitative analysis of contour variations was performed by use of volumes and radial distances. Results: The interobserver and intraobserver contouring uncertainty was larger in MVCT compared with KVCT. Observers consistently segmented larger volumes on MVCT where the ratio of average prostate and SV volumes was 1.1 and 1.2, respectively. On average (interobserver and intraobserver), the local delineation variability, in terms of standard deviations [Δσ = √(σ 2 MVCT - σ 2 KVCT )], increased by 0.32 cm from KVCT to MVCT. Conclusions: Although MVCT was inferior to KVCT for prostate delineation, the application of MVCT in prostate radiotherapy remains useful

  4. Skin-sparing Helical Tomotherapy vs 3D-conformal Radiotherapy for Adjuvant Breast Radiotherapy: In Vivo Skin Dosimetry Study

    International Nuclear Information System (INIS)

    Capelle, Lisa; Warkentin, Heather; MacKenzie, Marc; Joseph, Kurian; Gabos, Zsolt; Pervez, Nadeem; Tankel, Keith; Chafe, Susan; Amanie, John; Ghosh, Sunita; Parliament, Matthew; Abdulkarim, Bassam

    2012-01-01

    Purpose: We investigated whether treatment-planning system (TPS)-calculated dose accurately reflects skin dose received for patients receiving adjuvant breast radiotherapy (RT) with standard three-dimensional conformal RT (3D-CRT) or skin-sparing helical tomotherapy (HT). Methods and Materials: Fifty patients enrolled in a randomized controlled trial investigating acute skin toxicity from adjuvant breast RT with 3D-CRT compared to skin-sparing HT, where a 5-mm strip of ipsilateral breast skin was spared. Thermoluminescent dosimetry or optically stimulated luminescence measurements were made in multiple locations and were compared to TPS-calculated doses. Skin dosimetric parameters and acute skin toxicity were recorded in these patients. Results: With HT there was a significant correlation between calculated and measured dose in the medial and lateral ipsilateral breast (r = 0.67, P V50 (1.4% vs 5.9%, respectively; P=.001) but higher skin V40 and skin V30 (71.7% vs 64.0%, P=.02; and 99.0% vs 93.8%, P=.001, respectively) than 3D-CRT plans. Conclusion: The 3D-CRT TPS more accurately reflected skin dose than the HT TPS, which tended to overestimate dose received by 14% in patients receiving adjuvant breast RT.

  5. Reference dosimetry for helical tomotherapy: Practical implementation and a multicenter validation

    International Nuclear Information System (INIS)

    De Ost, B.; Schaeken, B.; Vynckier, S.; Sterpin, E.; Van den Weyngaert, D.

    2011-01-01

    Purpose: The aim of this study was to implement a protocol for reference dosimetry in tomotherapy and to validate the beam output measurements with an independent dosimetry system. Methods: Beam output was measured at the reference depth of 10 cm in water for the following three cases: (1) a 5 x 10 cm 2 static machine specific reference field (MSR), (2) a rotational 5 x 10 cm 2 field without modulation and no tabletop in the beam, (3) a plan class specific reference (PCSR) field defined as a rotational homogeneous dose delivery to a cylindrical shaped target volume: plan with modulation and table-top movement. The formalism for reference dosimetry of small and nonstandard fields [Med.Phys.35: 5179-5186, 2008] and QA recommendations [Med.Phys.37: 4817-4853, 2010] were adopted in the dose measurement protocol. All ionization chamber measurements were verified independently using alanine/EPR dosimetry. As a pilot study, the beam output was measured on tomotherapy Hi-art systems at three other centers and directly compared to the centers specifications and to alanine dosimetry. Results: For the four centers, the mean static output at a depth of 10 cm in water and SAD = 85 cm, measured with an A1SL chamber following the TG-148 report was 6.238 Gy/min ± 0.058 (1 SD); the rotational output was 6.255 Gy/min ± 0.069 (1 SD). The dose stated by the center was found in good agreement with the measurements of the visiting team: D center /D visit = 1.000 ± 0.003 (1 SD). The A1SL chamber measurements were all in good agreement with Alanine/EPR dosimetry. Going from the static reference field to the rotational/non modulated field the dose rate remains constant within 0.2% except for one center where a deviation of 1.3% was detected. Conclusions: Following the TG-148 report, beam output measurements in water at the reference depth using a local protocol, as developed at different centers, was verified. The measurements were found in good agreement with alanine/EPR dosimetry. The

  6. A method for testing the performance and the accuracy of the binary MLC used in helical tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lissner, Steffen; Schubert, Kai; Klueter, Sebastian; Oetzel, Dieter; Debus, Juergen [University Hospital Heidelberg (Germany). Dept. of Radiation Oncology

    2013-08-01

    During a helical tomotherapy a binary MLC is used for fluence modulation. The 64 pneumatically driven leaves of the MLC are either completely open or closed. Th e fast and frequent leaf movements result in a high demand of accuracy and stability of the MLC. This article is based on the analytical investigation of the accuracy and the stability of the MLC. Different patterns of MLC movements were generated to investigate the characteristics of the MLC. One of the considered aspects contains the friction between the leaves. The influence of variations of the compressed air on the MLC was also explored. The integrated MVCT detector of the tomotherapy system deposits the treatment data in a matrix. The detector is triggered with the linear accelerator, which is pulsed by 300Hz. The data matrix is available after the treatment. An IDL (Interactive Data Language) routine was programmed in order to analyse the matrix. The points of time, at which the leaves open (POT), and the period, in which the leaves stay open (LOT), were measured and compared with the desired values. That procedure has been repeated several times a week for approximately 6 months to investigate the stability of the MLC. Relative deviations of the LOT from -0.4% to -5.4% were measured. The friction between the leaves had no significant influence on the LOT. The available compressed air, that is used to move the leaves, depends on the number of moving leaves and also on the previous movements of the MLC. Variations of the compressed air resulted in deviations of the LOT from -1.8% to -3.7%. The measured POT deviates from the programmed POT up to -18.4ms {+-} 0.7ms. This maximal deviation correlates with a shift of the gantry angle of 0.52 which is negligible. The MLC has shown a stable behaviour over the 6 months. A separate consideration of the leaves showed no higher standard deviation of the LOT than {+-} 0.7ms during the investigated time. The variation between the different leaves is much higher

  7. A method for testing the performance and the accuracy of the binary MLC used in helical tomotherapy

    International Nuclear Information System (INIS)

    Lissner, Steffen; Schubert, Kai; Klueter, Sebastian; Oetzel, Dieter; Debus, Juergen

    2013-01-01

    During a helical tomotherapy a binary MLC is used for fluence modulation. The 64 pneumatically driven leaves of the MLC are either completely open or closed. Th e fast and frequent leaf movements result in a high demand of accuracy and stability of the MLC. This article is based on the analytical investigation of the accuracy and the stability of the MLC. Different patterns of MLC movements were generated to investigate the characteristics of the MLC. One of the considered aspects contains the friction between the leaves. The influence of variations of the compressed air on the MLC was also explored. The integrated MVCT detector of the tomotherapy system deposits the treatment data in a matrix. The detector is triggered with the linear accelerator, which is pulsed by 300Hz. The data matrix is available after the treatment. An IDL (Interactive Data Language) routine was programmed in order to analyse the matrix. The points of time, at which the leaves open (POT), and the period, in which the leaves stay open (LOT), were measured and compared with the desired values. That procedure has been repeated several times a week for approximately 6 months to investigate the stability of the MLC. Relative deviations of the LOT from -0.4% to -5.4% were measured. The friction between the leaves had no significant influence on the LOT. The available compressed air, that is used to move the leaves, depends on the number of moving leaves and also on the previous movements of the MLC. Variations of the compressed air resulted in deviations of the LOT from -1.8% to -3.7%. The measured POT deviates from the programmed POT up to -18.4ms ± 0.7ms. This maximal deviation correlates with a shift of the gantry angle of 0.52 which is negligible. The MLC has shown a stable behaviour over the 6 months. A separate consideration of the leaves showed no higher standard deviation of the LOT than ± 0.7ms during the investigated time. The variation between the different leaves is much higher than

  8. SU-F-T-435: Helical Tomotherapy for Craniospinal Irradiation: What We Have Learned from a Multi-Institutional Study

    Energy Technology Data Exchange (ETDEWEB)

    Du, D; Kaprealian, T; Low, D; Qi, X [University of California Los Angeles, Los Angeles, CA (United States); Han, C [City of Hope National Medical Center, Los Angeles, CA (United States); Chen, J; Perez-Andujar, A [University of California San Francisco, Lafayette, CA (United States); Lee, B [University of California, Los Angeles, Los Angeles, CA (United States)

    2016-06-15

    Purpose: To report cranio-spinal irradiation (CSI) planning experience, compare dosimetric quality and delivery efficiency with Tomotherapy from different institutions, and to investigate effect of planning parameters on plan quality and treatment time. Methods: Clinical helical tomotherapy IMRT plans for thirty-nine CSI cases from three academic institutions were retrospectively evaluated. The planning parameters: field width (FW), pitch, modulation factor (MF), and achieved dosimetric endpoints were cross-compared. A fraction-dose-delivery-timing index (FDTI), defined as treatment time per fraction dose per PTV length, was utilized to evaluate plan delivery efficiency. A lower FDTI indicates higher delivery efficiency. We studied the correlation between planning quality, treatment time and planning parameters by grouping the plans under specific planning parameters. Additionally, we created new plans using 5cm jaw for a subset of plans that used 2.5cm jaw to exam if treatment efficiency can be improved without sacrificing plan quality. Results: There were significant dosimetric differences for organ at risks (OARs) among different institutions (A,B,C). Using the lowest average MF (1.9±0.4) and 5cm field width, C had the highest lung, heart, kidney, liver mean doses and maximum doses for lens. Using the same field width of 5cm, but higher MF (2.6±0.6), B had lower doses to the OARs in the thorax and abdomen area. Most of A’s plans were planned with 2.5cm jaw, the plans yielded better PTV coverage, higher OAR doses and slightly shorter FDTI compared to institution B. The replanned 5cm jaw plans achieved comparable PTV coverage and OARs sparing, while saving up to 44.7% treatment time. Conclusion: Plan quality and delivery efficiency could vary significantly in CSI planning on Tomotheapy due to choice of different planning parameters. CSI plans using a 5cm jaw, with proper selection of pitch and MF, can achieve comparable/ better plan quality with shorter

  9. Comparison of the effectiveness of different immobilization systems in different body regions using daily megavoltage CT in helical tomotherapy

    Science.gov (United States)

    Cheng, K-F

    2014-01-01

    Objective: Effective immobilization is crucial for the accurate delivery of radiotherapy. This study aimed to compare the effectiveness of the commonly used immobilization systems for different body regions using megavoltage CT (MVCT). Methods: Daily treatment set-up data from 212 patients treated by helical tomotherapy (Accuray, Sunnyvale, CA) in 6 body regions (52 head and neck, 41 chest, 38 abdomen, 36 pelvis, 18 breast and 27 cranium) were obtained. Based on a verification tool using the pre-treatment MVCT, set-up corrections for each patient were recorded. Mean systematic and random errors of lateral, longitudinal, vertical and roll directions and three-dimensional vectors were compared between immobilization systems of each region. Results: Smaller set-up deviations were observed in the Orfit system (Orfit Industries NV, Wijnegem, Belgium) of the head and neck region, while the performance of immobilization systems for the chest, abdomen and pelvis regions was similar. Larger differences were noted in the breast group, where the prone BodyFIX® system (Medical Intelligence, Medizintechnik GmbH, Schwabmünchen, Germany) was less stable than the supine VacLok® system (CIVCO Medical Solutions, Orange City, IA). Conclusion: Differences were found between the immobilization systems in the head and neck region, in which the Orfit system was relatively more effective, whereas the VacLok and BodyFIX systems performed similarly in the chest, abdomen and pelvis regions. For the breast case, the supine position with VacLok was much more stable than the prone breast technique. The results provided references for the estimation of clinical target volume–planning target volume margins. Advances in knowledge: This is the first article on comprehensive comparisons performed in immobilization systems for main body regions that provides some practical recommendations. PMID:24398111

  10. Fast Megavoltage Computed Tomography: A Rapid Imaging Method for Total Body or Marrow Irradiation in Helical Tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Magome, Taiki [Department of Radiological Sciences, Faculty of Health Sciences, Komazawa University, Tokyo (Japan); Department of Radiology, The University of Tokyo Hospital, Tokyo (Japan); Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota (United States); Haga, Akihiro [Department of Radiology, The University of Tokyo Hospital, Tokyo (Japan); Takahashi, Yutaka [Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota (United States); Department of Radiation Oncology, Osaka University, Osaka (Japan); Nakagawa, Keiichi [Department of Radiology, The University of Tokyo Hospital, Tokyo (Japan); Dusenbery, Kathryn E. [Department of Therapeutic Radiology, University of Minnesota, Minneapolis, Minnesota (United States); Hui, Susanta K., E-mail: shui@coh.org [Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota (United States); Department of Therapeutic Radiology, University of Minnesota, Minneapolis, Minnesota (United States); Department of Radiation Oncology and Beckman Research Institute, City of Hope, Duarte, California (United States)

    2016-11-01

    Purpose: Megavoltage computed tomographic (MVCT) imaging has been widely used for the 3-dimensional (3-D) setup of patients treated with helical tomotherapy (HT). One drawback of MVCT is its very long imaging time, the result of slow couch speeds of approximately 1 mm/s, which can be difficult for the patient to tolerate. We sought to develop an MVCT imaging method allowing faster couch speeds and to assess its accuracy for image guidance for HT. Methods and Materials: Three cadavers were scanned 4 times with couch speeds of 1, 2, 3, and 4 mm/s. The resulting MVCT images were reconstructed using an iterative reconstruction (IR) algorithm with a penalty term of total variation and with a conventional filtered back projection (FBP) algorithm. The MVCT images were registered with kilovoltage CT images, and the registration errors from the 2 reconstruction algorithms were compared. This fast MVCT imaging was tested in 3 cases of total marrow irradiation as a clinical trial. Results: The 3-D registration errors of the MVCT images reconstructed with the IR algorithm were smaller than the errors of images reconstructed with the FBP algorithm at fast couch speeds (2, 3, 4 mm/s). The scan time and imaging dose at a speed of 4 mm/s were reduced to 30% of those from a conventional coarse mode scan. For the patient imaging, faster MVCT (3 mm/s couch speed) scanning reduced the imaging time and still generated images useful for anatomic registration. Conclusions: Fast MVCT with the IR algorithm is clinically feasible for large 3-D target localization, which may reduce the overall time for the treatment procedure. This technique may also be useful for calculating daily dose distributions or organ motion analyses in HT treatment over a wide area. Automated integration of this imaging is at least needed to further assess its clinical benefits.

  11. Conformal radiotherapy by intensity modulation of pediatrics tumors; Radiotherapie conformationnelle par modulation d'intensite des tumeurs pediatriques

    Energy Technology Data Exchange (ETDEWEB)

    Leseur, J.; Le Prise, E. [Centre Eugene-Marquis, 35 - Rennes (France); Carrie, C. [Centre Leon Berard, 69 - Lyon (France); Bernier, V. [Centre Alexis-Vautrin, 54 - Nancy (France); Beneyton, V. [Centre Paul-Strauss, 67 - Strasbourg (France); Mahe, M.A.; Supiot, S. [Centre Rene-Gauducheau, 44 - Nantes (France)

    2009-10-15

    The objective of this study is to take stock on the validated and potential indications of the conformal radiotherapy with intensity modulation ( intensity modulated radiotherapy I.M.R.T.) in pediatrics and to propose recommendations for its use as well as the adapted dose constraints. About 40 to 50% of children treated for a cancer are irradiated. The I.M.R.T., by linear accelerator or helical tomo-therapy has for aim to give a homogenous dose to the target volume and to save organs at risk. Its use in pediatrics seems particularly interesting because of the complexity of target volumes and the closeness of organs at risk. In compensation for these positive elements, the importance of low doses irradiation given in big volumes makes fear event consequences on growth and an increased incidence of secondary cancers in children suffering from tumors with high cure rates and long life expectancy. (N.C.)

  12. Measurement of MV CT dose index for Hi-ART helical tomotherapy unit

    International Nuclear Information System (INIS)

    Wang Yunlai; Liao Xiongfei

    2010-01-01

    Objective: To evaluate the patient dose from Hi-ART MV helical CT imaging in image-guided radiotherapy. Methods: Weighted CT dose index (CTDI W ) was measured with PTW TM30009 CT ion chamber in head and body phantoms, respectively,for slice thicknesses of 2, 4, 6 mm with scanned range of 5 cm and 15 cm. Dose length products (DLP) were subsequently calculated. The CTDI W and DLP were compared with XVI kV CBCT and ACQSim simulator CT for routine clinical protocols. Results: An inverse relationship between CTDI and the slice thickness was found. The dose distribution was inhomogeneous owing to the attenuation of the couch. CTDI and DLP had close relationship with the slice thickness and the scanned range. Patient dose from MVCT was lower than XVI CBCT for head, but larger for body scan. Conclusions: CTDI W can be used to assess the patient dose in MV helical CT due to its simplicity for measurement and reproducibility. Regular measurement should be performed in QA and QC program. Appropriate slice thickness and scan range should be chosen to reduce the patient dose. (authors)

  13. Three dimensional conformal irradiation with intensity modulation by tomo-therapy at the skull base in three patients with a acrochordoma and a patient with a chondrosarcoma; Irradiation conformationnelle tridimensionnelle avec modulation d'intensite par tomotherapie de la base du crane chez 3 patients atteints d'un chordome et un patient atteint d'un chondrosarcome

    Energy Technology Data Exchange (ETDEWEB)

    Noel, G.; Meyer, P.; Niederst, C.; Antoni, D.; Karamanoukian, D. [Centre de lutte contre le cancer Paul-Strauss, 67 - Strasbourg (France); Froelich, S.; Boyer, P. [Hopital Universitaire de Hautepierre, 67 - Strasbourg (France); George, B. [Hopital Universitaire Lariboisiere, AP-HP, 75 - Paris (France)

    2009-10-15

    The tomo-therapy of acrochordomas and chondrosarcomas of the skull base is possible. The dose distribution is satisfying the tolerance is acceptable. A dosimetry comparison with protons is being. (N.C.)

  14. Dosimetric comparison of helical tomotherapy, RapidArc, and a novel IMRT and Arc technique for esophageal carcinoma

    International Nuclear Information System (INIS)

    Martin, Spencer; Chen, Jeff Z.; Rashid Dar, A.; Yartsev, Slav

    2011-01-01

    Purpose: To compare radiotherapy treatment plans for mid- and distal-esophageal cancer with primary involvement of the gastroesophageal (GE) junction using a novel IMRT and Arc technique (IMRT and Arc), helical tomotherapy (HT), and RapidArc (RA1 and RA2). Methods and materials: Eight patients treated on HT for locally advanced esophageal cancer with radical intent were re-planned for RA and IMRT and Arc. RA plans employed single and double arcs (RA1 and RA2, respectively), while IMRT and Arc plans had four fixed-gantry IMRT fields and a conformal arc. Dose-volume histogram statistics, dose uniformity, and dose homogeneity were analyzed to compare treatment plans. Results: RA2 plans showed significant improvement over RA1 plans in terms of OAR dose and PTV dose uniformity and homogeneity. HT plan provided best dose uniformity (p = 0.001) and dose homogeneity (p = 0.002) to planning target volume (PTV), while IMRT and Arc and RA2 plans gave lowest dose to lungs among four radiotherapy techniques with acceptable PTV dose coverage. Mean V 10 of the lungs was significantly reduced by the RA2 plans compared to IMRT and Arc (40.3%, p = 0.001) and HT (66.2%, p 15 of the lungs for the RA2 plans also showed significant improvement over the IMRT and Arc (25.2%, p = 0.042) and HT (34.8%, p = 0.027) techniques. These improvements came at the cost of higher doses to the heart volume compared to HT and IMRT and Arc techniques. Mean lung dose (MLD) for the IMRT and Arc technique (21.2 ± 5.0% of prescription dose) was significantly reduced compared to HT (26.3%, p = 0.004), RA1 (23.3%, p = 0.028), and RA2 (23.2%, p = 0.017) techniques. Conclusion: The IMRT and Arc technique is a good option for treating esophageal cancer with thoracic involvement. It achieved optimal low dose to the lungs and heart with acceptable PTV coverage. HT is a good option for treating esophageal cancer with little thoracic involvement as it achieves superior dose conformality and uniformity. The RA2

  15. Toxic risk of stereotactic body radiotherapy and concurrent helical tomotherapy followed by erlotinib for non-small-cell lung cancer treatment - case report

    Directory of Open Access Journals (Sweden)

    Chen Chien-An

    2010-12-01

    Full Text Available Abstract Background Stereotactic body radiation therapy (SBRT applied by helical tomotherapy (HT is feasible for lung cancer in clinical. Using SBRT concurrently with erlotinib for non-small cell lung cancer (NSCLC is not reported previously. Case Presentation A 77-year-old man with stage III NSCLC, received erlotinib 150 mg/day, combined with image-guided SBRT via HT. A total tumor dose of 54 Gy/9 fractions was delivered to the tumor bed. The tumor responded dramatically and the combined regimen was well tolerated. After concurrent erlotinib-SBRT, erlotinib was continued as maintenance therapy. The patient developed dyspnea three months after the combined therapy and radiation pneumonitis with interstitial lung disease was suspected. Conclusions Combination SBRT, HT, and erlotinib therapy provided effective anti-tumor results. Nonetheless, the potential risks of enhanced adverse effects between radiation and erlotinib should be monitored closely, especially when SBRT is part of the regimen.

  16. Toxic risk of stereotactic body radiotherapy and concurrent helical tomotherapy followed by erlotinib for non-small-cell lung cancer treatment - case report

    International Nuclear Information System (INIS)

    Hsieh, Chen-Hsi; Chen, Chun-Yi; Shueng, Pei-Wei; Chang, Hou-Tai; Lin, Shih-Chiang; Chen, Yu-Jen; Wang, Li-Ying; Hsieh, Yen-Ping; Chen, Chien-An; Chong, Ngot-Swan; Lin, Shoei Long

    2010-01-01

    Stereotactic body radiation therapy (SBRT) applied by helical tomotherapy (HT) is feasible for lung cancer in clinical. Using SBRT concurrently with erlotinib for non-small cell lung cancer (NSCLC) is not reported previously. A 77-year-old man with stage III NSCLC, received erlotinib 150 mg/day, combined with image-guided SBRT via HT. A total tumor dose of 54 Gy/9 fractions was delivered to the tumor bed. The tumor responded dramatically and the combined regimen was well tolerated. After concurrent erlotinib-SBRT, erlotinib was continued as maintenance therapy. The patient developed dyspnea three months after the combined therapy and radiation pneumonitis with interstitial lung disease was suspected. Combination SBRT, HT, and erlotinib therapy provided effective anti-tumor results. Nonetheless, the potential risks of enhanced adverse effects between radiation and erlotinib should be monitored closely, especially when SBRT is part of the regimen

  17. Image-guided total-marrow irradiation using helical tomotherapy in patients with multiple myeloma and acute leukemia undergoing hematopoietic cell transplantation.

    Science.gov (United States)

    Wong, Jeffrey Y C; Rosenthal, Joseph; Liu, An; Schultheiss, Timothy; Forman, Stephen; Somlo, George

    2009-01-01

    Total-body irradiation (TBI) has an important role in patients undergoing hematopoietic cell transplantation (HCT), but is associated with significant toxicities. Targeted TBI using helical tomotherapy results in reduced doses to normal organs, which predicts for reduced toxicities compared with standard TBI. Thirteen patients with multiple myeloma were treated in an autologous tandem transplantation Phase I trial with high-dose melphalan, followed 6 weeks later by total-marrow irradiation (TMI) to skeletal bone. Dose levels were 10, 12, 14, and 16 Gy at 2 Gy daily/twice daily. In a separate allogeneic HCT trial, 8 patients (5 with acute myelogenous leukemia, 1 with acute lymphoblastic leukemia, 1 with non-Hodgkin's lymphoma, and 1 with multiple myeloma) were treated with TMI plus total lymphoid irradiation plus splenic radiotherapy to 12 Gy (1.5 Gy twice daily) combined with fludarabine/melphalan. For the 13 patients in the tandem autologous HCT trial, median age was 54 years (range, 42-66 years). Median organ doses were 15-65% that of the gross target volume dose. Primarily Grades 1-2 acute toxicities were observed. Six patients reported no vomiting; 9 patients, no mucositis; 6 patients, no fatigue; and 8 patients, no diarrhea. For the 8 patients in the allogeneic HCT trial, median age was 52 years (range, 24-61 years). Grades 2-3 nausea, vomiting, mucositis, and diarrhea were observed. In both trials, no Grade 4 nonhematologic toxicity was observed, and all patients underwent successful engraftment. This study shows that TMI using helical tomotherapy is clinically feasible. The reduced acute toxicities observed compare favorably with those seen with standard TBI. Initial results are encouraging and warrant further evaluation as a method to dose escalate with acceptable toxicity or to offer TBI-containing regimens to patients unable to tolerate standard approaches.

  18. Image-Guided Total-Marrow Irradiation Using Helical Tomotherapy in Patients With Multiple Myeloma and Acute Leukemia Undergoing Hematopoietic Cell Transplantation

    International Nuclear Information System (INIS)

    Wong, Jeffrey Y.C.; Rosenthal, Joseph; Liu An; Schultheiss, Timothy; Forman, Stephen; Somlo, George

    2009-01-01

    Purpose: Total-body irradiation (TBI) has an important role in patients undergoing hematopoietic cell transplantation (HCT), but is associated with significant toxicities. Targeted TBI using helical tomotherapy results in reduced doses to normal organs, which predicts for reduced toxicities compared with standard TBI. Methods and Materials: Thirteen patients with multiple myeloma were treated in an autologous tandem transplantation Phase I trial with high-dose melphalan, followed 6 weeks later by total-marrow irradiation (TMI) to skeletal bone. Dose levels were 10, 12, 14, and 16 Gy at 2 Gy daily/twice daily. In a separate allogeneic HCT trial, 8 patients (5 with acute myelogenous leukemia, 1 with acute lymphoblastic leukemia, 1 with non-Hodgkin's lymphoma, and 1 with multiple myeloma) were treated with TMI plus total lymphoid irradiation plus splenic radiotherapy to 12 Gy (1.5 Gy twice daily) combined with fludarabine/melphalan. Results: For the 13 patients in the tandem autologous HCT trial, median age was 54 years (range, 42-66 years). Median organ doses were 15-65% that of the gross target volume dose. Primarily Grades 1-2 acute toxicities were observed. Six patients reported no vomiting; 9 patients, no mucositis; 6 patients, no fatigue; and 8 patients, no diarrhea. For the 8 patients in the allogeneic HCT trial, median age was 52 years (range, 24-61 years). Grades 2-3 nausea, vomiting, mucositis, and diarrhea were observed. In both trials, no Grade 4 nonhematologic toxicity was observed, and all patients underwent successful engraftment. Conclusions: This study shows that TMI using helical tomotherapy is clinically feasible. The reduced acute toxicities observed compare favorably with those seen with standard TBI. Initial results are encouraging and warrant further evaluation as a method to dose escalate with acceptable toxicity or to offer TBI-containing regimens to patients unable to tolerate standard approaches

  19. Maximum likelihood as a common computational framework in tomotherapy

    International Nuclear Information System (INIS)

    Olivera, G.H.; Shepard, D.M.; Reckwerdt, P.J.; Ruchala, K.; Zachman, J.; Fitchard, E.E.; Mackie, T.R.

    1998-01-01

    Tomotherapy is a dose delivery technique using helical or axial intensity modulated beams. One of the strengths of the tomotherapy concept is that it can incorporate a number of processes into a single piece of equipment. These processes include treatment optimization planning, dose reconstruction and kilovoltage/megavoltage image reconstruction. A common computational technique that could be used for all of these processes would be very appealing. The maximum likelihood estimator, originally developed for emission tomography, can serve as a useful tool in imaging and radiotherapy. We believe that this approach can play an important role in the processes of optimization planning, dose reconstruction and kilovoltage and/or megavoltage image reconstruction. These processes involve computations that require comparable physical methods. They are also based on equivalent assumptions, and they have similar mathematical solutions. As a result, the maximum likelihood approach is able to provide a common framework for all three of these computational problems. We will demonstrate how maximum likelihood methods can be applied to optimization planning, dose reconstruction and megavoltage image reconstruction in tomotherapy. Results for planning optimization, dose reconstruction and megavoltage image reconstruction will be presented. Strengths and weaknesses of the methodology are analysed. Future directions for this work are also suggested. (author)

  20. Intensity-Modulated Whole Abdominal Radiotherapy After Surgery and Carboplatin/Taxane Chemotherapy for Advanced Ovarian Cancer: Phase I Study

    International Nuclear Information System (INIS)

    Rochet, Nathalie; Sterzing, Florian; Jensen, Alexandra D.; Dinkel, Julien; Herfarth, Klaus K.; Schubert, Kai; Eichbaum, Michael H.; Schneeweiss, Andreas; Sohn, Christof; Debus, Juergen; Harms, Wolfgang

    2010-01-01

    Purpose: To assess the feasibility and toxicity of consolidative intensity-modulated whole abdominal radiotherapy (WAR) after surgery and chemotherapy in high-risk patients with advanced ovarian cancer. Methods and Materials: Ten patients with optimally debulked ovarian cancer International Federation of Gynecology and Obstetrics Stage IIIc were treated in a Phase I study with intensity-modulated WAR up to a total dose of 30 Gy in 1.5-Gy fractions as consolidation therapy after adjuvant carboplatin/taxane chemotherapy. Treatment was delivered using intensity-modulated radiotherapy in a step-and-shoot technique (n = 3) or a helical tomotherapy technique (n = 7). The planning target volume included the entire peritoneal cavity and the pelvic and para-aortal node regions. Organs at risk were kidneys, liver, heart, vertebral bodies, and pelvic bones. Results: Intensity-modulated WAR resulted in an excellent coverage of the planning target volume and an effective sparing of the organs at risk. The treatment was well tolerated, and no severe Grade 4 acute side effects occurred. Common Toxicity Criteria Grade III toxicities were as follows: diarrhea (n = 1), thrombocytopenia (n = 1), and leukopenia (n = 3). Radiotherapy could be completed by all the patients without any toxicity-related interruption. Median follow-up was 23 months, and 4 patients had tumor recurrence (intraperitoneal progression, n = 3; hepatic metastasis, n = 1). Small bowel obstruction caused by adhesions occurred in 3 patients. Conclusions: The results of this Phase I study showed for the first time, to our knowledge, the clinical feasibility of intensity-modulated whole abdominal radiotherapy, which could offer a new therapeutic option for consolidation treatment of advanced ovarian carcinoma after adjuvant chemotherapy in selected subgroups of patients. We initiated a Phase II study to further evaluate the toxicity of this intensive multimodal treatment.

  1. Intensity-modulated whole abdominal radiotherapy after surgery and carboplatin/taxane chemotherapy for advanced ovarian cancer: phase I study.

    Science.gov (United States)

    Rochet, Nathalie; Sterzing, Florian; Jensen, Alexandra D; Dinkel, Julien; Herfarth, Klaus K; Schubert, Kai; Eichbaum, Michael H; Schneeweiss, Andreas; Sohn, Christof; Debus, Juergen; Harms, Wolfgang

    2010-04-01

    To assess the feasibility and toxicity of consolidative intensity-modulated whole abdominal radiotherapy (WAR) after surgery and chemotherapy in high-risk patients with advanced ovarian cancer. Ten patients with optimally debulked ovarian cancer International Federation of Gynecology and Obstetrics Stage IIIc were treated in a Phase I study with intensity-modulated WAR up to a total dose of 30 Gy in 1.5-Gy fractions as consolidation therapy after adjuvant carboplatin/taxane chemotherapy. Treatment was delivered using intensity-modulated radiotherapy in a step-and-shoot technique (n = 3) or a helical tomotherapy technique (n = 7). The planning target volume included the entire peritoneal cavity and the pelvic and para-aortal node regions. Organs at risk were kidneys, liver, heart, vertebral bodies, and pelvic bones. Intensity-modulated WAR resulted in an excellent coverage of the planning target volume and an effective sparing of the organs at risk. The treatment was well tolerated, and no severe Grade 4 acute side effects occurred. Common Toxicity Criteria Grade III toxicities were as follows: diarrhea (n = 1), thrombocytopenia (n = 1), and leukopenia (n = 3). Radiotherapy could be completed by all the patients without any toxicity-related interruption. Median follow-up was 23 months, and 4 patients had tumor recurrence (intraperitoneal progression, n = 3; hepatic metastasis, n = 1). Small bowel obstruction caused by adhesions occurred in 3 patients. The results of this Phase I study showed for the first time, to our knowledge, the clinical feasibility of intensity-modulated whole abdominal radiotherapy, which could offer a new therapeutic option for consolidation treatment of advanced ovarian carcinoma after adjuvant chemotherapy in selected subgroups of patients. We initiated a Phase II study to further evaluate the toxicity of this intensive multimodal treatment.

  2. Helical Tomotherapy-Based STAT Stereotactic Body Radiation Therapy: Dosimetric Evaluation for a Real-Time SBRT Treatment Planning and Delivery Program

    International Nuclear Information System (INIS)

    Dunlap, Neal; McIntosh, Alyson; Sheng Ke; Yang Wensha; Turner, Benton; Shoushtari, Asal; Sheehan, Jason; Jones, David R.; Lu Weigo; Ruchala, Keneth; Olivera, Gustavo; Parnell, Donald; Larner, James L.; Benedict, Stanley H.; Read, Paul W.

    2010-01-01

    Stereotactic body radiation therapy (SBRT) treatments have high-dose gradients and even slight patient misalignment from the simulation to treatment could lead to target underdosing or organ at risk (OAR) overdosing. Daily real-time SBRT treatment planning could minimize the risk of geographic miss. As an initial step toward determining the clinical feasibility of developing real-time SBRT treatment planning, we determined the calculation time of helical TomoTherapy-based STAT radiation therapy (RT) treatment plans for simple liver, lung, and spine SBRT treatments to assess whether the planning process was fast enough for practical clinical implementation. Representative SBRT planning target volumes for hypothetical liver, peripheral lung, and thoracic spine lesions and adjacent OARs were contoured onto a planning computed tomography scan (CT) of an anthropomorphic phantom. Treatment plans were generated using both STAT RT 'full scatter' and conventional helical TomoTherapy 'beamlet' algorithms. Optimized plans were compared with respect to conformality index (CI), heterogeneity index (HI), and maximum dose to regional OARs to determine clinical equivalence and the number of required STAT RT optimization iterations and calculation times were determined. The liver and lung dosimetry for the STAT RT and standard planning algorithms were clinically and statistically equivalent. For the liver lesions, 'full scatter' and 'beamlet' algorithms showed a CI of 1.04 and 1.04 and HI of 1.03 and 1.03, respectively. For the lung lesions, 'full scatter' and 'beamlet' algorithms showed a CI of 1.05 and 1.03 and HI of 1.05and 1.05, respectively. For spine lesions, 'full scatter' and 'beamlet' algorithms showed a CI of 1.15 and 1.14 and HI of 1.22 and 1.14, respectively. There was no difference between treatment algorithms with respect to maximum doses to the OARs. The STAT RT iteration time with current treatment planning systems is 45 sec, and the treatment planning required 3

  3. Patient- and therapy-related factors associated with the incidence of xerostomia in nasopharyngeal carcinoma patients receiving parotid-sparing helical tomotherapy.

    Science.gov (United States)

    Lee, Tsair-Fwu; Liou, Ming-Hsiang; Ting, Hui-Min; Chang, Liyun; Lee, Hsiao-Yi; Wan Leung, Stephen; Huang, Chih-Jen; Chao, Pei-Ju

    2015-08-20

    We investigated the incidence of moderate to severe patient-reported xerostomia among nasopharyngeal carcinoma (NPC) patients treated with helical tomotherapy (HT) and identified patient- and therapy-related factors associated with acute and chronic xerostomia toxicity. The least absolute shrinkage and selection operator (LASSO) normal tissue complication probability (NTCP) models were developed using quality-of-life questionnaire datasets from 67 patients with NPC. For acute toxicity, the dosimetric factors of the mean doses to the ipsilateral submandibular gland (Dis) and the contralateral submandibular gland (Dcs) were selected as the first two significant predictors. For chronic toxicity, four predictive factors were selected: age, mean dose to the oral cavity (Doc), education, and T stage. The substantial sparing data can be used to avoid xerostomia toxicity. We suggest that the tolerance values corresponded to a 20% incidence of complications (TD20) for Dis = 39.0 Gy, Dcs = 38.4 Gy, and Doc = 32.5 Gy, respectively, when mean doses to the parotid glands met the QUANTEC 25 Gy sparing guidelines. To avoid patient-reported xerostomia toxicity, the mean doses to the parotid gland, submandibular gland, and oral cavity have to meet the sparing tolerance, although there is also a need to take inherent patient characteristics into consideration.

  4. A Dosimetric Comparison of Accelerated Partial Breast Irradiation Techniques: Multicatheter Interstitial Brachytherapy, Three-Dimensional Conformal Radiotherapy, and Supine Versus Prone Helical Tomotherapy

    International Nuclear Information System (INIS)

    Patel, Rakesh R.; Becker, Stewart J.; Das, Rupak K.; Mackie, Thomas R.

    2007-01-01

    Purpose: To compare dosimetrically four different techniques of accelerated partial breast irradiation (APBI) in the same patient. Methods and Materials: Thirteen post-lumpectomy interstitial brachytherapy (IB) patients underwent imaging with preimplant computed tomography (CT) in the prone and supine position. These CT scans were then used to generate three-dimensional conformal radiotherapy (3D-CRT) and prone and supine helical tomotherapy (PT and ST, respectively) APBI plans and compared with the treated IB plans. Dose-volume histogram analysis and the mean dose (NTD mean ) values were compared. Results: Planning target volume coverage was excellent for all methods. Statistical significance was considered to be a p value mean dose of 1.3 Gy 3 and 1.2 Gy 3 , respectively. Both of these methods were statistically significantly lower than the supine external beam techniques. Overall, all four methods yielded similar low doses to the heart. Conclusions: The use of IB and PT resulted in greater normal tissue sparing (especially ipsilateral breast and lung) than the use of supine external beam techniques of 3D-CRT or ST. However, the choice of APBI technique must be tailored to the patient's anatomy, lumpectomy cavity location, and overall treatment goals

  5. Intensity modulated radiotherapy for elderly bladder cancer patients

    International Nuclear Information System (INIS)

    Hsieh, Chen-Hsi; Wang, Li-Ying; Hsieh, Yen-Ping; Shueng, Pei-Wei; Chung, Shiu-Dong; Chan, Pei-Hui; Lai, Siu-Kai; Chang, Hsiao-Chun; Hsiao, Chi-Huang; Wu, Le-Jung; Chong, Ngot-Swan; Chen, Yu-Jen

    2011-01-01

    To review our experience and evaluate treatment planning using intensity-modulated radiotherapy (IMRT) and helical tomotherapy (HT) for the treatment of elderly patients with bladder cancer. From November 2006 through November 2009, we enrolled 19 elderly patients with histologically confirmed bladder cancer, 9 in the IMRT and 10 in the HT group. The patients received 64.8 Gy to the bladder with or without concurrent chemotherapy. Conventional 4-field 'box' pelvic radiation therapy (2DRT) plans were generated for comparison. The median patient age was 80 years old (range, 65-90 years old). The median survival was 21 months (5 to 26 months). The actuarial 2-year overall survival (OS) for the IMRT vs. the HT group was 26.3% vs .37.5%, respectively; the corresponding values for disease-free survival were 58.3% vs. 83.3%, respectively; for locoregional progression-free survival (LRPFS), the values were 87.5% vs. 83.3%, respectively; and for metastases-free survival, the values were 66.7% vs. 60.0%, respectively. The 2-year OS rates for T1, 2 vs. T3, 4 were 66.7% vs. 35.4%, respectively (p = 0.046). The 2-year OS rate was poor for those whose RT completion time greater than 8 weeks when compared with the RT completed within 8 wks (37.9% vs. 0%, p = 0.004). IMRT and HT provide good LRPFS with tolerable toxicity for elderly patients with invasive bladder cancer. IMRT and HT dosimetry and organ sparing capability were superior to that of 2DRT, and HT provides better sparing ability than IMRT. The T category and the RT completion time influence OS rate

  6. Intensity modulated radiotherapy for elderly bladder cancer patients

    Directory of Open Access Journals (Sweden)

    Chong Ngot-Swan

    2011-06-01

    Full Text Available Abstract Background To review our experience and evaluate treatment planning using intensity-modulated radiotherapy (IMRT and helical tomotherapy (HT for the treatment of elderly patients with bladder cancer. Methods From November 2006 through November 2009, we enrolled 19 elderly patients with histologically confirmed bladder cancer, 9 in the IMRT and 10 in the HT group. The patients received 64.8 Gy to the bladder with or without concurrent chemotherapy. Conventional 4-field "box" pelvic radiation therapy (2DRT plans were generated for comparison. Results The median patient age was 80 years old (range, 65-90 years old. The median survival was 21 months (5 to 26 months. The actuarial 2-year overall survival (OS for the IMRT vs. the HT group was 26.3% vs .37.5%, respectively; the corresponding values for disease-free survival were 58.3% vs. 83.3%, respectively; for locoregional progression-free survival (LRPFS, the values were 87.5% vs. 83.3%, respectively; and for metastases-free survival, the values were 66.7% vs. 60.0%, respectively. The 2-year OS rates for T1, 2 vs. T3, 4 were 66.7% vs. 35.4%, respectively (p = 0.046. The 2-year OS rate was poor for those whose RT completion time greater than 8 weeks when compared with the RT completed within 8 wks (37.9% vs. 0%, p = 0.004. Conclusion IMRT and HT provide good LRPFS with tolerable toxicity for elderly patients with invasive bladder cancer. IMRT and HT dosimetry and organ sparing capability were superior to that of 2DRT, and HT provides better sparing ability than IMRT. The T category and the RT completion time influence OS rate.

  7. Comparative analysis of 60Co intensity-modulated radiation therapy

    International Nuclear Information System (INIS)

    Fox, Christopher; Romeijn, H Edwin; Lynch, Bart; Dempsey, James F; Men, Chunhua; Aleman, Dionne M

    2008-01-01

    In this study, we perform a scientific comparative analysis of using 60 Co beams in intensity-modulated radiation therapy (IMRT). In particular, we evaluate the treatment plan quality obtained with (i) 6 MV, 18 MV and 60 Co IMRT; (ii) different numbers of static multileaf collimator (MLC) delivered 60 Co beams and (iii) a helical tomotherapy 60 Co beam geometry. We employ a convex fluence map optimization (FMO) model, which allows for the comparison of plan quality between different beam energies and configurations for a given case. A total of 25 clinical patient cases that each contain volumetric CT studies, primary and secondary delineated targets, and contoured structures were studied: 5 head-and-neck (H and N), 5 prostate, 5 central nervous system (CNS), 5 breast and 5 lung cases. The DICOM plan data were anonymized and exported to the University of Florida optimized radiation therapy (UFORT) treatment planning system. The FMO problem was solved for each case for 5-71 equidistant beams as well as a helical geometry for H and N, prostate, CNS and lung cases, and for 3-7 equidistant beams in the upper hemisphere for breast cases, all with 6 MV, 18 MV and 60 Co dose models. In all cases, 95% of the target volumes received at least the prescribed dose with clinical sparing criteria for critical organs being met for all structures that were not wholly or partially contained within the target volume. Improvements in critical organ sparing were found with an increasing number of equidistant 60 Co beams, yet were marginal above 9 beams for H and N, prostate, CNS and lung. Breast cases produced similar plans for 3-7 beams. A helical 60 Co beam geometry achieved similar plan quality as static plans with 11 equidistant 60 Co beams. Furthermore, 18 MV plans were initially found not to provide the same target coverage as 6 MV and 60 Co plans; however, adjusting the trade-offs in the optimization model allowed equivalent target coverage for 18 MV. For plans with comparable

  8. Tomotherapy: IMRT and tomographic verification

    International Nuclear Information System (INIS)

    Mackie, T.R.

    2000-01-01

    Full text: External beam radiation therapy delivery began around the turn of the century with the use of one or a few kilovoltage beams directed to the presumed site of the tumor. Often the treatment lasted until erythema dose was reached. Delivering the beams rotationally allowed the dose to be focused on the tumor and the skin to be spared. With the advent of megavoltage radiation therapy in the 1950's, using Co-60 teletherapy and betatrons, the treatment could once again be delivered from only a few beam directions and the dose to the skin would be kept below tolerance. Fields were shaped by lead blocks and later by custom-made blocks fabricated from low-melting temperature heavy metal. Linear accelerators did not fundamentally change the way in which radiation was delivered. It is likely that this delivery paradigm would not have changed had it not been for the advent of computers. Brahme and Cormack showed in the late 1980's that highly conformal treatments could be delivered with non-uniform intensity beams. At that time the only way in which the intensity modulated beams could be delivered was using custom-milled compensators. Fabricating and using compensators for multiple fields is time-consuming and labor-intensive. Serial tomotherapy was the first successful delivery method for IMRT and went back to the earlier practice of rotation therapy. The NOMOS Peacock system uses a binary (on-off) multileaf collimator (MLC) system to modulate a fan beam of radiation. It uses an optimization system to determine when leaves should be opened and closed. The system delivers two beam slices at once and the couch is indexed to the next slices by precisely translating the couch. This approach was first used in 1994 and to-date has treated several thousand patients. Prior to the advent of IMRT, accelerator vendors introduced the multileaf collimator (MLC) to provide field shaping without the need to fabricate custom blocking. Most new linear accelerator purchases today

  9. Three-dimensional analysis of the respiratory interplay effect in helical tomotherapy: Baseline variations cause the greater part of dose inhomogeneities seen.

    Science.gov (United States)

    Tudor, G Samuel J; Harden, Susan V; Thomas, Simon J

    2014-03-01

    Dose differences from those planned can occur due to the respiratory interplay effect on helical tomotherapy. The authors present a technique to calculate single-fraction doses in three-dimensions resulting from craniocaudal motion applied to a patient CT set. The technique is applied to phantom and patient plans using patient respiratory traces. An additional purpose of the work is to determine the contribution toward the interplay effect of different components of the respiratory trace. MATLAB code used to calculate doses to a CT dataset from a helical tomotherapy plan has been modified to permit craniocaudal motion and improved temporal resolution. Real patient traces from seven patients were applied to ten phantom plans of differing field width, modulation factor, pitch and fraction dose, and simulations made with peak-to-peak amplitudes ranging from 0 to 2.5 cm. PTV voxels near the superior or inferior limits of the PTV are excluded from the analysis. The maximum dose discrepancy compared with the static case recorded along with the proportion of voxels receiving more than 10% and 20% different from prescription dose. The analysis was repeated with the baseline variation of the respiratory trace removed, leaving the cyclic component of motion only. Radiochromic film was used on one plan-trace combination and compared with the software simulation. For one case, filtered traces were generated and used in simulations which consisted only of frequencies near to particular characteristic frequencies of the treatment delivery. Intraslice standard deviation of dose differences was used to identify potential MLC interplay, which was confirmed using nonmodulated simulations. Software calculations were also conducted for four realistic patient plans and modeling movement of a patient CT set with amplitudes informed by the observed motion of the GTV on 4DCT. The maximum magnitude of dose difference to a PTV voxel due to the interplay effect within a particular plan

  10. Development of a software tool for the management of quality control in a helical tomotherapy unit; Desarrollo de una herramienta de software para la gestion integral del control de calidad en una unidad de tomoterapia helicoidal

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Repiso, S.; Hernandez Rodriguez, J.; Martin Rincon, C.; Ramos Pacho, J. A.; Verde Velasco, J. M.; Delgado Aparacio, J. M.; Perez Alvarez, M. e.; Gomez Gonzalez, N.; Cons Perez, V.; Saez Beltran, M.

    2013-07-01

    The large amount of data and information that is managed in units of external radiotherapy quality control tests makes necessary the use of tools that facilitate, on the one hand, the management of measures and results in real time, and on other tasks of management, file, query and reporting of stored data. This paper presents an application of software of own development which is used for the integral management of the helical TomoTherapy unit in the aspects related to the roles and responsibilities of the hospital Radiophysics. (Author)

  11. Can We Spare the Pancreas and Other Abdominal Organs at Risk? A Comparison of Conformal Radiotherapy, Helical Tomotherapy and Proton Beam Therapy in Pediatric Irradiation.

    Science.gov (United States)

    Jouglar, Emmanuel; Wagner, Antoine; Delpon, Grégory; Campion, Loïc; Meingan, Philippe; Bernier, Valérie; Demoor-Goldschmidt, Charlotte; Mahé, Marc-André; Lacornerie, Thomas; Supiot, Stéphane

    2016-01-01

    Late abdominal irradiation toxicity during childhood included renal damage, hepatic toxicity and secondary diabetes mellitus. We compared the potential of conformal radiotherapy (CRT), helical tomotherapy (HT) and proton beam therapy (PBT) to spare the abdominal organs at risk (pancreas, kidneys and liver- OAR) in children undergoing abdominal irradiation. We selected children with abdominal tumors who received more than 10 Gy to the abdomen. Treatment plans were calculated in order to keep the dose to abdominal OAR as low as possible while maintaining the same planned target volume (PTV) coverage. Dosimetric values were compared using the Wilcoxon signed-rank test. The dose distribution of 20 clinical cases with a median age of 8 years (range 1-14) were calculated with different doses to the PTV: 5 medulloblastomas (36 Gy), 3 left-sided and 2 right-sided nephroblastomas (14.4 Gy to the tumor + 10.8 Gy boost to para-aortic lymphnodes), 1 left-sided and 4 right-sided or midline neuroblastomas (21 Gy) and 5 Hodgkin lymphomas (19.8 Gy to the para-aortic lymphnodes and spleen). HT significantly reduced the mean dose to the whole pancreas (WP), the pancreatic tail (PT) and to the ipsilateral kidney compared to CRT. PBT reduced the mean dose to the WP and PT compared to both CRT and HT especially in midline and right-sided tumors. PBT decreased the mean dose to the ispilateral kidney but also to the contralateral kidney and the liver compared to CRT. Low dose to normal tissue was similar or increased with HT whereas integral dose and the volume of normal tissue receiving at least 5 and 10 Gy were reduced with PBT compared to CRT and HT. In children undergoing abdominal irradiation therapy, proton beam therapy reduces the dose to abdominal OAR while sparing normal tissue by limiting low dose irradiation.

  12. Evaluation of the optimal combinations of modulation factor and pitch for Helical TomoTherapy plans made with TomoEdge using Pareto optimal fronts.

    Science.gov (United States)

    De Kerf, Geert; Van Gestel, Dirk; Mommaerts, Lobke; Van den Weyngaert, Danielle; Verellen, Dirk

    2015-09-17

    Modulation factor (MF) and pitch have an impact on Helical TomoTherapy (HT) plan quality and HT users mostly use vendor-recommended settings. This study analyses the effect of these two parameters on both plan quality and treatment time for plans made with TomoEdge planning software by using the concept of Pareto optimal fronts. More than 450 plans with different combinations of pitch [0.10-0.50] and MF [1.2-3.0] were produced. These HT plans, with a field width (FW) of 5 cm, were created for five head and neck patients and homogeneity index, conformity index, dose-near-maximum (D2), and dose-near-minimum (D98) were analysed for the planning target volumes, as well as the mean dose and D2 for most critical organs at risk. For every dose metric the median value will be plotted against treatment time. A Pareto-like method is used in the analysis which will show how pitch and MF influence both treatment time and plan quality. For small pitches (≤0.20), MF does not influence treatment time. The contrary is true for larger pitches (≥0.25) as lowering MF will both decrease treatment time and plan quality until maximum gantry speed is reached. At this moment, treatment time is saturated and only plan quality will further decrease. The Pareto front analysis showed optimal combinations of pitch [0.23-0.45] and MF > 2.0 for a FW of 5 cm. Outside this range, plans will become less optimal. As the vendor-recommended settings fall within this range, the use of these settings is validated.

  13. Effect of image value-to-density table (IVDT) on the accuracy of delivery quality assurance (DQA) process in helical tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Song, Ju-Young [Department of Radiation Oncology, Chonnam National University Medical School, Gwangju (Korea, Republic of); Ahn, Sung-Ja, E-mail: dandy@catholic.ac.kr [Department of Radiation Oncology, Chonnam National University Medical School, Gwangju (Korea, Republic of)

    2012-10-01

    The effect of the accuracy in the application of the image value-to-density table (IVDT) from kilovoltage computed tomography (kVCT) and mega-voltage computed tomography (MVCT) images on the delivery quality assurance (DQA) in helical tomotherapy (HT) was analyzed. The DQA plans were prepared with a kVCT image of a cheese phantom for 10 HT patients, and the difference in absolute dose equivalence between the planned and real measurement was evaluated according to the accuracy of IVDT application. The difference between the calculated dose distribution and real dose distribution measured with MapCHECK (SunNuclear, Melbourne, FL) was analyzed through the DQA process with a kVCT MapCHECK image and the same analysis was performed with an MVCT MapCHECK image. The IVDT for kVCT was applied to MVCT and the variation in error between the planned and real measurement caused by improper application of IVDT was evaluated. The accuracy of the IVDT application in the homogeneous water-equivalent cheese phantom had only a minor influence on the dose calculation. Although the overall accuracy of the calculated dose was increased when the proper IVDT was applied, this result had no statistical significance. The MVCT image of MapCHECK contained less error between the calculated dose and delivered dose with a high pass rate. The proper IVDT application to the MVCT image of MapCHECK increased the accuracy of dose calculation, and this result had a statistical significance. Application of the correct IVDT is important in HT DQA and its significance is increased when using phantoms consisting of inhomogeneous density materials.

  14. Evidence of Limited Motion of the Prostate by Carefully Emptying the Rectum as Assessed by Daily MVCT Image Guidance with Helical Tomotherapy

    International Nuclear Information System (INIS)

    Fiorino, Claudio Ph.D.; Di Muzio, Nadia; Broggi, Sara; Cozzarini, Cesare; Maggiulli, Eleonora M.Sc.; Alongi, Filippo; Valdagni, Riccardo; Fazio, Ferruccio; Calandrino, Riccardo

    2008-01-01

    Purpose: To assess setup and organ motion error by means of analysis of daily megavoltage computed tomography (MVCT) of patients treated with hypofractionated helical tomotherapy (71.4-74.2 Gy in 28 fractions). Methods and Materials: Data from 21 patients were analyzed. Patients were instructed to empty the rectum carefully before planning CT and every morning before therapy by means of a self-applied rectal enema. The position of the prostate was assessed by means of automatic bone matching (BM) with the planning kilovoltage CT (BM, setup error) followed by a direct visualization (DV) match on the prostate. Deviations between planning and therapy positions referred to BM and BM + DV were registered for the three main axes. In case of a full rectum at MVCT with evident shift of the prostate, treatment was postponed until after additional rectal emptying procedures; in this case, additional MVCT was performed before delivering the treatment. Data for 522 fractions were available; the impact of post-MVCT procedure was investigated for 17 of 21 patients (410 fractions). Results: Prostate motion relative to bony anatomy was limited. Concerning posterior-anterior shifts, only 4.9% and 2.7% of fractions showed deviation of 3 mm or greater of the prostate relative to BM without and with consideration of post-MVCT procedures, respectively. Interobserver variability for BM + DV match was within 0.8 mm (1 SD). Conclusions: Daily MVCT-based correction is feasible. The BM + DV matching was found to be consistent between operators. Rectal emptying using a daily enema is an efficient tool to minimize prostate motion, even for centers that have not yet implemented image-guided radiotherapy

  15. Bowel sparing in pediatric cranio-spinal radiotherapy: a comparison of combined electron and photon and helical TomoTherapy techniques to a standard photon method

    International Nuclear Information System (INIS)

    Harron, Elizabeth; Lewis, Joanne

    2012-01-01

    The aim of this study was to compare the dose to organs at risk (OARs) from different craniospinal radiotherapy treatment approaches available at the Northern Centre for Cancer Care (NCCC), with a particular emphasis on sparing the bowel. Method: Treatment plans were produced for a pediatric medulloblastoma patient with inflammatory bowel disease using 3D conformal 6-MV photons (3DCP), combined 3D 6-MV photons and 18-MeV electrons (3DPE), and helical photon TomoTherapy (HT). The 3DPE plan was a modification of the standard 3DCP technique, using electrons to treat the spine inferior to the level of the diaphragm. The plans were compared in terms of the dose-volume data to OARs and the nontumor integral dose. Results: The 3DPE plan was found to give the lowest dose to the bowel and the lowest nontumor integral dose of the 3 techniques. However, the coverage of the spine planning target volume (PTV) was least homogeneous using this technique, with only 74.6% of the PTV covered by 95% of the prescribed dose. HT was able to achieve the best coverage of the PTVs (99.0% of the whole-brain PTV and 93.1% of the spine PTV received 95% of the prescribed dose), but delivered a significantly higher integral dose. HT was able to spare the heart, thyroid, and eyes better than the linac-based techniques, but other OARs received a higher dose. Conclusions: Use of electrons was the best method for reducing the dose to the bowel and the integral dose, at the expense of compromised spine PTV coverage. For some patients, HT may be a viable method of improving dose homogeneity and reducing selected OAR doses.

  16. Extended helical tomo-therapy and concomitant chemotherapy for an uterine cervix carcinoma: dosimetry parameters and hematological toxicity; Tomotherapie helicoidale etendue et chimiotherapie concomitante pour un cancer du col de l'uterus: parametres dosimetriques et toxicite hematologique

    Energy Technology Data Exchange (ETDEWEB)

    Haddad, H.; Thomas, L.; Belhomme, S.; Chemin, A.; Caron, J.; Dejean, C.; Kantor, G.; Richaud, P. [Institut Bergonie, Dept. de Radiotherapie, 33 - Bordeaux (France); Floquet, A.; Guyon, F. [Institut Bergonie, Dept. de Chirurgie, 33 - Bordeaux (France)

    2009-10-15

    the extended tomo-therapy associated to concomitant chemotherapy is feasible and allows a dose escalation at the ganglions level. It is necessary to continue to study the dosimetry parameters at the hematopoietic marrow level that are predictive for a hematological toxicity. (N.C.)

  17. A comparative planning study of step-and-shoot IMRT versus helical tomotherapy for whole-pelvis irradiation in cervical cancer

    International Nuclear Information System (INIS)

    Chitapanarux, Imjai; Tharavichitkul, Ekkasit; Nobnop, Wannapa; Wanwilairat, Somsak; Vongtama, Roy; Traisathit, Patrinee

    2015-01-01

    The aim of this study was to compare the dosimetric parameters of whole-pelvis radiotherapy (WPRT) for cervical cancer between step-and-shoot IMRT (SaS-IMRT) and Helical Tomotherapy TM (HT). Retrospective analysis was performed on 20 cervical cancer patients who received WPRT in our center between January 2011 and January 2014. SaS-IMRT and HT treatment plans were generated for each patient. The dosimetric values for target coverage and organ-at-risk (OAR) sparing were compared according to the criteria of the International Commission on Radiation Units and Measurements 83 (ICRU 83) guidelines. Differences in beam-on time (BOT) were also compared. All the PTV dosimetric parameters (D5%, D50% and D95%) for the HT plan were (statistically significantly) of better quality than those for the SaS-IMRT plan (P-value < 0.001 in all respects). HT was also significantly more accurate than SaS-IMRT with respect to the D98% and Dmean of the CTV (P-values of 0.008 and <0.001, respectively). The median Conformity Index (CI) did not differ between the two plans (P-value = 0.057). However, the Uniformity Index for HT was significantly better than that for SaS-IMRT (P-value < 0.001). The median of D50% for the bladder, rectum and small bowel were significantly lower in HT planning than SaS-IMRT (P-value < 0.001). For D2%, we found that HT provided better sparing to the rectum and bladder (P-value < 0.001). However, the median of D2% for the small bowel was comparable for both plans. The median of Dmax of the head of the left femur was significantly lower in the HT plan, but this did not apply for the head of the right femur. BOT for HT was significantly shorter than for SaS-IMRT (P-value < 0.001). HT provided highly accurate plans, with more homogeneous PTV coverage and superior sparing of OARs than SaS-IMRT. In addition, HT enabled a shorter delivery time than SaS-IMRT. (author)

  18. A phase II multi-institutional study assessing simultaneous in-field boost helical tomotherapy for 1-3 brain metastases

    International Nuclear Information System (INIS)

    Rodrigues, George; Yartsev, Slav; Tay, Keng Yeow; Pond, Gregory R; Lagerwaard, Frank; Bauman, Glenn

    2012-01-01

    Our research group has previously published a dosimetric planning study that demonstrated that a 60 Gy/10 fractions intralesional boost with whole-brain radiotherapy (WBRT) to 30 Gy/10 fractions was biologically equivalent with a stereotactic radiosurgery (SRS) boost of 18 Gy/1 fraction with 30 Gy/10 fractions WBRT. Helical tomotherapy (HT) was found to be dosimetrically equivalent to SRS in terms of target coverage and superior to SRS in terms of normal tissue tolerance. A phase I trial has been now completed at our institution with a total of 60 enrolled patients and 48 evaluable patients. The phase II dose has been determined to be the final phase I cohort dose of 60 Gy/10 fractions. The objective of this clinical trial is to subject the final phase I cohort dose to a phase II assessment of the endpoints of overall survival, intracranial control (ICC) and intralesional control (ILC). We hypothesize HT would be considered unsuitable for further study if the median OS for patients treated with the HT SIB technique is degraded by 2 months, or the intracranial progression-free rates (ICC and ILC) are inferior by 10% or greater compared to the expected results with treatment by whole brain plus SRS as defined by the RTOG randomized trial. A sample size of 93 patients was calculated based on these parameters as well as the statistical assumptions of alpha = 0.025 and beta = 0.1 due to multiple statistical testing. Secondary assessments of toxicity, health-related quality-of-life, cognitive changes, and tumor response are also integrated into this research protocol. To summarize, the purpose of this phase II trial is to assess this non-invasive alternative to SRS in terms of central nervous system (CNS) control when compared to SRS historical controls. A follow-up phase III trial may be required depending on the results of this trial in order to definitively assess non-inferiority/superiority of this approach. Ultimately, the purpose of this line of research is to

  19. Dosimetric selection for helical tomotherapy based stereotactic ablative radiotherapy for early-stage non-small cell lung cancer or lung metastases.

    Directory of Open Access Journals (Sweden)

    Alexander Chi

    Full Text Available BACKGROUND: No selection criteria for helical tomotherapy (HT based stereotactic ablative radiotherapy (SABR to treat early stage non-small cell lung cancer (NSCLC or solitary lung metastases has been established. In this study, we investigate the dosimetric selection criteria for HT based SABR delivering 70 Gy in 10 fractions to avoid severe toxicity in the treatment of centrally located lesions when adequate target dose coverage is desired. MATERIALS AND METHODS: 78 HT-SABR plans for solitary lung lesions were created to prescribe 70 Gy in 10 fractions to the planning target volume (PTV. The PTV was set to have ≥95% PTV receiving 70 Gy in each case. The cases for which dose constraints for ≥1 OAR could not be met without compromising the target dose coverage were compared with cases for which all target and OAR dose constraints were met. RESULTS: There were 23 central lesions for which OAR dose constraints could not be met without compromising PTV dose coverage. Comparing to cases for which optimal HT-based SABR plans were generated, they were associated with larger tumor size (5.72±1.96 cm vs. 3.74±1.49 cm, p<0.0001, higher lung dose, increased number of immediately adjacent OARs ( 3.45±1.34 vs. 1.66±0.81, p<0.0001, and shorter distance to the closest OARs (GTV: 0.26±0.22 cm vs. 0.88±0.54 cm, p<0.0001; PTV 0.19±0.18 cm vs. 0.48±0.36 cm, p = 0.0001. CONCLUSION: Delivery of 70 Gy in 10 fractions with HT to meet all the given OAR and PTV dose constraints are most likely when the following parameters are met: lung lesions ≤3.78 cm (11.98 cc, ≤2 immediately adjacent OARs which are ≥0.45 cm from the gross lesion and ≥0.21 cm from the PTV.

  20. Helical Tomotherapy for Whole-Brain Irradiation With Integrated Boost to Multiple Brain Metastases: Evaluation of Dose Distribution Characteristics and Comparison With Alternative Techniques

    International Nuclear Information System (INIS)

    Levegrün, Sabine; Pöttgen, Christoph; Wittig, Andrea; Lübcke, Wolfgang; Abu Jawad, Jehad; Stuschke, Martin

    2013-01-01

    Purpose: To quantitatively evaluate dose distribution characteristics achieved with helical tomotherapy (HT) for whole-brain irradiation (WBRT) with integrated boost (IB) to multiple brain metastases in comparison with alternative techniques. Methods and Materials: Dose distributions for 23 patients with 81 metastases treated with WBRT (30 Gy/10 fractions) and IB (50 Gy) were analyzed. The median number of metastases per patient (N mets ) was 3 (range, 2-8). Mean values of the composite planning target volume of all metastases per patient (PTV mets ) and of the individual metastasis planning target volume (PTV ind met ) were 8.7 ± 8.9 cm 3 (range, 1.3-35.5 cm 3 ) and 2.5 ± 4.5 cm 3 (range, 0.19-24.7 cm 3 ), respectively. Dose distributions in PTV mets and PTV ind met were evaluated with respect to dose conformity (conformation number [CN], RTOG conformity index [PITV]), target coverage (TC), and homogeneity (homogeneity index [HI], ratio of maximum dose to prescription dose [MDPD]). The dependence of dose conformity on target size and N mets was investigated. The dose distribution characteristics were benchmarked against alternative irradiation techniques identified in a systematic literature review. Results: Mean ± standard deviation of dose distribution characteristics derived for PTV mets amounted to CN = 0.790 ± 0.101, PITV = 1.161 ± 0.154, TC = 0.95 ± 0.01, HI = 0.142 ± 0.022, and MDPD = 1.147 ± 0.029, respectively, demonstrating high dose conformity with acceptable homogeneity. Corresponding numbers for PTV ind met were CN = 0.708 ± 0.128, PITV = 1.174 ± 0.237, TC = 0.90 ± 0.10, HI = 0.140 ± 0.027, and MDPD = 1.129 ± 0.030, respectively. The target size had a statistically significant influence on dose conformity to PTV mets (CN = 0.737 for PTV mets ≤4.32 cm 3 vs CN = 0.848 for PTV mets >4.32 cm 3 , P=.006), in contrast to N mets . The achieved dose conformity to PTV mets , assessed by both CN and PITV, was in all investigated volume strata

  1. SU-E-T-197: Helical Cranial-Spinal Treatments with a Linear Accelerator

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, J; Bernard, D; Liao, Y; Templeton, A; Turian, J; Chu, J [Rush University Medical Center, Chicago, IL (United States)

    2014-06-01

    Purpose: Craniospinal irradiation (CSI) of systemic disease requires a high level of beam intensity modulation to reduce dose to bone marrow and other critical structures. Current helical delivery machines can take 30 minutes or more of beam-on time to complete these treatments. This pilot study aims to test the feasibility of performing helical treatments with a conventional linear accelerator using longitudinal couch travel during multiple gantry revolutions. Methods: The VMAT optimization package of the Eclipse 10.0 treatment planning system was used to optimize pseudo-helical CSI plans of 5 clinical patient scans. Each gantry revolution was divided into three 120° arcs with each isocenter shifted longitudinally. Treatments requiring more than the maximum 10 arcs used multiple plans with each plan after the first being optimized including the dose of the others (Figure 1). The beam pitch was varied between 0.2 and 0.9 (couch speed 5- 20cm/revolution and field width of 22cm) and dose-volume histograms of critical organs were compared to tomotherapy plans. Results: Viable pseudo-helical plans were achieved using Eclipse. Decreasing the pitch from 0.9 to 0.2 lowered the maximum lens dose by 40%, the mean bone marrow dose by 2.1% and the maximum esophagus dose by 17.5%. (Figure 2). Linac-based helical plans showed dose results comparable to tomotherapy delivery for both target coverage and critical organ sparing, with the D50 of bone marrow and esophagus respectively 12% and 31% lower in the helical linear accelerator plan (Figure 3). Total mean beam-on time for the linear accelerator plan was 8.3 minutes, 54% faster than the tomotherapy average for the same plans. Conclusions: This pilot study has demonstrated the feasibility of planning pseudo-helical treatments for CSI targets using a conventional linac and dynamic couch movement, and supports the ongoing development of true helical optimization and delivery.

  2. Head and neck region consolidation radiotherapy and prophylactic cranial irradiation with hippocampal avoidance delivered with helical tomotherapy after induction chemotherapy for non-sinonasal neuroendocrine carcinoma of the upper airways

    International Nuclear Information System (INIS)

    Franco, Pierfrancesco; La Porta, Maria Rosa; Girelli, Giuseppe; Borca, Valeria Casanova; Pasquino, Massimo; Tofani, Santi; Ozzello, Franca; Ricardi, Umberto; Numico, Gianmauro; Migliaccio, Fernanda; Catuzzo, Paola; Cante, Domenico; Ceroni, Paola; Sciacero, Piera; Carassai, Pierpaolo; Canzi, Paolo

    2012-01-01

    Non-sinonasal neuroendocrine carcinomas (NSNECs) of the head and neck are considered an unfrequent clinico-pathological entity. Combined modality treatment represents an established therapeutic option for undifferentiated forms where distant metastasis is a common pattern of failure. We report on a case of NSNEC treated with sequential chemo-radiation consisting of 6 cycles of cisplatin and etoposide followed by loco-regional radiation to the head and neck and simultaneous prophylactic cranial irradiation to prevent from intracranial spread, delivered with helical tomotherapy with the 'hippocampal avoidance' technique in order to reduce neuro-cognitive late effects. One year after the end of the whole combined modality approach, the patient achieved complete remission, with no treatment-related sub-acute and late effects. The present report highlights the importance of multidisciplinary management for NSNECs of the head and neck, as the possibility to achieve substantial cure rates with mild side effects with modern radiotherapy techniques

  3. 4D-CT scans reveal reduced magnitude of respiratory liver motion achieved by different abdominal compression plate positions in patients with intrahepatic tumors undergoing helical tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Yong, E-mail: hu.yong@zs-hospital.sh.cn; Zhou, Yong-Kang, E-mail: zhouyk2009@163.com; Chen, Yi-Xing, E-mail: chen.yixing@zs-hospital.sh.cn; Shi, Shi-Ming, E-mail: shiming32@126.com; Zeng, Zhao-Chong, E-mail: zeng.zhaochong@zs-hospital.sh.cn [Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Feng Lin Road, Shanghai 200032 (China)

    2016-07-15

    Purpose: While abdominal compression (AC) can be used to reduce respiratory liver motion in patients receiving helical tomotherapy for hepatocellular carcinoma, the nature and extent of this effect is not well described. The purpose of this study was to evaluate the changes in magnitude of three-dimensional liver motion with abdominal compression using four-dimensional (4D) computed tomography (CT) images of several plate positions. Methods: From January 2012 to October 2015, 72 patients with intrahepatic carcinoma and divided into four groups underwent 4D-CT scans to assess respiratory liver motion. Of the 72 patients, 19 underwent abdominal compression of the cephalic area between the subxiphoid and umbilicus (group A), 16 underwent abdominal compression of the caudal region between the subxiphoid area and the umbilicus (group B), 11 patients underwent abdominal compression of the caudal umbilicus (group C), and 26 patients remained free breathing (group D). 4D-CT images were sorted into ten-image series, according to the respiratory phase from the end inspiration to the end expiration, and then transferred to treatment planning software. All liver contours were drawn by a single physician and confirmed by a second physician. Liver relative coordinates were automatically generated to calculate the liver respiratory motion in different axial directions to compile the 10 ten contours into a single composite image. Differences in respiratory liver motion were assessed with a one-way analysis of variance test of significance. Results: The average respiratory liver motion in the Y axial direction was 4.53 ± 1.16, 7.56 ± 1.30, 9.95 ± 2.32, and 9.53 ± 2.62 mm in groups A, B, C, and D, respectively, with a significant change among the four groups (p < 0.001). Abdominal compression was most effective in group A (compression plate on the subxiphoid area), with liver displacement being 2.53 ± 0.93, 4.53 ± 1.16, and 2.14 ± 0.92 mm on the X-, Y-, and Z

  4. Use of semiconductor diodes for dosimetry TomoTherapy Hi-Art unit; Utilizacion de diodos de semiconductor para la dosimetria de una unidad Tomotherapy Hi-Art

    Energy Technology Data Exchange (ETDEWEB)

    Hernandez Rodriguez, J.; Garcia Repiso, S.; Martin Rincon, C.; Ramos Pacho, J. A.; Verde Velasco, J. M.; Montes Fuentes, C.; Dena Espinel, E. de; Gomez Llorente, P. L.; Fernandez Bordes, M.

    2011-07-01

    The radiotherapy unit TIT-Art TomoTherapy allows the realization of intensity modulated treatments in a helical manner through design, consisting of a linear accelerator installed on a rotating gantry in combination with the longitudinal movement of the treatment table and a multi leaf collimator (MLC) binary. The acceptance tests include, among other things, the acquisition of a set of dosimetric data (profiles and PDD), for later comparison with a reference set of measures taken at the factory, called the gold standard. Being pre commissioning from the factory, the unit will be accepted provided that the measured data meet the gold standard within preset tolerances. The dosimetric equipment used in the test of acceptance is provided by the manufacturer and so far is done with water tank, camera, software electrometer and associate of Standard Imaging and marketed by TomoTherapy Inc. The objective of this study is to compare the measures obtained with a semiconductor diode with the gold standard. (Author)

  5. Intensity-modulated radiation therapy.

    Science.gov (United States)

    Goffman, Thomas E; Glatstein, Eli

    2002-07-01

    Intensity-modulated radiation therapy (IMRT) is an increasingly popular technical means of tightly focusing the radiation dose around a cancer. As with stereotactic radiotherapy, IMRT uses multiple fields and angles to converge on the target. The potential for total dose escalation and for escalation of daily fraction size to the gross cancer is exciting. The excitement, however, has greatly overshadowed a range of radiobiological and clinical concerns.

  6. Use of semiconductor diodes for dosimetry TomoTherapy Hi-Art unit

    International Nuclear Information System (INIS)

    Hernandez Rodriguez, J.; Garcia Repiso, S.; Martin Rincon, C.; Ramos Pacho, J. A.; Verde Velasco, J. M.; Montes Fuentes, C.; Dena Espinel, E. de; Gomez Llorente, P. L.; Fernandez Bordes, M.

    2011-01-01

    The radiotherapy unit TIT-Art TomoTherapy allows the realization of intensity modulated treatments in a helical manner through design, consisting of a linear accelerator installed on a rotating gantry in combination with the longitudinal movement of the treatment table and a multi leaf collimator (MLC) binary. The acceptance tests include, among other things, the acquisition of a set of dosimetric data (profiles and PDD), for later comparison with a reference set of measures taken at the factory, called the gold standard. Being pre commissioning from the factory, the unit will be accepted provided that the measured data meet the gold standard within preset tolerances. The dosimetric equipment used in the test of acceptance is provided by the manufacturer and so far is done with water tank, camera, software electrometer and associate of Standard Imaging and marketed by TomoTherapy Inc. The objective of this study is to compare the measures obtained with a semiconductor diode with the gold standard. (Author)

  7. Light intensity modulation in phototherapy

    Science.gov (United States)

    Lukyanovich, P. A.; Zon, B. A.; Kunin, A. A.; Pankova, S. N.

    2015-04-01

    A hypothesis that blocking ATP synthesis is one of the main causes of the stimulating effect is considered based on analysis of the primary photostimulation mechanisms. The light radiation intensity modulation is substantiated and the estimates of such modulation parameters are made. An explanation is offered to the stimulation efficiency decrease phenomenon at the increase of the radiation dose during the therapy. The results of clinical research of the medical treatment in preventive dentistry are presented depending on the spectrum and parameters of the light flux modulation.

  8. Comparative analysis of {sup 60}Co intensity-modulated radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Fox, Christopher [Sun Nuclear Corporation, 425-A Pineda Court, Melbourne, FL 32940 (United States); Romeijn, H Edwin; Lynch, Bart; Dempsey, James F [Department of Radiation Oncology, University of Florida, Gainesville, FL 32610-0385 (United States); Men, Chunhua [Department of Industrial and Systems Engineering, University of Florida, Gainesville, FL 32611-6595 (United States); Aleman, Dionne M [Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, Ontario (Canada)], E-mail: chrisfox@sunnuclear.com, E-mail: romeijn@ise.ufl.edu, E-mail: lynchb@ufl.edu, E-mail: chhmen@ufl.edu, E-mail: aleman@mie.utoronto.edu, E-mail: dempsey@ufl.edu

    2008-06-21

    In this study, we perform a scientific comparative analysis of using {sup 60}Co beams in intensity-modulated radiation therapy (IMRT). In particular, we evaluate the treatment plan quality obtained with (i) 6 MV, 18 MV and {sup 60}Co IMRT; (ii) different numbers of static multileaf collimator (MLC) delivered {sup 60}Co beams and (iii) a helical tomotherapy {sup 60}Co beam geometry. We employ a convex fluence map optimization (FMO) model, which allows for the comparison of plan quality between different beam energies and configurations for a given case. A total of 25 clinical patient cases that each contain volumetric CT studies, primary and secondary delineated targets, and contoured structures were studied: 5 head-and-neck (H and N), 5 prostate, 5 central nervous system (CNS), 5 breast and 5 lung cases. The DICOM plan data were anonymized and exported to the University of Florida optimized radiation therapy (UFORT) treatment planning system. The FMO problem was solved for each case for 5-71 equidistant beams as well as a helical geometry for H and N, prostate, CNS and lung cases, and for 3-7 equidistant beams in the upper hemisphere for breast cases, all with 6 MV, 18 MV and {sup 60}Co dose models. In all cases, 95% of the target volumes received at least the prescribed dose with clinical sparing criteria for critical organs being met for all structures that were not wholly or partially contained within the target volume. Improvements in critical organ sparing were found with an increasing number of equidistant {sup 60}Co beams, yet were marginal above 9 beams for H and N, prostate, CNS and lung. Breast cases produced similar plans for 3-7 beams. A helical {sup 60}Co beam geometry achieved similar plan quality as static plans with 11 equidistant {sup 60}Co beams. Furthermore, 18 MV plans were initially found not to provide the same target coverage as 6 MV and {sup 60}Co plans; however, adjusting the trade-offs in the optimization model allowed equivalent target

  9. Comparison study of the partial-breast irradiation techniques: Dosimetric analysis of three-dimensional conformal radiation therapy, electron beam therapy, and helical tomotherapy depending on various tumor locations

    International Nuclear Information System (INIS)

    Kim, Min-Joo; Park, So-Hyun; Son, Seok-Hyun; Cheon, Keum-Seong; Choi, Byung-Ock; Suh, Tae-Suk

    2013-01-01

    The partial-breast irradiation (PBI) technique, an alternative to whole-breast irradiation, is a beam delivery method that uses a limited range of treatment volume. The present study was designed to determine the optimal PBI treatment modalities for 8 different tumor locations. Treatment planning was performed on computed tomography (CT) data sets of 6 patients who had received lumpectomy treatments. Tumor locations were classified into 8 subsections according to breast quadrant and depth. Three-dimensional conformal radiation therapy (3D-CRT), electron beam therapy (ET), and helical tomotherapy (H-TOMO) were utilized to evaluate the dosimetric effect for each tumor location. Conformation number (CN), radical dose homogeneity index (rDHI), and dose delivered to healthy tissue were estimated. The Kruskal-Wallis, Mann-Whitney U, and Bonferroni tests were used for statistical analysis. The ET approach showed good sparing effects and acceptable target coverage for the lower inner quadrant—superficial (LIQ-S) and lower inner quadrant—deep (LIQ-D) locations. The H-TOMO method was the least effective technique as no evaluation index achieved superiority for all tumor locations except CN. The ET method is advisable for treating LIQ-S and LIQ-D tumors, as opposed to 3D-CRT or H-TOMO, because of acceptable target coverage and much lower dose applied to surrounding tissue

  10. A treatment planning study comparing whole breast radiation therapy against conformal, IMRT and tomotherapy for accelerated partial breast irradiation

    International Nuclear Information System (INIS)

    Oliver, Mike; Chen, Jeff; Wong, Eugene; Van Dyk, Jake; Perera, Francisco

    2007-01-01

    Purpose and background: Conventional early breast cancer treatment consists of a lumpectomy followed by whole breast radiation therapy. Accelerated partial breast irradiation (APBI) is an investigational approach to post-lumpectomy radiation for early breast cancer. The purpose of this study is to compare four external beam APBI techniques, including tomotherapy, with conventional whole breast irradiation for their radiation conformity index, dose homogeneity index, and dose to organs at risk. Methods and materials: Small-field tangents, three-dimensional conformal radiation therapy, intensity-modulated radiation therapy and helical tomotherapy were compared for each of 15 patients (7 right, 8 left). One radiation conformity and two dose homogeneity indices were used to evaluate the dose to the target. The mean dose to organs at risk was also evaluated. Results: All proposed APBI techniques improved the conformity index significantly over whole breast tangents while maintaining dose homogeneity and without a significant increase in dose to organs at risk. Conclusion: The four-field IMRT plan produced the best dosimetric results; however this technique would require appropriate respiratory motion management. An alternative would be to use a four-field conformal technique that is less sensitive to the effects of respiratory motion

  11. Multi-institutional Feasibility Study of a Fast Patient Localization Method in Total Marrow Irradiation With Helical Tomotherapy: A Global Health Initiative by the International Consortium of Total Marrow Irradiation

    International Nuclear Information System (INIS)

    Takahashi, Yutaka; Vagge, Stefano; Agostinelli, Stefano; Han, Eunyoung; Matulewicz, Lukasz; Schubert, Kai; Chityala, Ravishankar; Ratanatharathorn, Vaneerat; Tournel, Koen; Penagaricano, Jose A.; Florian, Sterzing; Mahe, Marc-Andre; Verneris, Michael R.; Weisdorf, Daniel J.

    2015-01-01

    Purpose: To develop, characterize, and implement a fast patient localization method for total marrow irradiation. Methods and Materials: Topographic images were acquired using megavoltage computed tomography (MVCT) detector data by delivering static orthogonal beams while the couch traversed through the gantry. Geometric and detector response corrections were performed to generate a megavoltage topogram (MVtopo). We also generated kilovoltage topograms (kVtopo) from the projection data of 3-dimensional CT images to reproduce the same geometry as helical tomotherapy. The MVtopo imaging dose and the optimal image acquisition parameters were investigated. A multi-institutional phantom study was performed to verify the image registration uncertainty. Forty-five MVtopo images were acquired and analyzed with in-house image registration software. Results: The smallest jaw size (front and backup jaws of 0) provided the best image contrast and longitudinal resolution. Couch velocity did not affect the image quality or geometric accuracy. The MVtopo dose was less than the MVCT dose. The image registration uncertainty from the multi-institutional study was within 2.8 mm. In patient localization, the differences in calculated couch shift between the registration with MVtopo-kVtopo and MVCT-kVCT images in lateral, cranial–caudal, and vertical directions were 2.2 ± 1.7 mm, 2.6 ± 1.4 mm, and 2.7 ± 1.1 mm, respectively. The imaging time in MVtopo acquisition at the couch speed of 3 cm/s was <1 minute, compared with ≥15 minutes in MVCT for all patients. Conclusion: Whole-body MVtopo imaging could be an effective alternative to time-consuming MVCT for total marrow irradiation patient localization

  12. Skin-Sparing Radiation Using Intensity-Modulated Radiotherapy After Conservative Surgery in Early-Stage Breast Cancer: A Planning Study

    International Nuclear Information System (INIS)

    Saibishkumar, Elantholi P.; MacKenzie, Marc A.; Severin, Diane; Mihai, Alina; Hanson, John M.Sc.; Daly, Helene; Fallone, Gino; Parliament, Matthew B.; Abdulkarim, Bassam S.

    2008-01-01

    Purpose: To evaluate the feasibility of skin-sparing by configuring it as an organ-at-risk (OAR) while delivering whole-breast intensity-modulated radiotherapy (IMRT) in early breast cancer. Methods and Materials: Archival computed tomography scan images of 14 left-sided early-breast tumor patients who had undergone lumpectomy were selected for this study. Skin was contoured as a 4- to 5-mm strip extending from the patient outline to anterior margin of the breast planning target volume (PTV). Two IMRT plans were generated by the helical tomotherapy approach to deliver 50 Gy in 25 fractions to the breast alone: one with skin dose constraints (skin-sparing plan) and the other without (non-skin-sparing plan). Comparison of the plans was done using a two-sided paired Student t test. Results: The mean skin dose and volume of skin receiving 50 Gy were significantly less with the skin-sparing plan compared with non-skin-sparing plan (42.3 Gy vs. 47.7 Gy and 12.2% vs. 57.8% respectively; p < 0.001). The reduction in skin dose was confirmed by TLD measurements in anthropomorphic phantom using the same plans. Dose-volume analyses for other OARs were similar in both plans. Conclusions: By configuring the skin as an OAR, it is possible to achieve skin dose reduction while delivering whole-breast IMRT without compromising dose profiles to PTV and OARs

  13. Local Setup Reproducibility of the Spinal Column When Using Intensity-Modulated Radiation Therapy for Craniospinal Irradiation With Patient in Supine Position

    International Nuclear Information System (INIS)

    Stoiber, Eva Maria; Giske, Kristina; Schubert, Kai; Sterzing, Florian; Habl, Gregor; Uhl, Matthias; Herfarth, Klaus; Bendl, Rolf; Debus, Jürgen

    2011-01-01

    Purpose: To evaluate local positioning errors of the lumbar spine during fractionated intensity-modulated radiotherapy of patients treated with craniospinal irradiation and to assess the impact of rotational error correction on these uncertainties for one patient setup correction strategy. Methods and Materials: 8 patients (6 adults, 2 children) treated with helical tomotherapy for craniospinal irradiation were retrospectively chosen for this analysis. Patients were immobilized with a deep-drawn Aquaplast head mask. Additionally to daily megavoltage control computed tomography scans of the skull, once-a-week positioning of the lumbar spine was assessed. Therefore, patient setup was corrected by a target point correction, derived from a registration of the patient's skull. The residual positioning variations of the lumbar spine were evaluated applying a rigid-registration algorithm. The impact of different rotational error corrections was simulated. Results: After target point correction, residual local positioning errors of the lumbar spine varied considerably. Craniocaudal axis rotational error correction did not improve or deteriorate these translational errors, whereas simulation of a rotational error correction of the right–left and anterior–posterior axis increased these errors by a factor of 2 to 3. Conclusion: The patient fixation used allows for deformations between the patient's skull and spine. Therefore, for the setup correction strategy evaluated in this study, generous margins for the lumbar spinal target volume are needed to prevent a local geographic miss. With any applied correction strategy, it needs to be evaluated whether or not a rotational error correction is beneficial.

  14. Cerebrospinal tomo-therapy; Tomotherapie cerebrospinale

    Energy Technology Data Exchange (ETDEWEB)

    Fumagalli, I.; Coche-Dequeant, B.; Lacornerie, T.; Reynaert, N.; Lartigau, E. [Centre Oscar-Lambret, 59 - Lille (France)

    2010-10-15

    The authors report the study of the feasibility of a cerebrospinal tomo-therapy, of the protection of organs at risk, and of tolerance. Nine patients have been treated, one with a bi-fractionated irradiation and the others with a conventional fractionation. Seven had chemotherapy before radiotherapy, and two had intensification with self-grafting of stem cells. The dose constraints and the planning target volume (PTV) differed with respect to the treated organ (kidney, lung, thyroid, parotid, hypophysis). The tolerance was good. It appears that cerebrospinal tomo-therapy results in a better comfort for the patient and an easier treatment plan with a good dose homogeneity. Short communication

  15. Analytical model of the binary multileaf collimator of tomotherapy for Monte Carlo simulations

    International Nuclear Information System (INIS)

    Sterpin, E; Vynckier, S; Salvat, F; Olivera, G H

    2008-01-01

    Helical Tomotherapy (HT) delivers intensity-modulated radiotherapy by the means of many configurations of the binary multi-leaf collimator (MLC). The aim of the present study was to devise a method, which we call the 'transfer function' (TF) method, to perform the transport of particles through the MLC much faster than the time consuming Monte Carlo (MC) simulation and with no significant loss of accuracy. The TF method consists of calculating, for each photon in the phase-space file, the attenuation factor for each leaf (up to three) that the photon passes, assuming straight propagation through closed leaves, and storing these factors in a modified phase-space file. To account for the transport through the MLC in a given configuration, the weight of a photon is simply multiplied by the attenuation factors of the leaves that are intersected by the photon ray and are closed. The TF method was combined with the PENELOPE MC code, and validated with measurements for the three static field sizes available (40x5, 40x2.5 and 40x1 cm 2 ) and for some MLC patterns. The TF method allows a large reduction in computation time, without introducing appreciable deviations from the result of full MC simulations

  16. Fan beam intensity modulated proton therapy

    Science.gov (United States)

    Hill, Patrick M.

    A fan beam proton therapy is developed which delivers intensity modulated proton therapy using distal edge tracking. The system may be retrofit onto existing proton therapy gantries without alterations to infrastructure in order to improve treatments through intensity modulation. A novel range and intensity modulation system is designed using acrylic leaves that are inserted or retracted from subsections of the fan beam. Leaf thicknesses are chosen in a base-2 system and motivated in a binary manner. Dose spots from individual beam channels range between 1 and 5 cm. Integrated collimators attempting to limit crosstalk among beam channels are investigated, but found to be inferior to uncollimated beam channel modulators. A treatment planning system performing data manipulation in MATLAB and dose calculation in MCNPX is developed. Beamlet dose is calculated on patient CT data and a fan beam source is manually defined to produce accurate results. An energy deposition tally follows the CT grid, allowing straightforward registration of dose and image data. Simulations of beam channels assume that a beam channel either delivers dose to a distal edge spot or is intensity modulated. A final calculation is performed separately to determine the deliverable dose accounting for all sources of scatter. Treatment plans investigate the effects that varying system parameters have on dose distributions. Beam channel apertures may be as large as 20 mm because the sharp distal falloff characteristic of proton dose provides sufficient intensity modulation to meet dose objectives, even in the presence of coarse lateral resolution. Dose conformity suffers only when treatments are delivered from less than 10 angles. Jaw widths of 1--2 cm produce comparable dose distributions, but a jaw width of 4 cm produces unacceptable target coverage when maintaining critical structure avoidance. Treatment time for a prostate delivery is estimated to be on the order of 10 minutes. Neutron production

  17. Intensity-modulated arc therapy simplified

    International Nuclear Information System (INIS)

    Wong, Eugene; Chen, Jeff Z.; Greenland, Jonathan

    2002-01-01

    Purpose: We present a treatment planning strategy for intensity-modulated radiation therapy using gantry arcs with dynamic multileaf collimator, previously termed intensity-modulated arc therapy (IMAT). Methods and Materials: The planning strategy is an extension of the photon bar arc and asymmetric arc techniques and is classified into three levels of complexity, with increasing number of gantry arcs. This principle allows us to generalize the analysis of the number of arcs required for intensity modulation for a given treatment site. Using a phantom, we illustrate how the current technique is more flexible than the photon bar arc technique. We then compare plans from our strategy with conventional three-dimensional conformal treatment plans for three sites: prostate (prostate plus seminal vesicles), posterior pharyngeal wall, and chest wall. Results: Our strategy generates superior IMAT treatment plans compared to conventional three-dimensional conformal plans. The IMAT plans spare critical organs well, and the trade-off for simplicity is that the dose uniformity in the target volume may not rival that of true inverse treatment plans. Conclusions: The analyses presented in this paper give a better understanding of IMAT plans. Our strategy is easier to understand and more efficient in generating plans than inverse planning systems; our plans are also simpler to modify, and quality assurance is more intuitive

  18. Cerebrospinal tomo-therapy

    International Nuclear Information System (INIS)

    Fumagalli, I.; Coche-Dequeant, B.; Lacornerie, T.; Reynaert, N.; Lartigau, E.

    2010-01-01

    The authors report the study of the feasibility of a cerebrospinal tomo-therapy, of the protection of organs at risk, and of tolerance. Nine patients have been treated, one with a bi-fractionated irradiation and the others with a conventional fractionation. Seven had chemotherapy before radiotherapy, and two had intensification with self-grafting of stem cells. The dose constraints and the planning target volume (PTV) differed with respect to the treated organ (kidney, lung, thyroid, parotid, hypophysis). The tolerance was good. It appears that cerebrospinal tomo-therapy results in a better comfort for the patient and an easier treatment plan with a good dose homogeneity. Short communication

  19. Feasibility of intensity-modulated and image-guided radiotherapy for locally advanced esophageal cancer

    International Nuclear Information System (INIS)

    Nguyen, Nam P; Desai, Anand; Smith-Raymond, Lexie; Jang, Siyoung; Vock, Jacqueline; Vinh-Hung, Vincent; Chi, Alexander; Vos, Paul; Pugh, Judith; Vo, Richard A; Ceizyk, Misty

    2014-01-01

    In this study the feasibility of intensity-modulated radiotherapy (IMRT) and tomotherapy-based image-guided radiotherapy (IGRT) for locally advanced esophageal cancer was assessed. A retrospective study of ten patients with locally advanced esophageal cancer who underwent concurrent chemotherapy with IMRT (1) and IGRT (9) was conducted. The gross tumor volume was treated to a median dose of 70 Gy (62.4-75 Gy). At a median follow-up of 14 months (1-39 months), three patients developed local failures, six patients developed distant metastases, and complications occurred in two patients (1 tracheoesophageal fistula, 1 esophageal stricture requiring repeated dilatations). No patients developed grade 3-4 pneumonitis or cardiac complications. IMRT and IGRT may be effective for the treatment of locally advanced esophageal cancer with acceptable complications

  20. Comparing two strategies of dynamic intensity modulated radiation therapy (dIMRT with 3-dimensional conformal radiation therapy (3DCRT in the hypofractionated treatment of high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Yartsev Slav

    2008-01-01

    Full Text Available Abstract Background To compare two strategies of dynamic intensity modulated radiation therapy (dIMRT with 3-dimensional conformal radiation therapy (3DCRT in the setting of hypofractionated high-risk prostate cancer treatment. Methods 3DCRT and dIMRT/Helical Tomotherapy(HT planning with 10 CT datasets was undertaken to deliver 68 Gy in 25 fractions (prostate and simultaneously delivering 45 Gy in 25 fractions (pelvic lymph node targets in a single phase. The paradigms of pelvic vessel targeting (iliac vessels with margin are used to target pelvic nodes and conformal normal tissue avoidance (treated soft tissues of the pelvis while limiting dose to identified pelvic critical structures were assessed compared to 3DCRT controls. Both dIMRT/HT and 3DCRT solutions were compared to each other using repeated measures ANOVA and post-hoc paired t-tests. Results When compared to conformal pelvic vessel targeting, conformal normal tissue avoidance delivered more homogenous PTV delivery (2/2 t-test comparisons; p dose, 1–3 Gy over 5/10 dose points; p Conclusion dIMRT/HT nodal and pelvic targeting is superior to 3DCRT in dose delivery and critical structure sparing in the setting of hypofractionation for high-risk prostate cancer. The pelvic targeting paradigm is a potential solution to deliver highly conformal pelvic radiation treatment in the setting of nodal location uncertainty in prostate cancer and other pelvic malignancies.

  1. Fan-beam intensity modulated proton therapy.

    Science.gov (United States)

    Hill, Patrick; Westerly, David; Mackie, Thomas

    2013-11-01

    This paper presents a concept for a proton therapy system capable of delivering intensity modulated proton therapy using a fan beam of protons. This system would allow present and future gantry-based facilities to deliver state-of-the-art proton therapy with the greater normal tissue sparing made possible by intensity modulation techniques. A method for producing a divergent fan beam of protons using a pair of electromagnetic quadrupoles is described and particle transport through the quadrupole doublet is simulated using a commercially available software package. To manipulate the fan beam of protons, a modulation device is developed. This modulator inserts or retracts acrylic leaves of varying thickness from subsections of the fan beam. Each subsection, or beam channel, creates what effectively becomes a beam spot within the fan area. Each channel is able to provide 0-255 mm of range shift for its associated beam spot, or stop the beam and act as an intensity modulator. Results of particle transport simulations through the quadrupole system are incorporated into the MCNPX Monte Carlo transport code along with a model of the range and intensity modulation device. Several design parameters were investigated and optimized, culminating in the ability to create topotherapy treatment plans using distal-edge tracking on both phantom and patient datasets. Beam transport calculations show that a pair of electromagnetic quadrupoles can be used to create a divergent fan beam of 200 MeV protons over a distance of 2.1 m. The quadrupole lengths were 30 and 48 cm, respectively, with transverse field gradients less than 20 T/m, which is within the range of water-cooled magnets for the quadrupole radii used. MCNPX simulations of topotherapy treatment plans suggest that, when using the distal edge tracking delivery method, many delivery angles are more important than insisting on narrow beam channel widths in order to obtain conformal target coverage. Overall, the sharp distal

  2. Local Setup Reproducibility of the Spinal Column When Using Intensity-Modulated Radiation Therapy for Craniospinal Irradiation With Patient in Supine Position

    Energy Technology Data Exchange (ETDEWEB)

    Stoiber, Eva Maria, E-mail: eva.stoiber@med.uni-heidelberg.de [Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg (Germany); Department of Medical Physics, German Cancer Research Center, Heidelberg (Germany); Giske, Kristina [Department of Medical Physics, German Cancer Research Center, Heidelberg (Germany); Schubert, Kai; Sterzing, Florian; Habl, Gregor; Uhl, Matthias; Herfarth, Klaus [Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg (Germany); Bendl, Rolf [Department of Medical Physics, German Cancer Research Center, Heidelberg (Germany); Medical Informatics, Heilbronn University, Heilbronn (Germany); Debus, Juergen [Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg (Germany)

    2011-12-01

    Purpose: To evaluate local positioning errors of the lumbar spine during fractionated intensity-modulated radiotherapy of patients treated with craniospinal irradiation and to assess the impact of rotational error correction on these uncertainties for one patient setup correction strategy. Methods and Materials: 8 patients (6 adults, 2 children) treated with helical tomotherapy for craniospinal irradiation were retrospectively chosen for this analysis. Patients were immobilized with a deep-drawn Aquaplast head mask. Additionally to daily megavoltage control computed tomography scans of the skull, once-a-week positioning of the lumbar spine was assessed. Therefore, patient setup was corrected by a target point correction, derived from a registration of the patient's skull. The residual positioning variations of the lumbar spine were evaluated applying a rigid-registration algorithm. The impact of different rotational error corrections was simulated. Results: After target point correction, residual local positioning errors of the lumbar spine varied considerably. Craniocaudal axis rotational error correction did not improve or deteriorate these translational errors, whereas simulation of a rotational error correction of the right-left and anterior-posterior axis increased these errors by a factor of 2 to 3. Conclusion: The patient fixation used allows for deformations between the patient's skull and spine. Therefore, for the setup correction strategy evaluated in this study, generous margins for the lumbar spinal target volume are needed to prevent a local geographic miss. With any applied correction strategy, it needs to be evaluated whether or not a rotational error correction is beneficial.

  3. Intensity-modulated whole abdomen irradiation following adjuvant carboplatin/taxane chemotherapy for FIGO stage III ovarian cancer. Four-year outcomes

    International Nuclear Information System (INIS)

    Rochet, Nathalie; Lindel, Katja; Katayama, Sonja; Schubert, Kai; Herfarth, Klaus; Harms, Wolfgang; Debus, Juergen; Schneeweiss, Andreas; Sohn, Christoph

    2015-01-01

    A prospective study to assess toxicity and survival outcomes after intensity-modulated whole-abdominal irradiation (IM-WAI) following surgery and adjuvant intravenous carboplatin/taxane chemotherapy in advanced FIGO stage III ovarian cancer. Between 2006 and 2009, 16 patients with optimally resected FIGO stage III ovarian cancer, who had received six cycles of adjuvant carboplatin/taxane chemotherapy were treated with consolidation IM-WAI. Radiotherapy was delivered to a total dose of 30 Gy in 1.5-Gy fractions, using step-and-shoot (n = 3) or helical tomotherapy (n = 13). The first 10 patients were treated within a phase I trial; the following patients received the same treatment modality. The target volume included the entire peritoneal cavity, the diaphragm, the liver capsule, and the pelvic and para-aortic node regions. Organs at risk were kidneys, liver, heart, and bone marrow. Median follow-up was 44 months (range 19.2-67.2 months). No grade 4 toxicities occurred during IM-WAI. Common Toxicity Criteria for Adverse Events (CTCAE) grade 3 toxicities were: diarrhea (25 %), leucopenia (19 %), nausea/vomiting (6 %), and thrombocytopenia (6 %). No toxicity-related treatment break was necessary. Small bowel obstruction occurred in a total of 6 patients: in 3 cases (19 %) due to postsurgical adhesions and in 3 cases due to local tumor recurrence (19 %). Median recurrence-free survival (RFS) was 27.6 months (95 % confidence interval, CI = 24-44 months) and median overall survival (OS) was 42.1 months (95 %CI = 17-68 months). The peritoneal cavity was the most frequent site of initial failure. Consolidation IM-WAI following surgery and adjuvant chemotherapy is feasible and can be performed with manageable acute and late toxicity. The favorable RFS outcome is promising and justifies further clinical trials. (orig.) [de

  4. A retrospective comparison of outcome and toxicity of preoperative image-guided intensity-modulated radiotherapy versus conventional pelvic radiotherapy for locally advanced rectal carcinoma

    International Nuclear Information System (INIS)

    Huang, Chun-Ming; Huang, Ming-Yii; Tsai, Hsiang-Lin; Huang, Ching-Wen; Ma, Cheng-Jen; Lin, Chih-Hung; Huang, Chih-Jen; Wang, Jaw-Yuan

    2017-01-01

    The aim of the study was to compare clinical outcomes and toxicity between 3D conformal radiotherapy (3DCRT) and image-guided intensity-modulated radiotherapy (IG-IMRT) administered through helical tomotherapy in locally advanced rectal cancer (LARC) patients receiving preoperative chemoradiotherapy. We reviewed 144 patients with Stage II–III rectal cancer receiving preoperative fluoropyrimidine-based chemoradiotherapy followed by radical resection. Tumor responses following chemoradiotherapy were evaluated using the Dworak tumor regression grade (TRG). Of the 144 patients, 45 received IG-IMRT and 99 received 3DCRT. A significant reduction in Grade 3 or 4 acute gastrointestinal toxicity (IG-IMRT, 6.7%; 3DCRT, 15.1%; P = 0.039) was observed by IG-IMRT. The pathologic complete response (pCR) rate did not differ between the IG-IMRT and the 3DCRT group (17.8% vs 15.1%, P = 0.52). Patients in the IG-IMRT group had the trend of favorable tumor regressions (TRG 3 or 4) compared with those in the 3DCRT group (66.7% vs 43.5%, P = 0.071). The median follow-up was 53 months (range, 18–95 months) in the 3DCRT group and 43 months (range, 17–69 months) in the IG-IMRT group. Four-year overall, disease-free, and local failure–free survival rates of the IG-IMRT and 3DCRT groups were 81.6% and 67.9% (P = 0.12), 53.8% and 51.8% (P = 0.51), and 88% and 75.1% (P = 0.031), respectively. LARC patients treated with preoperative IG-IMRT achieved lower acute gastrointestinal adverse effects and a higher local control rate than those treated with 3DCRT, but there was no prominent difference in distant metastasis rate and overall survival between two treatment modalities.

  5. Dosimetric comparison between intensity modulated brachytherapy versus external beam intensity modulated radiotherapy for cervix cancer: a treatment planning study

    International Nuclear Information System (INIS)

    Subramani, V.; Sharma, D.N.; Jothy Basu, K.S.; Rath, G.K.; Gopishankar, N.

    2008-01-01

    To evaluate the dosimetric superiority of intensity modulated brachytherapy (IMBT) based on inverse planning optimization technique with classical brachytherapy optimization and also with external beam intensity modulated radiotherapy planning technique in patients of cervical carcinoma

  6. Intensity modulated radiotherapy (IMRT) with compensators

    International Nuclear Information System (INIS)

    Salz, H.; Wiezorek, T.; Scheithauer, M.; Kleen, W.; Schwedas, M.; Wendt, T.G.

    2002-01-01

    The irradiation with intensity-modulated fields is possible with static as well as dynamic methods. In our university hospital, the intensity-modulated radiotherapy (IMRT) with compensators was prepared and used for the first time for patient irradiation in July 2001. The compensators consist of a mixture of tin granulate and wax, which is filled in a milled negative mould. The treatment planning is performed with Helax-TMS (MDS Nordion). An additional software is used for editing the modulation matrix ('Modifix'). Before irradiation of the first patient, extensive measurements have been carried out in terms of quality assurance of treatment planning and production of compensators. The results of the verification measurements have shown that IMRT with compensators possesses high spatial and dosimetric exactness. The calculated dose distributions are applied correctly. The accuracy of the calculated monitor units is normally better than 3%; in small volumes, further dosimetric inaccuracies between calculated and measured dose distributions are mostly less than 3%. Therefore, the compensators contribute to the achievement of high-level IMRT even when apparatuses without MLC are used. This paper describes the use of the IMRT with compensators, presents the limits of this technology, and discusses the first practical experiences. (orig.) [de

  7. Intensity modulated radiotherapy for breast cancer

    International Nuclear Information System (INIS)

    Riou, O.; Fenoglietto, P.; Lemanski, C.; Azria, D.

    2012-01-01

    Intensity modulated radiotherapy (IMRT) is a technique allowing dose escalation and normal tissue sparing for various cancer types. For breast cancer, the main goals when using IMRT were to improve dose homogeneity within the breast and to enhance coverage of complex target volumes. Nonetheless, better heart and lung protections are achievable with IMRT as compared to standard irradiation for difficult cases. Three prospective randomized controlled trials of IMRT versus standard treatment showed that a better breast homogeneity can translate into better overall cosmetic results. Dosimetric and clinical studies seem to indicate a benefit of IMRT for lymph nodes irradiation, bilateral treatment, left breast and chest wall radiotherapy, or accelerated partial breast irradiation. The multiple technical IMRT solutions available tend to indicate a widespread use for breast irradiation. Nevertheless, indications for breast IMRT should be personalized and selected according to the expected benefit for each individual. (authors)

  8. Intensity modulated radiotherapy (IMRT) in bilateral retinoblastoma

    International Nuclear Information System (INIS)

    Atalar, Banu; Ozyar, Enis; Gunduz, Kaan; Gungor, Gorkem

    2010-01-01

    External beam radiotherapy (EBRT) for retinoblastoma has traditionally been done with conventional radiotherapy techniques which resulted high doses to the surrounding normal tissues. A 20 month-old girl with group D bilateral retinoblastoma underwent intensity modulated radiotherapy (IMRT) to both eyes after failing chemoreduction and focal therapies including cryotherapy and transpupillary thermotherapy. In this report, we discuss the use of IMRT as a method for reducing doses to adjacent normal tissues while delivering therapeutic doses to the tumour tissues compared with 3-dimensional conformal radiotherapy (3DCRT). At one year follow-up, the patient remained free of any obvious radiation complications. Image guided IMRT provides better dose distribution than 3DCRT in retinoblastoma eyes, delivering the therapeutic dose to the tumours and minimizing adjacent tissue damage

  9. Tomotherapy for prostate adenocarcinoma: A report on acute toxicity

    International Nuclear Information System (INIS)

    Keiler, Louis; Dobbins, Donald; Kulasekere, Ravi; Einstein, Douglas

    2007-01-01

    Background and purpose: To analyze the impact of Tomotherapy (TOMO) intensity modulated radiotherapy (IMRT) on acute gastrointestinal (GI) and genitourinary (GU) toxicity in prostate cancer. Materials and methods: The records of 55 consecutively treated TOMO patients were reviewed. Additionally a well-matched group of 43 patients treated with LINAC-based step and shoot IMRT (LINAC) was identified. Acute toxicity was scored according to Radiation Therapy Oncology Group acute toxicity criterion. Results: The grade 2-3 acute GU toxicity rates for the TOMO vs. LINAC groups were 51% vs. 28% (p = 0.001). Acute grade 2 GI toxicity was 25% vs. 40% (p = 0.024), with no grade 3 GI toxicity in either group. In univariate analysis, androgen deprivation, prostate volume, pre-treatment urinary toxicity, and prostate dose homogeneity correlated with acute GI and GU toxicity. With multivariate analysis use of Tomotherapy, median bladder dose and bladder dose homogeneity remained significantly correlated with GU toxicity. Conclusions: Acute GI toxicity for prostate cancer is improved with Tomotherapy at a cost of increased acute GU toxicity possibly due to differences in bladder and prostate dose distribution

  10. Inverse planning of intensity modulated proton therapy

    International Nuclear Information System (INIS)

    Nill, S.; Oelfke, U.; Bortfeld, T.

    2004-01-01

    A common requirement of radiation therapy is that treatment planning for different radiation modalities is devised on the basis of the same treatment planning system (TPS). The present study presents a novel multi-modal TPS with separate modules for the dose calculation, the optimization engine and the graphical user interface, which allows to integrate different treatment modalities. For heavy-charged particles, both most promising techniques, the distal edge tracking (DET) and the 3-dimensional scanning (3D) technique can be optimized. As a first application, the quality of optimized intensity-modulated treatment plans for photons (IMXT) and protons (IMPT) was analyzed in one clinical case on the basis of the achieved physical dose distributions. A comparison of the proton plans with the photon plans showed no significant improvement in terms of target volume dose, however there was an improvement in terms of organs at risk as well as a clear reduction of the total integral dose. For the DET technique, it is possible to create a treatment plan with almost the same quality of the 3D technique, however with a clearly reduced number (factor of 5) of beam spots as well as a reduced optimization time. Due to its modular design, the system can be easily expanded to more sophisticated dose-calculation algorithms or to modeling of biological effects. (orig.) [de

  11. Film Dosimetry for Intensity Modulated Radiation Therapy

    International Nuclear Information System (INIS)

    Benites-Rengifo, J.; Martinez-Davalos, A.; Celis, M.; Larraga, J.

    2004-01-01

    Intensity Modulated Radiation Therapy (IMRT) is an oncology treatment technique that employs non-uniform beam intensities to deliver highly conformal radiation to the targets while minimizing doses to normal tissues and critical organs. A key element for a successful clinical implementation of IMRT is establishing a dosimetric verification process that can ensure that delivered doses are consistent with calculated ones for each patient. To this end we are developing a fast quality control procedure, based on film dosimetry techniques, to be applied to the 6 MV Novalis linear accelerator for IMRT of the Instituto Nacional de Neurologia y Neurocirugia (INNN) in Mexico City. The procedure includes measurements of individual fluence maps for a limited number of fields and dose distributions in 3D using extended dose-range radiographic film. However, the film response to radiation might depend on depth, energy and field size, and therefore compromise the accuracy of measurements. In this work we present a study of the dependence of Kodak EDR2 film's response on the depth, field size and energy, compared with those of Kodak XV2 film. The first aim is to devise a fast and accurate method to determine the calibration curve of film (optical density vs. doses) commonly called a sensitometric curve. This was accomplished by using three types of irradiation techniques: Step-and-shoot, dynamic and static fields

  12. Single-energy intensity modulated proton therapy

    Science.gov (United States)

    Farace, Paolo; Righetto, Roberto; Cianchetti, Marco

    2015-09-01

    In this note, an intensity modulated proton therapy (IMPT) technique, based on the use of high single-energy (SE-IMPT) pencil beams, is described. The method uses only the highest system energy (226 MeV) and only lateral penumbra to produce dose gradient, as in photon therapy. In the study, after a preliminary analysis of the width of proton pencil beam penumbras at different depths, SE-IMPT was compared with conventional IMPT in a phantom containing titanium inserts and in a patient, affected by a spinal chordoma with fixation rods. It was shown that SE-IMPT has the potential to produce a sharp dose gradient and that it is not affected by the uncertainties produced by metal implants crossed by the proton beams. Moreover, in the chordoma patient, target coverage and organ at risk sparing of the SE-IMPT plan resulted comparable to that of the less reliable conventional IMPT technique. Robustness analysis confirmed that SE-IMPT was not affected by range errors, which can drastically affect the IMPT plan. When accepting a low-dose spread as in modern photon techniques, SE-IMPT could be an option for the treatment of lesions (e.g. cervical bone tumours) where steep dose gradient could improve curability, and where range uncertainty, due for example to the presence of metal implants, hampers conventional IMPT.

  13. Single-energy intensity modulated proton therapy.

    Science.gov (United States)

    Farace, Paolo; Righetto, Roberto; Cianchetti, Marco

    2015-10-07

    In this note, an intensity modulated proton therapy (IMPT) technique, based on the use of high single-energy (SE-IMPT) pencil beams, is described.The method uses only the highest system energy (226 MeV) and only lateral penumbra to produce dose gradient, as in photon therapy. In the study, after a preliminary analysis of the width of proton pencil beam penumbras at different depths, SE-IMPT was compared with conventional IMPT in a phantom containing titanium inserts and in a patient, affected by a spinal chordoma with fixation rods.It was shown that SE-IMPT has the potential to produce a sharp dose gradient and that it is not affected by the uncertainties produced by metal implants crossed by the proton beams. Moreover, in the chordoma patient, target coverage and organ at risk sparing of the SE-IMPT plan resulted comparable to that of the less reliable conventional IMPT technique. Robustness analysis confirmed that SE-IMPT was not affected by range errors, which can drastically affect the IMPT plan.When accepting a low-dose spread as in modern photon techniques, SE-IMPT could be an option for the treatment of lesions (e.g. cervical bone tumours) where steep dose gradient could improve curability, and where range uncertainty, due for example to the presence of metal implants, hampers conventional IMPT.

  14. Single-energy intensity modulated proton therapy

    International Nuclear Information System (INIS)

    Farace, Paolo; Righetto, Roberto; Cianchetti, Marco

    2015-01-01

    In this note, an intensity modulated proton therapy (IMPT) technique, based on the use of high single-energy (SE-IMPT) pencil beams, is described.The method uses only the highest system energy (226 MeV) and only lateral penumbra to produce dose gradient, as in photon therapy. In the study, after a preliminary analysis of the width of proton pencil beam penumbras at different depths, SE-IMPT was compared with conventional IMPT in a phantom containing titanium inserts and in a patient, affected by a spinal chordoma with fixation rods.It was shown that SE-IMPT has the potential to produce a sharp dose gradient and that it is not affected by the uncertainties produced by metal implants crossed by the proton beams. Moreover, in the chordoma patient, target coverage and organ at risk sparing of the SE-IMPT plan resulted comparable to that of the less reliable conventional IMPT technique. Robustness analysis confirmed that SE-IMPT was not affected by range errors, which can drastically affect the IMPT plan.When accepting a low-dose spread as in modern photon techniques, SE-IMPT could be an option for the treatment of lesions (e.g. cervical bone tumours) where steep dose gradient could improve curability, and where range uncertainty, due for example to the presence of metal implants, hampers conventional IMPT. (note)

  15. Collimator setting optimization in intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Williams, M.; Hoban, P.

    2001-01-01

    Full text: The aim of this study was to investigate the role of collimator angle and bixel size settings in IMRT when using the step and shoot method of delivery. Of particular interest is minimisation of the total monitor units delivered. Beam intensity maps with bixel size 10 x 10 mm were segmented into MLC leaf sequences and the collimator angle optimised to minimise the total number of MU's. The monitor units were estimated from the maximum sum of positive-gradient intensity changes along the direction of leaf motion. To investigate the use of low resolution maps at optimum collimator angles, several high resolution maps with bixel size 5 x 5 mm were generated. These were resampled into bixel sizes, 5 x 10 mm and 10 x 10 mm and the collimator angle optimised to minimise the RMS error between the original and resampled map. Finally, a clinical IMRT case was investigated with the collimator angle optimised. Both the dose distribution and dose-volume histograms were compared between the standard IMRT plan and the optimised plan. For the 10 x 10 mm bixel maps there was a variation of 5% - 40% in monitor units at the different collimator angles. The maps with a high degree of radial symmetry showed little variation. For the resampled 5 x 5 mm maps, a small RMS error was achievable with a 5 x 10 mm bixel size at particular collimator positions. This was most noticeable for maps with an elongated intensity distribution. A comparison between the 5 x 5 mm bixel plan and the 5 x 10 mm showed no significant difference in dose distribution. The monitor units required to deliver an intensity modulated field can be reduced by rotating the collimator and aligning the direction of leaf motion with the axis of the fluence map that has the least intensity. Copyright (2001) Australasian College of Physical Scientists and Engineers in Medicine

  16. Intensity-modulated three-dimensional conformal radiotherapy

    International Nuclear Information System (INIS)

    Mohan, Radhe

    1996-01-01

    Optimized intensity-modulated treatments one of the important advances in photon radiotherapy. Intensity modulation provides a greatly increased control over dose distributions. Such control can be maximally exploited to achieve significantly higher levels of conformation to the desired clinical objectives using sophisticated optimization techniques. Safe, rapid and efficient delivery of intensity-modulated treatments has become feasible using a dynamic multi-leaf collimator under computer control. The need for all other field shaping devices such as blocks, wedges and compensators is eliminated. Planning and delivery of intensity-modulated treatments is amenable to automation and development of class solutions for each treatment site and stage which can be implemented not only at major academic centers but on a wide scale. A typical treatment involving as many as 10 fields can be delivered in times shorter than much simpler conventional treatments. The main objective of the course is to give an overview of the current state of the art of planning and delivery methods of intensity-modulated treatments. Specifically, the following topics will be covered using representative optimized plans and treatments: 1. A typical procedure for planning and delivering an intensity-modulated treatment. 2. Quantitative definition of criteria (i.e., the objective function) of optimization of intensity-modulated treatments. Clinical relevance of objectives and the dependence of the quality of optimized intensity-modulated plans upon whether the objectives are stated purely in terms of simple dose or dose-volume criteria or whether they incorporate biological indices. 3. Importance of the lateral transport of radiation in the design of intensity-modulated treatments. Impact on dose homogeneity and the optimum choice of margins. 4. Use of intensity-modulated treatments in escalation of tumor dose for the same or lower normal tissue dose. Fractionation of intensity-modulated treatments

  17. Intensity-modulated three-dimensional conformal radiotherapy

    International Nuclear Information System (INIS)

    Mohan, Radhe

    1997-01-01

    Optimized intensity-modulated treatments one of the important advances in photon radiotherapy. Intensity modulation provides a greatly increased control over dose distributions. Such control can be maximally exploited to achieve significantly higher levels of conformation to the desired clinical objectives using sophisticated optimization techniques. Safe, rapid and efficient delivery of intensity-modulated treatments has become feasible using a dynamic multi-leaf collimator under computer control. The need for all other field shaping devices such as blocks, wedges and compensators is eliminated. Planning and delivery of intensity-modulated treatments is amenable to automation and development of class solutions for each treatment site and stage which can be implemented not only at major academic centers but on a wide scale. A typical treatment involving as many as 10 fields can be delivered in times shorter than much simpler conventional treatments. The main objective of the course is to give an overview of the current state of the art of planning and delivery methods of intensity-modulated treatments. Specifically, the following topics will be covered using representative optimized plans and treatments: 1. A typical procedure for planning and delivering an intensity-modulated treatment. 2. Quantitative definition of criteria (i.e., the objective function) of optimization of intensity-modulated treatments. Clinical relevance of objectives and the dependence of the quality of optimized intensity-modulated plans upon whether the objectives are stated purely in terms of simple dose or dose-volume criteria or whether they incorporate biological indices. 3. Importance of the lateral transport of radiation in the design of intensity-modulated treatments. Impact on dose homogeneity and the optimum choice of margins. 4. Use of intensity-modulated treatments in escalation of tumor dose for the same or lower normal tissue dose. Fractionation of intensity-modulated treatments

  18. Pelvic tomo-therapy among 70 to 90 year old patients: feasibility and tolerance; Tomotherapie pelvienne chez les sujets ages de 70 a 90 ans: faisabilite et tolerance

    Energy Technology Data Exchange (ETDEWEB)

    Bibault, J.E.; Nickers, P.; Castelain, B.; Lacornerie, T.; Reynaert, N.; Lartigau, E. [Centre Oscar-Lambret, 59 - Lille (France)

    2010-10-15

    As population is getting older (the number of people older than 70 years will double by 2030), it is important to assess the feasibility and tolerance of new irradiation techniques, notably the intensity-modulated radiotherapy, for elderly people, particularly in the case of pelvic tumours. Based on a sample of 18 patients, the authors notice that tomo-therapy reduces the digestive and urinary toxicity, and thus could be used for the treatment of aged patients, even 80 to 90 year old patients in good general status. However, these results need to be confirmed by a study on a larger scale. Short communication

  19. Comparing two strategies of dynamic intensity modulated radiation therapy (dIMRT) with 3-dimensional conformal radiation therapy (3DCRT) in the hypofractionated treatment of high-risk prostate cancer

    International Nuclear Information System (INIS)

    Yuen, Jasper; Rodrigues, George; Trenka, Kristina; Coad, Terry; Yartsev, Slav; D'Souza, David; Lock, Michael; Bauman, Glenn

    2008-01-01

    To compare two strategies of dynamic intensity modulated radiation therapy (dIMRT) with 3-dimensional conformal radiation therapy (3DCRT) in the setting of hypofractionated high-risk prostate cancer treatment. 3DCRT and dIMRT/Helical Tomotherapy(HT) planning with 10 CT datasets was undertaken to deliver 68 Gy in 25 fractions (prostate) and simultaneously delivering 45 Gy in 25 fractions (pelvic lymph node targets) in a single phase. The paradigms of pelvic vessel targeting (iliac vessels with margin are used to target pelvic nodes) and conformal normal tissue avoidance (treated soft tissues of the pelvis while limiting dose to identified pelvic critical structures) were assessed compared to 3DCRT controls. Both dIMRT/HT and 3DCRT solutions were compared to each other using repeated measures ANOVA and post-hoc paired t-tests. When compared to conformal pelvic vessel targeting, conformal normal tissue avoidance delivered more homogenous PTV delivery (2/2 t-test comparisons; p < 0.001), similar nodal coverage (8/8 t-test comparisons; p = ns), higher and more homogenous pelvic tissue dose (6/6 t-test comparisons; p < 0.03), at the cost of slightly higher critical structure dose (D dose , 1–3 Gy over 5/10 dose points; p < 0.03). The dIMRT/HT approaches were superior to 3DCRT in sparing organs at risk (22/24 t-test comparisons; p < 0.05). dIMRT/HT nodal and pelvic targeting is superior to 3DCRT in dose delivery and critical structure sparing in the setting of hypofractionation for high-risk prostate cancer. The pelvic targeting paradigm is a potential solution to deliver highly conformal pelvic radiation treatment in the setting of nodal location uncertainty in prostate cancer and other pelvic malignancies

  20. Comparison of the efficacy of intensity modulated radiotherapy delivered by competing technologies

    International Nuclear Information System (INIS)

    Seco, Joao Carlos

    2003-01-01

    The project involved the study and comparison of the various intensity-modulated radiation therapy (IMRT) delivery techniques. IMRT can be delivered via (i) the NOMOS MIMiC tomotherapy device, (ii) the dynamic multileaf collimator (DMLC), and (iii) the technique of multiple-static fields (MSF) using a multileaf collimator (MLC). To evaluate the relative benefits and limitations of the different methods of delivering IMRT an inverse-planning simulation code was developed. The simulation uses two distinct beam models: (a) the PEACOCK pencil-beam model based on the double Gaussian convolution for the MIMiC, and (b) the macropencil beam model (with the extended source model included to correct for the output factor) which is used for the DMLC and MSF-MLC delivery techniques. The process of delivering an IMRT treatment may involve various beam-modifying techniques such as multileaf collimators, the NOMOS MIMiC, blocks, wedges, etc. The constraints associated with the IMRT delivery technique are usually neglected in the process of obtaining the 'optimal' inverse treatment plan. Consequently, dose optimization may be significantly reduced when the 'optimal' beam profiles are converted to leaf/diaphragm positions via a leaf-sequencing interpreter. The work developed assessed the effects on the optimum treatment plan of the following leaf-sequencing algorithms: MSF-MLC, DMLC, and NOMOS MIMiC. An increase of 2.5%, 3.7% and 5.7% was observed for the PTV dose, when delivering a fluence profile with the DMLC, MSF, and NOMOS MIMiC techniques, respectively. An intensity-modulated beam optimization algorithm was developed to incorporate the delivery constraints into the optimization cycle. The optimization algorithm was based on the quasi-Newton method of iteratively solving minimization problems. The developed algorithm iteratively corrects the incident, pencil-beam-like fluence to incorporate the delivery constraints. In the case of the DMLC and MSF the optimization converged

  1. Peripheral dose measurements with diode and thermoluminescence dosimeters for intensity modulated radiotherapy delivered with conventional and un-conventional linear accelerator

    International Nuclear Information System (INIS)

    Kinhikar, Rajesh; Tambe, Chandrashekhar; Kadam, Sudarshan; Deshpande, Deepak; Gamre, Poonam; Biju, George; Suryaprakash; Magai, C.S.; Shrivastava, Shyam; Dhote, Dipak

    2013-01-01

    The objective of this paper was to measure the peripheral dose (PD) with diode and thermoluminescence dosimeter (TLD) for intensity modulated radiotherapy (IMRT) with linear accelerator (conventional LINAC), and tomotherapy (novel LINAC). Ten patients each were selected from Trilogy dual-energy and from Hi-Art II tomotherapy. Two diodes were kept at 20 and 25 cm from treatment field edge. TLDs (LiF:MgTi) were also kept at same distance. TLDs were also kept at 5, 10, and 15 cm from field edge. The TLDs were read with REXON reader. The readings at the respective distance were recorded for both diode and TLD. The PD was estimated by taking the ratio of measured dose at the particular distance to the prescription dose. PD was then compared with diode and TLD for LINAC and tomotherapy. Mean PD for LINAC with TLD and diode was 2.52 cGy (SD 0.69), 2.07 cGy (SD 0.88) at 20 cm, respectively, while at 25 cm, it was 1.94 cGy (SD 0.58) and 1.5 cGy (SD 0.75), respectively. Mean PD for tomotherapy with TLD and diode was 1.681 cGy (SD 0.53) and 1.58 (SD 0.44) at 20 cm, respectively. The PD was 1.24 cGy (SD 0.42) and 1.088 cGy (SD 0.35) at 25 cm, respectively, for tomotherapy. Overall, PD from tomotherapy was found lower than LINAC by the factor of 1.2-1.5 PD measurement is essential to find out the potential of secondary cancer. PD for both (conventional LINAC) and novel LINACs (tomotherapy) were measured and compared with each other. The comparison of the values for PD presented in this work and those published in the literature is difficult because of the different experimental conditions. The diode and TLD readings were reproducible and both the detector readings were comparable. (author)

  2. Modelling simple helically delivered dose distributions

    International Nuclear Information System (INIS)

    Fenwick, John D; Tome, Wolfgang A; Kissick, Michael W; Mackie, T Rock

    2005-01-01

    In a previous paper, we described quality assurance procedures for Hi-Art helical tomotherapy machines. Here, we develop further some ideas discussed briefly in that paper. Simple helically generated dose distributions are modelled, and relationships between these dose distributions and underlying characteristics of Hi-Art treatment systems are elucidated. In particular, we describe the dependence of dose levels along the central axis of a cylinder aligned coaxially with a Hi-Art machine on fan beam width, couch velocity and helical delivery lengths. The impact on these dose levels of angular variations in gantry speed or output per linear accelerator pulse is also explored

  3. Potential clinical efficacy of intensity-modulated conformal therapy

    International Nuclear Information System (INIS)

    Meeks, Sanford L.; Buatti, John M.; Bova, Francis J.; Friedman, William A.; Mendenhall, William M.; Zlotecki, Robert A.

    1998-01-01

    Purpose: The purpose of this study was to examine the potential benefit of using intensity-modulated conformal therapy for a variety of lesions currently treated with stereotactic radiosurgery or conventional radiotherapy. Methods and Materials: Intensity-modulated conformal treatment plans were generated for small intracranial lesions, as well as head and neck, lung, breast, and prostate cases, using the Peacock Plan[reg] treatment-planning system (Nomos Corporation). For small intracranial lesions, intensity-modulated conformal treatment plans were compared with stereotactic radiosurgery treatment plans generated for patient treatment at the University of Florida Shands Cancer Center. For other sites (head and neck, lung, breast, and prostate), plans generated using the Peacock Plan[reg] were compared with conventional treatment plans, as well as beam's-eye-view conformal treatment plans. Plan comparisons were accomplished through conventional qualitative review of two-dimensional (2D) dose distributions in conjunction with quantitative techniques, such as dose-volume histograms, dosimetric statistics, normal tissue complication probabilities, tumor control probabilities, and objective numerical scoring. Results: For small intracranial lesions, there is little difference between intensity-modulated conformal treatment planning and radiosurgery treatment planning in the conformation of high isodose lines with the target volume. However, stereotactic treatment planning provides a steeper dose gradient outside the target volume and, hence, a lower normal tissue toxicity index. For extracranial sites, objective numerical scores for beam's-eye-view and intensity-modulated conformal planning techniques are superior to scores for conventional treatment plans. The beam's-eye-view planning technique prevents geographic target misses and better excludes healthy tissues from the treatment portal. Compared with scores for the beam's-eye-view planning technique, scores for

  4. Accuracy of out-of-field dose calculation of tomotherapy and Cyberknife treatment planning systems. A dosimetric study

    International Nuclear Information System (INIS)

    Schneider, Uwe; Hirslanden Medical Center, Aarau; Haelg, Roger A.; Hartmann, Matthias; Mack, Andreas; Storelli, Fabrizio; Besserer, Juergen; Joosten, Andreas; Moeckli, Raphael

    2014-01-01

    Purpose: Late toxicities such as second cancer induction become more important as treatment outcome improves. Often the dose distribution calculated with a commercial treatment planning system (TPS) is used to estimate radiation carcinogenesis for the radiotherapy patient. However, for locations beyond the treatment field borders, the accuracy is not well known. The aim of this study was to perform detailed out-of-field-measurements for a typical radiotherapy treatment plan administered with a Cyberknife and a Tomotherapy machine and to compare the measurements to the predictions of the TPS. Materials and methods: Individually calibrated thermoluminescent dosimeters were used to measure absorbed dose in an anthropomorphic phantom at 184 locations. The measured dose distributions from 6 MV intensity-modulated treatment beams for CyberKnife and TomoTherapy machines were compared to the dose calculations from the TPS. Results: The TPS are underestimating the dose far away from the target volume. Quantitatively the Cyberknife underestimates the dose at 40 cm from the PTV border by a factor of 60, the Tomotherapy TPS by a factor of two. If a 50% dose uncertainty is accepted, the Cyberknife TPS can predict doses down to approximately 10 mGy/treatment Gy, the Tomotherapy-TPS down to 0.75 mGy/treatment Gy. The Cyberknife TPS can then be used up to 10 cm from the PTV border the Tomotherapy up to 35 cm. Conclusions: We determined that the Cyberknife and Tomotherapy TPS underestimate substantially the doses far away from the treated volume. It is recommended not to use out-of-field doses from the Cyberknife TPS for applications like modeling of second cancer induction. The Tomotherapy TPS can be used up to 35 cm from the PTV border (for a 390 cm 3 large PTV). (orig.)

  5. Pelvic tomo-therapy among 70 to 90 year old patients: feasibility and tolerance

    International Nuclear Information System (INIS)

    Bibault, J.E.; Nickers, P.; Castelain, B.; Lacornerie, T.; Reynaert, N.; Lartigau, E.

    2010-01-01

    As population is getting older (the number of people older than 70 years will double by 2030), it is important to assess the feasibility and tolerance of new irradiation techniques, notably the intensity-modulated radiotherapy, for elderly people, particularly in the case of pelvic tumours. Based on a sample of 18 patients, the authors notice that tomo-therapy reduces the digestive and urinary toxicity, and thus could be used for the treatment of aged patients, even 80 to 90 year old patients in good general status. However, these results need to be confirmed by a study on a larger scale. Short communication

  6. Intensity-modulated whole abdomen irradiation following adjuvant carboplatin/taxane chemotherapy for FIGO stage III ovarian cancer. Four-year outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Rochet, Nathalie; Lindel, Katja; Katayama, Sonja; Schubert, Kai; Herfarth, Klaus; Harms, Wolfgang; Debus, Juergen [Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg (Germany); University of Heidelberg, Department of Radiation Oncology, Heidelberg (Germany); Schneeweiss, Andreas [University of Heidelberg, Nationales Centrum fuer Tumorerkrankungen (NCT), Heidelberg (Germany); Sohn, Christoph [University of Heidelberg, Department of Gynecology, Heidelberg (Germany)

    2015-07-15

    A prospective study to assess toxicity and survival outcomes after intensity-modulated whole-abdominal irradiation (IM-WAI) following surgery and adjuvant intravenous carboplatin/taxane chemotherapy in advanced FIGO stage III ovarian cancer. Between 2006 and 2009, 16 patients with optimally resected FIGO stage III ovarian cancer, who had received six cycles of adjuvant carboplatin/taxane chemotherapy were treated with consolidation IM-WAI. Radiotherapy was delivered to a total dose of 30 Gy in 1.5-Gy fractions, using step-and-shoot (n = 3) or helical tomotherapy (n = 13). The first 10 patients were treated within a phase I trial; the following patients received the same treatment modality. The target volume included the entire peritoneal cavity, the diaphragm, the liver capsule, and the pelvic and para-aortic node regions. Organs at risk were kidneys, liver, heart, and bone marrow. Median follow-up was 44 months (range 19.2-67.2 months). No grade 4 toxicities occurred during IM-WAI. Common Toxicity Criteria for Adverse Events (CTCAE) grade 3 toxicities were: diarrhea (25 %), leucopenia (19 %), nausea/vomiting (6 %), and thrombocytopenia (6 %). No toxicity-related treatment break was necessary. Small bowel obstruction occurred in a total of 6 patients: in 3 cases (19 %) due to postsurgical adhesions and in 3 cases due to local tumor recurrence (19 %). Median recurrence-free survival (RFS) was 27.6 months (95 % confidence interval, CI = 24-44 months) and median overall survival (OS) was 42.1 months (95 %CI = 17-68 months). The peritoneal cavity was the most frequent site of initial failure. Consolidation IM-WAI following surgery and adjuvant chemotherapy is feasible and can be performed with manageable acute and late toxicity. The favorable RFS outcome is promising and justifies further clinical trials. (orig.) [German] Es wurden Akut- und Langzeittoxizitaet sowie Ueberlebensdaten der konsolidierenden intensitaetsmodulierten Ganzabdomenbestrahlung (''intensity-modulated

  7. The pitfalls of dosimetric commissioning for intensity modulated radiation therapy

    International Nuclear Information System (INIS)

    Tohyama, Naoki; Kodama, Takashi; Hatano, K.

    2013-01-01

    Intensity modulated radiation therapy (IMRT) allows higher radiation dose to be focused to the target volumes while minimizing the dose to OAR. To start of clinical treatment in IMRTvwe must perform commissioning strictly than 3D-conformal radiotherapy (CRT). In this report, pitfalls of dosimetric commissioning for intensity modulated radiation therapy were reviewed. Multileaf collimator (MLC) offsets and MLC transmissions are important parameters in commissioning of RTPS for IMRT. Correction of depth scaling and fluence scaling is necessary for dose measurement using solid phantom. (author)

  8. Optimal field splitting for large intensity-modulated fields

    International Nuclear Information System (INIS)

    Kamath, Srijit; Sahni, Sartaj; Ranka, Sanjay; Li, Jonathan; Palta, Jatinder

    2004-01-01

    The multileaf travel range limitations on some linear accelerators require the splitting of a large intensity-modulated field into two or more adjacent abutting intensity-modulated subfields. The abutting subfields are then delivered as separate treatment fields. This workaround not only increases the treatment delivery time but it also increases the total monitor units (MU) delivered to the patient for a given prescribed dose. It is imperative that the cumulative intensity map of the subfields is exactly the same as the intensity map of the large field generated by the dose optimization algorithm, while satisfying hardware constraints of the delivery system. In this work, we describe field splitting algorithms that split a large intensity-modulated field into two or more intensity-modulated subfields with and without feathering, with optimal MU efficiency while satisfying the hardware constraints. Compared to a field splitting technique (without feathering) used in a commercial planning system, our field splitting algorithm (without feathering) shows a decrease in total MU of up to 26% on clinical cases and up to 63% on synthetic cases

  9. Implementation of intensity modulation with dynamic multileaf collimation

    Energy Technology Data Exchange (ETDEWEB)

    Wong, J W; Yu, C; Jaffray, D [William Beaumont Hospital, Royal Oak, MI (United States)

    1995-12-01

    The computer-controlled multileaf collimator (MLC) marks one of the most important advances in radiation therapy. The device efficiently replaces manual blocking to shape fields and can be used to modulate beam intensity. The results of a research programme at William Beaumont Hospital, aimed at bringing dynamic intensity modulation into clinical use, are discussed.

  10. Analysis of small-signal intensity modulation of semiconductor ...

    Indian Academy of Sciences (India)

    This paper demonstrates theoretical characterization of intensity modulation of semiconductor lasers (SL's). The study is based on a small-signal model to solve the laser rate equations taking into account suppression of optical gain. Analytical forms of the small-signal modulation response and modulation bandwidth are ...

  11. Intensity modulated tangential beam irradiation of the intact breast

    International Nuclear Information System (INIS)

    Hong, L.; Hunt, M.; Chui, C.; Forster, K.; Lee, H.; Lutz, W.; Yahalom, J.; Kutcher, G.J.; McCormick, B.

    1997-01-01

    Purpose/Objective: The purpose of this study was to evaluate the potential benefits of intensity modulated tangential beams in the irradiation of the intact breast. The primary goal was to develop an intensity modulated treatment which would substantially decrease the dose to coronary arteries, lung and contralateral breast while still using a standard tangential beam arrangement. Improved target dose homogeneity, within the limits imposed by opposed fields, was also desired. Since a major goal of the study was the development of a technique which was practical for use on a large population of patients, the design of 'standard' intensity profiles analogous in function to conventional wedges was also investigated. Materials and Methods: Three dimensional treatment planning was performed using both conventional and intensity modulated tangential beams. Plans were developed for both the right and left breast for a range of patient sizes and shapes. For each patient, PTV, lung, heart, origin and peripheral branches of the coronary artery, and contralateral breast were contoured. Optimum tangential beam direction and shape were designed using Beams-Eye-View display and then used for both the conventional and intensity modulated plans. For the conventional plan, the optimum wedge combination and beam weighting were chosen based on the dose distribution in a single transverse plane through the field center. Intensity modulated plans were designed using an algorithm which allows the user to specify the prescribed, maximum and minimum acceptable doses and dose volume constraints for each organ of interest. Plans were compared using multiple dose distributions and DVHs. Results: Significant improvements in the doses to critical structures were achieved using the intensity modulated plan. Coronary artery dose decreased substantially for patients treated to the left breast. Ipsilateral lung and contralateral breast doses decreased for all patients. For one patient treated to

  12. Abutment region dosimetry for serial tomotherapy

    International Nuclear Information System (INIS)

    Low, Daniel A.; Mutic, Sasa; Dempsey, James F.; Markman, Jerry; Goddu, S. Murty; Purdy, James A.

    1999-01-01

    Purpose: A commercial intensity modulated radiation therapy system (Corvus, NOMOS Corp.) is presently used in our clinic to generate optimized dose distributions delivered using a proprietary dynamic multileaf collimator (DMLC) (MIMiC) composed of 20 opposed leaf pairs. On our accelerator (Clinac 600C/D, Varian Associates, Inc.) each MIMiC leaf projects to either 1.00 x 0.84 or 1.00 x 1.70 cm 2 (depending on the treatment plan and termed 1 cm or 2 cm mode, respectively). The MIMiC is used to deliver serial (axial) tomotherapy treatment plans, in which the beam is delivered to a nearly cylindrical volume as the DMLC is rotated about the patient. For longer targets, the patient is moved (indexed) between treatments a distance corresponding to the projected leaf width. The treatment relies on precise indexing and a method was developed to measure the precision of indexing devices. A treatment planning study of the dosimetric effects of incorrect patient indexing and concluded that a dose heterogeneity of 10% mm -1 resulted. Because the results may be sensitive to the dose model accuracy, we conducted a measurement-based investigation of the consequences of incorrect indexing using our accelerator. Although the indexing provides an accurate field abutment along the isocenter, due to beam divergence, hot and cold spots will be produced below and above isocenter, respectively, when less than 300 deg. arcs were used. A preliminary study recently determined that for a 290 deg. rotation in 1 cm mode, 15% cold and 7% hot spots were delivered to 7 cm above and below isocenter, respectively. This study completes the earlier work by investigating the dose heterogeneity as a function of position relative to the axis of rotation, arc length, and leaf width. The influence of random daily patient positioning errors is also investigated. Methods and Materials: Treatment plans were generated using 8.0 cm diameter cylindrical target volumes within a homogeneous rectilinear film

  13. Intensity-modulated radiation therapy: first reported treatment in Australasia

    International Nuclear Information System (INIS)

    Corry, J.; Joon, D.L.; Hope, G.; Smylie, J.; Henkul, Z.; Wills, J.; Cramb, J.; Towns, S.; Archer, P.

    2002-01-01

    Intensity-modulated radiation therapy (IMRT) is an exciting new advance in the practice of radiation oncology. It is the use of non-uniform radiation beams to achieve conformal dose distributions. As a result of the high initial capital costs and the time and complexity of planning, IMRT is not yet a widely available clinical treatment option. We describe the process involved in applying this new technology to a case of locally advanced nasopharyngeal cancer. Copyright (2002) Blackwell Science Pty Ltd

  14. Evaluation of ovary dose for woman of childbearing age woman with breast cancer in tomotherapy

    International Nuclear Information System (INIS)

    Lee, Soo Hyeong; Park, Soo Yeon; Choi, Ji Min; Park, Ju Young; Kim, Jong Suk

    2014-01-01

    The aim of this study is to evaluate unwanted scattered dose to ovary by scattering and leakage generated from treatment fields of Tomotherapy for childbearing woman with breast cancer. The radiation treatments plans for left breast cancer were established using Tomotherapy planning system (Tomotherapy, Inc, USA). They were generated by using helical and direct Tomotherapy methods for comparison. The CT images for the planning were scanned with 2.5 mm slice thickness using anthropomorphic phantom (Alderson-Rando phantom, The Phantom Laboratory, USA). The measurement points for the ovary dose were determined at the points laterally 30 cm apart from mid-point of treatment field of the pelvis. The measurements were repeated five times and averaged using glass dosimeters (1.5 mm diameter and 12 mm of length) equipped with low-energy correction filter. The measures dose values were also converted to Organ Equivalent Dose (OED) by the linear exponential dose-response model. Scattered doses of ovary which were measured based on two methods of Tomo helical and Tomo direct showed average of 64.94±0.84 mGy and 37.64±1.20 mGy in left ovary part and average of 64.38±1.85 mGy and 32.96±1.11 mGy in right ovary part. This showed when executing Tomotherapy, measured scattered dose of Tomo Helical method which has relatively greater monitor units (MUs) and longer irradiation time are approximately 1.8 times higher than Tomo direct method. Scattered dose of left and right ovary of childbearing women is lower than ICRP recommended does which is not seriously worried level against the infertility and secondary cancer occurrence. However, as breast cancer occurrence ages become younger in the future and radiation therapy using high-precision image guidance equipment like Tomotherapy is developed, clinical follow-up studies about the ovary dose of childbearing women patients would be more required

  15. Evaluation of ovary dose for woman of childbearing age woman with breast cancer in tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Soo Hyeong; Park, Soo Yeon; Choi, Ji Min; Park, Ju Young; Kim, Jong Suk [Dept. of Radiation Oncology, Samsung Medical Center, Seoul (Korea, Republic of)

    2014-12-15

    The aim of this study is to evaluate unwanted scattered dose to ovary by scattering and leakage generated from treatment fields of Tomotherapy for childbearing woman with breast cancer. The radiation treatments plans for left breast cancer were established using Tomotherapy planning system (Tomotherapy, Inc, USA). They were generated by using helical and direct Tomotherapy methods for comparison. The CT images for the planning were scanned with 2.5 mm slice thickness using anthropomorphic phantom (Alderson-Rando phantom, The Phantom Laboratory, USA). The measurement points for the ovary dose were determined at the points laterally 30 cm apart from mid-point of treatment field of the pelvis. The measurements were repeated five times and averaged using glass dosimeters (1.5 mm diameter and 12 mm of length) equipped with low-energy correction filter. The measures dose values were also converted to Organ Equivalent Dose (OED) by the linear exponential dose-response model. Scattered doses of ovary which were measured based on two methods of Tomo helical and Tomo direct showed average of 64.94±0.84 mGy and 37.64±1.20 mGy in left ovary part and average of 64.38±1.85 mGy and 32.96±1.11 mGy in right ovary part. This showed when executing Tomotherapy, measured scattered dose of Tomo Helical method which has relatively greater monitor units (MUs) and longer irradiation time are approximately 1.8 times higher than Tomo direct method. Scattered dose of left and right ovary of childbearing women is lower than ICRP recommended does which is not seriously worried level against the infertility and secondary cancer occurrence. However, as breast cancer occurrence ages become younger in the future and radiation therapy using high-precision image guidance equipment like Tomotherapy is developed, clinical follow-up studies about the ovary dose of childbearing women patients would be more required.

  16. Intensity-modulated tangential beam irradiation of the intact breast

    International Nuclear Information System (INIS)

    Hong, L.; Hunt, M.; Chui, C.; Spirou, S.; Forster, K.; Lee, H.; Yahalom, J.; Kutcher, G.J.; McCormick, B.

    1999-01-01

    Purpose: To evaluate the potential benefits of intensity modulated tangential beams in the irradiation of the intact breast. Methods and Materials: Three-dimensional treatment planning was performed on five left and five right breasts using standard wedged and intensity modulated (IM) tangential beams. Optimal beam parameters were chosen using beams-eye-view display. For the standard plans, the optimal wedge angles were chosen based on dose distributions in the central plane calculated without inhomogeneity corrections, according to our standard protocol. Intensity-modulated plans were generated using an inverse planning algorithm and a standard set of target and critical structure optimization criteria. Plans were compared using multiple dose distributions and dose volume histograms for the planning target volume (PTV), ipsilateral lung, coronary arteries, and contralateral breast. Results: Significant improvements in the doses to critical structures were achieved using intensity modulation. Compared with a standard-wedged plan prescribed to 46 Gy, the dose from the IM plan encompassing 20% of the coronary artery region decreased by 25% (from 36 to 27 Gy) for patients treated to the left breast; the mean dose to the contralateral breast decreased by 42% (from 1.2 to 0.7 Gy); the ipsilateral lung volume receiving more than 46 Gy decreased by 30% (from 10% to 7%); the volume of surrounding soft tissue receiving more than 46 Gy decreased by 31% (from 48% to 33%). Dose homogeneity within the target volume improved greatest in the superior and inferior regions of the breast (approximately 8%), although some decrease in the medial and lateral high-dose regions (approximately 4%) was also observed. Conclusion: Intensity modulation with a standard tangential beam arrangement significantly reduces the dose to the coronary arteries, ipsilateral lung, contralateral breast, and surrounding soft tissues. Improvements in dose homogeneity throughout the target volume can also be

  17. TomoTherapy MLC verification using exit detector data

    International Nuclear Information System (INIS)

    Chen Quan; Westerly, David; Fang Zhenyu; Sheng, Ke; Chen Yu

    2012-01-01

    Purpose: Treatment delivery verification (DV) is important in the field of intensity modulated radiation therapy (IMRT). While IMRT and image guided radiation therapy (IGRT), allow us to create more conformal plans and enables the use of tighter margins, an erroneously executed plan can have detrimental effects on the treatment outcome. The purpose of this study is to develop a DV technique to verify TomoTherapy's multileaf collimator (MLC) using the onboard mega-voltage CT detectors. Methods: The proposed DV method uses temporal changes in the MVCT detector signal to predict actual leaf open times delivered on the treatment machine. Penumbra and scattered radiation effects may produce confounding results when determining leaf open times from the raw detector data. To reduce the impact of the effects, an iterative, Richardson-Lucy (R-L) deconvolution algorithm is applied. Optical sensors installed on each MLC leaf are used to verify the accuracy of the DV technique. The robustness of the DV technique is examined by introducing different attenuation materials in the beam. Additionally, the DV technique has been used to investigate several clinical plans which failed to pass delivery quality assurance (DQA) and was successful in identifying MLC timing discrepancies as the root cause. Results: The leaf open time extracted from the exit detector showed good agreement with the optical sensors under a variety of conditions. Detector-measured leaf open times agreed with optical sensor data to within 0.2 ms, and 99% of the results agreed within 8.5 ms. These results changed little when attenuation was added in the beam. For the clinical plans failing DQA, the dose calculated from reconstructed leaf open times played an instrumental role in discovering the root-cause of the problem. Throughout the retrospective study, it is found that the reconstructed dose always agrees with measured doses to within 1%. Conclusions: The exit detectors in the TomoTherapy treatment systems

  18. Longitudinal assessment of parotid function in patients receiving tomotherapy for head-and-neck cancer

    International Nuclear Information System (INIS)

    Voordeckers, M.; Tournel, K.; Verellen, D.; Esch, G. van; Storme, G.; Everaert, H.; Vanhove, C.; Baron, I.

    2008-01-01

    Background and purpose: conventional radiotherapy is associated with high doses to the salivary glands which causes xerostomia and adverse effects on quality of life. The study aims to investigate the potential of helical tomotherapy (Hi-Art Tomotherapy registered ) to preserve parotid function in head-and-neck cancer patients. Patients and methods: seven consecutive patients treated with helical tomotherapy at the UZ Brussel, Belgium, were included. During planning, priority was attributed to planning target volume (PTV) coverage: ≥ 95% of the dose must be delivered to ≥ 95% of the PTV. Elective nodal regions received 54 Gy (1.8 Gy/fraction). A dose of 70.5 Gy (2.35 Gy/fraction) was prescribed to the primary tumor and pathologic lymph nodes = simultaneous integrated boost scheme. If possible, the mean parotid dose was kept below 26 Gy. Salivary gland function was assessed by technetium scintigraphy. Results: there was a significant dose-response relationship between mean parotid dose and functional recuperation. If the mean dose was kept 26 %). In order to preserve 75% of SE, 46% of the parotid volume should receive a dose 26 Gy can be reduced. (orig.)

  19. Pump-to-Signal Intensity Modulation Transfer in Saturated- Gain Fiber Optical Parametric Amplifiers

    DEFF Research Database (Denmark)

    Lali-Dastjerdi, Zohreh; Lund-Hansen, Toke; Rottwitt, Karsten

    2011-01-01

    The pump-to-signal intensity modulation transfer in saturated degenerate FOPAs is numerically investigated over the whole gain bandwidth. The intensity modulation transfer decreases and the OSNR improves when the amplifier operates in the saturation regime....

  20. Energy and intensity modulated radiation therapy with electrons

    OpenAIRE

    Olofsson, Lennart

    2005-01-01

    In recent years intensity modulated radiation therapy with photons (xIMRT) has gained attention due to its ability to reduce the dose in the tissues close to the tumour volume. However, this technique also results in a large low dose volume. Electron IMRT (eIMRT) has the potential to reduce the integral dose to the patient due to the dose fall off in the electron depth dose curves. This dose fall off makes it possible to modulate the dose distribution in the direction of the beam by selecting...

  1. Dose profile analysis of small fields in intensity modulated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Medel B, E. [IMSS, Centro Medico Nacional Manuel Avila Camacho, Calle 2 Nte. 2004, Barrio de San Francisco, 72090 Puebla, Pue. (Mexico); Tejeda M, G.; Romero S, K., E-mail: romsakaren@gmail.com [Benemerita Universidad Autonoma de Puebla, Facultad de Ciencias Fisico Matematicas, Av. San Claudio y 18 Sur, Ciudad Universitaria, 72570 Puebla, Pue.(Mexico)

    2015-10-15

    Full text: Small field dosimetry is getting a very important worldwide task nowadays. The use of fields of few centimeters is more common with the introduction of sophisticated techniques of radiation therapy, as Intensity Modulated Radiotherapy (IMRT). In our country the implementation of such techniques is just getting started and whit it the need of baseline data acquisition. The dosimetry under small field conditions represents a challenge for the physicists community. In this work, a dose profile analysis was done, using various types of dosimeters for further comparisons. This analysis includes the study of quality parameters as flatness, symmetry, penumbra, and other in-axis measurements. (Author)

  2. Linear algebraic methods applied to intensity modulated radiation therapy.

    Science.gov (United States)

    Crooks, S M; Xing, L

    2001-10-01

    Methods of linear algebra are applied to the choice of beam weights for intensity modulated radiation therapy (IMRT). It is shown that the physical interpretation of the beam weights, target homogeneity and ratios of deposited energy can be given in terms of matrix equations and quadratic forms. The methodology of fitting using linear algebra as applied to IMRT is examined. Results are compared with IMRT plans that had been prepared using a commercially available IMRT treatment planning system and previously delivered to cancer patients.

  3. Intensity-modulated radiotherapy (IMRT) for carcinoma of the maxillary sinus: A comparison of IMRT planning systems

    International Nuclear Information System (INIS)

    Ahmed, Raef S.; Ove, Roger; Duan, Jun; Popple, Richard; Cobb, Glenn

    2006-01-01

    The treatment of maxillary sinus carcinoma with forward planning can be technically difficult when the neck also requires radiotherapy. This difficulty arises because of the need to spare the contralateral face while treating the bilateral neck. There is considerable potential for error in clinical setup and treatment delivery. We evaluated intensity-modulated radiotherapy (IMRT) as an improvement on forward planning, and compared several inverse planning IMRT platforms. A composite dose-volume histogram (DVH) was generated from a complex forward planned case. We compared the results with those generated by sliding window fixed field dynamic multileaf collimator (MLC) IMRT, using sets of coplanar beams. All setups included an anterior posterior (AP) beam, and 3-, 5-, 7-, and 9-field configurations were evaluated. The dose prescription and objective function priorities were invariant. We also evaluated 2 commercial tomotherapy IMRT delivery platforms. DVH results from all of the IMRT approaches compared favorably with the forward plan. Results for the various inverse planning approaches varied considerably across platforms, despite an attempt to prescribe the therapy similarly. The improvement seen with the addition of beams in the fixed beam sliding window case was modest. IMRT is an effective means of delivering radiotherapy reliably in the complex setting of maxillary sinus carcinoma with neck irradiation. Differences in objective function definition and optimization algorithms can lead to unexpected differences in the final dose distribution, and our evaluation suggests that these factors are more significant than the beam arrangement or number of beams

  4. Hematologic Toxicity in Patients Treated With Postprostatectomy Whole-Pelvis Irradiation With Different Intensity Modulated Radiation Therapy Techniques Is Not Negligible and Is Prolonged: Preliminary Results of a Longitudinal, Observational Study

    Energy Technology Data Exchange (ETDEWEB)

    Cozzarini, Cesare, E-mail: cozzarini.cesare@hsr.it [Department of Radiotherapy, San Raffaele Scientific Institute, Milan (Italy); Chiorda, Barbara Noris [Department of Radiotherapy, San Raffaele Scientific Institute, Milan (Italy); Sini, Carla; Fiorino, Claudio [Department of Medical Physics, San Raffaele Scientific Institute, Milan (Italy); Briganti, Alberto; Montorsi, Francesco [Department of Urology, Vita-Salute University, Milan (Italy); Di Muzio, Nadia [Department of Radiotherapy, San Raffaele Scientific Institute, Milan (Italy)

    2016-06-01

    Purpose: To address the thus-far poorly investigated severity and duration of hematologic toxicity from whole-pelvis radiation therapy (WPRT) in a cohort of chemo-naïve patients treated with postprostatectomy radiation therapy including WPRT with different intensity modulated radiation therapy (IMRT) techniques, doses, and fractionations. Methods and Materials: This analysis pertains to 125 patients (70 from a pilot study and 55 from an observational protocol) for whom 1 baseline and at least 3 subsequent blood samples (median 6), obtained at irradiation midpoint and end, and thereafter at 3, 6, and 12 months, were available. Patients were treated with adjuvant (n=73) or salvage intent; static-field IMRT (n=19); volumetric modulated arc therapy (n=60) or helical Tomotherapy (n=46); and conventional (n=39) or moderately hypofractionated (median 2.35 Gy per fraction, n=86) regimens. The median 2-Gy equivalent dose (EQD2) to the prostatic bed was 70.4 Gy with a lymph-nodal planning target volume of 50.2 Gy. Clinical and dosimetric data were collected. Results: Both leukopenia and thrombocytopenia were significant (median nadir count 65% and 67% of baseline, respectively), with leukopenia also persisting (1-year median count 75% of baseline). Lymphopenia was the major contributor to the severity and 1-year persistence of leukopenia; all patients developed acute grade ≥1 lymphopenia (61% and 26% grade 2 and ≥3, respectively), whereas 1-year grade ≥2 lymphopenia was still present in 16%. In addition to an independent predictive role of corresponding baseline values, multivariable analyses highlighted that higher EQD2 doses to lymph nodal planning target volume increased risk of acute neutropenia and hypofractionation for acute thrombocytopenia. Of note, patients of older age were at higher risk for acute grade 2 lymphopenia, and interestingly, increased risk of grade >2 lymphopenia for those who smoked at least one year. No role for different IMRT techniques

  5. Hematologic Toxicity in Patients Treated With Postprostatectomy Whole-Pelvis Irradiation With Different Intensity Modulated Radiation Therapy Techniques Is Not Negligible and Is Prolonged: Preliminary Results of a Longitudinal, Observational Study

    International Nuclear Information System (INIS)

    Cozzarini, Cesare; Chiorda, Barbara Noris; Sini, Carla; Fiorino, Claudio; Briganti, Alberto; Montorsi, Francesco; Di Muzio, Nadia

    2016-01-01

    Purpose: To address the thus-far poorly investigated severity and duration of hematologic toxicity from whole-pelvis radiation therapy (WPRT) in a cohort of chemo-naïve patients treated with postprostatectomy radiation therapy including WPRT with different intensity modulated radiation therapy (IMRT) techniques, doses, and fractionations. Methods and Materials: This analysis pertains to 125 patients (70 from a pilot study and 55 from an observational protocol) for whom 1 baseline and at least 3 subsequent blood samples (median 6), obtained at irradiation midpoint and end, and thereafter at 3, 6, and 12 months, were available. Patients were treated with adjuvant (n=73) or salvage intent; static-field IMRT (n=19); volumetric modulated arc therapy (n=60) or helical Tomotherapy (n=46); and conventional (n=39) or moderately hypofractionated (median 2.35 Gy per fraction, n=86) regimens. The median 2-Gy equivalent dose (EQD2) to the prostatic bed was 70.4 Gy with a lymph-nodal planning target volume of 50.2 Gy. Clinical and dosimetric data were collected. Results: Both leukopenia and thrombocytopenia were significant (median nadir count 65% and 67% of baseline, respectively), with leukopenia also persisting (1-year median count 75% of baseline). Lymphopenia was the major contributor to the severity and 1-year persistence of leukopenia; all patients developed acute grade ≥1 lymphopenia (61% and 26% grade 2 and ≥3, respectively), whereas 1-year grade ≥2 lymphopenia was still present in 16%. In addition to an independent predictive role of corresponding baseline values, multivariable analyses highlighted that higher EQD2 doses to lymph nodal planning target volume increased risk of acute neutropenia and hypofractionation for acute thrombocytopenia. Of note, patients of older age were at higher risk for acute grade 2 lymphopenia, and interestingly, increased risk of grade >2 lymphopenia for those who smoked at least one year. No role for different IMRT techniques

  6. Comparing the quality of passively-scattered proton and photon tomotherapy plans for brain and head and neck disease sites

    International Nuclear Information System (INIS)

    Kainz, Kristofer; Firat, Selim; Wilson, J Frank; Schultz, Christopher; Siker, Malika; Wang, Andrew; Olson, Dan; Allen Li, X

    2015-01-01

    We compare the quality of photon IMRT (helical tomotherapy) with classic proton plans for brain, head and neck tumors, in terms of target dose uniformity and conformity along with organ-at-risk (OAR) sparing. Plans were created for twelve target volumes among eight cases. All patients were originally planned and treated using helical tomotherapy. Proton plans were generated using a passively-scattered beam model with a maximum range of 32 g cm −2 (225 MeV), range modulation in 0.5 g cm −2 increments and range compensators with 4.8 mm milling tool diameters. All proton plans were limited to two to four beams. Plan quality was compared using uniformity index (UI), conformation number (CN) and a EUD-based plan quality index (fEUD). For 11 of the 12 targets, UI was improved for the proton plan; on average, UI was 1.05 for protons versus 1.08 for tomotherapy. For 7 of the 12 targets, the tomotherapy plan exhibited more favorable CN. For proximal OARs, the improved dose conformity to the target volume from tomotherapy led to a lower maximum dose. For distal OARs, the maximum dose was much lower for proton plans. For 6 of the 8 cases, near-total avoidance for distal OARs provided by protons leads to improved fEUD. However, if distal OARs are excluded in the fEUD calculation, the proton plans exhibit better fEUD in only 3 of the 8 cases. The distal OAR sparing and target dose uniformity are generally better with passive-scatter proton planning than with photon tomotherapy; proton therapy may be preferred if the clinician deems those attributes critical. However, tomotherapy may serve equally as well as protons for cases where superior target dose conformity from tomotherapy leads to plan quality nearly identical to or better than protons and for cases where distal OAR sparing is not concerning. (paper)

  7. Quality assurance of intensity-modulated radiation therapy.

    Science.gov (United States)

    Palta, Jatinder R; Liu, Chihray; Li, Jonathan G

    2008-01-01

    The current paradigm for the quality assurance (QA) program for intensity-modulated radiation therapy (IMRT) includes QA of the treatment planning system, QA of the delivery system, and patient-specific QA. Although the IMRT treatment planning and delivery system is the same as for conventional three-dimensional conformal radiation therapy, it has more parameters to coordinate and verify. Because of complex beam intensity modulation, each IMRT field often includes many small irregular off-axis fields, resulting in isodose distributions for each IMRT plan that are more conformal than those from conventional treatment plans. Therefore, these features impose a new and more stringent set of QA requirements for IMRT planning and delivery. The generic test procedures to validate dose calculation and delivery accuracy for both treatment planning and IMRT delivery have to be customized for each type of IMRT planning and delivery strategy. The rationale for such an approach is that the overall accuracy of IMRT delivery is incumbent on the piecewise uncertainties in both the planning and delivery processes. The end user must have well-defined evaluation criteria for each element of the planning and delivery process. Such information can potentially be used to determine a priori the accuracy of IMRT planning and delivery.

  8. Quality Assurance of Intensity-Modulated Radiation Therapy

    International Nuclear Information System (INIS)

    Palta, Jatinder R.; Liu, Chihray; Li, Jonathan G.

    2008-01-01

    The current paradigm for the quality assurance (QA) program for intensity-modulated radiation therapy (IMRT) includes QA of the treatment planning system, QA of the delivery system, and patient-specific QA. Although the IMRT treatment planning and delivery system is the same as for conventional three-dimensional conformal radiation therapy, it has more parameters to coordinate and verify. Because of complex beam intensity modulation, each IMRT field often includes many small irregular off-axis fields, resulting in isodose distributions for each IMRT plan that are more conformal than those from conventional treatment plans. Therefore, these features impose a new and more stringent set of QA requirements for IMRT planning and delivery. The generic test procedures to validate dose calculation and delivery accuracy for both treatment planning and IMRT delivery have to be customized for each type of IMRT planning and delivery strategy. The rationale for such an approach is that the overall accuracy of IMRT delivery is incumbent on the piecewise uncertainties in both the planning and delivery processes. The end user must have well-defined evaluation criteria for each element of the planning and delivery process. Such information can potentially be used to determine a priori the accuracy of IMRT planning and delivery

  9. The role of Cobalt-60 source in Intensity Modulated Radiation Therapy: From modeling finite sources to treatment planning and conformal dose delivery

    Science.gov (United States)

    Dhanesar, Sandeep Kaur

    Cobalt-60 (Co-60) units played an integral role in radiation therapy from the mid-1950s to the 1970s. Although they continue to be used to treat cancer in some parts of the world, their role has been significantly reduced due to the invention of medical linear accelerators. A number of groups have indicated a strong potential for Co-60 units in modern radiation therapy. The Medical Physics group at the Cancer Center of the Southeastern Ontario and Queen's University has shown the feasibility of Intensity Modulated Radiation Therapy (IMRT) via simple conformal treatment planning and dose delivery using a Co-60 unit. In this thesis, initial Co-60 tomotherapy planning investigations on simple uniform phantoms are extended to actual clinical cases based on patient CT data. The planning is based on radiation dose data from a clinical Co-60 unit fitted with a multileaf collimator (MLC) and modeled in the EGSnrc Monte Carlo system. An in house treatment planning program is used to calculate IMRT dose distributions. Conformal delivery in a single slice on a uniform phantom based on sequentially delivered pencil beams is verified by Gafchromic film. Volumetric dose distributions for Co-60 serial tomotherapy are then generated for typical clinical sites that had been treated at our clinic by conventional 6MV IMRT using Varian Eclipse treatment plans. The Co-60 treatment plans are compared with the clinical IMRT plans using conventional matrices such as dose volume histograms (DVH). Dose delivery based on simultaneously opened MLC leaves is also explored and a novel MLC segmentation method is proposed. In order to increase efficiency of dose calculations, a novel convolution based fluence model for treatment planning is also proposed. The ion chamber measurements showed that the Monte Carlo modeling of the beam data under the MIMiC MLC is accurate. The film measurements from the uniform phantom irradiations confirm that IMRT plans from our in-house treatment planning system

  10. Retrospective feasibility study of simultaneous integrated boost in cervical cancer using Tomotherapy: the impact of organ motion and tumor regression.

    Science.gov (United States)

    Herrera, Fernanda G; Callaway, Sharon; Delikgoz-Soykut, Ela; Coskun, Mehtap; Porta, Laetitia; Meuwly, Jean-Yves; Soares-Rodrigues, Joao; Heym, Leonie; Moeckli, Raphael; Ozsahin, Mahmut

    2013-01-03

    Whole pelvis intensity modulated radiotherapy (IMRT) is increasingly being used to treat cervical cancer aiming to reduce side effects. Encouraged by this, some groups have proposed the use of simultaneous integrated boost (SIB) to target the tumor, either to get a higher tumoricidal effect or to replace brachytherapy. Nevertheless, physiological organ movement and rapid tumor regression throughout treatment might substantially reduce any benefit of this approach. To evaluate the clinical target volume - simultaneous integrated boost (CTV-SIB) regression and motion during chemo-radiotherapy (CRT) for cervical cancer, and to monitor treatment progress dosimetrically and volumetrically to ensure treatment goals are met. Ten patients treated with standard doses of CRT and brachytherapy were retrospectively re-planned using a helical Tomotherapy - SIB technique for the hypothetical scenario of this feasibility study. Target and organs at risk (OAR) were contoured on deformable fused planning-computed tomography and megavoltage computed tomography images. The CTV-SIB volume regression was determined. The center of mass (CM) was used to evaluate the degree of motion. The Dice's similarity coefficient (DSC) was used to assess the spatial overlap of CTV-SIBs between scans. A cumulative dose-volume histogram modeled estimated delivered doses. The CTV-SIB relative reduction was between 31 and 70%. The mean maximum CM change was 12.5, 9, and 3 mm in the superior-inferior, antero-posterior, and right-left dimensions, respectively. The CTV-SIB-DSC approached 1 in the first week of treatment, indicating almost perfect overlap. CTV-SIB-DSC regressed linearly during therapy, and by the end of treatment was 0.5, indicating 50% discordance. Two patients received less than 95% of the prescribed dose. Much higher doses to the OAR were observed. A multiple regression analysis showed a significant interaction between CTV-SIB reduction and OAR dose increase. The CTV-SIB had important

  11. Retrospective feasibility study of simultaneous integrated boost in cervical cancer using tomotherapy: the impact of organ motion and tumor regression

    International Nuclear Information System (INIS)

    Herrera, Fernanda G; Ozsahin, Mahmut; Callaway, Sharon; Delikgoz-Soykut, Ela; Coskun, Mehtap; Porta, Laetitia; Meuwly, Jean-Yves; Soares-Rodrigues, Joao; Heym, Leonie; Moeckli, Raphael

    2013-01-01

    Whole pelvis intensity modulated radiotherapy (IMRT) is increasingly being used to treat cervical cancer aiming to reduce side effects. Encouraged by this, some groups have proposed the use of simultaneous integrated boost (SIB) to target the tumor, either to get a higher tumoricidal effect or to replace brachytherapy. Nevertheless, physiological organ movement and rapid tumor regression throughout treatment might substantially reduce any benefit of this approach. To evaluate the clinical target volume - simultaneous integrated boost (CTV-SIB) regression and motion during chemo-radiotherapy (CRT) for cervical cancer, and to monitor treatment progress dosimetrically and volumetrically to ensure treatment goals are met. Ten patients treated with standard doses of CRT and brachytherapy were retrospectively re-planned using a helical Tomotherapy - SIB technique for the hypothetical scenario of this feasibility study. Target and organs at risk (OAR) were contoured on deformable fused planning-computed tomography and megavoltage computed tomography images. The CTV-SIB volume regression was determined. The center of mass (CM) was used to evaluate the degree of motion. The Dice’s similarity coefficient (DSC) was used to assess the spatial overlap of CTV-SIBs between scans. A cumulative dose-volume histogram modeled estimated delivered doses. The CTV-SIB relative reduction was between 31 and 70%. The mean maximum CM change was 12.5, 9, and 3 mm in the superior-inferior, antero-posterior, and right-left dimensions, respectively. The CTV-SIB-DSC approached 1 in the first week of treatment, indicating almost perfect overlap. CTV-SIB-DSC regressed linearly during therapy, and by the end of treatment was 0.5, indicating 50% discordance. Two patients received less than 95% of the prescribed dose. Much higher doses to the OAR were observed. A multiple regression analysis showed a significant interaction between CTV-SIB reduction and OAR dose increase. The CTV-SIB had important

  12. Retrospective feasibility study of simultaneous integrated boost in cervical cancer using tomotherapy: the impact of organ motion and tumor regression

    Directory of Open Access Journals (Sweden)

    Herrera Fernanda G

    2013-01-01

    Full Text Available Abstract Background Whole pelvis intensity modulated radiotherapy (IMRT is increasingly being used to treat cervical cancer aiming to reduce side effects. Encouraged by this, some groups have proposed the use of simultaneous integrated boost (SIB to target the tumor, either to get a higher tumoricidal effect or to replace brachytherapy. Nevertheless, physiological organ movement and rapid tumor regression throughout treatment might substantially reduce any benefit of this approach. Purpose To evaluate the clinical target volume - simultaneous integrated boost (CTV-SIB regression and motion during chemo-radiotherapy (CRT for cervical cancer, and to monitor treatment progress dosimetrically and volumetrically to ensure treatment goals are met. Methods and materials Ten patients treated with standard doses of CRT and brachytherapy were retrospectively re-planned using a helical Tomotherapy - SIB technique for the hypothetical scenario of this feasibility study. Target and organs at risk (OAR were contoured on deformable fused planning-computed tomography and megavoltage computed tomography images. The CTV-SIB volume regression was determined. The center of mass (CM was used to evaluate the degree of motion. The Dice’s similarity coefficient (DSC was used to assess the spatial overlap of CTV-SIBs between scans. A cumulative dose-volume histogram modeled estimated delivered doses. Results The CTV-SIB relative reduction was between 31 and 70%. The mean maximum CM change was 12.5, 9, and 3 mm in the superior-inferior, antero-posterior, and right-left dimensions, respectively. The CTV-SIB-DSC approached 1 in the first week of treatment, indicating almost perfect overlap. CTV-SIB-DSC regressed linearly during therapy, and by the end of treatment was 0.5, indicating 50% discordance. Two patients received less than 95% of the prescribed dose. Much higher doses to the OAR were observed. A multiple regression analysis showed a significant interaction

  13. Intensity-modulated radiation therapy clinical evidence and techniques

    CERN Document Server

    Nishimura, Yasumasa

    2015-01-01

    Successful clinical use of intensity-modulated radiation therapy (IMRT) represents a significant advance in radiation oncology. Because IMRT can deliver high-dose radiation to a target with a reduced dose to the surrounding organs, it can improve the local control rate and reduce toxicities associated with radiation therapy. Since IMRT began being used in the mid-1990s, a large volume of clinical evidence of the advantages of IMRT has been collected. However, treatment planning and quality assurance (QA) of IMRT are complicated and difficult for the clinician and the medical physicist. This book, by authors renowned for their expertise in their fields, provides cumulative clinical evidence and appropriate techniques for IMRT for the clinician and the physicist. Part I deals with the foundations and techniques, history, principles, QA, treatment planning, radiobiology and related aspects of IMRT. Part II covers clinical applications with several case studies, describing contouring and dose distribution with cl...

  14. Intensity-Modulated Radiation Therapy for Primary Brain Tumors

    Institute of Scientific and Technical Information of China (English)

    Zhong-min Wang

    2004-01-01

    Radiation therapy has been used to treat primary brain tumors as standard primary and/or adjunctive therapies for decades. It is difficult for conventional radiotherapy to deliver a lethal dose of radiation to the tumors while sparing surrounding normal brain due to complicated structures and multifunction in human brain. With the understanding of radiation physics and computer technology, a number of novel and more precise radiotherapies have been developed in recent years. Intensity modulated radiotherapy (IMRT) is one of these strategies. The use of IMRT in the treatment of primary brain tumors is being increasing nowadays. It shows great promise for some of primary brain tumors and also presents some problems, This review highlights current IMRT in the treatment of mainly primary brain tumors.

  15. Effects of intensity-modulated radiotherapy on human oral microflora

    International Nuclear Information System (INIS)

    Shao Ziyang; Tang Zisheng; Jiang Yuntao; Ma Rui; Liu Zheng; Huang Zhengwei; Yan Chao

    2011-01-01

    This study aimed to evaluate changes in the biodiversity of the oral microflora of patients with head and neck cancer treated with postoperative intensity-modulated radiotherapy (IMRT) or conventional radiotherapy (CRT). Pooled dental plaque samples were collected during the radiation treatment from patients receiving IMRT (n=13) and CRT (n=12). Denaturing gradient gel electrophoresis (DGGE) was used to analyze the temporal variation of these plaque samples. The stimulated and unstimulated salivary flow rates were also compared between IMRT and CRT patients. Reductions in the severity of hyposalivation were observed in IMRT patients compared with CRT patients. We also observed that the temporal stability of the oral ecosystem was significantly higher in the IMRT group (69.96±7.82%) than in the CRT group (51.98±10.45%) (P<0.05). The findings of the present study suggest that IMRT is more conducive to maintaining the relative stability of the oral ecosystem than CRT. (author)

  16. Clinical implementation and quality assurance for intensity modulated radiation therapy

    International Nuclear Information System (INIS)

    Ma, C.-M.; Price, R.; McNeeley, S.; Chen, L.; Li, J.S.; Wang, L.; Ding, M.; Fourkal, E.; Qin, L.

    2002-01-01

    This paper describes the clinical implementation and quality assurance (QA) for intensity-modulated radiation therapy (IMRT) based on the experience at Fox Chase Cancer Center, Philadelphia, USA. We will review our procedures for the clinical implementation of the IMRT technique and the requirements for patient immobilization, target delineation, treatment optimization, beam delivery and system administration. We will discuss the dosimetric requirements and measurement procedures for beam commissioning and dosimetry verification for IMRT. We will examine the details of model-based dose calculation for IMRT treatment planning and the potential problems with such dose calculation algorithms. We will discuss the effect of beam delivery systems on the actual dose distributions received by the patients and the methods to incorporate such effects in the treatment optimization process. We will investigate the use of the Monte Carlo method for dose calculation and treatment verification for IMRT

  17. Intensity-modulated radiotherapy -the State of the Art

    International Nuclear Information System (INIS)

    Ling, C.

    2002-01-01

    Full text: In the last two decades of the last century, the development of three-dimensional conformal radiotherapy (3D-CRT) has substantially reduces the volume of critical organs irradiated to high doses, and has permitted the increase of tumor dose without concomitant increase in normal tissue complication. At Memorial Sloan Kettering Cancer Center, a clinical trial in cancer of the prostate has accrued >1600 patient and the prescription dose has been escalated to 81 Gy with 3D-CRT, and to 86.4 Gy using intensity modulated radiotherapy (IMRT), with promising results. 3D-CRT and IMRT involves the delineation of target and non-target structures from patient-specific 3D image data-sets (primarily CT, sometimes supplemented with MRI, PET etc.), the calculation and display of 3D dose distributions, the analysis and evaluation of structure-specific dose-volume data (DVH-dose volume histogram), radiation delivery with computer-controlled multileaf collimators (MLC), and treatment verification with electronic portal images. However, the dose distribution conformality achieved with 3D-CRT can be further improved by the use of computer-optimized IMRT. In addition, the treatment design phase of 3D-CRT involves several iterative steps and can be time-consuming, particularly when the anatomical geometry is complex. Thus, IMRT is an incremental advance from 3D-CRT with two key enhancements: 1) computerized iterative treatment plan optimization, and 2) the use of intensity-modulated radiation beams. To deliver the IM beams, one efficacious approach is to use MLC in the dynamic mode, using the so-called sliding-window technique, i.e. the leaves of the MLC are in motion while the radiation is being delivered. Since 1995, we have treated over 1500 patients with IMRT. This discussion shall describe the physical aspects of IMRT, emphasizing those features and benefits unique to this approach. Pertinent clinical results will also be briefly presented

  18. Comparison of simple and complex liver intensity modulated radiotherapy

    International Nuclear Information System (INIS)

    Lee, Mark T; Purdie, Thomas G; Eccles, Cynthia L; Sharpe, Michael B; Dawson, Laura A

    2010-01-01

    Intensity-modulated radiotherapy (IMRT) may allow improvement in plan quality for treatment of liver cancer, however increasing radiation modulation complexity can lead to increased uncertainties and requirements for quality assurance. This study assesses whether target coverage and normal tissue avoidance can be maintained in liver cancer intensity-modulated radiotherapy (IMRT) plans by systematically reducing the complexity of the delivered fluence. An optimal baseline six fraction individualized IMRT plan for 27 patients with 45 liver cancers was developed which provided a median minimum dose to 0.5 cc of the planning target volume (PTV) of 38.3 Gy (range, 25.9-59.5 Gy), in 6 fractions, while maintaining liver toxicity risk <5% and maximum luminal gastrointestinal structure doses of 30 Gy. The number of segments was systematically reduced until normal tissue constraints were exceeded while maintaining equivalent dose coverage to 95% of PTV (PTVD95). Radiotherapy doses were compared between the plans. Reduction in the number of segments was achieved for all 27 plans from a median of 48 segments (range 34-52) to 19 segments (range 6-30), without exceeding normal tissue dose objectives and maintaining equivalent PTVD95 and similar PTV Equivalent Uniform Dose (EUD(-20)) IMRT plans with fewer segments had significantly less monitor units (mean, 1892 reduced to 1695, p = 0.012), but also reduced dose conformity (mean, RTOG Conformity Index 1.42 increased to 1.53 p = 0.001). Tumour coverage and normal tissue objectives were maintained with simplified liver IMRT, at the expense of reduced conformity

  19. TomoTherapy MLC verification using exit detector data

    Energy Technology Data Exchange (ETDEWEB)

    Chen Quan; Westerly, David; Fang Zhenyu; Sheng, Ke; Chen Yu [TomoTherapy Inc., 1240 Deming Way, Madison, Wisconsin 53717 (United States); Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado 80045 (United States); Xinghua Cancer Hospital, Xinghua, Jiangsu 225700 (China); Department of Radiation Oncology, University of California-Los Angeles, Los Angeles, California 90095 (United States); TomoTherapy Inc., 1240 Deming Way, Madison, Wisconsin 53717 (United States)

    2012-01-15

    Purpose: Treatment delivery verification (DV) is important in the field of intensity modulated radiation therapy (IMRT). While IMRT and image guided radiation therapy (IGRT), allow us to create more conformal plans and enables the use of tighter margins, an erroneously executed plan can have detrimental effects on the treatment outcome. The purpose of this study is to develop a DV technique to verify TomoTherapy's multileaf collimator (MLC) using the onboard mega-voltage CT detectors. Methods: The proposed DV method uses temporal changes in the MVCT detector signal to predict actual leaf open times delivered on the treatment machine. Penumbra and scattered radiation effects may produce confounding results when determining leaf open times from the raw detector data. To reduce the impact of the effects, an iterative, Richardson-Lucy (R-L) deconvolution algorithm is applied. Optical sensors installed on each MLC leaf are used to verify the accuracy of the DV technique. The robustness of the DV technique is examined by introducing different attenuation materials in the beam. Additionally, the DV technique has been used to investigate several clinical plans which failed to pass delivery quality assurance (DQA) and was successful in identifying MLC timing discrepancies as the root cause. Results: The leaf open time extracted from the exit detector showed good agreement with the optical sensors under a variety of conditions. Detector-measured leaf open times agreed with optical sensor data to within 0.2 ms, and 99% of the results agreed within 8.5 ms. These results changed little when attenuation was added in the beam. For the clinical plans failing DQA, the dose calculated from reconstructed leaf open times played an instrumental role in discovering the root-cause of the problem. Throughout the retrospective study, it is found that the reconstructed dose always agrees with measured doses to within 1%. Conclusions: The exit detectors in the TomoTherapy treatment

  20. Tomotherapy dose distribution verification using MAGIC-f polymer gel dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Pavoni, J. F.; Pike, T. L.; Snow, J.; DeWerd, L.; Baffa, O. [Departamento de Fisica, Faculdade de Filosofia Ciencias e Letras de Ribeirao Preto-Universidade de Sao Paulo, Av. Bandeirantes, 3900 - CEP 14040-901 - Bairro Monte Alegre - Ribeirao Preto, SP (Brazil); Medical Radiation Research Center, Department of Medical Physics, University of Wisconsin, 1111 Highland Avenue, B1002 WIMR, Madison, Wisconsin 53705-2275 (United States); Departamento de Fisica, Faculdade de Filosofia Ciencias e Letras de Ribeirao Preto-Universidade de Sao Paulo, Av. Bandeirantes, 3900 - CEP 14040-901 - Bairro Monte Alegre - Ribeirao Preto, SP (Brazil)

    2012-05-15

    Purpose: This paper presents the application of MAGIC-f gel in a three-dimensional dose distribution measurement and its ability to accurately measure the dose distribution from a tomotherapy unit. Methods: A prostate intensity-modulated radiation therapy (IMRT) irradiation was simulated in the gel phantom and the treatment was delivered by a TomoTherapy equipment. Dose distribution was evaluated by the R2 distribution measured in magnetic resonance imaging. Results: A high similarity was found by overlapping of isodoses of the dose distribution measured with the gel and expected by the treatment planning system (TPS). Another analysis was done by comparing the relative absorbed dose profiles in the measured and in the expected dose distributions extracted along indicated lines of the volume and the results were also in agreement. The gamma index analysis was also applied to the data and a high pass rate was achieved (88.4% for analysis using 3%/3 mm and of 96.5% using 4%/4 mm). The real three-dimensional analysis compared the dose-volume histograms measured for the planning volumes and expected by the treatment planning, being the results also in good agreement by the overlapping of the curves. Conclusions: These results show that MAGIC-f gel is a promise for tridimensional dose distribution measurements.

  1. Tomotherapy dose distribution verification using MAGIC-f polymer gel dosimetry

    International Nuclear Information System (INIS)

    Pavoni, J. F.; Pike, T. L.; Snow, J.; DeWerd, L.; Baffa, O.

    2012-01-01

    Purpose: This paper presents the application of MAGIC-f gel in a three-dimensional dose distribution measurement and its ability to accurately measure the dose distribution from a tomotherapy unit. Methods: A prostate intensity-modulated radiation therapy (IMRT) irradiation was simulated in the gel phantom and the treatment was delivered by a TomoTherapy equipment. Dose distribution was evaluated by the R2 distribution measured in magnetic resonance imaging. Results: A high similarity was found by overlapping of isodoses of the dose distribution measured with the gel and expected by the treatment planning system (TPS). Another analysis was done by comparing the relative absorbed dose profiles in the measured and in the expected dose distributions extracted along indicated lines of the volume and the results were also in agreement. The gamma index analysis was also applied to the data and a high pass rate was achieved (88.4% for analysis using 3%/3 mm and of 96.5% using 4%/4 mm). The real three-dimensional analysis compared the dose-volume histograms measured for the planning volumes and expected by the treatment planning, being the results also in good agreement by the overlapping of the curves. Conclusions: These results show that MAGIC-f gel is a promise for tridimensional dose distribution measurements.

  2. Prone Breast Intensity Modulated Radiation Therapy: 5-Year Results

    International Nuclear Information System (INIS)

    Osa, Etin-Osa O.; DeWyngaert, Keith; Roses, Daniel; Speyer, James; Guth, Amber; Axelrod, Deborah; Fenton Kerimian, Maria; Goldberg, Judith D.; Formenti, Silvia C.

    2014-01-01

    Purpose: To report the 5-year results of a technique of prone breast radiation therapy delivered by a regimen of accelerated intensity modulated radiation therapy with a concurrent boost to the tumor bed. Methods and Materials: Between 2003 and 2006, 404 patients with stage I-II breast cancer were prospectively enrolled into 2 consecutive protocols, institutional trials 03-30 and 05-181, that used the same regimen of 40.5 Gy/15 fractions delivered to the index breast over 3 weeks, with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose 48 Gy). All patients were treated after segmental mastectomy and had negative margins and nodal assessment. Patients were set up prone: only if lung or heart volumes were in the field was a supine setup attempted and chosen if found to better spare these organs. Results: Ninety-two percent of patients were treated prone, 8% supine. Seventy-two percent had stage I, 28% stage II invasive breast cancer. In-field lung volume ranged from 0 to 228.27 cm 3 , mean 19.65 cm 3 . In-field heart volume for left breast cancer patients ranged from 0 to 21.24 cm 3 , mean 1.59 cm 3 . There was no heart in the field for right breast cancer patients. At a median follow-up of 5 years, the 5-year cumulative incidence of isolated ipsilateral breast tumor recurrence was 0.82% (95% confidence interval [CI] 0.65%-1.04%). The 5-year cumulative incidence of regional recurrence was 0.53% (95% CI 0.41%-0.69%), and the 5-year overall cumulative death rate was 1.28% (95% CI 0.48%-3.38%). Eighty-two percent (95% CI 77%-85%) of patients judged their final cosmetic result as excellent/good. Conclusions: Prone accelerated intensity modulated radiation therapy with a concomitant boost results in excellent local control and optimal sparing of heart and lung, with good cosmesis. Radiation Therapy Oncology Group protocol 1005, a phase 3, multi-institutional, randomized trial is ongoing and is evaluating the equivalence of a similar dose and fractionation

  3. Prone Breast Intensity Modulated Radiation Therapy: 5-Year Results

    Energy Technology Data Exchange (ETDEWEB)

    Osa, Etin-Osa O.; DeWyngaert, Keith [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States); Roses, Daniel [Department of Surgery, New York University School of Medicine, New York, New York (United States); Speyer, James [Department of Medical Oncology, New York University School of Medicine, New York, New York (United States); Guth, Amber; Axelrod, Deborah [Department of Surgery, New York University School of Medicine, New York, New York (United States); Fenton Kerimian, Maria [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States); Goldberg, Judith D. [Department of Population Health, New York University School of Medicine, New York, New York (United States); Formenti, Silvia C., E-mail: Silvia.formenti@nyumc.org [Department of Radiation Oncology, New York University School of Medicine, New York, New York (United States)

    2014-07-15

    Purpose: To report the 5-year results of a technique of prone breast radiation therapy delivered by a regimen of accelerated intensity modulated radiation therapy with a concurrent boost to the tumor bed. Methods and Materials: Between 2003 and 2006, 404 patients with stage I-II breast cancer were prospectively enrolled into 2 consecutive protocols, institutional trials 03-30 and 05-181, that used the same regimen of 40.5 Gy/15 fractions delivered to the index breast over 3 weeks, with a concomitant daily boost to the tumor bed of 0.5 Gy (total dose 48 Gy). All patients were treated after segmental mastectomy and had negative margins and nodal assessment. Patients were set up prone: only if lung or heart volumes were in the field was a supine setup attempted and chosen if found to better spare these organs. Results: Ninety-two percent of patients were treated prone, 8% supine. Seventy-two percent had stage I, 28% stage II invasive breast cancer. In-field lung volume ranged from 0 to 228.27 cm{sup 3}, mean 19.65 cm{sup 3}. In-field heart volume for left breast cancer patients ranged from 0 to 21.24 cm{sup 3}, mean 1.59 cm{sup 3}. There was no heart in the field for right breast cancer patients. At a median follow-up of 5 years, the 5-year cumulative incidence of isolated ipsilateral breast tumor recurrence was 0.82% (95% confidence interval [CI] 0.65%-1.04%). The 5-year cumulative incidence of regional recurrence was 0.53% (95% CI 0.41%-0.69%), and the 5-year overall cumulative death rate was 1.28% (95% CI 0.48%-3.38%). Eighty-two percent (95% CI 77%-85%) of patients judged their final cosmetic result as excellent/good. Conclusions: Prone accelerated intensity modulated radiation therapy with a concomitant boost results in excellent local control and optimal sparing of heart and lung, with good cosmesis. Radiation Therapy Oncology Group protocol 1005, a phase 3, multi-institutional, randomized trial is ongoing and is evaluating the equivalence of a similar dose and

  4. Benchmarking Dosimetric Quality Assessment of Prostate Intensity-Modulated Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Senthi, Sashendra, E-mail: sasha.senthi@petermac.org [Division of Radiation Oncology, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia); Gill, Suki S. [Division of Radiation Oncology, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia); Haworth, Annette; Kron, Tomas; Cramb, Jim [Department of Physical Sciences, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia); Rolfo, Aldo [Radiation Therapy Services, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia); Thomas, Jessica [Biostatistics and Clinical Trials, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia); Duchesne, Gillian M. [Division of Radiation Oncology, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia); Hamilton, Christopher H.; Joon, Daryl Lim [Radiation Oncology Department, Austin Repatriation Hospital, Heidelberg, VIC (Australia); Bowden, Patrick [Radiation Oncology Department, Tattersall' s Cancer Center, East Melbourne, VIC (Australia); Foroudi, Farshad [Division of Radiation Oncology, Peter MacCallum Cancer Center, East Melbourne, VIC (Australia)

    2012-02-01

    Purpose: To benchmark the dosimetric quality assessment of prostate intensity-modulated radiotherapy and determine whether the quality is influenced by disease or treatment factors. Patients and Methods: We retrospectively analyzed the data from 155 consecutive men treated radically for prostate cancer using intensity-modulated radiotherapy to 78 Gy between January 2007 and March 2009 across six radiotherapy treatment centers. The plan quality was determined by the measures of coverage, homogeneity, and conformity. Tumor coverage was measured using the planning target volume (PTV) receiving 95% and 100% of the prescribed dose (V{sub 95%} and V{sub 100%}, respectively) and the clinical target volume (CTV) receiving 95% and 100% of the prescribed dose. Homogeneity was measured using the sigma index of the PTV and CTV. Conformity was measured using the lesion coverage factor, healthy tissue conformity index, and the conformity number. Multivariate regression models were created to determine the relationship between these and T stage, risk status, androgen deprivation therapy use, treatment center, planning system, and treatment date. Results: The largest discriminatory measurements of coverage, homogeneity, and conformity were the PTV V{sub 95%}, PTV sigma index, and conformity number. The mean PTV V{sub 95%} was 92.5% (95% confidence interval, 91.3-93.7%). The mean PTV sigma index was 2.10 Gy (95% confidence interval, 1.90-2.20). The mean conformity number was 0.78 (95% confidence interval, 0.76-0.79). The treatment center independently influenced the coverage, homogeneity, and conformity (all p < .0001). The planning system independently influenced homogeneity (p = .038) and conformity (p = .021). The treatment date independently influenced the PTV V{sub 95%} only, with it being better at the start (p = .013). Risk status, T stage, and the use of androgen deprivation therapy did not influence any aspect of plan quality. Conclusion: Our study has benchmarked measures

  5. Benchmarking Dosimetric Quality Assessment of Prostate Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Senthi, Sashendra; Gill, Suki S.; Haworth, Annette; Kron, Tomas; Cramb, Jim; Rolfo, Aldo; Thomas, Jessica; Duchesne, Gillian M.; Hamilton, Christopher H.; Joon, Daryl Lim; Bowden, Patrick; Foroudi, Farshad

    2012-01-01

    Purpose: To benchmark the dosimetric quality assessment of prostate intensity-modulated radiotherapy and determine whether the quality is influenced by disease or treatment factors. Patients and Methods: We retrospectively analyzed the data from 155 consecutive men treated radically for prostate cancer using intensity-modulated radiotherapy to 78 Gy between January 2007 and March 2009 across six radiotherapy treatment centers. The plan quality was determined by the measures of coverage, homogeneity, and conformity. Tumor coverage was measured using the planning target volume (PTV) receiving 95% and 100% of the prescribed dose (V 95% and V 100% , respectively) and the clinical target volume (CTV) receiving 95% and 100% of the prescribed dose. Homogeneity was measured using the sigma index of the PTV and CTV. Conformity was measured using the lesion coverage factor, healthy tissue conformity index, and the conformity number. Multivariate regression models were created to determine the relationship between these and T stage, risk status, androgen deprivation therapy use, treatment center, planning system, and treatment date. Results: The largest discriminatory measurements of coverage, homogeneity, and conformity were the PTV V 95% , PTV sigma index, and conformity number. The mean PTV V 95% was 92.5% (95% confidence interval, 91.3–93.7%). The mean PTV sigma index was 2.10 Gy (95% confidence interval, 1.90–2.20). The mean conformity number was 0.78 (95% confidence interval, 0.76–0.79). The treatment center independently influenced the coverage, homogeneity, and conformity (all p 95% only, with it being better at the start (p = .013). Risk status, T stage, and the use of androgen deprivation therapy did not influence any aspect of plan quality. Conclusion: Our study has benchmarked measures of coverage, homogeneity, and conformity for the treatment of prostate cancer using IMRT. The differences seen between centers and planning systems and the coverage

  6. Design and implementation of a ''cheese'' phantom-based Tomotherapy TLD dose intercomparison

    Energy Technology Data Exchange (ETDEWEB)

    Schiefer, Hans; Buchauer, Konrad; Heinze, Simon [Medical Physics Group, Department of Radiation Oncology, St. Gallen (Switzerland); Henke, Guido; Plasswilm, Ludwig [Department of Radiation Oncology, St. Gallen (Switzerland)

    2015-11-15

    The unique beam-delivery technique of Tomotherapy machines (Accuray Inc., Sunnyvale, Calif.) necessitates tailored quality assurance. This requirement also applies to external dose intercomparisons. Therefore, the aim of the 2014 SSRMP (Swiss Society of Radiobiology and Medical Physics) dosimetry intercomparison was to compare two set-ups with different phantoms. A small cylindrical Perspex phantom, which is similar to the IROC phantom (Imaging and Radiation Oncology Core, Houston, Tex.), and the ''cheese'' phantom, which is provided by the Tomotherapy manufacturer to all institutions, were used. The standard calibration plans for the TomoHelical and TomoDirect irradiation techniques were applied. These plans are routinely used for dose output calibration in Tomotherapy institutions. We tested 20 Tomotherapy machines in Germany and Switzerland. The ratio of the measured (D{sub m}) to the calculated (D{sub c}) dose was assessed for both phantoms and irradiation techniques. The D{sub m}/D{sub c} distributions were determined to compare the suitability of the measurement set-ups investigated. The standard deviations of the TLD-measured (thermoluminescent dosimetry) D{sub m}/D{sub c} ratios for the ''cheese'' phantom were 1.9 % for the TomoHelical (19 measurements) and 1.2 % (11 measurements) for the TomoDirect irradiation techniques. The corresponding ratios for the Perspex phantom were 2.8 % (18 measurements) and 1.8 % (11 measurements). Compared with the Perspex phantom-based set-up, the ''cheese'' phantom-based set-up without individual planning was demonstrated to be more suitable for Tomotherapy dose checks. Future SSRMP dosimetry intercomparisons for Tomotherapy machines will therefore be based on the ''cheese'' phantom set-up. (orig.) [German] Die einzigartige Bestrahlungstechnik mit Tomotherapie-Bestrahlungsgeraeten (Accuray Inc., Sunnyvale, CA, USA) erfordert spezifische

  7. Outcome after intensity modulated radiotherapy for anaplastic thyroid carcinoma

    International Nuclear Information System (INIS)

    He, Xiayun; Li, Duanshu; Hu, Chaosu; Wang, Zhuoying; Ying, Hongmei; Wu, Yi

    2014-01-01

    Anaplastic thyroid carcinoma (ATC) is a malignancy with one of the highest fatality rates. We reviewed our recent clinical experience with intensity modulated radiotherapy (IMRT) combined with surgery and chemotherapy for the management of ATC. 13 patients with ATC who were treated by IMRT in our institution between October 2008 and February 2011, have been analyzed. The target volume for IMRT was planned to include Gross tumor volume (GTV): primary tumor plus any N + disease (66 Gy/33 F/6.6 W), with elective irradiation of thyroid bed, bilateral level II through VI and mediastinal lymph nodes to the level of the carina (54-60 Gy). Seven patients received surgical intervention and eleven patients had chemotherapy. The median radiotherapy dose to GTV was 60 Gy/30 fractions/6 weeks. The median survival time of the 13 patients was 9 months. The direct causes of death were distant metastases (75%) and progression of the locoregional disease (25%). Ten patients were spared dyspnea and tracheostomy because their primary neck lesion did not progress. The results showed that IMRT combined by surgery and chemotherapy for ATC might be beneficial to improve locoregional control. Further new therapies are needed to control metastases

  8. Current status of intensity-modulated radiation therapy (IMRT)

    International Nuclear Information System (INIS)

    Hatano, Kazuo; Araki, Hitoshi; Sakai, Mitsuhiro

    2007-01-01

    External-beam radiation therapy has been one of the treatment options for prostate cancer. The dose response has been observed for a dose range of 64.8-81 Gy. The problem of external-beam radiotherapy (RT) for prostate cancer is that as the dose increases, adverse effects also increase. Three-dimensional conformal radiation therapy (3D-CRT) has enabled us to treat patients with up to 72-76 Gy to the prostate, with a relatively acceptable risk of late rectal bleeding. Recently, intensity-modulated radiation therapy (IMRT) has been shown to deliver a higher dose to the target with acceptable low rates of rectal and bladder complications. The most important things to keep in mind when using an IMRT technique are that there is a significant trade-off between coverage of the target, avoidance of adjacent critical structures, and the inhomogeneity of the dose within the target. Lastly, even with IMRT, it should be kept in mind that a ''perfect'' plan that creates completely homogeneous coverage of the target volume and zero or small dose to the adjacent organs at risk is not always obtained. Participating in many treatment planning sessions and arranging the beams and beam weights create the best approach to the best IMRT plan. (author)

  9. Norwegian Oncologists' Expectations of Intensity-modulated Radiotherapy

    International Nuclear Information System (INIS)

    Muren, Ludvig P.; Mella, Olav; Hafslund, Rune; Dahl, Olav

    2002-01-01

    Although intensity-modulated radiotherapy (IMRT) may increase the therapeutic ratio of radiotherapy for a range of malignancies, only a few IMRT treatments have yet been performed in the Nordic countries. The scores derived from a national survey to assess Norwegian oncologists' expectations of IMRT are presented. A questionnaire was distributed to all consultants in oncology at Norwegian radiotherapy clinics. Summary scores of daily general radiotherapy workload (DGRTW), acquaintance with IMRT (AI) and expectations of IMRT (EI) were derived. Thirty-nine questionnaires (67%) were returned from a total of 58 oncologists. The oncologists' scores on the AI scale (mean score: 7.5 out of 21) were rather low. Their AI scores were found to be positively correlated with their DGRTW. Higher scores on the EI scale were documented (mean score: 6.2 out of 14): 15 oncologists (39%) rated IMRT as one of the three major contributors to potentially increased cancer survival. Oncologists treating patients with prostate, head and neck, gastrointestinal and CNS tumours had higher EI scores than the other oncologists (7.7 vs. 5.1; p=0.01). The Norwegian radiation oncologists' expectations of IMRT are high in terms of both the potential clinical benefit and the rate of implementation. This should encourage the radiotherapy communities to continue (or rapidly initiate) their efforts in providing the routines required for safe implementation of IMRT

  10. Dosimetric Uncertainties in Verification of Intensity Modulated Photon Beams

    International Nuclear Information System (INIS)

    Jurkovic, S.

    2010-01-01

    The doctoral thesis presents method for the calculation of the compensators' shape to modulate linear accelerators' beams. Characteristic of the method is more strict calculation of the scattered radiation in beams with an inhomogeneous cross-section than it was before. Method could be applied in various clinical situations. It's dosimetric verification was made in phantoms, measuring dose distributions using ionization chambers as well as radiographic film. Therefore, ionization chambers were used for the evaluation of modulator shape and film was used for the evaluation of two-dimensional dose distributions. It is well known that dosimetry of the intensity modulated photon beams is rather complicated regarding inhomogeneity of the dose distribution. The main reason for that is the beam modulator which changes spectral distribution of the beam. Possibility of use different types of detectors for the measurements of dose distributions in modulated photon beams and their accuracy were examined. Small volume ionization chambers, different diodes and amorphus silicon detector and radigraphic film were used. Measured dose distributions were compared between each other as well as with distributions simulated using Monte Carlo particle transport algorithm. In this way the most accurate method for the verification of modulate photon beams is suggested. (author)

  11. Intensity-modulated radiation therapy for anal carcinoma

    International Nuclear Information System (INIS)

    Peiffert, D.; Moreau-Claeys, M.V.; Tournier-Rangeard, L.; Huger, S.; Marchesi, V.

    2011-01-01

    Anal canal carcinoma are highly curable by irradiation, combined with chemotherapy in locally advanced disease, with preservation of sphincter function. The clinical target volume for the nodes is extended, often including the inguinal nodes, which is not usual for other pelvic tumours. Acute and late effects are correlated with the volume and dose delivered to organs at risk, i. e. small bowel, bladder and increased by concomitant chemotherapy. Intensity modulated irradiation (IMRT) makes it possible to optimize the dose distribution in this 'complex U shaped' volume, while maintaining the dose distribution for the target volumes. The conversion from conformal irradiation to IMRT necessitates good knowledge of the definition and skills to delineate target volumes and organs at risk, including new volumes needed to optimize the dose distribution. Dosimetric and clinical benefits of IMRT are described, based on early descriptions and evidence-based publication. The growing development of IMRT in anal canal radiotherapy must be encouraged, and long-term benefits should be soon published. Radiation oncologists should precisely learn IMRT recommendations before starting the technique, and evaluate its early and late results for adverse effects, but also for long-term tumour control. (authors)

  12. Dosimetric verification of the intensity-modulated radiation therapy

    International Nuclear Information System (INIS)

    Zou Huawei; Jia Mingxuan; Wu Rong; Xiao Fuda; Dong Xiaoqi

    2004-01-01

    Objective: To discuss the methods of the dosimetric verification in the intensity-modulated radiation therapy (IMRT) and insure correct execution of the IMRT planning in the clinical practice. Methods: The CMSFOCUS9200 inverse planning system was used to provide optimized 5-field IMRT treatment plans for the patients. A phantom was made from true water-equivalent material. The doses of the interesting points and isodose distributions of the interesting planes in the phantom were calculated using patients' treatment plan. The phantom was placed on the couch of the accelerator and was irradiated using the phantom's treatment planning data. The doses of interesting points were measured using a 0.23 cc chamber and the isodose distributions of interesting planes were measured using RIT 113 film dosimetry system in the phantom. The results were compared with those from calculation in planning system for verification. Results: The doses and isodose distributions measured by the chamber and the film were consistent with those predicted by the planning. The error between the measured dose and calculated dose in the interesting points was less than 3%. Conclusion: The dosimetric verification of IMRT is a reliable measure in the course of its implementation. (authors)

  13. Intensity-Modulated Radiation Therapy in Childhood Ependymoma

    International Nuclear Information System (INIS)

    Schroeder, Thomas M.; Chintagumpala, Murali; Okcu, M. Fatih; Chiu, J. Kam; Teh, Bin S.; Woo, Shiao Y.; Paulino, Arnold C.

    2008-01-01

    Purpose: To determine the patterns of failure after intensity-modulated radiation therapy (IMRT) for localized intracranial ependymoma. Methods and Materials: From 1994 to 2005, 22 children with pathologically proven, localized, intracranial ependymoma were treated with adjuvant IMRT. Of the patients, 12 (55%) had an infratentorial tumor and 14 (64%) had anaplastic histology. Five patients had a subtotal resection (STR), as evidenced by postoperative magnetic resonance imaging. The clinical target volume encompassed the tumor bed and any residual disease plus margin (median dose 54 Gy). Median follow-up for surviving patients was 39.8 months. Results: The 3-year overall survival rate was 87% ± 9%. The 3-year local control rate was 68% ± 12%. There were six local recurrences, all in the high-dose region of the treatment field. Median time to recurrence was 21.7 months. Of the 5 STR patients, 4 experienced recurrence and 3 died. Patients with a gross total resection had significantly better local control (p = 0.024) and overall survival (p = 0.008) than those with an STR. At last follow-up, no patient had developed visual loss, brain necrosis, myelitis, or a second malignancy. Conclusions: Treatment with IMRT provides local control and survival rates comparable with those in historic publications using larger treatment volumes. All failures were within the high-dose region, suggesting that IMRT does not diminish local control. The degree of surgical resection was shown to be significant for local control and survival

  14. Subcarrier intensity modulation for MIMO visible light communications

    Science.gov (United States)

    Celik, Yasin; Akan, Aydin

    2018-04-01

    In this paper, subcarrier intensity modulation (SIM) is investigated for multiple-input multiple-output (MIMO) visible light communication (VLC) systems. A new modulation scheme called DC-aid SIM (DCA-SIM) is proposed for the spatial modulation (SM) transmission plan. Then, DCA-SIM is extended for multiple subcarrier case which is called DC-aid Multiple Subcarrier Modulation (DCA-MSM). Bit error rate (BER) performances of the considered system are analyzed for different MIMO schemes. The power efficiencies of DCA-SIM and DCA-MSM are shown in correlated MIMO VLC channels. The upper bound BER performances of the proposed models are obtained analytically for PSK and QAM modulation types in order to validate the simulation results. Additionally, the effect of power imbalance method on the performance of SIM is studied and remarkable power gains are obtained compared to the non-power imbalanced cases. In this work, Pulse amplitude modulation (PAM) and MSM-Index are used as benchmarks for single carrier and multiple carrier cases, respectively. And the results show that the proposed schemes outperform PAM and MSM-Index for considered single carrier and multiple carrier communication scenarios.

  15. Clinically practical intensity modulation for complex head and neck lesions using multiple, static MLC fields

    International Nuclear Information System (INIS)

    Verhey, L.J.; Xia, P.; Akazawa, P.

    1997-01-01

    Purpose: A number of different beam delivery methods have been proposed for implementing intensity modulated radiotherapy (IMRT), including fixed gantry with multiple static MLC fields (MSMLC - often referred to as 'stop and shoot'), fixed gantry with dynamic MLC (DMLC), intensity modulated arc therapy (IMAT), Tomotherapy and Peacock MIMiC. Using two complex head and neck cases as examples, we have compared dose distributions achievable with 3-D conformal radiotherapy (3DCRT) to those which can be achieved using IMRT delivered with MSMLC, DMLC and Peacock MIMiC. The goal is to demonstrate the potential value of IMRT in the treatment of complex lesions in the head and neck and to determine whether MSMLC, the simplest of the proposed IMRT methods, can produce dose distributions which are competitive with dynamic IMRT methods and which can be implemented in clinically acceptable times. Materials and Methods: Two patients with nasopharyngeal carcinoma were selected from the archives of the Department of Radiation Oncology at the University of California, San Francisco (UCSF). These patients were previously planned and treated with CT-based 3-D treatment planning methods which are routinely used at UCSF, including non-axial beam directions and partial transmission blocks when indicated. The CT data tapes were then read into a test version of CORVUS, an inverse treatment planning program being developed by NOMOS Corporation, target volumes and critical normal structures were outlined on axial CT slices and dose goals and limits were defined for the targets and normal tissues of interest. Optimized dose plans were then obtained for each delivery method including MSMLC (4 or 5 hand-selected beams with 3 levels of intensity), DMLC (9 evenly spaced axial beams with 10 levels of intensity) and Peacock MIMiC (55 axial beams spanning 270 degrees with 10 levels of intensity). Dose-volume histograms (DVH's) for all IMRT plans were then compared with the 3DCRT plans. Treatment

  16. Intensity modulated operating mode of the rotating gamma system.

    Science.gov (United States)

    Sengupta, Bishwambhar; Gulyas, Laszlo; Medlin, Donald; Koroknai, Tibor; Takacs, David; Filep, Gyorgy; Panko, Peter; Godo, Bence; Hollo, Tamas; Zheng, Xiao Ran; Fedorcsak, Imre; Dobai, Jozsef; Bognar, Laszlo; Takacs, Endre

    2018-05-01

    The purpose of this work was to explore two novel operation modalities of the rotating gamma systems (RGS) that could expand its clinical application to lesions in close proximity to critical organs at risk (OAR). The approach taken in this study consists of two components. First, a Geant4-based Monte Carlo (MC) simulation toolkit is used to model the dosimetric properties of the RGS Vertex 360™ for the normal, intensity modulated radiosurgery (IMRS), and speed modulated radiosurgery (SMRS) operation modalities. Second, the RGS Vertex 360™ at the Rotating Gamma Institute in Debrecen, Hungary is used to collect experimental data for the normal and IMRS operation modes. An ion chamber is used to record measurements of the absolute dose. The dose profiles are measured using Gafchromic EBT3 films positioned within a spherical water equivalent phantom. A strong dosimetric agreement between the measured and simulated dose profiles and penumbra was found for both the normal and IMRS operation modes for all collimator sizes (4, 8, 14, and 18 mm diameter). The simulated falloff and maximum dose regions agree better with the experimental results for the 4 and 8 mm diameter collimators. Although the falloff regions align well in the 14 and 18 mm collimators, the maximum dose regions have a larger difference. For the IMRS operation mode, the simulated and experimental dose distributions are ellipsoidal, where the short axis aligns with the blocked angles. Similarly, the simulated dose distributions for the SMRS operation mode also adopt an ellipsoidal shape, where the short axis aligns with the angles where the orbital speed is highest. For both modalities, the dose distribution is highly constrained with a sharper penumbra along the short axes. Dose modulation of the RGS can be achieved with the IMRS and SMRS modes. By providing a highly constrained dose distribution with a sharp penumbra, both modes could be clinically applicable for the treatment of lesions in close

  17. Iterative regularization in intensity-modulated radiation therapy optimization

    International Nuclear Information System (INIS)

    Carlsson, Fredrik; Forsgren, Anders

    2006-01-01

    A common way to solve intensity-modulated radiation therapy (IMRT) optimization problems is to use a beamlet-based approach. The approach is usually employed in a three-step manner: first a beamlet-weight optimization problem is solved, then the fluence profiles are converted into step-and-shoot segments, and finally postoptimization of the segment weights is performed. A drawback of beamlet-based approaches is that beamlet-weight optimization problems are ill-conditioned and have to be regularized in order to produce smooth fluence profiles that are suitable for conversion. The purpose of this paper is twofold: first, to explain the suitability of solving beamlet-based IMRT problems by a BFGS quasi-Newton sequential quadratic programming method with diagonal initial Hessian estimate, and second, to empirically show that beamlet-weight optimization problems should be solved in relatively few iterations when using this optimization method. The explanation of the suitability is based on viewing the optimization method as an iterative regularization method. In iterative regularization, the optimization problem is solved approximately by iterating long enough to obtain a solution close to the optimal one, but terminating before too much noise occurs. Iterative regularization requires an optimization method that initially proceeds in smooth directions and makes rapid initial progress. Solving ten beamlet-based IMRT problems with dose-volume objectives and bounds on the beamlet-weights, we find that the considered optimization method fulfills the requirements for performing iterative regularization. After segment-weight optimization, the treatments obtained using 35 beamlet-weight iterations outperform the treatments obtained using 100 beamlet-weight iterations, both in terms of objective value and of target uniformity. We conclude that iterating too long may in fact deteriorate the quality of the deliverable plan

  18. Intensity Modulated Radiation Therapy. Development of the technique

    International Nuclear Information System (INIS)

    Rafailovici, L.; Alva, R.; Chiozza, J.; Donato, H.; Falomo, S.; Cardiello, C.; Furia, O.; Martinez, A.; Filomia, M.L.; Sansogne, R.; Arbiser, S.; Dosoretz, B.

    2008-01-01

    Full text: Introduction: Intensity Modulated Radiation Therapy (IMRT) is a result of advances in computer sciences that allowed the development of new technology related to planning and radiation therapy. IMRT was developed to homogenize the dose in the target volumes and decrease the dose in the surrounding healthy tissue. Using a software with high calculation capacity a simultaneous irradiation with different doses in a given volume is achieved. IMRT is based on internal planning. Material and methods: 628 patients were treated with IMRT in prostate lesions, head and neck, breast, thorax, abdomen and brain since August 2008. The software for IMRT is the XIO CMS and the accelerator used is a Varian Clinac 6 / 100. IMRT requires a first simulation, where immobilization systems are selected (mats, thermoplastic masks, among others) and the demarcation of the target structures, healthy tissue and dose prescription by a tattoo. Images of CT / MRI are merged when necessary. Once the system made the treatment optimization, this one is regulated by modulators. These are produced by numerical control machines from digital files produced by software. In a second modulation the planned irradiation is checked and tattoo is carried out according with this. We have a strict process of quality assurance to assess the viability of the plan before its implementation. We use the Map Check it possible to compare the dose on the central axis and the distribution in the whole plane regarding to that generated by the planning system. From 03/2008 the virtual simulation process was implemented integrating the described stages. Results and Conclusions: IMRT is a complex technique. The meticulous planning, implementation of process and quality control allows the use of this technique in a reliable and secure way. With IMRT we achieved a high level of dose conformation, less irradiation of healthy tissue, lower rates of complications and the dose escalation for some tumors. (authors) [es

  19. Prostate Bed Motion During Intensity-Modulated Radiotherapy Treatment

    International Nuclear Information System (INIS)

    Klayton, Tracy; Price, Robert; Buyyounouski, Mark K.; Sobczak, Mark; Greenberg, Richard; Li, Jinsheng; Keller, Lanea; Sopka, Dennis; Kutikov, Alexander; Horwitz, Eric M.

    2012-01-01

    Purpose: Conformal radiation therapy in the postprostatectomy setting requires accurate setup and localization of the prostatic fossa. In this series, we report prostate bed localization and motion characteristics, using data collected from implanted radiofrequency transponders. Methods and Materials: The Calypso four-dimensional localization system uses three implanted radiofrequency transponders for daily target localization and real-time tracking throughout a course of radiation therapy. We reviewed the localization and tracking reports for 20 patients who received ultrasonography-guided placement of Calypso transponders within the prostate bed prior to a course of intensity-modulated radiation therapy at Fox Chase Cancer Center. Results: At localization, prostate bed displacement relative to bony anatomy exceeded 5 mm in 9% of fractions in the anterior-posterior (A-P) direction and 21% of fractions in the superior-inferior (S-I) direction. The three-dimensional vector length from skin marks to Calypso alignment exceeded 1 cm in 24% of all 652 fractions with available setup data. During treatment, the target exceeded the 5-mm tracking limit for at least 30 sec in 11% of all fractions, generally in the A-P or S-I direction. In the A-P direction, target motion was twice as likely to move posteriorly, toward the rectum, than anteriorly. Fifteen percent of all treatments were interrupted for repositioning, and 70% of patients were repositioned at least once during their treatment course. Conclusion: Set-up errors and motion of the prostatic fossa during radiotherapy are nontrivial, leading to potential undertreatment of target and excess normal tissue toxicity if not taken into account during treatment planning. Localization and real-time tracking of the prostate bed via implanted Calypso transponders can be used to improve the accuracy of plan delivery.

  20. SU-E-T-409: Intensity Modulated Robotic Radiotherapy

    International Nuclear Information System (INIS)

    Wang, B; Jin, L; Li, J; Chen, L; Ma, C; Fan, J; Zhang, C

    2014-01-01

    Purpose: As compared with the IRIS-based models, the MLC-based CyberKnife system allows more efficient treatment delivery due to its improved coverage of large lesions and intensity modulation. The treatment delivery efficiency is mainly determined by the number of selected nodes. This study aimed to demonstrate that relatively small sets of optimally selected nodes could produce high-quality plans. Methods: The full body path of the CyberKnife system consists of 110 nodes, from which we selected various sets for 4 prostate cancer cases using our in-house beamselection software. With the selected nodes we generated IMRT plans using our in-house beamlet-based inverse-planning optimization program. We also produced IMRT plans using the MultiPlan treatment planning system (version 5.0) for the same cases. Furthermore, the nodes selected by MultiPlan were used to produce plans with our own optimization software so that we could compare the quality of the selected sets of nodes. Results: Our beam-selection program selected one node-set for each case, with the number of nodes ranging from 23 to 34. The IMRT plans based on the selected nodes and our in-house optimization program showed adequate target coverage, with favorable critical structure sparing for the cases investigated. Compared with the plans using the nodes selected by MultiPlan, the plans generated with our selected beams provided superior rectum/bladder sparing for 75% of the cases. The plans produced by MultiPlan with various numbers of nodes also suggested that the plan quality was not compromised significantly when the number of nodes was reduced. Conclusion: Our preliminary results showed that with beamletbased planning optimization, one could produce high-quality plans with an optimal set of nodes for MLC-based robotic radiotherapy. Furthermore, our beam-selection strategy could help further improve critical structure sparing

  1. Intensity-Modulated Radiotherapy for Resected Mesothelioma: The Duke Experience

    International Nuclear Information System (INIS)

    Miles, Edward F.; Larrier, Nicole A.; Kelsey, Christopher R.; Hubbs, Jessica L.; Ma Jinli; Yoo, Sua; Marks, Lawrence B.

    2008-01-01

    Purpose: To assess the safety and efficacy of intensity-modulated radiotherapy (IMRT) after extrapleural pneumonectomy for malignant pleural mesothelioma. Methods and Materials: Thirteen patients underwent IMRT after extrapleural pneumonectomy between July 2005 and February 2007 at Duke University Medical Center. The clinical target volume was defined as the entire ipsilateral hemithorax, chest wall incisions, including drain sites, and involved nodal stations. The dose prescribed to the planning target volume was 40-55 Gy (median, 45). Toxicity was graded using the modified Common Toxicity Criteria, and the lung dosimetric parameters from the subgroups with and without pneumonitis were compared. Local control and survival were assessed. Results: The median follow-up after IMRT was 9.5 months. Of the 13 patients, 3 (23%) developed Grade 2 or greater acute pulmonary toxicity (during or within 30 days of IMRT). The median dosimetric parameters for those with and without symptomatic pneumonitis were a mean lung dose (MLD) of 7.9 vs. 7.5 Gy (p = 0.40), percentage of lung volume receiving 20 Gy (V 20 ) of 0.2% vs. 2.3% (p = 0.51), and percentage of lung volume receiving 5 Gy (V 20 ) of 92% vs. 66% (p = 0.36). One patient died of fatal pulmonary toxicity. This patient received a greater MLD (11.4 vs. 7.6 Gy) and had a greater V 20 (6.9% vs. 1.9%), and V 5 (92% vs. 66%) compared with the median of those without fatal pulmonary toxicity. Local and/or distant failure occurred in 6 patients (46%), and 6 patients (46%) were alive without evidence of recurrence at last follow-up. Conclusions: With limited follow-up, 45-Gy IMRT provides reasonable local control for mesothelioma after extrapleural pneumonectomy. However, treatment-related pulmonary toxicity remains a significant concern. Care should be taken to minimize the dose to the remaining lung to achieve an acceptable therapeutic ratio

  2. Ultrasound-based guidance of intensity-modulated radiation therapy

    International Nuclear Information System (INIS)

    Fung, Albert Y.C.; Ayyangar, Komanduri M.; Djajaputra, David; Nehru, Ramasamy M.; Enke, Charles A.

    2006-01-01

    In ultrasound-guided intensity-modulated radiation therapy (IMRT) of prostate cancer, ultrasound imaging ascertains the anatomical position of patients during x-ray therapy delivery. The ultrasound transducers are made of piezoelectric ceramics. The same crystal is used for both ultrasound production and reception. Three-dimensional (3D) ultrasound devices capture and correlate series of 2-dimensional (2D) B-mode images. The transducers are often arranged in a convex array for focusing. Lower frequency reaches greater depth, but results in low resolution. For clear image, some gel is usually applied between the probe and the skin contact surface. For prostate positioning, axial and sagittal scans are performed, and the volume contours from computed tomography (CT) planning are superimposed on the ultrasound images obtained before radiation delivery at the linear accelerator. The planning volumes are then overlaid on the ultrasound images and adjusted until they match. The computer automatically deduces the offset necessary to move the patient so that the treatment area is in the correct location. The couch is translated as needed. The currently available commercial equipment can attain a positional accuracy of 1-2 mm. Commercial manufacturer designs differ in the detection of probe coordinates relative to the isocenter. Some use a position-sensing robotic arm, while others have infrared light-emitting diodes or pattern-recognition software with charge-couple-device cameras. Commissioning includes testing of image quality and positional accuracy. Ultrasound is mainly used in prostate positioning. Data for 7825 daily fractions of 234 prostate patients indicated average 3D inter-fractional displacement of about 7.8 mm. There was no perceivable trend of shift over time. Scatter plots showed slight prevalence toward superior-posterior directions. Uncertainties of ultrasound guidance included tissue inhomogeneities, speckle noise, probe pressure, and inter

  3. Quality assurance of patients for intensity modulated radiation therapy

    International Nuclear Information System (INIS)

    Yoon, Sang Min; Yi, Byong Yong; Choi, Eun Kyung; Kim, Jong Hoon; Ahn, Seung Do; Lee, Sang Wook

    2002-01-01

    To establish and verify the proper and the practical IMRT (intensity-modulated radiation therapy) patient QA (Quality Assurance). An IMRT QA which consists of 3 steps and 16 items were designed and examined the validity of the program by applying to 9 patients, 12 IMRT cases of various sites. The three step QA program consists of RTP related QA, treatment information flow QA, and a treatment delivery QA procedure. The evaluation of organ constraints, the validity of the point dose, and the dose distribution are major issues in the RTP related QA procedure. The leaf sequence file generation, the evaluation of the MLC control file, the comparison of the dry run film, and the IMRT field simulate image were included in the treatment information flow procedure QA. The patient setup QA, the verification of the IMRT treatment fields to the patients, and the examination of the data in the Record and Verify system make up the treatment delivery QA procedure. The point dose measurement results of 10 cases showed good agreement with the RTP calculation within 3%. One case showed more than a 3% difference and the other case showed more than 5%, which was out side the tolerance level. We could not find any differences of more than 2 mm between the RTP leaf sequence and the dry run film. Film dosimetry and the dose distribution from the phantom plan showed the same tendency, but quantitative analysis was not possible because of the film dosimetry nature. No error had been found from the MLC control file and one mis-registration case was found before treatment. This study shows the usefulness and the necessity of the IMRT patient QA program. The whole procedure of this program should be performed, especially by institutions that have just started to accumulate experience. But, the program is too complex and time consuming. Therefore, we propose practical and essential QA items for institutions in which the IMRT is performed as a routine procedure

  4. Intensity Modulated Radiation Therapy With Dose Painting to Treat Rhabdomyosarcoma

    International Nuclear Information System (INIS)

    Yang, Joanna C.; Dharmarajan, Kavita V.; Wexler, Leonard H.; La Quaglia, Michael P.; Happersett, Laura; Wolden, Suzanne L.

    2012-01-01

    Purpose: To examine local control and patterns of failure in rhabdomyosarcoma patients treated with intensity modulated radiation therapy (RT) with dose painting (DP-IMRT). Patients and Methods: A total of 41 patients underwent DP-IMRT with chemotherapy for definitive treatment. Nineteen also underwent surgery with or without intraoperative RT. Fifty-six percent had alveolar histologic features. The median interval from beginning chemotherapy to RT was 17 weeks (range, 4-25). Very young children who underwent second-look procedures with or without intraoperative RT received reduced doses of 24-36 Gy in 1.4-1.8-Gy fractions. Young adults received 50.4 Gy to the primary tumor and lower doses of 36 Gy in 1.8-Gy fractions to at-risk lymph node chains. Results: With 22 months of median follow-up, the actuarial local control rate was 90%. Patients aged ≤7 years who received reduced overall and fractional doses had 100% local control, and young adults had 79% (P=.07) local control. Three local failures were identified in young adults whose primary target volumes had received 50.4 Gy in 1.8-Gy fractions. Conclusions: DP-IMRT with lower fractional and cumulative doses is feasible for very young children after second-look procedures with or without intraoperative RT. DP-IMRT is also feasible in adolescents and young adults with aggressive disease who would benefit from prophylactic RT to high-risk lymph node chains, although dose escalation might be warranted for improved local control. With limited follow-up, it appears that DP-IMRT produces local control rates comparable to those of sequential IMRT in patients with rhabdomyosarcoma.

  5. Preliminary Retrospective Analysis of Daily Tomotherapy Output Constancy Checks Using Statistical Process Control.

    Science.gov (United States)

    Mezzenga, Emilio; D'Errico, Vincenzo; Sarnelli, Anna; Strigari, Lidia; Menghi, Enrico; Marcocci, Francesco; Bianchini, David; Benassi, Marcello

    2016-01-01

    The purpose of this study was to retrospectively evaluate the results from a Helical TomoTherapy Hi-Art treatment system relating to quality controls based on daily static and dynamic output checks using statistical process control methods. Individual value X-charts, exponentially weighted moving average charts, and process capability and acceptability indices were used to monitor the treatment system performance. Daily output values measured from January 2014 to January 2015 were considered. The results obtained showed that, although the process was in control, there was an out-of-control situation in the principal maintenance intervention for the treatment system. In particular, process capability indices showed a decreasing percentage of points in control which was, however, acceptable according to AAPM TG148 guidelines. Our findings underline the importance of restricting the acceptable range of daily output checks and suggest a future line of investigation for a detailed process control of daily output checks for the Helical TomoTherapy Hi-Art treatment system.

  6. Linear energy transfer incorporated intensity modulated proton therapy optimization

    Science.gov (United States)

    Cao, Wenhua; Khabazian, Azin; Yepes, Pablo P.; Lim, Gino; Poenisch, Falk; Grosshans, David R.; Mohan, Radhe

    2018-01-01

    The purpose of this study was to investigate the feasibility of incorporating linear energy transfer (LET) into the optimization of intensity modulated proton therapy (IMPT) plans. Because increased LET correlates with increased biological effectiveness of protons, high LETs in target volumes and low LETs in critical structures and normal tissues are preferred in an IMPT plan. However, if not explicitly incorporated into the optimization criteria, different IMPT plans may yield similar physical dose distributions but greatly different LET, specifically dose-averaged LET, distributions. Conventionally, the IMPT optimization criteria (or cost function) only includes dose-based objectives in which the relative biological effectiveness (RBE) is assumed to have a constant value of 1.1. In this study, we added LET-based objectives for maximizing LET in target volumes and minimizing LET in critical structures and normal tissues. Due to the fractional programming nature of the resulting model, we used a variable reformulation approach so that the optimization process is computationally equivalent to conventional IMPT optimization. In this study, five brain tumor patients who had been treated with proton therapy at our institution were selected. Two plans were created for each patient based on the proposed LET-incorporated optimization (LETOpt) and the conventional dose-based optimization (DoseOpt). The optimized plans were compared in terms of both dose (assuming a constant RBE of 1.1 as adopted in clinical practice) and LET. Both optimization approaches were able to generate comparable dose distributions. The LET-incorporated optimization achieved not only pronounced reduction of LET values in critical organs, such as brainstem and optic chiasm, but also increased LET in target volumes, compared to the conventional dose-based optimization. However, on occasion, there was a need to tradeoff the acceptability of dose and LET distributions. Our conclusion is that the

  7. Intensity-modulated radiotherapy for neoadjuvant treatment of gastric cancer

    International Nuclear Information System (INIS)

    Knab, Brian; Rash, Carla; Farrey, Karl; Jani, Ashesh B.

    2006-01-01

    Radiation therapy plays an integral role in the treatment of gastric cancer in the postsurgery setting, the inoperable/palliative setting, and, as in the case of the current report, in the setting of neoadjuvant therapy prior to surgery. Typically, anterior-posterior/posterior-anterior (AP/PA) or 3-field techniques are used. In this report, we explore the use of intensity-modulated radiotherapy (IMRT) treatment in a patient whose care was transferred to our institution after 3-field radiotherapy (RT) was given to a dose of 30 Gy at an outside institution. If the 3-field plan were continued to 50 Gy, the volume of irradiated liver receiving greater than 30 Gy would have been unacceptably high. To deliver the final 20 Gy, an opposed parallel AP/PA plan and an IMRT plan were compared to the initial 3-field technique for coverage of the target volume as well as dose to the kidneys, liver, small bowel, and spinal cord. Comparison of the 3 treatment techniques to deliver the final 20 Gy revealed reduced median and maximum dose to the whole kidney with the IMRT plan. For this 20-Gy boost, the volume of irradiated liver was lower for both the IMRT plan and the AP/PA plan vs. the 3-field plan. Comparing the IMRT boost plan to the AP/PA boost-dose range ( 10 Gy) in comparison to the AP/PA plan. The IMRT boost plan also irradiated a smaller volume of the small bowel compared to both the 3-field plan and the AP/PA plan, and also delivered lower dose to the spinal cord in comparison to the AP/PA plan. Comparison of the composite plans revealed reduced dose to the whole kidney using IMRT. The V20 for the whole kidney volume for the composite IMRT plan was 30% compared to approximately 60% for the composite AP/PA plan. Overall, the dose to the liver receiving greater than 30 Gy was lower for the composite IMRT plan and was well below acceptable limits. In conclusion, our study suggests a dosimetric benefit of IMRT over conventional planning, and suggests an important role for

  8. Pleural Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma

    International Nuclear Information System (INIS)

    Rosenzweig, Kenneth E.; Zauderer, Marjorie G.; Laser, Benjamin; Krug, Lee M.; Yorke, Ellen; Sima, Camelia S.; Rimner, Andreas; Flores, Raja; Rusch, Valerie

    2012-01-01

    Purpose: In patients with malignant pleural mesothelioma who are unable to undergo pneumonectomy, it is difficult to deliver tumoricidal radiation doses to the pleura without significant toxicity. We have implemented a technique of using intensity-modulated radiotherapy (IMRT) to treat these patients, and we report the feasibility and toxicity of this approach. Methods and Materials: Between 2005 and 2010, 36 patients with malignant pleural mesothelioma and two intact lungs (i.e., no previous pneumonectomy) were treated with pleural IMRT to the hemithorax (median dose, 46.8 Gy; range, 41.4–50.4) at Memorial Sloan-Kettering Cancer Center. Results: Of the 36 patients, 56% had right-sided tumors. The histologic type was epithelial in 78%, sarcomatoid in 6%, and mixed in 17%, and 6% had Stage I, 28% had Stage II, 33% had Stage III, and 33% had Stage IV. Thirty-two patients (89%) received induction chemotherapy (mostly cisplatin and pemetrexed); 56% underwent pleurectomy/decortication before IMRT and 44% did not undergo resection. Of the 36 patients evaluable for acute toxicity, 7 (20%) had Grade 3 or worse pneumonitis (including 1 death) and 2 had Grade 3 fatigue. In 30 patients assessable for late toxicity, 5 had continuing Grade 3 pneumonitis. For patients treated with surgery, the 1- and 2-year survival rate was 75% and 53%, and the median survival was 26 months. For patients who did not undergo surgical resection, the 1- and 2-year survival rate was 69% and 28%, and the median survival was 17 months. Conclusions: Treating the intact lung with pleural IMRT in patients with malignant pleural mesothelioma is a safe and feasible treatment option with an acceptable rate of pneumonitis. Additionally, the survival rates were encouraging in our retrospective series, particularly for the patients who underwent pleurectomy/decortication. We have initiated a Phase II trial of induction chemotherapy with pemetrexed and cisplatin with or without pleurectomy

  9. Pleural Intensity-Modulated Radiotherapy for Malignant Pleural Mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Rosenzweig, Kenneth E., E-mail: ken.rosenzweig@mountsinai.org [Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY (United States); Zauderer, Marjorie G. [Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Laser, Benjamin [Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI (United States); Krug, Lee M. [Department of Medicine, Thoracic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Yorke, Ellen [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Sima, Camelia S. [Department of Epidemiology/Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Rimner, Andreas [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Flores, Raja [Department of Surgery, Mount Sinai Medical Center, New York, NY (United States); Rusch, Valerie [Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

    2012-07-15

    Purpose: In patients with malignant pleural mesothelioma who are unable to undergo pneumonectomy, it is difficult to deliver tumoricidal radiation doses to the pleura without significant toxicity. We have implemented a technique of using intensity-modulated radiotherapy (IMRT) to treat these patients, and we report the feasibility and toxicity of this approach. Methods and Materials: Between 2005 and 2010, 36 patients with malignant pleural mesothelioma and two intact lungs (i.e., no previous pneumonectomy) were treated with pleural IMRT to the hemithorax (median dose, 46.8 Gy; range, 41.4-50.4) at Memorial Sloan-Kettering Cancer Center. Results: Of the 36 patients, 56% had right-sided tumors. The histologic type was epithelial in 78%, sarcomatoid in 6%, and mixed in 17%, and 6% had Stage I, 28% had Stage II, 33% had Stage III, and 33% had Stage IV. Thirty-two patients (89%) received induction chemotherapy (mostly cisplatin and pemetrexed); 56% underwent pleurectomy/decortication before IMRT and 44% did not undergo resection. Of the 36 patients evaluable for acute toxicity, 7 (20%) had Grade 3 or worse pneumonitis (including 1 death) and 2 had Grade 3 fatigue. In 30 patients assessable for late toxicity, 5 had continuing Grade 3 pneumonitis. For patients treated with surgery, the 1- and 2-year survival rate was 75% and 53%, and the median survival was 26 months. For patients who did not undergo surgical resection, the 1- and 2-year survival rate was 69% and 28%, and the median survival was 17 months. Conclusions: Treating the intact lung with pleural IMRT in patients with malignant pleural mesothelioma is a safe and feasible treatment option with an acceptable rate of pneumonitis. Additionally, the survival rates were encouraging in our retrospective series, particularly for the patients who underwent pleurectomy/decortication. We have initiated a Phase II trial of induction chemotherapy with pemetrexed and cisplatin with or without pleurectomy

  10. PET-guided dose escalation tomotherapy in malignant pleural mesothelioma

    Energy Technology Data Exchange (ETDEWEB)

    Fodor, Andrei; Dell' Oca, Italo; Pasetti, Marcella; Di Muzio, Nadia Gisella [San Raffaele Scientific Institute, Milan (Italy). Dept. of Radiotherapy; Fiorino, Claudio; Broggi, Sara; Cattaneo, Giovanni Mauro; Calandrino, Riccardo [San Raffaele Scientific Institute, Milan (Italy). Medical Physics; Gianolli, Luigi [San Raffaele Scientific Institute, Milan (Italy). Dept. of Nuclear Medicine

    2011-11-15

    To test the feasibility of salvage radiotherapy using PET-guided helical tomotherapy in patients with progressive malignant pleural mesothelioma (MPM). A group of 12 consecutive MPM patients was treated with 56 Gy/25 fractions to the planning target volume (PTV); FDG-PET/CT simulation was always performed to include all positive lymph nodes and MPM infiltrations. Subsequently, a second group of 12 consecutive patients was treated with the same dose to the whole pleura adding a simultaneous integrated boost of 62.5 Gy to the FDG-PET/CT positive areas (BTV). Good dosimetric results were obtained in both groups. No grade 3 (RTOG/EORTC) acute or late toxicities were reported in the first group, while 3 cases of grade 3 late pneumonitis were registered in the second group: the duration of symptoms was 2-10 weeks. Median overall survival was 8 months (1.2-50.5 months) and 20 months (4.3-33.8 months) from the beginning of radiotherapy, for groups I and II, respectively (p = 0.19). A significant impact on local relapse from radiotherapy was seen (median time to local relapse: 8 vs 17 months; 1-year local relapse-free rate: 16% vs 81%, p = 0.003). The results of this pilot study support the planning of a phase III study of combined sequential chemoradiotherapy with dose escalation to BTV in patients not able to undergo resection. (orig.)

  11. Direct UV written Michelson interferometer for RZ signal generation using phase-to-intensity modulation conversion

    DEFF Research Database (Denmark)

    Peucheret, Christophe; Geng, Yan; Zsigri, Beata

    2005-01-01

    An integrated Michelson delay interferometer structure making use of waveguide gratings as reflective elements is proposed and fabricated by direct ultraviolet writing. Successful return-to-zero alternate-mark-inversion signal generation using phase-to-intensity modulation conversion...

  12. MIMO Intensity-Modulation Channels: Capacity Bounds and High SNR Characterization

    KAUST Repository

    Chaaban, Anas; Rezki, Zouheir; Alouini, Mohamed-Slim

    2016-01-01

    The capacity of MIMO intensity modulation channels is studied. The nonnegativity of the transmit signal (intensity) poses a challenge on the precoding of the transmit signal, which limits the applicability of classical schemes in this type

  13. Selection of the optimal radiotherapy technique for locally advanced hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Lee, Ik-Jae; Seong, Jinsil; Koom, Woong-Sub; Kim, Yong-Bae; Jeon, Byeong-Chul; Kim, Joo-Ho; Han, Kwang-Hyub

    2011-01-01

    Various techniques are available for radiotherapy of hepatocellular carcinoma, including three-dimensional conformal radiotherapy, linac-based intensity-modulated radiotherapy and helical tomotherapy. The purpose of this study was to determine the optimal radiotherapy technique for hepatocellular carcinoma. Between 2006 and 2007, 12 patients underwent helical tomotherapy for locally advanced hepatocellular carcinoma. Helical tomotherapy computerized radiotherapy planning was compared with the best computerized radiotherapy planning for three-dimensional conformal radiotherapy and linac-based intensity-modulated radiotherapy for the delivery of 60 Gy in 30 fractions. Tumor coverage was assessed by conformity index, radical dose homogeneity index and moderated dose homogeneity index. Computerized radiotherapy planning was also compared according to the tumor location. Tumor coverage was shown to be significantly superior with helical tomotherapy as assessed by conformity index and moderated dose homogeneity index (P=0.002 and 0.03, respectively). Helical tomotherapy showed significantly lower irradiated liver volume at 40, 50 and 60 Gy (V40, V50 and V60, P=0.04, 0.03 and 0.01, respectively). On the contrary, the dose-volume of three-dimensional conformal radiotherapy at V20 was significantly smaller than those of linac-based intensity-modulated radiotherapy and helical tomotherapy in the remaining liver (P=0.03). Linac-based intensity-modulated radiotherapy showed better sparing of the stomach compared with helical tomotherapy in the case of separated lesions in both lobes (12.3 vs. 24.6 Gy). Helical tomotherapy showed the high dose-volume exposure to the left kidney due to helical delivery in the right lobe lesion. Helical tomotherapy achieved the best tumor coverage of the remaining normal liver. However, helical tomotherapy showed much exposure to the remaining liver at the lower dose region and left kidney. (author)

  14. Treatment and prognosis of patients with late rectal bleeding after intensity-modulated radiation therapy for prostate cancer

    International Nuclear Information System (INIS)

    Takemoto, Shinya; Kataoka, Hiromi; Mimura, Mikio; Shibamoto, Yuta; Ayakawa, Shiho; Nagai, Aiko; Hayashi, Akihiro; Ogino, Hiroyuki; Baba, Fumiya; Yanagi, Takeshi; Sugie, Chikao

    2012-01-01

    Radiation proctitis after intensity-modulated radiation therapy (IMRT) differs from that seen after pelvic irradiation in that this adverse event is a result of high-dose radiation to a very small area in the rectum. We evaluated the results of treatment for hemorrhagic proctitis after IMRT for prostate cancer. Between November 2004 and February 2010, 403 patients with prostate cancer were treated with IMRT at 2 institutions. Among these patients, 64 patients who developed late rectal bleeding were evaluated. Forty patients had received IMRT using a linear accelerator and 24 by tomotherapy. Their median age was 72 years. Each patient was assessed clinically and/or endoscopically. Depending on the severity, steroid suppositories or enemas were administered up to twice daily and Argon plasma coagulation (APC) was performed up to 3 times. Response to treatment was evaluated using the Rectal Bleeding Score (RBS), which is the sum of Frequency Score (graded from 1 to 3 by frequency of bleeding) and Amount Score (graded from 1 to 3 by amount of bleeding). Stoppage of bleeding over 3 months was scored as RBS 1. The median follow-up period for treatment of rectal bleeding was 35 months (range, 12–69 months). Grade of bleeding was 1 in 31 patients, 2 in 26, and 3 in 7. Nineteen of 45 patients (42%) observed without treatment showed improvement and bleeding stopped in 17 (38%), although mean RBS did not change significantly. Eighteen of 29 patients (62%) treated with steroid suppositories or enemas showed improvement (mean RBS, from 4.1 ± 1.0 to 3.0 ± 1.8, p = 0.003) and bleeding stopped in 9 (31%). One patient treated with steroid enema 0.5-2 times a day for 12 months developed septic shock and died of multiple organ failure. All 12 patients treated with APC showed improvement (mean RBS, 4.7 ± 1.2 to 2.3 ± 1.4, p < 0.001) and bleeding stopped in 5 (42%). After adequate periods of observation, steroid suppositories/enemas are expected to be effective. However, short

  15. Treatment and prognosis of patients with late rectal bleeding after intensity-modulated radiation therapy for prostate cancer

    Directory of Open Access Journals (Sweden)

    Takemoto Shinya

    2012-06-01

    Full Text Available Abstract Background Radiation proctitis after intensity-modulated radiation therapy (IMRT differs from that seen after pelvic irradiation in that this adverse event is a result of high-dose radiation to a very small area in the rectum. We evaluated the results of treatment for hemorrhagic proctitis after IMRT for prostate cancer. Methods Between November 2004 and February 2010, 403 patients with prostate cancer were treated with IMRT at 2 institutions. Among these patients, 64 patients who developed late rectal bleeding were evaluated. Forty patients had received IMRT using a linear accelerator and 24 by tomotherapy. Their median age was 72 years. Each patient was assessed clinically and/or endoscopically. Depending on the severity, steroid suppositories or enemas were administered up to twice daily and Argon plasma coagulation (APC was performed up to 3 times. Response to treatment was evaluated using the Rectal Bleeding Score (RBS, which is the sum of Frequency Score (graded from 1 to 3 by frequency of bleeding and Amount Score (graded from 1 to 3 by amount of bleeding. Stoppage of bleeding over 3 months was scored as RBS 1. Results The median follow-up period for treatment of rectal bleeding was 35 months (range, 12–69 months. Grade of bleeding was 1 in 31 patients, 2 in 26, and 3 in 7. Nineteen of 45 patients (42% observed without treatment showed improvement and bleeding stopped in 17 (38%, although mean RBS did not change significantly. Eighteen of 29 patients (62% treated with steroid suppositories or enemas showed improvement (mean RBS, from 4.1 ± 1.0 to 3.0 ± 1.8, p = 0.003 and bleeding stopped in 9 (31%. One patient treated with steroid enema 0.5-2 times a day for 12 months developed septic shock and died of multiple organ failure. All 12 patients treated with APC showed improvement (mean RBS, 4.7 ± 1.2 to 2.3 ± 1.4, p  Conclusions After adequate periods of observation, steroid suppositories

  16. Concurrent image-guided intensity modulated radiotherapy and chemotherapy following neoadjuvant chemotherapy for locally advanced nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Shueng, Pei-Wei; Hsieh, Chen-Hsi; Shen, Bing-Jie; Wu, Le-Jung; Liao, Li-Jen; Hsiao, Chi-Huang; Lin, Yu-Chin; Cheng, Po-Wen; Lo, Wu-Chia; Jen, Yee-Min

    2011-01-01

    To evaluate the experience of induction chemotherapy followed by concurrent chemoradiationwith helical tomotherapy (HT) for nasopharyngeal carcinoma (NPC). Between August 2006 and December 2009, 28 patients with pathological proven nonmetastatic NPC were enrolled. All patients were staged as IIB-IVB. Patients were first treated with 2 to 3 cycles of induction chemotherapy with EP-HDFL (Epirubicin, Cisplatin, 5-FU, and Leucovorin). After induction chemotherapy, weekly based PFL was administered concurrent with HT. Radiation consisted of 70 Gy to the planning target volumes of the primary tumor plus any positive nodal disease using 2 Gy per fraction. After completion of induction chemotherapy, the response rates for primary and nodal disease were 96.4% and 80.8%, respectively. With a median follow-up after 33 months (Range, 13-53 months), there have been 2 primary and 1 nodal relapse after completion of radiotherapy. The estimated 3-year progression-free rates for local, regional, locoregional and distant metastasis survival rate were 92.4%, 95.7%, 88.4%, and 78.0%, respectively. The estimated 3-year overall survival was 83.5%. Acute grade 3, 4 toxicities for xerostomia and dermatitis were only 3.6% and 10.7%, respectively. HT for locoregionally advanced NPC is feasible and effective in regard to locoregional control with high compliance, even after neoadjuvant chemotherapy. None of out-field or marginal failure noted in the current study confirms the potential benefits of treating NPC patients by image-guided radiation modality. A long-term follow-up study is needed to confirm these preliminary findings

  17. Helical filaments

    Energy Technology Data Exchange (ETDEWEB)

    Barbieri, Nicholas; Lim, Khan; Durand, Magali; Baudelet, Matthieu; Richardson, Martin [Townes Laser Institute, CREOL—The College of Optics and Photonics, University of Central Florida, Orlando, Florida 32816 (United States); Hosseinimakarem, Zahra; Johnson, Eric [Micro-Photonics Laboratory – Center for Optical Material Science, Clemson, Anderson, South Carolina 29634 (United States)

    2014-06-30

    The shaping of laser-induced filamenting plasma channels into helical structures by guiding the process with a non-diffracting beam is demonstrated. This was achieved using a Bessel beam superposition to control the phase of an ultrafast laser beam possessing intensities sufficient to induce Kerr effect driven non-linear self-focusing. Several experimental methods were used to characterize the resulting beams and confirm the observed structures are laser air filaments.

  18. Prospective Trial of High-Dose Reirradiation Using Daily Image Guidance With Intensity-Modulated Radiotherapy for Recurrent and Second Primary Head-and-Neck Cancer

    International Nuclear Information System (INIS)

    Chen, Allen M.; Farwell, D. Gregory; Luu, Quang; Cheng, Suzan; Donald, Paul J.; Purdy, James A.

    2011-01-01

    Purpose: To report a single-institutional experience using intensity-modulated radiotherapy with daily image-guided radiotherapy for the reirradiation of recurrent and second cancers of the head and neck. Methods and Materials: Twenty-one consecutive patients were prospectively treated with intensity-modulated radiotherapy from February 2006 to March 2009 to a median dose of 66 Gy (range, 60-70 Gy). None of these patients received concurrent chemotherapy. Daily helical megavoltage CT scans were obtained before each fraction as part of an image-guided radiotherapy registration protocol for patient alignment. Results: The 1- and 2-year estimates of in-field control were 72% and 65%, respectively. A total of 651 daily megavoltage CT scans were obtained. The mean systematic shift to account for interfraction motion was 1.38 ± 1.25 mm, 1.79 ± 1.45 mm, and 1.98 ± 1.75 mm for the medial-lateral, superior-inferior, and anterior-posterior directions, respectively. Pretreatment shifts of >3 mm occurred in 19% of setups in the medial-lateral, 27% in the superior-inferior, and 33% in the anterior-posterior directions, respectively. There were no treatment-related fatalities or hospitalizations. Complications included skin desquamation, odynophagia, otitis externa, keratitis, naso-lacrimal duct stenosis, and brachial plexopathy. Conclusions: Intensity-modulated radiotherapy with daily image guidance results in effective disease control with relatively low morbidity and should be considered for selected patients with recurrent and second primary cancers of the head and neck.

  19. Head and neck intensity modulated radiation therapy leads to an increase of opportunistic oral pathogens

    NARCIS (Netherlands)

    Schuurhuis, Jennifer M.; Stokman, Monique A.; Witjes, Max J. H.; Langendijk, Johannes A.; van Winkelhoff, Arie J.; Vissink, Arjan; Spijkervet, Frederik K. L.

    Objectives: The introduction of intensity modulated radiation therapy (IMRT) has led to new possibilities in the treatment of head and neck cancer (HNC). Limited information is available on how this more advanced radiation technique affects the oral microflora. In a prospective study we assessed the

  20. A proton beam delivery system for conformal therapy and intensity modulated therapy

    International Nuclear Information System (INIS)

    Yu Qingchang

    2001-01-01

    A scattering proton beam delivery system for conformal therapy and intensity modulated therapy is described. The beam is laterally spread out by a dual-ring double scattering system and collimated by a program-controlled multileaf collimator and patient specific fixed collimators. The proton range is adjusted and modulated by a program controlled binary filter and ridge filters

  1. Validation of GPU based TomoTherapy dose calculation engine.

    Science.gov (United States)

    Chen, Quan; Lu, Weiguo; Chen, Yu; Chen, Mingli; Henderson, Douglas; Sterpin, Edmond

    2012-04-01

    The graphic processing unit (GPU) based TomoTherapy convolution/superposition(C/S) dose engine (GPU dose engine) achieves a dramatic performance improvement over the traditional CPU-cluster based TomoTherapy dose engine (CPU dose engine). Besides the architecture difference between the GPU and CPU, there are several algorithm changes from the CPU dose engine to the GPU dose engine. These changes made the GPU dose slightly different from the CPU-cluster dose. In order for the commercial release of the GPU dose engine, its accuracy has to be validated. Thirty eight TomoTherapy phantom plans and 19 patient plans were calculated with both dose engines to evaluate the equivalency between the two dose engines. Gamma indices (Γ) were used for the equivalency evaluation. The GPU dose was further verified with the absolute point dose measurement with ion chamber and film measurements for phantom plans. Monte Carlo calculation was used as a reference for both dose engines in the accuracy evaluation in heterogeneous phantom and actual patients. The GPU dose engine showed excellent agreement with the current CPU dose engine. The majority of cases had over 99.99% of voxels with Γ(1%, 1 mm) engine also showed similar degree of accuracy in heterogeneous media as the current TomoTherapy dose engine. It is verified and validated that the ultrafast TomoTherapy GPU dose engine can safely replace the existing TomoTherapy cluster based dose engine without degradation in dose accuracy.

  2. Image-guided intensity-modulated radiotherapy for refractory bilateral breast cancer in a patient with extensive cutaneous metastasis in the chest and abdominal walls

    Directory of Open Access Journals (Sweden)

    Lu YF

    2016-05-01

    Full Text Available Yueh-Feng Lu,1 Yu-Chin Lin,2 Kuo-Hsin Chen,3,4 Pei-Wei Shueng,1 Hsin-Pei Yeh,1 Chen-Hsi Hsieh1,5,6 1Division of Radiation Oncology, Department of Radiology, 2Division of Oncology and Hematology, Department of Medicine, 3Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, 4Department of Electrical Engineering, Yuan-Ze University, Taoyuan, 5Department of Medicine, 6Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Abstract: Treatment for bilateral breast cancer with chest wall and abdominal skin invasion normally involves conventional radiotherapy (RT; however, conventional RT provides inadequate target volume coverage and excessive treatment of large volumes of normal tissue. Helical tomotherapy (HT has the ability to deliver continuous craniocaudal irradiation that suppresses junction problems and provides good conformity of dose distribution. A 47-year-old female with stage IV bilateral breast cancer with chest wall and pectoralis major muscle invasion, lymphadenopathy, bilateral pleural effusion, and multiple bone metastases received chemotherapy and target therapy beginning in January 2014; 4 months after the initiation of chemotherapy, computed tomography revealed progression of chest and abdominal wall invasion. A total dose of 70.2 Gy was delivered to both breasts, the chest wall, the abdominal wall, and the bilateral supraclavicular nodal areas in 39 fractions via HT. The total planning target volume was 4,533.29 cm3. The percent of lung volume receiving at least 20 Gy (V20 was 28%, 22%, and 25% for the right lung, left lung, and whole lung, respectively. The mean dose to the heart was 8.6 Gy. Follow-up computed tomography revealed complete response after the RT course. Grade 1 dysphagia, weight loss, grade 2 neutropenia, and grade 3 dermatitis were noted during the RT course. Pain score decreased from 6 to 1. No cardiac, pulmonary, liver, or intestinal toxicity

  3. A dosimetric comparison of 3D-CRT, IMRT, and static tomotherapy with an SIB for large and small breast volumes

    Energy Technology Data Exchange (ETDEWEB)

    Michalski, Andrea [Department of Health Science (MRS), The University of Sydney, Lidcombe, New South Wales (Australia); Central Coast Cancer Centre, Gosford Hospital, Gosford, New South Wales (Australia); Atyeo, John, E-mail: john.atyeo@sydney.edu.au [Department of Health Science (MRS), The University of Sydney, Lidcombe, New South Wales (Australia); Cox, Jennifer [Department of Health Science (MRS), The University of Sydney, Lidcombe, New South Wales (Australia); Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, New South Wales (Australia); Rinks, Marianne [Department of Health Science (MRS), The University of Sydney, Lidcombe, New South Wales (Australia); Radiation Oncology, Cancer Services, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales (Australia); Morgia, Marita; Lamoury, Gillian [Department of Radiation Oncology, Royal North Shore Hospital, St Leonards, New South Wales (Australia)

    2014-07-01

    Radiation therapy to the breast is a complex task, with many different techniques that can be employed to ensure adequate dose target coverage while minimizing doses to the organs at risk. This study compares the dose planning outcomes of 3 radiation treatment modalities, 3 dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and static tomotherapy, for left-sided whole-breast radiation treatment with a simultaneous integrated boost (SIB). Overall, 20 patients with left-sided breast cancer were separated into 2 cohorts, small and large, based on breast volume. Dose plans were produced for each patient using 3D-CRT, IMRT, and static tomotherapy. All patients were prescribed a dose of 45 Gy in 20 fractions to the breast with an SIB of 56 Gy in 20 fractions to the tumor bed and normalized so that D{sub 98%} > 95% of the prescription dose. Dosimetric comparisons were made between the 3 modalities and the interaction of patient size. All 3 modalities offered adequate planning target volume (PTV) coverage with D{sub 98%} > 95% and D{sub 2%} < 107%. Static tomotherapy offered significantly improved (p = 0.006) dose homogeneity to the PTV{sub boost} {sub eval} (0.079 ± 0.011) and breast minus the SIB volume (Breast{sub SIB}) (p < 0.001, 0.15 ± 0.03) compared with the PTV{sub boost} {sub eval} (0.085 ± 0.008, 0.088 ± 0.12) and Breast{sub SIB} (0.22 ± 0.05, 0.23 ± 0.03) for IMRT and 3D-CRT, respectively. Static tomotherapy also offered statistically significant reductions (p < 0.001) in doses to the ipsilateral lung mean dose of 6.79 ± 2.11 Gy compared with 7.75 ± 2.54 Gy and 8.29 ± 2.76 Gy for IMRT and 3D-CRT, respectively, and significantly (p < 0.001) reduced heart doses (mean = 2.83 ± 1.26 Gy) compared to both IMRT and 3D-CRT (mean = 3.70 ± 1.44 Gy and 3.91 ± 1.58 Gy). Static tomotherapy is the dosimetrically superior modality for the whole breast with an SIB compared with IMRT and 3D-CRT. IMRT is superior to 3D

  4. Implementation and utility of a daily ultrasound-based localization system with intensity-modulated radiotherapy for prostate cancer

    International Nuclear Information System (INIS)

    Morr, Jody; DiPetrillo, Thomas; Tsai, J.-S.; Engler, Mark; Wazer, David E. MD.

    2002-01-01

    Purpose: To evaluate the clinical feasibility of daily computer-assisted transabdominal ultrasonography for target position verification in the setting of intensity-modulated radiotherapy (IMRT) for prostate cancer. Methods and Materials: Twenty-three patients with clinically localized prostate cancer were treated using a sequential tomotherapy IMRT technique (Peacock) and daily computer-assisted transabdominal ultrasonography (BAT) for target localization. Patients were instructed to maintain a full bladder and were placed in the supine position using triangulation tattoos and a leg immobilizer to minimize pelvic rotation. The BAT ultrasound system is docked to the treatment collimator and electronically imports the CT simulation target contours and isocenter. The system is able to use the machine isocenter as a reference point to overlay the corresponding CT contours onto the ultrasound images captured in the transverse and sagittal planes. A touch screen menu is used to maneuver the CT contours in three dimensions such that they match the ultrasound images. The system then displays the three-dimensional couch shifts required to produce field alignment. Data were prospectively collected to measure the frequency by which useful ultrasound images were obtained, the amount of time required for localization/setup, and the direction/magnitude of the positional adjustments. Results: Of the 23 patients, the BAT ultrasound system produced images of sufficient quality to perform the overlay of the CT contours in 19 patients such that positional verification could be reliably performed. Poor image quality was associated with patient inability to maintain a full bladder, large body habitus, or other anatomic constraints. Of the 19 assessable patients, a total of 185 treatment alignments were performed (mean 8.8/patient). For all cases, the average time required for the daily ultrasound imaging and positional adjustments was 11.9 min. After the initial 5 cases, the user

  5. [Position-checking by imaging embarked there tomotherapy and the delegation to the radiology technician].

    Science.gov (United States)

    Autret, A; Choupeaux, D; Le Mée, M

    2016-10-01

    Tomotherapy is a technique of IMRT and IGRT using a linear accelerator and a helical CT-scanner. To reach this targeting of precision, the repositioning of the patient is essential. The use of a contention adapted according to the location of the disease and the morphology of the patient is necessary for the safety of this one and the treatment. Once the patient positioned on the reference table, technicians of imager's team check by the acquisition of helical imagery with the reference CT-scanner the position of the patient, the zone of the PTV and healthy organs in the protected surroundings. At first, adjustment will be made automatically on three planes of the space (axial, sagittal, frontal) and three rotations (pitch, roll and yaw) by the device of treatment, then the technicians of imagery will bring a modification of these recalls manually. After validation, the processing will then be made in complete safety for the patient and the nursing. This check by MVCT is daily before every session of processing. It is made by the technicians of imagery. The radiation oncologist confirms the images at j0, then controls once a week MVCT. Traceability in the file of the patient of the various marks (osseous and\\or soft tissue) necessary for the daily gaps will be noted by this one to delegate to the technicians of imagery the validation of the MVCT before every session. Copyright © 2016. Published by Elsevier SAS.

  6. Sparing functional anatomical structures during intensity-modulated radiotherapy: an old problem, a new solution.

    Science.gov (United States)

    Tan, Wenyong; Han, Guang; Wei, Shaozhong; Hu, Desheng

    2014-08-01

    During intensity-modulated radiotherapy, an organ is usually assumed to be functionally homogeneous and, generally, its anatomical and spatial heterogeneity with respect to radiation response are not taken into consideration. However, advances in imaging and radiation techniques as well as an improved understanding of the radiobiological response of organs have raised the possibility of sparing the critical functional structures within various organs at risk during intensity-modulated radiotherapy. Here, we discuss these structures, which include the critical brain structure, or neural nuclei, and the nerve fiber tracts in the CNS, head and neck structures related to radiation-induced salivary and swallowing dysfunction, and functional structures in the heart and lung. We suggest that these structures can be used as potential surrogate organs at risk in order to minimize their radiation dose and/or irradiated volume without compromising the dose coverage of the target volume during radiation treatment.

  7. Predicting the effects of organ motion on the dose delivered by dynamic intensity modulation

    International Nuclear Information System (INIS)

    Yu, C.X.; Jaffray, David; Martinez, A.A.; Wong, J.W.

    1997-01-01

    Purpose: Computer-optimized treatment plans, aimed to enhance tumor control and reduce normal tissue complication, generally require non-uniform beam intensities. One of the techniques for delivering intensity-modulated beams is the use of dynamic multileaf collimation, where the beam aperture and field shape change during irradiation. When intensity-modulated beams are delivered with dynamic collimation, intra-treatment organ motion may not only cause geometric misses at the field boundaries but also create hot and cold spots in the target. The mechanism for producing such effects has not been well understood. This study analyzes the dosimetric effects of intra-treatment organ motion on dynamic intensity modulation. A numerical method is developed for predicting the intensity distributions in a moving target before dose is delivered with dynamic intensity modulation. Material and Methods: In the numerical algorithm, the change in position and shape of the beam aperture with time were modeled as a three-dimensional 'tunnel', with the shape of the field aperture described in the x-y plane and its temporal position shown in the z-dimension. A point in the target had to be in the tunnel in order to receive irradiation and the dose to the point was proportional to the amount of time that this point stayed in the tunnel. Since each point in the target were analyzed separately, non-rigid body variations could easily be handled. The dependency of the dose variations on all parameters involved, including the speed of collimator motion, the frequency and amplitude of the target motion, and the size of the field segments, was analyzed. The algorithm was verified by irradiating moving phantoms with beams of dynamically modulated intensities. Predictions were also made for a treatment of a thoracic tumor using a dynamic wedge. The changes of target position with time were based on the MRI images of the chest region acquired using fast MRI scans in a cine fashion for a duration

  8. Implementation of intensity-modulated conformational radiotherapy for cervical cancers at the Alexis Vautrin Centre

    International Nuclear Information System (INIS)

    Renard-Oldrini, Sophie

    2010-01-01

    As platinum salt based concomitant conformational radiotherapy and chemotherapy have been used as a standard treatment for cervical cancers but resulted in digestive and haematological toxicities, this research thesis reports the application of intensity-modulated conformational radiation therapy. After having recalled some epidemiological, anatomical aspects, diagnosis and treatments aspects regarding cervical cancer, the author presents this last treatment technique (principles, benefits, practical implementation). The author discusses results obtained by an experiment during which seven patients have been treated by simple conformational radiation therapy, and four by intensity-modulated conformational radiation therapy. Results are discussed in terms of volumes (clinical target volume, growth target volume, planned target volume), dosimetric results, toxicities (urine and skin), weight loss [fr

  9. Optical Intensity Modulation in an LiNbO3 Slab-Coupled Waveguide

    Directory of Open Access Journals (Sweden)

    Yalin Lu

    2008-01-01

    Full Text Available Optical intensity modulation has been demonstrated through switching the optical beam between the main core waveguide and a closely attached leaky slab waveguide by applying a low-voltage electrical field. Theory for simulating such an LiNbO3 slab-coupled waveguide structure was suggested, and the result indicates the possibility of making the spatial guiding mode large, circular and symmetric, which further allows the potential to significantly reduce the coupling losses with adjacent lasers and optical networks. Optical intensity modulation using electro-optic effect was experimentally demonstrated in a 5 cm long waveguide fabricated by using a procedure of soft proton exchange and then an overgrowth of thin LN film on top of a c-cut LiNbO3 wafer.

  10. Conformal radiation therapy with or without intensity modulation in the treatment of localized prostate cancer

    International Nuclear Information System (INIS)

    Maingon, P.; Truc, G.; Bosset, M.; Peignaux, K.; Ammor, A.; Bolla, M.

    2005-01-01

    Conformal radiation therapy has now to be considered as a standard treatment of localized prostatic adenocarcinomas. Using conformational methods and intensity modulated radiation therapy requires a rigorous approach for their implementation in routine, focused on the reproducibility of the treatment, target volume definitions, dosimetry, quality control, setup positioning. In order to offer to the largest number of patients high-dose treatment, the clinicians must integrate as prognostic factors accurate definition of microscopic extension as well as the tolerance threshold of critical organs. High-dose delivery is expected to be most efficient in intermediary risks and locally advanced diseases. Intensity modulated radiation therapy is specifically dedicated to dose escalation. Perfect knowledge of classical constraints of conformal radiation therapy is required. Using such an approach in routine needs a learning curve including the physicists and a specific quality assurance program. (author)

  11. A method of simulating intensity modulation-direct detection WDM systems

    Institute of Scientific and Technical Information of China (English)

    HUANG Jing; YAO Jian-quan; LI En-bang

    2005-01-01

    In the simulation of Intensity Modulation-Direct Detection WDM Systems,when the dispersion and nonlinear effects play equally important roles,the intensity fluctuation caused by cross-phase modulation may be overestimated as a result of the improper step size.Therefore,the step size in numerical simulation should be selected to suppress false XPM intensity modulation (keep it much less than signal power).According to this criterion,the step size is variable along the fiber.For a WDM system,the step size depends on the channel separation.Different type of transmission fiber has different step size.In the split-step Fourier method,this criterion can reduce simulation time,and when the step size is bigger than 100 meters,the simulation accuracy can also be improved.

  12. Chemotherapy and intensity modulated conformational radiotherapy for locally advanced pancreas cancers

    International Nuclear Information System (INIS)

    Huguet, F.; Wu, A.; Zhang, Z.; Winston, C.; Reidy, D.; Ho, A.; Allen, P.; Karyn, G.

    2011-01-01

    The authors report a retrospective study of the tolerance and survival of 48 patients who have been treated by a chemotherapy followed by a chemotherapy concomitant with an intensity-modulated radiotherapy for a locally advanced pancreas cancer. Results are discussed in terms of toxicity, cancer response, operability, survival rate. Tolerance is good. Local control rates, global survival rates and secondary resection rates are promising. Short communication

  13. Conceptual source design and dosimetric feasibility study for intravascular treatment: a proposal for intensity modulated brachytherapy

    International Nuclear Information System (INIS)

    Kim, Si Yong; Han, Eun Young; Palta, Jatinder R.; Ha, Sung W.

    2003-01-01

    To propose a conceptual design of a novel source for intensity modulated brachytherapy. The source design incorporates both radioactive and shielding materials (stainless steel or tungsten), to provide an asymmetric dose intensity in the azimuthal direction. The intensity modulated intravascular brachytherapy was performed by combining a series of dwell positions and times, distributed along the azimuthal coordinates. Two simple designs for the beta-emitting sources, with similar physical dimensions to a 90 Sr/Y Novoste Beat-Cath source, were considered in the dosimetric feasibility study. In the first design, the radioactive and materials each occupy half of the cylinder and in the second, the radioactive material occupies only a quarter of the cylinder. The radial and azimuthal dose distributions around each source were calculated using the MCNP Monte Carlo code. The preliminary hypothetical simulation and optimization results demonstrated the 87% difference between the maximum and minimum doses to the lumen wall, due to off-centering of the radiation source, could be reduced to less than 7% by optimizing the azimuthal dwell positions and times of the partially shielded intravascular brachytherapy sources. The novel brachytherapy source design, and conceptual source delivery system, proposed in this study show promising dosimetric characteristics for the realization of intensity modulated brachytherapy in intravascular treatment. Further development of this concept will center on building a delivery system that can precisely control the angular motion of a radiation source in a small-diameter catheter

  14. Conceptual source design and dosimetric feasibility study for intravascular treatment: a proposal for intensity modulated brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Si Yong; Han, Eun Young; Palta, Jatinder R. [College of Medicine, Florida Univ., Florida (United States); Ha, Sung W. [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    2003-06-01

    To propose a conceptual design of a novel source for intensity modulated brachytherapy. The source design incorporates both radioactive and shielding materials (stainless steel or tungsten), to provide an asymmetric dose intensity in the azimuthal direction. The intensity modulated intravascular brachytherapy was performed by combining a series of dwell positions and times, distributed along the azimuthal coordinates. Two simple designs for the beta-emitting sources, with similar physical dimensions to a {sub 90}Sr/Y Novoste Beat-Cath source, were considered in the dosimetric feasibility study. In the first design, the radioactive and materials each occupy half of the cylinder and in the second, the radioactive material occupies only a quarter of the cylinder. The radial and azimuthal dose distributions around each source were calculated using the MCNP Monte Carlo code. The preliminary hypothetical simulation and optimization results demonstrated the 87% difference between the maximum and minimum doses to the lumen wall, due to off-centering of the radiation source, could be reduced to less than 7% by optimizing the azimuthal dwell positions and times of the partially shielded intravascular brachytherapy sources. The novel brachytherapy source design, and conceptual source delivery system, proposed in this study show promising dosimetric characteristics for the realization of intensity modulated brachytherapy in intravascular treatment. Further development of this concept will center on building a delivery system that can precisely control the angular motion of a radiation source in a small-diameter catheter.

  15. Comparison study of intensity modulated arc therapy using single or multiple arcs to intensity modulated radiation therapy for high-risk prostate cancer

    International Nuclear Information System (INIS)

    Ashamalla, Hani; Tejwani, Ajay; Parameritis, Loannis; Swamy, Uma; Luo, Pei Ching; Guirguis, Adel; Lavaf, Amir

    2013-01-01

    Intensity modulated arc therapy (IMAT) is a form of intensity modulated radiation therapy (IMRT) that delivers dose in single or multiple arcs. We compared IMRT plans versus single-arc field (1ARC) and multi-arc fields (3ARC) IMAT plans in high-risk prostate cancer. Sixteen patients were studied. Prostate (PTV P ), right pelvic (PTV RtLN ) and left pelvic lymph nodes (PTV LtLN ), and organs at risk were contoured. PTVP, PTV RtLN , and PTV LtLN received 50.40 Gy followed by a boost to PTV B of 28.80 Gy. Three plans were per patient generated: IMRT, 1ARC, and 3ARC. We recorded the dose to the PTV, the mean dose (D MEAN ) to the organs at risk, and volume covered by the 50% isodose. Efficiency was evaluated by monitor units (MU) and beam on time (BOT). Conformity index (CI), Paddick gradient index, and homogeneity index (HI) were also calculated. Average Radiation Therapy Oncology Group CI was 1.17, 1.20, and 1.15 for IMRT, 1ARC, and 3ARC, respectively. The plans' HI were within 1% of each other. The D MEAN of bladder was within 2% of each other. The rectum D MEAN in IMRT plans was 10% lower dose than the arc plans (p < 0.0001). The GI of the 3ARC was superior to IMRT by 27.4% (p = 0.006). The average MU was highest in the IMRT plans (1686) versus 1ARC (575) versus 3ARC (1079). The average BOT was 6 minutes for IMRT compared to 1.3 and 2.9 for 1ARC and 3ARC IMAT (p < 0.05). For high-risk prostate cancer, IMAT may offer a favorable dose gradient profile, conformity, MU and BOT compared to IMRT.

  16. Intensity Modulated Proton Therapy Versus Intensity Modulated Photon Radiation Therapy for Oropharyngeal Cancer: First Comparative Results of Patient-Reported Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Sio, Terence T. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona (United States); Lin, Huei-Kai; Shi, Qiuling [Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Gunn, G. Brandon [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Cleeland, Charles S. [Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Lee, J. Jack; Hernandez, Mike [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Blanchard, Pierre; Thaker, Nikhil G.; Phan, Jack; Rosenthal, David I.; Garden, Adam S.; Morrison, William H.; Fuller, C. David [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mendoza, Tito R. [Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Mohan, Radhe [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Wang, Xin Shelley [Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Frank, Steven J., E-mail: sjfrank@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2016-07-15

    Purpose: We hypothesized that patients with oropharyngeal cancer treated with intensity modulated proton therapy (IMPT) would have lower symptom burdens, as measured by patient-reported outcome (PRO) surveys, than patients treated with intensity modulated photon therapy (IMRT). Methods and Materials: Patients were treated for oropharyngeal cancer from 2006 to 2015 through prospective registries with concurrent chemotherapy and IMPT or chemotherapy and IMRT and completed the MD Anderson Symptom Inventory for Head and Neck Cancer (MDASI-HN) module at various times before treatment (baseline), during treatment (acute phase), within the first 3 months after treatment (subacute phase), and afterward (chronic phase). Individual symptoms and the top 5 and top 11 most severe symptoms were summarized and compared between the radiation therapy modalities. Results: PRO data were collected and analyzed from 35 patients treated with chemotherapy and IMPT and from 46 treated with chemotherapy and IMRT. The baseline symptom burdens were similar between both groups. The overall top 5 symptoms were food taste problems (mean score 4.91 on a 0-10 scale), dry mouth (4.49), swallowing/chewing difficulties (4.26), lack of appetite (4.08), and fatigue (4.00). Among the top 11 symptoms, changes in taste and appetite during the subacute and chronic phases favored IMPT (all P<.048). No differences in symptom burden were detected between modalities during the acute and chronic phases by top-11 symptom scoring. During the subacute phase, the mean (±standard deviation) top 5 MDASI scores were 5.15 ± 2.66 for IMPT versus 6.58 ± 1.98 for IMRT (P=.013). Conclusions: According to the MDASI-HN, symptom burden was lower among the IMPT patients than among the IMRT patients during the subacute recovery phase after treatment. A prospective randomized clinical trial is underway to define the value of IMPT for the management of head and neck tumors.

  17. Dosimetric advantages of intensity-modulated proton therapy for oropharyngeal cancer compared with intensity-modulated radiation: A case-matched control analysis

    Energy Technology Data Exchange (ETDEWEB)

    Holliday, Emma B. [Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (United States); Kocak-Uzel, Esengul [Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (United States); Department of Radiation Therapy, Beykent University, Istanbul (Turkey); Feng, Lei [Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX (United States); Thaker, Nikhil G.; Blanchard, Pierre; Rosenthal, David I.; Gunn, G. Brandon; Garden, Adam S. [Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (United States); Frank, Steven J., E-mail: sjfrank@mdanderson.org [Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (United States)

    2016-10-01

    A potential advantage of intensity-modulated proton therapy (IMPT) over intensity-modulated (photon) radiation therapy (IMRT) in the treatment of oropharyngeal carcinoma (OPC) is lower radiation dose to several critical structures involved in the development of nausea and vomiting, mucositis, and dysphagia. The purpose of this study was to quantify doses to critical structures for patients with OPC treated with IMPT and compare those with doses on IMRT plans generated for the same patients and with a matched cohort of patients actually treated with IMRT. In this study, 25 patients newly diagnosed with OPC were treated with IMPT between 2011 and 2012. Comparison IMRT plans were generated for these patients and for additional IMRT-treated controls extracted from a database of patients with OPC treated between 2000 and 2009. Cases were matched based on the following criteria, in order: unilateral vs bilateral therapy, tonsil vs base of tongue primary, T-category, N-category, concurrent chemotherapy, induction chemotherapy, smoking status, sex, and age. Results showed that the mean doses to the anterior and posterior oral cavity, hard palate, larynx, mandible, and esophagus were significantly lower with IMPT than with IMRT comparison plans generated for the same cohort, as were doses to several central nervous system structures involved in the nausea and vomiting response. Similar differences were found when comparing dose to organs at risks (OARs) between the IMPT cohort and the case-matched IMRT cohort. In conclusion, these findings suggest that patients with OPC treated with IMPT may experience fewer and less severe side effects during therapy. This may be the result of decreased beam path toxicities with IMPT due to lower doses to several dysphagia, odynophagia, and nausea and vomiting–associated OARs. Further study is needed to evaluate differences in long-term disease control and chronic toxicity between patients with OPC treated with IMPT in comparison to

  18. Intensity Modulated Proton Therapy Versus Intensity Modulated Photon Radiation Therapy for Oropharyngeal Cancer: First Comparative Results of Patient-Reported Outcomes

    International Nuclear Information System (INIS)

    Sio, Terence T.; Lin, Huei-Kai; Shi, Qiuling; Gunn, G. Brandon; Cleeland, Charles S.; Lee, J. Jack; Hernandez, Mike; Blanchard, Pierre; Thaker, Nikhil G.; Phan, Jack; Rosenthal, David I.; Garden, Adam S.; Morrison, William H.; Fuller, C. David; Mendoza, Tito R.; Mohan, Radhe; Wang, Xin Shelley; Frank, Steven J.

    2016-01-01

    Purpose: We hypothesized that patients with oropharyngeal cancer treated with intensity modulated proton therapy (IMPT) would have lower symptom burdens, as measured by patient-reported outcome (PRO) surveys, than patients treated with intensity modulated photon therapy (IMRT). Methods and Materials: Patients were treated for oropharyngeal cancer from 2006 to 2015 through prospective registries with concurrent chemotherapy and IMPT or chemotherapy and IMRT and completed the MD Anderson Symptom Inventory for Head and Neck Cancer (MDASI-HN) module at various times before treatment (baseline), during treatment (acute phase), within the first 3 months after treatment (subacute phase), and afterward (chronic phase). Individual symptoms and the top 5 and top 11 most severe symptoms were summarized and compared between the radiation therapy modalities. Results: PRO data were collected and analyzed from 35 patients treated with chemotherapy and IMPT and from 46 treated with chemotherapy and IMRT. The baseline symptom burdens were similar between both groups. The overall top 5 symptoms were food taste problems (mean score 4.91 on a 0-10 scale), dry mouth (4.49), swallowing/chewing difficulties (4.26), lack of appetite (4.08), and fatigue (4.00). Among the top 11 symptoms, changes in taste and appetite during the subacute and chronic phases favored IMPT (all P<.048). No differences in symptom burden were detected between modalities during the acute and chronic phases by top-11 symptom scoring. During the subacute phase, the mean (±standard deviation) top 5 MDASI scores were 5.15 ± 2.66 for IMPT versus 6.58 ± 1.98 for IMRT (P=.013). Conclusions: According to the MDASI-HN, symptom burden was lower among the IMPT patients than among the IMRT patients during the subacute recovery phase after treatment. A prospective randomized clinical trial is underway to define the value of IMPT for the management of head and neck tumors.

  19. Adjuvant intensity-modulated proton therapy in malignant pleural mesothelioma. A comparison with intensity-modulated radiotherapy and a spot size variation assessment

    Energy Technology Data Exchange (ETDEWEB)

    Lorentini, S. [Agenzia Provinciale per la Protonterapia (ATreP), Trento (Italy); Padova Univ. (Italy). Medical Physics School; Amichetti, M.; Fellin, F.; Schwarz, M. [Agenzia Provinciale per la Protonterapia (ATreP), Trento (Italy); Spiazzi, L. [Brescia Hospital (Italy). Medical Physics Dept.; Tonoli, S.; Magrini, S.M. [Brescia Hospital (Italy). Radiation Oncology Dept.

    2012-03-15

    Intensity-modulated radiation therapy (IMRT) is the state-of-the-art treatment for patients with malignant pleural mesothelioma (MPM). The goal of this work was to assess whether intensity-modulated proton therapy (IMPT) could further improve the dosimetric results allowed by IMRT. We re-planned 7 MPM cases using both photons and protons, by carrying out IMRT and IMPT plans. For both techniques, conventional dose comparisons and normal tissue complication probability (NTCP) analysis were performed. In 3 cases, additional IMPT plans were generated with different beam dimensions. IMPT allowed a slight improvement in target coverage and clear advantages in dose conformity (p < 0.001) and dose homogeneity (p = 0.01). Better organ at risk (OAR) sparing was obtained with IMPT, in particular for the liver (D{sub mean} reduction of 9.5 Gy, p = 0.001) and ipsilateral kidney (V{sub 20} reduction of 58%, p = 0.001), together with a very large reduction of mean dose for the contralateral lung (0.2 Gy vs 6.1 Gy, p = 0.0001). NTCP values for the liver showed a systematic superiority of IMPT with respect to IMRT for both the esophagus (average NTCP 14% vs. 30.5%) and the ipsilateral kidney (p = 0.001). Concerning plans obtained with different spot dimensions, a slight loss of target coverage was observed along with sigma increase, while maintaining OAR irradiation always under planning constraints. Results suggest that IMPT allows better OAR sparing with respect to IMRT, mainly for the liver, ipsilateral kidney, and contralateral lung. The use of a spot dimension larger than 3 x 3 mm (up to 9 x 9 mm) does not compromise dosimetric results and allows a shorter delivery time.

  20. Application of failure mode and effects analysis (FMEA) to pretreatment phases in tomotherapy.

    Science.gov (United States)

    Broggi, Sara; Cantone, Marie Claire; Chiara, Anna; Di Muzio, Nadia; Longobardi, Barbara; Mangili, Paola; Veronese, Ivan

    2013-09-06

    The aim of this paper was the application of the failure mode and effects analysis (FMEA) approach to assess the risks for patients undergoing radiotherapy treatments performed by means of a helical tomotherapy unit. FMEA was applied to the preplanning imaging, volume determination, and treatment planning stages of the tomotherapy process and consisted of three steps: 1) identification of the involved subprocesses; 2) identification and ranking of the potential failure modes, together with their causes and effects, using the risk probability number (RPN) scoring system; and 3) identification of additional safety measures to be proposed for process quality and safety improvement. RPN upper threshold for little concern of risk was set at 125. A total of 74 failure modes were identified: 38 in the stage of preplanning imaging and volume determination, and 36 in the stage of planning. The threshold of 125 for RPN was exceeded in four cases: one case only in the phase of preplanning imaging and volume determination, and three cases in the stage of planning. The most critical failures appeared related to (i) the wrong or missing definition and contouring of the overlapping regions, (ii) the wrong assignment of the overlap priority to each anatomical structure, (iii) the wrong choice of the computed tomography calibration curve for dose calculation, and (iv) the wrong (or not performed) choice of the number of fractions in the planning station. On the basis of these findings, in addition to the safety strategies already adopted in the clinical practice, novel solutions have been proposed for mitigating the risk of these failures and to increase patient safety.

  1. The Impact of the Grid Size on TomoTherapy for Prostate Cancer

    Science.gov (United States)

    Kawashima, Motohiro; Kawamura, Hidemasa; Onishi, Masahiro; Takakusagi, Yosuke; Okonogi, Noriyuki; Okazaki, Atsushi; Sekihara, Tetsuo; Ando, Yoshitaka; Nakano, Takashi

    2017-01-01

    Discretization errors due to the digitization of computed tomography images and the calculation grid are a significant issue in radiation therapy. Such errors have been quantitatively reported for a fixed multifield intensity-modulated radiation therapy using traditional linear accelerators. The aim of this study is to quantify the influence of the calculation grid size on the dose distribution in TomoTherapy. This study used ten treatment plans for prostate cancer. The final dose calculation was performed with “fine” (2.73 mm) and “normal” (5.46 mm) grid sizes. The dose distributions were compared from different points of view: the dose-volume histogram (DVH) parameters for planning target volume (PTV) and organ at risk (OAR), the various indices, and dose differences. The DVH parameters were used Dmax, D2%, D2cc, Dmean, D95%, D98%, and Dmin for PTV and Dmax, D2%, and D2cc for OARs. The various indices used were homogeneity index and equivalent uniform dose for plan evaluation. Almost all of DVH parameters for the “fine” calculations tended to be higher than those for the “normal” calculations. The largest difference of DVH parameters for PTV was Dmax and that for OARs was rectal D2cc. The mean difference of Dmax was 3.5%, and the rectal D2cc was increased up to 6% at the maximum and 2.9% on average. The mean difference of D95% for PTV was the smallest among the differences of the other DVH parameters. For each index, whether there was a significant difference between the two grid sizes was determined through a paired t-test. There were significant differences for most of the indices. The dose difference between the “fine” and “normal” calculations was evaluated. Some points around high-dose regions had differences exceeding 5% of the prescription dose. The influence of the calculation grid size in TomoTherapy is smaller than traditional linear accelerators. However, there was a significant difference. We recommend calculating the final

  2. Monte Carlo simulation of the Tomotherapy treatment unit in the static mode using MC HAMMER, a Monte Carlo tool dedicated to Tomotherapy

    International Nuclear Information System (INIS)

    Sterpin, E; Tomsej, M; Cravens, B; Salvat, F; Ruchala, K; Olivera, G H; Vynckier, S

    2007-01-01

    Helical tomotherapy (HT) is designed to deliver highly modulated IMRT treatments. The concept of HT provides new challenges in MC simulation, because simultaneous movement of the gantry, the couch and the multi-leaf collimator (MLC) must be simulated accurately. However, before accounting for gantry, couch movement and multileaf collimator configurations, high accuracy must be achieved while simulating open static fields (1 x 40, 2.5 x 40 and 5 x 40 cm 2 ). This is performed using MC HAMMER, which is a graphical user interface allowing MC simulation using PENELOPE for various configurations of HT. Since the geometry of the different elements and materials involved in the beam generation are precisely known and defined, the only parameters that need to be tuned on are therefore electron source spot size and electron energy. Beyond the build up region, good agreement (2%/1mm) is achieved for all the field sizes between measurements (ion chamber) and simulations with an electron source energy set to 5.5 MeV. The electron source spot size is modelled as a gaussian distribution with full width half maximum equal to 1.4 mm. This value was chosen to match measured and calculated penumbras in the longitudinal direction

  3. An automatic contour propagation method to follow parotid gland deformation during head-and-neck cancer tomotherapy

    International Nuclear Information System (INIS)

    Faggiano, E; Scalco, E; Rizzo, G; Fiorino, C; Broggi, S; Cattaneo, M; Maggiulli, E; Calandrino, R; Dell'Oca, I; Di Muzio, N

    2011-01-01

    We developed an efficient technique to auto-propagate parotid gland contours from planning kVCT to daily MVCT images of head-and-neck cancer patients treated with helical tomotherapy. The method deformed a 3D surface mesh constructed from manual kVCT contours by B-spline free-form deformation to generate optimal and smooth contours. Deformation was calculated by elastic image registration between kVCT and MVCT images. Data from ten head-and-neck cancer patients were considered and manual contours by three observers were included in both kVCT and MVCT images. A preliminary inter-observer variability analysis demonstrated the importance of contour propagation in tomotherapy application: a high variability was reported in MVCT parotid volume estimation (p = 0.0176, ANOVA test) and a larger uncertainty of MVCT contouring compared with kVCT was demonstrated by DICE and volume variability indices (Wilcoxon signed rank test, p -4 for both indices). The performance analysis of our method showed no significant differences between automatic and manual contours in terms of volumes (p > 0.05, in a multiple comparison Tukey test), center-of-mass distances (p = 0.3043, ANOVA test), DICE values (p = 0.1672, Wilcoxon signed rank test) and average and maximum symmetric distances (p = 0.2043, p = 0.8228 Wilcoxon signed rank tests). Results suggested that our contour propagation method could successfully substitute human contouring on MVCT images.

  4. An automatic contour propagation method to follow parotid gland deformation during head-and-neck cancer tomotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Faggiano, E; Scalco, E; Rizzo, G [Istituto di Bioimmagini e Fisiologia Molecolare (IBFM), CNR, Milan (Italy); Fiorino, C; Broggi, S; Cattaneo, M; Maggiulli, E; Calandrino, R [Department of Medical Physics, San Raffaele Scientific Institute, Milan (Italy); Dell' Oca, I; Di Muzio, N, E-mail: fiorino.claudio@hsr.it [Department of Radiotherapy, San Raffaele Scientific Institute, Milan (Italy)

    2011-02-07

    We developed an efficient technique to auto-propagate parotid gland contours from planning kVCT to daily MVCT images of head-and-neck cancer patients treated with helical tomotherapy. The method deformed a 3D surface mesh constructed from manual kVCT contours by B-spline free-form deformation to generate optimal and smooth contours. Deformation was calculated by elastic image registration between kVCT and MVCT images. Data from ten head-and-neck cancer patients were considered and manual contours by three observers were included in both kVCT and MVCT images. A preliminary inter-observer variability analysis demonstrated the importance of contour propagation in tomotherapy application: a high variability was reported in MVCT parotid volume estimation (p = 0.0176, ANOVA test) and a larger uncertainty of MVCT contouring compared with kVCT was demonstrated by DICE and volume variability indices (Wilcoxon signed rank test, p < 10{sup -4} for both indices). The performance analysis of our method showed no significant differences between automatic and manual contours in terms of volumes (p > 0.05, in a multiple comparison Tukey test), center-of-mass distances (p = 0.3043, ANOVA test), DICE values (p = 0.1672, Wilcoxon signed rank test) and average and maximum symmetric distances (p = 0.2043, p = 0.8228 Wilcoxon signed rank tests). Results suggested that our contour propagation method could successfully substitute human contouring on MVCT images.

  5. Dosimetric Comparison of Three-Dimensional Conformal Proton Radiotherapy, Intensity-Modulated Proton Therapy, and Intensity-Modulated Radiotherapy for Treatment of Pediatric Craniopharyngiomas

    Energy Technology Data Exchange (ETDEWEB)

    Boehling, Nicholas S. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Grosshans, David R., E-mail: dgrossha@mdanderson.org [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Bluett, Jaques B. [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Palmer, Matthew T. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Song, Xiaofei; Amos, Richard A.; Sahoo, Narayan [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Meyer, Jeffrey J.; Mahajan, Anita; Woo, Shiao Y. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

    2012-02-01

    Purpose: Cranial irradiation in pediatric patients is associated with serious long-term adverse effects. We sought to determine whether both three-dimensional conformal proton radiotherapy (3D-PRT) and intensity-modulated proton therapy (IMPT) compared with intensity-modulated radiotherapy (IMRT) decrease integral dose to brain areas known to harbor neuronal stem cells, major blood vessels, and other normal brain structures for pediatric patients with craniopharyngiomas. Methods and Materials: IMRT, forward planned, passive scattering proton, and IMPT plans were generated and optimized for 10 pediatric patients. The dose was 50.4 Gy (or cobalt Gy equivalent) delivered in 28 fractions with the requirement for planning target volume (PTV) coverage of 95% or better. Integral dose data were calculated from differential dose-volume histograms. Results: The PTV target coverage was adequate for all modalities. IMRT and IMPT yielded the most conformal plans in comparison to 3D-PRT. Compared with IMRT, 3D-PRT and IMPT plans had a relative reduction of integral dose to the hippocampus (3D-PRT, 20.4; IMPT, 51.3%{sup Asterisk-Operator }), dentate gyrus (27.3, 75.0%{sup Asterisk-Operator }), and subventricular zone (4.5, 57.8%{sup Asterisk-Operator }). Vascular organs at risk also had reduced integral dose with the use of proton therapy (anterior cerebral arteries, 33.3{sup Asterisk-Operator }, 100.0%{sup Asterisk-Operator }; middle cerebral arteries, 25.9%{sup Asterisk-Operator }, 100%{sup Asterisk-Operator }; anterior communicating arteries, 30.8{sup Asterisk-Operator }, 41.7%{sup Asterisk-Operator }; and carotid arteries, 51.5{sup Asterisk-Operator }, 77.6{sup Asterisk-Operator }). Relative reduction of integral dose to the infratentorial brain (190.7{sup Asterisk-Operator }, 109.7%{sup Asterisk-Operator }), supratentorial brain without PTV (9.6, 26.8%{sup Asterisk-Operator }), brainstem (45.6, 22.4%{sup Asterisk-Operator }), and whole brain without PTV (19.4{sup Asterisk

  6. Breast-conserving radiation therapy using combined electron and intensity-modulated radiotherapy technique

    International Nuclear Information System (INIS)

    Li, J.G.; Williams, S.S.; Goffinet, D.R.; Boer, A.L.; Xing, L.

    2000-01-01

    An electron beam with appropriate energy was combined with four intensity modulated photon beams. The direction of the electron beam was chosen to be tilted 10-20 laterally from the anteroposterior direction. Two of the intensity-modulated photon beams had the same gantry angles as the conventional tangential fields, whereas the other two beams were rotated 15-25' toward the anteroposterior directions from the first two photon beams. An iterative algorithm was developed which optimizes the weight of the electron beam as well as the fluence profiles of the photon beams for a given patient. Two breast cancer patients with early-stage breast tumors were planned with the new technique and the results were compared with those from 3D planning using tangential fields as well as 9-field intensity-modulated radiotherapy (IMRT) techniques. The combined electron and IMRT plans showed better dose conformity to the target with significantly reduced dose to the ipsilateral lung and, in the case of the left-breast patient, reduced dose to the heart, than the tangential field plans. In both the right-sided and left-sided breast plans, the dose to other normal structures was similar to that from conventional plans and was much smaller than that from the 9-field IMRT plans. The optimized electron beam provided between 70 to 80% of the prescribed dose at the depth of maximum dose of the electron beam. The combined electron and IMRT technique showed improvement over the conventional treatment technique using tangential fields with reduced dose to the ipsilateral lung and the heart. The customized beam directions of the four IMRT fields also kept the dose to other critical structures to a minimum. (author)

  7. Intensity modulated radiation therapy using laser-accelerated protons: a Monte Carlo dosimetric study

    International Nuclear Information System (INIS)

    Fourkal, E; Li, J S; Xiong, W; Nahum, A; Ma, C-M

    2003-01-01

    In this paper we present Monte Carlo studies of intensity modulated radiation therapy using laser-accelerated proton beams. Laser-accelerated protons coming out of a solid high-density target have broad energy and angular spectra leading to dose distributions that cannot be directly used for therapeutic applications. Through the introduction of a spectrometer-like particle selection system that delivers small pencil beams of protons with desired energy spectra it is feasible to use laser-accelerated protons for intensity modulated radiotherapy. The method presented in this paper is a three-dimensional modulation in which the proton energy spectrum and intensity of each individual beamlet are modulated to yield a homogeneous dose in both the longitudinal and lateral directions. As an evaluation of the efficacy of this method, it has been applied to two prostate cases using a variety of beam arrangements. We have performed a comparison study between intensity modulated photon plans and those for laser-accelerated protons. For identical beam arrangements and the same optimization parameters, proton plans exhibit superior coverage of the target and sparing of neighbouring critical structures. Dose-volume histogram analysis of the resulting dose distributions shows up to 50% reduction of dose to the critical structures. As the number of fields is decreased, the proton modality exhibits a better preservation of the optimization requirements on the target and critical structures. It is shown that for a two-beam arrangement (parallel-opposed) it is possible to achieve both superior target coverage with 5% dose inhomogeneity within the target and excellent sparing of surrounding tissue

  8. Clinical Outcomes of Intensity-Modulated Pelvic Radiation Therapy for Carcinoma of the Cervix

    International Nuclear Information System (INIS)

    Hasselle, Michael D.; Rose, Brent S.; Kochanski, Joel D.; Nath, Sameer K.; Bafana, Rounak; Yashar, Catheryn M.; Hasan, Yasmin; Roeske, John C.; Mundt, Arno J.; Mell, Loren K.

    2011-01-01

    Purpose: To evaluate disease outcomes and toxicity in cervical cancer patients treated with pelvic intensity-modulated radiation therapy (IMRT). Methods and Materials: We included all patients with Stage I-IVA cervical carcinoma treated with IMRT at three different institutions from 2000-2007. Patients treated with extended field or conventional techniques were excluded. Intensity-modulated radiation therapy plans were designed to deliver 45 Gy in 1.8-Gy daily fractions to the planning target volume while minimizing dose to the bowel, bladder, and rectum. Toxicity was graded according to the Radiation Therapy Oncology Group system. Overall survival and disease-free survival were estimated by use of the Kaplan-Meier method. Pelvic failure, distant failure, and late toxicity were estimated by use of cumulative incidence functions. Results: The study included 111 patients. Of these, 22 were treated with postoperative IMRT, 8 with IMRT followed by intracavitary brachytherapy and adjuvant hysterectomy, and 81 with IMRT followed by planned intracavitary brachytherapy. Of the patients, 63 had Stage I-IIA disease and 48 had Stage IIB-IVA disease. The median follow-up time was 27 months. The 3-year overall survival rate and the disease-free survival rate were 78% (95% confidence interval [CI], 68-88%) and 69% (95% CI, 59-81%), respectively. The 3-year pelvic failure rate and the distant failure rate were 14% (95% CI, 6-22%) and 17% (95% CI, 8-25%), respectively. Estimates of acute and late Grade 3 toxicity or higher were 2% (95% CI, 0-7%) and 7% (95% CI, 2-13%), respectively. Conclusions: Intensity-modulated radiation therapy is associated with low toxicity and favorable outcomes, supporting its safety and efficacy for cervical cancer. Prospective clinical trials are needed to evaluate the comparative efficacy of IMRT vs. conventional techniques.

  9. An optimal algorithm for configuring delivery options of a one-dimensional intensity-modulated beam

    International Nuclear Information System (INIS)

    Luan Shuang; Chen, Danny Z; Zhang, Li; Wu Xiaodong; Yu, Cedric X

    2003-01-01

    The problem of generating delivery options for one-dimensional intensity-modulated beams (1D IMBs) arises in intensity-modulated radiation therapy. In this paper, we present an algorithm with the optimal running time, based on the 'rightmost-preference' method, for generating all distinct delivery options for an arbitrary 1D IMB. The previously best known method for generating delivery options for a 1D IMB with N left leaf positions and N right leaf positions is a 'brute-force' solution, which first generates all N! possible combinations of the left and right leaf positions and then removes combinations that are not physically allowed delivery options. Compared with the brute-force method, our algorithm has several advantages: (1) our algorithm runs in an optimal time that is linearly proportional to the total number of distinct delivery options that it actually produces. Note that for a 1D IMB with multiple peaks, the total number of distinct delivery options in general tends to be considerably smaller than the worst case N!. (2) Our algorithm can be adapted to generating delivery options subject to additional constraints such as the 'minimum leaf separation' constraint. (3) Our algorithm can also be used to generate random subsets of delivery options; this feature is especially useful when the 1D IMBs in question have too many delivery options for a computer to store and process. The key idea of our method is that we impose an order on how left leaf positions should be paired with right leaf positions. Experiments indicated that our rightmost-preference algorithm runs dramatically faster than the brute-force algorithm. This implies that our algorithm can handle 1D IMBs whose sizes are substantially larger than those handled by the brute-force method. Applications of our algorithm in therapeutic techniques such as intensity-modulated arc therapy and 2D modulations are also discussed

  10. Local failure patterns for patients with nasopharyngeal carcinoma after intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Li, Jia-xin; Huang, Shao-min; Jiang, Xin-hua; Ouyang, Bin; Han, Fei; Liu, Shuai; Wen, Bi-xiu; Lu, Tai-xiang

    2014-01-01

    To investigate the clinical feature and the local failure patterns after intensity-modulated radiotherapy for nasopharyngeal carcinoma. Between March 2007 and July 2009, 710 patients with nasopharyngeal carcinoma were treated with intensity-modulated radiotherapy. The magnetic resonance imagings obtained at recurrence were registered with the original planning computed tomography for dosimetry analysis. With a median follow-up of 38 months, 34 patients have developed local recurrence (32 cases valid). The incidence of invasion to nasopharynx, parapharyngeal space and the retropharyngeal space by the primary tumors was 100%, 75.0% and 62.5%, respectively, but 78.1%, 34.4% and 21.9% at recurrence, respectively. The rate of invasion to ethmoid sinus was 3.1% by the primary tumors but 28.1% at recurrence (p = 0.005). The topographic analysis of the local failure patterns showed 'central' in 16 patients; 'marginal' in 9; and 'outside' in 7. The median volumes of primary gross tumor were 45.84 cm 3 in the central failure group, 29.44 cm 3 in the marginal failure group, and 21.52 cm 3 in the outside failure group, respectively (p = 0.012), and the median volumes of primary clinical target1 were 87.28 cm 3 , 61.90 cm 3 and 58.74 cm 3 in the three groups, respectively (p = 0.033). In patients with nasopharyngeal carcinoma treated with intensity-modulated radiotherapy, the recurrent tumors had their unique characteristic and regularity of invasion to adjacent structures. 'Central' failure was the major local failure pattern. The volumes of primary gross tumor and clinical target1 were significantly correlated with recurrent patterns. Employ more aggressive approaches to tumor cells which will be insensitive to radiotherapy may be an effective way to reduce the central failure

  11. Performance analysis of subcarrier intensity modulation using rectangular QAM over Malaga turbulence channels with integer and non-integerβ

    KAUST Repository

    Alheadary, Wael Ghazy; Park, Kihong; Alouini, Mohamed-Slim

    2016-01-01

    In this paper, we derive the performances of optical wireless communication system utilizing adaptive subcarrier intensity modulation over the Malaga turbulent channel. More specifically, analytical closed-form solutions and asymptotic results

  12. Laser Noise and its Impact on the Performance of Intensity-Modulation with Direct-Detection Analog Photonic Links

    National Research Council Canada - National Science Library

    Urick, Vincent J; Devgan, Preetpaul S; McKinney, Jason D; Dexter, James L

    2007-01-01

    The equations for radio-frequency gain, radio-frequency noise figure, compression dynamic range and spurious-free dynamic range are derived for an analog photonic link employing intensity modulation and direct detection...

  13. Radiochromic film in the dosimetric verification of intensity modulated radiation therapy

    International Nuclear Information System (INIS)

    Zhou Yingjuan; Huang Shaomin; Deng Xiaowu

    2007-01-01

    Objective: Objective To investigate the dose-response behavior of a new type of radio- chromic film( GAFCHROMIC EBT) and explore the clinical application means and precision of dosage measurement, which can be applied for: (1) plan-specific dosimetric verification for intensity modulated radiation therapy, (2) to simplify the process of quality assurance using traditional radiographic film dosimetric system and (3) to establish a more reliable, more efficient dosimetric verification system for intensity modulated radiation therapy. Methods: (1) The step wedge calibration technique was used to calibrate EBT radiochromic film and EDR2 radiographic film. The dose characteristics, the measurement consistency and the quality assurance process between the two methods were compared. (2) The in-phantom dose-measurement based verification technique has been adopted. Respectively, EBT film and EDR2 film were used to measure the same dose plane of IMRT treatment plans. The results of the dose map, dose profiles and iso- dose curves were compared with those calculated by CORVUS treatment planning system to evaluate the function of EBT film for dosimetric verification for intensity modulated radiation therapy. Results: (1) Over the external beam dosimetric range of 0-500 cGy, EBT/VXR-16 and EDR2/VXR-16 film dosimetric system had the same measurement consistency with the measurement variability less then 0.70%. The mean measurement variability of these two systems was 0.37% and 0.68%, respectively. The former proved to be the superior modality at measurement consistency, reliability, and efficiency over dynamic clinical dose range , furthermore, its quality assurance showed less process than the latter. (2) The dosimetric verification of IMRT plane measured with EBT film was quite similar to that with EDR2 film which was processed under strict quality control. In a plane of the phantom, the maximal dose deviation off axis between EBT film measurement and the TPS calculation was

  14. Intensity-modulated radiation therapy: a review with a physics perspective.

    Science.gov (United States)

    Cho, Byungchul

    2018-03-01

    Intensity-modulated radiation therapy (IMRT) has been considered the most successful development in radiation oncology since the introduction of computed tomography into treatment planning that enabled three-dimensional conformal radiotherapy in 1980s. More than three decades have passed since the concept of inverse planning was first introduced in 1982, and IMRT has become the most important and common modality in radiation therapy. This review will present developments in inverse IMRT treatment planning and IMRT delivery using multileaf collimators, along with the associated key concepts. Other relevant issues and future perspectives are also presented.

  15. Evidence-based review: Quality of life following head and neck intensity-modulated radiotherapy

    International Nuclear Information System (INIS)

    Scott-Brown, Martin; Miah, Aisha; Harrington, Kevin; Nutting, Chris

    2010-01-01

    Inverse planned Intensity modulated radiotherapy (IMRT) can minimize the dose to normal structures and therefore can reduce long-term radiotherapy-related morbidity and may improve patients' long-term quality of life. Despite overwhelming evidence that IMRT can reduce late functional deficits in patients with head and neck cancer, treated with radiotherapy, a review of the published literature produced conflicting results with regard to quality of life outcomes. Following a critical appraisal of the literature, reasons for the discrepant outcomes are proposed.

  16. Pump-To-Signal Intensity Modulation Transfer Characteristics in FOPAs: Modulation Frequency and Saturation Effect

    DEFF Research Database (Denmark)

    Lali-Dastjerdi, Zohreh; Cristofori, Valentina; Lund-Hansen, Toke

    2012-01-01

    This paper reports a comprehensive study of pump- to-signal intensity modulation transfer (IMT) in single-pump fiber optic parametric amplifiers (FOPAs). In particular, the IMT is studied for the first time for high-frequency fluctuations of the pump as well as in the saturated gain regime. The IMT...... cut-off frequency in typical single-pump FOPAs is around 100–200 GHz. The possibilities to shift this frequency based on dispersion and nonlinearities involved in the parametric gain are discussed. The severe IMT to the signal at low modulation frequencies can be suppressed by more than 50...

  17. The technical feasibility of an image-guided intensity-modulated radiotherapy (IG-IMRT) to perform a hypofractionated schedule in terms of toxicity and local control for patients with locally advanced or recurrent pancreatic cancer

    International Nuclear Information System (INIS)

    Son, Seok Hyun; Song, Jin Ho; Choi, Byung Ock; Kang, Young-nam; Lee, Myung Ah; Kang, Ki Mun; Jang, Hong Seok

    2012-01-01

    The purpose of this study was to evaluate the technical feasibility of an image-guided intensity modulated radiotherapy (IG-IMRT) using involved-field technique to perform a hypofractionated schedule for patients with locally advanced or recurrent pancreatic cancer. From May 2009 to November 2011, 12 patients with locally advanced or locally recurrent pancreatic cancer received hypofractionated CCRT using TomoTherapy Hi-Art with concurrent and sequential chemotherapy at Seoul St. Mary’s Hospital, the Catholic University of Korea. The total dose delivered was 45 Gy in 15 fractions or 50 Gy in 20 fractions. The target volume did not include the uninvolved regional lymph nodes. Treatment planning and delivery were performed using the IG-IMRT technique. The follow-up duration was a median of 31.1 months (range: 5.7-36.3 months). Grade 2 or worse acute toxicities developed in 7 patients (58%). Grade 3 or worse gastrointestinal and hematologic toxicity occurred in 0% and 17% of patients, respectively. In the response evaluation, the rates of partial response and stable disease were 58% and 42%, respectively. The rate of local failure was 8% and no regional failure was observed. Distant failure was the main cause of treatment failure. The progression-free survival and overall survival durations were 7.6 and 12.1 months, respectively. The involved-field technique and IG-IMRT delivered via a hypofractionated schedule are feasible for patients with locally advanced or recurrent pancreatic cancer

  18. Helicity content and tokamak applications of helicity

    International Nuclear Information System (INIS)

    Boozer, A.H.

    1986-05-01

    Magnetic helicity is approximately conserved by the turbulence associated with resistive instabilities of plasmas. To generalize the application of the concept of helicity, the helicity content of an arbitrary bounded region of space will be defined. The definition has the virtues that both the helicity content and its time derivative have simple expressions in terms of the poloidal and toroidal magnetic fluxes, the average toroidal loop voltage and the electric potential on the bounding surface, and the volume integral of E-B. The application of the helicity concept to tokamak plasmas is illustrated by a discussion of so-called MHD current drive, an example of a stable tokamak q profile with q less than one in the center, and a discussion of the possibility of a natural steady-state tokamak due to the bootstrap current coupling to tearing instabilities

  19. Intensity-Modulated Radiotherapy for Sinonasal Cancer: Improved Outcome Compared to Conventional Radiotherapy

    International Nuclear Information System (INIS)

    Dirix, Piet; Vanstraelen, Bianca; Jorissen, Mark; Vander Poorten, Vincent; Nuyts, Sandra

    2010-01-01

    Purpose: To evaluate clinical outcome and toxicity of postoperative intensity-modulated radiotherapy (IMRT) for malignancies of the nasal cavity and paranasal sinuses. Methods and Materials: Between 2003 and 2008, 40 patients with cancer of the paranasal sinuses (n = 34) or nasal cavity (n = 6) received postoperative IMRT to a dose of 60 Gy (n = 21) or 66 Gy (n = 19). Treatment outcome and toxicity were retrospectively compared with that of a previous patient group (n = 41) who were also postoperatively treated to the same doses but with three-dimensional conformal radiotherapy without intensity modulation, from 1992 to 2002. Results: Median follow-up was 30 months (range, 4-74 months). Two-year local control, overall survival, and disease-free survival were 76%, 89%, and 72%, respectively. Compared to the three-dimensional conformal radiotherapy treatment, IMRT resulted in significantly improved disease-free survival (60% vs. 72%; p = 0.02). No grade 3 or 4 toxicity was reported in the IMRT group, either acute or chronic. The use of IMRT significantly reduced the incidence of acute as well as late side effects, especially regarding skin toxicity, mucositis, xerostomia, and dry-eye syndrome. Conclusions: Postoperative IMRT for sinonasal cancer significantly improves disease-free survival and reduces acute as well as late toxicity. Consequently, IMRT should be considered the standard treatment modality for malignancies of the nasal cavity and paranasal sinuses.

  20. Dosimetric comparison of three-dimensional conformal and intensity modulated radiotherapy in brain glioma

    International Nuclear Information System (INIS)

    Lu Jie; Zhang Guifang; Bai Tong; Yin Yong; Fan Tingyong; Wu Chaoxia

    2009-01-01

    Objective: To investigate the dosimetry advantages of intensity modulated radiotherapy (IMRT)of brain glioma compared with that of three-dimensional conformal radiotherapy (SD CRT). Methods: Ten patients with brain glioma were enrolled in this study. Three-dimensional conf0rmal and intensity modulated radiotherapy plans were performed for each patient. The dose distributions of target volume and normal tissues, conformal index (CI) and heterogeneous index (HI) were analyzed using the dose-volume histogram (DVH). The prescription dose was 60 Gy in 30 fractions. Results: IMRT plans decrease the maximum dose and volume of brainstem, mean dose of affected side parotid and maximum dose of spinal-cord. The CI for PTV of IMRT was superior to that of SD CRT, the HI for PTV has no statistical significance of the two model plans. Conclusions: IMRT plans can obviously decrease the dose and volume of brainstem. IMRT is a potential method in the treatment of brain glioma, and dose escalation was possible in patients with brain glioma. (authors)

  1. Validation of intensity modulated radiation therapy patient plans with portal images

    International Nuclear Information System (INIS)

    Delpon, G.; Warren, S.; Mahe, D.; Gaudaire, S.; Lisbona, A.

    2007-01-01

    The goal of this study was to show the feasibility of step and shoot intensity-modulated radiation therapy pre-treatment quality control for patients using the electronic portal imaging device (iViewGT) fitted on a Sli+ linac (Elekta Oncology Systems, Crawley, UK) instead of radiographic films. Since the beginning of intensity-modulated radiation therapy treatments, the dosimetric quality control necessary before treating each new patient has been a time-consuming and therefore costly obligation. In order to fully develop this technique, it seems absolutely essential to reduce the cost of these controls, especially the linac time. Up to now, verification of the relative dosimetry field by field has been achieved by acquiring radiographic films in the isocenter plane and comparing them to the results of the XiO planning system (Computerized Medical Systems, Missouri, USA) using RIT113 v4.1 software (Radiological Imaging Technology, Colorado, USA). A qualitative and quantitative evaluation was realised for every field of every patient. A quick and simple procedure was put into place to be able to make the same verifications using portal images. This new technique is not a modification of the overall methodology of analysis. The results achieved by comparing the measurement with the electronic portal imaging device and the calculation with the treatment planning system were in line with those achieved with the films for all indicators we studied (isodoses, horizontal and vertical dose profiles and gamma index). (authors)

  2. [Positioning errors of CT common rail technique in intensity-modulated radiotherapy for nasopharyngeal carcinoma].

    Science.gov (United States)

    Tian, Fei; Xu, Zihai; Mo, Li; Zhu, Chaohua; Chen, Chaomin

    2012-11-01

    To evaluate the value of CT common rail technique for application in intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC). Twenty-seven NPC patients underwent Somatom CT scans using the Siemens CTVision system prior to the commencement of the radiotherapy sessions. The acquired CT images were registered with the planning CT images using the matching function of the system to obtain the linear set-up errors of 3 directions, namely X (left to right), Y (superior to inferior), and Z (anterior to posterior). The errors were then corrected online on the moving couch. The 27 NPC patients underwent a total of 110 CT scans and the displacement deviations of the X, Y and Z directions were -0.16∓1.68 mm, 0.25∓1.66 mm, and 0.33∓1.09 mm, respectively. CT common rail technique can accurately and rapidly measure the space error between the posture and the target area to improve the set-up precision of intensity-modulated radiotherapy for NPC.

  3. Intensity-modulated radiotherapy for pituitary adenomas: The preliminary report of Cleveland Clinic experience

    International Nuclear Information System (INIS)

    Mackley, Heath B.; Reddy, Chandana A. M.S.; Lee, S.-Y.; Harnisch, Gayle A.; Mayberg, Marc R.; Hamrahian, Amir H.; Suh, John H.

    2007-01-01

    Purpose: Intensity-modulated radiotherapy (IMRT) is being increasingly used for the treatment of pituitary adenomas. However, there have been few published data on the short- and long-term outcomes of this treatment. This is the initial report of Cleveland Clinic's experience. Methods and Materials: Between February 1998 and December 2003, 34 patients with pituitary adenomas were treated with IMRT. A retrospective chart review was conducted for data analysis. Results: With a median follow-up of 42.5 months, the treatment has proven to be well tolerated, with performance status remaining stable in 90% of patients. Radiographic local control was 89%, and among patients with secretory tumors, 100% had a biochemical response. Only 1 patient required salvage surgery for progressive disease, giving a clinical progression free survival of 97%. The only patient who received more than 46 Gy experienced optic neuropathy 8 months after radiation. Smaller tumor volume significantly correlated with subjective improvements in nonvisual neurologic complaints (p = 0.03), and larger tumor volume significantly correlated with subjective worsening of visual symptoms (p = 0.05). New hormonal supplementation was required for 40% of patients. Younger patients were significantly more likely to require hormonal supplementation (p 0.03). Conclusions: Intensity-modulated radiation therapy is a safe and effective treatment for pituitary adenomas over the short term. Longer follow-up is necessary to determine if IMRT confers any advantage with respect to either tumor control or toxicity over conventional radiation modalities

  4. Simulation of novel intensity modulated cascaded coated LPFG sensor based on PMTP

    Science.gov (United States)

    Feng, Wenbin; Gu, Zhengtian; Lin, Qiang; Sang, Jiangang

    2017-12-01

    This paper presents a novel intensity modulated cascaded long-period fiber grating (CLPFG) sensor which is cascaded by two same coated long-period fiber gratings (LPFGs) operating at the phase-matching turning point (PMTP). The sensor combines the high sensitivity of LPFG operating at PMTP and the narrow bandwidth of interference attenuation band of CLPFG, so a higher response to small change of the surrounding refractive index (SRI) can be obtained by intensity modulation. Based on the coupled-mode theory, the grating parameters of the PMTP of a middle odd order cladding mode of a single LPFG are calculated. Then this two same LPFGs are cascaded into a CLPFG, and the optical transmission spectrum of the CLPFG is calculated by transfer matrix method. A resonant wavelength of a special interference attenuation band whose intensity has the highest response to SRI, is selected form CLPFG’s spectrum, and setting the resonant wavelength as the operating wavelength of the sensor. Furthermore, the simulation results show that the resolution of SRI of this CLPFG is available to 1.97 × 10-9 by optimizing the film optical parameters, which is about three orders of magnitude higher than coated dual-peak LPFG and cascaded LPFG sensors. It is noteworthy that the sensor is also sensitive to the refractive index of coat, so that the sensor is expected to be applied to detections of gas, PH value, humidity and so on, in the future.

  5. A comparison of the quality assurance of four dosimetric tools for intensity modulated radiation therapy

    International Nuclear Information System (INIS)

    Son, Jaeman; Baek, Taesung; Lee, Boram; Shin, Dongho; Park, Sung Yong; Park, Jeonghoon; Lim, Young Kyung; Lee, Se Byeong; Kim, Jooyoung; Yoon, Myonggeun

    2015-01-01

    This study was designed to compare the quality assurance (QA) results of four dosimetric tools used for intensity modulated radiation therapy (IMRT) and to suggest universal criteria for the passing rate in QA, irrespective of the dosimetric tool used. Thirty fields of IMRT plans from five patients were selected, followed by irradiation onto radiochromic film, a diode array (Mapcheck), an ion chamber array (MatriXX) and an electronic portal imaging device (EPID) for patient-specific QA. The measured doses from the four dosimetric tools were compared with the dose calculated by the treatment planning system. The passing rates of the four dosimetric tools were calculated using the gamma index method, using as criteria a dose difference of 3% and a distance-to-agreement of 3 mm. The QA results based on Mapcheck, MatriXX and EPID showed good agreement, with average passing rates of 99.61%, 99.04% and 99.29%, respectively. However, the average passing rate based on film measurement was significantly lower, 95.88%. The average uncertainty (1 standard deviation) of passing rates for 6 intensity modulated fields was around 0.31 for film measurement, larger than those of the other three dosimetric tools. QA results and consistencies depend on the choice of dosimetric tool. Universal passing rates should depend on the normalization or inter-comparisons of dosimetric tools if more than one dosimetric tool is used for patient specific QA

  6. A comparison of the quality assurance of four dosimetric tools for intensity modulated radiation therapy.

    Science.gov (United States)

    Son, Jaeman; Baek, Taesung; Lee, Boram; Shin, Dongho; Park, Sung Yong; Park, Jeonghoon; Lim, Young Kyung; Lee, Se Byeong; Kim, Jooyoung; Yoon, Myonggeun

    2015-09-01

    This study was designed to compare the quality assurance (QA) results of four dosimetric tools used for intensity modulated radiation therapy (IMRT) and to suggest universal criteria for the passing rate in QA, irrespective of the dosimetric tool used. Thirty fields of IMRT plans from five patients were selected, followed by irradiation onto radiochromic film, a diode array (Mapcheck), an ion chamber array (MatriXX) and an electronic portal imaging device (EPID) for patient-specific QA. The measured doses from the four dosimetric tools were compared with the dose calculated by the treatment planning system. The passing rates of the four dosimetric tools were calculated using the gamma index method, using as criteria a dose difference of 3% and a distance-to-agreement of 3 mm. The QA results based on Mapcheck, MatriXX and EPID showed good agreement, with average passing rates of 99.61%, 99.04% and 99.29%, respectively. However, the average passing rate based on film measurement was significantly lower, 95.88%. The average uncertainty (1 standard deviation) of passing rates for 6 intensity modulated fields was around 0.31 for film measurement, larger than those of the other three dosimetric tools. QA results and consistencies depend on the choice of dosimetric tool. Universal passing rates should depend on the normalization or inter-comparisons of dosimetric tools if more than one dosimetric tool is used for patient specific QA.

  7. Intensity-Modulated Advanced X-ray Source (IMAXS) for Homeland Security Applications

    International Nuclear Information System (INIS)

    Langeveld, Willem G. J.; Johnson, William A.; Owen, Roger D.; Schonberg, Russell G.

    2009-01-01

    X-ray cargo inspection systems for the detection and verification of threats and contraband require high x-ray energy and high x-ray intensity to penetrate dense cargo. On the other hand, low intensity is desirable to minimize the radiation footprint. A collaboration between HESCO/PTSE Inc., Schonberg Research Corporation and Rapiscan Laboratories, Inc. has been formed in order to design and build an Intensity-Modulated Advanced X-ray Source (IMAXS). Such a source would allow cargo inspection systems to achieve up to two inches greater imaging penetration capability, while retaining the same average radiation footprint as present fixed-intensity sources. Alternatively, the same penetration capability can be obtained as with conventional sources with a reduction of the average radiation footprint by about a factor of three. The key idea is to change the intensity of the source for each x-ray pulse based on the signal strengths in the inspection system detector array during the previous pulse. In this paper we describe methods to accomplish pulse-to-pulse intensity modulation in both S-band (2998 MHz) and X-band (9303 MHz) linac sources, with diode or triode (gridded) electron guns. The feasibility of these methods has been demonstrated. Additionally, we describe a study of a shielding design that would allow a 6 MV X-band source to be used in mobile applications.

  8. Dependence of Achievable Plan Quality on Treatment Technique and Planning Goal Refinement: A Head-and-Neck Intensity Modulated Radiation Therapy Application

    International Nuclear Information System (INIS)

    Qi, X. Sharon; Ruan, Dan; Lee, Steve P.; Pham, Andrew; Kupelian, Patrick; Low, Daniel A.; Steinberg, Michael; Demarco, John

    2015-01-01

    Purpose: To develop a practical workflow for retrospectively analyzing target and normal tissue dose–volume endpoints for various intensity modulated radiation therapy (IMRT) delivery techniques; to develop technique-specific planning goals to improve plan consistency and quality when feasible. Methods and Materials: A total of 165 consecutive head-and-neck patients from our patient registry were selected and retrospectively analyzed. All IMRT plans were generated using the same dose–volume guidelines for TomoTherapy (Tomo, Accuray), TrueBeam (TB, Varian) using fixed-field IMRT (TB-IMRT) or RAPIDARC (TB-RAPIDARC), or Siemens Oncor (Siemens-IMRT, Siemens). A MATLAB-based dose–volume extraction and analysis tool was developed to export dosimetric endpoints for each patient. With a fair stratification of patient cohort, the variation of achieved dosimetric endpoints was analyzed among different treatment techniques. Upon identification of statistically significant variations, technique-specific planning goals were derived from dynamically accumulated institutional data. Results: Retrospective analysis showed that although all techniques yielded comparable target coverage, the doses to the critical structures differed. The maximum cord doses were 34.1 ± 2.6, 42.7 ± 2.1, 43.3 ± 2.0, and 45.1 ± 1.6 Gy for Tomo, TB-IMRT, TB-RAPIDARC, and Siemens-IMRT plans, respectively. Analyses of variance showed significant differences for the maximum cord doses but no significant differences for other selected structures among the investigated IMRT delivery techniques. Subsequently, a refined technique-specific dose–volume guideline for maximum cord dose was derived at a confidence level of 95%. The dosimetric plans that failed the refined technique-specific planning goals were reoptimized according to the refined constraints. We observed better cord sparing with minimal variations for the target coverage and other organ at risk sparing for the Tomo cases, and higher

  9. Helical type vacuum container

    International Nuclear Information System (INIS)

    Owada, Kimio.

    1989-01-01

    Helical type vacuum containers in the prior art lack in considerations for thermal expansion stresses to helical coils, and there is a possibility of coil ruptures. The object of the present invention is to avoid the rupture of helical coils wound around the outer surface of a vacuum container against heat expansion if any. That is, bellows or heat expansion absorbing means are disposed to a cross section of a helical type vacuum container. With such a constitution, thermal expansion of helical coils per se due to temperature elevation of the coils during electric supply can be absorbed by expansion of the bellows or absorption of the heat expansion absorbing means. Further, this can be attained by arranging shear pins in the direction perpendicular to the bellows axis so that the bellows are not distorted when the helical coils are wound around the helical type vacuum container. (I.S.)

  10. Practical and clinical considerations in Cobalt-60 tomotherapy

    Directory of Open Access Journals (Sweden)

    Joshi Chandra

    2009-01-01

    Full Text Available Cobalt-60 (Co-60 based radiation therapy continues to play a significant role in not only developing countries, where access to radiation therapy is extremely limited, but also in industrialized countries. Howver, technology has to be developed to accommodate modern techniques, in-clud-ing image guided and adaptive radiation therapy (IGART. In this paper we describe some of the practical and clinical considerations for Co-60 based tomotherapy by comparing Co-60 and 6 MV linac-based tomotherapy plans for a head and neck (HandN cancer and a prostate cancer case. The tomotherapy IMRT plans were obtained by modeling a MIMiC binary multi-leaf collimator attached to a Theratron-780c Co-60 unit and a 6 MV linear accelerator (CL2100EX. The EGSnrc/BEAMnrc Monte Carlo (MC code was used for the modeling of the treatment units with the MIMiC collimator and EGSnrc/DOSXYZnrc code was used for beamlet dose data. An in-house inverse treatment planning program was then used to generate optimized tomotherapy dose distributions for the H and N and prostate cases. The dose distributions, cumulative dose area histograms (DAHs and dose difference maps were used to evaluate and compare Co-60 and 6 MV based tomotherapy plans. A quantitative analysis of the dose distributions and dose-volume histograms shows that both Co-60 and 6 MV plans achieve the plan objectives for the targets (CTV and nodes and OARs (spinal cord in HandN case, and rectum in prostate case.

  11. Pelvic nodal dose escalation with prostate hypofractionation using conformal avoidance defined (H-CAD) intensity modulated radiation therapy

    International Nuclear Information System (INIS)

    Hong, Theodore S.; Tome, Wolfgang A.; Jaradat, Hazim; Raisbeck, Bridget M.; Ritter, Mark A.

    2006-01-01

    The management of prostate cancer patients with a significant risk of pelvic lymph node involvement is controversial. Both whole pelvis radiotherapy and dose escalation to the prostate have been linked to improved outcome in such patients, but it is unclear whether conventional whole pelvis doses of only 45-50 Gy are optimal for ultimate nodal control. The purpose of this study is to examine the dosimetric and clinical feasibility of combining prostate dose escalation via hypofractionation with conformal avoidance-based IMRT (H-CAD) dose escalation to the pelvic lymph nodes. One conformal avoidance and one conventional plan were generated for each of eight patients. Conformal avoidance-based IMRT plans were generated that specifically excluded bowel, rectum, and bladder. The prostate and lower seminal vesicles (PTV 70) were planned to receive 70 Gy in 2.5 Gy/fraction while the pelvic lymph nodes (PTV 56) were to concurrently receive 56 Gy in 2 Gy/fraction. The volume of small bowel receiving >45 Gy was restricted to 300 ml or less. These conformal avoidance plans were delivered using helical tomotherapy or LINAC-based IMRT with daily imaging localization. All patients received neoadjuvant and concurrent androgen deprivation with a planned total of two years. The conventional, sequential plans created for comparison purposes for all patients consisted of a conventional 4-field pelvic box prescribed to 50.4 Gy (1.8 Gy/fraction) followed by an IMRT boost to the prostate of 25.2 Gy (1.8 Gy/fraction) yielding a final prostate dose of 75.6 Gy. For all plans, the prescription dose was to cover the target structure. Equivalent uniform dose (EUD) analyses were performed on all targets and dose-volume histograms (DVH) were displayed in terms of both physical and normalized total dose (NTD), i.e. dose in 2 Gy fraction equivalents. H-CAD IMRT plans were created for and delivered to all eight patients. Analysis of the H-CAD plans demonstrates prescription dose coverage of >95

  12. Dose to Larynx Predicts for Swallowing Complications After Intensity-Modulated Radiotherapy

    International Nuclear Information System (INIS)

    Caglar, Hale B.; Tishler, Roy B.; Othus, Megan; Burke, Elaine; Li Yi; Goguen, Laura; Wirth, Lori J.; Haddad, Robert I.; Norris, Carl M.; Court, Laurence E.; Aninno, Donald J. D.; Posner, Marshall R.; Allen, Aaron M.

    2008-01-01

    Purpose: To evaluate early swallowing after intensity-modulated radiotherapy for head and neck squamous cell carcinoma and determine factors correlating with aspiration and/or stricture. Methods and Materials: Consecutive patients treated with intensity-modulated radiotherapy with or without chemotherapy between September 2004 and August 2006 at the Dana Farber Cancer Institute/Brigham and Women's Hospital were evaluated with institutional review board approval. Patients underwent swallowing evaluation after completion of therapy; including video swallow studies. The clinical- and treatment-related variables were examined for correlation with aspiration or strictures, as well as doses to the larynx, pharyngeal constrictor muscles, and cervical esophagus. The correlation was assessed with logistic regression analysis. Results: A total of 96 patients were evaluated. Their median age was 55 years, and 79 (82%) were men. The primary site of cancer was the oropharynx in 43, hypopharynx/larynx in 17, oral cavity in 13, nasopharynx in 11, maxillary sinus in 2, and unknown primary in 10. Of the 96 patients, 85% underwent definitive RT and 15% postoperative RT. Also, 28 patients underwent induction chemotherapy followed by concurrent chemotherapy, 59 received concurrent chemotherapy, and 9 patients underwent RT alone. The median follow-up was 10 months. Of the 96 patients, 31 (32%) had clinically significant aspiration and 36 (37%) developed a stricture. The radiation dose-volume metrics, including the volume of the larynx receiving ≥50 Gy (p = 0.04 and p = 0.03, respectively) and volume of the inferior constrictor receiving ≥50 Gy (p = 0.05 and p = 0.02, respectively) were significantly associated with both aspiration and stricture. The mean larynx dose correlated with aspiration (p = 0.003). Smoking history was the only clinical factor to correlate with stricture (p = 0.05) but not aspiration. Conclusion: Aspiration and stricture are common side effects after

  13. Interfractional Dose Variations in Intensity-Modulated Radiotherapy With Breath-Hold for Pancreatic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Mitsuhiro [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Shibuya, Keiko, E-mail: kei@kuhp.kyoto-u.ac.jp [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Nakamura, Akira [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Shiinoki, Takehiro [Department of Nuclear Engineering, Kyoto University Graduate School of Engineering, Kyoto (Japan); Matsuo, Yukinori [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan); Nakata, Manabu [Clinical Radiology Service Division, Kyoto University Hospital, Kyoto (Japan); Sawada, Akira; Mizowaki, Takashi; Hiraoka, Masahiro [Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Graduate School of Medicine, Kyoto (Japan)

    2012-04-01

    Purpose: To investigate the interfractional dose variations for intensity-modulated radiotherapy (RT) combined with breath-hold (BH) at end-exhalation (EE) for pancreatic cancer. Methods and Materials: A total of 10 consecutive patients with pancreatic cancer were enrolled. Each patient was fixed in the supine position on an individualized vacuum pillow with both arms raised. Computed tomography (CT) scans were performed before RT, and three additional scans were performed during the course of chemoradiotherapy using a conventional RT technique. The CT data were acquired under EE-BH conditions (BH-CT) using a visual feedback technique. The intensity-modulated RT plan, which used five 15-MV coplanar ports, was designed on the initial BH-CT set with a prescription dose of 39 Gy at 2.6 Gy/fraction. After rigid image registration between the initial and subsequent BH-CT scans, the dose distributions were recalculated on the subsequent BH-CT images under the same conditions as in planning. Changes in the dose-volume metrics of the gross tumor volume (GTV), clinical target volume (CTV = GTV + 5 mm), stomach, and duodenum were evaluated. Results: For the GTV and clinical target volume (CTV), the 95th percentile of the interfractional variations in the maximal dose, mean dose, dose covering 95% volume of the region of structure, and percentage of the volume covered by the 90% isodose line were within {+-}3%. Although the volume covered by the 39 Gy isodose line for the stomach and duodenum did not exceed 0.1 mL at planning, the volume covered by the 39 Gy isodose line for these structures was up to 11.4 cm{sup 3} and 1.8 cm{sup 3}, respectively. Conclusions: Despite variations in the gastrointestinal state and abdominal wall position at EE, the GTV and CTV were mostly ensured at the planned dose, with the exception of 1 patient. Compared with the duodenum, large variations in the stomach volume receiving high-dose radiation were observed, which might be beyond the

  14. Poster — Thur Eve — 15: Improvements in the stability of the tomotherapy imaging beam

    Energy Technology Data Exchange (ETDEWEB)

    Belec, J [The Ottawa Hospital Cancer Center, Ontario (Canada)

    2014-08-15

    Use of helical TomoTherapy based MVCT imaging for adaptive planning requires the image values (HU) to remain stable over the course of treatment. In the past, the image value stability was suboptimal, which required frequent change to the image value to density calibration curve to avoid dose errors on the order of 2–4%. The stability of the image values at our center was recently improved by stabilizing the dose rate of the machine (dose control servo) and performing daily MVCT calibration corrections. In this work, we quantify the stability of the image values over treatment time by comparing patient treatment image density derived using MVCT and KVCT. The analysis includes 1) MVCT - KVCT density difference histogram, 2) MVCT vs KVCT density spectrum, 3) multiple average profile density comparison and 4) density difference in homogeneous locations. Over two months, the imaging beam stability was compromised several times due to a combination of target wobbling, spectral calibration, target change and magnetron issues. The stability of the image values were analyzed over the same period. Results show that the impact on the patient dose calculation is 0.7% +− 0.6%.

  15. Analysis of Factors Influencing the Development of Xerostomia during Intensity-Modulated Radiotherapy

    Science.gov (United States)

    Randall, Ken; Stevens, Jason; Yepes, Juan Fernando; Randall, Marcus E.; Kudrimoti, Mahesh; Feddock, Jonathan; Xi, Jing; Kryscio, Richard J.; Miller, Craig S.

    2013-01-01

    OBJECTIVES Factors influencing xerostomia during intensity-modulated radiation therapy (IMRT) were assessed. METHODS A 6-week study of 32 head and neck cancer (HNC) patients was performed. Subjects completed the Xerostomia Inventory (XI) and provided stimulated saliva (SS) at baseline, week two and at end of IMRT. Influence of SS flow rate (SSFR), calcium and mucin 5b (MUC5b) concentrations and radiation dose on xerostomia was determined. RESULTS HNC subjects experienced mean SSFR decline of 36% by visit two (N=27; p=0.012) and 57% by visit three (N=20; p=0.0004), Concentrations of calcium and MUC5b increased, but not significantly during IMRT (p>0.05). Xerostomia correlated most with decreasing salivary flow rate as determined by Spearman correlations (pxerostomia. PMID:23523462

  16. American Society of Radiation Oncology Recommendations for Documenting Intensity-Modulated Radiation Therapy Treatments

    International Nuclear Information System (INIS)

    Holmes, Timothy; Das, Rupak; Low, Daniel; Yin Fangfang; Balter, James; Palta, Jatinder; Eifel, Patricia

    2009-01-01

    Despite the widespread use of intensity-modulated radiation therapy (IMRT) for approximately a decade, a lack of adequate guidelines for documenting these treatments persists. Proper IMRT treatment documentation is necessary for accurate reconstruction of prior treatments when a patient presents with a marginal recurrence. This is especially crucial when the follow-up care is managed at a second treatment facility not involved in the initial IMRT treatment. To address this issue, an American Society for Radiation Oncology (ASTRO) workgroup within the American ASTRO Radiation Physics Committee was formed at the request of the ASTRO Research Council to develop a set of recommendations for documenting IMRT treatments. This document provides a set of comprehensive recommendations for documenting IMRT treatments, as well as image-guidance procedures, with example forms provided.

  17. A new deconvolution approach to robust fluence for intensity modulation under geometrical uncertainty

    Science.gov (United States)

    Zhang, Pengcheng; De Crevoisier, Renaud; Simon, Antoine; Haigron, Pascal; Coatrieux, Jean-Louis; Li, Baosheng; Shu, Huazhong

    2013-09-01

    This work addresses random geometrical uncertainties that are intrinsically observed in radiation therapy by means of a new deconvolution method combining a series expansion and a Butterworth filter. The method efficiently suppresses high-frequency components by discarding the higher order terms of the series expansion and then filtering out deviations on the field edges. An additional approximation is made in order to set the fluence values outside the field to zero in the robust profiles. This method is compared to the deconvolution kernel method for a regular 2D fluence map, a real intensity-modulated radiation therapy field, and a prostate case. The results show that accuracy is improved while fulfilling clinical planning requirements.

  18. A new deconvolution approach to robust fluence for intensity modulation under geometrical uncertainty

    International Nuclear Information System (INIS)

    Zhang Pengcheng; Coatrieux, Jean-Louis; Shu Huazhong; De Crevoisier, Renaud; Simon, Antoine; Haigron, Pascal; Li Baosheng

    2013-01-01

    This work addresses random geometrical uncertainties that are intrinsically observed in radiation therapy by means of a new deconvolution method combining a series expansion and a Butterworth filter. The method efficiently suppresses high-frequency components by discarding the higher order terms of the series expansion and then filtering out deviations on the field edges. An additional approximation is made in order to set the fluence values outside the field to zero in the robust profiles. This method is compared to the deconvolution kernel method for a regular 2D fluence map, a real intensity-modulated radiation therapy field, and a prostate case. The results show that accuracy is improved while fulfilling clinical planning requirements. (paper)

  19. MIMO Intensity-Modulation Channels: Capacity Bounds and High SNR Characterization

    KAUST Repository

    Chaaban, Anas

    2016-10-01

    The capacity of MIMO intensity modulation channels is studied. The nonnegativity of the transmit signal (intensity) poses a challenge on the precoding of the transmit signal, which limits the applicability of classical schemes in this type of channels. To resolve this issue, capacity lower bounds are developed by using precoding-free schemes. This is achieved by channel inversion or QR decomposition to convert the MIMO channel to a set of parallel channels. The achievable rate of a DC-offset SVD based scheme is also derived as a benchmark. Then, a capacity upper bound is derived and is shown to coincide with the achievable rate of the QR decomposition based scheme at high SNR, consequently characterizing the high-SNR capacity of the channel. The high-SNR gap between capacity and the achievable rates of the channel inversion and the DC-offset SVD based schemes is also characterized. Finally, the ergodic capacity of the channel is also briefly discussed.

  20. Matching Intensity-Modulated Radiation Therapy to an Anterior Low Neck Field

    International Nuclear Information System (INIS)

    Amdur, Robert J.; Liu, Chihray; Li, Jonathan; Mendenhall, William; Hinerman, Russell

    2007-01-01

    When using intensity-modulated radiation therapy (IMRT) to treat head and neck cancer with the primary site above the level of the larynx, there are two basic options for the low neck lymphatics: to treat the entire neck with IMRT, or to match the IMRT plan to a conventional anterior 'low neck' field. In view of the potential advantages of using a conventional low neck field, it is important to look for ways to minimize or manage the problems of matching IMRT to a conventional radiotherapy field. Treating the low neck with a single anterior field and the standard larynx block decreases the dose to the larynx and often results in a superior IMRT plan at the primary site. The purpose of this article is to review the most applicable studies and to discuss our experience with implementing a technique that involves moving the position of the superior border of the low neck field several times during a single treatment fraction

  1. Optical intensity modulation direct detection versus heterodyne detection: A high-SNR capacity comparison

    KAUST Repository

    Chaaban, Anas

    2016-09-15

    An optical wireless communications system which employs either intensity-modulation and direct-detection (IM-DD) or heterodyne detection (HD) is considered. IM-DD has lower complexity and cost than HD, but on the other hand, has lower capacity. It is therefore interesting to investigate the capacity gap between the two systems. The main focus of this paper is to investigate this gap at high SNR. Bounds on this gap are established for two cases: between IM-DD and HD, and between IM-DD and an HD-PAM which is an HD system employing pulse-amplitude modulation (PAM). While the gap between IM-DD and HD increases as the signal-to-noise ratio (SNR) increases, the gap between IM-DD and an HD-PAM is upper bounded by a constant at high SNR. © 2015 IEEE.

  2. Intensity modulated radiotherapy (IMRT) for pediatric cancer patients: The advantage and fear of second malignant neoplasm

    International Nuclear Information System (INIS)

    Zaghloul, M.S.

    2013-01-01

    Intensity-modulated radiotherapy is used for delivering more efficient homogenous dose to the target and lowering of dose to the surrounding normal tissues. However, a second malignant neoplasm may develop after prolonged latent period. The use of modern precise radiotherapy techniques in the pediatric age group has many controversial issues in spite of its proven dosimetric distribution advantages and the considerable decrease of normal tissue complication probability (NTCP). This concern is due to many factors; mainly the exposure of a larger volume of normal tissues to low dose radiotherapy. Children have more proliferating tissues compared to the adults. However, the epidemiological data did not detect an increase in the incidence of radiation-induced second malignancy. This issue is still controversial as IMRT and other precise radiotherapy techniques were not widely used except recently. This may entail a thorough careful follow up for children treated with these techniques to detect any incidence increase

  3. 'Tongue-and-groove' effect in intensity modulated radiotherapy with static multileaf collimator fields

    International Nuclear Information System (INIS)

    Que, W; Kung, J; Dai, J

    2004-01-01

    The 'tongue-and-groove problem' in step-and-shoot delivery of intensity modulated radiotherapy is investigated. A 'tongue-and-groove' index (TGI) is introduced to quantify the 'tongue-and-groove' effect in step-and-shoot delivery. Four different types of leaf sequencing methods are compared. The sliding window method and the reducing level method use the same number of field segments to deliver the same intensity map, but the TGI is much less for the reducing level method. The leaf synchronization method of Van Santvoort and Heijmen fails in step-and-shoot delivery, but a new method inspired by the method of Van Santvoort and Heijmen is shown to eliminate 'tongue-and-groove' underdosage completely

  4. Locally Advanced Oncocytic Carcinoma of the Nasal Cavity Treated With Surgery and Intensity-modulated Radiotherapy

    Directory of Open Access Journals (Sweden)

    Yu-Wen Hu

    2010-03-01

    Full Text Available Oncocytic carcinomas of the nasal cavity are extremely rare. We report 1 patient whose primary tumor and neck lymphadenopathies were under control nearly 2 years after combined surgery and radiotherapy. An 80-year-old man with a history of nasal oncocytoma had received excision twice previously. Computed tomography demonstrated locally advanced recurrent tumor invading the paranasal sinuses and orbit with lymphadenopathies in the right neck. Skull base surgery was performed. Pathological examination revealed oncocytic carcinoma. Positron emission tomography showed hypermetabolic lesions in the surgical bed and right neck. The patient subsequently received intensity-modulated radiotherapy to the primary site and the whole neck. Follow-up computed tomography 4 months later showed marked shrinkage of the neck lymphadenopathies. There was no progression after nearly 2 years. Although these tumors have historically been regarded as radioresistant, the combined treatment of surgery followed by radiotherapy may offer the best chance for control of locally advanced disease.

  5. Optical intensity modulation direct detection versus heterodyne detection: A high-SNR capacity comparison

    KAUST Repository

    Chaaban, Anas; Alouini, Mohamed-Slim

    2016-01-01

    An optical wireless communications system which employs either intensity-modulation and direct-detection (IM-DD) or heterodyne detection (HD) is considered. IM-DD has lower complexity and cost than HD, but on the other hand, has lower capacity. It is therefore interesting to investigate the capacity gap between the two systems. The main focus of this paper is to investigate this gap at high SNR. Bounds on this gap are established for two cases: between IM-DD and HD, and between IM-DD and an HD-PAM which is an HD system employing pulse-amplitude modulation (PAM). While the gap between IM-DD and HD increases as the signal-to-noise ratio (SNR) increases, the gap between IM-DD and an HD-PAM is upper bounded by a constant at high SNR. © 2015 IEEE.

  6. Emotional Intensity Modulates the Integration of Bimodal Angry Expressions: ERP Evidence

    Directory of Open Access Journals (Sweden)

    Zhihui Pan

    2017-06-01

    Full Text Available Integration of information from face and voice plays a central role in social interactions. The present study investigated the modulation of emotional intensity on the integration of facial-vocal emotional cues by recording EEG for participants while they were performing emotion identification task on facial, vocal, and bimodal angry expressions varying in emotional intensity. Behavioral results showed the rates of anger and reaction speed increased as emotional intensity across modalities. Critically, the P2 amplitudes were larger for bimodal expressions than for the sum of facial and vocal expressions for low emotional intensity stimuli, but not for middle and high emotional intensity stimuli. These findings suggested that emotional intensity modulates the integration of facial-vocal angry expressions, following the principle of Inverse Effectiveness (IE in multimodal sensory integration.

  7. A method of segment weight optimization for intensity modulated radiation therapy

    International Nuclear Information System (INIS)

    Pei Xi; Cao Ruifen; Jing Jia; Cheng Mengyun; Zheng Huaqing; Li Jia; Huang Shanqing; Li Gui; Song Gang; Wang Weihua; Wu Yican; FDS Team

    2011-01-01

    The error caused by leaf sequencing often leads to planning of Intensity-Modulated Radiation Therapy (IMRT) arrange system couldn't meet clinical demand. The optimization approach in this paper can reduce this error and improve efficiency of plan-making effectively. Conjugate Gradient algorithm was used to optimize segment weight and readjust segment shape, which could minimize the error anterior-posterior leaf sequencing eventually. Frequent clinical cases were tasted by precise radiotherapy system, and then compared Dose-Volume histogram between target area and organ at risk as well as isodose line in computed tomography (CT) film, we found that the effect was improved significantly after optimizing segment weight. Segment weight optimizing approach based on Conjugate Gradient method can make treatment planning meet clinical request more efficiently, so that has extensive application perspective. (authors)

  8. Intensity-modulated photon arc therapy for treatment of pleural mesothelioma

    International Nuclear Information System (INIS)

    Tobler, Matt; Watson, Gordon; Leavitt, Dennis

    2002-01-01

    Radiotherapy plays a key role in the definitive or adjuvant management of patients with mesothelioma of the pleural surface. Many patients are referred for radiation with intact lung following biopsy or subtotal pleurectomy. Delivery of efficacious doses of radiation to the pleural lining while avoiding lung parenchyma toxicity has been a difficult technical challenge. Using opposed photon fields produce doses in lung that result in moderate-to-severe pulmonary toxicity in 100% of patients treated. Combined photon-electron beam treatment, at total doses of 4250 cGy to the pleural surface, results in two-thirds of the lung volume receiving over 2100 cGy. We have developed a technique using intensity-modulated photon arc therapy (IMRT) that significantly improves the dose distribution to the pleural surface with concomitant decrease in dose to lung parenchyma compared to traditional techniques. IMRT treatment of the pleural lining consists of segments of photon arcs that can be intensity modulated with varying beam weights and multileaf positions to produce a more uniform distribution to the pleural surface, while at the same time reducing the overall dose to the lung itself. Computed tomography (CT) simulation is critical for precise identification of target volumes as well as critical normal structures (lung and heart). Rotational arc trajectories and individual leaf positions and weightings are then defined for each CT plane within the patient. This paper will describe the proposed rotational IMRT technique and, using simulated isodose distributions, show the improved potential for sparing of dose to the critical structures of the lung, heart, and spinal cord

  9. Role of beam orientation optimization in intensity-modulated radiation therapy

    International Nuclear Information System (INIS)

    Pugachev, Andrei; Li, Jonathan G.; Boyer, Arthur L.; Hancock, Steven L.; Le, Quynh-Thu; Donaldson, Sarah S.; Lei Xing

    2001-01-01

    Purpose: To investigate the role of beam orientation optimization in intensity-modulated radiation therapy (IMRT) and to examine the potential benefits of noncoplanar intensity-modulated beams. Methods and Materials: A beam orientation optimization algorithm was implemented. For this purpose, system variables were divided into two groups: beam position (gantry and table angles) and beam profile (beamlet weights). Simulated annealing was used for beam orientation optimization and the simultaneous iterative inverse treatment planning algorithm (SIITP) for beam intensity profile optimization. Three clinical cases were studied: a localized prostate cancer, a nasopharyngeal cancer, and a paraspinal tumor. Nine fields were used for all treatments. For each case, 3 types of treatment plan optimization were performed: (1) beam intensity profiles were optimized for 9 equiangular spaced coplanar beams; (2) orientations and intensity profiles were optimized for 9 coplanar beams; (3) orientations and intensity profiles were optimized for 9 noncoplanar beams. Results: For the localized prostate case, all 3 types of optimization described above resulted in dose distributions of a similar quality. For the nasopharynx case, optimized noncoplanar beams provided a significant gain in the gross tumor volume coverage. For the paraspinal case, orientation optimization using noncoplanar beams resulted in better kidney sparing and improved gross tumor volume coverage. Conclusion: The sensitivity of an IMRT treatment plan with respect to the selection of beam orientations varies from site to site. For some cases, the choice of beam orientations is important even when the number of beams is as large as 9. Noncoplanar beams provide an additional degree of freedom for IMRT treatment optimization and may allow for notable improvement in the quality of some complicated plans

  10. Dynamic intensity-modulated non-coplanar arc radiotherapy (INCA) for head and neck cancer

    International Nuclear Information System (INIS)

    Krayenbuehl, Jerome; Davis, J. Bernard; Ciernik, I. Frank

    2006-01-01

    Background and purpose: To define the potential advantages of intensity-modulated radiotherapy (IMRT) applied using a non-coplanar dynamic arc technique for the treatment of head and neck cancer. Materials and methods: External beam radiotherapy (EBRT) was planned in ten patients with head and neck cancer using coplanar IMRT and non-coplanar arc techniques, termed intensity modulated non-coplanar arc EBRT (INCA). Planning target volumes (PTV1) of first order covered the gross tumor volume and surrounding clinical target volume treated with 68-70 Gy, whereas PTV2 covered the elective lymph nodes with 54-55 Gy using a simultaneous internal boost. Treatment plan comparison between IMRT and INCA was carried out using dose-volume histogram and 'equivalent uniform dose' (EUD). Results: INCA resulted in better dose coverage and homogeneity of the PTV1, PTV2, and reduced dose delivered to most of the organs at risk (OAR). For the parotid glands, a reduction of the mean dose of 2.9 (±2.0) Gy was observed (p 0.002), the mean dose to the larynx was reduced by 6.9 (±2.9) Gy (p 0.003), the oral mucosa by 2.4 (±1.1) Gy (p < 0.001), and the maximal dose to the spinal cord by 3.2 (±1.7) Gy (p = 0.004). The mean dose to the brain was increased by 3.0 (±1.4) Gy (p = 0.002) and the mean lung dose increased by 0.2 (±0.4) Gy (p = 0.87). The EUD suggested better avoidance of the OAR, except for the lung, and better coverage and dose uniformity were achieved with INCA compared to IMRT. Conclusion: Dose delivery accuracy with IMRT using a non-coplanar dynamic arc beam geometry potentially improves treatment of head and neck cancer

  11. Intensity Modulated Neutron Radiotherapy for the Treatment of Adenocarcinoma of the Prostate

    International Nuclear Information System (INIS)

    Santanam, Lakshmi; He, Tony; Yudelev, Mark; Forman, Jeffrey D.; Orton, Colin G.; Heuvel, Frank van den; Maughan, Richard L.; Burmeister, Jay

    2007-01-01

    Purpose: This study investigates the enhanced conformality of neutron dose distributions obtainable through the application of intensity modulated neutron radiotherapy (IMNRT) to the treatment of prostate adenocarcinoma. Methods and Materials: An in-house algorithm was used to optimize individual segments for IMNRT generated using an organ-at-risk (OAR) avoidance approach. A number of beam orientation schemes were investigated in an attempt to approach an optimum solution. The IMNRT plans were created retrospectively for 5 patients previously treated for prostate adenocarcinoma using fast neutron therapy (FNT), and a comparison of these plans is presented. Dose distributions and dose-volume histograms (DVHs) were analyzed and plans were evaluated based on percentage volumes of rectum and bladder receiving 95%, 80%, and 50% (V 95 , V 80 , V 50 ) of the prescription dose, and on V 60 for both the femoral heads and GM muscle group. Results: Plans were normalized such that the IMNRT DVHs for prostate and seminal vesicles were nearly identical to those for conventional FNT plans. Use of IMNRT provided reductions in rectum V 95 and V 80 of 10% (2-27%) and 13% (5-28%), respectively, and reductions in bladder V 95 and V 80 of 12% (3-26%) and 4% (7-10%), respectively. The average decrease in V 60 for the femoral heads was 4.5% (1-18%), with no significant change in V 60 for the GM muscle group. Conclusions: This study provides the first analysis of the application of intensity modulation to neutron radiotherapy. The IMNRT technique provides a substantial reduction in normal tissue dose in the treatment of prostate cancer. This reduction should result in a significant clinical advantage for this and other treatment sites

  12. Intensity modulated radiotherapy for sinonasal malignancies with a focus on optic pathway preservation

    Directory of Open Access Journals (Sweden)

    Chi Alexander

    2013-01-01

    Full Text Available Abstract Purpose To assess if intensity-modulated radiotherapy (IMRT can possibly lead to improved local control and lower incidence of vision impairment/blindness in comparison to non-IMRT techniques when treating sinonasal malignancies; what is the most optimal dose constraints for the optic pathway; and the impact of different IMRT strategies on optic pathway sparing in this setting. Methods and materials A literature search in the PubMed databases was conducted in July, 2012. Results Clinical studies on IMRT and 2D/3D (2 dimensional/3 dimensional RT for sinonasal malignancies suggest improved local control and lower incidence of severe vision impairment with IMRT in comparison to non-IMRT techniques. As observed in the non-IMRT studies, blindness due to disease progression may occur despite a lack of severe toxicity possibly due to the difficulty of controlling locally very advanced disease with a dose ≤ 70 Gy. Concurrent chemotherapy’s influence on the the risk of severe optic toxicity after radiotherapy is unclear. A maximum dose of ≤ 54 Gy with conventional fractionation to the optic pathway may decrease the risk of blindness. Increased magnitude of intensity modulation through increasing the number of segments, beams, and using a combination of coplanar and non-coplanar arrangements may help increase dose conformality and optic pathway sparing when IMRT is used. Conclusion IMRT optimized with appropriate strategies may be the treatment of choice for the most optimal local control and optic pathway sparing when treating sinonasal malignancy.

  13. Patterns of Failure and Toxicity after Intensity-Modulated Radiotherapy for Head and Neck Cancer

    International Nuclear Information System (INIS)

    Schoenfeld, Gordon O.; Amdur, Robert J.; Morris, Christopher G.; Li, Jonathan G.; Hinerman, Russell W.; Mendenhall, William M.

    2008-01-01

    Purpose: To determine the outcome of patients treated with intensity-modulated radiotherapy (IMRT) for head and neck cancer. Methods and Materials: We reviewed the charts of 100 consecutive patients treated with IMRT for squamous cell carcinoma of the oropharynx (64%), nasopharynx (16%), hypopharynx (14%), and larynx (6%). Most patients were treated with a concomitant boost schedule to 72 Gy. Of the 100 patients, 54 (54%) received adjuvant chemotherapy, mostly concurrent cisplatin. The dosimetry plans for patients with either locoregional failure or Grade 4-5 complications were reviewed and fused over the computed tomography images corresponding with the location of the event. Marginal failures were defined as those that occurred at a region of high-dose falloff, where conventional fields would have provided better coverage. Results: The median follow-up of living patients was 3.1 years (range, 1-5.2 years). The 3-year rate of local control, locoregional control, freedom from relapse, cause-specific survival, and overall survival for all patients was 89%, 87%, 72%, 78%, and 71%, respectively. The 3-year rate of freedom from relapse, cause-specific survival, and overall survival for the 64 oropharynx patients was 86%, 92%, and 84%, respectively. Of the 10 local failures, 2 occurred at the margin of the high-dose planning target volume. Both regional failures occurred within the planning target volume. No locoregional failures occurred outside the planning target volume. Of the 100 patients, 8 and 5 had Grade 4 and 5 complications from treatment, respectively. All patients with Grade 5 complications had received adjuvant chemotherapy. No attempt was made to discriminate between the complications from IMRT and other aspects of the patients' treatment. Conclusion: Intensity-modulated radiotherapy did not compromise the outcome compared with what we have achieved with conventional techniques. The 2 cases of recurrence in the high-dose gradient region highlight the

  14. VERIDOS: a new tool for quality assurance for intensity modulated radiotherapy.

    Science.gov (United States)

    Wiezorek, Tilo; Schwedas, Michael; Scheithauer, Marcel; Salz, Henning; Bellemann, Matthias; Wendt, Thomas G

    2002-12-01

    The use of intensity modulated radiation fields needs an extended quality assurance concept. This consists of a linac related part and a case related part. Case related means the verification of an individual treatment plan, optimized on a CT data set of an individual patient and prepared for the treatment of this patient. This part of the quality assurance work is usually time consuming, delivers only partially quantitative results and is uncomfortable without additional help. It will be shown in this paper how the software VERIDOS will improve the optimization of the case related part of the quality assurance work. The main function of the software is the quantitative comparison of the calculated dose distribution from the treatment planning software with the measured dose distribution of an irradiated phantom. Several additional functions will be explained. Two self-developed phantoms made of RW3 (solid water) and GAFCHROMIC films or Kodak EDR2 films for the measurement of the dose distributions were used. VERIDOS was tested with the treatment planning systems Helay-TMS and Brainscan. VERIDOS is a suitable tool for the import of calculated dose matrices from the treatment planning systems Helax-TMS and Brainscan and of measured dose matrices exported from the dosimetry software Mephysto (PTW). The import from other treatment planning systems and scanning software applications for film dosimetry is generally possible. In such case the import function has to be adapted to the special header of the import matrix. All other functions of this software tool like normalization (automatically, manually), working with corrections (ground substraction, factors), overlay/comparison of dose distributions, difference matrix, cutting function (profiles) and export functions work reliable. VERIDOS improves the optimization of the case related part of the quality assurance work for intensity modulated radiation therapy (IMRT). The diverse functions of the software offer the

  15. Intensity-Modulated Radiotherapy for Craniospinal Irradiation: Target Volume Considerations, Dose Constraints, and Competing Risks

    International Nuclear Information System (INIS)

    Parker, William; Filion, Edith; Roberge, David; Freeman, Carolyn R.

    2007-01-01

    Purpose: To report the results of an analysis of dose received to tissues and organs outside the target volume, in the setting of spinal axis irradiation for the treatment of medulloblastoma, using three treatment techniques. Methods and Materials: Treatment plans (total dose, 23.4 Gy) for a standard two-dimensional (2D) technique, a three-dimensional (3D) technique using a 3D imaging-based target volume, and an intensity-modulated radiotherapy (IMRT) technique, were compared for 3 patients in terms of dose-volume statistics for target coverage, as well as organ at risk (OAR) and overall tissue sparing. Results: Planning target volume coverage and dose homogeneity was superior for the IMRT plans for V 95% (IMRT, 100%; 3D, 96%; 2D, 98%) and V 107% (IMRT, 3%; 3D, 38%; 2D, 37%). In terms of OAR sparing, the IMRT plan was better for all organs and whole-body contour when comparing V 10Gy , V 15Gy , and V 20Gy . The 3D plan was superior for V 5Gy and below. For the heart and liver in particular, the IMRT plans provided considerable sparing in terms of V 10Gy and above. In terms of the integral dose, the IMRT plans were superior for liver (IMRT, 21.9 J; 3D, 28.6 J; 2D, 38.6 J) and heart (IMRT, 9 J; 3D, 14.1J; 2D, 19.4 J), the 3D plan for the body contour (IMRT, 349 J; 3D, 337 J; 2D, 555 J). Conclusions: Intensity-modulated radiotherapy is a valid treatment option for spinal axis irradiation. We have shown that IMRT results in sparing of organs at risk without a significant increase in integral dose

  16. [Intensity modulated radiation therapy for patients with gynecological malignancies after hysterectomy and chemotherapy/radiotherapy].

    Science.gov (United States)

    Chen, Zhen-yun; Ma, Yue-bing; Sheng, Xiu-gui; Zhang, Xiao-ling; Xue, Li; Song, Qu-qing; Liu, Nai-fu; Miao, Hua-qin

    2007-04-01

    To investigate the value of intensity modulated radiation therapy (IMRT) for patient with gynecological malignancies after treatment of hysterectomy and chemotherapy/radiotherapy. All 32 patients with cervical or endometrial cancer after hysterectomy received full course IMRT after 1 to 3 cycles of chemotherapy (Karnofsky performance status(KPS) > or =70). Seventeen of these patients underwent postoperative preventive irradiation and the other 15 patients were pelvic wall recurrence and/or retroperitoneal lymph node metastasis, though postoperative radiotherapy and/or chemotherapy had been given after operation. The median dose delivered to the PTV was 56.8 Gy for preventive irradiation, and 60.6 Gy for pelvic wall recurrence or retroperioneal lymph node metastasis irradiation. It was required that 90% of iso-dose curve could covere more than 99% of GTV. However, The mean dose irradiated to small intestine, bladder, rectum, kidney and spinal cord was 21.3 Gy, 37.8 Gy, 35.3 Gy, 8.5 Gy, 22.1 Gy, respectively. Fourteen patients presented grade I (11 patients) or II (3 patients) digestive tract side-effects, Five patients developed grade I or II bone marrow depression. Twelve patients had grade I skin reaction. The overall 1-year survival rate was 100%. The 2- and 3- year survival rate for preventive irradiation were both 100%, but which was 5/7 and 3/6 for the patients with pelvic wall recurrence or retroperioneal lymph node metastasis. Intensity modulated radiation therapy can provide a better dose distribution than traditional radiotherapy for both prevention and pelvic wall recurrence or retroperioneal lymph node metastasis. The toxicity is tolerable. The adjacent organs at risk can well be protected.

  17. Normal liver tissue sparing by intensity-modulated proton stereotactic body radiotherapy for solitary liver tumours

    International Nuclear Information System (INIS)

    Petersen, Joergen B. B.; Hansen, Anders T.; Lassen, Yasmin; Grau, Cai; Hoeyer, Morten; Muren, Ludvig P.

    2011-01-01

    Background. Stereotactic body radiotherapy (SBRT) is often the preferred treatment for the advanced liver tumours which owing to tumour distribution, size and multi-focality are out of range of surgical resection or radiofrequency ablation. However, only a minority of patients with liver tumours may be candidates for conventional SBRT because of the limited radiation tolerance of normal liver, intestine and other normal tissues. Due to the favourable depth-dose characteristics of protons, intensity-modulated proton therapy (IMPT) may be a superior alternative to photon-based SBRT. The purpose of this treatment planning study was therefore to investigate the potential sparing of normal liver by IMPT compared to photon-based intensity-modulated radiotherapy (IMRT) for solitary liver tumours. Material and methods. Ten patients with solitary liver metastasis treated at our institution with multi-field SBRT were retrospectively re-planned with IMRT and proton pencil beam scanning techniques. For the proton plans, two to three coplanar fields were used in contrast to five to six coplanar and non-coplanar photon fields. The same planning objectives were used for both techniques. A risk adapted dose prescription to the PTV surface of 12.5-16.75 Gy x 3 was used. Results. The spared liver volume for IMPT was higher compared to IMRT in all 10 patients. At the highest prescription dose level, the median liver volume receiving less than 15 Gy was 1411 cm 3 for IMPT and 955 cm 3 for IMRT (p D 15 Gy > 700 cm 3 constraint. For the D mean = 15 Gy constraint, nine of 10 cases could be treated at the highest dose level using IMPT whereas with IMRT, only two cases met this constraint at the highest dose level and six at the lowest dose level. Conclusion. A considerable sparing of normal liver tissue can be obtained using proton-based SBRT for solitary liver tumours

  18. A comparison of three optimization algorithms for intensity modulated radiation therapy

    International Nuclear Information System (INIS)

    Pflugfelder, D.; Wilkens, J.J.; Nill, S.; Oelfke, U.

    2008-01-01

    In intensity modulated treatment techniques, the modulation of each treatment field is obtained using an optimization algorithm. Multiple optimization algorithms have been proposed in the literature, e.g. steepest descent, conjugate gradient, quasi-Newton methods to name a few. The standard optimization algorithm in our in-house inverse planning tool KonRad is a quasi-Newton algorithm. Although this algorithm yields good results, it also has some drawbacks. Thus we implemented an improved optimization algorithm based on the limited-memory Broyden-Fletcher-Goldfarb-Shanno (L-BFGS) routine. In this paper the improved optimization algorithm is described. To compare the two algorithms, several treatment plans are optimized using both algorithms. This included photon (IMRT) as well as proton (IMPT) intensity modulated therapy treatment plans. To present the results in a larger context the widely used conjugate gradient algorithm was also included into this comparison. On average, the improved optimization algorithm was six times faster to reach the same objective function value. However, it resulted not only in an acceleration of the optimization. Due to the faster convergence, the improved optimization algorithm usually terminates the optimization process at a lower objective function value. The average of the observed improvement in the objective function value was 37%. This improvement is clearly visible in the corresponding dose-volume-histograms. The benefit of the improved optimization algorithm is particularly pronounced in proton therapy plans. The conjugate gradient algorithm ranked in between the other two algorithms with an average speedup factor of two and an average improvement of the objective function value of 30%. (orig.)

  19. Accommodating practical constraints for intensity modulated radiation therapy by means of compensators

    International Nuclear Information System (INIS)

    Meyer, Juergen

    2002-01-01

    The thesis deals with the practical implementation of intensity modulated radiation therapy (IMRT) generated by means of patient specific metal compensators. An elaborate comparison between several compensator-machining techniques, with respect to their suitability for production within a hospital workshop, is presented. The limitations associated with the selected compensator manufacturing technique are identified and implemented as constraints in an existing inverse treatment-planning algorithm. In order to obtain the profile of a compensator, which produces a desired intensity distribution, inverse modeling of the radiation attenuation within the compensator is required. Two novel and independent approaches, based on deconvolution and system identification, are proposed to accomplish this. To compare the approach with the 'rival' state of the art beam modulation technique, a theoretical and experimental examination of the modulated fields generated by manufactured compensators and multileaf collimators is presented. This comparison focused on the achievable resolution of the intensity modulated beams in lateral and longitudinal directions. To take into account the characteristics of a clinical environment the suitability of the most common commercially available treatment couch systems for IMRT treatments is studied. An original rule based advisory system is developed to alert the operator of any potential collision of the beam with the movable supporting structures of the treatment couch. The system is capable of finding alternative positions for the supporting frames and, if necessary, can suggest alternative beam directions. Finally, a head and neck phantom is designed for gel dosimetry to assess IMRT treatment delivery techniques. The phantom is based on a simplistic but realistic design and contains the main anatomical features

  20. Some aspects of the design of intensity modulated beams for breast radiotherapy

    International Nuclear Information System (INIS)

    Evans, PM; Hansen, VN; Swindell, W

    1995-01-01

    An electronic portal imaging system has been used to design intensity modulated beams to achieve compensation for missing tissue and tissue heterogeneity in tangential irradiation of the breast. A portal image of the breast is calibrated for radiological thickness and an estimate of the outline of lung and soft tissue is made. This is used with the desired dose prescription to design intensity modulated beams, IMBs. The practical implementation of the IMBs may be achieved using a multileaf collimator, MLC. The leaves of the MLC may be scanned dynamically or a set of multiple static fields may be used. We have compared the uniformity of the achievable dose distribution for both cases. In the static case, the effects of varying the number of fields and their relative intensities have been investigated. The use of scanning leaves yields a dose distribution which is close to optimal. Multiple static fields produce results close to optimal if a large number, typically 30 are used. However, even for the more practicable case of 5 fields, the hot and cold spots are significantly reduced compared to a simple wedge. When studying the optimum intensity distribution for the set of static fields, it was found that having the first field with a large intensity irradiating the whole target volume and a set of 'top-up' fields of equal magnitude was best. This study suggests that an MLC may indeed be used to deliver IMBs for radiotherapy of the breast. We can presently deliver the multiple static field technique. For the small number of beams which are presently deliverable, an improvement of dosimetry over the use of a simple wedge is indicated. In the future, with the scanning leaves technique, dose distributions with greatly reduced dose inhomogeneities should be achievable

  1. Radiation-Induced Cancers From Modern Radiotherapy Techniques: Intensity-Modulated Radiotherapy Versus Proton Therapy

    International Nuclear Information System (INIS)

    Yoon, Myonggeun; Ahn, Sung Hwan; Kim, Jinsung; Shin, Dong Ho; Park, Sung Yong; Lee, Se Byeong; Shin, Kyung Hwan; Cho, Kwan Ho

    2010-01-01

    Purpose: To assess and compare secondary cancer risk resulting from intensity-modulated radiotherapy (IMRT) and proton therapy in patients with prostate and head-and-neck cancer. Methods and Materials: Intensity-modulated radiotherapy and proton therapy in the scattering mode were planned for 5 prostate caner patients and 5 head-and-neck cancer patients. The secondary doses during irradiation were measured using ion chamber and CR-39 detectors for IMRT and proton therapy, respectively. Organ-specific radiation-induced cancer risk was estimated by applying organ equivalent dose to dose distributions. Results: The average secondary doses of proton therapy for prostate cancer patients, measured 20-60cm from the isocenter, ranged from 0.4 mSv/Gy to 0.1 mSv/Gy. The average secondary doses of IMRT for prostate patients, however, ranged between 3 mSv/Gy and 1 mSv/Gy, approximately one order of magnitude higher than for proton therapy. Although the average secondary doses of IMRT were higher than those of proton therapy for head-and-neck cancers, these differences were not significant. Organ equivalent dose calculations showed that, for prostate cancer patients, the risk of secondary cancers in out-of-field organs, such as the stomach, lungs, and thyroid, was at least 5 times higher for IMRT than for proton therapy, whereas the difference was lower for head-and-neck cancer patients. Conclusions: Comparisons of organ-specific organ equivalent dose showed that the estimated secondary cancer risk using scattering mode in proton therapy is either significantly lower than the cases in IMRT treatment or, at least, does not exceed the risk induced by conventional IMRT treatment.

  2. Patterns of local-regional failure after primary intensity modulated radiotherapy for nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Kong, Fangfang; Ying, Hongmei; Du, Chengrun; Huang, Shuang; Zhou, Junjun; Chen, Junchao; Sun, Lining; Chen, Xiaohui; Hu, Chaosu

    2014-01-01

    To analyze patterns of local-regional failure after primary intensity modulated radiotherapy (IMRT) for nasopharyngeal carcinoma (NPC). A total of 370 non-metastatic NPC patients consecutively treated with IMRT (with or without chemotherapy) were analyzed. Radiotherapy was administered using a simultaneous integrated boost (SIB) technique at the total prescribed dose of 66-70.4Gy (2.0-2.2Gy per fraction). The location and extent of local-regional failures were transferred to the pretreatment planning computed tomography (CT) for dosimetric analysis. The dose of radiation received by V recur (volume of recurrence) was calculated and analyzed with dose-volume histogram (DVH). Failures were classified as: 'in field' if 95% of V recur was within the 95% isodose, 'marginal' if 20% to 95% of V recur was within the 95% isodose, or 'outside' if less than 20% of V recur was inside the 95% isodose. With a median follow up of 26 months, 25 local-regional failures were found in 18 patients. The 1- and 2-year actuarial local-regional control rates for all patients were 99.7% and 95.5% respectively. Among the 22 local–regional failures with available diagnostic images, 16 (64%) occurred within the 95% isodose lines and were considered in-field failures; 3 (12%) were marginal and 3 (12%) were outside-field failures. Intensity-modulated radiotherapy provides excellent local-regional control for NPC. In-field failures are the main patterns for local-regional recurrence. Reducing the coverage of critical adjacent tissues in CTV purposefully for potential subclinical diseases was worth of study. Great attention in all IMRT steps is necessary to reduce potential causes of marginal failures. More studies about radioresistance are needed to reduce in-field failures

  3. Intensity-modulated Radiosurgery for patients with brain metastases: a mature outcomes analysis.

    Science.gov (United States)

    Wang, Samuel J; Choi, Mehee; Fuller, Clifton D; Salter, Bill J; Fuss, Martin

    2007-06-01

    The purpose of this study was to evaluate the outcomes of patients with brain metastases treated by tomotherapeutic Intensity-modulated Radiosurgery (IMRS). Using retrospective chart review, we analyzed the outcomes of 78 patients (age 33-83 years, median 57 years) who underwent 111 sessions of IMRS (1 to 7 sessions per patient, median 1) for brain metastases (1 to 4 targets per IMRS session, median 1) treated between 2000 and 2005 using a serial tomotherapeutic intensity-modulated radiotherapy treatment (IMRT) planning and delivery system (Peacock, Nomos Corp., Cranberry Township, PA). Treatment planning was performed using an inverse treatment planning optimization algorithm that was optimized for IMRS. A median prescription dose of 15 Gy in combination with WBI, and median 20 Gy for IMRS alone was delivered using 2-4 couch angles over 4-24 rotational arcs. Overall survival was calculated using Kaplan-Meier analysis. To determine the effects of prognostic variables on survival, univariate and multivariate analyses using proportional hazards were performed to assess the effects of age, tumor size, the combination with whole brain irradiation, presence of multiple brain metastases, and presence of extracranial disease. The median overall survival was 6.5 months (95% CI, 5.5-7.9). One- and two-year survival rates were 24% and 10%. In multivariate analyses, age greater than 60 years was the only statistically significant variable that affected survival (hazard rate 1.29, p=0.049). We conclude that tomotherapeutic IMRS is safe and effective to treat patients with brain metastases.

  4. Independent monitor unit calculation for intensity modulated radiotherapy using the MIMiC multileaf collimator

    International Nuclear Information System (INIS)

    Chen Zhe; Xing Lei; Nath, Ravinder

    2002-01-01

    A self-consistent monitor unit (MU) and isocenter point-dose calculation method has been developed that provides an independent verification of the MU for intensity modulated radiotherapy (IMRT) using the MIMiC (Nomos Corporation) multileaf collimator. The method takes into account two unique features of IMRT using the MIMiC: namely the gantry-dynamic arc delivery of intensity modulated photon beams and the slice-by-slice dose delivery for large tumor volumes. The method converts the nonuniform beam intensity planned at discrete gantry angles of 5 deg. or 10 deg. into conventional nonmodulated beam intensity apertures of elemental arc segments of 1 deg. This approach more closely simulates the actual gantry-dynamic arc delivery by MIMiC. Because each elemental arc segment is of uniform intensity, the MU calculation for an IMRT arc is made equivalent to a conventional arc with gantry-angle dependent beam apertures. The dose to the isocenter from each 1 deg. elemental arc segment is calculated by using the Clarkson scatter summation technique based on measured tissue-maximum-ratio and output factors, independent of the dose calculation model used in the IMRT planning system. For treatments requiring multiple treatment slices, the MU for the arc at each treatment slice takes into account the MU, leakage and scatter doses from other slices. This is achieved by solving a set of coupled linear equations for the MUs of all involved treatment slices. All input dosimetry data for the independent MU/isocenter point-dose calculation are measured directly. Comparison of the MU and isocenter point dose calculated by the independent program to those calculated by the Corvus planning system and to direct measurements has shown good agreement with relative difference less than ±3%. The program can be used as an independent initial MU verification for IMRT plans using the MIMiC multileaf collimators

  5. MOSFET detectors in quality assurance of tomotherapy treatments.

    Science.gov (United States)

    Cherpak, Amanda; Studinski, Ryan C N; Cygler, Joanna E

    2008-02-01

    The purpose of this work was to characterize metal oxide semiconductor field-effect transistors (MOSFETs) in a 6 MV conventional linac and investigate their use for quality assurance of radiotherapy treatments with a tomotherapy Hi-Art unit. High sensitivity and standard sensitivity MOSFETs were first calibrated and then tested for reproducibility, field size dependence, and accuracy of measuring surface dose in a 6 MV beam as well as in a tomotherapy Hi-Art unit. In vivo measurements were performed on both a RANDO phantom and several head and neck cancer patients treated with tomotherapy and compared to TLD measurements and treatment plan doses to evaluate the performance of MOSFETs in a high gradient radiation field. The average calibration factor found was 0.345+/-2.5%cGy/mV for the high sensitivity MOSFETs tested and 0.901+/-2.4%cGy/mV for the standard sensitivity MOSFETs. MOSFET measured surface doses had an average agreement with ion chamber measurements of 1.55% for the high sensitivity MOSFET and 5.23% for the standard sensitivity MOSFET when averaged over all trials and field sizes tested. No significant dependence on field size was found for the standard sensitivity MOSFETs, however a maximum difference of 5.34% was found for the high sensitivity MOSFET calibration factors in the field sizes tested. Measurements made with MOSFETS on head and neck patients treated on a tomotherapy Hi-Art unit had an average agreement of (3.26+/-0.03)% with TLD measurements, however the average of the absolute difference between the MOSFET measurements and the treatment plan skin doses was (12.2+/-7.5)%. The MOSFET measured patient skin doses also had good reproducibility, with inter-fraction deviations ranging from 1.4% to 6.6%. Similar results were found from trials using a RANDO phantom. The MOSFETs performed well when used in the tomotherapy Hi-Art unit and did not increase the overall treatment set-up time when used for patient measurements. It was found that MOSFETs

  6. Intensity modulated radiation therapy: Analysis of patient specific quality control results, experience of Rene-Gauducheau Centre

    International Nuclear Information System (INIS)

    Chiavassa, S.; Brunet, G.; Gaudaire, S.; Munos-Llagostera, C.; Delpon, G.; Lisbona, A.

    2011-01-01

    Purpose. - Systematic verifications of patient's specific intensity-modulated radiation treatments are usually performed with absolute and relative measurements. The results constitute a database which allows the identification of potential systematic errors. Material and methods. - We analyzed 1270 beams distributed in 232 treatment plans. Step-and-shoot intensity-modulated radiation treatments were performed with a Clinac (6 and 23 MV) and sliding window intensity-modulated radiation treatments with a Novalis (6 MV). Results. - The distributions obtained do not show systematic error and all the control meet specified tolerances. Conclusion. - These results allow us to reduce controls specific patients for treatments performed under identical conditions (location, optimization and segmentation parameters of treatment planning system, etc.). (authors)

  7. The field-matching problem as it applies to the peacock three dimensional conformal system for intensity modulation

    International Nuclear Information System (INIS)

    Carol, Mark; Grant, Walter H.; Bleier, Alan R.; Kania, Alex A.; Targovnik, Harris S.; Butler, E. Brian; Shiao, W. Woo

    1996-01-01

    Purpose: Intensity modulated beam systems have been developed as a means of creating a high-dose region that closely conforms to the prescribed target volume while also providing specific sparing of organs at risk within complex treatment geometries. The slice-by-slice treatment paradigm used by one such system for delivering intensity modulated fields introduces regions of dose nonuniformity where each pair of treatment slices abut. A study was designed to evaluate whether or not the magnitude of the nonuniformity that results from this segmental delivery paradigm is significant relative to the overall dose nonuniformity present in the intensity modulation technique itself. An assessment was also made as to the increase in nonuniformity that would result if errors were made in indexing during treatment delivery. Methods and Materials: Treatment plans were generated to simulate correctly indexed and incorrectly indexed treatments of 4, 10, and 18 cm diameter targets. Indexing errors of from 0.1 to 2.0 mm were studied. Treatment plans were also generated for targets of the same diameter but of lengths that did not require indexing of the treatment couch. Results: The nonuniformity that results from the intensity modulation delivery paradigm is 11-16% for targets where indexing is not required. Correct indexing of the couch adds an additional 1-2% in nonuniformity. However, a couch indexing error of as little as 1 mm can increase the total nonuniformity to as much as 25%. All increases in nonuniformity from indexing are essentially independent of target diameter. Conclusions: The dose nonuniformity introduced by the segmental strip delivery paradigm is small relative to the nonuniformity present in the intensity modulation paradigm itself. A positioning accuracy of better than 0.5 mm appears to be required when implementing segmental intensity modulated treatment plans

  8. A comparison of optic nerve dosimetry in craniospinal radiotherapy planned and treated with conventional and intensity modulated techniques

    International Nuclear Information System (INIS)

    Rene, Nicholas J.; Brodeur, Marylene; Parker, William; Roberge, David; Freeman, Carolyn

    2010-01-01

    Background and purpose: Some CNS tumours present leptomeningeal dissemination. Craniospinal radiotherapy is complex and recurrences may occur at sites of target volume underdosage. IMRT, being highly conformal to the target, could theoretically underdose the optic nerves if they are not specifically targeted leading to optic nerve recurrences. We analyzed optic nerve dosimetry when they are not specifically targeted. Materials and methods: We designed 3D-conformal and tomotherapy plans for our last five patients treated to the craniospinal axis, not including the optic nerves in the target volume. We analyzed the dose delivered to the optic nerves, to the anterior and posterior half of the optic nerves, and to a theoretical optic nerve-PTV. Results: The dose delivered to the optic nerves was similar for both plans in all patients (V95% close to 100%) except one in whom tomotherapy considerably underdosed the anterior optic nerves. The dose to the optic nerve-PTV was lower with tomotherapy in all patients. Conclusion: Despite not intentionally targeting the optic nerves, the dose to the optic nerves with IMRT was similar to 3D-conformal plans in most cases but left no margin for setup error. In individual cases the anterior half of the optic nerves could be significantly underdosed.

  9. Spinal cordd biological safety comparison of intensity modulated radiotherapy and conventional radiation therapy

    International Nuclear Information System (INIS)

    Xilinbaoleri; Xu Wanlong; Chen Gang; Liu Hao; Wang Ruozheng; Bai Jingping

    2010-01-01

    Objective: To compare the spine intensity modulated radiation therapy (IMRT) and the conventional radiation therapy on the beagle spinal cord neurons, in order t