Experimental validation of deterministic Acuros XB algorithm for IMRT and VMAT dose calculations with the Radiological Physics Center's head and neck phantom

International Nuclear Information System (INIS)

Han Tao; Mourtada, Firas; Kisling, Kelly; Mikell, Justin; Followill, David; Howell, Rebecca

2012-01-01

Purpose: The purpose of this study was to verify the dosimetric performance of Acuros XB (AXB), a grid-based Boltzmann solver, in intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT). Methods: The Radiological Physics Center (RPC) head and neck (H and N) phantom was used for all calculations and measurements in this study. Clinically equivalent IMRT and VMAT plans were created on the RPC H and N phantom in the Eclipse treatment planning system (version 10.0) by using RPC dose prescription specifications. The dose distributions were calculated with two different algorithms, AXB 11.0.03 and anisotropic analytical algorithm (AAA) 10.0.24. Two dose report modes of AXB were recorded: dose-to-medium in medium (D m,m ) and dose-to-water in medium (D w,m ). Each treatment plan was delivered to the RPC phantom three times for reproducibility by using a Varian Clinac iX linear accelerator. Absolute point dose and planar dose were measured with thermoluminescent dosimeters (TLDs) and GafChromic registered EBT2 film, respectively. Profile comparison and 2D gamma analysis were used to quantify the agreement between the film measurements and the calculated dose distributions from both AXB and AAA. The computation times for AAA and AXB were also evaluated. Results: Good agreement was observed between measured doses and those calculated with AAA or AXB. Both AAA and AXB calculated doses within 5% of TLD measurements in both the IMRT and VMAT plans. Results of AXB Dm,m (0.1% to 3.6%) were slightly better than AAA (0.2% to 4.6%) or AXB Dw,m (0.3% to 5.1%). The gamma analysis for both AAA and AXB met the RPC 7%/4 mm criteria (over 90% passed), whereas AXB Dm,m met 5%/3 mm criteria in most cases. AAA was 2 to 3 times faster than AXB for IMRT, whereas AXB was 4-6 times faster than AAA for VMAT. Conclusions: AXB was found to be satisfactorily accurate when compared to measurements in the RPC H and N phantom. Compared with AAA, AXB results were equal

Efficient and reliable 3D dose quality assurance for IMRT by combining independent dose calculations with measurements

International Nuclear Information System (INIS)

Visser, R.; Wauben, D. J. L.; Godart, J.; Langendijk, J. A.; Veld, A. A. van't; Korevaar, E. W.; Groot, M. de

2013-01-01

Purpose: Advanced radiotherapy treatments require appropriate quality assurance (QA) to verify 3D dose distributions. Moreover, increase in patient numbers demand efficient QA-methods. In this study, a time efficient method that combines model-based QA and measurement-based QA was developed; i.e., the hybrid-QA. The purpose of this study was to determine the reliability of the model-based QA and to evaluate time efficiency of the hybrid-QA method. Methods: Accuracy of the model-based QA was determined by comparison of COMPASS calculated dose with Monte Carlo calculations for heterogeneous media. In total, 330 intensity modulated radiation therapy (IMRT) treatment plans were evaluated based on the mean gamma index (GI) with criteria of 3%/3mm and classification of PASS (GI ≤ 0.4), EVAL (0.4 0.6), and FAIL (GI ≥ 0.6). Agreement between model-based QA and measurement-based QA was determined for 48 treatment plans, and linac stability was verified for 15 months. Finally, time efficiency improvement of the hybrid-QA was quantified for four representative treatment plans. Results: COMPASS calculated dose was in agreement with Monte Carlo dose, with a maximum error of 3.2% in heterogeneous media with high density (2.4 g/cm 3 ). Hybrid-QA results for IMRT treatment plans showed an excellent PASS rate of 98% for all cases. Model-based QA was in agreement with measurement-based QA, as shown by a minimal difference in GI of 0.03 ± 0.08. Linac stability was high with an average GI of 0.28 ± 0.04. The hybrid-QA method resulted in a time efficiency improvement of 15 min per treatment plan QA compared to measurement-based QA. Conclusions: The hybrid-QA method is adequate for efficient and accurate 3D dose verification. It combines time efficiency of model-based QA with reliability of measurement-based QA and is suitable for implementation within any radiotherapy department.

IMRT: Improvement in treatment planning efficiency using NTCP calculation independent of the dose-volume-histogram

International Nuclear Information System (INIS)

Grigorov, Grigor N.; Chow, James C.L.; Grigorov, Lenko; Jiang, Runqing; Barnett, Rob B.

2006-01-01

The normal tissue complication probability (NTCP) is a predictor of radiobiological effect for organs at risk (OAR). The calculation of the NTCP is based on the dose-volume-histogram (DVH) which is generated by the treatment planning system after calculation of the 3D dose distribution. Including the NTCP in the objective function for intensity modulated radiation therapy (IMRT) plan optimization would make the planning more effective in reducing the postradiation effects. However, doing so would lengthen the total planning time. The purpose of this work is to establish a method for NTCP determination, independent of a DVH calculation, as a quality assurance check and also as a mean of improving the treatment planning efficiency. In the study, the CTs of ten randomly selected prostate patients were used. IMRT optimization was performed with a PINNACLE3 V 6.2b planning system, using planning target volume (PTV) with margins in the range of 2 to 10 mm. The DVH control points of the PTV and OAR were adapted from the prescriptions of Radiation Therapy Oncology Group protocol P-0126 for an escalated prescribed dose of 82 Gy. This paper presents a new model for the determination of the rectal NTCP ( R NTCP). The method uses a special function, named GVN (from Gy, Volume, NTCP), which describes the R NTCP if 1 cm 3 of the volume of intersection of the PTV and rectum (R int ) is irradiated uniformly by a dose of 1 Gy. The function was 'geometrically' normalized using a prostate-prostate ratio (PPR) of the patients' prostates. A correction of the R NTCP for different prescribed doses, ranging from 70 to 82 Gy, was employed in our model. The argument of the normalized function is the R int , and parameters are the prescribed dose, prostate volume, PTV margin, and PPR. The R NTCPs of another group of patients were calculated by the new method and the resulting difference was <±5% in comparison to the NTCP calculated by the PINNACLE3 software where Kutcher's dose

Comparison of analytic source models for head scatter factor calculation and planar dose calculation for IMRT

International Nuclear Information System (INIS)

Yan Guanghua; Liu, Chihray; Lu Bo; Palta, Jatinder R; Li, Jonathan G

2008-01-01

The purpose of this study was to choose an appropriate head scatter source model for the fast and accurate independent planar dose calculation for intensity-modulated radiation therapy (IMRT) with MLC. The performance of three different head scatter source models regarding their ability to model head scatter and facilitate planar dose calculation was evaluated. A three-source model, a two-source model and a single-source model were compared in this study. In the planar dose calculation algorithm, in-air fluence distribution was derived from each of the head scatter source models while considering the combination of Jaw and MLC opening. Fluence perturbations due to tongue-and-groove effect, rounded leaf end and leaf transmission were taken into account explicitly. The dose distribution was calculated by convolving the in-air fluence distribution with an experimentally determined pencil-beam kernel. The results were compared with measurements using a diode array and passing rates with 2%/2 mm and 3%/3 mm criteria were reported. It was found that the two-source model achieved the best agreement on head scatter factor calculation. The three-source model and single-source model underestimated head scatter factors for certain symmetric rectangular fields and asymmetric fields, but similar good agreement could be achieved when monitor back scatter effect was incorporated explicitly. All the three source models resulted in comparable average passing rates (>97%) when the 3%/3 mm criterion was selected. The calculation with the single-source model and two-source model was slightly faster than the three-source model due to their simplicity

Comparison of analytic source models for head scatter factor calculation and planar dose calculation for IMRT

Energy Technology Data Exchange (ETDEWEB)

Yan Guanghua [Department of Nuclear and Radiological Engineering, University of Florida, Gainesville, FL 32611 (United States); Liu, Chihray; Lu Bo; Palta, Jatinder R; Li, Jonathan G [Department of Radiation Oncology, University of Florida, Gainesville, FL 32610-0385 (United States)

2008-04-21

The purpose of this study was to choose an appropriate head scatter source model for the fast and accurate independent planar dose calculation for intensity-modulated radiation therapy (IMRT) with MLC. The performance of three different head scatter source models regarding their ability to model head scatter and facilitate planar dose calculation was evaluated. A three-source model, a two-source model and a single-source model were compared in this study. In the planar dose calculation algorithm, in-air fluence distribution was derived from each of the head scatter source models while considering the combination of Jaw and MLC opening. Fluence perturbations due to tongue-and-groove effect, rounded leaf end and leaf transmission were taken into account explicitly. The dose distribution was calculated by convolving the in-air fluence distribution with an experimentally determined pencil-beam kernel. The results were compared with measurements using a diode array and passing rates with 2%/2 mm and 3%/3 mm criteria were reported. It was found that the two-source model achieved the best agreement on head scatter factor calculation. The three-source model and single-source model underestimated head scatter factors for certain symmetric rectangular fields and asymmetric fields, but similar good agreement could be achieved when monitor back scatter effect was incorporated explicitly. All the three source models resulted in comparable average passing rates (>97%) when the 3%/3 mm criterion was selected. The calculation with the single-source model and two-source model was slightly faster than the three-source model due to their simplicity.

The MLC tongue-and-groove effect on IMRT dose distributions

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Deng Jun [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305 (United States). E-mail: jun@reyes.stanford.edu; Pawlicki, Todd; Chen Yan; Li Jinsheng; Jiang, Steve B.; Ma, C.-M. [Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305 (United States)

2001-04-01

We have investigated the tongue-and-groove effect on the IMRT dose distributions for a Varian MLC. We have compared the dose distributions calculated using the intensity maps with and without the tongue-and-groove effect. Our results showed that, for one intensity-modulated treatment field, the maximum tongue-and-groove effect could be up to 10% of the maximum dose in the dose distributions. For an IMRT treatment with multiple gantry angles ({>=} 5), the difference between the dose distributions with and without the tongue-and-groove effect was hardly visible, less than 1.6% for the two typical clinical cases studied. After considering the patient setup errors, the dose distributions were smoothed with reduced and insignificant differences between plans with and without the tongue-and-groove effect. Therefore, for a multiple-field IMRT plan ({>=} 5), the tongue-and-groove effect on the IMRT dose distributions will be generally clinically insignificant due to the smearing effect of individual fields. The tongue-and-groove effect on an IMRT plan with small number of fields (<5) will vary depending on the number of fields in a plan (coplanar or non-coplanar), the MLC leaf sequences and the patient setup uncertainty, and may be significant (>5% of maximum dose) in some cases, especially when the patient setup uncertainty is small ({<=} 2 mm). (author)

Study of the IMRT interplay effect using a 4DCT Monte Carlo dose calculation.

Science.gov (United States)

Jensen, Michael D; Abdellatif, Ady; Chen, Jeff; Wong, Eugene

2012-04-21

Respiratory motion may lead to dose errors when treating thoracic and abdominal tumours with radiotherapy. The interplay between complex multileaf collimator patterns and patient respiratory motion could result in unintuitive dose changes. We have developed a treatment reconstruction simulation computer code that accounts for interplay effects by combining multileaf collimator controller log files, respiratory trace log files, 4DCT images and a Monte Carlo dose calculator. Two three-dimensional (3D) IMRT step-and-shoot plans, a concave target and integrated boost were delivered to a 1D rigid motion phantom. Three sets of experiments were performed with 100%, 50% and 25% duty cycle gating. The log files were collected, and five simulation types were performed on each data set: continuous isocentre shift, discrete isocentre shift, 4DCT, 4DCT delivery average and 4DCT plan average. Analysis was performed using 3D gamma analysis with passing criteria of 2%, 2 mm. The simulation framework was able to demonstrate that a single fraction of the integrated boost plan was more sensitive to interplay effects than the concave target. Gating was shown to reduce the interplay effects. We have developed a 4DCT Monte Carlo simulation method that accounts for IMRT interplay effects with respiratory motion by utilizing delivery log files.

Independent dosimetric calculation with inclusion of head scatter and MLC transmission for IMRT

International Nuclear Information System (INIS)

Yang, Y.; Xing, L.; Li, J.G.; Palta, J.; Chen, Y.; Luxton, Gary; Boyer, A.

2003-01-01

Independent verification of the MU settings and dose calculation of IMRT treatment plans is an important step in the IMRT quality assurance (QA) procedure. At present, the verification is mainly based on experimental measurements, which are time consuming and labor intensive. Although a few simplified algorithms have recently been proposed for the independent dose (or MU) calculation, head scatter has not been precisely taken into account in all these investigations and the dose validation has mainly been limited to the central axis. In this work we developed an effective computer algorithm for IMRT MU and dose validation. The technique is superior to the currently available computer-based MU check systems in that (1) it takes full consideration of the head scatter and leaf transmission effects; and (2) it allows a precise dose calculation at an arbitrary spatial point instead of merely a point on the central axis. In the algorithm the dose at an arbitrary spatial point is expressed as a summation of the contributions of primary and scatter radiation from all beamlets. Each beamlet is modulated by a dynamic modulation factor (DMF), which is determined by the MLC leaf trajectories, the head scatter, the jaw positions, and the MLC leaf transmission. A three-source model was used to calculate the head scatter distribution for irregular segments shaped by MLC and the scatter dose contributions were computed using a modified Clarkson method. The system reads in MLC leaf sequence files (or RTP files) generated by the Corvus (NOMOS Corporation, Sewickley, PA) inverse planning system and then computes the doses at the desired points. The algorithm was applied to study the dose distributions of several testing intensity modulated fields and two multifield Corvus plans and the results were compared with Corvus plans and experimental measurements. The final dose calculations at most spatial points agreed with the experimental measurements to within 3% for both the specially

Dose variations with varying calculation grid size in head and neck IMRT

Energy Technology Data Exchange (ETDEWEB)

Chung, Heeteak [Department of Nuclear and Radiological Engineering, University of Florida, Gainesville, Fl 32611-8300 (United States); Jin, Hosang [Department of Nuclear and Radiological Engineering, University of Florida, Gainesville, Fl 32611-8300 (United States); Palta, Jatinder [Department of Radiation Oncology, University of Florida, Gainesville, Fl 32610-0385 (United States); Suh, Tae-Suk [Department of Biomedical Engineering, Catholic University of Korea (Korea, Republic of); Kim, Siyong [Department of Radiation Oncology, University of Florida, Gainesville, Fl 32610-0385 (United States)

2006-10-07

Ever since the advent and development of treatment planning systems, the uncertainty associated with calculation grid size has been an issue. Even to this day, with highly sophisticated 3D conformal and intensity-modulated radiation therapy (IMRT) treatment planning systems (TPS), dose uncertainty due to grid size is still a concern. A phantom simulating head and neck treatment was prepared from two semi-cylindrical solid water slabs and a radiochromic film was inserted between the two slabs for measurement. Plans were generated for a 5400 cGy prescribed dose using Philips Pinnacle{sup 3} TPS for two targets, one shallow ({approx}0.5 cm depth) and one deep ({approx}6 cm depth). Calculation grid sizes of 1.5, 2, 3 and 4 mm were considered. Three clinical cases were also evaluated. The dose differences for the varying grid sizes (2 mm, 3 mm and 4 mm from 1.5 mm) in the phantom study were 126 cGy (2.3% of the 5400 cGy dose prescription), 248.2 cGy (4.6% of the 5400 cGy dose prescription) and 301.8 cGy (5.6% of the 5400 cGy dose prescription), respectively for the shallow target case. It was found that the dose could be varied to about 100 cGy (1.9% of the 5400 cGy dose prescription), 148.9 cGy (2.8% of the 5400 cGy dose prescription) and 202.9 cGy (3.8% of the 5400 cGy dose prescription) for 2 mm, 3 mm and 4 mm grid sizes, respectively, simply by shifting the calculation grid origin. Dose difference with a different range of the relative dose gradient was evaluated and we found that the relative dose difference increased with an increase in the range of the relative dose gradient. When comparing varying calculation grid sizes and measurements, the variation of the dose difference histogram was insignificant, but a local effect was observed in the dose difference map. Similar results were observed in the case of the deep target and the three clinical cases also showed results comparable to those from the phantom study.

Dose variations with varying calculation grid size in head and neck IMRT

International Nuclear Information System (INIS)

Chung, Heeteak; Jin, Hosang; Palta, Jatinder; Suh, Tae-Suk; Kim, Siyong

2006-01-01

Ever since the advent and development of treatment planning systems, the uncertainty associated with calculation grid size has been an issue. Even to this day, with highly sophisticated 3D conformal and intensity-modulated radiation therapy (IMRT) treatment planning systems (TPS), dose uncertainty due to grid size is still a concern. A phantom simulating head and neck treatment was prepared from two semi-cylindrical solid water slabs and a radiochromic film was inserted between the two slabs for measurement. Plans were generated for a 5400 cGy prescribed dose using Philips Pinnacle 3 TPS for two targets, one shallow (∼0.5 cm depth) and one deep (∼6 cm depth). Calculation grid sizes of 1.5, 2, 3 and 4 mm were considered. Three clinical cases were also evaluated. The dose differences for the varying grid sizes (2 mm, 3 mm and 4 mm from 1.5 mm) in the phantom study were 126 cGy (2.3% of the 5400 cGy dose prescription), 248.2 cGy (4.6% of the 5400 cGy dose prescription) and 301.8 cGy (5.6% of the 5400 cGy dose prescription), respectively for the shallow target case. It was found that the dose could be varied to about 100 cGy (1.9% of the 5400 cGy dose prescription), 148.9 cGy (2.8% of the 5400 cGy dose prescription) and 202.9 cGy (3.8% of the 5400 cGy dose prescription) for 2 mm, 3 mm and 4 mm grid sizes, respectively, simply by shifting the calculation grid origin. Dose difference with a different range of the relative dose gradient was evaluated and we found that the relative dose difference increased with an increase in the range of the relative dose gradient. When comparing varying calculation grid sizes and measurements, the variation of the dose difference histogram was insignificant, but a local effect was observed in the dose difference map. Similar results were observed in the case of the deep target and the three clinical cases also showed results comparable to those from the phantom study

Verification of eye lens dose in IMRT by MOSFET measurement.

Science.gov (United States)

Wang, Xuetao; Li, Guangjun; Zhao, Jianling; Song, Ying; Xiao, Jianghong; Bai, Sen

2018-04-17

The eye lens is recognized as one of the most radiosensitive structures in the human body. The widespread use of intensity-modulated radiotherapy (IMRT) complicates dose verification and necessitates high standards of dose computation. The purpose of this work was to assess the computed dose accuracy of eye lens through measurements using a metal-oxide-semiconductor field-effect transistor (MOSFET) dosimetry system. Sixteen clinical IMRT plans of head and neck patients were copied to an anthropomorphic head phantom. Measurements were performed using the MOSFET dosimetry system based on the head phantom. Two MOSFET detectors were imbedded in the eyes of the head phantom as the left and the right lens, covered by approximately 5-mm-thick paraffin wax. The measurement results were compared with the calculated values with a dose grid size of 1 mm. Sixteen IMRT plans were delivered, and 32 measured lens doses were obtained for analysis. The MOSFET dosimetry system can be used to verify the lens dose, and our measurements showed that the treatment planning system used in our clinic can provide adequate dose assessment in eye lenses. The average discrepancy between measurement and calculation was 6.7 ± 3.4%, and the largest discrepancy was 14.3%, which met the acceptability criterion set by the American Association of Physicists in Medicine Task Group 53 for external beam calculation for multileaf collimator-shaped fields in buildup regions. Copyright © 2018 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

An IMRT dose distribution study using commercial verification software

International Nuclear Information System (INIS)

Grace, M.; Liu, G.; Fernando, W.; Rykers, K.

2004-01-01

Full text: The introduction of IMRT requires users to confirm that the isodose distributions and relative doses calculated by their planning system match the doses delivered by their linear accelerators. To this end the commercially available software, VeriSoft TM (PTW-Freiburg, Germany) was trialled to determine if the tools and functions it offered would be of benefit to this process. The CMS Xio (Computer Medical System) treatment planning system was used to generate IMRT plans that were delivered with an upgraded Elekta SL15 linac. Kodak EDR2 film sandwiched in RW3 solid water (PTW-Freiburg, Germany) was used to measure the IMRT fields delivered with 6 MV photons. The isodose and profiles measured with the film generally agreed to within ± 3% or ± 3 mm with the planned doses, in some regions (outside the IMRT field) the match fell to within ± 5%. The isodose distributions of the planning system and the film could be compared on screen and allows for electronic records of the comparison to be kept if so desired. The features and versatility of this software has been of benefit to our IMRT QA program. Furthermore, the VeriSoft TM software allows for quick and accurate, automated planar film analysis.Copyright (2004) Australasian College of Physical Scientists and Engineers in Medicine

Toward IMRT 2D dose modeling using artificial neural networks: A feasibility study

Energy Technology Data Exchange (ETDEWEB)

Kalantzis, Georgios; Vasquez-Quino, Luis A.; Zalman, Travis; Pratx, Guillem; Lei, Yu [Radiation Oncology Department, University of Texas, Health Science Center San Antonio, Texas 78229 and Radiation Oncology Department, Stanford University School of Medicine, Stanford, California 94305 (United States); Radiation Oncology Department, University of Texas, Health Science Center San Antonio, Texas 78229 (United States); Radiation Oncology Department, Stanford University School of Medicine, Stanford, California 94305 (United States); Radiation Oncology Department, University of Texas, Health Science Center San Antonio, Texas 78229 (United States)

2011-10-15

Purpose: To investigate the feasibility of artificial neural networks (ANN) to reconstruct dose maps for intensity modulated radiation treatment (IMRT) fields compared with those of the treatment planning system (TPS). Methods: An artificial feed forward neural network and the back-propagation learning algorithm have been used to replicate dose calculations of IMRT fields obtained from PINNACLE{sup 3} v9.0. The ANN was trained with fluence and dose maps of IMRT fields for 6 MV x-rays, which were obtained from the amorphous silicon (a-Si) electronic portal imaging device of Novalis TX. Those fluence distributions were imported to the TPS and the dose maps were calculated on the horizontal midpoint plane of a water equivalent homogeneous cylindrical virtual phantom. Each exported 2D dose distribution from the TPS was classified into two clusters of high and low dose regions, respectively, based on the K-means algorithm and the Euclidian metric in the fluence-dose domain. The data of each cluster were divided into two sets for the training and validation phase of the ANN, respectively. After the completion of the ANN training phase, 2D dose maps were reconstructed by the ANN and isodose distributions were created. The dose maps reconstructed by ANN were evaluated and compared with the TPS, where the mean absolute deviation of the dose and the {gamma}-index were used. Results: A good agreement between the doses calculated from the TPS and the trained ANN was achieved. In particular, an average relative dosimetric difference of 4.6% and an average {gamma}-index passing rate of 93% were obtained for low dose regions, and a dosimetric difference of 2.3% and an average {gamma}-index passing rate of 97% for high dose region. Conclusions: An artificial neural network has been developed to convert fluence maps to corresponding dose maps. The feasibility and potential of an artificial neural network to replicate complex convolution kernels in the TPS for IMRT dose calculations

Toward IMRT 2D dose modeling using artificial neural networks: A feasibility study

International Nuclear Information System (INIS)

Kalantzis, Georgios; Vasquez-Quino, Luis A.; Zalman, Travis; Pratx, Guillem; Lei, Yu

2011-01-01

Purpose: To investigate the feasibility of artificial neural networks (ANN) to reconstruct dose maps for intensity modulated radiation treatment (IMRT) fields compared with those of the treatment planning system (TPS). Methods: An artificial feed forward neural network and the back-propagation learning algorithm have been used to replicate dose calculations of IMRT fields obtained from PINNACLE 3 v9.0. The ANN was trained with fluence and dose maps of IMRT fields for 6 MV x-rays, which were obtained from the amorphous silicon (a-Si) electronic portal imaging device of Novalis TX. Those fluence distributions were imported to the TPS and the dose maps were calculated on the horizontal midpoint plane of a water equivalent homogeneous cylindrical virtual phantom. Each exported 2D dose distribution from the TPS was classified into two clusters of high and low dose regions, respectively, based on the K-means algorithm and the Euclidian metric in the fluence-dose domain. The data of each cluster were divided into two sets for the training and validation phase of the ANN, respectively. After the completion of the ANN training phase, 2D dose maps were reconstructed by the ANN and isodose distributions were created. The dose maps reconstructed by ANN were evaluated and compared with the TPS, where the mean absolute deviation of the dose and the γ-index were used. Results: A good agreement between the doses calculated from the TPS and the trained ANN was achieved. In particular, an average relative dosimetric difference of 4.6% and an average γ-index passing rate of 93% were obtained for low dose regions, and a dosimetric difference of 2.3% and an average γ-index passing rate of 97% for high dose region. Conclusions: An artificial neural network has been developed to convert fluence maps to corresponding dose maps. The feasibility and potential of an artificial neural network to replicate complex convolution kernels in the TPS for IMRT dose calculations have been

SU-G-TeP4-02: A Method for Evaluating the Direct Impact of Failed IMRT QAs On Patient Dose

International Nuclear Information System (INIS)

Geneser, S; Butkus, M

2016-01-01

Purpose: We developed a method to calculate patient doses corresponding to IMRT QA measurements in order to determine and assess the actual dose delivered for plans with failed (or borderline) IMRT QA. This work demonstrates the feasibility of automatically computing delivered patient dose from portal dosimetry measurements in the Varian TPS system, which would provide a valuable and clinically viable IMRT QA tool for physicists and physicians. Methods: IMRT QA fluences were measured using portal dosimetry, processed using in-house matlab software, and imported back into Eclipse to calculate dose on the planning CT. To validate the proposed workflow, the Eclipse calculated portal dose for a 5-field sliding window prostate boost plan was processed as described above. The resulting dose was compared to the planned dose and found to be within 0.5 Gy. Two IMRT QA results for the prostate boost plan (one that failed and one that passed) were processed and the resulting patient doses were evaluated. Results: The max dose difference between IMRT QA #1 and the original planned and approved dose is 4.5 Gy, while the difference between the planned and IMRT QA #2 dose is 4.0 Gy. The inferior portion of the PTV is slightly underdosed in both plans, and the superior portion is slightly overdosed. The patient dose resulting from IMRT QA #1 and #2 differs by only 0.5 Gy. With this new information, it may be argued that the evaluated plan alteration to obtain passing gamma analysis produced clinically irrelevant differences. Conclusion: Evaluation of the delivered QA dose on the planning CT provides valuable information about the clinical relevance of failed or borderline IMRT QAs. This particular workflow demonstrates the feasibility of pushing the measured IMRT QA portal dosimetry results directly back onto the patient planning CT within the Varian system.

SU-G-TeP4-02: A Method for Evaluating the Direct Impact of Failed IMRT QAs On Patient Dose

Energy Technology Data Exchange (ETDEWEB)

Geneser, S; Butkus, M [Yale University School of Medicine/YNHH Radiology, New Haven, CT (United States)

2016-06-15

Purpose: We developed a method to calculate patient doses corresponding to IMRT QA measurements in order to determine and assess the actual dose delivered for plans with failed (or borderline) IMRT QA. This work demonstrates the feasibility of automatically computing delivered patient dose from portal dosimetry measurements in the Varian TPS system, which would provide a valuable and clinically viable IMRT QA tool for physicists and physicians. Methods: IMRT QA fluences were measured using portal dosimetry, processed using in-house matlab software, and imported back into Eclipse to calculate dose on the planning CT. To validate the proposed workflow, the Eclipse calculated portal dose for a 5-field sliding window prostate boost plan was processed as described above. The resulting dose was compared to the planned dose and found to be within 0.5 Gy. Two IMRT QA results for the prostate boost plan (one that failed and one that passed) were processed and the resulting patient doses were evaluated. Results: The max dose difference between IMRT QA #1 and the original planned and approved dose is 4.5 Gy, while the difference between the planned and IMRT QA #2 dose is 4.0 Gy. The inferior portion of the PTV is slightly underdosed in both plans, and the superior portion is slightly overdosed. The patient dose resulting from IMRT QA #1 and #2 differs by only 0.5 Gy. With this new information, it may be argued that the evaluated plan alteration to obtain passing gamma analysis produced clinically irrelevant differences. Conclusion: Evaluation of the delivered QA dose on the planning CT provides valuable information about the clinical relevance of failed or borderline IMRT QAs. This particular workflow demonstrates the feasibility of pushing the measured IMRT QA portal dosimetry results directly back onto the patient planning CT within the Varian system.

Dosimetry investigation of MOSFET for clinical IMRT dose verification.

Science.gov (United States)

Deshpande, Sudesh; Kumar, Rajesh; Ghadi, Yogesh; Neharu, R M; Kannan, V

2013-06-01

In IMRT, patient-specific dose verification is followed regularly at each centre. Simple and efficient dosimetry techniques play a very important role in routine clinical dosimetry QA. The MOSFET dosimeter offers several advantages over the conventional dosimeters such as its small detector size, immediate readout, immediate reuse, multiple point dose measurements. To use the MOSFET as routine clinical dosimetry system for pre-treatment dose verification in IMRT, a comprehensive set of experiments has been conducted, to investigate its linearity, reproducibility, dose rate effect and angular dependence for 6 MV x-ray beam. The MOSFETs shows a linear response with linearity coefficient of 0.992 for a dose range of 35 cGy to 427 cGy. The reproducibility of the MOSFET was measured by irradiating the MOSFET for ten consecutive irradiations in the dose range of 35 cGy to 427 cGy. The measured reproducibility of MOSFET was found to be within 4% up to 70 cGy and within 1.4% above 70 cGy. The dose rate effect on the MOSFET was investigated in the dose rate range 100 MU/min to 600 MU/min. The response of the MOSFET varies from -1.7% to 2.1%. The angular responses of the MOSFETs were measured at 10 degrees intervals from 90 to 270 degrees in an anticlockwise direction and normalized at gantry angle zero and it was found to be in the range of 0.98 ± 0.014 to 1.01 ± 0.014. The MOSFETs were calibrated in a phantom which was later used for IMRT verification. The measured calibration coefficients were found to be 1 mV/cGy and 2.995 mV/cGy in standard and high sensitivity mode respectively. The MOSFETs were used for pre-treatment dose verification in IMRT. Nine dosimeters were used for each patient to measure the dose in different plane. The average variation between calculated and measured dose at any location was within 3%. Dose verification using MOSFET and IMRT phantom was found to quick and efficient and well suited for a busy radiotherapy

SU-F-T-373: Monte Carlo Versus Pencil Beam Dose Calculation for Spine SBRT Treatments Using HybridARC and Sliding Windows IMRT

Energy Technology Data Exchange (ETDEWEB)

Venencia, C; Pino, M; Caussa, L; Garrigo, E [Instituto de Radioterapia - Fundacion Marie Curie, Cordoba (Argentina); Molineu, A [UT MD Anderson Cancer Center, Houston, TX (United States)

2016-06-15

Purpose: The purpose of this work was to quantify the dosimetric impact of Monte Carlo (MC) dose calculation algorithm compared to Pencil Beam (PB) on Spine SBRT with HybridARC (HA) and sliding windows IMRT (dMLC) treatment modality. Methods: A 6MV beam (1000MU/min) produced by a Novalis TX (BrainLAB-Varian) equipped with HDMLC was used. HA uses 1 arc plus 8 IMRT beams (arc weight between 60–40%) and dIMRT 15 beams. Plans were calculated using iPlan v.4.5.3 (BrainLAB) and the treatment dose prescription was 27Gy in 3 fractions. Dose calculation was done by PB (4mm spatial resolution) with heterogeneity correction and MC dose to water (4mm spatial resolution and 4% mean variance). PTV and spinal cord dose comparison were done. Study was done on 12 patients. IROC Spine Phantom was used to validate HA and quantify dose variation using PB and MC algorithm. Results: The difference between PB and MC for PTV D98%, D95%, Dmean, D2% were 2.6% [−5.1, 6.8], 0.1% [−4.2, 5.4], 0.9% [−1.5, 3.8] and 2.4% [−0.5, 8.3]. The difference between PB and MC for spinal cord Dmax, D1.2cc and D0.35cc were 5.3% [−6.4, 18.4], 9% [−7.0, 17.0] and 7.6% [−0.6, 14.8] respectively. IROC spine phantom shows PTV TLD dose variation of 0.98% for PB and 1.01% for MC. Axial and sagittal film plane gamma index (5%-3mm) was 95% and 97% for PB and 95% and 99% for MC. Conclusion: PB slightly underestimates the dose for the PTV. For the spinal cord PB underestimates the dose and dose differences could be as high as 18% which could have unexpected clinical impact. CI shows no variation between PB and MC for both treatment modalities Treatment modalities have no impact with the dose calculation algorithms used. Following the IROC pass-fail criteria, treatment acceptance requirement was fulfilled for PB and MC.

Phantoms for IMRT dose distribution measurement and treatment verification

International Nuclear Information System (INIS)

Low, Daniel A.; Gerber, Russell L.; Mutic, Sasa; Purdy, James A.

1998-01-01

Background: The verification of intensity-modulated radiation therapy (IMRT) patient treatment dose distributions is currently based on custom-built or modified dose measurement phantoms. The only commercially available IMRT treatment planning and delivery system (Peacock, NOMOS Corp.) is supplied with a film phantom that allows accurate spatial localization of the dose distribution using radiographic film. However, measurements using other dosimeters are necessary for the thorough verification of IMRT. Methods: We have developed a phantom to enable dose measurements using a cylindrical ionization chamber and the localization of prescription isodose curves using a matrix of thermoluminescent dosimetry (TLD) chips. The external phantom cross-section is identical to that of the commercial phantom, to allow direct comparisons of measurements. A supplementary phantom has been fabricated to verify the IMRT dose distributions for pelvis treatments. Results: To date, this phantom has been used for the verification of IMRT dose distributions for head and neck and prostate cancer treatments. Designs are also presented for a phantom insert to be used with polymerizing gels (e.g., BANG-2) to obtain volumetric dose distribution measurements. Conclusion: The phantoms have proven useful in the quantitative evaluation of IMRT treatments

Beam intensity scanner system for three dimensional dose verification of IMRT

International Nuclear Information System (INIS)

Vahc, Young W.; Kwon, Ohyun; Park, Kwangyl; Park, Kyung R.; Yi, Byung Y.; Kim, Keun M.

2003-01-01

Patient dose verification is clinically one of the most important parts in the treatment delivery of radiation therapy. The three dimensional (3D) reconstruction of dose distribution delivered to target volume helps to verify patient dose and determine the physical characteristics of beams used in IMRT. Here we present beam intensity scanner (BInS) system for the pre-treatment dosimetric verification of two dimensional photon intensity. The BInS is a radiation detector with a custom-made software for dose conversion of fluorescence signals from scintillator. The scintillator is used to produce fluorescence from the irradiation of 6 MV photons on a Varian Clinac 21EX. The digitized fluoroscopic signals obtained by digital video camera-based scintillator (DVCS) will be processed by our custom made software to reproduce 3D- relative dose distribution. For the intensity modulated beam (IMB), the BInS calculates absorbed dose in absolute beam fluence which is used for the patient dose distribution. Using BInS, we performed various measurements related to IMRT and found the following: (1) The 3D-dose profiles of the IMBs measured by the BInS demonstrate good agreement with radiographic film, pin type ionization chamber and Monte Carlo simulation. (2) The delivered beam intensity is altered by the mechanical and dosimetric properties of the collimation of dynamic and/or step MLC system. This is mostly due to leaf transmission, leaf penumbra scattered photons from the round edges of leaves, and geometry of leaf. (3) The delivered dose depends on the operational detail of how to make multi leaf opening. These phenomena result in a fluence distribution that can be substantially different from the initial and calculated intensity modulation and therefore, should be taken into account by the treatment planning for accurate dose calculations delivered to the target volume in IMRT. (author)

Peripheral doses of cranial pediatric IMRT performed with attenuator blocks; Doses perifericas de IMRT cranial pediatrica realizada com blocos atenuadores

Energy Technology Data Exchange (ETDEWEB)

Soboll, Danyel Scheidegger; Schitz, Ivette; Schelin, Hugo Reuters, E-mail: soboll@utfpr.edu.b, E-mail: iveteschitz@yahoo.com.b, E-mail: schelin@utfpr.edu.b [Universidade Tecnologica Federal do Parana (UTFPR), Curitiba, PR (Brazil); Silva, Ricardo Goulart da, E-mail: ricardo.goulart@ymail.co [Hospital Angelina Caron, Campina Grande do Sul, PR (Brazil); Viamonte, Alfredo, E-mail: aviamonte@inca.gov.b [Instituto Nacional do Cancer (INCa), Rio de Janeiro, RJ (Brazil)

2011-10-26

This paper presents values of peripheral doses measured at six vital points of simulator objects which represent the ages of 2, 5 and 10 years old, submitted to a cranial IMRT procedure that applied compensator blocks interposed to 6 MV beams. The found values indicate that there is independence of dose with position of measurements and age of the patient, as the peripheral dose at the points nearest and the 2 year old simulator object where larger. The doses in thyroid reached the range of 1.4 to 2.9% of the dose prescribed in the isocenter, indicating that the peripheral doses for IMRT that employ compensator blocks can be greater than for the IMRT produced with sliding window technique

Per-beam, planar IMRT QA passing rates do not predict clinically relevant patient dose errors

International Nuclear Information System (INIS)

Nelms, Benjamin E.; Zhen Heming; Tome, Wolfgang A.

2011-01-01

Purpose: The purpose of this work is to determine the statistical correlation between per-beam, planar IMRT QA passing rates and several clinically relevant, anatomy-based dose errors for per-patient IMRT QA. The intent is to assess the predictive power of a common conventional IMRT QA performance metric, the Gamma passing rate per beam. Methods: Ninety-six unique data sets were created by inducing four types of dose errors in 24 clinical head and neck IMRT plans, each planned with 6 MV Varian 120-leaf MLC linear accelerators using a commercial treatment planning system and step-and-shoot delivery. The error-free beams/plans were used as ''simulated measurements'' (for generating the IMRT QA dose planes and the anatomy dose metrics) to compare to the corresponding data calculated by the error-induced plans. The degree of the induced errors was tuned to mimic IMRT QA passing rates that are commonly achieved using conventional methods. Results: Analysis of clinical metrics (parotid mean doses, spinal cord max and D1cc, CTV D95, and larynx mean) vs IMRT QA Gamma analysis (3%/3 mm, 2/2, 1/1) showed that in all cases, there were only weak to moderate correlations (range of Pearson's r-values: -0.295 to 0.653). Moreover, the moderate correlations actually had positive Pearson's r-values (i.e., clinically relevant metric differences increased with increasing IMRT QA passing rate), indicating that some of the largest anatomy-based dose differences occurred in the cases of high IMRT QA passing rates, which may be called ''false negatives.'' The results also show numerous instances of false positives or cases where low IMRT QA passing rates do not imply large errors in anatomy dose metrics. In none of the cases was there correlation consistent with high predictive power of planar IMRT passing rates, i.e., in none of the cases did high IMRT QA Gamma passing rates predict low errors in anatomy dose metrics or vice versa. Conclusions: There is a lack of correlation between

Radiobiological impact of dose calculation algorithms on biologically optimized IMRT lung stereotactic body radiation therapy plans

International Nuclear Information System (INIS)

Liang, X.; Penagaricano, J.; Zheng, D.; Morrill, S.; Zhang, X.; Corry, P.; Griffin, R. J.; Han, E. Y.; Hardee, M.; Ratanatharathom, V.

2016-01-01

The aim of this study is to evaluate the radiobiological impact of Acuros XB (AXB) vs. Anisotropic Analytic Algorithm (AAA) dose calculation algorithms in combined dose-volume and biological optimized IMRT plans of SBRT treatments for non-small-cell lung cancer (NSCLC) patients. Twenty eight patients with NSCLC previously treated SBRT were re-planned using Varian Eclipse (V11) with combined dose-volume and biological optimization IMRT sliding window technique. The total dose prescribed to the PTV was 60 Gy with 12 Gy per fraction. The plans were initially optimized using AAA algorithm, and then were recomputed using AXB using the same MUs and MLC files to compare with the dose distribution of the original plans and assess the radiobiological as well as dosimetric impact of the two different dose algorithms. The Poisson Linear-Quadatric (PLQ) and Lyman-Kutcher-Burman (LKB) models were used for estimating the tumor control probability (TCP) and normal tissue complication probability (NTCP), respectively. The influence of the model parameter uncertainties on the TCP differences and the NTCP differences between AAA and AXB plans were studied by applying different sets of published model parameters. Patients were grouped into peripheral and centrally-located tumors to evaluate the impact of tumor location. PTV dose was lower in the re-calculated AXB plans, as compared to AAA plans. The median differences of PTV(D 95% ) were 1.7 Gy (range: 0.3, 6.5 Gy) and 1.0 Gy (range: 0.6, 4.4 Gy) for peripheral tumors and centrally-located tumors, respectively. The median differences of PTV(mean) were 0.4 Gy (range: 0.0, 1.9 Gy) and 0.9 Gy (range: 0.0, 4.3 Gy) for peripheral tumors and centrally-located tumors, respectively. TCP was also found lower in AXB-recalculated plans compared with the AAA plans. The median (range) of the TCP differences for 30 month local control were 1.6 % (0.3 %, 5.8 %) for peripheral tumors and 1.3 % (0.5 %, 3.4 %) for centrally located tumors. The lower

Does IMRT increase the peripheral radiation dose? A comparison of treatment plans 2000 and 2010

International Nuclear Information System (INIS)

Salz, Henning; Eichner, Regina; Wiezorek, Tilo

2012-01-01

It has been reported in several papers and textbooks that IMRT treatments increase the peripheral dose in comparison with non-IMRT fields. But in clinical practice not only open fields have been used in the pre-IMRT era, but also fields with physical wedges or composed fields. The aim of this work is to test the hypothesis of increased peripheral dose when IMRT is used compared to standard conformal radiotherapy. Furthermore, the importance of the measured dose differences in clinical practice is discussed and compared with other new technologies for the cases where an increase of the peripheral dose was observed. For cancers of the head and neck, the cervix, the rectum and for the brain irradiation due to acute leukaemia, one to four plans have been calculated with IMRT or conformal standard technique (non-IMRT). In an anthropomorphic phantom the dose at a distance of 30 cm in cranio-caudal direction from the target edge was measured with TLDs using a linear accelerator Oncor registered (Siemens) for both techniques. IMRT was performed using step-and-shoot technique (7 to 11 beams), non-IMRT plans with different techniques. The results depended on the site of irradiation. For head and neck cancers IMRT resulted in an increase of 0.05 - 0.09% of the prescribed total dose (Dptv) or 40 - 70 mGy (Dptv = 65 Gy), compared to non-IMRT technique without wedges or a decrease of 0.16% (approx. 100 mGy) of the prescribed total dose compared to non-IMRT techniques with wedges. For the cervical cancer IMRT resulted in an increased dose in the periphery (+ 0.07% - 0.15% of Dptv or 30 - 70 mGy at Dptv = 45 Gy), for the rectal cancer in a dose reduction (0.21 - 0.26% of Dptv or 100 - 130 mGy at Dptv = 50 Gy) and for the brain irradiation in an increase dose (+ 0.05% of Dptv = 18 Gy or 9 mSv). In summary IMRT does not uniformly cause increased radiation dose in the periphery in the model used. It can be stated that these dose values are smaller than reported in earlier papers

Per-beam, planar IMRT QA passing rates do not predict clinically relevant patient dose errors

Energy Technology Data Exchange (ETDEWEB)

Nelms, Benjamin E.; Zhen Heming; Tome, Wolfgang A. [Canis Lupus LLC and Department of Human Oncology, University of Wisconsin, Merrimac, Wisconsin 53561 (United States); Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53705 (United States); Departments of Human Oncology, Medical Physics, and Biomedical Engineering, University of Wisconsin, Madison, Wisconsin 53792 (United States)

2011-02-15

Purpose: The purpose of this work is to determine the statistical correlation between per-beam, planar IMRT QA passing rates and several clinically relevant, anatomy-based dose errors for per-patient IMRT QA. The intent is to assess the predictive power of a common conventional IMRT QA performance metric, the Gamma passing rate per beam. Methods: Ninety-six unique data sets were created by inducing four types of dose errors in 24 clinical head and neck IMRT plans, each planned with 6 MV Varian 120-leaf MLC linear accelerators using a commercial treatment planning system and step-and-shoot delivery. The error-free beams/plans were used as ''simulated measurements'' (for generating the IMRT QA dose planes and the anatomy dose metrics) to compare to the corresponding data calculated by the error-induced plans. The degree of the induced errors was tuned to mimic IMRT QA passing rates that are commonly achieved using conventional methods. Results: Analysis of clinical metrics (parotid mean doses, spinal cord max and D1cc, CTV D95, and larynx mean) vs IMRT QA Gamma analysis (3%/3 mm, 2/2, 1/1) showed that in all cases, there were only weak to moderate correlations (range of Pearson's r-values: -0.295 to 0.653). Moreover, the moderate correlations actually had positive Pearson's r-values (i.e., clinically relevant metric differences increased with increasing IMRT QA passing rate), indicating that some of the largest anatomy-based dose differences occurred in the cases of high IMRT QA passing rates, which may be called ''false negatives.'' The results also show numerous instances of false positives or cases where low IMRT QA passing rates do not imply large errors in anatomy dose metrics. In none of the cases was there correlation consistent with high predictive power of planar IMRT passing rates, i.e., in none of the cases did high IMRT QA Gamma passing rates predict low errors in anatomy dose metrics or vice versa

Evaluation of dose prediction errors and optimization convergence errors of deliverable-based head-and-neck IMRT plans computed with a superposition/convolution dose algorithm

International Nuclear Information System (INIS)

Mihaylov, I. B.; Siebers, J. V.

2008-01-01

The purpose of this study is to evaluate dose prediction errors (DPEs) and optimization convergence errors (OCEs) resulting from use of a superposition/convolution dose calculation algorithm in deliverable intensity-modulated radiation therapy (IMRT) optimization for head-and-neck (HN) patients. Thirteen HN IMRT patient plans were retrospectively reoptimized. The IMRT optimization was performed in three sequential steps: (1) fast optimization in which an initial nondeliverable IMRT solution was achieved and then converted to multileaf collimator (MLC) leaf sequences; (2) mixed deliverable optimization that used a Monte Carlo (MC) algorithm to account for the incident photon fluence modulation by the MLC, whereas a superposition/convolution (SC) dose calculation algorithm was utilized for the patient dose calculations; and (3) MC deliverable-based optimization in which both fluence and patient dose calculations were performed with a MC algorithm. DPEs of the mixed method were quantified by evaluating the differences between the mixed optimization SC dose result and a MC dose recalculation of the mixed optimization solution. OCEs of the mixed method were quantified by evaluating the differences between the MC recalculation of the mixed optimization solution and the final MC optimization solution. The results were analyzed through dose volume indices derived from the cumulative dose-volume histograms for selected anatomic structures. Statistical equivalence tests were used to determine the significance of the DPEs and the OCEs. Furthermore, a correlation analysis between DPEs and OCEs was performed. The evaluated DPEs were within ±2.8% while the OCEs were within 5.5%, indicating that OCEs can be clinically significant even when DPEs are clinically insignificant. The full MC-dose-based optimization reduced normal tissue dose by as much as 8.5% compared with the mixed-method optimization results. The DPEs and the OCEs in the targets had correlation coefficients greater

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

Energy Technology Data Exchange (ETDEWEB)

Samuvel, K; Yadav, G; Bhushan, M; Tamilarasu, S; Kumar, L; Suhail, M [Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi (India)

2016-06-15

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

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

Energy Technology Data Exchange (ETDEWEB)

Chow, J [Princess Margaret Cancer Centre, Toronto, ON (Canada); Jiang, R [Grand River Regional Cancer Centre, Kitchener, ON (Canada); Kiciak, A [University of Waterloo, Waterloo, ON (Canada)

2016-06-15

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

Verification of IMRT dose distributions using a water beam imaging system

International Nuclear Information System (INIS)

Li, J.S.; Boyer, Arthur L.; Ma, C.-M.

2001-01-01

A water beam imaging system (WBIS) has been developed and used to verify dose distributions for intensity modulated radiotherapy using dynamic multileaf collimator. This system consisted of a water container, a scintillator screen, a charge-coupled device camera, and a portable personal computer. The scintillation image was captured by the camera. The pixel value in this image indicated the dose value in the scintillation screen. Images of radiation fields of known spatial distributions were used to calibrate the device. The verification was performed by comparing the image acquired from the measurement with a dose distribution from the IMRT plan. Because of light scattering in the scintillator screen, the image was blurred. A correction for this was developed by recognizing that the blur function could be fitted to a multiple Gaussian. The blur function was computed using the measured image of a 10 cmx10 cm x-ray beam and the result of the dose distribution calculated using the Monte Carlo method. Based on the blur function derived using this method, an iterative reconstruction algorithm was applied to recover the dose distribution for an IMRT plan from the measured WBIS image. The reconstructed dose distribution was compared with Monte Carlo simulation result. Reasonable agreement was obtained from the comparison. The proposed approach makes it possible to carry out a real-time comparison of the dose distribution in a transverse plane between the measurement and the reference when we do an IMRT dose verification

Fluence-convolution broad-beam (FCBB) dose calculation

Energy Technology Data Exchange (ETDEWEB)

Lu Weiguo; Chen Mingli, E-mail: wlu@tomotherapy.co [TomoTherapy Inc., 1240 Deming Way, Madison, WI 53717 (United States)

2010-12-07

IMRT optimization requires a fast yet relatively accurate algorithm to calculate the iteration dose with small memory demand. In this paper, we present a dose calculation algorithm that approaches these goals. By decomposing the infinitesimal pencil beam (IPB) kernel into the central axis (CAX) component and lateral spread function (LSF) and taking the beam's eye view (BEV), we established a non-voxel and non-beamlet-based dose calculation formula. Both LSF and CAX are determined by a commissioning procedure using the collapsed-cone convolution/superposition (CCCS) method as the standard dose engine. The proposed dose calculation involves a 2D convolution of a fluence map with LSF followed by ray tracing based on the CAX lookup table with radiological distance and divergence correction, resulting in complexity of O(N{sup 3}) both spatially and temporally. This simple algorithm is orders of magnitude faster than the CCCS method. Without pre-calculation of beamlets, its implementation is also orders of magnitude smaller than the conventional voxel-based beamlet-superposition (VBS) approach. We compared the presented algorithm with the CCCS method using simulated and clinical cases. The agreement was generally within 3% for a homogeneous phantom and 5% for heterogeneous and clinical cases. Combined with the 'adaptive full dose correction', the algorithm is well suitable for calculating the iteration dose during IMRT optimization.

Prostate Dose Escalation by a Innovative Inverse Planning-Driven IMRT

National Research Council Canada - National Science Library

Xing, Lei

2008-01-01

...) Developed a voxel-specific penalty scheme for TRV-based inverse planning; (iv) Established a cine-EPID image retrospective dose reconstruction in IMRT dose delivery for adaptive planning and IMRT dose verification. These works are both timely and important and should lead to widespread impact on prostate cancer management.

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

International Nuclear Information System (INIS)

Folkerts, M; Graves, Y; Tian, Z; Gu, X; Jia, X; Jiang, S

2014-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

Folkerts, M [The University of Texas Southwestern Medical Ctr, Dallas, TX (United States); University of California, San Diego, La Jolla, CA (United States); Graves, Y [University of California, San Diego, La Jolla, CA (United States); Tian, Z; Gu, X; Jia, X; Jiang, S [The University of Texas Southwestern Medical Ctr, Dallas, TX (United States)

2014-06-01

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

Peripheral doses of cranial pediatric IMRT performed with attenuator blocks

International Nuclear Information System (INIS)

Soboll, Danyel Scheidegger; Schitz, Ivette; Schelin, Hugo Reuters; Silva, Ricardo Goulart da; Viamonte, Alfredo

2011-01-01

This paper presents values of peripheral doses measured at six vital points of simulator objects which represent the ages of 2, 5 and 10 years old, submitted to a cranial IMRT procedure that applied compensator blocks interposed to 6 MV beams. The found values indicate that there is independence of dose with position of measurements and age of the patient, as the peripheral dose at the points nearest and the 2 year old simulator object where larger. The doses in thyroid reached the range of 1.4 to 2.9% of the dose prescribed in the isocenter, indicating that the peripheral doses for IMRT that employ compensator blocks can be greater than for the IMRT produced with sliding window technique

Influence of metallic dental implants and metal artefacts on dose calculation accuracy.

Science.gov (United States)

Maerz, Manuel; Koelbl, Oliver; Dobler, Barbara

2015-03-01

Metallic dental implants cause severe streaking artefacts in computed tomography (CT) data, which inhibit the correct representation of shape and density of the metal and the surrounding tissue. The aim of this study was to investigate the impact of dental implants on the accuracy of dose calculations in radiation therapy planning and the benefit of metal artefact reduction (MAR). A second aim was to determine the treatment technique which is less sensitive to the presence of metallic implants in terms of dose calculation accuracy. Phantoms consisting of homogeneous water equivalent material surrounding dental implants were designed. Artefact-containing CT data were corrected using the correct density information. Intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans were calculated on corrected and uncorrected CT data and compared to 2-dimensional dose measurements using GafChromic™ EBT2 films. For all plans the accuracy of dose calculations is significantly higher if performed on corrected CT data (p = 0.015). The agreement of calculated and measured dose distributions is significantly higher for VMAT than for IMRT plans for calculations on uncorrected CT data (p = 0.011) as well as on corrected CT data (p = 0.029). For IMRT and VMAT the application of metal artefact reduction significantly increases the agreement of dose calculations with film measurements. VMAT was found to provide the highest accuracy on corrected as well as on uncorrected CT data. VMAT is therefore preferable over IMRT for patients with metallic implants, if plan quality is comparable for the two techniques.

Influence of metallic dental implants and metal artefacts on dose calculation accuracy

International Nuclear Information System (INIS)

Maerz, Manuel; Koelbl, Oliver; Dobler, Barbara

2015-01-01

Metallic dental implants cause severe streaking artefacts in computed tomography (CT) data, which inhibit the correct representation of shape and density of the metal and the surrounding tissue. The aim of this study was to investigate the impact of dental implants on the accuracy of dose calculations in radiation therapy planning and the benefit of metal artefact reduction (MAR). A second aim was to determine the treatment technique which is less sensitive to the presence of metallic implants in terms of dose calculation accuracy. Phantoms consisting of homogeneous water equivalent material surrounding dental implants were designed. Artefact-containing CT data were corrected using the correct density information. Intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans were calculated on corrected and uncorrected CT data and compared to 2-dimensional dose measurements using GafChromic trademark EBT2 films. For all plans the accuracy of dose calculations is significantly higher if performed on corrected CT data (p = 0.015). The agreement of calculated and measured dose distributions is significantly higher for VMAT than for IMRT plans for calculations on uncorrected CT data (p = 0.011) as well as on corrected CT data (p = 0.029). For IMRT and VMAT the application of metal artefact reduction significantly increases the agreement of dose calculations with film measurements. VMAT was found to provide the highest accuracy on corrected as well as on uncorrected CT data. VMAT is therefore preferable over IMRT for patients with metallic implants, if plan quality is comparable for the two techniques. (orig.) [de

Dosimetric verification and evaluation of segmental multileaf collimator (SMLC)-IMRT for quality assurance. The second report. Absolute dose

International Nuclear Information System (INIS)

Tateoka, Kunihiko; Hareyama, Masato; Oouchi, Atsushi; Nakata, Kensei; Nagase, Daiki; Saikawa, Tsunehiko; Shimizume, Kazunari; Sugimoto, Harumi; Waka, Masaaki

2003-01-01

Intensity-modulated radiation therapy (IMRT) was developed to irradiate the target are more conformally, sparing organs at risk (OARs). Since the beams are sequentially delivered by many, small, irregular, and off-center fields in IMRT, dosimetric quality assurance (QA) is an extremely important issue. QA is performed by verifying both the dose distribution and doses at arbitrary points. In this work, we describe the verification of doses at arbitrary points in our hospital for Segmental multileaf collimator (SMLC)-IMRT. In general, verification of the absolute doses for IMRT is performed by comparison between the calculated doses using Radiation Treatment Planning Systems (RTP) and the measured doses using an ionization chamber with a small volume at arbitrary points in relatively flat regions of the dose gradients. However, no clear definitions of the dose gradients and the flat regions have yet been reported. We carried out verification by comparison of the measured doses with the average dose and the central point dose in a virtual Farmer type ionization chamber (V-F) and a virtual PinPoint ionization chamber (V-P) equal to the Farmer-type ionization chamber volume and PinPoint ionization chamber volumes using the RTP. Furthermore, we defined the dose gradients as the deviation of the maximum dose from the minimum dose in the virtual ionization chamber volume. In IMRT, the dose gradients may be as high as 80% or more in the virtual ionization chamber volume. Therefore, it is thought that the effective center of the ionization chamber varies by segment for IMRT fields (i.e., the variation of the ionization chamber replacement effect). Additionally, in regions with a higher dose gradient, uncertainty in the measured doses is influenced by the variations in the ionization chamber replacement effect and the ionization chamber positioning error. We more objectively examined the verification method for the absolute dose in IMRT using the virtual ionization chamber

Poster — Thur Eve — 33: The Influence of a Modeled Treatment Couch on Dose Distributions During IMRT and RapidArc Treatment Delivery

International Nuclear Information System (INIS)

Aldosary, Ghada; Nobah, Ahmad; Al-Zorkani, Faisal; Moftah, Belal; Devic, Slobodan

2014-01-01

Treatment couches have been known to perturb dose delivery in patients. This effect is most pronounced in techniques such as IMRT and RapidArc. Although modern treatment planning systems (TPS) include data for a “default” treatment couch, actual couches are not manufactured identically. Thus, variations in their Hounsfield Unit (HU) values may exist. This study demonstrates a practical and simple method of acquiring reliable HU data for any treatment couch. We also investigate the effects of both the default and modeled treatment couches on absorbed dose. Experimental verifications show that by neglecting to incorporate the treatment couch in the TPS, dose differences of up to 9.5% and 7.3% were present for 4 MV and 10 MV photon beams, respectively. Furthermore, a clinical study based on a cohort of 20 RapidArc and IMRT (brain, pelvis and abdominal) cases is performed. 2D dose distributions show that without the couch in the planning phase, differences ≤ 4.6% and 5.9% for RapidArc and IMRT cases are present for the same cases that the default couch was added to. Additionally, in comparison to the default couch, employing the modeled couch in the calculation process influences dose distributions by ≤ 2.7% and 8% for RapidArc and IMRT cases, respectively. This result was found to be site specific; where an accurate couch proves to be preferable for IMRT brain plans. As such, adding the couch during dose calculation decreases dose calculation errors, and a precisely modeled treatment couch offers higher dose delivery accuracy for brain treatment using IMRT

Poster — Thur Eve — 33: The Influence of a Modeled Treatment Couch on Dose Distributions During IMRT and RapidArc Treatment Delivery

Energy Technology Data Exchange (ETDEWEB)

Aldosary, Ghada [Medical Physics Unit, Montreal General Hospital, McGill University, Montreal, Quebec (Canada); Nobah, Ahmad; Al-Zorkani, Faisal; Moftah, Belal [Biomedical Physics Department, King Faisal Specialist Hospital and Research Center, Riyadh (Saudi Arabia); Devic, Slobodan [Department of Radiation Oncology, Jewish General Hospital, McGill University, Montreal, Quebec (Canada)

2014-08-15

Treatment couches have been known to perturb dose delivery in patients. This effect is most pronounced in techniques such as IMRT and RapidArc. Although modern treatment planning systems (TPS) include data for a “default” treatment couch, actual couches are not manufactured identically. Thus, variations in their Hounsfield Unit (HU) values may exist. This study demonstrates a practical and simple method of acquiring reliable HU data for any treatment couch. We also investigate the effects of both the default and modeled treatment couches on absorbed dose. Experimental verifications show that by neglecting to incorporate the treatment couch in the TPS, dose differences of up to 9.5% and 7.3% were present for 4 MV and 10 MV photon beams, respectively. Furthermore, a clinical study based on a cohort of 20 RapidArc and IMRT (brain, pelvis and abdominal) cases is performed. 2D dose distributions show that without the couch in the planning phase, differences ≤ 4.6% and 5.9% for RapidArc and IMRT cases are present for the same cases that the default couch was added to. Additionally, in comparison to the default couch, employing the modeled couch in the calculation process influences dose distributions by ≤ 2.7% and 8% for RapidArc and IMRT cases, respectively. This result was found to be site specific; where an accurate couch proves to be preferable for IMRT brain plans. As such, adding the couch during dose calculation decreases dose calculation errors, and a precisely modeled treatment couch offers higher dose delivery accuracy for brain treatment using IMRT.

A two isocenter IMRT technique with a controlled junction dose for long volume targets

International Nuclear Information System (INIS)

Zeng, G G; Heaton, R K; Catton, C N; Chung, P W; O'Sullivan, B; Lau, M; Parent, A; Jaffray, D A

2007-01-01

Most IMRT techniques have been designed to treat targets smaller than the field size of conventional linac accelerators. In order to overcome the field size restrictions in applying IMRT, we developed a two isocenter IMRT technique to treat long volume targets. The technique exploits an extended dose gradient throughout a junction region of 4-6 cm to minimize the impact of field match errors on a junction dose and manipulates the inverse planning and IMRT segments to fill in the dose gradient and achieve dose uniformity. Techniques for abutting both conventional fields with IMRT ('Static + IMRT') and IMRT fields ('IMRT + IMRT') using two separate isocenters have been developed. Five long volume sarcoma cases have been planned in Pinnacle (Philips, Madison, USA) using Elekta Synergy and Varian 2100EX linacs; two of the cases were clinically treated with this technique. Advantages were demonstrated with well-controlled junction target uniformity and tolerance to setup uncertainties. The junction target dose heterogeneity was controlled at a level of ±5%; for 3 mm setup errors at the field edges, the junction target dose changed less than 5% and the dose sparing to organs at risk (OARs) was maintained. Film measurements confirmed the treatment planning results

3-D dose verification for IMRT using optical CT based polymer gel dosimetry

Energy Technology Data Exchange (ETDEWEB)

Wuu, C [Department of Radiation Oncology, Columbia University, New York, New York (United States); Xu, Y [Department of Radiation Oncology, Columbia University, New York, New York (United States); Maryanski, M J [Department of Radiation Oncology, Columbia University, New York, New York (United States); MGS Research Inc., Madison, Connecticut (United States)

2004-01-01

In this study BANG[reg] polymer gels in conjunction with OCTOPUS{sup TM} optical CT scanner (MGS Research Inc., Madison, CT) was employed to measure the relative 3D dose distribution of an IMRT treatment. Measured relative dose distributions from the gel measurement were compared with those from treatment planning system calculations and EDR2 film measurements with regard to planar dose distributions in axial, coronal, and sagittal orientations.

3-D dose verification for IMRT using optical CT based polymer gel dosimetry

International Nuclear Information System (INIS)

Wuu, C; Xu, Y; Maryanski, M J

2004-01-01

In this study BANG[reg] polymer gels in conjunction with OCTOPUS TM optical CT scanner (MGS Research Inc., Madison, CT) was employed to measure the relative 3D dose distribution of an IMRT treatment. Measured relative dose distributions from the gel measurement were compared with those from treatment planning system calculations and EDR2 film measurements with regard to planar dose distributions in axial, coronal, and sagittal orientations

An absorbed dose calorimeter for IMRT dosimetry

International Nuclear Information System (INIS)

Duane, S.; Aldehaybes, M.; Bailey, M.; Lee, N.D.; Thomas, C.G.; Palmans, H.

2012-01-01

A new calorimeter for dosimetry in small and complex fields has been built. The device is intended for the direct determination of absorbed dose to water in moderately small fields and in composite fields such as IMRT treatments, and as a transfer instrument calibrated against existing absorbed dose standards in conventional reference conditions. The geometry, materials and mode of operation have been chosen to minimize detector perturbations when used in a water phantom, to give a reasonably isotropic response and to minimize the effects of heat transfer when the calorimeter is used in non-reference conditions in a water phantom. The size of the core is meant to meet the needs of measurement in IMRT treatments and is comparable to the size of the air cavity in a type NE2611 ionization chamber. The calorimeter may also be used for small field dosimetry. Initial measurements in reference conditions and in an IMRT head and neck plan, collapsed to gantry angle zero, have been made to estimate the thermal characteristics of the device, and to assess its performance in use. The standard deviation (estimated repeatability) of the reference absorbed dose measurements was 0.02 Gy (0.6%). (authors)

Three-dimensional portal image-based dose reconstruction in a virtual phantom for rapid evaluation of IMRT plans

International Nuclear Information System (INIS)

Ansbacher, W.

2006-01-01

A new method for rapid evaluation of intensity modulated radiation therapy (IMRT) plans has been developed, using portal images for reconstruction of the dose delivered to a virtual three-dimensional (3D) phantom. This technique can replace an array of less complete but more time-consuming measurements. A reference dose calculation is first created by transferring an IMRT plan to a cylindrical phantom, retaining the treatment gantry angles. The isocenter of the fields is placed on or near the phantom axis. This geometry preserves the relative locations of high and low dose regions and has the required symmetry for the dose reconstruction. An electronic portal image (EPI) is acquired for each field, representing the dose in the midplane of a virtual phantom. The image is convolved with a kernel to correct for the lack of scatter, replicating the effect of the cylindrical phantom surrounding the dose plane. This avoids the need to calculate fluence. Images are calibrated to a reference field that delivers a known dose to the isocenter of this phantom. The 3D dose matrix is reconstructed by attenuation and divergence corrections and summed to create a dose matrix (PI-dose) on the same grid spacing as the reference calculation. Comparison of the two distributions is performed with a gradient-weighted 3D dose difference based on dose and position tolerances. Because of its inherent simplicity, the technique is optimally suited for detecting clinically significant variances from a planned dose distribution, rather than for use in the validation of IMRT algorithms. An analysis of differences between PI-dose and calculation, δ PI , compared to differences between conventional quality assurance (QA) and calculation, δ CQ , was performed retrospectively for 20 clinical IMRT cases. PI-dose differences at the isocenter were in good agreement with ionization chamber differences (mean δ PI =-0.8%, standard deviation σ=1.5%, against δ CQ =0.3%, σ=1.0%, respectively). PI-dose

Effects of intra-fraction motion on IMRT dose delivery: statistical analysis and simulation

International Nuclear Information System (INIS)

Bortfeld, Thomas; Jokivarsi, Kimmo; Goitein, Michael; Kung, Jong; Jiang, Steve B.

2002-01-01

There has been some concern that organ motion, especially intra-fraction organ motion due to breathing, can negate the potential merit of intensity-modulated radiotherapy (IMRT). We wanted to find out whether this concern is justified. Specifically, we wanted to investigate whether IMRT delivery techniques with moving parts, e.g., with a multileaf collimator (MLC), are particularly sensitive to organ motion due to the interplay between organ motion and leaf motion. We also wanted to know if, and by how much, fractionation of the treatment can reduce the effects. We performed a statistical analysis and calculated the expected dose values and dose variances for volume elements of organs that move during the delivery of the IMRT. We looked at the overall influence of organ motion during the course of a fractionated treatment. A linear-quadratic model was used to consider fractionation effects. Furthermore, we developed software to simulate motion effects for IMRT delivery with an MLC, with compensators, and with a scanning beam. For the simulation we assumed a sinusoidal motion in an isocentric plane. We found that the expected dose value is independent of the treatment technique. It is just a weighted average over the path of motion of the dose distribution without motion. If the treatment is delivered in several fractions, the distribution of the dose around the expected value is close to a Gaussian. For a typical treatment with 30 fractions, the standard deviation is generally within 1% of the expected value for MLC delivery if one assumes a typical motion amplitude of 5 mm (1 cm peak to peak). The standard deviation is generally even smaller for the compensator but bigger for scanning beam delivery. For the latter it can be reduced through multiple deliveries ('paintings') of the same field. In conclusion, the main effect of organ motion in IMRT is an averaging of the dose distribution without motion over the path of the motion. This is the same as for treatments

Evaluation of the 'dose of the day' for IMRT prostate cancer patients derived from portal dose measurements and cone-beam CT

International Nuclear Information System (INIS)

Zijtveld, Mathilda van; Dirkx, Maarten; Breuers, Marcel; Kuipers, Ruud; Heijmen, Ben

2010-01-01

Purpose: High geometrical and dosimetrical accuracies are required for radiotherapy treatments where IMRT is applied in combination with narrow treatment margins in order to minimize dose delivery to normal tissues. As an overall check, we implemented a method for reconstruction of the actually delivered 3D dose distribution to the patient during a treatment fraction, i.e., the 'dose of the day'. In this article results on the clinical evaluation of this concept for a group of IMRT prostate cancer patients are presented. Materials and methods: The actual IMRT fluence maps delivered to a patient were derived from measured EPID-images acquired during treatment using a previously described iterative method. In addition, the patient geometry was obtained from in-room acquired cone-beam CT images. For dose calculation, a mapping of the Hounsfield Units from the planning CT was applied. With the fluence maps and the modified cone-beam CT the 'dose of the day' was calculated. The method was validated using phantom measurements and evaluated clinically for 10 prostate cancer patients in 4 or 5 fractions. Results: The phantom measurements showed that the delivered dose could be reconstructed within 3%/3 mm accuracy. For prostate cancer patients, the isocenter dose agreed within -0.4 ± 1.0% (1 SD) with the planned value, while for on average 98.1% of the pixels within the 50% isodose surface the actually delivered dose agreed within 3% or 3 mm with the planned dose. For most fractions, the dose coverage of the prostate volume was slightly deteriorated which was caused by small prostate rotations and small inaccuracies in fluence delivery. The dose that was delivered to the rectum remained within the constraints used during planning. However, for two patients a large degrading of the dose delivery was observed in two fractions. For one patient this was related to changes in rectum filling with respect to the planning CT and for the other to large intra-fraction motion during

Method to account for dose fractionation in analysis of IMRT plans: Modified equivalent uniform dose

International Nuclear Information System (INIS)

Park, Clinton S.; Kim, Yongbok; Lee, Nancy; Bucci, Kara M.; Quivey, Jeanne M.; Verhey, Lynn J.; Xia Ping

2005-01-01

Purpose: To propose a modified equivalent uniform dose (mEUD) to account for dose fractionation using the biologically effective dose without losing the advantages of the generalized equivalent uniform dose (gEUD) and to report the calculated mEUD and gEUD in clinically used intensity-modulated radiotherapy (IMRT) plans. Methods and Materials: The proposed mEUD replaces the dose to each voxel in the gEUD formulation by a biologically effective dose with a normalization factor. We propose to use the term mEUD D o /n o that includes the total dose (D o ) and number of fractions (n o ) and to use the term mEUD o that includes the same total dose but a standard fraction size of 2 Gy. A total of 41 IMRT plans for patients with nasopharyngeal cancer treated at our institution between October 1997 and March 2002 were selected for the study. The gEUD and mEUD were calculated for the planning gross tumor volume (pGTV), planning clinical tumor volume (pCTV), parotid glands, and spinal cord. The prescription dose for these patients was 70 Gy to >95% of the pGTV and 59.4 Gy to >95% of the pCTV in 33 fractions. Results: The calculated average gEUD was 72.2 ± 2.4 Gy for the pGTV, 54.2 ± 7.1 Gy for the pCTV, 26.7 ± 4.2 Gy for the parotid glands, and 34.1 ± 6.8 Gy for the spinal cord. The calculated average mEUD D o /n o using 33 fractions was 71.7 ± 3.5 Gy for mEUD 70/33 of the pGTV, 49.9 ± 7.9 Gy for mEUD 59.5/33 of the pCTV, 27.6 ± 4.8 Gy for mEUD 26/33 of the parotid glands, and 32.7 ± 7.8 Gy for mEUD 45/33 of the spinal cord. Conclusion: The proposed mEUD, combining the gEUD with the biologically effective dose, preserves all advantages of the gEUD while reflecting the fractionation effects and linear and quadratic survival characteristics

A silicon strip detector dose magnifying glass for IMRT dosimetry

International Nuclear Information System (INIS)

Wong, J. H. D.; Carolan, M.; Lerch, M. L. F.; Petasecca, M.; Khanna, S.; Perevertaylo, V. L.; Metcalfe, P.; Rosenfeld, A. B.

2010-01-01

Purpose: Intensity modulated radiation therapy (IMRT) allows the delivery of escalated radiation dose to tumor while sparing adjacent critical organs. In doing so, IMRT plans tend to incorporate steep dose gradients at interfaces between the target and the organs at risk. Current quality assurance (QA) verification tools such as 2D diode arrays, are limited by their spatial resolution and conventional films are nonreal time. In this article, the authors describe a novel silicon strip detector (CMRP DMG) of high spatial resolution (200 μm) suitable for measuring the high dose gradients in an IMRT delivery. Methods: A full characterization of the detector was performed, including dose per pulse effect, percent depth dose comparison with Farmer ion chamber measurements, stem effect, dose linearity, uniformity, energy response, angular response, and penumbra measurements. They also present the application of the CMRP DMG in the dosimetric verification of a clinical IMRT plan. Results: The detector response changed by 23% for a 390-fold change in the dose per pulse. A correction function is derived to correct for this effect. The strip detector depth dose curve agrees with the Farmer ion chamber within 0.8%. The stem effect was negligible (0.2%). The dose linearity was excellent for the dose range of 3-300 cGy. A uniformity correction method is described to correct for variations in the individual detector pixel responses. The detector showed an over-response relative to tissue dose at lower photon energies with the maximum dose response at 75 kVp nominal photon energy. Penumbra studies using a Varian Clinac 21EX at 1.5 and 10.0 cm depths were measured to be 2.77 and 3.94 mm for the secondary collimators, 3.52 and 5.60 mm for the multileaf collimator rounded leaf ends, respectively. Point doses measured with the strip detector were compared to doses measured with EBT film and doses predicted by the Philips Pinnacle treatment planning system. The differences were 1.1%�

Evaluation of the effect of patient dose from cone beam computed tomography on prostate IMRT using Monte Carlo simulation.

Science.gov (United States)

Chow, James C L; Leung, Michael K K; Islam, Mohammad K; Norrlinger, Bernhard D; Jaffray, David A

2008-01-01

The aim of this study is to evaluate the impact of the patient dose due to the kilovoltage cone beam computed tomography (kV-CBCT) in a prostate intensity-modulated radiation therapy (IMRT). The dose distributions for the five prostate IMRTs were calculated using the Pinnacle treatment planning system. To calculate the patient dose from CBCT, phase-space beams of a CBCT head based on the ELEKTA x-ray volume imaging system were generated using the Monte Carlo BEAMnr code for 100, 120, 130, and 140 kVp energies. An in-house graphical user interface called DOSCTP (DOSXYZnrc-based) developed using MATLAB was used to calculate the dose distributions due to a 360 degrees photon arc from the CBCT beam with the same patient CT image sets as used in Pinnacle. The two calculated dose distributions were added together by setting the CBCT doses equal to 1%, 1.5%, 2%, and 2.5% of the prescription dose of the prostate IMRT. The prostate plan and the summed dose distributions were then processed in the CERR platform to determine the dose-volume histograms (DVHs) of the regions of interest. Moreover, dose profiles along the x- and y-axes crossing the isocenter with and without addition of the CBCT dose were determined. It was found that the added doses due to CBCT are most significant at the femur heads. Higher doses were found at the bones for a relatively low energy CBCT beam such as 100 kVp. Apart from the bones, the CBCT dose was observed to be most concentrated on the anterior and posterior side of the patient anatomy. Analysis of the DVHs for the prostate and other critical tissues showed that they vary only slightly with the added CBCT dose at different beam energies. On the other hand, the changes of the DVHs for the femur heads due to the CBCT dose and beam energy were more significant than those of rectal and bladder wall. By analyzing the vertical and horizontal dose profiles crossing the femur heads and isocenter, with and without the CBCT dose equal to 2% of the

Evaluation of the effect of patient dose from cone beam computed tomography on prostate IMRT using Monte Carlo simulation

International Nuclear Information System (INIS)

Chow, James C. L.; Leung, Michael K. K.; Islam, Mohammad K.; Norrlinger, Bernhard D.; Jaffray, David A.

2008-01-01

The aim of this study is to evaluate the impact of the patient dose due to the kilovoltage cone beam computed tomography (kV-CBCT) in a prostate intensity-modulated radiation therapy (IMRT). The dose distributions for the five prostate IMRTs were calculated using the Pinnacle3 treatment planning system. To calculate the patient dose from CBCT, phase-space beams of a CBCT head based on the ELEKTA x-ray volume imaging system were generated using the Monte Carlo BEAMnrc code for 100, 120, 130, and 140 kVp energies. An in-house graphical user interface called DOSCTP (DOSXYZnrc-based) developed using MATLAB was used to calculate the dose distributions due to a 360 deg. photon arc from the CBCT beam with the same patient CT image sets as used in Pinnacle3. The two calculated dose distributions were added together by setting the CBCT doses equal to 1%, 1.5%, 2%, and 2.5% of the prescription dose of the prostate IMRT. The prostate plan and the summed dose distributions were then processed in the CERR platform to determine the dose-volume histograms (DVHs) of the regions of interest. Moreover, dose profiles along the x- and y-axes crossing the isocenter with and without addition of the CBCT dose were determined. It was found that the added doses due to CBCT are most significant at the femur heads. Higher doses were found at the bones for a relatively low energy CBCT beam such as 100 kVp. Apart from the bones, the CBCT dose was observed to be most concentrated on the anterior and posterior side of the patient anatomy. Analysis of the DVHs for the prostate and other critical tissues showed that they vary only slightly with the added CBCT dose at different beam energies. On the other hand, the changes of the DVHs for the femur heads due to the CBCT dose and beam energy were more significant than those of rectal and bladder wall. By analyzing the vertical and horizontal dose profiles crossing the femur heads and isocenter, with and without the CBCT dose equal to 2% of the

Is uniform target dose possible in IMRT plans in the head and neck?

International Nuclear Information System (INIS)

Vineberg, K.A.; Eisbruch, A.; Coselmon, M.M.; McShan, D.L.; Kessler, M.L.; Fraass, B.A.

2002-01-01

Purpose: Various published reports involving intensity-modulated radiotherapy (IMRT) plans developed using automated optimization (inverse planning) have demonstrated highly conformal plans. These reported conformal IMRT plans involve significant target dose inhomogeneity, including both overdosage and underdosage within the target volume. In this study, we demonstrate the development of optimized beamlet IMRT plans that satisfy rigorous dose homogeneity requirements for all target volumes (e.g., ±5%), while also sparing the parotids and other normal structures. Methods and Materials: The treatment plans of 15 patients with oropharyngeal cancer who were previously treated with forward-planned multisegmental IMRT were planned again using an automated optimization system developed in-house. The optimization system allows for variable sized beamlets computed using a three-dimensional convolution/superposition dose calculation and flexible cost functions derived from combinations of clinically relevant factors (costlets) that can include dose, dose-volume, and biologic model-based costlets. The current study compared optimized IMRT plans designed to treat the various planning target volumes to doses of 66, 60, and 54 Gy with varying target dose homogeneity while using a flexible optimization cost function to minimize the dose to the parotids, spinal cord, oral cavity, brainstem, submandibular nodes, and other structures. Results: In all cases, target dose uniformity was achieved through steeply varying dose-based costs. Differences in clinical plan evaluation metrics were evaluated for individual cases (eight different target homogeneity costlets), and for the entire cohort of plans. Highly conformal plans were achieved, with significant sparing of both the contralateral and ipsilateral parotid glands. As the homogeneity of the target dose distributions was allowed to decrease, increased sparing of the parotids (and other normal tissues) may be achieved. However, it

Intensity-modulated radiotherapy (IMRT) and conventional three-dimensional conformal radiotherapy for high-grade gliomas: Does IMRT increase the integral dose to normal brain?

International Nuclear Information System (INIS)

Hermanto, Ulrich; Frija, Erik K.; Lii, MingFwu J.; Chang, Eric L.; Mahajan, Anita; Woo, Shiao Y.

2007-01-01

Purpose: To determine whether intensity-modulated radiotherapy (IMRT) treatment increases the total integral dose of nontarget tissue relative to the conventional three-dimensional conformal radiotherapy (3D-CRT) technique for high-grade gliomas. Methods and Materials: Twenty patients treated with 3D-CRT for glioblastoma multiforme were selected for a comparative dosimetric evaluation with IMRT. Original target volumes, organs at risk (OAR), and dose-volume constraints were used for replanning with IMRT. Predicted isodose distributions, cumulative dose-volume histograms of target volumes and OAR, normal tissue integral dose, target coverage, dose conformity, and normal tissue sparing with 3D-CRT and IMRT planning were compared. Statistical analyses were performed to determine differences. Results: In all 20 patients, IMRT maintained equivalent target coverage, improved target conformity (conformity index [CI] 95% 1.52 vs. 1.38, p mean by 19.8% and D max by 10.7%), optic chiasm (D mean by 25.3% and D max by 22.6%), right optic nerve (D mean by 37.3% and D max by 28.5%), and left optic nerve (D mean by 40.6% and D max by 36.7%), p ≤ 0.01. This was achieved without increasing the total nontarget integral dose by greater than 0.5%. Overall, total integral dose was reduced by 7-10% with IMRT, p < 0.001, without significantly increasing the 0.5-5 Gy low-dose volume. Conclusions: These results indicate that IMRT treatment for high-grade gliomas allows for improved target conformity, better critical tissue sparing, and importantly does so without increasing integral dose and the volume of normal tissue exposed to low doses of radiation

IMRT for Image-Guided Single Vocal Cord Irradiation

Energy Technology Data Exchange (ETDEWEB)

Osman, Sarah O.S., E-mail: s.osman@erasmusmc.nl [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands); Astreinidou, Eleftheria; Boer, Hans C.J. de; Keskin-Cambay, Fatma; Breedveld, Sebastiaan; Voet, Peter; Al-Mamgani, Abrahim; Heijmen, Ben J.M.; Levendag, Peter C. [Department of Radiation Oncology, Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam (Netherlands)

2012-02-01

Purpose: We have been developing an image-guided single vocal cord irradiation technique to treat patients with stage T1a glottic carcinoma. In the present study, we compared the dose coverage to the affected vocal cord and the dose delivered to the organs at risk using conventional, intensity-modulated radiotherapy (IMRT) coplanar, and IMRT non-coplanar techniques. Methods and Materials: For 10 patients, conventional treatment plans using two laterally opposed wedged 6-MV photon beams were calculated in XiO (Elekta-CMS treatment planning system). An in-house IMRT/beam angle optimization algorithm was used to obtain the coplanar and non-coplanar optimized beam angles. Using these angles, the IMRT plans were generated in Monaco (IMRT treatment planning system, Elekta-CMS) with the implemented Monte Carlo dose calculation algorithm. The organs at risk included the contralateral vocal cord, arytenoids, swallowing muscles, carotid arteries, and spinal cord. The prescription dose was 66 Gy in 33 fractions. Results: For the conventional plans and coplanar and non-coplanar IMRT plans, the population-averaged mean dose {+-} standard deviation to the planning target volume was 67 {+-} 1 Gy. The contralateral vocal cord dose was reduced from 66 {+-} 1 Gy in the conventional plans to 39 {+-} 8 Gy and 36 {+-} 6 Gy in the coplanar and non-coplanar IMRT plans, respectively. IMRT consistently reduced the doses to the other organs at risk. Conclusions: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates.

IMRT for Image-Guided Single Vocal Cord Irradiation

International Nuclear Information System (INIS)

Osman, Sarah O.S.; Astreinidou, Eleftheria; Boer, Hans C.J. de; Keskin-Cambay, Fatma; Breedveld, Sebastiaan; Voet, Peter; Al-Mamgani, Abrahim; Heijmen, Ben J.M.; Levendag, Peter C.

2012-01-01

Purpose: We have been developing an image-guided single vocal cord irradiation technique to treat patients with stage T1a glottic carcinoma. In the present study, we compared the dose coverage to the affected vocal cord and the dose delivered to the organs at risk using conventional, intensity-modulated radiotherapy (IMRT) coplanar, and IMRT non-coplanar techniques. Methods and Materials: For 10 patients, conventional treatment plans using two laterally opposed wedged 6-MV photon beams were calculated in XiO (Elekta-CMS treatment planning system). An in-house IMRT/beam angle optimization algorithm was used to obtain the coplanar and non-coplanar optimized beam angles. Using these angles, the IMRT plans were generated in Monaco (IMRT treatment planning system, Elekta-CMS) with the implemented Monte Carlo dose calculation algorithm. The organs at risk included the contralateral vocal cord, arytenoids, swallowing muscles, carotid arteries, and spinal cord. The prescription dose was 66 Gy in 33 fractions. Results: For the conventional plans and coplanar and non-coplanar IMRT plans, the population-averaged mean dose ± standard deviation to the planning target volume was 67 ± 1 Gy. The contralateral vocal cord dose was reduced from 66 ± 1 Gy in the conventional plans to 39 ± 8 Gy and 36 ± 6 Gy in the coplanar and non-coplanar IMRT plans, respectively. IMRT consistently reduced the doses to the other organs at risk. Conclusions: Single vocal cord irradiation with IMRT resulted in good target coverage and provided significant sparing of the critical structures. This has the potential to improve the quality-of-life outcomes after RT and maintain the same local control rates.

SU-E-T-454: Impact of Calculation Grid Size On Dosimetry and Radiobiological Parameters for Head and Neck IMRT

Energy Technology Data Exchange (ETDEWEB)

Srivastava, S; Das, I [Purdue University, West Lafayette, IN (United States); Indiana University Health Methodist Hospital, Indianapolis, IN (United States); Indiana University- School of Medicine, Indianapolis, IN (United States); Cheng, C [Purdue University, West Lafayette, IN (United States); Indiana University Health Methodist Hospital, Indianapolis, IN (United States)

2014-06-01

Purpose: IMRT has become standard of care for complex treatments to optimize dose to target and spare normal tissues. However, the impact of calculation grid size is not widely known especially dose distribution, tumor control probability (TCP) and normal tissue complication probability (NTCP) which is investigated in this study. Methods: Ten head and neck IMRT patients treated with 6 MV photons were chosen for this study. Using Eclipse TPS, treatment plans were generated for different grid sizes in the range 1–5 mm for the same optimization criterion with specific dose-volume constraints. The dose volume histogram (DVH) was calculated for all IMRT plans and dosimetric data were compared. ICRU-83 dose points such as D2%, D50%, D98%, as well as the homogeneity and conformity indices (HI, CI) were calculated. In addition, TCP and NTCP were calculated from DVH data. Results: The PTV mean dose and TCP decreases with increasing grid size with an average decrease in mean dose by 2% and TCP by 3% respectively. Increasing grid size from 1–5 mm grid size, the average mean dose and NTCP for left parotid was increased by 6.0% and 8.0% respectively. Similar patterns were observed for other OARs such as cochlea, parotids and spinal cord. The HI increases up to 60% and CI decreases on average by 3.5% between 1 and 5 mm grid that resulted in decreased TCP and increased NTCP values. The number of points meeting the gamma criteria of ±3% dose difference and ±3mm DTA was higher with a 1 mm on average (97.2%) than with a 5 mm grid (91.3%). Conclusion: A smaller calculation grid provides superior dosimetry with improved TCP and reduced NTCP values. The effect is more pronounced for smaller OARs. Thus, the smallest possible grid size should be used for accurate dose calculation especially in H and N planning.

A clinical study of lung cancer dose calculation accuracy with Monte Carlo simulation.

Science.gov (United States)

Zhao, Yanqun; Qi, Guohai; Yin, Gang; Wang, Xianliang; Wang, Pei; Li, Jian; Xiao, Mingyong; Li, Jie; Kang, Shengwei; Liao, Xiongfei

2014-12-16

The accuracy of dose calculation is crucial to the quality of treatment planning and, consequently, to the dose delivered to patients undergoing radiation therapy. Current general calculation algorithms such as Pencil Beam Convolution (PBC) and Collapsed Cone Convolution (CCC) have shortcomings in regard to severe inhomogeneities, particularly in those regions where charged particle equilibrium does not hold. The aim of this study was to evaluate the accuracy of the PBC and CCC algorithms in lung cancer radiotherapy using Monte Carlo (MC) technology. Four treatment plans were designed using Oncentra Masterplan TPS for each patient. Two intensity-modulated radiation therapy (IMRT) plans were developed using the PBC and CCC algorithms, and two three-dimensional conformal therapy (3DCRT) plans were developed using the PBC and CCC algorithms. The DICOM-RT files of the treatment plans were exported to the Monte Carlo system to recalculate. The dose distributions of GTV, PTV and ipsilateral lung calculated by the TPS and MC were compared. For 3DCRT and IMRT plans, the mean dose differences for GTV between the CCC and MC increased with decreasing of the GTV volume. For IMRT, the mean dose differences were found to be higher than that of 3DCRT. The CCC algorithm overestimated the GTV mean dose by approximately 3% for IMRT. For 3DCRT plans, when the volume of the GTV was greater than 100 cm(3), the mean doses calculated by CCC and MC almost have no difference. PBC shows large deviations from the MC algorithm. For the dose to the ipsilateral lung, the CCC algorithm overestimated the dose to the entire lung, and the PBC algorithm overestimated V20 but underestimated V5; the difference in V10 was not statistically significant. PBC substantially overestimates the dose to the tumour, but the CCC is similar to the MC simulation. It is recommended that the treatment plans for lung cancer be developed using an advanced dose calculation algorithm other than PBC. MC can accurately

Variable beam dose rate and DMLC IMRT to moving body anatomy

International Nuclear Information System (INIS)

Papiez, Lech; Abolfath, Ramin M.

2008-01-01

Derivation of formulas relating leaf speeds and beam dose rates for delivering planned intensity profiles to static and moving targets in dynamic multileaf collimator (DMLC) intensity modulated radiation therapy (IMRT) is presented. The analysis of equations determining algorithms for DMLC IMRT delivery under a variable beam dose rate reveals a multitude of possible delivery strategies for a given intensity map and for any given target motion patterns. From among all equivalent delivery strategies for DMLC IMRT treatments specific subclasses of strategies can be selected to provide deliveries that are particularly suitable for clinical applications providing existing delivery devices are used. Special attention is devoted to the subclass of beam dose rate variable DMLC delivery strategies to moving body anatomy that generalize existing techniques of such deliveries in Varian DMLC irradiation methodology to static body anatomy. Few examples of deliveries from this subclass of DMLC IMRT irradiations are investigated to illustrate the principle and show practical benefits of proposed techniques.

Variable beam dose rate and DMLC IMRT to moving body anatomy

Energy Technology Data Exchange (ETDEWEB)

Papiez, Lech; Abolfath, Ramin M. [Department of Radiation Oncology, UTSouthwestern Medical Center, Dallas, Texas 75390 (United States)

2008-11-15

Derivation of formulas relating leaf speeds and beam dose rates for delivering planned intensity profiles to static and moving targets in dynamic multileaf collimator (DMLC) intensity modulated radiation therapy (IMRT) is presented. The analysis of equations determining algorithms for DMLC IMRT delivery under a variable beam dose rate reveals a multitude of possible delivery strategies for a given intensity map and for any given target motion patterns. From among all equivalent delivery strategies for DMLC IMRT treatments specific subclasses of strategies can be selected to provide deliveries that are particularly suitable for clinical applications providing existing delivery devices are used. Special attention is devoted to the subclass of beam dose rate variable DMLC delivery strategies to moving body anatomy that generalize existing techniques of such deliveries in Varian DMLC irradiation methodology to static body anatomy. Few examples of deliveries from this subclass of DMLC IMRT irradiations are investigated to illustrate the principle and show practical benefits of proposed techniques.

Analysis of Radiation Treatment Planning by Dose Calculation and Optimization Algorithm

Energy Technology Data Exchange (ETDEWEB)

Kim, Dae Sup; Yoon, In Ha; Lee, Woo Seok; Baek, Geum Mun [Dept. of Radiation Oncology, Asan Medical Center, Seoul (Korea, Republic of)

2012-09-15

Analyze the Effectiveness of Radiation Treatment Planning by dose calculation and optimization algorithm, apply consideration of actual treatment planning, and then suggest the best way to treatment planning protocol. The treatment planning system use Eclipse 10.0. (Varian, USA). PBC (Pencil Beam Convolution) and AAA (Anisotropic Analytical Algorithm) Apply to Dose calculation, DVO (Dose Volume Optimizer 10.0.28) used for optimized algorithm of Intensity Modulated Radiation Therapy (IMRT), PRO II (Progressive Resolution Optimizer V 8.9.17) and PRO III (Progressive Resolution Optimizer V 10.0.28) used for optimized algorithm of VAMT. A phantom for experiment virtually created at treatment planning system, 30x30x30 cm sized, homogeneous density (HU: 0) and heterogeneous density that inserted air assumed material (HU: -1,000). Apply to clinical treatment planning on the basis of general treatment planning feature analyzed with Phantom planning. In homogeneous density phantom, PBC and AAA show 65.2% PDD (6 MV, 10 cm) both, In heterogeneous density phantom, also show similar PDD value before meet with low density material, but they show different dose curve in air territory, PDD 10 cm showed 75%, 73% each after penetrate phantom. 3D treatment plan in same MU, AAA treatment planning shows low dose at Lung included area. 2D POP treatment plan with 15 MV of cervical vertebral region include trachea and lung area, Conformity Index (ICRU 62) is 0.95 in PBC calculation and 0.93 in AAA. DVO DVH and Dose calculation DVH are showed equal value in IMRT treatment plan. But AAA calculation shows lack of dose compared with DVO result which is satisfactory condition. Optimizing VMAT treatment plans using PRO II obtained results were satisfactory, but lower density area showed lack of dose in dose calculations. PRO III, but optimizing the dose calculation results were similar with optimized the same conditions once more. In this study, do not judge the rightness of the dose

Analysis of Radiation Treatment Planning by Dose Calculation and Optimization Algorithm

International Nuclear Information System (INIS)

Kim, Dae Sup; Yoon, In Ha; Lee, Woo Seok; Baek, Geum Mun

2012-01-01

Analyze the Effectiveness of Radiation Treatment Planning by dose calculation and optimization algorithm, apply consideration of actual treatment planning, and then suggest the best way to treatment planning protocol. The treatment planning system use Eclipse 10.0. (Varian, USA). PBC (Pencil Beam Convolution) and AAA (Anisotropic Analytical Algorithm) Apply to Dose calculation, DVO (Dose Volume Optimizer 10.0.28) used for optimized algorithm of Intensity Modulated Radiation Therapy (IMRT), PRO II (Progressive Resolution Optimizer V 8.9.17) and PRO III (Progressive Resolution Optimizer V 10.0.28) used for optimized algorithm of VAMT. A phantom for experiment virtually created at treatment planning system, 30x30x30 cm sized, homogeneous density (HU: 0) and heterogeneous density that inserted air assumed material (HU: -1,000). Apply to clinical treatment planning on the basis of general treatment planning feature analyzed with Phantom planning. In homogeneous density phantom, PBC and AAA show 65.2% PDD (6 MV, 10 cm) both, In heterogeneous density phantom, also show similar PDD value before meet with low density material, but they show different dose curve in air territory, PDD 10 cm showed 75%, 73% each after penetrate phantom. 3D treatment plan in same MU, AAA treatment planning shows low dose at Lung included area. 2D POP treatment plan with 15 MV of cervical vertebral region include trachea and lung area, Conformity Index (ICRU 62) is 0.95 in PBC calculation and 0.93 in AAA. DVO DVH and Dose calculation DVH are showed equal value in IMRT treatment plan. But AAA calculation shows lack of dose compared with DVO result which is satisfactory condition. Optimizing VMAT treatment plans using PRO II obtained results were satisfactory, but lower density area showed lack of dose in dose calculations. PRO III, but optimizing the dose calculation results were similar with optimized the same conditions once more. In this study, do not judge the rightness of the dose

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

International Nuclear Information System (INIS)

Martin, Jeffrey M.; Handorf, Elizabeth A.; Price, Robert A.; Cherian, George; Buyyounouski, Mark K.; Chen, David Y.; Kutikov, Alexander; Johnson, Matthew E.; Ma, Chung-Ming Charlie; Horwitz, Eric M.

2015-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

Martin, Jeffrey M. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Handorf, Elizabeth A. [Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA (United States); Price, Robert A.; Cherian, George [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Buyyounouski, Mark K. [Department of Radiation Oncology, Stanford University, Stanford, CA (United States); Chen, David Y.; Kutikov, Alexander [Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Johnson, Matthew E.; Ma, Chung-Ming Charlie [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Horwitz, Eric M., E-mail: eric.horwitz@fccc.edu [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)

2015-10-01

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

An analysis of tolerance levels in IMRT quality assurance procedures

International Nuclear Information System (INIS)

Basran, Parminder S.; Woo, Milton K.

2008-01-01

Increased use of intensity modulated radiation therapy (IMRT) has resulted in increased efforts in patient quality assurance (QA). Software and detector systems intended to streamline the IMRT quality assurance process often report metrics, such as percent discrepancies between measured and computed doses, which can be compared to benchmark or threshold values. The purpose of this work is to examine the relationships between two different types of IMRT QA processes in order to define, or refine, appropriate tolerances values. For 115 IMRT plans delivered in a 3 month period, we examine the discrepancies between (a) the treatment planning system (TPS) and results from a commercial independent monitor unit (MU) calculation program; (b) TPS and results from a commercial diode-array measurement system; and (c) the independent MU calculation and the diode-array measurements. Statistical tests were performed to assess significance in the IMRT QA results for different disease site and machine models. There is no evidence that the average total dose discrepancy in the monitor unit calculation depends on the disease site. Second, the discrepancies in the two IMRT QA methods are independent: there is no evidence that a better --or worse--monitor unit validation result is related to a better--or worse--diode-array measurement result. Third, there is marginal benefit in repeating the independent MU calculation with a more suitable dose point, if the initial IMRT QA failed a certain tolerance. Based on these findings, the authors conclude at some acceptable tolerances based on disease site and IMRT QA method. Specifically, monitor unit validations are expected to have a total dose discrepancy of 3% overall, and 5% per beam, independent of disease site. Diode array measurements are expected to have a total absolute dose discrepancy of 3% overall, and 3% per beam, independent of disease site. The percent of pixels exceeding a 3% and 3 mm threshold in a gamma analysis should be

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

Science.gov (United States)

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

2017-10-01

Given the reduction in death from breast cancer, as well as improvements in overall survival, adjuvant radiotherapy is considered the standard treatment for breast cancer. However, left-sided breast irradiation was associated with an increased rate of fatal cardiovascular events due to incidental irradiation of the heart. Recently, considerable efforts have been made to minimize cardiac toxicity of left-sided breast irradiation by new treatment methods such as deep-inspiration breath-hold (DIBH) and new radiation techniques, particularly intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). The primary aim of this study was to evaluate the effect of DIBH irradiation on cardiac dose compared with free-breathing (FB) irradiation, while the secondary objective was to compare the advantages of IMRT versus VMAT plans in both the FB and the DIBH position for left-sided breast cancer. In all, 25 consecutive left-sided breast cancer patients underwent CT simulation in the FB and DIBH position. Five patients were excluded with no cardiac displacement following DIBH-CT simulation. The other 20 patients were irradiated in the DIBH position using respiratory gating. Four different treatment plans were generated for each patient, an IMRT and a VMAT plan in the DIBH and in the FB position, respectively. The following parameters were used for plan comparison: dose to the heart, left anterior descending coronary artery (mean dose, maximum dose, D25% and D45%), ipsilateral, contralateral lung (mean dose, D20%, D30%) and contralateral breast (mean dose). The percentage in dose reduction for organs at risk achieved by DIBH for both IMRT and VMAT plans was calculated and compared for each patient by each treatment plan. DIBH irradiation significantly reduced mean dose to the heart and left anterior descending coronary artery (LADCA) using both IMRT (heart -20%; p = 0.0002, LADCA -9%; p = 0.001) and VMAT (heart -23%; p = 0.00003, LADCA -16%; p = 0

SU-E-T-163: Evaluation of Dose Distributions Recalculated with Per-Field Measurement Data Under the Condition of Respiratory Motion During IMRT for Liver Cancer

Energy Technology Data Exchange (ETDEWEB)

Song, J; Yoon, M; Nam, T; Ahn, S; Chung, W [Chonnam National University Hwasun Hospital, Hwasun-kun, Chonnam (Korea, Republic of)

2014-06-01

Purpose: The dose distributions within the real volumes of tumor targets and critical organs during internal target volume-based intensity-modulated radiation therapy (ITV-IMRT) for liver cancer were recalculated by applying the effects of actual respiratory organ motion, and the dosimetric features were analyzed through comparison with gating IMRT (Gate-IMRT) plan results. Methods: The 4DCT data for 10 patients who had been treated with Gate-IMRT for liver cancer were selected to create ITV-IMRT plans. The ITV was created using MIM software, and a moving phantom was used to simulate respiratory motion. The period and range of respiratory motion were recorded in all patients from 4DCT-generated movie data, and the same period and range were applied when operating the dynamic phantom to realize coincident respiratory conditions in each patient. The doses were recalculated with a 3 dose-volume histogram (3DVH) program based on the per-field data measured with a MapCHECK2 2-dimensional diode detector array and compared with the DVHs calculated for the Gate-IMRT plan. Results: Although a sufficient prescription dose covered the PTV during ITV-IMRT delivery, the dose homogeneity in the PTV was inferior to that with the Gate-IMRT plan. We confirmed that there were higher doses to the organs-at-risk (OARs) with ITV-IMRT, as expected when using an enlarged field, but the increased dose to the spinal cord was not significant and the increased doses to the liver and kidney could be considered as minor when the reinforced constraints were applied during IMRT plan optimization. Conclusion: Because Gate-IMRT cannot always be considered an ideal method with which to correct the respiratory motional effect, given the dosimetric variations in the gating system application and the increased treatment time, a prior analysis for optimal IMRT method selection should be performed while considering the patient's respiratory condition and IMRT plan results.

Influence of intravenous contrast agent on dose calculations of intensity modulated radiation therapy plans for head and neck cancer

International Nuclear Information System (INIS)

Choi, Youngmin; Kim, Jeung-Kee; Lee, Hyung-Sik; Hur, Won-Joo; Hong, Young-Seoub; Park, Sungkwang; Ahn, Kijung; Cho, Heunglae

2006-01-01

Background and purpose: To evaluate the effect of an intravenous contrast agent (CA) on dose calculations and its clinical significance in intensity modulated radiation therapy (IMRT) plans for head and neck cancer. Materials and methods: Fifteen patients with head and neck cancer and involved neck nodes were enrolled. Each patient took two sets of computerized tomography (CT) in the same position before and after intravenous CA injections. Target volumes and organs at risk (OAR) were contoured on the enhanced CT, and then an IMRT plan of nine equiangular beams with a 6 MV X-ray was created. After the fusion of non-enhanced and enhanced CTs, the contours and the IMRT plan created from the enhanced CT were copied and placed to the non-enhanced CT. Doses were calculated again from the non-enhanced CT by the same IMRT plan. The radiation doses calculated from the two sets of CTs were compared with regard to planning target volumes (PTV) and the three OARs, both parotid glands and the spinal cord, by Wilcoxon's signed rank test. Results: The doses (maximum, mean, and the dose of 95% of PTV received (D 95% )) of PTV70 and PTV59.4 calculated from the enhanced CTs were lower than those from the non-enhanced CTs (p < 0.05), but the dose differences were less than 1% compared to the doses calculated from the enhanced CTs. The doses of PTV50.4, parotid glands, and spinal cord were not significantly different between the non-enhanced and enhanced CTs. Conclusions: The difference between the doses calculated from the CTs with and without CA enhancement was tolerably small, therefore using intravenous CA could be recommended for the planning CT of head and neck IMRT

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

Dosimetric impact of Acuros XB deterministic radiation transport algorithm for heterogeneous dose calculation in lung cancer

International Nuclear Information System (INIS)

Han Tao; Followill, David; Repchak, Roman; Molineu, Andrea; Howell, Rebecca; Salehpour, Mohammad; Mikell, Justin; Mourtada, Firas

2013-01-01

Purpose: The novel deterministic radiation transport algorithm, Acuros XB (AXB), has shown great potential for accurate heterogeneous dose calculation. However, the clinical impact between AXB and other currently used algorithms still needs to be elucidated for translation between these algorithms. The purpose of this study was to investigate the impact of AXB for heterogeneous dose calculation in lung cancer for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT). Methods: The thorax phantom from the Radiological Physics Center (RPC) was used for this study. IMRT and VMAT plans were created for the phantom in the Eclipse 11.0 treatment planning system. Each plan was delivered to the phantom three times using a Varian Clinac iX linear accelerator to ensure reproducibility. Thermoluminescent dosimeters (TLDs) and Gafchromic EBT2 film were placed inside the phantom to measure delivered doses. The measurements were compared with dose calculations from AXB 11.0.21 and the anisotropic analytical algorithm (AAA) 11.0.21. Two dose reporting modes of AXB, dose-to-medium in medium (D m,m ) and dose-to-water in medium (D w,m ), were studied. Point doses, dose profiles, and gamma analysis were used to quantify the agreement between measurements and calculations from both AXB and AAA. The computation times for AAA and AXB were also evaluated. Results: For the RPC lung phantom, AAA and AXB dose predictions were found in good agreement to TLD and film measurements for both IMRT and VMAT plans. TLD dose predictions were within 0.4%–4.4% to AXB doses (both D m,m and D w,m ); and within 2.5%–6.4% to AAA doses, respectively. For the film comparisons, the gamma indexes (±3%/3 mm criteria) were 94%, 97%, and 98% for AAA, AXB Dm,m , and AXB Dw,m , respectively. The differences between AXB and AAA in dose–volume histogram mean doses were within 2% in the planning target volume, lung, heart, and within 5% in the spinal cord. However

Monte Carlo simulations to replace film dosimetry in IMRT verification

International Nuclear Information System (INIS)

Goetzfried, Thomas; Trautwein, Marius; Koelbi, Oliver; Bogner, Ludwig; Rickhey, Mark

2011-01-01

Patient-specific verification of intensity-modulated radiation therapy (IMRT) plans can be done by dosimetric measurements or by independent dose or monitor unit calculations. The aim of this study was the clinical evaluation of IMRT verification based on a fast Monte Carlo (MC) program with regard to possible benefits compared to commonly used film dosimetry. 25 head-and-neck IMRT plans were recalculated by a pencil beam based treatment planning system (TPS) using an appropriate quality assurance (QA) phantom. All plans were verified both by film and diode dosimetry and compared to MC simulations. The irradiated films, the results of diode measurements and the computed dose distributions were evaluated, and the data were compared on the basis of gamma maps and dose-difference histograms. Average deviations in the high-dose region between diode measurements and point dose calculations performed with the TPS and MC program were 0.7 ± 2.7% and 1.2 ± 3.1%, respectively. For film measurements, the mean gamma values with 3% dose difference and 3 mm distance-to-agreement were 0.74 ± 0.28 (TPS as reference) with dose deviations up to 10%. Corresponding values were significantly reduced to 0.34 ± 0.09 for MC dose calculation. The total time needed for both verification procedures is comparable, however, by far less labor intensive in the case of MC simulations. The presented study showed that independent dose calculation verification of IMRT plans with a fast MC program has the potential to eclipse film dosimetry more and more in the near future. Thus, the linac-specific QA part will necessarily become more important. In combination with MC simulations and due to the simple set-up, point-dose measurements for dosimetric plausibility checks are recommended at least in the IMRT introduction phase. (orig.)

A GPU-based finite-size pencil beam algorithm with 3D-density correction for radiotherapy dose calculation

International Nuclear Information System (INIS)

Gu Xuejun; Jia Xun; Jiang, Steve B; Jelen, Urszula; Li Jinsheng

2011-01-01

Targeting at the development of an accurate and efficient dose calculation engine for online adaptive radiotherapy, we have implemented a finite-size pencil beam (FSPB) algorithm with a 3D-density correction method on graphics processing unit (GPU). This new GPU-based dose engine is built on our previously published ultrafast FSPB computational framework (Gu et al 2009 Phys. Med. Biol. 54 6287-97). Dosimetric evaluations against Monte Carlo dose calculations are conducted on ten IMRT treatment plans (five head-and-neck cases and five lung cases). For all cases, there is improvement with the 3D-density correction over the conventional FSPB algorithm and for most cases the improvement is significant. Regarding the efficiency, because of the appropriate arrangement of memory access and the usage of GPU intrinsic functions, the dose calculation for an IMRT plan can be accomplished well within 1 s (except for one case) with this new GPU-based FSPB algorithm. Compared to the previous GPU-based FSPB algorithm without 3D-density correction, this new algorithm, though slightly sacrificing the computational efficiency (∼5-15% lower), has significantly improved the dose calculation accuracy, making it more suitable for online IMRT replanning.

Optimization of dose distributions for adjuvant locoregional radiotherapy of gastric cancer by IMRT

International Nuclear Information System (INIS)

Lohr, F.; Dobler, B.; Mai, S.; Hermann, B.; Tiefenbacher, U.; Wieland, P.; Steil, V.; Wenz, F.

2003-01-01

Background and Purpose: Locoregional relapse is a problem frequently encountered with advanced gastric cancer. Data from the randomized Intergroup trial 116 suggest effectiveness of adjuvant radiochemotherapy, albeit with significant toxicity. The potential of intensity-modulated radiotherapy (IMRT) to reduce toxicity by significantly reducing maximum and median doses to organs at risk while still applying sufficient dose to the target volume in the upper abdomen was studied. Patient and Methods: For a typical configuration of target volumes and organs, a step-and-shoot IMRT plan (eight beam orientations), developed as a class solution for treatment of tumors in the upper abdomen (Figures 1 to 3), a conventional plan, a combination of the conventional plan with a kidney-sparing boost plan, and a conventional plan with noncoplanar ap and pa fields for improved kidney sparing were compared with respect to coverage of target volume and dose to organs at risk with a dose of 45 Gy delivered as the median dose to the target volume. Results: When using the conventional three-dimensionally planned box techniques, the right kidney could be kept below tolerance, but median dose to the left kidney amounted to between 14.8 and 26.9 Gy, depending on the plan. IMRT reduced the median dose to the left kidney to 10.5 Gy, while still keeping the dose to the right kidney 90% of prescription dose were delivered to > 90% of target volume with IMRT (Table 1). Conclusion: IMRT has the potential to deliver efficient doses to target volumes in the upper abdomen, while delivering dose to organs at risk in a more advantageous fashion than a conventional technique. For clinical implementation, the possibility of extensive organ motion in the upper abdomen has to be taken into account for treatment planning and patient positioning. The multitude of potential risks related to its application has to be the subject of thorough follow-up and further studies. (orig.)

IMRT delivers lower radiation doses to dental structures than 3DRT in head and neck cancer patients.

Science.gov (United States)

Fregnani, Eduardo Rodrigues; Parahyba, Cláudia Joffily; Morais-Faria, Karina; Fonseca, Felipe Paiva; Ramos, Pedro Augusto Mendes; de Moraes, Fábio Yone; da Conceição Vasconcelos, Karina Gondim Moutinho; Menegussi, Gisela; Santos-Silva, Alan Roger; Brandão, Thais B

2016-09-07

Radiotherapy (RT) is frequently used in the treatment of head and neck cancer, but different side-effects are frequently reported, including a higher frequency of radiation-related caries, what may be consequence of direct radiation to dental tissue. The intensity-modulated radiotherapy (IMRT) was developed to improve tumor control and decrease patient's morbidity by delivering radiation beams only to tumor shapes and sparing normal tissue. However, teeth are usually not included in IMRT plannings and the real efficacy of IMRT in the dental context has not been addressed. Therefore, the aim of this study is to assess whether IMRT delivers lower radiation doses to dental structures than conformal 3D radiotherapy (3DRT). Radiation dose delivery to dental structures of 80 patients treated for head and neck cancers (oral cavity, tongue, nasopharynx and oropharynx) with IMRT (40 patients) and 3DRT (40 patients) were assessed by individually contouring tooth crowns on patients' treatment plans. Clinicopathological data were retrieved from patients' medical files. The average dose of radiation to teeth delivered by IMRT was significantly lower than with 3DRT (p = 0.007); however, only patients affected by nasopharynx and oral cavity cancers demonstrated significantly lower doses with IMRT (p = 0.012 and p = 0.011, respectively). Molars received more radiation with both 3DRT and IMRT, but the latter delivered significantly lower radiation in this group of teeth (p dental groups. Maxillary teeth received lower doses than mandibular teeth, but only IMRT delivered significantly lower doses (p = 0.011 and p = 0.003). Ipsilateral teeth received higher doses than contralateral teeth with both techniques and IMRT delivered significantly lower radiation than 3DRT for contralateral dental structures (p radiation doses to teeth than 3DRT, but only for some groups of patients and teeth, suggesting that this decrease was more likely due to the protection of

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)

Comparison of 3D anatomical dose verification and 2D phantom dose verification of IMRT/VMAT treatments for nasopharyngeal carcinoma

International Nuclear Information System (INIS)

Lin, Hailei; Huang, Shaomin; Deng, Xiaowu; Zhu, Jinhan; Chen, Lixin

2014-01-01

The two-dimensional phantom dose verification (2D-PDV) using hybrid plan and planar dose measurement has been widely used for IMRT treatment QA. Due to the lack of information about the correlations between the verification results and the anatomical structure of patients, it is inadequate in clinical evaluation. A three-dimensional anatomical dose verification (3D-ADV) method was used in this study to evaluate the IMRT/VMAT treatment delivery for nasopharyngeal carcinoma and comparison with 2D-PDV was analyzed. Twenty nasopharyngeal carcinoma (NPC) patients treated with IMRT/VMAT were recruited in the study. A 2D ion-chamber array was used for the 2D-PDV in both single-gantry-angle composite (SGAC) and multi-gantry-angle composite (MGAC) verifications. Differences in the gamma pass rate between the 2 verification methods were assessed. Based on measurement of irradiation dose fluence, the 3D dose distribution was reconstructed for 3D-ADV in the above cases. The reconstructed dose homogeneity index (HI), conformity index (CI) of the planning target volume (PTV) were calculated. Gamma pass rate and deviations in the dose-volume histogram (DVH) of each PTV and organ at risk (OAR) were analyzed. In 2D-PDV, the gamma pass rate (3%, 3 mm) of SGAC (99.55% ± 0.83%) was significantly higher than that of MGAC (92.41% ± 7.19%). In 3D-ADV, the gamma pass rates (3%, 3 mm) were 99.75% ± 0.21% in global, 83.82% ± 16.98% to 93.71% ± 6.22% in the PTVs and 45.12% ± 32.78% to 98.08% ± 2.29% in the OARs. The maximum HI increment in PTVnx was 19.34%, while the maximum CI decrement in PTV1 and PTV2 were -32.45% and -6.93%, respectively. Deviations in dose volume of PTVs were all within ±5%. D2% of the brainstem, spinal cord, left/right optic nerves, and the mean doses to the left/right parotid glands maximally increased by 3.5%, 6.03%, 31.13%/26.90% and 4.78%/4.54%, respectively. The 2D-PDV and global gamma pass rate might be insufficient to provide an accurate assessment for

IMRT delivers lower radiation doses to dental structures than 3DRT in head and neck cancer patients

International Nuclear Information System (INIS)

Fregnani, Eduardo Rodrigues; Parahyba, Cláudia Joffily; Morais-Faria, Karina; Fonseca, Felipe Paiva; Ramos, Pedro Augusto Mendes; Moraes, Fábio Yone de; Conceição Vasconcelos, Karina Gondim Moutinho da; Menegussi, Gisela; Santos-Silva, Alan Roger; Brandão, Thais B.

2016-01-01

Radiotherapy (RT) is frequently used in the treatment of head and neck cancer, but different side-effects are frequently reported, including a higher frequency of radiation-related caries, what may be consequence of direct radiation to dental tissue. The intensity-modulated radiotherapy (IMRT) was developed to improve tumor control and decrease patient’s morbidity by delivering radiation beams only to tumor shapes and sparing normal tissue. However, teeth are usually not included in IMRT plannings and the real efficacy of IMRT in the dental context has not been addressed. Therefore, the aim of this study is to assess whether IMRT delivers lower radiation doses to dental structures than conformal 3D radiotherapy (3DRT). Radiation dose delivery to dental structures of 80 patients treated for head and neck cancers (oral cavity, tongue, nasopharynx and oropharynx) with IMRT (40 patients) and 3DRT (40 patients) were assessed by individually contouring tooth crowns on patients’ treatment plans. Clinicopathological data were retrieved from patients’ medical files. The average dose of radiation to teeth delivered by IMRT was significantly lower than with 3DRT (p = 0.007); however, only patients affected by nasopharynx and oral cavity cancers demonstrated significantly lower doses with IMRT (p = 0.012 and p = 0.011, respectively). Molars received more radiation with both 3DRT and IMRT, but the latter delivered significantly lower radiation in this group of teeth (p < 0.001), whereas no significant difference was found for the other dental groups. Maxillary teeth received lower doses than mandibular teeth, but only IMRT delivered significantly lower doses (p = 0.011 and p = 0.003). Ipsilateral teeth received higher doses than contralateral teeth with both techniques and IMRT delivered significantly lower radiation than 3DRT for contralateral dental structures (p < 0.001). IMRT delivered lower radiation doses to teeth than 3DRT, but only for some groups of patients and

Evaluation of homogeneity and dose conformity in IMRT planning in prostate radiotherapy; Avaliacao da homogeneidade e conformidade de dose em planejamentos de IMRT de prostata em radioterapia

Energy Technology Data Exchange (ETDEWEB)

Lopes, Juliane S.; Leidens, Matheus; Estacio, Daniela R., E-mail: juliane.lopes@pucrs.br [Hospital Sao Lucas (PUC-RS), Porto Alegre, RS (Brazil). Servico de Radioterapia; Razera, Ricardo A.Z.; Streck, Elaine E.; Silva, Ana M.M. da [Pontificia Universidade Catolica do Rio Grande do Sul (PUC-RS), Porto Alegre, RS (Brazil). Faculdade de Fisica

2015-12-15

The goal of this study was to evaluate the dose distribution homogeneity and conformity of radiation therapy plans of prostate cancer using IMRT. Data from 34 treatment plans of Hospital Sao Lucas of PUCRS, where those plans were executed, were retrospectively analyzed. All of them were done with 6MV X-rays from a linear accelerator CLINAC IX, and the prescription doses varied between 60 and 74 Gy. Analyses showing the homogeneity and conformity indices for the dose distribution of those plans were made. During these analyses, some comparisons with the traditional radiation therapy planning technic, the 3D-CRT, were discussed. The results showed that there is no correlation between the prescribed dose and the homogeneity and conformity indices, indicating that IMRT works very well even for higher doses. Furthermore, a comparison between the results obtained and the recommendations of ICRU 83 was carried out. It has also been observed that the indices were really close to the ideal values. 82.4% of the cases showed a difference below 5% of the ideal value for the index of conformity, and 88.2% showed a difference below 10% for the homogeneity index. Concluding, it is possible to confirm the quality of the analyzed radiation therapy plans of prostate cancer using IMRT. (author)

Application of monomer/polymer gel dosimetry to study the effects of tissue inhomogeneities on intensity-modulated radiation therapy (IMRT) dose distributions.

Science.gov (United States)

Vergote, Koen; De Deene, Yves; Claus, Filip; De Gersem, Werner; Van Duyse, Bart; Paelinck, Leen; Achten, Eric; De Neve, Wilfried; De Wagter, Carlos

2003-04-01

When planning an intensity-modulated radiation therapy (IMRT) treatment in a heterogeneous region (e.g. the thorax), the dose computation algorithm of a treatment planning system may need to account for these inhomogeneities in order to obtain a reliable prediction of the dose distribution. An accurate dose verification technique such as monomer/polymer gel dosimetry is suggested to verify the outcome of the planning system. The effects of low-density structures: (a) on narrow high-energy (18 MV) photon beams; and (b) on a class-solution IMRT treatment delivered to a thorax phantom have been examined using gel dosimetry. The used phantom contained air cavities that could be filled with water to simulate a homogeneous or heterogeneous configuration. The IMRT treatment for centrally located lung tumors was delivered on both cases, and gel derived dose maps were compared with computations by both the GRATIS and Helax-TMS planning system. Dose rebuildup due to electronic disequilibrium in a narrow photon beam is demonstrated. The gel measurements showed good agreement with diamond detector measurements. Agreement between measured IMRT dose maps and dose computations was demonstrated by several quantitative techniques. An underdosage of the planning target volume (PTV) was revealed. The homogeneity of the phantom had only a minor influence on the dose distribution in the PTV. An expansion of low-level isodoses in the lung volume was predicted by collapsed cone computations in the heterogeneous case. For the class-solution described, the dose in centrally located mediastinal tumors can be computed with sufficient accuracy, even when neglecting the lower lung density. Polymer gel dosimetry proved to be a valuable technique to verify dose calculation algorithms for IMRT in 3D in heterogeneous configurations.

IMRT in a pregnant patient: how to reduce the fetal dose?

DEFF Research Database (Denmark)

Josipovic, Mirjana; Nyström, Håkan; Kjaer-Kristoffersen, Flemming

2008-01-01

dose distribution. The peripheral dose originating from the final IMRT plan was measured at distances reaching from the most proximal to the most distal fetal position, along the accelerator's longitudinal axis, using an anthropomorphic phantom extended with water-equivalent plastic. The measured...... was built and placed beneath the accelerator head, extending caudally from the field edge, to function as an extra collimator jaw. This shield reduced the fetal dose by a factor of 3.5. The peripheral dose components were also measured for simple rectangular fields and also here the collimator scatter...... was the greatest contributor to the peripheral dose. Therefore, the shielding used for the IMRT treatment of our patient could also be used when shielding in conventional radiotherapy. It is important for a radiation therapy department to be prepared for treatment of a pregnant patient to shield the fetus...

SU-F-J-133: Adaptive Radiation Therapy with a Four-Dimensional Dose Calculation Algorithm That Optimizes Dose Distribution Considering Breathing Motion

Energy Technology Data Exchange (ETDEWEB)

Ali, I; Algan, O; Ahmad, S [University of Oklahoma Health Sciences, Oklahoma City, OK (United States); Alsbou, N [University of Central Oklahoma, Edmond, OK (United States)

2016-06-15

Purpose: To model patient motion and produce four-dimensional (4D) optimized dose distributions that consider motion-artifacts in the dose calculation during the treatment planning process. Methods: An algorithm for dose calculation is developed where patient motion is considered in dose calculation at the stage of the treatment planning. First, optimal dose distributions are calculated for the stationary target volume where the dose distributions are optimized considering intensity-modulated radiation therapy (IMRT). Second, a convolution-kernel is produced from the best-fitting curve which matches the motion trajectory of the patient. Third, the motion kernel is deconvolved with the initial dose distribution optimized for the stationary target to produce a dose distribution that is optimized in four-dimensions. This algorithm is tested with measured doses using a mobile phantom that moves with controlled motion patterns. Results: A motion-optimized dose distribution is obtained from the initial dose distribution of the stationary target by deconvolution with the motion-kernel of the mobile target. This motion-optimized dose distribution is equivalent to that optimized for the stationary target using IMRT. The motion-optimized and measured dose distributions are tested with the gamma index with a passing rate of >95% considering 3% dose-difference and 3mm distance-to-agreement. If the dose delivery per beam takes place over several respiratory cycles, then the spread-out of the dose distributions is only dependent on the motion amplitude and not affected by motion frequency and phase. This algorithm is limited to motion amplitudes that are smaller than the length of the target along the direction of motion. Conclusion: An algorithm is developed to optimize dose in 4D. Besides IMRT that provides optimal dose coverage for a stationary target, it extends dose optimization to 4D considering target motion. This algorithm provides alternative to motion management

After low and high dose-rate interstitial brachytherapy followed by IMRT radiotherapy for intermediate and high risk prostate cancer

International Nuclear Information System (INIS)

Nakamura, Satoshi; Murakami, Naoya; Inaba, Koji; Wakita, Akihisa; Kobayashi, Kazuma; Takahashi, Kana; Okamoto, Hiroyuki; Umezawa, Rei; Morota, Madoka; Sumi, Minako; Igaki, Hiroshi; Ito, Yoshinori; Itami, Jun

2016-01-01

The study aimed to compare urinary symptoms in patients with clinically localized prostate cancer after a combination of either low-dose-rate or high-dose-rate interstitial brachytherapy along with intensity-modulated radiation therapy (LDR-ISBT + IMRT or HDR-ISBT + IMRT). From June 2009 to April 2014, 16 and 22 patients were treated with LDR-ISBT + IMRT and HDR-ISBT + IMRT, respectively. No patient from these groups was excluded from this study. The prescribed dose of LDR-ISBT, HDR-ISBT, and IMRT was 115 Gy, 20 Gy in 2 fractions, and 46 Gy in 23 fractions, respectively. Obstructive and irritative urinary symptoms were assessed by the International Prostate Symptom Score (IPSS) examined before and after treatments. After ISBT, IPSS was evaluated in the 1st and 4th weeks, then every 2–3 months for the 1st year, and every 6 months thereafter. The median follow-up of the patients treated with LDR-ISBT + IMRT and HDR-ISBT + IMRT was 1070.5 days and 1048.5 days, respectively (p = 0.321). The IPSS-increment in the LDR-ISBT + IMRT group was greater than that in the HDR-ISBT + IMRT between 91 and 180 days after ISBT (p = 0.015). In the LDR-ISBT + IMRT group, the IPSS took longer time to return to the initial level than in the HDR-ISBT + IMRT group (in LDR-ISBT + IMRT group, the recovery time was 90 days later). The dose to urethra showed a statistically significant association with the IPSS-increment in the irritative urinary symptoms (p = 0.011). Clinical outcomes were comparable between both the groups. Both therapeutic modalities are safe and well suited for patients with clinically localized prostate cancer; however, it took patients longer to recover from LDR-ISBT + IMRT than from HDR-ISBT + IMRT. It is possible that fast dose delivery induced early symptoms and early recovery, while gradual dose delivery induced late symptoms and late recovery. Urethral dose reductions were associated with small increments in IPSS

A virtual photon source model of an Elekta linear accelerator with integrated mini MLC for Monte Carlo based IMRT dose calculation.

Science.gov (United States)

Sikora, M; Dohm, O; Alber, M

2007-08-07

A dedicated, efficient Monte Carlo (MC) accelerator head model for intensity modulated stereotactic radiosurgery treatment planning is needed to afford a highly accurate simulation of tiny IMRT fields. A virtual source model (VSM) of a mini multi-leaf collimator (MLC) (the Elekta Beam Modulator (EBM)) is presented, allowing efficient generation of particles even for small fields. The VSM of the EBM is based on a previously published virtual photon energy fluence model (VEF) (Fippel et al 2003 Med. Phys. 30 301) commissioned with large field measurements in air and in water. The original commissioning procedure of the VEF, based on large field measurements only, leads to inaccuracies for small fields. In order to improve the VSM, it was necessary to change the VEF model by developing (1) a method to determine the primary photon source diameter, relevant for output factor calculations, (2) a model of the influence of the flattening filter on the secondary photon spectrum and (3) a more realistic primary photon spectrum. The VSM model is used to generate the source phase space data above the mini-MLC. Later the particles are transmitted through the mini-MLC by a passive filter function which significantly speeds up the time of generation of the phase space data after the mini-MLC, used for calculation of the dose distribution in the patient. The improved VSM model was commissioned for 6 and 15 MV beams. The results of MC simulation are in very good agreement with measurements. Less than 2% of local difference between the MC simulation and the diamond detector measurement of the output factors in water was achieved. The X, Y and Z profiles measured in water with an ion chamber (V = 0.125 cm(3)) and a diamond detector were used to validate the models. An overall agreement of 2%/2 mm for high dose regions and 3%/2 mm in low dose regions between measurement and MC simulation for field sizes from 0.8 x 0.8 cm(2) to 16 x 21 cm(2) was achieved. An IMRT plan film verification

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

Micro ionization chamber dosimetry in IMRT verification: Clinical implications of dosimetric errors in the PTV

International Nuclear Information System (INIS)

Sanchez-Doblado, Francisco; Capote, Roberto; Rosello, Joan V.; Leal, Antonio; Lagares, Juan I.; Arrans, Rafael; Hartmann, Guenther H.

2005-01-01

Background and purpose: Absolute dose measurements for Intensity Modulated Radiotherapy (IMRT) beamlets is difficult due to the lack of lateral electron equilibrium. Recently we found that the absolute dosimetry in the penumbra region of the IMRT beamlet, can suffer from significant errors (Capote et al., Med Phys 31 (2004) 2416-2422). This work has the goal to estimate the error made when measuring the Planning Target Volume's (PTV) absolute dose by a micro ion chamber (μIC) in typical IMRT treatment. The dose error comes from the assumption that the dosimetric parameters determining the absolute dose are the same as for the reference conditions. Materials and Methods: Two IMRT treatment plans for common prostate carcinoma case, derived by forward and inverse optimisation, were considered. Detailed geometrical simulation of the μIC and the dose verification set-up was performed. The Monte Carlo (MC) simulation allows us to calculate the delivered dose to water and the dose delivered to the active volume of the ion chamber. However, the measured dose in water is usually derived from chamber readings assuming reference conditions. The MC simulation provides needed correction factors for ion chamber dosimetry in non reference conditions. Results: Dose calculations were carried out for some representative beamlets, a combination of segments and for the delivered IMRT treatments. We observe that the largest dose errors (i.e. the largest correction factors) correspond to the smaller contribution of the corresponding IMRT beamlets to the total dose delivered in the ionization chamber within PTV. Conclusion: The clinical impact of the calculated dose error in PTV measured dose was found to be negligible for studied IMRT treatments

SU-E-T-196: Comparative Analysis of Surface Dose Measurements Using MOSFET Detector and Dose Predicted by Eclipse - AAA with Varying Dose Calculation Grid Size

Energy Technology Data Exchange (ETDEWEB)

Badkul, R; Nejaiman, S; Pokhrel, D; Jiang, H; Kumar, P [University of Kansas Medical Center, Kansas City, KS (United States)

2015-06-15

Purpose: Skin dose can be the limiting factor and fairly common reason to interrupt the treatment, especially for treating head-and-neck with Intensity-modulated-radiation-therapy(IMRT) or Volumetrically-modulated - arc-therapy (VMAT) and breast with tangentially-directed-beams. Aim of this study was to investigate accuracy of near-surface dose predicted by Eclipse treatment-planning-system (TPS) using Anisotropic-Analytic Algorithm (AAA)with varying calculation grid-size and comparing with metal-oxide-semiconductor-field-effect-transistors(MOSFETs)measurements for a range of clinical-conditions (open-field,dynamic-wedge, physical-wedge, IMRT,VMAT). Methods: QUASAR™-Body-Phantom was used in this study with oval curved-surfaces to mimic breast, chest wall and head-and-neck sites.A CT-scan was obtained with five radio-opaque markers(ROM) placed on the surface of phantom to mimic the range of incident angles for measurements and dose prediction using 2mm slice thickness.At each ROM, small structure(1mmx2mm) were contoured to obtain mean-doses from TPS.Calculations were performed for open-field,dynamic-wedge,physical-wedge,IMRT and VMAT using Varian-21EX,6&15MV photons using twogrid-sizes:2.5mm and 1mm.Calibration checks were performed to ensure that MOSFETs response were within ±5%.Surface-doses were measured at five locations and compared with TPS calculations. Results: For 6MV: 2.5mm grid-size,mean calculated doses(MCD)were higher by 10%(±7.6),10%(±7.6),20%(±8.5),40%(±7.5),30%(±6.9) and for 1mm grid-size MCD were higher by 0%(±5.7),0%(±4.2),0%(±5.5),1.2%(±5.0),1.1% (±7.8) for open-field,dynamic-wedge,physical-wedge,IMRT,VMAT respectively.For 15MV: 2.5mm grid-size,MCD were higher by 30%(±14.6),30%(±14.6),30%(±14.0),40%(±11.0),30%(±3.5)and for 1mm grid-size MCD were higher by 10% (±10.6), 10%(±9.8),10%(±8.0),30%(±7.8),10%(±3.8) for open-field, dynamic-wedge, physical-wedge, IMRT, VMAT respectively.For 6MV, 86% and 56% of all measured values

A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer: A radiobiological modeling study

Energy Technology Data Exchange (ETDEWEB)

Fatyga, M.; Williamson, J. F.; Dogan, N.; Todor, D.; Siebers, J. V.; George, R.; Barani, I.; Hagan, M. [Department of Radiation Oncology, Virginia Commonwealth University Medical Center, 401 College Street, Richmond, Virginia 23298 (United States)

2009-09-15

A course of one to three large fractions of high dose rate (HDR) interstitial brachytherapy is an attractive alternative to intensity modulated radiation therapy (IMRT) for delivering boost doses to the prostate in combination with additional external beam irradiation for intermediate risk disease. The purpose of this work is to quantitatively compare single-fraction HDR boosts to biologically equivalent fractionated IMRT boosts, assuming idealized image guided delivery (igIMRT) and conventional delivery (cIMRT). For nine prostate patients, both seven-field IMRT and HDR boosts were planned. The linear-quadratic model was used to compute biologically equivalent dose prescriptions. The cIMRT plan was evaluated as a static plan and with simulated random and setup errors. The authors conclude that HDR delivery produces a therapeutic ratio which is significantly better than the conventional IMRT and comparable to or better than the igIMRT delivery. For the HDR, the rectal gBEUD analysis is strongly influenced by high dose DVH tails. A saturation BED, beyond which no further injury can occur, must be assumed. Modeling of organ motion uncertainties yields mean outcomes similar to static plan outcomes.

Towards biologically conformal radiation therapy (BCRT): Selective IMRT dose escalation under the guidance of spatial biology distribution

International Nuclear Information System (INIS)

Yang Yong; Xing Lei

2005-01-01

It is well known that the spatial biology distribution (e.g., clonogen density, radiosensitivity, tumor proliferation rate, functional importance) in most tumors and sensitive structures is heterogeneous. Recent progress in biological imaging is making the mapping of this distribution increasingly possible. The purpose of this work is to establish a theoretical framework to quantitatively incorporate the spatial biology data into intensity modulated radiation therapy (IMRT) inverse planning. In order to implement this, we first derive a general formula for determining the desired dose to each tumor voxel for a known biology distribution of the tumor based on a linear-quadratic model. The desired target dose distribution is then used as the prescription for inverse planning. An objective function with the voxel-dependent prescription is constructed with incorporation of the nonuniform dose prescription. The functional unit density distribution in a sensitive structure is also considered phenomenologically when constructing the objective function. Two cases with different hypothetical biology distributions are used to illustrate the new inverse planning formalism. For comparison, treatments with a few uniform dose prescriptions and a simultaneous integrated boost are also planned. The biological indices, tumor control probability (TCP) and normal tissue complication probability (NTCP), are calculated for both types of plans and the superiority of the proposed technique over the conventional dose escalation scheme is demonstrated. Our calculations revealed that it is technically feasible to produce deliberately nonuniform dose distributions with consideration of biological information. Compared with the conventional dose escalation schemes, the new technique is capable of generating biologically conformal IMRT plans that significantly improve the TCP while reducing or keeping the NTCPs at their current levels. Biologically conformal radiation therapy (BCRT

Dose distribution of IMRT and 3D-CRT on treating central non-small-cell lung cancer

International Nuclear Information System (INIS)

Zhu Xiaoyang; Yu Guangwei

2010-01-01

3D-CRT and IMRT were used in the radiation therapy of Central Non-small-cell lung cancer (NSCLC), and the dose difference of the methods was estimated. Thirty-two patients suffering with II class NSCLC were selected. Based on CT images, each patient was given 1 3D-CRT (3 dimensional conformal radiotherapy) and 2 IMRT(intensity modulated radiation therapy) treatment plans (5 fields and 7 fields), respectively, and the dose distribution was evaluated too. The results showed that PTVD mean and the PTV max , PTVD max (%) and CI of IMRT were both higher than those of 3D-CRT, but the uniformity was not as good as 3D-CRT. All indexes of lung and spinal cord treated with IMRT were lower than that treated with 3D-CRT. Moreover, there was no significance of the difference between 5 fields and 7 fields. In a conclusion, IMRT could not only decrease the target dose of NSCLC, but it can protect normal tissue from radiation damage effectively. And when IMRT was used, 5 fields might be enough. (authors)

GPU-Monte Carlo based fast IMRT plan optimization

Directory of Open Access Journals (Sweden)

Yongbao Li

2014-03-01

Full Text Available Purpose: Intensity-modulated radiation treatment (IMRT plan optimization needs pre-calculated beamlet dose distribution. Pencil-beam or superposition/convolution type algorithms are typically used because of high computation speed. However, inaccurate beamlet dose distributions, particularly in cases with high levels of inhomogeneity, may mislead optimization, hindering the resulting plan quality. It is desire to use Monte Carlo (MC methods for beamlet dose calculations. Yet, the long computational time from repeated dose calculations for a number of beamlets prevents this application. It is our objective to integrate a GPU-based MC dose engine in lung IMRT optimization using a novel two-steps workflow.Methods: A GPU-based MC code gDPM is used. Each particle is tagged with an index of a beamlet where the source particle is from. Deposit dose are stored separately for beamlets based on the index. Due to limited GPU memory size, a pyramid space is allocated for each beamlet, and dose outside the space is neglected. A two-steps optimization workflow is proposed for fast MC-based optimization. At first step, a rough dose calculation is conducted with only a few number of particle per beamlet. Plan optimization is followed to get an approximated fluence map. In the second step, more accurate beamlet doses are calculated, where sampled number of particles for a beamlet is proportional to the intensity determined previously. A second-round optimization is conducted, yielding the final result.Results: For a lung case with 5317 beamlets, 105 particles per beamlet in the first round, and 108 particles per beam in the second round are enough to get a good plan quality. The total simulation time is 96.4 sec.Conclusion: A fast GPU-based MC dose calculation method along with a novel two-step optimization workflow are developed. The high efficiency allows the use of MC for IMRT optimizations.--------------------------------Cite this article as: Li Y, Tian Z

Inverse planning IMRT

International Nuclear Information System (INIS)

Rosenwald, J.-C.

2008-01-01

The lecture addressed the following topics: Optimizing radiotherapy dose distribution; IMRT contributes to optimization of energy deposition; Inverse vs direct planning; Main steps of IMRT; Background of inverse planning; General principle of inverse planning; The 3 main components of IMRT inverse planning; The simplest cost function (deviation from prescribed dose); The driving variable : the beamlet intensity; Minimizing a 'cost function' (or 'objective function') - the walker (or skier) analogy; Application to IMRT optimization (the gradient method); The gradient method - discussion; The simulated annealing method; The optimization criteria - discussion; Hard and soft constraints; Dose volume constraints; Typical user interface for definition of optimization criteria; Biological constraints (Equivalent Uniform Dose); The result of the optimization process; Semi-automatic solutions for IMRT; Generalisation of the optimization problem; Driving and driven variables used in RT optimization; Towards multi-criteria optimization; and Conclusions for the optimization phase. (P.A.)

Evaluation of homogeneity and dose conformity in IMRT planning in prostate radiotherapy

International Nuclear Information System (INIS)

Lopes, Juliane S.; Leidens, Matheus; Estacio, Daniela R.; Razera, Ricardo A.Z.; Streck, Elaine E.; Silva, Ana M.M. da

2015-01-01

The goal of this study was to evaluate the dose distribution homogeneity and conformity of radiation therapy plans of prostate cancer using IMRT. Data from 34 treatment plans of Hospital Sao Lucas of PUCRS, where those plans were executed, were retrospectively analyzed. All of them were done with 6MV X-rays from a linear accelerator CLINAC IX, and the prescription doses varied between 60 and 74 Gy. Analyses showing the homogeneity and conformity indices for the dose distribution of those plans were made. During these analyses, some comparisons with the traditional radiation therapy planning technic, the 3D-CRT, were discussed. The results showed that there is no correlation between the prescribed dose and the homogeneity and conformity indices, indicating that IMRT works very well even for higher doses. Furthermore, a comparison between the results obtained and the recommendations of ICRU 83 was carried out. It has also been observed that the indices were really close to the ideal values. 82.4% of the cases showed a difference below 5% of the ideal value for the index of conformity, and 88.2% showed a difference below 10% for the homogeneity index. Concluding, it is possible to confirm the quality of the analyzed radiation therapy plans of prostate cancer using IMRT. (author)

Tolerance limits and methodologies for IMRT measurement-based verification QA: Recommendations of AAPM Task Group No. 218.

Science.gov (United States)

Miften, Moyed; Olch, Arthur; Mihailidis, Dimitris; Moran, Jean; Pawlicki, Todd; Molineu, Andrea; Li, Harold; Wijesooriya, Krishni; Shi, Jie; Xia, Ping; Papanikolaou, Nikos; Low, Daniel A

2018-04-01

Patient-specific IMRT QA measurements are important components of processes designed to identify discrepancies between calculated and delivered radiation doses. Discrepancy tolerance limits are neither well defined nor consistently applied across centers. The AAPM TG-218 report provides a comprehensive review aimed at improving the understanding and consistency of these processes as well as recommendations for methodologies and tolerance limits in patient-specific IMRT QA. The performance of the dose difference/distance-to-agreement (DTA) and γ dose distribution comparison metrics are investigated. Measurement methods are reviewed and followed by a discussion of the pros and cons of each. Methodologies for absolute dose verification are discussed and new IMRT QA verification tools are presented. Literature on the expected or achievable agreement between measurements and calculations for different types of planning and delivery systems are reviewed and analyzed. Tests of vendor implementations of the γ verification algorithm employing benchmark cases are presented. Operational shortcomings that can reduce the γ tool accuracy and subsequent effectiveness for IMRT QA are described. Practical considerations including spatial resolution, normalization, dose threshold, and data interpretation are discussed. Published data on IMRT QA and the clinical experience of the group members are used to develop guidelines and recommendations on tolerance and action limits for IMRT QA. Steps to check failed IMRT QA plans are outlined. Recommendations on delivery methods, data interpretation, dose normalization, the use of γ analysis routines and choice of tolerance limits for IMRT QA are made with focus on detecting differences between calculated and measured doses via the use of robust analysis methods and an in-depth understanding of IMRT verification metrics. The recommendations are intended to improve the IMRT QA process and establish consistent, and comparable IMRT QA

A hybrid electron and photon IMRT planning technique that lowers normal tissue integral patient dose using standard hardware.

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Rosca, Florin

2012-06-01

To present a mixed electron and photon IMRT planning technique using electron beams with an energy range of 6-22 MeV and standard hardware that minimizes integral dose to patients for targets as deep as 7.5 cm. Ten brain cases, two lung, a thyroid, an abdominal, and a parotid case were planned using two planning techniques: a photon-only IMRT (IMRT) versus a mixed modality treatment (E+IMRT) that includes an enface electron beam and a photon IMRT portion that ensures a uniform target coverage. The electron beam is delivered using a regular cutout placed in an electron cone. The electron energy was chosen to provide a good trade-off between minimizing integral dose and generating a uniform, deliverable plan. The authors choose electron energies that cover the deepest part of PTV with the 65%-70% isodose line. The normal tissue integral dose, the dose for ring structures around the PTV, and the volumes of the 75%, 50%, and 25% isosurfaces were used to compare the dose distributions generated by the two planning techniques. The normal tissue integral dose was lowered by about 20% by the E+IMRT plans compared to the photon-only IMRT ones for most studied cases. With the exception of lungs, the dose reduction associated to the E+IMRT plans was more pronounced further away from the target. The average dose ratio delivered to the 0-2 cm and the 2-4 cm ring structures for brain patients for the two planning techniques were 89.6% and 70.8%, respectively. The enhanced dose sparing away from the target for the brain patients can also be observed in the ratio of the 75%, 50%, and 25% isodose line volumes for the two techniques, which decreases from 85.5% to 72.6% and further to 65.1%, respectively. For lungs, the lateral electron beams used in the E+IMRT plans were perpendicular to the mostly anterior/posterior photon beams, generating much more conformal plans. The authors proved that even using the existing electron delivery hardware, a mixed electron/photon planning

Feasibility of CBCT-based dose calculation: Comparative analysis of HU adjustment techniques

International Nuclear Information System (INIS)

Fotina, Irina; Hopfgartner, Johannes; Stock, Markus; Steininger, Thomas; Lütgendorf-Caucig, Carola; Georg, Dietmar

2012-01-01

Background and purpose: The aim of this work was to compare the accuracy of different HU adjustments for CBCT-based dose calculation. Methods and materials: Dose calculation was performed on CBCT images of 30 patients. In the first two approaches phantom-based (Pha-CC) and population-based (Pop-CC) conversion curves were used. The third method (WAB) represents override of the structures with standard densities for water, air and bone. In ROI mapping approach all structures were overridden with average HUs from planning CT. All techniques were benchmarked to the Pop-CC and CT-based plans by DVH comparison and γ-index analysis. Results: For prostate plans, WAB and ROI mapping compared to Pop-CC showed differences in PTV D median below 2%. The WAB and Pha-CC methods underestimated the bladder dose in IMRT plans. In lung cases PTV coverage was underestimated by Pha-CC method by 2.3% and slightly overestimated by the WAB and ROI techniques. The use of the Pha-CC method for head–neck IMRT plans resulted in difference in PTV coverage up to 5%. Dose calculation with WAB and ROI techniques showed better agreement with pCT than conversion curve-based approaches. Conclusions: Density override techniques provide an accurate alternative to the conversion curve-based methods for dose calculation on CBCT images.

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

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Sakka, Mazen; Grabenbauer, Gerhard G. [Coburg Cancer Center, Department of Radiation Oncology, Coburg (Germany); Friedrich-Alexander University of Erlangen-Nuernberg, Faculty of Medicine, Erlangen (Germany); Kunzelmann, Leonie; Metzger, Martin [Coburg Cancer Center, Department of Radiation Oncology, Coburg (Germany)

2017-10-15

Given the reduction in death from breast cancer, as well as improvements in overall survival, adjuvant radiotherapy is considered the standard treatment for breast cancer. However, left-sided breast irradiation was associated with an increased rate of fatal cardiovascular events due to incidental irradiation of the heart. Recently, considerable efforts have been made to minimize cardiac toxicity of left-sided breast irradiation by new treatment methods such as deep-inspiration breath-hold (DIBH) and new radiation techniques, particularly intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT). The primary aim of this study was to evaluate the effect of DIBH irradiation on cardiac dose compared with free-breathing (FB) irradiation, while the secondary objective was to compare the advantages of IMRT versus VMAT plans in both the FB and the DIBH position for left-sided breast cancer. In all, 25 consecutive left-sided breast cancer patients underwent CT simulation in the FB and DIBH position. Five patients were excluded with no cardiac displacement following DIBH-CT simulation. The other 20 patients were irradiated in the DIBH position using respiratory gating. Four different treatment plans were generated for each patient, an IMRT and a VMAT plan in the DIBH and in the FB position, respectively. The following parameters were used for plan comparison: dose to the heart, left anterior descending coronary artery (mean dose, maximum dose, D25% and D45%), ipsilateral, contralateral lung (mean dose, D20%, D30%) and contralateral breast (mean dose). The percentage in dose reduction for organs at risk achieved by DIBH for both IMRT and VMAT plans was calculated and compared for each patient by each treatment plan. DIBH irradiation significantly reduced mean dose to the heart and left anterior descending coronary artery (LADCA) using both IMRT (heart -20%; p = 0.0002, LADCA -9%; p = 0.001) and VMAT (heart -23%; p = 0.00003, LADCA -16%; p = 0

The role and strategy of IMRT in radiotherapy of pelvic tumors: Dose escalation and critical organ sparing in prostate cancer

International Nuclear Information System (INIS)

Liu, Y.-M.; Shiau, C.-Y.; Lee, M.-L.; Huang, P.-I.; Hsieh, C.-M.; Chen, P.-H.; Lin, Y.-H.; Wang, L.-W.; Yen, S.-H.

2007-01-01

Purpose: To investigate the intensity-modulated radiotherapy (IMRT) strategy in dose escalation of prostate and pelvic lymph nodes. Methods and Materials: Plan dosimetric data of 10 prostate cancer patients were compared with two-dimensional (2D) or IMRT techniques for pelvis (two-dimensional whole pelvic radiation therapy [2D-WPRT] or IM-WPRT) to receive 50 Gy or 54 Gy and additional prostate boost by three-dimensional conformal radiation therapy or IMRT (3D-PBRT or IM-PBRT) techniques up to 72 Gy or 78 Gy. Dose-volume histograms (DVHs), normal tissue complication probabilities (NTCP) of critical organ, and conformity of target volume in various combinations were calculated. Results: In DVH analysis, the plans with IM-WPRT (54 Gy) and additional boost up to 78 Gy had lower rectal and bladder volume percentage at 50 Gy and 60 Gy, compared with those with 2D-WPRT (50 Gy) and additional boost up to 72 Gy or 78 Gy. Those with IM-WPRT (54 Gy) also had better small bowel sparing at 30 Gy and 50 Gy, compared with those with 2D-WPRT (50 Gy). In NTCP, those with IM-WPRT and total dose of 78 Gy achieved lower complication rates in rectum and small bowel, compared with those of 2D-WPRT with total dose of 72 Gy. In conformity, those with IM-WPRT had better conformity compared with those with 2D-WPRT with significance (p < 0.005). No significant difference in DVHs, NTCP, or conformity was found between IM-PBRT and 3D-PBRT after IM-WPRT. Conclusions: Initial pelvic IMRT is the most important strategy in dose escalation and critical organ sparing. IM-WPRT is recommended for patients requiring WPRT. There is not much benefit for critical organ sparing by IMRT after 2D-WPRT

SU-F-T-628: An Evaluation of Grid Size in Eclipse AcurosXB Dose Calculation Algorithm for SBRT Lung

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Pokharel, S [21st Century Oncology, Naples, FL (United States); Rana, S [McLaren Proton Therapy Center, Karmanos Cancer Institute at McLaren-Flint, Flint, MI (United States)

2016-06-15

Purpose: purpose of this study is to evaluate the effect of grid size in Eclipse AcurosXB dose calculation algorithm for SBRT lung. Methods: Five cases of SBRT lung previously treated have been chosen for present study. Four of the plans were 5 fields conventional IMRT and one was Rapid Arc plan. All five cases have been calculated with five grid sizes (1, 1.5, 2, 2.5 and 3mm) available for AXB algorithm with same plan normalization. Dosimetric indices relevant to SBRT along with MUs and time have been recorded for different grid sizes. The maximum difference was calculated as a percentage of mean of all five values. All the plans were IMRT QAed with portal dosimetry. Results: The maximum difference of MUs was within 2%. The time increased was as high as 7 times from highest 3mm to lowest 1mm grid size. The largest difference of PTV minimum, maximum and mean dose were 7.7%, 1.5% and 1.6% respectively. The highest D2-Max difference was 6.1%. The highest difference in ipsilateral lung mean, V5Gy, V10Gy and V20Gy were 2.6%, 2.4%, 1.9% and 3.8% respectively. The maximum difference of heart, cord and esophagus dose were 6.5%, 7.8% and 4.02% respectively. The IMRT Gamma passing rate at 2%/2mm remains within 1.5% with at least 98% points passing with all grid sizes. Conclusion: This work indicates the lowest grid size of 1mm available in AXB is not necessarily required for accurate dose calculation. The IMRT passing rate was insignificant or not observed with the reduction of grid size less than 2mm. Although the maximum percentage difference of some of the dosimetric indices appear large, most of them are clinically insignificant in absolute dose values. So we conclude that 2mm grid size calculation is best compromise in light of dose calculation accuracy and time it takes to calculate dose.

Dose planning objectives in anal canal cancer IMRT: the TROG ANROTAT experience

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Brown, Elizabeth, E-mail: elizabeth@mebrown.net [Princess Alexandra Hospital, Brisbane, Queensland (Australia); Cray, Alison [Peter MacCallum Cancer Cancer Centre, Box Hill, Victoria (Australia); Haworth, Annette [Peter MacCallum Cancer Cancer Centre, Box Hill, Victoria (Australia); University of Melbourne, Melbourne, Victoria (Australia); Chander, Sarat [Peter MacCallum Cancer Cancer Centre, Box Hill, Victoria (Australia); Lin, Robert [Medica Oncology, Hurstville, New South Wales (Australia); Subramanian, Brindha; Ng, Michael [Radiation Oncology Victoria, Melbourne, Victoria (Australia); Princess Alexandra Hospital, Brisbane, Queensland (Australia)

2015-06-15

Intensity modulated radiotherapy (IMRT) is ideal for anal canal cancer (ACC), delivering high doses to irregular tumour volumes whilst minimising dose to surrounding normal tissues. Establishing achievable dose objectives is a challenge. The purpose of this paper was to utilise data collected in the Assessment of New Radiation Oncology Treatments and Technologies (ANROTAT) project to evaluate the feasibility of ACC IMRT dose planning objectives employed in the Australian situation. Ten Australian centres were randomly allocated three data sets from 15 non-identifiable computed tomography data sets representing a range of disease stages and gender. Each data set was planned by two different centres, producing 30 plans. All tumour and organ at risk (OAR) contours, prescription and dose constraint details were provided. Dose–volume histograms (DVHs) for each plan were analysed to evaluate the feasibility of dose planning objectives provided. All dose planning objectives for the bone marrow (BM) and femoral heads were achieved. Median planned doses exceeded one or more objectives for bowel, external genitalia and bladder. This reached statistical significance for bowel V30 (P = 0.04), V45 (P < 0.001), V50 (P < 0.001), external genitalia V20 (P < 0.001) and bladder V35 (P < 0.001), V40 (P = 0.01). Gender was found to be the only significant factor in the likelihood of achieving the bowel V50 (P = 0.03) and BM V30 constraints (P = 0.04). The dose planning objectives used in the ANROTAT project provide a good starting point for ACC IMRT planning. To facilitate clinical implementation, it is important to prioritise OAR objectives and recognise factors that affect the achievability of these objectives.

SU-F-T-686: Considerations About Dose Protraction Factor in TCP Calculations for Prostate VMAT Treatments

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Clemente, F; Perez-Vara, C; Clavo, M [Herranz Hospital Central de la Defensa “Gomez Ulla”, Madrid (Spain)

2016-06-15

Purpose: Dose protraction factor should be considered in order to model the TCP calculations. Nevertheless, this study describes a brief discussion showing that the lack of its inclusion should not invalidate these calculations for prostate VMAT treatments. Methods: Dose protraction factor (G) modifies the quadratic term of the linear-quadratic expression in order to take into account the sublethal damage repair of protracting the dose delivery. If the delivery takes a short time (instantaneous), G = 1. For any other dose delivery pattern, G < 1. The Lea-Catcheside dose protraction factor for external beam radiotherapy contains terms depending of on the tissue specific repair parameter (λ) and the irradiation time (T). Expanding the exponential term using a Taylor’s series and neglecting terms of order (λT){sup 3}, the approximation leads to G = 1. The described situation occurs for 3DCRT techniques, where treatment times are about few minutes. For IMRT techniques, fraction times are prolonged compared to 3DCRT times. Wang et al. (2003) and Fowler et al. (2004) investigated the protraction effect with respect to IMRT treatments, reporting clinically significant loss in biological effect associated with IMRT delivery times. Results: Treatment times are noticeably reduced for prostate treatments using VMAT techniques. These times are comparable to 3DCRT times, leading to consider the previous approximation. Conclusion: Dose protraction factor can be approximated by G = 1 in TCP calculations for prostate treatments using VMAT techniques.

Comparison of dose distribution between 3DCRT and IMRT in middle thoracic and under thoracic esophageal carcinoma

International Nuclear Information System (INIS)

Li Dingjie; Liu Hailong; Mao Ronghu; Liu Ru; Guo Xiaoqi; Lei Hongchang; Wang Jianhua

2011-01-01

Objective: To compare the dose distribution between three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) in treating esophageal carcinoma (middle thoracic section and under thoracic section) and to select reasonable treatment methods for esophagus cancer. Methods: Ten cases with cancer of the middle thoracic section and under thoracic section esophagus were chosen for a retrospective treatment-planning study. 3DCRT and IMRT plans were created for each patient: Some critical indicators were evolved in evaluating the treatment plans of IMRT (5B and 7B) and 3DCRT (3B), such as, PTV coverage and dose-volumes to irradiated normal structures. Evaluation indicators: prescription of 50 Gy. total lung volume (V5, V10, V20), mean lung dose (MLD), spinal cord (Dmax), heart (V40) and conformality index (CI). Each plan was evaluated with respect to dose distribution,dose-volume histograms (DVHs), and additional dosimetric endpoints described below. Results: There is no significance of CRT and IMRT technique in protection of total lung volume,mean lung dose, spinal cord (Dmax), target, CI and heart. Conclusion: As To radiotherapy of esophagus cancer of the middle thoracic section and under thoracic section, IMRT has no advantage compared with 3DCRT, the selection of plan should be adapted to the situations of every patient. (authors)

Acceptance for clinical use of a treatment planning system with IMRT and VMAT techniques; Aceptacion para uso clinico de un sistema de planificacion de tratamientos con tecnicas de IMRT y VMAT

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Serna, A.; Puchades, V.; Mata, F.

2011-07-01

Purpose: In this work the set of measurements and results to test the reliability of the calculated absorbed dose by our treatment planning system (Tps) for intensity modulated radiation therapy (Imr) and volumetric modulated arc therapy (Vat) is reported. Method: A set of measures was performed, both point and planar absorbed dose, selecting a set of conventional and Imr and Vat treatment fields. A gamma criteria 3 mm distance to agreement and 3% dose difference (referred to the maximum dose) was used for the planar distribution analysis, using a 10% of maximum dose as threshold. Based on this set of measures the confidence limits were calculated for the Imr and VMAT plans, and compared with the reference values given in AAPM TG119 document. Results: The average percentage deviation of point dose measures was lower than 0.5% for conventional fields and lower than 1% for IMRT and VMAT fields. Calculated confidence limits were 3.6% and 4.6% for point dose and almost zero for planar dose distributions, for IMRT and VMAT respectively. Conclusions: Our confidence levels improve significantly the AAPM TG119 reference levels both for point and planar doses, thus ensuring the reliability of the TPS performing IMRT and VMAT dose calculations. (Author) 17 refs.

Intensity modulated radiation therapy (IMRT: differences in target volumes and improvement in clinically relevant doses to small bowel in rectal carcinoma

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Delclos Marc E

2011-06-01

Full Text Available Abstract Background A strong dose-volume relationship exists between the amount of small bowel receiving low- to intermediate-doses of radiation and the rates of acute, severe gastrointestinal toxicity, principally diarrhea. There is considerable interest in the application of highly conformal treatment approaches, such as intensity-modulated radiation therapy (IMRT, to reduce dose to adjacent organs-at-risk in the treatment of carcinoma of the rectum. Therefore, we performed a comprehensive dosimetric evaluation of IMRT compared to 3-dimensional conformal radiation therapy (3DCRT in standard, preoperative treatment for rectal cancer. Methods Using RTOG consensus anorectal contouring guidelines, treatment volumes were generated for ten patients treated preoperatively at our institution for rectal carcinoma, with IMRT plans compared to plans derived from classic anatomic landmarks, as well as 3DCRT plans treating the RTOG consensus volume. The patients were all T3, were node-negative (N = 1 or node-positive (N = 9, and were planned to a total dose of 45-Gy. Pairwise comparisons were made between IMRT and 3DCRT plans with respect to dose-volume histogram parameters. Results IMRT plans had superior PTV coverage, dose homogeneity, and conformality in treatment of the gross disease and at-risk nodal volume, in comparison to 3DCRT. Additionally, in comparison to the 3DCRT plans, IMRT achieved a concomitant reduction in doses to the bowel (small bowel mean dose: 18.6-Gy IMRT versus 25.2-Gy 3DCRT; p = 0.005, bladder (V40Gy: 56.8% IMRT versus 75.4% 3DCRT; p = 0.005, pelvic bones (V40Gy: 47.0% IMRT versus 56.9% 3DCRT; p = 0.005, and femoral heads (V40Gy: 3.4% IMRT versus 9.1% 3DCRT; p = 0.005, with an improvement in absolute volumes of small bowel receiving dose levels known to induce clinically-relevant acute toxicity (small bowel V15Gy: 138-cc IMRT versus 157-cc 3DCRT; p = 0.005. We found that the IMRT treatment volumes were typically larger than that

SU-E-T-492: The Dosimetric and Clinical Impact of the Metallic Dental Implants on Radiation Dose Distributions in IMRT Head and Neck Cancer Patients.

Science.gov (United States)

Wang, L; Xing, L; Le, Q

2012-06-01

In H&N cancer patients, the development of oral mucositis is related closely to the radiation dose to the oral cavity. It is generally presumed that the existence of metallic dental implants makes it worse due to the scattering effect of the metal. This study investigates the effects of the dental implants on radiation doses to PTV, tongue mucosa, and other structures for IMRT H&N cancer patients by Monte Carlo (MC) dose calculations. Two H&N cancer patients who have dental implant and are treated by IMRT technique are selected for the purpose. The BEAMnrc/DOSXYZnrc MC codes are employed for the CT-image based dose calculations. The radiation sources are the validated Varian phase-space files for 6MV linac beams. The CT image artifacts caused by the dental fillings are replaced by tissue material. Two sets of MC calculations for each patient are performed at a calculation statistics of 1%: one treats all dental implants as bones, the other substitutes the implants by metal of either titanium or gold with correct density. Doses in PTV and various tissue structures are compared for the two scenarios. With titanium implant, there is no significant difference in doses to PTV and tongue mucosa from that when treating implant as bone. With gold implant, the mean dose to PTV is slightly lowered by 1%; the mean dose to tongue mucosa is reduced by less than 0.5%, although the maximum dose is increased by 5%. The scattering dose from titanium implants is not of concern for H&N patients irradiated by 6MV IMRT beams. For gold implants, the scattering dose to tongue mucosa is not as severe as presumed; and the dose to PTV could be slightly compromised due to the attenuation effect of the metal. This work was supported in part by Varian Medical Systems. © 2012 American Association of Physicists in Medicine.

Skin dose for head and neck cancer patients treated with intensity-modulated radiation therapy(IMRT)

Science.gov (United States)

Fu, Hsiao-Ju; Li, Chi-Wei; Tsai, Wei-Ta; Chang, Chih-Chia; Tsang, Yuk-Wah

2017-11-01

The reliability of thermoluminescent dosimeters (ultrathin TLD) and ISP Gafchromic EBT2 film to measure the surface dose in phantom and the skin dose in head-and-neck patients treated with intensity-modulated radiation therapy technique(IMRT) is the research focus. Seven-field treatment plans with prescribed dose of 180 cGy were performed on Eclipse treatment planning system which utilized pencil beam calculation algorithm(PBC). In calibration tests, the variance coefficient of the ultrathin TLDs were within 3%. The points on the calibration curve of the Gafchromic film was within 1% variation. Five measurements were taken on phantom using ultrathin TLD and EBT2 film respectively. The measured mean surface doses between ultrathin TLD or EBT2 film were within 5% deviation. Skin doses of 6 patients were measured for initial 5 fractions and the mean dose per-fraction was calculated. If the extrapolated doses for 30 fractions were below 4000 cGy, the skin reaction grading observed according to Radiation Therapy Oncology Group (RTOG) was either grade 1 or grade 2. If surface dose exceeded 5000 cGy in 32 fractions, then grade 3 skin reactions were observed.

SU-E-T-49: A Multi-Institutional Study of Independent Dose Verification for IMRT

International Nuclear Information System (INIS)

Baba, H; Tachibana, H; Kamima, T; Takahashi, R; Kawai, D; Sugawara, Y; Yamamoto, T; Sato, A; Yamashita, M

2015-01-01

Purpose: AAPM TG114 does not cover the independent verification for IMRT. We conducted a study of independent dose verification for IMRT in seven institutes to show the feasibility. Methods: 384 IMRT plans in the sites of prostate and head and neck (HN) were collected from the institutes, where the planning was performed using Eclipse and Pinnacle3 with the two techniques of step and shoot (S&S) and sliding window (SW). All of the institutes used a same independent dose verification software program (Simple MU Analysis: SMU, Triangle Product, Ishikawa, JP), which is Clarkson-based and CT images were used to compute radiological path length. An ion-chamber measurement in a water-equivalent slab phantom was performed to compare the doses computed using the TPS and an independent dose verification program. Additionally, the agreement in dose computed in patient CT images between using the TPS and using the SMU was assessed. The dose of the composite beams in the plan was evaluated. Results: The agreement between the measurement and the SMU were −2.3±1.9 % and −5.6±3.6 % for prostate and HN sites, respectively. The agreement between the TPSs and the SMU were −2.1±1.9 % and −3.0±3.7 for prostate and HN sites, respectively. There was a negative systematic difference with similar standard deviation and the difference was larger in the HN site. The S&S technique showed a statistically significant difference between the SW. Because the Clarkson-based method in the independent program underestimated (cannot consider) the dose under the MLC. Conclusion: The accuracy would be improved when the Clarkson-based algorithm should be modified for IMRT and the tolerance level would be within 5%

Image guided IMRT dosimetry using anatomy specific MOSFET configurations.

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Amin, Md Nurul; Norrlinger, Bern; Heaton, Robert; Islam, Mohammad

2008-06-23

We have investigated the feasibility of using a set of multiple MOSFETs in conjunction with the mobile MOSFET wireless dosimetry system, to perform a comprehensive and efficient quality assurance (QA) of IMRT plans. Anatomy specific MOSFET configurations incorporating 5 MOSFETs have been developed for a specially designed IMRT dosimetry phantom. Kilovoltage cone beam computed tomography (kV CBCT) imaging was used to increase the positional precision and accuracy of the detectors and phantom, and so minimize dosimetric uncertainties in high dose gradient regions. The effectiveness of the MOSFET based dose measurements was evaluated by comparing the corresponding doses measured by an ion chamber. For 20 head and neck IMRT plans the agreement between the MOSFET and ionization chamber dose measurements was found to be within -0.26 +/- 0.88% and 0.06 +/- 1.94% (1 sigma) for measurement points in the high dose and low dose respectively. A precision of 1 mm in detector positioning was achieved by using the X-Ray Volume Imaging (XVI) kV CBCT system available with the Elekta Synergy Linear Accelerator. Using the anatomy specific MOSFET configurations, simultaneous measurements were made at five strategically located points covering high dose and low dose regions. The agreement between measurements and calculated doses by the treatment planning system for head and neck and prostate IMRT plans was found to be within 0.47 +/- 2.45%. The results indicate that a cylindrical phantom incorporating multiple MOSFET detectors arranged in an anatomy specific configuration, in conjunction with image guidance, can be utilized to perform a comprehensive and efficient quality assurance of IMRT plans.

Influence of daily setup measurements and corrections on the estimated delivered dose during IMRT treatment of prostate cancer patients

International Nuclear Information System (INIS)

Haaren, Paul M.A. van; Bel, Arjan; Hofman, Pieter; Vulpen, Marco van; Kotte, Alexis N.T.J.; Heide, Uulke A. van der

2009-01-01

Purpose: To evaluate the impact of marker-based position verification, using daily imaging and an off-line correction protocol, by calculating the delivered dose to prostate, rectum and bladder. Methods: Prostate cancer patients (n = 217) were treated with IMRT, receiving 35 daily fractions. Plans with five beams were optimized taking target coverage (CTV, boost) and organs-at-risk (rectum and bladder) into account. PTV margins were 8 mm. Prostate position was verified daily using implanted fiducial gold markers by imaging the first segment of all the five beams on an EPID. Setup deviations were corrected off-line using an adapted shrinking-action-level protocol. The estimated delivered dose, including daily organ movements, was calculated using a version of PLATO's dose engine, enabling batch processing of large numbers of patients. The dose was calculated ± inclusion of setup corrections, and was evaluated relative to the original static plan. The marker-based measurements were considered representative for all organs. Results: Daily organ movements would result in an underdosage of 2-3 Gy to CTV and boost volume relative to the original plan, which was prevented by daily setup corrections. The dose to rectum and bladder was on average unchanged, but a large spread was introduced by organ movements, which was reduced by including setup corrections. Conclusions: Without position verification and setup corrections, margins of 8mm would be insufficient to account for position uncertainties during IMRT of prostate cancer. With the daily off-line correction protocol, the remaining variations are accommodated adequately

A dose planning study on applicator guided stereotactic IMRT boost in combination with 3D MRI based brachytherapy in locally advanced cervical cancer

International Nuclear Information System (INIS)

Assenholt, Marianne S.; Petersen, Joergen B.; Nielsen, Soeren K.; Lindegaard, Jacob C.; Tanderup, Kari

2008-01-01

Purpose. Locally advanced cervical cancer is usually treated with external beam radiotherapy followed by brachytherapy (BT). However, if response or tumour topography is unfavourable it may be difficult to reach a sufficient BT dose. The purpose of this study was to explore whether an applicator guided stereotactic IMRT boost could be combined with brachytherapy to improve dose volume parameters. Material and methods. Dose plans of 6 patients with HR CTV volumes of 31-100cc at the time of BT were analysed. MRI was performed with a combined intracavitary (IC)-interstitial (IS) ring applicator in situ. A radiotherapy schedule consisting of 45Gy (1.8Gyx25) IMRT followed by boost of 28Gy (7Gyx4fx) was modelled. Four different boost techniques were evaluated: IC-BT, IC/IS-BT, IC-BT+IMRT and IMRT. Dose plans were optimised for maximal tumour dose (D90) and coverage (V85Gy) while respecting DVH constraints in organs at risk: D2cc <75Gy in rectum and sigmoid and <90Gy in bladder (EQD2). In combined BT+IMRT dose plans, the IMRT plan was optimised on top of the BT dose distribution. Volumes irradiated to more than 60 Gy EQD2 (V60Gy) were evaluated. Results. Median dose coverage in IC plans was 74% [66-93%]. By using IC/IS or IC-BT+IMRT boost, the median coverage was improved to 95% [78-99%], and to 96% [69-99%] respectively. For IMRT alone, a median coverage of 98% [90-100%] was achieved, but V60Gy volumes were significantly increased by a median factor of 2.0 [1.4-2.3] as compared to IC/IS. It depended on the individual tumour topography whether IC/IS-BT or IC-BT+IMRT boost was the most favourable technique. Conclusion. It is technically possible to create dose plans that combine image guided BT and IMRT. In this study the dose coverage could be significantly increased by adding IS-BT or IMRT boost to the intracavitary dose. Using IMRT alone for boost cannot be advocated since this results in a significant increase of the volume irradiated to 60Gy

Investigating the feasibility of 3D dosimetry in the RPC IMRT H and N phantom

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Sakhalkar, H S; Sterling, D [Department of Radiation Oncology Physics, Duke University Medical Center, Durham, NC (United States); Adamovics, J [Department of Chemistry and Biology, Rider University, Lawrenceville, NJ (United States); Ibbott, G [Department of Radiation Physics, M. D. Anderson Cancer Center, Houston, Tx (United States); Oldham, M, E-mail: mark.oldham@duke.edu

2009-05-01

An urgent requirement for 3D dosimetry has been recognized because of high failure rate ({approx}25%) in RPC credentialing, which relies on point and 2D dose measurements. Comprehensive 3D dosimetry is likely to resolve more errors and improve IMRT quality assurance. This work presents an investigation of the feasibility of PRESAGE/optical-CT 3D dosimetry in the Radiologic Physics Center (RPC) IMRT H and N phantom. The RPC H and N phantom (with standard and PRESAGE dosimetry inserts alternately) was irradiated with the same IMRT plan. The TLD and EBT film measurement data from standard insert irradiation was provided by RPC. The 3D dose measurement data from PRESAGE insert irradiation was readout using the OCTOPUS{sup TM} 5X optical-CT scanner at Duke. TLD, EBT and PRESAGE dose measurements were inter-compared with Eclipse calculations to evaluate consistency of planning and delivery. Results showed that the TLD point dose measurements agreed with Eclipse calculations to within 5% dose-difference. Relative dose comparison between Eclipse dose, EBT dose and PRESAGE dose was conducted using profiles and gamma comparisons (4% dose-difference and 4 mm distance-to-agreement). Profiles showed good agreement between measurement and calculation except along steep dose gradient regions where Eclipse modelling might be inaccurate. Gamma comparisons showed that the measurement and calculation showed good agreement (>96%) if edge artefacts in measurements are ignored. In conclusion, the PRESAGE/optical-CT dosimetry system was found to be feasible as an independent dosimetry tool in the RPC IMRT H and N phantom.

Investigating the feasibility of 3D dosimetry in the RPC IMRT H and N phantom

International Nuclear Information System (INIS)

Sakhalkar, H S; Sterling, D; Adamovics, J; Ibbott, G; Oldham, M

2009-01-01

An urgent requirement for 3D dosimetry has been recognized because of high failure rate (∼25%) in RPC credentialing, which relies on point and 2D dose measurements. Comprehensive 3D dosimetry is likely to resolve more errors and improve IMRT quality assurance. This work presents an investigation of the feasibility of PRESAGE/optical-CT 3D dosimetry in the Radiologic Physics Center (RPC) IMRT H and N phantom. The RPC H and N phantom (with standard and PRESAGE dosimetry inserts alternately) was irradiated with the same IMRT plan. The TLD and EBT film measurement data from standard insert irradiation was provided by RPC. The 3D dose measurement data from PRESAGE insert irradiation was readout using the OCTOPUS TM 5X optical-CT scanner at Duke. TLD, EBT and PRESAGE dose measurements were inter-compared with Eclipse calculations to evaluate consistency of planning and delivery. Results showed that the TLD point dose measurements agreed with Eclipse calculations to within 5% dose-difference. Relative dose comparison between Eclipse dose, EBT dose and PRESAGE dose was conducted using profiles and gamma comparisons (4% dose-difference and 4 mm distance-to-agreement). Profiles showed good agreement between measurement and calculation except along steep dose gradient regions where Eclipse modelling might be inaccurate. Gamma comparisons showed that the measurement and calculation showed good agreement (>96%) if edge artefacts in measurements are ignored. In conclusion, the PRESAGE/optical-CT dosimetry system was found to be feasible as an independent dosimetry tool in the RPC IMRT H and N phantom.

Dosimetric comparison of standard three-dimensional conformal radiotherapy followed by intensity-modulated radiotherapy boost schedule (sequential IMRT plan) with simultaneous integrated boost-IMRT (SIB IMRT) treatment plan in patients with localized carcinoma prostate.

Science.gov (United States)

Bansal, A; Kapoor, R; Singh, S K; Kumar, N; Oinam, A S; Sharma, S C

2012-07-01

DOSIMETERIC AND RADIOBIOLOGICAL COMPARISON OF TWO RADIATION SCHEDULES IN LOCALIZED CARCINOMA PROSTATE: Standard Three-Dimensional Conformal Radiotherapy (3DCRT) followed by Intensity Modulated Radiotherapy (IMRT) boost (sequential-IMRT) with Simultaneous Integrated Boost IMRT (SIB-IMRT). Thirty patients were enrolled. In all, the target consisted of PTV P + SV (Prostate and seminal vesicles) and PTV LN (lymph nodes) where PTV refers to planning target volume and the critical structures included: bladder, rectum and small bowel. All patients were treated with sequential-IMRT plan, but for dosimetric comparison, SIB-IMRT plan was also created. The prescription dose to PTV P + SV was 74 Gy in both strategies but with different dose per fraction, however, the dose to PTV LN was 50 Gy delivered in 25 fractions over 5 weeks for sequential-IMRT and 54 Gy delivered in 27 fractions over 5.5 weeks for SIB-IMRT. The treatment plans were compared in terms of dose-volume histograms. Also, Tumor Control Probability (TCP) and Normal Tissue Complication Probability (NTCP) obtained with the two plans were compared. The volume of rectum receiving 70 Gy or more (V > 70 Gy) was reduced to 18.23% with SIB-IMRT from 22.81% with sequential-IMRT. SIB-IMRT reduced the mean doses to both bladder and rectum by 13% and 17%, respectively, as compared to sequential-IMRT. NTCP of 0.86 ± 0.75% and 0.01 ± 0.02% for the bladder, 5.87 ± 2.58% and 4.31 ± 2.61% for the rectum and 8.83 ± 7.08% and 8.25 ± 7.98% for the bowel was seen with sequential-IMRT and SIB-IMRT plans respectively. For equal PTV coverage, SIB-IMRT markedly reduced doses to critical structures, therefore should be considered as the strategy for dose escalation. SIB-IMRT achieves lesser NTCP than sequential-IMRT.

SU-E-T-643: Pure Alanine Dosimeter for Verification Dosimetry in IMRT

International Nuclear Information System (INIS)

Al-Karmi, Anan M.; Zraiqat, Fadi

2015-01-01

Purpose: The objective of this study was evaluation of accuracy of pure alanine dosimeters measuring intensity-modulated radiation therapy (IMRT) dose distributions in a thorax phantom. Methods: Alanine dosimeters were prepared in the form of 110 mg pure L-α-alanine powder filled into clear tissue-equivalent polymethylmethacrylate (PMMA) plastic tubes with the dimensions 25 mm length, 3 mm inner diameter, and 1 mm wall thickness. A dose-response calibration curve was established for the alanine by placing the dosimeters at 1.5 cm depth in a 30×30×30 cm 3 solid water phantom and then irradiating on a linac with 6 MV photon beam at 10×10 cm 2 field size to doses ranging from 1 to 5 Gy. Electron paramagnetic resonance (EPR) spectroscopy was used to determine the absorbed dose in alanine. An IMRT treatment plan was designed for a commercial heterogeneous CIRS thorax phantom and the dose values were calculated at three different points located in tissue, lung, and bone equivalent materials. A set of dose measurements was carried out to compare measured and calculated dose values by placing the alanine dosimeters at those selected locations inside the thorax phantom and delivering the IMRT to the phantom. Results: The alanine dose measurements and the IMRT plan dose calculations were found to be in agreement within ±2%. Specifically, the deviations were −0.5%, 1.3%, and −1.7% for tissue, lung, and bone; respectively. The slightly large deviations observed for lung and bone may be attributed to tissue inhomogeneity, steep dose gradients in these regions, and uncontrollable changes in spectrometer conditions. Conclusion: The results described herein confirmed that pure alanine dosimeter was suitable for in-phantom dosimetry of IMRT beams because of its high sensitivity and acceptable accuracy. This makes the dosimeter a promising option for quality control of the therapeutic beams, complementing the commonly used ionization chambers, TLDs, and films

Comparison of measured and calculated doses for narrow MLC defined fields

International Nuclear Information System (INIS)

Lydon, J.; Rozenfeld, A.; Lerch, M.

2002-01-01

Full text: The introduction of Intensity Modulated Radiotherapy (IMRT) has led to the use of narrow fields in the delivery of radiation doses to patients. Such fields are not well characterized by calculation methods commonly used in radiotherapy treatment planning systems. The accuracy of the dose calculation algorithm must therefore be investigated prior to clinical use. This study looked at symmetrical and asymmetrical 0.1 to 3cm wide fields delivered with a Varian CL2100C 6MV photon beam. Measured doses were compared to doses calculated using Pinnacle, the ADAC radiotherapy treatment planning system. Two high resolution methods of measuring dose were used. A MOSFET detector in a water phantom and radiographic film in a solid water phantom with spatial resolutions of 10 and 89μm respectively. Dose calculations were performed using the collapsed cone convolution algorithm in Pinnacle with a 0.1cm dose calculation grid in the MLC direction. The effect of Pinnacle not taking into account the rounded leaf ends was simulated by offsetting the leaves by 0.1cm in the dose calculation. Agreement between measurement and calculation is good for fields of 1cm and wider. However, fields of less than 1cm width can show a significant difference between measurement and calculation

The effect of source-axis distance on integral dose: implications for IMRT

International Nuclear Information System (INIS)

Keall, P.

2001-01-01

The source-axis distance (SAD) is a treatment machine design parameter that affects integral dose, dose rate and patient clearance. The aim of this work was to investigate the effect of source-axis distance on integral dose for conformal arc therapy. This work is part of a larger project to determine the ideal characteristics of a dedicated IMRT machine. The sensitivity of SAD to beam energy, PTV size, body size and PTV position were determined for conformal arc therapy. For the calculations performed here it was assumed that dose equals terma. The integral dose ratio (IDR) was used to quantify the calculation results. It was found that the IDR increases as both SAD and photon energy increase, though the dependence of IDR on SAD decreases as energy increases. The PTV size was found to have a negligible effect on the relationship between the SAD and IDR, however the body size does affect the relationship between the SAD and IDR. The position of the PTV within the body also affects the IDR. From dosimetric considerations alone, the larger the SAD, the better the possible dose distribution. The IDR for a very large SAD is increased by approximately 5% when compared with the IDR for 100 cm SAD. Similarly, the IDR for 100 cm SAD is approximately 5% higher than the IDR at 50 cm SAD. Copyright (2001) Australasian College of Physical Scientists and Engineers in Medicine

Tomotherapy: IMRT and tomographic verification

International Nuclear Information System (INIS)

Mackie, T.R.

2000-01-01

include MLC's and many clinics use them to replace 90% or more of the field-shaping requirements of conventional radiotherapy. Now, several academic centers are treating patients with IMRT using conventional MLC's to modulate the field. IMRT using conventional MLC's have the advantage that the patient is stationary during the treatment and the MLC's can be used in conventional practice. Nevertheless, tomotherapy using the Peacock system delivers the most conformal dose distributions of any commercial system to date. The biggest limitation with the both the NOMOS Peacock tomotherapy system and conventional MLC's for IMRT delivery is the lack of treatment verification. In conventional few-field radiotherapy one relied on portal images to determine if the patient was setup correctly and the beams were correctly positioned. With IMRT the image contrast is superimposed on the beam intensity variation. Conventional practice allowed for monitor unit calculation checks and point dosimeters placed on the patient's surface to verify that the treatment was properly delivered. With IMRT it is impossible to perform hand calculations of monitor units and dosimeters placed on the patient's surface are prone to error due to high gradients in the beam intensity. NOMOS has developed a verification phantom that allows multiple sheets of film to be placed in a light-tight box that is irradiated with the same beam pattern that is used to treat the patient. The optical density of the films are adjusted, normalized, and calibrated and then quantitatively compared with the dose calculated for the phantom delivery. However, this process is too laborious to be used for patient-specific QA. If IMRT becomes ubiquitous and it can be shown that IMRT is useful on most treatment sites then there is a need to design treatment units dedicated to IMRT delivery and verification. Helical tomotherapy is such a redesign. Helical tomotherapy is the delivery of a rotational fan beam while the patient is

Does IGRT ensure target dose coverage of head and neck IMRT patients?

International Nuclear Information System (INIS)

Graff, Pierre; Hu Weigang; Yom, Sue S.; Pouliot, Jean

2012-01-01

Purpose: To determine if image-guided radiotherapy (IGRT) ensures dose coverage to the target, and to assess the dosimetric impact of anatomic changes using megavoltage cone-beam CT (MVCBCT) for patient positioning during head and neck IMRT. Methods and materials: Forty-eight MVCBCT from 10 head and neck IMRT/IGRT patients were analyzed off-line. Target volumes and organs at risk (OARs) contours delineated on CT were transferred and adjusted on MVCBCT images. Each MVCBCT was processed to allow dose recalculation, resulting in 469 dose–volume histograms (DVHs). The concept of dosimetric latitude was introduced to provide a clinical perspective. Results: MVCBCT target DVHs showed a moderate level of difference in D95 (dose to ⩾95% of volume), generally less than a 5% difference from the planned dose. Delivered-dose increases to the spinal cord and brainstem showed no apparent time trend. The 4 mm margin around OARs was a useful precaution to prevent exceeding critical dose thresholds. The parotid glands showed progressive increases in mean dose related to shrinkage of the external contours. Conclusion: IGRT repositioning ensured target volume coverage, but significant dose variations were observed for OARs. The dosimetric impact of anatomic changes during radiotherapy was of lesser importance than the effects of IGRT repositioning.

Contralateral breast doses measured by film dosimetry: tangential techniques and an optimized IMRT technique

International Nuclear Information System (INIS)

Saur, S; Frengen, J; Fjellsboe, L M B; Lindmo, T

2009-01-01

The contralateral breast (CLB) doses for three tangential techniques were characterized by using a female thorax phantom and GafChromic EBT film. Dose calculations by the pencil beam and collapsed cone algorithms were included for comparison. The film dosimetry reveals a highly inhomogeneous dose distribution within the CLB, and skin doses due to the medial fields that are several times higher than the interior dose. These phenomena are not correctly reproduced by the calculation algorithms. All tangential techniques were found to give a mean CLB dose of approximately 0.5 Gy. All wedged fields resulted in higher CLB doses than the corresponding open fields, and the lateral open fields resulted in higher CLB doses than the medial open fields. More than a twofold increase in the mean CLB dose from the medial open field was observed for a 90 deg. change of the collimator orientation. Replacing the physical wedge with a virtual wedge reduced the mean dose to the CLB by 35% and 16% for the medial and lateral fields, respectively. Lead shielding reduced the skin dose for a tangential technique by approximately 50%, but the mean CLB dose was only reduced by approximately 11%. Finally, a technique based on open medial fields in combination with several IMRT fields is proposed as a technique for minimizing the CLB dose. With and without lead shielding, the mean CLB dose using this technique was found to be 0.20 and 0.27 Gy, respectively.

Dysphagia and trismus after concomitant chemo-Intensity-Modulated Radiation Therapy (chemo-IMRT) in advanced head and neck cancer; dose-effect relationships for swallowing and mastication structures

NARCIS (Netherlands)

van der Molen, Lisette; Heemsbergen, Wilma D.; de Jong, Rianne; van Rossum, Maya A.; Smeele, Ludi E.; Rasch, Coen R. N.; Hilgers, Frans J. M.

2013-01-01

Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and mastication. Assessment of 55 patients before, 10-weeks (N=49) and 1-year post-treatment (N=37). Calculation of dose-volume parameters

Integration method of 3D MR spectroscopy into treatment planning system for glioblastoma IMRT dose painting with integrated simultaneous boost

International Nuclear Information System (INIS)

Ken, Soléakhéna; Cassol, Emmanuelle; Delannes, Martine; Celsis, Pierre; Cohen-Jonathan, Elizabeth Moyal; Laprie, Anne; Vieillevigne, Laure; Franceries, Xavier; Simon, Luc; Supper, Caroline; Lotterie, Jean-Albert; Filleron, Thomas; Lubrano, Vincent; Berry, Isabelle

2013-01-01

To integrate 3D MR spectroscopy imaging (MRSI) in the treatment planning system (TPS) for glioblastoma dose painting to guide simultaneous integrated boost (SIB) in intensity-modulated radiation therapy (IMRT). For sixteen glioblastoma patients, we have simulated three types of dosimetry plans, one conventional plan of 60-Gy in 3D conformational radiotherapy (3D-CRT), one 60-Gy plan in IMRT and one 72-Gy plan in SIB-IMRT. All sixteen MRSI metabolic maps were integrated into TPS, using normalization with color-space conversion and threshold-based segmentation. The fusion between the metabolic maps and the planning CT scans were assessed. Dosimetry comparisons were performed between the different plans of 60-Gy 3D-CRT, 60-Gy IMRT and 72-Gy SIB-IMRT, the last plan was targeted on MRSI abnormalities and contrast enhancement (CE). Fusion assessment was performed for 160 transformations. It resulted in maximum differences <1.00 mm for translation parameters and ≤1.15° for rotation. Dosimetry plans of 72-Gy SIB-IMRT and 60-Gy IMRT showed a significantly decreased maximum dose to the brainstem (44.00 and 44.30 vs. 57.01 Gy) and decreased high dose-volumes to normal brain (19 and 20 vs. 23% and 7 and 7 vs. 12%) compared to 60-Gy 3D-CRT (p < 0.05). Delivering standard doses to conventional target and higher doses to new target volumes characterized by MRSI and CE is now possible and does not increase dose to organs at risk. MRSI and CE abnormalities are now integrated for glioblastoma SIB-IMRT, concomitant with temozolomide, in an ongoing multi-institutional phase-III clinical trial. Our method of MR spectroscopy maps integration to TPS is robust and reliable; integration to neuronavigation systems with this method could also improve glioblastoma resection or guide biopsies

Monte Carlo-based QA for IMRT of head and neck cancers

Science.gov (United States)

Tang, F.; Sham, J.; Ma, C.-M.; Li, J.-S.

2007-06-01

It is well-known that the presence of large air cavity in a dense medium (or patient) introduces significant electronic disequilibrium when irradiated with megavoltage X-ray field. This condition may worsen by the possible use of tiny beamlets in intensity-modulated radiation therapy (IMRT). Commercial treatment planning systems (TPSs), in particular those based on the pencil-beam method, do not provide accurate dose computation for the lungs and other cavity-laden body sites such as the head and neck. In this paper we present the use of Monte Carlo (MC) technique for dose re-calculation of IMRT of head and neck cancers. In our clinic, a turn-key software system is set up for MC calculation and comparison with TPS-calculated treatment plans as part of the quality assurance (QA) programme for IMRT delivery. A set of 10 off-the-self PCs is employed as the MC calculation engine with treatment plan parameters imported from the TPS via a graphical user interface (GUI) which also provides a platform for launching remote MC simulation and subsequent dose comparison with the TPS. The TPS-segmented intensity maps are used as input for the simulation hence skipping the time-consuming simulation of the multi-leaf collimator (MLC). The primary objective of this approach is to assess the accuracy of the TPS calculations in the presence of air cavities in the head and neck whereas the accuracy of leaf segmentation is verified by fluence measurement using a fluoroscopic camera-based imaging device. This measurement can also validate the correct transfer of intensity maps to the record and verify system. Comparisons between TPS and MC calculations of 6 MV IMRT for typical head and neck treatments review regional consistency in dose distribution except at and around the sinuses where our pencil-beam-based TPS sometimes over-predicts the dose by up to 10%, depending on the size of the cavities. In addition, dose re-buildup of up to 4% is observed at the posterior nasopharyngeal

SU-E-T-427: Feasibility Study for Evaluation of IMRT Dose Distribution Using Geant4-Based Automated Algorithms

International Nuclear Information System (INIS)

Choi, H; Shin, W; Testa, M; Min, C; Kim, J

2015-01-01

Purpose: For intensity-modulated radiation therapy (IMRT) treatment planning validation using Monte Carlo (MC) simulations, a precise and automated procedure is necessary to evaluate the patient dose distribution. The aim of this study is to develop an automated algorithm for IMRT simulations using DICOM files and to evaluate the patient dose based on 4D simulation using the Geant4 MC toolkit. Methods: The head of a clinical linac (Varian Clinac 2300 IX) was modeled in Geant4 along with particular components such as the flattening filter and the multi-leaf collimator (MLC). Patient information and the position of the MLC were imported from the DICOM-RT interface. For each position of the MLC, a step- and-shoot technique was adopted. PDDs and lateral profiles were simulated in a water phantom (50×50×40 cm 3 ) and compared to measurement data. We used a lung phantom and MC-dose calculations were compared to the clinical treatment planning used at the Seoul National University Hospital. Results: In order to reproduce the measurement data, we tuned three free parameters: mean and standard deviation of the primary electron beam energy and the beam spot size. These parameters for 6 MV were found to be 5.6 MeV, 0.2378 MeV and 1 mm FWHM respectively. The average dose difference between measurements and simulations was less than 2% for PDDs and radial profiles. The lung phantom study showed fairly good agreement between MC and planning dose despite some unavoidable statistical fluctuation. Conclusion: The current feasibility study using the lung phantom shows the potential for IMRT dose validation using 4D MC simulations using Geant4 tool kits. This research was supported by Korea Institute of Nuclear safety and Development of Measurement Standards for Medical Radiation funded by Korea research Institute of Standards and Science. (KRISS-2015-15011032)

Hybrid IMRT plans-concurrently treating conventional and IMRT beams for improved breast irradiation and reduced planning time

International Nuclear Information System (INIS)

Mayo, Charles S.; Urie, Marcia M.; Fitzgerald, Thomas J.

2005-01-01

Purpose: To evaluate a hybrid intensity modulated radiation therapy (IMRT) technique as a class solution for treatment of the intact breast. Methods and materials: The following five plan techniques were compared for 10 breast patients using dose-volume histogram analysis: conventional wedged-field tangents (Tangents), forward-planned field-within-a-field tangents (FIF), IMRT-only tangents (IMRT tangents), conventional open plus IMRT tangents (4-field hybrid), and conventional open plus IMRT tangents with 2 anterior oblique IMRT beams (6-field hybrid). Results: The 4-field hybrid and FIF achieved dose distributions better than Tangents and IMRT tangents. The volume of tissue outside the planning target volume receiving ≥110% of prescribed dose was largest for IMRT tangents (average 158 cc) and least for 6-field hybrid (average 1 cc); the FIF and 4-field hybrid were comparable (average 15 cc). Heart volume ≥30 Gy averaged 13 cc for all techniques, except Tangents, for which it was 32 cc. Average total lung volume ≥20 Gy was 7% for all. Contralateral breast doses were < 3% for all. Planning time for hybrid techniques was significantly less than for conventional FIF technique. Conclusions: The 4-field hybrid technique is a viable class solution. The 6-field hybrid technique creates the most conformal dose distribution at the expense of more normal tissue receiving low dose

Implementation of a Monte Carlo based inverse planning model for clinical IMRT with MCNP code

International Nuclear Information System (INIS)

He, Tongming Tony

2003-01-01

Inaccurate dose calculations and limitations of optimization algorithms in inverse planning introduce systematic and convergence errors to treatment plans. This work was to implement a Monte Carlo based inverse planning model for clinical IMRT aiming to minimize the aforementioned errors. The strategy was to precalculate the dose matrices of beamlets in a Monte Carlo based method followed by the optimization of beamlet intensities. The MCNP 4B (Monte Carlo N-Particle version 4B) code was modified to implement selective particle transport and dose tallying in voxels and efficient estimation of statistical uncertainties. The resulting performance gain was over eleven thousand times. Due to concurrent calculation of multiple beamlets of individual ports, hundreds of beamlets in an IMRT plan could be calculated within a practical length of time. A finite-sized point source model provided a simple and accurate modeling of treatment beams. The dose matrix calculations were validated through measurements in phantoms. Agreements were better than 1.5% or 0.2 cm. The beamlet intensities were optimized using a parallel platform based optimization algorithm that was capable of escape from local minima and preventing premature convergence. The Monte Carlo based inverse planning model was applied to clinical cases. The feasibility and capability of Monte Carlo based inverse planning for clinical IMRT was demonstrated. Systematic errors in treatment plans of a commercial inverse planning system were assessed in comparison with the Monte Carlo based calculations. Discrepancies in tumor doses and critical structure doses were up to 12% and 17%, respectively. The clinical importance of Monte Carlo based inverse planning for IMRT was demonstrated

Dosimetric comparison of treatment techniques IMRT and VMAT for breast cancer; Comparacion dosimetrica de las tecnicas de tratamiento IMRT y VMAT para cancer en mama

Energy Technology Data Exchange (ETDEWEB)

Urbina, G. L. [Universidad Nacional de Ingenieria, Maestria en Fisica Medica, Av. Tupac Amaru s/n, Rimac, Lima 25 (Peru); Garcia, B. G., E-mail: gerlup@hotmail.com [Red AUNA, Clinica Delgado, Av. Angamos Cdra. 4 esquina Gral. Borgono, Miraflores, Lima (Peru)

2015-10-15

In this study the dosimetric distribution was compared in the different treatment techniques such as Volumetric Modulated Arc Therapy (VMAT) and Intensity Modulated Radiation Therapy (IMRT) in female patients with breast cancer with stage II-B and III-A, 6 cases (both calculated on VMAT and IMRT) were studied, comparison parameter that are taken into account are: compliance rate, homogeneity index, monitor units, volume dose 50 Gy (D-50%) and 5 Gy (D-5%) volume dose. Comparisons are made in primary tumor volume to optimize treatment in patients with breast cancer, with IMRT using Step, Shoot and VMAT Monte Carlo algorithm, in addition to the organs at risk; the concern to make this work is due to technological advances in radiotherapy and the application of new treatment techniques, that increase the accuracy allowing treatment dose climbing delivering a higher dose to the patient. (Author)

TH-E-BRE-08: GPU-Monte Carlo Based Fast IMRT Plan Optimization

Energy Technology Data Exchange (ETDEWEB)

Li, Y; Tian, Z; Shi, F; Jiang, S; Jia, X [The University of Texas Southwestern Medical Ctr, Dallas, TX (United States)

2014-06-15

Purpose: Intensity-modulated radiation treatment (IMRT) plan optimization needs pre-calculated beamlet dose distribution. Pencil-beam or superposition/convolution type algorithms are typically used because of high computation speed. However, inaccurate beamlet dose distributions, particularly in cases with high levels of inhomogeneity, may mislead optimization, hindering the resulting plan quality. It is desire to use Monte Carlo (MC) methods for beamlet dose calculations. Yet, the long computational time from repeated dose calculations for a number of beamlets prevents this application. It is our objective to integrate a GPU-based MC dose engine in lung IMRT optimization using a novel two-steps workflow. Methods: A GPU-based MC code gDPM is used. Each particle is tagged with an index of a beamlet where the source particle is from. Deposit dose are stored separately for beamlets based on the index. Due to limited GPU memory size, a pyramid space is allocated for each beamlet, and dose outside the space is neglected. A two-steps optimization workflow is proposed for fast MC-based optimization. At first step, rough beamlet dose calculations is conducted with only a small number of particles per beamlet. Plan optimization is followed to get an approximated fluence map. In the second step, more accurate beamlet doses are calculated, where sampled number of particles for a beamlet is proportional to the intensity determined previously. A second-round optimization is conducted, yielding the final Result. Results: For a lung case with 5317 beamlets, 10{sup 5} particles per beamlet in the first round, and 10{sup 8} particles per beam in the second round are enough to get a good plan quality. The total simulation time is 96.4 sec. Conclusion: A fast GPU-based MC dose calculation method along with a novel two-step optimization workflow are developed. The high efficiency allows the use of MC for IMRT optimizations.

IMRT dose fractionation for head and neck cancer: Variation in current approaches will make standardisation difficult

Energy Technology Data Exchange (ETDEWEB)

Ho, Kean F. (Academic Dept. of Radiation Oncology, Univ. of Manchester, Manchester (United Kingdom)); Fowler, Jack F. (Dept. of Human Oncology and Medical Physics, Univ. of Wisconsin, Wisconsin (United States)); Sykes, Andrew J.; Yap, Beng K.; Lee, Lip W.; Slevin, Nick J. (Dept. of Clinical Oncology, Christie Hospital NHS Foundation Trust, Manchester (United Kingdom))

2009-04-15

Introduction. Altered fractionation has demonstrated clinical benefits compared to the conventional 2 Gy/day standard of 70 Gy. When using synchronous chemotherapy, there is uncertainty about optimum fractionation. IMRT with its potential for Simultaneous Integrated Boost (SIB) adds further to this uncertainty. This survey will examine international practice of IMRT fractionation and suggest possible reasons for diversity in approach. Material and methods. Fourteen international cancer centres were surveyed for IMRT dose/fractionation practised in each centre. Results. Twelve different types of dose fractionation were reported. Conventional 70-72 Gy (daily 2 Gy/fraction) was used in 3/14 centres with concurrent chemotherapy while 11/14 centres used altered fractionation. Two centres used >1 schedule. Reported schedules and number of centres included 6 fractions/week DAHANCA regime (3), modest hypofractionation (=2.2 Gy/fraction) (3), dose-escalated hypofractionation (=2.3 Gy/fraction) (4), hyperfractionation (1), continuous acceleration (1) and concomitant boost (1). Reasons for dose fractionation variability include (i) dose escalation; (ii) total irradiated volume; (iii) number of target volumes; (iv) synchronous systemic treatment; (v) shorter overall treatment time; (vi) resources availability; (vii) longer time on treatment couch; (viii) variable GTV margins; (ix) confidence in treatment setup; (x) late tissue toxicity and (xi) use of lower neck anterior fields. Conclusions. This variability in IMRT fractionation makes any meaningful comparison of treatment results difficult. Some standardization is needed particularly for design of multi-centre randomized clinical trials.

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

Energy Technology Data Exchange (ETDEWEB)

Delgado, A Brito; Cohen, D; Eng, T; Gutierrez, A [University of Texas Health Science Center San Antonio, San Antonio, TX (United States)

2016-06-15

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

A comprehensive analysis of the IMRT dose delivery process using statistical process control (SPC)

Energy Technology Data Exchange (ETDEWEB)

Gerard, Karine; Grandhaye, Jean-Pierre; Marchesi, Vincent; Kafrouni, Hanna; Husson, Francois; Aletti, Pierre [Research Center for Automatic Control (CRAN), Nancy University, CNRS, 54516 Vandoeuvre-les-Nancy (France); Department of Medical Physics, Alexis Vautrin Cancer Center, 54511 Vandoeuvre-les-Nancy Cedex (France) and DOSIsoft SA, 94230 Cachan (France); Research Laboratory for Innovative Processes (ERPI), Nancy University, EA 3767, 5400 Nancy Cedex (France); Department of Medical Physics, Alexis Vautrin Cancer Center, 54511 Vandoeuvre-les-Nancy Cedex (France); DOSIsoft SA, 94230 Cachan (France); Research Center for Automatic Control (CRAN), Nancy University, CNRS, 54516 Vandoeuvre-les-Nancy, France and Department of Medical Physics, Alexis Vautrin Cancer Center, 54511 Vandoeuvre-les-Nancy Cedex (France)

2009-04-15

The aim of this study is to introduce tools to improve the security of each IMRT patient treatment by determining action levels for the dose delivery process. To achieve this, the patient-specific quality control results performed with an ionization chamber--and which characterize the dose delivery process--have been retrospectively analyzed using a method borrowed from industry: Statistical process control (SPC). The latter consisted in fulfilling four principal well-structured steps. The authors first quantified the short term variability of ionization chamber measurements regarding the clinical tolerances used in the cancer center ({+-}4% of deviation between the calculated and measured doses) by calculating a control process capability (C{sub pc}) index. The C{sub pc} index was found superior to 4, which implies that the observed variability of the dose delivery process is not biased by the short term variability of the measurement. Then, the authors demonstrated using a normality test that the quality control results could be approximated by a normal distribution with two parameters (mean and standard deviation). Finally, the authors used two complementary tools--control charts and performance indices--to thoroughly analyze the IMRT dose delivery process. Control charts aim at monitoring the process over time using statistical control limits to distinguish random (natural) variations from significant changes in the process, whereas performance indices aim at quantifying the ability of the process to produce data that are within the clinical tolerances, at a precise moment. The authors retrospectively showed that the analysis of three selected control charts (individual value, moving-range, and EWMA control charts) allowed efficient drift detection of the dose delivery process for prostate and head-and-neck treatments before the quality controls were outside the clinical tolerances. Therefore, when analyzed in real time, during quality controls, they should

A comprehensive analysis of the IMRT dose delivery process using statistical process control (SPC).

Science.gov (United States)

Gérard, Karine; Grandhaye, Jean-Pierre; Marchesi, Vincent; Kafrouni, Hanna; Husson, François; Aletti, Pierre

2009-04-01

The aim of this study is to introduce tools to improve the security of each IMRT patient treatment by determining action levels for the dose delivery process. To achieve this, the patient-specific quality control results performed with an ionization chamber--and which characterize the dose delivery process--have been retrospectively analyzed using a method borrowed from industry: Statistical process control (SPC). The latter consisted in fulfilling four principal well-structured steps. The authors first quantified the short-term variability of ionization chamber measurements regarding the clinical tolerances used in the cancer center (+/- 4% of deviation between the calculated and measured doses) by calculating a control process capability (C(pc)) index. The C(pc) index was found superior to 4, which implies that the observed variability of the dose delivery process is not biased by the short-term variability of the measurement. Then, the authors demonstrated using a normality test that the quality control results could be approximated by a normal distribution with two parameters (mean and standard deviation). Finally, the authors used two complementary tools--control charts and performance indices--to thoroughly analyze the IMRT dose delivery process. Control charts aim at monitoring the process over time using statistical control limits to distinguish random (natural) variations from significant changes in the process, whereas performance indices aim at quantifying the ability of the process to produce data that are within the clinical tolerances, at a precise moment. The authors retrospectively showed that the analysis of three selected control charts (individual value, moving-range, and EWMA control charts) allowed efficient drift detection of the dose delivery process for prostate and head-and-neck treatments before the quality controls were outside the clinical tolerances. Therefore, when analyzed in real time, during quality controls, they should improve the

TU-D-201-05: Validation of Treatment Planning Dose Calculations: Experience Working with MPPG 5.a

Energy Technology Data Exchange (ETDEWEB)

Xue, J; Park, J; Kim, L; Wang, C [MD Anderson Cancer Center at Cooper, Camden, NJ (United States); Balter, P; Ohrt, J; Kirsner, S; Ibbott, G [UT MD Anderson Cancer Center, Houston, TX (United States)

2016-06-15

Purpose: Newly published medical physics practice guideline (MPPG 5.a.) has set the minimum requirements for commissioning and QA of treatment planning dose calculations. We present our experience in the validation of a commercial treatment planning system based on MPPG 5.a. Methods: In addition to tests traditionally performed to commission a model-based dose calculation algorithm, extensive tests were carried out at short and extended SSDs, various depths, oblique gantry angles and off-axis conditions to verify the robustness and limitations of a dose calculation algorithm. A comparison between measured and calculated dose was performed based on validation tests and evaluation criteria recommended by MPPG 5.a. An ion chamber was used for the measurement of dose at points of interest, and diodes were used for photon IMRT/VMAT validations. Dose profiles were measured with a three-dimensional scanning system and calculated in the TPS using a virtual water phantom. Results: Calculated and measured absolute dose profiles were compared at each specified SSD and depth for open fields. The disagreement is easily identifiable with the difference curve. Subtle discrepancy has revealed the limitation of the measurement, e.g., a spike at the high dose region and an asymmetrical penumbra observed on the tests with an oblique MLC beam. The excellent results we had (> 98% pass rate on 3%/3mm gamma index) on the end-to-end tests for both IMRT and VMAT are attributed to the quality beam data and the good understanding of the modeling. The limitation of the model and the uncertainty of measurement were considered when comparing the results. Conclusion: The extensive tests recommended by the MPPG encourage us to understand the accuracy and limitations of a dose algorithm as well as the uncertainty of measurement. Our experience has shown how the suggested tests can be performed effectively to validate dose calculation models.

A Phase I Dose-Escalation Study (ISIDE-BT-1) of Accelerated IMRT With Temozolomide in Patients With Glioblastoma

International Nuclear Information System (INIS)

Morganti, Alessio G.; Balducci, Mario; Salvati, Maurizio; Esposito, Vincenzo; Romanelli, Pantaleo; Ferro, Marica; Calista, Franco; Digesu, Cinzia; Macchia, Gabriella; Ianiri, Massimo; Deodato, Francesco; Cilla, Savino; Piermattei, Angelo M.P.; Valentini, Vincenzo; Cellini, Numa; Cantore, Gian Paolo

2010-01-01

Purpose: To determine the maximum tolerated dose (MTD) of fractionated intensity-modulated radiotherapy (IMRT) with temozolomide (TMZ) in patients with glioblastoma. Methods and Materials: A Phase I clinical trial was performed. Eligible patients had surgically resected or biopsy-proven glioblastoma. Patients started TMZ (75 mg/day) during IMRT and continued for 1 year (150-200 mg/day, Days 1-5 every 28 days) or until disease progression. Clinical target volume 1 (CTV1) was the tumor bed ± enhancing lesion with a 10-mm margin; CTV2 was the area of perifocal edema with a 20-mm margin. Planning target volume 1 (PTV1) and PTV2 were defined as the corresponding CTV plus a 5-mm margin. IMRT was delivered in 25 fractions over 5 weeks. Only the dose for PTV1 was escalated (planned dose escalation: 60 Gy, 62.5 Gy, 65 Gy) while maintaining the dose for PTV2 (45 Gy, 1.8 Gy/fraction). Dose limiting toxicities (DLT) were defined as any treatment-related nonhematological adverse effects rated as Grade ≥3 or any hematological toxicity rated as ≥4 by Radiation Therapy Oncology Group (RTOG) criteria. Results: Nineteen consecutive glioblastoma were treated with step-and-shoot IMRT, planned with the inverse approach (dose to the PTV1: 7 patients, 60 Gy; 6 patients, 62.5 Gy; 6 patients, 65 Gy). Five coplanar beams were used to cover at least 95% of the target volume with the 95% isodose line. Median follow-up time was 23 months (range, 8-40 months). No patient experienced DLT. Grade 1-2 treatment-related neurologic and skin toxicity were common (11 and 19 patients, respectively). No Grade >2 late neurologic toxicities were noted. Conclusion: Accelerated IMRT to a dose of 65 Gy in 25 fractions is well tolerated with TMZ at a daily dose of 75 mg.

Three-dimensional dose accumulation in pseudo-split-field IMRT and brachytherapy for locally advanced cervical cancer.

Science.gov (United States)

Sun, Baozhou; Yang, Deshan; Esthappan, Jackie; Garcia-Ramirez, Jose; Price, Samantha; Mutic, Sasa; Schwarz, Julie K; Grigsby, Perry W; Tanderup, Kari

2015-01-01

Dose accumulation of split-field external beam radiotherapy (EBRT) and brachytherapy (BT) is challenging because of significant EBRT and BT dose gradients in the central pelvic region. We developed a method to determine biologically effective dose parameters for combined split-field intensity-modulated radiation therapy (IMRT) and image-guided BT in locally advanced cervical cancer. Thirty-three patients treated with split-field-IMRT to 45.0-51.2 Gy in 1.6-1.8 Gy per fraction to the elective pelvic lymph nodes and to 20 Gy to the central pelvis region were included in this study. Patients received six weekly fractions of high-dose rate BT to 6.5-7.3 Gy per fraction. A dose tracker software was developed to compute the equivalent dose in 2-Gy fractions (EQD2) to gross tumor volume (GTV), organs-at-risk and point A. Total dose-volume histogram parameters were computed on the 3D combined EQD2 dose based on rigid image registration. The dose accumulation uncertainty introduced by organ deformations between IMRT and BT was evaluated. According to International Commission on Radiation Unit and Measurement and GEC European Society for Therapeutic Radiology and Oncology recommendations, D98, D90, D50, and D2cm3 EQD2 dose-volume histogram parameters were computed. GTV D98 was 84.0 ± 26.5 Gy and D2cc was 99.6 ± 13.9 Gy, 67.4 ± 12.2 Gy, 75.0 ± 10.1 Gy, for bladder, rectum, and sigmoid, respectively. The uncertainties induced by organ deformation were estimated to be -1 ± 4 Gy, -3 ± 5 Gy, 2 ± 3 Gy, and -3 ± 5 Gy for bladder, rectum, sigmoid, and GTV, respectively. It is feasible to perform 3D EQD2 dose accumulation to assess high and intermediate dose regions for combined split-field IMRT and BT. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

Evaluation tools of quality control for patients submitted to IMRT

International Nuclear Information System (INIS)

Lavor, Milton

2011-01-01

Intensity modulated radiation therapy (IMRT) is currently been implemented in a rapidly growing number of centers in Brazil. As consequence many institutions are now facing the problem of performing a comprehensive quality control program before and during the implementation of IMRT in the clinical routine practice. The aim of this work is to evaluate and propose a methodology for quality assurance in IMRT treatments. An ionization chamber and a two-dimensional array detector were performed to assess the absolute value of the total dose of all fields in one specific point. The relative total dose distribution of all fields was measured with a radiochromic film and a two-dimensional array at one depth in a phantom. A comparison between measured and calculated dose distributions was performed using the gamma-index method, assessing the percentage of points that meet the criteria of +-3% dose difference and +-3 mm distance to agreement. As a result of 113 tested IMRT beams using ionization chamber and 81 using two-dimensional array, the proposal was to take an action level of about +- 5% compared to the treatment planning systems and measurements, for the verification of the dose in a single point at the low gradient dose region. Analysis of the two-dimensional array measurements showed that the gamma value was <1 for 97.7% of the data and for the film the gamma value was <1 for 96.6% of the data. This can be concluded that for an accurate delivery of dose in 'sliding-window' IMRT with micro multileaf collimator, the absolute value of the total dose and the relative total dose distribution should be checked by absolute and relative dosimetry respectively. (author)

Sweeping-window arc therapy: an implementation of rotational IMRT with automatic beam-weight calculation

International Nuclear Information System (INIS)

Cameron, C

2005-01-01

Sweeping-window arc therapy (SWAT) is a variation of intensity-modulated radiation therapy (IMRT) with direct aperture optimization (DAO) that is initialized with a leaf sequence of sweeping windows that move back and forth periodically across the target as the gantry rotates. This initial sequence induces modulation in the dose and is assumed to be near enough to a minimum to allow successful optimization, done with simulated annealing, without requiring excessive leaf speeds. Optimal beam weights are calculated analytically, with easy extension to allow for variable beam weights. In this paper SWAT is tested on a phantom model and clinical prostate case. For the phantom, constant and variable beam weights are used. Although further work (in particular, improving the dose model) is required, the results show SWAT to be a feasible approach to generating deliverable dynamic arc treatments that are optimized

Sweeping-window arc therapy: an implementation of rotational IMRT with automatic beam-weight calculation

Energy Technology Data Exchange (ETDEWEB)

Cameron, C [Division of Radiation Physics, Department of Radiation Oncology, Stanford Cancer Center, 875 Blake Wilbur Drive, Rm G-233, Stanford, CA 94305-5847 (United States)

2005-09-21

Sweeping-window arc therapy (SWAT) is a variation of intensity-modulated radiation therapy (IMRT) with direct aperture optimization (DAO) that is initialized with a leaf sequence of sweeping windows that move back and forth periodically across the target as the gantry rotates. This initial sequence induces modulation in the dose and is assumed to be near enough to a minimum to allow successful optimization, done with simulated annealing, without requiring excessive leaf speeds. Optimal beam weights are calculated analytically, with easy extension to allow for variable beam weights. In this paper SWAT is tested on a phantom model and clinical prostate case. For the phantom, constant and variable beam weights are used. Although further work (in particular, improving the dose model) is required, the results show SWAT to be a feasible approach to generating deliverable dynamic arc treatments that are optimized.

Three-dimensional dose accumulation in pseudo-split-field IMRT and brachytherapy for locally advanced cervical cancer

DEFF Research Database (Denmark)

Sun, Baozhou; Yang, Deshan; Esthappan, Jackie

2015-01-01

-field intensity-modulated radiation therapy (IMRT) and image-guided BT in locally advanced cervical cancer. METHODS AND MATERIALS: Thirty-three patients treated with split-field-IMRT to 45.0-51.2 Gy in 1.6-1.8 Gy per fraction to the elective pelvic lymph nodes and to 20 Gy to the central pelvis region were...... included in this study. Patients received six weekly fractions of high-dose rate BT to 6.5-7.3 Gy per fraction. A dose tracker software was developed to compute the equivalent dose in 2-Gy fractions (EQD2) to gross tumor volume (GTV), organs-at-risk and point A. Total dose-volume histogram parameters were...

Spatial resolution of 2D ionization chamber arrays for IMRT dose verification: single-detector size and sampling step width

International Nuclear Information System (INIS)

Poppe, Bjoern; Djouguela, Armand; Blechschmidt, Arne; Willborn, Kay; Ruehmann, Antje; Harder, Dietrich

2007-01-01

The spatial resolution of 2D detector arrays equipped with ionization chambers or diodes, used for the dose verification of IMRT treatment plans, is limited by the size of the single detector and the centre-to-centre distance between the detectors. Optimization criteria with regard to these parameters have been developed by combining concepts of dosimetry and pattern analysis. The 2D-ARRAY Type 10024 (PTW-Freiburg, Germany), single-chamber cross section 5 x 5 mm 2 , centre-to-centre distance between chambers in each row and column 10 mm, served as an example. Additional frames of given dose distributions can be taken by shifting the whole array parallel or perpendicular to the MLC leaves by, e.g., 5 mm. The size of the single detector is characterized by its lateral response function, a trapezoid with 5 mm top width and 9 mm base width. Therefore, values measured with the 2D array are regarded as sample values from the convolution product of the accelerator generated dose distribution and this lateral response function. Consequently, the dose verification, e.g., by means of the gamma index, is performed by comparing the measured values of the 2D array with the values of the convolution product of the treatment planning system (TPS) calculated dose distribution and the single-detector lateral response function. Sufficiently small misalignments of the measured dose distributions in comparison with the calculated ones can be detected since the lateral response function is symmetric with respect to the centre of the chamber, and the change of dose gradients due to the convolution is sufficiently small. The sampling step width of the 2D array should provide a set of sample values representative of the sampled distribution, which is achieved if the highest spatial frequency contained in this function does not exceed the 'Nyquist frequency', one half of the sampling frequency. Since the convolution products of IMRT-typical dose distributions and the single

Direct aperture optimization for IMRT using Monte Carlo generated beamlets

International Nuclear Information System (INIS)

Bergman, Alanah M.; Bush, Karl; Milette, Marie-Pierre; Popescu, I. Antoniu; Otto, Karl; Duzenli, Cheryl

2006-01-01

This work introduces an EGSnrc-based Monte Carlo (MC) beamlet does distribution matrix into a direct aperture optimization (DAO) algorithm for IMRT inverse planning. The technique is referred to as Monte Carlo-direct aperture optimization (MC-DAO). The goal is to assess if the combination of accurate Monte Carlo tissue inhomogeneity modeling and DAO inverse planning will improve the dose accuracy and treatment efficiency for treatment planning. Several authors have shown that the presence of small fields and/or inhomogeneous materials in IMRT treatment fields can cause dose calculation errors for algorithms that are unable to accurately model electronic disequilibrium. This issue may also affect the IMRT optimization process because the dose calculation algorithm may not properly model difficult geometries such as targets close to low-density regions (lung, air etc.). A clinical linear accelerator head is simulated using BEAMnrc (NRC, Canada). A novel in-house algorithm subdivides the resulting phase space into 2.5x5.0 mm 2 beamlets. Each beamlet is projected onto a patient-specific phantom. The beamlet dose contribution to each voxel in a structure-of-interest is calculated using DOSXYZnrc. The multileaf collimator (MLC) leaf positions are linked to the location of the beamlet does distributions. The MLC shapes are optimized using direct aperture optimization (DAO). A final Monte Carlo calculation with MLC modeling is used to compute the final dose distribution. Monte Carlo simulation can generate accurate beamlet dose distributions for traditionally difficult-to-calculate geometries, particularly for small fields crossing regions of tissue inhomogeneity. The introduction of DAO results in an additional improvement by increasing the treatment delivery efficiency. For the examples presented in this paper the reduction in the total number of monitor units to deliver is ∼33% compared to fluence-based optimization methods

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

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Gedik Sonay

2017-01-01

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

Evaluation of quality control tools for patients submitted to IMRT; Avaliacao das ferramentas de controle da qualidade para pacientes submetidos ao IMRT

Energy Technology Data Exchange (ETDEWEB)

Lavor, Milton; Rodrigues, Laura N.; Silva, Marco A., E-mail: miltonlavor@gmail.com [Universidade de Sao Paulo (HCFMRP/USP), Sao Paulo, SP (Brazil). Hospital das Clinicas. Servico de Radioterapia

2013-04-15

Intensity modulated radiation therapy (IMRT) is currently being implemented in a rapidly growing number of centers in Brazil. As consequence many institutions are now facing the problem of performing a comprehensive quality control program before and during the implementation of IMRT in the clinical practice. This paper proposes a methodology for quality control and presents the results and evaluations of the data obtained from the proposed methodology. Ionization chamber and two-dimensional array detector were performed in IMRT treatment planning in order to assess the absolute value of the total dose of all fields. The relative total dose distribution of all fields was measured with a radiochromic film and a two-dimensional array in a phantom. A comparison between measured and calculated dose distributions was performed using the gamma-index method, assessing the percentage of points that meet the criteria of ±3% dose difference and ±3mm distance to agreement. As a result and review of 113 tested IMRT beams using ionization chamber and 81 using two-dimensional array, the proposal was to take an action level of about ±5% compared to the treatment planning systems and measurements, for the verification of the dose in a single point at the low gradient dose region. Analysis of the two-dimensional array measurements showed that the gamma value was <1 for 97.7% of the data and for the film the gamma value was <1 for 96.6% of the data. This work can establish action levels required for quality control program proposed and implemented in the Department of Radiotherapy - Hospital das Clinicas in Sao Paulo that allows an accurate delivery of dose in 'sliding-window' IMRT with micro multi leaf collimator. (author)

Dose domain regularization of MLC leaf patterns for highly complex IMRT plans

Energy Technology Data Exchange (ETDEWEB)

Nguyen, Dan; Yu, Victoria Y.; Ruan, Dan; Cao, Minsong; Low, Daniel A.; Sheng, Ke, E-mail: ksheng@mednet.ucla.edu [Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California 90095 (United States); O’Connor, Daniel [Department of Mathematics, University of California Los Angeles, Los Angeles, California 90095 (United States)

2015-04-15

Purpose: The advent of automated beam orientation and fluence optimization enables more complex intensity modulated radiation therapy (IMRT) planning using an increasing number of fields to exploit the expanded solution space. This has created a challenge in converting complex fluences to robust multileaf collimator (MLC) segments for delivery. A novel method to regularize the fluence map and simplify MLC segments is introduced to maximize delivery efficiency, accuracy, and plan quality. Methods: In this work, we implemented a novel approach to regularize optimized fluences in the dose domain. The treatment planning problem was formulated in an optimization framework to minimize the segmentation-induced dose distribution degradation subject to a total variation regularization to encourage piecewise smoothness in fluence maps. The optimization problem was solved using a first-order primal-dual algorithm known as the Chambolle-Pock algorithm. Plans for 2 GBM, 2 head and neck, and 2 lung patients were created using 20 automatically selected and optimized noncoplanar beams. The fluence was first regularized using Chambolle-Pock and then stratified into equal steps, and the MLC segments were calculated using a previously described level reducing method. Isolated apertures with sizes smaller than preset thresholds of 1–3 bixels, which are square units of an IMRT fluence map from MLC discretization, were removed from the MLC segments. Performance of the dose domain regularized (DDR) fluences was compared to direct stratification and direct MLC segmentation (DMS) of the fluences using level reduction without dose domain fluence regularization. Results: For all six cases, the DDR method increased the average planning target volume dose homogeneity (D95/D5) from 0.814 to 0.878 while maintaining equivalent dose to organs at risk (OARs). Regularized fluences were more robust to MLC sequencing, particularly to the stratification and small aperture removal. The maximum and

Dosimetric comparison of treatment techniques IMRT and VMAT for breast cancer

International Nuclear Information System (INIS)

Urbina, G. L.; Garcia, B. G.

2015-10-01

In this study the dosimetric distribution was compared in the different treatment techniques such as Volumetric Modulated Arc Therapy (VMAT) and Intensity Modulated Radiation Therapy (IMRT) in female patients with breast cancer with stage II-B and III-A, 6 cases (both calculated on VMAT and IMRT) were studied, comparison parameter that are taken into account are: compliance rate, homogeneity index, monitor units, volume dose 50 Gy (D-50%) and 5 Gy (D-5%) volume dose. Comparisons are made in primary tumor volume to optimize treatment in patients with breast cancer, with IMRT using Step, Shoot and VMAT Monte Carlo algorithm, in addition to the organs at risk; the concern to make this work is due to technological advances in radiotherapy and the application of new treatment techniques, that increase the accuracy allowing treatment dose climbing delivering a higher dose to the patient. (Author)

Single-Arc IMRT?

International Nuclear Information System (INIS)

Bortfeld, Thomas; Webb, Steve

2009-01-01

The idea of delivering intensity-modulated radiation therapy (IMRT) with a multileaf collimator in a continuous dynamic mode during a single rotation of the gantry has recently gained momentum both in research and industry. In this note we investigate the potential of this Single-Arc IMRT technique at a conceptual level. We consider the original theoretical example case from Brahme et al that got the field of IMRT started. Using analytical methods, we derive deliverable intensity 'landscapes' for Single-Arc as well as standard IMRT and Tomotherapy. We find that Tomotherapy provides the greatest flexibility in shaping intensity landscapes and that it allows one to deliver IMRT in a way that comes close to the ideal case in the transverse plane. Single-Arc and standard IMRT make compromises in different areas. Only in relatively simple cases that do not require substantial intensity modulation will Single-Arc be dosimetrically comparable to Tomotherapy. Compared with standard IMRT, Single-Arc could be dosimetrically superior in certain cases if one is willing to accept the spreading of low dose values over large volumes of normal tissue. In terms of treatment planning, Single-Arc poses a more challenging optimization problem than Tomotherapy or standard IMRT. We conclude that Single-Arc holds potential as an efficient IMRT technique especially for relatively simple cases. In very complex cases, Single-Arc may unduly compromise the quality of the dose distribution, if one tries to keep the treatment time below 2 min or so. As with all IMRT techniques, it is important to explore the tradeoff between plan quality and the efficiency of its delivery carefully for each individual case. (note)

Dose evaluation of TPS according to treatment sites in IMRT

International Nuclear Information System (INIS)

Kim, Jin Man; Kim, Jong Sik; Hong, Chae Seon; Park, Ju Young; Park, Su Yeon; Ju, Sang Gyu

2013-01-01

This study executed therapy plans on prostate cancer (homogeneous density area) and lung cancer (non-homogeneous density area) using radiation treatment planning systems such as Pinnacle 3 (version 9.2, Philips Medical Systems, USA) and Eclipse (version 10.0, Varian Medical Systems, USA) in order to quantify the difference between dose calculation according to density in IMRT. The subjects were prostate cancer patients (n=5) and lung cancer patients (n=5) who had therapies in our hospital. Identical constraints and optimization process according to the Protocol were administered on the subjects. For the therapy plan of prostate cancer patients, 10 MV and 7Beam were used and 2.5 Gy was prescribed in 28 fx to make 70 Gy in total. For lung cancer patients, 6 MV and 6Beam were used and 2 Gy was prescribed in 33 fx to make 66 Gy in total. Through two therapy planning systems, maximum dose, average dose, and minimum dose of OAR (Organ at Risk) of CTV, PTV and around tumor were investigated. In prostate cancer, both therapy planning systems showed within 2% change of dose of CTV and PTV and normal organs (Bladder, Both femur and Rectum out) near the tumor satisfied the dose constraints. In lung cancer, CTV and PTV showed less than 2% changes in dose and normal organs (Esophagus, Spinal cord and Both lungs) satisfied dose restrictions. However, the minimum dose of Eclipse therapy plan was 1.9% higher in CTV and 3.5% higher in PTV, and in case of both lungs there was 3.0% difference at V5 Gy. Each TPS according to the density satisfied dose limits of our hospital proving the clinical accuracy. It is considered more accurate and precise therapy plan can be made if studies on treatment planning for diverse parts and the application of such TPS are made

SU-E-T-430: Modeling MLC Leaf End in 2D for Sliding Window IMRT and Arc Therapy

International Nuclear Information System (INIS)

Liang, X; Zhu, T

2014-01-01

Purpose: To develop a 2D geometric model for MLC accounting for leaf end dose leakage for dynamic IMRT and Rapidarc therapy. Methods: Leaf-end dose leakage is one of the problems for MLC dose calculation and modeling. Dosimetric leaf gap used to model the MLC and to count for leakage in dose calculation, but may not be accurate for smaller leaf gaps. We propose another geometric modeling method to compensate for the MLC round-shape leaf ends dose leakage, and improve the accuracy of dose calculation and dose verification. A triangular function is used to geometrically model the MLC leaf end leakage in the leaf motion direction, and a step function is used in the perpendicular direction. Dose measurements with different leaf gap, different window width, and different window height were conducted, and the results were used to fit the analytical model to get the model parameters. Results: Analytical models have been obtained for stop-and-shoot and dynamic modes for MLC motion. Parameters a=0.4, lw'=5.0 mm for 6X and a=0.54, lw'=4.1 mm for 15x were obtained from the fitting process. The proposed MLC leaf end model improves the dose profile at the two ends of the sliding window opening. This improvement is especially significant for smaller sliding window openings, which are commonly used for highly modulated IMRT plans and arc therapy plans. Conclusion: This work models the MLC round leaf end shape and movement pattern for IMRT dose calculation. The theory, as well as the results in this work provides a useful tool for photon beam IMRT dose calculation and verification

Clinical experience transitioning from IMRT to VMAT for head and neck cancer

Energy Technology Data Exchange (ETDEWEB)

Studenski, Matthew T., E-mail: matthew.studenski@jeffersonhospital.org [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Bar-Ad, Voichita; Siglin, Joshua [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Cognetti, David; Curry, Joseph [Department of Otolaryngology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Tuluc, Madalina [Department of Pathology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Harrison, Amy S. [Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States)

2013-07-01

To quantify clinical differences for volumetric modulated arc therapy (VMAT) versus intensity modulated radiation therapy (IMRT) in terms of dosimetric endpoints and planning and delivery time, twenty head and neck cancer patients have been considered for VMAT using Nucletron Oncentra MasterPlan delivered via an Elekta linear accelerator. Differences in planning time between IMRT and VMAT were estimated accounting for both optimization and calculation. The average delivery time per patient was obtained retrospectively using the record and verify software. For the dosimetric comparison, all contoured organs at risk (OARs) and planning target volumes (PTVs) were evaluated. Of the 20 cases considered, 14 had VMAT plans approved. Six VMAT plans were rejected due to unacceptable dose to OARs. In terms of optimization time, there was minimal difference between the two modalities. The dose calculation time was significantly longer for VMAT, 4 minutes per 358 degree arc versus 2 minutes for an entire IMRT plan. The overall delivery time was reduced by 9.2 ± 3.9 minutes for VMAT (51.4 ± 15.6%). For the dosimetric comparison of the 14 clinically acceptable plans, there was almost no statistical difference between the VMAT and IMRT. There was also a reduction in monitor units of approximately 32% from IMRT to VMAT with both modalities demonstrating comparable quality assurance results. VMAT provides comparable coverage of target volumes while sparing OARs for the majority of head and neck cases. In cases where high dose modulation was required for OARs, a clinically acceptable plan was only achievable with IMRT. Due to the long calculation times, VMAT plans can cause delays during planning but marked improvements in delivery time reduce patient treatment times and the risk of intra-fraction motion.

Theoretical and practical model for implementing intensity modulated radiotherapy (IMRT) based on openness in head and neck tumors

International Nuclear Information System (INIS)

Napoles Morales, Misleidy; Yanes Lopez, Yaima; Ascension, Yudith; Alfonso La Guardia, Rodolfo; Calderon, Carlos

2009-01-01

Certain requirements have been internationally recommended for the transition from radiation therapy (3D-CRT) to intensity modulated radiation therapy (IMRT). They have been filling in clinical practice in the physical, dosimetry and quality of treatment. Prior to the implementation of IMRT have been developed preclinical will proceed according to the treatment planning techniques in the real images of patients, validating the rationale for the transition from the point of view and radiobiological dosimetry. The comparison was based on a group of patients eligible for IMRT, which were actually treated with 3D-CRT. IMRT plans were designed and applied to virtually the same patients, simulating the IMRT treatment. The prescribed dose and fractionation were similar in both techniques, to be able to compare radiobiology. The results show the rationality of IMRT in terms of reducing complications and the possibility of scaling doses in the PTV. Were used Dose Volume Histograms (HDV) obtained from the dosimetric calculations for radiobiological evaluation of treatment plans, letting through a software: 'Albireo Target' version 4.0.1.2008 calculate the equivalent uniform dose (EUD) for tumor and organs of risks (OAR) and tumor control probability (TCP) and the likelihood of damage to healthy tissue (NTCP). The results obtained with IMRT plans were more significant than with 3D-CRT especially in terms of EUD for organs at risk and NTCP. These results allow us to create the definitive basis for the implementation of IMRT in our environment. (Author)

Fast online Monte Carlo-based IMRT planning for the MRI linear accelerator

Science.gov (United States)

Bol, G. H.; Hissoiny, S.; Lagendijk, J. J. W.; Raaymakers, B. W.

2012-03-01

The MRI accelerator, a combination of a 6 MV linear accelerator with a 1.5 T MRI, facilitates continuous patient anatomy updates regarding translations, rotations and deformations of targets and organs at risk. Accounting for these demands high speed, online intensity-modulated radiotherapy (IMRT) re-optimization. In this paper, a fast IMRT optimization system is described which combines a GPU-based Monte Carlo dose calculation engine for online beamlet generation and a fast inverse dose optimization algorithm. Tightly conformal IMRT plans are generated for four phantom cases and two clinical cases (cervix and kidney) in the presence of the magnetic fields of 0 and 1.5 T. We show that for the presented cases the beamlet generation and optimization routines are fast enough for online IMRT planning. Furthermore, there is no influence of the magnetic field on plan quality and complexity, and equal optimization constraints at 0 and 1.5 T lead to almost identical dose distributions.

SU-F-T-428: An Optimization-Based Commissioning Tool for Finite Size Pencil Beam Dose Calculations

Energy Technology Data Exchange (ETDEWEB)

Li, Y; Tian, Z; Song, T; Jia, X; Gu, X; Jiang, S [UT Southwestern Medical Center, Dallas, TX (United States)

2016-06-15

Purpose: Finite size pencil beam (FSPB) algorithms are commonly used to pre-calculate the beamlet dose distribution for IMRT treatment planning. FSPB commissioning, which usually requires fine tuning of the FSPB kernel parameters, is crucial to the dose calculation accuracy and hence the plan quality. Yet due to the large number of beamlets, FSPB commissioning could be very tedious. This abstract reports an optimization-based FSPB commissioning tool we have developed in MatLab to facilitate the commissioning. Methods: A FSPB dose kernel generally contains two types of parameters: the profile parameters determining the dose kernel shape, and a 2D scaling factors accounting for the longitudinal and off-axis corrections. The former were fitted using the penumbra of a reference broad beam’s dose profile with Levenberg-Marquardt algorithm. Since the dose distribution of a broad beam is simply a linear superposition of the dose kernel of each beamlet calculated with the fitted profile parameters and scaled using the scaling factors, these factors could be determined by solving an optimization problem which minimizes the discrepancies between the calculated dose of broad beams and the reference dose. Results: We have commissioned a FSPB algorithm for three linac photon beams (6MV, 15MV and 6MVFFF). Dose of four field sizes (6*6cm2, 10*10cm2, 15*15cm2 and 20*20cm2) were calculated and compared with the reference dose exported from Eclipse TPS system. For depth dose curves, the differences are less than 1% of maximum dose after maximum dose depth for most cases. For lateral dose profiles, the differences are less than 2% of central dose at inner-beam regions. The differences of the output factors are within 1% for all the three beams. Conclusion: We have developed an optimization-based commissioning tool for FSPB algorithms to facilitate the commissioning, providing sufficient accuracy of beamlet dose calculation for IMRT optimization.

IMRT implementation and patient specific dose verification with film and ion chamber array detectors

International Nuclear Information System (INIS)

Saminathan, S.; Manickam, R.; Chandraraj, V.; Supe, S. S.; Keshava, S. L.

2009-01-01

Implementation of Intensity Modulation Radiotherapy (IMRT) and patient dose verification was carried out with film and I'mariXX using linear accelerator with 120-leaf Millennium dynamic multi leaf collimator (dMLC). The basic mechanical and electrical commissioning and quality assurance tests of linear accelerator were carried out. The leaf position accuracy and leaf position repeatability checks were performed for static MLC positions. Picket fence test and garden fence test were performed to check the stability of the dMLC and the reproducibility of the gap between leaves. The radiation checks were performed to verify the position accuracy of MLCs in the collimator system. The dMLC dosimetric checks like output stability, average leaf transmission and dosimetric leaf separation were also investigated. The variation of output with gravitation at different gantry angles was found to be within 0.9%. The measured average leaf transmission for 6 MV was 1.6% and 1.8% for 18 MV beam. The dosimetric leaf separation was found to be 2.2 mm and 2.3 mm for 6 MV and 18 MV beams. In order to check the consistency of the stability and the precision of the dMLC, it is necessary to carryout regular weekly and monthly checks. The dynalog files analysis for Garden fence, leaf gap width and step wedge test patterns carried out weekly were in good agreement. Pretreatment verification was performed for 50 patients with ion chamber and I'matiXX device. The variations of calculated absolute dose for all treatment fields with the ion chamber measurement were within the acceptable criterion. Treatment Planning System (TPS) calculated dose distribution pattern was comparable with the I'matriXX measured dose distribution pattern. Out of 50 patients for which the comparison was made, 36 patients were agreed with the gamma pixel match of>95% and 14 patients were with the gamma pixel match of 90-95% with the criteria of 3% delta dose (DD) and 3 mm distance-to-agreement (DTA). Commissioning and

A Monte Carlo dose calculation tool for radiotherapy treatment planning

International Nuclear Information System (INIS)

Ma, C.-M.; Li, J.S.; Pawlicki, T.; Jiang, S.B.; Deng, J.; Lee, M.C.; Koumrian, T.; Luxton, M.; Brain, S.

2002-01-01

A Monte Carlo user code, MCDOSE, has been developed for radiotherapy treatment planning (RTP) dose calculations. MCDOSE is designed as a dose calculation module suitable for adaptation to host RTP systems. MCDOSE can be used for both conventional photon/electron beam calculation and intensity modulated radiotherapy (IMRT) treatment planning. MCDOSE uses a multiple-source model to reconstruct the treatment beam phase space. Based on Monte Carlo simulated or measured beam data acquired during commissioning, source-model parameters are adjusted through an automated procedure. Beam modifiers such as jaws, physical and dynamic wedges, compensators, blocks, electron cut-outs and bolus are simulated by MCDOSE together with a 3D rectilinear patient geometry model built from CT data. Dose distributions calculated using MCDOSE agreed well with those calculated by the EGS4/DOSXYZ code using different beam set-ups and beam modifiers. Heterogeneity correction factors for layered-lung or layered-bone phantoms as calculated by both codes were consistent with measured data to within 1%. The effect of energy cut-offs for particle transport was investigated. Variance reduction techniques were implemented in MCDOSE to achieve a speedup factor of 10-30 compared to DOSXYZ. (author)

Evaluation of dose coverage to target volume and normal tissue sparing in the adjuvant radiotherapy of gastric cancers: 3D-CRT compared with dynamic IMRT.

Science.gov (United States)

Murthy, Kk; Shukeili, Ka; Kumar, Ss; Davis, Ca; Chandran, Rr; Namrata, S

2010-01-01

To assess the potential advantage of intensity-modulated radiotherapy (IMRT) over 3D-conformal radiotherapy (3D-CRT) planning in postoperative adjuvant radiotherapy for patients with gastric carcinoma. In a retrospective study, for plan comparison, dose distribution was recalculated in 15 patients treated with 3D-CRT on the contoured structures of same CT images using an IMRT technique. 3D-conformal plans with three fields and four-fields were compared with seven-field dynamic IMRT plans. The different plans were compared by analyzing the dose coverage of planning target volume using TV(95), D(mean), uniformity index, conformity index and homogeneity index parameters. To assess critical organ sparing, D(mean), D(max), dose to one-third and two-third volumes of the OARs and percentage of volumes receiving more than their tolerance doses were compared. The average dose coverage values of PTV with 3F-CRT and 4F-CRT plans were comparable, where as IMRT plans achieved better target coverage(p3D-CRT plans. The doses to the liver and bowel reduced significantly (p3D-CRT plans. For all OARs the percentage of volumes receiving more than their tolerance doses were reduced with the IMRT plans. This study showed that a better target coverage and significant dose reduction to OARs could be achieved with the IMRT plans. The IMRT can be preferred with caution for organ motion. The authors are currently studying organ motion in the upper abdomen to use IMRT for patient treatment.

Dose-volume based ranking of incident beam direction and its utility in facilitating IMRT beam placement

International Nuclear Information System (INIS)

Schreibmann, Eduard; Xing Lei

2005-01-01

Purpose: Beam orientation optimization in intensity-modulated radiation therapy (IMRT) is computationally intensive, and various single beam ranking techniques have been proposed to reduce the search space. Up to this point, none of the existing ranking techniques considers the clinically important dose-volume effects of the involved structures, which may lead to clinically irrelevant angular ranking. The purpose of this work is to develop a clinically sensible angular ranking model with incorporation of dose-volume effects and to show its utility for IMRT beam placement. Methods and Materials: The general consideration in constructing this angular ranking function is that a beamlet/beam is preferable if it can deliver a higher dose to the target without exceeding the tolerance of the sensitive structures located on the path of the beamlet/beam. In the previously proposed dose-based approach, the beamlets are treated independently and, to compute the maximally deliverable dose to the target volume, the intensity of each beamlet is pushed to its maximum intensity without considering the values of other beamlets. When volumetric structures are involved, the complication arises from the fact that there are numerous dose distributions corresponding to the same dose-volume tolerance. In this situation, the beamlets are not independent and an optimization algorithm is required to find the intensity profile that delivers the maximum target dose while satisfying the volumetric constraints. In this study, the behavior of a volumetric organ was modeled by using the equivalent uniform dose (EUD). A constrained sequential quadratic programming algorithm (CFSQP) was used to find the beam profile that delivers the maximum dose to the target volume without violating the EUD constraint or constraints. To assess the utility of the proposed technique, we planned a head-and-neck and abdominal case with and without the guidance of the angular ranking information. The qualities of the

SU-E-T-192: Commissioning of a Commercial 3D Dose Calculation Program

International Nuclear Information System (INIS)

Langen, K; Guerrero, M; Xu, H; Zhou, J; Zhang, B; Chen, S; Killefer, M

2015-01-01

Purpose: To commission a commercial software package (CSP) that is used as secondary dose calculation check. The CSP uses an independent golden data beam model. However, some parameters can be modified to generate a customer specific model. Plan comparisons and point dose measurements were performed to test if and to what extent the beam model needed adjustment to optimize results. Methods: Beam parameter configurations were compared between the CSP and both TPS. Twelve phantom test plans ranging from simple to complex were generated in two treatment planning systems (TPS). Tests included small field, off axis, EDW, IMRT and VMAT plans. For each plan a point dose was measured to establish ground truth. Lastly, patient plans were compared for both TPS systems and the CSP. Results: Beam parameters agreed within 2%. The output factors for small fields were changed for the 15 MV beam by 2 and 1.5 % for the 1 cm and 2 cm field sizes, respectively. For the 6 MV beam output factors were adjusted by 3−0.8% for field sizes ranging from 1 to 5 cm. The MLC dynamic leaf gap was adjusted by 1.5 mm for 18 MV beam. Differences between the CSP and the TPS were noted in the built-up region. These differences affected the gamma pass rate in the surface region, however this effect is reduced with increasing number of beam angles and does not affect point dose calculations at depth. All IMRT and VMAT plans agreed with the CSP using a gamma pass rate of 95% (3%, 3mm). Conclusion: The CSP is used to verify point doses for all 3D plans generated in our clinic for the last 6 months. No point dose mismatches were encountered since the CSP was implemented. Next, the CSP will be adapted for secondary checks of all IMRT plans. KL had a beta tester agreement with Mobius Medical for an in-kind equipment and software loan

SU-E-T-192: Commissioning of a Commercial 3D Dose Calculation Program

Energy Technology Data Exchange (ETDEWEB)

Langen, K; Guerrero, M; Xu, H; Zhou, J; Zhang, B; Chen, S [University of Maryland School of Medicine, Baltimore, MD (United States); Killefer, M [Hastings College, Hastings, Nebraska (United States)

2015-06-15

Purpose: To commission a commercial software package (CSP) that is used as secondary dose calculation check. The CSP uses an independent golden data beam model. However, some parameters can be modified to generate a customer specific model. Plan comparisons and point dose measurements were performed to test if and to what extent the beam model needed adjustment to optimize results. Methods: Beam parameter configurations were compared between the CSP and both TPS. Twelve phantom test plans ranging from simple to complex were generated in two treatment planning systems (TPS). Tests included small field, off axis, EDW, IMRT and VMAT plans. For each plan a point dose was measured to establish ground truth. Lastly, patient plans were compared for both TPS systems and the CSP. Results: Beam parameters agreed within 2%. The output factors for small fields were changed for the 15 MV beam by 2 and 1.5 % for the 1 cm and 2 cm field sizes, respectively. For the 6 MV beam output factors were adjusted by 3−0.8% for field sizes ranging from 1 to 5 cm. The MLC dynamic leaf gap was adjusted by 1.5 mm for 18 MV beam. Differences between the CSP and the TPS were noted in the built-up region. These differences affected the gamma pass rate in the surface region, however this effect is reduced with increasing number of beam angles and does not affect point dose calculations at depth. All IMRT and VMAT plans agreed with the CSP using a gamma pass rate of 95% (3%, 3mm). Conclusion: The CSP is used to verify point doses for all 3D plans generated in our clinic for the last 6 months. No point dose mismatches were encountered since the CSP was implemented. Next, the CSP will be adapted for secondary checks of all IMRT plans. KL had a beta tester agreement with Mobius Medical for an in-kind equipment and software loan.

Comparison of film dosimetry and Monte Carlo simulations in small field IMRT

Energy Technology Data Exchange (ETDEWEB)

Kim, S.R.; Suh, T.S.; Choe, B.Y.; Lee, H.K. [The Catholic Univ., Seoul (Korea, Republic of); Sohn. Jason W. [Washington Univ., St. Louis (United States)

2002-07-01

Intensity modulated radiation therapy(IMRT) is a recent useful technique that conforms a high dose to the target volume while restricting dose to the surrounding critical organs. In IMRT, the small size beam let is used for intensity modulation. Thus, dose calculation in small field is very important. But, dose calculation in small field is not accurate in recent RTP system because electronic disequilibrium and the effect of multiple scattering electron are not considered in dose calculation. and therefore, We have evaluated the errors of depth dose and beam profile between measurement data and Monte Carlo simulation. With a homogeneous phantom and two heterogeneous phantoms, A thermoluminescent dosimeter (TLD) and radiochromic films have been selected for dose measurement in 6 MV photon beams. A linear accelerator Varian 2300C (Varian Medical Systems, USA) equipped with a multileaf collimator have been used in dose measurement. The results of simulations using the Monte Carlo systems BEAM/EGS4 (NRC, Canada) to model the beam geometry have been compared with dose measurements. Generally good agreements were found between measurements and dose calculations of Monte Carlo simulation. But some discrepancies were found in this study. Thus further study will be needed to compensate these errors.

Four-dimensional dose distributions of step-and-shoot IMRT delivered with real-time tumor tracking for patients with irregular breathing: Constant dose rate vs dose rate regulation

International Nuclear Information System (INIS)

Yang Xiaocheng; Han-Oh, Sarah; Gui Minzhi; Niu Ying; Yu, Cedric X.; Yi Byongyong

2012-01-01

Purpose: Dose-rate-regulated tracking (DRRT) is a tumor tracking strategy that programs the MLC to track the tumor under regular breathing and adapts to breathing irregularities during delivery using dose rate regulation. Constant-dose-rate tracking (CDRT) is a strategy that dynamically repositions the beam to account for intrafractional 3D target motion according to real-time information of target location obtained from an independent position monitoring system. The purpose of this study is to illustrate the differences in the effectiveness and delivery accuracy between these two tracking methods in the presence of breathing irregularities. Methods: Step-and-shoot IMRT plans optimized at a reference phase were extended to remaining phases to generate 10-phased 4D-IMRT plans using segment aperture morphing (SAM) algorithm, where both tumor displacement and deformation were considered. A SAM-based 4D plan has been demonstrated to provide better plan quality than plans not considering target deformation. However, delivering such a plan requires preprogramming of the MLC aperture sequence. Deliveries of the 4D plans using DRRT and CDRT tracking approaches were simulated assuming the breathing period is either shorter or longer than the planning day, for 4 IMRT cases: two lung and two pancreatic cases with maximum GTV centroid motion greater than 1 cm were selected. In DRRT, dose rate was regulated to speed up or slow down delivery as needed such that each planned segment is delivered at the planned breathing phase. In CDRT, MLC is separately controlled to follow the tumor motion, but dose rate was kept constant. In addition to breathing period change, effect of breathing amplitude variation on target and critical tissue dose distribution is also evaluated. Results: Delivery of preprogrammed 4D plans by the CDRT method resulted in an average of 5% increase in target dose and noticeable increase in organs at risk (OAR) dose when patient breathing is either 10% faster or

SU-F-T-288: Impact of Trajectory Log Files for Clarkson-Based Independent Dose Verification of IMRT and VMAT

Energy Technology Data Exchange (ETDEWEB)

Takahashi, R; Kamima, T [Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto, Tokyo (Japan); Tachibana, H [National Cancer Center, Kashiwa, Chiba (Japan)

2016-06-15

Purpose: To investigate the effect of the trajectory files from linear accelerator for Clarkson-based independent dose verification in IMRT and VMAT plans. Methods: A CT-based independent dose verification software (Simple MU Analysis: SMU, Triangle Products, Japan) with a Clarksonbased algorithm was modified to calculate dose using the trajectory log files. Eclipse with the three techniques of step and shoot (SS), sliding window (SW) and Rapid Arc (RA) was used as treatment planning system (TPS). In this study, clinically approved IMRT and VMAT plans for prostate and head and neck (HN) at two institutions were retrospectively analyzed to assess the dose deviation between DICOM-RT plan (PL) and trajectory log file (TJ). An additional analysis was performed to evaluate MLC error detection capability of SMU when the trajectory log files was modified by adding systematic errors (0.2, 0.5, 1.0 mm) and random errors (5, 10, 30 mm) to actual MLC position. Results: The dose deviations for prostate and HN in the two sites were 0.0% and 0.0% in SS, 0.1±0.0%, 0.1±0.1% in SW and 0.6±0.5%, 0.7±0.9% in RA, respectively. The MLC error detection capability shows the plans for HN IMRT were the most sensitive and 0.2 mm of systematic error affected 0.7% dose deviation on average. Effect of the MLC random error did not affect dose error. Conclusion: The use of trajectory log files including actual information of MLC location, gantry angle, etc should be more effective for an independent verification. The tolerance level for the secondary check using the trajectory file may be similar to that of the verification using DICOM-RT plan file. From the view of the resolution of MLC positional error detection, the secondary check could detect the MLC position error corresponding to the treatment sites and techniques. This research is partially supported by Japan Agency for Medical Research and Development (AMED)

A planning and delivery study of a rotational IMRT technique with burst delivery

International Nuclear Information System (INIS)

Kainz, Kristofer; Chen, Guang-Pei; Chang, Yu-Wen; Prah, Douglas; Sharon Qi, X.; Shukla, Himanshu P.; Stahl, Johannes; Allen Li, X.

2011-01-01

Purpose: A novel rotational IMRT (rIMRT) technique using burst delivery (continuous gantry rotation with beam off during MLC repositioning) is investigated. The authors evaluate the plan quality and delivery efficiency and accuracy of this dynamic technique with a conventional flat 6 MV photon beam. Methods: Burst-delivery rIMRT was implemented in a planning system and delivered with a 160-MLC linac. Ten rIMRT plans were generated for five anonymized patient cases encompassing head and neck, brain, prostate, and prone breast. All plans were analyzed retrospectively and not used for treatment. Among the varied plan parameters were the number of optimization points, number of arcs, gantry speed, and gantry angle range (alpha) over which the beam is turned on at each optimization point. Combined rotational/step-and-shoot rIMRT plans were also created by superimposing multiple-segment static fields at several optimization points. The rIMRT trial plans were compared with each other and with plans generated using helical tomotherapy and VMAT. Burst-mode rotational IMRT plans were delivered and verified using a diode array, ionization chambers, thermoluminescent dosimeters, and film. Results: Burst-mode rIMRT can achieve plan quality comparable to helical tomotherapy, while the former may lead to slightly better OAR sparing for certain cases and the latter generally achieves slightly lower hot spots. Few instances were found in which increasing the number of optimization points above 36, or superimposing step-and-shoot IMRT segments, led to statistically significant improvements in OAR sparing. Using an additional rIMRT partial arc yielded substantial OAR dose improvements for the brain case. Measured doses from the rIMRT plan delivery were within 4% of the plan calculation in low dose gradient regions. Delivery time range was 228-375 s for single-arc rIMRT 200-cGy prescription with a 300 MU/min dose rate, comparable to tomotherapy and VMAT. Conclusions: Rotational IMRT

SU-F-T-440: The Feasibility Research of Checking Cervical Cancer IMRT Pre- Treatment Dose Verification by Automated Treatment Planning Verification System

Energy Technology Data Exchange (ETDEWEB)

Liu, X; Yin, Y; Lin, X [Shandong Cancer Hospital and Institute, China, Jinan, Shandong (China)

2016-06-15

Purpose: To assess the preliminary feasibility of automated treatment planning verification system in cervical cancer IMRT pre-treatment dose verification. Methods: The study selected randomly clinical IMRT treatment planning data for twenty patients with cervical cancer, all IMRT plans were divided into 7 fields to meet the dosimetric goals using a commercial treatment planning system(PianncleVersion 9.2and the EclipseVersion 13.5). The plans were exported to the Mobius 3D (M3D)server percentage differences of volume of a region of interest (ROI) and dose calculation of target region and organ at risk were evaluated, in order to validate the accuracy automated treatment planning verification system. Results: The difference of volume for Pinnacle to M3D was less than results for Eclipse to M3D in ROI, the biggest difference was 0.22± 0.69%, 3.5±1.89% for Pinnacle and Eclipse respectively. M3D showed slightly better agreement in dose of target and organ at risk compared with TPS. But after recalculating plans by M3D, dose difference for Pinnacle was less than Eclipse on average, results were within 3%. Conclusion: The method of utilizing the automated treatment planning system to validate the accuracy of plans is convenientbut the scope of differences still need more clinical patient cases to determine. At present, it should be used as a secondary check tool to improve safety in the clinical treatment planning.

Investigation of the use of MOSFET for clinical IMRT dosimetric verification

International Nuclear Information System (INIS)

Chuang, Cynthia F.; Verhey, Lynn J.; Xia Ping

2002-01-01

With advanced conformal radiotherapy using intensity modulated beams, it is important to have radiation dose verification measurements prior to treatment. Metal oxide semiconductor field effect transistors (MOSFET) have the advantage of a faster and simpler reading procedure compared to thermoluminescent dosimeters (TLD), and with the commercial MOSFET system, multiple detectors can be used simultaneously. In addition, the small size of the detector could be advantageous, especially for point dose measurements in small homogeneous dose regions. To evaluate the feasibility of MOSFET for routine IMRT dosimetry, a comprehensive set of experiments has been conducted, to investigate the stability, linearity, energy, and angular dependence. For a period of two weeks, under a standard measurement setup, the measured dose standard deviation using the MOSFETs was ±0.015 Gy with the mean dose being 1.00 Gy. For a measured dose range of 0.3 Gy to 4.2 Gy, the MOSFETs present a linear response, with a linearity coefficient of 0.998. Under a 10x10 cm 2 square field, the dose variations measured by the MOSFETs for every 10 degrees from 0 to 180 degrees is ±2.5%. The percent depth dose (PDD) measurements were used to verify the energy dependence. The measured PDD using the MOSFETs from 0.5 cm to 34 cm depth agreed to within ±3% when compared to that of the ionization chamber. For IMRT dose verification, two special phantoms were designed. One is a solid water slab with 81 possible MOSFET placement holes, and another is a cylindrical phantom with 48 placement holes. For each IMRT phantom verification, an ionization chamber and 3 to 5 MOSFETs were used to measure multiple point doses at different locations. Preliminary results show that the agreement between dose measured by MOSFET and that calculated by Corvus is within 5% error, while the agreement between ionization chamber measurement and the calculation is within 3% error. In conclusion, MOSFET detectors are suitable for

Real-time beam monitoring for error detection in IMRT plans and impact on dose-volume histograms. A multi-center study

Energy Technology Data Exchange (ETDEWEB)

Marrazzo, Livia; Arilli, Chiara; Casati, Marta [Careggi University Hospital, Medical Physic Unit, Florence (Italy); Pasler, Marlies [Lake Constance Radiation Oncology Center, Singen-Friedrichshafen (Germany); Kusters, Martijn; Canters, Richard [Radboud University Medical Center, Department of Radiation Oncology, Nijmegen (Netherlands); Fedeli, Luca; Calusi, Silvia [University of Florence, Department of Experimental and Clinical Biomedical Sciences ' ' Mario Serio' ' , Florence (Italy); Talamonti, Cinzia; Pallotta, Stefania [Careggi University Hospital, Medical Physic Unit, Florence (Italy); University of Florence, Department of Experimental and Clinical Biomedical Sciences ' ' Mario Serio' ' , Florence (Italy); Simontacchi, Gabriele [Careggi University Hospital, Radiation Oncology Unit, Florence (Italy); Livi, Lorenzo [University of Florence, Department of Experimental and Clinical Biomedical Sciences ' ' Mario Serio' ' , Florence (Italy); Careggi University Hospital, Radiation Oncology Unit, Florence (Italy)

2018-03-15

This study aimed to test the sensitivity of a transmission detector for online dose monitoring of intensity-modulated radiation therapy (IMRT) for detecting small delivery errors. Furthermore, the correlation of changes in detector output induced by small delivery errors with other metrics commonly employed to quantify the deviations between calculated and delivered dose distributions was investigated. Transmission detector measurements were performed at three institutions. Seven types of errors were induced in nine clinical step-and-shoot (S and S) IMRT plans by modifying the number of monitor units (MU) and introducing small deviations in leaf positions. Signal reproducibility was investigated for short- and long-term stability. Calculated dose distributions were compared in terms of γ passing rates and dose-volume histogram (DVH) metrics (e.g., D{sub mean}, D{sub x%}, V{sub x%}). The correlation between detector signal variations, γ passing rates, and DVH parameters was investigated. Both short- and long-term reproducibility was within 1%. Dose variations down to 1 MU (∇signal 1.1 ± 0.4%) as well as changes in field size and positions down to 1 mm (∇signal 2.6 ± 1.0%) were detected, thus indicating high error-detection sensitivity. A moderate correlation of detector signal was observed with γ passing rates (R{sup 2} = 0.57-0.70), while a good correlation was observed with DVH metrics (R{sup 2} = 0.75-0.98). The detector is capable of detecting small delivery errors in MU and leaf positions, and is thus a highly sensitive dose monitoring device for S and S IMRT for clinical practice. The results of this study indicate a good correlation of detector signal with DVH metrics; therefore, clinical action levels can be defined based on the presented data. (orig.) [German] In dieser Arbeit wurde die Sensitivitaet bezueglich der Fehlererkennung eines Transmissionsdetektors fuer die Online-Dosisueberwachung von intensitaetsmodulierter Strahlentherapie (IMRT

Restricted Field IMRT Dramatically Enhances IMRT Planning for Mesothelioma

International Nuclear Information System (INIS)

Allen, Aaron M.; Schofield, Deborah; Hacker, Fred; Court, Laurence E.; Czerminska, Maria M.S.

2007-01-01

Purpose: To improve the target coverage and normal tissue sparing of intensity-modulated radiotherapy (IMRT) for mesothelioma after extrapleural pneumonectomy. Methods and Materials: Thirteen plans from patients previously treated with IMRT for mesothelioma were replanned using a restricted field technique. This technique was novel in two ways. It limited the entrance beams to 200 o around the target and three to four beams per case had their field apertures restricted down to the level of the heart or liver to further limit the contralateral lung dose. New constraints were added that included a mean lung dose of <9.5 Gy and volume receiving ≥5 Gy of <55%. Results: In all cases, the planning target volume coverage was excellent, with an average of 97% coverage of the planning target volume by the target dose. No change was seen in the target coverage with the new technique. The heart, kidneys, and esophagus were all kept under tolerance in all cases. The average mean lung dose, volume receiving ≥20 Gy, and volume receiving ≥5 Gy with the new technique was 6.6 Gy, 3.0%, and 50.8%, respectively, compared with 13.8 Gy, 15%, and 90% with the previous technique (p < 0.0001 for all three comparisons). The maximal value for any case in the cohort was 8.0 Gy, 7.3%, and 57.5% for the mean lung dose, volume receiving ≥20 Gy, and volume receiving ≥5 Gy, respectively. Conclusion: Restricted field IMRT provides an improved method to deliver IMRT to a complex target after extrapleural pneumonectomy. An upcoming Phase I trial will provide validation of these results

COMPARISON OF THE PERIPHERAL DOSES FROM DIFFERENT IMRT TECHNIQUES FOR PEDIATRIC HEAD AND NECK RADIATION THERAPY.

Science.gov (United States)

Toyota, Masahiko; Saigo, Yasumasa; Higuchi, Kenta; Fujimura, Takuya; Koriyama, Chihaya; Yoshiura, Takashi; Akiba, Suminori

2017-11-01

Intensity-modulated radiation therapy (IMRT) can deliver high and homogeneous doses to the target area while limiting doses to organs at risk. We used a pediatric phantom to simulate the treatment of a head and neck tumor in a child. The peripheral doses were examined for three different IMRT techniques [dynamic multileaf collimator (DMLC), segmental multileaf collimator (SMLC) and volumetric modulated arc therapy (VMAT)]. Peripheral doses were evaluated taking thyroid, breast, ovary and testis as the points of interest. Doses were determined using a radio-photoluminescence glass dosemeter, and the COMPASS system was used for three-dimensional dose evaluation. VMAT achieved the lowest peripheral doses because it had the highest monitor unit efficiency. However, doses in the vicinity of the irradiated field, i.e. the thyroid, could be relatively high, depending on the VMAT collimator angle. DMLC and SMLC had a large area of relatively high peripheral doses in the breast region. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Implementation of dosimetric quality control on IMRT and VMAT treatments in radiotherapy using diodes; Implementacion de control de calidad dosimetrico en tratamientos de IMRT y VMAT en radioterapia usando diodos

Energy Technology Data Exchange (ETDEWEB)

Gonzales, A.; Garcia, B.; Ramirez, J.; Marquina, J., E-mail: andres.gonzales@aliada.com.pe [ALIADA, Oncologia Integral, Av. Jose Galvez Barrenechea 1044, San Isidro, Lima 27 (Peru)

2014-08-15

To implement quality control of IMRT and VMAT treatments Rapid Arc radiotherapy using diode array. Were tested 90 patients with IMRT and VMAT Rapid Arc, comparing the planned dose to the dose administered, used the Map-Check-2 and Arc-Check of Sun Nuclear, they using the gamma factor for calculating and using comparison parameters 3% / 3m m. The statistic shows that the quality controls of the 90 patients analyzed, presented a percentage of diodes that pass the test between 96,7% and 100,0% of the irradiated diodes. Implemented in Clinical ALIADA Oncologia Integral, the method for quality control of IMRT and VMAT treatments Rapid Arc radiotherapy using diode array. (Author)

MRI-based treatment planning for radiotherapy: Dosimetric verification for prostate IMRT

International Nuclear Information System (INIS)

Chen, Lili; Price, Robert A.; Wang Lu; Li Jinsheng; Qin Lihong; McNeeley, Shawn; Ma, C.-M. Charlie; Freedman, Gary M.; Pollack, Alan

2004-01-01

Purpose: Magnetic resonance (MR) and computed tomography (CT) image fusion with CT-based dose calculation is the gold standard for prostate treatment planning. MR and CT fusion with CT-based dose calculation has become a routine procedure for intensity-modulated radiation therapy (IMRT) treatment planning at Fox Chase Cancer Center. The use of MRI alone for treatment planning (or MRI simulation) will remove any errors associated with image fusion. Furthermore, it will reduce treatment cost by avoiding redundant CT scans and save patient, staff, and machine time. The purpose of this study is to investigate the dosimetric accuracy of MRI-based treatment planning for prostate IMRT. Methods and materials: A total of 30 IMRT plans for 15 patients were generated using both MRI and CT data. The MRI distortion was corrected using gradient distortion correction (GDC) software provided by the vendor (Philips Medical System, Cleveland, OH). The same internal contours were used for the paired plans. The external contours were drawn separately between CT-based and MR imaging-based plans to evaluate the effect of any residual distortions on dosimetric accuracy. The same energy, beam angles, dose constrains, and optimization parameters were used for dose calculations for each paired plans using a treatment optimization system. The resulting plans were compared in terms of isodose distributions and dose-volume histograms (DVHs). Hybrid phantom plans were generated for both the CT-based plans and the MR-based plans using the same leaf sequences and associated monitor units (MU). The physical phantom was then irradiated using the same leaf sequences to verify the dosimetry accuracy of the treatment plans. Results: Our results show that dose distributions between CT-based and MRI-based plans were equally acceptable based on our clinical criteria. The absolute dose agreement for the planning target volume was within 2% between CT-based and MR-based plans and 3% between measured dose

SU-F-SPS-04: Dosimetric Evaluation of the Dose Calculation Accuracy of Different Algorithms for Two Different Treatment Techniques During Whole Breast Irradiation

Energy Technology Data Exchange (ETDEWEB)

Pacaci, P; Cebe, M; Mabhouti, H; Codel, G; Serin, E; Sanli, E; Kucukmorkoc, E; Doyuran, M; Kucuk, N; Canoglu, D; Altinok, A; Acar, H; Caglar Ozkok, H [Medipol University, Istanbul, Istanbul (Turkey)

2016-06-15

Purpose: In this study, dosimetric comparison of field in field (FIF) and intensity modulated radiation therapy (IMRT) techniques used for treatment of whole breast radiotherapy (WBRT) were made. The dosimetric accuracy of treatment planning system (TPS) for Anisotropic Analytical Algorithm (AAA) and Acuros XB (AXB) algorithms in predicting PTV and OAR doses was also investigated. Methods: Two different treatment planning techniques of left-sided breast cancer were generated for rando phantom. FIF and IMRT plans were compared for doses in PTV and OAR volumes including ipsilateral lung, heart, left ascending coronary artery, contralateral lung and the contralateral breast. PTV and OARs doses and homogeneity and conformality indexes were compared between two techniques. The accuracy of TPS dose calculation algorithms was tested by comparing PTV and OAR doses measured by thermoluminescent dosimetry with the dose calculated by the TPS using AAA and AXB for both techniques. Results: IMRT plans had better conformality and homogeneity indexes than FIF technique and it spared OARs better than FIF. While both algorithms overestimated PTV doses they underestimated all OAR doses. For IMRT plan, PTV doses, overestimation up to 2.5 % was seen with AAA algorithm but it decreased to 1.8 % when AXB algorithm was used. Based on the results of the anthropomorphic measurements for OAR doses, underestimation greater than 7 % is possible by the AAA. The results from the AXB are much better than the AAA algorithm. However, underestimations of 4.8 % were found in some of the points even for AXB. For FIF plan, similar trend was seen for PTV and OARs doses in both algorithm. Conclusion: When using the Eclipse TPS for breast cancer, AXB the should be used instead of the AAA algorithm, bearing in mind that the AXB may still underestimate all OAR doses.

Dosimetric verification of IMRT plans

International Nuclear Information System (INIS)

Bulski, W.; Cheimicski, K.; Rostkowska, J.

2012-01-01

Intensity modulated radiotherapy (IMRT) is a complex procedure requiring proper dosimetric verification. IMRT dose distributions are characterized by steep dose gradients which enable to spare organs at risk and allow for an escalation of the dose to the tumor. They require large number of radiation beams (sometimes over 10). The fluence measurements for individual beams are not sufficient for evaluation of the total dose distribution and to assure patient safety. The methods used at the Centre of Oncology in Warsaw are presented. In order to measure dose distributions in various cross-sections the film dosimeters were used (radiographic Kodak EDR2 films and radiochromic Gafchromic EBT films). The film characteristics were carefully examined. Several types of tissue equivalent phantoms were developed. A methodology of comparing measured dose distributions against the distributions calculated by treatment planning systems (TPS) was developed and tested. The tolerance level for this comparison was set at 3% difference in dose and 3 mm in distance to agreement. The so called gamma formalism was used. The results of these comparisons for a group of over 600 patients are presented. Agreement was found in 87 % of cases. This film dosimetry methodology was used as a benchmark to test and validate the performance of commercially available 2D and 3D matrices of detectors (ionization chambers or diodes). The results of these validations are also presented. (authors)

ICRU reference dose in an era of intensity-modulated radiation therapy clinical trials: Correlation with planning target volume mean dose and suitability for intensity-modulated radiation therapy dose prescription

International Nuclear Information System (INIS)

Yaparpalvi, Ravindra; Hong, Linda; Mah, Dennis; Shen Jin; Mutyala, Subhakar; Spierer, Marnee; Garg, Madhur; Guha, Chandan; Kalnicki, Shalom

2008-01-01

Background and Purpose: IMRT clinical trials lack dose prescription and specification standards similar to ICRU standards for two- and three-dimensional external beam planning. In this study, we analyzed dose distributions for patients whose treatment plans incorporated IMRT, and compared the dose determined at the ICRU reference point to the PTV doses determined from dose-volume histograms. Additionally, we evaluated if ICRU reference type single-point dose prescriptions are suitable for IMRT dose prescriptions. Materials and methods: For this study, IMRT plans of 117 patients treated at our institution were randomly selected and analyzed. The treatment plans were clinically applied to the following disease sites: abdominal (11), anal (10), brain (11), gynecological (15), head and neck (25), lung (15), male pelvis (10) and prostate (20). The ICRU reference point was located in each treatment plan following ICRU Report 50 guidelines. The reference point was placed in the central part of the PTV and at or near the isocenter. In each case, the dose was calculated and recorded to this point. For each patient - volume and dose (PTV, PTV mean, median and modal) information was extracted from the planned dose-volume histogram. Results: The ICRU reference dose vs PTV mean dose relationship in IMRT exhibited a weak positive association (Pearson correlation coefficient 0.63). In approximately 65% of the cases studied, dose at the ICRU reference point was greater than the corresponding PTV mean dose. The dose difference between ICRU reference and PTV mean doses was ≤2% in approximately 79% of the cases studied (average 1.21% (±1.55), range -4% to +4%). Paired t-test analyses showed that the ICRU reference doses and PTV median doses were statistically similar (p = 0.42). The magnitude of PTV did not influence the difference between ICRU reference and PTV mean doses. Conclusions: The general relationship between ICRU reference and PTV mean doses in IMRT is similar to that

Is the dose distribution distorted in IMRT and RapidArc treatment when patient plans are swapped across beam‐matched machines?

Science.gov (United States)

Radha, Chandrasekaran Anu; Subramani, Vendhan; Gunasekaran, Madhan Kumar

2016-01-01

The purpose of this study is to evaluate the degree of dose distribution distortion in advanced treatments like IMRT and RapidArc when patient plans are swapped across dosimetrically equivalent so‐called “beam‐matched” machines. For this purpose the entire work is divided into two stages. At forefront stage all basic beam properties of 6 MV X‐rays like PDD, profiles, output factors, TPR20/10 and MLC transmission of two beam‐matched machines — Varian Clinac iX and Varian 600 C/D Unique — are compared and evaluated for differences. At second stage 40 IMRT and RapidArc patient plans from the pool of head and neck (H&N) and pelvis sites are selected for the study. The plans are swapped across the machines for dose recalculation and the DVHs of target and critical organs are evaluated for dose differences. Following this, the accuracy of the beam‐matching at the TPS level for treatments like IMRT and RapidArc are compared. On PDD, profile (central 80%) and output factor comparison between the two machines, a maximum percentage disagreement value of −2.39%,−2.0% and −2.78%, respectively, has been observed. The maximum dose difference observed at volumes in IMRT and RapidArc treatments for H&N dose prescription of 69.3 Gy/33 fractions is 0.88 Gy and 0.82 Gy, respectively. Similarly, for pelvis, with a dose prescription of 50 Gy/25 fractions, a maximum dose difference of 0.55 Gy and 0.53 Gy is observed at volumes in IMRT and RapidArc treatments, respectively. Overall results of the swapped plans between two machines' 6 MV X‐rays are well within the limits of accepted clinical tolerance. PACS number(s): 87.56.bd PMID:27685106

Evaluation of the Delta4 phantom for IMRT and VMAT verification

International Nuclear Information System (INIS)

Bedford, James L; Lee, Young K; Wai, Philip; South, Christopher P; Warrington, Alan P

2009-01-01

The Delta 4 diode array phantom (Scandidos, Uppsala, Sweden) was evaluated for verification of segmental intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) on an Elekta linear accelerator (Crawley UK). The device was tested for angular sensitivity by irradiating it from 36 different gantry angles, and the responses of the device to various step-and-shoot segment doses and dose rates were evaluated using an ionization chamber as a comparison. The phantom was then compared with ionization chamber and film results for two prostate and pelvic nodes IMRT plans, two head and neck IMRT plans and two lung VMAT plans. These plans were calculated using Pinnacle 3 (Philips Radiation Oncology Systems, Madison, WI). The uniformity of angular response was better than 0.5% over the range of gantry angles. The uniformity of response of the Delta 4 to different segment monitor units and dose rates was better than 0.5%. The assessment of the IMRT and VMAT plans showed that the Delta 4 measured a dose within 2.5% of the ionization chamber, and compared to film recorded a slightly larger region (range -2% to +7%) agreeing with the planned dose to within 3% and 3 mm. The Delta 4 is a complex device and requires careful benchmarking, but following the successful completion of these measurements, the Delta 4 has been introduced into clinical use. (note)

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

Science.gov (United States)

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

2013-05-01

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

Novel method based on Fricke gel dosimeters for dose verification in IMRT techniques

International Nuclear Information System (INIS)

Aon, E.; Brunetto, M.; Sansogne, R.; Castellano, G.; Valente, M.

2008-01-01

Modern radiotherapy is becoming increasingly complex. Conformal and intensity modulated (IMRT) techniques are nowadays available for achieving better tumour control. However, accurate methods for 3D dose verification for these modern irradiation techniques have not been adequately established yet. Fricke gel dosimeters consist, essentially, in a ferrous sulphate (Fricke) solution fixed to a gel matrix, which enables spatial resolution. A suitable radiochromic marker (xylenol orange) is added to the solution in order to produce radiochromic changes within the visible spectrum range, due to the chemical internal conversion (oxidation) of ferrous ions to ferric ions. In addition, xylenol orange has proved to slow down the internal diffusion effect of ferric ions. These dosimeters suitably shaped in form of thin layers and optically analyzed by means of visible light transmission imaging have recently been proposed as a method for 3D absorbed dose distribution determinations in radiotherapy, and tested in several IMRT applications employing a homogeneous plane (visible light) illuminator and a CCD camera with a monochromatic filter for sample analysis by means of transmittance images. In this work, the performance of an alternative read-out method is characterized, consisting on visible light images, acquired before and after irradiation by means of a commercially available flatbed-like scanner. Registered images are suitably converted to matrices and analyzed by means of dedicated 'in-house' software. The integral developed method allows performing 1D (profiles), 2D (surfaces) and 3D (volumes) dose mapping. In addition, quantitative comparisons have been performed by means of the Gamma composite criteria. Dose distribution comparisons between Fricke gel dosimeters and traditional standard dosimetric techniques for IMRT irradiations show an overall good agreement, supporting the suitability of the method. The agreement, quantified by the gamma index (that seldom

Conformal intensity-modulated radiotherapy (IMRT) delivered by robotic linac-conformality versus efficiency of dose delivery

International Nuclear Information System (INIS)

Webb, Steve

2000-01-01

Intensity-modulated radiotherapy (IMRT) may be delivered with a high-energy-photon linac mounted on a robotic gantry and executing a complex trajectory. In a previous paper an inverse-planning technique was developed for such an application. Here the work is extended to demonstrate the dependence of conformality on the size of the elemental pencil beam, on the complexity of the trajectory and on the sampling of azimuth and elevation of the collimated source. The improved conformality of complex trajectories is demonstrated and benchmarked relative to simpler trajectories, more representative of existing non-robotic IMRT techniques. Specifically, by choosing a very fine pencil beam, exquisitely conformal dose distributions have been obtained. Important sampling considerations have been determined. Expressions have been derived for the dosimetry and monitor-unit efficiency of robotic IMRT. Equivalent trajectories were computed for executing the complex robotic trajectories instead by using a conventional linac. The work benchmarks an ideal in IMRT against which more practical and more common techniques may be measured. (author)

Rotational IMRT techniques compared to fixed gantry IMRT and Tomotherapy: multi-institutional planning study for head-and-neck cases

International Nuclear Information System (INIS)

Wiezorek, Tilo; Schubert, Kai; Wagner, Daniela; Wendt, Thomas G; Brachwitz, Tim; Georg, Dietmar; Blank, Eyck; Fotina, Irina; Habl, Gregor; Kretschmer, Matthias; Lutters, Gerd; Salz, Henning

2011-01-01

Recent developments enable to deliver rotational IMRT with standard C-arm gantry based linear accelerators. This upcoming treatment technique was benchmarked in a multi-center treatment planning study against static gantry IMRT and rotational IMRT based on a ring gantry for a complex parotid gland sparing head-and-neck technique. Treatment plans were created for 10 patients with head-and-neck tumours (oropharynx, hypopharynx, larynx) using the following treatment planning systems (TPS) for rotational IMRT: Monaco (ELEKTA VMAT solution), Eclipse (Varian RapidArc solution) and HiArt for the helical tomotherapy (Tomotherapy). Planning of static gantry IMRT was performed with KonRad, Pinnacle and Panther DAO based on step&shoot IMRT delivery and Eclipse for sliding window IMRT. The prescribed doses for the high dose PTVs were 65.1Gy or 60.9Gy and for the low dose PTVs 55.8Gy or 52.5Gy dependend on resection status. Plan evaluation was based on target coverage, conformity and homogeneity, DVHs of OARs and the volume of normal tissue receiving more than 5Gy (V 5Gy ). Additionally, the cumulative monitor units (MUs) and treatment times of the different technologies were compared. All evaluation parameters were averaged over all 10 patients for each technique and planning modality. Depending on IMRT technique and TPS, the mean CI values of all patients ranged from 1.17 to 2.82; and mean HI values varied from 0.05 to 0.10. The mean values of the median doses of the spared parotid were 26.5Gy for RapidArc and 23Gy for VMAT, 14.1Gy for Tomo. For fixed gantry techniques 21Gy was achieved for step&shoot+KonRad, 17.0Gy for step&shoot+Panther DAO, 23.3Gy for step&shoot+Pinnacle and 18.6Gy for sliding window. V 5Gy values were lowest for the sliding window IMRT technique (3499 ccm) and largest for RapidArc (5480 ccm). The lowest mean MU value of 408 was achieved by Panther DAO, compared to 1140 for sliding window IMRT. All IMRT delivery technologies with their associated TPS

Compensating for the impact of non-stationary spherical air cavities on IMRT dose delivery in transverse magnetic fields

International Nuclear Information System (INIS)

Bol, G H; Lagendijk, J J W; Raaymakers, B W

2015-01-01

With the development of the 1.5 T MRI linear accelerator and the clinical introduction of the 0.35 T ViewRay™ system, delivering intensity-modulated radiotherapy (IMRT) in a transverse magnetic field becomes increasingly important. When delivering dose in the presence of a transverse magnetic field, one of the most prominent phenomena occurs around air cavities: the electron return effect (ERE). For stationary, spherical air cavities which are centrally located in the phantom, the ERE can be compensated by using opposing beams configurations in combination with IMRT. In this paper we investigate the effects of non-stationary spherical air cavities, centrally located within the target in a phantom containing no organs at risk, on IMRT dose delivery in 0.35 T and 1.5 T transverse magnetic fields by using Monte Carlo simulations. We show that IMRT can be used for compensating ERE around those air cavities, except for intrafraction appearing or disappearing air cavities. For these cases, gating or plan re-optimization should be used. We also analyzed the option of using IMRT plans optimized at 0 T to be delivered in the presence of 0.35 T and 1.5 T magnetic field. When delivering dose at 0.35 T, IMRT plans optimized at 0 T and 0.35 T perform equally well regarding ERE compensation. Within a 1.5 T environment, the 1.5 T optimized plans perform slightly better for the static and random intra- and interfraction air cavity movement cases than the 0 T optimized plans. For non-stationary spherical air cavities with a baseline shift (intra- and interfraction) the 0 T optimized plans perform better. These observations show the intrinsic ERE compensation by equidistant and opposing beam configurations for spherical air cavities within the target area. IMRT gives some additional compensation, but only in case of correct positioning of the air cavity according to the IMRT compensation. For intrafraction appearing or disappearing air cavities this correct

Inverse IMRT workflow process at Austin health

International Nuclear Information System (INIS)

Rykers, K.; Fernando, W.; Grace, M.; Liu, G.; Rolfo, A.; Viotto, A.; Mantle, C.; Lawlor, M.; Au-Yeung, D.; Quong, G.; Feigen, M.; Lim-Joon, D.; Wada, M.

2004-01-01

Full text: The work presented here will review the strategies adopted at Austin Health to bring IMRT into clinical use. IMRT is delivered using step and shoot mode on an Elekta Precise machine with 40 pairs of 1cm wide MLC leaves. Planning is done using CMS Focus/XiO. A collaborative approach for RO's, Physicists and RTs from concept to implementation was adopted. An overview will be given of the workflow for the clinic, the equipment used, tolerance levels and the lessons learned. 1. Strategic Planning for IMRT 2. Training a. MSKCC (New York) b.ESTRO (Amsterdam) c.Elekta (US and UK) 3. Linac testing and data acquisition a. Equipment and software review and selection b. Linac reliability/geometric and mechanical checks c. Draft Patient QA procedure d. EPI Image matching checks and procedures 4. Planning system checks a. export of dose matrix (options) b. dose calculation choices 5. IMRT Research Initiatives a. IMRT Planning Studies, Stabilisation, On-line Imaging 6. Equipment Procurement and testing a. Physics and Linac Equipment, Hardware, Software/Licences, Stabilisation 7. Establishing a DICOM Environment a. Prescription sending, Image transfer for EPI checks b. QA Files 8. Physics QA (Pre-Treatment) a.Clinical plan review; DVH checks b. geometry; dosimetry checks; DICOM checks c. 2D Distance to agreement; mm difference reports; Gamma function index 9. Documentation a.Protocol Development i. ICRU 50/62 reporting and prescribing b. QA for Physics c. QA for RT's d. Generation of a report for RO/patient history. Copyright (2004) Australasian College of Physical Scientists and Engineers in Medicine

Implementation of dosimetric quality control on IMRT and VMAT treatments in radiotherapy using diodes

International Nuclear Information System (INIS)

Gonzales, A.; Garcia, B.; Ramirez, J.; Marquina, J.

2014-08-01

To implement quality control of IMRT and VMAT treatments Rapid Arc radiotherapy using diode array. Were tested 90 patients with IMRT and VMAT Rapid Arc, comparing the planned dose to the dose administered, used the Map-Check-2 and Arc-Check of Sun Nuclear, they using the gamma factor for calculating and using comparison parameters 3% / 3m m. The statistic shows that the quality controls of the 90 patients analyzed, presented a percentage of diodes that pass the test between 96,7% and 100,0% of the irradiated diodes. Implemented in Clinical ALIADA Oncologia Integral, the method for quality control of IMRT and VMAT treatments Rapid Arc radiotherapy using diode array. (Author)

Minimizing Late Effects for Patients With Mediastinal Hodgkin Lymphoma: Deep Inspiration Breath-Hold, IMRT, or Both?

Energy Technology Data Exchange (ETDEWEB)

Aznar, Marianne C., E-mail: marianne.camille.aznar@regionh.dk [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Faculty of Sciences, Niels Bohr Institute, and Faculty of Health Sciences, University of Copenhagen, Copenhagen (Denmark); Maraldo, Maja V.; Schut, Deborah A. [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Lundemann, Michael [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Faculty of Sciences, Niels Bohr Institute, and Faculty of Health Sciences, University of Copenhagen, Copenhagen (Denmark); Brodin, N Patrik [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Institute of Onco-Physics, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York (United States); Vogelius, Ivan R. [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Berthelsen, Anne K. [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark); Specht, Lena; Petersen, Peter M. [Department of Oncology, Section of Radiotherapy, Rigshospitalet, University of Copenhagen, Copenhagen (Denmark)

2015-05-01

Purpose: Hodgkin lymphoma (HL) survivors have an increased risk of cardiovascular disease (CD), lung cancer, and breast cancer. We investigated the risk for the development of CD and secondary lung, breast, and thyroid cancer after radiation therapy (RT) delivered with deep inspiration breath-hold (DIBH) compared with free-breathing (FB) using 3-dimensional conformal RT (3DCRT) and intensity modulated RT (IMRT). The aim of this study was to determine which treatment modality best reduced the combined risk of life-threatening late effects in patients with mediastinal HL. Methods and Materials: Twenty-two patients with early-stage mediastinal HL were eligible for the study. Treatment plans were calculated with both 3DCRT and IMRT on both DIBH and FB planning computed tomographic scans. We reported the estimated dose to the heart, lung, female breasts, and thyroid and calculated the estimated life years lost attributable to CD and to lung, breast, and thyroid cancer. Results: DIBH lowered the estimated dose to heart and lung regardless of delivery technique (P<.001). There was no significant difference between IMRT-FB and 3DCRT-DIBH in mean heart dose, heart V20Gy, and lung V20Gy. The mean breast dose was increased with IMRT regardless of breathing technique. Life years lost was lowest with DIBH and highest with FB. Conclusions: In this cohort, 3DCRT-DIBH resulted in lower estimated doses and lower lifetime excess risks than did IMRT-FB. Combining IMRT and DIBH could be beneficial for a subgroup of patients.

SU-E-T-202: Impact of Monte Carlo Dose Calculation Algorithm On Prostate SBRT Treatments

Energy Technology Data Exchange (ETDEWEB)

Venencia, C; Garrigo, E; Cardenas, J; Castro Pena, P [Instituto de Radioterapia - Fundacion Marie Curie, Cordoba (Argentina)

2014-06-01

Purpose: The purpose of this work was to quantify the dosimetric impact of using Monte Carlo algorithm on pre calculated SBRT prostate treatment with pencil beam dose calculation algorithm. Methods: A 6MV photon beam produced by a Novalis TX (BrainLAB-Varian) linear accelerator equipped with HDMLC was used. Treatment plans were done using 9 fields with Iplanv4.5 (BrainLAB) and dynamic IMRT modality. Institutional SBRT protocol uses a total dose to the prostate of 40Gy in 5 fractions, every other day. Dose calculation is done by pencil beam (2mm dose resolution), heterogeneity correction and dose volume constraint (UCLA) for PTV D95%=40Gy and D98%>39.2Gy, Rectum V20Gy<50%, V32Gy<20%, V36Gy<10% and V40Gy<5%, Bladder V20Gy<40% and V40Gy<10%, femoral heads V16Gy<5%, penile bulb V25Gy<3cc, urethra and overlap region between PTV and PRV Rectum Dmax<42Gy. 10 SBRT treatments plans were selected and recalculated using Monte Carlo with 2mm spatial resolution and mean variance of 2%. DVH comparisons between plans were done. Results: The average difference between PTV doses constraints were within 2%. However 3 plans have differences higher than 3% which does not meet the D98% criteria (>39.2Gy) and should have been renormalized. Dose volume constraint differences for rectum, bladder, femoral heads and penile bulb were les than 2% and within tolerances. Urethra region and overlapping between PTV and PRV Rectum shows increment of dose in all plans. The average difference for urethra region was 2.1% with a maximum of 7.8% and for the overlapping region 2.5% with a maximum of 8.7%. Conclusion: Monte Carlo dose calculation on dynamic IMRT treatments could affects on plan normalization. Dose increment in critical region of urethra and PTV overlapping region with PTV could have clinical consequences which need to be studied. The use of Monte Carlo dose calculation algorithm is limited because inverse planning dose optimization use only pencil beam.

Monte Carlo investigation of collapsed versus rotated IMRT plan verification.

Science.gov (United States)

Conneely, Elaine; Alexander, Andrew; Ruo, Russell; Chung, Eunah; Seuntjens, Jan; Foley, Mark J

2014-05-08

IMRT QA requires, among other tests, a time-consuming process of measuring the absorbed dose, at least to a point, in a high-dose, low-dose-gradient region. Some clinics use a technique of measuring this dose with all beams delivered at a single gantry angle (collapsed delivery), as opposed to the beams delivered at the planned gantry angle (rotated delivery). We examined, established, and optimized Monte Carlo simulations of the dosimetry for IMRT verification of treatment plans for these two different delivery modes (collapsed versus rotated). The results of the simulations were compared to the treatment planning system dose calculations for the two delivery modes, as well as to measurements taken. This was done in order to investigate the validity of the use of a collapsed delivery technique for IMRT QA. The BEAMnrc, DOSXYZnrc, and egs_chamber codes were utilized for the Monte Carlo simulations along with the MMCTP system. A number of different plan complexity metrics were also used in the analysis of the dose distributions in a bid to qualify why verification in a collapsed delivery may or may not be optimal for IMRT QA. Following the Alfonso et al. formalism, the kfclin,frefQclin,Q correction factor was calculated to correct the deviation of small fields from the reference conditions used for beam calibration. We report on the results obtained for a cohort of 20 patients. The plan complexity was investigated for each plan using the complexity metrics of homogeneity index, conformity index, modulation complexity score, and the fraction of beams from a particular plan that intersect the chamber when performing the QA. Rotated QA gives more consistent results than the collapsed QA technique. The kfclin,frefQclin,Qfactor deviates less from 1 for rotated QA than for collapsed QA. If the homogeneity index is less than 0.05 then the kfclin,frefQclin,Q factor does not deviate from unity by more than 1%. A value this low for the homogeneity index can only be obtained

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

Energy Technology Data Exchange (ETDEWEB)

Cao, N; Young, L; Parvathaneni, U; Liao, J; Richard, P; Ford, E; Sandison, G [University of Washington, Department of Radiation Oncology, Seattle, WA (United States)

2014-06-01

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

Can All Centers Plan Intensity-Modulated Radiotherapy (IMRT) Effectively? An External Audit of Dosimetric Comparisons Between Three-Dimensional Conformal Radiotherapy and IMRT for Adjuvant Chemoradiation for Gastric Cancer

International Nuclear Information System (INIS)

Chung, Hans T.; Lee, Brian; Park, Eileen; Lu, Jiade J.; Xia Ping

2008-01-01

Purpose: To compare dosimetric endpoints between three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) at our center with limited IMRT experience, and to perform an external audit of the IMRT plans. Methods and Materials: Ten patients, who received adjuvant chemoradiation for gastric cancer, formed the study cohort. For standardization, the planning target volume (PTV) and organs at risk were recontoured with the assistance of a study protocol radiologic atlas. The cohort was replanned with CMS Xio to generate coplanar 3D-CRT and IMRT plans. All 10 datasets, including volumes but without the plans (i.e., blinded), were transmitted to an experienced center where IMRT plans were designed using Nomos Corvus (IMRT-C) and ADAC Pinnacle (IMRT-P). All IMRT plans were normalized to D95% receiving 45 Gy. Results: Intensity-modulated radiotherapy yielded higher PTV V45 (volume that receives ≥45 Gy) (p < 0.001) than 3D-CRT. No difference in V20 was seen in the right (p = 0.9) and left (p 0.3) kidneys, but the liver mean dose (p < 0.001) was superior with IMRT. For the external audit, IMRT-C (p = 0.002) and IMRT-P (p < 0.001) achieved significantly lower left kidney V20 than IMRT, and IMRT-P (p < 0.001) achieved lower right kidney V20 than IMRT. The IMRT-C (p = 0.003) but not IMRT-P (p = 0.6) had lower liver mean doses than IMRT. Conclusions: At our institution with early IMRT experience, IMRT improved PTV dose coverage and liver doses but not kidney doses. An external audit of IMRT plans showed that an experienced center can yield superior IMRT plans

SU-F-J-109: Generate Synthetic CT From Cone Beam CT for CBCT-Based Dose Calculation

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Wang, H; Barbee, D; Wang, W; Pennell, R; Hu, K; Osterman, K [Department of Radiation Oncology, NYU Langone Medical Center, New York, NY (United States)

2016-06-15

Purpose: The use of CBCT for dose calculation is limited by its HU inaccuracy from increased scatter. This study presents a method to generate synthetic CT images from CBCT data by a probabilistic classification that may be robust to CBCT noise. The feasibility of using the synthetic CT for dose calculation is evaluated in IMRT for unilateral H&N cancer. Methods: In the training phase, a fuzzy c-means classification was performed on HU vectors (CBCT, CT) of planning CT and registered day-1 CBCT image pair. Using the resulting centroid CBCT and CT values for five classified “tissue” types, a synthetic CT for a daily CBCT was created by classifying each CBCT voxel to obtain its probability belonging to each tissue class, then assigning a CT HU with a probability-weighted summation of the classes’ CT centroids. Two synthetic CTs from a CBCT were generated: s-CT using the centroids from classification of individual patient CBCT/CT data; s2-CT using the same centroids for all patients to investigate the applicability of group-based centroids. IMRT dose calculations for five patients were performed on the synthetic CTs and compared with CT-planning doses by dose-volume statistics. Results: DVH curves of PTVs and critical organs calculated on s-CT and s2-CT agree with those from planning-CT within 3%, while doses calculated with heterogeneity off or on raw CBCT show DVH differences up to 15%. The differences in PTV D95% and spinal cord max are 0.6±0.6% and 0.6±0.3% for s-CT, and 1.6±1.7% and 1.9±1.7% for s2-CT. Gamma analysis (2%/2mm) shows 97.5±1.6% and 97.6±1.6% pass rates for using s-CTs and s2-CTs compared with CT-based doses, respectively. Conclusion: CBCT-synthesized CTs using individual or group-based centroids resulted in dose calculations that are comparable to CT-planning dose for unilateral H&N cancer. The method may provide a tool for accurate dose calculation based on daily CBCT.

SU-F-J-109: Generate Synthetic CT From Cone Beam CT for CBCT-Based Dose Calculation

International Nuclear Information System (INIS)

Wang, H; Barbee, D; Wang, W; Pennell, R; Hu, K; Osterman, K

2016-01-01

Purpose: The use of CBCT for dose calculation is limited by its HU inaccuracy from increased scatter. This study presents a method to generate synthetic CT images from CBCT data by a probabilistic classification that may be robust to CBCT noise. The feasibility of using the synthetic CT for dose calculation is evaluated in IMRT for unilateral H&N cancer. Methods: In the training phase, a fuzzy c-means classification was performed on HU vectors (CBCT, CT) of planning CT and registered day-1 CBCT image pair. Using the resulting centroid CBCT and CT values for five classified “tissue” types, a synthetic CT for a daily CBCT was created by classifying each CBCT voxel to obtain its probability belonging to each tissue class, then assigning a CT HU with a probability-weighted summation of the classes’ CT centroids. Two synthetic CTs from a CBCT were generated: s-CT using the centroids from classification of individual patient CBCT/CT data; s2-CT using the same centroids for all patients to investigate the applicability of group-based centroids. IMRT dose calculations for five patients were performed on the synthetic CTs and compared with CT-planning doses by dose-volume statistics. Results: DVH curves of PTVs and critical organs calculated on s-CT and s2-CT agree with those from planning-CT within 3%, while doses calculated with heterogeneity off or on raw CBCT show DVH differences up to 15%. The differences in PTV D95% and spinal cord max are 0.6±0.6% and 0.6±0.3% for s-CT, and 1.6±1.7% and 1.9±1.7% for s2-CT. Gamma analysis (2%/2mm) shows 97.5±1.6% and 97.6±1.6% pass rates for using s-CTs and s2-CTs compared with CT-based doses, respectively. Conclusion: CBCT-synthesized CTs using individual or group-based centroids resulted in dose calculations that are comparable to CT-planning dose for unilateral H&N cancer. The method may provide a tool for accurate dose calculation based on daily CBCT.

Dosimetric comparison of intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) in total scalp irradiation: a single institutional experience

International Nuclear Information System (INIS)

Ostheimer, Christian; Huebsch, Patrick; Janich, Martin; Gerlach, Reinhard; Vordermark, Dirk

2016-01-01

Total scalp irradiation (TSI) is a rare but challenging indication. We previously reported that non-coplanar intensity-modulated radiotherapy (IMRT) was superior to coplanar IMRT in organ-at-risk (OAR) protection and target dose distribution. This consecutive treatment planning study compared IMRT with volumetric-modulated arc therapy (VMAT). A retrospective treatment plan databank search was performed and 5 patient cases were randomly selected. Cranial imaging was restored from the initial planning computed tomography (CT) and target volumes and OAR were redelineated. For each patients, three treatment plans were calculated (coplanar/non-coplanar IMRT, VMAT; prescribed dose 50 Gy, single dose 2 Gy). Conformity, homogeneity and dose volume histograms were used for plan. VMAT featured the lowest monitor units and the sharpest dose gradient (1.6 Gy/mm). Planning target volume (PTV) coverage and homogeneity was better in VMAT (coverage, 0.95; homogeneity index [HI], 0.118) compared to IMRT (coverage, 0.94; HI, 0.119) but coplanar IMRT produced the most conformal plans (conformity index [CI], 0.43). Minimum PTV dose range was 66.8% –88.4% in coplanar, 77.5%–88.2% in non-coplanar IMRT and 82.8%–90.3% in VMAT. Mean dose to the brain, brain stem, optic system (maximum dose) and lenses were 18.6, 13.2, 9.1, and 5.2 Gy for VMAT, 21.9, 13.4, 14.5, and 6.3 Gy for non-coplanar and 22.8, 16.5, 11.5, and 5.9 Gy for coplanar IMRT. Maximum optic chiasm dose was 7.7, 8.4, and 11.1 Gy (non-coplanar IMRT, VMAT, and coplanar IMRT). Target coverage, homogeneity and OAR protection, was slightly superior in VMAT plans which also produced the sharpest dose gradient towards healthy tissue

Dosimetric comparison of intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) in total scalp irradiation: a single institutional experience

Energy Technology Data Exchange (ETDEWEB)

Ostheimer, Christian; Huebsch, Patrick; Janich, Martin; Gerlach, Reinhard; Vordermark, Dirk [Dept. of Radiation Oncology, Faculty of Medicine, Martin Luther University Halle-Wittenberg, Halle (Germany)

2016-12-15

Total scalp irradiation (TSI) is a rare but challenging indication. We previously reported that non-coplanar intensity-modulated radiotherapy (IMRT) was superior to coplanar IMRT in organ-at-risk (OAR) protection and target dose distribution. This consecutive treatment planning study compared IMRT with volumetric-modulated arc therapy (VMAT). A retrospective treatment plan databank search was performed and 5 patient cases were randomly selected. Cranial imaging was restored from the initial planning computed tomography (CT) and target volumes and OAR were redelineated. For each patients, three treatment plans were calculated (coplanar/non-coplanar IMRT, VMAT; prescribed dose 50 Gy, single dose 2 Gy). Conformity, homogeneity and dose volume histograms were used for plan. VMAT featured the lowest monitor units and the sharpest dose gradient (1.6 Gy/mm). Planning target volume (PTV) coverage and homogeneity was better in VMAT (coverage, 0.95; homogeneity index [HI], 0.118) compared to IMRT (coverage, 0.94; HI, 0.119) but coplanar IMRT produced the most conformal plans (conformity index [CI], 0.43). Minimum PTV dose range was 66.8% –88.4% in coplanar, 77.5%–88.2% in non-coplanar IMRT and 82.8%–90.3% in VMAT. Mean dose to the brain, brain stem, optic system (maximum dose) and lenses were 18.6, 13.2, 9.1, and 5.2 Gy for VMAT, 21.9, 13.4, 14.5, and 6.3 Gy for non-coplanar and 22.8, 16.5, 11.5, and 5.9 Gy for coplanar IMRT. Maximum optic chiasm dose was 7.7, 8.4, and 11.1 Gy (non-coplanar IMRT, VMAT, and coplanar IMRT). Target coverage, homogeneity and OAR protection, was slightly superior in VMAT plans which also produced the sharpest dose gradient towards healthy tissue.

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

Rotational IMRT techniques compared to fixed gantry IMRT and Tomotherapy: multi-institutional planning study for head-and-neck cases

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Lutters Gerd

2011-02-01

Full Text Available Abstract Background Recent developments enable to deliver rotational IMRT with standard C-arm gantry based linear accelerators. This upcoming treatment technique was benchmarked in a multi-center treatment planning study against static gantry IMRT and rotational IMRT based on a ring gantry for a complex parotid gland sparing head-and-neck technique. Methods Treatment plans were created for 10 patients with head-and-neck tumours (oropharynx, hypopharynx, larynx using the following treatment planning systems (TPS for rotational IMRT: Monaco (ELEKTA VMAT solution, Eclipse (Varian RapidArc solution and HiArt for the helical tomotherapy (Tomotherapy. Planning of static gantry IMRT was performed with KonRad, Pinnacle and Panther DAO based on step&shoot IMRT delivery and Eclipse for sliding window IMRT. The prescribed doses for the high dose PTVs were 65.1Gy or 60.9Gy and for the low dose PTVs 55.8Gy or 52.5Gy dependend on resection status. Plan evaluation was based on target coverage, conformity and homogeneity, DVHs of OARs and the volume of normal tissue receiving more than 5Gy (V5Gy. Additionally, the cumulative monitor units (MUs and treatment times of the different technologies were compared. All evaluation parameters were averaged over all 10 patients for each technique and planning modality. Results Depending on IMRT technique and TPS, the mean CI values of all patients ranged from 1.17 to 2.82; and mean HI values varied from 0.05 to 0.10. The mean values of the median doses of the spared parotid were 26.5Gy for RapidArc and 23Gy for VMAT, 14.1Gy for Tomo. For fixed gantry techniques 21Gy was achieved for step&shoot+KonRad, 17.0Gy for step&shoot+Panther DAO, 23.3Gy for step&shoot+Pinnacle and 18.6Gy for sliding window. V5Gy values were lowest for the sliding window IMRT technique (3499 ccm and largest for RapidArc (5480 ccm. The lowest mean MU value of 408 was achieved by Panther DAO, compared to 1140 for sliding window IMRT. Conclusions All

Hepatic arterial phase and portal venous phase computed tomography for dose calculation of stereotactic body radiation therapy plans in liver cancer: a dosimetric comparison study

International Nuclear Information System (INIS)

Xiao, Jianghong; Li, Yan; Jiang, Qingfeng; Sun, Lan; Henderson Jr, Fraser; Wang, Yongsheng; Jiang, Xiaoqin; Li, Guangjun; Chen, Nianyong

2013-01-01

To investigate the effect of computed tomography (CT) using hepatic arterial phase (HAP) and portal venous phase (PVP) contrast on dose calculation of stereotactic body radiation therapy (SBRT) for liver cancer. Twenty-one patients with liver cancer were studied. HAP, PVP and non-enhanced CTs were performed on subjects scanned in identical positions under active breathing control (ABC). SBRT plans were generated using seven-field three-dimensional conformal radiotherapy (7 F-3D-CRT), seven-field intensity-modulated radiotherapy (7 F-IMRT) and single-arc volumetric modulated arc therapy (VMAT) based on the PVP CT. Plans were copied to the HAP and non-enhanced CTs. Radiation doses calculated from the three phases of CTs were compared with respect to the planning target volume (PTV) and the organs at risk (OAR) using the Friedman test and the Wilcoxon signed ranks test. SBRT plans calculated from either PVP or HAP CT, including 3D-CRT, IMRT and VMAT plans, demonstrated significantly lower (p <0.05) minimum absorbed doses covering 98%, 95%, 50% and 2% of PTV (D98%, D95%, D50% and D2%) than those calculated from non-enhanced CT. The mean differences between PVP or HAP CT and non-enhanced CT were less than 2% and 1% respectively. All mean dose differences between the three phases of CTs for OARs were less than 2%. Our data indicate that though the differences in dose calculation between contrast phases are not clinically relevant, dose underestimation (IE, delivery of higher-than-intended doses) resulting from CT using PVP contrast is larger than that resulting from CT using HAP contrast when compared against doses based upon non-contrast CT in SBRT treatment of liver cancer using VMAT, IMRT or 3D-CRT

Intensity-modulated radiation therapy (IMRT) of cancers of the head and neck: Comparison of split-field and whole-field techniques

International Nuclear Information System (INIS)

Dabaja, Bouthaina; Salehpour, Mohammad R.; Rosen, Isaac; Tung, Sam; Morrison, William H.; Ang, K. Kian; Garden, Adam S.

2005-01-01

Background: Oropharynx cancers treated with intensity-modulated radiation (IMRT) are often treated with a monoisocentric or half-beam technique (HB). IMRT is delivered to the primary tumor and upper neck alone, while the lower neck is treated with a matching anterior beam. Because IMRT can treat the entire volume or whole field (WF), the primary aim of the study was to test the ability to plan cases using WF-IMRT while obtaining an optimal plan and acceptable dose distribution and also respecting normal critical structures. Methods and Materials: Thirteen patients with early-stage oropharynx cancers had treatment plans created with HB-IMRT and WF-IMRT techniques. Plans were deemed acceptable if they met the planning guidelines (as defined or with minor violations) of the Radiation Therapy Oncology Group protocol H0022. Comparisons included coverage to the planning target volume (PTV) of the primary (PTV66) and subclinical disease (PTV54). We also compared the ability of both techniques to respect the tolerance of critical structures. Results: The volume of PTV66 treated to >110% was less in 9 of the 13 patients in the WF-IMRT plan as compared to the HB-IMRT plan. The calculated mean volume receiving >110% for all patients planned with WF-IMRT was 9.3% (0.8%-25%) compared to 13.7% (2.7%-23.7%) with HB-IMRT (p = 0.09). The PTV54 volume receiving >110% of dose was less in 10 of the 13 patients planned with WF-IMRT compared to HB-IMRT. The mean doses to all critical structures except the larynx were comparable with each plan. The mean dose to the larynx was significantly less (p = 0.001), 18.7 Gy, with HB-IMRT compared to 47 Gy with WF-IMRT. Conclusions: Regarding target volumes, acceptable plans can be generated with either WF-IMRT or HB-IMRT. WF-IMRT has an advantage if uncertainty at the match line is a concern, whereas HB-IMRT, particularly in cases not involving the base of tongue, can achieve much lower doses to the larynx

Rectal balloon use limits vaginal displacement, rectal dose, and rectal toxicity in patients receiving IMRT for postoperative gynecological malignancies.

Science.gov (United States)

Wu, Cheng-Chia; Wuu, Yen-Ruh; Yanagihara, Theodore; Jani, Ashish; Xanthopoulos, Eric P; Tiwari, Akhil; Wright, Jason D; Burke, William M; Hou, June Y; Tergas, Ana I; Deutsch, Israel

2018-01-01

Pelvic radiotherapy for gynecologic malignancies traditionally used a 4-field box technique. Later trials have shown the feasibility of using intensity-modulated radiotherapy (IMRT) instead. But vaginal movement between fractions is concerning when using IMRT due to greater conformality of the isodose curves to the target and the resulting possibility of missing the target while the vagina is displaced. In this study, we showed that the use of a rectal balloon during treatment can decrease vaginal displacement, limit rectal dose, and limit acute and late toxicities. Little is known regarding the use of a rectal balloon (RB) in treating patients with IMRT in the posthysterectomy setting. We hypothesize that the use of an RB during treatment can limit rectal dose and acute and long-term toxicities, as well as decrease vaginal cuff displacement between fractions. We performed a retrospective review of patients with gynecological malignancies who received postoperative IMRT with the use of an RB from January 1, 2012 to January 1, 2015. Rectal dose constraint was examined as per Radiation Therapy Oncology Group (RTOG) 1203 and 0418. Daily cone beam computed tomography (CT) was performed, and the average (avg) displacement, avg magnitude, and avg magnitude of vector were calculated. Toxicity was reported according to RTOG acute radiation morbidity scoring criteria. Acute toxicity was defined as less than 90 days from the end of radiation treatment. Late toxicity was defined as at least 90 days after completing radiation. Twenty-eight patients with postoperative IMRT with the use of an RB were examined and 23 treatment plans were reviewed. The avg rectal V40 was 39.3% ± 9.0%. V30 was65.1% ± 10.0%. V50 was 0%. Separate cone beam computed tomography (CBCT) images (n = 663) were reviewed. The avg displacement was as follows: superior 0.4 + 2.99 mm, left 0.23 ± 4.97 mm, and anterior 0.16 ± 5.18 mm. The avg magnitude of displacement was superior

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

Domestic comparison of radiation treatment techniques for breast cancer: 3D-CRT, IMRT and VMAT

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Lee, Bo Ram; Yoon, Myong Geun [Dept. of Bio-convergence Engineering, College of Health Science, Korea University, Seoul (Korea, Republic of); Lee, Sun Young [Dept. of Radiation Oncology, Yusung Sun Medical Center, Daejeon (Korea, Republic of)

2013-09-15

The purpose of this study is to compare method in the treatment of breast cancer using dose index. And, it is to find the optimized treatment technique to the patient. The phantom filled with tissue-equivalent material were used simulation and treatment as techniques of 3D-CRT, IMRT, VMAT was planned using Eclipse v10. By using HI(homogeneity index), CI(Conformity index), OE (Organ equivalent dose), EAR(Excess Absolute Risk), were assessed for each treatment plans. HI and CI of 3D-CRT, IMRT, VMAT were calculated 16.89, 11.21, 9.55 and 0.59, 0.61, 0.83. The organ average doses of Lt lung, Rt lung, liver, heart, esophagus, cord, Lt breast, trachea and stomach were 0.01 ∼ 2.02 Gy, 0.36 ∼ 5.01 Gy, 0.25 ∼ 2.49 Gy, 0.14 ∼ 6.92 Gy, 0.03 ∼ 2.02 Gy, 0.01 ∼ 1.06 Gy, 0.25 ∼ 6.08 Gy, 0.08 ∼ 0.59 Gy, 0.01 ∼ 1.34 Gy, respectively. The OED, EAR of the IMRT and VMAT show higher than 3D-CRT. As the result of this study, we could confirm being higher dose index(HI, CI) in IMRT and VMAT than 3D-CRT, but doses of around normal organs was higher IMRT, VMAT than 3D-CRT.

Dosimetric impact of interplay effect in lung IMRT and VMAT treatment using in-house dynamic thorax phantom

International Nuclear Information System (INIS)

Mukhlisin; Pawiro, S A

2016-01-01

Tumor motion due to patient's respiratory is a significant problem in radiotherapy treatment of lung cancer. The purpose of this project is to study the interplay effect through dosimetry verification between the calculated and delivered dose, as well as the dosimetric impact of leaf interplay with breathing-induced tumor motion in IMRT and VMAT treatment. In this study, a dynamic thorax phantom was designed and constructed for dosimetry measurement. The phantom had a linear sinusoidal tumor motion toward superior-inferior direction with variation of amplitudes and periods. TLD-100 LiF:Mg,Ti and Gafchromic EBT2 film were used to measure dose in the midpoint target and the spinal cord. The IMRT and VMAT treatment had prescription dose of 200 cGy per fraction. The dosimetric impact due to interplay effect during IMRT and VMAT treatment were resulted in the range of 0.5% to -6.6% and 0.9% to -5.3% of target dose reduction, respectively. Meanwhile, mean dose deviation of spinal cord in IMRT and VMAT treatment were around 1.0% to -6.9% and 0.9% to -6.3%, respectively. The results showed that if respiratory management technique were not implemented, the presence of lung tumor motion during dose delivery in IMRT and VMAT treatment causes dose discrepancies inside tumor volume. (paper)

A convolution-superposition dose calculation engine for GPUs

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Hissoiny, Sami; Ozell, Benoit; Despres, Philippe [Departement de genie informatique et genie logiciel, Ecole polytechnique de Montreal, 2500 Chemin de Polytechnique, Montreal, Quebec H3T 1J4 (Canada); Departement de radio-oncologie, CRCHUM-Centre hospitalier de l' Universite de Montreal, 1560 rue Sherbrooke Est, Montreal, Quebec H2L 4M1 (Canada)

2010-03-15

Purpose: Graphic processing units (GPUs) are increasingly used for scientific applications, where their parallel architecture and unprecedented computing power density can be exploited to accelerate calculations. In this paper, a new GPU implementation of a convolution/superposition (CS) algorithm is presented. Methods: This new GPU implementation has been designed from the ground-up to use the graphics card's strengths and to avoid its weaknesses. The CS GPU algorithm takes into account beam hardening, off-axis softening, kernel tilting, and relies heavily on raytracing through patient imaging data. Implementation details are reported as well as a multi-GPU solution. Results: An overall single-GPU acceleration factor of 908x was achieved when compared to a nonoptimized version of the CS algorithm implemented in PlanUNC in single threaded central processing unit (CPU) mode, resulting in approximatively 2.8 s per beam for a 3D dose computation on a 0.4 cm grid. A comparison to an established commercial system leads to an acceleration factor of approximately 29x or 0.58 versus 16.6 s per beam in single threaded mode. An acceleration factor of 46x has been obtained for the total energy released per mass (TERMA) calculation and a 943x acceleration factor for the CS calculation compared to PlanUNC. Dose distributions also have been obtained for a simple water-lung phantom to verify that the implementation gives accurate results. Conclusions: These results suggest that GPUs are an attractive solution for radiation therapy applications and that careful design, taking the GPU architecture into account, is critical in obtaining significant acceleration factors. These results potentially can have a significant impact on complex dose delivery techniques requiring intensive dose calculations such as intensity-modulated radiation therapy (IMRT) and arc therapy. They also are relevant for adaptive radiation therapy where dose results must be obtained rapidly.

A Nomogram to predict parotid gland overdose in head and neck IMRT

International Nuclear Information System (INIS)

Castelli, J.; Simon, A.; Rigaud, B.; Lafond, C.; Chajon, E.; Ospina, J. D.; Haigron, P.; Laguerre, B.; Loubière, A. Ruffier; Benezery, K.; Crevoisier, R. de

2016-01-01

To generate a nomogram to predict parotid gland (PG) overdose and to quantify the dosimetric benefit of weekly replanning based on its findings, in the context of intensity-modulated radiotherapy (IMRT) for locally-advanced head and neck carcinoma (LAHNC). Twenty LAHNC patients treated with radical IMRT underwent weekly computed tomography (CT) scans during IMRT. The cumulated PG dose was estimated by elastic registration. Early predictors of PG overdose (cumulated minus planned doses) were identified, enabling a nomogram to be generated from a linear regression model. Its performance was evaluated using a leave-one-out method. The benefit of weekly replanning was then estimated for the nomogram-identified PG overdose patients. Clinical target volume 70 (CTV70) and the mean PG dose calculated from the planning and first weekly CTs were early predictors of PG overdose, enabling a nomogram to be generated. A mean PG overdose of 2.5Gy was calculated for 16 patients, 14 identified by the nomogram. All patients with PG overdoses >1.5Gy were identified. Compared to the cumulated delivered dose, weekly replanning of these 14 targeted patients enabled a 3.3Gy decrease in the mean PG dose. Based on the planning and first week CTs, our nomogram allowed the identification of all patients with PG overdoses >2.5Gy to be identified, who then benefitted from a final 4Gy decrease in mean PG overdose by means of weekly replanning

Incorporating multi-leaf collimator leaf sequencing into iterative IMRT optimization

International Nuclear Information System (INIS)

Siebers, Jeffrey V.; Lauterbach, Marc; Keall, Paul J.; Mohan, Radhe

2002-01-01

Intensity modulated radiation therapy (IMRT) treatment planning typically considers beam optimization and beam delivery as separate tasks. Following optimization, a multi-leaf collimator (MLC) or other beam delivery device is used to generate fluence patterns for patient treatment delivery. Due to limitations and characteristics of the MLC, the deliverable intensity distributions often differ from those produced by the optimizer, leading to differences between the delivered and the optimized doses. Objective function parameters are then adjusted empirically, and the plan is reoptimized to achieve a desired deliverable dose distribution. The resulting plan, though usually acceptable, may not be the best achievable. A method has been developed to incorporate the MLC restrictions into the optimization process. Our in-house IMRT system has been modified to include the calculation of the deliverable intensity into the optimizer. In this process, prior to dose calculation, the MLC leaf sequencer is used to convert intensities to dynamic MLC sequences, from which the deliverable intensities are then determined. All other optimization steps remain the same. To evaluate the effectiveness of deliverable-based optimization, 17 patient cases have been studied. Compared with standard optimization plus conversion to deliverable beams, deliverable-based optimization results show improved isodose coverage and a reduced dose to critical structures. Deliverable-based optimization results are close to the original nondeliverable optimization results, suggesting that IMRT can overcome the MLC limitations by adjusting individual beamlets. The use of deliverable-based optimization may reduce the need for empirical adjustment of objective function parameters and reoptimization of a plan to achieve desired results

Stereotactic IMRT using a MMLC

International Nuclear Information System (INIS)

Hoban, P.; Short, R.; Biggs, D.; Rose, A.; Smee, R.; Schneider, M.

2001-01-01

Full text: The leaf width of the multileaf collimator (MLC) used for intensity modulated radiotherapy (IMRT ) largely determines the resolution of the intensity maps that define the entire profile of each beam. In turn it is this resolution, and consequently the achievable degree of beam modulation, that determines the ability to conform the 3D dose distribution to complex target volumes. As such, the leaf width is of more importance than in fixed-field MLC treatments where only the beam edges are affected.A Radionics micro-multileaf collimator (MMLC) with 4 mm leaf width, attached to a Siemens Primus linear accelerator, is in use for stereotactic IMRT at PbWH. Treatment planning is performed with the XPlan system including an integrated IMRT module. Cases treated have so far been with conventional fractionation, including both malignant and benign cranial lesions. Meningiomas in particular often require a complex dose distribution because of their en-plaque nature and/or proximity to the brainstem. Stereotactic localisation and fixation is with the Gill-Thomas-Cosman head-ring or Head and Neck localiser. Cases are typically planned both for fixed-field treatment and IMRT, with IMRT being used if significant benefit is seen. IMRT treatment with the Siemens MLC is also an option. A quality assurance system has been set up, including a flowchart/checklist and phantom dosimetry using TLDs. As expected, treatment plans show IMRT with the MMLC to consistently be the best option dosimetrically. In particular, for a given target coverage there is always better sparing of nearby organs at risk (OARs) with MMLC rather than MLC-based IMRT. Adjustments such as the inclusion of a margin around the target volume or an increase in the penalty for target underdosage improve coverage for MLC plans but generally at the expense of increased OAR involvement. MMLC IMRT treatments commonly require 30-50 fields and can be delivered in approximately 10-15 minutes using an autosequence

SU-F-303-17: Real Time Dose Calculation of MRI Guided Co-60 Radiotherapy Treatments On Free Breathing Patients, Using a Motion Model and Fast Monte Carlo Dose Calculation

International Nuclear Information System (INIS)

Thomas, D; O’Connell, D; Lamb, J; Cao, M; Yang, Y; Agazaryan, N; Lee, P; Low, D

2015-01-01

Purpose: To demonstrate real-time dose calculation of free-breathing MRI guided Co−60 treatments, using a motion model and Monte-Carlo dose calculation to accurately account for the interplay between irregular breathing motion and an IMRT delivery. Methods: ViewRay Co-60 dose distributions were optimized on ITVs contoured from free-breathing CT images of lung cancer patients. Each treatment plan was separated into 0.25s segments, accounting for the MLC positions and beam angles at each time point. A voxel-specific motion model derived from multiple fast-helical free-breathing CTs and deformable registration was calculated for each patient. 3D images for every 0.25s of a simulated treatment were generated in real time, here using a bellows signal as a surrogate to accurately account for breathing irregularities. Monte-Carlo dose calculation was performed every 0.25s of the treatment, with the number of histories in each calculation scaled to give an overall 1% statistical uncertainty. Each dose calculation was deformed back to the reference image using the motion model and accumulated. The static and real-time dose calculations were compared. Results: Image generation was performed in real time at 4 frames per second (GPU). Monte-Carlo dose calculation was performed at approximately 1frame per second (CPU), giving a total calculation time of approximately 30 minutes per treatment. Results show both cold- and hot-spots in and around the ITV, and increased dose to contralateral lung as the tumor moves in and out of the beam during treatment. Conclusion: An accurate motion model combined with a fast Monte-Carlo dose calculation allows almost real-time dose calculation of a free-breathing treatment. When combined with sagittal 2D-cine-mode MRI during treatment to update the motion model in real time, this will allow the true delivered dose of a treatment to be calculated, providing a useful tool for adaptive planning and assessing the effectiveness of gated treatments

On the use of biomathematical models in patient-specific IMRT dose QA

Energy Technology Data Exchange (ETDEWEB)

Zhen Heming [UT Southwestern Medical Center, Dallas, Texas 75390 (United States); Nelms, Benjamin E. [Canis Lupus LLC, Merrimac, Wisconsin 53561 (United States); Tome, Wolfgang A. [Department of Radiation Oncology, Division of Medical Physics, Montefiore Medical Center and Institute of Onco-Physics, Albert Einstein College of Medicine, Bronx, New York 10461 (United States)

2013-07-15

Purpose: To investigate the use of biomathematical models such as tumor control probability (TCP) and normal tissue complication probability (NTCP) as new quality assurance (QA) metrics.Methods: Five different types of error (MLC transmission, MLC penumbra, MLC tongue and groove, machine output, and MLC position) were intentionally induced to 40 clinical intensity modulated radiation therapy (IMRT) patient plans (20 H and N cases and 20 prostate cases) to simulate both treatment planning system errors and machine delivery errors in the IMRT QA process. The changes in TCP and NTCP for eight different anatomic structures (H and N: CTV, GTV, both parotids, spinal cord, larynx; prostate: CTV, rectal wall) were calculated as the new QA metrics to quantify the clinical impact on patients. The correlation between the change in TCP/NTCP and the change in selected DVH values was also evaluated. The relation between TCP/NTCP change and the characteristics of the TCP/NTCP curves is discussed.Results:{Delta}TCP and {Delta}NTCP were summarized for each type of induced error and each structure. The changes/degradations in TCP and NTCP caused by the errors vary widely depending on dose patterns unique to each plan, and are good indicators of each plan's 'robustness' to that type of error.Conclusions: In this in silico QA study the authors have demonstrated the possibility of using biomathematical models not only as patient-specific QA metrics but also as objective indicators that quantify, pretreatment, a plan's robustness with respect to possible error types.

On the use of biomathematical models in patient-specific IMRT dose QA

International Nuclear Information System (INIS)

Zhen Heming; Nelms, Benjamin E.; Tomé, Wolfgang A.

2013-01-01

Purpose: To investigate the use of biomathematical models such as tumor control probability (TCP) and normal tissue complication probability (NTCP) as new quality assurance (QA) metrics.Methods: Five different types of error (MLC transmission, MLC penumbra, MLC tongue and groove, machine output, and MLC position) were intentionally induced to 40 clinical intensity modulated radiation therapy (IMRT) patient plans (20 H and N cases and 20 prostate cases) to simulate both treatment planning system errors and machine delivery errors in the IMRT QA process. The changes in TCP and NTCP for eight different anatomic structures (H and N: CTV, GTV, both parotids, spinal cord, larynx; prostate: CTV, rectal wall) were calculated as the new QA metrics to quantify the clinical impact on patients. The correlation between the change in TCP/NTCP and the change in selected DVH values was also evaluated. The relation between TCP/NTCP change and the characteristics of the TCP/NTCP curves is discussed.Results:ΔTCP and ΔNTCP were summarized for each type of induced error and each structure. The changes/degradations in TCP and NTCP caused by the errors vary widely depending on dose patterns unique to each plan, and are good indicators of each plan's “robustness” to that type of error.Conclusions: In this in silico QA study the authors have demonstrated the possibility of using biomathematical models not only as patient-specific QA metrics but also as objective indicators that quantify, pretreatment, a plan's robustness with respect to possible error types

A novel approach to EPID-based 3D volumetric dosimetry for IMRT and VMAT QA

Science.gov (United States)

Alhazmi, Abdulaziz; Gianoli, Chiara; Neppl, Sebastian; Martins, Juliana; Veloza, Stella; Podesta, Mark; Verhaegen, Frank; Reiner, Michael; Belka, Claus; Parodi, Katia

2018-06-01

Intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) are relatively complex treatment delivery techniques and require quality assurance (QA) procedures. Pre-treatment dosimetric verification represents a fundamental QA procedure in daily clinical routine in radiation therapy. The purpose of this study is to develop an EPID-based approach to reconstruct a 3D dose distribution as imparted to a virtual cylindrical water phantom to be used for plan-specific pre-treatment dosimetric verification for IMRT and VMAT plans. For each depth, the planar 2D dose distributions acquired in air were back-projected and convolved by depth-specific scatter and attenuation kernels. The kernels were obtained by making use of scatter and attenuation models to iteratively estimate the parameters from a set of reference measurements. The derived parameters served as a look-up table for reconstruction of arbitrary measurements. The summation of the reconstructed 3D dose distributions resulted in the integrated 3D dose distribution of the treatment delivery. The accuracy of the proposed approach was validated in clinical IMRT and VMAT plans by means of gamma evaluation, comparing the reconstructed 3D dose distributions with Octavius measurement. The comparison was carried out using (3%, 3 mm) criteria scoring 99% and 96% passing rates for IMRT and VMAT, respectively. An accuracy comparable to the one of the commercial device for 3D volumetric dosimetry was demonstrated. In addition, five IMRT and five VMAT were validated against the 3D dose calculation performed by the TPS in a water phantom using the same passing rate criteria. The median passing rates within the ten treatment plans was 97.3%, whereas the lowest was 95%. Besides, the reconstructed 3D distribution is obtained without predictions relying on forward dose calculation and without external phantom or dosimetric devices. Thus, the approach provides a fully automated, fast and easy QA

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

Dosimetric Comparison Between 3DCRT and IMRT Using Different Multileaf Collimators in the Treatment of Brain Tumors

International Nuclear Information System (INIS)

Ding Meisong; Newman, Francis M.S.; Chen Changhu; Stuhr, Kelly; Gaspar, Laurie E.

2009-01-01

We investigated the differences between 3-dimensional conformal radiotherapy (3DCRT) and intensity modulated radiotherapy (IMRT), and the impact of collimator leaf-width on IMRT plans for the treatment of nonspherical brain tumors. Eight patients treated by 3DCRT with Novalis were selected. We developed 3 IMRT plans with different multileaf collimators (Novalis m3, Varian MLC-120, and Varian MLC-80) with the same treatment margins, number of beams, and gantry positions as in the 3DCRT treatment plans. Treatment planning utilized the BrainLAB treatment planning system. For each patient, the dose constraints and optimization parameters remained identical for all plans. The heterogeneity index, the percentage target coverage, critical structures, and normal tissue volumes receiving 50% of the prescription dose were calculated to compare the dosimetric difference. Equivalent uniform dose (EUD) and tumor control probability (TCP) were also introduced to evaluate the radiobiological effect for different plans. We found that IMRT significantly improved the target dose homogeneity compared to the 3DCRT. However, IMRT showed the same radiobiological effect as 3DCRT. For the brain tumors adjacent to (or partially overlapping with) critical structures, IMRT dramatically spared the volume of the critical structures to be irradiated. In IMRT plans, the smaller collimator leaf width could reduce the volume of critical structures irradiated to the 50% level for those partially overlapping with the brain tumors. For relatively large and spherical brain tumors, the smaller collimator leaf widths give no significant benefit

Radiotherapy-induced secondary cancer risk for breast cancer: 3D conformal therapy versus IMRT versus VMAT

International Nuclear Information System (INIS)

Lee, Boram; Sung, Jiwon; Yoon, Myonggeun; Lee, Sunyoung

2014-01-01

This study evaluated the secondary cancer risk to various organs due to radiation treatment for breast cancer. Organ doses to an anthropomorphic phantom were measured using a photoluminescent dosimeter (PLD) for breast cancer treatment with 3D conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). Cancer risk based on the measured dose was calculated using the BEIR (Biological Effects of Ionizing Radiation) VII models. The secondary dose per treatment dose (50.4 Gy) to various organs ranged from 0.02 to 0.36 Gy for 3D-CRT, but from 0.07 to 8.48 Gy for IMRT and VMAT, indicating that the latter methods are associated with higher secondary radiation doses than 3D-CRT. The result of the homogeneity index in the breast target shows that the dose homogeneity of 3D-CRT was worse than those of IMRT and VMAT. The organ specific lifetime attributable risks (LARs) to the thyroid, contralateral breast and ipsilateral lung per 100 000 population were 0.02, 19.71, and 0.76 respectively for 3D-CRT, much lower than the 0.11, 463.56, and 10.59 respectively for IMRT and the 0.12, 290.32, and 12.28 respectively for VMAT. The overall estimation of LAR indicated that the radiation-induced cancer risk due to breast radiation therapy was lower with 3D-CRT than with IMRT or VMAT. (paper)

Use of a realistic breathing lung phantom to evaluate dose delivery errors

International Nuclear Information System (INIS)

Court, Laurence E.; Seco, Joao; Lu Xingqi; Ebe, Kazuyu; Mayo, Charles; Ionascu, Dan; Winey, Brian; Giakoumakis, Nikos; Aristophanous, Michalis; Berbeco, Ross; Rottman, Joerg; Bogdanov, Madeleine; Schofield, Deborah; Lingos, Tania

2010-01-01

Purpose: To compare the effect of respiration-induced motion on delivered dose (the interplay effect) for different treatment techniques under realistic clinical conditions. Methods: A flexible resin tumor model was created using rapid prototyping techniques based on a computed tomography (CT) image of an actual tumor. Twenty micro-MOSFETs were inserted into the tumor model and the tumor model was inserted into an anthropomorphic breathing phantom. Phantom motion was programed using the motion trajectory of an actual patient. A four-dimensional CT image was obtained and several treatment plans were created using different treatment techniques and planning systems: Conformal (Eclipse), step-and-shoot intensity-modulated radiation therapy (IMRT) (Pinnacle), step-and-shoot IMRT (XiO), dynamic IMRT (Eclipse), complex dynamic IMRT (Eclipse), hybrid IMRT [60% conformal, 40% dynamic IMRT (Eclipse)], volume-modulated arc therapy (VMAT) [single-arc (Eclipse)], VMAT [double-arc (Eclipse)], and complex VMAT (Eclipse). The complex plans were created by artificially pushing the optimizer to give complex multileaf collimator sequences. Each IMRT field was irradiated five times and each VMAT field was irradiated ten times, with each irradiation starting at a random point in the respiratory cycle. The effect of fractionation was calculated by randomly summing the measured doses. The maximum deviation for each measurement point per fraction and the probability that 95% of the model tumor had dose deviations less than 2% and 5% were calculated as a function of the number of fractions. Tumor control probabilities for each treatment plan were calculated and compared. Results: After five fractions, measured dose deviations were less than 2% for more than 95% of measurement points within the tumor model for all plans, except the complex dynamic IMRT, step-and-shoot IMRT (XiO), complex VMAT, and single-arc VMAT plans. Reducing the dose rate of the complex IMRT plans from 600 to 200 MU

Use of a realistic breathing lung phantom to evaluate dose delivery errors

Energy Technology Data Exchange (ETDEWEB)

Court, Laurence E.; Seco, Joao; Lu Xingqi; Ebe, Kazuyu; Mayo, Charles; Ionascu, Dan; Winey, Brian; Giakoumakis, Nikos; Aristophanous, Michalis; Berbeco, Ross; Rottman, Joerg; Bogdanov, Madeleine; Schofield, Deborah; Lingos, Tania [Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts 02115 (United States); Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114 (United States); Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02130 (United States); JA Jouetsu Hospital, Jouetsu 355-0063 (Japan); University of Massachusetts Memorial Medical Center, Worcester, Massachusetts 01655 (United States); William Beaumont Hospital, Royal Oak, Michigan 48073 (United States); Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts 02115 (United States) and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114 (United States); Dana-Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, Massachusetts 02115 (United States)

2010-11-15

Purpose: To compare the effect of respiration-induced motion on delivered dose (the interplay effect) for different treatment techniques under realistic clinical conditions. Methods: A flexible resin tumor model was created using rapid prototyping techniques based on a computed tomography (CT) image of an actual tumor. Twenty micro-MOSFETs were inserted into the tumor model and the tumor model was inserted into an anthropomorphic breathing phantom. Phantom motion was programed using the motion trajectory of an actual patient. A four-dimensional CT image was obtained and several treatment plans were created using different treatment techniques and planning systems: Conformal (Eclipse), step-and-shoot intensity-modulated radiation therapy (IMRT) (Pinnacle), step-and-shoot IMRT (XiO), dynamic IMRT (Eclipse), complex dynamic IMRT (Eclipse), hybrid IMRT [60% conformal, 40% dynamic IMRT (Eclipse)], volume-modulated arc therapy (VMAT) [single-arc (Eclipse)], VMAT [double-arc (Eclipse)], and complex VMAT (Eclipse). The complex plans were created by artificially pushing the optimizer to give complex multileaf collimator sequences. Each IMRT field was irradiated five times and each VMAT field was irradiated ten times, with each irradiation starting at a random point in the respiratory cycle. The effect of fractionation was calculated by randomly summing the measured doses. The maximum deviation for each measurement point per fraction and the probability that 95% of the model tumor had dose deviations less than 2% and 5% were calculated as a function of the number of fractions. Tumor control probabilities for each treatment plan were calculated and compared. Results: After five fractions, measured dose deviations were less than 2% for more than 95% of measurement points within the tumor model for all plans, except the complex dynamic IMRT, step-and-shoot IMRT (XiO), complex VMAT, and single-arc VMAT plans. Reducing the dose rate of the complex IMRT plans from 600 to 200 MU

TH-AB-BRA-07: PENELOPE-Based GPU-Accelerated Dose Calculation System Applied to MRI-Guided Radiation Therapy

International Nuclear Information System (INIS)

Wang, Y; Mazur, T; Green, O; Hu, Y; Li, H; Rodriguez, V; Wooten, H; Yang, D; Zhao, T; Mutic, S; Li, H

2016-01-01

Purpose: The clinical commissioning of IMRT subject to a magnetic field is challenging. The purpose of this work is to develop a GPU-accelerated Monte Carlo dose calculation platform based on PENELOPE and then use the platform to validate a vendor-provided MRIdian head model toward quality assurance of clinical IMRT treatment plans subject to a 0.35 T magnetic field. Methods: We first translated PENELOPE from FORTRAN to C++ and validated that the translation produced equivalent results. Then we adapted the C++ code to CUDA in a workflow optimized for GPU architecture. We expanded upon the original code to include voxelized transport boosted by Woodcock tracking, faster electron/positron propagation in a magnetic field, and several features that make gPENELOPE highly user-friendly. Moreover, we incorporated the vendor-provided MRIdian head model into the code. We performed a set of experimental measurements on MRIdian to examine the accuracy of both the head model and gPENELOPE, and then applied gPENELOPE toward independent validation of patient doses calculated by MRIdian’s KMC. Results: We achieve an average acceleration factor of 152 compared to the original single-thread FORTRAN implementation with the original accuracy preserved. For 16 treatment plans including stomach (4), lung (2), liver (3), adrenal gland (2), pancreas (2), spleen (1), mediastinum (1) and breast (1), the MRIdian dose calculation engine agrees with gPENELOPE with a mean gamma passing rate of 99.1% ± 0.6% (2%/2 mm). Conclusions: We developed a Monte Carlo simulation platform based on a GPU-accelerated version of PENELOPE. We validated that both the vendor provided head model and fast Monte Carlo engine used by the MRIdian system are accurate in modeling radiation transport in a patient using 2%/2 mm gamma criteria. Future applications of this platform will include dose validation and accumulation, IMRT optimization, and dosimetry system modeling for next generation MR-IGRT systems.

TH-AB-BRA-07: PENELOPE-Based GPU-Accelerated Dose Calculation System Applied to MRI-Guided Radiation Therapy

Energy Technology Data Exchange (ETDEWEB)

Wang, Y; Mazur, T; Green, O; Hu, Y; Li, H; Rodriguez, V; Wooten, H; Yang, D; Zhao, T; Mutic, S; Li, H [Washington University School of Medicine, Saint Louis, MO (United States)

2016-06-15

Purpose: The clinical commissioning of IMRT subject to a magnetic field is challenging. The purpose of this work is to develop a GPU-accelerated Monte Carlo dose calculation platform based on PENELOPE and then use the platform to validate a vendor-provided MRIdian head model toward quality assurance of clinical IMRT treatment plans subject to a 0.35 T magnetic field. Methods: We first translated PENELOPE from FORTRAN to C++ and validated that the translation produced equivalent results. Then we adapted the C++ code to CUDA in a workflow optimized for GPU architecture. We expanded upon the original code to include voxelized transport boosted by Woodcock tracking, faster electron/positron propagation in a magnetic field, and several features that make gPENELOPE highly user-friendly. Moreover, we incorporated the vendor-provided MRIdian head model into the code. We performed a set of experimental measurements on MRIdian to examine the accuracy of both the head model and gPENELOPE, and then applied gPENELOPE toward independent validation of patient doses calculated by MRIdian’s KMC. Results: We achieve an average acceleration factor of 152 compared to the original single-thread FORTRAN implementation with the original accuracy preserved. For 16 treatment plans including stomach (4), lung (2), liver (3), adrenal gland (2), pancreas (2), spleen (1), mediastinum (1) and breast (1), the MRIdian dose calculation engine agrees with gPENELOPE with a mean gamma passing rate of 99.1% ± 0.6% (2%/2 mm). Conclusions: We developed a Monte Carlo simulation platform based on a GPU-accelerated version of PENELOPE. We validated that both the vendor provided head model and fast Monte Carlo engine used by the MRIdian system are accurate in modeling radiation transport in a patient using 2%/2 mm gamma criteria. Future applications of this platform will include dose validation and accumulation, IMRT optimization, and dosimetry system modeling for next generation MR-IGRT systems.

IMRT QA using machine learning: A multi-institutional validation.

Science.gov (United States)

Valdes, Gilmer; Chan, Maria F; Lim, Seng Boh; Scheuermann, Ryan; Deasy, Joseph O; Solberg, Timothy D

2017-09-01

To validate a machine learning approach to Virtual intensity-modulated radiation therapy (IMRT) quality assurance (QA) for accurately predicting gamma passing rates using different measurement approaches at different institutions. A Virtual IMRT QA framework was previously developed using a machine learning algorithm based on 498 IMRT plans, in which QA measurements were performed using diode-array detectors and a 3%local/3 mm with 10% threshold at Institution 1. An independent set of 139 IMRT measurements from a different institution, Institution 2, with QA data based on portal dosimetry using the same gamma index, was used to test the mathematical framework. Only pixels with ≥10% of the maximum calibrated units (CU) or dose were included in the comparison. Plans were characterized by 90 different complexity metrics. A weighted poison regression with Lasso regularization was trained to predict passing rates using the complexity metrics as input. The methodology predicted passing rates within 3% accuracy for all composite plans measured using diode-array detectors at Institution 1, and within 3.5% for 120 of 139 plans using portal dosimetry measurements performed on a per-beam basis at Institution 2. The remaining measurements (19) had large areas of low CU, where portal dosimetry has a larger disagreement with the calculated dose and as such, the failure was expected. These beams need further modeling in the treatment planning system to correct the under-response in low-dose regions. Important features selected by Lasso to predict gamma passing rates were as follows: complete irradiated area outline (CIAO), jaw position, fraction of MLC leafs with gaps smaller than 20 or 5 mm, fraction of area receiving less than 50% of the total CU, fraction of the area receiving dose from penumbra, weighted average irregularity factor, and duty cycle. We have demonstrated that Virtual IMRT QA can predict passing rates using different measurement techniques and across multiple

Investigation of effective decision criteria for multiobjective optimization in IMRT.

Science.gov (United States)

Holdsworth, Clay; Stewart, Robert D; Kim, Minsun; Liao, Jay; Phillips, Mark H

2011-06-01

To investigate how using different sets of decision criteria impacts the quality of intensity modulated radiation therapy (IMRT) plans obtained by multiobjective optimization. A multiobjective optimization evolutionary algorithm (MOEA) was used to produce sets of IMRT plans. The MOEA consisted of two interacting algorithms: (i) a deterministic inverse planning optimization of beamlet intensities that minimizes a weighted sum of quadratic penalty objectives to generate IMRT plans and (ii) an evolutionary algorithm that selects the superior IMRT plans using decision criteria and uses those plans to determine the new weights and penalty objectives of each new plan. Plans resulting from the deterministic algorithm were evaluated by the evolutionary algorithm using a set of decision criteria for both targets and organs at risk (OARs). Decision criteria used included variation in the target dose distribution, mean dose, maximum dose, generalized equivalent uniform dose (gEUD), an equivalent uniform dose (EUD(alpha,beta) formula derived from the linear-quadratic survival model, and points on dose volume histograms (DVHs). In order to quantatively compare results from trials using different decision criteria, a neutral set of comparison metrics was used. For each set of decision criteria investigated, IMRT plans were calculated for four different cases: two simple prostate cases, one complex prostate Case, and one complex head and neck Case. When smaller numbers of decision criteria, more descriptive decision criteria, or less anti-correlated decision criteria were used to characterize plan quality during multiobjective optimization, dose to OARs and target dose variation were reduced in the final population of plans. Mean OAR dose and gEUD (a = 4) decision criteria were comparable. Using maximum dose decision criteria for OARs near targets resulted in inferior populations that focused solely on low target variance at the expense of high OAR dose. Target dose range, (D

The clinical impact of the couch top and rails on IMRT and arc therapy

International Nuclear Information System (INIS)

Pulliam, Kiley B; Howell, Rebecca M; Followill, David; Luo, Dershan; Kry, Stephen F; White, R Allen

2011-01-01

The clinical impact of the Varian Exact Couch on dose, volume coverage to targets and critical structures, and tumor control probability (TCP) has not been described. Thus, we examined their effects on IMRT and arc therapy. Five clinical prostate patients were planned with both 6 MV eight-field IMRT and 6 MV two-arc RapidArc techniques using the Eclipse treatment planning system. These plans neglected treatment couch attenuation, as is a common clinical practice. Dose distributions were then recalculated in Eclipse with the inclusion of the Varian Exact Couch (imaging couch top) and the rails in varying configurations. The changes in dose and coverage were evaluated using the dose-volume histograms from each plan iteration. We used a TCP model to calculate losses in tumor control resulting from not accounting for the couch top and rails. We also verified dose measurements in a phantom. Failure to account for the treatment couch and rails resulted in clinically unacceptable dose and volume coverage losses to the targets for both IMRT and RapidArc. The couch caused average prescription dose losses (relative to plans that ignored the couch) to the prostate of 4.2% and 2.0% for IMRT with the rails out and in, respectively, and 3.2% and 2.9% for RapidArc with the rails out and in, respectively. On average, the percentage of the target covered by the prescribed dose dropped to 35% and 84% for IMRT (rails out and in, respectively) and to 18% and 17% for RapidArc (rails out and in, respectively). The TCP was also reduced by as much as 10.5% (6.3% on average). Dose and volume coverage losses for IMRT plans were primarily due to the rails, while the imaging couch top contributed most to losses for RapidArc. Both the couch top and rails contribute to dose and coverage losses that can render plans clinically unacceptable. A follow-up study we performed found that the less attenuating unipanel mesh couch top available with the Varian Exact couch does not cause a clinically

Lhermitte's Sign Developing after IMRT for Head and Neck Cancer

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Dong C. Lim

2010-01-01

Full Text Available Background. Lhermitte's sign (LS is a benign form of myelopathy with neck flexion producing an unpleasant electric-shock sensation radiating down the extremities. Although rare, it can occur after head and neck radiotherapy. Results. We report a case of Lhermitte's developing after curative intensity-modulated radiotherapy (IMRT for a patient with locoregionally advanced oropharyngeal cancer. IMRT delivers a conformal dose of radiation in head and neck cancer resulting in a gradient of radiation dose throughout the spinal cord. Using IMRT, more dose is delivered to the anterior spinal cord than the posterior cord. Conclusions. Lhermitte's sign can develop after IMRT for head and neck cancer. We propose an anterior spinal cord structure, the spinothalamic tract to be the target of IMRT-caused LS.

Dosimetry tools and techniques for IMRT

International Nuclear Information System (INIS)

Low, Daniel A.; Moran, Jean M.; Dempsey, James F.; Dong Lei; Oldham, Mark

2011-01-01

Intensity modulated radiation therapy (IMRT) poses a number of challenges for properly measuring commissioning data and quality assurance (QA) radiation dose distributions. This report provides a comprehensive overview of how dosimeters, phantoms, and dose distribution analysis techniques should be used to support the commissioning and quality assurance requirements of an IMRT program. The proper applications of each dosimeter are described along with the limitations of each system. Point detectors, arrays, film, and electronic portal imagers are discussed with respect to their proper use, along with potential applications of 3D dosimetry. Regardless of the IMRT technique utilized, some situations require the use of multiple detectors for the acquisition of accurate commissioning data. The overall goal of this task group report is to provide a document that aids the physicist in the proper selection and use of the dosimetry tools available for IMRT QA and to provide a resource for physicists that describes dosimetry measurement techniques for purposes of IMRT commissioning and measurement-based characterization or verification of IMRT treatment plans. This report is not intended to provide a comprehensive review of commissioning and QA procedures for IMRT. Instead, this report focuses on the aspects of metrology, particularly the practical aspects of measurements that are unique to IMRT. The metrology of IMRT concerns the application of measurement instruments and their suitability, calibration, and quality control of measurements. Each of the dosimetry measurement tools has limitations that need to be considered when incorporating them into a commissioning process or a comprehensive QA program. For example, routine quality assurance procedures require the use of robust field dosimetry systems. These often exhibit limitations with respect to spatial resolution or energy response and need to themselves be commissioned against more established dosimeters. A chain of

Improving IMRT-plan quality with MLC leaf position refinement post plan optimization

International Nuclear Information System (INIS)

Niu Ying; Zhang Guowei; Berman, Barry L.; Parke, William C.; Yi Byongyong; Yu, Cedric X.

2012-01-01

Purpose: In intensity-modulated radiation therapy (IMRT) planning, reducing the pencil-beam size may lead to a significant improvement in dose conformity, but also increase the time needed for the dose calculation and plan optimization. The authors develop and evaluate a postoptimization refinement (POpR) method, which makes fine adjustments to the multileaf collimator (MLC) leaf positions after plan optimization, enhancing the spatial precision and improving the plan quality without a significant impact on the computational burden. Methods: The authors’ POpR method is implemented using a commercial treatment planning system based on direct aperture optimization. After an IMRT plan is optimized using pencil beams with regular pencil-beam step size, a greedy search is conducted by looping through all of the involved MLC leaves to see if moving the MLC leaf in or out by half of a pencil-beam step size will improve the objective function value. The half-sized pencil beams, which are used for updating dose distribution in the greedy search, are derived from the existing full-sized pencil beams without need for further pencil-beam dose calculations. A benchmark phantom case and a head-and-neck (HN) case are studied for testing the authors’ POpR method. Results: Using a benchmark phantom and a HN case, the authors have verified that their POpR method can be an efficient technique in the IMRT planning process. Effectiveness of POpR is confirmed by noting significant improvements in objective function values. Dosimetric benefits of POpR are comparable to those of using a finer pencil-beam size from the optimization start, but with far less computation and time. Conclusions: The POpR is a feasible and practical method to significantly improve IMRT-plan quality without compromising the planning efficiency.

Critical dose and toxicity index of organs at risk in radiotherapy: Analyzing the calculated effects of modified dose fractionation in non–small cell lung cancer

Energy Technology Data Exchange (ETDEWEB)

Pedicini, Piernicola, E-mail: ppiern@libero.it [Service of Medical Physics, I.R.C.C.S. Regional Cancer Hospital C.R.O.B, Rionero in Vulture (Italy); Strigari, Lidia [Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome (Italy); Benassi, Marcello [Service of Medical Physics, Scientific Institute of Tumours of Romagna I.R.S.T., Meldola (Italy); Caivano, Rocchina [Service of Medical Physics, I.R.C.C.S. Regional Cancer Hospital C.R.O.B, Rionero in Vulture (Italy); Fiorentino, Alba [U.O. of Radiotherapy, I.R.C.C.S. Regional Cancer Hospital C.R.O.B., Rionero in Vulture (Italy); Nappi, Antonio [U.O. of Nuclear Medicine, I.R.C.C.S. Regional Cancer Hospital C.R.O.B., Rionero in Vulture (Italy); Salvatore, Marco [U.O. of Nuclear Medicine, I.R.C.C.S. SDN Foundation, Naples (Italy); Storto, Giovanni [U.O. of Nuclear Medicine, I.R.C.C.S. Regional Cancer Hospital C.R.O.B., Rionero in Vulture (Italy)

2014-04-01

To increase the efficacy of radiotherapy for non–small cell lung cancer (NSCLC), many schemes of dose fractionation were assessed by a new “toxicity index” (I), which allows one to choose the fractionation schedules that produce less toxic treatments. Thirty-two patients affected by non resectable NSCLC were treated by standard 3-dimensional conformal radiotherapy (3DCRT) with a strategy of limited treated volume. Computed tomography datasets were employed to re plan by simultaneous integrated boost intensity-modulated radiotherapy (IMRT). The dose distributions from plans were used to test various schemes of dose fractionation, in 3DCRT as well as in IMRT, by transforming the dose-volume histogram (DVH) into a biological equivalent DVH (BDVH) and by varying the overall treatment time. The BDVHs were obtained through the toxicity index, which was defined for each of the organs at risk (OAR) by a linear quadratic model keeping an equivalent radiobiological effect on the target volume. The less toxic fractionation consisted in a severe/moderate hyper fractionation for the volume including the primary tumor and lymph nodes, followed by a hypofractionation for the reduced volume of the primary tumor. The 3DCRT and IMRT resulted, respectively, in 4.7% and 4.3% of dose sparing for the spinal cord, without significant changes for the combined-lungs toxicity (p < 0.001). Schedules with reduced overall treatment time (accelerated fractionations) led to a 12.5% dose sparing for the spinal cord (7.5% in IMRT), 8.3% dose sparing for V{sub 20} in the combined lungs (5.5% in IMRT), and also significant dose sparing for all the other OARs (p < 0.001). The toxicity index allows to choose fractionation schedules with reduced toxicity for all the OARs and equivalent radiobiological effect for the tumor in 3DCRT, as well as in IMRT, treatments of NSCLC.

Dosimetry and planning audit of IMRT prostate treatment in the Czech Republic with a pelvic phantom

International Nuclear Information System (INIS)

Koniarova, I.; Horakova, I.; Dufek, V.; Kotik, L.

2014-01-01

In 2013, the national end-to-end audit of IMRT prostate treatment with a pelvic phantom has been carried out in the Czech Republic. It has been performed by the NRPI on site and the participation was voluntary. All departments (17) where IMRT is used for prostate treatment participated. In total, 21 plans have been evaluated. Phantom with clearly defined structures that were the same for all departments has been used. There was a dosimetric and a planning part of the audit. The determination of absorbed doses with ionization chambers placed in the PTV and in the rectum and the comparison to the planned doses was performed. Planar dose distribution was verified with gafchromic film. Majority of departments were able to deliver the IMRT plan successfully. The dose to PTV measured with ionization chamber in the phantom exceeded tolerance level of 3% in 4 cases. The mean of measured to planned dose for PTV was 0.991 ± 0.004. In one case, the tolerance level for planar dose was significantly exceeded. Constraints used for planning, volumes calculation, and DVHs were analyzed. (authors)

Quantifying the interplay effect in prostate IMRT delivery using a convolution-based method

International Nuclear Information System (INIS)

Li, Haisen S.; Chetty, Indrin J.; Solberg, Timothy D.

2008-01-01

The authors present a segment-based convolution method to account for the interplay effect between intrafraction organ motion and the multileaf collimator position for each particular segment in intensity modulated radiation therapy (IMRT) delivered in a step-and-shoot manner. In this method, the static dose distribution attributed to each segment is convolved with the probability density function (PDF) of motion during delivery of the segment, whereas in the conventional convolution method (''average-based convolution''), the static dose distribution is convolved with the PDF averaged over an entire fraction, an entire treatment course, or even an entire patient population. In the case of IMRT delivered in a step-and-shoot manner, the average-based convolution method assumes that in each segment the target volume experiences the same motion pattern (PDF) as that of population. In the segment-based convolution method, the dose during each segment is calculated by convolving the static dose with the motion PDF specific to that segment, allowing both intrafraction motion and the interplay effect to be accounted for in the dose calculation. Intrafraction prostate motion data from a population of 35 patients tracked using the Calypso system (Calypso Medical Technologies, Inc., Seattle, WA) was used to generate motion PDFs. These were then convolved with dose distributions from clinical prostate IMRT plans. For a single segment with a small number of monitor units, the interplay effect introduced errors of up to 25.9% in the mean CTV dose compared against the planned dose evaluated by using the PDF of the entire fraction. In contrast, the interplay effect reduced the minimum CTV dose by 4.4%, and the CTV generalized equivalent uniform dose by 1.3%, in single fraction plans. For entire treatment courses delivered in either a hypofractionated (five fractions) or conventional (>30 fractions) regimen, the discrepancy in total dose due to interplay effect was negligible

A Phase I Dose Escalation Study of Hypofractionated IMRT Field-in-Field Boost for Newly Diagnosed Glioblastoma Multiforme

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Monjazeb, Arta M., E-mail: arta.monjazeb@ucdmc.ucdavis.edu [U.C. Davis School of Medicine, Department of Radiation Oncology, Sacramento, CA (United States); Ayala, Deandra; Jensen, Courtney [Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Case, L. Douglas [Biostatistical Sciences, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Bourland, J. Daniel; Ellis, Thomas L. [Neurosurgery, Wake Forest University Health Sciences, Winston-Salem, NC (United States); McMullen, Kevin P.; Chan, Michael D. [Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Tatter, Stephen B. [Neurosurgery, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Lesser, Glen J. [Hematology Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States); Shaw, Edward G. [Radiation Oncology, Wake Forest University Health Sciences, Winston-Salem, NC (United States)

2012-02-01

Objectives: To describe the results of a Phase I dose escalation trial for newly diagnosed glioblastoma multiforme (GBM) using a hypofractionated concurrent intensity-modulated radiotherapy (IMRT) boost. Methods: Twenty-one patients were enrolled between April 1999 and August 2003. Radiotherapy consisted of daily fractions of 1.8 Gy with a concurrent boost of 0.7 Gy (total 2.5 Gy daily) to a total dose of 70, 75, or 80 Gy. Concurrent chemotherapy was not permitted. Seven patients were enrolled at each dose and dose limiting toxicities were defined as irreversible Grade 3 or any Grade 4-5 acute neurotoxicity attributable to radiotherapy. Results: All patients experienced Grade 1 or 2 acute toxicities. Acutely, 8 patients experienced Grade 3 and 1 patient experienced Grade 3 and 4 toxicities. Of these, only two reversible cases of otitis media were attributable to radiotherapy. No dose-limiting toxicities were encountered. Only 2 patients experienced Grade 3 delayed toxicity and there was no delayed Grade 4 toxicity. Eleven patients requiring repeat resection or biopsy were found to have viable tumor and radiation changes with no cases of radionecrosis alone. Median overall and progression-free survival for this cohort were 13.6 and 6.5 months, respectively. One- and 2-year survival rates were 57% and 19%. At recurrence, 15 patients received chemotherapy, 9 underwent resection, and 5 received radiotherapy. Conclusions: Using a hypofractionated concurrent IMRT boost, we were able to safely treat patients to 80 Gy without any dose-limiting toxicity. Given that local failure still remains the predominant pattern for GBM patients, a trial of dose escalation with IMRT and temozolomide is warranted.

A Phase I Dose Escalation Study of Hypofractionated IMRT Field-in-Field Boost for Newly Diagnosed Glioblastoma Multiforme

International Nuclear Information System (INIS)

Monjazeb, Arta M.; Ayala, Deandra; Jensen, Courtney; Case, L. Douglas; Bourland, J. Daniel; Ellis, Thomas L.; McMullen, Kevin P.; Chan, Michael D.; Tatter, Stephen B.; Lesser, Glen J.; Shaw, Edward G.

2012-01-01

Objectives: To describe the results of a Phase I dose escalation trial for newly diagnosed glioblastoma multiforme (GBM) using a hypofractionated concurrent intensity-modulated radiotherapy (IMRT) boost. Methods: Twenty-one patients were enrolled between April 1999 and August 2003. Radiotherapy consisted of daily fractions of 1.8 Gy with a concurrent boost of 0.7 Gy (total 2.5 Gy daily) to a total dose of 70, 75, or 80 Gy. Concurrent chemotherapy was not permitted. Seven patients were enrolled at each dose and dose limiting toxicities were defined as irreversible Grade 3 or any Grade 4–5 acute neurotoxicity attributable to radiotherapy. Results: All patients experienced Grade 1 or 2 acute toxicities. Acutely, 8 patients experienced Grade 3 and 1 patient experienced Grade 3 and 4 toxicities. Of these, only two reversible cases of otitis media were attributable to radiotherapy. No dose-limiting toxicities were encountered. Only 2 patients experienced Grade 3 delayed toxicity and there was no delayed Grade 4 toxicity. Eleven patients requiring repeat resection or biopsy were found to have viable tumor and radiation changes with no cases of radionecrosis alone. Median overall and progression-free survival for this cohort were 13.6 and 6.5 months, respectively. One- and 2-year survival rates were 57% and 19%. At recurrence, 15 patients received chemotherapy, 9 underwent resection, and 5 received radiotherapy. Conclusions: Using a hypofractionated concurrent IMRT boost, we were able to safely treat patients to 80 Gy without any dose-limiting toxicity. Given that local failure still remains the predominant pattern for GBM patients, a trial of dose escalation with IMRT and temozolomide is warranted.

Patient specific 3D printed phantom for IMRT quality assurance

International Nuclear Information System (INIS)

Ehler, Eric D; Higgins, Patrick D; Dusenbery, Kathryn E; Barney, Brett M

2014-01-01

The purpose of this study was to test the feasibility of a patient specific phantom for patient specific dosimetric verification. Using the head and neck region of an anthropomorphic phantom as a substitute for an actual patient, a soft-tissue equivalent model was constructed with the use of a 3D printer. Calculated and measured dose in the anthropomorphic phantom and the 3D printed phantom was compared for a parallel-opposed head and neck field geometry to establish tissue equivalence. A nine-field IMRT plan was constructed and dose verification measurements were performed for the 3D printed phantom as well as traditional standard phantoms. The maximum difference in calculated dose was 1.8% for the parallel-opposed configuration. Passing rates of various dosimetric parameters were compared for the IMRT plan measurements; the 3D printed phantom results showed greater disagreement at superficial depths than other methods. A custom phantom was created using a 3D printer. It was determined that the use of patient specific phantoms to perform dosimetric verification and estimate the dose in the patient is feasible. In addition, end-to-end testing on a per-patient basis was possible with the 3D printed phantom. Further refinement of the phantom construction process is needed for routine use. (paper)

Software for simulating IMRT protocol

Energy Technology Data Exchange (ETDEWEB)

Fonseca, Thelma C.F.; Campos, Tarcisio P.R. de, E-mail: tcff@ufmg.b, E-mail: campos@nuclear.ufmg.b [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Dept. de Engenharia Nuclear

2009-07-01

The Intensity Modulated Radiation Therapy - IMRT is an advanced technique to cancer treatment widely used on oncology around the world. The present paper describes the SOFT-RT software which is a tool for simulating IMRT protocol. Also, it will be present a cerebral tumor case of studied in which three irradiation windows with distinct orientation were applied. The SOFT-RT collect and export data to MCNP code. This code simulates the photon transport on the voxel model. Later, a out-module from SOFT-RT import the results and express the dose-response superimposing dose and voxel model in a tree-dimensional graphic representation. The present paper address the IMRT software and its function as well a cerebral tumor case of studied is showed. The graphic interface of the SOFT-RT illustrates the example case. (author)

Software for simulating IMRT protocol

International Nuclear Information System (INIS)

Fonseca, Thelma C.F.; Campos, Tarcisio P.R. de

2009-01-01

The Intensity Modulated Radiation Therapy - IMRT is an advanced technique to cancer treatment widely used on oncology around the world. The present paper describes the SOFT-RT software which is a tool for simulating IMRT protocol. Also, it will be present a cerebral tumor case of studied in which three irradiation windows with distinct orientation were applied. The SOFT-RT collect and export data to MCNP code. This code simulates the photon transport on the voxel model. Later, a out-module from SOFT-RT import the results and express the dose-response superimposing dose and voxel model in a tree-dimensional graphic representation. The present paper address the IMRT software and its function as well a cerebral tumor case of studied is showed. The graphic interface of the SOFT-RT illustrates the example case. (author)

IMRT for adjuvant radiation in gastric cancer: A preferred plan?

International Nuclear Information System (INIS)

Ringash, Jolie; Perkins, Greg; Brierley, James; Lockwood, Gina; Islam, Mohammad; Catton, Pamela; Cummings, Bernard; Kim, John; Wong, Rebecca; Dawson, Laura

2005-01-01

Purpose: To assess the potential advantage of intensity-modulated radiotherapy (IMRT) over conformal planning for postoperative adjuvant radiotherapy in patients with gastric carcinoma. Methods and Materials: Twenty patients who had undergone treatment planning with conformal beam arrangements for 4500 cGy adjuvant radiotherapy between 2000 and 2001 underwent repeat planning using IMRT techniques. Conformal five-field plans were compared with seven- to nine-field coplanar sliding-window IMRT plans. For each patient, the cumulative dose-volume histograms and organ-dose summaries (without distributions or digitally reconstructed radiographs) were provided to two independent, 'blinded' GI radiation oncologists. The oncologists indicated which plan provided better planning target volume coverage and critical organ sparing, any safety concerns with either plan, and which plan they would choose to treat the patient. Results: In 18 (90%) of 20 cases, both oncologists chose the same plan. Cases with disagreement were given to a third 'blinded' reviewer. A 'preferred plan' could be determined in 19 (95%) of 20 cases. IMRT was preferred in 17 (89%) of 19 cases. In 4 (20%) of 20 IMRT plans at least one radiation oncologist had safety concerns because of the spinal cord dose (3 cases) or small bowel dose (2 cases). Of 42 ratings, IMRT was thought to provide better planning target volume coverage in 36 (86%) and better sparing of the spinal cord in 31 (74%) of 42, kidneys in 29 (69%), liver in 30 (71%), and heart in 29 (69%) of 42 ratings. The median underdose volume (1.7 vs. 4.1 cm 3 ), maximal dose to the spinal cord (36.85 vs. 45.65 Gy), and dose to 50% of the liver (17.29 vs. 27.97), heart (12.89 vs. 15.50 Gy), and left kidney (15.50 vs. 16.06 Gy) were lower with IMRT than with the conformal plans. Conclusion: Compared with the conformal plans, oncologists frequently preferred IMRT plans when using dose-volume histogram data. The advantages of IMRT plans include both

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

SU-E-T-16: A Hybrid VMAT/IMRT Technique for the Treatment of Nasopharyngeal Carcinoma

International Nuclear Information System (INIS)

Zhao, N; Yang, R; Wang, J

2014-01-01

Purpose: To investigate a Hybrid VMAT/IMRT technique which combines volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods: 2 full arcs VMAT, 9-field IMRT and Hybrid VMAT/IMRT plans were created for 10 patients with NPC. The Hybrid VMAT/IMRT technique consisted of 1 full VMAT arc and 7 IMRT fields. The dose distribution of planning target volume (PTV) and organs at risk (OARs) for Hybrid VMAT/IMRT was compared with IMRT and VMAT. The monitor units (MUs) were also evaluated. Results: The Hybrid VMAT/IMRT technique significantly improved target dose homogeneity compared with IMRT and VMAT for PTV70 and PTV54. For PTV70 and PTV60, the Hybrid VMAT/IMRT technique significantly improved target dose conformity compared with IMRT (0.62 vs 0.47; p<0.05 and 0.64 vs 0.58; p<0.05, respectively) and VMAT (0.62 vs 0.43; p<0.05 and 0.64 vs 0.6; p<0.05, respectively). The near maximum dose (D2%) of temporomandibular joint (TMJ), temporal lobe and mandible for Hybrid plans were 5.5%, 7.9% and 5.2% lower than IMRT plans (p<0.05). The mean dose of TMJ, temporal lobe, mandible and unspecified tissue for Hybrid plans were 12.8%, 11.4%, 4.2% and 4.1% lower than IMRT plans (p<0.05). The mean dose of right parotid, mandible and unspecified tissue for Hybrid plans were 3.3%, 2.4% and 3.1% lower than VMAT plans (p<0.05). The mean MUs needed for IMRT, VMAT and Hybrid plans were 2256, 507 and 1394, respectively. Conclusion: Hybrid VMAT/IMRT technique significantly improved the target dose homogeneity and conformity compared with IMRT and VMAT and reduced the dose of OARs and unspecified tissue compared with IMRT with fewer MUs. Compared with VMAT, Hybrid VMAT/IMRT technique can better protect parotid gland, mandible and unspecified tissue. Ruijie Yang was funded by the grant project: National Natural Science Foundation of China (No. 81071237). Other authors have no competing interest for this work

SU-E-T-16: A Hybrid VMAT/IMRT Technique for the Treatment of Nasopharyngeal Carcinoma

Energy Technology Data Exchange (ETDEWEB)

Zhao, N; Yang, R; Wang, J [Peking University Third Hospital, Beijing, Beijing (China)

2014-06-01

Purpose: To investigate a Hybrid VMAT/IMRT technique which combines volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma (NPC). Methods: 2 full arcs VMAT, 9-field IMRT and Hybrid VMAT/IMRT plans were created for 10 patients with NPC. The Hybrid VMAT/IMRT technique consisted of 1 full VMAT arc and 7 IMRT fields. The dose distribution of planning target volume (PTV) and organs at risk (OARs) for Hybrid VMAT/IMRT was compared with IMRT and VMAT. The monitor units (MUs) were also evaluated. Results: The Hybrid VMAT/IMRT technique significantly improved target dose homogeneity compared with IMRT and VMAT for PTV70 and PTV54. For PTV70 and PTV60, the Hybrid VMAT/IMRT technique significantly improved target dose conformity compared with IMRT (0.62 vs 0.47; p<0.05 and 0.64 vs 0.58; p<0.05, respectively) and VMAT (0.62 vs 0.43; p<0.05 and 0.64 vs 0.6; p<0.05, respectively). The near maximum dose (D2%) of temporomandibular joint (TMJ), temporal lobe and mandible for Hybrid plans were 5.5%, 7.9% and 5.2% lower than IMRT plans (p<0.05). The mean dose of TMJ, temporal lobe, mandible and unspecified tissue for Hybrid plans were 12.8%, 11.4%, 4.2% and 4.1% lower than IMRT plans (p<0.05). The mean dose of right parotid, mandible and unspecified tissue for Hybrid plans were 3.3%, 2.4% and 3.1% lower than VMAT plans (p<0.05). The mean MUs needed for IMRT, VMAT and Hybrid plans were 2256, 507 and 1394, respectively. Conclusion: Hybrid VMAT/IMRT technique significantly improved the target dose homogeneity and conformity compared with IMRT and VMAT and reduced the dose of OARs and unspecified tissue compared with IMRT with fewer MUs. Compared with VMAT, Hybrid VMAT/IMRT technique can better protect parotid gland, mandible and unspecified tissue. Ruijie Yang was funded by the grant project: National Natural Science Foundation of China (No. 81071237). Other authors have no competing interest for this work.

SU-C-BRD-03: Closing the Loop On Virtual IMRT QA

International Nuclear Information System (INIS)

Valdes, G; Scheuermann, R; Y, H C.; Olszanski, A; Bellerive, M; Solberg, T

2015-01-01

Purpose: To develop an algorithm that predicts a priori IMRT QA passing rates. Methods: 416 IMRT plans from all treatment sites were planned in Eclipse version 11 and delivered using a dynamic sliding window technique on Clinac iX or TrueBeam linacs (Varian Medical Systems, Palo Alto, CA). The 3%/3mm and 2%/2mm local distance to agreement (DTA) were recorded during clinical operations using a commercial 2D diode array (MapCHECK 2, Sun Nuclear, Melbourne, FL). Each plan was characterized by 37 metrics that describe different failure modes between the calculated and measured dose. Machine-learning algorithms (MLAs) were trained to learn the relation between the plan characteristics and each passing rate. Minimization of the cross validated error, together with maximum a posteriori estimation (MAP), were used to choose the model parameters. Results: 3%/3mm local DTA can be predicted with an error smaller than 3% for 98% of the plans. For the remaining 2% of plans, the residual error was within 5%. For 2%/2mm local DTA passing rates, 96% percent of the plans were successfully predicted with an error smaller than 5%. All high-risk plans that failed the 2%/2mm local criteria were correctly identified by the algorithm. The most important metric to describe the passing rates was determined to be the MU per Gray (modulation factor). Conclusions: Logs files and independent dose calculations have been suggested as possible substitutes for measurement based IMRT QA. However, none of these methods answer the fundamental question of whether a plan can be delivered with a clinically acceptable error given the limitations of the linacs and the treatment planning system. Predicting the IMRT QA passing rates a priori closes that loop. For additional robustness, virtual IMRT QA can be combined with Linac QA and log file analysis to confirm appropriate delivery

SU-C-BRD-03: Closing the Loop On Virtual IMRT QA

Energy Technology Data Exchange (ETDEWEB)

Valdes, G; Scheuermann, R; Y, H C.; Olszanski, A; Bellerive, M; Solberg, T [University of Pennsylvania, Philadelphia, PA (United States)

2015-06-15

Purpose: To develop an algorithm that predicts a priori IMRT QA passing rates. Methods: 416 IMRT plans from all treatment sites were planned in Eclipse version 11 and delivered using a dynamic sliding window technique on Clinac iX or TrueBeam linacs (Varian Medical Systems, Palo Alto, CA). The 3%/3mm and 2%/2mm local distance to agreement (DTA) were recorded during clinical operations using a commercial 2D diode array (MapCHECK 2, Sun Nuclear, Melbourne, FL). Each plan was characterized by 37 metrics that describe different failure modes between the calculated and measured dose. Machine-learning algorithms (MLAs) were trained to learn the relation between the plan characteristics and each passing rate. Minimization of the cross validated error, together with maximum a posteriori estimation (MAP), were used to choose the model parameters. Results: 3%/3mm local DTA can be predicted with an error smaller than 3% for 98% of the plans. For the remaining 2% of plans, the residual error was within 5%. For 2%/2mm local DTA passing rates, 96% percent of the plans were successfully predicted with an error smaller than 5%. All high-risk plans that failed the 2%/2mm local criteria were correctly identified by the algorithm. The most important metric to describe the passing rates was determined to be the MU per Gray (modulation factor). Conclusions: Logs files and independent dose calculations have been suggested as possible substitutes for measurement based IMRT QA. However, none of these methods answer the fundamental question of whether a plan can be delivered with a clinically acceptable error given the limitations of the linacs and the treatment planning system. Predicting the IMRT QA passing rates a priori closes that loop. For additional robustness, virtual IMRT QA can be combined with Linac QA and log file analysis to confirm appropriate delivery.

AAA and AXB algorithms for the treatment of nasopharyngeal carcinoma using IMRT and RapidArc techniques.

Science.gov (United States)

Kamaleldin, Maha; Elsherbini, Nader A; Elshemey, Wael M

2017-09-27

The aim of this study is to evaluate the impact of anisotropic analytical algorithm (AAA) and 2 reporting systems (AXB-D m and AXB-D w ) of Acuros XB algorithm (AXB) on clinical plans of nasopharyngeal patients using intensity-modulated radiotherapy (IMRT) and RapidArc (RA) techniques. Six plans of different algorithm-technique combinations are performed for 10 patients to calculate dose-volume histogram (DVH) physical parameters for planning target volumes (PTVs) and organs at risk (OARs). The number of monitor units (MUs) and calculation time are also determined. Good coverage is reported for all algorithm-technique combination plans without exceeding the tolerance for OARs. Regardless of the algorithm, RA plans persistently reported higher D 2% values for PTV-70. All IMRT plans reported higher number of MUs (especially with AXB) than did RA plans. AAA-IMRT produced the minimum calculation time of all plans. Major differences between the investigated algorithm-technique combinations are reported only for the number of MUs and calculation time parameters. In terms of these 2 parameters, it is recommended to employ AXB in calculating RA plans and AAA in calculating IMRT plans to achieve minimum calculation times at reduced number of MUs. Copyright © 2017 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

Phase I Trial of Pelvic Nodal Dose Escalation With Hypofractionated IMRT for High-Risk Prostate Cancer

Energy Technology Data Exchange (ETDEWEB)

Adkison, Jarrod B.; McHaffie, Derek R.; Bentzen, Soren M.; Patel, Rakesh R.; Khuntia, Deepak [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States); Petereit, Daniel G. [Department of Radiation Oncology, John T. Vucurevich Regional Cancer Care Institute, Rapid City Regional Hospital, Rapid City, SD (United States); Hong, Theodore S.; Tome, Wolfgang [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States); Ritter, Mark A., E-mail: ritter@humonc.wisc.edu [Department of Human Oncology, University of Wisconsin Carbone Cancer Center, School of Medicine and Public Health, Madison, WI (United States)

2012-01-01

Purpose: Toxicity concerns have limited pelvic nodal prescriptions to doses that may be suboptimal for controlling microscopic disease. In a prospective trial, we tested whether image-guided intensity-modulated radiation therapy (IMRT) can safely deliver escalated nodal doses while treating the prostate with hypofractionated radiotherapy in 5 Vulgar-Fraction-One-Half weeks. Methods and Materials: Pelvic nodal and prostatic image-guided IMRT was delivered to 53 National Comprehensive Cancer Network (NCCN) high-risk patients to a nodal dose of 56 Gy in 2-Gy fractions with concomitant treatment of the prostate to 70 Gy in 28 fractions of 2.5 Gy, and 50 of 53 patients received androgen deprivation for a median duration of 12 months. Results: The median follow-up time was 25.4 months (range, 4.2-57.2). No early Grade 3 Radiation Therapy Oncology Group or Common Terminology Criteria for Adverse Events v.3.0 genitourinary (GU) or gastrointestinal (GI) toxicities were seen. The cumulative actuarial incidence of Grade 2 early GU toxicity (primarily alpha blocker initiation) was 38%. The rate was 32% for Grade 2 early GI toxicity. None of the dose-volume descriptors correlated with GU toxicity, and only the volume of bowel receiving {>=}30 Gy correlated with early GI toxicity (p = 0.029). Maximum late Grades 1, 2, and 3 GU toxicities were seen in 30%, 25%, and 2% of patients, respectively. Maximum late Grades 1 and 2 GI toxicities were seen in 30% and 8% (rectal bleeding requiring cautery) of patients, respectively. The estimated 3-year biochemical control (nadir + 2) was 81.2 {+-} 6.6%. No patient manifested pelvic nodal failure, whereas 2 experienced paraaortic nodal failure outside the field. The six other clinical failures were distant only. Conclusions: Pelvic IMRT nodal dose escalation to 56 Gy was delivered concurrently with 70 Gy of hypofractionated prostate radiotherapy in a convenient, resource-efficient, and well-tolerated 28-fraction schedule. Pelvic nodal dose

Dose and volume effects of gastrointestinal toxicity during neoadjuvant IMRT for rectal cancer

DEFF Research Database (Denmark)

Appelt, A. L.; Vogelius, I. R.; Jakobsen, Anders

2015-01-01

. Materials and Methods: We explored dose metrics correlating with acute diarrhea and chemotherapy compliance for a single-institution cohort of rectal cancer patients (n=115) treated with IMRT. Acute diarrhea during treatment was scored prospectively by trained RT nurses (CTCAE v3.0). The highest toxicity.......03) and patients with diabetes (OR=7.29, 1.21-43.8, p=0.03). Age, brachytherapy boost, prior abdominal surgery, smoking history, or domestic status had no influence on any of the two endpoints, nor had concurrent chemotherapy on the risk of acute diarrhea. Conclusions: We found that dose to the intestinal cavity...

Dosimetric Verification Using 2D Planar Diode Arrays and 3D Cylindrical Diode Arrays in IMRT and VMAT

International Nuclear Information System (INIS)

Utitsarn, K.; Suriyapee, S.; Oonsiri, S.; Oonsiri, P.

2012-01-01

Introduction: Dosimetric verification of intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) before treatment is necessary due to the complexity of delivery beams. This work aims to evaluate the performance of 2D planar and 3D cylindrical diode arrays for patient specific QA in IMRT and VMAT. Methods: MapCHECK and ArcCHECK were studied for their properties before clinical use. The clinical performance was demonstrated with IMRT and VMAT plans, the measured results were compared with the calculation from Eclipse treatment planning. The gamma index of 3% /3mm with 10% threshold dose were the criteria of agreement between measured and calculated. Results: MapCHECK and ArcCHECK showed linearly dose response and demonstrated a short term and long term reproducibility within ± 0.2 and ± 2%, the repeatability rate effect was within ± 0.1 and ± 0.25 %, respectively. The dose rate response was within ± 1% for both detectors. The field size dependence was the same as ionization chamber response. The variation in energy response was within ± 4.5% for MapCHECK and ± 2% for ArcCHECK. The measured beam profile of open and 30° of hard and enhance dynamic wedge showed good agreement with calculated dose. Both detectors showed the excellent percentage passing for all 15 IMRT and VMAT plans. For IMRT, The average of the % pass of MapCHECK was 97.31 with the mean gamma of 0.45. The average number of detector was 344.80, while the average of the % pass of ArcCHECK was 97.21 with the mean gamma of 0.46. The average number of detector was 1049.31. For VMAT, The average of the % pass of MapCHECK was 98.55 with the mean gamma of 0.37. The average number of detector was 410, while the average of the % pass of ArcCHECK was 97.04 with the mean γ of 0.43. The average number of detector was 1054. Discussion: The more detectors of ArcCHECK than MapCHECK make more dose measurement points that increase the chance of dose difference. In addition, Map

Dosimetric adaptive IMRT driven by fiducial points

International Nuclear Information System (INIS)

Crijns, Wouter; Van Herck, Hans; Defraene, Gilles; Van den Bergh, Laura; Haustermans, Karin; Slagmolen, Pieter; Maes, Frederik; Van den Heuvel, Frank

2014-01-01

Purpose: Intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy have become standard treatments but are more sensitive to anatomical variations than 3D conformal techniques. To correct for inter- and intrafraction anatomical variations, fast and easy to implement methods are needed. Here, the authors propose a full dosimetric IMRT correction that finds a compromise in-between basic repositioning (the current clinical practice) and full replanning. It simplifies replanning by avoiding a recontouring step and a full dose calculation. It surpasses repositioning by updating the preoptimized fluence and monitor units (MU) using a limited number of fiducial points and a pretreatment (CB)CT. To adapt the fluence the fiducial points were projected in the beam's eye view (BEV). To adapt the MUs, point dose calculation towards the same fiducial points were performed. The proposed method is intrinsically fast and robust, and simple to understand for operators, because of the use of only four fiducial points and the beam data based point dose calculations. Methods: To perform our dosimetric adaptation, two fluence corrections in the BEV are combined with two MU correction steps along the beam's path. (1) A transformation of the fluence map such that it is realigned with the current target geometry. (2) A correction for an unintended scaling of the penumbra margin when the treatment beams scale to the current target size. (3) A correction for the target depth relative to the body contour and (4) a correction for the target distance to the source. The impact of the correction strategy and its individual components was evaluated by simulations on a virtual prostate phantom. This heterogeneous reference phantom was systematically subjected to population based prostate transformations to simulate interfraction variations. Additionally, a patient example illustrated the clinical practice. The correction strategy was evaluated using both dosimetric

Dosimetric adaptive IMRT driven by fiducial points

Energy Technology Data Exchange (ETDEWEB)

Crijns, Wouter, E-mail: wouter.crijns@uzleuven.be [Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Herestraat 49, 3000 Leuven, Belgium and Medical Imaging Research Center, KU Leuven, Herestraat 49, 3000 Leuven (Belgium); Van Herck, Hans [Medical Imaging Research Center, KU Leuven, Herestraat 49, 3000 Leuven, Belgium and Department of Electrical Engineering (ESAT) – PSI, Center for the Processing of Speech and Images, KU Leuven, 3000 Leuven (Belgium); Defraene, Gilles; Van den Bergh, Laura; Haustermans, Karin [Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Herestraat 49, 3000 Leuven (Belgium); Slagmolen, Pieter [Medical Imaging Research Center, KU Leuven, Herestraat 49, 3000 Leuven (Belgium); Department of Electrical Engineering (ESAT) – PSI, Center for the Processing of Speech and Images, KU Leuven, 3000 Leuven (Belgium); iMinds-KU Leuven Medical IT Department, KU Leuven, 3000 Leuven (Belgium); Maes, Frederik [Medical Imaging Research Center, KU Leuven, Herestraat 49, 3000 Leuven (Belgium); Department of Electrical Engineering (ESAT) – PSI, Center for the Processing of Speech and Images, KU Leuven and iMinds, 3000 Leuven (Belgium); Van den Heuvel, Frank [Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Herestraat 49, 3000 Leuven, Belgium and Department of Oncology, MRC-CR-UK Gray Institute of Radiation Oncology and Biology, University of Oxford, Oxford OX1 2JD (United Kingdom)

2014-06-15

Purpose: Intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy have become standard treatments but are more sensitive to anatomical variations than 3D conformal techniques. To correct for inter- and intrafraction anatomical variations, fast and easy to implement methods are needed. Here, the authors propose a full dosimetric IMRT correction that finds a compromise in-between basic repositioning (the current clinical practice) and full replanning. It simplifies replanning by avoiding a recontouring step and a full dose calculation. It surpasses repositioning by updating the preoptimized fluence and monitor units (MU) using a limited number of fiducial points and a pretreatment (CB)CT. To adapt the fluence the fiducial points were projected in the beam's eye view (BEV). To adapt the MUs, point dose calculation towards the same fiducial points were performed. The proposed method is intrinsically fast and robust, and simple to understand for operators, because of the use of only four fiducial points and the beam data based point dose calculations. Methods: To perform our dosimetric adaptation, two fluence corrections in the BEV are combined with two MU correction steps along the beam's path. (1) A transformation of the fluence map such that it is realigned with the current target geometry. (2) A correction for an unintended scaling of the penumbra margin when the treatment beams scale to the current target size. (3) A correction for the target depth relative to the body contour and (4) a correction for the target distance to the source. The impact of the correction strategy and its individual components was evaluated by simulations on a virtual prostate phantom. This heterogeneous reference phantom was systematically subjected to population based prostate transformations to simulate interfraction variations. Additionally, a patient example illustrated the clinical practice. The correction strategy was evaluated using both dosimetric

A mathematical framework for virtual IMRT QA using machine learning.

Science.gov (United States)

Valdes, G; Scheuermann, R; Hung, C Y; Olszanski, A; Bellerive, M; Solberg, T D

2016-07-01

It is common practice to perform patient-specific pretreatment verifications to the clinical delivery of IMRT. This process can be time-consuming and not altogether instructive due to the myriad sources that may produce a failing result. The purpose of this study was to develop an algorithm capable of predicting IMRT QA passing rates a priori. From all treatment, 498 IMRT plans sites were planned in eclipse version 11 and delivered using a dynamic sliding window technique on Clinac iX or TrueBeam Linacs. 3%/3 mm local dose/distance-to-agreement (DTA) was recorded using a commercial 2D diode array. Each plan was characterized by 78 metrics that describe different aspects of their complexity that could lead to disagreements between the calculated and measured dose. A Poisson regression with Lasso regularization was trained to learn the relation between the plan characteristics and each passing rate. Passing rates 3%/3 mm local dose/DTA can be predicted with an error smaller than 3% for all plans analyzed. The most important metrics to describe the passing rates were determined to be the MU factor (MU per Gy), small aperture score, irregularity factor, and fraction of the plan delivered at the corners of a 40 × 40 cm field. The higher the value of these metrics, the worse the passing rates. The Virtual QA process predicts IMRT passing rates with a high likelihood, allows the detection of failures due to setup errors, and it is sensitive enough to detect small differences between matched Linacs.

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

A GPU-accelerated Monte Carlo dose calculation platform and its application toward validating an MRI-guided radiation therapy beam model

International Nuclear Information System (INIS)

Wang, Yuhe; Mazur, Thomas R.; Green, Olga; Hu, Yanle; Li, Hua; Rodriguez, Vivian; Wooten, H. Omar; Yang, Deshan; Zhao, Tianyu; Mutic, Sasa; Li, H. Harold

2016-01-01

Purpose: The clinical commissioning of IMRT subject to a magnetic field is challenging. The purpose of this work is to develop a GPU-accelerated Monte Carlo dose calculation platform based on PENELOPE and then use the platform to validate a vendor-provided MRIdian head model toward quality assurance of clinical IMRT treatment plans subject to a 0.35 T magnetic field. Methods: PENELOPE was first translated from FORTRAN to C++ and the result was confirmed to produce equivalent results to the original code. The C++ code was then adapted to CUDA in a workflow optimized for GPU architecture. The original code was expanded to include voxelized transport with Woodcock tracking, faster electron/positron propagation in a magnetic field, and several features that make gPENELOPE highly user-friendly. Moreover, the vendor-provided MRIdian head model was incorporated into the code in an effort to apply gPENELOPE as both an accurate and rapid dose validation system. A set of experimental measurements were performed on the MRIdian system to examine the accuracy of both the head model and gPENELOPE. Ultimately, gPENELOPE was applied toward independent validation of patient doses calculated by MRIdian’s KMC. Results: An acceleration factor of 152 was achieved in comparison to the original single-thread FORTRAN implementation with the original accuracy being preserved. For 16 treatment plans including stomach (4), lung (2), liver (3), adrenal gland (2), pancreas (2), spleen(1), mediastinum (1), and breast (1), the MRIdian dose calculation engine agrees with gPENELOPE with a mean gamma passing rate of 99.1% ± 0.6% (2%/2 mm). Conclusions: A Monte Carlo simulation platform was developed based on a GPU- accelerated version of PENELOPE. This platform was used to validate that both the vendor-provided head model and fast Monte Carlo engine used by the MRIdian system are accurate in modeling radiation transport in a patient using 2%/2 mm gamma criteria. Future applications of this

A GPU-accelerated Monte Carlo dose calculation platform and its application toward validating an MRI-guided radiation therapy beam model.

Science.gov (United States)

Wang, Yuhe; Mazur, Thomas R; Green, Olga; Hu, Yanle; Li, Hua; Rodriguez, Vivian; Wooten, H Omar; Yang, Deshan; Zhao, Tianyu; Mutic, Sasa; Li, H Harold

2016-07-01

The clinical commissioning of IMRT subject to a magnetic field is challenging. The purpose of this work is to develop a GPU-accelerated Monte Carlo dose calculation platform based on penelope and then use the platform to validate a vendor-provided MRIdian head model toward quality assurance of clinical IMRT treatment plans subject to a 0.35 T magnetic field. penelope was first translated from fortran to c++ and the result was confirmed to produce equivalent results to the original code. The c++ code was then adapted to cuda in a workflow optimized for GPU architecture. The original code was expanded to include voxelized transport with Woodcock tracking, faster electron/positron propagation in a magnetic field, and several features that make gpenelope highly user-friendly. Moreover, the vendor-provided MRIdian head model was incorporated into the code in an effort to apply gpenelope as both an accurate and rapid dose validation system. A set of experimental measurements were performed on the MRIdian system to examine the accuracy of both the head model and gpenelope. Ultimately, gpenelope was applied toward independent validation of patient doses calculated by MRIdian's kmc. An acceleration factor of 152 was achieved in comparison to the original single-thread fortran implementation with the original accuracy being preserved. For 16 treatment plans including stomach (4), lung (2), liver (3), adrenal gland (2), pancreas (2), spleen(1), mediastinum (1), and breast (1), the MRIdian dose calculation engine agrees with gpenelope with a mean gamma passing rate of 99.1% ± 0.6% (2%/2 mm). A Monte Carlo simulation platform was developed based on a GPU- accelerated version of penelope. This platform was used to validate that both the vendor-provided head model and fast Monte Carlo engine used by the MRIdian system are accurate in modeling radiation transport in a patient using 2%/2 mm gamma criteria. Future applications of this platform will include dose validation and

A GPU-accelerated Monte Carlo dose calculation platform and its application toward validating an MRI-guided radiation therapy beam model

Energy Technology Data Exchange (ETDEWEB)

Wang, Yuhe; Mazur, Thomas R.; Green, Olga; Hu, Yanle; Li, Hua; Rodriguez, Vivian; Wooten, H. Omar; Yang, Deshan; Zhao, Tianyu; Mutic, Sasa; Li, H. Harold, E-mail: hli@radonc.wustl.edu [Department of Radiation Oncology, Washington University School of Medicine, 4921 Parkview Place, Campus Box 8224, St. Louis, Missouri 63110 (United States)

2016-07-15

Purpose: The clinical commissioning of IMRT subject to a magnetic field is challenging. The purpose of this work is to develop a GPU-accelerated Monte Carlo dose calculation platform based on PENELOPE and then use the platform to validate a vendor-provided MRIdian head model toward quality assurance of clinical IMRT treatment plans subject to a 0.35 T magnetic field. Methods: PENELOPE was first translated from FORTRAN to C++ and the result was confirmed to produce equivalent results to the original code. The C++ code was then adapted to CUDA in a workflow optimized for GPU architecture. The original code was expanded to include voxelized transport with Woodcock tracking, faster electron/positron propagation in a magnetic field, and several features that make gPENELOPE highly user-friendly. Moreover, the vendor-provided MRIdian head model was incorporated into the code in an effort to apply gPENELOPE as both an accurate and rapid dose validation system. A set of experimental measurements were performed on the MRIdian system to examine the accuracy of both the head model and gPENELOPE. Ultimately, gPENELOPE was applied toward independent validation of patient doses calculated by MRIdian’s KMC. Results: An acceleration factor of 152 was achieved in comparison to the original single-thread FORTRAN implementation with the original accuracy being preserved. For 16 treatment plans including stomach (4), lung (2), liver (3), adrenal gland (2), pancreas (2), spleen(1), mediastinum (1), and breast (1), the MRIdian dose calculation engine agrees with gPENELOPE with a mean gamma passing rate of 99.1% ± 0.6% (2%/2 mm). Conclusions: A Monte Carlo simulation platform was developed based on a GPU- accelerated version of PENELOPE. This platform was used to validate that both the vendor-provided head model and fast Monte Carlo engine used by the MRIdian system are accurate in modeling radiation transport in a patient using 2%/2 mm gamma criteria. Future applications of this

SU-E-T-393: Evaluation of Large Field IMRT Versus RapidArc Planning for Carcinoma Cervix with Para-Aotic Node Irradiation

International Nuclear Information System (INIS)

Raman, S Kothanda; Girigesh, Y; MISHRA, M; Lalit, K

2015-01-01

Purpose: The objective of this work is to evaluate and compare Large field IMRT and RapidArc planning for Carcinoma Cervix and Para-aotic node irradiation. Methods: In this study, ten patients of Cervix with para-aotic node have been selected with PTV length 35+2cm. All plans were generated in Eclipse TPS V10.0 with Dynamic IMRT and RapidArc technique using 6MV photon energy. In IMRT planning, 7 fields were chosen to get optimal plan and in RapidArc, double Full arc clockwise and counter clockwise were used for planning. All the plans were generated with single isocenter and calculated using AAA dose algorithm. For all the cases the prescribed dose to PTV was same and the plan acceptance criteria is; 95% of the PTV volume should receive 100% prescribed dose. The tolerance doses for the OAR’s is also taken in to account. The evaluation criteria used for analysis are; 1) Homogeneity Index, 2) Conformity Index, 3) Mean Dose to OAR’s, 4)Total monitor units delivered. Results: DVH analysis were performed for both IMRT and RapidArc planning. In both the plans, 95% of PTV volume receives prescribed dose and maximum dose are less than 107%. The conformity index are same in both the techniques. The mean Homogeneity index are 1.036 and 1.053 for IMRT and RapidArc plan. The mean (mean + SD) dose of bladder and rectum in IMRT is 44.2+1.55, 42.05+2.52 and RapidArc is 46.66+1.6, 44.2+2.75 respectively. There is no significant difference found in Right Femoral head, Left Femoral head and Kidney doses. It is found that total MU’s are more in IMRT compared with RapidArc planning. Conclusion: In the case of cervix with Para-arotic node single isocenter irradiation, IMRT planning in large-field is better compared to RapidArc planning in terms of Homogeneity Index and mean dose of Bladder and Rectum

SU-E-T-393: Evaluation of Large Field IMRT Versus RapidArc Planning for Carcinoma Cervix with Para-Aotic Node Irradiation

Energy Technology Data Exchange (ETDEWEB)

Raman, S Kothanda; Girigesh, Y; MISHRA, M; Lalit, K [Rajiv Gandhi Cancer Institute & Research Centre, New Delhi (India)

2015-06-15

Purpose: The objective of this work is to evaluate and compare Large field IMRT and RapidArc planning for Carcinoma Cervix and Para-aotic node irradiation. Methods: In this study, ten patients of Cervix with para-aotic node have been selected with PTV length 35+2cm. All plans were generated in Eclipse TPS V10.0 with Dynamic IMRT and RapidArc technique using 6MV photon energy. In IMRT planning, 7 fields were chosen to get optimal plan and in RapidArc, double Full arc clockwise and counter clockwise were used for planning. All the plans were generated with single isocenter and calculated using AAA dose algorithm. For all the cases the prescribed dose to PTV was same and the plan acceptance criteria is; 95% of the PTV volume should receive 100% prescribed dose. The tolerance doses for the OAR’s is also taken in to account. The evaluation criteria used for analysis are; 1) Homogeneity Index, 2) Conformity Index, 3) Mean Dose to OAR’s, 4)Total monitor units delivered. Results: DVH analysis were performed for both IMRT and RapidArc planning. In both the plans, 95% of PTV volume receives prescribed dose and maximum dose are less than 107%. The conformity index are same in both the techniques. The mean Homogeneity index are 1.036 and 1.053 for IMRT and RapidArc plan. The mean (mean + SD) dose of bladder and rectum in IMRT is 44.2+1.55, 42.05+2.52 and RapidArc is 46.66+1.6, 44.2+2.75 respectively. There is no significant difference found in Right Femoral head, Left Femoral head and Kidney doses. It is found that total MU’s are more in IMRT compared with RapidArc planning. Conclusion: In the case of cervix with Para-arotic node single isocenter irradiation, IMRT planning in large-field is better compared to RapidArc planning in terms of Homogeneity Index and mean dose of Bladder and Rectum.

WE-AB-202-04: Statistical Evaluation of Lung Function Using 4DCT Ventilation Imaging: Proton Therapy VS IMRT

Energy Technology Data Exchange (ETDEWEB)

Huang, Q; Zhang, M; Chen, T; Yue, N; Zou, J [Rutgers University, New Brunswick, NJ (United States)

2016-06-15

Purpose: Variation in function of different lung regions has been ignored so far for conventional lung cancer treatment planning, which may lead to higher risk of radiation induced lung disease. 4DCT based lung ventilation imaging provides a novel yet convenient approach for lung functional imaging as 4DCT is taken as routine for lung cancer treatment. Our work aims to evaluate the impact of accounting for spatial heterogeneity in lung function using 4DCT based lung ventilation imaging for proton and IMRT plans. Methods: Six patients with advanced stage lung cancer of various tumor locations were retrospectively evaluated for the study. Proton and IMRT plans were designed following identical planning objective and constrains for each patient. Ventilation images were calculated from patients’ 4DCT using deformable image registration implemented by Velocity AI software based on Jacobian-metrics. Lung was delineated into two function level regions based on ventilation (low and high functional area). High functional region was defined as lung ventilation greater than 30%. Dose distribution and statistics in different lung function area was calculated for patients. Results: Variation in dosimetric statistics of different function lung region was observed between proton and IMRT plans. In all proton plans, high function lung regions receive lower maximum dose (100.2%–108.9%), compared with IMRT plans (106.4%–119.7%). Interestingly, three out of six proton plans gave higher mean dose by up to 2.2% than IMRT to high function lung region. Lower mean dose (lower by up to 14.1%) and maximum dose (lower by up to 9%) were observed in low function lung for proton plans. Conclusion: A systematic approach was developed to generate function lung ventilation imaging and use it to evaluate plans. This method hold great promise in function analysis of lung during planning. We are currently studying more subjects to evaluate this tool.

Fast optimization and dose calculation in scanned ion beam therapy

International Nuclear Information System (INIS)

Hild, S.; Graeff, C.; Trautmann, J.; Kraemer, M.; Zink, K.; Durante, M.; Bert, C.

2014-01-01

Purpose: Particle therapy (PT) has advantages over photon irradiation on static tumors. An increased biological effectiveness and active target conformal dose shaping are strong arguments for PT. However, the sensitivity to changes of internal geometry complicates the use of PT for moving organs. In case of interfractionally moving objects adaptive radiotherapy (ART) concepts known from intensity modulated radiotherapy (IMRT) can be adopted for PT treatments. One ART strategy is to optimize a new treatment plan based on daily image data directly before a radiation fraction is delivered [treatment replanning (TRP)]. Optimizing treatment plans for PT using a scanned beam is a time consuming problem especially for particles other than protons where the biological effective dose has to be calculated. For the purpose of TRP, fast optimization and fast dose calculation have been implemented into the GSI in-house treatment planning system (TPS) TRiP98. Methods: This work reports about the outcome of a code analysis that resulted in optimization of the calculation processes as well as implementation of routines supporting parallel execution of the code. To benchmark the new features, the calculation time for therapy treatment planning has been studied. Results: Compared to the original version of the TPS, calculation times for treatment planning (optimization and dose calculation) have been improved by a factor of 10 with code optimization. The parallelization of the TPS resulted in a speedup factor of 12 and 5.5 for the original version and the code optimized version, respectively. Hence the total speedup of the new implementation of the authors' TPS yielded speedup factors up to 55. Conclusions: The improved TPS is capable of completing treatment planning for ion beam therapy of a prostate irradiation considering organs at risk in this has been overseen in the review process. Also see below 6 min

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)

Determination of beam intensity in a single step for IMRT inverse planning

International Nuclear Information System (INIS)

Chuang, Keh-Shih; Chen, Tzong-Jer; Kuo, Shan-Chi; Jan, Meei-Ling; Hwang, Ing-Ming; Chen, Sharon; Lin, Ying-Chuan; Wu, Jay

2003-01-01

In intensity modulated radiotherapy (IMRT), targets are treated by multiple beams at different orientations each with spatially-modulated beam intensities. This approach spreads the normal tissue dose to a greater volume and produces a higher dose conformation to the target. In general, inverse planning is used for IMRT treatment planning. The inverse planning requires iterative calculation of dose distribution in order to optimize the intensity profile for each beam and is very computation intensive. In this paper, we propose a single-step method utilizing a figure of merit (FoM) to estimate the beam intensities for IMRT treatment planning. The FoM of a ray is defined as the ratio between the delivered tumour dose and normal tissue dose and is a good index for the dose efficacy of the ray. To maximize the beam utility, it is natural to irradiate the tumour with intensity of each ray proportional to the value of the FoM. The nonuniform beam intensity profiles are then fixed and the weights of the beam are determined iteratively in order to yield a uniform tumour dose. In this study, beams are employed at equispaced angles around the patient. Each beam with its field size that just covers the tumour is divided into a fixed number of beamlets. The FoM is calculated for each beamlet and this value is assigned to be the beam intensity. Various weighting factors are incorporated in the FoM computation to accommodate different clinical considerations. Two clinical datasets are used to test the feasibility of the algorithm. The resultant dose-volume histograms of this method are presented and compared to that of conformal therapy. Preliminary results indicate that this method reduces the critical organ doses at a small expense of uniformity in tumour dose distribution. This method estimates the beam intensity in one single step and the computation time is extremely fast and can be finished in less than one minute using a regular PC

IMRT QA: Selecting gamma criteria based on error detection sensitivity

Energy Technology Data Exchange (ETDEWEB)

Steers, Jennifer M. [Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California 90048 and Physics and Biology in Medicine IDP, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095 (United States); Fraass, Benedick A., E-mail: benedick.fraass@cshs.org [Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California 90048 (United States)

2016-04-15

Purpose: The gamma comparison is widely used to evaluate the agreement between measurements and treatment planning system calculations in patient-specific intensity modulated radiation therapy (IMRT) quality assurance (QA). However, recent publications have raised concerns about the lack of sensitivity when employing commonly used gamma criteria. Understanding the actual sensitivity of a wide range of different gamma criteria may allow the definition of more meaningful gamma criteria and tolerance limits in IMRT QA. We present a method that allows the quantitative determination of gamma criteria sensitivity to induced errors which can be applied to any unique combination of device, delivery technique, and software utilized in a specific clinic. Methods: A total of 21 DMLC IMRT QA measurements (ArcCHECK®, Sun Nuclear) were compared to QA plan calculations with induced errors. Three scenarios were studied: MU errors, multi-leaf collimator (MLC) errors, and the sensitivity of the gamma comparison to changes in penumbra width. Gamma comparisons were performed between measurements and error-induced calculations using a wide range of gamma criteria, resulting in a total of over 20 000 gamma comparisons. Gamma passing rates for each error class and case were graphed against error magnitude to create error curves in order to represent the range of missed errors in routine IMRT QA using 36 different gamma criteria. Results: This study demonstrates that systematic errors and case-specific errors can be detected by the error curve analysis. Depending on the location of the error curve peak (e.g., not centered about zero), 3%/3 mm threshold = 10% at 90% pixels passing may miss errors as large as 15% MU errors and ±1 cm random MLC errors for some cases. As the dose threshold parameter was increased for a given %Diff/distance-to-agreement (DTA) setting, error sensitivity was increased by up to a factor of two for select cases. This increased sensitivity with increasing dose

Implementation of a free software for quality control of IMRT

International Nuclear Information System (INIS)

Chinillace, N.; Alonso, S.; Cortina, T.; Reinado, D.; Ricos, B.; Diaz, S.; Campayo, J. M.

2011-01-01

In this paper we focus on implementation and launch of software that allows us to compare quantitatively the two-dimensional dose distributions calculated and measured experimentally in IMRT treatment. The tool we are using to make this comparison is the free software DoseLab. This is a program written in MatLab and open source, thereby allowing in some cases adapt the program to the needs of each user. This program will be able to calculate the gamma function of these distributions, a parameter that simultaneously evaluates the difference in dose between two pixels of the image and the distance between them, giving us an objective and quantitative, allowing us to decide if both distributions are compatible or not.

IMRT and 3D conformal radiotherapy with or without elective nodal irradiation in locally advanced NSCLC: A direct comparison of PET-based treatment planning.

Science.gov (United States)

Fleckenstein, Jochen; Kremp, Katharina; Kremp, Stephanie; Palm, Jan; Rübe, Christian

2016-02-01

The potential of intensity-modulated radiation therapy (IMRT) as opposed to three-dimensional conformal radiotherapy (3D-CRT) is analyzed for two different concepts of fluorodeoxyglucose positron emission tomography (FDG PET)-based target volume delineation in locally advanced non-small cell lung cancer (LA-NSCLC): involved-field radiotherapy (IF-RT) vs. elective nodal irradiation (ENI). Treatment planning was performed for 41 patients with LA-NSCLC, using four different planning approaches (3D-CRT-IF, 3D-CRT-ENI, IMRT-IF, IMRT-ENI). ENI included a boost irradiation after 50 Gy. For each plan, maximum dose escalation was calculated based on prespecified normal tissue constraints. The maximum prescription dose (PD), tumor control probability (TCP), conformal indices (CI), and normal tissue complication probabilities (NTCP) were analyzed. IMRT resulted in statistically significant higher prescription doses for both target volume concepts as compared with 3D-CRT (ENI: 68.4 vs. 60.9 Gy, p ENI, there was a considerable theoretical increase in TCP (IMRT: 27.3 vs. 17.7 %, p ENI: 12.3 vs. 30.9 % p < 0.0001; IF: 15.9 vs. 24.1 %; p < 0.001). The IMRT technique and IF target volume delineation allow a significant dose escalation and an increase in TCP. IMRT results in an improved sparing of OARs as compared with 3D-CRT at equivalent dose levels.

MO-FG-202-09: Virtual IMRT QA Using Machine Learning: A Multi-Institutional Validation

International Nuclear Information System (INIS)

Valdes, G; Scheuermann, R; Solberg, T; Chan, M; Deasy, J

2016-01-01

Purpose: To validate a machine learning approach to Virtual IMRT QA for accurately predicting gamma passing rates using different QA devices at different institutions. Methods: A Virtual IMRT QA was constructed using a machine learning algorithm based on 416 IMRT plans, in which QA measurements were performed using diode-array detectors and a 3%local/3mm with 10% threshold. An independent set of 139 IMRT measurements from a different institution, with QA data based on portal dosimetry using the same gamma index and 10% threshold, was used to further test the algorithm. Plans were characterized by 90 different complexity metrics. A weighted poison regression with Lasso regularization was trained to predict passing rates using the complexity metrics as input. Results: In addition to predicting passing rates with 3% accuracy for all composite plans using diode-array detectors, passing rates for portal dosimetry on per-beam basis were predicted with an error <3.5% for 120 IMRT measurements. The remaining measurements (19) had large areas of low CU, where portal dosimetry has larger disagreement with the calculated dose and, as such, large errors were expected. These beams need to be further modeled to correct the under-response in low dose regions. Important features selected by Lasso to predict gamma passing rates were: complete irradiated area outline (CIAO) area, jaw position, fraction of MLC leafs with gaps smaller than 20 mm or 5mm, fraction of area receiving less than 50% of the total CU, fraction of the area receiving dose from penumbra, weighted Average Irregularity Factor, duty cycle among others. Conclusion: We have demonstrated that the Virtual IMRT QA can predict passing rates using different QA devices and across multiple institutions. Prediction of QA passing rates could have profound implications on the current IMRT process.

MO-FG-202-09: Virtual IMRT QA Using Machine Learning: A Multi-Institutional Validation

Energy Technology Data Exchange (ETDEWEB)

Valdes, G; Scheuermann, R; Solberg, T [University of Pennsylvania, Philadelphia, PA (United States); Chan, M; Deasy, J [Memorial Sloan-Kettering Cancer Center, New York, NY (United States)

2016-06-15

Purpose: To validate a machine learning approach to Virtual IMRT QA for accurately predicting gamma passing rates using different QA devices at different institutions. Methods: A Virtual IMRT QA was constructed using a machine learning algorithm based on 416 IMRT plans, in which QA measurements were performed using diode-array detectors and a 3%local/3mm with 10% threshold. An independent set of 139 IMRT measurements from a different institution, with QA data based on portal dosimetry using the same gamma index and 10% threshold, was used to further test the algorithm. Plans were characterized by 90 different complexity metrics. A weighted poison regression with Lasso regularization was trained to predict passing rates using the complexity metrics as input. Results: In addition to predicting passing rates with 3% accuracy for all composite plans using diode-array detectors, passing rates for portal dosimetry on per-beam basis were predicted with an error <3.5% for 120 IMRT measurements. The remaining measurements (19) had large areas of low CU, where portal dosimetry has larger disagreement with the calculated dose and, as such, large errors were expected. These beams need to be further modeled to correct the under-response in low dose regions. Important features selected by Lasso to predict gamma passing rates were: complete irradiated area outline (CIAO) area, jaw position, fraction of MLC leafs with gaps smaller than 20 mm or 5mm, fraction of area receiving less than 50% of the total CU, fraction of the area receiving dose from penumbra, weighted Average Irregularity Factor, duty cycle among others. Conclusion: We have demonstrated that the Virtual IMRT QA can predict passing rates using different QA devices and across multiple institutions. Prediction of QA passing rates could have profound implications on the current IMRT process.

Parotid-sparing intensity-modulated radiotherapy (IMRT) for nasopharyngeal carcinoma: Preserved parotid function after IMRT on quantitative salivary scintigraphy, and comparison with historical data after conventional radiotherapy

International Nuclear Information System (INIS)

Hsiung, C.-Y.; Ting, H.-M.; Huang, H.-Y.; Lee, C.-H.; Huang, E.-Y.; Hsu, H.-C.

2006-01-01

Purpose: To evaluate the parotid function after parotid-sparing intensity-modulated radiotherapy (IMRT) in patients with nasopharyngeal carcinoma (NPC). Methods and Materials: From March 2003 to May 2004, 16 patients with nonmetastatic NPC underwent parotid-sparing IMRT. Eight of these patients had Stage III or IV NPC based on the 1997 American Joint Committee on Cancer staging system. The post-IMRT parotid function was evaluated by quantitative salivary scintigraphy and represented by the maximal excretion ratio (MER) of the parotid gland after sialogogue stimulation. The parotid function of 16 NPC patients who were previously treated with conventional radiotherapy was reviewed as the historical control. Results: In the parotid-sparing IMRT group, all 16 patients were alive and without cancer at the end of follow-up period (median, 24.2 months). The mean parotid MER was 53.5% before radiotherapy, 10.7% at 1 month post-IMRT, and 23.3% at 9 months post-IMRT. In the conventional radiotherapy group, the mean parotid MER was 0.6% at 6 to 12 months postradiotherapy. The difference was statistically significant (23.3% vs. 0.6%, p < 0.001, Mann-Whitney test). In the IMRT group, the mean parotid doses ranged from 33.2 Gy to 58.8 Gy (average, 43.9 Gy). The correlation between the mean parotid dose and the percentage decrease of parotid MER at 9 months post-IMRT (dMER) was statically significant (p = 0.008, Pearson correlation). Conclusions: Although the mean parotid doses are relatively high, the significant preservation of parotid function is achieved with IMRT for NPC patients. The significant correlation between mean parotid dose and parotid dMER demonstrates the dose-function relationship of the parotid gland

Implementation of a free software for quality control of IMRT; Puesta en marcha de un soltware de libre distribucion para el control de calidad IMRT

Energy Technology Data Exchange (ETDEWEB)

Chinillace, N.; Alonso, S.; Cortina, T.; Reinado, D.; Ricos, B.; Diaz, S.; Campayo, J. M.

2011-07-01

In this paper we focus on implementation and launch of software that allows us to compare quantitatively the two-dimensional dose distributions calculated and measured experimentally in IMRT treatment. The tool we are using to make this comparison is the free software DoseLab. This is a program written in MatLab and open source, thereby allowing in some cases adapt the program to the needs of each user. This program will be able to calculate the gamma function of these distributions, a parameter that simultaneously evaluates the difference in dose between two pixels of the image and the distance between them, giving us an objective and quantitative, allowing us to decide if both distributions are compatible or not.

IMRT limits nephrotoxicity after chemoradiotherapy for gastric cancer.

Science.gov (United States)

Trip, Anouk Kirsten; Nijkamp, Jasper; van Tinteren, Harm; Cats, Annemieke; Boot, Henk; Jansen, Edwin Petrus Marianus; Verheij, Marcel

2014-08-01

This observational study compares the effect of different radiotherapy techniques on late nephrotoxicity after postoperative chemoradiotherapy for gastric cancer. Dosimetric parameters were compared between AP-PA, 3D-conformal and IMRT techniques. Renal function was measured by (99m)Tc-MAG-3 renography, glomerular filtration rate (GFR) and the development of hypertension. Mixed effects models were used to compare renal function over time. Eighty-seven patients treated between 2002 and 2010 were included, AP-PA (n=31), 3D-conformal (n=25) and IMRT (n=31), all 45 Gy in 25 fractions. Concurrent chemotherapy: 5FU/leucovorin (n=4), capecitabine (n=37), and capecitabine/cisplatin (n=46). Median follow-up time was 4.7 years (range 0.2-8). With IMRT, the mean dose to the left kidney was significantly lower. Left kidney function decreased progressively in the total study population, however with IMRT this occurred at a lower rate. A dose-effect relationship was present between mean dose to the left kidney and the left kidney function. GFR decreased only moderately in time, which was not different between techniques. Six patients developed hypertension, of whom none in the IMRT group. This study confirms progressive late nephrotoxicity in patients treated with postoperative chemoradiotherapy by different techniques for gastric cancer. Nephrotoxicity was less severe with IMRT and should be considered the preferred technique. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Matching tomographic IMRT fields with static photon fields

International Nuclear Information System (INIS)

Sethi, A.; Leybovich, L.; Dogan, N.; Emami, B.

2001-01-01

The matching of abutting radiation fields presents a challenging problem in radiation therapy. Due to sharp penumbra of linear accelerator beams, small (1-2 mm) errors in field positioning can lead to large (>30%) hot or cold spots in the abutment region. With head and neck immobilization devices (thermoplastic mask/aquaplast) an average setup error of 3 mm has been reported. Therefore hot or cold spots approaching 50% of the prescription dose may occur along the matchline. Although abutting radiation fields have been investigated for static fields, there is no reported study regarding matching of tomographic IMRT and static fields. Compared to static fields, the matching of tomographic IMRT fields with static fields is more complicated. Since IMRT and static fields are planned on separate treatment planning computers, the dose in the abutment region is not specified. In addition, commonly used techniques for matching fields, such as feathering of junctions, are not practical. We have developed a method that substantially reduces dose inhomogeneity in the abutment region. In this method, a 'buffer zone' around the matchline was created and was included as part of the target for both IMRT and static field plans. In both fields, a small dose gradient (≤3%/mm) in the buffer zone was created. In the IMRT plan, the buffer zone was divided into three sections with dose varying from 83% to 25% of prescription dose. The static field dose profile was modified using either a specially designed physical (hard) or a dynamic (soft) wedge. When these modified fields were matched, the combined dose in the abutment region varied by ≤10% in the presence of setup errors spanning 4 mm (±2 mm) when the hard wedge was used and 10 mm (±5 mm) with the soft wedge

Direct aperture optimization of breast IMRT and the dosimetric impact of respiration motion

International Nuclear Information System (INIS)

Zhang Guowei; Jiang Ziping; Shepard, David; Zhang Bin; Yu, Cedric

2006-01-01

We have studied the application of direct aperture optimization (DAO) as an inverse planning tool for breast IMRT. Additionally, we have analysed the impact of respiratory motion on the quality of the delivered dose distribution. From this analysis, we have developed guidelines for balancing the desire for a high-quality optimized plan with the need to create a plan that will not degrade significantly in the presence of respiratory motion. For a DAO optimized breast IMRT plan, the tangential fields incorporate a flash field to cover the range of respiratory motion. The inverse planning algorithm then optimizes the shapes and weights of additional segments that are delivered in combination with the open fields. IMRT plans were generated using DAO with the relative weights of the open segments varied from 0% to 95%. To assess the impact of breathing motion, the dose distribution for the optimized IMRT plan was recalculated with the isocentre sampled from a predefined distribution in a Monte Carlo convolution/superposition dose engine with the breast simulated as a rigid object. The motion amplitudes applied in this study ranged from 0.5 to 2.0 cm. For a range of weighting levels assigned to the open field, comparisons were made between the static plans and the plans recalculated with motion. For the static plans, we found that uniform dose distributions could be generated with relative weights for the open segments equal to and below 80% and unacceptable levels of underdosage were observed with the weights larger than 80%. When simulated breathing motion was incorporated into the dose calculation, we observed a loss in dose uniformity as the weight of the open field was decreased to below 65%. More quantitatively, for each 1% decrease in the weight, the per cent volume of the target covered by at least 95% of the prescribed dose decreased by approximately 0.10% and 0.16% for motion amplitudes equal to 1.5 cm and 2.0 cm, respectively. When taking into account the

IMRT fluence map editing to control hot and cold spots

International Nuclear Information System (INIS)

Taylor Cook, J.; Tobler, Matt; Leavitt, Dennis D.; Watson, Gordon

2005-01-01

Manually editing intensity-modulated radiation therapy (IMRT) fluence maps effectively controls hot and cold spots that the IMRT optimization cannot control. Many times, re-optimizing does not reduce the hot spots or increase the cold spots. In fact, re-optimizing only places the hot and cold spots in different locations. Fluence-map editing provides manual control of dose delivery and provides the best treatment plan possible. Several IMRT treatments were planned using the Varian Eclipse planning system. We compare the effects on dose distributions between fluence-map editing and re-optimization, discuss techniques for fluence-map editing, and analyze differences between fluence editing on one beam vs. multiple beams. When editing a beam's fluence map, it is essential to choose a beam that least affects dose to the tumor and critical structures. Editing fluence maps gives an advantage in treatment planning and provides controlled delivery of IMRT dose

Planning issues for IMRT

International Nuclear Information System (INIS)

Hoban, P.; Schneider, M.; Smee, R.

2001-01-01

Full text: Despite the 'inverse planning' stage of an intensity modulated radiotherapy (IMRT) treatment there remains a large number of variables that can, and must, be set manually. These variables can significantly affect the quality of the dose distribution arrived at by the optimisation. Clinical IMRT planning with the Radionics XPlan system for micro-multileaf collimator (MMLC) delivery has allowed for important lessons to be learned regarding the best beam and organ configurations prior to optimisation of beamlet weights. Important user-definable variables are beam directions, organ parameters (dose goals/penalties), and the margin (if any) around the planning target volume (PTV) used to aid coverage. Conventional stereotactic radiotherapy (SRT) treatments typically involve non-coplanar beams since there is often an advantage in terms of cranial organ at risk (OAR) sparing. IMRT can also benefit from such a configuration. The balance between target coverage and OAR sparing is largely controlled by user-defined goal doses and penalties. Once optimisation has been performed, intensity maps can be discretised into a selected number of levels. Less levels means less field segments and thus a shorter treatment time. Although IMRT beams attempt to spare structures which are in the 'beam's eye view' (BEV) of the target volume, sparing is greater if beams which minimise the involvement of OARs in their view are used. It has been found that the use of a margin is an effective way to ensure adequate PTV coverage. Alternatively the PTV penalties can be made larger. The best result is often obtained by the use of a 3-4 mm margin, whose penalty for underdosage is somewhat less than that for the PTV. Discretising the intensity maps to 4 or 5 levels is typically a good balance between shortening treatment time and not overly degrading the dose distribution. Beam configuration is still an important step in IMRT planning, even though optimisation of intensity maps is

Radiotherapy through intensity modulation (IMRT). A new modality in the treatment of head and neck cancer

International Nuclear Information System (INIS)

Besa de C, Pelayo; Venencia M, Daniel

2006-01-01

Objective: To describe the treatment and evaluate the advantages of IMRT in the treatment of head and neck cancer. Material and methods: Four years ago, at the Cancer Center of the Pontificia Universidad Catolica, the IMRT technique for the treatment of head and neck tumors was implemented. The IMRT technique is based on modifying the intensity of the radiation beam through a multisheet collimator in order to produce a more exact distribution in the radiation doses. The results are evaluated with dose/ volume histograms. The distributions of doses and toxicity for tridimensional con formed therapy (CRT-3D) and IMRT are compared. Results: The distribution of the dose in the dose/volume histograms showed a better coverage of the white volume (PTV), with IMRT. The doses received by the organs under risk: salivary glands, eyes, ears and brain diminish with IMRT. The spinal marrow is protected with IMRT without dividing the treatment area, preventing points with lower dosage that could reduce control of the tumor. Conclusions: IMRT achieves a better conformation of the dose obtaining a better coverage of the tumor and higher protection of the organs under risk

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

Consequences of leaf calibration errors on IMRT delivery

International Nuclear Information System (INIS)

Sastre-Padro, M; Welleweerd, J; Malinen, E; Eilertsen, K; Olsen, D R; Heide, U A van der

2007-01-01

IMRT treatments using multi-leaf collimators may involve a large number of segments in order to spare the organs at risk. When a large proportion of these segments are small, leaf positioning errors may become relevant and have therapeutic consequences. The performance of four head and neck IMRT treatments under eight different cases of leaf positioning errors has been studied. Systematic leaf pair offset errors in the range of ±2.0 mm were introduced, thus modifying the segment sizes of the original IMRT plans. Thirty-six films were irradiated with the original and modified segments. The dose difference and the gamma index (with 2%/2 mm criteria) were used for evaluating the discrepancies between the irradiated films. The median dose differences were linearly related to the simulated leaf pair errors. In the worst case, a 2.0 mm error generated a median dose difference of 1.5%. Following the gamma analysis, two out of the 32 modified plans were not acceptable. In conclusion, small systematic leaf bank positioning errors have a measurable impact on the delivered dose and may have consequences for the therapeutic outcome of IMRT

The financial impact of the incorporation of IMRT and RapidArc™ techniques on shielding calculation of a linear accelerator

International Nuclear Information System (INIS)

Santos, Maira R.; Silveira, Thiago B.; Garcia, Paulo L.; Trindade, Cassia; Martins, Lais P.; Batista, Delano V.S.

2013-01-01

Given the new methodology introduced in the shielding calculation due to recent modulated techniques in radiotherapy treatment, it became necessary to evaluate the impact of changes in the accelerator routine using such techniques. Based on a group of 30 patients from the National Cancer Institute (INCA) the workload multiplier factors for intensity modulated radiotherapy (IMRT factor) and for RapidArc™ (RA factor) were established. Four different routines in a 6 MV generic accelerator were proposed to estimate the impact of these modified workloads in the building cost of the secondary barriers. The results indicate that if 50% of patients are treating with IMRT, the secondary barrier becomes 14,1% more expensive than the barrier calculated for conformal treatments exclusive. While RA, in the same proportion, leads to a barrier only 3,7% more expensive. Showing that RA can, while reducing treatment time, increase the proportion of patients treated with modulation technique, without increasing the cost of the barrier, when compared with IMRT. (author)

The Quality Control of Intensity Modulated Radiation Therapy (IMRT for ONCOR Siemens Linear Accelerators Using Film Dosimetry

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Keyvan Jabbari

2012-03-01

Full Text Available Introduction Intensity Modulated Radiation Therapy (IMRT has made a significant progress in radiation therapy centers in recent years. In this method, each radiation beam is divided into many subfields that create a field with a modulated intensity. Considering the complexity of this method, the quality control for IMRT is a topic of interest for researchers. This article is about the various steps of planning and quality control of Siemens linear accelerators for IMRT, using film dosimetry. This article in addition to review of the techniques, discusses the details of experiments and possible sources of errors which are not mentioned in the protocols and other references. Materials and Methods This project was carried out in Isfahan Milad hospital which has two Siemens ONCOR linear accelerators. Both accelerators are equipped with Multi-Leaf Collimators (MLC which enables us to perform IMRT delivery in the step-and-shoot method. The quality control consists of various experiments related to the sections of radiation therapy. In these experiments, the accuracy of some components such as treatment planning system, imaging device (CT, MLC, control system of accelerator, and stability of the output are evaluated. The dose verification is performed using film dosimetry method. The films were KODAK-EDR2, which were calibrated before the experiments. One of the important steps is the comparison of the calculated dose with planning system and the measured dose in experiments. Results The results of the experiments in various steps have been acceptable according to the standard protocols. The calibration of MLC and evaluation of the leakage through the leaves of MLC was performed by using the film dosimetry and visual check. In comparison with calculated and measured dose, more that 80% of the points have to be in agreement within 3% of the value. In our experiments, between 85 and 90% of the points had such an agreement with IMRT delivery. Conclusion

Evaluation of secondary dose and cancer risk for out-of-field organ in esophageal cancer IMRT in a chinese hospital using atom phantom measurements

International Nuclear Information System (INIS)

Qi, Yaping; He, Lijuan; Liu, Yuanyuan; Liu, Hongdong; Huo, Wanli; Chen, Zhi; Wang, Zhi; Xu, X. George

2017-01-01

There have been few studies on the secondary cancer after radiation treatment in Chinese hospitals. This study has measured out-of-field absorbed organ doses from intensity-modulated radiation therapy (IMRT) radiotherapy for esophageal cancer in a Chinese hospital and evaluated the risks of secondary cancer. The dose measurements were based on the thermoluminescence dosemeter (TLD) and the ATOM phantom, which represents an adult male. Over 100 TLD chips were placed in 35 different organ sites and one group of the same TLDs was set as background contrast. All TLDs were calibrated against the same Linac accelerator performing an IMRT plan for esophageal cancer. The measured doses were used to calculate the secondary cancer risks according to biological effects of ionizing radiation (BEIR) VII methodology. The baseline risks and survival data were based on relevant statistics for the Chinese population. It is found that the out-of-field organ doses depended greatly on the distance between organ sites and the target isocenter. The organ doses decreased exponentially as the distance from the target isocenter increased, and, for distances <15 cm, the organ doses fell off more rapidly and almost decreased by 99.55%. When compared with the calculation results by the Pinnacle treatment planning system (TPS), most of the out-of-field organ doses were underestimated in the TPS and the percentage of underestimation reached 100% for distant organs such as the bladder, prostate and testis. These trends are due to a known fact that out-of-field organs received secondary radiation resulted from patients and collimator scattering as well as leakage in the gantry head. The higher lifetime attribute risks (LARs) per 100 000 population were in the lower esophagus (186) and lungs (93.2) near the target. But all LARs of considered organs were found to be less than the baseline cancer risks. Results in this article can help to provide a database about the effect of radiotherapy

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

Dose verification in HDR brachytherapy and IMRT with Fricke gel-layer dosimeters

International Nuclear Information System (INIS)

Gambarini, G.; Negri, A.; Bartesaghi, G.; Pirola, L.; Carrara, M.; Gambini, I.; Tomatis, S.; Fallai, C.; Zonca, G.; Stokucova, J.

2009-10-01

At the Department of Physics of the Universita degli Studi di Milano in collaboration with the Medical Physics Unit and the Radiotherapy Unit of the Fondazione IRCCS Istituto Nazionale dei Tumori di Milano the research of a dosimetric technique based on Fricke gel layers and optical analysis in under study. In fact, Fricke gel layer dosimeters (FGLD) have various advantages such as the tissue-equivalence for photons in the clinical energy interval, the possibility to obtain the spatial information about continuous dose distribution and not only a point dose distribution as it is for example in the case of ionization chambers, TLD or diodes and the possibility to obtain the information about 3D dose distributions. In this work, specific applications of FGLD to absolute dosimetry in radiotherapy have been studied, i.e. in-phantom measurements of complex intensity modulated radiation therapy fields (IMRT) and complex brachytherapy fields. (Author)

In Vivo Diode Dosimetry for Imrt Treatments Generated by Pinnacle Treatment Planning System

International Nuclear Information System (INIS)

Alaei, Parham; Higgins, Patrick D.; Gerbi, Bruce J.

2009-01-01

Dose verification using diodes has been proposed and used for intensity modulated radiation therapy (IMRT) treatments. We have previously evaluated diode response for IMRT deliveries planned with the Eclipse/Helios treatment planning system. The Pinnacle treatment planning system generates plans that are delivered in a different fashion than Eclipse. Whereas the Eclipse-generated segments are delivered in organized progression from one side of each field to the other, Pinnacle-generated segments are delivered in a much more randomized fashion to different areas within the field. This makes diode measurements at a point more challenging because the diode may be exposed fully or partially to multiple small segments during one single field's treatment as opposed to being exposed to very few segments scanning across the diode during an Eclipse-generated delivery. We have evaluated in vivo dosimetry for Pinnacle-generated IMRT plans and characterized the response of the diode to various size segments on phantom. We present results of patient measurements on approximately 300 fields, which show that 76% of measurements agree to within 10% of the treatment-plan generated calculated doses. Of the other 24%, about 11% are within 15% of the calculated dose. Comparison of these with phantom measurements indicates that many of the discrepancies are due to diode positioning on patients and increased diode response at short source-to-surface distances (SSDs), with the remainder attributable to other factors such as segment size and partial irradiation of the diode

Iterative metal artifact reduction improves dose calculation accuracy. Phantom study with dental implants

Energy Technology Data Exchange (ETDEWEB)

Maerz, Manuel; Mittermair, Pia; Koelbl, Oliver; Dobler, Barbara [Regensburg University Medical Center, Department of Radiotherapy, Regensburg (Germany); Krauss, Andreas [Siemens Healthcare GmbH, Forchheim (Germany)

2016-06-15

Metallic dental implants cause severe streaking artifacts in computed tomography (CT) data, which affect the accuracy of dose calculations in radiation therapy. The aim of this study was to investigate the benefit of the metal artifact reduction algorithm iterative metal artifact reduction (iMAR) in terms of correct representation of Hounsfield units (HU) and dose calculation accuracy. Heterogeneous phantoms consisting of different types of tissue equivalent material surrounding metallic dental implants were designed. Artifact-containing CT data of the phantoms were corrected using iMAR. Corrected and uncorrected CT data were compared to synthetic CT data to evaluate accuracy of HU reproduction. Intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans were calculated in Oncentra v4.3 on corrected and uncorrected CT data and compared to Gafchromic trademark EBT3 films to assess accuracy of dose calculation. The use of iMAR increased the accuracy of HU reproduction. The average deviation of HU decreased from 1006 HU to 408 HU in areas including metal and from 283 HU to 33 HU in tissue areas excluding metal. Dose calculation accuracy could be significantly improved for all phantoms and plans: The mean passing rate for gamma evaluation with 3 % dose tolerance and 3 mm distance to agreement increased from 90.6 % to 96.2 % if artifacts were corrected by iMAR. The application of iMAR allows metal artifacts to be removed to a great extent which leads to a significant increase in dose calculation accuracy. (orig.) [German] Metallische Implantate verursachen streifenfoermige Artefakte in CT-Bildern, welche die Dosisberechnung beeinflussen. In dieser Studie soll der Nutzen des iterativen Metall-Artefakt-Reduktions-Algorithmus iMAR hinsichtlich der Wiedergabetreue von Hounsfield-Werten (HU) und der Genauigkeit von Dosisberechnungen untersucht werden. Es wurden heterogene Phantome aus verschiedenen Arten gewebeaequivalenten Materials mit

Genital marginal failures after intensity-modulated radiation therapy (IMRT) in squamous cell anal cancer: no higher risk with IMRT when compared to 3DCRT.

Science.gov (United States)

Dell'Acqua, V; Kobiela, J; Kraja, F; Leonardi, M C; Surgo, A; Zerella, M A; Arculeo, S; Fodor, C; Ricotti, R; Zampino, M G; Ravenda, S; Spinoglio, G; Biffi, R; Bazani, A; Luraschi, R; Vigorito, S; Spychalski, P; Orecchia, R; Glynne-Jones, R; Jereczek-Fossa, B A

2018-03-28

Intensity-modulated radiotherapy (IMRT) is considered the preferred option in squamous cell canal cancer (SCAC), delivering high doses to tumor volumes while minimizing dose to surrounding normal tissues. IMRT has steep dose gradients, but the technique is more demanding as deep understanding of target structures is required. To evaluate genital marginal failure in a cohort of patients with non-metastatic SCAC treated either with IMRT or 3DCRT and concurrent chemotherapy, 117 patients with SCAC were evaluated: 64 and 53 patients were treated with IMRT and 3DCRT techniques, respectively. All patients underwent clinical and radiological examination during their follow-up. Tumor response was evaluated with response evaluation criteria in solid tumors v1.1 guideline on regular basis. All patients' data were analyzed, and patients with marginal failure were identified. Concomitant chemotherapy was administered in 97 and 77.4% of patients in the IMRT and 3DCRT groups, respectively. In the IMRT group, the median follow-up was 25 months (range 6-78). Progressive disease was registered in 15.6% of patients; infield recurrence, distant recurrence and both infield recurrence and distant recurrence were identified in 5, 4 and 1 patient, respectively. Two out of 64 patients (3.1%) had marginal failures, localized at vagina/recto-vaginal septum and left perineal region. In the 3DCRT group, the median follow-up was 71.3 months (range 6-194 months). Two out of 53 patients (3.8%) had marginal failures, localized at recto-vaginal septum and perigenital structures. The rate of marginal failures was comparable in IMRT and 3DCRT groups (χ 2 test p = 0.85). In this series, the use of IMRT for the treatment of SCAC did not increase the rate of marginal failures offering improved dose conformity to the target. Dose constraints should be applied with caution-particularly in females with involvement of the vagina or the vaginal septum.

Intensity-Modulated Radiotherapy for Locally Advanced Non-Small-Cell Lung Cancer: A Dose-Escalation Planning Study

International Nuclear Information System (INIS)

Lievens, Yolande; Nulens, An; Gaber, Mousa Amr; Defraene, Gilles; De Wever, Walter; Stroobants, Sigrid; Van den Heuvel, Frank

2011-01-01

Purpose: To evaluate the potential for dose escalation with intensity-modulated radiotherapy (IMRT) in positron emission tomography-based radiotherapy planning for locally advanced non-small-cell lung cancer (LA-NSCLC). Methods and Materials: For 35 LA-NSCLC patients, three-dimensional conformal radiotherapy and IMRT plans were made to a prescription dose (PD) of 66 Gy in 2-Gy fractions. Dose escalation was performed toward the maximal PD using secondary endpoint constraints for the lung, spinal cord, and heart, with de-escalation according to defined esophageal tolerance. Dose calculation was performed using the Eclipse pencil beam algorithm, and all plans were recalculated using a collapsed cone algorithm. The normal tissue complication probabilities were calculated for the lung (Grade 2 pneumonitis) and esophagus (acute toxicity, grade 2 or greater, and late toxicity). Results: IMRT resulted in statistically significant decreases in the mean lung (p <.0001) and maximal spinal cord (p = .002 and 0005) doses, allowing an average increase in the PD of 8.6-14.2 Gy (p ≤.0001). This advantage was lost after de-escalation within the defined esophageal dose limits. The lung normal tissue complication probabilities were significantly lower for IMRT (p <.0001), even after dose escalation. For esophageal toxicity, IMRT significantly decreased the acute NTCP values at the low dose levels (p = .0009 and p <.0001). After maximal dose escalation, late esophageal tolerance became critical (p <.0001), especially when using IMRT, owing to the parallel increases in the esophageal dose and PD. Conclusion: In LA-NSCLC, IMRT offers the potential to significantly escalate the PD, dependent on the lung and spinal cord tolerance. However, parallel increases in the esophageal dose abolished the advantage, even when using collapsed cone algorithms. This is important to consider in the context of concomitant chemoradiotherapy schedules using IMRT.

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

International Nuclear Information System (INIS)

Kendall, E; Ahmad, S; Algan, O; Higby, C; Hossain, S

2016-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

Kendall, E; Ahmad, S; Algan, O; Higby, C; Hossain, S [University of Oklahoma Health Sciences Center, Oklahoma City, OK (United States)

2016-06-15

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

Poster - 53: Improving inter-linac DMLC IMRT dose precision by fine tuning of MLC leaf calibration

International Nuclear Information System (INIS)

Nakonechny, Keith; Tran, Muoi; Sasaki, David; Beck, James; Poirier, Yannick; Malkoske, Kyle

2016-01-01

Purpose: To develop a method to improve the inter-linac precision of DMLC IMRT dosimetry. Methods: The distance between opposing MLC leaf banks (“gap size”) can be finely tuned on Varian linacs. The dosimetric effect due to small deviations from the nominal gap size (“gap error”) was studied by introducing known errors for several DMLC sliding gap sizes, and for clinical plans based on the TG119 test cases. The plans were delivered on a single Varian linac and the relationship between gap error and the corresponding change in dose was measured. The plans were also delivered on eight Varian 2100 series linacs (at two institutions) in order to quantify the inter-linac variation in dose before and after fine tuning the MLC calibration. Results: The measured dose differences for each field agreed well with the predictions of LoSasso et al. Using the default MLC calibration, the variation in the physical MLC gap size was determined to be less than 0.4 mm between all linacs studied. The dose difference between the linacs with the largest and smallest physical gap was up to 5.4% (spinal cord region of the head and neck TG119 test case). This difference was reduced to 2.5% after fine tuning the MLC gap calibration. Conclusions: The inter-linac dose precision for DMLC IMRT on Varian linacs can be improved using a simple modification of the MLC calibration procedure that involves fine adjustment of the nominal gap size.

Poster - 53: Improving inter-linac DMLC IMRT dose precision by fine tuning of MLC leaf calibration

Energy Technology Data Exchange (ETDEWEB)

Nakonechny, Keith; Tran, Muoi; Sasaki, David; Beck, James; Poirier, Yannick; Malkoske, Kyle [Simcoe-Muskoka Regional Cancer Centre (Canada)

2016-08-15

Purpose: To develop a method to improve the inter-linac precision of DMLC IMRT dosimetry. Methods: The distance between opposing MLC leaf banks (“gap size”) can be finely tuned on Varian linacs. The dosimetric effect due to small deviations from the nominal gap size (“gap error”) was studied by introducing known errors for several DMLC sliding gap sizes, and for clinical plans based on the TG119 test cases. The plans were delivered on a single Varian linac and the relationship between gap error and the corresponding change in dose was measured. The plans were also delivered on eight Varian 2100 series linacs (at two institutions) in order to quantify the inter-linac variation in dose before and after fine tuning the MLC calibration. Results: The measured dose differences for each field agreed well with the predictions of LoSasso et al. Using the default MLC calibration, the variation in the physical MLC gap size was determined to be less than 0.4 mm between all linacs studied. The dose difference between the linacs with the largest and smallest physical gap was up to 5.4% (spinal cord region of the head and neck TG119 test case). This difference was reduced to 2.5% after fine tuning the MLC gap calibration. Conclusions: The inter-linac dose precision for DMLC IMRT on Varian linacs can be improved using a simple modification of the MLC calibration procedure that involves fine adjustment of the nominal gap size.

SU-F-T-295: MLCs Performance and Patient-Specific IMRT QA Using Log File Analysis

Energy Technology Data Exchange (ETDEWEB)

Osman, A [King Fahd University of Petroleum and Minerals, Dhahran (Saudi Arabia); American University of Biuret Medical Center, Biuret (Lebanon); Maalej, N [King Fahd University of Petroleum and Minerals, Dhahran (Saudi Arabia); Jayesh, K; Abdel-Rahman, W [King Fahad Specialist Hospital-Dammam, Eastern Province (Saudi Arabia)

2016-06-15

Purpose: To analyze the performance of the multi-leaf collimators (MLCs) from the log files recorded during the intensity modulated radiotherapy (IMRT) treatment and to construct the relative fluence maps and do the gamma analysis to compare the planned and executed MLCs movement. Methods: We developed a program to extract and analyze the data from dynamic log files (dynalog files) generated from sliding window IMRT delivery treatments. The program extracts the planned and executed (actual or delivered) MLCs movement, calculates and compares the relative planned and executed fluences. The fluence maps were used to perform the gamma analysis (with 3% dose difference and 3 mm distance to agreement) for 3 IMR patients. We compared our gamma analysis results with those obtained from portal dose image prediction (PDIP) algorithm performed using the EPID. Results: For 3 different IMRT patient treatments, the maximum difference between the planned and the executed MCLs positions was 1.2 mm. The gamma analysis results of the planned and delivered fluences were in good agreement with the gamma analysis from portal dosimetry. The maximum difference for number of pixels passing the gamma criteria (3%/3mm) was 0.19% with respect to portal dosimetry results. Conclusion: MLC log files can be used to verify the performance of the MLCs. Patientspecific IMRT QA based on MLC movement log files gives similar results to EPID dosimetry results. This promising method for patient-specific IMRT QA is fast, does not require dose measurements in a phantom, can be done before the treatment and for every fraction, and significantly reduces the IMRT workload. The author would like to thank King Fahd University of petroleum and Minerals for the support.

Clinical implementation of dose-volume histogram predictions for organs-at-risk in IMRT planning

International Nuclear Information System (INIS)

Moore, K L; Appenzoller, L M; Tan, J; Michalski, J M; Thorstad, W L; Mutic, S

2014-01-01

True quality control (QC) of the planning process requires quantitative assessments of treatment plan quality itself, and QC in IMRT has been stymied by intra-patient anatomical variability and inherently complex three-dimensional dose distributions. In this work we describe the development of an automated system to reduce clinical IMRT planning variability and improve plan quality using mathematical models that predict achievable OAR DVHs based on individual patient anatomy. These models rely on the correlation of expected dose to the minimum distance from a voxel to the PTV surface, whereby a three-parameter probability distribution function (PDF) was used to model iso-distance OAR subvolume dose distributions. DVH models were obtained by fitting the evolution of the PDF with distance. Initial validation on clinical cohorts of 40 prostate and 24 head-and-neck plans demonstrated highly accurate model-based predictions for achievable DVHs in rectum, bladder, and parotid glands. By quantifying the integrated difference between candidate DVHs and predicted DVHs, the models correctly identified plans with under-spared OARs, validated by replanning all cases and correlating any realized improvements against the predicted gains. Clinical implementation of these predictive models was demonstrated in the PINNACLE treatment planning system by use of existing margin expansion utilities and the scripting functionality inherent to the system. To maintain independence from specific planning software, a system was developed in MATLAB to directly process DICOM-RT data. Both model training and patient-specific analyses were demonstrated with significant computational accelerations from parallelization.

Experience on IMRT treatment for prostate cancer. Planning, dosimetry and quality assurance; Experiencia en el tratamiento de IMRT en cancer de prostata. Planificacion, dosimetria y garantia de calidad

Energy Technology Data Exchange (ETDEWEB)

Gomez Barrado, A.; Garcia Vicente, F.; Fernandez Bedoya, V.; Zapatero Laborda, A.; Fernandez, I.; Bermudez Luna, R.; Perez Gonzalez, L.; Torres Escobar, J. J.

2011-07-01

In this study a revision concerning the treatment of prostate cancer with intensity-modulated radiation therapy (IMRT) is performed. Planning and verification of treatments involving dose calculations and image positioning are considered. A set of 110 patients is analysed concerning dosimetry and 92 considering image verification. Dose calculation is verified both experimentally and by means of a monitor unit (MU) calculation system. Positioning control of the prostate is achieved using intraprostatic fiducial markers and digitally reconstructed radiographs (DRRs) as well as a home-made software. All patients studied were consistent with the specifications of the treatment protocol regarding dose prescription in planning target volume (PTV), organ at risk (OAR) dose limitations, dosimetric quality assurance and positioning control. The procedure includes a learning curve considering every aspect of the treatment. The MU calculation system itself has been proved as an effective and functional tool for treatment verification. (Author) 12 refs.

Comparative study between IMRT planning and RapidArc® sliding window for head and neck tumors; Estudo comparativo de planejamento entre IMRT sliding window e RapidArc® para tumores de cabeca e pescoco

Energy Technology Data Exchange (ETDEWEB)

Pirani, Luiz F.; Silva, Leonardo P.; Lima, Marilia B.; Bittencourt, Guilherme R.; Ferreira, Anne Caroline M.; Batista, Delano V.S., E-mail: nando_lfp@yahoo.com.br [Instituto Nacional de Cancer (INCA), Rio de Janeiro, RJ (Brazil)

2012-12-15

This study aims to evaluate the RapidArc (RA) technique in the treatment of head and neck tumors and compare the results of treatments with intensity modulated radiation therapy (IMRT) in the National Cancer Institute (INCA). Head and neck carcinomas have a natural history with relative expansion to others regions, especially in advanced levels. Faster treatments, with better coverage of the Planning Target Volume (PTV) and sparing more risks organs (ROs) are necessary and bring a better clinical impact. Ten patients with head and neck cancer, planned with IMRT technique were replanned using the RA technique. Some dosimetric indexes were calculated for both techniques, with the intention of verifying which of them, at the same time, would promote greater coverage of the PTV and preserve more healthy tissue. In terms of coverage, both indexes were similar. The RA technique was more efficient for delivered doses to ROs. The number of monitor units (MU), number of fields and treatments time estimated were lower than IMRT technique. Finally, the results have showed that the RA technique clearly reduces the treatment time, reducing the average and maximum dose to ROs and conforming the target as IMRT technique. (author)

IMRT delivery verification using a spiral phantom

International Nuclear Information System (INIS)

Richardson, Susan L.; Tome, Wolfgang A.; Orton, Nigel P.; McNutt, Todd R.; Paliwal, Bhudatt R.

2003-01-01

In this paper we report on the testing and verification of a system for IMRT delivery quality assurance that uses a cylindrical solid water phantom with a spiral trajectory for radiographic film placement. This spiral film technique provides more complete dosimetric verification of the entire IMRT treatment than perpendicular film methods, since it samples a three-dimensional dose subspace rather than using measurements at only one or two depths. As an example, the complete analysis of the predicted and measured spiral films is described for an intracranial IMRT treatment case. The results of this analysis are compared to those of a single field perpendicular film technique that is typically used for IMRT QA. The comparison demonstrates that both methods result in a dosimetric error within a clinical tolerance of 5%, however the spiral phantom QA technique provides a more complete dosimetric verification while being less time consuming. To independently verify the dosimetry obtained with the spiral film, the same IMRT treatment was delivered to a similar phantom in which LiF thermoluminescent dosimeters were arranged along the spiral trajectory. The maximum difference between the predicted and measured TLD data for the 1.8 Gy fraction was 0.06 Gy for a TLD located in a high dose gradient region. This further validates the ability of the spiral phantom QA process to accurately verify delivery of an IMRT plan