Medical dosimetry: official journal of the American Association of Medical Dosimetrists

Publisher: Elsevier

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Publications in this journal

  • Jin Shen, Edward Bender, Ravindra Yaparpalvi, Hsiang-Chi Kuo, Amar Basavatia, Linda Hong, William Bodner, Madhur K Garg, Shalom Kalnicki, Wolfgang A Tomé
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    ABSTRACT: An efficient and simple class solution is proposed for hippocampal-avoidance whole-brain radiation therapy (HA-WBRT) planning using the Volumetric Arc Therapy (VMAT) delivery technique following the NRG Oncology protocol NRG-CC001 treatment planning guidelines. The whole-brain planning target volume (PTV) was subdivided into subplanning volumes that lie in plane and out of plane with the hippocampal-avoidance volume. To further improve VMAT treatment plans, a partial-field dual-arc technique was developed. Both the arcs were allowed to overlap on the in-plane subtarget volume, and in addition, one arc covered the superior out-of-plane sub-PTV, while the other covered the inferior out-of-plane subtarget volume. For all plans (n = 20), the NRG-CC001 protocol dose-volume criteria were met. Mean values of volumes for the hippocampus and the hippocampal-avoidance volume were 4.1cm(3) ± 1.0cm(3) and 28.52cm(3) ± 3.22cm(3), respectively. For the PTV, the average values of D2% and D98% were 36.1Gy ± 0.8Gy and 26.2Gy ± 0.6Gy, respectively. The hippocampus D100% mean value was 8.5Gy ± 0.2Gy and the maximum dose was 15.7Gy ± 0.3Gy. The corresponding plan quality indices were 0.30 ± 0.01 (homogeneity index), 0.94 ± 0.01 (target conformality), and 0.75 ± 0.02 (confirmation number). The median total monitor unit (MU) per fraction was 806MU (interquartile range [IQR]: 792 to 818MU) and the average beam total delivery time was 121.2 seconds (IQR: 120.6 to 121.35 seconds). All plans passed the gamma evaluation using the 5-mm, 4% criteria, with γ > 1 of not more than 9.1% data points for all fields. An efficient and simple planning class solution for HA-WBRT using VMAT has been developed that allows all protocol constraints of NRG-CC001 to be met. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 01/2015;
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    ABSTRACT: Radiation pneumonitis is a well-documented side effect of radiation therapy for breast cancer. The purpose of this study was to compare combined photon-electron, photon-only, and electron-only plans in the radiation treatment of the supraclavicular lymph nodes. In total, 13 patients requiring chest wall and supraclavicular nodal irradiation were planned retrospectively using combined photon-electron, photon-only, and electron-only supraclavicular beams. A dose of 50Gy over 25 fractions was prescribed. Chest wall irradiation parameters were fixed for all plans. The goal of this planning effort was to cover 95% of the supraclavicular clinical target volume (CTV) with 95% of the prescribed dose and to minimize the volume receiving ≥ 105% of the dose. Comparative end points were supraclavicular CTV coverage (volume covered by the 95% isodose line), hotspot volume, maximum radiation dose, contralateral breast dose, mean total lung dose, total lung volume percentage receiving at least 20Gy (V20Gy), heart volume percentage receiving at least 25Gy (V25Gy). Electron and photon energies ranged from 8 to 18MeV and 4 to 6MV, respectively. The ratio of photon-to-electron fractions in combined beams ranged from 5:20 to 15:10. Supraclavicular nodal coverage was highest in photon-only (mean = 96.2 ± 3.5%) followed closely by combined photon-electron (mean = 94.2 ± 2.5%) and lowest in electron-only plans (mean = 81.7 ± 14.8%, p < 0.001). The volume of tissue receiving ≥ 105% of the prescription dose was higher in the electron-only (mean = 69.7 ± 56.1cm(3)) as opposed to combined photon-electron (mean = 50.8 ± 40.9cm(3)) and photon-only beams (mean = 32.2 ± 28.1cm(3), p = 0.114). Heart V25Gy was not statistically different among the plans (p = 0.999). Total lung V20Gy was lowest in electron-only (mean = 10.9 ± 2.3%) followed by combined photon-electron (mean = 13.8 ± 2.3%) and highest in photon-only plans (mean = 16.2 ± 3%, p < 0.001). As expected, photon-only plans demonstrated the highest target coverage and total lung V20Gy. The superiority of electron-only beams, in terms of decreasing lung dose, is set back by the dosimetric hotspots associated with such plans. Combined photon-electron treatment is a feasible technique for supraclavicular nodal irradiation and results in adequate target coverage, acceptable dosimetric hotspot volume, and slightly reduced lung dose. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 01/2015;
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    ABSTRACT: Four-dimensional (4D) dose calculations for lung cancer radiotherapy have been technically feasible for a number of years but have not become standard clinical practice. The purpose of this study was to determine if clinically significant differences in tumor control probability (TCP) exist between 3D and 4D dose calculations so as to inform the decision whether 4D dose calculations should be used routinely for treatment planning. Radiotherapy plans for Stage I-II lung cancer were created for 8 patients. Clinically acceptable treatment plans were created with dose calculated on the end-exhale 4D computed tomography (CT) phase using a Monte Carlo algorithm. Dose was then projected onto the remaining 9 phases of 4D-CT using the Monte Carlo algorithm and accumulated onto the end-exhale phase using commercially available deformable registration software. The resulting dose-volume histograms (DVH) of the gross tumor volume (GTV), planning tumor volume (PTV), and PTVsetup were compared according to target coverage and dose. The PTVsetup was defined as a volume including the GTV and a margin for setup uncertainties but not for respiratory motion. TCPs resulting from these DVHs were estimated using a wide range of alphas, betas, and tumor cell densities. Differences of up to 5Gy were observed between 3D and 4D calculations for a PTV with highly irregular shape. When the TCP was calculated using the resulting DVHs for fractionation schedules typically used in stereotactic body radiation therapy (SBRT), the TCP differed at most by 5% between 4D and 3D cases, and in most cases, it was by less than 1%. We conclude that 4D dose calculations are not necessary for most cases treated with SBRT, but they might be valuable for irregularly shaped target volumes. If 4D calculations are used, 4D DVHs should be evaluated on volumes that include margin for setup uncertainty but not respiratory motion. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 12/2014;
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    ABSTRACT: The purpose of this work was to report dosimetric experience with 2 kinds of multilumen balloon (MLB), 5-lumen Contura MLB (C-MLB) and 4-lumen MammoSite MLB (MS-MLB), to deliver accelerated partial-breast irradiation, and compare the ability to achieve target coverage and control skin and rib doses between 2 groups of patients treated with C-MLB and MS-MLB brachytherapy. C-MLB has 5 lumens, the 4 equal-spaced peripheral lumens are 5mm away from the central lumen. MS-MLB has 4 lumens, the 3 equal-spaced peripheral lumens are 3mm away from the central lumen. In total, 43 patients were treated, 23 with C-MLB, and 20 with MS-MLB. For C-MLB group, 8 patients were treated with a skin spacing < 7mm and 12 patients with rib spacing < 7mm. For MS-MLB group, 2 patients were treated with a skin spacing < 7mm and 5 patients with rib spacing < 7mm. The dosimetric goals were (1) ≥ 95% of the prescription dose (PD) covering ≥ 95% of the target volume (V95% ≥ 95%), (2) maximum skin dose ≤ 125% of the PD, (3) maximum rib dose ≤ 145% of the PD (if possible), and (4) the V150% ≤ 50cm(3) and V200% ≤ 10cm(3). All dosimetric criteria were met concurrently in 82.6% of C-MLB patients, in 80.0% of MS-MLB patients, and in 81.4% of all 43 patients. For each dosimetric parameter, t-test of these 2 groups showed p > 0.05. Although the geometric design of C-MLB is different from that of MS-MLB, both applicators have the ability to shape the dose distribution and to provide good target coverage, while limiting the dose to skin and rib. No significant difference was observed between the 2 patient groups in terms of target dose coverage and dose to organs at risk. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 12/2014;
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    ABSTRACT: To identify anatomic and treatment characteristics that correlate with organ-at-risk (OAR) sparing with deep inspiration breath-hold (DIBH) technique to guide patient selection for this technique. Anatomic and treatment characteristics and radiation doses to OARs were compared between free-breathing and DIBH plans. Linear regression analysis was used to identify factors independently predicting for cardiac sparing. We identified 64 patients: 44 with intact breast and 20 postmastectomy. For changes measured directly on treatment planning scans, DIBH plans decreased heart-chest wall length (6.5 vs 5.0cm, p < 0.001), and increased lung volume (1074.4 vs 1881.3cm(3), p < 0.001), and for changes measured after fields are set, they decreased maximum heart depth (1.1 vs 0.3cm, p < 0.001) and heart volume in field (HVIF) (9.1 vs 0.9cm(3), p < 0.001). DIBH reduced the mean heart dose (3.4 vs 1.8Gy, p < 0.001) and lung V20 (19.6% vs 15.3%, p < 0.001). Regression analysis found that only change in HVIF independently predicted for cardiac sparing. We identified patients in the bottom quartile of the dosimetric benefits seen with DIBH and categorized the cause of this "minimal benefit." Overall, 29% of patients satisfied these criteria for minimal benefit with DIBH and the most common cause was favorable baseline anatomy. Only the reduction in HVIF predicted for reductions in mean heart dose; no specific anatomic surrogate for the dosimetric benefits of DIBH technique could be identified. Most patients have significant dosimetric benefit with DIBH, and this technique should be planned and evaluated for all patients receiving left-sided breast/chest wall radiation. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 12/2014;
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    ABSTRACT: The purposes of this article were to compare the biophysical dosimetry for postmastectomy left-sided breast cancer using 4 different radiotherapy (RT) techniques. In total, 30 patients with left-sided breast cancer were randomly selected for this treatment planning study. They were planned using 4 RT techniques, including the following: (1) 3-dimensional conventional tangential fields (TFs), (2) tangential intensity-modulated therapy (T-IMRT), (3) 4 fields IMRT (4F-IMRT), and (4) single arc volumetric-modulated arc therapy (S-VMAT). The planning target volume (PTV) dose was prescribed 50Gy, the comparison of target dose distribution, conformity index, homogeneity index, dose to organs at risk (OARs), tumor control probability (TCP), normal tissue complication probability (NTCP), and number of monitor units (MUs) between 4 plans were investigated for their biophysical dosimetric difference. The target conformity and homogeneity of S-VMAT were better than the other 3 kinds of plans, but increased the volume of OARs receiving low dose (V5). TCP of PTV and NTCP of the left lung showed no statistically significant difference in 4 plans. 4F-IMRT plan was superior in terms of target coverage and protection of OARs and demonstrated significant advantages in decreasing the NTCP of heart by 0.07, 0.03, and 0.05 compared with TFs, T-IMRT, and S-VMAT plan. Compared with other 3 plans, TFs reduced the average number of MUs. Of the 4 techniques studied, this analysis supports 4F-IMRT as the most appropriate balance of target coverage and normal tissue sparing. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 12/2014;
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    ABSTRACT: Recent research has shown treating pancreatic cancer with volumetric-modulated arc therapy (VMAT) to be superior to either intensity-modulated radiation therapy or 3-dimensional conformal radiotherapy (3D-CRT), with respect to reducing normal tissue toxicity, monitor units, and treatment time. Furthermore, using avoidance sectors with RapidArc planning can further reduce normal tissue dose while maintaining target conformity. This study looks at the methods in reducing dose to the ipsilateral kidney, in pancreatic head cases, while observing dose received by other critical organs using avoidance sectors. Overall, 10 patients were retrospectively analyzed. Each patient had preoperative/unresectable pancreatic tumor and were selected based on the location of the right kidney being situated within the traditional 3D-CRT treatment field. The target planning target volume (286.97 ± 85.17cm(3)) was prescribed to 50.4Gy using avoidance sectors of 30°, 40°, and 50° and then compared with VMAT as well as 3D-CRT. Analysis of the data shows that the mean dose to the right kidney was reduced by 11.6%, 15.5%, and 21.9% for avoidance angles of 30°, 40°, and 50°, respectively, over VMAT. The mean dose to the total kidney also decreased by 6.5%, 8.5%, and 11.0% for the same increasing angles. Spinal cord maximum dose, however, increased as a function of angle by 3.7%, 4.8%, and 6.1% compared with VMAT. Employing avoidance sector angles as a complement to VMAT planning can significantly reduce high dose to the ipsilateral kidney while not greatly overdosing other critical organs. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 12/2014;
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    ABSTRACT: We report our experience of establishing planning objectives to achieve dose coverage, conformity, and dose falloff for spine stereotactic body radiation therapy (SBRT) plans. Patients with spine lesions were treated using SBRT in our institution since September 2009. Since September 2011, we established the following planning objectives for our SBRT spine plans in addition to the cord dose constraints: (1) dose coverage-prescription dose (PD) to cover at least 95% planning target volume (PTV) and 90% PD to cover at least 99% PTV; (2) conformity index (CI)-ratio of prescription isodose volume (PIV) to the PTV < 1.2; (3) dose falloff-ratio of 50% PIV to the PTV (R50%); (4) and maximum dose in percentage of PD at 2cm from PTV in any direction (D2cm) to follow Radiation Therapy Oncology Group (RTOG) 0915. We have retrospectively reviewed 66 separate spine lesions treated between September 2009 and December 2012 (31 treated before September 2011 [group 1] and 35 treated after [group 2]). The χ(2) test was used to examine the difference in parameters between groups. The PTV V100% PD ≥ 95% objective was met in 29.0% of group 1 vs 91.4% of group 2 (p < 0.01) plans. The PTV V90% PD ≥ 99% objective was met in 38.7% of group 1 vs 88.6% of group 2 (p < 0.01) plans. Overall, 4 plans in group 1 had CI > 1.2 vs none in group 2 (p = 0.04). For D2cm, 48.3% plans yielded a minor violation of the objectives and 16.1% a major violation for group 1, whereas 17.1% exhibited a minor violation and 2.9% a major violation for group 2 (p < 0.01). Spine SBRT plans can be improved on dose coverage, conformity, and dose falloff employing a combination of RTOG spine and lung SBRT protocol planning objectives. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 12/2014;
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    ABSTRACT: To compare the dosimetric and delivery characteristics of two arc-based stereotactic body radiotherapy (SBRT) techniques for early-stage lung cancer treatment. SBRT treatment plans for lung tumors of different sizes and locations were designed using a single-isocenter multisegment dynamic conformal arc technique (SiMs-arc) and a volumetric modulated arc therapy technique (RapidArc) for 5 representative patients treated previously with lung SBRT. The SiMs-arc plans were generated with the isocenter located in the geometric center of patient׳s axial plane (which allows for collision-free gantry rotation around the patient) and 6 contiguous 60° arc segments spanning from 1° to 359°. 2 RapidArc plans, one using the same arc geometry as the SiMs-arc and the other using typical partial arcs (210°) with the isocenter inside planning target volume (PTV), were generated for each corresponding SiMs-arc plan. All plans were generated using the Varian Eclipse treatment planning system (V10.0) and were normalized with PTV V100 to 95%. PTV coverage, dose to organs at risk, and total monitor units (MUs) were then compared and analyzed. For PTV coverage, the RapidArc plans generally produced higher PTV D99 (by 1.0% to 3.3%) and higher minimum dose (by 2.7% to 12.7%), better PTV conformality index (by 1% to 8%), and less volume of 50% dose outside 2cm from PTV (by 0 to 20.8cm(3)) than the corresponding SiMs-arc plans. For normal tissues, no significant dose differences were observed for the lungs, trachea, chest wall, and heart; RapidArc using partial arcs produced lowest maximum dose to spinal cord. For dose delivery, the RapidArc plans typically required 50% to 90% more MUs than SiMs-arc plans to deliver the same prescribed dose. The additional intensity modulation afforded by variable gantry speed and dose rate and by overlapping arcs enabled RapidArc plans to produce dosimetrically improved plans for lung SBRT, but required more MUs (by a factor > 1.5) to deliver. The dosimetric improvements, most notably in PTV minimum dose and in dose conformality for irregularly shaped PTVs, may outweigh the increased MUs in using RapidArc. For small and peripherally located tumors, SiMs-arc produces comparable dosimetric quality and could be more efficient in both treatment planning and dose delivery. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 12/2014;
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    ABSTRACT: This study evaluated the secondary cancer risk from volumetric-modulated arc therapy (VMAT) for spine radiotherapy compared with intensity-modulated radiotherapy (IMRT) and 3-dimensional conformal radiotherapy (3DCRT). Computed tomography images of an Radiological Physics Center spine anthropomorphic phantom were exported to a treatment planning system (Pinnacle(3), version 9.4). Radiation treatment plans for spine were prepared using VMAT (dual-arc), 7-field IMRT (beam angles: 110°, 130°, 150°, 180°, 210°, 230°, and 250°), and 4-field 3DCRT technique. The mean and maximum doses, dose-volume histograms, and volumes receiving more than 2 and 4Gy to organs at risk (OARs) were calculated and compared. The lifetime risk for secondary cancers was estimated according to the National Cancer Registry Programme Report 116. VMAT delivered the lowest maximum dose to the esophagus (4.03Gy), bone (8.11Gy), heart (2.11Gy), spinal cord (6.45Gy), and whole lung (5.66Gy) as compared with other techniques (IMRT and 3DCRT). The volumes of OAR (esophagus) receiving more than 4Gy were 0% for VMAT, 27.06% for IMRT, and up to 32.35% for 3DCRT. The estimated risk for secondary cancer in the respective OAR is considerably lower in VMAT compared with other techniques. The results of maximum doses and volumes of OARs suggest that the risk of secondary cancer induction for the spine in VMAT is lower than IMRT and 3DCRT, whereas VMAT has the best target coverage compared with the other techniques. Copyright © 2014 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 11/2014;
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    ABSTRACT: Stereotactic body radiation therapy (SBRT) treatment planning and delivery can be accomplished using a variety of techniques that achieve highly conformal dose distributions. Herein, we describe a template-based automated treatment field approach that enables rapid delivery of more than 20 coplanar fields. A case study is presented to demonstrate how modest adaptations to traditional SBRT planning can be implemented to take clinical advantage of this technology. Treatment was planned for a left-sided lung lesion adjacent to the chest wall using 25 coplanar treatment fields spaced at 11° intervals. The plan spares the contralateral lung and is in compliance with the conformality standards set forth in Radiation Therapy and Oncology Group protocol 0915, and the dose tolerances found in the report of the American Association of Physicists in Medicine Task Group 101. Using a standard template, treatment planning was accomplished in less than 20 minutes, and each 10Gy fraction was delivered in approximately 5.4 minutes. For those centers equipped with linear accelerators capable of automated treatment field delivery, the use of more than 20 coplanar fields is a viable SBRT planning approach and yields excellent conformality and quality combined with rapid planning and treatment delivery. Although the case study discusses a laterally located lung lesion, this technique can be applied to centrally located tumors with similar results.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 09/2014;
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    ABSTRACT: In recent years, small-field electron beams have been used for the treatment of superficial lesions, which requires small circular fields. However, when using very small electron fields, some significant dosimetric problems may occur. In this study, dose distributions and outputs of circular fields with dimensions of 5cm and smaller, for nominal energies of 6, 9, and 15MeV from the Siemens ONCOR Linac, were measured and compared with data from a treatment planning system using the pencil-beam algorithm in electron beam calculations. All dose distribution measurements were performed using the Gafchromic EBT film; these measurements were compared with data that were obtained from the Computerized Medical Systems (CMS) XiO treatment planning system (TPS), using the gamma-index method in the PTW VeriSoft software program. Output measurements were performed using the Gafchromic EBT film, an Advanced Markus ion chamber, and thermoluminescent dosimetry (TLD). Although the pencil-beam algorithm is used to model electron beams in many clinics, there is no substantial amount of detailed information in the literature about its use. As the field size decreased, the point of maximum dose moved closer to the surface. Output factors were consistent; differences from the values obtained from the TPS were, at maximum, 42% for 6 and 15MeV and 32% for 9MeV. When the dose distributions from the TPS were compared with the measurements from the Gafchromic EBT films, it was observed that the results were consistent for 2-cm diameter and larger fields, but the outputs for fields of 1-cm diameter and smaller were not consistent. In CMS XiO TPS, calculated using the pencil-beam algorithm, the dose distributions of electron treatment fields that were created with circular cutout of a 1-cm diameter were not appropriate for patient treatment and the pencil-beam algorithm is not convenient for monitor unit (MU) calculations in electron dosimetry.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 09/2014;
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    ABSTRACT: Use of a patient test dose before single-fraction total body irradiation (TBI) allows review of in vivo dosimetry and modification of the main treatment setup. However, use of computed tomography (CT) planning and online in vivo dosimetry may reduce the need for this additional step. Patients were treated using a supine CT-planned extended source-to-surface distance (SSD) technique with lead compensators and bolus. In vivo dosimetry was performed using thermoluminescent dosimeters (TLDs) and diodes at 10 representative anatomical locations, for both a 0.1-Gy test dose and the treatment dose. In total, 28 patients were treated between April 2007 and July 2013, with changes made in 10 cases (36%) following test dose results. Overall, 98.1% of measured in vivo treatment doses were within 10% of the prescribed dose, compared with 97.0% of test dose readings. Changes made following the test dose could have been applied during the single-fraction treatment itself, assuming that the dose was delivered in subportions and online in vivo dosimetry was available for all clinically important anatomical sites. This alleviates the need for a test dose, saving considerable time and resources.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 08/2014;
  • Medical dosimetry: official journal of the American Association of Medical Dosimetrists 07/2014;
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    ABSTRACT: Volumetric-modulated arc therapy (VMAT) is now widely used clinically, as it is capable of delivering a highly conformal dose distribution in a short time interval. We retrospectively analyzed patient-specific quality assurance (QA) of VMAT and examined the relationships between the planning parameters and the QA results. A total of 118 clinical VMAT cases underwent pretreatment QA. All plans had 3-dimensional diode array measurements, and 69 also had ion chamber measurements. Dose distribution and isocenter point dose were evaluated by comparing the measurements and the treatment planning system (TPS) calculations. In addition, the relationship between QA results and several planning parameters, such as dose level, control points (CPs), monitor units (MUs), average field width, and average leaf travel, were also analyzed. For delivered dose distribution, a gamma analysis passing rate greater than 90% was obtained for all plans and greater than 95% for 100 of 118 plans with the 3%/3-mm criteria. The difference (mean ± standard deviation) between the point doses measured by the ion chamber and those calculated by TPS was 0.9% ± 2.0% for all plans. For all cancer sites, nasopharyngeal carcinoma and gastric cancer have the lowest and highest average passing rates, respectively. From multivariate linear regression analysis, the dose level (p = 0.001) and the average leaf travel (p < 0.001) showed negative correlations with the passing rate, and the average field width (p = 0.003) showed a positive correlation with the passing rate, all indicating a correlation between the passing rate and the plan complexity. No statistically significant correlation was found between MU or CP and the passing rate. Analysis of the results of dosimetric pretreatment measurements as a function of VMAT plan parameters can provide important information to guide the plan parameter setting and optimization in TPS.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 06/2014;
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    ABSTRACT: Craniospinal irradiation (CSI) requires abutting fields at the cervical spine. Junction shifts are conventionally used to prevent setup error-induced overdosage/underdosage from occurring at the same location. This study compared the dosimetric differences at the cranial-spinal junction between a single-gradient junction technique and conventional multiple-junction shifts and evaluated the effect of setup errors on the dose distributions between both techniques for a treatment course and single fraction. Conventionally, 2 lateral brain fields and a posterior spine field(s) are used for CSI with weekly 1-cm junction shifts. We retrospectively replanned 4 CSI patients using a single-gradient junction between the lateral brain fields and the posterior spine field. The fields were extended to allow a minimum 3-cm field overlap. The dose gradient at the junction was achieved using dose painting and intensity-modulated radiation therapy planning. The effect of positioning setup errors on the dose distributions for both techniques was simulated by applying shifts of ± 3 and 5mm. The resulting cervical spine doses across the field junction for both techniques were calculated and compared. Dose profiles were obtained for both a single fraction and entire treatment course to include the effects of the conventional weekly junction shifts. Compared with the conventional technique, the gradient-dose technique resulted in higher dose uniformity and conformity to the target volumes, lower organ at risk (OAR) mean and maximum doses, and diminished hot spots from systematic positioning errors over the course of treatment. Single-fraction hot and cold spots were improved for the gradient-dose technique. The single-gradient junction technique provides improved conformity, dose uniformity, diminished hot spots, lower OAR mean and maximum dose, and one plan for the entire treatment course, which reduces the potential human error associated with conventional 4-shifted plans.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 06/2014;
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    ABSTRACT: Stereotactic radiotherapy (SRT) requires tight margins around the tumor, thus producing a steep dose gradient between the tumor and the surrounding healthy tissue. Any setup errors might become clinically significant. To date, no study has been performed to evaluate the dosimetric variations caused by setup errors with a 3-dimensional dosimeter, the PRESAGE. This research aimed to evaluate the potential effect that setup errors have on the dose distribution of intracranial SRT. Computed tomography (CT) simulation of a CIRS radiosurgery head phantom was performed with 1.25-mm slice thickness. An ideal treatment plan was generated using Brainlab iPlan. A PRESAGE was made for every treatment with and without errors. A prescan using the optical CT scanner was carried out. Before treatment, the phantom was imaged using Brainlab ExacTrac. Actual radiotherapy treatments with and without errors were carried out with the Novalis treatment machine. Postscan was performed with an optical CT scanner to analyze the dose irradiation. The dose variation between treatments with and without errors was determined using a 3-dimensional gamma analysis. Errors are clinically insignificant when the passing ratio of the gamma analysis is 95% and above. Errors were clinically significant when the setup errors exceeded a 0.7-mm translation and a 0.5° rotation. The results showed that a 3-mm translation shift in the superior-inferior (SI), right-left (RL), and anterior-posterior (AP) directions and 2° couch rotation produced a passing ratio of 53.1%. Translational and rotational errors of 1.5mm and 1°, respectively, generated a passing ratio of 62.2%. Translation shift of 0.7mm in the directions of SI, RL, and AP and a 0.5° couch rotation produced a passing ratio of 96.2%. Preventing the occurrences of setup errors in intracranial SRT treatment is extremely important as errors greater than 0.7mm and 0.5° alter the dose distribution. The geometrical displacements affect dose delivery to the tumor and the surrounding normal tissues.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 06/2014;
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    ABSTRACT: In this study, we investigated the correlation between 2-dimensional (2D) and 3D gamma analysis using the new PTW OCTAVIUS 4D system for various parameters. For this study, we selected 150 clinically approved volumetric-modulated arc therapy (VMAT) plans of head and neck (50), thoracic (esophagus) (50), and pelvic (cervix) (50) sites. Individual verification plans were created and delivered to the OCTAVIUS 4D phantom. Measured and calculated dose distributions were compared using the 2D and 3D gamma analysis by global (maximum), local and selected (isocenter) dose methods. The average gamma passing rate for 2D global gamma analysis in coronal and sagittal plane was 94.81% ± 2.12% and 95.19% ± 1.76%, respectively, for commonly used 3-mm/3% criteria with 10% low-dose threshold. Correspondingly, for the same criteria, the average gamma passing rate for 3D planar global gamma analysis was 95.90% ± 1.57% and 95.61% ± 1.65%. The volumetric 3D gamma passing rate for 3-mm/3% (10% low-dose threshold) global gamma was 96.49% ± 1.49%. Applying stringent gamma criteria resulted in higher differences between 2D planar and 3D planar gamma analysis across all the global, local, and selected dose gamma evaluation methods. The average gamma passing rate for volumetric 3D gamma analysis was 1.49%, 1.36%, and 2.16% higher when compared with 2D planar analyses (coronal and sagittal combined average) for 3mm/3% global, local, and selected dose gamma analysis, respectively. On the basis of the wide range of analysis and correlation study, we conclude that there is no assured correlation or notable pattern that could provide relation between planar 2D and volumetric 3D gamma analysis. Owing to higher passing rates, higher action limits can be set while performing 3D quality assurance. Site-wise action limits may be considered for patient-specific QA in VMAT.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 06/2014;
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    ABSTRACT: This study is aimed to test a postprostatectomy volumetric-modulated arc therapy (VMAT) planning class solution. The solution applies to both the progressive resolution optimizer algorithm version 2 (PRO 2) and the algorithm version 3 (PRO 3), addressing the effect of an upgraded algorithm. A total of 10 radical postprostatectomy patients received 68Gy to 95% of the planning target volume (PTV), which was planned using VMAT. Each case followed a set of planning instructions; including contouring, field setup, and predetermined optimization parameters. Each case was run through both algorithms only once, with no user interaction. Results were averaged and compared against Radiation Therapy Oncology Group (RTOG) 0534 end points. In addition, the clinical target volume (CTV) D100, PTV D99, and PTV mean doses were recorded, along with conformity indices (CIs) (95% and 98%) and the homogeneity index. All cases satisfied PTV D95 of 68Gy and a maximum dose < 74.8Gy. The average result for the PTV D99 was 64.1Gy for PRO 2 and 62.1Gy for PRO 3. The average PTV mean dose for PRO 2 was 71.4Gy and 71.5Gy for PRO 3. The CTV D100 average dose was 67.7 and 68.0Gy for PRO 2 and PRO 3, respectively. The mean homogeneity index for both algorithms was 0.08. The average 95% CI was 1.17 for PRO 2 and 1.19 for PRO 3. For 98%, the average results were 1.08 and 1.12 for PRO 2 and PRO 3, respectively. All cases for each algorithm met the RTOG organs at risk dose constraints. A successful class solution has been established for prostate bed VMAT radiotherapy regardless of the algorithm used.
    Medical dosimetry: official journal of the American Association of Medical Dosimetrists 06/2014;