Investigation of dose homogeneity for loose helical tomotherapy delivery in the context of breath-hold radiation therapy

Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada
Physics in Medicine and Biology (Impact Factor: 2.76). 06/2005; 50(10):2387-404. DOI: 10.1088/0031-9155/50/10/014
Source: PubMed


Loose helical delivery is a potential solution to account for respiration-driven tumour motion in helical tomotherapy (HT). In this approach, a treatment is divided into a set of interlaced 'loose' helices commencing at different gantry angles. Each loose helix covers the entire target length in one gantry rotation during a single breath-hold. The dosimetric characteristics of loose helical delivery were investigated by delivering a 6 MV photon beam in a HT-like manner. Multiple scenarios of conventional 'tight' HT and loose helical deliveries were modelled in treatment planning software, and carried out experimentally with Kodak EDR2 film. The advantage of loose helical delivery lies in its ability to produce a more homogeneous dose distribution by eliminating the 'thread' effect-an inherent characteristic of HT, which results in dose modulations away from the axis of gantry rotation. However, loose helical delivery was also subjected to undesirable dose modulations in the direction of couch motion (termed 'beating' effect), when the ratio between the number of beam projections per gantry rotation (n) and pitch factor (p) was a non-integer. The magnitude of dose modulations decreased with an increasing n/p ratio. The results suggest that for the current HT unit (n = 51), dose modulations could be kept under 5% by selecting a pitch factor smaller than 7. A pitch factor of this magnitude should be able to treat a target up to 30 cm in length. Loose helical delivery should increase the total session time only by a factor of 2, while the planning time should stay the same since the total number of beam projections remains unchanged. Considering its dosimetric advantage and clinical practicality, loose helical delivery is a promising solution for the future HT treatments of respiration-driven targets.

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    • "With the recent introduction of new radiographic and radiochromic films, the dose ranges for film dosimetry have been extended. Both this development and the high spatial resolution that can be reached, make film dosimetry of great value for use in different quality control procedures (Morrell and Rogers 2004, Zhu et al 2002, Kim et al 2005). "
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    ABSTRACT: The optical density (OD) range for the scanners used in film dosimetry is limited due to saturation and noise. As the OD increases, saturation causes the rate of change of the output with respect to the input to become smaller, while at the same time noise remains fairly constant or increases. The combined effect leads to a degradation of the signal-to-noise ratio (SNR) at high optical densities. In this study, the uncertainty in the OD measurement, d(m), is expressed as a function of the optical density d. The functional relationship obtained gives the amplitude w of an interval around d in which d(m) will be found with a given probability p. The relationship w = w(d, p) is later used to determine which OD ranges fulfil a set of requirements on w and p. As an application of the procedure, the noise and saturation characteristics of a commercial film digitizer system are measured. Their contribution to the uncertainties of the dosimetric procedure is reported, and the data are used to provide an optical density range for a given uncertainty and confidence level associated with the digitizer. These data can be further combined with the data from other sources of noise such as film noise in order to estimate the final uncertainty of the dosimetric process.
    Full-text · Article · Sep 2007 · Physics in Medicine and Biology
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    ABSTRACT: Tomotherapy is the delivery of intensity modulated radiation therapy using rotational delivery of a fan beam in the manner of a CT scanner. In helical tomotherapy the couch and gantry are in continuous motion akin to a helical CT scanner. Helical tomotherapy is inherently capable of acquiring CT images of the patient in treatment position and using this information for image guidance. This review documents technological advancements of the field concentrating on the conceptual beginnings through to its first clinical implementation. The history of helical tomotherapy is also a story of technology migration from academic research to a university-industrial partnership, and finally to commercialization and widespread clinical use.
    Preview · Article · Aug 2006 · Physics in Medicine and Biology
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    ABSTRACT: To report results from two clinical trials evaluating helical tomotherapy (HT). Patients were enrolled in one of two prospective trials of HT (one for palliative and one for radical treatment). Both an HT plan and a companion three-dimensional conformal radiotherapy (3D-CRT) plan were generated. Pretreatment megavoltage computed tomography was used for daily image guidance. From September 2004 to January 2006, a total of 61 sites in 60 patients were treated. In all but one case, a clinically acceptable tomotherapy plan for treatment was generated. Helical tomotherapy plans were subjectively equivalent or superior to 3D-CRT in 95% of plans. Helical tomotherapy was deemed equivalent or superior in two thirds of dose-volume point comparisons. In cases of inferiority, differences were either clinically insignificant and/or reflected deliberate tradeoffs to optimize the HT plan. Overall imaging and treatment time (median) was 27 min (range, 16-91 min). According to a patient questionnaire, 78% of patients were satisfied to very satisfied with the treatment process. Helical tomotherapy demonstrated clear advantages over conventional 3D-CRT in this diverse patient group. The prospective trials were helpful in deploying this technology in a busy clinical setting.
    No preview · Article · Jul 2007 · International Journal of Radiation OncologyBiologyPhysics
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