A comparison of the dosimetric effects of intrafraction motion on step-and-shoot, compensator, and helical tomotherapy-based IMRT

Intrafraction motion during intensity‐modulated radiation therapy can cause differences between the planned and delivered patient dose. The magnitude of these differences is dependent on a number of variables, including the treatment modality. This study was designed to compare the relative susceptibility of plans generated with three different treatment modalities to intrafraction motion. The dosimetric effects of motion were calculated using computational algorithms for seven lung tumor patients. Three delivery techniques — MLC‐based step‐and‐shoot (SNS), beam attenuating compensators, and helical tomotherapy (HT) — were investigated. In total 840 motion‐encoded dose‐volume histograms (DVHs) were calculated for various combinations of CTV margins and sinusoidal CTV motion including CTV offsets. DVH‐based metrics (e.g., D95% and D05%) were used to score plan degradations. For all three modalities, dosimetric degradations were typically smaller than 3% if the CTV displacement was smaller than the CTV margin. For larger displacements, technique and direction‐specific sensitivities existed. While the HT plans show similar D95% degradations for motion in the SI and AP directions, SNS and compensator plans showed larger D95% degradations for motion in the SI direction than for motion in the AP direction. When averaged over all motion/margin combinations, compensator plans resulted in 0.9% and 0.6% smaller D95% reductions compared to SNS and HT plans, respectively. These differences were statistically significant. No statistically significant differences in D95% degradations were found between SNS and HT for data averaged over all margin and motion track combinations. For CTV motion that is larger than the CTV margin, the dosimetric impact on the CTV varies with treatment technique and the motion direction. For the cases presented here, the effect of motion on CTV dosimetry was statistically smaller for compensator deliveries than SNS and HT, likely due to the absence of the interplay effect which is present for the more dynamic treatment deliveries. The differences between modalities were, however, small and might not be clinically significant. As expected, margins that envelop the CTV motion provide dosimetric protection against motion for all three modalities.

PACS numbers: 87.53.Jw, 87.55.dk, 87.55.de

SU-E-J-201: What is the Importance of Dose Recalculation for Adaptive Radiotherapy Dose Assessment?

PURPOSE

To quantify the effect of using the planned dose distributions in lieu of performing dose recalculations on daily in-room images for adaptive radiotherapy (ART) dose assessment of head and neck cancer patients.

METHODS

16 patients with cancers of the head and neck were treated using the TomoTherapy Hi-Art II (Accuray Inc., Sunnyvale, CA). Images of all patients were acquired prior to each treatment using the megavoltage CT (MVCT) capability of the TomoTherapy unit. Overall, images from 528 fractions were evaluated. For every image set, the delivered dose was estimated by both recalculating the dose distribution using the acquired MVCT and also by simply overlaying the planned distribution on the new images. ART dose assessment was performed using deformable image registration (DIR) to deform contours from the treatment plan to the images acquired during each fraction and to accumulate the estimated dose delivered during each fraction back to the reference treatment plan. The same DIR maps were applied to both dose estimation methods. Dosimetric endpoints were then compared between the DVHs computed using the recalculated or planned dose distributions.

RESULTS

The mean PTV D95% and D05% endpoints were 0.6±0.5% and 1.4±0.8% lower using the planned dose distributions compared to the recalculated distributions, respectively, across all patients. The mean parotid D50% was 2.4±1.5% greater using the planned distributions compared to the recalculated distributions. The parotid D50% from the planned distributions was also highly correlated with the parotid D50% from the recalculated distributions for each patient (mean r2=0.97±0.09).

CONCLUSIONS

For this treatment modality and site, dosimetric differences observed between overlaying the planned dose distributions and recalculating distributions on daily images were typically well within ±5%. This indicates that the dose distribution itself is robust against anatomic variations. This study was funded, in part, by a grant from Accuray Inc.

Helical tomotherapy: image-guided and adaptive radiotherapy

Helical tomotherapy is a treatment device that is designed to deliver intensity-modulated radiation therapy treatments. Helical tomotherapy systems have been used to treat a wide spectrum of anatomical sites. In addition to its unique delivery technique, the capability to obtain megavoltage-based CT (MVCT) images is highly integrated into the system's image guidance. The introduction of MVCT imaging into clinical practice has prompted a range of technical and clinical investigations. The image quality, image dose and use of MVCT images for dose calculation have been investigated. At the same time, routine clinical use of MVCT imaging has provided a wealth of clinical experience. Both technical and clinical experiences with the MVCT system will be reviewed in this chapter.

Cain and Abel reloaded? Kin recognition and male-male aggression in three-spined sticklebacks Gasterosteus aculeatus L

The influence of relatedness on male-male aggression was tested in three-spined sticklebacks Gasterosteus aculeatus. The intensity of aggression against brothers and non-kin males did not differ significantly, indicating that kin recognition plays at most a minor role in aggressive interactions between male G. aculeatus.