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İnan GA, Aral IP, Arslan A, Celik TO, Ozturk HF, Arslan SA, Tezcan Y. Helical tomotherapy experience in breast cancer adjuvant radiotherapy and acute toxicity results. Rep Pract Oncol Radiother 2022; 27:973-981. [PMID: 36632291 PMCID: PMC9826657 DOI: 10.5603/rpor.a2022.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 11/04/2022] [Indexed: 12/12/2022] Open
Abstract
Background This study aimed to evaluate acute toxicity and oncological outcomes of breast cancer patients who underwent adjuvant radiotherapy (RT) with tomotherapy. Materials and methods The results of 114 patients who underwent adjuvant RT with Tomotherapy device between 17.08.10-12.06.2021 in Ankara Atatürk Training and Research Hospital and Ankara City Hospital were evaluated retrospectively. The primary endpoint of the study was acute adverse events, and the secondary endpoints were overall survival (OS) and disease-free survival (DFS). Results The results of 103 patients who met the inclusion criteria were analyzed. The median follow-up was 21 (range 1-125.8) months. Grade +3 esophagitis was not observed in any patient; no esophagitis was observed in 60 (58.3%) patients. Grade 3 dermatitis was observed in 3 (2.9%) patients. In addition, dermatitis was not observed in 47 (45.6%) patients. The relationship between chest wall volume and esophagitis development was statistically significant (p = 0.006; Z score: -2769). The median OS was 24.1 (range 1-128.5) and median disease-free survival was 21.1 (range 1-125.8) months. Five patients (4.9%) died and 9 patients (8.7%) relapsed. Local recurrence was observed in only 1 (1%) patient. There was a statistically significant correlation between OS and contralateral lung V20 dose [p < 0.001; Spearman Correlation Coefficient (SCC) -406) and heart mean dose (p < 0.001; SCC -370)]. There was a statically significant correlation between DFS and cN (p < 0.001); pN (p < 0.001); heart mean dose (p < 0.001; SCC -351); contralateral lung V5 dose (p = 0.041; SCC -213); contralateral lung V20 dose (p < 0.001; SCC -434). Conclusion Acute toxicity results show improvement in breast cancer adjuvant radiotherapy with helical tomotherapy.
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Affiliation(s)
- Gonca Altınışık İnan
- Radiation Oncology, Ankara Şehir Hastanesi, Radyasyon Onkolojisi Bölümü, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
| | - Ipek Pinar Aral
- Radiation Oncology, Ankara Şehir Hastanesi, Radyasyon Onkolojisi Bölümü, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
| | - Aliye Arslan
- Radiation Oncology, Ankara City Hospital, Cankaya, Turkey
| | | | - Huseyin Furkan Ozturk
- Radiation Oncology, Ankara Şehir Hastanesi, Radyasyon Onkolojisi Bölümü, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
| | - Suheyla Aytac Arslan
- Radiation Oncology, Ankara Şehir Hastanesi, Radyasyon Onkolojisi Bölümü, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
| | - Yilmaz Tezcan
- Radiation Oncology, Ankara Şehir Hastanesi, Radyasyon Onkolojisi Bölümü, Ankara Yildirim Beyazit Universitesi Tip Fakultesi, Ankara, Turkey
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Puttanawarut C, Sirirutbunkajorn N, Tawong N, Khachonkham S, Pattaranutaporn P, Wongsawat Y. Impact of Interfractional Error on Dosiomic Features. Front Oncol 2022; 12:726896. [PMID: 35756677 PMCID: PMC9231355 DOI: 10.3389/fonc.2022.726896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The purpose of this study was to investigate the stability of dosiomic features under random interfractional error. We investigated the differences in the values of features with different fractions and the error in the values of dosiomic features under interfractional error. Material and Methods The isocenters of the treatment plans of 15 lung cancer patients were translated by a maximum of ±3 mm in each axis with a mean of (0, 0, 0) and a standard deviation of (1.2, 1.2, 1.2) mm in the x, y, and z directions for each fraction. A total of 81 dose distributions for each patient were then calculated considering four fraction number groups (2, 10, 20, and 30). A total of 93 dosiomic features were extracted from each dose distribution in four different regions of interest (ROIs): gross tumor volume (GTV), planning target volume (PTV), heart, and both lungs. The stability of dosiomic features was analyzed for each fraction number group by the coefficient of variation (CV) and intraclass correlation coefficient (ICC). The agreements in the means of dosiomic features among the four fraction number groups were tested by ICC. The percent differences (PD) between the dosiomic features extracted from the original dose distribution and the dosiomic features extracted from the dose distribution with interfractional error were calculated. Results Eleven out of 93 dosiomic features demonstrated a large CV (CV ≥ 20%). Overall CV values were highest in GTV ROIs and lowest in lung ROIs. The stability of dosiomic features decreased as the total number of fractions decreased. The ICC results showed that five out of 93 dosiomic features had an ICC lower than 0.75, which indicates intermediate or poor stability under interfractional error. The mean dosiomic feature values were shown to be consistent with different numbers of fractions (ICC ≥ 0.9). Some of the dosiomic features had PD greater than 50% and showed different PD values with different numbers of fractions. Conclusion Some dosiomic features have low stability under interfractional error. The stability and values of the dosiomic features were affected by the total number of fractions. The effect of interfractional error on dosiomic features should be considered in further studies regarding dosiomics for reproducible results.
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Affiliation(s)
- Chanon Puttanawarut
- Chakri Naruebodindra Medical Institute, Ramathibodi Hospital, Mahidol University, Samutprakarn, Thailand.,Brain-Computer Interface Laboratory, Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakhorn Pathom, Thailand
| | - Nat Sirirutbunkajorn
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Narisara Tawong
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suphalak Khachonkham
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poompis Pattaranutaporn
- Department of Diagnostic and Therapeutic Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yodchanan Wongsawat
- Brain-Computer Interface Laboratory, Department of Biomedical Engineering, Faculty of Engineering, Mahidol University, Nakhorn Pathom, Thailand
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Castriconi R, Esposito PG, Tudda A, Mangili P, Broggi S, Fodor A, Deantoni CL, Longobardi B, Pasetti M, Perna L, Del Vecchio A, Di Muzio NG, Fiorino C. Replacing Manual Planning of Whole Breast Irradiation With Knowledge-Based Automatic Optimization by Virtual Tangential-Fields Arc Therapy. Front Oncol 2021; 11:712423. [PMID: 34504790 PMCID: PMC8423088 DOI: 10.3389/fonc.2021.712423] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/02/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose To implement Knowledge Based (KB) automatic planning for right and left-sided whole breast treatment through a new volumetric technique (ViTAT, Virtual Tangential-fields Arc Therapy) mimicking conventional tangential fields (TF) irradiation. Materials and Method A total of 193 clinical plans delivering TF with wedged or field-in-field beams were selected to train two KB-models for right(R) and left(L) sided breast cancer patients using the RapidPlan (RP) tool implemented in the Varian Eclipse system. Then, a template for ViTAT optimization, incorporating individual KB-optimized constraints, was interactively fine-tuned. ViTAT plans consisted of four arcs (6 MV) with start/stop angles consistent with the TF geometry variability within our population; the delivery was completely blocked along the arcs, apart from the first and last 20° of rotation for each arc. Optimized fine-tuned KB templates for automatic plan optimization were generated. Validation tests were performed on 60 new patients equally divided in R and L breast treatment: KB automatic ViTAT-plans (KB-ViTAT) were compared against the original TF plans in terms of OARs/PTVs dose-volume parameters. Wilcoxon-tests were used to assess the statistically significant differences. Results KB models were successfully generated for both L and R sides. Overall, 1(3%) and 7(23%) out of 30 automatic KB-ViTAT plans were unacceptable compared to TF for R and L side, respectively. After the manual refinement of the start/stop angles, KB-ViTAT plans well fitted TF-performances for these patients as well. PTV coverage was comparable, while PTV D1% was improved with KB-ViTAT by R:0.4/L:0.2 Gy (p < 0.05); ipsilateral OARs Dmean were similar with a slight (i.e., few % volume) improvement/worsening in the 15–35 Gy/2–15 Gy range, respectively. KB-ViTAT better spared contralateral OARs: Dmean of contralateral OARs was 0.1 Gy lower (p < 0.05); integral dose was R:5%/L:8% lower (p < 0.05) than TF. The overall time for the automatic plan optimization and final dose calculation was 12 ± 2 minutes. Conclusions Fully automatic KB-optimization of ViTAT can efficiently replace manually optimized TF planning for whole breast irradiation. This approach was clinically implemented in our institute and may be suggested as a large-scale strategy for efficiently replacing manual planning with large sparing of time, elimination of inter-planner variability and of, seldomly occurring, sub-optimal manual plans.
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Affiliation(s)
| | | | - Alessia Tudda
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Paola Mangili
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Sara Broggi
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | - Andrei Fodor
- Radiotherapy, San Raffaele Scientific Institute, Milano, Italy
| | | | | | | | - Lucia Perna
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
| | | | | | - Claudio Fiorino
- Medical Physics, San Raffaele Scientific Institute, Milano, Italy
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Luo J, Yin Z, Zhang Z, Guo X, Yu X, Wang J. Does the protocol-required uniform margin around the CTV adequately account for setup inaccuracies in whole breast irradiation? Radiat Oncol 2021; 16:143. [PMID: 34344403 PMCID: PMC8336062 DOI: 10.1186/s13014-021-01863-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 07/19/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose To use cone-beam computed tomography (CBCT) imaging to determine the impacts of patient characteristics on the magnitude of geometric setup errors and obtain patient-specific planning target volume (PTV) margins from the correlated patient characteristics in whole breast irradiation (WBI). Methods Between January 2019 and December 2019, a total of 97 patients who underwent breast-conserving surgery, followed by intensity-modulated radiation therapy in WBI, were scanned with pre-treatment CBCT for the first three treatment fractions and weekly for the subsequent fractions. Setup errors in the left–right (LR), superior–inferior (SI) and anterior–posterior (AP) directions were recorded and analyzed with patient characteristics—including age, tumor location, body mass index (BMI), chest circumference (CC) and breast volume (BV)—to examine the predictors for setup errors and obtain specific PTV margins. Results A total of 679 CBCT images from 97 patients were acquired for analysis. The mean setup errors for the whole group were 2.32 ± 1.21 mm, 3.71 ± 2.21 mm and 2.75 ± 1.56 mm in the LR, SI and AP directions, respectively. Patients’ BMI, CC and BV were moderately associated with setup errors, especially in the SI directions (R = 0.40, 0.43 and 0.22, respectively). Setup errors in the SI directions for patients with BMI > 23.8 kg/m2, CC > 89 cm and BV > 657 cm3 were 4.56 ± 2.59 mm, 4.77 ± 2.42 mm and 4.30 ± 2.43 mm, respectively, which were significantly greater than those of patients with BMI ≤ 23.8 kg/m2, CC ≤ 89 cm and BV ≤ 657 cm3 (P < 0.05). Correspondingly, the calculated PTV margins in patients with BMI > 23.8 kg/m2, CC > 89 cm and BV > 657 cm3 were 4.25/7.95/4.93 mm, 4.37/7.66/5.24 mm and 4.22/7.54/5.29 mm in the LR/SI/AP directions, respectively, compared with 3.64/4.64/5.09 mm, 3.31/4.50/4.82 mm and 3.29/5.74/4.73 mm for BMI ≤ 23.8 kg/m2, CC ≤ 89 cm and BV ≤ 657 cm3, respectively. Conclusions The magnitude of geometric setup errors was moderately correlated with BMI, CC and BV. It was recommended to set patient-specific PTV margins according to patient characteristics in the absence of daily image-guided treatment setup.
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Affiliation(s)
- Jurui Luo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhihai Yin
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiaomao Guo
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiaoli Yu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Juanqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 DongAn Road, Shanghai, China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
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Deveau MA, Sutton M, Baetge C, Diesel AB. A case report of total skin photon radiation therapy for cutaneous epitheliotropic lymphoma in a dog. BMC Vet Res 2019; 15:407. [PMID: 31706321 PMCID: PMC6842533 DOI: 10.1186/s12917-019-2105-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 09/20/2019] [Indexed: 11/13/2022] Open
Abstract
Background Total skin electron beam radiation therapy (TSEBT) is an effective treatment for primary diffuse cutaneous lymphomas in humans. While several techniques exist, they all require significant commitment of staff time and resources. In veterinary medicine, canine-specific techniques and strategies have been adapted and delivered but deemed not “realistically” clinically implementable given the time commitment of over 2.5 h plus per fraction or have been relegated to palliative intent. Leveraging these technologies of helical tomotherapy and 3D printing, we developed and clinically implemented a radiotherapeutic treatment strategy for the management of medically refractory diffuse cutaneous lymphoma in the dog. Case presentation A 13.5-year-old female spayed Bichon Frise presented to the Oncology service at Texas A&M University, College of Veterinary Medicine due to the progression of diffuse cutaneous epitheliotropic lymphoma (CEL) that had failed medical management. Twenty-seven gray were delivered to the patient with a treatment time requirement under 40 min including real time monitoring of anesthesia during setup and treatment. A partial response was noticeable after four fractions and the tumor completely regressed progressively over the entire treated area by the end of therapy. A grade 1 lethargy, fatigue, weight loss, and oral mucositis and grade 2 alopecia, nail/claw changes, pruritus, scaling, anorexia, and diarrhea were noted during treatment. Additionally, a grade 3 thrombocytopenia developed after fraction eight requiring a treatment interruption of 6 weeks and prescription modification prior to treatment continuation and completion. From the beginning of total skin photon radiation therapy (TSPT) treatment until the time of the patient was euthanized unrelated to cutaneous epitheliotropic lymphoma (123 days), only one new lesion on the head was identified and confirmed by histopathology within the treated fields. Conclusions The proposed technique is an acceptable alternative to TSEBT that is actually clinically implementable within a palliative or definitive setting and clinical constraints, however further testing and refinement is needed to reduce hematological complications and to confirm and expand on preliminary findings.
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Affiliation(s)
- Michael A Deveau
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX, 77843-4474, USA.
| | - Megan Sutton
- Mission Veterinary Specialty and Emergency, San Antonio, TX, 78249, USA
| | - Courtney Baetge
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX, 77843-4474, USA
| | - Alison B Diesel
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, 4474 TAMU, College Station, TX, 77843-4474, USA
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Chitapanarux I, Nobnop W, Tippanya D, Sripan P, Chakrabandhu S, Klunklin P, Onchan W, Jia-Mahasap B, Tharavichitkul E. Clinical outcomes and dosimetric study of hypofractionated Helical TomoTherapy in breast cancer patients. PLoS One 2019; 14:e0211578. [PMID: 30703145 PMCID: PMC6355009 DOI: 10.1371/journal.pone.0211578] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/16/2019] [Indexed: 11/23/2022] Open
Abstract
We present a single center’s experience of treatment outcomes and dosimetric parameters for breast cancer patients treated with hypofractionated Helical TomoTherapy (HT). This is a retrospective study of one hundred and thirty-six patients with invasive breast cancer treated between March 2012 and October 2016. Dosimetric parameters and 3-year loco-regional failure free survival (LRFFS) were analyzed. Dose to ipsilateral lung, heart and contralateral breast as well as acute and late toxicities were recorded. The median follow-up time is 45 months (range: 5–83). Two patients had loco-regional failure. The 3-year LRFFS was 99%. Acute grade 1 and 2 skin toxicities occurred in 95% and 1%, respectively. Coverage of the target volumes was achieved with the mean ± standard deviation (SD) of homogeneity and conformity index being 0.1 ± 0.04, and 0.8 ± 0.07, respectively. Dose to ipsilateral lung, contralateral breast, and heart was also within the limited constraints regardless of the complexity of target volumes. Only two percent of patients experienced late grade 2 skin toxicity. No late grade 2 subcutaneous tissue toxicity was found. Nine percent of patients developed late grade 1 lung toxicity. Hypofractionated radiotherapy using Helical TomoTherapy in breast irradiation provides excellent 3-year LRFFS and minimal acute and late toxicities. A careful, longer follow-up of healthy tissue effects to lung, heart, and contralateral breast is warranted.
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Affiliation(s)
- Imjai Chitapanarux
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Chiang Mai Cancer Registry, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wannapha Nobnop
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Damrongsak Tippanya
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Patumrat Sripan
- Northern Thai Research Group of Radiation Oncology (NTRG-RO), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Somvilai Chakrabandhu
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pitchayaponne Klunklin
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wimrak Onchan
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Bongkot Jia-Mahasap
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ekkasit Tharavichitkul
- Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Imaging dose of megavoltage computed tomography (MVCT) for treatment verification in the tomotherapy of breast cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2018. [DOI: 10.1017/s1460396917000590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractAimThe purpose of this study was to investigate whether significant difference exists on radiation dose delivered to organs at risks in megavoltage computed tomography (MVCT) verification using three predefined scanning modes, namely fine (2 mm), normal (4 mm) and coarse (6 mm). This will provide information for the imaging protocol of tomotherapy for the left breast.Materials and methodsOrgan doses were measured using thermoluminescent dosimeters (TLD-100) placed within a female Rando phantom for MVCT imaging. Kruskal–Wallis test was conducted with p<0·05 to evaluate the significant difference between the three MVCT scanning modes.ResultsStatistically significant difference existed in organ absorbed dose between different scan mode selections (p<0·001). Relative to the normal scan selection (4 mm), the absorbed dose to the organs of interests can be scaled down by 0·7 and scaled up by 2·1 for coarse (6 mm) and fine scans (2 mm) respectively.ConclusionsOptimisation of imaging protocols is of paramount importance to keep the radiation exposure ‘as low as reasonably achievable’. The recommendation of undergoing daily coarse mode for MVCT verification in breast tomotherapy not only mitigates the radiation exposure to normal tissues, but also trims the scan-acquisition time.
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Meyer P, Le Pennec F, Hui SK, Dehaynin N, Jarnet D, Gantier M, Niederst C, Mazzara C, Baudrier E, Noblet V. Megavoltage 2D topographic imaging: An attractive alternative to megavoltage CT for the localization of breast cancer patients treated with TomoDirect. Phys Med 2017; 39:33-38. [DOI: 10.1016/j.ejmp.2017.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 11/28/2022] Open
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Ricotti R, Ciardo D, Fattori G, Leonardi MC, Morra A, Dicuonzo S, Rojas DP, Pansini F, Cambria R, Cattani F, Gianoli C, Spinelli C, Riboldi M, Baroni G, Orecchia R, Jereczek-Fossa BA. Intra-fraction respiratory motion and baseline drift during breast Helical Tomotherapy. Radiother Oncol 2017; 122:79-86. [DOI: 10.1016/j.radonc.2016.07.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/08/2016] [Accepted: 07/09/2016] [Indexed: 11/30/2022]
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In phantom assessment of superficial doses under TomoTherapy irradiation. Phys Med 2016; 32:1263-1270. [PMID: 27756536 DOI: 10.1016/j.ejmp.2016.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 09/21/2016] [Accepted: 09/23/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Aim of this work is the assessment of build-up and superficial doses of different clinical Head&Neck plans delivered with Helical TomoTherapy (HT) (Accuray, Sunnyvale, CA). Depth dose profiles and superficial dose points were measured in order to evaluate the Treatment Planning System (TPS) capability of an accurate dose modeling in regions of disequilibrium. Geometries and scattering conditions were investigated, similar to the ones generally encountered in clinical treatments. METHODS Measurements were performed with two dosimeters: Gafchromic® EBT3 films (Ashland Inc., Wayne, NJ) and a synthetic single crystal diamond detector (PTW-Frieburg microDiamond, MD). A modified version of the Alderson RANDO phantom was employed to house the detectors. A comparison with TPS data was carried out in terms of dose difference (DD) and distance-to-agreement (DTA). RESULTS DD between calculated data and MD measurements are within 4% even in points with high spatial dose variation. For depth profiles, EBT3 data show a DDmax of 3.3% and DTAmax of 2.2mm, in low and high gradient regions, respectively, and compare well with MD data. EBT3 superficial points always results in measured doses lower than TPS evaluated ones, with a maximum DTA value of 1.5mm. CONCLUSIONS Doses measured with the two devices are in good agreement and compare well with calculated data. The deviations found in the present work are within the reference tolerance level, suggesting that the HT TPS is capable of a precise dose estimation both in superficial regions and in correspondence with interfaces between air and PMMA.
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Galle JO, Chilukuri MB, Buckley SL, Hall MJ, Wilcox LR, Ove R. Tolerance of Superficial Dose to Setup Error With Tomotherapy. Technol Cancer Res Treat 2016; 15:411-5. [DOI: 10.1177/1533034615583760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2015] [Accepted: 03/31/2015] [Indexed: 11/15/2022] Open
Abstract
Background: In cancers of the head and neck, gross tumor or areas at risk of microscopic disease often lie close to the skin, while the skin itself may not be at risk. With intensity-modulated radiotherapy, setup errors can lead to underdosage of superficial structures because the collimator will not by default open beyond the skin surface to apply coverage in the air overlying the skin. Thus, small setup errors can move superficial structures out of field for some beams. Some planning systems allow for manually extrapolating fluence for beams tangential to superficial targets. It is unclear whether this problem is significant with tomotherapy. Methods: A head and neck phantom was utilized. A 3-mm bolus was used to represent the skin and allow placement of dosimeters at 3 mm depth. Thermoluminescent dosimeters were placed at reproducible points on the skin surface and at 3 mm depth. The phantom was irradiated, with the target volume deep to the thermoluminescent dosimeters receiving a dose of 5 Gy. This process was repeated with the phantom displaced 2.5 mm and again with a displacement of 5 mm. These displacements simulated setup errors that in clinical practice would correspond to bending or twisting of the neck that could not be corrected with rotations or translations. Results: When the phantom was displaced 2.5 mm, the dose measured at 3 mm depth was 99.2% (95.9%-102.5%) of the control. With a 5-mm displacement, the dose at 3 mm only dropped to 91.1% (88.8%-93.4%) of the control. Dose measured at skin surface decreased to a greater degree with such setup error. Conclusions: Dose at superficial depths degraded only slightly with 2.5-mm and even 5-mm displacements. With the tomotherapy system, superficial dose appears to be robust to clinically relevant setup errors. However, if the skin is at risk, bolus should be used to ensure adequate coverage.
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Affiliation(s)
- James O. Galle
- University of South Alabama, School of Medicine, Mobile, AL, USA
| | - Madhu B. Chilukuri
- University of South Alabama Mitchell Cancer Institute, Dept of Radiation Oncology, Mobile, AL, USA
| | - Stacey L. Buckley
- University of South Alabama Mitchell Cancer Institute, Dept of Radiation Oncology, Mobile, AL, USA
| | - Martha J. Hall
- University of South Alabama Mitchell Cancer Institute, Dept of Radiation Oncology, Mobile, AL, USA
| | - LaChandra R. Wilcox
- University of South Alabama Mitchell Cancer Institute, Dept of Radiation Oncology, Mobile, AL, USA
| | - Roger Ove
- University of South Alabama Mitchell Cancer Institute, Dept of Radiation Oncology, Mobile, AL, USA
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Batumalai V, Holloway L, Delaney GP. A review of setup error in supine breast radiotherapy using cone-beam computed tomography. Med Dosim 2016; 41:225-9. [DOI: 10.1016/j.meddos.2016.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 02/22/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
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13
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Shimizu H, Sasaki K, Iwata M, Kawai M, Nakashima K, Kubota T, Osaki H, Nakayama M, Yoshimoto M, Kodaira T. Rotational output and beam quality evaluations for helical tomotherapy with use of a third-party quality assurance tool. Radiol Phys Technol 2016; 9:53-9. [DOI: 10.1007/s12194-015-0333-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 10/23/2022]
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Jacob J, Heymann S, Borget I, Dumas I, Riahi E, Maroun P, Ezra P, Roberti E, Rivera S, Deutsch E, Bourgier C. Dosimetric Effects of the Interfraction Variations during Whole Breast Radiotherapy: A Prospective Study. Front Oncol 2015; 5:199. [PMID: 26442211 PMCID: PMC4584980 DOI: 10.3389/fonc.2015.00199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 08/31/2015] [Indexed: 11/27/2022] Open
Abstract
Introduction The aim of this work was to assess the dosimetric impact of the interfraction variations during breast radiotherapy. Materials and methods Daily portal imaging measurements were prospectively performed in 10 patients treated with adjuvant whole breast irradiation (50 Gy/25 fractions). Margins between the clinical target volume and the planning target volume (PTV) were 5 mm in the three dimensions. Parameters of interest were the central lung distance (CLD) and the inferior central margin (ICM). Daily movements were applied to the baseline treatment planning (TP1) to design a further TP (TP2). The PTV coverage and organ at risk exposure were measured on both TP1 and TP2, before being compared. Results A total of 241 portal images were analyzed. The random and systematic errors were 2.6 and 3.7 mm for the CLD, 4.3 and 6.9 mm for the ICM, respectively. No significant consequence on the PTV treatments was observed (mean variations: +0.1%, p = 0.56 and −1.8%, p = 0.08 for the breast and the tumor bed, respectively). The ipsilateral lung and heart exposure was not significantly modified. Conclusion In our series, the daily interfraction variations had no significant effect on the PTV coverage or healthy tissue exposure during breast radiotherapy.
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Affiliation(s)
- Julian Jacob
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Steve Heymann
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Isabelle Borget
- Department of Biostatistics and Epidemiology, Gustave Roussy , Villejuif , France ; University Paris-Sud , Kremlin-Bicêtre , France
| | - Isabelle Dumas
- Department of Physics, Gustave Roussy , Villejuif , France
| | - Elyes Riahi
- Department of Physics, Gustave Roussy , Villejuif , France
| | - Pierre Maroun
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Patrick Ezra
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Elena Roberti
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Sofia Rivera
- Department of Radiotherapy, Gustave Roussy , Villejuif , France
| | - Eric Deutsch
- Department of Radiotherapy, Gustave Roussy , Villejuif , France ; University Paris-Sud , Kremlin-Bicêtre , France
| | - Céline Bourgier
- Department of Oncologic Radiotherapy, Institut du Cancer de Montpellier , Montpellier , France
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Jung JH, Cho KH, Moon SK, Bae SH, Min CK, Kim ES, Yeo SG, Choi JH, Jung JY, Choe BY, Suh TS. Rotation Errors of Breast Cancer on 3D-CRT in TomoDirect. ACTA ACUST UNITED AC 2015. [DOI: 10.14316/pmp.2015.26.1.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jae Hong Jung
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
- Department of Biomedical Engineering and Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul, Korea
| | - Kwang Hwan Cho
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
| | - Seong Kwon Moon
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
| | - Sun Hyun Bae
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
| | - Chul Kee Min
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
| | - Eun Seog Kim
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
| | - Seung-Gu Yeo
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University of Korea, Bucheon, Korea
| | - Jin Ho Choi
- Department of Radiation Oncology, Gachon University Gil Medical Center of Korea, Incheon, Korea
| | - Joo-Yong Jung
- Department of Biomedical Engineering and Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul, Korea
| | - Bo Young Choe
- Department of Biomedical Engineering and Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul, Korea
| | - Tae Suk Suh
- Department of Biomedical Engineering and Research Institute of Biomedical Engineering, The Catholic University of Korea, Seoul, Korea
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Sánchez-Rubio P, Rodríguez-Romero R, Castro-Tejero P. A retrospective tomotherapy image-guidance study: analysis of more than 9,000 MVCT scans for ten different tumor sites. J Appl Clin Med Phys 2014; 15:4663. [PMID: 25493505 PMCID: PMC5711128 DOI: 10.1120/jacmp.v15i6.4663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 06/24/2014] [Accepted: 06/18/2014] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study was to quantify the systematic and random errors for various disease sites when daily MVCT scans are acquired, and to analyze alterna- tive off-line verification protocols (OVP) with respect to the patient setup accuracy achieved. Alignment data from 389 patients (9,418 fractions) treated at ten differ- ent anatomic sites with daily image-guidance (IG) on a helical tomotherapy unit were analyzed. Moreover, six OVP were retrospectively evaluated. For each OVP, the frequency of the residual setup errors and additional margins required were calculated for the treatment sessions without image guidance. The magnitude of the three-dimensional vector displacement and its frequency were evaluated for all OVP. From daily IG, the main global systematic error was in the vertical direction (4.4-9.4 mm), and all rotations were negligible (less than 0.5°) for all anatomic sites. The lowest systematic and random errors were found for H&N and brain patients. All OVP were effective in reducing the mean systematic error to less than 1 mm and 0.2° in all directions and roll corrections for almost all treatment sites. The treatment margins needed to adapt the residual errors should be increased by 2-5 mm for brain and H&N, around 8 mm in the vertical direction for the other anatomic sites, and up to 19 mm in the longitudinal direction for abdomen patients. Almost 70% of the sessions presented a setup error of 3 mm for OVPs with an imaging frequency above 50%. Only for brain patients it would be feasible to apply an OVP because the residual setup error could be compensated for with a slight margin increase. However, daily imaging should be used for anatomic sites of difficult immobilization and/or large interfraction movement.
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Feng CH, Gerry E, Chmura SJ, Hasan Y, Al-Hallaq HA. An image-guided study of setup reproducibility of postmastectomy breast cancer patients treated with inverse-planned intensity modulated radiation therapy. Int J Radiat Oncol Biol Phys 2014; 91:58-64. [PMID: 25442344 DOI: 10.1016/j.ijrobp.2014.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/09/2014] [Accepted: 09/02/2014] [Indexed: 12/25/2022]
Abstract
PURPOSE To calculate planning target volume (PTV) margins for chest wall and regional nodal targets using daily orthogonal kilovolt (kV) imaging and to study residual setup error after kV alignment using volumetric cone-beam computed tomography (CBCT). METHODS AND MATERIALS Twenty-one postmastectomy patients were treated with intensity modulated radiation therapy with 7-mm PTV margins. Population-based PTV margins were calculated from translational shifts after daily kV positioning and/or weekly CBCT data for each of 8 patients, whose surgical clips were used as surrogates for target volumes. Errors from kV and CBCT data were mathematically combined to generate PTV margins for 3 simulated alignment workflows: (1) skin marks alone; (2) weekly kV imaging; and (3) daily kV imaging. RESULTS The kV data from 613 treatment fractions indicated that a 7-mm uniform margin would account for 95% of daily shifts if patients were positioned using only skin marks. Total setup errors incorporating both kV and CBCT data were larger than those from kV alone, yielding PTV expansions of 7 mm anterior-posterior, 9 mm left-right, and 9 mm superior-inferior. Required PTV margins after weekly kV imaging were similar in magnitude as alignment to skin marks, but rotational adjustments of patients were required in 32% ± 17% of treatments. These rotations would have remained uncorrected without the use of daily kV imaging. Despite the use of daily kV imaging, CBCT data taken at the treatment position indicate that an anisotropic PTV margin of 6 mm anterior-posterior, 4 mm left-right, and 8 mm superior-inferior must be retained to account for residual errors. CONCLUSIONS Cone-beam CT provides additional information on 3-dimensional reproducibility of treatment setup for chest wall targets. Three-dimensional data indicate that a uniform 7-mm PTV margin is insufficient in the absence of daily IGRT. Interfraction movement is greater than suggested by 2-dimensional imaging, thus a margin of at least 4 to 8 mm must be retained despite the use of daily IGRT.
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Affiliation(s)
- Christine H Feng
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois
| | - Emily Gerry
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois
| | - Steven J Chmura
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois
| | - Yasmin Hasan
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois
| | - Hania A Al-Hallaq
- Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, Illinois.
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Agostinelli S, Garelli S, Bellini A, Pupillo F, Guenzi M, Bosetti D, Blandino G, Taccini G. Helical Tomotherapy of the breast: can thermoplastic immobilization improve the reproducibility of the treatment setup and the accuracy of the delivered dose? Phys Med 2014; 31:49-53. [PMID: 25281291 DOI: 10.1016/j.ejmp.2014.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/31/2014] [Accepted: 09/09/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate the impact of thermoplastic mask immobilization in the setup reproducibility and delivered dose for Helical Tomotherapy (HT) of the breast/chest wall. METHODS 16 patients treated with Accuray Hi-Art HT for breast-cancer were considered. Patients were positioned supine with arms extended above the head using Civco Wing Board (WB) system. In 50% of patients an Orfit thermoplastic mask was added in order to improve immobilization. Before each treatment fraction a megavoltage CT (MVCT) scan was taken and registered to the planning CT by experienced medical staff. The impact of thermoplastic mask was investigated analysing MVCT shift-roll data and MVCT dose distribution using Planned Adaptive software. RESULTS In the analysed cases, the addition of thermoplastic mask had minor impact on the lateral, longitudinal and roll data distribution. Variance of vertical shifts was significantly reduced in the WB + Orfit group. Van Herk's margins were not affected by addition of thermoplastic immobilization. In both groups, target coverage (V95) and maximum dose (D1) were almost identical to planned values. D1 of organs at risk were not significantly different in the two groups. CONCLUSIONS Analysis of shift-roll data shows no improvement in the group of patients immobilized with the addition of thermoplastic mask. Van Herk's margin is quite large (7-10 mm) in both groups evidencing the need to perform daily setup correction. The adapted dose distribution complies well with the planned one, showing that if MVCT is used before each treatment fraction, a 3 mm margin (setup component) for CTVs expansion could be adequate.
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Affiliation(s)
- S Agostinelli
- UOC Fisica Medica e Sanitaria, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy.
| | - S Garelli
- UOC Fisica Medica e Sanitaria, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
| | - A Bellini
- UOC Fisica Medica e Sanitaria, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
| | - F Pupillo
- UOC Fisica Medica e Sanitaria, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
| | - M Guenzi
- UOC Oncologia Radioterapica, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
| | - D Bosetti
- UOC Oncologia Radioterapica, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
| | - G Blandino
- UOC Oncologia Radioterapica, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
| | - G Taccini
- UOC Fisica Medica e Sanitaria, IRCCS AOU San Martino - IST, L.go R. Benzi 10, 16132 Genova, Italy
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Liem X, Chira C, Fourquet A, Campana F, Peurien D, Fournier-Bidoz N, Kirova Y. Résultats préliminaires d’une tomothérapie hélicoïdale adjuvante avec boost intégré dans le cadre d’un traitement conservateur d’un cancer du sein. Cancer Radiother 2014; 18:15-22. [DOI: 10.1016/j.canrad.2013.07.149] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/22/2013] [Accepted: 07/03/2013] [Indexed: 12/24/2022]
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Dzintars E, Papanikolaou N, Mavroidis P, Sadeghi A, Stathakis S. Application of an independent dose calculation software for estimating the impact of inter-fractional setup shifts in Helical Tomotherapy treatments. Phys Med 2013; 29:615-23. [PMID: 23044458 DOI: 10.1016/j.ejmp.2012.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 09/04/2012] [Accepted: 09/10/2012] [Indexed: 12/25/2022] Open
Abstract
The purpose of this study is to validate the capability of in-house independent point dose calculation software to be used as a second check for Helical Tomotherapy treatment plans. The software performed its calculations in homogenous conditions (using the Cheese phantom, which is a cylindrical phantom with radius 15 cm and length 18 cm) using a factor-based algorithm. Fifty patients, who were treated for pelvic (10), prostate (14), lung (10), head & neck (12) and brain (4) cancers, were used. Based on the individual patient kVCT images and the pretreatment MVCT images for each treatment fraction, the corresponding daily patient setup shifts in the IEC-X, IEC-Y, and IEC-Z directions were registered. For each patient, the registered fractional setup shifts were grouped into systematic and random shifts. The average systematic dosimetric variations showed small dose deviation for the different cancer types (1.0%-3.0%) compared to the planned dose. Of the fifty patients, only three had percent differences larger than 5%. The average random dosimetric variations showed relatively small dose deviations (0.2%-1.1%) compared to the planned dose. None of the patients had percent differences larger than 5%. By examining the individual fractions of each patient, it is observed that only in 31 out of 1358 fractions the percent differences exceeded the border of 5%. These results indicate that the overall dosimetric impact from systematic and random variations is small and that the software is a capable platform for independent point dose validation for the Helical Tomotherapy modality.
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Affiliation(s)
- Erik Dzintars
- Department of Radiation Oncology, University of Texas Health Science Center, San Antonio, TX, USA
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Quinn A, Holloway L, Hardcastle N, Tomé WA, Rosenfeld A, Metcalfe P. Normal tissue dose and second cancer risk due to megavoltage fan-beam CT, static tomotherapy and helical tomotherapy in breast radiotherapy. Radiother Oncol 2013; 108:266-8. [DOI: 10.1016/j.radonc.2013.05.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 05/13/2013] [Accepted: 05/21/2013] [Indexed: 11/25/2022]
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Avanzo M, Drigo A, Ren Kaiser S, Roggio A, Sartor G, Chiovati P, Franchin G, Mascarin M, Capra E. Dose to the skin in helical tomotherapy: Results of in vivo measurements with radiochromic films. Phys Med 2013; 29:304-11. [DOI: 10.1016/j.ejmp.2012.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 04/10/2012] [Accepted: 04/14/2012] [Indexed: 12/21/2022] Open
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Michalski A, Atyeo J, Cox J, Rinks M. Inter- and intra-fraction motion during radiation therapy to the whole breast in the supine position: A systematic review. J Med Imaging Radiat Oncol 2012; 56:499-509. [DOI: 10.1111/j.1754-9485.2012.02434.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 04/25/2012] [Indexed: 11/28/2022]
Affiliation(s)
| | - John Atyeo
- Faculty of Health Science (MRS) Radiation Therapy; The University of Sydney
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Capelle L, Warkentin H, MacKenzie M, Joseph K, Gabos Z, Pervez N, Tankel K, Chafe S, Amanie J, Ghosh S, Parliament M, Abdulkarim B. Skin-sparing Helical Tomotherapy vs 3D-conformal Radiotherapy for Adjuvant Breast Radiotherapy: In Vivo Skin Dosimetry Study. Int J Radiat Oncol Biol Phys 2012; 83:e583-90. [DOI: 10.1016/j.ijrobp.2012.01.086] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 01/06/2012] [Accepted: 01/30/2012] [Indexed: 10/28/2022]
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Effect of Breast Volume on Treatment Reproducibility on a Tomotherapy Unit in the Treatment of Breast Cancer. Int J Radiat Oncol Biol Phys 2011; 80:417-21. [DOI: 10.1016/j.ijrobp.2010.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 02/11/2010] [Accepted: 02/16/2010] [Indexed: 11/17/2022]
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Ito S, Parker BC, Levine R, Sanders ME, Fontenot J, Gibbons J, Hogstrom K. Verification of calculated skin doses in postmastectomy helical tomotherapy. Int J Radiat Oncol Biol Phys 2011; 81:584-91. [PMID: 21300469 DOI: 10.1016/j.ijrobp.2010.11.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 09/22/2010] [Accepted: 11/09/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE To verify the accuracy of calculated skin doses in helical tomotherapy for postmastectomy radiation therapy (PMRT). METHODS AND MATERIALS In vivo thermoluminescent dosimeters (TLDs) were used to measure the skin dose at multiple points in each of 14 patients throughout the course of treatment on a TomoTherapy Hi·Art II system, for a total of 420 TLD measurements. Five patients were evaluated near the location of the mastectomy scar, whereas 9 patients were evaluated throughout the treatment volume. The measured dose at each location was compared with calculations from the treatment planning system. RESULTS The mean difference and standard error of the mean difference between measurement and calculation for the scar measurements was -1.8% ± 0.2% (standard deviation [SD], 4.3%; range, -11.1% to 10.6%). The mean difference and standard error of the mean difference between measurement and calculation for measurements throughout the treatment volume was -3.0% ± 0.4% (SD, 4.7%; range, -18.4% to 12.6%). The mean difference and standard error of the mean difference between measurement and calculation for all measurements was -2.1% ± 0.2% (standard deviation, 4.5%: range, -18.4% to 12.6%). The mean difference between measured and calculated TLD doses was statistically significant at two standard deviations of the mean, but was not clinically significant (i.e., was <5%). However, 23% of the measured TLD doses differed from the calculated TLD doses by more than 5%. CONCLUSIONS The mean of the measured TLD doses agreed with TomoTherapy calculated TLD doses within our clinical criterion of 5%.
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Affiliation(s)
- Shima Ito
- Department of Physics and Astronomy, Louisiana State University and Agricultural and Mechanical College, Baton Rouge, LA, USA
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