1
|
Duan L, Qi W, Chen Y, Cao L, Chen J, Zhang Y, Xu C. Evaluation of complexity and deliverability of IMRT treatment plans for breast cancer. Sci Rep 2023; 13:21474. [PMID: 38052915 PMCID: PMC10698170 DOI: 10.1038/s41598-023-48331-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/25/2023] [Indexed: 12/07/2023] Open
Abstract
This study aimed to predict the outcome of patient specific quality assurance (PSQA) in IMRT for breast cancer using complexity metrics, such as MU factor, MAD, CAS, MCS. Several breast cancer plans were considered, including LBCS, RBCS, LBCM, RBCM, left breast, right breast and the whole breast for both Edge and TrueBeam LINACS. Dose verification was completed by Portal Dosimetry (PD). The receiver operating characteristic (ROC) curve was employed to determine whether the treatment plans pass or failed. The area under the curve (AUC) was used to assess the classification performance. The correlation of PSQA and complexity metrics was examined using Spearman's rank correlation coefficient (Rs). For LINACS, the most suitable complexity metric was found to be the MU factor (Edge Rs = - 0.608, p < 0.01; TrueBeam Rs = - 0.739, p < 0.01). Regarding the specific breast cancer categories, the optimal complexity metrics were as follows: MAD (AUC = 0.917) for LBCS, MCS (AUC = 0.681) for RBCS, MU factor (AUC = 0.854) for LBCM and MAD (AUC = 0.731) for RBCM. On the Edge LINAC, the preferable method for breast cancers was MCS (left breast, AUC = 0.938; right breast, AUC = 0.813), while on the TrueBeam LINAC, it became MU factor (left breast, AUC = 0.950) and MCS (right breast, AUC = 0.806), respectively. Overall, there was no universally suitable complexity metric for all types of breast cancers. The choice of complexity metric depended on different cancer types, locations and treatment LINACs. Therefore, when utilizing complexity metrics to predict PSQA outcomes in IMRT for breast cancer, it was essential to select the appropriate metric based on the specific circumstances and characteristics of the treatment.
Collapse
Affiliation(s)
- Longyan Duan
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Weixiang Qi
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Lu Cao
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jiayi Chen
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yibin Zhang
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Cheng Xu
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| |
Collapse
|
2
|
Ma Y, Wang X, Mai R, Wang T, Pei Y, Liu S, Guo Y. An electronic portal image device (EPID)-based multiplatform rapid daily LINAC QA tool. J Appl Clin Med Phys 2021; 22:45-58. [PMID: 33410254 PMCID: PMC7856503 DOI: 10.1002/acm2.13055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 08/07/2020] [Accepted: 09/11/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To develop an efficient and economic daily quality research tool (DQRT) for daily check of multiplatform linear accelerators (LINACs) with flattening filter (FF) and flattening filter-free (FFF) photon beams by using an Electronic Portal Image Device (EPID). MATERIALS AND METHODS After EPID calibration, the monitored parameters were analyzed from a 10 cm × 10 cm open and 60° wedge portal images measured by the EPID with 100 MU exposure. Next, the repeatability of the EPID position accuracy, long-term stability, and linearity between image gray value and exposure were verified. Output and beam quality stability of the 6-MV FF and FFF beams measured by DQRT with the introduced setup errors of EPID were also surveyed. Besides, some test results obtained by DQRT were compared with those measured by FC65-G and Matrixx. At last, the tool was evaluated on three LINACs (Synergy, VersaHD, TrueBeam) for 2 months with two popular commercial QA tools as references. RESULTS There are no differences between repeatability tests for all monitored parameters. Image grayscale values obtained by EPID and exposure show good linearity. Either 6 MV FF or FFF photon beam shows minimal impact to the results. The differences between FC65-G, Matrixx and DQRT results are negligible. Monitor results of the two commercial tools are consistent with the DQRT results collected during the 2-month period. CONCLUSION With a shorter time and procedure, the DQRT is useful to daily QA works of LINACs, producing a QA result quality similarly to or more better than the traditional tools and giving richer contents to the QA results. For hospitals with limited QA time window available or lack of funding to purchase commercial QA tools, the proposed DQRT can provide an alternative and economic approach to accomplish the task of daily QA for LINACs.
Collapse
Affiliation(s)
- Yangguang Ma
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xuemin Wang
- Department of Radiotherapy Hospital Unit Radiation Therapy, Shaanxi Provincial Tumor Hospital, Xi'an, China
| | - Rizhen Mai
- Department of Medical Equipment, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tao Wang
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuntong Pei
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuaipeng Liu
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuexin Guo
- Department of Radiation Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
3
|
Shimozato T, Okudaira K. [Dose Distribution Combinations of Different Electron Beam Energy for Treatment Region Expansion in High-energy Electron Beam Radiation Therapy: A Feasibility Study]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2020; 76:259-269. [PMID: 32201416 DOI: 10.6009/jjrt.2020_jsrt_76.3.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION External electron beams have excellent distributions in treatment for superficial tumors while suppressing influence deeper normal tissue. However, the skin surface cannot be given a sufficient dose due to the build-up effect. In this study, we have investigated the combination of electron beams to expand the treatment region by keeping the dose gradient beyond dmax. MATERIALS AND METHODS The percentage depth doses of different electron beams were superimposed on a spreadsheet to determine the combinations of electron beams so that the treatment range was maximized. Based on the obtained weight for electron beams, dose distributions were calculated using a treatment planning system and examined for potential clinical application. RESULTS With the combination of 4 MeV and 9 MeV electron beams, the 90% treatment range in the depth direction increased by 8.0 mm, and with 4 MeV and 12 MeV beams, it increased by 4.0 mm, with the same maximum dose depth and halfdose depth of the absorbed dose. The dose calculations were performed using the treatment planning system yielded similar results with a matching degree of ±1.5%. CONCLUSIONS Although the influences of low monitor unit values and daily output differences remain to be considered, the results suggest that the proposed approach can be clinically applied to expand treatment regions easily.
Collapse
Affiliation(s)
- Tomohiro Shimozato
- Department of Radiological Technology, Faculty of Health Science, Gifu University of Medical Science
| | | |
Collapse
|
4
|
Cai B, He Y, Bollinger D, Li H, Goddu SM, Mutic S, Sun B. Three year experience of electronic portal imaging device based daily QA for photon radiation beams. Biomed Phys Eng Express 2018. [DOI: 10.1088/2057-1976/aae419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
5
|
González-López A. A multiresolution processing method for contrast enhancement in portal imaging. Phys Med Biol 2018; 63:145003. [DOI: 10.1088/1361-6560/aacd19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
6
|
Agarwal A, Rastogi N, Maria Das KJ, Yoganathan SA, Udayakumar D, Kumar S. Investigating the Electronic Portal Imaging Device for Small Radiation Field Measurements. J Med Phys 2017; 42:59-64. [PMID: 28706350 PMCID: PMC5496271 DOI: 10.4103/jmp.jmp_131_16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Purpose: With the advent of state-of-the-art treatment technologies, the use of small fields has increased, and dosimetry in small fields is highly challenging. In this study, the potential use of Varian electronic portal imaging device (EPID) for small field measurements was explored for 6 and 15 MV photon beams. Materials and Methods: The output factors and profiles were measured for a range of jaw-collimated square field sizes starting from 0.8 cm × 0.8 cm to 10 cm × 10 cm using EPID. For evaluation purpose, reference data were acquired using Exradin A16 microionization chamber (0.007 cc) for output factors and stereotactic field diode for profile measurements in a radiation field analyzer. Results: The output factors of EPID were in agreement with the reference data for field sizes down to 2 cm × 2 cm and for 2 cm × 2 cm; the difference in output factors was +2.06% for 6 MV and +1.56% for 15 MV. For the lowest field size studied (0.8 cm × 0.8 cm), the differences were maximum; +16% for 6 MV and +23% for 15 MV photon beam. EPID profiles of both energies were closely matching with reference profiles for field sizes down to 2 cm × 2 cm; however, penumbra and measured field size of EPID profiles were slightly lower compared to its counterpart. Conclusions: EPID is a viable option for profile and output factor measurements for field sizes down to 2 cm × 2 cm in the absence of appropriate small field dosimeters.
Collapse
Affiliation(s)
- Arpita Agarwal
- Department of Physics, School of Sciences, IFTM University, Moradabad, Uttar Pradesh, India
| | - Nikhil Rastogi
- Department of Physics, School of Sciences, IFTM University, Moradabad, Uttar Pradesh, India
| | - K J Maria Das
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - S A Yoganathan
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - D Udayakumar
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shaleen Kumar
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
7
|
Use of electronic portal imaging devices for electron treatment verification. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2015; 39:199-209. [PMID: 26581763 DOI: 10.1007/s13246-015-0401-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/04/2015] [Indexed: 11/27/2022]
Abstract
This study aims to help broaden the use of electronic portal imaging devices (EPIDs) for pre-treatment patient positioning verification, from photon-beam radiotherapy to photon- and electron-beam radiotherapy, by proposing and testing a method for acquiring clinically-useful EPID images of patient anatomy using electron beams, with a view to enabling and encouraging further research in this area. EPID images used in this study were acquired using all available beams from a linac configured to deliver electron beams with nominal energies of 6, 9, 12, 16 and 20 MeV, as well as photon beams with nominal energies of 6 and 10 MV. A widely-available heterogeneous, approximately-humanoid, thorax phantom was used, to provide an indication of the contrast and noise produced when imaging different types of tissue with comparatively realistic thicknesses. The acquired images were automatically calibrated, corrected for the effects of variations in the sensitivity of individual photodiodes, using a flood field image. For electron beam imaging, flood field EPID calibration images were acquired with and without the placement of blocks of water-equivalent plastic (with thicknesses approximately equal to the practical range of electrons in the plastic) placed upstream of the EPID, to filter out the primary electron beam, leaving only the bremsstrahlung photon signal. While the electron beam images acquired using a standard (unfiltered) flood field calibration were observed to be noisy and difficult to interpret, the electron beam images acquired using the filtered flood field calibration showed tissues and bony anatomy with levels of contrast and noise that were similar to the contrast and noise levels seen in the clinically acceptable photon beam EPID images. The best electron beam imaging results (highest contrast, signal-to-noise and contrast-to-noise ratios) were achieved when the images were acquired using the higher energy electron beams (16 and 20 MeV) when the EPID was calibrated using an intermediate (12 MeV) electron beam energy. These results demonstrate the feasibility of acquiring clinically-useful EPID images of patient anatomy using electron beams and suggest important avenues for future investigation, thus enabling and encouraging further research in this area. There is manifest potential for the EPID imaging method proposed in this work to lead to the clinical use of electron beam imaging for geometric verification of electron treatments in the future.
Collapse
|
8
|
Sun B, Goddu SM, Yaddanapudi S, Noel C, Li H, Cai B, Kavanaugh J, Mutic S. Daily QA of linear accelerators using only EPID and OBI. Med Phys 2015; 42:5584-94. [DOI: 10.1118/1.4929550] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
|