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Huang Y, Qin T, Yang M, Liu Z. Impact of ovary-sparing treatment planning on plan quality, treatment time and gamma passing rates in intensity-modulated radiotherapy for stage I/II cervical cancer. Medicine (Baltimore) 2023; 102:e36373. [PMID: 38115303 PMCID: PMC10727547 DOI: 10.1097/md.0000000000036373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND This study aimed to investigate the impact of ovary-sparing intensity-modulated radiotherapy (IMRT) on plan quality, treatment time, and gamma passing rates for stage I/II cervical cancer patients. METHODS Fifteen stage I/II cervical cancer patients were retrospectively enrolled, and a pair of clinically suitable IMRT plans were designed for each patient, with (Group A) and without (Group B) ovary-sparing. Plan factors affecting plan quality, treatment time, and gamma passing rates, including the number of segments, monitor units, percentage of small-area segments (field area < 20 cm2), and percentage of small-MU segments (MU < 10), were compared and statistically analyzed. Key plan quality indicators, including ovarian dose, target dose coverage (D98%, D95%, D50%, D2%), conformity index, and homogeneity index, were evaluated and statistically assessed. Treatment time and gamma passing rates collected by IBA MatriXX were also compared. RESULTS The median ovarian dose in Group A and Group B was 7.61 Gy (range 6.71-8.51 Gy) and 38.52 Gy (range 29.84-43.82 Gy), respectively. Except for monitor units, all other plan factors were significantly lower in Group A than in Group B (all P < .05). Correlation coefficients between plan factors, treatment time, and gamma passing rates that were statistically different were all negative. Both Groups of plans met the prescription requirement (D95% ≥ 45.00 Gy) for clinical treatment. D98% was smaller for Group A than for Group B (P < .05); D50% and D2% were larger for Group A than for Group B (P < .05, P < .05). Group A plans had worse conformity index and homogeneity index than Group B plans (P < .05, P < .05). Treatment time did not differ significantly (P > .05). Gamma passing rates in Group A were higher than in Group B with the criteria of 2%/3 mm (P < .05) and 3%/2 mm (P < .05). CONCLUSION Despite the slightly decreased quality of the treatment plans, the ovary-sparing IMRT plans exhibited several advantages including lower ovarian dose and plan complexity, improved gamma passing rates, and a negligible impact on treatment time.
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Affiliation(s)
- Yangyang Huang
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Tingting Qin
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Menglin Yang
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - Zongwen Liu
- Department of Radiotherapy, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
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Tanaka S, Kadoya N, Ishizawa M, Katsuta Y, Arai K, Takahashi H, Xiao Y, Takahashi N, Sato K, Takeda K, Jingu K. Evaluation of Unity 1.5 T MR-linac plan quality in patients with prostate cancer. J Appl Clin Med Phys 2023; 24:e14122. [PMID: 37559561 PMCID: PMC10691646 DOI: 10.1002/acm2.14122] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/26/2023] [Accepted: 07/31/2023] [Indexed: 08/11/2023] Open
Abstract
The Unity magnetic resonance (MR) linear accelerator (MRL) with MR-guided adaptive radiotherapy (MRgART) is capable of online MRgART where images are acquired on the treatment day and the radiation treatment plan is immediately replanned and performed. We evaluated the MRgART plan quality and plan reproducibility of the Unity MRL in patients with prostate cancer. There were five low- or moderate-risk and five high-risk patients who received 36.25 Gy or 40 Gy, respectively in five fractions. All patients underwent simulation magnetic resonance imaging (MRI) and five online adaptive MRI. We created plans for 5, 7, 9, 16, and 20 beams and for 60, 100, and 150 segments. We evaluated the target and organ doses for different number of beams and segments, respectively. Variation in dose constraint between the simulation plan and online adaptive plan was measured for each patient to assess plan reproducibility. The plan quality improved with the increasing number of beams. However, the proportion of significantly improved dose constraints decreased as the number of beams increased. For some dose parameters, there were statistically significant differences between 60 and 100 segments, and 100 and 150 segments. The plan of five beams exhibited limited reproducibility. The number of segments had minimal impact on plan reproducibility, but 60 segments sometimes failed to meet dose constraints for online adaptive plan. The optimization and delivery time increased with the number of beams and segments. We do not recommend using five or fewer beams for a reproducible and high-quality plan in the Unity MRL. In addition, many number of segments and beams may help meet dose constraints during online adaptive plan. Treatment with the Unity MRL should be performed with the appropriate number of beams and segments to achieve a good balance among plan quality, delivery time, and optimization time.
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Affiliation(s)
- Shohei Tanaka
- Department of Radiation OncologyTohoku University Graduate School of MedicineSendaiJapan
| | - Noriyuki Kadoya
- Department of Radiation OncologyTohoku University Graduate School of MedicineSendaiJapan
| | - Miyu Ishizawa
- Department of Radiological TechnologySchool of Health SciencesFaculty of MedicineTohoku UniversitySendaiJapan
| | - Yoshiyuki Katsuta
- Department of Radiation OncologyTohoku University Graduate School of MedicineSendaiJapan
| | - Kazuhiro Arai
- Department of Radiation OncologyTohoku University Graduate School of MedicineSendaiJapan
| | - Haruna Takahashi
- Department of Radiation OncologyTohoku University Graduate School of MedicineSendaiJapan
| | - Yushan Xiao
- Department of Radiation OncologyTohoku University Graduate School of MedicineSendaiJapan
| | - Noriyoshi Takahashi
- Department of Radiation OncologyTohoku University Graduate School of MedicineSendaiJapan
| | - Kiyokazu Sato
- Radiation TechnologyTohoku University HospitalSendaiJapan
| | - Ken Takeda
- Department of Radiological TechnologySchool of Health SciencesFaculty of MedicineTohoku UniversitySendaiJapan
| | - Keiichi Jingu
- Department of Radiation OncologyTohoku University Graduate School of MedicineSendaiJapan
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Ramesh P, Valdes G, O'Connor D, Sheng K. A unified path seeking algorithm for IMRT and IMPT beam orientation optimization. Phys Med Biol 2023; 68:195011. [PMID: 37659406 DOI: 10.1088/1361-6560/acf63f] [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: 05/31/2023] [Accepted: 09/01/2023] [Indexed: 09/04/2023]
Abstract
Objective. Fully automated beam orientation optimization (BOO) for intensity-modulated radiotherapy and intensity modulated proton therapy (IMPT) is gaining interest, since achieving optimal plan quality for an unknown number of fixed beam arrangements is tedious. Fast group sparsity-based optimization methods have been proposed to find the optimal orientation, but manual tuning is required to eliminate the exact number of beams from a large candidate set. Here, we introduce a fast, automated gradient descent-based path-seeking algorithm (PathGD), which performs fluence map optimization for sequentially added beams, to visualize the dosimetric benefit of one added field at a time.Approach. Several configurations of 2-4 proton and 5-15 photon beams were selected for three head-and-neck patients using PathGD, which was compared to group sparsity-regularized BOO solved with the fast iterative shrinkage-thresholding algorithm (GS-FISTA), and manually selected IMPT beams or one coplanar photon VMAT arc (MAN). Once beams were chosen, all plans were compared on computational efficiency, dosimetry, and for proton plans, robustness.Main results. With each added proton beam, Clinical Target Volume (CTV) and organs at risk (OAR) dosimetric cost improved on average across plans by [1.1%, 13.6%], and for photons, [0.6%, 2.0%]. Comparing algorithms, beam selection for PathGD was faster than GS-FISTA on average by 35%, and PathGD matched the CTV coverage of GS-FISTA plans while reducing OAR mean and maximum dose in all structures by an average of 13.6%. PathGD was able to improve CTV [Dmax, D95%] by [2.6%, 5.2%] and reduced worst-case [max, mean] dose in OARs by [11.1%, 13.1%].Significance. The benefit of a path-seeking algorithm is the beam-by-beam analysis of dosimetric cost. PathGD was shown to be most efficient and dosimetrically desirable amongst group sparsity and manual BOO methods, and highlights the sensitivity of beam addition for IMPT in particular.
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Affiliation(s)
- Pavitra Ramesh
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA 90095, United States of America
| | - Gilmer Valdes
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143, United States of America
| | - Daniel O'Connor
- Department of Mathematics and Statistics, University of San Francisco, San Francisco, CA, 94117, United States of America
| | - Ke Sheng
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, 94143, United States of America
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Shimizu H, Sasaki K, Tanaka H, Aoyama T, Tachibana H, Koide Y, Iwata T, Kitagawa T, Kodaira T. Dosimetric effects of dose calculation grid size on the epidural space dose. Med Dosim 2020; 45:327-333. [DOI: 10.1016/j.meddos.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/18/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
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Fourie N, Ali OA, Rae WID. Development and verification of a time delivery model for prostate intensity modulated radiotherapy using a Siemens® Artiste™ 160 Multi-leaf Collimator Linac. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2017; 40:51-56. [DOI: 10.1007/s13246-016-0518-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 12/24/2016] [Indexed: 11/30/2022]
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Müller BS, Wilkens JJ. Prioritized efficiency optimization for intensity modulated proton therapy. Phys Med Biol 2016; 61:8249-8265. [DOI: 10.1088/0031-9155/61/23/8249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kim JI, Chung JB, Song JY, Kim SK, Choi Y, Choi CH, Choi WH, Cho B, Kim JS, Kim SJ, Ye SJ. Confidence limits for patient-specific IMRT dose QA: a multi-institutional study in Korea. J Appl Clin Med Phys 2016; 17:62-69. [PMID: 26894332 PMCID: PMC5690221 DOI: 10.1120/jacmp.v17i1.5607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 09/26/2015] [Accepted: 09/23/2015] [Indexed: 11/23/2022] Open
Abstract
This study aims to investigate tolerance levels for patient-specific IMRT dose QA (DQA) using the confidence limits (CL) determined by a multi-institutional study. Eleven institutions participated in the multi-institutional study in Korea. A total of 155 DQA measurements, consisting of point-dose differences (high- and low-dose regions) and gamma passing rates (composite and per-field) for IMRT patients with brain, head and neck (H&N), abdomen, and prostate cancers were examined. The Shapiro-Wilk test was used to evaluate the normality of data grouped by the treatment sites and the DQA methods. The confidence limit coefficients in cases of the normal distribution, and the two-sided Student's t-distribution were applied to determine the confidence limits for the grouped data. The Spearman's test was applied to assess the sensitivity of DQA results within the limited groups. The differences in CLs between the two confidence coefficients based on the normal and t-distributions were negligible for the point-dose data and the gamma passing rates with 3%/3 mm criteria. However, with 2%/2 mm criteria, the difference in CLs were 1.6% and 2.2% for composite and per-field measurements, respectively. This resulted from the large standard deviation and the more sensitive criteria of 2%/2 mm. There was no noticeable correlation among the different QA methods. Our multi-institutional study suggested that the CL was not a suitable metric for defining the tolerance level when the statistics of the sample group did not follow the normality and had a large standard deviation.
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Wang J, Jin X, Zhao K, Peng J, Xie J, Chen J, Zhang Z, Studenski M, Hu W. Patient feature based dosimetric Pareto front prediction in esophageal cancer radiotherapy. Med Phys 2015; 42:1005-11. [PMID: 25652513 DOI: 10.1118/1.4906252] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To investigate the feasibility of the dosimetric Pareto front (PF) prediction based on patient's anatomic and dosimetric parameters for esophageal cancer patients. METHODS Eighty esophagus patients in the authors' institution were enrolled in this study. A total of 2928 intensity-modulated radiotherapy plans were obtained and used to generate PF for each patient. On average, each patient had 36.6 plans. The anatomic and dosimetric features were extracted from these plans. The mean lung dose (MLD), mean heart dose (MHD), spinal cord max dose, and PTV homogeneity index were recorded for each plan. Principal component analysis was used to extract overlap volume histogram (OVH) features between PTV and other organs at risk. The full dataset was separated into two parts; a training dataset and a validation dataset. The prediction outcomes were the MHD and MLD. The spearman's rank correlation coefficient was used to evaluate the correlation between the anatomical features and dosimetric features. The stepwise multiple regression method was used to fit the PF. The cross validation method was used to evaluate the model. RESULTS With 1000 repetitions, the mean prediction error of the MHD was 469 cGy. The most correlated factor was the first principal components of the OVH between heart and PTV and the overlap between heart and PTV in Z-axis. The mean prediction error of the MLD was 284 cGy. The most correlated factors were the first principal components of the OVH between heart and PTV and the overlap between lung and PTV in Z-axis. CONCLUSIONS It is feasible to use patients' anatomic and dosimetric features to generate a predicted Pareto front. Additional samples and further studies are required improve the prediction model.
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Affiliation(s)
- Jiazhou Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xiance Jin
- The 1st Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000, China
| | - Kuaike Zhao
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiayuan Peng
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiang Xie
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Junchao Chen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Matthew Studenski
- Department of Radiation Oncology, University of Miami-Miller School of Medicine, Miami, Florida 33136
| | - Weigang Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China and Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
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Huang B, Wu L, Lin P, Chen C. Dose calculation of Acuros XB and Anisotropic Analytical Algorithm in lung stereotactic body radiotherapy treatment with flattening filter free beams and the potential role of calculation grid size. Radiat Oncol 2015; 10:53. [PMID: 25886628 PMCID: PMC4353664 DOI: 10.1186/s13014-015-0357-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/15/2015] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The study aimed to appraise the dose differences between Acuros XB (AXB) and Anisotropic Analytical Algorithm (AAA) in stereotactic body radiotherapy (SBRT) treatment for lung cancer with flattening filter free (FFF) beams. Additionally, the potential role of the calculation grid size (CGS) on the dose differences between the two algorithms was also investigated. METHODS SBRT plans with 6X and 10X FFF beams produced from the CT scan data of 10 patients suffering from stage I lung cancer were enrolled in this study. Clinically acceptable treatment plans with AAA were recalculated using AXB with the same monitor units (MU) and identical multileaf collimator (MLC) settings. Furthermore, different CGS (2.5 mm and 1 mm) in the two algorithms was also employed to investigate their dosimetric impact. Dose to planning target volumes (PTV) and organs at risk (OARs) between the two algorithms were compared. PTV was separated into PTV_soft (density in soft-tissue range) and PTV_lung (density in lung range) for comparison. RESULTS The dose to PTV_lung predicted by AXB was found to be 1.33 ± 1.12% (6XFFF beam with 2.5 mm CGS), 2.33 ± 1.37% (6XFFF beam with 1 mm CGS), 2.81 ± 2.33% (10XFFF beam with 2.5 mm CGS) and 3.34 ± 1.76% (10XFFF beam with 1 mm CGS) lower compared with that by AAA, respectively. However, the dose directed to PTV_soft was comparable. For OARs, AXB predicted a slightly lower dose to the aorta, chest wall, spinal cord and esophagus, regardless of whether the 6XFFF or 10XFFF beam was utilized. Exceptionally, dose to the ipsilateral lung was significantly higher with AXB. CONCLUSIONS AXB principally predicts lower dose to PTV_lung compared to AAA and the CGS contributes to the relative dose difference between the two algorithms.
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Affiliation(s)
- Baotian Huang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515031, China.
| | - Lili Wu
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515031, China.
| | - Peixian Lin
- Department of Nosocomial Infection Management, The Second Affiliated Hospital of Shantou University Medical College, 69 North Dongxia Road, Shantou, 515041, China.
| | - Chuangzhen Chen
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou, 515031, China.
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Park JM, Park SY, Kim H, Kim JH, Carlson J, Ye SJ. Modulation indices for volumetric modulated arc therapy. Phys Med Biol 2014; 59:7315-40. [DOI: 10.1088/0031-9155/59/23/7315] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Rosewall T, Kong V, Heaton R, Currie G, Milosevic M, Wheat J. The Effect of Dose Grid Resolution on Dose Volume Histograms for Slender Organs at Risk during Pelvic Intensity-modulated Radiotherapy. J Med Imaging Radiat Sci 2014; 45:204-209. [DOI: 10.1016/j.jmir.2014.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 01/22/2014] [Indexed: 10/25/2022]
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