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Wang Q, Li Q, Wang Z, Yang C, Zhang D, Wang J, Wang P, Wang W. Characterization of a novel VenusX orthogonal dual-layer multileaf collimator. J Appl Clin Med Phys 2024; 25:e14357. [PMID: 38620027 PMCID: PMC11087167 DOI: 10.1002/acm2.14357] [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: 07/31/2023] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 04/17/2024] Open
Abstract
PURPOSE To investigate and characterize the performance of a novel orthogonal dual-layer alpha multileaf collimator (αMLC) mounted on the LinaTech VenusX linac. METHODS We evaluated leaf positioning accuracy and reproducibility using an electronic portal imaging device through the picket fence test. The average, interleaf, intraleaf, and leaf tip transmissions of the single and dual layers were measured using an ionization chamber. Square and rhombus fields were used to evaluate the leaf penumbra of αMLC. To investigate the advantages of the orthogonal dual-layer multileaf collimator (MLC) in field shaping, right triangular and circular pattern fields were formed using both the dual layers and single layers of the αMLC. RESULTS The average maximum positioning deviations of the upper and lower αMLC over 1 year were 0.76 ± 0.09 mm and 0.62 ± 0.07 mm, respectively. The average transmissions were 1.87%, 1.83%, and 0.03% for the upper-, lower- and dual-layer αMLC, respectively. The maximum interleaf transmissions of the lower- and dual-layer were 2.43% and 0.17%, respectively. The leaf tip transmissions were 9.34% and 0.25%, respectively. The penumbra of the square field was 6.2 mm in the X direction and 8.0 mm in the Y direction. The average penumbras of the rhombus fields with side lengths of 5 and 10 cm were 3.6 and 4.9 mm, respectively. For the right triangular and circular fields, the fields shaped by the dual-layer leaves were much closer to the set field than those shaped by single-layer leaves. The dose undulation amplitude of the 50% isodose lines and leaf stepping angle change of the dual-layer leaves were smaller than those of the single-layer leaves. CONCLUSIONS The αMLC benefits from its orthogonal dual-layer design. Leaf transmission, dose undulations at the field edge, and MLC field dependence of the leaf stepping angle of the dual-layer αMLC were remarkably reduced.
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Affiliation(s)
- Qingxin Wang
- School of Precision Instrument and Opto‐Electronics EngineeringTianjin UniversityTianjinChina
- Department of Radiation OncologyTianjin Medical University Cancer Institute & HospitalNational Clinical Research Center for CancerTianjin's Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinChina
| | - Qifeng Li
- School of Precision Instrument and Opto‐Electronics EngineeringTianjin UniversityTianjinChina
| | - Zhongqiu Wang
- Department of Radiation OncologyTianjin Medical University Cancer Institute & HospitalNational Clinical Research Center for CancerTianjin's Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinChina
| | - Chengwen Yang
- Department of Radiation OncologyTianjin Medical University Cancer Institute & HospitalNational Clinical Research Center for CancerTianjin's Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinChina
| | - Daguang Zhang
- Department of Radiation OncologyTianjin Medical University Cancer Institute & HospitalNational Clinical Research Center for CancerTianjin's Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinChina
| | - Jun Wang
- Department of Radiation OncologyTianjin Medical University Cancer Institute & HospitalNational Clinical Research Center for CancerTianjin's Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinChina
- Department of Radiation OncologyTianjin Cancer Hospital Airport HospitalTianjinChina
| | - Ping Wang
- Department of Radiation OncologyTianjin Medical University Cancer Institute & HospitalNational Clinical Research Center for CancerTianjin's Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinChina
- Department of Radiation OncologyTianjin Cancer Hospital Airport HospitalTianjinChina
| | - Wei Wang
- Department of Radiation OncologyTianjin Medical University Cancer Institute & HospitalNational Clinical Research Center for CancerTianjin's Clinical Research Center for CancerKey Laboratory of Cancer Prevention and TherapyTianjinChina
- Department of Radiation OncologyTianjin Cancer Hospital Airport HospitalTianjinChina
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Azzi A, Heilemann G, Georg D, Ardjo Pawiro S, Mart T, Lechner W. Impact of log file source and data frequency on accuracy of log file-based patient specific quality assurance. Z Med Phys 2023:S0939-3889(23)00075-2. [PMID: 37365087 DOI: 10.1016/j.zemedi.2023.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/04/2023] [Accepted: 05/20/2023] [Indexed: 06/28/2023]
Abstract
Performing phantom measurements for patient-specific quality assurance (PSQA) adds a significant amount of time to the adaptive radiotherapy procedure. Log file based PSQA can be used to increase the efficiency of this process. This study compared the dosimetric accuracy of high-frequency linear accelerator (Linac) log files and low-frequency log data stored in the oncology information system (OIS). Thirty patients were included, that were recently treated in the head and neck (HN), brain, and prostate region with volumetric modulated arc therapy (VMAT) and an additional ten patients treated using stereotactic body radiation therapy (SBRT) with 3D-conformal radiotherapy (3D-CRT) technique. Log data containing a single fraction were used to calculate the dose distributions. The dosimetric differences between Linac log files and OIS logs were evaluated with a gamma analysis with 2%/2 mm criterion and dose threshold of 30%. The original treatment plan was used as a reference. Moreover, DVH parameters of D98%, D50%, and D2% of the planning-target volume (PTV) and dose to several organs at risk (OARs) were reported. Significant differences in dose distributions between the two log types and the original dose were observed for PTV D98% and D2% (r < 0.001) for HN cases, PTV D98% (r = 0.005) for brain cases, and PTV D50% (r = 0.015) for prostate cases. No significant differences were found between the two log types with respect to D50%. The root mean square (RMS) error of the leaf positions of the OIS log was approximately twice the RMS error of the Linac log file for VMAT plans, but identical for 3D-CRT plans. The relationship between the gamma pass rate and the RMS error showed a moderate correlation for the Linac log files (r = -0.58, p < 0.001) and strong correlation for OIS logs (r = -0.71, p < 0.001). Furthermore, all doses calculated using Linac log files and OIS log data had a GPR >90% for an RMS error < 3.3 mm. Based on these findings, a tolerance limit of RMS error of 3.3 mm for considering OIS log based PSQA was established. Nevertheless, the OIS log data quality should be improved to achieve adequate PSQA.
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Affiliation(s)
- Akbar Azzi
- Department of Physics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, 16424 Depok, Indonesia
| | - Gerd Heilemann
- Department of Radiation Oncology, Division of Medical Physics, Medical University of Vienna, 1090 Vienna, Austria
| | - Dietmar Georg
- Department of Radiation Oncology, Division of Medical Physics, Medical University of Vienna, 1090 Vienna, Austria
| | - Supriyanto Ardjo Pawiro
- Department of Physics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, 16424 Depok, Indonesia.
| | - Terry Mart
- Department of Physics, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, 16424 Depok, Indonesia
| | - Wolfgang Lechner
- Department of Radiation Oncology, Division of Medical Physics, Medical University of Vienna, 1090 Vienna, Austria
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Fathy MM, Hassan BZ, El-Gebaly RH, Mokhtar MH. Dosimetric evaluation study of IMRT and VMAT techniques for prostate cancer based on different multileaf collimator designs. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2023; 62:97-106. [PMID: 36576578 PMCID: PMC9950215 DOI: 10.1007/s00411-022-01011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
The hypofractionated radiotherapy modality was established to reduce treatment durations and enhance therapeutic efficiency, as compared to conventional fractionation treatment. However, this modality is challenging because of rigid dosimetric constraints. This study aimed to assess the impact of multi-leaf collimator (MLC) widths (10 mm and 5 mm) on plan quality during the treatment of prostate cancer. Additionally, this study aimed to investigate the impact of the MLC mode of energy on the Agility flattening filter (FF), MLC Agility-free flattening filter (FFF), and MLCi2 for patients receiving hypofractionated radiotherapy. Two radiotherapy techniques; Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Radiotherapy (VMAT), were used in this research. In the present study, computed tomography simulations of ten patients (six plans per patient) with localized prostate adenocarcinoma were analyzed. Various dosimetric parameters were assessed, including monitor units, treatment delivery times, conformity, and homogeneity indices. To evaluate the plan quality, dose-volume histograms (DVHs) were estimated for each technique. The results demonstrated that the determined dosimetric parameters of planning target volume (PTV)p (such as D mean, conformity, and homogeneity index) showed greater improvement with MLC Agility FF and MLC Agility FFF than with MLCi2. Additionally, the treatment delivery time was reduced in the MLC Agility FF (by 31%) and MLC Agility FFF (by 10.8%) groups compared to the MLCi2 group. It is concluded that for both the VMAT and IMRT techniques, the smaller width (5 mm) MLCs revealed better planning target volume coverage, improved the dosimetric parameters for PTV, reduced the treatment time, and met the constraints for OARs. It is therefore recommended to use 5 mm MLCs for hypofractionated prostate cancer treatment due to better target coverage and better protection of OARs.
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Affiliation(s)
- Mohamed M Fathy
- Department of Biophysics, Faculty of Science, Cairo University, Giza, Egypt.
| | - Belal Z Hassan
- Department of Biophysics, Faculty of Science, Cairo University, Giza, Egypt
- Department of Radiotherapy, Al-Ziraeyeen Hospital, Cairo University, Giza, Egypt
| | - Reem H El-Gebaly
- Department of Biophysics, Faculty of Science, Cairo University, Giza, Egypt
| | - Maha H Mokhtar
- Department of Radiotherapy and Nuclear Medicine, Medical Physics Unit, National Cancer Institute, Cairo University, Giza, Egypt
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Guimarães MVC, Teixeira MJ, Zaninotto ALC, Martins JA, Costa JSE, Paiva WS. Letter: Importance of Cobalt-60 Dose Rate and Biologically Effective Dose on Local Control for Intracranial Meningiomas Treated With Stereotactic Radiosurgery. Neurosurgery 2022; 91:e131-e132. [PMID: 36053066 PMCID: PMC10553188 DOI: 10.1227/neu.0000000000002137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/05/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
| | | | | | | | | | - Wellingson Silva Paiva
- Psychiatry and Neuroimaging Department, Harvard Medical School, Boston, Massachusetts, USA
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Huo M, Tsang DS. In Reply: Importance of Cobalt-60 Dose Rate and Biologically Effective Dose on Local Control for Intracranial Meningiomas Treated With Stereotactic Radiosurgery. Neurosurgery 2022; 91:e133-e134. [PMID: 36053084 DOI: 10.1227/neu.0000000000002138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Michael Huo
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
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Takase H, Yamamoto T. Bone Invasive Meningioma: Recent Advances and Therapeutic Perspectives. Front Oncol 2022; 12:895374. [PMID: 35847854 PMCID: PMC9280135 DOI: 10.3389/fonc.2022.895374] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
Meningioma is the most common primary neoplasm of the central nervous system (CNS). Generally, these tumors are benign and have a good prognosis. However, treatment can be challenging in cases with aggressive variants and poor prognoses. Among various prognostic factors that have been clinically investigated, bone invasion remains controversial owing to a limited number of assessments. Recent study reported that bone invasion was not associated with WHO grades, progression, or recurrence. Whereas, patients with longer-recurrence tended to have a higher incidence of bone invasion. Furthermore, bone invasion may be a primary preoperative predictor of the extent of surgical resection. Increasing such evidence highlights the potential of translational studies to understand bone invasion as a prognostic factor of meningiomas. Therefore, this mini-review summarizes recent advances in pathophysiology and diagnostic modalities and discusses future research directions and therapeutic strategies for meningiomas with bone invasion.
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Affiliation(s)
- Hajime Takase
- Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University Hospital, Yokohama, Japan
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
- *Correspondence: Hajime Takase, ; orcid.org/0000-0001-5813-1386
| | - Tetsuya Yamamoto
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
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Almatani T, Hugtenburg RP, Smakovs A. A Monte Carlo model of an agility head for a 10-MV photon beam. JOURNAL OF TAIBAH UNIVERSITY FOR SCIENCE 2022. [DOI: 10.1080/16583655.2022.2050097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Richard P. Hugtenburg
- College of Medicine, Swansea University, Swansea, UK
- Department of Medical Physics and Clinical Engineering, Swansea Bay University Health Board, Swansea, UK
| | - Artjoms Smakovs
- Department of Medical Physics and Clinical Engineering, Swansea Bay University Health Board, Swansea, UK
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Chiavassa S, Bessieres I, Edouard M, Mathot M, Moignier A. Complexity metrics for IMRT and VMAT plans: a review of current literature and applications. Br J Radiol 2019; 92:20190270. [PMID: 31295002 PMCID: PMC6774599 DOI: 10.1259/bjr.20190270] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 12/21/2022] Open
Abstract
Modulated radiotherapy with multileaf collimators is widely used to improve target conformity and normal tissue sparing. This introduced an additional degree of complexity, studied by multiple teams through different properties. Three categories of complexity metrics were considered in this review: fluence, deliverability and accuracy metrics. The first part of this review is dedicated to the inventory of these complexity metrics. Different applications of these metrics emerged. Influencing the optimizer by integrating complexity metrics into the cost function has been little explored and requires more investigations. In modern treatment planning system, it remains confined to MUs or treatment time limitation. A large majority of studies calculated metrics only for analysis, without plan modification. The main application was to streamline the patient specific quality assurance workload, investigating the capability of complexity metrics to predict patient specific quality assurance results. Additionally complexity metrics were used to analyze behaviour of TPS optimizer, compare TPS, operators and plan properties, and perform multicentre audit. Their potential was also explored in the context of adaptive radiotherapy and automation planning. The second part of the review gives an overview of these studies based on the complexity metrics.
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Affiliation(s)
- Sophie Chiavassa
- Department of Medical Physics, Institut de Cancérologie de l’Ouest Centre René Gauducheau, 44805 Saint-Herblain, France
| | - Igor Bessieres
- Departement of Medical Physics, Centre Georges-François Leclerc, 1 rue Professeur Marion, 21000 Dijon, France
| | - Magali Edouard
- Department of Radiation Oncology, Gustave Roussy, 114 rue Édouard-Vaillant, 94805 Villejuif, France
| | - Michel Mathot
- Liege University Hospital, Domaine du Sart Tilman - B.35 - B-4000 LIEGE1, Belgium
| | - Alexandra Moignier
- Department of Medical Physics, Institut de Cancérologie de l’Ouest Centre René Gauducheau, 44805 Saint-Herblain, France
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Zollner B, Ganswindt U, Maihöfer C, Corradini S, Albert NL, Schichor C, Belka C, Niyazi M. Recurrence pattern analysis after [ 68Ga]-DOTATATE-PET/CT -planned radiotherapy of high-grade meningiomas. Radiat Oncol 2018; 13:110. [PMID: 29898747 PMCID: PMC6000954 DOI: 10.1186/s13014-018-1056-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/28/2018] [Indexed: 12/25/2022] Open
Abstract
Background The aim of the present study was to evaluate the influence of the applied safety margins of modern intensity-modulated radiotherapy (IMRT) in patients with high-grade meningiomas on local control and recurrence patterns. Methods Twenty patients with a neuropathological diagnosis of a high-grade meningioma (WHO°II or °III) treated with adjuvant or definitive radiotherapy between 2010 and 2015 were included in the present retrospective analysis. All patients were planned PET-based. Recurrence patterns were assessed by means of MRI and/or DOTATATE-PET/computertomography (CT). Results The median follow-up was 31.0 months [95% confidence interval (CI): 20.1–42.0] and the progression-free survival (PFS) after 24 months was 87.5%. Overall, four patients had a local recurrence of their meningioma. Of these, three were located in field according to the prior radiotherapy treatment region, while only one patient had a distant relapse. There were no independent factors influencing progression-free or overall survival (OS). Conclusion After radiotherapy (RT), patients with atypical or anaplastic meningiomas still have a defined risk of tumor recurrence. The aim of the present study was to examine mono-institutional data concerning target volume definition and recurrence patterns after radiotherapy of high-grade meningiomas as there are limited data available. Our data suggest that extended safety margins are necessary to achieve a favorable local control for high-grade meningiomas.
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Affiliation(s)
- Barbara Zollner
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Ute Ganswindt
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Cornelius Maihöfer
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Nathalie Lisa Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Schichor
- Department of Neurosurgery, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), partner site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. .,German Cancer Consortium (DKTK), partner site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany.
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Corradini S, Ballhausen H, Weingandt H, Freislederer P, Schönecker S, Niyazi M, Simonetto C, Eidemüller M, Ganswindt U, Belka C. Left-sided breast cancer and risks of secondary lung cancer and ischemic heart disease : Effects of modern radiotherapy techniques. Strahlenther Onkol 2017; 194:196-205. [PMID: 28916844 DOI: 10.1007/s00066-017-1213-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/30/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE Modern breast cancer radiotherapy techniques, such as respiratory-gated radiotherapy in deep-inspiration breath-hold (DIBH) or volumetric-modulated arc radiotherapy (VMAT) have been shown to reduce the high dose exposure of the heart in left-sided breast cancer. The aim of the present study was to comparatively estimate the excess relative and absolute risks of radiation-induced secondary lung cancer and ischemic heart disease for different modern radiotherapy techniques. METHODS Four different treatment plans were generated for ten computed tomography data sets of patients with left-sided breast cancer, using either three-dimensional conformal radiotherapy (3D-CRT) or VMAT, in free-breathing (FB) or DIBH. Dose-volume histograms were used for organ equivalent dose (OED) calculations using linear, linear-exponential, and plateau models for the lung. A linear model was applied to estimate the long-term risk of ischemic heart disease as motivated by epidemiologic data. Excess relative risk (ERR) and 10-year excess absolute risk (EAR) for radiation-induced secondary lung cancer and ischemic heart disease were estimated for different representative baseline risks. RESULTS The DIBH maneuver resulted in a significant reduction of the ERR and estimated 10-year excess absolute risk for major coronary events compared to FB in 3D-CRT plans (p = 0.04). In VMAT plans, the mean predicted risk reduction through DIBH was less pronounced and not statistically significant (p = 0.44). The risk of radiation-induced secondary lung cancer was mainly influenced by the radiotherapy technique, with no beneficial effect through DIBH. VMAT plans correlated with an increase in 10-year EAR for radiation-induced lung cancer as compared to 3D-CRT plans (DIBH p = 0.007; FB p = 0.005, respectively). However, the EARs were affected more strongly by nonradiation-associated risk factors, such as smoking, as compared to the choice of treatment technique. CONCLUSION The results indicate that 3D-CRT plans in DIBH pose the lowest risk for both major coronary events and secondary lung cancer.
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Affiliation(s)
- Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany.
| | - Hendrik Ballhausen
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Helmut Weingandt
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Philipp Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Stephan Schönecker
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Cristoforo Simonetto
- Institute of Radiation Protection, Helmholtz Zentrum München, Neuherberg, Germany
| | - Markus Eidemüller
- Institute of Radiation Protection, Helmholtz Zentrum München, Neuherberg, Germany
| | - Ute Ganswindt
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
- Department of Radiation Oncology, Medical University, Innsbruck, Austria
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
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Hansen CR, Bertelsen A, Hazell I, Zukauskaite R, Gyldenkerne N, Johansen J, Eriksen JG, Brink C. Automatic treatment planning improves the clinical quality of head and neck cancer treatment plans. Clin Transl Radiat Oncol 2016; 1:2-8. [PMID: 29657987 PMCID: PMC5893480 DOI: 10.1016/j.ctro.2016.08.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Treatment plans for head and neck (H&N) cancer are highly complex due to multiple dose prescription levels and numerous organs at risk (OARs) close to the target. The plan quality is inter-planner dependent since it is dependent on the skills and experience of the dosimetrist. This study presents a blinded prospective clinical comparison of automatic (AU) and manually (MA) generated H&N VMAT plans made for clinical use. Methods MA and AU plans were generated for 30 consecutive patients in Pinnacle3 using the IMRT optimisation module and the new Autoplan module, respectively. The plan quality was blindedly compared by three senior oncologists and the best plan was selected for treatment of the patient. Planning time was measured as the active operator time used. The plan quality was analysed with DVH metrics and the dose delivery accuracy validated on the ArcCheck phantom. Results For twenty-nine out of the thirty patients the AU plan was chosen for treatment. Target doses were more homogenous with the AU plans and the OAR doses were significantly reduced, between 0.5 and 6.5 Gy. The average operator time spent on creating a manual plan was 64 min which was halved by Autoplan. The AU plans were more modulated as illustrated by an increase in MUs, which might cause the slightly lower pass rate of 97.7% in the ArcCheck measurements. Conclusions Target doses were similar between MA and AU plan, while AU plans spared all OAR considerably better than the MA plans.
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Affiliation(s)
- Christian Rønn Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
- Corresponding author at: Odense University Hospital, Sdr. Boulevard 29, 5000 Odense, Denmark.Odense University HospitalSdr. Boulevard 295000 OdenseDenmark
| | - Anders Bertelsen
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Irene Hazell
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
| | - Ruta Zukauskaite
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - Jørgen Johansen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Jesper G. Eriksen
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Carsten Brink
- Laboratory of Radiation Physics, Odense University Hospital, Odense, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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Capability of leaf interdigitation with different inverse planning strategies in Monaco: an investigation of representative tumour sites. Radiat Oncol 2016; 11:82. [PMID: 27316707 PMCID: PMC4912757 DOI: 10.1186/s13014-016-0655-1] [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: 10/01/2015] [Accepted: 05/26/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this study was to experimentally assess the dosimetric impact of leaf interdigitation using different inverse treatment strategies for representative tumour sites and to identify the situations in which leaf interdigitation can benefit these tumour sites. Material and methods Sixty previously treated patients (15 nasopharyngeal carcinoma (NPC), 15 multiple brain metastasis (MBM), 15 cervical cancer and 15 prostate cancer) were re-planned for volumetric modulated arc therapy (VMAT), sliding window IMRT (dMLC) and step-and-shoot IMRT (ssIMRT) with and without leaf interdigitation. Various dosimetric variables, such as PTV coverage, OARs sparing, delivery efficiency and planning time, were evaluated for each plan. In addition, a protocol developed by our group was applied to identify the situations in which leaf interdigitation can achieve benefits in clinical practice. Results Leaf interdigitation produced few benefits in PTV homogeneity for the MBM VMAT plans and NPC ssIMRT plans. For OARs, sparing was equivalent with and without leaf interdigitation. Leaf interdigitation showed an increase in MUs for dMLC plans and a decrease in MUs for ssIMRT plans. Leaf interdigitation resulted in an increase in segments for dMLC plans and a decrease in segments for NPC and MBM ssIMRT plans. For beam on time, leaf interdigitation showed an increase in MBM dMLC, NPC ssIMRT and prostate ssIMRT plans. In addition, leaf interdigitation saved planning time for VMAT and dMLC plans but increased planning time for ssIMRT plans. Conclusion Leaf interdigitation does not improve plan quality when performing inverse treatment strategies, regardless of whether the target is simple or complex. However, it influences the delivery efficiency and planning time. Based on these observations, our study suggests that leaf interdigitation should be utilized when performing MBM VMAT plans and NPC ssIMRT plans. Electronic supplementary material The online version of this article (doi:10.1186/s13014-016-0655-1) contains supplementary material, which is available to authorized users.
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Berwouts D, Olteanu LAM, Speleers B, Duprez F, Madani I, Vercauteren T, De Neve W, De Gersem W. Intensity modulated arc therapy implementation in a three phase adaptive (18)F-FDG-PET voxel intensity-based planning strategy for head-and-neck cancer. Radiat Oncol 2016; 11:52. [PMID: 27039294 PMCID: PMC4818905 DOI: 10.1186/s13014-016-0629-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/28/2016] [Indexed: 12/15/2022] Open
Abstract
Background This study investigates the implementation of a new intensity modulated arc therapy (IMAT) class solution in comparison to a 6-static beam step-and-shoot intensity modulated radiotherapy (s-IMRT) for three-phase adaptive 18F-FDG-PET-voxel-based dose-painting-by-numbers (DPBN) for head-and-neck cancer. Methods We developed 18F-FDG-PET-voxel intensity-based IMAT employing multiple arcs and compared it to clinically used s-IMRT DPBN. Three IMAT plans using 18F-FDG-PET/CT acquired before treatment (phase I), after 8 fractions (phase II) and CT acquired after 18 fractions (phase III) were generated for each of 10 patients treated with 3 s-IMRT plans based on the same image sets. Based on deformable image registration (ABAS, version 0.41, Elekta CMS Software, Maryland Heights, MO), doses of the 3 plans were summed on the pretreatment CT using validated in-house developed software. Dosimetric indices in targets and organs-at-risk (OARs), biologic conformity of treatment plans set at ≤5 %, treatment quality and efficiency were compared between IMAT and s-IMRT for the whole group and for individual patients. Results Doses to most organs-at-risk (OARs) were significantly better in IMAT plans, while target levels were similar for both types of plans. On average, IMAT ipsilateral and contralateral parotid mean doses were 14.0 % (p = 0.001) and 12.7 % (p < 0.001) lower, respectively. Pharyngeal constrictors D50% levels were similar or reduced with up to 54.9 % for IMAT compared to s-IMRT for individual patient cases. IMAT significantly improved biologic conformity by 2.1 % for treatment phases I and II. 3D phantom measurements reported an agreement of ≥95 % for 3 % and 3 mm criteria for both treatment modalities. IMAT delivery time was significantly shortened on average by 41.1 %. Conclusions IMAT implementation significantly improved the biologic conformity as compared to s-IMRT in adaptive dose-escalated DPBN treatments. The better OAR sparing and faster delivery highly improved the treatment efficiency. Electronic supplementary material The online version of this article (doi:10.1186/s13014-016-0629-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dieter Berwouts
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium. .,Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium.
| | - Luiza Ana Maria Olteanu
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | | | - Frédéric Duprez
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Indira Madani
- Ghent University, Ghent, Belgium.,Zürich University Hospital, Zürich, Switzerland
| | - Tom Vercauteren
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium
| | - Wilfried De Neve
- Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.,Ghent University, Ghent, Belgium
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Kantz S, Söhn M, Troeller A, Reiner M, Weingandt H, Alber M, Belka C, Ganswindt U. Impact of MLC properties and IMRT technique in meningioma and head-and-neck treatments. Radiat Oncol 2015; 10:184. [PMID: 26328628 PMCID: PMC4556413 DOI: 10.1186/s13014-015-0447-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/25/2015] [Indexed: 11/10/2022] Open
Abstract
Purpose The impact of multileaf collimator (MLC) design and IMRT technique on plan quality and delivery improvements for head-and-neck and meningioma patients is compared in a planning study. Material and methods Ten previously treated patients (5 head-and-neck, 5 meningioma) were re-planned for step-and-shoot IMRT (ssIMRT), sliding window IMRT (dMLC) and VMAT using the MLCi2 without (−) and with (+) interdigitation and the Agility-MLC attached to an Elekta 6MV linac. This results in nine plans per patient. Consistent patient individual optimization parameters are used. Plans are generated using the research tool Hyperion V2.4 (equivalent to Elekta Monaco 3.2) with hard constraints for critical structures and objectives for target structures. For VMAT plans, the improved segment shape optimization is used. Critical structures are evaluated based on QUANTEC criteria. PTV coverage is compared by EUD, Dmean, homogeneity and conformity. Additionally, MU/plan, treatment times and number of segments are evaluated. Results As constrained optimization is used, all plans fulfill the hard constraints. Doses to critical structures do not differ more than 1Gy between the nine generated plans for each patient. Only larynx, parotids and eyes differ up to 1.5Gy (Dmean or Dmax) or 7 % (volume-constraint) due to (1) increased scatter, (2) not avoiding structures when using the full range of gantry rotation and (3) improved leaf sequencing with advanced segment shape optimization for VMAT plans. EUD, Dmean, homogeneity and conformity are improved using the Agility-MLC. However, PTV coverage is more affected by technique. MU increase with the use of dMLC and VMAT, while the MU are reduced by using the Agility-MLC. Fastest treatments are always achieved using Agility-MLC, especially in combination with VMAT. Conclusion Fastest treatments with the best PTV coverage are found for VMAT plans with Agility-MLC, achieving the same sparing of healthy tissue compared to the other combinations of ssIMRT, dMLC and VMAT with either MLCi2−/+ or Agility.
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Affiliation(s)
- Steffi Kantz
- Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany.
| | - Matthias Söhn
- Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany.
| | - Almut Troeller
- Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany. .,Department of Radiation Oncology, William Beaumont Health System, Royal Oak, MI, USA.
| | - Michael Reiner
- Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany.
| | - Helmut Weingandt
- Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany.
| | - Markus Alber
- Department of Clinical Medicine, Department of Oncology, Aarhus University, Aarhus, Denmark.
| | - Claus Belka
- Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany.
| | - Ute Ganswindt
- Department of Radiation Oncology, Ludwig-Maximilians-University, Munich, Germany.
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