1
|
Seok JH, Ahn SH, Ahn WS, Choi DH, Shin SS, Choi W, Jung IH, Lee R, Kim JS. Comparison of skin dose in IMRT and VMAT with TrueBeam and Halcyon linear accelerator for whole breast irradiation. Phys Eng Sci Med 2024; 47:443-451. [PMID: 38224383 PMCID: PMC11166860 DOI: 10.1007/s13246-023-01373-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: 03/28/2023] [Accepted: 12/18/2023] [Indexed: 01/16/2024]
Abstract
With the increasing use of flattening filter free (FFF) beams, it is important to evaluate the impact on the skin dose and target coverage of breast cancer treatments. This study aimed to compare skin doses of treatments using FFF and flattening filter (FF) beams for breast cancer. The study established treatment plans for left breast of an anthropomorphic phantom using Halcyon's 6-MV FFF beam and TrueBeam's 6-MV FF beam. Volumetric modulated arc therapy (VMAT) with varying numbers of arcs and intensity modulated radiation therapy (IMRT) were employed, and skin doses were measured at five points using Gafchromic EBT3 film. Each measurement was repeated three times, and averaged to reduce uncertainty. All plans were compared in terms of plan quality to ensure homogeneous target coverage. The study found that when using VMAT with two, four, and six arcs, in-field doses were 19%, 15%, and 6% higher, respectively, when using Halcyon compared to TrueBeam. Additionally, when using two arcs for VMAT, in-field doses were 10% and 15% higher compared to four and six arcs when using Halcyon. Finally, in-field dose from Halcyon using IMRT was about 1% higher than when using TrueBeam. Our research confirmed that when treating breast cancer with FFF beams, skin dose is higher than with traditional FF beams. Moreover, number of arcs used in VMAT treatment with FFF beams affects skin dose to the patient. To maintain a skin dose similar to that of FF beams when using Halcyon, it may be worth considering increasing the number of arcs.
Collapse
Affiliation(s)
- Jae Hyun Seok
- Department of Integrative Medicine, Yonsei University College of Medicine, Seoul, Korea
- Medical Physics and Biomedical Engineering Lab (MPBEL), Yonsei University College of Medicine, Seoul, Korea
| | - So Hyun Ahn
- Ewha Medical Research Institute, Ewha Womans University College of Medicine, Seoul, Korea.
- Ewha Medical Artifical Intelligence Research Institute, Ewha Womans University College of Medicine, Seoul, Korea.
| | - Woo Sang Ahn
- Department of Radiation Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
| | - Dong Hyeok Choi
- Medical Physics and Biomedical Engineering Lab (MPBEL), Yonsei University College of Medicine, Seoul, Korea
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Soo Shin
- Department of Radiation Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Wonsik Choi
- Department of Radiation Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - In-Hye Jung
- Department of Radiation Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Rena Lee
- Department of Biomedical Engineering, Ewha Womans University, Seoul, Korea
- Ewha Medical Artifical Intelligence Research Institute, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jin Sung Kim
- Medical Physics and Biomedical Engineering Lab (MPBEL), Yonsei University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
2
|
Choi DH, Ahn SH, Kim DW, Choi SH, Ahn WS, Kim J, Kim JS. Development of shielding evaluation and management program for O-ring type linear accelerators. Sci Rep 2024; 14:10719. [PMID: 38729975 PMCID: PMC11087655 DOI: 10.1038/s41598-024-60362-6] [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] [Received: 11/29/2023] [Accepted: 04/22/2024] [Indexed: 05/12/2024] Open
Abstract
The shielding parameters can vary depending on the geometrical structure of the linear accelerators (LINAC), treatment techniques, and beam energies. Recently, the introduction of O-ring type linear accelerators is increasing. The objective of this study is to evaluate the shielding parameters of new type of linac using a dedicated program developed by us named ORSE (O-ring type Radiation therapy equipment Shielding Evaluation). The shielding evaluation was conducted for a total of four treatment rooms including Elekta Unity, Varian Halcyon, and Accuray Tomotherapy. The developed program possesses the capability to calculate transmitted dose, maximum treatable patient capacity, and shielding wall thickness based on patient data. The doses were measured for five days using glass dosimeters to compare with the results of program. The IMRT factors and use factors obtained from patient data showed differences of up to 65.0% and 33.8%, respectively, compared to safety management report. The shielding evaluation conducted in each treatment room showed that the transmitted dose at every location was below 1% of the dose limit. The results of program and measurements showed a maximum difference of 0.003 mSv/week in transmitted dose. The ORSE program allows for the shielding evaluation results to the clinical environment of each institution based on patient data.
Collapse
Affiliation(s)
- Dong Hyeok Choi
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - So Hyun Ahn
- Ewha Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, South Korea.
| | - Dong Wook Kim
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea.
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
| | - Sang Hyoun Choi
- Department of Radiation Oncology, Institute of Radiological and Medical Sciences, Seoul, Republic of Korea
| | - Woo Sang Ahn
- Department of Radiation Oncology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| | - Jihun Kim
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Sung Kim
- Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Patodi V, Soni TP, Singh DK, Patni N, Jakhotia N, Chittappurath V, Kuyyanangadan R, Jenny A, Kanniyappan E, Gupta AK, Gupta TC, Singhal H, Natrajan T, Kather FS. Dosimetric comparison of O-ring versus conventional C-arm linear accelerator for volumetric modulated arc therapy (VMAT) of head and neck cancer and carcinoma cervix patients. RADIATION PROTECTION DOSIMETRY 2024; 200:538-543. [PMID: 38441907 DOI: 10.1093/rpd/ncae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 04/23/2024]
Abstract
The objective of this study is dosimetric comparison between the O-ring Halcyon and C-arm Clinac iX linac for volumetric modulated arc therapy (VMAT) plans for head & neck (H&N) cancer and carcinoma cervix patients. Total 60 patients of H&N cancer and carcinoma cervix were enrolled prospectively from March 2021 to March 2023. VMAT plans with 6 MV photons for Halcyon and Clinac iX were generated and compared for each patient by dose volume histogram for planning target volume coverage and organ at risk (OAR) sparing. There were no differences in between both the linacs for PTV D2% and D98%, homogeneity index, conformity index, Dmax (maximum dose) and Dmean (mean dose) of OAR. Halcyon had significantly shorter treatment time compared to Clinac iX. Halcyon delivered higher integral dose and monitor units. O-ring Halcyon produces VMAT plans comparable to other C-arm linacs for H&N and carcinoma cervix patients.
Collapse
Affiliation(s)
- Vibhor Patodi
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Tej P Soni
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Dinesh K Singh
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Nidhi Patni
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Naresh Jakhotia
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Vineeth Chittappurath
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Rajkamal Kuyyanangadan
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Ashna Jenny
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Elumalai Kanniyappan
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Anil K Gupta
- Department of Surgical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Tara C Gupta
- Department of Medical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Harish Singhal
- Department of Clinical Trials, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Thirumoorthy Natrajan
- Department of Radiation Oncology, Narayana Multispeciality Hospital, Jaipur, Rajasthan, India
| | - Farzana S Kather
- Department of Radiation Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| |
Collapse
|
5
|
Zhang H, Zhang B, Lasio G, Chen S, Nasehi Tehrani J. Assessing quality assurance of multi-leaf collimator using the structural similarity index. J Appl Clin Med Phys 2024; 25:e14288. [PMID: 38345201 PMCID: PMC11005984 DOI: 10.1002/acm2.14288] [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] [Received: 07/31/2023] [Revised: 12/11/2023] [Accepted: 01/22/2024] [Indexed: 04/11/2024] Open
Abstract
PURPOSE This study aims to evaluate the viability of utilizing the Structural Similarity Index (SSI*) as an innovative imaging metric for quality assurance (QA) of the multi-leaf collimator (MLC). Additionally, we compared the results obtained through SSI* with those derived from a conventional Gamma index test for three types of Varian machines (Trilogy, Truebeam, and Edge) over a 12-week period of MLC QA in our clinic. METHOD To assess sensitivity to MLC positioning errors, we designed a 1 cm slit on the reference MLC, subsequently shifted by 0.5-5 mm on the target MLC. For evaluating sensitivity to output error, we irradiated five 25 cm × 25 cm open fields on the portal image with varying Monitor Units (MUs) of 96-100. We compared SSI* and Gamma index tests using three linear accelerator (LINAC) machines: Varian Trilogy, Truebeam, and Edge, with MLC leaf widths of 1, 0.5, and 0.25 mm. Weekly QA included VMAT and static field modes, with Picket fence test images acquired. Mechanical uncertainties related to the LINAC head, electronic portal imaging device (EPID), and MLC during gantry rotation and leaf motion were monitored. RESULTS The Gamma index test started detecting the MLC shift at a threshold of 4 mm, whereas the SSI* metric showed sensitivity to shifts as small as 2 mm. Moreover, the Gamma index test identified dose changes at 95MUs, indicating a 5% dose difference based on the distance to agreement (DTA)/dose difference (DD) criteria of 1 mm/3%. In contrast, the SSI* metric alerted to dose differences starting from 97MUs, corresponding to a 3% dose difference. The Gamma index test passed all measurements conducted on each machine. However, the SSI* metric rejected all measurements from the Edge and Trilogy machines and two from the Truebeam. CONCLUSIONS Our findings demonstrate that the SSI* exhibits greater sensitivity than the Gamma index test in detecting MLC positioning errors and dose changes between static and VMAT modes. The SSI* metric outperformed the Gamma index test regarding sensitivity across these parameters.
Collapse
Affiliation(s)
- Hong Zhang
- Departments of Radiation OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Baoshe Zhang
- Departments of Radiation OncologyMedical SchoolUniversity of MarylandBaltimoreMarylandUSA
| | - Giovanni Lasio
- Departments of Radiation OncologyMedical SchoolUniversity of MarylandBaltimoreMarylandUSA
| | - Shifeng Chen
- Departments of Radiation OncologyMedical SchoolUniversity of MarylandBaltimoreMarylandUSA
| | - Joubin Nasehi Tehrani
- Departments of Radiation OncologyMedical SchoolUniversity of MarylandBaltimoreMarylandUSA
| |
Collapse
|
6
|
Quintero P, Benoit D, Cheng Y, Moore C, Beavis A. Evaluation of the dataset quality in gamma passing rate predictions using machine learning methods. Br J Radiol 2023; 96:20220302. [PMID: 37129359 PMCID: PMC10321263 DOI: 10.1259/bjr.20220302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 03/12/2023] [Accepted: 04/02/2023] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE Gamma passing rate (GPR) predictions using machine learning methods have been explored for treatment verification of radiotherapy plans. However, these methods presented datasets with unbalanced number of plans having different treatment conditions (heterogeneous datasets), such as anatomical sites or dose per fractions, leading to lower model interpretability and prediction performance. METHODS We investigated the impact of the dataset composition on GPR binary classification (pass/fail) using random forest (RF), XG-boost, and neural network (NN) models. 945 plans were used to create one reference dataset (randomly assembled) and 24 customized datasets that considered four heterogeneity factors independently (anatomical region, number of arcs, dose per fraction, and treatment unit). 309 predictor features were extracted and calculated from plan parameters, modulation complexity metrics, and radiomic analysis (leave-trajectory maps, 3D dose distributions, and portal dosimetry images). The models' performances were measured using the area under the curve from the receiver operating characteristic (ROC-AUC). RESULTS Radiomics features for reference models increased ROC-AUC values up to 13%, 15%, and 5% for RF, XG-Boost, and NN, respectively. The datasets with higher heterogeneous conditions presented the lower ROC-AUC values (RF: 0.72 ± 0.11, XG-Boost: 0.67 ± 0.1, NN: 0.89 ± 0.05) compared to models with less heterogeneous treatment conditions (RF: 0.88 ± 0.06, XG-Boost: 0.89 ± 0.07, NN: 0.98 ± 0.01). The ten most important features for each heterogeneity dataset group demonstrated their correlation with the treatments' physical aspects and GPR prediction. CONCLUSION Improvements in data generalization and model performances can be associated with datasets having similar treatment conditions. This analysis might be implemented to evaluate the dataset quality and model consistency of further ML applications in radiotherapy. ADVANCES IN KNOWLEDGE Dataset heterogeneities decrease ML model performance and reliability.
Collapse
Affiliation(s)
| | - David Benoit
- Faculty of Science and Engineering, University of Hull, Hull, United Kingdom
| | - Yongqiang Cheng
- Faculty of Science and Engineering, University of Hull, Hull, United Kingdom
| | - Craig Moore
- Medical Physics Service, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Castle Road, Hull, United Kingdom
| | | |
Collapse
|
7
|
Díaz JFR. Cost analysis of three-dimensional radiation therapy versus intensity-modulated chemoradiotherapy for locally advanced cervical cancer in Peruvian citizens. Ecancermedicalscience 2023; 17:1531. [PMID: 37138970 PMCID: PMC10151083 DOI: 10.3332/ecancer.2023.1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Indexed: 05/05/2023] Open
Abstract
Background and objectives The standard treatment for locally advanced cervical cancer (CC) is chemoradiotherapy (CTRT) followed by high-dose-rate brachytherapy (HDRBT). The ideal scenario would be under novel intensity-modulated radiation therapy (IMRT) volumetric-modulated arc therapy (VMAT) radiation techniques over three-dimensional (3D) radiation therapy. However, radiotherapy (RT) centres in low- and middle-income countries have limited equipment for teletherapy services like HDRBT. This is why the 3D modality is still in use. The objective of this study was to analyse costs in a comparison of 3D versus IMRT versus VMAT based on clinical staging. Materials and methods From 02/01/2022 to 05/01/2023 a prospective registry of the costs for oncological management was carried out for patients with locally advanced CC who received CTRT ± HDRBT. This included the administration of radiation with chemotherapy. The cost associated with patient and family transfers and hours in the hospital was also identified. These expenses were used to project the direct and indirect costs of 3D versus IMRT versus VMAT. Results The treatment regimens for stage IIIC2, including 3D and novel techniques, are those with the highest costs. The administration of 3D RT for IIIC2 and novel IMRT or VMAT techniques, is $3,881.69, $3,374.76, and $2,862.80, respectively. The indirect cost from stage IIB to IIIC1 in descending order is IMRT, 3D and VMAT, but in IIIC2 the novel technique regimens reduce by up to 33.99% compared to 3D. Conclusion In RT centres with an available supply of RT equipment, VMAT should be preferred over IMRT/3D since it reduces costs and toxicity. However, in RT centres where demand exceeds supply in the VMAT technique planning systems, the use of 3D teletherapy over IMRT/VMAT could continue to be used in patients with stage IIB to IIIC1.
Collapse
Affiliation(s)
- José Fernando Robles Díaz
- Regional Institute for Neoplastic Diseases, Central Region, Concepción, Junín 12126, Peru and Los Andes Peruvian University, Huancayo 12002, Peru
| |
Collapse
|
8
|
Sun T, Lin X, Li K, Qiu Q, Duan J, Zhang G, Yin Y. Volumetric modulated arc therapy for hippocampal-sparing prophylactic cranial irradiation: Planning comparison of Halcyon and C-arm accelerators. Front Oncol 2023; 13:993809. [PMID: 36959800 PMCID: PMC10028073 DOI: 10.3389/fonc.2023.993809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/06/2023] [Indexed: 03/09/2023] Open
Abstract
Background The purpose of the study was to evaluate the dosimetry of the Halcyon in prophylactic cranial irradiation (PCI) with volumetric modulated arc therapy (VMAT) and hippocampal-sparing for small cell lung cancer (SCLC). Methods Five VMAT plans were designed on CT images of 15 patients diagnosed with SCLC and received PCI. Three plans with two full arcs were generated on the Trilogy and the TrueBeam accelerators, and flattening filter (FF) and flattening filter free (FFF) modes were used on TrueBeam. Two Halcyon plans with two and three full arcs were generated, referred to as H-2A and H-3A, respectively. The prescription dose was 25 Gy in 2.5-Gy fractions. The dose limit for hippocampus were D100 ≤ 9Gy and Dmax ≤ 16Gy. The Wilcoxon matched-paired signed-rank test was used to evaluate the significance of the observed differences between the five plans. Results H-2A plans significantly increased the D2 of PTV, and H-3A plans showed comparable or even better target dosimetry (better conformity) compared to the three plans on C-arm accelerators. Compared to T and TB plans, the two Halcyon plans significantly reduced the D100 and mean doses of bilateral hippocampus, the mean doses of eyeballs, and the maximum doses of lenses. D100 of hippocampus was reduced in TrueBeam plans comparing to Trilogy plans. The FFF plans on TrueBeam also represented advantages in Dmean and D100 of hippocampas, Dmean and Dmax of eyeballs, and the Dmax of lenses compared to FF plans. Halcyon plans and TrueBeam plans with FFF mode increased the MUs compared to FF plans. Comparing to H-2A, the H-3A plans exhibited additional dosimetric advantages, including D2, CI and HI of PTV, as well as the maximum and mean doses of hippocampus and eyeballs, and the maximum doses of optic nerves and brainstem. The two Halcyon plans significantly reduced the delivery time and showed the higher gamma passing rate than the three plans of C-arm accelerators. Conclusions Compared with the C-arm accelerators, the dose of hippocampus and the delivery times on Halcyon are relatively significantly reduced for hippocampal-sparing PCI. Three arcs are recommended for VMAT plans with the Halcyon in hippocampal-sparing PCI.
Collapse
|
9
|
Evaluation of an automated template-based treatment planning system for radiotherapy of anal, rectal and prostate cancer. Tech Innov Patient Support Radiat Oncol 2022; 22:30-36. [PMID: 35464888 PMCID: PMC9020095 DOI: 10.1016/j.tipsro.2022.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/11/2022] [Accepted: 04/05/2022] [Indexed: 11/21/2022] Open
Abstract
Automated treatment planning system compared to manual planning. Equivalent plan quality between VMAT manually generated- and IMRT automatically generated plans. Evaluation of anal, prostate and rectum treatment plans. Generation of highly consistent IMRT automated plan within 2 to 3.5 min.
Background and purpose The Ethos system has enabled online adaptive radiotherapy (oART) by implementing an automated treatment planning system (aTPS) for both intensity-modulated radiotherapy (IMRT) and volumetric modulated arc radiotherapy (VMAT) plan creation. The purpose of this study is to evaluate the quality of aTPS plans in the pelvic region. Material and Methods Sixty patients with anal (n = 20), rectal (n = 20) or prostate (n = 20) cancer were retrospectively re-planned with the aTPS. Three IMRT (7-, 9- and 12-field) and two VMAT (2 and 3 arc) automatically generated plans (APs) were created per patient. The duration of the automated plan generation was registered. The best IMRT-AP and VMAT-AP for each patient were selected based on target coverage and dose to organs at risk (OARs). The AP quality was analyzed and compared to corresponding clinically accepted and manually generated VMAT plans (MPs) using several clinically relevant dose metrics. Calculation-based pre-treatment plan quality assurance (QA) was performed for all plans. Results The median total duration to generate the five APs with the aTPS was 55 min, 39 min and 35 min for anal, prostate and rectal plans, respectively. The target coverage and the OAR sparing were equivalent for IMRT-APs and VMAT-MPs, while VMAT-Aps. demonstrated lower target dose homogeneity and higher dose to some OARs. Both conformity and homogeneity index were equivalent (rectal) or better (anal and prostate) for IMRT-APs compared to VMAT-MPs. All plans passed the patient-specific QA tolerance limit. Conclusions The aTPS generates plans comparable to MPs within a short time-frame which is highly relevant for oART treatments.
Collapse
Key Words
- AP, automatically generated plan
- Automated treatment planning
- CN, conformity number
- CT, computed tomography
- CTV, clinical target volume
- DVH, dose volume histogram
- FFF, flattening filter free
- GTV, gross tumor volume
- HI, homogeneity index
- IMRT, intensity modulated radiotherapy
- Intelligent optimization engine
- KPB, knowledge-based planning
- Linac, Linear accelerators
- MCO, multi-criteria optimization
- MLC, multileaf collimator
- MP, manually-generated plan
- MR, magnetic resonance
- MU, Monitor Unit
- OAR, Organ at risk
- Online adaptive radiotherapy
- PTV, planning target volume
- Pelvic cancer
- Plan quality
- QA, Quality assurance
- SD, standard deviation
- Template-based Ethos TPS
- VMAT, volumetric arc radiotherapy
- aTPS, automated treatment planning system
- oART, online adaptive radiotherapy
Collapse
|
10
|
Rachi T, Parshuram RV, Tanaka Y, Togo H. Examination of conversion method of dose distribution of lung cancer IMRT using fluence reversible calculation function in O-ring type linac and C-type linac. Phys Eng Sci Med 2022; 45:559-567. [PMID: 35438453 PMCID: PMC9239951 DOI: 10.1007/s13246-022-01122-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/24/2022] [Indexed: 11/26/2022]
Abstract
Generally, converting irradiation plans between C-arm linacs (C-linac) when the linac fails is possible without recalculating the dose distribution using a treatment planning system (TPS), because they have similar mechanical structure. However, the O-ring-type linac (O-linac) differs from the C-linac in forming the dose distribution. Therefore, if O-linac breaks down, it is necessary to formulate a treatment plan from scratch. In this study, we investigated a method for converting irradiation from an O-linac to a C-linac. Thirty patients with lung cancer who underwent volumetric-modulated arc therapy with an O-linac were included in this study. The O-linac dose distribution was converted into energy fluence by the function of the TPS. The alternative linac multi-leaf collimator (MLC) was then optimized to achieve energy fluence. The homogeneity index, conformity index, and planning treatment volume (D95%, D2%) of the converted plan were compared with the original plan. For organ at risk (OAR), the dose-volume histograms (DVHs) of the lung, esophagus, heart, and spinal cord were evaluated. Additionally, the shapes of the isodose curves were compared using the Dice similarity coefficient (DSC). There was no significant difference between the target and OARs (p > 0.05). The mean DSCs of 30% to 100% isodose curves of the prescribed dose and the isodose ≥ 105% and ≤ 20%were > 0.8 and < 0.8, respectively. Due to the structural differences of MLC, the dose-volume and generation positions were different in the dose range of ≥ 105% and ≤ 20%; hence, DSCs decreased. However, no statistically significant difference in the DVH was identified for either treatment plan. Based on this result, we propose a simple replanning method for performing MLC fitting after converting the dose to the energy fluence.
Collapse
Affiliation(s)
- Toshiya Rachi
- Department of Radiological Technology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Raturi Vijay Parshuram
- Department of Radiation Oncology and Particle Therapy, National Cancer Center Hospital East, Kashiwa, Japan
- Course of Advance Clinical Research of Cancer, Graduate School of Medicine, Juntendo University, Bunkyo, Japan
| | - Yuki Tanaka
- Department of Radiological Technology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Haruki Togo
- Department of Radiological Technology, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| |
Collapse
|
11
|
Zheng J, Xia Y, Sun L. A Comprehensive Evaluation of the Application of the Halcyon(2.0) IMRT Technique in Long-Course Radiotherapy for Rectal Cancer. Technol Cancer Res Treat 2022; 21:15330338221074501. [PMID: 35235486 PMCID: PMC8894964 DOI: 10.1177/15330338221074501] [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] [Indexed: 11/17/2022] Open
Abstract
Objective: To evaluate if the Halcyon(2.0) Intensity Modulation Radiotherapy (IMRT) technique has an advantage in the long-course rectal cancer radiotherapy. Methods: A total of 20 clinical IMRT plans of Halcyon(2.0) for long-course (2Gy in 25 fractions) rectal cancer radiotherapy were randomly selected. Based on the parameters of these plans, 20 TrueBeam (with the Millennium 120 MLC) plans were redesigned, respectively. The dosimetry indexes, field complexity parameters, the Gamma Passing Rates (GPR), and the delivery time of the 2 groups of plans were obtained as measures of the plan quality, the modulation complexity, the delivery accuracy, and the delivery efficiency. The differences between the 2 groups of parameters were analyzed, with P < .05 means statistically significant. Results: In terms of dosimetry, there was no significant or clinical difference between the 2 groups in critical dosimetry parameters. The Monitor Unit of the Halcyon(2.0) fields is lower than the TrueBeam fields by 26.39, while the modulation complexity score (MCS), the mean aperture area variability (AAV), and the mean leaf sequence variability (LSV) of the Halcyon(2.0) fields were 23.8%, 20%, and 2.3% larger than those of the TrueBeam fields, respectively. Neither the ArcCheck-based GPRs nor the portal-dosimetry-based GPRs in both 3%/3 mm and 2%/2 mm criteria showed the difference between the Halcyon(2.0) fields and the TrueBeam fields. The Pearson correlation coefficient between GPR(2%/2 mm) and MCS of the Halcyon(2.0) fields was 0.335, while that of the TrueBeam fields was 0.502. The mean total delivery time of the TrueBeam plans was 195.55 ± 22.86 s, while that of Halcyon(2.0) was 124.25 ± 10.42 s (P < .001), which was reduced approximatively by 36%. Conclusion: For long-course rectal cancer radiotherapy, the Halcyon(2.0) IMRT plans behave almost the same in dosimetry and delivery accuracy as the TrueBeam plans. However, the lower MU and the field modulation complexity, combined with the higher delivery efficiency, make Halcyon(2.0) a feasible and reliable platform in long-course radiotherapy for the rectal cancer.
Collapse
Affiliation(s)
- Jiajun Zheng
- 26481Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yuqing Xia
- 26481Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Li Sun
- 26481Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
12
|
Yokoyama K, Kurosaki H, Oyoshi H, Miura K, Utsumi N. Plan Quality Comparison Between Hippocampus-Sparing Whole-Brain Radiotherapy Treated With Halcyon and Tomotherapy Intensity-Modulated Radiotherapy. Technol Cancer Res Treat 2022; 21:15330338221108529. [PMID: 35770302 PMCID: PMC9252014 DOI: 10.1177/15330338221108529] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective: Hippocampus-sparing whole-brain radiotherapy using Halcyon, an instrument dedicated to volumetric modulated arc therapy, has not been studied till date; hence, we aimed to examine whether it can meet the RTOG0933 criteria. Based on this, we compared Halcyon to Tomotherapy, which also uses an O-ring-type linear accelerator. Methods: This exploratory, experimental, and retrospective study used 5 sets of computed tomography images in the head area to investigate the planning target volume, hippocampal doses, and irradiation time. Calculations were performed from 1 to 4 arcs to determine the optimal number of arcs in the Halcyon plan, which were compared to those of Tomotherapy. Results: The Radiation Therapy Oncology Group 0933 criteria could not be satisfied in Halcyon with 1 arc. With 2 arcs, the condition Dmax<16 Gy was not satisfied for 1 case in the hippocampus. Since there were no significant differences between 3 and 4 arcs, including the irradiation time, 3 arcs were considered the best. We compared Halcyon at 3 arcs with tomotherapy and found that tomotherapy was inferior to Halcyon at D98%; however, it was superior to Halcyon in other dose parameters. In contrast, the irradiation time in Halcyon was overwhelmingly superior, with the irradiation time for Halcyon being 1/ninth the time for Tomotherapy. Conclusion: Halcyon was effective in handling hippocampus-sparing whole-brain radiotherapy. We believe that 3-arc radiation is best suited for this procedure. Although Halcyon was inferior to Tomotherapy in terms of dose distribution excluding D98%, it was overwhelmingly superior in terms of irradiation time.
Collapse
Affiliation(s)
| | - Hiromasa Kurosaki
- School of Health Science, Suzuka University of Medical Science, Mie, Japan.,37004JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan.,158026Edogawa Hospital, Tokyo, Japan
| | - Hajime Oyoshi
- 26351National Cancer Center Hospital East, Chiba, Japan
| | - Kosei Miura
- 37004JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan.,13121University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nobuko Utsumi
- 37004JCHO Tokyo Shinjuku Medical Center, Tokyo, Japan
| |
Collapse
|
13
|
Tamihardja J, Razinskas G, Exner F, Richter A, Kessler P, Weick S, Kraft J, Mantel F, Flentje M, Polat B. Comparison of treatment plans for hypofractionated high-dose prostate cancer radiotherapy using the Varian Halcyon and the Elekta Synergy platforms. J Appl Clin Med Phys 2021; 22:262-270. [PMID: 34351055 PMCID: PMC8425948 DOI: 10.1002/acm2.13380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/17/2021] [Accepted: 07/16/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose To compare radiotherapy plans between an O‐ring and a conventional C‐arm linac for hypofractionated high‐dose prostate radiotherapy in terms of plan quality, dose distribution, and quality assurance in a multi‐vendor environment. Methods Twenty prostate cancer treatment plans were irradiated on the O‐ring Varian Halcyon linac and were re‐optimized for the C‐arm Elekta Synergy Agility linac. Dose‐volume histogram metrics for target coverage and organ at risk dose, quality assurance, and monitor units were retrospectively compared. Patient‐specific quality assurance with ion chamber measurements, gamma index analysis, and portal dosimetry was performed using the Varian Portal Dosimetry system and the ArcCHECK® phantom (Sun Nuclear Corporation). Prostate‐only radiotherapy was delivered with simultaneous integrated boost (SIB) volumetric modulated arc therapy (VMAT) in 20 fractions of 2.5/3.0 Gy each. Results For both linacs, target coverage was excellent and plan quality comparable. Homogeneity in PTVBoost was high for Synergy as well as Halcyon with a mean homogeneity index of 0.07 ± 0.01 and 0.05 ± 0.01, respectively. Mean dose for the organs at risk rectum and bladder differed not significantly between the linacs but were higher for the femoral heads and penile bulb for Halcyon. Quality assurance showed no significant differences in terms of ArcCHECK gamma pass rates. Median pass rate for 3%/2 mm was 99.3% (96.7 to 99.8%) for Synergy and 99.8% (95.6 to 100%) for Halcyon. Agreement between calculated and measured dose was high with a median deviation of −0.6% (−1.7 to 0.8%) for Synergy and 0.2% (−0.6 to 2.3%) for Halcyon. Monitor units were higher for the Halcyon by approximately 20% (p < 0.001). Conclusion Hypofractionated high‐dose prostate cancer SIB VMAT on the Halcyon system is feasible with comparable plan quality in reference to a standard C‐arm Elekta Synergy linac.
Collapse
Affiliation(s)
- Jörg Tamihardja
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Gary Razinskas
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Florian Exner
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Anne Richter
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Patrick Kessler
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Stefan Weick
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Johannes Kraft
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Frederick Mantel
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Michael Flentje
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Bülent Polat
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| |
Collapse
|
14
|
He C, Lu X, Li J, Shen K, Bai Y, Li Y, Luan H, Tuo S. The effect of quercetin on cervical cancer cells as determined by inducing tumor endoplasmic reticulum stress and apoptosis and its mechanism of action. Am J Transl Res 2021; 13:5240-5247. [PMID: 34150114 PMCID: PMC8205781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to explore the effect of quercetin on cervical cancer cells by inducing tumor endoplasmic reticulum stress (ERS) and apoptosis and its mechanism of action. METHODS HeLa cells were treated with different concentrations of quercetin, and the cell viability was measured using methyl thiazolyl tetrazolium (MTT) colorimetric assays. The apoptosis rate was measured using flow cytometry. The changes in the related protein X (Bax), B-cell lymphoma/leukemia-2 (Bcl-2), and G1/S-specific cyclin-D1 (Cyclin D1) levels after the HeLe apoptosis were determined using Western blot, and the changes in the human cystinase-3 (Caspase-3), glucoprotein 78 (GRP78), and enhancer-binding protein homologous protein (CHOP) levels, and the receptor-related protein levels in the ERS pathway/endoribonuclease inositol requiring enzyme 1 (IRE1), and the phosphorylated pancreatic endoplasmic reticulum stress kinase (p-Perk), and the activated transcription factor-6 (ATF6) levels were also quantified. RESULTS After treating the HeLa cells with different concentrations of quercetin, the cell viability was inhibited to varying degrees, showing a significant time and concentration dependence. The apoptosis rate in the quercetin group increased significantly in comparison with the blank control group, and the apoptosis rate also showed a tendency to increase progressively with an increasing concentration of the quercetin (P<0.05). The Bax and Bcl-2 levels in the quercetin intervention group showed a tendency to increase progressively in comparison with the blank control group, and Cyclin D1 showed a tendency to decrease progressively (P<0.05). The of Caspase-3, GRP78, and CHOP expression levels in the quercetin intervention group rose significantly in comparison with the blank control group (P<0.05). The IRE1, p-Perk, and c-ATF6 levels in the quercetin intervention group showed a tendency to rise gradually in comparison with the blank control group (P<0.05). CONCLUSION Quercetin may promote the apoptosis of cervical cancer HeLe cells by inducing the tumor ERS pathway.
Collapse
Affiliation(s)
- Chunxiao He
- Department of Gynecology, Gansu Provincial Maternity and Child-care Hospital Lanzhou 730050, Gansu Province, P. R. China
| | - Xiaohui Lu
- Department of Gynecology, Gansu Provincial Maternity and Child-care Hospital Lanzhou 730050, Gansu Province, P. R. China
| | - Juan Li
- Department of Gynecology, Gansu Provincial Maternity and Child-care Hospital Lanzhou 730050, Gansu Province, P. R. China
| | - Ke Shen
- Department of Gynecology, Gansu Provincial Maternity and Child-care Hospital Lanzhou 730050, Gansu Province, P. R. China
| | - Yang Bai
- Department of Gynecology, Gansu Provincial Maternity and Child-care Hospital Lanzhou 730050, Gansu Province, P. R. China
| | - Yilin Li
- Department of Gynecology, Gansu Provincial Maternity and Child-care Hospital Lanzhou 730050, Gansu Province, P. R. China
| | - Hua Luan
- Department of Gynecology, Gansu Provincial Maternity and Child-care Hospital Lanzhou 730050, Gansu Province, P. R. China
| | - Shumei Tuo
- Department of Gynecology, Gansu Provincial Maternity and Child-care Hospital Lanzhou 730050, Gansu Province, P. R. China
| |
Collapse
|
15
|
Quintero P, Cheng Y, Benoit D, Moore C, Beavis A. Effect of treatment planning system parameters on beam modulation complexity for treatment plans with single-layer multi-leaf collimator and dual-layer stacked multi-leaf collimator. Br J Radiol 2021; 94:20201011. [PMID: 33882242 PMCID: PMC8173683 DOI: 10.1259/bjr.20201011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE High levels of beam modulation complexity (MC) and monitor units (MU) can compromise the plan deliverability of intensity-modulated radiotherapy treatments. Our study evaluates the effect of three treatment planning system (TPS) parameters on MC and MU using different multi-leaf collimator (MLC) architectures. METHODS 192 volumetric modulated arc therapy plans were calculated using one virtual prostate phantom considering three main settings: (1) three TPS-parameters (Convergence; Aperture Shape Controller, ASC; and Dose Calculation Resolution, DCR) selected from Eclipse v15.6, (2) four levels of dose-sparing priority for organs at risk (OAR), and (3) two treatment units with same nominal conformity resolution and different MLC architectures (Halcyon-v2 dual-layer MLC, DL-MLC & TrueBeam single-layer MLC, SL-MLC). We use seven complexity metrics to evaluate the MC, including two new metrics for DL-MLC, assessed by their correlation with γ passing rate (GPR) analysis. RESULTS DL-MLC plans demonstrated lower dose-sparing values than SL-MLC plans (p<0.05). TPS-parameters did not change significantly the complexity metrics for either MLC architectures. However, for SL-MLC, significant variations of MU, target volume dose-homogeneity, and dose spillage were associated with ASC and DCR (p<0.05). MU were found to be correlated (highly or moderately) with all complexity metrics (p<0.05) for both MLC plans. Additionally, our new complexity metrics presented a moderate correlation with GPR (r<0.65). An important correlation was demonstrated between MC (plan deliverability) and dose-sparing priority level for DL-MLC. CONCLUSIONS TPS-parameters selected do not change MC for DL-MLC architecture, but they might have a potential use to control the MU, PTV homogeneity or dose spillage for SL-MLC. Our new DL-MLC complexity metrics presented important information to be considered in future pre-treatment quality assurance programs. Finally, the prominent dependence between plan deliverability and priority applied to OAR dose sparing for DL-MLC needs to be analyzed and considered as an additional predictor of GPRs in further studies. ADVANCES IN KNOWLEDGE Dose-sparing priority might influence in modulation complexity of DL-MLC.
Collapse
Affiliation(s)
- Paulo Quintero
- Medical Physics Service, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Hull, UK.,Department of Physics and Mathematics, University of Hull, Hull, UK
| | - Yongqiang Cheng
- Department of Computer Science and Technology, University of Hull, Hull, UK
| | - David Benoit
- Department of Physics and Mathematics, University of Hull, Hull, UK
| | - Craig Moore
- Medical Physics Service, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Andrew Beavis
- Medical Physics Service, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Hull, UK.,Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK.,Faculty of Health Sciences, University of Hull, Hull, UK
| |
Collapse
|
16
|
Sun T, Lin X, Zhang G, Qiu Q, Li C, Yin Y. Treatment planning comparison of volumetric modulated arc therapy with the trilogy and the Halcyon for bilateral breast cancer. Radiat Oncol 2021; 16:35. [PMID: 33602267 PMCID: PMC7890882 DOI: 10.1186/s13014-021-01763-z] [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: 10/10/2020] [Accepted: 02/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background The Halcyon is a new machine from the Varian company. The purpose of this study was to evaluate the dosimetry of the Halcyon in treatment of bilateral breast cancer with volumetric modulated arc therapy. Methods On CT images of 10 patients with bilateral breast cancer, four Halcyon plans with different setup fields were generated, and dosimetric comparisons using Bonferroni’s multiple comparisons test were conducted among the four plans. Whole and partial arc plans on the Trilogy and the Halcyon, referred to as T-4arc, T-8arc, H-4arc and H-8arc, were designed. The prescription dose was 50 Gy in 2-Gy fractions. All plans were designed with the Eclipse version 15.5 treatment planning system. The dosimetric differences between whole and partial arc plans in the same accelerator were compared using the Mann–Whitney U test. The better Halcyon plan was selected for the further dosimetric comparison of the plan quality and delivery efficiency between the Trilogy and the Halcyon. Results Halcyon plans with high‐quality megavoltage cone beam CT setup fields increased the Dmean, D2 and V107 of the planning target volume (PTV) and the V5 and Dmean of the heart, left ventricle (LV) and lungs compared with other Halcyon setup plans. The mean dose and low dose volume of the heart, lungs and liver were significantly decreased in T-8arc plans compared to T-4arc plans. In terms of the V5, V20, V30, V40 and Dmean of the heart, the V20, V30, V40 and Dmean of the LV, the V30, V40, Dmax and Dmean of the left anterior descending artery (LAD), and the V5 and V40 of lungs, H-8arc was significantly higher than H-4arc (p < 0.05). Compared with the Trilogy’s plans, the Halcyon’s plans reduced the high-dose volume of the heart and LV but increased the mean dose of the heart. For the dose of the LAD and the V20 and V30 of lungs, there was no significant difference between the two accelerators. Compared with the Trilogy, plans on the Halcyon significantly increased the skin dose but also significantly reduced the delivery time. Conclusion For the Halcyon, the whole-arc plans have more dosimetric advantages than partial-arc plans in bilateral breast cancer radiotherapy. Although the mean dose of the heart and the skin dose are increased, the doses of the cardiac substructure and other OARs are comparable to the Trilogy, and the delivery time is significantly reduced.
Collapse
Affiliation(s)
- Tao Sun
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Xiutong Lin
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Guifang Zhang
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Qingtao Qiu
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Chengqiang Li
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China
| | - Yong Yin
- Department of Radiation Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Jinan, 250117, Shandong, China.
| |
Collapse
|
17
|
Kang S, Wu J, Liu X, Wang P, Li J, Wu F, Tang B. Dosimetric and delivery comparison of helical tomotherapy with dynamic jaw and fixed jaw for cervical carcinoma. J Cancer Res Ther 2021; 17:1626-1630. [DOI: 10.4103/jcrt.jcrt_393_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
18
|
Panda S, Swamidas J, Chopra S, Mangaj A, Fogliata A, Kupelian P, Agarwal JP, Cozzi L. Treatment planning comparison of volumetric modulated arc therapy employing a dual-layer stacked multi-leaf collimator and helical tomotherapy for cervix uteri. Radiat Oncol 2020; 15:22. [PMID: 32000832 PMCID: PMC6990476 DOI: 10.1186/s13014-020-1473-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/19/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose To ascertain the dosimetric performance of a new delivery system (the Halcyon system, H) equipped with dual-layer stacked multi-leaf collimator (MLC) for risk-adapted targets in cervix uteri cancer patients compared to another ring-based system in clinical operation (Helical Tomotherapy, HT). Methods Twenty patients were retrospectively included in a treatment planning study (10 with positive lymph nodes and 10 without). The dose prescription (45Gy to the primary tumour volume and a simultaneously integrated boost up to 55Gy for the positive patients) and the clinical planning objectives were defined consistently as recommended by an ongoing multicentric clinical trial. Halcyon plans were optimised for the volumetric modulated arc therapy. The plan comparison was performed employing the quantitative analysis of the dose-volume histograms. Results The coverage of the primary and nodal target volumes was comparable for both techniques and both subsets of patients. The primary planning target volume (PTV) receiving at least 95% of the prescription isodose ranged from 97.2 ± 1.1% (node-negative) to 99.1 ± 1.2% (node-positive) for H and from 96.5 ± 1.9% (node-negative) to 98.3 ± 0.9% (node-positive) for HT. The uncertainty is expressed at one standard deviation from the cohort of patient per each group. For the nodal clinical target volumes, the dose received by 98% of the planning target volume ranged 55.5 ± 0.1 to 56.0 ± 0.8Gy for H and HT, respectively. The only significant and potentially relevant differences were observed for the bowels. In this case, V40Gy resulted 226.3 ± 35.9 and 186.9 ± 115.9 cm3 for the node-positive and node-negative patients respectively for Halcyon. The corresponding findings for HT were: 258.9 ± 60.5 and 224.9 ± 102.2 cm3. On the contrary, V15Gy resulted 1279.7 ± 296.5 and 1557.2 ± 359.9 cm3 for HT and H respectively for node-positive and 1010.8 ± 320.9 versus 1203.8 ± 332.8 cm3 for node-negative. Conclusion This retrospective treatment planning study, based on the dose constraints derived from the Embrace II study protocol, suggested the essential equivalence between Halcyon based and Helical Tomotherapy based plans for the intensity-modulated rotational treatment of cervix uteri cancer. Different levels of sparing were observed for the bowels with H better protecting in the high-dose region and HT in the mid-low dose regions. The clinical impact of these differences should be further addressed.
Collapse
Affiliation(s)
- S Panda
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - J Swamidas
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - S Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - A Mangaj
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - A Fogliata
- Humanitas Research Hospital, Radiotherapy and Cancer Center Radiosurgery Dept, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - P Kupelian
- Varian Medical Systems, Palo Alto, CA, USA.,Radiation Oncology Dept., University of California, Los Angeles, USA
| | - J P Agarwal
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - L Cozzi
- Humanitas Research Hospital, Radiotherapy and Cancer Center Radiosurgery Dept, Via Manzoni 56, 20089, Milan-Rozzano, Italy. .,Dept. of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy.
| |
Collapse
|