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Title: Poster — Thur Eve — 35: The impact of intensity- and energy-modulated photon radiotherapy (XMRT) optimization on a variety of organ geometries

Abstract

We previously reported on a novel, modulated in both energy and intensity; photon radiotherapy (XMRT) optimization technique. The purpose of this investigation was to test this XMRT optimization against conventional intensity modulated radiotherapy (IMRT) optimization on four different organ test geometries. All geometries mimicked clinically relevant scenarios. Both IMRT and XMRT were based on a linear programming approach where the objective function was the mean dose to healthy organs and organ-specific linear dose-point constraints were used. For IMRT, the beam energy was fixed to 6 MV while XMRT optimized in terms of both 6 and 18 MV beams. All plans consisted of a seven beam coplanar arrangement. All organ geometries were contoured on a 25cm diameter cylindrical water phantom in open source radiotherapy research software known as CERR. Solutions for both IMRT and XMRT were obtained for each geometry using a numerical solver Gurobi. Analyzing the quality of the solutions was done by comparing dose distributions and dose volume histograms calculated using CERR. For all four geometries, IMRT and XMRT solutions were comparable in terms of target coverage. For two of the geometries, IMRT provided an advantage in terms of reduced dose to the healthy structures. XMRT showed improved dosemore » reduction to healthy organs for one geometry and a comparable dose distribution to IMRT for the remaining geometry. The inability to exploit the benefits of using multiple energies may be attributed to limited water phantom diameter and having the majority of the organs in close proximity to the transverse axis.« less

Authors:
; ;  [1];  [2];  [3]
  1. Department of Physics and Astronomy, University of Calgary, Calgary, AB (Canada)
  2. (Canada)
  3. Department of Mathematics and Statistics, University of Calgary, Calgary, AB (Canada)
Publication Date:
OSTI Identifier:
22407657
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 41; Journal Issue: 8; Other Information: (c) 2014 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; COMPARATIVE EVALUATIONS; CYLINDRICAL CONFIGURATION; LINEAR PROGRAMMING; OPTIMIZATION; ORGANS; PHANTOMS; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY

Citation Formats

McGeachy, P., Villarreal-Barajas, J. E., Khan, R., Department of Medical Physics, Tom Baker Cancer Center, Calgary, AB, and Zinchenko, Y. Poster — Thur Eve — 35: The impact of intensity- and energy-modulated photon radiotherapy (XMRT) optimization on a variety of organ geometries. United States: N. p., 2014. Web. doi:10.1118/1.4894894.
McGeachy, P., Villarreal-Barajas, J. E., Khan, R., Department of Medical Physics, Tom Baker Cancer Center, Calgary, AB, & Zinchenko, Y. Poster — Thur Eve — 35: The impact of intensity- and energy-modulated photon radiotherapy (XMRT) optimization on a variety of organ geometries. United States. doi:10.1118/1.4894894.
McGeachy, P., Villarreal-Barajas, J. E., Khan, R., Department of Medical Physics, Tom Baker Cancer Center, Calgary, AB, and Zinchenko, Y. Fri . "Poster — Thur Eve — 35: The impact of intensity- and energy-modulated photon radiotherapy (XMRT) optimization on a variety of organ geometries". United States. doi:10.1118/1.4894894.
@article{osti_22407657,
title = {Poster — Thur Eve — 35: The impact of intensity- and energy-modulated photon radiotherapy (XMRT) optimization on a variety of organ geometries},
author = {McGeachy, P. and Villarreal-Barajas, J. E. and Khan, R. and Department of Medical Physics, Tom Baker Cancer Center, Calgary, AB and Zinchenko, Y.},
abstractNote = {We previously reported on a novel, modulated in both energy and intensity; photon radiotherapy (XMRT) optimization technique. The purpose of this investigation was to test this XMRT optimization against conventional intensity modulated radiotherapy (IMRT) optimization on four different organ test geometries. All geometries mimicked clinically relevant scenarios. Both IMRT and XMRT were based on a linear programming approach where the objective function was the mean dose to healthy organs and organ-specific linear dose-point constraints were used. For IMRT, the beam energy was fixed to 6 MV while XMRT optimized in terms of both 6 and 18 MV beams. All plans consisted of a seven beam coplanar arrangement. All organ geometries were contoured on a 25cm diameter cylindrical water phantom in open source radiotherapy research software known as CERR. Solutions for both IMRT and XMRT were obtained for each geometry using a numerical solver Gurobi. Analyzing the quality of the solutions was done by comparing dose distributions and dose volume histograms calculated using CERR. For all four geometries, IMRT and XMRT solutions were comparable in terms of target coverage. For two of the geometries, IMRT provided an advantage in terms of reduced dose to the healthy structures. XMRT showed improved dose reduction to healthy organs for one geometry and a comparable dose distribution to IMRT for the remaining geometry. The inability to exploit the benefits of using multiple energies may be attributed to limited water phantom diameter and having the majority of the organs in close proximity to the transverse axis.},
doi = {10.1118/1.4894894},
journal = {Medical Physics},
number = 8,
volume = 41,
place = {United States},
year = {Fri Aug 15 00:00:00 EDT 2014},
month = {Fri Aug 15 00:00:00 EDT 2014}
}
  • Purpose: To develop a new radiotherapy plan optimization technique that, for a given organ geometry, will find the optimal photon beam energies and fluences to produce a desirable dose distribution. This new modulated (both in energy and fluence) photon radiotherapy (XMRT) was compared with intensity modulated radiotherapy (IMRT) for a simple organ geometry. Methods: The XMRT optimization was formulated using a linear programming approach where the objective function is the mean dose to the healthy organs and dose-point constraints were assigned to each organ of interest. The organ geometry consisted of a target, two organs at risk (OARs), and normalmore » tissue. A seven-equispaced-coplanar beam arrangement was used. For conventional IMRT, only 6 MV beams were available, while XMRT was optimized using 6 and 18 MV beams. A prescribed dose (PD) of 72 GY was assigned to the target, with upper and lower bounds of 110% and 95% of the PD, respectively. Both OARs were assigned a maximum dose of 64 Gy, while the normal tissue was assigned a maximum dose of 66 Gy. A numerical solver, Gurobi, generated solutions for the XMRT and IMRT problems. The dose-volume histograms from IMRT and XMRT solutions were compared. Results: The maximum, minimum, mean, and homogeneity of the dose to the target were comparable between IMRT and XMRT. Though IMRT had improved dose conformity relative to XMRT, XMRT reduced the mean dose to both OARs by more than 1 Gy. For normal tissue, an increase of 5 Gy in mean dose and 27 percent in integral dose was seen for IMRT relative to XMRT. Conclusion: This work demonstrates the benefits of simultaneously modulating photon beam energy and fluence using our XMRT approach in a given phantom geometry. While target coverage was comparable, dose to healthy structures was reduced using XMRT.« less
  • Purpose: Modulated Photon Radiotherapy (XMRT), which simultaneously optimizes photon beamlet energy (6 and 18 MV) and fluence, has recently shown dosimetric improvement in comparison to conventional IMRT. That said, the degree of smoothness of resulting fluence maps (FMs) has yet to be investigated and could impact the deliverability of XMRT. This study looks at investigating FM smoothness and imposing smoothing constraint in the fluence map optimization. Methods: Smoothing constraints were modeled in the XMRT algorithm with the sum of positive gradient (SPG) technique. XMRT solutions, with and without SPG constraints, were generated for a clinical prostate scan using standard dosimetricmore » prescriptions, constraints, and a seven coplanar beam arrangement. The smoothness, with and without SPG constraints, was assessed by looking at the absolute and relative maximum SPG scores for each fluence map. Dose volume histograms were utilized when evaluating impact on the dose distribution. Results: Imposing SPG constraints reduced the absolute and relative maximum SPG values by factors of up to 5 and 2, respectively, when compared with their non-SPG constrained counterparts. This leads to a more seamless conversion of FMS to their respective MLC sequences. This improved smoothness resulted in an increase to organ at risk (OAR) dose, however the increase is not clinically significant. Conclusions: For a clinical prostate case, there was a noticeable improvement in the smoothness of the XMRT FMs when SPG constraints were applied with a minor increase in dose to OARs. This increase in OAR dose is not clinically meaningful.« less
  • This study investigated dosimetric impact due to the bone backscatter in orthovoltage radiotherapy. Monte Carlo simulations were used to calculate depth doses and photon fluence spectra using the EGSnrc-based code. Inhomogeneous bone phantom containing a thin water layer (1–3 mm) on top of a bone (1 cm) to mimic the treatment sites of forehead, chest wall and kneecap was irradiated by the 220 kVp photon beam produced by the Gulmay D3225 x-ray machine. Percentage depth doses and photon energy spectra were determined using Monte Carlo simulations. Results of percentage depth doses showed that the maximum bone dose was about 210–230%more » larger than the surface dose in the phantoms with different water thicknesses. Surface dose was found to be increased from 2.3 to 3.5%, when the distance between the phantom surface and bone was increased from 1 to 3 mm. This increase of surface dose on top of a bone was due to the increase of photon fluence intensity, resulting from the bone backscatter in the energy range of 30 – 120 keV, when the water thickness was increased. This was also supported by the increase of the intensity of the photon energy spectral curves at the phantom and bone surface as the water thickness was increased. It is concluded that if the bone inhomogeneity during the dose prescription in the sites of forehead, chest wall and kneecap with soft tissue thickness = 1–3 mm is not considered, there would be an uncertainty in the dose delivery.« less
  • In this work, we demonstrate inconsistencies in commonly used Monte Carlo methods of scoring linear energy transfer (LET) in proton therapy beams. In particle therapy beams, the LET is an important parameter because the relative biological effectiveness (RBE) depends on it. LET is often determined using Monte Carlo techniques. We used a realistic Monte Carlo model of a proton therapy nozzle to score proton LET in spread-out Bragg peak (SOBP) depth-dose distributions. We used three different scoring and calculation techniques to determine average LET at varying depths within a 140 MeV beam with a 4 cm SOBP and a 250more » MeV beam with a 10 cm SOBP. These techniques included fluence-weighted (Φ-LET) and dose-weighted average (D-LET) LET calculations from: 1) scored energy spectra converted to LET spectra through a lookup table, 2) directly scored LET spectra and 3) accumulated LET scored ‘on-the-fly’ during simulations. All protons (primary and secondary) were included in the scoring. Φ-LET was found to be less sensitive to changes in scoring technique than D-LET. In addition, the spectral scoring methods were sensitive to low-energy (high-LET) cutoff values in the averaging. Using cutoff parameters chosen carefully for consistency between techniques, we found variations in Φ-LET values of up to 1.6% and variations in D-LET values of up to 11.2% for the same irradiation conditions, depending on the method used to score LET. Variations were largest near the end of the SOBP, where the LET and energy spectra are broader.« less
  • Purpose: The dosimetric outcome of optimized treatment plans obtained by modulating the photon beamlet energy and fluence on a small cohort of four Head and Neck (H and N) patients was investigated. This novel optimization technique is denoted XMRT for modulated photon radiotherapy. The dosimetric plans from XMRT for H and N treatment were compared to conventional, 6 MV intensity modulated radiotherapy (IMRT) optimization plans. Methods: An arrangement of two non-coplanar and five coplanar beams was used for all four H and N patients. Both XMRT and IMRT were subject to the same optimization algorithm, with XMRT optimization allowing bothmore » 6 and 18 MV beamlets while IMRT was restricted to 6 MV only. The optimization algorithm was based on a linear programming approach with partial-volume constraints implemented via the conditional value-at-risk method. H and N constraints were based off of those mentioned in the Radiation Therapy Oncology Group 1016 protocol. XMRT and IMRT solutions were assessed using metrics suggested by International Commission on Radiation Units and Measurements report 83. The Gurobi solver was used in conjunction with the CVX package to solve each optimization problem. Dose calculations and analysis were done in CERR using Monte Carlo dose calculation with VMC{sub ++}. Results: Both XMRT and IMRT solutions met all clinical criteria. Trade-offs were observed between improved dose uniformity to the primary target volume (PTV1) and increased dose to some of the surrounding healthy organs for XMRT compared to IMRT. On average, IMRT improved dose to the contralateral parotid gland and spinal cord while XMRT improved dose to the brainstem and mandible. Conclusion: Bi-energy XMRT optimization for H and N patients provides benefits in terms of improved dose uniformity to the primary target and reduced dose to some healthy structures, at the expense of increased dose to other healthy structures when compared with IMRT.« less