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Title: SU-F-T-269: Preliminary Experience of Kuwait Cancer Control Center (KCCC) On IMRT Treatment Planning and Pre-Treatment Verification

Abstract

Purpose: The complexity of IMRT delivery requires pre-treatment quality assurance and plan verification. KCCC has implemented IMRT clinically in few sites and will extend to all sites. Recently, our Varian linear accelerator and Eclipse planning system were upgraded from Millennium 80 to 120 Multileaf Collimator (MLC) and from v8.6 to 11.0 respectively. Our preliminary experience on the pre-treatment quality assurance verification is discussed. Methods: Eight Breast, Three Prostate and One Hypopharynx cancer patients were planned with step and shoot IMRT. All breast cases were planned before the upgrade with 60% cases treated. The ICRU 83 recommendations were followed for the dose prescription and constraints to OAR for all cases. Point dose measurement was done with CIRS cylindrical phantom and PTW 0.125 cc ionization chamber. Measured dose was compared with calculated dose at the point of measurement. Map CHECK diode array phantom was used for the plan verification. Planned and measured doses were compared by applying gamma index of 3% (dose difference) / 3 mm DTA (average distance to agreement). For all cases, a plan is considered to be successful if more than 95% of the tested diodes pass the gamma test. A prostate case was chosen to compare the planmore » verification before and after the upgrade. Results: Point dose measurement results were in agreement with the calculated doses. The maximum deviation observed was 2.3%. The passing rate of average gamma index was measured higher than 97% for the plan verification of all cases. Similar result was observed for plan verification of the chosen prostate case before and after the upgrade. Conclusion: Our preliminary experience from the obtained results validates the accuracy of our QA process and provides confidence to extend IMRT to all sites in Kuwait.« less

Authors:
; ; ; ;  [1]
  1. Kuwait Cancer Control Center, Kuwait (Kuwait)
Publication Date:
OSTI Identifier:
22648883
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 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; 61 RADIATION PROTECTION AND DOSIMETRY; 43 PARTICLE ACCELERATORS; IONIZATION CHAMBERS; KUWAIT; LINEAR ACCELERATORS; MAMMARY GLANDS; NEOPLASMS; PLANNING; PROSTATE; QUALITY ASSURANCE; RADIATION DOSES; RADIOTHERAPY; VERIFICATION

Citation Formats

Sethuraman, TKR, Sherif, M, Subramanian, N, Zoueil, O, and Mirza, K. SU-F-T-269: Preliminary Experience of Kuwait Cancer Control Center (KCCC) On IMRT Treatment Planning and Pre-Treatment Verification. United States: N. p., 2016. Web. doi:10.1118/1.4956409.
Sethuraman, TKR, Sherif, M, Subramanian, N, Zoueil, O, & Mirza, K. SU-F-T-269: Preliminary Experience of Kuwait Cancer Control Center (KCCC) On IMRT Treatment Planning and Pre-Treatment Verification. United States. doi:10.1118/1.4956409.
Sethuraman, TKR, Sherif, M, Subramanian, N, Zoueil, O, and Mirza, K. 2016. "SU-F-T-269: Preliminary Experience of Kuwait Cancer Control Center (KCCC) On IMRT Treatment Planning and Pre-Treatment Verification". United States. doi:10.1118/1.4956409.
@article{osti_22648883,
title = {SU-F-T-269: Preliminary Experience of Kuwait Cancer Control Center (KCCC) On IMRT Treatment Planning and Pre-Treatment Verification},
author = {Sethuraman, TKR and Sherif, M and Subramanian, N and Zoueil, O and Mirza, K},
abstractNote = {Purpose: The complexity of IMRT delivery requires pre-treatment quality assurance and plan verification. KCCC has implemented IMRT clinically in few sites and will extend to all sites. Recently, our Varian linear accelerator and Eclipse planning system were upgraded from Millennium 80 to 120 Multileaf Collimator (MLC) and from v8.6 to 11.0 respectively. Our preliminary experience on the pre-treatment quality assurance verification is discussed. Methods: Eight Breast, Three Prostate and One Hypopharynx cancer patients were planned with step and shoot IMRT. All breast cases were planned before the upgrade with 60% cases treated. The ICRU 83 recommendations were followed for the dose prescription and constraints to OAR for all cases. Point dose measurement was done with CIRS cylindrical phantom and PTW 0.125 cc ionization chamber. Measured dose was compared with calculated dose at the point of measurement. Map CHECK diode array phantom was used for the plan verification. Planned and measured doses were compared by applying gamma index of 3% (dose difference) / 3 mm DTA (average distance to agreement). For all cases, a plan is considered to be successful if more than 95% of the tested diodes pass the gamma test. A prostate case was chosen to compare the plan verification before and after the upgrade. Results: Point dose measurement results were in agreement with the calculated doses. The maximum deviation observed was 2.3%. The passing rate of average gamma index was measured higher than 97% for the plan verification of all cases. Similar result was observed for plan verification of the chosen prostate case before and after the upgrade. Conclusion: Our preliminary experience from the obtained results validates the accuracy of our QA process and provides confidence to extend IMRT to all sites in Kuwait.},
doi = {10.1118/1.4956409},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To assess the preliminary feasibility of automated treatment planning verification system in cervical cancer IMRT pre-treatment dose verification. Methods: The study selected randomly clinical IMRT treatment planning data for twenty patients with cervical cancer, all IMRT plans were divided into 7 fields to meet the dosimetric goals using a commercial treatment planning system(PianncleVersion 9.2and the EclipseVersion 13.5). The plans were exported to the Mobius 3D (M3D)server percentage differences of volume of a region of interest (ROI) and dose calculation of target region and organ at risk were evaluated, in order to validate the accuracy automated treatment planning verification system.more » Results: The difference of volume for Pinnacle to M3D was less than results for Eclipse to M3D in ROI, the biggest difference was 0.22± 0.69%, 3.5±1.89% for Pinnacle and Eclipse respectively. M3D showed slightly better agreement in dose of target and organ at risk compared with TPS. But after recalculating plans by M3D, dose difference for Pinnacle was less than Eclipse on average, results were within 3%. Conclusion: The method of utilizing the automated treatment planning system to validate the accuracy of plans is convenientbut the scope of differences still need more clinical patient cases to determine. At present, it should be used as a secondary check tool to improve safety in the clinical treatment planning.« less
  • We investigate an off-line strategy to incorporate inter fraction organ movements in IMRT treatment planning. Nowadays, imaging modalities located in the treatment room allow for several CT scans of a patient during the course of treatment. These multiple CT scans can be used to estimate a probability distribution of possible patient geometries. This probability distribution can subsequently be used to calculate the expectation value of the delivered dose distribution. In order to incorporate organ movements into the treatment planning process, it was suggested that inverse planning could be based on that probability distribution of patient geometries instead of a singlemore » snapshot. However, it was shown that a straightforward optimization of the expectation value of the dose may be insufficient since the expected dose distribution is related to several uncertainties: first, this probability distribution has to be estimated from only a few images. And second, the distribution is only sparsely sampled over the treatment course due to a finite number of fractions. In order to obtain a robust treatment plan these uncertainties should be considered and minimized in the inverse planning process. In the current paper, we calculate a 3D variance distribution in addition to the expectation value of the dose distribution which are simultaniously optimized. The variance is used as a surrogate to quantify the associated risks of a treatment plan. The feasibility of this approach is demonstrated for clinical data of prostate patients. Different scenarios of dose expectation values and corresponding variances are discussed.« less
  • Intensity modulated radiotherapy (IMRT) is ideal for anal canal cancer (ACC), delivering high doses to irregular tumour volumes whilst minimising dose to surrounding normal tissues. Establishing achievable dose objectives is a challenge. The purpose of this paper was to utilise data collected in the Assessment of New Radiation Oncology Treatments and Technologies (ANROTAT) project to evaluate the feasibility of ACC IMRT dose planning objectives employed in the Australian situation. Ten Australian centres were randomly allocated three data sets from 15 non-identifiable computed tomography data sets representing a range of disease stages and gender. Each data set was planned by twomore » different centres, producing 30 plans. All tumour and organ at risk (OAR) contours, prescription and dose constraint details were provided. Dose–volume histograms (DVHs) for each plan were analysed to evaluate the feasibility of dose planning objectives provided. All dose planning objectives for the bone marrow (BM) and femoral heads were achieved. Median planned doses exceeded one or more objectives for bowel, external genitalia and bladder. This reached statistical significance for bowel V30 (P = 0.04), V45 (P < 0.001), V50 (P < 0.001), external genitalia V20 (P < 0.001) and bladder V35 (P < 0.001), V40 (P = 0.01). Gender was found to be the only significant factor in the likelihood of achieving the bowel V50 (P = 0.03) and BM V30 constraints (P = 0.04). The dose planning objectives used in the ANROTAT project provide a good starting point for ACC IMRT planning. To facilitate clinical implementation, it is important to prioritise OAR objectives and recognise factors that affect the achievability of these objectives.« less
  • Purpose: To compare intensity-modulated photon radiotherapy (IMRT) with three-dimensional conformal proton therapy (3D-CPT) for early-stage prostate cancer, and explore the potential utility of intensity-modulated proton therapy (IMPT). Methods and Materials: Ten patients were planned with both 3D-CPT (two parallel-opposed lateral fields) and IMRT (seven equally spaced coplanar fields). Prescribed dose was 79.2 Gy (or cobalt Gray-equivalent, [CGE] for protons) to the prostate gland. Dose-volume histograms, dose conformity, and equivalent uniform dose (EUD) were compared. Additionally, plans were optimized for 3D-CPT with nonstandard beam configuration, and for IMPT assuming delivery with beam scanning. Results: At least 98% of the planning targetmore » volume received the prescription dose. IMRT plans yielded better dose conformity to the target, whereas proton plans achieved higher dose homogeneity and better sparing of rectum and bladder in the range below 30 Gy/CGE. Bladder volumes receiving more than 70 Gy/CGE (V{sub 70}) were reduced, on average, by 34% with IMRT vs. 3D-CPT, whereas rectal V{sub 70} were equivalent. EUD from 3D-CPT and IMRT plans were indistinguishable within uncertainties for both bladder and rectum. With the use of small-angle lateral-oblique fields in 3D-CPT and IMPT, the rectal V{sub 70} was reduced by up to 35% compared with the standard lateral configuration, whereas the bladder V{sub 70} increased by less than 10%. Conclusions: In the range higher than 60 Gy/CGE, IMRT achieved significantly better sparing of the bladder, whereas rectal sparing was similar with 3D-CPT and IMRT. Dose to healthy tissues in the range lower than 50% of the target prescription was substantially lower with proton therapy.« less
  • Purpose: To investigate the feasibility of utilizing Dynamic Arc (DA) and IMRT with 5mm MLC leaf of VERO treatment unit for SRS/FSRT brain cancer patients with non-invasive stereotactic treatments. The DA and IMRT plans using the VERO unit (BrainLab Inc, USA) are compared with cone-based planning and proton plans to evaluate their dosimetric advantages. Methods: The Vero treatment has unique features like no rotational or translational movements of the table during treatments, Dynamic Arc/IMRT, tracking of IR markers, limitation of Ring rotation. Accuracies of the image fusions using CBCT, orthogonal x-rays, and CT are evaluated less than ∼ 0.7mm withmore » a custom-made target phantom with 18 hidden targets. 1mm margin is given to GTV to determine PTV for planning constraints considering all the uncertainties of planning computer and mechanical uncertainties of the treatment unit. Also, double-scattering proton plans with 6F to 9F beams and typical clinical parameters, multiple isocenter plans with 6 to 21 isocenters, and DA/IMRT plans are evaluated to investigate the dosimetric advantages of the DA/IMRT for complex shape of targets. Results: 3 Groups of the patients are divided: (1) Group A (complex target shape), CI's are same for IMRT, and DGI of the proton plan are better by 9.5% than that of the IMRT, (2) Group B, CI of the DA plans (1.91+/−0.4) are better than cone-based plan, while DGI of the DA plan is 4.60+/−1.1 is better than cone-based plan (5.32+/−1.4), (3) Group C (small spherical targets), CI of the DA and cone-based plans are almost the same. Conclusion: For small spherical targets, cone-based plans are superior to other 2 plans: DS proton and DA plans. For complex or irregular plans, dynamic and IMRT plans are comparable to cone-based and proton plans for complex targets.« less