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Title: SU-F-T-501: Dosimetric Comparison of Single Arc-Per-Beam and Two Arc-Per-Beam VMAT Optimization in the Monaco Treatment Planning System

Abstract

Purpose: The purpose of this study was to evaluate the dosimetric and practical effects of the Monaco treatment planning system “max arcs-per-beam” optimization parameter in pelvic radiotherapy treatments. Methods: A total of 17 previously treated patients were selected for this study with a range of pelvic disease site including prostate(9), bladder(1), uterus(3), rectum(3), and cervix(1). For each patient, two plans were generated, one using a arc-per-beam setting of ‘1’ and another with setting of ‘2’. The setting allows the optimizer to add a gantry direction change, creating multiple arc passes per beam sequence. Volumes and constraints established from the initial clinical treatments were used for planning. All constraints and dose coverage objects were kept the same between plans, and all plans were normalized to 99.7% to ensure 100% of the PTV received 95% of the prescription dose. We evaluated the PTV conformity index, homogeneity index, total monitor units, number of control points, and various dose volume histogram (DVH) points for statistical comparison (alpha=0.05). Results: We found for the 10 complex shaped target volumes (small central volumes with extending bilateral ‘arms’ to cover nodal regions) that the use of 2 arcs-per-beam achieved significantly lower average DVH values for the bladder V20more » (p=0.036) and rectum V30 (p=0.001) while still meeting the high dose target constraints. DVH values for the simpler, more spherical PTVs were not found significantly different. Additionally, we found a beam delivery time reduction of approximately 25%. Conclusion: In summary, the dosimetric benefit, while moderate, was improved over a 1 arc-per-beam setting for complex PTVs, and equivalent in other cases. The overall reduced delivery time suggests that the use of multiple arcs-per-beam could lead to reduced patient on table time, increased clinical throughput, and reduced medical physics quality assurance effort.« less

Authors:
; ; ;  [1];  [2];  [3]
  1. University of Washington Medical Center, Seattle, WA (United States)
  2. (United States)
  3. Seattle Cancer Care Alliance, Seattle, WA (United States)
Publication Date:
OSTI Identifier:
22649088
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; LIMITING VALUES; OPTIMIZATION; PATIENTS; PLANNING; QUALITY ASSURANCE; RADIOTHERAPY; SPHERICAL CONFIGURATION

Citation Formats

Kalet, A, Cao, N, Meyer, J, Dempsey, C, Seattle Cancer Care Alliance, Seattle, WA, and Richardson, H. SU-F-T-501: Dosimetric Comparison of Single Arc-Per-Beam and Two Arc-Per-Beam VMAT Optimization in the Monaco Treatment Planning System. United States: N. p., 2016. Web. doi:10.1118/1.4956686.
Kalet, A, Cao, N, Meyer, J, Dempsey, C, Seattle Cancer Care Alliance, Seattle, WA, & Richardson, H. SU-F-T-501: Dosimetric Comparison of Single Arc-Per-Beam and Two Arc-Per-Beam VMAT Optimization in the Monaco Treatment Planning System. United States. doi:10.1118/1.4956686.
Kalet, A, Cao, N, Meyer, J, Dempsey, C, Seattle Cancer Care Alliance, Seattle, WA, and Richardson, H. 2016. "SU-F-T-501: Dosimetric Comparison of Single Arc-Per-Beam and Two Arc-Per-Beam VMAT Optimization in the Monaco Treatment Planning System". United States. doi:10.1118/1.4956686.
@article{osti_22649088,
title = {SU-F-T-501: Dosimetric Comparison of Single Arc-Per-Beam and Two Arc-Per-Beam VMAT Optimization in the Monaco Treatment Planning System},
author = {Kalet, A and Cao, N and Meyer, J and Dempsey, C and Seattle Cancer Care Alliance, Seattle, WA and Richardson, H},
abstractNote = {Purpose: The purpose of this study was to evaluate the dosimetric and practical effects of the Monaco treatment planning system “max arcs-per-beam” optimization parameter in pelvic radiotherapy treatments. Methods: A total of 17 previously treated patients were selected for this study with a range of pelvic disease site including prostate(9), bladder(1), uterus(3), rectum(3), and cervix(1). For each patient, two plans were generated, one using a arc-per-beam setting of ‘1’ and another with setting of ‘2’. The setting allows the optimizer to add a gantry direction change, creating multiple arc passes per beam sequence. Volumes and constraints established from the initial clinical treatments were used for planning. All constraints and dose coverage objects were kept the same between plans, and all plans were normalized to 99.7% to ensure 100% of the PTV received 95% of the prescription dose. We evaluated the PTV conformity index, homogeneity index, total monitor units, number of control points, and various dose volume histogram (DVH) points for statistical comparison (alpha=0.05). Results: We found for the 10 complex shaped target volumes (small central volumes with extending bilateral ‘arms’ to cover nodal regions) that the use of 2 arcs-per-beam achieved significantly lower average DVH values for the bladder V20 (p=0.036) and rectum V30 (p=0.001) while still meeting the high dose target constraints. DVH values for the simpler, more spherical PTVs were not found significantly different. Additionally, we found a beam delivery time reduction of approximately 25%. Conclusion: In summary, the dosimetric benefit, while moderate, was improved over a 1 arc-per-beam setting for complex PTVs, and equivalent in other cases. The overall reduced delivery time suggests that the use of multiple arcs-per-beam could lead to reduced patient on table time, increased clinical throughput, and reduced medical physics quality assurance effort.},
doi = {10.1118/1.4956686},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To commission the Monaco Treatment Planning System for the Novalis Tx machine. Methods: The commissioning of Monte-Carlo (MC), Collapsed Cone (CC) and electron Monte-Carlo (eMC) beam models was performed through a series of measurements and calculations in medium and in water. In medium measurements relied Octavius 4D QA system with the 1000 SRS detector array for field sizes less than 4 cm × 4 cm and the 1500 detector array for larger field sizes. Heterogeneity corrections were validated using a custom built phantom. Prior to clinical implementation, an end to end testing of a Prostate and H&N VMAT plansmore » was performed. Results: Using a 0.5% uncertainty and 2 mm grid sizes, Tables I and II summarize the MC validation at 6 MV and 18 MV in both medium and water. Tables III and IV show similar comparisons for CC. Using the custom heterogeneity phantom setup of Figure 1 and IGRT guidance summarized in Figure 2, Table V lists the percent pass rate for a 2%, 2 mm gamma criteria at 6 and 18 MV for both MC and CC. The relationship between MC calculations settings of uncertainty and grid size and the gamma passing rate for a prostate and H&N case is shown in Table VI. Table VII lists the results of the eMC calculations compared to measured data for clinically available applicators and Table VIII for small field cutouts. Conclusion: MU calculations using MC are highly sensitive to uncertainty and grid size settings. The difference can be of the order of several per cents. MC is superior to CC for small fields and when using heterogeneity corrections, regardless of field size, making it more suitable for SRS, SBRT and VMAT deliveries. eMC showed good agreement with measurements down to 2 cm − 2 cm field size.« less
  • Purpose: To compare the plan quality and performance of Simultaneous Integrated Boost (SIB) Treatment plan between Seven field (7F) and Nine field(9F) Intensity Modulated Radiotherapies and Single Arc (SA) and Dual Arc (DA) Volumetric Modulated Arc Therapy( VMAT). Methods: Retrospective planning study of 16 patients treated in Elekta Synergy Platform (mlci2) by 9F-IMRT were replanned with 7F-IMRT, Single Arc VMAT and Dual Arc VMAT using CMS, Monaco Treatment Planning System (TPS) with Monte Carlo simulation. Target delineation done as per Radiation Therapy Oncology Protocols (RTOG 0225&0615). Dose Prescribed as 70Gy to Planning Target Volumes (PTV70) and 61Gy to PTV61 inmore » 33 fraction as a SIB technique. Conformity Index(CI), Homogeneity Index(HI) were used as analysis parameter for Target Volumes as well as Mean dose and Max dose for Organ at Risk(OAR,s).Treatment Delivery Time(min), Monitor unit per fraction (MU/fraction), Patient specific quality assurance were also analysed. Results: A Poor dose coverage and Conformity index (CI) was observed in PTV70 by 7F-IMRT among other techniques. SA-VMAT achieved poor dose coverage in PTV61. No statistical significance difference observed in OAR,s except Spinal cord (P= 0.03) and Right optic nerve (P=0.03). DA-VMAT achieved superior target coverage, higher CI (P =0.02) and Better HI (P=0.03) for PTV70 other techniques (7F-IMRT/9F-IMRT/SA-VMAT). A better dose spare for Parotid glands and spinal cord were seen in DA-VMAT. The average treatment delivery time were 5.82mins, 6.72mins, 3.24mins, 4.3mins for 7F-IMRT, 9F-IMRT, SA-VMAT and DA-VMAT respectively. Significance difference Observed in MU/fr (P <0.001) and Patient quality assurance pass rate were >95% (Gamma analysis (Γ3mm, 3%). Conclusion: DA-VAMT showed better target dose coverage and achieved better or equal performance in sparing OARs among other techniques. SA-VMAT offered least Treatment Time than other techniques but achieved poor target coverage. DA-VMAT offered shorter delivery time than 7F-IMRT and 9F-IMRT without compromising the plan quality.« less
  • Purpose: Validation of iBEAM™ evo couch-top for different relative electron density (RED) combination during photon beam dose calculation in Monaco− TPS. Methods: The iBEAM™ evo couch-top has two layers:outer carbon fiber (CF) and inner foam core (FC). To study the beam intensity attenuation of couch-top, measured doses were compared with doses calculated for different REDs. Measurements were performed in solid water phantom with PTW-0.125cc ion-chamber positioned at center of the phantom with 5.3cm thickness slabs placed above and below the chamber. Similarly, in TPS, iBEAM™ evo couch-top was simulated and doses were calculated for different RED combinations (0.2CF-0.2FC, 0.4CF-0.2FC, 0.6CF-0.2FC,more » 0.8CF-0.2FC, and 1.0CF-0.2FC) by using Monte Carlo dose calculation algorithm in Monaco TPS (V5.1). Doses were measured for every 10 degree gantry angle separation, 10×10cm{sup 2} field size and 6MV photons. Then, attenuation is defined as the ratio of output at posterior gantry angle to output of its opposed anterior gantry angle (e.g.225°/45°). output fluctuation with different gantry angle was within ±0.21%. To confirm above results, dose-planes were measured for five pelvic VMAT plans (360°arc) in PTW two-dimensional array and compared with different calculated dose-planes of above-mentioned couch REDs. Gamma pass rates<1.00) were analyzed for 3%/2mm criteria. Results: Measured and calculated attenuation was in good agreement for the RED combination of 0.2CF-0.2FC and difference was within ±0.515%. However, other density combination showed difference of ±0.9841%, ±1.667%, ±2.9241% and ±2.8832% for 0.4CF-0.2FC, 0.6CF-0.2FC, 0.8CF-0.2FC, and 1.0CF-0.2FC, respectively. Maximum couch-top attenuation was observed at 110°–120° and 240°–250° and decreases linearly as the gantry angle approaches 180°. Moreover, gamma pass rate confirmed the above results and showed maximum pass rate of 96.23% for 0.2CF-0.2FC, whereas others were 95.72%, 95.12%, 94.31% and 93.24%. Conclusion: RED value of 0.2CF-0.2FC was found to be suitable for accurate couch-top modeling for 6MV photon beam Monte Carlo calculations in Monaco TPS.« less
  • Purpose: The purpose of this study was to compare dosimetric indices of Cyberknife versus Linac for localised prostate cancer Methods: In this study, twenty patients were taken from Cyberknife Multiplan TPS v 4.6.0. All these patients underwent hypo fractionated boost treatment for localised prostate cancer in Cyberknife with the prescription dose of 18Gy in 3 fractions. For each patient VMAT stereotactic plans were generated in Monaco TPS v 5.0 using Elekta beam modulator MLC machine for 6MV photon beam. The plans quality were evaluated by comparing dosimetry indices such that D95, D90, D5 for target volume and V100, V80, V50,more » V30 for critical organs. The p values were calculated for target and OAR to ascertain the significant differences. Results: For each case, D95 of target coverage was achieved with 100% prescription dose with p value of 0.9998. The p value for D90, D5 and V100 for linac and Cyberknife plans was 0.9938, 0.9918 and 0.9838 respectively. For rectum, rectum-PTV and bladder doses were significantly less in Cyberknife compared to linac plans. For rectum, rectum-PTV and bladder at V100 the p value is 0.2402, 0.002, and 0.1615 respectively. Other indices V80, V50 and V30 were comparable in both plans. Conclusion: This study demonstrated that both linac and Cyberknife plans were shown adequate target coverage, while in Cyberknife the treatment time is longer and more MUs to be delivered. However, better conformity, lesser doses to the critical organs and dose gradient outside target for localised prostate treatment were achieved in Cyberknife plans due to multiple non coplanar beam arrangements.« less
  • Purpose: To evaluate the effects of leaf with or without interdigitation in multiple brain metastasis volumetric modulated arc therapy (VMAT) plans. Methods: Twenty patients with 2 to 6 brain metastases of our hospital were retrospectively studied to be planned with dual arc VMAT using Monaco 3.3 TPS on the Elekta Synergy linear accelerator. The prescription dose of PTV was 60Gy/30 fractions. Two plans with or without leaf interdigitation were designed. The homogeneity index (HI), conformity index (CI), dose volume histograms (DVHs), monitor unit (MU), treatment time (T), the segments, the dose coverage of the target, were all evaluated. Results: Themore » plans with leaf interdigitation could achieve better CI (p<0.05) than without leaf interdigitation, while no significant difference were found in HI (p> 0.05) and the dose coverage of the target (p> 0.05).The MU,T, and the segments of the plan with leaf interdigitation were more than the plan without leaf interdigitation (p<0.05). There was no significant difference found in radiation dose of spinal cord, lenses and parotids, while the maximum dose of brain stem of leaf without interdigitation was higher than leaf with interdigitation (p< 0.05). It was worth noting that the areas of low dose regions with leaf interdigitation plan were much less than the without leaf interdigitation plan in the doublication planes (p< 0.05). Conclusion: This study shows that leaf with interdigitation has some advantages than leaf without interdigitation in multiple brain metastasis VMAT plans although the clinical relevance remains to be proven.« less