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Title: SU-F-T-528: Relationship Between Tumor Size and Plan Quality Using FFF and Non-FFF Modes in Rapidarc

Abstract

Purpose: For a give PTV dose, beam-on time is shorter in the FFF than the non-FFF mode because of higher MU/min. Larger tumors usually require more complex intensity modulation, which might affect plan quality and total MU. We investigated the relationship between PTV size and plan quality using FFF and non-FFF modes. Methods: Two different PTV volumes (PTV and PTV+1 cm margin) were drawn in brain, lung and liver. 3-full to 7-partial arc (Rapidarc) of 6 MV, 1400 MU/min were studied. Plan quality was evaluated by: (a) DVH for PTV and normal tissues, (b) total MU and beam-on time, and (c) passing rate for IMRT plan QA. Results: For the same PTV coverage, DVH for normal tissue was the same or slightly lower in the FFF compared with non-FFF. Total MU was 13% higher in FFF than non-FFF in the 3-arc, 7 Gy treatment, but the difference became smaller when arc number increased to 6–7 for 10–24 Gy. Larger PTV did not affect the difference in the total MU. FFF required a short beam-on time and the ratio of FFF and non-FFF was 0.34 to 0.88 for 7- and 3-arc, respectively. For larger PTV, the ratio increased to 0.45–0.90. Ratiomore » of total MU for large PTV was 3–8% lower in the non-FFF plans. Although the small difference in MU, beam-on time was 1.1 to-1.6 times longer in the 3- and 7-arc non-FFF plans. Plan verification showed the similar gamma index passing rate. Conclusion: While total MU was similar with FFF and non-FFF modes, the beam-on time was shorter in the FFF treatment. The advantage of FFF was greater in treatments with high dose per fraction using more arc numbers. For dose less than 10 Gy, using FFF and non-FFF modes, tumor size did not affect the relationship of total MU, beam-on time.« less

Authors:
 [1]
  1. Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan (China)
Publication Date:
OSTI Identifier:
22649112
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; ANIMAL TISSUES; BEAMS; BRAIN; COMPARATIVE EVALUATIONS; DOSES; INDEXES; LIVER; LUNGS; MODULATION; NEOPLASMS; RADIOTHERAPY; VERIFICATION

Citation Formats

Chen, F. SU-F-T-528: Relationship Between Tumor Size and Plan Quality Using FFF and Non-FFF Modes in Rapidarc. United States: N. p., 2016. Web. doi:10.1118/1.4956713.
Chen, F. SU-F-T-528: Relationship Between Tumor Size and Plan Quality Using FFF and Non-FFF Modes in Rapidarc. United States. doi:10.1118/1.4956713.
Chen, F. Wed . "SU-F-T-528: Relationship Between Tumor Size and Plan Quality Using FFF and Non-FFF Modes in Rapidarc". United States. doi:10.1118/1.4956713.
@article{osti_22649112,
title = {SU-F-T-528: Relationship Between Tumor Size and Plan Quality Using FFF and Non-FFF Modes in Rapidarc},
author = {Chen, F},
abstractNote = {Purpose: For a give PTV dose, beam-on time is shorter in the FFF than the non-FFF mode because of higher MU/min. Larger tumors usually require more complex intensity modulation, which might affect plan quality and total MU. We investigated the relationship between PTV size and plan quality using FFF and non-FFF modes. Methods: Two different PTV volumes (PTV and PTV+1 cm margin) were drawn in brain, lung and liver. 3-full to 7-partial arc (Rapidarc) of 6 MV, 1400 MU/min were studied. Plan quality was evaluated by: (a) DVH for PTV and normal tissues, (b) total MU and beam-on time, and (c) passing rate for IMRT plan QA. Results: For the same PTV coverage, DVH for normal tissue was the same or slightly lower in the FFF compared with non-FFF. Total MU was 13% higher in FFF than non-FFF in the 3-arc, 7 Gy treatment, but the difference became smaller when arc number increased to 6–7 for 10–24 Gy. Larger PTV did not affect the difference in the total MU. FFF required a short beam-on time and the ratio of FFF and non-FFF was 0.34 to 0.88 for 7- and 3-arc, respectively. For larger PTV, the ratio increased to 0.45–0.90. Ratio of total MU for large PTV was 3–8% lower in the non-FFF plans. Although the small difference in MU, beam-on time was 1.1 to-1.6 times longer in the 3- and 7-arc non-FFF plans. Plan verification showed the similar gamma index passing rate. Conclusion: While total MU was similar with FFF and non-FFF modes, the beam-on time was shorter in the FFF treatment. The advantage of FFF was greater in treatments with high dose per fraction using more arc numbers. For dose less than 10 Gy, using FFF and non-FFF modes, tumor size did not affect the relationship of total MU, beam-on time.},
doi = {10.1118/1.4956713},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = {Wed Jun 15 00:00:00 EDT 2016},
month = {Wed Jun 15 00:00:00 EDT 2016}
}
  • Purpose: To conduct a feasibility study on retrospective respiratory gating and marker tracking for lung stereotactic body radiotherapy (SBRT) with a gated RapidArc delivery using a 6MV flattened filter free photon mode. Methods: A CIRS dynamic thorax phantom Model 008A with different inserts was used for treatment planning and respiratory gating. 4D CT had a free breathing simulation followed by a respiration gated, ten phased CT using a Philips Brilliance CT with a Varian RPM respiratory gating system. The internal target volume was created from the ten phase gated CT images, followed by exporting to a Varian Eclipse TPS v11more » for treatment planning on the free breath images. Both MIP and AIP were also generated for comparison of planning and target motion tracking. The planned dose was delivered with a 6MV FFF photon beam from a Varian TrueBeam accelerator. Gated target motion was also verified by tracking the implanted makers during delivery using continuous kV imaging in addition to CBCT, kV and MV localization and verification. Results: Gating was studied in three situations of lower, normal, and faster breathing at a respiratory cycle of 5, 15 and 25 breaths per minute, respectively. 4D treatment planning was performed at a normal breathing of 15 breaths per minute. The gated patterns obtained using the TrueBeam IR camera were compared with the planned ones while gating operation was added prior to delivery . Gating was realized only when the measured respiratory patterns matched to the planned ones. The gated target motion was verified within the tolerance by kV and MV imaging. Either free breathing CT or averaged CT images were studied to be good for image guidance to align the target. Conclusion: Gated RapidArc SBRT delivered with a 6MV FFF photon beam is realized using a dynamic lung phantom.« less
  • Purpose: Objective of this study was to evaluate the impact of using flattening filter free (FFF) beam with 0.5 cm multileaf collimator (MLC) leaves over conventional flattened beam with 1 cm leaf width MLC on the treatment plan quality in cranio-spinal irradiation (CSI). Methods: For five medulloblastoma cases (3 males and 2 females), who were previously treated by volumetric modulated arc therapy (VMAT) technique using conventional flattened beam shaped by 1 cm width MLC leaves, four test plans were generated and compared against the delivered plan. These retrospective plans consisted of four different combinations of flattened and FFF beams frommore » Elekta’s Agility treatment head with 0.5 cm width MLC leaves. Sparing of organs at risks (OAR) in terms of dose to 5%, 50%, 75% and 90% volumes, mean and maximum dose were evaluated. Results: All plans satisfied the planning objective of covering 95% of PTV by at least 95% of prescription dose. Marginal variation of dose spillage was observed between different VMAT plans at very low dose range (1–5 Gy). Variation in dose statistics for PTVs and OARs were within 1% or 1 Gy. Amongst the five plans, the plan with flattened beam with 1 cm MLC had the highest number of MUs, 2.13 times higher than the plan with Agility MLC with FFF beam that had the least number of MUs. No statistically significant difference (p≥0.05) was observed between the reference plan and the retrospectively generated plans in terms of PTV coverage, cold spot, hot spot and organ at risk doses. Conclusion: In the treatment of CSI cases by VMAT technique, FFF beams and/or finer width MLC did not exhibit advantage over the flattened beams or wider MLC in terms of plan quality except for reduction in MUs.« less
  • Purpose: To compare the dosimetry of coplanar and non-coplanar RapidArc whole brain plans for hippocampal sparing Methods: We studied the RapidArc plans of patient with brain metastases, with the prescription of 3750 cGy in 15 fractions. The coplanar approach used a full clockwise (CW) arc and a full counterclockwise (CCW) arc, with the couch angle to be 0°. The non-coplanar approach used a full arc with a couch angle of 0°, and a partial arc with a couch angle of 90°. Treatment planning system is Eclipse Ver. 11. Constraints for eyes, lens, brainstem, optical nerves and chiasm are employed inmore » the optimization so that these OARs’ dose are below tolerance. Constraints for hippocampus are employed so that they receive dose as low as possible while maintain good coverage to whole brain. The beam delivery machine is Varian 21 IX. T1-weighted MRI images were used for hippocampus contouring. Results: The target coverage index for coplanar and non-coplanar RapidArc plans are 94.9% and 95.4%, respectively, with homogeneity index of 0.223 vs 0.226, which is defined as (D2% – D98%)/Dmean of target volume. V95 and V100 are 99.0% and 94.8% for coplanar plan, vs 99.1% and 95.4% for non-coplanar plan, while the mean dose of hippocampus are 1244.5 cGy for coplanar plan vs 1212.3 cGy for non-coplanar plan. Dose for eyes, lens, optical nerves, optical chiasm and brainstem are all below tolerance. Conclusion: Coplanar RapidArc plan provides good target coverage while achieves good hippocampal sparing, and there is no benefit to use non-coplanar approach.« less
  • Purpose: The purpose of this work was to see if the EPID is a viable alternative to other QA devices for routine FFF QA and plan dose measurements. Methods: Sensitivity measurements were made to assess response to small changes in field size and beam steering. QA plans were created where field size was varied from baseline values (5–5.5cm, 20–20.5cm). Beam steering was adjusted by altering values in service mode (Symmetry 0–3%). Plans were measured using the Varian portal imager (aS1200 DMI panel), QA3 (Sun Nuclear), and Starcheck Maxi (PTW). FFF beam parameters as stated in Fogliata et al were calculated.more » Constancy measurements were taken using all 3 QC devices to measure a MLC defined 20×20cm field. Two clinical SABR patient plans were measured on a Varian Edge linac, using the Portal Dosimetry module in ARIA, and results compared with analysis made using Delta4 (ScandiDos). Results: The EPID and the Starcheck performed better at detecting clinically relevant changes in field size with the QA3 performing better when detecting similar changes in beam symmetry. Consistency measurements with the EPID and Starcheck were equivalent, with comparable standard deviations. Clinical plan measurements on the EPID compared well with Delta4 results at 3%/1mm. Conclusion: Our results show that for FFF QA measurements such as field size and symmetry, using the EPID is a viable alternative to other QA devices. The EPID could potentially be used for QC measurements with a focus on geometric accuracy, such as MLC positional QA, due to its high resolution compared to other QA devices (EPID 0.34mm, Starcheck 3mm, QA3 5mm). Good agreement between Delta4 and portal dosimetry also indicated the EPID may be a suitable alternative for measurement of clinical plans.« less
  • Purpose: To characterize efficiency and plan quality for the FFF beams for various sites. Methods: 5 brain, Head and Neck, prostate, lung and liver cancer patients IMRT plans (25 total) were generated on either Prowess 4.6 or Eclipse 13.5 using the same dose constraints for each treatment site. Step and shoot with static gantry IMRT was used for treatment delivery. PTV coverage, critical structure doses, MUs, number of segments and beam on times were compared. Results: The average PTV size was 29.0, 34.9, 89.2, 257.6, 289.2 cm3 for liver, lung, prostate, head and neck and brain respectively.All plans were normalizedmore » such that 95% of the PTV volume would receive at least 95% of prescribed dose. All doses to the critical structures for both the FFF and flat beam met the targeted dose constraints.For plans with field sizes < 10 cm, the number of segments and MUs required to achieve the same plan quality were similar. For these small field sizes with large dose per fraction, an increase in efficiency up to 58.8% is seen.Plans with field sizes > 10 cm, required 10% – 20% more segments and MUs for the FFF beam to achieve the same plan quality as the flat beam. Despite this, for fraction sizes less than 2.5 Gy the FFF beam is still approximately 13.9% more efficient in terms of delivery time. Conclusion: For the various treatment sites studied here, plans generated with the FFF beam were dosimetrically similar to those generated with a flattened beam. Despite the greater number of MUs and segments required to achieve the same plan quality as the flat beam for some plans, the FFF beam is still more efficient compared to the flat beam.« less