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Title: SU-F-T-531: Determination of Site-Specific Dynamic-Jaw Versus Static-Jaw RapidArc Delivery

Abstract

Purpose: Dynamic-jaw tracking maximizes the area blocked by both jaw and MLC in RapidArc. We developed a method to quantify jaw tracking. Methods: An Eclipse Scripting API (ESAPI) was used to export beam parameters for each arc’s control points. The specific beam parameters extracted were: gantry angle, control point number, meterset, x-jaw positions, y-jaw positions, MLC bank-number, MLC leaf-number, and MLC leaf-position. Each arc contained 178 control points with 120 MLC positions. MATLAB routines were written to process these parameters in order to calculate both the beam aperture (unblocked) size for each control point. An average aperture size was weighted by meterset. Jaw factor was defined as the ratio between dynamic-jaw to static-jaw aperture size. Jaw factor was determined for forty retrospectively replanned patients treated with static-jaw delivery sites including lung, brain, prostate, H&N, rectum, and bladder. Results: Most patients had multiple arcs and reduced-field boosts, resulting in 151 fields. Of these, the lowest (0.4722) and highest (0.9622) jaw factor was observed in prostate and rectal cases, respectively. The median jaw factor was 0.7917 meaning there is the potential unincreased blocking by 20%. Clinically, the dynamic-jaw tracking represents an area surrounding the target which would receive MLC-only leakage transmission ofmore » 1.68% versus 0.1% with jaws. Jaw-tracking was more pronounced at areas farther from the target. In prostate patients, the rectum and bladder had 5.5% and 6.3% lower mean dose, respectively; the structures closer to the prostate such as the rectum and bladder both had 1.4% lower mean dose. Conclusion: A custom ESAPI script was coupled with a MATLAB routine in order to extract beam parameters from static-jaw plans and their replanned dynamic-jaw deliveries. The effects were quantified using jaw factor which is the ratio between the meterset weighted aperture size for dynamic-jaw fields versus static-jaw fields.« less

Authors:
 [1];  [2];  [3]
  1. Community Hospital, Munster, IN (United States)
  2. Franciscan St Margaret Health, Hammond, IN (United States)
  3. University of Miami, Miami, FL (United States)
Publication Date:
OSTI Identifier:
22649115
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; APERTURES; BEAMS; BLADDER; DELIVERY; PATIENTS; PROSTATE; RADIOTHERAPY; RECTUM

Citation Formats

Tien, C, Brewer, M, and Studenski, M. SU-F-T-531: Determination of Site-Specific Dynamic-Jaw Versus Static-Jaw RapidArc Delivery. United States: N. p., 2016. Web. doi:10.1118/1.4956716.
Tien, C, Brewer, M, & Studenski, M. SU-F-T-531: Determination of Site-Specific Dynamic-Jaw Versus Static-Jaw RapidArc Delivery. United States. doi:10.1118/1.4956716.
Tien, C, Brewer, M, and Studenski, M. Wed . "SU-F-T-531: Determination of Site-Specific Dynamic-Jaw Versus Static-Jaw RapidArc Delivery". United States. doi:10.1118/1.4956716.
@article{osti_22649115,
title = {SU-F-T-531: Determination of Site-Specific Dynamic-Jaw Versus Static-Jaw RapidArc Delivery},
author = {Tien, C and Brewer, M and Studenski, M},
abstractNote = {Purpose: Dynamic-jaw tracking maximizes the area blocked by both jaw and MLC in RapidArc. We developed a method to quantify jaw tracking. Methods: An Eclipse Scripting API (ESAPI) was used to export beam parameters for each arc’s control points. The specific beam parameters extracted were: gantry angle, control point number, meterset, x-jaw positions, y-jaw positions, MLC bank-number, MLC leaf-number, and MLC leaf-position. Each arc contained 178 control points with 120 MLC positions. MATLAB routines were written to process these parameters in order to calculate both the beam aperture (unblocked) size for each control point. An average aperture size was weighted by meterset. Jaw factor was defined as the ratio between dynamic-jaw to static-jaw aperture size. Jaw factor was determined for forty retrospectively replanned patients treated with static-jaw delivery sites including lung, brain, prostate, H&N, rectum, and bladder. Results: Most patients had multiple arcs and reduced-field boosts, resulting in 151 fields. Of these, the lowest (0.4722) and highest (0.9622) jaw factor was observed in prostate and rectal cases, respectively. The median jaw factor was 0.7917 meaning there is the potential unincreased blocking by 20%. Clinically, the dynamic-jaw tracking represents an area surrounding the target which would receive MLC-only leakage transmission of 1.68% versus 0.1% with jaws. Jaw-tracking was more pronounced at areas farther from the target. In prostate patients, the rectum and bladder had 5.5% and 6.3% lower mean dose, respectively; the structures closer to the prostate such as the rectum and bladder both had 1.4% lower mean dose. Conclusion: A custom ESAPI script was coupled with a MATLAB routine in order to extract beam parameters from static-jaw plans and their replanned dynamic-jaw deliveries. The effects were quantified using jaw factor which is the ratio between the meterset weighted aperture size for dynamic-jaw fields versus static-jaw fields.},
doi = {10.1118/1.4956716},
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 investigate the effect of dynamic and static jaw tracking on patient peripheral doses. Materials and Methods: A patient plan with a large sacral metastasis (volume 800cm3, prescription 600cGyx5) was selected for this study. The plan was created using 2-field RapidArc with jaw tracking enabled (Eclipse, V11.0.31). These fields were then exported and edited in MATLAB with static jaw positions using the control point with the largest field size for each respective arc, but preserving the optimized leaf sequences for delivery. These fields were imported back into Eclipse for dose calculation and comparison and copied to a Rando phantommore » for delivery analysis. Points were chosen in the phantom at depth and on the phantom surface at locations outside the primary radiation field, at distances of 12cm, 20cm, and 30cm from the isocenter. Measurements were acquired with OSLDs placed at these positions in the phantom with both the dynamic and static jaw deliveries for comparison. Surface measurements included an additional 1cm bolus over the OSLDs to ensure electron equilibrium. Results: The static jaw deliveries resulted in cumulative jaw-defined field sizes of 17.3% and 17.4% greater area than the dynamic jaw deliveries for each arc. The static jaw plan resulted in very small differences in calculated dose in the treatment planning system ranging from 0–16cGy. The measured dose differences were larger than calculated, but the differences in absolute dose were small. The measured dose differences at depth (surface) between the two deliveries showed an increase for the static jaw delivery of 2.2%(11.4%), 15.6%(20.0%), and 12.7%(12.7%) for distances of 12cm, 20cm, and 30cm, respectively. Eclipse calculates a difference of 0–3.1% for all of these points. The largest absolute dose difference between all points was 6.2cGy. Conclusion: While we demonstrated larger than expected differences in peripheral dose, the absolute dose differences were small.« less
  • Purpose: To compare the extended dose profile delivered by 3DCRT and VMAT techniques for flattened and flattening-filter-free(FFF) photon beams (6X, 6XFFF,10XFFF), with and without jaw-tracking (JT) on Varian TrueBeam linac. The goal is to determine which treatment technique/modality will minimize the peripheral photon dose exposure (and ultimately minimize the risk of second malignant neoplasms (SMN)) in pediatric patients. Methods: 3DCRT, VMAT, and jaw tracking VMAT (JTVMAT) plans with 6X, 6XFFF and 10XFFF x-ray beams were created on a 30×60×22.5cm solid water phantom with a 551 cc PTV. The 3DCRT plans consisted of a 4FLD arrangement. The optimization objectives for themore » single-arc VMAT plans was V95%Rx=98% to PTV and minimize dose to a 5cm diameter organ at risk (OAR). The OAR to PTV distance varied from 0–30cm along the long axis at 7.5cm depth. The dose to the center of the OAR was measured using a 0.6cc ion chamber. Results: Relative to the 6X flattened beam, the 10XFFF photon beam had the lowest dose in the penumbra and peripheral region (>15 cm) region by up to 20% and 40%, respectively for all modalities (3DCRT, VMAT, JTVMAT). The 6XFFF beams only showed a dose reduction in the peripheral region (by up to 20%). JT did not significantly affect the peripheral dose for all modalities and energies. Conclusion: Treating pediatric patients with a 10XFFF beam is the most effective way to reduce photon scatter dose in both the penumbra and peripheral regions. However, the neutron dose contribution resulting from the 10MV beam still needs to be considered. For all modalities, 6XFFF was the next effective method to reduce peripheral photon doses. 3DCRT beams had the lowest peripheral doses for all energies compared to VMAT and JTVMAT, however previous publications have shown that this comes at the expense of PTV conformity and OAR sparing.« less
  • Purpose: To determine the dosimetric impact of jaw tracking and beam energies on dose conformity and normal-brain-tissue doses for intracranial tumors using VMAT (RapidArc). Methods: Seven patients with 1–2 and three patients with 4–6 intracranial tumors were planned using RapidArc for Varian TrueBeam STx machine with beam energies 6MV-FFF (Flattening-Filter-Free), 8MV, 10MV, and 10MV-FFF. The prescription dose ranged from 14–23Gy. Between 2 and 8 arcs were used with the following geometries: 2 full coplanar arcs and the non-coplanar half arcs. Plans were optimized (jaw tracking ON) with a high priority to Normal-Tissue-Objective and normal-brain-tissue. Plans were calculated on 1mm gridmore » size using AAA algorithm and then normalized so that 99% of each target volume received the prescription dose. Plans for the 6MV-FFF were also optimized without jaw tracking (No-JT) for comparison. Plan quality was assessed by target coverage using Paddick Conformity Index (PCI), sparing of normal-brain-tissue through analysis of V4Gy, V8Gy and V12Gy, and integral dose. Results: The average PCI ± standard deviation was 0.76±0.21 and 0.76±0.22 for 6MV-FFF and 10 MV-FFF, respectively. The average ratio in normal brain tissue volume (reported as follows V4,V8,V12) were (1.12±0.07,1.12±0.07,1.14±0.04), (1.12±0.08,1.12±0.09,1.13±0.06), (1.19±0.10,1.18±0.10,1.20±0.04), and (1.04±0.03,1.03±0.03,1.03±0.04) for 8MV/6MV-FFF, 10MV-FFF/6MV-FFF, 10MV/6MV-FFF, 6MV-FFF No-JT/6MV-FFF, respectively. Statistically significant differences in normal-brain-tissue for V4, V8, and V12 were observed in all cases for the different energies (p-values <0.05). V4 data shows significant differences in JT vs. No-JT (p=0.04), however no difference was found for V8 and V12. Brain tissue sparing from best to worst occurred in this order 6MV-FFF, 6MV-FFF no-JT, 10MV-FFF, 8MV, and 10MV. The average ratio of integral brain dose was 1.05±0.04 (p=0.21), 1.04±0.05 (p=0.33), 1.09±0.06 (p=0.04), and 1.02±0.06 (p=0.61) for 8MV/6MV-FFF, 10MV-FFF/6MV-FFF, 10MV/6MV-FFF, and 6MV-FFF No-JT/6MV-FFF, respectively. Conclusion: Normal brain tissue and integral dose improved using the lower energy and FFF beams, though plan conformity showed energy independence.« less
  • Purpose: Clinical implementations of adaptive radiotherapy (ART) are limited mainly by the requirement of delivery QA (DQA) prior to the treatment. Small segment size and small segment MU are two dominant factors causing failures of DQA. The aim of this project is to explore the feasibility of ART treatment without DQA by using a partial optimization approach. Methods: A retrospective simulation study was performed on two prostate cancer patients treated with SMLC-IMRT. The prescription was 180cGx25 fractions with daily CT-on-rail imaging for target alignment. For each patient, seven daily CTs were selected randomly across treatment course. The contours were deformablelymore » transferred from the simulation CT onto the daily CTs and modified appropriately. For each selected treatment, dose distributions from original beams were calculated on the daily treatment CTs (DCT plan). An ART plan was also created by optimizing the segmental MU only, while the segment shapes were preserved and the minimum MU constraint was respected. The overlaps, between PTV and the rectum, between PTV and the bladder, were normalized by the PTV volume. This ratio was used to characterize the difficulty of organs-at-risk (OAR) sparing. Results: Comparing to the original plan, PTV coverage was compromised significantly in DCT plans (82% ± 7%) while all ART plans preserved PTV coverage. ART plans showed similar OAR sparing as the original plan, such as V40Gy=11.2cc (ART) vs 11.4cc (original) for the rectum and D10cc=4580cGy vs 4605cGy for the bladder. The sparing of the rectum/bladder depends on overlap ratios. The sparing in ART was either similar or improved when overlap ratios in treatment CTs were smaller than those in original plan. Conclusion: A partial optimization method is developed that may make the real-time ART feasible on selected patients. Future research is warranted to quantify the applicability of the proposed method.« less
  • Purpose: To assess the clinical efficacy of auto beam hold during prostate RapidArc delivery, triggered by fiducial localization on kV imaging with a Varian True Beam. Methods: Prostate patients with four gold fiducials were candidates in this study. Daily setup was accomplished by aligning to fiducials using orthogonal kV imaging. During RapidArc delivery, a kV image was automatically acquired with a momentary beam hold every 60 degrees of gantry rotation. The position of each fiducial was identified by a search algorithm and compared to a predetermined 1.4 cm diameter target area. Treatment continued if all the fiducials were within themore » target area. If any fiducial was outside the target area the beam hold was not released, and the operators determined if the patient needed re-alignment using the daily setup method. Results: Four patients were initially selected. For three patients, the auto beam hold performed seamlessly. In one instance, the system correctly identified misaligned fiducials, stopped treatment, and the patient was re-positioned. The fourth patient had a prosthetic hip which sometimes blocked the fiducials and caused the fiducial search algorithm to fail. The auto beam hold was disabled for this patient and the therapists manually monitored the fiducial positions during treatment. Average delivery time for a 2-arc fraction was increased by 59 seconds. Phantom studies indicated the dose discrepancy related to multiple beam holds is <0.1%. For a plan with 43 fractions, the additional imaging increased dose by an estimated 68 cGy. Conclusion: Automated intrafraction kV imaging can effectively perform auto beam holds due to patient movement, with the exception of prosthetic hip patients. The additional imaging dose and delivery time are clinically acceptable. It may be a cost-effective alternative to Calypso in RapidArc prostate patient delivery. Further study is warranted to explore its feasibility under various clinical conditions.« less