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Title: SU-F-T-646: SBRT Lung: Moving Beyond the 3D Conformal Paradigm with An Elekta VersaHD Accelerator

Abstract

Purpose: To develop a volumetric modulated arc therapy (VMAT) planning and delivery methodology for lung stereotactic body radiation therapy (SBRT) that addresses the unique geometric challenges presented when using an Elekta VersaHD linear accelerator. Methods: The Elekta VersaHD imaging panels are fixed at 160cm SID when deployed, limiting the ability to perform non-coplanar treatments due to collisions with the treatment table. The panels can be folded in a stored position for non-coplanar treatments, but in this configuration, longitudinal table travel is restricted by the space required for the folded panels. To overcome these design features, a non-coplanar VMAT technique was designed and evaluated for 6 patients that uses a superiorly placed isocenter near the apex of the lung. A coplanar VMAT technique with isocenter placement within the target was also assessed for each patient. Non-coplanar plans included three arcs, totalling 340° of arc angle, while coplanar plans included two arcs, totalling 280° of arc angle. Each technique avoided the contralateral lung and major overlap on patient skin. Corresponding 3DCRT plans were used as a baseline for each patient in evaluating VMAT plans. Results: Coplanar and noncoplanar VMAT plans yielded a high dose conformity index (CI) improvement of 6% and lowmore » dose CI improvements of 9% and 11%, respectively, over corresponding 3DCRT plans. While both VMAT techniques provided greater skin sparing compared to 3DCRT, the non-coplanar technique offered an improvement of 20% over the coplanar approach. Treatment time with for VMAT was ∼2.5 minutes compared to ∼10 minutes for 3DCRT. Conclusion: Two VMAT techniques were developed for lung SBRT that account for machine design limitations and provide greater dose conformity and normal tissue sparing than 3DCRT plans. The non-coplanar VMAT plans showed a marginal improvement over coplanar VMAT plans and may not warrant the additional complexity.« less

Authors:
; ; ; ;  [1]
  1. University of Iowa Hospitals and Clinics, Iowa City, IA (United States)
Publication Date:
OSTI Identifier:
22649204
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; BIOMEDICAL RADIOGRAPHY; DESIGN; DOSES; LINEAR ACCELERATORS; LUNGS; PATIENTS; PLANNING; RADIOTHERAPY

Citation Formats

Dalhart, A, Hyer, D, Allen, B, Flynn, R, and Johnston, H. SU-F-T-646: SBRT Lung: Moving Beyond the 3D Conformal Paradigm with An Elekta VersaHD Accelerator. United States: N. p., 2016. Web. doi:10.1118/1.4956831.
Dalhart, A, Hyer, D, Allen, B, Flynn, R, & Johnston, H. SU-F-T-646: SBRT Lung: Moving Beyond the 3D Conformal Paradigm with An Elekta VersaHD Accelerator. United States. doi:10.1118/1.4956831.
Dalhart, A, Hyer, D, Allen, B, Flynn, R, and Johnston, H. 2016. "SU-F-T-646: SBRT Lung: Moving Beyond the 3D Conformal Paradigm with An Elekta VersaHD Accelerator". United States. doi:10.1118/1.4956831.
@article{osti_22649204,
title = {SU-F-T-646: SBRT Lung: Moving Beyond the 3D Conformal Paradigm with An Elekta VersaHD Accelerator},
author = {Dalhart, A and Hyer, D and Allen, B and Flynn, R and Johnston, H},
abstractNote = {Purpose: To develop a volumetric modulated arc therapy (VMAT) planning and delivery methodology for lung stereotactic body radiation therapy (SBRT) that addresses the unique geometric challenges presented when using an Elekta VersaHD linear accelerator. Methods: The Elekta VersaHD imaging panels are fixed at 160cm SID when deployed, limiting the ability to perform non-coplanar treatments due to collisions with the treatment table. The panels can be folded in a stored position for non-coplanar treatments, but in this configuration, longitudinal table travel is restricted by the space required for the folded panels. To overcome these design features, a non-coplanar VMAT technique was designed and evaluated for 6 patients that uses a superiorly placed isocenter near the apex of the lung. A coplanar VMAT technique with isocenter placement within the target was also assessed for each patient. Non-coplanar plans included three arcs, totalling 340° of arc angle, while coplanar plans included two arcs, totalling 280° of arc angle. Each technique avoided the contralateral lung and major overlap on patient skin. Corresponding 3DCRT plans were used as a baseline for each patient in evaluating VMAT plans. Results: Coplanar and noncoplanar VMAT plans yielded a high dose conformity index (CI) improvement of 6% and low dose CI improvements of 9% and 11%, respectively, over corresponding 3DCRT plans. While both VMAT techniques provided greater skin sparing compared to 3DCRT, the non-coplanar technique offered an improvement of 20% over the coplanar approach. Treatment time with for VMAT was ∼2.5 minutes compared to ∼10 minutes for 3DCRT. Conclusion: Two VMAT techniques were developed for lung SBRT that account for machine design limitations and provide greater dose conformity and normal tissue sparing than 3DCRT plans. The non-coplanar VMAT plans showed a marginal improvement over coplanar VMAT plans and may not warrant the additional complexity.},
doi = {10.1118/1.4956831},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To present the commissioning process of recently-released Elekta VersaHD linear accelerator, equipped with Agility 160-leaf multileaf collimator and flattening-filter free (FFF) photon modes. Methods: In addition to routine QA procedures, we adopted an EPID-based method to perform the table rotation and Winston-Lutz tests, and a novel multiradiation isocenter alignment check. The beam data acquired include photon percent-depth dose (PDD) of 6X, 6XFFF, 10X, 10XFFF, and 15X in the field size from 2×2 to 40×40cm{sup 2}, profiles, collimator and phantom scatter factors (Sc and Sp), wedge factor, electron (6, 9, 12, and 15MeV) PDD and profiles, cone and cutout factors,more » and virtual SSD. Validation measurements were carried out in water tank to evaluate the accuracy of beam modeling by the Pinnacle planning system. End-to-End test and IMRT QA were performed to validate the overall delivery accuracy. A theoretical model has also been used to extract the primary dose ratio and off-axis beam softening effects by fitting photon beam profile measurements. Results: The PDDs of FFF beams with field size 10×10cm{sup 2} at 10cm depth, 100cm SSD were intentionally adjusted within 1% of the non-FFF beams. The photon profiles of 30×30cm{sup 2} at 10cm depth between non-FFF and FFF beams are very different, OAR(10)=0.74 and 0.63, respectively, for 6XFFF and 10XFFF. The collimator and phantom scatter factors of FFF beam demonstrated smaller variation with field sizes. The EPID-based method demonstrated the maximum deviation between the table rotation axis and radiation isocenter is within 1mm, and the radiation isocenters are within 0.4mm relative to that of 6X. The validation measurement shows less than 2% deviation between the measurement and Pinnacle modeling for most of the test conditions. Conclusion: To the best of our knowledge, this is the first study reporting the Elekta VersaHD commissioning experience, which can be a valuable reference for the radiotherapy community.« less
  • Purpose: The purpose of this study is to report the dosimetric aspects of commissioning performed on an Elekta VersaHD linear accelerator with high dose rate flattening-filter-free (FFF) photon modes and electron modes. Methods: Acceptance and commissioning was performed on an Elekta VersaHD linac with 5 photon energies (6MV, 10MV, 18MV, 6FFF, 10FFF), 4 electron energies (6MeV, 9MeV, 12MeV, 15MeV) and 160 leaf (5mm wide) multi-leaf collimators (MLCs). Mechanical and dosimetric data was measured and evaluated. The measurements include percent depth doses (PDDs), inplane and crossplane profiles, head scatter factor (Sc), relative photon output factors (Scp), universal wedge transmission factor, MLCmore » transmission factors, and electron cone factors. Results: Gantry, collimator, couch isocentricity measurements were within 1mm, 0.7mm and 0.7mm diameter respectively. The PDDs of 6FFF and 10FFF beams show deeper dmax and steeper fall-off with depth than the corresponding flattened beams. While flatness values of 6FFF and 10FFF normalized profiles were higher than the corresponding flattened beams, the symmetry values were almost identical. The crossplane penumbra values were higher than the inplane penumbra values for all the energies. The MLC transmission values were 0.5%, 0.6% and 0.6% for 6MV, 10MV, and 18MV photon beams. The electron PDDs, profiles and cone factors is validated by literature. Conclusion: The outcome of radiation treatment is directly related to the accuracy in the dose modeled in the treatment planning system which is based on the commissioned data. Commissioning data provided us a valuable insight into the dosimetric characteristics of the beam. This set of commissioning data can provide comparison data to others performing VersaHD commissioning thus improving patient safety.« less
  • Purpose: The Monaco treatment planning system (TPS) uses a Monte-Carlo algorithm based dose computation engine to model the photon beams of a linear accelerator. The aim is to perform verification of Monaco TPS beam modeling of a Elekta VersaHD linac with 6MV, 6MV FFF, 10 MV, 10MV FFF, 18MV photon beams and 160 multileaf collimators (MLC) with a projected width of 5-mm at the isocenter. Methods: A series of dosimetric tests were performed to validate Monaco calculated beams including point dose measurement in water with and without heterogeneity and 2-dimensional dose distributions on a Delta4 bi-planar diode dosimeter array (Scandidos,more » Uppsala, Sweden). 3D conformal beams of different field sizes, source-to-surface distances, wedges, and gantry angles were delivered onto a phantom consisting of several plastic water and Styrofoam slabs. Point dose measurements were verified with a PTW 31013 Semiflex 0.3 cc ionization chamber (PTW, Freiburg, Germany). In addition, 8 step and shoot intensity modulated radiotherapy (IMRT) and volumetric modulated arc radiotherapy (VMAT) beams included in the Monaco TPS commissioning suite were verified against measurements on Delta4 to test and fine tune parameters in the beam model. IMRT verification was computed using gamma analysis with dose difference and distance-to-agreement criteria of 3%/3mm with a dose threshold of 10%. Results: Point dose measurements agreed within 2% in the homogeneous phantom and within 3% in the heterogeneous phantom for all photon energies. IMRT beams yielded a passing percentage of 99.1±1.1% in the gamma analysis which is well above the institutional passing threshold of 90%. Conclusion: Monaco TPS commissioning was successfully performed for all the photon energies on the Elekta VersaHD linac prior to clinical usage.« less
  • Purpose: Lung stereo-tactic body radiotherapy(SBRT) treatment requires high accuracy of lung tumor positioning during treatment, which is usually accomplished by free breathing Cone-Beam computerized tomography (CBCT) scan. However, respiratory motion induced image artifacts in free breathing CBCT may degrade such positioning accuracy. The purpose of this study is to investigate the feasibility of gated CBCT imaging for lung SBRT treatment. Methods: Six Lung SBRT patients were selected for this study. The respiratory motion of the tumors ranged from 1.2cm to 3.5cm, and the gating windows for all patients were set between 35% and 65% of the respiratory phases. Each Lungmore » SBRT patient underwent free-breathing CBCT scan using half-fan scan technique. The acquired projection images were transferred out for off-line analyses. An In-house semi-automatic algorithm was developed to trace the diaphragm movement from those projection images to acquire a patient's specific respiratory motion curve, which was used to correlate respiratory phases with each projection image. Afterwards, a filtered back-projection algorithm was utilized to reconstruct the gated CBCT images based on the projection images only within the gating window. Results: Target volumes determined by free breathing CBCT images were 71.9%±72% bigger than the volume shown in gated CBCT image. On the contrary, the target volume differences between gated CBCT and planning CT images at exhale stage were 5.8%±2.4%. The center to center distance of the targets shown in free breathing CBCT and gated CBCT images were 9.2±8.1mm. For one particular case, the superior boundary of the target was shifted 15mm between free breathing CBCT and gated CBCT. Conclusion: Gated CBCT imaging provides better representation of the moving lung tumor with less motion artifacts, and has the potential to improve the positioning accuracy in lung SBRT treatment.« less
  • To implement modified dynamic conformal arc (MDCA) technique and Radiation Therapy Oncology Group (RTOG) protocols in our clinic for stereotactic body radiation therapy (SBRT) treatment of patients with Stage I/II non–small cell lung cancer. Five patients with non–small cell lung cancer have been treated with SBRT. All the patients were immobilized using CIVCO Body Pro-Lok system and scanned using GE 4-slice computed tomography. The MDCA technique that was previously published was adopted as our planning technique, and RTOG protocols for the lung SBRT were followed. The patients were treated on Novalis Tx system with cone-beam computed tomography imaging guidance. Allmore » the patient plans passed the RTOG criteria. The conformal index ranges from 0.99 to 1.12 for the planning target volume, and the biological equivalent dose for the planning target volume is overall 100 Gy. Critical structures (lung, spinal cord, brachial plexus, skin, and chest wall) also meet RTOG protocols or published data. A 6-month follow-up of one of the patients shows good local disease control. We have successfully implemented the MDCA technique into our clinic for the lung SBRT program. It shows that the MDCA is useful and efficient for the lung SBRT planning, with the plan quality meeting the RTOG protocols.« less