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Title: SU-G-BRB-17: Dosimetric Evaluation of the Respiratory Interplay Effect During VMAT Delivery Using IPAGAT Polymer Gel Dosimeter

Abstract

Purpose: To evaluate the dosimetric impact of the interplay effect between multileaf collimator (MLC) movement and tumor respiratory motion during delivery of volumetric modulate arc therapy (VMAT) by using customized polymer gel dosimeter. Methods: Polyacrylamide-based gel dosimeter contained magnesium chloride as a sensitizer (iPAGAT) was used in this study. An excellent gas barrier PAN (BAREX) techno bottle (φ8 cm, 650 mL) filled with iPAGAT was set to the QUASAR™ respiratory motion phantom, and was moved with motion amplitudes of 1 and 2 cm with a 4 second period during VMAT delivery by the Novalis Tx linear accelerator (Varian/BrainLAB). Two spherical tumors with a 2 cm diameter (GTV1 and GTV2) were defined, and ITV1 (GTV1+1 cm) and ITV2 (GTV2+2 cm) with expansion in the superior-inferior (S-I) direction were also defined with simulated respiratory motion. PTV margin was 2 mm around the ITV considering the setup uncertainty. Two single arc VMAT plans with 30 Gy at 3 Gy per fraction (GTV: D98>100%, PTV: D95=100%) were generated by the Varian Eclipse treatment planning system. Three-dimensional dose distribution in iPAGAT was read out by the Signa 1.5T MRI system (GE), and was evaluated by dose-volume histogram (DVH) using in-house developed software. Results: According tomore » DVH analysis by iPAGAT, D98 of GTV1 and GTV2 were more than 100% of the prescribed dose. In contrast, D95 of PTV1 and PTV2 were about 85% and 65%, respectively. Furthermore, low-to-intermediate dose was widespread with motion amplitude of 2 cm. Conclusion: DVH analysis using iPAGAT polymer gel dosimeter was performed in this study. As a result, interplay effect was negligible, since dose coverage of GTV was sufficient during VMAT delivery with simulated respiratory motion. However, the dose reduction of PTV and the spread of low-to-intermediate dose compared to the planned dose require scrupulous attention for large tumor respiratory motion.« less

Authors:
; ; ;  [1];  [2];  [3];  [4]
  1. Hiroshima Heiwa Clinic, Hiroshima, JP (Japan)
  2. Hiroshima International University, Hiroshima, JP (Japan)
  3. Hiroshima University Hospital, Hiroshima, JP (Japan)
  4. R-TECH.INC, Tokyo, JP (Japan)
Publication Date:
OSTI Identifier:
22649288
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; COMPUTER CODES; DELIVERY; DOSEMETERS; GELS; LINEAR ACCELERATORS; MAGNESIUM CHLORIDES; NEOPLASMS; NMR IMAGING; POLYMERS; RADIATION DOSE DISTRIBUTIONS; RADIOTHERAPY; THREE-DIMENSIONAL CALCULATIONS

Citation Formats

Ono, K, Fujimoto, S, Akagi, Y, Hirokawa, Y, Hayashi, S, Hioki, K, and Miyazawa, M. SU-G-BRB-17: Dosimetric Evaluation of the Respiratory Interplay Effect During VMAT Delivery Using IPAGAT Polymer Gel Dosimeter. United States: N. p., 2016. Web. doi:10.1118/1.4956924.
Ono, K, Fujimoto, S, Akagi, Y, Hirokawa, Y, Hayashi, S, Hioki, K, & Miyazawa, M. SU-G-BRB-17: Dosimetric Evaluation of the Respiratory Interplay Effect During VMAT Delivery Using IPAGAT Polymer Gel Dosimeter. United States. doi:10.1118/1.4956924.
Ono, K, Fujimoto, S, Akagi, Y, Hirokawa, Y, Hayashi, S, Hioki, K, and Miyazawa, M. Wed . "SU-G-BRB-17: Dosimetric Evaluation of the Respiratory Interplay Effect During VMAT Delivery Using IPAGAT Polymer Gel Dosimeter". United States. doi:10.1118/1.4956924.
@article{osti_22649288,
title = {SU-G-BRB-17: Dosimetric Evaluation of the Respiratory Interplay Effect During VMAT Delivery Using IPAGAT Polymer Gel Dosimeter},
author = {Ono, K and Fujimoto, S and Akagi, Y and Hirokawa, Y and Hayashi, S and Hioki, K and Miyazawa, M},
abstractNote = {Purpose: To evaluate the dosimetric impact of the interplay effect between multileaf collimator (MLC) movement and tumor respiratory motion during delivery of volumetric modulate arc therapy (VMAT) by using customized polymer gel dosimeter. Methods: Polyacrylamide-based gel dosimeter contained magnesium chloride as a sensitizer (iPAGAT) was used in this study. An excellent gas barrier PAN (BAREX) techno bottle (φ8 cm, 650 mL) filled with iPAGAT was set to the QUASAR™ respiratory motion phantom, and was moved with motion amplitudes of 1 and 2 cm with a 4 second period during VMAT delivery by the Novalis Tx linear accelerator (Varian/BrainLAB). Two spherical tumors with a 2 cm diameter (GTV1 and GTV2) were defined, and ITV1 (GTV1+1 cm) and ITV2 (GTV2+2 cm) with expansion in the superior-inferior (S-I) direction were also defined with simulated respiratory motion. PTV margin was 2 mm around the ITV considering the setup uncertainty. Two single arc VMAT plans with 30 Gy at 3 Gy per fraction (GTV: D98>100%, PTV: D95=100%) were generated by the Varian Eclipse treatment planning system. Three-dimensional dose distribution in iPAGAT was read out by the Signa 1.5T MRI system (GE), and was evaluated by dose-volume histogram (DVH) using in-house developed software. Results: According to DVH analysis by iPAGAT, D98 of GTV1 and GTV2 were more than 100% of the prescribed dose. In contrast, D95 of PTV1 and PTV2 were about 85% and 65%, respectively. Furthermore, low-to-intermediate dose was widespread with motion amplitude of 2 cm. Conclusion: DVH analysis using iPAGAT polymer gel dosimeter was performed in this study. As a result, interplay effect was negligible, since dose coverage of GTV was sufficient during VMAT delivery with simulated respiratory motion. However, the dose reduction of PTV and the spread of low-to-intermediate dose compared to the planned dose require scrupulous attention for large tumor respiratory motion.},
doi = {10.1118/1.4956924},
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: ArcCHECK and 3DVH system (Sun Nuclear) can reconstruct the three-dimensional (3D) dose distribution and provide the DVH analysis in a patient. The aim of this study was to evaluate dosimetric accuracy of this system using customized polymer gel dosimeter, and also Gafchromic EBT3 films. Methods: Polyacrylamide-based gel contained magnesium chloride as a sensitizer (iPAGAT) was used in this study. Volumetric-modulated arc therapy (VMAT) plan was performed for the C-shape structure by the Eclipse treatment planning system (Varian) and used to irradiate the ArcCHECK by the Novalis Tx linear accelerator (Varian/BrainLAB). The cubic phantom filled with iPAGAT and EBT3 filmsmore » placed in three orthogonal planes (axial, sagittal, and coronal) inserted into the I’mRT Phantom (IBA Dosimetry) simulated a patient were irradiated with the same VMAT plan. The measurement-guided 3D dose distribution was reconstructed using 3DVH software from the measured data of the ArcCHECK. The 3D dose distribution in iPAGAT was read out by Signa 1.5 T MRI system (GE), and 2D dose distribution on EBT3 was read out by color scanner (Epson). The comparison of all the dose distributions was performed with dose profiles and gamma index analysis in orthogonal planes using in-house developed software. Results: A good agreement was observed by overlaying the dose profiles of 3DVH, EBT3, and iPAGAT. The mean pass rates by gamma index analysis with 3%/3 mm criteria in orthogonal planes were 94.3% (3DVH vs EBT3), 91.1% (3DVH vs iPAGAT), and 96.4% (iPAGAT vs EBT3), respectively. Conclusion: 3D dose distribution reconstructed by ArcCHECK and 3DVH system was estimated accurately in a patient. However, slightly differences were observed between 3DVH and iPAGAT because of MRI noise, therefore further study is required to improve the accuracy of MRI based polymer gel dosimetry for the DVH analysis.« less
  • Purpose: The advent of the MR-Linac enables real-time and high soft tissue contrast image guidance in radiation therapy (RT) delivery. Potential hot-spots at air-tissue interfaces, such as the sphenoid sinus, in RT for head and neck cancer (HNC), could potentially occur due to the electron return effect (ERE). In this study, we investigate the dosimetric effects of ERE on the dose distribution at air-tissues interfaces in HNC IMRT treatment planning. Methods: IMRT plans were generated based on planning CT’s acquired for HNC cases (nasopharynx, base of skull and paranasal sinus) using a research planning system (Monaco, v5.09.06, Elekta) employing Montemore » Carlo dose calculations with or without the presence of a transverse magnetic field (TMF). The dose in the air cavity was calculated in a 1 & 2 mm thick tissue layer, while the dose to the skin was calculated in a 1, 3 and 5 mm thick tissue layer. The maximum dose received in 1 cc volume, D1cc, were collected at different TMF strengths. Plan qualities generated with or without TMF or with increasing TMF were compared in terms of commonly-used dose-volume parameters (DVPs). Results: Variations in DVPs between plans with and without a TMF present were found to be within 5% of the planning CT. The presence of a TMF results in <5% changes in sinus air tissue interface. The largest skin dose differences with and without TMF were found within 1 mm of the skin surface Conclusion: The presence of a TMF results in practically insignificant changes in HNC IMRT plan quality, except for skin dose. Planning optimization with skin DV constraints could reduce the skin doses. This research was partially supported by Elekta Inc. (Crowley, U.K.)« less
  • Purpose: To investigate the sensitivity of an EPID-based 3D dose verification system to detect delivery errors in VMAT treatments. Methods: For this study 41 EPID-reconstructed 3D in vivo dose distributions of 15 different VMAT plans (H&N, lung, prostate and rectum) were selected. To simulate the effect of delivery errors, their TPS plans were modified by: 1) scaling of the monitor units by ±3% and ±6% and 2) systematic shifting of leaf bank positions by ±1mm, ±2mm and ±5mm. The 3D in vivo dose distributions where then compared to the unmodified and modified treatment plans. To determine the detectability of themore » various delivery errors, we made use of a receiver operator characteristic (ROC) methodology. True positive and false positive rates were calculated as a function of the γ-parameters γmean, γ1% (near-maximum γ) and the PTV dose parameter ΔD{sub 50} (i.e. D{sub 50}(EPID)-D{sub 50}(TPS)). The ROC curve is constructed by plotting the true positive rate vs. the false positive rate. The area under the ROC curve (AUC) then serves as a measure of the performance of the EPID dosimetry system in detecting a particular error; an ideal system has AUC=1. Results: The AUC ranges for the machine output errors and systematic leaf position errors were [0.64 – 0.93] and [0.48 – 0.92] respectively using γmean, [0.57 – 0.79] and [0.46 – 0.85] using γ1% and [0.61 – 0.77] and [ 0.48 – 0.62] using ΔD{sub 50}. Conclusion: For the verification of VMAT deliveries, the parameter γmean is the best discriminator for the detection of systematic leaf position errors and monitor unit scaling errors. Compared to γmean and γ1%, the parameter ΔD{sub 50} performs worse as a discriminator in all cases.« less
  • Purpose: We investigated the dosimetric impact of the interplay effect during RapidArc stereotactic body radiation therapy for lung tumors using flattening filter-free (FFF) beams with different dose rates. Methods and Materials: Seven tumors with motion ≤20 mm, treated with 10-MV FFF RapidArc, were analyzed. A programmable phantom with sinusoidal longitudinal motion (30-mm diameter “tumor” insert; period = 5 s; individualized amplitude from planning 4-dimensional computed tomography) was used for dynamic dose measurements. Measurements were made with GafChromic EBT III films. Plans delivered the prescribed dose to 95% of the planning target volume, created by a 5-mm expansion of the internalmore » target volume. They comprised 2 arcs and maximum dose rates of 400 and 2400 MU/min. For 2400 MU/min plans, measurements were repeated at 3 different initial breathing phases to model interplay over 2 to 3 fractions. For 3 cases, 2 extra plans were created using 1 full rotational arc (with contralateral lung avoidance sector) and 1 partial arc of 224° to 244°. Dynamic and convolved static measurements were compared by use of gamma analysis of 3% dose difference and 1 mm distance-to-agreement. Results: For 2-arc 2400 MU/min plans, maximum dose deviation of 9.4% was found in a single arc; 7.4% for 2 arcs (single fraction) and <5% and 3% when measurements made at 2 and 3 different initial breathing phases were combined, simulating 2 or 3 fractions. For all 7 cases, >99% of the area within the region of interest passed the gamma criteria when all 3 measurements with different initial phases were combined. Single-fraction single-arc plans showed higher dose deviations, which diminished when dose distributions were summed over 2 fractions. All 400 MU/min plans showed good agreement in a single fraction measurement. Conclusion: Under phantom conditions, single-arc and single-fraction 2400 MU/min FFF RapidArc lung stereotactic body radiation therapy is susceptible to interplay. Two arcs and ≥2 fractions reduced the effect to a level that appeared unlikely to be clinically significant.« less
  • Purpose: In this study, the dose responses of the MAGIC gel with various concentrations and type of saccharide are examined to clarify the roles of mono and disaccharide in the polymerization process. Then we focused on the tissue equivalence and dose sensitivity of MAGIC gel dosimeters. Methods: The gel is composed of HPLC, 8% gelatin, 2 × 10-3 M L-ascorbic acid, 1.8 × 10-2 M hydroquinone, 8 × 10-5 M copper(II)sulfate and 9% methacrylic acid, new polymer gels are synthesized by adding glucose(monosaccharide), sucrose(disaccharide) and urea in the concentration range of 5∼35%. For irradiation of the gel, cesium-137 gamma-ray irradiatormore » was used, radiation dose was delivered from 5∼50 Gy. MRI images of the gel were acquired by using a 3.0 T MRI system. Results: When saccharide and urea were added, the O/C, O/N and C/N ratios agreed with those of soft tissue with 1.7%. The dose-response of glucose and sucrose gel have slope-to-intercept ratio of 0.044 and 0.283 respectively. The slope-to-ratio is one important determinant of gel sensitivity. R-square values of glucose and sucrose gel dosimeters were 0.984 and 0.994 respectively. Moreover when urea were added, the slope-to-intercept ratio is 0.044 and 0.073 respectively. R-square values of mono and disaccharide gel were 0.973 and 0.989 respectively. When a saccharide is added into the MAGIC gel dosimeter, dose sensitivity is increased. However when urea were added, dose sensitivity is slightly decreased. Conclusion: In this study, it was possible to obtain the following conclusions by looking at the dose response characteristics after adding mono-, di-saccharide and urea to a MAGIC gel dosimeter. Saccharide was a tendency of increasing dose sensitivity with disaccharide. Sa.ccharide is cost effective, safe, soft tissue equivalent, and can be used under various experimental conditions, making it a suitable dosimeter for some radiotherapy applications.« less