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Title: SU-E-T-393: Investigation of Hot Spots in Tomotherapy 3D Conformal Breast Plan

Purpose: The purpose of this study is to determine the root-cause of hotspots inherent to Tomotherapy static beam 3D conformal radiotherapy (3DCRT) for breast treatment. ASTRO (ref here) recommends that IMRT be avoided for breast treatments. Despite Tomotherapy's inherent IMRT-like optimization and delivery, our experience at a Tomotherapy-only site has been that Tomotherapy 3DCRT fail to produce a clinically acceptable plan for 79% of our breast patients. Hot-spots have been one of the major obstacles. Methods: Eight lumpectomy patients were planned according to RTOG-1005 specification. Two or four tangential beams were used for 3DCRT breast planning. To spare the contralateral breast and ipsilateral lung, part of the PTV was not covered by the primary beam, yielding adjacent hot-spots. We hypothesize that the planning system creates hotspots adjacent to the cold spots to yield scatter radiation dose compensation in the blocked region. Various phantom and patient setup were used to test the hypothesis. Results: Hot spots outside of PTV in the range of 135% - 174% were observed for patient plan. It is confirmed that the PTV partial block causes the adjacent hot spot. The root cause is the optimizer quadratic objective function over- weighs improving the cold spot. The IMRTmore » flexibility offered by Tomotherapy is counter-productive in static-beam 3DCRT breast treatment. For phantom case, as the Modulation-Factor increases from 1.1 to 5, the hot spot increases from 110% to 300%. Limiting the 3DCRT intensity modulation is shown to produce clinically acceptable plan. Conclusion: Most of the hot spots in Tomotherapy 3DCRT breast plan originate from the planning-system optimizer attempting to cover PTV cold spots rather than from the beam energy. Altering the objective function could improve clinical acceptability of static beam Tomotherapy 3DCRT.« less
Authors:
; ;  [1]
  1. University of Virginia, Charlottesville, VA (United States)
Publication Date:
OSTI Identifier:
22355936
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 41; Journal Issue: 6; Other Information: (c) 2014 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; BEAMS; COMPUTERIZED TOMOGRAPHY; CT-GUIDED RADIOTHERAPY; FLEXIBILITY; HOT SPOTS; LUNGS; MAMMARY GLANDS; PATIENTS; PHANTOMS; PLANNING; RADIATION DOSES