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Misson-Yates S, Cunningham R, Gonzalez R, Diez P, Clark CH. Optimised conformal total body irradiation: a heterogeneous practice, so where next? Br J Radiol 2023; 96:20220650. [PMID: 36475820 PMCID: PMC10078861 DOI: 10.1259/bjr.20220650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The use of volumetric arc therapy and inverse planning has been in routine use in radiotherapy for two decades. However, use in total body irradiation (TBI) has been more recent and few guidelines exist as to how to plan or verify. This has led to heterogeneous approaches. The goal of this review is to provide an overview of current advanced planning and dosimetry verification protocols used in optimised conformal TBI as a basis for investigating the need for greater standardisation in TBI.
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Affiliation(s)
- Sarah Misson-Yates
- Department of Medical Physics, Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Rissa Cunningham
- Department of Medical Physics, Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Regina Gonzalez
- Department of Medical Physics, Guy's Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Patricia Diez
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK
| | - Catharine H Clark
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK
- Metrology for Medical Physics Centre, National Physical Laboratory, Teddington, UK
- Radiotherapy Physics, University College London Hospitals NHS Foundation Trust, London, UK
- Medical Physics and Bioengineering Department, University College London, London, UK
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Uehara T, Monzen H, Tamura M, Inada M, Otsuka M, Doi H, Matsumoto K, Nishimura Y. Feasibility study of volumetric modulated arc therapy with Halcyon™ linac for total body irradiation. Radiat Oncol 2021; 16:236. [PMID: 34906180 PMCID: PMC8670260 DOI: 10.1186/s13014-021-01959-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/29/2021] [Indexed: 01/11/2023] Open
Abstract
Background The use of total body irradiation (TBI) with linac-based volumetric modulated arc therapy (VMAT) has been steadily increasing. Helical tomotherapy has been applied in TBI and total marrow irradiation to reduce the dose to critical organs, especially the lungs. However, the methodology of TBI with Halcyon™ linac remains unclear. This study aimed to evaluate whether VMAT with Halcyon™ linac can be clinically used for TBI. Methods VMAT planning with Halcyon™ linac was conducted using a whole-body computed tomography data set. The planning target volume (PTV) included the body cropped 3 mm from the source. A dose of 12 Gy in six fractions was prescribed for 50% of the PTV. The organs at risk (OARs) included the lens, lungs, kidneys, and testes. Results The PTV D98%, D95%, D50%, and D2% were 8.9 (74.2%), 10.1 (84.2%), 12.6 (105%), and 14.2 Gy (118%), respectively. The homogeneity index was 0.42. For OARs, the Dmean of the lungs, kidneys, lens, and testes were 9.6, 8.5, 8.9, and 4.4 Gy, respectively. The V12Gy of the lungs and kidneys were 4.5% and 0%, respectively. The Dmax of the testes was 5.8 Gy. Contouring took 1–2 h. Dose calculation and optimization was performed for 3–4 h. Quality assurance (QA) took 2–3 h. The treatment duration was 23 min. Conclusions A planning study of TBI with Halcyon™ to set up VMAT-TBI, dosimetric evaluation, and pretreatment QA, was established. Supplementary Information The online version contains supplementary material available at 10.1186/s13014-021-01959-3.
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Affiliation(s)
- Takuya Uehara
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hajime Monzen
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Mikoto Tamura
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masahiro Inada
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Masakazu Otsuka
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Kenji Matsumoto
- Department of Medical Physics, Graduate School of Medical Science, Kindai University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
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The impact of different optimization strategies on the agreement between planned and delivered doses during volumetric modulated arc therapy for total marrow irradiation. Contemp Oncol (Pozn) 2021; 25:100-106. [PMID: 34667436 PMCID: PMC8506427 DOI: 10.5114/wo.2021.107742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/13/2021] [Indexed: 11/17/2022] Open
Abstract
Aim of the study To evaluate the agreement between planned and delivered doses and its potential correlation with the plans' complexity subjected to dosimetric verification. Material and methods Four isocentre volumetric modulated arc therapy for total marrow irradiation plans optimized simultaneously with (P1) and without (P2) MU reduction were evaluated dosimetrically by γ method performed in a global mode for 4 combinations of γ-index criteria (2%/2 mm, 2%/3 mm, 3%/2 mm, and 3%/3 mm). The evaluation was conducted for 4 regions (head and neck, chest, abdomen and upper pelvis, and lower pelvis and thighs) that were determined geometrically by the isocentres. The Wilcoxon test was used to detect significant differences between γ passing rate (GPR) analysis results for the P1 and P2 plans. The Pearson correlation was used to check the relationship between GPR and the plans' complexity. Results Except for the head and neck region, the P2 plans had better GPRs than the P1 plans. Only for hard combinations of γ-index criteria (i.e. 2%/3 mm, 2%/2 mm) were the GPRs differences between P1 and P2 clinically meaningful, and they were detected in the chest, abdomen and upper pelvis, and lower pelvis and thighs regions. The highest correlations between GPR and the indices describing the plans' complexity were found for the chest region. No correlation was found for the head and neck region. Conclusions The P2 plans showed better agreement between planned and delivered doses compared to the P1 plans. The GPR and the plans' complexity depend on the anatomy region and are most important for the chest region.
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Thiyagarajan R, Sharma DS, Kaushik S, Sawant M, Ganapathy K, Nambi Raj NA, Chilukuri S, Sundar SC, Patro KC, Manikandan A, Noufal MP, Sivaraman R, Easow J, Jalali R. Leaf open time sinogram (LOTS): a novel approach for patient specific quality assurance of total marrow irradiation. Radiat Oncol 2020; 15:236. [PMID: 33054792 PMCID: PMC7557063 DOI: 10.1186/s13014-020-01669-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
There is no ideal detector-phantom combination to perform patient specific quality assurance (PSQA) for Total Marrow (TMI) and Lymphoid (TMLI) Irradiation plan. In this study, 3D dose reconstruction using mega voltage computed tomography detectors measured Leaf Open Time Sinogram (LOTS) was investigated for PSQA of TMI/TMLI patients in helical tomotherapy. The feasibility of this method was first validated for ten non-TMI/TMLI patients, by comparing reconstructed dose with (a) ion-chamber (IC) and helical detector array (ArcCheck) measurement and (b) planned dose distribution using 3Dγ analysis for 3%@3mm and dose to 98% (D98%) and 2% (D2%) of PTVs. Same comparison was extended for ten treatment plans from five TMI/TMLI patients. In all non-TMI/TMLI patients, reconstructed absolute dose was within ± 1.80% of planned and IC measurement. The planned dose distribution agreed with reconstructed and ArcCheck measured dose with mean (SD) 3Dγ of 98.70% (1.57%) and 2Dγ of 99.48% (0.81%). The deviation in D98% and D2% were within 1.71% and 4.10% respectively. In all 25 measurement locations from TMI/TMLI patients, planned and IC measured absolute dose agreed within ± 1.20%. Although sectorial fluence verification using ArcCHECK measurement for PTVs chest from the five upper body TMI/TMLI plans showed mean ± SD 2Dγ of 97.82% ± 1.27%, the reconstruction method resulted poor mean (SD) 3Dγ of 92.00% (± 5.83%), 64.80% (± 28.28%), 69.20% (± 30.46%), 60.80% (± 19.37%) and 73.2% (± 20.36%) for PTVs brain, chest, torso, limb and upper body respectively. The corresponding deviation in median D98% and D2% of all PTVs were < 3.80% and 9.50%. Re-optimization of all upper body TMI/TMLI plans with new pitch and modulation factor of 0.3 and 3 leads significant improvement with 3Dγ of 100% for all PTVs and median D98% and D2% < 1.6%. LOTS based PSQA for TMI/TMLI is accurate, robust and efficient. A field width, pitch and modulation factor of 5 cm, 0.3 and 3 for upper body TMI/TMLI plan is suggested for better dosimetric outcome and PSQA results.
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Affiliation(s)
- Rajesh Thiyagarajan
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, 600096, Tamil Nadu, India.,School of Advanced Sciences, VIT University, Vellore, 632014, India
| | | | - Suryakant Kaushik
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, 600096, Tamil Nadu, India
| | - Mayur Sawant
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, 600096, Tamil Nadu, India
| | - K Ganapathy
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, 600096, Tamil Nadu, India
| | - N Arunai Nambi Raj
- Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT), VIT University, Vellore, 632014, India
| | - Srinivas Chilukuri
- Department of Radiation Oncology, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, 600096, Tamil Nadu, India
| | - Sham C Sundar
- Department of Radiation Oncology, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, 600096, Tamil Nadu, India
| | - Kartikeswar Ch Patro
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, 600096, Tamil Nadu, India
| | - Arjunan Manikandan
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, 600096, Tamil Nadu, India
| | - M P Noufal
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, 600096, Tamil Nadu, India
| | - Rangasamy Sivaraman
- Department of Medical Physics, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, 600096, Tamil Nadu, India
| | - Jose Easow
- Department of Haematology, Blood and Marrow Transplantation, Apollo Speciality Hospital, Teynampet, Chennai, India
| | - Rakesh Jalali
- Department of Radiation Oncology, Apollo Proton Cancer Centre, 100 Feet Road Tharamani, Chennai, 600096, Tamil Nadu, India
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Bai H, Zhu S, Wu X, Liu X, Chen F, Yan J. Study on the ability of 3D gamma analysis and bio-mathematical model in detecting dose changes caused by dose-calculation-grid-size (DCGS). Radiat Oncol 2020; 15:161. [PMID: 32631380 PMCID: PMC7336463 DOI: 10.1186/s13014-020-01603-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023] Open
Abstract
Objective To explore the efficacy and sensitivity of 3D gamma analysis and bio-mathematical model for cervical cancer in detecting dose changes caused by dose-calculation-grid-size (DCGS). Methods 17 patients’ plans for cervical cancer were enrolled (Pinnacle TPS, VMAT), and the DCGS was changed from 2.0 mm to 5.0 mm to calculate the planned dose respectively. The dose distribution calculated by DCGS = 2.0 mm as the “reference” data set (RDS), the dose distribution calculated by the rest DCGS as the“measurement”data set (MDS), the 3D gamma passing rates and the (N) TCPs of the all structures under different DCGS were obtained, and then analyze the ability of 3D gamma analysis and (N) TCP model in detecting dose changes and what factors affect this ability. Results The effect of DCGS on planned dose was obvious. When the gamma standard was 1.0 mm, 1.0 and 10.0%, the difference of the results of the DCGS on dose-effect could be detected by 3D gamma analysis (all p value < 0.05). With the decline of the standard, 3D gamma analysis’ ability to detect this difference shows weaker. When the standard was 1.0 mm, 3.0 and 10.0%, the p value of > 0.05 accounted for the majority. With DCGS = 2.0 mm being RDS, ∆gamma-passing-rate presented the same trend with ∆(N) TCPs of all structures except for the femurs only when the 1.0 mm, 1.0 and 10.0% standards were adopted for the 3D gamma analysis. Conclusions The 3D gamma analysis and bio-mathematical model can be used to analyze the effect of DCGS on the planned dose. For comparison, the former’s detection ability has a lot to do with the designed standard, and the latter’s capability is related to the parameters and calculated accuracy instrinsically.
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Affiliation(s)
- Han Bai
- Department of Radiation Oncology, Yunnan Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, No.519 Kunzhou, Road, Xishan District, Kunming, Yunnan, China
| | - Sijin Zhu
- Department of Radiation Oncology, Yunnan Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, No.519 Kunzhou, Road, Xishan District, Kunming, Yunnan, China
| | - Xingrao Wu
- Department of Radiation Oncology, Yunnan Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, No.519 Kunzhou, Road, Xishan District, Kunming, Yunnan, China.
| | - Xuhong Liu
- Department of Radiation Oncology, Yunnan Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, No.519 Kunzhou, Road, Xishan District, Kunming, Yunnan, China
| | - Feihu Chen
- Department of Radiation Oncology, Yunnan Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, No.519 Kunzhou, Road, Xishan District, Kunming, Yunnan, China
| | - Jiawen Yan
- Department of Radiation Oncology, Yunnan Tumor Hospital, The Third Affiliated Hospital of Kunming Medical University, No.519 Kunzhou, Road, Xishan District, Kunming, Yunnan, China
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