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Li C, Yu S, Shen J, Liang B, Fu X, Hua L, Hu H, Jiang P, Lei R, Guan Y, Li T, Li Q, Shi A, Zhang Y. Clinical association between plan complexity and the local-recurrence-free-survival of non-small-cell lung cancer patients receiving stereotactic body radiation therapy. Phys Med 2024; 122:103377. [PMID: 38838467 DOI: 10.1016/j.ejmp.2024.103377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/18/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE To investigate the clinical impact of plan complexity on the local recurrence-free survival (LRFS) of non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiation therapy (SBRT). METHODS Data from 123 treatment plans for 113 NSCLC patients were analyzed. Plan-averaged beam modulation (PM), plan beam irregularity (PI), monitor unit/Gy (MU/Gy) and spherical disproportion (SD) were calculated. The γ passing rates (GPR) were measured using ArcCHECK 3D phantom with 2 %/2mm criteria. High complexity (HC) and low complexity (LC) groups were statistically stratified based on the aforementioned metrics, using cutoffs determined by their significance in correlation with survival time, as calculated using the R-3.6.1 packages. Kaplan-Meier analysis, Cox regression, and Random Survival Forest (RSF) models were employed for the analysis of local recurrence-free survival (LRFS). Propensity-score-matched pairs were generated to minimize bias in the analysis. RESULTS The median follow-up time for all patients was 25.5 months (interquartile range 13.4-41.2). The prognostic capacity of PM was suggested using RSF, based on Variable Importance and Minimal Depth methods. The 1-, 2-, and 3-year LRFS rates in the HC group were significantly lower than those in the LC group (p = 0.023), when plan complexity was defined by PM. However, no significant difference was observed between the HC and LC groups when defined by other metrics (p > 0.05). All γ passing rates exceeded 90.5 %. CONCLUSIONS This study revealed a significant association between higher PM and worse LRFS in NSCLC patients treated with SBRT. This finding offers additional clinical evidence supporting the potential optimization of pre-treatment quality assurance protocols.
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Affiliation(s)
- Chenguang Li
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China; Department of Physics and Astronomy, University of British Columbia, 6224 Agricultural Road, Vancouver, BC V6T1Z1, Canada; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shutong Yu
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Junyue Shen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Baosheng Liang
- Department of Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Xinhui Fu
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ling Hua
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Huimin Hu
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, Haidian District, Beijing 100191, China
| | - Runhong Lei
- Department of Radiation Oncology, Peking University Third Hospital, Haidian District, Beijing 100191, China
| | - Ying Guan
- Beijing United Family Hospital, Beijing 100015, China
| | - Tian Li
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Quanfu Li
- Department of Medical Oncology, Ordos Central Hospital, Ordos 017000, China.
| | - Anhui Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
| | - Yibao Zhang
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China; Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.
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Saglam Y, Selek U, Bolukbasi Y. A novel and clinically useful weight-optimized dynamic conformal arc in stereotactic radiation therapy of non-small cell lung cancer: Dosimetric comparison of treatment plans with volumetric‐modulated arc therapy. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.110623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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von Münchow A, Straub K, Losert C, Shpani R, Hofmaier J, Freislederer P, Heinz C, Thieke C, Söhn M, Alber M, Floca R, Belka C, Parodi K, Reiner M, Kamp F. Statistical breathing curve sampling to quantify interplay effects of moving lung tumors in a 4D Monte Carlo dose calculation framework. Phys Med 2022; 101:104-111. [PMID: 35988480 DOI: 10.1016/j.ejmp.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 05/28/2022] [Accepted: 07/27/2022] [Indexed: 10/15/2022] Open
Abstract
PURPOSE The interplay between respiratory tumor motion and dose application by intensity modulated radiotherapy (IMRT) techniques can potentially lead to undesirable and non-intuitive deviations from the planned dose distribution. We developed a 4D Monte Carlo (MC) dose recalculation framework featuring statistical breathing curve sampling, to precisely simulate the dose distribution for moving target volumes aiming at a comprehensive assessment of interplay effects. METHODS We implemented a dose accumulation tool that enables dose recalculations of arbitrary breathing curves including the actual breathing curve of the patient. This MC dose recalculation framework is based on linac log-files, facilitating a high temporal resolution up to 0.1 s. By statistical analysis of 128 different breathing curves, interplay susceptibility of different treatment parameters was evaluated for an exemplary patient case. To facilitate prospective clinical application in the treatment planning stage, in which patient breathing curves or linac log-files are not available, we derived a log-file free version with breathing curves generated by a random walk approach. Interplay was quantified by standard deviations σ in D5%, D50% and D95%. RESULTS Interplay induced dose deviations for single fractions were observed and evaluated for IMRT and volumetric arc therapy (σD95% up to 1.3 %) showing a decrease with higher fraction doses and an increase with higher MU rates. Interplay effects for conformal treatment techniques were negligible (σ<0.1%). The log-file free version and the random walk generated breathing curves yielded similar results (deviations in σ< 0.1 %) and can be used as substitutes for interplay assessment. CONCLUSION It is feasible to combine statistically sampled breathing curves with MC dose calculations. The universality of the presented framework allows comprehensive assessment of interplay effects in retrospective and prospective clinically relevant scenarios.
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Affiliation(s)
- Asmus von Münchow
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Katrin Straub
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Christoph Losert
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Roel Shpani
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Jan Hofmaier
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Philipp Freislederer
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Heinz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Christian Thieke
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Söhn
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Markus Alber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Ralf Floca
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Institute of Radiation Oncology (HIRO), National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Munich, Germany; Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Germany
| | - Katia Parodi
- Department of Experimental Physics - Medical Physics, Faculty of Physics, LMU Munich, Munich, Germany
| | - Michael Reiner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Florian Kamp
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
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Leste J, Medjahed I, Chauvin M, Younes T, Vieillevigne L, Ferrand R, Franceries X, Bardies M, Simon L. A study of the interplay effect in radiation therapy using a Monte-Carlo model. Phys Med 2021; 87:73-82. [PMID: 34120071 DOI: 10.1016/j.ejmp.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE In modulated radiotherapy, breathing motion can lead to Interplay (IE) and Blurring (BE) effects that can modify the delivered dose. The aim of this work is to present the implementation, the validation and the use of an open-source Monte-Carlo (MC) model that computes the delivered dose including these motion effects. METHODS The MC model of the Varian TrueBeam was implemented using GATE. The dose delivered by different modulated plans is computed for several breathing patterns. A validation of these MC predictions is achieved by a comparison with measurements performed using a dedicated programmable motion platform, carrying a quality assurance phantom. A specific methodology was used to separate the IE and the BE. The influence of different motion parameters (period, amplitude, shape) and plan parameters (volume margin, dose per fraction) was also analyzed. RESULTS The MC model was validated against measurement performed with motion with a mean 3D global gamma index pass rate of 97.5% (3%/3 mm). A significant correlation is found between the IE and the period and the antero-posterior amplitude of the motion but not between the IE and the CTV margin or the shape of motion. The results showed that the IE increases D2% and decreases the D98% of CTV with mean values of +6.9% and -3.3% respectively. CONCLUSIONS We validated the feasibility to assess the IE using a MC model. We found that the most important parameter is the number of breathing cycles that must be greater than 20 for one arc to limit the IE.
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Affiliation(s)
- Jeremy Leste
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Université de Toulouse, UPS, INSERM, Toulouse, France
| | - Imene Medjahed
- Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département Oncologie Médicale, Toulouse, France
| | - Maxime Chauvin
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Université de Toulouse, UPS, INSERM, Toulouse, France
| | - Tony Younes
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Université de Toulouse, UPS, INSERM, Toulouse, France
| | - Laure Vieillevigne
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Université de Toulouse, UPS, INSERM, Toulouse, France; Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département Oncologie Médicale, Toulouse, France
| | - Regis Ferrand
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Université de Toulouse, UPS, INSERM, Toulouse, France; Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département Oncologie Médicale, Toulouse, France
| | - Xavier Franceries
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Université de Toulouse, UPS, INSERM, Toulouse, France
| | - Manuel Bardies
- Cancer Research Institute of Montpellier, U1194 INSERM/ICM/Montpellier University, and Cancer Institute of Montpellier, Montpellier, France
| | - Luc Simon
- Centre de Recherches en Cancérologie de Toulouse (CRCT), Université de Toulouse, UPS, INSERM, Toulouse, France; Institut Claudius Regaud (ICR), Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-O), Département Oncologie Médicale, Toulouse, France.
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Huesa-Berral C, Burguete J, Moreno-Jiménez M, Diego Azcona J. A method using 4D dose accumulation to quantify the interplay effect in lung stereotactic body radiation therapy. Phys Med Biol 2021; 66:035025. [PMID: 33264758 DOI: 10.1088/1361-6560/abd00f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to devise and evaluate a method to quantify the dosimetric uncertainty produced by the interplay between the movement of multileaf collimator and respiratory motion in lung stereotactic body radiation therapy. The method calculates the dose distribution for all control points from a dynamic treatment in all respiratory phases. The methodology includes some characteristics of a patient's irregular breathing patterns. It selects, for each control point, the phases with maximum and minimum mean dose over the tumor and their corresponding adjacent phases, whenever necessary. According to this selection, the dose matrices from each control point are summed up to obtain two dose distributions in each phase, which are accumulated in the reference phase subsequently by deformable image registration (DIR). D 95 and [Formula: see text] were calculated over those accumulated dose distributions for Gross Tumor Volume (GTV), Planning Target Volume-based on Internal Target Volume approach-and Evaluation Target Volume (ETV), a novel concept that applies to 4D dose accumulation. With the ETV, DIR and interplay uncertainties are separated. The methodology also evaluated how variations in the breathing rate and field size affects the mean dose received by the GTV. The method was applied retrospectively in five patients treated with intensity modulated radiotherapy-minimum area defined by the leaves configuration at any control point was at least 4 cm2. Uncertainties in tumor coverage were small (in most patients, changes on D 95 and [Formula: see text] were below 2% for GTV and ETV) but significant over- and under-dosages near ETV, which can be accentuated by highly irregular breathing. Uncertainties in mean dose for GTV tended to decrease exponentially with increasing field size and were reduced by an increase of breathing rate. The implementation of this method would be helpful to assess treatment quality in patients with irregular breathing. Furthermore, it could be used to study interplay uncertainties when small field sizes are used.
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Affiliation(s)
- Carlos Huesa-Berral
- Department of Physics and Applied Mathematics, School of Sciences, Universidad de Navarra. C/ Irunlarrea, E-31008 Pamplona, Navarra, Spain.,Service of Radiation Physics and Radiation Protection, Clínica Universidad de Navarra, Avda. Pío XII, E-31008 Pamplona, Navarra, Spain
| | - Javier Burguete
- Department of Physics and Applied Mathematics, School of Sciences, Universidad de Navarra. C/ Irunlarrea, E-31008 Pamplona, Navarra, Spain
| | - Marta Moreno-Jiménez
- Service of Radiation Oncology, Clínica Universidad de Navarra, Avda. Pío XII, E-31008 Pamplona, Navarra, Spain
| | - Juan Diego Azcona
- Service of Radiation Physics and Radiation Protection, Clínica Universidad de Navarra, Avda. Pío XII, E-31008 Pamplona, Navarra, Spain
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Hou L, Zhang H, Sun X, Liu Q, Chen T, Liu Y, Jiang X, Yao S. Dosimetric Evaluation of the QFix kVue TM Calypso Couch Top. Technol Cancer Res Treat 2021; 20:15330338211011964. [PMID: 33910440 PMCID: PMC8107663 DOI: 10.1177/15330338211011964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/25/2021] [Accepted: 03/29/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate the dosimetric accuracy of the default couch model of the QFix kVueTM Calypso couch top in the treatment planning system. METHODS With the gantry 180°, field size 20 × 20 cm, 6 MV, we measured the depth dose, off-axis dose, and dose plane of different depths in the phantom with the couch rails in and out, respectively. Isocenter doses at different angles were also obtained. The results were compared to the doses calculated using the default couch top model and the real scanned couch top model. Then we revised the default model according to the measured results. RESULTS With "Rails In," the depth dose, off-axis dose, and dose plane of the default couch top model had a big difference with the dose of the real scanned couch top model and the measured result. The dose of the real scanned couch top model was much closer to the measured result, but in the region of the rail edge, the difference was still significant. With "Rails Out," there was a minor difference between the measured result, the dose of the default couch top model and the real scanned couch top model. The difference between the measurement and the default couch top model became very small after being revised. CONCLUSIONS It is better to avoid the beam angle passing through the couch rails in treatment plans, or you should revise the parameter of the QFix kVueTM Calypso couch top model based on the measured results, and verify the treatment plan before clinical practice.
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Affiliation(s)
- Lingtong Hou
- Department of Radiation Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiqin Zhang
- Department of Oncology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Xiaomei Sun
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Qianqian Liu
- Department of Radiation Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingfeng Chen
- Department of Radiation Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Liu
- Department of Radiation Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaodong Jiang
- Department of Oncology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
| | - Shengyu Yao
- Department of Radiation Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Yamauchi R, Mizuno N, Itazawa T, Kawamori J. The influence of respiratory motion on dose distribution in accelerated partial breast irradiation using volumetric modulated arc therapy. Phys Med 2020; 80:23-33. [PMID: 33075732 DOI: 10.1016/j.ejmp.2020.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Accelerated partial breast irradiation (APBI) is alternative treatment option for patients with early stage breast cancer. The interplay effect on volumetric modulated arc therapy APBI (VMAT-APBI) has not been clarified. This study aimed to evaluate the feasibility of VMAT-APBI for patients with small breasts and investigate the amplitude of respiratory motion during VMAT-APBI delivery that significantly affects dose distribution. METHODS The VMAT-APBI plans were generated with 28.5 Gy in five fractions. We performed patient-specific quality assurance using Delta4 phantom under static conditions. We also measured point dose and dose distribution using the ionization chamber and radiochromic film under static and moving conditions of 2, 3 and 5 mm. We compared the measured and calculated point doses and dose distributions by dose difference and gamma passing rates. RESULTS A total of 20 plans were generated; the dose distributions were consistent with those of previous reports. For all measurements under static conditions, the measured and calculated point doses and dose distributions showed good agreement. The dose differences for chamber measurement were within 3%, regardless of moving conditions. The mean gamma passing rates with 3%/2 mm criteria in the film measurement under static conditions and with 2 mm, 3 mm, and 5 mm of amplitude were 95.0 ± 2.0%, 93.3 ± 3.3%, 92.1 ± 6.2% and 84.8 ± 7.8%, respectively. The difference between 5 mm amplitude and other conditions was statistically significant. CONCLUSIONS Respiratory management should be considered for the risk of unintended dose distribution if the respiratory amplitude is >5 mm.
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Affiliation(s)
- Ryohei Yamauchi
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan.
| | - Norifumi Mizuno
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoko Itazawa
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Jiro Kawamori
- Department of Radiation Oncology, St. Luke's International Hospital, Tokyo, Japan
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Tamura M, Matsumoto K, Otsuka M, Monzen H. Plan complexity quantification of dual-layer multi-leaf collimator for volumetric modulated arc therapy with Halcyon linac. Phys Eng Sci Med 2020; 43:947-957. [DOI: 10.1007/s13246-020-00891-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 06/23/2020] [Indexed: 12/31/2022]
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Laugeman E, Heermann A, Hilliard J, Watts M, Roberson M, Morris R, Goddu S, Sethi A, Zoberi I, Kim H, Mutic S, Hugo G, Cai B. Comprehensive validation of halcyon 2.0 plans and the implementation of patient specific QA with multiple detector platforms. J Appl Clin Med Phys 2020; 21:39-48. [PMID: 32368862 PMCID: PMC7386180 DOI: 10.1002/acm2.12881] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 01/01/2023] Open
Abstract
Purpose To perform a comprehensive validation of plans generated on a preconfigured Halcyon 2.0 with preloaded beam model, including evaluations of new features and implementing the patient specific quality assurance (PSQA) process with multiple detectors. Methods A total of 56 plans were generated in Eclipse V15.6 (Varian Medical System) with a preconfigured Halcyon treatment machine. Ten plans were developed via the AAPM TG‐119 test suite with both IMRT and VMAT techniques. 34 clinically treated plans using C‐arm LINAC from 24 patients were replanned on Halcyon using IMRT or VMAT techniques for a variety of sites including: brain, head and neck, lung, breast, abdomen, and pelvis. Six of those plans were breast VMAT plans utilizing the extended treatment field technique available with Halcyon 2.0. The dynamically flattened beam (DFB), another new feature on Halcyon 2.0, was also used for an AP/PA spine and four field box pelvis, as well as ten 3D breast plans. All 56 plans were measured with an ion chamber (IC), film, portal dosimetry (PD), ArcCHECK, and Delta4. Tolerance and action limits were calculated and compared to the recommendations of TG‐218. Results TG‐119 IC and film confidence limits met those set by the task group, except for IMRT target point dose. Forty‐four of 46 clinical plans were within 3% for IC measurements. Average gamma passing rates with 3% dose difference and 2mm distance‐to‐agreement for IMRT/VMAT plans were: Film – 96.8%, PD – 99.9%, ArcCHECK – 99.1%, and Delta4 – 99.2%. Calculated action limits were: Film – 86.3%, PD – 98.4%, ArcCHECK – 96.1%, and Delta4 – 95.7%. Extended treatment field technique was fully validated and 3D plans with DFB had similar results to IMRT/VMAT plans. Conclusion Halcyon plan deliveries were verified with multiple measurement devices. New features of Halcyon 2.0 were also validated. Traditional PSQA techniques and process specific tolerance and action limits were successfully implemented.
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Affiliation(s)
- Eric Laugeman
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Ana Heermann
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Jessica Hilliard
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Michael Watts
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Marshia Roberson
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Robert Morris
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Sreekrishna Goddu
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Abhishek Sethi
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Imran Zoberi
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Hyun Kim
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Sasa Mutic
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Geoffrey Hugo
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
| | - Bin Cai
- Department of Radiation Oncology, Washington University, St. Louis, MO, USA
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Wang R, Du Y, Yao K, Liu Z, Wang H, Yue H, Zhang Y, Wu H. Halcyon clinical performance evaluation: A log file-based study in comparison with a C-arm Linac. Phys Med 2020; 71:14-23. [PMID: 32086148 DOI: 10.1016/j.ejmp.2020.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/27/2019] [Accepted: 01/26/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The aim of this study is to compare the dosimetric and mechanical accuracy of Volumetric Modulation Arc Therapy (VMAT) delivery on the Halcyon, a recent ring-shaped Treatment Delivery System (TDS) featuring fast rotating gantry, with a conventional C-arm Linac. METHODS The comparison was performed via log file analysis, where mechanical parameters of related components was extracted. 480 and 3951 VMAT log files of clinically delivered fractions from a Halcyon and a TrueBeam Linac were analyzed respectively. The relations between mechanical parameters and errors were extensively explored to further investigate the differences between the two Linacs. The mechanical parameter fluctuations were taken into account for dose recalculations, and the Dose Volume Parameters (DVP) on the PTV were evaluated to quantify such dosimetric variations. RESULTS The Multi-Leaf Collimator (MLC) leaf mean Root Mean Square (RMS) errors were 0.028 mm and 0.031 mm for Halcyon and TrueBeam respectively. Maximum systematic error on the MLC leaves introduced by the gravity effect were 0.04 mm and 0.01 mm for the Halcyon and TrueBeam respectively. Thanks to the O-ring design, the Halcyon achieved 0.035° in mean RMS error in gantry angle compared with the 0.065° of the TrueBeam. Overall mechanical errors introduced similar levels of dose-volume parameter variations (about 0.1%) on both Linacs. CONCLUSION The Halcyon TDS can achieve similar mechanical leaf positioning accuracy compared with the TrueBeam TDS with a doubled delivery speed. In terms of dosimetric accuracy, The DVP standard deviations on the studied TB are generally larger than that on the Halcyon.
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Affiliation(s)
- Ruoxi Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yi Du
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Kaining Yao
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Zhuolun Liu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hanlin Wang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Haizhen Yue
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yibao Zhang
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hao Wu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China.
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Sasaki M, Nakamura M, Mukumoto N, Goto Y, Ishihara Y, Nakata M, Sugimoto N, Mizowaki T. Variation in accumulated dose of volumetric-modulated arc therapy for pancreatic cancer due to different beam starting phases. J Appl Clin Med Phys 2019; 20:118-126. [PMID: 31539194 PMCID: PMC6806466 DOI: 10.1002/acm2.12720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/07/2019] [Accepted: 08/28/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To assess the effects of different beam starting phases on dosimetric variations in the clinical target volume (CTV) and organs at risk (OARs), and to identify the relationship between plan complexity and the dosimetric impact of interplay effects in volumetric-modulated arc therapy (VMAT) plans for pancreatic cancer. METHODS Single and double full-arc VMAT plans were generated for 11 patients. A dose of 50.4 Gy in 28 fractions was prescribed to cover 50% of the planning target volume. Patient-specific Digital Imaging and Communications in Medicine-Radiation Therapy plan files were divided into 10 files based on the respiratory phases in four-dimensional computed tomography (4DCT) simulations. The phase-divided VMAT plans were calculated in consideration of the beam starting phase for each arc and were then combined in the mid-ventilation phase of 4DCT (4D plans). The dose-volumetric parameters were compared with the calculated dose distributions without consideration of the interplay effects (3D plans). Additionally, relationships among plan parameters such as modulation complexity scores, monitor units (MUs), and dose-volumetric parameters were evaluated. RESULTS Dosimetric differences in the median values associated with different beam starting phases were within ± 1.0% and ± 0.2% for the CTV and ± 0.5% and ± 0.9% for the OARs during single and double full-arc VMAT, respectively. Significant differences caused by variations in the beam starting phases were observed only for the dose-volumetric parameters of the CTV during single full-arc VMAT (P < 0.05), associated with moderate or strong correlations between the MUs and the dosimetric differences between the 4D and 3D plans. CONCLUSIONS The beam starting phase affected CTV dosimetric variations of single full-arc VMAT. The use of double full-arc VMAT mitigated this problem. However, variation in the dose delivered to OARs was not dependent on the beam starting phase, even for single full-arc VMAT.
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Affiliation(s)
- Makoto Sasaki
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.,Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Mitsuhiro Nakamura
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.,Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Nobutaka Mukumoto
- Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoko Goto
- Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshitomo Ishihara
- Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Manabu Nakata
- Division of Clinical Radiology Service, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Naozo Sugimoto
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takashi Mizowaki
- Radiation Oncology and Image-applied Therapy, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Azcona JD, Huesa‐Berral C, Moreno‐Jiménez M, Barbés B, Aristu JJ, Burguete J. A novel concept to include uncertainties in the evaluation of stereotactic body radiation therapy after 4D dose accumulation using deformable image registration. Med Phys 2019; 46:4346-4355. [DOI: 10.1002/mp.13759] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Juan Diego Azcona
- Service of Radiation Physics and Radiation Protection Clínica Universidad de Navarra Avda. Pío XII 31008Pamplona Navarra Spain
| | - Carlos Huesa‐Berral
- Service of Radiation Physics and Radiation Protection Clínica Universidad de Navarra Avda. Pío XII 31008Pamplona Navarra Spain
- Department of Physics and Applied Mathematics, School of Sciences Universidad de Navarra. C/ Irunlarrea 31008Pamplona Navarra Spain
| | - Marta Moreno‐Jiménez
- Service of Radiation Oncology Clínica Universidad de Navarra Avda. Pío XII 31008Pamplona Navarra Spain
| | - Benigno Barbés
- Service of Radiation Physics and Radiation Protection Clínica Universidad de Navarra Avda. Pío XII 31008Pamplona Navarra Spain
| | - José Javier Aristu
- Service of Radiation Oncology Clínica Universidad de Navarra Avda. Pío XII 31008Pamplona Navarra Spain
| | - Javier Burguete
- Department of Physics and Applied Mathematics, School of Sciences Universidad de Navarra. C/ Irunlarrea 31008Pamplona Navarra Spain
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Barsky AR, O'Grady F, Kennedy C, Taunk NK, Dong L, Metz JM, Li T, Freedman GM. Initial Clinical Experience Treating Patients with Breast Cancer on a 6-MV Flattening-Filter-Free O-Ring Linear Accelerator. Adv Radiat Oncol 2019; 4:571-578. [PMID: 31673650 PMCID: PMC6817541 DOI: 10.1016/j.adro.2019.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/19/2022] Open
Abstract
Purpose Three-dimensional (3D) conformal radiation therapy is the standard technique used for adjuvant breast radiation. We report the clinical use of a novel 6-MV flattening-filter-free O-ring linear accelerator (6X-FFF ORL) for breast cancer that may improve upon 3D conformal radiation therapy with its higher dose rate and faster rotation and leaf speed than traditional C-arm gantries. Methods and Materials We retrospectively identified consecutive women with breast cancer who underwent surgery followed by radiation therapy to the breast or chest wall on Halcyon (Varian Medical Systems, Palo Alto, CA), a novel 6X-FFF ORL. We report their clinicopathologic information, radiation therapy details, acute toxicities, dose-volume histogram data, couch corrections, and treatment times. Results Thirty-four women were treated for breast cancer on a 6X-FFF ORL between February 2018 and September 2018. All patients underwent lumpectomy (92%) or mastectomy (8%). Tumors were left sided in 44% and bilateral in 9%, and 9% included comprehensive nodal radiation therapy. Twelve percent of patients were treated prone and 29% with deep-inspiration breath hold. Standard target and normal-tissue constraints were met in nearly all plans. The 3D vector couch correction average was 0.77 ± 0.05 cm. The mean beam-on time was 2.0 ± 0.3 minutes, and mean treatment time from start of imaging to beam-off was 4.4 ± 0.4 minutes. Grade 2 dermatitis, fatigue, and breast pain occurred in 18%, 9%, and 3% of patients, respectively. Conclusions In this first clinical report of breast radiation therapy with a 6X-FFF ORL, treatment was versatile and fast for complex setups and techniques, with acceptable toxicity and organ-at-risk doses. Thus, a 6X-FFF ORL can increase throughput or reduce length of day compared with a conventional C-arm linear accelerator in departments with a busy breast service.
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Edvardsson A, Scherman J, Nilsson MP, Wennberg B, Nordström F, Ceberg C, Ceberg S. Breathing-motion induced interplay effects for stereotactic body radiotherapy of liver tumours using flattening-filter free volumetric modulated arc therapy. ACTA ACUST UNITED AC 2019; 64:025006. [DOI: 10.1088/1361-6560/aaf5d9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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