Use of genetic algorithm for PTV optimization in single isocenter multiple metastases radiosurgery treatments with Brainlab Elements™

Assessing tumor volumetric reduction with consideration for setup errors based on mathematical tumor model and microdosimetric kinetic model in single-isocenter VMAT for brain metastases

The volumetric reduction rate (VRR) was evaluated with consideration for six degrees-of-freedom (6DoF) patient setup errors based on a mathematical tumor model in single-isocenter volumetric modulated arc therapy (SI-VMAT) for brain metastases. Simulated gross tumor volumes (GTV) of 1.0 cm and dose distribution were created (27 Gy/3 fractions). The distance between the GTV center and isocenter (d) was set at 0-10 cm. The GTV was translated within 0-1.0 mm (Trans) and rotated within 0-1.0° (Rot) in the three axis directions using affine transformation. The tumor growth volume was calculated using a multicomponent mathematical model (MCTM), and lethal effects of irradiation and repair from damage during irradiation were calculated by a microdosimetric kinetic model (MKM) for non-small cell lung cancer (NSCLC) A549 and NCI-H460 (H460) cells. The VRRs were calculated 5 days after the end of irradiation using the physical dose to the GTV for varying d and 6DoF setup errors. The tolerance value of VRR, the GTV volume reduction rate, was set at 5%, based on the pre-irradiation GTV volume. With the exception of the only one A549 condition where (Trans, Rot) = (1.0 mm, 1.0°) was repeated for 3 fractions, all conditions met all the tolerance VRR values for A549 and H460 cells with varying d from 0 to 10 cm. Evaluation based on the mathematical tumor model suggested that if the 6DoF setup errors at each irradiation could be kept within 1.0 mm and 1.0°, there would be little effect on tumor volume regardless of the distance from the isocenter in SI-VMAT.

Effect of different optimization parameters in single isocenter multiple brain metastases radiosurgery

PURPOSE

Automated treatment planning for multiple brain metastases differs from traditional planning approaches. It is therefore helpful to understand which parameters for optimization are available and how they affect the plan quality. This study aims to provide a reference for designing multi-metastases treatment plans and to define quality endpoints for benchmarking the technique from a scientific perspective.

METHODS

In all, 20 patients with a total of 183 lesions were retrospectively planned according to four optimization scenarios. Plan quality was evaluated using common plan quality parameters such as conformity index, gradient index and dose to normal tissue. Therefore, different scenarios with combinations of optimization parameters were evaluated, while taking into account dependence on the number of treated lesions as well as influence of different beams.

RESULTS

Different scenarios resulted in minor differences in plan quality. With increasing number of lesions, the number of monitor units increased, so did the dose to healthy tissue and the number of interlesional dose bridging in adjacent metastases. Highly modulated cases resulted in 4-10% higher V10% compared to less complex cases, while monitor units did not increase. Changing the energy to a flattening filter free (FFF) beam resulted in lower local V12Gy (whole brain-PTV) and even though the number of monitor units increased by 13-15%, on average 46% shorter treatment times were achieved.

CONCLUSION

Although no clinically relevant differences in parameters where found, we identified some variation in the dose distributions of the different scenarios. Less complex scenarios generated visually more dose overlap; therefore, a more complex scenario may be preferred although differences in the quality metrics appear minor.

Dosimetric effects of rotational errors for single isocenter multiple targets in HyperArc plans: A phantom and retrospective imaging analysis study

PURPOSE

This study uses a phantom to investigate the dosimetric impact of rotational setup errors for Single Isocenter Multiple Targets (SIMT) HyperArc plans. Additionally, it evaluates intra-fractional rotational setup errors in patients treated with Encompass immobilization system.

METHODS

The Varian HyperArc system (Varian Medical systems) was used to create plans targeting spherical PTVs with diameters of 5, 10, and 15 mm and with offsets of 1.3-5.3 cm from the isocenter. Dosimetric parameters, including mean and maximum dose, D99% and D95% were evaluated for various rotational setup errors ranging from 0.5° to 2° for the PTVs and certain CTVs created within PTVs. These rotational errors were applied in an order and direction that resulted in the maximum displacement of targets. The rotation was applied both uniformly around all three axes and individually around each axis. Furthermore, to link the findings to actual treatment scenarios, the intra-fractional rotational setup errors were obtained for stereotactic cranial patients treated with the Encompass system using CBCT images acquired during treatments.

RESULTS

The maximum displacement of 2.7 mm was observed for targets located at 4.4 and 4.5 cm from the isocenter with rotational setup errors of 2°. The dose reduction for D99% values corresponding to this displacement were about 50%, 40%, and 30% for PTVs with diameters of 5, 10, and 15 mm, respectively. Both D99% and D95% showed a consistent trend of dose reduction across various rotational errors and PTV volumes. While the maximum dose remained consistent for different targets with various rotational errors, the mean dose decreased by approximately 25%, 12%, and 6% for PTVs with diameters of 5, 10, and 15 cm, respectively, with rotational errors of 2°. In addition, by analyzing CBCT images, the absolute mean rotational setup errors obtained during treatment with Encompass for pitch, roll, and yaw were 0.17° ± 0.13°, 0.11° ± 0.10°, and 0.12° ± 0.10° respectively. This data, combined with existing studies, suggest that a 0.5° rotational setup error is a safe choice to consider for calculating additional PTV margin to ensure adequate CTV coverage. Therefore, the assessment of maximum displacement and dosimetric parameters in this study, for a 0.5° rotational error, highlights the need for an additional 0.7 mm PTV margin for targets positioned at distances of 4.4 cm or greater from the isocenter.

CONCLUSIONS

For SIMT Plans, a 0.5° rotational setup error is recommended as a basis for calculating additional PTV margins to ensure adequate CTV coverage when using the Encompass system.

Innovative margin design and optimized isocenter to minimize the normal tissue in target volumes for single-isocenter multi-target stereotactic radiosurgery

Objective.Treating multiple brain metastases in a single plan is a popular radiosurgery technique. However, targets positioned off-isocenter are subject to rotational uncertainties. This work introduces two new planning target volumes (PTVs) that address this increased uncertainty. The volume of normal tissue included in these PTVs when paired with optimized isocenters are evaluated and compared with conventional methods.Approach.Sets of 1000 random multi-target radiosurgery patients were simulated, each patient with a random number of spherical targets (2-10). Each target had a random volume (0.1-15 cc) and was randomly positioned between 5 and 50 mm or 100 mm from isocenter. Two new PTVs ('LensPTV' and 'SwipePTV') and conventional isotropic PTVs were created using isocenters derived from the center-of-centroids, the center-of-mass, or optimized per PTV type. The total volume of normal tissue in the PTVs for each patient was calculated and compared using 1 mm translations and 0.5°, 1.0°, and 2.0° rotations.Main results.Using the new PTVs and/or using optimized isocenters decreased the total volume of normal tissue in the PTVs per patient. The SwipePTV, in particular, provided the greatest decrease. Compared to the SwipePTV, the LensPTV and the conventional isotropic PTV included an extra 0.68 and 0.73 cc of normal tissue per patient (median), respectively, when using 50 mm max distance to isocenter and 1° max rotation angle. Under these conditions, 25% of patients had extra volume of normal tissue ≥ 0.96 and 1.04 cc. When using 100 mm max distance to isocenter and 2° max rotation angle, 25% of patients had extra volume of normal tissue ≥ 4.35 and 5.75 cc.Significance.PTVs like those presented here, especially when paired with optimized isocenters, can decrease the total volume of included normal tissue and reduce the risk of toxicity without compromising target coverage.

Optimization of isocenter position for multiple brain metastases single-isocenter stereotactic radiosurgery to minimize dosimetric variations due to rotational uncertainty

PURPOSE

This paper studied a novel calculation framework that can determine the optimal value isocenter position of single isocenter SRS treatment plan for multiple brain metastases, in order to minimize the dosimetric variations caused by rotational uncertainty.

MATERIALS AND METHODS

21 patients with 2-4 GTVswho received SRS treatment for multiple brain metastases in our institution were selected for the retrospective study. The PTVwas obtained by expanding GTV 1 mm isotropic margin. We studied a stochastic optimization framework, which determined the optimal value isocenter location by maximizing the average target dose coverageC_target,meanwith a rotation error of no more than 1°. We evaluated the performance of the optimal isocenter by comparing theC_target,meanand average dice similarity coefficient (DSC)with the optimal value and the center of mass (CM) respectively as the treatment isocenter. The extra PTV margin to achieve 100% target dose coverage was calculated by our framework.

RESULTS

Compared to the CM method, the optimal value isocenter method increased the averageC_target,meanof all targets from 97.0% to 97.7%and the average DSC from 0.794to 0.799. Throughout all the cases, the average extra PTV margin to obtain full target dose coverage was 0.7 mmwhen using the optimal value isocenter as the treatment isocenter.

CONCLUSION

We studied a novel computational framework using stochastic optimization to determine the optimal isocenter position of SRS treatment plan for multiple brain metastases. At the same time, our framework gave the extra PTV margin to obtain full target dose coverage.

Multicomponent mathematical model for tumor volume calculation with setup error using single-isocenter stereotactic radiotherapy for multiple brain metastases

We evaluated the tumor residual volumes considering six degrees-of-freedom (6DoF) patient setup errors in stereotactic radiotherapy (SRT) with multicomponent mathematical model using single-isocenter irradiation for brain metastases. Simulated spherical gross tumor volumes (GTVs) with 1.0 (GTV 1), 2.0 (GTV 2), and 3.0 (GTV 3)-cm diameters were used. The distance between the GTV center and isocenter (d) was set at 0-10 cm. The GTV was simultaneously translated within 0-1.0 mm (T) and rotated within 0°-1.0° (R) in the three axis directions using affine transformation. We optimized the tumor growth model parameters using measurements of non-small cell lung cancer cell lines' (A549 and NCI-H460) growth. We calculated the GTV residual volume at the irradiation's end using the physical dose to the GTV when the GTV size, d, and 6DoF setup error varied. The d-values that satisfy tolerance values (10%, 35%, and 50%) of the GTV residual volume rate based on the pre-irradiation GTV volume were determined. The larger the tolerance value set for both cell lines, the longer the distance to satisfy the tolerance value. In GTV residual volume evaluations based on the multicomponent mathematical model on SRT with single-isocenter irradiation, the smaller the GTV size and the larger the distance and 6DoF setup error, the shorter the distance that satisfies the tolerance value might need to be.

Automatic measurement of beam-positioning accuracy at off-isocenter positions

PURPOSE

This study performed an automatic measurement of the off-axis beam-positioning accuracy at a single isocenter via the TrueBeam Developer mode and evaluated the beam-positioning accuracy considering the effect of couch rotational errors.

METHODS

TrueBeam STx and the Winston-Lutz test-dedicated phantom, with a 3 mm diameter steel ball, were used in this study. The phantom was placed on the treatment couch, and the Winston-Lutz test was performed at the isocenter for four gantry angles (0°, 90°, 180°, and 270°) using an electronic portal imaging device. The phantom offset positions were at distances of 0, 25, 50, 75, and 100 mm from the isocenter along the superior-inferior, anterior-posterior, and left-right directions. Seventeen patterns of multileaf collimator-shaped square fields of 10 × 10 mm² were created at the isocenter and off-axis positions for each gantry angle. The beam-positioning accuracy was evaluated with couch rotation along the yaw-axis (0°, ± 0.5°, and ± 1.0°).

RESULTS

The mean beam-positioning errors at the isocenter and off-isocenter distances (from the isocenter to ±100 mm) were 0.46-0.60, 0.44-0.91, and 0.42-1.11 mm for the couch angles of 0°, ±0.5°, and ±1°, respectively. The beam-positioning errors increased as the distance from the isocenter and couch rotation increased.

CONCLUSION

These findings suggest that the beam-positioning accuracy at the isocenter and off-isocenter positions can be evaluated quickly and automatically using the TrueBeam Developer mode. The proposed procedure is expected to contribute to an efficient evaluation of the beam-positioning accuracy at off-isocenter positions.

Rotational effect and dosimetric impact: HDMLC vs 5-mm MLC leaf width in single isocenter multiple metastases radiosurgery with Brainlab Elements™

Purpose:

To analyse the impact of multileaf collimator (MLC) leaf width in multiple metastases radiosurgery (SRS) considering the target distance to isocenter and rotational displacements.

Methods:

Ten plans were optimised. The plans were created with Elements Multiple Mets SRS v2·0 (Brainlab AG, Munchen, Germany). The mean number of metastases per plan was 5 ± 2 [min 3, max 9], and the mean volume of gross tumour volume (GTV) was 1·1 ± 1·3 cc [min 0·02, max 5·1]. Planning target volume margin criterion was based on GTV-isocenter distance and target dimensions. Plans were performed using 6 MV with high-definition MLC (HDMLC) and reoptimised using 5-mm MLC (MLC-5). Plans were compared using Paddick conformity index (PCI), gradient index, monitor units , volume receiving half of prescription isodose (PIV50), maximum dose to brainstem, optic chiasm and optic nerves, and V12Gy, V10Gy and V5Gy for healthy brain were analysed. The maximum displacement due to rotational combinations was optimised by a genetic algorithm for both plans. Plans were reoptimised and compared using optimised margin.

Results:

HDMLC plans had better conformity and higher dose falloff than MLC-5 plans. Dosimetric differences were statistically significant (p < 0·05). The smaller the lesion volume, the higher the dosimetric differences between both plans. The effect of rotational displacements produced for each target in SRS was not dependent on the MLC (p > 0·05).

Conclusions:

The finer HDMLC offers dosimetric advantages compared with the MLC-5 in terms of target conformity and dose to the surrounding organs at risk. However, only dose falloff differences due to rotations depend on MLC.