1
|
Sarudis S, Karlsson A, Nyman J, Bäck A. Dosimetric effects of respiratory motion during stereotactic body radiation therapy of lung tumors. Acta Oncol 2022; 61:1004-1011. [PMID: 35905048 DOI: 10.1080/0284186x.2022.2092420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Respiratory-induced lung tumor motion may affect the delivered dose in stereotactic body radiation therapy (SBRT). Previous studies are often based on phantom studies for one specific treatment technique. In this study, the dosimetric effect of tumor motion was quantified in real patient geometries for different modulated treatments and tumor motion amplitudes for lung-SBRT. MATERIAL AND METHODS A simulation method using deformable image registrations and 4-dimensional computed tomographies (4DCT) was developed to assess the dosimetric effects of tumor motion. The method was evaluated with ionization chamber and Gafchromic film measurements in a thorax phantom and used to simulate the effect for 15 patients with lung tumors moving 7.3-27.4 mm. Four treatment plans with different complexities were created for each patient and the motion-induced dosimetric effect to the gross tumor volume (GTV) was simulated. The difference between the planned dose to the static tumor and the simulated delivered dose to the moving tumor was quantified for the near minimum (D98%), near maximum (D2%) and mean dose (Dmean) to the GTV as well as the largest observed local difference within the GTV (Maxdiff). RESULTS No correlation was found between the dose differences and the tumor motion amplitude or plan complexity. However, the largest deviations were observed for tumors moving >15.0 mm. The simulated delivered dose was within 2.5% from the planned dose for D98% (tumors moving <15 mm) and within 3.3% (tumors moving >15 mm). The corresponding values were 1.7% vs. 6.4% (D2%); 1.7% vs. 2.4% (Dmean) and 8.9% vs. 35.2% (Maxdiff). Using less complex treatment techniques minimized Maxdiff for tumors moving >15.0 mm. CONCLUSION The dosimetric effects of respiratory-induced motion during lung SBRT are patient and plan specific. The magnitude of the dosimetric effect cannot be assessed solely based upon tumor motion amplitude or plan complexity.
Collapse
Affiliation(s)
- Sebastian Sarudis
- Department of Medical Radiation Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Medical Physics, County Hospital Ryhov, Jönköping, Sweden
| | - Anna Karlsson
- Department of Medical Radiation Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jan Nyman
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Bäck
- Department of Medical Radiation Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Therapeutic Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden
| |
Collapse
|
2
|
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.
Collapse
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.
| |
Collapse
|
3
|
Keall PJ, Sawant A, Berbeco RI, Booth JT, Cho B, Cerviño LI, Cirino E, Dieterich S, Fast MF, Greer PB, Munck Af Rosenschöld P, Parikh PJ, Poulsen PR, Santanam L, Sherouse GW, Shi J, Stathakis S. AAPM Task Group 264: The safe clinical implementation of MLC tracking in radiotherapy. Med Phys 2021; 48:e44-e64. [PMID: 33260251 DOI: 10.1002/mp.14625] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/11/2020] [Accepted: 11/18/2020] [Indexed: 12/25/2022] Open
Abstract
The era of real-time radiotherapy is upon us. Robotic and gimbaled linac tracking are clinically established technologies with the clinical realization of couch tracking in development. Multileaf collimators (MLCs) are a standard equipment for most cancer radiotherapy systems, and therefore MLC tracking is a potentially widely available technology. MLC tracking has been the subject of theoretical and experimental research for decades and was first implemented for patient treatments in 2013. The AAPM Task Group 264 Safe Clinical Implementation of MLC Tracking in Radiotherapy Report was charged to proactively provide the broader radiation oncology community with (a) clinical implementation guidelines including hardware, software, and clinical indications for use, (b) commissioning and quality assurance recommendations based on early user experience, as well as guidelines on Failure Mode and Effects Analysis, and (c) a discussion of potential future developments. The deliverables from this report include: an explanation of MLC tracking and its historical development; terms and definitions relevant to MLC tracking; the clinical benefit of, clinical experience with and clinical implementation guidelines for MLC tracking; quality assurance guidelines, including example quality assurance worksheets; a clinical decision pathway, future outlook and overall recommendations.
Collapse
Affiliation(s)
- Paul J Keall
- ACRF Image X Institute, The University of Sydney Faculty of Medicine and Health, Sydney, NSW, 2006, Australia
| | - Amit Sawant
- Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Ross I Berbeco
- Radiation Oncology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Jeremy T Booth
- Radiation Oncology, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, 2006, Australia
| | - Byungchul Cho
- Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, Republic of Korea
| | - Laura I Cerviño
- Radiation Medicine & Applied Sciences, Radiation Oncology PET/CT Center, UC San Diego, LA Jolla, CA, 92093-0865, USA.,Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065-6007, USA
| | - Eileen Cirino
- Lahey Health and Medical Center, Burlington, MA, 01805, USA
| | - Sonja Dieterich
- Department of Radiation Oncology, UC Davis Medical Center, Sacramento, CA, 95618, USA
| | - Martin F Fast
- Department of Radiotherapy, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
| | - Peter B Greer
- Calvary Mater Newcastle, Newcastle, NSW, 2310, Australia
| | - Per Munck Af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Parag J Parikh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI, 48202, USA
| | - Per Rugaard Poulsen
- Department of Oncology and Danish Center for Particle Therapy, Aarhus University Hospital, 8200, Aarhus, Denmark
| | - Lakshmi Santanam
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, 10065-6007, USA
| | | | - Jie Shi
- Sun Nuclear Corp, Melbourne, FL, 32940, USA
| | - Sotirios Stathakis
- University of Texas Health San Antonio Cancer Center, San Antonio, TX, 78229, USA
| |
Collapse
|
4
|
Saito M, Suzuki H, Sano N, Ashizawa K, Yoshizawa K, Shibata Y, Ueda K, Komiyama T, Marino K, Aoki S, Saito R, Maehata Y, Onishi H. Evaluation of the target dose coverage of stereotactic body radiotherapy for lung cancer using helical tomotherapy: A dynamic phantom study. Rep Pract Oncol Radiother 2020; 25:200-205. [PMID: 32021577 DOI: 10.1016/j.rpor.2020.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/19/2019] [Accepted: 01/10/2020] [Indexed: 12/25/2022] Open
Abstract
Aim To evaluate the target dose coverage for lung stereotactic body radiotherapy (SBRT) using helical tomotherapy (HT) with the internal tumor volume (ITV) margin settings adjusted according to the degree of tumor motion. Background Lung SBRT with HT may cause a dosimetric error when the target motion is large. Materials and methods Two lung SBRT plans were created using a tomotherapy planning station. Using these original plans, five plans with different ITV margins (4.0-20.0 mm for superior-inferior [SI] dimension) were generated. To evaluate the effects of respiratory motion on HT, an original dynamic motion phantom was developed. The respiratory wave of a healthy volunteer was used for dynamic motion as the typical tumor respiratory motion. Five patterns of motion amplitude that corresponded to five ITV margin sizes and three breathing cycles of 7, 14, and 28 breaths per minute were used. We evaluated the target dose change between a static delivery and a dynamic delivery with each motion pattern. Results The target dose difference increased as the tumor size decreased and as the tumor motion increased. Although a target dose difference of <5 % was observed at ≤10 mm of tumor motion for each condition, a maximum difference of -9.94 % ± 7.10 % was observed in cases of small tumors with 20 mm of tumor motion under slow respiration. Conclusions Minimizing respiratory movement is recommended as much as possible for lung SBRT with HT, especially for cases involving small tumors.
Collapse
Affiliation(s)
- Masahide Saito
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Hidekazu Suzuki
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Naoki Sano
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | | | - Kazuya Yoshizawa
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Yuki Shibata
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Koji Ueda
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | | | - Kan Marino
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Shinichi Aoki
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Ryo Saito
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | | | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Mukhlisin, Pawiro SA. Dosimetric impact of interplay effect in lung IMRT and VMAT treatment using in-house dynamic thorax phantom. ACTA ACUST UNITED AC 2016. [DOI: 10.1088/1742-6596/694/1/012009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
7
|
Tyler MK. Quantification of interplay and gradient effects for lung stereotactic ablative radiotherapy (SABR) treatments. J Appl Clin Med Phys 2016; 17:158-166. [PMID: 26894347 PMCID: PMC5690216 DOI: 10.1120/jacmp.v17i1.5781] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 08/17/2015] [Accepted: 07/01/2015] [Indexed: 12/14/2022] Open
Abstract
This study quantified the interplay and gradient effects on GTV dose coverage for 3D CRT, dMLC IMRT, and VMAT SABR treatments for target amplitudes of 5–30 mm using 3DVH v3.1 software incorporating 4D Respiratory MotionSim (4D RMS) module. For clinically relevant motion periods (5 s), the interplay effect was small, with deviations in the minimum dose covering the target volume (D99%) of less than ±2.5% for target amplitudes up to 30 mm. Increasing the period to 60 s resulted in interplay effects of up to ±15.0% on target D99% dose coverage. The gradient effect introduced by target motion resulted in deviations of up to ±3.5% in D99% target dose coverage. VMAT treatments showed the largest deviation in dose metrics, which was attributed to the long delivery times in comparison to dMLC IMRT. Retrospective patient analysis indicated minimal interplay and gradient effects for patients treated with dMLC IMRT at the NCCI. PACS numbers: 87.55.km, 87.56.Fc
Collapse
|
8
|
Olding T, Alexander KM, Jechel C, Nasr AT, Joshi C. Delivery validation of VMAT stereotactic ablative body radiotherapy at commissioning. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/1742-6596/573/1/012019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|