Dataset Information

The dosimetric impact of replacing the TG-43 algorithm by model based dose calculation for liver brachytherapy.

ABSTRACT: PURPOSE:To compare treatment plans for interstitial high dose rate (HDR) liver brachytherapy with 192Ir calculated according to current-standard TG-43U1 protocol with model-based dose calculation following TG-186 protocol. METHODS:We retrospectively evaluated dose volume histogram (DVH) parameters for liver, organs at risk (OARs) and clinical target volumes (CTVs) of 20 patient cases diagnosed with hepatocellular carcinoma (HCC) or metastatic colorectal cancer (mCRC). Dose calculations on a homogeneous water geometry (TG-43U1 surrogate) and on a computed tomography (CT) based geometry (TG-186) were performed using Monte Carlo (MC) simulations. The CTs were segmented based on a combination of assigning TG-186 recommended tissues to fixed Hounsfield Unit (HU) ranges and using organ contours delineated by physicians. For the liver, V5Gy and V10Gy were analysed, and for OARs the dose to 1 cubic centimeter (D1cc). Target coverage was assessed by calculating V150, V100, V95 and V90 as well as D95 and D90. For every DVH parameter, median, minimum and maximum values of the deviations of TG-186 from TG-43U1 were analysed. RESULTS:TG-186-calculated dose was found to be on average lower than dose calculated with TG-43U1. The deviation of highest magnitude for liver parameters was -6.2% of the total liver volume. For OARs, the deviations were all smaller than or equal to -0.5 Gy. Target coverage deviations were as high as -1.5% of the total CTV volume and -3.5% of the prescribed dose. CONCLUSIONS:In this study we found that TG-43U1 overestimates dose to liver tissue compared to TG-186. This finding may be of clinical importance for cases where dose to the whole liver is the limiting factor.

SUBMITTER: Duque AS

PROVIDER: S-EPMC7063719 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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The dosimetric impact of replacing the TG-43 algorithm by model based dose calculation for liver brachytherapy.

Duque Anna Sophie AS Corradini Stefanie S Kamp Florian F Seidensticker Max M Streitparth Florian F Kurz Christopher C Walter Franziska F Parodi Katia K Verhaegen Frank F Ricke Jens J Belka Claus C Fonseca Gabriel Paiva GP Landry Guillaume G

Radiation oncology (London, England) 20200309 1

<h4>Purpose</h4>To compare treatment plans for interstitial high dose rate (HDR) liver brachytherapy with <sup>192</sup>Ir calculated according to current-standard TG-43U1 protocol with model-based dose calculation following TG-186 protocol.<h4>Methods</h4>We retrospectively evaluated dose volume histogram (DVH) parameters for liver, organs at risk (OARs) and clinical target volumes (CTVs) of 20 patient cases diagnosed with hepatocellular carcinoma (HCC) or metastatic colorectal cancer (mCRC). D ...[more]

PMID: 32151255

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Project description:The novel deterministic radiation transport algorithm, Acuros XB (AXB), has shown great potential for accurate heterogeneous dose calculation. However, the clinical impact between AXB and other currently used algorithms still needs to be elucidated for translation between these algorithms. The purpose of this study was to investigate the impact of AXB for heterogeneous dose calculation in lung cancer for intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT).The thorax phantom from the Radiological Physics Center (RPC) was used for this study. IMRT and VMAT plans were created for the phantom in the Eclipse 11.0 treatment planning system. Each plan was delivered to the phantom three times using a Varian Clinac iX linear accelerator to ensure reproducibility. Thermoluminescent dosimeters (TLDs) and Gafchromic EBT2 film were placed inside the phantom to measure delivered doses. The measurements were compared with dose calculations from AXB 11.0.21 and the anisotropic analytical algorithm (AAA) 11.0.21. Two dose reporting modes of AXB, dose-to-medium in medium (Dm,m) and dose-to-water in medium (Dw,m), were studied. Point doses, dose profiles, and gamma analysis were used to quantify the agreement between measurements and calculations from both AXB and AAA. The computation times for AAA and AXB were also evaluated.For the RPC lung phantom, AAA and AXB dose predictions were found in good agreement to TLD and film measurements for both IMRT and VMAT plans. TLD dose predictions were within 0.4%-4.4% to AXB doses (both Dm,m and Dw,m); and within 2.5%-6.4% to AAA doses, respectively. For the film comparisons, the gamma indexes (± 3%∕3 mm criteria) were 94%, 97%, and 98% for AAA, AXB_Dm,m, and AXB_Dw,m, respectively. The differences between AXB and AAA in dose-volume histogram mean doses were within 2% in the planning target volume, lung, heart, and within 5% in the spinal cord. However, differences up to 8% between AXB and AAA were found at lung∕soft tissue interface regions for individual IMRT fields. AAA was found to be 5-6 times faster than AXB for IMRT, while AXB was 4-5 times faster than AAA for VMAT plan.AXB is satisfactorily accurate for the dose calculation in lung cancer for both IMRT and VMAT plans. The differences between AXB and AAA are generally small except in heterogeneous interface regions. AXB Dw,m and Dm,m calculations are similar inside the soft tissue and lung regions. AXB can benefit lung VMAT plans by both improving accuracy and reducing computation time.

Project description:CivaTech Oncology Inc. (Durham, NC) has developed a novel low-dose rate (LDR) brachytherapy source called the CivaSheet.TM The source is a planar array of discrete elements ("CivaDots") which are directional in nature. The CivaDot geometry and design are considerably different than conventional LDR cylindrically symmetric sources. Thus, a thorough investigation is required to ascertain the dosimetric characteristics of the source. This work investigates the repeatability and reproducibility of a primary source strength standard for the CivaDot and characterizes the CivaDot dose distribution by performing in-phantom measurements and Monte Carlo (MC) simulations. Existing dosimetric formalisms were adapted to accommodate a directional source, and other distinguishing characteristics including the presence of gold shield x-ray fluorescence were addressed in this investigation. Primary air-kerma strength (SK ) measurements of the CivaDots were performed using two free-air chambers namely, the Variable-Aperture Free-Air Chamber (VAFAC) at the University of Wisconsin Medical Radiation Research Center (UWMRRC) and the National Institute of Standards and Technology (NIST) Wide-Angle Free-Air Chamber (WAFAC). An intercomparison of the two free-air chamber measurements was performed along with a comparison of the different assumed CivaDot energy spectra and associated correction factors. Dose distribution measurements of the source were performed in a custom polymethylmethacrylate (PMMA) phantom using GafchromicTM EBT3 film and thermoluminescent dosimeter (TLD) microcubes. Monte Carlo simulations of the source and the measurement setup were performed using MCNP6 radiation transport code. The CivaDot SK was determined using the two free-air chambers for eight sources with an agreement of better than 1.1% for all sources. The NIST measured CivaDot energy spectrum intensity peaks were within 1.8% of the MC-predicted spectrum intensity peaks. The difference in the net source-specific correction factor determined for the CivaDot free-air chamber measurements for the NIST WAFAC and UW VAFAC was 0.7%. The dose-rate constant analog was determined to be 0.555 cGy h-1 U-1 . The average difference observed in the estimated CivaDot dose-rate constant analog using measurements and MCNP6-predicted value (0.558 cGy h-1 U-1 ) was 0.6% ± 2.3% for eight CivaDot sources using EBT3 film, and -2.6% ± 1.7% using TLD microcube measurements. The CivaDot two-dimensional dose-to-water distribution measured in phantom was compared to the corresponding MC predictions at six depths. The observed difference using a pixel-by-pixel subtraction map of the measured and the predicted dose-to-water distribution was generally within 2-3%, with maximum differences up to 5% of the dose prescribed at the depth of 1 cm. Primary SK measurements of the CivaDot demonstrated good repeatability and reproducibility of the free-air chamber measurements. Measurements of the CivaDot dose distribution using the EBT3 film stack phantom and its subsequent comparison to Monte Carlo-predicted dose distributions were encouraging, given the overall uncertainties. This work will aid in the eventual realization of a clinically viable dosimetric framework for the CivaSheet based on the CivaDot dose distribution.

Project description:To investigate the dosimetric impact of the heterogeneity dose calculation Acuros (Transpire Inc., Gig Harbor, WA), a grid-based Boltzmann equation solver (GBBS), for brachytherapy in a cohort of cervical cancer patients.The impact of heterogeneities was retrospectively assessed in treatment plans for 26 patients who had previously received (192)Ir intracavitary brachytherapy for cervical cancer with computed tomography (CT)/magnetic resonance-compatible tandems and unshielded colpostats. The GBBS models sources, patient boundaries, applicators, and tissue heterogeneities. Multiple GBBS calculations were performed with and without solid model applicator, with and without overriding the patient contour to 1 g/cm(3) muscle, and with and without overriding contrast materials to muscle or 2.25 g/cm(3) bone. Impact of source and boundary modeling, applicator, tissue heterogeneities, and sensitivity of CT-to-material mapping of contrast were derived from the multiple calculations. American Association of Physicists in Medicine Task Group 43 (TG-43) guidelines and the GBBS were compared for the following clinical dosimetric parameters: Manchester points A and B, International Commission on Radiation Units and Measurements (ICRU) report 38 rectal and bladder points, three and nine o'clock, and (D2cm3) to the bladder, rectum, and sigmoid.Points A and B, D(2) cm(3) bladder, ICRU bladder, and three and nine o'clock were within 5% of TG-43 for all GBBS calculations. The source and boundary and applicator account for most of the differences between the GBBS and TG-43 guidelines. The D(2cm3) rectum (n = 3), D(2cm3) sigmoid (n = 1), and ICRU rectum (n = 6) had differences of >5% from TG-43 for the worst case incorrect mapping of contrast to bone. Clinical dosimetric parameters were within 5% of TG-43 when rectal and balloon contrast were mapped to bone and radiopaque packing was not overridden.The GBBS has minimal impact on clinical parameters for this cohort of patients with unshielded applicators. The incorrect mapping of rectal and balloon contrast does not have a significant impact on clinical parameters. Rectal parameters may be sensitive to the mapping of radiopaque packing.

Project description:A new design of 125I (Model IR-Seed2) brachytherapy source has been manufactured recently at the Applied Radiation Research School, Nuclear Science and Technology Research Institute in Iran. The source consists of six resin beads (0.5 mm diameter) that are sealed in a cylindrical titanium capsule of 0.7 mm internal and 0.8 mm external diameters. This work aims to evaluate the dosimetric parameters of the newly designed 125I source using experimental measurements and Monte Carlo (MC) simulations. Dosimetric characteristics (dose rate constant, radial dose function, and 2D and 1D anisotropy functions) of the IR-Seed2 were determined using experimental measurements and MC simulations following the recommendations by the Task Group 43 (TG-43U1) report of the American Association of Physicists in Medicine (AAPM). MC simulations were performed using the MCNP5 code in water and Plexiglas, and experimental measurements were carried out using thermoluminescent dosimeters (TLD-GR207A) in Plexiglas phantoms. The measured dose to water in Plexiglas data were used for verification of the accuracy of the source and phantom geometry in the Monte Carlo simulations. The final MC simulated data to water in water were recommended for clinical applications. The MC calculated dose rate constant (?) of the IR-Seed2 125I seed in water was found to be 0.992 ± 0.025 cGy h-1U-1. Additionally, its radial dose function by line and point source approximations, gL(r) and gp(r), calculated for distances from 0.1 cm to 7 cm. The values of gL(r) at radial distances from 0.5 cm to 5 cm were measured in a Plexiglas phantom to be between 1.212 and 0.413. The calculated and measured of values for 2D anisotropy function, F(r, ?), were obtained for the radial distances ranging from 1.5 cm to 5 cm and angular range of 0°-90° in a Plexiglas phantom. Also, the 2D anisotropy function was calculated in water for the clinical application. The results of these investigations show that the uncertainty of the experimental data is within ± 7% between the measured and simulated data in Plexiglas. Based on these results, the MC-simulated dosimetric parameters of the new 125I source model in water are presented for its clinical applications in brachytherapy treatments.

Project description:The aim of this work is to evaluate the performance of a commercial brachytherapy treatment planning system (TPS) with TG-43 Vendors Input Data (VID), analyze possible discrepancies with respect to a proper reference source and its implications for standard treatments, and judge the effectiveness of certain widespread recommended quality controls to find potential errors related with the interpolations of TG-43 VID tables. The TPS evaluated was a BrachyVision 8.6 loaded with TG-43 VID for a VariSource high-dose-rate 192Ir source (Vs2000). The reference data chosen were the TG-43 data published in the literature. In the first step, we compared TG-43 VID with respect to the chosen reference data. Next, we used percent dose-rate differences in a point array matrix to compare the outcomes of the TPS on standard treatment setup with respect to an in-house developed program (MATLAB R2009a-based) loaded with the chosen full TG-43 reference data. The cases with major discrepancies were evaluated using the gamma-index analysis. The comparison with the reference data indicated a lack of sample in the angles between near to the tip (between 165 < θ < 180) and cable (0 < θ < 15) of the F(r,θ)(VID), which causes a dose underestimation of approximately 17% in the investigated points due to inaccurate interpolations. The differences over 2% encompassed approximately 17% of the surrounding source volume. These results have special relevance in treatment using one applicator with a few dwell steps or in Fletcher treatments where 10% dose underestimates were identified within the tumor or in organs at risk, respectively. Our results suggest that the differences found in the TPS under study are created by a lack of information on the angles in high-gradient zones in the F(r,θ)(VID), which generates important differences in dosimetric results. In contrast, the gamma analysis shows very good results (between 90% and 100% of passed points) in the analyzed treatments (one dwell and Fletcher). Further studies are required to exclude the possibility of finding noticeable effects in the DVH of treatment plans caused by the discrepancies here described. To achieve more strict control over the TPS dose-rate calculation, we recommend using QA test thinking in a source with nonaxial symmetry, adding a control point on the angles of the high-dose gradient zones (e.g., between 0° and 15° and between 165° and 180°). More studies are required to achieve full understanding of the clinical implication of such discrepancies.

Dataset Information

The dosimetric impact of replacing the TG-43 algorithm by model based dose calculation for liver brachytherapy.

Publications

The dosimetric impact of replacing the TG-43 algorithm by model based dose calculation for liver brachytherapy.

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