Dataset Information

Use of a head-tilting baseplate during volumetric-modulated arc therapy (VMAT) to better protect organs at risk in hippocampal sparing whole brain radiotherapy (HS-WBRT).

ABSTRACT: PURPOSE:Coplanar arcs are used with limited arc range to prevent direct beam entrance through the lens, which is challenging for satisfactory planning of hippocampal sparing in whole brain radiotherapy (HS-WBRT) with VMAT. We evaluated the dosimetric impact of applying a head-tilting technique during VMAT, which allows unrestricted use of the arc range. METHODS AND MATERIALS:Twenty patients with multiple brain metastases who had received two computed tomography (CT)-simulation sessions between January 2016 and December 2018 were included. One session was delivered in a traditional supine position; the other was delivered with a tilting acrylic supine baseplate (MedTec, USA) to elevate the patients' head by 40°. For each patient, a VMAT without (sVMAT) and with head-tilting (htVMAT) plan was generated. Conformity index (CI), homogeneity index (HI), and organ at risk (OAR) dose were evaluated. The Wilcoxon-signed test was used to compare the effect between two plans. RESULTS:The mean CI was 0.860±0.007 and 0.864±0.008 (p<0.05), and mean HI was 0.179±0.020 and 0.167±0.021 (p<0.05) for sVMAT and htVMAT, respectively. The mean dose to the hippocampus (9.91±0.30 Gy) was significantly lower in htVMAT than in sVMAT (10.36±0.29 Gy, P<0.05). htVMAT was associated with significantly reduced mean dose to the parotid gland, and right and left lens (4.77±1.97 Gy vs. 5.92±1.68 Gy, p<0.05; 3.29±0.44 Gy vs. 7.22±1.26 Gy, p<0.05; 3.33±0.45 Gy vs. 6.73±1.01 Gy, p<0.05, respectively). CONCLUSION:This is the first study to demonstrate that the head-tilting technique might be useful for HS-WBRT planning with VMAT. This method could remove the limitations associated with the arc range, resulting in improved dose distribution and conformity, while sparing healthy organs, including the hippocampus, lens, and parotid gland.

SUBMITTER: Oh SA

PROVIDER: S-EPMC7190113 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Use of a head-tilting baseplate during volumetric-modulated arc therapy (VMAT) to better protect organs at risk in hippocampal sparing whole brain radiotherapy (HS-WBRT).

Oh Se An SA Yea Ji Woon JW Park Jae Won JW Park Jaehyeon J

PloS one 20200429 4

<h4>Purpose</h4>Coplanar arcs are used with limited arc range to prevent direct beam entrance through the lens, which is challenging for satisfactory planning of hippocampal sparing in whole brain radiotherapy (HS-WBRT) with VMAT. We evaluated the dosimetric impact of applying a head-tilting technique during VMAT, which allows unrestricted use of the arc range.<h4>Methods and materials</h4>Twenty patients with multiple brain metastases who had received two computed tomography (CT)-simulation ses ...[more]

PMID: 32348379

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Project description:The objective of this study is to validate the capabilities of a cylindrical diode array system for volumetric-modulated arc therapy (VMAT) treatment quality assurance (QA). The VMAT plans were generated by the Eclipse treatment planning system (TPS) with the analytical anisotropic algorithm (AAA) for dose calculation. An in-house Monte Carlo (MC) code was utilized as a validation tool for the TPS calculations and the ArcCHECK measurements. The megavoltage computed tomography (MVCT) of the ArcCHECK system was adopted for the geometry reconstruction in the TPS and for MC simulations. A 10 × 10 cm2 open field validation was performed for both the 6 and 10 MV photon beams to validate the absolute dose calibration of the ArcCHECK system and also the TPS dose calculations for this system. The impact of the angular dependency on noncoplanar deliveries was investigated with a series of 10 × 10 cm2 fields delivered with couch rotation 0° to 40°. The sensitivity of detecting the translational (1 to 10 mm) and the rotational (1° to 3°) misalignments was tested with a breast VMAT case. Ten VMAT plans (six prostate, H&N, pelvis, liver, and breast) were investigated to evaluate the agreement of the target dose and the peripheral dose among ArcCHECK measurements, and TPS and MC dose calculations. A customized acrylic plug holding an ion chamber was used to measure the dose at the center of the ArcCHECK phantom. Both the entrance and the exit doses measured by the ArcCHECK system with and without the plug agreed with the MC simulation to 1.0%. The TPS dose calculation with a 2.5 mm grid overestimated the exit dose by up to 7.2% when the plug was removed. The agreement between the MC and TPS calculations for the ArcCHECK without the plug improved significantly when a 1 mm dose calculation grid was used in the TPS. The noncoplanar delivery test demonstrated that the angular dependency has limited impact on the gamma passing rate (< 1.2% drop) for the 2%-3% dose and 2mm-3 mm DTA criteria. A 1° rotational misalignment introduces 11.3% (3%/3mm) to 21.3% (1%/1 mm) and 0.2% (3%/3 mm) to 0.8% (1%/1 mm) Gamma passing rate drop for ArcCHECK system and MatriXX system, respectively. Both systems have comparable sensitivity to the AP misalignments. However, a 2 mm RL misalignment introduces gamma passing rate drop ranging from 0.9% (3%/3 mm) to 4.0% (1%/1 mm) and 5.0% (3%/3 mm) to 12.0% (1%/1 mm) for ArcCHECK and MatriXX measurements, respectively. For VMAT plan QA, the gamma analysis passing rates ranged from 96.1% (H&N case) to 99.9% (prostate case), when using the 3%/3 mm DTA criteria for the peripheral dose validation between the TPS and ArcCHCEK measurements. The peripheral dose validation between the MC simulation and ArcCHECK measurements showed at least 97.9% gamma passing rates. The central dose validation also showed an agreement within 2.2% between TPS/MC calculations and ArcCHECK measurements. The worst discrepancy was found in the H&N case, which is the most complex VMAT case. The ArcCHECK system is suitable for VMAT QA evaluation based on the sensitivity to detecting misalignments, the clinical impact of the angular dependency, and the correlation between the dose agreements in the peripheral region and the central region. This work also demonstrated the importance of carrying out a thorough validation of both the TPS and the dosimetry system prior to utilizing it for QA, and the value of having an independent dose calculation tool, such as the MC method, in clinical practice.

Project description:Volumetric-modulated arc therapy (VMAT) plans may require more control points (or segments) than some of fixed-beam IMRT plans that are created with a limited number of segments. Increasing number of control points in a VMAT plan for a given prescription dose could create a large portion of the total number of segments with small number monitor units (MUs) per segment. The purpose of this study is to investigate the impact of the small number MU/segment on the delivery accuracy of VMAT delivered with various dose rates. Ten patient datasets were planned for hippocampus sparing for whole brain irradiation. For each dataset, two VMAT plans were created with maximum dose rates of 600 MU/min (the maximum field size of 21 × 40 cm2) and 1000 MU/min (the maximum field size of 15 × 15 cm2) for a daily dose of 3 Gy. Without reoptimization, the daily dose of these plans was purposely reduced to 1.5 Gy and 1.0 Gy while keeping the same total dose. Using the two dose rates and three different daily doses, six VMAT plans for each dataset were delivered to a physical phantom to investigate how the changes of dose rate and daily doses impact on delivery accuracy. Using the gamma index, we directly compared the delivered planar dose profiles with the reduced daily doses (1.5 Gy and 1.0 Gy) to the delivered planar dose at 3 Gy daily dose, delivered at dose rate of 600 MU/min and 1000 MU/min, respectively. The average numbers of segments with MU/segment ? 1 were 35 ± 8, 87 ± 6 for VMAT-600 1.5 Gy, VMAT-600 1 Gy plans, and 30 ± 7 and 42 ± 6 for VMAT-1000 1.5 Gy and VMAT-1000 1 Gy plans, respectively. When delivered at 600 MU/min dose rate, the average gamma index passing rates (1%/1 mm criteria) of comparing delivered 1.5 Gy VMAT planar dose profiles to 3.0 Gy VMAT delivered planar dose profiles was 98.28% ± 1.66%, and the average gamma index passing rate of comparing delivered 1.0 Gy VMAT planar dose to 3.0 Gy VMAT delivered planar dose was 83.75% ± 4.86%. If using 2%/2mm and 3%/3 mm criteria, the gamma index passing rates were greater than 97% for both 1.5 Gy VMAT and 1.0 Gy VMAT delivered planar doses. At 1000MU/min dose rate, the average gamma index passing rates were 96.59% ± 2.70% for 1.5 Gy VMAT planar dose profiles and 79.37% ± 9.96% for 1.0 Gy VMAT planar dose profiles when compared to the 3.0 Gy VMAT planar delivered dose profile. When using 2%/2 mm and 3%/3 mm criteria, the gamma index passing rates were greater than 93% for both 1.5 Gy VMAT and 1.0 Gy VMAT planar delivered dose. Under a stricter gamma index criterion (1%/1 mm), significant differences in delivered planar dose profiles at different daily doses were detected, indicating that the known communication delay between the MU console and MLC console may affect VMAT delivery accuracy.

Project description:To introduce a hybrid volumetric modulated arc therapy/intensity modulated radiation therapy (VMAT/IMRT) optimization strategy called FusionArc that combines the delivery efficiency of single-arc VMAT with the potentially desirable intensity modulation possible with IMRT.A beamlet-based inverse planning system was enhanced to combine the advantages of VMAT and IMRT into one comprehensive technique. In the hybrid strategy, baseline single-arc VMAT plans are optimized and then the current cost function gradients with respect to the beamlets are used to define a metric for predicting which beam angles would benefit from further intensity modulation. Beams with the highest metric values (called the gradient factor) are converted from VMAT apertures to IMRT fluence, and the optimization proceeds with the mixed variable set until convergence or until additional beams are selected for conversion. One phantom and two clinical cases were used to validate the gradient factor and characterize the FusionArc strategy. Comparisons were made between standard IMRT, single-arc VMAT, and FusionArc plans with one to five IMRT∕hybrid beams.The gradient factor was found to be highly predictive of the VMAT angles that would benefit plan quality the most from beam modulation. Over the three cases studied, a FusionArc plan with three converted beams achieved superior dosimetric quality with reductions in final cost ranging from 26.4% to 48.1% compared to single-arc VMAT. Additionally, the three beam FusionArc plans required 22.4%-43.7% fewer MU∕Gy than a seven beam IMRT plan. While the FusionArc plans with five converted beams offer larger reductions in final cost--32.9%-55.2% compared to single-arc VMAT--the decrease in MU∕Gy compared to IMRT was noticeably smaller at 12.2%-18.5%, when compared to IMRT.A hybrid VMAT∕IMRT strategy was implemented to find a high quality compromise between gantry-angle and intensity-based degrees of freedom. This optimization method will allow patients to be simultaneously planned for dosimetric quality and delivery efficiency without switching between delivery techniques. Example phantom and clinical cases suggest that the conversion of only three VMAT segments to modulated beams may result in a good combination of quality and efficiency.

Dataset Information

Use of a head-tilting baseplate during volumetric-modulated arc therapy (VMAT) to better protect organs at risk in hippocampal sparing whole brain radiotherapy (HS-WBRT).

Publications

Use of a head-tilting baseplate during volumetric-modulated arc therapy (VMAT) to better protect organs at risk in hippocampal sparing whole brain radiotherapy (HS-WBRT).

Similar Datasets

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