Conversion of helical tomotherapy plans to step-and-shoot IMRT plans-Pareto front evaluation of plans from a new treatment planning system

Purpose: The resulting plans from a new type of treatment planning system called SharePlan (TM) have been studied. This software allows for the conversion of treatment plans generated in a TomoTherapy system for helical delivery, into plans deliverable on C-arm linear accelerators (linacs), which is of particular interest for clinics with a single TomoTherapy unit. The purpose of this work was to evaluate and compare the plans generated in the SharePlan system with the original TomoTherapy plans and with plans produced in our clinical treatment planning system for intensity-modulated radiation therapy (IMRT) on C-arm linacs. In addition, we have analyzed how the agreement between SharePlan and TomoTherapy plans depends on the number of beams and the total number of segments used in the optimization. Methods: Optimized plans were generated for three prostate and three head-and-neck (H&N) cases in the TomoTherapy system, and in our clinical treatment planning systems (TPS) used for IMRT planning with step-and-shoot delivery. The TomoTherapy plans were converted into step-and-shoot IMRT plans in SharePlan. For each case, a large number of Pareto optimal plans were created to compare plans generated in SharePlan with plans generated in the Tomotherapy system and in the clinical TPS. In addition, plans were generated in SharePlan for the three head-and-neck cases to evaluate how the plan quality varied with the number of beams used. Plans were also generated with different number of beams and segments for other patient cases. This allowed for an evaluation of how to minimize the number of required segments in the converted IMRT plans without compromising the agreement between them and the original TomoTherapy plans. Results: The plans made in SharePlan were as good as or better than plans from our clinical system, but they were not as good as the original TomoTherapy plans. This was true for both the head-and-neck and the prostate cases, although the differences between the plans for the latter were small. The evaluation of the head-and-neck cases also showed that the plans generated in SharePlan were improved when more beams were used. The SharePlan Pareto front came close to the front for the TomoTherapy system when a sufficient number of beams were added. The results for plans generated with varied number of beams and segments demonstrated that the number of segments could be minimized with maintained agreement between SharePlan and TomoTherapy plans when 10-19 beams were used. Conclusions: This study showed (using Pareto front evaluation) that the plans generated in SharePlan are comparable to plans generated in other TPSs. The evaluation also showed that the plans generated in SharePlan could be improved with the use of more beams. To minimize the number of segments needed in a plan with maintained agreement between the converted IMRT plans and the original TomoTherapy plans, 10-19 beams should be used, depending on target complexity. SharePlan has proved to be useful and should thereby be a time-saving complement as a backup system for clinics with a single TomoTherapy system installed alongside conventional C-arm linacs. (C) 2011 American Association of Physicists in Medicine. [DOI: 10.1118/1.3592934

Haematological toxicity in adult patients receiving craniospinal irradiation - Indication of a dose-bath effect.

The purpose of this study was to investigate the correlation between the haematological toxicity observed in patients treated with craniospinal irradiation, and the dose distribution in normal tissue, specifically the occurrence of large volumes exposed to low dose

QA procedures needed for advanced RT techniques and its impact on treatment outcome

The radiotherapy process is reviewed briefly and potential risks or pitfalls are identified. The focus is on modern advanced modalities in radiation therapy such as IMRT, VMAT, gating and tracking and also for the unknown to come. Existing methods, or quality controls (QC), or with better word barriers, are introduced at important steps of process with the purpose of prohibiting errors to continue through the process and thus avoiding an unwanted erroneous irradiation of the patient. The soft branch of quality assurance (QA) such as peer-review is also a major component of today's process and its safety. The importance of knowing your QCs is pointed out. The role of dosimetry method i.e. 3D-dosimetry is reviewed. Staff have to be working with awareness and alertness that can reduce most of the risks. Having comprehensive protocols known by all involved together with well-trained staff at the department with dedicated functions and responsibilities will further reduce the risk for unintended irradiations of patient. Having a well-designed QA system with the appropriate barriers have the possibility of producing high quality radiotherapy, which will also result in better outcome for the patients. The international head and neck trial illustrates very well the importance of accurate radiotherapy

Monte Carlo based verification of a beam model used in a treatment planning system

Modern treatment planning systems (TPSs) usually separate the dose modelling into a beam modelling phase, describing the beam exiting the accelerator, followed by a subsequent dose calculation in the patient. The aim of this work is to use the Monte Carlo code system EGSnrc to study the modelling of head scatter as well as the transmission through multi-leaf collimator (MLC) and diaphragms in the beam model used in a commercial TPS (MasterPlan, Nucletron B. V.). An Elekta Precise linear accelerator equipped with an MLC has been modelled in BEAMnrc, based on available information from the vendor regarding the material and geometry of the treatment head. The collimation in the MLC direction consists of leafs which are complemented with a backup diaphragm. The characteristics of the electron beam, i. e., energy and spot size, impinging on the target have been tuned to match measured data. Phase spaces from simulations of the treatment head are used to extract the scatter from, e. g., the flattening filter and the collimating structures. Similar data for the source models used in the TPS are extracted from the treatment planning system, thus a comprehensive analysis is possible. Simulations in a water phantom, with DOSXYZnrc, are also used to study the modelling of the MLC and the diaphragms by the TPS. The results from this study will be helpful to understand the limitations of the model in the TPS and provide knowledge for further improvements of the TPS source modelling

Application of the Fano theorem in inhomogeneous media using a convolution algorithm

For photon fields, separate dose distribution kernels have been generated for charged particles produced in the first interaction, for single and multiple scattered photons, including bremsstrahlung and annihilation. These kernels are applied in absorbed dose calculations for radiotherapy treatment planning using a convolution technique. The vast amount of kernel data required for 3D calculations can be accurately generated out of a small subset, due to rotational symmetry. Due to the discrete sampling of both the irradiated object and the dose distribution kernels, application of the Fano theorem and O'Connor's scaling theorem is not possible without difficulties. The scaling process has been thoroughly investigated and a density dependent correction factor applied to the central kernel value has been derived. The calculated absorbed dose distributions were found to agree well with Monte Carlo calculated data using the EGS4 program

Which depth dose data should be used for dose planning when wedge filters are used to modify the photon beam?

The use of beam data for open photon fields when calculating absorbed dose distributions for beams with wedge filters has been studied. The depth doses for beams with wedge filters are changed through beam hardening and the dose maximum can be shifted; both these changes result in errors in the final dose calculations of several per cent if open beam data are used. The errors are larger for 6 MV than for 18 MV x-rays. The depth of measurement for determining the wedge factor and the influence of other beam modifying devices are discussed. It is recommended that the reference depth be used instead of the dose maximum for these kinds of measurements since the influence of contaminating electrons in the beam will then be avoided and the wedge factor will be correct at a clinically relevant depth

A virtual linear accelerator for verification of treatment planning systems

A virtual linear accelerator is implemented into a commercial pencil-beam-based treatment planning system (TPS) with the purpose of investigating the possibility of verifying the system using a Monte Carlo method. The characterization set for the TPS includes depth doses, profiles and output factors, which is generated by Monte Carlo simulations. The advantage of this method over conventional measurements is that variations in accelerator output are eliminated and more complicated geometries can be used to study the performance of a TPS. The difference between Monte Carlo simulated and TPS calculated profiles and depth doses in the characterization geometry is less than +/-2% except for the build up region. This is of the same order as previously reported results based on measurements. In an inhomogeneous, mediastinum-like case, the deviations between TPS and simulations are small in the unit-density regions. In low-density regions, the TPS overestimates the dose, and the overestimation increases with increasing energy from 3.5% for 6 MV to 9.5% for 18 MV. This result points out the widely known fact that the pencil beam concept does not handle changes in lateral electron transport, nor changes in scatter due to lateral inhomogeneitics. It is concluded that verification of a pencil-beam-based TPS with a Monte Carlo based virtual accelerator is possible, which facilitates the verification procedure