Effectiveness of the No action level protocol for head & neck patients – Time considerations

BackgroundThe No Action Protocol (NAL) was used to diminish the systematic set-up error. Recently, owing to the development of image registration technologies, the on-line positioning control is more often used. This method significantly reduces the CTV–PTV margin at the expense of the lengthening of a treatment session. The efficiency of NAL in decreasing the total treatment time for Head&Neck patients was investigated.MethodsResults of set-up control of 30 patients were analyzed. The set-up control was carried out on-line. For each patient and each fraction, the set-error and the time needed for making the set-up control procedure were measured. Next, retrospectively, the NAL was applied to this data. The number of initial errors (without interventions) and after NAL protocol were compared in terms of errors larger than 3 and 4 mm. The average and total time used for portal control was calculated and compared.ResultsThe number of setup errors in the posterior-anterior, inferior-superior, and right–left directions ≥3 mm and ≥4 mm were 98, 79, and 91 sessions and 44, 38 and 30 sessions out of 884 sessions. After NAL protocol the number of errors ≥3 mm and ≥4 mm decreased to 84, 57, and 39 sessions and 31, 15 and 10 sessions, respectively. The average time needed for one set-up control was 5.1 min. NAL protocol allows saving 4049 min for the whole group.ConclusionsFor locations where the random set-up errors are small, the NAL enables a very precise treatment of patients. Implementation of this protocol significantly decreases the total treatment time

Bi-Level Optimization to Enhance Intensity Modulated Radiation Therapy Planning

Intensity Modulated Radiation Therapy is an effective cancer treatment. Models based on the Generalized Equivalent Uniform Dose (gEUD) provide radiation plans with excellent planning target volume coverage and low radiation for organs at risk. However, manual adjustment of the parameters involved in gEUD is required to ensure that the plans meet patient-specific physical restrictions. This paper proposes a radiotherapy planning methodology based on bi-level optimization. We evaluated the proposed scheme in a real patient and compared the resulting irradiation plans with those prepared by clinical planners in hospital devices. The results in terms of efficiency and effectiveness are promising

Dependence of tissue inhomogeneity correction factors on photon-beam energy

Introduction: Commissioning of the treatment-planning system includes the accuracy of dose calculations in the inhomogeneous absorber. Several results of measurements with regard to inhomogeneity correction factors (CFs) have been published. However, the dependence of CFs on photon-beam energy may preclude such results from being applied to the photon beams of general users. Purpose: The aim of this study was to assess the dependence of CFs on the photon-beam energy. Materials and methods: CFs were calculated by the Batho method for several slab geometries comprised of concentrations of lung tissue and water of 0.25 and 1.00 g/cm3, respectively. The CFs were calculated at 6 MV (TPR2010 = 0.67 ± k * 0.01) and 15 MV (TPR2010 = 0.76 ± k * 0.01) where k = -3, -2, -1, 0, 1, 2, 3. All calculations were performed in the region where a charged-particle equilibrium exists. Results: Changes in CFs of less than 2% were observed across the considered energy ranges. With a change in TPR20,10 of 0.01, both at 6 and 15 MV at a depth of 5 cm below the lung; and lung thicknesses of 3, 5 and 8 cm over a fi eld surface area of 10 × 10 cm2, the change in CF never exceeded 2.4%. The dependences of changes in CFs in terms of TPR20,10 were 1.74% and 1.20% for field surface areas of 5 × 5 cm2 and 20 × 20 cm2, respectively. A comparison of 42 linear accelerators (LINACs) exhibiting 6 MV and 15 MV of energy installed in Poland showed that the maximum differences in terms of TPR20,10 at 6 MV and 15 MV were 4.2% and 2.2%, respectively. Conclusion: A linear dependence of CFs on energy was observed. According to observations, the smaller the surface area of the field and deeper the point of interest below the lung, the more dependent CFs are on energy