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IMRT planning parameter optimization for spine stereotactic radiosurgery
Authors:Gabriel B. Ayala  Kieu A. Doan  Hie Ji Ko  Peter K. Park  Edwin D. Santiago  Shirly J. Kuruvila  Amol J. Ghia  Tina M. Briere  Zhifei Wen
Affiliation:2. Departments of Radiation Dosimetry, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;3. Departments of Radiation Oncology, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;4. Departments of Radiation Physics, School of Health Professions, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
Abstract:Spine stereotactic radiosurgery (SSRS) is a noninvasive treatment for metastatic spine lesions. MD Anderson Cancer Center reports a quality assurance (QA) failure rate approaching 15% for SSRS cases, which we hypothesized is due to difficulties in accurately calculating dose resulting from a large number of small-area segments. Clinical plans typically use 9 beams with an average of 10 segments per beam and minimum segment area of 2-3 cm2. The purpose of this study was to identify a set of intensity-modulated radiation therapy (IMRT) planning parameters that attempts to optimize the balance among QA passing rate, plan quality, dose calculation accuracy, and delivery time for SSRS plans. Using Pinnacle version 9.10, we evaluated the effects of 2 IMRT parameters: maximum number of segments and minimum segment area. Initial evaluation of the data revealed that 5 segments per beam along with minimum segment area of 4 cm2 and 4 monitor units (MU) per segment (5-4-4 plans) was the most promising. IMRT QA was performed using a PTW OCTAVIUS 4D phantom with a 2D detector array. Our data showed no significant plan quality change with decreased number of segments and increased minimum segment area. The average coverage of GTV and CTV was 82.5 ± 13% (clinical) vs 82.5 ± 13% (5-4-4) and 92.3 ± 8% (clinical) vs 91.5 ± 8% (5-4-4). Maximum point dose to cord was 11.4 ± 3.5 Gy (clinical) vs 11.0 ± 4.0 Gy (5-4-4). Total plan delivery time was decreased by an average of 11.3% for the 5-4-4 plans. For IMRT QA, the gamma index passing rate (distance to agreement: 2.5 mm, local dose difference: 4%) for the original plans vs the 5-4-4 plans averaged 90.3% and 91.9%, respectively. In conclusion, IMRT parameters of 5 segments per beam and 4 cm2 minimum segment areas provided a better balance of plan quality, delivery efficiency, and plan dose calculation accuracy for SSRS.
Keywords:Reprint requests to Gabriel B. Ayala, B.S., School of Health Professions, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.  Spine stereotactic radiosurgery (SSRS)  Intensity-modulated radiation therapy (IMRT)  Parameter optimization  Quality assurance (QA)
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