Dosimetric evaluation of breast radiotherapy in a dynamic phantom

This phantom study quantifies changes in delivered dose due to respiratory motion for four breast radiotherapy planning techniques: three intensity-modulated techniques (forward-planned, surface-compensated and hybrid intensity-modulated radiation therapy (IMRT)); using a combination of open fields and inverse planned IMRT) and a 2D conventional technique. The plans were created on CT images of a wax breast phantom with a cork lung insert, and dose distributions were measured using films inserted through slits in the axial and sagittal planes. Films were irradiated according to each plan under a static (modeling breathhold) and three dynamic conditions--isocenter set at mid-respiratory cycle with motion amplitudes of 1 and 2 cm and at end-cycle with 2 cm motion amplitude (modeling end-exhale). Differences between static and moving deliveries were most pronounced for the more complex planning techniques with hot spots of up to 107% appearing in the anterior portion of all three IMRT plans at the largest motion at the end-exhale set-up. The delivered dose to the moving phantom was within 5% of that to the static phantom for all cases, while measurement accuracy was ±3%. The homogeneity index was significantly decreased only for the 2 cm motion end-exhale set-up; however, this same motion increased the equivalent uniform dose because of improved posterior breast coverage. Overall, the study demonstrates that the effect of respiratory motion is negligible for all planning techniques except in occasional instances of large motion.     

Quantifying the effect of intrafraction motion during breast IMRT planning and dose delivery

Respiratory motion during intensity modulated radiation therapy (IMRT) causes two types of problems. First, the clinical target volume (CTV) to planning target volume (PTV) margin needed to account for respiratory motion means that the lung and heart dose is higher than would occur in the absence of such motion. Second, because respiratory motion is not synchronized with multileaf collimator (MLC) motion, the delivered dose is not the same as the planned dose. The aims of this work were to evaluate these problems to determine (a) the effects of respiratory motion and setup error during breast IMRT treatment planning, (b) the effects of the interplay between respiratory motion and multileaf collimator (MLC) motion during breast IMRT delivery, and (c) the potential benefits of breast IMRT using breath-hold, respiratory gated, and 4D techniques. Seven early stage breast cancer patient data sets were planned for IMRT delivered with a dynamic MLC (DMLC). For each patient case, eight IMRT plans with varying respiratory motion magnitudes and setup errors (and hence CTV to PTV margins) were created. The effects of respiratory motion and setup error on the treatment plan were determined by comparing the eight dose distributions. For each fraction of these plans, the effect of the interplay between respiratory motion and MLC motion during IMRT delivery was simulated by superimposing the respiratory trace on the planned DMLC leaf motion, facilitating comparisons between the planned and expected dose distributions. When considering respiratory motion in the CTV-PTV expansion during breast IMRT planning, our results show that PTV dose heterogeneity increases with respiratory motion. Lung and heart doses also increase with respiratory motion. Due to the interplay between respiratory motion and MLC motion during IMRT delivery, the planned and expected dose distributions differ. This difference increases with respiratory motion. The expected dose varies from fraction to fraction. However, for the seven patients studied and respiratory trace used, for no breathing, shallow breathing, and normal breathing, there were no statistically significant differences between the planned and expected dose distributions. Thus, for breast IMRT, intrafraction motion degrades treatment plans predominantly by the necessary addition of a larger CTV to PTV margin than would be required in the absence of such motion. This motion can be limited by breath-hold, respiratory gated, or 4D techniques.     

Inverse planning for intensity-modulated arc therapy using direct aperture optimization

Intensity-modulated arc therapy (IMAT) is a radiation therapy delivery technique that combines gantry rotation with dynamic multi-leaf collimation (MLC). With IMAT, the benefits of rotational IMRT can be realized using a conventional linear accelerator and a conventional MLC. Thus far, the advantages of IMAT have gone largely unrealized due to the lack of robust automated planning tools capable of producing efficient IMAT treatment plans. This work describes an inverse treatment planning algorithm, called 'direct aperture optimization' (DAO) that can be used to generate inverse treatment plans for IMAT. In contrast to traditional inverse planning techniques where the relative weights of a series of pencil beams are optimized, DAO optimizes the leaf positions and weights of the apertures in the plan. This technique allows any delivery constraints to be enforced during the optimization, eliminating the need for a leaf-sequencing step. It is this feature that enables DAO to easily create inverse plans for IMAT. To illustrate the feasibility of DAO applied to IMAT, several cases are presented, including a cylindrical phantom, a head and neck patient and a prostate patient.     

Effect of respiratory motion on the delivery of breast radiotherapy using SMLC intensity modulation

This study evaluates the effects of respiratory motion on breast radiotherapy delivered using segmented multileaf collimator (SMLC) intensity modulation. An anthropomorphic breast phantom was constructed of polystyrene plates between which radiographic films were inserted. The phantom was mounted on a moving platform to simulate one-dimensional sinusoidal oscillation with variable amplitude and frequency. The motion effect on two breast IMRT techniques, a beamlet-based plan created using the Corvus treatment planning system and an aperture-based plan, was evaluated via film comparison. Motion-induced differences in the treatment region are generally within +5%, with the exception of the posterior field edge and the apex of the breast in the Corvus IMRT plan. Considering the experimental uncertainty arising from the setup and film dosimetry, this result indicates that respiratory motion-induced dose variations are generally relatively insignificant. It appears that the anterior hot spots observed in the Corvus IMRT plan result from the high intensity fluence delivered to the "virtual bolus" area which must be created during the planning process in order to provide "flash" for the respiratory motion. The potential magnitude of such effects resulting from the interplay between fluence modulation and patient motion are unique to the individual planning system and planning technique, as well as the delivery equipment and technique. Such effects should be carefully investigated prior to the implementation of IMRT for breast radiotherapy.     

Monte Carlo based treatment planning for modulated electron beam radiation therapy

A Monte Carlo based treatment planning system for modulated electron radiation therapy (MERT) is presented. This new variation of intensity modulated radiation therapy (IMRT) utilizes an electron multileaf collimator (eMLC) to deliver non-uniform intensity maps at several electron energies. In this way, conformal dose distributions are delivered to irregular targets located a few centimetres below the surface while sparing deeper-lying normal anatomy. Planning for MERT begins with Monte Carlo generation of electron beamlets. Electrons are transported with proper in-air scattering and the dose is tallied in the phantom for each beamlet. An optimized beamlet plan may be calculated using inverse-planning methods. Step-and-shoot leaf sequences are generated for the intensity maps and dose distributions recalculated using Monte Carlo simulations. Here, scatter and leakage from the leaves are properly accounted for by transporting electrons through the eMLC geometry. The weights for the segments of the plan are re-optimized with the leaf positions fixed and bremsstrahlung leakage and electron scatter doses included. This optimization gives the final optimized plan. It is shown that a significant portion of the calculation time is spent transporting particles in the leaves. However, this is necessary since optimizing segment weights based on a model in which leaf transport is ignored results in an improperly optimized plan with overdosing of target and critical structures. A method of rapidly calculating the bremsstrahlung contribution is presented and shown to be an efficient solution to this problem. A homogeneous model target and a 2D breast plan are presented. The potential use of this tool in clinical planning is discussed.     

Segmentation of IMRT plans for radical lung radiotherapy delivery with the step-and-shoot technique

The purpose of this work was to determine a segmentation protocol for the treatment of localized non-small-cell lung cancer (NSCLC) with intensity-modulated radiotherapy (IMRT) that is as effective as possible while practically simple and hence robust to known practical inaccuracies. This study focused on the stratification of continuous profiles into a discrete number of intensity levels. The selection of the segmentation parameters for the delivery of the fluence profiles using multiple static fields has been considered. Five-field equispaced IMRT treatment plans of five patients with NSCLC were selected. The study comprised nine treatment plans for each patient, starting from a conformal plan, optimizing it for IMRT and then segmenting it utilizing different numbers of segments in each case and optimizing for segment weights separately. A conformal plan, optimized for beam directions, collimator and wedge angles, was also used for comparison with the IMRT plans, so as to consider the best coplanar conformal case. A dose objective for the PTV and the organs-at-risk plus a constraint for the spinal cord were set for all inverse plans. All stages were compared with the aid of dose-volume histograms, dose distributions at the plane of the isocenter, intensity maps for key beams and plots of PTV homogeneity and overall conformality versus complexity. The unsegmented IMRT plans gave the best results but cannot be realized in practice with an MLC. They were best approximated by plans that needed 106-167 segments to deliver, but did not deteriorate significantly when approximated by plans which required 26-40 segments in total. All segmented IMRT plans gave a better lung sparing than the conformal plans, indicating that the deterioration of IMRT plans following segmentation is not equivalent to that of unmodulated, conformal plans. However, optimized conformal plans have the potential to approach the lung sparing achieved by segmented IMRT plans. Among the IMRT situations examined, five-field treatment plans for the lung, utilizing a maximum of 40 segments in total, have proven to give a good approximation of the IMRT plans with continuous modulation.     

Comparison between manual and automatic segment generation in step-and-shoot IMRT of prostate cancer

PURPOSE: To compare two methods to generate treatment plans for intensity-modulated radiotherapy (IMRT) of prostate cancer, delivered in a step-and-shoot mode. The first method uses fluence optimization (inverse planning) followed by conversion of the fluence weight map into a limited number of segments. In the second method, segments are manually assigned using a class solution (forward planning), followed by computer optimization of the segment weights. METHODS: Treatment plans for IMRT, utilizing a simultaneous integrated boost, were created. Plans comprise a five-field technique to deliver 78 Gy to the prostate plus seminal vesicles. Five patients were evaluated. Optimization objectives of both planning approaches concerned dose coverage of the target volumes and the dose distribution in the rectal wall. The two methods were evaluated by comparing dose distributions, the complexity of the resulting plan and the time expenditure to generate and to deliver the plan. RESULTS: For both planning approaches 99% of the target volumes received 95% of the prescribed dose, which complies with our planning objectives. Inverse planning resulted in more conformal dose distributions than forward planning (conformity index: 1.37 versus 1.51). Inverse planning reduced the dose to the rectal wall compared to a manually designed plan, albeit to a small extent. The theoretical probability of severe rectal proctitis and/or stenosis was reduced on average by 1.9% with inverse planning. Maximal sparing of the rectal wall was achieved with inverse planning for a patient whose target volume was partly wrapped around the rectum. The number of segments generated with inverse planning ranged between 33 and 52, and between 9 and 13 segments for manually created segments. CONCLUSION: Dose coverage of the planning target volumes is adequate for both approaches of planning. Inverse planning results in slightly better dose distributions with respect to the rectal wall compared to manual planning, at the cost of an increase of the number of segments by a factor of 3.     

Maximizing the potential of direct aperture optimization through collimator rotation

Intensity-modulated radiation therapy (IMRT) treatment plans are conventionally produced by the optimization of fluence maps followed by a leaf sequencing step. An alternative to fluence based inverse planning is to optimize directly the leaf positions and field weights of multileaf collimator (MLC) apertures. This approach is typically referred to as direct aperture optimization (DAO). It has been shown that equivalent dose distributions may be generated that have substantially fewer monitor units (MU) and number of apertures compared to fluence based optimization techniques. Here we introduce a DAO technique with rotated apertures that we call rotating aperture optimization (RAO). The advantages of collimator rotation in IMRT have been shown previously and include higher fluence spatial resolution, increased flexibility in the generation of aperture shapes and less interleaf effects. We have tested our RAO algorithm on a complex C-shaped target, seven nasopharynx cancer recurrences, and one multitarget nasopharynx carcinoma patient. A study was performed in order to assess the capabilities of RAO as compared to fixed collimator angle DAO. The accuracy of fixed and rotated collimator aperture delivery was also verified. An analysis of the optimized treatment plans indicates that plans generated with RAO are as good as or better than DAO while maintaining a smaller number of apertures and MU than fluence based IMRT. Delivery verification results show that RAO is less sensitive to tongue and groove effects than DAO. Delivery time is currently increased due to the collimator rotation speed although this is a mechanical limitation that can be eliminated in the future.     

Comparison of IMRT planning with two-step and one-step optimization: a way to simplify IMRT

Intensity-modulated radiotherapy (IMRT) plans are often complex, increasing the potential for dosimetric errors and prolonged treatment times. The purpose of this study is to evaluate the effectiveness and efficiency of one-step optimization as compared to conventional two-step optimization in inverse IMRT planning and to investigate the tradeoff between the number of segments and IMRT plan quality. Ten IMRT cases were studied, including five prostate patients and five nasopharynx patients. For each patient, seven research plans were generated with the same beam angles and objectives as the clinical plan using a commercial treatment planning system with the ability to perform one-step and two-step optimization. Two-step plans had the number of intensity levels set to 10, 5 and 3. One-step plans had the maximum number of segments set at 80, 60, 40 and 20 for prostate, and 100, 65, 50 and 25 for nasopharynx. When compared with two-step plans with similar numbers of segments, one-step plans resulted in lower MUs, higher homogeneity and conformal indices, and lower doses to sensitive structures. One-step optimization is an effective method for simplifying IMRT plans, resulting in a significant reduction in the number of segments for step and shoot delivery without significantly sacrificing plan quality.     

Effect of beamlet step-size on IMRT plan quality

We have studied the degree to which beamlet step-size impacts the quality of intensity modulated radiation therapy (IMRT) treatment plans. Treatment planning for IMRT begins with the application of a grid that divides each beam's-eye-view of the target into a number of smaller beamlets (pencil beams) of radiation. The total dose is computed as a weighted sum of the dose delivered by the individual beamlets. The width of each beamlet is set to match the width of the corresponding leaf of the multileaf collimator (MLC). The length of each beamlet (beamlet step-size) is parallel to the direction of leaf travel. The beamlet step-size represents the minimum stepping distance of the leaves of the MLC and is typically predetermined by the treatment planning system. This selection imposes an artificial constraint because the leaves of the MLC and the jaws can both move continuously. Removing the constraint can potentially improve the IMRT plan quality. In this study, the optimized results were achieved using an aperture-based inverse planning technique called direct aperture optimization (DAO). We have tested the relationship between pencil beam step-size and plan quality using the American College of Radiology's IMRT test case. For this case, a series of IMRT treatment plans were produced using beamlet step-sizes of 1, 2, 5, and 10 mm. Continuous improvements were seen with each reduction in beamlet step size. The maximum dose to the planning target volume (PTV) was reduced from 134.7% to 121.5% and the mean dose to the organ at risk (OAR) was reduced from 38.5% to 28.2% as the beamlet step-size was reduced from 10 to 1 mm. The smaller pencil beam sizes also led to steeper dose gradients at the junction between the target and the critical structure with gradients of 6.0, 7.6, 8.7, and 9.1 dose%/mm achieved for beamlet step sizes of 10, 5, 2, and 1 mm, respectively.     

Simulation and visualization of dose uncertainties due to interfractional organ motion

In this paper, we deal with the effects of interfractional organ motion during radiation therapy. We consider two problems: first, treatment plan evaluation in the presence of motion, and second, the incorporation of organ motion into IMRT optimization. Concerning treatment plan evaluation, we face the problem that the delivered dose cannot be predicted with certainty at the time of treatment planning but is associated with uncertainties. We present a method to simulate stochastic properties of the dose distribution. This provides the treatment planner with information about motion-related risks of different plans and may support the decision for or against a treatment plan. This information includes the display of probabilities of individual voxels to receive doses from a therapeutical interval or above critical levels, as well as a diagram that shows the variability of the dose volume histogram. Concerning the incorporation of organ motion into IMRT planning, we further analyse the approach of inverse planning based on probability distributions of possible patient geometries. We consider three different sources of uncertainty, namely uncertainty about the amplitude of motion, a systematic error and a random error. We analyse the impact of these sources of uncertainty on the optimized treatment plans for prostate cancer.     

Evaluation of dose coverage to target volume and normal tissue sparing in the adjuvant radiotherapy of gastric cancers: 3D-CRT compared with dynamic IMRT

Purpose:

To assess the potential advantage of intensity-modulated radiotherapy (IMRT) over 3D-conformal radiotherapy (3D-CRT) planning in postoperative adjuvant radiotherapy for patients with gastric carcinoma.

Methods and materials:

In a retrospective study, for plan comparison, dose distribution was recalculated in 15 patients treated with 3D-CRT on the contoured structures of same CT images using an IMRT technique. 3D-conformal plans with three fields and four-fields were compared with seven-field dynamic IMRT plans. The different plans were compared by analyzing the dose coverage of planning target volume using TV₉₅, D_mean, uniformity index, conformity index and homogeneity index parameters. To assess critical organ sparing, D_mean, D_max, dose to one-third and two-third volumes of the OARs and percentage of volumes receiving more than their tolerance doses were compared.

Results:

The average dose coverage values of PTV with 3F-CRT and 4F-CRT plans were comparable, where as IMRT plans achieved better target coverage(p<0.001) with higher conformity index value of 0.81±0.07 compared to both the 3D-CRT plans. The doses to the liver and bowel reduced significantly (p<0.001) with IMRT plans compared to other 3D-CRT plans. For all OARs the percentage of volumes receiving more than their tolerance doses were reduced with the IMRT plans.

Conclusion:

This study showed that a better target coverage and significant dose reduction to OARs could be achieved with the IMRT plans. The IMRT can be preferred with caution for organ motion. The authors are currently studying organ motion in the upper abdomen to use IMRT for patient treatment.     

An examination of the number of required apertures for step-and-shoot IMRT

We have examined the degree to which step-and-shoot IMRT treatment plans can be simplified (using a small number of apertures) without sacrificing the dosimetric quality of the plans. A key element of this study was the use of direct aperture optimization (DAO), an inverse planning technique where all of the multi-leaf collimator constraints are incorporated into the optimization. For seven cases (1 phantom, 1 prostate, 3 head-and-neck and 2 lung), DAO was used to perform a series of optimizations where the number of apertures per beam direction varied from 1 to 15. In this work, we attempt to provide general guidelines for how many apertures per beam direction are sufficient for various clinical cases using DAO. Analysis of the optimized treatment plans reveals that for most cases, only modest improvements in the objective function and the corresponding DVHs are seen beyond 5 apertures per beam direction. However, for more complex cases, some dosimetric gain can be achieved by increasing the number of apertures per beam direction beyond 5. Even in these cases, however, only modest improvements are observed beyond 9 apertures per beam direction. In our clinical experience, 38 out of the first 40 patients treated using IMRT plans produced using DAO were treated with 9 or fewer apertures per beam direction. The results indicate that many step-and-shoot IMRT treatment plans delivered today are more complex than necessary and can be simplified without sacrificing plan quality.     

Inverse plan optimization accounting for random geometric uncertainties with a multiple instance geometry approximation (MIGA)

Radiotherapy treatment plans that are optimized to be highly conformal based on a static patient geometry can be degraded by setup errors and/or intratreatment motion, particularly for IMRT plans. To achieve improved plans in the face of geometrical uncertainties, direct simulation of multiple instances of the patient anatomy (to account for setup and/or motion uncertainties) is used within the inverse planning process. This multiple instance geometry approximation (MIGA) method uses two or more instances of the patient anatomy and optimizes a single beam arrangement for all instances concurrently. Each anatomical instance can represent expected extremes or a weighted distribution of geometries. The current implementation supports mapping between instances that include distortions, but this report is limited to the use of rigid body translations/ rotations. For inverse planning, the method uses beamlet dose calculations for each instance, with the resulting doses combined using a weighted sum of the results for the multiple instances. Beamlet intensities are then optimized using the inverse planning system based on the cost for the composite dose distribution. MIGA can simulate various types of geometrical uncertainties, including random setup error and intratreatment motion. A limited number of instances are necessary to simulate Gaussian-distributed errors. IMRT plans optimized using MIGA show significantly less degradation in the face of geometrical errors, and are robust to the expected (simulated) motions. Results for a complex head/neck plan involving multiple target volumes and numerous normal structures are significantly improved when the MIGA method of inverse planning is used. Inverse planning using MIGA can lead to significant improvements over the use of simple PTV volume expansions for inclusion of geometrical uncertainties into inverse planning, since it can account for the correlated motions of the entire anatomical representation. The optimized plan results reflect the differing patient geometry situations which can be important near the surface or heterogeneities. For certain clinical situations, the MIGA optimization approach can correct for a significant part of the degradation of the plan caused by the setup uncertainties.     

Monte Carlo evaluation of 6 MV intensity modulated radiotherapy plans for head and neck and lung treatments

Intensity modulated radiotherapy (IMRT) beams may have strong fluence variations and are advantageous at disease sites such as lung and head and neck (H&N), where neighboring tissues have very different electron densities. We use Monte Carlo (MC) dose calculations to evaluate the dosimetric effects of these inhomogeneities for 10 clinical IMRT treatment plans for five lung patients and four H&N patients. All beams are 6 MV photons. "Standard plans" were first produced on a clinical treatment planning system which optimizes beam intensity distributions to meet dose and dose-volume constraints and calculates dose using a measurement-based pencil-beam algorithm with an equivalent pathlength inhomogeneity correction. Patient anatomy and electron densities were obtained from patient-specific CT images. The dose distribution of each beam was recalculated with the MC method, using the same CT images, beam geometry, beam weighting and optimized fluence intensity distributions as the corresponding standard plan. For the lung cases, the MC calculated dose distributions are characterized by reduced penetrations and increased penumbra due to larger secondary electron range in the low-density media, which is not accurately accounted for in the pencil beam algorithm. For the lung cases, the PTV was underdosed; except for one dose-volume index, underdose was less than 10%. Individual H&N fields are affected to different degrees by tissue inhomogeneities, depending on specific anatomy, especially the size and location of air cavities in relation to the beam orientation and field size. For four H&N plans, PTV coverage changed by less than 2%; for the fifth, there was less than 10% difference between the standard and the MC plans. Critical normal tissue DVHs (cord, lung, brainstem) are changed by <10% at the high dose end and mean lung doses are changed by <6%.     

Planning lung radiotherapy using 4D CT data and a motion model

This work is a feasibility study to use a four-dimensional computed tomography (4D CT) dataset generated by a continuous motion model for treatment planning in lung radiotherapy. The model-based 4D CT data were derived from multiple breathing cycles. Four patients were included in this retrospective study. Treatment plans were optimized at end-exhale for each patient and the effect of respiratory motion on the dose delivery investigated. The accuracy of the delivered dose as determined by the number of intermediate respiratory phases used for the calculation was considered. The time-averaged geometry of the anatomy representing the mid-ventilation phase of the breathing cycle was generated using the motion model and a treatment plan was optimized for this phase for one patient. With respiratory motion included, the mid-ventilation plan achieved better target coverage than the plan optimized at end-exhale when standard margins were used to expand the clinical target volume (CTV) to planning target volume (PTV). Using a margin to account for set-up uncertainty only, resulted in poorer target coverage and healthy tissue sparing. For this patient cohort, the results suggest that conventional three-dimensional treatment planning was sufficient to maintain target coverage despite respiratory motion. The motion model has proved a useful tool in 4D treatment planning.     

The effect of statistical uncertainty on inverse treatment planning based on Monte Carlo dose calculation

The effect of the statistical uncertainty, or noise, in inverse treatment planning for intensity modulated radiotherapy (IMRT) based on Monte Carlo dose calculation was studied. Sets of Monte Carlo beamlets were calculated to give uncertainties at Dmax ranging from 0.2% to 4% for a lung tumour plan. The weights of these beamlets were optimized using a previously described procedure based on a simulated annealing optimization algorithm. Several different objective functions were used. It was determined that the use of Monte Carlo dose calculation in inverse treatment planning introduces two errors in the calculated plan. In addition to the statistical error due to the statistical uncertainty of the Monte Carlo calculation, a noise convergence error also appears. For the statistical error it was determined that apparently successfully optimized plans with a noisy dose calculation (3% 1sigma at Dmax), which satisfied the required uniformity of the dose within the tumour, showed as much as 7% underdose when recalculated with a noise-free dose calculation. The statistical error is larger towards the tumour and is only weakly dependent on the choice of objective function. The noise convergence error appears because the optimum weights are determined using a noisy calculation, which is different from the optimum weights determined for a noise-free calculation. Unlike the statistical error, the noise convergence error is generally larger outside the tumour, is case dependent and strongly depends on the required objectives.     

全乳腺放射治疗3种照射技术对比

目的评价不同全乳腺放射治疗技术的剂量学优缺点。方法选取乳腺癌保乳术后患者10例,均为女性,年龄25～58岁,中位年龄42岁。用常规切线野、野中野调强、多野调强3种技术设计全乳腺放射治疗计划并进行剂量学对比。结果与常规切线野计划比较,野中野调强计划99%靶区体积含盖剂量从（4640±72）cGy增加到（4753±25）cGy;剂量不均匀指数从1.104±0.017下降到1.060±0.008。常规切线野计划与野中野调强计划在危及器官受量上的差异无统计学意义。野中野调强计划与多野调强计划在靶区剂量分布上的差异无统计学意义;与野中野调强计划比较,多野调强计划中心脏接受高于10Gy剂量的体积（V10）从（13.0±8.5）%增加到（53.3±22.7）%;同侧肺的V10从（25.2±3.4）%增加到（42.7±3.7）%;对侧乳腺、对侧肺、非特异正常组织的V5分别从（1.9±3.1）%增加到（32.6±2.3）%、从0到（18.5±8.3）%、从（9.9±1.0）%到（32.1±3.6）%。结论野中野调强技术较常规切线野技术明显改善靶区剂量分布;在此基础上多野调强技术未能明显进一步改善靶区剂量,但增加正常组织照射。     

Monte Carlo simulation of RapidArc radiotherapy delivery

RapidArc radiotherapy technology from Varian Medical Systems is one of the most complex delivery systems currently available, and achieves an entire intensity-modulated radiation therapy (IMRT) treatment in a single gantry rotation about the patient. Three dynamic parameters can be continuously varied to create IMRT dose distributions-the speed of rotation, beam shaping aperture and delivery dose rate. Modeling of RapidArc technology was incorporated within the existing Vancouver Island Monte Carlo (VIMC) system (Zavgorodni et al 2007 Radiother. Oncol. 84 S49, 2008 Proc. 16th Int. Conf. on Medical Physics). This process was named VIMC-Arc and has become an efficient framework for the verification of RapidArc treatment plans. VIMC-Arc is a fully automated system that constructs the Monte Carlo (MC) beam and patient models from a standard RapidArc DICOM dataset, simulates radiation transport, collects the resulting dose and converts the dose into DICOM format for import back into the treatment planning system (TPS). VIMC-Arc accommodates multiple arc IMRT deliveries and models gantry rotation as a series of segments with dynamic MLC motion within each segment. Several verification RapidArc plans were generated by the Eclipse TPS on a water-equivalent cylindrical phantom and re-calculated using VIMC-Arc. This includes one 'typical' RapidArc plan, one plan for dual arc treatment and one plan with 'avoidance' sectors. One RapidArc plan was also calculated on a DICOM patient CT dataset. Statistical uncertainty of MC simulations was kept within 1%. VIMC-Arc produced dose distributions that matched very closely to those calculated by the anisotropic analytical algorithm (AAA) that is used in Eclipse. All plans also demonstrated better than 1% agreement of the dose at the isocenter. This demonstrates the capabilities of our new MC system to model all dosimetric features required for RapidArc dose calculations.