scholarly journals Evaluation of Auto-Planning for Left-Side Breast Cancer After Breast-Conserving Surgery Based on Geometrical Relationship

2021 ◽  
Vol 20 ◽  
pp. 153303382110330
Author(s):  
Yijiang Li ◽  
Han Bai ◽  
Danju Huang ◽  
Feihu Chen ◽  
Yaoxiong Xia
Keyword(s):  
Breast Cancer ◽  
Correlation Coefficient ◽  
Breast Conserving Surgery ◽  
Target Volume ◽  
Planning System ◽  
Treatment Planning System ◽  
Weak Correlation ◽  
Geometric Information ◽  
Organ At Risk ◽  
Geometrical Relationship

Purpose: This study aimed to evaluate (1) the performance of the Auto-Planning module embedded in the Pinnacle treatment planning system (TPS) with 30 left-side breast cancer plans and (2) the dose-distance correlations between dose-based patients and overlap volume histogram-based (OVH) patients. Method: A total of 30 patients with left-side breast cancer after breast-conserving surgery were enrolled in this study. The clinical manual-planning (MP) and the Auto-Planning (AP) plans were generated by Monaco and by the Auto-Planning module in Pinnacle respectively. The geometric information between organ at risk (OAR) and planning target volume (PTV) of each patient was described by the OVH. The AP and MP plans were ranked to compare with the geometry-based patients from OVH. The Pearson product-moment correlation coefficient (R) was used to describe the correlations between dose-based patients (APs and MPs) and geometry-based patients (OVH). Dosimetric differences between MP and AP plans were evaluated with statistical analysis. Result: The correlation coefficient (mean R = 0.71) indicated that the AP plans have a high correlation with geometry-based patients from OVH, whereas the correlation coefficient (mean R = 0.48) shows a weak correlation between MP plans and geometry-based patients. The dosimetric comparison revealed a statistically significant improvement in the ipsilateral lung V5Gy and V10Gy, and in the heart V5Gy of AP plans compared to MP plans, while statistical reduction was seen in PTV V107% for MP plans compared to AP plans. Conclusion: The overall results of AP plans were superior to MP plans. The dose distribution in AP plans was more consistent with the distance-dose relationship described by OVH. After eliminating the interference of human factors, the AP was able to provide more stable and objective plans for radiotherapy patients.

Evaluation of Auto-Planning for Left-Side Breast Cancer After Breast-Conserving Surgery Based on Geometrical Relationship

2020 ◽  
Author(s):  
Yijiang Li ◽  
Han Bai ◽  
Danju Huang ◽  
Feihu Chen ◽  
Xuhong Liu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Correlation Coefficient ◽  
Dose Distribution ◽  
Breast Conserving Surgery ◽  
Target Volume ◽  
Planning System ◽  
Treatment Planning System ◽  
Geometric Information ◽  
Ipsilateral Lung ◽  
Geometrical Relationship

Abstract Purpose: This study aimed to evaluate (1) the performance of the Auto-Planning module embedded in the Pinnacle treatment planning system (TPS) with 30 left-side breast cancer plans and (2) the dose-distance correlations between dose-based patients and overlap volume histogram-based (OVH) patients. Method: A total of 30 patients with left-side breast cancer after breast-conserving surgery were enrolled in this study. The clinical manual-planning (MP) and the Auto-Planning (AP) plans were generated by Monaco and by the Auto-Planning module in Pinnacle respectively. The geometric information between organ at risk (OAR) and planning target volume (PTV) of each patient was described by the OVH. The AP and MP plans were ranked to compare with the geometry-based patients from OVH. The Pearson product-moment correlation coefficient (R) was used to describe the correlations between dose-based patients (APs and MPs) and geometry-based patients (OVH). Dosimetric differences between MP and AP plans were evaluated with statistical analysis. Result: The correlation coefficient (mean R = 0.71) indicated that the AP plans have a high correlation with geometry-based patients from OVH, whereas the correlation coefficient (mean R = 0.48) shows a weak correlation between MP plans and geometry-based patients. For different indicators, the dose distribution of V5Gy in the ipsilateral lung (AP: mean R = 0.82; MP: mean R = 0.58) is more relevant to geometry-based patients compared to the dose distribution of in the heart (AP: mean R = 0.4; MP: mean R = 0.19). The dosimetric comparison revealed a statistically significant improvement in ipsilateral lung V5Gy and V10Gy and in the heart V5Gy of AP plans compared to MP plans. Conclusion: The overall results of AP plans were superior to MP plans. The dose distribution in AP plans was more consistent with the distance-dose relationship described by OVH. After eliminating the interference of human factors, the AP was able to provide more stable and objective plans for radiotherapy patients.

scholarly journals Evaluation of Auto-Planning for Left-Side Breast Cancer After Breast-Conserving Surgery Based on Geometrical Relationship

2020 ◽  
Author(s):  
Yijiang Li ◽  
Han Bai ◽  
Danju Huang ◽  
Feihu Chen ◽  
Xuhong Liu ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Dose Distribution ◽  
Breast Conserving Surgery ◽  
Target Volume ◽  
Planning System ◽  
Treatment Planning System ◽  
Ipsilateral Lung ◽  
Organ At Risk ◽  
Geometrical Relationship ◽  
Better Than

Abstract BackgroundThis study aimed to evaluate (1) the performance of Auto-Planning module embedded in Pinnnacle treatment planning system (TPS) with 30 left-side breast cancer plans; (2) the dose-distance relations based on overlap volume histogram (OVH) curve.Method30 patients with left-side breast cancer after breast-serving surgery were enrolled in this study. The clinical manual plan (MP) and the automatic plan (AP) were generated by Monaco and Auto-planning module respectively. The geometric relations between organ at risk (OAR) and planning target volume (PTV) of each patient were described by the overlap volume histogram (OVH). The patients were ranked according to the extension distance from PTV at a specific volume on the OVH curve. The MP and AP plans then were ranked to compare with the ranking of the OVH curves. Dosimetric difference between MP and AP plans were evaluated with statistical analysis.ResultThe comparative result shows a higher degree of correlation between AP and OVH curve. For different indicators, the dose distribution of , , in ipsilateral lung is more consistent with the distance-dose relation compared to the dose distribution of in heart. Dosimetric comparison shows a statistically significant improvement in ipsilateral lung and , and in heart of AP plans compared to MP plans. However, the result of ipsilateral lung of MP plans are better than that of AP plans.ConclusionThe overall results of AP plans are superior to MP plans. The dose distribution in AP plans are more consistent with the distance-dose relationship, which was described by OVH. After eliminating the interference of human factors, the AP is able to provide more stable and objective plans for radiotherapy patients.

scholarly journals TREATMENT PLANNING SYSTEM (TPS) KANKER PAYUDARA MENGGUNAKAN TEKNIK 3DCRT

2020 ◽  
Vol 6 (1) ◽  
pp. 150
Author(s):  
Wida Farhiyati ◽  
Rinarto Subroto ◽  
I Wayan Ari Makmur ◽  
Nurul Qomariyah ◽  
Rahadi Wirawan
Keyword(s):  
Breast Cancer ◽  
At Risk ◽  
Left Lung ◽  
Planning System ◽  
International Commission ◽  
Treatment Planning System ◽  
Anisotropic Analytical Algorithm ◽  
Analytical Algorithm ◽  
Organ At Risk ◽  
The Mean

ABSTRAKPenelitian ini bertujuan untuk mengevaluasi hasil  simulasi TPS teknik 3DCRT pada  kasus kanker payudara agar sesuai dengan standar yang diizinkan International Commission on Radiation Units and Measurements (ICRU). Proses TPS menggunakan program Eclipse dengan algoritma Anisotropic Analytical Algorithm. Kurva histogram dosis volume kumulatif 3DCRT dianalisis untuk mendapatkan dosis radiasi yang diterima organ at risk (OAR) paru-paru kiri, paru-paru kanan dan jantung. Hasil TPS  menunjukkan dosis yang diterima OAR berada di bawah batas ambang yang ditentukan yaitu paru-paru kiri dengan mean dose 54,7 cGy yang melingkupi volume 1238,5 cm3 dan pada paru-paru kanan dosis mean dose 2113,2 cGy melingkupi volume 1474,5 cm3 serta pada jantung mean dose 96,5 cGy melingkupi volume 175,5 cm3. Simulasi TPS yang dilakukan berhasil mendapatkan data perencanaan penyinaran  kasus kanker payudara yang memenuhi syarat dosis relatif yang melingkupi volume PTV yang diizinkan ICRU (volume terlingkupi 95%-107%) yaitu besarnya dosis relatif untuk target sebesar 95% yang melingkupi 95,5% volume target. Kata kunci: radioterapi, TPS, dosis, PTV, OAR. ABSTRACTThis study objective is to evaluate the simulation results of the 3DCRT technique TPS  in breast cancer cases to conform to the standards permitted by the International Commission on Radiation Units and Measurements (ICRU). The TPS process uses the Eclipse program with the Anisotropic Analytical Algorithm algorithm. The 3DCRT cumulative dose-volume histogram curve was analyzed to obtain the absorbed dose received by the organ at risk (OAR) of the left lung, right lung and heart. The TPS results show that the dose received by OAR was below the prescribed threshold of the left lung with a mean dose of 54.7 cGy covering a volume of 1238.5 cm3 and to the right lung the mean dose of 2113.2 cGy surrounding the volume of 1474, 5 cm3 and at the heart the mean dose of 96.5 cGy covers a volume of 175.5 cm 3. TPS simulation carried out successfully obtained data on the planning of radiation from breast cancer cases that met the relative dosage requirements that covered the volume of PTV permitted by ICRU (95% -107% enclosed volume), that is, the relative dose for the target of 95% which covered 95.5% of the target volume. Keywords: radiotherapy, TPS, dose, PTV, OAR.

HYBRID IMRT RADIATION TECHNIQUE COMPARISON WITH 3D-CRT FOR LEFT-SIDED WHOLE BREAST CANCER

2021 ◽  
Author(s):  
Nina Pavlović ◽  
◽  
Tatjana Miladinović ◽  
Darko Stojanović ◽  
Aleksandar Miladinović ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Radiation Therapy ◽  
Target Volume ◽  
Planning System ◽  
Treatment Planning System ◽  
Conformity Index ◽  
Treatment Technique ◽  
Dose Ratio ◽  
Conformal Radiation Therapy ◽  
3D Crt

To identify the best treatment technique for patients with left-sided breast cancer, we compared plans obtained with a hybrid intensity-modulated radiation therapy (hIMRT) and conventional three- dimensional conformal radiation therapy (3D-CRT). Dosimetric indices for PTVs and OARs were calculated. Also, the dose coverage, homogeneity index, conformity index of the target, and the dose volumes of critical structures were analyzed. A sample of seven patients who were selected randomly treated in University Clinical Center Kragujevac between 2019 and 2020 was selected for the study. Therapy plans for both techniques were made with an ECLIPSE treatment planning system for each patient based on the same images and contours. The hybrid IMRT technique consists of two static opposed tangential fields and four optimized IMRT fields (dose ratio 70:30). For 3D-CRT planning, one isocenter with half-beam blocked tangential fields with wedges was used. All treatment plans were generated with 6 MV photon beam. Hybrid IMRT plans compared to the 3D-CRT resulted in better dose delivered to 95% (D95) of the planning target volume (PTV) and better heterogeneity HI and conformity CI. Protection for critical organs such as the heart, lungs, and contralateral breast is slightly worse than those obtained by 3D-CRT.

Dosimetric comparison of fractionated radiosurgery plans using frameless Gamma Knife ICON and CyberKnife systems with linear accelerator–based radiosurgery plans for multiple large brain metastases

2020 ◽  
Vol 132 (5) ◽  
pp. 1473-1479 ◽  
Author(s):  
Eun Young Han ◽  
He Wang ◽  
Dershan Luo ◽  
Jing Li ◽  
Xin Wang
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Linear Accelerator ◽  
Treatment Time ◽  
Target Volume ◽  
Planning System ◽  
Treatment Planning System ◽  
Normal Brain ◽  
Large Brain ◽  
The Mean

OBJECTIVEFor patients with multiple large brain metastases with at least 1 target volume larger than 10 cm3, multifractionated stereotactic radiosurgery (MF-SRS) has commonly been delivered with a linear accelerator (LINAC). Recent advances of Gamma Knife (GK) units with kilovolt cone-beam CT and CyberKnife (CK) units with multileaf collimators also make them attractive choices. The purpose of this study was to compare the dosimetry of MF-SRS plans deliverable on GK, CK, and LINAC and to discuss related clinical issues.METHODSTen patients with 2 or more large brain metastases who had been treated with MF-SRS on LINAC were identified. The median planning target volume was 18.31 cm3 (mean 21.31 cm3, range 3.42–49.97 cm3), and the median prescribed dose was 27.0 Gy (mean 26.7 Gy, range 21–30 Gy), administered in 3 to 5 fractions. Clinical LINAC treatment plans were generated using inverse planning with intensity modulation on a Pinnacle treatment planning system (version 9.10) for the Varian TrueBeam STx system. GK and CK planning were retrospectively performed using Leksell GammaPlan version 10.1 and Accuray Precision version 1.1.0.0 for the CK M6 system. Tumor coverage, Paddick conformity index (CI), gradient index (GI), and normal brain tissue receiving 4, 12, and 20 Gy were used to compare plan quality. Net beam-on time and approximate planning time were also collected for all cases.RESULTSPlans from all 3 modalities satisfied clinical requirements in target coverage and normal tissue sparing. The mean CI was comparable (0.79, 0.78, and 0.76) for the GK, CK, and LINAC plans. The mean GI was 3.1 for both the GK and the CK plans, whereas the mean GI of the LINAC plans was 4.1. The lower GI of the GK and CK plans would have resulted in significantly lower normal brain volumes receiving a medium or high dose. On average, GK and CK plans spared the normal brain volume receiving at least 12 Gy and 20 Gy by approximately 20% in comparison with the LINAC plans. However, the mean beam-on time of GK (∼ 64 minutes assuming a dose rate of 2.5 Gy/minute) plans was significantly longer than that of CK (∼ 31 minutes) or LINAC (∼ 4 minutes) plans.CONCLUSIONSAll 3 modalities are capable of treating multiple large brain lesions with MF-SRS. GK has the most flexible workflow and excellent dosimetry, but could be limited by the treatment time. CK has dosimetry comparable to that of GK with a consistent treatment time of approximately 30 minutes. LINAC has a much shorter treatment time, but residual rotational error could be a concern.

scholarly journals Dosimetric comparison of MR-linac-based IMRT and conventional VMAT treatment plans for prostate cancer

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Vanessa Da Silva Mendes ◽  
Lukas Nierer ◽  
Minglun Li ◽  
Stefanie Corradini ◽  
Michael Reiner ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Target Volume ◽  
Planning System ◽  
Treatment Planning System ◽  
Target Coverage ◽  
Treatment Delivery ◽  
Ptv Margin ◽  
Delivery Times ◽  
Low Field ◽  
Treatment Plans

Abstract Background The aim of this study was to evaluate and compare the performance of intensity modulated radiation therapy (IMRT) plans, planned for low-field strength magnetic resonance (MR) guided linear accelerator (linac) delivery (labelled IMRT MRL plans), and clinical conventional volumetric modulated arc therapy (VMAT) plans, for the treatment of prostate cancer (PCa). Both plans used the original planning target volume (PTV) margins. Additionally, the potential dosimetric benefits of MR-guidance were estimated, by creating IMRT MRL plans using smaller PTV margins. Materials and methods 20 PCa patients previously treated with conventional VMAT were considered. For each patient, two different IMRT MRL plans using the low-field MR-linac treatment planning system were created: one with original (orig.) PTV margins and the other with reduced (red.) PTV margins. Dose indices related to target coverage, as well as dose-volume histogram (DVH) parameters for the target and organs at risk (OAR) were compared. Additionally, the estimated treatment delivery times and the number of monitor units (MU) of each plan were evaluated. Results The dose distribution in the high dose region and the target volume DVH parameters (D98%, D50%, D2% and V95%) were similar for all three types of treatment plans, with deviations below 1% in most cases. Both IMRT MRL plans (orig. and red. PTV margins) showed similar homogeneity indices (HI), however worse values for the conformity index (CI) were also found when compared to VMAT. The IMRT MRL plans showed similar OAR sparing when the orig. PTV margins were used but a significantly better sparing was feasible when red. PTV margins were applied. Higher number of MU and longer predicted treatment delivery times were seen for both IMRT MRL plans. Conclusions A comparable plan quality between VMAT and IMRT MRL plans was achieved, when applying the same PTV margin. However, online MR-guided adaptive radiotherapy allows for a reduction of PTV margins. With a red. PTV margin, better sparing of the surrounding tissues can be achieved, while maintaining adequate target coverage. Nonetheless, longer treatment delivery times, characteristic for the IMRT technique, have to be expected.

Skin dose assessment with treatment planning system (TPS) and skin reaction evaluation of early breast cancer patients treated via an intraoperative radiation therapy (IORT) device

2018 ◽  
Vol 17 (4) ◽  
pp. 417-421
Author(s):  
Omid Baziar ◽  
Hamid Gholamhosseinian ◽  
Mohammad Naser Forghani
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Planning System ◽  
Treatment Planning System ◽  
Intraoperative Radiation Therapy ◽  
Skin Dose ◽  
Breast Cancer Patients ◽  
Skin Reactions ◽  
Intraoperative Radiation ◽  
Skin Doses

AbstractPurposeTo assess skin dose and incidence of skin reactions in early breast cancer patients treated via Intrabeam™ intraoperative radiation therapy (IORT) device.Materials and methodsIn total, 250 breast cancer patients treated with a single fraction of 20 Gy using 50 kV photon were recruited. The applicator to skin distance (ASD) was measured before the initiation of the radiation and the skin dose in each patient was accordingly calculated based on the treatment planning system (TPS).ResultsThe average skin doses calculated were equal to 7·91, 5·83, 3·96 and 2·14 Gy for 6–10, 10–15, 15–20 and 20–30 mm ASD values, respectively. It is noticeable that the skin doses could be lower than the TPS measurements up to 45%, mostly due to lack of backscatter radiation in breast tissue compared with the full scatter condition in the Zeiss water phantom. Finally, only three patients showed low-grade skin reactions 1 week after IORT. A review of the related literature also revealed the incidence of lower skin complications among patients treated via Intrabeam™ compared with MammoSite™ machine.ConclusionsThe Intrabeam™ TPS did not seem to be very reliable for accurate skin dosimetry. However, breast cancer treatment using Intrabeam™ could result in fewer incidences of skin reactions than MammoSite™ machine.

Utilising virtual bolus in superficial planning target volume dose optimisation (TomoTherapy): a phantom study

2019 ◽  
Vol 19 (1) ◽  
pp. 65-70
Author(s):  
Gim Chee Ooi ◽  
Iskandar Shahrim Bin Mustafa
Keyword(s):  
Treatment Planning ◽  
Planning Target Volume ◽  
Treatment Plan ◽  
Target Volume ◽  
The Body ◽  
Phantom Study ◽  
Planning System ◽  
Treatment Planning System ◽  
Dose Volume Histograms ◽  
Photon Fluence

AbstractAim:This is a phantom study to evaluate the dosimetry effects of using virtual bolus (VB) in TomoTherapy Treatment Planning System (TPS) optimisation for superficial planning target volume (PTV) that extends to the body surface. Without VB, the inverse-planning TPS will continuously boost the photon fluence at the surface of the superficial PTV due to lack of build-up region. VB is used during TPS optimisation only and will not be present in actual treatment delivery.Materials and methods:In this study, a dummy planning target was contoured on a cylindrical phantom which extends to the phantom surface, and VB of various combinations of thickness and density was used in treatment planning optimisation with TomoTherapy TPS. The plans were then delivered with the treatment modality TomoTherapy. Radiochromic films (Gafchromic EBT3) were calibrated and used for dose profiles measurements. TomoTherapy Planned-Adaptive software was used to analyse the delivered Dose-Volume Histograms (DVHs).Results:The use of 2 mm VB was not providing adequate build-up area and was unable to reduce the hot spots during treatment planning and actual delivery. The use of 4 mm VB was able to negate the photon fluence boosting effect by the TPS, and the actual delivery showed relatively small deviations from the treatment plan. The use of 6 mm VB caused significant dose overestimation by the TPS in the superficial regions resulting in insufficient dose coverage delivered.Findings:VB with the combination of 4 mm thickness and 1·0 g/cc density provides the most robust solution for the TomoTherapy TPS optimisation of superficial PTV.

NOVALIS INTENSITY-MODULATED RADIOSURGERY

Neurosurgery ◽  
2008 ◽  
Vol 62 (suppl_5) ◽  
pp. A2-A10 ◽  
Author(s):  
Randy L. Jensen ◽  
Merideth M. Wendland ◽  
Shyh-Shi Chern ◽  
Dennis C. Shrieve
Keyword(s):  
Magnetic Resonance Imaging ◽  
Optic Nerve ◽  
Magnetic Resonance ◽  
Stereotactic Radiosurgery ◽  
Target Volume ◽  
Planning System ◽  
Treatment Planning System ◽  
Resonance Imaging ◽  
Dose Volume Histograms ◽  
Intensity Modulated

ABSTRACT OBJECTIVE The Novalis stereotactic radiotherapy system (BrainLAB, Heimstetten, Germany) allows for precise treatment of cranial base tumors with single-fraction radiosurgery. In some cases, however, proximity of the optic nerve and chiasm is a concern. In these cases, intensity-modulated stereotactic radiosurgery (IMRS) can be used to limit the dose to these structures. IMRS planning can be labor intensive, which poses a problem when it is performed on the day of treatment. We describe our methods and results of preprocedure planning for IMRS for patients with lesions in the cavernous sinus or parasellar regions in whom the dose to the optic nerve or chiasm might exceed our acceptable tolerance dose (8 Gy). METHODS Patients whose lesions were more than 4 mm from the optic nerve and chiasm on standard magnetic resonance imaging scans but who were questionable candidates for radiosurgery because of concerns of dose to the optic nerve or chiasm were considered for IMRS. Preprocedure imaging (computed tomography and magnetic resonance imaging) was fused and analyzed using the BrainLAB BrainScan 5.3 treatment planning system. Dynamic conformal arc plans for stereotactic radiosurgery and IMRS were evaluated. Doses to the planning target volume and optic apparatus were assessed by dose-volume histograms and conformality index calculated to characterize the quality of the different plans. When IMRS was used, the preplan allowed for a rapid recalculation on the treatment day, minimizing the time patients were in the head frame before treatment. RESULTS We describe three patients with recurrent pituitary tumors and three with meningiomas. Doses were 1500 to 2000 cGy prescribed to the 80 to 96% isodose line delivered by eight to 22 fields. Tumor volumes ranged from 2.70 to 8.82 cm3 (mean, 5.7 cm3). In five of the six patients, the dynamic conformal arc plan precluded delivery of therapeutic dose without exceeding optic nerve tolerance. On the basis of 95% coverage of target volume, maximum prescription doses of 7.7 to 20.64 Gy were possible with the dynamic conformal arc plans without exceeding 8 Gy to the optic apparatus. IMRS allowed maximum doses of 20 to 31 Gy using the same optic apparatus dose restriction. No complications have occurred, and all tumors have remained stable since treatment (mean follow-up period, 30 mo). CONCLUSION We believe this pretreatment technique streamlines the process for IMRS, allowing for better patient comfort and efficient physician time use.

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