Dosimetric Effects of Air Cavities for MRI-Guided Online Adaptive Radiation Therapy (MRgART) of Prostate Bed after Radical Prostatectomy

Purpose: To evaluate dosimetric impact of air cavities and their corresponding electron density correction for 0.35 tesla (T) Magnetic Resonance-guided Online Adaptive Radiation Therapy (MRgART) of prostate bed patients. Methods: Three 0.35 T MRgRT plans (anterior–posterior (AP) beam, AP–PA beams, and clinical intensity modulated radiation therapy (IMRT)) were generated on a prostate bed patient’s (Patient A) planning computed tomography (CT) with artificial rectal air cavities of various sizes (0–3 cm, 0.5 cm increments). Furthermore, two 0.35 T MRgART plans (‘Deformed’ and ‘Override’) were generated on a prostate bed patient’s (Patient B) daily magnetic resonance image (MRI) with artificial rectal air cavities of various sizes (0–3 cm, 0.5 cm increments) and on five prostate bed patient’s (Patient 1–5) daily MRIs (2 MRIs: Fraction A and B) with real air cavities. For each MRgART plan, daily MRI electron density map was obtained by deformable registration with simulation CT. In the ‘Deformed’ plan, a clinical IMRT plan is calculated on the daily MRI with electron density map obtained from deformable registration only. In the ‘Override’ plan, daily MRI and simulation CT air cavities are manually corrected and bulk assigned air and water density on the registered electron density map, respectively. Afterwards, the clinical IMRT plan is calculated. Results: For the MRgRT plans, AP and AP–PA plans’ rectum/rectal wall max dose increased with increasing air cavity size, where the 3 cm air cavity resulted in a 20%/17% and 13%/13% increase, relative to no air cavity, respectively. Clinical IMRT plan was robust to air cavity size, where dose change remained less than 1%. For the MRgART plans, daily MRI electron density maps, obtained from deformable registration with simulation CT, was unable to accurately produce electron densities reflecting the air cavities. However, for the artificial daily MRI air cavities, dosimetric change between ‘Deformed’ and ‘Override’ plan was small (<4%). Similarly, for the real daily MRI air cavities, clinical constraint changes between ‘Deformed’ and ‘Override’ plan was negligible and did not lead to change in clinical decision for adaptive planning except for two fractions. In these fractions, the ‘Override’ plan indicated that the bladder max dose and rectum V35.7 exceeded the constraint, while the ‘Deformed’ plan showed acceptable dose, although the absolute difference was only 0.3 Gy and 0.03 cc, respectively. Conclusion: Clinical 0.35 T IMRT prostate bed plans are dosimetrically robust to air cavities. MRgART air cavity electron density correction shows clinically insignificant change and is not warranted on low-field systems.

Dosimetric comparison and biological evaluation of fixed-jaw intensity-modulated radiation therapy for T-shaped esophageal cancer

Background To evaluate the dosimetric and biological benefits of the fixed-jaw (FJ) intensity-modulated radiation therapy (IMRT) technique for patients with T-shaped esophageal cancer. Methods FJ IMRT plans were generated for thirty-five patients and compared with jaw tracking (JT) IMRT, static jaw (SJ) IMRT and JT volumetric modulated arc therapy (VMAT). Dosimetric parameters, tumor control probability (TCP) and normal tissue complication probability (NTCP), monitor units (MUs), delivery time and gamma passing rate, as a measure of dosimetric verification, were compared. The correlation between the length of PTV-C below the upper boundary of lung tissue (PTV-Cinferior) and dosimetric parameters and NTCP of the lung tissue were analyzed. Results The homogeneity and conformity of the target in the four plans were basically equivalent. When compared to the JT IMRT and SJ IMRT plans, FJ IMRT plan led to a statistically significant improvement in the NTCP and low-middle dosimetric parameters of the lung, and the improvement had a moderately positive correlation with the length of PTV-Cinferior, with a correlation coefficient ranging from 0.523 to 0.797; the FJ IMRT plan exhibited better lung sparing in low-dose volumes than the JT VMAT plan. The FJ IMRT plan had similar MUs (888 ± 99) and delivery times (516.1 ± 54.7 s) as the JT IMRT plan (937 ± 194, 522 ± 5.6 s) but higher than SJ IMRT (713 ± 137, 488.8 ± 45.2 s) and JT VMAT plan (517 ± 59, 263.7 ± 43.3 s). Conclusions The FJ IMRT technique is superior in reducing the low-dose volumes of lung tissues for patients with T-shaped esophageal cancer.

Application of AAPM TG119 to evaluate the Intensity-Modulated radiotherapy (JO-IMRT) plan on the Prowess Panther treatment planning system

Intensity-modulated radiation therapy (IMRT), one of the modern radiotherapy techniques, is one of the most common treatments for cancer. IMRT technique can deliver higher doses to tumor and reduces the minimum dose to normal tissue. Because IMRT technique is more complex than the 3D-CRT techniques, IMRT is potential to underdose the tumor and overdose the nearby critical structures. The American Association of Physicists in Medicine (AAPM) published the TG119 report, including tests and the quality assurance QA process with the aim of to assessing the overall accuracy of planning and delivery of IMRT treatments. The purpose of this research was to study and apply TG119 to evaluate the Prowess Panther planning (TPS) system for JO-IMRT plan at Dong Nai General Hospital with 4 test cases of TG119. Four test cases of TG119 were carried out on the Prowess Panther planning (TPS) system the obtained results were compared to those results of other authors. The results showed that only the prostate plan met 100% of the dose requirements prescribed by TG119, the other plans were relatively appropriate and still met most of the requirements of TG119. From these results, we concluded that Prowess Panther was a good for JO-IMRT.

Comparison of a Hybrid IMRT/VMAT technique with non-coplanar VMAT and non-coplanar IMRT for unresectable olfactory neuroblastoma using the RayStation treatment planning system—EUD, NTCP and planning study

The purpose of this study was to compare hybrid intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (Hybrid IMRT/VMAT), with non-coplanar (nc) IMRT and nc-VMAT treatment plans for unresectable olfactory neuroblastoma (ONB). Hybrid IMRT/VMAT, nc-IMRT and nc-VMAT plans were optimized for 12 patients with modified Kadish C stage ONB. Dose prescription was 65 Gy in 26 fractions. Dose–volume histogram parameters, conformation number (CN), homogeneity index (HI), integral dose and monitor units (MUs) delivered per fraction were assessed. Equivalent uniform dose (EUD) and normal tissue complication probability (NTCP) based on the EUD model (NTCPLogit) and the Lyman–Kutcher–Burman model (NTCPLKB) were also evaluated. We found that the Hybrid IMRT/VMAT plan significantly improved the CN for clinical target volume (CTV) and planning treatment volume (PTV) compared with the nc-VMAT plan. In general, sparing of organs at risk (OARs) is similar with the three techniques, although the Hybrid IMRT/VMAT plan resulted in a significantly reduced Dmax to contralateral (C/L) optic nerve compared with the nc-IMRT plan. The Hybrid IMRT/VMAT plan significantly reduce EUD to the ipsilateral (I/L) and C/L optic nerve in comparison with the nc-IMRT plan and nc-VMAT plan, but the difference in NTCP between the three technique was &lt;1%. We concluded that the Hybrid IMRT/VMAT technique can offer improvement in terms of target conformity and EUD for optic nerves, while achieving equal or better OAR sparing compared with nc-IMRT and nc-VMAT, and can be a viable radiation technique for treating unresectable ONB. However, the clinical benefit of these small differences in dosimetric data, EUD and NTCP of optic nerves may be minimal.

Plan Quality Comparisons Between Three-dimensional Conformal Radiotherapy, Intensity-modulated Radiotherapy, and Volumetric Modulated Arc Therapy Based on Four-dimensional Computed Tomography for Gastric Mucosa-associated Lymphoid Tissue Lymphoma: a Planning Study

Background: Previous planning studies in radiotherapy (RT) for gastric mucosa-associated lymphoid tissue (MALT) lymphoma have been based on three-dimensional computed tomography (3D-CT) images, which do not contain information on the respiratory motion of the stomach. Therefore, we compared the plan quality between 3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT) for gastric MALT lymphoma using four-dimensional computed tomography (4D-CT).Methods: Three different treatment plans of four-field 3D-CRT, seven-field IMRT, and double arc VMAT were created based on 4D-CT images of seven patients with gastric MALT lymphoma. An RT dose of 30 Gy was prescribed to the planning target volume (PTV) in 20 fractions. We calculated the minimum dose coverage for 95% of the PTV (D95), homogeneity index (HI), and conformity index (CI) of the PTV, and organs at risk (OARs) doses for the liver, kidneys, spinal cord, and small bowel. Plan quality metric (PQM) scores were also calculated for a comprehensive and objective assessment.Results: There was no significant difference among the three plans in D95 of PTV. HI of PTV for the IMRT plan was significantly better than that of the VMAT (p = 0.047) and 3D-CRT (p = 0.047) plans. HI of PTV for the VMAT plan was significantly better than that of the 3D-CRT plan (p = 0.047). CIs of PTV for the IMRT and VMAT plans were significantly better than that of the 3D-CRT plan (p = 0.047 and p = 0.047, respectively). Dmean of the liver for 3D-CRT was significantly higher than that for the IMRT (p = 0.047) and VMAT (p = 0.047) plans. The PQM scores of the VMAT and IMRT plans were significantly higher than that of the 3D-CRT plan (p = 0.047 and p = 0.047, respectively). The PQM score of the IMRT plan was significantly higher than that of the VMAT plan (p = 0.047).Conclusions: The IMRT plan yields the best plan quality for gastric MALT lymphoma. In terms of plan quality, as opposed to the 3D-CRT plan, we recommend the IMRT and VMAT plans.

Đánh giá ảnh hưởng của hốc khí và trường chiếu nhỏ tới phân bố liều của kế hoạch JO - IMRT trên bệnh nhân ung thư đầu cổ bằng phương pháp MONTE CARLO

Purposes: The goal of this study was to use Monte Carlo (MC) simulation to examine the dosimetric effects of the air cavity on JO-IMRT dose distribution at air-tissues interfaces in head-and-neck (H&N) patients. Methods: The EGSnrc - MC code system was used to calculate the dose reductions in air-tissue interface region for single field irradiations with 1×1, 2×2, 3×3, 4×4, and 5×5 cm2 in solid acrylic phantoms (30×30×20 cm3) and seven fields in a JO-IMRT plan. With phantom, the PDD values in both with and without an air cavity (15×4×4 cm3) which is 2.5 cm away from the anterior surface of phantom were used to evaluate. With the JO-IMRT plan, the dose-volume histograms (DVH), slice by slice isodose, and the gamma index using global methods implemented in PTW-VeriSoft with 3%/3 mm criteria were used to evaluate. Results: The study results indicate that the dose reductions in the air-tissue interface region of the phantom are strongly dependent on field size. The average percentage dose reductions at 1 mm from the air‑water interface for the field size 1×1, 2×2, 3×3, 4×4, and 5×5 cm2 are 62.04%, 52.34%, 40.71%, 26.72%, and 19.85%, respectively. Additionally, the mean MC dose in the PTV (65.58 Gy) of patients were lower than the TPS predicted dose (71.41 Gy). Conclusions: From this study, we conclude that the dose reduction in near air-tissue interfaces is a significant effect on JO-IMRT dose distribution in head-and-neck (H&N) patients.