The purpose of this study was to investigate the prediction of mechanical error using DICOM-RT plan parameters for volumetric modulated arc therapy (VMAT). We created plans for gantry rotation arcs of 360° and 18...The purpose of this study was to investigate the prediction of mechanical error using DICOM-RT plan parameters for volumetric modulated arc therapy (VMAT). We created plans for gantry rotation arcs of 360° and 180° (full-arc and half-arc VMAT) for six maxillary sinus cancer cases using a Monaco treatment planning system, and delivered the doses with a linear accelerator. We calculated DICOM-RT plan parameters, including gantry, multileaf collimator (MLC) positions and Monitor Units (MU). We compared plans with regard to gantry angle per MU (degrees/MU) and MLC travel per MU (mm/MU) for each segment. Calculated gantry angle/MLC position speeds and errors were evaluated by comparison with the log file. On average, the half-arc VMAT plan resulted in 47% and 35% fewer degrees/MU and mm/MU than the full-arc VMAT plan, respectively. The root mean square (r.m.s.) gantry and MLC speeds showed a linear relationship with calculated degrees/MU and mm/MU, with coefficients of determination (R2) of 0.86 and 0.72, respectively. The r.m.s. gantry angle and MLC position errors showed a linear relationship with calculated degrees/MU and mm/MU with R2 of 0.63 and 0.76, respectively. Deviations from plan parameters were related to mechanical error for VMAT, and provided quantitative information without the need for VMAT delivery. These parameters can be used in the selection of treatment planning.展开更多
Introduction: Radiation therapy after breast surgery is an integral part of the treatment of early breast cancer. The goal of radiation therapy is to achieve the best possible coverage of the planning target volume (P...Introduction: Radiation therapy after breast surgery is an integral part of the treatment of early breast cancer. The goal of radiation therapy is to achieve the best possible coverage of the planning target volume (PTV), while reducing the dose to organs at risk (OARs) which are normal tissues whose sensitivity to irradiation could cause damage that can lead to modification of the treatment plan. In the last decade, radiation oncologist started to use the Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) for irradiating the breast, in order to achieve better dose distribution and target dose to the PTV and OAR. The aim of this study is to compare 2 external radiotherapy techniques (VMAT vs 3D) for patients with node-positive left breast cancer. Patients and Methods: We randomly selected 10 cases of postoperative radiotherapy for breast cancer in our hospital. The patients are all female, the average age was 45.4 years old, and the primary lesions are left breast. The ANOVA test was used to compare the mean difference between subgroups, and the p value Results: Dose volume histogram (DVH) was used to analyze each evaluation dose of clinical target volume (CTV) and organs at risk (OARs). Compared to 3DCRT plans, VMAT provided more uniform coverage to the breast and regional lymph nodes. The max point dose for tVMAT was lower on average (106.4% for VMAT versus 109% for 3DCRT). OAR sparing was improved with tVMAT, with a lower average V17Gy for the left lung (27.91% for VMAT versus 30.04% for 3DCRT, p and lower for V28Gy (13.75% for VMAT versus 22.34% for 3DCRT, p = 0.01). We also found a lower V35Gy for the heart on VMAT plan (p = 0.02). On the contrary, dose of contralateral breast was lower in 3DCRT than VMAT (0.59 Gy vs 3.65 Gy, p = 0.00). Conclusion: The both types of plans can meet the clinical dosimetry demands of postoperative radiotherapy for left breast cancer. The VMAT plan has a better conformity, but 3CDRT can provide a lower dose to the contralateral organs (breast and lung) to avoid the risk of secondary cancers.展开更多
Background:The effects of oral contrast agents(OCAs)on dosimetry have not been studied in detail.Therefore,this study aimed to examine the influence of OCAs on dose calculation in volumetric-modulated arc therapy plan...Background:The effects of oral contrast agents(OCAs)on dosimetry have not been studied in detail.Therefore,this study aimed to examine the influence of OCAs on dose calculation in volumetric-modulated arc therapy plans for rectal cancer.Methods:From 2008 to 2016,computed tomography(CT)images were obtained from 33 rectal cancer patients administered OCA with or without intravenous contrast agent(ICA)and 14 patients who received no contrast agent.CT numbers of organs at risk were recorded and converted to electronic densities.Volumetric-modulated arc therapy plans were designed before and after the original densities were replaced with non-enhanced densities.Doses to the planned target volume(PTV)and organs at risk were compared between the plans.Results:OCA significantly increased the mean and maximum densities of the bowels,while the effects of ICA on these parameters depended on the blood supply of the organs.With OCA,the actual doses for PTV were significantly higher than planned and doses to the bowel increased significantly although moderately.However,the increase in the volume receiving a high-range doses was substantial the absolute change of intestine volume receiving≥52 Gy:1.46[0.05-3.99,cubic centimeter range:-6.74 to 128.12],the absolute change of colon volume receiving≥50 Gy:0.34[0.01-1.53 cc,range:-0.08 to 3.80 cc].Dose changes due to ICA were insignificant.Pearson correlation showed that dose changes were significantly correlated with a high intestinal volume within or near the PTV(ρ>0.5,P<0.05)and with the density of enhanced intestine(ρ>0.3,P<0.05).Conclusions:Contrast agents applied in simulation cause underestimation of doses in actual treatment.The overdose due to ICA was slight,while that due to OCA was moderate.The bowel volume receiving≥50Gy was dramatically increased when OCA within the bowel was absent.Physicians should be aware of these issues if the original plan is barely within clinical tolerance or if a considerable volume of enhanced intestine is within or near the PTV.展开更多
Importance:Irradiation treatment for pediatric patients with neuroblastoma represents a major challenge due to the pediatric dose limits for critical structures and the necessity of sufficient dose coverage of the cli...Importance:Irradiation treatment for pediatric patients with neuroblastoma represents a major challenge due to the pediatric dose limits for critical structures and the necessity of sufficient dose coverage of the clinical target volume for local control.Objective:To investigate dosimetric differences between tomotherapy(TOMO)and volumetric-modulated arc therapy(VMAT)as retroperitoneal radiotherapy for children with neuroblastoma.Methods:Eight patients who received retroperitoneal radiotherapy for neuroblastoma were selected for comparison of TOMO and VMAT treatment plans.The D min,D max,D mean,D 95,D 2,and D 98 of planning target volume(PTV),conformity index(CI),heterogeneity index(HI),and organs at risk(OARs)parameters were compared.Delivery machine unit(MU)and image-guide radiotherapy solution results were also compared.Results:All patients received a cumulative dose of 19.5 Gy to the PTV.VMAT showed higher CI(0.93±0.02),compared with TOMO(0.87±0.03,P<0.001).Notably,the average PTV HI was significantly better using TOMO(1.05±0.01)than VMAT(1.08±0.02,P=0.003).Compared with VMAT,the D min,D 95,and D 98 all exhibited increases in TOMO;D max variation was less than 1%in TOMO.The D 0.1cc for the spinal cord and D 2cc for the small intestine were better in TOMO in terms of OARs.However,TOMO had more MUs and required a longer delivery time.Interpretation:Both planning techniques are capable of producing high-quality treatment plans.TOMO is superior for PTV coverage,but inferior for CI.TOMO requires extra treatment time;its cost is greater than the cost of VMAT.展开更多
目的基于Halcyon加速器比较左乳腺癌改良根治术后2弧、3弧、4弧和5弧的容积调强放射治疗(VMAT)计划的剂量学差异。方法选择德阳市人民医院肿瘤科行左侧乳腺癌改良根治术后患者20例,均为女性;年龄32~69岁,中位年龄51岁;肿瘤分期均为T3~T4...目的基于Halcyon加速器比较左乳腺癌改良根治术后2弧、3弧、4弧和5弧的容积调强放射治疗(VMAT)计划的剂量学差异。方法选择德阳市人民医院肿瘤科行左侧乳腺癌改良根治术后患者20例,均为女性;年龄32~69岁,中位年龄51岁;肿瘤分期均为T3~T4、N1;位置为非内象限。基于Halcyon加速器为每位患者分别设计2弧、3弧、4弧和5弧4组VMAT计划。比较4组计划的计划靶区体积(PTV)和危及器官的剂量学指标、跳数(MU)、出束时间和γ通过率的差异。结果4弧组和5弧组VMAT计划在PTV的适形度指数(CI)、均匀性指数(HI)、D_(98)、D_(50)、D_(2)和Dmean上均优于2弧组和3弧组,而5弧组仅在PTV的D_(2)稍低于4弧组[(5311.9±30.74)cGy vs(5332.5±31.13)cGy。P<0.05]。危及器官,4弧组和5弧组左肺(患侧肺)V_(5)、V_(20)、V_(30)、V_(40)和Dmean最低,V_(10)亦低于3弧组[(33.09±2.60)%vs(32.98±2.65)%vs(34.23±2.53)%。P<0.05]。4弧组和5弧组右肺(健侧肺)Dmean低于2弧组[435(339,464)cGy vs 435(394,462)cGy vs 447(417,490)cGy。P<0.05]。4弧组和5弧组心脏V_(20)[(7.96±4.17)%、(7.99±4.19)%]和V_(30)[(3.60±2.58)%、(3.41±2.46)%]最低,V_(10)和Dmean亦低于2弧组[22.8(17.7,25.7)%vs 22.6(18.3,25.7)%vs 23.75(19.0,27.5)%、836(705,898)cGy vs 835(708,931)cGy vs 857(741,959)cGy。P<0.05]。4弧组和5弧组食管Dmean[(1362.0±370.4)cGy、(1363.2±367.3)cGy]最低,右乳Dmax亦低于2弧组[(901.4±162.9)cGy vs(900.4±170.4)cGy vs(973.9±181.5)cGy。P<0.05]。5弧组与4弧组各危及器官的剂量差异均无统计学意义(P>0.05)。4弧组MU和出束时间较2弧组和3弧组有少量增加,分别增加26.15 MU、0.05 min和28.9 MU、0.04 min,5弧组较4弧组也分别增加31.8 MU和0.05 min(P<0.05)。4组计划的γ通过率均>95%,组间差异无统计学意义(P>0.05)。结论4弧的乳腺癌VMAT计划可获得更优的剂量学分布。因此推荐左乳腺癌改良根治术后在Halcyon加速器上采用4弧的VMAT计划。展开更多
文摘The purpose of this study was to investigate the prediction of mechanical error using DICOM-RT plan parameters for volumetric modulated arc therapy (VMAT). We created plans for gantry rotation arcs of 360° and 180° (full-arc and half-arc VMAT) for six maxillary sinus cancer cases using a Monaco treatment planning system, and delivered the doses with a linear accelerator. We calculated DICOM-RT plan parameters, including gantry, multileaf collimator (MLC) positions and Monitor Units (MU). We compared plans with regard to gantry angle per MU (degrees/MU) and MLC travel per MU (mm/MU) for each segment. Calculated gantry angle/MLC position speeds and errors were evaluated by comparison with the log file. On average, the half-arc VMAT plan resulted in 47% and 35% fewer degrees/MU and mm/MU than the full-arc VMAT plan, respectively. The root mean square (r.m.s.) gantry and MLC speeds showed a linear relationship with calculated degrees/MU and mm/MU, with coefficients of determination (R2) of 0.86 and 0.72, respectively. The r.m.s. gantry angle and MLC position errors showed a linear relationship with calculated degrees/MU and mm/MU with R2 of 0.63 and 0.76, respectively. Deviations from plan parameters were related to mechanical error for VMAT, and provided quantitative information without the need for VMAT delivery. These parameters can be used in the selection of treatment planning.
文摘Introduction: Radiation therapy after breast surgery is an integral part of the treatment of early breast cancer. The goal of radiation therapy is to achieve the best possible coverage of the planning target volume (PTV), while reducing the dose to organs at risk (OARs) which are normal tissues whose sensitivity to irradiation could cause damage that can lead to modification of the treatment plan. In the last decade, radiation oncologist started to use the Intensity Modulated Radiotherapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) for irradiating the breast, in order to achieve better dose distribution and target dose to the PTV and OAR. The aim of this study is to compare 2 external radiotherapy techniques (VMAT vs 3D) for patients with node-positive left breast cancer. Patients and Methods: We randomly selected 10 cases of postoperative radiotherapy for breast cancer in our hospital. The patients are all female, the average age was 45.4 years old, and the primary lesions are left breast. The ANOVA test was used to compare the mean difference between subgroups, and the p value Results: Dose volume histogram (DVH) was used to analyze each evaluation dose of clinical target volume (CTV) and organs at risk (OARs). Compared to 3DCRT plans, VMAT provided more uniform coverage to the breast and regional lymph nodes. The max point dose for tVMAT was lower on average (106.4% for VMAT versus 109% for 3DCRT). OAR sparing was improved with tVMAT, with a lower average V17Gy for the left lung (27.91% for VMAT versus 30.04% for 3DCRT, p and lower for V28Gy (13.75% for VMAT versus 22.34% for 3DCRT, p = 0.01). We also found a lower V35Gy for the heart on VMAT plan (p = 0.02). On the contrary, dose of contralateral breast was lower in 3DCRT than VMAT (0.59 Gy vs 3.65 Gy, p = 0.00). Conclusion: The both types of plans can meet the clinical dosimetry demands of postoperative radiotherapy for left breast cancer. The VMAT plan has a better conformity, but 3CDRT can provide a lower dose to the contralateral organs (breast and lung) to avoid the risk of secondary cancers.
基金This work was supported by the grants from the National Key Projects of Research and Development of China(No.2016YFC0904600)the Beijing Municipal Science&Technology Commission of China(No.Z171100001017116)。
文摘Background:The effects of oral contrast agents(OCAs)on dosimetry have not been studied in detail.Therefore,this study aimed to examine the influence of OCAs on dose calculation in volumetric-modulated arc therapy plans for rectal cancer.Methods:From 2008 to 2016,computed tomography(CT)images were obtained from 33 rectal cancer patients administered OCA with or without intravenous contrast agent(ICA)and 14 patients who received no contrast agent.CT numbers of organs at risk were recorded and converted to electronic densities.Volumetric-modulated arc therapy plans were designed before and after the original densities were replaced with non-enhanced densities.Doses to the planned target volume(PTV)and organs at risk were compared between the plans.Results:OCA significantly increased the mean and maximum densities of the bowels,while the effects of ICA on these parameters depended on the blood supply of the organs.With OCA,the actual doses for PTV were significantly higher than planned and doses to the bowel increased significantly although moderately.However,the increase in the volume receiving a high-range doses was substantial the absolute change of intestine volume receiving≥52 Gy:1.46[0.05-3.99,cubic centimeter range:-6.74 to 128.12],the absolute change of colon volume receiving≥50 Gy:0.34[0.01-1.53 cc,range:-0.08 to 3.80 cc].Dose changes due to ICA were insignificant.Pearson correlation showed that dose changes were significantly correlated with a high intestinal volume within or near the PTV(ρ>0.5,P<0.05)and with the density of enhanced intestine(ρ>0.3,P<0.05).Conclusions:Contrast agents applied in simulation cause underestimation of doses in actual treatment.The overdose due to ICA was slight,while that due to OCA was moderate.The bowel volume receiving≥50Gy was dramatically increased when OCA within the bowel was absent.Physicians should be aware of these issues if the original plan is barely within clinical tolerance or if a considerable volume of enhanced intestine is within or near the PTV.
基金Funding source Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(No.2019XK320014)。
文摘Importance:Irradiation treatment for pediatric patients with neuroblastoma represents a major challenge due to the pediatric dose limits for critical structures and the necessity of sufficient dose coverage of the clinical target volume for local control.Objective:To investigate dosimetric differences between tomotherapy(TOMO)and volumetric-modulated arc therapy(VMAT)as retroperitoneal radiotherapy for children with neuroblastoma.Methods:Eight patients who received retroperitoneal radiotherapy for neuroblastoma were selected for comparison of TOMO and VMAT treatment plans.The D min,D max,D mean,D 95,D 2,and D 98 of planning target volume(PTV),conformity index(CI),heterogeneity index(HI),and organs at risk(OARs)parameters were compared.Delivery machine unit(MU)and image-guide radiotherapy solution results were also compared.Results:All patients received a cumulative dose of 19.5 Gy to the PTV.VMAT showed higher CI(0.93±0.02),compared with TOMO(0.87±0.03,P<0.001).Notably,the average PTV HI was significantly better using TOMO(1.05±0.01)than VMAT(1.08±0.02,P=0.003).Compared with VMAT,the D min,D 95,and D 98 all exhibited increases in TOMO;D max variation was less than 1%in TOMO.The D 0.1cc for the spinal cord and D 2cc for the small intestine were better in TOMO in terms of OARs.However,TOMO had more MUs and required a longer delivery time.Interpretation:Both planning techniques are capable of producing high-quality treatment plans.TOMO is superior for PTV coverage,but inferior for CI.TOMO requires extra treatment time;its cost is greater than the cost of VMAT.
文摘目的基于Halcyon加速器比较左乳腺癌改良根治术后2弧、3弧、4弧和5弧的容积调强放射治疗(VMAT)计划的剂量学差异。方法选择德阳市人民医院肿瘤科行左侧乳腺癌改良根治术后患者20例,均为女性;年龄32~69岁,中位年龄51岁;肿瘤分期均为T3~T4、N1;位置为非内象限。基于Halcyon加速器为每位患者分别设计2弧、3弧、4弧和5弧4组VMAT计划。比较4组计划的计划靶区体积(PTV)和危及器官的剂量学指标、跳数(MU)、出束时间和γ通过率的差异。结果4弧组和5弧组VMAT计划在PTV的适形度指数(CI)、均匀性指数(HI)、D_(98)、D_(50)、D_(2)和Dmean上均优于2弧组和3弧组,而5弧组仅在PTV的D_(2)稍低于4弧组[(5311.9±30.74)cGy vs(5332.5±31.13)cGy。P<0.05]。危及器官,4弧组和5弧组左肺(患侧肺)V_(5)、V_(20)、V_(30)、V_(40)和Dmean最低,V_(10)亦低于3弧组[(33.09±2.60)%vs(32.98±2.65)%vs(34.23±2.53)%。P<0.05]。4弧组和5弧组右肺(健侧肺)Dmean低于2弧组[435(339,464)cGy vs 435(394,462)cGy vs 447(417,490)cGy。P<0.05]。4弧组和5弧组心脏V_(20)[(7.96±4.17)%、(7.99±4.19)%]和V_(30)[(3.60±2.58)%、(3.41±2.46)%]最低,V_(10)和Dmean亦低于2弧组[22.8(17.7,25.7)%vs 22.6(18.3,25.7)%vs 23.75(19.0,27.5)%、836(705,898)cGy vs 835(708,931)cGy vs 857(741,959)cGy。P<0.05]。4弧组和5弧组食管Dmean[(1362.0±370.4)cGy、(1363.2±367.3)cGy]最低,右乳Dmax亦低于2弧组[(901.4±162.9)cGy vs(900.4±170.4)cGy vs(973.9±181.5)cGy。P<0.05]。5弧组与4弧组各危及器官的剂量差异均无统计学意义(P>0.05)。4弧组MU和出束时间较2弧组和3弧组有少量增加,分别增加26.15 MU、0.05 min和28.9 MU、0.04 min,5弧组较4弧组也分别增加31.8 MU和0.05 min(P<0.05)。4组计划的γ通过率均>95%,组间差异无统计学意义(P>0.05)。结论4弧的乳腺癌VMAT计划可获得更优的剂量学分布。因此推荐左乳腺癌改良根治术后在Halcyon加速器上采用4弧的VMAT计划。
