Abstract
Purpose: This study aimed to develop a volumetric independent dose calculation (vIDC) system for verification of the treatment plan in image-guided adaptive brachytherapy (IGABT) and to evaluate the feasibility of the vIDC in clinical practice with simulated cases.Methods: The vIDC is based on the formalism of TG-43. Four simulated cases of cervical cancer were selected to retrospectively evaluate the dose distributions in IGABT. Some reference point doses, such as points A and B and rectal points, were calculated by vIDC using absolute coordinate. The 3D dose volume was also calculated to acquire dose-volume histograms (DVHs) with grid resolutions of 1.0 × 1.0 (G1.0), 2.5 × 2.5 (G2.5), and 0.5 × 0.5 mm2 (G0.5). Dosimetric parameters such as D90% and D2cc doses covering 90% of the high-risk critical target volume (HR-CTV) and 2 cc of the organs at risk (OARs) were obtained from DVHs. D90% also converted to equivalent dose in 2-Gy fractions (EQD2) to produce the same radiobiological effect as external beam radiotherapy. In addition, D90% was obtained in two types with or without the applicator volume to confirm the effect of the applicator itself. Validation of the vIDC was also performed using gamma evaluation by comparison with Monte Carlo simulation.Results: The average percentage difference of point doses was <2.28%. The DVHs for the HR-CTV and OARs showed no significant differences between the vIDC and the treatment planning system (TPS). Without considering the applicator volume, the D90% of the HR-CTV calculated by the vIDC decreases with a decreasing calculated dose-grid size (32.4, 5.65, and −2.20 cGy in G2.5, G1.0, and G0.5, respectively). The overall D90% is higher when considering the applicator volume. The converted D90% by EQD2 ranged from −1.29 to 1.00%. The D2cc of the OARs showed that the averaged dose deviation is <10 cGy regardless of the dose-grid size. Based on gamma analysis, the passing rate was 98.81% for 3%/3-mm criteria.Conclusion: The vIDC was developed as an independent dose verification system for verification of the treatment plan in IGABT. We confirmed that the vIDC is suitable for second-check dose validation of the TPS under various conditions.
Highlights
Image-guided adaptive brachytherapy (IGABT) based on magnetic resonance images (MRIs) has been introduced as a new standard technique to improve the treatment outcome in cervical cancer [1,2,3,4,5,6]
In order to examine the efficiency of the functions and the clinical feasibility for the volumetric IDC (vIDC), we retrospectively evaluated with simulated cases treated using IGABT
The vIDC was developed for use as a second dose check to verify the clinical IGABT treatment plans
Summary
Image-guided adaptive brachytherapy (IGABT) based on magnetic resonance images (MRIs) has been introduced as a new standard technique to improve the treatment outcome in cervical cancer [1,2,3,4,5,6]. IGABT delivers a high dose with a small number of fractions after external beam radiotherapy (EBRT). The treatment plan of IGABT is optimized by using dosimetric parameters to meet dose constraints for the organs at risk (OARs) and high-risk clinical target volume (HR-CTV). IGABT based on MRIs is more advantageous in the delineation of a region of interest (ROI) such as the HR-CTV and OARs than is high-dose-rate brachytherapy (BTHDR) based on computed tomography (CT) images [7, 8]. Because compensation of IGABT for treatment outcomes is difficult, it is more important to generate the correct treatment plan and to deliver accurate doses than with other conventional treatments [9]. The re-optimized treatment plan should be validated for safe and accurate delivery [10]
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