Evaluation of three VMAT-TMI planning methods to find an appropriate balance between plan complexity and the resulting dose distribution

Abstract

PurposeEvaluation of different planning methods of treatment plan preparation for volumetric modulated arc therapy during total marrow irradiation (VMAT-TMI). MethodThree different planning methods were evaluated to establish the most appropriate VMAT-TMI technique, based on organ at risk (OAR) dose reduction, conformity and plan simplicity. The methods were: (M1) the sub-plan method, (M2) use of eight arcs optimised simultaneously and (M3) M2 with monitor unit reduction. Friedman ANOVA comparison, with Nemenyi's procedures, was used in the statistical analysis of the results. ResultsThe dosimetric results obtained for the planning target volume and for most OARs do not differ statistically between methods. The M3 method was characterized by the lowest numbers of monitor units (3259 MU vs. 4450 MU for M1 and 4216 MU for M2) and, in general, the lowest complexity. The variability of the monitor units from control points was almost half for M3 than M1 and M2 (i.e. 0.33 MU vs. 0.61 MU for M1 and 0.58 for M2). Analysing the relationship between the dose distributions obtained for the plans and their complexity, the best result was observed for the M3 method. ConclusionThe use of eight simultaneously optimised arcs with MU reduction allows to obtain VMAT-TMI plans that are characterized by the lowest complexity, with dose distributions comparable to the plans generated by other methods.