Conformity Index Research Articles

Current practices of craniospinal irradiation techniques in Turkey: a comprehensive dosimetric analysis

ObjectiveThis study evaluates various craniospinal irradiation (CSI) techniques used in Turkish centers to understand their advantages, disadvantages and overall effectiveness, with a focus on enhancing dose distribution.MethodsAnonymized CT scans of adult and pediatric patients, alongside target volumes and organ-at-risk (OAR) structures, were shared with 25 local radiotherapy centers. They were tasked to develop optimal treatment plans delivering 36 Gy in 20 fractions with 95% PTV coverage, while minimizing OAR exposure. The same CT data was sent to a US proton therapy center for comparison. Various planning systems and treatment techniques (3D conformal RT, IMRT, VMAT, tomotherapy) were utilized. Elekta Proknow software was used to analyze parameters, assess dose distributions, mean doses, conformity index (CI), and homogeneity index (HI) for both target volumes and OARs. Comparisons were made against proton therapy.ResultsAll techniques consistently achieved excellent PTV coverage (V95 > 98%) for both adult and pediatric patients. Tomotherapy closely approached ideal Dmean doses for all PTVs, while 3D-CRT had higher Dmean for PTV_brain. Tomotherapy excelled in CI and HI for PTVs. IMRT resulted in lower pediatric heart, kidney, parotid, and eye doses, while 3D-CRT achieved the lowest adult lung doses. Tomotherapy approached proton therapy doses for adult kidneys and thyroid, while IMRT excelled for adult heart, kidney, parotid, esophagus, and eyes.ConclusionModern radiotherapy techniques offer improved target coverage and OAR protection. However, 3D techniques are continued to be used for CSI. Notably, proton therapy stands out as the most efficient approach, closely followed by Tomotherapy in terms of achieving superior target coverage and OAR protection.

Knowledge-based planning for Gamma Knife.

Current methods for Gamma Knife (GK) treatment planning utilizes either manual forward planning, where planners manually place shots in a tumor to achieve a desired dose distribution, or inverse planning, whereby the dose delivered to a tumor is optimized for multiple objectives based on established metrics. For other treatment modalities like IMRT and VMAT, there has been a recent push to develop knowledge-based planning (KBP) pipelines to address the limitations presented by forward and inverse planning. However, no complete KBP pipeline has been created forGK. To develop a novel (KBP) pipeline, using inverse optimization (IO) with 3D dose predictions for GK. Data were obtained for 349 patients from Sunnybrook Health Sciences Centre. A 3D dose prediction model was trained using 322 patients, based on a previously published deep learning methodology, and dose predictions were generated for the remaining 27 out-of-sample patients. A generalized IO model was developed to learn objective function weights from dose predictions. These weights were then used in an inverse planning model to generate deliverable treatment plans. A dose mimicking (DM) model was also implemented for comparison. The quality of the resulting plans was compared to their clinical counterparts using standard GK quality metrics. The performance of the models was also characterized with respect to the dosepredictions. Across all quality metrics, plans generated using the IO pipeline performed at least as well as or better than the respective clinical plans. The average conformity and gradient indices of IO plans was 0.737 0.158 and 3.356 1.030 respectively, compared to 0.713 0.124 and 3.452 1.123 for the clinical plans. IO plans also performed better than DM plans for five of the six quality metrics. Plans generated using IO also have average treatment times comparable to that of clinical plans. With regards to the dose predictions, predictions with higher conformity tend to result in higher quality KBP plans. Plans resulting from an IO KBP pipeline are, on average, of equal or superior quality compared to those obtained through manual planning. The results demonstrate the potential for the use of KBP to generate GK treatment with minimal humanintervention.

Analysis of the treatment planning metrics and their correlation with morphology of intracranial lesions in Gamma Knife stereotactic radiosurgery.

Gamma Knife Radiosurgery (GKRS) has established a role in treating various benign brain pathologies. The radiosurgery planning necessitates a proper understanding of radiation dose distribution in relation to the target lesion and surrounding eloquent area. The quality of a radiosurgery plan is determined by various planning parameters. Here, we have reviewed various GKRS planning parameters and analyzed their correlation with the morphology of treated brain lesions. A total of 430 treatment plans (71 meningioma, 133 vestibular schwannoma/VS, 150 arteriovenous malformation/AVM, 76 pituitary adenoma/PA treated with GKRS between December 2013 and May 2023) were analyzed for target coverage (TC), conformity index (CI), homogeneity index (HI), and gradient index (GI). The values of CIPaddick and CILomax for PA were lower and differed significantly from meningioma, VS, and AVM. The value of HI for PA was higher and differed significantly when compared with meningioma, VS, and AVM. The values of HI for AVM were also significantly higher than VS and meningioma. The mean GI was 3.02, 2.92, 3.03, and 2.88 for meningioma, VS, AVM, and PA, respectively. The value of GI for meningioma and AVM was significantly higher when compared with the values for VS and PA. The mean TC was 0.94 for meningioma, 0.96 for VS, 0.95 for AVM, and 0.90 for PA. The value TC of PA was lower and differed significantly when compared with VS, AVM, and meningioma. Lesions with a volume of ≤1 cc had poor planning metrics as the spillage of radiation may be higher. The GKRS planning parameters depend on the size, shape, nature, and location of intracranial lesions. Therefore, each treatment plan needs to be evaluated thoroughly and a long-term follow-up is needed to establish their relation with clinical outcome.

Low-dose radiation therapy for COVID-19 pneumonia: Comparison of dosimetry and life-time attributable risk of cancer with conventional AP-PA fields and bone marrow sparing VMAT.

Low-dose radiation therapy (LDRT) to lungs did show encouraging results in COVID-19 patients in some clinical trials. However, there has been some concern regarding the long-term risk of radiation-induced cancer (RIC). Compared to the conventional AP-PA field technique, volumetric modulated arc therapy (VMAT) can potentially reduce the dose to the marrow and other organs at risk (OARs) and thus minimize the risk of cancer. We designed a dosimetry study to study if VMAT can reduce the exposure to the marrow and other OAR doses and curtail the estimated life-time attributable risk (LAR) of cancer. We retrieved the computed tomography scan data of 10 patients (aged 40-60 years, median 48 years) who have been already treated for any malignancy in the region of the thorax. A dose of 1.0 Gy in single fraction was prescribed to both lungs. All the organs were delineated as per the established guidelines. The dosimetry achieved by the two plans was compared to find the difference. Mean OAR doses were used to estimate the LAR for both plans and compared. Planning target volume coverage parameters like conformity index and homogeneity index were significantly better with VMAT (P value < 0.05 for all). The mean dose to most OARs was significantly lower with VMAT (P value < 0.05 for all). The mean dose to the marrow was significantly lower with VMAT (59.05 vs 81.9 cGy with P value < 0.05). The overall LAR was significantly lower with VMAT as compared to the conventional plan (0.357% vs 0.398%, P value < 0.05). Compared to the conventional technique, VMAT provides better OAR dosimetry for lung irradiation (a prescription dose of 1.0 Gy or more) in COVID-19 pneumonia. VMAT significantly reduces the risk of RIC. We therefore suggest if lung LDRT is used for COVID-19 patients, VMAT is the preferred technique for a prescription dose of ≥1.0 Gy.

Quality Assessment Radiotherapy Planning of Breast Cancer Patients with Built-In Metal Port Implants

Purpose: To evaluate the quality of radiation planning for breast cancer patients with implants with a built-in metal port. Conduct a quantitative analysis of the quality of planning, assess the dose load on critical organs for this category of patients.Material and methods: Homogeneity and conformity indices were calculated, and dose loads in critical organs were assessed for irradiation plans using 3D conformal RT (3D CRT) technology for 23 breast cancer patients with a built-in metal port implants. Calculations were carried out both taking into account (outlining) the metal port and artifacts from it on CT images, and without taking it into account.Results: Based on the results of the analysis of the calculated values of conformity and homogeneity indices, doses in critical organs of irradiation plans for 23 patients with breast cancer, it was shown that the presence of a metal port and artifacts from it affects the nature of the dose distribution.Conclusions: When creating a 3D CRT treatment plan, it is necessary to delineate the metal port and artifacts and assign true densities.

Dosimetry and treatment efficiency of SBRT using TaiChiB radiotherapy system for two-lung lesions with one overlapping organs at risk.

This study aims to assess the dosimetry and treatment efficiency of TaiChiB-based Stereotactic Body Radiotherapy (SBRT) plans applying to treat two-lung lesions with one overlapping organs at risk. For four retrospective patients diagnosed with two-lung lesions each patient, four treatment plans were designed including Plan Edge, TaiChiB linac-based, RGS-based, and a linac-RGS hybrid (Plan TCLinac, Plan TCRGS, and Plan TCHybrid). Dosimetric metrics and beam-on time were employed to evaluate and compare the TaiChiB-based plans against Plan Edge. For Conformity Index (CI), Plan TCRGS outperformed all other plans with an average CI of 1.06, as opposed to Plan Edge's 1.33. Similarly, for R50%, Plan TCRGS was superior with an average R50% of 3.79, better than Plan Edge's 4.28. In terms of D2 cm, Plan TCRGS also led with an average of 48.48%, compared to Plan Edge's 56.25%. For organ at risk (OAR) sparing, Plan TCRGS often displayed the lowest dosimetric values, notably for the spinal cord (Dmax 5.92 Gy) and lungs (D1500cc 1.00 Gy, D1000cc 2.61 Gy, V10 Gy 15.14%). However, its high Dmax values for the heart and great vessels sometimes exceeded safety thresholds. Plan TCHybrid presented a balanced approach, showing doses comparable to or better than Plan Edge without crossing safety limits. In terms of beam-on time, Plan TCLinac emerged as the most efficient treatment option in three out of four cases, followed closely by Plan Edge in one case. Plan TCRGS, despite its dosimetric advantages, was the least efficient, recording notably longer beam-on times, with a peak at 33.28 minutes in Case 2. For patients with two-lung lesions treated by SBRT whose one lesion overlaps with OARs, the Plan TCHybrid delivered by TaiChiB digital radiotherapy system can be recommended as a clinical option.

Peak ADAMTS13 activity to assess ADAMTS13 conformation and risk of relapse in immune-mediated thrombotic thrombocytopenic purpura

AbstractPrevious studies have demonstrated that >38% of patients with immune-mediated thrombotic thrombocytopenic purpura in remission with activity >50% had an open ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13) conformation. We assessed ADAMTS13 conformation in remission (ADAMTS13 activity >60%), focusing on peak ADAMTS13 activity levels and longitudinal assessment in 420 samples across 157 patients. Fewer cases had an open conformation at peak ADAMTS13 activity than unselected remission samples with ADAMTS13 activity >60% (23% vs 43%). Patients with a closed ADAMTS13 conformation at peak ADAMTS13 activity had an eightfold lower relapse rate in the subsequent year (9% vs 46%) and a fivefold lower relapse rate within 2 years (23% vs 62%) compared with cases with an open conformation. Patients with an open conformation at peak ADAMTS13 activity required preemptive anti-CD20 treatment earlier than those with a closed conformation (median, 10 vs 25 months). Longitudinally, an open conformation was evident at, and often preceded relapse. When the conformation was already open before relapse, an increase in the conformation index at relapse was seen despite the undetectable anti-ADAMTS13 immunoglobulin G (IgG) antibody. In cases with detectable anti-ADAMTS13 IgG antibody, these became undetectable before achieving a closed conformation, highlighting the relapse risk even with undetectable anti-ADAMTS13 IgG antibody and the clinical utility of open/closed during monitoring. To our knowledge, this is the first study to show an association between relapse risk and ADAMTS13 conformation when activity levels are at a peak. The open conformation identifies antibody-mediated subclinical disease that is not detectable by the current ADAMTS13 testing.

Research on seedling sowing method based on high voltage electrostatic characteristics

In response to the difficult problem of high leakage rate and low seed pick-up rate of traditional air-suction seed dischargers. This study proposes a new high-voltage electrostatic vegetable seedling sowing method and system based on phase sucking of opposite charges and repulsive seeding of same charges. This method does away with small orifices and long conductance suction holes. It can solve the technical bottleneck of the traditional air-suction seed rower at the source, which causes a decrease in seed rowing accuracy due to clogging of the suction holes when facing irregular small vegetable seeds that are not pelleted. Combining high voltage electrostatic polarisation for seed vigour with precision seeding technology. Improving seed vigour and crop yield while precision sowing. Modelling the mechanics of adsorption seeding and repulsive seeding systems. Identify the main factors affecting electrostatic adsorption and phase repulsion forces and their interrelationships; Analysis of the decay mechanism of the electrostatic adsorption force upon repeated action. Proposing measures for the rapid restoration of the original equilibrium state of the dielectric insulation by reverse electric field polarization; Analysis of the migration pattern of electric particles during polarisation. Solving the equations for seed dynamics during sowing; At positive input voltages of 16 kV and negative input voltages of 0, 4, 8, 12, 16 and 20 kV. Separate dielectric insulation layer adsorption seeding tests. The test results show that: The reverse electric field polarisation of the dielectric insulating layer is effective in containing the electrostatic adsorption decay. The best containment was achieved at a positive input voltage of 16 kV and a negative input voltage of 16 kV; Seeding performance verification tests at a positive input voltage of 16 kV and a negative input voltage of 16 kV. The test results show that: The sowing conformity index was 90.25 %, the reseeding index 3.40 % and the missed sowing index 6.35 %. In the evaluation of applied research, the multi-objective optimization design with the objective function of maximum seed discharge qualification index, minimum leakage index and replanting index, the optimal parameter combinations of the test factors can be obtained as follows: the size of the type hole is 5.977 mm, and the output voltage of the positive high-voltage electrostatic generator is 16.423 kV, and at this time, the seeding machine's seed discharge qualification index is 90.78 %, the replanting index is 3.05 %, and the leakage index is 6.17 %. To verify the reliability of the optimal design of structural parameters, the seeding performance verification test is carried out, which can be obtained: the qualified index of row seeding is 90.54 %, the index of reseeding is 2.86 %, and the index of leakage is 6.60 %, which meets the technical requirements of precision seeding. The research not only provides a reference for the development of precision sowing machinery and equipment for irregular small-grain vegetable seeds. It also provides an academic reference for the research of quantitative adsorption and rapid separation methods and theories for irregular small particle materials.

DOSIMETRIC COMPARISON OF INTENSITY-MODULATED RADIATION THERAPY (IMRT) AND VOLUMETRIC-MODULATED ARC THERAPY (VMAT) IN RECTAL CANCER PATIENTS: A COMPREHENSIVE ANALYSIS

This study aimed to conduct a thorough dosimetric comparison between two advanced radiotherapy techniques, Intensity-Modulated Radiation Therapy (IMRT) and Volumetric-Modulated Arc Therapy (VMAT), to ascertain the superior modality in terms of dose distribution and organ-at-risk sparing for rectal cancer patients. Thirty-three patients with ECOG performance status 1, aged between 18 to 60 years, diagnosed with Stage II to III rectal cancer, were included in this prospective study. Each patient underwent treatment planning with IMRT and VMAT techniques using Varian system simulation computed tomography scans. The dosimetric analysis encompassed the evaluation of target volume dose homogeneity, conformity, and doses to at-risk organs. The dosimetric comparison was conducted utilizing seven-field IMRT and dual arc VMAT plans. Statistical analysis was performed using paired t-tests and SPSS 20 software. Treatment plan constraints adhered to the RTOG 9406 guidelines, ensuring adequate planning target volume (PTV) coverage, homogeneity index, conformity index, and dose limits for organs at risk, including small bowel V20 (&lt;200cc), bladder V45 (&lt;21Gy), and femoral head V50 (≤30 Gy). Volumetric arc therapy plans demonstrated superior dose homogeneity to fixed-field intensity-modulated plans (p-value = 0.04), particularly in femoral head dose-limiting toxicity (p-value = 0.00). However, intensity-modulated therapy exhibited equivalent or superior performance in other evaluated parameters. Our findings suggest that while VMAT offers advantages in PTV coverage homogeneity and femoral head dose-limiting toxicity, IMRT remains competitive and potentially preferable in certain dosimetric aspects. The choice between IMRT and VMAT should be carefully considered based on individual patient characteristics and treatment goals. This comprehensive dosimetric comparison contributes valuable insights into optimizing radiotherapy planning for rectal cancer patients, potentially guiding clinical decision-making and improving treatment outcomes.

Comparative Dosimetric Analysis of IMRT and VMAT in Head and Neck Cancers

Purpose: The aim of study was to dosimetrically evaluate and compare IMRT and VMAT plans for irradiation of local head and neck cancers focusing on target coverage, conformity index, homogeneity index and dose perceived by the organs at risk (OAR). Methods: Prospective study conducted on 50 patients selected randomly and divided in two groups in which one group receive IMRT plan and another received VMAT plan. Results: PTV coverage was similar for both the techniques. The conformity index was higher for VMAT in comparison to IMRT which is statistically significant. The homogeneity index was also better in VMAT plans as compared to IMRT except for higher PTV volume where IMRT had better plans. The mean dose to parotid were significantly lesser in parotid glands in VMAT plans. Also, the point max dose to spinal cord, brainstem, vestibulocochlear nerve was lesser. There was no significant difference in dose received by spinal cord in both arms. Conclusion: VMAT provides better dose conformity, more homogenous target coverage and OAR sparing in comparison to IMRT.

Self-Shielding Gyroscopic Radiosurgery: A Prospective Experience and Analysis of the First 100 Patients.

Background Stereotactic radiosurgery is a well-established treatment option for the management of various benign and malignant brain tumors. It can be delivered with several treatment platforms, usually requiring shielded radiation vaults to meet regulatory safety requirements. Recent technical advances have led to the first self-shielding platform enabling the delivery of gyroscopic radiosurgery (GRS). Given the limited number of GRS treatment platforms, the novelty of its characteristics, and the lack of available data, we report our prospective experience with the first 100 patients treated with GRS. Materials and methods Patients undergoing GRS for the treatment of intracranial tumors were enrolled in this prospective study. Patient and treatment characteristics, including patient satisfaction, were collected and analyzed. Results A total of 100 patients with 155 tumors were treated. The most commonly treated tumors comprised brain metastases (BM) (49%), vestibular schwannomas (31%), and meningiomas (14%). The median prescription dose for malignant and benign tumors was 20 and 13 Gy, respectively. The median prescription isodose line was 56%. Gross tumor volumes were small, with a median of 0.37 cc for BM and 0.92 cc for the other entities. The median total treatment time was 40 minutes. Dosimetric performance indices showed median values of 1.20 (conformity index), 1.24 (new conformity index), 1.74 (homogeneity index), and 3.13 (gradient index). Volumetric assessment of the treated tumors showed an overall decrease in size at the first available follow-up. Most patients were satisfied with the treatment experience. Conclusion Our first prospective experience of the use of GRS is favorable. Analyses of the dosimetric performance, treatment times, volumetric assessment, and patient satisfaction demonstrate its suitability for stereotactic treatments of intracranial tumors. Further prospective clinical and dosimetric analyses for GRS are pending.

Dosimetry and efficiency comparison of knowledge-based and manual planning using volumetric modulated arc therapy for craniospinal irradiation.

Craniospinal irradiation (CSI) poses a challenge to treatment planning due to the large target, field junction, and multiple organs at risk (OARs) involved. The aim of this study was to evaluate the performance of knowledge-based planning (KBP) in CSI by comparing original manual plans (MP), KBP RapidPlan initial plans (RPI), and KBP RapidPlan final plans (RPF), which received further re-optimization to meet the dose constraints. Dose distributions in the target were evaluated in terms of coverage, mean dose, conformity index (CI), and homogeneity index (HI). The dosimetric results of OARs, planning time, and monitor unit (MU) were evaluated. All MP and RPF plans met the plan goals, and 89.36% of RPI plans met the plan goals. The Wilcoxon tests showed comparable target coverage, CI, and HI for the MP and RPF groups; however, worst plan quality was demonstrated in the RPI plans than in MP and RPF. For the OARs, RPF and RPI groups had better dosimetric results than the MP group (P < 0.05 for optic nerves, eyes, parotid glands, and heart). The planning time was significantly reduced by the KBP from an average of 677.80 min in MP to 227.66 min (P < 0.05) and 307.76 min (P < 0.05) in RPI, and RPF, respectively. MU was not significantly different between these three groups. The KBP can significantly reduce planning time in CSI. Manual re-optimization after the initial KBP is recommended to enhance the plan quality.

ДИНАМИКА ЖИВОЙ МАССЫ МОЛОДНЯКА МЯСНЫХ ПОРОД В УСЛОВИЯХ РЕСПУБЛИКИ ТЫВА

The aim of the study is to evaluate the growth and development of young meat cattle in the Republic of Tuva. Objectives: to study the growth and development of young cattle by live weight at birth, 3 and 6 months; to determine the average daily and absolute gains; to take the main measurements and to calculate the body conformation indices. The object of the study was young Hereford and Kalmyk cattle (6 months old). The animals were assessed for appearance, their measurements were taken and body conformation indices were calculated. The obtained data were processed in the MS Excel spreadsheet editor. The study of the dynamics of live weight indicators and growth rates up to 6 months showed an advantage of Hereford calves: live weight at birth – by 4.3 kg; at 3 months of age – by 6.2 kg; at 6 months of age – by 13.8 kg; the average daily gain at the age of 3–6 months is 96 g more, and the absolute gain from birth to 3 months is 6.8 % more, from 3 to 6 months is 11.3 %. In the neonatal and 6-month period, Hereford calves were taller than their Kalmyk peers: by oblique body length – by 5.1 and 7.1 cm; height at the withers – by 7 and 3.9; chest girth behind the shoulder blades – by 5.5 and 4.5 cm, respectively. At 6 months, Kalmyk calves had highly reliable indicators of the leanness index (by 4.1 %), and the Herefords – the bone index (by 9 %). The advantage of the young Hereford breed in all the studied indicators can be due to their breed characteristics, as well as a fairly long adaptation of this breed to the conditions of the Republic of Tuva.

Dosimetric comparison of O-ring versus conventional C-arm linear accelerator for volumetric modulated arc therapy (VMAT) of head and neck cancer and carcinoma cervix patients.

The objective of this study is dosimetric comparison between the O-ring Halcyon and C-arm Clinac iX linac for volumetric modulated arc therapy (VMAT) plans for head & neck (H&N) cancer and carcinoma cervix patients. Total 60 patients of H&N cancer and carcinoma cervix were enrolled prospectively from March 2021 to March 2023. VMAT plans with 6 MV photons for Halcyon and Clinac iX were generated and compared for each patient by dose volume histogram for planning target volume coverage and organ at risk (OAR) sparing. There were no differences in between both the linacs for PTV D2% and D98%, homogeneity index, conformity index, Dmax (maximum dose) and Dmean (mean dose) of OAR. Halcyon had significantly shorter treatment time compared to Clinac iX. Halcyon delivered higher integral dose and monitor units. O-ring Halcyon produces VMAT plans comparable to other C-arm linacs for H&N and carcinoma cervix patients.

IMRT Planning Using 5, 7 and 9 Radiation Field Directions for Nasopharyngeal Cancer Cases

Nasopharyngeal carcinoma (NPC) is one of the deadliest cancers in the world. In treating NPC, Intensity Modulated Radiation Therapy (IMRT) uses radiation fields from several directions to kill cancer cells and shrink tumours. IMRT requires accurate planning using the Treatment Planning System (TPS) to avoid organs at risk (OARs) around the nasopharyngeal cavity. The purpose of this study is to analyse the results of different number of radiation field directions in treatment planning for nasopharyngeal cancer using IMRT. The study focuses on the distribution of dose in the target tumour and organs at risk around the target. The treatment planning parameters are Dose Volume Histogram (DVH), Conformity Index (CI), Homogeneity Index (HI), dose at organs at risk (OARs) and beam on time (BOT). This study used TPS Monaco with the Monte Carlo algorithm and the inverse planning method. Based on DVH, CI, HI and BOT parameters, the results of this study indicate that the most optimal number of radiation field directions to give prescribed doses was 9 radiation field directions. There was no significant difference in the average dose received by OARs in planning with 7 and 9 radiation field directions. In the planning using 5 field directions, some of the OARs received doses above the tolerance limit. While in the planning using 7 and 9 field directions, most of the OARs received doses below the tolerated doses which met the permitted treatment requirements.

Stereotactic Optimized Automated Radiotherapy (SOAR): a novel automated planning solution for multi-metastatic SRS compared to HyperArc™

Objective. Automated Stereotactic Radiosurgery (SRS) planning solutions improve clinical efficiency and reduce treatment plan variability. Available commercial solutions employ a template-based strategy that may not be optimal for all SRS patients. This study compares a novel beam angle optimized Volumetric Modulated Arc Therapy (VMAT) planning solution for multi-metastatic SRS to the commercial solution HyperArc. Approach. Stereotactic Optimized Automated Radiotherapy (SOAR) performs automated plan creation by combining collision prediction, beam angle optimization, and dose optimization to produce individualized high-quality SRS plans using Eclipse Scripting. In this retrospective study 50 patients were planned using SOAR and HyperArc. Assessed dose metrics included the Conformity Index (CI), Gradient Index (GI), and doses to organs-at-risk. Complexity metrics evaluated the modulation, gantry speed, and dose rate complexity. Plan dosimetric quality, and complexity were compared using double-sided Wilcoxon signed rank tests (α = 0.05) adjusted for multiple comparisons. Main Results. The median target CI was 0.82 with SOAR and 0.79 with HyperArc (p < .001). Median GI was 1.85 for SOAR and 1.68 for HyperArc (p < .001). The median V12Gy normal brain volume for SOAR and HyperArc were 7.76 cm3 and 7.47 cm3 respectively. Median doses to the eyes, lens, optic nerves, and optic chiasm were statistically significant favoring SOAR. The SOAR algorithm scored lower for all complexity metrics assessed. Significance. In-house developed automated planning solutions are a viable alternative to commercial solutions. SOAR designs high-quality patient-specific SRS plans with a greater degree of versatility than template-based methods.

Comparative Study of Eclipse and RayStation Multi-Criteria Optimization-Based Prostate Radiotherapy Treatment Planning Quality.

Multi-criteria optimization (MCO) function has been available on commercial radiotherapy (RT) treatment planning systems to improve plan quality; however, no study has compared Eclipse and RayStation MCO functions for prostate RT planning. The purpose of this study was to compare prostate RT MCO plan qualities in terms of discrepancies between Pareto optimal and final deliverable plans, and dosimetric impact of final deliverable plans. In total, 25 computed tomography datasets of prostate cancer patients were used for Eclipse (version 16.1) and RayStation (version 12A) MCO-based plannings with doses received by 98% of planning target volume having 76 Gy prescription (PTV76D98%) and 50% of rectum (rectum D50%) selected as trade-off criteria. Pareto optimal and final deliverable plan discrepancies were determined based on PTV76D98% and rectum D50% percentage differences. Their final deliverable plans were compared in terms of doses received by PTV76 and other structures including rectum, and PTV76 homogeneity index (HI) and conformity index (CI), using a t-test. Both systems showed discrepancies between Pareto optimal and final deliverable plans (Eclipse: -0.89% (PTV76D98%) and -2.49% (Rectum D50%); RayStation: 3.56% (PTV76D98%) and -1.96% (Rectum D50%)). Statistically significantly different average values of PTV76D98%,HI and CI, and mean dose received by rectum (Eclipse: 76.07 Gy, 0.06, 1.05 and 39.36 Gy; RayStation: 70.43 Gy, 0.11, 0.87 and 51.65 Gy) are noted, respectively (p < 0.001). Eclipse MCO-based prostate RT plan quality appears better than that of RayStation.

Technical feasibility of novel immunostimulatory low-dose radiation for polymetastatic disease with CBCT-based online adaptive and conventional approaches.

A workflow/planning strategy delivering low-dose radiation therapy (LDRT) (1Gy) to all polymetastatic diseases using conventional planning/delivery (Raystation/Halcyon="conventional") and the AI-based Ethos online adaptive RT (oART) platform is developed/evaluated. Using retrospective data for ten polymetastatic non-small cell lung cancer patients (5-52 lesions each) with PET/CTs, gross tumor volumes (GTVs) were delineated using PET standardized-uptake-value (SUV) thresholding. A 1cm uniform expansion of GTVs to account for setup/contour uncertainty and organ motion-generated planning target volumes (PTVs). Dose optimization/calculation used the diagnostic CT from PET/CT. Dosimetric objectives were: Dmin,0.03cc ≥ 95% (acceptable variation (Δ) ≥ 90%), V100% ≥ 95% (Δ ≥ 90%), and D0.03cc ≤ 120% (Δ ≤ 125%). Additionally, online adaptation was simulated. When available, subsequent diagnostic CT was used to represent on-treatment CBCT. Otherwise, the CT from PET/CT used for initial planning was deformed to simulate clinically representative changes. All initial plans generated, both for Raystation and Ethos, achieved clinical goals within acceptable variation. For all patients, Dmin,0.03cc ≥ 95%, V100% ≥ 95%, and D0.03cc ≤ 120% goals were achieved for 84.8%/99.5%, 97.7%/98.7%, 97.4%/92.3%, in conventional/Ethos plans, respectively. The ratio of 50% isodose volume to PTV volume (R50%), maximum dose at 2cm from PTV (D2cm), and the ratio of the 100% isodose volume to PTV volume (conformity index) in Raystation/Ethos plans were 7.9/5.9; 102.3%/88.44%; and 0.99/1.01, respectively. In Ethos, online adapted plans maintained PTV coverage whereas scheduled plans often resulted in geographic misses due to changes in tumor size, patient position, and body habitus. The average total duration of the oART workflow was 26:15 (min:sec) ranging from 6:43 to 57:30. The duration of each oART workflow step as a function of a number of targets showed a low correlation coefficient for influencer generation and editing (R2=0.04 and 0.02, respectively) and high correlation coefficient for target generation, target editing and plan generation (R2=0.68, 0.63 and 0.69, respectively). This study demonstrates feasibility of conventional planning/treatment with Raystation/Halcyon and highlights efficiency gains when utilizing semi-automated planning/online-adaptive treatment with Ethos for immunostimulatory LDRT conformally delivered to all sites of polymetastatic disease.

Feasibility of board tilt angle on critical organs during hippocampus-sparing whole-brain radiotherapy

The objective of this study was to investigate the impact of altering the board angle on critical organ doses during whole-brain irradiation. Tomography images of the head region of the rando phantom were taken at angles of 0°, 10°, 20°, 30°, and 40°. Target volume (PTV) and organ at risk (OAR) contours were created on CT images using RTOG 0933 criteria. Tomography images of the head region of the rando phantom were taken at angles of 0°, 10°, 20°, 30°, and 40°. Target volume (PTV) and critical organ contours were created on CT images using RTOG 0933 criteria. During this comparative study, we aimed to achieve a standardized dose distribution in the PTV. We evaluated the doses received by D2 (minimum dose received by 2% of the target volume), D98 (minimum dose received by 98% of the target volume), D50 (dose received by 50% of the target volume), and organs at risk (OAR) in the PTV using CT scans taken at different angles. Additionally, we compared the homogeneity index (HI), conformity index (CI), and treatment time (MU) values. This method aimed to decrease the dose of the OAR region near the target volume, specifically the hippocampus. Our findings indicate that a board angle of 300 offers the greatest protection in terms of critical organ doses.

Dosimetric evaluation of ultrafractionated dose escalation with simultaneous integrated boost to intraprostatic lesion using 1.5-Tesla MR-Linac in localized prostate cancer.

We analyzed a dose escalation of 36.25 Gy to the entire prostate and a dose increment up to 40 Gy with 1.25 Gy increments to intraprostatic lesion (IPL) using simultaneous integrated boost (SIB) in five fractions. Eighteen low- and intermediate-risk prostate cancer patients treated with 1.5T MR-Linac were retrospectively evaluated. The same planning computed tomography (CT) images generated four plans: no SIB, 37.5 Gy SIB, 38.75 Gy SIB, and 40 Gy SIB. In four plans, planning target volume (PTV) doses, organ at risk (OAR) doses, and PTV-SIB homogeneity index (HI), gradient index (GI) and conformity index (CI) were compared. All plans met the criteria for PTV and PTV-SIB coverage. PTV 40 Gy plan has higher maximum PTV and PTV-SIB doses than other plans. The PTV HI was significantly higher in the SIB 40 Gy plan (0.135 ± 0.007) compared to SIB 38.75 Gy plan (0.099 ± 0.007; p = 0.001), SIB 37.5 Gy (0.067 ± 0.008; p < 0.001), and no SIB plan (0.049 ± 0.010; p < 0.001), while there were no significant differences in HI, GI and CI for PTV-SIB between three plans. Four rectum and bladder plans had similar dosimetric parameters. The urethra D5 was significantly higher in SIB 40 Gy plan compared to no SIB plan (37.7 ± 1.1 Gy vs. 37.0 ± 0.7 Gy; p = 0.009) and SIB 37.5 Gy plan (36.9 ± 0.8 Gy; p = 0.008). There was no significant difference in monitor units between the four consecutive plans. Ultra-hypofractionated dose escalation to IPL up to 40 Gy in 5 fractions with a 1.5-T MR-linac is dosimetrically feasible, potentially paving the way for clinical trials.