Dedicated Treatment Planning System Research Articles

Evaluation of RADIANCE Monte Carlo algorithm for treatment planning in electron based Intraoperative Radiotherapy (IOERT)

PurposeTo perform experimental as well as independent Monte Carlo (MC) evaluation of the MC algorithm implemented in RADIANCE version 4.0.8, a dedicated treatment planning system (TPS) for 3D electron dose calculations in intraoperative radiation therapy (IOERT). Methods and materialsThe MOBETRON 2000 (IntraOp Medical Corporation, Sunnyvale, CA) IOERT accelerator was employed. PDD and profiles for five cylindrical plastic applicators with 50–90 mm diameter and 0°, 30° beveling were measured in a water phantom, at nominal energies of 6, 9 and 12 MeV. Additional PDD measurements were performed for all the energies without applicator. MC modeling of the MOBETRON was performed with the user code BEAMnrc and egs_chamber of the MC simulation toolkit EGSnrc. The generated phase space files of the two 0°-bevel applicators (50 mm, 80 mm) and three energies in both RADIANCE and BEAMnrc, were used to determine PDD and profiles in various set-ups of virtual water phantoms with air and bone inhomogeneities. 3D dose distributions were also calculated in image data sets of an anthropomorphic tissue-equivalent pelvis phantom. Image acquisitions were realized with a CT scanner (Philips Big Bore CT, Netherlands). Gamma analysis was applied to quantify the deviations of the RADIANCE calculations to the measurements and EGSnrc calculations. Gamma criteria normalized to the global maximum were investigated between 2%, 2 mm and 3%, 3 mm. ResultsRADIANCE MC calculations satisfied the gamma criteria of 3%, 3 mm with a tolerance limit of 85% passing rate compared to in- water phantom measurements, except for the dose profiles of the 30° beveled applicators. Mismatches lay in surface doses, in umbra regions and in the beveled end of the 30° applicators. A very good agreement to the EGSnrc calculations in heterogeneous media was observed. Deviations were more pronounced for the larger applicator diameter and higher electron energy. In 3D dose comparisons in the anthropomorphic phantom, gamma passing rates were higher than 96 % for both simulated applicators. ConclusionsRADIANCE MC algorithm agrees within 3%, 3 mm criteria with in-water phantom measurements and EGSnrc MC dose distributions in heterogeneous media for 0°-bevel applicators. The user should be aware of missing scattering components and the 30° beveled applicators should be used with attention.

Evaluation of a dedicated software for semi-automated VMAT planning of spine Stereotactic Body Radiotherapy (SBRT)

PurposeTo determine whether SBRT of spinal metastasis using a dedicated treatment planning system (TPS) and delivered with a gantry-based LINAC could provide plans of similar quality to the Cyberknife technology. Additional comparison was also done with other commercial TPS used for volumetric modulated arc therapy (VMAT) planning. Materials and MethodsThirty Spine SBRT patients, previously treated in our institution with CyberKnife (Accuray, Sunnyvale) using Multiplan TPS, were replanned in VMAT with an dedicated TPS (Elements Spine SRS, Brainlab, Munich) and our clinical TPS (Monaco, Elekta LTD, Stockholm), using exactly the same arc geometry. The comparison was done by assessing differences in dose delivered to PTV, CTV and spinal cord, calculating modulation complexity scores (MCS) and performing quality control (QA) of the plans. ResultsRegardless of the vertebra level, in general, no statistical difference was found in PTV coverage between all TPS. Conversely, PTV and CTV D50% were found significantly higher for the dedicated TPS compared to others. In addition, the dedicated TPS also resulted in better gradient index (GI) than clinical VMAT TPS, whatever the vertebral level, and better GI than Cyberknife TPS for the thoracic level only. The D2% to the spinal cord was generally significantly lower with the dedicated TPS compared with others. No significant difference was found in the MCS between both VMAT TPS. All QA were clinically acceptable. ConclusionThe Elements Spine SRS TPS offers very effective and user-friendly semi-automated planning tools and is secure and promising for gantry-based LINAC spinal SBRT.

Potential utility of cone-beam CT-guided adaptive radiotherapy under end-exhalation breath-hold conditions for pancreatic cancer.

The purpose of this study was to demonstrate the potential utility of cone-beam computed tomography (CBCT)-guided online adaptive radiotherapy (ART) under end-exhalation breath-hold (EE-BH) conditions for pancreatic cancer (PC). Eleven PC patients who underwent 15-fraction volumetric-modulated arc therapy under EE-BH conditions were included. Planning CT images and daily 165 CBCT images were imported into a dedicated treatment planning system. The prescription dose was set to 48Gy in 15 fractions. The reference plan was automatically generated along with predefined clinical goals. After segmentation was completed on CBCT images, two different plans were generated: One was an adapted (ADP) plan in which re-optimization was performed on the anatomy of the day, and the other was a scheduled (SCH) plan, which was the same as the reference plan. The dose distributions calculated using the synthetic CT created from both planning CT and CBCT were compared between the two plans. Independent calculation-based quality assurance was also performed for the ADP plans, with a gamma passing rate of 3%/3mm. All clinical goals were successfully achieved during the reference plan generation. Of the 165 sessions, gross tumor volume D98% and clinical target volume D98% were higher in 100 (60.1%) and 122 (74.0%) ADP fractions. In each fraction, the V3Gy <1cm3 of the stomach and duodenum was violated in 47 (28.5%) and 48 (29.1%), respectively, of the SCH fractions, whereas no violations were observed in the ADP fractions. There were statistically significant differences in the dose-volume indices between the SCH and ADP fractions (p<0.05). The gamma passing rates were above 95% in all ADP fractions. The CBCT-guided online ART under EE-BH conditions successfully reduced the dose to the stomach and duodenum while maintaining target coverage.

Interstitial Photodynamic Therapy for Glioblastomas: A Standardized Procedure for Clinical Use.

Simple SummaryThe most frequent primary high-grade brain tumors are glioblastomas (GBMs). The current standard of care for GBM is maximal surgical resection followed by radiotherapy and chemotherapy. Despite all these treatments, the overall survival is still limited, with a median of 15 months. The challenge is to improve the local control of this infiltrative disease. Interstitial photodynamic therapy (iPDT) is a minimally invasive treatment relying on the interaction of light, a photosensitizer and oxygen. It consists of introducing optical fibers inside the tumor to illuminate the cancer cells which have been sensitized to light thanks to a natural photosensitizer agent. Herein, we propose a standardized and reproducible workflow for the clinical application of iPDT to GBM. This workflow, which involves intraoperative imaging, a dedicated treatment planning system (TPS) and robotic assistance for the implantation of stereotactic optical fibers, represents a key step in the deployment of iPDT for the treatment of GBM.Glioblastomas (GBMs) are high-grade malignancies with a poor prognosis. The current standard of care for GBM is maximal surgical resection followed by radiotherapy and chemotherapy. Despite all these treatments, the overall survival is still limited, with a median of 15 months. For patients harboring inoperable GBM, due to the anatomical location of the tumor or poor general condition of the patient, the life expectancy is even worse. The challenge of managing GBM is therefore to improve the local control especially for non-surgical patients. Interstitial photodynamic therapy (iPDT) is a minimally invasive treatment relying on the interaction of light, a photosensitizer and oxygen. In the case of brain tumors, iPDT consists of introducing one or several optical fibers in the tumor area, without large craniotomy, to illuminate the photosensitized tumor cells. It induces necrosis and/or apoptosis of the tumor cells, and it can destruct the tumor vasculature and produces an acute inflammatory response that attracts leukocytes. Interstitial PDT has already been applied in the treatment of brain tumors with very promising results. However, no standardized procedure has emerged from previous studies. Herein, we propose a standardized and reproducible workflow for the clinical application of iPDT to GBM. This workflow, which involves intraoperative imaging, a dedicated treatment planning system (TPS) and robotic assistance for the implantation of stereotactic optical fibers, represents a key step in the deployment of iPDT for the treatment of GBM. This end-to-end procedure has been validated on a phantom in real operating room conditions. The thorough description of a fully integrated iPDT workflow is an essential step forward to a clinical trial to evaluate iPDT in the treatment of GBM.

Commissioning cranial single-isocenter multi-target radiosurgery for the Versa HD.

PurposeBrainlab’s Elements Multiple Brain Mets SRS (MBMS) is a dedicated treatment planning system for single‐isocenter multi‐target (SIMT) cranial stereotactic radiosurgery (SRS) treatments. The purpose of this study is to present the commissioning experience of MBMS on an Elekta Versa HD.MethodsMBMS was commissioned for 6 X, 6 FFF, and 10 FFF. Beam data collected included: output factors, percent depth doses (PDDs), diagonal profiles, collimator transmission, and penumbra. Beam data were processed by Brainlab and resulting parameters were entered into the planning system to generate the beam model. Beam model accuracy was verified for simple fields. MBMS plans were created on previously treated cranial SRS patient data sets. Plans were evaluated using Paddick inverse conformity (ICI), gradient indices (GI), and cumulative volume of brain receiving 12 Gy. Dosimetric accuracy of the MBMS plans was verified using microDiamond, Gafchromic film, and SRS Mapcheck measurements of absolute dose and dose profiles for individual targets. Finally, an end‐to‐end (E2E) test was performed with a MR‐CT compatible phantom to validate the accuracy of the simulation‐to‐delivery process.ResultsFor square fields, calculated scatter factors were within 1.0% of measured, PDDs were within 0.5% past dmax, and diagonal profiles were within 0.5% for clinically relevant off‐axis distances (<10 cm). MBMS produced plans with ICIs < 1.5 and GIs < 5.0 for targets > 10 mm. Average point doses of the MBMS plans, measured by microDiamond, were within 0.31% of calculated (max 2.84%). Average per‐field planar pass rates were 98.0% (95.5% minimum) using a 2%/1 mm/10% threshold relative gamma analysis. E2E point dose measurements were within 1.5% of calculated and Gafchromic film pass rates were 99.6% using a 5%/1 mm/10% threshold gamma analysis.ConclusionThe experience presented can be used to aid the commissioning of the Versa HD in the Brainlab MBMS treatment planning system, to produce safe and accurate SIMT cranial SRS treatments.

Comparison of Intensity Modulated Radiotherapy Treatment Plans Between 1.5T MR-Linac and Conventional Linac

In this study, we assess the dosimetric qualities and usability of planning for 1.5 T MR-Linac based intensity modulated radiotherapy (MRL-IMRT) for various clinical sites in comparison with IMRT plans using a conventional linac. In total of 30 patients with disease sites in the brain, esophagus, lung, rectum and vertebra were re-planned retrospectively for simulated MRL-IMRT using the Elekta Unity dedicated treatment planning system (TPS) Monaco (v5.40.01). Currently, the step-and-shoot (ss) is the only delivery technique for IMRT available on Unity. All patients were treated on an Elekta Versa HDTM with IMRT using the dynamic multileaf collimator (dMLC) technique, and the plans were designed using Monaco v5.11. For comparison, the same dMLC-IMRT plan was recalculated with the same machine and TPS but only changing the technique to step-and-shoot. The dosimetric qualities of the MRL-IMRT plans, to be evaluated by the Dose Volume Histograms (DVH) metrics, Homogeneity Index and Conformality Index, were compared with the clinical plans. The planning usability was measured by the optimization time and the number of Monitor Units (MUs). Comparing MRL-IMRT with conventional linac based plans, all created plans were clinically equivalent to current clinical practice. However, MRL-IMRT plans had higher dose to skin and larger low dose region of normal tissues. Furthermore, MRL-IMRT plans had significantly reduced optimization time by comparing conventional linac based plans. The number of MUs of MRL-IMRT was increased by 23% compared with ss-IMRT, and no difference from dMLC-IMRT. In conclusion, clinically acceptable plans can be achieved with 1.5 T MR-Linac system for multiple tumor sites. Given the differences in machine characteristics, some minor differences in plan quality were found between MR-Linac plans and current clinical practice and this should be considered in clinical practice.

Dose assessment in high dose rate brachytherapy with cobalt-60 source for cervical cancer treatment: a phantom study

Abstract Transition from low dose rate brachytherapy to high dose rate brachytherapy at our department necessitated the performance of dose verification test, which served as an end-to-end quality assurance procedure to verify and validate dose delivery in intracavitary brachytherapy of the cervix and the vaginal walls based on the Manchester system. An in-house water phantom was designed and constructed from Perspex sheets to represent the cervix region of a standard adult patient. The phantom was used to verify the whole dose delivery chain such as calibration of the cobalt-60 source in use, applicator, and source localization method, the output of treatment planning with dedicated treatment planning system, and actual dose delivery process. Since the above factors would influence the final dose delivered, doses were measured with calibrated gafchromic EBT3 films at various points within the in-house phantom for a number of clinical implants that were used to treat a patient based on departmental protocol. The measured doses were compared to those of the treatment planning system. The discrepancies between measured doses and their corresponding calculated doses obtained with the treatment planning system ranged from -29.67 to 40.34% (mean of ±13.27%). These compared similarly to other studies.

Hybrid Tri-Co-60 MRI radiotherapy for locally advanced rectal cancer: An in silico evaluation.

Aim of this paper is to investigate the plan quality of a tri-Co-60 MRI-Hybrid system for intensity-modulated radiation therapy (IMRT) in patients affected by locally advanced rectal cancer (LARC) undergoing neo-adjuvant radiotherapy. Ten consecutive LARC patients were selected. Tri-Co-60 step and shoot IMRT plans were generated simulating the presence of the magnetic field (Bon) or not (Boff) with the dedicated treatment planning system (TPS).The total planned dose was 45 Gy in 25 fractions to the mesorectum and the pelvic nodes (planning target volume 2, PTV2) and 55 Gy to the tumor and correspondent mesorectum (PTV1) through simultaneous integrated boost (SIB). Tri-Co-60 IMRT plans were compared with Volumetric Modulated Arc Therapy (VMAT) and IMRT plans for Linear Accelerator (Linac). Bon and Boff tri-Co-60 IMRT plans showed no relevant differences. Mean values of PTV1 and PTV2 receiving at least 95% of the Dp (V95%) were higher than 95% in all treatment plans. All plans met the V105% constraint for the PTV1. Mean values of V105% for the PTV2 were 14.8, 5.0, and 7.3% respectively for tri-Co-60, VMAT and IMRT. Mean Wu's HI values were similar in all plans (7.4-7.8%). All plans met the V45Gy constraint for small bowel, but mean V45Gy value was higher with tri-Co-60.Bladder irradiation was comparable and always lower than the chosen D max 65 Gy constraint.Mean values of V5Gy and V20Gy to the body and median skin doses were higher with tri-Co-60 plans. Treatment plans with Tri-Co-60 step and shoot IMRT met the dose-volume objectives in patients with LARC. Nevertheless, a larger volume of normal tissue received low-moderate doses when compared with Linac based VMAT and IMRT.

Retrospective Voxel-Based Dosimetry for Assessing the Ability of the Body-Surface-Area Model to Predict Delivered Dose and Radioembolization Outcome.

The aim of this study was to quantitatively evaluate the ability of the body-surface-area (BSA) model to predict tumor-absorbed dose and treatment outcome through retrospective voxel-based dosimetry. Methods: Data from 35 hepatocellular carcinoma patients with a total of 42 90Y-resin microsphere radioembolization treatments were included. Injected activity was planned with the BSA model. Voxel dosimetry based on 99mTc-labeled macroaggregated albumin SPECT and 90Y-microsphere PET was retrospectively performed using a dedicated treatment planning system. Average dose and dose-volume histograms (DVHs) of the anatomically defined tumors were analyzed. The selected dose metrics extracted from DVHs were minimum dose to 50% and 70% of the tumor volume and percentage of the volume receiving at least 120 Gy. Treatment response was evaluated 6 mo after therapy according to the criteria of the European Association for the Study of the Liver. Results: Six-month response was evaluated in 26 treatments: 14 were considered to produce an objective response and 12 a nonresponse. Retrospective evaluation of 90Y-microsphere PET-based dosimetry showed a large interpatient variability with a median average absorbed dose of 60 Gy to the tumor. In 62% (26/42) of the cases, tumor, nontumoral liver, and lung doses would have complied with the recommended thresholds if the injected activity calculated by the BSA method had been increased. Average doses, minimum dose to 50% and 70% of the tumor volume, and percentage of the volume receiving at least 120 Gy were significantly higher in cases of objective response than in nonresponse. Conclusion: In our population, average tumor-absorbed dose and DVH metrics were associated with tumor response. However, the activity calculated by the BSA method could have been increased to reach the recommended tumor dose threshold. Tumor uptake, target and nontarget volumes, and dose distribution heterogeneity should be considered for activity planning.

Fragmentation of 120 and 200 MeV u−1 4He ions in water and PMMA targets

Recently, the use of 4He particles in cancer radiotherapy has been reconsidered as they potentially represent a good compromise between protons and 12C ions. The first step to achieve this goal is the development of a dedicated treatment planning system, for which basic physics information such as the characterization of the beam lateral scattering and fragmentation cross sections are required. In the present work, the attenuation of 4He primary particles and the build-up of secondary charged fragments at various depths in water and polymethyl methacrylate were investigated experimentally for 120 and 200 MeV u−1 beams delivered by the synchrotron at the Heidelberg Ion-Beam Therapy Center, Heidelberg. Species and isotope identification was accomplished combining energy loss and time-of-flight measurements. Differential yields and energy spectra of all fragments types were recorded between 0° and 20° with respect to the primary beam direction.

The influence of respiratory motion on dose delivery in a mouse lung tumour irradiation using the 4D MOBY phantom.

During precision irradiation of a preclinical lung tumour model, the tumour is subject to breathing motion and it can partially move out of the irradiation field. This work aimed to perform a quantitative analysis of the impact of respiratory motion on a mouse lung tumour irradiation with small fields. A four-dimensional digital mouse whole body phantom (MOBY) with a virtual 4-mm spherical lung tumour at different locations in both lungs is used to simulate a breathing anaesthetized mouse in different breathing phases representing a full breathing cycle. The breathing curve is determined by fluoroscopic imaging of an anaesthetized mouse. Each MOBY time frame is loaded in a dedicated treatment planning system (small animal radiotherapy-Plan) and is irradiated by a full arc with a 5-mm circular collimator. Mean and time-dependent organ doses are calculated for the tumour, heart and spinal cord. Depending on the location of the lung tumour, an overestimation of the mean tumour dose up to 11% is found. The mean heart dose could be both overestimated or underestimated because the heart moves in or out of the irradiation field depending on the beam target location. The respiratory motion does not affect the mean spinal cord dose. A dose gradient is visible in the time-dependent tumour dose distribution. In the future, new methods need to be developed to track the lung tumour motion before preclinical irradiation to adjust the irradiation plan. Margins, collimator diameter and target dose could be changed easily, but they all have their drawbacks. State-of-the-art clinical techniques such as respiratory gating or motion tracking may offer a solution for the cold spots in the time-dependent tumour dose. Advances in knowledge: A suitable method is found to quantify changes in organ dose due to respiratory motion in mouse lung tumour image-guided precision irradiation.

A.210 - Innovative approach in IORT sarcoma assessment using a dedicated treatment planning system

A.210 - Innovative approach in IORT sarcoma assessment using a dedicated treatment planning system

A.41 - An innovative tool for image guided intra-operative radiotherapy (IGIORT): The validation process of a dedicated treatment planning system

A.41 - An innovative tool for image guided intra-operative radiotherapy (IGIORT): The validation process of a dedicated treatment planning system

SU-E-T-262: Development of An In-House Forward Planning System for Conformal Arc Therapy

Purpose: Conformal radiotherapy with forward planning has many practical advantages (e.g., more uniform target dose) and has been used routinely for stereotactic body radiation therapy (SBRT) and other conventional treatment. This study investigates a forward-planning approach for conformal arc therapy and a dedicated treatment planning system (TPS) for a newly designed cobalt 60 machine with a ring type gantry and a multileaf collimator (MLC). Methods: Conformal arcs were modeled with continuous delivery of treatment fields conformal to the target cross-section. Treatment plans were further optimized by weighting or offsetting beams based on the target-critical structure relationship. CT and structure data of seven previous SBRT patients treated at our center were used for plan evaluation. An in-house forward planning tool was developed to aid the forward planning process. A graphical user interface (GUI) was designed with interactive and automatic adjustment between beam gantry angle and the beam weight. Dose distributions were calculated using our in-house Monte Carlo based TPS. Dose contributions from individual beam angles were summed together with different weight factors, which were continuously optimized until the pre-set dose conformity goal was met. Results: We were able to achieve target coverage and critical structure sparing to meet the required clinical criteria in all studied cases. It should be mentioned that those cases were selected having critical structures not proximal to the target. However, this was usually the case in the majority of SBRT cases especially those involving lung targets. The developed GUI tool was very useful in the forward treatment planning process. Conclusion: Conformal arcs can be used successfully on the new Cobalt 60 modality for the treatment of a sizeable fraction of cancer patients, which can be efficiently planned with our simple forward planning approach.

Development and validation of a treatment planning system for small animal radiotherapy: SmART-Plan

Background and purposeImage-guided equipment for precision irradiation of small animals for pre-clinical radiotherapy research became recently available. To enable downscaled radiotherapy studies that can be translated into human radiotherapy knowledge, a treatment planning system for pre-clinical studies is required. Material and methodsA dedicated treatment planning system (SmART-Plan) for small animal radiotherapy studies was developed. It is based on Monte Carlo simulation of particle transport in an animal. The voxel geometry is derived from the onboard cone beam CT imaging panel. SmART-Plan was validated using radiochromic film (RCF) dosimetry in various phantoms: uniform, multislab and a realistic plasticized mouse geometry. ResultsGood agreement was obtained between SmART-Plan dose calculations and RCF dose measurements in all phantoms. For various delivered plans agreement was obtained within 10% for the majority of the targeted dose region, with larger differences between 10% and 20% near the penumbra regions and for the smallest 1mm collimator. Absolute depth and lateral dose distributions showed better agreement for 5 and 15-mm collimators than for a 1-mm collimator, indicating that accurate dose prediction for the smallest field sizes is difficult. ConclusionSmART-Plan offers a useful dose calculation tool for pre-clinical small animal irradiation studies.

A dedicated treatment planning system for contrast-enhanced stereotactic synchrotron radiation therapy

Introduction Contrast-enhanced Stereotactic Synchrotron Radiation Therapy (SSRT) is an innovative technique based on localized dose-enhancement effects obtained by reinforced photoelectric absorption in the target. Medium energy monochromatic X-rays (50–100 keV) are used for irradiating tumors previously loaded with high-Z elements. SSRT clinical trials are undergoing at the European Synchrotron Radiation Facility (ESRF). The first patients are treated at 80 keV, with 10 conformational beams. A dedicated treatment planning system (TPS) was developed for this purpose, based on the ISOgray commercial TPS (Dosisoft, Cachan, France). Material and methods The PENELOPE -based Monte Carlo virtual simulation module was adapted to SSRT specificities: simulation of lower energy photons and electrons (100 keV and lower) and polarized photons. The synchrotron beamline geometry was modeled. Dedicated Phase Space Files were built. Additional materials were implemented in the patient voxelized geometry, to model the high-Z element biodistribution in the tumor. A dedicated computation method for irradiation times (instead of monitor units) was implemented. The simulation process was optimized and parallelized. This dedicated TPS was validated with depth dose curves, dose profiles and absolute dose measurements performed at the ESRF in a water tank and in solid water phantoms with or without bone slabs. A PTW semiflex ionization chamber (0.125 cm3) and gafchromic films were used for the measurements. Results The PSF based simulation has been validated against a full simulation from the virtual source to the water tank geometry. No significant difference appears, as the relative difference remains within 2%, except for low doses (under 30% of the reference dose) due to higher computation uncertainties. Computations and measurements in water match within 2% or 2 mm both in depth and laterally. Computations including a bone slab also match within 2% in depth, and 3% or 3 mm laterally. The relative difference between measured and simulated depth dose curves remains below 2% or below the 3 sigma statistical uncertainty. The c-index test (2%, 2 mm) is verified for the profiles at any depth, between −30 and 30 mm from the beam axis (5 × 5 cm 2 reference square field). Conclusion The treatment planning system was validated for dose computations in water and in presence of bone heterogeneities. The next step is to validate the TPS on dedicated clinical cases, with the presence of contrast media in the tumor.

GammaPod—A new device dedicated for stereotactic radiotherapy of breast cancer

This paper introduces a new external beam radiotherapy device named GammaPod that is dedicated for stereotactic radiotherapy of breast cancer. The design goal of the GammaPod as a dedicated system for treating breast cancer is the ability to deliver ablative doses with sharp gradients under stereotactic image guidance. Stereotactic localization of the breast is achieved by a vacuum-assisted breast immobilization cup with built-in stereotactic frame. Highly focused radiation is achieved at the isocenter due to the cross-firing from 36 radiation arcs generated by rotating 36 individual Cobalt-60 beams. The dedicated treatment planning system optimizes an optimal path of the focal spot using an optimization algorithm borrowed from computational geometry such that the target can be covered by 90%-95% of the prescription dose and the doses to surrounding tissues are minimized. The treatment plan is intended to be delivered with continuous motion of the treatment couch. In this paper the authors described in detail the gamma radiation unit, stereotactic localization of the breast, and the treatment planning system of the GammaPod system. A prototype GammaPod system was installed at University of Maryland Medical Center and has gone through a thorough functional, geometric, and dosimetric testing. The mechanical and functional performances of the system all meet the functional specifications. An image-guided breast stereotactic radiotherapy device, named GammaPod, has been developed to deliver highly focused and localized doses to a target in the breast under stereotactic image guidance. It is envisioned that the GammaPod technology has the potential to significantly shorten radiation treatments and even eliminate surgery by ablating the tumor and sterilizing the tumor bed simultaneously.

Integration of functional neuroimaging in CyberKnife radiosurgery: feasibility and dosimetric results

The integration of state-of-the-art neuroimaging into treatment planning may increase the therapeutic potential of stereotactic radiosurgery. Functional neuroimaging, including functional MRI, navigated brain stimulation, and diffusion tensor imaging-based tractography, may guide the orientation of radiation beams to decrease the dose to critical cortical and subcortical areas. The authors describe their method of integrating functional neuroimaging technology into radiosurgical treatment planning using the CyberKnife radiosurgery system. The records of all patients who had undergone radiosurgery for brain lesions at the CyberKnife Center of the University of Messina, Italy, between July 2010 and July 2012 were analyzed. Among patients with brain lesions in critical areas, treatment planning with the integration of functional neuroimaging was performed in 25 patients. Morphological and functional imaging data sets were coregistered using the Multiplan dedicated treatment planning system. Treatment planning was initially based on morphological data; radiation dose distribution was then corrected in relation to the functionally relevant cortical and subcortical areas. The change in radiation dose distribution was then calculated. The data sets could be easily and reliably integrated into the Cyberknife treatment planning. Using an inverse planning algorithm, the authors achieved an average 17% reduction in the radiation dose to functional areas. Further gain in terms of dose sparing compromised other important treatment parameters, including target coverage, conformality index, and number of monitor units. No neurological deficit due to radiation was recorded at the short-term follow-up. Radiosurgery treatments rely on the quality of neuroimaging. The integration of functional data allows a reduction in radiation doses to functional organs at risk, including critical cortical areas, subcortical tracts, and vascular structures. The relative simplicity of integrating functional neuroimaging into radiosurgery warrants further research to implement, standardize, and identify the limits of this procedure.

Optimization of Monte Carlo Code for Clinical Simulation of Electron Beams

The aim of this work is to optimize a Monte Carlo (MC) kernel for electron radiation therapy (IOERT) compatible with intraoperative usage and to integrate it within an existing IOERT dedicated treatment planning system (TPS).

TU‐E‐BRB‐03: A Treatment Planning System for Contrast‐Enhanced Stereotactic Synchrotron Radiation Therapy Clinical Trials

Purpose: Contrast‐enhanced stereotactic synchrotron radiation therapy (SSRT) is an innovative technique based on localized dose‐enhancement effects obtained by reinforced photoelectric absorption in the target. Medium energy monochromatic x‐rays (50 –100 keV) are used for irradiating tumors previously loaded with high‐Z elements. SSRT clinical trials are being prepared at the European Synchrotron Radiation Facility. The first patients are scheduled in summer‐autumn 2011. They should be treated at 80 keV, with 10 conformational beams. A dedicated treatment planning system (TPS) was developed for this purpose, based on the ISOgray commercial TPS (Dosisoft, Cachan, France).Methods: The PENELOPE‐based Monte Carlo virtual simulation module was adapted to SSRT specificities: simulation of lower energy photons and electrons (100 keV and lower) and polarized photons. The synchrotron beamline geometry was modeled. Dedicated Phase Space Files were built. Additional materials were implemented in the patient voxelized geometry, to model the high‐Z element biodistribution in the tumor. A dedicated computation method for irradiation times (instead of monitor units) was implemented. The simulation process was optimized and parallelized. This dedicated TPS was validated with depth dose curves, dose profiles and absolute dose measurements performed at the ESRF in a water tank and in solid water phantoms with or without bone slabs. A PTW semiflex ionization chamber (0.125 cm3) and gafchromic films were used for the measurements. Results: Computations and measurements in water match within 2 % or 2 mm both in depth and laterally. Computations including a bone slab also match within 2 % in depth, and 3 % or 3 mm laterally. Conclusions: The treatment planning system was validated for dose computations in water and in presence of bone heterogeneities. The last step before treating the first patients is to validate the TPS on dedicated clinical cases, with the presence of contrast media in the tumor.