Pencil Beam Convolution Research Articles

SU‐E‐T‐802: Verification of Implanted Cardiac Pacemaker Doses in Intensity‐Modulated Radiation Therapy: Dose Prediction Accuracy and Reduction Effect of a Lead Sheet

Purpose:To verify delivered doses on the implanted cardiac pacemaker, predicted doses with and without dose reduction method were verified using the MOSFET detectors in terms of beam delivery and dose calculation techniques in intensity‐modulated radiation therapy (IMRT).Methods:The pacemaker doses for a patient with a tongue cancer were predicted according to the beam delivery methods [step‐and‐shoot (SS) and sliding window (SW)], intensity levels for dose optimization, and dose calculation algorithms. Dosimetric effects on the pacemaker were calculated three dose engines: pencil‐beam convolution (PBC), analytical anisotropic algorithm (AAA), and Acuros‐XB. A lead shield of 2 mm thickness was designed for minimizing irradiated doses to the pacemaker. Dose variations affected by the heterogeneous material properties of the pacemaker and effectiveness of the lead shield were predicted by the Acuros‐XB. Dose prediction accuracy and the feasibility of the dose reduction strategy were verified based on the measured skin doses right above the pacemaker using mosfet detectors during the radiation treatment.Results:The Acuros‐XB showed underestimated skin doses and overestimated doses by the lead‐shield effect, even though the lower dose disagreement was observed. It led to improved dose prediction with higher intensity level of dose optimization in IMRT. The dedicated tertiary lead sheet effectively achieved reduction of pacemaker dose up to 60%.Conclusion:The current SS technique could deliver lower scattered doses than recommendation criteria, however, use of the lead sheet contributed to reduce scattered doses.Thin lead plate can be a useful tertiary shielder and it could not acuse malfunction or electrical damage of the implanted pacemaker in IMRT. It is required to estimate more accurate scattered doses of the patient with medical device to design proper dose reduction strategy.

SU‐E‐T‐31: A Fast Finite Size Pencil Beam (FSPB) Convolution Algorithm for a New Co‐60 Arc Therapy Machine

Purpose:Present a fast Finite Size Pencil Beam (FSPB) convolution algorithm for a new Co‐60 arc therapy machine. The FSPB algorithm accounts for (i) strong angular divergence (short SAD), (ii) heterogeneity effect for primary attenuation, and (iii) source energy spectrum.Methods:The FSPB algorithm is based on a 0.5×0.5‐cm2 dose kernel calculated using the GEPTS (Gamma Electron and Positron Transport System) Monte Carlo code. The dose kernel is tabulated using a thin XYZ mesh (0.1 mm steps in lateral directions) for radius less than 1 cm and using an RZ mesh (with varying steps) for larger radial distance. To account for SSD effect, 11 dose kernels with SSDs varying between 30 cm to 80 cm are calculated. Maynord factor and “lateral stretching” are applied to account for differences between closest and actual SSD. Appropriate rotations and second order interpolation are used to calculate the dose from a given beamlet to a point.Results:Accuracy: Dose distributions in water with 80 cm SSD are calculated using the new FSPB convolution algorithm and full Monte Carlo simulation (gold standard). Figs 1–4 show excellent agreements between FSPB and Monte Carlo calculations for different field sizes and at different depths. The dose distribution for a prostate case is calculated using FSPB (Fig.5). Sixty conformal beams with rectum blocking are assumed. Figs 6–8 show the comparison with Monte Carlo simulation based on the same beam apertures. The excellent agreement demonstrates the accuracy of the new algorithm in handling SSD variation, oblique incidence, and scatter contribution.Speed: The FSPB convolution algorithm calculates 28 million dose points per second using a single 2.2‐GHz CPU. The present algorithm is seven times faster than a similar algorithm from Gu et al. (Phys. Med. Biol. 54, 2009, 6287–6297).Conclusion:A fast and accurate FSPB convolution algorithm was developed and benchmarked.

Evaluation of the radiotherapy treatment planning in the presence of a magnetic valve tissue expander.

The combination of radiotherapy treatments and breast reconstruction, using temporary tissue expanders, generates several concerns due to the presence of a magnetic valve inside the radiation field. The objective of this work is to evaluate a radiotherapy treatment planning for a patient using a tissue expander. Isodose curve maps, obtained using radiochromic films, were compared to the ones calculated with two different dose calculation algorithms of the Eclipse radiotherapy Treatment Planning System (TPS), considering the presence or absence of the heterogeneity. The TPS calculation considering the presence of the heterogeneity shows changes around 5% in the isodose curves when they were compared with the calculation without heterogeneity correction. This calculation did not take in account the real density value of the heterogeneity. This limitation was quantified to be around 10% in comparison with the TPS calculation and experimental measurements using the radiochromic film. These results show that the magnetic valve should be taken in account in dose calculations of the TPS. With respect to the AAA and Pencil Beam Convolution algorithms, when the calculation is compared with the real distribution, AAA presents a distribution more similar to experimental dose distribution.

Impact of dose calculation accuracy during optimization on lung IMRT plan quality

The purpose of this study was to evaluate the effect of dose calculation accuracy and the use of an intermediate dose calculation step during the optimization of intensity‐modulated radiation therapy (IMRT) planning on the final plan quality for lung cancer patients. This study included replanning for 11 randomly selected free‐breathing lung IMRT plans. The original plans were optimized using a fast pencil beam convolution algorithm. After optimization, the final dose calculation was performed using the analytical anisotropic algorithm (AAA). The Varian Treatment Planning System (TPS) Eclipse v11, includes an option to perform intermediate dose calculation during optimization using the AAA. The new plans were created using this intermediate dose calculation during optimization with the same planning objectives and dose constraints as in the original plan. Differences in dosimetric parameters for the planning target volume (PTV) dose coverage, organs‐at‐risk (OARs) dose sparing, and the number of monitor units (MU) between the original and new plans were analyzed. Statistical significance was determined with a p‐value of less than 0.05. All plans were normalized to cover 95% of the PTV with the prescription dose. Compared with the original plans, the PTV in the new plans had on average a lower maximum dose (69.45 vs. 71.96 Gy, p=0.005), a better homogeneity index (HI) (0.08 vs. 0.12, p=0.002), and a better conformity index (CI) (0.69 vs. 0.59, p=0.003). In the new plans, lung sparing was increased as the volumes receiving 5, 10, and 30 Gy were reduced when compared to the original plans (40.39% vs. 42.73%, p=0.005; 28.93% vs. 30.40%, p=0.001; 14.11% vs. 14.84%, p=0.031). The volume receiving 20 Gy was not significantly lower (19.60% vs. 20.38%, p=0.052). Further, the mean dose to the lung was reduced in the new plans (11.55 vs. 12.12 Gy, p=0.024). For the esophagus, the mean dose, the maximum dose, and the volumes receiving 20 and 60 Gy were lower in the new plans than in the original plans (17.91 vs. 19.24 Gy, p=0.004; 57.32 vs. 59.81 Gy, p=0.020; 39.34% vs. 41.59%, p=0.097; 12.56% vs. 15.35%, p=0.101). For the heart, the mean dose, the maximum dose, and the volume receiving 40 Gy were also lower in new plans (11.07 vs. 12.04 Gy, p=0.007; 56.41 vs. 57.7 Gy, p=0.027; 7.16% vs. 9.37%, p=0.012). The maximum dose to the spinal cord in the new plans was significantly lower than in the original IMRT plans (29.1 vs. 31.39 Gy, p=0.014). Difference in MU between the IMRT plans was not significant (1216.90 vs. 1198.91, p=0.328). In comparison to the original plans, the number of iterations needed to meet the optimization objectives in the new plans was reduced by a factor of 2 (2–3 vs. 5–6 iterations). Further, optimization was 30% faster corresponding to an average time savings of 10–15 min for the reoptimized plans. Accuracy of the dose calculation algorithm during optimization has an impact on planning efficiency, as well as on the final plan dosimetric quality. For lung IMRT treatment planning, utilizing the intermediate dose calculation during optimization is feasible for dose homogeneity improvement of the PTV and for improvement of optimization efficiency.PACS numbers: 87.55.D‐, 87.55.de, 87.55.dk

A computerized framework for monitoring four-dimensional dose distributions during stereotactic body radiation therapy using a portal dose image-based 2D/3D registration approach

A computerized framework for monitoring four-dimensional (4D) dose distributions during stereotactic body radiation therapy based on a portal dose image (PDI)-based 2D/3D registration approach has been proposed in this study. Using the PDI-based registration approach, simulated 4D “treatment” CT images were derived from the deformation of 3D planning CT images so that a 2D planning PDI could be similar to a 2D dynamic clinical PDI at a breathing phase. The planning PDI was calculated by applying a dose calculation algorithm (a pencil beam convolution algorithm) to the geometry of the planning CT image and a virtual water equivalent phantom. The dynamic clinical PDIs were estimated from electronic portal imaging device (EPID) dynamic images including breathing phase data obtained during a treatment. The parameters of the affine transformation matrix were optimized based on an objective function and a gamma pass rate using a Levenberg–Marquardt (LM) algorithm. The proposed framework was applied to the EPID dynamic images of ten lung cancer patients, which included 183 frames (mean: 18.3 per patient). The 4D dose distributions during the treatment time were successfully obtained by applying the dose calculation algorithm to the simulated 4D “treatment” CT images. The mean±standard deviation (SD) of the percentage errors between the prescribed dose and the estimated dose at an isocenter for all cases was 3.25±4.43%. The maximum error for the ten cases was 14.67% (prescribed dose: 1.50Gy, estimated dose: 1.72Gy), and the minimum error was 0.00%. The proposed framework could be feasible for monitoring the 4D dose distribution and dose errors within a patient's body during treatment.

A clinical study of lung cancer dose calculation accuracy with Monte Carlo simulation

BackgroundThe accuracy of dose calculation is crucial to the quality of treatment planning and, consequently, to the dose delivered to patients undergoing radiation therapy. Current general calculation algorithms such as Pencil Beam Convolution (PBC) and Collapsed Cone Convolution (CCC) have shortcomings in regard to severe inhomogeneities, particularly in those regions where charged particle equilibrium does not hold. The aim of this study was to evaluate the accuracy of the PBC and CCC algorithms in lung cancer radiotherapy using Monte Carlo (MC) technology.Methods and materialsFour treatment plans were designed using Oncentra Masterplan TPS for each patient. Two intensity-modulated radiation therapy (IMRT) plans were developed using the PBC and CCC algorithms, and two three-dimensional conformal therapy (3DCRT) plans were developed using the PBC and CCC algorithms. The DICOM-RT files of the treatment plans were exported to the Monte Carlo system to recalculate. The dose distributions of GTV, PTV and ipsilateral lung calculated by the TPS and MC were compared.ResultFor 3DCRT and IMRT plans, the mean dose differences for GTV between the CCC and MC increased with decreasing of the GTV volume. For IMRT, the mean dose differences were found to be higher than that of 3DCRT. The CCC algorithm overestimated the GTV mean dose by approximately 3% for IMRT. For 3DCRT plans, when the volume of the GTV was greater than 100 cm3, the mean doses calculated by CCC and MC almost have no difference. PBC shows large deviations from the MC algorithm. For the dose to the ipsilateral lung, the CCC algorithm overestimated the dose to the entire lung, and the PBC algorithm overestimated V20 but underestimated V5; the difference in V10 was not statistically significant.ConclusionsPBC substantially overestimates the dose to the tumour, but the CCC is similar to the MC simulation. It is recommended that the treatment plans for lung cancer be developed using an advanced dose calculation algorithm other than PBC. MC can accurately calculate the dose distribution in lung cancer and can provide a notably effective tool for benchmarking the performance of other dose calculation algorithms within patients.

Fast motion-including dose error reconstruction for VMAT with and without MLC tracking

Multileaf collimator (MLC) tracking is a promising and clinically emerging treatment modality for radiotherapy of mobile tumours. Still, new quality assurance (QA) methods are warranted to safely introduce MLC tracking in the clinic. The purpose of this study was to create and experimentally validate a simple model for fast motion-including dose error reconstruction applicable to intrafractional QA of MLC tracking treatments of moving targets.MLC tracking experiments were performed on a standard linear accelerator with prototype MLC tracking software guided by an electromagnetic transponder system. A three-axis motion stage reproduced eight representative tumour trajectories; four lung and four prostate. Low and high modulation 6 MV single-arc volumetric modulated arc therapy treatment plans were delivered for each trajectory with and without MLC tracking, as well as without motion for reference. Temporally resolved doses were measured during all treatments using a biplanar dosimeter. Offline, the dose delivered to each of 1069 diodes in the dosimeter was reconstructed with 500 ms temporal resolution by a motion-including pencil beam convolution algorithm developed in-house. The accuracy of the algorithm for reconstruction of dose and motion-induced dose errors throughout the tracking and non-tracking beam deliveries was quantified.Doses were reconstructed with a mean dose difference relative to the measurements of −0.5% (5.5% standard deviation) for cumulative dose. More importantly, the root-mean-square deviation between reconstructed and measured motion-induced 3%/3 mm γ failure rates (dose error) was 2.6%. The mean computation time for each calculation of dose and dose error was 295 ms.The motion-including dose reconstruction allows accurate temporal and spatial pinpointing of errors in absorbed dose and is adequately fast to be feasible for online use. An online implementation could allow treatment intervention in case of erroneous dose delivery in both tracking and non-tracking treatments.

Stereotactic Ablative Radiation Therapy for Subcentimeter Lung Tumors: Clinical, Dosimetric, and Image Guidance Considerations

Use of stereotactic ablative radiation therapy (SABR) for subcentimeter lung tumors is controversial. We report our outcomes for tumors with diameter ≤1 cm and their visibility on cone beam computed tomography (CBCT) scans and retrospectively evaluate the planned dose using a deterministic dose calculation algorithm (Acuros XB [AXB]). We identified subcentimeter tumors from our institutional SABR database. Tumor size was remeasured on an artifact-free phase of the planning 4-dimensional (4D)-CT. Clinical plan doses were generated using either a pencil beam convolution or an anisotropic analytic algorithm (AAA). All AAA plans were recalculated using AXB, and differences among D95 and mean dose for internal target volume (ITV) and planning target volume (PTV) on the average intensity CT dataset, as well as for gross tumor volume (GTV) on the end respiratory phases were reported. For all AAA patients, CBCT scans acquired during each treatment fraction were evaluated for target visibility. Progression-free and overall survival rates were calculated using the Kaplan-Meier method. Thirty-five patients with 37 subcentimeter tumors were eligible for analysis. For the 22 AAA plans recalculated using AXB, Mean D95 ± SD values were 2.2 ± 4.4% (ITV) and 2.5 ± 4.8% (PTV) lower using AXB; whereas mean doses were 2.9 ± 4.9% (ITV) and 3.7 ± 5.1% (PTV) lower. Calculated AXB doses were significantly lower in one patient (difference in mean ITV and PTV doses, as well as in mean ITV and PTV D95 ranged from 22%-24%). However, the end respiratory phase GTV received at least 95% of the prescription dose. Review of 92 CBCT scans from all AAA patients revealed that the tumor was visualized in 82 images, and its position could be inferred in other images. The 2-year local progression-free survival was 100%. Patients with subcentimeter lung tumors are good candidates for SABR, given the dosimetry, ability to localize tumors with image guidance, and excellent local control.

A decision tool to adjust the prescribed dose after change in the dose calculation algorithm

Purpose:This work aims to introduce a method to quantify and assess the differences in monitor unites MUs when changing to new dose calculation software that uses a different algorithm, and to evaluate the need and extent of adjustment of the pr e- scribed dose to ma intain the same clinical results. Methods:Doses were calculated using two classical algorithms based on the Pencil Beam Convolution PBC model, using 6 patients presenting lung cancers. For each patient, 3 treatment plans were gene r- ated: Plan 1 wascalculated using reference algorithm PBC without heterogeneity correction, Plan 2 was calculated using test algorithm with heterogeneity correction, and in plan 3 the dose was recalculated using test algorithm and monitor unites MUs obtained from plan 1 as input. To assess the differences in the calculated MUs, isocenter dose, and spatial dose distributions u s- ing a gamma index were compared. Statistical analysis was based on a Wilcoxon signed rank test. Results:The test algorithm in plan 2 calculated signi ficantly less MUs than reference algorithm in plan 1 by on average 5%, ( p<0.001). We also found unde r- estimating dose for target volumes using 3D gamma index analysis. In this example, in order to obtain the same clinical ou t- comes with the two algorithms the prescribed dose should be adjusted by 5%.This method provides a quantitative evaluation of the differences between two dose calculation algorithms and the consequences on the prescribed dose. It could b e used to adjust the prescribed dose when changing calculation software to maintain the same clinical results as obtained with the former software. In particular, the gamma evaluation could be applied to any situation where changes in the dose calculation occur in radiotherapy.

The choice of statistical methods for comparisons of dosimetric data in radiotherapy.

PurposeNovel irradiation techniques are continuously introduced in radiotherapy to optimize the accuracy, the security and the clinical outcome of treatments. These changes could raise the question of discontinuity in dosimetric presentation and the subsequent need for practice adjustments in case of significant modifications. This study proposes a comprehensive approach to compare different techniques and tests whether their respective dose calculation algorithms give rise to statistically significant differences in the treatment doses for the patient.MethodsStatistical investigation principles are presented in the framework of a clinical example based on 62 fields of radiotherapy for lung cancer. The delivered doses in monitor units were calculated using three different dose calculation methods: the reference method accounts the dose without tissues density corrections using Pencil Beam Convolution (PBC) algorithm, whereas new methods calculate the dose with tissues density correction for 1D and 3D using Modified Batho (MB) method and Equivalent Tissue air ratio (ETAR) method, respectively. The normality of the data and the homogeneity of variance between groups were tested using Shapiro-Wilks and Levene test, respectively, then non-parametric statistical tests were performed. Specifically, the dose means estimated by the different calculation methods were compared using Friedman’s test and Wilcoxon signed-rank test. In addition, the correlation between the doses calculated by the three methods was assessed using Spearman’s rank and Kendall’s rank tests.ResultsThe Friedman’s test showed a significant effect on the calculation method for the delivered dose of lung cancer patients (p <0.001). The density correction methods yielded to lower doses as compared to PBC by on average (−5 ± 4.4 SD) for MB and (−4.7 ± 5 SD) for ETAR. Post-hoc Wilcoxon signed-rank test of paired comparisons indicated that the delivered dose was significantly reduced using density-corrected methods as compared to the reference method. Spearman’s and Kendall’s rank tests indicated a positive correlation between the doses calculated with the different methods.ConclusionThis paper illustrates and justifies the use of statistical tests and graphical representations for dosimetric comparisons in radiotherapy. The statistical analysis shows the significance of dose differences resulting from two or more techniques in radiotherapy.

A 3D quantitative evaluation for assessing the changes of Treatment Planning System and irradiation techniques in radiotherapy

Purpose: This work proposes and compares two 3D global evaluation methods for assessing the alteration of calculated dose distributions when treatment planning system algorithms or irradiation techniques is modified in radiation therapy. Methods : The global analysis is based on gamma index (γ) proposed by Low et al . 1 and Chi (χ) index proposed by Bakai et al . 2 . The γ and χ values are signed in order to identify the over and under estimating dosage. The 3D maps, the cumulative Gamma Voxels Histograms (GVHs) and Chi Voxels Histograms (CVHs) were generated using two software. The γ and χ criteria were set to 3 mm for the distance to agreement and 3% for dose. Pearson's Chi-squared test was applied to assess the statistically significance between GVHs and CVHs. We illustrated this method for the change of dose calculation algorithms for lung cancer, and the change of irradiation techniques for breast cancer. For each patient, 2 treatment plans were generated. For the example of change of dose calculation algorithms, a plan 1 was calculated using Pencil Beam Convolution (PBC) algorithm and a plan 2 was calculated using Modified Batho method (PBC-MB). For the example of change of irradiation technique, a plan 1 was calculated using Source Skin Distance SSD technique and a plan 2 was calculated using a single isocenter technique. Results: The 3D analysis based on γ and χ indexes showed a significant effect on the dosimetric representation in the lung cancer when we change the PBC algorithm to PBC-MB method. The comparison between the two irradiation techniques showed that the single isocenter technique produces a better dose distribution for the treatment of breast cancer. Pearson's Chi-squared test showed that there was no statistically significance between GVHs and CVHs generated by γ and χ indexes, ( p &gt; 0.05). The global analysis using 3D for γ and χ indexes confirmed the results obtained from dosimetric analysis. Conclusion : The methods proposed in this study provide useful tools for radiotherapy to compare two dose distributions obtained using different algorithms or different irradiation techniques. The χ-index was (~190) times faster than γ-index. The χ-index is thus a valuable and more convenient method for 3D global analysis compared with γ-index. ------------------------ Cite this article as: Chaikh A, Giraud JY, Balosso J. A 3D quantitative evaluation for assessing the changes of treatment planning system and irradiation techniques in radiotherapy. Int J Cancer Ther Oncol 2014; 2 (3):02033. DOI : 10.14319/ijcto.0203.3

Irradiation of lung and esophagus tumors: A comparison of dose distributions calculated by anisotropic analytical algorithm and pencil beam convolution algorithm, a retrospective dosimetric study

Purpose: The aim of this study was to evaluate dosimetric differences between pencil beam convolution (PBC) algorithm and anisotropic analytical algorithm (AAA) calculations in patients with lung and esophageal cancers. Methods : The existing plans calculated with PBC for 60 patients treated in 2012 were recalculated with AAA maintaining the same beam geometry and dose monitor units. For these plans, dose prescription ranges were 41.4 Gy to 56.0 Gy for esophageal cancers and 50.0 Gy to 64.0 Gy for lung cancers. Dosimetric variables were the 95% PTV coverage, mean PTV dose, maximum spinal cord dose, lung V 5Gy , and lung V 20Gy . Results: The 95% PTV coverage’s for both lung and esophageal tumors were reduced when recalculated with AAA. Maximum spinal cord doses for lung cancer patients were reduced by 0.7 Gy and by 0.3 Gy for esophageal cancer patients on AAA. On the other hand, lung V 5Gy had 3.5% increase for both lung and esophageal cancer patients on AAA, whereas lung V 20Gy increased by 1.5% also on AAA for esophageal cancer patients. Conclusion : These clinical results confirm the differences between AAA and PBC algorithms as observed in phantom dosimetric studies, and give an indication of the clinical implications of changing from one calculation algorithm to another. --------------------------------------- Cite this article as: Amankwaa-Frempong E, Vernimmen F, Blay S, Ezhilalan R. Irradiation of lung and esophagus tumors: A comparison of dose distributions calculated by anisotropic analytical algorithm and pencil beam convolution algorithm, a retrospective dosimetric study. Int J Cancer Ther Oncol 2014; 2(2):020210. DOI: 10.14319/ijcto.0202.10

In vivo verification of radiation dose delivered to healthy tissue during radiotherapy for breast cancer

Different treatment planning system (TPS) algorithms calculate radiation dose in different ways. This work compares measurements made in vivo to the dose calculated at out-of-field locations using three different commercially available algorithms in the Eclipse treatment planning system. LiF: Mg, Cu, P thermoluminescent dosimeter (TLD) chips were placed with 1 cm build-up at six locations on the contralateral side of 5 patients undergoing radiotherapy for breast cancer. TLD readings were compared to calculations of Pencil Beam Convolution (PBC), Anisotropic Analytical Algorithm (AAA) and Acuros XB (XB). AAA predicted zero dose at points beyond 16 cm from the field edge. In the same region PBC returned an unrealistically constant result independent of distance and XB showed good agreement to measured data although consistently underestimated by ~0.1 % of the prescription dose. At points closer to the field edge XB was the superior algorithm, exhibiting agreement with TLD results to within 15 % of measured dose. Both AAA and PBC showed mixed agreement, with overall discrepancies considerably greater than XB. While XB is certainly the preferable algorithm, it should be noted that TPS algorithms in general are not designed to calculate dose at peripheral locations and calculation results in such regions should be treated with caution.

Performance of dose calculation algorithms from three generations in lung SBRT: comparison with full Monte Carlo‐based dose distributions

The accuracy of dose calculation is a key challenge in stereotactic body radiotherapy (SBRT) of the lung. We have benchmarked three photon beam dose calculation algorithms — pencil beam convolution (PBC), anisotropic analytical algorithm (AAA), and Acuros XB (AXB) — implemented in a commercial treatment planning system (TPS), Varian Eclipse. Dose distributions from full Monte Carlo (MC) simulations were regarded as a reference. In the first stage, for four patients with central lung tumors, treatment plans using 3D conformal radiotherapy (CRT) technique applying 6 MV photon beams were made using the AXB algorithm, with planning criteria according to the Nordic SBRT study group. The plans were recalculated (with same number of monitor units (MUs) and identical field settings) using BEAMnrc and DOSXYZnrc MC codes. The MC‐calculated dose distributions were compared to corresponding AXB‐calculated dose distributions to assess the accuracy of the AXB algorithm, to which then other TPS algorithms were compared. In the second stage, treatment plans were made for ten patients with 3D CRT technique using both the PBC algorithm and the AAA. The plans were recalculated (with same number of MUs and identical field settings) with the AXB algorithm, then compared to original plans. Throughout the study, the comparisons were made as a function of the size of the planning target volume (PTV), using various dose‐volume histogram (DVH) and other parameters to quantitatively assess the plan quality. In the first stage also, 3D gamma analyses with threshold criteria 3%/3 mm and 2%/2 mm were applied. The AXB‐calculated dose distributions showed relatively high level of agreement in the light of 3D gamma analysis and DVH comparison against the full MC simulation, especially with large PTVs, but, with smaller PTVs, larger discrepancies were found. Gamma agreement index (GAI) values between 95.5% and 99.6% for all the plans with the threshold criteria 3%/3 mm were achieved, but 2%/2 mm threshold criteria showed larger discrepancies. The TPS algorithm comparison results showed large dose discrepancies in the PTV mean dose (D50%), nearly 60%, for the PBC algorithm, and differences of nearly 20% for the AAA, occurring also in the small PTV size range. This work suggests the application of independent plan verification, when the AAA or the AXB algorithm are utilized in lung SBRT having PTVs smaller than 20‐25 cc. The calculated data from this study can be used in converting the SBRT protocols based on type ‘a’ and/or type ‘b’ algorithms for the most recent generation type ‘c’ algorithms, such as the AXB algorithm.PACS numbers: 87.55.‐x, 87.55.D‐, 87.55.K‐, 87.55.kd, 87.55.Qr

Correlation between target volume and electron transport effects affecting heterogeneity corrections in stereotactic body radiotherapy for lung cancer

Recently, stereotactic body radiotherapy (SBRT) for lung cancer is conducted with heterogeneity-corrected treatment plans, as the correction greatly affects the dose delivery to the lung tumor. In this study, the correlation between the planning target volume (PTV) and the dose delivery is investigated by separation of the heterogeneity correction effects into photon attenuation and electron transport. Under Institutional Review Board exemption status, 74 patients with lung cancer who were treated with SBRT were retrospectively evaluated. All treatment plans were generated using an anisotropic analytical algorithm (AAA) of an Eclipse (Varian Medical Systems, Palo Alto, CA) treatment planning system. Two additional plans were created using the same treatment parameters (monitor units, beam angles and energy): a plan with no heterogeneity correction (NC), and a plan calculated with a pencil beam convolution algorithm (PBC). Compared with NC, AAA and PBC isocenter doses were on average 13.4% and 21.8% higher, respectively. The differences in the isocenter dose and the dose coverage for 95% of the PTV (D95%) between PBC and AAA were correlated logarithmically (ρ = 0.78 and ρ = 0.46, respectively) with PTV. Although D95% calculated with AAA was in general 2.9% larger than that for NC, patients with a small PTV showed a negative ΔD95% for AAA due to the significant effect of electron transport. The PTV volume shows logarithmic correlation with the effects of the lateral electron transport. These findings indicate that the dosimetric metrics and prescription, especially in clinical trials, should be clearly evaluated in the context of target volume characteristics and with proper heterogeneity correction.

Clinical implications of different calculation algorithms in breast radiotherapy: A comparison between pencil beam and collapsed cone convolution

BackgroundThis investigation focused on the clinical implications of the use of the Collapsed Cone Convolution algorithm (CCC) in breast radiotherapy and investigated the dosimetric differences as respect to Pencil Beam Convolution algorithm (PBC). Material and methods15 breast treatment plans produced using the PBC algorithm were re-calculated using the CCC algorithm with the same MUs. In a second step, plans were re-optimized using CCC algorithm with modification of wedges and beam weightings to achieve optimal coverage (CCCr plans). For each patient, dosimetric comparison was performed using the standard tangential technique (SWT) and a forward-planned IMRT technique (f-IMRT). ResultsThe CCC algorithm showed significant increased dose inhomogeneity. Mean and minimum PTV doses decreased by 1.4% and 2.8% (both techniques). Mean V95% decreased to 83.7% and 90.3%, respectively for the SWT and f-IMRT. V95% was correlated to the ratio of PTV and lung volumes into the treatment field. The re-optimized CCCr plans achieved similar target coverage, but high-dose volume was significantly larger (V107%: 7.6% vs 2.3% (SWT), 7.1% vs 2.1% (f-IMRT). There was a significantly increase in the ipsilateral lung volume receiving low doses (V5 Gy: 31.3% vs 26.2% in SWT, 27.0% vs 23.0% in f-IMRT). MUs needed for PTV coverage in CCCr plans were higher by 3%. ConclusionsThe PBC algorithm overestimated PTV coverage in terms of all important dosimetric metrics. If previous clinical experience are based on the use of PBC model, especially needed is discussion between medical physicists and radiation oncologists to fully understand the dosimetric changes.

A method to quantify and assess the dosimetric and clinical impact resulting from the heterogeneity correction in radiotherapy for lung cancer

Purpose: The aim of this study was to propose a method to quantify and assess the differences in dose computations using heterogeneity correction algorithms for the planning target volumes and organs at risk. Methods: Six patients with lung cancer treated with 3-dimensional conformal radiation therapy were included and analysed. Dose calculations were performed using the pencil beam convolution (PBC) algorithm without heterogeneity correction and the Modified Batho method (PBC-MB) with heterogeneity correction. For each patient, 3 treatment plans were generated using exactly the same beam configuration. In plan 1, the dose was calculated using the PBC algorithm. In plan 2, the dose was calculated using the PBC-MB. In plan 3, the dose was calculated using the PBC-MB method but with the same number of monitor units obtained from plan 1. To evaluate the treatment plans computed by the PBC and PBC-MB, the monitor units, dose at the isocenter, spatial isodose distribution, dose volume histograms, conformity index, homogeneity index, planning target volumes conformity index, and geometrical index were compared. A statistical analysis was carried out using Wilcoxon signed rank test. Results: The PBC-MB method in plan 2 produced a lower number of monitor units than in plan 1 using PBC algorithm (p &lt; 0.001). Dosimetric parameters derived from the dose volume histograms were higher for the planning target volumes and organs at risks using PBC-MB method for plans 2 and 3 when compared to plan 1. There was no significant difference for all the quality indices between plan 1 and plan 2, (p &gt; 0.05), but a significant difference for the geometric index between plans 2 and 3 (p = 0.002) was observed. Conclusion: The risks related to the modification from the homogeneity plan to the heterogeneity plan were the reduction of delivered dose in monitor units for the planning target volumes and the increment of the dose to the organs at risk. We suggest the adaption in the dose prescriptions when switching the dose calculation algorithm from the PBC to PBC-MB. ------------------------------------------------------ Cite this article as: Chaikh A, Giraud J, Balosso J. A method to quantify and assess the dosimetric and clinical impact resulting from the heterogeneity correction in radiotherapy for lung cancer. Int J Cancer Ther Oncol 2014; 2 (1):020110. DOI : http://dx.doi.org/10.14319/ijcto.0201.10

Limitation of Pencil Beam Convolution (PBC) Algorithm for Photon Dose Calculations in Inhomogeneous Medium

Purpose: The main purpose of this study is to investigate the accuracy of pencil beam convolution (PBC) algorithm when high-density inhomogeneity is involved along the photon beam path. This study will help the PBC users understand the limitation of PBC during the treatment planning of real cancer treatment plans, especially when tumor is located beyond high-density tissue such as bone. Methods: Inhomogeneous phantom (30 cm x 30 cm, 17 cm deep) with a 5 cm thick solid water as the top layer followed by 5 cm thick PVC and 7 cm solid water was manufactured for depth dose calculations and measurements. Data were obtained beyond PVC medium for three field sizes: 5 x 5 cm2, 10 x 10 cm2, and 20 x 20 cm2. Dose calculations were performed using PBC and measurements were done using chamber. Measured and calculated data were compared against each other. Results: PBC produced dose prediction errors beyond high density medium by 3.7% to 7.3% for field size 5 x 5 cm2, by 4.8% to 6.9% for field size 10 x 10 cm2, and by 5.9% to 7.3% for field size 20 x 20 cm2. The results of this study, however, showed no clear dependency on the field size. Similarly, difference between the PBC and measurements did not show a clear trend when results at various points were compared with each other. Conclusion: PBC can overestimate the dose by up to 7.3% beyond high-density medium. High density materials such metallic immobilization devices must be avoided in the beam path during the patient treatment.

Dosimetric verification of enhanced dynamic wedges by a 2D ion chamber array

Wedge filters are commonly used to achieve dose uniformity in the target volume in radiotherapy and can be categorized as physical wedges (PWs) and enhanced dynamic wedges (EDWs). The EDW generates PW-like dose profiles while moving the upper jaw in the Y directions with a varying dose rate in the treatment beams. Task Group 53 of the AAPM (American Association of Physicists in Medicine) recommended that the dynamic wedge be verified before implementation in the radiation treatment planning (RTP) system. The aim of this study was to use the I’mRT MatriXX to verify the dose profiles of the EDWs manufactured by Varian. We used Pencil Beam Convolution algorithms (eclipse 8.6) for the calculation and I’mRT MatriXX with Plastic Water® phantom MULTICube for dose measurements. The gamma indices of the calculations and the measurements for the EDWs were 84.84% and 86.54% in 2%/2 mm tolerance, and 99.47% and 99.64% in 3%/3 mm tolerance for wedge angles of 15°, 30°, 45° and 60°, respectively. The dose distributions differed between the calculations using the system and the measurements in the penumbra and the outer beam regions of the wedge fields. We confirmed that the dosimetric verifications of the EDW were acceptable when using the criterion for external beam dose calculations of Task Group 53.

Influence of different dose calculation algorithms on the estimate of NTCP for lung complications

Due to limitations and uncertainties in dose calculation algorithms, different algorithms can predict different dose distributions and dose‐volume histograms for the same treatment. This can be a problem when estimating the normal tissue complication probability (NTCP) for patient‐specific dose distributions. Published NTCP model parameters are often derived for a different dose calculation algorithm than the one used to calculate the actual dose distribution. The use of algorithm‐specific NTCP model parameters can prevent errors caused by differences in dose calculation algorithms. The objective of this work was to determine how to change the NTCP model parameters for lung complications derived for a simple correction‐based pencil beam dose calculation algorithm, in order to make them valid for three other common dose calculation algorithms. NTCP was calculated with the relative seriality (RS) and Lyman‐Kutcher‐Burman (LKB) models. The four dose calculation algorithms used were the pencil beam (PB) and collapsed cone (CC) algorithms employed by Oncentra, and the pencil beam convolution (PBC) and anisotropic analytical algorithm (AAA) employed by Eclipse. Original model parameters for lung complications were taken from four published studies on different grades of pneumonitis, and new algorithm‐specific NTCP model parameters were determined. The difference between original and new model parameters was presented in relation to the reported model parameter uncertainties. Three different types of treatments were considered in the study: tangential and locoregional breast cancer treatment and lung cancer treatment. Changing the algorithm without the derivation of new model parameters caused changes in the NTCP value of up to 10 percentage points for the cases studied. Furthermore, the error introduced could be of the same magnitude as the confidence intervals of the calculated NTCP values. The new NTCP model parameters were tabulated as the algorithm was varied from PB to PBC, AAA, or CC. Moving from the PB to the PBC algorithm did not require new model parameters; however, moving from PB to AAA or CC did require a change in the NTCP model parameters, with CC requiring the largest change. It was shown that the new model parameters for a given algorithm are different for the different treatment types.PACS numbers: 87.53.‐j, 87.53.Kn, 87.55.‐x, 87.55.dh, 87.55.kd