Three-dimensional Radiotherapy Treatment Planning Research Articles

Study on esophageal cancer radiotherapy dosimetry and position verification for volumetric modulated arc therapy

BackgroundThis study analyzed the respective advantages and disadvantages by comparing volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) on the dose distribution and position verification distribution characteristics in esophageal cancer radiotherapy, in order to provide the reference for the clinical radiotherapy technology optimization of esophageal cancer. MethodsA total of 56 cases of patients with esophageal cancer were selected and applied to the Pinnacle three-dimensional radiation treatment planning system (TPS), in order to design a VMAT plan and IMRT plan under the guidance of image-guided radiotherapy (IGRT). The dosimetry and position verification difference were compared between the two groups. ResultsRevealed that the target dose distribution of the VMAT plan and IMRT plan meets the requirements in clinical dosimetry for all 56 patients in this study. Under the premise of similar target coverage, the conformal index (CI) of the VMAT plan, homogeneity index (HI), target volume, BODY-PTV radiated volume and spinal cord Dmax, bilateral lung V5, V20 and mean lung dose (MLD), monitor unit (MU) and treatment time (TT), as well as position verification and others, were obviously superior to those in the IMRT plan; and the difference was statistically significant. ConclusionCBCT guided VMAT is a potential effective treatment for esophageal cancer and may be more effective and safer than IMRT.

Comparative evaluation of respiratory-gated and ungated FDG-PET for target volume definition in radiotherapy treatment planning for pancreatic cancer

ObjectiveThe purpose of this study was to evaluate the usefulness of respiratory-gated positron emission tomography (4D-PET) in pancreatic cancer radiotherapy treatment planning (RTTP). Materials and methodsFourteen patients with 18F-fluorodeoxyglucose (FDG)-avid pancreatic tumours were evaluated between December 2013 and March 2015. Two sets of volumes were contoured for the pancreatic tumour of each patient. The biological target volume in three-dimensional RTTP (BTV3D) was contoured using conventional respiratory un-gated PET. The BTV3D was then expanded using population-based margins to generate a series of internal target volume 3D (ITV3D) values. The ITV 4D (ITV4D) was contoured using 4D-PET. Each of the five phases of 4D-PET was used for 4D contouring, and the ITV4D was constructed by summing the volumes defined on the five individual 4D-PET images. The relative volumes and normalized volumetric overlap were computed between ITV3D and ITV4D. ResultsOn average, the FDG-avid tumour volumes were 1.6 (range: 0.8–2.3) fold greater in the ITV4D than in the BTV3D. On average, the ITV3D values were 2.0 (range: 1.1–3.4) fold larger than the corresponding ITV4D values. ConclusionThe ITV generated from 4D-PET can be used to improve the accuracy or reduce normal tissue irradiation compared with conventional un-gated PET-based ITV.

Addition of magnetic resonance imaging to computed tomography-based three-dimensional conformal radiotherapy planning for postoperative treatment of astrocytomas: Changes in tumor volume and isocenter shift.

Introduction:Postoperative radiotherapy is the current gold standard treatment in astrocytomas. Computed tomography (CT)-based radiotherapy planning leads to either missing of the tumor volume or underdosing. The aim of this prospective study was to study the changes in tumor volume on addition of magnetic resonance imaging (MRI) to CT-based three-dimensional radiotherapy treatment planning of astrocytomas.Materials and Methods:Twenty-five consecutive patients of astrocytoma (WHO grades I-IV) for postoperative three-dimensional conformal radiotherapy were included in this prospective study. Postoperative tumor volumes were contoured on CT-based images and recontoured on CT-MRI images after automated MRI co-registration on treatment planning system Eclipse 8.9.15 as per ICRU-50 report. Tumor volumes were compared with each other.Result:The MRI-based mean and median tumor volume was 24.24 cc ± 13.489 and 18.72 cc (range 5.6–46.48 cc), respectively, while for CT it was 19.4 cc ± 11.218 and 16.24 cc (range: 5.1-38.72 cc), respectively. The mean and median isocenter shift between CT and MRI was 4.05 mm and 4.39 mm (range 0.92–6.32 mm), respectively. There is a linear relationship between MRI and CT volume with a good correlation coefficient of R2 = 0.989, and MRI-based tumor volume was 1.208 times as compared to CT volume. Statistical analysis using paired sample t-test for the difference in CT and MRI tumor volume was highly significant (P < 0.001).Conclusion:Addition of MRI to the CT-based three-dimensional radiation treatment planning reduces the chances of geographical miss or tumor under dosing. Thus, MRI should be an integral part of three-dimensional planning of astrocytomas.

Deterministic photon kerma distribution based on the Boltzmann equation for external beam radiation therapy

A photon transport algorithm for fully three-dimensional radiotherapy treatment planning has been developed based on the discrete ordinates (SN) solution of the Boltzmann equation. The algorithm is characterized by orthogonal adaptive meshes, which place additional points where large gradients occur and a procedure to evaluate the collided flux using the representation of spherical harmonic expansion instead of the summation of the volume-weighted contribution from discrete angles. The Boltzmann equation was solved in the form of SN spatial, energy, and angular discretization with mitigation of ray effects by the first-collision source method. Unlike existing SN codes, which were designed for general purpose for multiparticle transport in areas such as nuclear engineering, our code is optimized for medical radiation transport. To validate the algorithm, several examples were employed to calculate the photon flux distribution. Numerical results show good agreement with the Monte Carlo calculations using EGSnrc.

Evaluating Commercially Available Three-Dimensional Radiotherapy Treatment Planning Systems.

Over the past year we have developed two similar questionnaires on three-dimensional radiotherapy treatment planning (3DRTP) systems and used them to conduct a study of the function and features of commercially available 3DRTP systems. The issues which we reviewed to develop these questionnaires are important to all current and potential users of 3DRTP systems. The items identified in this article should aid readers in developing their own review questionnaire based on the items we discuss as well as their own clinical practice. Because it is not possible to develop a universal questionnaire that will satisfy every clinic because of site-specific treatment techniques and capabilities, this information should aid an institution contemplating the purchase of such a system to develop their own specific set of questions to aid them in their system selection. We believe that a high-level checklist of this nature will prove quite helpful to those institutions preparing to purchase such a system.

Photon Dose Calculations for Three-Dimensional Radiation Treatment Planning.

I n the treatment of cancer with radiation, the radiation oncologist is faced with the problem of prescribing a treatment regime that either cures or controls the disease, but does not inflict serious complications to the patient. The difficulty of this task is illustrated by the dose-response relationships between tumor/normal tissues and the radiation dose delivered. In general, published clinical and experimental results show tumor control or normal tissue effect response as a very steep function of radiation dose. For example, a small change in the dose delivered (*5%) can result in a dramatic change in the local response of the tissue (+ZO%).‘~* Moreover, the prescribed curative doses are often close to the dose tolerated by the normal tissue. Thus, for optimum treatment, the radiation dose must be planned and delivered with a high degree of accuracy. While it is difficult to assess how accurate the overall process should be, the International Commission on Radiation Units and Measurements (ICRU) recommends that dose be delivered with an error less than ?5%.3 Thus, each step (eg, machine calibration, patient positioning, dose calculation) needs to be performed to an accuracy much better than +5%. For the dose-calculation step, the necessary accuracy is believed to be on the order of 2% to 3%.4 Today, most computerized planning of radiation therapy is still treated as a two-dimensional problem because of technical limitations of the planning computer, even though it is recognized that the relationship of the tumor and neighboring normal critical structures is an inherently three-dimensional problem.5 However, in recent years the availability of affordable higher performance computers and graphics devices has greatly spurred the development of

A study of multi-modality imaging for three-dimensional radiotherapy treatment planning of brain tumors

Integration of information from multiple imaging modalities like CT/MRI/SPECT/PET helps in management of cancer, from tumor detection to assessment of treatment efficacy since each imaging modality provides unique information about the tumor and normal structures. This Ph.D. study has been aimed at evaluation of multi-modality imaging in target localization and radiation treatment planning in patients with malignant glioma undergoing radiotherapy. Variations of gross tumor and the edema volumes delineated by a radiologist on CT and MRI scans were addressed. These scans were registered and transferred to the treatment planning system (TPS) using Windows based automatic image registrationsoftware developed in house using AIR routines (Roger Woods, UCLA). QA tests were designed and tested for the 3D automatic target expansion algorithm of the treatment planning system. The influences of variation of target volumes in CT and MRIimages on cumulative dose distribution were also analyzed.Software for quantitative analysis of DVHs has been developed (for Isis-3D TPS) and results showed the importance of incorporation of targets from multiple imaging modalities. A novel approach to study the radiation-induced changes in normal appearing white matter (NAWM) using T2 and magnetization transfer ratio (MTR) maps was developed. The study demonstrated dose-dependent changes of the MTR values and reversal of MTR values seen for doses Gy . However, the T2 maps did not show any dose depended changes within the time period studied. The following in-house software tools were developed to accomplish various tasks of the thesis work: (a) Windows based automatic image registration (AIR) of multi-modality images suitable for radiotherapy planning, (b) to preprocess “bitmap” images from film scanner suitable for AIR software, (c) to transfer registered “tiff” images into the Isis-3D planning system, (d) quantitative analysis of DVH curves generated by the Isis-3D system, and (e) quantitative analysis of sequential MRI scans to generate and analyze T2, MTR, and ADC maps. These software tools, along with source codes, can be freely supplied upon request to the author.

Three-dimensional treatment planning using electrocardiographically gated multi-detector row CT

Purpose Information concerning the amount and nature of target motion is essential for the determination of internal margin size. However, there are few published reports outlining the motion with heart and aortic pulsation. We introduce a method for three-dimensional radiation treatment planning (3D-RTP) by using electrocardiographically (ECG) gated spiral scanning with a four-section CT system. We describe a new approach to visualize internal organ motion resulting from cardiac motion with ECG gated multidetector row CT. Methods and materials Five patients with lung or liver tumors were studied with a multidetector row CT system under shallow inspiration breath-holding. With retrospective ECG gating, only data acquired within a predefined interval of the cardiac cycle are used for image reconstruction. All reconstructed image data at diastolic and systolic phases of the cardiac cycle were transferred to the 3D-RTP system. The shift of the internal organs between the cardiac cycles was evaluated. Results Cardiac contraction influences anterior thorax, pulmonary peripheral vessels, and liver position, in addition to locations near the heart. Apparent movements more than 5 mm between diastolic and systolic phases were observed in the left ventricle, right atrium, and superior vena cava. Two-phase imaging was useful for showing the movement of internal organs during cardiac contraction under breath-holding. Conclusion Spatial information using ECG-gated CT has the potential to determine the planning target volume of moving lung and liver tumors more precisely than conventional CT planning.

Monitor unit calculation for tangential breast treatments: Verification in an anthropomorphic phantom

This paper presents an anthropomorphic phantom study of dose delivered to a specific point during tangential breast irradiation to verify monitor unit calculations. Measurements were made using a 0.6 cc Farmer type cylindrical ionization chamber in the phantom and compared to calculations made on a three-dimensional radiotherapy treatment planning system using single digitized contour through to multi slice CT data. A large breast phantom was used for a single field size with a combination of open and wedged fields for three different energies (4, 6, and 18 MV). Solid flat phantom measurements were also performed for comparison. Results showed a lower calculated dose than the dose measured for a fixed number of monitor units where the variations were within a range of 0.8% to 4.5%. Differences were larger for the anthropomorphic phantom than the flat phantom. We conclude that little accuracy is gained from CT based monitor unit calculations compared to those based on digitised contours for this breast treatment but that the dose distributions will be affected. This type of test is recommended as one of a large set, in the commissioning and testing procedures for treatment planning systems. PACS number(s): 87.52.Df, 87.53.Dq, 87.53.Xd

Monitor unit calculation for tangential breast treatments: Verification in an anthropomorphic phantom

This paper presents an anthropomorphic phantom study of dose delivered to a specific point during tangential breast irradiation to verify monitor unit calculations. Measurements were made using a 0.6 cc Farmer type cylindrical ionization chamber in the phantom and compared to calculations made on a three‐dimensional radiotherapy treatment planning system using single digitized contour through to multi slice CT data. A large breast phantom was used for a single field size with a combination of open and wedged fields for three different energies (4, 6, and 18 MV). Solid flat phantom measurements were also performed for comparison. Results showed a lower calculated dose than the dose measured for a fixed number of monitor units where the variations were within a range of 0.8% to 4.5%. Differences were larger for the anthropomorphic phantom than the flat phantom. We conclude that little accuracy is gained from CT based monitor unit calculations compared to those based on digitised contours for this breast treatment but that the dose distributions will be affected. This type of test is recommended as one of a large set, in the commissioning and testing procedures for treatment planning systems.PACS number(s): 87.52.Df, 87.53.Dq, 87.53.Xd

Use of an implanted marker and real-time tracking of the marker for the positioning of prostate and bladder cancers

Purpose: A real-time tracking radiotherapy was investigated to assess its usefulness in precise localization and verification of prostate and bladder cancers. Methods and Materials: The real-time tracking radiation therapy (RTRT) system consists of implantation of a 2.0-mm gold marker into a clinical target volume (CTV), three-dimensional radiation treatment planning (3DRTP) system, and the use of two sets of diagnostic x-ray television systems in the linear accelerator room, image processing units, and an image display unit. The position of the patient can be corrected by adjusting the actual marker position to the planned marker position, which has been transferred from the 3DRTP and superimposed on the fluoroscopic image on the display unit of the RTRT system. The position of the markers can be visualized during irradiation and after treatment delivery to verify the accuracy of the localization. Ten patients with prostate cancer and 5 patients with bladder cancer were examined using this system for the treatment setup on 91 occasions. Results: After manual setup using skin markers, the median of absolute value of discrepancies between the actual position of the marker and the planned position of the marker for prostate cancer was 3.4 (0.1–8.9) mm, 4.1 (0.2–18.1) mm, and 2.3 (0.0–10.6) mm for the lateral, anteroposterior, and craniocaudal directions, respectively. The 3D median distance between the actual and planned positions of the marker was 6.9 (1.1–18.2) mm for prostate cancer and 6.9 (1.7–18.6) mm for bladder cancer. After relocation using RTRT, the 3D distance between the actual and planned position of the marker was 0.9 ± 0.9 mm. Median 3D distances between actual positions after treatment delivery and planned positions were 1.6 (0.0–6.3) mm and 2.0 (0.5–8.0) mm during daily radiotherapy for the marker in patients with prostate cancer and bladder cancer, respectively. Conclusion: We believe the new positioning system can reduce uncertainty due to setup error and internal organ motion, although further improvement is needed for the system to account for the rotational and elastic changes of the affected tissues.

Linear programming based on neural networks for radiotherapy treatment planning

In this paper, we propose a neural network model for linear programming that is designed to optimize radiotherapy treatment planning (RTP). This kind of neural network can be easily implemented by using a kind of `neural' electronic system in order to obtain an optimization solution in real time. We first give an introduction to the RTP problem and construct a non-constraint objective function for the neural network model. We adopt a gradient algorithm to minimize the objective function and design the structure of the neural network for RTP. Compared to traditional linear programming methods, this neural network model can reduce the time needed for convergence, the size of problems (i.e., the number of variables to be searched) and the number of extra slack and surplus variables needed. We obtained a set of optimized beam weights that result in a better dose distribution as compared to that obtained using the simplex algorithm under the same initial condition. The example presented in this paper shows that this model is feasible in three-dimensional RTP.

A quality assurance phantom for three-dimensional radiation treatment planning

Purpose: Three-dimensional (3D) radiation treatment planning is facilitated through the use of computerized radiation treatment planning systems (RTPSs) and CT simulators (CT-sims). Quality assurance (QA) of these systems is necessary for ensuring that they fulfill their potential. However, comprehensive tools for the systematic QA of these systems have not been developed. We present a phantom that facilitates the evaluation of a large number of nondosimetric functions. These include CT image acquisition and transfer, graphical displays of 3D radiation beams, multiplanar CT image reconstructions, digitally reconstructed radiographs, the representation and manipulation of contoured patient anatomy, dose volume histograms, and the conversion of CT numbers to relative electron densities. Methods and Materials: A phantom was constructed which contains materials and geometries that are appropriate for the routine QA of the features described above. The anatomy of the phantom is used as a standard against which the performance of the 3D-RTPS or CT-sim is evaluated. The phantom was used to evaluate three different 3D-RTPSs and a CT-sim at four institutions. Results: Using this phantom, clinically significant errors and limitations in commercially available 3D treatment planning software were discovered. No errors were discovered in the beam display or image reconstructions in the systems examined. Problems were found in the anatomy display, automatic tools, and the CT number to relative electron density conversion data used in some of the systems. Conclusion: This phantom is a unique tool designed explicitly for the QA of 3D treatment planning software. Errors and limitations discovered through its use indicate that the QA of commercial treatment planning software is necessary, and that this phantom is an effective device for this task.

The value of F-18-fluorodeoxyglucose PET for the 3-D radiation treatment planning of malignant gliomas

Purpose: The aim of the study was to determine the impact of positron emission tomography using the glucose analogue fluorine-18-fluorodeoxyglucose (FDG-PET) on the delineation of the target volume in three-dimensional radiation treatment planning of primary brain tumors. Methods and Materials: In 18 patients with histologically proven (8× biopsy, 10× subtotal resection) primary brain tumors (8 astrocytomas °III, one mixed glioma °III, and 9 glioblastomas), magnetic resonance imaging (MRI) with gadolinium-DTPA and FDG-PET were performed in radiation treatment position within the same week. A computer program was developed for fusion of the PET and MR images. On corresponding axial slices, FDG uptake was compared to contrast enhancement in T1-weighted and to signal hyperintensity in T2-weighted MR images. Based on PET and MRI data, three-dimensional treatment planning was performed. All patients underwent linear accelerator (LINAC) radiotherapy. Results: In MRI, all tumors and the surrounding edema were visible as hyperintense lesions in the T2-weighted images. 17/18 tumors showed contrast enhancement. In FDG-PET, 16 tumors showed hypermetabolism compared to normal white matter, whereas only 8/18 tumors showed hypermetabolism compared to normal gray matter. White matter edema was associated with decreased FDG uptake in all patients. The area of increased FDG uptake correlated closely with contrast enhancement, only in one case the volume of increased FDG uptake was larger than the area of contrast enhancement. Mean tumor volumes obtained by MRI T1 + Gd, T2, and PET were 30, 106, and 10 ml, respectively. Survival was comparable to data in the literature with a 1-year survival of 39% and a median survival of 310 days. Conclusion: Only in a minority of patients did FDG-PET provide additional information for radiation treatment planning. This is mainly caused by the high intensity of FDG uptake in normal brain tissue. PET may be of greater value in the definition of regions that should obtain a radiation dose boost.

Dose escalation for non-small cell lung cancer using conformal radiation therapy

Improved local control of non-small cell lung cancer (NSCLC) may be possible with an increased dose of radiation. Three-dimensional radiation treatment planning (3D RTP) was used to design a radiation therapy (RT) dose escalation trial, where the dose was determined by (a) the effective volume of normal lung irradiated, and (b) the estimated risk of a complication. Preliminary results of this trial were reviewed. A graph of the iso-normal tissue complication probability (NTCP) levels associated with a dose and effective volume (V(eff)) was derived, using normal tissue parameters derived from the literature. This led to a dose escalation schema, where patients were sorted into 1 of 5 treatment bins, determined by the V(eff) of the best possible treatment plan. The starting doses ranged from 63 to 84 Gy. Each treatment bin was then escalated separately, as in Phase I dose escalation fashion, with Grade > or = 3 radiation pneumonitis defined as dose limiting. To allow for dose escalation, we required patient follow-up to be > or = 6 months for at least three patients. 3D treatment planning was used to irradiate only the radiographically abnormal areas, with 2.1 Gy (corrected for lung inhomogeneity)/day. Clinically uninvolved lymph nodes were not treated prophylactically. A total of 48 NSCLC patients have been treated (Stage I/II: 18 patients; Stage III: 28 patients; mediastinal recurrence postsurgery: 2 patients). No radiation pneumonitis has been observed in the 30 patients currently evaluable beyond the 6-month time point. All treatment bins have been escalated at least once. Current doses in the five treatment bins are 69.3, 69.3, 75.6, 84, and 92.4 Gy. None of the 15 evaluable patients in any bin with > or = 30% NTCP experienced clinical radiation pneumonitis, implying that the actual risk is < 20% (beta error rate 5%). Despite the observation of the clinically negative lymph nodes at high risk, there has been no failure in the untreated mediastinum as the sole site of first failure. Three of 10 patients receiving > or = 84 Gy have had biopsy proven residual or locally recurrent disease. Successful dose escalation in a volume-dependent organ can be performed using this technique. By incorporating the effective volume of irradiated tissue, some patients have been treated to a total dose of radiation over 50% higher than traditional doses. The literature-derived parameters appear to overestimate pneumonitis risk with higher volumes. There has been no obvious negative effect due to exclusion of elective lymph node radiation. When completed, this trial will have determined the maximum tolerable dose of RT as a single agent for NSCLC and the appropriate dose for Phase II investigation.

Evaluating commercially available three-dimensional radiotherapy treatment planning systems

Over the past year we have developed two similar questionnaires on three-dimensional radiotherapy treatment planning (3DRTP) systems and used them to conduct a study of the function and features of commercially available 3DRTP systems. The issues which we reviewed to develop these questionnaires are important to all current and potential users of 3DRTP systems. The items identified in this article should aid readers in developing their own review questionnaire based on the items we discuss as well as their own clinical practice. Because it is not possible to develop a universal questionnaire that will satisfy every clinic because of site-specific treatment techniques and capabilities, this information should aid an institution contemplating the purchase of such a system to develop their own specific set of questions to aid them in their system selection. We believe that a high-level checklist of this nature will prove quite helpful to those institutions preparing to purchase such a system.

Three-dimensional treatment planning and conformal radiation therapy: preliminary evaluation

Preliminary clinical results are presented for 209 patients with cancer who had treatment planned on our three-dimensional radiation treatment planning (3-D RTP) system and were treated with external beam conformal radiation therapy. Average times (min) for CT volumetric simulation were: 74 without or 84 with contrast material; 36 for contouring of tumor/target volume and 44 for normal anatomy; 78 for treatment planning; 53 for plan evaluation/optimization; and 58 for verification simulation. Average time of daily treatment sessions with 3-D conformal therapy or standard techniques was comparable for brain, head and neck, thoracic, and hepatobiliary tumors (11.8–14 min and 11.5–12.1, respectively). For prostate cancer patients treated with 3-D conformal technique and Cerrobend blocks, mean treatment time was 19 min; with multileaf collimation it was 14 min and with bilateral arc rotation, 9.8 min. Acute toxicity was comparable to or lower than with standard techniques. Sophisticated 3-D RTP and conformal irradiation can be performed in a significant number of patients at a reasonable cost. Further efforts, including dose-escalation studies, are necessary to develop more versatile and efficient 3-D RTP systems and to enhance the cost benefit of this technology in treatment of patients with cancer.

Three-dimensional radiation treatment planning study for patients with carcinoma of the lung

Purpose : Several reports in the literature suggest that local-regional control and possibly survival could be improved for inoperable nonsmall cell lung cancer if the radiation dose to the target volume could be increased. Higher doses, however, bring with them the potential for increased side effects and complications of normal tissues. Three-dimensional treatment planning has shown significant potential for improving radiation treatment planning in several sites, both for tumor coverage and for sparing of normal tissue from high doses of radiation and, thus, has the potential of developing radiation therapy techniques that result in uncomplicated local-regional control of lung cancer. We have studied the feasibility of large-scale implementation of true three-dimensional technologies in the treatment of patients with cancers of the thorax. Methods and Materials : CT scans were performed on 10 patients with inoperable nonsmall cell lung cancer to obtain full volumetric image data, and therapy was planned on our three-dimensional radiotherapy treatment planning system. Target volumes were determined using the new ICRU nomenclature—Gross Tumor Volume, Clinical Target Volume, and Planning Target Volume. Plans were performed according to our standard treatment policies based on traditional two-dimensional radiotherapy treatment planning methodologies and replanned using noncoplanar three-dimensional beam techniques. The results were quantitatively compared using dose-volume histograms, dose-surface displays, and dose statistics. Results : Target volume delineation remains a difficult problem for lung cancer. Defining Gross Tumor Volume and Clinical Target Volume may depend on window and level settings of the three-dimensional radiotherapy treatment planning system, suggesting that target volume delineation on hard copy film is inadequate. Our study shows that better tumor coverage is possible with three-dimensional plans. Dose to critical structures (e.g., the heart) could often be reduced (or at least remain acceptable) using noncoplanar beams even with dose escalation to 75 to 80 Gy for the planning volume surrounding the Gross Target Volume. Conclusion : Commonly used beam arrangements for treatment of lung cancer appear to be inadequate to safely deliver tumor doses of higher than 70 Gy. Although conventional treatment techniques may be adequate for tumor coverage, they are inadequate for sparing of normal tissues when the prescription dose is escalated. The ability to use noncoplanar fields for such patients is a major advantage of three-dimensional planning. This capability led to better tumor coverage and reduced dose to critical normal tissues. However, this advantage was achieved at the expense of a greater time commitment by the treatment planning staff (particularly the radiation oncologist) and a greater complexity of treatment delivery. In summary, three-dimensional radiotherapy treatment planning appears to provide the radiation oncologist with the necessary tools to increase tumor dose, which may lead to increased local-regional control in patients with lung cancer while maintaining normal tissue doses at acceptable tolerance levels.

Retrospective reconstruction of three-dimensional radiotherapy treatment plans of the thorax from two dimensional planning data

Purpose : A method for the retrospective reconstruction of three-dimensional (3-D) radiotherapy treatment plans from two-dimensional (2-D) planning data is detailed in this paper. Methods and Materials : With these techniques the user can register an arbitrarily shaped portal on a simulation film with a diagnostic computed tomography study of the patient and then generate the resultant 3-D dose distribution or dose-volume histogram. Seven treatment plans were reconstructed of patients who had previously undergone 3-D treatment planning for fields involving the thorax and who had had a diagnostic computed tomography (CT) scan. The dose-volume histograms and the spatial positions of the beams on the reconstructed plans were then compared to those of the original 3-D plan, which until then, were not made available to the investigators. Results : The dose-volume histograms of the reconstructed plans did not differ from those of the original plans by more than 3% except in the low dose region. The error in positioning the beam in the reconstructed plan was determined to be approximately 5 mm. Conclusion : The technique of 3-D treatment plan reconstruction can be used, through retrospective studies, to obtain better assessments of normal tissue complication probabilities and tumor control probabilities.

Three-dimensional reconstruction of monoclonal antibody uptake in tumor and calculation of beta dose-rate nonuniformity.

The measurement of the heterogeneity of radiolabeled monoclonal antibody uptake in tumor has an essential role in the calculation and interpretation of the absorbed dose of radiation. Large data arrays and long calculation times have been limiting factors in the calculation of three-dimensional dose-rate distributions used to study the relationship between uptake heterogeneity and dose. Serial autoradiographs of tumor sections were digitized with approximately 100 microns resolution using a laser densitometer. The section images were aligned to form a registered tumor-image data set. The image data were corrected for film response versus activity density to create a three dimensional activity density distribution using features of a three-dimensional radiotherapy treatment planning system. Dose-rate distributions were formed by convolution with a beta dose kernel using fast Fourier transforms. Differential dose-rate-volume histograms (derived from the dose-rate distribution) were created to summarize the dose-rate nonuniformity throughout the tumor volume. Effects of section sampling interval, interpolation methods between section planes, and calculation resolution on the dose-rate-volume histograms were illustrated. The several orders of magnitude improvement in calculational speed provided by the fast Fourier transform technique allowed an investigation of the effects of the calculational parameters. This investigation enabled tuning of both data acquisition and dose computation. These studies can lead to further enhancements in the calculational efficiency of three-dimensional dose-rate distributions. These improvements will allow the study of summing techniques to yield average total dose distributions.