Dosimetric Comparison Between 3-Dimensional Conformal and Robotic SBRT Treatment Plans for Accelerated Partial Breast Radiotherapy.

Accelerated partial breast irradiation is an attractive alternative to conventional whole breast radiotherapy for selected patients. Recently, CyberKnife has emerged as a possible alternative to conventional techniques for accelerated partial breast irradiation. In this retrospective study, we present a dosimetric comparison between 3-dimensional conformal radiotherapy plans and CyberKnife plans using circular (Iris) and multi-leaf collimators. Nine patients who had undergone breast-conserving surgery followed by whole breast radiation were included in this retrospective study. The CyberKnife planning target volume (PTV) was defined as the lumpectomy cavity + 10 mm + 2 mm with prescription dose of 30 Gy in 5 fractions. Two sets of 3-dimensional conformal radiotherapy plans were created, one used the same definitions as described for CyberKnife and the second used the RTOG-0413 definition of the PTV: lumpectomy cavity + 15 mm + 10 mm with prescription dose of 38.5 Gy in 10 fractions. Using both PTV definitions allowed us to compare the dose delivery capabilities of each technology and to evaluate the advantage of CyberKnife tracking. For the dosimetric comparison using the same PTV margins, CyberKnife and 3-dimensional plans resulted in similar tumor coverage and dose to critical structures, with the exception of the lung V5%, which was significantly smaller for 3-dimensional conformal radiotherapy, 6.2% when compared to 39.4% for CyberKnife-Iris and 17.9% for CyberKnife-multi-leaf collimator. When the inability of 3-dimensional conformal radiotherapy to track motion is considered, the result increased to 25.6%. Both CyberKnife-Iris and CyberKnife-multi-leaf collimator plans demonstrated significantly lower average ipsilateral breast V50% (25.5% and 24.2%, respectively) than 3-dimensional conformal radiotherapy (56.2%). The CyberKnife plans were more conformal but less homogeneous than the 3-dimensional conformal radiotherapy plans. Approximately 50% shorter treatment times and 50% lower number of delivered monitor units (MU) were achievable with CyberKnife-multi-leaf collimator than with CyberKnife-Iris. The CyberKnife-multi-leaf collimator treatment times were comparable to 3-dimensional conformal radiotherapy, however, the number of MU delivered was approximately 2.5 times larger. The suitability of 10 + 2 mm margins warrants further investigation.

SU-E-T-446: Effect of Dose Calculation Grid Size Variability on the Specification of Spinal Cord Dose Tolerance for Spinal Stereotactic Body Radiation Therapy.

PURPOSE: To investigate the effect of the dose grid resolution variability on the spinal cord dose for spinal SBRT treatments. METHOD: 10 CyberKnife plans were selected for the proximity of the PTV to the spinal cord. All dose distributions were calculated with Monte Carlo using high spatial resolution and minimal relative uncertainty. The plans were renormalized to a 16 Gy prescription dose and to ensure a target coverage > 95% in order to compare the calculated dose distributions. Each dose matrix was resampled 12 times, covering a grid resolution range of 0.95 mm to 13.52 mm. The spinal cord DVHs were generated for each resampled dose grid. The variations of the maximum point dose (DmaxCord) and dose-coverage to partial volumes (D[V]) up to 5 cc were investigated against the grid resolution. RESULTS: The mean variation of DmaxCord with grid resolution is characterized by an inverse power law, with a sharp initial decrease leading to potentially large underestimates of DmaxCord (24%, 40% and 55% at resolutions of 2 mm, 4 mm and 8 mm). The variability of mean D[V] values decreases from smaller to larger grid resolutions, however large disparities are observed between patient plans. We introduced the variability threshold volume (Vth) as a constraint to express the dose coverage independently from the grid resolution. For resolutions up to 8 mm, the mean Vth value is (0.96±0.10) cc with a corresponding dose coverage of (26± 12) % relative to the initial DmaxCord value. CONCLUSIONS: Dose distributions calculated with grid resolutions larger than 2 mm could Result in significant underestimates of DmaxCord. Furthermore, the sensitivity of the dose coverage to grid resolution variability is patient dependent. Consequently, a specified cord dose tolerance should be quoted at a particular grid resolution uniformly adopted between institutions; 2 mm or less is an appropriate value.

A two-step optimization method for improving multiple brain lesion treatments with robotic radiosurgery.

Planning robotic radiosurgery treatments for multiple (n > 3) metastatic brain lesions is challenging due to the need of satisfying a large number of dose-volume constraints and the requirement of prescribing different dose levels to individual targets. In this study, we developed a sequential two-step optimization technique to improve the planning quality of such treatments. In contrast to the conventional approach of where all targets are simultaneously planned, we have developed a two-step optimization method. In this method, the first step was to create treatment plans for individual targets. In the second step, the 3D dose matrices associated with each plan were exported to Dicom-RT digital files and subsequently optimized. For the optimization, a singular-value-decomposition (SVD) algorithm was implemented to minimize the dose interferences among different targets. Finally, we compared the optimized treatment plans with the treatment plans created using the conventional method to determine the effectiveness of the new method. Large improvements in target dose distributions as well as normal brain sparing were found for the two-step optimization treatment plans as compared with the conventional treatment plans. The two-step optimization significantly lowered the volume of normal brain receiving relatively low doses. For example, the normal brain volume receiving 12-Gy was reduced by averaged 42% (range 34%-47%) with the two-step optimization. Such improvements generally enlarged with increasing number of targets being treated regardless of target sizes. Of note, normal brain dose was found to increase non-linearly with increasing number of targets. In summary, a two-step optimization technique is demonstrated to significantly improve the treatment plan quality as well as reduce the planning effort for multi-target robotic radiosurgery.

Characteristics of megavoltage cone-beam digital tomosynthesis.

This article reports on the image characteristics of megavoltage cone-beam digital tomosynthesis (MVCB DT). MVCB DT is an in-room imaging technique, which enables the reconstruction of several two-dimensional slices from a set of projection images acquired over an arc of 20 degrees-40 degrees. The limited angular range reduces the acquisition time and the dose delivered to the patient, but affects the image quality of the reconstructed tomograms. Image characteristics (slice thickness, shape distortion, and contrast-to-noise ratio) are studied as a function of the angular range. Potential clinical applications include patient setup and the development of breath holding techniques for gated imaging.

Sci-Thurs PM: Delivery-12: Correction and calibration of megavoltage cone-beam CT images for the calculation of the dose of the day.

PURPOSE: To show that accurate dose calculations can be achieved with megavoltage cone-beam CT (MVCBCT) images of head-and-neck (H&N) and prostate sites, allowing the verification of the daily dose distribution received by these patients. METHOD AND MATERIALS: Corrections for the cupping and missing data artifacts seen on MVCBCT images were developed for both H&N and pelvic imaging. MVCBCT images of six H&N and two prostate patients were acquired weekly during the course of their treatment. Several regions of interest were contoured including: the prostate and rectum and the spinal cord and parotids. Dose calculation was performed with the MVCBCT images using the plan beams. Variations from treatment plan dosimetric endpoints were analyzed. RESULTS: Dose calculations with kVCT and corrected MVCBCT images of the H&N (pelvic) regions show standard deviations of 1.9% (0.6%). The mean dose to the right parotid of H&N patients had an average increase of 18% during treatment. The maximum dose to 1% of the spinal cord went up by 2% on average. For prostate patients on one fraction the dose received by 95% of the prostate diminished by 3%. One patient had an average increase of 3.6% of the maximum dose received by 1% of the rectum. CONCLUSION: MVCBCT can be used to verify daily dose distributions for H&N and prostate patients. An increase in the mean dose to normal tissues was observed during H&N treatment. Underdosage of the prostate and the dosimetric consequences of volume changes in rectum and bladder were observed. Research supported by Siemens.

Order-to-chaos transition in rotational nuclei.

We have developed a new method to study the order-to-chaos transition in rotational nuclei. Correlations between successive gamma rays are used to determine the average complexity of the intermediate levels and thereby the ratio of the interaction potential between levels to the level spacing. The measured ratios, 0.15 to 1.5, span the range from nearly fully ordered to nearly fully chaotic.