Dose conformity and falloff in single-lesion intracranial SRS with DCA and VMAT methods.

BACKGROUND: Intracranial stereotactic radiosurgery (SRS) aims at achieving highly conformal dose distribution and, at the same time, attaining rapid dose falloff outside the treatment target. SRS is performed using different techniques including dynamic conformal arcs (DCA) and volumetric modulated arc therapy (VMAT). PURPOSE: In this study, we compare dose conformity and falloff in DCA and VMAT plans for SRS with a single target. METHODS: To compare dose conformity in SRS plans, we employ a novel conformity index C I d e x p $C{I}_{{d}_{exp}}$ , RTOG conformity index ( C I R T O G $C{I}_{RTOG}$ ), and Riet-Paddick conformity index ( C I R P $C{I}_{RP}$ ). In addition, we use indices R 50 % $R50\% $ , V 10 G y ${V}_{10Gy}$ , and V 12 G y ${V}_{12Gy}$ to evaluate dose falloff. For each of the considered 118 cases of SRS, two plans were created using DCA and VMAT. A two-tailed Student's t-test was used to evaluate the difference between the employed indices for the DCA and VMAT plans. RESULTS: The studied VMAT plans were characterized by higher dose conformity than the DCA plans. The differences between the conformity indices for the DCA plans and VMAT plans were statistically significant. The DCA plans had a smaller number of monitor units (MUs) and smaller indices R50%, V10 Gy, and V12 Gy than the VMAT plans. However, the differences between R50%, V10 Gy, and V12 Gy for the DCA and VMAT plans were not statistically significant. CONCLUSIONS: Although the studied VMAT plans had higher dose conformity, they also had larger MUs than the DCA plans. In terms of dose falloff characterized by parameters R50%, V10 Gy, and V12 Gy, DCA serves as a reasonable alternative to VMAT in the case of a single brain metastasis.

Toward an improved assessment of dose conformity in radiotherapy.

BACKGROUND: Evaluation of dose conformity is important to ensure minimum dose to normal tissue and sufficient dose coverage of the planning target volume (PTV). The existing conformity indices depend on the PTV volume and do not differentiate between two different scenarios: overdosing normal tissue and underdosing PTV. PURPOSE: In this study, we introduce a novel index to assess conformity of dose distributions in radiotherapy. METHODS: The suggested conformity index C I d e x p $C{I_{{d_{exp}}}}$ is defined by the ratio of the volume representing actual "non-conformity" of the planned dose and the volume representing acceptable "non-conformity." The latter volume is produced by expanding the PTV. If both the average distance ( d ¯ $\overline d $ ) between the reference isodose surface and planning target volume and arbitrarily selected PTV expansion margin ( d e x p ${d_{exp}}$ ) are much smaller than the size of the PTV, C I d e x p $C{I_{{d_{exp}}}}$ approximately equals the ratio d ¯ d e x p $\dfrac{{\bar d}}{{{d_{exp}}}}$ . In this work, C I d e x p $C{I_{{d_{exp}}}}$ was utilized to analyze 90 cases of brain metastases treated with stereotactic radiation therapy (SRS) and 102 cases of lung cancer treated with stereotactic body radiation therapy (SBRT). RESULTS: For d e x p ${d_{exp}}$  = 0.1 cm, all considered SRS treatment plans were characterized by C I d e x p < 1 $C{I_{{d_{exp}}}} < 1$ while 2 out of 102 SBRT plans had C I d e x p > 1 $C{I_{{d_{exp}}}} > 1$ . The average values of C I d e x p $C{I_{{d_{exp}}}}$ for SRS and SBRT plans were 0.31 and 0.43, respectively. For d e x p ${d_{exp}}$  = 0.2 cm, all studied treatment plans had C I d e x p < 1 $C{I_{{d_{exp}}}} < 1$ , and the average values of C I d e x p $C{I_{{d_{exp}}}}$ for SRS and SBRT plans were 0.15 and 0.25, respectively. CONCLUSIONS: The suggested conformity index C I d e x p $C{I_{{d_{exp}}}}$ varies less with PTV volume than the RTOG and Riet-Paddick indices frequently used for evaluation of dose conformity. In addition, C I d e x p $C{I_{{d_{exp}}}}$ can be expressed as a sum of two terms which describe "over-coverage" and "under-coverage" of the treatment target. The results confirm that C I d e x p $C{I_{{d_{exp}}}}$ can be used for evaluation of dose conformity in SRS and SBRT.

Novel approach for the evaluation of dose conformity in radiotherapy.

PURPOSE: We describe a new approach to evaluate conformity of dose distributions in radiotherapy. METHODS: The suggested conformity factor λ is defined by using existing conformity indices and expansion of the planning target volume (PTV). If the average distance ( d ¯ $\bar d$ ) between the PTV and reference isodose surface and an arbitrarily selected PTV expansion margin ( d e x p ${d_{exp}}$ ) are both much smaller than the size of the PTV, then λ approximately equals the ratio d ¯ d e x p $\frac{{\bar d}}{{{d_{exp}}}}$ . We use λ to analyze several cases of stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). RESULTS: In the case of SRS with a single target or multiple targets, treatment plans produced with the help of volumetric modulated arc therapy (VMAT) have smaller λ than plans produced by using dynamic conformal arcs (DCA). Likewise, it is demonstrated that in the case of SBRT, λ is reduced by employing VMAT instead of DCA. It is also shown that if the distance between the reference isodose surface and surface of the PTV is fixed, λ varies less with variations in PTV volume compared to frequently used conformity indices. CONCLUSIONS: The described conformity factor λ can be applied clinically to compare and rank treatment plans for lesions of different sizes. It is suggested that conditions λ < 1 $\lambda < 1$ and λ > 1 can be employed as "pass" and "fail" criteria, respectively, for dose conformity assessment with appropriate choice of d e x p ${d_{exp}}$ .

Impact of target dose inhomogeneity on BED and EUD in lung SBRT.

PURPOSE: To evaluate the effect of dose heterogeneity in the treatment target on biologically effective dose (BED) for frequently used hypofractionation regimens in stereotactic body radiation therapy (SBRT). METHODS: In the case of non-uniform target dose, BED in the planning target volume (PTV) is determined by using the linear-quadratic model. An expression for BED is obtained for an arbitrary dose distribution in the PTV in the case of small variance of the target dose. Another analytical expression for BED is obtained by assuming a Gaussian dose distribution in the target. RESULTS: Analytical expressions for BED as a function of the variance of the target dose have been derived. It is shown that a relatively small dose inhomogeneity (<5%-6%) can cause a significant reduction (i.e. >10%) in the corresponding BED and equivalent uniform dose (EUD) compared to the case of uniform target dose. CONCLUSIONS: Small variations in the absorbed dose can significantly reduce BED and EUD in the PTV. The effect of dose non-uniformity on BED increases with increasing dose per fraction. The observed reduction in BED compared to that for uniform target dose can be several times greater for SBRT than for standard fractionation with dose per fraction varying between 1.8 and 2 Gy.

Technical Note: New similarity index for radiotherapy and medical imaging.

PURPOSE: To describe a new similarity index and consider its biomedical applications. METHODS: Similarity index for a pair of objects is defined by the number of shared features and total number of features in these objects. Similarity measure for more than two objects is commonly defined by using pairwise similarity indices. In the current study we suggest a novel similarity index which depends on the number of features shared between multiple objects and does not have the limitations of the recently described similarity measures. In order to introduce the new index, we consider a concept of "commonality." For a collection of sets A 1 , A 2 … , A N , commonality of a given element equals the number of sets this element belongs to. The similarity index for the compared sets is then defined by a weighted sum of normalized commonalities. RESULTS: The considered biomedical applications of the proposed index include comparison of independent delineations of critical cranial structures in MR images and comparison of isodose distributions from different radiotherapy plans. CONCLUSIONS: This study describes a novel similarity index which can be used to assess the similarity of multiple independent delineations of the anatomical structure or similarity of multiple dose distributions. Unlike the commonly used pairwise similarity indices, the new index is defined by the number of elements shared between multiple sets. Potential applications of the suggested similarity index for radiotherapy and medical imaging have been described.

Effect of radiation protraction in hypofractionated radiotherapy.

PURPOSE: To evaluate how protracted delivery of radiation affects radiobiological properties of hypofractionated radiotherapy. METHODS: The utilized approach is based on the concept of biologically effective dose (BED). The linear-quadratic model replete with a protraction factor is used to describe changes in biologically effective dose in normal tissue (BEDnt ) caused by varying number of fractions under the condition of fixed BED in the treatment target (BEDtar ). In the derivations, we study the influence of fraction time (T) and associated repair of sublethal damage of irradiated cells on BEDnt . RESULTS: We have analytically derived conditions under which hypofractionation lowers BEDnt , in a parallel or serial organ at risk (OAR) in the presence of radiation protraction, as compared to standard fractionation. In the considered examples, maximum value of BEDnt in the spinal cord decreased with decreasing number of fraction when T was relatively short (e.g., T = 5 min). In contrast, in the case of long fraction times of 30 and 45 min, maximum BEDnt in the cord increased with decreasing number of fractions. In the case of lung cancer, the average BEDnt in the lung increased with decreasing number of fractions. The maximum increase in BEDnt varied between 4% for T = 1 min and 19% for T = 22 min. CONCLUSION: In the case when repair of sublethal damage occurs faster in the target than in the affected OAR, shortening fraction time helps lower BEDnt in hypofractionated regimen as compared to standard fractionation. In contrast, in the case when repair rate is higher in the OAR than in the target, long fraction times can be radiobiologically beneficial for hypofractionated radiotherapy. Consequently, comparison of different fractionation schemes should take into account both repair rates in the target and OAR, and fraction time.

Cell kill by megavoltage protons with high LET.

The aim of the current study is to develop a radiobiological model which describes the effect of linear energy transfer (LET) on cell survival and relative biological effectiveness (RBE) of megavoltage protons. By assuming the existence of critical sites within a cell, analytical expression for cell survival S as a function of LET is derived. The obtained results indicate that in cases where dose per fraction is small, [Formula: see text] is a linear-quadratic (LQ) function of dose while both alpha and beta radio-sensitivities are non-linearly dependent on LET. In particular, in the current model alpha increases with increasing LET while beta decreases. Conversely, in the case of large dose per fraction, the LQ dependence of [Formula: see text] on dose is invalid. The proposed radiobiological model predicts cell survival probability and RBE which, in general, deviate from the results obtained by using conventional LQ formalism. The differences between the LQ model and that described in the current study are reflected in the calculated RBE of protons.

Effect of variable dose rate on biologically effective dose.

PURPOSE: To investigate the effect of variable dose rate on biologically effective dose (BED). MATERIALS AND METHODS: By using the linear-quadratic (LQ) model with bi-exponential repair, we analytically determine the time-dependent dose rate [Formula: see text] which minimizes the effective protraction factor (Geff) and BED under the condition of fixed fraction time and dose per fraction. Because normal tissue complication probability (NTCP) monotonically decreases with decreasing BED, the dose rate [Formula: see text] also minimizes NTCP. RESULTS: The dependences of Geff , BED and NTCP on fraction time were determined for different radiobiological parameters and two different dose rates: constant dose rate R0 and varying dose rate [R]. CONCLUSION: The results of this study indicate that under certain conditions the reduction in BED for late-responding tissues due to increased fraction time can be significantly greater than the reduction in BED for tumors. Our analysis also indicates that dose rate optimization can be radiobiologically beneficial because of the resulting decrease in NTCP.

Analytical representation for varian EDW factors at off-center points.

The purpose of this study is to describe and evaluate a new analytical model for Varian enhanced dynamic wedge factors at off-center points. The new model was verified by comparing measured and calculated wedge factors for the standard set of wedge angles (i.e., 15 degrees, 30 degrees, 45 degrees and 60 degrees), different symmetric and asymmetric fields, and two different photon energies. The maximum difference between calculated and measured wedge factors is less than 2%. The average absolute difference is within 1%. The obtained results indicate that the suggested model can be useful for independent dose calculation with enhanced dynamic wedges.

A new analytical model for Varian enhanced dynamic wedge factors.

Dynamic and physical (hard) wedges are used in 3D conformal radiotherapy in order to improve dose distribution in patients. Unlike wedge factors for physical wedges that depend on wedge material and thickness, wedge factors for Varian dynamic wedges depend on the relationship between the position of the moving jaw and the number of delivered monitor units. In this study, we describe a new analytical model for dynamic wedge factors. We also review the existing analytical models and compare calculated and measured wedge factors. The comparison is performed for different wedge angles, symmetric and asymmetric fields and two different photon energies. The obtained results indicate that the new dynamic wedge model provides the best overall agreement (within 1%) with the measured wedge factors.

On the usefulness of portal monitor unit subtraction in radiation therapy.

In order to avoid additional dose to patients caused by portal imaging with megavoltage x-rays, portal monitor units (MUs) are frequently subtracted from the actual treatment MUs. This study examines the usefulness of portal MU subtraction in radiation therapy. For 11 prostate cancer patients treated with 23 MV photons, dose to prostate due to portal filming with 6 MV photons was determined. In all 11 patients subtraction of portal MU values from the actual treatment MUs resulted in a small underdosing of the prostate with an average treatment error of -0.5%. Portal filming without MU subtraction would cause small overdosing of the prostate with an average treatment error of 1.2%. The results of this study indicate that the benefits of portal MU subtraction are in doubt if (a) the energy of treatment x-rays is much higher than that of the portal x-rays and/or (b) when radiotherapy is performed with physical wedges. Based on the obtained results, we argue against unconditional use of the portal MU subtraction method to eliminate the dose from portal imaging.