Conformal radiation treatment of prostate cancer using inversely-planned intensity-modulated photon beams produced with dynamic multileaf collimation

Ling, C. Clifton; Burman, Chandra; Chui, Chen‐Shou; Kutcher, Gerald J.; Leibel, Steven A.; LoSasso, Thomas; Mohan, Radhe; Bortfeld, Thomas; Reinstein, L. E.; Spirou, Spiridon V.

doi:10.1016/0360-3016(96)00174-5

Cited by 337 publications

(153 citation statements)

References 25 publications

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“…Intensity‐modulated radiation therapy (IMRT) at its introduction in the late 1990s generated tremendous excitement 1 , 2 , 3 , 4 . The anticipation was that the new technique would accurately target tumors, 5 , 6 while at the same time sparing adjacent normal tissues (7) .…”

Section: Introductionmentioning

confidence: 99%

Initial clinical experience with ArcCHECK for IMRT/VMAT QA

Aristophanous

Suh

et al. 2016

J Applied Clin Med Phys

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Many devices designed for the purpose of performing patient‐specific IMRT/VMAT QA are commercially available. In this work we report our experience and initial clinical results with the ArcCHECK. The ArcCHECK consists of a cylindrical array of diode detectors measuring entry and exit doses. The measured result is a cumulative dose displayed as a 2D matrix. The detector array requires both an absolute dose calibration, and a calibration of the detector response, relative to each other. In addition to the calibrations suggested by the manufacturer, various tests were performed in order to assess its stability and performance prior to clinical introduction. Tests of uniformity, linearity, and repetition rate dependence of the detector response were conducted and described in this work. Following initial testing, the ArcCHECK device was introduced in the clinic for routine patient‐specific IMRT QA. The clinical results from one year of use were collected and analyzed. The gamma pass rates at the 3%/3 mm criterion were reported for 3,116 cases that included both IMRT and VMAT treatment plans delivered on 18 linear accelerators. The gamma pass rates were categorized based on the treatment site, treatment technique, type of MLCs, operator, ArcCHECK device, and LINAC model. We recorded the percent of failures at the clinically acceptable threshold of 90%. In addition, we calculated the threshold that encompasses two standard deviations (2 SD) (95%) of QAs (T95) for each category investigated. The commissioning measurements demonstrated that the device performed as expected. The uniformity of the detector response to a constant field arc delivery showed a 1% standard deviation from the mean. The variation in dose with changing repetition rate was within 1 cGy of the mean, while the measured dose showed a linear relation with delivered MUs. Our initial patient QA results showed that, at the clinically selected passing criterion, 4.5% of cases failed. On average T95 was 91%, ranging from 73% for gynecological sites to 96.5% for central nervous system sites. There are statistically significant differences in passing rates between IMRT and VMAT, high‐definition (HD) and non‐HD MLCs, and different LINAC models (p‐values <<0.001). An additional investigation into the failing QAs and a comparison with ion‐chamber measurements reveals that the differences observed in the passing rates between the different studied factors can be largely explained by the field size dependence of the device. Based on our initial experience with the ArcCHECK, our passing rates are, on average, consistent with values reported in the AAPM TG‐119. However, the significant variations between QAs that were observed based on the size of the treatment fields may need to be corrected to improve the specificity and sensitivity of the device.PACS number(s): 87.55.Qr, 87.56.Fc

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Section: Introductionmentioning

confidence: 99%

Initial clinical experience with ArcCHECK for IMRT/VMAT QA

Aristophanous

Suh

et al. 2016

J Applied Clin Med Phys

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“…Radiation beam modifiers to produce nonuniform beams are evolving continually by incorporating available technological advancements. Since inception, intensity‐modulated radiation therapy (IMRT) using multileaf collimators (MLC) (1) has become widespread with a variety of different dose delivery methods (i.e. step‐and‐shoot, dynamic MLC, tomotherapy.…”

Section: Introductionmentioning

confidence: 99%

Application of AAPM TG 119 to volumetric arc therapy (VMAT)

Mynampati

Yaparpalvi

Hong

et al. 2012

J Applied Clin Med Phys

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The purpose of this study was to create AAPM TG 119 benchmark plans for volumetric arc therapy (VMAT) and to compare VMAT plans with IMRT plan data. AAPM TG 119 proposes a set of test clinical cases for testing the accuracy of IMRT planning and delivery system. For these test cases, we generated two treatment plans, the first plan using 7–9 static dMLC IMRT fields and a second plan utilizing one‐ or two‐arc VMAT technique. Dose optimization and calculations performed using 6 MV photons and Eclipse treatment planning system. Dose prescription and planning objectives were set according to the TG 119 goals. Plans were scored based on TG 119 planning objectives. Treatment plans were compared using conformity index (CI) for reference dose and homogeneity index (HI) (for D5‐D95). F or test cases prostate, head‐and‐neck, C‐shape and multitarget prescription dose are 75.6 Gy, 50.4 Gy, 50 Gy and 50 Gy, respectively. VMAT dose distributions were comparable to dMLC IMRT plans. Our planning results matched TG 119 planning results. For treatment plans studied, conformity indices ranged from 1.05–1.23 (IMRT) and 1.04–1.23 (VMAT). Homogeneity indices ranged from 4.6%–11.0% (IMRT) and 4.6%–10.5% (VMAT). The ratio of total monitor units necessary for dMLC IMRT to that of VMAT was in the range of 1.1–2.0. AAPM TG 119 test cases are useful to generate VMAT benchmark plans. At preclinical implementation stage, plan comparison of VMAT and IMRT plans of AAPM TG 119 test case allowed us to understand basic capabilities of VMAT technique.PACS number: 87.55.Qr

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“…In the sliding window technique, a window defined by the MLC leaves sweeps across the treatment field at variable speed, while the monitor units are delivered continuously (Ling et al, 1996). With serial and helical tomotherapy, the intensity modulation is achieved through the use of a binary MLC (radiation is either delivered or not).…”

Section: Brief History Of Imrtmentioning

confidence: 99%

Intensity-modulated radiation therapy: emerging cancer treatment technology

et al. 2005

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The use of intensity-modulated radiation therapy (IMRT) is rapidly advancing in the field of radiation oncology. Intensity-modulated radiation therapy allows for improved dose conformality, thereby affording the potential to decrease the spectrum of normal tissue toxicities associated with IMRT. Preliminary results with IMRT are quite promising; however, the clinical data is relatively immature and overall patient numbers remain small. High-quality IMRT requires intensive physics support and detailed knowledge of threedimensional anatomy and patterns of tumour spread. This review focuses on basic principles, and highlights the clinical implementation of IMRT in head and neck and prostate cancer.

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Conformal radiation treatment of prostate cancer using inversely-planned intensity-modulated photon beams produced with dynamic multileaf collimation

Cited by 337 publications

References 25 publications

Initial clinical experience with ArcCHECK for IMRT/VMAT QA

Initial clinical experience with ArcCHECK for IMRT/VMAT QA

Application of AAPM TG 119 to volumetric arc therapy (VMAT)

Intensity-modulated radiation therapy: emerging cancer treatment technology

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