On the complexity of helical tomotherapy treatment plans

Santos, T.; Ventura, Tiago; Mateus, J.; Capela, M.; Lopes, Maria do Carmo

doi:10.1002/acm2.12895

Cited by 9 publications

(23 citation statements)

References 31 publications

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“…In fact, the TTDF can be considered as a simple indicator of complexity, since it is somehow related to the longitudinal extension of the target volume and to the pitch. A similar behaviour was recently reported by Santos et al [ 17 ].…”

Section: Discussionsupporting

confidence: 91%

Analysis of clinical patient-specific pre-treatment quality assurance with the new helical tomotherapy platform, following the AAPM TG-218 report

et al. 2021

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Purpose This study presents patient-specific quality assurance (QA) results from the first 395 clinical cases for the new helical TomoTherapy® platform (Radixact) coupled with dedicated Precision TPS. Methods The passing rate of the Gamma Index (GP%) of 395 helical QA of patient-specific tomotherapy, acquired with ArcCHECK, is presented, analysed and correlated to various parameters of the plan. Following TG-218 recommendations, the clinic specific action limit (ALcs) and tolerance limit (TLcs) were calculated for our clinic and monitored during the analysed period. Results The mean values (± 1 standard deviation) of GP% (3%/2 mm) (both global and local normalization) are: 97.6% and 90.9%, respectively. The proposed ALcs and TLcs, after a period of two years’ process monitoring are 89.4% and 91.1% respectively. Conclusions The phantom measurements closely match the planned dose distributions, demonstrating that the calculation accuracy of the new Precision TPS and the delivery accuracy of the Radixact unit are adequate, with respect to international guidelines and reports. Furthermore, a first correlation with the planning parameters was made. Action and tolerance limits have been set for the new Radixact Linac.

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Section: Discussionsupporting

confidence: 91%

Analysis of clinical patient-specific pre-treatment quality assurance with the new helical tomotherapy platform, following the AAPM TG-218 report

et al. 2021

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Section: Discussionsupporting

confidence: 91%

Analysis of Clinical Patient-Specific Pre-Treatment Quality Assurance with the New Helical TomoTherapy® Platform, following the AAPM TG-218 Report

Fusella

Cavinato

Germani

et al. 2021

Preprint

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Purpose: This study presents patient-specific quality assurance (QA) results from the first 395 clinical cases for the new helical TomoTherapy® platform (Radixact) coupled with dedicated Precision TPS.Methods: The passing rate of the Gamma Index (GP%) of 395 helical QA of patient-specific Tomotherapy, acquired with ArcCHECK, is presented, analysed and correlated to various parameters of the plan. Following TG-218 recommendations, the clinic specific action limit (ALcs) and tolerance limit (TLcs) were calculated for our clinic and monitored during the analysed period.Results: the mean values (± 1 standard deviation) of GP% (3% / 2mm) (both global and local normalization) are: 97.6% and 90.9%, respectively. The proposed ALcs and TLcs, after a period of two years’ process monitoring are 89.4% and 91.1% respectively.Conclusions: The phantom measurements closely match the planned dose distributions, demonstrating that the calculation accuracy of the new Precision TPS and the delivery accuracy of the Radixact unit are adequate, with respect to international guidelines and reports. Furthermore, a first correlation with the planning parameters was made. Action and tolerance limits have been set for the new Radixact Linac.

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“…Some TPSs incorporate methods to restrict complexity during optimization, e.g. the aperture shape controller (ASC) tool in the Eclipse TPS [94] and the modulation factor (MF) in the TomoTherapy Hi-Art treatment system [95][96][97], but most TPSs still do not directly incorporate advanced complexity metrics [77]. Thus, unnecessary plan complexity is sometimes a consequence of inverse planning and better tools are needed to handle plan complexity [98].…”

Section: Plan Complexitymentioning

confidence: 99%

What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans

Hernández

Hansen

Widesott³

et al. 2020

Radiotherapy and Oncology

131

114

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Plan evaluation is a key step in the radiotherapy treatment workflow. Central to this step is the assessment of treatment plan quality. Hence, it is important to agree on what we mean by plan quality and to be fully aware of which parameters it depends on. We understand plan quality in radiotherapy as the clinical suitability of the delivered dose distribution that can be realistically expected from a treatment plan. Plan quality is commonly assessed by evaluating the dose distribution calculated by the treatment planning system (TPS). Evaluating the 3D dose distribution is not easy, however; it is hard to fully evaluate its spatial characteristics and we still lack the knowledge for personalising the prediction of the clinical outcome based on individual patient characteristics. This advocates for standardisation and systematic collection of clinical data and outcomes after radiotherapy. Additionally, the calculated dose distribution is not exactly the dose delivered to the patient due to uncertainties in the dose calculation and the treatment delivery, including variations in the patient set-up and anatomy. Consequently, plan quality also depends on the robustness and complexity of the treatment plan. We believe that future work and consensus on the best metrics for quality indices are required. Better tools are needed in TPSs for the evaluation of dose distributions, for the robust evaluation and optimisation of treatment plans, and for controlling and reporting plan complexity. Implementation of such tools and a better understanding of these concepts will facilitate the handling of these characteristics in clinical practice and be helpful to increase the overall quality of treatment plans in radiotherapy.

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On the complexity of helical tomotherapy treatment plans

Cited by 9 publications

References 31 publications

Analysis of clinical patient-specific pre-treatment quality assurance with the new helical tomotherapy platform, following the AAPM TG-218 report

Analysis of clinical patient-specific pre-treatment quality assurance with the new helical tomotherapy platform, following the AAPM TG-218 report

Analysis of Clinical Patient-Specific Pre-Treatment Quality Assurance with the New Helical TomoTherapy® Platform, following the AAPM TG-218 Report

What is plan quality in radiotherapy? The importance of evaluating dose metrics, complexity, and robustness of treatment plans

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