The utility of megavoltage computed tomography images from a helical tomotherapy system for setup verification purposes

Forrest, Lisa J.; Mackie, Thomas Rockwell; Ruchala, K; Turek, Michelle; Kapatoes, Jeff; Jaradat, H.; Song, Hui; Balog, John; Vail, David M.; Mehta, Minesh P.

doi:10.1016/j.ijrobp.2004.08.016

Cited by 131 publications

(93 citation statements)

References 12 publications

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“…More recently, the advent of image‐guided radiation therapy (IGRT) has enabled us to achieve sophisticated three‐dimensional volume and soft‐tissue contrast information 2 , 3 . They include mobile in‐room computed tomography (CT) scanners, (4) CT on rails, 5 , 6 B‐mode ultrasound systems, (6) tomotherapy, (6) and kilovoltage 7 , 8 and megavoltage 2 , 9 cone‐beam CT scanners (CBCT), widely in use currently.…”

Section: Introductionmentioning

confidence: 99%

Adaptive optimization by 6 DOF robotic couch in prostate volumetric IMRT treatment: rototranslational shift and dosimetric consequences

Chiesa

Placidi

Azario

et al. 2015

J Applied Clin Med Phys

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The purpose of this study was to investigate the magnitude and dosimetric relevance of translational and rotational shifts on IGRT prostate volumetric‐modulated arc therapy (VMAT) using Protura six degrees of freedom (DOF) Robotic Patient Positioning System. Patients with cT3aN0M0 prostate cancer, treated with VMAT simultaneous integrated boost (VMAT‐SIB), were enrolled. PTV2 was obtained adding 0.7 cm margin to seminal vesicles base (CTV2), while PTV1 adding to prostate (CTV1) 0.7 cm margin in all directions, except 1.2 cm, as caudal margin. A daily CBCT was acquired before dose delivery. The translational and rotational displacements were corrected through Protura Robotic Couch, collected and applied to the simulation CT to obtain a translated CT (tCT) and a rototranslated CT (rtCT) on which we recalculated the initial treatment plan (TP). We analyzed the correlation between dosimetric coverage, organs at risk (OAR) sparing, and translational or rotational displacements. The dosimetric impact of a rototranslational correction was calculated. From October 2012 to September 2013, a total of 263 CBCT scans from 12 patients were collected. Translational shifts were <5mm in 81% of patients and the rotational shifts were <2∘ in 93% of patient scans. The dosimetric analysis was performed on 172 CBCT scans and calculating 344 VMAT‐TP. Two significant linear correlations were observed between yaw and the V20 femoral heads and between pitch rotation and V50 rectum (p<0.001); rototranslational correction seems to impact more on PTV2 than on PTV1, especially when margins are reduced. Rotational errors are of dosimetric significance in sparing OAR and in target coverage. This is relevant for femoral heads and rectum because of major distance from isocenter, and for seminal vesicles because of irregular shape. No correlation was observed between translational and rotational errors. A study considering the intrafractional error and the deformable registration is ongoing.PACS number: 87.55.de

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Section: Introductionmentioning

confidence: 99%

Adaptive optimization by 6 DOF robotic couch in prostate volumetric IMRT treatment: rototranslational shift and dosimetric consequences

Chiesa

Placidi

Azario

et al. 2015

J Applied Clin Med Phys

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“…The megavoltage (MV) computed tomography (CT) acquisition capability of helical tomotherapy has proved very effective for pretreatment patient positioning to decrease setup errors (1,2). The MVCT image sets depict the patient's anatomy with image contrast and resolution that is slightly inferior to a kilovoltage CT (kVCT) study, but has enough soft-tissue contrast to reliably contour organs or lesions in many areas of the body (3,4).…”

Section: Introductionmentioning

confidence: 99%

Adaptive Radiotherapy Planning on Decreasing Gross Tumor Volumes as Seen on Megavoltage Computed Tomography Images

Woodford

Yartsev

Dar

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

159

155

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Purpose: To evaluate gross tumor volume (GTV) changes for patients with non-small-cell lung cancer by using daily megavoltage (MV) computed tomography (CT) studies acquired before each treatment fraction on helical tomotherapy and to relate the potential benefit of adaptive image-guided radiotherapy to changes in GTV. Methods and Materials: Seventeen patients were prescribed 30 fractions of radiotherapy on helical tomotherapy for non-small-cell lung cancer at London Regional Cancer Program from Dec 2005 to March 2007. The GTV was contoured on the daily MVCT studies of each patient. Adapted plans were created using merged MVCT-kilovoltage CT image sets to investigate the advantages of replanning for patients with differing GTV regression characteristics.Results: Average GTV change observed over 30 fractions was À38%, ranging from À12 to À87%. No significant correlation was observed between GTV change and patient's physical or tumor features. Patterns of GTV changes in the 17 patients could be divided broadly into three groups with distinctive potential for benefit from adaptive planning. Conclusions: Changes in GTV are difficult to predict quantitatively based on patient or tumor characteristics. If changes occur, there are points in time during the treatment course when it may be appropriate to adapt the plan to improve sparing of normal tissues. If GTV decreases by greater than 30% at any point in the first 20 fractions of treatment, adaptive planning is appropriate to further improve the therapeutic ratio. Ó 2007 Elsevier Inc.

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“…The MVCT image reveals sufficient information of the tumor and normal anatomy for patient repositioning and treatment planning. ( 10 , 11 , 28 ) It is worth noting that recent studies show output instabilities over time of the tomotherapy imaging beam and the consequent dose effect can be as large as 3%. ( 29 , 30 ) Therefore, our protocol requires acquisition of a new IVDT prior to every MVCT scans for dose calculation purpose.…”

Section: Discussionmentioning

confidence: 99%

A planning study for palliative spine treatment using StatRT and megavoltage CT simulation

Rong

Yadav

Paliwal

et al. 2010

J Applied Clin Med Phys

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Megavoltage CT (MVCT) simulation on the TomoTherapy Hi·Art system is an alternative to conventional CT for treatment planning in the presence of severe metal artifact. StatRT is a new feature that was implemented on the TomoTherapy operator station for performing online MVCT scanning, treatment planning and treatment delivery in one session. The clinical feasibility of using the StatRT technique and MVCT simulation to palliative treatment for a patient with substantial spinal metallic hardware is described. A patient with metastatic non‐small‐cell lung cancer involving the thoracic spine underwent conventional kilovoltage CT simulation. The metal artifact due to stainless steel spine‐stabilizing rods was too severe for treatment planning, despite attempts to correct using density override. The patient was then re‐scanned using MVCT on a tomotherapy unit. Plans were generated using both StatRT and conventional tomotherapy planning (Tomo plan) with different settings for comparison. StatRT planning ran a total of five iterations in a short planning window (10–15 min). Two Tomo plans were generated using: (1) five iterations in the “full scatter” mode, and (2) 300 iterations in the “beamlet” mode. It was noted that the DVH of the StatRT plan was almost identical to the Tomo plan optimized by the “full scatter” mode and the same number of iterations. Dose distribution analysis reveals that these three planning methods yielded comparable doses to heart, lungs and targets. This work also demonstrated that undermodulation can result in a high degree of thread effects. The overall time for the treatment process (including 7 minutes for simulation, 15 minutes for contouring, 10 minutes for planning and 5 minutes for delivery) decreases from hours to around 40 minutes using the StatRT procedure. StatRT is a feasible treatment‐planning tool for physicians to scan, contour and treat patients within one hour. This can be particularly beneficial in urgent palliative treatments.Conflict of Interest Statement: James S. Welsh has received honoraria for speaking for TomoTherapy, Inc.; Yi Rong has received travel sponsorship for TomoTherapy, Inc.PACS numbers: 87.55.D‐, 87.57.C‐

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The utility of megavoltage computed tomography images from a helical tomotherapy system for setup verification purposes

Cited by 131 publications

References 12 publications

Adaptive optimization by 6 DOF robotic couch in prostate volumetric IMRT treatment: rototranslational shift and dosimetric consequences

Adaptive optimization by 6 DOF robotic couch in prostate volumetric IMRT treatment: rototranslational shift and dosimetric consequences

Adaptive Radiotherapy Planning on Decreasing Gross Tumor Volumes as Seen on Megavoltage Computed Tomography Images

A planning study for palliative spine treatment using StatRT and megavoltage CT simulation

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