Purpose:
To analyse the impact of multileaf collimator (MLC) leaf width in multiple metastases radiosurgery (SRS) considering the target distance to isocenter and rotational displacements.
Methods:
Ten plans were optimised. The plans were created with Elements Multiple Mets SRS v2·0 (Brainlab AG, Munchen, Germany). The mean number of metastases per plan was 5 ± 2 [min 3, max 9], and the mean volume of gross tumour volume (GTV) was 1·1 ± 1·3 cc [min 0·02, max 5·1]. Planning target volume margin criterion was based on GTV-isocenter distance and target dimensions. Plans were performed using 6 MV with high-definition MLC (HDMLC) and reoptimised using 5-mm MLC (MLC-5). Plans were compared using Paddick conformity index (PCI), gradient index, monitor units , volume receiving half of prescription isodose (PIV50), maximum dose to brainstem, optic chiasm and optic nerves, and V12Gy, V10Gy and V5Gy for healthy brain were analysed. The maximum displacement due to rotational combinations was optimised by a genetic algorithm for both plans. Plans were reoptimised and compared using optimised margin.
Results:
HDMLC plans had better conformity and higher dose falloff than MLC-5 plans. Dosimetric differences were statistically significant (p < 0·05). The smaller the lesion volume, the higher the dosimetric differences between both plans. The effect of rotational displacements produced for each target in SRS was not dependent on the MLC (p > 0·05).
Conclusions:
The finer HDMLC offers dosimetric advantages compared with the MLC-5 in terms of target conformity and dose to the surrounding organs at risk. However, only dose falloff differences due to rotations depend on MLC.
Purpose: To study the impact on dose coverage and the dose to the healthy tissue applying optimized margins in single isocenter multiple brain metastases radiosurgery (SIMM-SRS) in linac machine based on setup rotations/translations induced errors calculated by a genetic algorithm (GA).
Method: The following quality indices of SIMM-SRS were analyzed for 32 plans (256 lesions): Paddick conformity index (PCI), gradient index (GI), maximum (Dmax) and mean (Dmean) doses, local and global V12 for the healthy brain. A GA based on Python packages were used to determine the maximum shift produced by induced errors of 0.2º/0.2 mm, and 0.5º/0.5 mm in 6 degrees of freedom.
Results: In terms of Dmax, and Dmean, the quality of the optimized-margin plans remains unchanged (p>0.072) concerning the original plan. However, considering the 0.5º/0.5 mm plans, PCI and GI decreased for ≥ 10 metastases, and local, and global V12 increased considerably in all cases. To consider 0.2º/0.2 mm plans, PCI and GI get worse but local, and global V12 improved in all cases.
Conclusion: GA facilities to find the individualized margins automatically among the number of possible permutations of the setup order. The user-dependent margins are avoided. This computational approach takes into account more SRS sources of uncertainty, enabling the protection of the healthy brain by “smartly” reducing the margins, and maintaining clinically acceptable target volumes’ coverage in most cases.
Introduction:
The use of volumetric modulated arc therapy (VMAT) on the breast has several dosimetric advantages but its impact on skin dose should be evaluated and compared to well-established treatment techniques using tangential fields. The aim of this work is to contrast the skin dose for VMAT and field-in-field (FIF) and to estimate the magnitude of the skin dose involved.
Method:
The skin dose was measured, without build-up, using thermoluminescent dosimeter (TLD) and optically stimulated luminescence dosimeter (OSLD) in breast radiotherapy by an in-house anthropomorphic phantom. Two different treatment techniques were used: FIF and VMAT, based on the planning strategy proposed by Nicolini et al. The dose levels were 4300 cGy, 4600 cGy and 5600 cGy in 20 fractions. In vivo dosimetry with TLD for VMAT was performed for different breast sizes in the same locations as phantom measurements.
Results:
The ipsilateral phantom breast skin dose using both treatment techniques was equivalent. TLD measured doses by the VMAT technique were up to 5% higher than OSLD, although they agree if we consider the geometry uncertainty of the TLD. In accordance with in vivo dosimetry, the mean dose of the ipsilateral breast skin was 62 ± 6% (51%, 75%) relative to the prescribed dose, regardless of the breast size for the volumes considered with this small population (n = 9) as shown by Mann–Whitney U-test (Z = 1·9, 95% confidence). The uncertainty expected in this region due to geometry (volume) changes is up to 9% higher for volumes from 225·9 cc to 968·8 cc. According to the treatment techniques and in vivo dosimetry, the contralateral breast skin dose was 1·0% in FIF and 2·5% in VMAT concerning the prescribed dose.
Conclusion:
There is no difference in skin dosimetry between VMAT and FIF techniques on the ipsilateral breast. It provides useful support for the use of VMAT as a planning technique for breast irradiation. The work describes the importance of quantifying potential differences in skin dosimetry.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.