Tomotherapy: A new concept for the delivery of dynamic conformal radiotherapy

Varian introduced (in 2010) the option of removing the flattening filter (FF) in their C‐Arm linacs for intensity‐modulated treatments. This mode, called flattening filter‐free (FFF), offers the advantage of a greater dose rate. Varian's “Portal Dosimetry” is an electronic portal imager device (EPID)‐based tool for IMRT verification. This tool lacks the capability of verifying flattening filter‐free (FFF) modes due to saturation and lack of an image prediction algorithm. (Note: the latest versions of this software and EPID correct these issues.) The objective of the present study is to research the feasibility of said verifications (with the older versions of the software and EPID). By placing the EPID at a greater distance, the images can be acquired without saturation, yielding a linearity similar to the flattened mode. For the image prediction, a method was optimized based on the clinically used algorithm (analytical anisotropic algorithm (AAA)) over a homogeneous phantom. The depth inside the phantom and its electronic density were tailored. An application was developed to allow the conversion of a dose plane (in DICOM format) to Varian's custom format for Portal Dosimetry. The proposed method was used for the verification of test and clinical fields for the three qualities used in our institution for IMRT: 6X, 6FFF and 10FFF. The method developed yielded a positive verification (more than 95% of the points pass a 2%/2 mm gamma) for both the clinical and test fields. This method was also capable of “predicting” static and wedged fields. A workflow for the verification of FFF fields was developed. This method relies on the clinical algorithm used for dose calculation and is able to verify the FFF modes, as well as being useful for machine quality assurance. The procedure described does not require new hardware. This method could be used as a verification of Varian's Portal Dose Image Prediction.PACS number(s): 87.53.Kn, 87.55.T‐, 87.56.bd, 87.59.‐e

Section: Introductionmentioning

confidence: 99%

On flattening filter‐free portal dosimetry

Pardo

Novais

López

et al. 2016

“…The technical details of tomotherapy have been described before (4) . In brief, the tomotherapy treatment unit consists of a linear accelerator mounted on a ring gantry through which the treatment couch is moved during treatment.…”

Section: Introductionmentioning

confidence: 99%

“…The treatment beam is modulated by a binary multileaf collimator, and the beam width is determined by the opening width of the secondary collimator, the so‐called “jaws”. Until the introduction of TomoEdge, which was called Running‐Start‐Stop in earlier publications (5) and was already described in the initial publication on tomotherapy, (4) the beam width remained fixed for the duration of a treatment (see Fig. 1(a)).…”

Section: Introductionmentioning

confidence: 99%

Accelerated tomotherapy delivery with TomoEdge technique

Katayama

Haefner

Mohr

et al. 2015

TomoEDGE is an advanced delivery form of tomotherapy which uses a dynamic secondary collimator. This plan comparison study describes the new features, their clinical applicability, and their effect on plan quality and treatment speed. For the first 45 patients worldwide that were scheduled for a treatment with TomoEdge, at least two plans were created: one with the previous “standard”mode with static jaws and 2.5 cm field width (Reg 2.5) and one with TomoEdge technique and 5 cm field width (Edge 5). If, after analysis in terms of beam on time, integral dose, dose conformity, and organ at risk sparing the treating physician decided that the Edge 5 plan was not suitable for clinical treatment, a plan with TomoEdge and 2.5 cm field width was created (Edge 2.5) and used for the treatment. Among the 45 cases, 30 were suitable for Edge 5 treatment, including treatments of the head and neck, rectal cancer, anal cancer, malignancies of the chest, breast cancer, and palliative treatments. In these cases, the use of a 5 cm field width reduced beam on time by more than 30% without compromising plan quality. The 5 cm beam could not be clinically applied to treatments of the pelvic lymph nodes for prostate cancer and to head and neck irradiations with extensive involvement of the skull, as dose to critical organs at risk such as bladder (average dose 28 Gy vs. 29 Gy, Reg 2.5 vs. Edge 5), small bowel (29% vs. 31%, Reg 2.5 vs. Edge 5) and brain (average dose partial brain 19 Gy vs. 21 Gy, Reg 2.5 vs. Edge 5) increased to a clinically relevant, yet not statistically significant, amount. TomoEdge is an advantageous extension of the tomotherapy technique that can speed up treatments and thus increase patient comfort and safety in the majority of clinical settings.PACS numbers: 87.55.de, 87.55ne

“…These techniques usually need more beam‐on time than open field treatments, which puts a higher burden onto the acceleration machine. It is widely known that the tungsten target of the TomoTherapy Hi·Art system (TomoTherapy, Madison, WI, USA, ( 1 ) ) suffers from wear effects ( 2 – 5 ) and needs periodic replacement. This replacement normally takes a couple of days, including the time for delivering the spare parts.…”

Section: Introductionmentioning

confidence: 99%

Measurements to predict the time of target replacement of a helical tomotherapy

Kampfer

Schell

Duma

et al. 2011

Intensity‐modulated radiation therapy (IMRT) requires more beam‐on time than normal open field treatment. Consequently, the machines wear out and need more spare parts. A helical tomotherapy treatment unit needs a periodical tungsten target replacement, which is a time consuming event. To be able to predict the next replacement would be quite valuable. We observed unexpected variations towards the end of the target lifetime in the performed pretreatment measurements for patient plan verification. Thus, we retrospectively analyze the measurements of our quality assurance program. The time dependence of the quotient of two simultaneous dose measurements at different depths within a phantom for a fixed open field irradiation is evaluated. We also assess the time‐dependent changes of an IMRT plan measurement and of a relative depth dose curve measurement. Additionally, we performed a Monte Carlo simulation with Geant4 to understand the physical reasons for the measured values. Our measurements show that the dose at a specified depth compared to the dose in shallower regions of the phantom declines towards the end of the target lifetime. This reproducible effect can be due to the lowering of the mean energy of the X‐ray spectrum. These results are supported by the measurements of the IMRT plan, as well as the study of the relative depth dose curve. Furthermore, the simulation is consistent with these findings since it provides a possible explanation for the reduction of the mean energy for thinner targets. It could be due to the lowering of low energy photon self‐absorption in a worn out and therefore thinner target. We state a threshold value for our measurement at which a target replacement should be initiated. Measurements to observe a change in the energy are good predictors of the need for a target replacement. However, since all results support the softening of the spectrum hypothesis, all depth‐dependent setups are viable for analyzing the deterioration of the tungsten target. The suggested measurements and criteria to replace the target can be very helpful for every user of a TomoTherapy machine.PACS numbers: 87.55.N‐, 87.55.Qr, 87.55.T‐, 87.56.bd