Collimator angle is usually rotated when planning volumetric modulated arc therapy (VMAT) due to the leakage of radiation between multi-leaf collimator (MLC) leaves. We studied the effect of the collimator angles on the results of dosimetric verification of the VMAT plans for head and neck patients. We studied VMAT plans for 10 head and neck patients. We made 2 sets of VMAT plans for each patient. Each set was composed of 10 plans with collimator angles of 0, 5, 10, 15, 20, 25, 30, 35, 40, 45 degrees. Plans in the first set were optimized individually and plans in the second set shared the 30 degree collimator angle optimization. Two sets of plans were verified using the 2-dimensional ion chamber array MatriXX (IBA Dosimetry, Germany). The comparison between the calculation and measurements were made by the $γ$-index analysis. The $γ$-index (2\%/2 mm) and (3\%/3 mm) passing rates had negative correlations with the collimator angle. Maximum difference between $γ$-index (3\%/3 mm) passing rates of different collimator angles for each patient ranged from 1.46\% to 5.60\% with an average of 3.67\%. There were significant differences (maximum 5.6\%) in the passing rates of different collimator angles. The results suggested that the accuracy of the delivered dose depends on the collimator angle. These findings are informative when choosing a collimator angle in VMAT plans.
In intensity-modulated radiation therapy, optimal intensity distributions of incoming beams are decomposed into linear combinations of leaf openings of a multileaf collimator (segments). In order to avoid inefficient dose delivery, the decomposition should satisfy a number of dosimetric constraints due to suboptimal dose characteristics of small segments. However, exact decomposition with dosimetric constraints is only in limited cases possible. The present work introduces new heuristic segmentation algorithms for the following optimization problem: Find a segmentation of an approximated matri…
In this study, two proton beam delivery designs, passive scattering proton therapy (PSPT) and pencil beam scanning (PBS), were quantitatively compared in terms of dosimetric indices. The GATE Monte Carlo code was used to simulate the proton beam system; and the developed simulation engines were benchmarked with respect to the experimental measurements. A water phantom was used to simulate system energy parameters using a set of depth-dose data in the energy range of 120-235 MeV. To compare the performance of PSPT against PBS, multiple dosimetric parameters including FWHM, peak position, range,…
The purpose of this study was to use various dosimetrical indices to determine the best IMRT modality technique for treating patients with prostate cancer. Ten patients with prostate cancer were included in this study. Intensity modulated radiation therapy plans were designed to include different modalities, including the linac step and shoot, Tomotherapy, RapidArc, and Proton systems. Various dosimetrical indices, like the prescription isodose to target volume (PITV) ratio, conformity index (CI), homogeneity index (HI), target coverage index (TCI), modified dose homogeneity index (MHI), confo…
During Stereotactic Body Radiotherapy (SBRT) for the treatment of prostate cancer, an inflatable endorectal balloon (ERB) may be used to reduce motion of the target and reduce the dose to the posterior rectal wall. This work assessed the dosimetric impact of manual interventions on ERB position in patients receiving prostate SBRT and investigated the impact of ERB interventions on prostate shape. Daily kilovoltage (kV) cone-beam computed tomography (CBCT) imaging was performed to localize the PTV, and an automated fusion with the planning images yielded displacements required for PTV re-locali…
A dosimetric and robustness analysis of Proton Arc Therapy (PAT) with Early Energy Layer and Spot Assignment (ELSA) for lung cancer versus conventional Intensity modulated therapy (IMPT)
The quality of SPECT Bremsstrahlung images of patients treated with Y-90 is poor, mainly because of scattered radiation and collimator septa penetration. To minimize the latter effect, High Energy (HE) or Medium Energy (ME) collimators can be used. Scatter correction is not possible through the methods commonly used for the diagnostic radionuclides (Tc-99m, etc.) because the Bremsstrahlung radiation does not have distinct photopeaks, but a broad spectrum of energies ranging from zero to the maximum one detectable by the gamma-camera crystal is registered. Scatter radiation and collimator septa…
The Fast Dose Calculator (FDC), a track repeating algorithm Monte Carlo method was initially developed for proton therapy. The validation for proton therapy has been demonstrated in a previous work. This method can be expanded to ion applications. Our purpose of this paper is to validate the FDC for carbon therapy. We compare the 3D dose distributions and dose-volume-histograms (DVH) for carbon calculated by FDC with a full Monte Carlo method, GEANT 4. 19 patients in total will be discussed, including 3 patients of prostate, 5 of brain, 3 of head and neck, 4 of lung and 4 of spine. We use gamm…
This study evaluates dynamic conformal arc (DCA) therapy as an alternative to volumetric modulated arc therapy (VMAT) for stereotactic body radiation therapy (SBRT) of lung cancer. The rationale for DCA is lower geometric complexity and hence reduced risk for interplay errors induced by respiratory motion. Forward planned DCA and inverse planned DCA based on segment-weight optimization were compared to VMAT for single arc treatments of three lung patients. Analysis of dose-volume histograms and clinical goal fulfillment revealed that DCA can generate satisfactory and near equivalent dosimetric…
Given the sensitivity of proton therapy to anatomical variations, this cancer treatment modality is expected to benefit greatly from integration with magnetic resonance (MR) imaging. One of the obstacles hindering such an integration are strong magnetic field induced dose distortions. These have been predicted in simulation studies, but no experimental validation has been performed so far. Here we show the first measurement of planar distributions of dose deposited by therapeutic proton pencil beams traversing a one-Tesla transversal magnetic field while depositing energy in a tissue-like phan…
Purpose: To verify dose delivery and quality assurance of volumetric modulated arc therapy (VMAT) for head and neck cancer. Method: The Imaging and Radiation Oncology Core Houston (IROC-H) head and neck phantom with thermo- luminescent dosimeters (TLDs) and films, were imaged with computed tomography scan and the reconstructed image was transferred to pinnacle treatment planning system (TPS). On TPS the planning target volume (PTV), secondary target volume (STV) and organ at risk (OAR) were delineated manually and a treatment plan was made. The dose constraints were determined for the concerne…
Beam orientation optimization (BOO) is a key component in the process of IMRT treatment planning. It determines to what degree one can achieve a good treatment plan quality in the subsequent plan optimization process. In this paper, we have developed a BOO algorithm via adaptive l_1 minimization. Specifically, we introduce a sparsity energy function term into our model which contains weighting factors for each beam angle adaptively adjusted during the optimization process. Such an energy term favors small number of beam angles. By optimizing a total energy function containing a dosimetric term…
We developed a novel method of creating intensity modulated proton arc therapy (IMPAT) plans that uses computing resources efficiently and may offer a dosimetric benefit for patients with ependymoma or similar tumor geometries. Our IMPAT planning method consists of a geometry-based energy selection step with major scanning spot contributions as inputs computed using ray-tracing and single-Gaussian approximation of lateral spot profiles. Based on the geometric relation of scanning spots and dose voxels, our energy selection module selects a minimum set of energy layers at each gantry angle such…
The presence of metal implants within CT imaging causes severe attenuation of the X-ray beam. Due to the incomplete information recorded by CT detectors, artifacts in the form of streaks and dark bands would appear in the resulting CT images. The metal-induced artifacts would firstly affect the quantitative accuracy of CT imaging, and consequently, the radiation treatment planning and dose estimation in radiation therapy. To address this issue, CT scanner vendors have implemented metal artifact reduction (MAR) algorithms to avoid such artifacts and enhance the overall quality of CT images. The…
Background: The deep inspiration breath hold technique (DIBH) is widely used for left-sided breast radiotherapy (RT), in order to reduce the dose to the heart and the risk of cardiotoxicity. The volumetric arc therapy (VMAT) technique increases the dose conformity to the planning target volume (PTV). We hereby describe the procedure of combining VMAT and DIBH without a dedicated equipment, and report a dosimetric study related on our implemented technique. Methods: The DIBH technique is based on voluntary breath hold of the patient which is controlled by a laser on tattoo marks. Patients were …
Aim: To improve treatment plan robustness with respect to small shifts in patient position during the VMAT treatment by ensuring a linear ramp-like dose profile in treatment field overlap regions. Background: Craniospinal irradiation (CSI) is considered technically challenging because the target size exceeds the maximal field size, which necessitates using abutted or overlapping treatment fields. Volumetric modulated arc therapy (VMAT) is increasingly being examined for CSI, as it offers both better dose homogeneity and better dose conformance while also offering a possibility to create field …
Purpose: To quantitatively compare the dosimetric and biologic differences in treatment plans from flattened and flattening-filter-free (FFF) beam for three anatomic cancer sites. Methods and Materials: Treatment plans with static intensity-modulated radiotherapy beams and volumetric modulated arc therapy beams were generated for 13 patients for both the flattened beam and the FFF beam of the TrueBeam system. Beam energies of 6 MV and 10 MV were chosen for planning. A total of 104 treatment plans were generated in 13 patients. In order to analyze the biological effectiveness of treatment plans…
The main approach to smooth Pareto surface navigation for radiation therapy multi-criteria treatment planning involves taking real-time averages of pre-computed treatment plans. In fluence-based treatment planning, fluence maps themselves can be averaged, which leads to the dose distributions being averaged due to the linear relationship between fluence and dose. This works for fluence-based photon plans and proton spot scanning plans. In this technical note, we show that two or more sliding window volumetric modulated arc therapy (VMAT) plans can be combined by averaging leaf positions in a c…
In recent years, volumetric modulated arc therapy (VMAT) has been becoming a more and more important radiation technique widely used in clinical application for cancer treatment. One of the key problems in VMAT is treatment plan optimization, which is complicated due to the constraints imposed by the involved equipments. In this paper, we consider a model with four major constraints: the bound on the beam intensity, an upper bound on the rate of the change of the beam intensity, the moving speed of leaves of the multi-leaf collimator (MLC) and its directional-convexity. We solve the model by a…
Radiation therapy treatment planning can be viewed as an iterative hyperparameter tuning process to balance conflicting clinical goals. In this work, we investigated the performance of modern Bayesian Optimization (BO) methods on automated treatment planning problems in high-dimensional settings. 20 locally advanced rectal cancer patients treated with intensity-modulated radiation therapy (IMRT) were retrospectively selected as test cases. We implemented an automated treatment planning framework that adjusts dose objectives and weights simultaneously, and tested the performance of two BO metho…
Within the setting of intensity modulated radiation therapy (IMRT) and the fully continuous version of IMRT called volumetric modulated radiation therapy (VMAT), we consider the problem of matching a given fluence map as well as possible in limited time by the use of a linear accelerator (linac) with a multi-leaf collimator (MLC). We introduce two modeling strategies to manage the nonconvexity and the associated local minima of this problem. The first is the use of linear splines to model the MLC leaf positions as functions of time. The second is a progressively controllable smooth model (inst…
A work recently published experimentally demonstrates an increase in the radiobiological efficacy of clinical proton beams when a tumour is treated in the presence of a concentration of 11B. The paper, for the first time, demonstrates the potential role of the p+11B to 3α (for brevity, p-B) reaction in the biological enhancement of proton therapy effectiveness. The work reports robust experimental data in terms of clonogenic cell survival and chromosomal aberrations and unambiguously shows the presence of an enhancement when cells were exposed to a clinical proton beam subject to treatment wit…
Cycle-consistent Generative Adversarial Network Synthetic CT for MR-only Adaptive Radiation Therapy on MR-Linac
Dartmouth College（达特茅斯学院）；Thayer School of Engineering, Dartmouth College（达特茅斯学院塞耶工程学院）；Geisel School of Medicine, Dartmouth College（达特茅斯学院盖泽尔医学院）；Dartmouth Cancer Center, Dartmouth-Hitchcock Medical Center（达特茅斯-希区柯克医疗中心达特茅斯癌症中心）；Westchester Medical Center, New York Medical College（纽约医学院韦斯特切斯特医疗中心）
The aim of this study is to set up statistical quality control for monitoring of volumetric modulated arc therapy (VMAT) delivery error using machine log data. Eclipse and Clinac iX linac with the RapidArc system (Varian Medical Systems, Palo Alto, USA) is used for delivery of the VMAT plan. During the delivery of the RapidArc fields, the machine determines the delivered motor units (MUs) and gantry angle position accuracy and the standard deviations of MU (sigma_MU; dosimetric error) and gantry angle (sigma_GA; geometric error) are displayed on the console monitor after completion of the Rapi…
Purpose: To develop a novel aperture-based algorithm for volumetric modulated arc therapy (VMAT) treatment plan optimization with high quality and high efficiency. Methods: The VMAT optimization problem is formulated as a large-scale convex programming problem solved by a column generation approach. We consider a cost function consisting two terms, the first which enforces a desired dose distribution while the second guarantees a smooth dose rate variation between successive gantry angles. At each iteration of the column generation method, a subproblem is first solved to generate one more deli…
A central problem in the field of radiation therapy (RT) is how to optimally deliver dose to a patient in a way that fully accounts for anatomical position changes over time. As current RT is a static process, where beam intensities are calculated before the start of treatment, anatomical deviations can result in poor dose conformity. To overcome these limitations, we present a simulation study on a fully dynamic real-time adaptive radiation therapy (RT-ART) optimization approach that uses ultra-fast beamlet control to dynamically adapt to patient motion in real-time. A virtual RT-ART machine …
Bi-level Multi-criteria Optimization for Risk-informed Radiotherapy
Fraunhofer Institute for Industrial Mathematics (ITWM)（弗劳恩霍夫工业数学研究所）；Department of Radiation Oncology, Massachusetts General Hospital & Harvard Medical School（马萨诸塞州总医院及哈佛医学院放射肿瘤学系）
We propose a novel optimization model for volumetric modulated arc therapy (VMAT) planning that directly optimizes deliverable leaf trajectories in the treatment plan optimization problem, and eliminates the need for a separate arc-sequencing step. In this model, a 360-degree arc is divided into a given number of arc segments in which the leaves move unidirectionally. This facilitates an algorithm that determines the optimal piecewise linear leaf trajectories for each arc segment, which are deliverable in a given treatment time. Multi-leaf collimator (MLC) constraints, including maximum leaf s…
Patient-Specific Deep Reinforcement Learning for Automatic Replanning in Head-and-Neck Cancer Proton Therapy
Department of Radiation and Cellular Oncology University of Chicago（辐射与细胞肿瘤学系，芝加哥大学）；Division of Environmental and Occupational Health Sciences University of Illinois at Chicago（环境与职业卫生科学系，伊利诺伊大学芝加哥分校）；Department of Radiation Oncology and Winship Cancer Institute Emory University（放射肿瘤学系和Winship癌症研究所，埃默里大学）
Unsupervised deep learning model for fast energy layer pre-selection of delivery-efficient proton arc therapy plan optimization of nasopharyngeal carcinoma
Research Center of GNSS, Wuhan University（武汉大学GNSS研究中心）；Tongji Medical College, Huazhong University of Science and Technology（同济医学院，华中科技大学）；Wuhan University（武汉大学）；Anhui No. 2 Provincial People's Hospital（安徽省第二人民医院）
A new delivery option for cancer centers equipped with linear accelerators fitted with multi-leaf collimators (MLC) -- i.e. centers which can perform intensity modulated radiation therapy (IMRT) -- is rotational delivery. In rotational delivery, the beam is on while the gantry is rotating and the MLC leaves are moving, thus treating the patient more efficiently (regarding time) than in IMRT. A consideration that should be examined when evaluating this new type of delivery method is the tradeoff between treatment plan quality and delivery time: what do we sacrifice in terms of plan quality by g…
Causal Machine Learning Analysis of Empirical Relative Biological Effectiveness (RBE) for Mandible Osteoradionecrosis in Head and Neck Cancer Radiotherapy
