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At least 343 records · Page 19
All sourcesNASA NTRSDOE OSTI
DOE OSTI2015

SU-E-T-129: Are Knowledge-Based Planning Dose Estimates Valid for Distensible Organs?

Purpose: Knowledge-based planning programs have become available to assist treatment planning in radiation therapy. Such programs can be used to generate estimated DVHs and planning constraints for organs at risk (OARs), based upon a model generated from previous plans. These estimates are based upon the planning CT scan. However, for distensible OARs like the bladder and rectum, daily variations in volume may make the dose estimates invalid. The purpose of this study is to determine whether knowledge-based DVH dose estimates may be valid for distensible OARs. Methods: The Varian RapidPlan™ knowledge-based planning module was used to generate OAR dose estimates and planning objectives for 10 prostate cases previously planned with VMAT, and final plans were calculated for each. Five weekly setup CBCT scans of each patient were then downloaded and contoured (assuming no change in size and shape of the target volume), and rectum and bladder DVHs were recalculated for each scan. Dose volumes were then compared at 75, 60,and 40 Gy for the bladder and rectum between the planning scan and the CBCTs. Results: Plan doses and estimates matched well at all dose points., Volumes of the rectum and bladder varied widely between planning CT and the CBCTs, ranging from 0.46 to 2.42 for the bladder and 0.71 to 2.18 for the rectum, causing relative dose volumes to vary between planning CT and CBCT, but absolute dose volumes were more consistent. The overall ratio of CBCT/plan dose volumes was 1.02 ±0.27 for rectum and 0.98 ±0.20 for bladder in these patients. Conclusion: Knowledge-based planning dose volume estimates for distensible OARs are still valid, in absolute volume terms, between treatment planning scans and CBCT’s taken during daily treatment. Further analysis of the data is being undertaken to determine how differences depend upon rectum and bladder filling state. This work has been supported by Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-143: Automatic PBS Treatment Planning for Prostate Cancer

Purpose: This study presents a novel idea of using automated planning technique for parallel-opposed prostate plans with pencil beam scanning proton therapy. Methods: A random 5 clinical prostate patients treated with parallel-opposed modulated-scanning proton beam in our proton center were selected in this study. All of the 5 cases were re-planned with in-house developed python scripts integrated into RayStation 4.0 clinical version. This automatic tool was designed to perform patient DICOM data import, external structure contours, CT density assignment, prescription to PTV assignment, beam placement, optimization, and dose calculation. Results: The mean time to generate a complete treatment plan was 1 minute per plan. For the automatically generated plans, 5 out of 5 plans (100%) were deemed clinically acceptable by one experienced radiation oncologist. In addition, the automated plans were overall dosimetrically equivalent to the clinical plans when scored for target coverage, rectum and bladder dose. Mann-Whitney U tests did not show significant dosimetric differences for normal tissue structures between the clinical and automated plans. Conclusion: We have developed a robust and automated method for fully inversed planned paralleled-opposed prostate proton treatment planning. This efficient method can be readily integrated into clinical practice. The tool produces clinically acceptable plans using only manually contoured anatomic structures and simulation CT data set. We anticipate that this tool will not only improve patient access to high-quality proton treatment by simplifying the planning process and will also reduce the effort and cost of incorporating more advanced planning into clinical practice in the near future.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-E-T-151: Breathing Synchronized Delivery (BSD) Planning for RapicArc Treatment

Purpose: To propose a workflow for breathing synchronized delivery (BSD) planning for RapicArc treatment. Methods: The workflow includes three stages: screening/simulation, planning, and delivery. In the screening/simulation stage, a 4D CT with the corresponding breathing pattern is acquired for each of the selected patients, who are able to follow their own breathing pattern. In the planning stage, one breathing phase is chosen as the reference, and contours are delineated on the reference image. Deformation maps to other phases are performed along with contour propagation. Based on the control points of the initial 3D plan for the reference phase and the respiration trace, the correlation with respiration phases, the leaf sequence and gantry angles is determined. The beamlet matrices are calculated with the corresponding breathing phase and deformed to the reference phase. Using the 4D dose evaluation tool and the original 3D plan DVHs criteria, the leaf sequence is further optimized to meet the planning objectives and the machine constraints. In the delivery stage, the patients are instructed to follow the programmed breathing patterns of their own, and all other parts are the same as the conventional Rapid-Arc delivery. Results: Our plan analysis is based on comparison of the 3D plan with a static target (SD), 3D plan with motion delivery (MD), and the BSD plan. Cyclic motion of range 0 cm to 3 cm was simulated for phantoms and lung CT. The gain of the BSD plan over MD is significant and concordant for both simulation and lung 4DCT, indicating the benefits of 4D planning. Conclusion: Our study shows that the BSD plan can approach the SD plan quality. However, such BSD scheme relies on the patient being able to follow the same breathing curve that is used in the planning stage during radiation delivery. Funded by Varian Medical Systems.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2015

SU-F-BRB-07: A Plan Comparison Tool to Ensure Robustness and Deliverability in Online-Adaptive Radiotherapy

Purpose: To develop a plan comparison tool that will ensure robustness and deliverability through analysis of baseline and online-adaptive radiotherapy plans using similarity metrics. Methods: The ViewRay MRIdian treatment planning system allows export of a plan file that contains plan and delivery information. A software tool was developed to read and compare two plans, providing information and metrics to assess their similarity. In addition to performing direct comparisons (e.g. demographics, ROI volumes, number of segments, total beam-on time), the tool computes and presents histograms of derived metrics (e.g. step-and-shoot segment field sizes, segment average leaf gaps). Such metrics were investigated for their ability to predict that an online-adapted plan reasonably similar to a baseline plan where deliverability has already been established. Results: In the realm of online-adaptive planning, comparing ROI volumes offers a sanity check to verify observations found during contouring. Beyond ROI analysis, it has been found that simply editing contours and re-optimizing to adapt treatment can produce a delivery that is substantially different than the baseline plan (e.g. number of segments increased by 31%), with no changes in optimization parameters and only minor changes in anatomy. Currently the tool can quickly identify large omissions or deviations from baseline expectations. As our online-adaptive patient population increases, we will continue to develop and refine quantitative acceptance criteria for adapted plans and relate them historical delivery QA measurements. Conclusion: The plan comparison tool is in clinical use and reports a wide range of comparison metrics, illustrating key differences between two plans. This independent check is accomplished in seconds and can be performed in parallel to other tasks in the online-adaptive workflow. Current use prevents large planning or delivery errors from occurring, and ongoing refinements will lead to increased assurance of plan quality.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-241: Reduction in Planning Errors Via a Process Control Developed Using the Eclipse Scripting API

Purpose: Errors found during initial physics plan checks frequently require replanning and reprinting, resulting decreased departmental efficiency. Additionally, errors may be missed during physics checks, resulting in potential treatment errors or interruption. This work presents a process control created using the Eclipse Scripting API (ESAPI) enabling dosimetrists and physicists to detect potential errors in the Eclipse treatment planning system prior to performing any plan approvals or printing. Methods: Potential failure modes for five categories were generated based on available ESAPI (v11) patient object properties: Images, Contours, Plans, Beams, and Dose. An Eclipse script plugin (PlanCheck) was written in C# to check errors most frequently observed clinically in each of the categories. The PlanCheck algorithms were devised to check technical aspects of plans, such as deliverability (e.g. minimum EDW MUs), in addition to ensuring that policy and procedures relating to planning were being followed. The effect on clinical workflow efficiency was measured by tracking the plan document error rate and plan revision/retirement rates in the Aria database over monthly intervals. Results: The number of potential failure modes the PlanCheck script is currently capable of checking for in the following categories: Images (6), Contours (7), Plans (8), Beams (17), and Dose (4). Prior to implementation of the PlanCheck plugin, the observed error rates in errored plan documents and revised/retired plans in the Aria database was 20% and 22%, respectively. Error rates were seen to decrease gradually over time as adoption of the script improved. Conclusion: A process control created using the Eclipse scripting API enabled plan checks to occur within the planning system, resulting in reduction in error rates and improved efficiency. Future work includes: initiating full FMEA for planning workflow, extending categories to include additional checks outside of ESAPI via Aria database queries, and eventual automated plan checks.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-284: The Effect of Linear Accelerator Output Variation On the Quality of Patient Specific Rapid Arc Verification Plans

Purpose: The aim of the current study is to investigate the effect of machine output variation on the delivery of the RapidArc verification plans. Methods: Three verification plans were generated using Eclipse™ treatment planning system (V11.031) with plan normalization value 100.0%. These plans were delivered on the linear accelerators using ArcCHECK− device, with machine output 1.000 cGy/MU at calibration point. These planned and delivered dose distributions were used as reference plans. Additional plans were created in Eclipse− with normalization values ranging 92.80%–102% to mimic the machine output ranging 1.072cGy/MU-0.980cGy/MU, at the calibration point. These plans were compared against the reference plans using gamma indices (3%, 3mm) and (2%, 2mm). Calculated gammas were studied for its dependence on machine output. Plans were considered passed if 90% of the points satisfy the defined gamma criteria. Results: The gamma index (3%, 3mm) was insensitive to output fluctuation within the output tolerance level (2% of calibration), and showed failures, when the machine output exceeds ≥3%. Gamma (2%, 2mm) was found to be more sensitive to the output variation compared to the gamma (3%, 3mm), and showed failures, when output exceeds ≥1.7%. The variation of the gamma indices with output variability also showed dependence upon the plan parameters (e.g. MLC movement and gantry rotation). The variation of the percentage points passing gamma criteria with output variation followed a non-linear decrease beyond the output tolerance level. Conclusion: Data from the limited plans and output conditions showed that gamma (2%, 2mm) is more sensitive to the output fluctuations compared to Gamma (3%,3mm). Work under progress, including detail data from a large number of plans and a wide range of output conditions, may be able to conclude the quantitative dependence of gammas on machine output, and hence the effect on the quality of delivered rapid arc plans.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-338: Flattening Filter Free Photon Beams Can Achieve the Same Plan Quality as Conventional Flattened Beams for Prostate Radiotherapy

Purpose: Some modern linear accelerators are equipped with one low energy flat beam and two flattening filter free (FFF) beams at high and low energies. The purpose of this study is to investigate whether the high energy FFF beam can produce the same plan quality as the conventional low energy flat beam, using a volumetric modulated arc (VMAT) technique for prostate patients. Methods: Ten prostate cancer patients were selected with a prescription of 78Gy. For each patient, three plans were created: (a) double arc flat 6MV plan used clinically; (b) double arc 10MV FFF plan; (c) single arc 10MV FFF plan. Each plan was prescribed so that at least 95% of the PTV received the prescription dose. The following dosimetric endpoints were evaluated: volume receiving 78Gy (V78) of the CTV and PTV, PTV conformality index (CI, ratio of prescription isodose volume to the PTV volume), bladder volume receiving 70Gy (V70) and 60Gy (V60), rectum volume receiving 70Gy (V70) and 50Gy (V50), dose to 10cc of the rectum, and volume of both femoral heads receiving 50Gy (V50). Total monitor units for each plan were recorded. Results: No significant difference was found for all dosimetric endpoints between all plans (p>0.05). Compared to the 6MV plans, monitor units were higher with the double arc 10MV FFF plans and lower with the single arc 10MV FFF plans, 29% and 4% respectively. Conclusion: Both single arc and double arc 10MV FFF VMAT can achieve equivalent plan quality as 6MV flat beam double arc treatment plans. With the gantry speed restriction, a high dose rate of 2400MU/min may allow the optimizer to use more MUs than actually needed. Single arc 10MV FFF VMAT plans are a reasonable alternative to double arc 6MV flat beam VMAT plans.

60 APPLIED LIFE SCIENCES↗
DOE OSTI2016

SU-F-T-402: The Effect of Extremely Narrow MLC Leaf Width On the Plan Quality of VMAT for Prostate Cancer

Purpose: To investigate the effect of multi-leaf collimators (MLCs) with leaf width of 1.25 mm on the plan quality of volumetric modulated arc therapy (VMAT) for prostate cancer. Methods: A total of 20 patients with prostate cancer were retrospectively selected. Using a high definition MLC (HD MLC), primary and boost VMAT plans with two full arcs were generated for each patient (original plan). After that, by shifting patient CT images by 1.25 mm in the cranio-caudal direction between the 1st and the 2nd arc, we simulated fluences made with MLCs with leaf width of 1.25 mm. After shifting, primary and boost plans were generated for each patient (shifted plan). A sum plan was generated by summation of the primary and boost plan for each patient. Dose-volumetric parameters were calculated and compared. Results: Both homogeneity index (HI) and conformity index (CI) of the shifted plans were better than those of the original plans in primary plans (HI = 0.044 vs. 0.040 with p < 0.001 and CI = 1.056 vs. 1.044 with p = 0.006). Similarly, the shifted plans for boost target volume showed better homogeneity and conformity than did the original plans (HI = 0.042 vs. 0.037 with p = 0.006 and CI = 1.015 vs. 1.009 with p < 0.001). The total body volumes of the original plans irradiated by the prescription dose were larger than those of the shifted plans in sum plans (60.9 cc vs. 49.0 cc with p = 0.007). Conclusion: Use of extremely narrow MLCs could increase dose homogeneity and conformity of the target volume for prostate VMAT. This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. 2015R1C1A1A02036331).

60 APPLIED LIFE SCIENCES↗
NASA NTRS2010

Collective Intelligence and Three Aspects of Planning in Organizations: A NASA Example

For many complex sociotechnical systems, planning seems to require explicit coordination; certainly, in executing a plan the activities of different actors must be tightly coupled. However, distributing the needed planning information can be very burdensome and error prone, because different groups need different collections of information, updated or kept current on different time cycles. Further, the information needed to form successful plans is often highly distributed, and while feedback about the success of prior plans may exist, it may not be available to those in a position of using this to improve plans or to detect and resolve other problems in the system (Weick, 1995). Tools to support various aspects of planning have been developed, and can provide a huge benefit to the individuals working on that aspect. To be tractable, most solutions address a quite bounded slice of work, isolating it from the larger context. Prospective planning takes place over multiple, nested cycles of decision making. This builds a plan that specifies activities of different granularity. "Subplans" may specify multiple parallel activities by different groups and individuals, as well as sequential, nested actions by a single actor. Planning produces valuable, sharable, external, representations: in addition to prospective use, plans support retrospective assessment and also action in the present. Viewing planning in a larger context - both temporal and organizational -- enables noticing what one does not know and generating more systemic and effective solutions. Viewing a problem as one of collective intelligence invites thinking about the larger organizational context. Many approaches to supporting collective intelligence do not support execution of highly contingent actions, distributed across many players, and hence provide incomplete support for planning. However, CI technology maybe helpful in managing the processes of gathering information for decision making in planning and of distributing plan information to various actors, needed on various time cycles.

Billman, Dorrit↗
NASA NTRS2022

Balancing Predictive and Reactive Science Planning for Mars 2020 Perseverance

The design of the science planning process for a space science mission needs to find a balance between operational and resource constraints and scientific decision-making. Science planning has previously been characterized as either predictive or reactive. Predictive science planning is needed when constraints drive science activities to be planned far in advance. For example, a combination of long one-way light time plus high-stakes science decisions drove the Cassini-Huygens mission to Saturn to have an extremely predictive planning process. On the other extreme, reactive science planning is needed when constraints drive science activities to be planned based on the results of the previous plan. For example, the Mars Exploration Rover mission interacted with the surface of Mars, and so the planning team needed to know the state of the rover at the end of each planning cycle before starting the next cycle. Operational and resource constraints that require management on intermediate timescales has led to the development of a science planning process between these two extremes. For example, the Mars Science Laboratory is a technically complex rover and has a parallel predictive process that allows the operations team to manage engineering constraints several days in advance while maintaining the reactive tactical planning process similar to that of MER. The Mars 2020 Perseverance rover is a technically complex rover in the MSL style, but has an added layer of science complexity: it is tasked with collecting a returnable cache of scientifically valuable samples of Mars within prime mission. Thus, the science planning process also needs to accommodate high-stakes longer-term science decisions in the style of Cassini. In order to balance the push-pull of these constraints, we have developed a science campaign-focused operational paradigm for Mars 2020 Perseverance that allows for both predictive planning to accommodate technological complexity and high-stakes science decisions as well as reactive planning to accommodate the realities of interacting with the martian surface. This paradigm influenced the design of operational processes and operational tools.

Spanovich, Nicole↗
DOE OSTI2013

Whole breast and excision cavity radiotherapy plan comparison: Conformal radiotherapy with sequential boost versus intensity-modulated radiation therapy with a simultaneously integrated boost

A comparative study was conducted comparing the difference between (1) conformal radiotherapy (CRT) to the whole breast with sequential boost excision cavity plans and (2) intensity-modulated radiation therapy (IMRT) to the whole breast with simultaneously integrated boost to the excision cavity. The computed tomography (CT) data sets of 25 breast cancer patients were used and the results analysed to determine if either planning method produced superior plans. CT data sets from 25 past breast cancer patients were planned using (1) CRT prescribed to 50 Gy in 25 fractions (Fx) to the whole-breast planning target volume (PTV) and 10 Gy in 5Fx to the excision cavity and (2) IMRT prescribed to 60 Gy in 25Fx, with 60 Gy delivered to the excision cavity PTV and 50 Gy delivered to the whole-breast PTV, treated simultaneously. In total, 50 plans were created, with each plan evaluated by PTV coverage using conformity indices, plan maximum dose, lung dose, and heart maximum dose for patients with left-side lesions. CRT plans delivered the lowest plan maximum doses in 56% of cases (average CRT = 6314.34 cGy, IMRT = 6371.52 cGy). They also delivered the lowest mean lung dose in 68% of cases (average CRT = 1206.64 cGy, IMRT = 1288.37 cGy) and V20 in 88% of cases (average CRT = 20.03%, IMRT = 21.73%) and V30 doses in 92% of cases (average CRT = 16.82%, IMRT = 17.97%). IMRT created more conformal plans, using both conformity index and conformation number, in every instance, and lower heart maximum doses in 78.6% of cases (average CRT = 5295.26 cGy, IMRT = 5209.87 cGy). IMRT plans produced superior dose conformity and shorter treatment duration, but a slightly higher planning maximum and increased lung doses. IMRT plans are also faster to treat on a daily basis, with shorter fractionation.

62 RADIOLOGY AND NUCLEAR MEDICINE↗
DOE OSTI2013

A detailed evaluation of TomoDirect 3DCRT planning for whole-breast radiation therapy

The goal of this work was to develop planning strategies for whole-breast radiotherapy (WBRT) using TomoDirect three-dimensional conformal radiation therapy (TD-3DCRT) and to compare TD-3DCRT with conventional 3DCRT and TD intensity-modulated radiation therapy (TD-IMRT) to evaluate differences in WBRT plan quality. Computed tomography (CT) images of 10 women were used to generate 150 WBRT plans, varying in target structures, field width (FW), pitch, and number of beams. Effects on target and external maximum doses (EMD), organ-at-risk (OAR) doses, and treatment time were assessed for each parameter to establish an optimal planning technique. Using this technique, TD-3DCRT plans were generated and compared with TD-IMRT and standard 3DCRT plans. FW 5.0 cm with pitch = 0.250 cm significantly decreased EMD without increasing lung V20 Gy. Increasing number of beams from 2 to 6 and using an additional breast planning structure decreased EMD though increased lung V20 Gy. Changes in pitch had minimal effect on plan metrics. TD-3DCRT plans were subsequently generated using FW 5.0 cm, pitch = 0.250 cm, and 2 beams, with additional beams or planning structures added to decrease EMD when necessary. TD-3DCRT and TD-IMRT significantly decreased target maximum dose compared to standard 3DCRT. FW 5.0 cm with 2 to 6 beams or novel planning structures or both allow for TD-3DCRT WBRT plans with excellent target coverage and OAR doses. TD-3DCRT plans are comparable to plans generated using TD-IMRT and provide an alternative to conventional 3DCRT for WBRT.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2013

Dosimetric comparison of different multileaf collimator leaves in treatment planning of intensity-modulated radiotherapy for cervical cancer

To study the effect of multileaf collimator (MLC) leaf widths (standard MLC [sMLC] width of 10 mm and micro-MLC [mMLC] width of 4 mm) on intensity-modulated radiotherapy (IMRT) for cervical cancer. Between January 2010 and August 2010, a retrospective analysis was conducted on 12 patients with cervical cancer. The treatment plans for all patients were generated with the same machine setup parameters and optimization methods in a treatment planning system (TPS) based on 2 commercial Elekta MLC devices. The dose distribution for the planning tumor volume (PTV), the dose sparing for organs at risk (OARs), the monitor units (MUs), and the number of IMRT segments were evaluated. For the delivery efficiency, the MUs were significantly higher in the sMLC-IMRT plan than in the mMLC-IMRT plan (802 ± 56.9 vs 702 ± 56.7; p < 0.05). The number of segments in the plans were 58.75 ± 1.8 and 59 ± 1.04 (p > 0.05). For the planning quality, the conformity index (CI) between the 2 paired IMRT plans with the mMLC and the sMLC did not differ significantly (average: 0.817 ± 0.024 vs 0.810 ± 0.028; p > 0.05). The differences of the homogeneity index (HI) between the 2 paired plans were statistically significant (average: 1.122 ± 0.010 vs 1.132 ± 0.014; p < 0.01). For OARs, the rectum, bladder, small intestine, and bony pelvis were evaluated in terms of V{sub 10}, V{sub 20}, V{sub 30}, and V{sub 40}, percentage of contoured OAR volumes receiving 10, 20, 30, and 40 Gy, respectively, and the mean dose (D{sub mean}) received. The IMRT plans with the mMLC protected the OARs better than the plans with the sMLC. There were significant differences (p < 0.05) in evaluated parameters between the 2 paired IMRT plans, except for V{sub 30} and V{sub 40} of the rectum and V{sub 10}, V{sub 20}, V{sub 40}, and D{sub mean} of the bladder. IMRT plans with the mMLC showed advantages over the plans with the sMLC in dose homogeneity for targets, dose sparing of OARs, and fewer MUs in cervical cancer.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

A treatment planning approach to spatially fractionated megavoltage grid therapy for bulky lung cancer

The purpose of this study was to explore the treatment planning methods of spatially fractionated megavoltage grid therapy for treating bulky lung tumors using multileaf collimator (MLC). A total of 5 patients with lung cancer who had gross tumor volumes ranging from 277 to 635 cm{sup 3} were retrospectively chosen for this study. The tumors were from 6.5 to 9.6 cm at shortest dimension. Several techniques using either electronic compensation or intensity-modulated radiation therapy (IMRT) were used to create a variety of grid therapy plans on the Eclipse treatment planning system. The dose prescription point was calculated to the volume, and a dose of 20 Gy with 6-MV/15-MV beams was used in each plan. The dose-volume histogram (DVH) curves were obtained to evaluate dosimetric characteristics. In addition, DVH curves from a commercially available cerrobend grid collimator were also used for comparison. The linear-quadratic radiobiological response model was used to assess therapeutic ratios (TRs) and equivalent uniform doses (EUD) for all generated plans. A total of 6 different grid therapy plans were created for each patient. Overall, 4 plans had different electronic compensation techniques: Ecomps-Tubes, Ecomps-Circles, Ecomps-Squares, and Ecomps-Weave; the other 2 plans used IMRT and IMRT-Weave techniques. The DVH curves and TRs demonstrated that these MLC-based grid therapy plans can achieve dosimetric properties very similar to those of the cerrobend grid collimator. However, the MLC-based plans have larger EUDs than those with the cerrobend grid collimator. In addition, the field shaping can be performed for targets of any shape in MLC-based plans. Thus, they can deliver a more conformal dose to the targets and spare normal structures better than the cerrobend grid collimator can. The plans generated by the MLC technique demonstrated the advantage over the standard cerrobend grid collimator on accommodating targets and sparing normal structures. Overall, 6 different plans showed 6 different dosimetric parameters. However, an optimal grid therapy plan selection from among these 6 types requires more information from clinical trials and radiobiological studies.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2014

Dosimetric comparison of IMRT rectal and anal canal plans generated using an anterior dose avoidance structure

To describe a dosimetric method using an anterior dose avoidance structure (ADAS) during the treatment planning process for intensity-modulated radiation therapy (IMRT) for patients with anal canal and rectal carcinomas. A total of 20 patients were planned on the Elekta/CMS XiO treatment planning system, version 4.5.1 (Maryland Heights MO) with a superposition algorithm. For each patient, 2 plans were created: one employing an ADAS (ADAS plan) and the other replanned without an ADAS (non-ADAS plan). The ADAS was defined to occupy the volume between the inguinal nodes and primary target providing a single organ at risk that is completely outside of the target volume. Each plan used the same beam parameters and was analyzed by comparing target coverage, overall plan dose conformity using a conformity number (CN) equation, bowel dose-volume histograms, and the number of segments, daily treatment duration, and global maximum dose. The ADAS and non-ADAS plans were equivalent in target coverage, mean global maximum dose, and sparing of small bowel in low-dose regions (5, 10, 15, and 20 Gy). The mean difference between the CN value for the non-ADAS plans and ADAS plans was 0.04 ± 0.03 (p < 0.001). The mean difference in the number of segments was 15.7 ± 12.7 (p < 0.001) in favor of ADAS plans. The ADAS plan delivery time was shorter by 2.0 ± 1.5 minutes (p < 0.001) than the non-ADAS one. The ADAS has proven to be a powerful tool when planning rectal and anal canal IMRT cases with critical structures partially contained inside the target volume.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2016

Implementation of a volumetric modulated arc therapy treatment planning solution for kidney and adrenal stereotactic body radiation therapy

To develop a volumetric modulated arc therapy (VMAT) treatment planning solution in the treatment of primary renal cell carcinoma and oligometastatic adrenal lesions with stereotactic body radiation therapy. Single-arc VMAT plans (n = 5) were compared with clinically delivered step-and-shoot intensity-modulated radiotherapy (IMRT) with planning target volume coverage normalized between techniques. Target volume conformity, organ-at-risk (OAR) dose, treatment time, and monitor units were compared. A VMAT planning solution, created from a combination of arc settings and optimization constraints, auto-generated treatment plans in a single optimization. The treatment planning solution was evaluated on 15 consecutive patients receiving kidney and adrenal stereotactic body radiation therapy. Treatment time was reduced from 13.0 ± 2.6 to 4.0 ± 0.9 minutes for IMRT and VMAT, respectively. The VMAT planning solution generated treatment plans with increased target homogeneity, improved 95% conformity index, and a reduced maximum point dose to nearby OARs but with increased intermediate dose to distant OARs. The conformity of the 95% isodose improved from 1.32 ± 0.39 to 1.12 ± 0.05 for IMRT and VMAT treatment plans, respectively. Evaluation of the planning solution showed clinically acceptable dose distributions for 13 of 15 cases with tight conformity of the prescription isodose to the planning target volume of 1.07 ± 0.04, delivering minimal dose to OARs. The introduction of a stereotactic body radiation therapy VMAT treatment planning solution improves the efficiency of planning and delivery time, producing treatment plans of comparable or superior quality to IMRT in the case of primary renal cell carcinoma and oligometastatic adrenal lesions.

61 RADIATION PROTECTION AND DOSIMETRY↗
DOE OSTI2026

Assessing heat resilience coordination in networks of plans

Networks of plans coordinating on hazard mitigation can limit losses. We offer a novel network analysis methodology to investigate how networks of plans explicitly coordinate, and the purpose and nature of coordination. We illustrate the method using networks of plans shaping heat resilience in seven Arizona cities. The network analysis can help planners to identify influential plans that need to be high quality, peripheral plans, and potential governance silos. Furthermore, investigation into plan roles offers an ontological lens into how plans network, consult, and share information. The nature of coordination varies by purpose. General plans are cited for goals, while hazard mitigation plans are referenced for heat fact base. Transportation plans cite goals and fact base in other transportation plans, but rarely cite other plan types. Furthermore, these findings will help planners to consider the roles and merits of different plans while integrating hazards across the next generation of networks of plans.

coordination↗
DOE OSTI2013

Experimental evaluations of the accuracy of 3D and 4D planning in robotic tracking stereotactic body radiotherapy for lung cancers

Purpose: Due to the complexity of 4D target tracking radiotherapy, the accuracy of this treatment strategy should be experimentally validated against established standard 3D technique. This work compared the accuracy of 3D and 4D dose calculations in respiration tracking stereotactic body radiotherapy (SBRT). Methods: Using the 4D planning module of the CyberKnife treatment planning system, treatment plans for a moving target and a static off-target cord structure were created on different four-dimensional computed tomography (4D-CT) datasets of a thorax phantom moving in different ranges. The 4D planning system used B-splines deformable image registrations (DIR) to accumulate dose distributions calculated on different breathing geometries, each corresponding to a static 3D-CT image of the 4D-CT dataset, onto a reference image to compose a 4D dose distribution. For each motion, 4D optimization was performed to generate a 4D treatment plan of the moving target. For comparison with standard 3D planning, each 4D plan was copied to the reference end-exhale images and a standard 3D dose calculation was followed. Treatment plans of the off-target structure were first obtained by standard 3D optimization on the end-exhale images. Subsequently, they were applied to recalculate the 4D dose distributions using DIRs. All dose distributions that were initially obtained using the ray-tracing algorithm with equivalent path-length heterogeneity correction (3D{sub EPL} and 4D{sub EPL}) were recalculated by a Monte Carlo algorithm (3D{sub MC} and 4D{sub MC}) to further investigate the effects of dose calculation algorithms. The calculated 3D{sub EPL}, 3D{sub MC}, 4D{sub EPL}, and 4D{sub MC} dose distributions were compared to measurements by Gafchromic EBT2 films in the axial and coronal planes of the moving target object, and the coronal plane for the static off-target object based on the {gamma} metric at 5%/3mm criteria ({gamma}{sub 5%/3mm}). Treatment plans were considered acceptable if the percentage of pixels passing {gamma}{sub 5%/3mm} (P{sub {gamma}<1}) {>=} 90%. Results: The averaged P{sub {gamma}<1} values of the 3D{sub EPL}, 3D{sub MC}, 4D{sub EPL}, and 4D{sub MC} dose calculation methods for the moving target plans are 95%, 95%, 94%, and 95% for reproducible motion, and 95%, 96%, 94%, and 93% for nonreproducible motion during actual treatment delivery. The overall measured target dose distributions are in better agreement with the 3D{sub MC} dose distributions than the 4D{sub MC} dose distributions. Conversely, measured dose distributions agree much better with the 4D{sub EPL/MC} than the 3D{sub EPL/MC} dose distributions in the static off-target structure, resulting in higher P{sub {gamma}<1} values with 4D{sub EPL/MC} (91%) vs 3D{sub EPL} (24%) and 3D{sub MC} (25%). Systematic changes of target motion reduced the averaged P{sub {gamma}<1} to 47% and 53% for 4D{sub EPL} and 4D{sub MC} dose calculations, and 22% for 3D{sub EPL/MC} dose calculations in the off-target films. Conclusions: In robotic tracking SBRT, 4D treatment planning was found to yield better prediction of the dose distributions in the off-target structure, but not necessarily in the moving target, compared to standard 3D treatment planning, for reproducible and nonreproducible target motion. It is important to ensure on a patient-by-patient basis that the cumulative uncertainty associated with the 4D-CT artifacts, deformable image registration, and motion variability is significantly smaller than the cumulative uncertainty occurred in standard 3D planning in order to make 4D planning a justified option.

60 APPLIED LIFE SCIENCES↗