Jin-Beom Chung

Dosimetric effects of the acuros XB and anisotropic analytical algorithm on volumetric modulated arc therapy planning for prostate cancer using an endorectal balloon

BackgroundTo compare the dosimetric effects of Acuros XB (AXB) and Anisotropic Analytical Algorithm (AAA) on volumetric modulated arc therapy (VMAT) planning for postoperative prostate cancer patients irradiated using an endorectal balloon (ERB).MethodsWe measured central axis doses with film in a phantom containing an air cavity, and compared measurements with calculations of the AAA and AXB. For clinical study, 10 patients who had undergone whole pelvic radiotherapy (WPRT) followed by prostatic bed-only radiotherapy (PBRT) using VMAT were enrolled. An ERB was used for PBRT but not for WPRT. To compare dosimetric parameters, the cumulative dose-volume histograms, mean, maximum, and minimum doses were measured for the planning target volume. Homogeneity of plans were confirmed using V95%, V107% (VX%, percentage volumes receiving at least X% of prescribed doses) and conformity indices (homogeneity index [HI], conformity index [CI], and conformation number [CN]). We compared volumes of the organ-at-risk receiving 10% to 100% (10-tier at 10% interval) of prescribed doses (V10% – V100%).ResultsIn the phantom study, the AAA showed larger disagreement with the measurements, and overestimated the dose in the air cavity, comparing with the AXB. For WPRT planning, the AAA predicted a lower maximum dose and V107% than the AXB. For PBRT planning, the AAA estimated a higher minimum dose, lower maximum dose, and smaller V107%, and larger V95% than the AXB. Regarding the conformity indices, the AAA was estimated to be more homogenous than the AXB for PBRT planning (HI, 0.088 vs. 0.120, p = 0.005; CI, 1.052 vs. 1.038, p = 0.022; and CN, 0.920 vs. 0.900, p = 0.007) but not for WPRT planning. Among V10% to V100% of the rectum, the PBRT exhibited significant discrepancies in V30%, V40%, V70%, V80%, and V90%; while the WPRT did in V20% and V30%.ConclusionsThe phantom study demonstrated that the AXB calculates more accurately in the air cavity than the AAA. In the clinical setting, the AXB exhibited different dosimetric distributions in the VMAT plans for PBRT containing an ERB. The AXB should be considered for prostate cancer patients irradiated with an ERB for better applying of heterogeneous condition.

Radiobiological model-based bio-anatomical quality assurance in intensity-modulated radiation therapy for prostate cancer

A bio-anatomical quality assurance (QA) method employing tumor control probability (TCP) and normal tissue complication probability (NTCP) is described that can integrate radiobiological effects into intensity-modulated radiation therapy (IMRT). We evaluated the variations in the radiobiological effects caused by random errors (r-errors) and systematic errors (s-errors) by evaluating TCP and NTCP in two groups: patients with an intact prostate (Gintact) and those who have undergone prostatectomy (Gtectomy). The r-errors were generated using an isocenter shift of ±1 mm to simulate a misaligned patient set-up. The s-errors were generated using individual leaves that were displaced inwardly and outwardly by 1 mm on multileaf collimator field files. Subvolume-based TCP and NTCP were visualized on computed tomography (CT) images to determine the radiobiological effects on the principal structures. The bio-anatomical QA using the TCP and NTCP maps differentiated the critical radiobiological effects on specific volumes, particularly at the anterior rectal walls and planning target volumes. The s-errors showed a TCP variation of –40–25% in Gtectomy and –30–10% in Gintact, while the r-errors were less than 1.5% in both groups. The r-errors for the rectum and bladder showed higher NTCP variations at ±20% and ±10%, respectively, and the s-errors were greater than ±65% for both. This bio-anatomical method, as a patient-specific IMRT QA, can provide distinct indications of clinically significant radiobiological effects beyond the minimization of probable physical dose errors in phantoms.

Confidence limits for patient-specific IMRT dose QA: a multi-institutional study in Korea

This study aims to investigate tolerance levels for patient-specific IMRT dose QA (DQA) using the confidence limits (CL) determined by a multi-institutional study. Eleven institutions participated in the multi-institutional study in Korea. A total of 155 DQA measurements, consisting of point-dose differences (high- and low-dose regions) and gamma passing rates (composite and per-field) for IMRT patients with brain, head and neck (H&N), abdomen, and prostate cancers were examined. The Shapiro-Wilk test was used to evaluate the normality of data grouped by the treatment sites and the DQA methods. The confidence limit coefficients in cases of the normal distribution, and the two-sided Students t-distribution were applied to determine the confidence limits for the grouped data. The Spearmans test was applied to assess the sensitivity of DQA results within the limited groups. The differences in CLs between the two confidence coefficients based on the normal and t-distributions were negligible for the point-dose data and the gamma passing rates with 3%/3 criteria. However, with 2%/2 criteria, the difference in CLs were 1.6% and 2.2% for composite and per-field measurements, respectively. This resulted from the large standard deviation and the more sensitive criteria of 2%/2. There was no noticeable correlation among the different QA methods. Our multi-institutional study suggested that the CL was not a suitable metric for defining the tolerance level when the statistics of the sample group did not follow the normality and had a large standard deviation. PACS number: 87.55.Qr.This study aims to investigate tolerance levels for patient‐specific IMRT dose QA (DQA) using the confidence limits (CL) determined by a multi‐institutional study. Eleven institutions participated in the multi‐institutional study in Korea. A total of 155 DQA measurements, consisting of point‐dose differences (high‐ and low‐dose regions) and gamma passing rates (composite and per‐field) for IMRT patients with brain, head and neck (H&N), abdomen, and prostate cancers were examined. The Shapiro‐Wilk test was used to evaluate the normality of data grouped by the treatment sites and the DQA methods. The confidence limit coefficients in cases of the normal distribution, and the two‐sided Students t‐distribution were applied to determine the confidence limits for the grouped data. The Spearmans test was applied to assess the sensitivity of DQA results within the limited groups. The differences in CLs between the two confidence coefficients based on the normal and t‐distributions were negligible for the point‐dose data and the gamma passing rates with 3%/3 criteria. However, with 2%/2 criteria, the difference in CLs were 1.6% and 2.2% for composite and per‐field measurements, respectively. This resulted from the large standard deviation and the more sensitive criteria of 2%/2. There was no noticeable correlation among the different QA methods. Our multi‐institutional study suggested that the CL was not a suitable metric for defining the tolerance level when the statistics of the sample group did not follow the normality and had a large standard deviation. PACS number: 87.55.Qr

Comparison of Dosimetric Performance among Commercial Quality Assurance Systems for Verifying Pretreatment Plans of Stereotactic Body Radiotherapy Using Flattening-Filter-Free Beams

The purpose of this study was to compare the performance of different commercial quality assurance (QA) systems for the pretreatment verification plan of stereotactic body radiotherapy (SBRT) with volumetric arc therapy (VMAT) technique using a flattening-filter-free beam. The verification for 20 pretreatment cancer patients (seven lung, six spine, and seven prostate cancers) were tested using three QA systems (EBT3 film, I’mRT MatriXX array, and MapCHECK). All the SBRT-VMAT plans were optimized in the Eclipse (version 11.0.34) treatment planning system (TPS) using the Acuros XB dose calculation algorithm and were delivered to the Varian TrueBeam® accelerator equipped with a high-definition multileaf collimator. Gamma agreement evaluation was analyzed with the criteria of 2% dose difference and 2 mm distance to agreement (2%/2 mm) or 3%/3 mm. The highest passing rate (99.1% for 3%/3 mm) was observed on the MapCHECK system while the lowest passing rate was obtained on the film. The pretreatment verification results depend on the QA systems, treatment sites, and delivery beam energies. However, the delivery QA results for all QA systems based on the TPS calculation showed a good agreement of more than 90% for both the criteria. It is concluded that the three 2D QA systems have sufficient potential for pretreatment verification of the SBRT-VMAT plan.

To propose adding index of achievement (IOA) to IMRT QA process

BackgroundIn intensity modulated radiation therapy (IMRT) quality assurance (QA), evaluation of QA result using a pass/non-pass strategy under an acceptance criterion often suffers from lack of information on how good the plan is in absolute manner. In this study, we suggested adding an index system, previously developed for dose painting technique, to current IMRT QA process for better understanding of QA result.MethodsThe index system consists of three indices, index of achievement (IOA), index of hotness (IOH) and index of coldness (IOC). As indicated by its name, IOA does measure the level of agreement. IOH and IOC, on the other hand, measure the magnitude of overdose and underdose, respectively. A systematic analysis was performed with three 1-dimensional hypothetical dose distributions to investigate the characteristics of the index system. The feasibility of the system was also assessed with clinical volumetric modulated arc therapy (VMAT) QA cases from 8 head & neck and 5 prostate patients. In both simulation studies, certain amount of errors was intentionally induced to each dose distribution. Furthermore, we applied the proposed system to compare calculated with actual measured data for a total of 60 patients (30 head & neck and 30 prostate cases). QA analysis was made using both the index system and gamma method, and results were compared.ResultsWhile the gamma evaluation showed limited sensitivity in evaluating QA result depending on the level of tolerance criteria used, the proposed indices tended to better distinguish plans in terms of the amount of errors. Hotness and coldness of prescribed dose in the plan could be evaluated quantitatively by the indices.ConclusionsThe proposed index system provides information with which IMRT QA result would be better evaluated, especially when gamma pass rates are identical or similar among multiple plans. In addition, the independency of the index system on acceptance criteria would help making clear communications among readers of published articles and researchers in multi-institutional studies.

Accuracy of automatic matching of Catphan 504 phantom in cone‐beam computed tomography for tube current–exposure time product

The purpose of this study is to evaluate the accuracy of automatic matching in cone-beam computed tomography (CBCT) images relative to the reduction of total tube current-exposure time product (mAs) for the X-ray imaging (XI) system. The CBCT images were acquired with the Catphan 504 phantom various total mAs ratios such as 1.00, 0.83, 0.67, 0.57, and 0.50. For studying the automatic matching accuracy, the phantom images were acquired with a six-dimensional shifting table. The image quality and correction of automatic matching were compared. With a decreasing total mAs ratio, the noise of the images increased and the low-contrast resolution decreased, while the accuracy of the automatic matching did not change. Therefore, this study shows that a change of the total mAs while acquiring CBCT images has no effect on the automatic matching of Catphan 504 phantom in XI system. PACS number(s): 87.57.C-, 87.57.Q.The purpose of this study is to evaluate the accuracy of automatic matching in cone‐beam computed tomography (CBCT) images relative to the reduction of total tube current–exposure time product (mAs) for the X‐ray imaging (XI) system. The CBCT images were acquired with the Catphan 504 phantom various total mAs ratios such as 1.00, 0.83, 0.67, 0.57, and 0.50. For studying the automatic matching accuracy, the phantom images were acquired with a six‐dimensional shifting table. The image quality and correction of automatic matching were compared. With a decreasing total mAs ratio, the noise of the images increased and the low‐contrast resolution decreased, while the accuracy of the automatic matching did not change. Therefore, this study shows that a change of the total mAs while acquiring CBCT images has no effect on the automatic matching of Catphan 504 phantom in XI system. PACS number(s): 87.57.C‐, 87.57.Q‐