Shinichi Ueda

Accuracy of Dose Delivery in Multiple Breath-Hold Segmented Volumetric Modulated Arc Therapy: A Static Phantom Study

Purpose. Accuracy of dose delivery in multiple breath-hold segmented volumetric modulated arc therapy (VMAT) was evaluated in comparison to noninterrupted VMAT using a static phantom. Material and Methods. Five VMAT plans were evaluated. A Synergy linear accelerator (Elekta AB, Stockholm, Sweden) was employed. A VMAT delivery sequence was divided into multiple segments according to each of the predefined breath-hold periods (10, 15, 20, 30, and 40 seconds). The segmented VMAT delivery was compared to noninterrupted VMAT delivery in terms of the isocenter dose and pass rates of a dose difference of 1% with a dose threshold of 10% of the maximum dose on a central coronal plane using a two-dimensional dosimeter, MatriXX Evolution (IBA Dosimetry, Schwarzenbruck, Germany). Results. Means of the isocenter dose differences were 0.5%, 0.2%, 0.2%, 0.0%, and 0.0% for the beam-on-times between interrupts of 10, 15, 20, 30, and 40 seconds, respectively. Means of the pass rates were 85%, 99.9%, 100%, 100%, and 100% in the same order as the above. Conclusion. Our static phantom study indicated that the multiple breath-hold segmented VMAT maintains stable and accurate dose delivery when the beam-on-time between interrupts is 15 seconds or greater.

Evaluation of Deformable Image Registration Between High Dose Rate Brachytherapy and Intensity Modulated Radiation Therapy for Prostate Cancer

High risk prostate cancer is treated with a combination of intensity-modulated radiation therapy (IMRT) and high dose rate brachytherapy (HDR-BT). Deformable image registration (DIR) techniques used for dose accumulation sums dose distributions. The accuracy of DIR would get worse when density of an organ in a pair of registering two images differs greatly each other. Needles and contrast medium are used in HDR-BT. In this study, the effect of needles and contrast medium for DIR accuracy was evaluated. Six patients with prostate cancer were enrolled, who were treated with the combination of HDR-BT and IMRT. In the HDR-BT plan, needleless image (NI) and needleless and no-contrast medium image (NCI) were created from the original HDR-BT plan image (OI) to investigate the influence of needles and contrast medium. Both DIR and rigid registration (RR) were performed on the OI, NIs and NCIs by using MIM Maestro ver. 6.7.6 (MIM software Inc, Cleveland, USA) and after that the dose distribution of HDR-BT (used as the reference image) and IMRT were accumulated. The Dice Similarity coefficient (DSC) between DIR and RR were analyzed and compared each other. The mean DSC values of the prostate with DIR on OI, NI and NCI were 0.51, 0.57 and 0.73, respectively. The DSC with DIR on NCI was higher than DSC with DIR on OI and NI. The DSC values improved by removing the contrast medium.

An uncertainty metric to evaluate deformation vector fields for dose accumulation in radiotherapy

Background and purpose In adaptive radiotherapy, deformable image registration (DIR) is used to propagate delineations of tumors and organs into a new therapy plan and to calculate the accumulated total dose. Many DIR accuracy metrics have been proposed. An alternative proposed here could be a local uncertainty (LU) metric for DIR results. Materials and methods The LU represented the uncertainty of each DIR position and was focused on deformation evaluation in uniformly-dense regions. Four cases demonstrated LU calculations: two head and neck cancer cases, a lung cancer case, and a prostate cancer case. Each underwent two CT examinations for radiotherapy planning. Results LU maps were calculated from each DIR of the clinical cases. Reduced fat regions had LUs of 4.6 ± 0.9 mm, 4.8 ± 1.0 mm, and 4.5 ± 0.7 mm, while the shrunken left parotid gland had a LU of 4.1 ± 0.8 mm and the shrunken lung tumor had a LU of 3.7 ± 0.7 mm. The bowels in the pelvic region had a LU of 10.2 ± 3.7 mm. LU histograms for the cases were similar and 99% of the voxels had a LU < 3 mm. Conclusions LU is a new uncertainty metric for DIR that was demonstrated for clinical cases. It had a tolerance of <3 mm.