For left-sided postmastectomy patients requiring chest wall plus comprehensive nodal irradiation, sometimes traditional techniques such as partial wide tangents or electron/tangents combination are not feasible due to abnormal chest wall contour or heart position or unusually wide excision scar. We developed electron chest wall irradiation technique using Electron Monte Carlo (EMC) dose algorithm that will achieve heart sparing with acceptable ipsilateral lung dose, minimal contralateral lung, and breast dose. Ten left-sided postmastectomy patients with very challenging anatomy were selected for this dosimetry study. The en face electron fields were designed from a single isocenter and gantry angle with different energy beams using different cutouts that matched on the skin. Smaller energy was used in the central thin chest wall part and higher energy in the medial internal mammary nodes (IMN) area, superior part of the thick chest wall, and/or axillary nodal area. The electron fields were matched to the photon supraclavicular field in the superior region. Daily field junctions were used to feather the match lines between all the fields. Electron field dose calculations were done with Monte Carlo. Five patients’ chest wall fields were planned with 6/9MeVcombination, 1 with 6/12 MeV, 2 with 9/12 MeV, 1 with 9/16 MeV, and 1 with 6/9/12 MeV. Institutional criteria of prescription dose of 50 Gy for target volumes and normal tissue dose were met with this technique in spite of the challenging anatomy. Mean heart dose averaged 3.0 Gy ± 0.8 Gy. For ipsilateral lung, V20Gy and V5Gy averaged 33.2% ± 4.5% and 64.6% ± 9.6%, respectively. For contralateral lung, V5Gy averaged 5.1% ± 5.0%. For contralateral breast, V5Gy averaged 3.3% ± 3.1%. The electron chest wall irradiation technique using EMC dose algorithm can provide adequate dose coverage to the chest wall, IMNs, and/or axillary nodes while achieving heart sparing with acceptable ipsilateral lung dose, minimal contralateral lung, and breast dose.
Commissioning a new treatment planning system (TPS) involves many time-consuming tasks. We investigated the role that knowledge-based planning (KBP) can play in aiding a clinic’s transition to a new TPS. Sixty clinically treated prostate/prostate bed intensity-modulated radiation therapy (IMRT) plans were exported from an in-house TPS and were used to create a KBP model in a newly implemented commercial application. To determine the benefit that KBP may have in a TPS transition, the model was tested on 2 groups of patients. Group 1 consisted of the first 10 prostate/prostate bed patients treated in the commercial TPS after the transition from the in-house TPS. Group 2 consisted of 10 patients planned in the commercial TPS after 8 months of clinical use. The KBP-generated plan was compared with the clinically used plan in terms of plan quality (ability to meet planning objectives and overall dose metrics) and planning efficiency (time required to generate clinically acceptable plans). The KBP-generated plans provided a significantly improved target coverage (p = 0.01) compared with the clinically used plans for Group 1, but yielded plans of comparable target coverage to the clinically used plans for Group 2. For the organs at risk, the KBP-generated plans produced lower doses, on average, for every normal-tissue objective except for the maximum dose to 0.1 cc of rectum. The time needed for the KBP-generated plans ranged from 6 to 15 minutes compared to 30 to 150 and 15 to 60 minutes for manual planning in Groups 1 and 2, respectively. KBP is a promising tool to aid in the transition to a new TPS. Our study indicates that high-quality treatment plans could have been generated in the newly implemented TPS more efficiently compared with not using KBP. Even after 8 months of the clinical use, KBP still showed an increase in plan quality and planning efficiency compared with manual planning.
Brachytherapy was among the first methods of radiotherapy and has steadily continued to evolve. Here we present a brief review of the progression of dose calculation methods in brachytherapy to the current state-of-the art computerized methods for heterogeneity correction. We further review the origin and development of the Brachy Vision (Varian Medical Systems,Inc.,PaloAlto,CA)treatmentplanningsystemandevaluatedosimetricresultsfrom 12 patients implanted with the strut-assisted volumetric implant (SAVI) applicator (Cianna Medical, Aliso Viejo, CA) for accelerated partial breast irradiation (APBI). Dosimetric results from plans calculated using homogenous and heterogeneous algorithms have been compared to investigate the impact of heterogeneity corrections. Our study showed large percent difference between mean cardiac doses 11.8±6.2% (p=0.0007) calculated with and without heterogeneity corrections. Our findings are consistent with those of others, indicating an overestimation of the distal dose to organs-at-risk by traditional methods, especially at interfaces between air and tissue.
The helical tomotherapy is a technologically advanced radiation dose delivery system designedtoperformintensity-modulatedradiationtherapy(IMRT).Itismechanisticallyunique, based on a small 6-MV linear accelerator mounted on a ring gantry that rotates around the patient while the patient moves through a bore, ultimately yielding a helical path of radiationdosedelivery.Thehelicalpatternofdosedeliverydifferentiatedtomotherapyfromother contemporary radiation therapy systems at the time of its inception. The accompanying 3-dimensional (3D) treatment planning system has been developed to solely support this specific type of dose delivery system. The treatment planning system has 2 modules identified as TomoHelical and TomoDirect to perform IMRT and conformal radiation therapy, respectively. The focus of this work within the scope of this special issue on 3D treatment planning systems is to assess the use of planning tools to generate treatment plans for helical tomotherapy. Clinical examples are used throughout to demonstrate the quality and differences of various clinical scenarios planned with tomotherapy.
The purpose of this study was to establish intensity-modulated radiation therapy(IMRT) and volumetric-modulated arc therapy (VMAT) treatment plans for synchronous bilateral breast cancer (SBBC) and to compare those plans with the previous treatment plans using 3D conformal radiation therapy (3DCRT). The differences among the treatments were also statistically compared regarding dosimetry distribution and treatment efficiency. The research was conducted with 10 SBBC patients. The study established IMRT (12 fields with a single isocenter) and VMAT (2 partial arcs with a single isocenter) treatment plans for SBBC patients and then compared those plans with 3DCRT (8 fields with multiple isocenters). The plans were evaluated based on a dose-volume histogram analysis. For planning target volumes (PTVs), the mean doses and the values of V95%, V105%, conformity index, and homogeneity index were reported. For the organs at risk, the analysis included the mean dose, maximum dose, and VXGy, depending on the organs (lungs, heart, and liver). To objectively evaluate the efficiency of the treatment plans, each plan’s beam times, treatment times (including set-up time), and monitor units were compared. Tukey test and one-way analysis of variance were used to compare the PTV and organs at risk values of the 3 techniques. Additionally, the independent samples t-test was used to compare the 2 techniques (IMRT and VMAT) based on the values of Rt. PTV and Lt. PTV (p<0.05). For PTV dose distribution, IMRT showed increases of approximately 1.2% in Dmean and of approximately 5.7% in V95% dose distribution compared with 3DCRT. In comparison to VMAT, 3DCRT showed about 3.0% higher dose distribution in Dmean and V95%. IMRT was the best in terms of conformity index and homogeneity index (p<0.05), whereas 3DCRT and VMAT did not significantly differ from each other. In terms of dose distribution on lungs, heart, and liver, the percentage of volume at high doses such as V30Gy and V40Gy was approximately 70% lower for IMRT and approximately 40% lower for VMAT than for 3DCRT. For distribution volumes of low doses such as V5% and V10%, that for 3DCRT was approximately 60% smaller than for IMRT and approximately 70% smaller than for VMAT. Comparison between IMRT and VMAT showed that the IMRT was superior in all distribution factors. VMAT showed better treatment efficiency than 3DCRT or IMRT. Among the SBBC radiotherapy treatment plans, IMRT was superior to 3DCRT and VMAT in terms of PTV dose distribution, whereas VMAT showed the most outstanding treatment efficiency.
We critically evaluated the quality and consistency of volumetric-modulated arc therapy (VMAT) prostate planning at a single institution to quantify objective measures for plan quality and establish clear guidelines for plan evaluation and quality assurance. A retrospective analysis was conductedon34plansgeneratedonthePinnacle3version9.4and9.8treatmentplanningsystem to deliver 78Gy in 39 fractions to the prostate only using VMAT. Data were collected on contoured structure volumes, overlaps and expansions, planning target volume (PTV) and organs at risk volumes and relationship, dose volume histogram, plan conformity, plan homogeneity, low-dose wash, and beam parameters. Standard descriptive statistics were used to describe the data. Despite a standardized planning protocol, we found variability was present in all steps of the planning process. Deviations from protocol contours by radiation oncologists and radiation therapists occurred in 12% and 50% of cases, respectively, and the number of optimization parameters ranged from 12 to 27 (median 17). This contributed to con?icts within the optimization process re?ected by the mean composite objective value of 0.07 (range 0.01 to 0.44). Methods used to control low-intermediate dose wash were inconsistent. At the PTV rectum interface, the dose-gradient distance from the 74.1Gy to 40Gy isodose ranged from 0.6 cm to 2.0 cm (median 1.0cm). Increasing collimator angle was associated with a decrease in monitor units and a single full 6 MV arc was su?cient for the majority of plans. A signi?cant relationship was found between clinical target volume-rectum distance and rectal tolerances achieved. A linear relationship was determined between the PTV volume and volume of 40Gy isodose. Objective values and composite objective values were useful in determining plan quality. Anatomic geometry and overlap of structures has a measurable impact on the plan quality achieved for prostate patients being treated with VMAT. By evaluating multiple planning variables, we have been able to determine important factors in?uencing plan quality and develop predictive models for quality metrics that have been incorporated into our new protocol and will be tested and re?ned in future studies.
The purpose of this study was to compare the variations in doses to the ipsilateral lung and heart between the supine whole breast and nodal volumetric-modulated arc therapy (VMAT) technique and the prone 3-dimensional conformal radiation therapy (3DCRT) technique. In this study, 3 patients who were simulated in the prone and supine positions were planned using supine VMAT and prone 3DCRT techniques to compare planning target volume (PTV) coverage as well as dose to organs at risk (ORs), including the heart and ipsilateral lung. Although all constraints were met, the ideal treatment technique depended on the patient’s anatomy and lumpectomy location. Supine VMAT provided excellent coverage to the target structures but encountered difficulty in limiting dose to the ipsilateral lung and heart. When compared with the supine VMAT technique, the prone 3DCRT limited dose to the ipsilateral lung and heart but provided less dose coverage to the target volumes.
This study aims to estimate the incidence of hypothyroidism (HT) and to evaluate the predictors affecting the development of HT after radiotherapy (RT) for breast cancer, with a focus on radiation dose-volumetric parameters. Between 2009 and 2015, 243 patients undergoing RT for breast cancer were retrospectively analyzed. Free triiodothyronine (FT3), free thyroxin (FT4), and thyrotropin (TSH) were monitored before and after RT. The relation between the doses to thyroid gland (Dmean, Dmax, Dmin), percentage of thyroid volume receiving > 10 Gy, 20 Gy, 30 Gy, 40 Gy, and 50 Gy (V10 to V50), absolute thyroid volume, and HT were analyzed. The risk of HT according to radiation fields and the other clinic factors were also evaluated. The median follow-up was 41 (range; 6 to 130) months. Sixty-seven percent of the patients received RT to the breast/chest wall and ipsilateral supraclavicular fossa. Of 243 patients, 51 (21%) were diagnosed with HT. The median time to the onset of HT was 27 (range; 5 to 64) months. There were no significant relationships observed between Dmin or V10 to V50 and HT. The surgery type, clinical stage, nodal status, RT field, Dmean, and Dmax were statistically significant predictors for HT in univariate analysis. The Dmean was the only prognostic factor predicting HT in multivariate analysis, and Dmean > 21 Gy was a threshold value for the evolvement of HT. In this study, we present evidence that postoperative irradiation of patients with breast cancer may frequently lead to HT. Patients who have received RT for breast cancer, especially irradiation on the supraclavicular region, may require thyroid function screening after RT.
Presented by Cory Neill, MS, CMD, RT(R)(T)
Carson-Tahoe Radiation Oncology
From the AAMD 42nd Annual Meeting
Presented by Nishele Lenards, MS, CMD, RT(R)(T), FAAMD
University of Wisconsin – La Crosse, Medical Dosimetry Program
From the AAMD 42nd Annual Meeting
Presented by Ben Nelms, PhD
ProKnow Systems
From the AAMD 42nd Annual Meeting
Presented by Mark Gooding, PhD
Mirada Medical, Ltd.
From the AAMD 42nd Annual Meeting
Presented by Robert Adams, EdD, CMD
University of North Carolina
From the AAMD 42nd Annual Meeting
Presented by Anthony Magliari, MS, CMD
Varian Medical Systems
From the AAMD 42nd Annual Meeting
Presented by Colleen DesRosiers, PhD, DABR
Indiana University Simon Cancer Center
From the AAMD 42nd Annual Meeting
Presented Pehr Hartvigson, MD
University of Washington
From the AAMD 42nd Annual Meeting
Presented by David Long, MD
Indiana University Radiation Oncology
From the AAMD 42nd Annual Meeting
Recorded by Michael Rambaud, CMD
MD Anderson Proton Therapy Center
Presented by Daniel W Bailey, PhD, DABR
Medical Physicist
Northside Hospital Cancer Institute.
Pediatric Radiation Therapy Planning and Treatment
Presented by Arthur Olch, PhD, FAAPM
Professor of Clinical Radiation Oncology and Pediatrics
University of Southern California Keck School of Medicine
Chief of Physics
Radiation Oncology Program
Children’s Hospital Los Angeles
Presented by: Stacey Schmidt, CMD
Presented by: Greg Ouelette
Sponsored by: Philips
December 14, 2016
1:00pm ET
Presented by: Jennifer Dorth, MD
Presented by: David Lege, CMD, RT(T)
Presented by: Lia M. Halasz, MD
Presented by: Todd Pawlicki, PhD
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Sigmoid.
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Anorectum.
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is The Bladder.
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is The Uterocervix.
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is The Hypothalamus.
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is The Thyroid.
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It may be free to add this activity to your library there are Member and Non-Member prices and payment that will be completed on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Pons.
AAMD Member Prices:
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This session is free to add to your library, however there are Member and Non-Member prices and payment that will be completed on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the The Brain
AAMD Member Prices:
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It is free to add this activity to your library, however there are Member and Non-Member prices and payment that will be completed on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the The Small Bowel
AAMD Member Prices:
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the The Duodenum
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the The Len.
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the The Larynx
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Pituitary Gland.
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Hippocampus.
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Eye.
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Cochlea.
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is The Lacrimal Gland.
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Large Bowel.
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Yearly subscription price $360 (13 structures)
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Sigmoid.
AAMD Member Prices:
Yearly subscription price $306 (13 structures)
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Yearly subscription price $360 (13 structures)
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While it may be free to add this activity to your library there are Member and Non-Member prices and payment that will be completed on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Rectum.
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While it may be free to add this activity to your library there are Member and Non-Member prices and payment that will be completed on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Optic Nerve.
AAMD Member Prices:
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This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Optic Chiasm.
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It may be free to add this activity to your library there are Member and Non-Member prices and payment that will be completed on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Submandibular Gland.
AAMD Member Prices:
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It may be free to add this activity to your library there are Member and Non-Member prices and payment that will be completed on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Right Parotid.
AAMD Member Prices:
Yearly subscription price $306 (13 structures)
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Yearly subscription price $360 (13 structures)
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It may be free to add this activity to your library there are Member and Non-Member prices and payment that will be completed on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Brainstem.
AAMD Member Prices:
Yearly subscription price $306 (13 structures)
Individual structures $31.88
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Yearly subscription price $360 (13 structures)
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While it may be free to add this activity to your library there are Member and Non-Member prices and payment that will be completed on the ProKnow website.
This program focuses on contouring accuracy and combines the use of education media (documents and learning movies) combined with interactive contouring and measurement of performance compared to a set of “gold” contours provided by an expert radiation oncologist. The focus of this particular training is the Brachial Plexus.
AAMD Member Prices:
Yearly subscription price $306 (13 structures)
Individual structures $31.88
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Yearly subscription price $360 (13 structures)
Individual structures $37.50