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W De Neve

Publications and source records attributed to W De Neve.

At least 19 recordsLinked to original sources
PubMed2006

Precautions and strategies in using a commercial flatbed scanner for radiochromic film dosimetry.

The purpose of this study was to investigate the value of a commercially available flatbed scanner for film dosimetry with radiochromic film for external radiotherapy. The EPSON Pro 1680 Expression scanner was examined as a densitometer for two-dimensional film dosimetry with Gafchromic EBT film. An accurate and efficient scanning procedure was established. Possible drift and warm-up effects of the scanner were studied and the direct physical influence of the scanner light on the radiochromic film was assessed. Next, we investigated the scan field uniformity. Also, we examined if the accuracy of radiochromic film was improved by subtracting the optical density of the unirradiated blank film from the optical density of the irradiated film. To assess the accuracy of Gafchromic EBT film when the EPSON scanner was used as a densitometer, the depth dose of a 2 x 15 cm(2) field and the in-plane and cross-plane profiles of a 15 x 15 cm(2) field were measured and compared with diamond detector measurements. When taking consecutive scans, we found that the optical density taken from the first scan was about 1% higher than the optical density taken from subsequent scans. We attribute this to the warming up of the lamp of the scanner. Longer-term drift of the scanner was found to be absent. We found that the use of a correction matrix was necessary to correct for the non-uniform scanner response over the scan field. Subtracting the optical density of the unirradiated blank film from the irradiated film improves the precision of the Gafchromic EBT film. Depth dose and profile measurements with Gafchromic EBT film and the diamond detector are in agreement within 2.5%. The EPSON Pro 1680 Expression scanner is an excellent tool for accurate two-dimensional film dosimetry with Gafchromic EBT film provided that some precautions and corrections are taken into account.

Calibration↗
PubMed2005

Decoupling initial electron beam parameters for Monte Carlo photon beam modelling by removing beam-modifying filters from the beam path.

A new method is presented to decouple the parameters of the incident e(-) beam hitting the target of the linear accelerator, which consists essentially in optimizing the agreement between measurements and calculations when the difference filter, which is an additional filter inserted in the linac head to obtain uniform lateral dose-profile curves for the high energy photon beam, and flattening filter are removed from the beam path. This leads to lateral dose-profile curves, which depend only on the mean energy of the incident electron beam, since the effect of the radial intensity distribution of the incident e- beam is negligible when both filters are absent. The location of the primary collimator and the thickness and density of the target are not considered as adjustable parameters, since a satisfactory working Monte Carlo model is obtained for the low energy photon beam (6 MV) of the linac using the same target and primary collimator. This method was applied to conclude that the mean energy of the incident e- beam for the high energy photon beam (18 MV) of our Elekta SLi Plus linac is equal to 14.9 MeV. After optimizing the mean energy, the modelling of the filters, in accordance with the information provided by the manufacturer, can be verified by positioning only one filter in the linac head while the other is removed. It is also demonstrated that the parameter setting for Bremsstrahlung angular sampling in BEAMnrc ('Simple' using the leading term of the Koch and Motz equation or 'KM' using the full equation) leads to different dose-profile curves for the same incident electron energy for the studied 18 MV beam. It is therefore important to perform the calculations in 'KM' mode. Note that both filters are not physically removed from the linac head. All filters remain present in the linac head and are only rotated out of the beam. This makes the described method applicable for practical usage since no recommissioning process is required.

Algorithms↗
PubMed2005

Investigation of geometrical and scoring grid resolution for Monte Carlo dose calculations for IMRT.

Monte Carlo based treatment planning of two different patient groups treated with step-and-shoot IMRT (head-and-neck and lung treatments) with different CT resolutions and scoring methods is performed to determine the effect of geometrical and scoring voxel sizes on DVHs and calculation times. Dose scoring is performed in two different ways: directly into geometrical voxels (or in a number of grouped geometrical voxels) or into scoring voxels defined by a separate scoring grid superimposed on the geometrical grid. For the head-and-neck cancer patients, more than 2% difference is noted in the right optical nerve when using voxel dimensions of 4 x 4 x 4 mm3 compared to the reference calculation with 1 x 1 x 2 mm3 voxel dimensions. For the lung cancer patients, 2% difference is noted in the spinal cord when using voxel dimensions of 4 x 4 x 10 mm3 compared to the 1 x 1 x 5 mm3 calculation. An independent scoring grid introduces several advantages. In cases where a relatively high geometrical resolution is required and where the scoring resolution is less important, the number of scoring voxels can be limited while maintaining a high geometrical resolution. This can be achieved either by grouping several geometrical voxels together into scoring voxels or by superimposing a separate scoring grid of spherical voxels with a user-defined radius on the geometrical grid. For the studied lung cancer cases, both methods produce accurate results and introduce a speed increase by a factor of 10-36. In cases where a low geometrical resolution is allowed, but where a high scoring resolution is required, superimposing a separate scoring grid on the geometrical grid allows a reduction in geometrical voxels while maintaining a high scoring resolution. For the studied head-and-neck cancer cases, calculations performed with a geometrical resolution of 2 x 2 x 2 mm3 and a separate scoring grid containing spherical scoring voxels with a radius of 2 mm produce accurate results and introduce a speed increase by a factor of 13. The scoring grid provides an additional degree of freedom for limiting calculation time and memory requirements by selecting optimized scoring and geometrical voxel dimensions in an independent way.

Algorithms↗
PubMed2005

Experimental verification of lung dose with radiochromic film: comparison with Monte Carlo simulations and commercially available treatment planning systems.

The purpose of this study was to assess the absorbed dose in and around lung tissue by performing radiochromic film measurements, Monte Carlo simulations and calculations with superposition convolution algorithms. We considered a layered polystyrene phantom of 12 x 12 x 12 cm3 containing a central cavity of 6 x 6 x 6 cm3 filled with Gammex RMI lung-equivalent material. Two field configurations were investigated, a small 1 x 10 cm2 field and a larger 10 x 10 cm2 field. First, we performed Monte Carlo simulations to investigate the influence of radiochromic film itself on the measured dose distribution when the film intersects a lung-equivalent region and is oriented parallel to the central beam axis. To that end, the film and the lung-equivalent materials were modelled in detail, taking into account their specific composition. Next, measurements were performed with the film oriented both parallel and perpendicular to the central beam axis to verify the results of our Monte Carlo simulations. Finally, we digitized the phantom in two commercially available treatment planning systems, Helax-TMS version 6.1A and Pinnacle version 6.2b, and calculated the absorbed dose in the phantom with their incorporated superposition convolution algorithms to compare with the Monte Carlo simulations. Comparing Monte Carlo simulations with measurements reveals that radiochromic film is a reliable dosimeter in and around lung-equivalent regions when the film is positioned perpendicular to the central beam axis. Radiochromic film is also able to predict the absorbed dose accurately when the film is positioned parallel to the central beam axis through the lung-equivalent region. However, attention must be paid when the film is not positioned along the central beam axis, in which case the film gradually attenuates the beam and decreases the dose measured behind the cavity. This underdosage disappears by offsetting the film a few centimetres. We find deviations of about 3.6% between Monte Carlo and the superposition convolution algorithm of Pinnacle behind the lung region, for both field configurations. Pinnacle is quite accurate in the lung region. Deviations up to 5.6% for the small field are found in the lung region between Monte Carlo and the superposition convolution algorithm of Helax-TMS. Behind the lung region, Helax-TMS is in better agreement with Monte Carlo. Radiochromic film measurements or Monte Carlo simulations are reliable methods to establish the dose in and around lung tissue.

Algorithms↗
PubMed2005

The importance of accurate linear accelerator head modelling for IMRT Monte Carlo calculations.

Two Monte Carlo dose engines for radiotherapy treatment planning, namely a beta release of Peregrine and MCDE (Monte Carlo dose engine), were compared with Helax-TMS (collapsed cone superposition convolution) for a head and neck patient for the Elekta SLi plus linear accelerator. Deviations between the beta release of Peregrine and MCDE up to 10% were obtained in the dose volume histogram of the optical chiasm. It was illustrated that the differences are not caused by the particle transport in the patient, but by the modelling of the Elekta SLi plus accelerator head and more specifically the multileaf collimator (MLC). In MCDE two MLC modules (MLCQ and MLCE) were introduced to study the influence of the tongue-and-groove geometry, leaf bank tilt and leakage on the actual dose volume histograms. Differences in integral dose in the optical chiasm up to 3% between the two modules have been obtained. For single small offset beams though the FWHM of lateral profiles obtained with MLCE can differ by more than 1.5 mm from profiles obtained with MLCQ. Therefore, and because the recent version of MLCE is as fast as MLCQ, we advise to use MLCE for modelling the Elekta MLC. Nevertheless there still remains a large difference (up to 10%) between Peregrine and MCDE. By studying small offset beams we have shown that the profiles obtained with Peregrine are shifted, too wide and too flat compared with MCDE and phantom measurements. The overestimated integral doses for small beam segments explain the deviations observed in the dose volume histograms. The Helax-TMS results are in better agreement with MCDE, although deviations exceeding 5% have been observed in the optical chiasm. Monte Carlo dose deviations of more than 10% as found with Peregrine are unacceptable as an influence on the clinical outcome is possible and as the purpose of Monte Carlo treatment planning is to obtain an accuracy of 2%. We would like to emphasize that only the Elekta MLC has been tested in this work, so it is certainly possible that alpha releases of Peregrine provide more accurate results for other accelerators.

Dose-Response Relationship, Radiation↗
PubMed2005

Comparison of build-up dose between Elekta and Varian linear accelerators for high-energy photon beams using radiochromic film and clinical implications for IMRT head and neck treatments.

Skin toxicity has been reported for IMRT of head and neck cancer. The purpose of this study was to investigate the dose in the build-up region delivered by a 6 MV treatment plan for which important skin toxicity was observed. We also investigated if the different designs of the treatment head of an Elekta and a Varian linear accelerator, especially the lower position of the Varian multi-leaf collimator, give rise to different build-up doses. For regular square open beams, the build-up dose along the central beam axis is higher for the Varian machine than for the Elekta machine, both for 6 MV and 18 MV. At the Elekta machine at 18 MV, the superficial dose of a diamond shaped 10 x 10 cm2 field is 3.6% lower than the superficial dose of a regular 10 x 10 cm2 field. This effect is not seen at 6 MV. At the Varian machine, the superficial dose of the diamond shaped field is respectively 3.5 and 14.2% higher than the superficial dose of the regular 10 x 10 cm2 field for 6 MV and 18 MV. Despite the differences measured in build-up dose for single beams between the Elekta and the Varian linear accelerator, there were no measurable differences in superficial dose when a typical IMRT dose plan of 6 MV for a head and neck tumour is executed at the two machines.

Head and Neck Neoplasms↗
PubMed2005

The Healthgrid White Paper.

Over the last four years, a community of researchers working on Grid and High Performance Computing technologies started discussing the barriers and opportunities that grid technologies must face and exploit for the development of health-related applications. This interest lead to the first Healthgrid conference, held in Lyon, France, on January 16th-17th, 2003, with the focus of creating increased awareness about the possibilities and advantages linked to the deployment of grid technologies in health, ultimately targeting the creation of a European/international grid infrastructure for health. The topics of this conference converged with the position of the eHealth division of the European Commission, whose mandate from the Lisbon Meeting was "To develop an intelligent environment that enables ubiquitous management of citizens' health status, and to assist health professionals in coping with some major challenges, risk management and the integration into clinical practice of advances in health knowledge." In this context "Health" involves not only clinical procedures but covers the whole range of information from molecular level (genetic and proteomic information) over cells and tissues, to the individual and finally the population level (social healthcare). Grid technology offers the opportunity to create a common working backbone for all different members of this large "health family" and will hopefully lead to an increased awareness and interoperability among disciplines. The first HealthGrid conference led to the creation of the Healthgrid association, a non-profit research association legally incorporated in France but formed from the broad community of European researchers and institutions sharing expertise in health grids. After the second Healthgrid conference, held in Clermont-Ferrand on January 29th-30th, 2004, the need for a "white paper" on the current status and prospective of health grids was raised. Over fifty experts from different areas of grid technologies, eHealth applications and the medical world were invited to contribute to the preparation of this document.

Computer Communication Networks↗
PubMed2004

DOSSCORE: an accelerated DOSXYZnrc code with an efficient stepping algorithm and scoring grid.

DOSSCORE is an accelerated version of DOSXYZnrc that allows photons to cross voxel boundaries of the same medium and utilizes a separate scoring grid superimposed on the geometrical grid. Two different stepping algorithms, the hownear method and the scaling method are implemented in DOSSCORE. The hownear method allows particles to travel larger distances in homogeneous regions where there is no interest in the dose deposition of these particles, whilst the scaling method utilizes a stepping algorithm in which particles are only slowed down by the boundaries of the geometrical voxels and not by the boundaries of the scoring voxels. For CT-based phantoms, only photon ray tracing is applied, which results in a rather modest speed gain of factor 1.2 compared to DOSXYZnrc. The hownear method and scaling method do not increase the speed for CT-based phantoms, but only for homogeneous phantoms and phantoms with a limited number of small heterogeneities. In cases where a small number of scoring voxels are needed, the hownear method performs better than the scaling method, whilst the opposite is true for cases when many scoring voxels are needed. The photon transport is accelerated by almost a factor of 2 for all phantoms (homogeneous, heterogeneous with much homogeneity and CT-based phantoms) compared to DOSXYZnrc. For a small number of scoring voxels, the hownear method is up to a factor of 2.6 and 1.9 faster than DOSXYZnrc for homogeneous and heterogeneous phantoms in the case of photon beams. For an electron beam, a speed gain of factor 2.4 is obtained. For a full scoring grid like the one used in DOSXYZnrc, the scaling method is up to a factor of 2.2 and 1.7 faster than DOSXYZnrc for homogeneous and heterogeneous phantoms in the case of photon beams. For an electron beam, a speed gain of factor 2 is obtained. A speed increase without biasing the results is very relevant. The use of two separate grids, the more efficient stepping algorithms and the accelerated photon transport can be applied to every EGS-based or other Monte Carlo code.

Algorithms↗
PubMed2004

MCDE: a new Monte Carlo dose engine for IMRT.

A new accurate Monte Carlo code for IMRT dose computations, MCDE (Monte Carlo dose engine), is introduced. MCDE is based on BEAMnrc/DOSXYZnrc and consequently the accurate EGSnrc electron transport. DOSXYZnrc is reprogrammed as a component module for BEAMnrc. In this way both codes are interconnected elegantly, while maintaining the BEAM structure and only minimal changes to BEAMnrc.mortran are necessary. The treatment head of the Elekta SLiplus linear accelerator is modelled in detail. CT grids consisting of up to 200 slices of 512 x 512 voxels can be introduced and up to 100 beams can be handled simultaneously. The beams and CT data are imported from the treatment planning system GRATIS via a DICOM interface. To enable the handling of up to 50 x 10(6) voxels the system was programmed in Fortran95 to enable dynamic memory management. All region-dependent arrays (dose, statistics, transport arrays) were redefined. A scoring grid was introduced and superimposed on the geometry grid, to be able to limit the number of scoring voxels. The whole system uses approximately 200 MB of RAM and runs on a PC cluster consisting of 38 1.0 GHz processors. A set of in-house made scripts handle the parallellization and the centralization of the Monte Carlo calculations on a server. As an illustration of MCDE, a clinical example is discussed and compared with collapsed cone convolution calculations. At present, the system is still rather slow and is intended to be a tool for reliable verification of IMRT treatment planning in the case of the presence of tissue inhomogeneities such as air cavities.

Adenocarcinoma↗
PubMed2004

Validation and application of polymer gel dosimetry for the dose verification of an intensity-modulated arc therapy (IMAT) treatment.

Polymer gel dosimetry was used to assess an intensity-modulated arc therapy (IMAT) treatment for whole abdominopelvic radiotherapy. Prior to the actual dosimetry experiment, a uniformity study on an unirradiated anthropomorphic phantom was carried out. A correction was performed to minimize deviations in the R2 maps due to radiofrequency non-uniformities. In addition, compensation strategies were implemented to limit R2 deviations caused by temperature drift during scanning. Inter- and intra-slice R2 deviations in the phantom were thereby significantly reduced. This was verified in an investigative study where the same phantom was irradiated with two rectangular superimposed beams: structural deviations between gel measurements and computational results remained below 3% outside high dose gradient regions; the spatial shift in those regions was within 2.5 mm. When comparing gel measurements with computational results for the IMAT treatment, dose deviations were noted in the liver and right kidney, but the dose-volume constraints were met. Root-mean-square differences between both dose distributions were within 5% with spatial deviations not more than 2.5 mm. Dose fluctuations due to gantry angle discretization in the dose computation algorithm were particularly noticeable in the low-dose region.

Algorithms↗
PubMed2004

Updated European core curriculum for radiotherapists (radiation oncologists). Recommended curriculum for the specialist training of medical practitioners in radiotherapy (radiation oncology) within Europe.

AIM: To produce updated state-of-the-art recommendations for harmonised medical specialist training in radiotherapy within Europe. MATERIAL AND METHODS: The Minimum Curriculum for the Theoretical Education in Radiation Oncology in Europe from 1991 was updated under consideration of new developments in medicine in general, and in radiotherapy and its basic sciences in particular. Recent medical developments, national guidelines and training programmes from European countries, as well as equivalent documents from the USA and Australia were reviewed by an expert panel jointly appointed by the European Society of Therapeutic Radiology and Oncology and the European Board of Radiotherapy. A draft document prepared by this group was circulated among the national and professional societies for radiotherapy in Europe for review before a European consensus conference took place in Brussels in December 2002. RESULTS: The updated European Core Curriculum for Radiotherapists (Radiation Oncologists) was endorsed by representatives of 35 European nations during the Brussels consensus conference on December 14, 2002. Compared to the earlier version the updated document contains specific recommendations not only for the 5 year training curriculum but also for organisatoric and infrastructural aspects of teaching departments, and for supplementation of the training by formal teaching courses. CONCLUSION: The updated European core curriculum is an important step on the way to fully harmonise medical specialist training in Europe and to guarantee equal access for all European citizens to highest quality medical care. The responsibility for the implementation of the standards and guidelines set in the updated Core Curriculum for radiotherapy (radiation oncology) will lie with the local and/or national training bodies and authorities.

Clinical Competence↗
PubMed2003

The value of radiochromic film dosimetry around air cavities: experimental results and Monte Carlo simulations.

In this study we investigate radiochromic film dosimetry around air cavities with particular focus on the perturbation of the dose distribution by the film when the film is parallel to the beam axis. We considered a layered polystyrene phantom containing an air cavity as a model for the air-soft tissue geometry that may occur after surgical resection of a paranasal sinus tumour. A radiochromic film type MD-55 was positioned within the phantom so that it intersected the cavity. Two phantom set-ups were examined. In the first case, the air cavity is at the centre of the phantom, thus the film is lying along the central beam axis. In the second case, the cavity and film are located 2 cm offset from the phantom centre and the central beam axis. In order to examine the influence of the film on the dose distribution and to interpret the film-measured results, Monte Carlo simulations were performed. The film was modelled rigorously to incorporate the composition and structure of the film. Two field configurations, a 1 x 10 cm2 field and a 10 x 10 cm2 field, were examined. The dose behind the air cavity is reduced by 6 to 7% for both field configurations when a film that intersects the cavity contains the central beam axis. This is due to the attenuation exerted by the film when photons cross the cavity. Offsetting the beam to the cavity and the film by 2 cm removes the dose reduction behind the air cavity completely. Another result was that the rebuild-up behind the cavity for the 10 x 10 cm2 field, albeit less significant than for the 1 x 10 cm2 field, could only be measured by the film that was placed offset with respect to the central beam axis. Although radiochromic film is approximately soft-tissue equivalent and energy independent as compared to radiographic films, care should be taken in the case of inhomogeneous phantoms when the film intersects air cavities and contains the beam central axis. Errors in dose measurement can be expected distal to the air cavity due to attenuation in the film itself. This attenuation would not occur in the absence of the film. Both experiments and Monte Carlo computations support this conclusion.

Air↗
PubMed2003

Monte Carlo model of the Elekta SLiplus accelerator: validation of a new MLC component module in BEAM for a 6 MV beam.

A new component module (CM), called MLCE, has been implemented in the BEAM program. The CM takes into account the particular 'tongue-and-groove' design of the Elekta multi-leaf collimator (MLC) and the air gap between the leaves. The model was validated by two series of measurements and simulations. The first benchmarking series focuses on the interleaf leakage and the intraleaf transmission. The measurement showed a total transmission through the MLC of 1.42% of the open field dose. Two Monte Carlo (MC) simulations were made, the first with the new CM MLCE (inclusive of air gap) and the second with the CM MLCQ (exclusive of air gap), which is available in the BEAM distribution. When the air gap between the leaves was determined by varying the parameters of the leaf geometry within tolerance limits on the technical drawing, the total measured transmission of 1.42% was well reproduced by the CM MLCE. In contrast, MC simulations with MLCQ showed that the transmission through the MLC calculated without the interleaf leakage is only 44% of the total transmitted radiation. The relevance of the detailed MLC modelling was demonstrated also by studying the 'adjacent' tongue-and-groove effect, where two adjacent (not opposing) leaves are complementary, opened or closed. The two complementary leaf settings were simulated both with the CM MLCE and MLCQ. A comparison with measurements was made. In regions covered by two or more leaves, the dose increased by 14% for two leaves and by 40% for more than two leaves when the interleaf leakage was included in the transmission. The tongue-and-groove effect was perfectly reproduced by the MLCE module.

Algorithms↗
PubMed2002

The value of radiographic film for the characterization of intensity-modulated beams.

In this paper the performance of radiographic film (KODAK X-Omat V) for analysing intensity-modulated (IM) beams in a plane at reference depth (5 cm for 6 MV, 10 cm for 18 MV) was investigated. The field size dependence of the film response was studied for small and medium field sizes. The dose rate dependence of the response and possible effects of fractionating the dose were assessed. In the end, profiles were measured for two clinically delivered IM beams, and the results were compared with diamond detector data. We found that the response of the radiographic film increases with field size, but for field sizes up to 15 x 15 cm the deviations remain within 3% for measurements with the films in a plane at reference depth. We found that the response of the films decreases with decreasing dose rate, and that the extent of this effect differs from film batch to film batch. For clinical IM beams the effect can amount to about 9% at the location of shielded organs at risk. Also, fractionating the dose reduces the net optical density, but this effect is normally small when assessing IM beams. In low-dose regions low-energy photons have an important contribution, resulting in a higher response at these positions. This may counteract the dose rate dependence of the response. In the high-dose regions of the two IM beams that were studied, the relative dose measurements with film are within 1% of those obtained with a diamond detector, when the results of three films are averaged. In shielded organs at risk the deviations can mount to about 3%, depending on the film batch. In conclusion, radiographic film is a suitable detector for characterizing IM beams in a plane at reference depth.

Dose-Response Relationship, Radiation↗
PubMed2002

Underdosage of the upper-airway mucosa for small fields as used in intensity-modulated radiation therapy: a comparison between radiochromic film measurements, Monte Carlo simulations, and collapsed cone convolution calculations.

Head-and-neck tumors are often situated at an air-tissue interface what may result in an underdosage of part of the tumor in radiotherapy treatments using megavoltage photons, especially for small fields. In addition to effects of transient electronic disequilibrium, for these small fields, an increased lateral electron range in air will result in an important extra reduction of the central axis dose beyond the cavity. Therefore dose calculation algorithms need to model electron transport accurately. We simulated the trachea by a 2 cm diameter cylindrical air cavity with the rim situated 2 cm beneath the phantom surface. A 6 MV photon beam from an Elekta SLiplus linear accelerator, equipped with the standard multileaf collimator (MLC), was assessed. A 10 x 2 cm2 and a 10 x 1 cm2 field, both widthwise collimated by the MLC, were applied with their long side parallel to the cylinder axis. Central axis dose rebuild-up was studied. Radiochromic film measurements were performed in an in-house manufactured polystyrene phantom with the films oriented either along or perpendicular to the beam axis. Monte Carlo simulations were performed with BEAM and EGSnrc. Calculations were also performed using the pencil beam (PB) algorithm and the collapsed cone convolution (CCC) algorithm of Helax-TMS (MDS Nordion, Kanata, Cahada) version 6.0.2 and using the CCC algorithm of Pinnacle (ADAC Laboratories, Milpitas, CA, USA) version 4.2. A very good agreement between the film measurements and the Monte Carlo simulations was found. The CCC algorithms were not able to predict the interface dose accurately when lateral electronic disequilibrium occurs, but were shown to be a considerable improvement compared to the PB algorithm. The CCC algorithms overestimate the dose in the rebuild-up region. The interface dose was overestimated by a maximum of 31% or 54%, depending on the implementation of the CCC algorithm. At a depth of 1 mm, the maximum dose overestimation was 14% or 24%.

Air↗
PubMed2001

Leaf position optimization for step-and-shoot IMRT.

PURPOSE: To describe the theoretical basis, the algorithm, and implementation of a tool that optimizes segment shapes and weights for step-and-shoot intensity-modulated radiation therapy delivered by multileaf collimators. METHODS AND MATERIALS: The tool, called SOWAT (Segment Outline and Weight Adapting Tool) is applied to a set of segments, segment weights, and corresponding dose distribution, computed by an external dose computation engine. SOWAT evaluates the effects of changing the position of each collimating leaf of each segment on an objective function, as follows. Changing a leaf position causes a change in the segment-specific dose matrix, which is calculated by a fast dose computation algorithm. A weighted sum of all segment-specific dose matrices provides the dose distribution and allows computation of the value of the objective function. Only leaf position changes that comply with the multileaf collimator constraints are evaluated. Leaf position changes that tend to decrease the value of the objective function are retained. After several possible positions have been evaluated for all collimating leaves of all segments, an external dose engine recomputes the dose distribution, based on the adapted leaf positions and weights. The plan is evaluated. If the plan is accepted, a segment sequencer is used to make the prescription files for the treatment machine. Otherwise, the user can restart SOWAT using the new set of segments, segment weights, and corresponding dose distribution. The implementation was illustrated using two example cases. The first example is a T1N0M0 supraglottic cancer case that was distributed as a multicenter planning exercise by investigators from Rotterdam, The Netherlands. The exercise involved a two-phase plan. Phase 1 involved the delivery of 46 Gy to a concave-shaped planning target volume (PTV) consisting of the primary tumor volume and the elective lymph nodal regions II-IV on both sides of the neck. Phase 2 involved a boost of 24 Gy to the primary tumor region only. SOWAT was applied to the Phase 1 plan. Parotid sparing was a planning goal. The second implementation example is an ethmoid sinus cancer case, planned with the intent of bilateral visus sparing. The median PTV prescription dose was 70 Gy with a maximum dose constraint to the optic pathway structures of 60 Gy. RESULTS: The initial set of segments, segment weights, and corresponding dose distribution were obtained, respectively, by an anatomy-based segmentation tool, a segment weight optimization tool, and a differential scatter-air ratio dose computation algorithm as external dose engine. For the supraglottic case, this resulted in a plan that proved to be comparable to the plans obtained at the other institutes by forward or inverse planning techniques. After using SOWAT, the minimum PTV dose and PTV dose homogeneity increased; the maximum dose to the spinal cord decreased from 38 Gy to 32 Gy. The left parotid mean dose decreased from 22 Gy to 19 Gy and the right parotid mean dose from 20 to 18 Gy. For the ethmoid sinus case, the target homogeneity increased by leaf position optimization, together with a better sparing of the optical tracts. CONCLUSIONS: By using SOWAT, the plans improved with respect to all plan evaluation end points. Compliance with the multileaf collimator constraints is guaranteed. The treatment delivery time remains almost unchanged, because no additional segments are created.

Humans↗