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Comparison of linac-based fractionated stereotactic radiotherapy and tomotherapy treatment plans for intra-cranial tumors

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Chinese Physics C 2010年第11期34卷 1768-1774页

作者： Jang Bo Shim Suk Lee Sam Ju Cho Sang Hoon Lee Juree Kim Kwang Hwan Cho Chul Kee Min Hyun Do Huh Rena Lee Dae Sik Yang Young Je Park Won Seob Yoon Chul Yong Kim Soo Il Kwon Department of Radiation Oncology College of MedicineKorea University Department of Medical Physics Kyonggi University Department of Radiation Oncology College of MedicineEulji University Department of Radiation Oncology Cheil General Hospital & Women's Healthcare CenterKwandong University College of Medicine Department of Radiation Oncology Soonchunhyang University Boocheon Hospital Department of Radiation Oncology Konyang University Hospital Department of Radiation Oncology Inha University Hospital Department of Radiation Oncology School of MedicineEwha Womans University

This study compares and analyzes stereotactic radiotherapy using tomotherapy and linac-based fractionated stereotactic radiotherapy in the treatment of intra-cranial tumors,according to some *** this study,linac-based fractionated stereotactic radiotherapy and tomotherapy treatment were administered to five patients diagnosed with intra-cranial cancer in which the dose of 18–20 Gy was applied on 3–5 separate *** tumor dosing was decided by evaluating the inhomogeneous index （II） and conformity index （CI）.Also,the radiation-sensitive tissue was evaluated using low dose factors V1,V2,V3,V4,V5,and V10,as well as the non-irradiation ratio volume （NIV）.The values of the II for each prescription dose in the linacbased non-coplanar radiotherapy plan and tomotherapy treatment plan were （0.125±0.113） and （0.090±0.180）,respectively,and the values of the CI were （0.899±0.149） and （0.917±0.114）,*** low dose areas,V1,V2,V3,V4,V5,and V10,in radiation-sensitive tissues in the linac-based non-coplanar radiotherapy plan fell into the ranges 0.3%–95.6%,0.1%–87.6%,0.1%–78.8%,38.8%–69.9%,26.6%–65.2%,and 4.2%–39.7%,respectively,and the tomotherapy treatment plan had ranges of 13.6%–100%,3.5%–100%,0.4%–94.9%,0.2%– 82.2%,0.1%–78.5%,and 0.3%–46.3%,*** the NIV for each organ,it is possible to obtain similar values except for the irradiation area of the brain *** percentages of NIV10%,NIV20%,and NIV30%for the brain stem in each patient were 15%–99.8%,33.4%–100%,and 39.8%–100%,respectively,in the fractionated stereotactic treatment plan and 44.2%–96.5%,77.7%–99.8%,and 87.8%–100%,respectively,in the tomotherapy treatment *** order to achieve higher-quality treatment of intra-cranial tumors,treatment plans should be tailored according to the isodose target volume,inhomogeneous index,conformity index,position of the tumor upon fractionated stereotactic radiosurgery,and radiation dosage for radiation-sensitive tissues.

关键词： fractionated stereotactic radiotherapy tomotherapy treatment plan virtual organ delineation

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Evaluation of Efficacy and Toxicity of Helical tomotherapy in the Treatment of Patients with Nasal NK/T-Cell Lymphoma

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2015年第1期4卷 32-40页

作者： Baolin Qu Xiao Zhao Lingling Meng Shouping Xu Chuanbin Xie Jack Yang Department of radiotherapy PLA General Hospital Beijing China Department of Radiation Oncology Monmouth Medical Center Long Branch USA

Purpose: Nasal lymphoma created dosimetric challenges in radiotherapy due to the complex anatomical structures. This study was to evaluate the efficacy and toxicity of helical tomotherapy (HT) in the treatment of nasal NK/T-cell lymphoma (NKTCL) patients. Methods and Materials: Between August 2008 and April 2013, a total of 25 NKTCL patients were treated with HT in our department;Among them, three patients have not received chemotherapy, one patient has received concurrent chemo-radiation with CHOP plus L-ASP, two patients have received the sequential chemotherapy regimen following irradiation, and all the others have received 1 - 2 cycles of induction chemotherapy followed by irradiation and then with sequential chemotherapy. CHOP-L with 1 - 7 cycles (median: 4 cycles) was utilized as the main chemotherapy regimen. As for HT, the gross tumor volume (GTV) received target doses (TD) ranging from 50 to 56 Gy (median: 50 Gy) at 2 - 2.78 Gy per fraction;and the clinical target volume (CTV) from 36 to 50 Gy (median: 40 Gy) at 1.6 - 2 Gy per fraction. Results: For those patients who had received irradiation, thirteen achieved complete remission (CR), four partial responses (PR);four had progressive disease (PD), two were lost to follow-up, two died within one month after irradiation and were not followed. In 21 patients with follow-up records, the overall response (CR + PR) was 81.0% with the 3-year survival rate of 87.2%, and the mean survival time was 52.8 months [95% confidence interval (CI): 45.2 - 60.4 months]. After radiotherapy the majority of patients had dry mouth and taste changes in varying degrees, and a small portion of patients had compromised hearing or vision functions. No brain injury symptoms occurred during radiation radiotherapy. Conclusions: As compared with conventional three-dimensional conformal radiotherapy (3D-CRT) and intensity modulated radiation therapy (IMRT) performed with HT, HT appears to have more favorable efficacy and toxicity profiles

关键词： tomotherapy NK/T Cell Lymphoma IMRT Survival

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Systematic Analysis of the ArcCheck Diode Arrays for tomotherapy Delivery Verification

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2014年第4期3卷 218-225页

作者： Qi Yue Jimei Duan Rongqing Li Jack Yang Department of Radiation Oncology First Affiliated Hospital of Kunming Medical University Kunming China Department of Radiation Oncology Monmouth Medical Center Long Branch NJ USA

Objective: The aim of this study was to evaluate the functional characteristics of ArcCheck? array detectors and the application for tomotherapy IMRT plan verification. Method and Materials: The basic character of the ArcCheck applying on tomotherapy system was tested. The diode testing procedures included the followings: The short term reproducibility, linearity, dose rate dependence, the profile measurement compared to ion chamber. The effect of insert on gamma passing rate was also studied. A total number of 602 tomotherapy Delivery Quality Assurance (DQA) plans were retrospectively analyzed to obtain the action limit results with statistical significance evaluation. Results: The short term reproducibility, linearity, dose rate dependence, profile to ion chamber correlation and clinical application were all compared with satisfactory outcome with this device. If anterior diode points were properly calibrated with machine absolute output, then there was no significant difference between the ArcCheck phantom with and without insert on gamma passing rate. The average passing rate was 97.5% and the recommend action level was established at 92% based on the 602 patients’ clinical data with 95% confidence level criteria. Conclusion: This comprehensive study shows that ArcCheck is an accurate and efficient device for quality assurance of tomotherapy with remarkable consistency of 3D volume analysis of arc therapy.

关键词： ArcCheck Gamma Passing Rate tomotherapy

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Dosimetric Comparison of Craniospinal Axis Irradiation (CSI) Treatments Using Helical tomotherapy, Smartarc<sup>TM</sup>, and 3D Conventional Radiation Therapy

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2013年第1期2卷 30-38页

作者： Pamela Myers Sotirios Stathakis Alonso N. Gutiérrez Carlos Esquivel Panayiotis Mavroidis Niko Papanikolaou Departments of Radiology and Radiation Oncology Cancer Therapy and Research Center University of Texas Health Science Center San Antonio USA

Purpose: Craniospinal axis irradiation (CSI) is a method of treating various central nervous system malignancies. The large target volume typically includes entire spinal cord and whole brain. Dosimetric comparison was performed between tomotherapy, volumetric modulated arc therapy (VMAT), and 3D conformal radiation therapy (3D-CRT) for CSI. Methods and Materials: Five (n = 5) CSI patients were planned using 3D-CRT, VMAT, and tomotherapy (normalized such that 95% of PTV received at least 23.4 Gy in 13 fractions). Plans were compared using PTV conformity number (CN) and homogeneity index (HI), normal tissue (NT) dose statistics, integral dose, and treatment time. Results: On average, tomotherapy plans showed higher CN (0.932 vs. 0.860 and 0.672 for SmartArc and 3D-CRT). In terms of HI, VMAT plans consistently showed better dose homogeneity (1.07 vs. 1.15 and 1.13 for tomotherapy and 3D-CRT). SmartArc delivered lower maximum dose for majority of NT, but higher mean dose. 3D-CRT plans delivered higher maximum dose but lower mean dose to NT. Conclusions: SmartArc treatments achieved better PTV homogeneity and reduced maximum dose to NT. tomotherapy showed better target conformity, but 3D-CRT was shown to reduce mean dose to NT. Integral doses were similar between treatment modalities, but tomotherapy treatment times were much longer.

关键词： CSI tomotherapy SmartArc Medulloblastoma

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Variations in tomotherapy Beam Outputs: A Multiple-Institutional Investigation

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2018年第1期7卷 87-99页

作者： Hidetoshi Shimizu Koji Sasaki Kentaro Sugi Hiroshi Fukuma Tadashi Nakabayashi Taiki Isomura Hiroyuki Tachibana Takeshi Kodaira Department of Radiation Oncology Aichi Cancer Center Hospital Aichi Japan Department of Radiation Therapy Education and Research Graduate School of Radiological Technology Gunma Prefectural College of Health Sciences Gunma Japan Hitachi Ltd. Healthcare Business Unit Tokyo Japan Department of Radiology Nagoya City University Hospital Aichi Japan Customer Support & Area Operation Headquarters Physics & Clinical Support Accuray Japan K.K. Tokyo Japan

This study aimed to determine variations in tomotherapy beam outputs at multiple institutions. Measurements were obtained at 22 radiotherapy institutions. The first parameter was the absolute dose to water (Dfmsrw, Qmsr) in the machine-specific reference field (fmsr), which indicated a static field in the tomotherapy reference conditions defined by the International Atomic Energy Agency (IAEA) study group. The second measured parameter was the difference between the measured and the planed doses in the intensity modulated radiotherapy (IMRT) verification plans, which were created using a solid phantom by the vendor during tomotherapy apparatus installation to adjust the beam output. The IMRT verification plan error at each institution was defined as the systematic error of the beam output;Dfmsrw, Qmsr was subsequently modified. The Dfmsrw, Qmsr values of four institutions with a modified energy fluence per ideal open time (EFIOT) were lower than the values at other institutions. The mean value of all institutions except those four was 0.994 ± 0.013 Gy (range: 0.974 Gy, 1.017 Gy). When the Dfmsrw, Qmsr value was corrected by the IMRT verification error, this variation decreased. In addition, the mean IMRT verification errors in the TomoDirectTM and TomoHelicalTM modes with the TomoEDGETM mode were 1.2% ± 0.8% (range: -0.6%, 1.8%) and 0.2% ± 0.5% (range: -0.6%, 0.9%), respectively (p

关键词： tomotherapy Machine-Specific Reference Field Multiple Institutions Beam Output

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Evaluation of Delivery Analysis to Detect Intrafractional Motion during tomotherapy

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International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2019年第4期8卷 225-235页

作者： Kazuo Tarutani Masao Tanooka Keisuke Sano Okada Wataru Masayuki Fujiwara Koichiro Yamakado Department of Radiology Hyogo College of Medicine Nishinomiya Japan Japan Organization of Occupational Health and Safety Kansai Rousai Hospital Amagasaki Japan Department of Radiotherapy Takarazuka City Hospital Takarazuka Japan

The purpose of this study was to investigate the ability of a management system (Delivery Analysis: DA) to detect intrafractional motion during intensity-modulated radiation therapy (IMRT) in tomotherapy mode. tomotherapy has made it possible to manage internal movements during treatment using software DA, which quantifies using the information of the passing dose obtained during the radiation treatment of patients. First, three treatment plans for the test were created (lumbar spine, prostate, and femur). Second, a pelvis phantom was moved in the X, Y, and Z directions, and a sinogram was acquired. The magnitudes of the movements were 3 mm, 5 mm, and 10 mm, respectively. Finally, the ability of DA to detect the motion was evaluated by comparing the sinogram obtained by moving the phantom with a reference sinogram obtained without movement. The sensitivity of DA could be detected with a shift amount of 3 mm (gamma analysis tolerance 0.3 mm/0.3%). The average gamma analysis of each direction at 0.3 mm/0.3% tolerance at each treatment site was 96.1% for the prostate, 93.5% for the lumbar spine, and 94.4% for the femur. Additionally, the average gamma pass rate results for the pelvic phantom in the X, Y, Z directions for a 10 mm shift were 96.2%, 96.3%, and 95.9%, respectively. DA is a powerful tool with high detection sensitivity and ability to detect body movement during treatment.

关键词： Delivery Analysis (DA) tomotherapy Sinogram Intra-Fraction Motion Quality Assurance (QA)

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Evaluation of Deformable Image Registration and Dose Accumulation Using Histogram Matching Algorithm between kVCT and MVCT with Helical tomotherapy

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Journal of Modern Physics 2018年第13期9卷 2274-2285页

作者： Masahide Saito Yuki Shibata Naoki Sano Kengo Kuriyama Takafumi Komiyama Kan Marino Shinichi Aoki Hiroshi Onishi Department of Radiology University of Yamanashi Yamanashi Japan

Purpose: To evaluate the accuracy of deformable image registration (DIR) between the planning kVCT (pCT) and the daily MVCT combined with the histogram matching (HM) algorithm, and evaluate the deformable dose accumulation using a suggested method for adaptive radiotherapy with Helical Tomotharapy (HT). Methods: For five prostate cancer patients (76 Gy/38 Fr) treated with HT in our institution, seven MVCT series (a total of 35 series) acquired weekly were investigated. First, to minimize the effect of different HU values between pCT and MVCT, this image-processing method adjusts HU values between pCT and MVCT images by using image cumulative histograms of HU values, generating an HM-MVCT. Then, the DIR of the pCT to the HM-MVCT was performed, generating a deformed pCT. Finally, deformable dose accumulation was performed toward the pCT image. Results: The accuracy of DIR was significantly improved by using the HM algorithm, compared with non-HM method for several structures (p ±0.05, 0.83 ±0.06, and 0.90 ± 0.04 for the CTV, rectum, and bladder, respectively, while that of the HM method was 0.81 ±0.06, 0.81 ±0.04, and 0.92 ±0.06, respectively. For the deformable dose accumulation, some difference was observed between the two methods, particularly for the small calculated regions, such as rectum V60 and V70. Conclusion: Adapting the HM method can improve the accuracy of DIR. Furthermore, dose calculation using the deformed pCT using HM methods can be an effective tool for adaptive radiotherapy.

关键词： Radiotherapy tomotherapy MVCT Histogram-Matching Deformable Image Registration

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Dosimetric comparison of tomotherapy and volumetric-modulated arc therapy for children with neuroblastoma

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Pediatric Investigation 2020年第3期4卷 186-191页

作者： Xia Liu Zhikai Liu Tingtian Pang Tingting Dong Jie Qiu Department of Radiotherapy Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijingChina

Importance:Irradiation treatment for pediatric patients with neuroblastoma represents a major challenge due to the pediatric dose limits for critical structures and the necessity of sufficient dose coverage of the clinical target volume for local ***:To investigate dosimetric differences between tomotherapy(TOMO)and volumetric-modulated arc therapy(VMAT)as retroperitoneal radiotherapy for children with ***:Eight patients who received retroperitoneal radiotherapy for neuroblastoma were selected for comparison of TOMO and VMAT treatment *** D min,D max,D mean,D 95,D 2,and D 98 of planning target volume(PTV),conformity index(CI),heterogeneity index(HI),and organs at risk(OARs)parameters were *** machine unit(MU)and image-guide radiotherapy solution results were also ***:All patients received a cumulative dose of 19.5 Gy to the *** showed higher CI(0.93±0.02),compared with TOMO(0.87±0.03,P<0.001).Notably,the average PTV HI was significantly better using TOMO(1.05±0.01)than VMAT(1.08±0.02,P=0.003).Compared with VMAT,the D min,D 95,and D 98 all exhibited increases in TOMO;D max variation was less than 1%in *** D 0.1cc for the spinal cord and D 2cc for the small intestine were better in TOMO in terms of ***,TOMO had more MUs and required a longer delivery ***:Both planning techniques are capable of producing high-quality treatment *** is superior for PTV coverage,but inferior for *** requires extra treatment time;its cost is greater than the cost of VMAT.

关键词： tomotherapy Volumetric-modulated arc therapy Neuroblastoma Dosimetric comparison Pediatric

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tomotherapy ***放射治疗系统故障分析与排除

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医疗卫生装备 2020年第1期41卷 106-108页

作者：李益坤周彬曹晓卉孙向东东部战区总医院放疗科

介绍了tomotherapy ***放射治疗系统的基本组成及多叶光栅(multi-leaf collimator,MLC)的工作原理,详细分析了单片MLC故障、MLC初始化失败故障、MLC over travelled故障等产生的原因并给出了具体的排除方法,为同行维修类似故障提供参考。

关键词： tomotherapy Hi.Art放射治疗系统多叶光栅故障维修

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tomotherapy在全身放疗方面的应用

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中国医学物理学杂志 2012年第5期29卷 3606-3609页

作者：岳麒段继梅王志伟谷丹杨秀美杨红波张燕华李荣清昆明医学院第一附属医院肿瘤放疗科云南昆明650032

目的:本文报道一例tomotherapy全身照射病例,介绍其调强计划方案,并分析其计划及验证结果。方法:由定位CT获取病人全身CT图像,在CMS医生工作站进行靶区和重要器官的勾画,传至tomotherapy计划工作站进行计划设计。用ArcCheck三维半导体... 详细信息

目的:本文报道一例tomotherapy全身照射病例,介绍其调强计划方案,并分析其计划及验证结果。方法:由定位CT获取病人全身CT图像,在CMS医生工作站进行靶区和重要器官的勾画,传至tomotherapy计划工作站进行计划设计。用ArcCheck三维半导体矩阵对计划实施验证,计划验证通过后在螺旋断层放疗设备上完成对病人的全身照射。结果:85%的靶区接受10Gy的处方剂量,靶区适形度CI和均匀指数HI分别为0.76和1.16。重要器官限制剂量达到临床要求,左晶体的最大剂量为3.4Gy,右晶体的最大剂量为4.3Gy,肺的平均剂量为5.5Gy,V5为45%,左肾的平均剂量为5Gy,右肾的平均剂量为5.7Gy。结论:tomotherapy可以完成全身的照射,肺的剂量可以降得更低,减少毒副反应。为全身放疗提供了一种安全的方法。

关键词： tomotherapy 全身照射剂量验证

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