Converting Treatment Plans From Helical Tomotherapy to L-Shape Linac

Clinical Workflow and Dosimetric Evaluation

Zilong Yuan, Chithra Kumaran Nair, Stanley H Benedict, Richard K Valicenti, Shyam Rao, Ruben C Fragoso, Cari Wright, Jianfeng Qiu, Yi Rong

Research output: Contribution to journalArticle

Abstract

This work evaluated a commercial fallback planning workflow designed to provide cross-platform treatment planning and delivery. A total of 27 helical tomotherapy intensity-modulated radiotherapy plans covering 4 anatomical sites were selected, including 7 brain, 5 unilateral head and neck, 5 bilateral head and neck, 5 pelvis, and 5 prostate cases. All helical tomotherapy plans were converted to 7-field/9-field intensity-modulated radiotherapy and volumetric-modulated radiotherapy plans through fallback dose-mimicking algorithm using a 6-MV beam model. The planning target volume (PTV) coverage ( D1, D99, and homogeneity index) and organs at risk dose constraints were evaluated and compared. Overall, all 3 techniques resulted in relatively inferior target dose coverage compared to helical tomotherapy plans, with higher homogeneity index and maximum dose. The organs at risk dose ratio of fallback to helical tomotherapy plans covered a wide spectrum, from 0.87 to 1.11 on average for all sites, with fallback plans being superior for brain, pelvis, and prostate sites. The quality of fallback plans depends on the delivery technique, field numbers, and angles, as well as user selection of structures for organs at risk. In actual clinical scenario, fallback plans would typically be needed for 1 to 5 fractions of a treatment course in the event of machine breakdown. Our results suggested that <1% dose variance can be introduced in target coverage and/or organs at risk from fallback plans. The presented clinical workflow showed that the fallback plan generation typically takes 10 to 20 minutes per case. Fallback planning provides an expeditious and effective strategy for transferring patients cross platforms, and minimizing the untold risk of a patient missing treatment(s).

Original languageEnglish (US)
JournalTechnology in cancer research & treatment
Volume17
DOIs
StatePublished - Jan 1 2018

Fingerprint

Intensity-Modulated Radiotherapy
Workflow
Organs at Risk
Pelvis
Prostate
Neck
Therapeutics
Head
Brain
Radiotherapy
Odds Ratio

Keywords

  • fallback planning
  • helical tomotherapy
  • homogeneity index
  • intensity-modulated radiotherapy
  • volumetric-modulated radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

@article{3db42e40e220496cb26ddb7faaa2c95e,
title = "Converting Treatment Plans From Helical Tomotherapy to L-Shape Linac: Clinical Workflow and Dosimetric Evaluation",
abstract = "This work evaluated a commercial fallback planning workflow designed to provide cross-platform treatment planning and delivery. A total of 27 helical tomotherapy intensity-modulated radiotherapy plans covering 4 anatomical sites were selected, including 7 brain, 5 unilateral head and neck, 5 bilateral head and neck, 5 pelvis, and 5 prostate cases. All helical tomotherapy plans were converted to 7-field/9-field intensity-modulated radiotherapy and volumetric-modulated radiotherapy plans through fallback dose-mimicking algorithm using a 6-MV beam model. The planning target volume (PTV) coverage ( D1, D99, and homogeneity index) and organs at risk dose constraints were evaluated and compared. Overall, all 3 techniques resulted in relatively inferior target dose coverage compared to helical tomotherapy plans, with higher homogeneity index and maximum dose. The organs at risk dose ratio of fallback to helical tomotherapy plans covered a wide spectrum, from 0.87 to 1.11 on average for all sites, with fallback plans being superior for brain, pelvis, and prostate sites. The quality of fallback plans depends on the delivery technique, field numbers, and angles, as well as user selection of structures for organs at risk. In actual clinical scenario, fallback plans would typically be needed for 1 to 5 fractions of a treatment course in the event of machine breakdown. Our results suggested that <1{\%} dose variance can be introduced in target coverage and/or organs at risk from fallback plans. The presented clinical workflow showed that the fallback plan generation typically takes 10 to 20 minutes per case. Fallback planning provides an expeditious and effective strategy for transferring patients cross platforms, and minimizing the untold risk of a patient missing treatment(s).",
keywords = "fallback planning, helical tomotherapy, homogeneity index, intensity-modulated radiotherapy, volumetric-modulated radiotherapy",
author = "Zilong Yuan and Nair, {Chithra Kumaran} and Benedict, {Stanley H} and Valicenti, {Richard K} and Shyam Rao and Fragoso, {Ruben C} and Cari Wright and Jianfeng Qiu and Yi Rong",
year = "2018",
month = "1",
day = "1",
doi = "10.1177/1533033818785279",
language = "English (US)",
volume = "17",
journal = "Technology in Cancer Research and Treatment",
issn = "1533-0346",
publisher = "Adenine Press",

}

TY - JOUR

T1 - Converting Treatment Plans From Helical Tomotherapy to L-Shape Linac

T2 - Clinical Workflow and Dosimetric Evaluation

AU - Yuan, Zilong

AU - Nair, Chithra Kumaran

AU - Benedict, Stanley H

AU - Valicenti, Richard K

AU - Rao, Shyam

AU - Fragoso, Ruben C

AU - Wright, Cari

AU - Qiu, Jianfeng

AU - Rong, Yi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - This work evaluated a commercial fallback planning workflow designed to provide cross-platform treatment planning and delivery. A total of 27 helical tomotherapy intensity-modulated radiotherapy plans covering 4 anatomical sites were selected, including 7 brain, 5 unilateral head and neck, 5 bilateral head and neck, 5 pelvis, and 5 prostate cases. All helical tomotherapy plans were converted to 7-field/9-field intensity-modulated radiotherapy and volumetric-modulated radiotherapy plans through fallback dose-mimicking algorithm using a 6-MV beam model. The planning target volume (PTV) coverage ( D1, D99, and homogeneity index) and organs at risk dose constraints were evaluated and compared. Overall, all 3 techniques resulted in relatively inferior target dose coverage compared to helical tomotherapy plans, with higher homogeneity index and maximum dose. The organs at risk dose ratio of fallback to helical tomotherapy plans covered a wide spectrum, from 0.87 to 1.11 on average for all sites, with fallback plans being superior for brain, pelvis, and prostate sites. The quality of fallback plans depends on the delivery technique, field numbers, and angles, as well as user selection of structures for organs at risk. In actual clinical scenario, fallback plans would typically be needed for 1 to 5 fractions of a treatment course in the event of machine breakdown. Our results suggested that <1% dose variance can be introduced in target coverage and/or organs at risk from fallback plans. The presented clinical workflow showed that the fallback plan generation typically takes 10 to 20 minutes per case. Fallback planning provides an expeditious and effective strategy for transferring patients cross platforms, and minimizing the untold risk of a patient missing treatment(s).

AB - This work evaluated a commercial fallback planning workflow designed to provide cross-platform treatment planning and delivery. A total of 27 helical tomotherapy intensity-modulated radiotherapy plans covering 4 anatomical sites were selected, including 7 brain, 5 unilateral head and neck, 5 bilateral head and neck, 5 pelvis, and 5 prostate cases. All helical tomotherapy plans were converted to 7-field/9-field intensity-modulated radiotherapy and volumetric-modulated radiotherapy plans through fallback dose-mimicking algorithm using a 6-MV beam model. The planning target volume (PTV) coverage ( D1, D99, and homogeneity index) and organs at risk dose constraints were evaluated and compared. Overall, all 3 techniques resulted in relatively inferior target dose coverage compared to helical tomotherapy plans, with higher homogeneity index and maximum dose. The organs at risk dose ratio of fallback to helical tomotherapy plans covered a wide spectrum, from 0.87 to 1.11 on average for all sites, with fallback plans being superior for brain, pelvis, and prostate sites. The quality of fallback plans depends on the delivery technique, field numbers, and angles, as well as user selection of structures for organs at risk. In actual clinical scenario, fallback plans would typically be needed for 1 to 5 fractions of a treatment course in the event of machine breakdown. Our results suggested that <1% dose variance can be introduced in target coverage and/or organs at risk from fallback plans. The presented clinical workflow showed that the fallback plan generation typically takes 10 to 20 minutes per case. Fallback planning provides an expeditious and effective strategy for transferring patients cross platforms, and minimizing the untold risk of a patient missing treatment(s).

KW - fallback planning

KW - helical tomotherapy

KW - homogeneity index

KW - intensity-modulated radiotherapy

KW - volumetric-modulated radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=85056701661&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056701661&partnerID=8YFLogxK

U2 - 10.1177/1533033818785279

DO - 10.1177/1533033818785279

M3 - Article

VL - 17

JO - Technology in Cancer Research and Treatment

JF - Technology in Cancer Research and Treatment

SN - 1533-0346

ER -