Background and purpose
Motion‐induced uncertainties hamper the clinical implementation of pencil beam scanning proton therapy (PBS‐PT). Prospective pretreatment evaluations only provide multiscenario ...predictions without giving a clear conclusion for the actual treatment. Therefore, in this proof‐of‐concept study we present a methodology for a fraction‐wise retrospective four‐dimensional (4D) dose reconstruction and accumulation aiming at the evaluation of treatment quality during and after treatment.
Material and methods
We implemented an easy‐to‐use, script‐based 4D dose assessment of PBS‐PT for patients with moving tumors in a commercially available treatment planning system. This 4D dose accumulation uses treatment delivery log files and breathing pattern records of each fraction as well as weekly repeated 4D‐CT scans acquired during the treatment course. The approach was validated experimentally and was executed for an exemplary dataset of a lung cancer patient.
Results
The script‐based 4D dose reconstruction and accumulation was implemented successfully, requiring minimal user input and a reasonable processing time (around 10 min for a fraction dose assessment). An experimental validation using a dynamic CIRS thorax phantom confirmed the precision of the 4D dose reconstruction methodology. In a proof‐of‐concept study, the accumulation of 33 reconstructed fraction doses showed a linear increase of D98 values. Projected treatment course D98 values revealed a CTV underdosage after fraction 25. This loss of target coverage was confirmed in a dose volume histogram comparison of the nominal, the projected (after 16 fractions) and the accumulated (after 33 fractions) dose distribution.
Conclusions
The presented method allows for the assessment of the conformity between planned and delivered dose as the treatment course progresses. The implemented approach considers the influence of changing patient anatomy and variations in the breathing pattern. This facilitates treatment quality evaluation and supports decisions regarding plan adaptation. In a next step, this approach will be applied to a larger patient cohort to investigate its capability as 4D quality control and decision support tool for treatment adaptation.
Irradiation log-files store useful information about the plan delivery, and together with independent Monte Carlo dose engine calculations can be used to reduce the time needed for patient-specific ...quality assurance (PSQA). Nonetheless, machine log-files carry an uncertainty associated to the measurement of the spot position and intensity that can influence the correct evaluation of the quality of the treatment delivery. This work addresses the problem of the inclusion of these uncertainties for the final verification of the treatment delivery. Dedicated measurements performed in an IBA Proteus Plus gantry with a pencil beam scanning (PBS) dedicated nozzle have been carried out to build a 'room-dependent' model of the spot position uncertainties. The model has been obtained through interpolation of the look-up tables describing the systematic and random uncertainties, and it has been tested for a clinical case of a brain cancer patient irradiated in a dry-run. The delivered dose has been compared with the planned dose with the inclusion of the errors obtained applying the model. Our results suggest that the accuracy of the treatment delivery is higher than the spot position uncertainties obtained from the log-file records. The comparison in terms of DVHs shows that the log-reconstructed dose is compatible with the planned dose within the 95% confidence interval obtained applying our model. The initial mean dose difference between the calculated dose to the patient based on the plan and recorded data is around 1%. The difference is essentially due to the log-file uncertainties and it can be removed with a correct treatment of these errors. In conclusion our new PSQA protocol allows for a fast verification of the dose delivered after every treatment fraction through the use of machine log-files and an independent Monte Carlo dose engine. Moreover, the inclusion of log-file uncertainties in the dose calculation allows for a correct evaluation of the quality of the treatment plan delivery.
Experimental methods are commonly used for patient‐specific IMRT delivery verification. There are a variety of IMRT QA techniques which have been proposed and clinically used with a common ...understanding that not one single method can detect all possible errors. The aim of this work was to compare the efficiency and effectiveness of independent dose calculation followed by machine log file analysis to conventional measurement‐based methods in detecting errors in IMRT delivery. Sixteen IMRT treatment plans (5 head‐and‐neck, 3 rectum, 3 breast, and 5 prostate plans) created with a commercial treatment planning system (TPS) were recalculated on a QA phantom. All treatment plans underwent ion chamber (IC) and 2D diode array measurements. The same set of plans was also recomputed with another commercial treatment planning system and the two sets of calculations were compared. The deviations between dosimetric measurements and independent dose calculation were evaluated. The comparisons included evaluations of DVHs and point doses calculated by the two TPS systems. Machine log files were captured during pretreatment composite point dose measurements and analyzed to verify data transfer and performance of the delivery machine. Average deviation between IC measurements and point dose calculations with the two TPSs for head‐and‐neck plans were 1.2±1.3% and 1.4±1.6%, respectively. For 2D diode array measurements, the mean gamma value with 3% dose difference and 3 mm distance‐to‐agreement was within 1.5% for 13 of 16 plans. The mean 3D dose differences calculated from two TPSs were within 3% for head‐and‐neck cases and within 2% for other plans. The machine log file analysis showed that the gantry angle, jaw position, collimator angle, and MUs were consistent as planned, and maximal MLC position error was less than 0.5 mm. The independent dose calculation followed by the machine log analysis takes an average 47±6 minutes, while the experimental approach (using IC and 2D diode array measurements) takes an average about 2 hours in our clinic. Independent dose calculation followed by machine log file analysis can be a reliable tool to verify IMRT treatments. Additionally, independent dose calculations have the potential to identify several problems (heterogeneity calculations, data corruptions, system failures) with the primary TPS, which generally are not identifiable with a measurement‐based approach. Additionally, machine log file analysis can identify many problems (gantry, collimator, jaw setting) which also may not be detected with a measurement‐based approach. Machine log file analysis could also detect performance problems for individual MLC leaves which could be masked in the analysis of a measured fluence.
PACS numbers: 87.53.Bn, 87.55.Qr, 87.55.km, 87.57.Uq
The purpose of this study was to compare the measurement‐derived (3DVH) dose reconstruction method with machine log file‐derived dose reconstruction method in patient geometries for VMAT delivery. A ...total of ten patient plans were selected from a regular fractionation plan to complex SBRT plans. Treatment sites in the lung and abdomen were chosen to explore the effects of tissue heterogeneity on the respective dose reconstruction algorithms. Single‐ and multiple‐arc VMAT plans were generated to achieve the desired target objectives. Delivered plan in the patient geometry was reconstructed by using ArcCHECK Planned Dose Perturbation (ACPDP) within 3DVH software, and by converting the machine log file to Pinnacle3 9.0 treatment plan format and recalculating dose with CVSP algorithm. In addition, delivered gantry angles between machine log file and 3DVH 4D measurement were also compared to evaluate the accuracy of the virtual inclinometer within the 3DVH. Measured ion chamber and 3DVH‐derived isocenter dose agreed with planned dose within 0.4%±1.2% and ‐1.0%±1.6%, respectively. 3D gamma analysis showed greater than 98% between log files and 3DVH reconstructed dose. Machine log file reconstructed doses and TPS dose agreed to within 2% in PTV and OARs over the entire treatment. 3DVH reconstructed dose showed an average maximum dose difference of 3% ± 1.2% in PTV, and an average mean difference of ‐4.5%±10.5% in OAR doses. The average virtual inclinometer error (VIE) was ‐0.65° ± 1.6° for all patients, with a maximum error of ‐5.16° ± 4.54° for an SRS case. The time averaged VIE was within 1°–2°, and did not have a large impact on the overall accuracy of the estimated patient dose from ACPDP algorithm. In this study, we have compared two independent dose reconstruction methods for VMAT QA. Both methods are capable of taking into account the measurement and delivery parameter discrepancy, and display the delivered dose in CT patient geometry rather than the phantom geometry. The dose discrepancy can be evaluated in terms of DVH of the structures and provides a more intuitive understanding of the dosimetric impact of the delivery errors on the target and normal structure dose.
PACS number: 87.55
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