Multi-institutional comparison of simulated treatment delivery errors in ssIMRT,manually planned VMAT and autoplan-VMAT plans for nasopharyngeal radiotherapy |
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| Affiliation: | 1. Institute of Medical Physics, School of Physics, University of Sydney, Sydney 2006, Australia;2. Liverpool and Macarthur Cancer Therapy Centres, Liverpool 2170, Australia;3. Ingham Institute for Applied Medical Research, Sydney 2170, Australia;4. Laboratory of Radiation Physics, Odense University Hospital, 5000, Denmark;5. Institute of Clinical Research, University of Southern Denmark, 5000, Denmark;6. Illawarra Cancer Care Center, Wollongong 2500, Australia;7. University of Wollongong, Wollongong 2500, Australia;8. South Western Sydney Clinical School, University of New South Wales, Sydney 2170, Australia;1. Hiroshima High-Precision Radiotherapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan;2. Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan;1. International Atomic Energy Agency, Department of Nuclear Sciences and Applications, Division of Human Health, Dosimetry and Medical Radiation Physics Section, Vienna International Centre, PO Box 100, A-1400 Vienna, Austria;2. Technische Universität München, Klinikum Rechts der Isar, Klinik für Strahlentherapie und Radiologische Onkologie, Ismaninger Str.22, D-81675 Munich, Germany;3. Centers for Disease Control and Prevention, Radiation Studies Branch, Div. of Environmental Hazards and Health Effects, National Center for Environmental Health, 4770 Buford Highway, NE, Atlanta 30341-3717, GA, United States;4. International Atomic Energy Agency, Department of Nuclear Safety and Security, Division of Radiation, Office of the Deputy Director General, Incident and Emergency Centre, Vienna International Centre, PO Box 100, A-1400 Vienna, Austria;5. Medical and Technical Director REAC/TS and Clinical Professor, Department of Therapeutic Radiology, Yale University School of Medicine Radiation Emergency Assistance Center/Training Site, P.O. Box 117, MS 39, Oak Ridge, TN 37831, United States;6. Executive Officer, National Institutes for Quantum and Radiological Science and Technology (QST) 4-9-1 Anagawa, Inage-ku, Chiba-city, Chiba 263-8555, Japan;7. International Atomic Energy Agency, Department of Nuclear Safety and Security, Division of Radiation, Transport and Waste Safety, Radiation Safety and Monitoring Section, Radiation Protection of Patients Unit, Vienna International Centre, PO Box 100, A-1400 Vienna, Austria;8. Department of Radiation Health Management, Fukushima Medical University, Fukushima 960-1295, Japan;1. Departamento de Fisiología Médica y Biofísica, Universidad de Sevilla, Spain;2. Servicio de Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, Spain;3. Instituto de Física, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile;4. Istituto Nazionale di Fisica Nucleare, Frascati, Italy;1. School of Health Sciences, University of South Australia, Adelaide, Australia;2. Sansom Institute for Health Research, University of South Australia, Adelaide, Australia;3. School of Physical Sciences, University of Adelaide, Adelaide, Australia;4. The Thailand Office for Peace, Bangkok, Thailand;5. Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia;6. School of Medicine, University of Adelaide, Adelaide, Australia;7. Faculty of Science, University of Oradea, Oradea 410087, Romania;1. Department of Radiological Technology, Faculty of Medical Technology, Mahidol University, Bangkok, Thailand;2. Department of Radiology, Siriraj Hospital, Bangkok, Thailand;3. Comprehensive Heart Failure Centre (CHFC), University Hospital Würzburg, Würzburg, Germany;4. The Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, USA;5. Philips Healthcare Korea, Seoul, Republic of Korea |
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| Abstract: | PurposeTo quantify the impact of simulated errors for nasopharynx radiotherapy across multiple institutions and planning techniques (auto-plan generated Volumetric Modulated Arc Therapy (ap-VMAT), manually planned VMAT (mp-VMAT) and manually planned step and shoot Intensity Modulated Radiation Therapy (mp-ssIMRT)).MethodsTen patients were retrospectively planned with VMAT according to three institution’s protocols. Within one institution two further treatment plans were generated using differing treatment planning techniques. This resulted in mp-ssIMRT, mp-VMAT, and ap-VMAT plans. Introduced treatment errors included Multi Leaf Collimator (MLC) shifts, MLC field size (MLCfs), gantry and collimator errors. A change of more than 5% in most selected dose metrics was considered to have potential clinical impact. The original patient plan total Monitor Units (MUs) were correlated to the total number of dose metrics exceeded.ResultsThe impact of different errors was consistent, with ap-VMAT plans (two institutions) showing larger dose deviations than mp-VMAT created plans (one institution). Across all institutions’ VMAT plans the significant errors included; ±5° for the collimator angle, ±5 mm for the MLC shift and +1, ±2 and ±5 mm for the MLC field size. The total number of dose metrics exceeding tolerance was positively correlated to the VMAT total plan MUs (r = 0.51, p < 0.001), across all institutions and techniques.ConclusionsDifferences in VMAT robustness to simulated errors across institutions occurred due to planning method differences. Whilst ap-VMAT was most sensitive to MLC errors, it also produced the best quality treatment plans. Mp-ssIMRT was most robust to errors. Higher VMAT treatment plan complexity led to less robust plans. |
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| Keywords: | Nasopharynx VMAT Uncertainties MLC errors Simulated |
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