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IMRT planning and delivery incorporating daily dose from mega-voltage cone-beam computed tomography imaging
Journal article   Peer reviewed

IMRT planning and delivery incorporating daily dose from mega-voltage cone-beam computed tomography imaging

Moyed Miften, Olivier Gayou, Bodo Reitz, Russell Fuhrer, Brian Leicher and David Parda
Medical physics (Lancaster), v 34(10), pp 3760-3767
12 Sep 2007
PMID: 17985621

Abstract

dose exposure IMRT MV-CBCT optimization
The technology of online mega-voltage cone-beam (CB) computed tomography (MV-CBCT) imaging is currently used in many institutions to generate a 3D anatomical dataset of a patient in treatment position. It utilizes an accelerator therapy beam, delivered with 200° gantry rotation, and captured by an electronic portal imager to account for organ motion and setup variations. Although the patient dose exposure from a single volumetric MV-CBCT imaging procedure is comparable to that from standard double-exposure orthogonal portal images, daily image localization procedures can result in a significant dose increase to healthy tissue. A technique to incorporate the daily dose, from a MV-CBCT imaging procedure, in the IMRT treatment planning optimization process was developed. A composite IMRT plan incorporating the total dose from the CB was optimized with the objective of ensuring uniform target coverage while sparing the surrounding normal tissue. One head and neck cancer patient and four prostate cancer patients were planned and treated using this technique. Dosimetric results from the prostate IMRT plans optimized with or without CB showed similar target coverage and comparable sparing of bladder and rectum volumes. Average mean doses were higher by 1.6 ± 1.0 Gy for the bladder and comparable for the rectum ( − 0.3 ± 1.4 Gy ) . In addition, an average mean dose increase of 1.9 ± 0.8 Gy in the femoral heads and 1.7 ± 0.6 Gy in irradiated tissue was observed. However, the V 65 and V 70 values for bladder and rectum were lower by 2.3 ± 1.5 % and 2.4 ± 2.1 % indicating better volume sparing at high doses with the optimized plans incorporating CB. For the head and neck case, identical target coverage was achieved, while a comparable sparing of the brain stem, optic chiasm, and optic nerves was observed. The technique of optimized planning incorporating doses from daily online MV-CBCT procedures provides an alternative method for imaging IMRT patients. It allows for daily treatment modifications where other volumetric tomographic imaging techniques may not be feasible and/or available and where accurate patient localization with a high degree of precision is required.

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Collaboration types
Domestic collaboration
Web of Science research areas
Radiology, Nuclear Medicine & Medical Imaging
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