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Evaluating efficiency of Vertical MLC VMAT plan for naso-pharyngeal carcinoma (비인두암 Vertical MLC VMAT plan 유용성 평가)

  • Chae, Seung Hoon;Son, Sang Jun;Lee, Je Hee
    • The Journal of Korean Society for Radiation Therapy
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    • v.33
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    • pp.127-135
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    • 2021
  • Purpose : The purpose of the study is to evaluate the efficiency of Vertical MLC VMAT plan(VMV plan) Using 273° and 350° collimator angle compare to Complemental MLC VMAT plan(CMV plan) using 20° and 340° collimator angle for nasopharyngeal carcinoma. Materials & Methods : Thirty patients treated for nasopharyngeal carcinoma with the VMAT technique were retrospectively selected. Those cases were planned by Eclipse, PO and AcurosXB Algorithm with two 6MV 360° arcs and Each arc has 273° and 350° of collimator angle. The Complemental MLC VMAT plans are based on existing treatment plans. Those plans have the same parameters of existing treatment plans but collimator angle. For dosimetric evaluation, the dose-volumetric(DV) parameters of the planning target volume (PTV) and organs at risk (OARs) were calculated for all VMAT plans. MCSv(Modulation complexity score of VMAT), MU and treatment time were also compared. In addition, Pearson's correlation analysis was performed to confirm whether there was a correlation between the difference in the MCSv and the difference in each evaluation index of the two treatment plans. Result : In the case of PTV evaluation index, the CI of PTV_67.5 was improved by 3.76% in the VMV Plan, then for OAR, the dose reduction effect of the spinal cord (-14.05%) and brain stem (-9.34%) was remarkable. In addition, the parotid glands (left parotid : -5.38%, right : -5.97%) and visual organs (left optic nerve: -4.88%, right optic nerve: -5.80%, optic chiasm : -6.12%, left lens: -6.12%, right lens: -5.26%), auditory organs (left: -11.74%, right: -12.31%) and thyroid gland (-2.02%) were also confirmed. The difference in MCSv of the two treatment plans showed a significant negative (-) correlation with the difference in CI (r=-0.55) of PTV_54 and the difference in CI (r=-0.43) of PTV_48. Spinal cord (r=0.40), brain stem (r=0.34), and both salivary glands (left: r=0.36, right: r=0.37) showed a positive (+) correlation. (For all the values, p<.05) Conclusion : Compared to the CMV plan, the VMV plan is considered to be helpful in improving the quality of the treatment plan by allowing the MLC to be modulated more efficiently

Development of Adjustable Head holder Couch in H&N Cancer Radiation Therapy (두경부암 방사선 치료 시 Set-Up 조정 Head Holder 장치의 개발)

  • Shim, JaeGoo;Song, KiWon;Kim, JinMan;Park, MyoungHwan
    • The Journal of Korean Society for Radiation Therapy
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    • v.26 no.1
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    • pp.43-50
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    • 2014
  • In case of all patients who receive radiation therapy, a treatment plan is established and all steps of treatment are planned in the same geometrical condition. In case of head and neck cancer patients who undergo simulated treatment through computed tomography (CT), patients are fixed onto a table for planning, but laid on the top of the treatment table in the radiation therapy room. This study excogitated and fabricated an adjustable holder for head and neck cancer patients to fix patient's position and geometrical discrepancies when performing radiation therapy on head and neck cancer patients, and compared the error before and after adjusting the position of patients due to difference in weight to evaluate the correlation between patients' weight and range of error. Computed tomography system(High Advantage, GE, USA) is used for phantom to maintain the supine position to acquire the images of the therapy site for IMRT. IMRT 4MV X-rays was used by applying the LINAC(21EX, Varian, U.S.A). Treatment planning system (Pinnacle, ver. 9.1h, Philips, Madison, USA) was used. The setup accuracy was compared with each measurement was repeated five times for each weight (0, 15, and 30Kg) and CBCT was performed 30 times to find the mean and standard deviation of errors before and after the adjustment of each weight. SPSS ver.19.0(SPSS Inc., Chicago, IL,USA) statistics program was used to perform the Wilcoxon Rank test for significance evaluation and the Spearman analysis was used as the tool to analyze the significance evaluation of the correlation of weight. As a result of measuring the error values from CBCT before and after adjusting the position due to the weight difference, X,Y,Z axis was $0.4{\pm}0.8mm$, $0.8{\pm}0.4mm$, 0 for 0Kg before the adjustment. In 15Kg CBCT before and after adjusting the position due to the weight difference, X,Y,Z axis was $0.2{\pm}0.8mm$, $1.2{\pm}0.4mm$, $2.0{\pm}0.4mm$. After adjusting position was X,Y,Z axis was $0.2{\pm}0.4mm$, $0.4{\pm}0.5mm$, $0.4{\pm}0.5mm$. In 30Kg CBCT before and after adjusting the position due to the weight difference, X,Y,Z axis was $0.8{\pm}0.4mm$, $2.4{\pm}0.5mm$, $4.4{\pm}0.8mm$. After adjusting position was X,Y,Z axis was $0.6{\pm}0.5mm$, $1.0{\pm}0mm$, $0.6{\pm}0.5mm$. When the holder for the head and neck cancer was used to adjust the ab.0ove error value, the error values from CBCT were $0.2{\pm}0.8mm$ for the X axis, $0.40{\pm}0.54mm$ for Y axis, and 0 for Z axis. As a result of statistically analyzing each value before and after the adjustment the value was significant with p<0.034 at the Z axis with 15Kg of weight and with p<0.038 and p<0.041 at the Y and Z axes respectively with 30Kg of weight. There was a significant difference with p<0.008 when the analysis was performed through Kruscal-Wallis in terms of the difference in the adjusted values of the three weight groups. As it could reduce the errors, patients' reproduction could be improved for more precise and accurate radiation therapy. Development of an adjustable device for head and neck cancer patients is significant because it improves the reproduction of existing equipment by reducing the errors in patients' position.