• Progress in Medical Physics
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• v.33 no.4
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• pp.121-128
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• 2022

Purpose: This study evaluated the quality of plans based on magnetic resonance-guided radiotherapy (MRgRT) tri-Co-60, linac, and conventional linac-based volumetric modulated arc therapy (linac-VMAT) for prostate cancer. Methods: Twenty patients suffering from prostate cancer with intermediate risk who were treated by MAT were selected. Additional treatment plans (primary and boost plans) were generated based on MRgRT-tri-Co-60 and MRgRT-linac. The planning target volume (PTV) of MRgRT-based plans was created by adding a 3 mm margin from the clinical target volume (CTV) due to high soft-tissue contrast and real-time motion imaging. On the other hand, the PTV of conventional linac was generated based on a 1 cm margin from CTV. The targets of primary and boost plans were prostate plus seminal vesicle and prostate only, respectively. All plans were normalized to cover 95% of the target volume by 100% of the prescribed dose. Dosimetric characteristics were evaluated for each of the primary, boost, and sum plans. Results: For target coverage and conformity, the three plans showed similar results. In the sum plans, the average value of V_65Gy of the rectum of MRgRT-linac (2.62%±2.21%) was smaller than those of MRgRT tri-Co-60 (9.04%±3.01%) and linac-VMAT (9.73%±7.14%) (P<0.001). In the case of bladder, the average value of V_65Gy of MRgRT-linac was also smaller. Conclusions: In terms of organs at risk sparing, MRgRT-linac shows the best value while maintaining comparable target coverage among the three plans.

• Progress in Medical Physics
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• v.33 no.4
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• pp.142-149
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• 2022

Purpose: This study seeks to compare the dosimetric parameters of the bulk electron density (ED) approach and synthetic computed tomography (CT) image in terms of position variation of the air cavity in magnetic resonance-guided radiotherapy (MRgRT) for patients with pancreatic cancer. Methods: This study included nine patients that previously received MRgRT and their simulation CT and magnetic resonance (MR) images were collected. Air cavities were manually delineated on simulation CT and MR images in the treatment planning system for each patient. The synthetic CT images were generated using the deep learning model trained in a prior study. Two more plans with identical beam parameters were recalculated with ED maps that were either manually overridden by the cavities or derived from the synthetic CT. Dose calculation accuracy was explored in terms of dose-volume histogram parameters and gamma analysis. Results: The D_95% averages were 48.80 Gy, 48.50 Gy, and 48.23 Gy for the original, manually assigned, and synthetic CT-based dose distributions, respectively. The greatest deviation was observed for one patient, whose D_95% to synthetic CT was 1.84 Gy higher than the original plan. Conclusions: The variation of the air cavity position in the gastrointestinal area affects the treatment dose calculation. Synthetic CT-based ED modification would be a significant option for shortening the time-consuming process and improving MRgRT treatment accuracy.