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Evaluation of clinical implications in the use of dose to water versus dose to medium by using NTCP and TCP models for urinary bladder tumours

Bharati Avinav, Mandal Susama R., Srivastava Anoop K., Rastogi Madhup, Khurana Rohini, Hadi Rahat, Gandhi Ajeet K., Mishra Lalatendu, Mishra Surendra P.

Polish Journal of Medical Physics and Engineering

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2021

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Vol. 27, Iss. 1

19--24

EN

Purpose: To analyze the dosimetric and radiobiological differences between dose to water versus dose to medium for patients with carcinoma of the urinary bladder. Materials and Methods: 15 patients with cancer of urinary bladder were selected for the study. VMAT plans were generated for each patient. The dose distributions were calculated in the modes dose to water and to medium with the Monaco treatment planning system. A dosimetric comparative analysis has been made between the two modes of planning in this study. Subsequently, NTCP and TCP were determined for OARs and targets respectively. Results: The mean dose to 2 cc of the rectum, small bowel, left and right femoral heads respectively was higher by 0.8, 1.2, 2.7, and 2.2% for the dose to water calculation. Similarly, the mean dose to D2, D50, and D98 for PTV was higher by 0.4, 0.3, and 0.3% for dose to water calculation. Such small dose differences had little effect on the values of TCP and NTCP. Conclusion: For patients with the urinary bladder there were very small differences between results between calculations carried out in dose to medium and dose to water modes.

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Evaluation of various common prostate IMRT techniques based on estimated tumor control and normal tissue complication probabilities in correlation with patients anatomical parameters derived from the CT scans

Banaei Amin, Hashemi Bijan, Bakhshandeh Mohsen, Mofid Bahram

Polish Journal of Medical Physics and Engineering

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2019

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Vol. 25, Iss. 1

35--41

EN

Background: The relationship between the prostate IMRT techniques and patients anatomical parameters has been rarely investigated. Objective: to evaluate various prostate IMRT techniques based on tumor control and normal tissue complication probability (TCP and NTCP) values and also the correlation of such techniques with patients anatomical parameters. Methods: Four IMRT techniques (9, 7 and 5 fields and also automatic) were planned on the CT scans of 63 prostate cancer patients. The sum of distances between the organs at risk (OARs) and target tissue and also their average joint volumes were measured and assumed as anatomical parameters. Selected dosimetric and radiobiological parameters (TCP and NTCP) values were compared among various techniques and the correlation with the above anatomical parameters were assessed using Pearsons’ correlation. Results: High correlations were found between the dosimetric/radiobiological parameters of OARs with the joint volumes and with the distances between the OARs and target tissue in all the techniques. The TCP and complication free tumor control probability (P+) values were decreased with increasing the joint volume and decreasing the distances between the OARs and target tissue (as poly-nominal functions). The NTCP values were increased with increasing the joint volumes and decreasing the distances (3-degree poly-nominal functions). For the low percent joint volumes (<20%) and high distances (>7 cm), The TCP, NTCP and P+ showed no statistical differences between various techniques (P-value>0.07). However, 9 and 7 fields techniques indicated better radiobiological results (P-value<0.05) in almost other ranges (>20% joint volumes and <7 cm distances). Conclusion: Based on our results, it would be possible to compare radiobiological effects of various common IMRT techniques and choose the best one regarding to patients anatomical parameters derived from the CT scans.

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Comparison of three and four- field radiotherapy technique and the effect of laryngeal shield on vocal and spinal cord radiation dose in radiotherapy of non-laryngeal head and neck tumors

Pour N. H., Farajollahi A., Jamali M., Zeinali A., Jangjou A. G.

Polish Journal of Medical Physics and Engineering

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2018

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Vol. 24, Iss. 1

25--31

EN

Introduction: Due to the effect of radiation on both the tumor and the surrounding normal tissues, the side effects of radiation in normal tissues are expected. One of the important complications in the head and neck radiotherapy is the doses reached to the larynx and spinal cord of patients with non-laryngeal head and neck tumors. Materials and Methods: In this study, CT scan images of 25 patients with non-laryngeal tumors including; lymph nodes, tongue, oropharynx and nasopharynx were used. A three-field and a four-field treatment planning with and without laryngeal shield in 3D CRT technique were planned for each patient. Subsequently, the values of Dmin, Dmean, Dmax and Dose Volume Histogram from the treatment planning system and NTCP values of spinal cord and larynx were calculated with BIOPLAN and MATLAB software for all patients. Results: Statistical results showed that mean values of doses of larynx in both three and four-field methods were significantly different between with and without shield groups. Comparison of absorbed dose didn’t show any difference between the three and four field methods (P>0.05). Using Shield, just the mean and minimum doses of spinal cord decreased in both three and four fields. The NTCP of the spinal cord and larynx by three and four-field methods with shield in the LKB and EUD models significantly are less than that of the three and four fields without shields, and in the four-field method NTCP of larynx is less than three radiation field. Conclusion: The results of this study indicate that there is no significant difference in doses reached to larynx and spinal cord between the treatments techniques, but laryngeal shield reduce dose and NTCP values in larynx considerably.

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Zastosowanie techniki VMAT z bramkowaniem oddechowym w radiochirurgii stereotaktycznej

Ślosarek K., Dolata Ł., Kulik R., Leszczyński W., Osewski W.

Inżynier i Fizyk Medyczny

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2016

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Vol. 5, nr 4

191--197

PL

Radiochirurgia to sposób frakcjonowania dawki w radioterapii, polegający na podaniu kilku dużych dawek frakcyjnych w małej objętości. Jej realizację umożliwiają zaawansowane techniki dynamiczne. Jedną z nich jest technika, w której zastosowane są wiązki o zmiennym kształcie przy jednoczesnym obrocie głowicy akceleratora oraz zmiennej mocy dawki. Technikę tę określamy jako technikę obrotową z modulacją intensywności dawki VMAT (Volumetric Modulated Arc Therapy). Zmiany nowotworowe położone w strukturach anatomicznych zmieniających swoje położenie na skutek oddychania wymagają zastosowania techniki bramkowania oddechowego w celu zmniejszenia dawki w tkankach zdrowych otaczających guz nowotworowy. Bramkowanie oddechowe to technika, która polega na wyłączeniu ekspozycji promieniowania, kiedy guz nowotworowy znajduje się, wskutek oddychania pacjenta, poza wiązką promieniowania. Połączenie wyżej opisanych technik napromieniania z frakcjonowaniem radiochirurgicznym pozwala optymalnie wykorzystać oprogramowanie do obliczania rozkładu dawki, możliwości techniczne akceleratorów biomedycznych oraz radiobiologię w celu zwiększenia prawdopodobieństwa miejscowego wyleczenia. Jednak powiązanie technik napromieniania ze zmianą sposobu frakcjonowania dawki nie wystarczy, aby zastosować te metody w praktyce klinicznej. Czynnikiem niezbędnym jest obrazowe zweryfikowanie pozycji terapeutycznej pacjenta oraz dozymetryczne sprawdzenie poprawności obliczonego rozkładu dawki. Technika radiochirurgiczna z wykorzystaniem bramkowania oddechowego i VMAT omówiona zostanie na przykładzie pacjenta, który otrzymał dwa niezależne kursy radioterapii w odstępie ośmiu miesięcy. W celu zweryfikowania dawki całkowitej otrzymanej przez pacjenta zastosowano oprogramowanie do deformacji obrazu tomografii komputerowej, obrysów struktur oraz rozkładów dawki.

EN

Radiosurgery is the way of the dose fractionation were few high doses are delivered in small volume. It’s realization is possible due to dynamic techniques. One of such a technique is VMAT (Volumetric Modulated Arc Therapy) technique where the beams with variable shape are used together with accelerator gantry rotation and dose rate modulation. If cancerous lesions are located in anatomical structures, which one could change its position by patient breathing, then it is required to use respiratory gating system to reduce delivered dose to normal tissues surrounding the tumor. Respiratory gating system turns off the radiation when the tumor is outside the radiation beam due to patient breathing. The combination of respiratory gated VMAT technique with radiosurgery allows optimum use of the dose distribution calculating system, technical capabilities of biomedical accelerators and radiobiology in order to increase the probability of a local cure. However, the combination of irradiation techniques with the changes in the dose fractionation is not enough to apply these method in clinical practice. The image guided radiation therapy is the necessary factor to verify patient treatment position. Additionally dosimetry verification of the calculated dose distribution have to be done. The respiratory gated VMAT technique will be discussed on the example of a patient who received two independent radiotherapy courses (with eight months break between). To verify the total dose, received by the patient, the dedicated software was used to perform deformation of the computed tomography volume, structures outlines and dose distributions.