Objective Radiotherapy combined with conservative surgery plays an important role in the treatment of early-stage breast cancer. Volumetric modulated arc therapy(VMAT) has been introduced into clinical practice. The p...Objective Radiotherapy combined with conservative surgery plays an important role in the treatment of early-stage breast cancer. Volumetric modulated arc therapy(VMAT) has been introduced into clinical practice. The purpose of this study was to investigate the dosimetric effects of different multileaf collimators(MLC) on VMAT radiotherapy plans for treating breast cancer.Methods Fifteen breast cancer patients who were treated using a conventional technique in our department were selected to participate in this retrospective analysis. VMAT plans based on three types of Elekta MLCs [Beam Modulator(BM) with 4-mm leaf width, Agility with 5-mm leaf width and MLCi2 with 10-mm leaf width] were independently generated for each patient. Plan comparisons were performed based on dose-volume histogram(DVH) analysis including dosimetric parameters such as the homogeneity index(HI), conformity index(CI), Dmax, Dmin, and Dmean for the planning treatment volume(PTV), in addition to dose-volume parameters for the organs at risk(OARs). The delivery efficiency of the three types of MLCs was compared in terms of the beam delivery time and the monitor units(MUs) per fraction for each plan. Results Both target uniformity and conformity were improved in plans for Agility and BM MLC compared with the plan using MLCi2. The mean HI decreased from 1.14 for MLCi2 to 1.13 for BM and 1.10 for Agility, while the mean CI increased from 0.68 for MLCi2 to 0.73 for BM and 0.75 for Agility. Furthermore, at both low and high dose levels, smaller volumes of ipsilateral lung, heart, contralateral lung, and breast were irradiated with Agility MLC than with the other two types of MLCs. The delivery time with Agility MLC was reduced by 10.8% and 32.1%, respectively, compared with that for MLCi2 and BM.Conclusion Our results indicate that the Agility MLC exhibits a dosimetric advantage and a significant improvement in delivery efficiency for the treatment of breast cancer using VMAT.展开更多
Objective The aiom of the study was to compare the impacts of two types of multileaf collimators （MLC） [standard MLC with a width of 10 mm （sMLC） and micro-MLC with a width of 5 mm （mMLC）] on volumetric modulate...Objective The aiom of the study was to compare the impacts of two types of multileaf collimators （MLC） [standard MLC with a width of 10 mm （sMLC） and micro-MLC with a width of 5 mm （mMLC）] on volumetric modulated arc therapy （VMAT） planning for malignant pleural mesothelioma. Methods VMAT for ten patients with inoperable malignant pleural mesotheliomas was retrospectively planned with the sMLC and mMLC. Histogram-based dose-volume parameters of the planning target vol- ume （PTV） [conformity index （CI） and homogeneous index （HI）] and organs-at-risk were compared for VMAT plans with sMLC （sMLC-VMAT） and mMLC （mMLC-VMAT）. Results The mMLC-VMAT plans were more efficient （average delivery time： 2.67±1.49 min） than the sMLC-VMAT plans （average delivery time： 4.21 ± 2.03 min; P 〈 0.05）. Moreover, compared to the sMLC plans, the mMLC plans demonstrated advantages in the dose coverage of the PTV （CI 0.75 ± 0.08 vs 0.73± 0.09; HI 1.09 ±0.02 vs 1.10± 0.02）, although the difference was not statistically significant （P 〉 0.05）. In addition, significant dose sparing in the fraction of the ipsilateral lung volume receiving 〉 20 Gy （V20; 54.72± 27.08 vs 58.52 ± 29.30） and 〉 30 Gy （V30; 42.74 ± 27.86 vs 46.86± 31.49） radiation, respectively, was observed for the mMLC plans （P 〈 0.05）. Conclusion Comparing sMLC-VMAT and mMLC-VMAT not only demonstrated the higher efficiency and better optimal target coverage of mMLC-VMAT, but also considerably improved the dose sparing of the ipsilateral lung in the VMAT plans for mali qnant pleural mesothelioma.展开更多
Background: In linear accelerators, the treatment field’s uniform intensity is achieved by including a flattening filter in the beam. However, to produce more conformal dose distributions, contemporary radiotherapy p...Background: In linear accelerators, the treatment field’s uniform intensity is achieved by including a flattening filter in the beam. However, to produce more conformal dose distributions, contemporary radiotherapy practice now frequently uses fluence and aperture modifying techniques, such as volumetric modulated arc therapy. In these circumstances, the flattening filter in the beam manufacturing process is no longer required. It is therefore necessary to compare the monitor units of 6 MV and flattening filter free plans and how it influences the gamma pass rates to determine which is best for treating cervical cancer with pelvic lymph node metastasis. Methods: VMAT plans for fifteen patients with cervical cancer with pathological pelvic lymph node metastasis were included in this study. Each patient had two VMAT plans using conventional 6 MV beam with flattening filter and one with flattening filter free beam (FFF). The VMAT plans were made using two arcs, and then recalculated to give the planned dose distribution to the detectors in a Delta4 phantom. The VMAT plans were irradiated on the Delta4 phantom using an Elekta linear accelerator (6 MV). Results: The mean monitor unit for the 6 MV plans was 506.3 MU and a standard deviation of 48.6 while that of the FFF plans had a mean MU of 701.5 with a standard deviation of 87.6. The total monitor units (MUs) for the FFF plans were significantly greater than the 6 MV plans (p = 6.1 × 10<sup>-5</sup>). Conclusion: Flattening filter free (FFF) plans require more numbers of monitor units in comparison to conventional 6 MV filtered beams for external radiation of cervical cancer with pelvic lymph nodes involvement.展开更多
This work aims to summarize and evaluate the current planning progress based on the linear accelerator in stereotactic radiotherapy(SRT).The specific techniques include 3-dimensional conformal radiotherapy,dynamic con...This work aims to summarize and evaluate the current planning progress based on the linear accelerator in stereotactic radiotherapy(SRT).The specific techniques include 3-dimensional conformal radiotherapy,dynamic conformal arc therapy,intensity-modulated radiotherapy,and volumetric-modulated arc therapy(VMAT).They are all designed to deliver higher doses to the target volume while reducing damage to normal tissues;among them,VMAT shows better prospects for application.This paper reviews and summarizes several issues on the planning of SRT to provide a reference for clinical application.展开更多
Intensity modulated radiation therapy （IMRT） requires the determination of the appropriate multileaf collimator settings to deliver an intensity map. The purpose of this work was to attempt to regulate the shape bet...Intensity modulated radiation therapy （IMRT） requires the determination of the appropriate multileaf collimator settings to deliver an intensity map. The purpose of this work was to attempt to regulate the shape between adjacent multileaf collimator apertures by a leaf sequencing algorithm. To qualify and validate this algorithm, the integral test for the segment of the multileaf collimator of ARTS was performed with clinical intensity map experiments. By comparisons and analyses of the total number of monitor units and number of segments with benchmark results, the proposed algorithm performed well while the segment shape constraint produced segments with more compact shapes when delivering the planned intensity maps, which may help to reduce the multileaf collimator＇s specific effects.展开更多
Objective This study aimed to analyze the dosimetric parameters of volumetric modulated arc therapy(VMAT) and dynamic multileaf collimator(DMLC) plans with lumbosacral spine(LS) and pelvic bone marrow(PBM) sparing in ...Objective This study aimed to analyze the dosimetric parameters of volumetric modulated arc therapy(VMAT) and dynamic multileaf collimator(DMLC) plans with lumbosacral spine(LS) and pelvic bone marrow(PBM) sparing in the flattening filter-free(FFF) model.Methods Thirty patients with cervical cancer were selected for analysis.For each patient,four plans with different strategies were generated:VMAT_FF,VMAT_FFF,DMLC_FF,and DMLC_FFF.Dose volumes for organs at risk,conformity index,heterogeneity index(HI),and total number of machine unit(MU) were compared by paired t-test.Result Compared with plans in the FF model,the irradiated dose to LS significantly decreased both VMAT_FFF and DMLC_FFF plans in the FFF model while the MU increased.The mean dose of LS decreased by 107.2 cGy(P<0.05) in the VMAT_FFF plan.In comparison with the VMAT plans in both models of FF and FFF,the DMLC plans reduced the dose volume of 10 Gy by 5.9%(P<0.05),and the mean dose of LS was 189.6-293.1 cGy.The PBM volume receiving 40 Gy showed a decrease of 0.5%-1.1%(P<0.05) as well.The HI increased in the VMAT plans by approximately 0.053 and 0.039.Conclusion The DMLC plans exhibited the best sparing of the PBM and LS in both FF and FFF models and increased the HI.The plans in the FFF model could limit the volume dose of LS but increase the MU.展开更多
文摘Objective Radiotherapy combined with conservative surgery plays an important role in the treatment of early-stage breast cancer. Volumetric modulated arc therapy(VMAT) has been introduced into clinical practice. The purpose of this study was to investigate the dosimetric effects of different multileaf collimators(MLC) on VMAT radiotherapy plans for treating breast cancer.Methods Fifteen breast cancer patients who were treated using a conventional technique in our department were selected to participate in this retrospective analysis. VMAT plans based on three types of Elekta MLCs [Beam Modulator(BM) with 4-mm leaf width, Agility with 5-mm leaf width and MLCi2 with 10-mm leaf width] were independently generated for each patient. Plan comparisons were performed based on dose-volume histogram(DVH) analysis including dosimetric parameters such as the homogeneity index(HI), conformity index(CI), Dmax, Dmin, and Dmean for the planning treatment volume(PTV), in addition to dose-volume parameters for the organs at risk(OARs). The delivery efficiency of the three types of MLCs was compared in terms of the beam delivery time and the monitor units(MUs) per fraction for each plan. Results Both target uniformity and conformity were improved in plans for Agility and BM MLC compared with the plan using MLCi2. The mean HI decreased from 1.14 for MLCi2 to 1.13 for BM and 1.10 for Agility, while the mean CI increased from 0.68 for MLCi2 to 0.73 for BM and 0.75 for Agility. Furthermore, at both low and high dose levels, smaller volumes of ipsilateral lung, heart, contralateral lung, and breast were irradiated with Agility MLC than with the other two types of MLCs. The delivery time with Agility MLC was reduced by 10.8% and 32.1%, respectively, compared with that for MLCi2 and BM.Conclusion Our results indicate that the Agility MLC exhibits a dosimetric advantage and a significant improvement in delivery efficiency for the treatment of breast cancer using VMAT.
文摘Objective The aiom of the study was to compare the impacts of two types of multileaf collimators （MLC） [standard MLC with a width of 10 mm （sMLC） and micro-MLC with a width of 5 mm （mMLC）] on volumetric modulated arc therapy （VMAT） planning for malignant pleural mesothelioma. Methods VMAT for ten patients with inoperable malignant pleural mesotheliomas was retrospectively planned with the sMLC and mMLC. Histogram-based dose-volume parameters of the planning target vol- ume （PTV） [conformity index （CI） and homogeneous index （HI）] and organs-at-risk were compared for VMAT plans with sMLC （sMLC-VMAT） and mMLC （mMLC-VMAT）. Results The mMLC-VMAT plans were more efficient （average delivery time： 2.67±1.49 min） than the sMLC-VMAT plans （average delivery time： 4.21 ± 2.03 min; P 〈 0.05）. Moreover, compared to the sMLC plans, the mMLC plans demonstrated advantages in the dose coverage of the PTV （CI 0.75 ± 0.08 vs 0.73± 0.09; HI 1.09 ±0.02 vs 1.10± 0.02）, although the difference was not statistically significant （P 〉 0.05）. In addition, significant dose sparing in the fraction of the ipsilateral lung volume receiving 〉 20 Gy （V20; 54.72± 27.08 vs 58.52 ± 29.30） and 〉 30 Gy （V30; 42.74 ± 27.86 vs 46.86± 31.49） radiation, respectively, was observed for the mMLC plans （P 〈 0.05）. Conclusion Comparing sMLC-VMAT and mMLC-VMAT not only demonstrated the higher efficiency and better optimal target coverage of mMLC-VMAT, but also considerably improved the dose sparing of the ipsilateral lung in the VMAT plans for mali qnant pleural mesothelioma.
文摘Background: In linear accelerators, the treatment field’s uniform intensity is achieved by including a flattening filter in the beam. However, to produce more conformal dose distributions, contemporary radiotherapy practice now frequently uses fluence and aperture modifying techniques, such as volumetric modulated arc therapy. In these circumstances, the flattening filter in the beam manufacturing process is no longer required. It is therefore necessary to compare the monitor units of 6 MV and flattening filter free plans and how it influences the gamma pass rates to determine which is best for treating cervical cancer with pelvic lymph node metastasis. Methods: VMAT plans for fifteen patients with cervical cancer with pathological pelvic lymph node metastasis were included in this study. Each patient had two VMAT plans using conventional 6 MV beam with flattening filter and one with flattening filter free beam (FFF). The VMAT plans were made using two arcs, and then recalculated to give the planned dose distribution to the detectors in a Delta4 phantom. The VMAT plans were irradiated on the Delta4 phantom using an Elekta linear accelerator (6 MV). Results: The mean monitor unit for the 6 MV plans was 506.3 MU and a standard deviation of 48.6 while that of the FFF plans had a mean MU of 701.5 with a standard deviation of 87.6. The total monitor units (MUs) for the FFF plans were significantly greater than the 6 MV plans (p = 6.1 × 10<sup>-5</sup>). Conclusion: Flattening filter free (FFF) plans require more numbers of monitor units in comparison to conventional 6 MV filtered beams for external radiation of cervical cancer with pelvic lymph nodes involvement.
文摘This work aims to summarize and evaluate the current planning progress based on the linear accelerator in stereotactic radiotherapy(SRT).The specific techniques include 3-dimensional conformal radiotherapy,dynamic conformal arc therapy,intensity-modulated radiotherapy,and volumetric-modulated arc therapy(VMAT).They are all designed to deliver higher doses to the target volume while reducing damage to normal tissues;among them,VMAT shows better prospects for application.This paper reviews and summarizes several issues on the planning of SRT to provide a reference for clinical application.
基金supported by National Natural Science Foundation of China (No. 10805012)Fundamental Research Funds for the Central Universities (Nos. 2010HGXJ0216, 2012HGXJ0057, 2012HGXJ0062, 2012HGXJ0071, 2012HGBZ0190)Seed Foundation of Hefei University of Technology (2012HGZY0007)
文摘Intensity modulated radiation therapy （IMRT） requires the determination of the appropriate multileaf collimator settings to deliver an intensity map. The purpose of this work was to attempt to regulate the shape between adjacent multileaf collimator apertures by a leaf sequencing algorithm. To qualify and validate this algorithm, the integral test for the segment of the multileaf collimator of ARTS was performed with clinical intensity map experiments. By comparisons and analyses of the total number of monitor units and number of segments with benchmark results, the proposed algorithm performed well while the segment shape constraint produced segments with more compact shapes when delivering the planned intensity maps, which may help to reduce the multileaf collimator＇s specific effects.
基金General program of National Natural Science Foundation of China,31371425microRNA regulates the mechanism of mitochondrial fusion protein OPA1 involved in apoptosis induced by chemotherapy drugs Special fund of NSFC director,31240025regulation of mitochondrial injury on apoptosis induced by sorafenib
文摘Objective This study aimed to analyze the dosimetric parameters of volumetric modulated arc therapy(VMAT) and dynamic multileaf collimator(DMLC) plans with lumbosacral spine(LS) and pelvic bone marrow(PBM) sparing in the flattening filter-free(FFF) model.Methods Thirty patients with cervical cancer were selected for analysis.For each patient,four plans with different strategies were generated:VMAT_FF,VMAT_FFF,DMLC_FF,and DMLC_FFF.Dose volumes for organs at risk,conformity index,heterogeneity index(HI),and total number of machine unit(MU) were compared by paired t-test.Result Compared with plans in the FF model,the irradiated dose to LS significantly decreased both VMAT_FFF and DMLC_FFF plans in the FFF model while the MU increased.The mean dose of LS decreased by 107.2 cGy(P<0.05) in the VMAT_FFF plan.In comparison with the VMAT plans in both models of FF and FFF,the DMLC plans reduced the dose volume of 10 Gy by 5.9%(P<0.05),and the mean dose of LS was 189.6-293.1 cGy.The PBM volume receiving 40 Gy showed a decrease of 0.5%-1.1%(P<0.05) as well.The HI increased in the VMAT plans by approximately 0.053 and 0.039.Conclusion The DMLC plans exhibited the best sparing of the PBM and LS in both FF and FFF models and increased the HI.The plans in the FFF model could limit the volume dose of LS but increase the MU.
