A population based statistical model for daily geometric variations in the thorax.

PURPOSE: To develop a population based statistical model of the systematic interfraction geometric variations between the planning CT and first treatment week of lung cancer patients for inclusion as uncertainty term in future probabilistic planning. MATERIALS AND METHODS: Deformable image registrations between the planning CT and first week CBCTs of 235 lung cancer patients were used to generate deformation vector fields (DVFs) representing the geometric variations of lung cancer patients. Using a second deformable registration step, the average DVF per patient was mapped to an average patient CT. Subsequently, the dominant modes of systematic geometric variations were extracted using Principal Component Analysis (PCA). For evaluation a leave-one-out cross-validation was performed. RESULTS: The first three PCA components mainly described cranial-caudal, anterior-posterior, and left-right variations, respectively. Fifty and 112 components were needed to describe correspondingly 75% and 90% of the variance. An overall systematic variation of 3.6mm SD was observed and could be described with an accuracy of about 1.0mm with the PCA model. CONCLUSIONS: A PCA based model for systematic geometric variations in the thorax was developed, and its accuracy determined. Such a model can serve as a basis for probability based treatment planning in lung cancer patients.

Effects of anatomical changes on pencil beam scanning proton plans in locally advanced NSCLC patients.

BACKGROUND AND PURPOSE: Daily anatomical variations can cause considerable differences between delivered and planned dose. This study simulates and evaluates these effects in spot-scanning proton therapy for lung cancer patients. MATERIALS AND METHODS: Robust intensity modulated treatment plans were designed on the mid-position CT scan for sixteen locally advanced lung cancer patients. To estimate dosimetric uncertainty, deformable registration was performed on their daily CBCTs to generate 4DCT equivalent scans for each fraction and to map recomputed dose to a common frame. RESULTS: Without adaptive planning, eight patients had an undercoverage of the targets of more than 2GyE (maximum of 14.1GyE) on the recalculated treatment dose from the daily anatomy variations including respiration. In organs at risk, a maximum increase of 4.7GyE in the D1 was found in the mediastinal structures. The effect of respiratory motion alone is smaller: 1.4GyE undercoverage for targets and less than 1GyE for organs at risk. CONCLUSIONS: Daily anatomical variations over the course of treatment can cause considerable dose differences in the robust planned dose distribution. An advanced planning strategy including knowledge of anatomical uncertainties would be recommended to improve plan robustness against interfractional variations. For large anatomical changes, adaptive therapy is mandatory.

Dynamic collimator angle adjustments during volumetric modulated arc therapy to account for prostate rotations.

PURPOSE: Rotations of the prostate gland induce considerable geometric uncertainties in prostate cancer radiation therapy. Collimator and gantry angle adjustments can correct these rotations in intensity modulated radiation therapy. Modern volumetric modulated arc therapy (VMAT) treatments, however, include a wide range of beam orientations that differ in modulation, and corrections require dynamic collimator rotations. The aim of this study was to implement a rotation correction strategy for VMAT dose delivery and validate it for left-right prostate rotations. METHODS AND MATERIALS: Clinical VMAT treatment plans of 5 prostate cancer patients were used. Simulated left-right prostate rotations between +15° and -15° were corrected by collimator rotations. We compared corrected and uncorrected plans by dose volume histograms, minimum dose (Dmin) to the prostate, bladder surface receiving ≥78 Gy (S78) and rectum equivalent uniform dose (EUD; n=0.13). Each corrected plan was delivered to a phantom, and its deliverability was evaluated by γ-evaluation between planned and delivered dose, which was reconstructed from portal images acquired during delivery. RESULTS: On average, clinical target volume minimum dose (Dmin) decreased up to 10% without corrections. Negative left-right rotations were corrected almost perfectly, whereas Dmin remained within 4% for positive rotations. Bladder S78 and rectum EUD of the corrected plans matched those of the original plans. The average pass rate for the corrected plans delivered to the phantom was 98.9% at 3% per 3 mm gamma criteria. The measured dose in the planning target volume approximated the original dose, rotated around the simulated left-right angle, well. CONCLUSIONS: It is feasible to dynamically adjust the collimator angle during VMAT treatment delivery to correct for prostate rotations. This technique can safely correct for left-right prostate rotations up to 15°.