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Dosimetric adaptive IMRT driven by fiducial points.

Wouter Crijns1, Hans Van Herck2, Gilles Defraene3

  • 1Department of Oncology, Laboratory of Experimental Radiotherapy, KU Leuven, Herestraat 49, 3000 Leuven, Belgium and Medical Imaging Research Center, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.

Medical Physics
|June 1, 2014
PubMed
Summary

This study introduces a fast dosimetric correction method for intensity modulated radiotherapy (IMRT) that uses fiducial points and pretreatment imaging. The approach ensures target dose and improves organ at risk protection, outperforming current clinical practices.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Radiotherapy Planning

Background:

  • Intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy are standard treatments but sensitive to anatomical variations.
  • Current methods like basic repositioning lack precision, while full replanning is time-consuming.
  • There is a need for fast, easy-to-implement methods to correct for inter- and intrafraction anatomical variations in IMRT.

Purpose of the Study:

  • To propose a full dosimetric IMRT correction method that balances accuracy and efficiency.
  • To simplify replanning by avoiding recontouring and full dose calculation.
  • To update preoptimized fluence and monitor units (MU) using limited fiducial points and pretreatment CBCT.

Main Methods:

  • A dosimetric adaptation combining two fluence corrections (realignment, penumbra scaling) and two MU corrections (target depth, source distance).
  • Utilized four fiducial points projected in the beam's eye view (BEV) for fluence adaptation.
  • Performed point dose calculations to fiducial points for MU adaptation.
  • Evaluated using simulations on a virtual prostate phantom with systematic transformations and a clinical patient example.

Main Results:

  • The proposed method assured intended target dose and tumor control probability (TCP ≥ TCP(intended)).
  • Conformity index error was reduced by more than half (ΔCI(95%) from 40% to 16%), improving organ at risk protection.
  • Individual correction steps demonstrated added value to the full correction strategy.

Conclusions:

  • A limited number of fiducial points and in-room CBCT enable full dosimetric correction for IMRT plans without organ recontouring.
  • The corrected IMRT plans offer superior dose distributions compared to current clinical practice in the presence of interfraction variations.