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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Dose-based optimisation for multi-leaf collimator tracking during radiation therapy.

Lars Mejnertsen1, Emily Hewson1, Doan Trang Nguyen1,2

  • 1ACRF Image X Institute, Faculty of Medicine and Health, University of Sydney, NSW, Australia.

Physics in Medicine and Biology
|February 19, 2021
PubMed
Summary
This summary is machine-generated.

This study introduces a new dose optimization method for multi-leaf collimator (MLC) tracking during radiation therapy. This advanced technique significantly reduces radiation dose errors caused by patient movement compared to current methods.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Image-guided Radiation Therapy

Background:

  • Patient anatomy motion during radiation therapy can compromise treatment efficacy and increase healthy tissue exposure.
  • Current multi-leaf collimator (MLC) tracking methods optimize aperture based on fluence, failing to fully account for 3D dose distribution.
  • Intrafraction motion necessitates adaptive strategies to maintain dose accuracy in radiation therapy.

Purpose of the Study:

  • To develop and evaluate a novel real-time adaptive MLC tracking algorithm based on dose optimization.
  • To compare the performance of dose optimization tracking against fluence optimization and no tracking methods.
  • To improve the accuracy of dose delivery in the presence of intrafraction motion.

Main Methods:

  • Developed a novel MLC tracking algorithm that optimizes the MLC aperture based on real-time dose delivered, using a simplified dose calculation.
  • Applied the dose optimization MLC tracking method in silico to a prostate cancer VMAT dataset with simulated intrafraction motion.
  • Quantitatively assessed performance using 3D gamma (γ) failure rate (2 mm/2%) and dose error.

Main Results:

  • Dose optimization achieved a significantly lower γ failure rate (4.7 ± 1.2)% compared to fluence optimization (7.5 ± 2.9)% (p < 0.01).
  • The method without MLC tracking showed a substantially higher γ failure rate (15.3 ± 12.9)%.
  • Dose optimization effectively adapted the MLC aperture to account for moving anatomy, targeting underdosed regions and avoiding overdosed areas.

Conclusions:

  • Real-time adaptive MLC tracking based on dose optimization offers superior accuracy in radiation therapy compared to fluence optimization.
  • This novel approach effectively manages intrafraction motion by considering the cumulative dose delivered to moving anatomy.
  • Dose optimization represents a significant advancement for adaptive radiation therapy, enhancing treatment precision and patient safety.