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Development of a Monte Carlo based robustness calculation and evaluation tool.

Hannes A Loebner1, Werner Volken1, Silvan Mueller1

  • 1Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Medical Physics
|April 22, 2022
PubMed
Summary

A new Monte Carlo tool quantifies radiotherapy plan robustness against various uncertainties, aiding in selecting the most reliable intensity-modulated radiotherapy (IMRT) plans for improved patient outcomes.

Keywords:
Monte Carloplan evaluationrobustness (to patient and machine-related uncertainties)

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Radiotherapy Planning

Background:

  • Evaluating the robustness of radiotherapy plans is crucial for ensuring treatment accuracy.
  • Understanding the impact of uncertainties is essential for reliable treatment delivery.

Purpose of the Study:

  • To develop a flexible Monte Carlo (MC)-based tool for calculating and evaluating the dosimetric robustness of intensity-modulated radiotherapy (IMRT) plans.
  • To explore the impact of systematic and random uncertainties from patient setup, anatomy changes, and machine limitations.

Main Methods:

  • Automated MC dose calculation for user-defined uncertainty scenarios using the Swiss Monte Carlo Plan (SMCP).
  • Development of a graphical user interface (GUI) for evaluating dose-volume histogram (DVH) parameters, gamma analysis, and dose differences.
  • Introduction of a robustness index (RI) to quantify robustness against multiple uncertainties, with optional scenario weighting.

Main Results:

  • The tool enables simultaneous calculation and fast evaluation of uncertainty scenarios.
  • Planning target volume (PTV) coverage remained largely stable, while organs at risk (OARs) near the PTV showed larger deviations.
  • Volumetric modulated arc therapy (VMAT) and dynamic trajectory radiotherapy (DTRT) plans demonstrated superior robustness against patient setup uncertainties compared to IMRT.
  • Delta4 validation measurements showed >96% agreement with calculations.

Conclusions:

  • The developed robustness tool was successfully implemented and demonstrated on a brain case.
  • The tool provides a user-friendly GUI for quantitative assessment and comparison of treatment plan robustness against combined uncertainties.