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Dynamic Tumor Tracking (DTT) for Hepatocellular Carcinoma Using the Vero4DRT Gimbaled Linac Stereotactic Body Radiation Therapy (SBRT) System.

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Monte Carlo Modeling of Dynamic Tumor Tracking on a Gimbaled Linear Accelerator.

Emilie E Carpentier1,2, Ronan L Mcdermott3, Shiqin Su2

  • 1Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada.

Journal of Medical Physics
|June 21, 2023
PubMed
Summary

Monte Carlo (MC) modeling of dynamic tumor tracking (DTT) in radiation therapy revealed potential organ at risk (OAR) dose overestimation by treatment planning systems (TPS). This highlights the need for 4D MC for accurate QA of DTT treatments.

Keywords:
Dynamic tumor trackingMonte Carlofour-dimensional dose calculationsmotion management

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Computational Imaging

Background:

  • Dynamic tumor tracking (DTT) utilizes linear accelerators to follow real-time tumor motion during radiation therapy.
  • Accurate dose calculation is critical for ensuring treatment efficacy and patient safety, especially with complex motion management techniques.

Purpose of the Study:

  • To model the panning/tilting motion of the Vero4DRT linear accelerator using Monte Carlo (MC) simulations.
  • To perform quality assurance (QA) of four-dimensional (4D) dose distributions generated by treatment planning systems (TPS) for DTT.

Main Methods:

  • Intensity-modulated radiation therapy (IMRT) plans were optimized for liver cancer patients.
  • Plans were recalculated using MC on 4D computed tomography (4DCT) data, incorporating real-time beam panning/tilting.
  • Respiratory-weighted 4D dose distributions were accumulated and compared against TPS calculations.

Main Results:

  • MC simulations showed an average 10% greater maximum dose to organs at risk (OARs) compared to TPS.
  • MC identified 6 out of 24 OARs potentially exceeding dose limits, with average maximum dose increases of 4% (up to 13%) compared to TPS 4D calculations.
  • The largest dose discrepancies between MC and TPS were observed in the beam penumbra region.

Conclusions:

  • MC modeling of panning/tilting for DTT is a validated tool for QA of 4D dose distributions.
  • Significant dose differences underscore the importance of 4D MC for verifying OAR safety prior to DTT implementation.