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Delineation Errors Caused by Replication and Expansion Operations in Monaco.

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The Monaco system’s structure manipulation functions can introduce errors, affecting radiation dose accuracy. Clinicians must be aware of these potential issues during treatment planning.

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Planning

Background:

  • The Monaco treatment planning system is widely used in radiotherapy.
  • Accurate delineation and manipulation of structures are critical for precise radiation delivery.
  • Understanding system-specific errors is essential for reliable dosimetry.

Purpose of the Study:

  • To investigate structural errors in volume and shape generated by Monaco's replication, expansion, and merging operations.
  • To analyze the impact of these errors on radiation dose evaluation.
  • To identify potential inaccuracies in radiotherapy planning and delivery.

Main Methods:

  • Retrospective analysis of 30 radiotherapy patients.
  • Utilized Monaco's Margins function for structure expansion (0-10 mm) on CT images.
  • Employed replication and merging functions for target structures in various patient cohorts.
  • Evaluated volume deviations and maximum dose (Dmax) changes post-manipulation.

Main Results:

  • Monaco's Margins function introduced volume errors, equivalent to 0.3-0.4 mm expansion per operation.
  • Volume deviation reached 12.99% for a 5 mm radius cylinder.
  • Copy Structure function caused <1% volume reduction across CTs.
  • Lens replication increased Dmax by a median of 31.3 cGy for left lenses.

Conclusions:

  • Monaco's structure manipulation functions (replication, expansion, merging) can lead to significant errors.
  • These errors can result in inaccurate radiation dose assessments.
  • Awareness and careful utilization of these functions are crucial for physicians to ensure accurate dosimetry.