Practical methods for improving dose distributions in Monte Carlo-based IMRT planning of lung wall-seated tumors treated with SBRT.

Michael B. Altman, Jian Yue Jin, Sangroh Kim, Ning Wen, Dezhi Liu, Salim M. Siddiqui, Munther I. Ajlouni, Benjamin Movsas, Indrin J. Chetty

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Current commercially available planning systems with Monte Carlo (MC)-based final dose calculation in IMRT planning employ pencil-beam (PB) algorithms in the optimization process. Consequently, dose coverage for SBRT lung plans can feature cold-spots at the interface between lung and tumor tissue. For lung wall (LW)-seated tumors, there can also be hot spots within nearby normal organs (example: ribs). This study evaluated two different practical approaches to limiting cold spots within the target and reducing high doses to surrounding normal organs in MC-based IMRT planning of LW-seated tumors. First, "iterative reoptimization", where the MC calculation (with PB-based optimization) is initially performed. The resultant cold spot is then contoured and used as a simultaneous boost volume. The MC-based dose is then recomputed. The second technique uses noncoplanar beam angles with limited path through lung tissue. Both techniques were evaluated against a conventional coplanar beam approach with a single MC calculation. In all techniques the prescription dose was normalized to cover 95% of the PTV. Fifteen SBRT lung cases with LW-seated tumors were planned. The results from iterative reoptimization showed that conformity index (CI) and/or PTV dose uniformity (UPTV) improved in 12/15 plans. Average improvement was 13%, and 24%, respectively. Nonimproved plans had PTVs near the skin, trachea, and/or very small lung involvement. The maximum dose to 1cc volume (D1cc) of surrounding OARs decreased in 14/15 plans (average 10%). Using noncoplanar beams showed an average improvement of 7% in 10/15 cases and 11% in 5/15 cases for CI and UPTV, respectively. The D1cc was reduced by an average of 6% in 10/15 cases to surrounding OARs. Choice of treatment planning technique did not statistically significantly change lung V5. The results showed that the proposed practical approaches enhance dose conformity in MC-based IMRT planning of lung tumors treated with SBRT, improving target dose coverage and potentially reducing toxicities to surrounding normal organs.

Original languageEnglish (US)
Pages (from-to)112-125
Number of pages14
JournalJournal of applied clinical medical physics / American College of Medical Physics
Volume13
Issue number6
DOIs
StatePublished - Dec 1 2012

Fingerprint

lungs
planning
Tumors
tumors
Planning
dosage
Lung
Neoplasms
organs
Tissue
pencil beams
Toxicity
Skin
Planning Techniques
trachea
optimization
Ribs
Trachea
acceleration (physics)
toxicity

Keywords

  • IMRT
  • Lung
  • Monte carlo
  • SBRT
  • Treatment planning

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Instrumentation

Cite this

Practical methods for improving dose distributions in Monte Carlo-based IMRT planning of lung wall-seated tumors treated with SBRT. / Altman, Michael B.; Jin, Jian Yue; Kim, Sangroh; Wen, Ning; Liu, Dezhi; Siddiqui, Salim M.; Ajlouni, Munther I.; Movsas, Benjamin; Chetty, Indrin J.

In: Journal of applied clinical medical physics / American College of Medical Physics, Vol. 13, No. 6, 01.12.2012, p. 112-125.

Research output: Contribution to journalArticle

Altman, Michael B. ; Jin, Jian Yue ; Kim, Sangroh ; Wen, Ning ; Liu, Dezhi ; Siddiqui, Salim M. ; Ajlouni, Munther I. ; Movsas, Benjamin ; Chetty, Indrin J. / Practical methods for improving dose distributions in Monte Carlo-based IMRT planning of lung wall-seated tumors treated with SBRT. In: Journal of applied clinical medical physics / American College of Medical Physics. 2012 ; Vol. 13, No. 6. pp. 112-125.
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