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Variable dose rate single-arc IMAT delivered with a constant dose rate and variable angular spacing

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Grace Tang1,2, Matthew A Earl1 and Cedric X Yu1

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Single-arc intensity-modulated arc therapy (IMAT) has gained worldwide interest in both research and clinical implementation due to its superior plan quality and delivery efficiency. Single-arc IMAT techniques such as the Varian RapidArc™ deliver conformal dose distributions to the target in one single gantry rotation, resulting in a delivery time in the order of 2 min. The segments in these techniques are evenly distributed within an arc and are allowed to have different monitor unit (MU) weightings. Therefore, a variable dose-rate (VDR) is required for delivery. Because the VDR requirement complicates the control hardware and software of the linear accelerators (linacs) and prevents most existing linacs from delivering IMAT, we propose an alternative planning approach for IMAT using constant dose-rate (CDR) delivery with variable angular spacing. We prove the equivalence by converting VDR-optimized RapidArc plans to CDR plans, where the evenly spaced beams in the VDR plan are redistributed to uneven spacing such that the segments with larger MU weighting occupy a greater angular interval. To minimize perturbation in the optimized dose distribution, the angular deviation of the segments was restricted to ≤± 5°. This restriction requires the treatment arc to be broken into multiple sectors such that the local MU fluctuation within each sector is reduced, thereby lowering the angular deviation of the segments during redistribution. The converted CDR plans were delivered with a single gantry sweep as in the VDR plans but each sector was delivered with a different value of CDR. For four patient cases, including two head-and-neck, one brain and one prostate, all CDR plans developed with the variable spacing scheme produced similar dose distributions to the original VDR plans. For plans with complex angular MU distributions, the number of sectors increased up to four in the CDR plans in order to maintain the original plan quality. Since each sector was delivered with a different dose rate, extra mode-up time (xMOT) was needed between the transitions of the successive sectors during delivery. On average, the delivery times of the CDR plans were approximately less than 1 min longer than the treatment times of the VDR plans, with an average of about 0.33 min of xMOT per sector transition. The results have shown that VDR may not be necessary for single-arc IMAT. Using variable angular spacing, VDR RapidArc plans can be implemented into the clinics that are not equipped with the new VDR-enabled machines without compromising the plan quality or treatment efficiency. With a prospective optimization approach using variable angular spacing, CDR delivery times can be further minimized while maintaining the high delivery efficiency of single-arc IMAT treatment.


 

General scientific summary. Single-arc intensity-modulated arc therapy (IMAT) techniques optimized with evenly spaced beams of variable weightings require dose-rate variation for delivery. This requirement complicates delivery and prevents most existing linear accelerators (linacs) from delivering IMAT due to their inability to provide continuous dose rate control. We hypothesize that constant dose rate (CDR) with variable beam spacing is equivalent to variable dose rate (VDR) with even beam space for achieving optimal dose distribution. This is proven by converting VDR-optimized RapidArc plans to CDR plans, where the evenly spaced beams in the VDR plan were redistributed such that the segments with larger MU occupy a greater angular interval. The resultant CDR plans showed similar plan quality as the original VDR plans. Delivery verifications were also performed. The beam-on times for delivering VDR plans on a VDR-enabled linac and delivering CDR plans on a linac incapable of VDR were similar.

For more information on this article see medicalphysicsweb.org

PACS

87.53.Kn Conformal radiation treatment

87.55.-x Treatment strategy

Subjects

Medical physics

Dates

Issue 21 (7 November 2009)

Received 17 June 2009, in final form 8 September 2009

Published 9 October 2009



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