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Clinical Implementation of Volumetric Intensity-Modulated Arc Therapy (VMAT) with ERGO++

Klinische Einführung von volumetrisch intensitätsmodulierter Arc-Therapy (VMAT) mit ERGO++

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Abstract

Background and Purpose:

Volumetric modulated arc therapy (VMAT) has the potential to deliver dose distributions comparable to the established intensity-modulated radiotherapy techniques for a multitude of target paradigms. Prior to implementing VMAT into their clinical routine in December 2008, the authors evaluated the dose calculation/delivery accuracy of 24 sample VMAT plans (prostate and anal cancer target paradigms) with film and ionization dosimetry. After the start of the clinical program, in vivo measurements with a rectal probe were performed.

Material and Methods:

The VMAT plans were generated by the treatment-planning system (TPS) ERGO++ (Elekta, Crawley, UK) and transferred to a phantom. Film dosimetry was performed with Kodak EDR2 films, and evaluated with dose profiles and γ-index analysis. Appropriate ionization chambers were used for absolute dose measurements in the phantom and for in vivo measurements. The ionization chamber was used with localization of the measurement volume based on positioning cone-beam computed tomography.

Results:

Plans were transferred from ERGO++ to the record and verify (R&V) system/linear accelerator (linac). The absolute dose deviations recorded with the ionization chamber were 1.74% ± 1.62% across both indications. The γ-index analysis of the film dosimetry showed no deviation > 3%/3 mm in the high-dose region. On in vivo measurements, a deviation between calculation and measurement of 2.09% ± 2.4% was recorded, when the chamber was successfully positioned in the high-dose region.

Conclusion:

VMAT plans can be planned and treated reproducibly in high quality after the commissioning of the complete delivery chain consisting of TPS, R&V system and linac. The results of the individual plan verification meet the commonly accepted requirements. The first in vivo measurements confirm the reproducible precision of the delivered dose during clinical treatments.

Zusammenfassung

Hintergrund und Ziel:

Die volumetrisch modulierte Arc-Therapie (VMAT) bietet die Möglichkeit, für einige Planparadigmata zur bisher etablierten intensitätsmodulierten Strahlentherapie vergleichbare Dosisverteilungen zu generieren. Vor der im Dezember 2008 erfolgten Einführung von VMAT in die eigene klinische Routine überprüften die Autoren Dosisberechnung und Bestrahlungsgenauigkeit anhand von 24 VMAT-Plänen (Anal- und Prostatakarzinomplanungsparadigmata) mittels Film- und Ionisationsdosimetrie. Erste Patientenbestrahlungen wurden mittels rektaler In-vivo-Dosimetrie verifiziert.

Material und Methodik:

Die VMAT-Pläne wurden mit dem Planungssystem ERGO++ (Elekta, Crawley, UK) generiert und in einem Phantom verifiziert. Filmdosimetrie wurde mittels Kodak-EDR2-Film, Dosisprofilen und der γ-Analyse realisiert. Geeignete Ionisationskammern wurden für absolute Dosismessungen im Phantom und für die In-vivo-Dosimetrie verwendet. Ein Cone-Beam-Computertomogramm wurde für die Lokalisation des Messvolumens der Ionisationskammer im Rektum verwendet.

Ergebnisse:

Die Pläne wurden durchgängig fehlerfrei von ERGO++ an das „record and verify“-(R&V-)System und an den Beschleuniger übertragen. Die mittlere Abweichung der Absolutdosimetrie betrug 1,74% ± 1,62%. Die γ-Index-Analyse der Filmdosimetrie zeigte keine Abweichung > 3%/3 mm im Hochdosisbereich. Die In-vivo-Messungen ergaben nach erfolgreicher Positionierung im Hochdosisbereich eine mittlere Abweichung zwischen berechneter und applizierter Dosis von 2,09% ± 2,4%.

Schlussfolgerung:

VMAT-Pläne können auf Basis der klinisch zugelassenen Kette aus Planungs-, R&V- und Bestrahlungssystem nach adäquater Kommissionierung reproduzierbar erzeugt und zuverlässig bestrahlt werden. Die Ergebnisse der Individualplanverifikation erfüllen die allgemein akzeptierten Bedingungen. Erste in vivo ermittelte Dosen bestätigen die Präzision der Dosisapplikation im klinischen Einsatz.

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Authors and Affiliations

  1. Department of Radiation Oncology of the University Medical Center Mannheim, University of Heidelberg, Heidelberg, Germany

    Dirk Wolff, Florian Stieler, Brigitte Hermann, Katharina Heim, Sven Clausen, Jens Fleckenstein, Martin Polednik, Volker Steil, Frederik Wenz & Frank Lohr

  2. Eichenstraße 7, 35745, Herborn, Germany

    Dirk Wolff

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  1. Dirk Wolff
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  2. Florian Stieler
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Correspondence to Dirk Wolff.

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Wolff, D., Stieler, F., Hermann, B. et al. Clinical Implementation of Volumetric Intensity-Modulated Arc Therapy (VMAT) with ERGO++. Strahlenther Onkol 186, 280–288 (2010). https://doi.org/10.1007/s00066-010-2071-z

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  • DOI: https://doi.org/10.1007/s00066-010-2071-z

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