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• W2013163974 abstract "Ray trace (effective path length method; EPL) is inferior to the Monte Carlo (MC) dose calculation algorithm when treating tumors at tissue interfaces of varying densities, such as lung tumors. We hypothesized that the anatomic complexity of the skull base would introduce similar uncertainties, due to the multiple tissue interfaces in this location (e.g. bone, brain, and air). We set out to determine whether differences between the EPL and the MC dose calculations were more pronounced for lesions of the skull base when compared to those within the substance of the brain and what dosimetric and anatomic characteristics influence these differences. A retrospective, comparative dosimetric study of 65 CyberKnife™ treatment plans was performed. All treatments were planned with the EPL dose calculation. The delivered plans were re-calculated using the MC algorithm, with identical beam orientation and number of monitor units, in MultiPlan v3.5.2 (Accuray, Inc.). Patients were designated as either having a lesion at the skull base (SB), adjacent to bone and air, or a control (CTRL) lesion, completely surrounded by brain tissue. Comparison of changes in the treatment plan characteristics between the two groups was performed when plans were recalculated with MC. Skull base and control lesions demonstrated a statistically significant drop in the target coverage (SB: 96.4% vs. 93.7%, P = 0.02; CTRL: 97.5% vs. 94.7%, P = 0.03) when the dose calculation was performed with MC. The degree and magnitude of these changes were similar for SB and CTRL plans. Recognizing this similar behavior we combined all 65 patients into one analysis. The mean target coverage decreased to a similar degree and magnitude as the individual groups; critical structure dose variations were insignificant. We identified 11 treatment plans with a >5% (range 6.25 to 23.25%) decrease in target coverage from EPL to MC dose calculation. Comparing these outliers with the remaining 54 treatment plans we found that they were more likely to have smaller target volumes (mean 1 cc vs. 6.9 cc; P<0.0001), and a trend towards a lower beam number per treatment plan (mean 95 vs. 121; P = 0.091). We demonstrate that the EPL dose calculation significantly overestimates the degree of radiation therapy dose coverage for all intracranial targets, regardless of location. Smaller intracranial targets (<1cc) treated with fewer beams (<100) had the greatest degree of variation in target coverage. As such we recommend the use of Monte Carlo dose calculation for all intracranial CyberKnife™ radiosurgery treatments." @default.
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• W2013163974 date "2011-10-01" @default.
• W2013163974 modified "2023-10-18" @default.
• W2013163974 title "Ray-Trace is Inferior to Monte Carlo Dose Calculation Algorithm for Intracranial Robotic Radiosurgical Treatment: A Comparative Dosimetry Study" @default.
• W2013163974 doi "https://doi.org/10.1016/j.ijrobp.2011.06.1528" @default.
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