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• W2018508631 abstract "Purpose/Objective: It is of great clinical concern that IMRT plans for head and neck patients are often overly modulated, which may cause potentially adverse dosimetric effects and significantly prolong treatment delivery times. This study demonstrates the impact of significant reductions in the number of segments and shortening of IMRT delivery time using static MLC with enhanced technical changes in the delivery system using static multi-leaf collimator (MLC). Materials/Methods: For IMRT plans delivered with static MLC, there is a time delay in-between segments based on required communication within the treatment delivery system. A recent technical enhancement in a commercial delivery system (Siemens) results in a reduction of the overhead of communication in-between segments. Furthermore, a new optimization method developed in a commercial treatment planning system allows us to specify the number of segments for an IMRT plan. In order to evaluate the impact of the modifications on IMRT treatment planning and delivery, we selected 5 previously treated patients with nasopharyngeal cancer, and retrospectively re-planned them using the initial target volumes and adjacent sensitive structures. The treatment goal is to concurrently deliver 70 Gy (GTV), 59.4 Gy (CTV), and 54 Gy (elective CTV) to >95% of these tumor volumes. The plan quality was assessed based on tumor coverage, multiple defined endpoints for sensitive structures, plan dose conformality and homogeneity index. The numbers of beam angles varied from 7–9. For each plan, total number of segments was gradually reduced from 98, 63, 48, to 24, while keeping the planning dose constraints and the number of beam angles the same as in the original plan. Results: All plans achieved the same tumor coverage, delivering >95% of tumor volumes to 70Gy (GTV), 59.4Gy (CTV), and 54Gy (elective CTV) simultaneously. As the number of segments decreased from 98, 63, 48, to 24, the average maximum doses to the brainstem changed from 50,8, 50.4, 51.3, to 55.1 Gy and the average maximum dose to the spinal cord changed from 41.9, 42.2, 41.5 to 42.3 Gy while the average mean parotid doses were 27.0, 26.7, 26.7, and 28.5G, respectively. As the total number of segments decreased, the average plan conformal indices were 0.63, 0.61, 0.65, and 0.46, and the average dose homogeneity indices were 89%, 87%, 88%, and 84%. Reduction of total MU is from 894, 759, 740, to 593. Based on these dosimetric data, it was judged that an average number of segments of 50 is adequate for these IMRT plans without significantly degrading the plan quality. With the enhanced communication within the LINAC control system, which reduced the inter-segment delay from six to two seconds, it was estimated that the average delivery time (not including patient setup) for plans with 50 segments is reduced from 14.4 minutes to 7.9 minutes. Conclusions: For patients with nasopharyngeal tumors treated with IMRT, 50 segments appear to be sufficient to achieve clinical requirements. With the latest IMRT delivery system, the treatment time excluding patient setup can be reduced to 8 minutes." @default.
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• W2018508631 date "2005-10-01" @default.
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• W2018508631 title "IMRT Plans for Head and Neck Patients Can be Simplified and Efficiently Delivered with Static MLC" @default.
• W2018508631 doi "https://doi.org/10.1016/j.ijrobp.2005.07.875" @default.
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