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• W2112785780 abstract "Purpose/Objective(s)Intensity-Modulated Radiosurgery (IMRS) was adopted in our clinic for treating intracranial lesions since 2006. RapidArc (RA), a modulated technique of rotational beams, was implemented in 2009. This study reports the comparison in dosimetric and delivery aspects of the two techniques in treating multiple brain metastases.Materials/MethodsTwelve patients with 2 to12 brain metastases treated by IMRS were re-planned with RA. The IMRS plans were delivered using a single-isocenter, and in a single fraction using 9-11 static beams and 6-9 couch angles. The prescribed dose was 18-20 Gy covering 98% of the PTV. Two coplanar arcs were adopted in all RA plans. The RA plans followed systematic strategies in arc optimization. Two or more RA plans were generated for each patient and the one with lower MUs and higher conformity was chosen for comparison with IMRS. For dosimetric evaluation, the homogeneity, conformity, and gradient indices were calculated and compared for each patient. The homogeneity index is defined as the ratio of the maximum PTV dose and the prescribed dose. The conformity index is the ratio of 100% dose volume and the PTV. The gradient index is the radii difference of two equivalent spheres of the volumes enclosed by 100% and 50% doses.ResultsIt is found that MU reduction by RA is more pronounced for patients with a larger number of brain lesions, as the ratio of MUs in RA and IMRS is reduced from 104% to 39% as the lesion increases from 2 to 12. It is also found that 2-arcs gave a better dose conformity than 1-arc but with comparable MUs. Adding vertical or oblique arcs actually increased the dose to the normal brain and brainstem with little benefit in dose conformity. The homogeneity indices in IMRS and RA are found to be comparable in each patient and the group average is 1.15 for both techniques. The conformity and gradient indices are slightly higher in RA, with an average conformity index of 1.6 and 1.3 and a gradient index of 2.3 cm and 2.0 cm, respectively. The mean dose to the normal brain, and maximal dose to brainstem, chiasm, eyes, and optic nerves were calculated in each plan and compared for each patient. It is found that the dosimetric data of those organs at risk are comparable but RA plans give slightly higher doses.ConclusionsRA has pros and cons in the radiosurgery of brain metastasis. Treatment time reduction is more significant in brain radiosurgery, since RA uses less MUs, fewer beams and couch angles than IMRS technique. Homogeneities are comparable in RA and IMRS, but RA results in slightly higher conformity and gradient indices, and critical organ doses. This may be due to increased leakage and transmission through the multileaf collimator, as larger field sizes are used for multiple brain lesions in RA, while beams in IMRS are designed to avoid critical organs as much as possible. Purpose/Objective(s)Intensity-Modulated Radiosurgery (IMRS) was adopted in our clinic for treating intracranial lesions since 2006. RapidArc (RA), a modulated technique of rotational beams, was implemented in 2009. This study reports the comparison in dosimetric and delivery aspects of the two techniques in treating multiple brain metastases. Intensity-Modulated Radiosurgery (IMRS) was adopted in our clinic for treating intracranial lesions since 2006. RapidArc (RA), a modulated technique of rotational beams, was implemented in 2009. This study reports the comparison in dosimetric and delivery aspects of the two techniques in treating multiple brain metastases. Materials/MethodsTwelve patients with 2 to12 brain metastases treated by IMRS were re-planned with RA. The IMRS plans were delivered using a single-isocenter, and in a single fraction using 9-11 static beams and 6-9 couch angles. The prescribed dose was 18-20 Gy covering 98% of the PTV. Two coplanar arcs were adopted in all RA plans. The RA plans followed systematic strategies in arc optimization. Two or more RA plans were generated for each patient and the one with lower MUs and higher conformity was chosen for comparison with IMRS. For dosimetric evaluation, the homogeneity, conformity, and gradient indices were calculated and compared for each patient. The homogeneity index is defined as the ratio of the maximum PTV dose and the prescribed dose. The conformity index is the ratio of 100% dose volume and the PTV. The gradient index is the radii difference of two equivalent spheres of the volumes enclosed by 100% and 50% doses. Twelve patients with 2 to12 brain metastases treated by IMRS were re-planned with RA. The IMRS plans were delivered using a single-isocenter, and in a single fraction using 9-11 static beams and 6-9 couch angles. The prescribed dose was 18-20 Gy covering 98% of the PTV. Two coplanar arcs were adopted in all RA plans. The RA plans followed systematic strategies in arc optimization. Two or more RA plans were generated for each patient and the one with lower MUs and higher conformity was chosen for comparison with IMRS. For dosimetric evaluation, the homogeneity, conformity, and gradient indices were calculated and compared for each patient. The homogeneity index is defined as the ratio of the maximum PTV dose and the prescribed dose. The conformity index is the ratio of 100% dose volume and the PTV. The gradient index is the radii difference of two equivalent spheres of the volumes enclosed by 100% and 50% doses. ResultsIt is found that MU reduction by RA is more pronounced for patients with a larger number of brain lesions, as the ratio of MUs in RA and IMRS is reduced from 104% to 39% as the lesion increases from 2 to 12. It is also found that 2-arcs gave a better dose conformity than 1-arc but with comparable MUs. Adding vertical or oblique arcs actually increased the dose to the normal brain and brainstem with little benefit in dose conformity. The homogeneity indices in IMRS and RA are found to be comparable in each patient and the group average is 1.15 for both techniques. The conformity and gradient indices are slightly higher in RA, with an average conformity index of 1.6 and 1.3 and a gradient index of 2.3 cm and 2.0 cm, respectively. The mean dose to the normal brain, and maximal dose to brainstem, chiasm, eyes, and optic nerves were calculated in each plan and compared for each patient. It is found that the dosimetric data of those organs at risk are comparable but RA plans give slightly higher doses. It is found that MU reduction by RA is more pronounced for patients with a larger number of brain lesions, as the ratio of MUs in RA and IMRS is reduced from 104% to 39% as the lesion increases from 2 to 12. It is also found that 2-arcs gave a better dose conformity than 1-arc but with comparable MUs. Adding vertical or oblique arcs actually increased the dose to the normal brain and brainstem with little benefit in dose conformity. The homogeneity indices in IMRS and RA are found to be comparable in each patient and the group average is 1.15 for both techniques. The conformity and gradient indices are slightly higher in RA, with an average conformity index of 1.6 and 1.3 and a gradient index of 2.3 cm and 2.0 cm, respectively. The mean dose to the normal brain, and maximal dose to brainstem, chiasm, eyes, and optic nerves were calculated in each plan and compared for each patient. It is found that the dosimetric data of those organs at risk are comparable but RA plans give slightly higher doses. ConclusionsRA has pros and cons in the radiosurgery of brain metastasis. Treatment time reduction is more significant in brain radiosurgery, since RA uses less MUs, fewer beams and couch angles than IMRS technique. Homogeneities are comparable in RA and IMRS, but RA results in slightly higher conformity and gradient indices, and critical organ doses. This may be due to increased leakage and transmission through the multileaf collimator, as larger field sizes are used for multiple brain lesions in RA, while beams in IMRS are designed to avoid critical organs as much as possible. RA has pros and cons in the radiosurgery of brain metastasis. Treatment time reduction is more significant in brain radiosurgery, since RA uses less MUs, fewer beams and couch angles than IMRS technique. Homogeneities are comparable in RA and IMRS, but RA results in slightly higher conformity and gradient indices, and critical organ doses. This may be due to increased leakage and transmission through the multileaf collimator, as larger field sizes are used for multiple brain lesions in RA, while beams in IMRS are designed to avoid critical organs as much as possible." @default.
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• W2112785780 date "2010-11-01" @default.
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• W2112785780 title "Comparison Study of Rotational vs. Static Intensity Modulated Radiosurgery for Multiple Brain Metastases" @default.
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