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• W2132129684 abstract "Purpose/Objective(s)The beamlet-based IMRT has two pronounced deficiencies: an elevated MU and a reduced MU-to- Gy coefficient. The former increases the scattered dose to uninvolved areas and the latter decreases the delivery and energy efficiency. As more and more patients treated with IMRT have shown long-term survival, there has been an increasing concern over the risk of developing secondary malignancies and other long-term morbidities as a direct result of these high MU treatments. To address these issues, we developed our own version of VMAT in late 2009. So far, several prostate patients have been treated with this new modality. A thorough literature search indicates that this is the first non-commercial VMAT in the field. Our objectives are 1) to minimize MU; 2) to maximize delivery efficiency and 3) to provide IMRT-comparable plans.Materials/MethodsWe used the aperture-based inverse optimization methodology. The aperture-based optimization can completely eliminate small MU and small aperture segments that are commonly seen in beamlet-based IMRT plans. These segments contribute little useful dose to the PTV coverage, but greatly decrease the delivery efficiency and increase the probability of producing hot spots. This reduction in fine intensity modulation is partially compensated for by increasing the beam sampling frequency to 180. To minimize the integral dose, an exponential normal tissue objective function (NTO) was included in the total quadratic cost function. Our VMAT was designed to optimize both MLC aperture shapes and corresponding MU weights simultaneously using a multi-level source sampling optimization scheme (MSSO). Unlike the beamlet-based IMRT, where intensity modulation is achieved through leaf motion alone, our VMAT produces intensity modulation through a synergistic combination of MLC aperture, temporal dose rate, and gantry angular speed modulations.ResultsOur VMAT plans were delivered on Varian RapidArc-enabled Trilogy machines at the fastest gantry angular speed (4.8°/sec). For a 360° plan consisting of 180 beams, the total delivery time was 75 seconds. Four prostate cancer patients have been recruited in our initial trial. All the VMAT plans met our institutional plan acceptance criteria and were comparable or close to the IMRT plans in key dosimetric parameters. However, the VMAT plans offered better target dose homogeneity. The mean beam on time was 283.4±7.67 MU for the VMAT plans and 522.7 ± 39.6 MU for the IMRT plans. The mean MU-to-c Gy coefficient was 1.58 ± 0.04 for the VMAT plans and 2.91 ± 0.22 for the IMRT plans, respectively.ConclusionsWe have successfully developed the first non-commercial VMAT. Our initial clinical experience indicates that our VMAT significantly improves the MU-to-c Gy coefficient and is a competitive and viable treatment modality. Purpose/Objective(s)The beamlet-based IMRT has two pronounced deficiencies: an elevated MU and a reduced MU-to- Gy coefficient. The former increases the scattered dose to uninvolved areas and the latter decreases the delivery and energy efficiency. As more and more patients treated with IMRT have shown long-term survival, there has been an increasing concern over the risk of developing secondary malignancies and other long-term morbidities as a direct result of these high MU treatments. To address these issues, we developed our own version of VMAT in late 2009. So far, several prostate patients have been treated with this new modality. A thorough literature search indicates that this is the first non-commercial VMAT in the field. Our objectives are 1) to minimize MU; 2) to maximize delivery efficiency and 3) to provide IMRT-comparable plans. The beamlet-based IMRT has two pronounced deficiencies: an elevated MU and a reduced MU-to- Gy coefficient. The former increases the scattered dose to uninvolved areas and the latter decreases the delivery and energy efficiency. As more and more patients treated with IMRT have shown long-term survival, there has been an increasing concern over the risk of developing secondary malignancies and other long-term morbidities as a direct result of these high MU treatments. To address these issues, we developed our own version of VMAT in late 2009. So far, several prostate patients have been treated with this new modality. A thorough literature search indicates that this is the first non-commercial VMAT in the field. Our objectives are 1) to minimize MU; 2) to maximize delivery efficiency and 3) to provide IMRT-comparable plans. Materials/MethodsWe used the aperture-based inverse optimization methodology. The aperture-based optimization can completely eliminate small MU and small aperture segments that are commonly seen in beamlet-based IMRT plans. These segments contribute little useful dose to the PTV coverage, but greatly decrease the delivery efficiency and increase the probability of producing hot spots. This reduction in fine intensity modulation is partially compensated for by increasing the beam sampling frequency to 180. To minimize the integral dose, an exponential normal tissue objective function (NTO) was included in the total quadratic cost function. Our VMAT was designed to optimize both MLC aperture shapes and corresponding MU weights simultaneously using a multi-level source sampling optimization scheme (MSSO). Unlike the beamlet-based IMRT, where intensity modulation is achieved through leaf motion alone, our VMAT produces intensity modulation through a synergistic combination of MLC aperture, temporal dose rate, and gantry angular speed modulations. We used the aperture-based inverse optimization methodology. The aperture-based optimization can completely eliminate small MU and small aperture segments that are commonly seen in beamlet-based IMRT plans. These segments contribute little useful dose to the PTV coverage, but greatly decrease the delivery efficiency and increase the probability of producing hot spots. This reduction in fine intensity modulation is partially compensated for by increasing the beam sampling frequency to 180. To minimize the integral dose, an exponential normal tissue objective function (NTO) was included in the total quadratic cost function. Our VMAT was designed to optimize both MLC aperture shapes and corresponding MU weights simultaneously using a multi-level source sampling optimization scheme (MSSO). Unlike the beamlet-based IMRT, where intensity modulation is achieved through leaf motion alone, our VMAT produces intensity modulation through a synergistic combination of MLC aperture, temporal dose rate, and gantry angular speed modulations. ResultsOur VMAT plans were delivered on Varian RapidArc-enabled Trilogy machines at the fastest gantry angular speed (4.8°/sec). For a 360° plan consisting of 180 beams, the total delivery time was 75 seconds. Four prostate cancer patients have been recruited in our initial trial. All the VMAT plans met our institutional plan acceptance criteria and were comparable or close to the IMRT plans in key dosimetric parameters. However, the VMAT plans offered better target dose homogeneity. The mean beam on time was 283.4±7.67 MU for the VMAT plans and 522.7 ± 39.6 MU for the IMRT plans. The mean MU-to-c Gy coefficient was 1.58 ± 0.04 for the VMAT plans and 2.91 ± 0.22 for the IMRT plans, respectively. Our VMAT plans were delivered on Varian RapidArc-enabled Trilogy machines at the fastest gantry angular speed (4.8°/sec). For a 360° plan consisting of 180 beams, the total delivery time was 75 seconds. Four prostate cancer patients have been recruited in our initial trial. All the VMAT plans met our institutional plan acceptance criteria and were comparable or close to the IMRT plans in key dosimetric parameters. However, the VMAT plans offered better target dose homogeneity. The mean beam on time was 283.4±7.67 MU for the VMAT plans and 522.7 ± 39.6 MU for the IMRT plans. The mean MU-to-c Gy coefficient was 1.58 ± 0.04 for the VMAT plans and 2.91 ± 0.22 for the IMRT plans, respectively. ConclusionsWe have successfully developed the first non-commercial VMAT. Our initial clinical experience indicates that our VMAT significantly improves the MU-to-c Gy coefficient and is a competitive and viable treatment modality. We have successfully developed the first non-commercial VMAT. Our initial clinical experience indicates that our VMAT significantly improves the MU-to-c Gy coefficient and is a competitive and viable treatment modality." @default.
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• W2132129684 date "2010-11-01" @default.
• W2132129684 modified "2023-09-27" @default.
• W2132129684 title "Clinical Implementation and Initial Experience of the First Non-commercial VMAT" @default.
• W2132129684 doi "https://doi.org/10.1016/j.ijrobp.2010.07.249" @default.
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