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- W2157067248 abstract "Balance between plan quality and computational cost as well as delivery feasibility has been the main challenge to 4D-IMRT planning required for tracking targets under respiration-induced motion. Currently available 4D planning methods utilize aperture transformation from a single-phased optimization (SPO). We studied if full-fledged direct 4D optimization improves the plan quality for patients with large target motion. A step-and-shoot 3D IMRT plan is optimized on a reference phase (SPO plan) and is used as the gold standard, i.e., a plan of full-fledged direct 4D optimization. The 3D plan is transformed to the remaining breathing phases using Segment Aperture Morphing (SAM) [1], which considers both target displacement and deformation and enforces the phase-to-phase connectivity of MLC apertures. Dose distribution on each breathing phase is transferred to the reference phase via deformable image registration (DIR) to obtain the cumulative dose of the complete 4D-IMRT plan. Four patients (2 lungs and 2 pancreases) whose ranges of tumor motions are larger than 1 cm are enrolled in this study. Phase-by-phase comparison of the SAM plan to the SPO plan shows that dose received by at least 95% of the PTV volume (D95) may decrease by 4 - 8% and maximum dose in PTV may increase by 3%, when tumor displacement and deformation are largest relative to the reference phase. In the cumulated 4D plan, D95 decreases by 2 - 3% and maximum dose increases by 2%. About 1% point of D95 decrease comes from the DIR process, another 1% point due to limited resolution of finite leaf width. Relative motion of organs at risk (OARs) to PTV during breathing, which is the ultimate motivation for direct 4D optimization, contributes to the variation of dose received by these organs, since the SAM transformation is solely based on target motion/deformation. In a lung case, the volume that receives 15 Gy of cumulative dose (V15) for both lungs increased from 27% (SPO) to 29% (SAM). In a pancreas case, V20 of the liver increased from 19% to 22%, V18 of the right kidney increased from 34% to 37%, while V18 of the left kidney decreased from 38% to 30%. Improved plan quality is expected from full-fledged 4D optimization than 4D-IMRT planning using SAM algorithm for cases with larger tumor motion. Compared to SAM planning, the dosimetric gain of direct 4D-IMRT optimization, regardless of the computational burden, will be additional 2 - 3% increase in target D95 and decrease in critical organ doses." @default.
- W2157067248 created "2016-06-24" @default.
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- W2157067248 date "2011-10-01" @default.
- W2157067248 modified "2023-10-18" @default.
- W2157067248 title "Is Full-fledged Four-dimensional Optimization Needed for Deliverable IMRT Planning Using Tumor Tracking?" @default.
- W2157067248 doi "https://doi.org/10.1016/j.ijrobp.2011.06.1183" @default.
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