Contemporary IMRT: Developing Physics and Clinical Implementation

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ISBN: 9780750310048 | 0750310049
Cover: Hardcover
Copyright: 10/1/2004

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- Steve Webb- Follows from his 2000 title Intensity-Modulated Radiation Therapy - a Follow up NOT a replacement- Looks at modern applications- Other IMRT books are usually edited collections - this is singly authored, by one of the leaders in radiotherapy applications.- Work at one of the top 3 European cancer research centres.

Preface and acknowledgments

1 Intensity-modulated radiation therapy (IMRT): General statements and points of debate

(17)

1.1 Observations on IMRT at the current time

(9)

1.2 Criticism of the philosophy of IMRT

(8)

2 Developments in rotation IMRT and tomotherapy

(21)

2.1 NOMOS MIMiC tomotherapy

(8)

2.1.1 Technology history

(3)

2.1.2 Matchline concerns and solutions

(2)

2.1.3 Energy considerations

(1)

2.1.4 Concerns about increased treatment time

(1)

2.1.5 Machine features

(1)

2.2 University of Wisconsin machine for tomotherapy

(9)

2.2.1 Development history

(2)

2.2.2 Generation and use of megavoltage computed tomography (MVCT) images

(5)

2.2.3 Clinical application

(1)

2.2.4 Commissioning issues

(1)

2.2.5 Verification of MIMIC and University of Wisconsin tomotherapy

(1)

2.3 Tomotherapy using a 60Co source

(2)

2.4 Tomotherapy with an MLC

(1)

2.5 Summary

(1)

3 Developments in IMRT using a multileaf collimator (MLC) (physics)

(122)

3.1 New sequencers/interpreters

(20)

3.1.1 General; dynamic IMRT sequencers with hard MLC constraints on leaves and jaws

(1)

3.1.2 Sequencing multiple-static MLC fields-clusters

(3)

3.1.3 Non-uniform spatial and fluence steps

(1)

3.1.4 Minimizing the number of segments

(2)

3.1.5 IMFAST

(1)

3.1.6 The best interpreter ever?

(3)

3.1.7 Sequencers exploiting MLC rotation

(2)

3.1.8 Comparison of dynamic MLC (dMLC) and multiple static field (MSF) techniques

(3)

3.1.9 Varian MLC and HELIOS planning system

(1)

3.1.10 Developments in Elekta IMRT

(1)

3.1.11 Other interpreters

(3)

3.1.12 The effect of removing the flattening filter

(1)

3.2 Radiation leakage and accounting for machine effects in IMRT delivery

(8)

3.2.1 General leakage issues

(2)

3.2.2 Factoring in delivery physics

(1)

3.2.2.1 Measurement and prediction of leakage and scatter

(2)

3.2.2.2 Using leakage and scatter knowledge in the MSF-MLC technique

(3)

3.2.3 The effect of rounded leaf ends: light-field to radiation-field discrepancy in IMRT

(1)

3.3 Dose calculation for IMRT

(3)

3.3.1 Application of colour theory

(1)

3.3.2 Penumbra sharpening for IMRT

(1)

3.3.3 MU verification

(1)

3.4 Features of MLC delivery of IMRT

(7)

3.4.1 Large-field IMRT-splitting the delivery

(1)

3.4.2 Tongue-and-groove effect

(3)

3.4.3 Leaf-speed limitations

(1)

3.4.4 Stability of accelerator and delivery of a small number of MUs and small fieldsizes

(3)

3.5 Dynamic arc therapy

(2)

3.6 Combining step-and-shoot and dynamic delivery for dMLC

(3)

3.7 IMAT-technical issues

(6)

3.7.1 IMAT in clinical use

(2)

3.7.2 IMAT modified to aperture-modulated-arc therapy (AMAT)

(1)

3.8 New ideas related to the dMLC technique

(1)

3.9 Compensators and comparisons of compensator and MLC-based IMRT

(81)

3.9.1 Do we need the MLC for IMRT?

(1)

3.9.2 Use of compensators for IMRT

(8)

3.9.3 Comparison of compensator and MLC-based IMRT

105

(1)

3.10 Optimum width of leaves for an MLC

106

(1)

3.11 MicroMLCs for IMRT

107

(9)

3.11.1 Siemens (virtual) microMLC

107

(1)

3.11.2 Varian (virtual) MLC

108

(1)

3.11.3 Elekta (virtual) microMLC and microMLC

108

(1)

3.11.4 Radionics microMLC

109

(1)

3.11.5 BrainLAB microMLC

110

(1)

3.11.6 DKFZ-originating microMLCs

111

(1)

3.11.6.1 The MRC systems GMBH/Siemens 'Moduleaf'

111

(1)

3.11.6.2 New DKFZ microMLC

112

(1)

3.11.7 3DLine microMLC

112

(1)

3.11.8 Comparison and use of microMLCs

112

(3)

3.11.9 Multi-level MLC

115

(1)

3.12 Increasing the spatial resolution of a conventional MLC

116

(4)

3.13 Verification of MLC-delivered IMRT

120

(32)

3.13.1 Electronic-portal-imager-based IMRT verification

120

(4)

3.13.2 Other EPID designs

124

(1)

3.13.3 Technical aspects of EPID imaging for IMRT

124

(1)

3.13.4 Extraction of anatomical images from portal images generated during IMRT

125

(1)

3.13.5 Blocking-tray-level measurement

126

(1)

3.13.6 The two-level MLC

127

(2)

3.13.7 Water-beam-imaging system (WBIS)

129

(2)

3.13.8 Integrated portal fluence and portal dosimetry

131

(1)

3.13.9 IMRT verification phantom measurements

132

(6)

3.13.10 Verification by software techniques

138

(3)

3.13.11 Comparison of delivered modulated fluence profile with plan-predicted modulated profile

141

(2)

3.13.12 Verification of canine and human IMRT using in-vivo dosimetry

143

(1)

3.13.13 Polyacrylamide gel (PAG) dosimetry for IMRT verification

144

(1)

3.13.13.1 Review

144

(1)

3.13.13.2 PAG readout techniques

145

(2)

3.13.13.3 Use of PAGs for IMRT verification

147

(3)

3.13.13.4 New PAGs

150

(1)

3.13.14 Film as an IMRT dosimeter

150

(2)

3.14 Quality assurance (QA) of MLC delivery

152

(7)

3.14.1 Average leaf-pair opening (ALPO)

152

(1)

3.14.2 Routine QA of MLC leaf movement

153

(5)

3.14.3 Modelling the effects of MLC error

158

(1)

3.15 Summary

159

(2)

4 Developments in IMRT not using an MI,C

161

(18)

4.1 The Cyberknife

161

(7)

4.2 The design of the shuttling MLC (SMLC)

168

(1)

4.3 IMRT with the 'jaws-plus-mask' technique

169

(5)

4.4 The variable aperture collimator (VAC)

174

(2)

4.5 One-dimensional IMRT

176

(1)

4.6 Summary

177

(2)

5 Clinical IMRT-evidence-based medicine?

179

(51)

5.1 IMRT of the prostate showing measurable clinical benefit

183

(4)

5.2 Comparison of treatment techniques for the prostate

187

(5)

5.3 Royal Marsden NHS Foundation Trust pelvic and other IMRT

192

(5)

5.4 Comparison of IMRT with conformal radiotherapy (CFRT) for complex shaped tumours

197

(2)

5.5 IMRT for whole-pelvic and gynaecological radiotherapy

199

(2)

5.6 Head-and-neck IMRT

201

(10)

5.6.1 Thyroid IMRT

202

(1)

5.6.2 Nasopharynx IMRT

203

(1)

5.6.3 Oropharynx IMRT

204

(1)

5.6.4 Oropharynx and nasopharynx IMRT

205

(1)

5.6.5 Larynx IMRT

205

(1)

5.6.6 Evidence for parotid sparing

206

(3)

5.6.7 Meningioma IMRT

209

(1)

5.6.8 Paediatric medulloblastoma IMRT

210

(1)

5.6.9 Ethmoid cancer IMRT

210

(1)

5.6.10 Other studies reported

210

(1)

5.7 Breast IMRT

211

(11)

5.7.1 Breast IMRT at William Beaumont Hospital

211

(3)

5.7.2 Other reports of techniques using small top-up fields

214

(2)

5.7.3 EPID-based techniques for breast IMRT

216

(2)

5.7.4 Modified wedge technique

218

(1)

5.7.5 Breast IMRT in combination with use of respiration gating

218

(1)

5.7.6 Comparison of IMRT delivery techniques for the breast

218

(2)

5.7.7 Reduced complications observed following breast IMRT

220

(2)

5.7.8 Combination of IMRT with charged-particle irradiation

222

(1)

5.8 Bladder IMRT at the Christie Hospital

222

(2)

5.9 Lung cancer IMRT

224

(1)

5.10 Scalp IMRT

225

(2)

5.11 Other clinical IMRT reports-various tumour sites

227

(1)

5.12 Summary

228

(2)

6 3D planning for CFRT and IMRT: Developments in imaging for planning and for assisting therapy

230

(149)

6.1 Challenges to IMRT and inverse planning

230

(1)

6.2 Determination of the GTV, CTV and PTV; the influence of 3D medical imaging

231

(19)

6.2.1 General comments on inhomogeneous dose to the PTV and image-guided planning

231

(1)

6.2.2 Interobserver variability in target-volume definition

231

(1)

6.2.3 Margin definition

232

(2)

6.2.4 Use of magnetic resonance for treatment planning

234

(1)

6.2.4.1 Distortion correction

234

(2)

6.2.4.2 Use of contrast agents

236

(1)

6.2.4.3 Planning based on MR images alone

237

(1)

6.2.4.4 Coregistered CT and MR planning

237

(3)

6.2.4.5 Increased protection of structures

240

(1)

6.2.4.6 Monitoring the response to radiotherapy via MRI

241

(1)

6.2.5 Use of functional information from SPECT and PET for treatment planning

242

(1)

6.2.5.1 Generalities and prostate imaging

242

(2)

6.2.5.2 Head-and-neck imaging

244

(2)

6.2.5.3 Lung imaging

246

(1)

6.2.5.4 Para-aortic lymph node (PALN) imaging

247

(1)

6.2.5.5 Combined PET-CT scanning

248

(1)

6.2.5.6 Imaging to overcome breathing-motion effects

248

(2)

6.2.6 Use of pathology specimens to compare with GTV and PTV

250

(1)

6.3 New inverse-planning methods for IMRT

250

(28)

6.3.1 Gradient-descent inverse planning

251

(1)

6.3.2 Simulated annealing inverse planning

251

(1)

6.3.3 Equivalent-uniform-dose-based inverse planning

251

(1)

6.3.4 Maximum entropy inverse planning

252

(1)

6.3.5 Genetic algorithms

253

(1)

6.3.6 Single-step inverse planning

254

(1)

6.3.7 Simulated particle dynamics

255

(2)

6.3.8 Optimization of surrogate parameters in beam space

257

(2)

6.3.9 Comparison of inverse-planning techniques

259

(2)

6.3.10 Features and comparison of commercial planning algorithms

261

(1)

6.3.11 Dependences of IMRT plans on target geometry

262

(1)

6.3.12 Multiple local minima and the global minimum in optimization

263

(3)

6.3.13 Sampling the dose matrix for IMRT optimization speed-up

266

(3)

6.3.14 Creating a uniform PTV dose in IMRT; cost tuning

269

(1)

6.3.15 Importance factors

269

(2)

6.3.15.1 Voxel-dependent IFs

271

(2)

6.3.16 Biological and physical optimization

273

(2)

6.3.17 Pareto optimal IMRT

275

(1)

6.3.18 Combined CFRT and IMRT

275

(1)

6.3.19 Split modulation

276

(2)

6.3.20 Summary on inverse-planning techniques

278

(1)

6.4 New forward-planning methods for IMRT; direct aperture optimization

278

(10)

6.4.1 Segmental inverse planning at Thomas Jefferson University (TJU)

279

(1)

6.4.2 Aperture-based planning at the University of Ghent

280

(4)

6.4.3 Direct aperture optimization (DAO) at the University of Maryland

284

(2)

6.4.4 DAO wobbling the MLC leaf positions

286

(1)

6.4.5 Other forward-planning studies

286

(1)

6.4.6 Summary on aperture-based IMRT

287

(1)

6.5 Smoothing IMBs

288

(7)

6.5.1 Smoothing techniques from the Royal Marsden NHS Foundation Trust

288

(1)

6.5.2 Smoothing techniques from the University of Virginia

288

(2)

6.5.3 Smoothing technique from the Memorial Sloan Kettering Cancer Institute

290

(1)

6.5.4 Smoothing technique from the University of Tubingen

290

(2)

6.5.5 Smoothing technique in the Nucletron PLATO TPS

292

(1)

6.5.6 Smoothing technique at the Thomas Jefferson University

292

(1)

6.5.7 Smoothing techniques at University of Maryland

292

(1)

6.5.8 Smoothing techniques at University of California, San Francisco

293

(1)

6.5.9 Smoothing techniques at Sichuan University, China

293

(1)

6.5.10 Summary on smoothing

294

(1)

6.6 Incorporating MLC equipment constraints in inverse planning

295

(1)

6.7 Beam direction optimization

296

(9)

6.8 Monte Carlo dose calculation

305

(12)

6.8.1 The debate over the usefulness of Monte Carlo dose-calculation techniques

305

(2)

6.8.2 Determination of photon spectrum and phase space data for Monte Carlo calculations

307

(1)

6.8.3 Comparison of Monte Carlo and pencil-beam calculations

307

(3)

6.8.4 MCDOSE

310

(2)

6.8.5 Speeding up Monte Carlo dose calculations

312

(1)

6.8.6 Monte Carlo calculation accuracy and error

313

(1)

6.8.7 Application to the dMLC technique

313

(2)

6.8.8 Monte Carlo calculations in tomotherapy

315

(1)

6.8.9 Monte Carlo calculations of IMAT

315

(1)

6.8.10 Other reports on Monte Carlo dosimetry

316

(1)

6.9 Energy in IMRT

317

(2)

6.10 Measuring and accounting for patient/tumour movement

319

(49)

6.10.1 General review

319

(1)

6.10.2 Some observations of the effects of movement

320

(1)

6.10.3 Optical imaging for movement correction

321

(1)

6.10.3.1 Breast movement

323

(1)

6.10.4 X-ray imaging of position

323

(1)

6.10.4.1 Intrafraction and interfraction prostate movement measurements

323

(1)

6.10.4.2 Intrafraction and interfraction lung movement measurements

327

(2)

6.10.5 Ultrasound measurement of position

329

(1)

6.10.5.1 The NOMOS BAT

331

(1)

6.10.5.2 Other ultrasound systems developed

335

(2)

6.10.6 Magnetic monitoring of position

337

(1)

6.10.7 Gating

337

(1)

6.10.7.1 Gating based on optical measurements of surface markers

337

(1)

6.10.7.2 Gating based on x-ray fluoroscopic measurements

339

(1)

6.10.7.3 Imaging and therapy gated by respiration monitor

341

(1)

6.10.7.4 Measurements using oscillating phantoms

343

(1)

6.10.7.5 Evidence against the need for gating

345

(1)

6.10.8 Robotic feedback

346

(1)

6.10.9 Held-breath self-gating

347

(1)

6.10.10 Intervention for immobilization

348

(1)

6.10.11 Active breathing control

348

(3)

6.10.12 Calculating the effect of tissue movement

351

(1)

6.10.12.1 Incorporating movement knowledge into the inverse planning itself

351

(1)

6.10.12.2 Use of multiple CT datasets and adaptive IMRT

352

(7)

6.10.12.3 Modelling the effect of intrafraction movement

359

(8)

6.10.12.4 Modelling set-up inaccuracy

367

(1)

6.10.12.5 Modelling the movement of OARs

368

(1)

6.11 Megavoltage CT (MVCT) and kilovoltage CT (kVCT) for position verification

368

(6)

6.11.1 MVCT

368

(4)

6.11.2 Flat-panel imaging for kVCT

372

(2)

6.12 MRI and IMRT simultaneously

374

(2)

6.13 IMRT using mixed photons and electrons

376

(3)

Epilogue

379

(3)

References

382

(82)

Index

464

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Contemporary IMRT: Developing Physics and Clinical Implementation

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