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Score Overlap ( )
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OARi
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PTVi
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g c A
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, Score Overlap
Target/OAR Overlap Map
CA=-
60;
GA=-60
CA=45;
GA=100
for particular patient
CA=0;
GA=-150
CA=85;
GA=60
Optimization of Couch/gantry Trajectory
To create an arc the algorithm searches the gantry couch overlap map to find To create an arc, the algorithm searches the gantry couch overlap map to find
those with minimum overlap score.
Algorithm must remove combos in the forbidden zone collisions areas
Link and extend small arcs to create longer arcs Link and extend small arcs to create longer arcs
Smooth arcs to accommodate mechanical constraints and limitations
Adding optimized Collimator Trajectories
137
o
80
o
Non-coplanar VMAT Delivery Using
TrueBeam in the Developer mode TrueBeam in the Developer mode
CNS Radiotherapy Planning & Comparison
Ten CNS cases, fourteen tumors, three with dose painting,
Rx: 25Gy/5fx 60Gy/30fx Rx: 25Gy/5fx 60Gy/30fx
Treatment techniques
IMRT: 4-6 non-coplanar beams
VMAT: 1-4 arc pairs (orthogonal collimator trajectories)
Std-VMAT: static couch and collimator
Tra-VMAT: dynamic couch and collimator y
Evaluate:
t t target coverage
maximum/mean dose to OARs.
Plan Evaluation
Tra Vmat
St d d VMAT Standard VMAT
IMRT IMRT
Tra Tra--VMAT vs VMAT vs IMRT vs Std IMRT vs Std--VMAT VMAT
Tra-VMAT Std-VMAT IMRT
PTV D
min
94.1
16.4% 93.1
17% 87.9
18.1%
B i t D 55 6 26 7% 57 9 25 7% 63 3 23 3% Brainstem D
mean
55.6
26.7% 57.9
25.7% 63.3
23.3%
Chiasm D
max
76.9
35.8% 78.5
36% 78.2
35.9%
Chiasm D
mean
61.6 34.1% 64.2
33.3% 59.4
32.3% 63.4
30.6%
Cochlea D
max
50.9
39.7% 52.3
38.9% 59.3
33.7%
Cochlea D 38 7
32 9% 40 6
32 2% 47 3
29 2% Cochlea D
mean
38.7
32.9% 40.6
32.2% 47.3
29.2%
MU 614
419 622
446 1262
783
B i V30%(
3
) 528 166 636 205 500 164 Brain V30%(
cm
3
) 528
166 636
205 500
164
Brain V70%(
cm
3
) 173
71 200
91 163
72
(medianSTD)
Summary Summary
Tra-VMAT vs IMRT
Higher PTV minimum dose, lower dose to brainstem,
chiasm, optical nerve, and cochlea
improved treatment efficiency (by 50%)
Tra-VMAT vs Std-VMAT
Better target conformality (ie lower brain dose)
Lower dose to brainstem, chiasm, and optical nerve
Superior mechanical flexibility of TrueBeam transforms to
better plan quality
Future endeavors at our intuition
1) Jaw tracking change jaws per control point
A) To reduce leakage between parked leaves in VMAT
delivery.
B) To reduce the need to split IMRT beams
2) Target motion tracking
A) Collimator trajectory to aid MLC target tracking.
B) Couch movement to track target motion B) Couch movement to track target motion