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Choreographing couch, collimator

d t ti i VMAT di ti and gantry motion in VMAT radiation


delivery y
Collaboration of the following people at MSKCC:
Laura Happersett Laura Happersett
Pengpeng Zhang
Yingli Yang
Gig Mageras
Margie Hunt
Jianping Xiong p g g
Jie Yang
Maria Chan
Kathryn Beal Kathryn Beal
Josh Yamada
Chronological order
1
st
project was collimator trajectory
Chronological order
1
st
project was collimator trajectory
in VMAT for paraspinal SBRT
2
nd
project was Choreographing couch,
gantry and collimator motion in gantry and collimator motion in
VMAT
Collimator trajectory in VMAT for paraspinal SBRT
Motivation
Improve dosimetric quality
o Increase target coverage
o Preserve better critical organ sparing
Explore additional mechanical freedom
IJROBP. 2010; 77(2):591-9.
Collimator trajectory in VMAT for paraspinal SBRT
Optimize collimator trajectory based on
target/organs at risk geometries target/organs at risk geometries
Synchronize collimator rotation with MLC y
motion, gantry rotation, and dose rate
modulation
Development and evaluation in paraspinal
SBRT SBRT
Collimator trajectory in VMAT for paraspinal SBRT
Why collimator matters? y
Determine collimator trajectory via
Collimator trajectory in VMAT for paraspinal SBRT
principle component analysis
Optimized Collimator trajectory
Collimator trajectory in VMAT for paraspinal SBRT
Optimized Collimator trajectory
Collimator trajectory in VMAT for paraspinal SBRT
Paraspinal SBRT study
1.Retrospective study following
MSKCC paraspinal SBRT protocol
2.Prescription dose: 24Gy to tumor,
cord maximum dose <14Gy
3.Coll-VMAT vs VMAT vs IMRT
Dose distribution comparison
Collimator trajectory in VMAT for paraspinal SBRT
Dose distribution comparison
All protocol constraints are met with all three plans
Dosimetry Results:
Collimator trajectory in VMAT for paraspinal SBRT
y
Coll-VMAT vs VMAT vs IMRT
Efficiency: Coll-VMAT vs VMAT
Collimator trajectory in VMAT for paraspinal SBRT
Efficiency: Coll VMAT vs VMAT
Again, Why collimator angle
tt matters
R d d MU ith VMAT
Collimator trajectory in VMAT for paraspinal SBRT
Reduced MU with VMAT
Technique Average MUs
Coll VMAT 5164
VMAT 4868
IMRT 13283
S
Collimator trajectory in VMAT for paraspinal SBRT
Summary
Coll-vmat provides an additional degree
of freedom
Dosimetric quality of VMAT plans is as
good or better as fixed gantry IMRT for
paraspinal SBRT
Cord dose lower with Coll VMAT than Cord dose lower with Coll VMAT than
IMRT
VMAT reduces beam on time by 60% VMAT reduces beam on time by 60%
Choreographing couch,
gantry and collimator
motion in VMAT motion in VMAT
We developed a software to facilitate the selection and We developed a software to facilitate the selection and
optimization of non-coplanar VMAT arcs
W l t d th t h i i th t t t f CNS We evaluated the technique in the treatment of CNS
tumors
IJROBP. 2011; 80(4):1238-47
Selecting couch/gantry trajectory
based on target/OAR geometries based on target/OAR geometries
Geometric Optimization
PTV Eye
Geometric Optimization
based on PTV/OAR area
overlap
Brainstem
Cord
( )
( ) ( )

|
|
|

|
+
i i
g c L g c L
w g c
, ,
Score Overlap ( )
( )
( )
( )
( )

|
|
.

\
+ =
i
OARi
i
PTVi
i
i
g c A
g
g c A
g
w g c
, ,
, 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

34.1% 65.9 34.1%


mean
Optical nerve D
max
57.1

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

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