Independent Dose Verification for IMRT Using Monte Carlo. C-M M Charlie Ma, Ph.D. Department of Radiation Oncology FCCC, Philadelphia, PA 19111, USA

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1 Independent Dose Verification for IMRT Using Monte Carlo C-M M Charlie Ma, Ph.D. Department of Radiation Oncology FCCC, Philadelphia, PA 19111, USA

2 Outline Why Monte Carlo for IMRT QA? Experimental verification Treatment plan comparison for IMRT Monte Carlo as an independent QA tool Investigation of new radiotherapy techniques

3 Why Use Monte Carlo for Radiotherapy Treatment Planning An accuracy of about 5% in dose delivery is required to effectively treat certain types of cancers and to reduce complications. ICRU Reports 24 (1976) and 42 (1988)

4 The Accuracy Requirement for Treatment Planning Dose Calculation σ 2 =σ 2 calib +σ2 dose if + dose +σ2 setup +σ2 motion + and σ 2σdose=5% then σdose=2.5%

5 Why Accurate Dosimetry for IMRT? Limitations of dose calculation algorithms source models narrow beam geometry heterogeneous patient anatomy Limitations of beam delivery systems complex intensity distributions complex MLC geometry

6 Beamlet Dose Distributions FSPB Monte Carlo

7 NX = 1 NX = 2 NX = 3 MLC LEAVES SIDE VIEW - ROUNDED ENDS LEAF B LEAF A X Z MLC CARRIAGE FRONT VIEW - NON DIVERGENT ENDS N

8 One field intensity map comparison Sharp No T&G Fuzzy T&G T&G

9 Fluence and Dose Comparison 8% underdosage for a single field with 1 mm voxels (a) W ithout T&G W ith T&G 6% underdosage for 4 mm voxels Fluence (arbitrary unit) % underdosage averaged over 1 cm leaf width T&G causes underdosage in high dose regions Dose (Gy) e-14 3e-14 2e Z-Axis (cm) (b) W ithout T&G W ith T&G T&G causes overdosage in low dose regions Deng et al e Z-Axis (cm)

10 Comparison of IMRT dose distributions (prostate) With (thin lines) and without (thick lines) T&G effect Doses with T&G effect increased by 1.6% Deng et al 2001

11 DVH comparison between prostate plans with and without tongue-and-groove effect Lines: without T&G Line-and-symbols: with T&G By shifting doses with T&G horizontally by 1.6%, two plans matches Volume (%) Lymph Node Skin Rectum Seminal Vesicle Bladder Prostate Dose (Gy) Deng et al 2001

12 Experimental Verification

13 Film vs Monte Carlo Lee et al

14 Film vs Monte Carlo Patient plan (Corvus) Delivery in film phantom Monte Carlo dose calculation superior inferior cm from isocenter Lee et al 2001

15 Calculations vs. Measurements Energy M-C Meas CORVUS 4 MV Gy Gy Gy 15 MV Gy Gy Gy

16 Monte Carlo for IMRT QA

17 Monte Carlo for MU calculation/check high accuracy and high efficiency independent calculation Monte Carlo for patient dose verification predict patient dose using leaf sequence verify patient dose using MLC log files

18 Prostate Monte Carlo Gy Corvus

19 Prostate 100 Volume (%) MC Corvus Bladder Prostate 20 Rectum Dose (Gy) 90

20 Pencil Beam Monte Carlo Pawlicki et al 2001

21 Dose Volume Histogram (H&N) RT Optic nerve Target Volume (%) RT Eye Pencil beam Monte Carlo 20 Spinal cord Pawlicki et al Dose (cgy)

22 Mean Target Dose (BP vs MC) 15.0 Mean target dose: Pencil beam vs Monte Carlo Difference relative to Rx dose (%) thorax / abd. pelvis head and neck Patient cases Pawlicki et al 2001

23 Minimum Target Dose (BP vs MC) Difference relative to Rx dose (%) thorax / abd. Minimum target dose: Pencil beam vs Monte Carlo pelvis head and neck Patient cases Pawlicki et al 2001

24 Max. Critical Structure Dose (BP vs MC) Difference relative to Rx dose (%) Maximum critical structure dose: Pencil beam vs Monte Carlo thorax / abd. pelvis head and neck Patient cases Pawlicki et al 2001

25 MU Check for IMRT

26 Ion Chamber Point Dose Verification Percent Difference Patient Index 69% are within 2% and 97% within 4% for 2000 patients Price et al 2005

27 MU Check for Hypofractionated Breast IMRT Percentage Difference (%) Number of IMRT Plan Li et al 2004

28 Dose Verification for Non-coplanar Prostate IMRT rectum Corvus without correction Corvus(CTV) with correction Monte Carlo Non-coplanar plan comparison Volume (%) bladder target 20 Yang et al Dose (cgy)

29 Effect of Couch Bar on IMRT Dose Distribution Attenuation for 18 MV photons 40 d=3.3cm calculated d=3.3cm measured d=10cm calculated d=10cm measured Relative Dose (%) Without bar Off-axis Distance (cm) MC vs film measurement Yang et al 2005 With bar

30 Effect of Couch Bar on IMRT Dose Distribution IMRT using 18 MV photons 18MV DVH IMRT using 6 MV photons DVH Data Volume (%) bladder-no bar rectum-no bar CTV-no bar bladder-with bar rectum-with bar CTV-with bar Volume (%) bladder - no bar rectum - no bar CTV - no bar bladder - with bar rectum - with bar CTV - with bar Dose (cgy) Dose Yang et al 2005

31 Dose Reconstruction Using MLC Log Files Original map Rebuilt map Luo et al 2006 Error map showing discrepancies between planning and delivery

32 DVHs for Different Leaf Position Errors 100 (dx is the shift of the A bank leaves) Volume (%) Prostate-TP Bladder-TP Rectum-TP Prostate-dx0 Bladder-dx0 Rectum-dx0 Prostate-dx1 Bladder-dx1 Rectum-dx1 Prostate-dx2 Bladder-dx2 Rectum-dx2 20 Luo et al Dose

33 Monte Carlo for IMRT QA Is calculation-based IMRT dose check sufficient? Yes if a comprehensive QA system exists A measurement-based QA procedure is more desirable! Monte Carlo is the way to go!

34 Why your own Monte Carlo code? Ideal for comparing different treatment techniques that use their own TPS (e.g., IMRT vs SRS) Ideal as a treatment QA tool (e.g., for IMRT/MU) Ideal for investigating new treatment techniques (e.g., for MERT, Cyberknife,, laser protons) Ideal for clinical research (e.g., customized studies)

35 Comparison of MERT and IMRT Photon IMRT MERT 58 Gy 50 Gy 30 Gy 20 Gy 10 Gy 5 Gy Lee et al 2002

36 MERT ( ) and IMRT ( ) Volume [%] 50 Target Volume [%] 50 Chias mnerve (L) Nerve (R) Volume [%] 50 Brainstem Spinal cord Volume [cc] Brain Dose [Gy] Dose [Gy] Lee et al 2002

37 Combined Photon/Electron Plan 58.0Gy 56.0Gy 47.3Gy 45.0Gy 42.8Gy 40.5Gy 36.0Gy 31.5Gy 22.5Gy 13.5Gy 4.5Gy Li et al 2004

38 Mixed Beam Breast Plan Optimize IMRT based on a fixed e- field Xiong et al 2005 Optimize IMRT and the e- field weight Optimize IMRT and MERT

39 Particle Therapy

40 Laser Plasma Acceleration for Electrons and Protons Laser beam 1 mm 1 μm Laser beam Proton beam Electron beam

41 Proton Spectrum Beamlet Dose Distribution Fourkal et al 2003

42 Fourkal et al 2003 Combined Dose Distribution

43 Comparison of Isodose Distribution 7 field IMRT 7 field laser protons Fourkal et al 2003

44 Comparison of DVH Target Rectum Bladder Femur Fourkal et al 2003

45 Acknowledgments The FCCC/Stanford Monte Carlo Team Charlie Ma Bob Price Lili Chen Eugene Fourkal Jinsheng Li Shawn McNeeley Kamen Paskalev Lu Wang Yan Chen Steve Jiang Todd Pawlicki Jun Deng Bilal Shahine Ajay Kapur Michael Lee Sotirios Stathakis Jay Chen Wei Luo James Fan Teh Lin Max Jin Jie Yang Lihong Qin Meisong Ding Omar Chibani Grisel Mora Thai Bing Nguyen William Xiong Antonio Leal Freek Du Plessis

46 Thank You

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