Specifics of treatment planning for active scanning and IMPT
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1 Specifics of treatment planning for active scanning and IMPT SFUD IMPT Tony Lomax, Centre for Proton Radiotherapy, Paul Scherrer Institute, Switzerland
2 Treatment planning for scanning 1. Single Field, Uniform Dose (SFUD) 2. Intensity Modulated Proton Therapy (IMPT) 3. Dealing with uncertainties 4. Summary
3 Single Field, Uniform Dose (SFUD) Single field, uniform dose (SFUD) planning The combination of individually optimised fields, each of which deliver a (more or less) homogenous dose across the target volume SFUD is the spot scanning equivalent of treating with open fields.
4 Single Field, Uniform Dose (SFUD) Selected spots Spot definition selection Making protons useful 2. Spot scanning in practice Dose calculation Initial dose distribution Incident field Spot weight optimisation Optimised dose Dose Calculation
5 Single Field, Uniform Dose (SFUD) A SFUD plan consists of the addition of one or more individually optimised fields. F3 F4 F1 Combined distribution F2 Note, each individual field is homogenous across the target volume
6 Treatment planning for scanning 1. Single Field, Uniform Dose (SFUD) 2. Intensity Modulated Proton Therapy (IMPT) 3. Dealing with uncertainties 4. Summary
7 Intensity Modulated Proton Therapy (IMPT) Intensity Modulated Proton Therapy (IMPT) The simultaneous optimisation of all Bragg peaks from all fields (with or without additional dose constraints to neighbouring critical structures) IMPT is the spot scanning equivalent of IMRT (and field patching for passive scattering proton therapy).
8 Intensity Modulated Proton Therapy (IMPT) The simultaneous optimisation of all Bragg peaks from all incident beams. E.g.. F3 F4 F1 Combined distribution F2 Lomax 1999, PMB 44:
9 Intensity Modulated Proton Therapy (IMPT) Passive scattering The three orders of proton therapy compared Spot scanning IMPT 1 field 1 field 1 field 3 fields 3 fields 3 fields
10 Intensity Modulated Proton Therapy (IMPT) Example clinical IMPT plans delivered at PSI Skull-base chordoma 3 field IMPT plan to an 8 year old boy 4 fields 3 fields
11 Intensity Modulated Proton Therapy (IMPT) There s more than one way to optimise an IMPT plan Two, 5 field IMPT dose distributions A B 3D IMPT DET Corresponding spot weight distributions from field 2
12 Treatment planning for scanning 1. Single Field, Uniform Dose (SFUD) 2. Intensity Modulated Proton Therapy (IMPT) 3. Dealing with uncertainties 4. Summary
13 Dealing with uncertainties To PTV or not to PTV To PTV or not to PTV? that is the question Definition of a PTV is conventional way of dealing with potential delivery errors For passive scattering protons, PTV often not used with uncertainties dealt with through expansion of apertures and smoothing and shaving of compensator No collimators or compensators for scanning, therefore current method is to define PTV Is this necessarily the best approach?
14 Dealing with uncertainties To PTV or not to PTV Do we need field specific PTV s? σ range σ pos E.g. could be necessary if σ pos <> σ range..or when passing along strong density interfaces (c.f. smearing of compensators)
15 Dealing with uncertainties To PTV or not to PTV Range adapted PTV s Dirk Boye, PSI
16 Dealing with uncertainties range uncertainties. Range uncertainty for SFUD and IMPT plans SFUD IMPT Lomax AJ (2007) in Proton and charged particle Radiotherapy, Lippincott, Williams and Wilkins
17 Volume (%) Volume (%) Dealing with uncertainties range uncertainties. Range uncertainty for SFUD and IMPT plans +5% CT -5% CT CTV (SFUD) Dose (%) Nominal CT +5% CT - 5% CTV (IMPT) Dose (%) Nominal CT +5% CT -5% Lomax AJ (2007) in Proton and charged particle Radiotherapy, Lippincott, Williams and Wilkins
18 Dealing with uncertainties range uncertainties. Dealing with range uncertainties - robust IMPT planning? Lomax et al 2001, Med. Phys. 28:
19 Relative volume Dealing with uncertainties range uncertainties. Dealing with range uncertainties - robust IMPT planning? Nominal -10% CT DVH analysis Spinal cord IMPT D tol Single field Lomax et al 2001, Med. Phys. 28: Single field IMPT plan Relative dose Nominal Overshoot Nominal Overshoot
20 Uncertainties and the need for adaptation Robust IMPT planning the automated approach Field 1 Field 2 Field 3 Optimised fields using robust optimisation Total dose Unkelbach et al, PMB, 52; , 2007
21 Range (difference) Set-up 85% (error bars) Dose distribution Dealing with uncertainties displaying uncertainties. SFUD IMPT (low gradient) IMPT (high gradient) Displaying errorbars for dose distributions Max-min displays Albertini et al 2011, PMB, 56:
22 How we do it at PSI... Typical skull base treatment at PSI 1st series (0-40CGE) 3 field SFUD plan to PTV + = Full treatment 2nd series (40-74CGE) 4 field IMPT plan with constraints on brainstem, optic structures
23 Summary Although many similarities with passive scattering, there are some significant differences and issues for planning active scanned proton and IMPT plans Is the conventional PTV criteria still valid? Are field specific PTV s required? Do we need probabalistic planning? Active scanned plans (fields) have a large degeneracy many distributions of pencil beam intensities give very similar dose distributions In general, SFUD plans are more sensitive to errors than conventional photon plans and IMPT plans more sensitive than SFUD plans Don t abandon simple planning techniques (e.g. SFUD)!
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