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Imrt Introduction and Workflow

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84 views

Imrt Introduction and Workflow

Uploaded by

fazli.samar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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IMRT INTRODUCTION AND WORKFLOW

Definitions
Clinical Workflow

VARIAN Physics Teachers EMEA September 2012


ONCOLOGY
SYSTEMS
1 | VARIAN ONCOLOGY SYSTEMS
Intensity Modulated Radiation Therapy - IMRT

• IMRT: ability to modulate radiation intensity within one treatment


field

2 | VARIAN ONCOLOGY SYSTEMS


Dynamic mode of MLC (dMLC)

• Used for delivery of IMRT fields


• Multileaf collimator is capable of changing the
shape while the machine is in “beam on” state
• ‘Step and shoot’ and ‘sliding window’ use this
mode

3 | VARIAN ONCOLOGY SYSTEMS


Electronic Compensation – Forward IMRT

• Replacement of physical compensator by


means of dynamic MLC delivery
• Eclipse offers 3 types of electronic
compensation:
• Electronic Compensator (planar)
• Field in Field Compensator – Forward
IMRT
• Irregular Surface Compensator

4 | VARIAN ONCOLOGY SYSTEMS


Inverse treatment planning planning

Basic idea

conventional IMRT

5 | VARIAN ONCOLOGY SYSTEMS


Inverse treatment planning

• Treatment planning process


• Clinical objectives specified mathematically
• Planning system able to change beam
parameters to satisfy defined clinical
objectives

• EIP – Eclipse Inverse Planning

6 | VARIAN ONCOLOGY SYSTEMS


Intensity Modulated Radiation Therapy - IMRT
Beamlet
• IMRT - ability to deliver
many beamlets of varying
radiation intensity within
one treatment field

7 | VARIAN ONCOLOGY SYSTEMS


Multiple Static Segment (MSS) Delivery

• An IMRT delivery method in which the


modulated beam is delivered in a sequence of
static MLC positions
• “Step and Shoot”

8 | VARIAN ONCOLOGY SYSTEMS


Sliding Window Delivery

• An IMRT delivery method in which the shape of


MLC is changed while the beam is delivered

9 | VARIAN ONCOLOGY SYSTEMS


Leaf Sequencing File

• Synonyms:
• Leaf Motion Pattern
• Leaf Sequencing Pattern
• Segmented Treatment Table file (STT)
• File describing the movement during the
dynamic MLC beam delivery
• ASCII file containing information about the
leaf position versus MU

10 | VARIAN ONCOLOGY SYSTEMS


Conformal Planning Workflow

Patient Contouring Field Setup


Preparation

Treatment Plan Dose


Evaluation Calculation

11 | VARIAN ONCOLOGY SYSTEMS


IMRT Planning Workflow

Patient Contouring: Field Setup Optimisation


Preparation with changes -or- & Leaf
for IMRT Beam Angle Motion
plans Optimisation Calculation

Treatment Plan Plan Dose


Verification Evaluation Calculation

12 | VARIAN ONCOLOGY SYSTEMS


New Considerations in Contouring

13 | VARIAN ONCOLOGY SYSTEMS


Contouring tools

 Boolean Operators
 Crop Structure
 Wall tool

14 | VARIAN ONCOLOGY SYSTEMS


Contouring – Organ motion
• Inter and Intra-fraction motion
• Addressed by margins for conventional treatment
• Important for IMRT as there may be interplay between
anatomy and MLC motion
Dose

Planned
Delivered
dose

Position

15 | VARIAN ONCOLOGY SYSTEMS


Interplay Between Anatomy and MLC Leaves

• Moving target leads to differences between planned


and delivered dose distribution
Dose

Planned dose
Delivered dose

Position

16 | VARIAN ONCOLOGY SYSTEMS


Inverse Planning Overview

• Static gantry inverse planning


• Beam Angle Optimization
• Based on dose volume objectives
• Fluence optimization
• Optimization of a field fluence
• Optimization of field weights
• Based on dose volume objectives
• Real time update of DVH, objective function and
fluence matrices
• Optimization on top of the base plan

17 | VARIAN ONCOLOGY SYSTEMS


Beam Angle Optimization (BAO) - optional

• Process to optimize the beam gantry angles


that uses Plan Geometry Optimization (PGO)
algorithm

18 | VARIAN ONCOLOGY SYSTEMS


Dose Volume Optimizer (DVO)
• Algorithm used in Eclipse Inverse Planning Module to
optimize fluences for static gantry IMRT
• Determines the
optimal fluence

19 | VARIAN ONCOLOGY SYSTEMS


Optimal Fluence

• Result of the mathematical optimization


• Independent of the delivery method

20 | VARIAN ONCOLOGY SYSTEMS


Manual Modification of Fluence

• Fluence Editor
• Edit optimal fluence
• Skin flash tool
• Create test fluence

21 | VARIAN ONCOLOGY SYSTEMS


Leaf Motion Calculator (LMC)

• Software module that converts the optimal


fluence into Actual Fluence
• Leaf Sequencing File (STT file) deliverable on
treatment unit by MLC device
• Takes into account DMLC characteristics
• Supports Sliding Window and MSS for Varian
• Supports MSS for third party linac
• Calculates MU (internally only)

22 | VARIAN ONCOLOGY SYSTEMS


Actual Fluence

• Derived from the optimal fluence by Leaf


Motion Calculator
• Depends on the delivery technique
• Accounts for physical, mechanical and dosimetric
characteristics of MLC

actual fluence - sliding window actual fluence - step&shoot

23 | VARIAN ONCOLOGY SYSTEMS


Verification Plans

• Verification plan support


• Transfer of IMRT plan to a phantom in Eclipse
• Dose distribution calculated inside a selected
phantom
• Transfer to verification system
• Dose from verification plan is not cumulated to the
patient reference points
• Verification plan and Portal Dosimetry

24 | VARIAN ONCOLOGY SYSTEMS


Protocols and Templates

 Efficient planning using

 Clinical Protocols and


 Load
 Templates
 Create
 Structure
 Import
 Plan
 Export
 Library of optimization objectives

25 | VARIAN ONCOLOGY SYSTEMS


Thank you for your interest
and attention
Questions?

26 | VARIAN ONCOLOGY SYSTEMS


Disclaimer
Notice

• This information is an educational aid only and is intended solely as a


supplemental document. This provides information concerning the use of the
Eclipse Treatment Planning System. For complete information concerning
components, safety instructions, installation, maintenance, troubleshooting,
etc., refer to the applicable Varian product Operator’s Manual. This
information does not replace the Varian Operator’s Manual.
• Carefully read all instructions prior to use. Observe all contraindications,
warnings and precautions noted in these instructions. Failure to do so may
result in patient and/or user complications.
• This information is subject to change without notice and does not represent a
commitment on the part of Varian. Varian is not liable for errors contained in
this information or for incidental or consequential damages in connection with
furnishing or use of this material. This contains proprietary information
protected by copyright. No part of this may be reproduced, translated, or
transmitted without the express written permission of Varian Medical Systems,
Inc.

27 | VARIAN ONCOLOGY SYSTEMS

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