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RPD Group3 Draft2

This study aims to determine if adjusting the Hounsfield unit value for bowel gas in the planning target volume can decrease hotspots and improve plan robustness for pancreatic radiotherapy by decreasing dose received by organs at risk and target hotspots on daily verification scans when using the Acuros XB dose calculation algorithm.

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38 views3 pages

RPD Group3 Draft2

This study aims to determine if adjusting the Hounsfield unit value for bowel gas in the planning target volume can decrease hotspots and improve plan robustness for pancreatic radiotherapy by decreasing dose received by organs at risk and target hotspots on daily verification scans when using the Acuros XB dose calculation algorithm.

Uploaded by

braith7811
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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1

Working Title:
Investigation of overriding the HU of bowel gas in the PTV to create a more robust treatment
plan for pancreatic radiotherapy.

Problem Statement:
The problem is that when creating an Acuros XB plan with air in the treatment volume, the
optimizer overcompensates fluence through the air cavity leading to target and OAR dose
changes with anatomic variations.

Purpose Statement:
The purpose of this study is to determine if adjusting the HU value for bowel gas in the PTV will
decrease hotspots and improve plan robustness for pancreatic radiotherapy.

Hypothesis Statements or Research Questions:


H1A: The first research hypothesis (H1) is that after adjusting the HU value for bowel gas to zero
in the PTV, maximum dose received by OAR will decrease by ≥ 5% on the daily verification
scans.
H10: The first null hypothesis (H10) is that after adjusting the HU value for bowel gas to zero in
the PTV, maximum dose received by OAR will not decrease by ≥ 5% on the daily verification
scans.
H2A: The second research hypothesis (H2) is that after adjusting the HU value for bowel gas to
zero in the PTV, the hotspot in the PTV will decrease by ≥ 2% on the daily verification scan.
H20: The second null hypothesis (H20) is that after adjusting the HU value for bowel gas to zero
in the PTV, the hotspot in the PTV will not decrease by ≥ 2% on the daily verification scan.
H3A: The third research hypothesis (H3) is that after adjusting the HU value for bowel gas to
zero in the PTV, the V105% in the PTV will decrease on the verification scan.
H30: The third null hypothesis (H30) is that after adjusting the HU value for bowel gas to zero in
the PTV, the V105% in the PTV will not decrease on the verification scan.

Summary
2

Dose calculation algorithms are pivotal in ensuring the efficacy and safety of treatment
plans in radiotherapy. The emergence of advanced algorithms like Acuros XB (AXB) has
significantly improved the accuracy of plans and dose reporting, especially in regions with tissue
inhomogeneities compared to more widespread methods like the Anisotropic Analytical
Algorithm (AAA), Collapsed Cone Convulution (CCC), or Monte Carlo (MC).1
Studies have shown that AXB more accurately demonstrates the air/tissue interface
compared to AAA, particularly when representing the lack of backscatter dose upon entering air
at the interface.2 However, transitioning from AAA to AXB presents challenges, notably
observed when the Treatment Planning System (TPS) optimizer strives to distribute adequate
dose to air structures within the Planning Target Volume (PTV).3
In clinical practice, issues persist with reproducing air in the bowel during treatment
planning, as demonstrated by significant dose variations (up to 28%) in small bowel doses
among rectal cancer patients during weekly CT scans.4 These challenges underscore the need for
ongoing adaption and improvement in our processes to optimize treatment plans for patient care.
This is especially true for pancreatic patients, where the location of bowel gas near the PTV can
change daily, thereby potentially changing the dose distribution in the region.
The problem is that when creating an Acuros XB plan with air in the treatment volume,
the optimizer overcompensates fluence through the air cavity leading to target and OAR dose
changes with anatomic variations. The purpose of this study is to determine if adjusting the HU
value for bowel gas in the PTV will decrease hotspots and improve plan robustness for
pancreatic radiotherapy. As dose calculation algorithms continue to change and improve, we
need to continue to adapt our processes and produce the optimal plans that adequately treat the
tumor volume while sparing the healthy surrounding tissues.

References
3

1. Bush K, Gagne IM, Zavgorodni S, Ansbacher W, Beckham W. Dosimetric validation of Acuros


XB with Monte Carlo methods for photon dose calculations. Med Phys. 2011; 38(4):2208-2221.
https://doi.org/10.1118/1.3567146
2. Bassi S, Tyner E. 6x Acuros algorithm validation in the presence of inhomogeneities for VMAT
treatment planning. Rep Pract Oncol Radiother. 2020; 25(4):539-547.
https://doi.org/10.1016/j.rpor.2020.03.018
3. Ito T, Monzen H, Kubo K, et al. Dose difference between anisotropic analytical algorithm (AAA)
and Acuros XB (AXB) caused by target’s air content for volumetric modulated arc therapy of
head and neck cancer. Rep Pract Oncol Radiother. 2023; 28(3):399-406.
https://doi.org/10.5603/RPOR.a2023.0032
4. Li S, Gong Y, Yang Y, Guo Q, Jianjun Q, Tian Y. Evaluation of small bowel motion and
feasibility of using the peritoneal space to replace bowel loops for dose constraints during
intensity-modulated radiotherapy for rectal cancer. Radiat Oncol. 2020; 15(211).
https://doi.org/10.1186/s13014-020-01650-z

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