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Liao, L

Publications and source records attributed to Liao, L.

SU-E-T-07: 4DCT Robust Optimization for Esophageal Cancer Using Intensity Modulated Proton Therapy

Purpose: To develop a 4DCT robust optimization method to reduce the dosimetric impact from respiratory motion in intensity modulated proton therapy (IMPT) for esophageal cancer. Methods: Four esophageal cancer patients were selected for this study. The different phases of CT from a set of 4DCT were incorporated into the worst-case dose distribution robust optimization algorithm. 4DCT robust treatment plans were designed and compared with the conventional non-robust plans. Result doses were calculated on the average and maximum inhale/exhale phases of 4DCT. Dose volume histogram (DVH) band graphic and ΔD95%, ΔD98%, ΔD5%, ΔD2% of CTV between different phases were used to evaluate the robustness of the plans. Results: Compare to the IMPT plans optimized using conventional methods, the 4DCT robust IMPT plans can achieve the same quality in nominal cases, while yield a better robustness to breathing motion. The mean ΔD95%, ΔD98%, ΔD5% and ΔD2% of CTV are 6%, 3.2%, 0.9% and 1% for the robustly optimized plans vs. 16.2%, 11.8%, 1.6% and 3.3% from the conventional non-robust plans. Conclusion: A 4DCT robust optimization method was proposed for esophageal cancer using IMPT. We demonstrate that the 4DCT robust optimization can mitigate the dose deviation caused by the diaphragm motion.

60 APPLIED LIFE SCIENCES↗

SU-E-T-43: A Methodology for Quality Control of IMPT Treatment Plan Based On VMAT Plan

Purpose: IMPT plan design is highly dependent on planner’s experiences. VMAT plan design is relatively mature and can even be automated. The quality of IMPT plan designed by in-experienced planner could be inferior to that of VMAT plan designed by experienced planner or automatic planning software. Here we introduce a method for designing IMPT plan based on VMAT plan to ensure the IMPT plan be superior to IMRT/VMAT plan for majority clinical scenario. Methods: To design a new IMPT plan, a VMAT plan is first generated either by experienced planner or by in-house developed automatic planning system. An in-house developed tool is used to generate the dose volume constrains for the IMPT plan as plan template to Eclipse TPS. The beam angles for IMPT plan are selected based on the preferred angles in the VMAT plan. IMPT plan is designed by importing the plan objectives generated from VMAT plan. Majority thoracic IMPT plans are designed using this plan approach in our center. In this work, a thoracic IMPT plan under RTOG 1308 protocol is selected to demonstrate the effectiveness and efficiency of this approach. The dosimetric indices of IMPT are compared with VMAT plan. Results: The PTV D95, lung V20, MLD, mean heart dose, esophagus D1, cord D1 are 70Gy, 31%, 17.8Gy, 25.5Gy, 73Gy, 45Gy for IMPT plan and 65.3Gy, 34%, 21.6Gy, 35Gy, 74Gy, 48Gy for VMAT plan. For majority cases, the high dose region of the normal tissue which is in proximity of PTV is comparable between IMPT and VMAT plan. The low dose region of the IMPT plan is significantly better than VMAT plan. Conclusion: Using the knowledge gained in VMAT plan design can help efficiently and effectively design high quality IMPT plan. The quality of IMPT plan can be controlled to ensure the superiority of IMPT plan compared to VMAT/IMRT plan.

60 APPLIED LIFE SCIENCES↗

SU-E-T-417: Experimental Verification of Robustness Optimized Intensity Modulated Proton Therapy Plans for Craniospinal Irradiation

Purpose: The robustness-optimized intensity modulated proton therapy (RO-IMPT) plans takes into account the setup errors to eliminate the hot/cold spots caused by setup errors at the junction for craniospinal (CSI) irradiation fields. The RO-IMPT requires a large area for the junction of two fields. This work is to verify the treatment planning system calculated dose with introduction of setup errors by two-dimensional (2D) dose measurement. Two fields of total lengths of 45 cm with junctions of 21 cm were measured. Methods: 2D dose distributions in the coronal plane were measured by a commercial 2D ion-chamber-array detector in a cubic solid water phantom. A total spine field consisting of an upper and a lower spine field was measured at the depths of 5.4 and 6.9 cm. The active area for the measurement was 24×24 cm{sup 2}2. The junction and the area outside the junction of the spine fields were measured separately to complete the verification for the total field. Six different amounts of set-up errors along the superior-inferior direction up to 1.4 cm were intentionally applied. The measured dose with and without set-up errors were compared with the calculated dose with and without set-up errors using Gamma-index analysis. 3%/3mm and 2%/2mm dose/distance agreement criteria were used. The point dose at the center of the junction was also compared. Results: For all fields with various introduced setup errors, 100 % of pixels passed the 3%/3mm criteria and on average 96% of pixels passed 2%/2mm criteria. Differences in the measured and calculated doses were within 1.1%. Conclusion: The efficacy of the robustness for the CSI RO-IMPT plans were verified by measurement. The measurement method can be used for patient treatment field specific QA for CSI RO-IMPT plans in our institution in the near future.

60 APPLIED LIFE SCIENCES↗

TH-C-BRD-12: Robust Intensity Modulated Proton Therapy Plan Can Eliminate Junction Shifts for Craniospinal Irradiation

Purpose: The passive scattering proton therapy (PSPT) technique is the commonly used radiotherapy technique for craniospinal irradiation (CSI). However, PSPT involves many numbers of junction shifts applied over the course of treatment to reduce the cold and hot regions caused by field mismatching. In this work, we introduced a robust planning approach to develop an optimal and clinical efficient techniques for CSI using intensity modulated proton therapy (IMPT) so that junction shifts can essentially be eliminated. Methods: The intra-fractional uncertainty, in which two overlapping fields shift in the opposite directions along the craniospinal axis, are incorporated into the robust optimization algorithm. Treatment plans with junction sizes 3,5,10,15,20,25 cm were designed and compared with the plan designed using the non-robust optimization. Robustness of the plans were evaluated based on dose profiles along the craniospinal axis for the plans applying 3 mm intra-fractional shift. The dose intra-fraction variations (DIV) at the junction are used to evaluate the robustness of the plans. Results: The DIVs are 7.9%, 6.3%, 5.0%, 3.8%, 2.8% and 2.2%, for the robustly optimized plans with junction sizes 3,5,10,15,20,25 cm. The DIV are 10% for the non-robustly optimized plans with junction size 25 cm. The dose profiles along the craniospinal axis exhibit gradual and tapered dose distribution. Using DIVs less than 5% as maximum acceptable intrafractional variation, the overlapping region can be reduced to 10 cm, leading to potential reduced number of the fields. The DIVs are less than 5% for 5 mm intra-fractional shifts with junction size 25 cm, leading to potential no-junction-shift for CSI using IMPT. Conclusion: This work is the first report of the robust optimization on CSI based on IMPT. We demonstrate that robust optimization can lead to much efficient carniospinal irradiation by eliminating the junction shifts.

60 APPLIED LIFE SCIENCES↗

SU-E-P-06: A Novel Hybrid Planning Approach to Allow More Patients Benefited by the Intensity Modulated Proton Therapy

Purpose: We report a hybrid scattering and scanning beam delivery approach, termed as (HimpsPT), which demonstrated that majority IMPT delivery can be potentially replaced with hybrid IMPT and PSPT delivery with similar or better plan quality. Methods: Three representative clinical cases, including head and neck (HN), skull base chordoma (CNS) and lung cancer, treated in MDACC Proton Therapy Center with IMPT were retrospectively redesigned using HimpsPT. The PSPT plans are designed with the same prescriptions as those of IMPT plans. The whole treatment can be delivered by either alternating or sequential PSPT and IMPT delivery. The dosimetric data and dose distributions of HimpsPT plans are compared with those of IMPT plans. We also performed a worst-case robust analysis for all plans. Results: The target coverages for all cases are comparable. For the HN case, the mean dose of esophagus larynx, left parotid and right submandibular, oral cavity V20, the max dose of cord is 18.0, 36.1, 23.6, 47.2, 0.1, 31.7 Gy in HimpsPT plan, and 25.5, 33.8, 24.9, 49.1, 0.2, 33.8 Gy in IMPT plan. For the lung case, the lung V5, V20, V30, mean lung dose, heart V40, esophagus V70, cord maximum dose are 50.5%, 37.0%, 31.7%, 21.3 Gy, 7.2%, 4.9%, 35.5 Gy in HimpsPT plan, and 55.4%, 36.7%, 30.1%, 21.3 Gy, 7.7%, 8.4%, 36.8Gy in IMPT plans. For the CNS case, brainstem maximum dose is 50.5 Gy in HimpsPT plan and 55.4 Gy in IMPT plan due to sharp penumbra offered by the aperture of the PSPT plan in HimpsPT technique. Conclusion: For majority disease sites, the dosimetric advantage of IMPT technique can be achieved by the hybrid PSPT and IMPT technique, which enables the centers equipped with both scattering and scanning beam facilities to treat more patients which can be benefited by the scanning beam.

60 APPLIED LIFE SCIENCES↗

An efficient iterative algorithm for computation of scattering from dielectric objects.

We have developed an efficient iterative algorithm for electromagnetic scattering of arbitrary but relatively smooth dielectric objects. The algorithm iteratively adapts the equivalent surface currents until the electromagnetic fields inside and outside the dielectric objects match the boundary conditions. Theoretical convergence is analyzed for two examples that solve scattering of plane waves incident upon air/dielectric slabs of semi-infinite and finite thicknesses. We applied the iterative algorithm for simulation of sinusoidally-perturbed dielectric slab on one side and the method converged for such unsmooth surfaces. We next simulated the shift in radiation pattern of a 6-inch dielectric lens for different offsets of the feed antenna on the focal plane. The result is compared to that of the Geometrical Optics (GO).

36 MATERIALS SCIENCE↗