Practical implementation of compensators in breast radiotherapy
Identifieur interne : 004B21 ( Istex/Corpus ); précédent : 004B20; suivant : 004B22Practical implementation of compensators in breast radiotherapy
Auteurs : Philip M. Evans ; Ellen M. Donovan ; Natalie Fenton ; Vibeke N. Hansen ; Ian Moore ; Michael Partridge ; Stephanie Reise ; Bridget Suter ; J. Richard N. Symonds-Tayler ; John R. YarnoldSource :
- Radiotherapy and Oncology [ 0167-8140 ] ; 1999.
English descriptors
Abstract
Background and purpose: A method of using electronic portal imaging to design compensators for tangential breast irradiation has been developed. We describe how this has been implemented. Materials and methods: The compensator design method generates wedged and unwedged beam weights, in conjunction with templates for multiple lead-sheet compensators and pseudo-CT outlines. The latter describe the breast and lung profiles in a set of transverse slices. The layers of the compensator and pseudo-CT outlines are transferred to a treatment planning system for verification. The accuracy of the planning system for the high transmission blocks used to describe the compensators has been verified using a plotting tank system. Dose volume histogram data and transaxial and sagittal plan slices have been compared for both standard and compensated treatments for a sample set of five patients. Results: The planning system predicted the dose at depths of 1.5 and 5 cm to within 2% for the compensators tested. The biggest source of discrepancy was a consequence of the planning system requiring blocks to have integer percentage transmission. For all patients studied, the compensated treatment resulted in a significant reduction in the percentage volume outside the 95–105% dose, with an average reduction of 10.2%. The percentage volume outside the 95–107% dose was also reduced by typically 3.4%. The implementation was found to yield a convenient automatic method of designing compensators using electronic portal imaging and verifying the results using a planning system. Conclusions: These results indicate that this method of implementation can be used in practice. The dosimetric accuracy of the treatment planning system is limited by the requirement that blocks should be of integer transmission, but this effect is small.
Url:
DOI: 10.1016/S0167-8140(98)00126-1
Links to Exploration step
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<front><div type="abstract" xml:lang="en">Background and purpose: A method of using electronic portal imaging to design compensators for tangential breast irradiation has been developed. We describe how this has been implemented. Materials and methods: The compensator design method generates wedged and unwedged beam weights, in conjunction with templates for multiple lead-sheet compensators and pseudo-CT outlines. The latter describe the breast and lung profiles in a set of transverse slices. The layers of the compensator and pseudo-CT outlines are transferred to a treatment planning system for verification. The accuracy of the planning system for the high transmission blocks used to describe the compensators has been verified using a plotting tank system. Dose volume histogram data and transaxial and sagittal plan slices have been compared for both standard and compensated treatments for a sample set of five patients. Results: The planning system predicted the dose at depths of 1.5 and 5 cm to within 2% for the compensators tested. The biggest source of discrepancy was a consequence of the planning system requiring blocks to have integer percentage transmission. For all patients studied, the compensated treatment resulted in a significant reduction in the percentage volume outside the 95–105% dose, with an average reduction of 10.2%. The percentage volume outside the 95–107% dose was also reduced by typically 3.4%. The implementation was found to yield a convenient automatic method of designing compensators using electronic portal imaging and verifying the results using a planning system. Conclusions: These results indicate that this method of implementation can be used in practice. The dosimetric accuracy of the treatment planning system is limited by the requirement that blocks should be of integer transmission, but this effect is small.</div>
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<abstract>Background and purpose: A method of using electronic portal imaging to design compensators for tangential breast irradiation has been developed. We describe how this has been implemented. Materials and methods: The compensator design method generates wedged and unwedged beam weights, in conjunction with templates for multiple lead-sheet compensators and pseudo-CT outlines. The latter describe the breast and lung profiles in a set of transverse slices. The layers of the compensator and pseudo-CT outlines are transferred to a treatment planning system for verification. The accuracy of the planning system for the high transmission blocks used to describe the compensators has been verified using a plotting tank system. Dose volume histogram data and transaxial and sagittal plan slices have been compared for both standard and compensated treatments for a sample set of five patients. Results: The planning system predicted the dose at depths of 1.5 and 5 cm to within 2% for the compensators tested. The biggest source of discrepancy was a consequence of the planning system requiring blocks to have integer percentage transmission. For all patients studied, the compensated treatment resulted in a significant reduction in the percentage volume outside the 95–105% dose, with an average reduction of 10.2%. The percentage volume outside the 95–107% dose was also reduced by typically 3.4%. The implementation was found to yield a convenient automatic method of designing compensators using electronic portal imaging and verifying the results using a planning system. Conclusions: These results indicate that this method of implementation can be used in practice. The dosimetric accuracy of the treatment planning system is limited by the requirement that blocks should be of integer transmission, but this effect is small.</abstract>
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<notesStmt><note type="content">Fig. 1: Compensator for left lateral irradiation. The thick lines are the sagittal breast outline and the sagittal lung edge. The thinner lines are the compensator layers. The numbers indicate the number of compensation layers.</note>
<note type="content">Fig. 2: Results from plotting tank measurements and Target II calculations for staircase compensator. (a) Profiles across the staircase. (b) The calculated value subtracted from the measured value (dashed line). The solid line labelled 0–5 shows the systematic rounding error in each layer of the compensator as a function of position.</note>
<note type="content">Fig. 3: Profiles across the colosseum compensator from measurements and Target II calculations. The thickness of the compensator in terms of the number of lead sheets is also shown. Data are shown for 1.5 and 5 cm depth.</note>
<note type="content">Fig. 4: Differences between Target II calculations and measurements for colosseum compensator in the direction of the wedge at a depth of 5 cm. A positive value indicates that the measurement is higher than the calculation and vice versa. (a) The results for the unwedged data. (b) The wedged data. (c) A weighted combination of the wedged and unwedged data in the ratio of 1:3.</note>
<note type="content">Fig. 5: Transaxial plans for the manually taken central outline. (a) Standard plan. (b) Compensated plan. The relative weights of the medial and lateral beams are taken from the standard plan. The wedged percentages for the standard beams are taken from the standard plan, whereas those for compensated beams are determined using the method presented in Section 2.3.</note>
<note type="content">Fig. 6: Sagittal plans for the EPID-generated outlines. (a) Standard plan. (b) Compensated plan. The relative weights of the medial and lateral beams are set equal. The wedged percentages for the standard beams are taken from the standard plan, whereas those for compensated beams are determined using the method presented in Section 2.3. The dashed line indicates the lung boundary.</note>
<note type="content">Fig. 7: Example dose volume histograms for wedged and compensated plans.</note>
<note type="content">Fig. 8: Flow diagram showing the stages in the compensator design process. IMB denotes intensity modulated beam. Boxes shown in bold indicate a part of the process that differs from the original model.</note>
<note type="content">Fig. 9: Illustration of the method used to determine edges of blocks. The 4×4 array of 1s and 0s is a binary map indicating whether an image pixel is inside (1) or outside (0) the lead sheet. The score grid is constructed between these points (circles with values between 0 and 15). The thick line joining score grid values of 4, 11, 13 etc. is the block edge.</note>
<note type="content">Table 1: Dose volume statistics for five patientsa</note>
</notesStmt>
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<abstract xml:lang="en"><p>Background and purpose: A method of using electronic portal imaging to design compensators for tangential breast irradiation has been developed. We describe how this has been implemented. Materials and methods: The compensator design method generates wedged and unwedged beam weights, in conjunction with templates for multiple lead-sheet compensators and pseudo-CT outlines. The latter describe the breast and lung profiles in a set of transverse slices. The layers of the compensator and pseudo-CT outlines are transferred to a treatment planning system for verification. The accuracy of the planning system for the high transmission blocks used to describe the compensators has been verified using a plotting tank system. Dose volume histogram data and transaxial and sagittal plan slices have been compared for both standard and compensated treatments for a sample set of five patients. Results: The planning system predicted the dose at depths of 1.5 and 5 cm to within 2% for the compensators tested. The biggest source of discrepancy was a consequence of the planning system requiring blocks to have integer percentage transmission. For all patients studied, the compensated treatment resulted in a significant reduction in the percentage volume outside the 95–105% dose, with an average reduction of 10.2%. The percentage volume outside the 95–107% dose was also reduced by typically 3.4%. The implementation was found to yield a convenient automatic method of designing compensators using electronic portal imaging and verifying the results using a planning system. Conclusions: These results indicate that this method of implementation can be used in practice. The dosimetric accuracy of the treatment planning system is limited by the requirement that blocks should be of integer transmission, but this effect is small.</p>
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<item><term>Radiotherapy</term>
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<item><term>Breast cancer</term>
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<item><term>Intensity modulated beams</term>
</item>
<item><term>Electronic portal imaging</term>
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<head><ce:title>Practical implementation of compensators in breast radiotherapy</ce:title>
<ce:author-group><ce:author><ce:given-name>Philip M.</ce:given-name>
<ce:surname>Evans</ce:surname>
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<ce:cross-ref refid="CORR1">*</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>Ellen M.</ce:given-name>
<ce:surname>Donovan</ce:surname>
<ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>Natalie</ce:given-name>
<ce:surname>Fenton</ce:surname>
<ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup>
</ce:cross-ref>
</ce:author>
<ce:author><ce:given-name>Vibeke N.</ce:given-name>
<ce:surname>Hansen</ce:surname>
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<ce:surname>Moore</ce:surname>
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<ce:author><ce:given-name>Michael</ce:given-name>
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<ce:author><ce:given-name>Bridget</ce:given-name>
<ce:surname>Suter</ce:surname>
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<ce:author><ce:given-name>J.Richard N.</ce:given-name>
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<ce:textfn>Joint Department of Physics, Institute of Cancer Research and Royal Marsden NHS Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK</ce:textfn>
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<ce:affiliation id="AFF2"><ce:label>b</ce:label>
<ce:textfn>Department of Radiotherapy, Institute of Cancer Research and Royal Marsden NHS Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK</ce:textfn>
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<ce:text>Corresponding author</ce:text>
</ce:correspondence>
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<ce:date-received day="8" month="6" year="1998"></ce:date-received>
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<ce:abstract><ce:section-title>Abstract</ce:section-title>
<ce:abstract-sec><ce:simple-para><ce:italic>Background and purpose</ce:italic>
: A method of using electronic portal imaging to design compensators for tangential breast irradiation has been developed. We describe how this has been implemented.</ce:simple-para>
<ce:simple-para><ce:italic>Materials and methods</ce:italic>
: The compensator design method generates wedged and unwedged beam weights, in conjunction with templates for multiple lead-sheet compensators and pseudo-CT outlines. The latter describe the breast and lung profiles in a set of transverse slices. The layers of the compensator and pseudo-CT outlines are transferred to a treatment planning system for verification. The accuracy of the planning system for the high transmission blocks used to describe the compensators has been verified using a plotting tank system. Dose volume histogram data and transaxial and sagittal plan slices have been compared for both standard and compensated treatments for a sample set of five patients.</ce:simple-para>
<ce:simple-para><ce:italic>Results</ce:italic>
: The planning system predicted the dose at depths of 1.5 and 5 cm to within 2% for the compensators tested. The biggest source of discrepancy was a consequence of the planning system requiring blocks to have integer percentage transmission. For all patients studied, the compensated treatment resulted in a significant reduction in the percentage volume outside the 95–105% dose, with an average reduction of 10.2%. The percentage volume outside the 95–107% dose was also reduced by typically 3.4%. The implementation was found to yield a convenient automatic method of designing compensators using electronic portal imaging and verifying the results using a planning system.</ce:simple-para>
<ce:simple-para><ce:italic>Conclusions</ce:italic>
: These results indicate that this method of implementation can be used in practice. The dosimetric accuracy of the treatment planning system is limited by the requirement that blocks should be of integer transmission, but this effect is small.</ce:simple-para>
</ce:abstract-sec>
</ce:abstract>
<ce:keywords class="keyword"><ce:section-title>Keywords</ce:section-title>
<ce:keyword><ce:text>Radiotherapy</ce:text>
</ce:keyword>
<ce:keyword><ce:text>Breast cancer</ce:text>
</ce:keyword>
<ce:keyword><ce:text>Intensity modulated beams</ce:text>
</ce:keyword>
<ce:keyword><ce:text>Electronic portal imaging</ce:text>
</ce:keyword>
</ce:keywords>
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<abstract lang="en">Background and purpose: A method of using electronic portal imaging to design compensators for tangential breast irradiation has been developed. We describe how this has been implemented. Materials and methods: The compensator design method generates wedged and unwedged beam weights, in conjunction with templates for multiple lead-sheet compensators and pseudo-CT outlines. The latter describe the breast and lung profiles in a set of transverse slices. The layers of the compensator and pseudo-CT outlines are transferred to a treatment planning system for verification. The accuracy of the planning system for the high transmission blocks used to describe the compensators has been verified using a plotting tank system. Dose volume histogram data and transaxial and sagittal plan slices have been compared for both standard and compensated treatments for a sample set of five patients. Results: The planning system predicted the dose at depths of 1.5 and 5 cm to within 2% for the compensators tested. The biggest source of discrepancy was a consequence of the planning system requiring blocks to have integer percentage transmission. For all patients studied, the compensated treatment resulted in a significant reduction in the percentage volume outside the 95–105% dose, with an average reduction of 10.2%. The percentage volume outside the 95–107% dose was also reduced by typically 3.4%. The implementation was found to yield a convenient automatic method of designing compensators using electronic portal imaging and verifying the results using a planning system. Conclusions: These results indicate that this method of implementation can be used in practice. The dosimetric accuracy of the treatment planning system is limited by the requirement that blocks should be of integer transmission, but this effect is small.</abstract>
<note type="content">Fig. 1: Compensator for left lateral irradiation. The thick lines are the sagittal breast outline and the sagittal lung edge. The thinner lines are the compensator layers. The numbers indicate the number of compensation layers.</note>
<note type="content">Fig. 2: Results from plotting tank measurements and Target II calculations for staircase compensator. (a) Profiles across the staircase. (b) The calculated value subtracted from the measured value (dashed line). The solid line labelled 0–5 shows the systematic rounding error in each layer of the compensator as a function of position.</note>
<note type="content">Fig. 3: Profiles across the colosseum compensator from measurements and Target II calculations. The thickness of the compensator in terms of the number of lead sheets is also shown. Data are shown for 1.5 and 5 cm depth.</note>
<note type="content">Fig. 4: Differences between Target II calculations and measurements for colosseum compensator in the direction of the wedge at a depth of 5 cm. A positive value indicates that the measurement is higher than the calculation and vice versa. (a) The results for the unwedged data. (b) The wedged data. (c) A weighted combination of the wedged and unwedged data in the ratio of 1:3.</note>
<note type="content">Fig. 5: Transaxial plans for the manually taken central outline. (a) Standard plan. (b) Compensated plan. The relative weights of the medial and lateral beams are taken from the standard plan. The wedged percentages for the standard beams are taken from the standard plan, whereas those for compensated beams are determined using the method presented in Section 2.3.</note>
<note type="content">Fig. 6: Sagittal plans for the EPID-generated outlines. (a) Standard plan. (b) Compensated plan. The relative weights of the medial and lateral beams are set equal. The wedged percentages for the standard beams are taken from the standard plan, whereas those for compensated beams are determined using the method presented in Section 2.3. The dashed line indicates the lung boundary.</note>
<note type="content">Fig. 7: Example dose volume histograms for wedged and compensated plans.</note>
<note type="content">Fig. 8: Flow diagram showing the stages in the compensator design process. IMB denotes intensity modulated beam. Boxes shown in bold indicate a part of the process that differs from the original model.</note>
<note type="content">Fig. 9: Illustration of the method used to determine edges of blocks. The 4×4 array of 1s and 0s is a binary map indicating whether an image pixel is inside (1) or outside (0) the lead sheet. The score grid is constructed between these points (circles with values between 0 and 15). The thick line joining score grid values of 4, 11, 13 etc. is the block edge.</note>
<note type="content">Table 1: Dose volume statistics for five patientsa</note>
<subject lang="en"><genre>Keywords</genre>
<topic>Radiotherapy</topic>
<topic>Breast cancer</topic>
<topic>Intensity modulated beams</topic>
<topic>Electronic portal imaging</topic>
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