A dosimetric comparison of whole-lung treatment techniques in the pediatric population

Christina L. Bosarge, Marvene M. Ewing, Colleen DesRosiers, Jeffrey C. Buchsbaum

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

To demonstrate the dosimetric advantages and disadvantages of standard anteroposterior-posteroanterior (S-AP/PAAAA), inverse-planned AP/PA (IP-AP/PA) and volumetry-modulated arc (VMAT) radiotherapies in the treatment of children undergoing whole-lung irradiation. Each technique was evaluated by means of target coverage and normal tissue sparing, including data regarding low doses. A historical approach with and without tissue heterogeneity corrections is also demonstrated. Computed tomography (CT) scans of 10 children scanned from the neck to the reproductive organs were used. For each scan, 6 plans were created: (1) S-AP/PAAAA using the anisotropic analytical algorithm (AAA), (2) IP-AP/PA, (3) VMAT, (4) S-AP/PANONE without heterogeneity corrections, (5) S-AP/PAPB using the Pencil-Beam algorithm and enforcing monitor units from technique 4, and (6) S-AP/PAAAA[FM] using AAA and forcing fixed monitor units. The first 3 plans compare modern methods and were evaluated based on target coverage and normal tissue sparing. Body maximum and lower body doses (50% and 30%) were also analyzed. Plans 4 to 6 provide a historic view on the progression of heterogeneity algorithms and elucidate what was actually delivered in the past. Averages of each comparison parameter were calculated for all techniques. The S-AP/PAAAA technique resulted in superior target coverage but had the highest maximum dose to every normal tissue structure. The IP-AP/PA technique provided the lowest dose to the esophagus, stomach, and lower body doses. VMAT excelled at body maximum dose and maximum doses to the heart, spine, and spleen, but resulted in the highest dose in the 30% body range. It was, however, superior to the S-AP/PAAAA approach in the 50% range. Each approach has strengths and weaknesses thus associated. Techniques may be selected on a case-by-case basis and by physician preference of target coverage vs normal tissue sparing.

Original languageEnglish (US)
JournalMedical Dosimetry
DOIs
StateAccepted/In press - May 1 2015

Fingerprint

Pediatrics
Lung
Population
Therapeutics
Transcription Factor AP-1
Esophagus
Stomach
Spine
Neck
Radiotherapy
Spleen
Tomography
Physicians

Keywords

  • Algorithms
  • Heterogeneity
  • Inverse plan
  • VMAT
  • Whole-lung irradiation

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology

Cite this

A dosimetric comparison of whole-lung treatment techniques in the pediatric population. / Bosarge, Christina L.; Ewing, Marvene M.; DesRosiers, Colleen; Buchsbaum, Jeffrey C.

In: Medical Dosimetry, 01.05.2015.

Research output: Contribution to journalArticle

@article{9d01367e71564abaa06f4a2495bb1b69,
title = "A dosimetric comparison of whole-lung treatment techniques in the pediatric population",
abstract = "To demonstrate the dosimetric advantages and disadvantages of standard anteroposterior-posteroanterior (S-AP/PAAAA), inverse-planned AP/PA (IP-AP/PA) and volumetry-modulated arc (VMAT) radiotherapies in the treatment of children undergoing whole-lung irradiation. Each technique was evaluated by means of target coverage and normal tissue sparing, including data regarding low doses. A historical approach with and without tissue heterogeneity corrections is also demonstrated. Computed tomography (CT) scans of 10 children scanned from the neck to the reproductive organs were used. For each scan, 6 plans were created: (1) S-AP/PAAAA using the anisotropic analytical algorithm (AAA), (2) IP-AP/PA, (3) VMAT, (4) S-AP/PANONE without heterogeneity corrections, (5) S-AP/PAPB using the Pencil-Beam algorithm and enforcing monitor units from technique 4, and (6) S-AP/PAAAA[FM] using AAA and forcing fixed monitor units. The first 3 plans compare modern methods and were evaluated based on target coverage and normal tissue sparing. Body maximum and lower body doses (50{\%} and 30{\%}) were also analyzed. Plans 4 to 6 provide a historic view on the progression of heterogeneity algorithms and elucidate what was actually delivered in the past. Averages of each comparison parameter were calculated for all techniques. The S-AP/PAAAA technique resulted in superior target coverage but had the highest maximum dose to every normal tissue structure. The IP-AP/PA technique provided the lowest dose to the esophagus, stomach, and lower body doses. VMAT excelled at body maximum dose and maximum doses to the heart, spine, and spleen, but resulted in the highest dose in the 30{\%} body range. It was, however, superior to the S-AP/PAAAA approach in the 50{\%} range. Each approach has strengths and weaknesses thus associated. Techniques may be selected on a case-by-case basis and by physician preference of target coverage vs normal tissue sparing.",
keywords = "Algorithms, Heterogeneity, Inverse plan, VMAT, Whole-lung irradiation",
author = "Bosarge, {Christina L.} and Ewing, {Marvene M.} and Colleen DesRosiers and Buchsbaum, {Jeffrey C.}",
year = "2015",
month = "5",
day = "1",
doi = "10.1016/j.meddos.2015.10.006",
language = "English (US)",
journal = "Medical Dosimetry",
issn = "0958-3947",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - A dosimetric comparison of whole-lung treatment techniques in the pediatric population

AU - Bosarge, Christina L.

AU - Ewing, Marvene M.

AU - DesRosiers, Colleen

AU - Buchsbaum, Jeffrey C.

PY - 2015/5/1

Y1 - 2015/5/1

N2 - To demonstrate the dosimetric advantages and disadvantages of standard anteroposterior-posteroanterior (S-AP/PAAAA), inverse-planned AP/PA (IP-AP/PA) and volumetry-modulated arc (VMAT) radiotherapies in the treatment of children undergoing whole-lung irradiation. Each technique was evaluated by means of target coverage and normal tissue sparing, including data regarding low doses. A historical approach with and without tissue heterogeneity corrections is also demonstrated. Computed tomography (CT) scans of 10 children scanned from the neck to the reproductive organs were used. For each scan, 6 plans were created: (1) S-AP/PAAAA using the anisotropic analytical algorithm (AAA), (2) IP-AP/PA, (3) VMAT, (4) S-AP/PANONE without heterogeneity corrections, (5) S-AP/PAPB using the Pencil-Beam algorithm and enforcing monitor units from technique 4, and (6) S-AP/PAAAA[FM] using AAA and forcing fixed monitor units. The first 3 plans compare modern methods and were evaluated based on target coverage and normal tissue sparing. Body maximum and lower body doses (50% and 30%) were also analyzed. Plans 4 to 6 provide a historic view on the progression of heterogeneity algorithms and elucidate what was actually delivered in the past. Averages of each comparison parameter were calculated for all techniques. The S-AP/PAAAA technique resulted in superior target coverage but had the highest maximum dose to every normal tissue structure. The IP-AP/PA technique provided the lowest dose to the esophagus, stomach, and lower body doses. VMAT excelled at body maximum dose and maximum doses to the heart, spine, and spleen, but resulted in the highest dose in the 30% body range. It was, however, superior to the S-AP/PAAAA approach in the 50% range. Each approach has strengths and weaknesses thus associated. Techniques may be selected on a case-by-case basis and by physician preference of target coverage vs normal tissue sparing.

AB - To demonstrate the dosimetric advantages and disadvantages of standard anteroposterior-posteroanterior (S-AP/PAAAA), inverse-planned AP/PA (IP-AP/PA) and volumetry-modulated arc (VMAT) radiotherapies in the treatment of children undergoing whole-lung irradiation. Each technique was evaluated by means of target coverage and normal tissue sparing, including data regarding low doses. A historical approach with and without tissue heterogeneity corrections is also demonstrated. Computed tomography (CT) scans of 10 children scanned from the neck to the reproductive organs were used. For each scan, 6 plans were created: (1) S-AP/PAAAA using the anisotropic analytical algorithm (AAA), (2) IP-AP/PA, (3) VMAT, (4) S-AP/PANONE without heterogeneity corrections, (5) S-AP/PAPB using the Pencil-Beam algorithm and enforcing monitor units from technique 4, and (6) S-AP/PAAAA[FM] using AAA and forcing fixed monitor units. The first 3 plans compare modern methods and were evaluated based on target coverage and normal tissue sparing. Body maximum and lower body doses (50% and 30%) were also analyzed. Plans 4 to 6 provide a historic view on the progression of heterogeneity algorithms and elucidate what was actually delivered in the past. Averages of each comparison parameter were calculated for all techniques. The S-AP/PAAAA technique resulted in superior target coverage but had the highest maximum dose to every normal tissue structure. The IP-AP/PA technique provided the lowest dose to the esophagus, stomach, and lower body doses. VMAT excelled at body maximum dose and maximum doses to the heart, spine, and spleen, but resulted in the highest dose in the 30% body range. It was, however, superior to the S-AP/PAAAA approach in the 50% range. Each approach has strengths and weaknesses thus associated. Techniques may be selected on a case-by-case basis and by physician preference of target coverage vs normal tissue sparing.

KW - Algorithms

KW - Heterogeneity

KW - Inverse plan

KW - VMAT

KW - Whole-lung irradiation

UR - http://www.scopus.com/inward/record.url?scp=84954287140&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84954287140&partnerID=8YFLogxK

U2 - 10.1016/j.meddos.2015.10.006

DO - 10.1016/j.meddos.2015.10.006

M3 - Article

C2 - 26778010

AN - SCOPUS:84954287140

JO - Medical Dosimetry

JF - Medical Dosimetry

SN - 0958-3947

ER -