Publication

Reproducibility of the lung anatomy under active breathing coordinator control: Dosimetric consequences for scanned proton treatments

den Otter, L. A., Kaza, E., Kierkels, R. G. J., Meijers, A., Ubbels, F. J. F., Leach, M. O., Collins, D. J., Langendijk, J. A. & Knopf, A-C., Dec-2018, In : Medical Physics. 45, 12, p. 5525-5534 10 p.

Research output: Contribution to journalArticleAcademicpeer-review

APA

den Otter, L. A., Kaza, E., Kierkels, R. G. J., Meijers, A., Ubbels, F. J. F., Leach, M. O., ... Knopf, A-C. (2018). Reproducibility of the lung anatomy under active breathing coordinator control: Dosimetric consequences for scanned proton treatments. Medical Physics, 45(12), 5525-5534. https://doi.org/10.1002/mp.13195

Author

den Otter, Lydia A. ; Kaza, Evangelia ; Kierkels, Roel G. J. ; Meijers, Arturs ; Ubbels, Fred J. F. ; Leach, Martin O. ; Collins, David J. ; Langendijk, Johannes A. ; Knopf, Antje-Christin. / Reproducibility of the lung anatomy under active breathing coordinator control : Dosimetric consequences for scanned proton treatments. In: Medical Physics. 2018 ; Vol. 45, No. 12. pp. 5525-5534.

Harvard

den Otter, LA, Kaza, E, Kierkels, RGJ, Meijers, A, Ubbels, FJF, Leach, MO, Collins, DJ, Langendijk, JA & Knopf, A-C 2018, 'Reproducibility of the lung anatomy under active breathing coordinator control: Dosimetric consequences for scanned proton treatments', Medical Physics, vol. 45, no. 12, pp. 5525-5534. https://doi.org/10.1002/mp.13195

Standard

Reproducibility of the lung anatomy under active breathing coordinator control : Dosimetric consequences for scanned proton treatments. / den Otter, Lydia A.; Kaza, Evangelia; Kierkels, Roel G. J.; Meijers, Arturs; Ubbels, Fred J. F.; Leach, Martin O.; Collins, David J.; Langendijk, Johannes A.; Knopf, Antje-Christin.

In: Medical Physics, Vol. 45, No. 12, 12.2018, p. 5525-5534.

Research output: Contribution to journalArticleAcademicpeer-review

Vancouver

den Otter LA, Kaza E, Kierkels RGJ, Meijers A, Ubbels FJF, Leach MO et al. Reproducibility of the lung anatomy under active breathing coordinator control: Dosimetric consequences for scanned proton treatments. Medical Physics. 2018 Dec;45(12):5525-5534. https://doi.org/10.1002/mp.13195


BibTeX

@article{c6414f66dab34e4683f65a1fce0bcd89,
title = "Reproducibility of the lung anatomy under active breathing coordinator control: Dosimetric consequences for scanned proton treatments",
abstract = "Purpose The treatment of moving targets with scanned proton beams is challenging. For motion mitigation, an Active Breathing Coordinator (ABC) can be used to assist breath-holding. The delivery of pencil beam scanning fields often exceeds feasible breath-hold durations, requiring high breath-hold reproducibility. We evaluated the robustness of scanned proton therapy against anatomical uncertainties when treating nonsmall-cell lung cancer (NSCLC) patients during ABC controlled breath-hold. Methods Four subsequent MRIs of five healthy volunteers (3 male, 2 female, age: 25-58, BMI: 19-29) were acquired under ABC controlled breath-hold during two simulated treatment fractions, providing both intrafractional and interfractional information about breath-hold reproducibility. Deformation vector fields between these MRIs were used to deform CTs of five NSCLC patients. Per patient, four or five cases with different tumor locations were modeled, simulating a total of 23 NSCLC patients. Robustly optimized (3 and 5 mm setup uncertainty respectively and 3{\%} density perturbation) intensity-modulated proton plans (IMPT) were created and split into subplans of 20 s duration (assumed breath-hold duration). A fully fractionated treatment was recalculated on the deformed CTs. For each treatment fraction the deformed CTs representing multiple breath-hold geometries were alternated to simulate repeated ABC breath-holding during irradiation. Also a worst-case scenario was simulated by recalculating the complete treatment plan on the deformed CT scan showing the largest deviation with the first deformed CT scan, introducing a systematic error. Both the fractionated breath-hold scenario and worst-case scenario were dosimetrically evaluated. Results Looking at the deformation vector fields between the MRIs of the volunteers, up to 8 mm median intra- and interfraction displacements (without outliers) were found for all lung segments. The dosimetric evaluation showed a median difference in D-98{\%} between the planned and breath-hold scenarios of -0.1 Gy (range: -4.1 Gy to 2.0 Gy). D-98{\%} target coverage was more than 57.0 Gy for 22/23 cases. The D-1 cc of the CTV increased for 21/23 simulations, with a median difference of 0.9 Gy (range: -0.3 to 4.6 Gy). For 14/23 simulations the increment was beyond the allowed maximum dose of 63.0 Gy, though remained under 66.0 Gy (110{\%} of the prescribed dose of 60.0 Gy). Organs at risk doses differed little compared to the planned doses (difference in mean doses",
keywords = "active breathing coordinator control, interfraction reproducibility, intrafraction reproducibility, nonsmall-cell lung cancer, pencil beam scanning, MOTION MITIGATION, TUMOR TRACKING, UNCERTAINTIES, THERAPY, OPTIMIZATION, BEAMS, RANGE, SETUP, ABC",
author = "{den Otter}, {Lydia A.} and Evangelia Kaza and Kierkels, {Roel G. J.} and Arturs Meijers and Ubbels, {Fred J. F.} and Leach, {Martin O.} and Collins, {David J.} and Langendijk, {Johannes A.} and Antje-Christin Knopf",
year = "2018",
month = "12",
doi = "10.1002/mp.13195",
language = "English",
volume = "45",
pages = "5525--5534",
journal = "Medical Physics",
issn = "0094-2405",
publisher = "Wiley",
number = "12",

}

RIS

TY - JOUR

T1 - Reproducibility of the lung anatomy under active breathing coordinator control

T2 - Dosimetric consequences for scanned proton treatments

AU - den Otter, Lydia A.

AU - Kaza, Evangelia

AU - Kierkels, Roel G. J.

AU - Meijers, Arturs

AU - Ubbels, Fred J. F.

AU - Leach, Martin O.

AU - Collins, David J.

AU - Langendijk, Johannes A.

AU - Knopf, Antje-Christin

PY - 2018/12

Y1 - 2018/12

N2 - Purpose The treatment of moving targets with scanned proton beams is challenging. For motion mitigation, an Active Breathing Coordinator (ABC) can be used to assist breath-holding. The delivery of pencil beam scanning fields often exceeds feasible breath-hold durations, requiring high breath-hold reproducibility. We evaluated the robustness of scanned proton therapy against anatomical uncertainties when treating nonsmall-cell lung cancer (NSCLC) patients during ABC controlled breath-hold. Methods Four subsequent MRIs of five healthy volunteers (3 male, 2 female, age: 25-58, BMI: 19-29) were acquired under ABC controlled breath-hold during two simulated treatment fractions, providing both intrafractional and interfractional information about breath-hold reproducibility. Deformation vector fields between these MRIs were used to deform CTs of five NSCLC patients. Per patient, four or five cases with different tumor locations were modeled, simulating a total of 23 NSCLC patients. Robustly optimized (3 and 5 mm setup uncertainty respectively and 3% density perturbation) intensity-modulated proton plans (IMPT) were created and split into subplans of 20 s duration (assumed breath-hold duration). A fully fractionated treatment was recalculated on the deformed CTs. For each treatment fraction the deformed CTs representing multiple breath-hold geometries were alternated to simulate repeated ABC breath-holding during irradiation. Also a worst-case scenario was simulated by recalculating the complete treatment plan on the deformed CT scan showing the largest deviation with the first deformed CT scan, introducing a systematic error. Both the fractionated breath-hold scenario and worst-case scenario were dosimetrically evaluated. Results Looking at the deformation vector fields between the MRIs of the volunteers, up to 8 mm median intra- and interfraction displacements (without outliers) were found for all lung segments. The dosimetric evaluation showed a median difference in D-98% between the planned and breath-hold scenarios of -0.1 Gy (range: -4.1 Gy to 2.0 Gy). D-98% target coverage was more than 57.0 Gy for 22/23 cases. The D-1 cc of the CTV increased for 21/23 simulations, with a median difference of 0.9 Gy (range: -0.3 to 4.6 Gy). For 14/23 simulations the increment was beyond the allowed maximum dose of 63.0 Gy, though remained under 66.0 Gy (110% of the prescribed dose of 60.0 Gy). Organs at risk doses differed little compared to the planned doses (difference in mean doses

AB - Purpose The treatment of moving targets with scanned proton beams is challenging. For motion mitigation, an Active Breathing Coordinator (ABC) can be used to assist breath-holding. The delivery of pencil beam scanning fields often exceeds feasible breath-hold durations, requiring high breath-hold reproducibility. We evaluated the robustness of scanned proton therapy against anatomical uncertainties when treating nonsmall-cell lung cancer (NSCLC) patients during ABC controlled breath-hold. Methods Four subsequent MRIs of five healthy volunteers (3 male, 2 female, age: 25-58, BMI: 19-29) were acquired under ABC controlled breath-hold during two simulated treatment fractions, providing both intrafractional and interfractional information about breath-hold reproducibility. Deformation vector fields between these MRIs were used to deform CTs of five NSCLC patients. Per patient, four or five cases with different tumor locations were modeled, simulating a total of 23 NSCLC patients. Robustly optimized (3 and 5 mm setup uncertainty respectively and 3% density perturbation) intensity-modulated proton plans (IMPT) were created and split into subplans of 20 s duration (assumed breath-hold duration). A fully fractionated treatment was recalculated on the deformed CTs. For each treatment fraction the deformed CTs representing multiple breath-hold geometries were alternated to simulate repeated ABC breath-holding during irradiation. Also a worst-case scenario was simulated by recalculating the complete treatment plan on the deformed CT scan showing the largest deviation with the first deformed CT scan, introducing a systematic error. Both the fractionated breath-hold scenario and worst-case scenario were dosimetrically evaluated. Results Looking at the deformation vector fields between the MRIs of the volunteers, up to 8 mm median intra- and interfraction displacements (without outliers) were found for all lung segments. The dosimetric evaluation showed a median difference in D-98% between the planned and breath-hold scenarios of -0.1 Gy (range: -4.1 Gy to 2.0 Gy). D-98% target coverage was more than 57.0 Gy for 22/23 cases. The D-1 cc of the CTV increased for 21/23 simulations, with a median difference of 0.9 Gy (range: -0.3 to 4.6 Gy). For 14/23 simulations the increment was beyond the allowed maximum dose of 63.0 Gy, though remained under 66.0 Gy (110% of the prescribed dose of 60.0 Gy). Organs at risk doses differed little compared to the planned doses (difference in mean doses

KW - active breathing coordinator control

KW - interfraction reproducibility

KW - intrafraction reproducibility

KW - nonsmall-cell lung cancer

KW - pencil beam scanning

KW - MOTION MITIGATION

KW - TUMOR TRACKING

KW - UNCERTAINTIES

KW - THERAPY

KW - OPTIMIZATION

KW - BEAMS

KW - RANGE

KW - SETUP

KW - ABC

U2 - 10.1002/mp.13195

DO - 10.1002/mp.13195

M3 - Article

VL - 45

SP - 5525

EP - 5534

JO - Medical Physics

JF - Medical Physics

SN - 0094-2405

IS - 12

ER -

ID: 72640558