@article{HaertlLoeschelReppetal., author = {Haertl, Petra Maria and L{\"o}schel, Rainer and Repp, Natalia and Pohl, Fabian and K{\"o}lbl, Oliver and Dobler, Barbara}, title = {Frameless fractionated stereotactic radiation therapy of intracranial lesions: Impact of cone beam CT based setup correction on dose distribution}, series = {Radiation Oncology}, volume = {8}, journal = {Radiation Oncology}, number = {1}, publisher = {BioMed Central}, address = {London}, doi = {10.1186/1748-717X-8-153}, abstract = {Background The purpose of this study was to evaluate the impact of Cone Beam CT (CBCT) based setup correction on total dose distributions in fractionated frameless stereotactic radiation therapy of intracranial lesions. Methods Ten patients with intracranial lesions treated with 30 Gy in 6 fractions were included in this study. Treatment planning was performed with Oncentra® for a SynergyS® (Elekta Ltd, Crawley, UK) linear accelerator with XVI® Cone Beam CT, and HexaPOD™ couch top. Patients were immobilized by thermoplastic masks (BrainLab, Reuther). After initial patient setup with respect to lasers, a CBCT study was acquired and registered to the planning CT (PL-CT) study. Patient positioning was corrected according to the correction values (translational, rotational) calculated by the XVI® system. Afterwards a second CBCT study was acquired and registered to the PL-CT to confirm the accuracy of the corrections. An in-house developed software was used for rigid transformation of the PL-CT to the CBCT geometry, and dose calculations for each fraction were performed on the transformed CT. The total dose distribution was achieved by back-transformation and summation of the dose distributions of each fraction. Dose distributions based on PL-CT, CBCT (laser set-up), and final CBCT were compared to assess the influence of setup inaccuracies. Results The mean displacement vector, calculated over all treatments, was reduced from (4.3 ± 1.3) mm for laser based setup to (0.5 ± 0.2) mm if CBCT corrections were applied. The mean rotational errors around the medial-lateral, superior-inferior, anterior-posterior axis were reduced from (-0.1 ± 1.4)°, (0.1 ± 1.2)° and (-0.2 ± 1.0)°, to (0.04 ± 0.4)°, (0.01 ± 0.4)° and (0.02 ± 0.3)°. As a consequence the mean deviation between planned and delivered dose in the planning target volume (PTV) could be reduced from 12.3\% to 0.4\% for D95 and from 5.9\% to 0.1\% for Dav. Maximum deviation was reduced from 31.8\% to 0.8\% for D95, and from 20.4\% to 0.1\% for Dav. Conclusion Real dose distributions differ substantially from planned dose distributions, if setup is performed according to lasers only. Thermoplasic masks combined with a daily CBCT enabled a sufficient accuracy in dose distribution.}, language = {en} } @article{DoblerStreckKleinetal., author = {Dobler, Barbara and Streck, Natalia and Klein, Elisabeth and L{\"o}schel, Rainer and Haertl, Petra Maria and K{\"o}lbl, Oliver}, title = {Hybrid plan verification for intensity-modulated radiation therapy (IMRT) using the 2D ionization chamber array I'mRT MatriXX--a feasibility study}, series = {Physics in medicine and biology}, volume = {55}, journal = {Physics in medicine and biology}, number = {2}, publisher = {IOP Publishing}, doi = {10.1088/0031-9155/55/2/N02}, pages = {N39 -- N55}, abstract = {The 2D ionization chamber array I'mRT MatriXX (IBA, Schwarzenbruck, Germany) has been developed for absolute 2D dosimetry and verification of intensity-modulated radiation therapy (IMRT) for perpendicular beam incidence. The aim of this study is to evaluate the applicability of I'mRT MatriXX for oblique beam incidence and hybrid plan verification of IMRT with original gantry angles. For the assessment of angular dependence, open fields with gantry angles in steps of 10 degrees were calculated on a CT scan of I'mRT MatriXX. For hybrid plan verification, 17 clinical IMRT plans and one rotational plan were used. Calculations were performed with pencil beam (PB), collapsed cone (CC) and Monte Carlo (MC) methods, which had been previously validated. Measurements were conducted on an Elekta SynergyS linear accelerator. To assess the potential and limitations of the system, gamma evaluation was performed with different dose tolerances and distances to agreement. Hybrid plan verification passed the gamma test with 4\% dose tolerance and 3 mm distance to agreement in all cases, in 82-88\% of the cases for tolerances of 3\%/3 mm, and in 59-76\% of the cases if 3\%/2 mm were used. Separate evaluation of the low dose and high dose regions showed that I'mRT MatriXX can be used for hybrid plan verification of IMRT plans within 3\% dose tolerance and 3 mm distance to agreement with a relaxed dose tolerance of 4\% in the low dose region outside the multileaf collimator (MLC).}, language = {en} }