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Potential dosimetric error in the adaptive workflow of a 1.5 T MR-Linac from patient movement relative to immobilisation systems

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机构: [1]Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China [2]Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China [3]Institute of Nuclear Technology and Automation Engineering, Chengdu University of Technology, Chengdu, China [4]Institute of Medical Physics, School of Physics, University of Sydney, Sydney, NSW, Australia [5]Sydney West Radiation Oncology Network, Crown Princess Mary Cancer Centre, Sydney, NSW, Australia [6]Radiotherapy Research Group, Leeds Institute of Medical Research, St James’s Hospital and University of Leeds, Leeds, UK
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关键词: Adaptive radiotherapy MR-linac Rectum cancer Thermoplastic masks Patient positioning systems

摘要:
In magnetic resonance- (MR-) based adaptive workflows for an MR-linac, the treatment plan is optimized and recalculated online using the daily MR images. The Unity MR-linac is supplied with a patient positioning device (ppd) using pelvic and abdomen thermoplastic masks attached to a board with high-density components. This study highlights the dosimetric effect of using this in such workflows when there are relative patient-ppd displacements, as these are not visualized on MR imaging and the treatment planning system assumes the patient is fixed relative to the ppd. The online adapted plans of two example rectum cancer patients treated at a Unity MR-linac were perturbed by introducing relative patient-ppd displacements, and the effect was evaluated on plan dosimetry. Forty-eight perturbed clinical adapted plans were recalculated, based on online MR-based synthetic computed tomography, and compared with the original plans, using dose-volume histogram parameters and gamma analysis. The target volume covered by the prescribed dose ([Formula: see text]) and by at least 107% of [Formula: see text] varied up to - 1.87% and + 3.67%, respectively for 0.5 cm displacements, and to - 3.18% and + 4.96% for 2 cm displacements; whilst 2%-2 mm gamma analysis showed a median value of 92.9%. The use of a patient positioning system with high-density components in a Unity MR-based online adaptive treatment workflow can introduce unrecognized errors in plan dosimetry and it is recommended not to use such a device for such treatments, without modifying the device and the workflow, followed by careful clinical evaluation, or alternatively to use other immobilization methods.© 2024. The Author(s).

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出版当年[2023]版:
大类 | 4 区 医学
小类 | 4 区 工程:生物医学 4 区 核医学
最新[2023]版:
大类 | 4 区 医学
小类 | 4 区 工程:生物医学 4 区 核医学
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出版当年[2023]版:
Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Q3 ENGINEERING, BIOMEDICAL
最新[2023]版:
Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Q3 ENGINEERING, BIOMEDICAL

影响因子: 最新[2023版] 最新五年平均 出版当年[2023版] 出版当年五年平均 出版前一年[2023版]

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第一作者机构: [1]Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China [2]Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China [3]Institute of Nuclear Technology and Automation Engineering, Chengdu University of Technology, Chengdu, China
通讯作者:
通讯机构: [1]Radiation Oncology Department, Sichuan Cancer Hospital & Institute, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China [2]Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cancer, Chengdu, China [6]Radiotherapy Research Group, Leeds Institute of Medical Research, St James’s Hospital and University of Leeds, Leeds, UK
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