Detection of anatomical changes in lung cancer patients with 2D time-integrated, 2D time-resolved and 3D time-integrated portal dosimetry: a simulation study

Cecile J. A. Wolfs, Mariana G. Bras, Lotte E. J. R. Schyns, Sebastiaan M. J. J. G. Nijsten, Wouter van Elmpt, Stefan G. Scheib, Christof Baltes, Mark Podesta, Frank Verhaegen*

*Corresponding author for this work

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Abstract

The aim of this work is to assess the performance of 2D time-integrated (2D-TI), 2D time-resolved (2D-TR) and 3D time-integrated (3D-TI) portal dosimetry in detecting dose discrepancies between the planned and (simulated) delivered dose caused by simulated changes in the anatomy of lung cancer patients.

For six lung cancer patients, tumor shift, tumor regression and pleural effusion are simulated by modifying their CT images. Based on the modified CT images, time-integrated (TI) and time-resolved (TR) portal dose images (PDIs) are simulated and 3D-TI doses are calculated. The modified and original PDIs and 3D doses are compared by a gamma analysis with various gamma criteria. Furthermore, the difference in the D-95% (Delta D-95%) of the GTV is calculated and used as a gold standard. The correlation between the gamma fail rate and the Delta D-95% is investigated, as well the sensitivity and specificity of all combinations of portal dosimetry method, gamma criteria and gamma fail rate threshold.

On the individual patient level, there is a correlation between the gamma fail rate and the Delta D-95%, which cannot be found at the group level. The sensitivity and specificity analysis showed that there is not one combination of portal dosimetry method, gamma criteria and gamma fail rate threshold that can detect all simulated anatomical changes.

This work shows that it will be more beneficial to relate portal dosimetry and DVH analysis on the patient level, rather than trying to quantify a relationship for a group of patients. With regards to optimizing sensitivity and specificity, different combinations of portal dosimetry method, gamma criteria and gamma fail rate should be used to optimally detect certain types of anatomical changes.

Original languageEnglish
Number of pages18
JournalPhysics in Medicine and Biology
Volume62
Issue number15
DOIs
Publication statusPublished - 7 Aug 2017

Keywords

  • portal dosimetry
  • adaptive radiotherapy
  • anatomical changes
  • gamma analysis
  • DVH metrics
  • MODULATED ARC THERAPY
  • RADIATION-THERAPY
  • ADAPTIVE RADIOTHERAPY
  • DOSE DISTRIBUTIONS
  • QUALITY-ASSURANCE
  • EPID DOSIMETRY
  • VMAT
  • VERIFICATION
  • ATELECTASIS
  • REGRESSION

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