New Developments in Proton Treatment Planning Systems Daniel … · 2009-05-12 · Beam Profile...
Transcript of New Developments in Proton Treatment Planning Systems Daniel … · 2009-05-12 · Beam Profile...
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New Developments in New Developments in Proton Treatment Planning Systems
Daniel Yeung
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Statement of Disclosure
Funded Research & Development:
Philips Medical Systems
IBA
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Proton Planning Systemsg y
C i l S t A d i S tCommercial Systems Academic SystemsAnalytical/Semi-Analytical CMS - Xio MGH, HCL
Varian – Eclipse Proton PSIVarian – EyePlan ClatterbridgeOptivus - Odyssey Loma LindaDosigray OrsayDosigray Orsay
Others… Others…* Under Development Philips – Pinnacle* UF*Monte Carlo CMS*, Varian*,… MGH, DKFZ,…
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Proton Pencil Beam Algorithmsg
Hong et al, MGH 1996
Szymanowski et al, Institut Curie 2001
Beam Model dosimetry in water inhomogeneity correction g y
• water equivalent thickness (wet) • HU stopping power
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Proton Pencil Beam Algorithmg
Beam Model
CAX Depth Dose (DD) broad beam pristine peak sobp
Radial Spread (RS) multi coloumb scatter
• beamline: degrader, nozzle elements (wet only)• compensator: material dependent scattering powerp p g p• patient: wet only
gaussian kernelσ2
total = σ2line + σ2
comp + σ2patientσ total σ line σ comp σ patient
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Proton Pencil Beam Algorithmg
Dose CalculationDose Calculation
Dose from a pencil beam
Convolve DD with RS for each pencil Sum dose from all pencils
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Bortfeld Model of Pristine Peak
Analytical model of proton BP (up to ~ 200 MeV)• accounts for energy spread • empirical model of nuclear fragmentation (data fitting)empirical model of nuclear fragmentation (data fitting)• numeric depth dose calculation of fitted BP• assumption – range straggling ‘constant’ with depth
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Pristine Peak - Analytical Model y
R=9 0 g/cm2R=5 86 g/cm2
R=21.86 g/cm2
R 9.0 g/cmR 5.86 g/cmV 8.0
V 8.1R=19.8 g/cm2
For R > 15 g/cm2,
Range straggling depth
E i B tf ld d l
Eclipse Model Bortfeld Model
Error in Bortfeld model
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Pristine Peak – Bortfeld Model
R=19.8 g/cm2
R=28.4 g/cm2
Bortfeld Model Bortfeld - Enhanced
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SOBP Calc vs MeasurementCalc vs Measurement
Courtesy R. Slopsema
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Beam Profile Calc vs MeasurementCalc vs Measurement
R=15.1 M=10.4
d=5 mm
d=10 cm
Option B5 - R=15.1 g/cm^2, M=10.4 g/cm^2, Air gap = 11.7cm, SSD=220.1, aperture: 15cmx15cm
1
1.11.2
1.3
umbr
a [c
m]
Eclipse convolved - @9.9 cm Measurement (av) - @9.9 cmEclipse convolved - @0.5 cm Measurement (av) - @0.5 cmEclipse convolved - @14.1 cm Measurement (av) - @14.1 cm
0.5
0.6
0.70.80.9
180
% L
ater
al P
enu
d=15 cm 0.3
0.4
0.00 5.00 10.00 15.00 20.00 25.00 30.00 35.00Air Gap [cm]
20%
-8
Courtesy R. Slopsema
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Proton Dose Calc in water is generally accurate!
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…ok, what about Clinical Issues?
Physics Clinical
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Match & Patch Fields
used to avoid OARs adjacent to target used to avoid OARs adjacent to target partition target into segments (sub-targets)
• sub-targets treated with ‘sub-beams’ • angle sub-beams to avoid OARs
combined with other fields for dose uniformity
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Match Fields match fields abutting each other penumbra matching penumbra penumbra matching penumbra
Inf - LAT Sup - RAO
matchline
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Patch Fields
th b t t ti l t t thru beam txt partial target residual txt with patch lateral penumbra (t beam) ‘matched’ with distal lateral penumbra (t-beam) matched with distal
falloff (p-beam) LPO beam (inferior) patched with SPO (superior) LPO beam (inferior) patched with SPO (superior)
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Lacrimal Gland CarcinomaPTV 50 4PTV 50.4
partition into sup + inf targetsb i t
sup
inf
brainstem
inf
PTV50 4 5 fi ld ith t h & t h
LPO-Inf (spare optics & BS)SPO-patch
PTV50.4: 5 fields with match & patch Target FieldsPTV LAO LPO50%
PTV(Inf) LPO-InfPTV(Sup) LAO-match SPO-patch
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Lacrimal Gland CarcinomaPTV50 4 – 5 FieldsPTV50.4 5 Fields
Inf - LPO Sup – LAO match Sup – SPO patch
LPO LAOLPO LAO
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Patch Field Selection
Patch Field Angle Selection optimal geometric coverage (G = 230 ) avoid inhomogeneity along path (G = 205 )
Patch line Patch line
Gantry 230 Gantry 205
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Patch Field – Beam Angle Selectiong
Gantry 230° Gantry 205°
G=205°
G 230°G=230°
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Distal Blockingg
selective pullback of range to spare OARs pullback achieved with added compensator potential pitfalls setup error or motion may nullify sparing ‘simple’ distal blocking may compromise
target coverage b t f h assess robustness of approach
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Distal Blockinggadded compensator
distal blockTarget
p
OAR
range pullback
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Distal Blockingg
underdose
Whole BS Partial BS
PTV
Whole BS Partial BS
BS
RPO FieldPartial BS
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Clinical Tools
I t t Cli i l kflIntegrate Clinical workflow clinical database web-based applications mu model physics qa plan evaluation
quality assurance clinical efficiency & efficacy
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Plan/Dvh Evaluation/
Dvh statistics for CTV, PTV, OARs
Courtesy R. Malyapa, C.McKenzie, Z. Li
, ,are extracted manually from plots
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RT PACSTPS
Treatment Plans Plan, Dose , ROI Information
Clinical RT-PACSTPS Information Server
Active Forms
SharePointServerPhysics
• Plan• Contouring • DVH
Q/A Forms
Clinicians
• Prescription
Tx Delivery
Electronic Q/A Process:Electronic Q/A Process:Upon export of Upon export of txtx plan to RTplan to RT--PACS, clinical Q/A forms are generated. PACS, clinical Q/A forms are generated. Tx. DeliveryActive forms are sent via email to the personnel on the list . Active forms are sent via email to the personnel on the list . Contents of active forms is stored in a Clinical Information Database.Contents of active forms is stored in a Clinical Information Database.
Courtesy V. Frouhar
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Electronic Q/A Process:Electronic Q/A Process:U f l RTU f l RT PACS i li i l Q/APACS i li i l Q/AUpon expert of treatment plan to RTUpon expert of treatment plan to RT--PACS, appropriate clinical Q/A PACS, appropriate clinical Q/A forms are generated. Active forms are sent via email to the personnel forms are generated. Active forms are sent via email to the personnel on the list . Contents of active forms is stored in a Clinical on the list . Contents of active forms is stored in a Clinical Information Database.Information Database.
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Integration of Clinical Workflow
Patient Information
R&VHIS
External Connectivity
IGRT LinacTPSPhysics Calc. Clinical
D t M t Machine Data
TPSCT SimPET/MRQuality
Assurance
RXDelivery Setup
Data Management&
Workflow
Clinical I f ti
PhysicianPhysicist
Information DosimetristTherapist
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Golden Beam Data
TPS commissioning time consuming share beam data among gantries (institutions)?s a e bea data a o g ga t es ( st tut o s)? golden beam data set accuracy requirements on modeling parameters accuracy requirements on modeling parameters
• pristine depth dose & sobp• effective source size• virtual sad• effective sad
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Golden Beam Data
max error in penumbra of ±0.5mm in air, at isocenter
Courtesy R. Slopsema
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Golden Beam Data
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Summaryy
Analytical Proton Algorithms provide accurate dose Analytical Proton Algorithms provide accurate dose model
Proton specific clinical planning issues requires p p g qvigilance
Dose plan is a snap shot of dose distribution Dose delivered depends on uncertainties in range, setup, organ motion, etc.
Select beams and parameters to minimi e ncertainties Select beams and parameters to minimize uncertainties Tools to integrate clinical workflow are essential Golden beam data looks feasible Golden beam data looks feasible
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Thanks!