1100 Grams
1100 Grams
Eclipse
Spine SBRT Re-plan attempt
Physics: “Choose isocenter so the MLCs can park over the cord!”
Spinal Cord
Target
Eclipse – Across Cord
95.0% 2% (global)/2mm
Measurement
Eclipse
80.7% 2% (local)/2mm
Eclipse
Eclipse––Across
Along Cord
Measurement
Eclipse
World’s Worst Spine SBRT Plan Ver 1.0:
Perpendicular to MLC –
tongue and groove
Parallel to MLC –
rounded end
Dose Profiles Parallel to MLC
200
150
Dose (cGy)
100
Film Measurement
50
Eclipse
0
0 10 20 30 40
Distance (mm)
Dose Profiles Perpendicular to MLC
200
150
Dose (cGy)
100
Film Measurement
50
Eclipse
0
0 10 20 30 40
Distance (mm)
What knobs can we turn in Eclipse?
• Dosimetric Leaf Gap (DLG)
• Transmission
• Source spot size
Dosimetric Leaf Gap
• On Varian machines, the ends of the MLC
leaves are rounded
• Because of this, some radiation passes through
completely closed leaf pairs
• Eclipse models the leaf end as flat and
compensates for the round end by shifting the
leaf tip positions back by half the DLG
• The DLG is configurable in Eclipse
This is what the This is what
MLC looks like in Eclipse thinks the
real life MLC looks like
Essentially widens
the profile
everywhere
200
150
Dose (cGy)
100
Film Measurement
50
Eclipse 2.5 mm DLG
0
0 10 20 30 40
Distance (mm)
Turn the knobs
• Knob #2: Transmission
Mainly increases
dose in the tails
Dose Profiles Parallel to MLC
200
150
Dose (cGy)
100
Eclipse 3.0% Transmission
Eclipse 1.5% Transmission
50
Film Measurement
0
0 10 20 30 40
Distance (mm)
Turn the knobs
• Knob #3: Source spot size
200
150
Dose (cGy)
100
Film Measurement
50 Eclipse x = 1 mm
0
0 10 20 30 40
Distance (mm)
Turn the knobs
• Turning the knobs individually, we still couldn’t
match the measured profiles in the problematic
region
• Turning knobs in combination, we still couldn’t
match the profiles and this became very
complicated (lots of possible iterations)
Dose Profiles Parallel to MLC
200
150
Dose (cGy)
We just need some extra dose in
this region.
Can we “trick” Eclipse into putting
100
more dose here???
Film Measurement
50
Eclipse
0
0 10 20 30 40
Distance (mm)
We can artificially broaden the penumbra by summing
two appropriately weighted fields: One with the original
MLC opening and a second with the MLCs opened by 5
mm on each side
95%
100%
= +
5%
100% 95% + 5%
=
Dose Profiles Parallel to MLC
200
150
Dose (cGy)
100
Film Measurement
50
Eclipse
0
0 10 20 30 40
Distance (mm)
Dose Profiles Parallel to MLC
200
150
Dose (cGy)
100
Film Measurement
50
Modified Eclipse
0
0 10 20 30 40
Distance (mm)
World’s Worst Spine SBRT Plan Ver 1.0:
Physics: “Choose isocenter so the MLCs can park over the cord!”
Spinal Cord
Target
Eclipse – Across Cord
95.0% 2% (global)/2mm
80.7% 2% (local)/2mm
Modified Eclipse – Across Cord
99.5% 2% (global)/2mm
93.1% 2% (local)/2mm
AcrossCord
Modified Eclipse – Along Cord
What about other treatment plans?
• Measured 25 IMRT QA plans with film
• Compared measurement to the original Eclipse
dose plane and also to the Modified Eclipse
dose plane
100
2% (Max)/0 mm DTA Pass Rate
95
90
85
80
75
70
65
60
Eclipse 1.5 mm DLG
55
50
0 5 10 15 20 25
Measurement
100
2% (Max)/0 mm DTA Pass Rate
95
90
85
80
75
70
65
60 Eclipse 1.5 mm DLG
55 Modified Eclipse
50
0 5 10 15 20 25
Measurement
Modified Eclipse
• Has lots of benefits:
• Gets square fields and IMRT/VMAT plans right
• Can calculate a new dose distribution and DVH
• Can predict pre-QA where a plan might fail
Modified Eclipse Plan – Original Eclipse Plan
Modified Eclipse
• Has lots of benefits:
• Gets square fields and IMRT/VMAT plans right
• Can calculate a new dose distribution and DVH
• Can predict pre-QA where a plan might fail
• But adds more steps and time to an already busy
workflow
• Is there something easier we can do that’s good
enough?
Can we just change the DLG?
• Modified Eclipse method adds dose by making
MLC pair openings 1 cm wider for 5% of the MU
• Will opening all MLCs by some ∆DLG do the
same thing?
• How much did the Modified Eclipse method
change the mean MLC opening?
Can we just change the DLG?
200
150
Dose (cGy)
100
Film Measurement
50 Eclipse 2.0 mm DLG
0
0 10 20 30 40
Distance (mm)
100
2% (Max)/0 mm DTA Pass Rate
95
90
85
80
75
70
65
60 Eclipse 1.5 mm DLG
55 Modified Eclipse
50
0 5 10 15 20 25
Measurement
100
2% (Max)/0 mm DTA Pass Rate
95
90
85
80
75
70
65
60 Eclipse 1.5 mm DLG
Modified Eclipse
55
Eclipse 2.0 mm DLG
50
0 5 10 15 20 25
Measurement
Spine SBRT Re-plan attempt
Physics: “Choose isocenter so the MLCs can park over the cord!”
Spinal Cord
Target
Eclipse 1.5 mm DLG
Modified Eclipse Eclipse 2 mm DLG
If the cord is relatively straight, you can rotate the collimator so
that the MLCs completely cover it by fully extending the leaves
200
150
Dose (cGy)
100
6X Film
50
Eclipse
0
0 10 20 30 40
Distance (mm)
Dose Profiles Parallel to MLC
200
150
Dose (cGy)
100
6X Film
6X Pinpoint
50
Eclipse
0
0 10 20 30 40
Distance (mm)
6X X direction ‐ profile parallel to MLC leaf direction
200
MatriXX
150 Eclipse
Dose (cGy)
100
50
0
‐12 ‐10 ‐8 ‐6 ‐4 ‐2 0 2 4 6 8 10 12
Distance (cm)
What about Acuros?
• Acuros is reported to be a more accurate
calculation than AAA
• It has not yet been commissioned at Mayo
Dose Profiles Parallel to MLC
200
150
Dose (cGy)
100
Acuros
Film Measurement
50
0
0 10 20 30 40
Distance (mm)
A quick note on calculation grid size
• Calculating on a 1 mm grid vs. a 2 mm grid
results in even worse agreement in the cord
region
1700
1500
Dose (cGy)
1300
1100
Film Measurement
900 Eclipse 1 mm grid
700 Eclipse 2 mm grid
500
30 50 70 90 110 130 150
Distance (mm)
Dose Profiles Parallel to MLC
200
150
Dose (cGy)
100 Eclipse 1 mm grid
Eclipse 2 mm grid
50
0
0 10 20 30 40
Distance (mm)