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1100 Grams

This document discusses methods for improving the accuracy of dose calculations in treatment planning systems when modeling MLC leaf positioning. It describes how adjusting parameters like the dosimetric leaf gap (DLG), leaf transmission, and source spot size in the planning system can help match measured dose profiles, but individual adjustments are not sufficient. The document presents a "Modified Eclipse" method that calculates dose as a weighted sum of the planned dose and a dose with the MLCs opened slightly wider. This approach improved agreement with measurements for simple test plans and IMRT plans. However, it adds complexity over simply increasing the default DLG value.

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0% found this document useful (0 votes)
30 views64 pages

1100 Grams

This document discusses methods for improving the accuracy of dose calculations in treatment planning systems when modeling MLC leaf positioning. It describes how adjusting parameters like the dosimetric leaf gap (DLG), leaf transmission, and source spot size in the planning system can help match measured dose profiles, but individual adjustments are not sufficient. The document presents a "Modified Eclipse" method that calculates dose as a weighted sum of the planned dose and a dose with the MLCs opened slightly wider. This approach improved agreement with measurements for simple test plans and IMRT plans. However, it adds complexity over simply increasing the default DLG value.

Uploaded by

pedroargolopie
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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MLC modeling and optimizing the

DLG: Predicting and preventing a


major mode of IMRT QA Failure
Mike Grams
Mayo Clinic
Rochester, MN
What makes a plan fail IMRT QA?
• “It has too many MUs.”
• “It’s too modulated.”
• “We’re pushing the planning system too hard.”
• “I don’t know.”
Measurement

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:

Collimator 0°, MLCs stationary but protecting “cord”, Simple case,


should be easy for Eclipse to model
World’s Worst Spine SBRT Plan Ver 2.0:

Collimator 90°, MLCs stationary but protecting “cord”, Simple case,


should be easy for Eclipse to model
Dose Profile Across “Cord” Region
Keep it simple: 2 x 2 cm2 open field

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

This distance is half the DLG


Leaf Transmission
• A small amount of radiation passes directly
through the leaves
• Transmission is configurable within Eclipse
Source spot size
• “The spot size parameter affects effectively the
penumbra shape…”
• “…have a significant effect on the calculated
absolute dose level for very small field sizes
(<=1x1 cm2) and for the shape of the calculated
penumbra for all field sizes.”
• Should “be manually adjusted for each
treatment unit” (default value is x = y = 0 mm)
• Is configurable in Eclipse, but requires re-
calculating beam data
Turn the knobs
• Knob #1: DLG

Essentially widens
the profile
everywhere

Not much help


out here
Dose Profiles Parallel to MLC

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

Tends to slant the


entire penumbra
Dose Profiles Parallel to MLC

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:

Collimator 0°, MLCs stationary but protecting “cord”, Simple case,


should be easy for Eclipse to model
Original Eclipse Modified Eclipse
Modified Eclipse
• Deliver 95% of the MUs with the original MLC
pattern, and the remaining 5% with the MLCs
opened an additional 5 mm on each side
• MATLAB code edits the MLC positions and
MUs and creates the additional fields
• Eclipse then calculates dose for all fields
• Works for simple cases, but what does it do for
actual treatment plans?
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

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?

Original Eclipse mean: Modified Eclipse mean:


orig new 0.95 orig 0.05 orig 1 cm
new orig 0.05 cm

Same as increasing DLG by 0.05 cm


Can we just change the DLG?
• Our previous DLG in Eclipse was 0.15 cm
• Based on the preceding analysis, the DLG was
changed to 0.20 cm
Dose Profiles Parallel to MLC

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

More desirable, entire length of MLC is parked over


the cord for large portions of the arcs
Summary
• Inaccurate modeling of the end of the MLC can
lead to IMRT QA failures
• By artificially broadening the penumbra, better
agreement between measurement and Eclipse
is obtained
• Based on the “Modified Eclipse” approach, we
were able to find an optimal DLG
• Plans calculated with this optimized DLG
normally agree just as well with measurement
as the Modified Eclipse
• There are a few exceptions, most notably, spine
SBRT cases
Thanks
• Amanda Deisher
• John Antolak
• Luis Fong de los Santos
Dose Profiles Parallel to MLC

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)

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