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Radiobiological-Cum-Dosimetric Quality Assurance of Complex Radiotherapy Plans

N Paudel

N Paudel1*, G Narayanasamy1 , X Zhang1 , J Penagaricano1 , P Mavroidis2 , A Pyakuryal3 , E Han4 , X Liang5 , D Kim6 , S Morrill1 , (1) University of Arkansas for Medical Sciences, Little Rock, AR, (2) University North Carolina, Chapel Hill, NC, (3) National Cancer Institute, Rockville, MD, (4) UT MD Anderson Cancer Center, Houston, TX, (5) University of Florida Health Proton Therapy Institute, Jacksonville, FL, (6) Kyung Hee University Hospital, Seol, Korea,


SU-G-TeP3-11 (Sunday, July 31, 2016) 5:00 PM - 5:30 PM Room: ePoster Theater

Purpose:Dosimetric gamma-analysis used for QA of complex radiotherapy plans tests the dosimetric equivalence of a delivered plan with the treatment planning system (TPS) optimized plan. It does not examine whether a dosimetric difference results in any radiobiological difference. This study introduces a method to test the radiobiological and dosimetric equivalence between a delivered and the TPS optimized plan.

Methods:Six head and neck and seven lung cancer VMAT or IMRT plans optimized for patient treatment were calculated and delivered to an ArcCheck phantom. ArcCheck measured dose distributions were compared with the TPS calculated dose distributions using a 2-D gamma-analysis. Dose volume histograms (DVHs) for various patient structures were obtained by using measured data in 3DVH software and compared against the TPS calculated DVHs using 3-D gamma analysis. DVH data were used in the Poisson model to calculate tumor control probability (TCP) for the treatment targets and in the sigmoid dose response model to calculate normal tissue complication probability (NTCP) for the normal structures.

Results:Two-D and three-D gamma passing rates among six H&N patient plans differed by 0 to 2.7% and among seven lung plans by 0.1 to 4.5%. Average ± SD TCPs based on measurement and TPS were 0.665±0.018 and 0.674±0.044 for H&N, and 0.791±0.027 and 0.733±0.031 for lung plans, respectively. Differences in NTCPs were usually negligible. The differences in dosimetric results, TCPs and NTCPs were insignificant.

Conclusion:The 2-D and 3-D gamma-analysis based agreement between measured and planned dose distributions may indicate their dosimetric equivalence. Small and insignificant differences in TCPs and NTCPs based on measured and planned dose distributions indicate the radiobiological equivalence between the measured and optimized plans. However, patient plans showing larger differences between 2-D and 3-D gamma-analysis can help us make a more definite conclusion through our ongoing research with a larger number of patients.

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