Program Information
The Potential Clinical Significance of Dose Mapping Error for Intra-Fraction Dose Mapping for Lung Cancer Patients
N Sayah1*, E Weiss2 , W Watkins3 , J Siebers4 , (1) Thomas Cancer Center, Richmond, VA, (2) Virginia Commonwealth University, Richmond, Virginia, (3) University of Virginia, Charlottesville, VA, (4) University of Virginia Health System, Charlottesville, VA
Presentations
SU-G-BRC-15 (Sunday, July 31, 2016) 4:00 PM - 6:00 PM Room: Ballroom C
Purpose: To evaluate the dose-mapping error (DME) inherent to conventional dose-mapping algorithms as a function of dose-matrix resolution.
Methods: As DME has been reported to be greatest where dose-gradients overlap tissue-density gradients, non-clinical 66 Gy IMRT plans were generated for 11 lung patients with the target edge defined as the maximum 3D density gradient on the 0% (end of inhale) breathing phase. Post-optimization, Beams were copied to 9 breathing phases. Monte Carlo dose computed (with 2*2*2 mm³ resolution) on all 10 breathing phases was deformably mapped to phase 0% using the Monte Carlo energy-transfer method with congruent mass-mapping (EMCM); an externally implemented tri-linear interpolation method with voxel sub-division; Pinnacle’s internal (tri-linear) method; and a post-processing energy-mass voxel-warping method(dTransform). All methods used the same base displacement-vector-field (or it’s pseudo-inverse as appropriate) for the dose mapping. Mapping was also performed at 4*4*4 mm³ by merging adjacent dose voxels.
Results: Using EMCM as the reference standard, no clinically significant (>1 Gy) DMEs were found for the mean lung dose (MLD), lung V20Gy, or esophagus dose-volume indices, although MLD and V20Gy were statistically different (2*2*2 mm³). Pinnacle-to-EMCM target D98% DMEs of 4.4 and 1.2 Gy were observed ( 2*2*2 mm³). However dTransform, which like EMCM conserves integral dose, had DME >1 Gy for one case. The root mean square RMS of the DME for the tri-linear-to- EMCM methods was lower for the smaller voxel volume for the tumor 4D-D98%, lung V20Gy, and cord D1%.
Conclusion: When tissue gradients overlap with dose gradients, organs-at-risk DME was statistically significant but not clinically significant. Target-D98%-DME was deemed clinically significant for 2/11 patients (2*2*2 mm³). Since tri-linear RMS-DME between EMCM and tri-linear was reduced at 2*2*2 mm³, use of this resolution is recommended for dose mapping. Interpolative dose methods are sufficiently accurate for the majority of cases.
Funding Support, Disclosures, and Conflict of Interest: J.V. Siebers receives funding support from Varian Medical Systems.
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