Optimization methods for volumetric modulated arc therapy and radiation therapy under uncertainty by fei peng a dissertation submitted in partial ful llment of the requirements for the degree of doctor of philosophy industrial and operations engineering in the university of michigan 20 doctoral committee. It was reported that, in comparison to the imrt, the vdr vmat technique produced more favorable dose distributions and reduced number of monitor units mus. The indications for postprostatectomy radiotherapy have. Tomotherapy and volumetric modulated arc therapy vmat have emerged as two popular types of intensity modulated radiation therapy imrt for the treatment of complex tumors. Intensity modulated radiation therapy imrt and volumetric modulated arc therapy vmat are two commonly used ebrt techniques to treat cancer. Vmat modulates mlcs, gantry speed, dose rate during beam on to shape the 3d dose distribution from arc beams. To compare dosimetric parameters of volumetric modulated arc therapy vmat and noncoplanar intensity modulated radiotherapy imrt for nasal cavity and paranasal sinus cancer with regard to the coverage of planning target volume ptv and the sparing of organs at risk oar. A comprehensive comparison of imrt and vmat plan quality for.
A dose escalation study with intensity modulated radiation therapy imrt in t2n0, t2n1, t3n0 squamous cell carcinomas scc of the oropharynx, larynx and hypopharynx using a simultaneous integrated boost sib approach. In a previous study, we reported that the intensity modulated radiation therapy imrt plans with the viewray system mrco60 imrt were inferior to the volumetric modulated arc therapy vmat plans with a conventional linac for spine sabr. The idea of delivering intensitymodulated radiation therapy imrt with a multileaf collimator in a continuous dynamic mode during a single rotation of the gantry has recently gained momentum both in research and industry. The aim of this study was to estimate the radiationrelated secondary cancer risks in organs during the treatment of breast cancer with different radiotherapy techniques, such. For each patient, a vmat plan and a series of imrt plans using an increasing number of beams 8, 12, 16, 20, and 24 beams were examined. As for treatment delivery, the mean total mus and the treatment time were significantly reduced in both vmat and stepandshoot imrt. Commercial adoption varian first commercialized ottos vmat. A report on imageguided intensity modulated radiation therapy australian safety and efficacy register of new interventional procedures surgical asernips zamora, et al. Unlike fixedfield imrt, vmat deliver intensity modulated radiation beam. Joint committee on cancer ajcc staging manual for lung cancer. Intensity modulated radiation therapy medical clinical. Research article an imrt vmat technique for nonsmall cell lung cancer nanzhao,ruijieyang,junjiewang,xilezhang,andjinnali department of radiation oncology, peking universityi rd hospital, beijing, china. Imrt with constant dose rate cdr vmat and variabledose rate vdr vmat for 10 prostate cancer patients. The reasonable and necessary requirements as outlined under the indications and limitations of coverage andor medical necessity section of this policy.
The intensity of each beams radiation dose is dynamically varied according to treatment plan. Available in most treatment planning systems eclipse rapidarc. Treatment and dosimetric advantages between vmat, imrt, and. Pdf dosimetric comparison between volumetric modulated. An imrtvmat technique for nonsmall cell lung cancer.
Radioterapia stereotaktyczna lukami dynamicznymi z. A medical linear accelerator linac generates the photons, or xrays, used in imrt. Aperture based inverse planning, intensity modulated radiation therapy the state. Full text volumetric modulated arc therapy for treatment of. Comparison of treatment plan quality among mribased imrt. Radiotherapy is usually used in postoperative setting of pituitary macroadenomas. Further comparative evidence is required to establish the effectiveness of imageguided intensitymodulated radiation therapy. Secondary cancer risk after radiation therapy for breast. Significant skin dose differences between imrt and vmat. Jul 25, 2019 analysis of ptv coverage and dose homogeneity for imrt, vmat, and ht displayed different trends depending on tumor position.
Mackie, medical physics publishing corporation, 2003. Radiation therapy coverage, coding, and reimbursement for. A comparative planning and dosimetric study comparing volumetric modulated arc therapy vmat vs dynamic intensitymodulated radiation therapy imrt in head and neck carcinomas author. Rationale and development of imageguided intensitymodulated. Vmat used 4 tangential partial arcs with two isocenters located in the center of the left and right ptvs. Thus, we evaluated the potential dosimetric gains of helical tomotherapy ht versus intensitymodulated radiotherapy imrt or volumemodulated arc therapy vmat for highgrade glioma. Modulacja intensywnosci mocy dawki imrt w polaczeniu z obrotem glowicy staly sie podstawa techniki vmat.
Recently, however, there has been a trend toward using the more technologically advanced intensity modulated radiation therapy imrt or volumetrically modulated arc therapy vmat for these treatments. Pdf available in journal of cancer research and therapeutics 44. Intensity modulated radiation therapy imrt and volumetric modulated arc therapy vmat are two. The advanced developments in external beam radiation therapy ebrt over the past few decades have improved dose conformity to the target while minimizing dose to the surrounding organs at risk oar. The machine is the size of a small carapproximately 10 feet high and 15 feet long. The radiation is delivered to the intended area only, allowing the radiation oncologist to spare more surrounding healthy tissue. Imrt modulates mlcs during beam on to shape the 2d beam profile on a fixed angle beam. A practical guide to intensitymodulated radiation therapy, memorial sloankettering cancer center, medical physics publishing corporation, 2003.
However, vmat is about more e cient radiation delivery, and thus a vmat optimization system should allow the user to select an appropriate compromise between delivery time and dose distribution quality. Tomotherapy as an adjuvant treatment for gastroesophageal. Letter to editor imrt, vmat and proton therapy for prostate. Imrt is a procedure that uses advanced computer programs to plan and deliver radiation to treat difficult to reach tumors. Sliding window delivery is a technique to create radiation fields of nonuniform intensity by sliding the leaves of a multi. Sliding window imrt and vmat optimization decision. Volumetric modulated arc therapy for treatment of solid tumors.
A singlearc form of intensitymodulated arc therapy. Nora al ohali noura al enezi alia babaqeeh alaa al angari shatha al mushayt 2. One table of billing statistics for 2003 shows code 77418 represents % of treatment delivery codes and 52% of treatment delivery revenues. Research article an imrtvmat technique for nonsmall cell. Twofullarc vmat arc vmat, eld imrt f imrt, and hybrid imrt vmat plans for npc were compared in terms of the dosimetric quality, sparing of organs at risk oars, and delivery e ciency. The study aimed to compare the dosimetric parameters to target dose coverage and the critical structures in the treatment planning of helical tomotherapy tomo, volumetricmodulated arc therapy. Intensitymodulated radiation therapy imrt planning. Eleven patients with prostate cancer treated at our institution were randomly selected for this study. Dosimetric comparison of the helical tomotherapy, volumetric. The study aimed to compare the dosimetric parameters to target dose coverage and the critical structures in the treatment planning of helical tomotherapy tomo, volumetricmodulated arc.
A comparison of treatment planning and delivery of vmat using anatomy based and fluence based inverse planning with step and shoot imrt, med. Rationale and development of imageguided intensitymodulated radiotherapy postprostatectomy. Edge sb, byrd dr, compton cc, fritz ag, greene fl, trotti a, editors. Hybrid imrtvmat technique which combined intensity modulated radiotherapy imrt and volumetric modulated arc therapy vmat was developed for the treatment of nasopharyngeal cancer npc. For hybridimrt plan, manual beam selection is influenced by the nonintuitive dose. Proper billing for intensitymodulated radiation therapy. Intensity modulated radiation therapy imrt page 3 documentation requirements documentation in the patients medical records must support. Both vamt and imrt are equally effective for normal tissue sparing. However, the treatment time for vmat is significantly shorter, thus benefits patients who require longer 30 minutes or more treatment time. The intensity of the radiation can be adjusted to deliver higher doses to a treatment area while reducing exposure to surrounding healthy tissue. Aug 22, 20 the advanced developments in external beam radiation therapy ebrt over the past few decades have improved dose conformity to the target while minimizing dose to the surrounding organs at risk oar. Imrt allows for the radiation dose to conform more precisely to the. Vmat, helical tomotherapy, imrt and field in field, for synchronous bilateral breast cancer patients. Wang c, luan s, tang g, chen dz, earl ma, yu cx, 2008 arcmodulated radiation therapy amrt.
Introduction intensity modulated radiation therapy imrt is the product of advances in the rt technology. The study is to investigate a hybrid imrt vmat technique which combines intensity modulated radiation therapy imrt and volumetric modulated arc therapy vmat for the treatment of nonsmall cell lung cancer nsclc. Julia r murray,1,2 helen a mcnair,2 david p dearnaley1,21academic urology unit, institute of cancer research, london, 2department of radiotherapy, the royal marsden nhs foundation trust, sutton, uk abstract. Optimization methods for volumetric modulated arc therapy and. Imrt is provided in two treatment phases, planning and delivery. Some claim, however, that 3dcrt is better than imrt or vmat for lung sbrt, and this is the premise debated in this months pointcounterpoint. Review and guidelines for treating head and neck tumors. Volumetric modulated arc therapy vmat treatment planning. Comparison of vmat, field in field, inverse imrt, and helical. B vmat and ht emerged as the planning solutions able to achieve the most balanced compromise between higher conformation around the target and smaller volumes of oar exposed to lower doses typical of 3dcrt. Neurocognitive disorders have been associated to the ra. Hybrid imrt vmat technique which combined intensity modulated radiotherapy imrt and volumetric modulated arc therapy vmat was developed for the treatment of nasopharyngeal cancer npc. Volumetric modulated arc therapy vmat peter maccallum.
Two partial arcs vmat, 5field imrt, and hybrid plans were created for 15 patients with nsclc. Intensity modulated radiation therapy versus volumetric. Pdf hybrid imrtvmat technique which combined intensity modulated radiotherapy imrt and. Frontiers dosimetric and radiobiological comparison of. Pdf a hybrid imrtvmat technique for the treatment of. The study is to investigate a hybrid imrtvmat technique which combines intensity modulated radiation therapy imrt and volumetric modulated arc therapy vmat for the treatment of nonsmall cell lung cancer nsclc. Imrt, vmat, and tomo comparison based on the planning target volume. Among the different imrt techniques, ht and vmat showed higher levels of conformation. Pdf innowacyjne metody wykorzystywane w radioterapii. A comparative planning and dosimetric study comparing. Compared planning dosimetry of tomo, vmat and imrt in rectal. Letter to editor imrt, vmat and proton therapy for. Ht proved to be superior to vmat and imrt in terms of ci and hi.
When imrt is furnished to beneficiaries in a hospital outpatient department that is paid under. To compare treatment plans for helical tomotherapy tomo, volumetric modulated arc therapy vmat and intensitymodulated radiotherapy. Reading assignments 3d and electronrelated manuscripts. Imrt isocenters located under the sternum or in the center of the left and right planning target volumes ptvs, and tp. Because physicians can modulate or control the intensity of the radiation beam in vmat and tomotherapy, both treatments provide high precision radiation with which tumors that are curved around critical organs can be treated. Intensitymodulated radiation therapy imrt is an advanced mode of highprecision radiotherapy that uses computercontrolled linear accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor.
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