Planning quality and delivery efficiency of sMLC delivered IMRT treatment of oropharyngeal cancers evaluated by RTOG H-0022 dosimetric criteria

J Appl Clin Med Phys. 2004 Autumn;5(4):80-95. doi: 10.1120/jacmp.v5i4.2014. Epub 2004 Oct 1.

Abstract

The time required to deliver intensity-modulated radiation therapy (IMRT) treatments can be significantly longer than conventional treatments, especially for the segmented multileaf collimator (sMLC) delivery system with a large record and verification (R&V) overhead. In this work, we evaluate the impact of the number of intensity-modulated beams (IMBs) and the number of intensity levels (ILs) on the quality and delivery efficiency of IMRT plans, generated by the Corvus planning system for sMLC delivery on a Siemens LINAC with the Lantis R&V system. Detailed studies were performed for three image data sets of previously treated oropharyngeal patients. Treatment plans for patient 1 were developed using 5, 7, 9, or 15 evenly spaced axial IMBs as well as one with 7 axial IMBs whose directions were user-selected, each using ILs of 3, 5, 10, or 20. For patients 2 and 3, plans with 15 IMBs and 20 ILs were not attempted. A total of 42 plans were developed using three oropharyngeal cancer CT image data sets. Plan quality was evaluated by assessing compliance with the Radiation Therapy Oncology Group (RTOG) H-0022 protocol criteria and the physician's clinical judgment. Plan efficiency was accessed by the number of segments of each plan. We found that for our treatment-planning and delivery system, an IMRT plan that uses a moderate number of IMBs and ILs, such as 7 or 9 IMBs with 3 or 5 ILs, would appear to be the optimal approach when both quality of the plan and delivery efficiency are considered. Based on this study, we have routinely used 9 IMBs with 3 ILs or 7 IMBs with 5 ILs for head and neck patients. A retrospective comparison indicates that delivery efficiency is improved on the order of 30% compared to plans generated with 9 IMBs with 5 ILs.

MeSH terms

  • Body Burden
  • Humans
  • Oropharyngeal Neoplasms / radiotherapy*
  • Practice Guidelines as Topic*
  • Quality Assurance, Health Care / methods*
  • Quality Assurance, Health Care / standards
  • Radiometry / methods*
  • Radiometry / standards
  • Radiotherapy Dosage
  • Radiotherapy Planning, Computer-Assisted / methods*
  • Radiotherapy Planning, Computer-Assisted / standards
  • Radiotherapy, Conformal / instrumentation
  • Radiotherapy, Conformal / methods*
  • Radiotherapy, Conformal / standards
  • Relative Biological Effectiveness
  • Treatment Outcome
  • United States