Objective To evaluate the absorbed doses of lower-neck and supraclaviclar subclinical target and the normal tissues of nasopharyngeal carcinoma using three different intensity-modulated radiation therapy (IMRT) techniques. Methods Three radiotherapy techniques were single tangential low neck-supraclavicular field technique (tech1), seven portal IMRT in which the gantry angles are 180°, 150°, 120°, 90°, 270°, 210°(tech2) and 240°and eight portal IMRT in which the gantry angles are 180°, 150°, 120°,90°,0°,270°,210°and 240°(tech3). The dose distribution of lower-neck and supraclaviclar subclinical target and normal tissues were analyzed through the dose-volume histograms, high dose volumes were analyzed using V60 (volume of accepted > 60 Gy/all volume × 100%). The delivery efficiencies were evaluated by means of the total number of segments and MUs. Results The V60 of PTV2 were 65%, 10% and 3% in tech1, tech2 and teeh3 respectively. The maximum doses of spinal cord were 42.0, 48.9 and 45.1 Gy in techl, tech2 and tech3 respectively. The average doses of trachea were 32.92, 52.17 and 36.56 Gy in techl, tech2 and tech3 respectively. Conclusions Tech1 is simple method, but the dose distribution is very nonuniform. Tech2 is better than the Tech1, but the spinal cord and trachea receive the highest doses in three strategies. Tech3 uses less number of segments and MUs than Tech2, and has the best dose distribution.

OBJECTIVETo evaluate the feasibility and accuracy of using Megavoltage CT(MVCT) for head and neck dose calculation.

METHODSThe cheese Phantom was imaged using MVCT scanner, and the MVCT value density calibration curve was established. Conventional CT and MVCT image of nasopharyngeal carcinoma was acquired respectively, and IMRT plan was designed on conventional CT image of NPC patient. The conventional CT plan was copied to MVCT image. The dose distribution was calculated for tumor and normal tissue using the MVCT value density calibration curve, and compared with that of conventional CT. Ten NPC patients were collected for dose verification of IMRT plan on MVCT images.

RESULTSThe MVCT numbers depended linearly on the electron density of the sample, and the stability of the MVCT numbers to electron density was good.The error between the measured dose and calculated dose in measured point was less than 3%.The isodose distribution was well agreement with that calculated by planning system.

CONCLUSIONSPerforming dose recalculation using MVCT of Tomotherapy in head and neck region was feasible.and the dose distributions on kVCT and MVCT were in excellent agreement.

Algorithms ; Head and Neck Neoplasms ; radiotherapy ; Humans ; Phantoms, Imaging ; Radiosurgery ; instrumentation ; methods ; Radiotherapy Dosage ; Tomography, Spiral Computed ; instrumentation

Objective To compare the dosimetric differences between helical tomotherapy (HT) and volume-modulated arc therapy (VMAT) in the treatment of upper thoracic esophageal carcinoma (UTEC).Methods A total of 10 patients with UTEC were randomly selected.HT plan and double-arc VMAT plan were designed and optimized for each patient.The prescription dose was 50 Gy/30 fractions for gross target volume (GTV), 66 Gy/30 fractions for planned target volume (PTV).The dose distribution and conformal index (CI), homogeneity index (HI) of target volume, the D1％, D5％, Dg5％, D99％, and dose of organ at risk (OAR) were analyzed by using the dose volume histogram (DVH).The monitor units and delivery time were also evaluated.Results For GTV and PTV, the D99％ of HT plans were slightly higher than those of VMAT plans (t =4.476, 3.756, P ＜ 0.05) , but no significant differences in D1％ , D5％ , D95％ , HI and CI (P ＞ 0.05) were found.The V10, V15, V20 and mean lung dose (MLD) to the total-lung of HT plans were all significantly lower than those of VMAT plans (t =-3.369,-4.824, -4.869,-3.657, P ＜ 0.05).There were no significant differences for V5, V30 and Dmax of cord (P ＞ 0.05).The monitor units and delivery time of VMAT plans were significantly lower than those of HT plans (t =13.970, 7.982, P ＜ 0.05).Conclusions Both HT and VMAT are appropriate for esophageal cancer radiotherapy.HT significantly reduces the radiation dose of the total-lung, while VMAT has obvious advantages in efficiency.

Objective To research the structure and principle of Helical Tomotherapy, and study the clinical application value of the equipment system. Methods As the first helical radiotherapy system in the mainland of China, its constructions, structure and principle were analyzed and discussed. Results Helical Tomotherapy is a new kind of radiotherapy equipment. The Hi-Art treatment system is a combination of a LINAC and a CT scanner capable of having the function of both systems. It was approved to achieve the best intensity modulated radiation therapy (IMRT), used for adjusting the setup position of the patient with MVCT and as the basis for dose reconstruction and other adaptive radiotherapy processes. It is the first integrated planning, delivery and verification system for IMRT. Conclusion Image-guided radiation therapy (IGRT) and IMRT have introduced a new era in radiation oncology which will better fight cancer and simultaneously improve the patients' quality of life. Having been designed from the ground up for IGRT and IMRT, the tomotherapy system is in the forefront of technical advancements for efficacy and processes to make it efficiently.

Objective The aim of this work is to compare the performances of EDR2 film dosimetry with two-dimensional ion chamber array (2DICA) in quality assurance (QA) procedures and to investigate the origin of possible discrepancies between the two methods.Methods A 2DICA, I′mRT MatriXX and MULTICube equivalent solid water phantom from IBA Company were used to verify the dose distribution of 15 tomotherapy plan cases.The combined phantom which includes EDR2 film on the array was set up to measure the dose distribution from coronal and sagittal orientations.After the irradiation, the dose distributions of 2DICA and film were compared with those calculated in the planning system for verification.The results and efficiency were evaluated independently in the two methods.Results The mean number of points satifying γ parameter ≤1 in the coronal and sagittal planes was 97.00%±1.56%& 95.98%±2.52%(t=-2.22,P=0.043) and 98.28%±1.55%& 95.42%±1.99%(t=0.75,P=0.464) of the 15 cases respectively for 2DICA and EDR2 film.The ratio of more than 90% and 95% were 93.3% and 66.7%.The results we presented show a very good agreement between the two methods when used to assess the dose distribution between calculated and measured doses,and a certain degree of correlation (r=0.14,P=0.001).Conclusions The 2DICA may effectively replace both film and ion chamber dosimetry in routine IMRT QA.The good agreement between 2DICA and EDR2 film may give a possible check regularly just as a gold standard.

ObjectiveTo investigate the factors related with curative effect and prognosis of postoperative radiotherapy for nasal and paranasal sinuses carcinoma.MethodsThe data of 95 patients with nasal and paranasal sinuses carcinoma and received postoperative radiotherapy were reviewed retrospectively. Kaplan-Meier method was used to analyze the survival, Logrank test used to compare the differences between different groups. Multivariate analysis was performed by Cox proportional hazard model.ResultsThe overall 1, 3, 5, 10-year survival rates of 95 patients were 84.2%, 50.5%, 44.2% and 20% respectively. Univariate analysis showed that sex, age, operative modality and tumor dose were not related with survival. Histological and clinical stages were related with survival. Multivariate analysis indicated that histological and clinical stages were independent prognostic factors. The follow-up results showed that visual disturbance, xerostomia, dysaudia were the major side effects.ConclusionPostoperative radiotherapy can improve therapeutic effect in the treatment of nasal and paranasal sinuses carcinoma, and histological and clinical stages are the independent prognostic factors effecting prognosis.

Objective To investigate the feasibility of dose verification of intensity modulated (IM) planning of helical tomotherapy (HT) using two-dimensional ion chamber array (2DICA),and develop an efficient way to validate the dose delivered under the parameters mirroring those during the treatment. Meth-ods A 2DICA,I'mRT MatriXX and MULTICube equivalent solid water phantom from IBA company were used to verify the dose distribution of 10 IM planning. The combined phantom was set up to measure the dose distributions on coronal and sagittal surface. The precise setup of phantom was guided by HTMVCT images. After the irradiation, the measured dose distributions on the coronal and sngittal plane were compared with those calculated by the IM planning system for verification. The results were evaluated and the feasibility of the different measuring methods was studied. Results The dose distribution measured by the MatriXX 2DICA was well consistent with that calculated by the treatment planning system. The errors between the measured dose and predicted dose in the selected points were within ±3%. In the comparison of the pixel-segmented ionization chamber versus treatment planning system using the 3 mm/3% γ criteria, the passing ratio of pixels with γ parameter ≤1 was 97.76% and 96.83%, respectively. Conclusions MatriXX is a-ble to measure the absolute and relative dose distributions simultaneously,which can be used for dose verifi-cation of IM planning.

Objective To evaluate the clinical feasibility of quality assurance of helical tomotherapy intensity modulated radiation therapy (IMRT) through a series of clinical case studies. Methods Tomotherapy planning system was used to provide optimized IMRT treatment plans. To verify the dose of IMRT plans,the cylindrical Virtual Water phantom,0.056cm3 AISL, ion chamber and EDR2 film were used for getting the absolute and relative doses from tomotherapy IMRT planning. The film and ion chamber were placed into the phantom. The doses of the interesting points and isodose distribution of the axial plane were measured,then the results were compared with those from the calculation in planning system for verification. Before the irradiation,kVCT images of the phantom were registered by tomotherapy MVCT images. So the setup of phantom was guided for verifying the position. Results The isedose distribution (on the axial plane) measured by the film was well consistent with that calculated by tomotherapy planning system. The error between the measured dose and predicted dose in the measured points was less than 3%. The setup error of the phantom was able to be kept within 1 mm. There was 2 mm offset along the vertical direction of couch from the virtual isocenter to beam isocenter,which should be considered during the phantom/patient setup. Conclusions The procedures for quality assurance of tomotherapy IMRT are feasible in our experience. And helical tomotherapy IMRT QA system has been constituted.

Objective To study dosimetric characteristics of helical tomotherapy (HT) by comparing its treatment plans with linear accelerator-based step-and-shoot intensity modulated radiation therapy (IMRT) for nasopharyngeal carcinoma(NPC). Methods Targets on CT images of 10 NPC patients were delineated and transferred to HT and IMRT treatment plan systems. The prescription dose was 70 Gy/33 f for pGTV and GTVnd,60 Gy/33 f for FTV1 ,and 54 Gy/33 f for PTV2. The limit dose of organ at risk was parotid V35 ＜50% ,brain-stem＜54 Gy,spinal cord ＜45 Gy and lens ＜9 Gy. Data of the two groups were compared by paired t-test. Results The dose distribution, conformality and homogeneity were good in both groups.But the homogeneity index(HI) and Dmean of PTV1 in HT group were better than IMRT group( P ＜ 0.01 ).The Dmean of PTV1 in HT group(63.84 Gy)was lower than IMRT group(70.30 Gy). The Dmean, V35 and V30 of parotids,and the Dmax of larynx-esophagus were lower in HT group than IMRT group. Conclusions Helical tomotherapy treatment plan has a better homogeneity, steeper dose gradient, and a better protection for organs at risk.

Objective To evaluate the dosimetric effect of carbon fiber tabletop on the patient doses in radiotherapy. Methods The transmission factors of couch and inserts were measured in air and solid water phantom using 0.6 cm3 ion chamber and PTW 2D ion chamber array for 6 MV ,10 MV and 18 MV X-ray,respectively. Absorbed doses at depth of maximum dose ,5 cm and 10 cm in solid water were measured with the 2D ion chamber array. Absorbed doses fluctuations with different gantry angles and air gaps between phantom and couch were also measured. Results The posterior field measurement showed that the reductions of absorbed doses at the depth maximum dose,5 cm and 10 cm were within 5%. The ratios of the absorbed doses with to without couch increased with the oblique incident angles and varied slightly with the air gap at depth of 5 cm. The transmission factors of inserts were less than those of couch owing to its thinner thickness. Conclusion The carbon-fiber tabletop affects the absorbed doses and dose distributions of the target, and this effect changes with the gantry angle and air gap. Special considerations should be taken during treatment planning.