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Dosimetric integration of daily mega-voltage cone-beam CT for image-guided intensity-modulated radiotherapy

PurposeThe goal of this work was to compare different methods of incorporating the additional dose of mega-voltage cone-beam CT (MV-CBCT) for image-guided intensity modulated radiotherapy (IMRT) of different tumor entities.Material and methodsThe absolute dose delivered by the MV-CBCT was calculated...

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Main Authors: Zabel-du Bois, Angelika (Author) , Nill, Simeon (Author) , Rhein, Bernhard (Author) , Schwahofer, Andrea (Author) , Milker-Zabel, Stefanie (Author)
Format: Article (Journal)
Language:English
Published: 5 January 2012
In: Strahlentherapie und Onkologie
Year: 2012, Volume: 188, Issue: 2, Pages: 120-126
ISSN:1439-099X
DOI:10.1007/s00066-011-0021-z
Online Access:Verlag, Volltext: http://dx.doi.org/10.1007/s00066-011-0021-z
Verlag, Volltext: https://doi.org/10.1007/s00066-011-0021-z
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Author Notes:A. Zabel-du Bois, S. Nill, S. Ulrich, U. Oelfke, B. Rhein, P. Haering, S. Milker-Zabel, A. Schwahofer

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520 |a PurposeThe goal of this work was to compare different methods of incorporating the additional dose of mega-voltage cone-beam CT (MV-CBCT) for image-guided intensity modulated radiotherapy (IMRT) of different tumor entities.Material and methodsThe absolute dose delivered by the MV-CBCT was calculated and considered by creating a scaled IMRT plan (scIMRT) by renormalizing the clinically approved plan (orgIMRT) so that the sum with the MV-CBCT dose yields the same prescribed dose. In the other case, a newly optimized plan (optIMRT) was generated by including the dose distribution of the MV-CBCT as pre-irradiation. Both plans were compared with the orgIMRT plan and a plan where the last fraction was skipped.ResultsNo significant changes were observed regarding the 95% conformity index of the target volume. The mean dose of the organs at risk (OAR) increased by approx. 7% for the scIMRT plan and 5% for the optIMRT plan. A significant increase of the mean dose to the outline contour was observed, ranging from 3.1 ± 1.3% (optIMRT) to 13.0 ± 6.1% (scIMRT) for both methods over all entities. If the dose of daily MV-CBCT would have been ignored, the additional dose accumulated to nearly a whole treatment fraction with a general increase of approx. 10% to the OARs and approx. 4% to the target volume.ConclusionBoth methods of incorporating the additional MV-CBCT dose into the treatment plan are suitable for clinical practice. The dose distribution of the target volume could be achieved as conformal as with the orgIMRT plan, while only a moderate increase of mean dose to OAR was observed. 
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