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Dosimetric study for spine stereotactic body radiation therapy: magnetic resonance guided linear accelerator versus volumetric modulated arc therapy Cover

Dosimetric study for spine stereotactic body radiation therapy: magnetic resonance guided linear accelerator versus volumetric modulated arc therapy

Open Access
|Sep 2019

Figures & Tables

Figure 1

Isodose distribution (right) for TrueBeamTM STx VMAT and MRIdian Linac Plans: 30 Gy to gross tumor volume (GTV) and 27 Gy to planning target volume (PTV) in 3 fractions. On left, solid and dashed lines represents dose volume histogram for TrueBeamTM STx VMAT and MRIdian Linac Plans for GTV, PTV, Spinal Cord and Spinal Cord+2mm.
Isodose distribution (right) for TrueBeamTM STx VMAT and MRIdian Linac Plans: 30 Gy to gross tumor volume (GTV) and 27 Gy to planning target volume (PTV) in 3 fractions. On left, solid and dashed lines represents dose volume histogram for TrueBeamTM STx VMAT and MRIdian Linac Plans for GTV, PTV, Spinal Cord and Spinal Cord+2mm.

Figure 2

A metastatic tumor in the vertebral body of lumbar spine and adjacent spinal cord scan acquired on 1.5T diagnostic magnetic resonance (MR) and 0.345T ViewRay MRIdian Linac system. MRIdian scan allows for accurate delineation of the tumor and the spinal cord without having to rely on the fused diagnostic MR scan.
A metastatic tumor in the vertebral body of lumbar spine and adjacent spinal cord scan acquired on 1.5T diagnostic magnetic resonance (MR) and 0.345T ViewRay MRIdian Linac system. MRIdian scan allows for accurate delineation of the tumor and the spinal cord without having to rely on the fused diagnostic MR scan.

Figure 3

Fractional 0.345T MRIdian Linac MR scan (Top) and Kilo Voltage Cone Beam (Bottom) used for daily setup verification before radiotherapy treatment. Visibility of spinal cord on 0.345T is demonstrated increasing the accuracy on treatment delivery.
Fractional 0.345T MRIdian Linac MR scan (Top) and Kilo Voltage Cone Beam (Bottom) used for daily setup verification before radiotherapy treatment. Visibility of spinal cord on 0.345T is demonstrated increasing the accuracy on treatment delivery.

Figure 4

Fractional 0.345T MRIdian Linac MR scan (Left) and TomoTherapy® Mega Voltage CT (Right) used for daily setup verification before radiotherapy treatment. Visibility of target (red) on 0.345T is demonstrated.
Fractional 0.345T MRIdian Linac MR scan (Left) and TomoTherapy® Mega Voltage CT (Right) used for daily setup verification before radiotherapy treatment. Visibility of target (red) on 0.345T is demonstrated.

Figure 5

0.345T MRIdian Linac cine acquired in sagittal plane. Any changes in reference setup results in shutting the radiation beam off as tracking structure (green) moves outside the boundary (red).
0.345T MRIdian Linac cine acquired in sagittal plane. Any changes in reference setup results in shutting the radiation beam off as tracking structure (green) moves outside the boundary (red).

Dose volume parameters for PTV, GTV, Spinal Cord and Cauda Equina for MRIdian Linac IMRT plans Vs TrueBeamTM STx VMAT plans

StructuresTrueBeamTM STx VMATMRIdian Linac IMRTp-value
PTVMedian(range)Median(range)
D98% (Gy)25.7 (15.6–29.5)26.5 (17.7–29.7)0.20
D50% (Gy)29.0 (27.9–39.1)30.0 (26.4–33.2)0.77
Conformity Index0.97 (0.93–1.0)0.97 (0.90–1.0)0.13
Dose Homogeneity Index0.22 (0.05–0.6)0.19 (0.1–0.57)0.49
R506.1 (2.9–16.7)5.2 (2.8–11.9)0.05
GTV
D50% (Gy)31.6 (30.4–34.2)31.7 (31.0–34.6)0.36
D98% (Gy)30.12 (25–33.63)30.35 (29.17–32.89)0.23
Conformity Index0.99 (0.95–1.0)0.99 (0.96–1.0)0.58
Dose Homogeneity Index0.09 (0.04–0.33)0.08 (0.01–0.18)0.30
R5032 (6.08–69.0)29 (5.8–66.0)0.01
Spinal Cord
Max dose (Gy)12.6 (9.1–15.6)13.3 (10.35–17.3)0.13
D0.03 (Gy)12 (9.0–15.3)12.8 (9.5–16.5)0.25
Cauda Equina
Max dose (Gy)16 (0.22–28.0)18 (0.3–32)0.38
D0.03 (Gy)13 (0.2–20.0)16 (0.25–31)0.07

Detailed Dose volume histogram parameters for PTV, GTV, Spinal Cord and Cauda Equina for MRIdian Linac IMRT plans Vs TrueBeamTM STx VMAT plans

PTV GTV Spinal Cord Cauda Equina

Case #VolumeMaximumDose (Gy)D95 (Gy)VolumeMaximumDose (Gy)D95 (Gy)MaximumDose (Gy)D0.03 cc(Gy)MaximumDose (Gy)D0.03cc (Gy)


(cc)MRIdian Linac IMRTTrue Beam VMATMRIdian Linac IMRTTrue Beam VMAT(cc)MRIdian Linac IMRTTrue Beam VMATMRIdian Linac IMRTTrue Beam VMATMRIdian Linac IMRTTrue Beam VMATMRIdian Linac IMRTTrue Beam VMATMRIdian Linac IMRTTrue Beam VMATMRIdian Linac IMRTTrue Beam VMAT
160.3734.6935.4427.4327.507.0234.6935.4432.4633.7614.8214.7714.6714.4719.7021.7219.6720.19
250.6332.4532.2727.0027.316.8232.9432.4130.1130.0513.3313.4513.0213.1020.0021.1519.9218.95
366.336.4137.0027.7527.1227.6736.4137.0032.5829.6117.0111.6916.5610.9021.0714.1220.2313.58
447.6331.6830.8527.1927.9418.834.0233.4530.0630.5213.2515.6512.6215.3424.0821.1922.4819.79
52.633.8730.7127.7327.260.933.8732.0230.2430.2112.5813.8111.9212.909.3112.377.737.56
63.9333.5231.4027.6727.891.6533.5234.9632.1727.3910.359.1010.329.0916.4418.0112.5812.32
73.0532.6430.8827.5027.821.0732.6533.7030.4429.0211.1710.1011.1510.0932.1328.0131.1619.32
825.4332.7334.0727.9227.992.3132.7334.0730.3131.4313.7210.9813.2210.3613.7210.613.1910.25
929.0233.9534.1427.5027.601.8935.7034.1430.0530.5211.049.259.538.960.320.220.250.21
1038.2933.0233.9527.8827.022.5133.0233.9530.4530.5117.3014.1114.5113.753.543.673.203.40
DOI: https://doi.org/10.2478/raon-2019-0042 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Language: English
Page range: 362 - 368
Submitted on: Mar 24, 2019
Accepted on: Jul 22, 2019
Published on: Sep 24, 2019
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2019 Poonam Yadav, Hima B. Musunuru, Jacob S. Witt, Michael Bassetti, John Bayouth, Andrew M. Baschnagel, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.