With volume modulated arc therapy, doses of radiation are delivered to the patient in an uninterrupted arc around the patient, greatly reducing the time of treatment. A comparative analysis of dosimetric and treatment delivery parameters. Intensity modulated radiation therapy and advanced rotational techniques such as volumetric modulated arc therapy have the potential to increase dose conformity and homogeneity and reduce treatment delivery times. Volumetric modulated arc therapy vmat combined with deep. Planning strategies in volumetric modulated arc therapy. Imat is a rotational intensity modulated radiation therapy imrt which can be delivered using conventional linear accelerator with conventional ulti leaf collimators mlc. Volumetric modulated arc therapy vmat in the treatment of a patient with prostate cancer 2 patient history and diagnosis this is a 62yearold white male that was diagnosed with prostate cancer in late 2010. A large number of treatment planning studies have evaluated the potential for vmat for different disease sites based on the currently available commercial implementations of vmat planning. Increasing radiation dose to the heart is associated with worse survival in stage iii nonsmall cell lung cancer.
The purpose of this study was to investigate the role of beam collimator rotation in volumetric. Vmat also has the potential to offer additional advantages, such as reduced treatment delivery time. Both clinical and treatment planning studies were investigated. The earlier form of arc therapy, termed intensity modulated arc therapy imat was first described by yu in 1995 and required the use of multiple superimposed arcs to achieve a satisfactory dose distribution. Optimization methods for volumetric modulated arc therapy. Volumetricmodulated arc therapy for leftsided breast. Collimator rotation in volumetric modulated arc therapy for craniospinal irradiation and the dose distribution in the beam junction region qilin li, wendong gu, jinming mu, wenming yin, min gao, juncong mo and honglei pei abstract purpose.
To investigate the feasibility of partial arc volumetric modulated arc therapy vmat in lung cancer stereotactic body radiotherapy sbrt, as well the volumetric and dosimetric effects of different internal target volume itv definitions with 4d ct. Optimizing laryngeal sparing with intensity modulated. Static imrt sliding window, single arc sa, da and ta plans were generated with eclipse planning system. Volumetric modulated arc therapy vmat is a novel radiation therapy technique that delivers the radiation dose continuously as the treatment machine rotates. Dose verification of volumetric modulated arc therapy. We sought to evaluate the ability of optimized volumetric modulated arc therapy vmat and intensity modulated proton therapy impt to spare cardiac substructures. Target volumes coverage appeared better with vmat than with mwt. A series of 17 patients with 2 to 5 brain metastatic lesions were studied. Linac parameters such as the multileaf collimator mlc position and jaw position, cumulative monitor units mus, and the corresponding gantry angle were recorded during the clinical delivery of volumetric modulated arc therapy for prostate, lung, and headneck cancer patients. Dose verification of volumetricmodulated arc therapy. We previously reported that noncoplanar intensity modulated radiotherapy imrt was superior to coplanar imrt in organatrisk oar protection and target dose distribution. Dose verification of volumetricmodulated arc therapy using. Partial and full arc volumetric modulated arc therapy in. Imat is a rotational intensity modulated radiation therapy imrt which can be delivered using conventional linear.
A total of 18 perturbations where introduced in 11 vmat treatment plans that shifted the isocenter from its reference position of 3, 5. Warrington, commissioning of volumetric modulated arc therapy vmat. Volumetric modulated arc therapy improves dosimetry and reduces treatment time compared to conventional intensity modulated radiotherapy for locoregional radiotherapy of leftsided breast cancer and internal mammary nodes. Code of practice for the quality assurance and control for.
Volumetric modulated arc therapy planning for distal. The use of fast sweeping uninterrupted arc of radiation beam not only reduces the time of the treatment from 8 15 minutes to less than 3 5 minutes but also enables in dose reduction to the patient. To compare variable doserate volumetric modulated arc therapy vmat with 7field, stepandshoot intensity modulated radiation therapy imrt in prostate cancer patients treated with a consistent planning target volume ptv to a uniform total radiation therapy dose. More recent vmat techniques have allowed the whole target volume to be treated using one or two arcs, although complex cases may require.
To evaluate how the use of volumetricmodulated arc therapy vmat with rapidarc can improve treatment delivery efficiency based on the. Volumetric modulated arc therapy vmat is considered to deliver a better dose distribution and to shorten treatment time. Keratoacanthomas following definitive volumetric modulated. Volumetric modulated arc therapy vmat, formally known as intensity modulated arc therapy imat was introduced by cedric yu 1995b1. Then, linac parameters were converted into the beamdata format used in the treatment planning system. Fourteen patients with primary and metastatic lung cancer underwent sbrt were enrolled.
More recent vmat techniques have allowed the whole target volume to be treated using one or two arcs, although complex cases may require more. This consecutive treatment planning study compared imrt with volumetric modulated arc therapy vmat. Volumetric modulated arc therapy vmat adopted in postmastectomy radiation therapy pmrt has the capacity to achieve highly conformal dose distributions. Imrt for the treatment of distal esophageal cancer. Critical appraisal of the role of volumetric modulated arc. Volumetric modulated arc therapy vmat may be another approach to investigate improvement in these parameters.
Volumetric modulated arc therapy is a novel form of treatment in the era of modern radiation oncology dealing with fast and rapid treatment of cancers. Pdf clinical applications of volumetric modulated arc. Volumetric modulated arc therapy for treatment of solid tumors ncbi. Volumetric modulated arc therapy vmat is an elegant technique of delivering imrt that allows for shorter treatment times achieved by optimizing mlc positions and dose rate while the gantry rotates around the patient with the beamon. Helical tomotherapy and volumetric modulated arc therapy.
Code of practice for the quality assurance and control for volumetric modulated arc therapy february 2015 this report was prepared by a subcommittee of the netherlands commission on radiation dosimetry ncs. Vmatimrt are complex radiation treatments that are normally used for. Anatomical features are identifiable on static phantom scatter images collected with 10 mu of delivered dose 2. Volumetric modulated arc therapy vmat is a specific type of intensity modulated radiation therapy imrt in which the gantry speed, multileaf collimator mlc leaf position and dose rate vary continuously during delivery. Dosimetric comparison between the prostate intensitymodulated radiotherapy imrt and volumetricmodulated arc therapy vmat plans using the planning target volume ptv dosevolume factor volume 15 issue 3 james c. In conventional radiation therapy, a motion encompassing margin is normally added to the clinical target volume ctv to ensure the tumour receives the planned. Minimizing radiation dose exposure to nearby organs is key to limiting clinical toxicities associated with radiotherapy. Volumetric modulated arc therapy vmat for hippocampal. And by using 3d imaging, volume modulated arc therapy allows physicians to visualize the tumor at the time of treatment and guide the radiation beams to maximize radiation dose. Volumetric modulated arc therapy versus intensity modulated radiotherapy for large volume retroperitoneal sarcomas.
Impact of positioning errors in the dosimetry of vmat left. Late cardiovascular diseaserelated adverse events are one of the most common causes of premature mortality among longterm survivors of childhood. The determination of optimal treatment plans for volumetric modulated arc therapy vmat p. Evaluation of the dosimetric advantage, if any, of rapidarc double arc and triple arc da and ta over standard fixed field intensity modulated radiation therapy imrt in gynecologic malignancies. Is volumetric modulated arc therapy rapidarc better than. Shepard swedish cancer institute, seattle, wa purposeobjectives. Largescale studies using standardized procedures should be conducted to validate our results. A volumetric modulated arc therapy vmat beam arrangement has previously been proposed for breast cases, where the chest wallbreast is treated with a limited angle partial arc tangential vmat. Vmat, considered to be similar to imrt was first described by yu et al. A total of 20 cases of gynecologic malignancies were included. In dual arc conventional volumetric modulated arc therapy dacvmat, the large irradiation field for whole brain planned target volume ptv requires a wide jaw opening in which substantial low dose volume to the hippocampus may be produced due to suboptimal multileaf collimator mlc movements.
For gynaecological cancers, volumetric modulated arc therapy vmat offers comparable plan quality with shorter treatment delivery times when compared to intensity modulated radiation therapy imrt. Anton mans danny schuring mark arends lia vugts jochem wolthaus heidi lotz marjan admiraal rob louwe. Pdf the physics behind volumetric modulated arc therapy. Volumetric modulated arc therapy vmat in the treatment of esophageal cancer patients article pdf available in medical oncology 3512 december 2018 with 255 reads how we measure reads. Volumetric modulated arc therapy vmat is a technique of intensity modulated radiation therapy imrt permitting improved planning target. 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. The capability of vmat to reduce heart and cord dose, while maintaining lung receiving 20 gy,20%, was evaluated for. Dose verification of volumetric modulated arc therapy using onedimensional and twodimensional dosimeters volume 18 issue 3 jalil ur rehman, zahra syed, ghulam hussain, nisar ahmad, h m noor ul huda khan asghar, zaheer abbas gilani. In breast radiotherapy with intensity modulation, it is a well established practice to extend the dose fluence outside the limit of the body contour to account for small changes in size and position of the target and the rest of the tissues due to respiration or to possible oedema. However, gating significantly prolongs treatment time. Dosimetric comparison between the prostate intensity modulated radiotherapy imrt and volumetric modulated arc therapy vmat plans using the planning target volume ptv dose volume factor volume 15 issue 3 james c. Volumetric modulated arc therapy for prostate cancer pdf. Pdf volumetric modulated arc therapy vmat is a novel radiation technique, which can achieve highly conformal dose distributions with improved target.
The purpose of this work was to investigate whether the mobius3d v. Pdf treatment planning for volumetric modulated arc. Volumetric modulated arc therapy vmat cleveland clinic. Volumetric modulated arc therapy for prostate cancer m. Volumetric modulated arc therapy vmat uses an aperturebased optimization technique, which minimizes both mu and radiation leakage. Purpose total scalp irradiation tsi is a rare but challenging indication. Volumetric modulated arc therapy vmat for leftsided breast treatment, including lymph node irradiation involving the imc, was recently compared with mwt 6, 7, but never with a forwardplanned multisegment technique with a monoisocenter monoiso. The role of volumetric modulated arc therapy vmat in. Collimator rotation in volumetric modulated arc therapy for. Effective heart sparing is possible for whole lung irradiation using volumetric modulated arc therapy. Effective heartsparing whole lung irradiation using. Plan quality and treatment planning technique for single.
Treatment of multiple brain metastases using stereotactic. Volumetric modulated case study arc therapy vmat in the. A dosimetric comparison of double arc volumetric modulated arc therapy with large field intensity modulated radiation therapy for head and neck cancer doi. Volumetric modulated arc therapy vmat has found widespread clinical application in recent years. In dual arc conventional volumetric modulated arc therapy dac vmat, the large irradiation field for whole brain planned target volume ptv requires a wide jaw opening in which substantial low dose volume to the hippocampus may be produced due to suboptimal multileaf collimator. Pdf application of volumetric modulated arc therapy.
Radiation pneumonitis in lung cancer treated with volumetric. A dosimetric comparison of double arc volumetric modulated. Purpose volumetric modulated arc therapy vmat is a specific type of intensity modulated radiation therapy imrt in which the gantry speed, multileaf collimator mlc leaf position, and dose rate vary continuously during delivery. As part of the diagnosis, the medical team generates threedimensional diagnostic images usually ct andor pet of the patients anatomy and then uses these images to specify the dose of radiation needed to treat the tumor. Pdf treatment planning for volumetric modulated arc therapy. This technique accurately shapes the radiation dose to the tumour while minimising the dose to the organs surrounding the tumour. Rapidarc always uses single arc to deliver treatment. Considerations in bilateral lung treatment planning with. Volumetric modulated arc therapy vmat is a novel radiation technique, which can achieve highly conformal dose distributions with improved target volume coverage and sparing of normal tissues compared with conventional radiotherapy techniques. Clinical applications of volumetric modulated arc therapy. Treatment planning for volumetric modulated arc therapy. Several treatment modalities such as split or wholefield intensity modulated radiotherapy sfimrt, wfimrt and volumetric modulated arc therapy vmat are being used to treat tonsillar cancer patients with unilateral neck radiotherapy.
Although arc therapy can be traced back to the dawn of the 20th century, arc therapy involving dynamic field shaping using a multileaf collimator was first described by takahashi in 1965. Application of volumetric modulated arc therapy vmat in a dualvendor environment article pdf available in radiation oncology 51. Vmatimrt are complex radiation treatments that are normally used for complex cancers requiring targeted radiation treatment. A four dimensional volumetric modulated arc therapy. Volumetric modulated arc therapy, based on the original investigation of otto 6 has been introduced in clinical practice in several institutes after an intensive validation at the planning level, compared with intensity modulated radio therapy imrt or other approaches.
Intensity modulated arc therapy imat the evolution of. Intensity modulated arc therapy imat was proposed by yu as an alternative to. Genesiscare provides vmatimrt to all patients at no additional cost and without delay to commencement of the treatment process. A novel 4d volumetric modulated arc therapy 4d vmat planning system is presented where radiation sparing of organs at risk oars is enhanced by exploiting relative target and healthy tissue motion induced by patient respiration. In a community cancer center, treating prostate cancer comprises about one third of a typical practices volume. Differences in isodose distribution between intensity modulated radiation therapy imrt in the eclipse treatment planning system and volumetric modulate arc therapy vmat in the monaco treatment planning system. This esurvey was carried out to facilitate the implementation and education of vmat volumetric modulated arc therapy in radiotherapyrt departments and. Popescu cc, olivotto ia, beckham wa, ansbacher w, zavgorodni s, shaffer r, wai es, otto k. Methods arc control points are created uniformly throughout one or more arcs.
We also wanted to determine how a cardiac optimization treatment planning algorithm influences dose distribution to. Optimization approaches to volumetric modulated arc. Purpose volumetric modulated arc therapy vmat is a specific type of intensitymodulated radiation therapy imrt in which the gantry speed, multileaf. A simple approach is not applicable with rapidarc volumetric modulated arc therapy not being based on a. Optimization approaches to volumetric modulated arc therapy. Dosimetric comparison between the prostate intensity. Pdf volumetric modulated arc therapy versus intensity. The clinical imrt plans of twenty gynaecological cancer patients were compared with a retrospectively generated vmat plan. Gated volumetric modulated arc therapy vmat is an emerging treatment modality for stereotactic body radiotherapy sbrt. Volumetricmodulated arc therapy for leftsided breast cancer. A dosimetric comparison of volumetric modulated arc. Chow, runqing jiang, alexander kiciak, daniel markel. Apr 14, 2014 differences in isodose distribution between intensity modulated radiation therapy imrt in the eclipse treatment planning system and volumetric modulate arc therapy vmat in the monaco treatment planning system. Optimization methods for volumetric modulated arc therapy and.
Istanbul, turkey abstract the success of radiation therapy depends on the ability to deliver the proper amount of radiation to cancerous cells. Nuclear medicine volume modulated arc therapy vmat. Dose verification of volumetric modulated arc therapy using onedimensional and twodimensional dosimeters volume 18 issue 3 jalil ur rehman, zahra syed, ghulam hussain, nisar ahmad, h m noor ul huda khan asghar, zaheer abbas gilani, gulfam nasar, malik m akhter, muhammad isa, tahir iqbal. A pubmedmedline search of the national library of medicine was performed to identify vmat and breast related articles.
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