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Radiation Oncology
Published in: Radiation Oncology 1/2015

Open Access 01-12-2015 | Research

Impact of MLC properties and IMRT technique in meningioma and head-and-neck treatments

Authors: Steffi Kantz, Matthias Söhn, Almut Troeller, Michael Reiner, Helmut Weingandt, Markus Alber, Claus Belka, Ute Ganswindt

Published in: Radiation Oncology | Issue 1/2015

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Abstract

Purpose

The impact of multileaf collimator (MLC) design and IMRT technique on plan quality and delivery improvements for head-and-neck and meningioma patients is compared in a planning study.

Material and methods

Ten previously treated patients (5 head-and-neck, 5 meningioma) were re-planned for step-and-shoot IMRT (ssIMRT), sliding window IMRT (dMLC) and VMAT using the MLCi2 without (−) and with (+) interdigitation and the Agility-MLC attached to an Elekta 6MV linac. This results in nine plans per patient. Consistent patient individual optimization parameters are used. Plans are generated using the research tool Hyperion V2.4 (equivalent to Elekta Monaco 3.2) with hard constraints for critical structures and objectives for target structures. For VMAT plans, the improved segment shape optimization is used.
Critical structures are evaluated based on QUANTEC criteria. PTV coverage is compared by EUD, Dmean, homogeneity and conformity. Additionally, MU/plan, treatment times and number of segments are evaluated.

Results

As constrained optimization is used, all plans fulfill the hard constraints. Doses to critical structures do not differ more than 1Gy between the nine generated plans for each patient. Only larynx, parotids and eyes differ up to 1.5Gy (Dmean or Dmax) or 7 % (volume-constraint) due to (1) increased scatter, (2) not avoiding structures when using the full range of gantry rotation and (3) improved leaf sequencing with advanced segment shape optimization for VMAT plans. EUD, Dmean, homogeneity and conformity are improved using the Agility-MLC. However, PTV coverage is more affected by technique. MU increase with the use of dMLC and VMAT, while the MU are reduced by using the Agility-MLC. Fastest treatments are always achieved using Agility-MLC, especially in combination with VMAT.

Conclusion

Fastest treatments with the best PTV coverage are found for VMAT plans with Agility-MLC, achieving the same sparing of healthy tissue compared to the other combinations of ssIMRT, dMLC and VMAT with either MLCi2−/+ or Agility.
Footnotes
1
This advanced segment shape optimization routine is also available for ssIMRT in Monaco 5.1 and higher, and for dMLC in Monaco 5.0 and higher. With this, improved plans for ssIMRT and dMLC will be found.
 
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Metadata
Title
Impact of MLC properties and IMRT technique in meningioma and head-and-neck treatments
Authors
Steffi Kantz
Matthias Söhn
Almut Troeller
Michael Reiner
Helmut Weingandt
Markus Alber
Claus Belka
Ute Ganswindt
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2015
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-015-0447-z

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