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Case Reports
. 2018 Apr 5;10(4):e2431.
doi: 10.7759/cureus.2431.

Evaluation of Online Plan Adaptation Strategies for the 1.5T MR-linac Based on "First-In-Man" Treatments

Dennis Winkel  1 , Gijsbert H Bol  1 , Ilse H Kiekebosch  1 , Bram Van Asselen  1 , Petra S Kroon  1 , Ina M Jürgenliemk-Schulz  1 , Bas W Raaymakers  1
Affiliations
Case Reports

Evaluation of Online Plan Adaptation Strategies for the 1.5T MR-linac Based on "First-In-Man" Treatments

Dennis Winkel et al. Cureus. .

Abstract

The superior soft tissue contrast provided by magnetic resonance (MR) images on the 1.5T MR-linac allows for the incorporation of patient anatomy information. In this retrospective case study, we present the simulated dosimetric effects and timings of full online replanning as compared to the five plan adaptation methods currently available on the 1.5T MR-linac treatment system. For this case, it is possible to create treatment plans with all six methods within a time slot suitable for an online treatment procedure. However, large dosimetric differences between the plan adaptation methods and full online replanning are present with regards to target coverage and dose to organs at risk (OARs).

Keywords: adaptive planning; adaptive radiotherapy; lumbar spine bone metastases; mr guided radiotherapy; mr-guided-rt; mr-igrt; mr-linac; online replanning.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Dose distribution of the pre-treatment plan generated on the pre-treatment computed tomography (CT, left) with the corresponding dose volume histogram (right). Visible are the planning target volume (PTV, blue), spinal cord (pink), and body (red).
Figure 2
Figure 2. Pre-treatment Computed Tomography (CT, left) and online, just before treatment, Magnetic Resonance Image (MRI, right). Visible are the Planning Target Volume (PTV, blue), spinal cord (pink) and body (red). Small variations between the delineations can be observed.
Figure 3
Figure 3. Dose distribution of the adapted plan using each of the five available plan adaptation methods (left) with the corresponding dose volume histograms (right). Visible are the planning target volume (PTV, blue), spinal cord (pink), and body (red).
Figure 4
Figure 4. Dose distribution of the full online replanned plan (left) with the corresponding dose volume histogram (right). Visible are the planning target volume (PTV, blue), spinal cord (pink), and body (red).
See this image and copyright information in PMC

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