Fully automated volumetric modulated arc therapy technique for radiation therapy of locally advanced breast cancer.

Background: This study aimed to evaluate an a-priori multicriteria plan optimization algorithm (mCycle) for locally advanced breast cancer radiation therapy (RT) by comparing automatically generated VMAT (Volumetric Modulated Arc Therapy) plans (AP-VMAT) with manual clinical Helical Tomotherapy (HT) plans.

Methods: The study included 25 patients who received postoperative RT using HT. The patient cohort had diverse target selections, including both left and right breast/chest wall (CW) and III-IV node, with or without internal mammary node (IMN) and Simultaneous Integrated Boost (SIB).

Simulation CT-based radiomics for prediction of response after neoadjuvant chemo-radiotherapy in patients with locally advanced rectal cancer.

Background: To report on the discriminative ability of a simulation Computed Tomography (CT)-based radiomics signature for predicting response to treatment in patients undergoing neoadjuvant chemo-radiation for locally advanced adenocarcinoma of the rectum.

Methods: Consecutive patients treated at the Universities of Tübingen (from 1/1/07 to 31/12/10, explorative cohort) and Florence (from 1/1/11 to 31/12/17, external validation cohort) were considered in our dual-institution, retrospective analysis. Long-course neoadjuvant chemo-radiation was performed according to local policy.

Clinical validation of an automatic atlas-based segmentation tool for male pelvis CT images.

Purpose: This retrospective work aims to evaluate the possible impact on intra- and inter-observer variability, contouring time, and contour accuracy of introducing a pelvis computed tomography (CT) auto-segmentation tool in radiotherapy planning workflow.

Methods: Tests were carried out on five structures (bladder, rectum, pelvic lymph-nodes, and femoral heads) of six previously treated subjects, enrolling five radiation oncologists (ROs) to manually re-contour and edit auto-contours generated with a male pelvis CT atlas created with the commercial software MIM MAESTRO. The ROs first delineated manual contours (M).

The influence of basic plan parameters on calculated small field output factors - A multicenter study.

Purpose: The influence of basic plan parameters such as slice thickness, grid resolution, algorithm type and field size on calculated small field output factors (OFs) was evaluated in a multicentric study.

Methods And Materials: Three computational homogeneous water phantoms with slice thicknesses (ST) 1, 2 and 3 mm were shared among twenty-one centers to calculate OFs for 1x1, 2x2 and 3x3 cm field sizes (FSs) (normalized to 10x10 cm FS), with their own treatment planning system (TPS) and the energy clinically used for stereotactic body radiation therapy delivery. OFs were calculated for each combination of grid resolution (GR) (1, 2 and 3 mm) and ST and finally compared with the OFs measured for the TPS commissioning.

Validation of a secondary dose check tool against Monte Carlo and analytical clinical dose calculation algorithms in VMAT.

Purpose: Patient-specific quality assurance (QA) is very important in radiotherapy, especially for patients with highly conformed treatment plans like VMAT plans. Traditional QA protocols for these plans are time-consuming reducing considerably the time available for patient treatments. In this work, a new MC-based secondary dose check software (SciMoCa) is evaluated and benchmarked against well-established TPS (Monaco and Pinnacle ) by means of treatment plans and dose measurements.

Local treatment for relapsing glioblastoma: A decision-making tree for choosing between reirradiation and second surgery.

In case of circumscribed recurrent glioblastoma (rec-GBM), a second surgery (Re-S) and reirradiation (Re-RT) are local strategies to consider. The aim is to provide an algorithm to use in the daily clinical practice. The first step is to consider the life expectancy in order to establish whether the patient should be a candidate for active treatment.

Methodological approach to create an atlas using a commercial auto-contouring software.

Purpose: The aim of this work was to establish a methodological approach for creation and optimization of an atlas for auto-contouring, using the commercial software MIM MAESTRO (MIM Software Inc. Cleveland OH).

Methods: A computed tomography (CT) male pelvis atlas was created and optimized to evaluate how different tools and options impact on the accuracy of automatic segmentation.

Re-irradiation for oligoprogression under Nivolumab in recurrent head and neck squamous cell carcinoma: A case report.

Immune checkpoint inhibitors (ICIs) represent a recently introduced class of agents active in head and neck squamous cell carcinoma (HNSCC). For a subgroup of patients with recurrent or metastatic disease, long-term benefit can be achieved: maintaining a sustained response to immunotherapy is therefore a critical factor for its efficacy at an individual level. In analogy to targeted agents, a limited pattern of progression, or "oligoprogression", can occur.

Automated planning through robust templates and multicriterial optimization for lung VMAT SBRT of lung lesions.

Purpose: To develop and validate a robust template for VMAT SBRT of lung lesions, using the multicriterial optimization (MCO) of a commercial treatment planning system.

Methods: The template was established and refined on 10 lung SBRT patients planned for 55 Gy/5 fr. To improve gradient and conformity a ring structure around the planning target volume (PTV) was set in the list of objectives.

ADAM phantom to test 4D medical imaging and dose delivery devices.

Radiotherapy treatment of moving lesions is a challenging task in which different strategies can be used. The clinical implementation of the variety of complex technical solutions pursued to treat cancer, while sparing healthy tissues, requires accurate quality assurance tests and adequate phantoms. The aim of this work is to report on the anthropomorphic dynamic breathing model (ADAM) and on its applications to test image quality and dose delivery for four-dimensional (4D) techniques used to compensate for breathing-induced tumor motion.

A multiparametric method to assess the MIM deformable image registration algorithm.

A quantitative evaluation of the performances of the deformable image registration (DIR) algorithm implemented in MIM-Maestro was performed using multiple similarity indices. Two phantoms, capable of mimicking different anatomical bending and tumor shrinking were built and computed tomography (CT) studies were acquired after applying different deformations. Three different contrast levels between internal structures were artificially created modifying the original CT values of one dataset.

Auto-planning for VMAT accelerated partial breast irradiation.

Purpose: To evaluate the quality of accelerated partial breast irradiation (APBI) plans generated by the Auto-Planning module of a commercial treatment planning system (TPS).

Material And Methods: Twenty patients, previously planned and treated with manual planning in a TPS (manM), were re-planned using manual (manP) and automatic (AP) module of a different TPS. Plans were compared in terms of dosimetric parameters, degree of modulation, monitor units and treatment time, and by blind qualitative scoring by a physician.

Assessment of a guideline-based heart substructures delineation in left-sided breast cancer patients undergoing adjuvant radiotherapy : Quality assessment within a randomized phase III trial testing a cardioprotective treatment strategy (SAFE-2014).

Background And Purpose: In our institute, breast cancer patients undergoing adjuvant treatment are included in a protocol aimed to reduce cardiovascular morbidity (SAFE-2014, NCT2236806), assessing preclinical heart damage with heart speckle-tracking ultrasound. To develop a dose constraint related to subclinical heart damage, a reliable delineation of heart substructures based on a pre-existing guideline was made.

Patients And Methods: Heart substructures of 16 left-sided breast cancer patients included in the SAFE protocol were delineated by five operators.

Fully automated, multi-criterial planning for Volumetric Modulated Arc Therapy - An international multi-center validation for prostate cancer.

Background And Purpose: Reported plan quality improvements with autoplanning of radiotherapy of the prostate and seminal vesicles are poor. A system for automated multi-criterial planning has been validated for this treatment in a large international multi-center study. The system is configured with training plans using a mechanism that strives for quality improvements relative to those plans.

Real-time beam monitoring for error detection in IMRT plans and impact on dose-volume histograms : A multi-center study.

Purpose: This study aimed to test the sensitivity of a transmission detector for online dose monitoring of intensity-modulated radiation therapy (IMRT) for detecting small delivery errors. Furthermore, the correlation of changes in detector output induced by small delivery errors with other metrics commonly employed to quantify the deviations between calculated and delivered dose distributions was investigated.

Methods: Transmission detector measurements were performed at three institutions.

γTools: A modular multifunction phantom for quality assurance in GammaKnife treatments.

Purpose: We present the γTools, a new phantom designed to assess geometric and dosimetric accuracy in Gamma Knife treatments, together with first tests and results of applications.

Methods: The phantom is composed of two modules: the imaging module, a regular grid of 1660 control points to evaluate image distortions and image registration result and the dosimetry module for delivered dose distribution measurements. The phantom is accompanied by a MatLab routine for image distortions quantification.

Lung stereotactic ablative body radiotherapy: A large scale multi-institutional planning comparison for interpreting results of multi-institutional studies.

Purpose: A large-scale multi-institutional planning comparison on lung cancer SABR is presented with the aim of investigating possible criticism in carrying out retrospective multicentre data analysis from a dosimetric perspective.

Methods: Five CT series were sent to the participants. The dose prescription to PTV was 54Gy in 3 fractions of 18Gy.

GafChromic(®) EBT3 films for patient specific IMRT QA using a multichannel approach.

Purpose: To evaluate EBT3 for pre-treatment patient specific quality assurance (QA). The method we propose combines the experience gained in our center with the guidelines of the protocol proposed by Lewis et al. in 2012.

A synthetic diamond diode in volumetric modulated arc therapy dosimetry.

Purpose: The aim of this work is to investigate the behavior of a single crystal diamond diode (SCDD) for volumetric modulated arc therapy (VMAT) dose verifications. This delivery technique is one of the most severe test of a dosimeter performance due to the modulation of the dose rate achieved by simultaneously changing the velocity of the gantry and the position of the collimator leaves. The performed measurements with VMAT photon beams can therefore contribute to an overall global validation of the device to be used in dose distribution verifications.

Simultaneous integrated boost-intensity-modulated radiotherapy in head and neck cancer.

Objectives/hypothesis: To review toxicity and outcomes in patients with head and neck cancer treated with simultaneous integrated boost-intensity-modulated radiotherapy (SIB-IMRT).

Study Design: Review of experience with the SIB-IMRT technique.

Methods: Fifty patients were treated with the SIB-IMRT technique.

Verification of IMRT fields by film dosimetry.

In intensity modulated radiation therapy (IMRT) the aim of an accurate conformal dose distribution is obtained through a complex process. This ranges from the calculation of the optimal distribution of fluence by the treatment planning system (TPS), to the dose delivery through a multilamellar collimator (MLC), with several segments per beam in the step and shoot approach. The above-mentioned consideration makes mandatory an accurate dosimetric verification of the IM beams.