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S1002
ESTRO 36
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The plans were then recalculated implementing the shifts
using the algorithm used for the clinical plans (Eclipse ™,
Varian Medical Systems, Palo Alto, AAA algorithm, v 13.6).
The mean and maximum doses for the lungs, kidneys,
brain and the (body-lungs-5mm) structure were extracted
and the difference between the planned and the
recalculated
doses
determined.Results
The mean doses change by a maximum of 0.6% (lungs), 0.6
(kidneys), 0.5% (brain) and 0.2% (body-lungs-5mm). The
greatest difference between the maximum doses are 8.0%
(lungs), 4.8% (kidneys), 2.6% (brain) and 12.0% (bodylungs-
5mm).
The standard deviation of the difference between the
calculated and recalculated doses are greater for the
maximum doses than the mean doses (figure 2). Given that
the minimum and maximum doses for SS TBI are typically
in the range 90-110% of the prescribed dose, the
differences in maximum dose should lead to care
being
taken when positioning patients for SS TBI.
Conclusion
Patient positioning for a total of 63 fractions of SS TBI is
such that the mean delivered doses differs from the
planned by less than 0.6%. However, the maximum doses
are more sensitive to incorrect patient positioning,
differing by up to 12% with the delivered dose being
greater than the maximum. Correct patient positioning or
SS TBI is pertinent.
EP-1830 Simple method on bladder filling simulation to
improve the soft-tissue evaluation on CBCT
K.L. Jakobsen
1
, K. Andersen
1
, D. Elezaj
1
, D. Sjöstrøm
1
1
University Hospital Herlev, Department of Oncology,
Herlev, Denmark
Purpose or Objective
The purpose of this study is to present a cost effective
method on how to evaluate the robustness of the
treatment plan on different bladder fillings during
treatment planning. Furthermore the purpose is to
evaluate how this method can be used to determine when
a bladder is too small during treatment of the patient.
Material and Methods
Patients suffering from anal and rectum cancer were
enrolled in the study. All patients were instructed to
follow our bladder protocol where the patients are asked
to empty their bladder 1 hour prior to scan/treatment and
then drink 2 glasses of water. The bladder and the bowel
were delineated on the CT image set according to
QUANTEC guidelines. At the treatment planning stage
different bladder fillings were simulated by cutting off ¼,
½ and ¾ of the bladder in the cranial-caudal direction
(Figure 1). By using the different bladder volumes the
corresponding bowel volumes were created. The
robustness of the treatment plans was evaluated by
identifying if the bowel constraint was fulfilled for the
different simulated bladder fillings. If bowel constraint
wasn’t fulfilled the treatment plan was re-optimized to
improve the robustness. Before each treatment CBCT was
acquired and the true bladder filling was compared to the
simulated situations. For the situations where the bladder
filling was identified to be too small so the bowel
constraint was violated the patients were asked to drink
more water. For some of the patients the true bladder was
delineated on CBCT and the corresponding bowel was
generated and compared to the simulated situation.
Results
For most of the rectum cancer patients the constraints was
fulfilled for all simulated situations. Due to the higher
prescription dose and also the location of the target the
anal cancer patients didn’t match the constraints to the
same extent. The study revealed that most of the
treatment plans was robust to bladder filling changes but
also identified situations were re-optimization could be
done to create a more robust treatment plan (Figure 2).
The RTTs found it feasible to compare the bladder on the
CBCT with the simulations
and was also able to identify
when additional actions were needed.
Conclusion
This procedure has shown to be very cost effective as it
doesn’t require additional imaging and it only takes 10-15
minutes to create the simulated structures. The latter can
be optimized further in the future e.g. we consider to only
simulating the smallest bladder (largest bowel) for the
rectum cancer patients. This should be compared with our
previous workflow with unreasonable demands on bladder
filling and delineation of the bladder on CBCT with the
rather subjective decision when the bladder was
considered to be too small. Furthermore this workflow has
made it able for the RTTs to get more involved in
evaluating and react on differences in soft tissue.
EP-1831 Entropic Boltzmann closure for MRI-guided
radiotherapy
J. Page
1
, J.L. Feugeas
1
, G. Birindelli
1
, J. Caron
1
, B.
Dubroca
1
, T. Pichard
1
, V. Tikhonchuk
1
, P. Nicolaï
1
1
CELIA, Interaction- Fusion par Confinement Inertiel-
Astrophysique, Talence, France
Purpose or Objective
The majority of patients affected by cancer are nowadays
treated by radiotherapy, which consists in delivering a
homogeneous dose with energetic particles. The main goal
of this technique is to target and destroy tumoral cells
without damaging the surrounding tissue. This treatment
possesses a great adaptability to the broad variety of
tumors. Therefore, a major effort was made on the last
decades to improve technologies involved in the
development and the optimization of this treatment. Our
work consists on the development and validation of a new
model designed to simulate the energy deposition of the
particles used in radiotherapy (electrons, photons and
protons), within human tissues.
Material and Methods
This model is based on a kinetic entropic closure of the
linearized Boltzmann equation, which describes the
transport of energetic particles in the matter. This
equation takes a lot of computation time to be resolved
due to the high number of variables. To simplify this, we
replace fluences by angular moments, which allows us
getting rid of the angular variables andimprove the