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Online/Offline adaptation
should not be acceptable clinically. Interfraction target
(prostate and SV) deformation/rotation and intrafraction
target motion were the major causes of the target dose
reduction
(26, 27)
.
Figure 2
shows the treatment dose deficits
organs, specifically the reduction in the bla
dicates the dosimetric effect of nonrigid var
and normal organs and the necessity of
adaptive planning modifications.
80.0%
90.0%
100.0%
110.0%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
%EUD of CTV
Daily Correction
Online Planning
Hybrid Adaptation
90.0%
100.0%
110.0%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
%EUD of Rectal Wall
Daily Correction
Online Planning
Hybrid Adaptation
50.0%
70.0%
90.0%
110.0%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
%EUD of Bladder
Daily Correction
Online Planning
Hybrid Adaptation
C
B
A
Fig. 1.
The normalized equivalent uniform dose (EUD) of the clinical target volume (CTV), the rectal wall,
of the individual patients for the 3 treatment techniques.
03/01/13
Qin A, Yan D IJROBP 2015
3
strategies:
1.
Daily online
repositioning
2.
Daily online
replaning
3.
Hybrid
adaptation :
Cumulative
dose
distribution on
5 post CBCT