David Santiago Ayala Alvarez, Peter G. F. Watson, Marija Popovic, Veng Jean Heng, Michael D. C. Evans, Valerie Panet-Raymond, Jan Seuntjens
{"title":"TG-43在胶质母细胞瘤术中放射剂量测定中的应用价值","authors":"David Santiago Ayala Alvarez, Peter G. F. Watson, Marija Popovic, Veng Jean Heng, Michael D. C. Evans, Valerie Panet-Raymond, Jan Seuntjens","doi":"10.1002/mp.17930","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Intraoperative radiation therapy (IORT) using the INTRABEAM system has shown promise in glioblastoma treatment. However, accurate dosimetry remains challenging due to the low-energy photons used and the heterogeneity of tissues in the brain. Current clinical practice relies on the TARGIT method, but more robust approaches, including the TG-43 formalism and Monte Carlo (MC) simulations, warrant investigation for potential improvements in dose calculation accuracy.</p>\n </section>\n \n <section>\n \n <h3> Purpose</h3>\n \n <p>To evaluate the TG-43 dosimetry formalism for IORT dose calculations in glioblastoma treatment using the INTRABEAM system, comparing it with the TARGIT method and MC simulations.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We analyzed the dose distributions in 20 patients from the INTRAGO trial. The TG-43 formalism was validated against MC simulations in water (<span></span><math>\n <semantics>\n <msub>\n <mi>MC</mi>\n <mi>w</mi>\n </msub>\n <annotation>${\\rm MC}_{\\rm w}$</annotation>\n </semantics></math>) using global/local dose differences and gamma analysis (1%/1mm). Organ at risk (OAR) doses were calculated using TG-43, TARGIT, <span></span><math>\n <semantics>\n <msub>\n <mi>MC</mi>\n <mi>w</mi>\n </msub>\n <annotation>${\\rm MC}_{\\rm w}$</annotation>\n </semantics></math>, and MC in heterogeneous media (<span></span><math>\n <semantics>\n <msub>\n <mi>MC</mi>\n <mi>het</mi>\n </msub>\n <annotation>${\\rm MC}_{\\rm het}$</annotation>\n </semantics></math>). Combined IORT and external beam radiotherapy (EBRT) doses were evaluated.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>TG-43 showed good agreement with <span></span><math>\n <semantics>\n <msub>\n <mi>MC</mi>\n <mi>w</mi>\n </msub>\n <annotation>${\\rm MC}_{\\rm w}$</annotation>\n </semantics></math>, with a 98.0% gamma pass rate. The mean global dose difference was 0.07% <span></span><math>\n <semantics>\n <mo>±</mo>\n <annotation>$\\pm$</annotation>\n </semantics></math> 0.29%, with TG-43 slightly overestimating dose compared to <span></span><math>\n <semantics>\n <msub>\n <mi>MC</mi>\n <mi>w</mi>\n </msub>\n <annotation>${\\rm MC}_{\\rm w}$</annotation>\n </semantics></math>. For OAR dose comparisons using TG-43 as reference, TARGIT underestimated doses by 0.1%–1.7%, while <span></span><math>\n <semantics>\n <msub>\n <mi>MC</mi>\n <mi>het</mi>\n </msub>\n <annotation>${\\rm MC}_{\\rm het}$</annotation>\n </semantics></math> showed larger differences near bony structures (up to 1.9% <span></span><math>\n <semantics>\n <mo>±</mo>\n <annotation>$\\pm$</annotation>\n </semantics></math> 1.4% for optic nerves). Combined IORT+EBRT analysis revealed more OAR constraint violations than identified by current clinical practice. Calculation times for TG-43 (0.6 s on average) were significantly shorter than for MC simulations (16–18 h on a computing cluster).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>The TG-43 formalism provides a reasonable compromise between accuracy and computational efficiency for IORT dose calculations in glioblastoma treatment. It offers improved accuracy over TARGIT while being significantly faster and thus more feasible for intraoperative use than full MC simulations. Implementation of validated volumetric dose calculation methods like TG-43 has the potential to improve the accuracy of IORT treatment planning and OAR dose assessment.</p>\n </section>\n </div>","PeriodicalId":18384,"journal":{"name":"Medical physics","volume":"52 7","pages":""},"PeriodicalIF":3.2000,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/mp.17930","citationCount":"0","resultStr":"{\"title\":\"Evaluation of the TG-43 formalism for intraoperative radiotherapy dosimetry in glioblastoma treatment\",\"authors\":\"David Santiago Ayala Alvarez, Peter G. F. Watson, Marija Popovic, Veng Jean Heng, Michael D. C. Evans, Valerie Panet-Raymond, Jan Seuntjens\",\"doi\":\"10.1002/mp.17930\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Intraoperative radiation therapy (IORT) using the INTRABEAM system has shown promise in glioblastoma treatment. However, accurate dosimetry remains challenging due to the low-energy photons used and the heterogeneity of tissues in the brain. Current clinical practice relies on the TARGIT method, but more robust approaches, including the TG-43 formalism and Monte Carlo (MC) simulations, warrant investigation for potential improvements in dose calculation accuracy.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>To evaluate the TG-43 dosimetry formalism for IORT dose calculations in glioblastoma treatment using the INTRABEAM system, comparing it with the TARGIT method and MC simulations.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>We analyzed the dose distributions in 20 patients from the INTRAGO trial. The TG-43 formalism was validated against MC simulations in water (<span></span><math>\\n <semantics>\\n <msub>\\n <mi>MC</mi>\\n <mi>w</mi>\\n </msub>\\n <annotation>${\\\\rm MC}_{\\\\rm w}$</annotation>\\n </semantics></math>) using global/local dose differences and gamma analysis (1%/1mm). Organ at risk (OAR) doses were calculated using TG-43, TARGIT, <span></span><math>\\n <semantics>\\n <msub>\\n <mi>MC</mi>\\n <mi>w</mi>\\n </msub>\\n <annotation>${\\\\rm MC}_{\\\\rm w}$</annotation>\\n </semantics></math>, and MC in heterogeneous media (<span></span><math>\\n <semantics>\\n <msub>\\n <mi>MC</mi>\\n <mi>het</mi>\\n </msub>\\n <annotation>${\\\\rm MC}_{\\\\rm het}$</annotation>\\n </semantics></math>). Combined IORT and external beam radiotherapy (EBRT) doses were evaluated.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>TG-43 showed good agreement with <span></span><math>\\n <semantics>\\n <msub>\\n <mi>MC</mi>\\n <mi>w</mi>\\n </msub>\\n <annotation>${\\\\rm MC}_{\\\\rm w}$</annotation>\\n </semantics></math>, with a 98.0% gamma pass rate. The mean global dose difference was 0.07% <span></span><math>\\n <semantics>\\n <mo>±</mo>\\n <annotation>$\\\\pm$</annotation>\\n </semantics></math> 0.29%, with TG-43 slightly overestimating dose compared to <span></span><math>\\n <semantics>\\n <msub>\\n <mi>MC</mi>\\n <mi>w</mi>\\n </msub>\\n <annotation>${\\\\rm MC}_{\\\\rm w}$</annotation>\\n </semantics></math>. For OAR dose comparisons using TG-43 as reference, TARGIT underestimated doses by 0.1%–1.7%, while <span></span><math>\\n <semantics>\\n <msub>\\n <mi>MC</mi>\\n <mi>het</mi>\\n </msub>\\n <annotation>${\\\\rm MC}_{\\\\rm het}$</annotation>\\n </semantics></math> showed larger differences near bony structures (up to 1.9% <span></span><math>\\n <semantics>\\n <mo>±</mo>\\n <annotation>$\\\\pm$</annotation>\\n </semantics></math> 1.4% for optic nerves). Combined IORT+EBRT analysis revealed more OAR constraint violations than identified by current clinical practice. Calculation times for TG-43 (0.6 s on average) were significantly shorter than for MC simulations (16–18 h on a computing cluster).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>The TG-43 formalism provides a reasonable compromise between accuracy and computational efficiency for IORT dose calculations in glioblastoma treatment. It offers improved accuracy over TARGIT while being significantly faster and thus more feasible for intraoperative use than full MC simulations. Implementation of validated volumetric dose calculation methods like TG-43 has the potential to improve the accuracy of IORT treatment planning and OAR dose assessment.</p>\\n </section>\\n </div>\",\"PeriodicalId\":18384,\"journal\":{\"name\":\"Medical physics\",\"volume\":\"52 7\",\"pages\":\"\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-07-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1002/mp.17930\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medical physics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/mp.17930\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medical physics","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/mp.17930","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
引用次数: 0
摘要
使用INTRABEAM系统的术中放射治疗（IORT）在胶质母细胞瘤治疗中显示出前景。然而，由于使用的低能量光子和大脑组织的异质性，精确的剂量测定仍然具有挑战性。目前的临床实践依赖于TARGIT方法，但更可靠的方法，包括TG-43形式化和蒙特卡罗（MC）模拟，值得研究剂量计算精度的潜在改进。目的评价利用INTRABEAM系统计算胶质母细胞瘤治疗中IORT剂量的TG-43剂量学形式，并将其与TARGIT方法和MC模拟进行比较。方法分析INTRAGO试验中20例患者的剂量分布。利用全局/局部剂量差和γ分析（1%/1mm），对水中MC模拟（MC w ${\rm MC}_{\rm w}$）验证了TG-43的形式。使用TG-43、TARGIT、MC w ${\rm MC}_{\rm w}$和异质培养基中的MC （MC het ${\rm MC}_{\rm het}$）计算器官危险（OAR）剂量。评估IORT和外束放疗（EBRT）联合剂量。结果TG-43与MC w ${\rm MC}_{\rm w}$吻合良好，gamma通过率为98.0%。总体平均剂量差为0.07%±0.29%，TG-43与MC w ${\rm MC}_{\rm w}$相比略高估剂量。对于以TG-43为参考的OAR剂量比较，TARGIT低估了0.1%-1.7%的剂量，而MC het ${\rm MC}_{\rm het}$在骨结构附近显示出更大的差异（视神经高达1.9%±$ $ pm$ 1.4%）。IORT+EBRT联合分析显示，与目前的临床实践相比，更多的OAR约束违规。TG-43的计算时间（平均0.6 s）明显短于MC模拟（在计算集群上16-18 h）。结论TG-43公式在胶质母细胞瘤治疗中IORT剂量计算的准确性和计算效率之间提供了合理的折衷。与TARGIT相比，它提供了更高的准确性，同时明显更快，因此在术中使用比完整MC模拟更可行。实施经过验证的体积剂量计算方法，如TG-43，有可能提高IORT治疗计划和OAR剂量评估的准确性。
Evaluation of the TG-43 formalism for intraoperative radiotherapy dosimetry in glioblastoma treatment
Background
Intraoperative radiation therapy (IORT) using the INTRABEAM system has shown promise in glioblastoma treatment. However, accurate dosimetry remains challenging due to the low-energy photons used and the heterogeneity of tissues in the brain. Current clinical practice relies on the TARGIT method, but more robust approaches, including the TG-43 formalism and Monte Carlo (MC) simulations, warrant investigation for potential improvements in dose calculation accuracy.
Purpose
To evaluate the TG-43 dosimetry formalism for IORT dose calculations in glioblastoma treatment using the INTRABEAM system, comparing it with the TARGIT method and MC simulations.
Methods
We analyzed the dose distributions in 20 patients from the INTRAGO trial. The TG-43 formalism was validated against MC simulations in water () using global/local dose differences and gamma analysis (1%/1mm). Organ at risk (OAR) doses were calculated using TG-43, TARGIT, , and MC in heterogeneous media (). Combined IORT and external beam radiotherapy (EBRT) doses were evaluated.
Results
TG-43 showed good agreement with , with a 98.0% gamma pass rate. The mean global dose difference was 0.07% 0.29%, with TG-43 slightly overestimating dose compared to . For OAR dose comparisons using TG-43 as reference, TARGIT underestimated doses by 0.1%–1.7%, while showed larger differences near bony structures (up to 1.9% 1.4% for optic nerves). Combined IORT+EBRT analysis revealed more OAR constraint violations than identified by current clinical practice. Calculation times for TG-43 (0.6 s on average) were significantly shorter than for MC simulations (16–18 h on a computing cluster).
Conclusions
The TG-43 formalism provides a reasonable compromise between accuracy and computational efficiency for IORT dose calculations in glioblastoma treatment. It offers improved accuracy over TARGIT while being significantly faster and thus more feasible for intraoperative use than full MC simulations. Implementation of validated volumetric dose calculation methods like TG-43 has the potential to improve the accuracy of IORT treatment planning and OAR dose assessment.
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