{"title":"使用Monaco计划系统在Elekta Versa HD直线加速器中进行脉冲低剂量率高级别胶质瘤复发治疗的低剂量率体积调制电弧治疗的剂量学准确性","authors":"Surendran Jagadeesan, S. P. Vijaya Chamundeeswari","doi":"10.1002/acm2.70253","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background and purpose</h3>\n \n <p>Reducing the dose rate enhances efficacy in radiation therapy by allowing increased repair of sub-lethal damage. Pulsed low-dose radiation therapy (PLDR) is an innovative approach that is safe and effective for the reirradiation of recurrent gliomas and radioresistant tumors. In this study, the accuracy of the low dose rate volumetric modulated arc therapy (VMAT) delivery is tested in an Elekta Versa HD linear accelerator (linac) for delivering PLDR.</p>\n </section>\n \n <section>\n \n <h3> Material and methods</h3>\n \n <p>A retrospective study was conducted on ten patients previously treated for high-grade glioma. The Monaco planning system was used to create two or three arc VMAT plans with a minimum monitor unit (MU) exceeding 570. The Mosaiq record and verification system (R&V) was used to select dose rates between 20 and 25 MU/min for delivering VMAT beams, achieving a beam-on time of 30 min and an effective dose rate of 6.7 cGy/min. Measurements from IBA MatriXX resolution were used for gamma analysis. Beam characteristics at low dose rates for 8 gantry angles were investigated using the measurements from the dolphin detector.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>All the deviations of flatness and symmetry were within 1.0% in all gantry angles. MU linearity was within 1% for the lowest dose rate of 20 MU/min. The output deviations were within 1% for all dose rates. The average dose rate achieved was 6.7 ± 0.1 cGy/min. The maximum dose rate achieved in the planning target volume (PTV) was 7.28 (6.86 to 7.28) cGy/min. The gamma pass rate was above 97%, with the analysis criterion 3%3 mm, 2%2 mm, and 2%1 mm for VMAT delivered at a low dose rate.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Low-dose rate VMAT delivery is feasible with higher accuracy in the delivered dose on the Elekta Versa HD linac. PLDR can be implemented successfully on Elekta linacs using the Monaco planning system.</p>\n </section>\n </div>","PeriodicalId":14989,"journal":{"name":"Journal of Applied Clinical Medical Physics","volume":"26 9","pages":""},"PeriodicalIF":2.2000,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aapm.onlinelibrary.wiley.com/doi/epdf/10.1002/acm2.70253","citationCount":"0","resultStr":"{\"title\":\"Dosimetric accuracy of low dose rate volumetric modulated arc therapy delivery in an Elekta Versa HD linear accelerator for pulsed low dose rate treatment of recurrent high-grade glioma using Monaco planning system\",\"authors\":\"Surendran Jagadeesan, S. P. Vijaya Chamundeeswari\",\"doi\":\"10.1002/acm2.70253\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background and purpose</h3>\\n \\n <p>Reducing the dose rate enhances efficacy in radiation therapy by allowing increased repair of sub-lethal damage. Pulsed low-dose radiation therapy (PLDR) is an innovative approach that is safe and effective for the reirradiation of recurrent gliomas and radioresistant tumors. In this study, the accuracy of the low dose rate volumetric modulated arc therapy (VMAT) delivery is tested in an Elekta Versa HD linear accelerator (linac) for delivering PLDR.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Material and methods</h3>\\n \\n <p>A retrospective study was conducted on ten patients previously treated for high-grade glioma. The Monaco planning system was used to create two or three arc VMAT plans with a minimum monitor unit (MU) exceeding 570. The Mosaiq record and verification system (R&V) was used to select dose rates between 20 and 25 MU/min for delivering VMAT beams, achieving a beam-on time of 30 min and an effective dose rate of 6.7 cGy/min. Measurements from IBA MatriXX resolution were used for gamma analysis. Beam characteristics at low dose rates for 8 gantry angles were investigated using the measurements from the dolphin detector.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>All the deviations of flatness and symmetry were within 1.0% in all gantry angles. MU linearity was within 1% for the lowest dose rate of 20 MU/min. The output deviations were within 1% for all dose rates. The average dose rate achieved was 6.7 ± 0.1 cGy/min. The maximum dose rate achieved in the planning target volume (PTV) was 7.28 (6.86 to 7.28) cGy/min. The gamma pass rate was above 97%, with the analysis criterion 3%3 mm, 2%2 mm, and 2%1 mm for VMAT delivered at a low dose rate.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Low-dose rate VMAT delivery is feasible with higher accuracy in the delivered dose on the Elekta Versa HD linac. 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Dosimetric accuracy of low dose rate volumetric modulated arc therapy delivery in an Elekta Versa HD linear accelerator for pulsed low dose rate treatment of recurrent high-grade glioma using Monaco planning system
Background and purpose
Reducing the dose rate enhances efficacy in radiation therapy by allowing increased repair of sub-lethal damage. Pulsed low-dose radiation therapy (PLDR) is an innovative approach that is safe and effective for the reirradiation of recurrent gliomas and radioresistant tumors. In this study, the accuracy of the low dose rate volumetric modulated arc therapy (VMAT) delivery is tested in an Elekta Versa HD linear accelerator (linac) for delivering PLDR.
Material and methods
A retrospective study was conducted on ten patients previously treated for high-grade glioma. The Monaco planning system was used to create two or three arc VMAT plans with a minimum monitor unit (MU) exceeding 570. The Mosaiq record and verification system (R&V) was used to select dose rates between 20 and 25 MU/min for delivering VMAT beams, achieving a beam-on time of 30 min and an effective dose rate of 6.7 cGy/min. Measurements from IBA MatriXX resolution were used for gamma analysis. Beam characteristics at low dose rates for 8 gantry angles were investigated using the measurements from the dolphin detector.
Results
All the deviations of flatness and symmetry were within 1.0% in all gantry angles. MU linearity was within 1% for the lowest dose rate of 20 MU/min. The output deviations were within 1% for all dose rates. The average dose rate achieved was 6.7 ± 0.1 cGy/min. The maximum dose rate achieved in the planning target volume (PTV) was 7.28 (6.86 to 7.28) cGy/min. The gamma pass rate was above 97%, with the analysis criterion 3%3 mm, 2%2 mm, and 2%1 mm for VMAT delivered at a low dose rate.
Conclusion
Low-dose rate VMAT delivery is feasible with higher accuracy in the delivered dose on the Elekta Versa HD linac. PLDR can be implemented successfully on Elekta linacs using the Monaco planning system.
期刊介绍：
Journal of Applied Clinical Medical Physics is an international Open Access publication dedicated to clinical medical physics. JACMP welcomes original contributions dealing with all aspects of medical physics from scientists working in the clinical medical physics around the world. JACMP accepts only online submission.
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