IMRT INTRODUCTION AND WORKFLOW
Definitions
Clinical Workflow
VARIAN Physics Teachers EMEA September 2012
ONCOLOGY
SYSTEMS
1 | VARIAN ONCOLOGY SYSTEMS
Intensity Modulated Radiation Therapy - IMRT
• IMRT: ability to modulate radiation intensity within one treatment
field
2 | VARIAN ONCOLOGY SYSTEMS
Dynamic mode of MLC (dMLC)
• Used for delivery of IMRT fields
• Multileaf collimator is capable of changing the
shape while the machine is in “beam on” state
• ‘Step and shoot’ and ‘sliding window’ use this
mode
3 | VARIAN ONCOLOGY SYSTEMS
Electronic Compensation – Forward IMRT
• Replacement of physical compensator by
means of dynamic MLC delivery
• Eclipse offers 3 types of electronic
compensation:
• Electronic Compensator (planar)
• Field in Field Compensator – Forward
IMRT
• Irregular Surface Compensator
4 | VARIAN ONCOLOGY SYSTEMS
Inverse treatment planning planning
Basic idea
conventional IMRT
5 | VARIAN ONCOLOGY SYSTEMS
Inverse treatment planning
• Treatment planning process
• Clinical objectives specified mathematically
• Planning system able to change beam
parameters to satisfy defined clinical
objectives
• EIP – Eclipse Inverse Planning
6 | VARIAN ONCOLOGY SYSTEMS
Intensity Modulated Radiation Therapy - IMRT
Beamlet
• IMRT - ability to deliver
many beamlets of varying
radiation intensity within
one treatment field
7 | VARIAN ONCOLOGY SYSTEMS
Multiple Static Segment (MSS) Delivery
• An IMRT delivery method in which the
modulated beam is delivered in a sequence of
static MLC positions
• “Step and Shoot”
8 | VARIAN ONCOLOGY SYSTEMS
Sliding Window Delivery
• An IMRT delivery method in which the shape of
MLC is changed while the beam is delivered
9 | VARIAN ONCOLOGY SYSTEMS
Leaf Sequencing File
• Synonyms:
• Leaf Motion Pattern
• Leaf Sequencing Pattern
• Segmented Treatment Table file (STT)
• File describing the movement during the
dynamic MLC beam delivery
• ASCII file containing information about the
leaf position versus MU
10 | VARIAN ONCOLOGY SYSTEMS
Conformal Planning Workflow
Patient Contouring Field Setup
Preparation
Treatment Plan Dose
Evaluation Calculation
11 | VARIAN ONCOLOGY SYSTEMS
IMRT Planning Workflow
Patient Contouring: Field Setup Optimisation
Preparation with changes -or- & Leaf
for IMRT Beam Angle Motion
plans Optimisation Calculation
Treatment Plan Plan Dose
Verification Evaluation Calculation
12 | VARIAN ONCOLOGY SYSTEMS
New Considerations in Contouring
13 | VARIAN ONCOLOGY SYSTEMS
Contouring tools
Boolean Operators
Crop Structure
Wall tool
14 | VARIAN ONCOLOGY SYSTEMS
Contouring – Organ motion
• Inter and Intra-fraction motion
• Addressed by margins for conventional treatment
• Important for IMRT as there may be interplay between
anatomy and MLC motion
Dose
Planned
Delivered
dose
Position
15 | VARIAN ONCOLOGY SYSTEMS
Interplay Between Anatomy and MLC Leaves
• Moving target leads to differences between planned
and delivered dose distribution
Dose
Planned dose
Delivered dose
Position
16 | VARIAN ONCOLOGY SYSTEMS
Inverse Planning Overview
• Static gantry inverse planning
• Beam Angle Optimization
• Based on dose volume objectives
• Fluence optimization
• Optimization of a field fluence
• Optimization of field weights
• Based on dose volume objectives
• Real time update of DVH, objective function and
fluence matrices
• Optimization on top of the base plan
17 | VARIAN ONCOLOGY SYSTEMS
Beam Angle Optimization (BAO) - optional
• Process to optimize the beam gantry angles
that uses Plan Geometry Optimization (PGO)
algorithm
18 | VARIAN ONCOLOGY SYSTEMS
Dose Volume Optimizer (DVO)
• Algorithm used in Eclipse Inverse Planning Module to
optimize fluences for static gantry IMRT
• Determines the
optimal fluence
19 | VARIAN ONCOLOGY SYSTEMS
Optimal Fluence
• Result of the mathematical optimization
• Independent of the delivery method
20 | VARIAN ONCOLOGY SYSTEMS
Manual Modification of Fluence
• Fluence Editor
• Edit optimal fluence
• Skin flash tool
• Create test fluence
21 | VARIAN ONCOLOGY SYSTEMS
Leaf Motion Calculator (LMC)
• Software module that converts the optimal
fluence into Actual Fluence
• Leaf Sequencing File (STT file) deliverable on
treatment unit by MLC device
• Takes into account DMLC characteristics
• Supports Sliding Window and MSS for Varian
• Supports MSS for third party linac
• Calculates MU (internally only)
22 | VARIAN ONCOLOGY SYSTEMS
Actual Fluence
• Derived from the optimal fluence by Leaf
Motion Calculator
• Depends on the delivery technique
• Accounts for physical, mechanical and dosimetric
characteristics of MLC
actual fluence - sliding window actual fluence - step&shoot
23 | VARIAN ONCOLOGY SYSTEMS
Verification Plans
• Verification plan support
• Transfer of IMRT plan to a phantom in Eclipse
• Dose distribution calculated inside a selected
phantom
• Transfer to verification system
• Dose from verification plan is not cumulated to the
patient reference points
• Verification plan and Portal Dosimetry
24 | VARIAN ONCOLOGY SYSTEMS
Protocols and Templates
Efficient planning using
Clinical Protocols and
Load
Templates
Create
Structure
Import
Plan
Export
Library of optimization objectives
25 | VARIAN ONCOLOGY SYSTEMS
Thank you for your interest
and attention
Questions?
26 | VARIAN ONCOLOGY SYSTEMS
Disclaimer
Notice
• This information is an educational aid only and is intended solely as a
supplemental document. This provides information concerning the use of the
Eclipse Treatment Planning System. For complete information concerning
components, safety instructions, installation, maintenance, troubleshooting,
etc., refer to the applicable Varian product Operator’s Manual. This
information does not replace the Varian Operator’s Manual.
• Carefully read all instructions prior to use. Observe all contraindications,
warnings and precautions noted in these instructions. Failure to do so may
result in patient and/or user complications.
• This information is subject to change without notice and does not represent a
commitment on the part of Varian. Varian is not liable for errors contained in
this information or for incidental or consequential damages in connection with
furnishing or use of this material. This contains proprietary information
protected by copyright. No part of this may be reproduced, translated, or
transmitted without the express written permission of Varian Medical Systems,
Inc.
27 | VARIAN ONCOLOGY SYSTEMS
