| dc.description.abstract |
<p>Since 2010, Duke University Medical Center has used the single-isocenter technique
to treat patients with multiple brain metastases. The purpose of this project is to
compare treatment planning techniques for these patients who received treatment. First,
we want to determine if volumetric modulated arc therapy (VMAT) or dynamic conformal
arc therapy (DCAT) is the better method for treatment for incoming patients. Next,
we want to know if using U-frame or frameless masks provide better plan quality. Lastly,
we want to test the use of a stationary couch to simulate imaging while treating with
the moving gantry. DCAT plans were created for each of the 40 single-isocenter patients
who received VMAT at Duke University Medical Center from 2016 to 2018. These patients
were randomly selected based only on the number of metastases, from 2 to 14. We created
the DCAT plans using 5 couch positions, 2 collimator angles, and 100° arcs on BrainLab
Elements. We modeled U-frame and frameless masks using 100° and 180° arcs, respectively.
To simulate imaging, we kept the couch at 0° while using only 180° arcs. The clinical
VMAT plans delivered to the 40 patients had an average conformity index of 1.47 and
average gradient index of 8.57. Average whole-brain V3 Gy and V5 Gy were 14.07% and
5.80%, respectively. In comparison, using DCAT the conformity index was 1.75 and the
gradient index was 6.87. Whole-brain V3 Gy and V5 Gy were 11.25% and 5.59%, respectively.
The frameless mask plans had conformity and gradient indexes of 1.68 and 6.39 and
V3 Gy and V5 Gy of 11.39% and 5.09%, respectively. Using VMAT for the imaging cases,
we found conformity and gradient indexes of 1.59 and 11.99 and V3 Gy and V5 Gy of
18.04% and 8.41%. Using DCAT for the imaging cases had conformity and gradient indexes
of 2.02 and 9.86 and V3 Gy and V5 Gy of 14.21% and 7.25%, respectively. Overall, VMAT
plans had higher conformity index with lower gradient index at the cost of healthy
brain protection compared to DCAT. Frameless masks also increased the conformity index
and decreased the gradient index with no significant impact on low doses to the brain.
The use of imaging while treating should be considered with the benefit when imaging
on a case-by-case basis.</p>
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