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Robust Planning for a Patient Treated in Decubitus Position with Proton Pencil Beam Scanning Radiotherapy

A challenging case was reported for a patient treated in decubitus position with proton pencil beam scanning. A regular robust plan with the consideration of the uncertainties of translational alignment and range accuracy cannot ensure the target coverage as revealed in two verification computed tom...

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Detalles Bibliográficos
Autores principales: Tang, Shikui, Song, Limin, Sturgeon, Jared D, Chang, Chang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690418/
https://www.ncbi.nlm.nih.gov/pubmed/29159012
http://dx.doi.org/10.7759/cureus.1706
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author Tang, Shikui
Song, Limin
Sturgeon, Jared D
Chang, Chang
author_facet Tang, Shikui
Song, Limin
Sturgeon, Jared D
Chang, Chang
author_sort Tang, Shikui
collection PubMed
description A challenging case was reported for a patient treated in decubitus position with proton pencil beam scanning. A regular robust plan with the consideration of the uncertainties of translational alignment and range accuracy cannot ensure the target coverage as revealed in two verification computed tomography (CT) scans during the first week of the treatment. The irreproducibility of daily alignment and anatomical variations in such a position is mainly due to patient’s roll. To mitigate the interfractional effect on the target coverage, a novel robust optimization against the patient’s angular setup uncertainties was implemented to improve the plan quality by introducing two artificial CT image sets by rolling the planning CT three degrees in both clockwise and counter-clockwise directions and adding them into robust optimization scenarios, which was shown to be an effective and simple way to mitigate target dose degradation with respect to interfractional variations. This method can be easily generalized and applied to other situations where angular variations in patient’s setup can introduce large dosimetric effects. It is recommended that angularly robust optimization method should be integrated into the treatment planning system as an option particularly for patient’s treatment subject to large angular variations, such as the one in the decubitus position reported here.
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spelling pubmed-56904182017-11-20 Robust Planning for a Patient Treated in Decubitus Position with Proton Pencil Beam Scanning Radiotherapy Tang, Shikui Song, Limin Sturgeon, Jared D Chang, Chang Cureus Radiation Oncology A challenging case was reported for a patient treated in decubitus position with proton pencil beam scanning. A regular robust plan with the consideration of the uncertainties of translational alignment and range accuracy cannot ensure the target coverage as revealed in two verification computed tomography (CT) scans during the first week of the treatment. The irreproducibility of daily alignment and anatomical variations in such a position is mainly due to patient’s roll. To mitigate the interfractional effect on the target coverage, a novel robust optimization against the patient’s angular setup uncertainties was implemented to improve the plan quality by introducing two artificial CT image sets by rolling the planning CT three degrees in both clockwise and counter-clockwise directions and adding them into robust optimization scenarios, which was shown to be an effective and simple way to mitigate target dose degradation with respect to interfractional variations. This method can be easily generalized and applied to other situations where angular variations in patient’s setup can introduce large dosimetric effects. It is recommended that angularly robust optimization method should be integrated into the treatment planning system as an option particularly for patient’s treatment subject to large angular variations, such as the one in the decubitus position reported here. Cureus 2017-09-20 /pmc/articles/PMC5690418/ /pubmed/29159012 http://dx.doi.org/10.7759/cureus.1706 Text en Copyright © 2017, Tang et al. http://creativecommons.org/licenses/by/3.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Radiation Oncology
Tang, Shikui
Song, Limin
Sturgeon, Jared D
Chang, Chang
Robust Planning for a Patient Treated in Decubitus Position with Proton Pencil Beam Scanning Radiotherapy
title Robust Planning for a Patient Treated in Decubitus Position with Proton Pencil Beam Scanning Radiotherapy
title_full Robust Planning for a Patient Treated in Decubitus Position with Proton Pencil Beam Scanning Radiotherapy
title_fullStr Robust Planning for a Patient Treated in Decubitus Position with Proton Pencil Beam Scanning Radiotherapy
title_full_unstemmed Robust Planning for a Patient Treated in Decubitus Position with Proton Pencil Beam Scanning Radiotherapy
title_short Robust Planning for a Patient Treated in Decubitus Position with Proton Pencil Beam Scanning Radiotherapy
title_sort robust planning for a patient treated in decubitus position with proton pencil beam scanning radiotherapy
topic Radiation Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5690418/
https://www.ncbi.nlm.nih.gov/pubmed/29159012
http://dx.doi.org/10.7759/cureus.1706
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