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T Bortfeld

Publications and source records attributed to T Bortfeld.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Inverse radiotherapy planning for intensity modulated photon fields].

Substantial improvement in conformal radiotherapy is possible using modulated irradiation fields. Such modulated fields may be generated even with conventional accelerators by means of individual metal compensators or with the recently available dynamic multileaf collimators (MLC). For treatment planning a new kind of planning program is required that can calculate the 2 D-intensity matrices for each photon field. At the German Cancer Research Center (Deutsches Krebsforschungszentrum) such a program has been developed under the name of "KonRad" (Conformal Radiotherapy). Although it is an independent application, it is proposed for clinical usage to supplement a planning system that is already present. So-called inverse planning differs from conventional 3 D planning, as the trial-and-error approach for finding good field parameters is nearly completely avoided. Instead, the radio-oncologist is given the chance directly to specify medically oriented criteria like the prescription dose in the target volume, maximal tolerance dose values for each organ at risk and their weighting factors. In addition, the so-called DVH optimization allows aimed, partial overdosage, especially in parallelly structured organs in order to obtain better overall planning results. Because of very fast dose calculation in connection with rapidly converging gradient optimization and an intuitive use interface, the planning is done in a comfortable and interactive manner. Using a workstation or a PC, a typical plan can be created within a few minutes.

Equipment Design↗
PubMed1998

[Stereotactic conforming irradiation of choroid metastases].

UNLABELLED: The aim of our study was to develop noninvasive stereotactic radiotherapy for patients with choroidal metastases. METHODS: The head of the patient was immobilized by an individual cast mask. The target volume and adjacent critical structures were three-dimensionally segmented based on ophthalmological findings and MRI. The beam angles were optimized by a beam's eye view technique with a micro-multileaf collimator. We use a linear accelerator with 6-MeV photons. A patient was treated in a phase I/II trial with a single dose of 22.5 Gy. RESULTS: The accuracy of stereotactic positioning of the eye was 0.8 mm. The dose gradients were 15% mm. It was possible to spare the lens and the lacrimal gland in all cases. The treatment with four to six fields took 35-50 min and was tolerated without acute complications. CONCLUSIONS: We introduce a new method to treat choroid metastases by stereotactic radiotherapy. This method allows to concentrate the dose to the target and to spare adjacent critical structures. One of the advantages of this noninvasive treatment is the short treatment time. The clinical role of this method has to be evaluated based on long-term results of tumor control and visual outcome in these patients.

Adenocarcinoma↗
PubMed1997

Potential role of proton therapy in the treatment of pediatric medulloblastoma/primitive neuroectodermal tumors: reduction of the supratentorial target volume.

PURPOSE: One of the components of radiotherapy (RT) in medulloblastoma/primitive neuroectodermal tumors is the prophylactic irradiation of the whole brain (WBI). With the aim of reducing late neuropsychologic morbidity a CT-scan-based dosimetric study was undertaken in which treatment was confined mainly or exclusively to supratentorial sites considered at high risk for disease recurrence. METHODS AND MATERIALS: A comparative dosimetric study is presented in which a three field (two laterals and one posterior) proton plan (spot scanning method) is compared with a two-field conventional WBI 6 MV x-ray plan, to a 6-field "hand-made" 6 MV x-ray plan, and to a computer-optimized 9-field "inverse" 15 MV x-ray plan. For favorable patients, 30 Gy were delivered to the ventricles and main cisterns, the subfrontal and subtemporal regions, and the posterior fossa. For the unfavorable patients, 10 Gy WBI preceeded a boost to 30 Gy to the same treatment volume chosen for favorable patients. The dose distribution was evaluated with dose-volume histograms to examine the coverage of the targets as well as the dose to the nontarget brain and optical structures. In addition, the risks of radiation-related late neuropsychologic effects after WBI were collected from the literature and used to predict normal tissue complication probabilities (NTCPs) for an intelligence quotient deficit after treatment with photon or proton beams. RESULTS: Proton beams succeeded better in reducing the dose to the brain hemispheres and eye than any of the photon plans. A 25.1% risk of an IQ score <90 was predicted after 30 Gy WBI. Almost a 10% drop in the predicted risk was observed when using proton beams in both favorable and unfavorable patients. However, predicted NTCPs for both optimized photon plans ("hand made" and "inverse") were only slightly higher (0.3-2.5%) than those of proton beams. An age-modifying factor was introduced in the predictive NTCP model to assess for IQ differences in relation with age at irradiation. Children with ages between age 4 to 8 benefitted most from the dose reduction in this exercise (similar NTCP predictions for both proton and "inverse" plans). CONCLUSION: Modulated proton beams may help to significantly reduce the irradiation of normal brain while optimally treating the supratentorial subsites at higher risk for relapse. A decrease in morbidity can be expected from protons and both optimized proton plans compared to WBI.

Brain Neoplasms↗
PubMed1997

Inverse radiotherapy planning for a concave-convex PTV in cervical and upper mediastinal regions. Simulation of radiotherapy using an Alderson-RANDO phantom. Planning target volume.

AIM: Three-dimensional inverse treatment planning with modulated beams was applied for dosimetric optimization of a lengthy (22 cm) and complex (concave-convex) shaped planning target volume (PTV) in the cervical and upper mediastinal regions. MATERIAL AND METHOD: The planning was done for 9 coplanar beams spaced evenly at 40 intervals. Properties of 15 MV photons from a linear accelerator were simulated. The optimization of the fluence modulation profiles for each beam was based on a definition of the desired/permitted relative dose levels in the PTV and organs at risk, and a definition of the strengths of the constraints to achieve these objectives. RESULTS: An adequate dose delivery to the PTV and protection of the spinal cord are completely achievable. The dose delivered to the lungs is clinically acceptable with respect to the risk of radiation-induced pneumonitis. For reasons of physics, no further decrease in the radiation burden on the lungs can be attained with X-rays without compromising the PTV coverage. The radiation burden on some critical part of normal tissues was effectively reduced by application of a dummy organ at risk. CONCLUSION: The inverse planning is an effective method for conformal radiotherapy of large tumors as well. However, the power of the technique is insufficient when the tolerance dose of the neighbouring normal tissue is too low and its volume effect is high. Although requiring further operator interactions, introduction of dummy organs at risk may be of help in reducing the radiation burden on normal tissues.

Body Burden↗
PubMed1997

The effect of stair-step leaf transmission on the 'tongue-and-groove problem' in dynamic radiotherapy with a multileaf collimator.

When intensity-modulated fields are created using a multileaf collimator with dynamic leaf movement the potential problem for underdosage beneath the tongue-and-groove interleaf regions has been identified and a solution based on leaf-movement synchronization has been provided by Van Santvoort and Heijmen. Their first-order analysis ignored the transmission through an exposed stair-step. In this brief Note we provide the extended analysis including this contribution and show the effect on irradiation with synchronization. The result is that the synchronization approach of Van Santvoort and Heijmen solves the tongue-and-groove problem even when the transmission through the stair-step is considered, but partial synchronization is generally sufficient.

Health Physics↗
PubMed1997

A fast algorithm for the dose calculation of irregularly shaped fields in stereotactic convergent beam irradiation.

A fast, irregular field dose calculation algorithm is described for use in stereotactic convergent beam irradiation (CBI) with high-energy photons. The dose distribution of an irregular field is approximated by a convolution of narrow pencil beams. Decomposition of pencil beams and a 'pre-selection' algorithm is used to avoid redundant calculations. A typical dose calculation for CBI with nine couch angles and nine different irregularly shaped fields takes less than 90 s on a DEC VAXstation 3100. Fortran. The difference between the measured and the calculated dose values increases with increasing distance from the isocentre. The error in 10% isodose line is less than 3% of the isocentre dose.

Algorithms↗
PubMed1997

Number and orientations of beams in intensity-modulated radiation treatments.

The fundamental question of how many equispaced coplanar intensity-modulated photon beams are required to obtain an optimum treatment plan is investigated in a dose escalation study for a typical prostate tumor. Furthermore, optimization of beam orientations to improve dose distributions is explored. A dose-based objective function and a fast gradient technique are employed for optimizing the intensity profiles (inverse planning). An exhaustive search and fast simulated annealing techniques (FSA) are used to optimize beam orientations. However, to keep computation times reasonable, the intensity profiles for each beam arrangement are still optimized using inverse planning. A pencil beam convolution algorithm is employed for dose calculation. All calculations are performed in three-dimensional (3D) geometry for 15 MV photons. DVHs, dose displays, TCP, NTCP, and biological score functions are used for evaluation of treatment plans. It is shown that for the prostate case presented here, the minimum required number of equiangular beams depends on the prescription dose level and ranges from three beams for 70 Gy plans to seven to nine beams for 81 Gy plans. For the highest dose level (81 Gy), beam orientations are optimized and compared to equiangular spaced arrangements. It is shown that (1) optimizing beam orientations is most valuable for a small numbers of beams (< or = 5) and the gain diminishes rapidly for higher numbers of beams; (2) if sensitive structures (for example rectum) are partially enclosed by the target volume, beams coming from their direction tend to be preferable, since they allow greater control over dose distributions; (3) while FSA and an exhaustive search lead to the same results, computation times using FSA are reduced by two orders of magnitude to clinically acceptable values. Moreover, characteristics of and demands on biology-based and dose-based objective functions for optimization of intensity-modulated treatments are discussed.

Algorithms↗
PubMed1997

An analytical approximation of the Bragg curve for therapeutic proton beams.

The knowledge of proton depth-dose curves, or "Bragg curves," is a fundamental prerequisite for dose calculations in radiotherapy planning, among other applications. In various cases it is desirable to have an analytical representation of the Bragg curve, rather than using measured or numerically calculated data. This work provides an analytical approximation of the Bragg curve in closed form. The underlying model is valid for proton energies between about 10 and 200 MeV. Its main four constituents are: (i) a power-law relationship describing the range-energy dependency; (ii) a linear model for the fluence reduction due to nonelastic nuclear interactions, assuming local deposition of a fraction of the released energy; (iii) a Gaussian approximation of the range straggling distribution; and (iv) a representation of the energy spectrum of poly-energetic beams by a Gaussian with a linear "tail." Based on these assumptions the Bragg curve can be described in closed form using a simple combination of Gaussians and parabolic cylinder functions. The resulting expression can be fitted to measurements within the measurement error. Very good agreement is also found with numerically calculated Bragg curves.

Calibration↗
PubMed1996

Conformal radiation treatment of prostate cancer using inversely-planned intensity-modulated photon beams produced with dynamic multileaf collimation.

PURPOSE: To implement radiotherapy with intensity-modulated beams, based on the inverse method of treatment design and using a multileaf collimation system operating in the dynamic mode. METHODS AND MATERIALS: An algorithm, based on the inverse technique, has been integrated into the radiotherapy treatment-planning computer system in our Center. This method of computer-assisted treatment design was used to derive intensity-modulated beams to optimize the boost portion of the treatment plan for a patient with a T1c cancer of the prostate. A dose of 72 Gy (in 40 fractions) was given with a six-field plan, and an additional 9 Gy (in five fractions) with six intensity-modulated beams. The intensity-modulated fields were delivered using dynamic multileaf collimation, that is, individual leaves were in motion during radiation delivery, with the treatment machine operating in the clinical mode. Exhaustive quality assurance measurement and monitoring were carried out to ensure safe and accurate implementation. RESULTS: Dose distribution and dose-volume histogram of the "inverse method" boost plan and of the composite (72 Gy primary + 9 Gy boost) plan were judged clinically acceptable. Compared to a manually designed boost plan, the inverse treatment design gave improved conformality and increased dose homogeneity in the planning target volume. Film and ion chamber dosimetry, performed prior to the first treatment, indicated that each of the six intensity-modulated fields was accurately produced. Thermoluminescent dosimeter (TLD) measurements performed on the patient confirmed that the intended dose was delivered in the treatment. In addition, computer-aided treatment-monitoring programs assured that the multileaf collimator (MLC) position file was executed to the specified precision. In terms of the overall radiation treatment process, there will likely be labor savings in the planning and the treatment phases. CONCLUSIONS: We have placed into clinical use an integrated system of conformal radiation treatment that incorporated the inverse method of treatment design and the use of dynamic multileaf collimation to deliver intensity-modulated beams. The system can provide better treatment design, which can be implemented reliably and safely. We are hopeful that improved treatment efficacy will result.

Humans↗
PubMed1996

Characterization of dose distribution in radiation therapy plans.

As a method of considering only significant radiation doses to different tissues, the ICRU Report 50 recommends taking the dose given to a significant tissue volume (minimum diameter greater then 15 mm) instead of choosing a single, potentially insignificant, voxel value. In order to find this significant volume, we have adapted an emission imaging analysis method to radiation therapy planning. The resulting method finds and characterizes the dose distribution in the volumes of interest in a way that includes spatial arrangement. The data can be used to signal significant hot or cold volumes in the dose plan and to score the plans based on significant dose to the tissues.

Humans↗
PubMed1996

An analytical approximation of depth-dose distributions for therapeutic proton beams.

A simple analytical approximation for the proximal part of the depth-dose distribution of a spread-out-Bragg-peak (SOBP) proton beam is derived. The basic assumption made is that the range-energy relationship follows a power law. The analytical formula depends only on the ratio of the distance from the proximal edge of the SOBP and the width of the SOBP. A comparison with measurements and with exact numerical calculations reveals a maximum deviation of 5% and a typical deviation of less than 2% of the target dose. The model comprises an analytical expression for the weighting of individual Bragg peaks as a function of the range, which is necessary to obtain an SOBP of the desired width and depth. Finally, an analytical expression for the total energy released in normal tissue is found by integrating the depth-dose distribution.

Biophysical Phenomena↗
PubMed1995

The influence of scatter on the design of optimized intensity modulations.

In contrast to the traditional treatment planning process where beam parameters are adjusted in order to produce a desired dose distribution, the inverse treatment planning technique starts from the desired dose distribution and employs mathematical inversion to derive a set of optimal intensity profiles for beams with predefined directions. Crucial to the success of the inverse technique is the mathematical inversion process that yields the optimized intensity modulation. This paper systematically investigates the influence of phantom scatter in the process of designing the optimized intensity modulation and assesses its clinical consequences through the resultant treatment plans. Optimized intensity modulations and the resultant dose distributions were calculated for four prostate patients and for a simple cubic phantom under two conditions: one includes scatter and the other ignores scatter in designing the optimized intensity modulation. The effects of scatter were assessed by comparing the isodose distributions, the dose-volume histograms of the target and of the critical organs, and the tumor control probabilities and the normal tissue complication probabilities of two set prostate treatment plans. The comparison reveals that the dose homogeneity to the target is significantly improved when scatter is included in the optimization process. For prostate patients, the dose to the volume enclosed by the outer rectal contour is concomitantly reduced. Our results suggest that it is important to include the scatter in the iterative design of the optimized intensity modulations.

Biophysical Phenomena↗
PubMed1994

Realization and verification of three-dimensional conformal radiotherapy with modulated fields.

PURPOSE: We describe the experimental demonstration of the delivery of a three-dimensional conformal radiotherapy dose distribution using in-field modulation of nine fixed-gantry fields. METHODS AND MATERIALS: Two-dimensional in-field modulation profiles, varying from field to field, were realized by quasi-dynamic multileaf collimation using the prototype of a commercially available multileaf collimator installed on a medical linear accelerator. The profiles were calculated to deliver an optimal dose distribution for a patient with a prostate carcinoma. The target volume surface was invaginated and bifurcated. The calculated dose distribution was delivered to a homogeneous polystyrene phantom consisting of 1 cm thick slices that were cut to match the patient's outer contour. Seven therapy verification films were placed between the phantom slices. RESULTS: Analysis of the films revealed a degree of conformation of the high-dose region to the target shape that would not be possible with unmodulated conformal therapy. However, small observed spatial displacements of the dose distribution confirm the need for very accurate positioning. CONCLUSIONS: It is feasible to deliver clinically relevant, three-dimensional dose distributions that conform to invaginated and bifurcated target volumes using fields modulated by multileaf collimators.

Feasibility Studies↗
PubMed1994

The potential and limitations of the inverse radiotherapy technique.

The objective of the work presented in this paper is to explore the scope of the applicability of the inverse radiotherapy technique for designing optimized intensity distributions to achieve a desired dose distribution. A specified desired uniform dose to the target volume is inverted, subject to constraints on the surrounding normal tissue dose, to produce optimum intensity distributions in a set of beams arranged around the target volume. We employed the inverse technique and software developed by Bortfeld and evaluated results both qualitatively and quantitatively using dose distribution displays, dose-volume histograms and biological indices including tumor control probability and normal tissue complication probabilities. So far we have applied this methodology to prostate and lung treatment plans. For prostate the inverse technique produces satisfactory approximations of the desired dose distributions. However, for lung its performance is considerably inferior. Our investigations point to a number of factors for this difference, the primary ones being differences in the tolerance doses of neighboring normal tissues, magnitudes of volume effect, tissue architectures, and the achievability of the specified desired dose distributions. We conclude that, for certain clinical situations, it is not sufficient to specify the objectives of optimization purely in terms of the desired pattern of the dose. The objectives must also include dose-volume effects and biological indices. Furthermore, the mathematics of optimization must be able to incorporate these factors into the process. We find that the inverse technique is not suitable for situations where dose-volume considerations and biological indices are important and that other methods of optimization of intensity distributions should be explored.

Adenocarcinoma↗
PubMed1994

Dynamic X-ray compensation for conformal radiotherapy by means of multi-leaf collimation.

The application of a multiple fixed field technique employing individually shaped and intensity-modulated beams makes it possible to produce dose distributions of high conformity even in the case of concave target volumes. With the technique presented here arbitrary intensity-modulated beams for the practical solution of the inverse problem can be generated. It is also possible to omit wedges, blocks and compensators in conventional radiotherapy. A continuous unidirectional sweep of independently computer-controlled leaves of a multi-leaf collimator is used to modulate the primary uniform beam. A new algorithm is introduced that computes the leaf trajectories. Also, a method is presented that accounts for leaf penumbra and transmission, which causes the generated fluence distribution to deviate from the desired fluence distribution. An optimization algorithm minimizing this deviation is described. The algorithm calculating the leaf trajectories, as well as the method considering penumbra and transmission and the successive optimization technique are used to calculate examples. Treatment times are calculated and compared to those needed when using compensators. A relationship between the treatment time and the maximum leaf speed is also deduced. To achieve good performance the maximum leaf speed should be no less than 20 mm/s.

Algorithms↗
PubMed1993

Stereotactically guided fractionated radiotherapy: technical aspects.

A system for high precision radiotherapy in the head and neck region has been developed. The components of the system are a head mask connected to a stereotactic frame, a localization unit that can be used during CT- and MR-imaging and a stereotactic target positioner. Conformal precision radiotherapy is planned with a new treatment planning system (Voxelplan-Heidelberg). Three different multi-leaf collimator systems are used. An evaluation of the precision and accuracy of the head fixation system, which was performed with a photogrammetry system, is presented.

Head↗