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Commissioning and first clinical application of mARC treatment

Kommissionierung und erste klinische Anwendung der mARC-Bestrahlung

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Abstract

Background

The modulated arc (mARC) technique has recently been introduced for Siemens ARTISTE linear accelerators. We present the first experiences with the commissioning of the system and first patient treatments.

Patients and Methods

Treatment planning and delivery are presented for the Prowess Panther treatment planning system or, alternatively, an in-house code. Dosimetric verification is performed both by point dose measurements and in 3D dose distribution.

Results

Depending on the target volume, one or two arcs can be used to create highly conformal plans. Dosimetric verification of the converted mARC plans with step-and-shoot plans shows deviations below 1 % in absolute point dose; in the 3D dose distribution, over 95 % of the points pass the 3D gamma criteria (3 % deviation in local dose and 3 mm distance to agreement for doses > 20 % of the maximum). Patient specific verification of the mARC dose distribution with the calculations has a similar pass rate. Treatment times range between 2 and 5 min for a single arc.

Conclusions

To our knowledge, this is the first report of clinical application of the mARC technique. The mARC offers the possibility to save significant amounts of time, with single-arc treatments of only a few minutes achieving comparable dose distribution to IMRT plans taking up to twice as long.

Zusammenfassung

Hintergrund

Die mARC (modulated arc) Technik wurde vor kurzen für Siemens ARTISTE Linearbeschleuniger eingeführt. Wir zeigen die ersten Erfahrungen mit der Kommissionierung des Systems sowie die ersten Patientenbestrahlungen.

Material und Methode

Bestrahlungsplanung und Behandlung werden für das Prowess Panther Bestrahlungsplanungssystem oder alternativ in einer in-house-Lösung präsentiert. Die dosimetrische Verifikation wurde sowohl mit Punktmessungen als auch für die 3D-Dosisverteilung durchgeführt.

Ergebnisse

Je nach Zielvolumen können mit einem oder zwei Bögen hochkonformale Pläne erzeugt werden. Die dosimetrische Verifikation konvertierter mARC-Pläne gegen step-and-shoot-Pläne weicht in absoluter Dosis um weniger als 1 % ab. In der 3D-Dosisverteilung erfüllen über 95 % der Punkte das 3D-Gamma-Kriterium (3 % lokale Dosis, 3 mm Abstand für alle Werte > 20 % der Maximaldosis). Die patienten-spezifische Verifikation der mARC-Dosisverteilung mit den Planberechnungen hat eine vergleichbare Übereinstimmung. Die Behandlungszeiten liegen zwischen 2 und 5 Minuten für eine Rotation.

Schlussfolgerung

Unseres Wissens ist dies der erste Bericht über eine klinische Anwendung der mARC-Technik. Der mARC ermöglicht eine signifikante Zeitersparnis. Mit einer Rotation von wenigen Minuten Dauer kann eine mit der IMRT vergleichbare Dosisverteilung erzielt werden.

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Acknowledgements

We are very grateful to the section editor Prof. Dr. Zink and an anonymous reviewer for their very insightful and constructive suggestions, which we feel have greatly improved this manuscript.

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Conflict of interest

Y. Dzierma, F. G. Nuesken, S. Kremp, J. Palm, N. P. Licht, and C. Rübe state that there are no conflict of interest.

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Correspondence to Yvonne Dzierma.

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Dzierma, Y., Nuesken, F., Kremp, S. et al. Commissioning and first clinical application of mARC treatment. Strahlenther Onkol 190, 1046–1052 (2014). https://doi.org/10.1007/s00066-014-0662-9

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  • DOI: https://doi.org/10.1007/s00066-014-0662-9

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