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Outline - Final - Group 3
Outline - Final - Group 3
ii. Purpose: The purpose of this study was to determine the value of an HU
optimization structure covering the target volume and lung overlap region
that will increase proton plan robustness and maintain the inter-fraction
target coverage.
iii. Hypotheses: The researchers tested that an HU optimization structure
using -400, -200, and 0 would increase original plan robustness of the
clinical target volume (CTV) such that 95% of the volume received at
least 100% or more of the prescribed dose (D95% ≥ 100%) for all
robustness curves (H1A, H2A, and H3A respectively) and maintain inter-
fraction CTV coverage D95% ≥ 95% (H4A, H5A, and H6A respectively).
III. Materials and Methods
A. Patient selection and Setup
i. PI: Inclusion and exclusion criteria
1. 15 retrospective cases from a single institution
2. Inclusion criteria: IMPT left lung targets with air in CTV overlap ≥
50 cm3, 5 verification scans throughout treatment, prescribed dose
of 60 Gy in 30 fractions to primary target
3. Exclusion criteria: Right lung targets, retreatments
ii. PII: Simulation procedures
1. 4DCT
B. Contouring
i. PI: Plan Details
1. Contour for CTV6000
2. Contours for OAR delineation (heart, lung, & esophagus)
3. Contour for HU optimization structure (Figure 1)
C. Treatment Planning
i. PI: Plan Setup
1. Eclipse TPS with NUPO algorithm
2. Single field optimization using re-paint vac machine
3. Field selection and number of beams
ii. PII: Plan Optimization
3
References
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Figures
Figure 1. This image shows a sample visual representation of a CTV volume without (A) and
with (B) an HU optimization structure in the axial (top), coronal (middle), and sagittal views
(bottom). The cyan color indicated by a striped arrow represents a CTV volume delineated by the
physician (A). The magenta color indicated by a solid black arrow represents the HU
optimization structure along the lung and tissue interface created for this study (B), given an HU
override value of either -400, -200, or 0.
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Figure 2. Target coverage of original plans without and with HU override values of -400, -200,
and 0. Original plans without an HU optimization structure are represented by white. Original
plans using an HU optimization structure with an override value of -400 are shown as vertical
stripes, -200 are shown as dots, and 0 are shown as horizontal stripes.
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Figure 3. Target coverage of verification plans to assess inter-fraction robustness without and
with HU override values of -400, -200, and 0. Verification plans without an HU optimization
structure are represented in white. Verification plans using an HU optimization structure with an
override value of -400 are shown as vertical stripes, -200 are shown as dots, and 0 are shown as
horizontal stripes.
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Figure 4. Values obtained for statistical analysis without and with an HU optimization structure
for target plan robustness evaluation are shown above for one patient within the research
population. Original plans are shown first with a thick black border (white representing no
override, vertical stripes representing an override using HU -400, dots representing an override
using HU -200, and horizontal stripes representing an override using HU 0). Five associated
verification plans follow their corresponding original plan. Solid black represents any
verification plan that fell below robustness evaluation criteria.