Journal of Medical Physics
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ORIGINAL ARTICLE
Year : 2022  |  Volume : 47  |  Issue : 3  |  Page : 262-269

To study the impact of different optimization methods on intensity-modulated radiotherapy and volumetric-modulated arc therapy plans for hip prosthesis patients


1 Amity Institute of Applied Sciences, Amity University, Noida, Uttar Pradesh; Department of Radiation Oncology, Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
2 Amity Institute of Applied Sciences, Amity University, Noida, Uttar Pradesh, India
3 Radiological Physics and Internal Dosimetry Group, Institute of Nuclear Medicine and Allied Sciences, Defence Research and Development Organisation, Delhi, India
4 Department of Radiation Oncology, Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India

Correspondence Address:
Mr. Pawan Kumar Singh
Amity Institute of Applied Sciences, Amity University, Noida, Uttar Pradesh; Department of Radiation Oncology, Division of Medical Physics, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmp.jmp_14_22

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Purpose: To study the impact of different optimization methods in dealing with metallic hip implant using intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) techniques. Materials and Methods: A cohort of 16 patients having metallic implants was selected for the study. Three sets of IMRT and VMAT plans were generated. Set 1 IMRT (IM_Base), VMAT (VM_Base) without any restrictions on beam entry and exit, set 2 (IM_ENT and VM_ENT) optimizer restricts the beam entry and set 3 (IM_EXT+ENT), neither entry nor exit doses were allowed toward the metallic implant. Results: There was no significant difference in target (D95%) and organ-at-risk doses between IM_Base and IM_ENT. There were significant (P = 0.002) improvements in planning target volume (PTV) V95% and homogeneity from IM_EXT+ENT to IM_ENT. There was no significant difference in plan quality between VM_Base and VM_ENT. There were significant (P = 0.005) improvements in PTV, V95%, homogeneity from VM_EXT+ENT to VM_ENT. V40Gy, V30Gy for bladder, rectum, bowel, and bowel maximum dose decreases significantly (P < 0.005) in IM_ENT compared to IM_EXT+ENT, but not significant for VMAT plans. Similarly, there was a significant decrease in dose spill outside target (P < 0.05) comparing 40%, 50%, 60%, and 70% dose spills for IM_ENT compared to IM_EXT+ENT, but variations among VMAT plans are insignificant. VMAT plans were always superior to IMRT plans for the same optimization methods. Conclusion: The best approach is to plan hip prosthesis cases with blocked entry of radiation beam for IMRT and VMAT. The VMAT plans had more volumetric coverage, fewer hotspots, and lesser heterogeneity.


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