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Abstract: Background and purpose: A dose compensation method is presented for patients with hip prosthesis based on Dynamic Multi Leaves Collimator (DMLC) planning. Calculations are done from an exit Portal Dose Image (PDI) from 6 MV Photon beam using an Electronic Portal Imaging Device (EPID) from Varian. Four different hip prostheses are used for this work. Methods: From an exit PDI the fluence needed to yield a uniform dose distribution behind the prosthesis is calculated. To back-project the dose distribution through the phantom, the lateral scatter is removed by deconvolution with a point spread function (PSF) determined for depths from 10 to 40cm. The dose maximum, Dmax, is determined from the primary plan which delivers the PDI. A further deconvolution to remove the dose glare effect in the EPID is performed as well. Additionally, this calculated fluence distribution is imported into the Treatment Planning System (TPS) for the final calculation of a DMLC plan. The fluence file contains information such as the relative central axis (CAX) position, grid size and fluence size needed for correct delivery of the DMLC plan. GafChromic EBT films positioned at 10cm depth are used as verification of uniform dose distributions behind the prostheses. As the prosthesis is positioned at the phantom surface the dose verifications are done 10cm from the prosthesis. Conclusion: The film measurement with 6 MV photon beam shows uniform doses within 5% for most points, but with hot/cold spots of 10% near the femoral head prostheses. [Copyright &y& Elsevier]

Abstract: Introduction: The aim of the present study was to test the feasibility of a Nickel–Titanium (Ni–Ti) stent technique (Memocore™) in a porcine model. The stent is intended as a new fiducial for gated image guided radiotherapy in the lung. The study included test of an improved insertion system and respiratory gated treatments with this new technique. Methods and materials: Tests were carried out in a porcine model using Göttingen mini-pigs. The study included 10 animals. Planning CT was performed as 4 dimensional CT (4DCT) using the Varian RPM system. Respiratory gated radiotherapy treatments were simulated using the Brainlab ExacTrac system. Reproducibility of stent position during treatment was analyzed off-line using an experimental version of the ExacTrac software. The experimental version has a dedicated algorithm for segmentation of the stent in the planning CT and subsequent registration to X-ray position images. Results: A total of 23 stents were inserted in the 10 animals. Stents could be placed in all parts of the lungs. No stent migrated within the four weeks the experiment lasted. Stent trajectories in the lung were not reproducible, even though respiration was highly standardized using a respirator. The best accuracy of stent position in the gating window was obtained using gating at the half_max amplitude as reference level. The smallest stent movement within the gating window was observed in the exhale phase. Further success of human application will depend on the possibility to insert the stent within or close to lung tumors. Conclusions: This new technique based on the Memocore™ lung stent used in connection with respiratory gated radiotherapy was demonstrated to be feasible in a porcine model. The study demonstrated lack of reproducibility in lung trajectories of inserted stents. The technique gave the best accuracy when applied to the exhale phase of respiration. [Copyright &y& Elsevier]

• Desentralised plan comparison is robust; however, many aspects of treatment planning need to be validated. • Local plan comparison between protons and photons seems to overestimate the ΔNTCP slightly. • Target and OAR contouring differences play an important role in the robustness of the patient selection. Proton treatment can potentially spare patients with H&N cancer for substantial treatment-related toxicities. The current study investigated the reproducibility of a decentralised model-based selection of patients for a proton treatment study when the selection plans were compared to the clinical treatment plans performed at the proton centre. Sixty-three patients were selected for proton treatment in the six Danish Head and Neck Cancer (DAHANCA) centres. The patients were selected based on normal tissue complication probability (NTCP) estimated from local photon and proton treatment plans, which showed a ΔNTCP greater than 5%-point for either grade 2 + dysphagia or grade 2 + xerostomia at six months. The selection plans were compared to the clinical treatment plans performed at the proton centre. Of the 63 patients, 49 and 25 were selected based on an estimated benefit in risk of dysphagia and xerostomia, respectively. Eleven patients had a potential gain in both toxicities. The mean ΔNTCP changed from the local selection plan comparison to the clinical comparison from 6.9 to 5.3 %-points (p = 0.01) and 7.3 to 4.9 %-points (p = 0.03) for dysphagia and xerostomia, respectively. Volume differences in both CTV and OAR could add to the loss in ΔNTCP. 61 of the 63 clinical plans had a positive ΔNTCP, and 38 had a ΔNTCP of 5%-points for at least one of the two endpoints. A local treatment plan comparison can be used to select candidates for proton treatment. The local comparative proton plan overestimates the potential benefit of the clinical proton plan. Continuous quality assurance of the delineation procedures and planning is crucial in the subsequent randomised clinical trial setting. [ABSTRACT FROM AUTHOR]