Phantom Verification of AAA and Acuros Dose Calculations for Lung Cancer: Do Tumor Size and Regression Matter? Satomi Shiraishi, PhD, Luis E. Fong de.

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Phantom Verification of AAA and Acuros Dose Calculations for Lung Cancer: Do Tumor Size and Regression Matter? Satomi Shiraishi, PhD, Luis E. Fong de los Santos, PhD, John A. Antolak, PhD, Kenneth R. Olivier, MD, Yolanda I. Garces, MD, Sean S. Park, MD, PhD, Michael P. Grams, PhD Practical Radiation Oncology Volume 9, Issue 1, Pages 29-37 (January 2019) DOI: 10.1016/j.prro.2018.06.008 Copyright © 2018 American Society for Radiation Oncology Terms and Conditions

Figure 1 (A) Water phantom with cork as lung surrogates. (B) Each cork and tumor splits in half for film placement. The largest tumor is shown. (C) Computed tomography images of 3 different solid water lung tumors and a cork lung that contained no tumor. Practical Radiation Oncology 2019 9, 29-37DOI: (10.1016/j.prro.2018.06.008) Copyright © 2018 American Society for Radiation Oncology Terms and Conditions

Figure 2 Examples of 3-dimensional conformal and volumetric modulated arc therapy dose distributions for the large tumor phantom. Doses displayed here are calculated by the Eclipse Analytical Anisotropic Algorithm. The red dashed line corresponds to the location of the measurement films. A-B: Axial view of the dose distributions for 3D conformal and VMAT plans, respectively. C-D: Coronal view of the dose distributions for 3D conformal and VMAT plans, respectively. (A color version of this figure is available at https://doi.org/10.1016/j.prro.2018.06.008.) Practical Radiation Oncology 2019 9, 29-37DOI: (10.1016/j.prro.2018.06.008) Copyright © 2018 American Society for Radiation Oncology Terms and Conditions

Figure 3 Schematics outlining the studies. For the tumor size study (Study 1), treatment plans designed to treat large, medium, and small tumors were delivered to corresponding phantoms. For the regressing tumor study (Study 2), treatment plans designed to treat a large tumor were delivered to smaller tumor phantoms. For both studies, the analyses involved comparing film measurements with AAA and Acuros calculations. Practical Radiation Oncology 2019 9, 29-37DOI: (10.1016/j.prro.2018.06.008) Copyright © 2018 American Society for Radiation Oncology Terms and Conditions

Figure 4 Left/right and superoinferior dose profiles through the isocenter for 6 MV volumetric modulated arc therapy plans (A-F) and for 10 MV 3-dimensional conformal plans (G-L). Gross and planning target volumes are indicated by the gray dotted and dash-dot lines, respectively. Practical Radiation Oncology 2019 9, 29-37DOI: (10.1016/j.prro.2018.06.008) Copyright © 2018 American Society for Radiation Oncology Terms and Conditions

Figure 5 Dosimetric changes for a 6 MV volumetric modulated arc therapy plan created for the treatment of a large tumor phantom. (A) Comparison of measured dose distributions when the large tumor plan was delivered to the phantom with the large tumor (Dlarge) and to the phantom with the medium tumor (Dmedium). Dose difference is indicated by, ΔDmedium = Dmedium – Dlarge. (B) Corresponding plot for measurements with small tumor phantom. (C) No-tumor phantom. The inner gray circles indicate the gross tumor volume and the outer black circles indicate the planning target volume. Practical Radiation Oncology 2019 9, 29-37DOI: (10.1016/j.prro.2018.06.008) Copyright © 2018 American Society for Radiation Oncology Terms and Conditions

Figure 6 Comparison of film measurements and Eclipse Analytical Anisotropic Algorithm (A-F) and Acuros (G-L) calculations through the isocenter. “Large tumor” corresponds to measurements and treatment planning system calculations with the largest tumor within the cork inserts. “No tumor” corresponds to the case without any solid water tumor and is meant to represent the extreme scenario of complete tumor regression. Practical Radiation Oncology 2019 9, 29-37DOI: (10.1016/j.prro.2018.06.008) Copyright © 2018 American Society for Radiation Oncology Terms and Conditions