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      Dosimetric Evaluation of the QFix kVue TM Calypso Couch Top

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          Abstract

          Purpose:

          To evaluate the dosimetric accuracy of the default couch model of the QFix kVue TM Calypso couch top in the treatment planning system.

          Methods:

          With the gantry 180°, field size 20 × 20 cm, 6 MV, we measured the depth dose, off-axis dose, and dose plane of different depths in the phantom with the couch rails in and out, respectively. Isocenter doses at different angles were also obtained. The results were compared to the doses calculated using the default couch top model and the real scanned couch top model. Then we revised the default model according to the measured results.

          Results:

          With “Rails In,” the depth dose, off-axis dose, and dose plane of the default couch top model had a big difference with the dose of the real scanned couch top model and the measured result. The dose of the real scanned couch top model was much closer to the measured result, but in the region of the rail edge, the difference was still significant. With “Rails Out,” there was a minor difference between the measured result, the dose of the default couch top model and the real scanned couch top model. The difference between the measurement and the default couch top model became very small after being revised.

          Conclusions:

          It is better to avoid the beam angle passing through the couch rails in treatment plans, or you should revise the parameter of the QFix kVue TM Calypso couch top model based on the measured results, and verify the treatment plan before clinical practice.

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          Most cited references34

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          Multi-institutional clinical experience with the Calypso System in localization and continuous, real-time monitoring of the prostate gland during external radiotherapy.

          To report the clinical experience with an electromagnetic treatment target positioning and continuous monitoring system in patients with localized prostate cancer receiving external beam radiotherapy. The Calypso System is a target positioning device that continuously monitors the location of three implanted electromagnetic transponders at a rate of 10 Hz. The system was used at five centers to position 41 patients over a full course of therapy. Electromagnetic positioning was compared to setup using skin marks and to stereoscopic X-ray localization of the transponders. Continuous monitoring was performed in 35 patients. The difference between skin mark vs. the Calypso System alignment was found to be >5 mm in vector length in more than 75% of fractions. Comparisons between the Calypso System and X-ray localization showed good agreement. Qualitatively, the continuous motion was unpredictable and varied from persistent drift to transient rapid movements. Displacements > or =3 and > or =5 mm for cumulative durations of at least 30 s were observed during 41% and 15% of sessions. In individual patients, the number of fractions with displacements > or =3 mm ranged from 3% to 87%; whereas the number of fractions with displacements > or =5 mm ranged from 0% to 56%. The Calypso System is a clinically efficient and objective localization method for positioning prostate patients undergoing radiotherapy. Initial treatment setup can be performed rapidly, accurately, and objectively before radiation delivery. The extent and frequency of prostate motion during radiotherapy delivery can be easily monitored and used for motion management.
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            Target localization and real-time tracking using the Calypso 4D localization system in patients with localized prostate cancer.

            The Calypso 4D Localization System is being developed to provide accurate, precise, objective, and continuous target localization during radiotherapy. This study involves the first human use of the system, to evaluate the localization accuracy of this technique compared with radiographic localization and to assess its ability to obtain real-time prostate-motion information. Three transponders were implanted in each of 20 patients. Eleven eligible patients of the 20 patients participated in a study arm that compared radiographic triangulated transponder locations to electromagnetically recorded transponder locations. Transponders were tracked for 8-min periods. The implantations were all successful, with no major complications. Intertransponder distances were largely stable. Comparison of the patient localization on the basis of transponder locations as per the Calypso system with the radiographic transponder localization showed an average (+/-SD) 3D difference of 1.5 +/- 0.9 mm. Upon tracking during 8 min, 2 of the 11 patients showed significant organ motion (>1 cm), with some motion lasting longer that 1 min. Calypso transponders can be used as magnetic intraprostatic fiducials. Clinical evaluation of this novel 4D nonionizing electromagnetic localization system with transponders indicates a comparable localization accuracy to isocenter, (within 2 mm) compared with X-ray localization.
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              Radiobiological basis of SBRT and SRS.

              Stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) have been demonstrated to be highly effective for a variety of tumors. However, the radiobiological principles of SBRT and SRS have not yet been clearly defined. It is well known that newly formed tumor blood vessels are fragile and extremely sensitive to ionizing radiation. Various lines of evidence indicate that irradiation of tumors with high dose per fraction, i.e. >10 Gy per fraction, not only kills tumor cells but also causes significant damage in tumor vasculatures. Such vascular damage and ensuing deterioration of the intratumor environment then cause ischemic or indirect/secondary tumor cell death within a few days after radiation exposure, indicating that vascular damage plays an important role in the response of tumors to SBRT and SRS. Indications are that the extensive tumor cell death due to the direct effect of radiation on tumor cells and the secondary effect through vascular damage may lead to massive release of tumor-associated antigens and various pro-inflammatory cytokines, thereby triggering an anti-tumor immune response. However, the precise role of immune assault on tumor cells in SBRT and SRS has not yet been clearly defined. The "4 Rs" for conventional fractionated radiotherapy do not include indirect cell death and thus 4 Rs cannot account for the effective tumor control by SBRT and SRS. The linear-quadratic model is for cell death caused by DNA breaks and thus the usefulness of this model for ablative high-dose SBRT and SRS is limited.
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                Author and article information

                Journal
                Technol Cancer Res Treat
                Technol Cancer Res Treat
                TCT
                sptct
                Technology in Cancer Research & Treatment
                SAGE Publications (Sage CA: Los Angeles, CA )
                1533-0346
                1533-0338
                29 April 2021
                2021
                : 20
                : 15330338211011964
                Affiliations
                [1 ]Department of Radiation Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
                [2 ]Department of Oncology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
                [3 ]Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
                Author notes
                [*]Shengyu Yao, MS, Department of Radiation Oncology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, No. 100 Haining Road, Hongkou District, Shanghai 200080, China. Email: jordanyao11@ 123456126.com
                [*]Xiaodong Jiang, PhD, Department of Oncology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang 222000, China. Email: jxdpaper@ 123456163.com
                Author information
                https://orcid.org/0000-0001-5388-0636
                Article
                10.1177_15330338211011964
                10.1177/15330338211011964
                8107663
                33910440
                12d5909e-fd9f-49ef-b434-3897ef330e07
                © The Author(s) 2021

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 21 September 2020
                : 25 January 2021
                : 29 March 2021
                Categories
                Original Article
                Custom metadata
                January-December 2021
                ts3

                calypso,couch rails,default model,dosimetric accuracy,model revision

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