SU-E-T-635: Effect of Planning Parameters on Tomotherapy Dosimetric Quality and Treatment Efficiency.

PURPOSE To investigate how the setting of optimization parameters, fractional dose and tuning structure in tomotherapy treatment planning affects plan dosimetric quality and treatment efficiency. METHODS A digital phantom to simulate head and neck radiotherapy was constructed for this study. Tumor was 10cm long C-shaped with two surrounding parallel normal structures (P-NS) and one serial normal structure (S-NS). Dose prescription was 54 Gy in total. Fourteen treatment plans were generated with varied parameters in five categories: a) jaw size (1 to 5cm), b) pitch (0.215 to 0.43), c) modulation factor (1.5 to 4), d) dose per fraction (100 to 600cGy) and e) whether to use tuning structure. Plans were compared with multiple dosimetric endpoints including target minimum/maximum/mean dose, V100%, conformity, heterogeneity, S-NS maximum dose, P-NS and body mean dose, and treatment times. The reference plan was defined for the plan with conventional parameters: jaw 2.5cm, pitch 0.287, modulation factor 3.0, 200cGy per fraction and use of a 2cm ring structure in optimization. RESULTS Compared with 2.5cm jaw reference plan, 1cm jaw plan decreased the mean body dose 10.7% while 5 cm jaw plan increased the dose 17.9%. Smaller pitch (p=0.215) made the plan more conform than reference plan, and bigger pitch (p=0.43) had opposite effect. A small modulation factor (M=1.5) failed to spare critical structures. A medium modulation factor (M=2) resulted in similar plan to the reference but with 29% less treatment time. A low fractional dose (100 cGy) planned with similar parameter as reference had much inferior target coverage (V100%=85.6% vs V100%=96.4). Lastly, the use of tuning structure improved the conformity of target. CONCLUSIONS Selection of optimization parameters in tomotherapy treatment planning affects target coverage, critical structure sparing, body dose, and treatment time. Target coverage is compromised if fractional dose is low to the range of 100 cGy.