Pinnacle Treatment Planning System User Manual
For an institution that already owns the licenses, it is economically advantageous and technically feasible to use Pinnacle TPS (Philips Radiation Oncology Systems, Fitchburg, WI) with the BrainLab Novalis delivery system (BrainLAB A.G., Heimstetten, Germany). This takes advantage of the improved accuracy of the convolution algorithm in the presence of heterogeneities compared with the pencil beam calculation, which is particularly significant for lung SBRT treatments.
The reference patient positioning DRRs still have to be generated by the BrainLab software from the CT images and isocenter coordinates transferred from Pinnacle. We validated this process with the end-to-end hidden target test, which showed an isocenter positioning error within one standard deviation from the previously established mean value. The Novalis treatment table attenuation is substantial (up to 6.2% for a beam directed straight up and up to 8.4% for oblique incidence) and has to be accounted for in calculations. A simple single-contour treatment table model was developed, resulting in mean differences between the measured and calculated attenuation factors of 0.0%-0.2%, depending on the field size.
The maximum difference for a single incidence angle is 1.1%. The BrainLab micro-MLC (mMLC) leaf tip, although not geometrically round, can be represented in Pinnacle by an arch with satisfactory dosimetric accuracy. Subsequently, step-and-shoot (direct machine parameter optimization) IMRT dosimetric agreement is excellent. VMAT (called 'SmartArc' in Pinnacle) treatments with constant gantry speed and dose rate are feasible without any modifications to the accelerator. Due to the 3 mm-wide mMLC leaves, the use of a 2 mm calculation grid is recommended. When dual arcs are used for the more complex cases, the overall dosimetric agreement for the SmartArc plans compares favorably with the previously reported results for other implementations of VMAT: gamma(3%,3mm) for absolute dose obtained with the biplanar diode array passing rates above 97% with the mean of 98.6%. However, a larger than expected dose error with the single-arc plans, confined predominantly to the isocenter region, requires further investigation.
.Seligman, Linda1993-01-01Describes approach to teaching treatment planning that author has used successfully in both seminars and graduate courses.Mathew, D; Alaei, P2016-01-01Purpose: A small-scale implementation of Failure Modes and Effects Analysis (FMEA) for treatment planning system QA by utilizing methodology of AAPM TG-100 report. Methods: FMEA requires numerical values for severity (S), occurrence (O) and detectability (D) of each mode of failure. The product of these three values gives a risk priority number (RPN). We have implemented FMEA for the treatment planning system (TPS) QA for two clinics which use Pinnacle and Eclipse TPS. Quantitative monthly QA data dating back to 4 years for Pinnacle and 1 year for Eclipse have been used to determine values for severity (deviations from predetermined doses at points or volumes), and occurrence of such deviations. The TPS QA protocol includes a phantom containing solid water and lung- and bone-equivalent heterogeneities.
Photon and electron plans have been evaluated in both systems. The dose values at multiple distinct points of interest (POI) within the solid water, lung, and bone-equivalent slabs, as well as mean doses to several volumes of interest (VOI), have been re-calculated monthly using the available algorithms. Results: The computed doses vary slightly month-over-month.
There have been more significant deviations following software upgrades, especially if the upgrade involved re-modeling of the beams. TG-100 guidance and the data presented here suggest an occurrence (O) of 2 depending on the frequency of re-commissioning the beams, severity (S) of 3, and detectability (D) of 2, giving an RPN of 12. Conclusion: Computerized treatment planning systems could pose a risk due to dosimetric errors and suboptimal treatment plans. The FMEA analysis presented here suggests that TPS QA should immediately follow software upgrades, but does not need to be performed every month.Mathew, D; Alaei, P University Minnesota, Minneapolis, MN (United States)2016-06-15Purpose: A small-scale implementation of Failure Modes and Effects Analysis (FMEA) for treatment planning system QA by utilizing methodology of AAPM TG-100 report. Methods: FMEA requires numerical values for severity (S), occurrence (O) and detectability (D) of each mode of failure. The product of these three values gives a risk priority number (RPN). We have implemented FMEA for the treatment planning system (TPS) QA for two clinics which use Pinnacle and Eclipse TPS.
Quantitative monthly QA data dating back to 4 years for Pinnacle and 1 year for Eclipse have been used to determine values for severity (deviations from predetermined doses at points or volumes), and occurrence of such deviations. The TPS QA protocol includes a phantom containing solid water and lung- and bone-equivalent heterogeneities. Photon and electron plans have been evaluated in both systems. The dose values at multiple distinct points of interest (POI) within the solid water, lung, and bone-equivalent slabs, as well as mean doses to several volumes of interest (VOI), have been re-calculated monthly using the available algorithms. Results: The computed doses vary slightly month-over-month. There have been more significant deviations following software upgrades, especially if the upgrade involved re-modeling of the beams.
TG-100 guidance and the data presented here suggest an occurrence (O) of 2 depending on the frequency of re-commissioning the beams, severity (S) of 3, and detectability (D) of 2, giving an RPN of 12. Conclusion: Computerized treatment planning systems could pose a risk due to dosimetric errors and suboptimal treatment plans.
The FMEA analysis presented here suggests that TPS QA should immediately follow software upgrades, but does not need to be performed every month.Saw, Cheng B; Li, Sicong2018-01-01Three-dimensional (3D) treatment planning systems have evolved and become crucial components of modern radiation therapy. The systems are computer-aided designing or planning softwares that speed up the treatment planning processes to arrive at the best dose plans for the patients undergoing radiation therapy. Furthermore, the systems provide new technology to solve problems that would not have been considered without the use of computers such as conformal radiation therapy (CRT), intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT).
The 3D treatment planning systems vary amongst the vendors and also the dose delivery systems they are designed to support. As such these systems have different planning tools to generate the treatment plans and convert the treatment plans into executable instructions that can be implemented by the dose delivery systems. The rapid advancements in computer technology and accelerators have facilitated constant upgrades and the introduction of different and unique dose delivery systems than the traditional C-arm type medical linear accelerators.
Virtual studio tv set free. The focus of this special issue is to gather relevant 3D treatment planning systems for the radiation oncology community to keep abreast of technology advancement by assess the planning tools available as well as those unique 'tricks or tips' used to support the different dose delivery systems. Copyright © 2018 American Association of Medical Dosimetrists.
Published by Elsevier Inc. All rights reserved.Moore, J A; Evans, K; Yang, W; Herman, J; McNutt, T2014-01-01Purpose: Using a database of prior treated patients, it is possible to predict the dose to critical structures for future patients. Automatic treatment planning speeds the planning process by generating a good initial plan from predicted dose values. Methods: A SQL relational database of previously approved treatment plans is populated via an automated export from Pinnacle 3. This script outputs dose and machine information and selected Regions of Interests as well as its associated Dose-Volume Histogram (DVH) and Overlap Volume Histograms (OVHs) with respect to the target structures.
Toxicity information is exported from Mosaiq and added to the database for each patient. The SQL query is designed to ask the system for the lowest achievable dose for a specified region of interest (ROI) for each patient with a given volume of that ROI being as close or closer to the target than the current patient. Results: The additional time needed to calculate OVHs is approximately 1.5 minutes for a typical patient. Database lookup of planning objectives takes approximately 4 seconds.
The combined additional time is less than that of a typical single plan optimization (2.5 mins). Conclusions: An automatic treatment planning interface has been successfully used by dosimetrists to quickly produce a number of SBRT pancreas treatment plans. The database can be used to compare dose to individual structures with the toxicity experienced and predict toxicities before planning for future patients.Palleri, Francesca; Baruffaldi, Fabio; Angelini, Anna Lisa; Ferri, Andrea; Spezi, Emiliano2008-01-01In external beam radiotherapy the calculation of dose distribution for patients with hip prostheses is critical. Metallic implants not only degrade the image quality but also perturb the dose distribution. Conventional treatment planning systems do not accurately account for high-Z prosthetic implants heterogeneities, especially at interfaces. The materials studied in this work have been chosen on the basis of a statistical investigation on the hip prostheses implanted in 70 medical centres. The first aim of this study is a systematic characterization of materials used for hip prostheses, and it has been provided by BEAMnrc Monte Carlo code.
The second aim is to evaluate the capabilities of a specific treatment planning system, Pinnacle 3, when dealing with dose calculations in presence of metals, also close to the regions of high-Z gradients. In both cases it has been carried out an accurate comparison versus experimental measurements for two clinical photon beam energies (6 MV and 18 MV) and for two experimental sets-up: metallic cylinders inserted in a water phantom and in a specifically built PMMA slab. Our results show an agreement within 2% between experiments and MC simulations. TPS calculations agree with experiments within 3%.Palleri, Francesca; Baruffaldi, Fabio; Angelini, Anna Lisa; Ferri, Andrea; Spezi, Emiliano2008-12-01In external beam radiotherapy the calculation of dose distribution for patients with hip prostheses is critical. Metallic implants not only degrade the image quality but also perturb the dose distribution.
Conventional treatment planning systems do not accurately account for high-Z prosthetic implants heterogeneities, especially at interfaces. The materials studied in this work have been chosen on the basis of a statistical investigation on the hip prostheses implanted in 70 medical centres. The first aim of this study is a systematic characterization of materials used for hip prostheses, and it has been provided by BEAMnrc Monte Carlo code.
The second aim is to evaluate the capabilities of a specific treatment planning system, Pinnacle 3, when dealing with dose calculations in presence of metals, also close to the regions of high-Z gradients. In both cases it has been carried out an accurate comparison versus experimental measurements for two clinical photon beam energies (6 MV and 18 MV) and for two experimental sets-up: metallic cylinders inserted in a water phantom and in a specifically built PMMA slab.
Our results show an agreement within 2% between experiments and MC simulations. TPS calculations agree with experiments within 3%.Krayenbuehl, Jerome; Norton, Ian; Studer, Gabriela; Guckenberger, Matthias2015-01-01This study evaluated an automated inverse treatment planning algorithm, Pinnacle Auto- Planning (AP), and compared automatically generated plans with historical plans in a large cohort of head and neck cancer patients. Fifty consecutive patients treated with volumetric modulated arc therapy (Eclipse, Varian Medical System, Palo Alto, CA) for head and neck were re- planned with AP version 9.10. Only one single cycle of plan optimization using one single template was allowed for AP. The dose to the planning target volumes (PTV’s; 3–4 dose levels), the organs at risk (OAR’s) and the effective working time for planning was evaluated.
Pinnacle Treatment Planning System User Manual Pdf Download Pc
Additionally, two experienced radiation oncologists blind-reviewed and ranked 10 plans. Dose coverage and dose homogeneity of the PTV were significantly improved with AP, however manually optimized plans showed significantly improved dose conformity. The mean dose to the parotid glands, oral mucosa, swallowing muscles, dorsal neck tissue and maximal dose to the spinal cord were significantly reduced with AP. In 64% of the plans, the mean dose to any OAR (spinal cord excluded) was reduced by 20% with AP in comparison to the manually optimized plans.
In 12% of the plans, the manually optimized plans showed reduced doses by 20% in at least one OAR. The experienced radiation oncologists preferred the AP plan and the clinical plan in 80 and 20% of the cases, respectively.
The average effective working time was 3.8 min ± 1.1 min in comparison to 48.5 min ± 6.0 min using AP compared to the manually optimized plans, respectively. The evaluated automated planning algorithm achieved highly consistent and significantly improved treatment plans with potentially clinically relevant OAR sparing by 20% in 64% of the cases. The effective working time was substantially reduced with Auto- Planning.Rosen, Isaac; Liu, H. Helen; Childress, Nathan; Liao Zhongxing2005-01-01Purpose: A new paradigm for treatment planning is proposed that embodies the concept of interactively exploring the space of optimized plans. In this approach, treatment planning ignores the details of individual plans and instead presents the physician with clinical summaries of sets of solutions to well-defined clinical goals in which every solution has been optimized in advance by computer algorithms.
Methods and materials: Before interactive planning, sets of optimized plans are created for a variety of treatment delivery options and critical structure dose-volume constraints. Then, the dose-volume parameters of the optimized plans are fit to linear functions. These linear functions are used to show in real time how the target dose-volume histogram (DVH) changes as the DVHs of the critical structures are changed interactively. A bitmap of the space of optimized plans is used to restrict the feasible solutions.
The physician selects the critical structure dose-volume constraints that give the desired dose to the planning target volume (PTV) and then those constraints are used to create the corresponding optimized plan. Results: The method is demonstrated using prototype software, Treatment Plan Explorer (TPEx), and a clinical example of a patient with a tumor in the right lung.
For this example, the delivery options included 4 open beams, 12 open beams, 4 wedged beams, and 12 wedged beams. Beam directions and relative weights were optimized for a range of critical structure dose-volume constraints for the lungs and esophagus.
Cord dose was restricted to 45 Gy. Using the interactive interface, the physician explored how the tumor dose changed as critical structure dose-volume constraints were tightened or relaxed and selected the best compromise for each delivery option. The corresponding treatment plans were calculated and compared with the linear parameterization presented to the physician in TPEx. The linear fits were best for the maximum PTV dose and worst.Cao, Y; Li, R; Chi, Z The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, CN, Shijiazhuang, Hebei (China)2014-06-01Purpose: To compare the performances of four commercial treatment planning systems (TPS) used for the intensity-modulated radiotherapy (IMRT). Methods: Ten patients of nasopharyngeal (4 cases), esophageal (3 cases) and cervical (3 cases) cancer were randomly selected from a 3-month IMRT plan pool at one radiotherapy center. For each patient, four IMRT plans were newly generated by using four commercial TPS (Corvus, Monaco, Pinnacle and Xio), and then verified with Matrixx (two-dimensional array/IBA Company) on Varian23EX accelerator. A pass rate (PR) calculated from the Gamma index by OminiPro IMRT 1.5 software was evaluated at four plan verification standards (1%/1mm, 2%/2mm, 3%/3mm, 4%/4mm and 5%/5mm) for each treatment plan.
Overall and multiple pairwise comparisons of PRs were statistically conducted by analysis of covariance (ANOVA) F and LSD tests among four TPSs. Results: Overall significant (p0.05) differences of PRs were found among four TPSs with F test values of 3.8 (p=0.02), 21.1(0.01), 14.0 (0.01), 8.3(0.01) at standards of 1%/1mm to 4%/4mm respectively, except at 5%/5mm standard with 2.6 (p=0.06). All means (standard deviation) of PRs at 3%/3mm of 94.3 ± 3.3 (Corvus), 98.8 ± 0.8 (Monaco), 97.5± 1.7 ( Pinnacle), 98.4 ± 1.0 (Xio) were above 90% and met clinical requirement. Multiple pairwise comparisons had not demonstrated a consistent low or high pattern on either TPS. Conclusion: Matrixx dose verification results show that the validation pass rates of Monaco and Xio plans are relatively higher than those of the other two; Pinnacle plan shows slight higher pass rate than Corvus plan; lowest pass rate was achieved by the Corvus plan among these four kinds of TPS.Zhang, L; Court, L; Balter, P; Dong, L2012-06-01The use of structure overlay on setup DRRs can aid the image alignment procedure for daily image-guided setup procedures. However, the accuracy of a 3D region-of-interest (ROI) projected on a 2D digitally reconstructed radiograph (DRR) has rarely been evaluated quantitatively. The goal of this study is to test the accuracy of two commercial treatment planning systems (TPS) in producing overlay structures on setup DRRs.
Software User Manual
We designed a novel method to identify landmarks which were on the boundary of the projected ROI on a DRR. The 3D ROIvolume is composed of a stack of 2D curves. We first mathematically project each 2D curve onto a beams-eye-view (BEV) plane. Next, we detectthe boundary points of the projected curves. Those boundary points serve aslandmarks. Finally, we project the binary mask of the 3D ROI volume using ray tracing method onto the BEV plane.
This projected binary mask is used to exclude the false landmarks. Once those landmarks are detected, wecompute the distance between the landmarks and ROI outlines from the TPS. We applied our validation method to 13 ROIs from a lung patient and 4 simulated ROIs on 2 BEV DRRs for two different TPS (Eclipse and Pinnacle). Average distance between the landmarks and ROIoutlines was 0.5mm for both Eclipse and Pinnacle approaches, which is close to the pixel resolution of the DRR. The maximum distance andaverage maximum distance was 2mm and 1 mm, respectively, for both TPS.The maximum distance occurred at points where the ROI curve has a sharpchange between slices. The accuracy of Eclipse and Pinnacle ROI projection method seems to be acceptable to within 1mm althoughprojection error can be as large as 2mm when structure shape has a sharp variation from one slice to the next. © 2012 American Association of Physicists in Medicine.Hatton, J.A.; Cornes, D.A.2011-01-01Full text: Clinical trials require robust quality assurance (QA) procedures to ensure commonality of all treatments, with independent reviews to assess compliance with trial protocols.
All clinical trials tools, including QA software, require testing for validity and reliability. Enabling inter- and intra-trial comparison. Unlike clinical radiotherapy treatment planning (RTP) systems, review software has no published guidelines. This study describes the design and development of a test suite to quantify the performance of review software in TROG clinical trials. Test areas are image handling and reconstruction; geometric accuracy; dosimetric accuracy; dose-volume histogram (DVH) calculation; display of plan parameters. TROG have developed tests for commissioning plan review software, assessed with SWAN 2.3, and CMS Elekta FocalPro.
While image handling tests were based on published guidelines for RTP systems, dosimetric tests used the TROG QA case review requirements. Treatment plans represented systems of all manufacturers ( Pinnacle, Eclipse, Xio and Oncentra) used in Australasian centres. The test suite identified areas for SW A software development, including the DVH algorithm, changed to reduce calculation time. Results, in Fig.
I, for known volumes of varying shapes and sizes, demonstrate differences between SWAN 2.1 and 2.3 when compared with Eclipse. Liaison with SWAN programmers enabled re-instatement of 2.1 algorithm. The test suite has quantified the RTP review software, prioritised areas for development with the programmers, and improved the user experience.Lewis, D; Chi, P; Tailor, R; Aristophanous, M; Tung, S UT MD Anderson Cancer Center, Houston, TX (United States)2016-06-15Purpose: To verify the accuracy of total body irradiation (TBI) measurement commissioning data using the treatment planning system (TPS) for a wide range of patient separations. Methods: Our institution conducts TBI treatments with an 18MV photon beam at 380cm extended SSD using an AP/PA technique.
Currently, the monitor units (MU) per field for patient treatments are determined using a lookup table generated from TMR measurements in a water phantom (75 × 41 × 30.5 cm3). The dose prescribed to an umbilicus midline point at spine level is determined based on patient separation, dose/ field and dose rate/MU. One-dimensional heterogeneous dose calculations from Pinnacle TPS were validated with thermoluminescent dosimeters (TLD) placed in an average adult anthropomorphic phantom and also in-vivo on four patients with large separations.
Subsequently, twelve patients with various separations (17–47cm) were retrospectively analyzed. Computed tomography (CT) scans were acquired in the left and right decubitus positions from vertex to knee. A treatment plan for each patient was generated. The ratio of the lookup table MU to the heterogeneous TPS MU was compared. Results: TLD Measurements in the anthropomorphic phantom and large TBI patients agreed with Pinnacle calculated dose within 2.8% and 2%, respectively.
The heterogeneous calculation compared to the lookup table agreed within 8.1% (ratio range: 1.014–1.081). A trend of reduced accuracy was observed when patient separation increases. Conclusion: The TPS dose calculation accuracy was confirmed by TLD measurements, showing that Pinnacle can model the extended SSD dose without commissioning a special beam model for the extended SSD geometry. The difference between the lookup table and TPS calculation potentially comes from lack of scatter during commissioning when compared to extreme patient sizes. The observed trend suggests the need for development of a correction factor between the lookup table and TPS dose.Grigorov, Grigor N.; Chow, James C.L.; Grigorov, Lenko; Jiang, Runqing; Barnett, Rob B.2006-01-01The normal tissue complication probability (NTCP) is a predictor of radiobiological effect for organs at risk (OAR). The calculation of the NTCP is based on the dose-volume-histogram (DVH) which is generated by the treatment planning system after calculation of the 3D dose distribution. Including the NTCP in the objective function for intensity modulated radiation therapy (IMRT) plan optimization would make the planning more effective in reducing the postradiation effects.
However, doing so would lengthen the total planning time. The purpose of this work is to establish a method for NTCP determination, independent of a DVH calculation, as a quality assurance check and also as a mean of improving the treatment planning efficiency. In the study, the CTs of ten randomly selected prostate patients were used. IMRT optimization was performed with a PINNACLE3 V 6.2b planning system, using planning target volume (PTV) with margins in the range of 2 to 10 mm.
The DVH control points of the PTV and OAR were adapted from the prescriptions of Radiation Therapy Oncology Group protocol P-0126 for an escalated prescribed dose of 82 Gy. This paper presents a new model for the determination of the rectal NTCP ( R NTCP). The method uses a special function, named GVN (from Gy, Volume, NTCP), which describes the R NTCP if 1 cm 3 of the volume of intersection of the PTV and rectum (R int ) is irradiated uniformly by a dose of 1 Gy. The function was 'geometrically' normalized using a prostate-prostate ratio (PPR) of the patients' prostates.
A correction of the R NTCP for different prescribed doses, ranging from 70 to 82 Gy, was employed in our model. The argument of the normalized function is the R int, and parameters are the prescribed dose, prostate volume, PTV margin, and PPR. The R NTCPs of another group of patients were calculated by the new method and the resulting difference was.