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Monaco tps

Manufactured by Elekta
Sourced in United Kingdom, United States

Monaco TPS is a radiation therapy treatment planning system developed by Elekta. It is designed to optimize and calculate radiation therapy plans for cancer treatment.

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11 protocols using monaco tps

1

Uniform Dose Distribution in Radiotherapy

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All TLDs were exposed to a uniform dose distribution of 2 Gy computed on Monaco TPS by Elekta with a collapsed cone convolution (CCC) algorithm and produced by a pair of opposing 6 MV photon beams. The reference set-up is shown in Figure 1. Irradiations were performed with Elekta Synergy Linear Accelerator (Elekta Instrument AB Stockholm).
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2

MR-Linac Adaptive Radiation Therapy

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This study received approval from the ethical review board of our institution and informed consent was waived. In this retrospective study, we analyzed 78 reference plans and 208 adaptive plans (129 ATP plans and 79 ATS plans) delivered using the Elekta Unity MR‐Linac (Elekta, Crawley, UK) over the past year. To avoid the impact of a single patient with many fractions, up to three fractions’ adaptive plans (initial, medium, and final fractions) were enrolled for each patient. For ATP plans, there were 37 head and neck cases, 9 thorax cases, 56 abdomen cases, and 27 pelvic cases. Conversely, all ATS plans were abdominal and pelvic cases, mostly for prostate cancer. All patients were treated with a 7 MV MR‐Linac Elekta Unity in the flattening filter‐free mode, and IMRT plans were optimized using the Monaco TPS (version 5.4, Elekta, Crawley, UK).
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3

Out-of-Field Dose Calculation for 3DCRT

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Out‐of‐field dose calculations were performed using the Monaco TPS (V5.40.01, Elekta AB, Stockholm, Sweden) with GPUMCD for 3DCRT treatments. The volume of the dosimeter (1 × 1 × 0.2 cm) was outlined to be approximately 0.2 cm3 in the TPS calculation. A dose uncertainty of 1 % was set and a 2.0 mm calculation grid size was adopted. The average dose of check points were calculated by TPS based on the dosimeter delineation. The locations of surface check points and internal simulated OARs were marked as interest points with three‐dimensional coordinates. Then, the distances from the PTV isocenter to the interest points were calculated. The TPS calculated dose were compared with the OSLD measurements to determine the out‐of‐field dose calculation deviation.
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4

Detailed Linac Beam Modeling Validation

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A beam model was developed by the vendor Elekta in the Monaco TPS (v.5.09.06) using the commissioned beam data of a clinical 6 MV Agility linac in our center. The beam model uses a virtual source model for simulating the linac head. The beam model parameters are the same for both the XVMC and GPUMCD codes (the two Monaco MC codes differ only in the radiation transport calculations within the patient). These are the parameters for modeling the distribution of primary and scattered photons, as well as secondary charged particles in the MC simulation of the linac head. It also includes nominal beam energy and off‐axis profiles. There are quite a large number of parameters in the list provided by the vendor and may not be relevant for the paper. Tighter criteria (2% or 2 mm in high gradient [30%/cm] region, 2% elsewhere in the percent depth dose [PDD] and beam profiles, and 2% in output factors for homogeneous water medium) than the requirements of the Van Dyk criteria(18) for matching the calculated data with the measured commissioned data was used by the vendor. The phantom size, dose calculation grid resolution, and the statistical uncertainty used by the vendor were in accordance with the recommendations of AAPM TG‐105.(9)
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5

Chemoradiotherapy Techniques for Cancer

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The chemoradiotherapy techniques have been previously described.6 ,13 ) Briefly, an Aquilion LB CT scanner (Toshiba, Ohtawara, Japan) was used to obtain the planning CT images. A XiO® treatment planning system (TPS) (Elekta, Stockholm, Sweden) was used to segment the volumes of interest in the CT dataset. A 3D conformal radiotherapy technique was performed using a Primus MD2 linear accelerator (Siemens, Munich, Germany) and a Synergy® linear accelerator (Elekta, Crawley, UK).6 ) Volumetric modulated arc therapy (VMAT) was used for intensity-modulated radiation therapy (IMRT). VMAT treatment plans were generated with a Monaco TPS (Elekta, Maryland Heights, MO, USA) and delivered with a Synergy® linear accelerator (Elekta, Crawley, UK).6 ,13 ) Radiotherapy was performed with daily 2-Gy fractions (Table 1). Concurrent IA-CRT using cisplatin was performed as previously described.6 ) Lesions of the neck were irradiated in patients with nodal metastasis.
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6

Comprehensive Dosimetry Verification for Prostate Cancer Treatment

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According to the dosimetry protocols, quality assurance plans (QA) are required and need to be prepared before starting a treatment. In this survey, four types of dose verification have been accomplished. In each of them, the gamma factor has been used to show significant differences between calculations in the treatment planning system and measured dose distribution. The fluency of the dose from the TPS was computed using Monte Carlo algorithm (Monaco TPS) and verified in 2D utilizing a MatriXX detector (1). The second independent method of pre-verification has been accomplished using iViewDose (2). The third method consisted of measuring the dose distribution in the patient’s body during a real treatment in vivo (3). The acquired dose was scattered by patient’s body and then compared to the dose distribution calculated in iViewDose software. Furthermore, each of the 43 prostate treatment plans were transferred to RayStation TPS (RaySearch Laboratories), then the dose calculations established the same beam settings as in Monaco TPS (Elekta), but the algorithm was modified into the Collapse Cone. Thereafter, the two fluence maps of quality assurance plans (rooted in MC and CC algorithm) were compared in the IBA MatriXX software using the gamma factor [4 (link)].
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7

Photon Beam Dose Validation in Pelvic Phantom

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The above film dose measurements were compared against counterpart dose calculations produced by a CMS XiO (v. 4.62) treatment planning system (TPS) for 6 and 15 MV photon beams for the single AP fields of 3 × 3, 5 × 5, 10 × 10, and 15 × 15 cm2. Prior to this, the phantom was CT‐scanned with a Toshiba AquilionTM 16LB CT scanner after which the DICOM images were imported into the TPS. A superposition algorithm was used for dose calculation employing a grid size of 2.0 mm.
Dose distributions for the two 6 and 15 MV parallel opposed pairs described in section II C were also calculated. In this case, an Elekta Monaco TPS utilizing the X‐ray voxel Monte Carlo (XVMC) (v. 5.00.00) algorithm was used for dose calculations. The treatment plans were generated for the pelvic phantom with inserted film and delivered on the linac. The field size was set to conform to a target contoured on the DICOM images of the phantom. The Monaco TPS calculated dose distributions were then compared to those measured with film in the pelvic phantom that contains the prosthesis. The relative errors (δ) between film measurements and TPS calculations were computed as follows. δ=[(DFilmDTPS)/DFilm]×100
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8

Commissioning and Validation of Elekta VersaHD Linac

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The 6FFF beam modality on Elekta’s VersaHDTM linear accelerator (linac) with Integrity 4.0.4 control software, was fully commissioned and the corresponding beam model validated in Elekta’s Monaco® TPS, version 5.11.02.8 Beam tuning, MLC calibration, and MLC beam modeling in Monaco® were performed according to Elekta’s recommended procedure, taking into account most recent findings.9 Performance of these procedures was well within required specifications. MLC parameters in Monaco® were fine‐tuned to achieve optimal agreement for point dose measurement and dose distribution for a range of VMAT and dynamic conformal arc therapy (DCAT) plans.10 However, clinical VMAT plans still showed unacceptably low pass rates on the VersaHDTM linac, especially for highly modulated fields and small targets. SunNuclear’s ArcCheckTM was used for these measurements.
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9

Monte Carlo Dose Recalculation for Varied Cancer Treatments

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Ten previously treated patients with a variety of treatment sites were randomly selected for dose recalculation using our in‐house Monte Carlo model, which utilized the BEAMnrc/DOSXYZnrc user codes.30, 31, 32 The patient cohort consisted of three head‐and‐neck cancer patients, three lung cancer patients, two gynecological cancer patients, and two prostate cancer patients. All patients were treated with 6‐MV VMAT photon beams, and each plan consisted of two arcs. Table 1 presents an overview of the patient cohort, including their assigned identifier. Each patient's plan was created in the Philips Pinnacle TPS, and the dose was initially calculated using the Collapsed Cone Convolution Superposition algorithm. The DICOM RP and DICOM RS (DICOM Version 3) files were exported to Elekta's Monaco TPS, and the dose was recalculated using the Monte Carlo algorithm in Monaco, with the dose‐to‐medium reported. All calculations in Pinnacle and Monaco were done with a 0.3 cm × 0.3 cm × 0.3 cm dose grid resolution. Doses calculated with Monaco's Monte Carlo algorithm were to be used for comparison with our in‐house Monte Carlo algorithm. Both the Pinnacle TPS and Monaco TPS have been previously verified for accuracy.33, 34 Patients’ DICOM RP files (files containing plan information), RD files (files containing dose information), and CT datasets were exported from the Pinnacle TPS.
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10

Optimized 6-MV X-ray VMAT Protocol

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All plans adopted 6-MV X-ray and Elekta VERSA HD accelerator (Stockholm, Sweden, 5 mm MLC), with prescription doses all set to 2.0Gy * 25 fractions. Monaco TPS (Elekta. Inc, V 5.40.03). was adopted for plan optimization, which utilized Monte Carlo for the dose calculation 1 arc, 150∼260 degree was designed, and according to the shape of target region, corresponding collimator angles were set, table angles all 0°, maximum dose rate 600 MU/min. After providing some optimizing constraints (shown in Table 1), distribution of dose curves was automatically optimized, and through repeated parameters adjustment, the ideal distribution of dose curves was achieved.
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