For definitive RT, external beam RT (EBRT) was performed using the four-field box technique, and intracavitary brachytherapy (ICBT) was subsequently performed using a remote after-loading system, in combination with EBRT, using the central shield by anteroposterior/posteroanterior field technique at 10 MV photons. The upper limit of the standard irradiation field was the upper edge of the 5th lumbar vertebra, and the lower limit was at least 3 cm below the lower edge of the obturator foramen or the lower edge of the vaginal infiltration. The outer side of the anterior-posterior irradiation field was 1.5–2 cm outside the inner edge of the pelvis, and the anterior edge of the lateral irradiation field was ~0.5 cm in front of the anterior pubic symphysis. A total dose of EBRT (TrueBeam™; Varian Medical Systems) at 50.4 Gy (range, 40.0–50.4 Gy) and ICBT (Micro Selectron™; Nucletron BV) at 24 Gy (range, 18–30 Gy) was administered. For postoperative adjuvant RT, IMRT (TrueBeam™, Varian Medical Systems) was performed with a total dose of 50.4 Gy (range, 50.4–60.0 Gy). A total dose of 10.0 Gy (range, 3.6–16.2 Gy) lymph node boost (TrueBeam™; Varian Medical Systems) was given to 54 patients (36.2%) with positive lymph node metastasis. For concurrent chemoradiotherapy, cisplatin (Cisplatin Maruko™; Yakult Honsha Co., Ltd.) was administered once a week for 5–6 cycles at 40 mg/m2.
Truebeam
Manufactured by Agilent Technologies
Sourced in United States, Canada
The TrueBeam is an advanced linear accelerator system designed for the delivery of image-guided radiotherapy and radiosurgery. It provides precise and accurate treatment delivery while incorporating advanced imaging and treatment planning capabilities. The core function of the TrueBeam is to generate and deliver high-energy radiation beams to target specific areas within the patient's body for the purpose of cancer treatment.
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Lab products found in correlation
Clinac ix, by Agilent Technologies (7 mentions)
Eclipse treatment planning system, by Agilent Technologies (5 mentions)
Truebeam stx, by Agilent Technologies (4 mentions)
Clinac 21ex, by Agilent Technologies (4 mentions)
Millennium 120 leaf mlc, by Agilent Technologies (3 mentions)
Truebeam linac, by Agilent Technologies (3 mentions)
T 25 culture flasks, by BD (3 mentions)
Exactrac, by Brainlab (3 mentions)
Arccheck, by Sun Nuclear (2 mentions)
Millennium 120 mlc, by Agilent Technologies (2 mentions)
Brilliance big bore, by Philips (2 mentions)
Pinnacle3, by Philips (2 mentions)
Artiste, by Siemens (2 mentions)
Rapidarc, by Agilent Technologies (2 mentions)
Novalis tx, by Agilent Technologies (2 mentions)
Paclitaxel, by Merck Group (2 mentions)
Cyberknife, by Accuray (2 mentions)
Filmqa pro, by Ashland (2 mentions)
Optima ct580w, by GE Healthcare (2 mentions)
Clinac 2100 cd, by Agilent Technologies (2 mentions)
172 protocols using truebeam
1
Multimodal Radiotherapy for Cervical Cancer
2
Dynamic MLC Log File Comparison
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All measurements were performed using a 6 MV flattening filter beam on a Varian 21iX and a 10 MV flattening filter‐free beam on a Varian Truebeam. Each linac was equipped with a Millennium 120‐leaf MLC organized in two banks (A and B), each with 60 round‐end leaves (Varian Medical Systems, Palo Alto, CA, USA). The 40 central leaves in each bank are 5 mm in width projected at isocenter, while the outer 20 leaves are 10 mm. Varian machines create dynamic log files that record gantry angle, MLC positions and cumulative MU information during each dynamic delivery at 50 and 20 ms intervals for the 21iX and Truebeam, respectively. Varian machine log files were used as a point of comparison for this study.
3
Stereotactic Arrhythmia Radioablation Protocol
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Stereotactic arrhythmia radioablation procedure was recently published: patients underwent to simulation with a 4D CT, with an immobilization system, and received a free breathing STAR with a prescription total dose of 25 Gy in 1 fraction. A ‘simultaneous integrated protection’ dose was realized to the interface between PVs and critical structures, including oesophagus and bronchus, to respect dose constraint value.13 (link),24–26 (link) The treatment was generated, optimized, and delivered by TrueBeamTM (Varian Medical System, Palo Alto, CA). Image-guided radiotherapy (IGRT) with cone beam CT and surface-guided radiotherapy (SGRT) with AlignRT (Vision RT) were used to reduce set-up error and to monitor patients during fraction. Radiotherapy delivery was temporally interrupted in case of deep breaths.
4
Intensity-Modulated Arc Therapy Optimization
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All cases were planned in ARIA Eclipse version 11.0.31 using a single 360 coplanar arc with a collimator angle of 30 . Two sets of treatment plans were generated for each case using conventional 6 MV FF and 6 MV FFF photon energy on a Varian TrueBeamTM linear accelerator. The smallest field aperture in the beams eye view was only 3.5 Â 3.5 cm. The same optimization objectives and constraints were used for both plans and were consistent with dose distribution requirements of the Radiation Therapy Oncology Group study 0813 criteria, namely: at least 95% of the PTV received the prescription dose, 99% of the PTV volume received 90% of the prescription dose, dose falloff gradient at 2 cm should be less than 50%. Treatment plans were computed using the Acuros XB algorithm. Acuros XB had been previously validated using homogeneous and heterogeneous calculations [14] . The dose normalization was set to 80% of the maximal dose to provide adequate target coverage.
5
Dosimetric Impact of sCT-based VMAT Planning
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Clinical IMRT treatment plans created on simulation CTs were recalculated onto corresponding sCTs to evaluate the dosimetric impact of any differences in CT number that were observed. Each patient had a 6MV photon Volumetric Modulated Arc Therapy (VMAT) plan created in Raystation version 11 (Raysearch Laboratories, Sweden), which had been optimized and approved for actual delivery to the patient. Each plan was created for delivery on a Varian Truebeam (Varian Medical Systems, Palo Alto, California, USA). The same CT to electron‐density table was used for dose calculation in both image sets. The choice of PTV doses was based on specific clinical considerations for each patient. PTV doses ranged from 5400 to 6996 cGy over 30 to 33 fractions. Each plan was delivered with a dose rate of 600MU/min. Plans included 2−3 simultaneous integrated boost (SIB) target volumes with a mean modulation factor of 3.8 ± 1.3 MU/cGy.
39 (link) The modulation factor was calculated by dividing the total MU delivered by the total dose delivered. A summary table of the modulation factors for each patient is included in Table2 .
39 (link) The modulation factor was calculated by dividing the total MU delivered by the total dose delivered. A summary table of the modulation factors for each patient is included in Table
6
Irradiation of Platelet Concentrates
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Human whole blood was collected from donors during routine donations at Kalmar Region Hospital, Sweden, and processed into units of erythrocytes, plasma, and interim platelet units (IPUs) using the Reveos® system (Terumo BCT, Larne, UK). IPUs from four to five donors were pooled with PAS-E (Macopharma, Mouvaux, France) using the platelet pooling set with a leukocyte filter (Terumo BCT). Three concentrates were prepared from whole blood and the platelets were processed into IPUs on the same day; three were stored overnight before processing, and four were a mix between IPUs processed from overnight-stored and fresh whole blood. The concentrate was analyzed for bacterial contamination using the BACT/ALERT®VIROTU® blood culture detection system (BioMérieux SA RCS, Lyon, France). Platelet count was assessed using an automated hematology system (Sysmex, Kobe, Japan) and leukocyte determination was conducted using flow cytometry (BD FACSCanto II, Franklin Lakes, NJ, USA). The RDPs were thereafter irradiated with 25 Gy gamma radiation (TrueBeam, Varian, Palo Alto, CA, USA). All commercial platforms mentioned above were used according to the manufacturer’s protocols.
7
Evaluating Fiducial-Based Gating Techniques
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For evaluation of fiducial‐based gating techniques plans were generated for a Truebeam (version 2.7, Varian Medical Systems, Palo Alto, CA) using a VMAT technique. Each plan utilized three arcs and 6FFF energy with a maximum dose rate of 1400 MU/min. The center of each fiducial is denoted as a “marker” in the plan. At the time of delivery, the user is able to acquire kV planar images at fixed gantry, MU, or time intervals. The user sets a given diameter of detection and if any detected fiducial position is outside of this range delivery is paused, the system continues to acquire images at the given time interval and will automatically continue beam delivery once the fiducials are within this range. For this study a 10 s imaging period and 4 mm detection diameter were utilized. In real patient deliveries orthogonal image pairs or 3D imaging may be necessary when patient fiducial positions do not return to within tolerance to adjust the patient position. Since the motions in this study are known, when any motions that would result in a continuous position difference greater than 2 mm were detected, the motion was restarted, resulting in the same effective motion as if the patient had been repositioned.
8
X-ray Simulation and Photocurrent Measurements
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All X-ray simulations were conducted using the Matlab R2020b software. The calculated current depending on the detector resistivity (Supplementary Note S1, Supporting Information ) was set to a random value within a previously established range of error. Mass attenuation coefficients (MACs) of the studied materials were retrieved from the NIST database [36 ] and used in other simulations based on the Beer–Lambert law. From the obtained MACs, a penetration or absorption rate was estimated at an MSC density set to 3.8 g/cm3 [37 (link)]. During X-ray evaluation, a Keithley 2636B source meter was used to measure the MSC photocurrents generated by the diagnostic medical and high-energy X-ray sources (GXR-S (DRGEM) and TrueBeam (Varian), respectively). To obtain the high-energy X-ray data, the TrueBeam linear accelerator installed at Samsung Changwon Hospital was used at a source-to-detector distance of 100 cm and field size of 10 × 10 cm2.
9
Fractionated Pelvic Irradiation in Mice
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The method has been described in detail elsewhere9 (link). In brief, at 9 to 10 weeks of age, the mice were anaesthetised and irradiated using a linear accelerator (Varian TrueBeam, Varian Medical Systems Inc., Charlottesville, VA, USA) with 6 MV nominal photon energy. The irradiation itself is pain-free but anaesthesia was used to immobilize the mice during the procedure. Mice were anaesthetised under the linear accelerator using a portable anaesthesia unit (Univentor 410 Anaesthesia Unit, Univentor Limited, Malta) with an air pump and a nose mask delivering a continuous air flow (300 mL/min) of 2.5–3% isoflurane. A silicone mold ensured identical positioning of the mice and the radiation field was oriented so that approximately 1.5 cm of the distal bowel was irradiated. Care was taken to exclude the spinal cord and testicles from the radiation field. Four fractions of 8 Gy per fraction (8 Gy × 4) were delivered at a dose-rate of 5.9 Gy/min. The fractions were spaced at 12 hours. The dose variation within the target volume was estimated to be ± 5%. Sham-irradiated mice were placed under the linear accelerator but received only anaesthesia.
10
Measurement-Guided Dose Reconstruction for IMRT Verification
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Nine treatment plans were delivered on a Varian TrueBeam equipped with HD Millennium 120 MLC, while the rest were delivered on a Varian Trilogy coupled with Millennium 120 MLC (also from Varian). Most of the H&N cases were treated on the Trilogy linac, due to the field size limitations of the TrueBeam. ArcCHECK (Sun Nuclear) was used to collect measurements with cavity plug inserted as recommended by the 3DVH manual for Eclipse. Verification plans on this phantom for each patient were calculated in the Eclipse TPS from their own error‐free treatment plans. An array calibration was performed at the beginning of this study, and absolute dose calibration was measured each day prior to measurement. Four DICOM files from the TPS: radiotherapy (RT) plan, RT structure, RT dose for patient treatment, and RT dose for verification on phantom, all from error‐free plans, were sent to 3DVH. Here, the original RT doses from Eclipse were considered as standard throughout this study. Composite ArcCHECK measurements for both error‐induced and error‐free plans were saved and imported to 3DVH. The imported measurement file and DICOM files were used to reconstruct a measurement‐guided dose reconstruction on the corresponding patient structures in the 3DVH environment.
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