Pinnacle Treatment Planning System User Manual
.Seligman, Linda1993-01-01Describes approach to teaching treatment planning that author has used successfully in both seminars and graduate courses. Clarifies nature and importance of systematic treatment planning, then describes context in which treatment planning seems more effectively taught, and concludes with step-by-step plan for teaching treatment planning.Wu, B; Pang, D; Kusters, MPurpose: Knowledge-based Planning (KBP) founded on prior planning experience and Auto- Planning Engine (APE; commercialized in Pinnacle v9.10 TPS) based on progressive optimization algorithm both aim to eliminate the trial-and-error process in radiotherapy inverse planning.
This study investigates the performance of the approaches in a multi-institutional setting to evaluate their functionalities in oropharyngeal cancer and offers suggestions how they can be implemented in the clinic. Methods: Radboud University Medical Center (RUMC) provided 35 oropharyngeal cancer patients (SIB-IMRT with two-dose-level prescription: 68 Gy to PTV68 and 50.3 Gy to PTV50.3) with corresponding comparative APE plans. Johns Hopkins University (JHU) contributed to amore » three-dose-level (70 Gy 63 Gy and 58.1 Gy) plan library for RUMC’s patient KBP generation. MedStar Georgetown University Hospital (MGUH) contributed to a KBP approach employing overlap-volume histogram (OVH-KBP) for generating RUMC’s patient KBP plans using JHU’s plan library. Since both approaches need their own user-defined parameters as initial inputs the first 10 patients were set aside as training set to finalize them. Meanwhile cross-institutional comparisons and adjustments were implemented for investigating institutions’ protocol discrepancies and the approaches’ user-defined parameters were updated accordingly.
The finalized parameters were then applied to the remaining 25 patients for OVH-KBP and APE generation. A Wilcoxon rank-sum test was used for statistical comparison with significance level of p0.2.
Conclusions: The study demonstrates that KBP and APE.Sonier, Marcus; Wronski, Matt; Yeboah, Collins2015-03-08Lens dose is a concern during the treatment of facial lesions with anterior electron beams. Lead shielding is routinely employed to reduce lens dose and minimize late complications. The purpose of this work is twofold: 1) to measure dose pro-files under large-area lead shielding at the lens depth for clinical electron energies via film dosimetry; and 2) to assess the accuracy of the Pinnacle treatment planning system in calculating doses under lead shields. First, to simulate the clinical geometry, EBT3 film and 4 cm wide lead shields were incorporated into a Solid Water phantom. With the lead shield inside the phantom, the film was positioned at a depth of 0.7 cm below the lead, while a variable thickness of solid water, simulating bolus, was placed on top. This geometry was reproduced in Pinnacle to calculate dose profiles using the pencil beam electron algorithm.
The measured and calculated dose profiles were normalized to the central-axis dose maximum in a homogeneous phantom with no lead shielding. The resulting measured profiles, functions of bolus thickness and incident electron energy, can be used to estimate the lens dose under various clinical scenarios. These profiles showed a minimum lead margin of 0.5 cm beyond the lens boundary is required to shield the lens to ≤ 10% of the dose maximum. Comparisons with Pinnacle showed a consistent overestimation of dose under the lead shield with discrepancies of 25% occur-ring near the shield edge. This discrepancy was found to increase with electron energy and bolus thickness and decrease with distance from the lead edge. Thus, the Pinnacle electron algorithm is not recommended for estimating lens dose in this situation. The film measurements, however, allow for a reasonable estimate of lens dose from electron beams and for clinicians to assess the lead margin required to reduce the lens dose to an acceptable level.Xing, Aitang; Arumugam, Sankar; Holloway, Lois; Goozee, Gary2014-03-01Scripting in radiotherapy treatment planning systems not only simplifies routine planning tasks but can also be used for clinical research.
Treatment planning scripting can only be utilized in a system that has a built-in scripting interface. Among the commercially available treatment planning systems, Pinnacle (Philips) and Raystation (Raysearch Lab.) have inherent scripting functionality. CMS XiO (Elekta) is a widely used treatment planning system in radiotherapy centres around the world, but it does not have an interface that allows the user to script radiotherapy plans. In this study an external scripting interface, PyCMSXiO, was developed for XiO using the Python programming language. The interface was implemented as a python package/library using a modern object-oriented programming methodology. The package was organized as a hierarchy of different classes (objects).
Each class (object) corresponds to a plan object such as the beam of a clinical radiotherapy plan. The interface of classes was implemented as object functions. Scripting in XiO using PyCMSXiO is comparable with Pinnacle scripting. This scripting package has been used in several research projects including commissioning of a beam model, independent three-dimensional dose verification for IMRT plans and a setup-uncertainty study. Ease of use and high-level functions provided in the package achieve a useful research tool. It was released as an open-source tool that may benefit the medical physics community.Fogliata, Antonella; Nicolini, Giorgia; Alber, Markus; Asell, Mats; Clivio, Alessandro; Dobler, Barbara; Larsson, Malin; Lohr, Frank; Lorenz, Friedlieb; Muzik, Jan; Polednik, Martin; Vanetti, Eugenio; Wolff, Dirk; Wyttenbach, Rolf; Cozzi, Luca2007-02-15To evaluate the performance of seven different TPS ( Treatment Planning Systems: Corvus, Eclipse, Hyperion, KonRad, Oncentra Masterplan, Pinnacle and Precise PLAN) when intensity modulated (IMRT) plans are designed for paediatric tumours. Datasets (CT images and volumes of interest) of four patients were used to design IMRT plans.
The tumour types were: one extraosseous, intrathoracic Ewing Sarcoma; one mediastinal Rhabdomyosarcoma; one metastatic Rhabdomyosarcoma of the anus; one Wilm's tumour of the left kidney with multiple liver metastases. Prescribed doses ranged from 18 to 54.4 Gy. To minimise variability, the same beam geometry and clinical goals were imposed on all systems for every patient.
Results were analysed in terms of dose distributions and dose volume histograms. For all patients, IMRT plans lead to acceptable treatments in terms of conformal avoidance since most of the dose objectives for Organs At Risk (OARs) were met, and the Conformity Index (averaged over all TPS and patients) ranged from 1.14 to 1.58 on primary target volumes and from 1.07 to 1.37 on boost volumes. The healthy tissue involvement was measured in terms of several parameters, and the average mean dose ranged from 4.6 to 13.7 Gy. A global scoring method was developed to evaluate plans according to their degree of success in meeting dose objectives (lower scores are better than higher ones).
For OARs the range of scores was between 0.75 +/- 0.15 (Eclipse) to 0.92 +/- 0.18 ( Pinnacle(3) with physical optimisation). For target volumes, the score ranged from 0.05 +/- 0.05 ( Pinnacle(3) with physical optimisation) to 0.16 +/- 0.07 (Corvus). A set of complex paediatric cases presented a variety of individual treatment planning challenges. Despite the large spread of results, inverse planning systems offer promising results for IMRT delivery, hence widening the treatment strategies for this very sensitive class of patients.Nawa, Kanabu; Haga, Akihiro; Nomoto, Akihiro; Sarmiento, Raniel A; Shiraishi, Kenshiro; Yamashita, Hideomi; Nakagawa, Keiichi2017-01-01Recent developments in Radiation Oncology treatment planning have led to the development of software packages that facilitate automated intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) planning. Such solutions include site-specific modules, plan library methods, and algorithm-based methods.
In this study, the plan quality for prostate cancer generated by the Auto- Planning module of the Pinnacle 3 radiation therapy treatment planning system (v9.10, Fitchburg, WI) is retrospectively evaluated. The Auto- Planning module of Pinnacle 3 uses a progressive optimization algorithm. Twenty-three prostate cancer cases, which had previously been planned and treated without lymph node irradiation, were replanned using the Auto- Planning module. Dose distributions were statistically compared with those of manual planning by the paired t-test at 5% significance level. Auto- Planning was performed without any manual intervention. Planning target volume (PTV) dose and dose to rectum were comparable between Auto- Planning and manual planning.
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The former, however, significantly reduced the dose to the bladder and femurs. Regression analysis was performed to examine the correlation between volume overlap between bladder and PTV divided by the total bladder volume and resultant V70. The findings showed that manual planning typically exhibits a logistic way for dose constraint, whereas Auto- Planning shows a more linear tendency. By calculating the Akaike information criterion (AIC) to validate the statistical model, a reduction of interoperator variation in Auto- Planning was shown.
We showed that, for prostate cancer, the Auto- Planning module provided plans that are better than or comparable with those of manual planning. By comparing our results with those previously reported for head and neck cancer treatment, we recommend the homogeneous plan quality generated by the Auto- Planning module, which exhibits less dependence on anatomic complexity.Li, Xiadong; Wang, Lu; Wang, Jiahao; Han, Xu; Xia, Bing; Wu, Shixiu; Hu, Weigang2017-01-01This study aimed to design automated volumetric-modulated arc therapy (VMAT) plans in Pinnacle auto- planning and compare it with manual plans for patients with lower thoracic esophageal cancer (EC). Thirty patients with lower thoracic EC were randomly selected for replanning VMAT plans using auto- planning in Pinnacle treatment planning system (TPS) version 9.10.
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Historical plans of these patients were then compared. Dose-volume histogram (DVH) statistics, dose uniformity, and dose homogeneity were analyzed to evaluate treatment plans. Auto- planning was superior in terms of conformity index (CI) and homogeneity index (HI) for planning target volume (PTV), significantly improving 8.2% (p = 0.013) and 25% (p = 0.007) compared with manual planning, respectively, and decreasing dose of heart and liver irradiated by 20 to 40 Gy and 5 to 30 Gy, respectively (p 50.4 Gy.
Version 9.2 of Pinnacle3 with SmartArc was used for treatment planning. Dosimetric quality was evaluated based on doses to several organs at risk, including the spinal cord, heart, and lung, over the same coverage of gross tumor volume. In upper thoracic EC, the IMRT treatment plan had a lower lung mean dose (P = 0.0126) and lung V5 (P = 0.0037) compared with VMAT; both techniques had similar coverage of the planning target volumes (PTVs) (P = 0.3575).
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In middle thoracic EC, a lower lung mean dose (P = 0.0010) and V5 (P = 0.0145), but higher lung V20 (P = 0.0034), spinal cord Dmax (P = 0.0262), and heart mean dose (P = 0.0054), were observed for IMRT compared with VMAT; IMRT provided better PTV coverage. Patients with lower thoracic ECs had a lower lung mean dose (P = 0.0469) and V5 (P = 0.0039), but higher spinal cord Dmax (P = 0.0301) and heart mean dose (P = 0.0020), with IMRT compared with VMAT.
PTV coverage was similar (P = 0.0858) for the 2 techniques. IMRT provided a lower mean dose and lung V5 in upper thoracic EC compared with VMAT, but exhibited different advantages and disadvantages in patients with middle or lower thoracic ECs. Thus, choosing different techniques for different EC locations is warranted. PMID:25929910.Rao, Min; Cao, Daliang; Chen, Fan; Ye, Jinsong; Mehta, Vivek; Wong, Tony; Shepard, David2010-11-01Volumetric modulated arc therapy (VMAT) has the potential to reduce treatment times while producing comparable or improved dose distributions relative to fixed-field intensity-modulated radiation therapy.
In order to take full advantage of the VMAT delivery technique, one must select a robust inverse planning tool. The purpose of this study was to evaluate the effectiveness and efficiency of VMAT planning techniques of three categories: anatomy-based, fluence-based and aperture-based inverse planning. We have compared these techniques in terms of the plan quality, planning efficiency and delivery efficiency.
Fourteen patients were selected for this study including six head-and-neck (HN) cases, and two cases each of prostate, pancreas, lung and partial brain. For each case, three VMAT plans were created.
The first VMAT plan was generated based on the anatomical geometry. In the Elekta ERGO treatment planning system (TPS), segments were generated based on the beam's eye view (BEV) of the target and the organs at risk. The segment shapes were then exported to Pinnacle3 TPS followed by segment weight optimization and final dose calculation. The second VMAT plan was generated by converting optimized fluence maps (calculated by the Pinnacle3 TPS) into deliverable arcs using an in-house arc sequencer.
The third VMAT plan was generated using the Pinnacle3 SmartArc IMRT module which is an aperture-based optimization method. All VMAT plans were delivered using an Elekta Synergy linear accelerator and the plan comparisons were made in terms of plan quality and delivery efficiency. The results show that for cases of little or modest complexity such as prostate, pancreas, lung and brain, the anatomy-based approach provides similar target coverage and critical structure sparing, but less conformal dose distributions as compared to the other two approaches. For more complex HN cases, the anatomy-based approach is not able to provide clinically acceptable VMAT plans while highly.De Freitas, T.A.; Dixon, O.A.; Mayr, U.1993-04-01Pinnacle reefs are commonly an attractive target for oil exploration because they are usually porous carbonate bodies entombed in impervious, deep-water shales that provide both the source and the seal for hydrocarbons. Silurian pinnacle reefs, the first described in the Canadian Arctic Archipelago, are exposed on Ellesmere and Devon Islands. Two main reef trends occur, one of early middle Llandovery to middle Ludlow age and a second of middle Ludlow to Late Silurian or Early Devonian age.
Reefs of both phases contain lime mudstone cores: some are stromatactoid-rich and others consist predominantly of microbialite-rich lime mudstone or microbial boundstone. Faciesmore » sequences of both reef phases show evidence of upward-shallowing overall, but, in the older reefs, isochronous capping facies are dominated either by coral-mirian or by stromatoporoid boundstone and floatstone. This difference perhaps reflects variation in wave stress and apparent ability of a few corals,thickly encrusted by or associated with microbial boundstone and skeletal algae, to withstand greater wave energy than a stromatoporoid-coral-rich reef community.
These reefs constitute one of the bright prospects of hydrocarbon exploration in rocks of the Franklinian succession. 43 refs., 9 figs.« less.Friedman, G.M.1995-09-01Onondaga pinnacle reefs, part of the Onondaga Formation, developed in an epeiric setting of the lowermost Middle Devonian (Eifelian). The reefs were initiated as coral-crinoidal mounds in the Edgecliff Member of the formation. Whereas most Devonian reefs are composed of rugose corals. Coral is the predominant kind of fossil, followed by crinoids, brachiopods, mollusks, undifferentiated skeletal debris, and possible sponges. The initial mineralogy of the corals is inferred to have been calcite.
The porosity of these reefs is almost unique among reef reservoirs. Most reefs produce from secondary or diagenetic porosity; by contrast Onondaga reefs display primary intracoralline or frameworkmore » porosity. Between framework builders and/or skeletal particles cryptocrystalline/microcrystalline cement fills pores. As observed in modern reefs this kind of cement resembles micrite, but probable formed as high-magnesian calcite in a high-energy setting.
Syntaxial or rim cement common lines crinoid particles. Some of these pinnacle reefs, formerly gas producers, are presently under development as gas-storage reservoirs.« less.2010-03-03. DEPARTMENT OF THE INTERIOR National Park Service Minor Boundary Revision of Pinnacles National Monument AGENCY: National Park Service, Interior. ACTION: Announcement of boundary revision. SUMMARY: This notice announces the revision to the boundary of Pinnacles National Monument, pursuant to the authority.