SU-E-J-254: Utility of Pinnacle Dynamic Planning Module Utilizing Deformable Image Registration in Adaptive Radiotherapy




For certain highly conformal treatment techniques, changes in patient anatomy due to weight loss and/or tumor shrinkage can result in significant changes in dose distribution. Recently, the Pinnacle treatment planning system added a Dynamic Planning module utilizing Deformable Image Registration (DIR). The objective of this study was to evaluate the effectiveness of this software in adapting to altered anatomy and adjusting treatment plans to account for it.


We simulated significant tumor response by changing patient thickness and altered chin positions using a commercially-available head and neck (H&N) phantom. In addition, we studied 23 CT image sets of fifteen (15) patients with H&N tumors and eight (8) patients with prostate cancer. In each case, we applied deformable image registration through Dynamic Planning module of our Pinnacle Treatment Planning System. The dose distribution of the original CT image set was compared to the newly computed dose without altering any treatment parameter. Result was a dose if we did not adjust the plan to reflect anatomical changes.


For the H&N phantom, a tumor response of up to 3.5 cm was correctly deformed by the Pinnacle Dynamic module. Recomputed isodose contours on new anatomies were within 1 mm of the expected distribution. The Pinnacle system configuration allowed dose computations resulting from original plans on new anatomies without leaving the planning system. Original and new doses were available side-by-side with both CT image sets. Based on DIR, about 75% of H&N patients (11/15) required a re-plan using new anatomy. Among prostate patients, the DIR predicted near-correct bladder volume in 62% of the patients (5/8).


The Dynamic Planning module of the Pinnacle system proved to be an accurate and useful tool in our ability to adapt to changes in patient anatomy during a course of radiotherapy.