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Fig 1.

Treatment plan for the biological study.

(a) Beam arrangement to a donut-shaped target. Dose distribution (b) and dose–volume histogram (c) of the treatment plan.

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Fig 2.

The heterogeneous phantom.

Three-dimension (a), axial (b), sagittal (b), and coronal (d) are depicted.

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Table 1.

Optimization parameters for the three treatment plans performed for the homogeneous and heterogeneous phantoms.

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Table 1 Expand

Fig 3.

Dose distribution comparisons.

Physical dose distribution of the independent calculation (a) and TPS (b), and gamma analysis result (c). Clinical dose distribution of the independent calculation (d) and TPS (e), and gamma analysis result (f).

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Fig 3 Expand

Fig 4.

The SF of HSGc-C5 cells comparison among the experiment irradiated by IMCT (blue bar), the independent calculation (orange bar), and the experiment irradiated by SFUD (gray bar).

The black horizontal solid line represents 10% of SF.

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Fig 4 Expand

Fig 5.

Individual dose distributions in the homogeneous phantom of the beams with the port angles of 0° (the first column from the left), 90° (the second column from the left), and 270° (middle column) and the total physical dose distribution (the second column from the right) and clinical dose distribution (the first column from the right) for plan-1 (upper row), plan-2 (middle row) and plan-3 (lower low) optimized with the SC algorithm. The CTV and OAR are represented by the red and yellow lines, respectively.

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Fig 5 Expand

Fig 6.

Total clinical dose distributions optimized with the SC algorithm in the homogeneous phantom for plan-1 (upper row), plan-2 (middle row), and plan-3 (lower row) recalculated with the efficient density perturbations of −3.5% (left column) and +3.5% (right column) at the intentional translation of +2 mm in each direction for all fields. The red and yellow lines depict the CTV and OAR, respectively.

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Fig 6 Expand

Fig 7.

The variation of the DVHs of dose distributions optimized using the SC algorithm in homogeneous (upper row) and heterogeneous (lower row) phantoms reassessed for 28 different perturbations of beam ranges and positions in the CTV and OAR for plan-1, plan-2, and plan-3. The DVHs in the nominal case are represented by the thick solid line.

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Fig 7 Expand

Table 2.

The D98 in the CTV and the for the nominal scenario optimized using the SC algorithm in homogeneous and heterogeneous phantoms.

The D98 and for the maximum and minimum scenarios as well as the deviation of D98 and —ΔD98 and Δ—over all reassessed dose distributions with 28 different perturbations of beam ranges and positions.

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Table 2 Expand

Fig 8.

The individual dose distributions in the heterogeneous phantom of the beams with the port angles of 0° (the first column from the left), 90° (the second column from the left), and 270° (middle column) and the total physical dose distribution (the second column from the right) and clinical dose distribution (the first column from the right) for plan-1 (upper row), plan-2 (middle row) and plan-3 (lower low) optimized using the SC algorithm, respectively. The red and yellow lines demonstrate the CTV and OAR, respectively.

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Fig 8 Expand

Fig 9.

The total clinical dose distributions optimized using the SC algorithm in the heterogeneous phantom for plan-1 (upper row), plan-2 (middle row), and plan-3 (lower row) reassessed with the perturbations of the efficient density of −3.5% (left column) and +3.5% (right column) at the intentional translation of +2 mm in each direction for all fields. The red and yellow lines denote the CTV and OAR, respectively.

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Fig 9 Expand

Fig 10.

The individual dose distributions in the homogeneous phantom of the beams with the port angles of 0° (the first column from the left), 90° (the second column from the left), and 270° (middle column) as well as the total physical dose distribution (the second column from the right) and clinical dose distribution (the first column from the right) for conventional IMCT (upper row) and WC IMCT (lower low) optimized using the WC algorithm. The red and yellow lines denote the CTV and OAR, respectively.

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Fig 10 Expand

Fig 11.

The total clinical dose distributions optimized using the WC algorithm in the homogeneous phantom for conventional IMCT (upper row) and WC IMCT (lower row) reassessed with the perturbations of effective density of −3.5% (left column) and +3.5% (right column) at the intentional translation of +2 mm in each direction for all fields. The red and yellow lines represent the CTV and OAR, respectively.

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Fig 11 Expand

Fig 12.

The variation of the DVHs of dose distributions optimized using the WC algorithm in homogeneous (upper row) and heterogeneous (lower row) phantom recalculated for 28 different perturbations of beam ranges and positions in the CTV and OAR for conventional IMCT and WC IMCT. The DVHs in the nominal case are represented by the thick solid line.

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Fig 12 Expand

Table 3.

The D98 in the CTV and the for the nominal scenario optimized using the WC algorithm in homogeneous and heterogeneous phantom.

The D98 and for the maximum and minimum scenarios and the deviation of D98 and —ΔD98 and Δ—over all reassessed dose distributions with 28 different perturbations of beam ranges and positions.

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Table 3 Expand

Fig 13.

The individual dose distributions in the heterogeneous phantom of the beams with the port angles of 0° (the first column from the left), 90° (the second column from the left), and 270° (middle column) as well as a complete physical dose distribution (the second column from the right) and clinical dose distribution (the first column from the right) for conventional IMCT (upper row) and WC IMCT (lower low) optimized using the WC algorithm. The red and yellow lines denote the CTV and OAR, respectively.

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Fig 13 Expand

Fig 14.

The total clinical dose distributions optimized with the WC algorithm in the heterogeneous phantom for conventional IMCT (upper row) and WC IMCT (lower row) reassessed with the perturbations of effective densities of −3.5% (left column) and +3.5% (right column) at the intentional translation of +2 mm in each direction for all fields. The red and yellow lines represent the CTV and OAR, respectively.

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Fig 14 Expand

Fig 15.

The individual dose distributions in the patient case of the beams with the port angles of 0° (the first column from the left), 90° (the second column from the left), and 270° (middle column) and the total physical dose distribution (the second column from the right) and clinical dose distribution (the first column from the right) for conventional IMCT (upper row), a range (setup) and gradient robust IMCT (middle row), and WC IMCT (lower low). The orange line depicts the CTV.

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Fig 15 Expand

Fig 16.

The variation of the DVHs of dose distributions in the patient case reassessed for 28 different perturbations of beam ranges and positions in the CTV (orange) and OAR (light blue) for conventional IMCT, the range (setup) and gradient robust IMCT, and WC IMCT.

The thick solid line depicts the DVHs in the nominal case.

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Fig 16 Expand

Table 4.

The D98 in the CTV and the for the nominal scenario in the patient case.

The D98 and for the maximum and minimum scenarios, and the deviation of D98 and —ΔD98 and Δ—over all reassessed dose distributions with 28 different perturbations of beam ranges and positions.

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Table 4 Expand