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. 2020 Jan 1;93(1105):20190655. doi: 10.1259/bjr.20190655

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© 2020 The Authors. Published by the British Institute of Radiology

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Figure 3. — Example delivered Co-60 and replanned linac MRI-RT SABR plans for a T5 spinal metastasis at 16 Gy prescription dose. (a) Co-60 treatment plan isodose levels in color (legend on right) overlaid on grayscale MRI simulation. The treatment plan is not conformal due to Co-60 penumbra and MLC width. Hot spots of over 115% (18.4 Gy) are observed outside of the PTV in adjacent fat. However the spinal cord is only touching the 10 Gy isodose line. Additional OARs in the area (esophagus, aorta, trachea and lung) were contoured and maintained below TG-101 objective doses. (b) The MRI-linac SABR plan is much more conformal, with excellent coverage, and hot spots almost entirely within the PTV. (c) Co-60 (dashed line) and linac (solid line) DVH is shown for this plan for the PTV (orange) and partial cord (green). The linac plan has less low dose to the spinal cord and is hotter within the PTV target. DVH, dose–volume histogram; OAR, organ at risk; MLC, multileaf collimator; SABR, stereotactic ablative radiotherapy; PTV, planningtarget volume.