A translating-bed technique for total-body irradiation

The accuracy of dose calculations at extended SSD is of significant importance in the dosimetric planning of total body irradiation (TBI). In a first step toward the implementation of electronic, multi‐leaf collimator compensation for dose inhomogeneities and surface contour in TBI, we have evaluated the ability of the Eclipse AAA to accurately predict dose distributions in water at extended SSD. For this purpose, we use the Eclipse AAA algorithm, commissioned with machine‐specific beam data for a 6 MV photon beam, at standard SSD (100 cm). The model was then used for dose distribution calculations at extended SSD (179.5 cm). Two sets of measurements were acquired for a 6 MV beam (from a Varian linear accelerator) in a water tank at extended SSD: i) open beam for 5 × 5, 10 × 10, 20 × 20 and 40×40 cm2 field sizes (defined at 179.5 cm SSD), and ii) identical field sizes but with a 1.3 cm thick acrylic spoiler placed 10 cm above the water surface. Dose profiles were acquired at 5 cm, 10 cm and 20 cm depths. Dose distributions for the two setups were calculated using the AAA algorithm in Eclipse. Confidence limits for comparisons between measured and calculated absolute depth dose curves and normalized dose profiles were determined as suggested by Venselaar et al. The confidence limits were within 2% and 2 mm for both setups. Extended SSD calculations were also performed using Eclipse AAA, commissioned with Varian Golden beam data at standard SSD. No significant difference between the custom commissioned and Golden Eclipse AAA was observed. In conclusion, Eclipse AAA commissioned at standard SSD can be used to accurately predict dose distributions in water at extended SSD for 6 MV open beams.PACS numbers: 87.53.Kn, 87.55.D‐, 87.55.de, 87.56.ng

Section: Methodsmentioning

confidence: 99%

Validation of the Eclipse AAA algorithm at extended SSD

Hussain

Villarreal-Barajas

Brown

et al. 2010

“…The results obtained with this revised technique are promising and superior to the SMT‐TBI translating bed technique in terms of lung shielding and dose homogeneity 2 , 3 , 4 , 5 , 8 , 9 . Respiratory motion management is an important consideration in radiotherapy treatments.…”

Section: Discussionmentioning

confidence: 93%

“…Large radiation fields are required to cover the entire patient during TBI dose delivery. In some cases, dedicated and specialized TBI facilities are used to cover the entire patient body 2 , 3 , 4 , 5 , 6 . To limit doses to OARs, labor‐intensive physical shielding blocks are usually used (7) …”

Section: Introductionmentioning

confidence: 99%

Translating bed total body irradiation lung shielding and dose optimization using asymmetric MLC apertures

Salhi

Brown

Ahmed

et al. 2016

A revised translating bed total body irradiation (TBI) technique is developed for shielding organs at risk (lungs) to tolerance dose limits, and optimizing dose distribution in three dimensions (3D) using an asymmetrically‐adjusted, dynamic multileaf collimator. We present a dosimetric comparison of this technique with a previously developed symmetric MLC‐based TBI technique. An anthropomorphic RANDO phantom is CT scanned with 3 mm slice thickness. Radiological depths (RD) are calculated on individual CT slices along the divergent ray lines. Asymmetric MLC apertures are defined every 9 mm over the phantom length in the craniocaudal direction. Individual asymmetric MLC leaf positions are optimized based on RD values of all slices for uniform dose distributions. Dose calculations are performed in the Eclipse treatment planning system over these optimized MLC apertures. Dose uniformity along midline of the RANDO phantom is within the confidence limit (CL) of 2.1% (with a confidence probability p=0.065). The issue of over‐ and underdose at the interfaces that is observed when symmetric MLC apertures are used is reduced from more than ±4% to less than ±1.5% with asymmetric MLC apertures. Lungs are shielded by 20%, 30%, and 40% of the prescribed dose by adjusting the MLC apertures. Dose‐volume histogram analysis confirms that the revised technique provides effective lung shielding, as well as a homogeneous dose coverage to the whole body. The asymmetric technique also reduces hot and cold spots at lung‐tissue interfaces compared to previous symmetric MLC‐based TBI technique. MLC‐based shielding of OARs eliminates the need to fabricate and setup cumbersome patient‐specific physical blocks.PACS number(s): 87.55.‐x, 87.55.de, 87.55.D‐

“…Pneumonitis is one of the major toxicity concerns with TBI, and was originally related to dose rate; however, since the introduction of fractionated regimes, several publications have shown the dose rate to have little effect 31, 32, 33, 34, 35, 36. The estimated dose rate in the chest region for this technique is 26 cGy/min, which is within the range of dose rates reported in the literature 2, 3.…”

Section: Discussionmentioning

confidence: 99%

Volumetric modulated arc therapy for total body irradiation: A feasibility study using Pinnacle³ treatment planning system and Elekta Agility™ linac

Symons

Morrison

Parry

et al. 2018

A study was undertaken to explore the use of volumetric modulated arc therapy (VMAT) for total body irradiation (TBI). Five patient plans were created in Pinnacle3 using nine 6 MV photon dynamic arcs. A dose of 12 Gy in six fractions was prescribed. The planning target volume (PTV) was split into four subsections for the head, chest, abdomen, and pelvis. The head and chest beams were optimized together, followed by the abdomen and pelvis beams. The last stage of the planning process involved turning all beams on and performing a final optimization to achieve a clinically acceptable plan. Beam isocenters were shifted by 3 or 5 mm in the left–right, anterior–posterior, and superior–inferior directions to simulate the effect of setup errors on the dose distribution. Treatment plan verification consisted of ArcCheck measurements compared to calculated doses using a global 3%/3 mm gamma analysis. All five patient plans achieved the planning aim of delivering 12 Gy to at least 90% of the target. The mean dose in the PTV was 12.7 Gy. Mean lung dose was restricted to 8 Gy, and a dose reduction of up to 40% for organs such as the liver and kidneys proved feasible. The VMAT technique was found to be sensitive to patient setup errors particularly in the superior–inferior direction. The dose predicted by the planning system agreed with measured doses and had an average pass rate of 99.2% for all arcs. VMAT was found to be a viable treatment technique for total body irradiation.