A variable speed translating couch technique for total body irradiation

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‐

Section: Discussionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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

Salhi

Brown

Ahmed

et al. 2016

“…A translational couch technique maintains a static beam and gantry, while the patient travels under the linac on a specialized translational couch 11. A homogeneous dose can be delivered by varying the speed of the couch movement 12, 13. Custom‐made lung shields and beam spoilers may still be required for these techniques.…”

Section: Introductionmentioning

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.

“…Due to the difficulties accommodating TBI treatments using conventional radiotherapy treatment units, and the associated suboptimal treatment characteristics, some facilities performing large numbers of TBI treatments have devised dedicated TBI units by modifying existing clinical equipment to overcome these shortcomings. Some examples of these units are described in the literature using either linear accelerators2, 3, 4, 5 or Co‐60 units 6, 7, 8…”

Section: Introductionmentioning

confidence: 99%

Commissioning of a dedicated commercial Co‐60 total body irradiation unit

Burmeister

Nalichowski

Snyder

et al. 2018

We describe the commissioning of the first dedicated commercial total body irradiation (TBI) unit in clinical operation. The Best Theratronics GammaBeam 500 is a Co‐60 teletherapy unit with extended field size and imaging capabilities. Radiation safety, mechanical and imaging systems, and radiation output are characterized. Beam data collection, calibration, and external dosimetric validation are described. All radiation safety and mechanical tests satisfied relevant requirements and measured dose distributions meet recommendations of American Association of Physicists in Medicine (AAPM) Report #17. At a typical treatment distance, the dose rate in free space per unit source activity using the thick flattening filter is 1.53 × 10−3 cGy*min−1*Ci−1. With a 14,000 Ci source, the resulting dose rate at the midplane of a typical patient is approximately 17 and 30 cGy/min using the thick and thin flattening filters, respectively, using the maximum source to couch distance. The maximum useful field size, defined by the 90% isodose line, at this location is 225 × 78 cm with field flatness within 5% over the central 178 × 73 cm. Measured output agreed with external validation within 0.5%. End‐to‐end testing was performed in a modified Rando phantom. In‐house MATLAB software was developed to calculate patient‐specific dose distributions using DOSXYZnrc, and fabricate custom 3D‐printed forms for creating patient‐specific lung blocks. End‐to‐end OSLD and diode measurements both with and without lung blocks agreed with Monte Carlo calculated doses to within 5% and in‐phantom film measurements validated dose distribution uniformity. Custom lung block transmission measurements agree well with design criteria and provide clinically favorable dose distributions within the lungs. Block placement is easily facilitated using the flat panel imaging system with an exposure time of 0.01 min. In conclusion, a novel dedicated TBI unit has been commissioned and clinically implemented. Its mechanical, dosimetric, and imaging capabilities are suitable to provide state‐of‐the‐art TBI for patients as large as 220 cm in height and 78 cm in width.