Considerations and adaptions to the modulated arc total body irradiation technique: dosimetry description

Effeney, Beth; Biggs, Jennifer; Brady, Carole; Pemberton, Melanie; Sim, Lucy; Pullar, Andrew

doi:10.1002/jmrs.363

Cited by 5 publications

(7 citation statements)

References 6 publications

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“…HT (including TomoDirect) 10–14,39–45 is the most widely used technique followed closely by VMAT 6–9,46,47 or VMAT hybrid techniques, where the lower limb fields are delivered using a FIF anteroposterior/posteroanterior (AP/PA) technique. 48–51 Extended SSD treatments such as FIF, IMRT 52–55 and arc or modulated arc therapy 56,57 also feature. Arc techniques require the patient to be placed on a specially designed couch near to the treatment floor with a supine then prone delivery of multiple arcs.…”

Section: Current Status Of Planning Techniquesmentioning

confidence: 99%

Optimised conformal total body irradiation: a heterogeneous practice, so where next?

Misson-Yates

Cunningham

Gonzalez

et al. 2023

BJR

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The use of volumetric arc therapy (VMAT) and inverse planning has been in routine use in radiotherapy for two decades. However, use in total body irradiation (TBI) has been more recent and few guidelines exist as to how to plan or verify. This has led to heterogeneous approaches. The goal of this review is to provide an overview of current advanced planning and dosimetry verification protocols used in optimised conformal TBI as a basis for investigating the need for greater standardisation in TBI.

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Section: Current Status Of Planning Techniquesmentioning

confidence: 99%

Optimised conformal total body irradiation: a heterogeneous practice, so where next?

Misson-Yates

Cunningham

Gonzalez

et al. 2023

BJR

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“…Then, the remaining arc fields used to treat PTV_Upper were simultaneously optimized for coverage and organ sparing. Since previous studies [15][16][17][18][19][20][21] have shown that lower dose rates can reduce pulmonary complications, the dose rate for the arcs that directly irradiate the lungs was set to 40 MU/min while all other arcs were increased to a dose rate of 300 MU/min, following the guidance of Held et al [16] to reduce the treatment time.…”

Section: Conventional Vmat Tbi Planningmentioning

confidence: 99%

Dosimetric Evaluation Between the Conventional Volumetrically Modulated Arc Therapy (VMAT) Total Body Irradiation (TBI) and the Novel Simultaneous Integrated Total Marrow Approach (SIMBa) VMAT TBI

Stanley¹,

McConnell²,

Iqbal³

et al. 2021

Cureus

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The purpose of this study was to assess the treatment planning feasibility of volumetrically modulated arc therapy total body irradiation (VMAT TBI) using a simultaneous integrated marrow and body approach (SIMBa). We also aimed to compare SIMBa TBI with the more conventional VMAT TBI approach using the entire body as the target. The goal of using an integrated approach like SIMBa is to balance the known clinical benefit of TBI with the toxicity decrease of Total Marrow Irradiation (TMI) using two prescription volumes. In anticipation of a clinical trial to investigate a novel conditioning regimen that uses SIMBa, our institution retrospectively analyzed the dosimetric differences between 20 clinical VMAT TBI which were replanned using SIMBa. MethodsTwenty patients who previously received conventional VMAT TBI at our institution with a dose of 12 Gy in six fractions were re-planned using SIMBa with a planning aim of delivering a uniform dose of 12 Gy to at least 90% of the PTV_BodyEval. The planning aims of SIMBa were to deliver a uniform dose of 12 Gy to at least 90% of the PTV_Marrow and 8 Gy to at least 90% of the PTV_TotalBody while limiting the mean lung dose to less than 8 Gy. The plans were normalized so that 100% of the PTV_Marrow received at least 90% of the dose with the PTV_TotalBody optimized to stay as close to 100% at 90% as possible. ResultsAll 20 patient plans achieved 12 Gy/8 Gy to at least 90% of the PTV_Marrow and PTV_TotalBody, respectively, with max doses of <16 Gy (130%). As compared with the delivered TBI, the following reductions in mean dose were notable: small bowel 21.3±4.2%, lung 16.3±7.9%, heart 25.3±8.6%, and kidney 16.4±6.2%. Coverage of the sanctuary sites was maintained despite a significant reduction to sensitive organs at risk (OARs). ConclusionThis study supports that VMAT TBI treatment planning with SIMBa is feasible. In this sample, SIMBa provided dosimetrically similar doses to marrow and sanctuary site doses as TBI while achieving lower doses to OARs. A clinical trial is needed to investigate the clinical implications of VMAT TBI with SIMBa.

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“…Because TBI is a complex radiotherapy treatment, most institutions use very simple treatment planning approaches and a homogenous dose calculation, being traditionally delivered using two‐dimensional (2D) techniques with a conventional linac (linear accelerator) using an anterior–posterior (AP/PA) or parallel‐opposed lateral beam arrangements at an extended source‐to‐surface distance (SSD) 3 . In the literature, a growing but still low number of papers deal with three‐dimensional treatment planning issues 6‐13 …”

Section: Introductionmentioning

confidence: 99%

“…3 In the literature, a growing but still low number of papers deal with three‐dimensional treatment planning issues. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

Commissioning of a three‐dimensional arc‐based technique for total body irradiation

Aldrovandi¹,

Farías²,

Mauri³

et al. 2021

J Applied Clin Med Phys

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The purpose of this study is to describe the commissioning of a novel three‐dimensional arc‐based technique for total body irradiation (TBI) treatments. The development and implementation of this technique allowed our institution to transition from a bilateral two‐dimensional (2D) technique to a methodology based on volumetric dose calculation. The methodology described in this work is a derivation from the MATBI technique, with the static fields being replaced by four contiguous arc‐fields for each anterior and posterior incidence. The reduced number of fields we employed makes it possible to reach a satisfactory dose uniformity through manual optimization in a straightforward process. We use the Eclipse anisotropic analytical algorithm (AAA) algorithm, commissioned with preconfigured beam data for a 6 MV photon beam, at standard SSD (100 cm). A thorough evaluation of the accuracy of the AAA algorithm at an extended distance (approximately 200 cm) was carried out. For the evaluation, we compared measured and calculated percentage depth–dose and profiles that included open‐field, penumbra, and out‐of‐field regions. The analysis was performed for both static and arc fields, taking into consideration unshielded fields and also in the presence of lung shielding blocks. End‐to‐end tests were carried out for our institutional template plan by two means: with a 2D ion chamber array detector in solid phantom and using Gafchromic films in an anthropomorphic phantom. The results obtained in this work demonstrate that the Eclipse AAA algorithm commissioned for standard treatments can be safely used with our TBI planning technique. Moreover, this technique proved to be a highly efficient path to replace conventional treatment techniques, providing a homogeneous dose distribution, dosimetric robustness, and shorter treatment times. In addition, as inherited from the MATBI technique, our methodology can be implemented in small treatment rooms, with no need for ancillary equipment.

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Considerations and adaptions to the modulated arc total body irradiation technique: dosimetry description

Cited by 5 publications

References 6 publications

Optimised conformal total body irradiation: a heterogeneous practice, so where next?

Optimised conformal total body irradiation: a heterogeneous practice, so where next?

Dosimetric Evaluation Between the Conventional Volumetrically Modulated Arc Therapy (VMAT) Total Body Irradiation (TBI) and the Novel Simultaneous Integrated Total Marrow Approach (SIMBa) VMAT TBI

Commissioning of a three‐dimensional arc‐based technique for total body irradiation

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