Development of an Immobilization Device for Total Marrow Irradiation

Mancosu, P.; Navarria, Pierina; Muren, L.P.; Castagna, Luca; Reggiori, G.; Clerici, Elena; Sarina, Barbara; Bramanti, Stefania; Philippis, Chiara De; Tomatis, S.; Santoro, Armando; Scorsetti, Marta

doi:10.1016/j.prro.2020.02.012

Cited by 12 publications

(17 citation statements)

References 27 publications

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“…Our patient setup errors and corrections were comparable to the one published recently by Mancosu et al [20] which compared two different immobilization systems (baseplates with and without inter-fixation). The study showed lesser setup corrections when the baseplates were inter-fixed.…”

Section: Discussionsupporting

confidence: 86%

Total marrow and lymphoid irradiation with helical tomotherapy: a practical implementation report

et al. 2020

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To standardize the technique; evaluate resources requirements and analyze our early experience of total marrow and lymphoid irradiation (TMLI) as part of the conditioning regimen before allogenic bone marrow transplantation using helical tomotherapy. Materials and Methods: Computed tomography (CT) scanning and treatment were performed in head first supine (HFS) and feet first supine (FFS) orientations with an overlap at mid-thigh. Patients along with the immobilization device were manually rotated by 180° to change the orientation after the delivery of HFS plan. The dose at the junction was contributed by a complementary dose gradient from each of the plans. Plan was to deliver 95% of 12 Gy to 98% of clinical target volume with dose heterogeneity <10% and pre-specified organs-at-risk dose constraints. Megavoltage-CT was used for position verification before each fraction. Patient specific quality assurance and in vivo film dosimetry to verify junction dose were performed in all patients. Results: Treatment was delivered in two daily fractions of 2 Gy each for 3 days with at least 8-hour gap between each fraction. The target coverage goals were met in all the patients. The average person-hours per patient were 16.5, 21.5, and 25.75 for radiation oncologist, radiation therapist, and medical physicist, respectively. Average in-room time per patient was 9.25 hours with an average beam-on time of 3.32 hours for all the 6 fractions. Conclusion: This report comprehensively describes technique and resource requirements for TMLI and would serve as a practical guide for departments keen to start this service. Despite being time and labor intensive, it can be implemented safely and robustly.

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Section: Discussionsupporting

confidence: 86%

Total marrow and lymphoid irradiation with helical tomotherapy: a practical implementation report

et al. 2020

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“…They introduced a novel rotational immobilization system for this type of treatment. Along those same lines, other institutions are reporting their efforts to develop accurate immobilization for these challenging treatments such as Mancosu et al 29 . for VMAT‐based TMI treatments and Losert et al 30 .…”

Section: Discussionmentioning

confidence: 99%

Automatic treatment planning for VMAT‐based total body irradiation using Eclipse scripting

Teruel¹,

Taneja²,

Galavis³

et al. 2021

J Applied Clin Med Phys

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The purpose of this work is to establish an automated approach for a multiple isocenter volumetric arc therapy (VMAT)-based TBI treatment planning approach. Five anonymized full-body CT imaging sets were used. A script was developed to automate and standardize the treatment planning process using the Varian Eclipse v15.6 Scripting API. The script generates two treatment plans: a headfirst VMAT-based plan for upper body coverage using four isocenters and a total of eight full arcs; and a feet-first AP/PA plan with three isocenters that covers the lower extremities of the patient. PTV was the entire body cropped 5 mm from the patient surface and extended 3 mm into the lungs and kidneys. Two plans were generated for each case: one to a total dose of 1200 cGy in 8 fractions and a second one to a total dose of 1320 cGy in 8 fractions. Plans were calculated using the AAA algorithm and 6 MV photon energy. One plan was created and delivered to an anthropomorphic phantom containing 12 OSLDs for in-vivo dose verification. For the plans prescribed to 1200 cGy total dose the following dosimetric results were achieved: median PTV V100% = 94.5%; median PTV D98% = 89.9%; median lungs Dmean = 763 cGy; median left kidney Dmean = 1058 cGy; and median right kidney Dmean = 1051 cGy. For the plans prescribed to 1320 cGy total dose the following dosimetric results were achieved: median PTV V100% = 95.0%; median PTV D98% = 88.7%; median lungs Dmean = 798 cGy; median left kidney Dmean = 1059 cGy; and median right kidney Dmean = 1064 cGy. Maximum dose objective was met for all cases. The dose deviation between the treatment planning dose and the dose measured by the OSLDs was within AE4%. In summary, we have demonstrated that scripting can produce high-quality plans based on predefined dose objectives and can decrease planning time by automatic target and optimization contours generation, plan creation, field and isocenter placement, and optimization objectives setup.

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“…The current study based on the same group of patients complements our previous findings by evaluating GPRs obtained for P 1 and P 2 and analysing how the reduction of complexity impacts the agreement between planned and delivered doses. The impact of patient positioning accuracy on the accuracy of delivered doses was examined elsewhere [ 25 ] as well as the doses deposited in the junction areas of the fields [ 22 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

The impact of different optimization strategies on the agreement between planned and delivered doses during volumetric modulated arc therapy for total marrow irradiation

Piotrowski

Kruszyna-Mochalska

Malicki

2021

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Aim of the study To evaluate the agreement between planned and delivered doses and its potential correlation with the plans’ complexity subjected to dosimetric verification. Material and methods Four isocentre volumetric modulated arc therapy for total marrow irradiation plans optimized simultaneously with (P1) and without (P2) MU reduction were evaluated dosimetrically by γ method performed in a global mode for 4 combinations of γ-index criteria (2%/2 mm, 2%/3 mm, 3%/2 mm, and 3%/3 mm). The evaluation was conducted for 4 regions (head and neck, chest, abdomen and upper pelvis, and lower pelvis and thighs) that were determined geometrically by the isocentres. The Wilcoxon test was used to detect significant differences between γ passing rate (GPR) analysis results for the P1 and P2 plans. The Pearson correlation was used to check the relationship between GPR and the plans’ complexity. Results Except for the head and neck region, the P2 plans had better GPRs than the P1 plans. Only for hard combinations of γ-index criteria (i.e. 2%/3 mm, 2%/2 mm) were the GPRs differences between P1 and P2 clinically meaningful, and they were detected in the chest, abdomen and upper pelvis, and lower pelvis and thighs regions. The highest correlations between GPR and the indices describing the plans’ complexity were found for the chest region. No correlation was found for the head and neck region. Conclusions The P2 plans showed better agreement between planned and delivered doses compared to the P1 plans. The GPR and the plans’ complexity depend on the anatomy region and are most important for the chest region.

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Development of an Immobilization Device for Total Marrow Irradiation

Cited by 12 publications

References 27 publications

Total marrow and lymphoid irradiation with helical tomotherapy: a practical implementation report

Total marrow and lymphoid irradiation with helical tomotherapy: a practical implementation report

Automatic treatment planning for VMAT‐based total body irradiation using Eclipse scripting

The impact of different optimization strategies on the agreement between planned and delivered doses during volumetric modulated arc therapy for total marrow irradiation

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