Dosimetric impact of the AeroForm tissue expander in postmastectomy radiation therapy: An ex vivo analysis

Moni, Janaki; Saleeby, Jonathan; Bannon, Elizabeth; Lo, Yuan‐Chyuan; Fitzgerald, Thomas J.

doi:10.1016/j.prro.2014.04.001

Cited by 22 publications

(15 citation statements)

References 11 publications

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“…However, several articles have now been published which document that radiation therapy can be safely administered while the carbon dioxide-based devices are still in patients. 13,14 In the American AirXpanders Patient Activated Controlled Tissue Expander trial, the device has been used only in patients who met a specific set of inclusion and exclusion criteria, namely, excluding smokers, patients with a body mass index over 33, patients younger than 18 or older than 70 years, and patients who must fly during the expansion process. In the future, it will also be helpful to evaluate the safety and efficacy in those patients with a higher risk of developing breast reconstruction complications.…”

Section: Discussionmentioning

confidence: 99%

Carbon Dioxide versus Saline Tissue Expanders

Ascherman

Zeidler

Jacoby

et al. 2016

Plastic and Reconstructive Surgery

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Section: Discussionmentioning

confidence: 99%

Carbon Dioxide versus Saline Tissue Expanders

Ascherman

Zeidler

Jacoby

et al. 2016

Plastic and Reconstructive Surgery

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“…Moni et al 12 showed that the presence of a metallic port in the tissue expander does not significantly contribute to the high complication rates. This is mainly because any increased dose due to the metallic port is observed in the immediate vicinity of the port (< 7 mm) where the effect is mostly observed in the expander volume and not the chest wall.…”

Section: Discussionmentioning

confidence: 99%

A dosimetric analysis of the aeroformTM tissue expander in radiation therapy

Ammar

Eldebawy

Maarouf

et al. 2014

Int J Cancer Ther Oncol

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The aim of this study is to evaluate the effects of the metallic reservoir and the use of gas within the Aeroform™ tissue expander with respect to the radiation dose distribution. Methods: Dosimetric effects of using a metallic reservoir within a breast tissue expander during external beam radiotherapy were investigated. To view the internal components of the reservoir, it was removed from the tissue expander and imaged on a Varian AS500 electronic portal imager. To calculate the relative density of each component within the reservoir, an ionization chamber within solid water was used to measure the dose and compared to a simulation within the Pinnacle treatment planning system (TPS). To examine the relative dose profile along the length of the reservoir, the reservoir was exposed on EBT3 film and analyzed using SNC Patient ™. In-vivo Dosimetry was performed using a RANDO ® Woman phantom. Thermo-luminescent dosimeters were placed within the wax bolus enveloping the tissue expander. Results: Imaging the reservoir on the electronic portal imager revealed it consists of 3 distinct components. The densities assigned in the TPS, which resulted in calculated doses which matched the measured doses were; Section 1 = 0 g/cm 3 , Section 2 = 2.8 g/cm 3 and Section 3 = 0.7 g/cm 3. Relative dose reductions were observed due to the metallic case; Section 1 = 20%, Section 2 = 40% and Section 3 = 30%. Entrance doses ranged from 2.39-2.53 Gy for both the medial and lateral beams. Exit doses ranging from 1.10-1.71 Gy were observed in both beams. There was a significant difference in measured and calculated doses at exit locations in the beam. Conclusion: Dosimetric effects due to the metallic reservoir within the Aeroform breast tissue expander have been demonstrated and have been observed to be significant. To increase the dosimetric accuracy when contouring, individual components of the reservoir should be distinguished. Our in-vivo experiment showed that dose homogeneity was difficult due to the metallic reservoir and we recommend stringent patient dose monitoring when using this expander during radiotherapy.

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“…12,13 Previous literature has proposed various solutions dealing with TEs in a radiation treatment planning systems (TPS). 14 17 Moni placed OSLDs at various locations around the Aero-Form TE on anthropomorphic phantom. The set-up was imaged and an RT plan was created and delivered.…”

Section: Introductionmentioning

confidence: 99%

“…Moni was also unable to observe the predicted "dose shadow" effect with OSLD measurements, possibly due to uncertainty in detector placement. 17 These areas are of significant clinical importance; clinicians require accurate dose calculation in these regions to assess overall RT plan quality.…”

Section: Introductionmentioning

confidence: 99%

Modeling AeroForm tissue expander for postmastectomy radiation therapy

Dziemianowicz

Gardner

Snyder

et al. 2019

J Applied Clin Med Phys

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The AeroForm chest wall tissue expander (TE) is a silicon shell containing a metallic CO 2 reservoir, placed surgically after mastectomy. The patient uses a remote control to release compressed CO 2 from the reservoir to inflate the expander. AeroForm poses challenges in a radiation therapy setting: The high density of the metallic reservoir causes imaging artifacts on the planning CT, which encumber structure definition and cause misrepresentation of density information, in turn affecting dose calculation. Additionally, convolution‐based dose calculation algorithms may not be well‐suited to calculate dose in and around high‐density materials. In this study, a model of the AeroForm TE was created in Eclipse treatment planning system (TPS). The TPS model was validated by comparing measured to calculated transmission through the AeroForm. Transmission was measured with various geometries using radiochromic film. Dose was calculated with both Varian’s Anisotropic Analytical Algorithm (AAA) and Acuros External Beam (AXB) algorithms. AAA and AXB were compared using dose profile and gamma analyses. While both algorithms modeled direct transmission well, AXB better modeled lateral scatter from the AeroForm TE. Clinical significance was evaluated using clinical data from four patients with AeroForm TEs. The AeroForm TPS model was applied, and RT plans were optimized using AAA, then re‐calculated with AXB. Structures of clinical significance were defined and dose volume histogram analysis was performed. Compared to AXB, AAA overestimates dose in the AeroForm device. Changes in clinically significant regions were patient‐ and plan‐specific. This study proposes a clinical procedure for modeling the AeroForm in a commercial TPS, and discusses the limitations of dose calculation in and around the device. An understanding of dose calculation accuracy in the vicinity of the AeroForm is critical for assessing individual plan quality, appropriateness of different planning techniques and dose calculation algorithms, and even the decision to use the AeroForm in a postmastectomy radiation therapy setting.

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Dosimetric impact of the AeroForm tissue expander in postmastectomy radiation therapy: An ex vivo analysis

Cited by 22 publications

References 11 publications

Carbon Dioxide versus Saline Tissue Expanders

Carbon Dioxide versus Saline Tissue Expanders

A dosimetric analysis of the aeroformTM tissue expander in radiation therapy

Modeling AeroForm tissue expander for postmastectomy radiation therapy

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