Estimating dose to implantable cardioverter-defibrillator outside the treatment fields using a skin QED diode, optically stimulated luminescent dosimeters, and LiF thermoluminescent dosimeters

Chan, Maria F.; Song, Yulin; Dauer, Lawrence T.; Li, Jingdong; Huang, David; Burman, Chandra

doi:10.1016/j.meddos.2011.11.007

Cited by 12 publications

(13 citation statements)

References 36 publications

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“…All other measurements had an ion chamber uncertainty less than or equal to 5%. Chan et al . also discusses the relative sensitivity of several detectors when applied to out‐of‐field dose measurements at the skin level.…”

Section: Discussionmentioning

confidence: 99%

Part I: Out‐of‐field dose mapping for 6X and 6X‐flattening‐filter‐free beams on the TrueBeam for extended distances

Wijesooriya

2019

Medical Physics

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Purpose With increasing cancer treatment success rates, many patients go on to live long, productive lives following recovery. Therefore, minimizing potential side effects due to dose outside the treated field is becoming a significant consideration in radiation therapy. With many potential treatment configurations available, it is important to quantify how out‐of‐field dose varies with common variables such as distance from isocenter, couch angle, jaw size, and flattening‐filter setting. The accurate quantification of out‐of‐field dose at extended distances could also benefit researchers and detector developers. While data exist for out‐of‐field dose from older linear accelerator (Linac) models, the phenomenon has not been described for the latest generation of machines, such as the Varian TrueBeam. The purpose of this study was to comprehensively quantify out‐of‐field dose for the Varian TrueBeam Linac low energy photons in a wide range of positions and treatment geometries. Method and Materials Out‐of‐field doses were measured using two phantom setups: (a) A large volume ion chamber with a buildup sleeve to quantify head leakage and collimator scatter background dose; and (b) A farmer ion chamber in solid water to incorporate phantom scatter in addition to collimator scatter, and head leakage background dose. In both cases, the ion chamber was positioned with its length along the slowly varying transverse direction (perpendicular to the radial from isocenter). Doses were measured for four symmetric jaw settings (2 × 2 cm2, 4 × 4 cm2, 10 × 10 cm2, and 20 × 20 cm2) for a range of distances from the isocenter (0–100 cm). The angular dependence of the out‐of‐field dose was measured using four different angles: 0°, 45°, 90°, and 135° with respect to the in‐plane direction. All measurements were performed for both 6X and 6X‐flattening‐filter‐free (FFF) beams. Results The lowest out‐of‐field doses were observed at 60 cm away from isocenter in both in‐plane and cross‐plane directions for fields smaller than 10 × 10 cm2. Out‐of‐field dose decreased with decreasing jaw size (a factor of 4.7 for 6X‐FFF and a factor of 3.1 for 6X going from 20 × 20 cm2 to 2 × 2 cm2 at 60 cm from isocenter in the in‐plane direction). The 6X‐FFF beam produced out‐of‐field doses as low as 64% of the 6X beam. Conclusion This study presents a comprehensive description of 6X and 6X‐FFF out‐of‐field doses on a Varian TrueBeam Linac including measurements at a range of positions, angles, and jaw settings and with and without phantom scatter.

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Section: Discussionmentioning

confidence: 99%

Part I: Out‐of‐field dose mapping for 6X and 6X‐flattening‐filter‐free beams on the TrueBeam for extended distances

Wijesooriya

2019

Medical Physics

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“…On the other hand, the TLD‐700 dosimeter has been reported to be insensitive to neutrons, but is not as widely used in clinic. Chan et al (27) reported a change in sensitivity of 3% (1%–11%) for the TLD‐700, a decrease of 10% (5%–21%) for OSLDs, and an increase of 16% (11%–19%) for skin QED diodes for distances up to 15 cm from edge of the treatment field.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric review of cardiac implantable electronic device patients receiving radiotherapy

Prisciandaro

Makkar

Fox

et al. 2015

J Applied Clin Med Phys

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A formal communication process was established and evaluated for the management of patients with cardiac implantable electronic devices (CIEDs) receiving radiation therapy (RT). Methods to estimate dose to the CIED were evaluated for their appropriateness in the management of these patients. A retrospective, institutional review board (IRB) approved study of 69 patients with CIEDs treated with RT between 2005 and 2011 was performed. The treatment sites, techniques, and the estimated doses to the CIEDs were analyzed and compared to estimates from published peripheral dose (PD) data and three treatment planning systems (TPSs) — UMPlan, Eclipse's AAA and Acuros algorithms. When measurements were indicated, radiation doses to the CIEDs ranged from 0.01–5.06 Gy. Total peripheral dose estimates based on publications differed from TLD measurements by an average of 0.94 Gy (0.05–4.49 Gy) and 0.51 Gy (0–2.74 Gy) for CIEDs within 2.5 cm and between 2.5 and 10 cm of the treatment field edge, respectively. Total peripheral dose estimates based on three TPSs differed from measurements by an average of 0.69 Gy (0.02–3.72 Gy) for CIEDs within 2.5 cm of the field edge. Of the 69 patients evaluated in this study, only two with defibrillators experienced a partial reset of their device during treatment. Based on this study, few CIED‐related events were observed during RT. The only noted correlation with treatment parameters for these two events was beam energy, as both patients were treated with high‐energy photon beams (16 MV). Differences in estimated and measured CIED doses were observed when using published PD data and TPS calculations. As such, we continue to follow conservative guidelines and measure CIED doses when the device is within 10 cm of the field or the estimated dose is greater than 2 Gy for pacemakers or 1 Gy for defibrillators.PACS number: 87.55.N‐

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“…The energy spectrum of a 6‐MV photon beam averages only 200–400 keV outside the treatment field, vs. 1.5 MeV inside . This will result in an overresponse of many dosimeters in terms of determining dose to tissue for out‐of‐field measurements . Although the relevant comparison may better be described as dose to SiO 2 , as discussed in Section 6.B., it is recommended to report dose‐to‐water when possible.…”

Section: Dose Assessment Considerationsmentioning

confidence: 99%

“…133,145 This will result in an overresponse of many dosimeters in terms of determining dose to tissue for out-of-field measurements. 146 Although the relevant comparison may better be described as dose to SiO 2 , as discussed in Section 6.B., it is recommended to report dose-to-water when possible. Therefore, dosimeters with a relatively flat energy response or well-known corrections are ideal.…”

Section: C2 Measurementmentioning

confidence: 99%

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

et al. 2019

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Managing radiotherapy patients with implanted cardiac devices (implantable cardiac pacemakers and implantable cardioverter‐defibrillators) has been a great practical and procedural challenge in radiation oncology practice. Since the publication of the AAPM TG‐34 in 1994, large bodies of literature and case reports have been published about different kinds of radiation effects on modern technology implantable cardiac devices and patient management before, during, and after radiotherapy. This task group report provides the framework that analyzes the potential failure modes of these devices and lays out the methodology for patient management in a comprehensive and concise way, in every step of the entire radiotherapy process.

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Estimating dose to implantable cardioverter-defibrillator outside the treatment fields using a skin QED diode, optically stimulated luminescent dosimeters, and LiF thermoluminescent dosimeters

Cited by 12 publications

References 36 publications

Part I: Out‐of‐field dose mapping for 6X and 6X‐flattening‐filter‐free beams on the TrueBeam for extended distances

Part I: Out‐of‐field dose mapping for 6X and 6X‐flattening‐filter‐free beams on the TrueBeam for extended distances

Dosimetric review of cardiac implantable electronic device patients receiving radiotherapy

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†

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Estimating dose to implantable cardioverter-defibrillator outside the treatment fields using a skin QED diode, optically stimulated luminescent dosimeters, and LiF thermoluminescent dosimeters

Cited by 12 publications

References 36 publications

Part I: Out‐of‐field dose mapping for 6X and 6X‐flattening‐filter‐free beams on the TrueBeam for extended distances

Part I: Out‐of‐field dose mapping for 6X and 6X‐flattening‐filter‐free beams on the TrueBeam for extended distances

Dosimetric review of cardiac implantable electronic device patients receiving radiotherapy

Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203†

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Product

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Management of radiotherapy patients with implanted cardiac pacemakers and defibrillators: A Report of the AAPM TG‐203^†