Practice patterns and recommendations for pediatric image‐guided radiotherapy: A Children's Oncology Group report

Hua, C.; Vern-Gross, Tamara; Hess, Clayton B.; Olch, Arthur J.; Alaei, Parham; Sathiaseelan, V.; Deng, Jun; Ulin, Kenneth; Laurie, Fran; Gopalakrishnan, Mahesh; Esiashvili, Natia; Wolden, Suzanne L.; Krasin, Matthew J.; Merchant, Thomas E.; Donaldson, Sarah S.; Fitzgerald, Thomas J.; Constine, Louis S.; Hodgson, David C.; Haas‐Kogan, Daphne A.; Mahajan, Anita; Laack, Nadia N.; Marcus, Karen J.; Taylor, Paige A.; Ahern, Verity; Followill, David S; Buchsbaum, Jeffrey C.; Breneman, John C.; Kalapurakal, John A.

doi:10.1002/pbc.28629

Cited by 14 publications

(11 citation statements)

References 38 publications

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“…Clinicians may be reluctant to perform daily CBCTs for fear of the added radiation dose to the patient but accept the small extra dose from daily kV orthogonal pair imaging. This mindset is particularly prevalent for pediatric treatments 5 . In an analysis performed to estimate the risk of cancer induction for pediatric patients undergoing kV or MV IGRT, an additional 0.5 breast cancer cases per 10 4 patient years (PY) and 0.08 lung cancers per 10 4 PY was found for kV CBCT 9 .…”

Section: Discussionmentioning

confidence: 99%

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How low can you go? A CBCT dose reduction study

Olch

Alaei

2021

J Applied Clin Med Phys

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Purpose Cone beam computed tomography (CBCT) is often used for patient setup based solely on bony anatomy. The goal of this work was to evaluate whether CBCT dose can be lowered to the level of kV image pair doses when used for bony anatomy‐based IGRT without compromising positioning accuracy. Methods An anthropomorphic phantom was CT scanned in the head, head and neck, chest, and pelvis regions and setup on the linear accelerator couch with the isocenter near the planned location. Cone beam computed tomographies were performed with the standard “full dose” protocol supplied by the linac vendor. With sequentially lowering the dose, three‐dimensional (3D) matching was performed for each without shifting the couch. The standard kV image pair protocol for each site was also used to image the phantoms. For all studies, six degrees of freedom was included in the 2D or 3D matching to the extent they could be employed. Imaging doses were determined in air at isocenter following the TG‐61 formalism. Results Cone beam computed tomography dose was reduced by 81–98% of the standard CBCT protocol to nearly that of the standard kV image pair dose for each site. Relative to the standard CBCT shift values, translational shifts were within 0.3 and 1.6 mm for all sites, for the reduced dose CBCT and kV image pair, respectively. Rotational shifts were within 0.2 degree and 0.7 degrees for all sites, for the reduced dose CBCTs and kV image pair, respectively. Conclusion For bony anatomy‐based image guidance, CBCT dose can be reduced to a value similar to that of a kV image pair with similar or better patient positioning accuracy than kV image pair alignment. Where rotations are important to correct, CBCT will be superior to orthogonal kV imaging without significantly increased imaging dose. This is especially important for image guidance for pediatric patient treatments.

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Section: Discussionmentioning

confidence: 99%

“…When imaging pediatric cases, some clinicians have elected not to use CBCT daily, but instead to perform lower dose orthogonal kV imaging daily or even weekly imaging 5 . This lack of full 3D information may reduce the patient positioning accuracy and understanding of changes in anatomy during treatment.…”

Section: Introductionmentioning

confidence: 99%

How low can you go? A CBCT dose reduction study

Olch

Alaei

2021

J Applied Clin Med Phys

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“…The reason for this was two‐fold: The low magnitude of imaging dose and the unavailability of tools to calculate it easily. On the other hand, there have been studies suggesting the benefit of knowing the imaging dose, especially for children 5,43,44 . So having a tool than can do so would be beneficial for those cases.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have suggested that an accurate dose calculation may be warranted for kilovoltage x rays in Image-Guided Radiotherapy (IGRT) due to potential long-term side effects of the imaging dose, especially for pediatric patients. [1][2][3][4][5] Such a dose calculation is not possible using commercial treatment planning systems 3,6 with the exception of a recent system proposed for pre-clinical studies. 7 Monte Carlo (MC), generally considered the gold standard method for this purpose, has been used to compute dose distributions from kilovoltage x rays.…”

Section: Introductionmentioning

confidence: 99%

Generation of material‐specific energy deposition kernels for kilovoltage x‐ray dose calculations

et al. 2021

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Purpose Dose calculation of kilovoltage x rays used in Image‐Guided Radiotherapy has been investigated in recent years using various methods. Among these methods are model‐based ones that suffer from inaccuracies in high‐density materials and at interfaces when used in the kilovoltage energy range. The main reason for this is the use of water energy deposition kernels and simplifications employed such as density scaling in heterogeneous media. The purpose of this study was to produce and characterize material‐specific energy deposition kernels, which could be used for dose calculations in this energy range. These kernels will also have utility in dose calculations in superficial radiation therapy and orthovoltage beams utilized in small animal irradiators. Methods Water energy deposition kernels with various resolutions; and high‐resolution, material‐specific energy deposition kernels were generated in the energy range of 10–150 kVp, using the EGSnrc Monte Carlo toolkit. The generated energy deposition kernels were further characterized by calculating the effective depth of penetration, the effective radial distance, and the effective lateral distance. A simple benchmarking of the kernels against Monte Caro calculations has also been performed. Results There was good agreement with previously reported water kernels, as well as between kernels with different resolution. The evaluation of effective depth of penetration, and radial and laterals distances, defines the relationship between energy, material density, and the shape of the material‐specific kernels. The shape of these kernels becomes more forwardly scattered as the energy and material density are increased. The comparison of the dose calculated using the kernels with Monte Carlo provides acceptable results. Conclusions Water and material‐specific energy deposition kernels in the kilovoltage energy range have been generated, characterized, and compared to previous work. These kernels will have utility in dose calculations in this energy range once algorithms capable of employing them are fully developed.

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“…For example, adjuvant flank RT is recommended for patients who have local stage III FHWT or stage IV with local stage III. 96 Local stage III refers to staging at the primary site regardless of metastases [see "Children's Oncology Group (COG) Staging of Wilms Tumor," available in these guidelines at NCCN.org]. Biopsy alone does not upstage a tumor to stage III for determining whether to give adjuvant RT.…”

Section: Radiation Therapymentioning

confidence: 99%

Wilms Tumor (Nephroblastoma), Version 2.2021, NCCN Clinical Practice Guidelines in Oncology

Balis

Green

Anderson

et al. 2021

Journal of the National Comprehensive Cancer Network

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The NCCN Guidelines for Wilms Tumor focus on the screening, diagnosis, staging, treatment, and management of Wilms tumor (WT, also known as nephroblastoma). WT is the most common primary renal tumor in children. Five-year survival is more than 90% for children with all stages of favorable histology WT who receive appropriate treatment. All patients with WT should be managed by a multidisciplinary team with experience in managing renal tumors; consulting a pediatric oncologist is strongly encouraged. Treatment of WT includes surgery, neoadjuvant or adjuvant chemotherapy, and radiation therapy (RT) if needed. Careful use of available therapies is necessary to maximize cure and minimize long-term toxicities. This article discusses the NCCN Guidelines recommendations for favorable histology WT.

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Practice patterns and recommendations for pediatric image‐guided radiotherapy: A Children's Oncology Group report

Cited by 14 publications

References 38 publications

How low can you go? A CBCT dose reduction study

How low can you go? A CBCT dose reduction study

Generation of material‐specific energy deposition kernels for kilovoltage x‐ray dose calculations

Wilms Tumor (Nephroblastoma), Version 2.2021, NCCN Clinical Practice Guidelines in Oncology

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