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Lee TF, Chang CH, Chi CH, Liu YH, Shao JC, Hsieh YW, Yang PY, Tseng CD, Chiu CL, Hu YC, Lin YW, Chao PJ, Lee SH, Yeh SA. Utilizing radiomics and dosiomics with AI for precision prediction of radiation dermatitis in breast cancer patients. BMC Cancer 2024; 24:965. [PMID: 39107701 PMCID: PMC11304569 DOI: 10.1186/s12885-024-12753-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 08/02/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE This study explores integrating clinical features with radiomic and dosiomic characteristics into AI models to enhance the prediction accuracy of radiation dermatitis (RD) in breast cancer patients undergoing volumetric modulated arc therapy (VMAT). MATERIALS AND METHODS This study involved a retrospective analysis of 120 breast cancer patients treated with VMAT at Kaohsiung Veterans General Hospital from 2018 to 2023. Patient data included CT images, radiation doses, Dose-Volume Histogram (DVH) data, and clinical information. Using a Treatment Planning System (TPS), we segmented CT images into Regions of Interest (ROIs) to extract radiomic and dosiomic features, focusing on intensity, shape, texture, and dose distribution characteristics. Features significantly associated with the development of RD were identified using ANOVA and LASSO regression (p-value < 0.05). These features were then employed to train and evaluate Logistic Regression (LR) and Random Forest (RF) models, using tenfold cross-validation to ensure robust assessment of model efficacy. RESULTS In this study, 102 out of 120 VMAT-treated breast cancer patients were included in the detailed analysis. Thirty-two percent of these patients developed Grade 2+ RD. Age and BMI were identified as significant clinical predictors. Through feature selection, we narrowed down the vast pool of radiomic and dosiomic data to 689 features, distributed across 10 feature subsets for model construction. In the LR model, the J subset, comprising DVH, Radiomics, and Dosiomics features, demonstrated the highest predictive performance with an AUC of 0.82. The RF model showed that subset I, which includes clinical, radiomic, and dosiomic features, achieved the best predictive accuracy with an AUC of 0.83. These results emphasize that integrating radiomic and dosiomic features significantly enhances the prediction of Grade 2+ RD. CONCLUSION Integrating clinical, radiomic, and dosiomic characteristics into AI models significantly improves the prediction of Grade 2+ RD risk in breast cancer patients post-VMAT. The RF model analysis demonstrates that a comprehensive feature set maximizes predictive efficacy, marking a promising step towards utilizing AI in radiation therapy risk assessment and enhancing patient care outcomes.
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Affiliation(s)
- Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Jiangong RdSanmin Dist., No.415, Kaohsiung, 80778, Taiwan, ROC
- Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, 807, Taiwan, ROC
- Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, 80708, Taiwan, ROC
| | - Chu-Ho Chang
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Jiangong RdSanmin Dist., No.415, Kaohsiung, 80778, Taiwan, ROC
| | - Chih-Hsuan Chi
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Jiangong RdSanmin Dist., No.415, Kaohsiung, 80778, Taiwan, ROC
| | - Yen-Hsien Liu
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Jiangong RdSanmin Dist., No.415, Kaohsiung, 80778, Taiwan, ROC
| | - Jen-Chung Shao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Jiangong RdSanmin Dist., No.415, Kaohsiung, 80778, Taiwan, ROC
| | - Yang-Wei Hsieh
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Jiangong RdSanmin Dist., No.415, Kaohsiung, 80778, Taiwan, ROC
| | - Pei-Ying Yang
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Jiangong RdSanmin Dist., No.415, Kaohsiung, 80778, Taiwan, ROC
| | - Chin-Dar Tseng
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Jiangong RdSanmin Dist., No.415, Kaohsiung, 80778, Taiwan, ROC
| | - Chien-Liang Chiu
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Jiangong RdSanmin Dist., No.415, Kaohsiung, 80778, Taiwan, ROC
| | - Yu-Chang Hu
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Yu-Wei Lin
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Jiangong RdSanmin Dist., No.415, Kaohsiung, 80778, Taiwan, ROC.
| | - Shen-Hao Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Jiangong RdSanmin Dist., No.415, Kaohsiung, 80778, Taiwan, ROC.
- Department of Radiation Oncology, Linkou Chang Gung Memorial Hospitaland, Chang Gung University College of Medicine, Linkou, Taiwan, ROC.
| | - Shyh-An Yeh
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Jiangong RdSanmin Dist., No.415, Kaohsiung, 80778, Taiwan, ROC.
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, 82445, Taiwan, ROC.
- Department of Radiation Oncology, E-DA Hospital, Kaohsiung, 82445, Taiwan, ROC.
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Mast M, Leong A, Korreman S, Lee G, Probst H, Scherer P, Tsang Y. ESTRO-ACROP guideline for positioning, immobilisation and setup verification for local and loco-regional photon breast cancer irradiation. Tech Innov Patient Support Radiat Oncol 2023; 28:100219. [PMID: 37745181 PMCID: PMC10511493 DOI: 10.1016/j.tipsro.2023.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/10/2023] [Indexed: 09/26/2023] Open
Affiliation(s)
- M.E. Mast
- Department of Radiation Oncology, Haaglanden Medical Center, Leidschendam, The Netherlands
| | - A. Leong
- Department of Radiation Therapy, University of Otago, Wellington, New Zealand
- Bowen Icon Cancer Centre, Wellington, New Zealand
| | - S.S. Korreman
- Department of Clinical Medicine, Aarhus University, Denmark
- Department of Oncology, Aarhus University Hospital, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | - G. Lee
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - H. Probst
- Sheffield Hallam University, Sheffield, United Kingdom
| | - P. Scherer
- Department of Radiotherapy and Radio-Oncology, LKH Salzburg, Paracelsus Medical University Clinics, Salzburg, Austria
| | - Y. Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
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Lv R, Yang G, Huang Y, Wang Y. Dosimetric effects of supine immobilization devices on the skin in intensity-modulated radiation therapy for breast cancer: a retrospective study. BMC Cancer 2021; 21:384. [PMID: 33836670 PMCID: PMC8034111 DOI: 10.1186/s12885-021-08119-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 03/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background The dose perturbation effect of immobilization devices is often overlooked in intensity-modulated radiation therapy (IMRT) for breast cancer (BC). This retrospective study assessed the dosimetric effects of supine immobilization devices on the skin using a commercial treatment planning system. Methods Forty women with BC were divided into four groups according to the type of primary surgery: groups A and B included patients with left and right BC, respectively, who received 50 Gy radiotherapy in 25 fractions after radical mastectomy, while groups C and D included patients with left and right BC, respectively, who received breast-conservation surgery (BCS) and 40.05 Gy in 15 fractions as well as a tumor bed simultaneous integrated boost to 45 Gy. A 0.2-cm thick skin contour and two sets of body contours were outlined for each patient. Dose calculations were conducted for the two sets of contours using the same plan. The dose differences were assessed by comparing the dose-volume histogram parameter results and by plan subtraction. Results The supine immobilization devices for BC resulted in significantly increased skin doses, which may ultimately lead to skin toxicity. The mean dose increased by approximately 0.5 and 0.45 Gy in groups A and B after radical mastectomy and by 2.7 and 3.25 Gy in groups C and D after BCS; in groups A–D, the percentages of total normal skin volume receiving equal to or greater than 5 Gy (V5) increased by 0.54, 1.15, 2.67, and 1.94%, respectively, while the V10 increased by 1.27, 1.83, 1.36, and 2.88%; the V20 by 0.85, 1.87, 2.76, and 4.86%; the V30 by 1.3, 1.24, 10.58, and 11.91%; and the V40 by 1.29, 0.65, 10, and 10.51%. The dose encompassing the planning target volume and other organs at risk, showed little distinction between IMRT plans without and with consideration of immobilization devices. Conclusions The supine immobilization devices significantly increased the dose to the skin, especially for patients with BCS. Thus, immobilization devices should be included in the external contour to account for dose attenuation and skin dose increment. Trial registration This study does not report on interventions in human health care.
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Affiliation(s)
- Ran Lv
- Second Affiliated Hospital of Fujian Medical University, NO 950, Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Guangyi Yang
- Second Affiliated Hospital of Fujian Medical University, NO 950, Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Yongzhi Huang
- Second Affiliated Hospital of Fujian Medical University, NO 950, Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China
| | - Yanhong Wang
- Second Affiliated Hospital of Fujian Medical University, NO 950, Donghai Street, Fengze District, Quanzhou, 362000, Fujian, China.
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Verde Nolasco A, de Faria LO. Head and Neck Immobilization Masks: Increase in Dose Surface Evaluated by EBT3, TLD‐100 and PBC Method. PRECISION RADIATION ONCOLOGY 2020. [DOI: 10.1002/pro6.1097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Arnie Verde Nolasco
- Department of Medical Physics São Francisco Radiotherapy Institute Itapagipe 762 Belo Horizonte Minas Gerais Brasil
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Bahreyni Toossi MT, Mohamadian N, Mohammadi M, Ghorbani M, Hassani M, Khajetash B, Khorshidi F, Knaup C. Assessment of skin dose in breast cancer radiotherapy: on-phantom measurement and Monte Carlo simulation. Rep Pract Oncol Radiother 2020; 25:456-461. [PMID: 32477012 DOI: 10.1016/j.rpor.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/27/2020] [Accepted: 03/12/2020] [Indexed: 12/24/2022] Open
Abstract
Aim The main purpose of the present study is assessment of skin dose in breast cancer radiotherapy. Background Accurate assessment of skin dose in radiotherapy can provide useful information for clinical considerations. Materials and methods A RANDO phantom was irradiated using a 6 MV Siemens Primus linac with medial and tangential radiotherapy fields for simulating breast cancer treatment. Dosimetry was also performed on various positions across the fields using an EBT3 radiochromic film. Similar conditions of measurement on the RANDO phantom including field size, irradiation angle, number of fields, etc. were subsequently simulated via the Monte Carlo N-Particle Transport code (MCNP). Ultimately, dose values for corresponding points from both methods were compared. Results Considering dosimetry using radiochromic films on the RANDO phantom, there were points having underdose and overdose based on the prescribed dose and skin tolerance levels. In this respect, 81.25% and 18.75% of the points had underdose and overdose, respectively. In some cases, several differences were observed between the measurement and the MCNP simulation results associated with skin dose. Conclusion Based on the results of the points which had underdose, it was suggested that a bolus should be used for the given points. With regard to overdose points, it was advocated to consider skin tolerance dose in treatment planning. Differences between the measurement and the MCNP simulation results might be due to voxel size of tally cells in simulations, effect of beam's angle of incidence, validation time of linac's head, lack of electronic equilibrium in the build-up region, as well as MCNP tally type.
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Affiliation(s)
| | - Nastaran Mohamadian
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Mohammadi
- Department of Medical Physics, Royal Adelaide Hospital, Adelaide, South Australia.,School of Physical Sciences, The University of Adelaide, Adelaide, South Australia
| | - Mahdi Ghorbani
- Biomedical Engineering and Medical Physics Department, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Hassani
- Department of Radiotherapy Physics, Cancer Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Benyamin Khajetash
- Medical Physics Department, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Farideh Khorshidi
- Medical Physics Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Courtney Knaup
- Comprehensive Cancer Centers of Nevada, Las Vegas, Nevada, USA
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Lancellotta V, Chierchini S, Perrucci E, Saldi S, Falcinelli L, Iacco M, Zucchetti C, Palumbo I, Bini V, Aristei C. Skin toxicity after chest wall/breast plus level III-IV lymph nodes treatment with helical tomotherapy. Cancer Invest 2018; 36:504-511. [PMID: 30516084 DOI: 10.1080/07357907.2018.1545854] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION To evaluate the incidence of toxicity in breast cancer with helical tomotherapy (HT). MATERIALS AND METHODS 51 patients with breast cancer were assigned to postoperative radiotherapy by means of HT to the chest wall/breast plus draining nodes. During HT treatment, toxicity was monitored and were assessed using the Common Terminology Criteria for Adverse Events 4.0 scale. RESULTS Acute skin G3 toxicity observed in 1.9% cases. No acute or late G4 toxicity was observed. At a median follow-up of 21 months 2 patients have late G1 toxicity. CONCLUSIONS HT was associated with a low incidence of low-grade skin toxicity.
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Affiliation(s)
- Valentina Lancellotta
- a Radiation Oncology Section , Department of Surgical and Biomedical Sciences , University of Perugia and Perugia General Hospital , Italy
| | | | | | | | | | - Martina Iacco
- d Medical Physics Unit, Perugia General Hospital , Italy
| | | | - Isabella Palumbo
- a Radiation Oncology Section , Department of Surgical and Biomedical Sciences , University of Perugia and Perugia General Hospital , Italy
| | - Vittorio Bini
- e Internal Medicine, Endocrine and Metabolic Science Section , University of Perugia , Perugia , Italy
| | - Cynthia Aristei
- a Radiation Oncology Section , Department of Surgical and Biomedical Sciences , University of Perugia and Perugia General Hospital , Italy
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Lee TF, Sung KC, Chao PJ, Huang YJ, Lan JH, Wu HY, Chang L, Ting HM. Relationships among patient characteristics, irradiation treatment planning parameters, and treatment toxicity of acute radiation dermatitis after breast hybrid intensity modulation radiation therapy. PLoS One 2018; 13:e0200192. [PMID: 30011291 PMCID: PMC6047778 DOI: 10.1371/journal.pone.0200192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
To evaluate the relationships among patient characteristics, irradiation treatment planning parameters, and treatment toxicity of acute radiation dermatitis (RD) after breast hybrid intensity modulation radiation therapy (IMRT). The study cohort consisted of 95 breast cancer patients treated with hybrid IMRT. RD grade ≥2 (2+) toxicity was defined as clinically significant. Patient characteristics and the irradiation treatment planning parameters were used as the initial candidate factors. Prognostic factors were identified using the least absolute shrinkage and selection operator (LASSO)-based normal tissue complication probability (NTCP) model. A univariate cut-off dose NTCP model was developed to find the dose-volume limitation. Fifty-two (54.7%) of ninety-five patients experienced acute RD grade 2+ toxicity. The volume of skin receiving a dose >35 Gy (V35) was the most significant dosimetric predictor associated with RD grade 2+ toxicity. The NTCP model parameters for V35Gy were TV50 = 85.7 mL and γ50 = 0.77, where TV50 was defined as the volume corresponding to a 50% incidence of complications, and γ50 was the normalized slope of the volume-response curve. Additional potential predictive patient characteristics were energy and surgery, but the results were not statistically significant. To ensure a better quality of life and compliance for breast hybrid IMRT patients, the skin volume receiving a dose >35 Gy should be limited to <85.7 mL to keep the incidence of RD grade 2+ toxicities below 50%. To avoid RD toxicity, the volume of skin receiving a dose >35 Gy should follow sparing tolerance and the inherent patient characteristics should be considered.
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Affiliation(s)
- Tsair-Fwu Lee
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.,Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Kuo-Chiang Sung
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.,Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC
| | - Pei-Ju Chao
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Yu-Jie Huang
- Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Jen-Hong Lan
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
| | - Horng-Yuan Wu
- Department of Electrical Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC
| | - Liyun Chang
- Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan, ROC
| | - Hui-Min Ting
- Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan, ROC.,Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC
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Katz LM, Perez CA, Gerber NK, Purswani J, McCarthy A, Das IJ. Skin recurrence in the radiation treatment of breast cancer. Adv Radiat Oncol 2018; 3:458-462. [PMID: 30202813 PMCID: PMC6128028 DOI: 10.1016/j.adro.2018.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/23/2018] [Accepted: 04/29/2018] [Indexed: 11/02/2022] Open
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Rijken J, Kairn T, Crowe S, Muñoz L, Trapp J. A simple method to account for skin dose enhancement during treatment planning of VMAT treatments of patients in contact with immobilization equipment. J Appl Clin Med Phys 2018; 19:239-245. [PMID: 29934993 PMCID: PMC6036355 DOI: 10.1002/acm2.12394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 12/31/2022] Open
Abstract
Purpose The ability to accurately predict skin doses and thereby design radiotherapy treatments that balance the likelihood of skin reactions against other treatment objectives is especially important when hypofractionated prescription regimes are used. However, calculations of skin dose provided by many commercial radiotherapy treatment planning systems are known to be inaccurate, especially if the presence of immobilization equipment is not accurately taken into account. This study proposes a simple method by which the accuracy of skin dose calculations can be substantially improved, to allow informed evaluation of volumetric modulated arc therapy (VMAT) treatment plans. Method A simple method was developed whereby dose calculation is split into grid regions, each with a correction factor which determines MU scaling for skin dose calculation. Correction factors were derived from film measurements made using a geometrically simple phantom in partial contact with a vacuum immobilization device. This method was applied to two different test treatments, planned for delivery to a humanoid phantom with a hypofractionated stereotactic body radiotherapy technique, and results were verified using film measurements of surface dose. Results Compared to the measured values, calculations of skin dose volumes corresponding to different grade tissue reactions were greatly improved through use of the method employed in this study. In some cases, the accuracy of skin dose evaluation improved by 76% and brought values to within 3% of those measured. Conclusion The method of skin dose calculation in this study is simple, can be made as accurate as the user requires and is applicable for various immobilization systems. This concept has been verified through use on SBRT lung treatment plans and will aid clinicians in predicting skin response in patients.
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Affiliation(s)
- James Rijken
- Genesis Care, Flinders Private Hospital, Bedford Park, SA, Australia.,Queensland University of Technology, Brisbane, QLD, Australia
| | - Tanya Kairn
- Queensland University of Technology, Brisbane, QLD, Australia.,Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Scott Crowe
- Queensland University of Technology, Brisbane, QLD, Australia.,Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Luis Muñoz
- Genesis Care, Flinders Private Hospital, Bedford Park, SA, Australia
| | - Jamie Trapp
- Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
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Zhao B, Maquilan G, Jiang S, Schwartz DL. Minimal mask immobilization with optical surface guidance for head and neck radiotherapy. J Appl Clin Med Phys 2018; 19:17-24. [PMID: 29119677 PMCID: PMC5768028 DOI: 10.1002/acm2.12211] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 09/11/2017] [Accepted: 09/13/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Full face and neck thermoplastic masks provide standard-of-care immobilization for patients receiving H&N IMRT. However, these masks are uncomfortable and increase skin dose. The purpose of this pilot trial was to investigate the feasibility and setup accuracy of minimal face and neck mask immobilization with optical surface guidance. METHODS Twenty patients enrolled onto this IRB-approved protocol. Patients were immobilized with masks securing only forehead and chin. Shoulder movement was restricted by either moldable cushion or hand held strap retractors. Positional information, including isocenter location and CT skin contours, were imported to a commercial surface image guidance system. Patients typically received standard-of-care IMRT to 60-70 Gy in 30-33 fractions. Patients were first set up to surface markings with optical image guidance referenced to regions of interest (ROIs) on simulation CT images. Positioning was confirmed by in-room CBCT. Following six-dimensional robotic couch correction, a new optical real-time surface image was acquired to track intrafraction motion and to serve as a reference surface for setup at the next treatment fraction. Therapists manually recorded total treatment time as well as couch shifts based on kV imaging. Intrafractional ROI motion tracking was automatically recorded by the optical image guidance system. Patient comfort was assessed by self-administered surveys. RESULTS Setup error was measured as six-dimensional shifts (vertical/longitudinal/lateral/rotation/pitch/roll). Mean error values were -0.51 ± 2.42 mm, -0.49 ± 3.30 mm, 0.23 ± 2.58 mm, -0.15 ± 1.01o , -0.02 ± 1.19o , and 0.06 ± 1.08o , respectively. Average treatment time was 21.6 ± 8.4 mins). Subjective comfort during surface-guided treatment was confirmed on patient surveys. CONCLUSION These pilot results confirm feasibility of minimal mask immobilization combined with commercially available optical image guidance. Patient acceptance of minimal mask immobilization has been encouraging. Follow-up validation, with direct comparison to standard mask immobilization, appears warranted.
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Affiliation(s)
- Bo Zhao
- Department of Radiation OncologyThe University of Texas Southwestern Medical CenterDallasTXUSA
| | - Genevieve Maquilan
- Department of Radiation OncologyThe University of Texas Southwestern Medical CenterDallasTXUSA
| | - Steve Jiang
- Department of Radiation OncologyThe University of Texas Southwestern Medical CenterDallasTXUSA
| | - David L. Schwartz
- Department of Radiation OncologyThe University of Texas Southwestern Medical CenterDallasTXUSA
- Department of Radiation OncologyUniversity of Tennessee Health Science Center‐West Cancer CenterMemphisTNUSA
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11
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Semiconductor real-time quality assurance dosimetry in brachytherapy. Brachytherapy 2017; 17:133-145. [PMID: 28964727 DOI: 10.1016/j.brachy.2017.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 08/22/2017] [Accepted: 08/28/2017] [Indexed: 11/23/2022]
Abstract
With the increase in complexity of brachytherapy treatments, there has been a demand for the development of sophisticated devices for delivery verification. The Centre for Medical Radiation Physics (CMRP), University of Wollongong, has demonstrated the applicability of semiconductor devices to provide cost-effective real-time quality assurance for a wide range of brachytherapy treatment modalities. Semiconductor devices have shown great promise to the future of pretreatment and in vivo quality assurance in a wide range of brachytherapy treatments, from high-dose-rate (HDR) prostate procedures to eye plaque treatments. The aim of this article is to give an insight into several semiconductor-based dosimetry instruments developed by the CMRP. Applications of these instruments are provided for breast and rectal wall in vivo dosimetry in HDR brachytherapy, urethral in vivo dosimetry in prostate low-dose-rate (LDR) brachytherapy, quality assurance of HDR brachytherapy afterloaders, HDR pretreatment plan verification, and real-time verification of LDR and HDR source dwell positions.
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Aoulad N, Massabeau C, de Lafontan B, Vieillevigne L, Hangard G, Ciprian C, Chaltiel L, Moyal É, Izar F. Toxicité aiguë de la tomothérapie des cancers mammaires. Cancer Radiother 2017; 21:180-189. [DOI: 10.1016/j.canrad.2016.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/19/2016] [Accepted: 11/25/2016] [Indexed: 11/29/2022]
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13
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In vivo skin dose measurement in breast conformal radiotherapy. Contemp Oncol (Pozn) 2016; 20:137-40. [PMID: 27358592 PMCID: PMC4925725 DOI: 10.5114/wo.2015.54396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 08/11/2015] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Accurate skin dose assessment is necessary during breast radiotherapy to assure that the skin dose is below the tolerance level and is sufficient to prevent tumour recurrence. The aim of the current study is to measure the skin dose and to evaluate the geometrical/anatomical parameters that affect it. MATERIAL AND METHODS Forty patients were simulated by TIGRT treatment planning system and treated with two tangential fields of 6 MV photon beam. Wedge filters were used to homogenise dose distribution for 11 patients. Skin dose was measured by thermoluminescent dosimeters (TLD-100) and the effects of beam incident angle, thickness of irradiated region, and beam entry separation on the skin dose were analysed. RESULTS Average skin dose in treatment course of 50 Gy to the clinical target volume (CTV) was 36.65 Gy. The corresponding dose values for patients who were treated with and without wedge filter were 35.65 and 37.20 Gy, respectively. It was determined that the beam angle affected the average skin dose while the thickness of the irradiated region and the beam entry separation did not affect dose. Since the skin dose measured in this study was lower than the amount required to prevent tumour recurrence, application of bolus material in part of the treatment course is suggested for post-mastectomy advanced breast radiotherapy. It is more important when wedge filters are applied to homogenize dose distribution.
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Alhakeem EA, AlShaikh S, Rosenfeld AB, Zavgorodni SF. Comparative evaluation of modern dosimetry techniques near low- and high-density heterogeneities. J Appl Clin Med Phys 2015; 16:142–158. [PMID: 26699322 PMCID: PMC5690181 DOI: 10.1120/jacmp.v16i5.5589] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/19/2015] [Accepted: 05/18/2015] [Indexed: 12/13/2022] Open
Abstract
The purpose of this study is to compare performance of several dosimetric methods in heterogeneous phantoms irradiated by 6 and 18 MV beams. Monte Carlo (MC) calculations were used, along with two versions of Acuros XB, anisotropic analytical algorithm (AAA), EBT2 film, and MOSkin dosimeters. Percent depth doses (PDD) were calculated and measured in three heterogeneous phantoms. The first two phantoms were a 30×30×30 cm3 solid‐water slab that had an air‐gap of 20×2.5×2.35 cm3. The third phantom consisted of 30×30×5 cm3 solid water slabs, two 30×30×5 cm3 slabs of lung, and one 30×30×1 cm3 solid water slab. Acuros XB, AAA, and MC calculations were within 1% in the regions with particle equilibrium. At media interfaces and buildup regions, differences between Acuros XB and MC were in the range of +4.4% to −12.8%. MOSkin and EBT2 measurements agreed to MC calculations within ∼2.5%, except for the first centimeter of buildup where differences of 4.5% were observed. AAA did not predict the backscatter dose from the high‐density heterogeneity. For the third, multilayer lung phantom, 6 MV beam PDDs calculated by all TPS algorithms were within 2% of MC. 18 MV PDDs calculated by two versions of Acuros XB and AAA differed from MC by up to 2.8%, 3.2%, and 6.8%, respectively. MOSkin and EBT2 each differed from MC by up to 2.9% and 2.5% for the 6 MV, and by −3.1% and ∼2% for the 18 MV beams. All dosimetric techniques, except AAA, agreed within 3% in the regions with particle equilibrium. Differences between the dosimetric techniques were larger for the 18 MV than the 6 MV beam. MOSkin and EBT2 measurements were in a better agreement with MC than Acuros XB calculations at the interfaces, and they were in a better agreement to each other than to MC. The latter is due to their thinner detection layers compared to MC voxel sizes. PACS numbers: 87.55.K‐, 87.55.kd, 87.55.km, 87.53.Bn, 87.55.k
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Affiliation(s)
- Eyad A Alhakeem
- University of Victoria, British Columbia Cancer Agency-Vancouver Island Centre; Ministry of Education.
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Depauw N, Batin E, Daartz J, Rosenfeld A, Adams J, Kooy H, MacDonald S, Lu HM. A novel approach to postmastectomy radiation therapy using scanned proton beams. Int J Radiat Oncol Biol Phys 2015; 91:427-34. [PMID: 25636765 DOI: 10.1016/j.ijrobp.2014.10.039] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/13/2014] [Accepted: 10/17/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Postmastectomy radiation therapy (PMRT), currently offered at Massachusetts General Hospital, uses proton pencil beam scanning (PBS) with intensity modulation, achieving complete target coverage of the chest wall and all nodal regions and reduced dose to the cardiac structures. This work presents the current methodology for such treatment and the ongoing effort for its improvements. METHODS AND MATERIALS A single PBS field is optimized to ensure appropriate target coverage and heart/lung sparing, using an in-house-developed proton planning system with the capability of multicriteria optimization. The dose to the chest wall skin is controlled as a separate objective in the optimization. Surface imaging is used for setup because it is a suitable surrogate for superficial target volumes. In order to minimize the effect of beam range uncertainties, the relative proton stopping power ratio of the material in breast implants was determined through separate measurements. Phantom measurements were also made to validate the accuracy of skin dose calculation in the treatment planning system. Additionally, the treatment planning robustness was evaluated relative to setup perturbations and patient breathing motion. RESULTS PBS PMRT planning resulted in appropriate target coverage and organ sparing, comparable to treatments by passive scattering (PS) beams but much improved in nodal coverage and cardiac sparing compared to conventional treatments by photon/electron beams. The overall treatment time was much shorter than PS and also shorter than conventional photon/electron treatment. The accuracy of the skin dose calculation by the planning system was within ±2%. The treatment was shown to be adequately robust relative to both setup uncertainties and patient breathing motion, resulting in clinically satisfying dose distributions. CONCLUSIONS More than 25 PMRT patients have been successfully treated at Massachusetts General Hospital by using single-PBS fields. The methodology and robustness of both the setup and the treatment have been discussed.
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Affiliation(s)
- Nicolas Depauw
- Francis H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts; Centre for Medical Radiation Physics, University of Wollongong, New South Wales, Australia.
| | - Estelle Batin
- Francis H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Julianne Daartz
- Francis H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anatoly Rosenfeld
- Centre for Medical Radiation Physics, University of Wollongong, New South Wales, Australia
| | - Judith Adams
- Francis H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hanne Kooy
- Francis H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shannon MacDonald
- Francis H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Hsiao-Ming Lu
- Francis H. Burr Proton Therapy Center, Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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Assessment of skin dose modification caused by application of immobilizing cast in head and neck radiotherapy. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2014; 37:535-40. [DOI: 10.1007/s13246-014-0283-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
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Arenas M, Hernández V, Farrús B, Müller K, Gascón M, Pardo A, Berenguer R, Sabater S. Do breast cups improve breast cancer dosimetry? A comparative study for patients with large or pendulous breasts. Acta Oncol 2014; 53:795-801. [PMID: 24655017 DOI: 10.3109/0284186x.2014.893062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Treating patients with large or pendulous breasts is challenging. Although brassiere cups are currently in use, no study has yet been carried out to assess their dosimetric impact. The aim of the present study was to evaluate the possible dosimetric advantages of the use of breast cups on patients with large or pendulous breasts. MATERIALS AND METHODS Two CT studies were carried out on 12 breast cancer patients with large or pendulous breasts, with one study involving the use of breast cups. Radiation plans were developed in accordance with each of the CT studies. The following were compared: planning target volume (PTV), volume irradiated by the 95% isodose, conformity index, homogeneity index, mean lung dose, and mean heart dose was also compared for left breast treatment. The plan involving the use of cups was found to be the best option, leading to all patients being treated with cups. The resulting acute toxicity and cosmesis were also recorded. Both scenarios involved the use of film dosimetry to evaluate the skin doses. RESULTS The use of breast cups resulted in a significant reduction of the PTV volume (from 1640 cm3 to 1283 cm3), of the irradiated volume (from 2154 cm3 to 1477 cm3) and of the conformity index (from 1383 to 1213). Despite slight improvements in the homogeneity index (from 0.12 to 0.10), statistical significance was not attained. The use of breast cups also led to significant dose reductions in V20 for lung (from 13.7% to 1.7%) and V5 for heart (from 9.8% to 2.7%). No differences in acute toxicity or cosmesis were observed compared to patients treated without cups. CONCLUSIONS Our results show that the use of brassiere cups during breast radiation therapy leads to improvements in the main dosimetric factors analyzed. Furthermore, modifications to standard irradiation protocols are not required. In summary, we consider the technique of using breast cups with radiation therapy highly appropriate when treating breast cancer patients with large or pendulous breasts.
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Affiliation(s)
- Meritxell Arenas
- Hospital Universitari Sant Joan, Radiation Oncology, Institut d'Investigacions Sanit ries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV) , Reus , Spain
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Olch AJ, Gerig L, Li H, Mihaylov I, Morgan A. Dosimetric effects caused by couch tops and immobilization devices: Report of AAPM Task Group 176. Med Phys 2014; 41:061501. [DOI: 10.1118/1.4876299] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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A comparison of surface doses for very small field size x-ray beams: Monte Carlo calculations and radiochromic film measurements. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2014; 37:303-9. [DOI: 10.1007/s13246-014-0260-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 03/04/2014] [Indexed: 12/15/2022]
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Pejovic S, Bosnjakovic P, Ciraj-Bjelac O, Pejovic MM. Characteristics of a pMOSFET suitable for use in radiotherapy. Appl Radiat Isot 2013; 77:44-9. [DOI: 10.1016/j.apradiso.2013.02.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 01/30/2013] [Accepted: 02/19/2013] [Indexed: 10/27/2022]
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Sharma R, Jursinic PA. In vivomeasurements for high dose rate brachytherapy with optically stimulated luminescent dosimeters. Med Phys 2013; 40:071730. [DOI: 10.1118/1.4811143] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Metcalfe P, Quinn A, Loo K, Lerch M, Petasecca M, Wong J, Hardcastle N, Carolan M, McNamara J, Cutajar D, Fuduli I, Espinoza A, Porumb C, Rosenfeld A. Review of four novel dosimeters developed for use in radiotherapy. ACTA ACUST UNITED AC 2013. [DOI: 10.1088/1742-6596/444/1/012008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Al-Rahbi ZS, Ravichandran R, Binukumar JP, Davis CA, Satyapal N, Al-Mandhari Z. A Dosimetric Comparison of Radiotherapy Techniques in the Treatment of Carcinoma of Breast. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jct.2013.411a002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Akino Y, Das IJ, Bartlett GK, Zhang H, Thompson E, Zook JE. Evaluation of superficial dosimetry between treatment planning system and measurement for several breast cancer treatment techniques. Med Phys 2012; 40:011714. [PMID: 23298084 DOI: 10.1118/1.4770285] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Yuichi Akino
- Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN, USA.
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Alnawaf H, Butson M, Yu PKN. Measurement and effects of MOSKIN detectors on skin dose during high energy radiotherapy treatment. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2012; 35:321-8. [PMID: 22972481 DOI: 10.1007/s13246-012-0153-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Accepted: 06/28/2012] [Indexed: 12/01/2022]
Abstract
During in vivo dosimetry for megavoltage X-ray beams, detectors such as diodes, Thermo luminescent dosimeters (TLD's) and MOSFET devices are placed on the patient's skin. This of course will affect the skin dose delivered during that fraction of the treatment. Whilst the overall impact on increasing skin dose would be minimal, little has been quantified concerning the level of increase in absorbed dose, in vivo dosimeters produce when placed in the beams path. To this extent, measurements have been made and analysis performed on dose changes caused by MOSKIN, MOSFET, skin dose detectors. Maximum increases in skin dose were measured as 15 % for 6 MV X-rays and 10 % for 10 MV X-rays at the active crystal of the MOSKIN device which is the thickest part of the detector. This is compared to 32 and 26 % for a standard 1 mm thick LiF TLD at 10 × 10 cm(2) field size for 6 and 10 MV X-rays respectively. Radiochromic film, EBT2 has been shown to provide a high resolution 2 dimensional map of skin dose from these detectors and measures the effects of in vivo dosimeters used for radiotherapy dose assessment.
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Affiliation(s)
- Hani Alnawaf
- Centre for Medical Radiation Physics, Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Gwynneville, NSW, Australia
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Kim JH, Hill R, Kuncic Z. An evaluation of calculation parameters in the EGSnrc/BEAMnrc Monte Carlo codes and their effect on surface dose calculation. Phys Med Biol 2012; 57:N267-78. [DOI: 10.1088/0031-9155/57/14/n267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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De Puysseleyr A, Srivastava RP, Paelinck L, De Neve W, De Wagter C. Evaluation of a glassless photographic film scanner for high-gradient radiochromic film dosimetry. Phys Med Biol 2011; 57:127-42. [DOI: 10.1088/0031-9155/57/1/127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Quinn A, Holloway L, Cutajar D, Hardcastle N, Rosenfeld A, Metcalfe P. Megavoltage cone beam CT near surface dose measurements: potential implications for breast radiotherapy. Med Phys 2011; 38:6222-7. [DOI: 10.1118/1.3641867] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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