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Pandu B, Khanna D, Mohandass P, Elavarasan R, Ninan H, Vivek TR, Jacob S. A Phantom Study on Feasibility of Manual Field-in-Field Clinical Implementation for Total Body Irradiation and Comparison of Midplane Dose with Different Bilateral TBI Techniques. J Med Phys 2023; 48:59-67. [PMID: 37342604 PMCID: PMC10277292 DOI: 10.4103/jmp.jmp_103_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 06/23/2023] Open
Abstract
Objective The aim of this study is to implement a new treatment technique in total body irradiation (TBI) using the manual field-in-field-TBI (MFIF-TBI) technique and dosimetrically verifying its results with respect to compensator-based TBI (CB-TBI) and open field TBI technique. Materials and Methods A rice flour phantom (RFP) was placed on TBI couch with knee bent position at 385 cm source to surface distance. Midplane depth (MPD) was calculated for skull, umbilicus, and calf regions by measuring separations. Three subfields were opened manually for different regions using the multi-leaf collimator and jaws. The treatment Monitor unit (MU) was calculated based on each subfield size. In the CB-TBI technique, Perspex was used as a compensator. Treatment MU was calculated using MPD of umbilicus region and the required compensator thickness was calculated. For open field TBI, treatment MU was calculated using MPD of umbilicus region, and the treatment was executed without placing compensator. The diodes were placed on the surface of RFP to measure the delivered dose and the results were compared. Results The MFIF-TBI results showed that the deviation was within ± 3.0% for the different regions, except for the neck for which the deviation was 8.72%. In the CB-TBI delivery, the dose deviation was ± 3.0% for different regions in the RFP. The open field TBI results showed that the dose deviation was not within the limit ± 10.0%. Conclusion The MFIF-TBI technique can be implemented for TBI treatment as no TPS is required, and laborious process of making a compensator can be avoided while ensuring that the dose uniformity in all the regions within the tolerance limit.
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Affiliation(s)
- Bharath Pandu
- Department of Applied Physics, Karunya Institute of Technology and Sciences, Coimbatore, Tamil Nadu, India
- Department of Radiotherapy, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - D. Khanna
- Department of Applied Physics, Karunya Institute of Technology and Sciences, Coimbatore, Tamil Nadu, India
| | - P. Mohandass
- Department of Radiation Oncology, Fortis Hospital, Sahibzada Ajit Singh Nagar, Punjab, India
| | - Rajadurai Elavarasan
- Department of Radiotherapy, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - Hima Ninan
- Department of Radiotherapy, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
| | - T. R. Vivek
- Department of Radiation Oncology, Tawam Hospital, Abu Dhabi, UAE
| | - Saro Jacob
- Department of Radiotherapy, Bangalore Baptist Hospital, Bengaluru, Karnataka, India
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Hoseinnezhad Zarghani E, Geraily G, Haddad P, Esfahani M, Farzin M, Rastjoo A, Amini MK. Dosimetric comparison of AP/PA and bilateral geometries for total body irradiation treatment. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2021; 60:663-672. [PMID: 34487229 DOI: 10.1007/s00411-021-00933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 08/07/2021] [Indexed: 06/13/2023]
Abstract
Total body irradiation (TBI) is an external radiotherapy technique. Its aim is to deliver a therapeutic dose uniformly within ± 10% of the absorbed dose to the prescription point. In the present study, the TBI technique was implemented in anterior/posterior (AP/PA), and bilateral geometry with photons from a 6 [Formula: see text] and 18 [Formula: see text] accelerator. The TBI technique was implemented on an Alderson Rando phantom at 312 [Formula: see text] source surface distance. During bilateral fraction, rice bags were applied as tissue compensators. To reduce the lung's absorbed dose to the acceptance level, in AP/PA geometry lung blocks made of Cerrobend were used. The required monitor unit (MU) for each fraction was calculated regarding depending on the prescribed dose and beam output. Gafchromic EBT3 films were used for dosimetry between the phantom layers in eight selected points. It is demonstrated that dose uniformity for AP/PA geometry with 6 [Formula: see text] and 18 [Formula: see text] photons was within ± 10%. In contrast, for the bilateral geometry the dose uniformity was not acceptable for both studied energies; However, the results for 18 [Formula: see text] were better than those for 6 [Formula: see text]. Dose accuracy for all measurements was within ± 5 of the prescribed dose. The absorbed dose to the lungs was successfully reduced using the lung blocks. By combining different therapeutic geometries and energies over six fractions, the results of uniformity and accuracy of dose delivery could be improved. It is concluded that the introduced TBI method achieved good dose accuracy and acceptable dose uniformity. Lungs absorbed dose was lower than 10 [Formula: see text] using the lungs blocks. Based on these results, the TBI technique can now be implemented in radiotherapy at Tehran's Imam Hospital. The approach developed in the present study can be used and adapted to match with the conditions at other hospitals.
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Affiliation(s)
- Elham Hoseinnezhad Zarghani
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazale Geraily
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Peiman Haddad
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahbod Esfahani
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Farzin
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Science, Tehran, Iran
| | - Ali Rastjoo
- Radiation Oncology Research Center, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kazem Amini
- Department of Medical Radiation Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran
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Hong CS, Kim MJ, Kim J, Chang KH, Park K, Kim DW, Han MC, Yoon HI, Kim JS, Lee H. Feasibility of hybrid TomoHelical- and TomoDirect-based volumetric gradient matching technique for total body irradiation. Radiat Oncol 2019; 14:233. [PMID: 31856870 PMCID: PMC6924057 DOI: 10.1186/s13014-019-1435-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tomotherapy-based total body irradiation (TBI) is performed using the head-first position (HFP) and feet-first position (FFP) due to treatment length exceeding the 135 cm limit. To reduce the dosimetric variation at the match lines, we propose and verify a volumetric gradient matching technique (VGMT) by combining TomoHelical (TH) and TomoDirect (TD) modes. METHODS Two planning CT image sets were acquired with HFP and FFP using 15 × 55 × 18 cm3 of solid water phantom. Planning target volume (PTV) was divided into upper, lower, and gradient volumes. The junction comprised 2-cm thick five and seven gradient volumes (5-GVs and 7-GVs) to create a dose distribution with a gentle slope. TH-IMRT and TD-IMRT plans were generated with 5-GVs and 7-GVs. The setup error in the calculated dose was assessed by shifting dose distribution of the FFP plan by 5, 10, 15, and 20 mm in the longitudinal direction and comparing it with the original. Doses for 95% (D95) and 5% of the PTV (D5) were calculated for all simulated setup error plans. Absolute dose measurements were performed using an ionization chamber in the junction. RESULTS The TH&TD plan produced a linear gradient in junction volume, comparable to that of the TH&TH plan. D5 of the PTV was 110% of the prescribed dose when the FFP plan was shifted 0.7 cm and 1.2 cm in the superior direction for 5-GVs and 7-GVs. D95 of the PTV decreased to < 90% of the prescribed dose when the FF plan was shifted 1.1 cm and 1.3 cm in the inferior direction for 5-GVs and 7-GVs. The absolute measured dose showed a good correlation with the calculated dose in the gradient junction volume. The average percent difference (±SD) in all measured points was - 0.7 ± 1.6%, and the average dose variations between depths was - 0.18 ± 1.07%. CONCLUSION VGMT can create a linear dose gradient across the junction area in both TH&TH and TH&TD and can minimize the dose sensitivity to longitudinal setup errors in tomotherapy-based TBI.
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Affiliation(s)
- Chae-Seon Hong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Min-Joo Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Jihun Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Kyung Hwan Chang
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Kwangwoo Park
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Dong Wook Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Min Cheol Han
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, South Korea.
| | - Ho Lee
- Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, South Korea.
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Lamichhane N, Patel VN, Studenski MT. Going the distance: validation of Acuros and AAA at an extended SSD of 400 cm. J Appl Clin Med Phys 2016; 17:63-73. [PMID: 27074473 PMCID: PMC5875551 DOI: 10.1120/jacmp.v17i2.5913] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 12/08/2015] [Accepted: 12/02/2015] [Indexed: 11/30/2022] Open
Abstract
Accurate dose calculation and treatment delivery is essential for total body irradiation (TBI). In an effort to verify the accuracy of TBI dose calculation at our institution, we evaluated both the Varian Eclipse AAA and Acuros algorithms to predict dose distributions at an extended source‐to‐surface distance (SSD) of 400 cm. Measurements were compared to calculated values for a 6 MV beam in physical and virtual phantoms at 400 cm SSD using open beams for both 5×5 and 40×40 cm2 field sizes. Inline and crossline profiles were acquired at equivalent depths of 5 cm, 10 cm, and 20 cm. Depth‐dose curves were acquired using EBT2 film and an ion chamber for both field sizes. Finally, a RANDO phantom was used to simulate an actual TBI treatment. At this extended SSD, care must be taken using the planning system as there is good relative agreement between measured and calculated profiles for both algorithms, but there are deviations in terms of the absolute dose. Acuros has better agreement than AAA in the penumbra region. PACS number(s): 87.55.kd
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Chakraborty S, Cheruliyil S, Bharathan R, Muttath G. Total Body Irradiation using VMAT (RapidArc): A Planning Study of a novel treatment delivery method. INTERNATIONAL JOURNAL OF CANCER THERAPY AND ONCOLOGY 2015. [DOI: 10.14319/ijcto.0302.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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