Use of new radiochromic devices for peripheral dose measurement: potential in-vivo dosimetry application

Out-of-field organ doses and associated risk of cancer development following radiation therapy with photons

Innovations in cancer treatment have contributed to the improved survival rate of these patients. Radiotherapy is one of the main options for cancer management nowadays. High doses of ionizing radiation are usually delivered to the tumor site with high energy photon beams. However, the therapeutic radiation exposure may lead to second cancer induction. Moreover, the introduction of intensity-modulated radiation therapy over the last decades has increased the radiation dose to out-of-field organs compared to that from conventional irradiation. The increased organ doses might result in elevated probabilities for developing secondary malignancies to critical organs outside the treatment volume. The organ-specific dosimetry is considered necessary for the theoretical second cancer risk assessment and the proper analysis of data derived from epidemiological reports. This study reviews the methods employed for the measurement and calculation of out-of-field organ doses from exposure to photons and/or neutrons. The strengths and weaknesses of these dosimetric approaches are described in detail. This is followed by a review of the epidemiological data associated with out-of-field cancer risks. Previously published theoretical cancer risk estimates for adult and pediatric patients undergoing radiotherapy with conventional and advanced techniques are presented. The methodology for the theoretical prediction of the probability of carcinogenesis to out-of-field sites and the limitations of this approach are discussed. The article also focuses on the factors affecting the magnitude of the probability for developing radiotherapy-induced malignancies. The restriction of out-of-field doses and risks through the use of different types of shielding equipment is presented.

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

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.

Dose distribution at the Bragg peak: Dose measurements using EBT and RTQA gafchromic film set at two positions to the central beam axis

AIM

To evaluate the impact of radiochromic film positioning relative to the central beam axis (CAX) in proton beam therapy. Secondarily, to compare the dosimetric measurements obtained by RTQA and EBT film and to compare these to the doses calculated by the treatment planning system (TPS).

METHODS

The EBT and RTQA dosimetric radiochromic films were immersed in a water phantom and irradiated with a proton beam. The films were placed parallel to the CAX and at a 5° angle on the horizontal plane to assess the effect of film inclination on Bragg peak profiles. Calibration was performed by irradiating small pieces of film at doses ranging from 0.0 Gy to 3.5 Gy in increments of 0.5 Gy. The TPS was used to create treatment plans for two different geometrical targets (cylindrical and cuboidal). After irradiation, all film pieces were scanned on a flatbed scanner and red channel data were extracted from the 48-bit RGB images using ImageJ, Photoshop, Origin8, and Excel software. The dose distributions from the irradiated films were compared to the dose obtained from the TPS. Bragg peak profiles were abstracted from the irradiated films and compared.

RESULTS

The dosimetric measurements obtained by both EBT and RTQA positioned at a 5° to the CAX closely matched the dose calculated by the TPS for the cylindrical target. In contrast, dose distributions measured in the cuboidal targets were less precise. Gamma index (GI) values (3%/3 mm acceptance criteria for isodose >90% of dose) were 99.8% and 93% for EBT film placed at a 5° angle versus 47.1% and 80.8% for EBT film parallel to the beam. The dosimetric measurements in RTQA film positioned parallel to the CAX showed GI values with <27% agreement with the TPS-calculated dose.

CONCLUSION

Our finding show that RTQA film can be used to accurately measure doses in the proton beam at the region of Bragg peak; however, to obtain the most accurate readings, the film should be positioned at a small angle to the CAX.

Estimating and reducing dose received by cardiac devices for patients undergoing radiotherapy

The objectives of this project are to quantify the dose reduction effect provided by a lead shield for patients with cardiac implantable electronic devices (CIED) during a clinically realistic radiation treatment on phantom and to provide a simple model of dose estimation to predict dose received by CIED in a wide range of situations. The shield used in this project is composed of a lead sheet wrapped in thermoplastic. Dose measurements were made with a plastic scintillation detector (PSD). The phantom was treated with ten different plans. Three of these cases were treated with intensity-modulated radiation therapy (IMRT) and the others received standard 3D conformal radiation therapy (3D CRT). Lateral dose measurement for photon fields was made to establish a dose prediction model. On average, the use of the lead shield reduced the dose to CIEDs by 19% ± 13%. Dose reduction was most important for breast cases, with a mean reduction of 31% ± 15%. In three cases, the total dose reduction was more than 25 cGy over the complete treatment. For the three IMRT cases, the mean dose reduction was 11% ± 9%. On average, the difference between the TPS prediction and the measurement was 71%, while it was only 14% for the dose prediction model. It was demonstrated that a lead shield can be efficiently used for reducing doses to CIED with a wide range of clinical plans. In patients treated with IMRT modality treatment, the shielding should be used only for those with more than two anterior fields over seven fields. In the case of 3D CRT patients, the shielding should be used for those with a dose on the CIED higher than 50 cGy and with a reduction of dose higher than 10 cGy. The dose prediction model developed in this study can be an easy way to have a better estimation of the out-of-field dose than the TPS.