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Left breast radiotherapy - the impact of heart and lad doses to cardiovascular diseases developed eight years after treatment. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210328031p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction/Objective. Left breast cancer patients undergoing radiotherapy
are at higher risk of cardiovascular diseases (CVD), as a partial volume of
the heart is anatomically close to target volume. This may cause
cardiovascular diseases in the years following cancer treatment. The aim of
this work was to develop a scoring system which identifies patients with
increased risk of development of cardiovascular diseases, as consequence of
left breast irradiation. Methods. The patients followed up in this study were
treated during 2009. Eight years later, they were invited to participate in a
study where they underwent a cardiology evaluation. Their current condition
was statistically correlated to the doses received by their heart and left
anterior descendant (LAD) artery. Results. Out of 114 patients, thirty-one
women were evaluable for cardiology assessment. Out of these 31 subjects, six
women were with a history of CVD before cancer treatment. Four women never
developed any kind of heart associated disease, while in the other 27, newly
onset CVD were diagnosed ranging from hypertension to myocardial infarction,
strongly positively correlated to doses to heart and LAD (p = 0.003).
Severity of developed cardiovascular toxicity was formulated through the
correlation of mean heart and mean LAD doses with cardiovascular diseases
developed in form of the scoring system. Conclusion. The doses to critical
organs depend on patient anatomy and technique of irradiation. The
cardiovascular complications are proven as consequence of radiotherapy.
Scoring system based on doses received by heart and LAD is reliable tool in
predicting CVD.
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Lehmann J, Alves A, Dunn L, Shaw M, Kenny J, Keehan S, Supple J, Gibbons F, Manktelow S, Oliver C, Kron T, Williams I, Lye J. Dosimetric end-to-end tests in a national audit of 3D conformal radiotherapy. Phys Imaging Radiat Oncol 2018; 6:5-11. [PMID: 33458381 PMCID: PMC7807562 DOI: 10.1016/j.phro.2018.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Independent dosimetry audits improve quality and safety of radiation therapy. This work reports on design and findings of a comprehensive 3D conformal radiotherapy (3D-CRT) Level III audit. MATERIALS AND METHODS The audit was conducted as onsite audit using an anthropomorphic thorax phantom in an end-to-end test by the Australian Clinical Dosimetry Service (ACDS). Absolute dose point measurements were performed with Farmer-type ionization chambers. The audited treatment plans included open and half blocked fields, wedges and lung inhomogeneities. Audit results were determined as Pass Optimal Level (deviations within 3.3%), Pass Action Level (greater than 3.3% but within 5%) and Out of Tolerance (beyond 5%), as well as Reported Not Scored (RNS). The audit has been performed between July 2012 and January 2018 on 94 occasions, covering approximately 90% of all Australian facilities. RESULTS The audit pass rate was 87% (53% optimal). Fifty recommendations were given, mainly related to planning system commissioning. Dose overestimation behind low density inhomogeneities by the analytical anisotropic algorithm (AAA) was identified across facilities and found to extend to beam setups which resemble a typical breast cancer treatment beam placement. RNS measurements inside lung showed a variation in the opposite direction: AAA under-dosed a target beyond lung and over-dosed the lung upstream and downstream of the target. Results also highlighted shortcomings of some superposition and convolution algorithms in modelling large angle wedges. CONCLUSIONS This audit showed that 3D-CRT dosimetry audits remain relevant and can identify fundamental global and local problems that also affect advanced treatments.
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Affiliation(s)
- Joerg Lehmann
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
- Institute of Medical Physics, School of Physics A28, University of Sydney NSW 2006, Australia
- School of Mathematical and Physical Sciences, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
- School of Science, Royal Melbourne Institute of Technology (RMIT) University, 124 La Trobe Street, Melbourne, VIC 3000, Australia
| | - Andrew Alves
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Leon Dunn
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Maddison Shaw
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
- School of Science, Royal Melbourne Institute of Technology (RMIT) University, 124 La Trobe Street, Melbourne, VIC 3000, Australia
| | - John Kenny
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Stephanie Keehan
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
- School of Science, Royal Melbourne Institute of Technology (RMIT) University, 124 La Trobe Street, Melbourne, VIC 3000, Australia
| | - Jeremy Supple
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Francis Gibbons
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Sophie Manktelow
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Chris Oliver
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Tomas Kron
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
- School of Science, Royal Melbourne Institute of Technology (RMIT) University, 124 La Trobe Street, Melbourne, VIC 3000, Australia
- Department of Radiation Oncology, Peter MacCallum Cancer Center, 305 Grattan Street, Melbourne, VIC 3000, Australia
| | - Ivan Williams
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - Jessica Lye
- Australian Clinical Dosimetry Service (ACDS), Australian Radiation Protection and National Safety Agency (ARPANSA), 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
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Verification of quality parameters for portal images in radiotherapy. Radiol Oncol 2010; 45:68-74. [PMID: 22933938 PMCID: PMC3423718 DOI: 10.2478/v10019-010-0052-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 11/10/2010] [Indexed: 11/20/2022] Open
Abstract
Background The purpose of the study was to verify different values of quality parameters of portal images in radiotherapy. Materials and methods We investigated image qualities of different field verification systems. Four EPIDs (Siemens OptiVue500aSi®, Siemens BeamView Plus®, Elekta iView® and Varian PortalVision™) were investigated with the PTW EPID QC PHANTOM® and compared with two portal film systems (Kodak X-OMAT® cassette with Kodak X-OMAT V® film and Kodak EC-L Lightweight® cassette with Kodak Portal Localisation ReadyPack® film). Results A comparison of the f50 and f25 values of the modulation transfer functions (MTFs) belonging to each of the systems revealed that the amorphous silicon EPIDs provided a slightly better high contrast resolution than the Kodak Portal Localisation ReadyPack® film with the EC-L Lightweight® cassette. The Kodak X-OMAT V® film gave a poor low contrast resolution: from the existing 27 holes only 9 were detectable. Conclusions On the base of physical characteristics, measured in this work, the authors suggest the use of amorphous-silicon EPIDs producing the best image quality. Parameters of the EPIDs with scanning liquid ionisation chamber (SLIC) were very stable. The disadvantage of older versions of EPIDs like SLIC and VEPID is a poor DICOM implementation, and the modulation transfer function (MTF) values (f50 and f25) are less than that of aSi detectors.
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