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Title: Lowering Whole-Body Radiation Doses in Pediatric Intensity-Modulated Radiotherapy Through the Use of Unflattened Photon Beams;Flattening filter; Pediatric; Intensity-modulated radiotherapy; Second cancers; Radiation-induced malignancies

Abstract

Purpose: Intensity modulated radiotherapy (IMRT) has been linked with an increased risk of secondary cancer induction due to the extra leakage radiation associated with delivery of these techniques. Removal of the flattening filter offers a simple way of reducing head leakage, and it may be possible to generate equivalent IMRT plans and to deliver these on a standard linear accelerator operating in unflattened mode. Methods and Materials: An Elekta Precise linear accelerator has been commissioned to operate in both conventional and unflattened modes (energy matched at 6 MV) and a direct comparison made between the treatment planning and delivery of pediatric intracranial treatments using both approaches. These plans have been evaluated and delivered to an anthropomorphic phantom. Results: Plans generated in unflattened mode are clinically identical to those for conventional IMRT but can be delivered with greatly reduced leakage radiation. Measurements in an anthropomorphic phantom at clinically relevant positions including the thyroid, lung, ovaries, and testes show an average reduction in peripheral doses of 23.7%, 29.9%, 64.9%, and 70.0%, respectively, for identical plan delivery compared to conventional IMRT. Conclusions: IMRT delivery in unflattened mode removes an unwanted and unnecessary source of scatter from the treatment head and lowers leakage dosesmore » by up to 70%, thereby reducing the risk of radiation-induced second cancers. Removal of the flattening filter is recommended for IMRT treatments.« less

Authors:
 [1];  [1];  [2]
  1. Radiotherapy Physics, Hall-Edwards Radiotherapy Research Group, University Hospital Birmingham, Edgbaston, Birmingham (United Kingdom)
  2. Cancer Centre, Hall-Edwards Radiotherapy Research Group, University Hospital Birmingham, Edgbaston, Birmingham (United Kingdom)
Publication Date:
OSTI Identifier:
21587620
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 80; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2010.10.002; PII: S0360-3016(10)03375-4; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; HAZARDS; HEAD; LUNGS; NEOPLASMS; OVARIES; PEDIATRICS; PHANTOMS; PHOTON BEAMS; RADIATION DOSES; RADIOTHERAPY; TESTES; THYROID; BEAMS; BODY; DISEASES; DOSES; ENDOCRINE GLANDS; FEMALE GENITALS; GLANDS; GONADS; MALE GENITALS; MEDICINE; MOCKUP; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; RESPIRATORY SYSTEM; STRUCTURAL MODELS; THERAPY

Citation Formats

Cashmore, Jason, E-mail: Jason.cashmore@uhb.nhs.uk, Ramtohul, Mark, and Ford, Dan. Lowering Whole-Body Radiation Doses in Pediatric Intensity-Modulated Radiotherapy Through the Use of Unflattened Photon Beams;Flattening filter; Pediatric; Intensity-modulated radiotherapy; Second cancers; Radiation-induced malignancies. United States: N. p., 2011. Web. doi:10.1016/j.ijrobp.2010.10.002.
Cashmore, Jason, E-mail: Jason.cashmore@uhb.nhs.uk, Ramtohul, Mark, & Ford, Dan. Lowering Whole-Body Radiation Doses in Pediatric Intensity-Modulated Radiotherapy Through the Use of Unflattened Photon Beams;Flattening filter; Pediatric; Intensity-modulated radiotherapy; Second cancers; Radiation-induced malignancies. United States. doi:10.1016/j.ijrobp.2010.10.002.
Cashmore, Jason, E-mail: Jason.cashmore@uhb.nhs.uk, Ramtohul, Mark, and Ford, Dan. Fri . "Lowering Whole-Body Radiation Doses in Pediatric Intensity-Modulated Radiotherapy Through the Use of Unflattened Photon Beams;Flattening filter; Pediatric; Intensity-modulated radiotherapy; Second cancers; Radiation-induced malignancies". United States. doi:10.1016/j.ijrobp.2010.10.002.
@article{osti_21587620,
title = {Lowering Whole-Body Radiation Doses in Pediatric Intensity-Modulated Radiotherapy Through the Use of Unflattened Photon Beams;Flattening filter; Pediatric; Intensity-modulated radiotherapy; Second cancers; Radiation-induced malignancies},
author = {Cashmore, Jason, E-mail: Jason.cashmore@uhb.nhs.uk and Ramtohul, Mark and Ford, Dan},
abstractNote = {Purpose: Intensity modulated radiotherapy (IMRT) has been linked with an increased risk of secondary cancer induction due to the extra leakage radiation associated with delivery of these techniques. Removal of the flattening filter offers a simple way of reducing head leakage, and it may be possible to generate equivalent IMRT plans and to deliver these on a standard linear accelerator operating in unflattened mode. Methods and Materials: An Elekta Precise linear accelerator has been commissioned to operate in both conventional and unflattened modes (energy matched at 6 MV) and a direct comparison made between the treatment planning and delivery of pediatric intracranial treatments using both approaches. These plans have been evaluated and delivered to an anthropomorphic phantom. Results: Plans generated in unflattened mode are clinically identical to those for conventional IMRT but can be delivered with greatly reduced leakage radiation. Measurements in an anthropomorphic phantom at clinically relevant positions including the thyroid, lung, ovaries, and testes show an average reduction in peripheral doses of 23.7%, 29.9%, 64.9%, and 70.0%, respectively, for identical plan delivery compared to conventional IMRT. Conclusions: IMRT delivery in unflattened mode removes an unwanted and unnecessary source of scatter from the treatment head and lowers leakage doses by up to 70%, thereby reducing the risk of radiation-induced second cancers. Removal of the flattening filter is recommended for IMRT treatments.},
doi = {10.1016/j.ijrobp.2010.10.002},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 80,
place = {United States},
year = {2011},
month = {7}
}