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Title: SU-F-T-410: Investigation of Treatment Planning Accuracy with the Presence of Magnetic Injection Port (breast Tissue Expander)

Abstract

Purpose: Mastectomy patients with breast reconstruction usually have a magnetic injection port inside the breast during radiation treatments. The magnet has a very high CT number and produces severe streaking artifact across the entire breast in CT images. Our routine strategy is to replace the artifact volumes with uniform water, and it is necessary to validate that the planned dose, with such an artifact correction, is sufficiently accurate. Methods: A phantom was made with a gelatine-filled container sitting on a Matrixx detector, and the magnetic port was inserted into gelatine with specific depths and orientations. The phantom was scanned on a CT simulator and imported into Eclipse for treatment planning. The dose distribution at the Matrixx detector plane was calculated for raw CT images and artifact-corrected images. The treatment beams were then delivered to the phantom and the dose distributions were acquired by the Matrixx detector. Gamma index was calculated to compare the planned dose and the measurement. Results: Three field sizes (10×10, 15×15 and 20×20) and two depths (50mm and 20mm) were investigated. With the 2%/2mm or 3%/3mm criteria, several points (6–10) failed in the plan for raw CT images, and the number of failure was reduced close tomore » zero for the corrected CT images. An assignment of 10,000 HU to the magnet further reduced the dose error directly under the magnet. Conclusion: It is validated that our routine strategy of artifact correction can effectively reduce the number of failures in the detector plane. It is also recommended to set the magnet with a CT number of 10,000HU, which could potentially improve the dose calculation at the points right behind the magnet.« less

Authors:
; ; ;  [1]
  1. Brigham and Women’s Hospital, Boston, MA and Harvard Medical School, Boston, MA (United States)
Publication Date:
OSTI Identifier:
22649006
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; COMPUTERIZED TOMOGRAPHY; CORRECTIONS; IMAGES; MAMMARY GLANDS; PHANTOMS; PLANNING; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY

Citation Formats

Cai, W, Wagar, M, Lyatskaya, Y, and Czerminska, M. SU-F-T-410: Investigation of Treatment Planning Accuracy with the Presence of Magnetic Injection Port (breast Tissue Expander). United States: N. p., 2016. Web. doi:10.1118/1.4956595.
Cai, W, Wagar, M, Lyatskaya, Y, & Czerminska, M. SU-F-T-410: Investigation of Treatment Planning Accuracy with the Presence of Magnetic Injection Port (breast Tissue Expander). United States. doi:10.1118/1.4956595.
Cai, W, Wagar, M, Lyatskaya, Y, and Czerminska, M. 2016. "SU-F-T-410: Investigation of Treatment Planning Accuracy with the Presence of Magnetic Injection Port (breast Tissue Expander)". United States. doi:10.1118/1.4956595.
@article{osti_22649006,
title = {SU-F-T-410: Investigation of Treatment Planning Accuracy with the Presence of Magnetic Injection Port (breast Tissue Expander)},
author = {Cai, W and Wagar, M and Lyatskaya, Y and Czerminska, M},
abstractNote = {Purpose: Mastectomy patients with breast reconstruction usually have a magnetic injection port inside the breast during radiation treatments. The magnet has a very high CT number and produces severe streaking artifact across the entire breast in CT images. Our routine strategy is to replace the artifact volumes with uniform water, and it is necessary to validate that the planned dose, with such an artifact correction, is sufficiently accurate. Methods: A phantom was made with a gelatine-filled container sitting on a Matrixx detector, and the magnetic port was inserted into gelatine with specific depths and orientations. The phantom was scanned on a CT simulator and imported into Eclipse for treatment planning. The dose distribution at the Matrixx detector plane was calculated for raw CT images and artifact-corrected images. The treatment beams were then delivered to the phantom and the dose distributions were acquired by the Matrixx detector. Gamma index was calculated to compare the planned dose and the measurement. Results: Three field sizes (10×10, 15×15 and 20×20) and two depths (50mm and 20mm) were investigated. With the 2%/2mm or 3%/3mm criteria, several points (6–10) failed in the plan for raw CT images, and the number of failure was reduced close to zero for the corrected CT images. An assignment of 10,000 HU to the magnet further reduced the dose error directly under the magnet. Conclusion: It is validated that our routine strategy of artifact correction can effectively reduce the number of failures in the detector plane. It is also recommended to set the magnet with a CT number of 10,000HU, which could potentially improve the dose calculation at the points right behind the magnet.},
doi = {10.1118/1.4956595},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: To model the magnetic port in the temporary breast tissue expanders and to improve accuracy of dose calculation in Pinnacle, a commercial treatment planning system (TPS). Methods: A magnetic port in the tissue expander was modeled with a radiological measurement-basis; we have determined the dimension and the density of the model by film images and ion chamber measurement under the magnetic port, respectively. The model was then evaluated for various field sizes and photon energies by comparing depth dose values calculated by TPS (using our new model) and ion chamber measurement in a water tank. Also, the model wasmore » further evaluated by using a simplified anthropomorphic phantom with realistic geometry by placing thermoluminescent dosimeters (TLD)s around the magnetic port. Dose perturbations in a real patient’s treatment plan from the new model and a current clinical model, which is based on the subjective contouring created by the dosimetrist, were also compared. Results: Dose calculations based on our model showed less than 1% difference from ion chamber measurements for various field sizes and energies under the magnetic port when the magnetic port was placed parallel to the phantom surface. When it was placed perpendicular to the phantom surface, the maximum difference was 3.5%, while average differences were less than 3.1% for all cases. For the simplified anthropomorphic phantom, the calculated point doses agreed with TLD measurements within 5.2%. By comparing with the current model which is being used in clinic by TPS, it was found that current clinical model overestimates the effect from the magnetic port. Conclusion: Our new model showed good agreement with measurement for all cases. It could potentially improve the accuracy of dose delivery to the breast cancer patients.« less
  • Purpose: Advanced stereotactic radiotherapy (SRT) treatments require accurate dose calculation for treatment planning especially for treatment sites involving heterogeneous patient anatomy. The purpose of this study was to evaluate the accuracy of dose calculation algorithms, Raytracing and Monte Carlo (MC), implemented in the MultiPlan treatment planning system (TPS) in presence of heterogeneities. Methods: First, the LINAC of a CyberKnife radiotherapy facility was modeled with the PENELOPE MC code. A protocol for the measurement of dose distributions with EBT3 films was established and validated thanks to comparison between experimental dose distributions and calculated dose distributions obtained with MultiPlan Raytracing and MCmore » algorithms as well as with the PENELOPE MC model for treatments planned with the homogenous Easycube phantom. Finally, bones and lungs inserts were used to set up a heterogeneous Easycube phantom. Treatment plans with the 10, 7.5 or the 5 mm field sizes were generated in Multiplan TPS with different tumor localizations (in the lung and at the lung/bone/soft tissue interface). Experimental dose distributions were compared to the PENELOPE MC and Multiplan calculations using the gamma index method. Results: Regarding the experiment in the homogenous phantom, 100% of the points passed for the 3%/3mm tolerance criteria. These criteria include the global error of the method (CT-scan resolution, EBT3 dosimetry, LINAC positionning …), and were used afterwards to estimate the accuracy of the MultiPlan algorithms in heterogeneous media. Comparison of the dose distributions obtained in the heterogeneous phantom is in progress. Conclusion: This work has led to the development of numerical and experimental dosimetric tools for small beam dosimetry. Raytracing and MC algorithms implemented in MultiPlan TPS were evaluated in heterogeneous media.« less
  • Purpose: The purpose of this study was to evaluate the likelihood of complications and cosmetic results among breast cancer patients who underwent modified radical mastectomy (MRM) and breast reconstruction followed by radiation therapy (RT) to either a temporary tissue expander (TTE) or permanent breast implant (PI). Methods and Materials: Records were reviewed of 74 patients with breast cancer who underwent MRM followed by breast reconstruction and RT. Reconstruction consisted of a TTE usually followed by exchange to a PI. RT was delivered to the TTE in 62 patients and to the PI in 12 patients. Dose to the reconstructed chestmore » wall was 50 Gy. Median follow-up was 48 months. The primary end point was the incidence of complications involving the reconstruction. Results: There was no significant difference in the rate of major complications in the PI group (0%) vs. 4.8% in the TTE group. No patients lost the reconstruction in the PI group. Three patients lost the reconstruction in the TTE group. There were excellent/good cosmetic scores in 90% of the TTE group and 80% of the PI group (p = 0.22). On multivariate regression models, the type of reconstruction irradiated had no statistically significant impact on complication rates. Conclusions: Patients treated with breast reconstruction and RT can experience low rates of major complications. We demonstrate no significant difference in the overall rate of major or minor complications between the TTE and PI groups. Postmastectomy RT to either the TTE or the PI should be considered as acceptable treatment options in all eligible patients.« less
  • Purpose: Inaccuracies in out-of-field calculations could lead to underestimation of dose to organs-at-risk. This study evaluates the dose calculation accuracy of a model-based calculation algorithm at points outside the primary treatment field for an intensity modulated radiation therapy (IMRT) plan using experimental measurements. Methods: The treatment planning system investigated is Varian Eclipse V.10 with Analytical Anisotropic Algorithm (AAA). The IMRT fields investigated are from real patient treatment plans. The doses from a dynamic (DMLC) IMRT brain plan were calculated and compared with measured doses at locations outside the primary treatment fields. Measurements were performed with a MatriXX system (2-D chambermore » array) placed in solid water. All fields were set vertically incident on the phantom and were 9 cm × 6 cm or smaller. The dose was normalized to the central axis for points up to 15 cm off isocenter. The comparisons were performed at depths of 2, 10, 15, and 20 cm Results: The measurements have shown that AAA calculations underestimate doses at points outside the primary treatment field. The underestimation occurs at 2 cm depth and decreases down to a factor of 2 as depth increases to 20 cm. In low dose (<2% of target dose) regions outside the primary fields the local dose underestimations can be >200% compared to measured doses. Relative to the plan target dose, the measured doses to points outside the field were less than 1% at shallow depths and less than 2% at greater depths. Conclusion: Compared to measurements, the AAA algorithm underestimated the dose at points outside the treatment field with the greatest differences observed at shallow depths. Despite large local dose uncertainties predicted by the treatment planning system, the impact of these uncertainties is expected to be insignificant as doses at these points were less than 1-2% of the prescribed treatment dose.« less
  • Purpose: To determine intervals between surgery and adjuvant chemotherapy and radiation in patients treated with mastectomy with immediate expander-implant reconstruction, and to evaluate locoregional and distant control and overall survival in these patients. Methods and Materials: Between May 1996 and March 2004, 104 patients with Stage II-III breast cancer were routinely treated at our institution under the following algorithm: (1) definitive mastectomy with axillary lymph node dissection and immediate tissue expander placement, (2) tissue expansion during chemotherapy, (3) exchange of tissue expander for permanent implant, (4) radiation. Patient, disease, and treatment characteristics and clinical outcomes were retrospectively evaluated. Results: Medianmore » age was 45 years. Twenty-six percent of patients were Stage II and 74% Stage III. All received adjuvant chemotherapy. Estrogen receptor staining was positive in 77%, and 78% received hormone therapy. Radiation was delivered to the chest wall with daily 0.5-cm bolus and to the supraclavicular fossa. Median dose was 5040 cGy. Median interval from surgery to chemotherapy was 5 weeks, from completion of chemotherapy to exchange 4 weeks, and from exchange to radiation 4 weeks. Median interval from completion of chemotherapy to start of radiation was 8 weeks. Median follow-up was 64 months from date of mastectomy. The 5-year rate for locoregional disease control was 100%, for distant metastasis-free survival 90%, and for overall survival 96%. Conclusions: Mastectomy with immediate expander-implant reconstruction, adjuvant chemotherapy, and radiation results in a median interval of 8 weeks from completion of chemotherapy to initiation of radiation and seems to be associated with acceptable 5-year locoregional control, distant metastasis-free survival, and overall survival.« less