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Title: SU-F-T-621: Impact of Vacuum and Treatment Couch On Surface Dose in Stereotactic Body Radiation Therapy With and Without a Flattening Filter

Abstract

Purpose: When treating lung cancer patients with stereotactic body radiation therapy (SBRT), better immobilization is needed for accurate delivery of high-dose radiation. However, using a treatment couch (TrueBeamTM) and vacuum bag (BlueBAGTM) may increase the surface dose and skin toxicity. This study investigated the influence of couch and vacuum bag on the surface dose. Methods: The relative surface dose (D{sub 0}/DMAX) was measured in an ion-chamber (Markus-type PTW, 0.05cm{sup 3}) with a solid water phantom and SSD to 100 cm. A comprehensive comparison of different parameter settings, including the different energies (6MV-FFF, 10MV-FF, and 10MV-FFF), field sizes (3 X 3 cm{sup 2}, 5 × 5 cm{sup 2}, 8 × x cm{sup 2} , 10 × 10 cm{sup 2}, and 15 × 15 cm{sup 2}), thickness of the vacuum bag (5mm, 15mm, 30mm, 39mm and 55mm), and couch (with and without), was performed. Results: The FFF increases the surface dose as compared to FF mode. In a similar setting with field of 10 × 10 cm{sup 2}, FFF mode increases the surface dose from 26.0% to 32.8% for 6 MV, and 17.4% to 21.5% for 10 MV. When the beam passes through the couch, the surface dose increases to 3.6, 4.6,more » 2.9, and 3.7 times for 6 MV-FF, 10 MV-FF, 6 MV-FFF, and 10 MV-FFF, respectively. At the same energy, the surface dose increases to 3.93, 4.11, 4.23, 4.16 and 4.24 times at 5 mm, 15 mm, 30 mm, 39 mm and 55 mm thickness of the vacuum, respectively. Conclusion: Using a couch and vacuum significantly increases the surface dose. For SBRT with a superficial target close to the couch and immobilization vacuum, reduction of vacuum thickness and careful attention to skin dose in planning would be helpful in avoiding severe skin toxicity.« less

Authors:
; ; ; ; ; ;  [1]
  1. National Taiwan University Hospital, Taipei City, Taiwan (China)
Publication Date:
OSTI Identifier:
22649184
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; IONIZATION CHAMBERS; RADIATION DOSES; RADIOTHERAPY; SKIN; THICKNESS

Citation Formats

Lan, HT, Lu, SH, Kuo, SH, Tsai, YC, Chen, LH, Wen, SY, and Wang, CW. SU-F-T-621: Impact of Vacuum and Treatment Couch On Surface Dose in Stereotactic Body Radiation Therapy With and Without a Flattening Filter. United States: N. p., 2016. Web. doi:10.1118/1.4956806.
Lan, HT, Lu, SH, Kuo, SH, Tsai, YC, Chen, LH, Wen, SY, & Wang, CW. SU-F-T-621: Impact of Vacuum and Treatment Couch On Surface Dose in Stereotactic Body Radiation Therapy With and Without a Flattening Filter. United States. doi:10.1118/1.4956806.
Lan, HT, Lu, SH, Kuo, SH, Tsai, YC, Chen, LH, Wen, SY, and Wang, CW. 2016. "SU-F-T-621: Impact of Vacuum and Treatment Couch On Surface Dose in Stereotactic Body Radiation Therapy With and Without a Flattening Filter". United States. doi:10.1118/1.4956806.
@article{osti_22649184,
title = {SU-F-T-621: Impact of Vacuum and Treatment Couch On Surface Dose in Stereotactic Body Radiation Therapy With and Without a Flattening Filter},
author = {Lan, HT and Lu, SH and Kuo, SH and Tsai, YC and Chen, LH and Wen, SY and Wang, CW},
abstractNote = {Purpose: When treating lung cancer patients with stereotactic body radiation therapy (SBRT), better immobilization is needed for accurate delivery of high-dose radiation. However, using a treatment couch (TrueBeamTM) and vacuum bag (BlueBAGTM) may increase the surface dose and skin toxicity. This study investigated the influence of couch and vacuum bag on the surface dose. Methods: The relative surface dose (D{sub 0}/DMAX) was measured in an ion-chamber (Markus-type PTW, 0.05cm{sup 3}) with a solid water phantom and SSD to 100 cm. A comprehensive comparison of different parameter settings, including the different energies (6MV-FFF, 10MV-FF, and 10MV-FFF), field sizes (3 X 3 cm{sup 2}, 5 × 5 cm{sup 2}, 8 × x cm{sup 2} , 10 × 10 cm{sup 2}, and 15 × 15 cm{sup 2}), thickness of the vacuum bag (5mm, 15mm, 30mm, 39mm and 55mm), and couch (with and without), was performed. Results: The FFF increases the surface dose as compared to FF mode. In a similar setting with field of 10 × 10 cm{sup 2}, FFF mode increases the surface dose from 26.0% to 32.8% for 6 MV, and 17.4% to 21.5% for 10 MV. When the beam passes through the couch, the surface dose increases to 3.6, 4.6, 2.9, and 3.7 times for 6 MV-FF, 10 MV-FF, 6 MV-FFF, and 10 MV-FFF, respectively. At the same energy, the surface dose increases to 3.93, 4.11, 4.23, 4.16 and 4.24 times at 5 mm, 15 mm, 30 mm, 39 mm and 55 mm thickness of the vacuum, respectively. Conclusion: Using a couch and vacuum significantly increases the surface dose. For SBRT with a superficial target close to the couch and immobilization vacuum, reduction of vacuum thickness and careful attention to skin dose in planning would be helpful in avoiding severe skin toxicity.},
doi = {10.1118/1.4956806},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = 2016,
month = 6
}
  • Purpose: We investigated the dosimetric impact of the interplay effect during RapidArc stereotactic body radiation therapy for lung tumors using flattening filter-free (FFF) beams with different dose rates. Methods and Materials: Seven tumors with motion ≤20 mm, treated with 10-MV FFF RapidArc, were analyzed. A programmable phantom with sinusoidal longitudinal motion (30-mm diameter “tumor” insert; period = 5 s; individualized amplitude from planning 4-dimensional computed tomography) was used for dynamic dose measurements. Measurements were made with GafChromic EBT III films. Plans delivered the prescribed dose to 95% of the planning target volume, created by a 5-mm expansion of the internalmore » target volume. They comprised 2 arcs and maximum dose rates of 400 and 2400 MU/min. For 2400 MU/min plans, measurements were repeated at 3 different initial breathing phases to model interplay over 2 to 3 fractions. For 3 cases, 2 extra plans were created using 1 full rotational arc (with contralateral lung avoidance sector) and 1 partial arc of 224° to 244°. Dynamic and convolved static measurements were compared by use of gamma analysis of 3% dose difference and 1 mm distance-to-agreement. Results: For 2-arc 2400 MU/min plans, maximum dose deviation of 9.4% was found in a single arc; 7.4% for 2 arcs (single fraction) and <5% and 3% when measurements made at 2 and 3 different initial breathing phases were combined, simulating 2 or 3 fractions. For all 7 cases, >99% of the area within the region of interest passed the gamma criteria when all 3 measurements with different initial phases were combined. Single-fraction single-arc plans showed higher dose deviations, which diminished when dose distributions were summed over 2 fractions. All 400 MU/min plans showed good agreement in a single fraction measurement. Conclusion: Under phantom conditions, single-arc and single-fraction 2400 MU/min FFF RapidArc lung stereotactic body radiation therapy is susceptible to interplay. Two arcs and ≥2 fractions reduced the effect to a level that appeared unlikely to be clinically significant.« less
  • Purpose: The present study aimed to investigate the dosimetric impacts of the anisotropic analytic algorithm (AAA) and the Acuros XB (AXB) plan for lung stereotactic ablative radiation therapy using flattening filter-free (FFF) beam. We retrospectively analyzed 10 patients. Methods: We retrospectively analyzed 10 patients. The dosimetric parameters for the target and organs at risk (OARs) from the treatment plans calculated with these dose calculation algorithms were compared. The technical parameters, such as the computation times and the total monitor units (MUs), were also evaluated. Results: A comparison of DVHs from AXB and AAA showed that the AXB plan produced amore » high maximum PTV dose by average 4.40% with a statistical significance but slightly lower mean PTV dose by average 5.20% compared to the AAA plans. The maximum dose to the lung was slightly higher in the AXB compared to the AAA. For both algorithms, the values of V5, V10 and V20 for ipsilateral lung were higher in the AXB plan more than those of AAA. However, these parameters for contralateral lung were comparable. The differences of maximum dose for the spinal cord and heart were also small. The computation time of AXB was found fast with the relative difference of 13.7% than those of AAA. The average of monitor units (MUs) for all patients was higher in AXB plans than in the AAA plans. These results indicated that the difference between AXB and AAA are large in heterogeneous region with low density. Conclusion: The AXB provided the advantages such as the accuracy of calculations and the reduction of the computation time in lung stereotactic ablative radiotherapy (SABR) with using FFF beam, especially for VMAT planning. In dose calculation with the media of different density, therefore, the careful attention should be taken regarding the impacts of different heterogeneity correction algorithms. The authors report no conflicts of interest.« less
  • Purpose: To study the dosimetric impact of relatively short-duration intrafraction shifts during a single fraction of RapidArc delivery for vertebral stereotactic body radiation therapy (SBRT) using flattened (FF) and flattening filter-free (FFF) beams. Methods and Materials: The RapidArc plans, each with 2 to 3 arcs, were generated for 9 patients using 6-MV FF and 10-MV FFF beams with maximum dose rates of 1000 and 2400 MU/min, respectively. A total of 1272 plans were created to estimate the dosimetric consequences in target and spinal cord volumes caused by intrafraction shifts during one of the arcs. Shifts of 1, 2, and 3more » mm for periods of 5, 10, and 30 seconds, and 5 mm for 5 and 10 seconds, were modelled during a part of the arc associated with high doses and steep dose gradients. Results: For FFF plans, shifts of 2 mm over 10 seconds and 30 seconds could increase spinal cord D{sub max} by up to 6.5% and 13%, respectively. Dosimetric deviations in FFF plans were approximately 2-fold greater than in FF plans. Reduction in target coverage was <1% for 83% and 96% of the FFF and FF plans, respectively. Conclusion: Even short-duration intrafraction shifts can cause significant dosimetric deviations during vertebral SBRT delivery, especially when using very high dose rate FFF beams and when the shift occurs in that part of the arc delivering high doses and steep gradients. The impact is greatest on the spinal cord and its planning-at-risk volume. Accurate and stable patient positioning is therefore required for vertebral SBRT.« less
  • The purpose of this study is to assess the real target dose coverage when radiation treatments were delivered to lung cancer patients based on treatment planning according to the RTOG-0236 Protocol. We compare calculated dosimetric results between the more accurate anisotropic analytical algorithm (AAA) and the pencil beam algorithm for stereotactic body radiation therapy treatment planning in lung cancer. Ten patients with non-small cell lung cancer were given 60 Gy in three fractions using 6 and 10 MV beams with 8-10 fields. The patients were chosen in accordance with the lung RTOG-0236 protocol. The dose calculations were performed using themore » pencil beam algorithm with no heterogeneity corrections (PB-NC) and then recalculated with the pencil beam with modified Batho heterogeneity corrections (PB-MB) and the AAA using an identical beam setup and monitor units. The differences in calculated dose to 95% or 99% of the PTV, between using the PB-NC and the AAA, were within 10% of prescribed dose (60 Gy). However, the minimum dose to 95% and 99% of PTV calculated using the PB-MB were consistently overestimated by up to 40% and 36% of the prescribed dose, respectively, compared to that calculated by the AAA. Using the AAA as reference, the calculated maximum doses were underestimated by up to 27% using the PB-NC and overestimated by 19% using the PB-MB. The calculations of dose to lung from PB-NC generally agree with that of AAA except in the small high-dose region where PB-NC underestimates. The calculated dose distributions near the interface using the AAA agree with those from Monte Carlo calculations as well as measured values. This study indicates that the real minimum PTV dose coverage cannot be guaranteed when the PB-NC is used to calculate the monitor unit settings in dose prescriptions.« less
  • To investigate the unexpected skin dose increase from intensity-modulated radiation therapy (IMRT) on vacuum cushions and carbon-fiber couches and then to modify the dosimetric plan accordingly. Eleven prostate cancer patients undergoing IMRT were treated in prone position with a vacuum cushion. Two under-couch beams scattered the radiation from the vacuum cushion and carbon-fiber couch. The IMRT plans with both devices contoured were compared with the plans not contouring them. The skin doses were measured using thermoluminescent dosimeters (TLDs) placed on the inguinal regions in a single IMRT fraction. Tissue equivalent thickness was transformed for both devices with the relative densities.more » The TLD-measured skin doses (59.5 {+-} 9.5 cGy and 55.6 {+-} 5.9 cGy at left and right inguinal regions, respectively) were significantly higher than the calculated doses (28.7 {+-} 4.7 cGy; p = 2.2 x 10{sup -5} and 26.2 {+-} 4.3 cGy; p = 1.5 x 10{sup -5}) not contouring the vacuum cushion and carbon-fiber couch. The calculated skin doses with both devices contoured (59.1 {+-} 8.8 cGy and 55.5 {+-} 5.7 cGy) were similar to the TLD-measured doses. In addition, the calculated skin doses using the vacuum cushion and a converted thickness of the simulator couch were no different from the TLD-measured doses. The recalculated doses of rectum and bladder did not change significantly. The dose that covered 95% of target volume was less than the prescribed dose in 4 of 11 patients, and this problem was solved after re-optimization applying the corrected contours. The vacuum cushion and carbon-fiber couch contributed to increased skin doses. The tissue-equivalent-thickness method served as an effective way to correct the dose variations.« less