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Title: Interplay effects between dose distribution quality and positioning accuracy in total marrow irradiation with volumetric modulated arc therapy

Purpose: To evaluate the dosimetric consequences of inaccurate isocenter positioning during treatment of total marrow (lymph-node) irradiation (TMI-TMLI) using volumetric modulated arc therapy (VMAT).Methods: Four patients treated with TMI and TMLI were randomly selected from the internal database. Plans were optimized with VMAT technique. Planning target volume (PTV) included all the body bones; for TMLI, lymph nodes and spleen were considered into the target, too. Dose prescription to PTV was 12 Gy in six fractions, two times per day for TMI, and 2 Gy in single fraction for TMLI. Ten arcs on five isocenters (two arcs for isocenter) were used to cover the upper part of PTV (i.e., from cranium to middle femurs). For each plan, three series of random shifts with values between −3 and +3 mm and three between −5 and +5 mm were applied to the five isocenters simulating involuntary patient motion during treatment. The shifts were applied separately in the three directions: left–right (L-R), anterior–posterior (A-P), and cranial–caudal (C-C). The worst case scenario with simultaneous random shifts in all directions simultaneously was considered too. Doses were recalculated for the 96 shifted plans (24 for each patient).Results: For all shifts, differences <0.5% were found for mean dosesmore » to PTV, body, and organs at risk with volumes >100 cm{sup 3}. Maximum doses increased up to 15% for C-C shifted plans. PTV covered by the 95% isodose decreased of 2%–8% revealing target underdosage with the highest values in C-C direction.Conclusions: The correct isocenter repositioning of TMI-TMLI patients is fundamental, in particular in C-C direction, in order to avoid over- and underdosages especially in the overlap regions. For this reason, a dedicated immobilization system was developed in the authors' center to best immobilize the patient.« less
Authors:
; ; ; ; ;  [1] ; ;  [2] ; ; ;  [3]
  1. Department of Radiation Oncology, Humanitas Clinical and Research Center, Rozzano, Milan 20089 (Italy)
  2. Bone Marrow Transplantation Unit, Humanitas Clinical and Research Center, Rozzano, Milan 20089 (Italy)
  3. Medical Physics Unit, Oncology Institute of Southern Switzerland, Bellinzona 6500 (Switzerland)
Publication Date:
OSTI Identifier:
22220254
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 40; Journal Issue: 11; Other Information: (c) 2013 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; 61 RADIATION PROTECTION AND DOSIMETRY; ACCURACY; DOSIMETRY; FEMUR; HEALTH HAZARDS; IRRADIATION; LYMPH NODES; PATIENTS; POSITIONING; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY; RANDOMNESS; SPLEEN