A novel AP/PA total body irradiation technique using abutting IMRT fields at extended SSD

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Main Authors: Xiaomin Liang, Peixiong Li, Qiuwen Wu
Format: Artículo Open Access
Published: Wiley 2024
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author Xiaomin Liang
Peixiong Li
Qiuwen Wu
author_facet Xiaomin Liang
Peixiong Li
Qiuwen Wu
Xiaomin Liang
Peixiong Li
Qiuwen Wu
collection Wiley Open Access
contents A novel AP/PA total body irradiation technique using abutting IMRT fields at extended SSD Xiaomin Liang Peixiong Li Qiuwen Wu Journal of Applied Clinical Medical Physics AbstractPurposeTo develop a Total Body Irradiation (TBI) technique using IMRT at extended SSD that can be performed in any size Linac room.MethodsPatients studied were placed on a platform close to the floor, directly under the gantry with cranial‐caudal axis parallel to the gantry rotation plane and at SSD ∼200 cm. Two abutting fields with the same external isocenter at gantry angles of ±21˚, collimator angle of 90˚, and field size of 25 × 40 cm2 are employed for both supine and prone positions. An iterative optimization algorithm was developed to generate a uniform dose at the patient mid‐plane with adequate shielding to critical organs such as lungs and kidneys. The technique was validated in both phantom and patient CT images for treatment planning, and dose measurement and QA were performed in phantom.ResultsA uniform dose distribution in the mid‐plane within ±5% of the prescription dose was reached after a few iterations. This was confirmed with ion‐chamber measurements in phantom. The mean dose to lungs and kidneys can be adjusted according to clinical requirements and can be as low as ∼25% of the prescription dose. For a typical prescription dose of 200 cGy/fraction, the total MU was ∼2400/1200 for the superior/inferior field. The overall treatment time for both supine/prone positions was ∼54 min to meet the maximum absorbed dose rate criteria of 15 cGy/min. IMRT QA with portal dosimetry shows excellent agreement.ConclusionsWe have developed a promising TBI technique using abutting IMRT fields at extended SSD. The patient is in a comfortable recumbent position with good reproducibility and less motion during treatment. An additional benefit of this technique is that full 3D dose distribution is available from the TPS with a DVH summary for organs of interest. The technique allows precise sparing of lungs and kidneys and can be executed in any linac room. 10.1002/acm2.14213 http://creativecommons.org/licenses/by/4.0/
doi_str_mv 10.1002/acm2.14213
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id wiley_oa_10_1002_acm2_14213
institution Wiley Open Access
license_str_mv http://creativecommons.org/licenses/by/4.0/
publishDate 2024
publisher Wiley
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spellingShingle A novel AP/PA total body irradiation technique using abutting IMRT fields at extended SSD
Xiaomin Liang
Peixiong Li
Qiuwen Wu
Journal of Applied Clinical Medical Physics
A novel AP/PA total body irradiation technique using abutting IMRT fields at extended SSD Xiaomin Liang Peixiong Li Qiuwen Wu Journal of Applied Clinical Medical Physics AbstractPurposeTo develop a Total Body Irradiation (TBI) technique using IMRT at extended SSD that can be performed in any size Linac room.MethodsPatients studied were placed on a platform close to the floor, directly under the gantry with cranial‐caudal axis parallel to the gantry rotation plane and at SSD ∼200 cm. Two abutting fields with the same external isocenter at gantry angles of ±21˚, collimator angle of 90˚, and field size of 25 × 40 cm2 are employed for both supine and prone positions. An iterative optimization algorithm was developed to generate a uniform dose at the patient mid‐plane with adequate shielding to critical organs such as lungs and kidneys. The technique was validated in both phantom and patient CT images for treatment planning, and dose measurement and QA were performed in phantom.ResultsA uniform dose distribution in the mid‐plane within ±5% of the prescription dose was reached after a few iterations. This was confirmed with ion‐chamber measurements in phantom. The mean dose to lungs and kidneys can be adjusted according to clinical requirements and can be as low as ∼25% of the prescription dose. For a typical prescription dose of 200 cGy/fraction, the total MU was ∼2400/1200 for the superior/inferior field. The overall treatment time for both supine/prone positions was ∼54 min to meet the maximum absorbed dose rate criteria of 15 cGy/min. IMRT QA with portal dosimetry shows excellent agreement.ConclusionsWe have developed a promising TBI technique using abutting IMRT fields at extended SSD. The patient is in a comfortable recumbent position with good reproducibility and less motion during treatment. An additional benefit of this technique is that full 3D dose distribution is available from the TPS with a DVH summary for organs of interest. The technique allows precise sparing of lungs and kidneys and can be executed in any linac room. 10.1002/acm2.14213 http://creativecommons.org/licenses/by/4.0/
title A novel AP/PA total body irradiation technique using abutting IMRT fields at extended SSD
topic Journal of Applied Clinical Medical Physics
url https://aapm.onlinelibrary.wiley.com/doi/10.1002/acm2.14213