The Estimation of Radiation Dose to Out-of-Field Points of Organs at Risk in Block and MLC Shielded Fields in Lung Cancer Radiation Therapy
-
Nastaran Sadat Momeni
,
Saeed Afraydoon
,
Nima Hamzian
,
Abolfazl Nikfarjam
,
Mahmoud Vakili Ghasemabad
,
Sepideh Abdollahi-Dehkordi
,
Masoud Shabani
,
Mahdi Dehestani
,
Adel Heidari
Abstract
Purpose: Photon-field shaping in radiation therapy with cerrobend block or Multi-Leaf Collimator (MLC) leads to an increase in the scattered dose to the out-of-field Organ At Risk (OAR). This study aimed to measure and compare the healthy organs absorbed dose outside the cerrobend block and MLC shielded field.
Materials and Methods: Computed Tomography (CT) images were taken of a heterogeneous Thorax phantom while the target volume and organ at risk, including the spinal cord, contralateral lung, and heart were contoured. Conformal Treatment planning was performed (POP fields, total dose 40 Gy, 5 fx/week, and 2 Gy/fx) on the Prowess Panter treatment Planning System (TPS). Irradiation was performed with 6 and 18 Mv X-ray of Siemens Oncor medical linear accelerator, once for the block-shielded field and again for the MLC-shielded field. At each energy, the radiation dose to the contoured out-of-field organs was measured by an ionization chamber and compared.
Results: At both 6 and 18 MV energies, the out-of-field dose in the MLC-shielded fields was significantly lower than in the block-shielded ones (P <0.001). The out-of-filed dose for contoured organ at risk was not significantly different at 18 MV compared with 6 MV. The dose calculated by the treatment planning system showed that the healthy organs absorbed doses in all conditions were significantly lower than the dosimetry results.
Conclusion: The use of MLC to shield the lung cancer treatment filed reduces the out-of-field OARs dose compared to cerrobend block. This reduction is greater at 18 MV photon beam but this difference is not statistically significant.
1- Freddie Bray, Jacques Ferlay, Isabelle Soerjomataram, Rebecca L Siegel, Lindsey A Torre, and Ahmedin Jemal, "Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries." CA: a cancer journal for clinicians, Vol. 68 (No. 6), pp. 394-424, (2018).
2- Rajamanickam Baskar, Kuo Ann Lee, Richard Yeo, and Kheng-Wei Yeoh, "Cancer and radiation therapy: current advances and future directions." International journal of medical sciences, Vol. 9 (No. 3), p. 193, (2012).
3- Edward C Halperin, Carlos A Perez, and Luther W Brady, "Perez and Brady's principles and practice of radiation oncology." (2020).
4- Faiz M Khan and John P Gibbons, Khan's the physics of radiation therapy. Lippincott Williams & Wilkins, (2014).
5- Gabriele Kragl et al., "Flattening filter free beams in SBRT and IMRT: dosimetric assessment of peripheral doses." Zeitschrift für medizinische Physik, Vol. 21 (No. 2), pp. 91-101, (2011).
6- M Behmadi et al., "Evaluation of breast cancer radiation therapy techniques in outfield organs of Rando phantom with thermoluminescence dosimeter." Journal of Biomedical Physics & Engineering, Vol. 9 (No. 2), p. 179, (2019).
7- Robin L Stern, "Peripheral dose from a linear accelerator equipped with multileaf collimation." Medical physics, Vol. 26 (No. 4), pp. 559-63, (1999).
8- Tim Lustberg et al., "Clinical evaluation of atlas and deep learning based automatic contouring for lung cancer." Radiotherapy and Oncology, Vol. 126 (No. 2), pp. 312-17, (2018).
9- Marilyn Stovall et al., "Fetal dose from radiotherapy with photon beams: report of AAPM Radiation Therapy Committee Task Group No. 36." Medical physics, Vol. 22 (No. 1), pp. 63-82, (1995).
10- C Roux, C Horvath, and R Dupuis, "Effects of pre-implantation low-dose radiation on rat embryos." Health Phys.;(United Kingdom), Vol. 45 (No. 5), (1983).
11- Sasa Mutic, Jacqueline Esthappan, and Eric E Klein, "Peripheral dose distributions for a linear accelerator equipped with a secondary multileaf collimator and universal wedge." Journal of applied clinical medical physics, Vol. 3 (No. 4), pp. 302-09, (2002).
12- A Fogliata, A Clivio, E Vanetti, G Nicolini, MF Belosi, and L Cozzi, "Dosimetric evaluation of photon dose calculation under jaw and MLC shielding." Medical physics, Vol. 40 (No. 10), p. 101706, (2013).
13- Ebtesam M Mohamedy, Hassan Fathy, Wafaa M Khalil, Nadia L Helal, and Ehab M Attalla, "Assessment the Photo-neutron Contamination of IMRT and 3D-Conformal Techniques Using Thermo-luminescent Dosimeter (TLD)." Journal of Pharmaceutical Research International, pp. 1-10, (2018).
14- MAHMOUD ALLAHVERDI, HOSSEIN KHOSRAVI, H GHARAATI, and HR KHOSRAVI, "DEPTH DOSE UNDER SHIELDING BLOCK: AN EVALUATION AND COMPARISON OF MEASURED & CALCULATED BY TREATMENT PLANNING SYSTEM (PLATO) AND SUGGESTION AN ALGORITHM FOR IT CORRECTION." (2003).
15- Mohamad M Alabdoaburas et al., "Experimental assessment of out‐of‐field dose components in high energy electron beams used in external beam radiotherapy." Journal of applied clinical medical physics, Vol. 16 (No. 6), pp. 435-48, (2015).
16- M Saiful Huq, "Absorbed dose determination in external beam radiotherapy: an international code of practice for dosimetry based on standards of absorbed dose to water." (2006).
17- Paul T Finger, "Radiation therapy for orbital tumors: concepts, current use, and ophthalmic radiation side effects." Survey of ophthalmology, Vol. 54 (No. 5), pp. 545-68, (2009).
18- Intensity Modulated Radiation Therapy Collaborative Working Group, "Intensity-modulated radiotherapy: current status and issues of interest." International Journal of Radiation Oncology* Biology* Physics, Vol. 51 (No. 4), pp. 880-914, (2001).
19- Sasa Mutic and Eric E Klein, "A reduction in the AAPM TG-36 reported peripheral dose distributions with tertiary multileaf collimation." International Journal of Radiation Oncology* Biology* Physics, Vol. 44 (No. 4), pp. 947-53, (1999).
20- Michalis Mazonakis, Fotini Zacharopoulou, Stefanos Kachris, Charalambos Varveris, John Damilakis, and Nicholas Gourtsoyiannis, "Scattered dose to gonads and associated risks from radiotherapy for common pediatric malignancies." Strahlentherapie und Onkologie, Vol. 183 (No. 6), pp. 332-37, (2007).
21- Sarah B Scarboro et al., "Effect of organ size and position on out-of-field dose distributions during radiation therapy." Physics in Medicine & Biology, Vol. 55 (No. 23), p. 7025, (2010).
22- Stephen F Kry, Susan A Smith, Rita Weathers, and Marilyn Stovall, "Skin dose during radiotherapy: a summary and general estimation technique." Journal of applied clinical medical physics, Vol. 13 (No. 3), pp. 20-34, (2012).
23- W Jalbout, R Howell, W Newhauser, F Geara, N Khater, and P Taddei, "Poster—Thur Eve—36: Out‐of‐Field dose in craniospinal irradiation." Medical physics, Vol. 39 (No. 7Part3), pp. 4631-31, (2012).
24- Elisabeth Weiss, Jeffrey V Siebers, and Paul J Keall, "An analysis of 6-MV versus 18-MV photon energy plans for intensity-modulated radiation therapy (IMRT) of lung cancer." Radiotherapy and oncology, Vol. 82 (No. 1), pp. 55-62, (2007).
25- James S Welsh, Thomas Rockwell Mackie, and Jeffrey P Limmer, "High-energy photons in IMRT: uncertainties and risks for questionable gain." Technology in cancer research & treatment, Vol. 6 (No. 2), pp. 147-49, (2007).
26- Martin J Butson, KN Peter, Tsang Cheung, and Peter Metcalfe, "Radiochromic film for medical radiation dosimetry." Materials Science and Engineering: R: Reports, Vol. 41 (No. 3-5), pp. 61-120, (2003).
27- Pamela J White, Robert D Zwicker, and David T Huang, "Comparison of dose homogeneity effects due to electron equilibrium loss in lung for 6 MV and 18 MV photons." International Journal of Radiation Oncology* Biology* Physics, Vol. 34 (No. 5), pp. 1141-46, (1996).
28- R Kaderka et al., "Out-of-field dose measurements in a water phantom using different radiotherapy modalities." Physics in Medicine & Biology, Vol. 57 (No. 16), p. 5059, (2012).
29- Ndimofor Chofor, Dietrich Harder, Antje Rühmann, Kay C Willborn, Tilo Wiezorek, and Björn Poppe, "Experimental study on photon-beam peripheral doses, their components and some possibilities for their reduction." Physics in Medicine & Biology, Vol. 55 (No. 14), p. 4011, (2010).
30- Luca Cozzi, Francesca M Buffa, and Antonella Fogliata, "Dosimetric features of linac head and phantom scattered radiation outside the clinical photon beam: experimental measurements and comparison with treatment planning system calculations." Radiotherapy and Oncology, Vol. 58 (No. 2), pp. 193-200, (2001).
31- Rebecca M Howell, Sarah B Scarboro, SF Kry, and Derek Z Yaldo, "Accuracy of out-of-field dose calculations by a commercial treatment planning system." Physics in Medicine & Biology, Vol. 55 (No. 23), p. 6999, (2010).
32- Andreas Joosten, Oscar Matzinger, Wendy Jeanneret-Sozzi, François Bochud, and Raphaël Moeckli, "Evaluation of organ-specific peripheral doses after 2-dimensional, 3-dimensional and hybrid intensity modulated radiation therapy for breast cancer based on Monte Carlo and convolution/superposition algorithms: implications for secondary cancer risk assessment." Radiotherapy and Oncology, Vol. 106 (No. 1), pp. 33-41, (2013).
2- Rajamanickam Baskar, Kuo Ann Lee, Richard Yeo, and Kheng-Wei Yeoh, "Cancer and radiation therapy: current advances and future directions." International journal of medical sciences, Vol. 9 (No. 3), p. 193, (2012).
3- Edward C Halperin, Carlos A Perez, and Luther W Brady, "Perez and Brady's principles and practice of radiation oncology." (2020).
4- Faiz M Khan and John P Gibbons, Khan's the physics of radiation therapy. Lippincott Williams & Wilkins, (2014).
5- Gabriele Kragl et al., "Flattening filter free beams in SBRT and IMRT: dosimetric assessment of peripheral doses." Zeitschrift für medizinische Physik, Vol. 21 (No. 2), pp. 91-101, (2011).
6- M Behmadi et al., "Evaluation of breast cancer radiation therapy techniques in outfield organs of Rando phantom with thermoluminescence dosimeter." Journal of Biomedical Physics & Engineering, Vol. 9 (No. 2), p. 179, (2019).
7- Robin L Stern, "Peripheral dose from a linear accelerator equipped with multileaf collimation." Medical physics, Vol. 26 (No. 4), pp. 559-63, (1999).
8- Tim Lustberg et al., "Clinical evaluation of atlas and deep learning based automatic contouring for lung cancer." Radiotherapy and Oncology, Vol. 126 (No. 2), pp. 312-17, (2018).
9- Marilyn Stovall et al., "Fetal dose from radiotherapy with photon beams: report of AAPM Radiation Therapy Committee Task Group No. 36." Medical physics, Vol. 22 (No. 1), pp. 63-82, (1995).
10- C Roux, C Horvath, and R Dupuis, "Effects of pre-implantation low-dose radiation on rat embryos." Health Phys.;(United Kingdom), Vol. 45 (No. 5), (1983).
11- Sasa Mutic, Jacqueline Esthappan, and Eric E Klein, "Peripheral dose distributions for a linear accelerator equipped with a secondary multileaf collimator and universal wedge." Journal of applied clinical medical physics, Vol. 3 (No. 4), pp. 302-09, (2002).
12- A Fogliata, A Clivio, E Vanetti, G Nicolini, MF Belosi, and L Cozzi, "Dosimetric evaluation of photon dose calculation under jaw and MLC shielding." Medical physics, Vol. 40 (No. 10), p. 101706, (2013).
13- Ebtesam M Mohamedy, Hassan Fathy, Wafaa M Khalil, Nadia L Helal, and Ehab M Attalla, "Assessment the Photo-neutron Contamination of IMRT and 3D-Conformal Techniques Using Thermo-luminescent Dosimeter (TLD)." Journal of Pharmaceutical Research International, pp. 1-10, (2018).
14- MAHMOUD ALLAHVERDI, HOSSEIN KHOSRAVI, H GHARAATI, and HR KHOSRAVI, "DEPTH DOSE UNDER SHIELDING BLOCK: AN EVALUATION AND COMPARISON OF MEASURED & CALCULATED BY TREATMENT PLANNING SYSTEM (PLATO) AND SUGGESTION AN ALGORITHM FOR IT CORRECTION." (2003).
15- Mohamad M Alabdoaburas et al., "Experimental assessment of out‐of‐field dose components in high energy electron beams used in external beam radiotherapy." Journal of applied clinical medical physics, Vol. 16 (No. 6), pp. 435-48, (2015).
16- M Saiful Huq, "Absorbed dose determination in external beam radiotherapy: an international code of practice for dosimetry based on standards of absorbed dose to water." (2006).
17- Paul T Finger, "Radiation therapy for orbital tumors: concepts, current use, and ophthalmic radiation side effects." Survey of ophthalmology, Vol. 54 (No. 5), pp. 545-68, (2009).
18- Intensity Modulated Radiation Therapy Collaborative Working Group, "Intensity-modulated radiotherapy: current status and issues of interest." International Journal of Radiation Oncology* Biology* Physics, Vol. 51 (No. 4), pp. 880-914, (2001).
19- Sasa Mutic and Eric E Klein, "A reduction in the AAPM TG-36 reported peripheral dose distributions with tertiary multileaf collimation." International Journal of Radiation Oncology* Biology* Physics, Vol. 44 (No. 4), pp. 947-53, (1999).
20- Michalis Mazonakis, Fotini Zacharopoulou, Stefanos Kachris, Charalambos Varveris, John Damilakis, and Nicholas Gourtsoyiannis, "Scattered dose to gonads and associated risks from radiotherapy for common pediatric malignancies." Strahlentherapie und Onkologie, Vol. 183 (No. 6), pp. 332-37, (2007).
21- Sarah B Scarboro et al., "Effect of organ size and position on out-of-field dose distributions during radiation therapy." Physics in Medicine & Biology, Vol. 55 (No. 23), p. 7025, (2010).
22- Stephen F Kry, Susan A Smith, Rita Weathers, and Marilyn Stovall, "Skin dose during radiotherapy: a summary and general estimation technique." Journal of applied clinical medical physics, Vol. 13 (No. 3), pp. 20-34, (2012).
23- W Jalbout, R Howell, W Newhauser, F Geara, N Khater, and P Taddei, "Poster—Thur Eve—36: Out‐of‐Field dose in craniospinal irradiation." Medical physics, Vol. 39 (No. 7Part3), pp. 4631-31, (2012).
24- Elisabeth Weiss, Jeffrey V Siebers, and Paul J Keall, "An analysis of 6-MV versus 18-MV photon energy plans for intensity-modulated radiation therapy (IMRT) of lung cancer." Radiotherapy and oncology, Vol. 82 (No. 1), pp. 55-62, (2007).
25- James S Welsh, Thomas Rockwell Mackie, and Jeffrey P Limmer, "High-energy photons in IMRT: uncertainties and risks for questionable gain." Technology in cancer research & treatment, Vol. 6 (No. 2), pp. 147-49, (2007).
26- Martin J Butson, KN Peter, Tsang Cheung, and Peter Metcalfe, "Radiochromic film for medical radiation dosimetry." Materials Science and Engineering: R: Reports, Vol. 41 (No. 3-5), pp. 61-120, (2003).
27- Pamela J White, Robert D Zwicker, and David T Huang, "Comparison of dose homogeneity effects due to electron equilibrium loss in lung for 6 MV and 18 MV photons." International Journal of Radiation Oncology* Biology* Physics, Vol. 34 (No. 5), pp. 1141-46, (1996).
28- R Kaderka et al., "Out-of-field dose measurements in a water phantom using different radiotherapy modalities." Physics in Medicine & Biology, Vol. 57 (No. 16), p. 5059, (2012).
29- Ndimofor Chofor, Dietrich Harder, Antje Rühmann, Kay C Willborn, Tilo Wiezorek, and Björn Poppe, "Experimental study on photon-beam peripheral doses, their components and some possibilities for their reduction." Physics in Medicine & Biology, Vol. 55 (No. 14), p. 4011, (2010).
30- Luca Cozzi, Francesca M Buffa, and Antonella Fogliata, "Dosimetric features of linac head and phantom scattered radiation outside the clinical photon beam: experimental measurements and comparison with treatment planning system calculations." Radiotherapy and Oncology, Vol. 58 (No. 2), pp. 193-200, (2001).
31- Rebecca M Howell, Sarah B Scarboro, SF Kry, and Derek Z Yaldo, "Accuracy of out-of-field dose calculations by a commercial treatment planning system." Physics in Medicine & Biology, Vol. 55 (No. 23), p. 6999, (2010).
32- Andreas Joosten, Oscar Matzinger, Wendy Jeanneret-Sozzi, François Bochud, and Raphaël Moeckli, "Evaluation of organ-specific peripheral doses after 2-dimensional, 3-dimensional and hybrid intensity modulated radiation therapy for breast cancer based on Monte Carlo and convolution/superposition algorithms: implications for secondary cancer risk assessment." Radiotherapy and Oncology, Vol. 106 (No. 1), pp. 33-41, (2013).
| Files | ||
| Issue | Vol 10 No 2 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/fbt.v10i2.12223 | |
| Keywords | ||
| Out Of Field Organs Multi Leaf Collimator Block Lung Cancer Radiation Therapy | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Momeni NS, Afraydoon S, Hamzian N, Nikfarjam A, Vakili Ghasemabad M, Abdollahi-Dehkordi S, Shabani M, Dehestani M, Heidari A. The Estimation of Radiation Dose to Out-of-Field Points of Organs at Risk in Block and MLC Shielded Fields in Lung Cancer Radiation Therapy. Frontiers Biomed Technol. 2023;10(2):188-194.
