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Accelerating total body irradiation with large field modulated arc therapy in standard treatment rooms without additional equipment

Weiterentwicklung einer Ganzkörperbestrahlungstechnik in modulierter Rotationstechnik mit großen Feldern für Standardbestrahlungsräume ohne zusätzliches Equipment

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Abstract

Purpose

The aim of this study was to develop a generic and ultra-efficient modulated arc technique for treatment with total body irradiation (TBI) without additional equipment in standard treatment rooms.

Methods

A continuous gantry arc between 300° and 70° composed of 26 subarcs (5° per subarc) using a field size of 40 × 40 cm2 was used to perform the initial beam data measurements. The profile was measured parallel to the direction of gantry rotation at a constant depth of 9 cm (phantom thickness 18 cm). Beam data were measured for single 5° subarcs, dissecting the individual contribution of each subarc to a certain measurement point. The phantom was moved to 20 measurement positions along the profile. Then profile optimization was performed manually by varying the weighting factors of all segments until calculated doses at all points were within ± 1 %. Finally, the dose distribution of the modulated arc was verified in phantom thicknesses of 18 and 28 cm.

Results

The measured profile showed a relative mean dose of 99.7 % [standard deviation (SD) 0.7 %)] over the length of 200 cm at a depth of 9 cm. The measured mean effective surface dose (at a depth of 2 cm) was 102.7 % (SD 2.1 %). The measurements in the 28 cm slab phantom revealed a mean dose of 95.9 % (SD 2.9 %) at a depth of 14 cm. The mean dose at a depth of 2 cm was 111.9 % (SD 4.1 %). Net beam-on-time for a 2 Gy fraction is approximately 8 min.

Conclusion

This highly efficient modulated arc technique for TBI can replace conventional treatment techniques, providing a homogeneous dose distribution, dosimetric robustness, extremely fast delivery, and applicability in small treatment rooms, with no need for additional equipment.

Zusammenfassung

Ziel

Das Ziel dieses Projekts war die Entwicklung einer generischen, hocheffizienten und modulierten Rotationsbestrahlungstechnik für Ganzkörperbestrahlung (TBI, „total body irradiation“), die ohne zusätzliches Equipment in Standartbehandlungsräumen angewendet werden kann.

Methodik

Ein kontinuierlicher Bestrahlungsbogen zwischen 70–300° mit einer Feldgröße von 40 × 40 cm2 wurde in 26 Abschnitte zu 5° unterteilt. Diese wurden für eine Basisdatenmessung in einem RW3-Plattenphantom verwendet. Die Phantomstärke betrug 18 cm. Die Messungen wurden in 9 cm Tiefe mit einer Stabkammer durchgeführt. Die Erhebung der Basisdaten erfolgte durch die Messung der relativen Dosisbeiträge der einzelnen 5°-Bogenabschnitte, die separat nacheinander gemessen wurden. Das Plattenphantom wurde sukzessive, entlang des Bestrahlungsfelds (über 2 m Länge) in 20 Messpositionen positioniert, um die einzelnen Dosisbeiträge der einzelnen 5°-Bogenabschnitte entlang der gesamten Profillänge zu ermitteln. Anschließend wurden die Wichtungsfaktoren der einzelnen Bogenabschnitte schrittweise so verändert, dass schließlich die relative Dosis in allen Messpunkten auf ± 1 % homogenisiert wurde. Der modulierte Bestrahlungsbogen wurde in zwei Phantomstärken, 18 und 28 cm, verifiziert.

Ergebnisse

Die gemessenen Profile zeigten in 9 cm Messtiefe eine relative mittlere Dosis von 99,7 % [Standardabweichung (SD) 0,7 %] über die gesamte Messlänge von 2 m. Die maximalen Abweichungen variierten zw. Dmin 98,3 % und Dmax 100,6 %. Die mittlere Dosis in 2 cm Tiefe betrug 102,7 % (SD 2,1 %). Die Messungen im Plattenphantom mit 28 cm Stärke zeigten eine mittlere Dosis von 95,9 % (SD 2,9 %) in 14 cm Messtiefe. Die mittlere Dosis in 2 cm Tiefe betrug 111,9 % (SD 4,1 %). Die Nettobestrahlungszeit für 2 Gy beträgt etwa 8 min.

Schlussfolgerung

Die von uns entwickelte modulierte Rotationstechnik bittet eine extrem schnelle, robuste und einfache Alternative zu etablierten Ganzkörperbehandlungstechniken, die ohne zusätzliches Equipment in kleinen Bestrahlungsräumen eine homogene Dosisapplikation ermöglicht.

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Authors and Affiliations

  1. Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer Ufer 1–3, 68167, Mannheim, Germany

    Martin Polednik Ph.D., Frank Lohr M.D., Michael Ehmann M.D. & Frederik Wenz M.D.

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  1. Martin Polednik Ph.D.
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  2. Frank Lohr M.D.
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  3. Michael Ehmann M.D.
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  4. Frederik Wenz M.D.
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Correspondence to Martin Polednik Ph.D..

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Conflict of interest

Martin Polednik has received teaching honoraria from Elekta. Frank Lohr has received research and travel support from Elekta, IBA, and C-Rad and teaching honoraria from Elekta and IBA and is a board member of C-Rad. Frederik Wenz has received honoraria and travel support as a medical advisor from Elekta.

Michael Ehmann has received teaching honoraria from Elekta.

The accompanying manuscript does not include studies on humans or animals.

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Polednik, M., Lohr, F., Ehmann, M. et al. Accelerating total body irradiation with large field modulated arc therapy in standard treatment rooms without additional equipment. Strahlenther Onkol 191, 869–874 (2015). https://doi.org/10.1007/s00066-015-0883-6

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  • DOI: https://doi.org/10.1007/s00066-015-0883-6

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