Skip to main content

Dosimetric analysis of the effects of a temporary tissue expander on the radiotherapy technique

La radiologia medica volume 126, pages 437–444 (2021)Cite this article

Abstract

Aims

The current study aimed to evaluate the dose effect of a temporary tissue expander (TTE) according to the radiotherapy technique for breast cancer patients.

Materials and methods

Computed tomography images of a 3D-printed breast phantom with a TTE were acquired for dosimetric analysis. For dose measurement during 180 cGy of radiotherapy, 13 EBT3 films were attached to the TTE while including the metal port area. Treatment planning was performed for three-dimensional conformal radiotherapy (3DCRT), field-in-field radiotherapy, intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT) while considering whether a bolus was used and whether artifacts were corrected. The difference at each point between the measured mean and calculated doses was analyzed to determine the association with the radiotherapy techniques.

Results

The effect of the metal port on the radiation dose was associated with the treatment technique. The dose difference between the measured and calculated doses was 6.8% (191.6 cGy vs. 179.5 cGy) for cases treated with 3DCRT with bolus and artifact correction. The dose difference for cases treated with VMAT and 3DCRT without bolus and with artifact correction was 5.8% (190.2 cGy vs. 179.8 cGy) and 5.6% (193.3 cGy vs. 183.1 cGy), respectively. IMRT with the bolus showed a minimum difference of 0.3% (180.7 cGy vs. 181.3 cGy).

Conclusion

The presence of the metal port within the TTE in radiation fields resulted to insignificant increased dose differences according to the treatment technique. Future studies should assess whether this dose difference could affect clinical outcomes.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

References

  1. Shankar RA, Nibhanupudy JR, Sridhar R, Ashton C, Goldson AL (2003) Immediate breast reconstruction-impact on radiation management. J Natl Med Assoc 95(4):286–295

    PubMed  PubMed Central  Google Scholar 

  2. Thompson RC, Morgan AM (2005) Investigation into dosimetric effect of a MAGNA-SITE tissue expander on post-mastectomy radiotherapy. Med Phys 32(6):1640–1646. https://doi.org/10.1118/1.1914545

    Article  PubMed  Google Scholar 

  3. Asena A, Kairn T, Crowe SB, Trapp JV (2015) Establishing the impact of temporary tissue expanders on electron and photon beam dose distributions. Phys Med 31(3):281–285. https://doi.org/10.1016/j.ejmp.2015.01.015

    CAS  Article  PubMed  Google Scholar 

  4. Strang B, Murphy K, Seal S, Cin AD (2013) Does the presence of an implant including expander with internal port alter radiation dose? An ex vivo model. Can J Plast Surg 21(1):37–40. https://doi.org/10.1177/229255031302100109

    Article  PubMed  PubMed Central  Google Scholar 

  5. Moni J, Graves-Ditman M, Cederna P, Griffith K, Krueger EA, Fraass BA, Pierce LJ (2004) Dosimetry around metallic ports in tissue expanders in patients receiving postmastectomy radiation therapy: an ex vivo evaluation. Med Dosim 29(1):49–54. https://doi.org/10.1016/j.meddos.2003.10.005

    Article  PubMed  Google Scholar 

  6. Moni J, Saleeby J, Bannon E, Lo YC, Fitzgerald TJ (2015) Dosimetric impact of the AeroForm tissue expander in postmastectomy radiation therapy: an ex vivo analysis. Pract Radiat Oncol 5(1):e1–8. https://doi.org/10.1016/j.prro.2014.04.001

    Article  PubMed  Google Scholar 

  7. Yoon J, Xie Y, Heins D, Zhang R (2018) Modeling of the metallic port in breast tissue expanders for photon radiotherapy. J Appl Clin Med Phys 19(3):205–214. https://doi.org/10.1002/acm2.12320

    Article  PubMed  PubMed Central  Google Scholar 

  8. Chen SA, Ogunleye T, Dhabbaan A, Huang EH, Losken A, Gabram S, Davis L, Torres MA (2013) Impact of internal metallic ports in temporary tissue expanders on postmastectomy radiation dose distribution. Int J Radiat Oncol Biol Phys 85(3):630–635. https://doi.org/10.1016/j.ijrobp.2012.06.046

    Article  PubMed  Google Scholar 

  9. Gee HE, Bignell F, Odgers D, Gill S, Martin D, Toohey J, Carroll S (2016) In vivo dosimetric impact of breast tissue expanders on post-mastectomy radiotherapy. J Med Imaging Radiat Oncol 60(1):138–145. https://doi.org/10.1111/1754-9485.12403

    Article  PubMed  Google Scholar 

  10. Shimamoto H, Sumida I, Kakimoto N, Marutani K, Okahata R, Usami A, Tsujimoto T, Murakami S, Furukawa S, Tetradis S (2015) Evaluation of the scatter doses in the direction of the buccal mucosa from dental metals. J Appl Clin Med Phys 16(3):5374. https://doi.org/10.1120/jacmp.v16i3.5374

    Article  PubMed  Google Scholar 

  11. Kesen ND, Akbas U, Koksal C, Bilge H (2019) Investigation of AAA dose calculation algorithm accuracy in surface and buildup region for 6MV photon beam using markus parallel-plate ion chamber. J X-ray Sci Technol 27(2):361–369. https://doi.org/10.3233/XST-180489

    CAS  Article  Google Scholar 

  12. Marroquin EY, Herrera Gonzalez JA, Camacho Lopez MA, Barajas JE, Garcia-Garduno OA (2016) Evaluation of the uncertainty in an EBT3 film dosimetry system utilizing net optical density. J Appl Clin Med Phys 17(5):466–481. https://doi.org/10.1120/jacmp.v17i5.6262

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chatzigiannis C, Lymperopoulou G, Sandilos P, Dardoufas C, Yakoumakis E, Georgiou E, Karaiskos P (2011) Dose perturbation in the radiotherapy of breast cancer patients implanted with the Magna-Site: a Monte Carlo study. J Appl Clin Med Phys 12(2):3295. https://doi.org/10.1120/jacmp.v12i2.3295

    Article  PubMed  Google Scholar 

  14. Kovacs DG, Rechner LA, Appelt AL, Berthelsen AK, Costa JC, Friborg J, Persson GF, Bangsgaard JP, Specht L, Aznar MC (2018) Metal artefact reduction for accurate tumour delineation in radiotherapy. Radiother Oncol 126(3):479–486. https://doi.org/10.1016/j.radonc.2017.09.029

    Article  PubMed  PubMed Central  Google Scholar 

  15. Shen ZL, Xia P, Klahr P, Djemil T (2015) Dosimetric impact of orthopedic metal artifact reduction (O-MAR) on Spine SBRT patients. J Appl Clin Med Phys 16(5):106–116. https://doi.org/10.1120/jacmp.v16i5.5356

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This work was supported by a research Grant from Jeju National University Hospital in 2018.

Author information

Affiliations

  1. Department of Radiation Oncology, Jeju National University Hospital, Jeju University College of Medicine, 15, Aran 13-gil, Jeju-si, Jeju-do, 63241, South Korea

    So Hyun Park, Young Suk Kim & Jinhyun Choi

Authors
  1. So Hyun Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Young Suk Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jinhyun Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Young Suk Kim or Jinhyun Choi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Park, S.H., Kim, Y.S. & Choi, J. Dosimetric analysis of the effects of a temporary tissue expander on the radiotherapy technique. Radiol med 126, 437–444 (2021). https://doi.org/10.1007/s11547-020-01297-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-020-01297-6

Keywords

  • Post-mastectomy radiotherapy
  • Temporary tissue expander
  • Metal port
  • Metal artifact
  • Dose effect