Planning of radiotherapy for patients with hip prosthesis

The presence of metallic prostheses during external beam radiotherapy of malignancies in the pelvic region has the potential to strongly influence the dose distribution to the target and to tissue surrounded by the prostheses. This study systematically investigates the perturbation effects of unilateral titanium prosthesis on 6 and 15 MV photon beam dose distributions using Gafchromic EBT2 film measurements in a novel pelvic phantom made out of a stack of nylon slices. Comparisons were also made between the film data and dose calculations made on XiO and Monaco treatment planning systems. The collapsed cone algorithm was chosen for the XiO and the Monte Carlo algorithm used on Monaco is XVMC. Transmission measurements were taken using a narrow‐beam geometry to determine the mass attenuation coefficient of nylon = 0.0458 cm2/g and for a water‐equivalent RW3 phantom, it was 0.0465 cm2/g. The perturbation effects of the prosthesis on dose distributions were investigated by measuring and comparing dose maps and profiles. The magnitude of dose perturbations was quantified by calculating dose enhancement and reduction factors using field sizes of 3 × 3, 5 × 5, 10 × 10, and 15 × 15 cm2. For the studied beams and field sizes, dose enhancements between 21 and 30% and dose reductions between 15 and 21% were observed at the nylon‐prosthesis interface on the proximal and distal sides of the prosthesis for film measurements. The dose escalation increases with beam energy, and the dose reduction due to attenuation decreases with increasing beam energy when compared to unattenuated beam data. A comparison of film and XiO depth doses for the studied fields gave relative errors between 1.1 and 23.2% at the proximal and distal interfaces of the Ti prosthesis. Also, relative errors < 4.0% were obtained between film and Monaco dose data outside the prosthesis for 6 and 15 MV lateral opposing fields.

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Dose comparison between Gafchromic film, XiO, and Monaco treatment planning systems in a novel pelvic phantom that contains a titanium hip prosthesis

Ade

Plessis

2017

Evaluation of dose calculation accuracy of treatment planning systems at hip prosthesis interfaces

Paulu

Alaei

2017

There are an increasing number of radiation therapy patients with hip prosthesis. The common method of minimizing treatment planning inaccuracies is to avoid radiation beams to transit through the prosthesis. However, the beams often exit through them, especially when the patient has a double‐prosthesis. Modern treatment planning systems employ algorithms with improved dose calculation accuracies but even these algorithms may not predict the dose accurately at high atomic number interfaces.The current study evaluates the dose calculation accuracy of three common dose calculation algorithms employed in two commercial treatment planning systems. A hip prosthesis was molded inside a cylindrical phantom and the dose at several points within the phantom at the interface with prosthesis was measured using thermoluminescent dosimeters. The measured doses were then compared to the predicted ones by the planning systems.The results of the study indicate all three algorithms underestimate the dose at the prosthesis interface, albeit to varying degrees, and for both low‐ and high‐energy x rays. The measured doses are higher than calculated ones by 5–22% for Pinnacle Collapsed Cone Convolution algorithm, 2–23% for Eclipse Acuros XB, and 6–25% for Eclipse Analytical Anisotropic Algorithm. There are generally better agreements for AXB algorithm and the worst results are for the AAA.

Study of dosimetric properties of flattened and unflattened megavoltage x ray beam on high Z implant materials

Rajamanickam

Muthu

Murugan

et al. 2018

PurposeAddition of high Z implants in the treatment vicinity or beam path is unavoidable in certain clinical situation. In this work, we study the properties of radiation interaction parameters such as mass attenuation coefficient (MAC), x ray beam transmission factor (indirect beam attenuation), interface effects like backscatter dose perturbation factor (BSDF) and forward dose perturbation factor (FDPF) for flattened (FF) and unflattened (UF) x ray beams.Methods MAC for stainless steel and titanium alloy was measured using CC13 chamber with appropriate buildup in narrow beam geometry. The x ray beam transmission factors were measured for stainless steel and titanium alloy for different field size, off‐axis, and depths. Profile analysis was performed using a radiation field analyzer (RFA) as a function of field size and depth to study the influence of phantom scattering and spectral variation in the beam. In addition, interface effects such as BSDF and FDPF were measured with gafchromic films at maximum BSDF peak position calculated using Acuros XB algorithm and with PPC40 chamber measured at exit side of high Z material, respectively.ResultsThe MAC in both cases decreases with increase in energy for stainless steel (SS) and titanium (Ti) alloy. The MAC increases with the change in x ray beam type from flattened to UF beam because of relatively lower mean energy. The x ray beam transmission factor increases with the increase in energy, field size, and depth owing to increase in penetration power phantom scatter, respectively. The measured BSDF and FDPF were found to be in good agreement with AXB algorithm.ConclusionThe dosimetric properties of x ray photon beam were studied comprehensively in the presence of high Z material like stainless steel and titanium alloy using both flattened and UF beams to understand and incorporate the findings of various parameters in clinical condition due to the variation in energy spectrum from FF to UF x ray beam.