Total body irradiation—an attachment free sweeping beam technique

Hartl, Philipp; Treutwein, Marius; Hautmann, Matthias G.; März, Manuel; Pohl, Fabian; Kölbl, Oliver; Dobler, Barbara

doi:10.1186/s13014-016-0658-y

Cited by 13 publications

(20 citation statements)

References 24 publications

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“…In our survey, when the moving-couch technique was used, the dose rate was calculated as the ratio of the dose to the total duration of irradiation. Because the moving couch or table transports the patient only once, during which time his or her whole body is irradiated, the point dose rates are high [ 26 , 27 ]. There are as yet no reports on how to calculate the dose rate in cases in which the moving-couch or moving-table method is used, nor has a potential association between the dose rate and toxicity been investigated.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the lungs were shielded in all patients treated at the eight institutions using the moving-couch technique. This may be because the total treatment duration is shorter in these patients than in patients treated using the long-SSD technique, and the moving couch allows for more precise placement of the shielding blocks [ 27 ]. Among the lung-shielding institutions, the most frequent maximum acceptable total dose for the lungs was 8 Gy, which was comparable with the acceptable total dose determined in the 2014 survey [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

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National survey of myeloablative total body irradiation prior to hematopoietic stem cell transplantation in Japan: survey of the Japanese Radiation Oncology Study Group (JROSG)

Ishibashi

Soejima

Kawaguchi

et al. 2018

Journal of Radiation Research

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A myeloablative regimen that includes total-body irradiation (TBI) before hematopoietic stem cell transplantation results in higher patient survival rates than achieved with regimens without TBI. The TBI protocol, however, varies between institutions. In October 2015, the Japanese Radiation Oncology Study Group initiated a national survey of myeloablative TBI (covering 2010–2014). Among the 186 Japanese institutions performing TBI, 90 (48%) responded. The 82 institutions that had performed myeloablative TBI during this period treated 2698 patients with malignant disease [leukemia (2082 patients, 77.2%), malignant lymphoma (378, 14%)] and 37 with non-malignant disease [severe aplastic anemia (20, 54%), inborn errors of metabolism (5, 14%)]. A linear accelerator was used at all institutions. The institutions were divided into 41 large and 41 small institutions based on the median number of patients. The long source–surface distance technique was the method of choice in the 34 institutions (82.9%) and the moving-couch technique in the 7 (17.1%) in the large institutions. The schedules most routinely used by the participating institutions consisted of 12 Gy/6 fractions/3 days (26 institutions, 63.5%) in the large institutions. The dose rate varied from 5 to 26 cGy/min. The lungs and lenses were routinely shielded in 23 large institutions (56.1%), and only the lungs in 9 large institutions (21.9%). At lung-shielding institutions, the most frequent maximum acceptable total dose for the lungs was 8 Gy (19 institutions, 27.5%). Our results reveal considerable differences in the TBI methods used by Japanese institutions and thus the challenges in designing multicenter randomized trials based on TBI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

National survey of myeloablative total body irradiation prior to hematopoietic stem cell transplantation in Japan: survey of the Japanese Radiation Oncology Study Group (JROSG)

Ishibashi

Soejima

Kawaguchi

et al. 2018

Journal of Radiation Research

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“…By changing assigned electron densities (ED) dialogs of couch model, to find the best electron densities for the modeled couchtop. To determine the PD for a beam perpendicular to lateral sections of the couch top, three positions of PD values were obtained as a function of gantry angle for A‐B direction: on the left half (L), in the center (C), and on the right half (R) of the couch zone (see Fig. ).…”

Section: Methodsmentioning

confidence: 99%

Quantification and comparison the dosimetric impact of two treatment couch model in VMAT

Zhang

Gao

Bai

2017

J Applied Clin Med Phys

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The use of Monte Carlo treatment planning systems (TPS) in radiation therapy has increased the dosimetric accuracy of VMAT treatment sequences. However, this accuracy is compromised by not including the treatment couch into the treatment planning process. Therefore, the impact of the treatment couch on radiation delivery output was determined, and two different couch models (uniform couch model A vs two components model B) were included and tested in the Monaco TPS to investigate which model can better quantify the couch influence on radiation dose. Relative attenuation measurements were performed following procedures outlined by TG‐176 with three phantom positions for A–B direction: on the left half (L), in the center (C) and on the right half (R) of the couch. As well as absolute dose comparison of static fields of 10 × 10 cm2 that were delivered through the couch tops with that calculated in the TPS with the couch model at 2 mm and 5 mm computing grid size respectively. The most severe percentage deviation was 4.60% for the phantom positioned at the left half of the couch with 5 mm grid size at gantry angle 120°. The couch model was included in the TPS with a uniform ED of 0.26 g/cm3 or a two component model with a fiber 0.52 g/cm3 and foam core 0.1 g/cm3. After including the treatment couch, the maximum mean dose attenuation was reduced from 3.68% without couch included to (0.60, 0.83, 0.72, and 1.02) % for model A and model B at 2 and 5 mm voxel grid size. The results obtained showed that Model A performed better than the model B, demonstrating lower deviations from measurements and better robustness against dose grid resolution changes. Considering the results of this study, we propose the systematic introduction of the couch Model A in clinical routine. All the reported findings are valid for the Elekta iBEAM ® evo Extension 415 couch and these methods can also be used for other couch model.

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“…Most importantly, these above conventional large-eld techniques require an extended source-to skin distance (SSD) that may not be available in standard-sized Linear accelerator room. 14 Petra M. Härt et al introduced a sweeping beam technique for total body irradiation in standard treatment rooms and for standard linear accelerators. The patient is positioned on a low couch on the oor, the longitudinal axis of the body in the rotational plane of the linac.…”

Section: Quality Assurancementioning

confidence: 99%

First Experience of Standard Linac, Rapid Arc and Dose-drop Scheme Based Total Body Irradiation

Xu¹,

Li²,

Hui³

et al. 2020

Preprint

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Background and purpose: To introduce a standard linac with true attachment free, rapid arc and dose-drop scheme for positioning related dose deviation control based total body irradiation(TBI).Materials/Methods: One eight years old girl diagnosed with acute lymphocytic leukemia underwent TBI in 2020. Target volumes and organs at risk were contoured after CT simulation. Total sixteen ARC and four AP-PA from five isocenters were designed. A dose-drop scheme on both sides of adjacent region were performed to reduce positioning-related dose deviation. A series of quality assurance before radiotherapy and real-time dose monitoring during radiotherapy were carried out.Results: The average on board imaging (OBI) time of per fraction was 40.3 min, the average beam on time of per fraction was 37.2 min, the average time to change from head first to feet first position was 18.4 min. The average mean lung dose was 9.89 Gy, the maximum lens dose was 7.60 Gy, the mean PTV_total dose was 12.17Gy, 98.23% PTV_total volume was covered by 90% of the prescription dose. The maximum dose (Dmax) of PTV_total was 13.65Gy. Dmean and V10.8 of PTV_total are only slightly different(0.49% - 1.89% and 0.26% - 1.04% respectively) even with an error of 5 - 20mm longitudinal misalignments. Gamma passing rate(3mm/ 3% Gamma criteria) are between 93.5% and 100%. Real-time dose monitoring showed an overall deviation of -3.9%±5.51%.Conclusions: Standard linac, rapid arc and dose-drop for positioning-related dose deviation control based total body irradiation is feasible, accurate, and reliable. It is worthy of clinical application.

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Total body irradiation—an attachment free sweeping beam technique

Cited by 13 publications

References 24 publications

National survey of myeloablative total body irradiation prior to hematopoietic stem cell transplantation in Japan: survey of the Japanese Radiation Oncology Study Group (JROSG)

National survey of myeloablative total body irradiation prior to hematopoietic stem cell transplantation in Japan: survey of the Japanese Radiation Oncology Study Group (JROSG)

Quantification and comparison the dosimetric impact of two treatment couch model in VMAT

First Experience of Standard Linac, Rapid Arc and Dose-drop Scheme Based Total Body Irradiation

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