IMRT/VMAT dose distributions generated for HD® and Millennium® collimators TrueBeam® and Clinac® accelerators

AimThe aim of this study is to answer the question whether the calculated dose distributions for HD and Millennium collimators (Varian Medical Systems) are equivalent for large treatment volumes.BackgroundModern biomedical linacs are equipped with multileaf collimators where leaves can be of different widths. Thinner leaves allow better fit to desired (tumor) shape. At the same time, however, the maximum size of the field that can be obtained with the collimator is also reduced. Varian Medical Systems HD and Millennium collimators can be a good sample. They have 40 cm or 22 cm × 40 cm maximal field size at the isocenter, respectively.Materials and methodsThis paper presents the comparison of selected statistical and dosimetric parameters achieved for treatment plans where the beams for a HD collimator had to be merged because of the size of the tumor volume.Results and discussionAchieved results show that, independently from irradiated volume, there is no statistically significant difference for calculated dose distributions, integral doses, MU values and coefficients evaluating dose distributions for HD and Millennium collimators.ConclusionsResults show that both types of collimators can be used interchangeably for preparing the treatment plans for large tumor volume without quality reduction of the prepared treatment plan.     

Lateral wedge with medial only cardiac shielding (LEMONADE) technique in left chest wall adjuvant radiotherapy

BackgroundThis dosimetric study compared lateral wedge with medial only cardiac shielding (LEMONADE) technique, for left chest wall (LCW) irradiation against three other commonly used techniques.Materials and methodsDosimetric parameters of 22 consecutive LBC patients treated using the P1 (LEMONADE technique) were compared with 3 other virtually reconstructed plans : no cardiac shielding with paired wedges; P2 (paired wedges and medial only Y-direction shielding) and P3 (paired wedges and bilateral Y-direction shielding).ResultsP1 showed better target volume (TV) coverage with the mean 90% isodose coverage of 85.59% ± 5.44 compared to 78.90% ± 8.59 and 74.22% ± 9.50 for P2 and P3, respectively. Compared to no cardiac shielding, for a 4.65% drop in TV coverage the V26Gy of heart dropped from 6.68% to a negligible 0.85% for P1. TV receiving < 30Gy is also significantly lesser for P1 compared to P2 and P3 (5.42% vs 10.64% and 15.8%), whilst there is a small difference of 2.75% between no cardiac shielding and P1.ConclusionWith the improvement in BC survival rate, cardiac toxicity associated with adjuvant irradiation for LBC is a major concern. P1 (LEMONADE) technique has a good compromise between cardiac sparing and target coverage and should suffice for most LCW irradiations. Furthermore, the LEMONADE technique is a simple, reproducible and involves fast planning for cardiac sparing, which is ideal for under-resourced departments with heavy workload.