EPID-based in vivo dosimetry for stereotactic body radiotherapy of non-small cell lung tumors: Initial clinical experience |
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| Institution: | 1. Fisica Sanitaria ACO San Filippo Neri, Roma, Italy;2. Istituto di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy;3. UOC di Fisica Sanitaria, Fondazione Policlinico Gemelli, Rome, Italy;4. UOC di Radioterapia, San Filippo Neri Hospital, ASL Roma1, Rome, Italy;1. Departamento de Fisiología Médica y Biofísica, Universidad de Sevilla, Spain;2. Servicio de Radiofísica, Hospital Universitario Virgen Macarena, Sevilla, Spain;3. Instituto de Física, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile;4. Istituto Nazionale di Fisica Nucleare, Frascati, Italy;1. Department of Medical Physics, Centre Oscar Lambret and University Lille 1, France;2. Academic Department of Radiation Oncology, Centre Oscar Lambret and University Lille 2, France;1. Hiroshima High-Precision Radiotherapy Cancer Center, 3-2-2, Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan;2. Department of Radiation Oncology, Institute of Biomedical & Health Science, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima 734-8551, Japan;1. CELIA, Centre Laser Intenses et Applications, Université de Bordeaux-CNRS-CEA, F-33400 Talence, France;2. Department of Radiotherapy, Institut Bergonié, Comprehensive Cancer Center, F-33076 Bordeaux, France;1. School of Health Sciences, University of South Australia, Adelaide, Australia;2. Sansom Institute for Health Research, University of South Australia, Adelaide, Australia;3. School of Physical Sciences, University of Adelaide, Adelaide, Australia;4. The Thailand Office for Peace, Bangkok, Thailand;5. Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia;6. School of Medicine, University of Adelaide, Adelaide, Australia;7. Faculty of Science, University of Oradea, Oradea 410087, Romania;1. International Atomic Energy Agency, Department of Nuclear Sciences and Applications, Division of Human Health, Dosimetry and Medical Radiation Physics Section, Vienna International Centre, PO Box 100, A-1400 Vienna, Austria;2. Technische Universität München, Klinikum Rechts der Isar, Klinik für Strahlentherapie und Radiologische Onkologie, Ismaninger Str.22, D-81675 Munich, Germany;3. Centers for Disease Control and Prevention, Radiation Studies Branch, Div. of Environmental Hazards and Health Effects, National Center for Environmental Health, 4770 Buford Highway, NE, Atlanta 30341-3717, GA, United States;4. International Atomic Energy Agency, Department of Nuclear Safety and Security, Division of Radiation, Office of the Deputy Director General, Incident and Emergency Centre, Vienna International Centre, PO Box 100, A-1400 Vienna, Austria;5. Medical and Technical Director REAC/TS and Clinical Professor, Department of Therapeutic Radiology, Yale University School of Medicine Radiation Emergency Assistance Center/Training Site, P.O. Box 117, MS 39, Oak Ridge, TN 37831, United States;6. Executive Officer, National Institutes for Quantum and Radiological Science and Technology (QST) 4-9-1 Anagawa, Inage-ku, Chiba-city, Chiba 263-8555, Japan;7. International Atomic Energy Agency, Department of Nuclear Safety and Security, Division of Radiation, Transport and Waste Safety, Radiation Safety and Monitoring Section, Radiation Protection of Patients Unit, Vienna International Centre, PO Box 100, A-1400 Vienna, Austria;8. Department of Radiation Health Management, Fukushima Medical University, Fukushima 960-1295, Japan |
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| Abstract: | PurposeEPID-based in vivo dosimetry (IVD) has been implemented for stereotactic body radiotherapy treatments of non-small cell lung cancer to check both isocenter dose and the treatment reproducibility comparing EPID portal images.Methods15 patients with lung tumors of small dimensions and treated with volumetric modulated arc therapy were enrolled for this initial experience. IVD tests supplied ratios R between in vivo reconstructed and planned isocenter doses. Moreover a γ-like analysis between daily EPID portal images and a reference one, in terms of percentage of points with γ-value smaller than 1, Pγ<1, and mean γ-values, γmean, using a local 3%–3 mm criteria, was adopted to check the treatment reproducibility. Tolerance levels of 5% for R ratio, Pγ<1 higher than 90% and γmean lower than 0.67 were adopted.ResultsA total of 160 EPID images, two images for each therapy session, were acquired during the treatment of the 15 patients. The overall mean of the R ratios was equal to 1.005 ± 0.014 (1 SD), with 96.9% of tests within ± 5%. The 2 D image γ-like analysis showed an overall γmean of 0.39 ± 0.12 with 96.1% of tests within the tolerance level, and an average Pγ<1 value equal to 96.4 ± 3.6% with 95.4% of tests with Pγ<1 > 90%. Paradigmatic discrepancies were observed in three patients: a set-up error and a patient morphological change were identified thanks to CBCT image analysis whereas the third discrepancy was not fully justified.ConclusionsThis procedure can provide improved patient safety as well as a first step to integrate IVD and CBCT dose recalculation. |
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| Keywords: | In vivo dosimetry EPID SBRT Lung |
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