Preliminary study of VMAT for total-body irradiation: rotating table design
DOI:
https://doi.org/10.32685/2590-7468/invapnuclear.6.2022.643Keywords:
total body irradiation (TBI), volumetric intensity modulated arctherapy (VMAT), rotating table, treatment planning system (TPS), immobilization, simulation
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Copyright (c) 2022 Andrés Pinzón C., Axel Simbaqueba, Juan Rodríguez, Stella Veloza, José Esguerra C.
This work is licensed under a Creative Commons Attribution 4.0 International License.
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Abstract
Total body irradiation (TBI) is a prebone marrow transplant therapy in which a uniform radiation dose is administered throughout the patient’s body. It seeks to minimize the dose delivered to different organs, such as the lungs and sometimes the kidneys [1]. In Colombia, X-rays by TBI generated by a linear accelerator are performed with the conventional technique, where the patient maintains a standing, fetal or lateral decubitus anatomical position during prolonged irradiation times, which implies that the treatment position for the patient is uncomfortable and has little reproducibility; additionally, its implementation requires source/patient distances of up to 4 meters, and the construction of customized protections [2]. To overcome these difficulties, the National Cancer Institute (INC) aims to develop a protocol to administer TBI using volumetric modulated arc therapy (VMAT). With this inverse optimization technique, a more uniform radiation dose throughout the patient’s body has been reported compared to the conventional technique, which reduces the dose received by organs at risk (OARs). In addition, its implementation does not require large areas in the treatment room, as it is performed at standard source/isocenter distances. This article presents a preliminary study of the TBI/VMAT protocol and its validation, employing an anatomical simulator called the Computerized Imaging Reference System (CIRS): the construction of a rotatable stretcher overlapped on the accelerator table and the tomograph facilitates the change of the patient treatment orientation from craniocauda to caudocraneal, recommendations for immobilization of the patient on the rotatable table, the production of computed tomography images of the whole body using partial image fusion, and the planning of treatment with multiple isocenters and multiple arcs for the calculation of absorbed dose and verification of treatment with overlapping dose measurements in SNC Patient software taken with ArcCheck detectors in different orientations.
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