Impact of respiratory motion on lung dose during total marrow irradiation
We evaluated the impact of respiratory motion on the lung dose during linac-based intensity-modulated total marrow irradiation (IMTMI) using two different approaches: (1) measurement of doses within the lungs of an anthropomorphic phantom using thermoluminescent detectors (TLDs) and (2) treatment de...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.924961/full |
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| author | Ayse Gulbin Kavak Murat Surucu Kang-Hyun Ahn Kang-Hyun Ahn Erik Pearson Bulent Aydogan Bulent Aydogan |
| author_facet | Ayse Gulbin Kavak Murat Surucu Kang-Hyun Ahn Kang-Hyun Ahn Erik Pearson Bulent Aydogan Bulent Aydogan |
| author_sort | Ayse Gulbin Kavak |
| collection | DOAJ |
| description | We evaluated the impact of respiratory motion on the lung dose during linac-based intensity-modulated total marrow irradiation (IMTMI) using two different approaches: (1) measurement of doses within the lungs of an anthropomorphic phantom using thermoluminescent detectors (TLDs) and (2) treatment delivery measurements using ArcCHECK where gamma passing rates (GPRs) and the mean lung doses were calculated and compared with and without motion. In the first approach, respiratory motions were simulated using a programmable motion platform by using typical published peak-to-peak motion amplitudes of 5, 8, and 12 mm in the craniocaudal (CC) direction, denoted here as M1, M2, and M3, respectively, with 2 mm in both anteroposterior (AP) and lateral (LAT) directions. TLDs were placed in five selected locations in the lungs of a RANDO phantom. Average TLD measurements obtained with motion were normalized to those obtained with static phantom delivery. The mean dose ratios were 1.01 (0.98–1.03), 1.04 (1.01–1.09), and 1.08 (1.04–1.12) for respiratory motions M1, M2, and M3, respectively. To determine the impact of directional respiratory motion, we repeated the experiment with 5-, 8-, and 12-mm motion in the CC direction only. The differences in average TLD doses were less than 1% when compared with the M1, M2, and M3 motions indicating a minimal impact from CC motion on lung dose during IMTMI. In the second experimental approach, we evaluated extreme respiratory motion 15 mm excursion in only the CC direction. We placed an ArcCHECK device on a commercial motion platform and delivered the clinical IMTMI plans of five patients. We compared, with and without motion, the dose volume histograms (DVHs) and mean lung dose calculated with the ArcCHECK-3DVH tool as well as GPR with 3%, 5%, and 10% dose agreements and a 3-mm constant distance to agreement (DTA). GPR differed by 11.1 ± 2.1%, 3.8 ± 1.5%, and 0.1 ± 0.2% with dose agreement criteria of 3%, 5%, and 10%, respectively. This indicates that respiratory motion impacts dose distribution in small and isolated parts of the lungs. More importantly, the impact of respiratory motion on the mean lung dose, a critical indicator for toxicity in IMTMI, was not statistically significant (p > 0.05) based on the Student’s t-test. We conclude that most patients treated with IMTMI will have negligible dose uncertainty due to respiratory motion. This is particularly reassuring as lung toxicity is the main concern for future IMTMI dose escalation studies. |
| first_indexed | 2024-04-13T19:43:02Z |
| format | Article |
| id | doaj.art-420a7c1ce5e34e899c6be67fc01b8970 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-13T19:43:02Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-420a7c1ce5e34e899c6be67fc01b89702022-12-22T02:32:49ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-10-011210.3389/fonc.2022.924961924961Impact of respiratory motion on lung dose during total marrow irradiationAyse Gulbin Kavak0Murat Surucu1Kang-Hyun Ahn2Kang-Hyun Ahn3Erik Pearson4Bulent Aydogan5Bulent Aydogan6Department of Radiation Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, TurkeyDepartment of Radiation Oncology, Stanford University School of Medicine, Stanford, CA, United StatesDepartment of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL, United StatesDepartment of Radiation Oncology, University of Illinois at Chicago Medical Center, Chicago, IL, United StatesDepartment of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL, United StatesDepartment of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL, United StatesDepartment of Radiation Oncology, University of Illinois at Chicago Medical Center, Chicago, IL, United StatesWe evaluated the impact of respiratory motion on the lung dose during linac-based intensity-modulated total marrow irradiation (IMTMI) using two different approaches: (1) measurement of doses within the lungs of an anthropomorphic phantom using thermoluminescent detectors (TLDs) and (2) treatment delivery measurements using ArcCHECK where gamma passing rates (GPRs) and the mean lung doses were calculated and compared with and without motion. In the first approach, respiratory motions were simulated using a programmable motion platform by using typical published peak-to-peak motion amplitudes of 5, 8, and 12 mm in the craniocaudal (CC) direction, denoted here as M1, M2, and M3, respectively, with 2 mm in both anteroposterior (AP) and lateral (LAT) directions. TLDs were placed in five selected locations in the lungs of a RANDO phantom. Average TLD measurements obtained with motion were normalized to those obtained with static phantom delivery. The mean dose ratios were 1.01 (0.98–1.03), 1.04 (1.01–1.09), and 1.08 (1.04–1.12) for respiratory motions M1, M2, and M3, respectively. To determine the impact of directional respiratory motion, we repeated the experiment with 5-, 8-, and 12-mm motion in the CC direction only. The differences in average TLD doses were less than 1% when compared with the M1, M2, and M3 motions indicating a minimal impact from CC motion on lung dose during IMTMI. In the second experimental approach, we evaluated extreme respiratory motion 15 mm excursion in only the CC direction. We placed an ArcCHECK device on a commercial motion platform and delivered the clinical IMTMI plans of five patients. We compared, with and without motion, the dose volume histograms (DVHs) and mean lung dose calculated with the ArcCHECK-3DVH tool as well as GPR with 3%, 5%, and 10% dose agreements and a 3-mm constant distance to agreement (DTA). GPR differed by 11.1 ± 2.1%, 3.8 ± 1.5%, and 0.1 ± 0.2% with dose agreement criteria of 3%, 5%, and 10%, respectively. This indicates that respiratory motion impacts dose distribution in small and isolated parts of the lungs. More importantly, the impact of respiratory motion on the mean lung dose, a critical indicator for toxicity in IMTMI, was not statistically significant (p > 0.05) based on the Student’s t-test. We conclude that most patients treated with IMTMI will have negligible dose uncertainty due to respiratory motion. This is particularly reassuring as lung toxicity is the main concern for future IMTMI dose escalation studies.https://www.frontiersin.org/articles/10.3389/fonc.2022.924961/fullorgan motiondose deliverybreathing motionTMItotal marrow irradiation |
| spellingShingle | Ayse Gulbin Kavak Murat Surucu Kang-Hyun Ahn Kang-Hyun Ahn Erik Pearson Bulent Aydogan Bulent Aydogan Impact of respiratory motion on lung dose during total marrow irradiation Frontiers in Oncology organ motion dose delivery breathing motion TMI total marrow irradiation |
| title | Impact of respiratory motion on lung dose during total marrow irradiation |
| title_full | Impact of respiratory motion on lung dose during total marrow irradiation |
| title_fullStr | Impact of respiratory motion on lung dose during total marrow irradiation |
| title_full_unstemmed | Impact of respiratory motion on lung dose during total marrow irradiation |
| title_short | Impact of respiratory motion on lung dose during total marrow irradiation |
| title_sort | impact of respiratory motion on lung dose during total marrow irradiation |
| topic | organ motion dose delivery breathing motion TMI total marrow irradiation |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.924961/full |
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