6. The technique of total body irradiation applied in the St. Leszczyński Memorial Hospital in Katowice

Abstract

At the St. Leszczynski Memorial Hospital in Katowice a modification of TBI technique was prepared. For this a special two variant of body frame – one for treatment planning and an another one for treatment delivery – was made. The total dose of 12 – 15 Gy (in lung not more than 9 Gy) was delivered in six fraction of 15 MV photons, produced in Primus linear accelerator, for 3 consecutive days. Patient was treated by a combination of fields: lateral – set at SSD of 330 cm and AP/PA – set at 135 cm. The dose-rate measured at 10 cm in a water phantom for lateral fields was 4,3 cGy/min., and for AP/PA fields 23,6 cGy/min. Lung shields were made from wood alloy and their shape was carried out from computerized tomograph scans (CT). For each patient a set of computerized tomograph scans was prepared. Patient during the CT was laying in supine position in the body frame made of 1 cm thick plexi plates. On the walls of that body frame a special marks of tin material were inserted. These marks allow to reproduce both – the same patient position during the irradiation and also in the treatment planning system HELAX. Position of shields before AP/PA fraction was determined by means of HELAX, and then shields were fastened to plexi trays inserted in the head of Primus. Lung was also shielded during one lateral fraction and the shape of the shield was carried out on a simulator. The volume between the patient and walls of the body frame was fulfilled by bolus (bags with rice) to get a homogenous dose distribution. The electron boost to the thorax wall (shielded for 15 MV photons) was delivered with a 6 or 9 MeV electron beam. The percentage deviation of dose, for all 9 irradiated patients, calculated at ten anatomical points representative of the body anatomy, was in the limit −0,4% to +13% (excluded in lung) from the dose delivered to PC (reference point: 1/2 AP and 1/2 lateral dimension at 1/2 of patient length in irradiation position). The in vivo measurements carried out by means of MOSFET detectors confirmed that accuracy.