Dosimetry of hip irradiation for the prevention of heterotopic bone formation after arthroplasty

Abstract

Purpose: The dosimetry of hip irradiation for the prevention of heterotopic bone formation following arthroplasty is complicated by the use of custom shielding in the treatment portal, and the fact that irradiation is usually required during a 48 hour period following surgery. Both the machine output and depth dose factors of the resulting fields are modified by the presence of the shielding blocks. A simplified dosimetric approach, based on correction factors for both the output and depth dose as a function of field geometry is presented for various megavoltage energy beams.Materials and Methods: Measurements of relative dose factors (RDF) and percentage depth dose (PDD) were carried out for different combinations of field size, block size and separation between adjacent blocks. Both RDF and PDD measurements were made in a water phantom. Ratios of RDF and PDD were obtained by dividing individual measurements or curves by the corresponding values for the open field (i.e., without blocks). The average values of these ratios constitute the correction factors to be applied for a given MU or treatment time calculation.Results: Extensive RDF and PDD measurements reveal that for the field and block dimensions of interest the correction factors for RDF can be parameterized as a function of separation between two adjacent blocks and beam energy alone and the depth correction factors are additionally only a function of depth. The correction factors for depth dose are equally valid for fixed source-skin distance techniques (that use PDD) and fixed source-axis distance techniques (that use TMR).Conclusion: A simple model for the calculation of output in hip irradiation is presented for the situation where the use of computer-based algorithms may not be practical. The model accurately predicts the RDF of the treatment portal to within 2% and the PDD to within 2% for the range of field sizes, block sizes, block gaps and beam energies of interest ignoring other variables.