Cerrobend Blocks Research Articles

A clinical solution for non-toxic 3D-printed photon blocks in external beam radiation therapy.

A well-known limitation of multi-leaf collimators is that they cannot easily form island blocks. This can be important in mantle region therapy. Cerrobend photon blocks, currently used for supplementary shielding, are labor-intensive and error-prone. To address this, an innovative, non-toxic, automatically manufactured photon block using 3D-printing technology is proposed, offering a patient-specific and accurate alternative. The study investigates the development of patient-specific photon shielding blocks using 3D-printing for three different patient cases. A 3D-printed photon block shell filled with tungsten ball bearings (BBs) was designed to have similar dosimetric properties to Cerrobend standards. The generation of the blocks was automated using the Eclipse Scripting API and Python. Quality assurance was performed by comparing the expected and actual weight of the tungsten BBs used for shielding. Dosimetric and field geometry comparisons were conducted between 3D-printed and Cerrobend blocks, utilizing ionization chambers, imaging, and field geometry analysis. The quality assurance assessment revealed a -1.3% average difference in the mass of tungsten ball bearings for different patients. Relative dose output measurements for three patient-specific blocks in the blocked region agreed within 2% of each other. Against the Treatment Planning System (TPS), both 3D-printed and Cerrobend blocks agreed within 2%. For each patient, 6MV image profiles taken through the 3D-printed and Cerrobend blocks agreed within 1% outside high gradient regions. Jaccard distance analysis of the MV images against the TPS planned images, found Cerrobend blocks to have 15.7% dissimilarity to the TPS, while that of the 3D-printed blocks was 6.7%. This study validates a novel, efficient 3D-printing method for photon block creation in clinical settings. Despite potential limitations, the benefits include reduced manual labor, automated processes, and greater precision. It holds potential for widespread adoption in radiation therapy, furthering non-toxic radiation shielding.

Tungsten Filled 3-Dimensional Printed Lung Blocks for Total Body Irradiation

Lung blocks for total-body irradiation are commonly used to reduce lung dose and prevent radiation pneumonitis. Currently, molten Cerrobend containing toxic materials, specifically lead and cadmium, is poured into molds to construct blocks. We propose a streamlined method to create 3-dimensional (3D)-printed lung block shells and fill them with tungsten ball bearings to remove lead and improve overall accuracy in the block manufacturing workflow. 3D-printed lung block shells were automatically generated using an inhouse software, printed, and filled with 2 to 3 mm diameter tungsten ball bearings. Clinical Cerrobend blocks were compared with the physician drawn blocks as well as our proposed tungsten filled 3D-printed blocks. Physical and dosimetric comparisons were performed on a linac. Dose transmission through the Cerrobend and 3D-printed blocks were measured using point dosimetry (ion-chamber) and the on-board Electronic-Portal-Imaging-Device (EPID). Dose profiles from the EPID images were used to compute the full-width-half-maximum and to compare with the treatment-planning-system. Additionally, the coefficient-of-variation in the central 80% of full-width-half-maximum was computed and compared between Cerrobend and 3D-printed blocks. The geometric difference between treatment-planning-system and 3D-printed blocks was significantly lower than Cerrobend blocks (3D: -0.88 ± 2.21 mm, Cerrobend: -2.28 ± 2.40 mm, P = .0002). Dosimetrically, transmission measurements through the 3D-printed and Cerrobend blocks for both ion-chamber and EPID dosimetry were between 42% to 48%, compared with the open field. Additionally, coefficient-of-variation was significantly higher in 3D-printed blocks versus Cerrobend blocks (3D: 4.2% ± 0.6%, Cerrobend: 2.6% ± 0.7%, P < .0001). We designed and implemented a tungsten filled 3D-printed workflow for constructing total-body-irradiation lung blocks, which serves as an alternative to the traditional Cerrobend based workflow currently used in clinics. This workflow has the capacity of producing clinically useful lung blocks with minimal effort to facilitate the removal of toxic materials from the clinic.

Treatment of Mantle and Inverted Y Fields in Modern Era: A VMAT Approach.

Hodgkin's lymphoma has been treated with combined modality therapy (chemotherapy and radiation) with a very high degree of success. Total Nodal Irradiation (TNI) performed with large AP/PA mantle fields for treatment of axillary, cervical, and mediastinal lymphatics, provide adequate coverage to the mediastinum and bilateral axillae and hila, while blocking lungs. The para-aortic and pelvic lymph nodes are treated with the so called inverted-Y AP/PA fields, which often includes the spleen in cases of TNI. Multileaf Collimators (MLC) have been tried, but due to the irregular shape of the fields and necessity of island blocking in 3D treatment, they have not been successful in full elimination of Cerrobend blocks. We hypothesize that using two or three matched Volumetric Modulated Arc Therapy (VMAT) fields will not only eliminate a need for Cerrobend blocks or island blocks, but will also provide better target coverage and better organs at risk (OAR) sparing. Under IRB study, 10 patients were retrospectively planned using two or three matched VMAT technique for mantle and inverted-Y treatments of TNI that had been previously treated using MLC and Cerrobend block combination. Pinnacle treatment planning system version 16.2.1 was used to generate plans using mantle/inverted-Y technique and corresponding VMAT plans using 2-3 arcs per isocenter (2 isocenters per plan). Optimization was performed to cover targets with the prescribed dose of 1500 cGy in 10 fractions per institutional protocol. The VMAT plans were compared with traditional 3D plans. VMAT consistently provided better or similar results to traditional field arrangements. Target coverage: V15Gy - 95.45% vs 77.99% (p = 0.00017), OAR coverage: total lung V5Gy 63.7% vs 68.8% (p = 0.016), bone marrow mean dose 539.1 cGy vs 727.8 cGy (p = 0.00047), Integral Dose 464.1 mJ vs 573.9 mJ (p = 0.0026). Low isodose lines- mean volume of 5 Gy isodose line was not significantly different - 24036 cc vs 25091 cc (p = 0.271). Cord maximum dose was 40% lower for VMAT plans (p = 0.00006). Mean bladder dose was similar in VMAT plans compared to 3D plan - 821.7 cGy vs 804.9 cGy (p = 0.454). One counter-intuitive result is that the mean integral dose for 10 patients was 24% lower for VMAT plans. VMAT based mantle fields for TNI eliminates Cerrobend blocks and improve dosimetry significantly for target volumes and all OARs; including bone marrow, which plays important role in patient's recovery after chemotherapy, radiation and often stem cell transplantation in recurrent disease. Lower integral dose for VMAT plans is explained by the large irradiated in-fields and small out-of-field volumes. The VMAT process requires minimal effort for optimization and is economical compared to the traditional planning, while improving the target coverage and decreasing dose to OARs.

The Estimation of Radiation Dose to Out-of-Field Points of Organs at Risk in Block and MLC Shielded Fields in Lung Cancer Radiation Therapy

Purpose: Photon-field shaping in radiation therapy with cerrobend block or Multi-Leaf Collimator (MLC) leads to an increase in the scattered dose to the out-of-field Organ At Risk (OAR). This study aimed to measure and compare the healthy organs absorbed dose outside the cerrobend block and MLC shielded field.&#x0D; Materials and Methods: Computed Tomography (CT) images were taken of a heterogeneous Thorax phantom while the target volume and organ at risk, including the spinal cord, contralateral lung, and heart were contoured. Conformal Treatment planning was performed (POP fields, total dose 40 Gy, 5 fx/week, and 2 Gy/fx) on the Prowess Panter Treatment Planning System (TPS). Irradiation was performed with 6 and 18 Mv X-ray of Siemens Oncor medical linear accelerator, once for the block-shielded field and again for the MLC-shielded field. At each energy, the radiation dose to the contoured out-of-field organs was measured by an ionization chamber and compared.&#x0D; Results: At both 6 and 18 MV energies, the out-of-field dose in the MLC-shielded fields was significantly lower than in the block-shielded ones (P &lt; 0.001). The out-of-filed dose for contoured organ at risk was not significantly different at 18 MV compared with 6 MV. The dose calculated by the treatment planning system showed that the healthy organs absorbed doses in all conditions were significantly lower than the dosimetry results.&#x0D; Conclusion: The use of MLC to shield the lung cancer treatment filed reduces the out-of-field OARs dose compared to cerrobend block. This reduction is greater at 18 MV photon beam but this difference is not statistically significant.

Effect of total body irradiation lung block parameters on lung doses using three-dimensional dosimetry.

PurposeTotal body irradiation (TBI) is an integral part of stem cell transplant. However, patients are at risk of treatment‐related toxicities, including radiation pneumonitis. While lung dose is one of the most crucial aspects of TBI dosimetry, currently available data are based on point doses. As volumetric dose distribution could be substantially altered by lung block parameters, we used 3D dosimetry in our treatment planning system to estimate volumetric lung dose and measure the impact of various lung block designs.Materials and methodsWe commissioned a TBI beam model in RayStation that matches the measured tissue‐phantom ratio under our clinical TBI setup. Cerrobend blocks were automatically generated in RayStation on thoracic Computed Tomography (CT) scans from three anonymized patients using the lung, clavicle, spine, and diaphragmatic contours. The margin for block edge was varied to 0, 1, or 2 cm from the superior, lateral, and inferior thoracic borders, with a uniform margin 2.5 cm lateral to the vertebral bodies. The lung dose was calculated and compared with a prescription dose of 1200 cGy in six fractions (three with blocks and three without).ResultThe point dose at midplane under the block and the average lung dose are at the range of 73%–76% and 80%–88% of prescription dose respectively regardless of the block margins. In contrast, the percent lung volume receiving 10 Gy increased by nearly two‐fold, from 31% to 60% over the margins from 0 to 2 cm.ConclusionsThe TPS‐derived 3D lung dose is substantially different from the nominal dose assumed with HVL lung blocks. Point doses under the block are insufficient to accurately gauge the relationship between dose and pneumonitis, and TBI dosimetry could be highly variable between patients and institutions as more descriptive parameters are not included in protocols. Much progress remains to be made to optimize and standardize technical aspects of TBI, and better dosimetry could provide more precise dosimetric predictors for pneumonitis risk.

Monte Carlo Simulation of the Gamma-Ray Transmissions for the newly Designed Shielding Blocks used in Radiotherapy

Radiotherapy is one of the most important treatment methods of cancer, which is the worldwide disease nowa-days. It is essential to protect the critical organs and healthy tissue inside the radiated area during the radiotherapy. For this reason, Cerrobend block (lipowitz alloy), which is made specifically for each patient, are commonly used in the hospitals. In the clinical application, the acceptable level of the gamma-ray transmission for Cerrobend blocks must be less than 5%. In this research, GEANT4 based GATE simulation program modelled to compare between gamma-ray transmissions of the standard Cerrobend block and newly designed Cerrobend blocks formed by adding the various number of the pure lead marbles. Experimental measurements were carried out with Alcyon II model Co-60 teletherapy machine for various field sizes by using Farmer type 0,6 cc ion chamber, PTW Unidos Dosimeter and solid phantom in Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital in 2010. The gamma-ray transmission of the newly designed Cerrobend block was found less than the standard block, therefore the protection of the critical organs for the patient could be better. The dose acquired by GEANT4 based GATE simulation program is consistent in experimentally measured radiation dose. Furthermore, the values of the linear attenuation coefficient theoretically obtained from XCOM software agree with the values acquired by experiment and simulation

Improving TBI lung dose calculations: Can the treatment planning system help?

Lung toxicity is a serious concern during total body irradiation (TBI). Therefore, evaluation of accurate dose calculation when using lung blocks is of utmost importance. Existing clinical treatment planning systems can perform the calculation but there are large inaccuracies when calculating volumetric dose at extended distances in the presence of high atomic number materials. Percent depth dose and absolute dose measurements acquired at 400 cm SSD with a cerrobend block were compared with calculated values from the Eclipse treatment planning system using AAA and Acuros. The block was simulated in 2 ways; (1) manually drawing a contour to mimic the block and (2) creating a virtual block in the accessory tray. Although the relative dose distribution was accurately calculated, larger deviations of around 50% and 40% were observed between measured depth dose and absolute dose with AAA and Acuros, respectively. Deviations were reduced by optimizing the relative electron density in the contoured block or the transmission factor in the virtual block.

Tungsten filled 3D printed field shaping devices for electron beam radiation therapy

PurposeElectron radiotherapy is a labor-intensive treatment option that is complicated by the need for field shaping blocks. These blocks are typically made from casting Cerrobend alloys containing lead and cadmium. This is a highly toxic process with limited precision. This work aims to provide streamlined and more precise electron radiotherapy by 3D using printing techniques.MethodsThe 3D printed electron cutout consists of plastic shells filled with 2 mm diameter tungsten ball bearings. Five clinical Cerrobend defined field were compared to the planned fields by measuring the light field edge when mounted in the electron applicator on a linear accelerator. The dose transmitted through the 3D printed and Cerrobend cutouts was measured using an IC profiler ion chamber array with 6 MeV and 16 MeV beams. Dose profiles from the treatment planning system were also compared to the measured dose profiles. Centering and full width half maximum (FWHM) metrics were taken directly from the profiler software.ResultsThe transmission of a 16MeV beam through a 12 mm thick layer of tungsten ball bearings agreed within 1% of a 15 mm thick Cerrobend block (measured with an ion chamber array). The radiation fields shaped by ball bearing filled 3D printed cutout were centered within 0.4 mm of the planned outline, whereas the Cerrobend cutout fields had shift errors of 1–3 mm, and shape errors of 0.5–2 mm. The average shift of Cerrobend cutouts was 2.3 mm compared to the planned fields (n = 5). Beam penumbra of the 3D printed cutouts was found to be equivalent to the 15 mm thick Cerrobend cutout. The beam profiles agreed within 1.2% across the whole 30 cm profile widths.ConclusionsThis study demonstrates that with a proper quality assurance procedure, 3D-printed cutouts can provide more accurate electron radiotherapy with reduced toxicity compared to traditional Cerrobend methods.

Measurement of fast neutron contamination caused by the presence of wedge and block using CR-39 detector.

Undesired neutron contamination imposed to patients during treatment is among the main factors increasing the risk of secondary cancer in radiotherapy. This additional undesirable dose is due to neutron contamination production in high-energy accelerators. In this study, neutron contamination is investigated in the presence of wedge and block in 15 MV photon fields of Siemens Primus linear accelerator. Neutron production by 30°, 45°, and 60° wedges and cerrobend block was investigated. Measurements were conducted in a 10 cm × 10 cm field at the source to -surface distance of 100 cm at 0.5, 2, 3, and 4 cm depths of a 30 cm × 30 cm × 30 cm Perspex phantom using the CR-39 passive film detectors. Chemical etching was performed using sodium hydroxide solution with 6.25 M concentration as the etchant at 85°C for 3 h. The neutron dosimetry results reveal that the presence of wedge and block increases the neutron contamination. However, the 45° wedge is most effective in producing neutron contamination. The results also show that the fast neutron contamination is lower in the steeper depths. The presence of a wedge in a therapeutic high-energy photon field is a source of neutron contamination and may be of concern regarding clinical aspects. The results of this study show that superficial tissues such as skin will incur higher fast neutron contamination than the deep tissues.

The evaluation of change in attenuation coefficient of cerrobend block used for radiation protection of healthy tissues in megavoltage photon radiation therapy after multiple melting

Introduction: Protecting the vital organs in radiation therapy is one of the most important issues. Cerrobend alloy, the most common material used as the shield, is melted several times and used for different patients. In this study changes in attenuation coefficient of cerrobend due to melting was investigated. Materials and Methods: In melting furnace, cerrobend was melted up to nine times and irradiated by Varian accelerator at radiotherapy department of Golestan hospital and the dose was measured by CC-13 ionization chamber with and without cerrobend blocks. The attenuation coefficients of cerrobend blocks were measured for irradiation fields of 6 × 6 cm2 and 10×10 cm2 at the photon energies of 6 mv and 18mv and analyzed by statistical methods. Results: Results of regression analysis with P<0.05, indicated that there was a significant relationship between the attenuation coefficient and frequencies of cerrobend melting: the attenuation coefficient increases with the increasing frequency of cerrobend melting. Conclusion: Continuous increasing in the frequency of cerrobend melting leads to increase in the attenuation coefficient of cerrobend block, thus cerrobend blocks can be used for patients, safely.

Assessment of Neutron Contamination Originating from the Presence of Wedge and Block in Photon Beam Radiotherapy.

One of the main causes of induction of secondary cancer in radiation therapy is neutron contamination received by patients during treatment. Objective: In the present study the impact of wedge and block on neutron contamination production is investigated. The evaluations are conducted for a 15 MV Siemens Primus linear accelerator. Simulations were performed using MCNPX Monte Carlo code. 30˚, 45˚ and 60˚ wedges and a cerrobend block with dimensions of 1.5 × 1.5 × 7 cm3 were simulated. The investigation were performed in the 10 × 10 cm2 field size at source to surface distance of 100 cm for depth of 0.5, 2, 3 and 4 cm in a water phantom. Neutron dose was calculated using F4 tally with flux to dose conversion factors and F6 tally. Results showed that the presence of wedge increases the neutron contamination when the wedge factor was considered. In addition, 45˚ wedge produced the most amount of neutron contamination. If the block is in the center of the field, the cerrobend block caused less neutron contamination than the open field due to absorption of neutrons and photon attenuation. The results showed that neutron contamination is less in steeper depths. The results for two tallies showed practically equivalent results. Wedge causes neutron contamination hence should be considered in therapeutic protocols in which wedge is used. In terms of clinical aspects, the results of this study show that superficial tissues such as skin will tolerate more neutron contamination than the deep tissues.

SU‐F‐T‐413: Calculation Accuracy of AAA and Acuros Using Cerrobend Blocks for TBI at 400cm

Purpose:It is essential to assess the lung dose during TBI to reduce toxicity. Here we characterize the accuracy of the AAA and Acuros algorithms when using cerrobend lung shielding blocks at an extended distance for TBI.Methods:We positioned a 30×30×30 cm3 solid water slab phantom at 400 cm SSD and measured PDDs (Exradin A12 and PTW parallel plate ion chambers). A 2 cm thick, 10×10 cm2 cerrobend block was hung 2 cm in front of the phantom. This geometry was reproduced in the planning system for both AAA and Acuros. In AAA, the mass density of the cerrobend block was forced to 9.38 g/cm3 and in Acuros it was forced to 8.0 g/cm3 (limited to selecting stainless steel). Three different relative electron densities (RED) were tested for each algorithm; 4.97, 6.97, and 8.97.Results:PDDs from both Acuros and AAA underestimated the delivered dose. AAA calculated that depth dose was higher for RED of 4.97 as compared to 6.97 and 8.97 but still lower than measured. There was no change in the percent depth dose with changing relative electron densities for Acuros.Conclusion:Care should be taken before using AAA or Acuros with cerrobend blocks as the planning system underestimates dose. Acuros limits the ability to modify RED when compared to AAA.

Patient-specific compensation for Co-60 TBI treatments based on Monte Carlo design: A feasibility study

PurposeTo develop an AP–PA treatment technique for the delivery of total body irradiation (TBI) at extended SSD using a modified Co-60 unit equipped with flattening filter and patient-specific compensators supported by Monte Carlo (MC) simulations and measurements. MethodsAn existing Eldorado-78 Co-60 teletherapy unit was stripped of its original collimator and equipped with two beam-defining cerrobend blocks. An acrylic flattening filter was numerically designed based on detailed mapping of the dose distribution of the large open field at a 10 cm depth in water using a primary radiation attenuation calculation. An EGSnrc/BEAMnrc MC model of the resulting unit was developed and experimentally validated and was used to calculate MC dose distributions in whole-body supine and prone CT images of a patient. AP–PA patient-specific compensators were designed based on the supine and prone mid-plane dose distributions. ResultsThe designed flattening filter flattens the beam to within ±2% over a 200 cm × 70 cm area at 10 cm depth in water. Experimental validation of the calculated dose profiles in the open and flattened beams shows agreement of better than 2% and 1%, respectively. Patient MC dose calculations in the flattened, uncompensated beam showed dose deviations from prescription dose most notably in lung, neck and extremities ranging from −5% to +25%. The use of patient-specific compensators reduced inhomogeneities to within −5% to +10%. ConclusionsThis work demonstrates that a Co-60 TBI setup upgraded with patient-specific compensators, numerically designed using MC patient dose calculations, is feasible and considerably improves the dose homogeneity.

SU‐E‐T‐248: Determining Output Factor of Irregular Electron Cutouts at Extended SSD

Purpose:To calculate the output factor (OPF) of any irregularly shaped electron beam at extended SSDMethods:Using Cerrobend block, circular cutouts with diameter ranging from 2.0cm to the maximum possible size for 15×15 applicator of Varian 2100C and 14×14 applicator of ELEKTA Synergy LINACs were prepared. In addition, two irregular cutouts were made. For each cutout, percentage depth dose (PDD) at standard SSD and point doses at different SSD were measured in water using Scanditronix diodes and PTW 0.125 cm3 ion‐chambers, respectively. In addition, the distance at which electron fluence along the central axis becomes independent of cutout size was determined using EDR2 films. On each LINAC, electron beam energies of 6, 9, 12, and 15/20 MeV were used.Results:Using the open applicator as the reference field, the lateral buildup ratio (LBR) for each circular cutout as a function of depth was calculated. From the LBR value and radius of the cutout, the corresponding lateral spread parameter (σR(z)) was determined. Taking the cutout side dependence of σR(z)) into account, PDD of the irregular cutouts at the standard SSD were calculated. From the point dose measurement at different SSDs, the effective SSD of each cutout was calculated. Taking the calculated PDD of the irregular cutout and effective SSD (SSDeff) of the circular cutout into account, OPFs of the irregular cutout at extended SSD values were calculated. Finally, the calculated output factors were compared with the measured values.Conclusion:In this research, the improved LBR method has been generalized to calculate output factor of irregular cutouts at extended SSD. In a clinically useful region, the percentage difference between the measured and the calculated output factors of the irregular cutouts was within 2%. Similar results were obtained for all available electron energies of both Varian 2100C and ELEKTA Synergy machines.

SU‐C‐BRB‐06: Utilizing 3D Scanner and Printer for Dummy Eye‐Shield: Artifact‐Free CT Images of Tungsten Eye‐Shield for Accurate Dose Calculation

Purpose:To evaluate the effect of a tungsten eye‐shield on the dose distribution of a patient.Methods:A 3D scanner was used to extract the dimension and shape of a tungsten eye‐shield in the STL format. Scanned data was transferred into a 3D printer. A dummy eye shield was then produced using bio‐resin (3D systems, VisiJet M3 Proplast). For a patient with mucinous carcinoma, the planning CT was obtained with the dummy eye‐shield placed on the patient's right eye. Field shaping of 6 MeV was performed using a patient‐specific cerrobend block on the 15 × 15 cm2 applicator. The gantry angle was 330° to cover the planning target volume near by the lens. EGS4/BEAMnrc was commissioned from our measurement data from a Varian 21EX. For the CT‐based dose calculation using EGS4/DOSXYZnrc, the CT images were converted to a phantom file through the ctcreate program. The phantom file had the same resolution as the planning CT images. By assigning the CT numbers of the dummy eye‐shield region to 17000, the real dose distributions below the tungsten eye‐shield were calculated in EGS4/DOSXYZnrc. In the TPS, the CT number of the dummy eye‐shield region was assigned to the maximum allowable CT number (3000).Results:As compared to the maximum dose, the MC dose on the right lens or below the eye shield area was less than 2%, while the corresponding RTP calculated dose was an unrealistic value of approximately 50%.Conclusion:Utilizing a 3D scanner and a 3D printer, a dummy eye‐shield for electron treatment can be easily produced. The artifact‐free CT images were successfully incorporated into the CT‐based Monte Carlo simulations. The developed method was useful in predicting the realistic dose distributions around the lens blocked with the tungsten shield.

Radiation dose distribution under the area protected using a Cerrobend block during external beam radiotherapy: a film study

AbstractBackgroundIn radiation therapy, to spare normal surrounding tissues, either Multileaf Collimators or Cerrobend blocks are used.PurposeThe current study focuses on the relative dose distribution under the areas protected by Cerrobend blocks.Materials and methodsA dual-energy linear accelerator and a Cobalt-60 machine were utilised as radiation sources. Several blocks were designed using commercially available materials to shield radiation fields. The relative dose distribution was then evaluated using extended dose range 2 films.ResultsResults showed that the dose distribution under protected areas depends on several parameters including the width and height of protecting blocks, incident photon beam energy, radiation field size and source to surface distance. An increase in Cerrobend block height from 80 to 95 mm significantly decreases the dose at the protected areas.ConclusionAn increase in the block width and photon energy decreases the relative dose deposition at the protected area. However, electron and neutron contaminations should also be taken into consideration.

EVALUATION OF THE DOSE DUE TO THE POSITION OF THE PROTECTION BLOCKS USED TO PROTECT THE EYES.

Several techniques have been proposed to perform the radiation treatment of medulloblastoma. However, each method presents limitations, and problems have occurred during irradiation due to the application of non-coplanar fields, such as the joint protection of fields and nearby organs that may be affected during irradiation. Among these organs is the eye, located 9 mm from the cribriform plate. With the improper positioning of the protection blocks, an underdosage in the cribriform plate could bring about a relapse of the tumor due to the migration of tumor cells, whereas an overdosage in the eye may well cause opacities of the crystalline lens or a total loss of vision. This study aims to evaluate the dose levels in four techniques of radiotherapy planning according to the positioning of the protection blocks and the collimator angle. In the first two treatments, the prescribed dose was 1.5 Gy/day, using a lead block with collimator angles of 11.3° and 348.7°. In the final two treatments, the prescribed dose was of 1.8 Gy/day, using the cerrobend block with a single field set-up and collimator angles of 9° and 351°. An ALDERSON-RANDOM anthropomorphic phantom and thermoluminescent dosimeters were used to implement these measures during treatment. Dose levels applied to the eyes were as follows: in the first two treatments, 27% of the prescribed dose; in the third treatment, 41% of the prescribed dose; and in the fourth treatment, 55% of the prescribed dose. In the first two treatments the dose are still within acceptable limits to prevent future sequel. In the cribriform plate, the doses were much higher: in the first treatment, doses were on average 128.4% of the prescribed dose; in the second and third treatments, doses reached 121.7%; and in the fourth treatment, doses reached 108.7%. These values show that the lead blocks protected better than did the cerrobend blocks, and that the collimator angles of 9° and 351° reduced the dose levels in the cribriform plate; however, these remained above the original prescribed dose.

Fricke dosimeter gel measurements of the profiles of shielded fields

In radiation therapy, the shielding of normal tissue can be made using Cerrobend® blocks or a multileaf collimator. In this work, profiles of shielded fields collimated by Cerrobend blocks were obtained through the Fricke Xylenol Gel (FXG) dosimeter irradiated with 6MV photon beams. The results show that the FXG system can be used in profile measurements of small fields in radiotherapy.

SU-E-T-556: Integration of Lung Blocks in the Inverse Planning Process of Modulated Arc Total Body Irradiation Using Cone Beam CT.

The sizing and placement of lung blocks for total-body irradiation (TBI) is critical to prevent lung toxicities and maintain effective treatments. During modulated-arc TBI (MATBI) treatment, the patient is stationary near the floor while open-field beams with varying exposures are delivered. The inverse planning process currently aims for a uniform dose to the body, without accounting for the presence of lung blocks. This study investigates the possibility of including the effect of these blocks in the MATBI optimization process. Dosimetric comparisons were performed using a water tank and a simple stack of solid water slabs. Lungs blocks made of cerrobend were fabricated and imaged using on-board megavoltage CBCT (MVCBCT). The reconstructed MVCBCT images were precisely registered with the reference CT for inverse planning. The cerrobend blocks were contoured in the planning system and the density was overridden to 9.3 g/cm3 . Simulated doses in Pinnacle were compared to ion chamber, diode array and gaf-chromic film measurements obtained at 1.0, 5.0, 10.0 and 20.0 cm depths. Specific optimization objectives on the lungs were tested on 5 patients including a lung re-treatment. The maximum difference between ion chamber measurements and the treatment planning predictions was 2.4%. The measurements profiles with the diode array correlated reasonably well (<5%) with predictions. Gaf-chromic films demonstrated good accuracy at depth but large differences (>10%) on the surface. Lung blocks reconstructed with MVCBCT were structuraly accurate without significant metal artifacts. A comparison of MATBI plans on patients shows that inclusion of lung blocks during optimization can reduce hot and cold areas in the lungs and the sternum. Reasonable predictions of the lung block transmission can be obtained following the developed technique using megavoltage CBCT. Thus, lung blocks can be included in the MATBI inverse planning process, which can help prevent complications and local failure.

Electron Irradiation of Conjunctival Lymphoma—Monte Carlo Simulation of the Minute Dose Distribution and Technique Optimization

External beam radiotherapy is the only conservative curative approach for Stage I non-Hodgkin lymphomas of the conjunctiva. The target volume is geometrically complex because it includes the eyeball and lid conjunctiva. Furthermore, the target volume is adjacent to radiosensitive structures, including the lens, lacrimal glands, cornea, retina, and papilla. The radiotherapy planning and optimization requires accurate calculation of the dose in these anatomical structures that are much smaller than the structures traditionally considered in radiotherapy. Neither conventional treatment planning systems nor dosimetric measurements can reliably determine the dose distribution in these small irradiated volumes. The Monte Carlo simulations of a Varian Clinac 2100 C/D and human eye were performed using the penelope and penEasyLinac codes. Dose distributions and dose volume histograms were calculated for the bulbar conjunctiva, cornea, lens, retina, papilla, lacrimal gland, and anterior and posterior hemispheres. The simulated results allow choosing the most adequate treatment setup configuration, which is an electron beam energy of 6 MeV with additional bolus and collimation by a cerrobend block with a central cylindrical hole of 3.0 cm diameter and central cylindrical rod of 1.0 cm diameter. Monte Carlo simulation is a useful method to calculate the minute dose distribution in ocular tissue and to optimize the electron irradiation technique in highly critical structures. Using a voxelized eye phantom based on patient computed tomography images, the dose distribution can be estimated with a standard statistical uncertainty of less than 2.4% in 3 min using a computing cluster with 30 cores, which makes this planning technique clinically relevant.