VMAT – dynamic radiotherapy procedure realization either for chest wall in patients with breast cancer after surgery or whole breast irradiation
Journal Title: Inżynier i Fizyk Medyczny - Year 2014, Vol 3, Issue 5
Abstract
The technological development of medical linacs as well as the expansion of dynamic techniques, i.e. VMAT (Volumetric Modulated Arc Therapy), dMLC (dynamic MLC IMRT = sliding window IMRT), etc. have made the usage of dynamic delivery of radiation treatment (RT) possible regardless the tumor location inside the human body. However, the application of dynamic RT with arched beams to the regions, inside which the organs’ movement seems to have a large impact on the quality and success of radiotherapy, has been perceived as controversial. For the purpose of the implementation of dynamic arch technique VMAT in breast cancer RT and chest wall irradiation, the 4D computed tomography (the approach known from so called gated RT), has been implemented to prepare the RT plan as well as to determine the target volume motion. Radiotherapy method as a combination of tangential arches (tVMAT) and partial c-shape arch (cVMAT), generally using the mixed photon beams (6MV and 10MV) has been developed and implemented in clinical practice. The particular cases require the preparation of personal bolus made of silicone to be used in RT process. The target delineation has been made on the MIP (Maximum Intensity Projection) reconstructed CT scans, whereas organs at risk (OARs) were contoured on the scans averaged over 10 different breathing phases (Avg10). Radiotherapeutic plans were prepared on the Agv10 scans with the use of Monaco v5.00.002 (Elekta) treatment planning system. The plans approved by the physician for the realization were beforehand verified with the use of MultiCube phantom (IBA-Dosimetry GmbH) in conjunction with the MatriXXEvolution dosimetry device (IBA-Dosimetry GmbH), RW3 plate phantom, as well as MatriXXEvolution device coupled with the Compass software (IBA-Dosimetry GmbH). This latter configuration enables to perform the stand-alone measurement of the dose distribution realized by the linac as well as the independent calculation of the patient-specific dose distribution with the use of a separate algorithm.
Authors and Affiliations
Aneta Kawa-Iwanicka, Kinga Polaczek-Grelik, Marta Stefańczyk, Agnieszka Giłka, Jakub Derus
Keywords
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