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Kopačin V, Brkić H, Ivković A, Kasabašić M, Knežević Ž, Majer M, Nodilo M, Turk T, Faj D. Development and validation of the low-cost pregnant female physical phantom for fetal dosimetry in MV photon radiotherapy. J Appl Clin Med Phys 2024; 25:e14240. [PMID: 38150580 PMCID: PMC10860449 DOI: 10.1002/acm2.14240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/27/2023] [Accepted: 11/27/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Monte Carlo (MC) simulations or measurements in anthropomorphic phantoms are recommended for estimating fetal dose in pregnant patients in radiotherapy. Among the many existing phantoms, there is no commercially available physical phantom representing the entire pregnant woman. PURPOSE In this study, the development of a low-cost, physical pregnant female phantom was demonstrated using commercially available materials. This phantom is based on the previously published computational phantom. METHODS Three tissue substitution materials (soft tissue, lung and bone tissue substitution) were developed. To verify Tena's substitution tissue materials, their radiation properties were assessed and compared to ICRP and ICRU materials using MC simulations in MV radiotherapy beams. Validation of the physical phantom was performed by comparing fetal doses obtained by measurements in the phantom with fetal doses obtained by MC simulations in computational phantom, during an MV photon breast radiotherapy treatment. RESULTS Materials used for building Tena phantom are matched to ICRU materials using physical density, radiation absorption properties and effective atomic number. MC simulations showed that percentage depth doses of Tena and ICRU material comply within 5% for soft and lung tissue, up to 25 cm depth. In the bone tissue, the discrepancy is higher, but again within 5% up to the depth of 5 cm. When the phantom was used for fetal dose measurements in MV photon breast radiotherapy, measured fetal doses complied with fetal doses calculated using MC simulation within 15%. CONCLUSIONS Physical anthropomorphic phantom of pregnant patient can be manufactured using commercial materials and with low expenses. The files needed for 3D printing are now freely available. This enables further studies and comparison of numerical and physical experiments in diagnostic radiology or radiotherapy.
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Affiliation(s)
- Vjekoslav Kopačin
- Faculty of MedicineDepartment of RadiologyJ. J. Strossmayer University Osijek, University Hospital Center OsijekDepartment of Diagnostic and Interventional RadiologyOsijekCroatia
| | - Hrvoje Brkić
- Faculty of MedicineDepartment of Biophysics and Medical PhysicsJ. J. Strossmayer University OsijekOsijekCroatia
- Faculty of Dental Medicine and HealthDepartment of BiophysicsBiology and ChemistryJ. J. Strossmayer University OsijekOsijekCroatia
| | - Ana Ivković
- Faculty of MedicineDepartment of Biophysics and Medical PhysicsJ. J. Strossmayer University Osijek, University Hospital Center OsijekDepartment of Medical PhysicsOsijekCroatia
| | - Mladen Kasabašić
- Faculty of MedicineDepartment of Biophysics and Medical PhysicsJ. J. Strossmayer University Osijek, University Hospital Center OsijekDepartment of Medical PhysicsOsijekCroatia
| | - Željka Knežević
- Division of Materials ChemistryRuđer Bošković InstituteZagrebCroatia
| | - Marija Majer
- Division of Materials ChemistryRuđer Bošković InstituteZagrebCroatia
| | - Marijana Nodilo
- Division of Materials ChemistryRuđer Bošković InstituteZagrebCroatia
| | - Tajana Turk
- Faculty of MedicineDepartment of RadiologyJ. J. Strossmayer University Osijek, University Hospital Center OsijekDepartment of Diagnostic and Interventional RadiologyOsijekCroatia
| | - Dario Faj
- Faculty of MedicineDepartment of Biophysics and Medical PhysicsJ. J. Strossmayer University OsijekOsijekCroatia
- Faculty of Dental Medicine and HealthDepartment of BiophysicsBiology and ChemistryJ. J. Strossmayer University OsijekOsijekCroatia
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Božanić A, Šegota D, Debeljuh DD, Kolacio MŠ, Radojčić ĐS, Ružić K, Budanec M, Kasabašić M, Hrepić D, Valković Zujić P, Brambilla M, Kalra MK, Jurković S. National reference levels of CT procedures dedicated for treatment planning in radiation oncology. Phys Med 2022; 96:123-129. [PMID: 35278930 DOI: 10.1016/j.ejmp.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To present results of the first national survey on reference levels of CT imaging performed for the treatment planning purposes in radiation oncology in Croatia. METHODS Data for CT protocols of five anatomical regions including head, head and neck, pelvis, breast, and thorax were collected at eight radiation oncology departments in Croatia. Data included volume CT dose index (CTDIvol), dose-length product (DLP), scan length and set of acquisition and reconstruction parameters. Data on a total of 600 patients were collected. Median values of scan length, DLP and CTDIvol were calculated for each acquisition protocol. Third quartiles of the median CTDIvol and DLP values were proposed as the national radiotherapy planning reference levels (RPRL). RESULTS The largest CoV were assessed for RT Breast (63.8% for CTDIvol), RT Thorax (79.7% for DLP) and RT H&N (21.2% for scan length). RT Head had the lowest CoV for CTDIvol (1,9%) and DLP (17,2%), while RT Breast had the lowest coefficient of variation for scan length (12.8%). Proposed national RPRLs are: for RT Head CTDIvol16cm = 62 mGy and DLP16cm = 1738 mGy.cm; for RT H&N CTDIvol16cm = 35 mGy and DLP16cm = 1444 mGy.cm; for RT Breast CTDIvol32cm = 16 mGy and DLP32cm = 731 mGy.cm; for RT Thorax CTDIvol32cm = 17 mGy and DLP32cm = 865 mGy.cm; for RT Pelvis CTDIvol32cm = 20 mGy and DLP32cm = 1133 mGy.cm. CONCLUSIONS Results of this study show variations in CT imaging for treatment planning practice at the national level which call for optimization of procedures.
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Affiliation(s)
- Ana Božanić
- Medical Physics and Radiation Protection Department, Clinical Hospital Centre Rijeka, Krešimirova 42, Rijeka, Croatia; Medical Physics and Biophysics Department, Medical Faculty, University of Rijeka, Braće Branchetta 20, Rijeka, Croatia.
| | - Doris Šegota
- Medical Physics and Radiation Protection Department, Clinical Hospital Centre Rijeka, Krešimirova 42, Rijeka, Croatia
| | - Dea Dundara Debeljuh
- Medical Physics and Radiation Protection Department, Clinical Hospital Centre Rijeka, Krešimirova 42, Rijeka, Croatia; Medical Physics and Biophysics Department, Medical Faculty, University of Rijeka, Braće Branchetta 20, Rijeka, Croatia; Radiology Department, General Hospital Pula, Santiorova 24a, Pula, Croatia
| | - Manda Švabić Kolacio
- Medical Physics and Radiation Protection Department, Clinical Hospital Centre Rijeka, Krešimirova 42, Rijeka, Croatia
| | - Đeni Smilović Radojčić
- Medical Physics and Radiation Protection Department, Clinical Hospital Centre Rijeka, Krešimirova 42, Rijeka, Croatia; Medical Physics and Biophysics Department, Medical Faculty, University of Rijeka, Braće Branchetta 20, Rijeka, Croatia
| | - Katarina Ružić
- Department of Medical Physics, The University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Mirjana Budanec
- University Clinical Hospital Center Sestre Milosrdnice, Department of Medical Physics, Vinogradska 29, Zagreb, Croatia
| | - Mladen Kasabašić
- Osijek University Hospital, Department of Medical Physics, Osijek, Josipa Huttlera 4, Croatia
| | - Darijo Hrepić
- Department of Medical Physics, University Hospital of Split, Spinčićeva 1, Split, Croatia
| | - Petra Valković Zujić
- Radiology Department, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia; Radiology Department, Medical Faculty, University of Rijeka, Braće Branchetta 20, Rijeka, Croatia
| | - Marco Brambilla
- Department of Medical Physics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Mannudeep K Kalra
- Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Slaven Jurković
- Medical Physics and Radiation Protection Department, Clinical Hospital Centre Rijeka, Krešimirova 42, Rijeka, Croatia; Medical Physics and Biophysics Department, Medical Faculty, University of Rijeka, Braće Branchetta 20, Rijeka, Croatia
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Majer M, Ambrožová I, Davídková M, De Saint-Hubert M, Kasabašić M, Knežević Ž, Kopeć R, Krzempek D, Krzempek K, Miljanić S, Mojżeszek N, Veršić I, Stolarczyk L, Harrison RM, Olko P. Out-of-field doses in pediatric craniospinal irradiations with 3D-CRT, VMAT and scanning proton radiotherapy - a phantom study. Med Phys 2022; 49:2672-2683. [PMID: 35090187 DOI: 10.1002/mp.15493] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 12/01/2021] [Accepted: 01/12/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Craniospinal irradiation (CSI) has greatly increased survival rates for patients with a diagnosis of medulloblastoma and other primitive neuroectodermal tumors. However, as it includes exposure of a large volume of healthy tissue to unwanted doses, there is a strong concern about the complications of the treatment, especially for the children. To estimate the risk of second cancers and other unwanted effects, out-of-field dose assessment is necessary. The purpose of this study is to evaluate and compare out-of-field doses in pediatric CSI treatment using conventional and advanced photon radiotherapy (RT) and advanced proton therapy. To our knowledge, it is the first such comparison based on in-phantom measurements. Additionally, for out-of-field doses during photon RT in this and other studies, comparisons were made using analytical modeling. METHODS In order to describe the out-of-field doses absorbed in a pediatric patient during actual clinical treatment, an anthropomorphic phantom which mimics the 10-year-old child was used. Photon 3D-conformal radiotherapy (3D-CRT) and two advanced, highly conformal techniques: photon volumetric modulated arc therapy (VMAT) and active pencil beam scanning (PBS) proton radiotherapy were used for CSI treatment. Radiophotoluminescent (RPL) and poly-allyl-diglycol-carbonate (PADC) nuclear track detectors were used for photon and neutron dosimetry in the phantom, respectively. Out-of-field doses from neutrons were expressed in terms of dose equivalent. A two-Gaussian model was implemented for out-of-field doses during photon RT. RESULTS The mean VMAT photon doses per target dose to all organs in this study were under 50% of the target dose (i.e., <500 mGy/Gy), while the mean 3D-CRT photon dose to oesophagus, gall bladder and thyroid, exceeded that value. However, for 3D-CRT, better sparing was achieved for eyes and lungs. The mean PBS photon doses for all organs were up to 3 orders of magnitude lower compared to VMAT and 3D-CRT and exceeded 10 mGy/Gy only for the oesophagus, intestine and lungs. The mean neutron dose equivalent during PBS for 8 organs of interest (thyroid, breasts, lungs, liver, stomach, gall bladder, bladder, prostate) ranged from 1.2 mSv/Gy for bladder to 23.1 mSv/Gy for breasts. Comparison of out-of-field doses in this and other phantom studies found in the literature showed that a simple and fast two-Gaussian model for out-of-field doses as a function of distance from the field edge can be applied in a CSI using photon RT techniques. CONCLUSIONS PBS is the most promising technique for out-of-field dose reduction in comparison to photon techniques. Among photon techniques, VMAT is a preferred choice for most of out-of-field organs and especially for the thyroid, while doses for eyes, breasts and lungs, are lower for 3D-CRT. For organs outside the field edge, a simple analytical model can be helpful for clinicians involved in treatment planning using photon RT but also for retrospective data analysis for cancer risk estimates and epidemiology in general. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Marija Majer
- Ruđer Bošković Institute, Zagreb, 10000, Croatia
| | - Iva Ambrožová
- Nuclear Physics Institute of the CAS, Řež, CZ-250 68, Czech Republic
| | - Marie Davídková
- Nuclear Physics Institute of the CAS, Řež, CZ-250 68, Czech Republic
| | | | - Mladen Kasabašić
- Osijek University Hospital, Osijek, 31000, Croatia.,Faculty of Medicine Osijek, J.J. Strossmayer University of Osijek, Osijek, 31000, Croatia
| | | | - Renata Kopeć
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
| | - Dawid Krzempek
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
| | - Katarzyna Krzempek
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
| | | | - Natalia Mojżeszek
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
| | - Ivan Veršić
- Department of Physics, Faculty of Science, University of Zagreb, Zagreb, 10000, Croatia
| | - Liliana Stolarczyk
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland.,Danish Center for Particle Therapy, Aarhus, Denmark
| | - Roger M Harrison
- University of Newcastle, Newcastle upon Tyne, NE2 4HH, United Kingdom
| | - Paweł Olko
- Institute of Nuclear Physics Polish Academy of Sciences, Krakow, 31-342, Poland
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Brkić H, Ivković A, Kasabašić M, Poje Sovilj M, Jurković S, Štimac D, Rubin O, Faj D. The influence of field size and off-axis distance on photoneutron spectra of the 18 MV Siemens Oncor linear accelerator beam. RADIAT MEAS 2016. [DOI: 10.1016/j.radmeas.2016.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Brkić H, Ivković A, Sovilj MP, Kasabašić M, Jurković S, Faj D. Analysis of neutron flux around medical electron linear accelerator placed in the room reconstructed after decommissioning of 60Co units using monte carlo simulation. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.07.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Jurković S, Svabić M, Diklić A, Smilović Radojčić D, Dundara D, Kasabašić M, Ivković A, Faj D. Reinforcing of QA/QC programs in radiotherapy departments in Croatia: results of treatment planning system verification. Med Dosim 2012; 38:100-4. [PMID: 23246197 DOI: 10.1016/j.meddos.2012.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/12/2012] [Accepted: 07/30/2012] [Indexed: 11/26/2022]
Abstract
Implementation of advanced techniques in clinical practice can greatly improve the outcome of radiation therapy, but it also makes the process much more complex with a lot of room for errors. An important part of the quality assurance program is verification of treatment planning system (TPS). Dosimetric verifications in anthropomorphic phantom were performed in 4 centers where new systems were installed. A total of 14 tests for 2 photon energies and multigrid superposition algorithms were conducted using the CMS XiO TPS. Evaluation criteria as specified in the International Atomic Energy Agency Technical Reports Series (IAEA TRS) 430 were employed. Results of measurements are grouped according to the placement of the measuring point and the beam energy. The majority of differences between calculated and measured doses in the water-equivalent part of the phantom were in tolerance. Significantly more out-of-tolerance values were observed in "nonwater-equivalent" parts of the phantom, especially for higher-energy photon beams. This survey was done as a part of continuous effort to build up awareness of quality assurance/quality control (QA/QC) importance in the Croatian radiotherapy community. Understanding the limitations of different parts of the various systems used in radiation therapy can systematically improve quality as well.
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Affiliation(s)
- Slaven Jurković
- Clinic for Radiotherapy and Oncology, Physics Division, University Hospital Rijeka, Rijeka, Croatia
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