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BACKGROUND AND PURPOSE: Image-guided radiotherapy (IGRT) involves frequent in-room imaging sessions contributing to additional patient irradiation. The present work provided patient-specific dosimetric data related to different imaging protocols and anatomical sites. MATERIAL AND METHODS: We developed a Monte Carlo based software able to calculate 3D personalized dose distributions for five imaging devices delivering kV-CBCT (Elekta and Varian linacs), MV-CT (Tomotherapy machines) and 2D-kV stereoscopic images from BrainLab and Accuray. Our study reported the dose distributions calculated for pelvis, head and neck and breast cases based on dose volume histograms for several organs at risk. RESULTS: 2D-kV imaging provided the minimum dose with less than 1 mGy per image pair. For a single kV-CBCT and MV-CT, median dose to organs were respectively around 30 mGy and 15 mGy for the pelvis, around 7 mGy and 10 mGy for the head and neck and around 5 mGy and 15 mGy for the breast. While MV-CT dose varied sparsely with tissues, dose from kV imaging was around 1.7 times higher in bones than in soft tissue. Daily kV-CBCT along 40 sessions of prostate radiotherapy delivered up to 3.5 Gy to the femoral heads. The dose level for head and neck and breast appeared to be lower than 0.4 Gy for every organ in case of a daily imaging session. CONCLUSIONS: This study showed the dosimetric impact of IGRT procedures. Acquisition parameters should therefore be chosen wisely depending on the clinical purposes and tailored to morphology. Indeed, imaging dose could be reduced up to a factor 10 with optimized protocols.
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PURPOSE: To evaluate the repositioning accuracy of 4 immobilization devices (ID) used for whole breast Helical Tomotherapy treatments: arm float with VacFix® (Par Scientific, Denmark), all-in-one® (AIO®) system (Orfit, Belgium), MacroCast thermoplastic mask (Macromedics, The Netherlands) and BlueBag® system with Arm-Shuttle (Elekta, Sweden). MATERIALS AND METHODS: Twenty four women with breast cancer with PTV including the breast/chest wall and lymph nodes were involved in this study (6 women per group). Pretreatment registration results were first collected using automatic bone registration + manual adjustment on the vertebra followed by independent registrations on different ROIs representing each treated area (axillary, mammary chain, clavicular, breast/chest wall). The differences in translations and rotations between reference registration and the above mentionned ROIs were calculated. A total of 120 MVCT images were analyzed. RESULTS: Significant differences were found between IDs (p < 0.0001), ROIs (p = 0.0002) and the session number (p < 0.0001) on the observed shifts, when examining 3D translation vectors. 3D-vectors were significantly lower for the BlueBag® than for the VacFix® or for the AIO® (p < 0.0001), but differences were not significant compared to the mask (p = 0.674). Finally, setup margins were overall smaller for the BlueBag® than for other IDs, with values ranging from 1.53 to 1.91 mm on the mammary chain area, 4.52-6.07 mm on the clavicular area, 2.71-4.62 mm on the axillary area, and 3.39-5.10 mm on the breast. CONCLUSION: We demonstrated in this study that the BlueBag® combined with arm shuttle is a robust solution for breast and nodes immobilization during HT treatments.