Estimation of Secondary Scattered Dose from Intensity-modulated Radiotherapy for Liver Cancer Cases

Dong Wook Kim; Jiwon Sung; Hyunho Lee; Myonggeun Yoon; Weon Kuu Chung; Sun Hyun Bae; Dong Oh Shin; Kwangzoo Chung; Young Kyung Lim; Donho Shin; Se Byeong Lee

doi:10.14316/pmp.2013.24.4.295

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Kim, Sung, Lee, Yoon, Chung, Bae, Shin, Chung, Lim, Shin, and Lee: Estimation of Secondary Scattered Dose from Intensity-modulated Radiotherapy for Liver Cancer Cases

Original Article

Progress in Medical Physics 2013;24(4):295-302.

Published online: 17 December 2013

DOI: https://doi.org/10.14316/pmp.2013.24.4.295

Estimation of Secondary Scattered Dose from Intensity-modulated Radiotherapy for Liver Cancer Cases

Dong Wook Kim^†, Jiwon Sung^∗,^†, Hyunho Lee^∗,^†, Myonggeun Yoon^∗, Weon Kuu Chung^†, Sun Hyun Bae^†, Dong Oh Shin^‡, Kwangzoo Chung^§, Young Kyung Lim^∥, Donho Shin^∥, Se Byeong Lee^∥

^∗Department of Bio-convergence Engineering, Korea University, Seoul, Korea

^†Department of Radiation Oncology, Kyung Hee University Hospital at Gandong, Seoul, Korea

^‡Department of Radiation Oncology, Kyung Hee University Medical Center, Seoul, Korea

^§Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea

^∥Proton Therapy Center, National Cancer Center, Goyang, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We estimated secondary scattered and leakage doses for intensity-modulated radiotherapy (IMRT), volumetric arc therapy (VMAT) and tomotherapy (TOMO) in patients with liver cancer. Five liver patients were planned by IMRT, VMAT and TOMO. Secondary scatter (and leakage) dose and organ equivalent doses (OEDs) are measured and estimated at various points 20 to 80 cm from the iso-center by using radiophotoluminescence glass dosimeter (RPLGD). The secondary dose per Gy from IMRT, VMAT and TOMO for liver cancer, measured 20 to 80 cm from the iso-center, are 0.01∼3.13, 0.03∼2.34 and 0.04∼1.29 cGy, respectively. The mean values of relative OED of secondary dose of VMAT and TOMO for five patients, which is normalized by IMRT, measured as 75.24% and 50.92% for thyroid, 75.14% and 40.61% for bowel, 72.30% and 47.77% for rectum, 76.21% and 49.93% for prostate. The secondary dose and OED from TOMO is relatively low to those from IMRT and VMAT. OED based estimation suggests that the secondary cancer risk from TOMO is less than or comparable to the risks from conventional IMRT and VMAT.

Keywords: Liver cancer, Scatter, Leakage, Intensity-modulated radiotherapy, Volumetric Arc therapy, Helical tomotherapy

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Fig. 1.

Treatment plan for patient #4 with different modalities; IMRT, VMAT and TOMO. The prescription dose 62.5 Gy with 25 fractions.

Fig. 2.

Secondary scattered dose measurement set up. Measuring positions are 20, 35, 50, 65 and 80 cm from the iso-center. Two RPLGDs are positioned at each measuring point.

Fig. 3.

The secondary scattered dose measurements of five patients for IMRT (diamond), VMAT (square) and TOMO (triangle) at each distance from the iso-center. All data are normalized by prescription dose.

Table 1.

Patient information.

ID	Sex	Age	Disease	Stage	PTV volume (cm³)
1	Male	62	Liver	III	483
2	Male	54	Liver	I	60
3	Male	59	Liver	III	421
4	Male	49	Liver	VI	2,112
5	Female	42	Liver	VI	214

Table 2.

Treatment planning information.

ID	Modality	# of fields (or arcs)	MU/Gy
1	IMRT	8	543
	VMAT	2	291
	TOMO	n/a	1,814
2	IMRT	8	312
	VMAT	2	346
	TOMO	n/a	1,039
3	IMRT	8	597
	VMAT	2	345
	TOMO	n/a	1,435
4	IMRT	8	722
	VMAT	2	317
	TOMO	n/a	3,173
5	IMRT	8	384
	VMAT	2	304
	TOMO	n/a	1,553

Table 3.

At each points, the secondary scattered dose measurements as percentage of prescription dose.

ID	Modality\Distance	20 cm	35 cm	50 cm	65 cm	80 cm
1	IMRT	0.95	0.32	0.15	0.09	0.06
	VMAT	0.82	0.27	0.11	0.06	0.04
	TOMO	0.42	0.21	0.13	0.10	0.08
2	IMRT	0.44	0.11	0.07	0.04	0.01
	VMAT	0.24	0.85	0.05	0.04	0.03
	TOMO	0.16	0.09	0.06	0.05	0.04
3	IMRT	1.32	0.40	0.17	0.10	0.07
	VMAT	1.29	0.38	0.16	0.08	0.06
	TOMO	0.35	0.18	0.11	0.08	0.07
4	IMRT	3.13	1.10	0.68	0.27	0.14
	VMAT	2.34	0.66	0.25	0.13	0.08
	TOMO	1.08	0.46	0.25	0.19	0.15
5	IMRT	0.64	0.21	0.12	0.06	0.04
	VMAT	0.46	0.15	0.07	0.04	0.03
	TOMO	0.22	0.13	0.09	0.07	0.06

Table 4.

Organ equivalent dose (Gy/Gy_Rx) measurement per prescription dose at planning target volume.

ID	Modality\Site	Thyroid	Bowel	Rectum	Prostate/Cervix
1	IMRT	0.22	0.35	0.23	0.24
	VMAT	0.18	0.30	0.19	0.20
	TOMO	0.14	0.18	0.14	0.14
2	IMRT	0.09	0.16	0.10	0.10
	VMAT	0.07	0.09	0.07	0.07
	TOMO	0.06	0.07	0.06	0.06
3	IMRT	0.24	0.41	0.26	0.26
	VMAT	0.23	0.40	0.24	0.25
	TOMO	0.10	0.14	0.11	0.11
4	IMRT	0.66	1.21	0.79	0.70
	VMAT	0.45	0.82	0.50	0.48
	TOMO	0.32	0.46	0.34	0.33
5	IMRT	0.18	0.29	0.19	0.20
	VMAT	0.13	0.20	0.13	0.14
	TOMO	0.10	0.13	0.10	0.11

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