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磁场剂量对大分割部分乳腺照射不同放射线束几何形状的影响。

Magnetic field dose effects on different radiation beam geometries for hypofractionated partial breast irradiation.

作者信息

Kim Anthony, Lim-Reinders Stephanie, McCann Claire, Ahmad Syed Bilal, Sahgal Arjun, Lee Justin, Keller Brian M

机构信息

Department of Medical Physics, Sunnybrook Health Sciences Centre/Odette Cancer Centre, Toronto, ON, Canada.

Faculty of Medicine, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada.

出版信息

J Appl Clin Med Phys. 2017 Nov;18(6):62-70. doi: 10.1002/acm2.12182. Epub 2017 Sep 13.

DOI:10.1002/acm2.12182
PMID:28901729
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5689934/
Abstract

PURPOSE

Hypofractionated partial breast irradiation (HPBI) involves treatment to the breast tumor using high doses per fraction. Recent advances in MRI-Linac solutions have potential in being applied to HPBI due to gains in the soft tissue contrast of MRI; however, there are potentially deleterious effects of the magnetic field on the dose distribution. The purpose of this work is to determine the effects of the magnetic field on the dose distribution for HPBI tumors using a tangential beam arrangement (TAN), 5-beam intensity-modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT).

METHODS

Five patients who have received HPBI were selected with two patients having bilateral disease resulting in a total of two tumors in this study. Six planning configurations were created using a treatment planning system capable of modeling magnetic field dose effects: TAN, IMRT and VMAT beam geometries, each of these optimized with and without a transverse magnetic field of 1.5 T.

RESULTS

The heart and lung doses were not statistically significant when comparing plan configurations. The magnetic field had a demonstrated effect on skin dose: for VMAT plans, the skin (defined to a depth of 3 mm) D1cc was elevated by +11% and the V30 by +146%; for IMRT plans, the skin D1cc was increased by +18% and the V30 by +149%. Increasing the number of beam angles (e.g., going from IMRT to VMAT) with the magnetic field on reduced the skin dose.

CONCLUSION

The impact of a magnetic field on HPBI dose distributions was analyzed. The heart and lung doses had clinically negligible effects caused by the magnetic field. The magnetic field increases the skin dose; however, this can be mitigated by increasing the number of beam angles.

摘要

目的

大分割局部乳腺照射（HPBI）涉及对乳腺肿瘤采用高剂量分次治疗。由于磁共振成像（MRI）软组织对比度的提高，MRI直线加速器解决方案的最新进展有应用于HPBI的潜力；然而，磁场对剂量分布可能存在有害影响。本研究的目的是使用切线野照射（TAN）、五野调强放射治疗（IMRT）和容积调强弧形治疗（VMAT）来确定磁场对HPBI肿瘤剂量分布的影响。

方法

选择5例接受HPBI治疗的患者，其中2例为双侧病变，本研究共涉及2个肿瘤。使用能够模拟磁场剂量效应的治疗计划系统创建了6种计划配置：TAN、IMRT和VMAT射野几何形状，每种配置分别在有和没有1.5T横向磁场的情况下进行优化。

结果

比较计划配置时，心脏和肺部剂量无统计学显著差异。磁场对皮肤剂量有显著影响：对于VMAT计划，皮肤（定义为深度3mm）的D1cc升高了11%，V30升高了146%；对于IMRT计划，皮肤D1cc增加了18%，V30增加了149%。在有磁场的情况下增加射野角度数量（例如，从IMRT变为VMAT）可降低皮肤剂量。

结论

分析了磁场对HPBI剂量分布的影响。磁场对心脏和肺部剂量的临床影响可忽略不计。磁场会增加皮肤剂量；然而，这可以通过增加射野角度数量来减轻。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/4749ae2297ca/ACM2-18-062-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/1690b0939bcc/ACM2-18-062-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/997aaa010252/ACM2-18-062-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/2a84ee4ca965/ACM2-18-062-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/badb88abc8d4/ACM2-18-062-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/3e8c61c4b4e5/ACM2-18-062-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/4749ae2297ca/ACM2-18-062-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/1690b0939bcc/ACM2-18-062-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/997aaa010252/ACM2-18-062-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/2a84ee4ca965/ACM2-18-062-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/badb88abc8d4/ACM2-18-062-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/3e8c61c4b4e5/ACM2-18-062-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3377/5689934/4749ae2297ca/ACM2-18-062-g006.jpg

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