Method to quickly and accurately calculate absorbed dose from therapeutic and stray photon exposures throughout the entire body in individual patients

• Published in: Medical physics (Lancaster) Vol. 47; no. 5; pp. 2254 - 2266
• Main Authors: Wilson, Lydia J., Newhauser, Wayne D., Schneider, Christopher W., Kamp, Florian, Reiner, Michael, Martins, Juliana C., Landry, Guillaume, Giussani, Augusto, Kapsch, Ralf‐Peter, Parodi, Katia
• Format: Journal Article
• Language: English
• Published: United States 01-06-2020
• Subjects: Absorption, Radiation; analytical model; CERR; Humans; out-of-field dose; Photons - adverse effects; Photons - therapeutic use; radiation therapy; Radiometry - methods; Time Factors; treatment planning system; whole-body dose; whole-body dose; out-of-field dose; treatment planning system; analytical model; CERR; radiation therapy
• ISSN: 0094-2405; 2473-4209
• DOI: 10.1002/mp.14018

Purpose
Photon radiotherapy techniques typically devote considerable attention to limiting the exposure of healthy tissues outside of the target volume. Numerous studies have shown, however, that commercial treatment planning systems (TPSs) significantly underestimate the absorbed dose outside of the treatment field. The purpose of this study was to test the feasibility of quickly and accurately calculating the total absorbed dose to the whole body from photon radiotherapy in individual patients.
Methods
We created an extended TPS by implementing a physics‐based analytical model for the absorbed dose from stray photons during photon therapy into a research TPS. We configured and validated the extended TPS using measurements of 6‐ and 15‐MV photon beams in water‐box and anthropomorphic phantoms. We characterized the additional computation time required for therapeutic and stray dose calculations in a 44 × 30 × 180 cm3 water‐box phantom.
Results
The extended TPS achieved superior dosimetric accuracy compared to the research TPS in both water and anthropomorphic phantoms, especially outside of the primary treatment field. In the anthropomorphic phantom, the extended TPS increased the generalized gamma index passing rate by a factor of 10 and decreased the median dosimetric discrepancy in the out‐of‐field region by a factor of 26. The extended TPS achieved an average discrepancy <1% in and near the treatment field and <1 mGy/Gy far from the treatment field in the anthropomorphic phantom. Characterization of computation time revealed that on average, the extended TPS only required 7% longer than the research TPS to calculate the total absorbed dose.
Conclusions
The results of this work suggest that it is feasible to quickly and accurately calculate whole‐body doses inside and outside of the therapeutic treatment field in individual patients on a routine basis using physics‐based analytical dose models. This additional capability enables a more personalized approach to minimizing the risk of radiogenic late effects, such as second cancer and cardiac toxicity, as part of the treatment planning process.