Low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope: Monte Carlo treatment planning and dose measurements in a postmortem subject.

Objective.The goal of this study was to use Monte Carlo (MC) simulations and measurements to investigate the dosimetric suitability of an interventional radiology (IR) c-arm fluoroscope to deliver low-dose radiotherapy to the lungs.Approach.A previously-validated MC model of an IR fluoroscope was used to calculate the dose distributions in a COVID-19-infected patient, 20 non-infected patients of varying sizes, and a postmortem subject. Dose distributions for PA, AP/PA, 3-field and 4-field treatments irradiating 95% of the lungs to a 0.5 Gy dose were calculated. An algorithm was created to calculate skin entrance dose as a function of patient thickness for treatment planning purposes. Treatments were experimentally validated in a postmortem subject by using implanted dosimeters to capture organ doses.Main results.Mean doses to the left/right lungs for the COVID-19 CT data were 1.2/1.3 Gy, 0.8/0.9 Gy, 0.8/0.8 Gy and 0.6/0.6 Gy for the PA, AP/PA, 3-field, and 4-field configurations, respectively. Skin dose toxicity was the highest probability for the PA and lowest for the 4-field configuration. Dose to the heart slightly exceeded the ICRP tolerance; all other organ doses were below published tolerances. The AP/PA configuration provided the best fit for entrance skin dose as a function of patient thickness (R2 = 0.8). The average dose difference between simulation and measurement in the postmortem subject was 5%.Significance.An IR fluoroscope should be capable of delivering low-dose radiotherapy to the lungs with tolerable collateral dose to nearby organs.

Monte Carlo simulations and phantom validation of low-dose radiotherapy to the lungs using an interventional radiology C-arm fluoroscope.

PURPOSE: To use MC simulations and phantom measurements to investigate the dosimetry of a kilovoltage x-ray beam from an IR fluoroscope to deliver low-dose (0.3-1.0 Gy) radiotherapy to the lungs. MATERIALS AND METHODS: PENELOPE was used to model a 125 kV, 5.94 mm Al HVL x-ray beam produced by a fluoroscope. The model was validated through depth-dose, in-plane/cross-plane profiles and absorbed dose at 2.5-, 5.1-, 10.2- and 15.2-cm depths against the measured beam in an acrylic phantom. CT images of an anthropomorphic phantom thorax/lungs were used to simulate 0.5 Gy dose distributions for PA, AP/PA, 3-field and 4-field treatments. DVHs were generated to assess the dose to the lungs and nearby organs. Gafchromic film was used to measure doses in the phantom exposed to PA and 4-field treatments, and compared to the MC simulations. RESULTS: Depth-dose and profile results were within 3.2% and 7.8% of the MC data uncertainty, respectively, while dose gamma analysis ranged from 0.7 to 1.0. Mean dose to the lungs were 1.1-, 0.8-, 0.9-, and 0.8- Gy for the PA, AP/PA, 3-field, and 4-field after isodose normalization to cover âˆ¼ 95% of each lung volume. Skin dose toxicity was highest for the PA and lowest for the 4-field, and both arrangements successfully delivered the treatment on the phantom. However, the dose distribution for the PA was highly non-uniform and produced skin doses up to 4 Gy. The dose distribution for the 4-field produced a uniform 0.6 Gy dose throughout the lungs, with a maximum dose of 0.73 Gy. The average percent difference between experimental and Monte Carlo values were -0.1% (range -3% to +4%) for the PA treatment and 0.3% (range -10.3% to +15.2%) for the 4-field treatment. CONCLUSION: A 125 kV x-ray beam from an IR fluoroscope delivered through two or more fields can deliver an effective low-dose radiotherapy treatment to the lungs. The 4-field arrangement not only provides an effective treatment, but also significant dose sparing to healthy organs, including skin, compared to the PA treatment. Use of fluoroscopy appears to be a viable alternative to megavoltage radiation therapy equipment for delivering low-dose radiotherapy to the lungs.

SU-E-T-278: Study of MAGIC-F Gel and PENELOPE Code Simulation Response for Clinical Electron Beams.

PURPOSE: To evaluate the response of MAGIC-f gel through dose response curves, percentage depth dose (PDD) and beam profile for clinical electron beams. METHODS: Glass tubes (Vacutainer ®), with 6 cm length and 0.5 cm radius, with MAGIC-f were positioned inside a water phantom to study the gel response with doses from 0.5 Gy to 20 Gy in electron beams of 6, 9 e 12 MeV. Glass tubes of 20 cm length and 1 cm radius and PMMA phantoms of 10 × 5 × 5 cm3 were used to PDD and beam profiles determinations, respectively, with a maximum dose of 2 Gy to the gel. The samples were analyzed through magnetic resonance imaging (MRI) with a 3 T tomography using a head coil, multiple spin echo sequence with 16 echos, TE 15ms and TR 4000ms. The MAGIC-f response was simulated with PENELOPE Monte Carlo code in the same geometry used in the irradiations. The results obtained with MAGIC-f and PENELOPE were compared with clinical data. RESULTS: Calibration curves for MAGIC-f showed a linear behavior, with correlation coefficient of 0.99, for all energies. The PDD and beam profile curves obtained with MAGIC-f presented differences lower than 1.5% and 3.0%, respectively, when compared to clinical data. Results obtained by PENELOPE and clinical data showed differences up to 1.0% and 1.5%, respectively, for PDD and profile curves. CONCLUSIONS: The dosimetric parameters for electron beams obtained experimentally with MAGIC-f and with PENELOPE code showed similar results to the clinical data. From the results it can be inferred that MAGIC-f can be used as a complementary dosimetric tool for electron beams due to its characteristics of high spatial resolution and the ability to construct tridimensional dose distributions. Also PENELOPE can be used to study MAGIC-f gel response in electron beams.