Evaluation of conventional IMRT and VMAT strategies for postmastectomy radiation therapy after immediate implant-based reconstruction using the new ESTRO-ACROP contouring guidelines.

This study evaluated the usability of conventional templates based on the new contour guidelines of the European Society of Radiation and Oncology and Advisory Committee in Radiation Oncology Practice (ESTRO-ACROP) for treatment plans of postmastectomy radiotherapy after immediate implant-based reconstruction. Intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) plans generated with two different treatment planning systems (TPSs, Eclipse and Monaco) were examined. Six computed tomography scans of patients aged 35-54 years were retrospectively analysed who had undergone mastectomy and breast reconstruction using silicone implants after being diagnosed with left breast cancer. Six radiation oncologists participated in this study, and each of them contoured the target volume of one left breast using conventional contour (CTV-CONV) and new contour (CTV-ESTRO) methods. This study showed that compared with CTV-CONV, using CTV-ESTRO with objectives and cost functions similar to those of TPSs worsened the target volume coverage and increased the total number of monitor units. Considering the organs at risk, CTV-ESTRO tended to increase the mean dose delivered to the contralateral lung. It is concluded that the approach used for the new ESTRO-ACROP contour method cannot be applied in a manner similar to that for the conventional breast contour method, implying that the new ESTRO-ACROP contour method may require more time for improving plans for a given treatment.

Mobile shielding evaluation on the fetal dose during a breast radiotherapy using Monte Carlo simulation.

PURPOSE: Evaluation of the out-of-field dose is an important aspect in radiotherapy. Due to the fetus radiosensitivity, this evaluation becomes even more conclusive when the patient is pregnant. In this work, a linear accelerator Varian Clinac 2100c operating at 6 MV, a pregnant anthropomorphic phantom (Maria), and different shields added above the abdominal region of the phantom were used for the analysis based on MCNPX. METHODS: The simulations were performed for the medial and lateral projections, using either an open field collimation (10×16cm2) or a multileaf collimator. The added shields (M1 and M2) were designed based on models proposed by Stovall et al. [1], intending to reduce the deposited dose on the fetus and related structures. RESULTS: The presence of the shields showed to be effective in reducing the doses on the fetus, amniotic sac, and placenta, for example. A reduction of about 43% was found in the dose on the fetus when M2 was added, using the open field collimation, in comparison with the situation with no shield, being the lateral projection the main responsible for the dose. The use of MLC significatively reduced the doses in different structures, including on the fetus and amniotic sac, for example, in comparison to the open field situation. A slight increment on the dose in organs such as the eyes, thyroid and brain was found in both collimation systems, due to the presence of the shields. The contribution of the leakage radiation from the tube head of the linear accelerator was found to be in the order of µGy, being reduced by the presence of the M2 shield. CONCLUSION: Using the shields showed to be an essential feature in order to reduce the dose not only on the fetus, but also in important structures responsible to its development.

Mass energy absorption coefficients and energy responses of magnesium tetraborate dosimeters for 0.02 MeV to 20 MeV photons using Monte Carlo simulations.

Thermoluminescence dosimeters containing boron, such as magnesium tetraborate (MgB4O7), are of interest because of their very high sensitivity, near tissue-equivalent absorption coefficients, low cost, easy handling, and very large linearity range for absorbed dose. Another important parameter that should be considered when working with thermoluminescent dosimeter (TLD) is the mass energy absorption coefficient (µen/ρ), which is a close approximation to the energy available for production of chemical, biological and other effects associated with exposure to ionizing radiation, therefore important in estimating dose in medical and health physics. In this study the mass energy absorption coefficients and energy responses of undoped and some doped magnesium tetraborates were calculated by Monte Carlo N-particle transport code for a range of photon energies between 20 keV and 20 MeV. The calculated parameters for MgB4O7, MgB4O7:Dy and MgB4O7:Dy,Li were evaluated in comparison with standard TLDs as Al2O3:C and TLD-100 (LiF: Mg, Ti) and ICRU tissue data. The influence of the dopant concentration in the MgB4O7 matrix on the energy dependence of TLD was also investigated. The analyses indicated a good agreement between the simulations and theoretical calculations. The µen/ρ and energy dependence of the materials are higher in the low energy range (E < 100 keV), which is related to the high probability of interaction between radiation and matter due to photoelectric absorption. With regard to the influence of dysprosium concentration in the MgB4O7 matrix an increase in the energy dependence of MgB4O7 for higher concentrations of dopants was observed in the low energy range.