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• W4308984580 abstract "Objectives A VMAT technique using a rotatable tabletop for TBI in supine position is newly applied at UMC Utrecht. We aimed to assess the dose distribution robustness against daily isocenter shifts. Methods The tabletop enables rotation from head-first (HF) to feet-first (FF) supine position while the patient remains immobilized in an individualized whole-body vacuum matrass and a thermoplastic facemask. The treatment plan was optimized on the HF and FF CT-scans, co-registered on the overlapping anatomical region (20 cm longitudinal). Depending on patient-length, 4 to 6 isocenters with overlapping arcs (4 cm longitudinal) were used. Prescription dose (PD) was 12Gy in 6 fractions with mean dose constraints for lungs/kidneys <10Gy and lenses <8Gy. Daily patient-position verification procedure (PV) comprised: pelvic HF-iso3 (CBCT + online corrected); thoracic HF-iso2 (CBCT only, no correction); knee region FF-iso (CBCT + online corrected). Brain HF-iso1 and FF-iso4 or -iso5 (patient length dependent) not imaged. HF (FF) radiation delivery followed HF (FF)-PV. After each fraction, the dose distribution of the first 3 treated patients (length range 110-195 cm) was recalculated applying the registered isocenter corrections/shifts. Then, the 6-fraction rigidly accumulated dose distribution was compared to the original. Results The maximum shift for HF-iso2 was 0.4 cm lateral, 0.8 cm longitudinal and 0.9 vertical and for the knee region FF-iso 0.7 cm lateral, 0.4 cm longitudinal and 0.5 cm vertical over all patients/fractions. Over all patients, the differences in PTV volume receiving 80%, 90% and 120% PD between accumulated and original dose distribution were <1%, while a +3% V110% PD maximum difference was found. The maximum mean dose difference for lenses, lungs and kidneys between accumulated and original dose distributions was +1.0 Gy, +0.2 Gy and +0.6 Gy, respectively. Conclusion The dose distribution of the described VMAT technique for TBI, is proven to be robust against daily observed isocenter shifts. A VMAT technique using a rotatable tabletop for TBI in supine position is newly applied at UMC Utrecht. We aimed to assess the dose distribution robustness against daily isocenter shifts. The tabletop enables rotation from head-first (HF) to feet-first (FF) supine position while the patient remains immobilized in an individualized whole-body vacuum matrass and a thermoplastic facemask. The treatment plan was optimized on the HF and FF CT-scans, co-registered on the overlapping anatomical region (20 cm longitudinal). Depending on patient-length, 4 to 6 isocenters with overlapping arcs (4 cm longitudinal) were used. Prescription dose (PD) was 12Gy in 6 fractions with mean dose constraints for lungs/kidneys <10Gy and lenses <8Gy. Daily patient-position verification procedure (PV) comprised: pelvic HF-iso3 (CBCT + online corrected); thoracic HF-iso2 (CBCT only, no correction); knee region FF-iso (CBCT + online corrected). Brain HF-iso1 and FF-iso4 or -iso5 (patient length dependent) not imaged. HF (FF) radiation delivery followed HF (FF)-PV. After each fraction, the dose distribution of the first 3 treated patients (length range 110-195 cm) was recalculated applying the registered isocenter corrections/shifts. Then, the 6-fraction rigidly accumulated dose distribution was compared to the original. The maximum shift for HF-iso2 was 0.4 cm lateral, 0.8 cm longitudinal and 0.9 vertical and for the knee region FF-iso 0.7 cm lateral, 0.4 cm longitudinal and 0.5 cm vertical over all patients/fractions. Over all patients, the differences in PTV volume receiving 80%, 90% and 120% PD between accumulated and original dose distribution were <1%, while a +3% V110% PD maximum difference was found. The maximum mean dose difference for lenses, lungs and kidneys between accumulated and original dose distributions was +1.0 Gy, +0.2 Gy and +0.6 Gy, respectively. The dose distribution of the described VMAT technique for TBI, is proven to be robust against daily observed isocenter shifts." @default.
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• W4308984580 date "2022-12-01" @default.
• W4308984580 modified "2023-09-27" @default.
• W4308984580 title "Robustness of a multi-isocenter VMAT Total Body Irradiation (TBI) dose distribution against daily patient setup errors" @default.
• W4308984580 doi "https://doi.org/10.1016/j.ijrobp.2022.09.019" @default.
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